Knee biomechanics

Question What is the largest joint in the body? What is the most frequently injured joint in the body? What are the three joints of the knee joint? What kind of joint is the knee? How many degrees of freedom does the knee have? The primary motion of the knee is what? The knee has some rotation possible but only in what position? What is the normal ROM for flexion extension? Range of motion or internal and external rotation is influenced by the amount of knee _________. In full knee extension rotation is almost completely restricted due to what? Rotation is at a maximum at __ degrees of knee flexion. Normal external rotation ROM is? Normal IR ROM is? ___ prevents excessive internal rotation, guides the knee in flexion, resists posterior translation of the tibia on the

Answer knee knee tibial-femoral, patello-femoral, superior tibfib modified hinge joint 2 flexion and extension knee flexion 0-140

Flexion

interlocking of femoral and tibial condyles 90 0-45 0-30 PCL

femur ___ stops excessive internal rotation, stabilizes the knee in full extension and prevents hyperextension What is the purpose of the meniscus? The meniscus Decreases friction by __% The meniscus increases contact area by __%

ACL It deepens tibial plateau and lends stability to the knee 20 70

Increase wear on articulating surfaces, Removing the meniscus can do and increase chance of developing what to the joint? degenerative joint disease Which menisci is C-shaped, thicker posteriorly, and has a medial meniscus firm attachment to the deep layers of the MCL? Which menisci is o-shaped, has uniform thickness, and a loose lateral meniscus attachment to the lateral capsule? What is the red-red zone of the Outer 1/3 of meniscus that has good meniscus? potential to heal due to better blood supply What is the red-white zone of Middle 1/3 that may have healing potential the meniscus? but less blood supply that outer portion What is the white-white zone of Inner 1/3 that has no blood supply and the meniscus? wont heal The MCL prevent what motion motion=abduction & ER, stress=valgus and what stress? The LCL prevents what motion motion=adduction, stress=varus and what stress? The MCL assists in _____ anterior translation of the tibia. What is the origin of the ACL? posteromedial aspect of lateral femoral

condyle What is the insertion of the ACL anterior intercondylar eminence of the tibia The ACL works to prevent ______ translation of the tibia anterior, valgus on the femur and also stabilizes against _____ stress as well. What becomes more active in stabilizing the knee when there the hamstrings is an ACL deficiency? The anteromedial bundle of the ACL functions with the knee in flexed a _____ position. The posterolateral bundle functions with the knee in extended ________ position From __ to __ degrees of motion the ACL is under the 30-0 most stress. From __ to __ degrees the ACL is under the least amount of 110-50 stress. The ___ is one of the strongest PCL ligaments in the body. The PCL prevents ________ translation of the tibia on the posterior femur. Is the PCL often injured in athletics? What is the most no, hitting dashboard in MVA common MOI of the PCL? What exercises might a physical therapist want to avoid hamstring exercises as they can while treating a patient with a posteriorly translate the tibia on the femur PCL injury? make a line from the ASIS to the middle of How do you measure the qthe patella, make another line from the angle? middle of the patella to the tibial tuberosity

and measure the angle between the two lines. What the typical q-angle for a 10-14 degrees, 15-17 degrees male? A female? The greatest compressive force at PF joint will be at 90 approximately __ degrees. As the Q-angle increases, the resultant sideways vector will increase ________. Synovial thickening present in ~ 50% What is PLICA? population People with this syndrome typically have pain medially and PLICA syndrome it may be caused by overuse or trauma.
Joints of foot - biomechanics during gait

Question

Answer The angle of gait is defined as the angle formed How would you between the longitudinal axis of foot and the line of measure the angle progression. 5-10 degrees of external rotation is of gait? normal. Base of gait is the distance between heel strike of Derfine base of gait one foot and the heel strike of the other, horizontally. What are the two main divisions/parts of the gait cycle, and Swing phase (40%) and Stance phase (60%) what % of the cycle does each occupy? How is a gait cycle One gait cycle is defined as floor contact of the heel defined? to the following heel contact of the same limb. Stance phase is the part of the gait cycle during Stance phase is... which the foot makes contact with the ground.

