PTH523: Module 13: Knee and Popliteal Fossa

Popliteal Fossa

"Diamond-shaped depression of the posterior aspect of knee."

1) femur, 2) tibia, and 3) patella; the fibula is NOT part of the knee joint

(3) Bones make up the knee joint. Identify these.

synovial membrane (*it is a SYNOVIAL jt.)

A __________ lines the fibrous capsule of this joint.

the anastomosis formed by the genicular branches (5) of the popliteal artery

A common site of arterial clotting is found just distal to the adductor hiatus. Identify an avenue (vessel(s)) by which blood can still be supplied to the lower limb.

knock-knee; intermalleolar distance

A genu valgum alignment of the tibiofemoral joint is more commonly referred to as "___________." This alignment is measured in reference to the inter_______ distance.

Bow legged; intercondylar distance

A genu varum alignment of the tibiofemoral joint is more commonly referred to as "__________." This alignment is measured in referrence to the inter________ distance.

tibial n.

All muscles of the popliteal fossa (i.e. 1) popliteus, 2) plantaris, and 3) gastrocnemius) are all innervated by the _________ n.

superior joint capsule

Articularis Genu attaches to the ___________ of the knee.

1) anterior, 2) posterior tibial arteries

At the inferior edge of popliteus, the popliteal artery divides into 1) ______ and 2) __________ arteries.

anterior/forward; "anterior drawer sign"

Damage to the ACL may cause the tibia to glide ______ relative to the femur. What is this pathology known as?

medial to lateral; adductor hiatus, femoral vein

Going proximally, the popliteal vein crosses from ____ to ____ side of the popliteal artery. The popliteal vein ends at the _______ where it becomes the _____ vein.

1) fibular head 2) Pes Anserinus 3) medial tibial condyle

Hamstrings: 1) Biceps femoris attach to _________ 2) Semiteninous inserts into _______ 3) Semimembranosus inserts into posterior part of __________

Adductor Magnus

Hip Adductors: __________ attaches onto the adductor tubercle of the femur.

e.g. kneeling occupations: flooring, roofing; bursitis

Identify an occupation which may be associated with inflammation of the bursa (a.k.a. _______) of the knee.

1) inferior lateral genicular artery (posterior), 2) anterior tibial recurrent artery (a branch of the popliteal a.; anterior)

Identify the (2) arteries which supply blood to the proximal tibiofibular joint:

Identify the (3) cutaneous nerves that supply the posterior popliteal fossa: 1) saphenous n. 2) lateral sural cutaneous n. 3) posterior cutaneous n. of thigh

Identify the (3) cutaneous nerves that supply the posterior popliteal fossa: 1) ________ n. 2) _________ n. 3) _________ n.

1) popliteal artery, 2) popliteal vein, 3) tibial n., 4) common fibular n. (divisions of sciatic n.)

Identify the (3) primary contents of the popliteal fossa: (HINT: 2 vessels and 2 nerves)

1) popliteal surface of the femur, 2) oblique popliteal ligament, 3) expansion of the semimembranous tendon, 4) popliteus fasica

Identify the (4) components that make up the roof of the popliteal fossa

Suprapatellar bursa

Identify the largest bursa of the knee joint.

tibial n.

Identify this branch of the sciatic n.: larger, medial branch

Coronary ligaments (a.k.a. meniscotibial ligaments)

Identify this ligament: Consists of capsular fibers that attach the meniscal margins to the tibia (;circular in shape)

skin and fascia

Identify what makes up the roof of the popliteal fossa

Biceps femoris tendon

Identify what makes up the superolateral border of the popliteal fossa.

Semimembranosus, semitendinosus

Identify what makes up the superomedial border of the popliteal fossa. (HINT: two components)

two heads of grastrocnemius

Identify what makes up the the inferior border of the popliteal fossa (HINT: two components)

tibial n.

Identify which structure of the popliteal fossa is the most superficial: popliteal artery, popliteal vein, tibial n., common fibular n.

