KNEE JOINT

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KNEE JOINT

• It is the largest and most complicated joint in
  the body.

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FUNCTIONS

• 1. Weight bearing.
• 2.Essential for daily activities standing
  walking climbing stairs.
• 3.The main joint responsible for sports
  running, jumping , kicking etc.

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ARTICULATING BONES

• 1. Lateral and medial articulations between the
  tibial condyles and their cartilaginous menisci
  and the corresponding femoral condyles.

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ARTICULATING BONES

• 2. Intermediate articulation between the patella
  and femur.

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THE FEMORAL CONDYLES

• The medial extends further forwards .
• The lateral is more oval.
• The condyles are convex from front to back.

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TIBIAL CONDYLES

• (PLATEAUS) are flat .
• The medial is oval The lateral is round.
• The articular surfaces are covered with hyaline
  cartilage.

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TYPE

• A synovial joint of the hinge variety between
  the medial and lateral condyles of the femur and
  the corresponding tibial condyles with some
  degree of rotation.

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TYPE

• A synovial joint of the plane gliding variety
  between the patella and the patellar surface of
  the femur.

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CAPSULE

• It is absent Anteriorly.
• It is
• Replaced by
• Quadriceps femoris tendon.
• Patella.
• Ligamentum patellae.

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CAPSULE

• Posteriorly
• (a) Superior
• Attached proximal to the articular margins of the
  femoral condyles and to the intercondylar fossa.
• It is deficient above the lateral condyle for the
  passage of tendon of popliteus.

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CAPSULE

• (b) Inferior
• Attached to the tibia EXCEPT when the tendon of
  Popliteus crosses the bone.

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EXTRACAPSULAR LIGAMENTS

• 1. Ligamentum Patellae
• It is the inter mediate part of the tendon of
  quadriceps femoris .It is supported by the
  patellar retinaculi (expansions from the vasti)
• They strengthen the capsule on each side.

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2. TIBIAL (MEDIAL) COLLATERAL

• A flat band.
• Attachment
• Above to the medial condyle of the femur.
• Below to the medial surface of the shaft of the
  tibia.
• Firmly attached to the medial meniscus.

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3. LATERAL (FIBULAR) COLLATERA

• Cord like.
• Attachment
• Above lateral condyle of the femur.
• Below head of the fibula.
• Separated from the lateral meniscus by the tendon
  of popliteus.

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4. OBLIQUE POPLITEAL

• An expansion of the Semimembranosus.
• It strengthens the capsule posteriorly.

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INTRA CAPSULAR STRUCTURES

• 1. CRUCIATE LIGAMENTS.
• 2. MENISCI.
• 3. TENDON OF POPLITEUS.

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CRUCIATE LIGAMENTS

• They are the main bond between the femur and
  tibia throughout the joints movements.
• They Cross each other within the joint cavity.
• They are named Anterior and Posterior according
  to their tibial attachments.

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ANTERIOR CRUCIATE

• Tibial attachment
• Anterior intercondylar area.
• Course
• Upward, backward and laterally.
• Femoral attachment
• Posterior part of medial surface of the lateral
  condyle.

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ANTERIOR CRUCIATE

• FUNCTION
• Prevent posterior displacement of the femur on
  the tibia and the tibia from being pulled
  anteriorly when the knee joint is flexed.
• It is taught in hyper extension.

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POSTERIOR CRUCIATE

• Tibial attachment
• posterior inter condylar area.
• Direction
• upward, forward and medially.
• Femoral attachment
• Anterior part of the lateral surface of the
  medial condyle.

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POSTERIOR CRUCIATE

• Function
• prevents anterior displacement of the femur on
  the tibia and the tibia from being pulled
  posteriorly when the knee joint is flexed.
• It is taught in hyper flexion.

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MENISCI

• C shaped sheets of fibro cartilage.
• The peripheral border is thick and attached to
  the capsule.
• The inner border is thin and concave and forms a
  free edge.

