1. ABOVE KNEE AMPUTATION

2. ARTHROSCOPY

3. KNEE JOINT
Block 14
GNK 483

4. Anatomy Classification Bones Capsule Ligaments Synovial membrane
Cruciate ligaments
Menisci
Nerve supply
Blood supply
Relationships
Bursae
Movements

5. Classification Synovial hinge joint
Medially & laterally: femur & tibia (hinge and rotation)
Intermediate: Femur & patella (gliding joint

6. Capsule Absent anteriorly
Synovial membrane protrudes to form the bursa beneath the tendon of quadriceps femoris
It is anteriorly reinforced by the tendon of quadriceps femoris, the patella and the patella retinacula

7. Capsule
Inferiorly, the capsule is fixed to the margins of the tibia, except where the tendon of popliteus passes
The capsule is reinforced on both sides by the expansions of vastus lateralis and medialis, as well as behind by the oblique popliteal ligament from the insertion of semimembranosus

8. Ligaments 5 extracapsular
Patellar ligaments – quadriceps reflex L2,3,4
Lateral collateral ligament
Medial collateral ligament
Oblique popliteal ligament
is an expansion from the insertion of semimembranosus
Arcuate popliteal ligament
Y-shaped ligament posterior that bridges the tendon of popliteus

9. Ligaments 4 intracapsular
Synovial membrane
Cruciate ligaments
Menisci
Tendon of popliteus

10. Synovial Membrane
Infrapatellar fold is a reflexion from the posterior surface of the patella-forms a fold to the intercondylar fossa
The synovial membrane from the posterior part of the capsule is reflected around the front of the cruciate ligaments-they are therefore intracapsular but extrasynovial

11. Cruciate Ligaments Extrasynovial
Anterior
Taut in extension
Prevents post displacement of femur on tibia
Prevents hyperextension of the knee

12. Cruciate Ligaments Extrasynovial
Posterior
Stronger
Taut during flexion
Prevents ant displacement of femur on tibia
Prevents hyperflexion of the knee

13. Menisci - General Medial & lateral C-shaped Fibrous cartilage
Upper surface concave
Outer margins thicker, convex,attached to capsule
Inner margins thinner, concave,free border
Transverse ligament extends between the 2 ant parts of the menisci

14. Menisci Medial meniscus Semicircular (oval)
Wider at back than in front
Attached to medial collateral ligament
Most commonly injured

15. Menisci Lateral meniscus Almost circular Even width front and back
Separated from lateral collateral ligament via popliteal tendon

16. Nerve Supply Br of femoral n to vastus medialis
Obturator n (the br passes with the femoral a thro the add hiatus to popliteus fossa
Sciatic n

17. Blood Supply Genicular anatomosis formed by brrs of popliteal a
Middle genicular a pierces the capsule & supplies cruciate lig’s, synovial mem, outer margins of menisci

18. Relations Anterior femoris quadriceps femoris & bursa Posterior
popliteal fossa+contents, popliteal a+v, tibial+c.peroneal nn
Lateral
Biceps femoris, lateral collateral ligament, tendon of popliteus
Medial
Sartorius, gracilis,medial coll lig,semitendinosus

19. Bursae – Anterior (4) Suprapatellar Prepatellar
Beneath quadriceps femoris
Prepatellar
Housemaids knee
Superficial infrapatellar
Betw skin & patellar ligament
Clergyman’s knee
Deep infrapatellar
Betw patellar lig & tibia

20. Bursae – Posterior (2)
Beneath popliteus
Beneath semimembranosus

21. Bursae – Posterior (2) Others: Biceps femoris
Lateral head of gastrocnemius
Medial head of gastrocnemius
Anserine bursa below insertion of:
Sartorius
Gracilis
semitendinosus

22. Movements Flexion Extension Rotation
hamstrings+sartorius,gracilis,gastroc
Extension
quadriceps femoris+medial rotation
Rotation
Passive: screw home mechanism
Active: medially in a flexed knee (SarGrTen)
laterally via Biceps femoris