Zimmer Biomet

Knee Sales Training

1/21/2018
Knee Structure and Function
Knee Structure and Function

• Objectives 1. Joint Structure

– The Bones
• Introduction – Soft Tissue

• Review 2. Articulation and Alignment

– Articular Surface
– Compartments
– Axes and Angles
– Dynamic vs. Static Knee
– Clinical Implication

3. Summary Review

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Knee Structure and Function

Objectives

• Upon Completion of Knee Structure and Function, you should be able to:
1. Identify the bones of the knee
2. Identify the structural landmarks of the femoral side of the knee
3. Identify the structural landmarks of the tibial side of the knee
4. Identify the menisci and their component parts
5. Identify the structural landmarks of the patella
6. Identify the ligaments of the knee
7. Label the axes and angles of the knee joint

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Knee Structure and Function

Introduction

• Structures of the knee are unique to allow the joint to accomplish its job of:
– Movement and stability while standing and moving

• You will need to understand the knee structures and how they work in order to:
– Present Zimmer Biomet prosthetic knee components to the customers you serve
– Cover the Zimmer Biomet surgical cases for the customers you serve

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Knee Structure and Function

Joint Structure

• Commonly called a hinged joint; the knee appears to move back and forth in one plane like a hinge.

• However, it’s only a hinge in appearance. The knee actually provides a complex interaction of
gliding, rolling, and rotational movements.

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Knee Structure and Function

Complex Interaction

• Necessary for the knee to serve two opposing functions.

– When “locked in” or “screwed home,” the position for standing (extension), the knee must provide
a high degree of stability; it cannot give away.

– Yet, in bending for movement such as walking, running, or climbing, the knee needs flexibility and
freedom of movement.

– https://www.youtube.com/watch?v=2Zqx09oQqQY

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Knee Structure and Function

The Bones

• Femur (distal end)*

• Tibia (proximal end)*
• Patella*
• Fibula

• *Bones that actually make up the knee joint

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Knee Structure and Function

The Femur

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Knee Structure and Function

The Femur

• The shallow groove between the condyles on their anterior surface is called the patellar surface or
patellofemoral groove.

• This groove continues anteriorly at a slight angle to the lateral side (“Q” angle) to allow for normal
tracking of the patella. This continuation is known as the femoral trochlea.

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Knee Structure and Function

The Tibia

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Knee Structure and Function

The Fibula

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Knee Structure and Function

The Patella

• Short, flat, irregularly shaped bone. Occasionally, the patella is referred to as the sesamoid bone,
referring to the shape of the bone.

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Knee Structure and Function

Soft Tissue

• Several soft tissue systems contribute to knee motion and/or knee stability, including:
– Menisci
– Joint Capsule
– Ligaments
– Muscles

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Knee Structure and Function

Menisci

• Crescent shaped wedges

• Ends are called horns
• Distribute body weight acting as shock absorbers
• Deepend the knee joint contributing to stability
• Lateral mensicus is relatively loose and moveable
• Medial is more prone to tearing

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Knee Structure and Function

Joint Capsule

• The joint capsule is composed of a

fibrous connective tissue on the outside
and the synovial membrane on the
inside.
• The capsule is attached to the posterior
surface of the patella and completely
envelops the femoral condyles and the
tibial plateau.
• The fibrous portion helps hold the two
bones together, and the synovial lining
produces the synovial fluid that lubricates
and nourishes the articulating surface.

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Knee Structure and Function

Ligaments

• Their primary function is to hold the knee joint together and provide stability through the full range of
motion (ROM).
• The two sets of knee ligaments, not including those of the menisci, are called:
– Medial collateral ligament
– Lateral collateral ligament
– Anterior cruciate ligament
– Posterior cruciate ligament

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Knee Structure and Function

Ligaments

• Collateral Ligaments.
– Collateral ligaments are located on the lateral and
medial aspects of the knee. The medial collateral
ligament starts at the medial epicondyle of the femur
and attaches to the media aspect of the proximal tibia.
It is also attached to the medial meniscus.
– The lateral collateral ligament connects the femoral
epicondyle to the proximal fibula. It is not attached to
the meniscus.
• Cruciate Ligaments.
– The cruciate ligaments are so-called because they
cross (forming an X-shape).
– The posterior cruciate ligament connects the posterior
tibia to the posterior femur. The anterior cruciate
ligament connects the anterior tibia to the posterior
femur.

