The Knee (Tibiofemoral Joint) By Todd Piraino Tammi Wells Holly Cox

Quadriceps femoris tendon Connects the quadriceps femoris muscles to the superior aspects of the patella. Controls knee flexion and extension

Patellar ligament Connects Patella to the tuberosity of the Tibia.

Oblique popliteal ligament A strong broad flat fibrous ligament that pass obliquely across and strengthens the posterior part of the knee.

Arcuate Popliteal Ligament A triangular band in the posterior part of the knee that passes medially downward from the lateral condyle of the femur to the area between the condyles of the tibia and to the head of the fibula

Tibial collateral ligament and Fibular collateral ligament Tibial Collateral ligament also known as Medial Collateral ligament or MCL. Fibular Collateral ligament is located on the lateral side of the knee.

Anterior Cruciate Ligament and Posterior Cruciate Ligament The function of the ACL is to provide stability to the knee. It limits rotational movements of the knee and restrains excessive extension of the lower leg. PCL prevents the Tibia from sliding to far backwards in relation to the Femur. Stronger of the two cruciate ligaments.

Transverse Ligament Connects the Anterior margin of the lateral meniscus to the anterior end of the medial meniscus.

Prepatellar Bursa, Deep Infrapatellar Bursa, Supra Patellar Bursa, Subcutaneous Infrapatellar Bursa Bursa are fluid filled capsules that prevent friction between tissues in joints.

Lateral Meniscus and Medial Meniscus The Meniscus are fibrocartilage that separate the Tibia and Femur to decrease contact area between the bone. Acts as a shock absorber and reduces friction between the two bones.

Femur: Lateral Condyle, Medial Condyle, Intercondylar Fossa. Condyles of the Femur articulate with the Tibia Lateral Condyle Medial Condyle Intercondylar Fossa

Femur: Lateral Epicondyle, Medial Epicondyle Epicondyles are not part of the articulating surface. Main purpose is attachment points for ligaments and tendons. Lateral Epicondyle Medial Epicondyle

Tibia: Lateral Condyle, Medial Condyle, Intercondylar Eminence. Articulate with the Femur. Intercondylar Eminence

Tibial Tuberosity and Head of Fibula

Buckwheat says, “Otay, that’s gonna leave a mark.”

This guy is probably hearing the sound of popcorn coming from his knee.

More sound of popcorn. Most likely a torn ACL

ACL Injury Most common type of Knee injury. Hyperextension is the main cause. Torn ACL’s are most often related to high impact sports or when the knee is forced to make sharp changes in movement during sudden stops from high speed. Very prevalent in Alpine skiing, Soccer, Rugby, Hockey, and martial arts.

Repair of ACL It has become an outpatient operation with many people returning home the day of the surgery and bearing weight within a week.

Surface Anatomy Popliteal fossa- a mostly fat-filled diamond shaped space posterior to the knee. All the important nerves and vessels from the thigh to the leg pass through this fossa. Patella- (knee cap) is a small, triangular bone located anterior to the knee joint. It articulates with the patellar surface of the femur.

Surface Anatomy *The soleus is a long flat muscle that runs down the posterior of the lower leg, underneath the gastrocnemius. *The gastrocnemius creates the distinctive shape of the calf and is an important muscle for overall leg development and symmetry. Gastrocnemius is Greek means ‘The belly of the calf’. The medial head is the inner head of the two gastrocnemius heads that are located at the rear of the lower leg. The lateral head is the outer head of the two gastrocnemius heads. Medial head of Lateral head of

Surface Anatomy The hamstrings are located on the posterior aspect of the thigh. It is made up of the Semitendinosus Semimembranosus Biceps femoris ******* Point of attachments for the Semimembranosus tendon Semitendinosus tendon Biceps femoris tendon

Surface Anatomy Vastus lateralis is the largest component of the quadriceps, located on the lateral aspect of the thigh. Vastus medialis covers the medial aspect of the thigh The Quadriceps femoris consists of four muscles: Rectus femoris Vastus lateralis Vastus intermedius Vastus medialis

Surface Anatomy Popliteal fossa Lateral head of Gastrocnemius Medial head of Gastronemius Soleus

Popliteal Fossa The popliteal fossa is a fat-filled diamond shaped shallow depression which is posterior to the knee. All the important nerves and vessels from the thigh to the leg pass through the popliteal fossa.

