Transcript 22-Knee & Ankle Joints121

KNEE
ANKLE
KNEE JOINT
ARTICULATION
•
•
Between the condyles of the femur and the condyles of the tibia.
Anteriorly, an articulation between the lower end of the femur and the
patella.
Prof. Makarem
TYPE
• Between the
femur & the tibia
it is a
• Synovial
modified hinge
joint, with some
degree of rotatory
movement.
• The joint between
the femur and
patella is a
synovial plane
gliding joint.
Prof. Makarem
CAPSULE
Attached to the margins of the articular surfaces and
surrounds the sides and the posterior aspect of the joint.
Prof. Makarem
The capsule is absent anteriorlly.
It is replaced anteriorly by the quadriceps tendon, patella & Ligamentum
patellae.
Prof. Makarem
The capsule is strengthened on each side of the patella by expansions of
the tendons of vastus lateralis and medialis and posteriorly by the
expansion of the semimemranous muscle (oblique popliteal ligament).
Prof. Makarem
SYNOVIAL MEMBRANE
 Attached to the
margins of the
articular surfaces.
 Lines the interior of
the capsule.
 Forms several
bursae around the
joint.
Prof. Makarem
EXTRACAPSULAR LIGAMENTS
1. Ligamentum patellae:
between the lower border of
the patella & the tuberosity
of the tibia. It is a
continuation of the tendon of
quadriceps femoris.
2. Lateral collateral ligament:
between the lateral condyle
of femur and the head of the
fibula.
3. Medial collateral ligament:
between the medial condyle
of the femur and medial side
of the shaft of the tibia
(behind SGS). Firmly
attached to the edge of the
medial meniscus.
Prof. Makarem
4. Oblique popliteal
ligament:
strengthens the
posterior side of the
capsule.
Prof. Makarem
INTRACAPSULAR LIGAMENTS
CRUCIATE LIGAMENTS
Anterior cruciate ligament:
• Between the anterior
intercondylar area of the
tibia and the posterior part
of the medial surface of the
lateral femoral condyle.
•
•
Function: prevents
posterior displacement of
the femur on the tibia.
In flexed knee, prevents the
tibia from being pulled
anteriorly.
Prof. Makarem
Posterior cruciate ligament:
• Between the posterior
intercondylar area of the
tibia and the anterior part of
the lateral surface of the
medial femoral condyle.
•
•
Function: prevents anterior
displacement of the femur
on the tibia.
In flexed knee, prevents the
tibia from being pulled
posteriorly.
Prof. Makarem
MENISCI
•
C-shaped intracapsular ligaments.
Prof. Makarem
•
•
•
The peripheral border
is thick and attached
to the capsule, the
inner border is thin
and free.
Each meniscus is
attached to the upper
surface of the tibia by
anterior and
posterior horns.
The medial meniscus
is firmly attached to
the medial collateral
ligament.
Prof. Makarem
• Function: to deepen the articular surface of the tibial
condyles and to serve as shock absorber.
Prof. Makarem
BURSAE
ANTERIOR
1- Suprapatellar:
beneath the
quadriceps femoris.
2- Prepatellar:
between the skin and
the patella.
3- Superficial
infrapatellar:
beween the skin and
the lower part of
ligamentum patellae.
4- Deep infrapatellar:
between ligamentum
patellae and the tibia.
Prof. Makarem
POSTERIOR
1- Popliteal:
beneath the tendon of
popliteus muscle
2- Semimembranous:
under the tendon of
semimembranous
muscle
Prof. Makarem
MOVEMENTS
• Flexion:
• biceps femoris, semitendinosus and semimembranosus,
assisted by gracilis, sartorius and popliteus. Limited by
contact with the back of thigh.
• Extension:
• quadriceps femoris. Limited by tension of the joint
ligaments.
• Medial rotation:
• sartorius, gracilis and semitendinosus.
• Lateral rotation:
• biceps femoris.
• Stability of the joint:
• dependent on the tone of the muscles and the strength of
the ligaments.
Prof. Makarem
Locked position:
• in full extension, the
femur is medially
rotated, producing
tightening of all of the
ligaments and
compression of the
menisci.
Unlocking:
• by contraction of the
popliteus muscle,
producing lateral
rotation of the femur.
• It is necessary to start
flexion.
Prof. Makarem
INJURIES
Common injury: when the knee is twisted while running
Prof. Makarem
ARTHROSCOPY
Prof. Makarem
BURSITIS
Prof. Makarem
ANKLE JOINT
ARTICULATION
• Between the
distal end of the
tibia, the two
malleoli and the
body of the talus.
• Type: synovial
hinge joint.
Prof. Makarem
LIGAMENTS
Medial (deltoid)
ligament:
 from the tip of the
medial malleolus to:
1- talus,
2- plantar
calcaneonavicular
ligament and
3- tuberosity of the
navicular bone.
Prof. Makarem
Lateral ligament:
3 bands
1. anterior
talofibular
ligament:
 from the lateral
malleolus to the
lateral surface
of the talus.
2.

3.

calcaneofibular ligament:
from the lateral malleolus to the lateral surface of the calcaneum.
posterior talofibular ligament:
from the lateral malleolus to the posterior tubercle of the talus.
Prof. Makarem
MOVEMENTS
•
1.
2.
3.
1.
•
1.
2.
3.
4.
5.
6.
7.
8.
Dorsiflexion:
Tibialis anterior,
Extensor hallucis longus,
Extensor digitorum longus and
Peroneus tertius.
Plantar flexion:
Gastrocnemius,
Soleus,
Plantaris,
Peroneus longus,
Peroneus brevis,
Tibialis posterior,
Flexor digitorum longus and
Flexor hallucis longus.
Prof. Makarem
MEDICAL IMAGING
Prof. Makarem
INJURIES
Sprained ankle:
• Usually inversion injury.
• Severe sprains lead to torn lateral ligament and fracture of
the lateral malleolus and result in instability of the ankle
Prof. Makarem
joint.