SESSION 8

Dr Atefeh Aboutorabi
Ph.D Orthotics and Prosthetics
Assistant Prof., Department of Prosthetics & Orthotics,
University of Social Welfare and Rehabilitation Sciences
Knee Joint
 actually 2 joints within the
articular capsule
 tibio-femoral
 patello-femoral
 the superior fibulo-tibial
joint is also near

 modified hinge joint or

condyliod
 flexion and extension is
primary motion
 some rotation is possible
when the knee is flexed
 epicondyles
condyles

patella

tibial plateaus
intercondylar notch
tibial tuberosity

Anterior Posterior Transverse Anterior

patellar groove AND intercondylar
notch
 Anteriorly, the condyles are seperated by Patello
femoral Groove.
 Posteriorly, the condyles are separated by the
intercondylar notch.
The Knee Joint

Femur

Anterior View
The Knee Joint

Fibula

Anterior View
The Knee Joint

Tibia
Anterior View
The Knee Joint

Patella

Anterior View
 Femoral articular surface
 Femur is proximal articular surface of the
knee joint with large medial & lateral
condyles.
 Because of obliquity of shaft, the femoral
condyles do not lie immediately below
the femoral head but are slightly medial
to it.
 The medial condyle extend further
distally, so that, despite the angulation of
the femur’s shaft, the distal end of the
femur remains essentially horizontal.

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 The Knee Joint

Consists of 3 distinct articulations

to form a complex hinge joint

• Medial Tibiofemoral joint

• Patellofemoral joint
 The Knee Joint

• Lateral Tibiofemoral joint

Tibio femoral alignment

Anatomic axis
Mechanical Axis
 Q angle
 Central line of pull for entire
quadriceps runs from ASIS to the
center of patella
 Line of pull of patella tendon runs
from center of patella to center of
tibial tuberosity
 Angle formed by the intersection of
these two lines at the patella is the Q
angle
 Normally, angle will be 15 degrees or
less for males & 20 degrees or less in
females
 Generally, females have higher
angles due to a wider pelvis
 Genu Valgus

 Genu Varus
 Menisci
fibrocartilaginous structures
Each Meniscus has an anterior and posterior horn through which
the Meniscus gains attachment to the tibial plateau
Medial meniscus has a firm bond to MCL
Lateral meniscus has no attachment to LCLAnterior horns

Medial Lateral
Meniscus Meniscus

Posterior horns

Superior view of proximal right tibia

 Both menisci are
 Open towards intercondylar
area
 Thick peripherally
 Thin centrally forming cavities
for femoral condyle
 By increasing congruence,
menisci play in reducing
friction between the joint
segment & serve as shock
absorber.

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 Menisci Function
 increases stability by
deepening tibial plateaus
 decreases friction by 20%
 increases contact area by 70%
 absorbs shock
 removal of menisci does NOT
preclude normal motion, but
 increase wear on articulating
surfaces
 Young children whose menisci have
ample of blood supply have low
incidence of injury
 In adult, only the peripheral
vascularized region is capable of
inflammation, repair & remodeling
following a tearing injury.
 Menisci are well innervated with free
nerve ending & 3 mechanoreceptors
(Ruffine corpuscle, Pacinian corpuscle &
Golgi tendon organs)

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 Meniscal attachment
 Common attachment of medial & lateral
Intercondylar tubercles of the tibia
 Tibial condyle via coronary ligaments
 Patella via patellomeniscal or patellofemoral ligament
 Transverse ligament between two menisci
 Anterior cruciate ligament (ACL)

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 Meniscal attachment
 Unique attachment of medial menisci –
 Medial collateral ligament (MCL)
 Semitendinous muscle
 Unique attachment of lateral menisci –
 meniscofemoral ligament
 Posterior cruciate ligament (PCL)
 Popliteus muscle

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 -: Ligaments of knee joint
:-

 Medial collateral ligament

 Lateral collateral ligament

 Ant. Cruciate ligament

 Post. Cruciate ligament

 MCL
 Attachment –
 Origin – medial aspect of medial femoral
condyle
 Insertion – proximal tibia
 Function –
 Resist valgus stress force (specially in
extended knee)
 Check lateral rotation of tibia MCL
 Also restrain anterior displacement of tibia
when ACL is absent.

Also attached to the medial meniscus, so injury to one can

result in injury to both.
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LCL
 Attachment –
 Origin – lateral femoral
condyle
 Insertion – posteriorly to
head of fibula
 Function –
 Resist varus stress force across
the knee
 Check combined lateral
rotation with posterior
displacement of tibia in
conjunction with tendon of
popliteal muscle.
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Cruciate ligament
 Cruciate = “Resembling a cross” in Latin.
 Located within the joint capsule & are
therefore called Intracapsular Ligaments.
 Cruciate ligament provide stability in
PCL
sagittal plane
ACL
 The ACL & PCL are centrally located
within the capsule but lie outside the
synovial cavity.

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ACL
 Attachment –
 Origin – from anterior surface the tibia in
the intercondylar area
 It spans the knee laterally to PCL & runs in a
superior & posterior direction
 Insertion – to posteriorly on medial side of
lateral condyle of femur
 ACL is divided into 2 bands –
 Antero-medial band (AMB)
 Postero-lateral band (PLB)

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Function of Acl
 Primarily –
 Check femur from being displaced posteriorly on the tibia
 Conversely, the tibia from being displaced anteriorly on
femur.
 It tightens during extension, preventing excessive
hyperextension of the knee.
 ACL carried 87% of load when anterior translatory force
was applied to tibia with extended knee.
 Check tibial medial rotation by twisting around PCL
 ACL injury is common when knee is in flexed & tibia
rotated in either direction

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PCL
 Attachment –
 Origin – from posterior tibia in
intercondylar area and runs in a
superior and anterior direction on
medial side of ACL.
 Insertion - to anterior femur on
the lateral side of medial condyle
 PCL is divided into 2 bands –
 Antero-medial band (AMB)
 Postero-lateral band (PLB)

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 Function of Pcl
 Primarily –
 Check femur from being displaced anteriorly on the
tibia or
 Tibia from being displaced posteriorly on femur.
 It tightens during flexion & is injured much less
frequently than ACL.
 PCL carry 93% of load when posterior translatory
force was applied to tibia with extended knee.

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  Summary of ACL & PCL attachments –
 ACL – Runs from anterior tibia to posterior femur
 PCL – Runs from posterior tibia to anterior femur

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