Kinematics of the Knee Joint

Patello-femoral Function
knee from 0-20 deg of is accompanied by internal rotation of the tibia, which decr Q angle & lateral directed quadriceps muscle vector patella is drawn into trochlear notch of femur, & patellofemoral contact is made from 0 to 20 deg of knee flexion the initial contact is made at the lateral facet of the patella

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Patello-femoral Function
further flexion of knee moves patella anterior relative to the center of rotation of the knee, which improves the mechanical advantage of the quadriceps mechanism patella continues to move laterally at 90 deg of knee flexion, and lateral border of the patella provides the primary loading site

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Condyles
femur ends in two rounded condyles joined anteriorly to from patellar articular surface and separated posteriorly by a deep intercondylar fossa condyles are almost in line w/ front of shaft, but they project backward well beyond shaft, as in letter J, circumstance of significance in movement of the joint medial condyle is larger, more curved, & projects further than lateral condyle, accounting for angle between femur & tibia

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Condyles
sides of condyles are roughened and project somewhat as medial and lateral epicondyles of interest, the bigger the posterior bulge of the femoral condyle, the greater can be ROM into flexion as tibia glides around convexity
this allows full flexion w/o contact between the posterior joint margins of the tibia and femur

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Condyles
the thick cartilaginous surfaces of the knee helps to spread out the joint reactive load over a wide area and helps contribute to the cam shape of the condyles which maximizes the extensor lever arm in degenerative arthritis the quality of the articular cartilage is lost
as wear occurs, the patello femoral joint is reduced to a cylindrical outline the mechanical outline is lost, but wear in the bone to bone contact area is reduced

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Tibial Plateau
on its expanded upper end, tibia has 2 slightly concave condyles separated by an intercondylar eminence and the sloping areas in front and behind it low elevation, tibial tuberosity, for insertion of quadriceps, is situated at the junction of anterior border of shaft with expanded upper end of the tibia

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Roll Back and Sliding of the Knee Joint

for reason of contour of femoral & tibial condyles, flexion & extension of knee joint are not simple hinge movements that occur at the elbow joint flexion & extension do not occur about a fixed transverse axis of rotation but rather about a constantly changing center of rotation, that is, polycentric rotation when plotted, path of this changing center of rotation describes a J shaped curve about the femoral condyles

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Roll Back and Sliding of the Knee Joint

for example, in full flexion, posterior portions of femoral condyles are in contact w/ posterior portions of the tibial condyles knee is extended, femoral condyles roll on tibial condyles & meniscii, movement resembling that of a rocking chair. there is also sliding of the femur backward.
as extension progresses, shorter, more highly curved lat condyle exhausts its articular surface & is checked by ACL, whereas larger & less curved medial condyle continues its forward roll & skids backward, assisted by tightening of PCL result is medial rotation of femur that tightens collateral ligaments, and the joint is "screwed home;

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Roll Back and Sliding of the Knee Joint

flexion of extended knee is preceded by lateral rotation of femur (or medial rotation of tibia), usually produced by popliteus muscle
this rotation relaxes tension of collateral ligaments suffic to permit flexion

exact ratio of rolling to gluiding differs between individuals and does not remain constant thruout all deg of flexion
it is estimated to be one to two in early flexion & to increase to one to four by end of flexion

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Roll Back and Sliding of the Knee Joint

during normal gait, tibia undergoes internal rotation during swing phase and external rotation during stance phase because the medial femoral condyle is larger than lateral fem condyle, the distance from extreme flexion contact point to extreme extension contact point of medial femoral condyle is about 17 mm > that of lateral femoral condyle as tibia travels from flexion to extension the medial tibial plataeu must cover a greater distance

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Knee Rotation
as extension progresses, shorter, more highly curved lateral condyle exhausts its articular surface and is checked by ACL, whereas larger and less curved medial condyle continues its forward roll & skids backward, assisted by tightening of PCL result is a medial rotation of femur (external tibial rotation) that tightens collateral ligaments, & joint is "screwed home", to use mechanical phraseology flexion of extended knee is preceded by lateral rotation of femur (or medial rotation of tibia) this rotation relaxes the tension of the collateral ligaments sufficiently to permit flexion

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Sagittal Plane
knee flexes twice during the gait cycle first, stance phaseflexion, starts at contact, and is associated with the loading response
by flexing through around 20 and then extending again, it absorbs some of the energy (often called shock) associated with impact

swing phase flexion is much larger

up to around 65- and is responsible for shortening the length of the leg to allow foot clearance

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Frontal Plane
normal knee is firmly stabilized in the frontal plane by strongcollateral ligaments this curve is often used as a quality control check on the gait analysis examination if more than a few (e.g. 10) degrees of motion are recorded in a patient without ligament laxity, it suggests that marker placement was imprecise. so it is a good idea to check the knee varus/valgus plot before interpretting the gait analysis report
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Transverse Plane
the ligaments of the knee normally restrict motion in thisplane to a few degrees the exact angle recorded is very sensitive to markerplacement, and this curve is rarely used for clinical interpretation

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