Knee Joint

What are the four bones that make up the knee joint? Femur Tibia Fibula Patella

A. Femur - the femur is the longest bone in the body.

B. Tibia - the tibia is the medial bone in the leg, bearing the weight of the lower leg

Bones of the Knee

Bones of the Knee

C. Fibula - the fibula serves as attachment sites for knee joint structures and muscles. It does not articulate with the femur or patella. It is a non-weight bearing bone. D. Patella - the patella is a sesamoid (free floating bone. It is embedded in the patellar tendon (or is it a ligament?). Not born with patellas. Protects structures beneath and changes angle of pull to create greater rotary force.

Knee Joint
What is the classification of the knee joint?

The knee is classified as a ginglymus or hinge joint. This is not entirely accurate, as the knee does allow some rotation.
The knee is a fairly complex, and somewhat unstable joint. It is often injured in athletics.

Knee Joint
In

addition to articular cartilage covering ends of bones, specialized cartilages menisci. Attached to tibia and deepen tibial plateau. Enhance stability. Both thicker on outside border, taper to very thin on inside border.

Knee Joint

Knee Joint Ligaments

A. Medial collateral ligament - prevents the knee from abduction or valgus forces. Often injured by blows to the lateral side of the knee. B. Lateral collateral ligament - prevents the knee from adduction or varus forces. This ligament can be injured by blows to the medial side of the knee. Does not occur frequently.

Knee Joint Ligaments

C. Anterior cruciate ligament - prevents the tibia from moving forward. The term cruciate means cross. This ligament crosses with the posterior cruciate ligament between the tibia and femur. It attaches to the tibia anteriorly and the femur posteriorly. It helps maintain rotary stability. This ligament is one of the most often injured in sports, and is caused by hyperextension, and rotary movements associated with planting and cutting.

Knee Joint Ligaments

D. Posterior cruciate ligament - prevents the tibia from moving posteriorly. It attaches anteriorly to the femur and posteriorly to the tibia.

This ligament in conjunction with the anterior cruciate helps maintain rotary stability. It is not as common of an injury as the anterior cruciate ligament. Injured more often in car accidents.

Motions of the Knee

What are the four motions that can occur in the knee joint? A. Flexion - bending or decreasing the angle of the knee characterized by the heel moving toward the buttocks. B. Extension - The opposite of flexion. Straightening or increasing the angle between the femur and the lower leg.

Knee Flexion

Knee Extension

Motions of the knee

C. External rotation - rotary movement of the lower leg laterally away from the midline. D. Internal rotation - Rotary movement of the lower leg medially toward the midline.

Knee Joint Muscles

Name the muscles that would be part of the quadriceps or knee extensor group: Rectus femoris

Vastus lateralis
Vastus medialis Vastus intermedialis

Knee Joint Muscles

Name the muscles that would be considered part of the hamstring or knee flexor group: Semimembranosus Semitendinosus

Biceps femoris What are the other knee joint muscles? Popliteus, Gracilis, Sartorius, Gastronemius

Quadriceps or knee extensor group

A. Vastus lateralis - vastus is the term for immense. These three muscles of the quadriceps group derive their name for their size and position. The vastus lateralis is the most lateral of the quadriceps group.

Quadriceps Rectus Femoris

Vasti

Quadriceps group
What are the actions of the vastus lateralis? Knee extension What are some good exercises for the vastus lateralis? Seated knee extension Hip sled Squats Seated leg press Lunges

Note: The vastus lateralis can be involved in lateral patellar subluxation. It has a slight lateral pull, and if over developed, can cause problems.

Quadriceps group
B. Vastus intermedius - this muscle is the middle of the three vastus muscles. It lies underneath the rectus femoris.

What are the actions of the vastus intermedius? Knee extension Exercises to strengthen the vastus intermedius would be identical to those for the vastus lateralis
To isolate the vastus muscles, knee extensions should be performed in the seated position.

Quadriceps group
C. Vastus medialis - this is the most medial of the vastus muscles. It is often a target of needle biopsies when the quadriceps muscle is studied for exercise. What are the actions of the vastus medialis?
Knee extension

Exercises to strengthen the vastus medialis are similar to the other vastus muscles, but it is emphasized in the last 10 to 20 degrees of extension.

Quadriceps group
D. Rectus femoris - recall that the rectus femoris was studied with the hip muscles. What are the actions of the rectus femoris?

Knee extension and hip flexion

Gluteus Maximus
Semimembranosus Biceps Femoris Semitendinosus

Gastrocnemius

Hamstring group
All of the muscles in the knee flexor/hamstring group were covered in the hip joint. What are the actions of the biceps femoris? Hip extension Knee flexion External rotation of hip and knee. What are the actions of the semitendinosus? Hip extension Knee flexion Internal rotation of the hip and knee

Hamstring group
What are the actions of the semitendinosus? Hip extension Knee flexion

Internal rotation of the hip and knee What are the actions of the semimembranosus? Hip extension Knee flexion

Internal rotation of the hip and knee

Another Knee Muscle

Because of its action, the

popliteus is remembered
as the key that unlocks the knee. It is the deepest muscle at the back of the knee. It is the only one-joint knee flexor.

Popliteus
What are the actions of the popliteus muscle? Flexion and internal rotation of the knee. It initiates knee flexion by medial rotation of the tibia to unlock the knee. Exercises to strengthen the popliteus include leg curls, and knee flexion with internal rotation.

Knee Flexion Assistants

Sartorius: flexes knee & internally rotates lower leg Gracilis: flexes knee & internally rotates lower leg Gastrocnemius: flexes knee Plantaris: short bellied muscle with long tendon insertion assists with knee flexion (missing in some humans)

Plantaris

Sartorius

Gracilis

Gastrocnemius

Knee Joint Injuries

A. ACL rupture - most commonly damaged ligament of the knee. Many sports apply external and internal forces to knee. Often caused by some type of cutting, twisting or hyperextension.

Unlike the MCL & PCL, the ACL does not have the capacity to heal. Once injured, it does not reconstitute as a functional entity.

ACL Tear

Normal ACL

Torn ACL

Knee Joint Injuries

ACL injury rates are 4 to 8 times higher in female athletes who take part in soccer, basketball, track, and softball (compared to baseball) than male athletes.

Sagittal plane landing mechanics may play less of a role in gender-related ACL injury than frontal and transverse plane mechanics. Effect of fatigue on knee valgus and internal rotation may have more consequence on female than male.

Numerous theories for gender ACL differences including: 1. Women have a wider pelvis, increasing the Q angle of the knee. 2. The place where the ACL passes through knee, intercondylar notch, of women is slightly smaller compared to men. 3. Lack of exposure to motor skills at early age leads to injuries at later age.
4. Hormones. Women in pre-ovulatory phase have more ACL injuries presumably due to laxity.

Q Angle

Knee Joint Injuries

B. Collateral ligament sprain - one of the most frequent knee injuries. Usually caused by blow to lateral knee. Deep fibers of medial collateral ligament attach to medial meniscus, so could disrupt meniscus too. C. Meniscus tearing frequently caused by planting foot during weight bearing while body undergoes rotation. Symptoms include pain, accompanied by locking or buckling of the joint.

Knee Joint Injuries

D. Chondromalacia - affects the articulating cartilage on the interior surface of the patella. Possibly caused by incongruence between patella and femur. Symptoms include pain, swelling and a grating sensation.
E. Osgood Schlatter Disease - usually affects children and is caused by repeated usage of the knee extensors. This overuse results in a tearing or avulsion at the epiphysis of the tibial tuberosity. Symptoms include pain, swelling, hemorrhage.

Osgood Schlatter Disease