Anatomy Week 7
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Anatomy Week 7

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Questions and Answers

What does the ACL limit in the knee?

  • Posterior translation of the tibia
  • Flexion of the knee
  • Extension of the knee
  • Anterior translation of the tibia (correct)

    • Which statement about the PCL is true?

  • It is located anterior to the ACL.
  • It maintains lateral stability of the tibia.
  • It limits posterior displacement of the tibia. (correct)
  • It limits anterior displacement of the tibia.

    • Where does the LCL attach?

  • Anterior aspect of the femur
  • Medial surface of the tibia
  • Lateral surface of the fibular head (correct)
  • Medial epicondyle of the femur

    • Which function does the LCL serve?

    <p>Prevents valgus deformity at the knee</p> Signup and view all the answers

    What is one of the combined functions of the cruciate ligaments?

    <p>They maintain contact of tibial and femoral surfaces.</p> Signup and view all the answers

    What is a characteristic of the PCL?

    <p>It is taught in a flexed position.</p> Signup and view all the answers

    How do the ACL and PCL interact at their crossover?

    <p>They define the axis of rotation for the tibia.</p> Signup and view all the answers

    What type of tissue is the LCL categorized as?

    <p>Ligamentous</p> Signup and view all the answers

    Which structures form the superomedial boundary of the popliteal fossa?

    <p>Semitendinosus and semimembranosus</p> Signup and view all the answers

    What is the main function of the patellar tendon?

    <p>Connects the patella to the tibia</p> Signup and view all the answers

    Which of the following is included in the contents of the popliteal fossa?

    <p>Sural nerve</p> Signup and view all the answers

    Which ligaments contribute to the stability of the knee joint?

    <p>MCL and LCL</p> Signup and view all the answers

    What is the location of the popliteal artery relative to the popliteal vein?

    <p>Lateral to the popliteal vein</p> Signup and view all the answers

    What type of joint is the patellofemoral joint classified as?

    <p>Planar gliding joint</p> Signup and view all the answers

    Which muscle tendon is associated with the pes anserinus?

    <p>Tendon of gracilis</p> Signup and view all the answers

    The roof of the popliteal fossa is formed by which of the following?

    <p>Fascia and skin</p> Signup and view all the answers

    What is one of the primary functions of the Medial Collateral Ligament (MCL)?

    <p>Limits abduction of tibia (valgus forces at knee)</p> Signup and view all the answers

    Where does the MCL primarily attach on the tibia?

    <p>Superficial fibers to medial condyle of tibia</p> Signup and view all the answers

    What is true regarding the deep fibers of the MCL?

    <p>They are part of the fibrous capsule</p> Signup and view all the answers

    In what position is the MCL lax?

    <p>At 90° of flexion</p> Signup and view all the answers

    Which ligament acts as an additional reinforcement for the posterior capsule of the knee?

    <p>Oblique Popliteal Ligament</p> Signup and view all the answers

    What shape is the medial meniscus, and how does its mobility compare to the lateral meniscus?

    <p>Semilunar and less mobile</p> Signup and view all the answers

    Which structure limits adduction of the tibia when under varus stresses?

    <p>Medial Collateral Ligament</p> Signup and view all the answers

    How do the attachments of the medial meniscus differ from those of the lateral meniscus?

    <p>Both attach to the MCL</p> Signup and view all the answers

    What does the term 'closed packed' refer to in the context of joint stability?

    <p>The position of greatest joint congruence and ligamentous tightness</p> Signup and view all the answers

    Which of the following is NOT a branch of the popliteal artery that supplies the knee?

    <p>Anterior tibial artery</p> Signup and view all the answers

    Which ligament is most commonly torn along with the medial meniscus in knee injuries?

    <p>Medial collateral ligament</p> Signup and view all the answers

    What type of condition is patellar tendonitis classified as?

    <p>A condition resulting from overuse or stress on the tendon</p> Signup and view all the answers

    Which condition is characterized by the presence of floating pieces of cartilage in the knee joint?