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MENISC

• The upper concave surfaces are in contact with
  the femoral condyles.
• The lower flat surfaces are in contact with the
  tibial condyles.

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MENISCI

• Functions
• 1. Deepen the tibial articular surfaces.
• 2. Act as cushions between the two bones.

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MEDIAL MENISCUS

• Crescentic in shape.
• More liable to injury due to its attachment to
  the medial collateral ligament and to the
  capsule.
• It is relatively immobile.

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LATERAL MENISCUS

• More rounded in shape.
• Its anterior and posterior ends lie within the
  ends of the medial meniscus.
• Posteriorly it is separated from the fibular
  collateral ligament by the tendon of popliteus.
• Less liable to injury.

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INJURY OF THE MENISCI

• The menisci are frequently injured especially in
  footballers and cricketers.
• The medial is torn three times more often than
  the lateral.
• The injury is produced by the rotation of the
  femur on the tibia or the reverse with the knee
  joint partially flexed and carries the weight of
  the body.

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INJURY OF THE MENISCI

• The torn part of the meniscus is wedged between
  the tibial and femoral condyles.
• No further movement is allowed and the joint is
  kept locked.

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SYNOVIAL MEMBRANE

• It lines the lateral and medial parts of the
  capsule.
• Anteriorly
• It forms the supra patellar bursa.
• It is attached to the inter condylar area of the
  tibia and to the lateral and medial borders of
  the patella.

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SYNOVIAL MEMBRANE

• It is reflected backward from the posterior
  surface of the ligamentum patellae to form the
  Infrapatellar fold.
• The free borders of the fold are the Alar folds.
• The space between these folds contains fat
  (Infrapatellar pad of fat).

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SYNOVIAL MEMBRANE

• Posteriorly
• It Passes out to surround the cruciate
  ligaments.
• It is continuous with the surface layer of the
  menisci.
• It covers the tendon of popliteus and forms a
  bursa around it (popliteal bursa).
• It forms the semimembranosus bursa.

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ANTERIOR BURSAE

• They are four
• 1. Suprapatellar
• It is 3 fingerbreadths above the patella.
• Always continuous with the joint cavity.
• Held in position by the articularis genus muscle.
• Accumulation of fluid in the joint causes excees
  fluid in the bursa leading to floating patella.

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ANTERIOR BURSAE

• 2. Prepatellar
• If enlarged it causes (House Maids) bursa.

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ANTERIOR BURSAE

• 3.Superficial Infrapatellar. (PARSONS bursa
• 4.Deep Infrapatellar.

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POSTERIOR BURSAE (6)

• 1. POPLITEAL
• Always continuous with the joint cavity.
• 2.SEMIMEMBRANOSU
• Usually communicates with the joint cavity.
• 3 4. GASTROCNEMIUS
• Around sartorius,gracilis and semitendinosus.

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MOVEMENTS

• 1. FLEXION
• Hamstrings( supplied by the sciatic nerve).
• Assisted by sartorius, popliteus and gracilis.
• Checked by back of calf in contact with the back
  of the thigh.

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MOVEMENTS

• 2. EXTENSION
• Quadriceps Femoris (supplied by the femoral
  nerve.)
• Limited by tension of the cruciate and collateral
  ligaments.

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MOVEMENTS

• 3. ROTATION
• (A) MEDIAL Sartorius, gracilis and
  semitendinosus.
• (B) LATERAL Biceps femoris

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NERVE SUPPLY

• Femoral.
• Obturator.
• Sciatic.
• Common peroneal.
• Tibial.

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UNLOCKING

• At the commencement of Flexion of the extended
  knee.
• Aim
• To slack the ligaments especially the cruciate.
• FEMUR Lateral rotation (the foot is on the
  ground)
• TIBIA Medial rotation.
• Muscle POPLITEUS

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LOCKING

• The joint assumes the position of full extension.
• It becomes a rigid structure.
• The menisci are compressed between the tibial and
  femoral condyles.
• Tightening of all the major ligaments.
• The femur is medially rotated on the tibia.

