Knee Anatomy Flashcards by Ronit Hardasani

What happens to the Linea Aspera in distal femur

Medially-> Medial Supracondylar Line-> Ends at Adductor Tubercle
Laterally-> Lateral Supracondylar line-> Ends at Lateral Femoral Condyle

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Which femoral condyle is more pronounced, why is this
Which is larger
What is the trochlear (Patellofemoral) groove

More pronounced- Lateral Femoral Condyle (Prevents lateral displacement of patella)
Larger- Medial Femoral Condyle

A depression on anterior surface, between the femoral condyles, that articulates between the patella

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Identify 3 functions of the patella

Acts as a fulcrum, enhancing the leverage exerted on the femur by the quadriceps tendon
Protection of anterior knee
Reduces frictional force between Quad. Tendon and femoral condyles during extension

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What is attached at the Lateral/ Interosseus border

What is its function

Interosseus membrane binds tibia and fibula together

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What is the main function of the fibula?

What are its 3 main articulations

Act as an attachment for muscles

Proximal tibiofibular joint: With lateral tibial condyle
Distal tibiofibular joint: With Fibular notch of tibia
Ankle joint: With talus bone of foot

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Why is the common Fibular nerve at risk of damage during a Proximal Fibular Fracture

Is the lateral or medial malleosus more prominent

The nerve winds around the posterior and lateral surface of the neck

Lateral

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What are the 2 articulations in the knee joint

Tibiofemoral: Medial and lateral condyles of tibia and femur articulate

Patellofemoral: Patella articulates with femur at the trochlear groove

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What supplies the blood to the knee joint

What branches are these supplied by

Knee joint supplied by genicular anastomoses, which are supplied by genicular branches of the femoral and popliteal arteries

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Identify 2 functions of the medial and lateral meniscus

Where is the blood supply to the menisci, how does this change with age and affect the healing when in adulthood

Deepen the Articular surface of tibia, increasing joint stability

Act as shock absorbers by increasing surface area

Blood flow is to meniscus periphery, decreases with age, so impaired healing in adulthood as it is avascular

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Why is the medial meniscus more commonly injured than the lateral meniscus

What is the Posterior Meniscofemoral Ligament attached to, what is its function

Attached peripherally to the Medial Collateral Ligament, so is less mobile

It attaches the lateral meniscus to the Posterior surface of the Medial Femoral Condyle, to stabilise the posterior horn of the Lateral Meniscus

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What are the 3 categories of ligaments in kne joint

Intracapsular: Cruciate ligaments

Extracapsular: Collateral + Patellar ligaments

Ligaments that strengthen the capsule: Oblique Popliteal

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Describe the attachments of the Anterior Cruciate Ligament

What is its 2 functions

ACL: From Medical Meniscus AND Anterior Interchondylar Area of Tibia to Posterior of Lateral Femoral Condyle

Resists anterior dislocation of the tibia relative to femur
Resists medial rotation of the tibia relative to the femur

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Describe the attachments of the Posterior Cruciate Ligament

What is its function

PCL: Posterior Interchondylar Area of Tibia to Medial Femoral Condyle

Resists posterior dislocation of tibia

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Describe the attachments of the Oblique Popliteal Ligament

What muscle is it a continuation of

Where does the patellar ligament insert

Medial Tibial Condyle to Lateral Femoral Condyle
Semimembranosus

Tibial Tuberosity

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Describe the attachments of the Medial (Tibial) Collateral Ligament

What is its function

Medial Femoral Epicondyle to Medial Tibial Condyle + Medial Meniscus

Resists valgus angulation of tibia, relative to femur

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Describe the attachments of the Lateral (Fibular) Collateral Ligament

What is its function

Lateral Femoral Epicondyle to a Depression on The Lateral Surface of the Fibula Head

Reinforced by IT tract

Resists varus angulation of tibia, relative to femur

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What is the purpose of a bursa

To reduce friction between bones and soft tissue (Muscles/ tendons) surrounding it

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Name the 6 Bursae found at knee joint and their locations

Suprapatellar Bursa: Between Quadriceps Femoris and Femur

Prepatellar Bursa: Between patella and skin

Subcutaneous Infrapatellar Bursa: Between Patellar ligament and skin

Deep Infrapatelar Bursa: Between tibia and patellar ligament

Semimembranosus Bursa: Between Semimembranosus muscle and medial head of gastrocnemius (behind knee joint)

Subsartorial Bursa: Between medial tibial condyle and common insertion of pes anserinus tendons

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Name 2 factors that resist lateral patellar displacement during knee extension

trochlear groove, which has more prominent lateral femoral condyle
Contraction of VMO fibres (Insert more distally and horizontally into patella than Vastus Lateralis)

VMO= Vastus Medialis Obliquus

Name the muscles in anterior compartment of the thigh (Knee extensors)

The branches of which artery supply this compartment? What are the branches called

Quadriceps Femoris
Iliopsoas (Iliacus + Psoas Major)
Pectineus
Sartorius

Profounda Femoris + Medial, Lateral Femoral Circumflex Arteries are branches of the Femoral Artery

Describe the origin and insertion of Iliopsoas

Psoas Major Origin: Transverse processes of T12-L5
Iliacus Origin: Iliac fossa

Iliopsoas Insertion: Lesser Trochanter

Identify the action of Iliopsoas, and its innervations

Action: Hip Flexion + Lateral rotation

Iliacus innervation: L1-L3
Psoas Major innovation: Femoral nerve

What are the muscles in Quadriceps Femoris

Describe their insertion and innervation

Rectus Femoris
Vastus Medialis/ Lateralis/ Intermedius

The 4 combine and insert onto patella base as the Quadriceps Tendon.

