 So this is going to be a preliminary dissection of the structures around the knee joint before we start Just let me show you some important landmarks My index finger here is on the condyle of the femur This is the apex of the patella and this is the antrolateral tubercle of jerdy So we have three points of a triangle and if we insert a needle Right through the center of the triangle then we can enter the knee joint And this is the site which we use for knee joint aspiration in case of knee joint effusion as well as intraarticular injection of steroids and anesthetic agent There are many other sites to classify we can use suprapatillur-infrapatillur lateral medial so the one which we have described just now was Infrapatillur lateral Having mentioned that now let's show some structures We have made it transverse incision across the quadriceps tendon and I would reflect the distal portion up In the distal portion we can see this center portion here This is the quadriceps tendon and outside we can see this was the quadriceps tendon and on either side We can see these two aponeurotic sheets These are the patella retinoculum the lateral and the medial patella retinoculum respectively Now let's take a look at the proximal portion again I have reflected it up and we can see the quadriceps tendon in the middle And we can see the lateral patella retinoculum and the medial patella retinoculum these retinoculum lateral and the medial They come respectively from the vastus lateralis and the vastus medialis and if you trace the fibers very carefully We can see that the lateral patella retinoculum the fibers are going like this And they get attached to the side of the patella and to the tibial condyle which is located here Likewise the medial patella retinoculum fibers they come like this They get attached to the sides of the patella and to the medial tibial condyle These patella retinoculum they reinforce the anterior capsule of the knee joint. So just to bring up to speed This is the rectus femoris Under that this is the vastus intermedius and this is the tendon of the vastus intermedius This is the vastus lateralis you can see the fibers of the vastus lateralis coming here And this is the vastus medialis and we can see the fibers of the vastus medialis coming here Now let's take a look at another structure under This is the anterior surface of the femur and we can see this fatty-looking structure here and The upper portion of the same fatty-looking structure here This is the cut portion of the suprapatellar bursa The suprapatellar bursa is the largest bursa of the knee and it communicates with the knee joint And if we notice carefully we will see some muscle fibers attached to the suprapatellar bursa On the top and we can see one set of muscle fibers here and we can see another set of muscle fibers here These two sets of muscle fibers They are referred to as the articularis genu. The articularis genu They are actually the deepest fibers of the quadriceps most specifically the vastus intermedius But they also take a little bit of attachment from the anterior surface of the femur and this Articularis genu muscle then they get inserted onto the suprapatellar bursa The function of this articularis genu is when the knee moves Extends and flexes the suprapatellar bursa is likely to get trapped between the patella and the femur So therefore it moves the suprapatellar bursa out of the way to prevent it from getting trapped That's the next structure that we can see here now. Let's come further down We have cut the ligamentum patellae here The ligamentum patellae is the stout ligament Which is actually the continuation of the quadriceps tendon and it continues from the apex of the patella to the tibial tuberosity So this is the apex of the patella. There's the tibial tuberosity and we have cut it here And again we are reflecting the distal portion and the proximal portion and in so doing we see another fatty structure here This is the infrapatellar fat and deep to the infrapatellar fat We can see this is the deep infrapatellar bursa So that brings me to what the per se around the knee joint one suprapatellar bursa. I have already described If there's a penetrating injury in this region or if there's any knee joint effusion the suprapatellar bursa swells up Suprapatellar bursa communicates with the knee joint This is the most important of the largest bursa and this can be clearly visualized in an arthrogram of the knee This is a video lateral view of the knee joint to show arthrogram and the suprapatellar bursa Then there is a prepatellar bursa Which is located under the skin of the patella and that is the one which gets inflamed in housemaid's knee Then we have a superficial infrapatellar bursa in front of the tibial tuberosity Which can get inflamed in clergy man's knee and then we have the deep Infrapatellar bursa which I described just now which the point to be remembered is the deep infrapatellar bursa does not communicate with the Knee joint now. Let me show you one more structure. We have lifted up this thin aponeurotic sheet We can see it is coming from above the patella