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knee
knee biomechanics
236
Anatomy
Graduate
12/10/2011

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Cards

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
no
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
convex
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
which condyle is longer?
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
which condyle is lower?
Definition
medial
Term
is the tibial plateau convex or concave?
Definition
concave
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
medial
Term
which side of tibial plateau experiences greater force?
Definition
medial
Term
where is arthritis more likely to develop?
Definition
medially
Term
what kind of joint is the tibiofemoral joint?
Definition
condyloid
Term
how many dof do condyloid joints usually have?
Definition
2
Term
how many dof does the tibiofemoral joint hav?
Definition
3
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
tibiofemoral joint
Term
how much force does the tibiofemoral joint bear during functional activities?
Definition
2-5x weight of the body
Term
what is the 1 volitional movement of the tibiofemoral joint?
Definition
flex/ext
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
knee flexion
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
minimal
Term
what is closepacked position of tibiofemoral joint?
Definition
extension
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
25 deg of knee flexion
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
65 deg
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
slight valgum
Term
how much is normal genu valgum?
Definition
5 deg
Term
what is genu recurvatum?
Definition
knee hyperextension
Term
in what plane is genu recurvatum?
Definition
sagittal
Term
in what plane is genu valgum/varum?
Definition
frontal
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
medial side
Term
does medial or lateral side of knee bear more load during normal gait?
Definition
medial
Term
why does medial knee bear more load during normal gait?
Definition
COM comes doen and creates external adduction moment, compressing medial side
Term
what do the menisci do?
Definition
increase congruency: increase stability and reduce shear force; distribute weightbearing forices
Term
shape of medial meniscus
Definition
semicircle
Term
shape of lateral meniscus
Definition
4/5 of a circle
Term
where are menisci thicker: periphery or center?
Definition
periphery
Term
what are coronary ligaments?
Definition
attach menisci to tibia
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
semimembranosus
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
popliteus
Term
what is the passive stabilizer of the lateral meniscus?
Definition
PCL
Term
which meniscus is more mobile?
Definition
lateral
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
medial
Term
which meniscus feels more force through it?
Definition
medial
Term
what are the menisci attached to?
Definition
tibia
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
periphery
Term
do the menisci heal well?
Definition
no: not vascular
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
anterior translation
Term
what causes tibia to translate anteriorly on femur in knee extension?
Definition
quads
Term
what produces posterior translation of tibia on femur?
Definition
hamstrings
Term
when do hamstrings produce the greatest amount of posterior translation of tibia on femur?
Definition
when knee is in flexion
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
6 bursa of the knee
Definition
suprapatellar, subcutaneous prepatellar, subcutaneous infrapatellar, deep infrapatellar, pes anserine bursa, semimembranosus bursa
Term
how does soleus control knee movement in closed chain?
Definition
extend flexed knee
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
anterior to knee axis
Term
where is ITB in relation to knee axis in flexion
Definition
posterior to knee axis
Term
what is the ITB?
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
path of ACL
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
path of PCL
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
anteromedial
Term
which ACL bundle tightens with knee flexion?
Definition
anteromedial
Term
which ACL bundle is larger?
Definition
posterolateral
Term
which ACL bundle tightens with knee extension?
Definition
posterolateral
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
when knee is in flexion
Term
when does the posterolateral bundle do a better job of resisting anterior translation of tibia on femur?
Definition
when knee is extended
Term
what muscle produces anterior tibial translation that the ACL resists?
Definition
quads
Term
when is ACL loosest?
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
hyperextension of knee
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
hamstrings
Term
when are hamstrings most effective
Definition
with flexion of knee
Term
what does increasing hamstring force also increase
Definition
compression
Term
what is likely in someone with a torn ACL
Definition
arthritis
Term
when is there more strain on the ACL?
Definition
knee extension
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
6-8%
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
posterolateral
Term
where is the posterior oblique ligament?
Definition
posteromedial
Term
what is the arcuate ligament responsible for?
Definition
posterolateral stability
Term
what is the posterior oblique ligament responsible for?
Definition
posteromedial stability
Term
what do both the arcuate and posterior oblique ligaments resist?
