Anatomy of the Knee Joint

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Questions and Answers

Damage to which structure would MOST directly compromise the knee's ability to prevent anterior translation of the tibia on the femur?

  • Medial Collateral Ligament (MCL)
  • Lateral Collateral Ligament (LCL)
  • Posterior Cruciate Ligament (PCL)
  • Anterior Cruciate Ligament (ACL) (correct)

A patient exhibits excessive valgus at the knee joint. Which ligament is MOST likely insufficient?

  • Anterior Cruciate Ligament (ACL)
  • Posterior Cruciate Ligament (PCL)
  • Lateral Collateral Ligament (LCL)
  • Medial Collateral Ligament (MCL) (correct)

During a complex pivoting movement, an athlete injures their knee. Post-injury assessment reveals a positive Lachman test and instability during internal rotation of the tibia. Which combination of structures is MOST likely damaged?

  • ACL, MCL, and Medial Meniscus (correct)
  • PCL and MCL
  • PCL, LCL, and Lateral Meniscus
  • ACL and LCL

Following a motorcycle accident, a patient presents with a complete loss of knee extension. Which nerve is MOST likely compromised, leading to paralysis of the quadriceps femoris muscle group?

<p>Femoral Nerve (B)</p> Signup and view all the answers

A surgeon is performing an arthroscopic procedure on the knee. To access the posterior aspect of the joint, they must navigate around a structure that attaches the lateral meniscus to the medial femoral condyle. Which structure is this?

<p>Posterior Meniscofemoral Ligament (Ligament of Wrisberg) (A)</p> Signup and view all the answers

An orthopedic surgeon is explaining the 'screw-home mechanism' to a medical student. Which combination of factors BEST describes this mechanism?

<p>External rotation of the tibia, tension in the ACL, and lateral pull of the quadriceps during terminal extension (A)</p> Signup and view all the answers

A patient reports pain during knee flexion and difficulty with internal rotation. Palpation reveals tenderness over the medial aspect of the knee joint. Which muscle group is MOST likely involved in this patient's symptoms?

<p>Popliteus, Semitendinosus, and Semimembranosus (B)</p> Signup and view all the answers

A researcher is studying the biomechanics of the knee joint during various athletic activities. During which movement is the highest risk of injury to the anterior cruciate ligament (ACL) typically observed?

<p>A rapid deceleration with a change in direction (cutting maneuver) (A)</p> Signup and view all the answers

A patient presents with pain and swelling in the knee joint. An MRI reveals damage to the fibrocartilaginous structure that is C-shaped and attached to the medial collateral ligament (MCL). Which specific structure is MOST likely injured?

<p>Medial Meniscus (D)</p> Signup and view all the answers

Which combination of movements is MOST directly facilitated by the menisci of the knee?

<p>Improved joint congruity and shock absorption during weight-bearing activities (B)</p> Signup and view all the answers

A competitive cyclist is experiencing anterior knee pain that worsens during hill climbs. Evaluation reveals an increased Q-angle. Which of the following BEST describes the Q-angle and its clinical relevance?

<p>The angle between the quadriceps muscle and the patellar tendon, associated with patellofemoral tracking issues (D)</p> Signup and view all the answers

During knee arthroplasty, a surgeon carefully preserves the periarticular anastomosis to maintain blood supply. Which set of arteries contributes MOST significantly to this anastomosis?

<p>Popliteal, femoral, and anterior tibial arteries (A)</p> Signup and view all the answers

A patient is unable to perform knee flexion against resistance. Which nerve is MOST likely affected, given that it innervates the primary knee flexors?

<p>Sciatic Nerve (Tibial Division) (D)</p> Signup and view all the answers

Following a sports injury, a patient presents with the inability to perform external rotation of the flexed knee. Which single muscle's dysfunction is MOST likely responsible for this deficit?

<p>Biceps Femoris (D)</p> Signup and view all the answers

A surgeon is repairing a torn lateral meniscus. What key anatomical feature distinguishes the lateral meniscus from the medial meniscus, directly influencing the surgical approach?

<p>The lateral meniscus is more circular and not attached to the LCL, while the medial meniscus is C-shaped and attached to the MCL. (A)</p> Signup and view all the answers

A physical therapist is assessing a patient's knee range of motion. What combined movements in the sagittal and transverse planes represent the typical range of motion for the knee?

<p>Flexion/extension: 0-135 degrees; internal/external rotation: increases as the knee flexes (D)</p> Signup and view all the answers

A patient has suffered damage to the posterior cruciate ligament (PCL). Which clinical sign would be MOST indicative of PCL injury during a physical examination?

