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Gastrocnemius
- Proximal Attachment: Lateral head: lateral aspect of lateral condyle of femur; Medial head: popliteal surface of femur, superior to medial condyle
- Distal Attachment: Posterior surface of calcaneus via calcaneal tendon
- Innervation: Tibial n. (S1, S2)
- Main Actions: Plantarflexes ankle when knee is extended; raises heel during walking; flexes leg at knee joint
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Plantaris m.
- Proximal Attachment: Inferior end of lateral supracondylar line of femur; oblique popoliteal ligament
- Distal Attachment: Posterior surface of calcaneus via the calcaneal tendon
- Innervation: Tibial n. (S1, S2)
- Main Actions: Weakly assists gastrocnemius in plantarflexing ankle
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Soleus
- Proximal Attachment: Posterior aspect of head and superior quarter of posterior surface of fibula; soleal line and middle third of medial border of tibia; and tendinous arch extending between the bony attachments
- Distal Attachment: Posterior surface of calcaneus via the calcaneal tendon
- Innervation: Tibial n. (S1, S2)
- Main Actions: Plantarflexes ankle joint independent of knee postition; steadies leg on foot
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Popliteus
- Proximal Attachment: Lateral surface of lateral condyle of femur and lateral meniscus
- Distal Attachment: Posterior surface of tibia superior to soleal line
- Innervation: Tibial n. (L4, L5, S1)
- Main Actions: Weakly flexes knee; medially rotates tibia
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Flexor Digitorum Longus
- Proximal Attachment: Medial part of posterior surface of tibia inferior to soleal line
- Distal Attachment: Bases of distal phalanges of lateral four digits
- Innervation: Tibial n. (S2, S3)
- Main Actions: Flexes lateral four digits; plantarflexes ankle; supports longitudinal arches of foot
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Flexor Hallucis Longus
- Proximal Attachment: Inferior two thirds of posterior surface of fibula; inferior part of interosseus membrane
- Distal Attachment: Base of distal phalanx of great toe (hallux)
- Innervation: Tibial n. (S2, S3)
- Main Actions: Flexes great toe at all joints; weakly plantarflexes ankle; supports medial longitudinal arch of foot
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Tibialis Posterior
- Proximal Attachment: Interosseus membrane; posteriomedial fibular; posterlateral tibia
- Distal Attachmnet: Tuberosity of navicular; cuboid, cuneiforms, MTs 2-4, sustentaculum tali of calcaneus
- Innervation: Tibial n. (L4-L5)
- Main Actions: Plantarflexes ankle; inverts foot
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Tibialis Anterior
- Proximal Attachment: Lateral condyle and and superior half of lateral surface of tibia and interosseus membrane
- Distal Attachment: Medial and inferior surfaces of medial cuneiform and base of first metatarsal
- Innervation: Deep peroneal n. (L4, L5)
- Main Actions: Dorsiflexes ankle; inverts foot
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Extensor Hallucis Longus
- Proximal Attachment: Medial part of anterior surface of fibula and interosseus membrane
- Distal Attachment: Dorsal aspect of base of distal phalanx of great toe (hallux)
- Innervation: Deep peroneal n. (L4, L5)
- Main Actions: Extends great toe (IP and MTP) and dorsiflexes ankle
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Extensor Digitorum Longus
- Proximal Attachment: Lateral condyle of tibia and superior three quarters of medial surface of fibula and interosseus membrane
- Distal Attachment: Middle and distal phalanges of lateral four digits
- Innervation: Deep peroneal n. (L4, L5)
- Main Actions: Extends lateral four digits (DIP, PIP, and MTP) and dorsiflexes ankle
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Extensor Digitorum Brevis
- Proximal Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
- Distal Attachment: Long extensor tendons of medial four digits (2-4)
- Innervation: Deep peroneal n. (L5, S1)
- Main Actions: Extends four medial toes at MTP and IP joints
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Extensor Hallucis Brevis
- Prxomial Attachment: Calcaneus; interosseus talocalcaneal ligament; stem of inferior extensor retinaculum
- Distal Attachment: Dorsal aspect of base of proximal phalanx of great toe
- Innervation: Deep peroneal n. (L5, S1)
- Main Actions: Extends great toe at MTP joint
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Peroneus Tertius
- Proximal Attachment: Inferior third of anterior surface of fibula and interosseus membrane
- Distal Attachment: Base and shaft of 5th metatarsal
- Innervation: Deep peroneal (L5, S1)
- Main Actions: Dorsiflexes ankle and aids in eversion of foot
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Peroneus Longus
- Proximal Attachment: Head and superior two thirds of lateral surface of fibula
- Distal Attachment: base of 1st metatarsal and medial cuneiform
- Innervation: Superficial peroneal n. (L5, S1)
- Main Actions: Everts foot and weakly plantarflexes ankle
- Behind lateral malleolus and under foot
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Peroneus Brevis
- Proximal Attachment: Inferior two thirds of lateral surface of fibula
- Distal Attachment: Dorsal surface of tuberosity on lateral side of base of 5th metatarsal
- Innervation: Superficial peroneal n. (L5, S1)
- Main Actions: Everts foot and weakly plantarflexes ankle
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Anterior Compartment
- Tibialis anterior
- Extensor Hallucis Longus
- Extensor Digitorum Longus
- Peroneus Tertius
- Deep peroneal n.
- Anterior tibial a. and vv.
