LE: Knee | Batch 2022

Lower Extremity: Kn

- Commonly a ected in knee OA — d/t the most of

Knee weight-bearing is received by the medial meniscus

2) Lateral Tibiofemoral Joint

Largest jt in the body
3) Patellofemoral Joint
MOST COMPLEX jt in the body — d/t the ligaments, meniscus, and
muscles

- Chondromalacia Patella: (+) pain felt on anterior

knee in prolonged sitting — “Cinema/Theater Sign”

Bones:

Femur (distal part)

Tibia (proximal part)

FEMORAL CONDYLES
Patella
Knee
Medial condyle Lateral condyle

Mahaba
Shorter

Malaki More anterior

Serves as a “butt rest” for the

patella — this is also why most
patella D/L is lateral

TIBIAL CONDYLES (TIBIAL PLATEAU)

Knee joint

Is an incongruent jt — congruency of the jt is provided by the

menisci
Largest jt

Knee joint

Type Modi ed Hinge Joint; Double Condyloid Joint

Patella DOF 2 DOF

Flexion - Extension

- largest “SESAMOID” bone

Internal Rotation - External Rotation
- 3-5 y/o

ROM Knee Flexion — 0o - 130-150o

- Loc: W/in Quadriceps tendon

Knee Extension — 0o - 15o
- Functions:

OPP 25° of knee exion

Stability

⬆ The e ciency of Quads

CPP Full Ext + Tibial ER

Reduces friction
Capsular Pattern Flexion limitation is a ected > than extension
Centralizes the faces of Quads

Bony protection Functional ADLs Level Walking — 60o-70o

Ascending Stairs — 80o

Sitting — 90o
3 Articulations in the Knee (accdg to Brunnstrom):

1) Medial Tibiofemoral Joint

1 PTRP, MD
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 LE: Knee | Batch 2022

Connects the meniscus to the tibia

Note:

Total Axial Rotation of the Knee: 40° (20° ER — 20° IR)

MENISCO FEMORAL LIGAMENTS
Connects the LATERAL meniscus to the femur

No menisco femoral ligaments in the medial meniscus

OKC Knee Flexion Knee Extension Ligament of Humphrey: Ant. Menisco Femoral Lig

Roll Posterior Anterior Ligament of Wrisberg: Post. Menisco Femoral Lig

Glide Posterior Anterior

KNEE LIGAMENTS
CKC Stand to Sit Sit to Stand
A. Collateral Ligaments
Roll Posterior Anterior Aka “Medio Lateral Stabilizers:

Laro sa ExColTa: Lateral Rotation + Extension, the

Glide Anterior Posterior
Collateral ligaments are Taut

MCL: Tibial Collateral Ligament

Tested by Valgus Stress Test

MENISCI (+) Swimmer’s Knee — seen in breast stroke

“Semilunar Cartilages”
Pellegrini Stieda Disease: Ossi cation of the MCL of
Generally avascular — outer 1/3 of the menisci is vascular
the knee; post-traumatic

Function: 2nd most injured ligament of the knee

⬆ Congruency of the knee jt LCL: Fibular Collateral lig.

Shock absorption Tested by Varus Stress Test

Lubrication
B. Cruciate Ligaments
⬇ Friction in the knee joint
Antero-Postero Stabilizers

Rotary Stabilizers of the knee

Menisci Code: InExCruTa — IR + Ext, Cruciates are Taut

ACL: Ligament that starts from the anterior tibia — upward

Medial menisci Lateral menisci
— backward — lateral ward to attach @ the lateral condyle
C- Shaped O - shaped
of the femur

Shape

(MCLO) Orientation: “PLS” Posterior — Lateral — Superior

ICES: IntraCapsular Extra Synovial (are inside the

Mobility Less Mobile
More Mobile

capsule but outside the synovium)

More xed
Less Fixed

6 mm 12 mm Commonly injured — 1st

Tautest Position: Ext + IR

Injury ⬆ Injured (occurs in closed ⬇ Injured Slackest Position: 30-60° of exion

kinematic chain)
PCL: Ligament that starts from the posterior tibia —
Ligaments MCL
PCL upward — forward — medial ward to attach @ the medial
ACL
condyle of the femur

Orientation: “SAM” Superior — Anterior — Medial

Unhappy Triad of ICES: IntraCapsular Extra Synovial (are inside the

Odonoghue: MAM capsule but outside the synovium)

Strongest lig of the knee

Code: MAM — Mcl ACL
Tautest Position:

Medial Meniscus

Muscles Semimembranosus Popliteus C. Oblique Popliteal Lig.

