Knee and Hip Joints: Osteology

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Questions and Answers

In the knee joint, what is the combined number of osseous structures and distinct joints?

  • 4
  • 8
  • 6 (correct)
  • 10

Which of the following structures is NOT part of the four osseous structures of the knee joint?

  • Proximal tibia
  • Distal femur
  • Patella
  • Calcaneus (correct)

How do geometry and shape of the two condyles of the distal femur impact knee joint function?

  • They facilitate obligatory axial rotation. (correct)
  • They minimize articular cartilage contact.
  • They ensure equal force distribution.
  • They prevent axial rotation.

What is the primary function of the intercondylar notch in the distal femur?

<p>To provide space for cruciate ligaments during movement. (A)</p>
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How does the dimension of the medial femoral condyle compare to the lateral femoral condyle, and what is a characteristic of its shape?

<p>Larger A/P dimension and symmetrical (A)</p>
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What structural feature makes the tibia suited to act as a pivot point during axial rotation?

<p>The intercondylar eminence fitting into the intercondylar notch of the femur. (C)</p>
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Which statement best describes the superior view profile and central part of the lateral tibial condyle?

<p>Circular; slightly hollowed (B)</p>
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In what way does the shape of the medial tibial condyle contribute to knee stability?

<p>It is concave in all planes. (C)</p>
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What is the main functional role of the menisci within the knee joint?

<p>To provide shock absorption and lubrication (A)</p>
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What action illustrates the function of menisci of creating a congruous joint surface?

<p>Providing a deeper fossa on the tibial surface. (D)</p>
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Which of the following statements accurately describes the shape of the medial meniscus?

<p>Semicircular with a wider posterior horn (B)</p>
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What primary movement does the anterior cruciate ligament (ACL) prevent in the knee joint?

<p>Anterior translation of the tibia on the femur (C)</p>
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The anterior cruciate ligament (ACL) attaches to which specific part of the lateral femoral condyle?

<p>Posterior aspect of the medial surface (C)</p>
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How does the tension within the fiber bundles of the ACL change throughout the flexion range?

<p>Part of the bundle of fibers remain taut. (A)</p>
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How does the attachment location of the posterior cruciate ligament (PCL) differ from that of the ACL on the tibial plateau?

<p>The PCL attachment is broader and on the posterior aspect. (B)</p>
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What is the specific term for the PCL bundle that is taut during knee extension?

<p>Posteromedial bundle (D)</p>
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Besides the ACL, what other structure provides primary resistance to anterior translation in the knee?

<p>Posterior Cruciate Ligament (A)</p>
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What is the secondary role for support against anterior translation?

<p>Collateral ligaments and joint capsule (C)</p>
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The superficial medial ligament of the tibial collateral ligament is also referred to as which of the following?

<p>Long fibers (B)</p>
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The deep medial ligament of the tibial collateral ligament can be alternatively described as which of the following?

<p>Medial Capsular Ligament (B)</p>
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What is the function of the posterior oblique ligament (POL) in relation to the medial collateral ligament (MCL)?

<p>It is a direct extension of the superficial MCL. (D)</p>
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When the knee flexes, how do the anterior and posterior bundles within the superficial ligament of the MCL respond?

<p>The anterior bundle tightens, and the posterior bundle slackens (A)</p>
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What specific type of stress is the superficial ligament of the medial collateral ligament (MCL) particularly influential in resisting?

<p>Valgus and rotatory stress (C)</p>
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What part of the fibular collateral ligament contributes to its function?

<p>Attachment to capsular structures (A)</p>
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What specific type of loading does the lateral collateral ligament resist?

<p>Tensile loading (D)</p>
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What type of movement does the lateral collateral ligament resist?

<p>Varus angulation (D)</p>
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Which statement best describes the role of the joint capsule in the knee?

<p>It provides static joint stability and is the largest synovial joint in the body. (A)</p>
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In the context of knee joint biomechanics, what action is described as translation along the z-axis?

<p>Distraction or compression at the joint surface (A)</p>
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An individual is standing in anatomical position. What will the effect of internal or external rotation of their knee have?

