SESSION 2:

KNEE
ANATOMY, PHYSIOLOGY, AND BIOMECHANICS
AT THE END OF THE SESSION, STUDENTS
MUST BE ABLE TO:
UNDERSTAND THE FUNDAMENTAL
STRUCTURE OF THE KNEE
UNDERSTAND AND DEFINE THE
MUSCLE, ORIGIN, INSERTION, NERVE,
AND ACTION OF THE KNEE
PALPATE THE BONY LANDMARKS
NEED
?
HELP
TOPIC OUTLINE

BONES
JOINTS
LIGAMENTS
MUSCLES
NEED
HELP
? BONES

FEMUR
TIBIA
PATELLA
 FEMUR
DISTAL STRUCTURES\
Medial and lateral
condyles
Med. Condyle larger
and extend distally
(1.7cm larger)
Intercondylar groovE
Intercondylar fossa
Epicondyles
TIBIA
MEDIAL KNEE BEARS GREATER
PRESSURE
PROXIMALSTRUCTURES
INTERCONDYLAREMINENCE
MEDIALANDLATERALCONDYLE
PLATEAU
TIBIALTUBEROSITY
TIBIALCREST
PATELLA
LARGEST SESAMOID BONE
OSSIFICATION:3RD-5THYR
LIES WITHIN THE TENDON OF THE
QUADRICEPS FEMORIS
APEX LIES INFERIORLY;
CONNECTED TO THE TIBIAL
TUBEROSITY VIA LIGAMENTUM
PATELLAE
PATELLA
CENTRALIZE FORCES OF THE
QUADRICEPS MUSCLES
SMOOTH GLIDING MECHANISM
FOR THE QUADRICEPS REDUCE
COMPRESSION&FRICTION
STABILITY OF THE KNEE
BONY PROTECTION FROM DIRECT
TRAUMA PATELLAR
 JOINTS
TIBIOFEMORALJOINT
MEDIAL TF JOINT
LATERAL TF JOINT
PATELLO FEMORAL JOINT
SUPERIOR TIBIO FIBULAR JOINT –
FORGOTTEN JOINT
TIBIOFEMORAL
JOINT
MOST COMPLEX AND LARGEST JOINT IN
THE BODY
SYNOVIAL, MODIFIED HINGE JOINT
(GINGLYMUS)
DEPENDS ON LIGAMENT FOR STABILITY
TIBIOFEMORAL
JOINT
MOST COMPLEX AND LARGEST JOINT IN
THE BODY
SYNOVIAL, MODIFIED HINGE JOINT
(GINGLYMUS)
DEPENDS ON LIGAMENT FOR STABILITY
TIBIOFEMORAL
JOINT
OSTEOKINEMATIC(2DOF)
FLEXION(0-135°)
ACTIVE:HAMSTRINGS GREATEST FORCE AT 45°TO10°
PASSIVE:FULLFLX(135°)ISOFTEN NOT NECESSARY,
SQUATTING TO TIE A SHOE LACE OR TO PULL ON A
SOCK:117°FLX
SITTING IN CHAIR:90°FLX
CLIMBING STAIRS:80°FLX
TIBIOFEMORAL JOINT
OSTEOKINEMATIC(2DOF)
EXTENSION(135°-0TO-15°)
ACTIVE:QUADS DEVELOP THE GREATEST FORCE NEAR 60°
TO COMPLETE THE LAST 15° OF EXT,60% INCREASE IN
FORCE OF THE QUADS IS REQUIRED
PASSIVE:FULL KNEE EXTISUSUALLY PREFERABLE FOR
EVERYDAY ACTIVITIES(E.G.,STANDING,WALKING)
AXIALROTATION
PASSIVE:OCCURSIN90°FLEXION
ROTATIONOFTIBIAONTHEFEMUR(OKC)
PATELLOFEMORAL
JOINT
MODIFIEDPLANEJOINT
5FACETS/RIDGES:
SUPERIOR
INFERIOR
LATERAL-LARGEST
MEDIAL
ODD–MC AFFECTED BY CHONDROMALACIA
PATELLA/PFPS
PATELLOFEMORAL
JOINT
QUADRICEPS ANGLE (Q-ANGLE)
A LINE DRAWN FROM
TIBIALTUBEROSITY – CENTEROF
THE PATELLA –ASIS
N: M = 11-15 ; F = >20
Q-ANGLE > 20 → PFPS (CM &
PATELLO FEMORAL
MALTRACKING)
PATELLOFEMORAL
JOINT
SUPERIOR TIBIOFIBULAR JOINT
PLANE SYNOVIAL
BET. TIBIA & FIBULAR HEAD
FIBULA
CAN BEAR UP TO 1/6TH OF THE
BW
Soft tissue
MENISCUS
LIGAMENTS
CAPSULE
BURSAE
MENISCUS
 MENISCUS
AID IN LUBRICATION & NUTRITION OF THE
JOINT
ACT AS SHOCK ABSORBERS
REDUCE FRICTION DURING MOVEMENT
AID THE LIGAMENTS & CAPSULE
PREVENTING HYPEREXTENSION
PREVENT THE JOINT CAPSULE FROM
ENTERING THE JOINT
PARTICIPATE THE "LOCKING" MECHANISM
OF THE JOINT
LIGAMENTS
1. INTRACAPSULAR
CRUCIATE LIGAMENT
2. EXTRACAPSULAR