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Lateral Compartment
- Peroneus Brevis
- Peroneus Longus
- Superficial Peroneal n.
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Superficial Posterior Compartment
- Gastrocnemus
- Soleus
- Plantaris
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Deep Posterior Compartment
- Tibialis Posterior
- Flexor Hallucis Longus
- Flexor Digitorum Longus
- Peroneal a. and vv.
- Posterior tibial a. and vv.
- Tibial n.
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Tibial n.
- Origin: Sciatic n.
- Roots: L4-S3
- Supplies: Muscles of posterior leg and knee joint
- Deep to soleus
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Common Peroneal n.
- Origin: Sciatic n.
- Roots: L4-S2
- Supplies: Skin of lateral part of posterior aspect of leg via lateral sural cutaneous n.; knee joint via articular branch
- Follows biceps femoris tendon around to front of knee
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Superficial Peroneal n.
- Origin: Common peroneal n.
- Roots: L5-S1
- Supplies: Peroneus longus and brevis and skin onf distal third of anterior surface of leg and dorsum of foot
- Deep to peroneus longus in superior leg, half way down becomes superficial to innervate skin
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Deep Peroneal n
- Origin: Common peroneal n.
- Roots: L4-S1
- Supplies: Anterior muscles of leg, dorsum of foot, and skin of first interdigital cleft
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Sural n.
- Origin: Tibial and common peroneal nn.
- Roots: S1, S2
- Supplies: Skin of posterior and lateral aspect of leg and lateral side of foot
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Lateral Sural Nerve
- Origin: Common peroneal n.
- Roots:
- Supplies: Skin of superior lateral leg
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Medial Sural Nerve
- Origin: Tibial n.
- Roots:
- Supplies: Skin over lateral head of gastrocnemeus
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Saphenous Nerve
- Orgin: Femoral n.
- Roots: L3, L4
- Supplies: Skin of medial leg and foot
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Flexor Retinaculum
Runs from the medial malleolus to the medial calcaneus.
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Q-angle
- Measures the axis of pull on the quadriceps tendon by the combined pull of all qaud muscles
- Usually a line up to the ASIS
- Angle is between line of pull and a line straight through patellar tendon, usually 10-15 degrees
- --> lateral tracking of patella
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Angle between femoral and tibial shafts
Normal is 170-175 degrees
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Genu Articularis m.
- Proximal Attachment: Anterior inferior shaft of femur
- Distal Attachment: Suprapatellar bursa
- Innervation:
- Main Actions: Holds suprapatellar bursa in place
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Bursas of the knee joint
- 14 total
- Prepatellar Bursa: in front of patella
- Popliteus Bursa: extension of synovial membrane in back; separates popliteus from tibia
- Pes Anserine Bursa: continuation of synovial membrane just superior to pes anserine on tibial condyle
- Semitendinosus Bursa: extension of synovial membrane where semitendinosus comes around back of knee
- Suprapateallar Bursa: continuation of synovial membrane superior to patella
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Medial and Lateral retinacula of knee
- Comes off the patella and goes to the tibia (but not via patellar ligament)
- Holds patella in place
- Provides stability to front of knee and guides patella
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Medial Meniscus
- More C shaped
- Firmly attached to tibia: anteriorly in front of ACL, posteriorly inf front of PCL
- Attached to MCL and semimembranosus
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Lateral Meniscus
- Almost a complete circle
- More freely movable; attached to tibia anteriorly and posteriorly between ACL and PCL
- Attached to popliteus
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Ligaments of menisci
- Transverse: attaches to anterior horns of both menisci linking them
- Meniscofemoral: come from posterior lateral meniscus to medial femoral condyle (Humphrey - anterior to PCL; Wrisberg - posterior to PCL) - stabilise lateral meniscus and PCL
- Coronary: "stitches" that anchor menisci to tibia (more on medial)
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Oblique popliteal ligament
- Medial tibial condyle to popliteal surface of femur
- Reinforces posterior knee capsule to prevent hyperextension
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Arcuate Popliteal ligament
- Arc over popliteus
- Reinforces posterior knee capsule to prevent hyperextension
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Medial Collateral Ligament
- Extracapsular ligament - thickening of joint capsule
- Broad; superficial anterior portion, deeper posterior portion
- Medial epicondyle of femur, down to just above pes anserine tendons (5cm below joint line), deep band attaches to medial meniscus
- Weaker than LCL
- Prevents: genu valgus forces in flexion and extension
- Secondarily: prevents external rotation in extension
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Lateral Collateral Ligament
- Extracapsular ligament - thickening of joint capsule
- Lateral epicondyle to fibular head
- No attachment to meniscus
- Superficial to poplietus’ tendon
- Biceps femoris tendon attaches to LCL → biceps can tighten LCL during activeflexion of knee
- Prevent: genus varus forces
- Secondarily: prevents internal rotation in knee extension
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Anterior Cruciat Ligament
- Infracapsular ligament
- Anterior surface of intercondylar area of tibia and up to medial aspect/inside of the lateral condyle
- Two bands: anterior medial (stronger in flexion); posterior lateral (larger portion stronger in extension); together: prevent anterior translation of tibia
- can prevent some varus and valgus forces
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Posterior Cruciate Ligament
- Infracapsular ligament
- Much thicker and stronger the ACL
- Back side of tibia up to inside on medial condyle of femur
- two bands
- Prevents posterior translation of tibia
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