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Clinical Anatomy of the knee
Mr CM Gupte Mr Alvin Chen
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Overview • Knee joint function • Surface anatomy • Bones • Ligaments • Tendons • Examination • Disease processes
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The Knee Joint
• Poorly constructed in terms of stability - femur round, tibia flat.
• Comprised of four bones. • Femur • Tibia • Fibula • Patella
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The knee joint
• Load bearing / Force transmission
• Locomotion
• Proprioception
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Bones • Patella: femur = patellofemoral
joint
• Femur: tibia = medial and lateral tibiofemoral joints
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Knee Arthroscopy Surface Landmarks
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Patella • Medial facet
• Lateral facet
• Articular cartilage
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Femur • Medial femoral
condyle
• Lateral femoral condyle (protrudes more)
• Trochlea
• Articular cartilage
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Femoral ligament insertions
• PCL inner aspect medial femoral condyle
• ACL inner aspect lateral femoral condyle
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Tibia • Medial and lateral
plateau
• Insertions of menisci and cruciate ligaments
• MCL/ semimembranosus
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Tibial plateau • Insertions of menisci/ • Cruciate ligaments
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Ligaments • Extracapsular: MCL/
LCL
• Intracapsular: ACL/PCL
Functions: • Stabilise • Proprioception
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ACL • Two bundles
• Prevents anterior drawer and pivot
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MRI
Normal ACL in RED Torn ACL
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Tests for ACL
Lachman’s Anterior Draw
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Arthroscopy
Intact ACL Torn ACL
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ACL Reconstruction
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PCL • Stronger than
ACL
• Prevents posterior drawer
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PCL injury
• Direct Blow onto Tibia on a flexed knee
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MRI PCL
Normal PCL PCL torn
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Posterior Sag from PCL rupture
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MCL • Medial • Prevents valgus stress • Deep and superficial parts • Heals well
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LCL • Lateral • Prevents varus stress • Cord like –weakest of the
ligaments but rarely torn in isolation
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Multiple Injuries
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Extensor mechanism
• Quadriceps • Patella • Patellar tendon
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Quadriceps
• VMO • Rectus femoris • Vastus intermedius • Vastus lateralis • Extend knee
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VMO • Medial most quad
• Helps prevent lateral dislocation of the patella
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Extensor Mechanism injuries I
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Extensor Tendon Injuries II
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Extensor Tendon Injuries III
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Hamstrings • Biceps laterally • Semitendinosus/semimembranosus
medially • Flex knee
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Pes • Sartorius • Gracilis
• Semitendinosus
• G and T used for ACL reconstruction
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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.
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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 .
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Examination • Look
• Feel • Move
• Think about structures and what you’re dong to them
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Diseases • OA • Meniscal tears • Ligament injuries • Patellofemoral tracking • Tendon injuries • Inflammatory arthritis • Infection/tumours
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Arthritic Knee X-ray
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Knee OA on arthroscopy
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Total Knee Replacement
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Patellofemoral Knee Replacement
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Unicondylar Knee Replacement
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Treatment of Meniscal Tears
Suture/ Repair Debridement
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Other Pathologies
Patella Maltracking Bone Tumour