KNEE JOINT

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 OUTLINE
1. CLASSIFICATION
2. ARTICULAR SURFACES
3. FIBROUS CAPSULE
4. SYNOVIAL MEMBRANE
5. MENISCI
6. INTRA-CAP LIGAMENTS
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7. EXTRA-CAP LIGAMENTS
8. BURSAE
9. RELATIONS
10. MOVEMENTS
11. STABILITY
12. BLOOD SUPPLY
13. INNERVATION
14. CLINICAL ANATOMY
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 CLASSIFICATION
Bicondylar type of Synovial joint
which mainly allows for flexion and
extension (and a small degree of
medial and lateral rotation)
•It is the largest and most
complicated synovial joint in the
body.
•Ii is classified as a modified hinge
joint 4
• It is formed by
articulations
between the patella,
femur and tibia.
tibia

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ARTICULAR SURFACES

•Femur
•Tibia
•Patella
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 FEMUR
• Lateral condyle
• Medial condyle
• Patellar surface
• Intercondylar area

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• Articular surfaces are not congruent

• Articular surfaces of the femur form a

broad ∩-shaped area for articulation
with the patella & tibia

• The patellar surface extends over the

anterior surface of both condyles but
more to the lateral condyle, concave,
from side to side
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• The tibial surface is divided into medial &
lateral parts by an intercondylar area; the
medial part covers the convex inferior and
post surface of medial condyle, gently
curved; the lateral tibial surface is broader
and passes straight backwards.

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 TIBIA
• The tibial articular surfaces (covered
with cartilage) are gently hollowed out
centrally, flattened peripherally,
separated by an intercondylar area and
covered by meniscus.

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 PATELLA
• The patella is formed inside the tendon of
the quadriceps femoris; its presence
minimises wear and tear on the tendon.
• Articular surface of patella is adapted
to the patella surface of femur- a more
extensive lateral surface & a smaller
medial surface.

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 FIBROUS CAPSULE
• Strong, reinforced by strong expansions
from tendons of the muscles that surround
the joint
• On the femur the capsule is attached below
the epiphyseal line down to the articular
margin except in 2 places
• At the back it is attached to the
intercondylar ridge at the lower limit of the
popliteal surface, and on the lateral condyle
it encloses the pit for tendon of popliteaus.
• Medial capsular fibres attached to the
femoral and tibial condyles just beyond
their articular margins; here the tibial blends
with the tibial collateral ligament

• Lat- attached to the femur above popliteus,

descends over its tendon to the tibial
condyle & fibular head. Fibular collateral lig
separated from capsule by fat & the inf lat
genicular vessels.

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 SYNOVIAL MEMBRANE

• Most extensive & complex in the body

• At the proximal patellar border, it forms a

large suprapatellar bursa (sustained by
articularis genu) b/w quadriceps femoris &
lower shaft of femur.

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• Alongside patella the SM extends
beneath the aponeurosis of the vasti,
more extensively under the medial.

• Attached all around the articular margin

of the femur. On the lateral condyle is
separated from the capsule by the
tendon of popliteus that lies b/w the 2.

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• On the tibia, it is attached to the articular
margins of med & lateral condyles, & is
reflected forwards over the ant cruciate
ligament from these margins.

• Distal to the patella the SM is separated

from the patella ligament by the infrapatellar
fat pad; an alar fold extends both med & lat
from it =these bear villi & then converge
post to form the single infrapatellar fold
(ligamentum mucosum) that curves post to
its attachment in the femoral intrcodylar
fossa. 17
 MENISCI
• Semilunar fibrocartilages on the articular surfaces
of the tibia.
• Wedge-shaped- thick at periphery; thin at internal
border
• Sup surface concave
• Inf surface flat
• Assit lubrication
• Facilitate combined sliding, rolling & spinning
• Shock absorbers
• Deepen articular surfaces
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 Menisci

• The medial and lateral menisci

are fibrocartilage structures in the knee
that serve two functions:
• To deepen the articular surface of the tibia,
thus increasing stability of the joint.
• To act as shock absorbers.
• They are C shaped, and attached at both
ends to the intercondylar area of the the
tibia.
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 MEDIAL MENISCUS
• Almost a semicircle

• Ant horn to the ant tibial intercondylar area

in front of ant cruciate lig, its post fibres
being continous with the transverse lig

