Term
| what are the 4 bones of the knee complex? |
|
Definition
| femur, tibia, fibula, patella |
|
|
Term
| what are the 3 articulations of the knee complex |
|
Definition
| medial femoral condyle/medial tibial plateau; lateral femoral condyle/lateral tibial plateau; patella-femur |
|
|
Term
| is a knee dislocation the same thing as a patella dislocation? |
|
Definition
|
|
Term
| why is a knee dislocation a medical emergency? |
|
Definition
| tibia slides backwards, causes problem for popliteal artery that supplies blood to everything below the knee |
|
|
Term
| are the femoral condyles convex or concave? |
|
Definition
|
|
Term
| what plane are the femoral condyles in? |
|
Definition
| sagittal, slightly in frontal |
|
|
Term
| are the femoral condyles spherical? |
|
Definition
| no, smaller radius posteriorly |
|
|
Term
|
Definition
| medial is condyle by 2/3 of an inch |
|
|
Term
| what is the intercondylar notch? |
|
Definition
| posterior separation between condyles |
|
|
Term
| where is patellar groove? |
|
Definition
| anterior, inferior in between condyles |
|
|
Term
|
Definition
|
|
Term
| is the tibial plateau convex or concave? |
|
Definition
|
|
Term
| how is the tibial plateau asymmetric? |
|
Definition
| medial side larger than lateral side |
|
|
Term
| which side of tibial plateau has thicker articular cartilage? |
|
Definition
|
|
Term
| which side of tibial plateau experiences greater force? |
|
Definition
|
|
Term
| where is arthritis more likely to develop? |
|
Definition
|
|
Term
| what kind of joint is the tibiofemoral joint? |
|
Definition
|
|
Term
| how many dof do condyloid joints usually have? |
|
Definition
|
|
Term
| how many dof does the tibiofemoral joint hav? |
|
Definition
|
|
Term
| what are the 3 movements of the tibiofemoral joint? |
|
Definition
| flex/ext, abd/add (valgus/varus), internal/external rotation) |
|
|
Term
| what is the largest synovial joint in the body? |
|
Definition
|
|
Term
| how much force does the tibiofemoral joint bear during functional activities? |
|
Definition
|
|
Term
| what is the 1 volitional movement of the tibiofemoral joint? |
|
Definition
|
|
Term
| why is the knee injured so often? |
|
Definition
| lots of forces go through the knee |
|
|
Term
| where is the axis of motion of the knees? |
|
Definition
| through the femoral condyles |
|
|
Term
| at what position of knee is internal/external rotation greater? |
|
Definition
|
|
Term
| how is knee flexion limited? |
|
Definition
| passive insufficiency of quads |
|
|
Term
| how is knee extension limited? |
|
Definition
| passive insufficiency of hamstrings |
|
|
Term
| how much abduction/adduction occurs at knee? |
|
Definition
|
|
Term
| what is closepacked position of tibiofemoral joint? |
|
Definition
|
|
Term
| what makes knee extension closepacked for tibiofemoral joint? |
|
Definition
| bony congruence: tibial tubercles lodged in intercondylar notch; ligaments taut |
|
|
Term
| what is loosepacked position of tibiofemoral joint? |
|
Definition
|
|
Term
| how is 25 deg of knee flexion loose packed position for tibiofemoral jiont? |
|
Definition
| minimal bony congruence; ligaments lax; minimal intra-articular pressure |
|
|
Term
| if someone has joint effusion, how will they hold their knee? |
|
Definition
| about 25 deg flexion: make more room for fluid in joint |
|
|
Term
| what is the functional range of tibiofemoral flexion for walking? |
|
Definition
|
|
Term
| what are the arthrokinematics of open chain knee flexion? |
|
Definition
| concave tibia rolls and slides posteriorly on convex femur |
|
|
Term
| what are the arthrokinematics of open chain knee extension? |
|
Definition
| concave tibia rolls and slides anteriorly on convex femur |
|
|
Term
| what are the arthrokinematics of closed chain knee flexion? |
|
Definition
| convex femur rolls posteriorly slides anteriorly on concave tibia |
|
|
Term
| what are the arthrokinematics of closed chain knee extension? |
|
Definition
| convex femur rolls anteriorly slides posteriorly on concave tibia |
|
|
Term
| what is screw home mechanism? |
|
Definition
| external rotation of tibia on femur during last 20 deg of extension |
|
|
Term
| reasons for screw home mechanism |
|
Definition
| medial tibial plateau and medial femoral condyle both larger than lateral => medial side slides further; ligament restrictions |
|
|
Term
| is normal alignment genu varum or valgum? |
