The Knee Tibiofemoral Joint BY JACKIE STACEY GABE

The Knee (Tibiofemoral) Joint BY: JACKIE, STACEY, GABE, AND SCHARLIE

Bones and Surface Anatomy By: Jackie

KNEE (TIBIOFEMORAL) JOINT FEMUR: • Lateral Epicondyle • Lateral Condyle • Medial Epicondyle • Medial Condyle • Intercondylar Fossa TIBIA: • Lateral Condyle • Medial Condyle • Tibial Tuberosity • Intercondylar Eminence FIBULA: • Head PATELLA

SURFACE ANATOMY • Vastus Medialis • Vastus Lateralis • Patella

SURFACE ANATOMY • Biceps Femoris Tendon • Semitendinous Tendon • Semimembranous Tendon

SURFACE ANATOMY • Medial Head of Gastronemius • Lateral Head of Gastronemius • Soleus • Popliteal Fossa

Ligaments, Bursae, and Cartilage BY: STACEY

Ligament Review lig·a·ment a short band of tough, flexible, fibrous connective tissue that connects two bones or cartilages or holds together a joint. a membranous fold that supports an organ and keeps it in position.

Knee Ligaments Patellar Ligament Transverse Ligament Anterior Cruciate Ligament Oblique Popliteal Ligament Tibial Collateral Ligament Arcuate Popliteal Ligament Fibular Collateral Ligament Posterior Cruciate Ligament PTA OTA Fine People

Patellar Ligament Tibial Collateral Ligament Anterior Cruciate Ligament Posterior Cruciate Ligament

Oblique Popliteal Arcuate Popliteal Fibular Collateral

Tendon Review ten·don a flexible but inelastic cord of strong fibrous collagen tissue attaching a muscle to a bone.

Quadriceps Femoris Tendon

Cartilage Review firm, whitish, flexible connective tissue found in various forms in the larynx and respiratory tract, in structures such as the external ear, and in the articulating surfaces of joints.

Lateral and Medial Menisci

Bursa Review bur·sa plural noun: bursae a fluid-filled sac or saclike cavity, especially one countering friction at a joint.

Prepatellar Bursa Deep Infrapatellar Bursa Subcutaneous Infrapatellar Bursa

Suprapatellar Bursa

Muscles and Nerves TIBIOFEMORAL JOINT BY: GABE

Rectus Femoris

Rectus Femoris Origin: ASIS Insertion: Patella via quadriceps tendon and then the tibial tuberosity via patellar tendon (ligament) Action: Hip Flexion and knee extension Nerve: Femoral Nerve

Vastus Intermedialis

Vastus Intermedialis Origin: Anterior 2/3 and the lateral shaft of the femur Insertion: Patella via quadriceps tendon and then tibial tuberosity via patellar ligament Action: Knee Extension Nerve: Femoral Nerve

Vastus Lateralis

Vastus Lateralis Origin: Intertrochanteric line and linea aspera of the femur Insertion: Patella via quadriceps tendon then tibial tuberosity via patellar tendon (ligament) Action: Knee Extension Nerve: Femoral Nerve

Vastus Medialis

Vastus Medialis Origin: Linea aspera of the femur Insertion: Patella via the quadriceps tendon and the tibial tuberosity via the patellar tendon (ligament) Action: Knee extension Nerve: Femoral Nerve

Biceps Femoris

Biceps Femoris Origin: Long Head- Ischial tuberosity Short Head- Linea aspera of the femur Insertion: Head of the fibula and lateral condyle of the tibia Action: Long Head- Extends hip and flexes knee Short Head- Flexes knee and laterally rotates hip Nerve: Tibial Nerve

Semimembranosus

Semimembranosus Origin: Ischial tuberosity Insertion: Posterior medial condyle of the tibia Action: Extends and medial rotates the hip; Knee flexion Nerve: Tibial Nerve

Semitendinosus

Semitendinosus Origin: Ischial tuberosity Insertion: Proximal part of medial shaft of tibia Action: Extends and medially rotates hip; Flexes knee Nerve: Tibial nerve

Popliteus

Popliteus Origin: Lateral condyle of femur and lateral meniscus Insertion: Posterior surface of tibia Action: Unlocks knee and weakly flexes the knee Nerve: Tibial

Gastrocnemius

Gastrocnemius Origin: Lateral head- Lateral condyle of femur Medial Head- Superior to medial condyle of femur Insertion: Posterior calcaneus via calcaneal (Achilles) tendon Action: Plantar flexes ankle Nerve: Tibial

Tibiofemoral Nerves Sciatic Nerve Femoral Nerve Tibial Nerve Superficial Fibular (Peroneal) Nerve Deep Fibular (Peroneal) Nerve

Tibiofemoral Nerves

Vascular Supply ARTERIES AND VEINS THAT PASS THROUGH THE KNEE (TIBIOFEMORAL) JOINT By: Scharlie

Arteries: Inferior Gluteal Artery Branches from the Internal Iliac Artery. Leaves pelvis through the greater sciatic foramen and passes inferior to the piriformis. Inferior Gluteal Artery (CUT) Posterio r View Medial Circumflex Femoral Artery

Medial Circumflex Femoral Artery Branches Femur Posteriorly behind Lateral Circumflex Femoral Artery Branches Femur Anteriorly in front of Both may branch from profundus femoris or femoral arteries Both Anterior View encircle thigh, anastomose, and supply thigh muscles and proximal end of Femur. Inferior Gluteal Artery

