Knee Joint Anatomy Quiz

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Questions and Answers

Which ligament is responsible for preventing the tibia from sliding backward on the femur?

  • Medial collateral ligament
  • Anterior cruciate ligament
  • Lateral collateral ligament
  • Posterior cruciate ligament (correct)

What is the primary function of the patella ligament?

  • Joins the medial and lateral menisci
  • Prevents lateral movement at the knee
  • Provides stability to the tibia
  • Facilitates knee extension (correct)

Where does the medial collateral ligament attach?

  • To the posterior tibial intercondylar area
  • To the anteromedial tibial condyle and medial meniscus (correct)
  • To the head of the fibula
  • To the lateral epicondyle of the femur

Which ligament is specifically designed to prevent motion of the menisci?

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

What distinguishes the lateral collateral ligament from the medial collateral ligament?

<p>It does not attach to the lateral meniscus. (C)</p> Signup and view all the answers

What is the primary role of synovial fluid in a synovial joint?

<p>Lubricates the joint surfaces (A)</p> Signup and view all the answers

Which ligament assists with pivoting at the knee?

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

How does the joint capsule contribute to knee motion?

<p>It contains vascular structures and allows free anteroposterior motion. (A)</p> Signup and view all the answers

Which type of joint movement primarily occurs at the knee joint?

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

Which ligaments are considered intracapsular ligaments in the knee joint?

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

What is the main role of the coronary ligaments?

<p>Fix the menisci to the tibial plateau (D)</p> Signup and view all the answers

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

<p>Absorbs shock and stabilizes the joint (C)</p> Signup and view all the answers

Which characteristic of the knee joint contributes to its stability when straight?

<p>Passive and dynamic structures around the joint (A)</p> Signup and view all the answers

Which of the following statements is true regarding the structure of the knee?

<p>The knee joint has two major components (D)</p> Signup and view all the answers

What can increase the risk of injury to the structures surrounding the knee joint?

<p>Improper warm-up before activity (D)</p> Signup and view all the answers

Which muscle is responsible for unlocking the knee by externally rotating the femur?

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

What is one of the key roles of the cruciate ligaments in the knee?

<p>Prevents excessive forward or backward movement of the tibia (C)</p> Signup and view all the answers

Which of the following muscles is classified as a knee flexor only?

<p>Biceps femoris (short head) (A)</p> Signup and view all the answers

Which arteries contribute to the anastomosis around the knee joint?

<p>Inferior medial genicular artery (D)</p> Signup and view all the answers

Which nerve is responsible for innervating the popliteus muscle?

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

What is the action of the popliteus muscle during the unlocking of a straight knee?

<p>Externally rotates the femur (D)</p> Signup and view all the answers

Which of the following muscles are NOT part of the extensors at the knee?

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

How does the knee locking mechanism improve stability?

<p>By tightening ligaments during internal rotation of the femur (D)</p> Signup and view all the answers

Which cutaneous area is NOT typically associated with nerve supply surrounding the knee?

<p>Medial cutaneous thigh (C)</p> Signup and view all the answers

What is the role of the arcuate popliteal ligament?

<p>It passes over the tendon of the popliteus to support the posterolateral area. (A)</p> Signup and view all the answers

Which veins drain into the popliteal vein?

<p>Posterior tibial and anterior tibial veins (A), Great and small saphenous veins (C)</p> Signup and view all the answers

Which structure does NOT contribute to the knee's stability?

<p>Patellar tendon (B)</p> Signup and view all the answers

What is the predominant motion of the knee joint?

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

Which joint is formed by the patella and the femur?

<p>Patellofemoral joint (B)</p> Signup and view all the answers

Which anatomical structure is located posterior-lateral to the pes anserinus bursa?

<p>Semimembranosus tendon (B)</p> Signup and view all the answers

What type of knee deformity is characterized by a hyperextension condition?

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

Which type of cartilage covers the deep side of the patella?

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

How can the muscles that act at the knee be categorized?

