Hip And Knee● 2 Joints of leg

● Bones that make up the joints

● Ligaments that support the joints

● Joint Capsule

● Muscles that move the joints

JointsHip Knee

● Ball and socket

● Connects pelvis and femur

● Thick muscles for stability

● Stability important for daily movement

● Hinge

● Connects femur to tibia

● Joint not snug

● Stabilized by ligaments and muscles

Review Landmarks of Pelvis

Landmarks

Head

Fovea

Neck

Greater Trochanter

Lesser Trochanter

Shaft

Linea Aspera

Lateral and Medial Epicondyles

Lateral and Medial Condyles

Patellar Surface

Intercondylar Fossa

Hip Joint● Pelvis and Femur● Ball and Socket joint

● Acetabulum – small bowl

● Femoral head

● Ligamentum Teres

● Labrum

Hip Joint

Capsule and ligament● Capsule attaches around rim of acetabulum and base

of femoral neck

● Ligaments

● Iliofemoral Ligament – strongest

● Pubofemoral Ligament

● Ischiofemoral ligament

Ligaments in motion● Flexion: Iliofemoral and pubofemoral relax

● Extension: Iliofemoral and pubofemoral taut

● Abduction: Upper Iliofemoral relaxed and pubofemoral taut

● Adduction: Upper Iliofemoral taut and pubofemoral relaxed

● Lateral Rotation: All taut

● Medial rotation: All relaxed

Femoral head variations● Maximal contact - flexion, abduction, and lateral rotation

● Variations:

● Angle of inclination – Angle between neck and shaft● Small angle (Coxa Vara)– ROM in abduction reduced

● Large angle (Coxa Valga)– ROM in abduction increased

● Neck concave and long – ROM in abduction and lateral rotation good

● Neck less concave and short – ROM restricted in abduction and lateral rotation

Movement of the hip● Pelvis Fixed

● Flexion

● Extension

● Abduction

● Adduction

● Medial rotation

● Lateral rotation

Movement of the Pelvis● Femur Fixed

● Anteversion – ASIS tips forward, Increases lordosis of spine

● Retroversion – ASIS tips up, Decreases lordosis

● Lateral flexion - inferolaterally

● Medial flexion - superomedially

● Lateral rotation - ASIS moves laterally

● Medial rotation - ASIS moves medially

Knee Joint● 3 Bones

● Femur

● Tibia

● Patella

● Primarily a hinge joint

Patella

● Knee cap

● Sesamoid bone

● Base – broad superior edge

● Apex – pointed inferior edge

● Articular Facets – 2 posterior to fit against femur

Intercondylar eminence

Interosseous border

Intercondylar eminence

Movements of knee● Flexion – decreases angle formed by posterior thigh

and leg

● ROM in passive flexion greater – flexors relaxed

● ROM greater when hip is flexed – position of rectus femoris

● Extension – increases angle formed between posterior thigh and leg

● ROM less when hip flexed- tension in hamstrings

● Hyperextension – Uncommon

Movements of the Knee● Medial rotation – tibial tuberosity moves medially

● Lateral rotation – tibial tuberosity moves laterally

● Rotation can only occur when knee is flexed –ligaments relaxed

Alignment of knee● Genu Valgum (knock kneed) – resulting from Coxa

Vara

● Genu Varum (bow legged) – resulting from Coxa Valga

Condyles of Femur and Tibia● Femur

● Less curve anteriorly (weight bearing)

● More curve posteriorly (flexion)