Originates from the semimembranosus tendon

Reinforces the Postero-Medial Aspect of the knee

D. Arcuate Lig.
originates from the popliteus tendon

Reinforces the Postero-Lateral Aspect of the knee

E. Iliotibial Band

Originates from the fascia of the TFL

Helps in stabilizing the Antero-Lateral aspect of the knee

Plica — remnants of synovium

- thickening of the synovium

- Location:

Infrapatellar Plica — MC; aka “Ligamentum

MENISCO TIBIAL LIGAMENTS Mucosum”

Suprapatellar Plica

Coronary ligaments

2 PTRP, MD
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 LE: Knee | Batch 2022

Mediopatellar Plica — MC injured plica; (+) Plica Action: Hip / + Knee Flex
Semitendinosus
Syndrome

Lateral Patellar Plica — Least common Semimebranosus Action: Hip / + Knee Flex

Popliteus Deepest muscle at the back of the knee

BURSAE “Unlocker of the knee”

Action: Knee FIR

Pre-patellar Bursa: Bursa before the patella that can be felt when
knee is exed Plantaris “Freshman’s Neve”, “Fisherman’s Nerve”

Housemaid’s Knee: Commonly in amed bursa

MC absent mm in the LE

Action: Knee Flex + PF

Suprapatellar Bursa: Above the patella; b/n the quadriceps and
femur 2 Heads

Gastrocnemius
Super cial Infrapatellar Bursa: Anterior to the patellar tendon; Primary ankle PF
Commonly in amed patella instead of the deep infrapatellar bursa

Vicar’s/ Clergyman’s/Nun’s Knee: In ammation of the

super cial infrapatellar bursa

Popliteal Bursa: Behind the knee

KNEE EXTENSORS
Baker’s Cyst: Popliteal bursitis
Quadriceps MC contused mm in the LE

Commonly in amed in RA of the knee

Charley Horse: Severe Contusion of the quads

MC site of myositis ossi cans (MO) in the body

Peak Activity: Heel strike to foot at/ Initial contact

to loading response

Eccentric contraction

Rectus Femoris Only 2-joint mm in quads group

Action: Knee Flex + Hip EXT

SLR mm

Vastus Lateralis Largest quads mm

Vastus Medialis “Workhorse of the LE”

Vastus Medialis Obliquus 1st mm to atrophy and last to recover post-knee

(VMO) surgery

Vastus intermedius Most e cient knee extensor

Aka “Purest Knee Extensor”

(+) Articularis Genu (Subcrureus): Accessory head

Screw home mechanism of the vastus intermedius; responsible for
retracting the capsule to prevent compression
Aka “ Terminal Rotation of the Knee”
during knee extension
Locking mechanism
Cannot be voluntarily produced or can be prevented

happens during the last 20° of knee Ext

Patellofemoral joint

Note: Type: Plane/Gliding Joint

Resting Position: Full EXT

Code: FIR — TER — Lock

Code: FER — TIR — Unlock Close Pack Position: Flexion 90o

CKC: FIR (Femur moves in IR)

OKC: TER (Tibia moves in ER) Patella

Largest sesamoid bone
Bone w/ the thickest cartilage

Muscles of the knee 5 Facets: Code: SIMLO

1) Superior facet

KNEE FLEXORS 2) Inferior Facet

3) Medial Facet

Hamstrings Primary knee exor

4) Lateral Facet

MC strained mm in the LE — d/t SLR

5) Odd Facet

Peak activity: Deceleration/Terminal Swing of gait

Eccentric contraction

Commonly a ected facet in Chondromalacia Patella

(+) Tripod Sign: In ammation of Hamstrings Contraindicated: Deep knee bends or deep
only mm that inserts on the head of the bula squats (not allowed for >90° of knee exion)

