What is the topic of the presentation?
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Knee Joints and Bony Landmarks
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What is the topic of the presentation?
Knee Joints and Bony Landmarks
What is the largest joint in the body?
The knee joint.
How is the knee joint described in terms of complexity?
It is very complex.
What type of joint is the knee primarily considered?
Primarily a hinge joint.
What are you expected to identify on the skeleton upon completion of the lesson?
Important bony features and relevant muscles of the knee, ankle, and foot joint.
What should you be able to differentiate regarding the knee, ankle, and foot joints?
The movements, moving mechanisms, functions, and the corresponding contributions from knee and ankle joint muscles.
What analysis should you be able to perform after completing the lesson?
Analyze the muscles involved in some simple exercise training drills.
What do the enlarged femoral condyles articulate with?
Enlarged tibial condyles.
What are the main anatomical regions of the knee joint shown in the image?
Anterior Knee, Anteromedial Knee, Posterior Knee, Tibial Plateau.
What forms the cavity for the femoral condyles?
Medial and lateral tibial condyles (medial and lateral tibial plateaus).
Which part of the knee joint is labeled as 'Anterior Knee' in the image?
The front part of the knee joint.
Which part of the tibia bears most of the weight?
The medial part of the tibia.
How is the knee joint (tibiofemoral joint) classified?
As a ginglymus joint (hinge joint).
What is the Q-angle in relation to the knee joint?
The Q-angle is a measure of the angle between the quadriceps muscles and the patella tendon.
Which part of the knee joint is labeled as 'Anteromedial Knee' in the image?
The front and inner part of the knee joint.
What is another term sometimes used to refer to the knee joint?
Trochoginglymus joint.
Where does the anterior cruciate ligament (ACL) arise from?
The posteromedial corner of the medial aspect of the lateral femoral condyle in the intercondylar notch.
Which part of the knee joint is labeled as 'Posterior Knee' in the image?
The back part of the knee joint.
What movements occur in the knee joint during flexion?
Internal and external rotation.
In which directions does the ACL run across the joint?
Anteriorly, medially, and distally.
Which part of the knee joint is labeled as 'Tibial Plateau' in the image?
The top surface of the tibia that interacts with the femur.
What is the alternative classification some argue for the knee joint?
Condyloid classification.
What is the primary function of the ACL?
To restrain anterior tibial displacement.
What is the primary topic of the slide?
Knee Muscles and Actions
What type of joint is the patellofemoral joint classified as?
Arthrodial joint.
What are the secondary functions of the ACL?
To restrain tibial rotation and varus.
How many bursae are there in and around the knee?
More than 10.
Where does the posterior cruciate ligament (PCL) originate?
From the anterolateral aspect of the medial femoral condyle within the notch.
What are the impacts to the knee joint if you stand and land with the position shown on the left picture?
Standing and landing with the position shown on the left picture can lead to misalignment of the knee joint, increased stress on the ligaments, potential for knee pain, and a higher risk of injury.
What provides static stability to the knee joint?
Ligaments.
What is the nature of the patella's movement on the femoral condyles?
Gliding.
What is the primary function of the Medial Collateral Ligament (MCL)?
To maintain medial stability by resisting valgus forces or preventing the knee from being abducted.
What is the function of bursae in the knee?
They absorb shock or prevent friction.
What is the primary function of the posterior cruciate ligament (PCL)?
To resist excessive posterior translation of the tibia.
What produces dynamic stability in the knee joint?
Quadriceps and hamstrings contractions.
Are all bursae in the knee connected to the synovial cavity?
No, only some are connected to the synovial cavity.
What is the secondary role of the MCL when the cruciate ligaments are torn?
It acts as a secondary stabilizer to anterior and posterior tibial translation.
Where is the fibula located in relation to the body?
The fibula is located laterally.
What is the secondary function of the posterior cruciate ligament (PCL)?
To stabilize the knee by preventing excessive rotation specifically between 90° and 120° of knee flexion.
