Dr Mazhar
03066980980
KNEE BIOMECHANICS
Knee joint
• Large synovial joint
• Three articulations within joint capsule
• Tibiofemoral joint
• Patellofemoral joint
• Proximal tibio-fibular joint ???
• Condyles of tibia== tibial plateaus
• Screw home –locking mechanism
• Open chain and closed chain
• Close pack position= full extension
• Modified hinge joint.
Structure of the Knee
What is the tibiofemoral joint?
• dual condyloid articulations between
the medial and lateral condyles of
the tibia and the femur; composing
the main hinge joint of the knee
• considered to be the knee joint
Femur
• Medial and lateral condyles
– Convex,asymmetric
– Medial larger than
lateral
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Tibia
• Tibial plateau
– Medial tibial condyle:concave
– Lateral tibial condyle:flat or convex
• Medial 50% larger than lateral
• Articular cartilage thicker on medial plateau
6
Structure of the Knee
Femur
Patella
Tibia
Fibula
Bony structure of the tibiofemoral joint.
Structure of the Knee
What are the menisci?
• cartilaginous discs located between the
tibial and femoral condyles
• structures that distribute the load at the
knee over a large surface area and
also help absorb shock
Structure of the Knee
Lateral meniscus Transverse ligament
Medial meniscus
Posterior cruciate ligament Anterior cruciate ligament
Superior view
The menisci of the knee.
• Semilunar cartilages
• Attached to superior tibial plateaus by
coronary ligament and joint capsule
• Joined together by transverse ligament
• Medial meniscus is also attached directly to
the medial collateral ligament
• Rich blood supply and innervations
• D eepens the articulating depression of tibial
plateaus
• Load transmission and shock absorption
• If menisci are removed stress may reach
up to 3 times
• Increased likelihood of degenerative
conditions
Medial & lateral stabilizers
(mostly ligaments)
• Ligaments
– most important static stabilizers
– tensile strength - related to composition
Medial side
• Superficial MCL
– Primary valgas restraint -57-78% restraining
moment of knee
– femoral attachment fans out around axis of rot.
– Lax in flexion
Lateral side
• LCL
– Primary Varus restraint
– lax in flexion
Cruciates
• ACL
– Primary static restraint to anterior displacement
– tense in extension,‘lax’in flexion
• PCL
– Primary restraint to post. D isplacement - 90%
– relaxed in extension,tense in flexion
– restraint to Varus/ valgus force
– resists rotation,esp.int rot of tibia on femur
• collateral ligaments - cross the medial
and lateral aspects of the knee
• cruciate ligaments - cross each other in
connecting the anterior and
posterior aspects of the knee
Structure of the Knee
What is the patellofemoral joint?
• articulation between the patella and the
femur
• (the patella improves the mechanical
advantage of the knee extensors by
as much as 50%)
Movements at the Knee
What muscles contribute to flexion at the
knee?
• popliteus - “unlocks” the fully extended
knee by laterally rotating the femur
with respect to the tibia to allow
flexion to proceed
Movements at the Knee
What muscles contribute to flexion at the
knee?
• Hamstrings
• assisted by:
• Gracilis
• Sartorius
• Popliteus
• Gastrocnemius
Lateral and medial rotation
•Medial rotation= Semimembranosus,
semitendinosus,Popliteus
•Lateral rotation= biceps femoris
•Passive abduction and adduction
Patellofemoral joint motion
• G liding movements== 7 cm in vertical
direction
• Superior glide
• Inferior glide
• Lateral and medial shifting
Loads on the knee joint
Tibiofemoral joint:
• Compression loading more in stance phase
• Shear loading= tendency of the femur to
displace anteriorly on tibial plateaus
• Role of menisci in weight bearing
• Medial meniscus
• Knee flexion angle exceeding than 90 degree
result in larger shear forces.
• Full squats not recommended for novice
athletes
forces at Patellofemoral joint
• 1/3rd of body weight compressive forces
during normal walking
• 3 times the body weight during stair climbing
• High compressive forces during knee flexion
• Squatting highly stressful to the knee complex
Common Injuries of the Knee &
Lower Leg
Knee Anatomy
Patella Fractures
• Result from direct blow such as
• knee hitting dashboard in MVA,
• fall on flexed knee,
• forceful contraction of quad. Muscle.
