Knee Kinematics and Kinetics

Definitions:
Kinematics is the study of movement
without reference to forces
http://www.cogsci.princeton.edu/cgi-bin/webwn2.0?stage=1&word=kinematics

Kinetics is the study of movement with

reference to forces

The largest and most complex joint structure

The Knee:

Transmit Loads Participate in motion Aids conservation of momentum Provides a force couple for body activities

Anatomy of the knee

3 Bones
Tibia, Femur, Patella

3 Compartments
Medial, Lateral, Patellofemoral

4 Ligaments
MCL, LCL, ACL, PCL

2 Menisci Articular Cartilage

The Knee Joint

Peculiar Anatomy
Menisci
Fibro-cartilage support

Internal ligaments
Carry loads during motion

Two menisci
Outer - lateral meniscus
Circular shaped , smaller ,more mobile Attached to the ACL Attached to the femur via the ligament of Wrisberg C shaped wider posterior than lateral attached to the MCL attached to the joint capsule

Inner - medial meniscus

Menisci

Menisci Functions
Deepen the articulation
Increase area of contact

Shock absorption
X10 BW a skier lands from a jump

Increase stability
Cups the femoral condyle

Nutrition of cartilage
Sweeping synovial fluid across joint

Range of Motion
Need to define planes
in which the particular motion is taking place The knee moves in six different directions of motions (6DOF)
Sagittal plane (0-1400)

Tibia-femoral motion in the sagittal plane

Activity Walking Climbing stairs Descending stairs Sitting down Tying a shoe Squatting Knee Flexion (degrees) 67 83 90 83-110 106 130

Tibio-femoral motion in the Transverse plane

Influenced by knee position in sagittal plane
Ex. If knee is in full extension rotation is restricted by interlocking of condyes with tibia

Rotation increases as the knee is flexed

maximum 900 flexion External 450 Internal 300 decreases, due to soft tissue restriction

Beyond 900

Tibia-femoral motion in the frontal plane

Abduction and Adduction is also affected
by the amount of knee flexion
Ex. Full extension precludes motion

Increased passive abduction and

adduction occurs with knee flexion < 300

Locating an ICR

Successive films taken 100 intervals of flexion (A,B) Tibia is parallel to the x-ray to prevent rotation Marking two identifiable points on femur, and join these points and draw perpendicular bisector (B) The intersection point of the perpendicular bisectors is the instant center of rotation.

Joint Contact Points in Flexion

Two contact points
@ femur & tibia

Medial
Translates slightly
anterior on tibia

Lateral
Translates considerably
posterior on tibia

Surface Joint Motion

Types of motion at knee joint

Rolling Motion
Initiates flexion

Gliding Motion
Occurs at end of flexion

Rolling Motion

Gliding Motion

Instantaneous Center of Rotation ICR

"If one rigid body rotates about another rigid
body, its motion at any instant can be described by a point or axis of rotation called the instantaneous center of rotation. For normal knees
Pathway of ICR is semicircular Located on the femoral condyles

ICR (contd)

Joint Contact Forces

Ideally
we would have equal distribution of forces w/o any varus or valgus stresses
Figure from Burstein and Wright, 1994

Joint Contact Forces in the knee

Joint Contact Forces in the knee (contd)

During varus stress
To balance the stress LCL tension rises Knee shifts 5 varus Increased stress on medial condyle Repeated cycles of varus / valgus loading Varus / valgus deformity Cartilage wear

Patello-femoral Joint

Patellar Kinematics
Patella directly contacts femoral condyles
in flexion Patella acts as the fulcrum It is said to be lateral side dominant
Greater surface area of contact on the lateral side as opposed to the medial

Patellar Kinematics
--Figure from Fulkerson, Disorders 1997 3rd ed.

Compressive Forces of Patella

Figure from Fulkerson 1997

Patellar Kinematics
There are predictable areas of contact
between patella and femoral condyles that change with degree of flexion:

--figure from Fulkerson 1997

Patellar Kinematics 2
Forces acting on the Patella: Laterally- lateral retinaculum, vastus lateralis m., iliotibial tract Medially- medial retinaculum and vastus medialis m. Superior- Quadriceps via quadriceps tendon Inferior- Patellar tendon

Patellar Kinematics 3

Figure from Fulkerson, 1997

Patellar Kinematics 4
Sum of forces acting in the four directions
Determine movement pattern of the knee joint

Additional forces considered are:

Friction forces, compressive forces, torques, translational forces and internal stabilizing forces from soft tissues

Patellar Kinematics 5
Q-angle : Angle formed at the knee joint
By connecting a line from the anterior superior iliac crest to the center of the patella And a second line from the center of the patella to the center of the patellar tendon insertion into the tibial tubercle

Q-Angle

Q-Angle (contd)
Q-angle of 12 to 15 degrees is considered normal; while patients with patellar subluxation may have a Q-angle as high as 30 degrees

Henry J.H., Goletz T.H., and Williamson B. Lateral Retinacular Release in Patellofemoral Subluxation. Am J of Sports Med. Vol. 14 No.2 1986 pp121129.

Patellar malalignment
Generally associated with tightness of
Lateral retinaculum Hamstrings Iliotibial band Quadriceps Hip rotators Achilles tendon

Knee Kinematics

The "Screw-Home mechanism

Rotation between the tibia and femur
Occurs automatically between full extension 0o and 20o of knee flexion

SHM is considered a key element to knee

stability for standing upright

Screw-Home mechanism
Tibia
Internal rotation during the swing phase External rotation during the stance phase Occurs during the terminal degrees of knee extension Difference in radius of curvature of the medial and smaller
lateral condyle

External rotation
Results in tightening of both cruciate ligaments Locks the knee Tibia is in the position of maximal stability with respect to the
femur

Ligament Attachments in the knee Joint

Screw-Home mechanism 2
During Knee extension
Tibia rolls anteriorly, PCL elongates PCL's pull on tibia causes it to glide anteriorly on femur
Axial View of the Knee of Right Leg

Screw-Home mechanism 3
During the last 200 of
knee extension
Anterior tibial glide persists on the tibia's medial condyle Because its articular
surface is longer in that dimension than the lateral condyles

Screw-Home mechanism 4
Prolonged anterior glide
on the medial side
Produces external tibia rotation The "screw-home" mechanism

Screw-Home mechanism 5
When the knee begins to
flex from a position of full extension
Tibia rolls posterior, elongating ACL ACL's pull on tibia causes it to glide posterior Glide begins first on the longer medial condyle

Screw-Home mechanism 6
Between 00 extension
and 200 flexion
Posterior glide on the medial side produces Relative tibial internal
rotation A reversal of the screwhome mechanism
Internal Tibial Rotation

New flexion and extension axis theory

A fixed flexion and extension axis

theory [based on 3-D observation of knee] Replacing the classic concept of the variable flexion and extension theory [based on observation in the sagittal plane]

Flexion-Extension Kinematics
it has recently been shown that the F-E axis of
the knee is FIXED within the femur and that the

articular surfaces of the condyles are circular in profile

(Hollister et al. 1994, Hollerbach and Hollister, 1995)

Flexion-Extension Kinematics

Kinematics in Osteoarthrosis

THE END