All innervated by femoral nerve

Identify the origin of Vastus Lateralis

What is its action

Greater trochanter and lateral lip of linea aspera

Extends knee joint and stabilises knee joint

Identify the origin of Vastus Intermedius | What is its action

Anterior and lateral surfaces of femoral shaft | Extends knee joint and stabilises patella

Identify the origin of Vastus Medialis | What is its action

Intertrochanteric line and medial lip of linea aspera Extends knee joint + Stabilises patella (VMO fibre contraction resists lateral patella displacement)

Identify the origin of Rectus Femoris | What is its action

Originates as 2 tendons Anterior tendon origin: Anterior inferior iliac spine Posterior tendon origin: Groove above acetabulum rim Knee extension + hip Flexion (Only quad muscle to cross both hip and knee joints)

Where does Sartorius originate and insert | What is its action

Origin: Anterior superior iliac spine Insertion: Medial aspect of proximal tibia (part of pes anserinus) Flexion, abduction and lateral rotation at hip joint Flexion and medial rotation at knee joint

Where does Pectineus originate and insert What is its action What is its innervation

Origin: Pectineal line on anterior surface of superior pubic ramus Insertion: Pectineal line on femur Adduction and Flexion at hip joint Innervation: Femoral nerve, may receive branch from Obturator

Name the muscles in the medial thigh compartment (Adductors) What nerve innervates, what artery supplies blood

Gracilis Obturator externus Adductor Brevis/ Longus/ Magnus Obturator nerve and Obturator artery

What are the 2 components of adductor Magnus State their origins and insertions What is the adductor hiatus

Hamstring; Origin: Ischial Tuberosity Insertion: Adductor Tubercle and Medial Supracondylar Line Adductor; Origin: Inferior pubic ramus and Ischium Insertion: Linea Aspera A gap that separates the 2 components of Adductor Magnus

What are the actions of the components of Adductor Magnus Identify their innervations

Hamstring: Adduction, Hip extension Adductor: Adduction, Hip Flexion Hamstring: Tibial nerve Adductor: Obturator nerve

State the origin and insertion of adductor longus

Origin: Pubic body Insertion: Middle third of linea aspera Action: Adduction

State the origin and insertion of adductor Brevis | State it’s action

Origin: Pubic body and inferior pubic ramus Insertion: Linea aspera, proximal to adductor longus Action: Adduction

State the origin and insertion of Gracilis | State it’s action

Origin: Pubic body and inferior pubic ramus Insertion: Medial aspect of proximal tibia, (between tendons of sartorius and semitendinosus as part of Pes Anserinus) Action: Adduction and knee Flexion

State the origin and insertion of Obturator Externus | State it’s action

Origin: External surface of Obturator membrane Insertion: Posterior greater trochanter Action: Adduction and lateral rotation

What are the 3 borders of the Femoral Triangle and what are they formed by

Superior border: Formed by inguinal ligament (ASIS to Pubic Tuberosity) Lateral Border: Medial border of sartorius muscle Medial Border: Adductor Longus

What compose the femoral triangle’s roof and base | Which lies anteriorly

Roof: Formed by fascia lata (Lies anteriorly) Base: Formed by Pectineus, Adductor Longus, Iliopsoas

Name 4 contents of the Femoral Triangle from lateral to medial

NAVEL ``` Femoral nerve Femoral artery Femoral vein Empty space Lymphatics ``` Last 2 are both in canal

What structures are in the Femoral Sheath

Artery Vein Canal

How can you locate the artery in the femoral triangle What is the Mid-point of the Inguinal Ligament

Use MIPA: Mid-Inguinal Point= Artery Mid-Inguinal Point is midway between ASIS and Pubis Symphisis Midpoint between ASIS and Pubic Tuberosity

What are the 4 borders of the femoral canal

Medial border: Lacunar ligament Lateral border: femoral vein Anterior border: inguinal ligament Posterior border: Pectineal ligament and superior pubic ramus

What is the femoral ring What is its closed by What is the purpose of empty space in the femoral canal

The opening to the femoral canal at superior border Closed by a CT layer- Femoral Septum Empty space allows distension of femoral vein

What is the adductor canal | What are the borders of the canal

A passageway from apex of femoral triangle to adductor hiatus Anterior: Sartorius Lateral: Vastus Medialis Posterior: Adductor longus and Magnus

What do you call the femoral artery/ vein as it passes through the adductor canal

Popliteal

Outline the femoral nerve pathway to thigh

1. Descends from lumbar plexus, passes through Psoas Major and exits the muscle through lateral border 2. Passes behind fascia iliaca to the Mid-Point of the Inguinal Ligament 3. Passes behind the inguinal ligament into thigh, splits into anterior and posterior

After entering thigh, outline how the femoral nerve innervates the anteriomedial thigh and leg/ foot

1. Passes through femoral triangle splits into Saphenous nerve (Terminal Cutaneous branch) and Anterior cutaneous branch 2. Anterior branches supply the anteriomedial thigh 3. Saphenous nerve goes through adductor canal to supply medial leg and foot