Session 4: Osteology of the Distal Femur, Patella, Tibia and Fibula Flashcards
1
Q
Where can you find the linea aspera?
A
On the posterior surface of the femoral shaft.
2
Q
Explain the lines of the femur.
A
Proximally the pectineal line from the medial side and the gluteal tuberosity from the lateral side merges in to form the linea aspera. The linea aspera descends the femur and splits into the medial supracondylar line and the lateral supracondylar line. Here it also forms the floor of the popliteal fossa.
3
Q
Where does the medial supracondylar line end?
A
At the adductor tubercle.
4
Q
What muscle inserts at the adductor tubercle?
A
Adductor Magnus.
5
Q
Label the diagram.
A
6
Q
Label the diagram
A
7
Q
What articulates with the patella?
A
The trochlear (patellofemoral) groove.
8
Q
Why is the medial femoral condyle larger than the lateral femoral condyle?
A
Because in standing position the centre of mass of the body passes medial to the knee joint.
9
Q
Which one is larger, the medial or lateral epicondyle?
A
The medial epicondyle.
10
Q
Outline the features of the medial and lateral epicondyles.
What originates at the lateral epicondyle?
What originates at the medial epicondyle?
A
Bony elevations superior the non-articular areas of the condyles.
Lateral collateral ligament. (lateral)
Medial collateral ligament. (medial)
11
Q
Label the diagram.
A
12
Q
What does the inferior and posterior surfaces of the femoral condyle articulate with?
A
The menisci of the knee and the tibia.
13
Q
The lateral femoral condyle is more prominent than the medial. What happens if there is a flatter lateral femoral condyle?
A
The prominence helps prevent lateral displacement. If it is more flat you are more likely to experience patellar instability.
14
Q
What is the intercondylar fossa?
A
A depression found on the posterior surface of the femur between the two condyles.
15
Q
Where is the patella located.
What is the patella attached to superiorly and inferiorly?
A
At the anterior aspect of the knee joint within the trochlear groove of the femur.
The patella is attached to the quadriceps tendon superiorly.
The patella is attached to the patellar ligament inferiorly.
16
Q
Label the diagram.
A
1 = Posterior meniscofemoral ligament
2 = Posterior cruciate ligament
3 = Anterior cruciate ligament
4 = Lateral meniscus
5 = Medial meniscus
17
Q
Label the diagram.
A
18
Q
Label the diagram
A
19
Q
- What does the medial facet articulate with?
- What does the lateral facet articulate with?
A
- Medial condyle of the femur
- Lateral condyle of the femur
20
Q
What three main functions does the patella have?
A
- Extension of the leg by acting as a fulcrum. The quadriceps muscle directly cross the anterior aspect of the knee. Patella therefore enhances the leverage that the quadriceps tendon can exert on the femur.
- Protection - protects the anterior aspect of the knee joint from physical trauma
- Stabilising structure by reduction of the frictional forces on the femoral condyles.
21
Q
What are the most superior parts of the proximal tibia?
The condyles form a flat surface - what is it called?
A
Medial and lateral condyle of the tibia.
Tibial plateau.
22
Q
What does the tibial plateau articulate with?
A
The femoral condyles to form the major articulation of the knee joint.
23
Q
How does the head of the tibula articulate with knee joint?
A
It doesn’t.
It articulates with the proximal tibia at the proximal tibiofibular joint.
24
Q
Label the diagram.
A
25
What attaches at the intercondylar eminence?
What does the intercondylar tubercles of the tibia articulate with?
Anterior cruciate ligament and the menisci of the knee joint.
The intercondylar fossa of the femur.
26
Where does the posterior cruciate ligament attach?
To the posterior edge of the intercondylar area.
27
Tibia is prism-shaped. What are the three borders?
Outline their features and attachments.
Anterior: Proximal aspect of the anterior border is marked by the tibial tuberosity. Insertion site for the patellar ligament.
