Knee & ankle joints · 2020. 11. 2. · IMPORTANCE Both joints are essential for competing in...

KNEE & ANKLE JOINTSKhaleel Alyahya, PhD, MEdwww.khaleelalyahya.net

RESOURCES

ESSENTIAL OF HUMAN ANATOMY & PHYSIOLOGY

By Elaine Marieb and Suzanne Keller

ATLAS OF HUMAN ANATOMY

By Frank Netter

GRAY’S ANATOMY

By Richard Drake, Wayne Vogl & Adam Mitchell

KENHUB

www.kenhub.com

2

IMPORTANCE

Both joints are essential for competing in almost every sport.

Both are the most common sites for injury in young athletes.

knee injuries make up about 55% of all sports injuries.

Both are threatening athletes and destroy their professionalcareers.

Healing requires long time with intensive health care.

The huge amount of pain in both joints during injuries isscary.

Rehabilitation is very important in both joints, and bothcould effect athletes from restoring their level of profession.

3Khaleel Alyahya, PhD, MEd

Ronaldo


Severe recurrent knee injuries

Retired at age 29 due to severe ankle injuries

Van Basten

Khaleel Alyahya, PhD, MEd

KNEE JOINTKhaleel Alyahya, PhD, MEdwww.khaleelalyahya.net

INTRODUCTION The knee joint is the largest in the body, and

one of the most easily injured.

It is a hinge type synovial joint, which mainlyallows for flexion and extension (with a smallof medial and lateral rotation).

It is formed by articulations between thepatella, femur and tibia.

It is made up of four main things: bones,cartilage, ligaments, and tendons, any ofwhich can be injured.

The most common knee injuries includefractures around the knee, dislocation,sprains and tears of soft tissues likeligaments.

In most cases, injuries involve more than onestructure in the knee.


ARTICULATING SURFACES

Both joints are essential for competing in almost every sport.

This joint consists of two articulations:• Tibiofemoral: medial and lateral condyles of the femur

articulating with the tibial condyles.

• Patellofemoral: anterior aspect of the distal femur articulatingwith the patella.

The tibiofemoral joint is the weight-bearing joint of the knee.

The patellofemoral joint allows the tendon of the quadricepsfemoris (the main extensor of the knee) to be inserteddirectly over the knee, increasing the efficiency of themuscle.

Both joint surfaces are lined with hyaline cartilage andenclosed within a single joint cavity.


TYPES OF ARTICULATING

The joint between the femur & the tibia is a synovialhinge joint, with some degree of rotatorymovement.

The joint between the femur and patella is a synovialplane gliding joint.


THE CAPSULE The knee joint capsule is the structure surrounding the knee,

made up of ligaments, bones, and fluid-filled cavities.

It allows the full knee to have flexion or bending motion.

The capsule is attached to the margins of the articular surfacesand surrounds the sides and the posterior aspect of the joint.

The capsule is absent anteriorly.

• replaced anteriorly by quadriceps tendon, patella & ligamentumpatellae.

It consists of two layers:

• the outer fibrous membrane that contain ligaments.

• the inner synovial membrane that secretes the lubricating.

The capsule is strengthened on each side of the patella byexpansions of the tendons of vastus lateralis and medialis, andposteriorly by the expansion of the semimembranosus muscleand oblique popliteal ligament.


SYNOVIAL MEMBRANE

A specialized connective tissue that lines the inner surfaceof capsules of synovial joints and tendon sheath.

It makes direct contact with the fibrous membrane on theoutside surface and with the synovial fluid lubricant on theinside surface

It attached to the margins of the articular surfaces.

Lines the interior of the capsule.

Forms several bursae around the joint.


LIGAMENTS OF KNEE

EXTRACAPSULAR LIGAMENTS

Ligamentum Patellae: between the lower border of the

patella & the tuberosity of thetibia.

It is a continuation of the tendonof quadriceps femoris.

Lateral (Fibular) Collateral Ligament: between the lateral condyle of

femur and the head of the fibula.

Medial (Tibial) Collateral Ligament: between the medial condyle of the

femur and medial side of the shaftof the tibia.

Oblique Popliteal Ligament: strengthens the posterior side of

the capsule.

12

INTRACAPSULAR LIGAMENTS

Anterior Cruciate Ligament: Between the anterior intercondylar

area of the tibia and the posteriorpart of the medial surface of thelateral femoral condyle.

Function: prevents posteriordisplacement of the femur on thetibia.• In flexed knee, prevents the tibia from

being pulled anteriorly.