What surfaces provide cushioning in the knee joint?
Articular cartilage surfaces on the femur and tibia.
In what type of sports are MCL injuries most common?
Contact or collision sports.
How often is the posterior cruciate ligament (PCL) injured?
It is not often injured.
What is one of the functions of the fibula in relation to the knee joint?
The fibula serves as the attachment for knee joint structures.
What forms cushions between the bones in the knee joint?
Menisci.
What is a common mechanism of injury for the posterior cruciate ligament (PCL)?
Direct contact with an opponent or playing surface.
How does the fibula contribute to the stability of the ankle joint?
The fibula provides stability to the ankle joint.
What type of bone is the patella?
The patella is a sesamoid (floating) bone.
To which bone are the menisci attached?
Tibia.
What is the significance of the distal end of the fibula?
The distal end of the fibula has several grooves for ligament attachments, which stabilize and provide leverage during ankle movements.
What is the origin of the lateral (fibular) collateral ligament (LCL)?
Lateral epicondyle of the femur.
What is the function of the menisci in the knee joint?
To deepen the tibial fossa and enhance stability.
Where is the patella embedded?
The patella is embedded in the quadriceps and patellar tendon.
What does the Q angle represent?
The Q angle represents the angle formed by the quadriceps muscle and the patellar tendon.
Does the fibula articulate with the femur or patella?
No, the fibula does not articulate with the femur or patella.
Where does the lateral (fibular) collateral ligament (LCL) insert?
Fibula head.
What is the origin of the Vastus Lateralis muscle?
Anteroinferior aspect of Greater trochanter and Upper half of Linea aspera (lateral lip).
What function does the patella serve in knee extension?
The patella serves similar to a pulley in improving the angle of pull, resulting in greater mechanical advantage in knee extension.
How does the Q angle differ between males and females?
Females typically have a larger Q angle compared to males.
Is the fibula considered a part of the knee joint?
No, the fibula is not part of the knee joint.
What structure augments the lateral (fibular) collateral ligament (LCL)?
The iliotibial band.
Where does the Vastus Lateralis muscle insert?
Base and lateral edge of Patella and Tibial tuberosity through Quadriceps tendon.
What is another name for the patella tendon?
The patella tendon is also known as the 'patella ligament'.
What is the function of the synovial cavity in the knee joint?
It supplies the knee with synovial fluid.
What is considered an abnormal Q angle?
An abnormal Q angle is one that deviates significantly from the normal range, potentially leading to knee problems.
What is the primary function of the lateral (fibular) collateral ligament (LCL)?
Primary varus stabiliser of the knee.
What is the patella tendon an extension of?
The patella tendon is an extension of the quadriceps tendons.
What nerve supplies the Vastus Lateralis muscle?
Femoral nerve (L2-4).
Where is the synovial cavity located in the knee joint?
It lies under the patella and between the surfaces of the tibia and femur.
What are the three knee joint positions shown in the image?
Hyperextension, Extension, and Flexion.
What anatomical landmarks are used to measure the Q angle?
The Q angle is measured using the anterior superior iliac spine, the center of the patella, and the tibial tuberosity.
What is the origin of the Vastus Medialis?
Medial lip of Linea aspera and Intertrochanteric line.
What is the secondary function of the lateral (fibular) collateral ligament (LCL) when the cruciate ligaments are torn?
Secondary stabiliser to anterior and posterior tibial translation.
What is the 'screw home' mechanism of the knee?
The knee 'screws home' to fully extend due to the shape of the medial femoral condyle, causing external rotation of approximately 10 to 20 degrees in nearly full extension.
Where does the patella tendon start and attach?
The patella tendon starts from the underside of the patella (kneecap) and attaches to the tibial tuberosity.
What is the primary action of the Vastus Lateralis muscle?
Knee extension.
What is another name for the synovial cavity in the knee joint?
Capsule of the knee.
What ligament is labeled in the image?
The Anterior Cruciate Ligament (ACL).
Why is the Q angle important in assessing knee health?
