Knee Joint Anatomy PDF

anatomy of lower limb Knee Joint By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study LOWER LIMB Unhappy triad of the knee joint...

anatomy of lower limb Knee Joint By Dr. Hassan Mohammed Rizk (Ph.D.) Associate Professor of Human Anatomy and Embryology  Case Study LOWER LIMB Unhappy triad of the knee joint Knee Joint By Dr. Hassan Rezk October 5, 2024 2  Objectives: by the end of this lecture the student must understand the following knowledge: Thigh, knee, and popliteal fossa - AMBOSS LOWER LIMB  Identify and demonstrate the Knee Joint regarding: 1) Articular surfaces. 2) Type. 3) Ligaments. 4) Special characters. 5) Movements. 6) Stability. Knee Joint By Dr. Hassan Rezk October 5, 2024 3  Objective # ( 1 ) Knee Joint Largest synovial joint in the body  Type synovial – Bicondylar joint 1. Femoro-tibial joint: between femoral and tibial condyles, which is weight- LOWER LIMB bearing.  Articular 2. Femoro-patellar joint: between the patella and the femur,. Surfaces  It allows the pull of the quadriceps femoris muscle to be directed anteriorly over the knee to the tibia without tendon wear Intra-articular two menisci: Fibula is not involved in  Special the knee joint 1) Medial meniscus. character 2) Lateral meniscus. Extra-capsular & Intra-capsular ligaments A. Extra-capsular ligaments: Please, Revise the (1) Fibular collateral ligament. Lectures to (2) Tibial collateral ligament. Enumerate the muscles  Supporting (3) Oblique popliteal ligament. producing each (4) Patellar ligament. movement? Ligaments (5) Popliteous tendon B. Intra-capsular ligaments: (1) Anterior cruciate ligament (ACL). (2) Posterior cruciate ligament (PCL)  Movements (Flexion & Extension) - (medial & lateral rotations) – (+/-Abduction & Adduction). Knee Joint By Dr. Hassan Rezk October 5, 2024 4 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 5 LOWER LIMB Anterior View of right flexed knee joint. Knee Joint By Dr. Hassan Rezk October 5, 2024 6  Anterior LOWER LIMB Cruciate ligament Posterior Cruciate ligament Lateral View of knee joint. Superior View of left knee joint. A. Extended knee joint. (after removal of femur) B. Flexed knee joint. Knee Joint By Dr. Hassan Rezk October 5, 2024 7  Knee Joint Menisci  Function: LOWER LIMB 1. Shock absorber. 2. Lubricates articular surfaces by distributing synovial fluid in a windshield-wiper manner. 3. Increase the convexity of the medial tibial condyle to accommodate the medial femoral condyle. Medial Meniscus Lateral Meniscus Shape  C shaped (semicircle).  Is nearly circular  It is fixed.  Is separated laterally from the fibular (or Character  As it is attached medially to medial lateral) collateral ligament by the tendon of collateral ligament. the popliteal muscle. Clinical Correlation  Fixed and thus more liable to injury.  Less fixed and it is less liable to injury. Knee Joint By Dr. Hassan Rezk October 5, 2024 8 LOWER LIMB Median sagittal section through knee joint Knee Joint By Dr. Hassan Rezk October 5, 2024 9  Parts of the meniscus LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 10  Arterial supply zones of the meniscus LOWER LIMB 1) Red zone: The periphery or outer-third of the meniscus is a well-vascularized area. 2) Red-white zone: The middle-third of the meniscus is a poorly vascularized area. 3) White zone: The inner third of the meniscus is an avascular area.  A peripheral meniscus has a better healing rate than a central meniscus tear. Knee Joint By Dr. Hassan Rezk October 5, 2024 11 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 12 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 13  Knee Joint Collateral Ligaments Extra-capsular Ligaments Medial (Tibial) Lateral (Fibular) (Peroneal) LOWER LIMB Collateral Ligament Collateral Ligament (TCL) (FCL)  Is firmly attached to the medial meniscus.  It is separated from the lateral meniscus by the Character tendon of the popliteus muscle.  From: the medial femoral epicondyle.  From: lateral femoral epicondyle. Attachments  To: the medial tibial condyle.  To: head of the fibula. 1. Prevents displacement of medial femoral & 1. Prevents displacement of lateral femoral & Function tibial condyles. tibial condyles. 2. Limits abduction of the leg. 2. limits adduction of the leg. Knee Joint By Dr. Hassan Rezk October 5, 2024 14  Patellar Ligament (Ligamentum Patellae) Is continuation of the quadriceps femoris tendon. May be used for repair of the anterior cruciate ligament. LOWER LIMB Attachments: Extends from the apex of the patella to the tuberosity of the tibia. Knee Joint By Dr. Hassan Rezk October 5, 2024 15  Knee Joint Cruciate Ligaments Intra-capsular Ligaments LOWER LIMB Anterior Cruciate Ligament Posterior Cruciate Ligament (ACL) (PCL)  From: anterior part of intercondylar area of tibia.  From: posterior part of intercondylar area of tibia. Attachments  Ascends posteriorly.  