Joints of the knee
5
Tibiofemoral Joint (Knee Joint)
Patellofemoral Joint
Proximal/Superior Tibiofibular Joint
Mid-Tibiofibular Joint
Distal TIbiofibular Joint
Type and Articular Surfaces
Tibiofemoral Joint
Synovial, Hinge (Ginglymus), Diarthrosis, Biaxial
Convex: Medial and lateral femoral condyles
Concave: medial and lateral superior articular surfaces of the tibia (tibial plateaus)
Ligaments and Movements
Tibiofemoral Joint
Ligaments:
Extracapsular: Fibrous capsule, Patellar, Medal patellar retinaculum, lateral patellar retinaculum, tibial or medial collateral, Fibular of lateral collateral, oblique pipliteal and arcuate popliteal
Intracapsular: anterior cruciate, posterior cruciate, posterior meniscofemoral, transverse, coronary, medial and lateral menisci
Movements: Gliding, flexion, extension, hyperextension, lateral/external rotation, medial/internal roration
ACL: Anterior Criciate Ligament
- From medial aspect of lateral femoral condyle to anterior aspect of tibial intercondylar eminence
- Resists anterior translation and medial rotation of the tibia on femur
- Taut in Hyperextension
PCL: Posterior Cruciate Ligament
- From posterior aspect of intercondylar eminence to lateral aspect of the medial femoral condyle.
- Resists posterior translation of the tibia on femur
- Taut in Hyperflexion
Meniscus
- Acts to disperse weight evenly and to reduce friction with movement
- The medial meniscus is attached to the medial collateral ligament and semimembranous musle/tendon
- The Lateral meniscus is attached to the posterior cruciate ligament and the popliteal muscle
- The menisci are attached to each other anteriorly by the transverse ligament of the knee, and to the margins of the head of the tibia by the coronary ligaments
Bursae
- Suprapatellar Bursa
- Superficial & Deep infrapatellar Bursae
- Prepatellar Bursa
- Popliteal Bursa
- Semimembranous Bursa
* Tendon insertion of biceps femoris
* tendon insertion of sartorius
* Gracilis
* Semitendinosus
* Origins of Lateral and Medial heads of Gastrocnemius
Tibiofemoral Joint
Loose Packed or Resting Postion
25º of Flexion
Tibiofemoral Joint
Close Packed Position
Full Extension, lateral rotation of tibia
Tibiofemoral Joint
Capsular Pattern of restriction
Flextion then Extension
Normal End Feels Tibiofemoral Joint
Flexion: Soft tissue or bony approximation
Extension: Elastic/firm, tissue stretch
ROM Tibiofemoral Joint
Flexion = 0 - 135º
Extension = 0 - 15º
Internal rotaton = 20 - 30º
External Rotation = 30 - 40º
Tibiofemoral Joint
Arthrokinematics
Open-Chain:
Flexion - Roll = Posterior and medial rotatio; Slide = Posterior
Extension - Roll = Anterior and lateral rotation; Slide = Anterior
Close chain:
Flexion - Roll = Posterior and lateral rotation; Slide = Anterior
Extension - Roll = Anterior and medial rotation; Slide = Posterior
Tibiofemoral Joint
Open kinetic Chain
Example: Kicking a ball
Flexion: Concave tibial plateau roll & glides on the convex femoral condyles
Extension: Concave tibial plateua rolls & glides anteriorly on convex femoral condyles
Tibiofemoral Joint
Closed Kinetic Chain
Example: Squat
Flexion: femoral condyles roll and glide on posteiror on tibial plateau (Squatting)
Extension: femoral condyles toll and glide anterior on tibial plateau (moving from squat to standing)
Q Angle
Genu Valgum: Q angle greater than 22º in women and 18º in men “knocked Knees”
Genu Varum: Q angle less than 0º, the distal points medially “bow legs”
Genu Recurvatum: Hyperextension of knee
Patellofemoral Joint
Type of joint: synovial, plane (gliding), diarthrotic, triaxial
Concave posteiror surface of patella and convex troclear surgace of distal anterior femur
Ligaments: patellar ligament, medial and lateral patellofemoral ligament
Movement: superior and inferior glide, medial and lateral glide, medial and lateral tilt and lateral and medial rotation
