HIP JOINT, KNEE JOINT AND ANKLE JOINT
A. ILIUM
I. HIP
Upper flattened part of the bone
Hip Bone
o
Possesses the iliac crest(top) which can be felt through the
skin along its entire length
Formed by 3 bones
Ends:
Ilium (superior),
In front: anterior superior iliac spine (ASIS)
Ischium (posteroinferior)
Behind: posterior superior iliac spine (PSIS)
Pubis (anteroinferior)
Iliac tubercle lies about 2 (5 cm) posterior the ASIS; lateral
expansion of the Iliac crest
Converge to form the ACETABULUM
Anterior inferior iliac spine prominence below ASIS
2/5 Acetabulum: Ilium
Posterior inferior iliac spine prominence below PSIS
1/5 Acetabulum: Pubis
Greater sciatic notch above and behind the acetabulum
2/5 Acetabulum: Ischium
SACROILIAC joint
o
Articulation of hipbones to the sacrum
B. ISCHIUM
L-shaped, possessing an upper thicker part (body), and a lower thicker
part (ramus)
SYMPHYSIS PUBIS
o
Articulation between hipbones anteriorly
Joined by FIBROCARTILAGE
SYMPHYSIS joint
Ischial spine projects from the posterior border of the ischium and
intervenes between the greater and lesser sciatic notches
Ischial tuberosity forms the posterior aspect of the lower part of the
body of the bone; associated with the hamstring muscles of the
posterior thigh
Greater and lesser sciatic notches converted into greater and lesser
foramina by the presence of the sacrospinous and sacrotuberous
ligaments
C. PUBIS
E. ACETABULAR FOSSA
Ventral part of the hip bone
Angle of TORSION: 12 - 15
Divided into a body, superior ramus, and an inferior ramus
Angle of INCLINATION: 126
Pubic crest forms the upper border of the body of the pubis, and ends
Contains:
laterally as the pubic tubercle
Ligamentum teres
Symphysis pubis bodies of the 2 pubic bones articulate with each
Fat pad
other in the midline anteriorly
Synovial membrane
Acetabulum superior ramus + ilium and ischium
Below obturator foramen inferior ramus + ischial ramus
Allows movement of ligamentum teres
Obturator foramen filled by obturator membrane
LIGAMENTUM TERES
o
Carries the artery of the ligamentum teres
D. ACETABULUM
PROXIMAL ARTICULAR SURFACE
Articulates with head of the femur to form the hip joint
Adduction + flexion + external rotation
Maximum contact between acetabulum and femur:
Adduction + extension + internal rotation
Flexion + slight external rotation + slight abduction
Inferior margin: deficient, marked by the acetabular notch
Articular surface
o
aka LUNATE SURFACE
Limited to a horseshoe- shaped area, covered with hyaline
cartilage
Where most of the weight is transmitted through the pelvis
to the femur
Floor: Nonarticular, aka ACETABULAR FOSSA
o
Provides attachment for the ligament of the head of the
femur
Anatomic position: front of symphysis pubis and ASIS same vertical
plane
Tension occurs during
RESERVOIR FOR SYNOVIAL FLUID
F. FEMUR
4. SHAFT
Angle of TORSION: 12 - 15 on transverse plane
Angle of INCLINATION: 126
1. HEAD
o
FOVEA CAPITIS
Small depression in the center of the head that serves
Descends from lateral to medial in the coronal place at an
angle of 7 from the vertical axis
Smooth and rounded on its anterior surface
Posteriorly has a ridge, the linea aspera
LINEA ASPERA
Where muscles and intermuscular septa are attached
Linea aspera diverge superiorly:
as an attachment of the ligament of the head
DISTAL ARTICULAR SURFACE
2. NECK
Superiorly &anteriorly:
Pectineal line - joins the intertrochanteric
line
3. GREATER and LESSER TROCHANTER
Superiorly &laterally:
Large eminences situated at the junction of the neck and shaft
Greater trochanter- extends superiorly from the shaft of the
trochanter; attachment of gluteus
femur; lateral to the region where the shaft joins the neck of
maximus
Gluteal tuberosity - Below greater
the femur
o
Lesser trochanter- projects posteromedially from the shaft;
inferior to the junction with the neck
Linea aspera diverge inferiorly:
Connecting the 2 trochanters:
medial supracondylar ridge to the adductor
Anteriorly: intertrochanteric line, where iliofemoral
ligament is attached
tubercle on the medial condyle