• Post horn fixed to the post tibial

intercondylar area, b/w the attachments of
the lateral meniscus & post cruciate lig
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 LATERAL MENISCUS
• Nearly a complete ring = ~4/5 of a circle
• Covers a larger area than the medial
• Groved posterolaterally by the popliteal tendon,
separating it from the fibular collater lig
• Ant horn attached in front of the intercondylar
eminence, posterolateral to the ant cruciate lig
• Post horn attached behind the int eminence, in
front of the post horn of the medial m
• Near its post attachment it commonly sends a
post meniscofemoral lig superomedially behind
the post cruciate lig to the medial femoral
condyle- Humphry & Wrisberg ligaments. 21
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 INTRA-CAP LIGAMENTS

• Anterior cruciate
• Post cruciate
• Humphry
• Wrisberg
• Transverse/menisco-meniscal

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 ANTERIOR CRUCIATE LIG
• weaker
• Arises from ant part of intercondylar area of
tibia
• Extends posterosuperiorly & laterally to
attach to post part of the medial surface of
lat condyle of femur
• Slacks when knee is flexed
• Taut when knee is extended
• Prevents post displacement of femur on
tibia & hyperextension of knee.
• L=38mm; W= 11mm
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 POSTERIOR CRUCIATE LIG
• Stronger; L= 38mm; w= 13mm
• Arises from post part of the intercondylar area of
tibia and passes superiorly and anteriorly on the
medial side of ant cruciate to attach to the ant
part of the lateral aspect of the medial femoral
condyle.
• Tightens during flexion of knee joint
• Prevents hyperflexion of knee, ant displacement
of femur on tibia, post displacement of tibia
• In the weight-bearing flexed knee it is the main
stabilizing factor for the femur especially when
downstairs 25
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 EXTRA-CAP LIGAMENTS

• Patellar
• Fibular collateral
• Tibial collateral
• Oblique popliteal
• Arcuate

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 LIGAMENTUN PATELLA
• The anterior ligament of the knee
joint
• Strong flat band
• 8 cm in length
• Essentially the centrally part of the
tendon of quadriceps femoris from
the apex of patella above to the
upper part of tibial tuberosity
below
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 ligamentum patella (ctd.)
• Its superficial fibres are continuous
over the patella with tendon of
quadriceps femoris, medial and lateral
parts of which descend to the side of
tibial tuberosity; these medial & lateral
patellar retinacula merge into the
fibrous capsule
• Deep surface separated above from
synovial membrane by infrapatellar fat
pad & below from tibia by deep
infrapatellar bursa 29
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 TIBIAL COLLATERAL LIG
• Srong, triangular, broad, flat band closer to
the posterior than anterior aspect of knee
• Proximal attachment- med epicond of
femur
• Distal attachment- med condyle & med
surface of shaft of tibia
• 2 parts
• Ant part is flat ~10cm long
• Post part short; blends with back of
capsule 31
 tibial collateral lig (ctd.)
• Ant margin separated from the capsule
& med meniscus by 1 or more bursae
• The post margins & deep fibres are
attached to the medial meniscus &
capsule
• Crossed below by the tendons of
sartorius, gracilis & semitendinosus
• Lower end separated from tibia by
medial inf genicular vessels 32
 FIBULAR COLLATERAL LIG
• Strong rounded cord
• ~5cm long
• Prox attach- lateral epicondyle of femur
• Distal attach- lateral surface of head of
fibula
• Free from capsule and lat meniscus, being
separated from meniscus by tendon of
popliteus & inf genicular vessels
• Hidden by tendon of biceps femoris which it
splits
• Upper part may fuse with capsule
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 OBLIQUE POPLITEAL LIG

• An expansion from tendon of

semimembranosus

• A broad band that partially blends with

fibrous capsule passing upwards and
laterally to be attached above to the
lateral part of the intercondylar line &
lateral condyle of femur
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 ARCUATE POPLITEAL LIGAMENT
• Y-shaped band of fibres, stem of which is
attached to the head of fibula
• As it passes superomedially the post limb
arches over the back of the knee to be
attached to the post border of the
intercondylar area of tibia
• Ant limb sometimes absent, extends to the
lat epicondyle of femur,connected with the
lat head of gastrocnemius= short lateral
genual ligament
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 TRANSVERSE LIGAMENT
• Connects ant convex margin of
the lateral meniscus to ant end
of medial meniscus
• Thickness varies
• Sometimes absent

