A
What type of cartilage are the knee menisci made up of?
Fibrocartilage
Which of the following is not a risk factor for ACL injury?
A- Female
B- Varus knee angulation
C- Poor footwear
D- Wet surfaces
B- Varus knee angulation
Valgus knee angulation more often results in ACL injury.
What is the function of synovial fluid?
Cushions ends of bones, provides lubrication and reduces friction
Which of the two collateral ligaments is thinner and rounder?
Lateral (fibular) collateral ligament
What does 'cruciate' mean?
Cross- the ACL and PCL cross over in the knee joint
What part of the knee joint deepens the articular surface of the tibia, increases stability and acts as a shock absorber by increasing surface area?
Medial and lateral menisci
What is the name for the mechanism of the locking of the knee joint?
Screw home mechanism
Which meniscus is attached to the tibial collateral ligament?
Medial meniscus
What are the two articulations of the knee?
Tibiofemoral and Palletofemoral
Where does the patellar ligament attach?
A- Fibular tuberosity
B- Tibial tuberosity
C- Medial condyle
D- Head of the fibula
B- Tibial tuberosity
Name 4 of the muscles involved in the flexion of the knee
Hamstrings (Biceps femoris, Semimembranosus, Semitendinosus)
Gracilis
Sartorius
Popliteus
Gastrocnemius
Plantaris
Name two of the bursae found in the knee joint
Suprapatella
Prepatella
Infrapatella
Semimembranous
(Pes Anserine)
What are the aims of rehabilitation/physiotherapy in ACL injuries?
Reduce pain and swelling
Restore range of motion
Strengthen muscles
What is a GHIC card and what is it used for?
UK Global Health Insurance Card- lets you get state healthcare in Europe at a reduced cost or sometimes for free.
What 4 muscles make up the quadriceps femoris?
Rectus femoris
Vastus medialis, lateralis and intermedius
Give three reasons why might people seek private medical care as opposed to standard free NHS care?
-Choice of time and location of treatment
-Reduced waiting times
-Private health insurance
-A wider range of available treatment
-Bad previous experience
The tendons of which three muscles make up the pes anserinus?
*hint* one from each thigh compartment
Gracilis
Semitendinosus
Sartorius
What is the Q-angle of the knee?
What is the normal value? What gender tends to have a larger Q-angle and why?
Q-angle= angle between the quadriceps line of pull and the patellar tendon intersection
Normal =15°
Wider in females due to broader pelvis
Give three reasons why John might be undergoing intensive physiotherapy rather than surgery for his ACL injury
-Doesn't have an active lifestyle
-Surgery brings unnecessary risks
-Knee is stable enough without surgery
-Quicker rehabilitation period without surgery
-No other knee ligaments/menisci are damaged
What are the borders and contents of the popliteal fossa?
Borders: Semimembranosus, Biceps femoris, medial and lateral head of gastrocnemius and plantaris
Contents: Popliteal artery and vein, tibial nerve, common fibular nerve
What are the most common tendons used in an ACL reconstruction graft?
Semitendinosus (hamstring) tendon
Patellar tendon
Describe the locking and unlocking mechanism of the knee
Locking- during the last 15-20° of knee extension with the foot free, the tibia rotates externally and ‘locks’ into extension
Unlocking of the knee- the popliteus muscle unlocks the knee either by externally rotating the femur (if the foot is planted) or internally rotating the tibia (if the foot is free)
Describe how to conduct an anterior drawer test and what would be seen in an ACL injury
With the knee flexed and foot on the couch, place both hands around the upper tibia, with your thumbs over the tibial tuberosity and index fingers tucked under the hamstrings to make sure these are relaxed. Stabilise the lower tibia with your forearm and gently pull the upper tibia forward. In a relaxed, normal patient there is normally a small degree of movement. More significant movement suggests anterior cruciate ligament laxity
Describe Lachman's test and what would be seen in an ACL injury
With the knee bent, stabilise the thigh with one hand and pull on the tibia anteriorly with the other. Should be a firm endpoint to the movement but with an ACL injury, can be very lax and uncomfortable.
Describe the Pivot Shift test and what would be seen in an ACL injury
Lift foot off the couch, held by the ankle. Internal tibial rotation with valgus stress then push the knee from extension to flexion. Should reproduce symptoms of injury.