Kneebiomechanic 120622054413 Phpapp02

Dr. Pukhrambam Ratan khuman (PT) M.P.T.
, (Ortho & Sports)
introduction
Participating bones
Femur
Tibia Patella
13 August 2013
Dr. Ratankhuman M.P.T., (Ortho & Sports)
Knee complex
Tibio-femoral joint Patello-femoral joint
13 August 2013
Tibio-femoral/Knee joint
Ginglymus (Hinge) ? A freely moving joint in which the bones are so articulated as to allow extensive movement in one plane.
Arthodial (Gliding) ? 6 degrees of freedom
3 Rotations
3 Translations
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Knee degree of freedom
Rotations
Flex/Ext 150 1400
Varus/Valgus 60 80 in extension Int/ext rotation 250 300 in flexion
Translations
AP 5 - 10mm Compression/Distraction 2 - 5mm
Medial/Lateral 1-2mm
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General Features of Tibio-femoral Joint

Double condyloid knee joint is also referred to as Medial & Lateral Compartments of the knee. Double condyloid joint with 30 freedom of Angular (Rotatory) motion.
Flexion/Extension Plane Sagittal plane Axis Coronal axis Medial/lateral (int/ext) rotation Plane Transverse plane Axis Longitudinal axis Abduction/Adduction Plane Frontal plane Axis Antero-posterior axis.
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Femoral articular surface

Femur is proximal articular surface of the knee joint with large medial & lateral condyles. Because of obliquity of shaft, the femoral condyles do not lie immediately below the femoral head but are slightly medial to it. The medial condyle extend further distally, so that, despite the angulation of the femurs shaft, the distal end of the femur remains essentially horizontal.
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In sagittal plane - Condyles have a convex shape In the frontal plane - Slight convexity The lateral femoral condyle
Shifted anteriorly in relation to medial
Articular surface is shorter

Inferiorly, the lateral condyle appears to be longer
Two condyles are separated

Inferiorly by Intercondylar notch
Anteriorly by an asymmetrical, shallow groove called
the Patellar Groove or Surface

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Tibial articulating surface

Asymmetrical medial & lateral tibial condyles constitute the distal articular surface of knee joint. Medial tibial plateau is longer in AP direction than lateral The lateral tibial articular cartilage is thicker than the medial side. Tibial plateau slopes posteriorly approx 70 to 100 Medial & lateral tibial condyles are separated by two bony spines called the Intercondylar Tubercles
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The tibial plateaus are predominantly flat, but convexity at anterior & posterior margins Because of this lack of bony stability, accessory joint structures (menisci) are necessary to improve joint congruency.
9o
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Menisci of knee joint

2 asymmetrical fibro cartilaginous joint disk called Menisci are located on tibial plateau. The medial meniscus is a semicircle & the lateral is 4/5 of a ring (Williams, PL, 1995).
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Both menisci are

Open towards intercondylar
area Thick peripherally Thin centrally forming cavities for femoral condyle
By increasing congruence, menisci play in reducing friction between the joint segment & serve as shock absorber.
Dr. Ratankhuman M.P.T., (Ortho & Sports) 14
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Meniscal attachment
Common attachment of medial & lateral

Intercondylar tubercles of the tibia
Tibial condyle via coronary ligaments

Patella via patellomeniscal or patellofemoral ligament Transverse ligament between two menisci
Anterior cruciate ligament (ACL)
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Meniscal attachment
Unique attachment of medial menisci

Medial collateral ligament (MCL)
Semitendinous muscle
Unique attachment of lateral menisci

Anterior & posterior meniscofemoral ligament
Posterior cruciate ligament (PCL) Popliteus muscle
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Young children whose menisci have ample of blood supply have low incidence of injury In adult, only the peripheral vascularized region is capable of inflammation, repair & remodeling following a tearing injury. Menisci are well innervated with free nerve ending & 3 mechanoreceptors (Ruffine
corpuscle, Pacinian corpuscle & Golgi tendon organs)
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TF alignment & weight bearing force
The anatomic/ longitudinal axis

Femur Oblique, directed inferiorly & medially
Tibia Directed vertically The femoral & tibial longitudinal axis form an angle
medially at the knee joint of 1850 1900, i.e. 50 100 creating Physiological Valgus at knee
In bilateral static stance equal weight distribution on medial & lateral condyle
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Deviation in normal force distribution

