Q1

Knee Text Knee

Identify the features on this model of the knee joint.

  • Bones

    • Patella
    • Femur
    • Fibula
    • Tibia
  • Features
    • Medial and lateral femoral condyles
    • Medial and lateral tibial condyles
    • Tibial tuberosity
    • Head and neck of the fibula
    • lateral and medial epicondyle femur
    • menisci
    • patellar tendon
  • Ligaments
    • Medial and lateral collateral
    • Anterior and posterior cruciates

Pass Criteria:

  • All bones + 5 features + all 4 ligaments

Describe the cruciate ligaments and their actions.

  • Attachment points

    • Anterior cruciate
      • Weaker, anterior intercondylar area tibia, extends superiorly posteriorly and laterally to attach to posterior part of medial side of lateral condyle femur
    • Posterior cruciate
      • Arises from posterior intercondylar area of tibia and passes superiorly and anteriorly on medial side of anterior cruciate to attach to anterior part of lateral surface of medial condyle of femur
  • Actions
    • Anterior cruciate
      • Prevents posterior movement of femur on tibia (or anterior movement of tibia on femur) and limits hyperextension of knee
    • Posterior cruciate
      • Limits anterior movement of femur on tibia (or posterior movement of tibia on femur) and prevents hyperflexion of knee

Pass Criteria:

  • 2/4 attachment points
  • 1/2 actions

What features confer stability on the knee joint?

  • Muscles and tendons – name and describe as able
    • including quadriceps muscles (especially inferior fibres of vastus medialis and vastus lateralis
    • “screw home” mechanism
  • Ligaments connecting femur to tibia
    • Collateral ligaments
    • Cruciate ligaments
  • Little or no bony contribution to stability

Pass Criteria:

  • Bold to pass

Q2

Knee Text Knee

Please identify the ligaments of the knee joint and their attachments.

  • Patellar ligament – apex of patella to tibial tuberosity
  • Fibular collateral ligament – lateral epicondyle of femur to – lateral surface of fibular head
  • Tibial collateral ligament – medial epicnodyle of femur – lateral and superior aspect of tibia
  • Anterior cruciate – anterior intercondylar area of tibia to anterior aspect of the lateral surface of medial condyle of femur
  • Posterior cruciate – posteiror intercondylar area of the tibia to anterior aspect of the lateral surface of medial condyle of femur
  • Posterior meniscofemoral ligament

Pass Criteria:

  • Identify attachments of 3/5

Describe the main movements of the knee joint and the muscles involved.

  • Extension – quadriceps femoris
  • Flexion – semitendinosis, semimembranosus, biceps femoris
  • Medial rotation – when flexed – ST, SM
  • When non weight bearing knee extended – popliteus

Pass Criteria:

  • Bold to pass

Describe the locking and unlocking process as the joint is extended and flexed.

  • When knee extended and weight bearing – knee passively locks due to medial rotation of femoral condyles on tibial plateau
  • Knee unlocks through contraction of of popliteus rotating femur laterally on the tibial plateau allowing flexion

Pass Criteria:

  • Understand concept

Q3

Model: Lower Leg

Identify the muscles of the posterior compartment of the leg.

  • Superficial posterior compartment:
    • Gastrocnemius m. (24a,b)
    • Soleus m. (24c)
    • Plantaris m. (24)
  • Deep posterior compartment:
    • Poplitues m. (26)
    • Flexor digitorum longus m. (27)
    • Tibialis posterior m. (28)
    • Flexor hallucis longus m. (29)
  • Triceps surae muscle (24a,b,c)
  • Popliteal a. (51)
  • Posterior tibial a. (56)

Pass Criteria:

  • 6 of 8 bold to pass

Which muscles form the Achillies tendon?

  • Gastrocnemius and soleus +/- plantaris

Pass Criteria:

  • Bold to pass

Where does the Achilles tendon insert?

  • Supero-posterior aspect of the calcaneus

Pass Criteria:

  • Bold to pass

Can you identify the nerve supply of these muscles?

  • Tibial n.

Pass Criteria:

  • Bold to pass

Can you identify the structures posterior to the medial malleolus?

  • Anterior to posterior:
    • Tibialis posterior
    • Flexor Digitorum Longus
    • Posterior Tibial a.
    • Tibial n.
    • Flexor Hallucis Longus

Pass Criteria:

  • 2 of 3 muscles and neurovasc bundle to pass

Supplementary Question: What is the blood supply of these muscles?

  • Gastrocnemius – sural a. (branch of popliteal a.)
  • Soleus – posterior tibial a. and peroneal a.

Q4

XR: Knee joint

Demonstrate the bony features on this x-ray.

  • Bones
    • Femur
    • Tibia
    • Fibula
  • Patella (sesamoid)
  • Tibia
    • Intercondylar eminence (ICE)
    • Posterior intercondylar area
    • Anterior intercondylar area
    • Tibial tuberosity
    • Condyles (lateral/medial)
  • Femur
    • Epicondyles (lateral/medial)
  • Fibula
    • Head of fibula

Pass Criteria:

  • 8 to pass

Using x-ray as a guide, describe the cruciate ligaments.

