BIOMECHANICS OF

KNEE JOINT
Dr.KARTHIKEYAN S
 INTRODUCTION

Complex hinge joint –

• Tibio-femoral joint
• Patello-femoral joint

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TIBIO - FEMORAL J O I N T
Ginglymus – Hinge joint
• A freely moving joint in which the bones are so
articulated as to allow extensive movement in one
plane.
Arthodial – Plane joint
• Opposed flat / curved surfaces allows gliding
movements
Tri-axial motion

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 KNEE D EGREE O F
F R
6 degrees of freedom
E E D O M
• 3 Rotations
• 3 Translations

Rotations
• Flexion / Extension : 0 – 1400
• Varus / Valgus : 6 – 80 in extension
• Int / ext rotation : 25 – 300 in flexion

Translations
• Anteroposterior : 5 - 10mm
• Compression / Distraction : 2 - 5mm
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• Medial / Lateral : 1-2mm
 FEMORAL A R T I C U L A R
S U R FA C E
• Medial & lateral condyles.
• Because of obliquity of shaft, the femoral condyles lie
slightly medial to the femoral head.
• The medial condyle extend further distally so that, despite the
angulation of the femur shaft, the distal end of the femur
remains essentially horizontal.

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In sagittal plane - Condyles have a convex shape
Lateral femoral condyle
• Shifted anteriorly in relation to medial
• Articular surface is shorter
Two condyles are separated –
• Inferiorly by Intercondylar notch
• Anteriorly by an asymmetrical, shallow groove called
the Patellar Groove or Sulcus

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 TIBIAL A RT I C U L AT I N G
S U R FA C E
• Asymmetrical medial & lateral tibial condyles.
• Antero-posteriorly medial tibial plateau is longer than
lateral.
• Tibial plateau slopes posteriorly approx 70 to 100.
• Medial & lateral tibial condyles are separated by two
bony spines called the Intercondylar / Tibial tubercles.
• The tibial plateaus are predominantly flat with
convexity at anterior and posterior margins.

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Medial condyle is 50% larger
than lateral condyle.

9o
congruency
.

22 June 2012 8
 MENISCI O F
KN E E J O I N T
• 2 asymmetrical fibro cartilaginous joint disk located
on tibial plateau.
• The medial meniscus is a semicircle and lateral is
4/5 of a ring.
• By increasing congruence, menisci play a role in
reducing friction between the joint segment and
serve as shock absorbers.
• In adult, only the peripheral vascularized region is
capable of inflammation, repair and remodeling
following a tearing injury. 9
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 MENISCAL
AT TA C H M E N T S
Common attachment of medial & lateral –
• Intercondylar tubercles of the tibia
• Tibial condyle via coronary ligaments
• Patella via patellomeniscal or patellofemoral ligament
• Transverse ligament between two menisci
• Anterior cruciate ligament (ACL)
Unique attachment of medial menisci –
• Medial collateral ligament (MCL)
• Semi-membranosus muscle
Unique attachment of lateral menisci –
• Anterior and posterior menisco-femoral ligament
• Posterior cruciate ligament (PCL)
• Popliteus muscle 11
 BIOMECHANICS OF MENISCI
 The compression of the menisci by the tibia and the femur
generates outward forces that push the meniscus out from
between the bones.
 The circumferential tension in the menisci counteracts
this radial force.
 Provision of stability
 Shock absorption
 Reduces contact stresses
 Provision of increased congruity
 Aids lubrication
 Prevents synovial impingement
 Limits extremes of flexion a n d extension
 Transmits loads across the joint – 50- 100% of load is
transmitted through menisci
 LIGAMENTS O F KN E E
JOINT
 Cruciate ligaments
• Anterior cruciate ligament (ACL)
• Posterior cruciate ligament (PCL)
 Collateral ligaments
• Medial collateral ligament ( MCL)
• Lateral collateral ligament (LCL)
 Posterior capsular ligament
 Meniscofemoral ligament
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 C RU C I AT E L I G A M E N T S
• Located within the joint capsule –
Intracapsular Ligaments but lie
outside the synovial cavity.
• Cruciate ligament provide stability
PCL
in sagittal plane.
ACL

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 ACL BIOMECHANICS
 Primarily –
• Check femur from being displaced posteriorly on the tibia.
• And anterior translation of tibia over femur.
 It tightens during extension, preventing excessive
hyperextension of the knee.
 ACL carries 87% of load when anterior translatory
force was applied to tibia with extended knee.
 Check tibial medial rotation by twisting around
PCL.
 ACL injury is common when knee is in flexed & tibia
rotated in either direction.
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 PCL BIOMECHANICS
 Primarily –
• Check femur from being displaced anteriorly on the tibia
• And posterio translation of tibia over femur.
 It tightens during flexion & is injured much less
frequently than ACL.
 PCL carry 93% of load when posterior translatory
force was applied to tibia with extended knee.
 PCL play a role in both restraining and
producing rotation of the tibia.

