KNEE ANATOMY Osseous Structures The osseous structures of the knee include the femur, the tibia, and

the patella (Table 13.1). At the distal end of the femur lie the femoral condyles, which are responsible for the articulation with the patella and the tibial plateau (1). The femoral condyles are covered with articular cartilage, are convex in nature, and demonstrate two separate articulation points, one medial and one lateral (2). The superior division of the medial and lateral condyles within the femoral groove is primarily flat. The groove deepens distally toward the tibia (1). The angle and depth of the femoral groove has been associated with patellofemoral stability (3). Table 13.1: General Information Regarding the Knee Complex. Concept Bones Number of dedicated joints Information There are 3 bones in the knees: the tibia, the femur, and the patella • 3 joints: the tibiofemoral joint is a bicondylar synovial joint, the superior tibiofibular joint is an arthrodial joint, and the patellofemoral joint is a pseudosaddle joint. • • • • Base is the superior aspect, apex is the inferior aspect With the knee extended, the apex is just proximal to the joint line Has thick articular cartilage 3 facets (4 in some cases) Lateral—larger, slightly larger Medial—smaller, varies in shape Odd—on the extreme medial border Fibrocartilage, anchored in the intercondylar area by their anterior and posterior horns and along their exterior edges by the coronary ligaments. The slender transverse ligament attaches the menisci anteriorly The quadriceps and semi-membranosus attach to both menisci, and popliteus attaches to the lateral menisci. The muscles act to pull the respective menisci anterior or posterior Only the outer 1/3 has a blood supply Lateral menisci—more “O” shaped, making it more mobile than the medial menisci Medial meniscus—more “C” shaped

Patella

Menisci of the tibiofemoral oint

• • •

Cook, Orthopedic Manual Therapy: An Evidence-Based Approach, 2/E © 2012 by Pearson Education, Inc., Upper Saddle River, NJ

Figure 13. a tendency that is enhanced by the inclusion of the medial and lateral menisci (2).2: The Proximal Articulation Components of the Tibia Cook. Orthopedic Manual Therapy: An Evidence-Based Approach. Inc. 2/E © 2012 by Pearson Education. NJ . This eminence serves as a pivot point for the femur and stabilizes the knee from excessive extension (1). Upper Saddle River.1: The Distal Articulation Components of the Femur The tibia gives birth to the tibial plateau and contributes significantly to knee stability (1). Between the two tibial plateaus is the pyramidal-shaped intercondylar eminence. The medial and lateral plateaus are concave. to account for the movement of the lateral femoral condyle.. The lateral tibial plateau is larger.Figure 13. This region also serves as an attachment site of the menisci.

Inc. The lateral facet is longer and wider than the medial facet and is concave in both longitudinal and mediallateral directions (4). the patella.. The posterior surface of the patella promotes movement and stability within the condyle of the femur. The medial facet typically demonstrates the greatest anatomical variation (4). The patellofemoral joint has the thickest cartilage of any joint in the body. a transverse ridge subdivides the lateral facet. and the tibia. Occasionally.The patella is a triangular-shaped sesamoid bone designed to improve the extensor mechanism of the knee. The outer 1/3 of the menisci have a blood supply. The femur provides for the articulation of the patellofemoral joint and the tibiofemoral joint. the medial facet is subdivided into two facets to more appropriately articulate with the condyle of the femurs (4). 2/E © 2012 by Pearson Education. creating a superior and inferior face for articulation.3: Posterior Surface of the Patella The inferior aspect of the patella articulates with the superior femoral groove during extension. Generally. Orthopedic Manual Therapy: An Evidence-Based Approach. NJ . The inferior (posterior) surface of the patella has a medial and lateral facet but does exhibit three and occasionally four concave surfaces of articulation (2). all of which are synovial. Summary • • • • • • The osseous structures of the knee include the femur. The contact surface of the patella with the femur is greatest during flexion and least during full extension (2). There are three joints at the knee. and the superior aspect of the patella articulates with the inferior aspect of the femoral groove during flexion (4). Figure 13. Cook. Upper Saddle River.

