Knee joint

anatomy and
Biomechanic

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 Knee joint anatomy
• The largest joint of the body • Bones:
• The largest and most complex synovial 1. Femur
membrane
2. Tibia
• Largest joint space
3. Patella
• Most amount of the synovial fluid.
• Tibiofemoral joint
• Patellofemoral Joint
• Since the articular surface of the
articulation is Bicondyle, it belongs to
Bicondyler joint group .
Femur
•Convex surfaces; medial condyle and lateral condyle.
•Condyles are oval anteriorly and spherical posteriorly.
•Their surfaces is covered with articular cartilage.
•Patellar facets
Tibia
•Concave surfaces: medial condyle and lateral condyle.
•It articulates with the femoral condyles in the middle and with the
meniscuses in the peripheral parts
•The most compatible position of the articular surfaces is when the knee
is fully extended .
 Patella

•The patella bone which is embeded

in the quadricep femoris tendon
•is the largest sesamoid bone .
•Apex patellae ( apex of patella)
•Basis patellae(base of the patella)
Articular surfaces
• medial articular surface is smaller
and flatter .
• Lateral articular surface is wider
and more hollow; it has the
thickest articular cartilage .
Function
•Protects the knee joint from external
forces and influences.
•İt increase the strength of the muscle
by moving the extensor muscles
tendons, away from the joint axis
•https://media.giphy.com/media/r3RyiS
5p7SZWw/giphy.mp4
Ossification:
•At 2-6 years old .
•Extra ossification centers can be seen in the superolateral corner
of the patella. (Patella bipartite tripartite)
•İt can be confused with patella fractures.
 Knee joint ligaments

• Extracapsular ligaments • İntracapsular ligaments

 Lig. patellae  Lig. cruciatum anterius(anterior
 Lig. popliteum curciate ligament)
obliquumoblique popliteal  Lig. cruciatum
ligament (posterior posterius(posterior curciate
ligament) ligament)
 Lig. popliteum arcuatum  Lig. meniscofemorale anterius
(arcuate popliteal ligament) (Humphrey. lig)(anterior
 Lig. collaterale tibiale (medial meniscofemoral. lig)
collateral ligament)  Lig. meniscofemorale posterius
 Lig. collateral fibulare (lateral (Wrisberg .lig)(posterior
collateral ligament) meniscufemoral lig)
 Lig. transversum
genus(transverse ligament of
knee)
 Lig. patellae:
• It attaches to the patella proximally and to the tibial tuberosity
distally.
• Quadriceps femoris tendon.
• Medial and lateral vatus tendons, medial and lateral retinaculum of
the patella extend from the sides of the patella to the tibia.
Lig. popliteum obliquum:
•İt attaches from the inner
condyle of the tibia to the outer
condyle of the femur.
•İt is the main ligament that
limits. The hyperextension.
Lig. popliteum arcuatum:
•İt is Y shaped, which is fused to
the joint capsule.
•One end is attached to the top of
the fibula’s head, the other end
is attached to the posterior part
of the area of the posterior
intercondylar in the tibia, and the
third end is attached to the
lateral epicondyle of the femur.
•İt controls the internal rotation
of the leg.
Lig. collaterale tibiale: MCL
•Medial epicondyle of the
femur
•Medial condyle of the tibia
And medial meniscus
•a. inferior medialis genus
inferrior medial artery .

Lig. collaterale fibulare:LCL

•Lateral epicondyle of the
femur
•Fibula’s head
•İt is seperated by muscle
popliteus tendon from lateral
meniscus
•a. inferior lateralis genus
inferior lateral artey
Lig. cruciatum anterius: anterior
curciate ligament
•Posterior part of the inner surface
of the lateral condyle of the femur.
•Anterior area of the tibia
intercondyle.
•Length 33mm width 11mm
Lig. cruciatum posterius:
posterior curciate ligament:
•Medial condyle of the femur
•Posterior area of the tibia
interconyle
•Length 38mm width 13mm
Knee Cruciate ligament blood supply
• A.poplitea branch of a.media genus
• A.inferior lateralis genus
• A.inferior medialis genus
• PCL vascularization is denser
And more homogenous than ACL.
Knee cruciate ligament innervation
• Posterior articular branches of
N.tibialis
 Ruffini receptors: sensitive to stretch
All these receptors act as
 Vater-Pacini receptors: sensitive to
proprioceptors, with
fast movements.
ligamentous feedback
 The free nerve ending: they secret crucial for muscular activity
neuropeptides and knee stabilization.
 Lig. transversum genus:
•İt connects the anterior edge of the
lateral meniscus to the anterior horn
of the medial meniscus

