Knee Joint

What are the four bones that make up the knee

joint?
Femur Tibia
Fibula Patella
A. Femur - the femur is the longest bone
in the body.

B. Tibia - the tibia is the medial bone in the leg,

bearing the weight of the lower leg
Bones of the Knee
 Bones of the Knee
C. Fibula - the fibula serves as attachment sites
for knee joint structures and muscles. It does
not articulate with the femur or patella. It is a
non-weight bearing bone.
D. Patella - the patella is a sesamoid (free floating
bone. It is embedded in the patellar tendon (or
is it a ligament?). Not born with patellas.
Protects structures beneath and changes angle
of pull to create greater rotary force.
 Knee Joint
What is the classification of the knee joint?

The knee is classified as a ginglymus or hinge

joint. This is not entirely accurate, as the knee
does allow some rotation.
The knee is a fairly complex, and somewhat
unstable joint. It is often injured in athletics.
 Knee Joint
 In addition to articular
cartilage covering ends
of bones, specialized
cartilages – menisci.
 Attached to tibia and
deepen tibial plateau.
 Enhance stability.
 Both thicker on outside
border, taper to very
thin on inside border.
Knee Joint
 Knee Joint Ligaments
A. Medial collateral ligament - prevents
the knee from abduction or valgus forces.
Often injured by blows to the lateral side of
the knee.
B. Lateral collateral ligament - prevents
the knee from adduction or varus forces.
This ligament can be injured by blows to the
medial side of the knee. Does not occur
frequently.
 Knee Joint Ligaments
C. Anterior cruciate ligament - prevents the tibia
from moving forward. The term cruciate means
“cross. This ligament crosses with the posterior
cruciate ligament between the tibia and femur.
It attaches to the tibia anteriorly and the femur
posteriorly. It helps maintain rotary stability.

This ligament is one of the most often injured in

sports, and is caused by hyperextension, and rotary
movements associated with planting and cutting.
 Knee Joint Ligaments
D. Posterior cruciate ligament - prevents the tibia
from moving posteriorly. It attaches anteriorly to
the femur and posteriorly to the tibia.

This ligament in conjunction with the anterior

cruciate helps maintain rotary stability. It is not
as common of an injury as the anterior cruciate
ligament. Injured more often in car accidents.
 Motions of the Knee
What are the four motions that can occur
in the knee joint?

A. Flexion - bending or decreasing the angle of the

knee characterized by the heel moving toward
the buttocks.
B. Extension - The opposite of flexion. Straightening
or increasing the angle between the femur and
the lower leg.
Knee Flexion
Knee Extension
 Motions of the knee
C. External rotation - rotary movement of the lower
leg laterally away from the midline.
D. Internal rotation - Rotary movement of the lower
leg medially toward the midline.
 Knee Joint Muscles
Name the muscles that would be part of the
quadriceps or knee extensor group:
Rectus femoris

Vastus lateralis
Vastus medialis
Vastus intermedialis
 Knee Joint Muscles
Name the muscles that would be considered
part of the hamstring or knee flexor group:

Semimembranosus Semitendinosus
Biceps femoris

What are the “other” knee joint muscles?

Popliteus, Gracilis, Sartorius, Gastronemius
 Quadriceps or knee extensor
group
A. Vastus lateralis - vastus is the term for
immense. These three muscles of the
quadriceps group derive their name for
their size and position.
The vastus lateralis is the most lateral of
the quadriceps group.
 Quadriceps

Rectus
Femoris

Vasti
 Quadriceps group
What are the actions of the vastus lateralis?
Knee extension
What are some good exercises for the vastus
lateralis?
Seated knee extension Seated leg press
Hip sled Squats Lunges
Note: The vastus lateralis can be involved in lateral
patellar subluxation. It has a slight lateral pull,
and if over developed, can cause problems.
 Quadriceps group
B. Vastus intermedius - this muscle is the middle
of the three vastus muscles. It lies underneath
the rectus femoris.

What are the actions of the vastus intermedius?

