The Knee (Tibiofemoral)

JointBY: JACKIE, STACEY, GABE, AND SCHARLIE

Bones and Surface

Anatomy

By: Jackie

KNEE (TIBIOFEMORAL) JOINT

FEMUR:• Lateral Epicondyle• Lateral Condyle• Medial Epicondyle• Medial Condyle• Intercondylar Fossa

TIBIA:• Lateral Condyle• Medial Condyle• Tibial Tuberosity• Intercondylar Eminence

FIBULA:• Head

PATELLA

SURFACE ANATOMY

• Vastus Medialis• Vastus Lateralis• Patella

SURFACE ANATOMY

• Biceps Femoris Tendon• Semitendinous Tendon• Semimembranous

Tendon

SURFACE ANATOMY

• Medial Head of Gastronemius

• Lateral Head of Gastronemius

• Soleus• Popliteal Fossa

Ligaments, Bursae, and

CartilageBY: STACEY

Ligament Review

lig·a·ment

a short band of tough, flexible, fibrous connective tissue that connects two bones or cartilages or holds together a joint.

a membranous fold that supports an organ and keeps it in position.

Knee LigamentsPatellar LigamentTransverse LigamentAnterior Cruciate LigamentOblique Popliteal LigamentTibial Collateral LigamentArcuate Popliteal LigamentFibular Collateral LigamentPosterior Cruciate LigamentPTA OTA Fine People

Patellar Ligament

Tibial Collateral Ligament

Anterior Cruciate Ligament

Posterior Cruciate Ligament

Oblique PoplitealArcuate PoplitealFibular Collateral

Tendon Review

ten·don

a flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone.

Quadriceps Femoris Tendon

Cartilage Review

firm, whitish, flexible connective tissue found in various forms in the larynx and respiratory tract, in structures

such as the external ear, and in the articulating surfaces of joints.

Lateral and Medial Menisci

Bursa Review

bur·sa

plural noun: bursae

a fluid-filled sac or saclike cavity, especially one countering friction at a joint.

Prepatellar Bursa

Deep Infrapatellar Bursa

Subcutaneous Infrapatellar Bursa

Suprapatellar Bursa

Muscles and NervesTIBIOFEMORAL JOINT

BY: GABE

Rectus Femoris

Rectus Femoris

Origin: ASIS

Insertion: Patella via quadriceps tendon and then the tibial tuberosity via patellar tendon (ligament)

Action: Hip Flexion and knee extension

Nerve: Femoral Nerve

Vastus Intermedialis

Vastus Intermedialis

Origin: Anterior 2/3 and the lateral shaft of the femur

Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament

Action: Knee Extension

Nerve: Femoral Nerve

Vastus Lateralis

Vastus Lateralis

Origin: Intertrochanteric line and linea aspera of the femur

Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar tendon (ligament)

Action: Knee Extension

Nerve: Femoral Nerve

Vastus Medialis

Vastus Medialis

Origin: Linea aspera of the femur

Insertion: Patella via the quadriceps tendon and the tibial tuberosity via the patellar tendon (ligament)

Action: Knee extension

Nerve: Femoral Nerve

Biceps Femoris

Biceps Femoris Origin:

Long Head- Ischial tuberosityShort Head- Linea aspera of the femur

Insertion: Head of the fibula and lateral condyle of the tibia

Action: Long Head- Extends hip and flexes kneeShort Head- Flexes knee and laterally rotates hip

Nerve: Tibial Nerve

Semimembranosus

Semimembranosus

Origin: Ischial tuberosity

Insertion: Posterior medial condyle of the tibia

Action: Extends and medial rotates the hip; Knee flexion

Nerve: Tibial Nerve

Semitendinosus

Semitendinosus

Origin: Ischial tuberosity

Insertion: Proximal part of medial shaft of tibia

Action: Extends and medially rotates hip; Flexes knee

Nerve: Tibial nerve

Popliteus

Popliteus

Origin: Lateral condyle of femur and lateral meniscus

Insertion: Posterior surface of tibia

Action: Unlocks knee and weakly flexes the knee

Nerve: Tibial

Gastrocnemius

Gastrocnemius

Origin: Lateral head- Lateral condyle of femurMedial Head- Superior to medial condyle of

femur Insertion: Posterior calcaneus via calcaneal

(Achilles) tendonAction: Plantar flexes ankleNerve: Tibial

Tibiofemoral Nerves

Sciatic NerveFemoral NerveTibial NerveSuperficial Fibular (Peroneal) NerveDeep Fibular (Peroneal) Nerve

Tibiofemoral Nerves

Vascular Supply

ARTERIES AND VEINS THAT PASS THROUGH THE KNEE

(TIBIOFEMORAL) JOINTBy: Scharlie

Arteries:

Inferior Gluteal Artery Branches from the Internal Iliac

Artery.

Leaves pelvis through the greater sciatic foramen and passes inferior to the piriformis.

Medial Circumflex Femoral Artery

Inferior Gluteal Artery (CUT)

Femoral Artery

Posterior View

Medial Circumflex Femoral Artery Branches Posteriorly behind

Femur

Lateral Circumflex Femoral Artery Branches Anteriorly in front

of Femur Both may branch from

profundus femoris or femoral arteries

Both encircle thigh, anastomose, and supply thigh muscles and proximal end of Femur.

