FACULTY OF HOMOEOPATHIC SCIENCE

KNEE JOINT

Knee joint is the most complicated and largest joint in the body.

It is consisting of 3 bones and an extensive network of ligaments and muscles.

Type of joint :Synovial joint

Subtype:1.According to degree of movements: Uniaxial2.According to form and shape of articular surface: modified hinge joint

There are two joints in the knee—the tibiofemoral joint, which joins the tibia to the femur and the patellofemoral joint which joins the kneecap to the femur.These two joints work together to form a modified hinge joint that allows the knee to bend and straighten, but also to rotate slightly and from side to side.

STRUCTURE OF THE KNEE JOINT

The main parts of the knee joint are bones, ligaments, tendons, cartilages and a joint capsule, all of which are made of collagen. Collagen is a fibrous tissue present throughout our body.

BONES OF THE KNEE JOINTThe bones give strength, stability and flexibility in the knee. three bones make up the knee:The bones are Femur, Tibia and Patella while the joints are tibiofemoral and patellofemoral joints. The tibiofemoral joint is a complex hinge joint between tibia and femur. The patellofemoral joint between femur and patella is a gliding synovial joint. These two joints work together to form a modified hinge joint that allows the knee to bend and straighten, but also to rotate slightly and from side to side.

ARTICULAR SURFACE OF THE KNEE JOINT

knee joint is formed by: 1.The condyles of the femur.2.The patella.3.The condyles of the tibia. The femoral condyle

articulate with the tibia condyle below and behind, and with the patella in front.

TENDONS OF THE KNEE JOINT Tendons are elastic tissues that technical part of the muscle and connect muscles to bones. Many of the tendons serve to stabilize the knee.There are two major tendons in the knee:•The quadriceps • Patellar

The quadriceps tendon connects the quadriceps muscles of the thigh to the kneecap and provides the power for straightening the knee.The patellar tendon connects the kneecap to the shinbone (tibia)—which means it’s really a ligament.

CARTILAGE OF THE KNEE JOINTIt is a thin, elastic tissue that protects the bone and makes certain that the joint surfaces can slide easily over each other. Cartilage ensures supply knee movement.There are two types of joint cartilage in the knees: •Fibrous cartilage (the meniscus)•Hyaline cartilage.

LIGAMENTS OF THE KNEE JOINTThe knee works similarly to a rounded surface sitting atop a flat surface. The function of ligaments is to attach bones to bones and give strength and stability to the knee as the knee has very little stability. Ligaments are strong, tough bands that are not particularly flexible. Once stretched, they tend to stay stretched and if stretched too far, they snap.

The ligaments surrounding the knee joint offer stability by limiting movements and, together with several menisci and bursae, protect the articular capsule.

Knee joint is supported by the following ligaments:•Fibrous capsule.•Ligamentum patellae •Tibial collateral ligament•Fibular collateral ligament•Oblique popliteal ligament•Arcuate popliteal ligament•Anterior cruciate ligament•Posterior cruciate ligament•Medial meniscus ligament•Lateral meniscus ligament•Transverse ligament

1. FIBROUS(ARTICULAR)CAPSULE The fibrous capsule is very thin,it is attached about half to one centimeter beyond the ariticular margins. Fibrous capsule is attached to the periphery of the menisci. The part of the capsule between the menisci and the tibia is sometimes called coronary ligament.

2. LIGAMENTUM PATELLAE The ligamentum patellae is about 7.5cm long and 2.5cm broad. Above It is attached to the margins and rough posterior surface of the apex of the patella, and below to the smooth, upper part of the tibial tuberosity. It realated to the superficial and deep infrapatellar bursae.

3.TIBIAL COLLATERAL OR MEDIAL LIGAMENT

It is attached to the medial epicondyle of the femur just below the adductor tubercle inferiorly, it divides into anterior and posterior part.The anterior or superficial part is about 10cm long and 1.25cm broad. It is attached below the medial border and posterior part of the medial surface of the shaft of the tibia. The posterior or deep part of the ligament is short and blends with the capsule and with the medial menisci. It is attached to the medial condyle of the tibia above the groove for the semimembranosus.

4. FIBULAR COLLATERAL OR (LATERAL) LIGAMENT

It is 5cm long. Superiorly attached to the lateral epicondyle of the femur just above the popliteal groove. Inferiorly, it is attached to the head of the fibula in front of its apex.

5. OBLIQUE POPLITEAL LIGAMENT

This is an expansion from the tendon of the semimebranosus. It runs upwards and laterally, blends with posterior surface of the capsule, and is attached to the intercondylar line and lateral condyle of the femur.

6. ARCUATE POPLITEAL LIGAMENT

It is the posterior expansion from the short lateral ligament. It extends backward from the head of the fibula, over the tendon of the popliteus, and s attached to the posterior border of the intercondylar area of the tibia.

7. CRUCIATE LIGAMENT Cruciate ligament are thick and strong fibrous band. They are act as direct bonds of union between tibia and femur, to maintain anteroposterior stability of knee joint. Two cruciate ligament: 1.Anterior cruciate ligament 2.Posterior cruciate ligament

8. MENISCI OR SEMILUNAR LIGAMENT

The menisci are 2 fibrocartilaginous disc. They divied the joint cavity in upper and lower compartment.Flexion and extention take place in the upper compartment. And rotation take place in the lower compartment. 2 ends: anterior and posterior 2 borders : inner and outer. 2 surface : upper and lower The peripheral thick part is vacular. The inner part is avascular and is nourished by synovial fluid.Because of their nerve supply, they also have a sensory function. They give rise to proprioceptive impulses.