<p>By their functional action at the knee, hip, and ankle (B)</p> Signup and view all the answers

Which knee motion is primarily observed during the stance phase of gait?

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

Which condition is NOT typically symptomatic but can be associated with lateral tracking of the patella?

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

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

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

What anatomical structure serves as the largest sesamoid bone in the body?

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

Which knee structures are primarily responsible for stability against lateral forces?

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

Which ligament provides strength specifically to the posterior aspect of the knee joint capsule?

<p>Oblique popliteal ligament (B)</p> Signup and view all the answers

What type of bursa is directly associated with the semimembranosus tendon?

<p>Pes anserinus bursa (D)</p> Signup and view all the answers

What position should the patient be in for the Posterior Sag test of a PCL rupture?

<p>Supine with knees flexed to 90 degrees (C)</p> Signup and view all the answers

Which method is used to potentially identify MCL damage during a collateral ligament test?

<p>Applying a valgus force with knee fully extended (A)</p> Signup and view all the answers

Which symptom is commonly associated with a meniscal injury?

<p>Swelling developing in the area post-injury (B)</p> Signup and view all the answers

During the Apley Compression Test, what specific movement is performed?

<p>Rotating the tibia internally and externally (A)</p> Signup and view all the answers

What group is notably at a higher risk for Patellofemoral joint syndrome?

<p>Young athletic individuals and obese adolescent females (D)</p> Signup and view all the answers

What factor is crucial when assessing the effectiveness of muscle function intervention for patellofemoral joint syndrome?

<p>Strength and timing of the VMO (D)</p> Signup and view all the answers

What is a common clinical sign during palpation of patellofemoral joint syndrome?

<p>Warmth and tightness around the lateral retinaculum (C)</p> Signup and view all the answers

What is NOT a characteristic of the Apley Compression Test?

<p>It only assesses for patellar dislocation. (C)</p> Signup and view all the answers

Flashcards

Joint Capsule of the Knee

A tough fibrous connective tissue that surrounds the knee joint, continuous with the periosteum. It's thicker and stronger at the sides, allowing free movement in the front and back. Provides stability and contains small blood vessels and nerves.

Anterior Cruciate Ligament (ACL)

A strong ligament that prevents the tibia from sliding forward on the femur. It also controls rotation and assists with pivoting.

Posterior Cruciate Ligament (PCL)

A ligament that stops the tibia from sliding backwards on the femur. It also prevents hyperextension and controls rotation.

Transverse Ligament of the Knee

Connects the anterior horns of the medial & lateral menisci, preventing their movement.

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Medial & Lateral Coronary Ligaments

Fibres from the joint capsule that surround the base of the medial and lateral menisci. They fix the menisci to the tibial plateau.

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Medial Collateral Ligament (MCL)

A strong ligament that provides medial stability to the knee. It runs from the medial epicondyle of the femur to the anteromedial tibial condyle and is attached to the medial meniscus.

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Lateral Collateral Ligament (LCL)

A thin cord-like ligament that provides lateral stability to the knee. It runs from the lateral epicondyle of the femur to the head of the fibula, but doesn't attach to the lateral meniscus.

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Patella Ligament

Connects the quadriceps tendon to the tibial tuberosity. It causes knee extension when the quadriceps muscles contract and provides anterior stability to the knee.

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What is a synovial joint?

A joint that allows free movement. It's enclosed by a fibrous capsule and lined with a synovial membrane.

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What is the knee joint?

Largest joint in the human body, consisting of two joints: the tibiofemoral joint and the patellofemoral joint. It's a modified hinge joint, providing stability for movement.

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What is hyaline cartilage?

A type of cartilage that covers bone ends in synovial joints. It acts as a cushion and helps distribute force.

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What are ligaments?

Tough, fibrous tissue that connects bones. They help stabilize joints and prevent excessive movement.

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What are menisci?

C-shaped pads of fibrocartilage within the knee joint. They cushion the joint, absorb shock, and improve stability.

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What are the cruciate ligaments?

The anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) are crucial for knee stability, preventing excessive forward and backward movement.

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What is the joint capsule?

The joint capsule encloses the knee joint, provides support, and helps maintain fluid balance.

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What is the knee locking mechanism?

A mechanism that 'locks' the knee joint in a fully extended position, providing additional stability. It involves the shape of the bones and the tension of ligaments.

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Rectus Femoris

The primary extensor of the knee. It's located on the front of the thigh.

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Quadriceps

This muscle group is responsible for extending the knee. They are located on the front of the thigh.

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Gluteus Maximus

The large muscle located on the back of the thigh. It helps extend the hip and flex the knee, contributing to walking, running, and climbing.

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Hamstring Muscles

Located on the back of the thigh, this muscle group helps flex the knee and extend the hip.

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Popliteus Muscle

The popliteus muscle helps unlock the knee by rotating the femur. It does this to allow for flexion (bending) of the knee.

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Knee Locking Mechanism

A straight knee is a stable knee. The femur rotates internally, tightening ligaments and locking the knee.

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Popliteal Fossa

Located behind the knee, the popliteal fossa is a triangular space containing nerves, blood vessels, and lymph nodes.

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Patella (Kneecap)

This structure is located at the front of the knee and serves as a protective cap for the knee joint.

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Arcuate Popliteal Ligament

A strong band of fibers that extends from the posterior head of the fibula to the tibial intercondylar area, forming a Y shape and passing over the popliteus tendon. It provides strength to the posterior capsule of the knee joint.

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Oblique Popliteal Ligament

A ligament that runs obliquely from the posterior head of the fibula to the tibial intercondylar area, attaching to the popliteus muscle. It provides stability to the posterior aspect of the knee joint.

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Patella

The largest sesamoid bone in the body, located within the tendon of the quadriceps muscle. It sits between the femoral condyles and is held in place by the vastus medialis and lateralis muscles, and the medial and lateral patellar retinacula. It allows for smooth movement of the quadriceps tendon over the femur and increases leverage during knee extension.

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Patellofemoral Joint

The joint formed by the articulation of the patella and the femur. It's covered with hyaline cartilage on the deep side of the patella and the joint surface of the femur.

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Knee Joint

The articulation of the femur (thigh bone) and tibia (shin bone). It's a hinge joint, allowing for flexion, extension, and some degree of rotation. It's complex, involving ligaments, tendons, and menisci to provide stability and smooth movement.

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Collateral Ligaments

Strong, fibrous structures that connect bones to bones. They provide stability and limit excessive movement in the knee joint. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are important for preventing side-to-side movement.

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Cruciate Ligaments

Strong, fibrous structures that connect bones to bones. They provide stability and limit excessive movement in the knee joint. These ligaments are located inside the joint capsule and are crucial for preventing anterior and posterior displacement of the tibia relative to the femur.

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Menisci

C-shaped pieces of fibrocartilage that act as shock absorbers and provide stability in the knee joint. There are two menisci: the medial meniscus and the lateral meniscus. They distribute forces and help prevent excessive movement.

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Knee Joint Motion

The knee joint primarily allows for flexion and extension, but can also accommodate some medial and lateral rotation, particularly during flexion. These movements occur both in open and closed kinetic chains.

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Open and Closed Kinetic Chains in Knee Movement

In open kinetic chain movements, the distal segment of the limb is free, while the proximal segment is fixed, for example, kicking a ball. In closed kinetic chain movements, the distal segment is fixed, and the proximal segment moves, for example, standing up from a chair.

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Knee Motion in Gait

This phase of gait involves the knee extending from flexion to full extension during the stance phase (heel strike to toe off) and flexes during the swing phase (toe off to heel strike) to prepare for the next heel strike.

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Genu Recurvatum

A condition where the knee hyperextends beyond the normal range of motion.

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Genu Varum

A condition where the knees are turned inwards, causing the legs to appear bow-legged.

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Genu Valgum

A condition where the knees are turned outwards, causing the legs to appear knock-kneed.

