Podcast
Questions and Answers
Which ligament provides strength to the posterior capsule of the knee joint?
Which ligament provides strength to the posterior capsule of the knee joint?
- Medial Collateral Ligament
- Anterior Cruciate Ligament
- Arcuate popliteal ligament (correct)
- Transverse Ligament
What shape does the arcuate popliteal ligament form as it connects to the tibial intercondylar area?
What shape does the arcuate popliteal ligament form as it connects to the tibial intercondylar area?
- V-shaped arch
- Circular ring
- Y-shaped fan (correct)
- Straight line
What is the primary role of the patella in the human body?
What is the primary role of the patella in the human body?
- Increase leverage of quadriceps (correct)
- Facilitate knee flexion
- Stabilize the femur
- Support weight during sitting
Which structures primarily stabilize the patella in its position?
Which structures primarily stabilize the patella in its position?
Which group accurately categorizes muscles acting solely at the knee?
Which group accurately categorizes muscles acting solely at the knee?
What type of cartilage is found on the deep side of the patella?
What type of cartilage is found on the deep side of the patella?
Which of the following structures is not considered part of the knee joint capsule?
Which of the following structures is not considered part of the knee joint capsule?
Which ligaments are included in the anterior and posterior structures of the knee?
Which ligaments are included in the anterior and posterior structures of the knee?
Which artery is NOT a direct branch related to the knee and its surrounding structures?
Which artery is NOT a direct branch related to the knee and its surrounding structures?
What is the primary function of the knee during gait?
What is the primary function of the knee during gait?
Which of the following conditions is characterized by 'knock knees'?
Which of the following conditions is characterized by 'knock knees'?
Which of the following veins does NOT drain into the popliteal vein?
Which of the following veins does NOT drain into the popliteal vein?
In relation to the pes anserinus bursa, which of the following tendons is the most posterior?
In relation to the pes anserinus bursa, which of the following tendons is the most posterior?
What is the primary motion of the knee joint during activities involving open and closed kinetic chains?
What is the primary motion of the knee joint during activities involving open and closed kinetic chains?
Which of the following describes an abnormal patellar position leading to chondromalacia patellae?
Which of the following describes an abnormal patellar position leading to chondromalacia patellae?
What is the primary role of the popliteal nodes in relation to the knee?
What is the primary role of the popliteal nodes in relation to the knee?
What is a characteristic feature of Baker's cyst?
What is a characteristic feature of Baker's cyst?
Which test is recognized as more sensitive for detecting ACL injuries?
Which test is recognized as more sensitive for detecting ACL injuries?
In conducting the Lachman test, what indicates a complete rupture of the ACL?
In conducting the Lachman test, what indicates a complete rupture of the ACL?
During the anterior drawer test, what is being assessed?
During the anterior drawer test, what is being assessed?
What is a key consideration when performing the posterior drawer test?
What is a key consideration when performing the posterior drawer test?
Which muscle primarily functions to unlock a straight knee by externally rotating the femur?
Which muscle primarily functions to unlock a straight knee by externally rotating the femur?
What is the role of the vastus medialis at the knee joint?
What is the role of the vastus medialis at the knee joint?
What is the primary function of the menisci in the knee joint?
What is the primary function of the menisci in the knee joint?
Which artery does NOT contribute directly to the anastomosis around the knee?
Which artery does NOT contribute directly to the anastomosis around the knee?
Which statement accurately describes the stability of the knee joint?
Which statement accurately describes the stability of the knee joint?
The knee locking mechanism is primarily controlled by which action during extension?
The knee locking mechanism is primarily controlled by which action during extension?
What type of joint is the knee classified as?
What type of joint is the knee classified as?
Which nerve is primarily responsible for innervating the popliteus muscle?
Which nerve is primarily responsible for innervating the popliteus muscle?
What role do the ligaments in the knee play?
What role do the ligaments in the knee play?
