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88 Cards in this Set

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What type of joint is the knee ?
The knee joint is a synovial joint. It is a modified bicondylar hinge joint.
What movements occur at the knee joint ?
Flexion/extension (in Sagittal plane) and some axial rotation (transverse plane)possible of flexed knee
How many degrees of freedom occur at the knee ?
There are two degrees of freedom at the knee joint.
What bones articulate at the knee ?
Distal Femur and proximal tibia. Patella and distal femur (patellofemoral articulation).
What muscles EXTEND the knee ?
Knee extensors:

Rectus Femoris
Vastus Medialis
Vastus Lateralis
Vastus Intermedius

Tensor Fasciae Latae
What is the origin/insertion of Rectus Femoris
Rectus Femoris
(straight head) originates on the AIIS and (reflected head)a groove immediately above the acetabulum.

Inserts - onto upper border of Patella (common Patellar Tendon)
What is the origin/insertion of Vastus Medialis ?
Vastus Medialis

Originates=Linea Aspera and round femur anteriorly to Intertrochanteric Line.

Inserts= onto upper border of Patella (common Patellar Tendon)
What is the origin/insertion of Vastus Intermedius ?
Vastus Intermedius

Originates=covers the anterior surface of femur

Inserts= onto upper border of Patella (common Patellar Tendon)
What is the origin/insertion of Vastus Lateralis ?
Vastus Lateralis

Originates= from the root of the Greater Trochanter and Linea Aspera, down to the Supracondylar Ridge

Inserts= onto upper border of Patella (common Patellar Tendon)
What is the origin/insertion of Tensor Fasciae Latae ?
Tensor Fasciae Latae

Originates=ASIS and tubercule of iliac crest

Inserts=ITT (above the greater trochanter)
What is the origin/insertion of the Iliotibial Tract ?
Iliotibial Tract

Originates=from tubercule of iliac crest and external ala of ilium

Inserts=lateral aspect of tibial tubercule
What movement occurs between the tibia and femur at the very end of knee extension ?
At the end of knee extension, the tibia rotates LATERALLY in relation to the femur.
NB the action of Popliteus to initiate knee flexion is rotation of the femur laterally on a fixed tibia. The actions of unlocking and locking are opposite.
The tendons of which muscles form the Pes Anserinus tendon ? Where does this tendon insert ?
Tendons of Gracilis, Semitendinosus, and Sartorius form the Pes Anserinus tendon which inserts onto the medial proximal tibia.
(knee joint) Are the medial and lateral articular surfaces of the tibia identical ?
No, the medial tibial condyle is larger in diameter.
How many seperate articulations make up the knee joint ?
Three articulations occur at the knee: two femorotibial and one femoropatellar.

These joints share a single joint cavity.
What planes of movement are allowed by the knee joint ?
Primarily only one. The knee allows flexion/extension in sagittal plane, plus some Axial leg rotation when knee is flexed.
What structures lend stability to the knee joint ?
Collateral and intracapsular ligaments, strong fibrous capsule, menisci and surrounding muscles.
True/false - the knee joint is vulnerable to strains and dislocations because it is relatively incongruent.
True - the knee relies on soft tissue structures to compensate for the fact the articular surfaces do not interlock.
Name the muscles that FLEX the KNEE, giving origins and insertions.
Knee flexors:

Biceps Femoris
O=long head from Ischial Tuberosity, short head from Linea Aspera
I=Head of Fibula

O=Ischial Tuberosity
I=Pes Anserinus (medial proximal tibia)

O=Ischial Tuberosity
I=posterior medial tibia

O=(medial) posterior medial femur below medial supracondylar ridge
(lateral) posterior lateral femur below supracondylar ridge
I=base of Patella (common patellar tendon)

O=Pubic Tubercule
I=Pes Anserinus tendon (medial proximal tibia)

I=Pes Anserinus tendon (medial proximal tibia)
think HAMSTRINGS, SARTORIUS and the muscles of the PES ANSERINUS tendon area
Name the muscles that LATERALLY ROTATE the KNEE, giving origins/insertions.
Biceps Femoris laterally rotates the knee.
O= ischial tuberosity) long head) and linea aspera (short head).
Inserts=on head of fibula (bifurcated by lateral collateral ligament).
Name the MEDIAL KNEE ROTATORS, their origins/insertions.
Medial rotators of the knee:

