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ANAT315 - Thigh & Knee Joint
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82
Anatomy
Undergraduate 3
11/23/2011

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Term
Linea Aspera
Definition
Set of parallel lines on posterior femur
Proximally, lines diverge to form lesser trochanter (medial) and gluteal tubercle (lateral)
Distally, lines diverge to form medial and lateral epicondyles
Term
On which side are the femoral condyles more prominent?
Definition
More prominent posteriorly
Term
Adductor Tubercle
Definition
Insertion point for most muscles in medial compartment of the thigh (adductors)
Located on the medial epicondyle of the femur
Term
What separates the femoral condyles vs. the tibial condyles?
Definition
Femoral = intercondylar notch
Tibial = intercondylar eminence
Term
Proximal Tibiofibular Joint
Definition
Head of the fibula nestles under the lateral tibial condyle
Term
IT band
Definition
Lateral thickening of the fascia lata of the thigh
Inserts onto Gerdy's tubercle on the lateral tibia
Term
Sartorius
Definition
O - ASIS
I - Goose's foot on the medial tibial condyle
A - FLEX at hip, FLEX at knee
I - femoral nerve (L2-L4)
Term
Rectus Femoris
Definition
O - AIIS
I - superior border of patella to insert on tibial tuberosity via patellar tendon
A - FLEX at hip, EXTEND at knee
I - femoral nerve
Term
Vastus Lateralis
Definition
O - lateral side of proximal femur (lateral to linea aspera)
I - lateral side of patella (more proximal than VM insertion)
A - EXTEND at knee
I - femoral nerve
Term
Vastus Medialis
Definition
O - medial side of proximal femur (medial to linea aspera)
I - medial side of patella (more distal than VI insertion)
A - EXTEND at knee
I - femoral nerve
Term
Why is the VM insertion more distal than the VI insertion?
Definition
To keep the patella in front of the knee
Term
Vastus Intermedius
Definition
O - proximal, anterior femur (deep to RF)
I - superior border of patella (deep to RF)
A - EXTEND at knee
I - femoral nerve
Term
Iliopsoas
Definition
O - inner portion of ileum (iliacus), T-processes of L-vertebrae (psoas major)
I - lesser trochanter
A - FLEX at hip (very strong hip flexor)
I - branches from lumbar plexus (L2, L3)
Term
Borders of the Femoral Triangle
Definition
Base = inguinal ligament
Lateral = sartorius
Medial = adductor longus
Term
What structures pass through the femoral triangle?
Definition
The femoral artery, vein and nerve
Term
Structures running through the femoral canal (lateral to medial)
Definition
Femoral Nerve, Femoral Artery, Vein, Empty (Fat), Lymphatics

NAVEL
Term
Which structures do/do not pass under the femoral sheath?
Definition
Femoral Nerve -> does not pass under femoral sheath (passes lateral to it)
Artery -> passes through lateral compartment of sheath
Vein, Fat & Lymphatics -> pass through medial compartment of sheath
Term
Structures running through the femoral canal (lateral to medial)
Definition
Femoral Nerve, Femoral Artery, Vein, Empty (Fat), Lymphatics

NAVEL
Term
Inguinal Ligament
Definition
Separates the abdominal & gluteal compartments
Runs between ASIS & pubis
Border which designates external iliac becoming the femoral artery
Term
Passage of the femoral artery through gluteal region & thigh
Definition
Passes inferior to the inguinal ligament
Travels through the lateral compartment of the femoral sheath, through femoral triangle into the subsartorial canal
Passes through adductor hiatus to become popliteal artery
Term
Branches of the femoral artery and what they supply
Definition
Medial Femoral Circumflex - posterior thigh & hip
Lateral Femoral Circumflex - anterior thigh & hip
Profunda Femoris - largest & deepest; sends perforating branches to posterior compartment
Term
Where does the saphenous nerve branch from and what does it supply?
Definition
Branches from the femoral nerve; supplies the skin of the inside of the LEG
Term
Layers of the medial thigh
Definition
Anterior - gracilis, pectineus, adductor longus
Posterior - adductor brevis & magnus
Term
Where do all of the adductors of the thigh originate?
