Bones Articulations Characteristics
Tibia Tibiofemoral joint Joint articulation occurs between the medial
Femur and lateral femoral and tibial condyles. The
tibiofemoral joint has two crescent-shaped
fibrocartilaginous structures, the lateral and
medial meniscus. The menisci are attached to
the tibial plateau by the coronary ligaments.
Both menisci are concave superiorly to
accommodate the surfaces of the femoral
condyles. Their role is to increase the contact
area between the tibial and femoral articular
surfaces, thus increasing the stability of the
joint.
Femur Patellofemoral Joint articulation is located between the
Patella joint anterior aspect of the distal femur and the
posterior surface of the patella.
Tibia Superior The STFJ comprises the tibial facet on the
Fibula (proximal) posterolateral aspect of the tibial condyle and
tibiofibular joint the fibular facet on the medial upper surfaces
(STFJ) of the head of the fibula.
Key palpation points
To palpate the femoral condyle, flex the knee and
locate the knee joint line by grasping and rotating the tibia.
The rotation movement of the tibia helps to mark the joint
line. Return the lower leg to full extension and keep your
fingers on the joint line. The medial condyle can be
palpated above the medial side of the joint line, and the
lateral condyle is above the lateral side of the joint line.
The medial epicondyle is the most medial part of the
medial condyle, while the lateral epicondyle is on the
lateral condyle.
To palpate the tibial tuberosity, start by locating the
patella. Move your finger down, past the apex of the
patella, and keep moving until you feel a bump on the
anterior part of the tibia. This is the tibial tuberosity.
To palpate the fibula, position the patient supine and find the tibial
tuberosity. Because the head of the fibula is in line with the tibial
tuberosity, move your finger in a lateral direction until you reach a
bony landmark - this is located more posterior than anterior. To
verify the location of the head of the fibula, place your finger on this
landmark and ask the patient to evert the foot. Your finger should
move up and down as the patient activates the fibularis longus, which
has its proximal attachment on the head of the fibula.
Joint Type of Plane of Motion Kinematics Closed pack Open pack
joint movement position position

Tibiofemoral Modified Saggital Flexion and Normal range of motion: Full extension 25 degrees of
Joint (TFJ) hinge Transverse extension; Extension: 0 degrees flexion
internal and external Flexion: 140 degrees
rotation of the tibia Internal and external rotation of
in relation to the the tibia in relation to the femur
femur when the knee is possible only when the knee
is flexed. is flexed

Patellofemoral Saddle Superior/inferior At full knee extension, the Full extension

Joint (PFJ) glide; patella rests on the suprapatellar with medial
medial and lateral fat pad. rotation of the
glide; At 20-30 degrees of knee femoral condyle
medial and lateral flexion, the patella moves
tilt; inferiorly, lying in the shallow
medial and lateral part of the intercondylar groove.
rotation The patella contacts the femur
with its inferior pole.
At 60-90 degrees of knee Flexion
flexion, the patella has
maximum contact with the
intercondylar groove (1/3 of the
posterior surface area of the
patella).
At 135 degrees of knee flexion,
the patella contacts the femur
with its superior pole and rests
below the intercondylar groove.
TIBIOFEMORAL (KNEE) JOINT
1. What type of joint is the knee joint and what are the two main movements that this type of joint allows (comment on the plane on
the axis of rotation)? Standing in anatomical position, do these movements and compare this to the movements of the elbow.
= The knee joint is primarily a hinge type of synovial joint, allowing Flexion and extension are the main knee movements;
some rotation occurs when the knee is flexed. However, the hinge movements are combined with gliding and rolling, and
with rotation about a vertical axis. (A modified hinge joint)
Normal range of motion: Extension: 0 degrees. Flexion: 140 degrees. Internal and external rotation of the tibia in relation to
the femur is possible only when the knee is flexed
=The knee consists of the lateral and medial compartments of the tibiofemoral joint and the patellofemoral joint. Motion at the
knee occurs in two planes, allowing flexion and extension, and internal and external rotation. Functionally, however, these
movements rarely occur independent of movement at other joints within the lower limb. Consider, for example, the interaction among
the hip, knee, and ankle during running, climbing, or standing from a seated position. The strong functional association within the
joints of the lower limb is reflected by the fact that about two thirds of the muscles that cross the knee also cross either the hip or the
ankle.

