Embed Size (px)
Citation preview
The Knee
The knee consists of:
The tibiofemoral joint
Patellofemoral joint
Clarification of Terms
Mansfield, p273
Distal Femur
Proximal tibia and fibula
Patella
Osteology of the Knee
Osteology of the Knee
Distal femur
Right Femur
(ADDuctor tubercle)
Osteology of the Knee
The proximal tibia & fibula
The medial and lateral
condyles of the tibia form the
shallow articulations with the
distal femur
The intercondylar/intercondyloid
eminence
the attachment point for the
cruciate ligaments
Tibial
Tuberosity Fibular
Head
Interosseous
Membrane
Osteology of the Knee
Patella
Tibiofemoral Joint
Articulation between the large condyles of the distal femur and the relatively flat proximal tibia
Patellofemoral Joint
Articulation between the patella and distal femur
Joint Structure
Mansfield, p273
Joint Structure: Alignment
Genu valgum refers to a
frontal deviation of the
position of the knee.
Commonly referred to as
“knock-knee” due to the
distal segments being
positioned more laterally
than normal
Genu varum refers to a
frontal deviation of the
position of the knee.
Commonly referred to as
“bow-leg” is the
opposite. Lippert, p294 & Mansfield, p278
Joint Structure: Alignment
Genurecurvatum:
Hyperextension of the tibiofemoral joint placing
excessive stress on the structures in the popliteal
space
Tibial nerve
Popliteal Vein
Popliteal Artery
Common Peroneal Nerve
Joint Structure: Alignment Q Angle
* angle between the quadriceps
muscle and the patellar tendon
* draw a line from the ASIS to
the midpoint of the patella and
from the tibial tuberosity to the
midpoint of the patella
* tends to be greater in females
due to wider pelvis
Lippert, p285
Tibiofemoral Joint:
Osteokinematics:
flexion, extension
Internal and external rotation
Arthrokinematics:
Open chain =
Closed chain =
(hint: convex distal femoral condyles and concave proximal tibial plateau)
Joint Movement
Lippert, p284 & Mansfield, p284
Patellofemoral Joint
Osteokinematics
n/a
Arthrokinematics
The smooth posterior surface of the patella glides over the femur
It glides and tilts in all 4 directions
Joint Movement
Lippert, p285
ACL & PCL (Sagittal plane stability)
MCL & LCL (Frontal Plane stability)
Posterior capsule
Medial and lateral menisci
Supporting Structures
Supporting Structures
Anterior Cruciate Ligament (ACL)
Keeps femur from moving posteriorly on tibia and from tibia from moving anteriorly on femur
Tightens during extension, preventing hyperextension
Posterior Cruciate Ligament (PCL)
Keeps femur from moving
anteriorly on tibia and from tibia from moving posteriorly on femur
Tightens during flexion
Lippert, p288
Supporting Structures: ACL & PCL
Supporting Structures
Medial Collateral Ligament (MCL)
Flat broad ligament attaching the medial condyles of femur and tibia
It protects the joint from stresses to the ____________ side of the knee.
Lateral Collateral Ligament (LCL)
Round, cordlike ligament attaching from lateral femoral condyle to fibular head
It protects the joint from stresses to ____________ side of the knee.
Lippert, p288
Supporting Structures: MCL & LCL
Posterior Capsule:
Prevents hyperextension of the knee
Supporting Structures
Mansfield, p282
Medial and lateral menisci
Two half-moon, wedge-shaped fibrocartilage disks
Located on the superior surface of the tibia
Designed to absorb shock
Thicker laterally than medially
Proximal surfaces are concave, deepening the relatively flat joint surface of the tibia
Supporting Structures
Lippert, p288
Knee Structure
Popliteal Space
Area behind the knee containing important nerves (tibial and common peroneal) and blood vessels (popliteal artery and vein)
Diamond shaped fossa
Bound superiorly by semitendinosus and semimembranosus on the medial side and biceps femoris on lateral side.
Bound inferiorly by the medial and lateral heads of the gastrocnemius
Lippert, p288
Muscles of the Knee
Myology
Area Mono-articular Muscle
Bi-articular Buslce
Anterior Vastus Lateralis Rectus Femoris
Vastus Medialis
Vastus Intermedialis
Posterior Biceps femoris (short)
Biceps femoris (long)
Popliteus Semimembranosus
Semitendinosus
Gastrocnemius
Medial Sartorius
Gracilis
Lateral Tensor Fascia Latae Lippert, p290
Myology of the Knee
Your subtopic goes here Rectus Femoris
Origin Anterior-inferior iliac spine
Insertion Tibial tuberosity via the quadriceps
tendon
Innervation Femoral n.