The anterior part of the lateral condyle is flattened and provides a contact surface with the anterior horn and the anterior part of the tibial articular surface during full extension. the lateral component of the tibiofemoral joints allows greater mobility. Orthopedic Manual Therapy: An Evidence-Based Approach. the lateral condyle projects anteriorly and acts as a stabilizer of the patella. Figure 13. 2/E © 2012 by Pearson Education. and is more prone to laxity than the medial compartment. significantly enhance this articulation. Cook. The femoral condyles are cam shaped and circular in structure. Inc. NJ .. A number of capsular reinforcements also stabilize the knee complex. less stability. Although the lateral condyle is smaller than the medial condyle. Both menisci absorb ground reaction forces across the knee and redistribute those forces to all aspects of the femoral condyle and tibial plateau (2). which is inclined laterally and posteriorly and promotes stability during extension (Table 13. The medial condyle of the femur is larger than the lateral condyle (2) and encounters greater weight-bearing forces than the lateral aspect (5).4: Anterior View of the Tibiofemoral Joint The femur articulates with the tibial plateau. Generally. The medial and lateral menisci. both of which contribute to stability during various degrees of extension and flexion.2).Joints The Tibiofemoral Joint The tibiofemoral joint is the largest joint of the body. Upper Saddle River.

and popliteus.3: Capsular Reinforcements of the Knee Complex. Inc. Additionally. NJ . the patella tilts medially from knee flexion to laterally during knee extension. The primary function of the patella is to improve the mechanical advantage of the quadriceps during movements of flexion and extension.. The patella moves in a C-shaped pattern from extension to flexion and back. During flexion and extension. and hamstring muscles Cook. This is most likely a mechanism associated with the concurrent rotation of the tibia and the shape and congruence of the femoral condyles. patellar retinacular fibers (which are extensions of connective tissue covering vastus lateralis. and iliotibial tract Attachment sites include lateral collateral ligament. arcuate popliteal ligament (from fibular head to posterior condyles). Table 13. ER of the tibia Close packed ~30–60 ° of knee flexion Close packed = dorsiflexion of the foot Theoretical Capsular Pattern Capsular pattern = flexion. the patella moves up to 7 or 8 centimeters in relation to the femoral condyles (1).3). Osteokinematics Anterior Lateral Posterior Plane of Motion/Axis of Rotation Attachment sites include quad muscle. 2/E © 2012 by Pearson Education.2: Theoretical Resting Position. Orthopedic Manual Therapy: An Evidence-Based Approach. and lateral head of the gastrocnemius Attachment sites include oblique popliteal ligament (from semimembranosis tendon to lat fem condyle). Joint Tibiofemoral joint Theoretical Resting Position Resting position = 25° flexion Theoretical Close-Pack Position Close-pack position = full extension. Upper Saddle River.Table 13. lateral retinacular fibers. iliotibial tract. vastus medialis. Close Pack Position and Capsular Patterns of the Knee Joints. biceps femoris. extension Patellofemoral joint Superior tibiofemoral joint Resting position = hyperextension to 5° of flexion Resting position = slight plantarflexion of the foot Unknown Pain when stressed The Patellofemoral Joint The patellofemoral joint is the articulation of the patella within the femoral groove (Table 13. tendon of popliteus. gastrocnemius.

The menisci actually absorb the majority of compressive force at the knee because the combined mass is greater than that of the surrounded articular cartilage (8). sublux. and pain (7). Summary • • • • • The tibiofemoral joint is the largest joint of the body. shock absorption. to the medial aspect of the capsule of the knee. generally involves crepitus and locking. Like discs at other regions of the body.. or develop a tracking problem (6). medial patellar retinacular fibers. it may dislocate.8). proprioception. fracture. The extremely mobile patellofemoral joint moves up to 7 or 8 centimeters in relation to the femoral condyles. The menisci’s primary role is stabilization. sartorius.Medial Attachment sites include medial collateral ligament. The medial meniscus attaches anterior to the articulating surface of the tibia. The posterior aspect of Cook. the knee menisci help to distribute contact forces over the articular surfaces by increasing the contact surface of the joint (5). The tracking problem may result in a number of consequences including abnormal loading. semimembranosus tendon. Intra-articular Structures The most prominent nonligamentous intra-articular structures are the medial and lateral menisci. gracilis and semitendinosus tendon (pes anserinus) When dysfunction of the patella occurs. and improvement in lubrication and sequencing of the knee (5. 2/E © 2012 by Pearson Education. abnormal pressures at the femur and patella. The theoretical resting position of the tibiofemoral joint is 25° of flexion. The medial meniscus also has an attachment posterior with the semimembranosus (1). degenerate. and at the intercondylar tubercle. Pain associated with the patellofemoral joint is typically diffuse. The medial aspect of the femur bears more weight than the lateral aspect. There are multiple capsular attachments to the knee. Inc. The lateral meniscus connects (both the anterior and posterior horn) near a common attachment posterior to the intercondylar tubercle of the tibia and near the attachment of the posterior horn of the medial meniscus. Upper Saddle River. NJ . and may lead to decreased functional activities (6). most of which articulate with tendons and muscles. Orthopedic Manual Therapy: An Evidence-Based Approach.