Which of the following muscles is NOT considered a flexor of the knee?
Which of the following muscles is NOT considered a flexor of the knee?
Which of the following correctly identifies the components of a synovial joint?
Which of the following correctly identifies the components of a synovial joint?
Which of these actions does the gastrocnemius muscle perform at the knee?
Which of these actions does the gastrocnemius muscle perform at the knee?
Which structure aids in the lubrication of the knee joint?
Which structure aids in the lubrication of the knee joint?
Which of the following options includes only flexors of the knee?
Which of the following options includes only flexors of the knee?
What is the function of hyaline cartilage in the knee?
What is the function of hyaline cartilage in the knee?
Which joint is NOT part of the knee?
Which joint is NOT part of the knee?
What is the primary function of the anterior cruciate ligament?
What is the primary function of the anterior cruciate ligament?
How do the medial and lateral coronary ligaments contribute to knee stability?
How do the medial and lateral coronary ligaments contribute to knee stability?
Which ligament prevents hyperextension of the knee?
Which ligament prevents hyperextension of the knee?
What structural adaptation allows the joint capsule to accommodate free movement in certain directions?
What structural adaptation allows the joint capsule to accommodate free movement in certain directions?
Which ligament is responsible for providing medial stability to the knee joint?
Which ligament is responsible for providing medial stability to the knee joint?
What is the role of the patella ligament in the knee?
What is the role of the patella ligament in the knee?
Which of the following ligaments does NOT attach to the lateral meniscus?
Which of the following ligaments does NOT attach to the lateral meniscus?
Which ligament serves to join the anterior horns of the medial and lateral menisci?
Which ligament serves to join the anterior horns of the medial and lateral menisci?
Flashcards
Synovial Joint
Synovial Joint
A joint that allows free movement, enclosed by a fibrous capsule and synovial membrane. The membrane secretes lubricating fluid. The ends of bones are covered in hyaline cartilage and separated by a joint cavity.
The Knee
The Knee
The largest synovial joint in the body, composed of two joints: the tibiofemoral joint and the patellofemoral joint. It's a modified hinge joint that's remarkably stable, especially when straight.
Articular Cartilage
Articular Cartilage
A type of cartilage found in synovial joints, helps absorb and redistribute force, and is attached to the bone ends by the joint capsule, MCL, and the transverse ligament.
Menisci
Menisci
Crescent-shaped wedges of fibrocartilage that fit between the bone ends in the knee joint. They protect and stabilize the knee, help lubricate it, and the medial meniscus is bigger than the lateral meniscus.
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Ligaments in the Knee
Ligaments in the Knee
Fibrous cords that connect bones, ligaments in the knee include the intracapsular ligaments (ACL & PCL, transverse ligament) and ligaments outside of the joint capsule.
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Cruciate Ligaments (ACL & PCL)
Cruciate Ligaments (ACL & PCL)
These are intracapsular ligaments within the joint capsule of the knee, responsible for maintaining knee stability. They're important for preventing excessive forward and backward movement.
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Patellofemoral Joint
Patellofemoral Joint
A joint formed between the patella and the femur, aids in extending the knee and provides stability during movement
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Knee Locking Mechanism
Knee Locking Mechanism
A mechanism that contributes to knee stability, particularly during extension. It involves the tightening of the ligaments and the locking of the femur onto the tibia.
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Anterior cruciate ligament
Anterior cruciate ligament
A structure located at the anterior tibial intercondylar area, extending upwards and backwards to the posterolateral femoral intercondylar notch. Prevents the tibia from moving forward relative to the femur, controls rotation, and aids in pivoting.
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Posterior cruciate ligament
Posterior cruciate ligament
A ligament situated at the posterior tibial intercondylar area, extending upwards and forwards to the anterior medial femoral intercondylar notch. Prevents the tibia from sliding backwards on the femur, restricts hyperextension, and controls rotation.