>90° Knee Flexion — Odd facet begins to contact

Sartorius Longest mm
the femoral condyles

Aka “Tailor’s mm”

135° Knee Flexion — Odd facet & lateral facet are

Hip: FABER

the ONLY ones in contact w/ femoral condyles

Knee: FIR

Gracilis Only 2-jointed among the adductor group

Phelps Test: For tight gracilis

3 PTRP, MD
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 LE: Knee | Batch 2022

Functions of the Patella Mid-patella

Tibial Tuberosity
⬆ Leverage/torque of quads
Patellofemoral Pain Syndrome (PFPS): Any condition that causes
Knee Stability
pain in the patellofemoral joint; may lead to excessive Q-angle

Malalignments that increase the risk of PFPS:

⬇ Friction over the quads tendon

1) Broad Pelvis
Bony protection

Women > Men

2) ⬆ Anteversion
KINEMATICS Prone to lateral patella D/L

During Knee Flexion 3) ⬆ Q-Angle

Patella moves ⬇
4) Genu Valgum
During Knee Extension Patella moves ⬆ 5) Patella Alta
6) External Tibial Torsion
7) Subtalar Pronation
Note:

Board Q’: To ⬆ Knee Ext, what glide will you incorporate to the
patella?
Tibiofemoral angle
Answer: Rostal (superior glide)
Normal: 185° (measured from the medial side of the knee)
Normal Valgus: 5°
PATELLAR MALPOSITIONS Medial Aspect of Knee = <170° Genu varum deformity

Bow Leg

Patella alta Abnormally HIGH patella

Newborn until 2 y.o.

(+) Camel Sign

OA

Patella baja Abnormally LOW patella Lateral Aspect of Knee = <170° Genu valgum deformity

Knocked Knee

Genu Recurvatum: Hyperextended knee

Patellofemoral loading Polio

3 causes:

WALKING 0.3 x BW 1) Quads weakness

2) Quads spasticity
ASCENDING 2.5 x BW
3) PF spasticity
DESCENDING 3.5 x BW
Politeal fossa
SQUAT 7 x BW
Diamond-shaped located posterior to the knee

Boundaries
Q-angle
Upper Lateral Boundary Biceps Femoris

Upper Med Boundary Semitendinosus

Semimembranosus

Lower Lat Boundary Lateral head of

Gastrocnemius

Plantaris

Lower Med Boundary Med. head of Gastrocs

Contents:

1) Popliteal Artery
2) popliteal Vein
3) Popliteal Nerves

Conditions
Normal: 13-18°
Landmarks of Q Angle:
KNEE rotator INSTABILITY
ASIS

4 PTRP, MD

 LE: Knee | Batch 2022

Antero-medial rotator Tx: 4-5 wks of cylinder cast immobilization of

knee at 60 degrees knee exion
instability

Antero-lateral r.i. Tx: 6-8 wks cast immobilization with knee exed
to 90 degrees and leg maximally ER

Postero-medial r.i.

Postero-lateral r.i. Tx: long leg cast over bulky compressive

dressing with knee positioned 60-70 degrees of
exion and tibia is IR on the femur for 5-6 wks

Osteochondritis dissecans

Px has hx of intermittent nonspeci c knee pain, usually related to

some form of exertion

Lesion of articular surface of the femoral condyles

MC Location: Lateral aspect of anterior margin of medial femoral

condyle
Sx:

• Acute episodes of locking, giving way, or joint e usion when a

fragment becomes detached and falls into the jt

Tx: Debridement with femoral condyle drilling to increase the

vascularity in the subchondral bone to help form a new articular
surface

Chondromalacia patella

5 PTRP, MD
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