O=ischial tuberosity
I=posterior medial proximal tibia (below medial condyle)

O=ischial tuberosity
I=medial proximal tibia (pes anserinus tendon)

O=pubic tubercule
I=medial proximal tibia (pes anserinus tendon)

I=medial proximal tibia (pes anserinus tendon)

O=popliteal groove (lateral femoral condyle)
I=triangular area above soleal line, posterior tibia
Popliteus laterally rotates femur on tibia.
Gracilis & Sartorius cross hip & knee
What muscle "unlocks" the knee at the start of flexion? What is its action ?
Popliteus is thought to initiate knee flexion. It laterally rotates the femur on a fixed tibia.
What is the function of the anterior cruciate ligament ? Demonstrate how to test its competency.
The anterior cruciate ligament prevents forward translation of the tibia on the femur.

The anterior "drawer test" indicates torn/ruptured ACL.
What is the function of the PCL ?
The posterior cruciate ligament prevents posterior translation of the tibia in relation to the femur.
Are the ACL and PCL intra- or extra-ARTICULAR?
The ACL and PCL are both INTRA-ARTICULAR structures. They lie within the joint capsule but not within the synovial membrane.
Describe and palpate on the model the head of the fibula.
locate tibial tuberosity and tibiofemoral joint line on model. head of fibula is on lateral knee inferior to joint line
Palpate the medial and lateral collateral ligaments, giving origins/insertions.
Medial collateral ligament - runs from medial femoral epicondyle to medial tibial condyle and shaft

Lateral collateral ligament - runs from the lateral epicondyle of femur to the lateral surface of the head of fibular (splits biceps femoris in half)
Describe where the synovial membrane is attached within the knee joint
The synovial membrane lines the joint capsule, attaching to the margins of the articular surfaces, and to the superior and inferior margins of the menisci. It loops around and doesn't include the ACL & PCL. Anteriorly there are folds immediately above and below the articulating surfaces of the patella.
True/false - the ACL and PCL are intrasynovial structures.
False - the ACL and PCL do not lie within the synovium.
Locate the popliteal fossa and describe its contents.
Find popliteal fossa with knee flexed.

It contains:
Popliteal Artery
Popliteal Vein
Tibial Nerve
Common Peroneal Nerve
Palpate the popliteal pulse.
Find popliteal fossa with knee flexed.
What structures create the borders of the popliteal fossa ?
Medially, Semimembranosus and Semitendinosus. Laterally, Biceps Femoris.

Medial and lateral heads of Gastrocnemius.
How would you distinguish the ITT from the hamstrings ?
The ITT lies on the lateral thigh, between the Vastus Lateralis muscle belly (anteriorly) and the belly of Biceps Femoris (posterolaterally).
ITT is a shared aponeurosis and not a muscle
What function does the ITT have in relation to the knee joint ? Explain this function.
The ITT enables the knee to remain fully extended on standing, without reliance on constant muscular effort.

