29. Blood supply /Genicular Anastamosis
• 10 vessels form periarterial anastomosis
around knee joint
• Five genicular branches of popliteal
• Descending genicular branch of femoral
• Descending branch of lat circumflex femoral
• Recurrent branches of ant tibial
• Circumflex fibular branch of post tibial
30. Nerves supply of knee joint
• Hilton’s law: nerves supplying muscles, crosses
joint to supply it
• Femoral nerve through its branches to vasti
• Sciatic nerve
• Tibial, common fibular nerves supply anterior
posterior & lateral aspects
• Obturator & saphenous nerve
31.
32.
33. Locking & unlocking
Locking : fully extended knee ,
• medial rotation of femur on tibia
Unlocking: popliteus contracts, lateral rotation
of femur on tibia
• Flexion of knee
34. Knee joint injuries
• Common due to low placed, mobile, weight
bearing joint
• Used in standing, walking & climbing stairs,
running, jumping, kicking & changing
directions
• Stability depends on its associated ligaments
& surrounding muscles
36. Knee sprain
• When force is applied against the knee, when
foot cannot move, ligament injuries occur
• Firm attachment of TCL to medial meniscus is
of significance, causing tearing of TCL &
medial meniscus
• Cause by blow on lateral side of extended
knee or excessive twisting of flexed knee
37.
38.
39. Unhappy triad
• Occurs in athletes, basketball,
football & volleyball players
• Rupture of ACL (anterior
cruciate ligament,TCL ( tibial
collateral ligament) & medial
meniscus
• Skiing accidents: ACL rupture
common
• Tested by Lachman test (
anterior drawer sign) Tibia is
drawn anteriorly over fixed
femur
40. Rupture of PCL
• PCL ruptures in conjuction with tibial or
fibular ligaments tear
• Can occur in head on collisions, when seat
belts are not worn & tibia strikes with
dashboard
• Posterior drawer sign is positive
• Tibia slide freely over femur
41.
42.
43.
44. Meniscal tears
• Usually involve medial meniscus, pain on
medial rotation of tibia on femur
• Lateral not commonly involved due to its
mobility
• If lateral meniscus involve, pain on lateral
rotation of tibia on femur
• Meniscal tear occurs in conjuction with ACL
&TCL tears
49. Arthroscopy of knee joint
• Endoscopic examination, to visualize interior
of knee joint with minimal disruption of
tissues
• Preferably perform under local or regional
anaesthesis
• Repair of menisci, ligament, loose body in
joints, debridement( excision of divitalized
articular cartilaginous material) in advance
cases of arthritis
51. Aspiration of knee joint
• When knee joint is excessively inflamed or
infected, amount of synovial fluid increases
• Suprapatellar bursa communicate with synovial
cavity of knee joint, fullness in thigh indicate
increase in volume of fluid
• Direct aspiration of knee joint is performed, with
flexed knee
• 3 Bony points used as land mark Anterolateral
tibial ( Gerdy’s tubercle ),lateral epicondyle of
femur & apex of patella
• These land marks also used for treating pathology
of knee joint ( during injection)
52.
53.
54.
55. Bursitis in knee
• Occur due to compression forces by direct blow,
or falling on flexed knee, long period of kneeling
• Prepatellar bursitis: friction between skin &
patella
• Also known as Housemaids knee: bursa
distended with fluid & swelling in front of knee
• Occur in hardwood floor workers, rug installers
56.
57.
58. • Subcutaneous infrapatellar bursitis ( clergy
man’s knee): excessive friction between skin &
tibial tuberosity
• occurs in roofers, floor tilers if not wearing knee
pad
• Deep infrapatellar bursitis: edema between
patellar ligament & tibia
• Enlargement obliterates dimple on each side of
patellar ligament when leg is extended
• Suprapatellar bursitis: infection can spread to
knee joint leads to localized redness & enlarged
popliteal & inguinal lymph nodes
59. Knee replacement( Arthroplasty)
• If knee is diseased due to osteoarthritis, osteoporosis,
artificial knee joint may be inserted
• Artificial knee have plastic or metal components which
are cemented to femoral &tibial bone ends after
removal of defective areas
• Low demand people: combination of plastic & metal
produces good results
• High demand people( active in sports): bone-cement
junctions may brake down, artificial components may
loosen
• Improvement in bioengineering & surgical techniques
provide better results