|
Definition
|
|
Term
| how much is normal genu valgum? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| in what plane is genu recurvatum? |
|
Definition
|
|
Term
| in what plane is genu valgum/varum? |
|
Definition
|
|
Term
| where is compression/tension in genu varum? |
|
Definition
| compression medially and tension laterally |
|
|
Term
| where are people with genu varum likely to get oa? |
|
Definition
|
|
Term
| does medial or lateral side of knee bear more load during normal gait? |
|
Definition
|
|
Term
| why does medial knee bear more load during normal gait? |
|
Definition
| COM comes doen and creates external adduction moment, compressing medial side |
|
|
Term
|
Definition
| increase congruency: increase stability and reduce shear force; distribute weightbearing forices |
|
|
Term
|
Definition
|
|
Term
| shape of lateral meniscus |
|
Definition
|
|
Term
| where are menisci thicker: periphery or center? |
|
Definition
|
|
Term
| what are coronary ligaments? |
|
Definition
|
|
Term
| why are menisci thicker at periphery? |
|
Definition
| that's where they accept the femoral condyles |
|
|
Term
| what ligaments attach to anterior menisci? |
|
Definition
| transverse ligament, patellomeniscal ligament |
|
|
Term
| what ligaments attach to medial meniscus? |
|
Definition
| medial collateral ligament, semimembranosus |
|
|
Term
| what ligaments attach to lateral meniscus? |
|
Definition
| posterior cruiciate ligament, popliteus |
|
|
Term
| what is the active stabilization of the medial meniscus? |
|
Definition
|
|
Term
| what is the passive stabilizer of the medial meniscus? |
|
Definition
| medial collateral ligament |
|
|
Term
| what is the active stabilizer of the lateral meniscus? |
|
Definition
|
|
Term
| what is the passive stabilizer of the lateral meniscus? |
|
Definition
|
|
Term
| which meniscus is more mobile? |
|
Definition
|
|
Term
| why does the lateral meniscus move more than medial meniscus? |
|
Definition
| medial is bound down more tightly |
|
|
Term
| which meniscus is injured more often? |
|
Definition
|
|
Term
| which meniscus feels more force through it? |
|
Definition
|
|
Term
| what are the menisci attached to? |
|
Definition
|
|
Term
| how do the menisci move with knee extension? |
|
Definition
| menisci deform and slide anteriorly |
|
|
Term
| how do the menisci move with knee flexion? |
|
Definition
| menisci deform and slide posteriorly |
|
|
Term
| why do menisci need to slide posteriorly in knee flexion |
|
Definition
| to keep from being pinched under femur |
|
|
Term
| what pulls menisci posteriorly in knee flexion |
|
Definition
| semimembranosus (medial) and popliteus tendons (lateral) |
|
|
Term
| what part of the menisci are vascular? |
|
Definition
|
|
Term
| do the menisci heal well? |
|
Definition
|
|
Term
| why are menisectomies bad? |
|
Definition
| meniscus helps distribute forces. If forces are distributed over smaller area, stress is increased bc stress = force/area |
|
|
Term
| functional importance of quads |
|
Definition
| stair ascents, descents; kneeling; squatting; rising or sitting in chair |
|
|
Term
| how does tibia translate on femur in open chain flexion? |
|
Definition
| no translation or slight posterior translation |
|
|
Term
| how does tibia translate on femur in open chain extension? |
|
Definition
|
|
Term
| what causes tibia to translate anteriorly on femur in knee extension? |
|
Definition
|
|
Term
| what produces posterior translation of tibia on femur? |
|
Definition
|
|
Term
| when do hamstrings produce the greatest amount of posterior translation of tibia on femur? |
|
Definition
|
|
Term
| how do the gastrocs affect the knee? |
|
Definition
| some flexion; prevent hyperextension |
|
|
Term
| what muscles provide medial knee joint stability? |
|
Definition
| pes anserine: sartorius, gracilis, semitendinosus |
|
|
Term
|
Definition
| suprapatellar, subcutaneous prepatellar, subcutaneous infrapatellar, deep infrapatellar, pes anserine bursa, semimembranosus bursa |
|
|
Term
| how does soleus control knee movement in closed chain? |
|
Definition
|
|
Term
| how does tibialis anterior affect knee movement in closed chain? |
|
Definition
| flexes extended knee by pulling tibia forward |
|
|
Term
| how does gluteus maximus affect closed chain knee flexion? |
|
Definition
| pulls up on femur to extend knee |
|
|
Term
| how does ITB provide passive support to knee? |
