The Anatomy of the knee joint the knee is the most complex organism from the point of anatomical and functional because it must be stable and at the same time should allow a good mobility.
Bones
formed by three bones: the femur, tibia and patella, it would be more correct to divide it into two articles
· patellofemoral joint (between the rear area of \u200b\u200bthe patella and the anterior distal femur),
· Tibiofemoral (between the distal epiphysis of the femur and the proximal epiphysis of the tibia).
the distal epiphysis of the femur has two condyles, which are sections of asymmetric ellipsoids, are separated by a posterior intercondylar fossa is clearly visible.
front, the condyles are joined together from this area which is a unique joint surfaces.
Knee seen before.
the sides of the condyles, there are two projections, epicondylitis, so named because they are above the condyles.
The condyles are the articular surfaces of the femur, while the epicondyles are not.
The tibia has expanded as a head feature, there is also the shin that can be find easily palpate the front of the leg.
At the top there is the tibial tuberosity which is the insertion of the patellar ligament.
The patella tendon is located in the bottom of the quadriceps femoris.
This tendon has a top and a bottom that is called the patellar ligament to join the tibial tuberosity.
The kneecap is shaped like a chestnut, the outer area is wrinkled with vertical grooves, while the inner surface is smooth and covered with articular cartilage.
The patella is included in the joint capsule.
Leg seen after
The femur and the tibia form a ginglimo, that a joint where the only movement allowed is the flexion-extension in the sagittal plane, with the bent knee is also possible because the rotational movement of the tibial articular surface is not exactly complementary to that of the femur has a concavity and pronounced that block certain movements .
the intense forces that is under load and the presence of almost the whole body.
The articular surfaces of the femur are the femoral condyles have a convex shape.
The tibia is articulated through the upper part of the bone with two condyles, the inner one is concave, the outer one convex.
The menisci menisci seen from
The menisci are two pads as fibro-cartilage shaped like a "C" inserted between the two bones.
The thickness of these two structures is greater outside than the medial.
The meniscus has a circular exterior nearly closed
and adheres to the capsule for almost the entire length except for a small area through which the tendon of the popliteus muscle, the Horns have approximately the same volume
The medial meniscus adheres to the capsule the length of the horns and different from each other, the front is narrower and lower than the rear.
The functions of the menisci are
· Power shocks.
shall address the body weight on the whole area of the tibial plateau, if there were no weight would have been charged over an area of \u200b\u200blower amplitude resulting in greater wear and tear of the knee.
· Spread the synovial fluid in order to streamline the movement because it reduces friction.
Improve joint congruence between the Tibia and Femur.
· limit the rotation.
The exterior gives mobility to the knee meniscus, while the interior makes a more stable joint.
In flexion, the external meniscus is pulled back from the popliteal muscle, while the inner one moves to a lesser extent, by the work of the semimembranosus muscle.
In the extension movement, within their anatomical location moved ligaments that join the menisci to the patella.
The patella is a sesamoid bone between the femoral and the patellar tendon, is used to centralize the forces exerted on the articulation, to protect the knee and facilitate the extension of the leg.
All articular surfaces of these bones are covered with smooth cartilage that serves to reduce friction during movement and make the flow of bone pain-free and uniform.
During the movement, part of the cartilage and synovial fluid is compressed before it is pushed into the coated dish, but when the joint is no longer under load or you stop, the cartilage absorbs the synovium behaving like a sponge.
ligaments.
The knee has the strong ligaments that are critical to the kinematics.
cruciate ligaments play the action of "Pivot Central", that is the pivot on which the joint moves.
the anterior cruciate ligament (ACL) at the tibia is inserted before the tibial spine, while on the ends on the medial femoral condyle of the exterior, not much is known vascular and fragile because it is frequently subject to attacks of the PCL.
has a crucial role in maintaining strong and stable joint, limited internal rotation and hyperextension, flexion also reduces the shift in forward compared to the femoral condyles of the tibia.
originates in the posterior cruciate ligament tibial intercondylar recess and inserts on the medial condyle of the femur on the inside, is well perfused and is much more robust than the LCA.
The LCP is essential in controlling the rotation and during the extension reduces the posterior displacement of the tibia compared to the femoral condyles.
The cruciate ligaments are in the form of "X", crossed over all three dimensions of space.
Knee front view without patella
Externally there are two ligaments in the knee: Lateral Collateral (LCL) and medial collateral (MCL). The first
origne dall'epicondilo side of the femur and inserted in the outer part of the fibular head, has a shape similar to a rope.
