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Questions and Answers
What type of joint is the knee classified as?
What type of joint is the knee classified as?
Which of the following terms describes a condition where the knees angle inward toward each other?
Which of the following terms describes a condition where the knees angle inward toward each other?
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 muscles are primarily responsible for extending the knee?
Which muscles are primarily responsible for extending the knee?
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What anatomical feature contributes to the stability of the knee joint?
What anatomical feature contributes to the stability of the knee joint?
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Which arteries provide the blood supply to the knee joint?
Which arteries provide the blood supply to the knee joint?
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What does the ACL primarily prevent?
What does the ACL primarily prevent?
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What is the primary function of the PCL?
What is the primary function of the PCL?
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During which condition are the ligaments notably taut?
During which condition are the ligaments notably taut?
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Which statement about the ACL and PCL is accurate?
Which statement about the ACL and PCL is accurate?
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What can increase the risk of ACL injury during activity?
What can increase the risk of ACL injury during activity?
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How does the blood supply to the ACL function?
How does the blood supply to the ACL function?
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What characterizes the red zone of the menisci in relation to healing capacity?
What characterizes the red zone of the menisci in relation to healing capacity?
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What happens during the last 15° of extension in the knee?
What happens during the last 15° of extension in the knee?
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Which muscle is responsible for unlocking the knee joint from full extension?
Which muscle is responsible for unlocking the knee joint from full extension?
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What occurs when the knee is locked in full extension?
What occurs when the knee is locked in full extension?
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What is the action of the popliteus muscle?
What is the action of the popliteus muscle?
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Why is the medial meniscus more prone to injury compared to the lateral meniscus?
Why is the medial meniscus more prone to injury compared to the lateral meniscus?
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During walking, what movement occurs to transition from knee flexion to extension?
During walking, what movement occurs to transition from knee flexion to extension?
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What anatomical feature does the popliteus muscle pierce?
What anatomical feature does the popliteus muscle pierce?
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What is the primary function of the collateral ligaments in the knee joint?
What is the primary function of the collateral ligaments in the knee joint?
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Which ligament is described as having a flat strap-like structure?
Which ligament is described as having a flat strap-like structure?
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In what position are the collateral ligaments taut?
In what position are the collateral ligaments taut?
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During normal walking, when does the body apply load to the knee joint?
During normal walking, when does the body apply load to the knee joint?
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Where does the lateral collateral ligament (LCL) attach?
Where does the lateral collateral ligament (LCL) attach?
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What additional support is provided to the knee joint?
What additional support is provided to the knee joint?
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Which structure is anchored to the medial meniscus?
Which structure is anchored to the medial meniscus?
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What is a characteristic feature of the medial collateral ligament (MCL)?
What is a characteristic feature of the medial collateral ligament (MCL)?
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How does the position of the knee affect the collateral ligaments during movement?
How does the position of the knee affect the collateral ligaments during movement?
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What type of forces do the collateral ligaments resist?
What type of forces do the collateral ligaments resist?
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Study Notes
The Knee Joint Overview
- The knee joint is a modified hinge joint.
- It is stable due to the presence of intra and extra-capsular ligaments.
- The articulation points include the patellofemoral joint and the medial and lateral tibiofemoral joints.
- The knee is not ideally congruent, so there is a potential for the femoral condyles to slip off the plateaus.
The Knee Menisci
- The menisci are intra-synovial articular discs that help create stability.
- They are wedge-shaped and help deepen the socket for more congruency and support.
- They also act as shock absorbers.
Muscles Crossing the Knee Joint
- Muscles produce movement across the knee and enhance joint stability.
- The anterior muscles (quadriceps group) extend the knee by crossing the knee via the patella.
- The posterior muscles (hamstring, gastrocnemius, popliteus, and plantaris) perform other movements.
Normal Range of Movements of the Knee
- The normal range of movement is 0-135 degrees.
- Flexion and extension range from 30-40 degrees and 10 degrees respectively.
- Pain, oedema, and muscle bulk can restrict this range.
Vasculature of the Knee Joint
- Blood supply comes from the popliteal artery and its anastomoses.
- There are five descending branches of the genicular arteries.
- The popliteal artery branches from the femoral artery.
Red Zones of the Menisci
- The red zone is more vascularised and heals better than other areas of the meniscus.
Tibio-Femoral Joint
- The joint is fully flexed and pulled apart.
- The most anterior part of the femoral condyle is reserved for the patella.
Tibio-Femoral Joint (cont.)
- During walking, a combination of rolling and gliding occurs between the femur and tibia.
