Download MBBS Anatomy PPT 93 Knee Joint Notes

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The knee joint is formed by the condyles of femur

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

It is a compound & complex synovial joint.

Functionally, the knee joint is a condylar & modified hinge

joint.

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

forward during extension & translates backward in

flexion;

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

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

more or less vertical axis.


BONES FORMING THE JOINT:

1. CONDYLES OF FEMUR

2. CONDYLES OF TIBIA

3. ARTICULAR SURFACE OF PATELLA

LIGAMENTS of KNEE JOINT

1. Capsular ligament
2. Synovial membrane
3. Ligamentum patellae
4. Tibial col ateral ligament
5. Fibular col ateral ligament
6. Oblique popliteal ligament
7. Arcuate popliteal ligament
8. Medial & lateral menisci




9. Anterior & posterior cruciate

ligments.

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


Proximal attachment of capsule


Posteriorly (1 gap ) for passage of TENDON OF

POPLITEUS

Distal attachment of capsule

Anteriorly (1 gap)


REFLECTION OF SYNOVIAL MEMBRANE


LIGAMENTUM PATELLAE

It is derived from the tendon of quadriceps femoris &

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

tubercle of tibia.

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

ligaments are taut except the ligamentum patellae.

TIBIAL COLLATERAL LIGAMENT

The ligament consist of superficial & deep part . Both part

are attached above to the medial epicondyle of femur. The

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

bone.




FIBULAR COLLATERAL LIGAMENT

It extends from lateral epicondyle of

femur to the head of fibula close to its

styloid process.

OBLIQUE POPLITEAL LIGAMENT

It is an expansion derived from the insertion of

semimembranosus & extend from the posterior surface

of medial condyle of tibia to the lateral part of

intercondylar line of femur.


ARCUATE LIGAMENT

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

styloid process of head of fibula. The posterior band is

attached to the lateral condyle of tibia & anterior band

is attached to the lateral condyle of femur.

CRUCIATE LIGAMENT

The anterior & posterior cruciate ligaments are

intracapsular but extrasynovial. They are named as

anterior & posterior according to their tibial

attachment.


CORONARY LIGAMENT: These are parts of capsule that

provide attachment to peripheral margins of medial and

lateral menisci.

TRANSVERSE LIGAMENT: It connect the anterior horn of

medial meniscus to the anterior margin of lateral meniscus.

MEDIAL & LATERAL MENISCI

They are composed of fibro-cartilage. Each menisci

divides the condylar part of the joint into menisco-

femoral & menisco-tibial compartments.

Function of the menisci-

1. They increase the concavity of tibial condyles for the

better adaptation with femoral condyles.

2. They maintain a potential joint space for flushing of

synovial fluid to provide nutrition to the articular

cartilage.

3. Menisci act as shock absorber.

4. Menisci help in the complex mechanism of gliding &

angular movements.

5. Peripheral attached part of the menisci is vascular &

gets nutrition from the capsular arteries.


MENISCO-FEMORAL LIGAMENT

The posterior horn of lateral meniscus is connected to

the medial condyle of femur by anterior & posterior

menisco-femoral ligaments.


BURSAE AROUND KNEE JOINT
Anteriorly

1. Subcutaneous pre - patellar bursa.
(inflammation causes House maid knee).

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

3. Deep infra-patellar bursa

4. Supra-patellar bursa (Communicates with the

joint cavity.)

BURSA AROUND KNEE JOINT


Lateral y :


?Between lateral head of gastrocnemius & the

capsule

?Between tendon of biceps femoris & fibular

collateral ligament.

?Between fibular collateral ligament & tendon of

popliteus muscle

?Between tendon of popliteus & lateral condyle of

tibia (communicates with joint cavity).


Medial y

1. Me dial head of gastrocnemius & the capsule

(communicates with joint cavity)

2. Superficial part of tibial collateral igament

sartorius, gracilis &semitendinosus.

3. Superficial & deep part of tibial collateral ligament.

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

communicate with joint cavity)
RELATIONS OF KNEE JOINT

Anteriorly- Quadriceps femoris

Antero-medial y- medial patellar retinaculum

Antero-lateral y- lateral patellar retinaculam & iliotibial

tract

Postero-medial y- Sartorius,gracilis, semimembranosus

& semitendinosus

Postero-lateral y- Tendon of biceps femoris & common

peroneal nerve

Posteriorly- popliteal vessels, tibial nerve, both head of

gastrocnemius & plantaris

ARTERIAL SUPPLY

1. Descending genicular branch of femoral artery.

2. Descending branch of lateral circumflex femoral

artery

3. Genicular branches of popliteal artery.

4. Recurrent branches of anterior tibial artery.

5. Circumflex fibular branch of posterior tibial artery.


NERVE SUPPLY

?From Femoral nerve ?

?nerves to the vasti.

?3 from the Tibial nerve ?

? superior medial Genicular

? inferior medial genicular

? middle genicular nerve.

?3 from the Common peroneal nerve -

? superior lateral Genicular

? inferior lateral genicular

? recurrent genicular nerve


MUSCLES PRODUCING THE MOVEMENTS:

Active movements performed at the knee joint are-

qExtension or straightening continues until leg & thigh

are in the same vertical lines.Extension is produced by

Quadriceps femoris & assisted by tensor fascia latae.

qFlexion ?prime movers: semimembranosus,

semitendinosus, biceps femoris;

initiated by, popliteus

Assisted by, sartorius, gracilis, both head of

gastrocnemius & plantaris.

q Medial rotation- by semimembranosus,

semitendinosus, popliteus, sartorius & gracilis.

q Lateral rotation-biceps femoris.


Applied Anatomy

Injuries to menisci

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

ground may sprain the tibial col ateral ligament, the attached

medial menisci may also be torn.

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.

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

a result of forcible rotation or abduction. The medial meniscus

suffers more frequently than the lateral.


?Rupture of cruciate ligaments is less common. Anterior

ligament is more commonly affected.

?If both cruciate ligaments are injured ,excessive forward

& backward gliding of tibia ,abduction & adduction of

joint occur.

?Fractureof patella is a frequent problem. Does not heal

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

?Acute traumatic synovitis.

Joint cavity is distended with fluid. swelling is above

and on the sides of patella.


. Inflammation of bursa-

Housemaids knee - Subcutaneous pre-patellar

bursa.

Clergyman's knee - Subcutaneous infra

patellarbursa.


. Osteoarthritis of knee joint.

Genu valgum (Knock knees)

Angle between long axis of thigh and leg is reduced

laterally

Genu varus ( bow legs)

Angle between long axis of thigh and leg is increased

laterally.


This post was last modified on 05 April 2022