Anatomy: The Knee and Lower Leg
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Questions and Answers

Damage to the anterior cruciate ligament (ACL) primarily restricts which movement?

  • Posterior movement of the tibia relative to the femur.
  • Anterior movement of the tibia relative to the femur.
  • Rotational movement of the femur. (correct)
  • Medial or lateral movement of the tibia relative to the femur.

What is the functional significance of the patella within the context of knee biomechanics?

  • It stabilizes the knee joint by preventing lateral movement.
  • It serves as a cushion to prevent direct contact between the femur and tibia. (correct)
  • It acts as a pulley to increase the lever arm of the quadriceps muscle.
  • It facilitates blood flow to the knee joint.

In a lateral view of the knee, which structure is positioned most anteriorly?

  • Patella.
  • Femoral lateral condyle.
  • Fibular head. (correct)
  • Tibial lateral condyle.

After the popliteal artery passes the adductor hiatus, what is the next artery encountered distally?

<p>Posterior tibial artery. (D)</p> Signup and view all the answers

Which statement best describes the relationship between the small saphenous vein and the popliteal fossa?

<p>The small saphenous vein drains into the popliteal vein through an opening in the fascia of the popliteal fossa. (B)</p> Signup and view all the answers

What is the articulating surface of the patella?

<p>Attachment for the patellar ligament. (D)</p> Signup and view all the answers

Following a traumatic injury to the knee resulting in damage to the medial collateral ligament, anterior cruciate ligament, and medial meniscus, which structure listed would you expect to be affected?

<p>Crural fascia. (A)</p> Signup and view all the answers

A patient presents with an inability to plantarflex the foot and flex the leg. Which muscle is most likely affected?

<p>Extensor digitorum longus. (B)</p> Signup and view all the answers

In the context of genicular anastomosis, what is the functional significance of this vascular network around the knee?

<p>The genicular anastomosis regulates the temperature of the knee joint through vasodilation and vasoconstriction. (B)</p> Signup and view all the answers

What is the action of the fibularis longus and brevis muscles?

<p>Invert the foot. (D)</p> Signup and view all the answers

What is the primary function of the cruciate ligaments in the knee joint?

<p>To connect the femur to the fibula. (B)</p> Signup and view all the answers

What is the functional significance of the sustentaculum tali?

<p>It articulates directly with the tibia to form the ankle joint. (B)</p> Signup and view all the answers

What is the correct order of arteries, from proximal to distal, found on the posterior aspect of the lower leg?

<p>Popliteal, posterior tibial, anterior tibial, fibular. (C)</p> Signup and view all the answers

A patient is diagnosed with damage to the deep fibular nerve. Which muscle is least likely impacted?

<p>Extensor hallucis longus. (C)</p> Signup and view all the answers

Which anatomical structure is responsible for providing the primary blood supply to the muscles in the lateral compartment of the leg?

<p>Popliteal artery. (B)</p> Signup and view all the answers

Which action would be most affected by damage to the superficial fibular nerve?

<p>Inversion of the foot. (B)</p> Signup and view all the answers

What is the collective action of the muscles located in the anterior compartment of the leg?

<p>Plantarflexion and eversion. (B)</p> Signup and view all the answers

The triceps surae is a functional muscle group in the superficial posterior compartment of the leg. What muscles make up this muscle group?

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

Which statement best describes the crural fascia?

<p>It is located in the lateral compartment. (C)</p> Signup and view all the answers

If a patient has difficulty with the flexion of toes 2 through 5, which muscle is most likely affected regarding this clinical presentation?

<p>Flexor digitorum longus. (B)</p> Signup and view all the answers

What are the actions of the tibialis posterior?

<p>Inversion and plantarflexion of the foot. (A)</p> Signup and view all the answers

What is the clinical significance of the popliteal fossa?

<p>It is the site of attachment for the patellar tendon. (C)</p> Signup and view all the answers

What is the best description of the mechanical role of the patella in knee extension?

<p>The patella decreases the compressive forces on the femoral condyles. (B)</p> Signup and view all the answers

What function would be lost if the posterior cruciate ligament (PCL) was damaged?

<p>Limits tibia movement too far anteriorly relative to the fibula. (C)</p> Signup and view all the answers

What are the parts of the sciatic nerve?

<p>Fibular and tibial nerve. (B)</p> Signup and view all the answers

What muscle unlocks the fully extended knee?

<p>Tibialis posterior. (B)</p> Signup and view all the answers

Where does the small saphenous vein drain into?

