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

The Knee (Tibiofemoral Joint)

By Todd PirainoTammi 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 TibiaLateral

Condyle MedialCondyle

Intercondylar Fossa

Femur: Lateral Epicondyle, Medial Epicondyle

Epicondyles are not part of the articulating surface. Main purpose is attachment points for ligaments and tendons.

MedialEpicondyle

LateralEpicondyle

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.

*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

Surface Anatomy

The hamstrings are located on the posterior aspect of the thigh. It is made up of the SemitendinosusSemimembranosus Biceps femoris

*******Point of attachments for the Semimembranosus tendonSemitendinosus tendonBiceps 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 lateralisVastus intermediusVastus medialis

Surface Anatomy

Soleus

Popliteal fossa

Lateral head of Gastrocnemius

Medial head of Gastronemius

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)

VeinsAnterior tibial veinPosterior tibial veinFibular (peroneal vein)Popliteal veinFemoral veinSmall saphenous veinGreat saphenous vein

Femoral artery

Great Saphenous vein

Femoral vein

Popliteal artery

Anterior tibial artery

Fibular (peroneal) artery

Posterior tibial artery

Dorsalis pedis

Small saphenous vein

Fibular (peroneal) vein

Anterior tibial vein

Posterior tibial vein

Popliteal vein

Wire man

Flat Man …………NERVES

*Femoral nerve

*Sciatic nerve

*Superficicial fibular nerve (peroneal)

*Deep fibular nerve (peroneal)

*Tibial nerve

Semitendinosus, SemimembranousBiceps femoris (long head)

Gastrocnemius, Popliteus

Rectus FemorisVastus intermedialisVastus lateralisVastus medialis

Common fibular nerveBiceps femoris

(long head)

Classroom ModelsExternal iliac artery

Femoral nerve

Femoral nerve

Femoral artery

Inguinal ligament

Classroom models

Anterior tibial artery

Deep fibular nerve (peroneal)Dorsalis

pedis artery

Femoral artery

Femoral vein

Femoral nerve

External iliac artery

Inguinal ligament

Classroom ModelsSciatic nerve

Tibial nerve

Common fibular(peroneal) nerve

Tibial nerve

Popliteal vein

Popliteal artery

Posterior tibial artery

Classroom Models

Sciatic nerve

Tibial nerve

MUSCLES

KNEE

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

VastusLateralis

Action:

• Knee Extension

POSTERIOR KNEE MUSCLES

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…

See how they work? Or not??

**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:

Origin:• Medial and

Lateral Condyles of Femur

Insertion:• Posterior

Calcaneus

Innervation:• Tibial Nerve

Vascular Supply:• Popliteal

Artery

The reason for high heels?

Action:• Ankle plantar flexion when knee extended• Raises heel while walking with knee extended

OR…

(Sorry, couldn’t resist!)

Action:• Knee

flexion

(Basketball players learning Charleston)

ByeFromBob

BFB:

Referenceswww.getfittogolf.com.auphysiomed.patientsite.comwww.anatomy.tvwww.freebase.comwww.chiropractic-help.comwww.orthobullets.comwww.msdlatinamerica.comwww.netteranatomy.com