The Knee

Joint
DISCLAIMER:
• The presentation includes some descriptions taken from google
images or books.
• Some of the contents are for educational purposes and not claim of
ownership
Description
• The knee joint (also known as
tibiofemoral Joint) is a hinge
type synovial joint, which permits
flexion and extension and to a
lesser extent medial and lateral
rotation.
• It is formed by articulations
between the patella, femur and
tibia.
 Articular surfaces
There are two articular surfaces in the knee joint. They
are: tibiofemoral and patellofemoral. These surfaces
are are lined with hyaline cartilage and are enclosed
within a single joint cavity.
• Tibiofemoral – medial and lateral condyles of the
femur articulate with the tibial condyles. It is the
weight-bearing component of the knee joint.
• Patellofemoral – anterior aspect of the distal femur
articulates with the patella. It allows the tendon of
the quadriceps femoris (knee extensor) to be
inserted directly over the knee – increasing the
efficiency of the muscle.
• The patella provides a fulcrum to increase power of
the knee extensor and serves as a stabilising
structure that reduces frictional forces placed on
 Menisci
• There are two menisci in the knee joint- the medial
and lateral menisci. The menisci are C shaped and
attached at both ends to the intercondylar area of
the tibia.
• The medial meniscus is fixed to the tibial collateral
ligament and the joint capsule and so any damage to
the tibial collateral ligament results in a medial
meniscal tear.
• The lateral meniscus is smaller and does not have any
extra attachments, rendering it fairly mobile.
• The two menisci are fibrocartilage in nature and are
there to :

1. To deepen the articular surface of the tibia, thus

increasing stability of the joint.
2. To act as shock absorbers by increasing surface area
to further dissipate forces.
 Bursae
• A bursa is aimed at reducing wear and tear on those
structures where they are located. It is a synovial fluid
filled sac between moving structures in a joint.
• There are four bursae found in the knee joint:
• Suprapatellar bursa – an extension of the synovial cavity
of the knee, located between the quadriceps femoris and
the femur.
• Prepatellar bursa – found between the apex of the patella
and the skin.
• Infrapatellar bursa – split into deep and superficial
(subcutaneous). The deep bursa lies between the tibia and
the patella ligament. The superficial lies between the
patella ligament and the skin.
• Semimembranosus bursa – located posteriorly in the knee
joint, between the semimembranosus muscle and the
medial head of the gastrocnemius.
 Ligaments
• There are three major ligaments in the knee joint: patellar, collateral
and cruciate ligaments
• Patellar ligament – a continuation of the quadriceps femoris tendon
distal to the patella. It attaches to the tibial tuberosity.
• Collateral ligaments – there are two types of collateral ligaments and
they act to stabilise the hinge motion of the knee, preventing
excessive medial or lateral movement
• Tibial (medial) collateral ligament – wide and flat ligament, found on the
medial side of the joint. Proximally, it attaches to the medial epicondyle of the
femur, distally it attaches to the medial condyle of the tibia.
• Fibular (lateral) collateral ligament – thinner and rounder than the tibial
collateral, this attaches proximally to the lateral epicondyle of the femur,
distally it attaches to a depression on the lateral surface of the fibular head.
 Ligaments
• Cruciate Ligaments – these two ligaments
connect the femur and the tibia. In doing so,
they cross each other, hence the term
‘cruciate’ (Latin for like a cross)
• Anterior cruciate ligament – attaches at the
anterior intercondylar region of the tibia where it
blends with the medial meniscus. It ascends
posteriorly to attach to the femur in the
intercondylar fossa. It prevents anterior
dislocation of the tibia onto the femur.
• Posterior cruciate ligament – attaches at the
posterior intercondylar region of the tibia and
ascends anteriorly to attach to the anteromedial
femoral condyle. It prevents posterior dislocation
of the tibia onto the femur.
Movements at the knee joint
There are four main movements that the knee joint permits:

