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KNEE JOINT, CAPSULE, & LIGAMENTS

The RECTUS FEMORIS and VASTUS INTERMEDIUS


KNEE JOINT
are attached to the base of the patella
It is a SYNOVIAL JOINT of the HINGED VARIETY
When contracted, the pull obliquely upward
Largest and the most complicated joint in the body
The VASTUS MEDIUS and the VASTUS LATERALIS
Comprised of 3 bones:
are continuous with each other at the patellar
Femur
attachment
Tibia
Occupy the space between the rectus femoris
Patella
and the vastus intermedius
Vastus Medialis: attached to the upper two thirds
The fibula is entirely excluded
of the medial border of the patella
In primitive life there were 3 joint cavities in this
Draws the patella medially
location, which is now merged into one
Vastus Lateralis: attached to the whole length of
Medial Condylar Articulation: Between the
the upper border
medial condyle of the femur and the tibia
Pulls the patella upward, not laterally
Lateral Condylar Articulation: Between the
Transverse Incision
lateral condyle of the femur and the tibia
Located above the patella and will incise
Patellar Articulation: Between the patella and
Skin
femur
Fat
The CONDYLAR ARTICULATIONS are further
Fascia lata
subdivided into UPPER & LOWER parts by the
Rectus tendon
MEDIAL and LATERAL MENISCI (Semilunar
Tendons of the V. Lateralis, Medius, &
Fibrocartilages)
Intermedius
In all positions the joint, the patella is in contact
Synovial joint capsule
with the femur, and the femur with the tibia
If the quadriceps is relaxed (as when the heel is
Bones do not interlock
placed on a chair):
Areas of contact are large
The patella may be moved medially and
Ligaments and surrounding muscles are strong
laterally
Dislocation of the knee joint is uncommon
The posterior articular surface may be palpated
PATELLA
Changing from extension to flexion:
A small sesamoid bone in the tendon of the
The patella glides laterally onto the under
Quadriceps Femoris
aspect of the lateral condyle of the femur (can
Roughly triangular in shape
be felt)
Inferior Angle: Apex
Leaves the trochlea and under aspect of the
Upper Border: Base
medial femoral condyle exposed
Medial & Lateral Borders: Rounded
Anterior surface is easily felt through the skin
Except the medial border of the
Partly separated by the subcutaneous prepatellar
intercondylar notch
bursa
Intercondylar Notch
Femoral articular surface is divided by a vertical
Articulates with a vertical facet on the medial
ridge into a larger lateral and a smaller medial area
part of the posterior surface of the patella
Below the articular surface: roughened & non- LIGAMENTS & CARTILAGES
articular
The knee has a fibrous & synovial capsule
Lower half covers the posterior aspect of the
Capsular Ligament
apex
Thin, wide, and membranous at the back
rd
th
Ossification: between the 3 and 5 years
Thicker and shorter at the sides
Complete by puberty
Borders:
In the anatomic position:
Anterior: Patella
The ball of the toes, the medial malleoli, and the
Superior: Tendon of the Quadriceps
knees of the two sides touch each other
Inferior: Ligamentum Patellae
Tibia are parallel, while the femora are not
Femoral attachments are to the sides of the
Femora are obliquely placed
condyles
Although in contact at the knee joint, they are
About inch from the articular margin
separated by the width of the pelvis