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Medial collateral ligament
Medial collateral ligament
A strong band of tissue extending from the medial epicondyle of the femur to the anteromedial tibial condyle, also attaching to the medial meniscus. Provides medial stability to the knee.
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Lateral collateral ligament
Lateral collateral ligament
A thin, cord-like structure originating from the lateral epicondyle of the femur, extending to the head of the fibula, and passing over the popliteus tendon. It does not attach to the lateral meniscus. Provides lateral stability to the knee.
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Transverse ligament
Transverse ligament
Connects the anterior horns of the medial and lateral menisci. Its role is to limit their movement.
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Joint capsule
Joint capsule
Thick fibrous tissue continuous with the periosteum, forming a protective covering around the knee joint. It is generally thicker at the sides and thinner anteriorly and posteriorly. Allows free anterior-posterior motion of the knee.
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Medial and lateral coronary ligaments
Medial and lateral coronary ligaments
Ligaments that extend from the base of the medial and lateral menisci to the tibial plateau, helping to secure them in place.
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Patellar ligament
Patellar ligament
A strong ligament that runs from the patella (kneecap) to the tibial tuberosity. It connects to the quadriceps tendon and plays a major role in knee extension.
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Arcuate Popliteal Ligament
Arcuate Popliteal Ligament
A strong ligament that originates from the posterior head of the fibula and forms a Y-shaped fan that attaches to the tibial intercondylar area. It passes over the popliteus muscle tendon, strengthening the posterolateral area of the joint capsule.
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Posterior Cruciate Ligament (PCL)
Posterior Cruciate Ligament (PCL)
A ligament that provides strength to the posterior joint capsule of the knee. It originates from the femur and attaches to the tibia, limiting the knee's ability to hyperextend. It's important for preventing excessive backward movement of the tibia.
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Medial Collateral Ligament (MCL)
Medial Collateral Ligament (MCL)
A ligament that runs along the inside of the knee, connecting the femur to the tibia. It helps to prevent excessive medial (inward) movement of the tibia in relation to the femur.
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Lateral Collateral Ligament (LCL)
Lateral Collateral Ligament (LCL)
A ligament that connects the head of the fibula to the lateral condyle of the tibia, strengthening the lateral side of the knee joint and preventing excessive lateral (outward) movement of the tibia.
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Tibiofemoral Joint
Tibiofemoral Joint
The main joint of the knee, it allows the lower leg to swing back and forth. It joins the femur to the tibia, allowing for flexion and extension, which enables movement like walking and running.
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Knee Extension
Knee Extension
The act of straightening the knee, a movement that's crucial for standing, walking, and running. Various muscles work together to achieve this extension.
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Knee Extensors
Knee Extensors
The group of muscles that extend (straighten) the knee.
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Knee Flexors
Knee Flexors
The group of muscles that flex (bend) the knee.
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Popliteus Muscle
Popliteus Muscle
The muscle that unlocks the knee by externally rotating the femur. It controls the locking mechanism by slowing internal rotation during extension.
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Popliteal Fossa
Popliteal Fossa
The area behind the knee, containing nerves, arteries, and veins.
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Tibia
Tibia
The large bone that forms the lower leg, below the knee.
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Genu Recurvatum
Genu Recurvatum
A condition where the knee hyperextends beyond its normal range of motion, often caused by ligament laxity or muscle weakness.
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Genu Valgum
Genu Valgum
Also known as "knock knees", this condition involves an inward deviation of the knees, causing the lower legs to be closer to the body than normal.
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Genu Varum
Genu Varum
Also known as "bow legs", this condition involves an outward deviation of the knees, resulting in the lower legs being more widely spaced.
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Squinting Patellae
Squinting Patellae
A condition where the patella seems to "squint" inwards due to excessive internal rotation of the thigh and/or a tight lateral retinaculum.
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Chondromalacia Patellae
Chondromalacia Patellae
A softening and degeneration of the cartilage on the back of the kneecap (patella), often caused by overuse or abnormal patellar tracking.