<p>Rotation around the z-axis. (D)</p>
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When assessing knee joint movement, what action is referred to as 'anteroposterior draw'?

<p>Translation along y-axis (D)</p>
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What type of movement involves rotation around the y-axis?

<p>Valgus / Varus (A)</p>
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In biomechanics, what specific movement is described as 'flexion or extension' of the knee joint?

<p>Rotation around x-axis (D)</p>
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What geometric shape is created by the loci of the instantaneous center of rotation (ICOR) during knee flexion?

<p>A reverse &quot;C&quot; shape (B)</p>
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Which term accurately describes the hip joint's structural classification?

<p>Ball and socket joint (D)</p>
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What is the combined function of the acetabular labrum and the transverse acetabular ligament?

<p>To stabilize the hip, enhancing articulation (D)</p>
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What effect on hip joint mechanics is most directly associated with a neck-shaft angle greater than 125 degrees?

<p>Coxa valga (B)</p>
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What is the name of the condition in which the neck-shaft angle is observed to be less than 125 degrees?

<p>Coxa vara (C)</p>
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When the femoral neck leans forward, which condition is observed?

<p>Anteversion (D)</p>
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What effect would a retroverted hip have?

<p>The femoral neck leans backward (B)</p>
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What specific role does the ligament of the head of the femur play in hip joint function?

<p>Provides blood supply to the femoral head (A)</p>
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What ligament is important for the hip during standing?

<p>Iliofemoral ligament (D)</p>
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Which statement accurately describes the effect on hip joint range of motion performed on the pubofemoral ligament?

<p>It resists abduction and external rotation (C)</p>
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Damage to what major part may be caused by posterior dislocation of the hip joint?

<p>Ischiofemoral ligament (D)</p>
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What is the normal range of abduction in the hip joint?

<p>40 (B)</p>
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The knee joint consists of 4 osseous structures: distal femur, proximal tibia, fibula, and radius.

<p>False (B)</p>
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The knee joint comprises of three distinct joints: patellofemoral, tibiofemoral, and hamstring.

<p>False (B)</p>
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The lateral femoral condyle is aligned with the shaft of the femur and acts as a main transmitter of compressive forces.

<p>True (A)</p>
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The two condyles of the distal femur have the same geometry and shape, ensuring equal weight distribution at the knee joint.

<p>False (B)</p>
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The distal femur is convex in both coronal and transverse planes.

<p>False (B)</p>
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The intercondylar notch separates the tibial plateau and provides space for cruciate ligaments during flexion and extension.

<p>False (B)</p>
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The medial femoral condyle has a smaller anterior/posterior dimension compared to the lateral condyle, and it is less symmetrical.

<p>False (B)</p>
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The fibula is the stronger of the two bones in the lower leg, bearing the majority of force transmission.

<p>False (B)</p>
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The lateral and medial condyles of the proximal tibia are separated by the intercondylar eminence, serving as a pivot during axial rotation.

<p>True (A)</p>
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The lateral tibial condyle is circular in profile when viewed superiorly, and articulated with the radial head.

<p>False (B)</p>
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The medial tibial condyle is more oval in outline and smaller than the lateral tibial condyle.

<p>False (B)</p>
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The medial tibial condyle is concave in all planes, contributing to knee stability.

<p>True (A)</p>
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Control of knee joint motion is exclusively regulated by the shapes of the articulating bones.

<p>False (B)</p>
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Menisci contribute to joint congruity by creating a shallower surface on the tibial plateau.

<p>False (B)</p>
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The lateral meniscus is semicircular with a wider posterior horn, making it less prone to injury than the medial meniscus.

<p>False (B)</p>
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The anterior cruciate ligament (ACL) restricts posterior translation of the tibia on the femur.

<p>False (B)</p>
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The posterior cruciate ligament (PCL) restricts external rotation of the tibia on the femur.

<p>False (B)</p>
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The posterior cruciate ligament (PCL) attaches on the tibial plateau lateral to the medio-lateral bisector.

<p>True (A)</p>
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The ACL is composed of a single, thick strand of collagen, providing consistent tension throughout the knee's range of motion.

