knee joint

functional anatomy
Tanatswa Mugadza R225155E
Godknows Ngodza R225148K
Melisa Denhere R218079E
Arsel Gwezhira R225191V
INTRODUCTION TO KNEE
JOINT
• bi-condylar synovial joint
• connects femur, tibia and patella bones
•complex hinge joint composed of 2" articulations
•tibiofemoral joint and patellofemoral joint
•it is largest and arguably the most stressed joint in
the body.
•the arrangement of the bones in the joints provides
fulcrum translates movements.
INTRO TO KNEE JOINT
• actions of the flexor and extensor muscles of the
knee
• the arrangement of extracellular & intracapsular
and ligaments as well as extensions of muscles that
cross the joint provide the much needed stability
that counters the considerable biomechanical
stress brought upon the joint.
• as a hinge joint, knee joint mostly allows movement
along one axis in terms of flexion and extension of
the knee in sagittal plane.
INTRO TO KNEE JOINT
• It also allows slight medial rotation during the
flexion and,
• it facilitates lateral rotation at the terminal
extension of the knee both at transverse plane
• as well as varus and valgus deviation about the
frontal plane.
Tibiofemoral Joint
• has 3 degrees of motion.
• three rotational mvts; internal/external,
varus/valgus and flexion/extension
• three translational mvts; anterior/posterior
translation, medial/posterior translation, and
vertical compression/distraction.
• articulations btwn the lateral & medial condyles of
the distal end of the femur & tibial plateaus, both
of which are covered by thick layer of healing
cartilage
Tibiofemoral Joint
• lateral and medial condyles - 2" bony projections
located at the distal end of the femur
• have a smooth convex surface, separated
posteriorly by deep groove called intercondylar
fossa.
• medial condyle is larger, more narrow and furthe
projected than its lateral counterpart.
• Tibial plateaus-2" slightly concave superior surfaces
at the proximal end of tibia
Tibiofemoral joint
• medial tibial plateau is much longer than the lateral
anteroposteriorly and diameter of the proximal
tibia is greater than the shaft posteriorly which is
sloped at approx 7 to 10° to facilitate flexion of the
femoral condyles on the tibia.
• the tibiofemoral joint articular surfaces are
generally incongruent, so compatibility is provided
by medial & lateral meniscus.
Tibiofemoral joint
• these are crescent-shaped fibrocartilaginous
structures that allow a more even distribution of
the femoral pressure on the tibia.
Patellofemoral Joint
• diarthrodial plane joint formed by articulations of
the patellar surface of the femur (trochlear groove)
and posterior surface of patella
• patella is triangular in shape, curved proximal and
pointed distal apex
• tightly held in place by quadriceps femoris muscle.
• distally held by patellar ligament that attaches at
the tibial tuberosity.
• it acts as a mechanical pulley for quadriceps.
it is reinforced by the medial patellofemoral and lateral
patellofemoral ligaments which provide stability and
prevent subluxation and dislocation of the patella.
patellofemoral joint syndrome
- is a condition characterized by pain felt in the front
of the knee, specifically around the patella (kneecap)
and the surrounding area. It is a common knee
problem, particularly among athletes and active
individuals.
-the exact cause of PFPS is often multifactorial and
can vary from person to person. Some factors that
may contribute to the development of PFPS include:
Patellofemoral joint syndrome
• 1. Overuse or repetitive stress: Activities that involve
repetitive knee motions, such as running, jumping, squatting,
or climbing stairs, can put excessive stress on the
patellofemoral joint and lead to pain and inflammation.
• 2. Muscle imbalances or weakness: Weakness or imbalances
in the muscles around the knee, particularly the quadriceps
and hip muscles, can affect the alignment and tracking of the
patella, leading to increased stress on the joint.