• Transverse fractures most common
Patella Fracture:
Femoral Condyle Fractures
• These injuries secondary to:
• direct trauma from fall
• axial loading
• blow to distal femur.
Femoral Condyle Fracture:
Knee Ligaments:
Anterior Cruciate Ligament injury
• Mechanism is usually a deceleration,
hyperextension or internal rotation of tibia on
femur
• Excessive anterior translation or rotation of femur
on the tibia
• May hear “pop”,swelling,assoc. w/medial meniscal
tear
• 70% in non- Contact sports,Basketball and team
hand ball
• Incidence of ACL injuries is more in females
RESULTS
• Notable weakness in quadriceps, impaired joint
range and proprioception
• Notable lessening of flexion extension range due to
quadriceps avoiding
• Altered joint kinetics== subsequent inset of
osteoarthritis
• Muscle inhibition: inability to activate all motor
units of a muscle during maximal voluntary
contraction
• Surgical repair through middle third of patellar
tendon
Posterior Cruciate Ligament injury
• Less common than ACL injury
• Mechanism is hyperflexion of knee with foot
plantarflexed
• Impact with dash board during motor vehicle
accident
• D irect force on proximal anterior tibia
• Isolated PCL injuries are commonly treated
non-operatively
Medial collateral ligament injury
• Blows to the lateral side more common
• Medial side is protected by opposite leg
• Valgus stress
• Contact sports= football= MCL injury more
common
• Both MCL and LCL injured in wrestling
Prophylactic knee bracing
• To prevent knee ligament injuries in contact
sports
• Protect ACL from ant. and torsional loads.
• Knee braces act to change the pattern of lower
extremity muscle activity
• Reduced sprinting speed and earlier onset of
fatigue
Meniscus Injuries
• Mechanism is usually squatting or twisting
maneuvers.
• Medial meniscus more commonly damaged due
to its attachment with the MCL
• ACL rupture causes double loads on medial
meniscus.
• Symptoms :locking of the knee on flexion or
extension that is painful or limits activity.
Iliotibial band friction syndrome
• Friction of posterior edge of Iliotibial band
against the lateral condyle of the femur during
foot strike
• Very common in distance runners,hence referred
as runner’s knee
• CAUSES:
• Training errors and anatomical malalignments
• Excessive tibial lateral torsion,excessive femoral
anteversion, genu valgum,genu varum,
increased Q angle etc,
Q-angle
which is the angle formed by a line drawn from the anterior superior iliac spine
through the center of the patella and a line drawn from the center of the patella
to the center of the tibial tubercle.
The degree of genu valgum can be estimated by the Q angle.
normally Q angle is 14 deg for
males and 17 deg for females
Breaststroker's knee
• A condition of pain and tenderness localized
on the medial aspect of the knee is often
associated with performance of the whip kick.
• Forceful whipping together of the lower leg
produces propulsive thrust
• Irritation of the MCL and medial border of the
patella
• Hip abduction less than 37 or greater than 42
degree == increased onset of knee pain
Patellofemoral pain syndrome
• Painful Patellofemoral joint motion involving
anterior knee pain after activities requiring
repeated flexion at the knee
• Causes :
• Anatomical malalignments
• Imbalance b/w Vastus Medialis Oblique and
Vastus Lateralis in strength or activation timings
• D ecreased Q uards. & Hams. strength
• Patellar maltracking
Chondromalacia Patellae
• Overuse syndrome of patellar cartilage
• Caused by patello-femoral malalignments
which leads to abnormality of patella putting
excessive lateral pressure on articular cartilage
• Seen in young active women, pain worse
w/stair climbing and rising from a chair
Shin Splints
• Term is applied to any pain originating from
ant. aspect of lower leg.
• G eneralized pain along the anterolateral or
posteromedial aspect of the lower leg is
commonly known as shin splints
• Overuse injury often associated with running,
dancing on the hard surface and running
uphill
