Popliteal Fossa

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POPLITEAL  FOSSA

  • It is a diamond-shaped space, behind the knee joint.

BOUNDARIES :-

Above & Medially -

  • Semitendinosus & semimembranosus

Above & Laterally -

  • Tendon of biceps femoris

Below & Medially -

  • Medial head of gastrocnemius

Below & Laterally -

  • Plantaris & Lateral head of gastrocnemius

Floor - It is formed from above downwards by-

  • Popliteal surface of femur
  • Oblique popliteal ligament
  • Posterior part of upper end of tibia
  • Fascia covering the popliteus muscle
  • Floor is pierced by middle genicular vessels & nerve, genicular branch of obturator nerve.

Roof -

  • Skin, superficial fascia, popliteal fascia
  • Roof is pierced b small saphenous vein, posterior femoral cutaneous nerve.

CONTENTS :-

  • Popliteal Artery
  • Popliteal Vein
  • Termination of Small Saphenous Vein
  • Tibial Nerve
  • Common Peroneal Nerve
  • Posterior Femoral Cutaneous Nerve
  • Genicular Branch of Obturator Nerve
  • Popliteal Lymph Nodes
  • Pad of Fat


POPLITEAL  ARTERY :-

Course -

Extends as a continuation of femoral artery from 5th osseo-aponeurotic opening of adductor magnus


Passes obliquely downward & laterally in close contact with the floor of popliteal fossa

Ends at the lower border of popliteus muscle by dividing into anterior & posterior tibial arteries.

Relations -

Deeply-

  • Popliteal surface of femur
  • Oblique popliteal ligament
  • Fascia covering popliteus

Superficially-

  • Crossed by popliteal vein & tibial nerve form lateral to medial side.

Laterally-

  • In the upper part- Biceps femoris, tibial nerve & popliteal vein.
  • In the lower part- Plantaris, Lateral head of gastrocnemius.

Medially-

  • In the upper part- Semimembranosus
  • In the lower part- Popliteal vein, tibial nerve & medial head of gastrocnemius.

Variations in Termination -

  • It may terminate at the upper border of popliteus.
  • It may terminate by dividing into anterior tibial, posterior tibial & peroneal arteries at the lower border of popliteus.

Branches -

Cutaneous branches-

  • They pierce the roof & supply the skin of the back of leg.

Muscular branches-

  • They supply the adjacent muscles.

Articular branches- 

  • They are 5 in number.
    • Superior medial genicular artery
    • Superior lateral genicular artery
    • Inferior medial genicular artery
    • Inferior lateral genicular artery
    • Middle genicular artery
  • They supply the knee joint by forming genicular anastomosis around the knee.

Genicular Anastomosis -

At the medial femoral condyle-

  • Superior medial genicualr artery anastomose with inferior medial genicular artery & descending genicular branch of femoral artery.

At the lateral femoral condyle-

  • Superior lateral genicular artery anastomose with inferior lateral genicular artery & descending branch of lateral circumflex femoral artery.

At the medial tibial condyle-

  • Inferior medial genicular artery anastomose with superior medial genicular artery & saphenous branch of descending genicular artery.

At the lateral tibial condyle-

  • Inferior lateral genicular artery anastomose with superior lateral genicular artery, anterior & posterior tibial recurrent branches & circumflex fibular branch.

POPITEAL  VEIN :-

  • It accompanies the artery in the fossa.
  • Crosses the artery superficially from lateral to medial side.
Tributaries -
  • Small saphenous vein
  • Veins accompanying the branches of popliteal artery.



TIBIAL  NERVE :-

  • It is the larger terminal branch of sciatic nerve.

Root Value -

  • Ventral divisions of ventral rami of L4 -S3.

Course -

It passes vertically from upper to lower angles of the fossa

 

Crosses  the popliteal vessels superficially from lateral to medial side

Branches -

Muscular branches-

  • They supply both the heads of gastrocnemius, plantaris, soleus & popliteus.
  • Branch to popliteus also supplies tibialis posterior.
  • Lateral side of the nerve is danger, as most of the muscular branches arise from its lateral side.

Articular branches-

  • They supply the knee joint.
  • They are superior, inferior & middle genicular nerves.

Cutaneous branch-

  • Sural nerve- It joins with sural communicating nerve after piercing the deep fascia of leg.

Vascular branches-

  • They convey post-ganglionic sympathetic fibres from T10-L2 spinal cord segments.
  • They supply popliteal vessels.

COMMON  PERONEAL  NERVE :-

  • It is the smaller terminal branch of sciatic nerve.

Root Value -

  • Dorsal divisions of ventral rami of L4-S2.

Course -

It appears in the fossa beneath the long head of biceps femoris

 

Slopes downward & laterally along the medial margin of biceps tendon

At the lateral angle of popliteal fossa it crosses superficial to the plantaris & lateral head of gastrocnemius

Reaches back of head of fibula where it can be rolled against the bone

It curves forward on to the lateral side of neck of fibula

 

Deep to peroneus longus it divides into deep & superficial peroneal nerves.

Branches -

Cutaneous branches-

  • Sural communicating nerve- joins with sural nerve.
  • Lateral sural nerve- supplies the skin of upper part of lateral side of the leg.
Articular branches-
  • Superior & inferior lateral genicular nerves- Supply the knee joint.
  • Recurrent genicular nerve- Supplies the antero-lateral part of capsule of knee joint & superior tibio-fibular joint.

POSTERIOR  FEMORAL  CUTANEOUS  NERVE :-

  • It pierces the popliteal fascia in the middle of the fossa & become cutaneous.
  • It supplies the skin over the popliteal fossa up to the middle of back of leg.

GENICULAR  BRANCH  OF  OBTURATOR  NERVE :-

  • It is the continuation of posterior division of obturator nerve.
  • Pierces the oblique popliteal ligament & supplies the capsule of knee joint.

POPLITEAL  LYMPH  NODES :-

  • These are usually 6 in number.
  • One is situated beneath the popliteal fascia at the junction of small saphenous vein & popliteal vein, it drains the lymph from lateral side of foot & back of leg.
  • Few nodes are situated on both sides of popliteal vessels, they drain the lymph from anterior & posterior tibial vessels.
  • Few nodes intervene between the knee joint & popliteal artery, they drain the lymph from knee joint.
  • Efferents from popliteal nodes drain into deep inguinal lymph nodes.

APPLIED  ASPECTS :-

Popliteal Artery Aneurysm :-

  • It is the abnormal dilatation of popliteal artery.
  • Popliteal artery is more prone for aneurysm than other arteries in the body.

Baker’s Cyst / Popliteal Cyst :-

  • A fluid filled cyst on the back of knee joint.
  • Cause- Pathological injury to cartilages of knee joint.

Injury to Tibial Nerve :-

Symptoms-

  • Motor paralysis of gastrocnemius, soleus, popliteus, tibialis posterior, flexor digitorum longus, flexor hallucis longus & all intrinsic muscles of the foot except extensor digitorum brevis.
  • Foot is dorsiflexed & everted.
  • Sensory loss on the entire sole of foot & dorsal aspect of terminal phalanges, may lead to trophic ulcers.

Injury to Common Peroneal Nerve :-

Cause- Fracture of neck of fibula.

Symptoms-

  • Motor paralysis of peroneal & extensor compartments of leg results in Foot drop.
  • Foot is plantarflexed & inverted.
  • Sensory loss on the dorsum of foot & lower part of front of leg.



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