• primary symptom of PFPS is pain in the front of the knee,
particularly around or behind the patella. The pain is typically
aggravated by activities that involve knee flexion, such as
running downhill, squatting, or prolonged sitting with the
knees bent
Muscles Overview:
• Muscles acting on the knee joint:
• Flexion; Biceps femoris, semitendinosus and
semimembranosus; initiated by popliteus; assisted
by gracilis and sartorius
• Extension ; Quadriceps femoris (rectus femoris,
vastus lateralis, vastus medialis and vastus
intermedius) assisted by tensor fasciae latae
• Medial rotation; Popliteus, semimembranosus and
semitendinosus, assisted by sartorius and gracilis.
• Lateral rotation; Biceps femoris
Popliteus Muscle
• major stabilising muscle of the knee
• involved in both the closed chain and open chain
phases of the gait cycle.
• fibers originate from the lateral condyle of the
femur and insert on the posterior surface of
thtubibia, superior to soleal line.
• it is capsular structure, although extra-articular and
separates the lateral meniscus from lateral
collateral ligament.
• it also assists in knee flexion
Popliteus
• it's function is dependent on whether the lower
extremity is in a weight-bearing or non-weight-
bearing;
• it is considered the primary internal rotator of tibia
in the NWB state.
• describes the femur medially rotating on the tibia,
allowing for full extension without muscular
expenditure
Popliteus
• when "unlocking" the knee, the popliteus contracts
causing flexion and lateral rotation of the femur on
the tibia.
• this is why some refer to the popliteus as the "key"
to the locked knee.
• when the knee motions into flexion, popliteus
retracts the lateral meniscus posteriorly to avoid
becoming entrapped btwn the femur and tibia.
Screw-Home Mechanism
• coupled motion: motion happening in one axis
consistently associated with another motion taking
place in another axis
• flexion/extension (sagittal plane) -
varus/valgus(frontal plane)
• NWB locking - closed packed position.
• terminal extension<---->lateral rotation of tibia
during the last 30° of extension, terminal rotation
• unlocking<------> medial rotation
• WB locking
• extension<----------->medial rotation of femur
• flexion<-------------> lateral rotation of femur
• sartorius helps in the post. distortion of medial
meniscus.
• gracilis -medial and knee flexor; valgus and rotator
stability in dynamic motion
• medial rotation <-------->transverse plane, vertical
axis
• lateral rotation<----‐---> longitudinal axis of tibia
• abduction/adduction <-----> valgus/varus} frontal
plane × AP - axis
• Posterolateral Corner Knee Injuries
• The popliteus is most often injured as part of an
associated posterolateral corner (PLC) knee injury.
PLC injuries occur secondary to:
• Direct blows to the anteromedial knee
• Varus blows to the flexed knee
• Varus/hyperextension (contact or non-contact
injuries)
• Knee dislocations
iliotibial band
• Distal anatomy:
• Proximal to the knee joint, the ITB attaches to the
intermuscular septum and supracondylar tubercle
of the femur. Proximal to the lateral epicondyle,
there is an interposed fat layer between the ITB
and the vastus lateralis.
• The ITB is more tendinous proximal to the lateral
femoral epicondyle, and at the level of the
epicondyle, the ITB contributes to lateral knee
stability secondary to its anatomic position, intimal
contact with the epicondyle, and relative to its
location with respect to the lateral collateral
ligament (LCL).
iliotibial band
Proximal ITB function includes:
• Hip extension
• Hip abduction
• Lateral hip rotation
• Distally, ITB function depends on the position of the knee joint
• 0 degrees/full extension to 20 to 30 degrees of flexion
• Active knee extensor
• The ITB lies anterior to the lateral femoral epicondyle
• 20 to 30 degrees of flexion to full flexion ROM
• Active knee flexor
• ITB lies posterior relative to the lateral femoral epicondyle
iliotibial band syndrome

• ITB syndrome and contracture is a condition

secondary to increased tension throughout the
structure most commonly causing symptoms near
the distal insertion site.
• this condition can be seen in individuals with
cerebral palsy and polio, however, more commonly
in individuals who have increased their physical
activity (particular lower extremity performance).
• Common presentations are usually runners or
cyclists that have increased their mileage during
recent training intervals.
