Download MBBS Anatomy PPT 93 Knee Joint Notes

The knee joint is formed by the condyles of femur

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& tibia, & posterior articular surface of the patel a.

It is a compound & complex synovial joint.

Functionally, the knee joint is a condylar & modified hinge

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joint.

1. Transverse axis of movement is not fixed, & moves

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forward during extension & translates backward in

flexion;

2. Along with extension & flexion, there is a conjunct

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rotation of femur on tibia(or vice versa) around a

more or less vertical axis.

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BONES FORMING THE JOINT:

1. CONDYLES OF FEMUR

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2. CONDYLES OF TIBIA

3. ARTICULAR SURFACE OF PATELLA

LIGAMENTS of KNEE JOINT

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1. Capsular ligament
2. Synovial membrane
3. Ligamentum patellae
4. Tibial col ateral ligament

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5. Fibular col ateral ligament
6. Oblique popliteal ligament
7. Arcuate popliteal ligament
8. Medial & lateral menisci

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9. Anterior & posterior cruciate

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ligments.

10 . Coronary ligament
11. Transverse ligament.
12. Menisco - femoral ligaments.

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Proximal attachment of capsule

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Posteriorly (1 gap ) for passage of TENDON OF

POPLITEUS

Distal attachment of capsule

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Anteriorly (1 gap)


REFLECTION OF SYNOVIAL MEMBRANE

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LIGAMENTUM PATELLAE

It is derived from the tendon of quadriceps femoris &

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extends from the apex of patella to the upper part of the

tubercle of tibia.

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When the knee joint is locked at the end of extension , al

ligaments are taut except the ligamentum patellae.

TIBIAL COLLATERAL LIGAMENT

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The ligament consist of superficial & deep part . Both part

are attached above to the medial epicondyle of femur. The

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superficial part extends downward & forward as a

flattened band & is attached to the medial condyle & upper

part of medial border of shaft of tibia along a rough strip of

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bone.

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FIBULAR COLLATERAL LIGAMENT

It extends from lateral epicondyle of

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femur to the head of fibula close to its

styloid process.

OBLIQUE POPLITEAL LIGAMENT

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It is an expansion derived from the insertion of

semimembranosus & extend from the posterior surface

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of medial condyle of tibia to the lateral part of

intercondylar line of femur.

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ARCUATE LIGAMENT

It forms a Y-shaped band .The stem is fixed to the

styloid process of head of fibula. The posterior band is

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attached to the lateral condyle of tibia & anterior band

is attached to the lateral condyle of femur.

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CRUCIATE LIGAMENT

The anterior & posterior cruciate ligaments are

intracapsular but extrasynovial. They are named as

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anterior & posterior according to their tibial

attachment.

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CORONARY LIGAMENT: These are parts of capsule that

provide attachment to peripheral margins of medial and

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lateral menisci.

TRANSVERSE LIGAMENT: It connect the anterior horn of

medial meniscus to the anterior margin of lateral meniscus.

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MEDIAL & LATERAL MENISCI

They are composed of fibro-cartilage. Each menisci

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divides the condylar part of the joint into menisco-

femoral & menisco-tibial compartments.

Function of the menisci-

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1. They increase the concavity of tibial condyles for the

better adaptation with femoral condyles.

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2. They maintain a potential joint space for flushing of

synovial fluid to provide nutrition to the articular

cartilage.

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3. Menisci act as shock absorber.

4. Menisci help in the complex mechanism of gliding &

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angular movements.

5. Peripheral attached part of the menisci is vascular &

gets nutrition from the capsular arteries.

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MENISCO-FEMORAL LIGAMENT

The posterior horn of lateral meniscus is connected to

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the medial condyle of femur by anterior & posterior

menisco-femoral ligaments.

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BURSAE AROUND KNEE JOINT
Anteriorly

1. Subcutaneous pre - patellar bursa.

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(inflammation causes House maid knee).

