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Clinical Anatomy of the knee

Clinical Anatomy of the knee. Mr CM Gupte Mr Alvin Chen. Overview. Knee joint function Surface anatomy Bones Ligaments Tendons Examination Disease processes. The Knee Joint. Poorly constructed in terms of stability - femur round, tibia flat. Comprised of four bones. Femur Tibia

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Clinical Anatomy of the knee

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  1. Clinical Anatomy of the knee Mr CM Gupte Mr Alvin Chen

  2. Overview • Knee joint function • Surface anatomy • Bones • Ligaments • Tendons • Examination • Disease processes

  3. The Knee Joint • Poorly constructed in terms of stability - femur round, tibia flat. • Comprised of four bones. • Femur • Tibia • Fibula • Patella

  4. The knee joint • Load bearing / Force transmission • Locomotion • Proprioception

  5. Surface Anatomy

  6. Bones • Patella: femur = patellofemoral joint • Femur: tibia = medial and lateral tibiofemoral joints

  7. Knee Arthroscopy Surface Landmarks

  8. Patella • Medial facet • Lateral facet • Articular cartilage

  9. Femur • Medial femoral condyle • Lateral femoral condyle (protrudes more) • Trochlea • Articular cartilage

  10. Femoral ligament insertions • PCL inner aspect medial femoral condyle • ACL inner aspect lateral femoral condyle

  11. Tibia • Medial and lateral plateau • Insertions of menisci and cruciate ligaments • MCL/semimembranosus

  12. Tibial plateau • Insertions of menisci/ • Cruciate ligaments

  13. Ligaments • Extracapsular: MCL/ LCL • Intracapsular: ACL/PCL Functions: • Stabilise • Proprioception

  14. ACL • Two bundles • Prevents anterior drawer and pivot

  15. ACL Injury

  16. MRI Normal ACL in RED Torn ACL

  17. Tests for ACL Lachman’s Anterior Draw

  18. Arthroscopy Intact ACL Torn ACL

  19. ACL Reconstruction

  20. PCL • Stronger than ACL • Prevents posterior drawer

  21. PCL injury • Direct Blow onto Tibia on a flexed knee

  22. MRI PCL Normal PCL PCL torn

  23. Posterior Sag from PCL rupture

  24. MCL • Medial • Prevents valgus stress • Deep and superficial parts • Heals well

  25. MCL Injury

  26. LCL • Lateral • Prevents varus stress • Cord like –weakest of the ligaments but rarely torn in isolation

  27. Multiple Injuries

  28. Extensor mechanism • Quadriceps • Patella • Patellar tendon

  29. Quadriceps • VMO • Rectus femoris • Vastus intermedius • Vastus lateralis • Extend knee

  30. VMO • Medial most quad • Helps prevent lateral dislocation of the patella

  31. Extensor Mechanism injuries I

  32. Extensor Tendon Injuries II

  33. Extensor Tendon Injuries III

  34. Hamstrings • Biceps laterally • Semitendinosus/semimembranosus medially • Flex knee

  35. Pes • Sartorius • Gracilis • Semitendinosus • G and T used for ACL reconstruction

  36. Movements of the Knee The principal muscles acting on the knee: • Extensors - quadriceps femoris • Flexors - hamstrings assisted by gracilis, gastrocnemius and sartorius. • Medial rotators- popliteus.

  37. Movements of the Knee • The principal knee movements are flexion and extension, but rotation of the knee is possible when the joint is in flexed position .

  38. Examination • Look • Feel • Move • Think about structures and what you’re dong to them

  39. Diseases • OA • Meniscal tears • Ligament injuries • Patellofemoral tracking • Tendon injuries • Inflammatory arthritis • Infection/tumours

  40. Arthritic Knee X-ray

  41. Knee Arthritis

  42. Knee OA on arthroscopy

  43. Total Knee Replacement

  44. Patellofemoral Knee Replacement

  45. Unicondylar Knee Replacement

  46. Meniscal Tears

  47. Treatment of Meniscal Tears Suture/ Repair Debridement

  48. Other Pathologies Patella Maltracking Bone Tumour

  49. Any Questions ?

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