Anatomy of Hip and Knee joints - PowerPoint Presentation

1. Anatomy of Hip and Knee jointsDr Ashraf Sadek PhD, MD, MRCPCH.Assistant Professor of anatomy and embryology.

2. The Hip JointType : synovial ball & socketArticular surfaces:(1) acetabulum of hip bone(2) head of femur

3. AcetabularnotchAcetabular fossaHyaline cartilageLabrumacetabulareTransverseAcetabularligamentHead offemurFovea of head offemurLigament of head of femurLunate surface

4. Fibrous capsule of hip jointAttachment:To margins of acetabulum outside labrum acetabulare & transverse acetabular ligamentTo neck of femur  anteriorly to intertrochanteric line & posteriorly one cm above intertrochanteric crest

5. 1 cmIntertrochantericcrest

6. Retinacula of neck of femur:Some fibers of the capsule are reflected along the neck of femur as longitudinal bands  retinaculaFunction of retinacula:In fracture neck of femur, retinacula helps to keep the broken fragments of bone together.Blood vessels pass along these retinacula to supply the head of femur

7. RetinaculaCapsuleBlood supply to head of femurChief blood supply to head of femur is from medial circumflex femoral arteryLateral circumflex femoral also supplies the head of femur.Obturator artery gives a branch which passes through ligament of head of femur to supply the head as well. In case of fracture neck of femur interruption to retinacular blood supply avascular necrosis of femoral headLCFMCFObturator a

8. Capsule of hip joint is strengthened from outside by 3 ligaments:Iliofemoral ligament adherent to front of capsulePubofemoral adherent to inferomedial part of capsuleIschiofemoral  adherent to back of capsule

9. AIISIliofemoral ligament:The strongest ligament in the body Y shaped:Stem of Y  AIIS2 bands  intertrochanteric line of femurFunction supports joint anteriorly & prevents hyperextensionThere is a tendency for hyperextension to occur in the hip joint as the line of body weight behind the center of the joint. Its medial band limits abduction, while its lateral band limits adduction & lateral rotation of the joint

10. 2) Pubofemoral ligament:Attached above to:Iliopectineal eminence & superior pubic ramus Below  blends with iliofemoral ligFunction : supports joint inferomedially & limits abduction

11. 3) Ischiofemoral ligament:Lies on posterior aspect of capsuleAttached above to ischium Below blends with iliofemoral ligamentFunction:Supports joint posteriorly and limits medial rotation

12. Ligament of head of femur:Base attached to acetabular notch & transverse acetabular ligamentApex attached to fovea of head of femurFunction: transmits a branch from obturator artery to head of femur

13. Synovial membrane: lines inner surface of capsuleCovers all intracapsular structures, except the articulating surfaces

14. Important relations of hip jointAnteriorly :1) Pectineus separating it from femoral vein2) Iliopsoas separating it from femoral artery & nervePosteriorly: piriformis, obt int & 2 gemelli separating it from sciatic nerve

15. Pectineus Femoral vFFemoral arteryFemoral nerveObturator int& 2 gemelliSciatic niliopsoasPiriformis

16. Stability of hip jointIt is a stable joint due to :1) Bony factor: Acetabulum is deep & well cupped to accommodate the femoral headLabrum acetabulare deepens the acetabulumLong & oblique femoral neck allows the lower limb to move freely away from the pelvis2) Strong ligaments3) Large & strong muscles around hip joint

17. Clinical noteHip could be dislocated as in car accidents, where it is usually a posterior dislocation sciatic nerve injury since the nerve lies posterior to the joint

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19. Nerve supplyFemoral nerve ( nerve to rectus femoris)Obturator nerve ( anterior division)Accessory obturator nerve ( if present )Nerve to quadratus femoris Superior gluteal nerve

20. Arterial supplyObturator artery Lateral & medial circumflex femoral arteries (ascending brs)

21. Profunda femoris aLateralCircumflex femoralMedial circumflexfemoralObturator a

22. The Knee JointType :Synovial bicondylarModified hinge synovial jointCompound joint:3 bones femoro - patellar femoro- tibial

