ANATOMY

The Tibiofemoral Joint (Knee Joint) is particularly susceptible to traumatic injury because it is located at
the ends of two long lever arms, the tibia and the femur. The joint is the largest joint in the body. is the
largest joint in the body. It is a modified hinge joint having 2° of freedom. The
synovium around the joint is extensive; it communicates with many of the bursae and pouches around
the knee joint.

Ligaments that connect the femur to the tibia and fibula are:

Medial Collateral Ligament (MCL)

-also known as the Tibial Collateral Ligament because it connects the Femur and Tibia, provides
stability to the inner (medial) aspect of the knee.
Lateral Collateral Ligament (LCL)
- also known as the Fibular Collateral Ligament because it connects the Femur and Fibula,
provides stability to the outer (lateral) aspect of the knee
Anterior Cruciate Ligament (ACL)
- in the center of the knee, limits rotation and forward movement of the Tibia
Posterior Cruciate Ligament (PCL),
-also in the center of the knee, and like the ACL secondarily limits rotation, while primarily limits
backward movement of the Tibia.
(http://www.interactive-biology.com/3992/functional-anatomy-of-the-knee-movement-and-
stability/)

Meniscus/Menisci
The space between the tibia and femur is partially filled
by two menisci that are attached to the tibia to add congruency.

 Medial Meniscus is a small part of a large circle (C shaped) and is thicker posteriorly than
anteriorly.
 Lateral Meniscus is a large part of a small circle (O shaped) and is generally of equal thickness
throughout.

Both menisci are thicker along the periphery and thinner along the inner margin.

Functions:
 Aid in lubrication and nutrition of the joint and act as shock absorbers.
 Make the joint surfaces more congruent and improve weight distribution by increasing
the area of contact between the condyles.
 Reduce friction during movement and aid the ligaments and capsule in preventing
hyperextension.
 Prevent the joint capsule from entering the joint and participate in the “locking”
mechanism of the joint into close pack by directing the movement of the femoral
articular condyles.
The Tibiofemoral Joint is a synovial type of joint which allow a significant amount of motion along their
extremely smooth articular surface. This joint is composed of the following:

 Articular cartilage
 Subchondral bone
 Synovial membrane
 Synovial fluid
 Joint capsule

The normal articular surface of synovial joints consists of articular cartilage (composed of chondrocytes)
surrounded by an extracellular matrix that includes various macromolecules, most importantly
proteoglycans and collagen.

The cartilage facilitates joint function and protects the underlying subchondral bone by distributing large
loads, maintaining low contact stresses, and reducing friction at the joint. Synovial fluid is formed
through a serum ultrafiltration process by cells that form the synovial membrane (synoviocytes).
Synovial cells also manufacture hyaluronic acid (HA, also known as hyaluronate), a glycosaminoglycan
that is the major noncellular component of synovial fluid. Synovial fluid supplies nutrients to the
avascular articular cartilage; it also provides the viscosity needed to absorb shock from slow
movements, as well as the elasticity required to absorb shock from rapid movements.
PATHOPHYSIOLOGY

Changes in Collagen
synthesis, minimizing
OVERUSE compressibility of the
Collagen fibers rupture
cartilage

Cartilage becomes Fibrillation, erosion, and

Decrease in proteoglycan
increasingly susceptible to cracking appear in the
content in the bone matrix
joint friction superficial layer of cartilage

Cartilage becomes yellowed

Synovial fluid volume might
Progressive destruction of and worn over articular
Softening and loss of increased considerably if
lysosomal enzymes surfaces, bone growth
elasticity by the cartilage subjected to excessive use or
outweighs its production increases at joint margins
minor injury
and bony outgrows develop

Subchondral bone becomes

Chondrocytes initially
deformed. Periarticular Mild inflammation due to
Body attempts to proliferate and increase their
tissues and synovial joint debris being engulfed
compensate synthesis of proteoglycans
membrane becomes by synovial tissue.
and collagen
thickened