JEEVAK AYURVEDIC MEDICAL COLLEGE
& HOSPITAL RESEARCH CENTER
Kamlapur, Akauni Chandauli, Uttar Pradesh
SUBJECT-RACHNA SHARIR
TOPIC: Sandhi Sharir W.R.T. Knee Joint
GUIDED BY: PRESENTED BY :
Dr. Amit Kumar Singh (Asso.Prof. & HOD) Shiv Dayal Singh
Dr. Varsha Gupta (Assistant Prof.) Roll No. : 17
Department of Rachna Sharir B.A.M.S. 1ST Year
Batch : 2022-23
संगम
कोर सन्धि (Hinge Joint)
परिचय
दरवाजे (Door), खिड़कियाँ (window) इनको स्थिर तथा चल रखने के लिए जो बन्धन उपयोग में लाये जाते हैं, उन्हें कोर (कब्जा-Hinge) कहते हैं। इसमें यही विशेषता होती है, कि दरवाजे या खिड़कियाँ जैसे खुलते हैं या बन्द होते हैं, वैसे ही यह कोर सन्धि गति या क्रिया करती है। इस प्रकार की क्रिया को संकोच तथा प्रसारण (Flexion and extension) कहते हैं।
स्थान - "तेषां अंगुलि-मणिबन्ध-गुल्फ-जानु-कूपरेषु-कोराः।“
क्रिया की दृष्टि से प्रकार - बहुचल सन्धि है।
Articular Surfaces
The knee joint is formed by:
1 The condyles of the femur
2 The patella
3 The condyles of the tibia.
The femoral condyles articulate with the tibial condyles below and behind, and with the patella in front.
1.Fibrous (Articular) Capsule
The fibrous capsule is very thin, and is deficient anteriorly, where it is replaced by the quadriceps femoris, the patella and the ligamentum patellae.
2.Ligamentum Patellae
This is the central portion of the common tendon of insertion of the quadriceps femoris; the remaining portions of the tendon form the medial and lateral patellar retinacula.
The ligamentum patellae is about 7.5 cm long and 2.5 cm broad.
It is attached above to the margins and rough posterior surface of the apex of the patella, and below to the smooth, upper part of the tibial tuberosity
(b) posterior view of patella
3.Tibial Collateral or Medial Ligament
This is a long band of great strength. Superiorly, it is attached to the medial epicondyle of the femur just below the adductor tubercle. Inferiorly, it divides into anterior and posterior parts.
The anterior or superficial part is about 10 cm long and 1.25 cm broad, and is separated from the capsule by one or two bursae
The posterior (deep) part of the ligament is short and blends with the capsule and with the medial meniscus. It is attached to the medial condyle of the tibia above the groove for the semimembranosus.
*Morphologically, the tibial collateral ligament represents the degenerated tendon of the adductor magnus muscle.
4.Fibular Collateral or Lateral Ligament
This ligament is strong and cord-like. It is about 5 cm long. Superiorly, it is attached to the lateral epicondyle of the femur just above the popliteal groove. Inferiorly, it is embraced by the tendon of the biceps femoris, and is attached to the head of the fibula in front of its apex . It is separated from the lateral meniscus by the tendon of the popliteus.
Morphologically, it represents the femoral attachment of the peroneus longus.
5.Oblique Popliteal Ligament
This is an expansion from the tendon of the semi- membranosus. It runs upwards and laterally, blends with the posterior surface of the capsule, and is attachedto the intercondylar line and lateral condyle of the femur.5
6.Arcuate Popliteal Ligament
This is a posterior expansion from the short lateral ligament. It extends backwards from the head of the fibula, arches over the tendon of the popliteus, and is attached to the posterior border of the intercondylar area of the tibia.
*Cruciate Ligaments
These are very thick and strong fibrous bands, which act as direct bonds of union between tibia and femur, to maintain anteroposterior stability of knee joint. They are named according to the attachment on tibia .
7.Anterior cruciate ligament: It begins from anterior part of intercondylar area of tibia, runs upwards, backwards and laterally and is attached to the posterior part of medial surface of lateral condyle of femur. It is taut during extension ofknee.
8.Posterior cruciate ligament: It begins from the posterior part of intercondylar area of tibia, runs upwards, forwards and medially and is attached to the anterior part of the lateral surface of medial condyle of femur.It is taut during flexion of the knee. These are supplied by middle genicular vessels and nerves .
*Menisci or Semilunar Cartilages
The menisci are two fibrocartilaginous discs. They are shaped like crescents. They deepen the articular surfaces of the condyles of the tibia, and partially divide the joint cavity into upper and lower compartments. Flexion and extension of the knee take place in the upper compartment, whereas rotation takes place in the lower compartment.
