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Joints • Hip region • Knee region • Ankle region Hip region sacroiliac joints hip joint pubic symphysis Hip region Hip region hip joint Knee region Knee joint • Menisci Medial meniscus lateral meniscus • Ligaments Cruciate ligaments Collateral ligaments Patellar ligament oblique popliteal ligament • Joint capsule Synovial membrane Fibrous membrane Knee region Minisci : fibrocartilaginous ‘shock absorbers’ semilunar cartilages Knee region Attachments Knee region 1. The medial meniscus is more injured than the lateral meniscus, why? Knee region Ligaments 1. anterior cruciate ligament (ACL) 2. posterior cruciate ligament (PCL) 3. medial collateral ligament (MCL, tibial collateral ligament) 4. lateral collateral ligament (LCL , fibular collateral ligament) 5. oblique popliteal ligament 6. ligamentum patellae Knee region Cruciate ligaments ACL: Anteromedial part of the intercondylar area of tibia to inner aspect of lateral condyle of femur. PCL: Posterolateral part of the intercondylar area of the tibia to inner aspect of medial condyle of femur. Knee region Anterior Cruciate ligament prevents anterior displacement of the tibia in relation to femur in flexion. Knee region Posterior Cruciate ligament prevents posterior displacement of the tibia in relation to femur in extension. Knee region How to test ACL and PCL? Drawer sign test Knee region Anterior Drawer Test for ACL • Physician Position & Movements • Patient Position Note direction of forces 15 Knee region Posterior Drawer Testing- PCL Note direction of forces 16 Knee region Collateral ligaments Knee region MCL attaches to the medial meniscus 2. The medial meniscus is more injured than the lateral meniscus, why? Knee region Collateral ligaments action 1. Protect the knee joint from bending side to side. 2. Helps the locking mechanism Knee region 3. The medial meniscus is more injured than the lateral meniscus, why? Knee region Locking mechanism: less energy to maintain the standing position 1. Medial rotation of femur on the tibia during full extension tighten colateral ligaments. Knee region Locking mechanism (2) • Joint surfaces become larger and more stable in extension. Knee region Locking mechanism (3) • body's center of gravity is positioned along a vertical line that passes anterior to the knee joint. Knee region Collateral ligaments test Knee region Test for MCL Note Direction Of Forces 26 Knee region Test for LCL Note direction of forces 27 Knee region Patellar ligament Strengthening Anterior Aspect of Knee Joint Knee region oblique popliteal ligament Knee region Review • (1) patellar ligament • (2) tibial (medial) collateral ligament • (3) fibular (lateral ) collateral ligament • (4) medial meniscus • (5) lateral meniscus • (6) anterior cruciate ligament • (7) posterior cruciate ligament Knee region Joint fibrous capsule Knee region Joint synovial membrane Knee region Knee region Bursa • little fluid sacs that helps the muscles and tendons slide freely: Prepatellar Infrapatellar Suprapatellar Knee region Bursa Knee region Prepatellar Bursitis Ankle region • Ankle joint (talocrural joint) • Subtalar joint (ST J.) • Talocalcaneonavicular joint (TCN J.) The ankle, or talocrural joint • Needs ligaments! Lateral ligament s of talocrural joint Medial ligament s of talocrural joint The ankle, or talocrural joint, is a hinge joint • Plantar Flexion • Dorsi Flexion Inversion/Eversion? Intertarsal joint: • Subtalar joint (ST J.) • Talocalcaneonavicular joint (TCN J.) • Calcaneocuboid (small rotation) • Naviculoconeiforms (almost no movement) Calcaneous bone Calcaneous bone Subtalar joint Lateral Medial sustentaculum tali (talar shelf) fracture Subtalar joint TCN joint Talocalcaneonavicular joint Calcaneonavicular L. Other ligaments • Calcaneofibular • Deltoid • Talocalcaneal Calcaneofibular Talar tilt test to evaluate the calcaneofibular ligament. Deltoid Deltoid eversion injuries : Pott's fracture inversion injuries: ankle sprain Inteosseeous talocalcaneal ligament separates the ST J. from TCN J.