|
Definition
| provides antero-lateral support to the knee. Limits anterior translation in the flexed knee. |
|
|
Term
| where is ITB in relation to knee axis in extension |
|
Definition
|
|
Term
| where is ITB in relation to knee axis in flexion |
|
Definition
|
|
Term
|
Definition
| thickening of lateral fascia lata |
|
|
Term
| how does ITB affect fat pad? |
|
Definition
| fat pad between ITB and femoral condyle can be painful. Fat pad is highly innervated |
|
|
Term
| what are the 6 ligaments of the kene |
|
Definition
| ACL, PCL, MCL, LCL, posterior oblique ligament, arcuate ligament |
|
|
Term
| describe the cruciate ligaments in relation to joint capsule/synovium |
|
Definition
| inside joint capsule (intracapsular and intra-articular) but outside synovium (extra-synovial) |
|
|
Term
| how are cruciate ligaments named |
|
Definition
| according to tibial attachment |
|
|
Term
|
Definition
| from lateral-posterior femur to medial-anterior tibia |
|
|
Term
| how do crossed fingers represent ACL, PCL? |
|
Definition
| cross index over middle, point them down: middle = acl, index = pcl |
|
|
Term
|
Definition
| anterior-medial femur to posterior-lateral tibia |
|
|
Term
| what are the 2 bundles of the ACL? |
|
Definition
| anteromedial bundle, posterolateral bundle |
|
|
Term
| which ACL bundle is smaller? |
|
Definition
|
|
Term
| which ACL bundle tightens with knee flexion? |
|
Definition
|
|
Term
| which ACL bundle is larger? |
|
Definition
|
|
Term
| which ACL bundle tightens with knee extension? |
|
Definition
|
|
Term
| what do both bundles of the ACL resist? |
|
Definition
| anterior translation of tibia on femur |
|
|
Term
| when does the anteromedial bundle do a better job of resisting anterior translation of tibia on femur? |
|
Definition
|
|
Term
| when does the posterolateral bundle do a better job of resisting anterior translation of tibia on femur? |
|
Definition
|
|
Term
| what muscle produces anterior tibial translation that the ACL resists? |
|
Definition
|
|
Term
|
Definition
| 30 deg flexion = loose packed position |
|
|
Term
| what does the KT 1000 do? |
|
Definition
| device that allows you to quantify anterior tibial translation, allowing you to see if ACL is torn |
|
|
Term
| what motion does the ACL resist? |
|
Definition
|
|
Term
| what is the ACL's primary restraint |
|
Definition
| anterior translation of tibia on femur/ hyperextension |
|
|
Term
| what is the ACL's secondary restraint |
|
Definition
| internal rotation of tibia on femur, varus and valgus forces |
|
|
Term
| how do hamstrings respond to ACL injury |
|
Definition
| provide posterior translation of tibia on femur |
|
|
Term
| what should be trained following ACL injury |
|
Definition
|
|
Term
| when are hamstrings most effective |
|
Definition
|
|
Term
| what does increasing hamstring force also increase |
|
Definition
|
|
Term
| what is likely in someone with a torn ACL |
|
Definition
|
|
Term
| when is there more strain on the ACL? |
|
Definition
|
|
Term
| what exercises should be avoided in someone right after ACL reconstruction? |
|
Definition
| isometric actions of quads in knee extension |
|
|
Term
| what happens to quads after ACL injury and arthroscopy |
|
Definition
| they tend to shut down and therefore must be strengthened. Just avoid strengthening them in full extension |
|
|
Term
| how much strain does it take to tear a ligament |
|
Definition
|
|
Term
| what is the PCL's primary restraint |
|
Definition
| posterior translation of tibia on femur |
|
|
Term
| when is the PCL strained/ |
|
Definition
| when hamstrings are active at close to full extension |
|
|
Term
| where is the arcuate ligament? |
|
Definition
|
|
Term
| where is the posterior oblique ligament? |
|
Definition
|
|
Term
| what is the arcuate ligament responsible for? |
|
Definition
|
|
Term
| what is the posterior oblique ligament responsible for? |
|
Definition
|
|
Term
| what do both the arcuate and posterior oblique ligaments resist? |
|
Definition
|
|
Term
| is the lateral collateral ligament part of the joint capusle? |
|
Definition
|
|
Term
| what does the lateral collateral ligament resist? |
|
Definition
| varus loading; external rotation of tibia on femur; hyperextension |
|
|
Term
| what is the path of the lateral collateral ligament |
|
Definition
| courses slightly posteriorly from femur to fibular head |
|
|
Term