Lig. meniscofemorale anterius (Humphrey lig)

Lig. meniscofemorale posterius (Wrisberg lig)
•Both ligaments start from the posterior horn of the lateral meniscus
and extend to the medial condyle of the femur.
•Movement control of the lateral meniscus posterior horn.
•They have a secondary role in tibia posterior translation stabilization
 menisci
•They are structures consisting of fibrous
cartilage in the form of a crescent, which
deepens the articular surfaces and ensures
their harmony with each other.
•The peripheral parts are thick and convex,
the free inner parts are thin and concave.
 Passive stabilization of the knee joint
Nutrition and supplying
in the slippery of the articular surface
İn proprioception
İn load transfer
İncreasing joint contact area
Excessive flexion and extension limitation
They play role in shock observation
Meniscus medialis: medial meniscus
•Semicircular ( C shape)
•anterior horn is at Anterior intercondylar
area of the of the tibia.
•İts posterior horn is attached to the
posterior area of tibia intercondyle.
•Because of attachment to capsule and
MCL , medial meniscus is less mobile than
lateral meniscus.
Meniscus lateralis: medial meniscus
•Circular shape( O shape )
•The anterior horn is at intercondylar
eminent.
•The posterior horn is Attached to the
posterior of the intercondylar eminent.
The tendon of the
M. Popliteus separates the lateral
meniscus from the lig. LCL and the joint
capsule.
Knee joint blood supply
A. femoralis
A. poplitea
A. tibialis anterior
A. tibialis posterior
Rete articulare genus (derin pleksus)
İs located Around the knee .
İt Has A rich network of anastomosis.
• Separated branches, nourish
either bone and knee joint
fibrous layer and synovial
membrane.
Rete patellare (superficial plexus )
İt is located between the skin and
deep fascia around the patella.
Knee joint nerves:
N. femoralis
N. obturatorius Joint
N. tibialis Branches
N. fibularis communis
R. infrapatellaris:
The anterior part of the knee
receives the skin senses.
 knee joint movements and biomechanic
• Biomechanics is the study of the movements of living things using the
science of mechanics. (Hatze, 1974)
• Biomechanics provides key information for the most effective and
safest movement patterns, equipment and related exercises needed
to improve human movement.
• Mechanics, on the
other hand, is a sub-
branch of physical
science that explains
motion and how
forces create
motion.
Knee movement
occurs in six plane:
•Anterior/ Posterior
translation
•Medial/ Lateral
translation
•Proximal/ Distal
translation
•flexion/ extension
•İnternal/ External
rotation
•Varus/ Valgus opening
During flexion; (120-160º)
A. Upright: F1 above T1
B. In the early flexion phase:F2, T2’nin üzerinde. F2 is above the T2.
The femur rolls backward on the tibial condyles.
C. In deep flexion phase: F3 is above T2. The femur rolls backward on
the tibia and slides forward.
Rotation in the knee joint
1- at the end of the extension,the femur internally rotates on the tibia.
At the beginning of the flexion, the femur rotates externally on the tibia
2- between 30-90 degrees of flexion ,
the spherical posterior part
of the femoral condyle act as
Spheroid joint on the tibia;
In this position, rotation is
made around the vertical
axis passing through the
Medial condyle, with the
Forward and backward
movement of the lateral condyle.
• in a flexed knee, the tibia internally rotate by m.gracillis , semitendenious and
sartorius;and by m.bicep femoris externally rotate.
• The internal and external ligaments are loosened in at least 30 degrees of
flexion
• In this case, the passive rotation is 60-70° and the active rotation is 20°.
screw-home mechanism
•Since the medial codyle of the
femur is longer than lateral
condyle;
Tibia perform a 15 degree of
external rotation during final 20
degree of the knee extension.
•In a person with a
hyperextended standing knee,
the joint is passively stable and
needs little muscular
activityAyakta dizi
•The gravity center of the knee ,
pass through the anterior of the
knee .
Anterior curciate lig biomechamic
(Lig. cruciatum anterior)
• Its primary function is to prevent
anterior translation of the tibia.
(Loading occurs mostly when going
into extension.)
• Its secondary function is to
counteract internal rotation of the
tibia and valgus angulation of the
knee.
• In full extension, the ACL is more
taut than the PCL
• The ACL is at its most taut in full
extension and full flexion.
• As the knee flex, the ACL relax,
and PCL begins to stretch.
• However, it is stretched by
internal rotation in the middle of
the flexion.
• Stability is reduced between 20-
50º of flexion as neither of the
cruciate ligaments is too tight
• In this case, the knee is in the
weakest and highest risk of
injury.
• It absorbs 75% of the anterior
translational load in full
extension and 85% in 30-90°
flexion.
Posterior curciate ligament biomechanic
(Lig. cruciatum posterior)
• It is the main stabilizer as it acts as an axis in
the flexion, extension and rotation
movements of the knee joint.
• Its primary function is to limit posterior
translation of the tibia at all joint degrees, in
which case the PCL lengthens and becomes
strained.
• The tensile strength of thePCLis
approximately twice time higher.
• Since it extends proximodistally in extension,
it prevents more hyperextension.
• Secondly, it opposes external rotation of the
tibia with excessive varus and valgus
angulations of the knee.
• The main knee stabilizer in extension is the
posterolateral corner structures.
 Lateral collateral lig. Medial collateral lig.
biomechanic Biomechanic
(Lig. Collaterale Laterale) (Lig. Collaterale Mediale)
•İt opposes varus force. •İt opposes against valgus force.
•The LCL is a vital load sharer that •The deep part of the ligament is
opposes the external rotation taut in extension and loosens as it
force of the knee in extension flexes.
•. Knee internal rotation is •The MCL largely provides internal
markedly increased in the rotation control of the tibia.
combined cuts of LCL and
Posterolateral corner structures.
Meniscus biomechanic
• In the extending knee, the tibia and
menisci slide forward, and in flexion,
they slide back.
• MM: m.semimembranosus fibers
• LM: m.popliteus fibers.
• Anterior-posterior movement of the
LM is greater than that of the MM
(11.2 mm-5.2 mm)
• This reduces the risk of LM damage.
• During tibia ext-rot, the MM moves
posteriorly, and the LM moves
anteriorly, relative to the tibial
plateau.
• During the int-rot, there is the
opposite movement.
Pattela femoral joint biomechani
(Articulatio patellofemorale)

