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The Knee11

Higgins notes on the knee

QuestionAnswer
The knee joint largest joint in body, very complex, primarily a hinge joint
Bones enlarged femoral condyles articulateon enlarged tibial condyles, med&lat tibial condyles(med&lat tibial plateaus), receptical for femoral condyles, tibial-medial(bears most weight)
Fibula lateral-serves as attachment for knee joint structure, doesnt articulate w/ patella or femur, not a part of knee joint
patella seasmoid bone, embedded in quad and patellar tendon, serves similar to a patellain improving angle of pull, resulting in greater mechanical advantage in knee extension,
knee joint proper-tibiofemoral joint classified as a ginglymus joint, sometiems reffered to as a trochoginglymus joint IR&ER occur during flex, some argue for concoloid classification
patellofemoral joint arthrodial joint classification, gliding nature of patella on femoral condyles
Tibiofemoral ant/post stability is from ACL/PCL, med/lat stability from MCL/LCL, med femoral condyle longer than lat condyle which contributes to screw-home mechanism, concave tibial plateus covered by menici, med plat larger than lat plat,
tibiofemoral joint motion tibia ER at full knee extension in open kinematic chain femur IR on tibia during closed kinectic chain movement
screw home mechanism rotation to allow for full ext due to med fem condyle, knee approaches full ext tibia must ER approx 10*to achieve proper alignment of tib&femcondyles, full ext-close congruency of articular surfaces, when flexing from tibia ir unlocking the knee
Patellofemoral joint pat articulates w/ intercondylar grooveon ant aspect of femur, patella slides inf w/ knee flex and sup w/ knee ext, patella comes in contact w/femur@20-30*of knee flex, flex/\contact on patella goes sup &ends on odd facet@ 135*flex, tib/fib rot cause path
Q angle normally 15*, draw a line from center of patella proximally to ASISand a second from center of patella to tibial tuberosity
Patella Alignment maintained by iliotibial band and lateral retinaculum, and the pull of the vastis medialis,
Malalignment of patella can be caused by genu valgum, wide pelvis, patella alta, lax medial retinaculum, atrophy of VMO, laterally placed tibial tubrcle, pronation of the subtalar joint and tight lateral retinaculum
patella alta high riding patella
patella baha low riding patella
Menisci functions attached to tibia, deepen tibial fossa, enhance stability, shock absorber, spread stress over joint surface, decreasing cartilage wear, lubricate and provide nutrients in joint, reduce frictionw/ movement, med meniscus, lat meniscus, articular cartilage
Medial Meniscus forms receptical for med femoral condyle, lat meniscus receives lat femoral condyle, thick on outside border becomes very thin on inside border, can slightly slip but held in place by tiny ligaments, larger and more open C shaped
lateral meniscus closed c configuration
Medial meniscus attachment firmly attached to the tibia by the coronary ligament, medial collateral ligament, ACL, and semimembranous, more subject to injury due to these attachments
Meniscal tears tears often occur due to signicant compression&shear forces during rotation while flexing or extending during quick directional changes in running
ACL/PCL cross w/in knee between tibia & femur, vital in respectively maintaining anterior and posterior stability , as well as rotary stability
ACL injuries one of the most common serious injuries to the knee, mechanism involves noncontact rotary forces associated w/planting&cutting, hyperextension, or violent quad contraction which pulls tibia forward on femur
ACL prevents ant displacement of tib on femur, and checks IR of tib on femur, Attaches ant med tibia, runs sup, post and lat to med aspect of femoral condyle, control rollin&gliding of femur, always taut-most taut in full ext, least-30-60flex
PCL not often injured, mechanism-contact w/ opponent orsurface driving tibia post, runs from post intercondylar area, forwrd med upwardto lat aspect of med femoral condyle, stops post moveof tib on femur, twists around ACL w tib IR, acts as center axis rot
MCL 2layers-deeplayer thickening of med joint capsule, superficial-strong broad triangularvant runs just below add tubercle about 4-6cmbelow med joint line, check valgus/ER of tib on femur, most taut in full ext, attaches to med meniscus
MCL mechanism of injuries occur most commonly in contact sports, opponent or teammate falls agains lat aspect of knee or leg causing medial opening of joint and stress to medial ligamentus structures
LCL round band of fibers running from lat femoral epicondyle to fibular head, tight on extension of knee adduction and ER of the tibia on the femur
Arcuate and popiliteal complex thickening of capsule in the posterior lateral aspect
Posterior oblique ligament help support the posterior medial aspect of the knee
coronary ligament attaches menisci to tibia
synovial cavity supplies knee w/ synovial fluid, lies under patellaand between surfaces of tibia and femur, "capsule of the knee"
infrapatellar fat pad just posterior to patellar tendon, insertion point for synovial folds of tissue known as plicia- an anatomical variant that maybe irritated or inflamed w/ injuries or overuse of the knee
Bursa more than 10 bursa in or around the knee, some are connected to synovial cavity, they absorb shock or prevent friction
anterior bursae quad, prepatellar, deep infrapatellar bursa, superficial infrapatella bursa
quadriceps bursa between quad and femur
prepatellar bursa lies on top of the patella-inflammation=house keepers knee
deep infrapatella bursa between patella tendon an tibia
superfiscial infrapatella bursa between patellar tendon and skin
posterior bursa bakers cyst
Baker's cyst lies between the semimembranosis tendon and the medial head of the gastroc muscle, bursae also exists beneath the ITB tendon and the pes anserine proxima to thier insertions
Quad contusion etiology-trauma to the quad, presentation-possible ecchymosis, pain with knee ext, limited knee flex, tenderness over the quad
Patella femoral syndrome etiology dysfunction of extensor mechanism due to: patella alta, lateral patellar tilt, VMO displasia, vastis lateralis hypertrophy, increase Q angle, squinting patella, increased p! w/ prolonged sitting, increased pronation
Patella femoral syndrome presntation anterior knee pain with descending stairs, crepitus, p! w/ siting or squatting for prolonged periods of time, tenderness over medial patellar boarder
Plica syndrome etiology-remains of embryonic synovial tissue around patella becomes irritated w/ trauma causing ant knee p!, presentation-similar to PFS but there is a palpable band on superior medaspect of patella
patellar tendonitis etiology-inflammation/irritation of patellar tendon usually occurs in ath who has excessive pounding though knee, presentation-p! along inferior pole of patella to palpate, p! w/ activity, jumping, stair climbing, tight quads/hamstrings
ACL injury etiology-hyperextension, IR, hyperflex by non contact valgus force w/ rotation can lead to acl rupture, Presentation- feeling pop in knee, unstable feeling, + ACL test, p! w/ movement, possibility hemarthrosis
PCL injury etiology-posterior force on tibia, hyper extension w/a varus or valgus stress, Presentation-+ PCL tests, unstable feeling with activity, possible hemarthrosis, p! with movement
MCL and LCL injury etiology-varus or valgus stress through the knee with foot planted, Presentation-+ varus stress test(LCL), + valgus stress test(MCL), unstable feeling with cutting, pain over adductor tubericle, possible swelling
Meniscal injury traction or compression w/ rotation and slight flex of the knee, Presention-p! along joint line, P! w/ clicking with McMurrays, p! w/ squatting, + appleys compression/distraction test, p! w/ stairs, p! with hamstring contracture
Created by: jwebst1