TF angle > 1900 Genu Valgum compress
lateral condyle TF angle < 1800 Genu Varum compress medial condyle
Compressive force in dynamic knee joint

2 3 time body weight in normal gait
5 6 time body weight in activities (like
Running, Stair Climbing etc.)
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Knee joint capsule

Joint capsule enclose TF & PF is large lax Outer portion firmly attached to the inferior aspect of femur & superior portion of tibia. Posterior attachment

Proximally to posterior margins of the femoral
condyles and intercondylar notch. Distally to posterior tibial condyle.
Anterior attachment
Superiorly Patella, tendon of quadriceps muscles Inferiorly patellar tendon complete the anterior
portion of the joint capsule.
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The antero-medial & antero-lateral portions of the capsule, are often separately identified as the medial and lateral patellar retinaculae or together as the extensor retinaculum. The joint capsule is reinforced medially, laterally & posteriorly by capsular ligaments.
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Extensor retinaculum
2 layers superficial & deeper Deeper layer
Connecting the capsule anteriorly to menisci &
tibia via coronary ligament (known as patellomeniscal or patellotibial band)
Superficial layer
Mixed with vastus medialis & lateralis muscle &
distal continue to posterior femoral condyle (patellofemoral ligament)
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Synovial lining
The intricacy of fibrous layer capsule is surpassed by its synovial lining except posteriorly. Synovium adheres to anterior aspect & side to the ACL & PCL. Embryologically, the synovial lining of the knee joint capsule is divided by septa into 3 separate compartment
Superior patellofemoral compartment 2 separate medial & lateral
tibiofemoral compartment
Ligament of knee joint
Collateral ligament
Medial collateral ligament (MCL)
Lateral collateral ligament (LCL)
Cruciate ligament
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)
Posterior capsular ligament Meniscofemoral ligament Iliotibial band
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MCL
Attachment
Origin medial aspect of medial femoral
condyle Insertion proximal tibia
Function
Resist valgus stress force (specially in extended knee) MCL Check lateral rotation of tibia Also restrain anterior displacement of tibia when ACL is absent.
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LCL
Attachment
Origin lateral femoral
condyle Insertion posteriorly to head of fibula
Function
Resist varus stress force across
the knee Check combined lateral rotation with posterior displacement of tibia in conjunction with tendon of popliteal muscle.
Cruciate ligament
Cruciate = Resembling a cross in Latin. Located within the joint capsule & are therefore called Intracapsular PCL Ligaments. Cruciate ligament provide stability in sagittal plane The ACL & PCL are centrally located within the capsule but lie outside the synovial cavity.
13 August 2013 Dr. Ratankhuman M.P.T., (Ortho & Sports)
ACL
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ACL
Attachment
Origin from anterior surface the tibia in the
intercondylar area just medial to medial meniscus. It spans the knee laterally to PCL & runs in a superior & posterior direction Insertion to posteriorly on lateral condyle of femur
ACL is divided into 2 bands

Antero-medial band (AMB)
Postero-lateral band (PLB)
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Function of acl
Primarily
Check femur from being displaced posteriorly on the tibia Conversely, the tibia from being displaced anteriorly on femur.
It tightens during extension, preventing excessive hyperextension of the knee. ACL carried 87% of load when anterior translatory force was applied to tibia with extended knee. Check tibial medial rotation by twisting around PCL ACL injury is common when knee is in flexed & tibia rotated in either direction
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PCL
Attachment
Origin from posterior tibia in intercondylar area
and runs in a superior and anterior direction on medial side of ACL. Insertion - to anterior femur on the medial condyle
PCL is divided into 2 bands

Antero-medial band (AMB)
Postero-lateral band (PLB)
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Function of pcl
Primarily
Check femur from being displaced anteriorly on the tibia
or Tibia from being displaced posteriorly on femur.
It tightens during flexion & is injured much less frequently than ACL. PCL carry 93% of load when posterior translatory force was applied to tibia with extended knee. PCL play a role in both restraining & producing rotation of the tibia.
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Summary of ACL & PCL attachments

ACL Runs from anterior tibia to posterior femur
PCL Runs from posterior tibia to anterior femur
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Posterior capsular ligament

