Download Knee Presentation PTA

The Knee
Tibiofemoral Joint
Jeremy, Brittany, Spirit, Kelsey
Medial
head
Popliteal
fossa
Surface Anatomy
Medial
head
Lateral
head
Lateral
head
Surface Anatomy
Patella
Surface Anatomy:
Tendons
● Biceps Femoris
● Semimembranosus
● Semitendinosus
Anterior View
Posterior View
Femur
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Lateral Condyle
Medial Condyle
Lateral Epicondyle
Medial Epicondyle
Intercondylar Fossa
Lateral
Epicondyle
Medial
Epicondyle
Intercondylar
Fossa
Medial
Condyle
Lateral
Condyle
Tibia
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Lateral Condyle
Medial Condyle
Tibial Tuberosity
Intercondylar Eminence
Medial
Condyle
Lateral
Condyle
Tibial
Tuberosity
Intercondylar
Eminence
Fibula
Head
● Head
● Lateral Malleolus
Lateral
Malleolus
Patella
● Base
● Apex
● Articular Surface
Base
Anterior
Apex
Articular Surface
Posterior
Meniscus
● Act as cushions
● Stabilize the knee joint
during flexion, extension,
and lateral movements
Meniscus
● Medial meniscus is more
“c” shaped and larger;
● Lateral meniscus is more
circular and smaller
Meniscus
● Medial meniscus is more
“c” shaped and larger;
● Lateral meniscus is more
circular and smaller.
Fibular Collateral
Ligament
Ligaments
Posterior Cruciate
Ligament
Collateral ligaments
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Resist lateral forces to knee
Also known as Lateral Collateral Ligament (LCL)
and Medial Collateral Ligament (MCL)
Transverse ligament
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Holds meniscus in place during knee extension
Cruciate (“cross”) ligaments
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Anterior Cruciate Ligament (ACL) - resists anterior
translation and medial rotation of the tibia on the
femur
Posterior Cruciate Ligament (PCL) - resists posterior
translation of tibia on femur
Transverse Ligament
Tibial Collateral Ligament
Ligaments
(part 2)
Clinical Concerns: Torn ACL
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Occurs in extension + lateral rotation of tibia
on femur.
Common injury in sports that involve
planting and changing directions or contact
to knee when extended.
Women more prone to ACL tears due to
wider Q-angle.
Terrible triad - ACL, MCL, and meniscus are
torn
Ligaments
(part 3)
Popliteal Ligaments
●
Tightens the posterior capsule of the knee
Oblique
Arcuate
Bursae
● Suprapatellar:
○ Between the femur and
quadriceps tendon
● Prepatellar:
○ Between patella and skin
● Deep Infrapatellar:
○ Between Tibia and patellar
ligament
● Subcutaneous Infrapatellar:
○ Between tibial tuberosity
and skin
Suprapatellar
bursa
● Located between the femur and
quadriceps tendon
Prepatellar bursa
● Located between patella
● and skin
Deep Infrapatellar
bursa
● Located between tibia and
patellar ligament
Subcutaneous
Infrapatellar
bursa
● Located between tibial
tuberosity and skin
Sciatic Nerve
● Largest single nerve in the
human body
● Originates from the lumbar &
sacral plexuses
○ Roots: L4 &L5, S1-S3
● Branches into tibial nerve &
common fibular (peroneal)
nerve
● Together with its terminal
branches, innervates muscles of
the posterior thigh, entire leg
and entire foot
Sciatic
Nerve
Common
Fibular
Nerve
Tibial
Nerve
Posterior View
Superficial Fibular
(Peroneal) Nerve
Common
Peroneal
Nerve
● Terminal branch of the
common peroneal nerve
● Innervates lateral lower leg
and the dorsum of the foot
and ankle
● Roots
○ L4-S1
Superficial
Fibular
(Peroneal)
Nerve
Anterior View
Deep Fibular
(Peroneal) Nerve
Common
Peroneal
Nerve
Deep Fibular
(Peroneal)
Nerve
● Branches from Common
Peroneal Nerve
