Survey
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
* Your assessment is very important for improving the workof artificial intelligence, which forms the content of this project
Knee region • • • • Bones Joint Muscles Artery & Nerves Knee osteology Distal end of femur Anterior Distal end of femur Posterior Femur ant. Femur post. Medial Lateral Patella Patella Proximal Tibio-fibular joint Tibia Fibula No movement! Distal Tibio-fibular joint Tibia Proximal end Anterior Posterior Tibiofemoral (knee) Joint • Largest and most complex joint • Actually 3 joints within a single synovial cavity: 1. Laterally: tibiofemoral joint 2. Medially: tibiofemoral joint 3. Intermediate: patellofemoral joint Knee joint • Menisci Medial meniscus lateral meniscus • Ligaments Cruciate ligaments Collateral ligaments Patellar ligament oblique popliteal ligament • Joint capsule Synovial membrane Fibrous membrane Minisci : fibrocartilaginous ‘shock absorbers’ semilunar cartilages Attachments 1. The medial meniscus is more injured than the lateral meniscus, why? Ligaments 1. anterior cruciate ligament (ACL) 2. posterior cruciate ligament (PCL) 3. medial collateral ligament (MCL, tibial collateral ligament) 4. lateral collateral ligament (LCL , fibular collateral ligament) 5. oblique popliteal ligament 6. ligamentum patellae Cruciate ligaments ACL: Anteromedial part of the intercondylar area of tibia to inner aspect of lateral condyle of femur. PCL: Posterolateral part of the intercondylar area of the tibia to inner aspect of medial condyle of femur. Anterior Cruciate ligament prevents anterior displacement of the tibia in relation to femur in flexion. Posterior Cruciate ligament prevents posterior displacement of the tibia in relation to femur in extension. How to test ACL and PCL? Drawer sign test Anterior Drawer Test for ACL • Physician Position & Movements • Patient Position Note direction of forces 29 Posterior Drawer Testing- PCL Note direction of forces 30 Collateral ligaments MCL attaches to the medial meniscus 2. The medial meniscus is more injured than the lateral meniscus, why? Collateral ligaments action 1. Protect the knee joint from bending side to side. 2. Helps the locking mechanism 3. The medial meniscus is more injured than the lateral meniscus, why? Locking mechanism: less energy to maintain the standing position 1. Medial rotation of femur on the tibia during full extension tighten colateral ligaments. Locking mechanism (2) • Joint surfaces become larger and more stable in extension. Locking mechanism (3) • body's center of gravity is positioned along a vertical line that passes anterior to the knee joint. Locking mechanism Collateral ligaments test Test for MCL Note Direction Of Forces 42 Test for LCL Note direction of forces 43 Patellar ligament Strengthening Anterior Aspect of Knee Joint Patellofemoral stress syndrome • “Runner’s Knee” • Patella does not glide up and down but rather laterally causing pain. oblique popliteal ligament Review • (1) patellar ligament • (2) tibial (medial) collateral ligament • (3) fibular (lateral ) collateral ligament • (4) medial meniscus • (5) lateral meniscus • (6) anterior cruciate ligament • (7) posterior cruciate ligament Joint fibrous capsule Joint synovial membrane Bursa • little fluid sacs that helps the muscles and tendons slide freely: Prepatellar Infrapatellar Suprapatellar Bursa Prepatellar Bursitis