G.

MAHEESWARI
MPT 1ST YEAR
 TIBIOFEMORAL JOINT STRUCTURE
- Articular surfaces
- Menisci
- Joint capsule
- Ligaments
- Iliotibial band
- Bursae
 TIBIOFEMORAL JOINT FUNCTION
- Kinematics
• It is the largest and the more complex
joint in the body.
• The knee joint is composed of tibiofemoral
and patellofemoral joints – single joint
capsule.
• Most injured joint – sustains high forces .
• Double condyloid joint with 3 degrees of freedom of
motion.
• Flexion and extension-sagittal plane
• Medial/lateral (internal/external)rotation -
transverse plane.
• Abduction and adduction - frontal plane.
• Double condyloid

Medial compartment Lateral compartment

• Motion – great in only sagittal plane – accounts for
all the motion
PROXIMAL (FEMUR)
• Lateral femoral condyle – in line with
shaft of femur – because of its
obliquity.
• Medial femoral condyle – large and
more prominent – results in horizontal femoral
surface.
• Intercondylar notch – separates the two condyles
inferiorly.
• Patellar groove – joins
the condyles anteriorly.
• Physiological valgus of the knee Long neck of the femur
displaces the shaft laterally - long axis of the shaft does not
coincide with that of the leg but forms an obtuse angle of I7O-
175deg open laterally
DISTAL (TIBIA) :
• Medial and lateral condyles – slightly convex at the
posterior and anterior margins .
• Does not match with proximal articular surface – lack
of bony stability.
• Intercondylar tubercles – condyles separated by
roughened area and two bony spines.
• Tibia – larger proximally – overhangs the shaft
posteriorly – 7-10 degrees.
• The fibrocartilaginous discs – open anterior and posterior
horns – firmly attached to tibia.
• Medial meniscus – C-shaped , greater compressive loads.
• Lateral meniscus – 4/5th of circle , covers greater % of area.
• Functions:
- distributes weight bearing forces.
- shock absorber.
- assumes 50 – 70% of
imposed load.
- Removal of menisci-
doubles articular car-
tilage stress on femur ,
multiplies the forces
by 6-7 times on tibial.
Internal Synovial Exterior/Superficial
Membrane Fibrous Layer
SYNOVIAL MEMBRANE:
• Inner lining of capsule – complex.
• Functions:
- secretes and absorbs synovial fluid – lubrication.
- nutrition to avascular structures (menisci).
• Patellar plicae – failure of synovial membrane to fully
resorbed.
FIBROUS LAYER :

Anterior Medial Lateral Posterior

-Extensor - MCL deep & -IT Band &
Retinaculum superficial its thick Medial Lateral
layers fascialata POL Arcuate L
 EXTENSOR RETINACULUM:
1.Medial Retinacula :
• Medial patellofemoral ligament (transverse) –
adductor tubercle of femur blends with vastus
medialis – inserts onto superomedial border of
patella.
• Medial patellotibial ligament (longitudinal).
2.Lateral Retinacula :
• Lateral Patellofemoral ligament (Transverse) – from
IT band to lateral border of patella.
• Lateral Patellotibial ligament (longitudinal).
- Medial collateral ligament
- Lateral collateral ligament
- Anterior cruciate ligament
- Posterior cruciate ligament
- Posterior capsule ligaments

1.MEDIAL COLLATERAL LIGAMENT :

• Superficial
Proximal Attachment – Medial femoral condyle
Distal Attachment – Medial aspect of proximal tibia
distal to pes anserinus
• Deep
Proximal Attachment – Inferior aspect of medial
femoral condyle.
Distal Attachment – Proximal aspect of the medial
tibial plateau.
FUNCTION :
• Primary restraint – excessive abduction (varus) and
Lateral rotation stresses – Extension.
• Supporting role – resisting anterior translation of tibia
on femur.
• Rich blood supply – Capacity to heal when ruptured.
2. LATERAL COLLATERAL LIGAMENT:
• Proximal Attachment – Lateral femoral condyle.
• Distal Attachment – joins with biceps femoris tendon
to form conjoined tendon.
FUNCTIONS :
• Primary restraint to excessive adduction (varus)
stresses – Extension.
• Can also limit lateral rotation of tibia.
3. ANTERIOR CRUCIATE LIGAMENT:
• Distal Attachment – Anterior tibial spine extends
superiorly and posteriorly.
• Proximal attachment – Posteromedial aspect of
lateral femoral condyle.
• It has two bands – AMB and PLB.
FUNCTION :
• Primary restraint against anterior translation of tibia
on femur.
- PLB – full extension.
- AMB – as knee flexion increases.
• Resists Hyperextension.
• Secondary restraint to both valgus and varus forces.
• Muscle – ACL
- Quads – increases anterior translational force on tibia -
increases strain .
- Hams – induces posterior translational forces - Decreases
strain.
4. POSTERIOR CRUCIATE LIGAMENT :
• Distal Attachment – Posterior tibial spine and travels
superiorly and anteriorly.
• Proximal Attachment – Lateral Aspect of medial
condyle.
• Two bands – AMB and PLB.
FUNCTION :
• Primary restraint to posterior translation of tibia on femur .