= Femur, Tibia, Fibula, Patella

 The two condyles are
on the same horizontal
level when the bone is
in its anatomical
position. To form the
knee joint, the femoral
condyles articulate
with menisci and tibial
condyles that glide as
a unit across the
The medial surface inferior and posterior
of the medial aspects of the femoral
condyle has a condyles during
larger and more
flexion and extension.
prominent medial
epicondyle, The condyles are
superior to which separated posteriorly
another elevation,
and inferiorly by an
the adductor
tubercle, forms in intercondylar fossa
relation to a but merge anteriorly,
tendon forming a shallow
attachment. longitudinal
depression, the
patellar surface which
articulates with the
patella.
The femoral condyles are subcutaneous and easily palpated when the knee is flexed or extended. At the Unlike that of the
center of the lateral aspect of each condyle is a prominent epicondyle that is easily palpable. femur, the shaft of
the tibia is truly
vertical within the
Intercondylar tubercles of intercondylar Intercondylar tubercles of intercondylar Lateral tibial plateau
leg. It is somewhat
triangular in cross
section, having
three surfaces and
borders: medial,
lateral/
interosseous, and
posterior.
The prominent
anterior border of
the tibia and the
adjacent medial
surface are
subcutaneous
throughout their
lengths and are
commonly known
as the “shin”. At
the superior end of
the anterior
border, a broad,
oblong tibial
tuberosity.
The superior (proximal) end widens to
form medial and lateral condyles and a
relatively flat superior articular
surface, or tibial plateau that
articulate with the large femoral
condyles. The articular surfaces are
separated by an intercondylar
eminence formed by two intercondylar
tubercles (medial and lateral fit into
the intercondylar fossa between the
femoral condyles) sided by relatively
rough anterior and posterior
intercondylar areas.
The intercondylar tubercles and areas
provide attachment for the menisci
and principal ligaments of the knee,
which hold the femur and tibia
together, maintaining contact
between their articular surfaces.
 The patella serves for
attachment of the quadriceps
tendon (superiorly) and the
patellar tendon (which attaches
to the tibial tubercle, inferiorly),
although few quadriceps tendon
fibres are continuous over the
anterior surface. The
quadriceps tendon and patellar
tendon are really the same
structure with the patella (as a
sesamoid bone) embedded
within it.

The patella (from the Latin, “small plate”) is a nearly triangular bone embedded within the quadriceps tendon. It is the largest
sesamoid bone in the body. The patella has a curved base superiorly and a pointed apex inferiorly. The thick patellar tendon
attaches to and between the apex of the patella and the tibial tuberosity. In a relaxed standing position, the apex of the patella lies
just proximal to the knee joint line. The subcutaneous anterior surface of the patella is convex in all directions.

The larger, medial articular surface is slightly concave, whereas the lateral articular surface is flat to slightly
convex. The articular surfaces are separated down the midline by an intercondylar eminence, formed by irregularly
shaped medial and lateral tubercles. Shallow anterior and posterior intercondylar areas flank both ends of the
eminence. The cruciate ligaments and menisci attach along the intercondylar region of the tibia.
The posterior articular surface of the patella is covered with articular cartilage up to 4 to 5 mm thick. Part of this
surface articulates with the intercondylar groove of the femur, forming the patellofemoral joint. The thick
cartilage helps to disperse the large compression forces that cross the joint.
Extra capsular ligaments: * Patellar ligament,
* medial and lateral patellar retinacula, in
addition to * tibial and fibular collateral ligament
The collateral ligaments of the knee are taut when the knee is fully
extended, contributing to stability while standing. As flexion proceeds,
they become increasingly slack, permitting and limiting rotation at the
knee.
It is the cruciate ligaments that maintain contact with the femoral
and tibial articular surfaces during flexion of the knee. ACL, it
prevents posterior displacement of the femur on the tibia and
hyperextension of the knee joint. While, PCL prevents anterior
displacement of the femur on the tibia and helps prevent hyperflexion
of the knee joint.
In the weight-bearing flexed knee, the PCL is the main stabilizing factor
for the femur (e.g., when walking downhill).