Posteriorly: intertrochanteric crest, on which is the
quadrate tubercle
Medial margin: continues below as the
Lateral margin: continuous below with the
lateral supracondylar ridge
Popliteal surface a flat, triangular area on it
posterior
surface,
formed
when
becomes broader toward its distal end
shaft
Lateral and medial condyles
Posterior distal end of shaft
Lines the capsule
Separated by the intercondylar notch
Attached to the margins of the articular surfaces
Covers the portion of the neck of the femur that lies within the
Anterior surface of the condyles joined by an articular surface
o
Ensheathes the ligament of the head of the femur
Take part in the formation of the knee joint
Covers the pad of fat contained in the acetabular fossa
Above the condyles are the medial and lateral epicondyles
Psoas bursa
Adductor tubercle continuous with the medial epicondyle
BALL-AND-SOCKET joint
Articulation between the hemispherical head of the femur and the cupshaped acetabulum of the hip bone
Acetabulum
o
Anterior surface: horseshoe shaped and is deficient inferiorly
at the acetabular notch
Cavity: deepened by the presence of fibrocartilaginous rim
o
joint capsule
for the patella
Synovial membrane
G. COXOFEMORAL Joint (HIP JOINT)
aka ACETABULAR LABRUM
Capsule
o
Encloses the joint and is attached to the acetabular labrum
medially
Laterally, it is attached to the intertrochanteric line of the
femur in front and halfway along the posterior aspect of the
neck of the bone behind
RETINACULA band of capsule fibers, accompanied by
blood vessels, which are reflected upward along the neck
H. Ligaments of Hip Joint
3 capsular ligaments
I. Movements of Hip Joint
1. FLEXION
o
Muscle ANTERIOR COMPARTMENT of thigh
Iliofemoral ligament
Pubofemoral ligament
muscles
Ischiofemoral ligament
Pectineus
Iliopsoas
Sartorius
Rectus femoris
1. ILIOFEMORAL ligament
o
Strong, inverted Y-shaped ligament
aka LIGAMENT OF BIGELOW
Superior: limits ADDUCTION
Anterior: limits HYPEREXTENSION
2. PUBOFEMORAL ligament
o
Triangular
Flexed knee: 120
Extended knee: 70 90
Limited by the tension of the hamstring muscles
2. EXTENSION 0 - 10
o
Limited
by
the
tension
of
the
ILIOFEMORAL,
PUBOFEMORAL, and ISCHIOFEMORAL ligaments
o
Anterior: limits EXTERNAL ROTATION
Inferior: limits ABDUCTION
3. ISCHIOFEMORAL ligament
Muscles
Gluteus maximus
Hamstring muscles
Thinnest
Adductor magnus (posterior belly)
Spiral-shaped
Semitendinous
Semimembranous
Biceps femoris (long head)
Posterior: limits INTERNAL ROTATION
Inferior: limits ABDUCTION
3. ABDUCTION 45
o
Limited by the tension of the PUBOFEMORAL ligament
Muscles
Gluteus medius and minimus
Tensor fascia lata
Piriformis
flexor group
4. ADDUCTION 30
Adductor magnus, longus, brevis
Pectineus
Gracilis
Limited by the ISCHIOFEMORAL ligament
Muscles
Internal rotators
External rotators
6. MEDIAL ROTATORS 60
Muscles
Gluteus medius
Tensor fasciae latae
7. CIRCUMDUCTION
o
TIGHT HAMSTRING
o
Limits HIP FLEXION (with KNEE EXTENSION)
Muscles
5. LATERAL ROTATION 30
The LATERAL ROTATORS are more powerful than the medial
rotators
The EXTENSOR GROUP of muscles is more powerful than the
Combination of all movements
NUTRIENT artery
o
Supply the shaft of the femur
II. KNEE COMPLEX
3 bones
o Femur
o Tibia
B. Ligaments
1. EXTRASCAPULAR LIGAMENTS
a. LIGAMENTUM PATELLAE
o Patella
* Fibula is not included
below to tibial tuberosity
b. OBLIQUE POPLITEAL ligament
o HINGE JOINTS between the medial and lateral
o Most stable in extension
expansion
of
semimembranous
c. LATERAL COLLATERAL ligament (LCL)
Attached above to lateral condyle of femur and
below to tibular head
condyles of the femur and the corresponding condyles of
the tibia
Tendinous
muscle
A. 2 Articulations
1. FEMOROTIBIAL joint
Attached above to lower border of patella and
Prevents ADDUCTION of tibia on femur
Taut on extension, slack on flexion
o SUPPORTS THE WEIGHT OF THE BODY
d. MEDIAL COLLATERAL ligament (MCL)
2. PATELLOFEMORAL joint
o PLANE GLIDING JOINT between the distal femur
and the patella
o Function as PULLEY for the quadriceps femoris
