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Anatomy and Biomechanics of the Knee

(copyright s h palmer 2009)

Movement of the knee joint can be classified as having six degrees of freedomthree translations: anterior/posterior, medial/lateral, and inferior/s perior and three rotations: flexion/extension, internal/external, and abd ction/add ction! "he movements of the knee joint are determined by the shape of the artic lating s rfaces of the tibia and fem r and the orientation of the fo r major ligaments of the knee joint: the anterior and posterior cr ciate ligaments and the medial and lateral collateral ligaments as a fo r bar linkage system !

#ig re $: "he ligaments of the knee %arro& sho&s direction of 'scre& home mechanism( ) see belo&*

#ig re +: ,aggital M-. scan sho&ing the anterior %small arro&* and posterior cr ciate ligaments %large arro&* Knee flexion/extension involves a combination of rolling and sliding called 'femoral roll back( &hich is an ingenio s &ay of allo&ing increased ranges of flexion! Beca se

of asymmetry bet&een the lateral and medial femoral condyles the lateral condyle it rolls a greater distance than the medial condyle d ring +/ degrees of knee flexion! "his ca ses co pled external rotation of the tibia &hich has been described as the 'scre&0home mechanism( of the knee &hich locks the knee into extension %see fig re $*! "he anterior cr ciate ligament drives this scre& home mechanism and absence of this control is the basis of the pivot shift test of an A12 deficient knee! "he primary f nction of the medial collateral ligament is to restrain valg s movement of the knee joint &ith its secondary f nction being control of external rotation! "he lateral collateral ligament restrains against var s rotation as &ell as resisting internal rotation! "he primary f nction of the anterior cr ciate ligament %A12* is to resist anterior displacement of the tibia on the fem r &hen the knee is flexed and control the scre& home mechanism of the tibia in terminal extension of the knee! A secondary f nction of the A12 is to resist var s or valg s rotation of the tibia, especially in the absence of the collateral ligaments! "he A12 also resists internal rotation of the tibia! "he main f nction of the posterior cr ciate ligament %312* is to allo& femoral rollback in flexion and resist posterior translation of the tibia relative to the fem r! "he menisci are intra0artic lar crescentic str ct res made of elastofibrocartilage! "hey are important for red cing contact stresses on the artic lar cartilage, shock absorption, circ lation of synovial fl id and joint stability! "he medial menisc s is tethered to the deep part of the medial collateral ligament and so is more prone to inj ry than the lateral menisc s &hich is more mobile! "he lateral menisc s is smaller than the medial and is sometimes discoid in shape!

#ig re 4: A normal medial menisc s seen at arthroscopy!

#ig re 5: A normal smaller lateral menisc s! "he movement of the patellofemoral joint can be characteri6ed as gliding and sliding! 7 ring flexion of the knee the patella moves distally on the fem r! "his movement is governed by its attachments to the 8 adriceps tendon, ligament m patellae and the anterior aspects of the femoral condyles! "he m scles and ligaments of the patellofemoral joint are responsible for prod cing extension of the knee! "he patella acts as a p lley in transmitting the force developed by the 8 adriceps m scles to the fem r and the patellar ligament! .t also increases the mechanical advantage of the 8 adriceps m scle relative to the instant center of rotation of the knee!

#ig re 9: "he patellofemoral joint as seen on a saggital M-. scan %arro&s mark the patella and patella tendon* "he mechanical axis of the lo&er limb is an imaginary line thro gh &hich the &eight of the body passes! .t r ns from the centre of the hip to the centre of the ankle thro gh the middle of the knee! "his is altered in the presence of deformity and m st be reconstit ted at s rgery %see fig re 5*! "his allo&s normalisation of gait and protects the prosthesis from eccentric loading and early fail re!

#ig re 5: A long leg vie& demonstrating abnormal mechanical axes &ith the line of body &eight passing thro gh the medial side of the knee in a footballer! "his predisposes the patient to medial joint damage and &ear!