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Kin191 A.Ch.6.Knee.Patellofemoral.Anatomy
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Kin191 A.Ch.6.Knee.Patellofemoral.Anatomy

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    • 1. KIN 191A Advanced Assessment of Lower Extremity Injuries KNEE /PATELLOFEMORAL ARTICULATION ANATOMY
    • 2. INTRODUCTION
      • ANATOMY
        • BONY STRUCTURES
        • ARTICULATIONS
        • LIGAMENTS
        • MENISCI
        • MUSCLES
        • BURSAE
        • NEUROANATOMY
        • VASCULAR ANATOMY
    • 3. BONY STRUCTURES
      • Femur
      • Tibia
      • Patellar
      • Fibular (Head)
    • 4. Femur
      • Distal end of the femur
        • Medial and lateral condyles  articulate with the tibia
        • Articular surface of medial condyle is longer than lateral condyle
        • Condyles share a common anterior surface, then diverge posteriorly, Intercondylar notch
    • 5.
      • Distal end of the femur
        • Anterior depression, femoral trochlea
          • Patellar glides it with the knee flexion/extension
    • 6. Video
    • 7.
        • Lateral epicondyle is wider and emanates from the femoral shaft at a less angle then the medial epicondyle
      • Linea aspera
        • Posterior ridge along medial and lateral lips
    • 8.
      • Adductor tubercle
        • Arises off the superior crest of the medial epicondyle
    • 9. Tibia
      • Medial and lateral tibial plateaus
        • Medial plateau: concave in both the frontal and sagittal planes
          • 50% larger than L.
        • Lateral plateau: concave in the frontal plane and convex in the sagittal plane
      Medial Lateral Anterior Posterior
    • 10.
      • Intercondylar eminence
        • Raised area between the tibial plateaus
        • Match the femur ’ s intercondylar notch
    • 11.
      • Tibial tuberosity
        • Infrapatellar tendon attachment site
    • 12. Patellar
      • Superior pole (Base), quadriceps femoris tendon attachment
      • Inferior pole (Apex), infrapatellar tendon attachment
      L M
    • 13.
      • Anteriorly protected/covered by prepatellar bursa
    • 14. Patellar
      • Lateral facet
        • Broader &
        • More concave than medial facet
      • Medial facet
        • Shallower
      • 3 rd facet
        • Contact with the medial femoral condyle in extreme flexion of the knee
      Lateral Medial
    • 15. Fibula
      • Head
        • Muscular and ligamentous attachment site
        • Biceps femoris, soleus, peroneus longus
        • LCL, Arcuate ligament, popliteofibular ligament, meniscofibular ligament
    • 16. Arcuate Ligament Popliteus Popliteal Artery
    • 17. ARTICULATIONS
      • Tibiofemoral joint
      • Petellofemoral joint
      • Proximal tibiofibular joint
      • Joint capsule
    • 18. Tibiofemoral Joint
      • Double condyloid articulation
      • 2 degrees of freedom
        • Flexion and Extension
        • Internal and External rotation
        • Other movements: valgus and varus bending & anterior and posterior glide (accessory motions)
    • 19. Joint Capsule
      • Anteriorly,
        • Arises superior to the femoral condyles and attaches distal to the tibial plateau
      • Posteriorly
        • Inserts on the posterior margins of the femoral condyles above the joint line and
        • Inferiorly, to the posterior tibial condyle
    • 20.
      • The strength of the capsule is reinforced by
        • Medial collateral ligament (MCL)
        • Patellofemoral ligament
        • Medial and lateral retinaculum
        • Posterioly,
          • Oblique popliteal ligament and arcuate ligament
        • Anteriorly,
          • Patellar tendon
        • Muscles that cross the knee joint
    • 21. Arcuate (Popliteal) Ligament Popliteus Oblique Popliteal Ligament Popliteus Fascia
    • 22.
