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HIP JOINT, KNEE JOINT AND ANKLE JOINT

A. ILIUM

I. HIP

Upper flattened part of the bone

Hip Bone
o

Possesses the iliac crest(top) which can be felt through the


skin along its entire length

Formed by 3 bones

Ends:

Ilium (superior),

In front: anterior superior iliac spine (ASIS)

Ischium (posteroinferior)

Behind: posterior superior iliac spine (PSIS)

Pubis (anteroinferior)

Iliac tubercle lies about 2 (5 cm) posterior the ASIS; lateral


expansion of the Iliac crest

Converge to form the ACETABULUM

Anterior inferior iliac spine prominence below ASIS

2/5 Acetabulum: Ilium

Posterior inferior iliac spine prominence below PSIS

1/5 Acetabulum: Pubis

Greater sciatic notch above and behind the acetabulum

2/5 Acetabulum: Ischium

SACROILIAC joint
o

Articulation of hipbones to the sacrum

B. ISCHIUM

L-shaped, possessing an upper thicker part (body), and a lower thicker


part (ramus)

SYMPHYSIS PUBIS
o

Articulation between hipbones anteriorly

Joined by FIBROCARTILAGE

SYMPHYSIS joint

Ischial spine projects from the posterior border of the ischium and
intervenes between the greater and lesser sciatic notches

Ischial tuberosity forms the posterior aspect of the lower part of the
body of the bone; associated with the hamstring muscles of the
posterior thigh

Greater and lesser sciatic notches converted into greater and lesser
foramina by the presence of the sacrospinous and sacrotuberous
ligaments

C. PUBIS

E. ACETABULAR FOSSA

Ventral part of the hip bone

Angle of TORSION: 12 - 15

Divided into a body, superior ramus, and an inferior ramus

Angle of INCLINATION: 126

Pubic crest forms the upper border of the body of the pubis, and ends

Contains:

laterally as the pubic tubercle

Ligamentum teres

Symphysis pubis bodies of the 2 pubic bones articulate with each

Fat pad

other in the midline anteriorly

Synovial membrane

Acetabulum superior ramus + ilium and ischium

Below obturator foramen inferior ramus + ischial ramus

Allows movement of ligamentum teres

Obturator foramen filled by obturator membrane

LIGAMENTUM TERES
o

Carries the artery of the ligamentum teres

D. ACETABULUM

PROXIMAL ARTICULAR SURFACE

Articulates with head of the femur to form the hip joint

Adduction + flexion + external rotation

Maximum contact between acetabulum and femur:

Adduction + extension + internal rotation

Flexion + slight external rotation + slight abduction

Inferior margin: deficient, marked by the acetabular notch

Articular surface
o

aka LUNATE SURFACE

Limited to a horseshoe- shaped area, covered with hyaline


cartilage

Where most of the weight is transmitted through the pelvis


to the femur

Floor: Nonarticular, aka ACETABULAR FOSSA


o

Provides attachment for the ligament of the head of the


femur

Anatomic position: front of symphysis pubis and ASIS same vertical


plane

Tension occurs during

RESERVOIR FOR SYNOVIAL FLUID

F. FEMUR

4. SHAFT

Angle of TORSION: 12 - 15 on transverse plane

Angle of INCLINATION: 126

1. HEAD
o

FOVEA CAPITIS

Small depression in the center of the head that serves

Descends from lateral to medial in the coronal place at an


angle of 7 from the vertical axis

Smooth and rounded on its anterior surface

Posteriorly has a ridge, the linea aspera

LINEA ASPERA

Where muscles and intermuscular septa are attached

Linea aspera diverge superiorly:

as an attachment of the ligament of the head

DISTAL ARTICULAR SURFACE

2. NECK

Superiorly &anteriorly:

Pectineal line - joins the intertrochanteric


line

3. GREATER and LESSER TROCHANTER

Superiorly &laterally:

Large eminences situated at the junction of the neck and shaft

Greater trochanter- extends superiorly from the shaft of the

trochanter; attachment of gluteus

femur; lateral to the region where the shaft joins the neck of

maximus

Gluteal tuberosity - Below greater

the femur
o

Lesser trochanter- projects posteromedially from the shaft;


inferior to the junction with the neck

Linea aspera diverge inferiorly:

