Knee Anatomy & Disorders

Knee Anatomy
- The Knee Joint is the largest & most complicated joint
in the body .

- It consists of 3 Joints within a single synovial cavity :

1) Medial Condylar Joint : Between the medial condyle
“of the femur” & the medial condyle “of the tibia” .
2) Latral Condylar Joint : Between the lateral condyle “of
the femur” & the lateral condyle “of the tibia” .
3) Patellofemoral Joint : Between the patella & the
patellar surface of the femur .

- The fibula is NOT directly involved in the joint .

Types :
- 1 & 2 : Hinge .
- 3 : Planar gliding .
Anatomical Components of the Knee

1) Capsule : Surrounds the sides & posterior

aspect of the joint… On the frontal side ,
the capsule is absent .
On each side of the patella , the capsule is
strengthened by the tendons of Vastus
Lateralis & Vastus Medialis .
2) Ligaments :
A] Extracapsular
Ligaments :
- Ligamentum Patellea
((a continuation of the
Quariceps Femoris
muscle ))
- Lateral Collateral Lig.
- Medial Collateral Lig.
- Oblique Popliteal Lig
(( derived from the
Semimembranosus
muscle )).
B ) Intracapsular Ligaments :
Cruciate Ligaments : 2 strong ligaments that cross each other within the
joint cavity .
~ Anterior Cruciate Ligament (ACL) :
= Attached to the anterior intercondylar area
of the tibia , passes upward , backward &
laterally to get attached to the lateral femoral
condyle .
= Prevents posterior displacement of the
femur (( With the knee joint flexed , the ACL
prevents the tibia from being pulled anteriorly)) .
~ Posterior Cruciate Ligament (PCL) :
=Attached to the posterior intercondylar area of the tibia , passes upward ,
forward , & medially to get attached to the medial femoral condyle .
= Prevents anterior displacement of the femur (( With the knee joint flexed ,
the PCL prevents the tibia from being pulled posteriorly )) .
- The medial and lateral menisci are 2 C-shaped sheets of
fibrocartilage between the tibial & femoral condyles

- Their peripheral border is thick & attached to the capsule ,

their inner border is thin & forms a free edge .

- Each meniscus is attached to the upper surface of the tibia by

anterior & posterior horns .

- They are connected to each other by the transversa ligament and to

the margins of the head of the tibia by coronary ligaments.
- There are several differences between the medial and lateral
meniscus, both anatomically (how they look) and functionally
(how they work).  Since the medial meniscus is attached to the joint
capsule all around its outer edge, it does not slide much in any
direction and is therefore more likely to tear.  The lateral meniscus
is more rounded, and there is a section where it is not attached to
the joint capsule wall.  Therefore it is more likely to move rather
than tear.

- They increase the stability of the knee, control rolling and gliding
actions of the knee & distribute the load during movement .
 One differentiates morphologically
(= related to the cellular structure) :
1. The meniscus base, which is in
immediate contact with the joint
capsule (red zone)
2. The intermediate meniscus region
(light red zone)
3. The white fringes.

Vessels penetrate through the red zone

until the central third of the
meniscus (designated as light red)…
By contrast, the white fringe
indicates no vessels. It is nourished
via the joint fluid (= joint
lubrication).
Thick, circular-triangular bone which articulates with the femur and
covers and protects the anterior articular surface of the knee joint.
It is the largest sesamoid bone .

Anterior surface
It can be divided into three parts:
 The upper third is coarse, flattened,
and rough; it serves for the attachment
of the tendon of the quadriceps and often has exostoses.
 The middle third has numerous vascular canaliculi.
 The lower third includes the distal apex which serves as the origin of
the patellar ligament.

Posterior surface
The upper three-quarters articulates with the femur and is subdivided into
a medial and a lateral facet by a vertical ledge which varies in shape.
 It is attached to the tendon of
the quadriceps femoris muscle, which contracts to
extend/straighten the knee. The vastus
intermedialis muscle is attached to the base of
patella. Thevastus lateralis and vastus
medialis are attached to lateral and medial borders
of patella respectively.
 The knee is normally in slight valgus so there is a
natural tendency for the patella to pulled to the
lateral side when the quadriceps muscle is
contracted
 The patella is stabilized by the insertion of vastus
medialis and the prominence of the anterior
femoral condyles, which prevent lateral
dislocation during flexion.
 When injuries occur, all structures are
simultaneously affected.
These ligaments hold the patella in place
during static and dynamic phases.
 Innervation of the Knee
 Femoral Nerve :
Common Peroneal
(( Fibular )) Nerve .
Tibial Nerve .
 Knee Movements
- Flexion : these muscles produce flexion :
Biceps femoris , Semitendinosus ,
Semimembranosus , Gracilis, Sartorius , Popliteus .
~ Flexion is limited by the contact of the back of the
leg with the thigh .

- Extension : by the Quadriceps femoris .

~ Extension is limited by the tension of all the
ligaments of the joint .

- Medial Rotation : by the Sartorius , Gracilis ,

Semtendinosus .