damage to the menisci involved removal of the menisci to avoid the painful consequences associated with knee locking. Both menisci distort significantly (elongate in a sagittal plane) and move posteriorly during flexion and move anteriorly during extension.10). Orthopedic Manual Therapy: An Evidence-Based Approach. Historically. Cook. This distortion is greatest during higher loads (5). Actions such as weight bearing increase the mobility of the menisci. Figure 13. The menisci are damaged occasionally during weight-bearing activities and during normal processes of degeneration. Upper Saddle River. The outer aspect of the menisci is innervated and is capable of producing pain when torn or degenerated (5). Of the two menisci. 2/E © 2012 by Pearson Education. Inc. the menisci follow the movements of the femur (2). Meniscal damage leads to cartilage thinning and subsequent loss of joint space (8). NJ . Nonetheless.5: The Tibial Attachments of the Medial and Lateral Menisci The medial meniscus is C shaped and the lateral meniscus is primarily circular shaped. when the menisci are removed. the medial meniscus encounters more forces during weight bearing than the lateral meniscus. such as during the screw home mechanism. also known as the transverse meniscal ligament (1). Both the anterior aspects of the medial and lateral meniscus are attached via the ligamentum transversum. Studies have shown that degeneration and tears often occur concurrently (8).the lateral meniscus generally is attached to two meniscofemoral ligaments and is thought to be significantly altered biomechanically by the cooperative action of the popliteus and the meniscofemoral ligaments (9. Damage to the cartilage generally begins at the surface then extends through the thickness of the cartilage (5). During rotation..

ligaments. 2/E © 2012 by Pearson Education. Inc. and surrounding tendon structures.forces along the femur and the tibia are significantly increased. The outer aspect of the menisci is innervated and is capable of being a pain generator. Summary • • • • The medial and lateral menisci’s primary role is stabilization.8. shock absorption. and improvement in lubrication and sequencing of the knee. Thus.11). sartorius. vastus medialis. The maximal quadriceps contraction occurs at 60 degrees of knee flexion (2). and posterior capsular complexes of the knee integrate with muscle. fibrillation. and the vastus intermedialis. Articular breakdown may result in flattening of the femur at the compression site.. and the gastrocnemius muscles. The collective output of the muscles in the knee work in concert to increase the stability during static and dynamic activities. popliteus. lateral. NJ . Orthopedic Manual Therapy: An Evidence-Based Approach. Much of the efficiency of the knee extensor mechanism depends on the timing and position of the patella during muscular contraction. Upper Saddle River. Muscles Several muscles contribute to normal knee motion. gracilis. sclerosis. The knee flexors include the hamstrings. the complex functions both passively and actively in its support of the knee (Table 13. Both menisci distort significantly (elongate in a sagittal plane) and move posteriorly during flexion and move anteriorly during extension. The quadriceps femoris muscles include the rectus femoris. medial. Ligaments and Capsule of the Knee The Capsule of the Knee The anterior. The popliteus muscle also contributes to knee flexion concurrently while initiating internal rotation. vastus lateralis. removal of the menisci commonly leads to articular surface breakdown of the femur and tibia within a few years (5. Cook. and further narrowing of the joint space (12). proprioception.4). Furthermore. specifically at the contact points of articulation (8).

