Lecture 17 (December 4, 1998)

Biomechanics of the Knee

Functions of the knee:
1. Transmit loads
2. Participates in motion
3. Aids in conservation of momentum (GAIT)
Composed of 2 joints:
1. Tibiofemoral
2. Patellofemoral
ROM:
Sagittal: 0-140 degrees
Transverse (rotation):
Full extension: virtually nothing
90 deg flexion (maximum): ER 45 degrees / IR
30 degrees
Frontal (ab/adduction):
Full extension: virtually nothing
30 deg flexion (maximum): few degrees only
Therefore, 2 degrees of freedom double condyloid joint
(medial and lateral articulating surfaces
Functional ROM:

0 117 degrees (Table 6-1)

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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 open ends of menisci are called horns susceptible to tears

connected to tibia via coronary ligaments as well as other
structures
patellomeniscal/patellotibial ligaments thickening of
anterior joint capsule
transverse ligament between anterior horns
lateral meniscus to PCL via coronary ligs. and post. capsule
lateral meniscus is more loosely attached to tibia than
medial making it less susceptible to tears
IMPORTANT medial meniscus attaches to the medial
collateral ligament
Adult meniscus is poorly vascularized only on periphery
What are the functions of the menisci?
1. Distribute and absorb forces
Joint reaction forces
2-3x BW in walking
5-6x BW in running and stair-climbing
menisci assume 40-60% of imposed load
removal of meniscus
increases magnitude of forces on articular
cartilage
decreases surface area over which forces are
distributed
can lead to arthritic changes in cartilage
2. Enhance congruency of the tibiofemoral joint
What is congruency?
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 Refers to the extent to which surfaces complement

each other in shape and size (perfect no gaps
between 2 sides of joint)
3. Assist in proper arthrokinematics
Alignment of Tibiofemoral Joint
Anatomic axes of tibia and femur tibiofemoral 185-190 deg.
slight valgus
Given this alignment, what would you say about the
compressive/tensile forces on the knee joint?
Not the case since:
Mechanical axis (femoral head talus) is only in 3 deg or less of
valgus therefore w\b forces distributed evenly medially and
laterally
Tibiofemoral angle > 195 degrees genu valgum
What happens to the forces on the knee joint?
Compressive forces increase laterally
Tensile forces increase medially
Tibiofemoral joint 180 degrees genu varum
What happens to the forces about the knee?
Compressive forces increase medially
Tensile forces increase laterally

Tibiofemoral Angle

Effect on compressive forces on medial meniscus

180
175

25% increase
50% increase

Instantaneous Axis of Rotation: moves with the degree of flexion

semicircular
See figures from Nordins book
Arthrokinematics of Tibiofemoral Joint
0 to 25 degrees flexion is primarily ROLLING (Ball analogy) of
femoral condyles on tibia
anterior gliding occurs with continued rolling (convex on
concave)
anterior gliding offsets the posterior displacement that would
result from the rolling PURE SPIN beyond 25 deg. of
flexion
wedge shape of meniscus forces femoral condyle to roll uphill
as knee flexes anterior shear
Screw-home or locking mechanism
Due to the asymmetry of the condyles the tibia externally rotates
during knee extension.
Begins at approximately 30 degrees of flexion and most evident
during final 5 degrees of extension

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

 Can create rotation of tibia (IR) with excessive

translation.
Injury caused by flexion and rotation in either
direction
With ER tightens as winds around PCL
With IR tightens as winds around lateral femoral
condyle
PCL
Primary restraint to posterior tibial translation
Maximal tibial translation occurs with knee flexed at
75-90 degrees
AMB lax in extension (maximal tension in 80-90 deg
of flexion)
PLB taut in extension
Minor role in resisting valgus/varus
Plays role in creating and restraining rotation
Posterior tibial translation is associated with tibial ER
Assists in ER for screw-home mechanism
Injury mechanism is a hyperextension event
ITB
Fascia from TFL, glute max and medius
Attaches to linea aspera on femur and lateral tubercle of
tibia
Gives rise to the iliopatellar band may cause patella
tracking problems
Reinforces anterolateral aspect of knee
Resists posterior translation of femur via connection to
BF and VL
Posterior Capsular Ligaments
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 Posteromedially oblique popliteal ligament

tendinous expansion of popliteus (lateral fermoral
condyle posterior tibia)
Arise from semimembranosus central aspect of
capsule
Posterolaterally arcuate ligament
Posterior fibula head tibial intercondylar area and
lateral epicondyle of femur
These ligaments are taut in extension check
hyperextension
Also arcuate checks varus and popliteal checks valgus
Patella
Function:
1. aids in extension by increasing the moment arm (anatomic
pulley) - > effect at 20 40 degrees of flexion
reduces forces generation by quads
2. allows for wider distribution of contact forces and reduces
friction between quad tendon and femur
3. protection
Anatomy:
Triangular shaped largest sesamoid bone least congruent joint
3 facets covered with articular cartilage:
1. lateral
2. medial (thickest articular cartilage in the body 7mm)
3. odd (most medial) reported in as much as 80% of
population

with flexion the patella translates caudally in fermoral

sulcus/trochlea
full flexion sinks in intercondylar notch
from 25 to 130 degrees of flexion the patella:
tilts medially (11 degrees) about a vertical axis to accommodate
the asymmetric femoral condyles
with malalignment excessive and irreducible lateral tilt
rotates laterally (7 degrees) about an anterior-posterior axis
failure of patella to slide, tilt, or rotate properly can lead to:
restricted patellofemoral ROM
restricted knee ROM
patellofemoral tracking problems pain tissue
damage
patellofemoral instability
Knee flexion angle
Patella contact
0
Little or no contact
10-20
Inferior margin across medial & lateral facets
Moves proximal and lateral
flexion
Beyond 90 deg
Medial facet intercondylar notch, odd facet
makes contact
At 135 deg
Contact via lateral and odd facets only
Medial facet receives most consistent contact (thickest articular
cartilage).
Odd facet receives least contact

These two areas are susceptible to degenerative changes.

In general, contact moves from inferior to superior with increased
flexion, and from :
Medial and lateral (before 90)
Lateral (past 90)
Lateral and odd (beyond 90-135)
Note: actual movement of the patella begins lateral and moves
medially and then upward.
PFJRF during Gait
10-15 deg

50% of BW

stair climbing/running hills

3.3 x BW at 60 deg.

deep squats to 130 degs

7.8 x BW

As you flex from 30 to 90 contact area increases and is mainly on

medial facet
70-90 patella tendon contacts femur helping to distribute the
load
Clinically, it is more important to understand contact stress rather
than joint reaction forces. Why?
Stress = force/area
Closed Chain
Stress increases from 0 to 90 deg flexion
90-120 deg., stress decreases or levels off
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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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2. excessive genu valgum Q angle (10-15 degrees is

normal, > 20 is abnormal)
3. excessive femoral anteversion Q angle
4. tight lateral retinaculum or loose medial retinaculum
5. tight ITB (iliopatella band)
6. diminished height of lateral femoral lip
Other factors affecting patella alignment/tracking:
status of gluteal muscles
anatomy of quads
position of tibial tuberosity
mechanics of the foot
Specific problems with VMO:
1. barely reaches the top of the patella
2. fibers run more vertical rather than oblique

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