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11/6/2012 The Knee Clarification of Terms The knee consists of: The tibiofemoral joint Patellofemoral joint Mansfield, p273 Osteology of the Knee Distal Femur Proximal tibia and fibula Patella 1 11/6/2012 Osteology of the Knee Distal femur (ADDuctor tubercle) Right Femur Osteology of the Knee The proximal tibia & fibula The medial and lateral condyles of the tibia form the shallow articulations with the distal femur Fibular Head Tibial Tuberosity The intercondylar/intercondyloid eminence the attachment point for the cruciate ligaments Interosseous Membrane Osteology of the Knee Patella 2 11/6/2012 Joint Structure Tibiofemoral Joint Articulation between the large condyles of the distal femur and the relatively flat proximal tibia Patellofemoral Joint Articulation between the patella and distal femur Mansfield, p273 Joint Structure: Alignment Genu valgum refers to a frontal deviation of the position of the knee. Commonly referred to as “knock-knee” due to the distal segments being positioned more laterally than normal Genu varum refers to a frontal deviation of the position of the knee. Commonly referred to as “bow-leg” is the opposite. Lippert, p294 & Mansfield, p278 Joint Structure: Alignment Genurecurvatum: Hyperextension of the tibiofemoral joint placing excessive stress on the structures in the popliteal space Tibial nerve Popliteal Vein Popliteal Artery Common Peroneal Nerve 3 11/6/2012 Joint Structure: Alignment Q Angle * angle between the quadriceps muscle and the patellar tendon * draw a line from the ASIS to the midpoint of the patella and from the tibial tuberosity to the midpoint of the patella * tends to be greater in females due to wider pelvis Lippert, p285 Joint Movement Tibiofemoral Joint: Osteokinematics: flexion, extension Internal and external rotation Arthrokinematics: Open chain = Closed chain = (hint: convex distal femoral condyles and concave proximal tibial plateau) Lippert, p284 & Mansfield, p284 Joint Movement Patellofemoral Joint Osteokinematics n/a Arthrokinematics The smooth posterior surface of the patella glides over the femur It glides and tilts in all 4 directions Lippert, p285 4 11/6/2012 Supporting Structures ACL & PCL (Sagittal plane stability) MCL & LCL (Frontal Plane stability) Posterior capsule Medial and lateral menisci Supporting Structures Anterior Cruciate Ligament (ACL) Keeps femur from moving posteriorly on tibia and from tibia from moving anteriorly on femur Tightens during extension, preventing hyperextension Posterior Cruciate Ligament (PCL) Keeps femur from moving anteriorly on tibia and from tibia from moving posteriorly on femur Tightens during flexion Lippert, p288 Supporting Structures: ACL & PCL 5 11/6/2012 Supporting Structures Medial Collateral Ligament (MCL) Flat broad ligament attaching the medial condyles of femur and tibia It protects the joint from stresses to the ____________ side of the knee. Lateral Collateral Ligament (LCL) Round, cordlike ligament attaching from lateral femoral condyle to fibular head It protects the joint from stresses to ____________ side of the knee. Lippert, p288 Supporting Structures: MCL & LCL Supporting Structures Posterior Capsule: Prevents hyperextension of the knee Mansfield, p282 6 11/6/2012 Lippert, p288 Supporting Structures Medial and lateral menisci Two half-moon, wedge-shaped fibrocartilage disks Located on the superior surface of the tibia Designed to absorb shock Thicker laterally than medially Proximal surfaces are concave, deepening the relatively flat joint surface of the tibia Knee Structure Popliteal Space Area behind the knee containing important nerves (tibial and common peroneal) and blood vessels (popliteal artery and vein) Diamond shaped fossa Bound superiorly by semitendinosus and semimembranosus on the medial side and biceps femoris on lateral side. Bound inferiorly by the medial and lateral heads of the gastrocnemius Lippert, p288 Myology Muscles of the Knee Area Mono-articular Muscle Bi-articular Buslce Anterior Vastus Lateralis Rectus Femoris Vastus Medialis Vastus Intermedialis Posterior Biceps femoris (short) Biceps femoris (long) Popliteus Semimembranosus Semitendinosus Gastrocnemius Medial Sartorius Gracilis Lateral Tensor Fascia Latae Lippert, p290 7 11/6/2012 Myology of the Knee Your