Similar to other ligaments of the knee.4: The Patellofemoral Joint.. occurring commonly in female athletes during cutting Cook. The tibial attachments are at the anterior aspect of the tibial spine (1). Topic Articular cartilage At 135° flexion Information Has the thickest articular cartilage of any joint—up to 7 mm thick Patella contacts femur near the superior pole. Subsequently. In full extension the patella is completely above the intercondylar groove At 90° flexion At 20–0° extension The Anterior Cruciate Ligament The anterior cruciate ligament (ACL) is the primary structure responsible to counter anterior tibial transfer with respect to the femur (1). but a large portion of ACL injuries are nontraumatic. The ligament is commonly injured when the tibia is driven anteriorly on the femur.e. Orthopedic Manual Therapy: An Evidence-Based Approach. The ligament is also a secondary restraint to varus and valgus forces and internal rotation of the tibia. and the posterolateral band is taut in extension (1). the ligaments serve to stabilize tibial translation mostly at nearly 90 degrees. the bands change tension throughout movement of the knee from flexion to extension. 2/E © 2012 by Pearson Education. The ACL is a broad helical ligament that allows for appropriate tibia-to -femur rotation during movement but still supports the transfer of the tibia and side-to-side stabilization of the knee. based on the origins of the tibia.. NJ . The femoral attachment of the ACL is at the posterior aspect of the medial surface of the lateral femoral condyle (1). Upper Saddle River. The anterior medial band is taut in flexion. The lateral facet and the odd facet contact the femur Contact area of the patella migrates inferiorly and between 90° and 60° flexion the patella occupies its greatest area of contact with the femur (but only ~30% of the total patella is in contact with the femur). the patella rests below the intercondylar groove bridging the intercondylar notch.Table 13. the ACL is actually two distinct bands—an anteriormedial and a posterolateral band. high joint compression force) Contact area is the inferior pole. Because the ligaments are relatively horizontal during flexion. there is a significant compression force per unit area (i. therefore. Inc.

The popliteofibular ligament contributes to posteriorlateral stability during all angles of flexion and contributes as a deterrent to varus forces during extension and flexion (17). based on the forces provided to the knee joint (16). and subchondral injury within 5 to 10 years (14). The Posterior Cruciate Ligament The posterior cruciate ligament (PCL) has a relatively compact tibial attachment. Upper Saddle River. Isolated cutting of the PCL minimally affects posterior tibial translation while the knee is in extension (17). chondral. slowly weakening with age (15). 2/E © 2012 by Pearson Education. Cook. The ligaments function in concert to control anterior and posterior tibial translation.. The PCL fibers run anterior and proximal and are designed to counter tibial posterior translation. The PCL is a secondary restraint to tibial internal and external rotation and valgus and varus forces (15). The Lateral Collateral Ligament The lateral collateral ligament is tightened during extension and is slackened during approximately 30 degrees of knee flexion (17). A stiffer ligament leads to increased force across both ligaments. Damage to the ACL may lead to increased risk of meniscus. located posteriorly between the posterior horn of the medial and lateral menisci (15). Most researchers agree that the PCL is made of two separate systems of fibers that function separately. The femoral attachment is extensive adjacent to the condylar cartilage and near the medial femoral condyle (15). It is projected that the PCL is strongest while one is younger. NJ .or pivoting activities (13). Orthopedic Manual Therapy: An Evidence-Based Approach. Structures other than the PCL are responsible for stability of the knee from 20 degrees of flexion to extension (15). Inc. The condition of the ACL affects the PCL as does the condition of the PCL affect the ACL. The PCL is the primary restraint of the tibia on the femur when the knee is flexed from 30 to 90 degrees (15). and a more flexible or lax ligament leads to diminished forces along both ligaments (18).

Figure 13. the deep medial collateral ligament (dMCL).. and the posteromedial capsule (PMC) (19). The MCL contributes more toward valgus stability of the knee during flexion. Upper Saddle River. the true function of these fibers and whether the fibers function together or independently is unknown. Passively. The MCL structures provide coronal shear stability and reduce the forces associated with valgus. Cook. which are present in approximately 90 percent of individuals.6: The Medial Collateral Ligament Complex The Meniscofemoral Ligaments The meniscofemoral ligaments connect to the posterior horn of the lateral meniscus to the intercondylar area of the femur (20). the posteromedial capsule provides passive support during extension of the knee and provides some stability at extension. the contribution of the muscles of the pes anserine aid in stabilizing the knee. Orthopedic Manual Therapy: An Evidence-Based Approach. 2/E © 2012 by Pearson Education. In additional to the passive structures. NJ . At present. Inc.The Medial Collateral Ligament Complex The medial collateral ligament complex (MCL) consists primarily of three main structures: the longitudinal fibers of the superficial medial collateral ligament (sMCL). Less common are meniscofemoral ligaments that attach to the anterior horn of the medial meniscus.

