Knee Joint Anatomy

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Questions and Answers

Which bones articulate to form the knee joint?

  • Tibia, fibula, and patella
  • Femur, tibia, patella, and fibula
  • Femur, patella, and fibula
  • Femur, tibia, and patella (correct)
  • Femur, fibula, and tibia

In a lateral radiograph of a normal knee joint, which bone is anterior?

  • Patella (correct)
  • Tibia
  • Calcaneus
  • Fibula
  • Femur

Which term best describes the type of joint present at the knee?

  • Condylar synovial joint (correct)
  • Pivot joint
  • Saddle joint
  • Hinge joint
  • Plane joint

What is the primary function of the menisci in the knee joint?

<p>To deepen the articular surface of the tibia and act as shock absorbers (E)</p> Signup and view all the answers

Which ligament primarily prevents anterior translation of the tibia on the femur?

<p>Anterior cruciate ligament (ACL) (E)</p> Signup and view all the answers

The 'screw-home' movement of the knee joint involves which motion of the tibia during terminal extension?

<p>External rotation (A)</p> Signup and view all the answers

Which arteries primarily supply blood to the outer one-third of the menisci?

<p>Genicular arteries (E)</p> Signup and view all the answers

In an MRI of the knee, normal menisci typically appear:

<p>Hypointense signal (B)</p> Signup and view all the answers

During the McMurray test for medial meniscus tear, which maneuver is typically performed while extending the knee?

<p>Valgus stress and external rotation of tibia (C)</p> Signup and view all the answers

Which structure is considered the primary restraint against varus forces at the knee?

<p>Lateral collateral ligament (LCL) (C)</p> Signup and view all the answers

Which of the following is a common non-contact mechanism of injury for the anterior cruciate ligament (ACL)?

<p>Sudden deceleration and internal rotation of the tibia (A)</p> Signup and view all the answers

The Lachman test is performed with the knee in approximately how many degrees of flexion?

<p>20-30 degrees (D)</p> Signup and view all the answers

A positive 'posterior sag sign' is indicative of injury to which ligament?

<p>Posterior cruciate ligament (PCL) (B)</p> Signup and view all the answers

The 'unhappy triad' of knee injuries typically involves damage to which three structures?

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

Which nerve provides cutaneous innervation to the lateral aspect of the leg and dorsum of the foot?

<p>Common fibular (peroneal) nerve (B)</p> Signup and view all the answers

Which muscle group is located in the anterior compartment of the leg?

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

Which of the following muscles is NOT located in the posterior compartment of the leg?

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

Which nerve innervates the muscles of the anterior compartment of the leg?

<p>Deep fibular (peroneal) nerve (D)</p> Signup and view all the answers

What is the primary action of the muscles in the lateral compartment of the leg?

<p>Eversion (E)</p> Signup and view all the answers

Which of the following bursae is located between the patella and the skin?

<p>Prepatellar bursa (E)</p> Signup and view all the answers

A Baker's cyst is most commonly associated with:

<p>Enlargement of the semimembranosus bursa (B)</p> Signup and view all the answers

Which of the following is a radiographic feature of osteoarthritis in the knee joint?

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

Genu varum is a congenital deformity characterized by:

<p>Knees angled outwards (bowlegs) (B)</p> Signup and view all the answers

The tibial tuberosity is an anatomical landmark for the insertion of which structure?

<p>Patellar ligament (D)</p> Signup and view all the answers

The medial collateral ligament (MCL) primarily resists which type of stress on the knee?

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

During knee flexion, what is the role of the popliteus muscle in the 'screw-home' mechanism?

<p>To 'unlock' the knee by medially rotating the femur on the tibia (B)</p> Signup and view all the answers

Which of the following statements is TRUE regarding the cruciate ligaments?

<p>They are intracapsular and extrasynovial. (A)</p> Signup and view all the answers

Which of the following is NOT a muscle that inserts via the pes anserinus?

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

Which nerve is most likely to be injured with a fracture of the neck of the fibula?

<p>Common fibular (peroneal) nerve (B)</p> Signup and view all the answers

In a cross-section of the leg, which compartment is located most anteriorly?

<p>Anterior compartment (B)</p> Signup and view all the answers

The tibial nerve is a branch of which larger nerve?

<p>Sciatic nerve (A)</p> Signup and view all the answers

What is the primary action of the Tibialis anterior muscle?

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

Which of the following muscles is a primary plantarflexor of the ankle?

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

Which of the following is NOT a function of the menisci?

<p>Providing nourishment to articular cartilage (E)</p> Signup and view all the answers

The anterior intercondylar area of the tibia serves as the tibial attachment site for which ligament?

<p>Anterior cruciate ligament (ACL) (A)</p> Signup and view all the answers

Which test is specifically designed to assess for pain on compression and distraction to differentiate between meniscal and ligamentous lesions?