Posterior: Marked by a ridge of bone known as soleal line - site of origin for part of the soleus muscle.
Lateral: Known as the interosseous border. Attachment to the interosseous membrane that binds the tibia and the fibula together.
28
1. What is the medial malleolus?
2. What does it articulate with?
3. What is lateral to the medial malleolus?
1. A bony projection continuing inferiorly on the medial aspect of the tibia.
2. Articulate with the tarsal bones to form part of the ankle joint.
3. The lateral malleolus but there is also a fibular notch where the fibula is bound to the tibia forming the inferior tibiofibular joint.
29
Label the diagram.
30
What is the main function of the fibula?
Act as attachment for muscles - not as weight-bearer.
31
What are the three main articulations of the fibula? What do they articulate with?
Proximal tibiofibular joint - articulates with the lateral condyle of the tibia
Distal tibiofibular joint - articulates with the fibular notch of the tibia
Ankle joint - articulates with the talus bone of the foot
32
The knee joints consists of two articulations.
1. Which?
2. What do they articulate with?
1. Tibiofemoral - the medial and lateral condyles of the femur articulate with the medial and lateral tibial condyles.
2. Patellofemoral - the patella articulates with the femur at the trochlear groove.
33
What are the joint surfaces lined with?
Hyaline cartilage.
34
Which is the weight-bearing joint of the knee?
The tibiofemoral joint
35
How is the knee joint supplied with blood?
By genicular anastomoses around the knee which are supplied by the genicular branches of the femoral and popliteal arteries.
36
There are two menisci. Which?
What are the made of?
Medial and lateral menisci.
Fibrocartilage.
37
Give the two main functions of the menisci.
1. To deepen the articular surface of the tibia to increase the stability of the joint.
2. To act as shock absorbers by increasing surface area to further dissipate forces.
38
Explain the structure of the menisci.
C-shaped and they are thicker peripherally than centrally.
39
What is the medial meniscus attached to?
Medial collateral ligament medially and the intercondylar area of the tibia.
40
What is the lateral meniscus attached to?
Intercondylar area. Nothing on the periphery.
41
What is the main difference between the lateral and medial menisci?
Why is this important clinically?
The medial is much more rigid because it is attached to the medial collateral ligament.
The lateral doesn't attach to the lateral collateral ligament so it is much more mobile, also it is smaller than the medial menisci.
It's important because it means that the medial is more prone to injury. Damage to the medial collateral ligament can lead to a tear in the medial meniscus.
42
How are the menisci connected to each other?
Anteriorly by the transverse ligament of the knee.
43
Where is the posterior meniscofemoral ligament and what is its function?
Located posterior to the posterior cruciate ligament and helps stabilise the posterior horn of the lateral menisucs by attaching it to the medial femoral condyle.
44
Why is the healing of the menisci impaired?
Because the blood flow to the menisci is poor and gets even worse as you age.
45
Label the diagram.
46
The major ligaments in the knee joint can be divided into three categories.
Which? - Examples
Intracapsular ligaments - cruciate ligaments
Ligaments that strengthen the capsule - oblique popliteal ligament
Extracapsular ligaments - collateral ligaments, patellar ligament
47
What are the two cruciate ligaments?
1 - attachments
2 - attachments
1. Anterior cruciate ligament attaching proximally to the posterolateral aspect of the intercondylar fossa - passes distally and anteromedially - attaches to the anterior aspect of the intercondylar eminence of the tibia.
2. Posterior cruciate ligament attaching proximally to the medial border and roof of the intercondylar fossa - passes distally and posterolaterally to attach to the posterior intercondylar area of the tibia.
48
What is the role of the ACL?
Resist anterior translation and medial rotation of the tibia in relation to the femur.
(Limits anterior movement of tibia on femur)
49
What is the role of the PCL?
Main stabiliser of the weight-bearing flex knee and limits the posterior movement of tibia on femur.
