Knee Complex

• Consists of two distinct articulations namely

2. Tibiofemoral joint
3. Patellofemoral joint
• In closed kinematic chain it works in
conjunction with hip & ankle to support body
weight in static erect posture
• In open kinematic chain knee provides
mobility for the foot in space
Tibiofemoral Joint:
• Double condyloid joint with 2° freedom of
motion
• Flexion/extension occur in saggital plane
about a coronal axis
• Medial/lateral rotation occur in transverse
plane about a vertical axis
Femoral articular surface:
• consists of lateral and medial condyles and
an intercondylar notch
• medial condyle is slightly longer than the
lateral one
Tibial articular surface:
• consists of two concave asymmetrical
medial and lateral condyles
• medial tibial articulating surface is 50%
larger than the lateral one
• two tibial condyles are separated by a
roughened area and two bony spines called
as intercondylar tubercles
• these tubercles become lodged in the
intercondylar notch of femur during knee
extension
Articulation:
• When condyles of femur are placed on tibial
condyles an incongruence develops
• Accessory joint structure menisci are present to
develop the congruency
Menisci:
• Asymmetrical fibrocartilage joint disks
• Medial is semicircle and lateral is four-fifths of a
ring
• Both are open towards the intercondylar area,thick
centrally,forming concavities
• Wedge shaped menisci increase radius of
curvature of tibial condyles and there fore joint
congruency
• Also play an important role in distributing
weight bearing forces,reducing friction and
serve as shock absorbers
• Menisci are attached around its periphery to
tibial condyle by coronary ligament
• Anterior horns are joined to each other by
transverse ligament
• Menisci are rich with free nerve endings
and three different mechanoreceptors and
hence act as a source of information about
joint position, direction of movement and
velocity of movement
• Menisci are important in distributing and
absorbing large forces crossing the knee
joint
• Ordinarily compressive forces in the
dynamic knee may reach 2-3 times body
weight in normal gait and 5-6 times in
activities such as running and stair climbing
• Menisci assume 40% – 60% of the imposed
load
Tibiofemoral alignment & weight bearing
forces:
• Anatomic axis of femur is oblique directed
inferiorly and medially from proximal to
distal end
• Anatomic axis of tibia is also directed
almost vertically
• Both axes normally form an angle medially
at knee of 185°-190°,femur is angulated off
vertical 5° -10° creating a normal valgus
angle at knee
• Mechanical axis of lower limb is weight
bearing line from center of head of femur to
superior surface of head of talus
• Because weight bearing line follows
mechanical rather than anatomic axes, the
weight bearing stresses on the knee in
bilateral stance are equally distributed
between medial and lateral condyles
• Deviations in normal force distribution may
be caused by an increase or decrease in
normal tibiofemoral angle
• If medial angle is greater than 195° -
Genu Valgum (knock knees)
• This will increase compressive force on
lateral condyle while increasing tensile
stresses on medial structures
• If medial angle is 180° or less -
Genu Varum (bow knees)
• This will increase compressive forces on
medial condyle while increasing tensile
stresses on lateral structures
• Constant overloading of stresses result in
damage to cartilage