Popliteal fossa

Popliteal fossa - diamond shaped hollow, located behind the knee joint , and limited top and inside the tendons paliperidonesee and polosuhinskoj muscles, from above and outside the tendon of the biceps femoris, bottom - internal and external heads calf muscles (Fig.). Leather popliteal fossa thin, mobile, in the subcutaneous layer passes the small saphenous vein and superficial nerves. Own fascia forms vagina for vessels and nerves. In adipose tissue are tibial and common peroneal nerve, popliteal vein and popliteal artery, adjacent to the capsule of the knee joint. Lymphatic vessels and nodes lie along the popliteal arteries.

popliteal fossa Popliteal fossa:
1 - outer groove of the thigh;
2 - outer vastus;
3 - double-headed muscle of the thigh;
4 - top Department popliteal fossa;
5 - the outer groove of the popliteal fossa;
6 - lateral popliteal fossa fold;
7 - the head of the fibula;
8 - outer head calf muscles;
9 - rear groove tibia;
10 - internal cylinder, the calf muscles;
11 - the lower part of the popliteal fossa;
12 - inner groove popliteal fossa;
13 - tendon polosuhinskoj muscles;
14 - paliperidonesee muscle.

Damage popliteal fossa are open or closed. Breaks large vessels possible with dislocated knee and fractures of the distal end of the femur. If the injuries vessels dangerous bleeding can occur traumatic aneurysm (see). Temporary stop bleeding from the popliteal fossa is a tourniquet on his thigh and tamponade same cannot be applied, as it threatens sdavlennoy vessels and gangrene limbs. Purulent processes popliteal fossa (abscesses and cellulitisare formed as a result of an open injury or suppurative lymphadenitis. Less frequent cold abscesses as a complication tuberculous lesions of the knee joint. In the popliteal fossa are hygroma From benign tumors - lipoma, fibroids, rarely - handsome and osteomas, from malignant - sarcoma.

Popliteal fossa (fossa poplitea) - a large part of the back of the knee (regio genus post.). Popliteal fossa has a diamond shape and revealed at external examination, if your leg slightly bent at the knee. The sides of the diamond is formed at the top of the medial ligaments polosuhinskoj and paliperidonesee muscles (m. semimembranosus et m. semitendinosus), lateral - tendon biceps femoris (m. biceps femoris), and below - medial and lateral heads calf muscles (caput laterale et caput mediale m. gastrocnemii) (Fig. 1).

Fig. 1. The relief of the popliteal fossa: 1 - sulcus femoris lat.; 2 - m. vastus lat.; 3 - m. biceps femoris; 4 - pars sup. fossae popliteae; 5 - sulcus lat. fossae popliteae; in - plicae transversae popliteae; 7 - caput fibulae; 8 - caput lat. m. gastrocnemii; 9 - sulcus post, cruris; 10 - caput med. m. gastrocnemii; 11 - pars inf. fossae popliteae; 12 - sulcus medialis fossae popliteae; 13 - Ty m. semitendinosi, 14 - m. semimembranosus.

In the surface layers are back cutaneous nerve of thigh (n. cutaneus femoris post.) in the middle fossa, saphenous nerve (n. saplienus) - in the medial, lateral cutaneous nerve of caviar (n. cutaneus surae lat.) - in lateral Department.
Own popliteal fascia (fascia poplitea), forming the roof of the popliteal fossa, has the character aponeurosis of cross-reaching fibres and has considerable density. In the lower right corner of the pit own fascia forms a channel (channel Pirogov), which passes the final Department of small saphenous vein (v. saphena parva) accompanied medial cutaneous nerve of caviar (n. cutaneus surae med.).
Fiber P. I. surrounds vessels and nerves and reported at the top with fiber rear hip accompanying sciatic nerve, continue with fiber buttocks and pelvis; at the bottom - fiber rear deep space Shin through the hole, limited tendon arc soleus muscles (m. soleus); front - with fiber front thigh during the popliteal and femoral vessels (through hiatus adductorius). The relationship vessels and nerves in the hollow of the knee is: median position respectively long (longitudinal) diagonals of a rhombus is, N. I. Pirogov, tibial nerve (n. tibialis), located in the most superficial way, deeper and medially from it is the popliteal vein (v. poplitea), and even deeper and medially, closer to the bone - popliteal artery (a, poplitea).
Tibial nerve is the largest branch of the sciatic and its continuation. Together with the posterior tibial vessels he goes on a Shin, in Galena-popliteal channel (canalis cruropopliteus). The other major branch of the sciatic nerve - the common peroneal nerve (n. peroneus communis) - along the tendon biceps femoris, around the neck of the fibula and goes to the front of the lower leg area. From tibial nerve depart in P. I. muscle branches and medial cutaneous nerve of caviar, from the common peroneal nerve (n. peroneus communis) - lateral cutaneous nerve of caviar (Fig. 2).


