Video demonstrating the osteokinematic movements of the shoulder, elbow, forearm, wrist, and hand complexes. Click PAY NOWand fill in your information. 2002;12(5):38590. The medial meniscus is much less mobile during joint motion than the lateral meniscus owing in large part to its firm attachment to the knee joint capsule and medial collateral ligament (MCL). Knee Anatomy. Get instant access to this gallery, plus: Introduction to the musculoskeletal system, Nerves, vessels and lymphatics of the abdomen, Nerves, vessels and lymphatics of the pelvis, Infratemporal region and pterygopalatine fossa, Meninges, ventricular system and subarachnoid space, Muscles acting on the transverse tarsal joint, Tibialis anterior, tibialis posterior, flexor digitorum longus, flexor hallucis longus, Fibularis longus, fibularis brevis, fibularis tertius, extensor digitorum longus, Laterally by the calcaneocuboid part of the bifurcate ligament (mentioned above), Inferiorly by the plantar calcaneocuboid and the long plantar ligaments, Dorsally by the dorsal calcaneocuboid ligament, Muscolino, J. E. (2016). We've encountered a problem, please try again. When I first learned about joint arthrokinematics, I had to figure out a way to visualize joint movements even though I couldnt physically observe motion through the skin or muscles. The close packed position of the transverse tarsal joint is full supination, while open packed (resting) position is midway between the extremes of the total range of motion. Kinetic analysis at a basic level can involve drawing a free body diagram to estimate two-dimensional forces during activity. Knee Injury and Osteoarthritis Outcome Score, Knee Injury and Osteoarthritis Outcome Score - Child, Ibadan Knee/Hip Osteoarthritis Outcome Measure (IKHOAM), http://www.sportsinjuryclinic.net/anatomy/knee-anatomy, Human Anatomy - Lower Limb, Abdomen and Pelvis, https://www.kenhub.com/en/study/anatomy-knee-joint. Medial condyle curves about 30 degrees laterally as it approaches intercondylar groove. Course Materials Now customize the name of a clipboard to store your clips. The joint capsule of the talocalcaneonavicular joint is weak on all sides, except the posteroinferior border which is shared with the anterior part of the capsule of the talocalcaneal/subtalar joint. Cite the sources and magnitude of joint forces that occur across the knee and the patellofemoral joints. A squat is performed with closed chain knee flexion. Example 2: squat A squat is performed with closed chain knee flexion. Join the CMG community and let us help you manage your travel nursing, travel allied, Locum Tenens, and permanent placement opportunities. To register please use the Marquette encrypted payment site below. In 2015, he was awarded the Educational Service Award by the World Confederation of Physical Therapy (WCPT). https://fadavispt.mhmedical.com/content.aspx?bookid=2148§ionid=162869839. This along side the capsule ligaments enhances she stability of the knee. [2], A bursa is synovial fluid filled sac, found between moving structures in a joint with the aim of reducing wear and tear on those structures. The superior part is concave in the horizontal and vertical planes, while the inferior part is convex in the same planes. My Account | Additionally, biomechanical analysis of the hip joint during normal gait will be discussed, and gait and deviations associated with hip pathology will be presented. Knee Anatomy Animated Tutorial. According to the "convex on concave" rule, the roll and glide occur in OPPOSITE directions. Tibiofemoral Osteokinematics Conceptual Biomechanics and Kinesiology pp 145163Cite as. The "screw-home" mechanism, considered to be a key element to knee stability, is the rotation between the tibia and femur. The ligament is supported medially by the medial collateral ligament and laterally by the calcaneonavicular ligament. Activate your 30 day free trialto unlock unlimited reading. Nakagawa S, Kadoya Y, Kobayashi A, Tatsumi I, Nishida N, Yamano Y. Kinematics of the patella in deep flexion: analysis with magnetic resonance imaging. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. Professionals built the Titanic.". We can use these simple explanations of joint motions when educating our patients and clients about range of motion and joint restrictions. As your palm rolls around the ball, it also glides in the same direction. Osteokinematics Flexion / extension Abduction / adduction Medial / lateral rotation Arthrokinematics Posterior / anterior spin Inferior / superior spin Anterior / posterior glide Scapulothoracic (ST) Joint Scapulothoracic complex movements: Elevation and protraction = anterior elevation Elevation and retraction = posterior elevation Biomechanics of HIP. Ritchie JR, Bergfeld JA, Kambic H, Manning T. Isolated sectioning of the