Biomechanics of Knee COMPLEX

D R . S U M I T R A G H AV ( P T )
A S S I S TA N T P R O F E S S O R
 Introduction

Knee complex plays a major role in supporting the

body during dynamic and static activities

In a closed kinematic chain, the knee complex works

with hip joint and ankle joint to support the body
weight in static erect posture.
Cont…

Dynamically, the knee complex is responsible for

moving and supporting the body in sitting and
squatting activities and supporting and transferring
the body weight during locomotor activities

In an open kinematic chain, the knee provides

mobility for the foot in space.
 Knee Complex

The knee complex is composed of two distinct

articulations:-

a) Tibio-femoral joint

b) Patello-femoral joint
Knee Complex
 Tibio-femoral Joint

Femoral Articulation: (Distal)

 Pulley shaped, convex, longer antero-posteriorly
than transversely.
Medial condyle 2/3 of inch longer than lateral
condyle

Tibial Articulation: (proximal)

Concave, medial tibial condyle (Plateau) is larger than
lateral condyle (approx. 50%)
 Tibio-femoral articulation

Femoral Articulation Tibial Articulation

Cont….

All articular surfaces are covered by cartilage with a

thickness of 3-4 mm.

Condyles (plateaus) of tibia are separated by a

roughened areas and two bony spines called the
inter-condylar tubercle, these tubercles become
lodged in the inter-condylar notch of the femur
during knee extension
 Tibio-femoral Articulation

When the large articular condyles of the femur are

placed on the shallow concavities of the tibial
condyles (Plateaus), the congruence of the knee joint
is evident.

Articular incongruence at the knee joint is

accompanied by a structure that enhances
congruence at the joint and assist in the balance
between mobility and stability, this structure is
called as Menisci.
Tibio-femoral Articulation
 Menisci

2 asymmetrical fibrocatilaginous joint disk called menisci

are located on tibial plataeus.

Medial meniscus is a semicircle and lateral is 4/5 of a ring

(Willium, PL, 1995)

Both menisci are open towards intercondylar area of

femur, thick peripherally, thin centrally forming cavities
for femoral condyle
Cont….

By increasing congruence, menisci play in reducing

friction between the joint segment and serve as shock
absorber.
Meniscal Attachment

Common attachment of medial and lateral side-

• Intercondylar tubercles of the tibia
• Tibial condyle via coronary ligaments
• Patella via patello-meniscal or patello-femoaral ligament
• Transverse ligament between two menisci
• Anterior cruciate ligament (ACL)
Young children whose menisci have ample of blood
supply have low incidence of injury.

In adult, only the peripheral vascularized region is

capable of inflammation, repair and remodeling
following a tearing injury.

Menisci are well innervated with free nerve ending

and 3 mechanoreceptors (Ruffine corpuscle,
Pacinian corpuscle and golgi tendon organs)
 TF Alignment and weight bearing force

The anatomic/ longitudinal axis-

Femur- oblique, directed inferiorly and medially
Tibia - directed vertically
The femoral and tibial longitudinal axis from an
angle medially at the knee joint of 185-190, i.e. 5-10
creating physiological valgus at knee
In bilateral static stance- equal weight distribution on
medial and lateral condyle
Conti….

Deviation in normal force distribution-

TF angle>190 - genu valgum- compress lateral
condyle
TF angle< 180- genu varum- compress medial condyle

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.)
Knee Joint Capsule

Joint capsule enclose TF and PF is large lax.

It’s outer portion firmly attached to the inferior
aspect of femur and superior portion of tibia.

Posterior attachment
Proximally to posterior margins of the femoral
condyles and intercondylar notch.
Distally to posterior tibial condyle
Cont….

Anterior attachment
Superiorly- patella, tendon of quadriceps muscles

Inferiorly patellar tendon complete the anterior

portion of the joint the capsule.

The antero-medial and antero-lateral portions of the

capsule, are often separately identified as the medial
and lateral patellar retinaculae or together as the
extensor retinaculum.
Cont….