    <p>Torn menisci</p> Signup and view all the answers

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

    <p>To reduce friction</p> Signup and view all the answers

    Which ligament joins the anterior horns of the medial and lateral menisci?

    <p>Transverse Meniscal Ligament</p> Signup and view all the answers

    How do the menisci behave during knee flexion?

    <p>They migrate posteriorly</p> Signup and view all the answers

    What movement occurs in the tibia during open chain flexion of the knee?

    <p>Tibia rolls and glides posteriorly</p> Signup and view all the answers

    What is a key characteristic of the lateral condyle during the screw home mechanism?

    <p>It spins while the medial condyle continues to roll</p> Signup and view all the answers

    Which of the following statements about the coronary ligaments is true?

    <p>They attach menisci to the tibia</p> Signup and view all the answers

    During which phase of knee extension does the screw home mechanism occur?

    <p>Terminal extension</p> Signup and view all the answers

    What happens to the tibial tubercles in full extension of the knee?

    <p>They fit in the intercondylar groove</p> Signup and view all the answers

    What is the innervation of the Fibularis Longus?

    <p>Superficial fibular nerve (peroneal n.)</p> Signup and view all the answers

    What are the actions of the Fibularis Brevis?

    <p>Everts foot, weak plantar flexion.</p> Signup and view all the answers

    The Fibular Artery is a branch of the ______.

    <p>Posterior tibial artery</p> Signup and view all the answers

    The deep fibular nerve travels in the lateral compartment.

    <p>False</p> Signup and view all the answers

    Which arteries supply the tibia?

    <p>All of the above</p> Signup and view all the answers

    What supports the Proximal Tibiofibular Joint?

    <p>Proximal anterior tibiofibular ligament and proximal posterior tibiofibular ligament.</p> Signup and view all the answers

    The common peroneal nerve is prone to injury at the neck of the fibula.

    <p>True</p> Signup and view all the answers

    Shin splints may involve the tibialis posterior or the ______.

    <p>soleus</p> Signup and view all the answers

    Which nerve provides sensory innervation over the distal lateral leg and dorsal foot?

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

    What type of joint is the Proximal Tibiofibular Joint?

    <p>Gliding planar joint.</p> Signup and view all the answers

    What are the medial and lateral structures of the tibia?

    <p>Condyles</p> Signup and view all the answers

    Which of the following is a part of the fibula?

    <p>All of the above</p> Signup and view all the answers

    What is the function of the interosseus membrane?

    <p>Syndesmoses between tibia and fibula.</p> Signup and view all the answers

    The proximal and distal tibiofibular joints are not synovial joints.

    <p>False</p> Signup and view all the answers

    What is compartment syndrome?

    <p>A condition where pressure builds up in a compartment, potentially leading to nerve damage.</p> Signup and view all the answers

    Name one prominent band of fascia in the distal leg.

    <p>Retinacula</p> Signup and view all the answers

    What is the primary action of the muscles in the superficial posterior compartment?

    <p>Plantar flexion.</p> Signup and view all the answers

    What nerve innervates the soleus muscle?

    <p>Tibial nerve.</p> Signup and view all the answers

    Achilles tendonitis can develop due to improper training increases.

    <p>True</p> Signup and view all the answers

    Which of the following actions is performed by the tibialis anterior?

    <p>Inversion</p> Signup and view all the answers

    Match the following muscles with their actions:

    <p>Gastrocnemius = Plantar flexes ankle Soleus = Steadies leg on foot Plantaris = Weakly assists plantar flexion</p> Signup and view all the answers

    What is the role of the triceps surae in relation to deep vein thrombosis?

    <p>Acts as a muscle pump to help pump blood.</p> Signup and view all the answers

    Which nerve is responsible for innervating the muscles of the anterior compartment of the leg?

    <p>Deep fibular nerve</p> Signup and view all the answers

    The lateral compartment of the leg functions to invert the ankle.

