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8/11/2019 KNEE ANATOMY-By Abu Saquib
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KNEE ANATOMY
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INTRODUCTION
• Hinge type Synovial joint.
• Can bear load more than 8 times of body
weight.
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GENRAL ANATOMICAL TERMS FOR KNEE
• ANTERIOR - FRONT OF KNEE
• POSTERIOR - BACK OF KNEE
• MEDIAL – SIDE OF KNEE CLOSSEST TO OTHER KNEE
• LATERAL – SIDE OF THE KNEE FARTHEST FROM OTHER SIDE
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CONSTRUCTION
BONES
MUSCLE
LIGAMENTS
CARTILAGES
BURSA
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BONES
FEMUR
TIBIA
FIBULA
PATELLA
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Bones of the Knee
The bones give strength, stability and
flexibility in the knee.•Femur :
Commonly known as thigh bone
Largest, longest & strongest
bone in body.Have two round end called
condyles with a groove in center.
•Tibia :
Commonly known as shim bone.Connect from knee to ankle.
Have top flat surface.
Flat surface act as a base of
meniscus.
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•Patella:
Commonly known as knee cap.
It’s flat and triangular in size.
Relive friction between bone
and muscle during movement.
Protect knee joint.
•Fibula:
Long thin bone in the lower leg.
Not directly a part of knee joint.
Act as a support for tibia.
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MUSCLES
• QUADRICEPS - It is a groupof 4 muscle present in front of
the thigh and are responsible
for straitening the knee by
bringing the bend knee to
straight position.
• HAMSTRINGS - It is a group
of 3 muscle present in the
back of the thigh and control
the knee moving from straight
to bend position.
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LIGAMENTS
Its function is to attachbones to bones and give
strength and stability to
the knee, as the knee
have very less stability.Ligaments are strong,
tough band that are not
flexible. Once stretched
they tend to stay
stretched and if stretched
too far, they snap
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LIGAMENTS•MEDIAL COLLATERAL LIGAMENT –
Attached medial femur to medial tibia and limits sidewaymotion.
•LATERAL COLLATERAL LIGAMENT –
Attached lateral femur to lateral tibia and limits sideway
motion
• ANTERIOR CRUCIATE LIGAMENT – Attaches tibia and femur in centre of the knee and limits
rotation as well as forward motion of tibia.
•POSTERIOR CRUCIATE LIGAMENT –
It is the strongest attaching the tibia and femur going deepinside the knee locating behind ACL, limiting backward
motion of knee.
•PATELLAR LIGAMENT – Attach the patellar to the tibia
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•FIBROUS CARTILAGE (the meniscus) – Has tensile strength and can resist pressure.
•HYALINE CARTILAGE (Articular cartilage) –
Covers the surface along which the joints move.
CARTILAGE
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CARTILAGES
•Cartilage is a thin, elastic tissue that protects the bone
and makes certain that the joint surfaces can slide easilyover each other. Cartilage ensures smooth knee
movement.
•Cartilage will wear over the years.
•Cartilage has a very limited capacity for self-restoration.
• The newly formed tissue will generally consist for a
large part of fibrous cartilage of lesser quality than theoriginal hyaline cartilage. As a result, new cracks and
tears will form in the cartilage over time.
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• MEDIAL MENISCUS
• LATERAL MENISCUS
MENISCUS
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• Shaped like a shallow socket.
• Rubbery in nature.
• Act as a shock absorber(more than 10xBW)
• Distribute the load from femur to tibia.
• Decrease friction by 20%.
• Increase contact area by 70%.
MENISCUS
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BURSA
A bursa is a small fluid-filled sac lined by synovial
membrane with an inner
capillary layer of viscous
fluid (similar in consistencyto that of a raw egg white).
It provides a cushion
between bones and
tendons and/or muscles
around a joint. This helps toreduce friction between the
bones and allows free
movement.
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JOINTS OF THE KNEE
•Tibiofemoral jointModified hinge joint.
Dual condyloid
articulation b/w medial
and lateral condyles offemur and the tibia.
Articulating surface are
not congruent.
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JOINTS OF THE KNEE
•Patellofemoral joint
Articulation b/w the
patella and femur.
The patella improves
the mechanicaladvantage of the knee
extensors by as much as
50%.
