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7/28/2013
The Knee
Clarification of Terms
 The knee consists of:
 The tibiofemoral joint
 Patellofemoral joint
Mansfield, p273
Osteology of the Knee
 Distal Femur
 Proximal tibia and fibula
 Patella
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Osteology of the Knee
Distal femur
(ADDuctor tubercle)
Right Femur
Osteology of the Knee
The proximal tibia & fibula
The medial and lateral
condyles of the tibia form the
shallow articulations with the
distal femur
Fibular
Head
Tibial
Tuberosity
The intercondylar/intercondyloid
eminence
the attachment point for the
cruciate ligaments
Interosseous
Membrane
Osteology of the Knee
Patella
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What can you palpate?
What can you NOT palpate?
Joint Structure
 Tibiofemoral Joint
 Articulation between the large condyles of the distal
femur and the relatively flat proximal tibia
 Patellofemoral Joint
 Articulation between the patella and distal femur
Mansfield, p273
Joint Structure: Alignment
Genu valgum refers to a
frontal deviation of the
position of the knee.
Commonly referred to as
“knock-knee” due to the
distal segments being
positioned more laterally
than normal
Genu varum refers to a
frontal deviation of the
position of the knee.
Commonly referred to as
“bow-leg” is the
opposite.
Lippert, p294 & Mansfield, p278
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Joint Structure: Alignment
Genurecurvatum:
Hyperextension of the tibiofemoral joint placing
excessive stress on the structures in the popliteal
space
Tibial nerve
Popliteal Vein
Popliteal Artery
Common Peroneal Nerve
Joint Structure: Alignment
Q Angle
* angle between the quadriceps
muscle and the patellar tendon
* draw a line from the ASIS to
the midpoint of the patella and
from the tibial tuberosity to the
midpoint of the patella
* tends to be greater in females
due to wider pelvis
Lippert, p285
Joint Movement
 Tibiofemoral Joint:
 Osteokinematics:
 flexion, extension
 Arthrokinematics:
 Open chain =
 Closed chain =
 (hint: convex distal femoral condyles and concave proximal
tibial plateau)
Lippert, p284 & Mansfield, p284
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Joint Movement
 Patellofemoral Joint
 Osteokinematics
 n/a
 Arthrokinematics
 The smooth posterior surface of the patella glides over the
femur
 It glides and tilts in all 4 directions
Lippert, p285
Supporting Structures




ACL & PCL (Sagittal plane stability)
MCL & LCL (Frontal Plane stability)
Posterior capsule
Medial and lateral menisci
Supporting Structures
Anterior Cruciate Ligament
(ACL)
 Keeps femur from moving
posteriorly on tibia and from
tibia from moving anteriorly on
femur
 Tightens during extension,
preventing hyperextension
Posterior Cruciate Ligament
(PCL)
 Keeps femur from moving
anteriorly on tibia and from
tibia from moving posteriorly
on femur
 Tightens during flexion
Lippert, p288
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Supporting Structures: ACL & PCL
Supporting Structures
Medial Collateral Ligament
(MCL)
 Flat broad ligament attaching
the medial condyles of femur
and tibia
 It protects the joint from
stresses to the ____________
side of the knee.
Lateral Collateral Ligament
(LCL)
 Round, cordlike ligament
attaching from lateral femoral
condyle to fibular head
 It protects the joint from
stresses to ____________ side
of the knee.
Lippert, p288
Supporting Structures: MCL & LCL
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Supporting Structures
 Posterior Capsule:
 Prevents hyperextension of the knee
Mansfield, p282
Lippert, p288
Supporting Structures
 Medial and lateral menisci