<p>False (B)</p>
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The anterior cruciate ligament is attached to the posterior aspect of the medial surface of the lateral femoral condyle.

<p>True (A)</p>
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The posteromedial bundle of the PCL is taut in flexion, while the anterolateral bundle is taut in extension.

<p>False (B)</p>
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The medial collateral ligament primarily resists varus stress, protecting the knee from excessive abduction.

<p>False (B)</p>
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The medial collateral ligament (MCL) has superficial, intermediate, and deep functional units that offer stability to the knee.

<p>False (B)</p>
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The posterior oblique ligament is an extension of the superficial MCL and joins the semimembranosus tendon to the anteromedial aspect of the joint capsule.

<p>False (B)</p>
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When the knee flexes, the anterior bundle of the superficial medial collateral ligament tightens, while the posterior bundle slackens.

<p>True (A)</p>
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The deep fibers of the medial collateral ligament offer little contribution to the overall stability provided by the superficial ligament.

<p>False (B)</p>
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The fibular collateral ligament attaches proximally to the medial epicondyle of the femur.

<p>False (B)</p>
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The fibular collateral ligament directly attaches to the meniscus and adjacent knee joint capsule.

<p>False (B)</p>
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The knee joint capsule provides dynamic stability, actively adjusting tension to maintain joint integrity.

<p>False (B)</p>
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Translation along the z-axis of the knee joint refers to medial-lateral movement of the tibia relative to the femur.

<p>False (B)</p>
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Rotation around the y-axis of the knee joint corresponds to flexion and extension movements.

<p>False (B)</p>
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Instantaneous center of rotation (ICOR) describes the precise point around which the knee rotates during all movements, remaining constant during activity.

<p>False (B)</p>
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The hip joint is a hinge joint, allowing primarily flexion and extension movements.

<p>False (B)</p>
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A neck-shaft angle greater than 125° in the frontal plane is termed Coxa vara.

<p>False (B)</p>
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In cases of femoral retroversion, the femur rotates internally to keep the femoral head within the acetabulum.

<p>False (B)</p>
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The ligament of the head of the femur contributes to stability when the hip is abducted.

<p>False (B)</p>
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The iliofemoral ligament, known as the 'Y' ligament of Bigelow, is a major stabilizer of the hip, especially during adduction.

<p>False (B)</p>
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The pubofemoral ligament resists abduction and external rotation of the hip.

<p>True (A)</p>
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The distal femur is convex in the sagittal plane but concave in the frontal plane.

<p>False (B)</p>
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The medial meniscus is circular, while the lateral meniscus has a semicircular shape, with a wider anterior horn.

<p>False (B)</p>
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The anterior cruciate ligament (ACL) attaches on the tibial plateau anterior to the medial intercondylar eminence and on the posterior aspect of the lateral femoral condyle.

<p>True (A)</p>
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The iliofemoral ligament, located at the hip, exhibits a 'V' shape and its primary role is to resist hyperabduction.

<p>False (B)</p>
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In the hip joint, a neck-shaft angle in the frontal plane measuring 130° would be classified as 'Coxa vara'.

<p>False (B)</p>
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Flashcards

What is Osteology?

The scientific study of bones.

What is the distal femur?

The distal end of the thigh bone, part of the knee joint.

What is the proximal tibia?

The upper part of the shin bone, forming the knee joint.

What is the Fibula?

The smaller, lateral bone of the lower leg.

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What is the patella?

The kneecap, a sesamoid bone in the quadriceps tendon.

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What is the patellofemoral joint?

The joint between the patella and the femur.

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What is the tibiofemoral joint?

The joint between the tibia and the femur.

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What is the trochlea (patellofemoral groove)?

A groove at the end of the femur where the patella rests.

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What is the Anterior Cruciate Ligament (ACL)?

Ligament preventing forward movement of shin bone.

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What is the Posterior Cruciate Ligament (PCL)?

Ligament preventing posterior movement of shin bone.

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What is the Intercondylar notch?

Space for cruciate ligaments during flexion/extension.

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What is the Medial Femoral Condyle?