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Squinting Patellae

A condition where the patella (kneecap) is misaligned, causing it to deviate laterally during knee extension. This can lead to pain and decreased function.

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What is the PCL Rupture Test?

A test used to identify a Posterior Cruciate Ligament (PCL) tear. The patient lies on their back with their knees at a 90-degree angle. The examiner holds the patient's heel and pulls the tibia backwards. If the tibia moves backwards excessively, it indicates a possible PCL injury.

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What is the Collateral Ligament Test?

A test involving applying a varus (LCL) or valgus (MCL) force on the knee. The patient's knee is fully extended or at 30 degrees of flexion. The examiner is assessing for pain, movement restrictions, and an endpoint feel. It helps determine if a collateral ligament injury is present.

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What is an Apley Compression Test?

A test used to assess for meniscal injuries in the knee. The patient lies on their stomach with their knee flexed at 90 degrees. The examiner pushes down on the foot and rotates the tibia. It applies pressure on the meniscus, causing pain if a tear is present.

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What is Patellofemoral Joint Syndrome?

A condition characterized by gradual pain around the kneecap, often caused by overuse. It's common in athletes and obese adolescents. Observing for patella position, swelling around the kneecap, and examining for tenderness, warmth, and tightness around the kneecap is essential during the assessment.

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How is Patellofemoral Joint Syndrome treated?

Treatments for Patellofemoral Joint Syndrome often focus on addressing patella position, muscle function, and support. Taping the kneecap towards the midline (McConnell taping) helps correct alignment. Strengthening the VMO muscle and promoting proper timing of its activation is crucial. Foot orthoses can also provide support and reduce stress on the knee.

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What is the role of the PCL?

The posterior cruciate ligament (PCL) helps prevent the tibia from sliding backwards on the femur. It also provides stability against hyperextending the knee and controls excessive rotation.

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What is the function of the MCL?

The medial collateral ligament (MCL) supports the medial side of the knee, preventing the knee from collapsing inwards. It also attaches to the medial meniscus, further enhancing stability.

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What is the role of the menisci in the knee?

The menisci are C-shaped pads of cartilage inside the knee that provide cushioning, shock absorption, and stability. They help distribute force and prevent wear and tear on the knee joint.

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Study Notes

Knee Joint Overview

  • The knee is the largest synovial joint in the body, a modified hinge joint with two articulations: the tibiofemoral joint and the patellofemoral joint.
  • It's remarkably stable, despite a lack of congruence between articular surfaces.
  • Stability comes from passive and dynamic structures around the joint, including ligaments and the locking mechanism.
  • Common injuries to the knee are mentioned as part of the aims.

Synovial Joint Structure

  • Synovial joints, like the knee, are characterized by free movement.
  • They are enclosed by a fibrous capsule, lined with a synovial membrane that secretes fluid for lubrication.
  • The articular ends of the bones are coated with hyaline cartilage.
  • Fibrocartilage pads (menisci) are present between bone ends in some joints, adding to the knee's complex structure.
  • Ligaments, fatty pads, and bursae also contribute to joint stability and function.

Knee Bones

  • The three main bones in the knee joint are the femur, tibia, and patella.
  • X-rays can be used to visualize these structures.

Cartilage in the Knee Joint

  • Hyaline cartilage covers the articulating surfaces of the femur, tibia, and patella, absorbing and distributing force.
  • Fibrocartilage forms the menisci, acting as shock absorbers and providing stability by fitting into grooves in the tibial plateau.

Ligaments of the Knee Joint

  • Ligaments connect bones and other structures, adding significant stability to the knee.

  • Intracapsular ligaments (cruciate ligaments: ACL and PCL, transverse ligament) and extracapsular ligaments (patellar, medial and lateral collateral ligaments, oblique and arcuate popliteal ligaments) play different crucial roles.

  • The joint capsule is a tough fibrous connective tissue, running continuously with periosteum. It's particularly strong at the sides of the joint capsule and thinner anteriorly and posteriorly.