Bursitis

Inflammation of the fluid-filled sac (bursa) that lies between a tendon and skin, or between a tendon and bone.

popliteus; fibular head, posterior

Like the oblique popliteal ligament, the arcuate popliteal ligament also passes over the _____ tendon. It originates at the _______ and spreads over the ______ knee joint.

Muscles of the Popliteal Fossa: Gastrocnemius P = Lateral head: posterior surface of lateral condyle of femur and highest three facets on the lateral condyle Medial head: Posterior surface of femur above medial condyle D = tendo calcaneus (*HINT: a tendon) N = Tibial n. Ax (2): 1) plantarflexes foot, 2) flexes knee (*HINT: same as plantaris)

Muscles of the Popliteal Fossa: Gastrocnemius P = Lateral head: posterior surface of _________ of femur and highest three facets on the "_______" Medial head: Posterior surface of femur above ________ D = ________ (*HINT: a tendon) N = _______ n. Ax (2): 1) ________ foot, 2) _______ knee (*HINT: same as plantaris)

Muscles of the Popliteal Fossa: Plantaris P = Lateral supracondylar ridge of femur above lateral head of gastrocnemius D = Tendo calcaneus (*HINT: a tendon) N = Tibial n. Ax (2): 1) Plantarflexes foot and 2) flexes knee (weak); debated that it may also act as a proprioceptive organ *Aside: commonly harvested for surgical repair of Achilles tendon

Muscles of the Popliteal Fossa: Plantaris P = ________ of femur above ______ head of gastrocnemius D = ________ (*HINT: a tendon) N = ________ n. Ax (2): 1) _______ foot and 2) ________ knee (weak); debated that it may mainly act as a __________ organ *Aside: commonly harvested for surgical repair of Achilles tendon

Muscles of the Popliteal Fossa: Popliteus P = lateral surface of the 1) lateral condyle of femur and 2) lateral meniscus D = posterior surface of tibia superior to soleal line N = tibial n. Ax (2): 1) laterally rotate femur 5 degrees to allow the knee to unlock (impt to flexion of the knee), 2) weakly flexes knee

Muscles of the Popliteal Fossa: Popliteus P = lateral surface of the 1) ___________ and 2) ____________ D = posterior surface of _________ superior to _________ line N = _______ n. Ax (2): 1) _________ femur ______ degrees to allow _________ (impt to flexion of the knee), 2) weakly ______

the medial and lateral head of the gastrocnemius, medial sural cutaneous n.

On a cadaver, we can identify the small saphenous vein between the __________, running alongside the ___________.

popliteal a. --> popliteal v. --> tibial n. --> common fibular n.

Organize the following popliteal fossa contents from most medial to most lateral: tibial n., popliteal v., common fibular n., popliteal a.

proximal tibiofibular joint = head of fibula + lateral condyle of tibia

Proximal tibiofibular joint: the _____ of the fibula articulates with the _______ of the tibia.

lateral malleolus, deep fascia, popliteal vein

Superficially, the small saphenous vein runs posterior from the _________ to pierce the ______ in the popliteal fossa and join the ________ vein.

extracapsular

The 1) patellar, 2) oblique popliteal, 3) and arcuate popliteal ligaments are all (extracapsular, intraarticular).

external

The _______ margins of the menisci attach to the fibrous capsule of the knee.

posterior

The _________ capsule is thin and not as strong and attached to the intercondylar fossa.

periphery, the rest

The _______of the menisci have blood supply, and thus can be repaired/heal, while the _______ of the menisci is avascular, and thus cannot be routinely repaired.