Arteries of knee The major blood vessels around the knee travel with the popliteal nerve down the back of the leg. The popliteal artery and popliteal vein are the largest blood supply to the leg and foot. If the popliteal artery is damaged beyond repair, it is very likely the leg will not be able to survive

Arteries ( and muscles they innervate) Femoral artery Popliteal artery (Popliteus, Gastrocnemius) Posterior tibial artery Dorsalis pedis Fibular (peroneal) Anterior tibial artery Lateral circumflex femoral artery (Rectus femoris, Vastus intermedialis, Vastus lateralis, Vastus medialis) Medial circumflex femoral artery Inferior gluteal artery (Biceps femoris, Semimembranosus) Deep femoral artery (profunda) (Semitendinosus)

Veins Anterior tibial vein Posterior tibial vein Fibular (peroneal vein) Popliteal vein Femoral vein Small saphenous vein Great saphenous vein

Wire man Femoral artery Popliteal artery Fibular (peroneal) artery Femoral vein Femoral artery Popliteal vein Popliteal artery Small saphenous vein Fibular (peroneal) artery Fibular (peroneal) vein Anterior tibial artery Great Saphenous vein Posterior tibial artery Anterior tibial vein Posterior tibial vein Dorsalis pedis

Flat Man …………NERVES *Femoral nerve *Sciatic nerve Common fibular nerve Semitendinosus, Semimembranous Biceps femoris (long head) Rectus Femoris Vastus intermedialis Vastus lateralis Vastus medialis Common fibular nerve *Deep fibular nerve (peroneal) Biceps femoris (long head) *Superficicial fibular nerve (peroneal) *Tibial nerve Gastrocnemius, Popliteus

Classroom Models Inguinal ligament External iliac artery Femoral nerve Femoral artery

Classroom models External iliac artery Femoral nerve Inguinal ligament Femoral artery Femoral vein Anterior tibial artery Deep fibular nerve (peroneal) Dorsalis pedis artery

Classroom Models Tibial nerve Sciatic nerve Common fibular (peroneal) nerve Popliteal vein Popliteal artery Tibial nerve Posterior tibial artery Tibial nerve

Classroom Models Sciatic nerve Tibial nerve

KNEE MUSCLES

ANTERIOR KNEE MUSCLES Function as extensors

Quadriceps Femoris: *largest muscle in the body, consists of 4 muscles

Rectus Femoris: Most anterior of quadriceps Origin: Anterior Inferior Iliac Spine Insertion: Tibial Tuberosity Innervation: Femoral Nerve Vascular Supply: Lateral Circumflex Femoral Artery

Action: Hip flexion Knee extension

Vastus Medialis Origin: Linea Aspera Insertion: Tibial Tuberosity via Patellar Tendon Innervation: Femoral Nerve Vascular Supply: Lateral Circumflex Femoral Artery

Action: Knee extension

Vastus Intermedialis Origin: Anterior Femur Insertion: Tibial Tuberosity via Patellar Tendon Innervation: Femoral Nerve Vascular Supply: Lateral Circumflex Femoral Artery

Action: Knee extension

Vastus lateralis: Origin: Linea Aspera Insertion: Tibial tuberosity via Patellar Tendon Innervation: Femoral Nerve Vascular Supply: Lateral Circumflex Femoral Artery Vastus Lateralis

Action: Knee Extension

POSTERIOR KNEE MUSCLES

(named due to tendons being long and stringlike in popliteal area) HAMSTRINGS: composed of Biceps Femoris, Semimembranous and Semitendinosus Function as flexors (named due to tendons being long and stringlike in popliteal area)

Ah, those hamstrings… Or not?? See how they work? **This is the torn version that we don’t need to know.

Biceps Femoris-long head: Origin: Ischial Tuberosity Insertion: Fibular Head Innervation: Sciatic Nerve Vascular Supply: Inferior Gluteal Artery

Action: Hip extension Knee flexion

Biceps Femoris – Short Head: Origin: Lateral Lip of Linea Aspera Insertion: Fibular Head Innervation: Common Peroneal Nerve Vascular Supply: Inferior Gluteal Artery

Action: Knee flexion

Semimembranosus: Origin: Ischial Tuberosity Insertion: Posterior surface of Medial Condyle of Tibia Innervation: Sciatic Nerve Vascular Supply: Inferior Gluteal Artery

Action: Extend hip Flex knee

Semitendinosus: Origin: Ischial Tuberosity Insertion: Anteromedial surface of proximal Tibia Innervation: Sciatic Nerve Vascular Supply: Deep Femoral Artery

Action: Extend hip Flex knee

Posterior Distal Knee Muscles: - Flexors

Popliteus: Origin: Lateral Condyle of Femur Insertion: Posteriorly on Medial Condyle of Tibia Innervation: Tibial Nerve Vascular Supply: Popliteal Artery

Action: Initiates knee flexion by unlocking the knee when fully extended

Gastrocnemius: Innervation: Origin: Tibial Nerve Vascular Supply: Popliteal Artery Origin: Medial and Lateral Condyles of Femur Insertion: Posterior Calcaneus The reason for high heels?

Action: Ankle plantar flexion when knee extended Raises heel while walking with knee extended Action: OR… (Sorry, couldn’t resist!)

Action: Knee flexion (Basketball players learning Charleston)

BFB: Bye From Bob

References www. getfittogolf. com. au physiomed. patientsite. com www References www.getfittogolf.com.au physiomed.patientsite.com www.anatomy.tv www.freebase.com www.chiropractic-help.com www.orthobullets.com www.msdlatinamerica.com www.netteranatomy.com