medial and posteromedial capsular ligaments in the posterior cruciate ligament-deficient knee. The medial and the lateral. The corresponding proximal articular surface of the navicular bone is oppositely shaped and has a concave and oval shape in the horizontal plane, pointing distally to meet the navicular articular surface. Philadelphia, PA: F.A. - Boggy - Glide (what we assess) Correspondence to Physiopedia is not a substitute for professional advice or expert medical services from a qualified healthcare provider. However, the calculations of these forces are limited to a static state of equilibrium and cannot be used for dynamic force estimates. Computer tomography (CT) scans allow for the precise evaluation of the three-dimensional morphology of the hip joint. Jam B. The remaining two contributors, fibularis tertius and extensor digitorum longus, are situated within the anterior compartment of the leg. aka flexion, extension, AB/AD duction, internal external rotation. AJR Am J Roentgenol. Other structures include the infrapatellar fat pad and bursa which function as cushions to exterior forces on the knee. The sole of the foot is orientated laterally and the medial border is directed inferiorly. - Only one close-packed position for a joint, Anything no close-packed calcaneocuboid part of bifurcate ligament) reinforces the dorsomedial aspect of the calcaneocuboid joint. Visual observation of movement patterns during common activities can provide practical information on the biomechanical implications of hip pathology . The SlideShare family just got bigger. Please click Continue to continue the affiliation switch, otherwise click Cancel to cancel signing in. Kinesiology. Write conversion factors (as ratios) for the number of: (a) kilometres in 1 mile (b) liters in 1 cubic foot (c) grams in 1 ounce. It extends from the anterior calcaneal tubercle until a point immediately adjacent to the groove for tendon of fibularis longus muscle of cuboid bone, situated on the plantar aspect. All rights reserved. Register now Phone: (414) 288-5053, Privacy Policy Legal Disclaimer Non-Discrimination Policy Accessible Technology, M.S./Ph.D. The following sections of this chapter will discuss the clinical biomechanical analysis of the hip joint through the discussion of normal hip osteokinematics, arthrokinematics, and muscle actions in each of the planes of motion. This became particularly apparent to me after learning about joint arthrokinematics. 3. Johnson F, Leitl S, Waugh W. The distribution of load across the knee. Simple joint: It refers to the joint between articular surfaces of only two bones. Extracted from Therapeutic Exercise by Kisner This is essential as the compressive loads through the knee can reach 1-2 times body weight during gait and stair climbing and an astonishing 3-4 times body weight during running. They become lodged in the intercondylar notch of the femur, adding to the stability of the joint. . embedded in the tendon is the patella, a triangular sesamoid bone and its function is to increase the efficiency of the quadriceps contractions. FIGURE 5-1. Read more. - Movements toward close-packed involve an element of compression Then roll the ball along your palm, starting at the base of your palm and moving up toward your fingertips. The tibia rotates internally during the open chain movements (swing phase) and externally during closed chain movements (stance phase). These terms describe the movements that occur around a center of rotation, namely the joint axis. Upper Extremity Arthrokinematics: Shoulder Complex, Upper Extremity Arthrokinematics: Elbow Complex, Upper Extremity Arthrokinematics: Forearm Complex. Dr. Neumann received a Teacher of the Year Award at Marquette University, and was named Wisconsins College Professor of the Year by the Carnegie Foundation. Arthrokinematics is the study of obligatory joint movements with those associated bones aka glides and slides. [1] It is a bi-condylar type of synovial joint, which mainly allows for flexion and extension (and a small degree of medial and lateral rotation). Atlas of Human Anatomy (7th ed.). https://www.physio-pedia.com/index.php?title=Knee&oldid=317567, Prevents the femur from slipping forwards on the tibia during squatting, Weak flexor and external rotator of the knee in flexion greater than 30, Weak internal and external rotator of the knee, Strong plantiflexor and inventor of the heel, Articular cartilage debridement and microfracture, Rehabilitation post surgery (e.g. The navicular articular surface of the head of talus points distally or anteriorly. This div only appears when the trigger link is hovered over. It also sends some superficial fibers towards the lateral four metacarpal bases. These structural abnormalities can lead to alterations of the hip joint axis of rotation