| when is the LCL tightest? |
|
Definition
|
|
Term
| is the MCL part of the joint capsule? |
|
Definition
|
|
Term
| what does the MCL attach to? |
|
Definition
|
|
Term
| when is the MCL tightest? |
|
Definition
|
|
Term
| what ist he MCL's primary restraint? |
|
Definition
|
|
Term
| what are the MCL's secondary restraints? |
|
Definition
| anterior translation of tibia on femur, external rotation of tibia, |
|
|
Term
| what are the primary restraints to anterior translation of tibia on femur? |
|
Definition
| ACL (passive), hamstrings (active) |
|
|
Term
| what are the secondary restraints to anterior transation of tibia on femur? |
|
Definition
|
|
Term
| what is the primary restraint to posterior translation of tibia on femur? |
|
Definition
|
|
Term
| what are secondary resistors to posterior translation of tibia on femur? |
|
Definition
| LCL, posterior portions of medial and lateral capsule |
|
|
Term
| what is the primary provider of medial stability of the knee? |
|
Definition
|
|
Term
| what are secondary providers to medial stability of the knee? |
|
Definition
|
|
Term
| what is the primary provider of lateral stability of the knee? |
|
Definition
|
|
Term
| what are the secondary providers of lateral stability of the knee? |
|
Definition
| IT band, popliteus, ACL, PCL |
|
|
Term
| what is the primary stability for internal rotation at the knee? |
|
Definition
|
|
Term
| what is the primary provider for external rotation at the knee? |
|
Definition
| collateral ligaments, PCL |
|
|
Term
| functions of patellofemoral joint |
|
Definition
| protection, act as pulley to redirect quads pull, increase moment arm of quads |
|
|
Term
| when is the quadriceps moment arm at max? |
|
Definition
|
|
Term
| what is the largest sesamoid bone in body? |
|
Definition
|
|
Term
| what is the patella embedded within? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| where is apex of triangle of patella |
|
Definition
|
|
Term
| what are the 3 facets of the patella? |
|
Definition
|
|
Term
| on what bone is the patellar groove? |
|
Definition
|
|
Term
| what makes up the sides of the patellar groove? |
|
Definition
| medial and lateral condyles of femur |
|
|
Term
| which femoral condyle projects farther anteriorly at patellar groove? |
|
Definition
|
|
Term
| is there more medial or lateral dislocation of patella? |
|
Definition
| medial bc less protection medially bc lateral condyle projects farther anteriorly |
|
|
Term
| where is the patellar groove more shallow? |
|
Definition
| more shallow proximally than distally |
|
|
Term
|
Definition
| synovial fold that is not completely resorbed and persists into adulthood |
|
|
Term
| what are the 3 locations for plica in the knee? |
|
Definition
| infrapatellar, suprapatellar, medioatellar |
|
|
Term
| why does the mediopatellar plica become irritated |
|
Definition
| from rubbing over medial femoral condyle |
|
|
Term
| what connects patella to tibia |
|
Definition
|
|
Term
| what are the active stabilizers of the patella? |
|
Definition
|
|
Term
| how does the vastus lateralis pull the patella? |
|
Definition
| slight lateral pull in frontal plane |
|
|
Term
| how does vastus medialis pull the patella? |
|
Definition
| slight medial pull in frontal plane |
|
|
Term
| how does the quads pull the patella in the sagittal plane? |
|
Definition
|
|
Term
| what are the passive stabilizers of the patellofemoral joint? |
|
Definition
| patellar retinaculum, IT band, ligaments, lateral femoral condyle |
|
|
Term
| what are the thickenings of the patellar retinaculum? |
|
Definition
| medial patellofemoral ligament, lateral patellofemoral ligament |
|
|
Term
| what does the medial patellaofemoral ligament attach to? |
|
Definition
| adductor tubercle to medial aspect of patella |
|
|
Term
| what does the lateral patellaofemoral ligament attach to? |
|
Definition
| from IT band to lateral aspect of patella |
|
|
Term
| what ligament is stretched when I pull patella to lateral side? |
|
Definition
| medial patellofemoral ligament |
|
|
Term
| if I dislocate my patella laterally, where do I feel pain/ |
|
Definition
| medially: adductor tubercle |
|
|
Term
| if my patella stays pulled to lateral side, what is probably happening? |
|
Definition
| IT band is tight and is pulling on lateral patellofemoral ligament |
|
|
Term
| is a patella dislocation a medical emergency? |
|
Definition
|
|
Term