Swing phase is that period of gait during which the Swing phase is... foot does not touch the ground, and is swung forwards. Double support is a period of bilateral foot contact What is "double with the floor. Double support occurs twice during support" ? stance phase (at start and end of stance phase). Heel strike/ContactForefoot LoadingMidstanceHeel What are the phases LiftPropulsionToe of the gait cycle? OffAccelerationMidswingDeceleration Cadence, or step-rate, is the number of steps per Cadence is... minute when a person walks. What is the average The average cadence is 101-122 steps per minute. cadence? What effect does increasing cadence Increasing cadence --> decreases time in double have on time spent support. in double support? Stride length is defined as the distance between two Stride length is... consecutive contacts of the same foot. A step is the period from heel strike of one limb to What is a "step"? heel strike of the other limb. True or False: a stride consists of two True: there are two steps in one stride steps What position is the At initial Heel Strike/Contact the Subtalar Joint is STJ in at initial Heel slightly SUPINATED. Strike/Contact ? During Midstance, Until the very end of midstance, the STJ is almost what is the position fully pronated. At the end of midstance, the STJ of the Subtalar supinates in preparation for heel lift and start of Joint? propulsion phase. What is the function The midtarsal joint (a) acts as a shock absorber on of the midtarsal joint contact and (b) as a rigid lever for propulsion during gait? What are the joint MTJ Longitudinal (Off Sagittal=9, off axes of the midtarsal Transverse=15)MTJ Oblique (off Sagittal=57, off

joint ? When the STJ is pronated, does this allow more or less MTJ movement? How does the MTJ behave during propulsion in gait? What joints make up the MTJ? What is the normal ROM of the MTJ? Explain the difference between Open and Closed chain motion. Normal ankle joint ROM is? Normal STJ ROM is? Normal MTJ ROM is? In what plane of motion is STJ motion measured? About what MTJ axis does frontal plane motion occur? How many axes of motion does the MTJ have? What bones make up the first ray? What first ray movement is

Transverse=52) STJ pronation "unlocks" the MTJ and allows more movement in the MTJ. In propulsion, the MTJ needs to become a rigid lever, which it can only do if the STJ supinates, thus "locking" the MTJ. The MTJ comprises two joints: the Talo/Navicular joint and the Calcaneo/Cuboid joint The normal MTJ ROM is 15 Eversion and 30 InversionA minimum of 6 degrees of MTJ inversion is required to that the STJ can pronate fully during gait. In Open chain motion, the distal segment is free i.e. non-weightbearing. In Closed Chain motion the distal segment is weighbearing. Ankle joint DF=10 min, PF=50 Normal STJ ROM is Eversion=10, Inversion=20 Normal MTJ ROM is Eversion=15, Inversion=30 STJ motion is triplanar, however STJ motion is assessed only in the FRONTAL plane. Frontal plane motion of the MTJ occurs around the LONGITUDINAL AXIS. The MTJ has 2 axes of motion: the longitudinal and oblique axes. 1st ray = medial cuneiform & 1st Met It is normal to see the 1st ray DF and PF equally 1cm each way.

"normal"? When assessing 1st ray movement, what reference point should be used? What joint ROM is normal at the !st MTPJ? What are the reference points for 1st MTPJ motion assessment? What is "subtalar neutral"? What minimum joint ROMs are required for normal gait? What movement occurs at the ankle joint? Describe what bones are moving during closed chain ankle dorsiflexion Which bones are moving and how during open chain ankle plantarflexion?