Action Hip flexion, knee extension
“tidbit” One of the heads of the “quads”
Lippert, p291
Myology of the Knee
Vastus Medialis
Origin Medial lip of the linea aspera
and the intertrochanterid line
of the femur
Insertion Tibial tuberosity via the
patellar tendon
Innervation Femoral n.
Action Knee extension
“tidbit” •One of the heads of the
“quad”
•“VMO” one of the first
muscles of the knee to atrophy
post-operatively,
• responsible for last 10-15o of
knee extension
Vastus
Medialis
Obliquus
Lippert, p291
Myology of the Knee
Vastus Lateralis
Origin Lateral lip of the linea aspera,
intertrochanteric line, lateral
region of the gluteal tuberosity
Insertion Tibial tuberosity via the
patellar tendon
Innervation Femoral n.
Action Knee extension
“tidbit” Part of the “quads”
Lippert, p291
Myology of the Knee
Vastus Intermedialus
Origin Upper 2/3 of the anterior
femoral shaft
Insertion Tibial tuberosity via the patellar
tendon
Innervation Femoral n.
Action Knee extension
Lippert, p291
Myology of the Knee
Your subtopic goes here Biceps Femoris
Origin Ischial tuberosity
Insertion Head of the fibula
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion
“tidbit” One of the hamstrings
A
A B C D Bicep F Bicep F Semimem Semiten
Lippert, 292
Myology of the Knee
Your subtopic goes here Semimembranosus
Origin Ischial tuberosity
Insertion Medial condyle of the tibia, posterior aspect
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion
“tidbit” One of the hamstrings
Lippert, p291
Myology of the Knee
Your subtopic goes here Semitendinosus
Origin Ischial tuberosity
Insertion Proximal-medial surface of the tibia
(pes anserinus)
Innervation Tibial portion of the sciatic n.
Action Hip extension, knee flexion,
“tidbit” One of the hamstrings
Lippert, 292
Myology of the Knee
Popliteus
Origin Posterior aspect of the
lateral femoral condyle
Insertion Posterior surface of the
proximal tibia
Innervation Tibial n.
Action Initiates knee flexion
Lippert, 292
Myology of the Knee
Gastrocnemius
Origin Medial head: posterior aspect of the
medial femoral condyle
Lateral head: posterior aspect of the
lateral femoral condyle
Insertion Calcaneal tuberosity via the Achilles
tendon
Innervation Tibial n.
Action Flexion of the knee, plantar flexion,
Lippert, 293
Myology of the Knee
Your subtopic goes here Sartorius
Origin ASIS
Insertion Proximal-medial surface of the tibia (via
the pes anserinus)
Innervation Femoral n.
Action Hip flexion, hip ABD, Hip ER, knee
flexion
“tidbit” Longest muscle in the body
Biel, p326
Myology of the Knee
Your subtopic goes here Gracillis
Origin Body and inferior ramus of the
pubis
Insertion Proximal-medial aspect of the
tibia (pes anserinus)
Innervation Obturator n.
Action Hip ADD, hip flexion, knee
flexion
Biel, p321
Myology of the Knee
Tensor Fascia Latae
Origin Iliac crest, posterior to ASIS
Insertion Iliotibial tract
Innervation Superior Gluteal Nerve
Action Hip flexion, ABD, internal
rotation
Biel, p324
Prime Movers of the Knee:
Extension:
Quadriceps group
Flexion:
Hamstring group
Popliteus
gastrocnemius
Myology
Lippert, p294
Summary of Muscle Innervation:
Myology
Muscle Nerve
Rectus femoris Femoral
Vastus lateralis Femoral
Vastus intermedialis Femoral
Vastus medialis Femoral
Semimembranosus Sciatic
Semitendinosus Sciatic
Biceps femoris – long head Sciatic
Biceps femoris – short head Common Peroneal
Popliteus Tibial
gastrocnemius Tibial
Lippert, p295
Genu Valgum
Genu Varum
Genu Recurvatum
Patellar Tendonitis
Osgood-Schlatter Disease
Patellofemoral Pain Syndrome
Chondromalacia Patella
Unhappy Triad
Common Knee Pathology
Genu Valgum and Varum
Lippert, p294
Genu Recurvatum
Lippert, p294
Osgood-Schlatter
Lippert, p294
Chondromalacia Patella
Lippert, p294
Unhappy Triad
Lippert, p294
Biel, A., (2010). Trail Guide to the Body, 4th ed. Boulder, CO: Books of Discovery.
Lippert, L.S. (2011). Clinical Kinesiology and Anatomy, 5th ed. Philadelphia, PA: F.A. Davis.
Mansfield, P.J., & Neumann, D.A. (2009). Essentials of Kinesiology for the Physical Therapist Assistant. St. Louis, MO: Mosby Elsevier.
References