50
Explain the orientation of the cruciate ligaments.
PAMs APpLes where you consider both cruciate ligaments from distal to proximal.
Posterior passes anterior inserts medially
Anterior passes posterior inserts laterally
51
What is the joint capsule strengthened by?
Laterally and medially by the inferior fibres of the vastus lateralis and vastus medialis.
Strengthened posteriorly by the oblique popliteal ligament.
52
What is the oblique popliteal ligament?
A continuation of some of the fibres from semimembranous tendon in a superolateral direction from its main insertion on the medial tibial condyle, posteriorly across the back of the knee, to the lateral femoral condyle.
53
Briefly outline the patellar ligament.
Where does it insert?
Where does it originate?
A continuation of the quadriceps femoris tendon distal to the patella.
Inserts onto the tibial tuberosity.
54
What are the roles of the collateral ligaments?
Act to stabilise the hinge motion of the knee, preventing excessive medial or lateral angulation of the tibia on the femur.
55
Explain the features of the medial collateral ligament + attachments.
A wide flat ligament found on the medial side of the joint.
Proximally attaches to the medial epicondyle of the femur, distally it attaches to the medial condyle of the tibia.
56
What is the role of the MCL?
Resisting valgus (lateral) forces on the tibia.
57
What is the role of the lateral collateral ligament?
Resists varus (medial) force on the tibia.
58
Explain the features and the attachments of the LCL.
Thinner and rounder than the MCL. Attaches proximally to the lateral epicondyle of the femur. Distally it attaches to a depression on the lateral surface of the fibular head.
Lateral collateral ligament is reinforced by the iliotibial tract.
59
Label the diagram.
60
What is a bursa?
What are their roles?
A small sac lined by synovial membrane.
Containing a thin layer of synovial fluid.
Provides a cushion between the bones and the tendons/muscles surrounding a joint.
Reduces friction between bones and soft tissues and allows free movement.
61
Label the diagram.
62
What are the four movements the knee joint permits?
1. Extension
2. Flexion
3. Lateral rotation
4. Medial rotation
63
What muscles are responsible for extension of the knee joint?
Where do they insert?
Quadriceps femoris:
* Rectus femoris
* Vastus medialis
* Vastus lateralis
* Vastus intermedius
Insert into the tibial tuberosity via the patellar ligament
64
What muscles are responsible for flexion?
By the hamstrings:
Biceps femoris
Semimembranous
Semitendinous
Assisted by:
Gracilis
Sartorius
Popliteus
Plantaris
Gastrocnemius
65
What muscles are responsible for lateral rotation in the knee.
This is only possible in a flexed knee and produced by the biceps femoris.
66
What muscles are responsible medial rotation?
Only possible in a flexed knee produced by semimembranous, semitendinous, gracilis, sartorius and popliteus.
67
Which meniscus is most commonly torn and why?
Medial meniscus because it is less mobile. It is connected to the medial collateral ligament and lateral trauma to that ligament commonly result in tearing of the medial meniscus.
68
Which triad of injuries commonly called the unhappy triad includes a meniscal tear?
Medial collateral ligament
Anterior cruciate ligament
Medial meniscus
69
What is the mechanical advantage of locking the knee in the extended position?
Knee becomes more solid and thigh and leg muscles can relax without rendering the joint unstable.
Makes less effort to stand.
70
How is the knee locked and unlocked?
Internal rotation of around 5 degrees locks the knee.
Lateral rotation of around 5 degrees by popliteus muscle.
71
What is the most important muscle in stabilising the knee joint?
(Hint: VMO)
The quadriceps femoris - especially the inferior fibres of the vastus medialis.
The inferior fibres of the vastus medialis are called vastus medialis obliquus. The fibres contract to resist lateral displacement of the patella out of the trochlea groove.
72
Why is lateral resistance of lateral displacement of the patella needed?
