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Anatomy - Lower limb > L12: Bones, ligaments and joints of leg (incl. knee and ankle) > Flashcards

L12: Bones, ligaments and joints of leg (incl. knee and ankle) Flashcards

1
Q

Patella - Knee cap

A
  • largest sesamoid bone of the body
  • suspended in the main extensor tendon of the knee
  • The deep surface of the patella forms part of the knee joint. [deep surface is smooth, lined with hyaline cartilage, and articulates with patellar surface of distal femur.]
    [superficial surface is rough, tendon inserts there]
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2
Q

tibia and fibula

A

tibia: articulates with: condyles of femur (posteriorly) and talus (inferiorly)

fibula: muscle attachment, and stability of ankle joint

connected by interosseous membrane

tibiofibular joint proximal and distal

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3
Q

Tibia ; articulation

A
  • weight bearing (shin) bone
  • second largest bone in body
  • Articulation:
    • knee joint
    • proximal tibiofibular joint
    • distal tibiofibular joint
    • medial malleolus of ankle joint
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4
Q

Tibia - bony landmarks - proximal

A
  • medial and lateral condyles
  • medial and lateral tibial plateau - articular surface
  • lateral condyles
    • the anteriolateral tibial tubercle (gerdys tubercle) attachment of illiotibial and fascia of lateral thigh
    • fibular articular facet on lateral condyle
  • Intercondylar eminence
    • medial and lateral intercondylar tubercles - fit into intercondylar fossa between femoral condyles
    • intercondylar areas (anterior and posterior
    • attachment sites for menisci and knee ligaments
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5
Q

Tibia - bony landmarks - anterior

A
  • shaft of tibia: triangular cross-section
  • surfaces: medial, lateral/interosseous, posterior
  • Shin: anterior border of medial surface
  • tibial tuberosity: distal attachment for patellar ligament
  • interosseous border: attachment of interosseous membrane
  • fibular notch: fibrous attachment at distal tibiofibular joint
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6
Q

Tibia - bony landmarks - posterior

A
  • soleal (popliteal) line: diagonal ridge runs inferomedially to the medial border, for soleus tendon
  • nutrient foramen: main artery supplying proximal end of bone and marrow
  • medial malleoulus: extends inferior to shaft
  • lateral surface of medial malleolus and inferior shaft articulate with talus
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7
Q

Fibula

A
  • slender non-weight bearing bone
  • the fibuLA is LAteral to the tibia
  • site for muscle attachment
    • 1 muscle insertion
    • 8 muscle origin
  • Articulation:
    -Proximal tibiofibular joint
    *Distal tibiofibular joint
    *Forms lateral malleolus of the ankle
    *Does NOT articulate with femur at knee joint
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8
Q

Fibula - bony landmarks - Proximal

A

-Enlarged head superior to small neck
-Common fibular nerve wraps around neck
-Head has pointed apexand articulates with fibular facet on lateral tibial condyle

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9
Q

Fibula - bony landmarks - distal

A
  • Enlarged
  • Lateral elongation to form lateral malleolus of ankle joint
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10
Q

Fibula - bony landmark - shaft

A

*Twisted and marked by sites of muscle attachment
*Triangular cross section
*Borders: anterior, interosseous, posterior
*Surfaces: medial, posterior, lateral

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11
Q

Palpable landmarks of tibia and fibula - surface anatomy

A
  • Palpable landmarks
  • Tibial tuberosity
  • Anteromedial surface of the tibia
  • Tibial condyles
  • Head of fibula
  • Neck of fibula (note common fibular nerve passing)
  • Medial malleolus
  • Lateral malleolus
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12
Q

Tibiofibular joints

A

Proximal tibiofibular joint
Distal tibiofibular joint

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13
Q

interosseous membrane

A

joins shafts of tibia and fibula

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14
Q

Oblique fibre direction of ligaments and membrane

A
  • fibres extend inferolaterally from tibia toward fibula
  • allow upward movement of fibula during dorsiflexion when wide end of trochlea of the talus is wedged between the malleoli
  • resist downward pull due to 8 muscle origins
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15
Q

Proximal tibiofibular joint; articulation

A

Plane synovial joint
articulation: head of fibula and fibular articular facet on lateral condyle of tibia

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16
Q

Proximal tibiofibular joint; ligaments + movement

A
  • anterior and posterior ligaments of the fibular head

Movement:
slight movement during dorsiflexion of foot due to wedging of trochlea of the talus between the malleoli

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17
Q

Proximal tibiofibular joint; blood supply + innervation

A

Blood supply: inferior lateral genicular and anterior tibial recurrent arteries

Innervation: common fibular nerve and nerve to the popliteus

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18
Q

distal tibiofibular syndesmosis; articulation

A

articulation: distal medial surface of fibula and fibular notch of tibia

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19
Q

distal tibiofibular syndesmosis; fibrous joint

A

Fibrous joint (syndesmosis):
*Interosseous tibiofibular ligament (continuation of interosseous membrane)
*Anterior tibiofibular ligament
*Posterior tibiofibular ligament (inferior transverse tibiofibular ligament)