Posterior Cruciate Ligament: Between the posterior intercondylar

area of the tibia and the anterior partof the lateral surface of the medialfemoral condyle.

Function: prevents anteriordisplacement of the femur on thetibia.• In flexed knee, prevents the tibia from

being pulled posteriorly.

Khaleel Alyahya, PhD, MEd 10

MENISCI

It is C shaped and attached at both ends tothe intercondylar area of the tibia.

The peripheral border is thick and attached to the capsule,the inner border is thin and free.

Each meniscus is attached to the upper surface of the tibiaby anterior and posterior horns.

The medial meniscus is firmly attached to the medialcollateral ligament.

Function: to deepen the articular surface of the tibialcondyles and to serve as shock absorber.


BURSAE

The bursa is a synovial fluid filled sacfound between moving structures in a joint with the aim ofreducing wear and tear on those structures.

There are four bursae found in the knee joint.

Anterior

• Suprapatellar: located beneath the quadriceps femoris.

• Prepatellar: located between the skin and the patella.

• Superficial infrapatellar: located between the skin and thelower part of ligamentum patellae.

• Deep infrapatellar: located between ligamentum patellaeand the tibia.

Posterior

• Popliteal: located beneath the tendon of popliteus muscle

• Semimembranosus: located under the tendon ofsemimembranosus muscle.


MOVEMENTS

Flexion:

• Biceps femoris, semitendinosus and semimembranosus,assisted by gracilis, sartorius and popliteus. Limited by contactwith the back of thigh.

Extension:

• Quadriceps femoris. Limited by tension of the joint ligaments.

Medial Rotation:

• Sartorius, gracilis and semitendinosus.

Lateral Rotation:

• Biceps femoris.

Stability of the joint:

• Dependent on the tone of the muscles and the strength of theligaments.

o NB: Lateral and medial rotation can only occur when the knee is flexed (if theknee is not flexed, the medial/lateral rotation occurs at the hip joint).


BLOOD CIRCULATION

The blood supply to the knee joint is through the genicularanastomoses around the knee.

The blood is provided to the knee joint by the branches of thefemoral and popliteal arteries.

The blood drainage of the knee on the posterior surface of theknee made by the anterior tibial, posterior tibial and fibularveins that unite to form the popliteal vein.

The popliteal vein enters the thigh via the adductor canal.


INNERVATION

The innervation to the knee joint is provided by the nerves thatsupply the muscles which cross the joint.

These are the femoral, tibial and common fibular nerves.


KNEE INJURIES

18

KNEE INJURY

In sports, with a great pressure on the knees, especially withtwisting forces, it is common to tear one or more ligaments orcartilages.

Some of the most common knee injuries are those to themedial side: medial knee injuries.

Anterior Cruciate Ligament (ACL) is the most commonly injuredligament of the knee.

The injury is common during sports.

Twisting of the knee is a common cause of over-stretching ortearing the CLs


INJURY OF COLLATERAL LIGAMENTS

Injury to the collateral ligaments is the most commonpathology affecting the knee joint.

It is caused by a force being applied to the side of the kneewhen the foot is placed on the ground.

Damage to the collateral ligaments can be assessed by askingthe patient to medially rotate and laterally rotate the leg.

Pain on medial rotation indicates damage to the medialligament, pain on lateral rotation indicates damage to thelateral ligament.

If the medial collateral ligament is damaged, it is more thanlikely that the medial meniscus is torn, due to their attachment.


CRUCIATE LIGAMENTS

The anterior cruciate ligament (ACL) can be tornby hyperextension of the knee joint, or by the application of alarge force to the back of the knee with the joint partly flexed.

To test for this, you can perform an anterior drawer test, whereyou attempt to pull the tibia forwards, if it moves, the ligamenthas been torn.

The most common mechanism of posterior cruciate ligament(PCL) damage is the “dashboard injury”.

This occurs when the knee is flexed, and a large force is appliedto the shins, pushing the tibia posteriorly.

The posterior cruciate ligament can also be torn byhyperextension of the knee joint, or by damage to the upperpart of the tibial tuberosity.

Signs and symptoms can include pain, swelling and instability.


BURSITIES

Friction between the skin and the patella cause the prepatellarbursa to become inflamed, producing a swelling on the anteriorside of the knee. This is known as housemaid’s knee.

Similarly, friction between the skin and tibia can cause theinfrapatellar bursae to become inflamed, resulting in what isknown as clergyman’s knee (classically caused by clergymenkneeling on hard surfaces during prayer).