Use the 2nd Met Head as a reference point for assessing 1st Ray movement. 1st MTPJ ROM should be at least 70 DF. PF is usually around 40 degrees. A line bisecting the medial aspect of the 1st Met shaft, and a line bisecting the proximal phalanx. STJ neutral = there is neither pronation nor supination occuring at the joint. (Root) Normal gait requires 1st MTPJ DF of 70 and ankle DF of 10 degrees. Ankle joint movement is mainly dorsiflexion/plantarflexion in the Sagittal plane, with some accompanying abduction/adduction. In closed chain ankle dorsiflexion, the talus is fixed and the distal tibia internally rotates and moves forward over the talus. In open chain ankle joint plantarflexion, the talus is free and the tibia is fixed. Therefore the talus plantarflexes and adducts in relation to the fixed tibia.

Passive ankle ROM is restricted by: Triceps Surae What restricts ankle muscles, the Posterior TaloFibular ligament and PROM? Posterior Deltoid Ligament, and the wider anterior aspect of the talar trochlea. What restricts Passive ankle plantarflexion is restricted by the passive ankle posterior talar tubercule (bony) and the Anterior plantarflexion? TaloFibular Ligament. What movements STJ movements are supination and pronation.

occur at the STJ? In open chain STJ pronation, the talus if fixed and the Describe open chain calcaneus moves freely. Motion consists of subtalar pronation dorsiflexion (foot), abduction (foot) and eversion (calc) In open chain STJ supination, the talus is fixed and Describe open chain the calcaneus and foot move around it. Supination STJ supination consists of plantarflexion, adduction and inversion (calcaneus). STJ supination is plantarflexion, adduction and Describe closed inversionbut in closed chain supination, the chain STJ calcaneus is fixed, and the talus & leg move around supination. it.Therefore, supination is achieved by:Talar Dorsiflexion and abductionCalcaneal inversion STJ pronation is dorsiflexion, abduction and eversion. But in closed chain the calcaneus is blocjed by the Describe closed grouns, so the talus must move instead. Thus in chain STJ pronation. closed chain, spuination consists of: talar plantarflexion and adduction, with calcaneal eversion. STJ inversion is restricted by which Cervical ligament restricts STJ inversion. ligament? Which ligament STJ eversion is restricted by the interosseous restricts STJ ligament which lies within the Sinus Tarsi. eversion? Excessive MTJ pronation is limited by calcaneal Describe the MTJ process of cuboid hitting the dorsal aspect of the "locking mechanism" calcaneus. Escessive supination of the Excessive supination of the MTJ is resctricted by the MTJ is restricted by Plantar Ligaments. what ? What is happening to the Plantar The Plantar ligaments and fascia will be stretched aponeurosis in a when the foot pronates in stance. pronated foot in stance?

In closed chain supination, describe In closed chain supination, the plantar ligaments and what is happening to fascia are relaxed. the plantar fascia and ligaments. At contact the STJ is slightly supinated. During Explain how the STJ contact and through midstance it pronates. Just moves during the before propulsion the STJ supinates, then during phases of gait. swing it becomes slightly pronated then slightly supinated ready for Heel Strike again. At Heel Strike the ankle is slightly DF, then PFxg Explain how the during contact. It DFx thru midstance 'til the DF peak ankle joint moves at heel lift, after which it PFx through propulsion. during gait. Peak PFxn occurs just after toe-off/end of propulsion. The ankle then DFx ready for Heel Strike. The STJ is supported by 5 ligaments: the What ligaments Interosseous and Cervical Ligaments within the Sinus support the STJ? Tarsi; and three Talo-Calcaneal Ligaments (medial, lateral & posterior) STJ axis runs Lateral, Posterior, Plantar --> Medial, The STJ axis runs.... Anterior, Dorsal What are the axes of The STJ axes lie 20 degrees from Sagittal and 42 the STJ? degrees from Transverse What are the joint The Longitudinal MTJ lies 9 degrees from Sagittal axes of the MTJ? and 15 degrees from Transverse What are the joint The Ankle joint axes lie 25 degrees from Sagittal and axes of the ANKLE 8 degrees from Frontal joint? The deviation of the joint axis from a cardinal plane Explain "Planal determines which components of the joint movement Dominance" will dominate in a given individual. How many articular The STJ normally involves three articulations facets are involved between the talus and calcaneus. in STJ motion? What is the theory "An open kinetic chain motion at a given joint will thath explains the produce an equal and opposite motion proximal to difference between the joint when in the closed kinetic chain". (Valmassy)

