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Structure & Function of the Knee

One of the most complex simple structures in the human body.


The middle child of the lower extremity.

Osteology of the Knee


Distal femur

(ADDuctor tubercle)

Right Femur

Osteology of the Knee


The proximal tibia & fibula
The medial and lateral
condyles of the tibia form the
shallow articulations with the
distal femur

Fibular
Head

Tibial
Tuberosity

The intercondylar/intercondyloid
eminence
the attachment point for the
cruciate ligaments
Interosseous
Membrane

Anatomy of the Knee: Anterior Aspect

Femur

Medial Condyle
Articular Cartilage
Quadriceps Tendon

Tibia

Tibial Plateau
Tibial Tuberosity
Patellar Tendon

Fibula
Medial Meniscus
Lateral Meniscus
Medial Collateral Ligament
Lateral Collateral Ligament

Anatomy of the Knee: Posterior Aspect

Femur

Medial condyle
Lateral condyle
ADDuctor Tubercle

Tibia

Fibula

Medial Meniscus
Lateral Meniscus
Posterior Cruciate Ligament
Lateral Collateral Ligament
Medial Collateral Ligament
Popliteal space
Tibial plateau
Fibular Head

Anatomy of the Knee


Cruciate Ligaments
Anterior: (ACL)
-resists anterior motion of the
tibia on a fixed femur
-resists extremes of knee
extension

Posterior: (PCL)
-resists posterior motion of
the tibia on a fixed femur
-resists extremes of knee
flexion

Anatomy of the Knee: Genu what?


Genu valgum refers to a
frontal deviation of the
position of the knee.
Commonly referred to as
knock-knee due to the
medial displacement of
the knee

Genu varum refers to a


frontal deviation of the
position of the knee.
Commonly referred to as
bow-leg

Anatomy of the Knee: Genu what?


Genurecurvatum:
Hyperextension of the tibiofemoral joint placing
excessive stress on the structures in the popliteal
space
Tibial nerve
Popliteal Vein
Popliteal Artery
Common Peroneal Nerve

Common Pathologies of the Knee


Osgood-Schlatters
Disease

Chondromalacia of
the Patella

Common Pathologies of the Knee


The menisci:
absorb shock and disperse large compressive forces
through the knee joint
They may not heal well:
inner 1/3: avascular (a)
middle 1/3: poor blood supply (b)
outer 1/3: good blood supply (c)

Myology of the Knee


Your
subtopic
goes here
Rectus
Femoris
Origin

Anterior-inferior iliac spine

Insertion

Tibial tuberosity via the quadriceps


tendon

Innervation

Femoral n.

Action

Hip flexion, knee extension

tidbit

One of the heads of the quads

Myology of the Knee


Vastus Medialis
Origin

Medial lip of the linea aspera


and the intertrochanterid line
of the femur

Insertion

Tibial tuberosity via the


patellar tendon

Innervation

Femoral n.

Action

Knee extension

tidbit

One of the heads of the


quad
VMO one of the first
muscles of the knee to atrophy
post-operatively,
responsible for last 10-15o of
knee extension

Vastus
Medialis
Obliquus

Myology of the Knee


Vastus Lateralis
Origin

Lateral lip of the linea aspera,


intertrochanteric line, lateral
region of the gluteal tuberosity

Insertion

Tibial tuberosity via the


patellar tendon

Innervation

Femoral n.

Action

Knee extension

tidbit

Part of the quads

Myology of the Knee


Vastus Intermedius
Origin

Upper 2/3 of the anterior


femoral shaft

Insertion

Tibial tuberosity via the patellar


tendon

Innervation

Femoral n.

Action

Knee extension

Q Angle of the Knee


The line of force of the quadriceps can be described by
the Q-angle. It identifies patellofemoral tracking.
Females:
-greater angle
-greater incidence
of patellofemoral
joint pain

Q
Angle

Compression at the Patellofemoral Joint


The Patella:
-also known as the knee cap, is a
thick, circular-triangular bone
which articulates with the femur
and covers and protects the
anterior articular surface of the
knee

Activity

Force

Walking

850 N

% Body Pounds of
Weight
Force
1/2 x BW 100 lbs

Bike

850 N

1/2 x BW 100 lbs

Stair Ascend

1500 N

3.3 x BW 660 lbs

Stair Descend 4000 N

5 x BW

1000 lbs

Jogging

5000 N

7 x BW

1400 lbs

Squatting

5000 N

7 x BW

1400 lbs

Deep Squatting 15000 N 20 x BW 4000 lbs

To Squat or not to Squat?


Alignment is the key
Balance among the heads
of the quads is critical to
the health of your knees

Myology of the Knee


Your
subtopic goes here
Semitendinosus
Origin

Ischial tuberosity

Insertion

Proximal-medial surface of the tibia


(pes anserinus)

Innervation

Tibial portion of the sciatic n.

Action

Hip extension, knee flexion,

tidbit

One of the hamstrings

Myology of the Knee


Your
subtopic
goes here
Biceps
Femoris
Origin

Ischial tuberosity

Insertion

Head of the fibula

Innervation

Tibial portion of the sciatic n.

Action

Hip extension, knee flexion

tidbit

One of the hamstrings

A
Bicep F

B
Bicep F

Semimem

Semiten

Myology of the Knee


Your
subtopic goes here
Semimembranosus
Origin

Ischial tuberosity

Insertion

Medial condyle of the tibia, posterior aspect

Innervation

Tibial portion of the sciatic n.

Action

Hip extension, knee flexion

tidbit

One of the hamstrings

Myology of the Knee


Your
subtopic goes here
Sartorius
Origin

ASIS

Insertion

Proximal-medial surface of the tibia (via


the pes anserinus)

Innervation

Femoral n.

Action

Hip flexion, hip ABD, Hip ER, knee


flexion

tidbit

Longest muscle in the body

Myology of the Knee


Your
subtopic goes here
Gracillis
Origin

Body and inferior ramus of the


pubis

Insertion

Proximal-medial aspect of the


tibia (pes anserinus)

Innervation

Obturator n.

Action

Hip ADD, hip flexion, knee


flexion

What is the Pes Anserinus?


The semitendinosus, sartorius and gracillis all attach to the proximal
medial tibia through a broad sheet of connective
tissue known as the pes anserinus.

The 3 muscles:
-originate from different
bones on the pelvis
-perform different actions
at the hip
-are innervated by different
nerves
The all perform the following at the knee:
-flexion
-medial stability

Myology of the Knee


Popliteus
Origin

Posterior aspect of the


lateral femoral condyle

Insertion

Posterior surface of the


proximal tibia

Innervation

Tibial n.

Action

Initiates knee flexion

Myology of the Knee


Gastrocnemius
Origin

Medial head: posterior aspect of the


medial femoral condyle
Lateral head: posterior aspect of the
lateral femoral condyle

Insertion

Calcaneal tuberosity via the Achilles


tendon

Innervation

Tibial n.

Action

Flexion of the knee, plantar flexion,

What can you identify?


Quadriceps
Vastus medialis
Vastus lateralis
Vastus intermedius?
Rectus femoris
Sartorius
Anything else?

(in her knee)

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