1) patella, 2) patella ligament

The anterior capsule of the knee is comprised of the 1) ________ and 2) ________.

intraarticular; medial wall of lateral femoral condyle in notch, anterior medial aspect of tibial spine; weaker; poor, poor, reconstruction; extension; 1) hyperextension, 2) forward gliding, 3) stabilizing knee in rotation; parallel to hamstrings, perpendicular to quadriceps

The anterior cruciate ligament (ACL) is (extracapsular/intra-articular). It originates on the ____________ and runs obliquely, distally, and medially to insert on the ____________. It is (weaker/stronger) than the PCL. This ligament has a (good/poor) blood supply and thus has (good/poor) results following repair and requires ________. It is tight on _________, and serves to prevent 1) ___________, 2) __________ of tibia relative to femur, while it promotes 3) ________ the knee in _______. It is (parallel/perpendicular) to the hamstrings and (parallel/perpendicular) to the quadriceps.

lateral femoral condyle, popliteus, tibia

The anterolateral capsule is deficient on the ________ to allow ________ tendon the pass out and attach to the ______.

medial

The anteromedial capsule is stronger on the (anterior/medial) side?

fibrous; femur, tibia

The articular capsule of the knee is also referred to as a _______ capsule. This articular capsule attaches to the ______ superiorly and the _______ inferiorly.

posterior, medial and lateral femoral condyles

The articular surface of the patella is on the (anterior/posterior) aspect and articulates with the ______ and ___________.

base - superior, apex - inferior

The base of the patella is (superior/inferior) and the apex of the patella is (superior/inferior)?

smaller; fibular head and neck

The common fibular (common peroneal) n. is (smaller/larger) than the tibial n. and it is commonly injured d/t it's close proximity to ________.

patella, patellar ligament

The common tendon of the quadriceps inserts into the _____, after which point it becomes the ______.

non weight-bearing

The fibula is a (weight-bearing/non weight-bearing) structure.

extracapsular; lateral epicondyle, head of the fibula; popliteus, does not attach; less (*makes sense, popliteus tendon runs beneath; more stable)

The fibular collateral ligament (i.e. the lateral collateral ligament, LCL) is (extracapsular/intraarticular). It originates on the ________ and inserts on the ________. The _______ tendon runs deep to the ligament, and the ligament (attaches/does not attach) to the lateral meniscus. Again, this ligament is (more/less) likely to be damaged than the MCL.

Suprapatellar bursa (a.k.a. "suprapatellar pouch")

The largest bursa of the knee joint:

circular-shaped; smaller, more freely movable

The lateral meniscus is nearly ________-shaped. It is (smaller/larger) and (more/less) freely moveable than the medial meniscus.

communicating branch, common fibular n., calf

The lateral sural cutaneous n., a _____ branch of the _______ n., supplies the skin of the ______.

semilunar/C-shaped; broader posterior than anterior, medial/tibial collateral ligament; injury

The medial meniscus is _______-shaped. It is broader (anterior/posterior) than (anterior/posterior) and has a strong attachment to the deep surface to the ________ ligament. It is more prone to _______ than the lateral meniscus d/t its attachment to other ligaments of the knee.

medial sural cutaneous + lateral sural cutaneous = sural n.

The medial sural cutanenous nerve (of the tibial n.) is joined by a communicating branch from the common fibular n. -- the _________ n. -- to form the ______.

intercondylar, tibia

The menisci are firmly attached at their ends in the _________ area of the _______.

are; fibrocartilage, 1) deepen joint surface, 2) reduce shock, 3) improve congruency, 4) proprioceptive feedback

The menisci of the knee (are/are not) within the articular capsule of the knee joint. Menisci are _______ disks that serve(4): to 1) deepen ______, 2) reduce _______, 3) improve______ of the rounded femoral condyles to the flatter tibial condyles, and 4) provide __________.

1) capsule of the knee joint, 2) cruciate ligaments (ACL + PCL), 3) synovial membrane, and 4) peripheral meniscal margins

The middle genicular branches of the popliteal artery supply (4): (HINT: these relate to structures of the knee - which is medial!)

popliteus; lateral femur, medial tibia; semimembranosus

The oblique popliteal ligament is layered over ______ muscle and extends from the _________ to the __________. This ligament is actually an expansion of the ________ tendon.

inferior pole of the patella, tibial tuberosity

The patellar ligament extends from the ________ to the __________.

deepest, femoral a., adductor hiatus

The popliteal artery is the ______ structure in the popliteal fossa. It is a continuation of the _______ a. after it passes through the _______.

