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INTRODUCTION
Hinge type Synovial joint.
Can bear load more than 8 times of body
weight.
GENRAL ANATOMICAL TERMS FOR KNEE
ANTERIOR - FRONT OF KNEE
POSTERIOR - BACK OF KNEE
MEDIAL SIDE OF KNEE CLOSSEST TO OTHER KNEE
LATERAL SIDE OF THE KNEE FARTHEST FROM OTHER SIDE
CONSTRUCTION
BONES
MUSCLE
LIGAMENTS
CARTILAGES
BURSA
BONES
FEMUR
TIBIA
FIBULA
PATELLA
Bones of the Knee
The bones give strength, stability and
flexibility in the knee.
Femur :
Commonly known as thigh bone
Largest, longest & strongest
bone in body.
Have two round end called
condyles with a groove in center.
Tibia :
Commonly known as shim bone.
Connect from knee to ankle.
Have top flat surface.
Flat surface act as a base of
meniscus.
Patella:
Commonly known as knee cap.
Its flat and triangular in size.
Relive friction between bone
and muscle during movement.
Protect knee joint.
Fibula:
Long thin bone in the lower leg.
Not directly a part of knee joint.
Act as a support for tibia.
MUSCLES
QUADRICEPS - It is a group
of 4 muscle present in front of
the thigh and are responsible
for straitening the knee by
bringing the bend knee to
straight position.
HAMSTRINGS - It is a group
of 3 muscle present in the
back of the thigh and control
the knee moving from straight
to bend position.
LIGAMENTS
Its function is to attach
bones to bones and give
strength and stability to
the knee, as the knee
have very less stability.
Ligaments are strong,
tough band that are not
flexible. Once stretched
they tend to stay
stretched and if stretched
too far, they snap
LIGAMENTS
MEDIAL COLLATERAL LIGAMENT
Attached medial femur to medial tibia and limits sideway
motion.
LATERAL COLLATERAL LIGAMENT
Attached lateral femur to lateral tibia and limits sideway
motion
ANTERIOR CRUCIATE LIGAMENT
Attaches tibia and femur in centre of the knee and limits
rotation as well as forward motion of tibia.
POSTERIOR CRUCIATE LIGAMENT
It is the strongest attaching the tibia and femur going deep
inside the knee locating behind ACL, limiting backward
motion of knee.
PATELLAR LIGAMENT Attach the patellar to the tibia
FIBROUS CARTILAGE (the meniscus)
Has tensile strength and can resist pressure.
HYALINE CARTILAGE (Articular cartilage)
Covers the surface along which the joints move.
CARTILAGE
CARTILAGES
Cartilage is a thin, elastic tissue that protects the bone
and makes certain that the joint surfaces can slide easily
over each other. Cartilage ensures smooth knee
movement.
Cartilage will wear over the years.
Cartilage has a very limited capacity for self-restoration.
The newly formed tissue will generally consist for a
large part of fibrous cartilage of lesser quality than the
original hyaline cartilage. As a result, new cracks and
tears will form in the cartilage over time.
MEDIAL MENISCUS
LATERAL MENISCUS
MENISCUS
Shaped like a shallow socket.
Rubbery in nature.
Act as a shock absorber(more than 10xBW)
Distribute the load from femur to tibia.
Decrease friction by 20%.
Increase contact area by 70%.
MENISCUS
BURSA
A bursa is a small fluid-
filled sac lined by synovial
membrane with an inner
capillary layer of viscous
fluid (similar in consistency
to that of a raw egg white).
It provides a cushion
between bones and
tendons and/or muscles
around a joint. This helps to
reduce friction between the
bones and allows free
movement.
JOINTS OF THE KNEE
Tibiofemoral joint
Modified hinge joint.
Dual condyloid
articulation b/w medial
and lateral condyles of
femur and the tibia.
Articulating surface are
not congruent.
JOINTS OF THE KNEE
Patellofemoral joint
Articulation b/w the
patella and femur.
The patella improves
the mechanical
advantage of the knee
extensors by as much as
50%.