| is a knee dislocation a medical emergency? |
|
Definition
|
|
Term
| when does the patella glide superiorly? |
|
Definition
|
|
Term
| when does the patella glide inferiorly? |
|
Definition
|
|
Term
| what is the total excursion of the patella? |
|
Definition
|
|
Term
| when the patella tilts medially, what is it doing? |
|
Definition
| anterior surface of patella moves medially |
|
|
Term
| when the patella tilts laterally, what is it doing? |
|
Definition
| anterior surface of patella moves laterally |
|
|
Term
| when is the patella naturally laterally titled |
|
Definition
| most of the time! Except not in extension |
|
|
Term
| when is the patella NOT tilted laterally? |
|
Definition
|
|
Term
| how is rotation of the patella named? |
|
Definition
| named for direction of the apex |
|
|
Term
| what painful thing can happen in posterior rotation of patella? |
|
Definition
| inferior pole can dip posteriorly and pinch fat pad |
|
|
Term
| when is there minimal contact of patellofemoral joint? |
|
Definition
|
|
Term
| when is there maximum contat of patellofemoral joint |
|
Definition
|
|
Term
| when does the odd facet of the patella contact the femur? |
|
Definition
|
|
Term
| where does patella start to contact femur when you begin to flex knee? |
|
Definition
| inferior patella starts to make contact |
|
|
Term
| how does contact area of patellofemoral joint change with flexion? |
|
Definition
| contact area increases as we increase knee flexion |
|
|
Term
| where is the normal patella position? |
|
Definition
| above joint line in extended knee |
|
|
Term
|
Definition
| patella is too high above joint line; comes out of groove too eraly |
|
|
Term
|
Definition
| patella is below joint line; never comes out of groove |
|
|
Term
| what is patellofemoral joint reaction force |
|
Definition
| compressive force of patella of femur |
|
|
Term
| what is the patellafemoral joint reaction force/compressive force dependent on? |
|
Definition
| quadriceps force, knee flexion angle |
|
|
Term
| what increases patellofemoral compression |
|
Definition
| increased quadriceps tension, increased knee flexion |
|
|
Term
| if we double the amount of quads force, how does patellofemoral compression change? |
|
Definition
|
|
Term
| when does patellofemoral joint have greatest contact area? |
|
Definition
|
|
Term
| when does the PF joint have greatest compressive force? |
|
Definition
|
|
Term
| how does stress at PF joint change? |
|
Definition
| increase compressive force or decrease area |
|
|
Term
| what are the pathomechanics of patellar malalignment? |
|
Definition
| patellar malalignment => reduced contact area of PF joint (forces go through smaller area) => increased stress causes articular cartilage to break down => bone below cartilage breakdown experiences abnormal stress and starts to hurt |
|
|
Term
| what 3 things contribute to increased PFJ stress? |
|
Definition
| altered PFJ mechanics such as decreased contact area or uneven distribution of forces; problem from somewhere else in lower kinematic chain; overuse |
|
|
Term
| what are bony/structural abnormalities that alter PFJ mechanics? |
|
Definition
| patella baja, trochlear dysplasia |
|
|
Term
| what are soft tissue factors that alter PFJ mechanics? |
|
Definition
| IT band/lateral retinaculum tightness, imbalance of vasti forces, general quads weakness |
|
|
Term
| how does a tight IT band alter PFJ mechanics? |
|
Definition
| pulls patella laterally into lateral femoral condyle, causing pressure and pain on lateral side |
|
|
Term
| how do vasti imbalances affect PFJ mechanics? |
|
Definition
| pulls patella to one side or another |
|
|
Term
| how does quadriceps weakness affect PFJ mechanics? |
|
Definition
| issue with alignment of patella as it glides superiorly/inferiorly |
|
|
Term
| what is the role of the vastus medialis oblique portion? |
|
Definition
|
|
Term
| can you activate one head of quadriceps? |
|
Definition
| no, you activate the whole quadriceps |
|
|
Term
|
Definition
| angle between line from ASIS to midpoint of patella and line from tibial tubercle to midpoint of patella |
|
|
Term
|
Definition
|
|
Term
| what does Q angle do to patella |
|
Definition
| pulls patella slightly laterally |
|
|
Term
| when does q angle pull patella laterally |
|
Definition
|
|
Term
| is q angle bigger in men or women? |
|
Definition
|
|
Term
|
Definition