Oblique popliteal ligament Posterior oblique ligament Arcuate ligament:
Arcuate ligament lateral branch Arcuate ligament medial branch
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Oblique popliteal ligament
Attachment
Origin The central part of posterior aspect of
the joint capsule Insertion - Posterior medial tibial condyle
Function
Reinforces posteromedial knee joint capsule
obliquely on a lateral-to-medial diagonal from proximal to distal
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Posterior oblique ligament
Attachment
Origin Near the proximal origin of the MCL
and adductor tubercle Insertion Posteromedial tibia, posterior capsule & posteromedial aspect of the medial meniscus
Function
Reinforces the posteromedial knee joint capsule
obliquely on a medial-to-lateral diagonal from proximal to distal
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Arcuate Ligament
Lateral Branch
Distal Attachment
Medial branch
From posterior aspect of the head of the fibula
Proximal To tendon of popliteus Into oblique popliteal lig on Attachment muscle & posterior capsule medial side of joint
Function
Reinforces the postero-lateral knee joint capsule obliquely on a medial to lateral from proximal to distal
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Meniscofemoral ligament (MFl)

There are 2 portions of MFL, at least one in 91% of knees & 30% knee having both. MFL are not true ligaments because they attach bone to meniscus, rather than bone to bone.
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Meniscofemoral ligament (MFl)
Attachment
Origin Both originate from posterior horn of lateral
meniscus Insertion to lateral aspect of medial femoral condyle

The Ligament of Humphry or Antero-MFL is the
ligament run anterior to PCL on tibia The Ligament of Wrisberg or Postero-MFL is the ligament run posterior to PCL, also known as 3rd Cruciate Ligament of Robert
Function
They may assist PCL in restraining posterior tibial translation Also assist popliteus muscle by checking tibial lateral rotation
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Bursa associated with knee
Pre-patellar bursa
Located between the skin & anterior surface of patella They allows free movement of skin over patella during
knee flexion & extension

Subcutaneous bursa
Located between patellar ligament & overlying skin
Deep infra-patellar bursa

Located between patellar ligament & tibial tuberosity Helps in reducing friction between the patellar
ligament & tibial tuberosity

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Function of knee joint
Osteokinemetic of knee joint

Primary motions Flexion / Extension Medial / Lateral Rotation Secondary motions Antero-posterior displacement of femur or tibia Abduction / Adduction through valgus or varus force
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Flexion & extension

Axis no fixed axis but move through ROM (frontal axis) Plan sagittal plan ROM of flexion / extension
Flexion 1300 1400 Extension 50 100 (Consider normal, beyond
this termed as Genurecurvatum)
In close kinematic chain (OKC) flexion / extension range is limited by ankle range.
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Medial / lateral rotation

Axis Longitudinal / Vertical axis Plan Transvers plan ROM at 900 knee flexion
Lateral rotation 00 400 Medial rotation 00 300
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TF CKC Flexion
Early 00 - 250 knee flexion

Posterior rolling of femoral
condyles on the tibia
As flexion continues
Posterior Rolling accompanied by
simultaneous Anterior glide of femur Create a pure Spin of femur on the posterior tibia
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TF CKC extension
Extension from flexion is a reversal of flexion motion. Early extension
Anterior rolling of femoral
condyles on tibial plateau
As extension continues
Anterior Rolling accompanied by
simultaneous Posterior glide of femur Produce a pure Spin of femoral condyles on tibial plateau
Tf ock flexion / extension
When tibia is flexed on a fixed femur

The tibia performed Both Posterior Rolling &
Gliding on relatively fixed femoral condyles.
When tibia is Extended on a fixed femur

The tibia performed Both Anterior Rolling &
Gliding on relatively fixed femoral condyles.
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Locking of knee joint
CKC femoral extension from 300 flexion

Larger medial femoral condyle continue rolling & gliding
posteriorly when smaller lateral side stopped. These result in medial rotation of femur on tibia, seen in last 50 of extension. The medial rotation of femur at final stage of extension is not voluntary or produce by muscular force, which is referred as Automatic or Terminal Rotation. The rotation within the joint bring the joint into a closed packed or Locked position. The consequences of automatic rotation is also known as Locking Mechanism or Screw Home Mechanism.
OKC lateral rotation of tibia on fixed femur

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Unlocking of knee joint

To initiate flexion, knee must be unlocked. A flexion force will automatically result in lateral rotation of femur
Because the larger medial condyle will move before
the shorter lateral condyle. Popliteus is the primary muscle to unlocked the knee.
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TF CKC Flexion: ACL Control

At full extension
Angle of ACL inclination greatest Anterior directed component force will eventually Restrain Posterior Femoral Roll
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TF CKC Flexion: ACL Control cont