The Q angle is important because an abnormal Q angle can indicate potential issues with knee alignment and function, leading to conditions like patellofemoral pain syndrome.
Where does the Vastus Medialis insert?
Medial edge of Patella and Tibial tuberosity through Quadriceps tendon.
How frequently is the lateral (fibular) collateral ligament (LCL) injured?
Infrequently injured.
What causes the knee to 'screw home' during full extension?
The shape of the medial femoral condyle.
What is the range of knee flexion?
135 to 140 degrees.
Where is the infrapatellar fat pad located?
Just posterior to the patellar tendon.
What happens to the ACL during hyperextension?
The ACL is stretched and can be at risk of injury.
What nerve supplies the Vastus Medialis?
Femoral nerve (L2-4).
What are the origins of the Biceps Femoris Long Head?
Ischial tuberosity (superior aspect) and Sacrotuberous ligament (inferior aspect).
What is the Q angle?
The angle formed by the intersection of the central line of pull for the quadriceps and the line of pull of the patella tendon at the patella.
How many degrees does the knee externally rotate during nearly full extension?
Approximately 10 to 20 degrees.
What is the range of knee extension?
0 to -10 degrees.
What is the plica in the knee joint?
A shelf-like membrane between the synovium of the patella and the tibiofemoral joint.
What is the normal position of the ACL during knee extension?
The ACL is in a relaxed state, maintaining knee stability.
What is the primary action of the Vastus Medialis?
Knee extension, especially for terminal extension.
From where to where does the central line of pull for the quadriceps run?
From the anterior superior iliac spine (ASIS) to the center of the patella.
Where does the Biceps Femoris Long Head insert?
Head of fibula and Fibular collateral ligament.
Is hyperextension of the knee common, and if so, to what degree?
Yes, hyperextension of 10 degrees or more is not uncommon.
What happens to the knee joint in full extension?
There is close congruency of articular surfaces and no appreciable rotation of the knee.
What is the position of the ACL during knee flexion?
The ACL is slightly taut, helping to control the movement of the tibia.
From where to where does the line of pull of the patella tendon run?
From the center of the patella to the center of the tibial tuberosity.
What nerve supplies the Biceps Femoris Long Head?
Sciatic nerve (Tibial division L5 - S2).
What happens when the knee is flexed 30 degrees or more?
Nearly involuntary movement occurs, including internal rotation of 30 degrees and external rotation of 45 degrees.
What occurs during the initial flexion from full extension in the knee?
The knee 'unlocks' and the tibia internally rotates.
What does the Q angle display?
The biomechanical effect of the quadriceps muscle on the knee.
What actions are performed by the Biceps Femoris Long Head?
Knee flexion, Knee external rotation, Hip extension, and Posterior pelvic tilt.
What is the degree of internal rotation that occurs with the knee flexed 30 degrees or more?
30 degrees.
Why do females generally have higher Q angles?
Due to a wider pelvis.
What is the origin of the Biceps Femoris Short Head?
Lower half of linea aspera (lateral lip).
What is the degree of external rotation that occurs with the knee flexed 30 degrees or more?
45 degrees.
What is the normal range for the Q angle?
Between 12 and 20 degrees.
Where does the Biceps Femoris Short Head insert?
Head of fibula and fibular collateral ligament.
What does VMO stand for?
Vastus Medialis Oblique.
Where do males usually fall within the normal Q angle range?
At the low end of the range.
What nerve supplies the Biceps Femoris Short Head?
Sciatic nerve (Fibular division L5-S2).
Which exercise involves squeezing a ball between the knees?
VMO exercise with a ball squeeze.
What actions are performed by the Biceps Femoris Short Head?
Knee flexion, knee external rotation, and posterior pelvic tilt.
What is the focus of the study by Hanten and Schulthies (1990)?
The effect of exercise on electromyographic activity of the Vastus Medialis Oblique and Vastus Lateralis muscles.
What did Sykes and Wong (2003) study in relation to the VMO?