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 COLLATERAL LIGAMENTS
MCL BIOMECHANICS –
• Resist valgus stress force (specially in extended knee).
• Check lateral rotation of tibia.
• Also restrain anterior displacement of tibia when ACL
is absent.
LCL BIOMECHANICS –

• Resist varus stress force.

• Check combined lateral rotation with posterior
displacement of tibia in conjunction with tendon of
popliteal muscle.

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 POSTERIOR CAPSULAR
LIGAMENTS
• Oblique popliteal ligament
• Posterior oblique ligament
• Arcuate ligament – Lateral and Medial branches

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 M E N I S CO - F E M O R A L
L I G A M E N T S (MFL)
Attachment –
Origin – Both originate from posterior horn of lateral meniscus
Insertion – lateral aspect of medial femoral condyle
• The “Ligament of Humphry” or “Antero-MFL”
is the ligament run anterior to PCL on tibia
• The “Ligament of Wrisberg” or “Postero-MFL” is the
ligament run posterior to PCL, also known as “3rd Cruciate
Ligament of Robert”
 BIOMECHANICS –
• They may assist PCL in restraining posterior tibial translation
• Also assist popliteus muscle by checking tibial lateral rotation 21
 BIOMECHANICS

 Tibiofemoral joint
Rotations
Translations
Screw home mechanism
 Axial & rotational alignment of
knee
 Patello femoral joint
 Joint forces
F L E X I O N AND E X T E N S I O N
 Axis – no fixed axis but move through ROM
(frontal axis)
 Plane – sagittal plane
 ROM of flexion / extension –
• Flexion – 1300 – 1400
• Extension – 50 – 100 ( Beyond this – Genu
recurvatum)
 In close kinematic chain (CKC) – flexion /
extension range is limited by ankle range.
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During an activity such as squatting, knee flexion
may reach as much as 160° as the hip and knee
are both flexed and the body weight is super-
imposed on the joint.

Normal gait on level ground requires

approximately 60° to 70° of knee flexion,
whereas ascending stairs requires about 80°,
and sitting down into and arising from a chair
requires 90° of flexion or more.
 INSTANT CENTRE OF MOTION
 Flexion axis varies in a helical fashion in a normal knee, with
an average of 2 mm of posterior translation of the medial
femoral condyle on the tibia compared with 21 mm of
translation of the lateral femoral condyle.
 As the knee flexes, the instant center of rotation on the femur
moves posteriorly.
TF CKC FLEXION AND
FEMORAL ROLLBACK
 Early 00 - 250 knee flexion –
• Posterior rolling of
femoral condyles occurs
over the tibia.
 As flexion continues –
• Posterior Rolling accompanied by
simultaneous Anterior glide of femur.
• Create a pure Spin of femur on the
posterior tibia.
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 TF CKC E X T E N S I O N
 Extension from flexion is a
reversal of flexion motion.
 Early extension –
• Anterior rolling of femoral
condyles on tibial plateau.
 As extension continues –
• Anterior Rolling accompanied by
simultaneous Posterior glide of
femur.
• Produce a pure Spin of femoral
condyles on tibial plateau.
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 TF OCK FLEXION /
EXTENSION
 When tibia is flexed on a fixed femur –
• The tibia performed Both Posterior Rolling and
Gliding on relatively fixed femoral condyles.

 When tibia is Extended on a fixed femur –

• The tibia performed Both Anterior Rolling and
Gliding on relatively fixed femoral condyles.

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ROLE OF THE CRUCIATE LIGAMENTS
IN FLEXION/EXTENSION
Posterior rolling of the femur during knee flexion
causes the “rigid” ACL to tighten (or serve as a check
rein).
Continued rolling of the femur would result in the
taut ACL’s simultaneously creating an anterior
translational force on the femoral condyles.
During knee extension, the femoral condyles roll
anteriorly on the tibial plateau until the “rigid” PCL
checks further anterior progression of the femur,
creating a posterior translational force on the
femoral condyles.
 ROLE OF THE MENISCI IN
FLEXION/EXTENSION
The anterior glide of the femur during flexion is
further facilitated by the shape of the menisci.

The wedge shape of the menisci posteriorly forces the

femoral condyle to roll “uphill” as the knee flexes.

The oblique contact force of the menisci on the

femur helps guide the femur anteriorly during
flexion while the reaction force of the femur on the
menisci deforms the menisci posteriorly on the tibial
plateau.
As the knee joint begins to return to extension from
full flexion, the posterior margins of the menisci
return to their neutral position.

As extension continues, the anterior margins of the

menisci deform anteriorly with the femoral
condyles.
This motion (or distortion) of the menisci is an
important component of tibiofemoral flexion
and extension.

