1. Knee region
Bones
Joint
Muscles
Artery & Nerves

2. Knee osteology

3. Distal end of femur
Anterior

4. Distal end of femur
Posterior

5. Femur ant.
Femur post.

6. Medial
Lateral

8. Patella

9. Patella
Lateral is toward the right! So it is right.

10. Tibia Fibula Proximal Tibio-fibular joint No movement!
Distal Tibio-fibular joint

11. Tibia Proximal end

12. Anterior
Posterior

15. Tibiofemoral (knee) Joint

16. Largest and most complex joint
Actually 3 joints within a single synovial cavity:
Laterally: tibiofemoral joint
Medially: tibiofemoral joint
Intermediate: patellofemoral joint

19. Knee joint Menisci Medial meniscus lateral meniscus
Ligaments Cruciate ligaments Collateral ligaments Patellar ligament oblique popliteal ligament
Joint capsule Synovial membrane Fibrous membrane

20. Minisci : fibrocartilaginous ‘shock absorbers’

21. semilunar cartilages

22. Attachments

23. 1. The medial meniscus is more injured than the lateral meniscus, why?

24. Ligaments anterior cruciate ligament (ACL)
posterior cruciate ligament (PCL)
medial collateral ligament (MCL, tibial collateral ligament)
lateral collateral ligament (LCL , fibular collateral ligament)
oblique popliteal ligament
ligamentum patellae

25. Cruciate ligaments
ACL: Anteromedial part of the intercondylar area of tibia to inner aspect of lateral condyle of femur.
PCL: Posterolateral part of the intercondylar area of the tibia to inner aspect of medial condyle of femur.

26. Anterior Cruciate ligament prevents anterior displacement of the tibia in relation to femur in flexion.

27. Posterior Cruciate ligament prevents posterior displacement of the tibia in relation to femur in extension.

28. How to test ACL and PCL?
Drawer sign test

29. Anterior Drawer Test for ACL
Physician Position & Movements
Patient Position
*Patient Position
Supine
Flex hip of affected knee to 45 degrees
Bend knee to 90 degrees
Patient's foot planted firmly on examination table
Physician position:
Sitting on dorsum of foot, place both hands behind knee
Once hamstrings relaxed, try to displace proximal leg anteriorly
Anterior drawer test is LESS SENSITIVE for ACL damage than Lachman’s Maneuver
Note direction of forces

30. Posterior Drawer Testing- PCL
*Patient Position
Supine
Affected knee at 90 degrees of flexion
Determine ‘neutral’ position by comparing resting position with unaffected knee
Physician Position & Movements
Patient's foot placed between examiner's legs while the palms of the hands are used to push the tibia posteriorly.
Tester directs pressure backward upon proximal tibia, similar to Anterior Drawer Testing
Interpretation of test:
Posterior instability - PCL injury indicated by increased posterior tibial translation
Confusion - trying to distinguish abnormal translation of tibia on femur - from excessive ACL or PCL laxity
Note direction of forces

31. Collateral ligaments

33. MCL attaches to the medial meniscus

34. 2. The medial meniscus is more injured than the lateral meniscus, why?

35. Collateral ligaments action
Protect the knee joint from bending side to side.
Helps the locking mechanism

36. 3. The medial meniscus is more injured than the lateral meniscus, why?

37. Locking mechanism: less energy to maintain the standing position
Medial rotation of femur on the tibia during full extension tighten colateral ligaments.

38. Locking mechanism (2)
Joint surfaces become larger and more stable in extension.

39. Locking mechanism (3)
body's center of gravity is positioned along a vertical line that passes anterior to the knee joint.

40. Locking mechanism

41. Collateral ligaments test

42. Test for MCL Note Direction Of Forces *VALGUS (MCL) stress
Proximal hand on lateral aspect of knee holds and stabilizes thigh
Distal hand directs ankle laterally
Attempt to open knee joint on medial side
Estimate the medial joint space and evaluate the stiffness of motion. Positive test = Significant gap in medial aspect of knee with valgus stress = MCL injury.
Laxity is graded on a 1 to 4 scale: 1+, 5mm of medial joint space opening with a firm but abnormal endpoint; 2+, 10mm medial opening with a soft endpoint; 3+ (15mm) and 4+ (20mm) may be indicative of an associated cruciate ligament injury and must be carefully examined.
Note Direction Of Forces

43. Test for LCL Note direction of forces *VARUS (LCL) Stress
Supine position, with knee at 20 to 30 degrees of flexion and thigh supported.
Stabilize medial aspect of knee and push ankle medially, trying to open knee joint on lateral side
Disruption of LCL is indicated by difference in degree of lateral knee tautness with varus stress. Compare affected knee to uninjured side
Note direction of forces

44. Strengthening Anterior Aspect of Knee Joint
Patellar ligament
Strengthening Anterior Aspect of Knee Joint

45. Patellofemoral stress syndrome
“Runner’s Knee”
Patella does not glide up and down but rather laterally causing pain.

46. oblique popliteal ligament

47. Review (1) patellar ligament (2) tibial (medial) collateral ligament
(3) fibular (lateral ) collateral ligament
(4) medial meniscus
(5) lateral meniscus
(6) anterior cruciate ligament
(7) posterior cruciate ligament

48. Joint fibrous capsule

49. Joint synovial membrane

51. Bursa
little fluid sacs that helps the muscles and tendons slide freely: Prepatellar Infrapatellar Suprapatellar

52. Bursa

53. Prepatellar Bursitis