Joints

JOINTS
Dr Qaisar Ali Khan

MSc/PGD Pain Medicine
MS/PGD ORTHOPEDIC MT/Med
Fellowship Ortho Rehab
Hip joint
The hip joint is a synovial articulation between the
head of the femur and the acetabulum of the pelvic
bone. The joint is a multiaxial ball and socket joint
designed for stability and weight-bearing at the
expense of mobility. Movements at the joint include
flexion, extension, abduction, adduction, medial and
lateral rotation, and circumduction.
The articular surfaces of the hip joint are:

■ the spherical head of the femur, and
■ the lunate surface of the acetabulum of the pelvic
bone.
The acetabulum almost entirely encompasses the

hemispherical head of the femur and contributes
substantially to joint stability. The non-articular
acetabular fossa contains loose connective tissue.
The lunate surface is covered by hyaline cartilage
and is broadest superiorly
The ligament of the head of the femur is a flat

band of delicate connective tissue that attaches at
Ligaments
Three ligaments reinforce the external surface of
the fibrous membrane and stabilize the joint: the
iliofemoral, pubofemoral, and ischiofemoral
ligaments.
■ The iliofemoral ligament is anterior to the hip
joint and is triangular shaped. Its apex is attached

to the ilium between the anterior inferior iliac spine
and the margin of the acetabulum and its base is
attached along the intertrochanteric line of the
femur. Parts of the ligament attached above and
below the intertrochanteric line are thicker than
the part attached to the central part of the line.
This results in the ligament having a Y appearance.
■ The pubofemoral ligament is anteroinferior to
the hip joint.