  • Cruciates
    • Anterior cruciate ligament
      • Anterior part of intercondylar eminence ? posteromedial lateral femoral condyle
    • Posterior cruciate ligament
      • Stronger
      • Posterior part of intercondylar eminence ? anterolateral medial femoral condyle
  • Ligaments of fibrous capsule:
    • Ligamentum patellae (continuation of quadriceps femoris tendon ? tibial tuberosity)
    • Fibular collateral (lateral) ligament (lateral epicondyle of femur ? head of fib)
    • Tibial collateral (medial) ligament (med epicondyle of femur ? medial surface of tibia)
    • Oblique popliteal ligament (expansion of tendon of semimebranosis; strengthens capsule posteriorly)
    • Arcuate popliteal ligament also strengthens capsule posteriorly; post aspect of head of fib ? ICE and post aspect of lateral epicondyle of femur)
  • Others:
    • Menisci joined anteriorly by transverse ligament
    • Medial cruciate joined to PCL by posterior menisco-femoral ligament

Pass Criteria:

  • 2 cruciates correct to pass, extra if doing well

If extra time: What are the factors that contribute to stability of the knee joint?

  • Strength of surrounding muscles (most important): particularly quadriceps femoris (especially lower fibres of vastus medialis and vastus lateralis)
  • Strength of surrounding ligaments
  • Bony structures (minor)

Q5

Photo: Tibia Bone

Describe the features of the proximal end of this bone.
Prompt: Demonstrate the attachments of the menisci and cruciate ligaments?

  • Meniscal attachments
  • Anterior & posterior cruciate attachments
  • Capsular margin
  • Tibial tuberosity
  • Median & lateral condyles
  • Tibiofibular joint

Pass Criteria:

  • At least 4 bony features to pass

Q6

Media: Model of the lower leg.

Identify the muscles of the posterior compartment of the leg, using this model.

  • Superficial – gastrocnemius (medial and lateral heads), soleus, plantaris
  • Deep – Popliteus, Flexor hallicus longus, Flexor digitorum longus, Tibialis posterior

Pass Criteria:

  • 2 superficial and 2 deep to pass.

What is the nerve supply of these muscles?

Tibial branch of the sciatic nerve. This is also called the tibial nerve, or posterior tibial nerve.

Pass Criteria:

  • Must name nerve to pass.

Using the model, describe the course of this nerve through the leg.

Formed at the apex of the popliteal fossa by the bifurcation of the sciatic nerve (the other branch is the common peroneal, or common fibular nerve). The tibial nerve runs vertically in the popliteal fossa with the popliteal artery, passing between the heads of the gastrocnemius and deep to the tendinous arch of the soleus muscle. It then runs inferiorly on tibialis posterior with the posterior tibial vessels. It then divides into medial and lateral plantar nerves under the flexor retinaculum.

Pass Criteria:

  • Bold to pass.

Q7

Media: Photo of lower leg vascular supply.

Identify the superficial boundaries and the contents of the popliteal fossa.

  • Superiorly – biceps femoris (1), semitendinosus (12), and semimembranosus (11)
  • Inferiorly – lateral (3) and medial (4) heads of gastrocnemius
  • Contents – Popliteal artery (8) and popliteal vein (10), small saphenous vein (13), tibial nerve (15), common fibular nerve (2), and sural nerve (14)

Pass Criteria:

  • To pass – biceps femoris, one of either semitendinosus/semimembranosus, both heads of gastrocnemius, common fibular nerve, tibial nerve, popliteal artery, and popliteal vein.

How does the popliteal artery supply the leg and foot?
Prompt: What are the main branches of the popliteal artery? What pulses can you palpate below the knee?

  • Divides into posterior and anterior tibial arteries at the lower border of the popliteus
  • The posterior tibial artery runs in the posterior compartment then palpable posterior to the medial malleolus and divides into medial and lateral plantar arteries that supply the sole of the foot
  • Main branch is the fibular artery to the posterior and lateral compartments –  anterior tibial artery runs in the anterior compartment then crosses anteriorly over the ankle to become the dorsalis pedis

Pass Criteria:

  • Bold to pass.

Q8

Media: Model of tibia

Identify this bone and its main features.

  • Left or Right tibia
  • Medial and lateral condyles
  • Medial and lateral tibial plateaus, separated by intercondylar tubercles of the intercondylar eminence
  • Tibial tuberosity
  • Shaft
  • Medial border
  • Anterior border
  • Interosseous border
  • Soleal line (posteriorly)
  • Medial malleolus
  • Fibula notch

Pass Criteria:

  • Bold to pass.

Please identify the attachments of the proximal end of this bone
Prompt: What attaches to the superior surface of the bone?.

  • Anterior and posterior horns of the medial meniscus
  • Anterior and posterior horns of the lateral meniscus
  • Anterior and posterior cruciate ligaments
  • Patellar ligament
  • Semimembranosus
  • Vastus medialis (medially)
  • Iliotibial tract
  • Extensor digitorum longus
  • Peroneus longus (laterally)

Pass Criteria:

  • Bold to pass.

 


Hip & Thigh  Ankle & Foot