OTHER TYPES OF KNEE INJURIES

Fractures• The most common bone broken around the knee is the patella.

The ends of the femur and tibia where they meet to form theknee joint can also be fractured.

Dislocation• A dislocation occurs when the bones of the knee are out of place,

either completely or partially. For example, the femur and tibiacan be forced out of alignment, and the patella can also slip out ofplace.

Tendon Tears• The quadriceps and patellar tendons can be stretched and torn.


ANKLE JOINTKhaleel Alyahya, PhD, MEdwww.khaleelalyahya.net

INTRODUCTION The ankle joint (or talocrural joint) is a

synovial hinge joint located in the lowerlimb.

It is formed by the bones of the leg (tibia andfibula) and the foot (talus).

Functionally, it is a hinge type joint,permitting dorsiflexion and plantarflexion ofthe foot.


ARTICULATING SURFACES

The ankle joint is formed by three bones; the tibia and fibula ofthe leg, and the talus of the foot:

The tibia and fibula are bound together by strong tibiofibularligaments.

Together, they form a bracket shaped socket, covered in hyalinecartilage. This socket is known as a mortise.

The body of the talus fits snugly into the mortise formed by thebones of the leg.

The articulating part of the talus is wedge shaped – it is broadanteriorly, and narrow posteriorly:

Dorsiflexion – the anterior part of the talus is held in themortise, and the joint is more stable.

Plantarflexion – the posterior part of the talus is held in themortise, and the joint is less stable.


LIGAMENTS There are two main sets of ligaments, which originate from each

malleolus.

Medial Ligament• The medial ligament (or deltoid ligament) is attached to the medial

malleolus (a bony prominence projecting from the medial aspect of thedistal tibia).

• It consists of four ligaments, which fan out from the malleolus, attaching tothe talus, calcaneus and navicular bones.

• The primary action of the medial ligament is to resist over-eversion of thefoot.

Lateral Ligament• The lateral ligament originates from the lateral malleolus (a bony

prominence projecting from the lateral aspect of the distal fibula).

• It resists over-inversion of the foot, and is comprised of three distinct andseparate ligaments:

o Anterior talofibular – spans between the lateral malleolus and lateralaspect of the talus.

o Posterior talofibular – spans between the lateral malleolus and theposterior aspect of the talus.

o Calcaneofibular – spans between the lateral malleolus and the calcaneus.


MOVEMENTS

The ankle joint is a hinge type joint, with movement permittedin one plane.

Thus, plantarflexion and dorsiflexion are the main movementsthat occur at the ankle joint.

Eversion and inversion are produced at the other joints of thefoot, such as the subtalar joint.

Plantarflexion – produced by the muscles in the posteriorcompartment of the leg (gastrocnemius, soleus, plantaris andposterior tibialis).

Dorsiflexion – produced by the muscles in the anteriorcompartment of the leg (tibialis anterior, extensor hallucislongus and extensor digitorum longus).


BLOOD SUPPLY & INNERVATION

The arterial supply to the ankle joint is derived from themalleolar branches of the anterior tibial, posterior tibial andfibular arteries.

Venous blood is drained through the corresponding veins.

Innervation is provided by tibial, superficial fibular and deepfibular nerves.


ANKLE INJURIES

ANKLE SPRAIN

An ankle sprain refers to partial or complete tears in theligaments of the ankle joint.

It usually occurs via excessive inversion to a plantarflexed andweight-bearing foot.

The lateral ligament is more likely to be damaged for two mainreasons:

• The lateral ligament is weaker than the medial ligament.

• The lateral ligament resists inversion.

The anterior talofibular ligament is the lateral ligament most atrisk of irreversible damage.


ANKLE DISLOCATION

A Pott’s fracture is a term used to describe a bimalleolar (medialand lateral malleoli) or trimalleolar (medial and lateral malleoli,and distal tibia) fracture.

This type of injury is produced by forced eversion of the foot.

It occurs in a series of stages:

• Forced eversion pulls on the medial ligaments, producing anavulsion fracture of the medial malleolus.

• The talus moves laterally, breaking off the lateral malleolus.

• The tibia is then forced anteriorly, shearing off the distal andposterior part against the talus.


[email protected]

www.khaleelalyahya.net

Knee & ankle joints · 2020. 11. 2. · IMPORTANCE Both joints are essential for competing in...

Documents

Transcript of Knee & ankle joints · 2020. 11. 2. · IMPORTANCE Both joints are essential for competing in...