It is also triangular in shape, with its base attached
medially to the iliopubic eminence, adjacent bone,
and obturator membrane. Laterally, it blends with
the fibrous membrane and with the deep surface
of the iliofemoral ligament.
■ The ischiofemoral ligament reinforces the
posterior aspect of the fibrous membrane. It is
knee joint is a hinge type synovial joint, which mainly
allows for flexion and extension (and a small degree of medial
and lateral rotation). It is formed by articulations between the
patella, femur and tibia.
Articulating Surfaces
The knee joint consists of two articulations – tibiofemoral and
patellofemoral. The joint surfaces are lined with hyaline
cartilage and are enclosed within a single joint cavity.
•Tibiofemoral – medial and lateral condyles of the femur
articulate with the tibial condyles. It is the weight-bearing
component of the knee joint.
•Patellofemoral – anterior aspect of the distal femur articulates
with the patella. It allows the tendon of the quadriceps femoris
(knee extensor) to be inserted directly over the knee –
increasing the efficiency of the muscle.
As the patella is both formed and resides within the quadriceps
femoris tendon, it provides a fulcrum to increase power of the
knee extensor and serves as a stabilising structure that reduces
frictional forces placed on femoral condyles.
Menisci
The medial and lateral menisci are C-shaped fibrocartilage rings
located within the knee joint. They serve two main functions:
•Deepens the articular surface of the tibia – increasing the
stability of the joint.
•Acts as shock absorbers– increasing surface area to further
dissipate forces that are transmitted across the joint.
They are attached at both ends to the intercondylar area of the
tibia. In addition to this attachment, the medial meniscus is
also fixed to the medial collateral ligament and the joint
capsule. Damage to the medial collateral ligament is often
associated with a medial meniscal tear.
The lateral meniscus is smaller and does not have any
additional attachments, rendering it more mobile.
Bursae
A bursa is a sac-like structure containing a small amount of
synovial fluid. It functions to decrease friction between
tendons, bone, and skin during movement. There are four main
bursae found in the knee joint:
•Suprapatellar bursa – located between the quadriceps femoris
and the femur.
•Prepatellar bursa – located between the apex of the patella
and the skin.
•Infrapatellar bursa – split into deep and superficial. The deep
bursa lies between the tibia and the patella ligament. The
superficial lies between the patella ligament and the skin.
•Semimembranosus bursa – located posterior to the knee
joint, between the semimembranosus muscle and the medial
head of the gastrocnemius.
Ligaments
The major ligaments in the knee joint are:
•Patellar ligament – a continuation of the quadriceps femoris tendon distal to
the patella. It attaches to the tibial tuberosity.
•Collateral ligaments – two strap-like ligaments. They act to stabilise the hinge
motion of the knee, preventing excessive medial or lateral movement
• Medial collateral ligament Proximally, it attaches to the medial
epicondyle of the femur, distally it attaches to the medial condyle of
the tibia.
• Lateral collateral ligament –It attaches proximally to the lateral
epicondyle of the femur and distally to a depression on the lateral
surface of the fibular head.
•Cruciate Ligaments – these two ligaments connect the femur and the tibia. In
doing so, they cross each other.
• Anterior cruciate ligament – attaches at the anterior intercondylar
region of the tibia. It ascends posteriorly to attach to the femur in the
intercondylar fossa. It prevents anterior dislocation of the tibia onto
the femur.
• Posterior cruciate ligament – attaches at the posterior intercondylar
region of the tibia and ascends anteriorly to attach to the
anteromedial femoral condyle. It prevents posterior dislocation of the
tibia onto the femur.
Movements
There are four main movements that the knee joint permits:
•Extension – produced by the quadriceps femoris, which inserts
into the tibial tuberosity.
•Flexion – produced by the hamstrings, gracilis, sartorius and
popliteus.
•Lateral rotation – produced by the biceps femoris.
•Medial rotation – produced by five muscles;
semimembranosus, semitendinosus, gracilis, sartorius and
popliteus.
Collateral Ligaments
Injury to the collateral ligaments is the most common pathology affecting the knee joint. It
is caused by a force being applied to the side of the knee when the foot is placed on the
ground.
Damage to the collateral ligaments can be assessed by asking the patient to
medially rotate and laterally rotate the leg. Pain on medial rotation indicates damage to the
medial ligament, pain on lateral rotation indicates damage to the lateral ligament.
If the medial collateral ligament is damaged, it is more than likely that the medial meniscus
is torn, due to their attachment.
Cruciate Ligaments
The anterior cruciate ligament (ACL) can be torn by hyperextension of the knee joint, or by
the application of a large force to the back of the knee with the joint partly flexed. To test
for this, you can perform an anterior drawer test, where you attempt to pull the tibia
forwards, if it moves, the ligament has been torn.
The most common mechanism of posterior cruciate ligament (PCL) damage is the
‘dashboard injury’. This occurs when the knee is flexed, and a large force is applied to the
shins, pushing the tibia posteriorly. This is often seen in car accidents, where the knee hits
the dashboard. The posterior cruciate ligament can also be torn by hyperextension of the
knee joint, or by damage to the upper part of the tibial tuberosity.
To test for PCL damage, perform the posterior draw test. This is where the clinician holds
the knee in flexed position, and pushes the tibia posteriorly. If there is movement, the
ligament has been torn.
Bursitis
Friction between the skin and the patella cause the prepatellar
bursa to become inflamed, producing a swelling on the anterior
side of the knee. This is known as housemaid’s knee.
Similarly, friction between the skin and tibia can cause the
infrapatellar bursae to become inflamed, resulting in what is
known as clergyman’s knee (classically caused by clergymen
kneeling on hard surfaces during prayer).
Unhappy Triad (Blown Knee)

As the medial collateral ligament is attached to the medial
meniscus, damage to either can affect both structure’s
functions. A lateral force to an extended knee, such as a rugby
tackle, can rupture the medial collateral ligament, damaging
the medial meniscus in the process. The ACL is also affected,
which completes the ‘unhappy triad’.

Joints

Uploaded by

Copyright:

Available Formats

Joints

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Joints

Uploaded by

Copyright:

Available Formats

JOINTS

Dr Qaisar Ali Khan

The articular surfaces of the hip joint are:

The acetabulum almost entirely encompasses the

The ligament of the head of the femur is a flat

joint and is triangular shaped. Its apex is attached

the hip joint.

Unhappy Triad (Blown Knee)

You might also like