9. TRANSVERSE LIGAMENT

It connects the anterior ends of the medial and lateral menisci

BURSA AROUND THE KNEE

There are 13 bursa arount the knee:•Four anterior•Four lateral•Five medial

ANTERIOR BURSA1.Subcutaneous prepatellar bursa.2.Subcutaneous infrapatellar bursa.3.Deep infrapatellar bursa.4.Suprapatellar bursa.

LATERAL BURSA1. Bursa deep to the lateral head of the gastrocnemius.2. Bursa between the fibular collateral ligament and the biceps femoris. 3. Bursa between the fibular collateral ligament and the tendon of the popliteus. 4. Bursa between the tendon of the popliteal and the lateral condyle of the tibia.

MEDIAL BURSA1. A bursa deep to the medial head of the gastrocnemius. 2. Anserine bursa 3. A bursa deep to the tibial collateral ligament. 4. A bursa deep to the semimembranosus.

MOVEMENTS

•Flexion •Extension•Medial rotation•Lateral rotation

MOVEMENT OF THE KNEE JOINT•Flexion:Mainly by:Biceps femoris, SemimembranosusSemitendinosus Assisted by:SartoriusGracilis PopliteusIt consist:120-150 degree

Extension:Mainly by:Quadriceps femoriesAssisted by:Tensor facia lataItconsist: 5-10 degree

Medial rotation:Mainly by:PopliteusSemimembranosusSemitendinosus Assisted by:Gracilis It consist:30-40 degree

Lateral rotation:Biceps femorisIt consist: 10 degree

BLOOD SUPPLY The knee joint is supplied by the anastomosis arund it. 1. Five genicular branches of the popliteal artery. 2. The descending genicular branch 3. The descending branch of the lateral circumflex femoral artery4. Two recurrent branches of the anterior tibial artery 5. The circumflex fibular branch of the posterior tibial artery.

NERVE SUPPLY 1. Femoral nerve 2. Sciatic nerve 3. Obturator nerve

CLINICAL ANATOMY1 : BURSITIS AROUND THE KNEE JOINT:I :Prepatellar bursitis : It is the result of friction between the skin and the patella or may be due to compressive force resulting from a direct blow or from falling on the flexed knee or who work on their knees without using kneepads.It is also known as beat knee, carpet layer's knee, coal miner's knee, rug cutter's knee, or nun's kneeII : Housemaid’s knee : If the prepatellar bursitis become chronic the bursa become filled with fluid and distended in front of the knee.

2 :Baker’s cyst: When synovial fluid from the synovial effusion of the knee joint or bursa around the knee collects in the popliteal fossa - causing stiffness and knee pain.

The pain typically worsens if the patient fully flexes or extends the knee, or when he/she is moving about.

This was described by Dr. William Morrant Baker (1838-1896) and so named as baker’s cyst.

3 : TEARING OF THE MENISCI : It is caused by the twisting force in flexed knee where sudden movement between the condyles of tibia and femur but menisci does not move result is due to serve grinding force the menisci crushed, torn or splits along its length.

TYPES OF MENISCAL TEARS1) HORIZONTAL TEARS2) VERTICAL TEARS3) RADIAL TEARS4) BUCKET HANDLE TEAR5) PARROT BEAK TEAR6) FLAP TEAR

4: DEFORMITIES OF THE KNEE JOINT : The direct injury or ostroarthritis which cause degeneration tear of the menisci,so

menisci does not act.. As a result two deformities occur. I : Genu valgum or knock knee II: Genu varum or bowleg

5) OSTEOARTHRITIS It is a degenerative condition of large weight

bearing joints. The articular cartilage wears out, degenerates

and there is formation of peripheral osteophytes .

The patients feels lots of pain due to rubbing of the bones during movements of the joints.

The degenerative changes or spondylitis may occur in the cervical spine, leading to narrowed intervertibral foramen, causing pressure on the spinal nerve.

5) OSTEOARTHRITIS:

6) KNEE REPLACEMENT:

Knee replacement is also known as arthroplasty.

It is surgical procedure to resurface the knee damaged by arthritis.

Metal and plastic parts are used to cap the ends of the bones that form the knee joint along with the knee cap.

This surgery may be considered for some one who has severe arthritis or a severe knee injury.

6) KNEE REPLACEMENT:

7) KNEE ARTHROSCOPY:Knee arthroscopy is a technique used to diagnose and treat problems in the knee joint. During the procedure, your surgeon will make a very small incision and insert a tiny camera—called an arthroscope—into your knee. This allows him or her to view the inside of the joint on a screen. The surgeon can then investigate a problem with the knee and, if necessary, correct the issue using small instruments within the arthroscope.

INJURIES TO CRUCIATE LIGAMENTS

1)RUPTURE OF ANTERIOR CRUCIATE LIGAMENT:

It may be injured in violent hypertension of the knee or in anterior dislocation of tibia.

It is more commonly damaged than the posterior cruciate ligament.

2)RUPTURE OF POSTERIOR CRUCIATE LIGAMENT:

It may be injured in posterior dislocation of tibia.

This injury may vary from simple sprain to complete tear.

Tear of this ligament leads to abnormal anteroposterior mobility.

These are less common and may be produced by severe abduction and adduction strains.

INJURIES TO COLLATERAL LIGAMENTS

Mentor:Dr. manish aroraMiss neha saini

Made by:Shruti singh

Patel sumaiyaChaudhary saroj

Maniar pooja