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KNEE MOVEMENTS
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AXIS OF ROTATION
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AXIS OF ROTATION
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KNEE GONIOMETRY
• Flexion
– 0-130-140 degrees
• Extension
– 0 degree
• Screw Home Mechanism
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SCREW HOME MECHANISM
•Locking mechanism as the kneenears its final extension
Automatic rotation of the tibia
externally (approx. 10 degrees)
during the last 20 degrees of knee
extension
•Forms a close-packed position for
the knee joint
•Femoral condyles are a different size
Causes internal rotation whenthe knee is flexed and external
rotation when the knee is
extended
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KNEE ROTATION
FlexionExternal
Rotation
Internal
Rotation
Extension
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Patella migrates posteriorly from extension to flexion
30 60 90
Patellar Translation
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Mechanical Function of Patella
• Increases angle of pull of
quads on tibia, improves the
ratio of motive: resistive torque
by 50%• Centralizes divergent tension
of quads into a single line of
action
• Some protection of anterioraspect of knee
without patella with patella
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Mechanical Function of Patella
• Patella contributes to
quadriceps moment arm
– 13% at 90o
– 31% at 0
o
• No angle without patella
& therefore no
compressive resultant
force
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Patellofemoral Compressive Force
Mechanics
• PFC force with flexion
– 0.5 x BW gait (walk)
– 3.4 x BW stairs
– 8.8 x BW squatting
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Q-Angle
• The Q-angle is the angle formed by
– A line from the anterior superior
spine of the ilium to the middle of
the patella
– A line from the middle of the
patella to the tibial tuberosity
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Q-angle
• Knee in extension
– Normal – males 13 degrees
– Normal - females – 18 degrees
• Knee in 90 degrees flexion – Both genders – 8 degrees
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A typical Q-angles
bowleggedness knock-knees
Genu Recurvatum
knee hyperextension
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Posture & WB Forces
• The mechanical axis of TF joint is the weight bearing linefrom the center of femoralhead to superior talus center
• Allows WB instance of the
medial = lateral Tibiofemoralcompartments
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• Increase in valgus results:
– Compression overload to the
lateral Tibiofemoral
compartment – Distraction overload to medial
Tibiofemoral compartment
Posture &WB Forces
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• Decrease in valgus results
– Compression overload to the
medial Tibiofemoral
compartment – Distraction overload to lateral
Tibiofemoral compartment
Posture & WB Forces
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Joint Mechanics
• Resultant force has a tendency tolaterally translate the patella
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• Laterally displace tibial tubercle – external tibial rotation
– external tibial torsion
• Medially displace patella
– internal femoral rotation – femoral anteversion
Joint Mechanics
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Tibial Torsion
• Tibial torsion
– An angle that measures less
than 15 degrees is an
indication of tibial torsion
– Inward twisting of the tibia
(and is the most common
cause of intoeing)
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KNEE FUNCTION
•The quadriceps Mechanism is made up of patella, patellar
tendon and the quadriceps muscle on the front of upper
leg. The patella fits into the patellofemoral groove on the
front of the femur and act like a fulcrum to give the leg its
power. The patella slides up and down the groove as theknee bends. When the quadriceps muscle contract they
cause the knee to straighten. When they relax, the knee
bend.
•The hamstring and calf muscles help flex and support the
knee.
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Movements of the knee
• Flexion
– hamstrings
– assisted by:
• gracilis• sartorius
• popliteus
• gastrocnemius
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Gracilis
Sartorious
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Popliteus
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Gastrocnemius
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Muscle Pull
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Movements of the knee
• Extension
– quadriceps:
• rectus femoris
• vastus lateralis
• vastus medialis
• vastus intermedius
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Rectus femoris
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Vastus lateralis
Vastus intermedius
Vastus medialis
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Muscle Pull
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Loads on Knee
• Forces at Tibiofemoral Joint
– Shear stress is greater during open kinetic chain
exercises such as knee extensions and knee
flexions
– Compressive stress is greater during closed kinetic
chain exercises such as squats and weight bearing
exercises
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Loads on Knee
• Forces at Patellofemoral Joint
– With a squat, reaction force is 7.6 times BW on this
joint
• Beneficial to rehab of cruciate ligament or
Patellofemoral surgery
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PROBLEMS IN THE KNEE
The knee doesn’t have much protection from trauma or
stress. In addition to wear and tear on the knee, sportsinjuries are the source of many knee problems.
•Symptoms:
Dull, sharp, constant or any type of pain.
Range of motion may vary, i.e. too little or too much.Grinding or popping sound coming from knee.
Week muscle.
Knee locking.
•Solutions: Some knee problems only need rest and ice, others need
physical therapy or even surgery.
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Swelling: There are two types of swelling.
•Knee producing too much synovial fluid
•Bleeding into the joint (hemarthrosis).
Swelling within the first hour of an injury is usually from
bleeding. Swelling from 2-24 hours is more likely to be from
the joint producing large amounts of synovial fluid trying to
lubricate an abnormality inside the knee.
Effect:
•Chronic swelling can distend the knee.
•Prohibit full range of motion.
•If the cause of the swelling is blood, the blood can be
destructive to the joint.
Therapy:
•R.I.C.E (Rest Ice Compression Elevation)
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Locking: Locking is when something is keeping the knee
from fully straightening out. This is usually a loose body in
the knee. The loose body can be as small as a grain of sandor as big as a quarter. The best treatment is removal of the
loose body by arthroscopy. Another type of locking is when
the knee hurts so bad that you just won’t use it. The best
treatment here is rest and maybe some ice; swelling is not
usually present.