<p>Apley's Grind test (D)</p> Signup and view all the answers

The infrapatellar branch of the saphenous nerve is clinically relevant because it can be injured during:

<p>All of the above (E)</p> Signup and view all the answers

Which of the following knee bursae is most likely to be affected in 'Housemaid's knee'?

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

In genu valgum, the distal part of the tibia is displaced in which direction relative to the femur?

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

The medial meniscus is more commonly injured than the lateral meniscus because:

<p>It is directly attached to the medial collateral ligament and joint capsule (B)</p> Signup and view all the answers

Which of the following muscles is NOT involved in knee flexion?

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

Which of the listed arteries is NOT a genicular artery contributing to the blood supply around the knee joint?

<p>Anterior tibial artery (B)</p> Signup and view all the answers

Which of the following bones does NOT directly participate in forming the knee joint?

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

The 'screw-home' mechanism of the knee joint, which provides added stability in full extension, is primarily driven by:

<p>The shape of the medial femoral condyle (D)</p> Signup and view all the answers

In a normal knee MRI, menisci typically exhibit which signal intensity on T2-weighted images?

<p>Hypointense (dark black) (B)</p> Signup and view all the answers

Which action during the McMurray test is MOST indicative of a medial meniscus tear?

<p>Pain and clicking during knee extension with tibial external rotation and valgus stress (E)</p> Signup and view all the answers

The primary stabilizer against valgus stress at the knee is the:

<p>Medial collateral ligament (MCL) (D)</p> Signup and view all the answers

A positive Lachman test suggests injury to which of the following ligaments?

<p>Anterior cruciate ligament (ACL) (E)</p> Signup and view all the answers

The 'unhappy triad' of knee injuries classically involves damage to the:

<p>ACL, MCL, and medial meniscus (B)</p> Signup and view all the answers

Which nerve provides the primary innervation to the muscles of the anterior compartment of the leg?

<p>Deep fibular (peroneal) nerve (A)</p> Signup and view all the answers

The primary action of the muscles located in the lateral compartment of the leg is:

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

Which of the following bursae is commonly affected in 'Housemaid's knee'?

<p>Prepatellar bursa (E)</p> Signup and view all the answers

A Baker's cyst is most accurately described as:

<p>A synovial cyst in the popliteal fossa, often associated with knee joint pathology (E)</p> Signup and view all the answers

Genu varum, a congenital deformity, is characterized by:

<p>Distal tibia displaced medially relative to the femur (D)</p> Signup and view all the answers

The tibial tuberosity serves as the distal attachment site for which tendon?

<p>Quadriceps tendon via the patellar ligament (D)</p> Signup and view all the answers

During knee flexion, the popliteus muscle plays a key role in the 'screw-home' mechanism by:

<p>Medially rotating the tibia on the femur to unlock the knee (A)</p> Signup and view all the answers

Which of the following muscles is NOT part of the pes anserinus insertion on the proximal tibia?

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

Injury to the common fibular nerve is most likely associated with fracture of which anatomical part of the fibula?

<p>Neck of the fibula (E)</p> Signup and view all the answers

The anterior intercondylar area of the tibia serves as the tibial attachment site for which structure?

<p>Anterior cruciate ligament (ACL) (C)</p> Signup and view all the answers

Apley's grind test is designed to assess for pain on compression and distraction at the knee joint. Pain that is WORSE with distraction, compared to compression, is MOST indicative of:

<p>Ligamentous lesion (E)</p> Signup and view all the answers

The infrapatellar branch of the saphenous nerve is clinically relevant because it is most vulnerable to injury during:

<p>ACL reconstruction using patellar tendon graft (D)</p> Signup and view all the answers

Which of the following statements BEST describes the anatomical difference contributing to the higher incidence of medial meniscus tears compared to lateral meniscus tears?

<p>The medial meniscus is firmly attached to the deep fibers of the medial collateral ligament, limiting its mobility. (E)</p> Signup and view all the answers

Flashcards

Name the bones of the knee joint

Femur, Tibia, Patella

Name the functions functions of the menisci

To deepen the articular surface of the tibia, act as shock absorbers, help in lubricating the joint cavity, give rise to proprioceptive impulses.

What is the blood supply of the menisci?

The outer 1/3 of the menisci receive blood supply via the genicular arteries. Nutrition to the inner 1/3 of meniscal tissue primarily occurs by synovial diffusion

How are the cruciate ligaments named?

Cruciate ligaments are named according to their attachment on the tibia

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What movements do the ACL and PCL limit?

The ACL limits anterior translation of the tibia, while the PCL limits posterior translation of the tibia

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What injuries make up the unhappy triad?

Valgus force on the knee often results in a MCL tear, ACL tear, and Medial meniscal tear

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Describe the screw home mechanism

Complete knee extension is followed by internal rotation of the femur on the tibia. This rotation brings the knee to a locked position in extension

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Describe the mechanism of noncontact ACL injuries

Noncontact ACL injuries involve internal rotation forces on the tibia, valgus/varus forces on the knee, and a sudden contraction of quadriceps.

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What is prepatellar bursitis?

