 The knee is a mechanism of three joints and

Four bones - the femur, tibia, patella and

fibula

 Interact in separate joints - the tibiofemoral &

patellofemoral

 The function of these joints is to allow certain

movements, restrict others, and to provide
load transfer through the lower limb.
 Tibiofemoral joint
rotations
translations
screw home mechanism
 Axial & rotational alignment of knee
 Patello femoral joint
 Joint forces
 Rotations
› Flexion/extension-0 to
1350
› varus valgus - 6-8o in
extension
› Int/ext rotation - 25 – 300
in flexion

 Translations
› AP 5 - 10mm
› comp/dist 2 - 5mm
› medio-lateral 1-2mm
 flexion axis varies in a helical fashion in a normal
knee, with an average of 2 mm of posterior
translation of the medial femoral condyle on the tibia
during flexion compared with 21 mm of translation
of the lateral femoral condyle.

 Relevance :posterior rollback

› as the knee flexes, the instant center of rotation on
the femur moves posteriorly
 flexion axis as varying in a helical fashion
allows for increased knee flexion by avoiding impingement
 the external rotation of the tibia on
the femur during extension and
internal rotation of the tibia during
knee flexion.
 cause
› medial tibial plateau articular
surface is longer than lateral
tibial plateau(Medially based
pivoting of the knee.)

 relevance
› "locks" knee decreasing the
work performed by the
quadriceps while standing
 mechanical axis of the lower limb is defined as the
line drawn on a standing long leg antero posterior
radiograph from the center of the femoral head to
the center of the talar dome

 anatomical axes of the femur and the tibia form a

valgus angle of 6 2 degrees.

 the tibial articular surface is in approximately 3 0of

varus with respect to the mechanical axis, and the
femoral articular surface is in 90 of valgus.
 "sliding" articulation
› patella moves 7cm caudally
during full flexion
 maximum contact between
femur and patella is at 45
degrees of flexion

 The primary function of the

patella is to increase the lever
arm of the extensor mechanism
around the knee, improving
the efficiency of quadriceps
contraction.
 The quadriceps and patellar tendons insert anteriorly
on the patella, with the thickness of the patella
displacing their respective force vectors away from the
center of rotation of the knee .

 This displacement or lengthening of the extensor lever

arm changes throughout the arc of knee motion.

 the extensor lever arm is greatest at 20 degrees of

flexion, and the quadriceps force required for knee
extension increases significantly in the last 20 degrees
of extension
 The length of the lever arm varies as a function
of the geometry of the trochlea, the varying
patellofemoral contact areas, and the varying
center of rotation of the knee.
 passive restraints to lateral
subluxation
› medial patellofemoral
ligament
 primary passive restraint to
lateral translation in 20
degrees of flexion
 60% of total restraining force
› medial patellomeniscal
ligament
 13% of total restraining force
› lateral retinaculum
 10% of total restraining force
 dynamic restraint
› quadriceps muscles
 The angle between the extended
anatomical axis of the femur &
the line between the center of the
patella & the tibial tubercle

 normal Q angle
› in flexion
 males
 13 degrees
 females
 18 degrees
› in extension
 8 degrees
 Limbs with larger Q angles have a greater tendency
for lateral patellar subluxation.

 Because the patella does not contact the trochlea in

early flexion, lateral subluxation of the patella in
this range is resisted primarily by the vastus
medialis obliquus fibers.
Position force acting on joint
 Standing on both feet - equal to body wt
 Swing phase - 1/2 x b.wt
 u/l stance phase – 2-4 x b.wt
 Jogging – 6x b.wt
 Walking
› 0.3 x body weight
 Ascending Stairs
› 2.5 x body weight
 Descending Stairs
› 3.5 x body weight
 Squatting
› 7 x body weight
 Prevent anterior tibial displacement on femur
 Secondarily, prevents hyperextension, varus &
valgus stresses
 Least stress on ACL between 30-60 degrees of
flexion

Anteromedial bundle tight

in flexion & extension

Posterior lateral bundle

tight only in extension
 Primary stabilizer of the knee against posterior
movement of the tibia on the femur
 resists rotation, esp.internal rotation of tibia on
femur

Two bundles
 Anterolateral, taut in flexion
 Posteromedial, taut in extension