Manual 57-62: Thigh and Patella Osteology Flashcards
the knee is a compound joint made of what 2 joints
- condylar joint between condyles of tibia and femur
- saddle/sellar joint between patella and femur
- ONE synovial membrane and one cavity
what is the orientation of the condylar joint of knee
10-12 degrees from midline
greater than this is genu valgum
what type of joint is the knee
condyloid joint
what is the movemnt at knee joitn
hinge
glinding
rotation
describe the articualr surface of tibia? fibula?
- flat
- rounded
what is the n supply to the knee joint
- articular branches of femoral
- obturator
- common peroneal
- tibial
blood supply to knee joint
- genicular anastomosis from descending genicular branch of femoral
- genicular popliteal
- recurrent branches of anterior tibial
- descending branch lateral femoral circumflex a
- circumflex fibular a
where is the articular capsule incomplete
anteriorly
replaced by medial/lateral retinacula of quadricps tendon
the tendon of popliteus m pierces the articular capsule ..
laterally
continuation of quadriceps tendon
patellar ligament
how long is the patellar ligament
8 cm
what protects the patellar ligament from tibia
- infrapatellar bursa
- the infrapatellar fat pad - inferior surface separates synovial membrane
what are the attachments of lateral collateral ligament
- lateral epicondyle of femur above groove popliteus m
- head of fibula
what tendons cover the lateral collateral ligament
tendon of biceps femoris - splits attach fibular head either side of LCL
is the LCL attahced to the capsule?
no
also not attached to lateral meniscus (separated by articular capsule and tendon of popliteus)
how is the tendon of popliteus related to LCL
deep
what is the proximal attachment of the anterolateral ligament
lateral femoral condyle anterior to proximal attachment of LCL w/ connecting fibers b/w two ligaments
- has an oblique course
what is the distal attachment of anterolateral ligament?
- anterolateral aspect tibia b/w gerdy’s tubercle and apex of fibula
- attaches also to the lateral meniscus
what is the function of the anterolateral ligament?
check internal rotation b/w 30-90 knee flexion
describe the medial collateral ligament. compare to lateral collateral
- broad flat band 10 cm long
- strong round fibrous
what are the proximal and distal attachments of MCL
proximal: medial epicondyle femur below adductor tubercle
distal: medial surface tibia 2-3 cm long
- also attaches to medial meniscus
what is above and below the MCL
- SGT cross superiorly
- capsule below ligament
what ligament serves to strengthen knee joint posteriorly
oblique popliteal
what ligament is the expansion of semimebranosus m
oblique popliteal
- passes obliquely from medial condyle tibia to lateral condyle of femure on the floor of popliteal fossa
what ligament is perforated by medial genicular on its way to knee joint
oblique popliteal
thickened capsular fibers over popliteus tendon
arcuate popliteal
- course mediallly from lateral condyle tibia and head fibula to posterior intercondylar area of the tibia
what is the function of anterior cruciate ligament
prevent hyperextensnion of knee - prevent femur from posterior sliding on tibia
what is the course of anterior cruciate ligament
travel superolateral from anterior intercondylar area on tibia to the posterior medial surface of lateral femoral condyle
how does the posterior cruciate ligament compare to the anterior
stronger and shorter
describe the course of the posterior cruciate ligament
- travels obliquely upward from the posterior intercondylar tibia crossing over ACL to attach on medial condyl (lateral surface)
what is the function of PCL
prevent hyperflexion of knee
what prevents femur forward sliding on tibial plateau
PCL
semilunar fibrocartilage discs the deepen the vacity of tibial condyles
menisci
which part of menisci are in contact with femoral condyles
central area
how much of condyle of tibia are covered by menisci
2/3
what is the peripheral attachment of menisci? aka what holds menisci to tibial condyles
fibrous capsule (coronary ligament) holds menisci to tibial condyles