The joint capsule is reinforced medially, laterally and

posteriorly by capsular ligaments.
Ligaments

Collateral ligament
Medial collateral ligament (MCL)
Lateral collateral ligament (LCL)

Cruciate ligaments
• Anterior cruciate ligament
• Posterior cruciate ligament

Posterior capsular ligament

MCL

Attachment-
Origin- medial aspect of medial femoral condyle
Insertion- proximal tibia

Function-
Resist valgus stress force (specially in extended
knee)
Check lateral rotation of tibia
Also restrain anterior displacement of tibia when
ACL is absent
LCL

Attachment-
Origin- lateral femoral condyle
Insertion- posteriorly to head of fibula

Function-
• It resists varus stress force across the knee
Check combined lateral rotation with posterior
displacement of tibia in conjunction with tendon of
popliteal muscle.
Cruciate Ligament

 Cruciate means “Resembling a cross” in latin.

 Located within the joint capsule and are therefore called

intra-capsular ligament.
 Cruciate ligament provide stability in sagittal plane

 The ACL and PCL are centrally located within the capsule

but lie outside the synovial cavity.

ACL

Attachment-
Origin- from anterior surface the tibia in the inter-condylar area
just medial to medial meniscus

It spans the knee laterally to PCL and runs in a superior and
posterior direction

Insertion – to posteriorly on lateral condyle of femur

ACL is divided into 2 Bands-

Antero-medial band
Postero-medial band
Function of ACL

Primarily-
Check femur from being displaced posteriorly on the
tibia
Conversely, the tibia from being displayed anteriorly
on femur
It tightens during extension, preventing excessive
hyperextension of the knee
ACL carried 87% of load when anterior translatory
forces was applied to tibia with extended knee
Cont….

Check tibial medial rotation by twisting around PCL

ACL injury is common when knee is in flexed and

tibia rotated in either direction
PCL

Attachment-
Origin- from posterior tibia in intercondylar area
and runs in superior and anterior direction on
medial side of ACL
Insertion- to anterior femur on the medial condyle

PCL is divided into 2 bands-

Antero-medial band
Postero-medial band
Function of PCL

Primarily-
Check femur from being displaced anteriorly on the
tibia or
Tibia from being displaced posteriorly on femur
It tightens during flexion and is injured much less
frequently than ACL
PCL carry 93% of load when posterior translatory
force was applied to the tibia with extended knee
PCL play a role in both restraining and producing
rotation of the tibia.
Summary of ACL & PCL attachments-

ACL- runs from anterior tibia to posterior femur

PCL- runs from posterior tibia to anterior femur
Posterior Capsular Ligament

Oblique popliteal ligament (OPL)

Posterior oblique ligament (POL)
Arcuate ligament:
 Arcuate ligament lateral Branch
 Arcuate ligament Medial Branch
OPL

Attachment-
Origin – the central part of posterior aspect of the
joint capsule
Insertion – posterior medial tibial condyle

Function-
Reinforces postero-medial knee joint capsule
obliquely on a lateral- to -medial diagonal from
proximal to tibia
Posterior Oblique Ligament

Attachment-
Origin- near the proximal origin of the MCL and
Adductor Tubercle
Insertion- Postero-medial tibia, posterior capsule
and postero-medial aspect of the medial meniscus

Function-
Reinforces the posteromedial knee joint capsule
obliquely on a medial-to-lateral diagonal from
proximal to distal
Arcuate Ligament

Lateral Branch
Proximally from tendon of popliteus muscle and
posterior capsule to posterior aspect of the head of
fibula distally.

Medial branch
Proximally from oblique popliteal ligament on
medial side of joint to posterior aspect of the head of
fibula distally.
Function

It reinforces the postero-lateral knee joint capsule

obliquely on a medial to lateral from proximal to
distal
BURSAE

Pre-Patellar Bursa-
Located between the skin and anterior surface of
patella
They allows free movement of skin over patella
during knee flexion and extension

Subcutaneous Bursa-
Located between patellar ligament and overlying
skin
Deep infra-patellar Bursa-
Located between patellar ligament and tibial
tuberosity
Helps in reducing friction between the patellar
ligament and tibial tuberosity
Function of Tibio-Femoral Joint

The primary motion of the tibio-femoral joint is

flexion/extension, although both medial /lateral
rotation and adduction/abduction motions can also
occur to a lesser extent.

In addition to motions, translation in an antero-

posterior direction is common on both the medial
and lateral tibial plateaus; to a lesser extent, medial
and lateral translations can occur in response to
varus and valgus forces.
Flexion

The large articular surface of the femur and the

relatively small tibial condyle create a potential
problem as the femur begins to flex on the fixed
tibia.

If the femoral condyles were permitted to roll

posteriorly on the tibial plateau, the femur would run
out tibia and limit the flexion excursion
Cont….