Knee extension
Exercises to strengthen the vastus intermedius
would be identical to those for the vastus lateralis
To isolate the vastus muscles, knee extensions
should be performed in the seated position.
 Quadriceps group
C. Vastus medialis - this is the most medial of the
vastus muscles. It is often a target of needle
biopsies when the quadriceps muscle is studied
for exercise.
What are the actions of the vastus medialis?
Knee extension
Exercises to strengthen the vastus medialis are
similar to the other vastus muscles, but it is
emphasized in the last 10 to 20 degrees of extension.
 Quadriceps group
D. Rectus femoris - recall that the rectus femoris
was studied with the hip muscles.

What are the actions of the rectus femoris?

Knee extension and hip flexion

 Gluteus
Maximus

Semimembranosus
Biceps
Femoris
Semitendinosus

Gastrocnemius
 Hamstring group
All of the muscles in the knee flexor/hamstring
group were covered in the hip joint.

What are the actions of the biceps femoris?

Hip extension Knee flexion
External rotation of hip and knee.
What are the actions of the semitendinosus?
Hip extension Knee flexion
Internal rotation of the hip and knee
 Hamstring group
What are the actions of the semitendinosus?

Hip extension Knee flexion

Internal rotation of the hip and knee
What are the actions of the semimembranosus?

Hip extension Knee flexion

Internal rotation of the hip and knee
 “Another” Knee Muscle
Because of its action, the
popliteus is remembered
as “the key that unlocks
the knee”. It is the deepest
muscle at the back of the knee.
It is the only one-joint knee
flexor.
 Popliteus
What are the actions of the popliteus muscle?

Flexion and internal rotation of the knee.

It initiates knee flexion by medial rotation

of the tibia to unlock the knee.
Exercises to strengthen the popliteus include
leg curls, and knee flexion with internal rotation.
 Knee Flexion Assistants
• Sartorius: flexes knee & internally rotates
lower leg
• Gracilis: flexes knee & internally rotates
lower leg
• Gastrocnemius: flexes knee
• Plantaris: short bellied muscle with long
tendon insertion assists with knee flexion
(missing in some humans)
 Plantaris

Sartorius

Gracilis
Gastrocnemius
 Knee Joint Injuries

A. ACL rupture - most commonly damaged

ligament of the knee. Many sports apply external
and internal forces to knee. Often caused by some
type of cutting, twisting or hyperextension.

Unlike the MCL & PCL, the ACL does not have
the capacity to heal. Once injured, it does not
reconstitute as a functional entity.
ACL Tear
Normal ACL Torn ACL
 Knee Joint Injuries
ACL injury rates are 4 to 8 times higher in
female athletes who take part in soccer,
basketball, track, and softball (compared to
baseball) than male athletes.
Sagittal plane landing mechanics may play
less of a role in gender-related ACL injury
than frontal and transverse plane
mechanics. Effect of fatigue on knee
valgus and internal rotation may have
more consequence on female than male.
 Numerous theories for gender ACL
differences including:
1. Women have a wider pelvis, increasing the
“Q” angle of the knee.
2. The place where the ACL passes through
knee, intercondylar notch, of women is
slightly smaller compared to men.
3. Lack of exposure to motor skills at early age
leads to injuries at later age.
4. Hormones. Women in pre-ovulatory phase
have more ACL injuries presumably due to laxity.
Q Angle
 Knee Joint Injuries
B. Collateral ligament sprain - one of the most
frequent knee injuries. Usually caused by
blow to lateral knee. Deep fibers of medial
collateral ligament attach to medial meniscus,
so could disrupt meniscus too.
C. Meniscus tearing – frequently caused by
planting foot during weight bearing while body
undergoes rotation. Symptoms include pain,
accompanied by locking or buckling of the
joint.
 Knee Joint Injuries
D. Chondromalacia - affects the articulating
cartilage on the interior surface of the patella.
Possibly caused by incongruence between
patella and femur. Symptoms include pain,
swelling and a grating sensation.
E. Osgood Schlatter Disease - usually affects
children and is caused by repeated usage of the
knee extensors. This overuse results in a tearing
or avulsion at the epiphysis of the tibial tuberosity.
Symptoms include pain, swelling, hemorrhage.
Osgood
Schlatter
Disease