shape of menisci
medial = semicircular lateral = almost circular
what are the attachments of the medial meniscus
- attached to tibia anterior to ACL at anterior intercondylar area
- posterior attachment posterior intercondylar area
what separates the lateral meniscus from LCL
tendon of popliteus
span of lateral meniscus
from anterior intercondylar area to posterior intercondylar area
what are the anterior/posterior meniscofemoral ligaments
posterior side
70% cases fibers extend to medial condyle of femur
what unites two meniscis anteriorly
transverse ligament
what facets meet in the superior tibiofibular joint
- fibular facet of lateral tibial condyle
- articular faet of medial aspect head of fibula
what are the shape of facets in superior tibiofibular jt
circural shaped
what ligaments are associated with superior tibiofibular jt
anterior and posterio superior tibiofibular ligaments
what type of joint is the superior tibiofibular jt
plane synovial jt
what type of joint is the distal tibiofibular jt
syndesmosis, fibrous jt
what forms the distal tibiofibular jt
- triangular surface of distal fibula (in inferior interoseous border)
- distal end of tibia
what ligaments are associated with distal tibiofibular jt
- interosseous tibiofibular lig
- anterior inferior tiiofibular ligament
- posterior inferior tibiofibular ligament
distal continuation of interosseous membrane
interosseous tibiofibular ligament
what shape is the anterior inferior tibiofibular ligament
triangular directly inferolaterally
what shape is the posterior inferior tibiofibular ligament
quadrangular shape directed inferolaterally
deep pportion of the posterior inferior tibiofibular ligament =
inferior transverse ligament (contains fibrocartilage)
- forms socket for talus
- extends from lateral malleolar fossa to margin of medial malleolus
the patella forms within …
tendon of quadriceps femoris m
shape of head of femur
ball-shaped
2/3 spherical covered by hyaline cartilage *not at pit/fovea where the ligament of head of femur attaches
the head of femurs lies ____ in articular capsule of hip joint
entirely
where does the femur articulate with hip bones
acetabulum
joins head and shaft of femur
neck
when is the femoral angle of inclination the greatest
at birth
- sex and body size determine angle
- adult male 125
- adult female 105 (wider bony pelvis)
what is the angle of declination
projection of neck of femur from the shaft 12-14 degrees
what is the shape of the neck of femur
hourglass (thinnest at middle)
what are the two surfaces of neck of femur
anterior and posterior
describe the anterior surface of neck of femur
- entirely in joint capsule of hip joint
- convex superior to inferior
- concave side to side
- intertrochanteric line
where is the intertrochanteric line and what is it?
- between greater and lesser trochanters of femur
- anterior surface of neck of femure
- continuous inferiorly with spiral line
describe the posterior surface of neck of femur
- more curved than anterior
- upper 1/2 to 2/3 lies within the joint capsule
- fewer but larger vascular formaina than anterior
which portion of the neck of the femur is grooved by tendon of obturator externus
lower portion of posterior surface
what forms at the joining of posterior surface of neck of femur with shaft of femur
intertrochanteric crest
- ridge of bone b/w greater and lesser trochanters
what are the borders of neck of femur
superior and inferior
- superior is short and thick and courses horizontally
- inferior is long and thin and courses vertically
which border of neck of femur ends at greater trochanter? lesser trochanter?
superior border
inferior border
what is the shape of the greater trochanter
qudrilateral-shaped
- located at lateral end of superior border of neck of femur
- projects lateral and posterior
what two surfaces are on the greater trochanter
lateral and medial
what is the shape of the lateral surface of greater trochanter
quadrilateral
- larger palpable surface (compared to medial)
there is an oblique bony ridge on lateral surface of greater trochanter, why?
