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1、Knee Anatomy Training,Knee Anatomy,Introduction 介绍 Very little bony stability 少的骨稳定 Behaves more like a round ball on flat surface运动主要是球在面上的滑动 Ligaments responsible for stability主要韧带稳定,Knee Anatomy,Looks simple, but most complex. 看似简单，最复杂的关节 More likely to be injured than any other joint in the body
2、 人体中更易受伤的关节 Largest joint of the body, actually consisting of 4 joints人体大关结，有4个关节组成 Patellofemoral膑股关节, Lateral tibio femoral外侧胫股关节, Medial tibio femoral内侧胫股关节, Tibiofibular胫腓关节,Knee Anatomy,Basic Structures基本组织 Bones骨 Femur股骨, Tibia胫骨, Fibula腓骨, Patella 膑骨 Muscles/ Tendons 肌肉及肌腱 Quadriceps四头肌, Hams
3、trings, Calf muscles Ligaments 韧带 Medial collateral内侧副韧带, Lateral collateral外侧副韧带, Anterior cruciate前交叉, Posterior cruciate后交叉, Popliteal ligament, Retinaculum Cartilage软骨 Meniscus半月板, Articular cartilage 关节软骨 Bursae,Knee Bones,Bones Femur股骨 Large/long bone of the thigh 大长骨 Tibia 胫骨 Large bone of th
4、e lower leg. Fibula 腓骨 Small bone of the lower leg. Patella膑骨 “Knee Cap”,Knee Bones: Anterior View,Femur, Tibia, Patella,Patella,No Patella,Knee Bones: Function,Patella膑骨 Patellofemoral groove (front of the femur). Patella tracking can affect the overall function of the knee.膑骨沟，膑骨轨迹影响膝的功能,Patella P
5、atellar Groove,Knee Bones: Lat/med Views,Femur, Tibia, Fibula, Patella,Lateral,Medial,Knee Bones: Posterior View,Femur, Tibia, Fibula,Primary Knee Ligaments主要的膝韧带,MCL Medial Collateral Lig.,LCL Lateral Collateral Lig.,Knee Ligaments,Medial and Lateral Collateral Ligaments help stabilize the knee by
6、preventing Varus and Valgus forces内外侧副韧带 防止内外翻,Varus Towards the Midline,Valgus外翻 Towards the Outside,Valgus内翻 Towards the Outside,Knee Ligaments,MCL,LCL,Cruciate Knee Ligaments (cruciate=cross)十字韧带,Anterior Cruciate Ligament前交叉韧带 Attaches anterior on the tibia & posterolateral on the femur附着于胫骨前部股骨
7、后部 Prevents anterior movement of the tibia on the femur防止胫骨相对股骨的前移 Checks external rotation of the tibia in flexion曲屈时防止胫骨外旋,Anterior,ACL,Inferior,Superior,Posterior,Knee: Cruciate Ligaments,Knee: ACL,ACL “Footprint前交叉胫骨附着点” Tibial attachment,Anterior,Posterior,Tibial Plateau,Tibial Plateau,Femoral
8、Attachment (Footprint),Posterior Cruciate后交叉韧带、 Attaches Posterior on the tibia & Antero- medial on the femur.附着于胫骨后股骨前内 The PCL is a strong fan shaped ligament that is the strongest in the body后叉强大的扇形韧带 Primary stabilizer against posterior movement of the tibia on the femur防止胫骨后移 Helps check the kn
9、ee in extension防止过伸,Cruciate Knee Ligaments (Cruciate=Cross),PCL,Knee: Cruciates,ACL,PCL,Anterior View,Posterior View,Knee,Hinge joint - flexion & extension.铰链式关节-屈和伸 Flexion is achieved by contracting the hamstring muscles in the back of the leg.通过收缩大腿后部肌肉屈曲关节 The Extensor Mechanism sits in front o
10、f the knee joint.伸膝装置在膝关节前 The extensor mechanism is made up of the patella, the patellar tendon, the quadriceps tendon and the quadriceps muscles.伸膝装置由膑骨、膑腱、股四头肌、股四头肌腱组成,Knee Muscles,Muscles肌肉、 Quadriceps股四头肌 Vastus lateralis外侧束, Vastus intermedius中间束, & Vastus medialis内侧束 Hamstrings Sartorius, Gra
11、cilis, Semimembranosus, Semitendinosis, & Biceps femoralis缝匠肌、股薄肌、半腱肌肉、半膜肌、二头肌 Calf Muscles小腿肌肉 Gastrocnemius, Soleus, Popliteus, Pes Anserine muscle attachment is into the medial tibia. 腓肠肌、比目鱼肌,Knee: Muscles,Quadriceps股四头肌,Vastus Medialis,Vastus Lateralis,Vastus Intermedius,Knee: Muscles,Quadricep
12、s,Vastus Medialis 股内侧肌,Rectus Femoris 股中间肌,Vastus Lateralis 股外侧肌,Knee: Quadriceps Mechanism,Its the motor that drives the knee joint, and allows us to walk. Composed of the patellar tendon, the patella, and the quadriceps muscles on the front of the thigh.走路的发动机由膑股、膑腱、股四头肌、股四头肌腱组成 The patella works
13、like a fulcrum, and increases the force exerted by the quadriceps muscles as the knee straightens. When the Quadriceps Muscles contract, the knee straightens. When they relax, the knee bends. 膑骨为增加股四头肌肉力量的支点，收缩伸膝，放松屈膝,Patellar Tendon,Quadriceps Tendon,Femur,Patella,Patellar Tracking:膑骨轨迹 The Patella
