clinical anatomy of the knee
DESCRIPTION
Clinical Anatomy of the knee. Mr CM Gupte Mr Alvin Chen. Overview. Knee joint function Surface anatomy Bones Ligaments Tendons Examination Disease processes. The Knee Joint. Poorly constructed in terms of stability - femur round, tibia flat. Comprised of four bones. Femur Tibia - PowerPoint PPT PresentationTRANSCRIPT
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Clinical Anatomy of the knee
Mr CM Gupte
Mr Alvin Chen
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Overview
• Knee joint function• Surface anatomy• Bones• Ligaments• Tendons• Examination• Disease processes
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The Knee Joint
• Poorly constructed in terms of stability - femur round, tibia flat.
• Comprised of four bones.• Femur• Tibia• Fibula• Patella
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The knee joint
• Load bearing / Force transmission
• Locomotion
• Proprioception
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Surface Anatomy
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Bones• Patella: femur
= patellofemoral joint
• Femur: tibia = medial and lateral tibiofemoral joints
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Knee Arthroscopy Surface Landmarks
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Patella
• Medial facet
• Lateral facet
• Articular cartilage
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Femur• Medial femoral condyle
• Lateral femoral condyle (protrudes more)
• Trochlea
• Articular cartilage
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Femoral ligament insertions
• PCL inner aspect medial femoral condyle
• ACL inner aspect lateral femoral condyle
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Tibia• Medial and lateral
plateau
• Insertions of menisci and cruciate ligaments
• MCL/semimembranosus
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Tibial plateau
• Insertions of menisci/• Cruciate ligaments
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Ligaments
• Extracapsular: MCL/ LCL
• Intracapsular: ACL/PCL
Functions: • Stabilise• Proprioception
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ACL
• Two bundles
• Prevents anterior drawer and pivot
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ACL Injury
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MRI
Normal ACL in RED Torn ACL
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Tests for ACL
Lachman’s Anterior Draw
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Arthroscopy
Intact ACL Torn ACL
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ACL Reconstruction
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PCL
• Stronger than ACL
• Prevents posterior drawer
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PCL injury
• Direct Blow onto Tibia on a flexed knee
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MRI PCL
Normal PCL PCL torn
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Posterior Sag from PCL rupture
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MCL
• Medial• Prevents valgus stress• Deep and superficial parts• Heals well
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MCL Injury
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LCL• Lateral• Prevents varus stress• Cord like –weakest of the
ligaments but rarely torn in isolation
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Multiple Injuries
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Extensor mechanism
• Quadriceps• Patella• Patellar tendon
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Quadriceps
• VMO• Rectus femoris• Vastus intermedius• Vastus lateralis• Extend knee
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VMO• Medial most quad
• Helps prevent lateral dislocation of the patella
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Extensor Mechanism injuries I
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Extensor Tendon Injuries II
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Extensor Tendon Injuries III
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Hamstrings• Biceps laterally• Semitendinosus/semimembranosus
medially• Flex knee
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Pes• Sartorius
• Gracilis
• Semitendinosus
• G and T used for ACL reconstruction
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Movements of the Knee
The principal muscles acting onthe knee:
• Extensors - quadriceps femoris
• Flexors - hamstrings assisted by gracilis, gastrocnemius
and sartorius.
• Medial rotators- popliteus.
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Movements of the Knee
• The principal knee movements are flexion and extension, but rotation of the knee is possible when the joint is in flexed position .
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Examination• Look
• Feel
• Move
• Think about structures and what you’re dong to them
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Diseases
• OA• Meniscal tears• Ligament injuries• Patellofemoral tracking• Tendon injuries• Inflammatory arthritis• Infection/tumours
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Arthritic Knee X-ray
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Knee Arthritis
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Knee OA on arthroscopy
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Total Knee Replacement
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Patellofemoral Knee Replacement
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Unicondylar Knee Replacement
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Meniscal Tears
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Treatment of Meniscal Tears
Suture/ Repair Debridement
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Other Pathologies
Patella Maltracking Bone Tumour
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Any Questions ?