Anatomi Klinis dan Fungsional Lutut / Knee .pptx

Anatomi Klinis dan Fungsional Lutut / Knee

1. Anatomi Klinis dan Fungsional Knee

2. Topographic Anatomy Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

3. Joint Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

4. Stability of the Knee STATIC Geometri Form femoral dan tibial condyle Meniscus Capsul Intraarticular Ligament : ACL, PCL Extraarticular Ligament : MCL, LCL, PLC DYNAMIC Otot – Otot yang melewati Lutut : Quadriceps, Hamstring dll Miller, M. D. (2012). Review of orthopaedics . 7 th ed. Philadelphia: Saunders. Utomo , D.N. 2020. ACL Injury : MY perspective. Departement Orthopaedi and Traumatologi . FK Unair RSDS Surabaya

5. Ligaments Of Knee Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

6. Anatomy : Anterior Aspect Scott, W. N., & Insall , J. N. (2012). Insall & Scott surgery of the knee . Philadelphia, 6 th Ed. PA: Elsevier/Churchill Livingstone. ACL Tibial attachment : anterior tibia, between intercondylar eminences Femoral attachment : lateral intercondylar ridge demarcates the anterior edge of the ACL Bundles named ( tibial attachment) AnteroMedial bundle : tightest in flexion, primarily for restraining anterior tibial translation (anterior drawer test) PosteroLateral bundle : tightest in extension, slack in mid-flexion primarily for rotational stability (pivot shift test) Vascular Supply : middle geniculate artery

7. Anatomy : Posterior Aspect Scott, W. N., & Insall , J. N. (2012). Insall & Scott surgery of the knee . Philadelphia, 6 th Ed. PA: Elsevier/Churchill Livingstone. PCL is 30% larger than the ACL Tibial attachment (Origin) : posterior tibial sulcus below the articular surface Femoral attachment (Insertion) : anterolateral medial femoral condyle Bundles named AnteroLateral bundle : tight in flexion, strongest and most important for posterior stability at 90° of flexion PosteroLateral bundle : tight in extension, reciprocal function to the anterolateral bundle Lies between the meniscofemoral ligaments (Lligament of Humphrey (anterior) and ligament of Wrisberg (posterior) ) Vascular Supply : middle geniculate artery

8. Anatomy : Medial Aspect Scott, W. N., & Insall , J. N. (2012). Insall & Scott surgery of the knee . Philadelphia, 6 th Ed. PA: Elsevier/Churchill Livingstone. MCL First layer Medial Aspect of The Knee : Sartorius Mucle, Vastus Medialis Superficial MCL layer II of the medial knee Femoral attachment : medial epicondyle, 1 cm anterior and distal to the adductor tubercle Tibial attachment : proximal tibia periosteum, 4.5cm distal to the joint line deep and posterior to the pes anserinus Deep MCL layer III of the medial knee  with joint capsule Composed of meniscofemoral and meniscotibial ligaments Vascular Supply : superior medial and inferior medial geniculate arteries

9. Anatomy : Lateral Aspect Scott, W. N., & Insall , J. N. (2012). Insall & Scott surgery of the knee . Philadelphia, 6 th Ed. PA: Elsevier/Churchill Livingstone. LCL Tubular, cordlike structure Origin : l ateral epicondyle femur Insertion : anterolateral fibula head Tight in extension and lax in flexion

10. Vascularization Vascularization from A. Medial Genicular branch of a. Poplitea Scott, W. N., & Insall , J. N. (2012). Insall & Scott surgery of the knee . Philadelphia, 6 th Ed. PA: Elsevier/Churchill Livingstone. Utomo , D.N. 2020. ACL Injury : MY perspective. Departement Orthopaedi and Traumatologi . FK Unair RSDS Surabaya

11. Innervation Vascularization Innervation from posterior articular branches of the tibial nerve, and consist of receptors Utomo , D.N. 2020. ACL Injury : MY perspective. Departement Orthopaedi and Traumatologi . FK Unair RSDS Surabaya

12. Meniscus Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

13. Meniscus Fibrocartilage discs interposed in femorotibial joints between femoral condyles and tibial plateaus. Have a triangular cross section—thickest at the periphery, then tapering to a thin central edge. Histologically made up of collagen (mostly type 1, also 2, 3, 5, 6), cells ( fibrochondrocytes ), water, proteoglycans, glycoproteins, elastin 3 layers seen microscopically: Superficial layer: woven collagen fiber pattern Surface layer: randomly oriented collagen fiber pattern Middle (deepest) layer: circumferential (longitudinal) oriented fibers . These fibers dissipate hoop stresses. Radial fibers . These fibers acts as “ties” to hold the circumferential fibers . Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

14. Meniscus Vascular supply from superior and inferior medial and lateral geniculate arteries. They form perimeniscal plexus in synovium/capsule. Peripheral portion (10-30% medially, 10-25% laterally) is vascular via vessels from the perimeniscal plexus. 3 zones: Red zone: 3mm from capsular junction (most tears will heal) Red/white zone: 3-5mm from capsular junction (some tears will heal) White zone: 5mm from capsular junction (most tears will not heal) The central, avascular 2⁄3 of the menisci receive nutrition from the synovial fluid • Medial meniscus: C-shaped, less mobile, firmly attached to tibia (via coronary ligaments) and capsule (via deep MCL) at midbody • Lateral meniscus: “circular”, more mobile, loose peripheral attachments, no attachment at popliteal hiatus (where popliteus tendon enters join) Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

15. Meniscus Function : Load transmission and shock absorption: the menisci absorb 50% (in extension) or 85% (in fl exion ) of forces across femorotibial joint. The transmission of this load to the meniscus helps protect the articular cartilage Joint congruity and stability: the menisci create congruity between the curved condyles and fl at plateaus, which increases stability. The menisci (esp. PHMM) also act as secondary stabilizers to translation (esp. in the ligamentdeficient knee) Joint lubrication: the menisci help distribute synovial fl uid across the articular surfaces. Joint nutrition: the menisci absorb, then release synovial fl uid nutrients for the cartilage. Proprioception: nerve endings provide sensory feedback for joint position. Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

16. Arteries Thompson, Jon C, 2010, NETTER’S CONCISE ORTHOPAEDIC ANATOMY, SECOND EDITION, Philadelphia, Elsevier

17. BIOMECHANIC OF THE KNEE

18. Knee Joint The knee is the largest and most complex joint in the body. It is an articulation among the distal femur, proximal tibia and patella, surrounded by a soft tissue envelope of capsule, ligaments, tendons and muscles. Malik, Sheras S and Malik, Shahbaz S., 2015, Orthopaedic biomechanics made easy, Cornwall, Cambridge University Press

19. Biomechanics of The Knee TIBIO FEMORAL JOINT

20. Ligament Stabilizer Miller, M. D. (2012). Review of orthopaedics . 7 th ed. Philadelphia: Saunders.

21. Force Transmission Knee Joint Utomo , D.N. 2020. ACL Injury : MY perspective. Departement Orthopaedi and Traumatologi . FK Unair RSDS Surabaya

22. Screw Home Mechanism Utomo , D.N. 2020. ACL Injury : MY perspective. Departement Orthopaedi and Traumatologi . FK Unair RSDS Surabaya During, knee flexion tibia rolls posteriorly, elongating the ACL and it is the ACL’s pull on tibia, that causes it to glide posteriorly. Similarly, during knee extension, tibia rolls anteriorly, elongating the PCL and the PCL’s pull on tibia, causes it to glide anteriorly.

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