● Tibia

● Concave to fit with Femur

Movement of Condyles ● Flexion

● Femoral Condyle first rolls then glides on Tibia

● Extension

● First glides then rolls

Menisci● C shaped disks

● Fibrocartilage

● Central tips connected to intercondylar eminence

● Margins attached to edges of tibial condyles

● Attached to nearby ligaments and tendons

● Mobile and aid in spreading synovial fluid during movement

● Weight bearing – greater surface area for articulation

● Stability

Menisci ● Extension

● Move anteriorly● Pushed by femoral condyle and pulled by meniscopatellar

ligaments

● Flexion

● Move posteriorly● Pushed by condyles and pulled by tendons of

semimembranosus and popliteus muscle and tibial collateral ligament

● Rotation

● Ipsilateral moves forward

Capsule and ligaments● Attaches outside articular surfaces of 3 bones

● Anteriorly- Slack, good for flexion

● Patella contained in anterior capsule

● Deep folds at front and sides in extension

● Posteriorly – thicker

● Ligaments essential for stability

Cruciate Ligaments● Anterior cruciate ligament

● Resists anterior displacement of tibia

● Posterior cruciate ligament

● Resists posterior displacement of tibia

● Flexion and Extension – Taut

● Lateral Rotation – Slacken

● Medial Rotation – Press against each other and become more taut

Ligaments of Knee

Collateral ligaments● Medial collateral ligament

● Medial epicondyle of femur to medial condyle and upper shaft of tibia

● Prevents joint from opening on medial side

● Lateral collateral ligament

● Lateral epicondyle of femur to head of fibula

● Prevents joint from opening on lateral side

● Extension – Taut

● Flexion – Slack

● Medial Rotation – Slack

● Lateral Rotation – Taut

Ligaments together● Stabilize the knee

● Extension more stable than flexion – All ligaments taut

Patella● Functions:

● Protects knee from external impact

● Protects quadriceps tendon● Slides into groove between femoral condyles during

movement

● Flexion – locked into place and pressed into groove

Tibiofibular Joints● Proximal

● Synovial and gliding

● Intermediate

● Synarthroses – Connected by Interosseous Membrane

● Distal

● Synarthroses

Muscles of the Hip● Deep Hip Muscles

● Piriformis

● Obturator Internus

● Obturator Externus

● Gemellus Superior

● Gemellus Inferior

● Quadratus Femoris

● Lateral Rotation of thigh

Piriformis● Origin – Anterior sacrum (passes under greater sciatic

notch)

● Insertion – Top of Greater Trochanter

● Actions

● Lateral rotation of thigh (thigh extended)

● Abduction of thigh (thigh flexed)

● Retroversion of pelvis (bilateral)

● Medial rotation of pelvis (unilateral)

Quadratus Femoris● Origin – Lateral ischium

● Insertion – Posterior aspect of greater trochanter

● Actions – Same as piriformis

Obturator internus● Origin – Obturator membrane and adjacent portions

of ischium and ilium

● Pass posteriorly through lesser sciatic notch

● Insertion – Medial aspect of greater trochanter

● Action

● Lateral rotation of thigh

● Stabilization of hip joint

● Retroversion of pelvis

● Medial rotation of pelvis

● Medial flexion of pelvis

Gemellus superior and inferior● Small muscles

● Origin: Above and below distal borders of obturator internus

● Insertion: Greater Trochanter

● Actions

● Reinforce actions of obturator internus

Obturator Externus● Origin – External surface of obturator membrane

● Passes posterior to femoral neck

● Insertion –medial surface of greater trochanter

● Action

● Lateral rotation of the thigh

● Anteversion of pelvis

● Medial flexion of pelvis

Obturators + Gemelli● Hammock supporting the pelvis

● Working together they decompress the hip joint

● Pelvis fixed – pull femur down

● Femur fixed – pull pelvis up

Psoas Major● Origin – Bodies of T12 – L5

● Runs anterior to pelvis and posterior to inguinal ligament

● Insertion – Lesser Trochanter

● Action

● Primary hip flexor

Iliacus● Origin – Internal iliac fossa

● Insertion – Merges with Psoas to insert of lesser trochanter via same tendon

● Action

● Assists psoas in flexion of hip

● Anteversion of pelvis

Gluteus Maximus● Largest muscle of body

● Buttocks

● Origin – Posterolateral sacrum, posterior ilium and sacrotuberous ligament

● Insertion – Gluteal tuberosity of posterosuperior femoral shaft (deep), Superior part of iliotibial tract (superficial)

● Actions

● Hip extension

● Lateral rotation of hip

● Retroversion, medial rotation and medial flexion

Gluteus Medius● Origin – External Iliac Fossa

● Insertion – Lateral aspect of greater trochanter

● Action

● Abduction of hip

● Assists in flexion and extension of hip

● Anteversion and Retroversion of Pelvis (depending on whether anterior or posterior fibers contract)