<p>Positive posterior drawer test (A)</p> Signup and view all the answers

Which of the following BEST describes the role of the patella within the patellofemoral joint?

<p>To enhance the mechanical advantage of the quadriceps muscle (D)</p> Signup and view all the answers

A patient reports numbness and tingling down the lateral aspect of their leg following a knee injury. Which nerve is MOST likely involved?

<p>Common Fibular Nerve (A)</p> Signup and view all the answers

A surgeon is preparing to perform a total knee arthroplasty. Understanding the anatomy of the knee, the surgeon knows that the fibula:

<p>Serves as an attachment site for muscles and ligaments that contribute to knee stability. (C)</p> Signup and view all the answers

While dissecting a cadaver, a medical student identifies a ligament that connects the menisci to the tibial plateau. This ligament is MOST likely the:

<p>Coronary Ligament (A)</p> Signup and view all the answers

A patient has suffered a direct blow to the lateral side of their knee. What structure is MOST vulnerable to injury from this mechanism?

<p>Medial Collateral Ligament (C)</p> Signup and view all the answers

During a surgery to repair a torn meniscus, it's noted that a portion of the meniscus has poor blood supply. This MOST directly impacts which aspect of recovery?

<p>Rate of healing following the procedure (C)</p> Signup and view all the answers

A patient presents with knee pain after hyperextending their knee. Which ligament is MOST likely injured in this scenario?

<p>Anterior Cruciate Ligament (C)</p> Signup and view all the answers

A patient is diagnosed with patellar tendinopathy ('jumper's knee'). Which exercise should be approached with MOST caution during rehabilitation?

<p>Open-chain knee extensions (D)</p> Signup and view all the answers

An athlete is experiencing decreased range of motion in knee flexion. Which anatomical structure is MOST likely contributing to this limitation?

<p>Contracture of the posterior capsule (D)</p> Signup and view all the answers

Following a meniscus injury, a patient is unable to fully extend their knee. This 'locking' sensation is MOST likely due to:

<p>A displaced fragment of the torn meniscus (C)</p> Signup and view all the answers

A patient has undergone a total knee replacement. What BEST describes the primary goal of postoperative rehabilitation?

<p>Achieving a stable, pain-free knee with functional range of motion (B)</p> Signup and view all the answers

A patient is being evaluated for a knee injury. During the examination, the clinician notes excessive anterior translation of the tibia when the knee is flexed at 90 degrees and the hamstring muscles are relaxed. This MOST likely indicates injury to which of the following ligaments?

<p>Anterior Cruciate Ligament (ACL) (D)</p> Signup and view all the answers

Which of the following statements BEST describes the contribution of the popliteus muscle to knee joint mechanics?

<p>The popliteus muscle is a primary knee flexor and unlocks the knee from full extension. (B)</p> Signup and view all the answers

A 25-year-old athlete is evaluated following a knee injury. During assessment, the clinician notes a positive McMurray's test. What anatomical structure is MOST directly implicated by this finding?

<p>Menisci (C)</p> Signup and view all the answers

During a surgical procedure, a surgeon needs to identify the structure that prevents posterior translation of the tibia relative to the femur. Which of the following anatomical structures is the MOST relevant?

<p>Posterior Cruciate Ligament (PCL) (C)</p> Signup and view all the answers

Following a knee dislocation, a patient demonstrates weakness in knee extension and sensory loss over the anterior thigh. Which nerve is MOST likely to have been injured?

<p>Femoral Nerve (D)</p> Signup and view all the answers

A rehabilitation specialist is designing an exercise program for a patient recovering from a medial meniscus repair. Which exercise is MOST appropriate to include early in the rehabilitation process?

<p>Mini-squats (0-45 degrees of knee flexion) (B)</p> Signup and view all the answers

Which of the following BEST describes the role of synovial fluid within the knee joint?

<p>Providing nutrients and lubrication to the articular cartilage. (A)</p> Signup and view all the answers

A patient is evaluated for chronic knee pain. Radiographic imaging reveals narrowing of the joint space between the femur and tibia. Which of the following is the MOST likely underlying cause of this finding?

<p>Osteoarthritis (C)</p> Signup and view all the answers

What biomechanical factor contributes MOST significantly to the higher incidence of ACL injuries in female athletes compared to male athletes?

<p>Increased hip adduction during dynamic movements (A)</p> Signup and view all the answers

A patient presents with pain and instability in the knee after a twisting injury. Examination reveals positive anterior drawer and Lachman tests, as well as a positive valgus stress test at 30 degrees of knee flexion. Which combination of structures is MOST likely injured?

