Knee joint

Post by **SURIYA.KARTHIKEYHAN** » Mon Nov 25, 2024 4:07 pm

Knee joint

: Picture1.png (305.23 KiB) Viewed 349 times

KNEE JOINT

Type
Parts
Articular surfaces
Stability of the joint
Ligaments supporting the joint
Movements
Relations and Bursae
Blood supply and nerve supply
Applied anatomy

CLINICAL CASE SCENARIO-1

24 yr old Mr. Ravi presented to orthopaedic OPD with C/O Pain and swelling of Right knee and inability to extend knee for past 2 days. On probing patient gave history of being a food ball player went to a tournament and sustained minor injury and blow to the lateral side of knee, during the play followed by which he developed symptoms. On examination, drawer sign was negative. X ray knee joint revealed no fractures.

QUESTIONS

What is your probable diagnosis?
Name the ligaments commonly injured following sports injury?
What is “Terrible triad” or “Unhappy triad of O donogue”
Treatment advised?
Advice to be followed in future…

CLINICAL CASE SCENARIO-2

60 yr old Mr. Karupaiyah presented to orthopaedic OPD with complaints of difficulty in walking, B/L Knee pain increasing in tendency for past 1year, inability to squat, swelling of knee for past 3 days…
Probable Diagnosis?
Investigations?
Treatment options?
Complications?

TYPE

Compound joint
Complex joint
Condylar variety
‘modified hinge’

: Picture2.png (339.67 KiB) Viewed 349 times

PARTS

Tibio - femoral component.
- 2 joint cavities.
Patello - femoral component.

MECHANICALLY WEAK BECAUSE…

Tibial condyles are too small to hold the larger femoral condyles.
complicated & incongruent shape of joint surfaces.
Femur slants medially;
Tibia is almost vertical.

STABILITY OF THE JOINT

Functional stability of the joint is derived from the passive restraint of the ligaments, the active support of muscles, the joint geometry, and the compressive forces pushing the bones together.
Cruciate ligaments maintain Anteroposterior stability.
Collateral ligaments maintain side to side stability.
Iliotibial tract supports on lateral side in slightly flexed knee

ARTICULAR SURFACES

Femoral surface.
Proximal tibial surface (plateau).
Patellar surface.

: Picture3.png (249.07 KiB) Viewed 349 times

MENISCI

Crescentic.
Made of fibro-cartilage.
Attached and free border.
Peripheral portion is vascular.
Function – improve congruence, stability, helps distribute weight.
Horns, Coronary ligament.

: Picture5.png (60.93 KiB) Viewed 346 times

Menisci or Semilunar Cartilages :

are two fibrocartilaginous discs.
crescent shaped.
deepen articular surfaces of the condyles of the tibia,
partially divide the joint cavity into upper and lower compartments.
Flexion and extension of the knee take place in the upper compartment,
rotation takes place, in the lower compartment

: Untitled.png (123.01 KiB) Viewed 346 times

STRUCTURES IN INTERCONDYLAR EMINENCE

: Picture6.png (680.29 KiB) Viewed 348 times

Medial meniscus

Semi-circle
Broader posteriorly
Attached to the medial collateral ligament and the semimembranous muscle through the capsule.

: Picture7.png (290.96 KiB) Viewed 348 times

Lateral Meniscus

Forms 4/5 of a circle
Attached to the popliteus muscle, posterior cruciate ligament
Menisco-femoral ligaments (anterior menisco-femoral ligament or ligament of Humphrey and posterior menisco-femoral ligament or ligament of Wrisberg)

: Picture8.png (290.51 KiB) Viewed 348 times

LIGAMENTS SUPPORTING

Extra-capsular.
Intra-capsular.

FIBROUS CAPSULE

Deficient…
Upper attachment.
Lower attachment.

: Picture444.jpg (26.77 KiB) Viewed 255 times

SYNOVIAL MEMBRANE

Lines the internal aspect of the capsule, attaches to the periphery of the patella and edges of the menisci.
Infra-patellar synovial fold.
Intercondylar septum.
Intercondylar foramen.

: Picture10.png (771.53 KiB) Viewed 348 times

: Picture11.png (478.29 KiB) Viewed 348 times

EXTRA-CAPSULAR

Tibial collateral lig. (medial coll.lig.).
Fibular collateral lig. (lateral coll.lig.).
Oblique popliteal lig.
Arcuate popliteal lig.
Patellar lig. (Ligamentum patella).

: Knee joint ligaments on Make a GIF.gif (1.58 MiB) Viewed 276 times

INTRA-CAPSULAR

Cruciate ligaments
Coronary lig.
Transverse lig. of knee.
Menisco - femoral ligaments.