insertion of gluteus medius
what divides the lateral surface of greater trochanter into 2 triangular areas
oblique bony ridge
- upper triangular area = bursae for gluteus medius
- lower triangular area = bursae for gluteus maximus
major feature of medial surface of greater trochanter
trochanteric fossa
- depression for insertion of obturator externus
tendon that inserts anterior to trochanteric fossa on greater trochanter
obturator internus tendon
- superior and inferior gemelli m terminate/insert into tendon of obturator internus
what are the four borders on greater trochanter
superior, inferior, anterior and posterior
superior border on greater trochanter is insertion for
piriformis
anterior border on greater trochanter is insertion for
gluteus minimus
inferior border on greater trochanter is insertion for
vastus lateralis (partial origin)
only border or surface of greater trochanter with no muscular attachment
posterior border
- free rounded edge inferiorly that blends with intertrochanteric crest
location of lesser trochanter
- medial, near junction of femoral neck and shat
- directed posteromedially
attachment to lesser trochanter
iliopsoas is only attachment
- psoas major inserts at apex
- iliacus inserts at base and between spiral and pectineal lines
where is the intertrochanteric line located?
- anterior on femur between greater and lesser trochanters at junction of neck and shaft
attachments to intertrochanteric line
- iliofemoral ligament (part of fibrous capsule of hip)
- vastus lateralis (partial origin)
- vastus medialis (partial origin)
where is the intertrochanteric crest
- posterior between greater and lesser trochanters
attachments to intertrochanteric crest
- NOT hip joint capsule
- quadratus femoris via the quadrate tubercle
site of insertion of quadratus femoris m on intertrochanteric crest
- quadrate tubercle mid-intertrochanteric location
describe the quadrate tubercle
- extends vertically 5 cm, superior extent located along itnertrochanteric crest
- posterior side of femur obvi
- at times a quadrate line can be present instead of tubercle
what are the borders of shaft of femur
medial, lateral and posterior
- medial and lateral are rough and poorly defined
major feature of posterior border of shaft of femur
linea aspera
- crest, posterior border, middle 1/3 femur
- medial and lateral lips with rough intermediate area
superioly the linea aspera is joined by …
3 lines/ridges
- spiral line
- pectineal line
- lateral line
describe the spiral line on shaft of femur
- joins linea aspera distally
- medial line
- proximally continuous with intertrochanteric line
describe the pectineal line of femur
- intermediate line
- ends proximally at lesser trochanter
- distally continuous with medial lip of linea aspera
what m inserts on pectineal line
pectineus m
describe the lateral line of femur
- extends from greater trochanter to lateral lip of linea aspera
- vertical
- gluteal tuberosity located on line
what m inserts on gluteal tuberosity
partial insertion of gluteus maximus (also inserts on iliotibial band)
if proximal portion of the gluteal tuberosity is enlarged and elongated it is …
called the third or guteal trochanter
what m. takes partial origin from medial lip of linea aspera
vastus medialis
what m attaches superiorly b/w adductor magnus and vastus medialis
iliacus and pectineus and adductor brevis and adductor longus
what m attaches on linea aspera superior to the adductor longus
adductor brevis
what m attaches on linea aspera inferior to adductor brevis
adductor longus
what are the attachments on adductor magnus on posterior shaft of femur (LOTS)
- linea aspera (extensive)
- gluteal tuberosity (superior - partial insertion)
- lateral line (partial)
- lateral lip of linea aspera (partial)
- medial lip of line aspera (lower fiber insertion)
- medial supracondylar line (lower fiber insertion)
- adductor tubercle (lower fiber insertion)
what m attaches to the gluteal tuberosity superiorly
gluteus maximus and adductor magnus both partially
- biceps femoris short head attaches inferior to the glut max
what are the posterior attachments on femur of vastus lateralis
lateral lip of linea aspera (partial) and greater trochanter (small origin)
the lateral and medial lip of linea aspera diverge as ..
lateral and medial supracondylar lines/ridges
distinct ridge extending toward the lateral epicondyle
lateral supracondylar ridge
ridge ending at adductor tubercle
medial supracondylar ridge
the medial and lateral supracondylar ridges form a triangular area called ..
