Biomechanics

Lecture (5)
Hip joint
 Acetabulum and head of femur forming diarthroidal synovial ball and socket joint.
 Bony structure:
1. Acetabulum:
o Cup-like socket.
o Contain acetabulum labrum the increases the depth so that head of femur is better
inserted.
2. Head of femur: convex component (2/3 of sphere).
3. Femoral neck:
o Between head of femur and shaft.
o Attached to the shaft between greater and lesser trochanters.
o Angle of inclination  from frontal plane between axis of femoral neck and axis of the
femoral shaft normal 125 degrees (earlier 150 degrees) and smaller in women.
o Angle of torsion  from transverse plane between femoral neck and femoral condyles
normal 12-20 degrees (earlier 30-35 degrees).
 Bon architecture of proximal femur:
o Trabeculli that withstand various sorts of loads
1. Arcuate bundle.
2. Vertical bundle.
3. Lateral bundle.
 Hip fibrous capsule:
o Strong and dense, comes from periphery of acetabulum to base of femoral neck.
 Intercapsular pressure:
o Usually it is lower than the atmospheric pressure.
o Has a suction effect that provides stability.
o Reduced pressure reduces distension of the inflamed capsule.
o Atmospheric pressure = 0mmHg at 160 degrees of flexion  and equal to 25mmHg at 120
degrees of flexion  and equal to 35mmHg at 90 degrees.
 Ligaments:
1. Iliofemoral ligament  taut during flexion and prevents hyperextension.
2. Pubofemoral ligament  taut in abduction and extension.
3. Ischiofemoral  taut in extension and slack in flexion.
 Surrounding muscles.
 Hip kinematics:
o Femoral head glides in acetabulum in opposite direction to the distal end of femur motion.
o Abduction and adduction & medial and lateral rotation includes gliding and spinning at the
beginning in the opposite direction of distal end of femur motion.
 Close packed position: maximal extension with medial rotation.
 Loose packed position: 30 degrees of flexion, abduction, and lateral rotation.
 Pathomechanics:
1. Coxa valga  inclination angle > 125 degrees.
2. Coxa vara  inclination angle < 125 degrees.
3. Anteversion  angle of torsion increased.
4. Retroversion  angle of torsion decreased.
 Hip flexion limitation:
o Aproximation between trunk and thigh.
o Posterior joint capsule and gluteus maximus.
o Obesity.
 Hip extension limitation:
o Anterior joint capsule with the ligaments.
  Hip adduction limitation:
o Pubofemoral ligament.
 Hip abduction limitation:
o Hip adductors.
 Medial rotation limitations:
o Ischio femoral ligament.
o Posterior capsule.
o Lateral rotators of the hip.
 Lateral rotation limitation:
o Anterior capsule.
o Iliofemoral ligament & pubofemoral ligament.
Knee joint
 Condyloid or modified hinge.
1. Tibio-femoral joint:
o Between tibial and femoral condyles.
o The medial plateau sustains more forces than lateral because it is 50% larger.
o Bony architecture:
- Trabeculae from cortical bone of femur to ipsilateral condyle and into contralateral
condyle.
- Another trabeculae runs horizontally to unite the two condyles and resists shear loading.
o The capsule of knee joint:
- Covers medial and lateral tibo-femoral joint and patellofemoral joint.
- Tightness of the capsule limits knee flexion.
o Ligaments of the knee:
1. Medial collateral ligament  resists abduction.
2. Lateral collateral ligament  resists adduction.
3. Anterior cruciate ligament  resist extension.
4. Posterior cruciate ligament  resists excessive posterior translation of tibia and excessive
anterior translation of femur.
o Menisci:
- The two menisci lies on medial and lateral condyles of tibia.
 Act as shock absorber.
 Distribute pressure from femur on tibia.
 Weight bearing.
 Increases stability by deepening the tibial plateau.
 Increase contact are by 75%.
o Muscles of the knee joint:
- Extensors  Quadriceps femoris.
- Flexors  Hamstrings.
- Rotators  the lateral rotators as biceps femoris & medial rotators as semimembranosus.
o Stability of tibio-femoral joint:
- Close packed position  full extension and lateral rotation.
- Loose packed position  25 degrees of flexion.
- Detected by screw home mechanism.
- Transverse stability: collateral ligaments & muscles.
- Antero-posterior stability: cruciate ligaments.
2. Patellofemoral joint:
o Between patella and patellar area on femur.
o Functions of patella:
 Increase angle of pull of quadriceps.
 Acts as a pulley and increases internal moment arm of quadriceps.
 Centralize divergent tension of quads in single line of action.
 Protection of anterior of the knee.
o Kinematics: gliding motion.
 o Range of motion become limited if patella is prevented from gliding distally in knee flexion.
o Q-angle:
- Between lines coming from ASIS and middle of patella & line from tibial tuberosity and
patella.
- Extension: in male = 13 degrees and females = 18 degrees.
- Flexion = 8 degrees in both.
 Pathomechanics:
1. Genu-varum: valgus angle > 175 degrees.
 Bowleg.
2. Genu valgum: valgus angle < 175 degrees.
 Knock knees.
3. Genu recurvatum: hyperextension beyond 10 degrees.
 Hyperextension.
 Patellectomy: removal of patella
 Patient must exercise to increase strength of quadriceps about 30% more (better before
the surgery).
 Meniscectomy: removal of the menisci
 Increases the stress on the cartilage of tibial plateau.
 Weakness in vastus lateralis reduces knee extension strength.
 However, weakness in vastus medialis contributes faulty of patella-femoral joint and causes anterior
pain  in stabilizes the patella during quadriceps contraction (most important part in relation to the
rest of quadriceps).
Ankle joint
 Articulation of tibia with talus.
 Hinge synovial joint.
 Capsule: thin capsule, weak anteriorly and thicker posteriorly.
 Ligaments:
1. Tibio-fibular interosseous ligament.
2. Anterior and posterior tibio-fibular ligaments.
3. Medial and lateral collateral ligaments.
 Stability:
 Shape of talus.
 Anterior and posterior tibio-fibular ligaments.
 Surrounding muscle.
 Ankle capsule.
 Kinematics: moves around transverse axis of motion.
Subtalar joint: Talo-calcaneal joint & stable and moves around oblique axis of rotation.
Metatarsophalangeal joints
 Condyloid synovial
 Supination  plantarflexion + inversion + adduction.
 Pronation  dorsiflexion + eversion + abduction.
Interphalangeal joints: Synovial hinge.
Arches of the foot
 Medial longitudinal  shock absorber.
 Lateral longitudinal  maintains body during standing.
 Transverse arch  spring like arch.
 Pathomechanics: flat foot.
The most common injury in ankle is ankle sprain (rupture in the lateral ligament is more common the
medial ligament) & sometimes fracture occurs.