COLLATERAL LIGAMENTS
COLLATERAL LIGAMENTS
COLLATERALSARE TAUT IN
EXTENSION&LATERAL
ROTATION
LATERAL COLLATERAL
LIGAMENT
SHORT,CORD-LIKE LIGAMENT
LIES UNDER THE TENDON OF THE BICEPS FEMORIS
MUSCLE
RESIST/PREVENTS VARUS STRESS
EXTENSION:HALF OF THE TOTAL VARUS PROTECTION
25°FLEXION:70%OF THE VARUS PROTECTION
MEDIAL COLLATERAL
LIGAMENT
MADE UP OF TWO LAYERS:
ANTERIOR: TAUT IN FLEXION/ LONGER (10CM)
POSTERIOR: TAUT IN EXTENSION/ SHORTER
DEEP LAYER IS A THICKENING OF THE JOINT CAPSULE
THAT BLENDS WITH THE MED. MENISCUS = MEDIAL
CAPSULAR LIGAMENT
RESIST/PREVENTS VALGUS STRESS
25°FLEXION: 80% OF THE VALGUS PROTECTION
ANTERIOR CRUCIATE LIGAMENT
From anterior
intercondylar fossa
Extends SPL
Inserts at posterior
part of the medial
surface of the lateral
femoral condyle
ANTERIOR CRUCIATE LIGAMENT
Anteromedial bundle is tight in both FLX & EXT
Posterolateral bundle is tight on EXT only
Least amount of stress between 30° and 60° FLX
Blood supply
Middle geniculate artery
Innervation
Posterior articular nerve branch of the TN
POSTERIOR CRUCIATE LIGAMENT
From posterior intercondylar fossa
Extends SAM
Inserts at anterior part of the
lateral surface of the medial
femoral condyle
The bulk of the fibers are tight at
30° FLX, but the posterolateral
fibers are loose in early flexion
 LIGAMENTS
Arcuate ligament
- Protects the posterolateral capsule against
hyperextension and rotational forces.
Oblique popliteal ligament
- Protects posterior knee from hyperextension
Popliteofibular ligament
- Resists posterolateral tibial rotation and posterior
tibial translation
 LIGAMENTS
Patellar ligament
- Serves as a continuation of the quadriceps tendon
and protects the anterior knee
Ligament of Humphrey (anterior meniscofemoral
ligament)
- Anchors lateral meniscus
Ligament of Wrisberg (posterior femoral ligament) ---
- Stabilizes lateral meniscus
 CAPSULE
Largest capsule of the body
Attachment
- Above: femoral condyles
- Below: tibial condyles
-260ml synovial fluid
 BURSAE
Anterior (4)
Prepatellar bursa - MC damaged bursa
''Housemaid’s knee ''
Suprapatellar bursa
Deep infrapatellar bursa
Superficial or subcutaneous infrapatellar bursa
Vicar’s knee
 BURSAE
LATERAL BURSAE (3)
BETWEEN:
- BICEPS MUSCLE & FIBULAR COLLATERAL LIGAMENT
- POPLITEUS MUSCLE & FIBULAR COLLATERAL
LIGAMENT
- LATERAL FEMUR CONDYLE & POPLITEUS MUSCLE
 BURSAE
Lateral Bursae (3)
Between:
- Biceps muscle & fibular collateral ligament
- Popliteus muscle & fibular collateral ligament
• Lateral femur condyle & popliteus muscle
 BURSAE
Medial Bursae (3)
– Pes Anserinus (SGT)
Between the MCL & semitendinosus
– Between the semimembranosus & tibia
 BURSAE
Posterior Bursae (2)
– Lateral head of the gastrocnemius & capsule
– Medial head of the gastrocnemius & capsule &
extending under the semimembranosus
– Baker’s Cyst
EXTENSORS

FLEXORS
TIBIAL MED. ROTATORS

TIBIAL LAT. ROTATORS

MOINA
THANK YOU FOR
PARTICIPATING!