SESSION 9

Dr Atefeh Aboutorabi
Ph.D Orthotics and Prosthetics
Assistant Prof., Department of Prosthetics & Orthotics,
University of Social Welfare and Rehabilitation Sciences
  Summary of ACL & PCL attachments –
 ACL – Runs from anterior tibia to posterior femur
 PCL – Runs from posterior tibia to anterior femur

27 November 2023 2
 Oblique popliteal ligament
 Attachment –
 Origin – The central part of
posterior aspect of the joint
capsule
 Insertion - Posterior medial tibial
condyle
 Function –
 Reinforces posteromedial knee
joint capsule obliquely on a
lateral-to-medial diagonal from
proximal to distal

27 November 2023 3
Meniscofemoral ligament (MFl)
 Origin – Both originate from posterior horn
of lateral meniscus
 Insertion – to 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”
 Function –
 They may assist PCL in restraining posterior tibial
translation
 Also assist popliteus muscle by checking tibial lateral
rotation
4
 Additional
Ligamentous
Support

•iliotibial band
thick, strong band of
tissue connecting
tensor fascia latae to
femur and tibia
Knee Joint Structures
 Bursa- fluid filled sac that reduce friction in a joint.
The knee has 13 due to all the tendons and their
vertical line of pull against bony area.
Bursa associated with knee
• Suprapatellar Bursa
Lies beneath the quadriceps muscle
Largest bursa and always communicates with the knee joint
 Pre-patellar bursa
 Located between the skin & anterior surface of patella
 They allows free movement of skin over patella during
knee flexion & extension
 Subcutaneous bursa
 Located between patellar ligament & overlying skin
 Deep infra-patellar bursa
 Located between patellar ligament & tibial tuberosity
 Helps in reducing friction between the patellar ligament
& tibial tuberosity

27 November 2023 7
27 November 2023 8
Knee Structures
 Popliteal space- area behind the knee that
contains important nerves and blood
vessels.
 The hamstrings and gastronemius make up
the diamond shaped boarder.
27 November 2023
Knee Joint
 Patellofemoral joint- articulation between the patella
and the femur.
 The triangular shape patella is a largest sesamoid bone in
body is a least congruent joint too.
 Patella’s main job is to increase the mechanical
advantage of the quad muscle and protect the knee
joint.
Knee Joint
 With a longer moment arm, there is more angular
force. With a shorter moment arm, the force would be
more directed to the joint than the tendon.
Patellofemural joint
 Posterior surface is divided by a vertical
ridge into medial & lateral patellar facets.
 The medial & lateral facet are flat &
slightly convex and Femoral surface are
concave side to side & convex 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.
 imbedded in quadriceps & patellar tendon
PFJ congruence
 The vertical position of
patella in is related to length
of patellar tendon,
approximately 1:1 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.

27 November 2023
 Contact area during movements
 At 100 – 200 of flexion – contact with
inferior margin of medial & lateral facet.
 By 900 of flexion – all portion of patella
contact with femur except the odd facet.
 Beyond 900 of flexion –odd facet
achieves contact for the first time.
 At 1350 of flexion – contact is on lateral
& odd facet with medial facet
completely out of contact.

27 November 2023 15
 Medial-lateral positioning of patella /
patellar tracking
 When the knee is fully extended & relax, the patella should
be able to passively displaced medially or laterally not more
then one half of patella.
 Imbalance in passive tension or change in line of pull of
dynamic structures will substantially influence the patella.
 Since the action line of quadriceps & patellar ligament do
not co-inside, patella tend to pulled slightly laterally &
increase compression on lateral patellar facets.
 Larger force on patella may cause it to subluxation or
dislocate off the lateral lip of femur.

27 November 2023 16
patellar tracking
 Medial-lateral positioning of patella /
patellar tracking
 Genu valgum increase the obliquity
of femur & oblique the pull of
quadriceps.
 weakness of VMO may cause the
patella to tilt laterally.
 Insufficient height of lateral lips of
femoral sulcus may create patellar
subluxation or fully dislocation, even
with relatively small lateral force.

27 November 2023 18
Patellofemoral Biomechanics
 Joint Reactive Force
 In flexion, patella
compressed onto femur
creating joint reactive force
 Stair climbing – 3.5 X BW
 Deep bends – 7-8 X BW
 Compressive force in dynamic
knee joint
 2 – 3 time body weight in normal
gait
 5 – 6 time body weight in
activities (like – Running, Stair
Climbing etc.)