23. Movements of hip jointMovementMain muscles1) flexionPsoas major & iliacus (Iliopsoas)  most important + sartorius, rectus femoris& pectineus2) extensionGluteus maximus + hamstrings3) abductionGluteus medius& minimus + sartorius & tensor fasciae latae4) adductionAdductors longus, brevis & magnus + gracilis & pectineus5) Medial rotationAnterior fibers of glutei medius & minimus 6) Lateral rotation6 lat rotators + gluteus maximus

24. Articular surface of femurPatellar SurfaceTibial SurfaceTibial SurfaceIntercondylar notch

25. Articular surface of tibiaMedialcondyleLateralcondyleIntercondylar area

26. Patellaarticular surface of patella  posterior surfaceAnterior viewPosterior view

27. The fibrous capsuleAnteriorly the capsule is absent & is replaced by quadriceps tendon, patella, patellar retinacula & ligamentum patellae

28. The synovial membraneMore extensive than any other joint due to large size & complexity of knee joint“Lines the inner surface of capsule & covers everything inside the joint except the articulating surfaces”Extends deep to quadriceps tendon forming suprapatellar bursaReflected to cover both menisciThe synovialmembrane

29. Quadriceps tendonSuprapatellar bursa

30. Ligaments of knee jointVery ImportantExtracapsular ligamentsIntracapsular ligamentsLigamentum patellaeAnterior cruciateTibial (Medial) collateral ligamentPosterior cruciateFibular (Lateral) collateral ligamentTransverse ligament of the knee jointPosterior oblique ligament

31. Extracapsular ligamentsLigamentum patellae:Extension of quadriceps tendon to insert into tibial tuberosity

32. Tibial collateral ligamentLies on medial aspect of knee joint It is firmly adherent to the capsule & medial meniscus

33. Fibular collateral ligamentLies on lateral aspect of knee jointIt is not adherent to capsule or lateral meniscus but is separated from them by tendon of popliteus

34. Fibular collateralligamentLateral meniscusTendon of popliteusFIBULA

35. Tibial collateral ligament is attached to medial meniscusFibular collateral ligamentis separated from lateral meniscus

36. The posterior oblique ligamentFormed by fibers reflected from insertion of semimembranosus

37. Intracapsular ligamentsThe cruciate ligaments: They are 2 ligaments anterior & posterior which form an X shaped figure in intercondylar notchVery strong ligaments which connect intercondylar area of tibia with intercondylar notch of femur

38. Medial meniscusLateral meniscusMENISCI

39. Posterior cruciate lig.Anterior cruciate lig.Cruciate ligaments

40. Posterior cruciate ligamentAttached to the most post. part of the post. intercondylar area of tibia behind post. horns of both menisciIt extends upwards, forwards & medially to attach to medial condyle of femurIt is stronger than ant. cruciate ligamentIt becomes tense during flexion of kneeIn the weight bearing flexed knee as in walking down the stairs, it is the main factor stabilizing the femur

41. Anterior cruciate ligamentAttached to anterior intercondylar area of tibia behind anterior horn of medial meniscus Passes upwards, backwards & laterally to attach to lat. condyle of femurBecomes tense during extension of knee joint  prevents hyperextension of knee joint

42. 165432TIBIAL PLATEAUFrom ant. to post.:Ant. horn of med. meniscusAnt. cruciateAnt. horn of lat. meniscus4) Post. horn of lat. meniscus5) Post. horn of medial meniscus6) Posterior crucuateTibia

43. Clinical Correlate The tests for the integrity of the anterior and posterior cruciate ligaments are the anterior and posterior drawer signs. Tearing of the anterior cruciate ligaments allows the tibia to be easily pulled forward (anterior drawer sign). Tearing of the posterior cruciate ligament allows the tibial to be easily pulled posteriorly (posterior drawer sign).