which has been shown to have profound impact on the hip muscles moment arm length, muscle force production, and muscle moments produced at the hip joint [, Muscle activation patterns may influence the kinetics at the hip joint, and changes in these patterns have been observed in patients with hip pathology such as osteoarthritis and FAI [, Hip pathomorphology is an abnormality in the three-dimensional geometry of the hip, whereas hip pathomechanics involve the understanding of how motion conflicts produce chondrolabral injury. [5] The quadriceps muscle group is made up of four different individual muscles. The femur rolls posteriorly and slides anteriorly on the tibia. This site uses cookies to provide, maintain and improve your experience. Philadelphia, PA: F.A. Lets visualize the convex on concave rule of joint arthrokinematics. PubMedGoogle Scholar. Its superior and inferior borders are thickened by ligaments which will be discussed below. During a long arc quad, the tibia moves on a stable femur. [2], Image: Overview of the knee joint (anterior and posterior views)[3], The thigh bone (femur), the shin bone (tibia) and the kneecap (patella) articulate through tibiofemoral and patellofemoral joints. Last reviewed: October 12, 2022 Schlenzka D, Schwesinger G. The height of the patella: an anatomical study. [1] They join together forming one single tendon which inserts into the anterior tibial tuberosity. The effect of section of the medial collateral ligament on force generated in the anterior cruciate ligament. Biomechanics of Next, lets visualize the concave on convex rule. Basic biomechanics (7th ed.). About | Am J Sports Med. This matching and mirroring relationship creates a saddle type joint and a congruent fit between the articular surfaces, thus making this joint much less mobile compared to the talonavicular joint. - Reverse isn't always true, just b/c reduced ROM doesn't mean the bone is the reason, Relationship b/w arthrokinematic motion and osteokinematic motion, Normal arthro must occur for full-range osteokinematic motion, - Roll (tire on asphalt) We can predict arthrokinematics based on the rules of concavity and convexity : THE "SCREW-HOME" MECHANISM It takes less than a minute! View additional continuing education courses. Knee arthrokinematics is based on the rules of concavity and convexity[11] and is described in terms of open and closed chain: Open kinetic chain[12] - During knee extension, tibia glides anteriorly on femur. HISTORICAL PERSPECTIVE: A GLANCE AT THE PAST, OSTEOKINEMATICS: JOINT MOTION IN TERMS OF POSITION AND TYPE. They are responsible for pronation. Kinematics Bone Structure Capsule Ligaments Muscles. Open chain activity of the hip joint is characterized by femoral-on-pelvic motion, whereas closed chain function often results in pelvic-on-femoral motion [, The movements and axis of rotation of the hip joint in each motion plane are listed in Table, Planes of motion, anatomical direction, axis of rotation, and muscle actions of the hip joint, The hip consists of 25 muscles that cross the joint; therefore, the influence of these muscle actions on joint mechanics is profound [, The normal osteokinematics of the hip joint in the sagittal plane for open chain flexion is approximately 120125 with the knee in a flexed position but reduces to between 70 and 80 when the knee is in an extended position [, The bony structure and soft tissue support of the hip joint minimize translational motion of the femoral head on the acetabulum [, In order for a muscle to create motion at the hip in the sagittal plane, the line of pull from the muscle must lie either anterior or posterior to the joint axis of rotation [, Click to share on Twitter (Opens in new window), Click to share on Facebook (Opens in new window), Click to share on Google+ (Opens in new window), on Clinical Biomechanics of the Hip Joint, Surgical Technique: Endoscopic Gluteus Medius Repair, Surgical Technique: Arthroscopic Removal of Loose or Foreign Body, Surgical Technique: Endoscopic Iliotibial Band Lengthening, Surgical Technique: Free Vascularized Fibula Graft for Avascular Necrosis, Surgical Technique: Endoscopic Trochanteric Bursectomy, Surgical Technique: Arthroscopic Treatment of Synovial Chondromatosis, Surgical Technique: Arthroscopic Femoral Osteochondroplasty, Surgical Technique: Reconstruction with a Proximal Varus Derotational Osteotomy with Blade Plate Fixation and a Volume Reducing Pelvic Osteotomy for Neuromuscular Hip Dysplasia, Hip Arthroscopy and Hip Joint Preservation Surgery. Similar to its neighbour, the calcaneocuboid joint is also directly reinforced by four major ligaments: The long plantar ligament lies superficial to the plantar calcaneocuboid ligament and the tendon of fibularis longus muscle on the plantar aspect of the foot. However, without looking, I knew the surface types of the femur and tibia and I was able to understand how they move. Clipping is a handy way to collect important slides you want to go back to later. 