Byt

henameofAl
lah

SudanUni
ver
sit
yOfSci
enceandTechnol
ogy

-Facul
tyofMedi
cine

Name:MohammedAdi
lAwadSay
ed

Year
:2ndYear

Subj
ect
:Anat
omy

Assi
gnment
Hi
psandKneeJoi
nts

Super
visor
:

Wal
aaAl
fat
eh
Hi
pjoi
nt
Thehipjoi
ntisasy nov
ialart
icul
ati
onbetweent heheadoft hefemurandt heacet
abul um oft
he
pel
v i
cbone(Fig.6.
30A).Thej oi
nti
samul ti
axi
al ball
andsocketjointdesi
gnedforstabil
it
yand
weight-
beari
ngattheexpenseofmobi li
ty.Movement satthejoi
ntincl
udef l
exi
on,extensi
on,
abducti
on,adducti
on,medialandlat
eralrot
ati
on, andci
rcumduction.

Whenconsi deri
ngtheeffect
sofmuscl eacti
ononthehipj
oint
,thelongneckoft hefemurand
theangulat
ionoftheneckont heshaftofthefemurmustbeborneinmi nd.Forexample,
medial
andlat
eralrotat
ionofthefemurinvol
vesmuscl est
hatmovethegreatertr
ochanterf
orwardand
backward,r
espectivel
y,r
elat
ivet
otheacet abul
um.

Thear
ti
cul
arsur
facesoft
hehi
pjoi
ntar
e:

▪t
hespher
ical
headoft
hef
emur
.

▪t
hel
unat
esur
faceoft
heacet
abul
um oft
hepel
vi
cbone.

Theacetabul
um almostenti
rel
yencompassest hehemispheri
calheadofthefemurand
contr
ibut
essubstanti
all
ytoj
ointstabi
l
ity
.Thenonarti
cul
aracetabularf
ossacontai
nsloose
connecti
veti
ssue.Thelunat
esurfaceiscover
edbyhy al
inecart
il
ageandisbroadestsuper
ior
ly.

Exceptf
ort
hef
ovea,
theheadoft
hef
emuri
sal
socov
eredbyhy
ali
necar
ti
lage.

Theri
m oftheacetabul
um i
srai
sedsli
ght
lybyafi
brocar
ti
laginouscol
l
ar(t
heacetabul
ar
l
abrum).I
nfer
ior
ly,
thelabr
um bri
dgesacr
osstheacet
abularnotchasthet
ransv
erseacet
abul
ar
l
igamentandconvertst
henotchint
oaforamen.

Thel i
gamentoftheheadoft hefemurisaf latbandofdeli
cateconnect
iveti
ssuethatattaches
atoneendt othefoveaontheheadoft hef emurandatt heotherendtotheacetabularf
ossa,
transver
seacetabul
arli
gament,andmar ginsoft heacet
abularnotch(
Fig.6.
31B).Itcarr
iesa
smal lbr
anchoftheobturat
orart
ery,whichcont r
ibut
estothebloodsupplyoftheheadoft he
femur.

Thesy novi
al membraneattachest othemar gi
nsofthear t
icul
arsurf
acesofthefemurand
acetabul um,formsat ubul
arcov er
ingaroundtheli
gamentoft heheadofthef emur,
andl i
nes
thefibrousmembr aneofthejoint(Fi
gs.6.31Band6.32).From i
tsatt
achmentt ot
hemar gi
nof
theheadoft hefemur, t
hesynov i
almembr anecover
st heneckoft hefemurbefor
erefl
ecting
ontot hef i
brousmembr ane.

Thefibr
ousmembr anethatenclosesthehipjoi
ntisstr
ongandgener allyt
hick.Mediall
y,i
tis
at
tachedtothemar gi
noft heacetabul
um,thetransver
seacetabularl
igament ,andtheadj
acent
marginoftheobtur
atorforamen(Fig.6.
33A).Later
all
y,i
tisatt
achedt otheintertr
ochant
eri
cline
ontheanteri
oraspectofthefemurandt otheneckofthef emurjustproxi
mal tothe
i
ntert
rochant
eri
ccrestont heposteri
orsur
face.
Kneej
oint
Thekneej ointisasynovi
alj
ointt
hatconnect
sthreebones;thef
emur,tibiaandpatel
la.I
tisa
compl exhingejoi
ntcomposedoft woarti
cul
ati
ons;t
hetibi
ofemoralj
ointandpatell
ofemoral
j
oint.Thetibiof
emoraljoi
nti
sanar ti
cul
ati
onbetweentheti
biaandthef emur,whi
lethe
patell
ofemor al
joi
nti
sanar t
icul
ati
onbetweenthepatel
laandthefemur .

