Chapter 10Chapter 10The Knee JointThe Knee Joint

FemurFemurHead

Patellar Surface

Lateral condyleMedial

condyle

Adductor Tubercle

Linea Aspera

Gluteal Tuberosity

Quadrate Tubercle

Intertrochanteric Crest

Intertrochanteric Line Lesser

Trochanter

Greater Trochanter

Neck

Fovea Capitus

Popliteal Surface

Intercondyloid Fossa

Right Femur (Anterior) Label

Right Femur (Posterior)

Tibia & FibulaTibia & Fibula

Anterior Border

Talus Articulation

Medial Malleolus

Inferior Fibular Articulation

Anterior Border

Interosseous Border

Superior Fibular Articulation

Soleal Line

Tibial Tuberosity

Lateral Condyle Medial

Condyle

Intercondyloid Eminence

Talus Articulation

Lateral Malleolus

Styloid Process

Head

Interosseus Border

Tibia Label

Fibula Label

PatellaPatella

Base

Apex

Lateral Border

Medial Border

Proximal Border

LabelRight Patella

a.a. Tibial (medial) Collateral Tibial (medial) Collateral LigamentLigament

c. Anterior Cruciate Ligamentc. Anterior Cruciate Ligament

d. Posterior Cruciate Ligamentd. Posterior Cruciate Ligament

b. Fibular (lateral) Collateral b. Fibular (lateral) Collateral LigamentLigament

e. Medial Meniscus (semicircular “C” shape) & Lateral Meniscus (more circular shaped)

JointsJoints

• Tibiofemoral (ginglymus)Tibiofemoral (ginglymus)– Trochoginglymus (pivot & ginglymus)Trochoginglymus (pivot & ginglymus)

• Attaches medial condyle of femur to medial condyle of tibia (medial meniscus attachment)

•Maintains stability by resisting valgus forces

Tibial (medial) Collateral Ligament

• Patellofemoral (arthrodial)

Fibular (lateral) Collateral Ligament

•Attaches lateral femoral condyle to styloid process of fibula

•Maintains lateral stability by resisting valgus forces

Anterior Cruciate Ligament

•Connects the anterior aspect of the intercondylar eminence of the tibia with the medial aspect of lateral femoral condyle•Prevents anterior displacement of the tibia on femur•Mode of Injury

Posterior Cruciate Ligament

•Connects the posterior aspect of intercondyloid fossa of the tibia to the anterolateral aspect of the medial condyle of femur•Prevents posterior displacement of the tibia on femur•Mode of Injury

Medial Meniscus (semicircular “C” shape) & Lateral Meniscus (more circular shaped)

•Sit atop tibial condyles•Serve to deepen the surface of the articular fossa of tibial condyles for reception of femoral condyles•Mode of Injury

Range of Motion (knee joint)Range of Motion (knee joint)

• Flexion: 135Flexion: 135°°

• Hyperextension: 0Hyperextension: 0°°-10-10°°– ““Screw Home” = Screw Home” =

approx. 10approx. 10°° external external rotation to align rotation to align condylescondyles

• With knee flexed 30With knee flexed 30°° or more: or more: – 3030°° internal rotation & internal rotation &

4545°° external rotation external rotation

MovementsMovements

• FlexionFlexion

• ExtensionExtension

• Internal RotationInternal Rotation

• External RotationExternal Rotation

MusclesMuscles• Rectus Rectus FemorisFemoris • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• VastusVastus LateralisLateralis • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• VastusVastus IntermediusIntermedius • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• VastusVastus MedialisMedialis • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• StrengtheningStrengthening

• StretchingStretching

• Biceps Biceps FemorisFemoris– Long headLong head– Short headShort head

MusclesMuscles• StrengtheningStrengthening

• StretchingStretching

• SemitendinosusSemitendinosus

MusclesMuscles• StrengtheningStrengthening

• StretchingStretching

• SemimembranosusSemimembranosus

MusclesMuscles• GracilisGracilis • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• SartoriousSartorious • StrengtheningStrengthening

• StretchingStretching

MusclesMuscles• PopliteusPopliteus • StrengtheningStrengthening

• StretchingStretching

Q AngleQ Angle(Quadriceps angle)(Quadriceps angle)

Contribute to large Q angle:

•Wide hips (females)

•Genu valgum

•Pronation of feet

•Patellar subluxation

• Patella alta (high patella)

•Weak vastus medialis

Knee DeviationsKnee Deviations

• Genu Genu VarumVarum

a.a. Condyle to Condyle to malleoli malleoli relationshiprelationship

b.b. Relationship to Relationship to pronationpronation

c.c. Strain on soft Strain on soft tissuestissues

• Genu Genu ValgumValgum

a.a. Condyle to Condyle to malleoli malleoli relationshiprelationship

b.b. Relationship to Relationship to pronationpronation

c.c. Strain on soft Strain on soft tissuestissues

• Genu Genu RecurvatumRecurvatum

– May be caused by:May be caused by:

a.a. EquinusEquinus

b.b. Hamstring Hamstring weaknessweakness

c.c. Quadriceps Quadriceps weaknessweakness

TorsionTorsion• an internal twist of a bone on itself. an internal twist of a bone on itself.

Requires a force - counterforce. Requires a force - counterforce.– Types of torsion. Types of torsion.

(Distal part is the reference)(Distal part is the reference)• Internal tibialInternal tibial• External tibialExternal tibial• Internal femoralInternal femoral• External femoralExternal femoral

– Testing procedureTesting procedure• Step #1: Determine that a torsion is present while subject Step #1: Determine that a torsion is present while subject

is standing (patella and feet do not line up)is standing (patella and feet do not line up)• Step #2: Have subject sit on table with feet dangling free.Step #2: Have subject sit on table with feet dangling free.

– Femoral torsion: Femoral torsion: Feet point straight aheadFeet point straight ahead

– Tibial torsion:Tibial torsion: Feet point out = external tibial torsionFeet point out = external tibial torsion Feet point in = internal tibial torsionFeet point in = internal tibial torsion