<p>ACL and MCL (D)</p> Signup and view all the answers

A patient presents with recurring knee effusions following minor activities. Diagnostic imaging reveals significant degradation of the menisci with associated bone remodeling, but no acute ligamentous injuries. Which aspect of meniscal function is MOST compromised in this scenario?

<p>Optimizing the distribution of compressive loads across the tibiofemoral joint, predisposing to accelerated cartilage wear. (A)</p> Signup and view all the answers

During a complex diagnostic procedure, a physician needs to anesthetize the nerve supplying the vastus intermedius muscle specifically, without affecting other quadriceps muscles. Which nerve branch should be targeted to achieve this selective block?

<p>A distal, isolated branch of the femoral nerve within the anterior compartment of the thigh. (B)</p> Signup and view all the answers

A patient presents with a knee injury that involves damage to the arcuate complex. Dysfunction in which movement is MOST likely to be associated with this injury?

<p>Posterolateral rotary stability of the knee. (A)</p> Signup and view all the answers

A researcher is investigating the effects of different rehabilitation protocols on knee joint proprioception following ACL reconstruction. Which outcome measure would MOST accurately assess restoration of dynamic joint stability and neuromuscular control?

<p>Time to stabilization following a single-leg hop landing on a force plate. (A)</p> Signup and view all the answers

A patient is diagnosed with a Grade II MCL sprain. Which intervention should be approached with the MOST caution during the acute phase of rehabilitation?

<p>Mobilization techniques applying valgus stress to the knee. (C)</p> Signup and view all the answers

Flashcards

The Knee Joint

Largest joint in the body; a modified hinge joint that joins the thigh and leg.

Tibiofemoral & Patellofemoral

The two articulations that form the knee joint.

Distal Femur, Proximal Tibia, Patella

Bones that form the knee joint

Fibula's Role

Not directly part of the knee, but serves as a site for muscle and ligament attachments.

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Femoral Condyles

These articulate with the tibial plateau.

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Intercondylar Fossa

Separates the femoral condyles.

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Tibial Tuberosity

Site of patellar tendon attachment.

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Patella

Sesamoid bone within the quadriceps tendon.

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Anterior Cruciate Ligament (ACL)

These prevent anterior translation of the tibia on the femur.

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Posterior Cruciate Ligament (PCL)

This prevents posterior translation of the tibia on the femur.

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Medial Collateral Ligament (MCL)

This resists valgus stress at the knee.

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Lateral Collateral Ligament (LCL)

This resists varus stress at the knee.

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Posterior Meniscofemoral Ligament (Ligament of Wrisberg)

Attaches the lateral meniscus to the medial femoral condyle.

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Coronary Ligaments

These attach the menisci to the tibial plateau.

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Menisci of the Knee

Fibrocartilaginous structures that deepen the articular surfaces of the tibia.

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C-Shaped (Medial Meniscus)

Shape of the medial meniscus.

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MCL Attachment to Medial Meniscus

The medial meniscus is attached to this ligament.

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More Circular (Lateral Meniscus)

Shape of the lateral meniscus.

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Lateral Meniscus (No LCL)

This meniscus is NOT attached to the LCL.

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Hamstrings, Gastrocnemius, Popliteus...

Muscles that cause knee flexion.

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Quadriceps Femoris

Muscles that cause knee extension.

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Semitendinosus, Semimembranosus...

Muscles that cause Internal rotation of the knee.

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Biceps Femoris

Muscle that causes external rotation of the knee.

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Knee Joint Capsule

Surrounds the knee joint, reinforced by ligaments and tendons.

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Synovial Membrane

The inner membrane producing synovial fluid.

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Femoral Nerve

This nerve supplies the quadriceps muscles.

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Sciatic Nerve

This nerve divides into the tibial and common fibular nerves.

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Tibial Nerve

This nerve innervates the hamstrings and posterior leg muscles.

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Common Fibular Nerve

This nerve innervates the anterior and lateral leg muscles.

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Obturator Nerve

This nerve supplies the adductor muscles.

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Genicular Branches

Blood supply to the knee region.

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Patellar Groove

The patella articulates with this on the anterior femur.

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Patella's Role

Enhances the mechanical advantage of the quadriceps muscle.

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Quadriceps Angle (Q-Angle)

Influences patellar tracking.

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Approx. 13 Degrees (Male)

Normal Q-angle in males (degrees).

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Approx. 18 Degrees (Female)

Normal Q-angle in females (degrees).

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Knee Flexion and Extension

The two movements that occur in the sagittal plane.

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0 to 135 Degrees

Normal range of motion for knee flexion.

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Glide and Roll

What happens to the femoral condyles during flexion?

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Move Anteriorly

Movement of the menisci during extension.

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Move Posteriorly

Movement of the menisci during flexion.