Giving Way: If your kneecap slips out of is groove for an
instant, it causes your thigh muscles to loose control causing
the feeling of instability—that is, you don’t feel like your knee
is stable, won’t support your weight—and you usually try tograb hold of something for support. Giving way can also be
caused by weak leg muscles or an old ligament injury.
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Snaps, Crackles and Pops: Noises coming from knee
without pain are likely nothing to worry about. Sometimes thenoise is caused by loose bodies that just float around and are
not causing pain or injury to the knee. However, If you have
pain, swelling or loss of knee function, you should see an
orthopedist. The most common cause—chondromalacia
patella—is caused by an injury. Another common cause is a
dislocating kneecap—that is, a kneecap that keeps slipping out
of its groove. Pops without trauma (injury) are not worrisome,
pops with trauma can mean ligament tears. Crackling, grinding
or grating (crepitus) means there is a roughness to the bonesurfaces and likely from degenerative disease or wear-and-
tear arthritis (osteoarthritis).
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Pain and Tenderness:. Where and how bad the pain iswill help find the underlying cause. It also helps to know what
caused it and what makes it hurt. Pain that gets worse with
activity is often tendinitis or stress fractures. Pain and
tenderness accompanied by swelling can be more serious
such as a tear or sprain. Some pain can be caused by musclesspasms associated with trauma.
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The most common knee problems are:
•Arthritis.
•Torn ligament.
•Torn meniscus.
•Chondromalacia.
•Loose body inside the knee joint.
ARTHRITIS
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ARTHRITIS
There are three basic types of arthritis:
•Osteoarthritis.Most common type.
Slowly degenerate knee joint bone tissues.
Mostly occur in middle or old age people.
•Rheumatoid Arthritis.Inflammatory type.
Affect both knee.
Can occur at any age.
•Post-traumatic ArthritisSimilar to osteoarthritis.
Occur after an injury of knee.
May develop years after a fracture, ligament injury, or
meniscus tear
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HEALTHY KNEE ARTHRITIS
SYMPTOMS
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Arthritis causes joint pain, swelling, stiffness, and limited
movement. Symptoms can include:
Joint pain.Joint swelling.
Reduced ability to move the joint.
Redness of the skin around a joint.
Stiffness, especially in the morning.
Warmth around a joint.
CAUSES
Genetic.
Age.
Weight.Previous injury.
Heavy sports.
Illness or infection.
TREATMENTS
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Non surgical treatment fall in four major group:
Lifestyle modifications.
Exercise.Supportive devices.
Other methods.
Surgical Treatment
Arthoscopy.
Osteotomy.
Arthroplasty (total knee replacement).
Knee Cartilage replacement*.
TORN LIGAMENT
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Sudden start-stop movements
and quick changes in directionare common causes of ligament
injuries. A torn knee ligament can
cause pain, swelling or difficulty
in walking. Ligament sprains can
take 4-6 weeks for recovery.Ligament injuries can also be
partial or complete tears. A torn
ligament needing reconstructive
surgery can take a year to heal.In addition, damage to the
meniscus may be found and
repaired during arthroscopy.
TORN LIGAMENT
RECONSTRUCTED ACL
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TORN MENISCUS
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Twisting the knee joint is the most common cause of a tornmeniscus. This can happen during sports or even during
normal daily activity. The meniscus also becomes softer with
age, making it easier to tear. Tears can occur along the edge of
the meniscus or larger tears can occur deeper into the
meniscus. A torn meniscus can cause catching or locking of theknee, giving way or buckling (instability) of the knee, pain or
swelling. The size and location of the tear determine both
treatment and recovery. Small tears need 4-6 weeks for
recovery while repair of larger tears can take 3 months or more.
TORN MENISCUS
MENISCUS TEAR
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MENISCUS TEAR
MENISCUS REPAIR OR REMOVAL
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MENISCUS REPAIR OR REMOVAL
CHONDROMALACIA
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Chondromalacia can be caused by overuse or injury to thekneecap and is a condition where the articular cartilage of the
knee bones softens. It is most common on the back of your
kneecap where the kneecap rubs with straightening of the
knee. As the cartilage softens, it wears away more easily during
joint movements. The cartilage can also be damaged bydirectly injuring the knee. Or the cartilage may just thin with
age, which can cause catching or locking of the knee, giving
way or buckling of the knee (instability), pain or swelling.
CHONDROMALACIA
CARTILAGE DEFECT
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CARTILAGE DEFECT
LOOSE BODY (Joint Mouse)
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Any free-floating object in the synovial fluid of the knee isknown as a loose body or joint mouse. It can be a fragment of
bone, cartilage, or meniscus. It can also be a piece of glass,
metal or any foreign object. A loose body isn’t usually
noticeable until it lodges somewhere in the joint. Your
symptoms can change depending upon the exact locationwithin your knee. A loose body can cause catching or locking of
the knee, giving way or buckling of the knee (instability), pain or
swelling.
LOOSE BODY (Joint Mouse)
LOOSE BODY REMOVAL
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LOOSE BODY REMOVAL