1) hamstrings, 2) gastrocnemius, 3) soleus, 4) plantaris

The popliteal artery supplies (4) different muscles. Identify these. ("Having good support perpetuates")

posterior

The popliteal surface is on the (anterior/posterior) aspect of the femur?

intraarticular; lateral wall of medial femoral condyle in notch, posterior aspect of proximal tibia; stronger; flexion, 1) prevent posterior gliding of the tibia relative to the femur.

The posterior cruciate ligament (PCL) is (extracapsular/intraarticular). It originates on the _________ and runs distally, posterior to the ACL, to insert on the _____________. It is (stronger/weaker) than the ACL. It tightens during _______ and serves to 1) prevent _________ of the tibia relative to the femur.

lateral meniscus, PCL, medial femoral condyle

The posterior meniscofemoral ligament has a strong slip that attaches the _______ to the 1) _______ and the 2) ________.

planar, synovial

The proximal tibiofibular joint is a ______ type of ______ joint.

fibrous capsule; patella, menisci

The synovial membrane is extensive and lines the internal aspect of the ________. It attaches to the periphery of the ______ and the edges of the ________.

bursa; e.g. suprapatellar pouch

The synovial membrane of the knee joint is continuous with some of the _______ of the knee (e.g. __________).

extra-synovial but intra-capsular

The synovial membrane reflects from the posterior aspect of the tibiofemoral joint onto cruciate ligaments, making them __________ but __________.

extracapsular; medial epicondyle of the femur, proximal medial tibia; medial meniscus, medial meniscus; more

The tibial collateral ligament (i.e. the medial collateral ligament, MCL) is (extracapsular/intraarticular). It originates on the ________ and inserts on the _________. At its midpoint, the MCL attaches to the ________. Consequently, if the MCL is torn, the "__________" tears, also. This ligament is (more/less) often damaged than the LCL.

slightly valgus, 7 degrees for males, 9 degrees for females

The tibiofemoral joint (i.e. the knee joint) is normally slight _______. With _____ degrees for males and ______ degrees for females.

menisci; move together

The transverse ligament of the knee is a slender fibrous band that connects the anterior edges of the _______, which allows them to _______.

12; 1) suprapatellar bursa, 2) popliteus bursa, 3) anserine bursa, 4) gastrocnemius bursa

There are (#) or more bursa of the knee, (4) of which communicate with the synovial cavity of the knee; identify these.

5 genicular branches; 1) form anastomosis of arterial blood supply around the knee

There are ____ genicular branches of the popliteal artery. These form an 1) __ of arterial blood supply around the knee.

3, popliteus

Tibiofibular ligaments: the anterior tibiofibular ligament is composed of ____ bands, and the posterior tibiofibular ligament, a single broad band, is covered by the ______ tendon.

True

True or False? Slight movement occurs at the proximal tibiofibular joint during dorsiflexion/plantarflexion and inversion/eversion of the ankle.

True

True or False? The medial and lateral menisci are within the synovial membrane.

Unhappy Triad: Refers to a complete or partial tear of the following (3): 1) MCL 2) ACL 3) medial and lateral meniscus - blow to the lateral side of the knee; jt. ruptures medially, damaging these structures; also known as a "blown" knee

Unhappy Triad: Refers to a complete or partial tear of the following (3): 1) _______ 2) ________ 3) _________

3; 1) medial superior genicular, 2) middle genicular, and 3) medial inferior genicular arteries

______ genicular n. branches accompany the 1) _________ genicular, 2) ________ genicular, and 3) _______ genicular arteries.

popliteal bursae

_________ are situated between the popliteus tendon and the lateral tibial condyle, and it (may/may not) communicate with the synovial cavity of the knee joint.