Antero-medial Thigh & Knee Joint

8/6/2019 Antero-medial Thigh & Knee Joint

1/39

ANTEROANTERO--MEDIAL THIGHMEDIAL THIGH

& KNEE JOINT& KNEE JOINT

Leona Melodia Torres-Matheus, M.D.FPCS, FPSGS


2/39

SurfaceSurfaceAnatomyAnatomy

ASIS Iliac crest

Pubic crest

Pubic tubercle Inguinal ligament


3/39

SkinSkin

Cutaneous nerves:1. Lateral cutaneous nerve

of the thigh (L2-L3)

2. Femoral branch of Genito-

femoral nerve (L1-L2)3. Ilioinguinal nerve (L1)

4. Medial cutaneous nerve

of the thigh

(femoral nerve)

5. Intermediate cutaneous

nerve of the thigh

(femoral nerve)

6. Obturator nerve

7. Patellar plexus


4/39

Superficial Veins:

1. Great Saphenous vein- drains medial side of

dorsal venous arch (offoot) & ends atfemoral vein (at

saphenous opening)- 3 tributaries:

a. superficial circumflexiliac vein

b. superficial epigastric veinc. superficial external

pudendal vein

2. Small Saphenous vein


5/39

Inguinal Lymph Nodes

Superficial lie in the

superficial fascia belowinguinal ligament

Divided into horizontal

and vertical groups

Drains into deepinguinal LN

Deep lie beneath the

deep fascia along medialside of femoral vein

Drains into nodes along

external iliac artery into

the abdomen


6/39

Superficial FasciaSuperficial Fascia Membranous layer ofsuperficial fascia of the

anterior abdomen extendsinto the thigh and is

attached to deep fascia

(fascia lata) about a

fingers-breadth below theinguinal ligament

Fatty layer of the

superficial fascia of theanterior abdomen extends

into the thigh and

continues downward w/o

interruption


7/39

Deep Fascia (Fascia Lata)Deep Fascia (Fascia Lata)

Iliotibial tract:

thickened lateral aspect Attached to iliac tubercle

above & lateral condyle

of tibia below

Conjoint aponeurosis ofgluteus maximus &

tensor fascia lata


8/39

SaphenousSaphenous opening:opening: ovaloval

opening in the deep fasciaopening in the deep fasciajust below inguinal ligament,just below inguinal ligament,

1 in (4 cm) below & lateral1 in (4 cm) below & lateral

to pubic tubercleto pubic tubercle

Transmits greatTransmits great saphenoussaphenousvein, small branches of femoralvein, small branches of femoral

artery & lymph vesselsartery & lymph vessels

Filled w/ loose connectiveFilled w/ loose connective

tissue calledtissue called CribriformCribriform fasciafascia

33 fascialfascial septasepta divides thighdivides thigh

into anterior, medial, &into anterior, medial, &

posterior compartmentsposterior compartments


9/39

Muscles of theMuscles of the

AnteriorAnteriorCompartmentCompartment

of the Thighof the Thigh

Sartorius

Iliacus

Psoas: MajorMinor

Pectineus


10/39


Anterior Compartment of the ThighAnterior Compartment of the Thigh


11/39


AnteriorAnteriorCompartmentCompartment


Quadriceps femoris

Rectus femoris

Vastus lateralis Vastus medialis

Vastus intemedius


12/39

Muscles: Anterior compartmentMuscles: Anterior compartment


13/39

Neurovascular Structures &Neurovascular Structures &

Relationships in the Anterior ThighRelationships in the Anterior Thigh Femoral Triangle: triangular

depression in the medial thigh

just below inguinal ligament

- Boundaries:

S = inguinal ligament

M = adductor longus

L = sartoriusFloor: L = iliopsoas

M = pectineus

Roof = skin, SQ tissue,

fascia lata, cribriform fascia


14/39

Contents of theFemoral Triangle:

1. Terminal part of

Femoral nerve &

its branches

2. Femoral sheath

3. Femoral artery &

its branches

4. Femoral vein &

its tributaries

5. Deep inguinal LN


15/39

Femoral Sheath: downward

protrusion of the fascia lining

abdominal walls

(A = fascia transversalis;

P = fascia iliaca)

Surrounds femoral vessels &lymphatics for about 1 inch below

inguinal ligament

3 compartments:

1. lateral femoral artery

2. intermediate femoral vein

3. medial lymph vessels &

LN ( of Cloquet)

= Femoral canal


16/39

Femoral canal: smallmedial compartment for

lymph vessels in. (1.3 cm) long

Upper opening:Femoral ring

Closed by extraperitonealtissue: Femoral septum

Potential site of a femoralhernia

Boundaries: A = inguinal ligament

P = superior ramus ofpubis

M = lacunar ligament

L = femoral vein


17/39


18/39

Femoral artery:pass behind

inguinal ligament as acontinuation of external

iliac artery

Main arterial supply to LE

Branches:1. superficial circumflex

iliac a.

2. superficial epigastric a.

3. superficial externalpudendal a.

4. deep external pudendal a.

5. profunda femoris a.

6. descending genicular a.


19/39

Femoral Vein: enters thighthrough opening in adductor

magnus as a continuation of

the popliteal vein

Pass behind inguinal ligamentto become the external iliac v.

