Outline 15: Leg, Knee, and Popliteal Fossa
What is the pathway of flexor hallucis longus?
- Goes from fibular to lateral side of foot around medial malleolus (correction needs to be made for direction of pull)
What is triceps surae and what is the attachment/ action?
1) Lateral head of gastrocnemis 2) Medial head of gastroc 3) Soleus Attach at achilles tendon (powerful)Plantarflexors
What are the articular surfaces of the femur and what do they articulate with?
1) Medial & lateral condyles: articulates with condylses of tibia 2) Trochlea: articulates with posterior aspect of patella
What are the 3 functions of the patella?
1) Protection of the knee joint 2) Reducing friction 3) Increasing leverage of quadraceps tendon by 30%
What two knee tendons act like ligaments?
1) Tendons of IT band 2) Pes anserinus
What are the two collateral knee ligaments?
1) Tibial (medial) collateral 2) Fibular (lateral) collateral
What are the 2 knee joints?
1) Tibiofemoral joint 2) Patellofemoral joint
What other branches from further up the leg supply the knee?
Lateral and medial descending genicular branhcnes
What are the two internal knee ligaments?
** go in between bones to attach to femur 1) Anterior cruciate 2) Posterior cruciate
What is the reverse action of popliteaus and when is it activated?
- Rotates femur laterally - When standing on tibia
What is the normal action of popliteus?
- Rotates tibia medially (internally)
What is significant about plantaris?
- Vestigial muscle with long skinny tendon
What does the anterior tibial artery give off?
1) Anterior tibial recurrent artery ( last of knee vessels) 2) Medial and lateral malleolar arteries
What are the 5 capsular ligaments and where do they connect?
1) Coronary: Minisci -> jt capsule 2) Arcuate popliteal: Fibular head -> lateral epicondyl of femur 3) Patellar retinacula: seals quadraceps tendon to jt. capsule 4) Oblique popliteal: from SM tendon (backward projection of SM)
What are the superficial veins of the lower leg, from the foot up?
1) Dorsal venous arch 2) Great Sapheneous Vein (medial) and small saphaneous vein (lateral)
What branches does the posterior tibial artery give off?
1) Fibular/ peroneal: supplies lateral compartment 2) Circumflex fibular: Goes around neck of fibula 3) Nutrient artery of tibia: Largest nutrient artery in the body 4) Melleolar branch: Goes towards medial malleolus 5) Calcaneal arteries: Supplies the heel
What are the two motions of the knee and how do the bones move?
1) Flexion: Femur rolls back & slides forward 2) Extension: Femur rolls up & slides back
What are the three functions of the menisci?
1) Increase congruence/ improve fit 2) Reduce friction 3) Shock abdorption
What reinforces knee joint stability?
1) ligaments 2) the jt. capsule 3) tendons 4) muscles 5) menisci
How many compartments are there is the leg and what separates them?
3 compartments, separated by fascia
How do you test the tibial and lateral collateral ligaments?
Abduct/ Abduct Tibia If tib abducts: damage to medical collateral ligament If tib adducts: damage to lateral collateral ligament
Is lateral rotation of the femur passive or active?
Active
When does the femoral artery change to the popliteal artery?
After going through the adductor hiatus
What does the popliteal artery split into?
Anterior and posterior tibial arteries
What does the anterior tibial artery supply?
Anterior compartment of the leg
What separates the anterior and lateral compartments?
Anterior intermuscular septum
Where does the great saphenous vein travel and what does it empty into?
Anterior to medial malleolus Travels up leg with the saphenous nerve Empties into femoral veins in femoral triangle
What are the compartments of the leg?
Anterior, posterior, and lateral
Both both ligaments name: Origin Femoral attachment What action does the ligament protect?
Anterior: Origin- anterior Femoral attachment: Lateral Protects: Extension Posterior: Origin- posterior Femoral attachment- medial Protects- Flexion
What damages the unhappy triad and why?
Anterolateral blow to fixed leg Pushes knee medially, tears tibial collateral ligament which is turn damages medial meniscus. Damages ant. cruc. because weight bearing
Where does the anterior tibial artery travel?
Between EHL and TA w/ deep peroneal nerve
Anserine bursae
Between pes anserinus and tibia
What forms the borders, roof, and floor of the popiteal fossa?
Borders: Biceps femoris Med/ lat had gastroc Semimembranous & semitendonisis Roof: Fascia, skin Floor: Popliteus Distal posterior femur Joint capsule Oblique popliteal ligament from semimembranosus tendon
What feeds in the the dorsal venous arch?
Branches from toe & metatarsal region
What are the menisci of the knee made of?
Connective tissue, fibrocartilage
What separates the anterior and posterior compartments?
Crural interosseous membrane
What is the "unhappy triad"?
Damage to: 1) Anterior cruciate 2) Tibial collateral ligament 3) Medial meniscus
How do you test the posterior cruciate ligament?
Shelf sign
What contributes to the great sapheneous vein?
Dorsal venous arch in medial side
What does the anterior tibial artery teminate as and what does it supply?
Dorsalis pedia artery, supplies dorsum of foot
What actions does peroneus tertius do?
Dorsiflexion and eversion
What kind of joint is the tibiofemoral joint and what actions take place there?
Double condyloid/ modified hinge Mostly F/E, a little rotation
How do you test the anterior cruciate ligament?
