1. Clinical Anatomy of the knee Mr CM Gupte Mr Alvin Chen

2. Overview • Knee joint function • Surface anatomy • Bones • Ligaments • Tendons • Examination • Disease processes

3. The Knee Joint • Poorly constructed in terms of stability - femur round, tibia flat. • Comprised of four bones. • Femur • Tibia • Fibula • Patella

4. The knee joint • Load bearing / Force transmission • Locomotion • Proprioception

5. Surface Anatomy

6. Bones • Patella: femur = patellofemoral joint • Femur: tibia = medial and lateral tibiofemoral joints

7. Knee Arthroscopy Surface Landmarks

8. Patella • Medial facet • Lateral facet • Articular cartilage

9. Femur • Medial femoral condyle • Lateral femoral condyle (protrudes more) • Trochlea • Articular cartilage

10. Femoral ligament insertions • PCL inner aspect medial femoral condyle • ACL inner aspect lateral femoral condyle

11. Tibia • Medial and lateral plateau • Insertions of menisci and cruciate ligaments • MCL/semimembranosus

12. Tibial plateau • Insertions of menisci/ • Cruciate ligaments

13. Ligaments • Extracapsular: MCL/ LCL • Intracapsular: ACL/PCL Functions: • Stabilise • Proprioception

14. ACL • Two bundles • Prevents anterior drawer and pivot

15. ACL Injury

16. MRI Normal ACL in RED Torn ACL

17. Tests for ACL Lachman’s Anterior Draw

18. Arthroscopy Intact ACL Torn ACL

19. ACL Reconstruction

20. PCL • Stronger than ACL • Prevents posterior drawer

21. PCL injury • Direct Blow onto Tibia on a flexed knee

22. MRI PCL Normal PCL PCL torn

23. Posterior Sag from PCL rupture

24. MCL • Medial • Prevents valgus stress • Deep and superficial parts • Heals well

25. MCL Injury

26. LCL • Lateral • Prevents varus stress • Cord like –weakest of the ligaments but rarely torn in isolation

27. Multiple Injuries

28. Extensor mechanism • Quadriceps • Patella • Patellar tendon

29. Quadriceps • VMO • Rectus femoris • Vastus intermedius • Vastus lateralis • Extend knee

30. VMO • Medial most quad • Helps prevent lateral dislocation of the patella

31. Extensor Mechanism injuries I

32. Extensor Tendon Injuries II

33. Extensor Tendon Injuries III

34. Hamstrings • Biceps laterally • Semitendinosus/semimembranosus medially • Flex knee

35. Pes • Sartorius • Gracilis • Semitendinosus • G and T used for ACL reconstruction

36. Movements of the Knee The principal muscles acting on the knee: • Extensors - quadriceps femoris • Flexors - hamstrings assisted by gracilis, gastrocnemius and sartorius. • Medial rotators- popliteus.

37. Movements of the Knee • The principal knee movements are flexion and extension, but rotation of the knee is possible when the joint is in flexed position .

38. Examination • Look • Feel • Move • Think about structures and what you’re dong to them

39. Diseases • OA • Meniscal tears • Ligament injuries • Patellofemoral tracking • Tendon injuries • Inflammatory arthritis • Infection/tumours

40. Arthritic Knee X-ray

41. Knee Arthritis

42. Knee OA on arthroscopy

43. Total Knee Replacement

44. Patellofemoral Knee Replacement

45. Unicondylar Knee Replacement

46. Meniscal Tears

47. Treatment of Meniscal Tears Suture/ Repair Debridement

48. Other Pathologies Patella Maltracking Bone Tumour

49. Any Questions ?