PATHOMECHANICS OF THE KNEE

Knee Deformities
Genu valgum Genu Varum Genu Recurvatum

Biomechanical Consideration
Length of Lever Arms Muscle Force to the knee joint Alignment of the femur and the tibia Orientation of the Joint axes Stresses in the femur

Length of Lever Arms

Length of the femur and tibia 25 % of the total ht The longer the length, the greater the stress on the tibia Due to medial angulation of the vertically directed femur, medial cruciate and collateral ligaments resist this angulation

Muscle Force to the knee joint

Ms contraction produces joint compression The Greater the weight imposed to the lower leg = the greater the ms force needed = the greater the compressive force or stress receive by the knee joint

Muscle Force to the knee joint

Stress cause sufficient pain and possible damage to joint

Muscle Force to the knee joint

Stress will occur if the following may occur: 1. Abnormal alignment of femur, tibia and patella 2. Improper relationship of anatomic transeverse joint axes 3. Uneven distribution of load on femur, tibia, ligaments and mucles
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Alignment of the femur and the tibia

femural and tibial shaft angle = 170 degrees

Orientation of the Joint axes

View from Frontal plane transverse axis of femur is horizontal Ankle axis is 25 deg. ER Angle of anteversion of the hip - 10 to 15 deg

Stresses in the femur

Femur will be receiving compressive or tensile stress = cause by gravity Lateral side of the femur = receive tensile stress Medial side = receive compressive stress ITB - helps to counteract gravitational stresses
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Angular Abnormalities
Genu Valgum Genu Varum Genu Recurvatum

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Genu Valgum
Knee are closer together and feet apart Uneven distribution of wt = > on the lat. Caused by laxity on the medial structures or ligaments ITB tightness exerts force that tends to produce genu valgum Patellar lateral displacement will lead to valgum
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Genu Valgum
Tilting of the joint axis: 1. Caused by damage of the lat. Epiphysis which retard the rate growth on the lateral side 2. Healed Fx with depressed lat.plateau or depressed shaft (F+T)

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Mechanical assistance
Laterally directed counterforce must be applied to resist the knee going medially = use of straps Shoe mod = medial heel and Sole wedge -it helps to reduce tendency of valgum deformity

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Genu varum
Lateral displacement of the knee joint Floor reaction = shifted medially Medial condyles - subjected for compressive forces 1 due to uneven growth of epiphysis May be due to bowing of the femur or tibia

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Genu varum
Genu varum may walk with either pes valgus or pes varus

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Mechanica Assitance
Apply Orthosis with medially directed force straps Lateral heel wedges and sole of the shoe will provide help If fixed deformities medial wedge and sole will be applied

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Genu recurvatum
Frequent in standing and walking Structures prevent Recurvatum:
1. 2. 3. 4. 5. 6. Collateral and cruciate ligs Oblique popliteal ligs Posterior capsule Menisci Hams and gastroc Configuration of the condyles
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Genu recurvatum
Inc hyperextension = increase conpression of the anterior aspect menisci Caused by paralyzed quads Also possible cause is adequate strength of quads but weak hamstring Lead to slight forward bending of the trunk Tends to push back the thigh using the hand
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Genu recurvatum
Also caused by plantar flexion contracture Mechanical assistance Provide forward directed force thigh band and calf band or pressure padding behind the knee

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