Dr.

Kumar Satish Ravi

M.B.B.S., M.D.(JIPMER)

The Popliteus Muscle

Tendon of Popliteus Lateral (Fibular) Collateral Lig. Popliteus

Nerve: Tibial n.
Actions: Unlocks

knee

Note: popliteal tendon intervenes between lateral meniscus and fibular collateral lig.

Weak flexor of knee

The Knee Joint

Articular surfaces - 3 subdivisions:
1. Medial - Medial femoral condyle +medial tibial condyle & meniscus
2. Lateral - Lateral femoral condyle +lateral tibial condyle & meniscus 3. Anterior Inferior end of femur + Patella

The Knee Joint - Type

Synovial Femerotibial artiticulation: 1. Hinge between femur and tibia 2. Small degree of gliding (rotation) between tibia and femur Patellofemoral artiticulation: gliding

Hinge

Gliding

Capsule of the Knee Joint

Capsule deficient anteriorly joint space closed by quadriceps tendon(QT), patella (P), patellar ligament (PL) QT P Prox to Femoral Condyles

Capsule deficient where popliteus enters

PL
Distal to Tibial Plateaus

Anterior View

Posterior View

Extracapsular Ligaments of the Knee Joint

1. Patellar lig.
2. Fibular collateral lig. 3. Tibial collateral lig.

4. Oblique popliteal lig.

5. Arcuate popliteal lig.

Intracapsular Ligaments
Anterior Cruciate Ligament (ACL) Posterior Cruciate Ligament (PCL)
ACL & PCL named according to tibial attachment Lie inside capsule but outside synovial cavity Functions: Prevent anterior and posterior displacement of femur and tibia on oneanother

ACL

PCL

Flexed Right Knee

Anterior Cruciate Ligament

Slack in knee flexion Taut in knee extension Prevents knee hyperextension Prevents posterior displacement of femur on tibia With knee flexed prevents tibia from being pulled anteriorly Rupture of the anterior cruciate ligament (common in skiing injuries) allows the tibia to slide anteriorly from the femur-called the anterior drawer sign.

Posterior Cruciate Ligament

Stronger than ACL Less likely to be injured Slack in extension & taut in flexion Prevents anterior displacement of the femur on the tibia
Rupture of the posterior cruciate ligament (rare, but happens in head-on collisions with no seatbelt when the tibia strikes the dashboard) allows the tibia to slide posteriorly from the femur-the posterior drawer sign

The Menisci (semilunar cartilages)

Functions: Stability: Deepen articular surfaces of tibia Compensate for incongruent bone surfaces Shock absorption Distribution of synovial fluid

Patella

Femur

Meniscus (Triangular in X-Section)

Tibia

The Menisci (semilunar cartilages) cont.

Lateral meniscus more mobile than med. popliteal tendon (P) separates it from the lat. collateral ligament (L) A few popleital fibers attach to lateral meniscus and move it
L P

Medial meniscus relatively immobile (fixed) attached to capsule, tibia & medial collateral ligament

The medial meniscus often tears with tears of the medial collateral lig.
Knee is hit from lateral side while weight bearing on ipsilateral side

Medial Meniscus
Direction of Impact

Direction of Fall Foot on Ground

The Unhappy Triad

(3 Cs: collateral, cartilage, cruciate)
With a blow the the knee from the lateral side: 1. Med. collat. lig. can tear; 2. This may cause med. meniscus to tear or detach; 3. The ACL may follow
1. Medial Collateral Lig.

3. ACL
2. Medial Meniscus

Synovial Membrane
Lines joint capsule Attached to margins of articular surfaces and to the peripheral edges of the menisci Largest joint space in body
Note: cruciates are intracapsular but extrasynovial

Bursae
Numerous bursae are associated with the knee joint. We shall describe them in terms of those: a. Which communicate with the synovial cavity b. Located on the anterior aspect of the joint

c. There are additional bursae associated with tendons surrounding the knee joint which we will not itemize

4 bursae Communicate With the Synovial Cavity of the Knee Joint:

1. 2. 3. 4.

Suprapatellar (ant.) Popliteus (posterolat.) Anserine (medial) Gastrocnemius (med head) (posteromed.)

Bursae Associated with Anterior Aspect of Knee J.

1. (Suprapatellar Bursa) 2. Prepatellar Bursa 3. Superficial Infrapatellar Bursa 4. Deep Infrapatellar Bursa

Bursitis

Prepatellar Bursitis (Housemaids Knee) common in coal miners and military personnel

Superficial Infrapatellar Bursitis (Clergymans Knee) common in roof tilers and carpet layers

The Genicular Anastomosis

Descending br. Lat. Descending Genicular br. Femoral A.

Circumflex Fem. A.
Lat. Sup. Genic. A.

Medial Sup. Genic. A.

Lat. Inf. Genic. A.

Anterior Tibial Recurrent A.

Medial Inf. Genic.A.

Anterior Tibial A.

Popliteal A. and its anastomosing branches

Movements
1. Extension 2. Flexion
Extension Some rotation occurs with weight bearing, femur rotates on tibia; when not weight bearing, tibia rotates on femur.

Flexion

Locking of the Knee

1. Knee extended by quads. until ACL taut. 2. Femur medially rotates on tibia (if weight bearing). Rotation is passive, due to shape of artic. surfaces. 3. Ant. Cruciate, collateral ligs, oblique popliteal lig. become taut. This screw home mechanism said to lock the joint In this position the joint is slightly hyperextended and all 4 ligaments are taut. ACL prevents hyperextension others prevent additional rotation

Unlocking of the Knee

Popliteus muscle contracts to unlock knee by laterally rotating the femur When weight bearing femur rotates laterally on tibia When not weight bearing tibia rotates medially in relation to femur The unlocked knee can be flexed by the hamstrings

Mechanisms to prevent patellar dislocation

There is a 170o angle between the femur and the tibia This would tend to pull the patella laterally but 2 anatomic factors prevent it:

1. Vastus medialis has horizontal fibers which insert into the patella and counter pull patella medially; 2. Lateral femoral condyle has a prominent trochlea which prevents the patella from sliding laterally

1
Note direction of fibers of vastus medialis

Prominent trochlea

The Popliteal Fossa

SM ST Biceps Femoris

Concerning the Popliteal Artery:

1. Pulsations may be felt but not always easy Gastrocnemius (& Plantaris) 2. It may be lacerated or compressed in condylar fractures of femur
1. 2. 3.

Contents 3. An arterial embolus Tibial N., Common Fib. N. may become lodged at Popliteal V. its bifurcation Popliteal A.

Proximal Tibiofibular Joint

Articulation: lateral tibial condyle & fibular head Type: synovial plane/gliding Capsule: surrounds joint Synovial membrane: lies capsule attaches to margins of articular surfaces

Proximal Tibiofibular Joint (cont.)

Ligaments: 1. Anterior and Posterior Ligaments 2. Interosseous Ligament also supports joint

Ant. Lig. Interosseous Lig. (memb)

Movements: a small amount of gliding during ankle plantar and dorsiflexion

Distal Tibiofibular Joint

Important to the Integrity of the Ankle Joint

Anterior Tibiofibular Lig.

Type: fibrous Capsule: none Ligament : Strong interosseous lig which is continuous with the interosseous membrane; weak Ant. & Post. Tibiofibular Ligs. Movement: a small amount during ankle plantar and dorsiflexion