Thekneej oi
ntisthelar gestandar guablythemostst ressedj ointint hebody.Thear rangement
ofthebonesi nthejoi
ntpr ov idesaf ulcrum thattranslat estheact i
onsoft heflexorandext ensor
muscl esoftheknee.Thear rangementoft heextracapsul arandi ntracapsul
arandl igament s,
as
wellasextensionsofmuscl est hatcrosst hejoint,prov i
det hemuchneededst abili
tythat
counterstheconsiderablebi omechani calstr
essbr oughtupont hej oint.Asahi ngedjoint,
the
kneejointmost l
yall
owsmov emental ongoneaxi si nt ermsoff lexionandext ensionoft heknee
i
nt hesagitt
alplane.I
tal soal lowssl i
ghtmedi alrotationdur ingf lexionandthel aststageof
extensionoftheknee, aswel l aslateralrotat
ionwhen“ unlocking”t heknee.

Keyf
act
saboutt
hekneej
oint

Ty
peTi
biof
emor
alj
oint
:Sy
nov
ial
hingej
oint
;

Pat
ell
ofemoraljoint:Pl
anej
oint
Art
icul
arsur
facesTi
biof
emor
alj
oint
:lat
eral
andmedi
alcondy
les
off
emur ,
tibi
alplateaus

Patell
ofemoral j
oint:patel
l
arsurf
aceoff emur ,
poster
iorsurfaceofpatel
l
aLigamentsand
MenisciExtr
acapsul arli
gaments:patel
larligament,medialandlater
alpatel
l
arret
inacul
a,t
ibi
al
(medial)col
later
al li
gament,fi
bul
ar(lateral)col
lat
erall
igament ,
obli
quepopli
teal
ligament
,
arcuatepoplit
ealligament,ant
erolat
eralligament(ALL)

I
ntr
acapsul
arl
i
gament
s:ant
eri
orcr
uci
atel
i
gament(
ACL)
,post
eri
orcr
uci
atel
i
gament(
PCL)
.

Theli
gament softhekneejoi
ntcanbedi vi
dedint
otwogr oups;
ext
racapsul
ar
l
igamentsandi ntr
acapsul
arl
igaments.Theseli
gamentsconnectt
hefemurandt
ibi
a,hol
ding
them i
nplace,provi
dingst
abi
lit
y,andprevent
ingdi
slocat
ion.

Extr
acapsularli
gamentsaref
oundoutsi
dethejoi
ntcapsuleandi ncl
udet
hepat ell
arl
igament
,
fi
bular(
lat
eral)andti
bial
(medi
al)col
l
ater
alli
gaments,andobliqueandarcuatepopli
teal
l
igaments.I
nt r
acapsul
arli
gamentsar
efoundinsi
dethejointcapsule,
wit
ht hecruci
ate
l
igamentsbei ngthemostwellknownofthi
ssubgroup.

Pat
ell
arl
i
gament

Thepatel
larl
igamentisastr
ong, t
hickfibr
ousbandt hati
sadi stalcont
inuat
ionof
thequadr
icepsfemori
stendon.Iti
sf oundsuperfi
cial
/anter
iortotheinf
rapatel
l
arbur
saand
extendsf
rom theapexofpatel
l
at othet i
bial
tuber
osity.
Alongitsoutermargins,
thepatell
arli
gamentblendswit
hthemedialandlateralpatel
l
ar
reti
nacula,
whi char
eextensionsofthev ast
usmedial
isandl
ater
ali
smuscl es,respect
ivel
y,as
wellastheov erl
yi
ngfascia.Thepatel
larli
gamentpl
aysamajorrol
einstabili
zingthepatel
laand
prevent
ingitsdispl
acement .

Lat
eral
(fi
bul
ar)col
l
ater
all
i
gament
:

Thef i
bul
arcol
lat
eralli
gamentisastrongli
gamentthatori
ginat
esfrom t
helateral
epicondy
leof
thefemur,j
ustposteri
ortotheproxi
mal at
tachmentoft
hepoplit
eus,andextendsdistal
l
yto
att
achont hel
ateralsurf
aceofthefi
bularhead.

Asitattachestothef i
bul
arhead,theli
gamentspl
it
sthetendonofbicepsf emori
smuscleintwo.
Thef i
bularcol
l
ateralli
gamentisfounddeeptothelat
eralpat
ell
arr
etinaculum,andsuper
fi
cialt
o
thetendonofpopliteusmuscle,whichsepar
atest
heligamentfr
om thelateral
meniscus.

Medi
al(
ti
bial
)col
l
ater
all
i
gament
:

Theti
bialcol
later
all
igamentisthestr
ong,f
latl
i
gamentofthemedi al
aspectoft hekneejoint.
Theti
bialcol
later
all
igament,i
nadditi
ontoit
sfi
bularcount
erpart,
actstosecur ethekneejoint
andpreventexcessi
vesidewaysmov ementbyrest
ri
cti
ngexternalandinternalr
otati
onofthe
ext
endedknee.Thet ibi
alcol
l
ateral
li
gamentissometimesdivi
dedt heli
teratur
eintosuperf
icial
anddeeppar t
s:

Superf
icialpart
: or
igi
natesjustproximal t
hemedial epi
condy leofthef emur.Thisli
gamenthas
twoattachmentpoi nts;aproximalattachmentont hemedi al condyleofthetibi
a,andadistal
att
achmentont hemedi alshaftofthetibi
a.Anter
iorly,
thesuper fi
cialpartbl
endswi tht
he
medialpatell
arreti
naculum andt hemedi alpat
ell
ofemor al
ligament ,whichcoursesfrom t
he
medialfemor alcondyletoattachontot hemedialborderoft hepatella.