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Transverse Plane

In which plane do internal and external rotation occur?

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Limited Rotation

Rotation range when knee is fully extended.

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Increases With Flexion

Rotation as the knee flexes.

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Screw-Home Mechanism

During terminal knee extension, the tibia externally rotates on the femur.

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Added Stability

Purpose of the screw-home mechanism.

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Study Notes

  • The knee is the largest joint and a modified hinge joint.
  • It joins the thigh with the leg and features the tibiofemoral and patellofemoral articulations.
  • The knee facilitates flexion, extension, and slight internal and external rotation.

Bones of the Knee

  • The knee joint's bony structures include the distal femur, proximal tibia, and patella.
  • The fibula isn't a direct part of the knee joint, instead serving as an attachment site for muscles and ligaments.
  • The femoral condyles articulate with the tibial plateau.
  • The intercondylar fossa separates the femoral condyles.
  • The tibial plateau consists of medial and lateral condyles articulating with the femur.
  • The tibial tuberosity is where the patellar tendon attaches.
  • The patella is a sesamoid bone inside the quadriceps tendon.

Ligaments of the Knee

  • Ligaments provide stability and control movement.
  • Cruciate ligaments (ACL and PCL) include:
    • The anterior cruciate ligament (ACL), preventing anterior tibial translation on the femur.
    • The posterior cruciate ligament (PCL), preventing posterior tibial translation on the femur.
    • These ligaments cross in the intercondylar notch.
  • Collateral ligaments (MCL and LCL) include:
    • The medial collateral ligament (MCL), resisting valgus stress.
    • The lateral collateral ligament (LCL), resisting varus stress.
  • Other ligaments:
    • The posterior meniscofemoral ligament (ligament of Wrisberg), attaching the lateral meniscus to the medial femoral condyle.
    • The coronary ligaments, attaching the menisci to the tibial plateau.

Menisci of the Knee

  • Menisci are fibrocartilaginous structures deepening the tibial articular surfaces.
  • They improve joint congruity and act as shock absorbers.
  • The medial meniscus is C-shaped and attached to the MCL.
  • The lateral meniscus is more circular, smaller, and not attached to the LCL.
  • Menisci contribute to joint stability, lubrication, and weight distribution.

Muscles of the Knee

  • Knee movement results from thigh and lower leg muscles.
  • Knee flexion:
    • Hamstrings (biceps femoris, semitendinosus, semimembranosus).
    • Gastrocnemius.
    • Popliteus.
    • Sartorius.
    • Gracilis.
  • Knee extension:
    • Quadriceps femoris (rectus femoris, vastus lateralis, vastus medialis, vastus intermedius).
  • Internal rotation:
    • Semitendinosus.
    • Semimembranosus.
    • Popliteus.
    • Sartorius.
    • Gracilis.
  • External rotation:
    • Biceps femoris.

Knee Joint Capsule

  • The knee joint capsule surrounds the knee joint.
  • It's reinforced by ligaments and tendons of surrounding muscles.
  • It contains a synovial membrane that produces lubricating synovial fluid.

Nerves of the Knee

  • The knee joint is innervated by branches of several nerves.
  • Femoral nerve: supplies the quadriceps muscles.
  • Sciatic nerve: divides into the tibial and common fibular (peroneal) nerves:
    • Tibial nerve: innervates the hamstrings and posterior leg muscles.
    • Common fibular nerve: innervates the anterior and lateral leg muscles.
  • Obturator nerve: supplies the adductor muscles.

Blood Supply of the Knee

  • Blood supply comes from the genicular branches of the femoral, popliteal, and anterior tibial arteries.
  • These arteries create a periarticular anastomosis around the knee.

Patellofemoral Joint

  • The patella articulates with the patellar groove on the anterior femur.
  • The patella enhances the mechanical advantage of the quadriceps muscle.
  • Patellar tracking is influenced by the quadriceps angle (Q-angle).
  • The Q-angle is measured between the quadriceps muscle and the patellar tendon.
  • Typical Q-angle is about 13 degrees in males and 18 degrees in females.

Knee Kinematics

  • Flexion and extension occur in the sagittal plane.
  • Typical range of motion is 0 to 135 degrees.
  • During flexion, the femoral condyles glide and roll on the tibial plateau.
  • Menisci move anteriorly during extension and posteriorly during flexion.
  • Internal and external rotation occur in the transverse plane:
    • Rotation is limited when fully extended.
    • It Increases as the knee flexes.
  • Screw-home mechanism: During terminal knee extension, the tibia externally rotates on the femur due to the shape of the medial femoral condyle, tension in the ACL, and lateral pull of the quadriceps.
  • This mechanism adds stability to the fully extended knee.

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