Knee Pain
Benjamin Apichai in Chinese Medicine for Lower Body Pain, 2021
The lower leg is made up of two bones, the tibia and fibula. The fibula is the slender one and posterolaterally situated to the tibia. It is a non-weight-bearing bone. These two bones are connected at two locations: Proximal tibiofibular joint—the fibula articulates with the inferior aspect of the lateral tibial condyle. It is supported by a tense joint capsule; the capsule attaches to the tibia and fibula at the margin of the articular surface and is reinforced anteriorly by the biceps femoris tendon insertion into the fibular capitulum, posteriorly by the popliteus tendon, superiorly by the lateral collateral ligament, and inferiorly by the interosseous membrane.Distal tibiofibular joint—the fibula articulates with the fibular notch of the tibia.
A to Z Entries
Clare E. Milner in Functional Anatomy for Sport and Exercise, 2019
The four ligaments associated with the tibiofemoral joint are in two pairs. Inside the joint are the anterior and posterior cruciate ligaments (ACL, PCL), and outside the joint are the medial and lateral collateral ligaments (MCL, LCL). Each ligament checks extremes of different rotations at the knee, according to its orientation and attachments. The ACL is the most commonly injured knee ligament in athletes, and is typically injured in a non-contact situation (see In Sports 4). The two cruciate ligaments are so named because they run on opposite diagonals in the middle of the knee joint, crossing over each other and making an X shape. The ACL runs in a posterolateral direction from the anterior portion of the intercondylar area of the tibia to the medial side of the lateral femoral condyle. The PCL runs anteromedially from the posterior part of the tibial intercondylar area to the lateral side of the medial condyle of the femur. The primary roles of the ACL and PCL are to prevent anterior and posterior sliding of the tibia respectively. Since the tibial plateau is relatively flat, this is important in maintaining the integrity of the joint when muscle action tends to translate the tibia on the femur. The cruciate ligaments also check axial rotation of the tibia, with the ACL checking internal rotation and the PCL external rotation.
Fibular flap
John Dudley Langdon, Mohan Francis Patel, Robert Andrew Ord, Peter Brennan in Operative Oral and Maxillofacial Surgery, 2017
The first vascularized fibula flap transfer was used for ulnar reconstruction by Ueba in 1974 (series of cases published in 1983).1 Taylor et al. subsequently reported free anterior compartment, extensor hallucis longus (EHL) and extensor digitorum longus are attached to the anterior surface of the fibula. The large tibialis anterior muscle is found near the tibia. Separating the anterior and posterior compartments is the anterior inter-osseus membrane – a white fibrous band that is attached to both fibula and tibia. The anterior tibial artery and deep tibial nerve can be found running close to this membrane. In the posterior compartment, lying between tibialis posterior and flexor hallucis longus (FHL) muscles (and close to the deep surface of the fibula) are the peroneal vessels. The soleus and gastrocnemius form the muscle bulk of the posterior compartment. Finally, the anterior crural septum runs between peroneus longus and brevis and EHL, whereas the posterior crural septum runs between the peroneus longus and FHL – the latter septum is usually used to reach the fibula during the dissection.
Total knee arthroplasty using a computerized assisted stereotaxic navigation system with bluetooth communication in obese patients - A randomized controlled study
Published in Computer Assisted Surgery, 2023
Gurion Rivkin, Leonid Kandel, Itay Perets, Tamir Tsohar, Tarek Nasrawy, Meir Liebergall
Full-length standing anteroposterior radiographs were collected from all patients pre-operatively and at 6-weeks post-operatively. All x-rays collected were performed with the same technique of bipodal standing with no hip rotation and patella facing forward. The change in alignment of the knee and the position of the tibial and femoral components were measured from these films. The mechanical axis is defined as the axis of the lower limb with its proximal extremity at the center of the femoral head and its distal extremity at the center of the ankle. The femoral mechanical axis is defined by the center of the femoral head and the center of the knee (the center of the knee being the center of the medial shaft in the intercondylar notch of the femur or femoral component). The tibial mechanical axis is defined by the center of the ankle and the middle of the tibia plateau.
In silico modelling of long bone healing involving osteoconduction and mechanical stimulation
Published in Computer Methods in Biomechanics and Biomedical Engineering, 2023
Jean-Louis Milan, Ian Manifacier, Nicolas Rousseau, Martine Pithioux
Mechanical stimulation of the bone should be included in the early phases of the healing process. In the case of the tibia this may be achieved by walking with crutches. Early weight-bearing is limited by the fixation device which provides most of the support, leaving a limited part of the load to be transmitted through the bone callus. Considering large long diaphyseal defects, the implantation of a scaffold and the application of mechanical loading allow bone tissue formation as observed in vivo in sheep by Pobloth et al. 2018. Diaphyseal defect was stabilized by a locking compressive plate. The mechanical stimulation was introduced by allowing the sheep to walk, the load applied to the scaffold being a portion of body weight. By implementing a mechanoregulation model, Perier-Metz et al. 2020 reproduced in silico the experimental conditions of Pobloth et al. 2018 and simulated the same results of bone healing . Bone healing was the result of the mechanical loading of the tissue that grew within scaffold pores. Mechanical stimulus depended on the level of stabilization of locking plate and on the mechanical properties of the scaffold. However, it is hard to predict the mechanical environment of the growing tissue and the studies did not report the deformation and displacement that were generated globally and locally.
Feasibility of heating metal implants with alternating magnetic fields (AMF) in scaled up models
Published in International Journal of Hyperthermia, 2022
Varun Sadaphal, Bibin Prasad, Walker Kay, Lisa Nehring, Trung Nyugen, John Tepper, Melissa Tanner, Dustin Williams, Nicholas Ashton, David E. Greenberg, Rajiv Chopra
For surgery, a sheep was first anesthetized (propofol 5-10 mg/kg followed by intubation and isoflurane inhalation 0.5–5.0%) and placed on a circulating water-heated pad. The proximal medial aspect region of the right hind leg was prepped with a betadine skin prep kit. An incision was made at the proximal medial tibia region to expose the flat surface of tibial bone. A simulated fracture fixation plate was then used as a template to drill 4 holes into the bone. Next, a plate with fiberoptic sensors epoxied to the front and side surfaces was fastened to the bone with cortical bone screws (Veterinary Orthopedic Implants catalog #ST 270.00). The fascia was sutured closed and two fiberoptic sensors were secured with sutures such that they resided on top of the fascia above the plate location. Finally, the skin was sutured closed, and a third sensor was secured (with sutures) on top of the skin above the plate location. The sensors were reinforced with surgical tape.
Related Knowledge Centers
- Femur
- Fibula
- Median Plane
- Leg
- Knee
- Tarsus
- Interosseous Membrane of Leg
- Fibrous Joint
- Syndesmosis
- Body