-: Introduction :--: Introduction :-

Tibiofemoral jointTibiofemoral joint

Patellofemoral jointPatellofemoral joint

Structure of the tibiofemoral joint.Structure of the tibiofemoral joint.

Type – Double condyloidType – Double condyloid

Articulating surface Articulating surface

Femur

Tibia

Tibio femoral alignment and weight-bearing forces

Mechanical Axis

Medial valgus angle

Anatomic axis

Genu Valgus

Genu Varus

Menisci

Menisci Attachement

Role of the menisci

Menisci nutrition

Menisci innervation

-: Joint capsule :-

Attachments

Synovial layer of the joint capsule

Fibrous layer of the joint capsule

-: Ligaments of knee joint :--: Ligaments of knee joint :-

Medial collateral ligament

Lateral collateral ligament

Ant. Cruciate ligament

Post. Cruciate ligament

Medial collateral ligamentMedial collateral ligamentSuperficial portion ->Superficial portion -> origin -: medial origin -: medial femoral epicondylefemoral epicondyle

Insertion -: med. Aspect of Insertion -: med. Aspect of proximal tibiaproximal tibiaRestrain to excessive Restrain to excessive abduction (valgus)&lat. abduction (valgus)&lat. Rotation stresses at kneeRotation stresses at kneeDeep portion->Deep portion-> Origin-: inf. Aspect of Origin-: inf. Aspect of med. Femoral condylemed. Femoral condyleInsetion-:proximal Insetion-:proximal aspect of med. Tibiaaspect of med. Tibia

-: Lateral collateral ligament :--: Lateral collateral ligament :- Lat. Side of Lat. Side of

tibiofemoral jointtibiofemoral joint

Proximally from lat. Proximally from lat. Femoral condyleFemoral condyle

Fibular headFibular head where it joins with where it joins with

tendon of biceps tendon of biceps femoris femoris

Responsible for Responsible for checking varus checking varus stresses stresses

-: Anterior Cruciate ligament :--: Anterior Cruciate ligament :- Attached to ant. Attached to ant.

Tibial spineTibial spine

sup and post. sup and post. attached to attached to posteromedial posteromedial aspect of lat. aspect of lat. Femoral condyleFemoral condyle

Anteromedial bandAnteromedial band Posterolateral band Posterolateral band

-: Posterior cruciate ligament :--: Posterior cruciate ligament :- Attached distally to the Attached distally to the

posterior tibial spine & posterior tibial spine & Anteriorly attached to Anteriorly attached to lat. Aspect of med. lat. Aspect of med. Femoral condyle Femoral condyle

restrain post. restrain post. Displacement Displacement

1. prevent Excessive knee extension 1. prevent Excessive knee extension

-: Role of ligaments :--: Role of ligaments :-

3. prevent ant. &post. Displacement of tibia med.&lat.3. prevent ant. &post. Displacement of tibia med.&lat. Rotation beneath the femur-both together called Rotation beneath the femur-both together called rotatery stabilization of tibiarotatery stabilization of tibia

2.Varus & valgus stresses at 2.Varus & valgus stresses at kneeknee

-: Iliotibial band :--: Iliotibial band :- Proximally fascia investing Proximally fascia investing TFL,TFL,

gluteus maximus &medius musclegluteus maximus &medius muscle Distally atteched intermuscular Distally atteched intermuscular

septum &inserted anterolateral septum &inserted anterolateral tibia tibia

Contraction of tfl &gluteus muscle Contraction of tfl &gluteus muscle attach to it band –produce attach to it band –produce minimal longitudinal excursion of minimal longitudinal excursion of band band

Fibrous connection of it band -Fibrous connection of it band -assisted assisted ACLACL------}checking ------}checking posterior femoral translation –full posterior femoral translation –full extension extension

Increase the stability of lat. Side Increase the stability of lat. Side of joint of joint

