02/01/2014

Definitions:

TheKnee:

KneeKinematicsandKinetics
Thelargestandmostcomplexjointstructure
TransmitLoads
haslargecomponents
Participateinmotionandambulation
haswideRangeofmotion
Aidsconservationofmomentum
TROCHOGINGLIMUS
2degreeoffreedomofmotion

Theknee
Isa2 jointstructure
Tibiofemoraljoint
Patellofemoraljoint

Sustainhighforcesandmoments

Kinematics:
isthestudyofmovement
withoutreferencetoforces

Kinetics
isthestudyofmovementwith
referencetoforces

Anatomyoftheknee
TheKneeJoint
3Bones
Tibia Femur Patella
4Ligaments
MCL,LCL,ACL,PCL
2Menisci
Meniscuslateralis
Meniscusmedialis
ArticularCartilage

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FEMUR

Tibial surface

2 condyles : medial ; lateral

Anterior : flat
;
posterior : curved
Medial condyle has smaller transverse
diameter than lateral condyle
Fossa intercondylar: u-shaped

2surfaces :Tibialsurface Patellarsurface

Femur
PatellarSurface
SaddleShape
Asymetrical
Lateralfacelarger
Andmoreconvex

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MCLBiomechanics

LCLBiomechanics

2fibers:Anterior&posterior

Verticaldirection

Anterior:attachtopatellarretinacularfibers
Posterior:attachtomedialmeniscus&M.Semimenbranosus

Fromlateralcondyletocaputfibula
NOTattachtomeniscuslateralis

Primaryroleistopreventagainstavalgusforce,extensionand
externalrotationofthetibia

Primaryroleistoprotectfromvarusforcesandexternal
rotationofthetibia,assistsin2 restraintforanteriorand
posteriortibialtranslation

ThroughoutFullRangeofMotion:
Bothfibersaretautinfullextension
Anteriorfibersaretautinflexion
Posteriorfibersaretautinmidrange

ThroughoutRangeofmotion:
Istautduringextension
Looseduringflexion
Especiallyafter30 offlexion

MeniscusStructure
PeculiarAnatomy
Menisci
FibroFibrocartilagesupport
Internalligaments
Carryloadsduringmotion

Theperipheralborderofeachmeniscusisthick
andattachedtotheinsidecapsuleofthejoint
theoppositebordertaperstoathinfreeedge
Theproximalsurfacesofthemenisciareconcaveandincontact
withthecondyles ofthefemur
Theirdistalsurfacesareflatandrestontheheadofthetibia. 1

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Meniscal Functions
Deepensthearticulationandfillsthegapsthat
normallyoccurduringthekneesarticulation
PrimaryFunctions:
Loaddistribution
JointStability
ShockAbsorption
SecondaryFunctions
JointLubrication
ArticularCartilageNutrition
ProprioceptiveFeedback

MenisciFunctions

MedialMeniscus
Semicircularinform.

Deepenthearticulation
Increaseareaofcontact
Shockabsorption
X10BW
askierlandsfromajump
Increasestability
Cupsthefemoralcondyle
Nutritionofcartilage
Sweepingsynovialfluidacrossjoint

Theanteriorhornisattachedtothe
anteriorintercondylar fossa.
Transverseligamentconnectsthe
anteriorhornsofthemedialand
lateralmenisci.
Theposteriorhornisfirmlyattached
totheposteriorintercondylar fossa
Theperipheryofthemedial
meniscusisattachedtothejoint
capsulethroughoutitslength 1
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LateralMeniscus
Almostcircularandcoversalarger
portionofthetibial articular surface

CRUCIATUMLIGAMENTS

Function
Loadbearing

Theanteriorhornisattachedtothetibia
infrontoftheintercondylar eminence
andbehindtheattachmentoftheACL

ShockAbsorption
JointStability

Alooseperipheralattachmenttothejoint
capsule

JointLubrication

Severalligamentsrunfromtheposterior
hornofthelateralmeniscustothemedial
femoralcondyle

Proprioception

Insertion-site anatomy of the

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human menisci 4

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Anatomy of the ACL

Itsoriginonanteriorcentral
tibialplateau
Runsobliquecoursefrommedial
anteriortolateralposterior
Inserttomedialsurfaceofthe
LateralFemoralcondyle(LFC)
2 bundles:
Antero-medial bundle (AM)
Postero-lateral bundle (PL)

Anatomy of the ACL

Biomechanics of the ACL

Anteromedialbundletight
inflexion&extension

Function:
Posteriorlateralbundle
tightonlyinextension

Preventanteriortibial
displacementonfemur

LeaststressonACLbetween
3060 offlexion

Preventshyperextension,
varus&valgusstresses

Mostinjuriesoccurin
ClosedKineticChain

AnatomyofPCL

PosteriorCruciateLigament

Twobundles
Anterolateral,tautinflexion
Posteromedial,tautinextension

Orientationpreventsposteriormotion
oftibia
PCLlarger&strongerthanACL
CSA120150%larger
CSAAL2xPM

Considerassociatedroleof
posterolateralcomplexwhen
discussingPCL

LCL
PopliteusComplex
ArcuateLigament
PosteriorLateralCapsule

Twobundles
Anterolateral,tautinflexion
Posteromedial,tautinextension

Orientationpreventsposteriormotion
oftibia
PCLlarger&strongerthanACL
CSA120150%larger
CSAAL2xPM

