Joints of the Lower Limb

HIP JOINT, KNEE JOINT and ANKLE JOINT Type Articulation Capsule Ligaments Movements Blood Supply Nerve Supply

Hip Joint The hip joint forms the connection between the lower limb and the pelvic girdle

HIP JOINT TYPE: ARTICULATIONS : BOLL & SOCKET TYPE Cup shaped acetabulum & Hemi spherical head of femur Acetebular surface is horseshoe shaped Cavity is deepended by – fibro cartilagenous rim called “ Acetabular labrum”

LIGAMENTS ILIO-FEMORAL LIGAMENT: 5 IN NO. 2. PUBO - FEMORAL LIGAMENT: - Strong, inverted “y” shaped Lig. - Base is above – from AIIS - 2 limbs are below from – upper & lower parts of Inter – trochanteric line 2. PUBO - FEMORAL LIGAMENT: - Triangular in shape Base – superior ramus of pubis Apex – Lower part of Inter trochanteric line Limits – extension & abduction

3. ISCHIOFEMORAL LIGAMENT: - Spiral shaped ligament - Acetabular margin of Ischium & greater trochanter - limits extension 4. TRANSVERS ACETABULAR LIGAMENT: - formed between the acetabular labrum ends - Bridges the acetabular notch 5. Lig. OF HEAD OF FEMUR: - Flat, triangular ligament - apex – pit on the head of femur - base – transvers Lig. & acetabular margins

MOVEMENTS: FLEXION: EXTENSION: ABDUCTION: ADDUCTION: LATERAL ROTATION: MEDIAL ROTATION: CIRCUMDUCTION:

Blood Supply of the Hip Joint The medial and lateral circumflex femoral arteries The artery to the head of the femur

Avscular Necrosis of head More common >60 years In female for osteoporosis Supplied mainly by Medial circumflex femoral artery by its retinacular branches Blood supplied through round ligament of femur(br. Of Obturator) is grossly inadequate.

Hip Joint Replacement A metal prosthesis anchored to femur by bone cement A plastic socket is cemented to acetabulum

Dislocation of hip joint Posterior dislocation Posterior tearing of joint capsule Dislocated femoral head lies on posterior surface of ischium Occurs in head-on collision Complications Sciatic nerve may damage.

Relatively Rare phenomena POSTEIOR DISLOCATION of hip joint can lead to sciatic nerve injury. Most common manifestation is foot drop due to damage to common fibular part Relatively Rare phenomena

KNEE JOINT TYPE : Femoro-Tibial joint – Synovial joint of Hinge variety Patello-Femoral joint – Synovial joint of gliding variety . ARTICULATIONS : 1. Femoro-Tibial joint : Above – Femoral condyles Below – Tibial condyles & their Cartilaginous menisci 2. Patello-Femoral joint : Above – Posterior surface of patella Below – Patellar surface of lower end of femur The articular surfaces are lined with Hyaline cartilage

LIGAMENTS I. EXTRACAPSULAR LIGAMENTS: 1. Ligamentum patellae:- Attachments Above – Lower border of patella Below – Tibial tuberosity It is a continuation of the central portion of common tendon of Quadriceps femoris 2. Lateral collateral ligament: card like above – Lateral condyle of femur below – Head of fibula

3. Medial collateral ligament: I. EXTRACAPSULAR LIGAMENTS: 3. Medial collateral ligament: is flat band like above – Medial condyle of femur below – medial surface of shaft of tibia It is firmly attached to the edge of the medial meniscus

II.INTRACAPSULAR LIGAMENTS: CRUCIATE LIGAMENTS: * Main lig.’s Bound between femur & tibia throughout joint range. 1.A.C.L. Attachments: below – Anterior intercondylar area of tibia above – posterior part of medial surface of lateral femoral condyle It prevents forward displacement of Tibial condyles

2.P.C.L.:- Attachments: below – posterior inter condylar area of tibia above – anterior part of lateral surface of medial femoral condyle It prevents backward displacement of tibial condyles and anterior displacement of femur on the tibia It prevents posterior pulling of tibia when the knee is flexed

3.Medial Meniscus and 4.Lateral Meniscus “C” shaped fibro cartilaginous sheets Peripheral border is thick & attached to capsule Inner border is thin, concave & free Upper surface – in contact with femoral condyles Lower surface – in contacts with tibial condyles Function : Shock absorbing cushion between two bones

MOVEMENTS: FLEXION EXTENSION MEDIAL ROTATION LATERAL ROTATION

Unhappy triad(TCL,MEDIAL MENISCUS AND ACL)

Knee Joint Injuries Anterior drawer sign: This injury causes the free tibia to slide anteriorly under the fixed femur.

