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Knee joint and Muscles of Leg Dr. Sama ul Haque.

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Presentation on theme: "Knee joint and Muscles of Leg Dr. Sama ul Haque."— Presentation transcript:

1 Knee joint and Muscles of Leg Dr. Sama ul Haque

2 Objectives Name and identify the bony features of the tibia and fibula. Know the type and formation of knee joint. Explain the stability factors of the knee joint. Identify the muscles that act at the knee joint. Know the locking and unlocking mechanism of the knee joint. Understand the functions of the Popliteus and Iliotiabial tract.

3 Objectives Identify the neurovasculature behind the knee (popliteal fossa) and in the leg. Enlist the contents of the muscular compartments of the leg. Identify the muscles of the leg in terms of their origin, insertion, nerve supply and actions. Enlist the muscles causing plantar flexion, dorsiflexion, eversion, inversion, flexion of digits and extension of digits.

4 Femur

5 Tibia and Fibula Anterior View

6 Tibia and Fibula Posterior View

7 Anterior. Patella articulates with the femur.
Sagittal section thru knee Tibia: Condyles Tibial tuberosity Tibia and fibula are united by an interosseous Membrane. [Proximal and distal tibio-fibular joints] The fibula is not part of the knee joint. Head of Fibula Patella articulates with the femur. interosseous membrane

8 During the entire range of knee flexion, the patella only articulates
with the femur. KNEE. Modified hinge jt. -flexion / extension (some rotation)

9 Superior view of tibial surface.
Tibial Condyles Tibial Condyles Medial and lateral articular surfaces, separated by an intercondylar eminence. Medial and lateral Meniscii: Fibrocartilage shock-absorbers that sit on surface of tibial condyles and deepen the articular surface. Anterior and posterior Cruciate ligaments (ACL, PCL): -hold femur and tibia together -stabilize knee joint lateral articular surface medial articular surface intercondylar eminence lateral meniscus PCL medial meniscus ACL

10 tibia at their ends (horns).
Medial and lateral femoral condyles have same shape as corresponding tibial condyles: Medial – elongated Lateral – circular Meniscii: Each is attached to tibia at their ends (horns). Femur

11 Anterior Cruciate Ligament:
- Weaker of the two, slack when knee is flexed & tightens in extension. - Prevents hyperextension. Posterior Cruciate Ligament: - Tightens during flexion of knee joint


13 Pes anserinus: Common insertion of Sartorius, gracilis, semitendinosus
Stabilization of the medial knee: Tibial collateral ligament. A flat strap which is attached to the medial aspect of tibia and medial femoral epicondyle. Its deeper fibres are attached to the medial meniscus. tibial collateral ligament Joint capsule Retinacular fibres Pes anserinus: Common insertion of Sartorius, gracilis, semitendinosus

14 Fibular collateral ligament
Stabilization of the lateral knee: Fibular collateral ligament - a cord which is attached to the head of the fibula and the lateral epicondyle of the femur. *Its deep fibers are not attached to the meniscus. Ilio-tibial band fibular collateral ligament Biceps femoris Head of fibula

15 Important details for the Knee
Remember the 3 C’s: -cartilage -cruciates -collaterals Unhappy triad - common associated injury to: ACL (anterior cruciate ligament) MCL (Medial / tibial collateral ligament) medial meniscus

16 Anterior knee in extension
Fibrous capsule of the KNEE (anterior): Stabilized by: Extensor Retinacula - Derived from insertions of vastus lateralis and vastis medialis into patella and into sides of patellar ligament. Vastus lateralis Vastus medialis extensor retinacula Patellar Ligament

17 Posterior knee in extension
Fibrous capsule of the KNEE (posterior): Thickened by ligaments: -Arcuate popliteal ligament (arching over popliteus muscle) -Oblique popliteal ligament (from tendon of insertion of semimembranosus m.) arcuate popliteal ligament Tendon of Semimembranosus oblique popliteal ligament Popliteus

18 Bursae of Knee Joint: Sagittal section shows: - Suprapatellar bursa
(extension of synovium under tendon of quadriceps femoris) Subcutaneous bursae: - Prepatellar, - Infrapatellar (2): (superficial & deep to patellar ligament). suprapatellar bursa prepatellar bursa infrapatellar bursae

19 Popliteal Fossa Popliteal fossa Diamond-shaped region
Posterior to knee -semimembranosus / semitendinosus -biceps femoris -medial & lateral heads of gastrocnemius. Contents: -popliteal vessels (from femoral vessels) -Tibial and Common fibular (peroneal) divisions of the sciatic nerve. Superficial: -Small saphenous vein draining into popliteal vein