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

A patient with a fracture of the fibular head may have injured what nerve?

<p>Deep fibular n. (C)</p> Signup and view all the answers

In a foot fixed position, what is the result of twisting the knee?

<p>The tendons are damaged. (B)</p> Signup and view all the answers

Where is the patella located?

<p>Embedded in cartilage. (D)</p> Signup and view all the answers

In the anterior compartment of the leg, which of the following actions are performed? (select all that apply)

<p>Plantar Flex Foot (B), Invert Foot (D)</p> Signup and view all the answers

What is the function of the genicular arteries in the knee?

<p>Provide nutrients to the joint. (C)</p> Signup and view all the answers

Which structure lies within the popliteal fossa?

<p>Femoral artery. (D)</p> Signup and view all the answers

The tibial plateau articulates with which structure?

<p>Femoral condyles. (A)</p> Signup and view all the answers

How is the patella attached to the quadriceps femoris tendon and patellar ligament?

<p>Distally to the quadriceps femoris tendon and proximally to the patellar ligament. (A)</p> Signup and view all the answers

Which structure allows the flexor hallucis longus tendon to pass through the plantar surface of the foot?

<p>Sustentacular groove. (B)</p> Signup and view all the answers

What structure is contained within the anterior compartment of the leg?

<p>Superficial fibular nerve (C)</p> Signup and view all the answers

What structure passes through the sustentacular groove?

<p>Tibialis anterior tendon. (D)</p> Signup and view all the answers

Which is a function of the plantaris?

<p>Plantarflex foot. (B)</p> Signup and view all the answers

Flashcards

What is the patella?

The bone located anterior to the knee joint; also known as the kneecap.

What attaches to the anterior patella?

Attachment point for the quadriceps femoris tendon and patellar ligament on the anterior side of the patella.

What is articular surface?

The articular surface of the patella that interfaces with the femoral condyles.

What are sesamoid bones?

A type of bone embedded within a tendon to provide mechanical advantages and protect the tendon.

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What mechanical role does the patella play?

The patella increases the lever arm of quadriceps femoris, thus boosting the efficiency of knee extension.

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What is the tibial tuberosity?

The prominence located inferior to the tibial condyles on the anterior surface; insertion point for patellar ligament.

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What is the anterior border of the tibia?

The sharp ridge running along the anterior surface of the tibia.

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What is the tibial plateau?

The tibial plateau is the flat surface at the proximal end of the tibia that articulates with the femoral condyles.

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What are the medial and lateral malleoli?

Projections on the medial and lateral aspects of the distal tibia and fibula, respectively, forming ankle joint.

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What is the interosseous membrane?

Broad band of dense connective tissue that joins the tibia and fibula along their length.

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What are ligaments?

Strong fibrous tissues that connect bones, providing stability and limiting excessive joint movement.

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What is the medial collateral ligament (MCL)?

Located on the medial aspect of the knee, connecting the femur to the tibia, prevents excessive valgus stress.

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What is the lateral collateral ligament (LCL)?

Located on the lateral aspect of the knee, connecting the femur to the fibula, resists excessive varus stress.

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What is the anterior cruciate ligament (ACL)?

Located in the center of the knee, prevents anterior translation of tibia relative to the femur.

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What is the posterior cruciate ligament (PCL)?

Located in the center of the knee, prevents posterior translation of tibia relative to the femur.

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What are the menisci?

Cartilaginous structures that improve the fit between the femur and tibia, providing stability and shock absorption.

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What is the unhappy triad?

Injury involving damage to the anterior cruciate ligament, medial collateral ligament, and medial meniscus.

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What is the popliteal artery?

Continuation of the femoral artery after it passes through the adductor hiatus, supplying blood to the knee and leg.

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What is the posterior tibial artery?

Artery that branches off the popliteal artery and runs down the posterior aspect of the lower leg.

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What is the anterior tibial artery?

Runs along the anterior aspect of the lower leg, supplying blood to the anterior compartment muscles.

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What is the fibular artery?

Also known as peroneal artery, it supplies blood to the lateral compartment of the leg.

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What are the genicular arteries?

Arteries that branch from the popliteal artery and supply blood to the knee joint.

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What is the small saphenous vein?

A superficial vein that drains blood from the skin of the posterior leg.

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Popliteal fossa

Diamond-shaped space on the posterior aspect of the knee, containing important vessels and nerves.

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What is the genicular anastomosis?

Network of arteries around the knee that provides collateral circulation, ensuring blood supply even if one artery is blocked.