Considerassociatedroleof
posterolateralcomplexwhendiscussing
PCL

LCL
PopliteusComplex
ArcuateLigament
PosteriorLateralCapsule

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Muscles

PCLBiomechanics

M.Quadricepsfemoris

Functions:
Primarystabilizeroftheknee
againstposteriormovementofthe
tibiaonthefemur
Preventsflexion,extension,and
hyperextension

M.Hamstring

Tautat30degreesofflexion
posteriorlateralfibersloosein
earlyflexion

Tibiafemoralmotion
inthesagittalplane

Rangeofmotion
Need to define planes
in which the particular
motion is taking place
The knee moves in six
different directions of
motions (6DOF)
Sagittal plane (0-140)

Rotations
Flexion extention :0 140
Varus valgus
:6 8 (inextension)
Int extrotation
:25 30 (flexext)

Translations
AP5 10mm
comp/dist2 5mm
mediolateral12mm

Activity
Walking
Climbing stairs
Descending stairs
Sitting down

Knee Flexion
(degrees)
67
83
90
83-110

Tying a shoe

106

Squatting

130

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TibioTibiofemoralmotion
intheTransverseplane
Influencedbykneepositioninsagittalplane
Ex.Ifkneeisinfullextensionrotationis
restrictedbyinterlockingofcondyeswithtibia
Rotationincreasesasthekneeisflexed
maximum90 flexion
External45
Internal30
Beyond90
decreases,duetosofttissuerestriction

RollingMotion

TibiaTibiafemoralmotion
inthefrontalplane
AbductionandAdductionisalsoaffectedby
theamountofkneeflexion
Ex.Fullextensionprecludesmotion
Increasedpassiveabductionand
adductionoccurswithkneeflexion<30

Typesofmotionatkneejoint
RollingMotion :
Initiatesflexion
GlidingMotion:
Occursatendofflexion

GlidingMotion

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LocatinganICR
Successive films taken 10 intervals of flexion (A,B)
Tibia is parallel to the x x-ray to prevent rotation
Marking two identifiable points on femur, and join these
points and draw perpendicular bisector (B)
The intersection point of the perpendicular bisectors is
the instant center of rotation.

ICR(contd)cont

InstantaneousCenterofRotationICR
"Ifonerigidbodyrotatesaboutanotherrigidbody,its
motionatanyinstantcanbedescribedbyapointor
axisofrotationcalledtheinstantaneouscenterof
rotation.
Fornormalknees
PathwayofICRissemicircular
Locatedonthefemoralcondyles
rotation.

ScrewHomemechanism

The"ScrewHomemechanism

ScrewHomemechanism3

Tibia

Rotation

between the tibia and femur

Occurs automatically between full
extension 0 and 20 of knee flexion

SHM is considered a key element to knee

stability for standing upright

Internal rotation during the swing phase

External rotation during the stance phase
External rotation
Occurs during the terminal degrees of knee
extension
Difference in radius of curvature of the medial and
smaller lateral condyle
Results in tightening of both cruciate ligaments
Locks the knee
Tibia is in the position of maximal stability with
respect to the femur

During the last 20 of

knee extension
Anterior tibial glide
persists on the tibia's
medial condyle
Because its articular
surface is longer in that
dimension than the lateral
condyle condyles

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ScrewHomemechanism4

PatellofemoralJoint

Patelladirectlycontactsfemoralcondylesin
flexion
Patellaactsasthefulcrum
Itissaidtobelateralsidedominant
dominant
Greatersurfaceareaofcontactonthelateral
sideasopposedtothemedial

Prolonged anterior glide

on the medial side
Produces external tibia
rotation
The "screw screw-home"
mechanism

PatellarKinematics

PatellarKinematics

CompressiveForcesofPatella

PatellarKinematics
There are predictable areas of contact between patella and femoral condyles
thatbetween thatchange with degree of flexion:

FigurefromFulkerson,Disorders19973rded.
Figure from Fulkerson 1997

-figure from Fulkerson 1997figure 1997

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PatellarKinematics2

PatellarKinematics3

PatellarKinematics4

ForcesactingonthePatella:

Sumofforcesactinginthefourdirections

Laterallylateralretinaculum,vastus
lateralism.,iliotibialtract

Determinemovementpatternofthekneejoint

Mediallymedialretinaculumandvastus

Additionalforcesconsideredare:

medialism.
SuperiorQuadricepsviaquadriceps
tendon
InferiorPatellartendon

PatellarKinematics5
Qangle:
Angleformedatthekneebyconnecting
alinefromtheanteriorsuperioriliaccresttothe
centerofthepatella
asecondlinefromthecenterofthepatellatothe
centerofthepatellartendoninsertionintothetibial
tubercle

Figure from Fulkerson, 1997Figure 1997

QAngle

Frictionforces,compressiveforces,torques,
translationalforcesandinternalstabilizingforces
fromsofttissues

QAngle(contd)
Q-angle of 12 to 15 degrees is considered normal;
while patients with patellar subluxation may have
a Q angle as high as 30 degrees QHenry J.H., Goletz T.H., and Williamson B. Lateral Retinacular Release in Patellofemoral
Subluxation. Am J of Sports Med . Vol. 14 No.2 1986 pp121 129. Subluxation. Med. pp121-

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Patellarmalalignment

KneeKinematics

Generally associated with tightness of

Lateral retinaculum
Hamstrings
Iliotibial band
Quadriceps
Hip rotators
Achilles tendon

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