PT 752 - Hip/Knee/Ankle Joints

The posterior capsule of the hip attaches to where on the femur?

Femoral neck

The posterior capsule of the hip attaches to where on the femur?

Femoral neck

What type of synovial joint is the hip?

Ball and socket with cartilage inside

What are the movements of the hip?

Flex/Ext

ABD/ADD

IR/ER

The ability to have more movement makes the hip?

Less stable

More movement = less stable

What are the 3 intrinsic ligaments of the hip?

Iliofemoral

Ischiofemoral

Pubofemoral

Blood supply to the hip joint comes from which arteries?

Fovular artery

Med and lat femoral circumflex arteries

Profunda femoral artery

The fovular artery comes off which artery?

Obturator

The medial and lateral femoral circumflex arteries come off which artery?

Femoral

The profunda femoral artery comes off which artery?

Femoral (largest branch off)

Which artery is the main artery bringing blood to the hip joint?

Profunda femoral artery

Nerve supply to hip joint comes from which three nerves?

Femoral n

Obturator n

Superior gluteal n

The knee joint is an articulation between what? And which is convex and which is concave?

Femoral condyles (convex)

Tibial Plateaus (concave)

What type of joint is the knee joint?

Condyloid

The patellofemoral joint is an articulation between what?

Patella

Trochlear groove of femur

What are the movements of the patella?

Superior

Inferior

Medial

Lateral

(tiny tilt accessory movement)

What are the 4 important ligaments of the knee joint?

ACL (anterior cruciate)

MCL (medial collateral)

LCL (lateral collateral)

PCL (posterior cruciate)

Which important ligaments of the knee provide medial/lateral stability?

MCL & LCL

Which important ligaments of the knee provide anterior/posterior stability?

ACL & PCL

The LCL is an intrinsic or extrinsic ligament? And why?

Extrinsic:

- no attachment to joint capsule

- no attachment to lateral meniscus

The LCL attaches from where to where?

From lateral femoral condyle to fibular head

What kinds of forces does the LCL resist?

Varus forces

When does the LCL require surgical repair?

Any injury/sprain beyond grade I

The MCL is an intrinsic or extrinsic ligament? And why?

Intrinsic:

- attaches to joint capsule

- attaches to medial meniscus

The MCL attaches from where to where?

From medial femoral condyle to medial tibial condyle

What kinds of forces does the MCL resist?

Valgus forces

How does the healing of the MCL differ from the LCL?

MCL heals better since it is intra-articular; it gets better blood supply

If someone has an isolated injury to their MCL, would they require surgery?

No, only if other structures are injured they will surgically repair

The ACL attaches from where to where?

From lateral femoral condyle to medial tibial plateau

Is the ACL intra-synovial?

No extra-synovial but intra-articular

The ACL prevents which movements?

Anterior translation of tibia on femur in open chain

OR

Posterior translation of femur on tibia in closed chain

ACL injuries typically occur after what kinds of motions in sports?

Landings motions like in soccer, basketball, and skiing

What are immediate symptoms after an ACL injury?

Get hot and immediately swells, weight bearing possible but often buckles and collapses

What kinds of athletes are ACL injuries common in?

Young female athletes (due to valgus and large Q angle)

The PCL attaches from where to where?

From medial femoral condyle to lateral tibial plateau

Is the PCL intra-synovial?

No it is extra-synovial but intra-articular

What kinds of movements does the PCL prevent?

Posterior translation of tibia on femur in open chain

OR

Anterior translation of femur on tibia in closed chain

What are the two meniscus in the knee?

Medial and lateral meniscus

What is the shape of the medial meniscus?

C-shaped

The medial meniscus attaches to what?

MCL

Semimembranosus

What is the shape of the lateral meniscus?

Circular

The lateral meniscus attaches to what?

Popliteus tendon

(No attachment to LCL)

What is the function of the meniscus?

Acts as a shock absorber, preventing bone rubbing on bone

What is the difference between the red and white zone of the meniscus?

Red zones get more blood supply and heal better than white

What is the main artery of the thigh? And its major branch?

Femoral artery

&

Profunda femoral artery

What does the femoral artery pass through before going posterior to the knee?

Hiatus of the adductor magnus

What does the femoral artery become after passing through the hiatus of the adductor magnus?

Popliteal artery

Blood supply to the knee joint comes from which arteries?

Medial and lateral geniculate arteries (branches of femoral)

Nerve supply to the knee joint comes from which nerves?

Obturator

Femoral

Tibial

Common fibular nerves

What are the three distinct regions of the foot?

Hindfoot

Midfoot

Forefoot

What are the bones of the hindfoot?

Talus

Calcaneus

What are the bones of the midfoot?

Navicular

3 Cuneiforms (medial, middle, and lateral)

Cuboid

What are the bones of the forefoot?

5 Metatarsals

14 Phalanges

Which tarsal bone does metatarsal 1 articulate with?

Medial cuneiform

Which tarsal bone does metatarsal 2 articulate with?

Middle Cuneiform

Which tarsal bone does metatarsal 3 articulate with?

Lateral Cuneiform

Which tarsal bone does metatarsal 4 & 5 articulate with?

Cuboid

The tibia stops on which tarsal bone?

Talus

What is the top of the talus called?

Trochlea

The talus sits on what?

The medial aspect of the calcaneus

What is the function of sustentaculum tali? And which tarsal bone is it found on?

Found on calcaneus

Prevents tipping of the talus on calcaneus (supports head of talus)

What is the name of the true ankle joint?

Talocrural joint

How many degrees of freedom does the talocrural joint have? And what are the movements of this joint?

1 degree of freedom

Plantar flexion/Dorsiflexion

What is the other ankle joint? And what movements does it allow?

Subtalar joint between talus and calcaneus

Allows inversion/eversion

How many arches foes the foot have? And what are the names of them?

2 arches

Transverse arch

Longitudinal arch (med & lat)

The transverse arch of the foot runs from where to where?

Medial to lateral

The longitudinal arch of the foot runs from where to where

Distal to proximal

Which arch would you look at when trying to determine if a patient is flat footed or has a high arch?

Longitudinal arch

What are the two ligament complexes of the ankle?

Lateral collateral ligament complex

Medial collateral ligament complex (aka deltoid ligament)

What are the ligaments of the lateral collateral ligament complex?

Anterior talofibular ligament

Posterior talofibular ligament

Calcaneofibular ligament

Which ligament of the ankle is the most common injured ligament?

Anterior talofibular ligament

Ligaments of the lateral collateral ligament complex of the ankle are most often injured with which movements?

Inversion ankle sprains

What are the ligaments of the medial collateral ligament (deltoid) complex?

Anterior tibiotalar

Posterior tibiotalar

Tibionavicular

Tibiocalcaneal

Ligaments of the medial collateral ligament complex of the ankle are most often injured with which movements?

Eversion ankle sprains

In this photo is there a fracture of the tibia?

No:

It is an open growth plate of a younger kid

What would need to be done if someone had a fracture that was displaced, or the fracture was intra-articular fracture?

An ORIF (open reduction internal fixation)