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Knee Complex : 1
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Introduction
The knee complex is one of the most often injured
numerous muscles crossing the joint, provide insight into the joints complexity.
and ankle to support the bodys weight during static erect posture.
moving and supporting the body during a variety of both routine and difficult activities.
well as major mobility roles is reflected in its structure and function. 4/7/12
articulations located within a single joint capsule: the tibiofemoral joint and the patellofemoral joint.
mechanism, the characteristics, responses, and problems of the patellofemoral joint are distinct enough from the tibiofemoral joint to warrant separate attention.
a part of the knee complex because it is not contained within the knee joint capsule and is functionally related to the ankle joint.
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around a coronal axis through the epicondyles of the distal femur, the transverse plane about a longitudinal axis through the lateral side of the medial tibial condyle, and
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medial and lateral articular surfaces, also referred to as the medial and lateral compartments of the knee.
relationship of the surfaces to each other are necessary for a full understanding of the knee joints movements and of both the functions and dysfunctions common to the joint.
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Femur
The proximal articular surface of the knee joint is
composed of the large medial and lateral condyles of the distal femur.
femoral condyles do not lie immediately below the femoral head but are slightly medial to it (Fig. 11-1A).
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distally, so that, despite the angulation of the femurs shaft, the distal end of the femur remains essentially horizontal.
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curvature in the frontal plane, both the medial and lateral condyles individually exhibit a slight convexity in the frontal plane.
excluded, it can be seen that the lateral tibial surface ends before the medial condyle. 4/7/12
intercondylar notch through most of their length but are joined anteriorly by an asymmetrical, shallow groove called the patellar groove or surface that engages the patella during early flexion.
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Tibia
The asymmetrical medial and lateral tibial condyles or
plateaus constitute the distal articular surface of the knee joint (Fig. 11-3A).
The
medial tibial plateau is longer in the anteroposterior direction than is the lateral plateau; however, the lateral tibial articular cartilage is thicker than the articular cartilage on the medial side.
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by a roughened area and two bony spines called the intercondylar tubercles (Fig. 11-4).
These tubercles become lodged in the intercondylar
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which suggests that the bony architecture of the tibial plateaus does not match up well with the convexity of the femoral condyle.
Because of this lack of bony stability, accessory joint
already noted, is oblique, directed inferiorly and medially from its proximal to distal end.
vertically.
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that is, the femur is angled up to 5 off vertical, creating a slight physiologic (normal) valgus angle at the knee (Fig. 11-5).
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stresses on the medial and lateral compartments of the knee joint. 4/7/12
alignment is performed by drawing a line from the center of the femoral head to the center of the head of the talus (see Fig. 11-5).
bearing line, of the lower extremity, and in a normally aligned knee, it will pass through the center of the joint between the intercondylar tubercles.
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knee joint are, therefore, equally distributed between the medial and lateral condyles (or medial and lateral compartments).
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However,
once unilateral stance is adopted or dynamic forces are applied to the joint, compartmental loading is altered.
phase of gait), the weight-bearing line must shift medially across the knee to account for the now smaller base of support below the center of mass (Fig. 11-6A).
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line onto the lateral compartment, increasing the lateral compressive force while increasing the tensile forces on the medial structures (Fig. 11-7A). 4/7/12
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constant overload of the lateral or medial articular cartilage, respectively, which may result in damage to the cartilage and the development of frontal plane laxity.
Genu varum, for instance, may con-tribute to the
the weight-bearing line is shifted medially, increasing the compressive force on the medial condyle, causes osteoarthritis and lead to excessive medial joint laxity as the medial capsular ligaments attachment sites are gradually approximated through the erosion of the medial compartments articular cartilage.
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End of Part - 1
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