• Extension: Produced by the quadriceps femoris, which

inserts into the tibial tuberosity.
• Flexion: Produced by the hamstrings, gracilis, sartorius and
popliteus.
• Lateral rotation: Produced by the biceps femoris.
• Medial rotation: Produced by five muscles;
semimembranosus, semitendinosus, gracilis, sartorius and
popliteus.
Clinical correlates
Collateral Ligaments
• Injury to the collateral ligaments is the most common. It is caused by a force being applied to the side of the
knee when the foot is placed on the ground.
• Damage to the collateral ligaments can be assessed by asking the patient to medially rotate and laterally rotate
the leg. Pain on medial rotation indicates damage to the medial ligament, pain on lateral rotation indicates
damage to the lateral ligament.
• If the medial collateral ligament is damaged, it is more than likely that the medial meniscus is torn, due to their
attachment.
Cruciate Ligaments
• The anterior cruciate ligament (ACL) can be torn by hyperextension of the knee joint, or by the application of a
large force to the back of the knee with the joint partly flexed.
• The most common mechanism of posterior cruciate ligament damage is the ‘dashboard injury’. This occurs
when the knee is flexed, and a large force is applied to the shins, pushing the tibia posteriorly. This is often
seen in car accidents, where the knee hits the dashboard. The posterior cruciate ligament can also be torn by
hyperextension of the knee joint, or by damage to the upper part of the tibial tuberosity.
Bursitis
• Friction between the skin and the patella cause the prepatellar bursa to become inflamed, producing a
swelling on the anterior side of the knee. This is known as housemaid’s knee.
• Similarly, friction between the skin and tibia can cause the infrapatellar bursae to become inflamed, resulting
in what is known as clergyman’s knee (classically caused by clergymen kneeling on hard surfaces during
prayer).
 Popliteal fossa
• It is a depression
• Posterior to the knee
• Diamond in shape
 Description
• The popliteal fossa is
a diamond shaped
area located on the
posterior aspect of
the knee. It is the
main path by which
vessels and nerves
pass between the
thigh and the leg.
 Borders
• The popliteal fossa has four borders.
These borders are formed by the
muscles in the posterior compartment
of the leg and thigh:
• Superomedial border –
semimembranosus.
• Superolateral border – biceps femoris.
• Inferomedial border – medial head of
the gastrocnemius.
• Inferolateral border – lateral head of
the gastrocnemius and plantaris.
The floor and roof
The floor of the popliteal fossa is formed by:
• the posterior surface of the knee joint capsule,
• popliteus muscle and
• posterior femur.
The roof is made of up two layers:
• popliteal fascia (is continuous with the fascia lata of the leg) and
• skin
Popliteal region
(superficial)

1- Greater saphenous vein

(medially)
2- Saphenous nerve
(medially)
3- Small saphenous vein
4- Medial sural cutaneous
nerve
5- Branches of post.
femoral cutaneous N.
 Contents
The popliteal fossa is the main conduit for neurovascular
structures entering and leaving the leg. Its contents are
(medial to lateral):
• Popliteal artery
• Popliteal vein
• Tibial nerve
• Common fibular nerve (common peroneal nerve)
The tibial and common fibular nerves are the most
superficial of the contents of the popliteal fossa. They
are both branches of the sciatic nerve. The common
fibular nerve follows the biceps femoris tendon,
travelling along the lateral margin of the popliteal fossa.
• The small saphenous vein pierces the popliteal fascia
and passes between the two heads of gastrocnemius
to empty into the popliteal vein.
• In the popliteal fossa, the deepest structure is
the popliteal artery. It is a continuation of the femoral
artery, and travels into the leg to supply it with blood.
 Clinical Correlates
Baker’s Cyst
• A Baker’s cyst (popliteal cyst) refers to the inflammation and swelling of
the semimembranosus bursa – a fluid filled sac found in the knee joint. It
usually arises in conjunction with osteoarthritis of the knee.
Popliteal aneurysm
An aneurysm is a dilation of an artery, which is greater than 50% of the
normal diameter. The popliteal fascia (the roof of the popliteal fossa)
is tough and non-extensible, and so an aneurysm of the popliteal artery has
consequences for the other contents of the popliteal fossa.
The tibial nerve is particularly susceptible to compression from the popliteal
artery. The major features of tibial nerve compression are:
1. Weakened or absent plantar flexion
2. Paraesthesia of the foot and posterolateral leg