 As the patella knee joint comes from

full flexion to full extension,
• 7 cm in proximal-distal direction
• 19 mm in foreground
• It is displaced 7 mm medially with
internal rotation and laterally with
external rotation.
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Q angle
•It is the angle between the
proximal and distal tensile forces
acting on the patella.
•Measurement:
•Q angle is the angle measured
between the spina iliaca anterior
superior-middle of the patella
and the middle of the patella-
tuberositas tibia by contracting
the quadriceps muscle while the
knee is extended in the supine
patient.
•Normally: 15º (±5)
Conditions that reduce the Q angle Conditions that increase the Q angle
Medial rotation of the tibia Lateral rotation of the tibia
Lateral rotation of the femur Medial rotation of the femur
Directory varus opening Knee valgus angulation
Joint reaction force
•The patella does not touch the
trochlea until the knee is in full
extension to 20° of flexion. After 20º,
contact begins and the joint reaction
force on the contact surface is the
result of the quadriceps tendon and
patellar tendon tensile forces.
•In walking, the patellofemoral joint
reaction force is highest when the
heel touches the ground, and the
knee flexion is greatest, and it is half
the body weight.
•The joint reaction force in the knee
bent up to 90º in climbing and
descending stairs increases 3.3 times
the body weight.
Dynamic stabilizator of the knee joint :
• M. quadriceps femoris
• Hamstrings
• M. gastrocnemius
• Tractus iliotibialis(iliotibial tract)
• M. gracilis
• M. sartorius
• M. popliteus

• M. quadriceps femoris contraction with posterior

cruciate ligament
• The contraction of the hamstrings is synergistic with the
anterior cruciate ligament.
Activities that improve co-contraction of the hamstrings and
quadriceps have an important place in the rehabilitation program
for cruciate ligament injuries!!
Knee in walking
 Relationships Between Knee Biomechanics and
Surrounding Structures

Gastrocnemius-soleus tension

Restriction of dorsiflexion in the ankle

increased knee flexion

Iliotibial band print

Iliotibial bant sendromu

 Relationships Between Knee
Biomechanics and Surrounding
Structures
Relationships Between Knee Biomechanics and
Surrounding Structures
 CYBEX
• Muscle strength
• Muscle strength imbalance
• M. quadriceps femoris
strength greater than 80%
of hamstring strength
increases the likelihood of
ACL injury.
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