Kirton Got Ae Sorby arre ivelle, KNEE COMPLEX Maria BelindanC. Fidel, M.O. KNEE COMPLEX + TIBIOFEMORAL + PATELLOFEMORAL + SUPERIOR TIBIOFIBULAR JOINT + 2.degrees of freedom FE - LRN, ictal College of Rehabilitation Sciences University of Santo Tomas FEMORAL ARTICULAR __ TIBIOFEMORAL cee Ae + Double condyloid joint + MEDIAL AND LATERAL Fi CONDYLES: structures AP coli constant wth 9 ‘sph ae — _TIBIAL ARTICULAR SURFACE, + Concave ésyrimitric medial and lateral ‘ial condyles/plateaus | * rmadial tibial condyle fe 60% larger than ‘aferal | Die to a larger medial femoral condyle | ~ Ateular cartlage of medal sia! condyle fs ‘3X thicker + INTERCONDYLAR TUBERCLES =Two bony roughened areas which operates the tibial surfaces TIBIOFEMORAL ARTICULATION + Large condyle + shallow concavity > incongruency + Enhanced by the accessory joint strpotures: MENISCL ikeMeniscl ® + Fibrocartilage joint dises + Wedge-shapod which Increases the radius of tho Distributing of WB forces Reduces the friction ‘between the joint segments + MEDIAL MENISCUS Somierce + LATERAL MENISCUS A6.ctaiog MENISCAL ATTACHMENTS Maa Lata *ietrcondyar tubercles of ta ‘ial condye vie pain via menicopeelr ot pastoral Feri horn a arevers lgarent 4 wet. 1 Post Meniacctrerat 2 Sanit tg. 2 POUACL 3. Poplteus mance a= MENISCI + Connections ofthe LM is loose which provides fair amount of mobility on the lateral tibial condyle ‘+ MM is more firmly attached and less movableMENISCI * nay rei ae wal alta afterwhich it gradually recedes centrally ‘outward, reacting hs edu frm ot 10-11 10-11 ylo vascularity is only 09 the + Adult menisch riohery by capillaries from the jont capsule Sd syroval membrane + Pattern of vascularty may account or the low incidence of meniscal injuries in young children TIBIOFEMORAL ALIGNMENT AND WB FORCES + Longitudinal axis of the femur is oblique = Inferior and medially from is proximal to distal end + Longitudinal axis ofthe tibia is almost vertical + PHYSIOLOGIC VALGUS = 185-190 deg” femur angled off vertical 5-10 deg + Weight is not more on the lateral side TIBIOFEMORAL ALIG: MENT AND WB FORCE 3 + ME SoftheLe 5 WB line from the center of the HOF to the Center ofthe superior surface the HO talus “spasses through the center of the Joint + GRF follows the mechanical « than the anatomical axis > Vs stresses are equally distribute between s rather GE grvtrd. Reaching ree TIBIOFEMORAL ALIGNMENT TIBIOFEMORAL ALIGNMENT AND WB FORCES AND WB FORCES + KNOCK KNEES/GENU VALGUM (>195 deg Increases the compressive force on the lateral condyle, while increasing tonsila stress on tho ‘medial structures * BOW LEGS/ GENU VARUM (<1 80 deg) ‘stresses are increased laterally + Overloading may result in lateral or ‘medial articular cartilage damageKNEE JOINT CAPSULE * Knee joint capsule and ligaments are responsible for restricting excessive ‘motions to maintain joint integrity and ‘normal joint function + Passive restraining mechanism are import for aay, ae KNEE JOINT CAPSULE + attached proximally to thefemoral condyles and intercondylar notch and distally to the posterior tibial condyle + reinforced by collateral ligaments (M-L),| patella and quadriceps (A-S) and VasM and VasL (AM and AcL) muscles and by the oblique popliteal and arcuate ligaments (P) KNEE JOINT LIGAMENTS * Control Media or lateral rotation ofthe tibia beneath the femur Combinations of AP cisplacoments and Totations of the tibia > rotatory stabilization COLLATERAL LIGAMENTS cL medial femoral condyle into the media ‘aspect of the proximal tibia Posteromedial fers of the igament blond withthe fibers of the joint capsule nd some extend fo the medial meniscusWee - Bie Ue flute COLLATERAL LIGAMENTS ites foro pond tothe head ofthe ua No atacent eter he menlcus ‘ainteapeus * Both MCL/LCL are taut in full extension ‘and help resist hyperextension of the knee COLLATERAL LIGAMENTS. MCL ~ Resist vaigus strss in an extended knee and imore 80 hn @ slighty flexed knee ~ Checks: atoral rotation ofthe tie + anterior of posterior displacement of the bia “Backup restraint to anterior displacement of, the tibia when ACL is absent COLLATERAL LIGAMENTS etekCOLLATERAL LIGAMENTS. +178 ~ Appears to be consistent taut regardiess ‘of knoe poston ~ Strength is comparable to an ACL ~ Fibrous connections o BF and Vi form @ ‘ing behind the lateral femoral condyie, ‘siting the ACL in preventing posterior displacement of feruur when tibia is fixed CRUCIATE LIGAMENTS + ACLIPCL - named according to ther tibial attachments + Both have main posterolateral and smalier ~anteromedial bands that behave differently + anteriortibia extends superiorly and Sones + AMB is moderately lax in extension, PLB tight + ANB is taut (maximally tensed of F) and PLB lax in flexion “ — ACL & + Primary restraint tanto displacement of fhe tis onthe "+ PLB tends to be injured in an extended knee ‘and AMB tends to be injured in a flexed knee + Checks excessive medial rotation / + Injury to the ACL appears to occur most ‘commonly when the knee is flexed and the ‘iia rotated in ether dlrection \tze firin + Cokin = womPCL. + Posterior tibia to the inner aspect of the + Primary restraint to posterior displacement oftbia Si *+ Some role in restraining varus and valgus stresses * Posterateral pect of capa i reinforced \TE LIGAMENT head of fbula POSTERIOR CAPSULAR LIGAMENTS ot he capsule is BLIQUE POPLITEAL~— oy and r ofthe poy ‘muscle to attach tothe intercond lar area of {bia and tothe lateral epicondyle of the femur POSTERIOR CAPSULAR LIGAMENTS -Obigue poeta oreuahs igaments 0 taut ful evtensen are + assis in checking hyperextension the knee of + Provans excessive fiona forces between -Supppealiles -abieer oa @ a « Supopte! bursa - between he ron of oo ‘medial head of the gastroc KNEE JOINT BURSA fieciat hgamortous and bony structures su soe sedate loo the tendon ofthe fate! conde 1 bursa -betwoen the tondon of medal fern and. condyleKNEE JOINT BURSA * Propateliar bursa ~ allows the skin over the ‘patella in movements * Infrapatellar bursa — between the ligament and an + Deop infrapatellar bursa - between the Dateliar ligament ar sbi! KNEE JOINT FUNCTION bert Bros eats KNEE JOINT FUNCTION ARTHROKINEMATICS > ROTATION i ae = toda Pca er et te ang ote ang tae pe Followed shetereaice” _ “Tenn AGL se cos eee fern rt oh en Seip nantes “me ae | ARTHROKINEMATICS » ARTHROKINEMATICS DE “ Locking and unlocking = 1* forward rolling then | glide of the ~ TeminaAutomate rotator’ ooking mechaniend nes -Matofor cman ho 0 cee Satire ecranas — oan “eee eoimranoee ac Se a a =]MUSCLES eka 9, Gastrocnemius + EXTENSORS: Quadriceps femoris SemT, BF, Sartorius, PATELLOFEMORAL JOINT + PATELLA ~ Ara puly and a mechanam oes Hon ‘Sheen he unc enn anatanrelconce ~ Greer ‘Patel sits on the anterior surtace of the __= lesion, sits onthe intercon notch Ealing wich occurs in the verte ax) 11 deg * cal iteg wh we cee om 26:38 ag SPateliac rotation (AP axis} 7 deg CaS oe pl mtn + Hon cc tan ary in PATELLOFEMORAL JOINT “Pi = Tiangular shaped ~ largest sesamoid bone inthe body = least congruntjort inthe body ~ Postar srace i iced by «vara ge PATELLOFEMORAL JOINT + Patol Arcular Surtice PATELLOFEMORAL JOINT + Paaotemoral Jove Conquer. = LT and LP in approximately 1:17) INDEX OF INSALL ANO SACVITL = Females have larger ition = 13 the.int of normal ato ~ Lgament shoul nt exceed oce than 20% > PATELLAALTA, fea DeePATELLOFEMORAL JOINT + Patetotemoral Joint Congruence ~ Imbalance in compression and releace of pressure PATELLOFEMORAL JOINT ‘superioriy- quadriceps + lnforiory- patellar tendon + medially: vastus medialis + latorally- vastus lateralis. _Q.angle — ASIS to midpoint of patella tibial tubercle and midpoint of patella normal. 15 deg EFFECTS OF INJURY AND DISEASE + MENISCUS 44gn retain of femur on ow ce be Bones + BURSAE AND TENDONS Nomemaieineefropiear) + PATELLOFEMORAL JOINT INJURY THANK YOU VERY MUCH!!!KE = Tikiay > Util OL Hb > dial Rut - Of