subtopic goes here Rectus Femoris Origin Anterior-inferior iliac spine Insertion Tibial tuberosity via the quadriceps tendon Innervation Femoral n. Action Hip flexion, knee extension “tidbit” One of the heads of the “quads” Lippert, p291 Myology of the Knee Vastus Medialis Origin Medial lip of the linea aspera and the intertrochanterid line of the femur Insertion Tibial tuberosity via the patellar tendon Innervation Femoral n. Action Knee extension “tidbit” •One of the heads of the “quad” •“VMO” one of the first muscles of the knee to atrophy post-operatively, • responsible for last 10-15o of knee extension Vastus Medialis Obliquus Lippert, p291 Myology of the Knee Vastus Lateralis Origin Lateral lip of the linea aspera, intertrochanteric line, lateral region of the gluteal tuberosity Insertion Tibial tuberosity via the patellar tendon Innervation Femoral n. Action Knee extension “tidbit” Part of the “quads” Lippert, p291 8 11/6/2012 Myology of the Knee Vastus Intermedialus Origin Upper 2/3 of the anterior femoral shaft Insertion Tibial tuberosity via the patellar tendon Innervation Femoral n. Action Knee extension Lippert, p291 Myology of the Knee Your subtopic goes here Biceps Femoris Origin Ischial tuberosity Insertion Head of the fibula Innervation Tibial portion of the sciatic n. Action Hip extension, knee flexion “tidbit” One of the hamstrings A Bicep F B Bicep F A C D Semimem Semiten Lippert, 292 Myology of the Knee Your subtopic goes here Semimembranosus Origin Ischial tuberosity Insertion Medial condyle of the tibia, posterior aspect Innervation Tibial portion of the sciatic n. Action Hip extension, knee flexion “tidbit” One of the hamstrings Lippert, p291 9 11/6/2012 Myology of the Knee Your subtopic goes here Semitendinosus Origin Ischial tuberosity Insertion Proximal-medial surface of the tibia (pes anserinus) Innervation Tibial portion of the sciatic n. Action Hip extension, knee flexion, “tidbit” One of the hamstrings Lippert, 292 Myology of the Knee Popliteus Origin Posterior aspect of the lateral femoral condyle Insertion Posterior surface of the proximal tibia Innervation Tibial n. Action Initiates knee flexion Lippert, 292 Myology of the Knee Gastrocnemius Origin Medial head: posterior aspect of the medial femoral condyle Lateral head: posterior aspect of the lateral femoral condyle Insertion Calcaneal tuberosity via the Achilles tendon Innervation Tibial n. Action Flexion of the knee, plantar flexion, Lippert, 293 10 11/6/2012 Myology of the Knee Your subtopic goes here Sartorius Origin ASIS Insertion Proximal-medial surface of the tibia (via the pes anserinus) Innervation Femoral n. Action Hip flexion, hip ABD, Hip ER, knee flexion “tidbit” Longest muscle in the body Biel, p326 Myology of the Knee Your subtopic goes here Gracillis Origin Body and inferior ramus of the pubis Insertion Proximal-medial aspect of the tibia (pes anserinus) Innervation Obturator n. Action Hip ADD, hip flexion, knee flexion Biel, p321 Myology of the Knee Tensor Fascia Latae Origin Iliac crest, posterior to ASIS Insertion Iliotibial tract Innervation Superior Gluteal Nerve Action Hip flexion, ABD, internal rotation Biel, p324 11 11/6/2012 Myology Prime Movers of the Knee: Extension: Quadriceps group Flexion: Hamstring group Popliteus gastrocnemius Lippert, p294 Myology Summary of Muscle Innervation: Muscle Nerve Rectus femoris Femoral Vastus lateralis Femoral Vastus intermedialis Femoral Vastus medialis Femoral Semimembranosus Sciatic Semitendinosus Sciatic Biceps femoris – long head Sciatic Biceps femoris – short head Common Peroneal Popliteus Tibial gastrocnemius Tibial Lippert, p295 Common Knee Pathology Genu Valgum Genu Varum Genu Recurvatum Patellar Tendonitis Osgood-Schlatter Disease Patellofemoral Pain Syndrome Chondromalacia Patella Unhappy Triad 12 11/6/2012 Genu Valgum and Varum Lippert, p294 Genu Recurvatum Lippert, p294 Osgood-Schlatter Lippert, p294 13 11/6/2012 Chondromalacia Patella Lippert, p294 Unhappy Triad Lippert, p294 References Biel, A., (2010). Trail Guide to the Body, 4th ed. Boulder, CO: Books of Discovery. Lippert, L.S. (2011). Clinical Kinesiology and Anatomy, 5th ed. Philadelphia, PA: F.A. Davis. Mansfield, P.J., & Neumann, D.A. (2009). Essentials of Kinesiology for the Physical Therapist Assistant. St. Louis, MO: Mosby Elsevier. 14