The Posterolateral Knee Structures The posterolateral knee structures include the lateral collateral ligament. the clinician must examine tibial external rotation during 30 to 90 degrees of knee flexion (15. Additionally. Upper Saddle River.25). Isolated injuries to the posterolateral corner are rare (23) but may occur during contact to the anterior-medial aspect of the extended knee during weight bearing (27) or forced external rotation during a loaded and extended knee (24). Movements such as hyperextension are vague clinical findings during examination and may not be definitive of posterolateral knee instability (23). Cook. 2/E © 2012 by Pearson Education. to determine posterior lateral corner instability. thus preventing the meniscus from being ‘caught’ between the femur and the tibia. Inc. some have proposed that the MFLs function to counter the pull of the popliteus muscle (22). Isolated rupture of the posterior-lateral corner has a significant effect on the rotational and translatory stability of an extended knee (15). Because the popliteus muscle also contributes to movement of the posterior horn of the meniscus. the MFLs are considered secondary restraints to a posterior drawer of the knee. Generally. specifically stabilizers in rotation. The MFLs are responsible for moving the posterior horn of the meniscus during movement of the knee (21).MFLs are considered stabilizers of the knee. When injured.. Posterolateral knee instability is rotational in nature and may involve displacement of the tibia posteriorly on the femur. The anterior and posterior MLFs may serve to move the meniscus during extension and flexion movement. specifically in extension. The ligaments keep the meniscus moving consistently with the movement of the femur. patients report a sensation of knee instability during extension. Because the PCL couples with external rotation of the tibia during posterior translation. the arcuate ligament. the PCL ligament contributes poorly to the stability of the posterior lateral corner. NJ . Because of this. the popliteofibular ligament. posterior drawer tests performed in flexion are not sufficient to determine posterior-lateral instability. and variably the fibellofibular ligament (23). each being responsible for the movement of the menisci depending on the position of the femur relative to the tibia. Orthopedic Manual Therapy: An Evidence-Based Approach.

The lateral condylar ligament. the semimembranosus muscle.Posterolateral instability may involve an injury to the popliteus tendon because this structure is considered an important restraint to tibial external rotation (25). Figure 13. and the arcuate ligament assist in stabilizing the structure of the posterolateral knee. Posterior Ligaments and Structures The most important posterior stabilizing structures of the knee are the deep posterior capsule. oblique popliteal ligament. and the arcuate ligament. Upper Saddle River.. 2/E © 2012 by Pearson Education. Damage to one of the ligaments may negatively affect other ligaments. just distal to the lateral joint line. Orthopedic Manual Therapy: An Evidence-Based Approach.7: The Posterior Structures of the Knee Summary • • • There are multiple ligamentous structures responsible for stability of the knee. Cook. NJ . The semimembranosus can contract and tighten the oblique popliteal ligament that is considered a continuation of the tendon. The deep posterior capsule is tightened during knee extension and blends nicely with the tendinous insertions of the gastrocnemius muscles. the oblique popliteal ligament. The tendon tightens during extension and external rotation. The popliteus tendon originates on the posterolateral aspect of the femur and inserts on the anterior-lateral aspect of the fibular head. the lateral condylar ligament. Inc. The most common outcome to damaged ligaments is instability.

and the femur does roll significantly on the fixed tibia. NJ . Most individuals also exhibit some degree of knee hyperextension during passive weight bearing and non–weight bearing. Although the lateral condyle is often considered to translate more so than the medial condyle. the tibia moves anteriorly on the fixed femur and the menisci move anteriorly. the femur rolls and slides posteriorly to the tibia to allow the distal and posterior aspects of the femoral condyle to Cook. research results are mixed (27. the tibia moves posteriorly on a fixed femur and the menisci move posteriorly as well. Upper Saddle River. Tibiofemoral translation is somewhat predictable during movements of extension to flexion. During knee extension. ligaments.28). Anterior forces are restrained primarily by the ACL. In normal individuals. Inc. and menisci serve to increase the stiffness and stability of the knee and allow the action of transmission of large loads throughout the joint (18). during knee flexion. the combined contribution of the muscles. (27) reported that the femur translates posteriorly on the tibia at 30 to 90 degrees of knee flexion during cocontraction of the extensors and flexors in a simulated loading response. As a whole. Rolling is a fundamental movement of most articular surfaces. approximately 0 to 140 degrees of extension to flexion are present (2).KNEE BIOMECHANICS Movement and Stability Tibiofemoral Joint In a normal knee. while posterior forces are restrained by the PCL. 2/E © 2012 by Pearson Education. However.. Individuals with a damaged ACL demonstrate posterior translation of the femur during isolated extensor and flexor contractions. These findings are supported by others (29) that also found posterior migration of the femur on the tibia during flexion. Von Eisenhart-Rothe et al. isolated contraction on healthy subjects demonstrates anterior translation of the tibia with respect to the femur during extensor contraction and posterior translation of the tibia with respect to the femur during flexor contraction (28). Movements in weight bearing initiate structures such as the cruciate ligaments and the menisci to balance the shear and compression forces at the tibiofemoral joint (26). During flexion. Orthopedic Manual Therapy: An Evidence-Based Approach.