44. The transverse ligamentA thin ligament lying transversely joining the anterior horns of both menisci

45. The Menisci2 -C shaped fibrocartilagenous plates which partly cover the articular surfaces of both tibial condyles.Each meniscus is attached to ant. intercondylar area by an ant. horn & to post. intercondylar area by a post. horn. The peripheral border of each meniscus is thick & gradually thins towards the center

46. Lateral meniscusMedial meniscusAPAP

47. MenisciIntracapsular & intrasynovialLower surface is flat for tibial condylesUpper surface is concave for femoral condylesOuter part of each meniscus is supplied by arteries, while inner part is avascular & so more liable to tears.capsuleSynovial membrane

48. Functions of menisciAdapt femoral to tibial condylesShock absorbersLubricate articular surfaces with synovial fluidIn flexion & extension of knee joint menisci move with tibia In rotatory movements of knee, with the foot fixed on the ground  menisci move with femur

49. Applied AnatomyThe tibial collateral ligament of the knee joint is adherent to the capsule & to the medial meniscus. This restricts the mobility of the medial meniscus .The lateral meniscus is not fixed to the capsule or the fibular collateral ligament but is separated from them by the tendon of popliteus, so it can adapt itself to sudden rotatory movements in the knee. This explains why the medial meniscus is more liable to injury than the lateral meniscus

50. Unhappy triada lateral blow to the knee causing a rupture in the anterior cruciate ligament, medial collateral ligament, and meniscus.

51. Lateral meniscusTendon ofPopliteus Fibular collateralligamentcapsuleMedial meniscusMedial meniscus, capsule & tibialcollateral ligament fused together

52. Movements of knee jointFlexion hamstrings + popliteus, sartorius & gracilis (with foot on the ground  gastrocnemius & plantaris)2. Extension quadriceps femoris + tensor fascialatae3. Medial rotation semimembranosus + SGS4. Lateral rotation biceps femoris

53. Locking and unlocking of the knee jointLocking of the knee is medial rotation of FEMUR on tibia at the end of extension .It occurs due to: Extension of the lateral femoral and tibial condyles with the lateral meniscus occurs before extension of the medial femoral and tibial condyles with the medial meniscus because they have a longer anteroposterior diameter. So medial rotation of the femur must occur at the terminal stage of extension (locking).

54. Locking and unlocking of the knee jointThe results after locking the knee joint: 1. All ligaments of the joint become tight 2. The quadriceps muscle relaxes to spare energy

55. Locking and unlocking of the knee jointUnlocking of the knee is lateral rotation of FEMUR at the beginning of flexion  produced by popliteusas a result of lateral rotation of the femur by the popliteus muscle at the beginning of flexion of the knee.

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57. Stability of the knee jointThe knee joint is not secure from the skeletal point of view as :1- The femur and tibia are the longest bones in the body.2- The articular surfaces are not well adapted to each other.

58. Stability of the knee jointHowever, the knee joint is still considered one of the stable joints in the body due to:1- Strong ligaments which connect the bones together: Cruciate  anteroposterior stability Collateral  side to side stability Iliotibial tract  stability in slightly flexed knee 2- The powerful muscles which surround the joint especially the quadriceps anteriorly

59. Bursae around the knee jointBursae are pillows (pockets) of synovial membrane filled with lubricating synovial fluid. They facilitate movements and reduce friction between tendons of muscles and bones.Many bursae surround the knee joint.

60. Subcutaneous prepatellar bursaSubcutaneous infrapatellar bursaDeep suprapatellar bursaDeep infrapatellar bursa

61. The nerve supply of the joint: 1) From the femoal nerve: through the nerves to the vasti 2) From the obturator nerve: a branch from its posterior division . 3) From the tibial nerve: 3 genicular branches. 4) From the common peroneal nerve: 3 genicular branches.clinical NOTE :pain of to knee joint.may be referred to pathology of hip joint.

62. Thank you