KNEE MOVEMENTS
AXIS OF ROTATION
AXIS OF ROTATION
KNEE GONIOMETRY
Flexion
0-130-140 degrees
Extension
0 degree
Screw Home Mechanism
SCREW HOME MECHANISM
Locking mechanism as the knee
nears its final extension
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
Femoral condyles are a different size
Causes internal rotation when
the knee is flexed and external
rotation when the knee is
extended
KNEE ROTATION
Flexion
External
Rotation
Internal
Rotation
Extension
Patella migrates posteriorly from extension to flexion
30
60 90
Patellar Translation
Mechanical Function of Patella
Increases angle of pull of
quads on tibia, improves the
ratio of motive: resistive torque
by 50%
Centralizes divergent tension
of quads into a single line of
action
Some protection of anterior
aspect of knee
without patella with patella
Mechanical Function of Patella
Patella contributes to
quadriceps moment arm
13% at 90
o
31% at 0
o
No angle without patella
& therefore no
compressive resultant
force
Patellofemoral Compressive Force
Mechanics
PFC force with flexion
0.5 x BW gait (walk)
3.4 x BW stairs
8.8 x BW squatting
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
A typical Q-angles
bowleggedness knock-knees
Genu Recurvatum
knee hyperextension
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 instance of the
medial = lateral Tibiofemoral
compartments
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
Posture & WB Forces
Joint Mechanics
Resultant force has a tendency to
laterally translate the patella
Laterally displace tibial tubercle
external tibial rotation
external tibial torsion
Medially displace patella
internal femoral rotation
femoral anteversion
Joint Mechanics
Tibial Torsion
Tibial torsion
An angle that measures less
than 15 degrees is an
indication of tibial torsion
Inward twisting of the tibia
(and is the most common
cause of intoeing)
KNEE FUNCTION
The quadriceps Mechanism is made up of patella, patellar
tendon and the quadriceps muscle on the front of upper
leg. The patella fits into the patellofemoral groove on the
front of the femur and act like a fulcrum to give the leg its
power. The patella slides up and down the groove as the
knee bends. When the quadriceps muscle contract they
cause the knee to straighten. When they relax, the knee
bend.
The hamstring and calf muscles help flex and support the
knee.
Movements of the knee
Flexion
hamstrings
assisted by:
gracilis
sartorius
popliteus
gastrocnemius
Gracilis
Sartorious
Popliteus
Gastrocnemius
Muscle Pull
Movements of the knee
Extension
quadriceps:
rectus femoris
vastus lateralis
vastus medialis
vastus intermedius
Rectus femoris
Vastus lateralis
Vastus intermedius
Vastus medialis
Muscle Pull
Loads on Knee
Forces at Tibiofemoral Joint
Shear stress is greater during open kinetic chain
exercises such as knee extensions and knee
flexions
Compressive stress is greater during closed kinetic
chain exercises such as squats and weight bearing
exercises
Loads on Knee
Forces at Patellofemoral Joint
With a squat, reaction force is 7.6 times BW on this
joint
Beneficial to rehab of cruciate ligament or
Patellofemoral surgery
PROBLEMS IN THE KNEE
The knee doesnt have much protection from trauma or
stress. In addition to wear and tear on the knee, sports
injuries are the source of many knee problems.
Symptoms:
Dull, sharp, constant or any type of pain.
Range of motion may vary, i.e. too little or too much.
Grinding or popping sound coming from knee.
Week muscle.
Knee locking.
Solutions:
Some knee problems only need rest and ice, others need
physical therapy or even surgery.
Swelling: There are two types of swelling.
Knee producing too much synovial fluid
Bleeding into the joint (hemarthrosis).
Swelling within the first hour of an injury is usually from
bleeding. Swelling from 2-24 hours is more likely to be from
the joint producing large amounts of synovial fluid trying to
lubricate an abnormality inside the knee.
Effect:
Chronic swelling can distend the knee.
Prohibit full range of motion.
If the cause of the swelling is blood, the blood can be
destructive to the joint.
Therapy:
R.I.C.E (Rest Ice Compression Elevation)
Locking: Locking is when something is keeping the knee
from fully straightening out. This is usually a loose body in
the knee. The loose body can be as small as a grain of sand
or as big as a quarter. The best treatment is removal of the
loose body by arthroscopy. Another type of locking is when
the knee hurts so bad that you just wont use it. The best
treatment here is rest and maybe some ice; swelling is not
usually present.
Giving Way: If your kneecap slips out of is groove for an
instant, it causes your thigh muscles to loose control causing
the feeling of instabilitythat is, you dont feel like your knee
is stable, wont support your weightand you usually try to
grab hold of something for support. Giving way can also be
caused by weak leg muscles or an old ligament injury.
