Leg and Knee Flashcards
Patella
Articulates with the trochlear groove of the distal femur.
Tibia and Fibula (3)
Joined by a fibrous interosseous membrane.
Tibia is weightbearing
Fibia functions primarily for muscle attachments, forms part of the ankle joint, and acts as a pulley for the fibularis longus and fibularis brevis muscle tendons.
Knee Joint
Largest of the synovial joint
The knee consists of the articulation between the femur and the tibia (biaxial condylar synovial joint) and between the patella and the femur
Distal knee joints
Tibiofemoral + Patellofemoral
Vascular supply for knee
Arises from genicular branches of the popliteal artery, the inferior
continuation of the femoral artery.
Osgood-Schlatter disease (OSD)
Partial avulsion of the tibial tuberosity.
Repetitive stress on the tuberosity may cause it to separate (avulse) from the tibia. The avulsed fragment continues to grow, with the intervening space filled with new bone or fibrous connective tissue, so that the tibial tuberosity is enlarged.
Common in children who engage in vigorous physical activity than in less active children.
Subluxation of the patella
Presents with tenderness along the medial patellar aspect and atrophy of the quadriceps tendon, especially the oblique portion medially derived from the vastus medialis.
Patellar ligament rupture
Occurs just inferior to the patella as a result of direct trauma
in younger people.
Quadriceps tendon rupture occurs mostly in older individuals, from either minor trauma or age-related degenerative changes,
Rupture of the anterior cruciate ligament (ACL) (3)
Common athletic injury usually related to sharp turns, when the knee is twisted while the foot is firmly on the ground.
The patient may hear a popping sound and feel a tearing sensation associated with acute pain.
Joint stability can be assessed by using the Lachman and anterior drawer tests.
Ligament injuries (sprains) of the knee (3)
First degree: stretched ligament with little or no tearing.
Second degree: partial tearing of the ligament with joint laxity.
Third degree: complete rupture of the ligament, resulting in an unstable joint
Fibrocartilaginous menisci injury
Often torn when the knee undergoes a twisting injury.
Patients complain of pain at the joint line, and the involved knee “gives way” when flexed or
extended.
Rupture of the tibial collateral ligament
Involves a tear of the medial meniscus because the ligament and meniscus are attached.
Iliotibial Tract (Band) Syndrome
Common in runners and presents as lateral knee pain, often in the midrange of flexion, between 20 and 70 degrees of knee flexion.
Proximal (superior) tibiofibular joint
Joint between the fibular head and the lateral condyle of the tibia.
The joint is stabilized by a wider and stronger anterior ligament and a narrow weaker posterior ligament; this joint allows for some minimal gliding movement.
Distal tibiofibular joint (tibiofibular syndesmosis)
Formed by the rough, convex surface of the medial side of the distal end of the fibula, and a rough concave surface on the lateral side of the tibia.
Muscles of posterior compartment of leg (7)
- gastrocnemius
- soleus
- plantaris
- popliteus
- flexor hallucis longus
- flexor digitorum longus
- tibialis posterior
Gastrocnemius
Origin:
- Lateral head: lateral aspect of lateral condyle of femur
- Medial head: popliteal surface of femur, superior to medial condyle
Insertion: Posterior surface of calcaneus via calcaneal tendon
Fx: Plantarflexes foot at ankle. raises heel during walking, flexes leg at knee joint
Soleus
Origin: Posterior aspect of head of fibula, superior quarter of posterior surface of fibula, soleal line, and medial border of tibia
Insertion: Posterior surface of calcaneus via calcaneal tendon
Fx: Plantarflexes foot at ankle; steadies foot on leg
Plantaris
Origin: Inferior end of lateral supracondylar line of femur and oblique popliteal ligament
Insertion: Posterior surface of calcaneus via calcaneal tendon
Fx: Weakly assists gastrocnemius in plantarflexing ankle and flexing knee
Popliteus
Origin: Lateral condyle of femur and lateral meniscus
Insertion: Posterior surface of tibia, superior to soleal line
Fx: Weakly flexes leg at knee and unlocks it
Flexor hallucis longus
Origin: Inferior two thirds of posterior surface of fibula and inferior part of interosseous membrane
Insertion: Base of distal phalanx of great toe (hallux)
Fx: Flexes great toe at all joints and plantarflexes foot at ankle; supports longitudinal arches of foot
Flexor digitorum longus
Origin: Medial part of posterior surface of tibia inferior to soleal line and by a
broad tendon to fibula
Insertion: Bases of distal phalanges of lateral four digits
Fx: Flexes lateral four digits; plantarflexes ankle; supports longitudinal arches of foot
Tibialis posterior
Origin: Interosseous membrane, posterior surface of tibia inferior to soleal line, and posterior surface of fibula
Insertion: Tuberosity of navicular, cuneiforms, and cuboid, and bases of 2nd–4th
metatarsals
Fx: Plantarflexes foot at ankle, and inverts foot
Anterior leg compartment muscles (4)
- Tibialis anterior
- Extensor hallucis longus
- Extensor digitorum longus
- Fibularis tertius
Tibialis anterior
Origin: Lateral condyle and superior half of lateral tibia and interosseous membrane
Insertion: Medial and inferior surfaces of medial cuneiform and base of 1st metatarsal
Fx: Dorsiflexes foot at ankle, and inverts foot
Extensor hallucis longus
Origin: Middle part of anterior surface of fibula and interosseous membrane
Insertion: Dorsal aspect of base of distal phalanx of great toe (hallux)
Fx: Extends great toe; dorsiflexes foot at ankle
Extensor digitorum longus
Origin: Lateral condyle of tibia and superior 2/3 of anterior surface of fibula and interosseous membrane
Insertion: Middle and distal phalanges of lateral four digits
Fx: Extends lateral four digits, and dorsiflexes foot at ankle
Fibularis tertius
Origin: Inferior third of anterior surface of fibula and interosseous membrane
Insertion: Dorsum of base of 5th metatarsal
Fx: Dorsiflexes foot at ankle and aids in foot eversion
Muscles of lateral leg compartment (2)
- Fibularis longus
2. Fibularis brevis
Fibularis longus
Origin: Head and superior two thirds of lateral surface of fibula
Insertion: Base of 1st metatarsal and medial cuneiform
Fx: Evert foot, and weakly plantarflex foot at ankle
Fibularis brevis
Origin: Inferior 2/3 of lateral surface of fibula
Insertion: Dorsal surface of tuberosity on lateral side of 5th metatarsal
Fx: Evert foot, and weakly plantarflex foot at ankle
Innervation and blood supply of anterior leg compartment
Deep fibular nerve + Anterior tibial artery
Blood supply and innervation of posterior leg compartment
Posterior and fibular artery + Tibial nerve