Housemaid's knee or carpenter's knee

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When using Apley's Grind test, what do Painful compression and Painful distraction mean?

To diagnose meniscal lesions, Apley's Grind Test can be performed. Painful compression indicates meniscal lesions, whereas painful distraction indicates ligamentous lesions.

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Which muscles make up the pes anserinus?

The 3 muscles that insert through the pes anserinus are the Sartorius, Gracilis, and Semitendinosus.

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What is a Baker's cyst?

A Baker's cyst is an enlarged semimembranosus bursa, often due to accumulation of synovial fluid

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Study Notes

Bony Anatomy of the Knee Joint

  • Bones forming the knee joint are the femur, tibia, and patella
  • Important anatomical landmarks on these bones must be identified
  • Recognize the radiographic appearance of normal knee joint structures on X-rays, including the "sunrise" view

Intra-Articular Structures of the Knee

  • Intra-articular structures including menisci and ligaments
  • The structure and function of the menisci: deepen the articular surface of the tibia, act as shock absorbers, help in lubricating the joint cavity, and give rise to proprioceptive impulses
  • Menisci receive blood supply via genicular arteries in the outer 1/3; the inner 1/3 relies on synovial diffusion for nutrition
  • Medial meniscus is more commonly injured
  • Tibial collateral ligament is more fixed
  • Lateral meniscus is more mobile
  • Meniscal tears are the second most common knee injury in athletes
  • Types of meniscal tears are identifiable on MRIs
  • Interpret MRI findings of normal and injured menisci
  • The layers are Outer Red, Red-White/Grey, and White.

Cruciate Ligaments

  • Differentiate between normal and pathological appearances of the anterior cruciate ligament (ACL) and posterior cruciate ligaments (PCL) on imaging such as MRI
  • Anterior Cruciate Ligament (ACL): prevents forward translation of the tibia
  • Posterior Cruciate Ligament (PCL): prevents posterior dislocation of tibia on femur, primary restraint on posterior glide
  • ACL originates from the anterior intercondylar area and inserts at the lateral condyle of the femur
  • PCL originates from the posterior intercondylar area and inserts on the medial condyle of the femur
  • ACL and PCL are intracapsular and extrasynovial
  • Understand common mechanisms of cruciate ligament injuries
  • The cruciate ligaments are named according to their attachment to the tibia
  • Cruciate ligaments are assessed via the anterior drawer test and Lachman test (for ACL), and the posterior drawer test (for PCL)

Knee Joint Stability and Diagnostic Tests

  • Cruciate ligaments maintain the knee joint stability
  • Extracapsular (or within) ligaments: lateral collateral ligament (outside capsule), medial collateral ligament, oblique popliteal ligament
  • Intracapsular ligaments: anterior cruciate ligament, posterior cruciate ligament
  • Muscles/Iliotibial band provide dynamic and static stability
  • Menisci aid in deepening the inferior articular surface
  • The lateral stabilizers include the lateral collateral ligament (primary restraint), cruciate ligaments, politeus tendon + capsule, and iliotibial band (secondary restraints) against varus forces
  • The medial stabilizers include the medial collateral ligament (primary restraint), cruciate ligaments, semimembranosus, and joint capsule (secondary restraints) against valgus forces
  • Demonstrate clinical tests used to diagnose anterior and posterior cruciate ligament injuries
  • ACL and PCL limit movements, and are taut during extension.
  • Assess for anteroposterior and rotary instability

Knee Bursae, Degenerative Diseases, and Congenital Deformities

  • Identify important knee bursae and their associated pathologies such as infectious prepatellar bursitis and infrapatellar bursitis (or clergyman's knee)
  • Housemaid's knee or carpenter's knee is prepatellar bursitis caused by kneeling
  • Baker's cyst is an enlarged semimembranosus bursa due to accumulation of synovial fluid and can be primary (in children) or secondary (due to joint pathology such as OA)
  • Describe common degenerative diseases (osteoarthritis) and congenital deformities (genu varum and genu valgum) affecting the knee joint
  • Osteoarthritis (OA) X-ray features: joint space narrowing, osteophyte formation, subchondral sclerosis, and cysts
  • Genu varum (bowlegs): knees out lateral
  • Genu valgum (knock-knees): knees near each other

Gross and Clinical Anatomy of the Leg

  • Identify the compartments of the leg and their associated muscles and explain the nerve supply and clinical relevance of leg anatomy
  • Anterior compartment: tibialis anterior, extensor hallucis longus, extensor digitorum longus, and peroneus tertius muscles- the deep fibular nerve provides innervation
    • Action: Inversion and Dorsiflexion
  • Lateral compartment: peroneus longus and peroneus brevis muscles- the superficial peroneal nerve provides innervation
    • Action: Eversion of foot
  • Posterior compartment muscles
    • Flexerhallucis longus, Flexor digitorum longus, Tibialis posterior, popliteus
    • The tibial nerve provides innervation
      • Action: Plantarflexion

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