-: Bursae :--: Bursae :- Set up potential for substantial Set up potential for substantial

frictional among muscular,bony frictional among muscular,bony structure,structure,

numerous bursanumerous bursa

Three type Three type 1.Suprapatellar bursae1.Suprapatellar bursae 2.Subpopliteal “2.Subpopliteal “ 3.gastrocnemius “3.gastrocnemius “ Infrapatellar bursae….It Infrapatellar bursae….It

separated by synovial cavity of separated by synovial cavity of jt by infrapatellar fat padjt by infrapatellar fat pad

-: TIBIOFEMORAL JOINT -: TIBIOFEMORAL JOINT FUNCTION :-FUNCTION :-

JOINT KINEMATICSJOINT KINEMATICS

Flexion / ExtensionFlexion / Extension Medial / Lateral Medial / Lateral

RotationRotation Varus / ValgusVarus / Valgus Coupled MotionsCoupled Motions

-: MUSCLES :--: MUSCLES :-

Knee Flexor GroupKnee Flexor Group

SemimembranosusSemimembranosus SemitendinosusSemitendinosus Biceps Femoris (Long and short heads)Biceps Femoris (Long and short heads) SartoriusSartorius GracilisGracilis PopliteusPopliteus GastrocnemiusGastrocnemius

Knee Extensor GroupKnee Extensor Group

Quadriceps FemorisQuadriceps Femoris

Rectus FemorisRectus Femoris Vastus MedialisVastus Medialis Vastus IntermediusVastus Intermedius Vastus LateralisVastus Lateralis

-: STABILIZERS OF KNEE :--: STABILIZERS OF KNEE :-

A-P/hyperextension stabilizersA-P/hyperextension stabilizers

Varus / Valgus stabilizersVarus / Valgus stabilizers

Internal / External rotational Internal / External rotational stabilizersstabilizers

Largest sesamoid bone.

Its function is to increase leverage of quadriceps muscle.

Patella is triangular with apex directed downwards

Anterior surface of the patella is gently convex

The joint surfaces are not very congruent. Upper3/4th part of the posterior surface is articular

Articular surface has a convex medial facet and a concave lateral facet

-: Anatomy of the patella :-

Patellar articular surface area & joint congruency

In knee extension

At mid range of flexion

At 90 degree of flexion

Beyond 90 degree of flexion

-: Motions of patella :-

1.Patellar flexion

2.Patellar extension

3.Medial patellar tilt

4.Lateral patellar tilt

5.Medial rotation

6.Lateral rotation

7.Patellar translation

8.Patellar shift

-: Patellofemoral joint stress :-Patellofemoral joint reaction

force in1.Knee flexion

2.Knee extensionInfluence of amount of

knee flexion and contact surface between patella and femurJoint reaction forces in daily living activity

Patella as anatomical pulley

Contact forces in vertical position of patella

Frontal plane patellofemoral joint stability

1.Longitudinal stabilizers

2.Transverse stabilizers

Quadriceps inhibition

Asymmetry of patellofemoral stabilization

stabilizers

No bony stabilization

1.Longitudinal stabilizers

Quadriceps and patellar tendon ( patellotibial tendon )

2.Transverse stabilizers

Superior portion of extensior retinaculum

Vastus lateralis and medialis

Medial and lateral patellofemoral ligament

Trochlear dysplasia

Stabilizers

Quadriceps inhibition

Patellar tendon injury

Quadriceps atrophy

VMO weakness

Limiting motion of patella

Asymmetry of Asymmetry of patellofemoral stabilizationpatellofemoral stabilization

Q- angle

Defination

In male and female

Problem with Q-angle

Another abnormalities

-: Weight bearing versus Non-weight bearing exercises with Patellofemoral pain :-

Effects of injury and diseaseTibiofemoral joint injury

Patellofemoral joint injury

Injury to menisci

Injury to Ligament

Injury to Bone

Patellar dislocaltion

Causes of patellar dislocation