Two half-moon, wedge-shaped fibrocartilage disks
Located on the superior surface of the tibia
Designed to absorb shock
Thicker laterally than medially
Proximal surfaces are concave, deepening the relatively
flat joint surface of the tibia
Knee Structure
 Popliteal Space
 Area behind the knee containing
important nerves (tibial and common
peroneal) and blood vessels
(popliteal artery and vein)
 Diamond shaped fossa
 Bound superiorly by semitendinosus
and semimembranosus on the medial
side and biceps femoris on lateral
side.
 Bound inferiorly by the medial and
lateral heads of the gastrocnemius
Lippert, p288
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Myology
 Muscles of the Knee
Area
Mono-articular
Muscle
Bi-articular Muscle
Anterior
Vastus Lateralis
Rectus Femoris
Vastus Medialis
Vastus Intermedialis
Posterior
Biceps femoris
(short)
Biceps femoris
(long)
Popliteus
Semimembranosus
Semitendinosus
Gastrocnemius
Medial
Sartorius
Gracilis
Lateral
Tensor Fascia Latae
Lippert, p290
Myology of the Knee
Your
subtopic
goes here
Rectus
Femoris
Origin
Anterior-inferior iliac spine
Insertion
Tibial tuberosity via the quadriceps
tendon
Innervation
Femoral n.
Action
Hip flexion, knee extension
“tidbit”
One of the heads of the “quads”
Lippert, p291
Myology of the Knee
Vastus Medialis
Origin
linea aspera
Insertion
Tibial tuberosity via the
patellar tendon
Innervation
Femoral n.
Action
Knee extension
“tidbit”
•One of the heads of the
“quad”
•“VMO” one of the first
muscles of the knee to atrophy
post-operatively,
• responsible for last 10-15o of
knee extension
Vastus
Medialis
Obliquus
Lippert, p291
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Myology of the Knee
Vastus Lateralis
Origin
Linea aspera,
Insertion
Tibial tuberosity via the
patellar tendon
Innervation
Femoral n.
Action
Knee extension
“tidbit”
Part of the “quads”
Lippert, p291
Myology of the Knee
Vastus Intermedialis
Origin
Upper 2/3 of the anterior
femoral shaft
Insertion
Tibial tuberosity via the patellar
tendon
Innervation
Femoral n.
Action
Knee extension
intermedialis
Lippert, p291
Myology of the Knee
Your
subtopic
goes here
Biceps
Femoris
Origin
Ischial tuberosity
Insertion
Head of the fibula
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion
“tidbit”
One of the hamstrings
A
Bicep F
B
Bicep F
A
C
D
Semimem
Semiten
Lippert, 292
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Myology of the Knee
Your
subtopic goes here
Semimembranosus
Origin
Ischial tuberosity
Insertion
Medial condyle of the tibia, posterior aspect
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion
“tidbit”
One of the hamstrings
Lippert, p291
Myology of the Knee
Your
subtopic goes here
Semitendinosus
Origin
Ischial tuberosity
Insertion
Proximal-medial surface of the tibia
(pes anserinus)
Innervation
Tibial portion of the sciatic n.
Action
Hip extension, knee flexion,
“tidbit”
One of the hamstrings
Lippert, 292
Myology of the Knee
Popliteus
Origin
Posterior aspect of the
lateral femoral condyle
Insertion
Posterior surface of the
proximal tibia
Innervation
Tibial n.
Action
Initiates knee flexion
Lippert, 292
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Myology of the Knee
Gastrocnemius
Origin
Medial head: posterior aspect of the
medial femoral condyle
Lateral head: posterior aspect of the
lateral femoral condyle
Insertion
Calcaneal tuberosity via the Achilles
tendon
Innervation
Tibial n.
Action
Flexion of the knee, plantar flexion,
Lippert, 293
Myology of the Knee
Your
subtopic goes here
Sartorius
Origin
ASIS
Insertion
Proximal-medial surface of the tibia (via
the pes anserinus)
Innervation
Femoral n.
Action
Hip flexion, hip ABD, Hip ER, knee
flexion
“tidbit”
Longest muscle in the body
Biel, p326
Myology of the Knee
Your
subtopic goes here
Gracillis
Origin
Body and inferior ramus of the
pubis
Insertion
Proximal-medial aspect of the
tibia (pes anserinus)
Innervation
Obturator n.
Action
Hip ADD, hip flexion, knee
flexion
Biel, p321
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Myology of the Knee
Tensor Fascia Latae
Origin
Iliac crest, posterior to ASIS
Insertion
Iliotibial tract
Innervation
Superior Gluteal Nerve
Action
Hip flexion, ABD, internal
rotation
Biel, p324
Myology
 Prime Movers of the Knee:
 Extension:
 Quadriceps group
 Flexion:
 Hamstring group
 Popliteus
 gastrocnemius
Lippert, p294
Myology
 Summary of Muscle Innervation:
Muscle
Nerve
Rectus femoris
Femoral
Vastus lateralis
Femoral
Vastus intermedialis
Femoral
Vastus medialis
Femoral
Semimembranosus
Sciatic
Semitendinosus
Sciatic
Biceps femoris – long head
Sciatic
Biceps femoris – short head
Common Peroneal
Popliteus
Tibial
gastrocnemius
Tibial
Lippert, p295
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Common Knee Pathology








Genu Valgum
Genu Varum
Genu Recurvatum
Patellar Tendonitis
Osgood-Schlatter Disease
Patellofemoral Pain Syndrome
Chondromalacia Patella
Unhappy Triad
Genu Valgum and Varum
Lippert, p294
Genu Recurvatum
Lippert, p294
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Osgood-Schlatter
Lippert, p294
Chondromalacia Patella
Lippert, p294
Unhappy Triad
Lippert, p294
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Pin the Tail on the Donkey
 Point to the location of the…
 Knee extensors
 Knee flexors
References
 Biel, A., (2010). Trail Guide to the Body, 4th ed.
Boulder, CO: Books of Discovery.
 Lippert, L.S. (2011). Clinical Kinesiology and Anatomy,
5th ed. Philadelphia, PA: F.A. Davis.
 Mansfield, P.J., & Neumann, D.A. (2009). Essentials of
Kinesiology for the Physical Therapist Assistant. St.
Louis, MO: Mosby Elsevier.
15