As TF
flexion increases
Angle of ACL inclination
decreases Anterior directed component force increases sufficient enough to produce Anterior Femoral Slide
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Hyperextension Impact on ACL

End ROM extension brings the midsubstance of the ACL in contact with the femoral intercondylar shelf (notch of Grant) This contact point acts as a fulcrum to tension load the ACL
TF CKC Flexion: PCL Control

Angle Of PCL Inclination is greatest at full flexion. Anterior directed component force will eventually Restrain Posterior Femoral Roll
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TF CKC Extension: PCL Control
As TF extension increases
Angle Of PCL Inclination
decreases
Posterior directed component
force increases sufficient enough to Produce Posterior Femoral Slide
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TF OKC Extension Arthrokinematics sagittal plan

Extension Meniscal migrate Anteriorly
Because of meniso-patellar
ligament
Menisco-patellar Ligaments
TF OKC flexion Arthrokinematics sagittal plan
Flexion Menisci migrate posteriorly because of

Semimembranosis attachment to medial meniscus Popliteus attachment to lateral meniscus
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Knee axial rotation
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Axial rotation of knee arthrokinemetic

Axis vertical axis Plan transvers plan ROM Maximum range is available at 90 of knee flexion. The magnitude rotation diminishes as the knee approaches both full extension and full flexion. Medial condyle acts as pivot point while the lateral condyles move through a greater arc of motion, regardless of direction of rotation.
rotation of tibia
During Tibial lateral rotation on the femur

Medial tibial condyle moves slightly anteriorly on
the relatively fixed medial femoral condyle, whereas lateral tibial condyle moves a larger distance posteriorly.
During tibial medial rotation

Medial tibial condyle moves only slightly
posteriorly, whereas the lateral condyle moves anteriorly through a larger arc of motion.
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During both medial and lateral rotation

The menisci reduce friction & distribute femoral
condyle force created on the tibial condyle without restricting the motion. Meniscus also maintain the relationship of tibia & femoral condyles just as they did in flexion and extension.
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Valgus (Abduction)/Varus (Adduction)

Axis Antero-posterior axis Plan Frontal plane ROM
8 at full extension 13 with 20 of knee flexion.
Excessive frontal plane motion could indicate ligamentous insufficiency
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pFj function
It work primarily as an anatomical pulley It reduce friction between quadriceps tendon & femoral condyle. The ability of patella to perform its function without restricting knee motion depends on its mobility.
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PFJ articulating surface

The triangular shape patella is a largest sesamoid bone in body is a least congruent joint too. Posterior surface is divided by a vertical ridge into medial & lateral patellar facets. The ridge is located slightly towards the medial facet making smaller medial facet The medial & lateral facet are flat & slightly convex side to side & top to bottom. At least 30% of patella have 2nd ridge separating medial facet from the extreme medial edge known as Odd Facet of Patella.
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Femoral articulating surface

Patella articulate in femur with intercondylar groove or femoral sulcus on anterior surface of distal femur. Femoral surface are concave side to side & convex top to bottom but lateral facet is more convex then medial surface.
PFJ congruence
The vertical position of patella in femoral sulcus is related to length of patellar tendon, approximately 1:1 is (referred to as Insall-Salvati index) An excessive long tendon produce an abnormally high position of patella on femoral sulcus known as patella alta. In neutral or extended knee, the patella has little or no contact with the femoral sulcus beneath.
At 100 200 of flexion contact with inferior margin of medial & lateral facet. By 900 of flexion all portion of patella contact with femur except the odd facet. Beyond 900 of flexion medial condyle inter the intercondylar notch & odd facet achieves contact for the first time. At 1350 of flexion contact is on lateral & odd facet with medial facet completely out of contact.
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Medial-lateral PFJ stability
PFJ is under permanent control of 2 restraining mechanism across each other at right angel.
Transvers group of stabilizer Longitudinal group of stabilizer
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Transvers
stabilizer
Medial & lateral retinaculum

Vastus Medialis & Lateralis The lateral PF ligament contributes 53% of total
force when in full extension of knee.
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Longitudinal stabilization
Patellar tendon inferiorly Quadriceps tendon superiorly
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Medial-lateral positioning of patella / patellar tracking

When the knee is fully extended & relax, the patella should be able to passively displaced medially or laterally not more then one half of patella. Imbalance in passive tension or change in line of pull of dynamic structures will substantially influence the patella. Abnormal force may influence the excursion of patella even in its more secure location within intercondylar notch in flexion.
Medial & lateral force on patella