Definition
The pubis
Term
Pectineus
Definition
O - pubis
I - uppermost insertion on medial lip of linea aspera
A - adduct thigh
I - obturator AND femoral nerves
Term
Gracilis
Definition
O - pubis
I - medial tibial condyle @ goose's foot
A - adduct, flex, and medially rotate the thigh
I - obturator nerve (L2-L4)
Term
Which muscles medially/laterally rotate the thigh?
Definition
Medial = gluteus medius & minimus, gracilis
Lateral = piriformis, obturator internus & externus, gemellus superior & inferior, quadratus femoris, gluteus maximus
Term
Muscles which flex the thigh at the hip?
Definition
Rectus femoris, iliopsoas, gracilis, sartorius
Term
Adductor Longus
Definition
O - pubis
I - below pectineus insertion on medial lip of linea aspera
A - adduct thigh
I - obturator nerve
Term
Adductor Brevis
Definition
O - pubis
I - behind pectineus insertion on medial lip of linea aspera
A - adduct thigh
I - obturator nerve
Term
Adductor Magnus
Definition
O - pubis
I - medial lip of linea aspera (top) & adductor tubercle on medial epicondyle of femur (bottom)
A - adduct thigh
I - obturator (top) and tibial branch of sciatic nerve (bottom)
Term
How do the perforating branches of the profunda femoris reach the posterior compartment?
Definition
Through holes in the adductors of the thigh
Term
Main blood supply to the medial compartment of the thigh
Definition
OBTURATOR ARTERY - branch from internal iliac; enters compartment via obturator canal
Term
Branches of the obturator nerve and what they supply...
Definition
Anterior - gracilis, pectineus, adductor longus + brevis, hip
Posterior - adductor magnus + knee
Term
Criteria for a true hamstring
Definition
- Origin on the ischial tuberosity
- Cross the hip & knee joints (extend at hip, flex at knee)
- Innervated by tibial branch of sciatic
Term
Biceps Femoris
Definition
Most lateral posterior muscle of the thigh
O - ischial tuberosity (long head), linea aspera (short head)
I - head of fibula
A - EXTEND at hip (long), FLEX at knee (both)
I - tibial branch of sciatic (long) and common peroneal (fibular) branch of sciatic (short)
Term
Semimembranosus
Definition
O - ischial tuberosity
I - behind medial tibial condyle
A - EXTEND at hip, FLEX at knee
I - tibial branch of sciatic nerve
Term
Semitendinosus
Definition
O - ischial tuberosity
I - goose's foot of medial tibial condyle
A - EXTEND at hip, FLEX at knee
I - tibial branch of sciatic nerve
Term
Borders of the popliteal fossa
Definition
Upper = hamstrings
Lower = gastrocnemius
Term
Location of popliteal fossa
Definition
Above and behind the knee
Term
Classification of the knee
Definition
Modified hinge joint; synovial
Term
Movements at the knee joint
Definition
UNIAXIAL when flexed (flex/ex)
BIAXIAL when extended (flex/ex, medial/lateral rotation)
Term
What movements allow for locking/unlocking of the knee?
Definition
Medial & lateral rotation at the knee which can occur when the knee is extended
Term
Which set of condyles are larger on the femur & tibia?
Definition
Medial condyles
Term
Menisci
Definition
Cartilage on borders of tibial condyles to aid in articulation w/ femoral condyles
Lateral & medial menisci at the knee joint
Term
Lateral Meniscus
Definition
C-shaped (circular); only attached at 2 ends
Moves ANTERIOR/POSTERIOR during extension
Term
Medial Meniscus
Definition
More elliptical; attached throughout -> therefore more likely to be injured b/c it cannot move
Term
The Knee Joint in Embryos
Definition
Actually have 2 joints
Prior to birth, joints fuse ANTERIORLY; form anterior joint space and the popliteal fossa posteriorly
Term
Suprapatellar Bursae
Definition
Located superior to the patellar femoral joint; important with DEEP FLEXION
Term
Medial Collateral Ligament of the Knee
Definition
Bipartite (superficial and deep ligaments)
Deep = fan-shaped; forms fibrous capsule
Superficial = cord-shaped; from medial femoral condyle to tibial shaft
Term
Lateral Collateral Ligament of the Knee
Definition
Cord-shaped from lateral femoral condyle to head of fibula
Term
Where are the cruciate ligaments located?
