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knee joint

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knee joint

Anatomy
- knee joint
  - Articulation:
    - Tibiofemoral
    - Patellofemoral
      - Importance of patella
        minimises wear and tear on the patellar tendon.
        dislocation
        Laterally because of Q angle
  - Capsule
    - posteriorly and on sides
      - opening for passing the tendon of popliteus
    - absent anteriorly
      - replaced by: 1. Quadriceps tendon 2. Patella 3. Patellar ligament & retinaculae.
  - Ligaments
    - extra-capsular
      - Lateral (fibular) collateral ligament (LCL)
        Rounded /cord-like, - Separated from the lat. meniscus by the tendon of popliteus. - Stronger than MCL
      - Medial (tibial) collateral lig. (MCL)
        Larger, broad & flat -Firmly attached to the med. meniscus
      - Oblique popliteal ligament (posteriorly
    - Intra-capsular
      - anterior cruciate lig
        prevent backward displacement of the femur on the tibia and hyperextension
        lax in flexion
      - posterior cruciate lig
        prevent forward displacement of the femur on the tibia
        lax in extension
      - transverse lig of the knee
      - posterior meniscofemoral lig.
  - menisci
  - bursae
    - suprapatellar-prepatellar -deep infrapatellar - subcutaneous [or superficial] infrapatellar- pretibial-lateral gastrocnemius -fibular - fibulopopliteal - subpoplitea- - medial gastrocnemius- anserine - bursa semimembranosa
  - INNERVATION
    - femoral , tibial, and common fibular nerves supply its anterior, posterior, and lateral aspects, respectively.
  - Anastomosis around the knee joint:
  - movement
- Anterior and lateral compartment of the leg
- Posterior compartment of the leg
Cartilage
- types
  - Hyaline Cartilage)
    - Bronchi- Bronchial Tubes- Costal Cartilages- Larynx- Nose- Trachea
  - fibrocartilage
    - Callus- Intervertebral discs- Menisci- Pubic Symphysis
  - elastic
    - Auditory tubes External ear Epiglottis
- compositions
  - Chondrocytes -: Collagenous extracellular matrix- that is rich in proteoglycan and elastin fibers- Perichondrium -Lacuna
- What
  - a resilient and smooth elastic tissue, rubber- like padding that cover the end of bones
Types of joints
special tests for knee injusry
osteoarthritis
- Epidemiology
  - the most common joint disorder in the world.
  - 10% men and 13% in women aged 60 years or older.
- risk factors
  - systemic
    - Age (the strongest risk factors )
    - Gender and hormones
    - Race/ethnicity
    - Genetics
    - Congenital/developmental conditions
    - diet
  - local
    - Obesity
    - Injury/surgery
    - Occupation
    - Physical activity/sports
    - Alignment
- Investigation
  - X-rays -CT scan and MRI -Blood markers Examples RA factor -Joint aspiration
    - x-ray findings
      - Osteophytes space narrowing Sclerosis Subchondral cyst
- Pathology
  - Chondrocyte Proliferation
  - Fibrillation of Cartilage
  - Eburnation of Bone
  - Joint Mice
  - Subchondral Cysts
  - Osteophytes
  - Sclerotic Articular Surface
  - Fibrous Synovial Pannus
- Signs and Symptoms
  - Steady or Intermittent pain in a joint
  - Pain worst at night
  - Stiffness that tends to follow periods of inactivity
  - Swelling/tenderness in one or more joints
  - Crepitus when bone is used
  - Prominent Osteophytes: Nodal Osteoarthritis
- Complications
  - pain and stiffness of the joints. Reduced mobility. Bone death (osteonecrosis). Stress fractures. Bleeding inside the joint. Infection in the joint. Deterioration or rupture of the tendons and ligaments around the joint, leading to loss of stability. Pinched nerve
- Management
  - pharmacological
    - Analgesiac agents
    - -NSAIDS s
    - -Intra-articular Corticosteriod
  - non-pharmacological
    - Physical exercise (Swimming most recommended)
    - Lifestyle adjustments (especially in obese patients)
    - Diet adjustment
    - Surgery
- psychology