가톨릭대학교

인천성모병원

재활의학과 김재민

Anatomy of Hip and Knee

Hip

Surface Anatomy of Hip

ASIS Inguinal ligament Femoral A.V.N.

Surface Anatomy of Hip

Greater trochanter

Iliac crest

Surface Anatomy of Hip

Gluteus medius

Surface Anatomy of Hip

Ischial tuberosity

Hamstring

Osseous and Articular Anatomy

• Ball and socket joint – Femoral head and acetabulum

• Cup-shaped acetabulum – Ilium, ischium, and pubis

• Acetabular labrum

– Triangular fibrocartilaginous structure – Increase the depth and surface of the acetabular cavity

• Ligamentum teres – Flat cord-like structure – Fovea centralis with lower portion of the acetabulum – Vascular supplying the femoral head

Osseous and Articular Anatomy

Joint and Ligament Complex

Joint and Ligament Complex

• The articular surface of the head of the femur – Deep inside the bony acetabulum – Cover 40% of it at any position of hip motion

• Strong capsule

• Powerful para-articular ligament

– Anterior iliofemoral & pubofemoral ligament – Posterior ischiofemoral ligament

Anterior Hip

• Superficial – Sartorius – Tensor fascia lata

• Deep – Rectus femoris – Iliopsoas – Rectineus

Medial Hip

• Adductor brevis • Adductor longus • Adductor magnus • Gracilis • Obturator externus

Posterior and Lateral Hip

• Superficial – Gluteus maximus – Gluteus medius

• Deep – Gluteus minimus – Piriformis – Obturator internus – Gemullus – Quadratus femoris

Posterior Hip

• Semitendinosus • Semimembranosus • Long head of biceps femoris

Neurovascular Structures

• Femoral A. V. N., lat. femoral cutaneous nerve • Sup. & Inf. gluteal A. V. N. and Sciatic nerve

Neurovascular Structures

• Lateral femoral cutaneous nerve – Lateral end of the inguinal ligament – Closed with anterior superior iliac spine – Purely sensory and supplied the skin of the anterior and lateral

aspects of the thigh

• Sciatic nerve

– Deep to the inferior margin of the piriformis – Midway between the greater trochanter and ischial tuberosity

Bursa

• Bursa – Greator trochanteric bursa – Subgluteus medius bursa – Subgluteus minimus bursa

• Facet – Anterior – Lateral – Superoposterior – Posterior

Bursa

• Iliopsoas bursa – Iliopsoas ~ anterior capsule of the hip

• Ischiogluteal bursa – Ischial tuberosity ~ glueus maximus

Knee

Surface Anatomy of Anterior Knee

Patella Patellar ligament Tibial tuberosity

Surface Anatomy of Medial Knee

Medial condyle Medial epicondyle Medial collateral ligament

1. Boundary of the joint 2. Iliotibial tract 3. Gerdy’s tubercle 4. Lateral epicondyle 5. Head of the fibular 6. Lateral collateral ligament 7. Biceps femoris 8. Common peroneal nerve

Surface Anatomy of Lateral Knee

Surface Anatomy of Lateral Knee

1. Biceps femoris 2. Common peroneal nerve 3. Tibial nerve 4. Semitendinosus 5. Gracilis

Surface Anatomy of Posterior Knee

Osseous and Articular Anatomy

Osseous and Articular Anatomy

• Femorotibial joint • Patellofemoral joint • Tibiofibular joint

– Shard a common synovial cavity

• Patella – Sesamoid bone – Lateral articular surface is larger and more concave

Joint and Ligament Complex

Joint and Ligament Complex

Ligament of the Knee

• Medial collateral ligament • Lateral collateral ligament • Anterior cruciate ligament • Posterior cruciate ligament • Medial patellar retinaculum • Lateral patellar retinaculum

Cruciate Ligament

• Anterior cruciate ligament – lateral condyle ~ anterior to tibial spine – Restraint to internal rotation of knee

• Posterior cruciate ligament

– Medial condyle ~ posterior intercondylar area – Posterior translational movement of the tibia

Anterior Knee

• Patella • Patellar tendon

– 3~5mm thickness

• Quadriceps tendon – Rectus femoris – Vastus medialis – Vastus lateralis – Vastus intermedius

Medial Knee

• Med. collateral lig., med. patellar retinaculum • Med, meniscus • Semimembranosus, med. head of gastrocnemius • Semitendinosus, gracilis, sartorius

Medial Knee

• Superficial layer – Crural fascia – Medial patellar retinaculum

• Intermediate layer – Superficial portion of the MCL

• Deep layer – Deep portion of the MCL – Meniscofemoral ligament, meniscotibial ligament

• Medial collateral ligament – 1.5cm width, 10~11cm length – Femoral attachment (5cm above joint line) – Tibial attachement (6~7cm below joint line)

Lateral Knee

• Lat. collateral lig., • Lat, meniscus • Biceps femoris, lat. head of gastrocnemius • Popliteus

Lateral Knee

• Superficial layer – Iliotibial tract – Biceps femoris tendon

• Intermediate layer – Lateral patellar retinaculum – Lateral collateral ligament

• Deep layer – Joint capsule – Popliteal tendon

• Lateral collateral ligament – Cord-like structure – Lateral femoral epicondyle ~ fibular head

Posterior Knee

• Semimembranosus • Semitendinosus • Biceps femoris • Gastrocnemius

• Popliteal Fossa

– Poplitieal A.V. – Tibial nerve – Common peroneal nerve

Bursa

• Prepatellar bursa • Superficial infrapatellar bursa • Infrapatellar bursa • Pes anserine bursa • Semimembranous-medial collateral ligament bursa • Biceps femoris-lateral collateral ligament bursa • Seminmembranous-gastrocnemius bursa

Bursa

• Prepatellar bursa • Superficial infrapatellar bursa • Infrapatellar bursa • Pes anserine bursa

Thank you for

your attention!