AnatomyKnee

Report
Chisholm Institute
Department of Health and Community Care
Diploma of Remedial Massage HLT50307
Anatomy & Physiology 2
Session 27: The knee joint.
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The knee joint
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Osteology of the knee joint
 Bony anatomy:
- femur
- medial & lateral condyles
- medial & lateral epicondyles
- adductor tubercle
- popliteal surface
- intercondylar ridge
- intercondylar groove (for patella)
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Osteology of the knee joint
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Osteology of the knee joint
 Tibia
- medial & lateral condyles
- intercondylar eminence
- tibial tuberosity
- superior tib-fib joint
 Patella
- base of the patella (superior)
- apex of the patella
 Fibula
- head of the fibula
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Osteology of the knee joint
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Osteology of the knee joint
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Joints of the knee
Patellofemoral joint (PFJ):
 Articulation between the patella
and the anterior surface of the femur
 The PFJ is a plane type of synovial joint.
 The articular surfaces are the facets on the posterior
patella & the anterior aspect of the femoral condyles.
 The patella is a sesamoid bone.
 One role of the patella is to increase the leverage of
the quadriceps tendon, by keeping it away from the
axis of the joint.
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Joints of the knee
Patellofemoral joint:
• The patella is susceptible to dislocation due to
excessive pull of vastus lateralis.
 To counter this, protective
measures include:
- a raised lateral condyle
on the femur
- medial pull of
vastus medialis.
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Joints of the knee
Tibiofemoral joint: - “knee” joint
• The articulation between the femur and the tibia is
considered the true knee joint.
• Described as a modified synovial hinge joint as it has the
additional features of menisci and cruciate ligaments.
 This enables a slight gliding and rotation during locking
and unlocking of the knee.
 It is enclosed within a joint capsule, which facilitates
many functions and requirements of the knee joint.
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Joints of the knee
Superior tib-fib joint:
• Articulation between the head of the fibula & the
undersurface of the lateral tibial condyle
• Plane synovial joint
• Anterior & posterior ligaments of the head of the
fibula support the joint
• Slight movement at the joint to give greater flexibility
between the tibia & fibula during ankle movements
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Supporting structures of the
knee
Menisci of the knee joint:
 The menisci are circular rims of fibrocartilage situated on
the articular surfaces of the head of the tibia that aid in
the congruency (fit) of the knee joint.
 Their functions include:
- enabling rotation to occur,
- acting as shock absorbers and
- assisting in the spread of synovial fluid.
 They attach to the periphery of their respective condyles
on the tibial plateau
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Supporting structures of the
knee
Menisci of the knee joint:
 The medial meniscus is longer and more crescent in shape. It
blends with the medial collateral ligament and this predisposes it to
injury.
 The lateral meniscus is shorter and more circular in shape and is
separated from the lateral collateral ligament by popliteus.
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Supporting structures of the
knee
Ligaments of the the knee joint (extrinsic):
 Patellar ligament/tendon – this is a strong, flat ligament
connecting the lower margin of the patella with the tibial
tuberosity.
 The superficial fibres are continuations of the quadriceps
femoris tendon.
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Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Medial (Tibial) Collateral ligament
 otherwise known as the ‘MCL’, it extends from the medial
epicondyle of the femur to the medial condyle of the tibia and
medial shaft
 It is a strong, flat, band-like ligament and blends with medial
meniscus.
 It passes downwards and
slightly forwards from
origin to insertion
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Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Lateral (Fibular) Collateral ligament
 otherwise known as the ‘LCL’, it extends from the lateral
epicondyle of the femur to the head of fibula.
 It is a thick, cord-like ligament that also splits the tendon of
biceps femoris.
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Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Oblique popliteal ligament
 this is a broad, flat ligament covering the back of the knee
joint.
 Medially, it blends with the semimembranosus tendon and
laterally with the lateral head of the gastrocnemius muscle.
 It protects the knee against hyperextension.
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Supporting structures of the
knee
Ligaments of the knee (extrinsic):
 Transverse ligament
 this is a short, slender ligament that connects from the anterior
margins of the lateral meniscus to the medial meniscus.
 Patellar retinaculum
 medial and lateral retinaculum
 provides support for the patella attaching to the femur and
tibia.
