Knee and Leg

• Tibia - large weight-bearing bone of the leg; more anteriorly projected than fibula
• Fibula - slender lateral bone of the leg; more distally projected than tibia and takes no part in articulation of knee joint but forms lateral malleolus of the ankle joint
• Patella - largest sesamoid bone; stabilized by medial and lateral ligament (retinaculum) attachment to tibia and femur
• Capsule - surrounds femoral & tibial condyles and patella

  • Fibrous, weak, and offers little support
  • Movements include flexion, extension, some gliding, and medial rotation
• Tibiofemoral - knee joint proper
• Patellofemoral - within the patella and distal femur

  • Quadriceps tendon - from muscles to superior patella; part of extension mechanism
• Proximate tibiofibular joint - forgotten joint
• • Extracapsular - outside capsule and being supported & reinforced by these ligaments
  • Intracapsular - extrasynovial; not lined with synovium
• Extracapsular

  • Tibial Collateral - from medial femoral to medial tibial epicondyle, has attachment on medial meniscus, limits extension and abduction of leg, checks valgus stress in knee joint
  • Fibular Collateral - from femoral epicondyle to fibulae head, overlies popliteus tendon, limits extension and adduction, checks varus stess
  • Patellar - patella to tibial tuberosity, acts in ext. of Quadriceps tendon
  • Arcuate Popliteal - from fibulae head to capsule
  • Oblique Popliteal - from SMB tendon to post. knee, limits hyperext. and lat. rotation
• Medial Meniscus


  • Attached to interarticular area of tibia, lies over medial facet
  • C-shaped
  • MCL attachment, which tears the ligament when injured
• Lateral Meniscus


  • Attached to interarticular surface of tibia, lied over lateral facet
  • O-shaped
• Anterior cruciate


  • From ant. intercondylar tibia to med. femoral condyle
  • Prevents post. slipping of femur on tibia / ant. slipping of tibia against femur
  • Often torn in hyperextension
• Posterior cruciate


  • From post. intercondylar tibia to med. femoral condyle
  • Prevents ant. slipping of femur on tibia / ant. slipping of tibia against femur
  • Short and stronger than ACL
• The Dangerous Triad of O’donoghue consists of the rupture of MCL, damage to medial meniscus, and rupture of ACL.
• Popliteal Fossa

  • Diamond-shaped area at the back of the knee
  • Contains:
  • Popliteal vessels
  • Saphenous vein
  • Common peroneal and tibial nerves
• Saphenous nerve - cutaneous branch of the femoral nerve that supplies the anteromedial leg
• Sural nerve - cutaneous branch of the tibial nerve that supplies the posterolateral leg
• Medial collateral ligament - very strong complex of 4 ligaments that limits eversion:

  • Anterior talotibial ligament (ATTL)
  • Posterior talotibial ligament (PTTL)
  • Calcaneotibial ligament (CTL)
  • Naviculotibial ligament (NTL)
• Lateral collateral ligament - complex of 3 ligaments that limits inversion:

  • Anterior talofibular ligament (ATFL) - most often involved in inversion (ankle) sprain; weakest ligament of the ankle
  • Posterior talofibular ligament (PTFL)
  • Calcaneofibular ligament (CFL)
• Avulsion of medial malleolus will usually occur first before the deltoid ligament is torn.
• Distal tibiofibular joint

  • Bears the weight of the tibia and fibula
  • Ligaments:
  • Anterior tibiofibular ligament 
  • Posterior tibiofibular ligament
  • Inferior transverse ligament
• Talocrural Joint

  • dorsiflexion and plantarflexion
• Subtalar Joint

  • inversion and eversion
  • Ligaments:
  • Medial and lateral ligaments
  • Interosseus ligament
• Short plantar ligament (calcaneocuboid) - staple for lateral longitudinal and transverse arch along with long plantar ligament
• Bifurcated ligament - strong, Y-shaped ligament on upper surface of the joint
• Tarsometatarsal Joint

  • Consists of the three cuneiforms and the cuboid as they join with the five metatarsals
  • Allow for gliding movements only
• Anterior Ankle

  • anterior to the extensor retinaculum - saphenous nerve and saphenous great vein
  • beneath or through the extensor retinaculum - tibialis anterior, EDL, EHL, anterior tibial artery, deep peroneal nerve, Peroneus tertius
• Posterior Ankle

  • behind medial malleolus and beneath flexor retinaculum - Tibialis posterior, FDL, FHL, posterior tibial artery, tibial nerve
  • behind lateral malleolus and beneath superior peroneal retinaculum -sural nerve, small saphenous vein, peroneus muscles which are held in the inferior peroneal retinaculum
  • behind the ankle - Achilles tendon, fat
• • Pes planus - flat-footed; deformity caused by the loss of the medial longitudinal arch resulting in an unstable foot
  • Pes cavus - arched foot; contracture of the intrinsic muscles of the foot
  • Pigeon toe - foot pointed inwards rather than forward
• • Supination of the foot:
  • Talocrural plantarflexion
  • Subtalar inversion
  • Midtarsal ADduction
  • Pronation of the foot:
  • Talocrural dorsiflexion
  • Subtalar eversion
  • Midtarsal ABduction
• Medial Longitudinal Arch

  • Consists of calcaneum, talus, navicular bone, three cuneiform bones, and the first three metatarsal bones
  • Keystone: talus and navicular
  • Staples: plantar ligaments & tendon of tib. post.
  • Suspension: tib. ant. & post. and medial ligaments of ankle joint
• Lateral Longitudinal Arch

  • Consists of calcaneum, cuboid, and the fourth & fifth metatarsal bones
  • Keystone: cuboid
  • Staples: long & short plantar ligaments and short muscles of foot
  • Suspension: peroneus longus and brevis
• Transverse Longitudinal Arch

  • Consists of the bases of the metatarsal bones, the cuboid, and the three cuneiform bones
  • Keystone: intermediate cuneiform and second metatarsal
  • Staples: deep transverse ligaments, plantar ligaments, dorsal interossei, and adductor hallucis (transverse head)
  • Suspension: peroneus longus