Osteology: 3 bones - femur, tibia, patella Position of femur atop of tibia = unstable Mechanisms to compensate: - Bearing surfaces of femur

and tibia are large - Articulate with each other as lateral and medial tibiofemoral joint o Separate d by intercondylar fossa on femur o Intercondylar eminence on the tibia o Patella articulates with the femur - 3 points of articulate are separate but share synovial joint space by virtue of openings between cavities o * Permit infection to spread from one are of articular to another Movements of knee joint 1. Hinge (flex-ext) with rolling, gliding on articular surfaces 2. Some rotation around vertical axis of the femur on the tibia Femoral condyles - large and convex - covered in hyaline cartilage Medial condyle is narrower and longer are on distal femur for the articulation of thee patella Tibial condyles - covered in hyaline cartilage separated by intercondylar eminence ad slightly concave. The medial condyle is slightly larger and slight more concave than lateral Menisci - on tibial condyles Menisci - non-congruent joint- menisci positioned on top of tibial condyles to create more concave tibial surfaces Medial and lateral menisci thicker at lateral borders Each menisci cover 2/3 of articular surface Medial - C shaped, lateral is O shaped Attached by variety of ligaments to the tibia bot h at me margins and to intercondylar region Periphery of each meniscus attached to fibrous joint capsule Medial meniscus attached to MCL Lateral meniscus less firmly attached to lateral capsule and collateral ligament Popliteus tendon lies between lateral capsule and LCL When muscle contracts lateral meniscus is pulled posteriorly Injuries to menisci - detachment of horn form bone, tear or longitudinal split. McMurrays test - Patient is supine with hip flexed - Knee maximally flexed to 140 - Leg is rotated medially or laterally - While maintaining rotated position, leg is then extended to about 90 degrees of flexion. - If pain or audible click positive Ligaments I. Ligaments A. Collateral - limit side to side (abduction and adduction) 1. Medial collateral ligament - vertical thickened band between medial epicondyle of femur and medial condyle of tibia. Thickening of joint capsule and attached to medial meniscus

2. Lateral collateral ligament - between lateral epicondyle and head of fibula separate from knee joint capsule 3. Testing: a. Valgus stress test - integrity of MCL i. Knee flexed to 30 ii. Push the lateral side of the knee while forcing the leg laterally iii. Very little movement should occur in MCL is intact b. Varus stress test - lateral collateral ligament i. Applying pressure on the medial side of the knee while trying to force the leg medially ii. Knee is tested at 30 degrees of flexion because collateral are tauter than the cruciate ligaments B. Cruciate ligaments - strong rounded cords that cross each other as they span between intercondylar eminence and intercondylar surface of femur. Provide stability to the knee joint by holding femur and tibia together 1. ACL - arises from anterior aspect of tibia plateau a. Slightly longer and attached to lateral femoral condyle b. Positioned to prevent anterior displacement of the tibia relative to a fixed femur 2. PCL - arise from posterior aspect of tibia a. Attached to medial femoral condyle b. Prevents posterior displacement of the tibia c. Injuries occur when knee is semi flexed 3. Clinical testing a. Anterior drawer test - ACL i. Grasp leg btwn knee positioned at 90 of flexion and pulling firmly in anterior position ii. If leg moves forward relative to femur more than 1 cm, test is positive b. Posterior drawer test PCL Knee has fibrous capsule being reinforced by multiple tendons and ligaments Synovial membrane lines the fibrous capsule, attached to the margins of articular surface and to peripheral edges of menisci Passes anterior to the ACL and PCL (excludes from joint cavity) Patellofemoral joint: sesamoid bone - formed in tendon of quadriceps muscles and glides on femur during flexion and extension of leg at knee joint