      • Synovial capsule
        • Lines the articular portions of the fibrous joint capsule
        • Synovium surrounds the articular condyles of the femur and tibia medially, anteriorly and laterally
        • Invaginates anteriorly along the femur ’ s intercondylar notch and tibia ’ s intercondylar eminences
          • Excluding the cruciate ligaments from the synovial membrane
    • 23. LIGAMENTS
      • Anterior Cruciate Ligament
      • Posterior Cruciate Ligament
      • Medial (Tibial) Collateral Ligament
      • Lateral (Fibular) Collateral Ligament
      • Arcuate Ligament Complex
      • Proximal Tibiofibular Ligaments
    • 24. A nterior C ruciate L igament
      • Arises from the anteromedial intercondylar eminance of the tibia, travels posterioly, and
      • Passes lateral to the posterior cruciate ligament to insert on the medial wall of the lateral femoral condyle
    • 25.
    • 26.
      • 1. MCL
      • 2. Medial condyle of
      • femur
      • 3. PCL
      • 4. Anterior
      • meniscofemoral L.
      • 5. ACL
      • 6. Lateral condyle of
      • femur
      • 7. Popliteus
      • 8. LCL
      • 9. Biceps tendon
      • 10. Lateral condyle
      • of tibia
      • 11. Lateral meniscus
      • 12. Medial meniscus
      • 13. Medial condyle of
      • tibia
      • 14. Posterior
      • meniscofemoral L.
      • 15. Capsule of
      • superior tibiofibular
      • joint
      • 16. Apex of head of fibula
    • 27.
      • ACL serves as a static stabilizer against
        • Femur from moving posteriorly during weight bearing (anterior translation of the tibia on the femur)
        • Internal rotation of the tibia on the femur
        • External rotation of the tibia on the femur
        • Hyperextension of the tibiofemoral joint
        • Secondary restraint for valgus and varus stress with collateral ligaments
        • Anteromedial bundle
          • Taut when the knee is fully flexed
        • Postolateral bundle
          • Taut when the knee is fully extended
    • 28. Video Lateral View
    • 29. P osterior C ruciate L igament
      • Arises from the posterior aspect of the tibia and takes a superior and anterior course, and
      • Passing medially to the ACL, to attach on the lateral portion of the femur ’ s medial condyle
      • The primary stabilizer of the knee
        • Stronger and wider than the ACL
    • 30.
    • 31.
      • Posterior cruciate ligament (PCL) serves as a static stabilizer against
        • Femur from moving anteriorly during weight bearing (posterior translation of the tibia on the femur)
        • External rotation of the tibia on the femur
        • Hyperextension of the tibiofemoral joint
        • Anterolateral bundle
          • Taut when the knee is between 40-120 degrees of flexion
        • Postomedial bundle
          • Taut when the knee is beyond 120 degrees of flexion
    • 32. Video Medial View
    • 33. Video Posterior View
    • 34. Medial Collateral Ligament
      • Primarily medial stabilizer of the knee
      • Protect the knee against valgus forces
        • Also providing a secondary restraint against external rotation
    • 35.
      • Formed by two layers
        • Deep layer is a thickening of the joint capsule
        • Attached to the medial meniscus
        • Separated from the deep layer by a bursa
        • Superficial layer arises from a broad band just below the adductor tubercle to insert on a relatively narrow site 7 to 10 cm below the joint line
    • 36.
        • As a unit, the two layers of the MCL are tight in complete extension
        • As the knee flexed to the mid range
          • Anterior fibers are taut
        • In complete flexion
          • The posterior fibers are tight
    • 37. Video
    • 38. Lateral Collateral Ligament
      • Primarily restraint against varus forces when the knee is between full extension and 30 degrees of flexion
        • Provides secondary restraint against internal and external rotation of the tibia and the femur
    • 39.
      • No attachment to the joint capsule or meniscus
      • A cordlike structure arises from the lateral femoral epicondyle, sharing a common site of origin with the lateral joint capsule, and inserts on the proximal aspect of the fibular head
      • Taut during knee extension but relaxed during flexion
    • 40. Video
    • 41. Arcuate Ligament Complex
      • Supports to the posterlateral joint capsule
      • Arcuate ligament
      • Lateral collateral ligament
      • Oblique popliteal ligament
      • Popliteus tendon
      • Lateral head of gastrocnemius
    • 42. Arcuate Ligament Popliteus Popliteal Artery LCL
    • 43. Arcuate (Popliteal) Ligament Popliteus Oblique Popliteal Ligament Popliteus Fascia LCL
    • 44. Proximal Tibiofibular Ligaments
      • Proximal anterior and posterior tibiofibular ligaments (proximal syndesmosis joint)
    • 45. MENISCI
      • Deepen the articular facets of the tibia
        • Increase the stability of the joint
      • Improve lubrication for the articular surfaces
      • Cushion any stress placed on the knee joint
      • Maintain spacing between the femoral condyles and tibial plateau
    • 46.
