Anatomy of the Knee, Lower Leg and Foot By Joshua Bower Peer Support 2013/14

The Knee

What type of joint is the knee? What movements does it permit? [3] Modified synovial hinge joint Flexion-extension Rotation (medial and lateral) Translocation

How many articulations are present at the knee? 3 (2x femero-tibial, 1x femero-patellar)

What are the menisci? Give FOUR functions [4] Crescent-shaped pieces of fibrocartilage which sit on the tibial condyles Increase surface area Weight bearing Shock absorbing Locking mechanism participation

https://www.youtube.com/watch?v=whFkZxaLxe4#t=303 Knee Arthroscopy

Give THREE functions of the patella [3] Reduce ligament strain Spread forces passing to femoral condyles Increases movement (mechanical bending force) of quadriceps

What ligaments are present in the knee? Anterior cruciate ligament Posterior cruciate ligament Medial collateral ligament Lateral collateral ligament

A 35 year old male tears his medial collateral ligament during a football match. What else might be damaged and with what consequence? The medial meniscus, as it is attached to the MCL. This typically leads to pain and swelling at the knee, and the patient may be unable to fully extend their leg.

What bursae are present around the knee What bursae are present around the knee? What is their bursitis known as?

What happens when the knee goes into full extension What happens when the knee goes into full extension? How is this reversed? The knee undergoes a passive movement, whereby the femur rotates medially on the tibia and ‘locks’. The ligaments are under tension, stabilising the knee joint. Unlocked by popliteus (lateral rotation)

The Leg

Compartments? Functions? Nerve supply? Blood supply? Anterior Compartment Foot & digit dorsiflexors & invertors Deep fibular nerve (L4,5,S1) Anterior tibial artery

Compartments? Functions? Nerve supply? Blood supply? Lateral Compartment Foot evertors Superficial fibular nerve (L5,S1) Fibular artery

Compartments? Functions? Nerve supply? Blood supply? Posterior Compartment Foot & digit plantarflexors & invertors Tibial nerve (L4,5, S1,2) Posterior tibial artery

Daylight Savings Time = DST Nerve supply tip Daylight Savings Time = DST

Anterior compartment 1 Tibialis anterior (L4) Loss? 2 Extensor digitorum (L5) Extensor hallucis (L5) 2 3

A 17 year old female was hit by a moving car on the lateral side of her knee. Why is she at risk of foot drop? Common fibular nerve is subcutaneous at the head of the fibula and at risk of damage/compression

Describe the surface anatomy of the dorsalis pedis artery

Lateral compartment 1 Fibularis longus (L5, S1) Fibularis brevis (L5, S1) 2

Posterior compartment 1 Soleus (S1-2) Gastrocnemius (S1-2) 3. Tibialis posterior (L4,5) 4. Flexor digitorum (S1,2) 5. Flexor hallucis (S1,2) 2 3 4 5 Loss of this compartment? Weak push off

The tendo-calcaneus reflex tests what nerves?

Arterial supply Popliteal artery 1 Anterior tibial artery 2 Posterior tibial artery Fibular artery 1 2 3 4

Greater saphenous vein Venous Supply Greater saphenous vein Lesser saphenous vein

The Ankle and Foot

What type of joint is the ankle? What bones articulate? Synovial hinge joint Talus, fibula and tibia

Talus Cuboid Navicular Cuneiforms (medial, intermediate, lateral) Tiger Cubs Need MILC 4 3 1 2

Which is dorsiflexion? Plantarflexion Dorsiflexion

(Turn the bottom of your foot INwards) Which is inversion? Inversion Eversion (Turn the bottom of your foot INwards)

List the contents of the tarsal tunnel [7]

What ligaments are present at the ankle? Medial collateral (deltoid) x4 Tibio-x (-calcaneal, anterior -talar, posterior -talar, - navicular) Lateral collateral x3 x-fibular (calcaneo-, ant and post talo-)

Lateral (it is weaker than the deltoid) Basic diagnosis? Patient landed on his foot ‘funny’, and now cannot weight-bear. There is swelling at the ankle and pain. Malleolar avulsion fracture Do you expect the pain to be on the medial or lateral ankle? Lateral (it is weaker than the deltoid)

What is it called if the arch support is lost? Name the foot arches What is it called if the arch support is lost?

Arterial supply 1 Digital arteries Plantar arch Lateral plantar artery Medial plantar artery Posterior tibial artery 2 3 4 5