Connecting the 2 trochanters:

medial supracondylar ridge to the adductor

Anteriorly: intertrochanteric line, where iliofemoral


ligament is attached

tubercle on the medial condyle

Posteriorly: intertrochanteric crest, on which is the


quadrate tubercle

Medial margin: continues below as the

Lateral margin: continuous below with the


lateral supracondylar ridge

Popliteal surface a flat, triangular area on it


posterior

surface,

formed

when

becomes broader toward its distal end

shaft

Lateral and medial condyles


Posterior distal end of shaft

Lines the capsule

Separated by the intercondylar notch

Attached to the margins of the articular surfaces

Covers the portion of the neck of the femur that lies within the

Anterior surface of the condyles joined by an articular surface


o

Ensheathes the ligament of the head of the femur

Take part in the formation of the knee joint

Covers the pad of fat contained in the acetabular fossa

Above the condyles are the medial and lateral epicondyles

Psoas bursa

Adductor tubercle continuous with the medial epicondyle

BALL-AND-SOCKET joint

Articulation between the hemispherical head of the femur and the cupshaped acetabulum of the hip bone
Acetabulum
o

Anterior surface: horseshoe shaped and is deficient inferiorly


at the acetabular notch

Cavity: deepened by the presence of fibrocartilaginous rim


o

joint capsule

for the patella

Synovial membrane

G. COXOFEMORAL Joint (HIP JOINT)

aka ACETABULAR LABRUM

Capsule
o

Encloses the joint and is attached to the acetabular labrum


medially

Laterally, it is attached to the intertrochanteric line of the


femur in front and halfway along the posterior aspect of the
neck of the bone behind

RETINACULA band of capsule fibers, accompanied by


blood vessels, which are reflected upward along the neck

H. Ligaments of Hip Joint

3 capsular ligaments

I. Movements of Hip Joint

1. FLEXION
o

Muscle ANTERIOR COMPARTMENT of thigh

Iliofemoral ligament

Pubofemoral ligament

muscles

Ischiofemoral ligament

Pectineus

Iliopsoas

Sartorius

Rectus femoris

1. ILIOFEMORAL ligament
o

Strong, inverted Y-shaped ligament

aka LIGAMENT OF BIGELOW

Superior: limits ADDUCTION

Anterior: limits HYPEREXTENSION

2. PUBOFEMORAL ligament
o

Triangular

Flexed knee: 120

Extended knee: 70 90

Limited by the tension of the hamstring muscles

2. EXTENSION 0 - 10
o

Limited

by

the

tension

of

the

ILIOFEMORAL,

PUBOFEMORAL, and ISCHIOFEMORAL ligaments


o

Anterior: limits EXTERNAL ROTATION

Inferior: limits ABDUCTION

3. ISCHIOFEMORAL ligament

Muscles

Gluteus maximus

Hamstring muscles

Thinnest

Adductor magnus (posterior belly)

Spiral-shaped

Semitendinous

Semimembranous

Biceps femoris (long head)

Posterior: limits INTERNAL ROTATION

Inferior: limits ABDUCTION

3. ABDUCTION 45
o

Limited by the tension of the PUBOFEMORAL ligament

Muscles

Gluteus medius and minimus

Tensor fascia lata

Piriformis

flexor group

4. ADDUCTION 30

Adductor magnus, longus, brevis

Pectineus

Gracilis

Limited by the ISCHIOFEMORAL ligament

Muscles

Internal rotators

External rotators

6. MEDIAL ROTATORS 60
Muscles

Gluteus medius

Tensor fasciae latae

7. CIRCUMDUCTION
o

TIGHT HAMSTRING
o

Limits HIP FLEXION (with KNEE EXTENSION)

Muscles

5. LATERAL ROTATION 30

The LATERAL ROTATORS are more powerful than the medial


rotators

The EXTENSOR GROUP of muscles is more powerful than the

Combination of all movements

NUTRIENT artery
o

Supply the shaft of the femur

II. KNEE COMPLEX

3 bones
o Femur
o Tibia

B. Ligaments

1. EXTRASCAPULAR LIGAMENTS
a. LIGAMENTUM PATELLAE

o Patella

* Fibula is not included

below to tibial tuberosity

b. OBLIQUE POPLITEAL ligament

o HINGE JOINTS between the medial and lateral

o Most stable in extension

expansion

of

semimembranous

c. LATERAL COLLATERAL ligament (LCL)

