Structure & Function of the Knee. One of the most complex simple structures in the human body.
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1 Structure & Function of the Knee One of the most complex simple structures in the human body.
2 Structure of the Knee Components of the knee Tibiofemoral joint Hinge joint Articulation between distal femur and proximal tibia Allows for : flexion, extension But not a true hinge, since also has a rotational component Patellofemoral joint Articulation between posterior surface of patella and the patellar surface of the femur Allows for : gliding of patella Lippert pg
3 Osteology of the Knee Distal femur (ADDuctor tubercle) Right Femur
4 Osteology of the Knee The proximal tibia & fibula The medial and lateral condyles of the tibia form the shallow articulations with the distal femur Fibular Head Tibial Tuberosity The intercondylar/intercondyloid eminence the attachment point for the cruciate ligaments Interosseous Membrane
5 Anatomy of the Knee: Anterior Aspect Femur Medial Condyle Articular Cartilage Quadriceps Tendon Tibia Tibial Plateau Tibial Tuberosity Patellar Tendon Fibula Medial Meniscus Lateral Meniscus Medial Collateral Ligament Lateral Collateral Ligament
6 Anatomy of the Knee: Posterior Aspect Femur Medial condyle Lateral condyle ADDuctor Tubercle Tibia Tibial plateau Fibula Fibular Head Medial Meniscus Lateral Meniscus Posterior Cruciate Ligament Lateral Collateral Ligament Medial Collateral Ligament Popliteal space
7 Anatomy of the Knee Cruciate Ligaments Anterior: (ACL) -resists anterior motion of the tibia on a fixed femur -resists extremes of knee extension Posterior: (PCL) -resists posterior motion of the tibia on a fixed femur -resists extremes of knee flexion
8 Alignment of the Knee Joint Genu valgum refers to a frontal deviation of the position of the knee. Commonly referred to as knock-knee due to the medial displacement of the knee Genu varum refers to a frontal deviation of the position of the knee. Commonly referred to as bow-leg
9 Alignment of the Knee Joint Genu varum refers to a frontal deviation of the position of the knee. Genu valgum refers to a frontal deviation of the position of the knee.
10 Alignment of the Knee Joint Genurecurvatum: Hyperextension of the tibiofemoral joint placing excessive stress on the structures in the popliteal space Tibial nerve Popliteal Vein Popliteal Artery Common Peroneal Nerve
11 Common Pathologies of the Knee Osgood-Schlatter s Disease Chondromalacia of the Patella
12 Common Pathologies of the Knee The menisci: absorb shock and disperse large compressive forces through the knee joint They may not heal well: inner 1/3: avascular (a) middle 1/3: poor blood supply (b) outer 1/3: good blood supply (c)
13 Myology of the Knee Anterior muscles Vastus lateralis Vastus medialis Vastus intermedialis Rectus femoris Posterior muscles Biceps femoris Popliteus Semimembranosus Semitendinosus Sartorius Gracilis Gastrocnemius Lateral muscle Tensor fascia latae Lippert pg 290
14 Myology of the Knee Your subtopic goes here Rectus Femoris Origin Insertion Innervation Femoral n. Action Anterior-inferior iliac spine Tibial tuberosity via the quadriceps tendon Hip flexion, knee extension tidbit One of the heads of the quads
15 Myology of the Knee Vastus Medialis Origin Insertion Innervation Femoral n. Action tidbit Medial lip of the linea aspera and the intertrochanterid line of the femur Tibial tuberosity via the patellar tendon Knee extension One of the heads of the quad VMO one of the first muscles of the knee to atrophy post-operatively, responsible for last o of knee extension Vastus Medialis Obliquus
16 Myology of the Knee Vastus Lateralis Origin Insertion Innervation Femoral n. Action tidbit Lateral lip of the linea aspera, intertrochanteric line, lateral region of the gluteal tuberosity Tibial tuberosity via the patellar tendon Knee extension Part of the quads
17 Myology of the Knee Vastus Intermedius Origin Insertion Upper 2/3 of the anterior femoral shaft Tibial tuberosity via the patellar tendon Innervation Femoral n. Action Knee extension
18 Q Angle of the Knee The line of force of the quadriceps can be described by the Q-angle. It identifies patellofemoral tracking. Females: -greater angle -greater incidence of patellofemoral joint pain Q Angle
19 Compression at the Patellofemoral Joint The Patella: -also known as the knee cap, is a thick, circular-triangular bone which articulates with the femur and covers and protects the anterior articular surface of the knee
20 Myology of the Knee Your subtopic goes here Semitendinosus Origin Insertion Ischial tuberosity Proximal-medial surface of the tibia (pes anserinus) Innervation Tibial portion of the sciatic n. Action tidbit Hip extension, knee flexion, One of the hamstrings
21 Myology of the Knee Your subtopic goes here Biceps Femoris Origin Insertion Ischial tuberosity Head of the fibula Innervation Tibial portion of the sciatic n. Action tidbit Hip extension, knee flexion One of the hamstrings A B C D Bicep F Bicep F Semimem Semiten A
22 Myology of the Knee Your subtopic goes here Semimembranosus Origin Insertion Ischial tuberosity Medial condyle of the tibia, posterior aspect Innervation Tibial portion of the sciatic n. Action tidbit Hip extension, knee flexion One of the hamstrings
23 Myology of the Knee Your subtopic goes here Sartorius Origin Insertion ASIS Innervation Femoral n. Action tidbit Proximal-medial surface of the tibia (via the pes anserinus) Hip flexion, hip ABD, Hip ER, knee flexion Longest muscle in the body
24 Myology of the Knee Your subtopic goes here Gracillis Origin Insertion Innervation Obturator n. Body and inferior ramus of the pubis Proximal-medial aspect of the tibia (pes anserinus) Action Hip ADD, hip flexion, knee flexion
25 What is the Pes Anserinus? The semitendinosus, sartorius and gracillis all attach to the proximal medial tibia through a broad sheet of connective tissue known as the pes anserinus. The 3 muscles: -originate from different bones on the pelvis -perform different actions at the hip -are innervated by different nerves The all perform the following at the knee: -flexion -medial stability
26 Myology of the Knee Popliteus Origin Insertion Innervation Tibial n. Action Posterior aspect of the lateral femoral condyle Posterior surface of the proximal tibia Initiates knee flexion
27 Myology of the Knee Gastrocnemius Origin Insertion Innervation Tibial n. Action Medial head: posterior aspect of the medial femoral condyle Lateral head: posterior aspect of the lateral femoral condyle Calcaneal tuberosity via the Achilles tendon Flexion of the knee, plantar flexion,
28 What can you identify? (in her knee) Quadriceps Vastus medialis Vastus lateralis Vastus intermedius? Rectus femoris Sartorius Anything else?
29 Common Knee Pathologies Genu valgum Genu varum Genu recurvatum Patellar tendonitis TTP at the patellar tendon Osgood Schlatter disease Chondromalacia patella Patellofemoral pain syndrome Causes diffuse anterior knee pain Terrible triad Tear of ACL, MCL, medial meniscus Lippert pg 295
30 How do you stretch the knee flexors? How do you strengthen the knee flexors? How do you stretch the knee extensors? How do you strengthen the knee extensors? Open chain? Closed chain?
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