closed and open chain motion at a joint? Patient prone on couch. With one hand pincering the How would you find talar head, evert/invert the calcaneus to find the "subtalar neutral" in midway position. This is STJ neutral. Can also be clinic? found standing in which case it is called NCSP. Gait is "any period of locomotion characterised by periodds of loading and unloading the limbs" (Kirtley). Define "Gait" "a method of locomotion involving the use of two legs alternately to provide both support and propulsion" (Whittle) The three main tasks of gait are (1) Weight What are the three acceptance (2) Single Limb Support and (3) Limb main tasks of gait? Advancement What tasks are achieved in the The loading response phase involves weight Loading Response acceptance (onto leading leg) and shock absorption phase of the gait (supporting leg). cycle? How would double support and base of Balance problems often result in gait adaptations that gait differ in increase time spent in double support, i.e. shorter someone with a step length, wide base of gait. balance problem? What supports the In static stance, the MLA is supported by ligaments MLA in static i.e. (1) plantar aponeurosis (2) Spring Ligament (3) stance? Interosseous ligaments (4) Long & Short Plantar Ligs. Dynamic support to the MLA is provided by What supports the MUSCLES. Flexor Hallucis Longus, Abductor MLA in movement? Hallucis Brevis and Medial Head of Flexor Digitorum Brevis Excessive pronation signs: 1) little or no MLA (2) Name 5 signs of Helbing's sign (bowing of Achilles tendon) (3) forefoot excessive abducted on rearfoot (4) calcaneus everted (5) PRONATION Talonavicular joint bulging (6) Creasing beneath lateral malleolus

Name 6 signs of excessive SUPINATION The MTJ oblique axis allows what movements? Will a foot in RCSP that has an everted calcaneus allow a greater or lesser MTJ ROM? A stride is defined as....? What percentage of gait is stance phase? The first ray is composed of which bones? What bones make up the Lateral Column?

Excessive supination signs include (1) high/exaggerated MLA (2) Helbing's sign (bowed Achilles tendon) (3) Forefoot appears adducted on rearfoot (4) inverted calcaneus (5) rigid foot (6) concavity beneath medial malleolus The oblique MTJ allows a great deal of sagittal and transverse plane movement. Because of the interdependence of the STJ and MTJs, a foot with an everted calcaneus (pronated) will allow increased MTJ motion. A stride is the period from initial heel strike of one foot to the next heel strike of the same foot. Stance occupies approximately 60% of gait. The first ray bones are the medial cuneiform and the 1st metatarsal. The Lateral Column comprises the Calcaneus, Cuboid, lateral Cuneiform and Mets 4&5

The STJ starts pronating after Heel Strike, reaching When in the gait peak pronation during Contact phase. Pronation is cycle is the STJ reduced throughout Midstance and continues until pronating? max supination is achieved just prior to Propulsion. After propulsion, supination reduces and the joinn What is the medial The medial column is the talus, navicular, all three column? cuneiforms and mets 1-3. What is the function The sesamoids increase the lever arm of Flexor of the sesamoids? Hallucis Brevis in stabiliting the hallux. What is the Forefoot = metatarsals + phalanges "forefoot" ? What is the Midfoot = Cuboid, Navicular and all three cuneiforms

"midfoot"? What is the rearfoot? How does the STJ affect MTJ movement? How does STJ movement enable adaptation to uneven terrain?

Rearfoot = Talus and Calcaneus When the STJ is pronated, this allows greater ROM at the MTJ. STJ unlocks the MTJ's longitudinal axis, enabling the foot to act as a rigid lever. STJ pronation allows more movement at the MTJ, which enables shock absorption and adaptation to uneven surfaces.