Chapter 10 The Knee Joint

Right Femur (Anterior) Right Femur (Posterior) Greater Trochanter Quadrate Tubercle Fovea Capitus Head Intertrochanteric Crest Intertrochanteric Line Neck Lesser Trochanter Gluteal Tuberosity Linea Aspera Adductor Tubercle Popliteal Surface Intercondyloid Fossa Patellar Surface Lateral condyle Medial condyle Right Femur (Anterior) Right Femur (Posterior) Label

Tibia & Fibula Intercondyloid Eminence Styloid Process Lateral Condyle Superior Fibular Articulation Medial Condyle Head Tibial Tuberosity Soleal Line Interosseous Border Anterior Border Interosseus Border Anterior Border Inferior Fibular Articulation Medial Malleolus Lateral Malleolus Talus Articulation Talus Articulation Fibula Label Tibia Label

Patella Proximal Border Base Lateral Border Medial Border Apex Right Patella Label

Joints Fibular (lateral) Collateral Ligament Medial Meniscus (semicircular “C” shape) & Lateral Meniscus (more circular shaped) Fibular (lateral) Collateral Ligament Posterior Cruciate Ligament Tibial (medial) Collateral Ligament Anterior Cruciate Ligament Joints Tibiofemoral (ginglymus) Trochoginglymus (pivot & ginglymus) Tibial (medial) Collateral Ligament b. Fibular (lateral) Collateral Ligament c. Anterior Cruciate Ligament d. Posterior Cruciate Ligament e. Medial Meniscus (semicircular “C” shape) & Lateral Meniscus (more circular shaped) Sit atop tibial condyles Serve to deepen the surface of the articular fossa of tibial condyles for reception of femoral condyles Mode of Injury Connects the posterior aspect of intercondyloid fossa of the tibia to the anterolateral aspect of the medial condyle of femur Prevents posterior displacement of the tibia on femur Mode of Injury Connects the anterior aspect of the intercondylar eminence of the tibia with the medial aspect of lateral femoral condyle Prevents anterior displacement of the tibia on femur Mode of Injury Attaches lateral femoral condyle to styloid process of fibula Maintains lateral stability by resisting valgus forces Attaches medial condyle of femur to medial condyle of tibia (medial meniscus attachment) Maintains stability by resisting valgus forces Patellofemoral (arthrodial)

Range of Motion (knee joint) Flexion: 135° Hyperextension: 0°-10° “Screw Home” = approx. 10° external rotation to align condyles With knee flexed 30° or more: 30° internal rotation & 45° external rotation

Movements Flexion Extension Internal Rotation External Rotation

Muscles Rectus Femoris Strengthening Stretching

Muscles Vastus Lateralis Strengthening Stretching

Muscles Vastus Intermedius Strengthening Stretching

Muscles Vastus Medialis Strengthening Stretching

Muscles Biceps Femoris Long head Short head Strengthening Stretching

Muscles Semitendinosus Strengthening Stretching

Muscles Semimembranosus Strengthening Stretching

Muscles Strengthening Stretching Gracilis

Muscles Sartorious Strengthening Stretching

Muscles Popliteus Strengthening Stretching

Q Angle (Quadriceps angle) Contribute to large Q angle: Wide hips (females) Genu valgum Pronation of feet Patellar subluxation Patella alta (high patella) Weak vastus medialis

Knee Deviations Genu Varum Genu Valgum Genu Recurvatum Condyle to malleoli relationship Relationship to pronation Strain on soft tissues Genu Valgum Condyle to malleoli relationship Relationship to pronation Strain on soft tissues Genu Recurvatum May be caused by: Equinus Hamstring weakness Quadriceps weakness

Torsion an internal twist of a bone on itself. Requires a force - counterforce. Types of torsion. (Distal part is the reference) Internal tibial External tibial Internal femoral External femoral Testing procedure Step #1: Determine that a torsion is present while subject is standing (patella and feet do not line up) Step #2: Have subject sit on table with feet dangling free. Femoral torsion: Feet point straight ahead Tibial torsion: Feet point out = external tibial torsion Feet point in = internal tibial torsion