Ascends anteriorly.  To: lateral wall of intercondylar fossa of femur.  To: medial wall of intercondylar fossa of femur. Restricts anterior displacement of the tibia relative Restricts posterior displacement of the tibia Function to the femur relative to the femur Knee Joint By Dr. Hassan Rezk October 5, 2024 16 LOWER LIMB Superolateral view of knee joint Knee Joint By Dr. Hassan Rezk October 5, 2024 17 LOWER LIMB SEE: Coronal MRI Section in the case scenario slide Knee Joint By Dr. Hassan Rezk October 5, 2024 18 LOWER LIMB The lateral view demonstrates how the posterior cruciate ligament resists anterior displacement of the femur on the tibia. The medial view demonstrates how the anterior cruciate ligament resists posterior displacement of the femur on the tibia. Knee Joint By Dr. Hassan Rezk October 5, 2024 19  Knee Joint Locking & Unlocking LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 20 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 21  Movements of Knee Joint ( Movement of the Leg ) Movements Muscle Nerve Supply 1. Gastrocnemius & Plantaris Posterior tibial nerve (Tibial nerve in leg) Long Head: Tibial part of sciatic nerve. LOWER LIMB 2. Biceps femoris Short Head: Common peroneal nerve 3. Semitendinosus Flexion Tibial part of sciatic nerve. 4. Semimembranosus 5. Sartorius Femoral nerve 6. Gracilis Obturator nerve 7. Popliteus Posterior tibial nerve (Tibial nerve in leg) Extension Quadriceps femoris (Which are ????) All are supplied by femoral nerve Popliteus Posterior tibial nerve (Tibial nerve in leg) Sartorius Femoral nerve Medial Rotation Semitendinosus (Unlocking of the knee) Tibial part of sciatic nerve. Semimembranosus Gracilis Obturator nerve Lateral Rotation Long Head: Tibial part of sciatic nerve. Biceps femoris (Locking of the knee) Short Head: Common peroneal nerve Knee Joint By Dr. Hassan Rezk October 5, 2024 22 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 23  Medial Lateral Quadratus femoris LOWER LIMB Ischial part of adductor magnus Semimembranosus Sciatic nerve Semitendinosus Biceps Femoris Tibial (medial popliteal) nerve Common peroneal (fibular) (lateral popliteal) nerve Knee Joint By Dr. Hassan Rezk October 5, 2024 24 LOWER LIMB Lateral View Posterior View Superficial layer Knee Joint By Dr. Hassan Rezk October 5, 2024 25 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 26  Clinical correlation Unhappy triad of the knee joint  Mechanism: football player’s cleated shoe is planted firmly in the turf and the knee is struck LOWER LIMB from the lateral side. (Knee is twisted, flexed and receive trauma on its lateral side)  Clinical picture:  Knee region is markedly swollen.  tenderness on application of pressure along the tibial collateral ligament.  It is characterized by (3 torns) (TCL, ACL & MM) a) Torn of the Tibial (Medial)Collateral Ligament, as a result of excessive abduction. b) Torn of the Anterior Cruciate Ligament, as a result of forward displacement of the tibia. c) Torn the Medial Meniscus, as a result of the tibial collateral ligament attachment Knee Joint By Dr. Hassan Rezk October 5, 2024 27  Lachman test Drawer tests  Step:  Step:  With the patient in supine position, the knee to be  The patient is in supine position, the leg to be examined is erect, examined is flexed at approximately 20°. and the knee is flexed at approximately 90°. LOWER LIMB  The examiner grips the distal upper leg with one hand  The examiner puts both hands around the lower leg (with the and the proximal lower leg with the second hand (thumb thumbs placed on the tibial tuberosity). placed on the tibial tuberosity).  To examine the ACL, the tibia is pulled ventrally.  The lower leg is then pulled ventrally.  To examine the PCL, the tibia is pushed dorsally.  Results:  Results:  Increased movability in the ventral direction and/or a  If the movability of the tibia is increased (particularly lax or nonexistent endpoint suggest injury of the (ACL), compared to the other leg) or if there is a lax endpoint, the particularly if there is a significant difference to the drawer test is said to be positive and may indicate an injury to other knee. the respective ligament. Knee Joint By Dr. Hassan Rezk October 5, 2024 28 LOWER LIMB Lachman test Drawer tests Knee Joint By Dr. Hassan Rezk October 5, 2024 29  Case Scenario LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 30 LOWER LIMB Reference  ISBN: 978-0-7020-5131-9  ISBN: 978-07817-7525-0  ISBN: 978-1-60913-446-4  Copyright© 2015, 2010, 2005 by  Copyright© 2010, by Lippincott  Copyright© 2012, by Lippincott Churchill Livingstone, an imprint of Williams & Wilkins, a Wolters Williams & Wilkins, a Wolters Elsevier Inc. Kluwer business. Kluwer business.  Chapter 6.  Chapter 5.  Chapter 10. Knee Joint By Dr. Hassan Rezk October 5, 2024 31 LOWER LIMB Knee Joint By Dr. Hassan Rezk October 5, 2024 32