• This condition seems to be secondary to overuse
and repetitive motion. However, there are some
conflicting thoughts as to the exact mechanism
eliciting the pain experienced.
• Several etiologies have been suggested, including
the friction induced by the band catching the lateral
epicondyle of the femur, compression of the
underlying connective tissue and fat, and chronic
inflammation of the ITB bursa.
• Other predisposing structural risk factors are gait
abnormalities (i.e., overpronation), leg length
discrepancies, and varus deformity of both knees.
Symptoms are also most pronounced when the arc
of motion reaches 30-40 degrees of knee flexion
and occurs along the lateral aspect of the knee.
CAPSULE
• Joint capsule attachments – fibrous in nature
– Does not form a complete capsule around the joint
– Reinforced in areas by capsular ligaments and replaced
in parts by adjacent structures
– Deficient posteriorly for the passage of the popliteus
tendon
• Femur – attached to the articular margins of the
femoral condyles. Posteriorly encloses the femoral
condyles and intercondylar notch
• Tibia – attached to the articular margins of the
tibial condyles
Capsular Pattern
• The capsular pattern of the knee
• This refers to the characteristic pattern of limitation
in movement that occurs when the joint capsule is
affected
• In the knee joint the pattern typically involves
limitations in both flexion and extension
• Flexion is more limited than extension
Ligaments
Medial Collateral Ligament
The medial/tibial collateral ligament (MCL) is a broad,
flat band that extends from the medial femoral
epicondyle to the medial meniscus, tibial plateau, and
adjacent shaft. It consists of superficial and deep
components.
•The superficial component attaches distally to the
medial aspect of the tibia and proximally to the medial
femoral epicondyle.
•The deeper component originates from the medial
joint capsule and attaches to the medial meniscus
Medial Collateral ligament
• has an important role in stabilizing the knee joint. The long fibers of the MCL
primarily stabilize the medial side of the knee against valgus and external
rotatory stress.
• The deeper part of this ligament also helps the anterior cruciate ligament in
avoiding an anterior translation of the tibia on the femur
• The ligament also plays a role in joint position sense or proprioceptive
feedback.
• The MCL is one of the most commonly injured ligaments of the knee.
• Valgus stress is the most common mechanism of injury.
• Injuries can be contact (a direct blow to the outer aspect of the lower thigh
or upper leg) or non-contact (common in skiing). Contact injuries are usually
more severe.
• Injuries to the MCL can have detrimental effects to surrounding structures.
• It is recognised that either partial or complete ruptures in the ligament
significantly increases the load on the ACL.
• Partial tears show that increases in ACL load were identified at 30 degree
knee flexion and valgus load and internal torque.
• The medial meniscus is often also injured due to its relationship with the
medial collateral ligament
Lateral Collateral Ligament
•The lateral collateral ligament (LCL) or fibular collateral ligament, is one of
the major stabilizers of the knee joint with a primary purpose of preventing
excess varus and posterior-lateral rotation of the knee
•The LCL is a strong connection between the lateral epicondyle of the femur
and the head of the fibula, with the function to resist varus stress on the
knee and tibial external rotation and thus a stabilizer of the knee. When the
knee is flexed to more than 30°, the LCL is loose. The ligament is strained
when the knee is in extension.
•Although less frequent than other ligament injuries, an injury to the lateral
collateral ligament (LCL) of the knee is most commonly seen after a high-
energy blow to the anteromedial knee, combining hyperextension and
extreme varus force.
• The LCL can also be injured with a non-contact varus stress or non contact
hyperextension.The LCL most commonly occurs in sports (40%) with high
velocity pivoting and jumping such as soccer basketball, skiing, football or
hockey. Tennis
Posterior Cruciate Ligament
Posteriror Cruciate Ligament
• originates from the anterolateral aspect of the medial femoral condyle
in the area of the intercondylar notch and inserts onto the posterior
aspect of the tibial plateau.
• It functions to prevent posterior translation of the tibia on the femur.
• To a lesser extent, the PCL functions to resist varus, valgus, and external
rotation forces.
