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Peggers’ Super Summaries: Knee Anatomy Knee Anatomy: ACL bundles o Anteromedial – tight in flexion o Posterolateral – tight in extension PCL bundles o Anterolateral – tight in flexion o Posteromedial – tightens in extension Muscle inserting into medial meniscus – semimembranosus Popliteal muscle is lateral to the knee Lateral meniscus is more circular Medial nerve of knee – infra-patella branch of saphenous nerve sacrificed in knee surgery leaving lateral numbness knee o Laterally – popliteal groove and epicondyle o Medially – adductor tubercle and MCL/epicondyle Wrisberg ligament o Posterior menisco femoral ligament o Both run from posterior horn of lateral meniscus to lateral side of medial femoral condyle Humphrey ligament o Anterior meniscofemoral ligament PCL anatomy: 38 x 13mm in size Humphrey & Wisberg Which bundle taught in flexion – anterolateral 17% injured in sport the rest in RTC etc Posterior translation increases with severity of ligamentous injury o PCL alone – 10-12mm o PCL + PLC - >12mm (60% involve pLC) Instability tests o Dial at 30 and 90o o recurvatum o sag sign Lateral side layers o Layer 1 – ITB & biceps tendon o 2 – Retinaculum and patellofemoral ligaments o 3 – LCL and joint capsule How to find common peroneal nerve – posterior to LH of biceps femoris Peggers’ Super Summaries: Knee Anatomy Blood supply to the knee o Geniculate (superior/middle/inferior) o Descending geniculate o Recurrent anterior tibial 85% of sports related PCL injuries are good without surgery whist this figure in RTC is only 17% ie more damage more likely NOT to cope. Grading posterior translation o 1 – 0-5mm o 2 – 5-10mm o 3 - >10mm thus needs reconstruction Knee Menisci Quiz: Menisci insert into tibia via insertional ligaments Menisci held together by intermeniscal ligament Menisci means crescent in Greek Ligament of wrisberg – the posterior meniscofemoral ligment ( the anterior meniscofemroal ligament is the ligament of Humphrey - 1 or other present in 70% of knees) Inside out meniscal repair – split ITB and Biceps tendon and retract lateral gastrocnemius posteriorly – potential to damage SAPHENOUR NERVE MEDIALLY Posterior meniscal repair has better success secondary to improved blood supply Discoid meniscus – causes the snapping knee – treatment with saucerization ie partial removal CI to meniscal transplant o ACL injury o Chondromalacia Bucket handle tear o Vertical mattress is better