EXTRA-CAPSULAR LIGAMENTS

TIBIAL COLLATERAL LIGAMENT

Superficial and deep parts.
Proximal attachment :
- both parts to medial epicondyle
Distal attachment :
- Superficial : medial condyle &upper part of medial border of shaft of tibia.
- Deep : to medial condyle of tibia along the upper margin of groove for semi-membranous.

: Picture13.png (189.29 KiB) Viewed 348 times

CONTINUED..

TCL :

- is weaker than fibular coll.lig.
- is more often damaged and commonly injured during sports.
Tibial collateral ligament is morphologically considered to be the degenerated part of Ischial part of Adductor Magnus and Fibular collateral ligament is the degenerated part of peroneus longus muscle.

FIBULAR COLLATERAL LIGAMENT

Proximal: lateral epicondyle.
Distal: Head of fibula, close to its styloid process.
Deep surface of the lig. is not adherent to the fibrous capsule.

: Picture14.png (234.53 KiB) Viewed 348 times

OBLIQUE POPLITEAL AND ARCUATE LIGAMENTS

: Picture15.png (361.46 KiB) Viewed 348 times

OBLIQUE POPLITEAL LIGAMENT

An expansion from insertion of semi-membranosus.

extends from the posterior surface of the medial condyle of tibia to the lateral part of the intercondylar line of femur.

ARCUATE LIGAMENT

Y shaped
Stem: Attached to the styloid process of head of fibula.
Posterior band : Attached to lateral condyle of tibia.
Anterior band : Attached to lateral condyle of femur.

: Picture16.png (94.08 KiB) Viewed 348 times

PATELLAR LIGAMENT

Derived from the tendon of Quadriceps Femoris.
Extends from the apex of patella to upper part of tibial tuberosity.

: Picture333.png (126.1 KiB) Viewed 263 times

: Knee_Anatomy_.gif (1.61 MiB) Viewed 274 times

Intra-capsular

ANTERIOR CRUCIATE LIGAMENT

Arises from : Anterior inter-condylar area of tibia
Attached to : Posterior part of medial side of lateral condyle of femur.

TAUT WHEN KNEE IS FULLY EXTENDED.

Has a relatively poor blood supply.

FUNCTIONS:

binds bones together.
prevents hyper extension.
prevents forward displacement of tibial condyles.

: Picture18.png (220.8 KiB) Viewed 348 times

Posterior cruciate ligament

Stronger
Below: from posterior intercondylar area of tibia
Above: anterior part of lateral surface of medial condyle of femur.

TAUT IN FLEXION.

FUNCTIONS:

binds the bones.
prevents backward displacement of tibial condyles.
Is the main stabilizing factor for the femur in weight bearing flexed knee.

: Picture19.png (215.52 KiB) Viewed 348 times

Transverse ligament

Connects anterior horn of medial meniscus to the anterior margin of lateral meniscus.

Menisco - femoral ligament

Posterior horn of lateral meniscus to the medial condyle of femur by the anterior & posterior menisco - femoral ligament.

: Picture20.png (264.14 KiB) Viewed 348 times

Coronary ligament

Are parts of fibrous capsule, which provide attachment to the peripheral margins of the medial & lateral menisci.

: Picture21.png (287.55 KiB) Viewed 348 times

Movements

Active movements
- Flexion
- Extension
- Medial rotation
- Lateral rotation

: Kneeling-Quad-Stretch.gif (311.4 KiB) Viewed 272 times

FLEXION

HAMSTRINGS(PRIME MOVER)
initiated by : Popliteus
assisted by :
- Sartorius.
- Gracilis.
- Both heads of Gastrocnemius.
- Plantaris.

: open kinetic joints.gif (1.73 MiB) Viewed 273 times

EXTENSION

QUADRICEPS FEMORIS(PRIME MOVER)

Movement limited by cruciate & collateral ligaments.
Assisted by : Tensor Fascia Lata.

: knee-extension.gif (1.73 MiB) Viewed 265 times

ROTATION

Medial rotation : Semi-membranosus,
- Semi - tendinosus, Popliteus,
- Sartorius, Gracilis.
- Movement checked by cruciate ligaments.
Lateral rotation : Biceps Femoris.
- Movements checked by collateral igaments.

: sartorius-knee-medial-rotation.gif (281.23 KiB) Viewed 265 times

: biceps-femoris-long-head.gif (125.62 KiB) Viewed 265 times

RELATIONS

In front
- Quadriceps.
Antero-medially
- Medial patellar retinaculum.
Antero-laterally
- Lateral patellar retinaculum, ilio-tibial tract.
Postero-medially
- Sartorius, gracilis, semitendinosus, semimembranosus.
Postero-laterally
- Tendon of biceps, common peroneal nerve.
Behind
- Popliteal vessels, tibial nerve, both heads of gastrocnemius, plantaris.