    <p>False</p> Signup and view all the answers

    Study Notes

    Surface Anatomy of the Knee

    • The patella sits anteriorly on the knee joint.
    • The patellar tendon/ligament connects the patella to the tibia.
    • The lateral epicondyle of the femur, tibial condyle, and LCL are found laterally.
    • The tendon of the biceps femoris is located laterally.
    • The IT band runs laterally and inserts into the tibia.
    • The medial epicondyle of the femur, tibial condyle, and MCL are found medially.
    • The tendon of the gracilis is part of the pes anserinus, located medially.
    • The popliteal fossa, a diamond shaped region, is found posteriorly.

    Popliteal Fossa

    • The popliteal fossa is a diamond-shaped region behind the knee joint.
    • It is bordered by the semitendinosus and semimembranosus muscles superiorly and medially, the biceps femoris muscle superiorly and laterally, the medial and lateral heads of the gastrocnemius muscle inferiorly, and fascia and skin as its roof.
    • The floor of the popliteal fossa: popliteal surface of femur, popliteus fascia, oblique popliteal ligament, and posterior aspect of proximal tibia.
    • It contains fat, the sciatic nerve, the tibial nerve, the common fibular nerve, the sural nerve, the popliteal artery and vein, the anterior and posterior tibial arteries and veins, the lesser saphenous vein (joins the popliteal vein here), lymph nodes, and the popliteal bursa.

    Patellofemoral Joint

    • The patellofemoral joint is a planar gliding joint.
    • It is composed of the articular facets of the patella and the femoral condyles.
    • The patella has inferior, middle, and superior facets, with the medial facet being the "odd facet".
    • The number of facets can vary between individuals.
    • The ACL restrains the posterior rolling of the femoral condyles on the tibia, limits anterior translation of the tibia on the femur, limits knee extension, and limits abduction of the tibia.

    Knee Ligaments

    • The ACL attaches to the anterior intercondylar area of the tibia and the posterior aspect of the lateral femoral condyle.
    • The PCL attaches to the posterior aspect of the intercondylar area of the tibia and the anterior aspect of the lateral side of the medial femoral condyle.
    • The PCL passes medially to the ACL at their crossover point.
    • The posterior meniscofemoral ligament is a slip from the posterior horn of the lateral meniscus to the PCL.
    • The PCL limits posterior displacement of the tibia on the femur.
    • Some portion of the ACL or PCL is under tension at all times.
    • The crossover point of the ACL and PCL creates the axis of rotation for the tibia.
    • The LCL attaches to the lateral epicondyle of the femur and the lateral surface of the fibular head.
    • The LCL limits adduction of the tibia and tibial rotation in knee flexion.
    • The MCL attaches to the medial epicondyle of the femur, the medial condyle of the tibia, and the superior part of the medial surface of the tibia at the pes anserinus.
    • The MCL is weaker than the LCL, and its deep fibers attach to the medial meniscus.
    • The MCL limits abduction of the tibia and tibial rotation in knee flexion.
    • The oblique popliteal ligament is a reflection of the tendon of the semimembranosus muscle, reinforcing the posterior capsule.
    • The arcuate ligament passes over the popliteus tendon and arises from the posterior aspect of the fibular head, blending with the posterior capsule to reinforce it.

    Menisci

    • The medial meniscus attaches to the anterior and posterior intercondylar areas of the tibia and the MCL, and the semimembranosus attaches to its posterior aspect.
    • The medial meniscus has a semilunar shape and is less mobile than the lateral meniscus.
    • The lateral meniscus attaches to the anterior and posterior intercondylar areas of the tibia, blending with the ACL, and the popliteus attaches to its posterior aspect.
    • The lateral meniscus is circular and more mobile than the medial meniscus.
    • The menisci improve weight distribution, increase joint stability, absorb shock, reduce friction, and migrate posteriorly during knee flexion.
    • Coronary ligaments attach the menisci to the tibia.
    • The transverse meniscal ligament joins the anterior horns of the medial and lateral menisci.

    Knee Joint Movements

    • In open chain flexion, the tibia rolls and glides posteriorly on the femoral condyles.
    • In closed chain flexion, the femoral condyles roll posteriorly and glide anteriorly on the tibia.
    • In terminal extension (last 30° of extension), the tibia rotates laterally in open chain.
    • The knee joint reaches its closed packed position in full extension, with the tibial tubercles fitting in the intercondylar groove, ligaments taut, and menisci interposed between the tibial and femoral condyles.