The LCL is divided into a superficial and a deep layer and joined to the capsule or the meniscus.
The medial collateral ligament, originates from the external face of the medial condyle and lateral area is part of the tibia.
The LCM is thinner than the LCL, is shaped like a rubber band, is located within the capsule and connected to the medial meniscus is longer than the lateral collateral.
The reactions are important because they block the movement of lateral inclination of the tibia on knee, in fact the two ends of the ligaments reach their maximum tension with knee extended, while during the downturn loosen.
In front of the knee is located on the transverse ligament that connects the knee meniscus and the medial meniscus to the intercondylar area.
the sides of the patella are the alar ligaments in the side of the alar ligament is external, is located in the medial part of the inner, their task is to prevent excessive lateral movement of the patella.
the back of the knee meniscus ligament-posterior femoral connects these two structures and oblique.
level of the patella are fibrous expansions that originate from the large medial and lateral side by inserting the edge of the patella. This continues to the lateral collateral tissue and the condyle of the tibia on the same side of the knee.
the capsule and the synovial membrane.
The fibrous capsule is a container type sleeve that connects the bones of the knee , originates on the back of the hip higher than the articular cartilage, before it connects to the sides of the kneecap and the lower part of the tibial articular surface.
The capsule is thicker in some places where you link to the ligaments of the knee, on the front of the knee becomes thickens and forms the patellar ligament that connects the kneecap to the tibia.
The synovial membrane carpets the inner surface of the capsule and is composed of fibrous connective tissue, is very useful because it produces the synovium or synovial fluid that nourishes the cartilage and lubricates the joint to decrease friction during movement.
in the knee joint, deep to the tendons, there are numerous bursae, that pockets of synovial fluid between bones and skin or between ligaments and muscles between.
The largest is located on the front of the knee, between the skin and the patella, is the pre-rotuea bursae between the quadriceps tendon and the femur is located the bag and between the patellar ligament patellar and tibia lies the bag infra-patellar.
This structure has the task to allow the sliding between the muscles and tendons keeping "oiled" the mechanism by decreasing the friction between the tissues.
PAPI PAPE
points and corner rear extension (PAPE) and external (PAPI) are structures formed by ligaments, tendons and joint capsule and have a joint action with the cruciate ligament to stabilize the knee antero to back and when turning, also avoid subluxation of the tibia during flexion or extension. The
PAPE is situated to the rear than the lateral collateral.
The postero-external corner point is made dynamic by the popliteus muscle, which has a tendon that is divided into three beams, the first fits sull'epicondilo side of the femur, the second term on fibular head (arcuate popliteal ligament) and the third connects to the external meniscus, this also includes the biceps femoris tendon.
This triple insertion of the tendon can exert a force on the meniscus during flexion and internal rotation, also acts as a stabilizer. between femur and tibia.
In the case of the posterior cruciate ligament injury, in most cases it affects the PAPE.
The PAPI is located on the medial aspect of the knee, inside the medial collateral ligament, is formed from the posteromedial capsule, the tendon of the semimembranosus muscle, the posterior oblique ligament and includes the medial meniscus.
the corner point Postero-interior serves to stabilize the medial side of the joint, acting in conjunction with the LCA.
The Paw Goose.
Among the muscles of the back loggia and medial thigh, there are three that have a common tendon called "Paw Goose" that fits on the inner surface of the proximal tibia.
This large tendon is synergistic in the stabilization of the medial collateral ligament of the knee and prevents excessive external rotation.
Hoffa's body.
The Body of Hoffa fat pad is below the patellar ligament and has a dual function, to absorb the impact and facilitate movement by reducing friction.
Muscles of Knee Muscle
TFL.
It 's a muscle is long and narrow and is located in the outer portion of the thigh.
originates from the SIAS (iliac spine Anterior Superior) and is part of the external condyle of the tibia, is bipolar and controls because it crosses two joints: the hip and knee.
The tendon that inserts on the tibia is very long, starts just below the line Pettineo and gluteal tuberosity and joins the femoral fascia lata or polypropylene mesh or stretch forming the ilio-tibial.
The action of the tensor fascia lata is the abduction of the thigh, is a synergistic extension of the leg thigh.
sartorius muscle.
And 'the more muscle we have long, narrow ribbon and has a trend to "S" and runs superficial to the quadriceps.
originates from the SIAS (anterior superior iliac spine) and is part of the medial tibial tuberosity joining the tendons of the gracilis and semitendinosus tendon, which together form a structure called "Paw Goose."