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20
Q

distal tibiofibular syndesmosis; ankle joint stabiliser

A

-Keeps lateral malleolus firmly against lateral surface of the talus
*Inferior transverse ligament forms posterior wall of the malleolar mortise for the trochlea of the talus

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21
Q

distal tibiofibular syndesmosis; movement

A

movement: slight upward movement during dorsiflexion

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22
Q

distal tibiofibular joint (tibiofibular syndesmosis); blood supply + innervation

A

Blood supply: perforating branch of fibular artery, and medial malleolar branches of anterior and posterior tibial arteries.

Innervation: deep fibular, tibial and saphenous nerves

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23
Q

Knee joint; consists of?

A
  • hinge type synovial joint
    > flexion, extension
    > also gliding, rolling, and rotation
  • 3 joints in a single cavity
    > lateral tibiofemoral joint
    > medial tibiofemoral joint
    > intermediate patellofemoral joint
  • fibula is not involved
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24
Q

tibiofemoral joint

A
  • medial and lateral condyles of femur articulate with medial and lateral condyles of tibia
  • non-articular area between condyles
  • weight bearing joint of the knee
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25
Q

patellofemoral joint

A
  • facets of the patella articulate with the patellar groove on anterior surface of femur
  • allows the pull of the tendon of quadriceps femoris (the main extensor) to be directed anteriorly over knee without tendon wear and increased leverage
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26
Q

joint capsule of knee; borders

A
  • external fibrous layer
  • Borders:
    > superiorly: proximal to articular margins of femoral condyles
    > posteriorly enclosed condyles and intercondylar fossa
    > opening posterior to the lateral tibial condyle for popliteus tendon
    > inferiorly: margin of tibial plateau
  • internal synovial membrane
    • excludes cruciate ligaments and the infrapatellar fat pad from articular cavity
27
Q

Extracapsular ligaments of knee joint

A
  • joint capsule: 5 extracapsular (intrinsic) ligaments
    > patellar ligament
    > fibular collateral ligament
    >tibial collateral ligament
    >oblique popliteal ligament
    >arcuate popliteal ligament
28
Q

patellar ligament ;

A

distal part of quadriceps femoris tendon
- from patella to tibial tuberosity

29
Q

fibular (lateral) collateral ligament

A

lateral epicondyle of femur to lateral surface of fibular head

30
Q

tibial (medial) collateral ligament

A
  • medial epicondyle of femur to medial condyle and superior medial surface of tibia
  • attached to medial meniscus
31
Q

oblique popliteal ligament

A

reinforces capsule posteriorly

32
Q

acruate popliteal ligament

A
  • strengthens joint capsule posterolaterally
  • posterior aspect of femoral head
33
Q

intra-articular ligaments of knee joint

A

cruciate ligaments
- criss-cross within joint capsule, but outside synovial cavity
- medial rotation of tibia on femur limited to 10* as ligaments wind around each other
- lateral rotation: unwind, permitting 40* lateral rotation of tibia when knee flexed
- oblique orientation means one ligament or part thereof is always in tension

34
Q

Anterior cruciate ligament - ACL
attachments + prevents

A

attachments:
- anterior intercondylar area of tibia
- posterior part of medial side of lateral condyle of femur

limits rolling of femoral condyles on tibial plateau during flexion (converts rolling to spin)

prevents:
- posterior displacement of femur on tibia
- hyperextension of knee

35
Q

Posterior cruciate ligament - PCL
attachment + prevents

A

Attachments:
- posterior intercondylar area of tibia
- anterior part of lateral side of medial condyle of femur

Limits rolling of femoral condyles on tibial plateau during extension (converts rolling to spin)

Prevents:
- anterior displacement of femur on tibia
- hyperflexion of knee

36
Q

Menisci of knee joint

A

*Medial and lateral menisci
*Crescent shaped fibrocartilage with wedge cross section on articular surface of tibia
*Anchored to intercondylar area of tibia and attached to joint capsule
*Medial meniscus fixed to tibial collateral ligament
*Deepen surface to provide passive joint stabilisation
*Shock absorption

37
Q

bursa:

A

a synovial sac found in between parts in a joint to reduce friction

38
Q

bursae around knee joint

A
  • at least 12 bursa around knee
39
Q

suprapatellar bursa:

A

between quadriceps and femur

40
Q

subcutaneous prepatellar bursa:

A

between apex of patella and skin

41
Q

infrapatellar bursa:

A

deep and superficial (subcutaneous)
- deep between tibia and patellar ligament
- superficial between patellar ligament and skin

