Anatomy of the Hip and Knee Flashcards
what increases the depth of the acetabulum?
fibrocartilaginous acetabular labrum and the transverse acetabular ligament
what part of the head of the femur is not covered in articular cartilage and why?
fovea
ligament of the head of the femur
name the 3 ligmaments in the hip capsule
iliofemoral
pubofemoral
ischiofemoral
describe the iliofemoral ligament
y shaped
prevents hyperextension
describe the pubofemoral ligament
prevents overabduction
describe the ischiofemoral ligament
from the ischial part of the acetabular rim to the neck of the femur
flexors of the hip
• Iliopsoas (Chief flexor of the hip joint Others Flexors: • Sartorius • Tensor fasciae latae • Rectus femoris • Pectineus • Adductor longus, brevis and magnus (anterior part) • Gracillis
hip extensors
• Gluteus maximus • Hamstrings : 1)Semitendinosus, 2) Semimembranosus 3) Biceps femoris – Long head • Adductor magnus- posterior part
hip adductors
- Pectineus
- Adductor longus
- Adductor brevis
- Adductor magnus
- Obturator externus
- Gracillis
hip abductors and medial rotators
• Gluteus medius
• Gluteus minimus
• Tensor fasciae
latae
hip lateral rotators
• Obturator internus & externus • Piriformis • Gluteus maximus • Gemelli • Quadratus femoris
blood and nerve supple of the hip joint
• Medial and lateral circumflex arteries – Branches of profunda femoris artery • Artery to head of femur – branch of the obturator artery • Nerve supply: Femoral, obturator and superior gluteal nerve
name the 5 capsular ligaments of the knee
- Patellar ligament
- Fibular or lateral collateral
ligament (FCL) - Tibial or medial collateral
ligament (TCL) - Oblique popliteal ligament
-Expansion of
semimembranosus tendon - Arcuate popliteal ligament
how many bursae surround the knee? how many communicate with the joint cavity?
12
4
name the 4 communicating bursae of the knee
1) Suprapatellar bursa
2) Popliteal bursa
3) Anserine bursa
4) Gastrocnemius bursa
describe the medial collateral ligament of the knee
- Extends from the medial epicondyle of the femur to medial condyle and medial surface of the tibia
- Deep fibres of the MCL are firmly attached to the medial meniscus
describe the lateral collateral ligament of the knee
- Extends from lateral epicondyle of femur to head of fibula
* Tendon of popliteus passes deep to the LCL
what are the intra-articular structures within the knee?
cruciate ligaments
menisci
describe the ACL
- Weaker of the two
- Poor blood supply
- Limits posterior rolling of femoral condyles on the tibia
- Prevents posterior displacement of the femur on the tibia and hyperextension of knee
describe the PCL
- Stronger of the two
- Limits anterior rolling of the femur on the tibia
- Prevents hyperflexion of the knee
what are the functions of the fibrocartilage menisci?
deepen the surface
shock absorption
proprioception
stability
describe the medical mensicus
C – shaped, broader posteriorly, and adheres to the deep surface of MCL
describe the lateral mensicus
Smaller and more freely movable than medial meniscus. Tendon of the popliteus separates it from the PCL
how does the knee lock and unlock?
• Locking (medial rotation of femur on the tibia) and unlocking (lateral rotation
of femur on the tibia) of knee
• Popliteus muscle unlocks the knee (initial flexion)
knee flexors
1) Hamstrings
2) Sartorius
3) Gracillis
4) Gastrocnemius
5) Popliteus
knee extensors
quadriceps femoris
what stabilises the hip?
• Static – Bony morphology • Congruence • Anteversion of ball and socket – Labrum – -ve intra-articular pressure • Dynamic – Musculature(never truly NWB-ing)
origin, insertion, innervation: iliopsoas
illiac blade/l-spine
lesser trochaneter
L1 ventral ramus/fem n
origin, insertion, innervation: rectus femoris
AISS/supra-acetabular tubercle
patella
femoral
origin, insertion, innervation: sartorius
ASIS
pes anserinus
femoral
origin, insertion, innervation: pectineus
pectineal line of pubis
pectineal line of femur
femoral
origin, insertion, innervation: glut max
illium, dorsal sacrum
ITB, glut tuberosity
inf glut
origin, insertion, innervation: semitinosus
ischial tuberosity
pes anserinus
sciatic
origin, insertion, innervation: semimembranosus
ischial tuberosity
pes anserinus
sciatic
origin, insertion, innervation: biceps femoris
ischial tuberosity
fibula/lateral tibia
sciatic
origin, insertion, innervation: glut med
illium
GT
sup glut
origin, insertion, innervation: glut min
ilium
GT
sup glut
origin, insertion, innervation: tensor fascia latae
iliac crest
Gerdy’s tubercle/ITB
sup glut
origin, insertion, innervation: adductor lognus
pubis
linea aspera
obturator
origin, insertion, innervation: adductor brevis
inf pubic ramus
pectineal line, linea aspera
obturator
origin, insertion, innervation: adductor magnus
pubic ramus, ischial tub
adductor tubercle
obturator/sciatic
origin, insertion, innervation: gracilis
body and inf pubic ramus
pes anserinus
obturator
origin, insertion, innervation: piriformis
ant sacrum
sup greater troch
n to piriformis
origin, insertion, innervation: sup gemellus
ischial spine
med GT
n to ob int
origin, insertion, innervation: inf gemellus
ischial spine
medial GT
to ob int
origin, insertion, innervation: obturator internus
obturator membrane
med GT
n to ob int
origin, insertion, innervation: obturator externus
obturator membrane
med GT
obturator
origin, insertion, innervation: quadratus femoris
ischia tub
intertrochanteric crest
n to quad fem
describe shenton’s line
formed by medial edge of the femoral neck and inferior edge of sup pubic ramis
loss = #NOF
blood supply to femoral head
- Capsule via Medial and Lateral Fem. Circumflex
- Intramedullary
- Ligamentum Teres via acetabular branch of Obturator Artery
management of intracapsular fracture of femur
• Blood supply compromised • Management based on age of patient, and displacement – Undisplaced-Fix – Displaced and Young – Fix – Displaced and Old – Replace (either hemiarthroplasty or THR)
origin, insertion, innervation: rectus femoris
ALLS/sup acetabular rim
tibial tuberosity
femoral
origin, insertion, innervation: vastus medialis
intertroch line/medial linea aspera
tib tuberosity
femoral
origin, insertion, innervation: vastus lateralis
GT, lat linea aspera
tib tub
fem
origin, insertion, innervation: vastus intermedialis
prox femoral shaft
tib tub
fem
origin, insertion, innervation: biceps femoris
ischial tub/linea aspera
fibula head/lat tibia
sciatic
origin, insertion, innervation: semimembranosus
ischial tuberosity
pes anserinus
sciatic
origin, insertion, innervation: semitendinosus
ischial tub
pes anserinus
sciatic
origin, insertion, innervation: gastrocenemius
med and lat femoral condyles
os calcis vis achilles
S1
describe ACL injuries
• Knee buckles during pivot • Unable to play on • Immediate haemarthrosis • Recurrent instability • X-ray – Haemarthrosis – Segond fracture
what does the femoral nerve supply? generally
anterior
knee extension
what does the obturator nerve supply? generally
medial
hip adduction
what does the sciatic nerve supply? generally
posterior
hip extension, rotation,
knee flexion
what does the sup glut nerve supply? generally
posterior
hip abduction, extension
classic hip dislocation
posteriorly
short
internally rotated
blood supple to head of femur
• Ligamentum Teres • Retinacular vessels • The Trochanteric anastomosis • Capsular attachment