Anterior View

Inferior Gluteal Artery

Femoral Continuation of External Iliac

Artery distal to inguinal ligament.

Passes through adductor hiatus and becomes Popliteal Artery

Popliteal Continuation of Femoral

Artery Passes behind Posterior Knee Divides into anterior and

posterior tibial arteries Gives Rise to Genicular

Arteries

Popliteal Artery

Femoral Artery

Anterior Tibial Artery

Posterior Tibial Artery

Anterior View

Anterior Tibial Artery Branches from Popliteal Artery Passes anteriorly between

Tibia and Fibula Runs down anterior/lateral

aspect of Tibia

Posterior Tibial Artery Branches from Popliteal Artery Continues down posterior

aspect of lower leg

Popliteal

Posterior Tibial

Anterior Tibial

Anterior View

Posterior View

Fibular (Peroneal)

Anterior Tibial

Fibular (Peroneal) Artery Braches from Popliteal Artery Runs down lateral aspect of lower

leg Perforating braches supply distal

muscles

Dorsalis Pedis Artery Continuation of Anterior Tibial

Artery Begins at ankle joint between

malleoli to top of foot

Anterior View of foot

Perforating

Fibular Artery

Dorsalis Pedis Artery

Anterior Tibial Artery

Veins:

Anterior Tibial Vein Superior continuation of

dorsalis Pedis Vein Runs up anterior tibia until

moving posterior to join posterior tibial vein

Drains into Popliteal Vein

Posterior Tibial Vein Drains into Popliteal Vein after

joining the Anterior Tibial Vein Both supply calf and foot

Anterior Tibial Vein

Posterior Tibial Vein

Anterior View

Fibular (Peroneal) Vein More posterior/lateral in

lower leg Drains into the Popliteal Vein

Popliteal Vein Anterior and Posterior Tibial

Veins join to form the Popliteal Vein

Crosses back of knee and becomes Femoral Vein at thigh

Femoral Vein Superior continuation of

Popliteal Vein Becomes the External Iliac

Vein in the inguinal region

Fibular (Peroneal)Vein

Femoral Vein

Popliteal Vein

Anterior View

Small Saphenous Vein Runs along lateral aspect of

foot and through the calf muscle

Drains into Popliteal Vein at the knee

Great Saphenous Vein Superficial and longest vein

in the body Begins in common with

Small Saphenous Vein in ankle

Extends up medial side of calf, knee, and thigh

Drains into the Femoral Vein

Small Saphenous Vein

Great Saphenous Vein

Anterior View

Overview: Arteries and VeinsQuiz

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Clinical Concerns for the Knee

(Tibiofemoral) Joint

TORN ACL, PLANTAR FASCIITIS, AND TKR By Scharlie

TKR By Gabe

Torn ACL

• The injury may occur with or without contact. Women have an increased risk of ACL injury because of differences in anatomy, muscle mass, and training. Symptoms of ACL tear include hearing a loud pop as the ligament tears, pain, knee swelling, and difficulty walking

Torn ACL Treatment

Treatment options include:

•Acute treatment: R.I.C.E•Nonsurgical treatment only: a physical rehab program.•ACL surgery to reconstruct the ACL (will still need physical therapy)

Recovery from an ACL injury varies for each person. Your treatment should continue until your knee is stable and strong rather than for a certain length of time.

Plantar Fasciitis

Signs and Symptoms:When plantar fasciitis occurs, the pain is typically sharp and unilateral. Heel pain worsens by bearing weight on the heel after long periods of rest. Improvement of symptoms is usually seen with continued walking

Risk Factors: Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, and flat feet. Obesity is seen in 70% of individuals with plantar fasciitis. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors.

Treatment:Non-surgical: (90% of cases)Include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, Achilles tendon, and plantar fascia, and weight reduction.Surgical: Plantar fasciotomy (release of fascia) is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort.

Videos:

Torn ACL Surgical Repairhttps://www.youtube.com/watch?v=9EgRHfoleLcDr. E. Edward Khalfayan, M.D.

Total Knee Replacement Surgeryhttp://www.youtube.com/watch?v=H9NrKylKMIY

Questions

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Resources:

Google Images:

https://www.google.com/search?q=anatomy+and+physiology&biw=1366&bih=650&source=lnms&tbm=isch&sa=X&ei=WIttVOG2DKWQigLJr4CYDQ&ved=0CAYQ_AUoAQ

Moore KL, Agur AM, Dalley AF, Essential Clinical Anatomy. 4th ed. Baltimore,MD: Lippincott Williams & Wilkins;2011.

Pearson Learning Solutions Lab Manual, Integrate Anatomy & Physiology: Pearson Learning Solutions;2011.

Youtube:

http://www.youtube.com/watch?v=H9NrKylKMIY

https://www.youtube.com/watch?v=9EgRHfoleLc

Google Web

http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/basics/definition/con-20025664#

http://www.webmd.com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-treatment-overview