42
Q

semimembranosus burse:

A

located between semimembranosus and gastrocnemius muscles

43
Q

neurovascular supply - knee
Blood supply

A
  • 10 vessels form peri-articular genicular anastomoses around knee
  • middle genicular branches of popliteal artery penetrate fibrous layer and supply cruciate ligaments, synovial membrane and peripheral margins of menisci
44
Q

neurovascular supply - knee
innervation

A

nerves supplying muscles crossing the knee joint also supply the joint
> femoral: anterior aspects
> tibial: posterior aspects
> common fibular: lateral aspects
> saphenous (cutaneous): medial aspect

45
Q

ankle joint (talocrural articulation)

A

*Hinge-type synovial joint
*The tibia and fibula are bound together by strong tibiofibular ligaments producing a bracket-shaped socket known as a mortise
*The body of the talus bone fits snugly into the mortise formed by the lateral malleolus (fibula) and medial malleolus (tibia)
*The articulating part of the talus is wedge shaped (wider anteriorly)

46
Q

lateral collateral ligament

A

lateral ligament (3 separate ligaments) from lateral malleolus
> anterior talofibular ligament
> posterior talofibular ligament
> calcaneofibular ligament

stabilises ankle during inversion (toes up)

47
Q

Medial (deltoid) collateral ligament
attachment + role

A
  • proximal attachment to medial malleolus
  • distal attachments to:
    • talus: anterior and posterior tibiotalar parts
    • calcaneus: tibiocalcaneal part
    • navicular: tibionavicular part

Stabilises ankle during eversion and prevents subluxation

48
Q

ankle (talocrural) joint capsule:

A

-capsule is thin anteriorly and posteriorly
- supported on each side by strong lateral and medial collateral ligaments

49
Q

Ankle joint capsule
Lateral ligament (3 separate ligaments) from lateral malleolus

A
  • anterior talofibular ligament
  • posterior talofibular ligament
  • calcaneofibular ligament

stabilises ankle during inversion

50
Q

ankle joint capsule
Medial (deltoid) ligament

A

proximal attachment to medial malleolus
distal attachments to :
- talus
- calcaneus
- navicular

Stabilises ankle during eversion and prevents subluxation

51
Q

Ankle (talocrural) joint - neurovascular supply
blood supply + nerve supply

A

blood supply: malleolar branches of fibular and anterior and posterior tibial arteries

nerve supply:
- saphenous
- tibial
- sural
- superficial and deep fibular nerves

52
Q

foot drop

A
  • patient cannot dorsiflex foot
  • fracture at right fibular neck
  • broken fibula causes damage to peroneal - -nerve
  • a brace prevents foot from dropping
53
Q

knee injury: unhappy triad / terrible triad

A

lateral side of knee, complete or partial tear of :
- cruciate ligament
- medial collateral ligament
- medial fibrocartilage meniscus

54
Q

knee injury: dislocation

A

usually anterior due to hyperextension of knee
damage to popliteal artery

55
Q

knee injury: patellar dislocation

A
  • slips out of normal position in patellofemoral groove
  • direct blow or sudden twist of leg
  • quadriceps muscle pulls patella proximally and laterally
56
Q

anterior cruciate ligament injuries

A

ACL injuries occur when bones of the leg twist in opposite directions under full body weight

57
Q

posterior cruciate ligament injuries

A

PCL occur usually to force
femur moves forward and tears PCL

58
Q

Knee arthroplasty (replacement)

A

*Replaces cartilage surface
*Total: distal end of femur, proximal end of tibia, posterior surface of patella
*Femur component – metal
*Tibial component – plastic
*Patella – plastic patellar implant
*Partial or uni-compartmental: only one side replaced

59
Q

prepatellar bursitis ( housemaid’s knee)

A

cause: excessive and repeated friction between skin and patella, e.g. jobs associated with kneeling

Inflammation of bursa in front of kneecap

60
Q

infrapatella bursitis ( clergyman’s knee)

A

cause: excessive friction between skin and tibial tuberosity, e.g. roofers, tilers who dont wear knee pads

61
Q

popliteal cyst (bakers cysts)

A
  • fluid filled sacs in synovial membrane in popliteal fossa region
  • usually, a complication of chronic knee joint effusion
62
Q

tibiofibular syndesmosis injury

A
  • high ankle sprain
  • injury to distal tibiofibular syndesmosis ligaments
  • dorsiflexion and eversion of the ankle with internal rotation of the tibia
  • radiography criteria: widening of tibiofibular ‘clear space’ to greater than 6 mm
63
Q

ankle sprain

A
  • most common major joint injury
  • torn fibres or ligaments
  • usually, an inversion injury involving twisting of weightbearing plantarflexed foot
  • anterior talofibular ligament is most vulnerable

Anatomy - Lower limb (6 decks)

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