Larger, more symmetrical, medial side of thigh bone end.

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What is the Lateral Femoral Condyle?

Aligned with femur shaft, transmits forces.

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What is the Tibia?

The bone that is stronger and transmits more force.

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What are the Lateral and Medial Condyles?

Structures separating condyles; pivoting point in axial rotation.

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What is the Lateral Tibial Condyle?

Articulates with fibular head, circular when viewed from above.

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What is the Medial Tibial Condyle?

Oval shaped supports and resists compression.

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What are the function of the Menisci?

Stabilizes and provides shock absorption.

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What is the Medial Meniscus?

Wider posterior horn, semicircular shape.

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What is the Lateral Meniscus?

Circular in shape; other knee cushion.

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What controls knee joint motion?

Capsular, intra- and extra-articular ligaments, Muscle.

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What is the function og the ACL?

Primary function is prevent tibia's anterior translation.

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What is the function of the PCL?

Primary function is to prevent tibia's posterior translation.

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What is the ACL made from?

The lower part of bundles that remain taut throughout.

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What makes up the PCL?

Posteromedial (taut in extension), Anterolateral (taut in flexion).

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What is a primary function if the ACL and PCL?

Prevent anterior translation.

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What is the primary function of the Medial Collateral Ligament (MCL)?

Provides medial stability.

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What are the three units of MCL?

Superficial medial ligament, deep medial ligament, posterior oblique ligament.

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What is the function of the posterior oblique fibers?

Support posterolateral knee, posterior joint capsule.

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What is the Fibular (lateral) collateral ligament Function?

Supports capsular structures.

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What is the function of lateral collateral ligament?

Maintaining taut support during flexion.

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What is the Knee Joint Capsule?

Largest synovial joint, provides static stability.

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What rotations happen at the Knee?

Distract/compress, In/Ext rotation, Anteroposterior draw, Valgus/Varus.

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What is the Instantaneous center of rotation (ICOR)?

The curved path of rotation during knee flexion.

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What kind of joint is the Hip joint?

Ball and socket joint.

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What the hip formed by?

Ball (femoral head) and socket (acetabulum).

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What makes the hip stable?

Acetabular labrum and transverse acetabular ligament.

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What is average hip anteversion?

Between neck axis and knee axis; ~12 degrees in adults.

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What happens in increases anteversion?

Femur rotates internally to keep head in acetabulum.

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What happens in increases retroversion?

Femur rotates externally to keep head in acetabulum.

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What is the Ligament of the head of femur function?

Blood supply to femoral head; provides stability when hip is adducted.

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What is Arthrology?

Scientific study of joints and associated tissues.

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Distal Femur Condyles?

Geometry and shape differences result in obligatory axial rotation.

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Forces to Tibial Plateau

Transmits forces from femur to tibia.

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Tibia force transmission

Medial and lateral condyles separated by the intercondylar eminence.

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Lateral Tibial Condyle

Posterolateral aspect for articulation with the fibular head.

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Medial Tibial Condyle

Concave in all planes, providing stability.

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Function of Tibial Condyles

Stable platform for femoral condyles to transmit compressive forces.

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What do posterior oblique fibers support?

Supports posterolateral knee and joint capsule action.

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Superficial Ligament Stability

Valgus and rotatory stress are resisted

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Knee Joint Motion

Joint surface distraction/compression, In/Ext rotation, Valgus/Varus.

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Transverse Acetabular Ligament

Spans acetabular notch, deepens labrum, increases stability.

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Iliofemoral Ligament

Strongest hip ligament, in an inverted Y shape

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Pubofemoral Ligament

Runs from pubis to iliofemoral ligament, resists abduction/external rotation.

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Ischiofemoral Ligament

Crosses over posterior-inferior joint capsule, may rupture with dislocation.

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Hip Flexion ROM

Normal flexion is 100 degrees.

