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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.

the Knee One of the most complex “simple” structures in the human body. The “middle child”

Osteology of the Knee

Distal femur

(ADDuctor tubercle)

Right Femur

Osteology of the Knee

Tibial Fibular Tuberosity Head Interosseous Membrane
Tibial
Fibular
Tuberosity
Head
Interosseous
Membrane

The proximal tibia & fibula

The medial and lateral condyles of the tibia form the

shallow articulations with the

distal femur

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

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

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

Tibial plateau

Fibula

Fibular Head

Medial Meniscus
Lateral Meniscus
Posterior Cruciate Ligament
Lateral Collateral Ligament
Medial Collateral Ligament
Popliteal space

• Posterior Cruciate Ligament • Lateral Collateral Ligament • Medial Collateral Ligament • Popliteal space

Anatomy of the Knee

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

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

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”

of the knee Genu varum refers to a frontal deviation of the position of the knee.
of the knee Genu varum refers to a frontal deviation of the position of the knee.

Anatomy of the Knee: Genu “what?”

Genurecurvatum:

Hyperextension of the tibiofemoral joint placing excessive stress on the structures in the popliteal space

excessive stress on the structures in the popliteal space Tibial nerve Popliteal Vein Popliteal Artery Common

Tibial nerve

Popliteal Vein Popliteal Artery Common Peroneal Nerve

Common Pathologies of the Knee

Osgood-Schlatter’s

Common Pathologies of the Knee Osgood- Schlatter’s Disease Chondromalacia of the Patella

Disease

Chondromalacia of the Patella

Common Pathologies of the Knee Osgood- Schlatter’s 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:

forces through the knee joint They may not heal well: inner 1/3: avascular (a) middle 1/3:

inner 1/3: avascular (a) middle 1/3: poor blood supply (b) outer 1/3: good blood supply (c)

They may not heal well: inner 1/3: avascular (a) middle 1/3: poor blood supply (b) outer

Myology of the Knee

Your Rectus subtopic Femoris goes here

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”

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 10-15 o of knee extension

Vastus Medialis Obliquus
Vastus
Medialis
Obliquus

Myology of the Knee

Vastus Lateralis Origin Lateral lip of the linea aspera, intertrochanteric line, lateral region of the
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”
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

Insertion Tibial tuberosity via the patellar tendon Innervation Femoral n. Action Knee extension
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

It identifies patellofemoral tracking. Females: - greater angle -greater incidence of patellofemoral joint pain Q Angle

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

Activity

Force

% Body

Pounds of

 

Weight

Force

Walking

850

N

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

knee

lbs Squatting 5000 N 7 x BW 1400 lbs Deep Squatting 15000 N 20 x BW

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

To Squat or not to Squat? Alignment is the key Balance among the heads of the
To Squat or not to Squat? Alignment is the key Balance among the heads of the
To Squat or not to Squat? Alignment is the key Balance among the heads of the

Myology of the Knee

Origin Ischial tuberosity Insertion Proximal-medial surface of the tibia (pes anserinus) Innervation Tibial portion
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

Your Semitendinosus subtopic goes here

n. Action Hip extension, knee flexion, “tidbit” One of the hamstrings Your Semitendinosus subtopic goes here

Myology of the Knee

Your Biceps subtopic Femoris goes here

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

A

C

Semimem

D

Semiten

Action Hip extension, knee flexion “tidbit” One of the hamstrings A Bicep F B Bicep F

Myology of the Knee

Your Semimembranosus subtopic goes here

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

Tibial portion of the sciatic n. Action Hip extension, knee flexion “tidbit” One of the hamstrings

Myology of the Knee

Origin ASIS Insertion Proximal-medial surface of the tibia (via the pes anserinus) Innervation Femoral n.
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

Your Sartorius subtopic goes here

Hip flexion, hip ABD, Hip ER, knee flexion “tidbit” Longest muscle in the body Your Sartorius

Myology of the Knee

Your Gracillis subtopic goes here

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

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.

broad sheet of connective tissue known as the pes anserinus. The 3 muscles: -originate from different

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

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,

tuberosity via the Achilles tendon Innervation Tibial n. Action Flexion of the knee, plantar flexion,

What can you identify?

(in her knee)

Quadriceps Vastus medialis

Vastus lateralis

Vastus intermedius?

Rectus femoris Sartorius

Anything else?

(in her knee) Quadriceps Vastus medialis Vastus lateralis Vastus intermedius? Rectus femoris Sartorius Anything else?