- PLB : Full Extension - AMB : 80 – 90 deg flexion

• Resists tibial medial rotation – 90 deg flexion

• Doesn’t resist lateral rotation.

• Muscle – PCL

- Quads – decreases strain - Hams – increases strain

5. POSTERIOR CAPSULE LIGAMENTS :

Medial Lateral
- Oblique popliteal Ligament - Arcuate Ligament
(tendinous expansion of SM) (y – shaped)
- Posterior oblique ligament
medial lateral
FUNCTION :
- Reinforces
joint capsule.
• Proximal Attachment – formed from
fascia investing tensor fascialata, gluteus
medius & maximus muscle.
• Distal Attachment – Lateral intermuscular
septum , inserts into anterolateral tibia.
• Note – moves anterior to joint in extension,
posterior to joint in flexion - it is consistently
taut .
• Function:
- Along with ACL – checks anterior tibial translation (full
extension).
- Knee flexion – IT band + LCL + Popliteal tendon , Increases
lateral stability.
1.Bursae that communicate or invaginations of
synovial membrane
• Suprapatellar – between quads tendon & Ant femur.
• Subpopliteal – between popliteus tendon & lateral
femoral condyle.
• Gastrocnemius – between gastrocnemius muscle and
medial femoral condyle.
FUNCTION:
 Allows lubricating synovial
fluid to move.
 Extension – Gastrocnemius
and
Subpopliteal bursae are
compressed –
shifts fluid anteriorly.
 Flexion – Suprapatellar bursa
is compressed – shifts fluid
posteriorly.
 Semiflexed – fluid is in least
amount of pressure.
2. Bursae that doesn’t communicate with synovial
capsule
• Prepatellar – between skin and ant surface of patella.
• Infrapatellar – between patellar tendon and
overlying skin.
FUNCTION :
 Allows free movement of skin.
• AXIS – horizontal line passing through femoral
condyles – not truly fixed but shifts due to
incongruent joint surfaces.
• FEMUR ON TIBIA (Ex: during squat).
*Flexion – femur rolls posteriorly (initial knee flexion :
0 - 25 deg) and glides anteriorly (spin).
*Extension – femur rolls anteriorly and glides
posteriorly.
• TIBIA ON FEMUR (Ex : during seated knee extension)
*Flexion – Tibia rolls and glides posteriorly.
*Extension – Tibia rolls and glides anteriorly.
• ROLE OF CRUCIATE LIGAMENTS
*Flexion - ACL gets taut during posterior rotation – causes
anterior translational force.
*Extension – PCL gets taut during anterior rotation –
causes posterior translational force.
• ROLE OF MENISCI
*Flexion – femur moves anterior – deforms menisci
posteriorly.
*Extension – menisci returns – deforms anteriorly to be
under femoral condyles.
• RANGE OF MOTION
*Flexion – Active – 140deg (hip flexed)
- 120 deg (hip extended)
- Passive – 160 deg
*Extension – 5deg
• AXIS – Longitudinal – runs through or close to medial
tibial intercondylar tubercle
• TIBIA ON FEMUR
*Lateral Rotation - Medial condyle – moves slightly
anterior , Lateral condyle – moves larger distance
posteriorly.
*Medial Rotation – opposite to LR.
• RANGE OF MOTION
- Maximum at 90 deg flexion –
diminishes towards flexion and extension.
MR - 0 – 15deg LR – 0 -20deg
• PLANE - frontal plane.
• Minimal but it does exist.
• Excessive frontal plane motion could indicate
ligamentous insufficiency.
EXTENSION
• During last 30 degrees the femoral lateral condyle
completes its rolling & gliding movement.
• As medial condyle is larger it continues the motion –
Lateral rotation of tibia.
• Tibial tubercles gets lodged in the intercondylar
notch – menisci are tightly interposed – ligament are
taut.
FLEXION :
• First medial rotation of tibia occurs – the larger
medial femoral condyle starts rolling and gliding.
• This unlocks the joint and further rolling and gliding
of both condyles takes place.
NOTE : Motions of knee joint , exclusive of automatic
rotation are produced to great extent by muscles.
FLEXOR GROUP :
1.Hamstrings
- Semimembranosus
- Semitendinosus two joint muscles
- Biceps femoris crosses hip and knee
long head
short head
2.Sartorius
3.Gracilis
4.Popliteus
5.Gastrocnemius
FUNCTIONS :
• All the flexor muscles help in the flexion movement.
• Semimembranosus, semitendinosus, popliteus,
gracilis and sartorius – medially rotates tibia on fixed
femur.
• Biceps femoris – laterally rotates.
• Lateral muscles – Biceps, lateral head of
gastrocnemius, popliteus – produces valgus
movement.
• Medial muscles – semimembranosus ,
semitendinosus, medial head of gastrocnemius –
produces varus movements.
EXTENSOR GROUP :
• Quadriceps femoris
- Rectus femoris – two joint muscle
- Vastus medialis
- Vastus intermedius common quads tendon
- Vastus lateralis
• Vastus medialis has upper and lower fibers.
• Upper fibers – Vastus medialis longus.
• Lower fibers – Vastus medialis obliqus.
• Joint Structure and Function: A Comprehensive
Analysis Fourth Edition – Cynthia Norkins.
• Kapandji – The physiology of joints – Volume 2 – The
Lower limb.