Since the action line of quadriceps & patellar ligament do not co-inside, patella tend to pulled slightly laterally & increase compression on lateral patellar facets. Larger force on patella may cause it to subluxation or dislocate off the lateral lip of femur. Genu valgum increase the obliquity of femur & oblique the pull of quadriceps.
Femoral anteversion & tibial torsion creates an increased obliquity in patella predisposing to excessive lateral pressure or to subluxation or dislocation. Excessive tension in lateral retinaculum (or weakness of VMO) may cause the patella to tilt laterally. Insufficient height of lateral lips of femoral sulcus may create patellar subluxation or fully dislocation, even with relatively small lateral force.
Muscles of knee & its function
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Muscles of the Knee

Area Anterior One-joint Muscle Vastus Lateralis vastus Medialis Vastus Intermedialis Two-joint Muscle Rectus Femoris
Posterior
Biceps Femoris (Short)
Lateral
Biceps Femoris (Long) Semimembranosus Semitendinosus Sartorius Gracilis Gastrocnemius Tensor Fascia Latae
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Muscles of Posterior Knee

Knee Flexors Semimembranosus, Semitendinosus, Biceps Femoris (Long & Short Heads), Sartorius, Gracilis, Popliteus & Gastrocnemius Muscles
Flex + Tibial Popliteus, Gracilis, Sartorius, Semimembranosus Medial Rotators & Semitendinosus Muscles
Flex + Tibial Biceps Femoris Lateral Rotator Flex + Abductor Flex + Adductor
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Biceps Femoris, Lateral Head Gastrocnemius & Popliteus Semimembranosus, Semitendinosus, Medial Head Gastrocnemius, Sartorius & Gracilis
p o s t e r i o r
t h i g h
M u s c l e s
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Knee flexor groups

7 muscles flex the knee [Semimembranosus, Semitendinosus, Biceps Femoris (Long & Short Heads), Sartorius, Gracilis, Popliteus & Gastrocnemius Muscles]. 5 muscles of flexors (Popliteus, Gracilis, Sartorius, Semimembranosus & Semitendinosus Muscles)
They have the potential to medially rotate the tibia on
a fixed femur Whereas the biceps femoris is capable of rotating the tibia laterally.
Knee flexor groups cont
The lateral muscles (Biceps Femoris, Lateral Head of Gastrocnemius, & Popliteus)
Capable of producing valgus moments at knee
The medial muscles (Semimembranosus, Semitendinosus, Medial Head of Gastrocnemius, Sartorius & Gracilis)
Can generate varus moments
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biceps femoris or Lateral Hamstring
Proximal attachments: By two heads:

Long head to the tuberosity of ischium,
having a common tendon of attachment with semitendinosus. Short head to the lower portion of shaft of femur & to lateral intermuscular septum.
Distal attachments:
2 heads unite to be attached to the head of
fibula, to the lateral condyle of the tibia & to the fascia of leg.
AXN:
Hip extension & external rotation Knee flexion & external rotation.
Semitendinosus or medial hamstring
Proximal attachment:
Tuberosity of ischium, having a
common tendon with the long head of the biceps.
Distal attachment:
Medial aspect of tibia near the
knee joint, distal to the attachment of the gracilis.
AXN:
Hip extension and internal rotation Knee flexion and internal rotation.
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semimembranosus

Tuberosity of the ischium
Distal attachment:
Medial condyle of the tibia.
AXN:
Knee flexion and internal rotation Hip extension and internal rotation.
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Gastrocnemius
Proximal attachments:
Above the femoral condyles and span the knee joint
on the flexor side. The muscular portion of the gastrocnemius may be seen contracting in resisted flexion of the knee. Because the gastrocnemius is more important as a plantar flexor of the ankle than as a knee flexor
Distal attachments:
To the posterior calcaneus
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Popliteus
By a strong tendon from the lateral condyle of
the femur. The muscle fibers take a downward medial course and are attached into proximal posterior portion of body of tibia.
Distal attachment:
widespread in a proximal-distal direction,
giving the muscle a somewhat triangular shape.
AXN:
Medial rotation and flexion of knee.
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Muscle passing medial knee
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Anterior Muscles
Quadriceps muscles comprise 4 muscles that cross the anterior knee

