KNEE ANKLE

KNEE JOINT

ARTICULATION Between the condyles of the femur and the condyles of the tibia. Anteriorly, an articulation between the lower end of the femur and the patella. Prof. Makarem

TYPE Between the femur & the tibia it is a Synovial modified hinge joint, with some degree of rotatory movement. The joint between the femur and patella is a synovial plane gliding joint. Prof. Makarem

CAPSULE Attached to the margins of the articular surfaces and surrounds the sides and the posterior aspect of the joint. Prof. Makarem

The capsule is absent anteriorlly. It is replaced anteriorly by the quadriceps tendon, patella & Ligamentum patellae. Prof. Makarem

The capsule is strengthened on each side of the patella by expansions of the tendons of vastus lateralis and medialis and posteriorly by the expansion of the semimemranous muscle (oblique popliteal ligament). Prof. Makarem

SYNOVIAL MEMBRANE Attached to the margins of the articular surfaces. Lines the interior of the capsule. Forms several bursae around the joint. Prof. Makarem

EXTRACAPSULAR LIGAMENTS Ligamentum patellae: between the lower border of the patella & the tuberosity of the tibia. It is a continuation of the tendon of quadriceps femoris. Lateral collateral ligament: between the lateral condyle of femur and the head of the fibula. Medial collateral ligament: between the medial condyle of the femur and medial side of the shaft of the tibia (behind SGS). Firmly attached to the edge of the medial meniscus. Prof. Makarem

Oblique popliteal ligament: strengthens the posterior side of the capsule. Prof. Makarem

Anterior cruciate ligament: INTRACAPSULAR LIGAMENTS CRUCIATE LIGAMENTS Anterior cruciate ligament: Between the anterior intercondylar area of the tibia and the posterior part of the medial surface of the lateral femoral condyle. Function: prevents posterior displacement of the femur on the tibia. In flexed knee, prevents the tibia from being pulled anteriorly. Prof. Makarem

Posterior cruciate ligament: Between the posterior intercondylar area of the tibia and the anterior part of the lateral surface of the medial femoral condyle. Function: prevents anterior displacement of the femur on the tibia. In flexed knee, prevents the tibia from being pulled posteriorly. Prof. Makarem

MENISCI C-shaped intracapsular ligaments. Prof. Makarem

The peripheral border is thick and attached to the capsule, the inner border is thin and free. Each meniscus is attached to the upper surface of the tibia by anterior and posterior horns. The medial meniscus is firmly attached to the medial collateral ligament. Prof. Makarem

Function: to deepen the articular surface of the tibial condyles and to serve as shock absorber. Prof. Makarem

3- Superficial infrapatellar: BURSAE ANTERIOR 1- Suprapatellar: beneath the quadriceps femoris. 2- Prepatellar: between the skin and the patella. 3- Superficial infrapatellar: beween the skin and the lower part of ligamentum patellae. 4- Deep infrapatellar: between ligamentum patellae and the tibia. Prof. Makarem

POSTERIOR 1- Popliteal: beneath the tendon of popliteus muscle 2- Semimembranous: under the tendon of semimembranous muscle Prof. Makarem

MOVEMENTS Flexion: biceps femoris, semitendinosus and semimembranosus, assisted by gracilis, sartorius and popliteus. Limited by contact with the back of thigh. Extension: quadriceps femoris. Limited by tension of the joint ligaments. Medial rotation: sartorius, gracilis and semitendinosus. Lateral rotation: biceps femoris. Stability of the joint: dependent on the tone of the muscles and the strength of the ligaments. Prof. Makarem

It is necessary to start flexion. Locked position: in full extension, the femur is medially rotated, producing tightening of all of the ligaments and compression of the menisci. Unlocking: by contraction of the popliteus muscle, producing lateral rotation of the femur. It is necessary to start flexion. Prof. Makarem

INJURIES Common injury: when the knee is twisted while running Prof. Makarem

ARTHROSCOPY Prof. Makarem

BURSITIS Prof. Makarem

ANKLE JOINT

ARTICULATION Between the distal end of the tibia, the two malleoli and the body of the talus. Type: synovial hinge joint. Prof. Makarem

Medial (deltoid) ligament: LIGAMENTS Medial (deltoid) ligament: from the tip of the medial malleolus to: 1- talus, 2- plantar calcaneonavicular ligament and 3- tuberosity of the navicular bone. Prof. Makarem

anterior talofibular ligament: Lateral ligament: 3 bands anterior talofibular ligament: from the lateral malleolus to the lateral surface of the talus. calcaneofibular ligament: from the lateral malleolus to the lateral surface of the calcaneum. posterior talofibular ligament: from the lateral malleolus to the posterior tubercle of the talus. Prof. Makarem

MOVEMENTS Dorsiflexion: Tibialis anterior, Extensor hallucis longus, 3. Extensor digitorum longus and Peroneus tertius. Plantar flexion: Gastrocnemius, Soleus, Plantaris, Peroneus longus, Peroneus brevis, Tibialis posterior, Flexor digitorum longus and Flexor hallucis longus. Prof. Makarem

MEDICAL IMAGING Prof. Makarem

INJURIES Sprained ankle: Usually inversion injury. Severe sprains lead to torn lateral ligament and fracture of the lateral malleolus and result in instability of the ankle joint. Prof. Makarem