Definition
Between the two halves of the joint, NOT within the joint space itself
Term
Anterior Cruciate Ligament
Definition
From medial tibial condyle to the lateral femoral condyle
Prevents backward dislocation & hyperextension
Term
Posterior Cruciate Ligament
Definition
From back of tibial intercondylar eminence to the medial femoral condyle
Prevents forward dislocation
Term
Which ligaments aid in the locking of the knee and how do they do so?
Definition
ACL, PCL, MCL, LCL
When the knee nears full extension, slight medial rotation tightens ligaments
Term
Branches of the popliteal artery at the knee
Definition
3 pairs of GENICULATE arteries - superior, middle, inferior
Term
Articular Surfaces of the Knee
Definition
When EXTENDED -> bottom of femur is FLAT
When FLEXED -> posterior side of femoral condyles is CURVED (helps w/ movement)
Term
Which surfaces of the femoral condyles articulate w/ the tibia during flexion/extension of the leg?
Definition
During extension - flat area on the inferior aspect articulates
During flexion - curved areas on the posterior aspect of the condyles articulates
Term
What is the largest sesamoid bone of the body?
Definition
The patella
Term
What is used as a fulcrum by the quads during extension?
Definition
The patella
Term
What are the articular surfaces of the knee?
Definition
Femoro-patellar = posterior latella and anterior of distal femur
Femoro-tibial = between femoral condyles & tibial plateau; 2 per knee - flat (during extension), rounded (during flexion)
Term
Knee locking muscle?
Definition
Popliteus
Term
Difference between locking and unlocking of the knee?
Definition
Locking - PASSIVE; reduces amount of work needed to maintain stance
Unlocking - ACTIVE; by the popliteus muscle (popliteus resists lateral rotation of knee to prevent locking)
Term
Which is the weaker of the 2 cruciate ligaments?
Definition
ACL
Term
Function of the ACL/PCL:
Definition
ACL - prevents anterior displacement of tibia/posterior displacement of femur
PCL - prevents posterior displacement of tibia/anterior displacement of femur
Term
Where do the ACL & PCL both originate?
Definition
On the tibia
Term
How many sets of bursae are at the knee?
Definition
3 - suprapatellar (superior), infrapatellar (inferior; have deep AND subcutaneous), prepatellar (anterior)
Term
What are the medial and lateral menisci attached to?
Definition
The tibial condyles
Term
Which direction does the lateral meniscus move during extension?
Definition
Anterior/posterior
Term
Which way does the medial meniscus move during extension?
Definition
DOES NOT MOVE b/c it is completely attached to the tibia (more likely to be damaged)
Term
Blood supply to the knee joint?
Definition
The popliteal artery gives off 3 pairs of geniculate arteries
Term
Floor of the femoral triangle?
Definition
Pectineus
Term
Which areas were likely damaged in the soccer injury?
Definition
The ACL, MCL and medial meniscus (known as "unhappy triad")
Term
What was the result of the damage to the soccer player?
Definition
Severe pain on medial side of knee
Unstable knee (unless locked in extension)
Positive Lachman test
Term
What does stress from a blow to the lateral knee usually result in?
Definition
Tearing of the MCL and medial meniscus
Term
What is the most sensitive test for an ACL rupture?
Definition
Lachman test
Term
Why does a blow to the medial side of the knee not usually damage BOTH the LCL and lateral meniscus?
Definition
It is because the LCL and lateral meniscus are not attached, they are separated by the tendon of the popliteus
In contrast, they medial meniscus and MCL are attached so they are typically injured together w/ a lateral blow to the knee.
Term
How is a Lachman test performed?
Definition
Bend knee at approx. 30 degrees
Stabilize femur & place other hand behind proximal tibia and pull tibia forward.
Amount of anterior movement (laxity of joint) indicates rupture
Term
Path of sciatic nerve at popliteal fossa:
Definition
Bifurcates into the tibial and common peroneal nerves
Tibia travels straight down middle of fossa
Common peroneal follows biceps tendon to lateral border of fossa
Term
When is the patella able to wiggle?
Definition
When the knee is locked (at extension)
Can wiggle patella because muscles are relaxed in this state
Term
Rotation of the humerus in which direction causes the ligaments of the knee to tighten?
Definition
Medial rotation of humerus causes ACL, PCL, LCL, MCL to tighten and secure joint
Term
Soleal line of tibia is analogous to....
Definition
Oblique line on radius
Soleal line = origin of soleus, which is similar in origin to the FDS of the upper limb
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