Because during extension of the knee the patella naturally tries to be displaced by the quadriceps and the patellar ligament due to the angle between line of pull.
73
What other factors resist the natural lateral movement of the patella?
A deep trochlear groove with a more prominent lateral femoral condyle anteriorly.
Iliotibial tract plays a role in stabilising the lateral knee joint and popliteus, the hamstrings and gastrocnemius.
74
The musculature of the thigh can be split into three compartments; which?
Anterior, medial and posterior.
75
What are the muscles in the anterior thigh?
The pectineus, sartorius and quadriceps femoris.
The iliopsoas muscle insertion is also in the anterior compartment of the thigh.
76
Label the diagram. (Muscles)
77
What are the two muscles of the iliopsoas?
Psoar major
Iliacus
78
The quadriceps is the collective name of four muscles.
Which?
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
79
Origination, insertion, action and innervation of psoas major.
Originates from the transverse process of the T12-L5 vertebrae and the lateral margins of the intervertebral discs between them.
Insert onto the lesser trochanter of the femur.
Action is to flex the lower limb at the hip joint and assist in lateral rotation of the femur at the hip joint.
Innervated by the anterior rami of L1-L3
80
Origination, insertion, action and innervation of iliacus.
Originates from the iliac fossa of the pelvis.
Insert onto the lesser trochanter of the femur.
Action to flex the lower limb at the hip joint and assist in lateral rotation of the femur at the hip joint.
Innervated by the femoral nerve.
81
Label
82
Origination, insertion, action and innervation of vastus lateralis.
Originates from the greater trochanter of the femur.
Insert onto the base of the patella via the quadriceps tendon.
Extensor of the knee and stabilises the patella.
Innervated by the femoral nerve.
83
Origination, insertion, action and innervation of vastus intermedius.
Originates from the anterior and lateral surfaces of the femoral shaft.
Inserts onto the base of the patella via the quadriceps tendon.
Action is to extend the knee joint and stabilise the patella.
Innervated by the femoral nerve.
84
Origination, insertion, action and innervation of vastus medialis.
Originates from the intertrochanteric line of the femur and the medial lip of the linea aspera.
Inserts onto the base of the patella via the quadriceps tendon.
Action is to extens the knee joint and stabilise the patella.
Innervated by the femoral nerve.
85
Vastus medialis has an additional action due to a specific part of it. What is it?
Vastus medialis has inferior fibres which are orientated horizontally. These fibres are known collectively as vastus medialis obliquus or VMO.
Contraction of VMO resists lateral displacement of the patella.
Innervated by the femoral nerve.
86
Origination, insertion, action and innervation of rectus femoris.
Originates as two tendons. There is an anterior and one posterior.
Anterior originates from the anterior inferior iliac spine of the pelvis.
The posterior tendon originates from a groove above the rim of the acetabulum. They then unite.
Rectus femoris inserts onto the base of the patella via the quadriceps tendon.
Action is to extend the leg at the knee but also since it crosses the hip joint it will also flex the thigh at the hip joint.
Innervated by femoral nerve.
87
Origination, insertion, action and innervation of sartorius.
Originates from the anterior iliac spine.
Inserts onto the medial aspect of the proximal tibia as part of the pes anserinus.
Actions are to abduct, flex and laterally rotate the thigh at the hip joint. Also flexes and medially rotates the tibia at the knee joint.
Innervated by the femoral nerve.
88
Origination, insertion, action and innervation of pectineus.
Flat muscle that forms the base of the femoral triangle. Considered a transitional muscle between the naterior thigh and the medial thigh compartments.
Originates from the pectineal line on the anterior surface of the superior pubic ramus.
Inserts on the pectineal line on the posterior surface of the femur, just inferior the lesser trochanter.
Actions are to adduct and flex the thigh at the hip joint.
Innervated by the femoral nerve but can also have innervation from the obturator nerve.
89
Label
90
Muscles of the medial compartment.
