This material has been reproduced and communicated to you by or on behalf of the University of
Melbourne in accordance with section 113P of the Copyright Act 1968 (Act).
The material in this communication may be subject to copyright under the Act.
Any further reproduction or communication of this material by you may be the subject of copyright
protection under the Act.
The material may also contain sensitive clinical and/or anatomical images and data. It may only
be used for personal study and should be done so with consideration to unintentional observance
by others.
Do not remove this notice
The
Knee
Joint
Assoc. Prof. Quentin A. Fogg
BSc(Hons), PhD, FRCPS(Glasg)
Braune, Wilhelm (1867-72) Topographisch-anatomischer Atlas : nach
Durchschnitten an gefrornen Cadavern. Verlag von Veit & Comp.,
Leipzig. Courtesy of National Library of Medicine.
Objectives
• This class will address the:
• basic mechanics on the knee joint
• principles of patellar dislocation
• quadriceps femoris muscles
• knee joint cavity
• knee ligaments and menisci
• developmental issues of the knee
• basis of common knee injuries
PART 1
ANTERIOR
Thigh/Knee Relations
• patellar position is closely related to knee
stability
– obliquus genu m. (part of vastus medialis m.) is the
key
• knee extension disengages the patella
• knee flexion engages the patella
Fogg (2017)
Fogg (2016)
anterior projection of the lateral condyle
“resists” the lateral pull of the quadriceps
femoris mm., ie. stops patella being dragged
laterally (most of the time!)
LATERAL MEDIAL
Fogg (2009)
Patellar Dislocation
lateral
medial
• almost always LATERAL
– angle of femur
– therefore predominance of vastus lateralis m.
– lateral tension from iliotibial band
– typically under-strength vastus medialis m. (esp.
obliquus genu part)
• requires significant medial force immediately, or
a long period of pharmaceutical muscle
relaxation to reduce
Anterior Compartment = knee extensors ANTERIOR
Superior Gluteal n.
tensor fascia
lata m.
Femoral n.
sartorius m.*,**
end of gluteal
region
QUADRICEPS FEMORIS MM.
rectus femoris m.**
lateral vastus medialis m.
vastus lateralis m.
quadriceps tendon
vastus intermedius m.
patella (hidden deep)
patellar ligament
* does NOT extend, but FLEXES the knee
Sobotta – Atlas of Human Anatomy (2001) **also hip flexors
Lippincott Williams & Wilkins
MEDIAL
Obliquus genu m.
– part of vastus medialis m.
attached to patella
– essential for realignment of the
patella
• powerful knee extension benefits
vastus lateralis m. first
– due to angulation of the femur
obliquus genu – hard to “work” the obliquus genu
part of m., so it is often weak
vastus – well trained athletes still have
medialis m. knee problems
– similar problems in the obese
patella patient
• specifically “working” this is easy
– but requires planning
patellar ligament – not suitable for all!
Sobotta – Atlas of Human Anatomy (2001) Lippincott
Williams & Wilkins
ANTERIOR POSTERIOR
medial
lateral
tibial plateau intercondylar
intercondylar
tubercle
tubercle
knee joint line
apex of
fibular head
most superior fibular
point of fibula head
∴ NOT part of
the knee joint!
TIBIA
fibular
FIBULA
tibial tuberosity neck
FIBULA
TIBIA
soleal line
Lateral
Sobotta – Atlas of Human Anatomy (2001)
Lateral
Lippincott Williams & Wilkins
The Juvenile Knee
• epiphyseal plates are not fused
– allows for growth
– vulnerable to forces normally tolerable to
adults
• rapid growth
– dramatic increase in bone length
– increase in muscle strength
– increase in hormone production
– social “specialisation”
• expanded entheses
– greater cartilage and fibrocartilage
volumes
• common results:
– patello-femoral pain syndrome
• referred hip pain?
– Osgood-Schlatter syndrome
radiopaedia.org
radiopaedia.org
Quick Quiz
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
End of
PART 1
This material has been reproduced and communicated to you by or on behalf of the University of
Melbourne in accordance with section 113P of the Copyright Act 1968 (Act).
