Knee complex
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Transcript of Knee complex
-: Introduction :--: Introduction :-
Tibiofemoral jointTibiofemoral joint
Patellofemoral jointPatellofemoral joint
Structure of the tibiofemoral joint.Structure of the tibiofemoral joint.
Type – Double condyloidType – Double condyloid
Articulating surface Articulating surface
Femur
Tibia
Tibio femoral alignment and weight-bearing forces
Mechanical Axis
Medial valgus angle
Anatomic axis
Genu Valgus
Genu Varus
Menisci
Menisci Attachement
Role of the menisci
Menisci nutrition
Menisci innervation
-: Joint capsule :-
Attachments
Synovial layer of the joint capsule
Fibrous layer of the joint capsule
-: Ligaments of knee joint :--: Ligaments of knee joint :-
Medial collateral ligament
Lateral collateral ligament
Ant. Cruciate ligament
Post. Cruciate ligament
Medial collateral ligamentMedial collateral ligamentSuperficial portion ->Superficial portion -> origin -: medial origin -: medial femoral epicondylefemoral epicondyle
Insertion -: med. Aspect of Insertion -: med. Aspect of proximal tibiaproximal tibiaRestrain to excessive Restrain to excessive abduction (valgus)&lat. abduction (valgus)&lat. Rotation stresses at kneeRotation stresses at kneeDeep portion->Deep portion-> Origin-: inf. Aspect of Origin-: inf. Aspect of med. Femoral condylemed. Femoral condyleInsetion-:proximal Insetion-:proximal aspect of med. Tibiaaspect of med. Tibia
-: Lateral collateral ligament :--: Lateral collateral ligament :- Lat. Side of Lat. Side of
tibiofemoral jointtibiofemoral joint
Proximally from lat. Proximally from lat. Femoral condyleFemoral condyle
Fibular headFibular head where it joins with where it joins with
tendon of biceps tendon of biceps femoris femoris
Responsible for Responsible for checking varus checking varus stresses stresses
-: Anterior Cruciate ligament :--: Anterior Cruciate ligament :- Attached to ant. Attached to ant.
Tibial spineTibial spine
sup and post. sup and post. attached to attached to posteromedial posteromedial aspect of lat. aspect of lat. Femoral condyleFemoral condyle
Anteromedial bandAnteromedial band Posterolateral band Posterolateral band
-: Posterior cruciate ligament :--: Posterior cruciate ligament :- Attached distally to the Attached distally to the
posterior tibial spine & posterior tibial spine & Anteriorly attached to Anteriorly attached to lat. Aspect of med. lat. Aspect of med. Femoral condyle Femoral condyle
restrain post. restrain post. Displacement Displacement
1. prevent Excessive knee extension 1. prevent Excessive knee extension
-: Role of ligaments :--: Role of ligaments :-
3. prevent ant. &post. Displacement of tibia med.&lat.3. prevent ant. &post. Displacement of tibia med.&lat. Rotation beneath the femur-both together called Rotation beneath the femur-both together called rotatery stabilization of tibiarotatery stabilization of tibia
2.Varus & valgus stresses at 2.Varus & valgus stresses at kneeknee
-: Iliotibial band :--: Iliotibial band :- Proximally fascia investing Proximally fascia investing TFL,TFL,
gluteus maximus &medius musclegluteus maximus &medius muscle Distally atteched intermuscular Distally atteched intermuscular
septum &inserted anterolateral septum &inserted anterolateral tibia tibia
Contraction of tfl &gluteus muscle Contraction of tfl &gluteus muscle attach to it band –produce attach to it band –produce minimal longitudinal excursion of minimal longitudinal excursion of band band
Fibrous connection of it band -Fibrous connection of it band -assisted assisted ACLACL------}checking ------}checking posterior femoral translation –full posterior femoral translation –full extension extension