- This causes medial rotation of the femur on the tibia in the final 15 degrees of extension.
- The rotation tightens all the ligaments and creates a closed-packed position.
Popliteus Muscle
- The popliteus muscle laterally rotates the femur to unlock the joint after full extension.
- It attaches to the lateral femoral condyle and pierces the capsule.
- The popliteus muscle is supplied by the tibial nerve.
Collateral Ligaments
- The LCL is a thinner cord-like structure attached to the lateral epicondyle of the femur and the head of the fibula.
- The MCL is a flat strap with two bands.
- The superficial band runs from the medial epicondyle of the femur to the proximal shaft of the tibia.
- The deep band is similar to the superficial, but also anchored to the medial meniscus.
Collateral Ligaments Function
- The collateral ligaments prevent sideways movement against varus or valgus force.
- They are taut in full extension and relaxed during flexion.
Additional Support
- Additional support is provided by the pes anserine tendons, gastrocnemius, hamstring, biceps femoris, and iliotibial band.
Valgus Stress Test
- The Valgus stress test assesses the MCL.
- The test is performed with the knee in extension as this is when the ligament is subjected to the greatest stress.
Varus Stress Test
- The Varus stress test assesses the LCL.
Cruciate Ligaments
- The cruciate ligaments get their name from the Latin word "crux" meaning cross.
- The ACL inserts into the anterior intercondylar ridge of the tibia and the lateral surface of the medial femoral condyle.
- The PCL inserts into the posterior intercondylar ridge of the tibia and the lateral surface of the medial femoral condyle.
Anterior Cruciate Ligament
- The ACL prevents the tibia from displacing anteriorly in relation to the femur.
- It is under great stress during full extension.
Posterior Cruciate Ligament
- The PCL prevents the tibia from displacing posteriorly and the femur from moving forward excessively.
- The PCL is three times thicker than the ACL.
- The tightness of the quadriceps muscle and the PCL work in tandem to prevent the femur from slipping forward.
Cruciate Ligament Injury
- When the knee is extended, the ligaments are taut.
- Sudden medial twisting can cause an injury to one or both cruciate ligaments.
- The ACL is thinner, so it is more prone to injury.
- The ligaments receive blood supply from the middle genicular artery, which forms a vascular synovial envelope.
- If ruptured, they can leak blood inside the joint capsule, causing a haematoma.
The Lachman’s Test
- The Lachman's test is used to evaluate an ACL rupture.
- It is executed with the knee at 30 degrees to relax the hamstring.
The Unhappy Triad
- The unhappy triad is the rupture of the ACL, MCL, and the medial meniscus.
- It is usually caused by a lateral force or twisting in extension.
Synovium of the Knee Joint
- The cruciate ligaments and the popliteal tendon lie outside the synovial membrane, although they are within the capsule.
Infrapatellar Fat Pad (Hoffa’s fat pad)
- It is located outside the synovium behind the patellar tendon.
- It acts as a cushion to prevent friction and fill the space for stabilisation.
- It is richly vascularised.
Infrapatellar Fat Pad Attachments
- The infrapatellar fat pad attaches to the patellar tendon and the superior aspect of the tibial plateau.
Bursae of the Knee Joint
- Bursae are fluid-filled sacs found around the knee that protect tendons close to the bone.
- The prepatellar bursa protects the skin.
- Four bursae have a connection with the joint capsule – the suprapatellar, semimembranosus, gastrocnemius, and popliteal bursae.
- The semimembranosus bursa and gastrocnemius bursa are often combined.
Popliteus Bursa
- The popliteus bursa protects the popliteus tendon as it winds laterally under the LCL.
- Enlargement of these bursae can cause swelling known as Baker’s Cyst.
- Baker’s cyst commonly occurs with inflammatory reactions in late stages of knee osteoarthritis.
Anserine Bursa
- It is the most common bursa affected by running, due to constant friction, excessive rotation, and valgus stress.
Suprapatellar Bursitis
- Inflammation of the suprapatellar bursa can cause swelling over the top of the patella.
Pre-Patellar Bursitis
- Inflammation of the prepatellar bursa, known as "housemaid's knee", can cause swelling over the patella.
Infrapatellar Bursitis
- Inflammation of the infrapatellar bursa can cause swelling below the patella.
Treatment for Bursitis
- Excess fluid is removed by aspiration.
- NSAID agents are used to treat the inflammation.
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Description
This quiz covers the anatomy, biomechanics, and function of the knee joint. It includes details about the knee joint structure, the role of menisci, muscles involved in movement, and the normal range of motion. Test your knowledge on these important aspects of knee function!