Femoral Artery Femoral Continuation of External Iliac Artery distal to inguinal ligament. Popliteal Passes through adductor hiatus Artery and becomes Popliteal Artery Anterior View Popliteal Continuation Passes of Femoral Artery behind Posterior Knee Divides into anterior and posterior tibial arteries Gives Rise to Genicular Arteries Anterior Tibial Artery Posterior Tibial Artery

Popliteal Anterior Tibial Artery Branches from Popliteal Artery Passes anteriorly between Tibia and Fibula Runs down anterior/lateral aspect of Tibia Posterior Tibial Artery Branches from Popliteal Artery Continues down posterior aspect of lower leg Anterior Tibial Anterior View Posterio r Tibial Anterior Tibial Posterior View Fibular (Peroneal)

Fibular (Peroneal) Artery Braches Runs down lateral aspect of lower leg braches supply distal muscles Dorsalis Pedis Artery Continuation Begins Anterior Tibial Artery from Popliteal Artery Perforating Anterior View of foot of Anterior Tibial Artery at ankle joint between malleoli to top of foot Perforating Fibular Artery Dorsalis Pedis Artery

Veins: Anterior Tibial Vein Superior continuation of dorsalis Pedis Vein up anterior tibia until moving posterior to join posterior tibial vein Anterior Tibial Vein Runs Drains into Popliteal Vein Posterior Tibial Vein Drains into Popliteal Vein after joining the Anterior Tibial Vein Both supply calf and foot Anterior View

Fibular (Peroneal) Vein More posterior/lateral in lower leg Drains Femoral Vein into the Popliteal Vein Anterior and Posterior Tibial Veins join to form the Popliteal Vein Crosses back of knee and becomes Femoral Vein at thigh Femoral Vein Superior continuation of Popliteal Vein Becomes the External Iliac Vein in the inguinal region Fibular (Peroneal) Vein Anterior View

Small Saphenous Vein Runs along lateral aspect of foot and through the calf muscle Drains into Popliteal Vein at the knee Great Saphenous Vein Superficial and longest vein in the body Begins in common with Small Saphenous Vein in ankle Extends up medial side of calf, knee, and thigh Drains into the Femoral Vein Small Saphenous Vein Anterior View

Overview: Arteries and Veins Quiz 1. 3. 2. 4. 5.

Clinical Concerns for the Knee (Tibiofemoral) Joint TORN ACL, PLANTAR FASCIITIS, AND TKR By Scharlie TKR By Gabe

Torn ACL • The injury may occur with or without contact. Women have an increased risk of ACL injury because of differences in anatomy, muscle mass, and training. Symptoms of ACL tear include hearing a loud pop as the ligament tears, pain, knee swelling, and difficulty walking

Torn ACL Treatment options include: • Acute treatment: R. I. C. E • Nonsurgical treatment only: a physical rehab program. • ACL surgery to reconstruct the ACL (will still need physical therapy) Recovery from an ACL injury varies for each person. Your treatment should continue until your knee is stable and strong rather than for a certain length of time.

Plantar Fasciitis

Signs and Symptoms: When plantar fasciitis occurs, the pain is typically sharp and unilateral. Heel pain worsens by bearing weight on the heel after long periods of rest. Improvement of symptoms is usually seen with continued walking Risk Factors: Identified risk factors for plantar fasciitis include excessive running, standing on hard surfaces for prolonged periods of time, high arches of the feet, and flat feet. Obesity is seen in 70% of individuals with plantar fasciitis. Achilles tendon tightness and inappropriate footwear have also been identified as significant risk factors. Treatment: Non-surgical: (90% of cases)Include rest, heat, ice, calf-strengthening exercises, techniques to stretch the calf muscles, Achilles tendon, and plantar fascia, and weight reduction. Surgical: Plantar fasciotomy (release of fascia) is often considered after conservative treatment has failed to resolve the issue after six months and is viewed as a last resort.

Videos: Torn ACL Surgical Repair https: //www. youtube. com/watch? v=9 Eg. RHfole. Lc Dr. E. Edward Khalfayan, M. D. Total Knee Replacement Surgery http: //www. youtube. com/watch? v=H 9 Nr. Kyl. KMIY

Questions ? ? ? ? ?

Resources: Google Images: https: //www. google. com/search? q=anatomy+and+physiology&biw=1366&bih=650&source=lnms&tbm=isch&sa=X&ei=WItt. V OG 2 DKWQig. LJr 4 CYDQ&ved=0 CAYQ_AUo. AQ Moore KL, Agur AM, Dalley AF, Essential Clinical Anatomy. 4 th ed. Baltimore, MD: Lippincott Williams & Wilkins; 2011. Pearson Learning Solutions Lab Manual, Integrate Anatomy & Physiology: Pearson Learning Solutions; 2011. Youtube: http: //www. youtube. com/watch? v=H 9 Nr. Kyl. KMIY https: //www. youtube. com/watch? v=9 Eg. RHfole. Lc Google Web http: //www. mayoclinic. org/diseases-conditions/plantar-fasciitis/basics/definition/con-20025664# http: //www. webmd. com/a-to-z-guides/anterior-cruciate-ligament-acl-injuries-treatment-overview