SESSION 10

Dr Atefeh Aboutorabi
Ph.D Orthotics and Prosthetics
Assistant Prof., Department of Prosthetics & Orthotics,
University of Social Welfare and Rehabilitation Sciences
Flexion & extension
 Axis – no fixed axis but move through ROM (frontal
axis)
 Plan – sagittal plan
 ROM of flexion / extension –
 Flexion – 1300 – 1400
 Extension – 50 – 100 (Consider normal, beyond this
termed as Genurecurvatum)
 In close kinematic chain (CKC) – flexion / extension
range is limited by ankle range.

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Medial / lateral rotation
 Axis – Longitudinal / Vertical axis
 Plan – Transvers plan
 ROM at 900 knee flexion –
 Lateral rotation – 00 – 400
 Medial rotation – 00 – 300

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 Arthrokinematics

 Concave Surface: Tibial Plateau

 Convex Surface: Femoral Condyles
 To facilitate extension:
 Open Kinematic : tibia rolls and glides anterior on femur
 CKC: femur rolls anterior and glides posterior on the tibia
 To facilitate knee flexion:
 OKC: tibia rolls & glides posterior on the femur
 CKC: femur rolls posterior and glides anterior on the tibia
Open kinematic chain
flexion / extension
 When tibia is flexed on a fixed femur –
 The tibia performed Both Posterior Rolling & Gliding on
relatively fixed femoral condyles.

 When tibia is Extended on a fixed femur –

 The tibia performed Both Anterior Rolling & Gliding on
relatively fixed femoral condyles.

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TF CKC Flexion
 Early 00 - 250 knee flexion –
 Posterior rolling of femoral condyles
on the tibia
 As flexion continues –
 Posterior Rolling accompanied by
simultaneous Anterior glide of femur
 Create a pure Spin of femur on the
posterior tibia

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 TF CKC extension
 Extension from flexion is a reversal
of flexion motion.
 Early extension –
 Anterior rolling of femoral condyles
on tibial plateau
 As extension continues –
 Anterior Rolling accompanied by
simultaneous Posterior glide of
femur
 Produce a pure Spin of femoral
condyles on tibial plateau
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The Screw Home Mechanism
Locking Mechanism
 Refers to the terminal external rotation or “Automatic
rotation "of the leg at the last 20 degrees of extension due
to unequal condylar configuration, muscle torque action &
ligamentous guidance
 In closed kinematic chain motion, terminal rotation is
seen as internal rotation of the femur on the fixed tibia
 In open kinematic chain motion, terminal rotation is seen
as the external rotation of the tibia on a fixed femur
 Rotation between the tibia and femur occurs automatically
between full extension (0˚) and 20˚ of knee flexion.
 Locking of knee joint
 CKC femoral extension from 300 flexion –
 Larger medial femoral condyle continue rolling &
gliding posteriorly when smaller lateral side stopped.
 These result in medial rotation of femur on tibia in
end of extension.
 The medial rotation of femur at final stage of extension
is not voluntary or produce by muscular force, which is
referred as “Automatic” or “Terminal Rotation”.
 The rotation within the joint bring the joint into a
closed packed or Locked position.
 OKC – lateral rotation of tibia on fixed femur

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Unlocking of knee joint
 To initiate flexion, knee must be unlocked.
 A flexion force will automatically result in lateral
rotation of femur
 Because the larger medial condyle will move before
the shorter lateral condyle.
 Popliteus is the primary muscle to unlocked the
knee.

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 TF OKC Extension Arthrokinematics sagittal plan
 Extension –
 Meniscal migrate Anteriorly –
 Because of meniso-patellar ligament

Menisco-patellar
Ligaments

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TF OKC flexion Arthrokinematics sagittal plan
 Flexion – Menisci migrate posteriorly because of
 Semimembranosis attachment to medial
meniscus
 Popliteus attachment to lateral meniscus

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 Knee axial rotation

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Axial rotation of knee
arthrokinemetic
 Axis – vertical axis
 Plan – transvers plan
 ROM – Maximum range is
available at 90 of knee flexion.
 The magnitude rotation
diminishes as the knee approaches
both full extension and full
flexion.
 Medial condyle acts as pivot point
while the lateral condyles move
through a greater arc of motion,
regardless of direction of rotation.
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Valgus (Abduction)/Varus
(Adduction)
 Axis – Antero-posterior axis
 Plan – Frontal plane
 ROM –
 8 at full extension
 13 with 20 of knee flexion.
 Excessive frontal plane motion could indicate
ligamentous insufficiency

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TF CKC Flexion: ACL Control
 At full extension –
 Angle of ACL
inclination greatest
 Anterior directed
component force will
eventually Restrain
Posterior Femoral Roll

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TF CKC Flexion: ACL Control cont…
 As TF flexion increases –
 Angle of ACL inclination
decreases
 Anterior directed
component force
increases sufficient
enough to produce
Anterior Femoral Slide

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TF CKC Flexion: PCL Control
 Angle Of PCL Inclination is
greatest at full flexion.
 Anterior directed component
force will eventually Restrain
Posterior Femoral Roll

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TF CKC Extension: PCL Control
 As TF extension increases –
 Angle Of PCL Inclination
decreases
 Posterior directed component
force increases sufficient
enough to Produce Posterior
Femoral Slide

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