popliteal surface of femur
m attachments to anterior surface of femur
vastus intermedius (upper 2/3) and articualris genu (distal)
more pronounced, broader condyle on femur
lateral
the medial condyle is longer
where does the medial condyle begin
adductor tubercle
what are the articulations of the medial and lateral condyles of femur
- posterior surface of patella
- repsective condyles of tibia
describe the femur’s condyles
large, rounded
knob-like
project further POSTERIOR than anterior
what do you call the sulcus/groove on each femoral condyle
lateral and medial sulci menisci
- separate patellar and tibial surfaces of femoral condyles
completely separates patellar surface (lateral femoral condyle) from tibial surface
lateral sulci menisci
deficient laterallly wehre tibial and patellar surfaces are continuous
medial sulcus menisci
separates femoral condyles posteriorly
intercondylar notch/fossa
posterior boundary of the intercondylar notch
intercondylar line
- forms base of popliteal surface of femur
attachments to the intercondylar notch (3)
- ACL (medial surface of lateral condyle - posterior attachment on femur)
- PCL (lateral surface of medial condyle - anterior attachment of femur)
- meniscofemoral ligament
where are the medial and lateral epicondyles
lie above the respective condyles
larger epicodyle
medial
- locaetd just below the adductor tubercle
what attaches to the adductor tubercle
adductor magnus tendon
what attachments are there to the medial epicondyle
- tibial (medial) collateral ligament
- medial head of gastrocnemius m (just post to adductor tubercle)
what attaches to the lateral epicondyle?
fibular/lateral collateral ligament
what two grooves are one the lateral epicondyle
- oblique groove (flexed knee)
- vertical groove (extended knee)
- located on lower portion of epicondyle for the popliteus tendon which shifts with knee movement
proximal extremity feeders to femur
- obturator (supplies femoral head)
- medial femoral circumflex (branch of profunda femoris)
- lateral femoral circumflex (enters at neck)
- inferior gluteal (enters at neck)
- first perforating (enters at neck)
what blood supply is especially important ininfants, children, teens during ossification of femur
obturator a
- supplies femoral head
- unimportant in adults
major supply to femoral head in adults
medial femoral circumflex
- enters at neck of femur
what a courses within ligament of head of femur
branch of obturator to supply the femoral head
femoral shaft arterial feeder
nutrient a (branch of second perforating artery)
where is the nutrient canal of femur located?
- posterior, upper end of linea aspera
- directed away from growing end of bone during development (obliquely upward)
*** for all long bones, the nutrient canal is directed …
obliquely away from the growing end of bone
distal extremity feeder areteries for femur
- superior lateral genicular a
- superior medial genicular a
- descending genicular a
- descending branch of lateral femoral circumflex a
how many centers of ossification in femur
5
1 primary (shaft)
4 secondary
the femur is the first bone to begin with this type of ossification
endochondral ossification
the femur is the ______ bone to ossify
second earliest (clavicle is first via intramembranous method)
femur primary ossification
shaft starting at 7th fetal week and ending at puberty
femur secondary ossification (4)
- distal extremity near birth to 16-18
- head 6mo to 17
- greater trochanter 4 y to 16
- lesser trochanter 12-14 y to 15 yo
largest sesamoid in body
patella (forms in quadratus femorus tendon)
the patella articulates with
femur (part of knee joint(
shape of patella
triangular (apex directed inferiorly)
borders of patella
superior (thick base(
medial
lateral
attachments to superior border of patella
- rectus femoris
- vastus intermedius
- vastus lateralis (lateral superior portion)
attachements to medial border of patella
- vastus medialis
- vastus lateralis
how is the anterior surface of patella shaped
convex with longitudinal stria and small nutrient foramina
what attaches to the longitudinal stria of patella
quadratus tendon
describe the upper 4/5th of posterior surface of patella
smooth, oval shaped
what separates the two patellar facets
vertical ridge
what does the vertical ridge of the patella articulate with…
intercondylar groove of femur
which of the patellar facets is larger
lateral facet
also deeper and more concave than medial
what attaches at the lower 1/5th of posterior surface of patella
patellar ligament
- nutrient foramen are also located on this surface
what is the blood supply to the patella
branches of gneicular arteries (by supplying the quadriceps tendon)
when does the patella ossify?
variable # centers
appear 3-6 yrs; additonal later in childhood
ossifies by puberty
