BIOMECHANICS OF KNEE U.RADHAKRISHNAN.M.P.T.
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Transcript of BIOMECHANICS OF KNEE U.RADHAKRISHNAN.M.P.T.
BIOMECHANICS OF KNEE
U.RADHAKRISHNAN.M.P.T
Knee Joint produces Functional shortening and Lengthening of extremity
Knee complex plays a major role in supporting the body in Dynamic and Static situation
The Knee complex is composed of TIBIOFEMORAL JOINT PATELLOFEMORAL JOINT
INTRODUCTION
KNEE COMPLEX
ARTICULATION: ON DISTAL FEMUR------
Convex,Asymmetric,Medial and Lateral condyle
ON PROXIMAL TIBIA-------Concave,Asymmetric,Medial and Lateral Plateau
The FEMORAL CONDYLES are twice as large as length of TIBIAL CONDYLES
TIBIOFEMORAL JOINT
Fibrocartilaginous Joint Disc Medial and Lateral Menisci---asymmetric The two ends are called horns Coronary ligament attaches the Menisci to
Tibial plateau Transverse ligament joins the two Menisci Medial Menisci is more fixed and attached
to capsule and Medial collateral ligament. They are less mobile and prone to injury
MENISCI
MENISCUS
Stability & Mobility Function STABILITY: Deepens articular surface Keeps the joint surface tight Distribute the load MOBILITY: Reduces friction
FUNCTIONS OF MENISCI
Joint capsule encloses Tibiofemoral and Patellofemoral Joint.
It is large,lax,with many folds The deep folds of capsule forms the Bursae Suprapatellar Bursae Prepatellar Bursae Infrapatellar Bursae Subpopleteal Bursae Gastrocnemius Bursae
JOINT CAPSULE & BURSAE
BURSAE
INTRACAPSULAR LIGAMENT
ANTERIOR CRUCIATE LIGAMENT: Extends superiorly and posteriorly attached to posterior part of inner aspect of Lateral condyle of Femur.It is more prone for injury eg. Foot ball players
POSTERIOR CRUCIATE LIGAMENT: Extends superiorly and anteriorly to attach to anterior portion of inner aspect of Medial femoral condyle
LIGAMENTS
LIGAMENTS
LIGAMENTS
MEDIAL COLLATERAL LIGAMENT:(TIBIAL) Extends from medial Femoral condyle to
medial part of proximal Tibia,attaches with medial meniscus
LATERALCOLLATERALLIGAMENT:(FIBULAR) Extends from Lateral Femoral condyle to
head of Fibula
LIGAMENTS
LIGAMENTS
STABILITY LIGAMENTS MUSCLESMEDIAL STABILITY MEDIAL COLLATERAL SEMIMEMBRANOSUSLATERAL STABILITY LATERAL COLLATERAL POPLITEUS.IT BANDANTERIOR STABILITY ANTERIOR CRUCIATE QUADRICEPS,
PATELLAPOSTERIORSTABILITY POSTERIOR CRUCIATE BICEPS
FEMORIS,POPLITEUSANTEROMEDIAL MEDIAL
COLLATERAL,ANTERIOR CRUCIATE
QUADRICEPS
ANTERIOLATERAL LATERAL COLLATERAL,POSTERIOR CRUCIATE
POSTERIOR MEDIAL OBLIQUE POPLITEAL LIGAMENT
SEMIMEMBRANOSUS
POSTERIOR LATERAL ARCUATE POPLITEAL POPLITEUS
STABILITY OF KNEE
A Line runs along the shaft of the Femur and shaft of Tibia they form angle of 170 to 175 degree
When the angle is less than 165 degree an abnormal condition called GENU VALGUM,
The medial aspect of knee is subjected to distraction force
When the angle is more than 180 degree an abnormal condition called GENU VARUM
The medial aspect of knee is subjected to Increase compression loading
ANATOMIC AXIS
FLEXION- EXTENSION Saggital plane,Mediolateral axis
ROTATION Transverse plane,vertical axis
Flexion active range is 120 degree restricted by contact of posterior muscle,active insufficiancy
passive range is 130 degree
MOVEMENTS
During complete Extension, the Tibial tubercle locks in to intercondylar fossa of Femur, it is the closed packed position.
ROTATION: It is not possible when knee in full Extension
as ligaments are taught When Knee in 90 degree Flexion---- Rotation
is possible, Lateral rotation is 40 degree and Medial rotation is 30 degree
ABDUCTION can be done passively
MOVEMENTS
FLEXION AND EXTENSION: During Flexion from full Extension Femoral
condyles roll in an posterior direction with sliding anteriorly.In First part of Flexion consist of Rolling and spinning
During Extension from full Flexion Femoral condyles roll in an anterior direction with sliding posteriorly.In last few degrees of Extension Femoral condyles Roll and Spin on Tibia
Pure Rolling will move condyles out
ARTHROKINEMATICS
The spin of Femur in last few degree of Extension causes a Medial rotation of Femur on Tibia will keep joint in closed packed position, so Femoral rotation is called LOCKING or SCREW HOME MECHANISM.The Knee is Unlocked by Lateral rotation of Femur
In open Kinematic chain Tibia laterally rotates on Femur during last few degrees of Extension to produce LOCKING.Unlocking by Medial rotation.
LOCKING AND UNLOCKING
EXTENSORS
QUADRICEPS
The efficiency of Quadriceps depends on PATELLA,it increases the moment arm
Supports the body weight
Resist the force of gravity
MUSCLES
FLEXORS
HAMSTRINGS
Work more effectively in Knee if they are lengthened over a Flexed hip
MUSCLES
MEDIAL MENISCUS INJURY: More common,it is fixed, attached to
capsule ANTERIOR CRUCIATE LIGAMENT INJURY: More common in foot ball players GENU VALGUM/GENU VARUM PREPATELLAR BURSITIS: Inflammation of Prepatellar bursae,common
in workers who kneel and work
PROBLEMS OF TIBIOFEMORAL JOINT
MENISCUS INJURY
GENU VALGUM/GENU VARUM
BURSITIS OF KNEE
Patella is the largest sesamoid bone ARTICULATION: Patella is attached to the patellar surface on
distal Femur. During Flexion , from Full Extension patella
slides downwards and rest in intercondylar notch
During Extension,from Full Flexion patella slides upwards
PATELLO FEMORAL JOINT
ARTCULATING SURFACES
QUADRICEPS ANGLE( Q ANGLE ): The angle formed by resultant vector of
Quadriceps and the pull of ligamentum patella
It is found by drawing two lines 1.From ASIS to midpoint of Patella 2.From Tibial tubercle to midpoint of Patella The normal angle is 15 degree When the angle is large -----Lateral pull on
patella is increased.
Q ANGLE
Q ANGLE
PATELLA ALTA: High riding of patella(elevation),there is
lateral stress to patella and instability.
CONDROMALACIA PATELLA: Softening of articular cartilage of
Patellofemoral joint. Later stage fibrillation and thining of
cartilage occurs and subchondral bone exposed.
PROBLEMS OF PATELLOFEMORAL JOINT
PATELLA ALTA / CMP
PATELLAR DISLOCATION