To the back of the femur along the inter


condylar line
Immediately above the articular margin of
the condyles
Tibial attachments are
To the posterior surfaces and the sides of
the condyles about inch below the
articular margin
To the anterior surfaces of the condyles
along the oblique lines that begin near the
articular margins of the sides and pass to
the sides of the tubercle of the tibia
Strengthened by expansions from surrounding
muscles
Closely attached to the capsule
On the anterolateral aspect, there is a definite
interval of fat, vessels, and nerves
Heads of the GASTROCNEMIUS and PLANTARIS
overlie the posterior part of the capsule
(opposite the femoral condyles)
The medial head is separated from it by a
bursa
The lateral head and the plantaris are partly
attached to it
The popliteus, after it emerges through the
capsule, derives some fleshy fibers of origin
from it
At the back of the medial femoral condyle,
there is a hole in the ligament
The
synovial
membrane
becomes
continuous with the bursa under the medial
head of the gastrocnemius
The tendon of the popliteus perforates the
capsular ligament opposite the lateral condyle
of the tibia
The ligament is also perforated by ARTICULAR
VESSELS AND NERVES
The capsule is overlaid by and incorporated
with the tendinous expansions of the lateral
and medial vasti muscles
Patellar Ligament (Ligamentum Patellae)
A strong fixed band about 3 inches long & 1 inch
wide
Attachments:
Above: Lower border of the patella
Below: Tubercle of the tibia
It extends about inch farther down on
the inner side
Constitutes:
The insertion of the quadriceps extensor
into the tibia
Separated from the skin by a bursa

Superficial fibers are continuous over the


patellar surface with the central part of the
common tendon of the quadriceps femoris
Deep surface is separated from the synovial
membrane by loose fatty tissue called the
INFRAPATELLAR PAD OF FAT
A bursa also separates it from the upper part of
the tibia
Crescentic
When enlarged/inflamed: has extensions
which pass upward along the sides of the
ligament
Lateral Ligament of the Knee
Also called the Fibular Collateral Ligament
A rounded, cordlike band
Approximately 2 inches long
Extends from the lateral epicondyle of the
femur (above) to the head of the fibula (below)
Upper part is fused with the underlying part of
the capsule
Most of it is separated from the capsule by
fatty tissue where the inferior lateral
geniculate vessels and nerves run
As the ligament crosses the lateral aspect of the
knee joint, the tendon of the popliteus muscles
intervenes between it and the lateral semilunar
cartilage (meniscus)
The biceps tendon (superficial to the lower part
of the ligament) is split in two by the lateral
ligament of the knee
Medial Ligament of the Knee
Also called the Tibial Collateral Ligament
Broad and strap-like
Closely applied to the bone (unlike the lateral
ligament)
Extends from the medial epicondyle of the
femur (above) to the upper fourth of the shaft
of the tibia (below)
Opposite the interval between the femur and
the tibia, it is closely fused with the capsular
ligament
It is attached to the medial meniscus
Three tendons cross the medial ligament:
Tendon of the Sartorius
Tendon of the Gracilis
Tendon of the Semitendinosus
Extends forward and under the
ligament to gain its insertion into the
medial condyle of the tibia
A bursa separates these 3 tendons from the
ligament
Significance of the Collateral Ligaments:

The 2 collateral ligaments are strong structures


and prevent lateral movements at the knee
joint
If stretched or torn, integrity of the knee joint is
lost
Three (3) Ligamentous Extensions of the
Semimembranosus
Oblique Popliteal Ligament
Strengthens the capsule posteriorly
Passes upward and outward from the
semimembranosus tendon and blends with
the capsule
The popliteal vessels lies on it
Perforated by the azygous geniculate artery
Popliteus Fascia
Passes downward and outward to cover the
popliteus muscle
Gains attachment to the popliteal line of
the tibia
Popliteal vessels lie upon it and end at its
lower border
Deep Fascia of the Inner Side of the Leg
Continuation of the semimembranosus
Cruciate Ligaments of the Knee
2 powerful cordlike structures
They cross each other like the limbs of the letter
X
The crucial arrangement is seen, whether
viewed from the front, sides, or back
Have been designed to prevent forward and
backward displacements of the tibia on the
femur
Requires great force/violence to tear one
ligament
When torn, great disability is caused by the
forward and backward gliding of the tibia upon
the femur
Covered in front and at the sides by synovial
membrane
Related posteriorly to the capsular ligament
(separated by fat)
Anterior Cruciate Ligament
Extends upward, backward, and laterally
from the anterior part of the intercondylar
area of the tibia to the posterior part of the
medial surface of the lateral condyle of the
femur
Tense in extension
Prevents backward sliding of the femur &
forward displacement of the tibia
When knee is flexed