Attached above to lateral condyle of femur and


below to tibular head

condyles of the femur and the corresponding condyles of


the tibia

Tendinous
muscle

A. 2 Articulations

1. FEMOROTIBIAL joint

Attached above to lower border of patella and

Prevents ADDUCTION of tibia on femur

Taut on extension, slack on flexion

o SUPPORTS THE WEIGHT OF THE BODY


d. MEDIAL COLLATERAL ligament (MCL)
2. PATELLOFEMORAL joint

o PLANE GLIDING JOINT between the distal femur


and the patella
o Function as PULLEY for the quadriceps femoris

Attached above to medial femoral condyle and


below to medial surface of tibial shaft

Prevents ABDUCTION of tibia on femur

Taut on extension, slack on flexion

2. INTRASCAPULAR LIGAMENT
o

C. MENISCI

CRUCIATE LIGAMENTS

Main connection between femur and tibia

a. ANTERIOR CRUCIATE Ligament

Attached to anterior intercondylar fossa

Passes upward and laterally to attach on the inside of

C-shaped fibrocartilage sheets

Peripheral border (thick) attached to capsule

Inner border (thin) concave and forms free edge

Functions:
o

the femoral condyles

the lateral femoral condyle

b. POSTERIOR CRUCIATE Ligament

Attached on posterior intercondylar fossa

Passes upward and medially to attach on the inside of

the medial femoral condyle


Prevents

ANTERIOR

DISPLACEMENT

of

femur on tibia

DRAWER TEST
o

Used in determining cruciate ligament injurires

Lockmans Maneuver
o

To identify the integrity of the anterior cruciate ligament


(ACL)

Serve as cushions between the femur and tibia

Prevents POSTERIOR DISPLACEMENT of the


femur on the tibia

Deepens the articular surfaces of the tibial condyles to receive

Attached to tibia through:


o

Their horns at the intercondylar fossae

The coronary ligaments

Other attachments:
o

transverse ligament

meniscopatellar fibers

medial collateral ligament

popliteus and semimembranous

meniscofemoral ligament

Moved and controlled on the tibia by both passive and active force

D. PATELLA

F. Muscles

A sesamoid bone

Articulated with anterior surface of femoral condyles

Functions:

1. EXTENSORS not more than 15


o

Increase leverage of the quads

Provide bony protection to the distal joint surfaces of the

2. FLEXORS 120 - 150

femoral condyles

Biceps femoris

Decrease pressure and distribute forces on the femur

Semitendinosus

Prevent

Semimembranosus

Gracilis

Sartorius

Popliteus

damaging compression forces on the quads

tendon with resisted knee flexion

E. BURSAE

Quadriceps femoris

Anterior
3. MEDIAL ROTATORS 40

Suprapatellar bursa (inflammation: STIFF KNEE)

Prepatellar bursa (inflammation: HOUSEMAIDS KNEE)

Sartorius

Superficial interpatellar bursa

Gracilis

Deep interpatellar bursa

Semitendinosus

Superficial and deep interpatellar inflammation: VICARS KNEE

4. LATERAL ROTATORS 2x as large as internal rotation


o

Posterior

Lateral

Medial

Biceps femoris

TERMINAL ROTATION OF THE KNEE


o

aka as SCREW-HOME mechanism

In the last 20 of knee extension, the tibia externally rotates


10-20 on the fixed femur/the femur internally rotates on the
fixed tibia

Occurs both in active and passive knee extension

Cannot be produced or prevented voluntarily

III. ANKLE JOINT (TALOCRURAL joint)

2. LATERAL COLLATERAL LIGAMENT

SYNOVIAL HINGE JOINT


o ANTERIOR TALOFIBULAR ligament

3 bones
o Distal tibia

Limits PLANTARFLEXION

Runs from the lateral malleolus to the lateral

o Distal fibula

surface of the talus

o Talus
o CALCANEOFIBULAR ligament

Runs from the tip of the lateral malleolus


downward and backward to the lateral surface of

A. Ligaments of the Ankle

the calcaneus

1. MEDIAL COLLATERAL LIGAMENTS


o Superficial

Tibionavicular ligament

Calcaneotibial ligament

Anterior talotibial ligament

Limits DORSIFLEXION

Runs from the lateral malleolus to the posterior


tubercle of the talus

o Deep

o POSTERIOR TALOFIBULAR ligament

Limits plantarflexion

Posterior talotibial ligament

Limits dorsiflexion

B. Motions

CLINICAL CORRRELATIONS

1. DORSIFLEXION 25
o

Muscles

Tibialis anterior

Decreased angle of inclination

Extensor hallucis longus

Distal segment deviates to midline

Extensor digitorum longus

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Peroneus tertius

2. PLANTARFLEXION 35
o

COXA VARA

Muscles

Gastrocnemius

Soleus

Peroneus longus and brevis

Flexor digitorum longus

Flexor hallucis longus

Tibialis posterior

COXA VALGA
o

Increased angle of inclination

Distal segment deviates away from midline

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Dislocations of hip joints are usually POSTERIORLY

GENA VARUM

Decreased Q-angle

Towards LATERAL

GENU VALGUM
o

Increased Q-angle

Towards MEDIAL

WADDLING GAIT
o

Most due to the injury of SUPERIOR GLUTEAL nerve

Caused by paralysis of the abductors of the thigh

Unsupported limb is dragged