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Anatomy of Knee

The knee joint is classified as a synovial joint that allows for hinge-like flexion and extension movement. It has three articulations - the femorotibial articulations on the lateral and medial sides, and the femoropatellar articulation. The knee joint is supported by ligaments like the ACL, PCL, MCL and LCL. It also contains menisci that act as shock absorbers and provide stability. Common clinical conditions affecting the knee joint include trauma, fractures, inflammation from osteoarthritis and rheumatoid arthritis.

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Manish Adhikari
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314 views28 pages

Anatomy of Knee

The knee joint is classified as a synovial joint that allows for hinge-like flexion and extension movement. It has three articulations - the femorotibial articulations on the lateral and medial sides, and the femoropatellar articulation. The knee joint is supported by ligaments like the ACL, PCL, MCL and LCL. It also contains menisci that act as shock absorbers and provide stability. Common clinical conditions affecting the knee joint include trauma, fractures, inflammation from osteoarthritis and rheumatoid arthritis.

Uploaded by

Manish Adhikari
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Anatomy: Knee Joint

Associate Prof Dr. Rohit Shrestha


Department of Orthopedics
Dhulikhel Hospital / Kathmandu University Hospital
2020 July 22

CLASSIFICATION OF JOINTS

B. Functional Classification (according to the degree


A. Structural Classification of mobility)

3. Synovial joints
a.  Ball-and-socket or
2. Cartilaginous joints
spheroidal joints
1. Fibrous joints a.  Primary cartilaginous Functional Classification (according to
b. Sellar or saddle joints
a. Sutures joints or the degree of mobility)
c. Condylar or bicondylar
b. Syndesmosis synchondrosis 1.  Synarthrosis (immovable), like fibrous
joints
c. Gomphosis b. Secondary joints
d. Ellipsoid joints
cartilaginous joints or 2. Amphiarthrosis (slightly movable), like
e. Hinge joints
symphysis cartilaginous joints
f. Pivot or trochoid joints
3. Diarthrosis (freely movable), like
g. Plane joints
synovial joints
Structure of synovial joint
Knee Joint
•  One of the largest and most superficial
•  “Hinge type” of synovial joint
•  Movement Flexion and extension
•  Also allows
• int. and ext. rotation of tibia .
Articular surfaces
3 articulations: - TRI-COMPARTMENT !

•  Femorotibial articulations (lateral and medial)


•  Femoropatellar articulation
Joint Capsule
•  Fibrous capsule
-It covers the joint on the
lateral,
medial and
posterior aspect
Anteriorly – patella, ligamentum patellae & fat pad
nerve supply – sensitive to pain
sensory branch help in proprioception
•  Synovial membrane
Lines the inner surface of capsule
Extracapsular Ligaments

1.  Patellar ligament


2.  Medial collateral ligament
3.  Lateral collateral ligament
4.  Oblique popliteal ligament
5.  Arcuate popliteal ligament
Collateral ligament
1.Medial collateral ligament : superficial and deep part
proximal attachment :posterior aspect of the medial femoral condyle.
distal attachment :metaphyseal region of the tibia, about 5cm distal to the joint,
lying beneath the pes anserinus ( it is the attachment of S. G. St. @ ant-med tibia)
Function :restraint to valgus stress

2. Lateral collateral ligament:
proximal attachment :lateral femoral
distal attachment :head of the fibula
Function : restraint to varus stress
Intra-articular Ligaments
• Cruciate ligament
Anterior cruciate ligament (ACL)
Posterior cruciate ligament (PCL)

(Intra capsular but extrasynovial!)
Cruciate Ligaments

cruciate à ‘cross’ ligaments



(form an ‘X’ or cross within the joint)

Named for their TIBIAL attachments
Function of cruciate ligament
Blood supply
Popliteal artery Recurrent anterior tibial artery
Meniscus à Semilunar Cartilage
•  The meniscus is a cushion structure
made of cartilage (type IV collagen)

M C L L M C
which fits within the knee joint
between the tibia and femur.
Medical College Lumbini Lumbini Medical College

Crutiate – PCL
M C L L M C


Medial – medial meniscus post horn

Lateral – lateral menicus post horn


Lateral – lateral meniscus ant horn

Crutiate – ACL

Medial – medial meniscus ant horn
Meniscus function
1.  Shock Absorbing

2.  Joint stability :The posterior horn of the medial meniscus is the main
secondary stabilizer of anterior translation

3.  Load sharing: The meniscus provides load sharing across the knee by
increasing the contact area and decreasing the contact stress.
contact stress increases 2-3 times when the meniscus is removed.

4. Proprioception: peripheral portion of the meniscus has nerve supply.


•  Lateral meniscus is more mobile
then medial meniscus

•  Medial meniscus is attached to MCL
(what is O’donogue unhappy triad?)

•  Medial meniscus tear occurs 3 times


more often than lateral meniscus.
Vascular Zone of Meniscus à reparability
Movement at Knee Joint
•  Flexion and Extension
•  Some degrees of Internal and External Rotation

(ITS NOT A SIMPLE HINGE JOINT!)


Extensors of Knee joint – Quadriceps !
Flexors of Knee joint – Hamstrings !
Patello-femoral Joint
Function of patella :
1.  Enhances the moment arm of quadriceps.
thus increase the force production of the quadriceps
2. Acts as pulley :changes direction of force
3. Centralizes the divergent muscles of the quadriceps
4. cosmetic benefit

With and without patella


Mechanism of Locking and Unlocking knee
Locking :
during extension by quadriceps , (Passive process)
internal rotation of femur by screw home mechanism


Unlocking:
external rotation of femur by popliteus muscle (active process)
Clinical Conditions related to Knee Joint
1.Trauma - Knee dislocation : end of one of the bones gets out of its socket.
- In subluxation, the end of the bone partially leaves its socket.
- Associated with popliteal artery (20-40)% and common peroneal nerve injury
(14-40)% and multiligamentous injury
2. Fractures around Knee :
Distal femur, Proximal Tibia, Patella !
Ligamentous injury à ACL, PCL, MCL, LCL tear ! à needs repair or reconstruction
3. Inflammation / Degeneration : Osteoarthritis
4. Inflammation : Rheumatoid arthritis


Osteoarthritis
Subluxation and dislocation

Knee dislocaton Rheumatois arthritis


Thank you

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