2 points of attachment
are
approximated
Ligament is relaxed
Prevents hyperextension of the knee joint
Posterior Cruciate Ligament
Tense in flexion
Passes upward, forward, and medially from
the posterior part of the intercondylar area
to the anterior part of the lateral surface of
the medial condyle of the femur (what a
mouthful o.O)
It prevents forward gliding of the femur and
backward displacement of the tibia during
flection
The anterior ligament passes backward and
outward, while the posterior passes inward and
forward
Semilunar Cartilages
2 crescentic plates of fibrocartilage
Lie on the circumferential portion of the
articular surfaces of the tibia
Deepens the areas for the reception of the
condyles of the femur
Elastic
Act as buffers which diminish the shocks
passing up the limbs (like in jumping)
Distal surfaces are flat; Proximal surfaces are
concave (for reception of the femoral condyles)
Each cartilage has 2 fibrous extremities
Called horns
Attached to the intercondylar area on the
proximal surface of the tibia
Thick toward the circumference of the joint
Lateral cartilage is thicker than the medial
Both cartilage thin out toward the center
End as a fine, free, concave edge
Do not cover the entire extent of the condylar
surfaces of the tibia
Lateral Semilunar Cartilage
Nearly circular in outline
Horns are fixed to the tibia close together
Anterior horn: attaches to the front of
the intercondylar eminence behind the
anterior cruciate ligament with which it
blends
Posterior horn: attaches to the back of
the intercondylar eminence and in
front of the posterior end of the medial
cartilage
Peripheral margin is adherent to the
capsular ligament, but to a lesser extent
than the medial cartilage

Due to the popliteus tendon and its


Responsible for the fact that injuries to the
bursal sheath which separates part of
medial meniscus are more frequent than to
the margin from the capsule
the lateral
The lateral semilunar cartilage is less fixed
Lateral: free to move slightly, but even
and it is more able to adapt to sudden
this slight degree is sufficient to provide
twisting movements of the knee
for its safety
A fibrous band leaves the posterior horn
Medial: fixed at one point by the tibial
and passes upward along the posterior
collateral ligament
cruciate ligament to become attached to
The medial ligament of the knee consists of
the medial condyle of the femur
long and short fibers
Called the LIGAMENT OF WRISBERG
Short: on the deep surface of the
Flexion & Extension:
ligament at its posterior part and are
attached to the margin of the medial
Tibia & cartilages move on the femur
meniscus (binds the meniscus to the
Rotatory Movements:
tibia)
Femur & cartilages move on the tibia

Passing between the 2 sets of fibers is


Medial Semilunar Cartilage
the tendon of the semimembranosus
C-shaped
The back part of the medial
Adapts the upper surface of the medial
meniscus is firmly fixed
condyle of the tibia to the curvature of the
Excessive rotation of the femur on
medial condyle of the femur
the tibia tears the movable front
Wider behind than in front
part away
Peripheral borders are thick

On
the
nonarticular area of the upper
Central border thins out into a fine edge
surface
of
the tibia, the structures from
Anterior horn: attaches to the anterior part
before backward:
of the intercondylar area in front of the
Transverse Ligament
anterior cruciate ligament
Anterior Horn of the Medial Semilunar
Posterior horn: attached to the posterior
Cartilage
part of the intercondylar area in front of the
Anterior Cruciate Ligament
posterior cruciate ligament
Anterior Horn of the Lateral Semilunar
Periphery is adherent to the capsule and
Cartilage
the medial ligament of the knee
Intercondylar Tubercle
Transverse Ligament of the Knee
Posterior Limb of the Lateral Semilunar
Fibrous band that stretches across the anterior
Cartilage
part of one semilunar cartilage to the