10.The medial meniscus is nearly semicircular, being wider behind than in front. The posterior fibres of the anterior end are continuous with the transverse ligament
11.The lateral meniscus is nearly circular (Fig. 12.11c). The posterior end of the meniscus is attached to the medial condyle of femur through two meniscofemoral ligaments
12.Transverse Ligament
It connects the anterior ends of the medial and lateral menisci
SYNOVIAL MEMBRANE
Features
* The synovial membrane of the knee joint lines the capsule, except posteriorly where it is reflected forwards by the cruciate ligaments, forming a common covering for both the ligaments.
* In front, it is absent from the patella. Above the patella, it is prolonged upwards for 5 cm or more as the suprapatellar bursa. Below the patella, it covers the deep surface of the infrapatellar pad of fat, which separates it from the ligamentum patellae. A median fold, the infrapatellar synovial fold, extends backwards from the pad of fat to the intercondylar fossa of the femur. An alar fold diverges on each side from the median fold to reach the lateral edges of the patella
Bursae around the Knee
As many as (12 bursae have been described around the knee-four anterior, four lateral, and four medial. These bursae are as follows.
Anterior
1 .Subcutaneous prepatellar bursa.
2 .Subcutaneous infrapatellar bursa.
3 .Deep infrapatellar bursa.
4. Suprapatellar bursa.
Lateral
1. A bursa deep to the lateral head of the gastrocnemius.
2. A bursa between the fibular collateral ligament and the . . . biceps femoris.
3. A bursa between the fibular collateral ligament and the . . tendon of the popliteus.
4. A bursa between the tendon of the popliteus and the . . . . . lateral condyle of the tibia.
Medial
1. A bursa deep to the medial head of the gastrocnemius.
2. The anserine bursa is a complicated bursa which separates the tendons of the sartorius, the gracilis and the semitendinosus from one another, from the tibia, and from the tibial collateral ligament.
3. A bursa deep to the tibial collateral ligament.
4. A bursa deep to the semimembranosus.
Relations of Knee Joint
Anteriorly
Anterior bursae, ligamentum patellae and patellar plexus of nerves.
Posteriorly
1. At the middle: Popliteal vessels, tibial nerve.
2.Posterolaterally: Lateral head of gastrocnemius, plantaris, and common peroneal nerve.
3. Posteromedially: Medial head of gastrocnemius, semi- tendinosus, semimembranosus, gracilis, and popliteus at its insertion.
Medially
1. Sartorius, gracilis and semitendinosus.
2. Great saphenous vein with saphenous nerve.
3. Semimembranosus.
Laterally
Biceps femoris, and tendon of origin of popliteus.
Morphology of Knee Joint
1 The tibial collateral ligament is the degenerated
tendon of the adductor magnus.
2 The fibular collateral ligament is the degenerated . tendon of the peroneus longus.
3 Cruciate ligaments represent the collateral ligaments of . the originally separate femorotibial joints.
4 Infrapatellar synovial fold indicates the lower limit of the . femoropatellar joint.
ABSTRACT
According to modern text joint is a place where two or more bones are articulates with each other. Aacharya Sushrutahas quoted that although there are numerous Sandhiin our body which cannot be counted so only Asthi Sandhishould be considered while enumerating Sandhi.Totaltwo hundred and ten Sandhiare present in human body. Every bone is unite by joints and covered by muscles and gets blood supply by different Siraand Dhamani. These bones unite to form Asthi Sandhi. In Ayurvedathe main Sthanaof Kapha Doshais all joints in human body. Janu Sandhi(knee) is the largest and most complex synovial joint of the body and is of great importance because it plays great role in movements like walking and stability, including maintenance of the erect posture and the transmission of the body weight. Sandhican be taken as union of two or more bone in Ayurvedic Samhitasthe description of anatomy of Sandhiin detail is not found. It is observed that the incidence of joints disorders is increasing day by day. It is burning problem for families and society.
CONCLUSION
In Ayurvedadetail of Sandhi Sharirand joints are close to each other on the basis of function and structure of joints. Janu Sandhiis anexample of Kora Sandhi. Sleshma dhara Kalacan be correlated to synovial membrane of knee joint. Sleshma (Sleshaka Kapha) can be correlated to synovial fluid. Adhogata Dhamanis, Kaphavaha sira, Rakta vaha siraand Vata vaha sirasupplying the knee region can be correlated to the arterial blood supply, venous drainage and nerve supply of knee joint. Literal and fundamental work has aim to correlate the age old knowledge into more clinician friendly as per terms of this new era butto retain its principles and their basics. To understand the deformity in joints in different diseases detail knowledge about anatomical structure of joint is necessary. In this article we have collected various anatomical concepts related to Sandhi Sharirspecially Janu Sandhi.
Cite this article as:
Rupesh Kumar Singh, Mahesh Kumar Gupta, Archana Kumari Rai. Detail Study of Sandhi Sharirwith special reference to Jaanu Sandhi. International Journal of Ayurveda and Pharma Research. 2023;11(8):83-87.