| gneu valgum; excessive hip adduction caused by glute med weakness |
|
|
Term
| what type of hip rotation increases lateral pull on patella? |
|
Definition
| hip internal rotation can increase lateral pull on patella |
|
|
Term
| why does hip internal rotation increase lateral pull on patella? |
|
Definition
| as you internally rotate your hip and keep your foot still, the femur is being moved under the patella to make the patella go lateral |
|
|
Term
| does femoral anteversion or retroversion increase lateral pull on patella |
|
Definition
|
|
Term
| does external or internal tibial torsion increase lateral pull on patella? |
|
Definition
|
|
Term
| how does the pelvis affect lateral pull of patella? |
|
Definition
| excessive hip internal rotation is caused by weak hip external rotators (glute max and deep ER's), femoral anteversion => femur rotates under patella |
|
|
Term
| what happens when femur rotates internally under patella/ |
|
Definition
| increases pressure between lateral femoral condyle and lateral facet of patella |
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Term
| how can excessive/prolonged pronation effect lateral pull of pateall? |
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Definition
| excessive/prolonged pronation => excessive/prolonged tibial internal rotation => compensatory internal rotation of femur => increased Q angle and lateral force on patella |
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Term
| when are you more likely to dislocate the patella? |
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Definition
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Term
| what things lead to patellar instability? |
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Definition
| patellar malalignment (patella alta), ligament integrity, trochlear depth |
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Term
| in closed kinetic chain, when is flexion moment arm greatest? |
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Definition
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Term
| in closed kinematic chain, what does primary external flexion moment come from? |
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Definition
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Term
| in closed kinematic chain, what counteracts external flexion moment? |
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Definition
| internal extension moment from quads |
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Term
| in open kinematic chain (seated knee extension), when when is flexion moment arm greatest? |
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Definition
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Term
| when is PF contact area the smallest |
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Definition
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Term
| when is PF compression force greatest in open chain? |
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Definition
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Term
| when is PF stress greatest in open chain? |
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Definition
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Term
| when is PF stress greatest in closed chain? |
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Definition
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Term
| how to strengthen without overloading joint in someone with PF pain? |
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Definition
| do knee extensions/flexions within a small range. Reduce ROM to get muscle overload without getting joint overload |
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Term
| how is it that MCL and LCL both resist external rotation of tibia? |
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Definition
| their attachments enable them both to tighten in ER |
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Term
| how do the quads resist posterior translation of tibia? |
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Definition
| by producing anterior translation of tibia on femur |
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Term
| what do the posterior portions of the knee joint capsule resist? |
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Definition
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