The sartorius is a muscle that allows you to take the typical position of the tailor with his legs crossed, hence its name, it flexes, abducts and externally rotated the thigh as well as flex and internally rotate the leg.
quadriceps femoris muscle.
E ' the most important knee extensor muscle and is a key to walking.
is located on the anterior thigh muscle is composed of four parts: 1
. Vastus lateralis
2. Broad Intermediate
3. Vastus medialis
4. Rectus femoris.
The rectus femoris is bipolar and originates from the Singularity Institute (Lower Anterior iliac spine) and the upper circumference of the acetabulum, the vastus lateralis originates from the side of the greater trochanter and the Rugged Line, the Broad-faced Intermediate origne Antero-Lateral femoral shaft and the vastus medialis originates from the medial side of the Line Rugged. These four muscles
proceed to the patella tendon to form a common said that is part of the quadriceps tendon Patella, some bands are still before the decision to end the tibial tuberosity. The quadriceps
covers the whole front of the femur, as well as extending the leg, the rectus femoris contributes to lower thigh.
the sides of the patella tendon of the quadriceps retinaculum is strengthened by two, ie bundles of fibrous connective tissue that connects the patella to the tibial condyles
The hamstring muscles
Three of the lodge back of the thigh are the biceps femoris, the semimembranosus and semitendinosus are all bipolar, having a common origin ischial bending action of the leg on the thigh and extension thigh, have an important role in the kinematics of the knee that by their action to protect the anterior cruciate ligament injuries.
The hamstring
Named one understands that this muscle has two heads, one that originates from the ischial tuberosity along with the semimembranosus muscle, the short stems in the distal half of the Line Rugged and lateral intermuscular septum.
After traveling back and side fits over the head of the fibula and lateral condyle of the tibia.
Action of hamstring to flex the leg is externally rotated on the thigh, is the only muscle that acts as an external rotation of the knee, also extends the thigh.
semitendinosus originates from the ischial tuberosity, but compared to the other hamstring is located in the upper and outside.
part of the back and medial thigh and inserts on the medial aspect of the medial condyle of the tibia.
The action of the semitendinosus and to flex and internally rotate the leg on the thigh, also extends the thigh.
The semimembranosus originates from the ischial tuberosity with the hamstring, is located in the posterior and medial thigh, the distal tendon is separated into three bundles: the branch "descendant" ends on the back of the Medial Tibial condyle, the branch "applicant" continues through the lateral condyle forming the Femoral popliteal ligament oblique, and the branch "front" or reflection that fits on the front of the Internal Condyle of the Tibia.
The action of the semimembranosus is flexion and internal rotation of the leg on the thigh and extension of the thigh.
gracilis
As the name implies, this muscle is small and ribbon, lies on the medial side of the thigh.
originates from the front of Branca pelvic bone and insert on the anterior and medial condyle of the tibia with the sartorius muscle and the semitendinosus forming the leg of goose.
alleges gracilis thigh, flexes and internally rotates the leg on the thigh. The popliteal muscle
It 's a deep muscle located in the lodge back of the leg is wide and thin.
originates from the external area of \u200b\u200bthe lateral femoral condyle and inserts on the top of the sloping line and the rear of the Tibia.
The popliteus muscle flexes and rotates leg medially.
the gastrocnemius
E 'consists of two parts symmetrical muscle, which originates from a medial femoral condyle and the inner portion of the internal capsule, and a side that originates from outside Feomrale Condyle and the outer portion of the capsule, is a muscle bipolar.
fits the rugged heel or Achilles tendon on the postero-superior area of \u200b\u200bthe heel.
The action of the gastrocnemius and plantar flexion of the foot and internal rotation also contributes to flexion of the leg on the thigh.
© Sebastian Kaulitzki - Fotolia.com
Private Clinic Physiotherapy Dr. Massimo Defilippo FisioterapistaTel 0522/260654 http://www.fisioterapiarubiera.com/ Defilippo.massimo @ gmail.com Via Roma 18, 42048 Rubiera (RE) Aut Sanit. n ° 3138 16/02/2009 Dir of Dr. St. John Defilippo Surgeon http://fisioterapiarubiera.blogspot.com/ http://www.linkedin.com/in/massimodefilippo http://fisioterapiarubiera.myplaxo.com/ fisioterapiarubiera@gmail.com fisioterapia_ ginocchio_tendinite @ gmail.com massimo_defilippo_fisioterapia@gmail.com