 This region may contribute to knee pathologies and is useful to
treat using DIP.
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Supporting structures of the
knee
Ligaments of the knee (extrinsic):
 Iliotibial band (ITB)
 otherwise known as the ‘iliotibial tract’, this strong
ligamentous like structure, which attaches to the tensor fascia
latae muscle, provides stabilisation for the lateral aspect of the
knee joint
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Supporting structures of the
knee
Ligaments of the knee (extrinsic):
The infrapatella ligament (deep) lies between the patella
ligament and the anterior surface of the tibia, superior to the
tibial tuberosity
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Supporting structures of the
knee
Ligaments of the knee (intrinsic):
 Anterior cruciate ligament
 otherwise known as the ‘ACL’, this ligament arises anteriorly,
from the intercondylar ridge of the tibia.
 It passes upward & backward to the intercondylar notch of the
femur (on the medial side of the lateral condyle).
 The ACL prevents anterior displacement of the tibia and therefore is
taut in extension of the knee.
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Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Anterior cruciate ligament:
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Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Anterior cruciate ligament
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Supporting structures of the
knee
Ligaments of the knee (intrinsic):
 Posterior cruciate ligament
 otherwise known as the ‘PCL’, this ligament arises posteriorly,
from the intercondylar ridge of the tibia.
 It passes upward & forward to the intercondylar notch of the
femur (on the medial condyle).
 The PCL prevents posterior displacement of the tibia.
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Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Posterior cruciate ligament:
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Supporting structures of the
knee
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 Lateral (Fibular) Collateral ligament
 otherwise known as the ‘LCL’, it extends from the
lateral epicondyle of the femur to the head of fibula.
 It is a thick, cord-like ligament that also splits the
tendon of biceps femoris.
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Supporting structures of the
knee
Bursae surrounding the knee joint:
 There are many bursae within the knee joint.
 The suprapatella bursa is one of the largest in the body.
- It extends upward from the knee joint under the
quadriceps muscle.
 The prepatellar bursa is located deep to the skin overlying
the patella.
 The infrapatella bursa (subcutaneous) lies directly over the
tibia, deep to the distal aspect of the patella ligament and tibial
tuberosity.
 Bursae also lie in the regions of popliteus, pes anserine,
gastrocnemius and semimembranosus.
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 Bursae also lie in the regions of popliteus, pes anserine,
gastrocnemius and semimembranosus.
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Movements of the knee joint
 The knee can usually extend to 180 deg’s although it is
not uncommon for some knees to hyperextend up to 10
deg’s or more. When recorded, this is listed as 0 degrees
 When the knee is in full extension, it can move to about
140 deg’s of flexion.
 With the knee flexed (30 deg’s or more), approximately
30 deg’s of tibial IR, and 45 deg’s of tibial ER can occur.
 Knee ROM:
flexion
= 0-140*
extension
= 0* (hyperE -10*)
tibial IR at 30* F
= 30*
tibial ER at 30* F = 45*
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Muscles about the knee joint
Name
Quads:
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Hamstrings:
Biceps femoris
Origin
AIIS
Lateral fem
Medial fem
Anterior fem
Insertion
Patellar
tendon/
ligament
Head of
fibula
Med tib cond
Med tib cond
Action
Innervation
Knee
extension
L2-L4
Femoral nerve
Knee
flexion
L5-S2
+ common
peroneal n.
Tibial portion
sciatic nerve
Semitendinosus
Semimembranosus
Ischial tub +
linea aspera
Ischial tub
Ischial tub
Popliteus
Lat fem cond Posterior tib
Lat rot fem
L5 tibial nerve
Gracilis
Inf pubic
ramus
Medial surf
tibial shaft
Knee
flexion
L2-L3
obturator n
Sartorius
ASIS
Med tib shaft
Lat rot fem
L2-3 femoral n
Gastrocemius
Med + lat
cond
Achilles
tendon
Knee flex
S1-2 tibial n
Biomechanical application
 1. Analyse the movements associated with mogul
skiing. What structures surrounding the knee joint
would be most susceptible to injury in this type of
sport?
 2. Describe the structures most at risk if an AFL
football player is tackled from in front and his
opponent lands across his outstretched leg.
 3. Determine which structures will be most affected in
a client who walks with a genu valgum gait pattern
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