Biomechanics of the Knee

Bony Structures
‡ Complex joint consists of
± Femur ± Tibia ± Fibula ± Patella

‡ Hinge joint w/ a rotational component

Joints of the Knee
‡ Tibiofermoral joint
± Dual condyloid articulations between the medial and lateral condyles of the tibia and the femur

Joints of the knee
‡ Patellofemoral joint ± Articulation between the patella and the femur ± The patella improves the mechanical advantage of the knee extensors by as much as 50%

Ligamentous Support
‡ Collateral ligaments - cross the medial and lateral aspects of the knee
± Medial Collateral ligament ± Lateral Collateral ligament

Collateral Ligaments
lateral (fibular)

medial (tibial) Prevents abduction and adduction movement of the knee

Ligamentous Support
‡ Cruciate ligaments - cross each other in connecting the anterior and posterior aspects of the knee
± Anterior cruciate ligament ± Posterior cruciate ligament

Anterior Cruciate Ligament
‡ Prevent anterior luxation ‡ Primary static restraint to anterior displacement ‡ Limit tibia rotation upon femur
± Esp, internal rotation

‡ Limit valgus and varus stress upon knee

Anterior Cruciate Ligament

Anterior Cruciate (ACL)

Posterior Cruciate Ligament
‡ Knee stabilizer ‡ Primary restraint to posterior displacement 90% ‡ Limit internal rotation of tibia upon femur during weight bearing ‡ Resist hyperextension

Posterior Cruciate Ligament

Posterior Crucuate (PCL) shorter and stronger than ACL

The ACL prevents the femur from sliding posteriorly on the tibia or the tibia from sliding anteriorly on the femur The PCL prevents the femur from sliding anteriorly on the tibia or the tibia from sliding posteriorly on the femur

F E M U R PATELLA T I B I A

Additional Ligamentous Support

‡iliotibial band
thick, strong band of tissue connecting tensor fascia latae to femur and tibia

Menisci
‡ Cartilaginous discs located between the tibial and femoral condyles ‡ The menisci distribute the load at the knee over a large surface area and also help absorb shock

Menisci
‡ The lateral meniscus is smaller and more mobile than the medial meniscus ‡ The inner portion of the menisci are avascular

Menisci Function
‡ Increases stability by deepening tibial plateaus ‡ Decreases friction by 20% ‡ Increases contact area by 70% ‡ Absorbs shock ‡ Distribute pressure between femur and tibia in weight bearing
‡ Balance intra-articular pressure of muscle action

Menisci Function
‡ Increases stability by deepening tibial plateaus ‡ Decreases friction by 20% ‡ Increases contact area by 70% ‡ Absorbs shock ‡ Distribute pressure between femur and tibia in weight bearing ‡ Balance intra-articular pressure of muscle action

Bursae & Fat Pad of the Knee

Knee Articulations
‡ Stability is due primarily to ligaments, joint capsule and muscles surrounding the joint ‡ Designed for stability w/ weight bearing and mobility in locomotion

Knee Articulations
‡ Tibiofemoral Joint
± Modified hinge joint ± 2-3 degrees of freedom ± Articulating surfaced are not congruent

Knee Articulations
‡ Proximal Tibiofibular Joint
± Syndesmosis joint

Knee Articulations
‡ Patellofemoral Joint
± Medial and lateral facets of the femoral condyles articulate with patella

Knee Movements

Axis of Rotation

Axis of Rotation

Knee Goniometry
‡ Flexion
± 0-130-140 degrees

‡ Extension
± 0 degree

‡ Screw Home Mechanism

Screw Home Mechanism
‡ Locking mechanism as the knee nears its final extension ± Automatic rotation of the tibia externally (approx. 10 degrees) during the last 20 degrees of knee extension ‡ Forms a close-packed position for the knee joint ‡ Femoral condyles are a different size ± Causes internal rotation when the knee is flexed and external rotation when the knee is extended

Knee Rotation

Extension

Flexion

External Rotation

Internal Rotation

Patellar Translation

30

60

90 

Patella migrates posteriorly from
extension to flexion

Patellar Contact Areas
‡ Normal length of patellar tendon = patellar height: 1:1 ratio

Patellar Contact Areas

1200

Mechanical Function of Patella
with patella without patella

(1) Increases angle of pull of quads on tibia, improves the ratio of motive: resistive torque by 50% (2) Centralizes divergent tension of quads into a single line of action (3) Some protection of anterior aspect of knee

Mechanical Function of Patella
‡ Patella contributes to quadriceps moment arm ±13% at 90o ±31% at 0o ‡ No angle without patella & therefore no compressive resultant force

Sagittal Plane PF Joint Mechanics: PF Compressive Force Function
‡ Stabilizes patella in trochlea groove ‡ Patella assures ³some´ compression in full extension ‡ Patella not in femoral sulcus however

Patellofemoral Compressive Force Mechanics

‡ PFC force o with o flexion ±0.5 x BW gait ±3.4 x BW stairs ±8.8 x BW squatting

Q-Angle
‡ The Q-angle is the angle formed by
± A line from the anterior superior spine of the ilium to the middle of the patella ± A line from the middle of the patella to the tibial tuberosity

Q-angle
‡ Knee in extension
± Normal ± males 13 degrees ± Normal - females ± 18 degrees

‡ Knee in 90 degrees flexion
± Both genders ± 8 degrees

Atypical Q-angles
bowleggedness knock-knees
knee hyperextension

Genu Recurvatum

Posture & WB Forces
‡ The mechanical axis of TF joint is the weight bearing line from the center of femoral head to superior talus center ‡ Allows WB in stance of the medial = lateral Tibiofemoral compartments

Posture & WB Forces
‡ Increase in valgus results: ±Compression overload to the lateral
Tibiofemoral

compartment ±Distraction overload to medial Tibiofemoral compartment

Posture & WB Forces
‡ Decrease in valgus results ±Compression overload to the medial
Tibiofemoral

compartment ±Distraction overload to lateral Tibiofemoral compartment

Joint Mechanics
‡ Resultant force has a tendency to laterally translate the patella

Joint Mechanics
‡ Laterally displace tibial tubercle ±external tibial rotation ±external tibial torsion ‡ Medially displace patella ±internal femoral rotation ±femoral anteversion ‡ Laterally displace ASIS (ASIS) ±females

Tibial Torsion
‡ Tibial torsion
± An angle that measures less than 15 degrees is an indication of tibial torsion ± Inward twisting of the tibia (and is the most common cause of intoeing

Movements of the knee
‡ Flexion ±hamstrings ± assisted by: ‡ gracilis ‡ sartorius ‡ popliteus ‡ gastrocnemius

Muscle Pull

Sartorious Gracilis

Popliteus

Gastrocnemius

Movements of the knee
‡ Extension ±quadriceps: ‡ rectus femoris ‡ vastus lateralis ‡ vastus medialis ‡ vastus intermedius

Rectus femoris

Vastus lateralis Vastus intermediate Vastus medialis

Muscle Pull

Loads on Knee
‡ Forces at tibiofemoral Joint
± Shear stress is greater during open kinetic chain exercises such as knee extensions and knee flexions ± Compressive stress is greater during closed kinetic chain exercises such as squats and weight bearing exercises

Loads on Knee
‡ Forces at Patellofemoral Joint
± With a squat, reaction force is 7.6 times BW on this joint ‡ Beneficial to rehab of cruciate ligament or patellofemoral surgery

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