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Surgical Anatomy > Knee and leg > Flashcards

Knee and leg Flashcards

1
Q

Landmarks of tibial plateau

A

intercondylar eminence, intercondylar tubercles
Joint capsular attaches to margins to circumference of plateau except there popliteus ligament inserts
Facet on superolaterally aspect of tibia for head of fibula to articulate
Meniscus attach anterior and posterior to intercondylar tubercles

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2
Q

Landmarks on the shaft and attachment

A

Subcutaneous on anterior surface
Triangle in cross section
Surfaces: anterior , Lateral, Posterior
Borders: Interosseous border where interosseous membrane attaches from tibia to fibula
Anterior to membrane = extensor compartment or anterior compartment of leg
Posterior to membrane = flexor or posterior compartment of leg
Function of interosseous membrane
joints tibia to fibula
allows for muscle attachment
prevents pulling of the muscles inferiorly. Most muscles pulling fibula inferior except biceps femoris that pull it superiorly
Soleus line
Attachment of soleus muscle
superiorly is attachment of popliteus muscle
Inferiorly = attachement of flexor digitorum longus and nutrient foramen

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3
Q

Describe the fibula

A 
Head, neck, shaft 
3 Surface
anterior = extensor muscle
Lateral
Posterior = flexor muscle
Borders
interosseous border
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4
Q

Describe the Tibiofibular joints

A

Superior tibiofibular joint = synovial joint +/- connect to knee joint
Distal tibiofibular joint = fibrous joint, ligament to bind this joint both tibofibula ligament and interosseous ligaments (most important)
Plantiflexion and particularly Dorsiflexion creates slight movement at these joints (apart) because the Talus is bigger anterior then it is posterior

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5
Q

Describe the calcaneous and its attachments

A

Articulates
anterior = cuboid
superior = Talus
Medial
- sustentaculum tali
- tendon of flexer hallaux longus passing inferiorly to this in a groove
- Spring (plantar calcaneonavicular) and deltoid ligament attach here
Lateral
- Trochlear: Fibularis brevis passes Superior , Fibularis longus passes Inferior?
Inferior
- Medial and lateral tubercule
- Function: weight bearing (medial tubercle and is larger) and muscle attachment and attachment of plantar aponeurosis and long plantar ligament.
Posterior
- Achillus (calaneal) tendon attaches superiorly to tuberosity
- Planter aponeurosis

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6
Q

Describe the Talus and it’s attachments

A

Head - rounded and anteromedially directed.
articulates with the Navicular forming the wall of the talocalcanonavicular joint
Neck
Body - transfer weight to calcaneous and fore foot (via osseoligamentous hammock)
Superior surface = trochlea (convex and articulates with tibia and fibula and concave on side)
Wider anterior then posterior therefore more stable in dorsiflexion
Posterior process
groove for tendon of the flexor hallucis longus
Medial tubercule attachment of deltoid ligament
Lateral tubercle attachment of talofibular ligament
Only bone with no muscular or ligamentous attachment

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7
Q

Describe the cuboid and its attachments

A

articulates
anteriorly with 4 and 5th metatarsal
Posteriorly with calcaneous
Medially with navicular and lateral cuneiform
lateral and inferior surface = groove for tendon of fibulas longus muscle
Tuberosity of cuboid

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8
Q

Describe the Navicular

A

Articulates
Anterior with medial, intermittent, lateral cuneiform. Convex
Lateral with cuboid
Posterior to Talus (concave)
Inferior surface = spring ligament from navicular to calcaneous
Surfaces
Medial surface = projects inferiorly to form navicular tuberosity which attachment of tibialis posterior muscle

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9
Q

Describe the articulation of the metatarsals

A

1st - largest and important is thrust and propulsion in gait cycle
2rd - articulate with all three cuneiform bones. Almost wedged between the medial and lateral.