For the femoral condyles to continue to roll as flexion

increases without leaving the tibial plateau, the femoral
condyles must simultaneously glide anteriorly.

The initiation of knee flexion (0-25 degree), therefore,

occurs primarily as rolling of the femoral condyles
posteriorly on the tibial condyle.

As flexion continues, the rolling of the femoral condyles is

accompanied by a simultaneous anterior glide that is just
sufficient to create a nearly pure spin of femur on
posterior tibia with little linear displacement of the
femoral condyles after 25 degree of flexion.
Extension

Extension of knee from flexion is essentially a reversal of this

motion.

Tibio-femoral extension occurs initially as an anterior rolling

of the femoral condyles on the tibial plateau, displacing the
femoral condyles back to a neutral position on the tibial
plateau.

After the initial forward rolling, the femoral condyles glides

posteriorly just enough to continue extension of the femur as
an almost pure spin of the femoral condyles on the tibial
plateau.
Cont….

The description of interdependent osteo-kinematics and

arthro-kinematics indicates that the femur was moving on a
fixed tibia (e.g., during squat).

The tibia, of course, is also capable of moving on a fixed

femur (e.g., during a seated knee extension or the swing
phase of gait).

In this case, the movements would be somewhat different.

When the tibia is flexing on a fixed femur, the both rolls and
glides posteriorly on the relatively fixed femoral condyles.
Cont….

Extension of the tibia on a fixed femur in corporates

an anterior roll and glide of the tibial plateau on the
fixed femur.
 Role of ligaments & menisci

The arthro-kinematics associated with tibio-femoral flexion

and extension are somewhat dictated by the presence of
cruciate ligaments.

If the cruciate ligaments are assumed to be rigid segments

with a constant length, posterior rolling of the femur during
knee flexion would cause the “rigid” ACL to tighten(or serve
as a check rein).

Continued rolling of femur would result in the taut ACL’s

simultaneously creating an anterior translation force on the
femoral condyle.
Cont….

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.

The anterior glide of femur during flexion may be

further facilitated by the shape of menisci. The
wedge shape of the menisci posteriorly forces the
femoral condyle to roll “uphill” as the knee flexes.
Conti….

The oblique contact force of 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.

Posterior deformation occurs because the rigid

attachments at the meniscal horns limit the ability of
menisci to move in its entirety.

Posterior deformation allows the menisci to remain under

the rounded femoral condyles move on the relatively flat
tibial plateau.
Cont….
As the knee joint begins to return to extension from full
flexion, the posterior margins the menisci return to their
neutral position.

As extension continues, the anterior margins of the menisci

deform anteriorly with the femoral condyles.

The motion of the menisci is an important component of

tibio-femoral flexion and extension. Given the need of the
menisci to reduce friction and absorb the forces of the
femoral condyles that are imposed on the relatively small
tibial plateau, the menisci must remain under the femoral
condyles to continue their action.
 Range Of Motion

Passive range of knee flexion is generally considered

to be 130 to 140. 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 superimposed on the joint.
Normal gait on level
 Arthrokinematics

Viewed in the sagittal plane, the femur's articulating

surface is convex while the tibia's in concave. Knee
arthrokinematics is based on the rules of concavity and
convexity and is described in terms of open and closed
chain.
 Open Kinetic Chain

During knee extension, tibia glides anteriorly on femur.

More precisely, from 200 knee flexion to full extension,
tibia rotates externally. During knee flexion, tibia glides
posteriorly on femur and from full knee extension to
200 flexion, tibia rotates internally.
 Closed Kinetic Chain

During knee extension, femur glides posteriorly on tibia.

To be more specific, from 200 knee flexion to full
extension, femur rotates internally on stable tibia. During
knee flexion, femur glides anteriorly on tibia and from
full knee extension to 200 flexion, femur rotates externally
on stable tibia.
 Screw Home Mechanism

The "screw-home" mechanism, considered to be a key element to

knee stability, is the rotation between the tibia and femur. It occurs at
the end of knee extension, between full extension (0 degrees) and 20
degrees of knee flexion.

The tibia rotates internally during the open chain movements (swing
phase) and externally during closed chain movements (stance phase).

External rotation occurs during the terminal degrees of knee

extension and results in tightening of both cruciate ligaments, which
locks the knee. The tibia is then in the position of maximal stability
with respect to the femur.