● Innervates the muscles of the
anterior compartment of the
leg and webbed space of skin
between the first and second
toes
● Roots
○ L4-L5
Superficial
Fibular
(Peroneal)
Nerve
Anterior View
Superficial & Deep Fibular (Peroneal) Nerves
Tibial Nerve
● Branches from sciatic nerve
and follows the midline of the
lower leg to the heel
Femoral Nerve
● Roots: L2-L4
● Largest nerve in the lumbar
plexus
● Innervates: Muscles that extend
the knee (Rectus Femoris,
Vastus Lateralis, Vastus
Intermedius, Vastus Medialis);
also muscles that flex the hip
(Iliacus, Psoas Major, Pectineus,
Sartorius)
Tendons:
Quadriceps
Femoris
Composed of 4 quadriceps muscles:
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Rectus Femoris
Vastus Lateralis,
Vastus Intermedius
Vastus Medialis
Rectus Femoris
Nerve: Femoral Nerve
Roots: L2 & L4
Action: Knee extension; Hip
flexion
Origin: Anterior inferior iliac
spine
Insertion: Patella via quadriceps
tendon & tibial tuberosity via
patellar ligament
Rectus Femoris
Synergists:
Hip Flexion: Iliopsoas, Pectineus, TFL,
Sartorius, Adductor (Longus & Brevis)
Knee Extension: Vastus (all)
Antagonists:
Hip Extension: Glute Max,
Semimembranosus, Semitendinosus,
Biceps Femoris
Knee Flexion: Semimembranosus,
Semitendinosus, Biceps Femoris,
Gracilis, Gastrocnemius, Popliteus,
Sartorius
Vastus
Intermedius
Nerve: Femoral Nerve
Roots: L2 & L4
Action: Knee extension
Origin: Anterior ⅔ and lateral
shaft of femur
Insertion: Patella via quadriceps
tendon & tibial tuberosity via
patellar ligament
Vastus Intermedius
Synergists:
Knee Extension: Rectus Femoris,
Vastus (Lateralis & Medialis)
Antagonists:
Knee Flexion: Biceps Femoris,
Semimembranosus,
Semitendinosus, Gracilis,
Gastrocnemius, Popliteus,
Sartorius
Vastus Medialis
O: Linea aspera of femur
I: Patella via quadriceps
tendon, tibial tuberosity via
patellar ligament
N: Femoral nerve
R: L2-L4
A: Extends the knee
Vastus Medialis
S: Extension: Rectus Femoris,
Vastus Lateralis, Vastus
Intermedius
A: Extension: Semimembranosus,
Semitendinosus, Biceps Femoris,
Gracilis, Gastrocnemius,
Popliteus, Sartorius
Vastus Lateralis
O: Intertrochanteric line
and linea aspera of femur
I: Patella via quadriceps
tendon, tibial tuberosity
via patellar ligament
N: Femoral nerve
R: L2-L4
A: Extends the knee
Vastus Lateralis
S: Extension: Rectus Femoris,
Vastus Medialis, Vastus
Intermedius
A: Extension: Semimembranosus,
Semitendinosus, Biceps Femoris,
Gracilis, Gastrocnemius,
Popliteus, Sartorius
Biceps Femoris
O: Long Head: Ischial Tuberosity
Short Head: Linea Aspera of Femur
I: Head of the fibula & lateral condyle
of tibia
A: Long Head: Extends hip & flexes
knee
Short Head: Flexes knee & laterally
rotates hip
Laterally rotates flexed knee
N: Tibial Nerve (LH) & Fibular Nerve
(SH)
R: L5, S1 & S2
Biceps Femoris
S: Hip Extension:
gluteus maximus, semitendinosus,
semimembranosus, adductor
Lateral Rotation:
gluteus maximus, piriformis, iliopsoas, sartorius
Knee Flexion:
semitendinosus, semimembranosus, gracilis,
sartorius, gastrocnemius
A: Hip Flexion:
Rectus femoris, iliopsoas, pectineus, TFL, Sartorius
Medial Rotation:
gluteus (medius & minimus), TFL, adductor
(magnus, longus, brevis), pectineus, gracilis
Knee Extension:
Vastus (medialis, lateralis, intermedius), rectus
femoris
Semitendinosus
O: Ischial Tuberosity
I: Proximal medial shaft of tibia at
Pes Anserinus tendon
A: Flexes knee, medially rotates
flexed knee & extends hip
N: Tibial Nerve
R: L5, S1 & S2
Semitendinosus
S: Knee Flexion:
Biceps femoris, semimembranosus, gracilis,
sartorius, gastrocnemius, popliteus
Hip Extension:
Gluteus maximus, biceps femoris,