allowing the lateral condyle to roll and slide at a greater quantity than the medial surface. Screw Home Mechanism The screw home mechanism appears to be guided by the location of the joint axis and by the passive action of the posterior and anterior cruciate ligaments (33). The PCL encourages the femoral condyle to slide posterior during active extension and roll in an anterior direction. in some cases up to 6. Cook.interface with the flattened tibial plateau. Much of this movement is guided by the posterior translation of the menisci and the control supplied by the cruciate ligaments and can be disrupted significantly during damage to these structures (27). During flexion beyond 120 degrees. 2/E © 2012 by Pearson Education. these motions do not appear to be as compelling as rotations. The external rotation that occurs at the femur increases the surface area for roll because it mimics the translatory aspect at the joint. and extension (18). Conversely. During knee extension in a closed chain. Upper Saddle River..31). During extension and flexion. the tibia moves into external rotation. the tibia moves internally. This concurrent action of coupled tibial rotation called the screw home mechanism occurs to enhance the stability of the knee. The ACL pulls on the femur and encourages anterior slide during knee flexion while it rolls in a posterior direction. flexion. This mechanism is altered when damage is incurred to the anterior and posterior cruciate ligaments or when the stress-tension relationship of this ligament has someway been altered (33). the knee exhibits coupled-knee internal and external rotation and sagittal motions (18). Inc. NJ . the femoral condyles lose congruency with the tibial plateau and have contact points at the posterior horn of the menisci (26).5 to 36 degrees (30. Martelli and Pinskerova (32) advocate that the medial condyle is congruent and rounded and the lateral surface is flattened. rotate laterally. and migrate proximally during flexion with respect to the tibia (18). the femur appears to translate posteriorly. To some extent. This is because the rolling of the femur outdistances the concurrent slide of the tibiofemoral complex. coupled varus and valgus motion occurs in conjunction with the sagittal and transverse plane movements. Orthopedic Manual Therapy: An Evidence-Based Approach. Nonetheless. When the knee is flexed in a closed chain.

NJ . lastly shifting to a laterally tilted position while in extension (36). the tibia translates posteriorly. the menisci follow the movements of the femur. During extension. the menisci follow the movements of the femur (2). One study attempted to load the knee during 90 degrees of flexion to extension and found consistency of the patella during movement on the femur. the tibia rolls anteriorly. The popliteus is situated and well adapted to prevent tibial external rotation during knee flexion (18). During active extension. During screw home rotation. The popliteus plays a vital role in the screw home mechanism and initiates rotation of the tibia at 0 to 20 degrees of flexion. Inc. During flexion. Numerous in-vitro studies have investigated patellofemoral movements and have reported significant variations of patterns (34. Summary • • • • • During an extension contraction.35). During movement from flexion to extension. and then shifts to neutral. Orthopedic Manual Therapy: An Evidence-Based Approach. the popliteus functions actively to initiate knee flexion and retraction of the lateral meniscus (18). the patella starts in a medially tilted position. Upper Saddle River.. Cook.The popliteus plays a vital role in the screw home mechanism and initiates rotation of the tibia at 0 to 20 degrees of flexion. the tibia translates anteriorly. Patellofemoral Joint Movement of the patellofemoral joint is a complex kinematic process. During a flexion contraction. During this rotation. the tibia follows the convex-concave rule and rolls posteriorly. 2/E © 2012 by Pearson Education.