What is the major action they do?
What are they innervated by?
What is the arterial supply?
Gracilis
Adductor longus
Adductor magnus
Adductor brevis
Obturator externus
Their collective action is to adduct the hip.
Innervated by the obturator nerve.
Supplied by obturator artery.
91
Label
92
Origination, insertion, action and innervation of adductor magnus (adductor component).
Lies posteriorly to the other muscles.
There are two part of it. Adductor component and hamstring component.
Adductor component originates from the inferior ramus of the pubis and the ischium.
Inserts onto the linea aspera of the femur.
Action is to adduct the thigh but also to flex the thigh.
Innervated by obturator nerve.
93
Origination, insertion, action and innervation of adductor magnus (hamstring component).
Originates from the ischial tuberosity.
Inserts onto the adductor tubercle and medial suprcondylar line of the femur.
Action is to adduct the thigh but also to extend it.
Innervated by the tibial component of the sciatic nerve (L4-S3).
94
What is the adductor hiatus?
The insertions of the adductor magnus are separated by adductor hiatus.
A space through which the femoral vessels pass.
95
Origination, insertion, action and innervation of adductor longus.
Overlies the adductor brevis and adductor magnus. Also forms the medial border of the femoral triangle.
Originates from the body of the pubis.
Expands into a fan shape.
Inserts broadly onto the middle third of the linea aspera of the femur.
Action is to adduct the thigh.
Innervated by the obturator nerve (L2-L4)
96
Origination, insertion, action and innervation of adductor brevis.
Proximal and deep to the adductor longus.
Originates from the body of pubis and the inferior pubic ramus.
Inserts onto the linea aspera on the posterior surface of the femur proximal to where adductor longus inserts.
Innervated by the obturator nerve (L2-L4)
97
Adductor brevis runs between two structure making it a landmark. Which two structures?
The anterior and posterior divisions of the obturator nerve.
98
Origination, insertion, action and innervation of gracilis.
Most superficial and medial of the muscles in the medial compartment.
Originates from the inferior pubic ramus and the body of the pubis.
Inserts onto the medial surface of the proximal tibia between the tendons of the sartorius anteriorly and the semitendinosus posteriorly as part of the pes anserinus.
Action is to adduct the thigh at the hip and flex the leg at the knee.
Innervated by the obturator nerve (L2-L4)
99
Origination, insertion, action and innervation of obturator externus.
Originates from the external surface of the obturator membrane.
Inserts onto the posterior aspect of the greater trochanter.
Actions are to adduct the thigh and to laterally rotate the thigh.
Innervated by the obturator nerve (L2-L4)
100
Superior border of the femoral triangle.
Lateral border of the femoral triangle.
Medial border of the femoral triangle.
Superior: Inguinal ligament which runs from the anterior superior iliac spine to the pubic tubercle. Acts as a flexor retinaculum.
Lateral: Medial border of sartorius.
Medial: Medial border of adductor longus.
101
Roof and floor of the femoral triangle.
Floor: pectineus, iliopsoas and adductor longus
Roof: Fascia lata and skin.
102
Contents of the femoral triangle.
List the from lateral to medial.
Mnemonic NAVEL:
Femoral nerve
Femoral artery
Femoral vein
Femoral canal: Empty space and lymphatics.
103
What is the femoral sheath?
A fascial compartment which the femoral artery, vein and canal are contained within.
However the femoral nerve is outside this structure.
104
What is the landmark of the femoral artery?
The mid-inguinal point.
(Not to be confused with the midpoint of the inguinal ligament)
105
Medial, lateral, anterior and posterior borders of the femoral canal.
Medial: lacunar ligament
Lateral: femoral vein
Anterior border: inguinal ligament
Posterior border: pectineal ligament
106
What is the femoral canal?
A canal located within the femoral triangle.
107
What is the femoral ring and the femoral septum?
Femoral ring is the opening of the femoral canal.