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Study Notes

  • Knee & Hip Joints are being discussed

Osteology of the Knee

  • The knee is made up of 4 osseous structures: distal femur, proximal tibia, fibula, and patella
  • The knee contains 2 distinct joints patellofemoral and tibiofemoral
  • Osteology is the Scientific study of bones

Frontal View

  • The frontal view of the right knee has the patella reflected to show underlying structures such as:
  • Femur (thighbone)
  • Patella (underside)
  • Trochlea (patellofemoral groove)
  • Anterior Cruciate Ligament
  • Posterior Cruciate Ligament
  • Lateral Femoral Condyle
  • Medial Collateral Ligament
  • Lateral Meniscus
  • Medial Meniscus
  • Lateral Collateral Ligament
  • Tibial Plateau
  • Tibia (shinbone)
  • Fibula
  • Tibial Tuberosity

Lateral View

  • The lateral view of the Patellofemoral Joint features the:
  • Femur
  • Quadriceps tendon
  • Patello-femoral joint
  • Patella
  • Articular cartilage
  • Patella tendon
  • Medial Meniscus
  • Lateral Meniscus
  • Tibia
  • Fibula

Distal Femur

  • Two condyles are different in geometry and shape, which results in obligatory axial rotation at the knee joint
  • The distal femur transmits forces to the tibial plateau
  • The distal femur is partially covered by articular surfaces which contain articular cartilages

Convex Distal Femur

  • Distal femur is convex in both the frontal and sagittal planes
  • It is separated by the intercondylar notch space for cruciate ligaments (ACL, PCL) during flexion and extension

Medial and Lateral Femoral Condyles

  • Medial femoral condyle has a Larger A/P dimension than the lateral condyle and is more symmetrical
  • Lateral femoral condyle is aligned with the shaft of the femur, and it is the primary transmitter of compressive forces

Lower Leg

  • The lower leg contains two osseous structures: the tibia and fibula.
  • The tibia is stronger for force transmission
  • Lateral and medial condyles are separated by the intercondylar eminences, which serves as a pivot point during axial rotation by locating into the intercondylar notch of the femur

Lateral Tibial Condyle

  • Lateral tibial condyle with a facet on posteriolateral aspect for articulation with the fibular head
  • Circular in profile when viewed superiorly, slightly hollowed in its central part

Medial Tibial Condyle

  • Medial tibial condyle is more oval in outline and larger than lateral tibial condyle
  • Concave in all planes for stability

Tibial Condyles

  • Lateral and medial tibial condyle are stable platforms upon which the femoral condyles can transmit compressive forces

Knee Joint Motion

  • Control of knee joint motion is shared by capsular structures, intra and extra-articular ligaments, joint contours, and muscles & tendons crossing the joint
  • Arthrology is the Scientific study of joints

Menisci Structure

  • The Menisci is an Intermediary structure to provide shock absorption, lubrication and stabilization
  • The Menisci makes the joint surface congruous by providing a deeper fossa (hollow or depression) on the tibial surface
  • The Menisci resists translation of femur on tibia by dispersing compressive forces in a radial manner across their structure.

Medial and Lateral Meniscus

  • Medial meniscus has a Semicircular shape with wider posterior horn
  • Lateral meniscus has a Circular shape

Cruciate Ligaments

  • The ACL prevents anterior translation of the tibia on femur and restricts external rotation of the tibia on femur
  • The PCL restricts posterior translation of the tibia on the femur and resists hyperextension

Anterior Cruciate Ligament (ACL)

  • Attachment is on the tibial plateau anterior to the medial intercondylar eminence and on the posterior aspect of the medial surface of lateral femoral condyle

ACL Information

  • ACL is a bundle of fibers rather than a single structure
  • Part of the bundle of fibers remain taut (stretched) throughout the flexion range.