It is going over the patella and it is continuing below the patella and this is the other end of the sheet Which we have lifted up here This is the thin aponeurotic sheet Which establishes the continuity between the quadriceps tendon across the patella to the ligament and patellae So therefore the patella is considered as a sesamoid bone within the composite Continuum of the quadriceps tendon and the ligament and patellae and therefore The patella is supposed to increase the mechanical advantage and the change the direction of pull of the quadriceps tendon and Help it to make the knee extension much more powerful That is the reason why the quadriceps tendon is a powerful extensor of the knee It is three times as powerful as its antagonist That is the flexor of the knee namely the hamstring muscles. Now, let us mention another structure If you take a look at this structure here, this is the iliotibial tract It is the tough lateral portion of the facial at her remnant of the facial at is here Most of it we have cut off and we can see the interior of the iliotibial tract here Incidentally, the iliotibial tract is the aponeurotic expansion of two muscles This is the tensor facial at her and this is the gruteus maximus and between the iliotibial tract and the vestus lateralis In this region there was a bursa which is referred to as the gluteal femoral bursa The iliotibial tract continues down and we can trace the fibers very carefully We can see the fibers are running down here and we can see the fibers coming all the way here and These fibers then get inserted onto this brony prominence which I've mentioned in the beginning of this dissection This is the antrolateral tubercula journey. So this is one structure, which is the lateral side Now we shall look at some structure from the medial side now The camera person is focusing it from the medial side just to bring up to speed This is the supine cadaver. This is the left knee I'm standing on the left side and the camera person is on the right side and we are looking at the Medial side of the left knee If you look closely, we can see this muscle here. This is the sartorius muscle The sartorius muscle It goes behind the medial side of the knee and the tendon then curves like this and it gets attached to the Upper media surface of the tibia. It was attached 10 third year by means of a facial sling which we have removed So therefore it has become mobile So I'm going to reflect this up and I'm going to show you this nerve here This is the subvenous nerve which was running inside the doctor canal and then it pierced through the fascia And it went under the sartorius muscle and we can see the other end of the subvenous nerve here The next structure, which I would like to draw your attention to is this one here This is the Gracilis muscle and we can see the Gracilis tendon also goes behind the medial side of the knee and it gets inserted Onto the upper medial aspect of the tibia So that brings me to the concept of what is known as Bess and Srinus which literally means the goose foot insertion It is the composite insertion of three muscles one each from the anterior medial and posterior compartment If you were to take a look on the opposite side We can see this is the tendon of the sartorius This is the tendon of the Gracilis and when I pull here we can see the Gracilis muscle is moving here and this is the tendon of the semitendinosus Sartorius Gracilis semitendinosus So this insertion this is called the Bess and Srinus for the goose foot insertion Under the Bess and Srinus there is a bursa called the ancerine bursa located between the insertion of the Bess and Srinus and the medial side of the tibia to prevent friction so that makes me to the concept of Laterality of these two on this side. We have the Iliotibia tract and on the medial side We have the Bess and Srinus they balance each other out and therefore they help to counter each other's action The next point which I want to mention was that the Iliotibia tract as I said earlier gives attachment to the tensor Facial and the gluteus maximus both of which take origin from the pelvic bone Likewise the Sartorius Gracilis and semitendinosus all these three muscles also take attachment from the pelvic bone and they all cross Not only the hip joint, but they also cross the knee joint So therefore these two sets of muscles one on the lateral side and one on the medial side They help to coordinate the movement of the hip joint and the knee joint and Stabilize the hip and the pelvis at the same time Counterbalancing each other one from the lateral side and one from the medial side So these are some functional aspects about the Iliotibia tract versus the Bess and Srinus So these are some of the structures which I wanted to show you on the superficial dissection of the knee Stay tuned for the next video which we will open out the knee joint and show the structures inside the knee Thank you very much for watching. Dr. Sanjay Sanyal signing out. David O is the camera person If you have any questions or comments, please put them in the comment section below. Have a nice day