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Patellar Subluxation
Patellar Subluxation
This refers to any movement of the patella that deviates from its normal position, often causing pain and instability.
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Patellar Dislocation
Patellar Dislocation
When the patella completely dislocates from its groove in the femur, causing severe pain and instability.
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Vastus Medialis Obliquus (VMO)
Vastus Medialis Obliquus (VMO)
A muscle that helps stabilize the patella and prevents it from moving laterally during knee extension. Weakness of this muscle can contribute to patellar instability.
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Baker's cyst
Baker's cyst
A posterior protrusion of the synovial membrane, appearing as swelling in the back of the knee, especially when the knee is bent or standing. It can happen spontaneously or be linked with rheumatoid arthritis.
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Cruciate Ligaments
Cruciate Ligaments
Injuries to these ligaments often occur when the leg is restricted from moving, and the thigh rotates excessively inwards or outwards.
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Anterior Drawer Sign
Anterior Drawer Sign
A test for ACL injury. With the knee bent at 90 degrees, a controlled pull on the lower leg forwards (anteriorly) assesses the amount of movement. A too-large movement or a lack of resistance indicates a possible ACL tear.
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Posterior Drawer Sign
Posterior Drawer Sign
Evaluates the PCL (Posterior Cruciate Ligament) by testing the extent of backward (posterior) movement of the tibia with the knee bent. An excessive amount of backward movement suggests a PCL injury.
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Lachman Test
Lachman Test
A test for ACL injury. With the knee slightly bent (30 degrees), the tibia is pulled forward to check for excessive movement and a firm endpoint. A lack of a firm endpoint or excessive movement indicates a potential ACL tear.
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Knee Joint Overview
- The knee is the largest synovial joint in the body.
- It's a modified hinge joint, diarthroidal, and synovial.
- It's remarkably stable, even though the joint surfaces aren't perfectly congruent.
- Stability is maintained through passive and dynamic structures around the knee and the locking mechanism.
- The knee has two separate joints: the tibiofemoral joint and patellofemoral joint.
Synovial Joint Structure
- A freely moving joint.
- Surrounded by a fibrous capsule and synovial membrane.
- Synovial membrane secretes fluid to lubricate the joint.
- Ends of bones are covered with hyaline cartilage.
- A joint cavity lies between the bones.
- Some joints have fibrocartilage pads (menisci) between bone ends.
- Ligaments, fatty pads, and bursae are also components.
Knee Bones
- Femur
- Tibia
- Patella
Knee Cartilage
- Hyaline cartilage: Covers bone ends; absorbs and redistributes force.
- Fibrocartilage (menisci): C-shaped wedges where bone ends meet. Medial meniscus is larger than lateral. It protects and stabilises the knee and helps lubricate the joint.
Knee Ligaments
- Intracapsular: ACL, PCL, Transverse ligament, and cruciate ligaments
- Extracapsular: Patellar ligament, MCL, LCL, oblique popliteal, and arcuate popliteal.
- Ligaments hold bones together and allow for free motion in some directions and prevent motion in others.
- Joint capsule surrounds the joint; thick and strong at sides; thinner anteriorly and posteriorly.
- The capsule is continuous with the periosteum; contains small vascular structures and nerves.
Anterior Cruciate Ligament (ACL)
- Originates from anterior tibial intercondylar area to posterolateral femoral intercondylar notch.
- Stops tibia from moving forward in relation to femur; controls rotation during pivoting.
Posterior Cruciate Ligament (PCL)
- Originates from posterior tibial intercondylar area to anteromedial femoral intercondylar notch.
- Stops tibia from sliding back on femur, controls hyperextension, and rotation.
Transverse Ligament
- Joins the anterior horns of the medial and lateral menisci.
- Prevents menisci movement.
Medial and Lateral Coronary Ligaments
- Fibres of joint capsule around base of medial and lateral menisci.