Rectus femoris
Vastus lateralis
Vastus Intermedialis Vastus Medialis
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Quadriceps muscle
Functions
Together, the 4 components of quadriceps femoris muscle
function to extend the knee. Rectus femoris being a 2 joint muscle, it also involved in hip flexion along with knee extension.
Angle of pull of Quadriceps

Vastus lateralis Pull 350 Lateral to long axis of femur Vastus Intermedius Pull Parallel to Shaft of femur, making
purest knee extensor. Vastus Medialis Pull depended on segment of muscle

Upper fibers Vastus Medialis Longus (VML) angled 150 180 Medially Distal fibers Vastus Medialis Oblique (VMO) angled 500 550 Medially
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Patellar Influence on Quadriceps Function

Patella lengthens the MA of quadriceps by increasing the distance of quadriceps tendon & patellar tendon from the axis of the knee joint. The patella, as an anatomic pulley, deflects the action line of quadriceps away from the joint centre, increasing the angle of pull & enhancing extension torque generation. Pull of quadriceps also creates anterior translation of tibia on femur increasing ACL restraint
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Quadriceps activities During weight-bearing
When an erect posture is attained

Minimal activity of quadriceps because the LOG
passes just anterior to knee axis results in a gravitational extension torque that maintains the joint in extension.
In weight-bearing with the knee slightly flexed

The LOG pass posterior to knee joint axis As the gravitational torque tend to promote knee
flexion, the activity of quadriceps is necessary to counterbalance the gravitational torque and maintain the knee joint in equilibrium.
LOG & Movement arm (MA) during squatting
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Quadriceps activities during nonweight-bearing

The MA of resistance is minimal when the knee is flexed to 900 but increases as knee extension progresses. Therefore, greater quadriceps force is required as the knee approaches full extension. The opposite happens during weight-bearing activities.
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LOG & Movement arm (MA) during non-weight bearing
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Quadriceps Strengthening: Weight-Bearing versus NonWeightBearing Weight-bearing quadriceps exercises as squat & leg press resulted in a posterior shear force at knee throughout the entire ROM There was No Anterior Shear anywhere in the ROM. In contrast, anterior shear force in a non weight bearing knee extension exercise maximal anterior shear occurring between 200 and 100.
Quadriceps Strengthening: Weight-Bearing versus Non Weight-Bearing cont A Posterior Shear Force was also found during NonWeight-Bearing Exercise, only between 600 and 1010 of flexion. Weight Bearing Exercises are often prescribed after ACL or PCL injury because of less stressful, more like functional movements & safer than nonweight-bearing exercises.
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Other muscles helping knee extension

The actions of the Gluteus Maximus & Soleus Muscles can influence knee motion in weight-bearing. Although they do not cross the knee joint, these muscles are capable of assisting with knee extension.
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Iliotibial Band or IT tract
Proximally
The IT band is from Tensor
GM TFL
Fascia Lata (TFL), Gluteus Maximus & Gluteus Medius muscles.
Distally
Attach to lateral intermuscular
septum & inserts into the Anterolateral Tibia (Gerdys Tubercle). IT band also attaches to patella via lateral PF ligament of lateral retinaculum.
13 August 2013 Dr. Ratankhuman M.P.T., (Ortho & Sports)
ITB
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AXN:
Reinforcing anterolateral aspect of knee joint Assisting ACL in checking posterior femoral or
anterior tibial translation when the knee joint is nearly full extension. With the knee in flexion, the combination of IT band, LCL & popliteal tendon increases the stability of lateral knee.
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AXN line for itb

In extended knee
IT band moves anterior to the knee joint axis.
In flexed knee
IT band moves posteriorly over the lateral femoral
condyle as the knee is flexed.
The IT band, therefore, remains consistently taut, regardless of hip or knees position.
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Stabilization of knee joint
Classification of supporting structure of knee

Functional Static stabilizer Dynamic stabilizer Structural Capsular method Extra-capsular method
Location Medial joint compartment Lateral joint compartment
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Static stabilizer
It include the passive structures, such as

Capsule
Ligaments Meniscopatellar lig, PF lig, MCL & LCL, ACL & PCL, Oblique poplitial & Transverse lig.
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Dynamic stabilizer
It includes following muscles & oponeuroses

