Anatomy of knee joint

Anatomy of knee joint by Dr Bipul Borthakur

1. ANATOMY OF KNEE JOINT DR BIPUL BORTHAKUR PROFESSOR AND HOD DEPARTMENT OF ORTHOPAEDICS SMCH

2. KNEE JOINT It is the largest and the most complex joint of body Complexity is result of fusion of three joints 1.Lateral femorotibial joint. 2.Medial femorotibial joint. 3.Femoropatellar joint. It is compound synovial joint

3. ARTICULAR SURFACE K nee joint is formed by :- 1. Condyle of femur. 2. Condyle of tibia. 3. Patella. The femoral condyle articulate with tibial condyle below and behind,and with patella infront .

4. LIGAMENTS OF KNEE JOINT . Knee joint supported by following ligament :- 1.Fibrous capsule 2.Ligamentum patella 3.Tibial Collateral or Medial Ligament 4.Fibular Collateral or Lateral ligament 5.Oblique popliteal ligament 6.Arcuate Popliteal ligament 7.Anterior Cruciate ligamen t

5. 8.Posterior cruciate ligament 9.Medial meniscus 10.Lateral meniscus 11.Transverse ligament

6. 1.FIBROUS (ARTICULAR) CAPSULE It is very thin and is deficient anteriorly, where it is replaced by quadriceps femoris , the patella and ligamentum patellae. The capsule has two constant gap :- 1. One leading into supra patellar bursa. 2. Another for exit of tendon of popliteus .

7. 2. LIGAMENTUM PATELLAE It is central portion of common tendon of insertion of quadricep femoris . It is attached above to the margins and rough posterior surface of apex of patella,and below to the smooth,upper part of tibial tuberosity.

8. 3.TIBIAL COLLATERAL OR MEDIAL LIGAMENT It is long band of great strength It resists force pushing the knee medially. It is attached proximally to the medial condyle of femur immediately below the adductor tubercle; below to the medial condyle of tibia and medial surface of its body.

9. 4. Fibular Collateral or Lateral ligament It is strong and cord like ligament. Attached superiorly to lateral epicondyle of femur just above the popliteal groove and Inferiorly to head of fibula. 5. Oblique Popliteal Ligament This is expantion from the tendon of semimembranous .

10. 6.Arcuate popliteal ligaments:- this is posterior expansion from short lateral ligament 7.Anterior Cruciate Ligaments:- It is attached to anterior intercondylar area of tibia run backward,upward and laterally to get attached to posteromedial aspect of lateral femoral condyle It prevent forward sliding of tibia on femur It prevent hyperextention of knee joint Taut during extention of knee

11. 8.Posterior Cruciate Ligament :- It begins from the posterior part of intercondylar area of tibia, runs upwards, forwards and medially and is attached to anterior part of lateral surface of medial condyle of femur. It prevent posterior translation of tibia to limit hyperflexion It taut during flexion of knee

12. MEDIAL MENISCUS C shaped,wider behind than in front. Its anterior horn attached to anterior tibial intercondylar area in front of anterior cruciate ligament. posterior horn fixed to posterior tibial intercondylar area,between attachments of lateral meniscus and posterior cruciate ligament.

13. 10.Lateral Meniscus .o shaped,it covers larger area than medial meniscus .Anterior horn attached in front of intercondylar eminence,posterolateral to anterior cruciate ligament. .posterior horn get attached behind this eminence, in front of posterior horn of medial meniscus 11.Transvers ligament It connects the anterior end of medial and lateral menisci.

14. SYNOVIAL MEMBRANE It lines the capsule,except posterorly where it is reflected forwards by cruciate ligament,forming a common covering for both ligaments.

15. Bursae around the knee . As many as 12 bursae have been describe around the knee . Anterior :1.subcutaneous prepatellar bursa 2.subcutaneous infrapatellar bursa 3.Deep infrapatellar bursa 4.Suprapatellar bursa

16. . Lateral :1.A bursa deep to lateral head of gastrocnemius 2.A bursa between the fibular collateral ligament and the biceps femoris . 3.A bursa between fibular collateral ligament and the tendon of popliteus 4.A bursa between tendon of popliteus and the lateral condyle of tibia.

17. Medial : 1.A bursa deep to medial head of gastrocnemius. 2.The anserine bursa 3.A bursa deep to tibial collateral ligament. 4.A bursa deep to semimembranosus.

18. Relation Of Knee Joint Anteriorly : 1.Anterior bursae 2.ligamentum patellae 3.Patellar plexus of nerves Posteriorly : 1.At middle : Popliteal vessels,Tibial nerve. 2.Posterolaterally :Lateral head of gastrocnemius, Plantaris,and Common peroneal nerve. 3.Posteromedially :Medial head of gastrocnemius, semitendinous , Gracilis and Popliteus at its insertion

19. Medially : 1.Sartorius,Gracilis and Semitendinosus 2.Great saphenous vein with saphenous nerve 3.semimembranosus Laterally : 1.Biceps Femoris 2.Tendon of origin of popliteus

20. BLOOD SUPPLY The chief sources of blood supply are :- 1.Five genicular branches of popliteal artery. 2.The descending genicular branch of Femoral artery. 3.The descending branch of the lateral circumflex femoral artery. 4.Two recurrent branches of anterior tibial artery 5.The circumflex fibular branch of posterior tibial artery.

21. Nerve supply :- 1.Femoral nerve,throgh its branches to vasti , especially vastus medialis . 2.Sciatic nerve,throgh genicular branches of the tibial and common peroneal nerves. 3.Obturator nerve,through its posterior division.

22. Muscle producing movement at knee joint Movement Principal muscles A.Extention Quadriceps femoris B.Flexion 1.Biceps femoris 2.Semitendinosus 3.semimembranosus C. Medial rotation 1.Popliteus 2.Semimembranosus 3.Semitendinosus D. Lateral rotation Biceps femoris

23. CLINICAL ANATOMY 1.Osteoarthritis : It is an age related cartilage degeneration of articular surface. characterise by growth of osteophyte at articular end,which makes movement limited and painful. 2.Structurally, the knee is a weak joint because the articular surface are not congruent.

24. 3.Deformity of the knee: a.Genu vulgum or Knock knee : Abnormaly abducted leg b. Genu varum or Bow knee: Abnormally adducted leg 4.Injury to knee : a.Injury to medial meniscus is more vulnerable than lateral meniscus because of its fixity to tibial collateral ligament b.Anterior cruciate ligament is more commonly damage than the posterior

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