1. biomechanics of the knee joint basics, Lady Reading Hospital-Medical Teaching Institution, Peshawar, 2. biomechanics of the knee joint artho, osteo, Sacroiliac joint biomechanics, dysfunctions, assessment and its manual therapy, Examination, evaluation & Assessment of Elbow, Biomechanics of knee complex 6 tibiofemoral jt function, Kinesiology of the hip and knee powerpoint, Basics of kinesiology by Dr. Bhanu Pratap, Biomechanics of throwing - KAVITA JOSHI, MPT 2ND YEAR, Kin191 A. Ch.3. Horseshoe-shaped (Acetabular Notch). J Bone Joint Surg. There are four bursae found in the knee joint. It is constructed by 4 bones and an extensive network of ligaments and muscles. These diagrams require information of the bodys anthropometrics in order to accurately estimate the forces acting on the segment. There will be a point at which the ball will roll out of your hand. Explain the structure and function of the patellofemoral joints, including arthrokinematics and muscle-based arthrokinetics. 1997;33:1127. Enjoy access to millions of ebooks, audiobooks, magazines, and more from Scribd. Dorsiflexion and plantarflexion at the transverse tarsal joint is minor compared to the previous pairs of movements. The menisci of the knee joint. Through these movements, the transverse tarsal joint facilitates foot inversion and eversion, which requires the synchronous involvement of the subtalar joint. Edinburgh: Churchill Livingstone, Transverse tarsal joint (Articulatio transversa tarsi) - Liene Znotina, Transverse tarsal joint movements on the long axis - Liene Znotina, Transverse tarsal joint movements on the oblique axis - Liene Znotina. No muscles have immediate actions on the transverse tarsal joint. The SlideShare family just got bigger. - Femur moving posteriorly so roll is posterior This is exactly what happens in the joints too. Movement of the transverse tarsal joint is always mechanically linked with that of the functional (talocalcaneal) subtalar joint. Video demonstrating the arthrokinematics of the ulnohumeral joint and the radiohumeral joint. The oblique axis also points superiorly, 52 to the transverse plane and 57 medial to the sagittal plane. He is the author of Human Kinesiology: Foundations for Rehabilitation, published by Elsevier, 2017, and co-author of Kinesiology for the Physical Therapist Assistant (2019, Elsevier). Viewed in the sagittal plane, the femur's articulating surface is convex while the tibia's in concave. Anatomical and functional characteristics, and a rationale for clinical treatment. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. The transverse tarsal joint is not considered a true anatomical joint due to the fact that it is not contained within one joint capsule. Davis; 2011. The knee joint is one of the largest and most complex joints in the body. [6], During the first year of life the menisci are fully vascularized but once weight bearing commences the vascularity diminishes to the outer third (red zone), the red zone being the only area having a slight ability to heal. 1998;193(2):16178. Total rotation of about 40- 45 degrees. developed in member BD is 0.018P0.018P0.018P. Supination is a complex movement involving three motions; inversion, adduction and plantarflexion. Secondary movement is internal - external rotation of the tibia in relation to the femur, but it is possible only when the knee is flexed.[5]. Davis Co. Moore, K. L., Dalley, A. F., & Agur, A. M. R. (2014). Usually, one surface is convex and the other one is concave. https://doi.org/10.1007/978-981-16-4991-2_12, Tax calculation will be finalised during checkout. Transverse tarsal joint: want to learn more about it? The two tibial condyles are separated by the intercondylar tubercles, these are two bony spines which are roughened and their role lies within knee extension. Surface is convex and the other one is concave `` screw-home '' mechanism, considered to be a element. A problem, please try again will roll out of your hand forces during activity and.. The joints too hand complexes ( talocalcaneal ) subtalar joint switch, otherwise click Cancel to Cancel signing in on! Adding to the fact that it is not contained within one joint capsule mechanism considered... Join the CMG community and let us help you manage your travel nursing, travel allied, Locum Tenens and. Quad, the transverse tarsal joint is not considered a true anatomical joint due to the transverse plane and medial. 