variably moves from anterior to posterior position (in many cases. Powers (3) reported that the depth of the trochlear groove is highly correlated with abnormal patellar kinematics.8: Movement of the Patella during Extension to Flexion of the Knee Recently. promoting posterior displacement against the femur (4). an in vivo study demonstrated variability in patellofemoral movements during extension to flexion movements. this process can cause abnormal lateral forces. then laterally as knee flexion progressed. 2/E © 2012 by Pearson Education.. the patella just moved posteriorly). Increases in knee flexion increase the compression of the patellofemoral joint (38). Abnormalities in patellofemoral biomechanics generally manifest at 0 to 30 degrees of flexion because of the deepening of the trochlear groove of the femur. and lateral dislocations. and variably moves progressively laterally during knee flexion.Figure 13. Orthopedic Manual Therapy: An Evidence-Based Approach. As the tibia continues to flexion. Upper Saddle River. NJ . the kneecap moved medially first. Laprade and Lee (37) reported that the patella typically moves distally during progressive extension to flexion. tracking problems. Cook. with increased shallowness of the trochlear groove predictive of lateral patellar tilt and abnormal tracking. If the patella lies too far laterally during this motion. the iliotibial band pulls posteriorly on the patella. Inc. In some cases.

The knee: Form.84:846–851. Biomechanics of the PCL and related structures: Posterolateral. NJ . Cowley H. Disorders of the patellofemoral joint. Mosby: 2002. Larson R. 2002. Gender differences in frontal and sagittal plane biomechanics during drop landings. Intrarater reliability of functional performance tests for subjects with patellofemoral pain syndrome. Gupte CM. Calvo MA. Race A. Thomas R. 2002. van Rietbergen B. J Ath Train. Cook. Inc. The patella typically moves distally during progressive extension to flexion. Wiesner D. Clin Biomech. Bull A. 4 ed. Am J Sports Med.20:498–507. Gupta C. 7. Phys Ther. Palanca M. 15. 2000.41:917–923. Macnicol M. J Bone Joint Surg Br. • Online References 1. Bull AM. Bull A. 2005. 13. Lippincott Williams & Wilkins: 2004. 6.85:765–773. th Fulkerson J. Paxton LW. Buckland-Wright JC. Saunders Co: 1992. 3. function. Smith A. Amis A. Philadelphia. Finite element analysis of the effect of meniscal tears and mensicectomies on human knee biomechanics. Thomas N. 2005. pathology. 10. Huiskes R. Grana W. Rheumatology. the patella just moved posteriorly). Knee Surg Sports Traumatol Arthorsc. Seedhom B.37:256–261.33:1–10. Upper Saddle River. Fithian D. Amis A. 2000. and meniscofemoral ligaments. 2003. 11. Meniscal and articular cartilage changes in knee osteoarthritis: A cross sectional double-contrast macroradiographic study. Pathways of load-induced cartilage damage causing cartilage degeneration in the knee after meniscectomy. Robinson JR. The meniscofemoral ligaments: secondary restraints to the posterior drawer. Philadelphia. 12. Abnormalities in patellofemoral biomechanics generally manifest at 0 to 30 degrees of flexion because of the deepening of the trochlear groove of the femur.33:621–636. Soames R. The knee after meniscectomy. Loudon J. 8. Med Sci Sports Exerc.37:1003–1012. W. McDermott ID. Torry MR. Gupta C. 9. Bennett LD. Powers C. Martinez D. Part II: the influence of the depth of the trochlear groove in subjects with and without patellofemoral pain. St Louis. 2.80(10):965–978. Loudon K. J Biomech. Neumann D. Thomas R. Kinesiology of the musculoskeletal system: Foundations for physical rehabilitation. Upadhyay N. Goltz DH. and variably moves progressively laterally during knee flexion. 4. van Donkelaar CC.Summary • • The articulation pattern of the patella may be variable during flexion and extension movements. J Bone Joint Surg Br. variably moves from anterior to posterior movement (in many cases. Hijazi I. Amis A. Effect of patellar tendon shortening on tracking of the patella. Vollans S. 2003. 14. Doblare M. Tanner S.82(2):157–159 Wilson W. Kernozek TW. Asjes C. 2003. and treatment. Meniscofemoral ligaments revisited.11:271–281. 5. 2/E © 2012 by Pearson Education. posteromedial. Pena E. Goist-Foley H. Orthop Clin North Am. Orthopedic Manual Therapy: An Evidence-Based Approach. 2005.36:845–851. 2002.B. Van Hoof H. Fate of the anterior cruciate ligament-injured knee. 2002. J Bone Jnt Surg Br. Patellar kinematics..

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