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Clinical Anatomy of the knee Mr CM Gupte Mr Alvin Chen
Overview Knee joint function Surface anatomy Bones Ligaments Tendons Examination Disease processes
The Knee Joint Poorly constructed in terms of stability - femur round, tibia flat. Comprised of four bones. Femur Tibia Fibula Patella
The knee joint Load bearing / Force transmission Locomotion Proprioception
Bones Patella: femur = patellofemoral joint Femur: tibia = medial and lateral tibiofemoral joints
Knee Arthroscopy Surface Landmarks
Patella Medial facet Lateral facet Articular cartilage
Femur Medial femoral condyle Lateral femoral condyle (protrudes more) Trochlea Articular cartilage
Femoral ligament insertions PCL inner aspect medial femoral condyle ACL inner aspect lateral femoral condyle
Tibia Medial and lateral plateau Insertions of menisci and cruciate ligaments MCL/ semimembranosus
Tibial plateau Insertions of menisci/ Cruciate ligaments
Ligaments Extracapsular: MCL/ LCL Intracapsular: ACL/PCL Functions: Stabilise Proprioception
ACL Two bundles Prevents anterior drawer and pivot
MRI Normal ACL in RED Torn ACL
Tests for ACL Lachman’s Anterior Draw
Arthroscopy Intact ACLTorn ACL
PCL Stronger than ACL Prevents posterior drawer
PCL injury Direct Blow onto Tibia on a flexed knee
MRI PCL Normal PCL PCL torn
Posterior Sag from PCL rupture
MCL Medial Prevents valgus stress Deep and superficial parts Heals well
LCL Lateral Prevents varus stress Cord like –weakest of the ligaments but rarely torn in isolation
Extensor mechanism Quadriceps Patella Patellar tendon
Quadriceps VMO Rectus femoris Vastus intermedius Vastus lateralis Extend knee
VMO Medial most quad Helps prevent lateral dislocation of the patella
Extensor Mechanism injuries I
Extensor Tendon Injuries II
Extensor Tendon Injuries III
Hamstrings Biceps laterally Semitendinosus/semimembranosus medially Flex knee
Pes Sartorius Gracilis Semitendinosus G and T used for ACL reconstruction
Movements of the Knee The principal muscles acting on the knee: Extensors - quadriceps femoris Flexors -hamstrings assisted by gracilis, gastrocnemius and sartorius. Medial rotators-popliteus.
Movements of the Knee The principal knee movements are flexion and extension, but rotation of the knee is possible when the joint is in flexed position.
Examination Look Feel Move Think about structures and what you’re dong to them
Diseases OA Meniscal tears Ligament injuries Patellofemoral tracking Tendon injuries Inflammatory arthritis Infection/tumours
Arthritic Knee X-ray
Knee OA on arthroscopy
Total Knee Replacement
Patellofemoral Knee Replacement
Unicondylar Knee Replacement
Treatment of Meniscal Tears Suture/ RepairDebridement
Other Pathologies Patella Maltracking Bone Tumour
Any Questions ?
Knee joint Skeleton Muscle ligament. skeleton Femur Tibia Fibula ( 未參與 knee joint) patella.
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