14、r Facets track in the Femoral Groove,Knee: Hamstring Muscles,Sartorius缝匠肌 Gracilis股薄肌 Semimembranosis 半腱肌 Semitendonosis 半膜肌,Biceps Femoris 股二头肌,Knee: Hamstring Muscles,Pes Anserine Attachment of the鹅足 Hamstring tendons (Sartorius shown here on the Medial Tibial Tuberosity),Medial Attachments,Knee:
15、Hamstring Muscles,Lateral Attachment 外侧附件 Biceps Femoris Attachment to the Fibula股二头肌肉腓骨附着点,Knee Ligaments,Knee Ligaments,Lateral & Medial Retinaculum,Medial Retinaculum Medial support for Patellar Tracking,Lateral Retinaculum Lateral support for Patellar Tracking,Vastus Medialis,Vastus Lateralis,Kn
16、ee: Tendons,Tendons Quadriceps Tendon Quadriceps Tendon connects the Quadriceps Muscles to the Patella四头肌腱连接四头肌和膑骨 Patellar Tendon Patellar Tendon connects the Patella to the Tibia. 膑腱连接膑韧带和胫骨 The Patella is a bone embedded within the Quadriceps and Patellar Tendons lying over the Femoral bone. Also
17、 known as a “sesamoid” bone.膑骨存在于股四头肌内，又成为籽骨,Knee: Tendons,QuadricepsTendon,Patellar Tendon,Knee: Meniscal Cartilage,Meniscus (plural = menisci)半月板 The articular surfaces between the femur and tibia are not congruent. They are closest in full extension. However this space must be filled by the menis
18、cus.股骨和胫骨关节面不是匹配的，在屈曲位是最接近的。空间被半月板填充 Both menisci are thicker at their periphery and thinner towards the middle. They both move in flexion and extension. 两个半月板都是四周厚中间薄，在屈伸时都是运动的 The lateral meniscus is not firmly attached to the collateral ligament or to the tibia as is the medial meniscus. Thus, it
19、 is less prone to distortion and injury.外侧半月板不像内侧半月板那样同侧副韧带或胫骨紧密附着,Knee: Meniscal Cartilage,Meniscus, ACL/ PCL Attachments The lateral meniscus is ”O“ shaped and generally of equal thickness.外侧半月板o形，等厚。 The medial meniscus is ”C“ shaped and is thicker posteriorly than anteriorly.内侧半月板c形，后侧比前侧厚,Later
20、al,Medial,Lateral,Medial,Knee,The menisci serve several functions 半月板装置的几个功能 A. Lubrication润滑 B. Nutrition营养 C. Shock absorbers震荡吸收 D. Spread stress传导压力 E. Decrease articular cartilage wear减少关节软骨磨损 F. Make joint spaces more congruent填充关节间隙 G. Prevent hyperextension防止过伸 The meniscus actually wraps ar
21、ound the upper bone to fill the space between the round femur and the flat tibia.,Knee: Meniscus,Meniscus Crescent-shaped fibrocartilage半月形纤维软骨 Collagen fibers arranged longitudinally and radially胶原纤维成经向放射装 Triangular in cross section横截面呈三角形,Knee,Meniscus The menisci are relatively avascular towards
22、 their inner 1/3, somewhat vascular in their middle 13, & vascular in their outer 1/3. They are held in place by the coronary ligaments半月板内1/3为白区，中1/3为红白区，外1/3为红区。中间被冠状韧带连接。 The menisci possess no nerves, thus there is no pain unless a coronary ligament (tibial attachment) has been damaged. There is
23、 seldom a bloody effusion, however, you might find synovial swelling.半月板没有神经，因而没有疼痛直到冠状韧带损伤。很少有血液渗出，但是能看到关节液增长,Blood supply peripherally,No blood supply proximal.,Articular Knee:Cartilage关节软骨,Covers ends of bones (joint)覆盖骨末端 ends of the femur, the top of the tibia, top of the fibula and the back of
24、 the patella股骨末端、胫骨及腓骨上端、膑骨背面 White, shiny material, tough, rubbery白色、有光泽、有弹性的、有硬度的 Consistency. ” thick Function absorb shock 吸收震荡 provide smooth surface (facilitate motion)提供表面的润滑,Knee: Articular Cartilage,Articular cartilage produces a wonderful lubrication 关节软骨产生关节液mechanism with almost zero fri
25、ction, which helps us articulate our joints during daily activities.关节液使日常运动零摩擦 Synovial fluid - thick viscous fluid layer inside the joint关节液粘稠的,Knee: Articular Cartilage,Hyaline Cartilage Composition透明软骨组成 Cells细胞 Chondrocytes (only one kind) Fluid 80% Water by Volume Extracelluar Matrix - The Fra
26、mework provides form & stability Collagens胶原 Proteoglycans蛋白多糖 Non-collagenous proteins,Knee: Cartilage,Knee: Articular Cartilage,The interaction between water & framework gives cartilage mechanical properties of stiffness & resilience.交换水及矿物质,Knee: NeuroVascular Concerns,Peroneal Nerve腓总神经,Popliteal Artery腘动脉,Popliteal Vein腘静脉,Popliteal/Tibial Nerve腘神经,Medial,Lateral,Knee,