Increase the stability of lat. Side Increase the stability of lat. Side of joint of joint
-: Bursae :--: Bursae :- Set up potential for substantial Set up potential for substantial
frictional among muscular,bony frictional among muscular,bony structure,structure,
numerous bursanumerous bursa
Three type Three type 1.Suprapatellar bursae1.Suprapatellar bursae 2.Subpopliteal “2.Subpopliteal “ 3.gastrocnemius “3.gastrocnemius “ Infrapatellar bursae….It Infrapatellar bursae….It
separated by synovial cavity of separated by synovial cavity of jt by infrapatellar fat padjt by infrapatellar fat pad
-: TIBIOFEMORAL JOINT -: TIBIOFEMORAL JOINT FUNCTION :-FUNCTION :-
JOINT KINEMATICSJOINT KINEMATICS
Flexion / ExtensionFlexion / Extension Medial / Lateral Medial / Lateral
RotationRotation Varus / ValgusVarus / Valgus Coupled MotionsCoupled Motions
-: MUSCLES :--: MUSCLES :-
Knee Flexor GroupKnee Flexor Group
SemimembranosusSemimembranosus SemitendinosusSemitendinosus Biceps Femoris (Long and short heads)Biceps Femoris (Long and short heads) SartoriusSartorius GracilisGracilis PopliteusPopliteus GastrocnemiusGastrocnemius
Knee Extensor GroupKnee Extensor Group
Quadriceps FemorisQuadriceps Femoris
Rectus FemorisRectus Femoris Vastus MedialisVastus Medialis Vastus IntermediusVastus Intermedius Vastus LateralisVastus Lateralis
-: STABILIZERS OF KNEE :--: STABILIZERS OF KNEE :-
A-P/hyperextension stabilizersA-P/hyperextension stabilizers
Varus / Valgus stabilizersVarus / Valgus stabilizers
Internal / External rotational Internal / External rotational stabilizersstabilizers
Largest sesamoid bone.
Its function is to increase leverage of quadriceps muscle.
Patella is triangular with apex directed downwards
Anterior surface of the patella is gently convex
The joint surfaces are not very congruent. Upper3/4th part of the posterior surface is articular
Articular surface has a convex medial facet and a concave lateral facet
-: Anatomy of the patella :-
Patellar articular surface area & joint congruency
In knee extension
At mid range of flexion
At 90 degree of flexion
Beyond 90 degree of flexion
-: Motions of patella :-
1.Patellar flexion
2.Patellar extension
3.Medial patellar tilt
4.Lateral patellar tilt
5.Medial rotation
6.Lateral rotation
7.Patellar translation
8.Patellar shift
-: Patellofemoral joint stress :-Patellofemoral joint reaction
force in1.Knee flexion
2.Knee extensionInfluence of amount of
knee flexion and contact surface between patella and femurJoint reaction forces in daily living activity
Patella as anatomical pulley
Contact forces in vertical position of patella
Frontal plane patellofemoral joint stability
1.Longitudinal stabilizers
2.Transverse stabilizers
Quadriceps inhibition
Asymmetry of patellofemoral stabilization
stabilizers
No bony stabilization
1.Longitudinal stabilizers
Quadriceps and patellar tendon ( patellotibial tendon )
2.Transverse stabilizers
Superior portion of extensior retinaculum
Vastus lateralis and medialis
Medial and lateral patellofemoral ligament
Trochlear dysplasia
Stabilizers
Quadriceps inhibition
Patellar tendon injury
Quadriceps atrophy
VMO weakness
Limiting motion of patella
Asymmetry of Asymmetry of patellofemoral stabilizationpatellofemoral stabilization
Q- angle
Defination
In male and female
Problem with Q-angle
Another abnormalities
-: Weight bearing versus Non-weight bearing exercises with Patellofemoral pain :-
Effects of injury and diseaseTibiofemoral joint injury
Patellofemoral joint injury
Injury to menisci
Injury to Ligament
Injury to Bone
Patellar dislocaltion
Causes of patellar dislocation