It is a shared tendon for Tensor Fasciae Latae and Gluteus Maximus. When these muscles contract, the articulating knee joint surfaces are held together.
During knee ------- the round part of the femoral condyles is in contact with the -----.
During knee FLEXION the rounded part of the femoral condyles is in contact with the TIBIA.
During knee --------- the flattened part of the femoral condyles makes contact with the tibia.
During knee EXTENSION the flattened part of the femoral condyles makes contact with the tibia.
Which muscles can produce movement at both hip and knee joints ?
The hamstrings can both flex the knee and extend the hip.
Describe the location of the Tibial Nerve and state what muscles and skin it supplies.
Tibial Nerve is a branch of the Sciatic Nerve (root L4,L5,S1-3). It becomes the tibial nerve just above the popliteal region.
Tibial Nerve innervates muscles of the posterior thigh, posterior leg and plantar surface of foot.
Sensory supply is to the plantar surface of the foot and toes.
In the foot, the tibial nerve divides into medial and lateral plantar nerves, each giving cutaneous supply to these regions.
Carry out the anterior drawer test on your model
The drawer test is designed to assess the integrity of the anterior and posterior cruciate ligaments. It involves firmly grasping the leg with both hands just below the knee, with the thumbs on the tibial tuberosity. With the knee flexed, the examiner pushes and pulls the leg in a line parallel to the long axis of the femur.
One of the menisci of the knee is often injured in a sprain of the knee because the:
a) ACL is attached to the lateral meniscus
b) ACL is attached to the medial meniscus
c) Lateral collateral ligament is attached to the lateral meniscus
d) Medial collateral ligament is attached to the medial meniscus
e) PCL is attached to the lateral meniscus
d) The Medial Collateral Ligament deep fibres are attached to the Medial Meniscus
The lateral collateral ligament of the knee is separated from the joint capsule by the tendon of which muscle ?
The lateral collateral ligament is separated from the joint capsule by the tendon of POPLITEUS.
A young man involved in a head-on automobile collision had his flexed knee hit the dashboard of the car. He was later found to have a major instability of the knee, in that his tibia could be moved posteriorly relative to the femur. What ligament was likely damaged?
his Posterior Cruciate Ligament
The anterior and posterior cruciate ligaments are intracapsular ligaments found within the knee capsule.
True. The ACl and PCL are intracapsular ligaments, but DO NOT LIE WITHIN THE SYNOVIUM.
What are the nerve roots for the Sciatic Nerve, what are its terminal branches, and where are they given off ?
The Sciatic nerve (roots L4,L5,S1-3) divides into the Tibial Nerve and Common Peroneal Nerve in the Popliteal Region.
Summarise the tibiofemoral joint
Bicondylar, synovial hinge joing with large fibrous joint capsule and synovial membrane. No bony limitations in sagittal plane and joint surfaces are incongruent. Menisci improve congruence, static stability provided by ligaments, dynamic stability provided by surrounding musculature.
What nerves supply the knee joint ?
The knee is supplied primarily by branches of the Femoral, Common Peroneal, Tibial and Saphenous nerves.
The collateral ligaments of the knee are at their tautest when the knee is in -------, and slack when the knee is in -------.
The collateral ligaments of the knee are at their tautest when the knee is in extension (close-packed position), and slack when the knee is in flexion (thus allowing medial/lateral knee rotation).
In which position is the knee LEAST stable ?
The knee is least stable in FLEXION, because:
- femoral condyles are more convex posteriorly than anteriorly, so in flexion there is less tibiofemoral contact
- both collateral ligaments become slack in flexion
Are the ACL and PCL inside or outside the joint capsule ?
The ACl and PCL are both within the joint capsule, but not within the synovium.
Describe where the ACL attaches within the joint.
The ACL attaches from the anterior intercondylar area, and runs upwards and backwards to attach onto the inside of the Lateral femoral condyle.
Describe where the PCL attaches within the joint.
The PCL attaches to the posterior intercondylar area and runs upwards and forwards to the inside of the medial femoral condyle.
What are the coronary ligaments, where are they located and what do they do ?
The coronary ligaments are portions of the joint capsule, that attach the menisci to the tibial shelf (by their margins).
Describe the menisci of the knee
The menisci are:
- two crescents of fibrocartilage interposed between tibia and femur
- wedge-shaped in cross-section
- the medial meniscus is of greater diameter than the lateral meniscus, and is wider posteriorly
What is the medial meniscus attached to ?
Medial meniscus is attached:
(a) to the MCL
(b) to the tibial plateau (via horns and coronary ligament)
What is the lateral meniscus attached to ?
Lateral meniscus ia attached
to the tibial plateau (by horns and coronary ligament)
but has NO ATTACHMENT to the LCL
Define GENU VALGUS deformity
In VALGUS deformity of the knee, the segment distal to the knee joint points INWARDS TO THE MIDLINE of the body.
Define GENU VARUS deformity
In VARUS deformity of the knee, the segment distal to the knee joint points OUTWARDS FROM THE MIDLINE of the BODY.
Palpate the tibiofemoral joint line
Name the borders and surfaces of the tibia. Which surface is subcutaneous ?
Tibial borders (edges) anterior, posterior and interosseous borders
Tibial surfaces (flat surfaces) are medial, lateral and posterior.