Posterior Horn of the Medial Semilunar


corresponding part of the other
Cartilage
The movements of one cartilage are partly
Posterior Cruciate Ligament
controlled and partly accompanied by the other
Coronary Ligaments
May be considered the continuation of the
Deeper portions of the capsule
peripheral fibers of each meniscus
Unites the semilunar cartilages to the tibia and
The more central fibers attach to the tibia
the femur
If any force acts on the periphery of the
Fibers that extend to the tibia are shorter, since
meniscus while the central part is fixed, it will
the cartilages follow the movements of the tibia
tear longitudinally along the line between these
more closely than those of the femur
inner and outer sets of fibers
A condition known as a BUCKET-HANDLE INTERIOR OF THE KNEE JOINT & SYNOVIAL
MEMBRANE
TEAR OF THE CARTILAGE
Infrapatellar Synovial Fold
Medial cartilage is the one usually affected
Also called LIGAMENTUM MUCOSUM
The relationship of the medial ligament of the
First structure to be seen
knee (tibial collateral ligament) to the medial
Triangular fold of synovial membrane which is
meniscus is clinically important
pinched upward

Apex: Attached to the most anterior part of the


Communicates with a bursa deep to the
intercondylar notch of the femur
semimembranosus
Base: Extends from below the articular surface
A bursa may exist under the lateral head of the
of the patella to the anterior intercondylar area
gastrocnemius
on the tibia
Four Anterior Bursae
Suprapatellar Bursa
Related to the infrapatellar fat pad which
Prepatellar Bursa
covers the deep surface of the ligamentum
patellae
Associated with the condition known as
Sides: Prolonged in a fringelike arrangement
HOUSEMAIDS KNEE
which forms the alar folds into which fat
Because in scrubbing the floor, the
extends
hands rest upon the floor, bringing the
Injuries may result in bruising of these fringes
bursae into contact with the ground
Alar folds remain free
Constant rubbing = Inflammation
Synovial Membrane
(Bursitis)
Lines the capsular ligament but leaves the
Subcutaneous and lies in front of the lower
capsule posteriorly to pass forward around the
half of the patella and the upper half of the
cruciate ligament
patellar ligament
BURSAE
Subcutaneous Infrapatellar Bursa
From the 3 primitive cavities in the knee joint
Situated between the skin and the lower
Suprapatellar Bursa
end of the ligamentum patellae (front of
Lies deep to the quadriceps femoris
the tibial tuberosity)
Between the anterior surface of the lower part
Deep Infrapatellar Bursa
of the femur and the deep surface of the
Situated between the deep aspect of the
quadriceps femoris
lower end of the ligamentum patella and
Extends about 3 fingerbreadths above the
the tibia
upper border of the patella when the limb is in
Two Posterior Bursae
EXTENSION
Located between each head of origin of the
Almost always communicates with the knee
gastrocnemius and the capsule of the joint
joint
Medial Head + Capsule: sends a prolongation
Removed in excision of the joint for
between the gastrocnemius and the
tuberculosis (TB of the knee joint)
semimembranosus muscles
Rests on the layer of fat which allows it to glide
If enlarged: forms a swelling at the inner side of
freely when the knee joint is in motion
the
popliteal
space
(enlarged
Apertures in the back of the capsule it often
semimembranosus bursa)
communicates with bursae under the head of
Three Medial Bursae
the gastrocnemius and the bursa of the
One separates the Sartorius, the gracilis, and
semimembranosus
semitendinosus from the tibial collateral
Popliteus Bursa
ligament medially and the head of the tibia
Situated between the popliteus tendon and the
laterally
lateral condyle of the femur
Semimembranosus tendon is placed between
Separates the popliteus tendon from the lateral
the ligament medially and the condyle of the
semilunar cartilage, the lateral tibial condyle
tibia laterally
and the superior tibiofibular joint
Three Lateral Bursae
A tube of synovial membrane
Between the biceps femoris tendon and the
Situated around the popliteus tendon
fibular collateral ligament
Communicates with the superior tibiofibular
Between the popliteus tendon and the lateral
joint
condyle of the femur
Gastrocnemius Bursa
Between the fibular collateral ligament and the
Situated deep to the medial head of the
popliteus tendon
gastrocnemius muscle
Does not always communicate with the medial REFERENCE: Anatomy in Surgery, 3rd Edition by Philip
condylar cavity
Thorek