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Knee complex
Anatomy and muscle functions of knee
133
Anatomy
Undergraduate 4
06/17/2012

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Term
Largest joint complex in human body
Definition
Knee joint
Term
Knee joint consists of what two joints and what type of joint are they?
Definition
Tibio femoral (condyloid)
Patellofemoral (gliding joint)
Term
Which is considered the actual knee joint?
Definition
Tibiofemoral
Term
The two large condyles of the distal femur are separated by what/
Definition
intercondylar posteriorly
Term
what explains the complex motions of the tibiofemoral articulation?
Definition
unique surfaces
Term
attachment site for PCL
Definition
intercondylar fossa medial wall
Term
attachment site for ACL
Definition
intercondylar fossa lateral wall
Term
Which condyle extends farther distally, is slightly curved int he transverse plane, is more curved posteriorly, flast on tis most distal surface, and is longer from anterior to posterior
Definition
Medial condyle
Term
which condyle projects more posteriorly in the sagittal plane, has variable curvature, and is flatter distally with a larger radius of curvature?
Definition
lateral condyle
Term
2nd longest bone of the body, with an expanded proximal end
Definition
proximal tibia
Term
which tibial condyle is larger?
Definition
medial
Term
are proximal tibia condyles smaller or lager than femoral condyles?
Definition
smaller
Term
condyles of the proximal tibia are separated by what?
Definition
nonarticulating intercondylar region
Term
attachment site for the medial and lateral menisci as well as ACL and PCL
Definition
nonarticulating intercondylar region of proximal tibia
Term
Largest sesamoid bone in the body imbedded in the tendon of the quadriceps with an oval articular surface
Definition
Patella
Term
central ridge that runs proximal to distal of the patella
Definition
medial and lateral facets
Term
Primary function of the patella
Definition
to improve the angle of pull of the quads
Term
increases the mechanical advantage in the knee extension
Definition
patella
Term
secondary function of the patella
Definition
protect quads tendon from excessive friction
Term
This bone does not participate directly in knee joint function and serves as the attachment site for knee joint structures
Definition
proximal fibula
Term
discs of fibrocartilage attached to the tibial plateaus and thicker along the periphery
Definition
menisci
Term
which meniscus is "C" shaped, less mobile, and horns are far apart
Definition
Medial meniscus
Term
which meniscus is "O" shaped, more mobile, and horns are close together
Definition
Lateral miniscus
Term
Increases stability by deepening tibial plateaus and contact area by 70%, decreases friction by 20%, serves as minimal shock absorption
Definition
meniscus
Term
removal of menisci does NOT preclude normal motion, but increases:
Definition
-wear on articulation surface
-chance of developing degenerative joint disease
Term
menisci move in concert with what?
Definition
rolling femoral condyles
Term
during knee flexion, menisci are:
Definition
pushed posteriorly
Term
during knee extension, menisci:
Definition
glide anteriorly during knee extension
Term
which meniscus moves furthest?
Definition
lateral
Term
as menisci slide, they also undergo what?
Definition
considerable distorion in shape, strain may contribute to eventual tear
Term
most common injury in the knee and which side is injured most often?
Definition
meniscal injury, medial side injured most
Term
determinants of repair or removal or meniscus?
Definition
location of tear and type of tear
Term
types of meniscus tears
Definition
longitudinal, bucket handle, radial
Term
which tears cannot be repair and must be removed?
Definition
tears in the white (deep/inner) zone because no nerves/blood supply
Term
4 other factors considered in repair of meniscus
Definition
-pre-existing articular cartilage damage
-duration of pain
-obesity
-alignment
-age
-gender
-occupation
-level of activity
Term
ligament that protects against a valgus stress
Definition
MCL (tibular)
Term
ligament that protects against a varus stress
Definition
LCL (fibular)
Term
broad, flat, triagular fibrous brand that covers most of the medial aspect of the knee
Definition
Medial Collateral Ligament
Term
2 parts of MCL
Definition
Anterior-more superficial
Posterior- deeper portion
Term
Superficial and deep layers of MCL blend together posteriorly and form what?
Definition
posteromedial joint capsule
Term
Cordlike structure the passes from lateral epicondyle to the head of the fibula
Definition
Lateral Collateral Ligament (LCL)
Term
This is less susceptible to injury than MCL
Definition
extra-capsular ligament (LCL)
Term
Cross ligaments
Definition
Cruciate ligaments
Term
named for their TIBIAL attachments
Definition
ACL and PCL
Term
found in the space between the synovial and fibrous layers of the knee joint capsule
Definition
Intracapsular but extrasynovial ligaments
Term
Multiple bundles of the PCL
Definition
Anterolateral bundle
Posteromedial bundle
Term
Limits posterior glide of the tibia on the femur
Definition
PCL
Term
Tension in PCL increases as what?