Quadriceps femoris,
IT band, Extensor retinaculum,
Poplitius,
Pes anserinus, Hamstrings and also
Gastrocnemius
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Medial joint stabilizers
Structure includes
Medial patellar retinaculum,
MCL, Oblique poplitial ligament &
PCL
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Lateral joint stabilizers
The structure included in static & dynamic stabilization of knee

IT band, Biceps femoris,
Popliteus,
LCL, Meniscofemoral arcuate,
ACL &
Lateral patellar retinaculum
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Knee Joint Stabilizers

Direction Structures Functions

A-P/ Hyperextension stabilizers
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Anterior cruciate ligament Iliotibial band Hamstring muscles Soleus muscle (in weightbearing) Gluteus maximus muscle (in weight-bearing) Posterior cruciate ligament Meniscofemoral ligaments Quadriceps muscle Popliteus muscle Medial & lateral heads of gastrocnemius
Limit anterior tibial (or posterior femoral) translation
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Direction Structures

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Functions
Varus/valgus stabilizers
Medial collateral ligament Anterior cruciate ligament Posterior cruciate ligament Arcuate ligament Posterior oblique ligament Sartorius muscle Gracilis muscle Semitendinosus muscle Semimembranosus muscle Medial head of gastrocnemius muscle Lateral collateral ligament Iliotibial band Anterior cruciate ligament Posterior cruciate ligament Arcuate ligament Posterior oblique ligament Biceps femoris muscle Lateral head of gastrocnemius muscle
Limits valgus of tibia
Limit Varus of tibia
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Direction Structures
Anterior cruciate ligament Posterior cruciate ligament Posteromedial capsule Meniscofemoral ligament Biceps femoris
Functions
Limit medial rotation of tibia
Posterolateral capsule Internal/external rotational stabilizers Medial collateral ligament Lateral collateral ligament Popliteus muscle Limit lateral rotation of Sartorius muscle tibia Gracilis muscle Semitendinosus muscle Semimembranosus muscle
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References
Joint Structure and Function: A Comprehensive Analysis, Fourth Edition, Cynthia C. Norkin, 2005 Joint Structure and Function: A Comprehensive Analysis, Third Edition, Cynthia C. Norkin Clinical Kinesiology and Anatomy, Fourth Edition, Lynn S. Lippert, 2006 Basic Biomechanics of the Musculoskeletal System, third edition, Margareta Nordin
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Kneebiomechanic 120622054413 Phpapp02

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Dr. Pukhrambam Ratan khuman (PT) M.P.T.

, (Ortho & Sports)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Arthodial (Gliding) ? 6 degrees of freedom

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Knee degree of freedom

Dr. Ratankhuman M.P.T., (Ortho & Sports)

General Features of Tibio-femoral Joint

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Femoral articular surface

13 August 2013 Dr. Ratankhuman M.P.T., (Ortho & Sports) 7

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Shifted anteriorly in relation to medial

Articular surface is shorter

Two condyles are separated

the Patellar Groove or Surface

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Tibial articulating surface

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Menisci of knee joint

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Both menisci are

Common attachment of medial & lateral

Tibial condyle via coronary ligaments

Anterior cruciate ligament (ACL)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Unique attachment of medial menisci

Unique attachment of lateral menisci

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

corpuscle, Pacinian corpuscle & Golgi tendon organs)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

TF alignment & weight bearing force

The anatomic/ longitudinal axis

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Deviation in normal force distribution

Compressive force in dynamic knee joint

5 6 time body weight in activities (like

Running, Stair Climbing etc.)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Knee joint capsule

condyles and intercondylar notch. Distally to posterior tibial condyle.

portion of the joint capsule.

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Connecting the capsule anteriorly to menisci &

tibia via coronary ligament (known as patellomeniscal or patellotibial band)

distal continue to posterior femoral condyle (patellofemoral ligament)

Dr. Ratankhuman M.P.T., (Ortho & Sports)

Superior patellofemoral compartment 2 separate medial & lateral

Ligament of knee joint

Posterior capsular ligament Meniscofemoral ligament Iliotibial band

13 August 2013 Dr. Ratankhuman M.P.T., (Ortho & Sports) 25

Dr. Ratankhuman M.P.T., (Ortho & Sports)

condyle Insertion proximal tibia

Dr. Ratankhuman M.P.T., (Ortho & Sports)

condyle Insertion posteriorly to head of fibula

13 August 2013 Dr. Ratankhuman M.P.T., (Ortho & Sports)

ACL is divided into 2 bands

Dr. Ratankhuman M.P.T., (Ortho & Sports)