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What does the sciatic nerve divide into?

Divides into the tibial and common fibular nerves.

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What does the tibial nerve do?

Innervates the posterior compartment of the leg and the plantar muscles of the foot.

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What does the common fibular nerve do?

Divides into deep and superficial branches, innervates the anterior and lateral leg compartments, respectively.

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Crural fascia?

Encloses the muscles of the leg, separating them into compartments.

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What muscles are contained in the anterior compartment of the leg?

Contains muscles that dorsiflex the foot and extend the toes; supplied by the anterior tibial artery and deep fibular nerve.

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What muscles are contained in the lateral compartment of the leg?

Contains muscles that evert the foot; supplied by the perforating branches of the fibular artery and superficial fibular nerve.

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What muscles are contained in the posterior compartment of the leg?

Contains muscles that plantarflex the foot and flex the toes; supplied by the posterior tibial and fibular arteries and the tibial nerve.

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What is the tibialis anterior?

Muscle in the anterior compartment that dorsiflexes and inverts the foot.

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What is the extensor digitorum/hallucis longus?

Muscles in the anterior compartment that extends the toes.

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What is the fibularis longus and brevis?

Muscles in the lateral compartment responsible for everting the foot.

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What is the gastrocnemius and soleus?

Muscles in the superficial posterior compartment that plantarflex the foot.

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What is the calcaneal tendon?

Also known as the Achilles tendon, Attaches the gastrocnemius and soleus to the calcaneus

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The plantaris

Smaller muscle in the superficial posterior compartment; weakly assists plantarflexion and may provide proprioceptive feedback

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What is the Flexor digitorum/hallucis longus?

Muscles in the deep posterior compartment responsible for flexing the toes.

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Tibialis posterior

Muscle in the deep posterior compartment that inverts and plantarflexes the foot; supports arch.

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What is the popliteus?

Muscle in the deep posterior compartment that unlocks the fully extended knee.

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Study Notes

  • The lower limb includes the knee and the leg.

Knee Anatomy

  • The knee comprises the:
    • Femur
    • Patella
    • Tibia
    • Fibula
  • Anterior view shows the location of:
    • Femur
    • Patella
    • Tibia
    • Fibula
  • Posterior view shows the location of:
    • Femoral Condyles
    • Tibial Condyles
  • Lateral view shows the location of:
    • Femoral lateral epicondyle
    • Femoral lateral condyle
    • Patella
    • Tibial lateral condyle
    • Tibia
    • Fibula

Patella

  • Anterior view of patella:
    • Attachment of quadriceps femoris tendon & patellar ligament is present
  • Posterior view of patella:
    • Articular surface with femoral condyles is present
  • The patella:
    • Is a sesamoid bone
    • Is embedded in tendon
    • Is superficial (anterior) to the joint capsule
  • Aids the mechanical advantage of the knee by acting as a pulley.

Leg Anatomy: Tibia and Fibula

  • The tibia and fibula attach to the Tibial Plateau
  • The Fibular Head is at the top of the fibula
  • Shafts (diaphyses) are present
  • An interosseous membrane is between the fibula and tibia
  • The Medial Malleolus is located at the inside lower leg, or ankle
  • The Lateral Malleolus connects on the outside of the ankle.
  • Tibial Condyles are at the top of the tibia
  • The Tibial Tuberosity can be found on the upper anterior of the tibia
  • Anterior Border is on the front of the tibia

Knee Ligaments and Menisci

  • Ligaments include:
    • Vastus lateralis m.
    • Vastus Medialis m.
    • Patella (within quadriceps femoris tendon)
    • Patellar ligament
    • Femoral condyles
    • Tibial plateau
    • Medial Collateral Ligament
    • Lateral Collateral Ligament
    • Anterior Cruciate Ligament
    • Posterior Cruciate Ligament
  • Menisci includes Lateral & Medial

Cruciate Ligaments

  • The Anterior Cruciate Ligament (ACL):
    • Prevents the tibia from moving too far anteriorly relative to the femur
  • The Posterior Cruciate Ligament (PCL):
    • Prevents the tibia from moving too far posteriorly relative to the femur

The Unhappy Triad

  • A common knee injury
  • Includes torn ligaments, such as:
    • Anterior Cruciate Ligament
    • Tibial Collateral Ligament
    • Medial Meniscus

Knee and Leg Blood Flow

  • Posterior Arteries are:
    • Popliteal Artery (after adductor hiatus)
    • Posterior Tibial Artery
    • Fibular Artery
    • Superior & Inferior Medial Genicular Arteries
    • Superior & Inferior Lateral Genicular Arteries
  • Anterior Arteries include
    • Anterior Tibial Artery
    • Superior & Inferior Medial Genicular Arteries
    • Superior & Inferior Lateral Genicular Arteries
  • Deeper veins take the same path as arteries and have the same names.
  • One additional superficial vein drains blood from the skin of the posterior leg.
    • Small Saphenous Vein - It drains into the popliteal vein through an opening in the fascia covering the popliteal fossa.