Patella

Patella
tendon

Tibial
tuberosity

Fibular
= The fibular collateral ligament, a cord-like extracapsular ligament, is strong. It head
extends inferiorly from the lateral epicondyle of the femur to the lateral surface of
the fibular head. = The tibial collateral ligament is a strong, flat, band that
extends from the medial epicondyle of the femur to the medial condyle and the
superior part of the medial surface of the tibia. At its midpoint, the deep fibers of
the TCL are firmly attached to the medial meniscus. TCL and medial meniscus are
commonly torn.
The articular capsule
of the knee extends
across all sides of the
tibiofemoral joint and
the patellofemoral
joint. Posteriorly, the
capsule attaches just
proximal to the
femoral condyles,
immediately distal to
the popliteal surface of
the femur.
Gerdy's tubercle is a
smooth facet on the
lateral aspect of the
upper tibia, just below
the knee joint and
adjacent to the
proximal tibio-fibular
joint. It is the point of
insertion for the
Iliotibial band of the
lateral thigh.
Important ligaments inside the knee
joint (intracapsular ligaments)
include the two cruciate ligaments
that lie in the intercondylar region of
the tibiofemoral joint, and cross
each other in the sagittal plane.
These are named according to their
attachment to the intercondylar area
of the Tibia. Interestingly, these
ligaments are enveloped by the
synovial membrane so they are
anatomically (and technically)
outside the joint cavity. Anterior
cruciate ligament: Attaches to the
Tibia at the anterior region of the
intercondylar area. Posterior
cruciate ligament: Attaches to the
Tibia at the Posterior region of the
intercondylar area
 The infrapatellar fat pad, is located immediately
posterior to the patellar tendon where it lies intracapsular
but is extra synovial and acts as a protective cushion,
separating patella from joining bones. The IFP distributes
pressure across the patellofemoral joint, facilitates
flexible deformation in the knee joint and supports
patellar stability. The IFP is a dynamic structure. It
alters position, pressure, and volume throughout the
knee ROM. In addition, the IFP may have a role as a
mechoreceptor / proprioceptor due to the relatively
PCL high density of nerves within it.
Tensor FL; when the knee is fully extended, it contributes to (increases) the extending force, adding
stability, and plays a role in supporting the femur on the tibia when standing if lateral sway occurs. When
the knee is flexed by other muscles, the tensor fasciae latae can synergistically augment flexion and lateral
rotation of the leg.
The ability of the rectus femoris to extend the knee is compromised during hip flexion, but it does contribute to the
extension force during the toe off phase of walking, when the thigh is extended. It is particularly efficient in movements
combining knee extension and hip flexion from a position of hip hyperextension and knee flexion, as in the preparatory
position for kicking a soccer ball. The rectus femoris is susceptible to injury and avulsion from the anterior inferior iliac
spine during kicking, hence the name “kicking muscle.” A loss of function of the rectus femoris may reduce thigh flexion
strength by as much as 17%.
The patellar ligament, the tendons of the four parts of the quadriceps unite in the distal portion of the thigh
to form a single, strong, broad quadriceps tendon attached to the tibial tuberosity. The ligament assists
in proper patellar alignment and knee extension and aids in knee extension, as the distal part of the
extensor mechanism of the knee.
The most important muscle in stabilizing the knee joint is the large quadriceps femoris, particularly
the inferior fibers of the vastus medialis and lateralis.
The medial and lateral vasti muscles also attach independently to the patella and form aponeuroses, the
medial and lateral patellar retinacula, which reinforce the joint capsule of the knee joint on each side of
the patella enroute to attachment to the anterior border of the tibial plateau. The retinacula also play a
role in keeping the patella aligned over the patellar surface of the femur.
The medial and lateral patellar
retinaculum, which are
condensations of fascia rather than
true ligaments, attach the patella
margins to surrounding fascia.
The medial patellar retinaculum
attaches to the vastus medialis /
sartorius fascia and resists lateral
patellar dislocation.
The lateral patellar retinaculum is
attached to the fascia of vastus
lateralis and iliotibial band 6.
The quadriceps muscles pull the
patella obliquely and laterally in
relation to the femur. There are
factors that prevent such
displacement: larger lateral condyle
of the femur, tension in the medial
retinacular fibers and direction of
insertion of fibers of the vastus
medialis muscle.
The medial patellofemoral ligament
(MPFL) originates near adductor
tubercle of the femur and inserts
into the superomedial aspect of the
patella. Its function is to prevent
lateral patellar dislocation during
knee extension.