- Lateral Rotation : by the Biceps femoris .

OSTEOARITHRITIS
 c/o: middle age patient complain
of pain starts insidiously and increase
slowly over time ( months and years )
aggravated by exertion and relieved by
rest, with time relief is less and less
complete.
 Stiffness :mainly after rest
 Symptoms follow an intermittent course
with periods of remission lasts for months
 In advance stage : deformity ,swelling,
muscle wasting and loss of mobility .
 No systemic manifestations in contrast to
inf. diseases.
Osteoarthritis (OA) : a chronic inflammatory
joint disorder in which there’s progressive
softening & destruction of the articular
cartilage , accompanied by new growth of
cartilage and bone at the joint margins
(osteophytes) and capsular fibrosis... leading
to bone exposure & severe pain .

OA is the most common joint dis.

The knee is the most common site.

It can be primary or secondary :
 Usually it’s Primary (( Idiopathic )) &
affecting both knee joints ((Bilateral)) .
 Secondary causes might be :
Trauma , localized or metabolic diseases ,
mechanical factors , Bone Dysplasia , etc …
 Secondary causes of OA
A. Trauma
1. Acute
2. Chronic (occupational, sports)
B. Congenital or
developmental
1. Localized diseases: Legg-Calve-
Perthes, congenital hip
dislocation, slipped epiphysis
2. Mechanical factors: unequal
lower extremity length,
valgus/varus deformity,
hypermobility syndromes
3. Bone dysplasias: epiphyseal
dysplasia, spondyloepiphyseal
dysplasia, osteonychondystrophy
C. Metabolic
1. Ochronosis (alkaptonuria)
2. Hemochromatosis
3. Wilson's disease
4. Gaucher's disease
D. Endocrine
1. Acromegaly
2. Hyperparathyroidism
3. Diabetes mellitus
4. Obesity
5. Hypothyroidism
E. Calcium deposition diseases
1. Calcium pyrophosphate dihydrate deposition
2. Apatite arthropathy
F. Other bone and joint diseases
1. Localized: fracture, avascular necrosis,
infection, gout
2. Diffuse: rheumatoid (inflammatory) arthritis,
Paget's disease, osteopetrosis,
osteochondritis
G. Neuropathic (Charcot joints)
H. Endemic
1. Kashin-Beck
2. Mseleni
I. Miscellaneous
1. Frostbite
2. Caisson's disease
3. Hemoglobinopathies
 Risk factors:
1- age .
The likelihood of developing osteoarthritis increases with age. The disease is equally
common among men and women aged 45-55 years. After age 55 years, the disease
becomes more common in women.
2- Racial difference.
Knee osteoarthritis appears to be more common in African American women than in
other groups.
3- 2ndy cause e.g hx of trauma .
4- obesity.
5- family Hx.

 Predisposing factors :
1) Articular surface injury .
2) Torn meniscus .
3) Ligament instability .
4) Preexisting deformity .
 OA results from a
disparity between the stress
applied to the articular
cartilage & the ability of the
cartilage to withstand that
stress , due to :

1)Weakening of the articular cartilage ( genetic defect in collagen

type ll or inflammatory disorder “RA” ) .
2) Increased mechanical stress in some parts of the articular surface .

The abraded bone under a cartilage ulcer may take on the

appearance of ivory (eburnation = the bony sclerosis which occurs
at the areas of cartilage loss.). Growth of cartilage and bone at the
joint margins leads to osteophytes (spurs), which alter the contour
of the joint and may restrict movement
- Appositional bone growth
occurs in the subchondral
region
- seen radiographically - .

Synovitis & thickening of

the joint capsule may occur
& further restrict movement

Periarticular muscle wasting is common & may play a

major role in symptoms .

- So , to summarize the cardinal features are:

1) Progressive loss of cartilage thickness .
2) Subarticular cyst formation and sclerosis.
3) Remodeling of the bone ends & osteophyte formation .
4) Synovial irritation (( Synovitis )) .
5) Capsular thickening & fibrosis .
 X-Ray Findings

1- narrowing of joint
space.
2- subarticular cyst
formation and sclerosis.
3- osteophyte formation.
4- evidences of 2ndry
causes
e.g. old fracture.

The first two are restricted initially to the

major load-bearing part of the joint but
later the entire joint is affected.
Pre Op…
Post Op… THR
 Management
- Early :
1) Relieve the pain : by using NSAIDs .
2) Joint mobility : by physiotherapy .
3) Reduce the load : by using a walking stick , soft
medical shoes, weight reduction & avoid
stressful activities .
If symptoms increase despite conservative treatment some form of operative
treatment may be needed such as joint debridement: removal of interfering
osteophytes and cartilage tags and loose bodies realignment osteotomy

- Late :
Surgical intervention :
Total Knee Arthroplasty (TKA) :
 The primary indication for TKA is to relieve pain caused by severe arthritis .
~ Pain should be significant & disabling , especially during night .
dysfunction of the knee is causing significant reduction in the patient's quality
of life
 significant deformity