Drawer sign
What tends to damage ligaments?
External blows
What are the five genticualr branches that supply the knee and where are they given off?
Given off in popliteal fossa Lateral Superior & inferior genicular Medical superior & inferior genicular Middle genicular
What is the path of Extensor Hallucis Longus?
Goes behind TA tendon Then down to big toe Travels between EDL and TA tendon
What do the deep. capsular parts of the tib and tib collateral ligaments do?
Help to reinforce jt. capsule on either ide
What is the landpart between the anterior tibial artery and dorsalis pedis?
Imaginary line between malleoli
What tends to damage menisci?
Internal forces: sudden change in direction of movement on fixed leg
What stabilizes the knee in relaxed standing?
Knees locked, so only need ligaments to stabilize the knee (especially anterior cruciate and posterior jt. capsule)
What does the fibular collateral ligament do?
Lateral femoral epicondyl -> fibular head Prevents tibular adduction
What genicular branches can be seen in the popiteal fossa?
Lateral sup & inf genicular Med sup & inf genicular Middle genicular
What stabilizes the knee in flexion?
Ligaments + muscle activation + iliotibial tract esp. posterior cruciate & popliteus
What results from conjunct rotation?
Locking of the knee
What do veins eventually drain into?
Lymph nodes
Which menisci is larger/ more open?
Medial
What are the articular surfaces of the tibia?
Medial & lateral condyles separated by intercondylar tubercles
What does the posterior tibial artery terminate as?
Medial and lateral plantar arteries on sole of foot
What does the tibial collateral ligament do?
Medial femoral epicondyl -> medial proximal tobia Prevents tibial abduction
What bones are part of the knee joint?
Only the femur and tibia
What is the iliopatellar band?
Part of the ITB that attaches to patella
Is conjunct rotation and active or passive process?
Passive
Does peroneus longus or brevis have better leverage for eversion?
Peroneus Longus
What muscles are found in the lateral compartment and what is the NS and BS?
Peroneus longus Peroneus brevis NS: superficial peroneal nerve BS: Peroneal artery
What kind of joint is the patellofemoral joint and what actions take place there?
Plane joint Patella glides up in extension, down in flexion
What are the contents of the popiteal fossa?
Popliteal artery Popliteal vein (small saphenous vein drains into) Sciatic Nerve Tibial nerve Common peroneal nerve Sural nerve
What muscle unlocks the knee and is it an active or passive process?
Popliteus muscle, active process
What does the posterior tibial artery supply?
Posterior compartment of the leg
What separates the lateral and posterior compartments?
Posterior intermuscular septum
Where does the small saphenous vein travel and what does it empty into?
Posterior to lateral malleolus Travels up back of leg w/ sural nerve Empties into popiteal vein in popiteal fossa
What is the patella embedded in?
Quadraceps tendon
What muscles does the tibial colalteral mligament run underneath?
Sartorius, semitendinosus, gracilis (common insertion of pes anserineos)
What nerve separates in the popiteal fossa?
Sciatic nerve into tibial (straight down) and common peroneal nerve (goes laterally)
What is conjunct rotation of the knee?
Smaller lateral condyl gets into final position on the tibia before the medial condyl, causing the femur to spi medially on the lateral condyl until the medial condyl is in position.
What is the path of peroneus brevis?
Starts distally Terminates on base of 5th metatarsal
What is the path of peroneus longus?
Starts proximally Goes down onto sole of foot
What muscles are found in the posterior compartment and is the NS And BS?
Superficial: - Gastroc - Soleus - Plantaris Deep: - Tibialis posterior - Flexor digitorum longus - Flexor hallucis longus - Popliteus NS: Tibial nerve BS: Posterior tibial artery except for Popliteus and Gastro which get popliteal artery
What is the other name for the achilles tendon?
Tendo calcaleous
What bone are the menisci attached to?
The Tibia
What femoral condyle is smaller?
The lateral condyl
What is the medial menisci closely attached to?
The medial collateral ligament (tibial collateral ligament)
Where does the quadriceps tendon insert?
The tibial tuberosity
Where does the posterior tibial artery travel?
W/ tibial nerve on tibialis posterior muscle Goes behind medial malleolus onto sole of foot
What ligament is torn/ damaged most often and what is often damaged along with it?
Tibial collateral ligament, medial meninscus
What muscle is the best dorsiflexor of the ankle?
Tibialis anterior
What muscles are found in the anterior compartment & what is the NS and BS?
Tibialis anterior Extensor hallucis longus Extensor digitorum longus Peroneus tertius NS: Deep peroneal nerve BS: Anterior tibial artery
What two muscles from the posterior and anterior compartments work together to invert the foot?
Tibialus anterior and tibialus posterior
What acromym can be used to remember the deep layer of the posterior leg?
Tom Dick And Nervous Harry
What surround the knee joint?
a joint capsule
Popliteus, gastroc, & semimembranous bursae
between muscles & what underlyes them
Deep infrapatellar
between patellar ligament and tibia
Suprapatellar bursae
between quadraceps tendon and femur
Subcutaneous prepatellar bursae
between skin & patella
Subcutaneous infrapatellar bursae
between skin & patella ligament
What separates the superficial and deep posterior compartments?
transverse crural intermuscular septum