BME 322

Biomechanics of the Knee

 Introduction
• Knee joint:
– Largest and most complex in the human body
– Two-joint structure: tibiofemoral and patellofemoral
joints
– Sustains high forces and moments and is situated
between the body’s two longest lever arms and
hence particularly susceptible to injury

• Knee functions:
– Transmit loads
– Facilitate positions and movement of the body
– Aids in conservation of momentum
– Provide movements for activities involving the leg
Knee Structure
 Knee Structure: Muscles
Anterior View Posterior View
 Knee Kinematics
• Tibiofemoral joint:
– Surface motion in 3 planes
– Largest motion in sagittal
plane

• Patellofemoral joint:
– Surface motion mainly in
sagittal plane
Kinematics: ROM
Kinematics: ROM
 Surface Joint Motion
• Surface joint motion is the motion between the articulating
surfaces of a joint

• A simple 19th century method is still used as a first step

(Reuleaux, 1876): Instant Center Technique (IC)

• IC Technique can be used in the sagittal and frontal planes but

not the transverse and provides a description of the uni-planar
motion of two adjacent segments of a body as well as the
direction of displacement of the contact points between the two
segments.
IC Technique
 IC Technique

https://www.youtube.com/watch?v=UtdSJZn62H8

• Used to describe surface joint motion

• In sagittal plane instant center follows a curved
pathway:
– It reflects changing femoral radii of curvature

• Displacements of tibiofemoral contact point tangential

to tibial surface:
– Sliding occurs throughout range of motion:
• Medial side: sliding motion only
• Lateral side: combination of rolling and sliding
 Surface Joint Motion

To identify the surface joint motion:

1. Identify the IC as shown
2. Draw a line from the IC to the joint
contact point
3. A second line is drawn at right angle
which indicates the direction of
displacement
In a normal knee this line is tangential
indicating sliding

A line drawn from the IC of the tibio

femoral joint to the contact point, line A,
forms a right angle with the tangential to
the tibial surface, line B, the arrow
indicates the direction of displacement of
the contact points.
Pure sliding of the femur on the tibia in knee
extension: the contact point on the tibia does not
change, as the femur slides over it

Pure rolling of the femur on the tibia in knee flexion:

both the femur and the tibia contact points change
as the femur roles over the tibia

Actual knee motion with both Sliding and rolling

Patellofemoral Joint
A: The position of the patella at different ranges of knee flexion:
Until 90° flexion, contact is on the lateral and medial sides of the femoral
trochlea.
In high flexion the contact splits into two distinct areas. Adapted with permission from Hehne,
H. J. (1990). Biomechanics of the patellofemoral joint and its clinical relevance. Clin Orthop, 258, 73–85.

B: The contact areas at different flexion angles. Note the gradual superior shift of
the contacts with the flexion angle. The split contact in high flexion is evident.
 Screw Home Mechanism
• Occurs in the tibiofemoral joint in extension
• It involves external rotation during tibial
extension
• Adds stability to knee joint in full extension
• Additional passive stability given by:
– Ligaments structures
– Menisci
• Dynamic stability given by:
– Muscles surrounding the knee

Due to:
1. large sagittal radii of the distal
anterior femoral condyles
2. Shallow anterior lateral tibia
3. Upsweep on anterior medial tibia
https://www.youtube.com/watch?v=8QDTbhViMs8
@ 2min.22s

https://www.youtube.com/watch?v=8QDTbhViMs8
 Knee Kinetics
• Both the tibiofemoral and patellofemoral joints are
typically subjected to high forces
• Forces from muscles have greatest influence
• Knee compressive force ranges between 2 and 4 BW
during simple daily activities
• Higher flexion activities = highest forces
• Medial side carries higher forces than lateral
 Knee Kinetics

• Load-bearing structures:
– Mainly tibial plateaus
– Cartilage, menisci, ligaments also
carry loads
– Menisci aid distributing stresses,
reducing pressures on tibial
plateau
 Kinetics: Role of the Patella
• The patella provides an
important biomechanical
function in the knee by
lengthening the lever arm of the
quadriceps muscle force about
the center of rotation of the
knee, and hence increasing the
mechanics and efficiency of the
quads
– This occurs throughout entire
range of motion
– This allows wider distribution
of compressive stress on
femur
Kinetic Analysis: Stair Climbing
 Dynamic Analysis
Example:
Kicking a football:
– What is the joint reaction force on the tibiofemoral joint
in a soccer game during kicking a football

– Given:
• using a motion capture system the max angular acceleration
(a), found at the instant the foot struck the ball = 453 rad/sec2
• The mass moment of inertia (I) for the lower leg can be
approximated = 0.35 Nm sec2
 Dynamic Analysis
• Solution:
M=Ia:

If the perpendicular distance from the tibiofemoral joint is 0.05, what is the muscle
Force?

Therefore, 3170 N is the maximal force exerted by the quads muscle during the
Kicking motion (about twice the body weight for a typical player)

The main factors that influence the magnitude of forces on a joint

in dynamic situations are
– The acceleration of the body part
– The mass moment of inertia
 Knee Forces in Vivo
• Forces fall under three categories:
1. Category 1: high cyclic loading with a
moderate load (2-3 BW), many cycles and
peak load at low flexion angles (ex. level
walking)
2. Category 2: high loads in mid flexion (3-4 BW)
(ex. stair ascent and descent and golf swing)
3. Category 3: moderate loads at high flexion
angles (2-3 BW) (ex. sit-to-stand and
squatting)
 Knee Forces in Vivo

On the medial side (and on the lateral side) the femoral-tibial force
acts over the dotted area. The resultant force F produces a radial
force F × sin M and a compressive force F × cos M. The radial force
component produces tensile (hoop) stresses in the meniscus
 Knee Forces in Vivo
• The axial compressive force is
made up of the direct weight
of the body on the joint + the
muscle force necessary to
stabilize the moment of the
external GRF about the joint
center of rotation
• In general, the lever arm
increases with the angle of
flexion (ex/ stair activities
generating higher forces than
level walking)
 Knee Forces in Vivo
• The anterposterior shear forces acting
on the tibia are of about 4 BW are the
result of the body weight and muscle
forces
• An anterior shear force on the tibia is
carried in a normal knee by the PCL, the
medial meniscus, the upsweep of the
tibial surface, and the MCL
• A posterior force is carried by the ACL,
the medial meniscus, and the MCL
• In a normal knee, the vertical force
component is carried by the meniscus as
well as by the articular cartilage (the
higher the load, the more the cartilage
support)
 Stability of the Knee Joint
• Stability is key to healthy knees.
• The osseous configuration,
meniscus, ligaments, and capsule
all provide static stability
• The muscles surrounding the knee
provide dynamic stability
• The ligaments in particular play a
crucial role in stability, where the
cruciate ligaments provide AP
stability but also some in
IntRot/ExtRot, while the collaterals
primarily provide varus-valgus
stability
 Stability of the Knee Joint

• If ACL is ruptured immediate repair

(mainly using a patellar tendon
graft) is often carried out if the
patient is active

• A ruptured ACL, although may be

tolerated for inactive people, may
lead to osteoarthritis
https://www.youtube.com/watch?v=8QDTbhViMs8
Homework:

1- Revise the topics taught in the class, and highlight the subjects that were
unclear

2- Survey those topics online, and present the list of sources that helped you
clear the subjects.

3- Answer the question:

Considering the Biomedical Engineering career, in which scenario do you
foresee the use of the subjects learned? Highlight its importance.