Posterior drawer sign: PCL ruptures allow the free tibia to slide posteriorly under the fixed femur.

BURSAE: ANTERIOR SIDE: 1. SUPRA PATELLAR BURSA 2. PRE - PATELLAR BURSA 3. INFRA PATELLAR BURSA i). Superficial ii). Deep

Bursitis in the Knee Region 1. Prepatellar bursitis: Prepatellar bursitis is caused by friction between the skin and the patella. This condition has been called housemaid's knee.

Subcutaneous infrapatellar bursitis caused by excessive friction between the skin and the tibial tuberosity.

Baker's Cyst Posterior herniation of synovial membrane through joint capsule into popliteal fossa Usually asymptomatic but Large swellings may interfere with knee movements

ANKLE JOINT TYPE : – Synovial joint of Hinge variety . ARTICULATIONS : Above – Lower end of tibia and fibula Below – Body of talus The articular surfaces are lined with Hyaline cartilage

LIGAMENTS Medial or Deltoid ligament: 1.Posterior tibiotalar 2.Anterior tibiotalar 3.Tibionavicular 4. Tibiocalcaneal 3 4 5

Medial ligament of the ankle joint (Deltoid ligament)

Lateral ligament of the ankle joint 1.Posterior talofibular thick strong lig. (malle.fossa to lat.tubercle of talus) 2.Anterior talofibularweak 3.calcaneofibular ligament round cord (lat. Mall to Lat.surface of calcaneus)

Lateral ligament of the ankle joint.

MOVEMENTS of the Ankle Joint 1. Dorsiflexion of the ankle 2. Plantarflexion of the ankle The movements of inversion and eversion take place at the tarsal joints and not at the ankle joint.

Clinical Anatomy

Ankle Injuries The lateral ligament is injured because it is much weaker than the medial ligament. The anterior talofibular ligament part of the lateral ligament is most vulnerable and most commonly torn during ankle sprains.

Pott fracture(dislocation of the ankle) Occurs when the foot is forcibly everted. Trimalleolar fracture: The combined fracture of the medial malleolus, lateral malleolus, and the posterior margin of the distal end of the tibia is known as a "trimalleolar fracture

TrimalleolarFractureRepair

Arches of the Foot The bones of the foot do not lie in a horizontal plane. Instead, they form longitudinal and transverse arches relative to the ground. The arches distribute weight over the pedal platform (foot), acting not only as shock absorbers but also as springboards for propelling it during walking, running, and jumping.

Longitudinal arch The longitudinal arch of the foot is formed between the posterior end of the calcaneus and the heads of the metatarsals. It is highest on the medial side where it forms the medial part of the longitudinal arch and lowest on the lateral side where it forms the lateral part.

Arches of the foot.

Transverse arch The transverse arch of the foot runs from side to side It is formed by the cuboid, cuneiforms, and bases of the metatarsals. The medial and lateral parts of the longitudinal arch serve as pillars for the transverse arch.

Major Ligaments of the Foot 1. Plantar calcaneonavicular ligament (spring ligament): The spring ligament supports the head of the talus and plays important roles in the transfer of weight from the talus and in maintaining the longitudinal arch of the foot, of which it is the keystone (superior most element). 2. Long plantar ligament 3. Plantar calcaneocuboid ligament (short plantar ligament).

Support for arches of the foot

Clinical Anatomy 1.Hallux Valgus: Hallux valgus is a foot deformity caused by pressure from footwear and degenerative joint disease; it is characterized by lateral deviation of the great toe

Flatfeet Flatfeet can either be flexible (flat, lacking a medial arch, when weight bearing but normal in appearance when not bearing weight or rigid (flat even when not bearing weight).

Genu Varum and Genu Valgum

Genu varum Genu varum (also called bow-leggedness), is a physical  deformity marked by (outward bowing) of the leg in relation to the thigh, giving the appearance of an archer's bow.

Genu valgum Genu valgum, commonly called "knock-knees", is a condition where the knees touch one another when the legs are straightened.