20 Popliteal fossa

21 Muscles that act on the knee (modified hinge joint):
Main movement = flexion / extension Flexion – mainly hamstrings (+ Sartorius, gracilis, gastrocnemius) Extension – mainly quadriceps (+ tensor fascia lata) Rotation (possible when the knee is partially flexed, or in the final stage of extension): [here defined as rotation of tibia with respect to the femur] Medial rotation – semitendinosus, semimembranosus popliteus (extended knee) Lateral rotation – biceps femoris

22 -held together by an interosseus membrane.
LEG. Tibia and fibula: -held together by an interosseus membrane. -anterior border of tibia is subcutaneus from the tibial condyles to its distal end. [Shin] -only the distal ¼ of fibula is subcutaneus The distal ends are held together to form the proximal articular surface of ankle. Each ends subcutaneusly as a Malleolus (medial – tibial and lateral - fibular). Proximal and distal tibio-fibular joints interosseous membrane Medial malleolus Lateral malleolus

23 Mid-shaft cross-section of leg:
Functional compartments. Fascial compartments: -anterior -lateral -posterior (superficial & deep) anterior compartment (dorsiflexion, extension of digits) deep posterior compartment (plantarflexion) lateral Compartment (eversion) superficial posterior compartment (inversion, flexion of digits)

24 Plantarflexion / dorsiflexion: (ankle joint)
Flexion / extension: (digits) Inversion / eversion: Complex twisting movement at transverse tarsal and subtalar joints. [inter-tarsal joints]

25 Anterior compartment of leg:
-tibialis anterior -extensor hallucis longus -extensor digitorum longus (fibularis tertius) All supplied by the deep fibular (peroneal) nerve. Hallux = big toe [hallucis] Tendons are bound down by extensor retinaculum as they cross the ankle jt. Function: -dorsiflexion (ankle) -extension (digits) -inversion tibialis anterior extensor digitorum longus extensor hallucis longus extensor retinaculum

26 DROP FOOT?????? Common Fibular n. Deep dissection Anterior view:
Note vulnerability of common fibular nerve as it winds around the neck of fibula. Deep Fibular n. Superficial Fibular n. Tibialis Anterior extensor digitorum longus extensor hallucis longus DROP FOOT??????

27 Lateral compartment of leg: - Fibularis (peroneus) longus
- Fibularis (peroneus) brevis -both supplied by the superficial fibular (peroneal) nerve. Tendons are bound down by fibular retinaculum as they pass behind the lateral malleolus. Functions: - eversion - plantarflexion Fibularis longus Fibularis brevis Fibularis tertius peroneal retinaculum FIBULARIS=PERONEUS

28 Posterior compartment of leg:
Superficial medial & lateral heads of gastrocnemius Insert into calcaneus (heel) Function –plantar flexion Innervated by Tibial nerve. gastrocnemius Achilles tendon (calcaneal tendon)

29 Deeper dissection of superficial posterior compartment:
- medial & lateral heads of gastrocnemius - soleus - (plantaris) Common tendon: Calcaneal (achilles) tendon - insert into calcaneus (heel) Function – plantar flexion Innervated by Tibial nerve. plantaris soleus

30 Popliteus

31 Posterior (deep) compartment of leg:
-Tibialis posterior -Flexor digitorum longus -Flexor hallucis longus Tendons are bound down by flexor retinaculum as they pass into foot behind the medial malleolus. Functions: -plantarflexion -flexion -inversion Innervated by Tibial nerve. flexor digitorum longus flexor hallucis longus tibialis posterior flexor retinaculum

32 Blood supply to the lower limb: Thigh: Femoral artery and branches:
(profunda, medial & lateral circumflex) Behind knee: Popliteal artery Leg: divides into anterior and posterior tibial arteries. to supply these compartments. The posterior tibial artery gives off the fibular (peroneal) artery to supply the lateral compartment. popliteal a. posterior tibial a. anterior tibial a. fibular artery

33 Cutaneus innervation of thigh and leg:
Anterior Posterior Anterior, lateral, medial thigh ( lumbar plexus). - branches of femoral n. - lateral femoral cutaneous n.) Posterior thigh – from sacral plexus. Anteromedial leg – branch of femoral n. (Saphenous nerve). Posterolateral leg – from Sciatic n. (Sural nerve). Anterior leg: - From Sciatic n. (Superficial fibular n.) Post. femoral cutaneous n. saphenous nerve sural nerve L4 S1

34 Superficial drainage of the lower limb
Varicose veins Great Saphenous vein: Drains into femoral vein in femoral triangle Small Saphenous vein: Drains into popliteal vein

35 Thank you

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