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 RELATIONS
• ANT & SIDES-quadriceps femoris
• POST- fascia of popliteus, popliteal
vessels, tibial n, popliteus, plantaris, lat
& med heads of gastronecmius, lymph
glands & vessels
• MEDIAL- sartorius, gracilis, semi-t,
Semi-m
• LATERAL- tendons of biceps &
popliteus; common fibular n 38
 MOVEMENTS
• FLEXION-hamstrings
• EXTENSION- quadriceps

ROTATION POSSIBLE WHEN KNEE IS

PARTIALLY FLEXED
• MED ROTATION- popliteus,
semitendinosus, semimembranosus
• LAT ROTATION- biceps femoris

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 BURSAE AROUND KNEE JOINT
Severals b/c
• Most tendons parallel to bones and pull
lengthwise across joint during knee
movements

Subcut bursae on ant aspect of joint

• facilitates unhindered of overlying skin
during movements at the knee joint

• Some communicate with synovial cavity of

KJ- suprapatellar, popliteus, anserine,
gasrtonecmius
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 BLOOD SUPPLY
• Genicular branches of the femoral
• Popliteal
• Pot recurrent branches of ant tibioal
• Circumflex fibular

• Middle genicular branches of popliteal

penetrates fibrous capsule- supply cruciate
ligaments, SM & peripheral margins of the
menisci.
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 INNERVATION
BRANCHES OF

• Obturator
• Femoral
• Tibial
• Common fibular
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 Movements

• There are four main movements that the

knee joint permits:
• Extension: Produced by the quadriceps
femoris, which inserts into the tibial
tuberosity.
• Flexion: Produced by the hamstrings,
gracilis, sartorius and popliteus.

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• Lateral rotation: Produced by the biceps
femoris.
• Medial rotation: Produced by five
muscles; semimembranosus,
semitendinosus, gracilis, sartorius and
popliteus.
• NB: Lateral and medial rotation can only
occur when the knee is flexed (if the knee
is not flexed, the medial/lateral rotation
occurs at the hip joint)

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 Clinical Relevance
• Injury to the Knee Joint
• Collateral ligaments
• Injury to the collateral ligaments is the
most common pathology affecting the
knee joint. It is caused by a force being
applied to the side of the knee when the
foot is placed on the ground.

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• Damage to the collateral ligaments can be
assessed by asking the patient to
mediallyrotate and laterally rotate the
[Link] on medial rotation indicates damage
to the medial ligament, pain on lateral
indicates damage to the lateral ligament.
• If the tibial collateral ligament is damaged, it
is more than likely that the medial meniscus
is torn, due to their attachment

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 Cruciate ligaments

• The anterior cruciate ligament (ACL) can

be torn by hyperextension of the knee
joint, or by the application of a large force
to the back of the knee with the joint partly
flexed. To test for this, you can perform an
anterior drawer test, where you attempt
the pull the tibia forwards, if it moves, the
ligament has been torn.

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• The most common mechanism of posterior
cruciate ligament (PCL) damage is the
‘dashboard injury’. This occurs when the
knee is flexed, and a large force is applied
to the shins, pushing the tibia posteriorly.

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• This is often seen in car accidents, where
the knee hits the dashboard. The posterior
cruciate ligament can also be torn by
hyperextension of the knee joint, or by
damage to the upper part of the tibial
tuberosity.

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• To test for PCL damage, perform the
posterior draw test. This is where the
clinician holds the knee in flexed position,
and pushes the shin posteriorly. If there is
movement, the ligament has been torn.

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 Inflammation of the Bursae

• Friction between the skin and the patella

cause the prepatella bursa to
become inflamed, producing a swelling on
the anterior side of the knee. This is
known as housemaids knee.

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• Similarly, friction between the skin and
tibia can cause the infrapatella bursa to
become inflamed, resulting in what is
known as clergyman’s
knee (typically caused by clergymen
kneeling on hard surfaces during prayer).

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 Unhappy triad

• Due to the attachment of the medial collateral

ligament to the medial meniscus, damage to
the medial collateral can affect this important
cartilaginous structure. A lateral force to an
extended knee, such as a rugby tackle, can
rupture the medial collateral ligament,
damaging the medial meniscus in the
process. The ACL is also affected, which
completes the ‘unhappy triad’.

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 CLINICAL ANATOMY
1. Injuries to ligaments
2. Meniscal injuries
3. Arthritis / Osteoarthritis
4. Patellofemoral syndrome
5. Bursitis
6. Popliteal cysts
7. Knee deformities
8. Knee aspiration
9. Arthroscopy
10. Knee replacement arthroplasty
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