Electrical activity of the Vastus Medialis Oblique muscle in straight leg raise exercise with different angles of hip rotation.
What is a common exercise to target the VMO?
Straight leg raise with different angles of hip rotation.
What is the origin of the semitendinosus muscle?
Ischial tuberosity (Superior aspect)
Where does the semitendinosus muscle insert?
Medial tibial condyle
What exercise is shown in the first image for hamstring strengthening?
Leg curl on a machine.
What nerve supplies the semitendinosus muscle?
Sciatic nerve (Tibial division L5 - S2)
What exercise is depicted in the second and third images for hamstring strengthening?
Deadlift.
What is the origin of the Vastus Intermedius muscle?
Upper 2/3 of the femoral shaft (anterior & lateral aspect).
What actions does the semitendinosus muscle perform at the knee?
Flexion and internal rotation
What exercise is shown in the top left image for quadriceps?
Barbell front squat.
Where does the Vastus Intermedius muscle insert?
Tibial tuberosity through the Quadriceps tendon.
What actions does the semitendinosus muscle perform at the hip?
Extension and posterior pelvic tilt
What exercise is shown in the top middle image for quadriceps?
Leg press.
What nerve supplies the Vastus Intermedius muscle?
Femoral nerve (L2-4).
What is the primary action of the Vastus Intermedius muscle?
Knee extension.
What exercise is shown in the top right image for quadriceps?
Leg extension machine.
What exercise is shown in the bottom image for quadriceps?
Walking lunges.
What are the four muscles that make up the quadriceps?
Vastus Medius, Vastus Intermedius, Vastus Lateralis, and Rectus Femoris.
What is the difference between these two hamstrings stretching positions?
The left image shows a seated hamstring stretch with one leg extended and the other leg bent inward. The right image shows a seated hamstring stretch with both legs extended and reaching forward.
Where is the origin point of the Vastus Medius?
Intertrochanteric Line.
Where is the insertion point of the Vastus Medius?
Quadriceps Tendon.
Where is the origin point of the Vastus Intermedius?
Anterior & Lateral surfaces of shaft of Femur (thigh bone).
Where is the insertion point of the Vastus Intermedius?
Quadriceps Tendon to the base of the Patella (knee cap) onto the Tibial Tuberosity via the Patellar Ligament.
Where is the origin point of the Vastus Lateralis?
Greater Trochanter.
Where is the insertion point of the Vastus Lateralis?
Quadriceps Tendon.
Where is the origin point of the Rectus Femoris?
Anterior Inferior Iliac Spine and Ilium.
Where is the insertion point of the Rectus Femoris?
Quadriceps Tendon to base of Patella (knee cap) and onto the Tibial Tuberosity via the Patellar Ligament.
What is the origin of the popliteus muscle?
Lateral femoral condyle (lateral aspect).
Where does the popliteus muscle insert?
Posterior surface of proximal tibia (superior to Soleal line).
Which muscles are considered weak knee flexors?
Gracilis and Sartorius.
What nerve supplies the popliteus muscle?
Tibial nerve (L4 - S1).
Which muscles contribute to knee stabilization through the iliotibial band (ITB)?
Tensor fascia lata and Gluteus maximus.
What are the actions of the popliteus muscle?
Knee internal rotation and knee flexion (unlocking the knee from full extension).
What is the origin of the semimembranosus muscle?
Ischial tuberosity (superior aspect).
What is the main topic of the provided slide?
Foot and Ankle Joints and Bony Landmarks
Which muscles are involved in knee internal rotation?
Gracilis and Sartorius.
Where does the semimembranosus muscle insert?
Posterior medial tibial condyle.
What nerve supplies the semimembranosus muscle?
Sciatic nerve (tibial division L5-S2).
What actions does the semimembranosus muscle perform at the knee?
Flexion.
What actions does the semimembranosus muscle perform at the hip?
Extension.
What is another action of the semimembranosus muscle besides knee flexion and hip extension?
Posterior pelvic tilt.