Posterior Cruciate Ligament (PCL)

  • Attached to tibial plateau in a broad area on the posterior aspect, usually lateral to the M-L bisector of the tibial plateau and is posterior to the ACL attachment on the femur
  • Crosses with the ACL
  • 2 major PCL bundles -Posteromedial bundle taut in extension -Anterolateral bundle taut in flexion

Primary Stabilizers of the Knee

  • For Anterior translation, the primary stabilizers are the: ACL and PCL, and the secondary stabilizers are the: Collateral ligaments and joint capsule
  • For the Medial aspect, the primary stabilizer is the: Medial collateral ligament, and the secondary stabilizer is the: ACL

Tibial (Medial) Collateral Ligament

  • Robust, broad, and flat structure
  • Consists of 3 function units -Superficial medial ligament, referred to as the long fibers -Deep medial ligament, alternatively described as the medial capsular ligament, and is anatomically completely separate from the superficial portion -Posterior oblique ligament

MCL - Medial Collateral Ligament

  • Superficial Ligament is below adductor tubercle and has the medial surface of the shaft of tibia
  • Deep Fibers have the Medial femoral condyle and Medial tibial plateau

Posterior Oblique Ligament

  • Is an Extension of the superficial MCL
  • Joins the semimembranosus tendon to the posteromedial aspect of the joint capsule
  • Reinforces the area

Functions of the MCL

  • All 3 units that constitute of the MCL work in conjunction as the primary medial stabilizer of the knee
  • The superficial ligament exerts most influence on stability, against valgus and rotatory stress
  • When the knee flexes - The anterior bundle tightens, and the posterior bundle slacken
  • The deep fibers of the medial collateral ligament reinforce the action of the superficial ligament
  • The posterior oblique fibers tends to support the posterolateral aspect of the knee and the posterior joint capsule

Fibular (Lateral) Collateral Ligament

  • The Main ligament supports the capsular structures
  • It is attached proximally to the lateral epicondyle of the femur and inserted on the posterior aspect of the fibular head
  • No attachments to the menisci/capsular structures

Lateral Collateral Ligament

  • Functions on the thin cord-like structure and remains taut during flexion range
  • Resists tensile loading and varus angulation

Joint Capsule

  • Knee joint is the largest synovial joint in the body
  • The joint capsule provides static joint stability
  • Muscular and tendinous insertions into the capsule provide further stability
  • Synovial joint: the ends of the bones are covered by a joint capsule filled with fluid for movement

Rotations and Translations

  • Translation along z-axis, distract/compress at joint surface
  • Rotation around z-axis, In / Ext rotation
  • Translation along y-axis, Anteroposterior draw
  • Rotation around y-axis, Valgus / Varus
  • Translation along x-axis, Medial-lateral translation
  • Rotation around x-axis, Flexion / Extension

ICOR

  • The loci of ICOR can be drawn as a reverse "C" shape when the flexion of the tibia was plotted relative to a femur tibia.
  • ICOR stands for Instantaneous center of rotation

Hip Joint

  • The hip joint is a ball and socket joint

Hip Osteology

  • Ball (femoral head) and socket (acetabulum) in structure
  • Acetabular labrum (ring of cartilage) & transverse acetabular ligament increase stability by deepening articulation

Neck-Shaft Angle

  • Neck-shaft angle in frontal plane ~125° -> 125 °Coxa valga -< 125 °Coxa vara

Anteversion & Retroversion

  • Anteversion refers to the angle between the femoral neck axis and knee axis in the transverse plane (Adult ~12 deg)
  • Increases in anteversion when femur rotate internally to keep femoral head in acetabulum
  • Increases in retroversion when femur rotates externally to keep femoral head in acetabulum

Ligamentous Structure

  • Ligament of the head of femur is responsible for blood supply to femoral head
  • Provides stability when hip is adducted

Spanning Ligaments

  • Transverse acetabular ligament spans the acetabular notch and together with acetabular labrum deepens and increases stability of the articulation

Stabilizing hip in extension

  • Iliofemoral ligament is the Strongest hip ligament, inverted Y shape, where the base attaches to ASIS Major element to stabilize hip in extension when a person is standing in erect position, where the Posterior bands also resists internal rotation

Pubofemoral Ligament

  • Runs horizontally from the pubis to the anterior band of the iliofemoral ligament.
  • It resists abduction and external rotation.

Ischiofemoral Ligament

  • Crosses over the posterior-inferior aspect of the joint capsule and may be ruptured by posterior dislocation of the hip joint

Range of Motion

  • Flexion: 100
  • Hyperextion: 30
  • Abduction: 40
  • Adduction: 20
  • Internal rotation: 40
  • External rotation: 50

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