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10
Q

Extra articular ligaments of knee

A

Patella ligament
Patella retinaculae
Fibrous extension from quad tendon and patella ligament that insert to the medial and lateral tibial condylar margin
Fibular colateral ligament
Lateral epicondylar to head of fibular
Separated from meniscus by popliteal ligament and lateral genicular vessels
Short round and cord like
Tibial colateral Ligament
Superior part: epicondylar of femor to anteriomedial aspect of tibia. wide and flat. ~12cm long. anterior has free border but posterior is attached to medial meniscus
Deep part: short and is thickening of capsular
Between collateral and bone is bursa and genicular arteries
Oblique popliteal ligament
thick round band that is an extension of the semi membraneous tendon
Joins the capsular above lateral condylar of femur

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11
Q

Intracapsular ligament of knee

A

Cruciate ligaments
Transverse ligament
Menisco femoral ligament
Menisci

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12
Q

Describe the cruciate ligament

A

anterior -
attached anterior on the surface of the tibial plateau then extending superior posterior and laterally to attach to the lateral condylar on femur in the intercondylar notch
Prevention anterior dislocation of the knee and hyper extension
Posterior
Attaches on the posterior surface of tibial plateau then continues superior anterior and medially to attach to the medial condylar on the intercondylar notch.
prevents posterior dislocation of knee and only stabiliser in the flexed knee position.
Inside the capsular but outside of the synovial membrane

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13
Q

Describe the transverse ligament

A

attached anterior horn of medial and lateral meniscus. Not always present

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14
Q

Menisco femoral ligament

A

Anterior and posterior. Attaches anterior and posterior to the posterior cruciate ligament.

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15
Q

Describe the Menisci

A

C shape cartilage disc of fibrocartilage. Triangle in shape. Thick is vascular and thin is avascular.
Provides stability and spread synovial fluid, and shock absorbers.

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16
Q

Describe the medial menisci

A

Medical is larger. more comma shaped with thin bit anterior.
poster horn attaches anterior to posterior Cruciate ligament
anterior horn attaches anterior to anterior cruciate ligament in the intercondylar area
Medial aspect is attached to medial collateral ligament

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17
Q

Describe the lateral menisci

A

C shaped and smaller
anterior and posterior horns are attached immediately anterior and posterior to intercondylar eminence.
Not attached to collateral ligament as tendon and bursa of popliteus passing between them.
Lateral meniscus attaches to popliteus tendon causing lateral meniscus to be move out of the way in flexion of the knee.
Attached to the Femur by the meniscofemural ligaments.

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18
Q

Popliteus

A

O - Lateral epicondylar of femur and lateral meniscus, some into the articulate popliteal ligament
Pathway: Outside of synovial membrane. Inferiorly and medially
I - Popliteal surface of tibia, superior to solar line
N - Tibial n (L4,L5 and S1)
A - Weakly flexes knee and unlocks it by rotating femur 5 degree on fixed tibia, medially rates tibia of unplanted leg

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19
Q

Describe the Bursa

A

Suprapatellar Bursa
Semi membranosus bursa
Gastrocnemius
Anserinus bursa

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20
Q

Describe the action of the knee

A

Flexion
ROM: 150 degree
Limiting: muscles of thigh and leg region
Muscles
Extension
Complex due to locking mechanism.
Limited by
anterior cruciate ligament - first. T
Oblique popliteal ligament
Colateral ligament
Description
Anterior cruciate ligament is first to limit movement by terminating the lateral condylar extension but the medial condylar continues to extend the knee joint
Medial rotation of femur on tibia tighten the oblique popliteal ligament and colaterals = locking the knee in slight hyperextension.
Further extension is limited by anterior cruciate ligament and further rotation is limited by the oblique and collaterals.
Unlock = contraction of popliteus to laterally rotate the femur on the tibia prior to flexion
Muscles
Primary is Quadriceps femoris
Weakly - tensor fascia lata
Pathology
Menicus tears due to the rotational movements on knee and medial meniscus is 20 times more likely to tear as it is not pulled out of the way like popliteus.

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21
Q

Arteries of the popliteal area

A 
Popliteal a. - descends as deepest structure
Branches
Genicular a
2 superior - medial and lateral
Middle - medial
Inferior - medial and lateral
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22
Q

Nerves of the popliteal region

A 
Femural nerve > vasta medialis 
Tibial genicular branch
cruciate ligament
medial colateral ligament
medial capsular
Common fibula nerve 
superior and inferior genicular n
lateral capsular
Recurrent genicular n
superior tibofibula knee joint
lateral knee joint
posterior division of obturator n
medial knee join
23
Q

Cutaneous nerve of Anterior thigh

A

Lateral proximal 1/3 leg = lateral cutaneous breach of subcostal
Lateral middle 1/3 of thigh = Lateral cutaneous nerve of thigh
Anterior middle on proximal below inguinal ligament = gentifemoral nerve
Anterior thigh distal 2/3 = Anterior cutaneous branches of femoral nerve
Medial proximal area = cutaneous branch of obturator nerve and ilioinguinal nerve

24
Q

Describe the veins of lower leg

A

Doral venous arch which drains the digital veins. Continues laterally crossing the sural n. Behind the lateral malleolus and up to form the small saphenous vein travelling up the mid line of posterior leg and drains into the popliteal vein at the popliteal fossa
Doral venous arch continues to great saphenous that travels up the medial leg to the groin and perforated the cribriform fascia to drain into the femoral vein. Perforating veins drain the superficial veins to deep veins along the full length of the great saphenous.