What is the peak patellofemoral joint (PFJ) loading in body weight during walking?
0.6 times body weight.
How much peak PFJ loading occurs when stepping down 10 cm?
3.1 times body weight.
What is the peak PFJ loading during a full depth squat?
4.5 times body weight.
What is the peak PFJ loading during a single leg countermovement hop?
6.4 times body weight.
Which bones are involved in the ankle joint?
Tibia, Fibula, and Talus.
What type of joints are the intertarsal and tarsometatarsal joints?
Arthrodial joints.
What is the role of the talus in the ankle joint?
It transmits forces from the calcaneus and allows plantar flexion, dorsiflexion, inversion, and eversion.
What is the characteristic movement of the intertarsal and tarsometatarsal joints?
Minimal movement.
Which bone in the ankle joint transmits forces from the calcaneus?
The talus.
What movements does the ankle joint allow?
Plantar flexion, dorsiflexion, inversion, and eversion.
How many bones are in the human foot?
26 bones.
How many tarsal bones are in the foot?
7 tarsal bones.
Which ligaments prevent inversion of the ankle?
Anterior talofibular ligament (ATFL), Posterior talofibular ligament (PTFL), Calcaneofibular ligament (CFL).
How many metatarsal bones are in the foot?
5 metatarsal bones.
How many phalanges are in the foot?
14 phalanges.
What is the transverse arch?
The transverse arch extends across the foot from the 1st metatarsal to the 5th metatarsal.
Which ligament prevents eversion of the ankle?
Deltoid ligament.
What are the three types of phalanges in the foot?
Proximal phalanges, middle phalanges, and distal phalanges.
From which metatarsal to which metatarsal does the transverse arch extend?
From the 1st metatarsal to the 5th metatarsal.
What is the shape of the deltoid ligament?
Triangular.
What type of joint is the tibiofibular joint?
Syndesmotic amphiarthrodial joint.
Which bone is known as the heel bone?
Calcaneus.
Which bone is referred to as the ankle bone?
Talus.
Where are the tibiofibular joints located?
At both proximal and distal ends of the tibia and fibula.
What is the Talocrural Joint also known as?
Mortise (hole)
Name the three cuneiform bones in the foot.
Lateral cuneiform, intermediate cuneiform, and medial cuneiform.
What provides support between the tibia and fibula shafts?
Ligaments and a strong, dense interosseous membrane.
What maintains the arches in the foot and ankle?
Ligaments in the foot and ankle.
Which bones form the medial and lateral malleolus in the Talocrural Joint?
Medial malleolus (tibia) and Lateral malleolus (fibula)
How much movement is possible in the tibiofibular joint?
Minimal movement.
How many longitudinal arches are there in the foot?
Two longitudinal arches.
Which bone is involved in the Talocrural Joint?
Talus
Where does the medial longitudinal arch extend from and to?
From the calcaneus bone to the talus, navicular, 3 cuneiforms, and proximal ends of 3 medial metatarsals.
In what type of sport is the distal tibiofibular joint occasionally sprained?
Heavy contact sport.
What type of joint is the Talocrural Joint?
Hinge joint
Where does the lateral longitudinal arch extend from and to?
From the calcaneus to the cuboid and proximal ends of the 4th and 5th metatarsals.
What is excessive foot pronation?
Excessive inward rolling of the foot during walking or running.
What movements are allowed by the Talocrural Joint?
Plantar flexion and Dorsiflexion
What are the possible heights of the long arches in the foot?
High, medium, or low.
What injuries are individuals with excessive foot pronation vulnerable to?
Knee and ankle injuries.
What type of joint is the Subtalar Joint classified as?
Gliding or arthrodial
What are some specific conditions that can result from excessive foot pronation?
Achilles tendinitis or even rupture, Hallux Valgus, and bunions.
What is Achilles tendinitis?
Inflammation of the Achilles tendon, which can lead to pain and potential rupture.
What is Hallux Valgus?
A deformity of the big toe joint, often leading to a bunion.
