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Tibiofemoral Joint
Anatomy of femur
Two condyles separated by the intercondylar notch/fossa
Notch becomes shallow patella groove
Medial condyle is longer anterior-posterior (2/3)
Medial condyle extends further distally creating a horizontal distal
femur in conjunction with oblique angle of femur
Anatomy of tibia
Medial and lateral condyles
Medial condyle is 50% larger than lateral condyle
articular cartilage is 3x thicker
two intercondylar tubercles (lodge in intercondylar notch of
femur)
Menisci dynamic as opposed to static structures
Asymmetric, fibrocartilagenous disk-like structures
Wedge-shaped
Medial meniscus
Semicircular or C-shaped
Lateral meniscus
4/5ths of a ring
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Tibiofemoral Angle
180
175
25% increase
50% increase
Full extension:
tibial tubercles lodged in intercondylar notch
menisci tightly interposed between femur and tibia
ligaments are taut
Closed-packed position
Passive Knee stabilizers:
Joint capsule
Extensor retinaculum anteromedial and anterolateral
portions of the capsule (medial and lateral patellar
retinacula)
MCL (runs anteriorly from post. Femur ant. Tibia)
Blends with capsule
Attaches to medial meniscus
Resists valgus stresses esp. when knee is flexed
Resists external rotation
Secondary to anterior tibial displacement
LCL (runs posteriorly to fibula head)
No attachments to meniscus, more distinct ligament
Resists varus stresses
Resists external rotation and posterior tibial
displacement
ACL
Resists anterior tibial translation and internal rotation
AMB lax in extension (max tension 70 deg flexion)
PLB taut in extension
Maximum excursion of tibia at 30 degrees of knee
flexion
Minor contribution to resist varus and valgus stresses
50% of BW
3.3 x BW at 60 deg.
7.8 x BW
Open chain
Forces and stress lowest at 90 deg. of flexion and full extension
Clinically
Open-chain safest between 25 90 degrees (60-90 if distal
lesions)
Closed chain safest between 0- 45 degrees especially if there are
proximal lesions
Medial-lateral stability of Patella
Transverse and longitudinal passive stabilizers:
Transverse:
medial patellar retinacula vastus medialis
lateral patellar retinacula vastus lateralis
longitudinal
patellar tendon
quadriceps tendon
these stabilizers influence the tracking of the patella
Forces on patella
quadriceps contracting results in lateral pull of patella
anything that the obliquity of the pull could cause:
1. excessive lateral compression
2. subluxation and/or dislocation laterally
causes of obliquity:
1. weakness of the VMO (dynamic stabilizer)
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