Thus menisci reduce friction and absorb the

forces of the femoral condyles that are imposed
on the relatively small tibial plateau.
 Also this posterior deformation of the menisci is assisted by
muscular mechanisms.
 During knee flexion the semimembranosus exerts a
posterior pull on the medial meniscus whereas the
popliteus assists with deformation of the lateral meniscus.
 MEDIAL / L A T E R A L
RO TAT I O N
 Axis – Longitudinal / Vertical axis
 Plane – Transverse plane
 ROM at 900 knee flexion –
• Lateral rotation – 00 – 400
• Medial rotation – 00 – 300

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The medial condyle acts as the pivot point while the
lateral condyle move through a greater arc of
motion.
During tibial medial rotation, the medial tibial
condyle moves slightly posteriorly whereas the
lateral condyle moves anteriorly through a larger
arc of motion and vice versa in lateral rotation.
 During both medial and lateral rotation, the menisci will
distort in the direction of movement of the corresponding
femoral condyle and therefore maintain their relationship to
the femoral condyles just as they did in flexion and extension.

 Axial rotation is permitted by articular incongurence and

ligamentous laxity. Therefore, the range of knee joint rotation
depends on the flexion/extension position of the knee.

 When the knee is in full extension the ligaments are taut, the
tibial tubercles are lodged in the intercondylar notch and
also the menisci are tightly interposed between the
articulating surfaces, hence very little axial rotation is
possible.
As the knee flexes toward 900, capsular and
ligamentous laxity increase, the tibial tubercles are
no longer in the intercondylar notch, and the
condyles of the tibia and femur are free to move on
each other.

The maximum range of axial rotation is available

at 900 of knee flexion. The magnitude of axial
rotation diminishes as the knee approaches both
full extension and full flexion.
 VALGUS (ABDUCTION) /
VARUS (ADDUCTION)
 Axis – Frontal axis
 Plane – Coronal plane
 ROM –
• Full extension – upto 80
• 20° of knee flexion – upto 13°
 Excessive coronal plane motion
indicates ligamentous insufficiency.
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 COUPLED MOTIONS
 The true flexion/extension axis is not perpendicular to the
shafts of the femur and tibia.
 Biplanar intra-articular motions can occur because of the
oblique orientation of the axes of motion with respect to the
bony levers.

 Therefore, flexion and extension do not occur as pure

sagittal plane motions but include frontal plane
components termed “coupled motions” (similar to coupling
that occurs with lateral flexion and rotation in the vertebral
column).
 Flexion is coupled with varus motion,while extension is
coupled with valgus motion.
LOCKING AND UNLOCKING
–
"SCREW-HOME
MECHANISM"

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LO C KI N G O F KN E E J O I N T
 CKC femoral extension from 300 flexion –
• Larger medial femoral condyle continue rolling and
gliding posteriorly when smaller lateral side stopped.
• These result in medial rotation of femur on tibia, seen in last
50 of extension.
• The medial rotation of femur at final stage of extension is
not voluntary or produce by muscular force, which is
referred as “Automatic” or “Terminal Rotation”.
• The rotation within the joint bring the joint into a closed
packed or Locked position.
• The consequences of automatic rotation is also known
as
• “Locking Mechanism” or “Screw Home Mechanism”.
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 OKC – lateral rotation of tibia occurs on fixed
UNLOCKING O F KNEE J O I N T

• To initiate flexion, knee must be unlocked.

• A flexion force will automatically result in lateral
rotation of femur and the larger medial condyle will
move before the shorter lateral condyle.
• Popliteus is the primary muscle for unlocking the
knee.

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 AXIAL AND ROTATIONAL
ALIGNMENT OF KNEE
Mechanical axis of the lower limb is defined as the line
drawn on a standing long leg antero posterior radiograph
from the center of the femoral head to the center of the talar
dome.
 Anatomic / longitudinal axis –
o Femur – Oblique, directed inferiorly & medially
o Tibia – Directed vertically
o The femoral and tibial longitudinal axis form an angle
(tibiofemoral angle) medially at the knee joint i.e. 50 – 100 creating
Physiological Valgus at knee.
 In bilateral static stance – equal weight distribution
on medial and lateral condyle.
Deviation in normal force distribution –
• TF angle > 100 – Genu Valgum – compress
lateral condyle
• TF angle < 00 – Genu Varum – compress
medial condyle
Compressive force in dynamic knee
joint
• 2 – 3 times body weight in normal gait
• 5 – 6 times body weight in activities (like –
Running, Stair Climbing etc.)