Deeppart:av er
ticalthickeni
ngoft hekneejointcapsul
efoundunderneaththesuperf
icialpar
t
ofthet
ibialcoll
ateralligament.Itori
ginat
esf r
om theareaofthedi
stalf
emur ,
thenattachesto
themedialmeni scus, andterminatesonthepr oximalt
ibi
a.Thesetwopartsoftheli
gamentar e
defi
nedasmeni scofemor alandmeni scoti
biall
igaments(seebel
ow).

Obl
i
quepopl
i
teal
li
gament
:

Theobliquepopli
teall
i
gament( Bour
ger
yli
gament)isanexpansi
onof
thesemi membranosustendonwhichor
igi
natesposter
iort
othemedialti
bial
condy
leand
ref
lect
ssuperior
lyandlater
all
ytoatt
achonthelat
eralcondyl
eofthefemur.

Asi
tspanstheint
ercondy
larf
ossa,t
heobli
quepopli
teal
li
gamentr
einf
orcest
hepost
eri
orpar
t
oft
hejoi
ntcapsul
eandblendswithi
tscent
ral
port
ion.
Ar
cuat
epopl
i
teal
li
gament
:

Arcuatepopli
teal
li
gamentisat hick,f
ibrousbandt hatari
sesontheposterioraspectoft he
fi
bularheadandarchessuperiorl
yandmedi al
lyt
oat tachontheposteri
orsideoft hejoint
capsuleoftheknee.Thearcuatepopliteall
i
gamentr einf
orcestheposter
olateralpartofthejoi
nt
capsule,andt
ogetherwit
ht heobliquepoplit
eall
igament ,
prevent
sov er
extensionoft heknee
j
oint.

Cr
uci
atel
i
gament
s

Thepai redcruciateli
gamentsgotthei
rnameduet othef
actt
hattheycr osseachother
obliquelywit
hint hejoi
ntinawaythatresemblesacr
oss(l
ati
n=cr ux),
oral et
terX.Theycross
withinthejoi
ntcapsul e,howev
erremainexter
naltot
hesynovi
alcavit
y.Thecruciat
eligaments
aredi v
idedasf ollows:

Ant eri
orcruciateligament :ar
isesfrom theanter i
orinter
condy larareaoft hetibi
ajustbehindthe
attachmentoft hemedi almeniscus,andextendspost er
olaterall
yandpr oxi mall
ytoattachon
thepost eri
orpar tofthemedi al surf
aceofthel ateralfemoralcondy le.Asi tcr
ossestot heother
sideoft hekneej oint,theli
gamentpassesunder neaththetransv er
sel i
gament( seebel ow)and
blendswi ththeant er
iorhornoft helater
almeni scus.Theant eriorcruci
atel i
gamentisi mportant
topr eventposteriorrolli
nganddi splacementoft hef emoralcondy leduringf l
exi
on,aswel lasto
prev enthyperextensionoft hekneej oint
.

Posteri
orcruciat
el i
gament :ari
sesfrom thepost eriori
ntercondyl
arareaoft heti
biaandextends
anter
omedi all
yandpr oximallytoatt
achont heant eri
orpartofthelateralsurf
aceofthemedial
femoralcondy l
e.Thisligamentisalmostt wi ceasst r
ongandhasbet terbloodsuppl
ythanthe
anter
iorcruciat
eligament .Theposteriorcruciat
eligamenthast heopposi tefunct
ionofthe
anter
iorcruciat
eligament ,serv
ingtopr eventanteriorrol
l
inganddi splacementofthefemoral
condyleduringextension,aswel l
ast oprev enthyperfl
exionofthekneej oint.

Bl
oodSuppl
y:

Descendingbranches:Descendingbranchoft
hel
ater
alci
rcumf
lexf
emor
alar
ter
y,descendi
ng
geni
cularbranchofthefemor al
arter
y.

Ascendingbranches:ci
rcumfl
exfibul
arbranchoftheposter
iort
ibi
alar
ter
y,ant
eri
orand
poster
iorti
bialr
ecurr
entbranchesoftheanter
iort
ibi
alart
ery.

Branchesoft
hepopli
teal
art
ery:
lateral
superi
orandi
nfer
iorgeni
cul
arart
eri
es,
themedi
al
superi
orandi
nfer
iorgeni
cul
arart
eries,
andthemiddl
egenicul
arart
eri
es.