25
Q

Describe the fascia of leg

A

Crural fascia: surrounds the leg and inter muscular septum separates compartment into anterior, lateral and posterior compartments including dividing posterior into superior and deep (transverse fascia)
Attache to posterior and anterior tibia
Thickens to form reticule

26
Q

Borders of the anterior compartment

A

Interosseous membrane
Tibia
Crural inter muscular septum and crural fascia

27
Q

Contents of anterior compartments

A

Tibialis anterior
Extensor Hallux Longus
Extensor digital longus
Fibularis tertius

28
Q

Describe Tibialis anterior

A

O - Tibia and interosseous membrane
I - tendon passing superior reticulum then it is covered by synovial sheath as it continues under the inferior reticulum to insert at medial aspect to the foot
A - Dorsiflexion and inversion

29
Q

Describe Extensor Hallux longus

A

O - Fibula and interosseous membrane
I - Proximal phalange of great toe
A - extends great toe, minor action to dorsiflex ankle

30
Q

Describe Extensor digital longus

A

O - fibula and interosseous membrane
I - Digits. Tendons divid into 3 slips.
central = base middle phalange
lateral 2 will reunite and insert into base of distal phalange
A - extension of toes and minor dorsiflexion of ankle
Pathway - deep to the reticulum in a synovial sheath with fibulas tertius tendon

31
Q

Describe Fibularis tertius

A

O- Fibular
I - Tendenous from the extensor reticulum then inserts at base of 5th metatarsal
A- inversion and dorsiflexion

32
Q

Describe the extensor reticulum

A

Held down by the extensor reticulum both superior and inferior
Superior: proximal to ankle
Inferior is y shaped. origin is calcaneous and inserts on medial malleolus and plantar aponeurosis. inferior to ankle join
Prevents bow stringing of tendons

33
Q

Nerve and arterial supply of anterior compartment

A

nerve: Deep fibular nerve
Arteries: anterior tibial a
2 anterior tibial vein

34
Q

Contents of posterior leg compartment

A 
Superior 
- Gastrocenmius
- Soleus
- Plantarus
Deep
- Posterior tibial a
- Tibial N
- Popliteus muscle
- Flexor digitorum longus muscle
- Tibialis posterior muscle
- Flexor Hallucis longus muscle
Insert = achilli tendon to calcareous
A - Plantiflexion
35
Q

Describe the gastrocenmius

A

O- Medial and lateral head. Lateral and medial condylar of femur
Important in rapid movement eg take off in race
Burse under both heads. Medial bursa continuous with joint, lateral may not

36
Q

Describe the soleus

A

O - Fibrous arch. Fibula at proximal fibular tiba joint and Tibia at solus line.
multipenate muscle. Powerful but slow
Fibrous arch. Allows popliteal a. v. and tibial n pass through
Fibrous aponeurosis on superior and deep surface
Pump = Squeezes blood from perforating veins to deep veins.

37
Q

Describe plantarus

A

O - Lateral condylar

Runs on medial side. Degenerating. small action. Can be used as a grafted.

38
Q

Vessels of the posterior compartment

A

A - posterior tibial a
N - tibial n
All pass posterior to the medial malleolus and deep to the flexor reticulum through the tarts tunnel.
Flexor reticulum from medial malleolus to calcareous. passes over all structures

39
Q

Describe Popliteus muscle

A

O- Lateral condylar of femur and lateral meniscus
I - proximal tibia above soleus line
A - Flexes and rotates leg medially to unlock extended knee, with tibia fixed rotates thigh laterally.

40
Q

Describe Flexor digitorum longus muscle

A

O- Extensive from posterior tibia
I - Inserts to distal phalanges of toes 2-5
A - Plantar flexes and inverts foot, flexes toes, helps foot “grip ground”. Helps maintain arch of foot. minor plantar flexes
Most medial muscle
Path- crosses the other muscle tendons. Medial 2 tendons receive inserts from Flexor hallucus longs to assist with take off.