• It is approximately 1.3 to 2 times as thick and about twice as strong as
the anterior cruciate ligament (ACL) and, consequently, less commonly
subject to injury
• Injuries to the PCL are caused by an extreme anterior force applied to
the proximal tibia of the flexed knee.
• Common causes include dashboard injuries where the knee is forced
into the dashboard during a motor vehicular collision. The PCL also can
Anterior Cruciate
• arises from the anteromedial aspect of the intercondylar area
on the tibial plateau and passes upwards and backwards to
attach to the posteromedial aspect of the lateral femoral
condyle.
• The ACL plays a crucial role in joint stability. It is the primary
restraint to anterior translation of the tibia relative to the femur
.
• The ACL also functions as a major secondary restraint to
internal rotation, particularly when the joint is near full
extension.
• ACL functions as a minor secondary restraint to external
rotation and varus–valgus angulation, particularly under
weightbearing conditions
ACL injuries
Meniscus
Meniscus
•The menisci serve many important biomechanical
functions:
A)They contribute to load transmission
B)shock absorption
C)stability and nutrition
D) joint lubrication
E)proprioception
F) They also serve to decrease contact stresses and
increase contact area and congruity of the knee.
Meniscus
• The geometric structure of the menisci provides an
important role in maintaining joint congruity and
stability.
• The superior surface of each meniscus is concave,
enabling effective articulation between the convex
femoral condyles and flat tibial plateau.
• When the meniscus is intact, axial loading of the
knee has a multidirectional stabilizing function,
limiting excess motion in all directions.
Clinical
Clinical
• A meniscus tear usually happens when you twist your knee
while playing sport. But it can also happen from more minor
injuries such as twisting when standing up.
• Symptoms of a meniscus tear include:
• knee pain or tenderness
• stiffness or swelling around your knee – the swelling may not
start for a few hours or days
• difficulty bending, straightening or moving your knee
• your knee giving way when you try to stand
• a crunching or clicking feeling when you move your knee
• The symptoms can be similar to sprains.
Clinicals
Genu Valgum
Genu Valgum
• Genu valgum or "knocked knees" are part of the
coronal plane deformities of the lower extremity.
The majority of patients are asymptomatic and
have no functional limitations. This condition can
be preceded by flat feet and occasional medial foot
and knee pain.
•Children start developing physiologic genu valgum
starting by age 2, and it becomes most prominent
between ages 3 to 4. After that, it typically decreases
to a stable, slightly valgus position by age 7 years
Blood Suppy
Venous Supply
Nerve Supply
Nerve Supply
Nerve Supply
Bursa of the knee
• The knee contains small fluid filled sacs called bursae which are
located near the knee joint
• These sacs serve to reduce friction between the skin and the
tendons and bones
• When these bursae become inflamed or irritated they cause a
condition known as bursitis.
• This inflammation causes pain, swelling and discomfort in the
affected area
• Bursitis can be caused by various activities including repetitive
motion such as kneeling or bending, which can lead to
inflammation or irritation of the bursae.
• When the bursae gets inflamed it can put pressure on adjacent
parts of the knee, leading to discomfort.
Other conditions
• 1. Arthritis- arthritis including rheumatoid and
osteoarthritis can affect the knee joint, leading to pain,
discomfort, swelling and reduced range of motion
• 2. Osgood-Schlatter Disease- is a condition commonly seen
in adolescents characterized by swelling around knee and
limping, which may worsen following activities
• 3. Other factors- factors affecting the postoperative limb
alignment and clinical outcome after knee arthroplasty can
also impact the knee
• Additionally, radiofrequency ablation of the genicular
nerves has gained interest as a treatment for knee
conditions
Significance of the Q angle to the
knee
• The Q angle is a significant measure related to the
knee joint. It represents the resultant force of a
vector of the quadriceps and patellar tendons
acting on the patella. An increased Q angle has
been associated with various knee-related issues,
including maltracking of the patella, which means it
does not travel over the front of the knee joint as it
should.
• This can lead to discomfort and potential
complications in the knee and function.
Thank You