- Fix menisci to tibial plateau.
Patellar Ligament
- Attaches patella to tibial tuberosity.
- Contributes to knee extension with quadriceps activation.
- Supports anterior knee stability.
Medial Collateral Ligament (MCL)
- Originates from medial epicondyle of femur; attaches to anteromedial tibial condyle and medial meniscus.
- A broad strong band of tissue, providing medial stability.
Lateral Collateral Ligament (LCL)
- Originates from lateral epicondyle of femur; attaches to head of fibula.
- Thinner cord-like structure; provides lateral stability.
Oblique Popliteal Ligament
- Originates from the semimembranosus tendon; attaches to posterior joint capsule.
- Strengthens posterior capsule.
Arcuate Popliteal Ligament
- Originates from posterior head of fibula; Y-shaped fan to tibial intercondylar area; passes over popliteus tendon.
- Strengthens posterolateral area of joint capsule.
Knee Muscles (Groups)
- Extensors (of knee): Rectus femoris, gluteus Maximus/tensor fascia lata (via iliotibial band);
- Flexors (of the knee): biceps femoris (long head) semimembranosus, semitendonosus, sartorius, gracilis.
- Extensors (of the knee only): vastus medialis, vastus lateralis, vastus intermedius.
- Flexors (of knee only): biceps femoris (short head)
- Popliteus: Unique muscle (origin- posterior tibia, insertion- femoral epicondyle), unlocking knee by externally rotating femur.
Nerve Supply and Cutaneous Innervation
- Motor nerves: femoral, tibial, common peroneal, obturator.
- Cutaneous nerves: saphenous, femoral cutaneous (medial, intermediate, and posterior), lateral cutaneous calf, and some obturator.
Knee Vascular Structures
- 8 arteries; arise from 4 main arteries (anastomosis around knee).
- Arteries from the popliteal: superior lateral genicular, superior medial genicular, inferior lateral genicular, inferior medial genicular.
- Arteries from the tibial: anterior tibial recurrent, posterior tibial recurrent.
- Arteries from the femoral: descending genicular, lateral circumflex genicular.
Knee Veins
- Companions to arteries, drain blood from the area.
- Drain into the popliteal vein.
- Posterior tibial, anterior tibial, small/long saphenous veins are part of the draining network.
Knee Lymphatics
- 6–7 popliteal nodes embedded in fatty tissue in popliteal fossa.
- Drain proximally to deep inguinal nodes.
Knee Joint Motion
- Predominantly flexion and extension, with these motions occurring in both open and closed kinetic chains.
- Some medial and lateral rotation is associated with knee locking mechanisms.
Abnormal Knee Positions
- Sagittal plane: genu recurvatum (hyperextension), genu valgum (bow legs), genu varum (knock knees).
- Frontal plane: Genu valgum (knock knees)
- Transverse plane: squinting patellae
Patellofemoral Joint
- Articulations between patella and femur.
- Patella is largest sesamoid in the body.
- Within quadriceps tendon group, held in position by vasti and retinacula.
- Patella cartilage on deep side and femur joint surfaces.
Patellofemoral Joint Clinical Presentation
- Issues include lateral tracking, weakness of VMO (vastus medialis oblique) muscle, resulting in patellar tilt, rotation, and displacement; clinical syndrome is termed chondromalacia patellae.
Knee Examination Techniques
- Observation: Adequately expose both knees, using correct exam tables; evaluate posture, Baker's cysts, synovial membrane protrusion.
- Palpation: Assessing tenderness, warmth, tight retinacula, active movement (with quadriceps), apprehension test.
- Clinical testing: anterior and posterior drawer signs, Lachman test, Apley's compression (meniscus).
Knee Joint Examination Summary
- Comprehensive assessments involve identifying and evaluating normal and abnormal knee structures, postures, movement patterns, and any associated symptoms during physical activity.
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