The femoral ring is closed by a connective tissue layer which is the femoral septum.
108
What does the femoral canal contain?
Lympathic vessels
Deep lymph node
Empty space
Loose connective tissue
109
Why is the empty space of the femoral canal important?
It allows distension of the adjacent femoral vein so it can cope with increased venous return or with distension due to increased intra-abdominal pressure.
110
Anterior
Lateral
Posterior
borders of the adductor canal.
Anterior: Sartorius
Lateral: Vastus medialis
Posterior: Adductor longus and adductor magnus
111
What is the adductor canal?
A tunnel located in the thigh. Extending from the apex of the femoral triangle to the adductor hiatus of the adductor magnus.
Serves as a passageway for structures passing between the anterior thigh and the posterior leg.
112
What does the adductor canal contain?
Superficial femoral artery
Femoral vein
Nerve to vastus medialis
Saphenous nerve
113
What happens to the femoral artery and femoral vein when they pass through the adductor canal via the adductor hiatus?
They enter the popliteal fossa and become known as the politeal artery and the popliteal vein.
114
Roots of femoral nerve.
Posterior divsions of L2, L3 and L4.
115
Explain the route the femoral nerve takes from the lumbar plexus to the thigh.
Descends from the **_lumbar plexus_** in the abdomen passing through the fibres of **_psoas major._** Exits psoas major at the inferior part of its lateral border passing behind the fascia iliaca.
Passes behind **_inguinal ligament_** to enter the thigh. Splits into anterior and posterior division 4 cm below the inguinal ligament.
Passes through **_femoral triangle_** lateral to the femoral vessels. Gives off articular brahces to the hip and knee joints.
116
What is the terminal cutaneous branch of the femoral nerve?
The saphenous nerve which continues with the femoral artery and vein through the adductor canal.
117
What does the femoral nerve innervate?
All the muscles in the anterior compartment of the thigh.
Sartorius, iliacus, pectineus, rectus femoris, vastus intermedius, vastus lateralis, vastus medialis.
118
What are the first cutaneous branches to arise from the femoral nerve?
What do these branches supply?
The anterior cutaneous branches
Supply the skin on the anteromedial thigh.
119
The terminal cutaneous branch of the femoral nerve is the saphenous nerve.
What does it supply?
Saphenous nerve supplies the skin on the medial side of the leg and the foot.
120
Route of obturator nerve.
Formed by the anterior divsions of the second, third and fourth lumbar nerves in the lumbar plexus.
Descends through the fibres of the **_psoas major_** emerges from its medial border (femoral nerve emerged from the lateral border).
Runs posteriorly to the common iliac arteries and laterally along the pelvic wall to the obturator foramen.
Enter the thigh through the obturator canal.
Splits into the anterior and posterior divisions. The anterior division runs anterior to adductor brevis, the posterior division runs posterior to adductor brevis.
The anterior division supplies adductor brevis, adductor longus and gracilis, pierces fascia lata to become cutaneous branch of the obturator nerve.
The posterior division supplies both adductor brevis, adductor part of the adductor magnus.
121
What is the main artery of the lower limb?
The femoral artery
122
What does the common femoral artery arise from?
It is a continuation of the external iliac artery.
123
When does the external iliac artery turn into the common femoral artery?
When it crosses the inguinal ligament and enter the femoral triangle.
124
Common femoral artery gives off a branch. Which?
Where?
Profunda femoris or deep femoral artery.
In the femoral triangle.
125
Profunda femoris artery gives off three branches. Which?
What do they supply?
Lateral femoral circumflex artery (**_LCFA_**) which wraps around the anterolateral aspect of the proximal femur supplying the **_femoral neck and the head_**.
Medial femoral circumflex artery (**_MCFA**_) which wraps around the posterior aspect of the proximal femur supplying the _**femoral neck and the head_**.