41
Q

Describe Tibialis Posterior muscle

A

O - Extensive origins from superior tibia and fibula and interosseous membrane, aponeuro of flexor digitoxin longs
I - several tarsal and metatarsal 2-4. navicular tubiosity.
Prime mover of foot inversion, planter flexes foo, stabilises medial longitudinal arch of foot.

42
Q

Describe the Flexor Hallucis longus

A

Most lateral
O- mid shaft of fibular and aponeurosis of flexor digitoxin longus
Pathway - deep to flexor reticulum then via the flexor halucis longs groove in talar shelf
I - distal phalanx of great toe
A - Plantar flexes and invests foot, flexes great toe at all joints, push off during walking, Help maintain long arch of foot

43
Q

describe the contents passing behind the medial malleolus

A 
Roof is flexor reticulum
Tom, Dick and very nervous harry
antioer to posterior
Tibialis posterior
Flexor digitorum longus 
Posterior tibial a
Tibial N
Flexor Hallucis longus
44
Q

Borders of the lateral compartment of the leg

A

Fibula
Anterior and posterior intramuscular septum
Crura fascia

45
Q

Contents of lateral compartment of leg

A

Superficial fibula nerve
Fibularis longus
Fibular brevis

46
Q

Describe Fibularis longus

A

O- Upper portion of lateral fibula (2/3) and inter muscular septum
I - long tendon that curves under foot to first metatarsal and medial cuneiform
A - Plantar flexes and everts foot. may help keep foot flat on ground
Travels posterior to lateral malleolus and then is separated by the Fibular trochlear on the calcaneous from the fibular brevis. Longus lays inferior. Tender passes through the groove on the inferior lateral aspect of the cuboid bone. Then crosses the foot to insert as above.
Maintains the lateral longitudinal and transverse arches of the foot.

47
Q

Describe the fibular brevis

A

O- distal fibular shaft (2/3)
I - by tendon running behind lateral malleolus to insert on proximal end of fifth metatarsal
A - Plantar flexes and everts foot

48
Q

Describe the tibial division of sciatic nerve

A

through the popliteal fossa and then passes deep to the soleus arch. Mid line.
Passes between the deep and superficial compartments of posterior leg.
Supplies both superficial and deep compartments of posterior leg
Passes posterior to medial malleolus where it divides into
Medial plantar nerve
Lateral plantar nerve

49
Q

Describe the common fibular nerve of the sciatic nerve

A

Inferior margin of gastroconemis to wrap around the neck of the fibula and enters the fibularis longus muscle where it divides into
Superficial fibular nerve
Comes out the fibular longus on anterior intramuscular septum and supplies lateral compartment muscles.
Branch into medial and lateral branches that supply all of the dorsal of the foot except for the area innervated by the deep fibular nerve. except for lateral and medial foot
deep fibular nerve
Comes out of the fibular longus muscle and passing to the interoessus membrane. Lays between extensor digitorium longus and tibialis anterior muscles and descend while suppling all of the anterior compartment.
Passing lateral to dorsalis pedis and piece the deep fascia to surface and supple the skin between the 1 and 2rd digit

50
Q

Describe the branches of popliteal artery

A

Leaves popliteal fossa passing deep to heads of gastrocnemius passing deep under the arch of soleus muscle then branches into anterior tibial artery, posterior tibial artery and fibular artery

51
Q

Describe the anterior tibial artery

A

Passing above the intereossus membrane to enter anterior compartment = supplies muscles here
Recurrent branch = form an anastomosis around proximal tibia
Malleoli branch
at the superior extensor reticulum it changes it’s name to dorsalis pedis

52
Q

Describe the posterior tibial artery

A

Through the fibrous tunnel of soleus.
Gives rise to nutrient artery of tibia. * largest nutrient artery in the body.
passing between deep and superior compartment then travels down behind the medial
Divides in medial and lateral arteries just above the biafication of the tibial nerve
supplies the sole of foot

53
Q

Describe the fibular artery

A

Supplies the tibialis posterior then wraps around the femur neck to give rise to a nutrient artery.
Supplies fibulas longus and breve
Ends by branching in to the following
lateral calcaneal branch
Perforating branch that perforates the interosseous? enters anterior compartment
It’s a branch of posterior tibial artery.

54
Q

Describe the veins of lower leg

A

Veins
Travel with arteries
venae comitantes
unite deeply to form popliteal vein

Surgical Anatomy (10 decks)

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