  • Provides stability to the knee, and has some integral thickenings (eg. patellar retinacula).

  • Contains vascular structures and nerves.

Cruciate Ligaments (ACL and PCL)

  • The ACL connects the anterior tibia to the posterior part of the femur, preventing anterior tibial translation and rotation control.
  • The PCL connects the posterior tibia to the anterior part of the femur, preventing posterior tibial translation and rotation control.

Knee Locking Mechanism

  • The knee's locking mechanism is a fundamental principle that relates its stability with the straight position.
  • Internal rotation of the femur on the tibia improves joint stability and strengthens ligaments, effectively locking the knee in the straight position. Popliteus is vital for controlling this process.
  • Popliteus is essential to unlock the knee by externally rotating the femur. This allows flexor muscles to function.

Surface Anatomy of the Knee

  • Key surface landmarks like the popliteal fossa, patella, tibial tuberosity, MCL, LCL and joint margin are important for anatomical location for assessment, diagnosis, and procedures.

Nerve Supply to the Knee

  • Motor nerves control muscle activation that moves the knee.
  • Branches from the femoral, tibial, common peroneal and obturator nerves provide joint innervation.
  • The skin surrounding the knee is innervated by cutaneous nerves, including the saphenous, femoral cutaneous(lateral, intermediate, medial, posterior). Lateral cutaneous calf and some obturator branches.

Vascular Structures of the Knee: Arteries

  • Eight main arteries supply the knee, forming an anastomosis around the joint.
  • Sources are the popliteal, tibial, and femoral arteries via their related genicular branches.

Vascular Structures of the Knee: Veins

  • Veins accompany the arteries and drain blood from the region.
  • They drain into the popliteal vein and connected to the anterior and posterior tibial veins
  • Connected to long and small saphenous veins.

Lymphatics of the Knee

  • Lymph nodes in the popliteal fossa are associated with the fatty tissue.
  • These drain proximally toward the deep inguinal lymph nodes.

Bursae of the Knee

  • Specific bursae such as the prepatellar, deep infrapatellar, and superficial infrapatellar bursa are located near the knee joint to assist in lubrication and movement.

Patellofemoral Joint (PFJ)

  • The PFJ is the articulation of the patella and femur. The patella is the largest sesamoid bone in the body.
  • It's located within the tendon of the quadriceps femoris muscle, between the femoral condyles, supported by medial, lateral, and infrapatellar retinacula.

Muscles Acting at the Knee

  • Muscles that act on the knee can be grouped by their actions (extensors, flexors) and/or their involvement (acting at the hip and knee simultaneously as well as only at the knee or knee and ankle).
  • Special muscles are mentioned, including popliteus, which is essential for unlocking the knee and controlling internal rotation.

Knee Joint Motion

  • The knee primarily moves through flexion and extension.
  • Some medial and lateral rotation is possible with knee extension.
  • Motion is related to the locking mechanism.
  • Examples are related to gait phases.

Abnormal Knee Positions

  • Knee positions in planes (sagittal, frontal, transverse) can be seen as abnormal or a sign of a problem.
  • Examples of abnormalities in each plane are given.

Patellofemoral Pain Syndrome

  • PFPS is a common condition associated with pain around the kneecap.
  • Related factors and observations (e.g. biomechanics during standing and lying)
  • Causes and incidence are noted.

Knee Exam: Observation

  • Proper viewing and exposure of both knees for observation, including stance assessment for problems, are needed for a thorough examination.
  • Signs of Baker's cyst or other protrusion of the synovial membrane are observed.

Tests for Injury to Specific Knee Structures

  • Specific procedures/testing methods exist to assess the health of ligaments (ACL, PCL) and menisci.
  • Tests for ligament stability and tears (anterior and posterior drawer signs, Lachman test, and posterior sag test) are described.
  • Apley compression test is detailed for assessing meniscal injury.

Treatment

  • Treatment strategies are not included in the summaries.

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