KNEE BIOMECHANICS

by amrita..

Objectives..
To discuss the following about THE KNEE JOINT Anatomy Osteokinematics Arthrokinematics Stabilizers (static & dynamic) Pathomechanics

Introduction
Most complex joint of the body Designed for maximum mobility.. & Stability.. During swing- shortens functional length of l/l During stance- remains slightly flexed allowing shock absorption.., conservation of energy..,& transmission of forces.. through lower limb

Knee is composed of 2 joints

Tibiofemoral joint

its biaxial
modified hinge jt. double condyloid with 2 interposed menisci supported by ligaments & muscles

Bony structure

menisci
Cartilaginous discs located between the tibial and femoral condyles Inner portion is avascular Horns and peripheral portion of M is innervated by mechanoreceptors & nociceptors.

Reduce compressive stress at TF joint and

reduce friction

Stabilize knee jt. during motion

shock absorber
LM covers greater % of smaller lateral tibial surface and more mobile than MM

Attachments of menisci

Clinical relevance
reduced mobility of MM

more incidence of injury

MM covers less surface area of medial condyle of tibia increased compressive forces at medial

Tib-fimoral jt

articular cartilage destruction

 Meniscal injury (at the periphery & horns) Injury to mechanoceptors and nociceptors pain & proprioceptive deficits

Thus, meniscectomy

doubles articular cartilage

stresses at tibial & femoral art.surface degenerative changes at Tib- fem jt

Joint capsule
Enclose TF and PF joint

Lax and large

2 layers - exterior (sup) fibrous layer

- interior (thin) synovial memb.

Innervated by nociceptors and mechanoceptors

Synovial membrane secretes and absorbs synovial fluid

lubricates jt. & nourish avascular structures (menisci)

Clinical relevance
Incomplete resorption of synovial septa appears as folds in synovial membrane

PLICA (Types superior, middle, inferior) Plica moves back & forth over femoral condyle occasionaly, plica gets irritated and inflamed

pain & effusion( PATELLAR PLICA SYNDROME)

 FOR Knee jt swelling

Resting position of knee jt- 15-30 deg

reduces tension in capsule & increase pt comfort

Thus this position is indicated in knee jt. swelling

LIGAMENTS

Collateral Ligaments
lateral (fibular)

medial (tibial)
Prevents abduction and adduction movement of the knee

Cruciate ligament
Anterior Cruciate ligament Posterior Cruciate ligament

ACL
Prevents anterior translation of tibia Limits internal tibial rotation (at 10-15 deg. of flexion) Acts as secondary restrain against varus and valgus motion at

knee
ACL is lax at about 30 deg. of knee flexion Divided in 2 bands AMB & PLB PLB is taut in full extension AMB becomes taut as flexion increases

ACL

Anterior Cruciate (ACL)

PCL
Restrains posterior displacement of tibia Limits internal tibial rotation (at 90 deg. knee flex.) PCL cross sectional area > ACL

so less susceptible to injury

PCL

PCL shorter and stronger than ACL

The ACL prevents the femur from sliding posteriorly on the tibia or the tibia from sliding anteriorly on the femur The PCL prevents the femur from sliding anteriorly on the tibia or the tibia from sliding posteriorly on the femur

F E M U R
PATELLA T I B I A

Clinical relevance
Anterior tibial translation caused by quads and prevented by ACL In ACL injury, Hams shares the role of ACL in resisting Ant. Translation of tibia and prevents strain on ACL -> thus ACL rehab should hams dominant exercises

 Posterior tibial translation - caused by hams and prevented by PCL In PCL injury, popliteus muscle shares the role of PCL in resisting Post. Tibial translation.

Bursae of the Knee

Clinical relevance
Trauma to front knee like prolonged kneeling positions-> inflammation of infrapatellar and prepatellar bursa -> pain and effusion

Osteokinematics
3 degrees of freedom 1. Flexion/ extension (medio lateral axis, sagital plane) 2. Abduction / adduction (AP axis, frontal plane) 3. Medial rotation / lateral rotation (vertical axis, horizontal plane)

Degree of ROM
According to AAOS , chicago (1965), Flexion 135 o Extension 5-10 o During 90 o knee flexion, lat rotation 0-20 o Med rotation 0-15 o

NWB

WB

Arthokinematics
In weight bearing

Screw home mechanism

Automatic rotation of the tibia externally (approx. 10 degrees) during the last 20 degrees of knee extension. Forms a close-packed position for the knee joint During knee flexion, tibia rotates internally(unlocking of knee) .

Driven by 3 factors

Patellofemoral joint

Patellar Contact Areas

Normal length of patellar tendon = patellar height: 1:1 ratio

Patellar contact area

Motions of patella

Rotation of patella follows rotation of tibia

PATELLO-FEMORAL JT. STRESS

Frontal Plane Stability

Mechanical Function of Patella

Q-Angle
The Q-angle is the angle

formed by
A line from the anterior superior

spine of the ilium to the middle

of the patella A line from the middle of the patella to the tibial tuberosity

Q-angle
Knee in extension
Normal - males - 13 degrees Normal - females - 18 degrees

Knee in 90 degrees flexion

Both genders - 8 degrees

Atypical Q-angles
Bow-leg knock-knees

Posture & WB Forces

The mechanical axis of TF joint is the weight bearing

line from the center of

femoral head to superior talus center Allows WB in stance of the medial = lateral

Tibiofemoral compartments

Posture & WB Forces

Increase in valgus results:
Compression overload to the lateral Tibiofemoral compartment Distraction overload to

medial Tibiofemoral
compartment

Posture & WB Forces

Decrease in valgus results

Compression overload to
the medial Tibiofemoral

compartment
Distraction overload to lateral Tibiofemoral compartment

Movements of the knee

Flexion Hamstrings (SM,ST,BF) assisted by: gracilis sartorius popliteus gastrocnemius

Sartorious Gracilis

Popliteus

Gastrocnemius

Muscle Pull

Movements of the knee

Extension quadriceps: rectus femoris vastus lateralis vastus medialis vastus intermedius

Rectus femoris

Vastus lateralis Vastus intermediate Vastus medialis

Muscle Pull

THANK YOU..