Fig. 2. Topography popliteal fossa: 1 - n. peroneus communis, 2 - m, biceps femoris; 3 - n. tibialis; 4 - a. genus superior lat.; 5 - n. cutaneus surae lat; 6 - aa. genus mediae; 7 - a. genus inf. lat ; 8 - m, plantaris; 9 - caput lat. m. gastrocnemii; 10 - m. soleus; 11 - v. sapliena parva; 12 - n. cutaneus surae med.; 13 - m. popliteus; 14 - caput med. m. gastrocnemii; IS - a. genus inf. med.; 16 - lig, popliteum obliquum; 17 - a. genus, sup. med.; 18 - fades poplitea femoris; 19 - Ty m. abductoris magni; 20 - Ty m. semitendinosi; 21 - m. semimembranosus; 22 - m vastus med.; 23 - a. et v. poplitea; 24 - ramus anastomoticus v. saphenae parvae et v. saphenae magnae; 25 - m adductor magnus.

From the popliteal artery other branches to the muscles and 5 branches to the knee joint, the upper two joint (AA. genus sup. lat. et med.), average (a. genus media) and two lower joint (AA. genus inf. lat. et med.). The latter, along with other blood vessels form the network of the knee
joint (rete articulare genus) and participate with branches of femoral artery and deep artery hips in creating collateral arcs in the joint. To the vessels lying close popliteal lymph nodes.
Medial Department P. I. goes into recess, called gaberovo the hole located above the medial condyle of the femur and the inner head of the calf muscle. Zhoberovs pit limits front tendon leading large muscle (m. adductor magnus), rear tendon polosuhinskoj, semi-webbed and tender muscles (m. gracilis), top tailoring muscle (m. sartorius) (Fig. 3).


Fig. 3. Topography of vessels and nerves in the internal Department of the popliteal fossa: 1 - m. sartorius; 2 - m. adductor magnus; 3 - a. et v. poplitea, 4 - m. semimembranosus; 5 - m. gracilis; 6 - Ty m. semitendinosi; 7 - caput med. m. gastrocnemii; 8 - n. tibialis, 9 - v. saphena magna et ramus cutaneus ant. (media) is) n. (emoralis; 10 - m. soleus; 11 - vasa tibialia post., 12 - a. genus inf. medialis; 13 - bursa m. semimembranosi; 14 - a genus descendens et n. saphenus; 15 - patella, 16 - fascia m. vasti med.; 17 - ramus cutaneus ant. (ramus infrapatellaris) n. femoralis.

The bottom of the popliteal fossa form facies poplitea - Playground triangular shape on the lower epiphysis of the femur, back capsule of the knee joint with a scythe knee ligament (lig. popliteum obliquum), popliteal muscle (m. popliteus). Back to the capsule of the knee joint adjacent several synovial bags and pockets (Fig. 4). Of them bag paliperidonesee muscles (bursa m. semimembranosi) in 50% of cases are reported bag medial head of the gastrocnemius muscle (bursa capitis medialis m. gastrocnemii), forming extensive bag (size 5x4 cm), which in turn reported in 75% of cases with the joint cavity; my pocket (recessus subpopliteus) a 3 X 2 cm always communicates with the joint cavity.
Pathology. Damage in the area of P. I. (gunshot and other wounds) are usually accompanied by a knee injury vessels and Shin nerves. Gunshot wounds of the popliteal artery very dangerous. According to S. A. Rusanov, during the great Patriotic war they frequency ranked third among the wounds of other major arteries of the extremities. Traumatic same aneurysm (see) this artery was approximately 11% of all aneurysms limbs. Naimisharanya hip fractures may also be accompanied by a knee injury vessels as peripheral fragments action calf muscles shifted at this backwards.
Of inflammatory processes in P. I. there are lymphadenitis (see) and adenoidectomy, emerging as a complication piodermitov or suppurating wounds in the heel region and in the Achilles tendon, the cause secondary infection of bone fracture of the tibia, on the grounds of purulent gonite can also develop paraartikulyarnye phlegmon.
From benign tumors in the area of P. I. more often lipoma and fibroid tumors; malignant sarcoma.
Accesses to the neurovascular bundle possible or back along the longest diagonal of the pit, either through zhoberovs pit. The purpose of the popliteal artery bypass surgery with occlusions applies combined access (A. A. Travin).


Fig. 4. Sinovialnuu bag on the back of the knee: 1 - m. biceps femoris; 2 - sinovialnuu bag between m. biceps femoris and caput laterale m. gastrocnemii (rare); 3 - m. plantaris and caput lat. m. gastrocnemii; 4 - bursa capitis lat. m. gastrocnemii; 5 - sinovialnuu bag, located between tendo m. poplitei and lig. collaterale fibulare; 6 - bursa m. bicipitis femoris; 7 - caput fibulae; 8 - recessus subpopliteus (bursa m. poplitei); 9 - m. soleus; 10 - m. popliteus; 11 - bursa anserina; 12 - pes anserinus; 13 - bursa m. semimembranosi; 14 - bursa capitis medialis m. gastrocnemii; 15 - caput mediale m. gastrocnemii; 16 - total m bag. semimembranosus and m. gastrocnemius; 17 - m. semimembranosus.