Attached above to medial femoral condyle and
below to medial surface of tibial shaft
Prevents ABDUCTION of tibia on femur
Taut on extension, slack on flexion
2. INTRASCAPULAR LIGAMENT
o
C. MENISCI
CRUCIATE LIGAMENTS
Main connection between femur and tibia
a. ANTERIOR CRUCIATE Ligament
Attached to anterior intercondylar fossa
Passes upward and laterally to attach on the inside of
C-shaped fibrocartilage sheets
Peripheral border (thick) attached to capsule
Inner border (thin) concave and forms free edge
Functions:
o
the femoral condyles
the lateral femoral condyle
b. POSTERIOR CRUCIATE Ligament
Attached on posterior intercondylar fossa
Passes upward and medially to attach on the inside of
the medial femoral condyle
Prevents
ANTERIOR
DISPLACEMENT
of
femur on tibia
DRAWER TEST
o
Used in determining cruciate ligament injurires
Lockmans Maneuver
o
To identify the integrity of the anterior cruciate ligament
(ACL)
Serve as cushions between the femur and tibia
Prevents POSTERIOR DISPLACEMENT of the
femur on the tibia
Deepens the articular surfaces of the tibial condyles to receive
Attached to tibia through:
o
Their horns at the intercondylar fossae
The coronary ligaments
Other attachments:
o
transverse ligament
meniscopatellar fibers
medial collateral ligament
popliteus and semimembranous
meniscofemoral ligament
Moved and controlled on the tibia by both passive and active force
D. PATELLA
F. Muscles
A sesamoid bone
Articulated with anterior surface of femoral condyles
Functions:
1. EXTENSORS not more than 15
o
Increase leverage of the quads
Provide bony protection to the distal joint surfaces of the
2. FLEXORS 120 - 150
femoral condyles
Biceps femoris
Decrease pressure and distribute forces on the femur
Semitendinosus
Prevent
Semimembranosus
Gracilis
Sartorius
Popliteus
damaging compression forces on the quads
tendon with resisted knee flexion
E. BURSAE
Quadriceps femoris
Anterior
3. MEDIAL ROTATORS 40
Suprapatellar bursa (inflammation: STIFF KNEE)
Prepatellar bursa (inflammation: HOUSEMAIDS KNEE)
Sartorius
Superficial interpatellar bursa
Gracilis
Deep interpatellar bursa
Semitendinosus
Superficial and deep interpatellar inflammation: VICARS KNEE
4. LATERAL ROTATORS 2x as large as internal rotation
o
Posterior
Lateral
Medial
Biceps femoris
TERMINAL ROTATION OF THE KNEE
o
aka as SCREW-HOME mechanism
In the last 20 of knee extension, the tibia externally rotates
10-20 on the fixed femur/the femur internally rotates on the
fixed tibia
Occurs both in active and passive knee extension
Cannot be produced or prevented voluntarily
III. ANKLE JOINT (TALOCRURAL joint)
2. LATERAL COLLATERAL LIGAMENT
SYNOVIAL HINGE JOINT
o ANTERIOR TALOFIBULAR ligament
3 bones
o Distal tibia
Limits PLANTARFLEXION
Runs from the lateral malleolus to the lateral
o Distal fibula
surface of the talus
o Talus
o CALCANEOFIBULAR ligament
Runs from the tip of the lateral malleolus
downward and backward to the lateral surface of
A. Ligaments of the Ankle
the calcaneus
1. MEDIAL COLLATERAL LIGAMENTS
o Superficial
Tibionavicular ligament
Calcaneotibial ligament
Anterior talotibial ligament
Limits DORSIFLEXION
Runs from the lateral malleolus to the posterior
tubercle of the talus
o Deep
o POSTERIOR TALOFIBULAR ligament
Limits plantarflexion
Posterior talotibial ligament
Limits dorsiflexion
B. Motions
CLINICAL CORRRELATIONS
1. DORSIFLEXION 25
o
Muscles
Tibialis anterior
Decreased angle of inclination
Extensor hallucis longus
Distal segment deviates to midline
Extensor digitorum longus
<r>
Peroneus tertius
2. PLANTARFLEXION 35
o
COXA VARA
Muscles
Gastrocnemius
Soleus
Peroneus longus and brevis
Flexor digitorum longus
Flexor hallucis longus
Tibialis posterior
COXA VALGA
o
Increased angle of inclination
Distal segment deviates away from midline
>l<
Dislocations of hip joints are usually POSTERIORLY
GENA VARUM
Decreased Q-angle
Towards LATERAL
GENU VALGUM
o
Increased Q-angle
Towards MEDIAL
WADDLING GAIT
o
Most due to the injury of SUPERIOR GLUTEAL nerve
Caused by paralysis of the abductors of the thigh
Unsupported limb is dragged