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PATELLO-FEMORAL JOINT
(PFJ)

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 PF J F U N C T I O N
• The triangular shaped patella is the largest sesamoid bone
in body.
• It works primarily as an anatomical pulley – increases the
lever arm of the extensor mechanism around the knee,
improving the efficiency of quadriceps contraction.
• It reduces the friction between quadriceps tendon and
femoral condyle.
• The ability of the patella to perform its function without
restricting knee motion depends on its mobility.
• “Sliding” articulation - patella moves 7cm caudally
during full flexion.
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 PFJ A R T I C U L A T I N G
S U R FA C E
• PFJ is the least congruent joint.
• The posterior surface of patella is divided by a vertical
ridge into medial and lateral patellar facets.
• The ridge is located slightly towards the medial facet
making smaller medial facet
• The medial and lateral facet are flat & slightly
convex side to side & top to bottom.
• At least 30% of patella have 2nd ridge separating medial
facet from the extreme medial edge known as Odd
Facet of Patella.
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 FEMORAL A R T I C U L AT I N G
S U R FA C E
• Patella articulates with
femur at intercondylar
groove or femoral sulcus
on anterior surface of
distal femur.
• Femoral surface are
concave side to side and
convex top to bottom.

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 PFJ CO N G RU E N C E
• The vertical position of the patella in femoral sulcus is
related to length of patellar tendon, approximately 1:1
and is referred to as Insall-Salvati index.
• An excessive long tendon produce an abnormally high
position of patella on femoral sulcus known as
Patella alta.
• In neutral / semi flexed or extended knee, the patella has
little or no contact with the femoral sulcus beneath.
• In the fully extended knee, the patella lies on the
femoral sulcus.
• At full flexion, the patella is lodged in the
intercondylar groove.
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• At 100 – 200 of flexion – contact with
inferior margin of medial and lateral
facet.
• By 900 of flexion – all portion of
patella contact with femur except the
odd facet.
• Beyond 900 of flexion – medial
condyle with the intercondylar notch
and the odd facet achieves contact
for the first time.
• At 1350 of flexion – contact is on
lateral and odd facet with medial
facet completely out of contact. 56
 PAT E L L O - F E M O R A L
J O I N T S TA B I L I Z E R S
M E D I A L - L A T E R A L PFJ
S TA B I L I T Y
 PFJ is under permanent control of 2 restraining
mechanism across each other at right angles.
• Transverse group of stabilizers
• Longitudinal group of stabilizers

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 TRANSVERSE STABILIZERS
• Medial and lateral retinaculum
• Vastus Medialis and Lateralis
• The lateral PF ligament contributes 53% of total
force in full extension of knee.

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L O N G I T U D I N A L S TA B I L I Z E R S
• Patellar tendon – inferiorly
• Quadriceps tendon – superiorly

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 M E D I A L - L AT E R A L
P O S I T I O N I N G O F PA T E L L A /
PAT E L L A R T R AC K I N G
• When the knee is fully extended and relaxed, the
patella should not be able to passively displaced
medially or laterally more than its half.
• Imbalance in passive tension or change in line of
pull of dynamic structures will substantially
influence the patella.
• Abnormal force may influence the excursion of
patella even in its more secure location within
intercondylar notch in flexion.
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 MEDIAL AND L A T E R A L
F O R C E S ON PA T E L L A
• Since the action line of quadriceps and patellar
ligament do not co-inside, patella tend to pulled
slightly laterally and increase compression on
lateral patellar facets.
• Larger force on patella may cause it to
subluxate or dislocate off the lateral lip of
femur.

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Conditions predisposing to lateral patellar
subluxation or dislocation –

• Genu valgum - increase the obliquity of femur and oblique

the pull of quadriceps.

• Femoral anteversion and tibial torsion (OA Hip) -

increased obliquity in patella.

• Excessive tension in lateral retinaculum / weakness of

VMO.

• Insufficient height of lateral lips of femoral sulcus.

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 Q-ANGLE
 The angle between the extended anatomical axis of
the femur and the line between the center of the patella
and the tibial tubercle.

 Normal Q-angle :
› in flexion -
Males - 13 degrees
Females - 18 degrees
› in extension -
8 degrees
 Limbs with larger Q-angles
have a greater chance for
lateral patellar subluxation.
JOINT FORCES
 TIBIO-FEMORAL JOINT FORCES
Positions Force acting on joint
 Standing on both feet - Same as body wt
 Swing phase -
Half of body wt
 U/L stance phase -
2-4 times body wt
 Jogging -
6 times body wt
PATELLO-FEMORAL JOINT LOADING
Walking
› 0.3 x body weight
 Ascending Stairs
› 2.5 x body weight
 Descending Stairs
› 3.5 x body weight
 Squatting
› 7 x body weight
 GOALS OF KNEE REPLACEMENT
 Restoring mechanical alignment

 Restoring the joint line

 Balancing ligaments

 Maintaining a normal Q-angle

THANK YOU