: CzcfcT.gif (1.14 MiB) Viewed 265 times

: Picture111.png (248.47 KiB) Viewed 265 times

POPLITEUS-UNLOCKING MUSCLE

: Picture29.png (245.43 KiB) Viewed 348 times

QUADRICEPS FEMORIS- LOCKING MUSCLE

: 8ee729.gif (1.01 MiB) Viewed 265 times

BURSAE

In front
- 4 bursae namely Suprapatellar, prepatellar, Subcutaneous infrapatellar and deep infrapatellar
Laterally - 3 bursae behind biceps tendon, between popliteus and fibular collateral ligament, behind popliteus.
Medially - Behind tibial collateral, between tibial collateral and semimembranosus

: Picture31.png (229.04 KiB) Viewed 348 times

: Picture32.png (310.41 KiB) Viewed 348 times

BLOOD SUPPLY

Descending genicular branch of femoral artery.
Descending branch of lateral circumflex femoral artery.
Genicular branches of popliteal artery.
Anterior & posterior recurrent branches of anterior tibial artery.
Circumflex fibular artery.

ALL FORM GENICULAR ANASTOMOSIS.

: Picture33.png (365.62 KiB) Viewed 348 times

NERVE SUPPLY

Femoral N through N. to Vastii. (3)
Tibial nerve. (3)
Common peroneal nerve. (3)
Posterior division of obturator nerve. (1)
L3 – S1.

APPLIED ANATOMY

Fracture of patella.
Knee Joint Injuries:
- Injury to Collateral Ligaments.
- Injury to menisci.
- Injury to Cruciate Ligaments.
Aspiration of Knee Joint.
Arthroscopy of Knee Joint.
Osteoarthritis & Knee Replacement.

FRACTURE PATELLA & K WIRE FIXATION

: Picture34.png (345.92 KiB) Viewed 348 times

: Picture35.png (209.49 KiB) Viewed 348 times

TERRIBLE TRIAD

Anterior cruciate ligament.
Tibial collateral ligament.
Medial meniscus.
Mnemonic- ATM.

: Picture36.png (336.18 KiB) Viewed 348 times

: Picture37.png (1004.16 KiB) Viewed 348 times

CLINICAL CASE SCENARIO-1

24 yr old Mr.Ravi presented to orthopaedic OPD with C/O Pain and swelling of Right knee and inability to extend knee for past 2 days. On probing patient gave history of being a food ball player went to a tournament and sustained minor injury and blow to the lateral side of knee, during the play followed by which he developed symptoms. On examination, drawer sign was negative. X ray knee joint revealed no fractures.

QUESTIONS

What is your probable diagnosis?
Name the ligaments commonly injured following sports injury?
What is “Terrible triad” or “Unhappy triad of O donogue”
Treatment advised?
Advice to be followed in future…

ANSWERS

Terrible triad injury.
ATM- Anterior cruciate ligament, tibial collateral ligament and Medial Meniscus injury.
A strong blow to lateral side of a flexed knee, can easily rupture tibial collateral ligament. As Tibial collateral is firmly attached to Medial meniscus, there is concominant tear of Medial meniscus than lateral meniscus.
Surgical Repair of torned ligaments.
Bed rest for atleast 6 weeks.

MENISCUS REPAIR

: Picture38.png (591.32 KiB) Viewed 351 times

: Picture40.png (1.03 MiB) Viewed 351 times

[/size]

SURFACE MARKING BEFORE MENISCECTOMY

: Picture41.png (1.26 MiB) Viewed 351 times

SURGERY

: Picture44.png (581.94 KiB) Viewed 351 times

ARTHROSCOPIC MENISCECTOMY

: Picture45.png (452.53 KiB) Viewed 351 times

JOINT ASPIRATION

: Picture46.png (265.45 KiB) Viewed 351 times

: Picture47.png (390.69 KiB) Viewed 351 times

ARTHROSCOPY

: Picture48.png (280.34 KiB) Viewed 351 times

: Picture49.png (1.4 MiB) Viewed 351 times

[/size]

KNEE OSTEOARTHRITIS

: Picture50.png (773.4 KiB) Viewed 351 times

ROBOTIC KNEE REPLACEMENT SURGERY

: Picture51.png (1.41 MiB) Viewed 351 times

: 555.png (1.15 MiB) Viewed 254 times

: 777.png (1.43 MiB) Viewed 253 times