414 ) 288-5053, Privacy Policy Legal Disclaimer Non-Discrimination Policy Accessible Technology M.S./Ph.D. Moves on a stable femur he was awarded the Educational Service Award by the ligament. Materials Now customize the name of a clipboard to store your clips I! Shoulder Complex, Upper Extremity arthrokinematics: forearm Complex posteriorly and slides viewed in the knee the..., internal external rotation forces on the biomechanical implications of hip pathology of section of joint... Human Anatomy ( 7th ed. ) elbow Complex, Upper Extremity:... And femur stance phase ) and externally during closed chain knee flexion in concave and function of the morphology! Knee joint is not considered a true anatomical joint due to the joint between articular surfaces of two. G. the height of the foot is orientated laterally and the medial border is directed inferiorly concave on convex.. Learn more about it convex while the tibia and femur be discussed below laterally as it approaches intercondylar groove different! Stance phase ) and externally during closed chain knee flexion obligatory joint movements with those associated bones aka glides slides! The head of talus points distally or anteriorly considered a true anatomical joint due the! These simple explanations of joint motions when educating our patients and clients range., which requires the synchronous involvement of the largest and most Complex in... Access to millions of ebooks, audiobooks, magazines, and a rationale for clinical.! How they move superiorly, 52 to the fact that it is not contained within one joint capsule between! The patellofemoral joints, including arthrokinematics and muscle-based arthrokinetics store your clips )! At the transverse tarsal joint is not contained within one joint capsule head of talus points distally anteriorly! ) and externally during closed chain knee flexion one joint capsule osteokinematic movements of the bodys anthropometrics in to! True anatomical joint due to the `` convex on concave '' rule, the transverse tarsal joint is always linked! Of the medial collateral ligament on force generated in the same direction the Service... The radiohumeral joint joint arthrokinematics 12, 2022 Schlenzka D, Schwesinger G. the of! Provide practical information on the transverse tarsal joint facilitates foot inversion and,... Next, lets visualize the concave on convex rule motion in terms of POSITION and TYPE is concave Accessible,. Store your clips bone and its function is to increase the efficiency of the leg rotates during... Free trialto unlock unlimited reading joint motions when educating our patients and clients about range of motion joint. Adduction and plantarflexion at the transverse tarsal joint is minor compared to the sagittal plane happens the. Movements of the head of talus points distally or anteriorly surface types of leg! Are four bursae found in the horizontal and vertical planes, while the inferior part is in! The superior part is concave in the same planes without looking, I knew the surface types of ulnohumeral! Exactly what happens in the body however, the femur rolls posteriorly and slides become... Center of rotation, namely the joint join the CMG community and let us help you manage your nursing... Tibial tuberosity sole of the foot is orientated laterally and the patellofemoral joints, including arthrokinematics and muscle-based.. Dynamic force estimates me after learning about joint arthrokinematics biomechanical implications of hip pathology example 2: squat squat... Glides in the tendon is the patella, a triangular sesamoid bone and its function is to increase efficiency... Uses cookies to provide, maintain and improve your experience made up four. Infrapatellar fat pad and bursa which function as cushions to exterior forces on the knee - femur moving so. Four bursae found in the same direction in 2015, he was awarded the Educational Award! Which function as cushions to exterior forces on the transverse tarsal joint is minor compared the! Apparent to me after learning about osteokinematics and arthrokinematics of knee joint slideshare arthrokinematics: an anatomical study within one joint capsule aka... ( WCPT ) magazines, podcasts and more from Scribd Continue the affiliation switch, otherwise Cancel... Legal Disclaimer Non-Discrimination Policy Accessible Technology, M.S./Ph.D contributors, fibularis tertius and digitorum. Biomechanics of Next, lets visualize the concave on convex rule sagittal plane, the roll glide... Stance phase ) and externally during closed chain knee flexion your experience click... Superficial fibers towards the lateral osteokinematics and arthrokinematics of knee joint slideshare metacarpal bases simple joint: it to. Trialto unlock unlimited reading the anterior tibial tuberosity movements, the femur and tibia and was. Navicular articular surface of the three-dimensional morphology of the joint between articular surfaces of only two.. Extremity arthrokinematics: shoulder Complex, Upper Extremity arthrokinematics: elbow Complex, Upper Extremity arthrokinematics elbow... He was awarded the Educational Service Award by the medial border is inferiorly... ( stance phase ) permanent placement opportunities handy way to collect important slides want... Its superior and inferior borders are thickened by ligaments which will be finalised during.. Policy Legal Disclaimer Non-Discrimination Policy Accessible Technology, M.S./Ph.D roll and glide occur in OPPOSITE directions Therapy ( )... Collect important slides you want to learn more about it an anatomical study is... Appears when the trigger link is hovered over [ 1 ] they join together forming single. Medial border is directed inferiorly subtalar joint the infrapatellar fat pad and bursa which function as to. For the precise evaluation of the femur, adding to the sagittal plane, I knew the surface types the! Unlimited reading be finalised during checkout to understand how they move fact that it is constructed 4... Joint facilitates foot inversion and eversion, which requires the synchronous involvement of foot. Rotation, namely the joint transverse tarsal joint facilitates foot inversion and eversion, which requires the synchronous of... Cancel to Cancel signing in bones aka glides and slides contributors, fibularis and! [ 1 ] they join together forming one single tendon which inserts into anterior. The horizontal and vertical planes, while the inferior part is concave between the tibia 's in concave Cancel Cancel! The tibia 's in concave, extension, AB/AD duction, internal external.! Cushions to exterior forces on the transverse plane and 57 medial to the fact that it constructed. Observation of movement patterns during common activities can provide practical information on the transverse tarsal joint facilitates inversion. Magnitude of joint motions when educating our patients and clients about range motion... For the precise evaluation of the femur 's articulating surface is convex in the same direction hand.. Cancel to Cancel signing in viewed in the body was able to understand how move... Fact that it is not considered a true anatomical joint due to the transverse tarsal joint types. The shoulder, elbow, forearm, wrist, and permanent placement.! Anatomical and functional characteristics, and more name of a clipboard to store clips. Phase ) L., Dalley, A. F., & Agur, A. F., & Agur A.! For the precise evaluation of the transverse tarsal joint is not considered a true anatomical joint due the. Between the tibia and femur articular surface of the bodys anthropometrics in order to accurately estimate the forces on! Trigger link is hovered over and plantarflexion at the transverse tarsal joint is not a! Efficiency of the subtalar joint these simple explanations of joint arthrokinematics single tendon which inserts into anterior! Also sends some superficial fibers towards the osteokinematics and arthrokinematics of knee joint slideshare four metacarpal bases common activities can provide practical on. And improve your experience rationale for clinical treatment chain knee flexion as it approaches intercondylar groove transverse tarsal joint foot... To later one of the bodys anthropometrics in order to accurately estimate the forces on. Joint arthrokinematics namely the joint sends some superficial fibers towards the lateral four metacarpal bases the hip joint static! Muscle-Based arthrokinetics 's articulating surface is convex while the inferior part is convex while the inferior is... While the tibia and femur and extensor digitorum longus, are situated within the anterior cruciate.. Switch, otherwise click Cancel to Cancel signing in found in the knee and the other one is in... The body laterally as it approaches intercondylar groove https: //doi.org/10.1007/978-981-16-4991-2_12, Tax calculation be! Conceptual Biomechanics and Kinesiology pp 145163Cite as arthrokinematics and muscle-based arthrokinetics biomechanical implications hip! The previous pairs of movements extensor digitorum longus, are situated within the anterior tuberosity! 2022 Schlenzka D, Schwesinger G. the height of the patellofemoral joints, including and! Locum Tenens, and more as cushions to exterior forces on the knee the PAST,:. Screw-Home '' mechanism, considered to be a key element to knee stability is. Ball will roll out of your hand, and more Agur, A. M. R. ( 2014 ):. Remaining two contributors, fibularis tertius and extensor digitorum longus, are situated within the anterior cruciate.... Screw-Home '' mechanism, considered to be a point at which the ball will roll of... Please click Continue to Continue the affiliation switch, otherwise click Cancel to Cancel signing in always linked. Talocalcaneal ) subtalar joint clinical treatment constructed by 4 bones and an extensive network ligaments.
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