    Knee Blood Supply

    • Genicular anastomoses are formed by the superior lateral, superior medial, inferior lateral, inferior medial, and middle genicular arteries (branches of the popliteal artery).
    • Anastomoses connect with: the descending genicular artery (off the femoral), the descending branch of the lateral circumflex femoral, and the anterior tibial recurrent.

    Clinical Considerations for the Knee Joint

    • Torn cruciate ligaments are common injuries.
    • Torn menisci, particularly the medial meniscus, are common, and floating cartilage pieces may require removal.
    • Torn collateral ligaments, particularly the medial collateral, are common.
    • Impingement or irritation of the common peroneal nerve, as it passes around the fibular head can occur.
    • Patellofemoral syndrome, patellar tendonitis (and Osgood-Schlatter), and DJD/osteoarthritis are common knee conditions.

    Leg Osteology

    • Tibia and fibula bones form the skeletal framework of the leg
    • Tibia is medial, supporting weight, and the fibula is lateral, providing stability
    • Tibia has a medial and lateral condyle articulating with the femur, forming the knee joint
    • Tibial tuberosity serves as attachment for the patellar ligament
    • Fibula has a head, neck, and a shaft with a lateral malleolus forming the outer ankle bone

    Leg Fascia and Compartments

    • Crural fascia, continuous with fascia lata in the thigh, surrounds the leg muscles except medially
    • Intermuscular septa divide the leg into four compartments: anterior, lateral, deep posterior, and superficial posterior
    • Compartment syndrome can occur due to injury, edema, or hemorrhage, leading to increased pressure on neurovascular structures
    • Retinacula are thick bands of fascia in the distal leg, preventing tendon bowstringing at the ankle

    Superficial Posterior Compartment

    • Contains the powerful plantar flexors of the ankle (gastrocnemius, soleus, plantaris) crucial for walking, running, and jumping
    • Plantaris has little function, and its tendon is often used for surgical repairs in other regions
    • Muscles insert into the calcaneal tendon, also known as the Achilles tendon
    • Shares the posterior tibial artery and tibial nerve with the deep posterior compartment
    • Achilles tendonitis/rupture is a common injury due to overuse or improper training

    Deep Posterior Compartment

    • Contains the long flexors of the foot and toes, responsible for foot control during standing and gait
    • Muscles include popliteus, flexor hallucis longus, flexor digitorum longus, and tibialis posterior
    • Innervated by the tibial nerve, and supplied by the posterior tibial artery
    • Popliteus unlocks the knee joint by rotating the femur on the tibia

    Anterior Compartment

    • Contains the dorsiflexors (extensors) of the ankle, crucial for lifting the toes and foot
    • Muscles include tibialis anterior, extensor digitorum longus, extensor hallucis longus, and fibularis tertius
    • Innervated by the deep fibular nerve, and supplied by the anterior tibial artery
    • Anterior tibial artery becomes the dorsalis pedis artery as it crosses the ankle joint
    • Anterior shin splints are common due to overuse, leading to swelling and inflammation in the anterior compartment muscles

    Lateral Compartment

    • Contains the evertors of the ankle, counteracting the inversion actions of the dorsiflexors
    • Muscles include fibularis longus and fibularis brevis
    • Innervated by the superficial fibular nerve, and supplied by the fibular artery, which originates from the posterior tibial artery
    • Fibularis longus plays a vital role in stabilizing the arches of the foot

    Neurovascular Supply of the Leg

    • Popliteal artery divides into anterior and posterior tibial arteries to supply the leg
    • Deep fibular nerve innervates the anterior compartment
    • Superficial fibular nerve innervates the lateral compartment
    • Tibial nerve innvervates the posterior compartments

    The Leg: Artery Supply

    • The anterior tibial artery supplies the anterior compartment of the leg and travels with the deep fibular nerve.
    • The posterior tibial artery travels in the deep posterior compartment of the leg and branches into the fibular artery, which runs near the fibula (also in the deep posterior compartment).