**_Perforating branches_** which perforate the adductor magnus muscle and contribue to the blood supply of the muscles and the medial and posterior thigh.
126
What happens to the common femoral artery after it has given off the profunda femoris artery branch?
It changes its name to the superficial femoral artery.
127
What happens to the superficial femoral artery after it exits the femoral triangle?
It enters the adductor canal. It descends the thigh via the adductor canal and supply the anterior thigh muscles.
128
Where does the superficial femoral artery end?
It goes through the adductor hiatus and enters the posterior compartment of the thigh proximal to the knee joint. Here it becomes the popliteal artery.
129
Label
130
What is the medial compartment of the thigh supplied by (blood).
Obturator artery.
131
What does the obturator artery arise from and where does it enter the medial compartment of the thigh?
Arise from the internal iliac artery.
Enter via the obturator canal.
132
What is the gluteal region supplied by (blood)?
Superior and inferior gluteal arteries.
133
What do the superior and inferior gluteal arteries arise from and where do they enter the gluteal region?
Arise from the internal iliac artery.
Enter the gluteal region via the greater sciatic foramen.
134
Where do the superior and inferior gluteal arteries leave the greater sciatic foramen?
Superior: above the piriformis
Inferior: below the piriformis
135
What else does the inferior gluteal artery supply?
Contributes to the blood supply of the posterior thigh.
136
Route of the femoral vein. (Direction of the blood flow)
Popliteal vein enters the thigh via adductor hiatus. It now becomes the femoral vein.
It ascends **_adductor canal._**
Profunda femoris vein follows the course of the profunda femoris artery and via perforating veins blood drain from the thigh muscles.
The femoral vein then leaves the thigh by passing deep to the inguinal ligament, medial to the femoral artery at which point it becomes the external iliac vein.
137
What is the gluteal region drained by?
Inferior and superior gluteal veins. They follow the course of the superior and inferior gluteal arteries and empty into the internal iliac vein.
138
What is the medial compartment of the thigh drained by?
The obturator vein. Enter the pelvis through the obturator formaen along with obturator artery and nerve.
Terminates by draining into the internal iliac vein.
139
What are the deep veins of the thigh and gluteal region?
Femoral vein, profunda femoris vein, inferior and superior gluteal veins and obturator veins.
140
Two major superficial veins of the lower limb.
Great (long) saphenous vein and small (short) saphenous vein.
141
In what do the superficial veins of the lower limb run in?
In subcutaneous tissue.
142
Route of the great saphenous vein.
Formed by dorsal venous arch of the foot and dorsal vein of the great toe. Passes **_anteriorly to the medial malleolus_** at the ankle and ascends the leg medially. Passes posterior to the medial border of the patella at the knee and then ascends in the medial aspect of the thigh to pierce saphenous opening of the fascia lata.
Drains into the femoral vein at the saphenofemoral junction in the femoral triangle.
143
Route of the small saphenous vein.
Formed by the dorsal venous arch of the foot and the dorsal vein of the little toe.
Passes posterior to the **_lateral malleolus_**. Passes lateral to the achilles tendon. Will then ascend the **_posterior leg_**.
Passes between the two heads of gastrocnemius muscle to drain into the **_popliteal vein**_ at the _**saphenopopliteal junction_** in the popliteal fossa.
144
Label
145
Label
146
What can the superficial lympathic vessels be divided into?
Medial vessels which closely follow the course of the great saphenous vein and drain into the inferior group of superficial inguinal lymph nodes in the femoral triangle.
Lateral vessels which follow small saphenous vein drain into popliteal lymph nodes in popliteal fossa. Can also cross to join the medial vessels.
Efferent lymphatic vessels from the popliteal nodes follow the femoral vein and drain into the deep inguinal nodes.
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What are the main groups of deep lymphatic vessels?
What do they follow?
Anterior tibial, posterior tibial and peroneal.
They follow the corresponding arteries and enter the popliteal lymph nodes.