The medial surface is subcutaneous.
Palpate the MCL
First find the tibiofemoral joint line. The MCL runs between the medial femoral condyle and medial tibial condyle/shaft.
Palpate the medial meniscus
First locate the medial margin of the tibiofemoral joint line. Then passively internally rotate the tibia.
What structures limit axial rotation of the knee joint ?
The anterior and posterior cruciate ligaments limit axial rotation of the knee.
The patella is attached superiorly to the tendon of --------- and inferiorly to the tibial ---------, via the ---------- -------.
ligamentum patella
If someone had the patella removed, would the quadriceps force needed for knee extension be greater or lesserr than before ?
Without a patella present, increased quads force would be needed for knee extension, because the patella serves to increase the leverage of the quads.
Locate the LCL on your model and explain where is originates and attaches.
lateral knee
LCL runs from lateral femoral epicondyle to head of fibula
Is it possible to palpate both menisci ?
No, you can only palpate the medial meniscus, not the lateral.
What is the "tibial plateau" ?
The tibial plateau or shelf is the articulating surfaces of the condyles of the tibia.
Describe the movement of the tibia relative to the femur at the end of knee extension.
At the last 20 degrees of knee extension (the "screw-home mechanism"), the tibia rotates laterally in relation to the femur.
(Terminal Knee Extension requires Lateral Tibial Rotation)
In addition to pure flexion/extension of the knee, what other movements occur at the tibiofemoral joint ?
Axial rotation (with flexed knee), also rolling and sliding facilitated by the menisci.
What movement does the MCL resist/control/limit ?
MCL checks lateral motion of the tibia on the femur e.g. at end of extension, and resists knee hyperextension.
The LCL limits excessive ------- plane movement at the knee joint.
frontal plane
How do you activate Rectus Femoris, Sartorius and TFF muscles on your model ?
Model spupine with leg flexed at 90 degrees and hip externally rotated. Ask model to maintain this position actively. Sart and TFF will form a v-shape, with RF visible also.
Which lies deepest - semimembranosus or semitendinosus ?
semimembranosus lies deep to semitendinosus
Palpate semimembranosus muscle belly on your model.
SM belly extends further distally than that of ST, and SM muscle belly can be palpated on both sides of ST near the tendon of insertion.
Demonstrate active knee flexion. In which plane does this movement occur ?
Ask model to straighten her leg off edge of couch.
Knee flexion occurs in the sagittal plane.
Palpate the muscle belly and tendon of Biceps Femoris on your live model.
Lateral thigh. Tendon can be palpated readily if subject moves to put right leg on left knee.
Define an eccentric contraction. What happens during the cross-bridge cycle during an eccentric contraction ?
Eccentric contraction involves muscle contraction and lengthening. Cross bridges between actin and myosin are pulled apart by gravity, sarcomere length increases.
What nerve innervates the skin on the lateral aspect of the knee and thigh ?
Lateral knee - Sural S1
Lateral thigh - Femoral L2-3
Demonstrate eccentric quadriceps contraction
Model sitting on edge of couch. Ask her to straighten her leg. Eccentric contraction occurs when she lowers her leg back to starting position with control.
Quads contract eccentrically during squat down-phase.
Demonstrate quads concentric contraction
Quads work concentrically when extending knee sitting on edge of couch, or to kick a ball from standing.
How can you show hamstrings working eccentrically ?
Model stands with knee flexed and hip extended, eccentric hams work occurs when she lowers her foot slowly to the ground.
Ask your model to demonstrate concentric hamstring contraction.
Model prone on couch. Model flexes knee to 85 degrees only.
Activate Vastus Medialis
Vastus Medialis works mostly in last 20 degrees of knee extension. Ask seated model to extend leg against resistance - VM will be visible.
Move knee joint passively in internal/external rotation
Sit model on edge of counch, knees at 90 flexion. Taking leg by foot and calf, move leg through internal/external rotation until end feel is reached.
Demonstrate how you would place the MCL and LCL under stress.
Model on couch with knee extended. Place one hand above knee on femur (to stabilise), hold ankle with other hand. "Open" the joint towards the direction of the ligament to be tested.
Describe the route of the ARTERIAL blood supply from the femoral artery to the knee joint.
Femoral Artery
(gives off Profunda Femoris &
Genicular Arteries)
Popliteal Artery
Describe the venous drainage from Popliteal Vein to Inguinal Ligament
Lesser Saphenous Vein, Anterior Tibial and Posterior Tibial Veins drain into Popliteal Vein at Popliteal Region. Popliteal Vein becomes Femoral Vein before entering pelvis under Inguinal Ligament and draining into External Iliac Vein.
What NERVES supply the knee joint area ?
Femoral, Saphenous, Tibial, Common Peroneal Nerves