2. Subcutaneous infra- patellar bursa
( inflammation causes Clergy-mans knee)

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3. Deep infra-patellar bursa

4. Supra-patellar bursa (Communicates with the

joint cavity.)

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BURSA AROUND KNEE JOINT


Lateral y :

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?Between lateral head of gastrocnemius & the

capsule

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?Between tendon of biceps femoris & fibular

collateral ligament.

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?Between fibular collateral ligament & tendon of

popliteus muscle

?Between tendon of popliteus & lateral condyle of

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tibia (communicates with joint cavity).


Medial y

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1. Me dial head of gastrocnemius & the capsule

(communicates with joint cavity)

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2. Superficial part of tibial collateral igament

sartorius, gracilis &semitendinosus.

3. Superficial & deep part of tibial collateral ligament.

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4.Semi-membranosus & medial condyle of tibia (may

communicate with joint cavity)
RELATIONS OF KNEE JOINT

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Anteriorly- Quadriceps femoris

Antero-medial y- medial patellar retinaculum

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Antero-lateral y- lateral patellar retinaculam & iliotibial

tract

Postero-medial y- Sartorius,gracilis, semimembranosus

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& semitendinosus

Postero-lateral y- Tendon of biceps femoris & common

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peroneal nerve

Posteriorly- popliteal vessels, tibial nerve, both head of

gastrocnemius & plantaris

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ARTERIAL SUPPLY

1. Descending genicular branch of femoral artery.

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2. Descending branch of lateral circumflex femoral

artery

3. Genicular branches of popliteal artery.

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4. Recurrent branches of anterior tibial artery.

5. Circumflex fibular branch of posterior tibial artery.

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NERVE SUPPLY

?From Femoral nerve ?

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?nerves to the vasti.

?3 from the Tibial nerve ?

? superior medial Genicular

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? inferior medial genicular

? middle genicular nerve.

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?3 from the Common peroneal nerve -

? superior lateral Genicular

? inferior lateral genicular

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? recurrent genicular nerve


MUSCLES PRODUCING THE MOVEMENTS:

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Active movements performed at the knee joint are-

qExtension or straightening continues until leg & thigh

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are in the same vertical lines.Extension is produced by

Quadriceps femoris & assisted by tensor fascia latae.

qFlexion ?prime movers: semimembranosus,

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semitendinosus, biceps femoris;

initiated by, popliteus

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Assisted by, sartorius, gracilis, both head of

gastrocnemius & plantaris.

q Medial rotation- by semimembranosus,

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semitendinosus, popliteus, sartorius & gracilis.

q Lateral rotation-biceps femoris.

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Applied Anatomy

Injuries to menisci

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qMost injured structures of the knee are Tibial col ateral

ligament, the medial menisci & ACL

o A blow to lateral aspect of the knee when the foot is on the

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ground may sprain the tibial col ateral ligament, the attached

medial menisci may also be torn.

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oACL tears may occur when the tibial col ateral ligament &

medial menisci are injured, a blow to the anterior aspect of

the flexed knee may tear only the ACL.

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q Injuries to the menisci commonly occur in the flexed knee as

a result of forcible rotation or abduction. The medial meniscus

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suffers more frequently than the lateral.


?Rupture of cruciate ligaments is less common. Anterior

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ligament is more commonly affected.

?If both cruciate ligaments are injured ,excessive forward

& backward gliding of tibia ,abduction & adduction of

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joint occur.

?Fractureof patella is a frequent problem. Does not heal

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as it is a sesamoid bone. Wiring has to be done.

?Acute traumatic synovitis.

Joint cavity is distended with fluid. swelling is above

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and on the sides of patella.


. Inflammation of bursa-

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Housemaids knee - Subcutaneous pre-patellar

bursa.

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Clergyman's knee - Subcutaneous infra

patellarbursa.

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. Osteoarthritis of knee joint.

Genu valgum (Knock knees)

Angle between long axis of thigh and leg is reduced

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laterally

Genu varus ( bow legs)

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Angle between long axis of thigh and leg is increased

laterally.

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