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Knee Structure and Function

Articulation and Alignment

• The geometry of the knee’s articulating surfaces is very important for two reasons.
– Each articulation essentially determines the biomechanical function of the knee. Because of this,
the geometry of the articulating surfaces must be taken into account in the design of prostheses
and instruments for knee arthroplasty.
– Those alignments include the compartment of the knee joint and the axes, planes, and angles of
the leg, thigh, and knee.

• This section includes a basic description of:

– Articular surfaces
– Compartments of the knee
– Alignment

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Knee Structure and Function

Articular Surfaces

• Altogether, the knee has six articular surfaces. These six surfaces are distributed among the three
bony components of the knee:
– Distal femur
– Proximal tibia
– Patella

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Knee Structure and Function

Distal Femur

• The distal femur has three of the articular surfaces. They include the:
– Medial femoral condyle
– Lateral femoral condyle
– Patellofemoral groove
• Both condyles are covered with articular cartilage.
• Both condyles are rounded in two planes – a large convex curve sagittally (anterior to
• posterior) and a smaller convex curve transversely (medial to lateral).
• The medial condyle is a bit narrower on the distal end than the lateral condyle, but it is also longer
and larger overall than the lateral condyle. However, from a lateral viewpoint, the distal femoral
curvature of the lateral condyle is larger than the curve of the medial condyle, similar to a pair of
wheels, one larger (lateral) and one smaller (medial).
• The patellofemoral groove is simply a groove on the anterior surface of the distal femur between the
two condyles. It runs laterally in approximately 5 degrees of valgus, and it accommodates the bony
geometry of the posterior patella surface.

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Knee Structure and Function

Proximal Tibia

• The proximal tibia provides two of the articular surfaces:

– Medial tibial plateau
– Lateral tibial plateau

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• Medial Plateau.
– The medial plateau is larger than the lateral plateau.
– The medial plateau is biconcave in two directions, that is, it is “dish-shaped”.

• Lateral Plateau.
– The lateral plateau is somewhat smaller than the medial plateau. The lateral plateau is also
shaped differently – it is concave in the frontal section and convex in the sagittal section. It
resembles a “saddle”.
• The femoral condyles do not exactly match the two tibial plateaus, i.e., they are not congruent. The
gap between the femoral and tibial articulating surfaces is filled by the menisci.
• In the biomechanics of knee motion, the gap changes as the knee moves. Because of their soft
fibrocartilaginous structure, the menisci provide an additional articulating surface that changes as the
gap between the tibia and femur changes.

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Knee Structure and Function

Compartments

• The six articulating surfaces of the knee are divided up into

three pairs. Each pair is referred to as a compartment:
– Medial compartment
– Lateral compartment
– Patellofemoral compartment

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Knee Structure and Function

Body Planes and Sections

• Sagittal Plane
– Movements of Flexion / Extension
• Coronal Plane
– Movements of Varus / Valgus
• Transvers Plane
– Movements of Internal / External Rotation

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Knee Structure and Function

Axes and Angles

• The femur, knee, and lower leg. If you stand straight,

assuming your knee and hip are functioning normally, the
bones of your leg and thus the joints are arranged at
particular angles to each other. These angles are similar
to the angles of the bones in any normal hip and knee.
• The line marked “V” is the vertical axis, a line
perpendicular to the ground. This is used as a reference
point in describing the axes of these bones.
• The mechanical axis “M” runs from the center of the
femoral head through the center of the distal femur,
between the two condyles to the center of the ankle. The
mechanical axis is tilted about 3 degrees laterally from
the vertical axis.

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Knee Structure and Function

Axes and Angles Continued

• The anatomic (shaft) axis of the femur “A” is different

from its mechanical axis. The anatomic axis is tilted 9
degrees laterally from the vertical axis, and as a result
the femur comes into the knee joint at an angle of 9
degrees from vertical.
• Note, however, that the mechanical and anatomic axes of
the tibia are the same, 3 degrees off vertical.
• One more axis is also important, the transverse axis. As
you can see, the transverse axis is a horizontal axis at
right angles to the vertical axis.
• When the thigh and leg are positioned as shown the
femoral condyles and tibial plateaus line up straight
across the transverse axis.

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