● Lateral flexion of pelvis

● Stabilizes pelvis during walking and standing on one foot

Gluteus minimus● Origin – Anterior to gluteus medius

● Insertion – Anterior aspect of greater trochanter

● Action

● Reinforces anterior part of gluteus medius● Abduction, flexion and medial rotation of thigh

● Anteversion of pelvis

● Lateral flexion of pelvis

● Lateral rotation of pelvis

Tensor Fascia Latae● Origin – Anterior Iliac Crest near ASIS

● Insertion – Fascia lata/Iliotibial Tract (Iliotibial band) which attaches to head of fibula

● Actions

● Abduction of thigh

● Flexion of thigh

● Medially rotates thigh

● Knee extension and lateral rotation (flexed knee)

● Anteversion, lateral flexion and lateral rotation of pelvis

Glut Max and Tensor Fascia Latae● Superficial gluteus maximus and tensor fascia latae

stabilize hip and knee during standing and walking

Quadriceps Femoris● 4 bodies

● Converge into one quadriceps tendon which inserts on and surrounds patella● Tendon continues as patellar ligament and inserts on tibial

tuberosity

Quadriceps● Vastus Intermedius

● Origin – upper 2/3 of anterior femoral shaft

● Vastus Lateralis and medialis

● Origin – either side of linea aspera on posterior femoral shaft

● Wrap around to meet superficial to vastus intermedius

● Rectus Femoris

● Origin – Anterior Inferior Iliac Spine and part of ilium near acetabulum

● Passes superficial to vasti

● Crosses hip as well as knee

Actions of Quadriceps● Extends knee

● Strongest muscle in body

● Knee flexed – medialis and lateralis play small part in rotating tibia

● Knee extended – medialis and lateralis stabilize patella and knee joint

● Rectus Femoris – acts on both hip and knee

● Flexes hip and extends knee

● Anteversion of pelvis

Sartorius● Longest muscle in body

● Tailor’s muscle

● Origin – ASIS

● Runs medially down thigh superficial to quads

● Insertion – Superomedial shaft of tibia

● Action

● Flexes, laterally rotates and abducts hip

● Flexes the knee

● Anteversion and medial rotation of pelvis

Hamstrings● 3 muscles

● Flex knee and extend thigh

● Retroversion of pelvis

● Originate from same place then spread out for both medial and lateral insertions

● Polyarticular – act on hip and knee

Hamstrings● Semimembranosus

● Origin – Ischial tuberosity

● Insertion – Posteromedial aspect of tibial condyle

● Semitendinosus

● Origin – Ischial tuberosity

● Insertion – Superomedial tibial shaft

● Biceps Femoris – 2 heads

● Origin – Ischial tuberosity (long head), posterior femoral shaft (short head)

● Insertion – Head of fibula

Adductors● Pectineus

● Origin – Lateral pubis

● Insertion – Pectineal line (connects lesser trochanter to linea aspera)

● Adductor brevis

● Origin – Medial pubis

● Insertion – Middle part of linea aspera

● Adductor longus

● Origin – Medial pubis

● Insertion – Lower part of linea aspera anterior to brevis

Adductors● Gracilis

● Origin – Inferomedial pubis

● Insertion – Tibial shaft just below medial condyle

● Adductor Magnus (largest and strongest of group)

● Origin – Ischiopubic ramus (anterior portion), Ischial tuberosity (posterior portion)

● Insertion - Broad insertion on linea aspera (anterior), medial femoral condyle (posterior)● Adductor hiatus: Gap between 2 insertions

Adductor Actions● ADDUCTION

● Hip flexion, lateral or medial rotation

● Extension if hip is flexed

● Gracilis – Flexes and medially rotates the knee

● Anteversion of pelvis

● Medial flexion of pelvis

● Lateral rotation of pelvis

● Gracilis and posterior adductor magnus – medial rotation of pelvis

Muscles of knee● Biceps Femoris

● Action – Lateral rotation of knee

● Popliteus

● Origin – Lateral aspect of lateral femoral condyle

● Insertion – Posterosuperomedial tibial shaft

● Action – Flexes and medially rotates knee

● Gastrocnemius

● Origin – posteroinferior femur above condyles (2 heads)

● Insertion – Calcaneus (heel bone) via Achilles tendon

● Action – Plantar Flexion, Flexion and medial rotation of knee