Snaps, Crackles and Pops: Noises coming from knee
without pain are likely nothing to worry about. Sometimes the
noise is caused by loose bodies that just float around and are
not causing pain or injury to the knee. However, If you have
pain, swelling or loss of knee function, you should see an
orthopedist. The most common causechondromalacia
patellais caused by an injury. Another common cause is a
dislocating kneecapthat is, a kneecap that keeps slipping out
of its groove. Pops without trauma (injury) are not worrisome,
pops with trauma can mean ligament tears. Crackling, grinding
or grating (crepitus) means there is a roughness to the bone
surfaces and likely from degenerative disease or wear-and-
tear arthritis (osteoarthritis).
Pain and Tenderness:. Where and how bad the pain is
will help find the underlying cause. It also helps to know what
caused it and what makes it hurt. Pain that gets worse with
activity is often tendinitis or stress fractures. Pain and
tenderness accompanied by swelling can be more serious
such as a tear or sprain. Some pain can be caused by muscles
spasms associated with trauma.
The most common knee problems are:
Arthritis.
Torn ligament.
Torn meniscus.
Chondromalacia.
Loose body inside the knee joint.
ARTHRITIS
There are three basic types of arthritis:
Osteoarthritis.
Most common type.
Slowly degenerate knee joint bone tissues.
Mostly occur in middle or old age people.
Rheumatoid Arthritis.
Inflammatory type.
Affect both knee.
Can occur at any age.
Post-traumatic Arthritis
Similar to osteoarthritis.
Occur after an injury of knee.
May develop years after a fracture, ligament injury, or
meniscus tear
HEALTHY KNEE
ARTHRITIS
SYMPTOMS
Arthritis causes joint pain, swelling, stiffness, and limited
movement. Symptoms can include:
Joint pain.
Joint swelling.
Reduced ability to move the joint.
Redness of the skin around a joint.
Stiffness, especially in the morning.
Warmth around a joint.
CAUSES
Genetic.
Age.
Weight.
Previous injury.
Heavy sports.
Illness or infection.
TREATMENTS
Non surgical treatment fall in four major group:
Lifestyle modifications.
Exercise.
Supportive devices.
Other methods.
Surgical Treatment
Arthoscopy.
Osteotomy.
Arthroplasty (total knee replacement).
Knee Cartilage replacement*.
Sudden start-stop movements
and quick changes in direction
are common causes of ligament
injuries. A torn knee ligament can
cause pain, swelling or difficulty
in walking. Ligament sprains can
take 4-6 weeks for recovery.
Ligament injuries can also be
partial or complete tears. A torn
ligament needing reconstructive
surgery can take a year to heal.
In addition, damage to the
meniscus may be found and
repaired during arthroscopy.
TORN LIGAMENT
RECONSTRUCTED ACL
Twisting the knee joint is the most common cause of a torn
meniscus. This can happen during sports or even during
normal daily activity. The meniscus also becomes softer with
age, making it easier to tear. Tears can occur along the edge of
the meniscus or larger tears can occur deeper into the
meniscus. A torn meniscus can cause catching or locking of the
knee, giving way or buckling (instability) of the knee, pain or
swelling. The size and location of the tear determine both
treatment and recovery. Small tears need 4-6 weeks for
recovery while repair of larger tears can take 3 months or more.
TORN MENISCUS
MENISCUS TEAR
MENISCUS REPAIR OR REMOVAL
Chondromalacia can be caused by overuse or injury to the
kneecap and is a condition where the articular cartilage of the
knee bones softens. It is most common on the back of your
kneecap where the kneecap rubs with straightening of the
knee. As the cartilage softens, it wears away more easily during
joint movements. The cartilage can also be damaged by
directly injuring the knee. Or the cartilage may just thin with
age, which can cause catching or locking of the knee, giving
way or buckling of the knee (instability), pain or swelling.
CHONDROMALACIA
CARTILAGE DEFECT
Any free-floating object in the synovial fluid of the knee is
known as a loose body or joint mouse. It can be a fragment of
bone, cartilage, or meniscus. It can also be a piece of glass,
metal or any foreign object. A loose body isnt usually
noticeable until it lodges somewhere in the joint. Your
symptoms can change depending upon the exact location
within your knee. A loose body can cause catching or locking of
the knee, giving way or buckling of the knee (instability), pain or
swelling.
LOOSE BODY (Joint Mouse)
LOOSE BODY REMOVAL