The material in this communication may be subject to copyright under the Act.
Any further reproduction or communication of this material by you may be the subject of copyright
protection under the Act.
The material may also contain sensitive clinical and/or anatomical images and data. It may only
be used for personal study and should be done so with consideration to unintentional observance
by others.
Do not remove this notice
The
Knee
Joint
Assoc. Prof. Quentin A. Fogg
BSc(Hons), PhD, FRCPS(Glasg)
Braune, Wilhelm (1867-72) Topographisch-anatomischer Atlas : nach
Durchschnitten an gefrornen Cadavern. Verlag von Veit & Comp.,
Leipzig. Courtesy of National Library of Medicine.
PART 2
ANTERIOR POSTERIOR
anterior cruciate lig.
• first to “lock” in “screw-
home” mechanism Transverse
• tibio-femoral rotation genicular
ligament
essential for knee
flexion/extension
• has longitudinal and
rotational fibres
∴two mechanisms of
injury
∴consider both in physical
examination
Ross and Lamperti (2006) Thieme Atlas of Anatomy, Thieme, Stuttgart, Germany.
Fogg (2008) using VH Dissector Pro
v2.5.1 (2007) Touch of Life
Technologies
ANTERIOR
POSTERIOR
ACL best transmits and
absorbs force in these
directions
POSTERIOR
posterior
meniscofemoral lig.
lateral meniscus
semimembranosus
tendon
oblique popliteal lig.
posterior cruciate lig.
popliteus m.
Sobotta – Atlas of Human Anatomy
(2001) Lippincott Williams & Wilkins
MEDIAL LATERAL
lateral collateral lig.
• thin & lax
• NOT part of the joint
capsule
• definitely NOT connected to
the lateral meniscus
• weaker
• but less load
• tensed under VARUS load
medial collateral lig.
• thick & taut
• part of the joint capsule
• attached to
medial meniscus
• stronger
• but under more load
∴ more likely to be
injured than LCL
• tensed under VALGUS load
Ross and Lamperti (2006) Thieme Atlas of Anatomy, Thieme, Stuttgart, Germany.
SUPERIOR
deep infrapatellar
bursa
anterior patellar lig.
cruciate lig.
medial
meniscus transverse
genicular lig.
lateral
medial
collateral lig.
collateral
lig. posterior posterior lateral
cruciate lig. menisco- meniscus
femoral lig.
Thieme (2008), Karl Wesker
Patterns of Multi-
Ligament Knee Injuries
– impact vs non-impact
– O’Donoghue’s “unhappy triad”
• classic NON-IMPACT pattern
1 • no unusual movements at time of injury
• internal injury is FIRST (i.e. ACL)
2
– IMPACT, or externally fixed
3 • extreme, unusual movement
• VALFE (valgus + flexion + external rotation)
= MCL then ACL then medial meniscus
“Unhappy Triad” of damage
O’Donoghue • VARFI (varus + flexion + internal rotation) =
LCL then ACL then lateral meniscus
Sequential tearing in this damage
order (if sufficient force): • external injury is typically FIRST (i.e. MCL
1. ACL or LCL) in these impact cases
2. medial meniscus
3. MCL
suprapatellar bursa
(extension of joint space)
prepatellar bursa
infrapatellar fat pad
infrapatellar bursa
meniscus
tibia
patella
suprapatellar
bursa
lateral meniscus
femur
ACL
synovial
membrane
Sobotta – Atlas of Human Anatomy
(2001) Lippincott Williams & Wilkins
Quick Quiz
ANSWERS
“taller” lateral femoral
condyle = prevents
dislocation of the patella
lateral collateral ligament =
thinner and more lax than
medial collateral ligament
patellar ligament = attached
to tibial tuberosity
Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Outcomes
Now you should be able to:
• discuss the basic mechanics on the knee joint
• discuss the principles of patellar dislocation
• identify the quadriceps femoris muscles
• describe the knee joint cavity
• identify the knee ligaments and menisci
• discuss developmental issues of the knee
• discuss the basis of common knee injuries