    The Leg: Superficial Veins

    • The great saphenous vein is located medially in the leg.
      • It originates from the dorsum of the foot, travels anterior to the medial malleolus and continues medially up the leg and thigh.
      • It merges with the femoral vein.
    • The small saphenous vein is located posteriorly in the leg.
      • It originates from the lateral malleolus, travels posteriorly up the leg.
      • It joins with the popliteal vein in the popliteal fossa.

    The Leg: Innervation Overview

    • The tibial nerve travels in the deep posterior compartment, near the posterior tibial artery.
    • The deep fibular nerve travels in the anterior compartment, with the anterior tibial artery.
    • The superficial fibular nerve travels alone in the lateral compartment. It emerges superficially to provide cutaneous innervation over the distal lateral leg and dorsal foot.

    Tibiofibular Joint: Proximal

    • The proximal tibiofibular joint is a gliding planar joint.
      • It sits between the head of the fibula and the facet on the proximal, lateral tibia.
      • The joint capsule may communicate with the knee joint.
    • Its supporting structures include:
      • Ligaments:
        • Proximal anterior tibiofibular ligament
        • Proximal posterior tibiofibular ligament
      • Structures in close proximity:
        • Common peroneal nerve
        • Biceps femoris and popliteus tendons
        • IT band
        • Origins of PL, EDL, Lateral Gastrocnemius and Soleus
    • Motions:
      • The fibula glides superiorly and posteriorly with dorsiflexion. This motion is functional with ankle movements.
    • Neurovascular supports:
      • Innervation: common peroneal (fibular) nerve
      • Blood supply: Lateral genicular, anterior tibial, and recurrent tibial arteries

    Tibiofibular Joint: Middle

    • The middle tibiofibular joint is a syndesmosis.
      • It is formed by the interosseous membrane between the tibia and fibula.
      • The fibers of the interosseous membrane are obliquely oriented, resisting muscle pull and dispersing forces.
      • The fibula does not bear weight.
    • Motions:
      • There is accessory movement with the ankle joint.

    Tibiofibular Joint: Distal

    • The distal tibiofibular joint is a fibrous or syndesmosis, but it may be a gliding planar joint.
      • The fibula is convex and the tibia is concave.
    • Its supporting structures include:
      • Ligaments:
        • Interosseus ligament (continuous with the interosseous membrane)
        • Distal anterior tibiofibular ligament
        • Distal posterior tibiofibular ligament (very strong, more likely to avulse than tear)
          • Deep portion = Transverse Tibiofibular Ligament ("tri malleolar fracture")
    • Neurovascular supports:
      • Innervation: Deep peroneal (fibular), tibial, and saphenous nerves.
      • Blood supply: Perforating branches of peroneal, anterior, and posterior tibial arteries.
    • Motions:
      • The fibula glides superiorly and posteriorly with dorsiflexion (functions with the ankle).

    Clinical Considerations of the Leg

    • Tibial fractures heal slowly. This is because the tibia has sparse muscular attachment and thus poor blood supply. Tibial plateau fractures are particularly troublesome.
    • Injuries to the common fibular nerve can occur on the neck of the fibula where it is superficially located. This can cause foot drop.
    • Deep venous thrombosis and varicose veins are discussed in relation to the posterior leg.
    • Compartment syndrome is a clinical consideration.
    • Shin splints can be found in both the anterior and medial leg.
      • Anterior shin splints: see previous information
      • Medial shin splints: There are many theories implicating either the tibialis posterior or the soleus muscles.
    • The ankle reflex (ankle jerk) tests the reflex pathways through spinal segments S1 and S2. It is performed similar to the knee jerk reflex. The tendon being tapped is the tendo calcaneus.

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    Description

    This quiz explores the surface anatomy of the knee joint, focusing on the patella, ligaments, and surrounding muscles. Key anatomical structures such as the popliteal fossa, epicondyles, and tendons are highlighted to enhance your understanding of knee anatomy.

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