Definition
Knee flexes
Term
Secondary stabilizer against varus, valgus and rotational stresses
Definition
PCL
Term
Resists anterior tibial translation and rotational loads
Definition
ACL
Term
One of the most frequently injured structures during sporting activies
Definition
ACL
Term
Causes of ACL injuries
Definition
noncatact rotary forces associated with planting & cutting, hyperextension, or by violent quads contraction which pulls tibia forward on femur or sporting activities with rapid deceleration or change of direction
Term
Eccentric Quad Contraction + Hamstring Weakness
Definition
high ACL strain
Term
"unhappy triad"
Definition
ACL
MCL
Medial meniscus
Term
what is reported in 80% of all ACL injuries?
Definition
Menisci or MCL
Term
Causes deterioration of the roll-glide mechanism, results in increased anterior tibial translation and internal rotation, increased loads applied to secondary structures
Definition
ACL deficient knee
Term
Alightment with normal full extension is a 180 degree angle between femure and tibia
Definition
Sagittal plane alignment
Term
Hyperextension of the knee, result of muscular imbalances at the ankle and/or knee, increases stress on the posterior joint capsule and the ACL
Definition
Genu recurvatum
Term
Frontal plane alignment of the knee includes:
Definition
Varus (adduction), Valgus (abduction)
Term
Normal knees have what degree of valgus?
Definition
5-10 degrees
Term
The angle between the anterior superior spine of the ilium to the middle of the patella and the middle of the patella to the tibial tuberosity
Definition
Q-angle
Term
Males and females have typically what Q-angles?
Definition
Males: 10-14 degrees
Females: 15-17 degrees
Term
Bowleggedness, small or negative Q-angle
Definition
Genu Varum
Term
Knock-knees, Q-angle larger than 17 degrees
Definition
Genu Valgum
Term
Tibial plateaus and femoral condyle should be parallel in full knee extension
Definition
Transverse plane alignment
Term
what are the versions of the knee
Definition
Lateral version and Medial version
Term
tibial condyles are rotated laterally wrt to the femoral condyles
Definition
Lateral version
Term
tibial condyles are rotated medially wrt the femoral condyles
Definition
Medial version
Term
Pure rolling motion is impossible in this joint because more articular surface on femoral side of the knee
Definition
Tibiofemoral joint
Term
During flexion, contact between the femur and tibia moves...?
Definition
progressively posteriorly
Term
6 to 30 degrees of internal rotation of the tibia on the femur occurs through what degree of knee flexion? created by what?
Definition
-90 degrees
-greater movement of the lateral condyle on the tibia
Term
screw home mechanism occurs in what position?
Definition
full extension
Term
In the flexed knee, the tibia does what?
Definition
Internally rotates
Term
In the extended knee, the tibia does what
Definition
Externally rotates
Term
ACL becomes taut just prior to the rotation, this may force what?
Definition
rotation of the femur on the tibia
Term
During final 20degrees of extension, the knee rotates into what position?
Definition
close-packed position
Term
Draw lines down middle of patella and tibial tuberosity, in 90degree flexion, tibial tuberosity is aligned with the medial half of the patella, in extension, the tibial tuberosity is aligned with the lateral half of the patella
Definition
The Helfet Test
Term
the screw home mechanism is believed to enhance what?
Definition
stability of the knee
Term
The closer the ICR is to the joint surface, the more what?
Definition
rolling there is between bones
Term
The farther the ICR is from the joint center, the less what?
Definition
rolling and more sliding or slipping there is
Term
In the normal knee, a line drawn from the ICR to the knee joint contact point forms what?
Definition
a right angle with the surface of the tibial plateaus
Term
Normal ICR indicates that the femur does what?
Definition
glides on the tibial condyles
Term
a line drawn from ICR to the knee joint contact point does NOT form a right angle with the surface of the tibial plateaus
Definition
Abnormal ICR
Term
Abnormal ICR indicates that the joint what?
Definition
is either distracted or compressed
Term
Patella is thought to lie centered int he what?
Definition
trochlear notch
Term
slight lateral deviation of patella is normal no more than
Definition
a few millimeters
Term
excess deviation is known as?
Definition
medial or lateral tracking
Term
The malalighment results in PFP from the abnormal stresses on the patella, this is associated with what?
