1. Knee Anatomy Principles of Orthopaedics and Trauma Care module January 2009 Alison Holman

2. The knee joint Complex Large Comprises how many joints ? Joint Biomechanics are very important

3. Surface Anatomy Using the resource of www.an@tomy.tv, on the next slide, please label the structures : A, B & C.www.an@tomy.tv Self examine or practice on a colleague to locate these structures, - Look - Feel - Move

4. Surface anatomy of the knee B A C

5. The Knee has 3 Joints Lateral Tibio-femoral joint - between the lateral femoral condyle, lateral meniscus & lateral condyle of the tibia Medial Tibio-femoral joint - between the medial femoral condyle, medial meniscus & medial condyle of the tibia Patello-femoral joint - between the patella and the patello-femoral surface

6. Clinical Application Examine the picture on the next page and work out,  how the tibia is likely to connect ?  at what angle (varus or valgus) ?  the implications for joint disease ? * A line has been drawn in green to suggest the line of the tibia.

7. Hip / knee alignment

8. Extra Capsular Ligaments Comprise a sheath of ligaments surrounding the joint consisting mostly of muscle tendons or their expansions. The most obvious of these to the eye and on examination are the fused tendons of the Quadriceps Femoris. The power of the quadriceps musculature is important in the stability of the knee.  Name the 4 muscles of the quadriceps complex & their origins

9. Ligaments that strengthen & support the knee joint Patella Ligament Medial & lateral Patellar Retinacula Oblique Popliteal Ligament Arcuate Popliteal Ligament Medial Collateral Ligament Lateral Collateral Ligament

10. Application to practice Using an@tomy.tv, label the identified structures on the next sheets. Then consider the ligament structures, their function & associated injuries you may have encountered. or from the media & SPORTING HEROES …?

11. Knee, Anterior view (Knee close up, layer 11) A B C

12. Knee, Posterior view (Knee close up, layer 10) A B

13. Knee, medial aspect (Knee close up, layer 11) ?

14. Knee, lateral aspect ( Knee close up, layer 11) ?

15. Intra Articular Ligaments Cruciate Ligaments from the word ‘ cross’ Anterior Cruciate Ligament (ACL), extends posteriorally & laterally from the area in front of the intercondylar eminence of the tibia, to the posterior part of the medial surface of the lateral femoral condyle. It resists forward movement of the femur on the tibia Label the Anterior Cruciate & related Ligament and any other interesting structures!

16. Anterior knee (Knee close up, layer 6) A B C

17. Posterior Cruciate Ligament (PCL) It extends anteriorly & medially from a depression of the posterior medial intercondylar area and the lateral meniscus to the anterior part of the femoral medial condyle. It resists backward displacement of the tibia Label the Posterior Cruciate & related Ligaments

18. Knee – posterior view (knee close up, layer 6) A B

19. Bursae ! Exercise: What is the function of the bursae … ? Name 4 important bursae

20. Menisci Structure : 2 Fibrocartilage discs Poor vascular supply Circumferential and radial fibres Semi-lunar shape, triangular in cross section, peripherally attached to the tibial plateau

21. Tibial Plateau & Menisci ? ?

22. Menisci Function : Deepens tibial plateau Joint stabiliser Transmits 50% of the compressive load in extension Transmits 85% of the compressive load in 90 degree flexion

23. Nerve Supply : derives from sciatic nerve which divides into Tibial & Common Peroneal nerve dermatomes - L1 - L5 supply front of the thigh, medial/lateral leg areas & sole of foot. Blood Supply : derives from External Iliac artery, becoming the Femoral artery then the Popliteal artery Venous drainage from External Iliac vein becoming the Femoral vein, then the Popliteal vein + also from the Right Saphenous vein

24. Knee Joint Movement & Muscles Flexion, - by hamstrings assisted by gracilis, gastrocnemius & sartorius Extension, - by quadriceps femoris Medial rotation, - by popliteus

25. The knee joint References: An@tomy.tv