      • Medial meniscus
        • “ C” shaped fibrocartilage, larger
      • Lateral meniscus
        • “ O” shaped fibrocartilage, smaller
    • 47. Meniscal Blood Supply
    • 48.
      • Coronary ligament
      • Transverse ligament
      • Meniscofemoral ligaments
        • Anterior: ligament of Humphrey
        • Posterior: ligament of Wrisberg
    • 49.  
    • 50. MUSCLES
      • Anterior – Quadriceps
      • Posterior – Hamstrings
      • Medially – Pes anserine group
      • Laterally – Il l iotibial band
    • 51. Anterior Musculature
      • Rectus femoris
      • Vastus lateralis
      • Vastus intermedius
      • Vastus medialis
    • 52. Rectus Femoris
      • O: AIIS
      • I: Tibial tuberosity via infrapatellar tendon
      • N: Femoral
      • A: Knee extension, hip flexion
    • 53. Vasti Muscles
      • O: VL – Greater trochanter, upper ½ of linea aspera; VI – Anterolateral upper 2/3 of femur, lower ½ of linea aspera VM – Distal intertrochanteric line, medial linea aspera
      • I: Tibial tuberosity via infrapatellar tendon
      • N: Femoral
      • A: Knee extension
    • 54. Posterior Musculature
      • Biceps femoris
      • Semimembranosus
      • Semitendinosus
      • Popliteus
      • (Gastrocnemius)
    • 55. Biceps Femoris
      • O: Long – ischial
      • tuberosity; Short – lateral linea aspera, upper 2/3 of supracondylar line
      • I: Fibular head, lateral tibial plateau
      • N: Long – tibial Short – common peroneal
      • A: Knee flexion, Hip extension (long H.), Knee external rotation
    • 56. Semimembranosus
      • O: Ischial tuberosity
      • I: Posteromedial of medial tibial plateau
      • N: Tibial
      • A: Knee flexion, Hip extension, Knee internal rotation
    • 57. Semitendinosus
      • O: Ischial tuberosity
      • I: Medial tibial flare (pes anserine)
      • N: Tibial
      • A: Knee flexion,
      • Hip extension, Knee internal rotation
    • 58. Popliteus
      • O: Lateral femoral condyle
      • I: Posteromedial tibia
      • N: Tibial
      • A: Knee internal rotation,
      • Knee flexion
    • 59. Pes Anserine Muscles
      • Sartorius (most anterior)
      • Gracilis (middle)
      • Semitendinosus (most posterior)
    • 60. Sartorius
      • O: ASIS
      • I: Anteromedial tibial flare (pes anserine)
      • N: Femoral
      • A: Hip flexion,
      • Hip abduction,
      • Hip external rotation
      • Knee flexion
    • 61. Gracilis
      • O: Symphysis pubis, inferior ramus of pubic bone
      • I: Anteromedial tibial flare (pes anserine)
      • N: Obturator
      • A: Hip adduction,
      • Hip flexion,
      • Knee flexion
    • 62. Iliotibial Band/TFL
      • O: Anterior superior iliac crest
      • I: Anterolateral tibia at Gerdy’s tubercle
      • N: Superior gluteal
      • A: Hip flexion,
      • Hip abduction,
      • Hip internal rotation
    • 63. Popliteal Fossa
      • Borders
        • Superomedial: semimembranosus
        • Superolateral: biceps femoris
        • Inferomedial: medial gastroc head
        • Inferolateral: lateral gastroc head
      • Contents
        • Popliteal artery and vein
        • Tibal and common peroneal nerves
    • 64. BURSAE
    • 65. NEUROANATOMY
      • Tibial nerve
      • Common peroneal nerve
      • Femoral nerve