Definition
Patellofemoral Pain
Term
ratio of the distance between the patella and the tibia to the length of the patella
Definition
proximal-distal alignment
Term
distance between the tibia and the patella is larger
Definition
Patellar alta
Term
distance between the patella and the tibia is smalled
Definition
patellar baja
Term
associated with anterior knee pain and abnormal loading of the patellar articular surface?
Definition
alignment of the PF joint
Term
Angle formed by a line drawn through the largest width of the patella and a line touching the most anterior surface of the medial and lateral femoral condyles
Definition
Patellar tilt
Term
Normal knee has slight what in full extension?
Definition
lateral patellar tilt
Term
angle formed by the lines drawn from the deepest point of the femoral sulcus to the highest point on each condyle
Definition
sulcus angle
Term
ranges of normal sulcus angle
Definition
ranges from 125-155 degrees
Term
angle formed by a line bisecting the sulcus angle and another line that projects from the apex of the sulcus angle through the peak of the patellar ridge
Definition
congruence angle
Term
congruence angle is the measure of how well the patella fits into what?
Definition
the patella fits into the trochlear notch of the femur
Term
is the congruence angle larger in men or women?
Definition
women
Term
Squinting patellas
Definition
medial tracking patellas
Term
frog-eyed patellas
Definition
lateral tracking patellas
Term
Patellofemoral joint motions
Definition
Medial-lateral tilt
Flexion-extension of the patella
Medial-lateral rotation
Term
rotation of the patella about a longitudinal axis
Definition
Medial-lateral tilt
Term
Rotation of the patella about a mediolateral axis
Definition
Flexion-extension
Term
Rotation of the patella about an anteroposterior axis
Definition
Medial-lateral rotation
Term
As the knee flexes,what occurs int he patella
Definition
-slight increase in lateral tilt
-flexion as the inferior pole tips toward the tibia
-rotation of the patella is negligible
Term
femoral contact on the patella occurs on the lateral facet at the inferior pole of the patella when what?
Definition
the knee is fully extended
Term
area of contact steadily increases as what?
Definition
knee flexes
Term
large changes in contact location and area produces what in patellofemoral stress?
Definition
large changes
Term
Knee movements
Definition
Flexion
Extension
External rotation
Internal rotation
Term
Anterior muscles that extend the knee
Definition
Quads
Term
Posterior muscles that flex the knee
Definition
Hamstrings
popliteus
TFL
sartorius
Gracilis
Gastrocnemius
Term
Primary function of rectus femoris
Definition
Hip Flexion and knee extension
Term
along with hip flexion and knee extension, rectus femoris also causes
Definition
hip abduction and anterior pelvic tilt when femure is stabilized
Term
Function of Vastus Lateralis
Definition
Knee Extension
Term
Function of Vastus Intermedius
Definition
Knee extension
Term
Function of Vastus Medialis
Definition
Knee extension
Term
Semitendinosus muscle primary functions
Definition
Hip extension, knee flexion
Term
along with hip extension and knee flexion, also causes hip internal rotation, knee internal rotation, and posterior pelvic tilt when femur is stabilized
Definition
Semitendinosus
Term
Semimembranosus muscle primary functions
Definition
Hip extension and knee flexion
Term
along with hip extension and knee flexion, also involved in hip internal rotation, knee internal rotation, and posterior pelvic tilt when femur is stabilized
Definition
Semimembranosus
Term
Primary function of biceps femoris muscle
Definition
Hip extension and knee flexion
Term
along with hip extension and knee flexion, also involved in hip and knee external rotation, and posterior pelvic tilt when femur is stabilized
Definition
Biceps Femoris
Term
Primary function of popliteus muscle
Definition
Knee internal rotation
Term
along with knee internal rotation, also involved in knee flexion and is the "KEY" to the knee
Definition
Popliteus Muscle
Term
Primary function of sartorius muscle
Definition
FABER:
hip Flexion
hip ABduction
hip External Rotation
knee flexion
Term
along with FABER, also involved in anterior pelvic tilt when femur is stabilized
Definition
Sartorius
Term
Gracilis function of the knee
Definition
weak knee flexion
Term
Gastrocnemius muscle involved in what movements
Definition
Ankle plantarflexion and knee flexion
Term
Knee extension muscles
Definition
Rectus Femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
Term
Knee flexion muscles
Definition
Biceps femoris (long and short)
Semitendinosus
Semimembranosus
Term
Knee internal rotation muscles
Definition
Semitendinosus
Semimembranosus
Popliteus
Term
Knee external rotation muscles
Definition
Biceps femoris (long & short heads)
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