semimembranosus
Medial Rotation:
Semimembranosus, gracilis, sartorius, popliteus
A: Knee Extension:
Rectus femoris, Vastus (medialis, lateralis,
intermedius)
Hip Flexion:
Rectus femoris, iliopsoas, pectineus, sartorius
Lateral Rotation:
Biceps Femoris
Semimembranosus
O: Ischial Tuberosity
I: Posterior medial condyle of tibia
A: Flexes knee, medially rotates
flexed knee & extends hip
N: Tibial Nerve
R: L5, S1 & S2
Semimembranosus
S: Knee Flexion:
Biceps femoris, semimembranosus, gracilis,
sartorius, gastrocnemius, popliteus
Hip Extension:
Gluteus maximus, biceps femoris,
semimembranosus
Medial Rotation:
Semimembranosus, gracilis, sartorius, popliteus
A: Knee Extension:
Rectus femoris, Vastus (medialis, lateralis,
intermedius)
Hip Flexion:
Rectus femoris, iliopsoas, pectineus, sartorius
Lateral Rotation:
Biceps Femoris
Popliteus
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Deep knee flexor muscle
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Action: unlocks the knee (flexion) when in
full extension (hyperextension)
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Innervation: Tibial Nerve (roots L4-S1)
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Origin: Lateral condyle of femur and lateral
meniscus
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Insertion: posterior tibia
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Synergists: Gracilis, Sartorius,
Semitendinosus, Semimembranosus, Biceps
Femoris, Gastrocnemius
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Antagonists: Rectus Femoris, Vastus Lateralis,
V. Intermedialis, V. Medialis
Gastrocnemius
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Superficial muscle which names means “leg
belly.” It gives the calf its shape
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Action: Knee flexion and ankle plantarflexion
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Innervation: Tibial Nerve (roots S1-S2)
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Origin:
Medial head - Superior to medial condyle of
femur
Lateral head - lateral condyle of femur
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Insertion: calcaneus via calcaneal (Achilles)
tendon
Gastrocnemius
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Synergists:
Knee flexion: Biceps Femoris, Sartorius,
Gracilis, Semitendinosus, Semimembranosus,
Popliteus
Plantarflexion: Soleus, Plantaris, Tibialis
Posterior, Fibularis longus, Fibularis Brevis
●
Antagonists:
Knee extension: Rectus Femoris, Vastus
Lateralis, Vastus Intermedialis, Vastus
Medialis
Dorsiflexion: Extensor Digitorum Longus,
Tibialis Anterior, Extensor Hallucis Longus,
Fibularis Tertius
Arteries of the knee
Femoral: supplies lower limbs
Popliteal: supplies capsule and
ligaments of knee joint
Anterior Tibial: supplies anterior
compartment of the leg; dorsal
surface of the foot
Posterior Tibial: supplies posterior
compartment of the leg; plantar
surface of the foot
Fibular (Peroneal): supplies blood
to lateral compartment of leg
Dorsalis Pedis: supplies dorsal
surface of foot
Arteries of the knee
Femoral
Popliteal
Anterior Tibial
Posterior Tibial
Dorsalis Pedis
Fibular/Peroneal
Veins of the knee
Small Saphenous: superficial vein;
passes through Gastrocnemius
Great Saphenous: superficial vein;
longest vein in the body
Anterior Tibial: follows artery
Posterior Tibial: follows artery
Fibular (Peroneal): follows artery
Popliteal: follows artery
Femoral: follows artery
Veins of the knee
Fibular/Peroneal
Anterior Tibial
Posterior Tibial
Popliteal
Small Saphenous
Femoral
Great Saphenous
External Iliac
Questions?