Definition
hyperextension of knee
Term
is the lateral collateral ligament part of the joint capusle?
Definition
no
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
full extension
Term
is the MCL part of the joint capsule?
Definition
yes
Term
what does the MCL attach to?
Definition
medial meniscus
Term
when is the MCL tightest?
Definition
knee extension
Term
what ist he MCL's primary restraint?
Definition
valgus force
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
MCL, IT band
Term
what is the primary restraint to posterior translation of tibia on femur?
Definition
PCL
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
MCL
Term
what are secondary providers to medial stability of the knee?
Definition
pes anserine, ACL, PCL
Term
what is the primary provider of lateral stability of the knee?
Definition
LCL
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
ACL
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
45 deg flexion
Term
what is the largest sesamoid bone in body?
Definition
patella
Term
what is the patella embedded within?
Definition
quadriceps tendon
Term
shape of patella
Definition
triangular
Term
where is apex of triangle of patella
Definition
inferior
Term
what are the 3 facets of the patella?
Definition
latearl, medial, odd
Term
on what bone is the patellar groove?
Definition
femur
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
lateral
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
what is plica
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
patellar tendon
Term
what are the active stabilizers of the patella?
Definition
quadriceps muscles
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
posteriorly
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
no
Term
is a knee dislocation a medical emergency?
Definition
yes
Term
when does the patella glide superiorly?
Definition
in extension
Term
when does the patella glide inferiorly?
Definition
in flexion
Term
what is the total excursion of the patella?
Definition
5-7cm
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
in extension
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
knee extension
Term
when is there maximum contat of patellofemoral joint
Definition
knee flexion
Term
when does the odd facet of the patella contact the femur?
Definition
only in full flexion
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
what is patella alta?
Definition
patella is too high above joint line; comes out of groove too eraly
Term
what is patella baja?
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
doubles
Term
when does patellofemoral joint have greatest contact area?
Definition
knee flexion
Term
when does the PF joint have greatest compressive force?
Definition
knee flexion
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
medial pull on patella
Term
can you activate one head of quadriceps?
Definition
no, you activate the whole quadriceps
Term
what is Q angle
Definition
angle between line from ASIS to midpoint of patella and line from tibial tubercle to midpoint of patella
Term
what is a normal Q angle
Definition
15 deg
Term
what does Q angle do to patella
Definition
pulls patella slightly laterally
Term
when does q angle pull patella laterally
Definition
everytime quads contract
Term
is q angle bigger in men or women?
Definition
women
Term
what increases Q angle
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
femoral anteversion
Term
does external or internal tibial torsion increase lateral pull on patella?
Definition
external tibial torsion
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
Term
how can excessive/prolonged pronation effect lateral pull of pateall?
Definition
excessive/prolonged pronation => excessive/prolonged tibial internal rotation => compensatory internal rotation of femur => increased Q angle and lateral force on patella
Term
when are you more likely to dislocate the patella?
Definition
extension
Term
what things lead to patellar instability?
Definition
patellar malalignment (patella alta), ligament integrity, trochlear depth
Term
in closed kinetic chain, when is flexion moment arm greatest?
Definition
greater knee flexion
Term
in closed kinematic chain, what does primary external flexion moment come from?
Definition
gravity
Term
in closed kinematic chain, what counteracts external flexion moment?
Definition
internal extension moment from quads
Term
in open kinematic chain (seated knee extension), when when is flexion moment arm greatest?
Definition
extension
Term
when is PF contact area the smallest
Definition
extension
Term
when is PF compression force greatest in open chain?
Definition
extension
Term
when is PF stress greatest in open chain?
Definition
extension
Term
when is PF stress greatest in closed chain?
Definition
flexion
Term
how to strengthen without overloading joint in someone with PF pain?
Definition
do knee extensions/flexions within a small range. Reduce ROM to get muscle overload without getting joint overload
Term
how is it that MCL and LCL both resist external rotation of tibia?
Definition
their attachments enable them both to tighten in ER
Term
how do the quads resist posterior translation of tibia?
Definition
by producing anterior translation of tibia on femur
Term
what do the posterior portions of the knee joint capsule resist?
Definition
hyperextension of knee
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