The Popliteal Fossa

  • Located on the Posterior side of the knee.
  • Contents include:
    • Popliteal artery
    • Popliteal vein
    • Sciatic nerve
  • The popliteal fossa is bordered by:
  • Gracilis m.
  • Semimembranosus m.
  • Semitendinosus m.
  • Biceps femoris m.
  • Gastrocnemius m.
  • Small saphenous vein

Genicular Anastomosis

  • Includes:
    • Femoral artery
    • Descending genicular artery
    • Musculoarterial branch
    • Saphenous branch
    • Popliteal artery
    • Superior lateral genicular artery
    • Superior medial genicular artery
    • Inferior lateral genicular artery
    • Inferior medial genicular artery
    • Anterior tibial recurrent artery
    • Anterior tibial artery
    • Posterior tibial artery

Sciatic Nerve

  • The two parts of the sciatic nerve include:
    • Tibial nerve
    • Common fibular nerve
  • Deep and Superficial fibular nerves

Leg Muscle Compartments Overview

  • Anterior
  • Lateral
  • Posterior
  • Crural Fascia surrounds all muscles & is superficial to compartments

Muscle Compartments

  • Anterior Compartment
  • Lateral Compartment
  • Deep Posterior Compartment
  • Superficial Posterior Compartment

Leg Anterior compartment

  • Muscles include:
    • Tibialis Anterior M. (to medial cuneiform)
    • Extensor Digitorum Longus M.
    • Extensor Hallucis Longus M.
  • Note the distribution of tendons
  • Blood source:
    • Anterior tibial artery
    • Anterior tibial vein
  • Nerve innervation:
    • Deep fibular nerve

Leg Lateral compartment

  • Muscles include:
    • Fibularis Longus M. (to MT1 and medial cuneiform)
    • Fibularis Brevis M. (to MT5)
  • Blood source:
    • Perforating branches of fibular artery
    • Perforating branches of fibular vein
  • Nerve innervation:
    • Superficial fibular nerve
  • Actions include:
    • Evert Foot

Superficial Posterior Compartment

  • Muscles include:
    • Plantaris M.
    • Plantaris Tendon (to the calcaneus)
    • Soleus M.
    • Gastrocnemius M.
  • These comprise the Triceps Surae
  • The Calcaneal (Achilles) Tendon is present

Deep Posterior Compartment

  • Muscles include:
    • Tibialis Posterior M.
    • Flexor Digitorum Longus M.
    • Flexor Hallucis Longus M.
    • Popliteus M.
  • There is also a Sustentacular Groove: Through which flexor hallucis longus tendon passes
  • Note the distribution of tendons

Sustentacular Groove

  • Sustentaculum tali: Shelf-like projection on the medial side of the calcaneus
  • Sustentacular groove: Bony groove on the inferior aspect of the sustentaculum tali

Leg Posterior Compartment

  • Blood source:
    • Posterior tibial artery
    • Fibular artery
    • Posterior tibial vein
    • Fibular vein
  • Nerve innervation:
    • Tibial nerve
  • Actions:
    • Gastrocnemius - Flex leg
    • Gastrocnemius & soleus - Plantarflex foot
    • Plantaris - Proprioceptor (senses spatial position of foot)
    • Popliteus - Unlocks fully extended knee
    • Flexor digitorum longus – Flex four toes (2nd - 5th)
    • Flexor hallucis longus - Flex big toe
    • Tibialis posterior - Invert & plantarflex foot

Tendons route to foot

  • The location of the Sustentacular Groove matters.
  • The following tendons apply to the foot:
    • Achilles Tendon
    • Tibialis Anterior Tendon
    • Long Flexor Tendons
    • Tibialis Posterior Tendon

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Description

An overview of the anatomy of the lower limb, focusing on the knee, tibia, and fibula. Key structures include the femur, patella, and condyles. The patella acts as a pulley, enhancing knee mechanics.

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