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RELATIONS

• Anterior
• Prepatellar bursa.

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RELATIONS

• Posterior
• Boundaries and contents of Popliteal Fossa.
• Medial
• SGS muscles.
• Lateral
• Biceps femoris and common peroneal nerve.

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STABILITY

• 1. Muscles
• QUADRICEPS particularly the inferior fibers of
  the vasti lateralis and medialis.
• Many sport injuries can be preventable through
  appropriate training and conditioning of the
  muscle.

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STABILITY

• 2. Ligaments
• The knee joint can function well following a
  ligamentous strain if the quadriceps is intact.

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INJURY OF THE JOINT

• TRIAD OF INJURY
• 1. Medial collateral ligament.
• 2. Medial meniscus.
• 3. Anterior cruciate ligament.
• The joint becomes swollen because it is filled
  with blood (hemarthrosis).

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ANTERIOR CRUCIATE INJURY

• Tear of the anterior cruciate ligament is more
  common than the posterior.
• The tibia can be pulled excessively forward on
  the femur

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POSTERIOR CRUCIATE INJURY

• The tibia can be pulled excessively backward on
  the femur.

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INJURY OF THE CRUCIATE LIGAMENTS

• Management
• Knee is kept immobilized in slight flexion.
• Active physiotherapy of the quadriceps femoris at
  once.
• Operative repair (incase of torn of the capsule
  and collateral ligaments).

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ANKLE JOINT

• TYPE
• Hinge synovial
• ARTICULATING BONES
• 1. Lower end of the tibia
• 2. Two malleoli.
• 3. Body of the talus.
• 4. The inferior transverse tibiofibular ligament
  deepens the socket for the body of the talus.

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ANKLE JOINT CONTD

• CAPSULE
• Encloses the joint and attached near the
  articular margins except anteriorly where
  anteriorly it is attached to the neck of the
  talus in front of the articular edge.
• It is thin in front and behind.
• Posteriorly it fuses with the inferior
  transverse tibiofibular ligament.

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SYNOVIAL MEMBRANE

• Lines the capsule.
• Reflected anteriorly on to the neck of the talus
  as far as the articular cartilage.
• May extend a short distance between the tibia and
  fibula.

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LIGAMENTS

• MEDIAL( DELTOID)
• Attached by its apex to the tip of the medial
  malleolus.
• Composed of deep and superficial fibers.
• DEEP FIBERS
• Attached to the non articular area on the medial
  surface of the body of the talus.
• SUPERFICIAL FIBERS
• Attached to

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LIGAMENTS CONTD

• Sustentaculum tali.
• Plantar calcaneonavicular ligament.
• Medial side of talus.
• Tuberosity of navicular bone.

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• LATERAL LIGAMENT
• Weaker than the medial.
• It consists of three bands
• 1. ANTERIOR TALOFIBULAR
• Between the lateral malleolus and the lateral
  surface of the talus.
• 2. CALCANEOFIBULAR
• From the tip of the lateral malleolus to the
  lateral surface of the calcaneum.

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• 3. POSTERIOR TALOFIBULAR
• Between the lateral malleolus and the posterior
  tubercle of the talus.

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STABILITY OF THE JOINT

• 1. Shape of the articulating bones.
• 2. Strength of the ligaments.
• 3.The surrounding tendons.

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RELATIONS
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MOVEMENTS

• DORSIFLEXION
• Tibialis anterior, extensors of the digits and
  big toe, peroneus tertius.
• LIMITED BY
• Tension of tendo calcaneus.
• Posterior fibers of the medial ligament.
• Calcaneofibular ligament.

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• PLANTAR FLEXION
• Tibialis posterior, peroneus (longus and brevis)
  gastrocnemius.
• LIMITED BY
• Tension of opposing muscles.
• Anterior fibers of the medial ligament.
• Anterior talofibular ligament.

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