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______________________________________________________________________ ANATOMY

SPECIAL REVIEW ON KNEE JOINT AND RELATED 2. Joint Line Tenderness sensitivity 76%, specificity
STRUCTURES 29%
DR. ABIOG / April 29, 2016 3. McMurray Test sensitivity 52%, specificity 97%
BURSAE
FINALS: PRACTICALS 1
Bold,red letters=Emphasized during lecture
PATELLA AND MENISCI

- Two important bursae:


a. Suprapatellar bursa
-aka Quadriceps Bursa
-Normal amount of fluid inside: <5ml
-You can aspirate fluid from this structure only
when you have bursitis
b. Anserine bursa
- Articularis Genu -bursitis in this structure is common
- Insertion: Suprapatellar bursa -Related structure: Pes Anserinus which means
- Action: Pulls up the suprapatellar foot of goose (STG: Sartorius-ant,
bursa semiTendinosus-post, Gracilis-medial)
- Function: To prevent impingement Other bursae:
of the bursa c. Prepatellar bursa
- Peri-patellar structures: -located anterior to patella
a. Lateral patellar retinaculum -clinical correlation: prepatellar bursitis
b. Medial patellar retinaculum -aka Housemaids knee
Clinical correlation: d. Nuns/Clergymans bursa
Medial patellar dislocation-looseness of medial patellar - aka Superficial infrapatellar bursa
retinaculum LIGAMENTS
Lateral patellar dislocation-looseness of lateral
patellar retinaculum and tight medial patellar
retinaculum
- MUST KNOW:
- To identify patella in superior, inferior,
lateral and medial view
- To know the difference between medial
and lateral facet

Collateral Ligaments:
a. Tibial collateral ligament
- To identify if patella is right or left -attachment in medial meniscus
- Menisci -Clinical correlation: When you injure your tibial
a. Medial meniscus collateral ligament, it may llead to tear of your
-crescent-shaped and more COMMON INJURED medial menisus challenging its medial stability
b. Lateral meniscus b. Fibular collateral ligament
-nearly circular -no attachment to lateral meniscus
Function: Shock absorber, joint lubrication, joint Cruciate Ligaments:
stabilization and equal weight distribution across a. Anterior cruciate ligament
the knee joint To test:
To test: 1. Lachman Test sensitivity 87%, specificity 93% -
1. Hyperflexion Test sensitivity 55-85%, specificity
BEST
29-67%
2. Anterior Drawer sensitivity 48%, specificity 87%

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TRANSCRIBERS: BALABBO, G. ,HALLARE, J. & SAN JUAN, R. Page 1 of 2
______________________________________________________________________ ANATOMY
3. Pivot Shift Test sensitivity 61%, specificity 97%
Main function: To prevent anterior displacement
of tibia
For femur? To prevent posterior displacement
2 parts: Anteromedial and Posterolateral
b. Posterior cruciate ligament
KINESIOLOGY OF THE KNEE JOINT
First 20 of flexion
Unlocking mechanism of knee by popliteus muscle
Gliding motion
At 40 rocking motion
Last 20 of extension, tibia externally rotates (10)
into its screw-home mechanism
With a drag by the post cruciate ligament
Further, rolling motion
Moving from a flexed position to extension
LOMBARDS PARADOX
While sitting in your chair, grasp your thigh so that the
thumbs palpate the belly of the rectus femoris and the
fingers palpate the bellies of the hamstrings muscles
As you arise from your chair by means of hip and knee
extension, you will feel both the rectus femoris and
hamstrings contracting
knowing both are biarticular muscles with opposite
actions, you might think these 2 will mutually neutralize
each others actions at both hip and knee joints
This seemingly contradictory situation is known as the
Lombards paradox
Explanation
At the hip joint, the lever arm (distance from the center
of rotation of the joint to the point of attachment of the
muscle) of the hamstrings for extension is greater than
that of the rectus femoris for flexion
At the knee joint, opposite situation exists: torque or RF
for knee extension is greater than the torque of
hamstrings for flexion
Although the two-joint muscles are movers for both
flexion and extension, the lever arms for extension are
greater than those for flexion
RELATED TUBEROSITY AND MUSCLES
Gerdys Tubercle
Anatomical significance: Insertion of Iliotibial tract or
band (ITB)
Adductor tubercle
attachment of adductor magnus
Adductor Magnus
-Nerve supply:
Anterior-Obturator nerve
Posterior-Tibial nerve
-No action on knee joint
Tibialis Anterior
Most important in the anterior compartment
Origin: Lateral condyle and superior half of lateral
surface of tibia and interosseous membrane

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TRANSCRIBERS: BALABBO, G. ,HALLARE, J. & SAN JUAN, R. Page 2 of 2