Tributaries:

1. Great saphenous v.

2. Veins that correspond tobranches of the femoral a.

(EXCEPT 3 superficial

branches = drain into great

saphenous vein)


20/39

Femoral Nerve: largest

branch of lumbar plexus

(L2-L4) Supplies all the muscles of

the anterior compartment

of the thigh

Emerges at lateral borderof psoas; pass downward

between psoas & iliacus

Enters thigh lateral to

femoral artery & femoralsheath

Does not enter the thigh

within the femoral sheath


21/39

Branches:Anterior division Cutaneous:

a. medial cutaneous nerveof the thigh

b. intermediate cutaneousnerve of the thigh

Muscular:

a. sartorius

b. pectineus

Branches: Posterior division Cutaneous:

a. Saphenous nerve

Muscular: Quadriceps femoris

a. rectus femoris = also supplyhip joint

b. vasti muscles = also supplyknee joint


22/39

Muscles ofMuscles of

the Medialthe MedialCompartmentCompartment


Gracilis

Adductor longus

Adductor brevis

Adductor magnus

Obturator

externus


23/39


Medial Compartment of the ThighMedial Compartment of the Thigh


24/39

Neurovascular Structures in theNeurovascular Structures in the

Medial ThighMedial Thigh

Profunda Femoris artery

- large artery that arises fromlateral side of femoral artery in

the femoral triangle, 1 in.below the inguinal ligament

- descends between adductores

longus & brevis

- Branches:1. Medial femoral circumflex a.

2. Lateral femoral circumflex a.

3. 4 perforating arteries


25/39

Profunda Femoris vein

- receive tributaries thatcorrespond to the

branches of the artery

- drains into the femoral

vein


26/39

Obturator artery

- branch of internal iliacartery

- Branches:

1. muscular

2. articular (to hip joint)

Obturator vein

- receives tributaries that

correspond tobranches of the artery

- drains into internal iliacvein


27/39

Obturator nerve

- from lumbar plexus (L2-L4)

- emerges on medial borderof psoas

- Branches: Anterior division

1. Muscular = gracilis,

adductor brevis, adductorlongus, pectineus

2. Articular = hip joint

- Branches: Posterior division

1. Muscular = obturator

externus, adductor

magnus (adductor part),

adductor brevis

2. Articular = knee joint


28/39

Knee JointKnee Joint


29/39

Knee JointKnee Joint

Largest & most

complicated joint

in the body

Consists of:1. gliding joint =

patella + femur

2. hinge joint =

femur + tibia

*Note: Fibula is not

directly involved in the

joint


30/39

LigamentsLigaments

ExtracapsularExtracapsular ligaments:ligaments:1.1. ligamentumligamentum patellae:patellae:

P = apex of patellaP = apex of patella

D =D = tibialtibial tuberositytuberosity

-- continuation of tendoncontinuation of tendonof quadricepsof quadriceps femorisfemoris

2.2. ObliqueOblique PoplitealPopliteal ligament:ligament:

derived fromderived from

SemimembranosusSemimembranosus ms.ms.

-- strengthens posteriorstrengthens posterior

aspect of jointaspect of joint


31/39

3. Medial collateral ligament:

P = medial condyle offemur

D = medial surface of

tibial shaft

- firmly attached to edgeof medial meniscus

4. Lateral collateral ligament:

P = lateral condyle of

femur

D = head of fibula


32/39

Intracapsular ligaments:

1. Cruciate ligaments:

2 ligaments that

cross each other

within the jointcavity

- named anterior& posterior

based on tibialattachments

- main bond between

femur & tibia


33/39

a) Anterior cruciate:A = ant. intercondylar

area of tibiaP = lat. femoral condyle

- prevents posteriordisplacement offemur on tibia

b) Posterior cruciate:P = post. intercondylar

area of tibia

A = med. femoral condyle- prevents anterior

displacement offemur on tibia


34/39

2. Menisci (Medial & Lateral):C-shaped fibro-cartilages that

a) deepen articularsurfaces of tibial

condylesb) serve as cushions

between femur& tibia

* Medial meniscusis relativelyimmobile (attached to medial collateralligament)


35/39

Posterior Bursae:Posterior Bursae:

1. Popliteal1. Popliteal associatedassociatedw/ popliteal tendonw/ popliteal tendon

2. Semimembranosus2. Semimembranosus

related to insertion ofrelated to insertion of

semimembranosussemimembranosus

Bursae related to the Knee JointBursae related to the Knee Joint


36/39

Anterior Bursae:Anterior Bursae:

1. suprapatellar1. suprapatellar

beneath quadricepsbeneath quadriceps

2. prepatellar2. prepatellar betweenbetween

skin & lower patella/skin & lower patella/

upper ligamentumupper ligamentum

patellaepatellae

3. superficial infrapatellar3. superficial infrapatellar

between skin & lowerbetween skin & lower

ligamentum patellaeligamentum patellae

4. deep infrapatellar4. deep infrapatellar

between ligamentumbetween ligamentum

patellae & tibiapatellae & tibia


37/39

MovementsMovements

Movements of the knee joint & themuscles that produce the movement:

1. Flexion = Biceps femoris,

semitendinosus, semimembranosusassisted by gracilis, sartorius, &

popliteus

2. Extension = Quadriceps femoris3. Medial rotation = Sartorius, gracilis,

semitendinosus

4. Lateral rotation = Biceps femoris


38/39

Nerve SupplyNerve Supply

Femoral nerve

Obturator nerve

Common peroneal nerve

Tibial nerve


39/39

Have a nice day!!!Have a nice day!!!

Documents

Antero-medial Thigh & Knee Joint