Chapter 9

Knee Joint
 Knee Joint

• Largest diarthrodial
joint in body

• Primarily a hinge joint

Jump to The Knee Joint, Appendix

 Bones
Enlarged femoral condyles
articulate on enlarged tibial
condyles

Top of medial & lateral

tibial condyles or medial
& lateral tibial plateaus

• Receptacles for femoral

condyles
 Bones
Tibia: medial
• Bears most of body
weight

Fibula: lateral
• Serves as attachment
for knee joint structures

• Does not articulate c/

femur or patella

• Not part of knee joint

 Bones
Patella

• Sesamoid / Floating bone

• Imbedded in quadriceps & patellar tendon

• Similar to a pulley
• Creates improved angle of pull resulting in greater
mechanical advantage in knee extension
Bones
 Bones

Three vasti muscles of quadriceps originate on

proximal femur & insert on superior pole of patella

• Insertion is ultimately on tibial tuberosity via the

large patella tendon

Iliotibial Tract of Tensor Fasciae Latae inserts on

Gerdy’s Tubercle
 Bones
• Sartorius, Gracilis, & Semitendinosus insert below
medial condyle on upper anteromedial tibial surface

• Semimembranosus inserts posteromedially on the

medial tibial condyle

• Biceps Femoris inserts on the fibular head

• Popliteus originates on the lateral aspect of lateral

femoral condyle
 Bones

• Tibial Collateral Ligament originates on

medial aspect of upper medial femoral
condyle & inserts on medial tibial surface

• Fibula Collateral originates on lateral

femoral condyle & inserts on fibular head
 Joints
• Ligaments provide static stability
• Quadriceps & hamstrings contractions produce dynamic
stability
• Articular cartilage protects surfaces on femur & tibia
 Joints

Menisci form cushions btw/ bones

• Attached to tibia
• Deepen tibial plateaus
• Enhance stability

Medial Meniscus forms a receptacle for medial femoral

condyle, & Lateral Meniscus receives the lateral femoral
condyle
 Menisci
• Can slip about slightly & are held in place by various
small ligaments

• Medial Meniscus: Larger & more open C appearance

• Lateral Meniscus: Closed C configuration

 Menisci
Either or both menisci may be torn in several different
areas from a variety of mechanisms, resulting in
varying degrees of problems

• Tears often occur due to significant compression &

shear forces during knee rotation
 Joints
Anterior & Posterior Cruciate Ligaments

• Cross within knee btw/ tibia & femur

• Maintaining anterior & posterior stability, as well as rotatory

stability

• Anterior Cruciate Ligament (ACL) Injury

• One of most common serious injuries to knee
• Disrupted by hyperextension or violent quadriceps
contraction, pulls tibia forward on femur
 Joints
Anterior & Posterior Cruciate Ligaments

Posterior Cruciate Ligament (PCL)

• Not often injured
 Joints
Fibular / Lateral Collateral Ligament (LCL)
• Infrequently injured

Tibial / Medial Collateral Ligament (MCL)

• Maintains medial stability by resisting valgus forces
or preventing knee joint abduction
 Joints
• Injuries occur commonly, in contact or collision sports
• Ex: Person may fall against another’s lateral aspect of knee or
leg, causing medial opening of knee joint &/or external
rotation resulting in stress to medial ligamentous structures
 Joints
Synovial Cavity

• Supplies knee joint c/ synovial fluid

• Lies under the patella & btw/ the surfaces of the

tibia & femur

• Called capsule of the knee

 Joints
Infrapatellar Fat Pad

• Lies posterior to patellar tendon

• Insertion point for synovial folds of tissue known as

“plica”

• An anatomical variant may be irritated or inflamed c/

injuries or overuse of knee
 Joints

Bursae

• >10 bursae located

around knee

• Some are connected to

synovial cavity

• Absorb shock or reduce

friction
 Muscles

Quadriceps Muscle Group

• Extends knee
• Located in anterior
compartment of thigh

• Consists of 4 Muscles
• Rectus Femoris
• Vastus Lateralis
• Vastus Intermedius
• Vastus Medialis Jump to Muscles, 1, Appendix
 Muscles
Q Angle

• Central line of pull for entire

quadriceps

• Runs from anterior superior iliac

spine to center of patella

• Line of pull of patella tendon runs

from center of patella to center
of tibial tuberosity

• Angle formed by intersection

of these two lines at patella Jump to Muscles, 2, Appendix
is Q angle
 Q Angle

• Normally, angle will be 15

degrees or less for males & 20
degrees or less for females

• Generally, females have higher

angles due to a wider pelvis

Jump to Muscles, 3, Appendix

 Q Angle

Higher Q angles generally predispose people, in

varying degrees, to a variety of potential knee
problems, including lateral patellar subluxation or
dislocation, patellar compression syndrome,
chondromalacia, & ligamentous injuries
 Muscles
Hamstring Muscle Group

• Responsible for knee flexion

• Posterior compartment of thigh

• Consists of 3 muscles
• Semitendinosus: medial & rotates internally
• Semimembranosus: medial & rotates internally
• Biceps Femoris: lateral & rotates externally

• Popliteus muscle assists medial hamstrings in internal rotation

of knee
 Muscles
Two-Joint Muscles

• Most effective when either origin or insertion is

stabilized to prevent movement in the direction of
the muscle when it contracts

• All hamstring muscles, as well as rectus femoris, are

biarticular or two-joint muscles
 Pes Anserinus

Gracilis, Sartorius, & Semitendinosus join together

distally to form Pes Anserinus

• Attaches to anteromedial aspect of the proximal tibia

below the level of tibial tuberosity

• Attachment & posteromedial line of pull enable them

to assist c/ knee flexion, particularly once knee is
flexed & hip is externally rotated
 Muscles

Knee Joint Muscles

• Anterior: Primarily Knee Extension

• Rectus Femoris, Vastus Medialis,
Vastus Intermedius, & Vastus
Lateralis

Jump to Muscles, 9, Appendix

 Muscles

Knee Joint Muscles

Posterior: Primarily Knee Flexion

• Biceps Femoris
• Semimembranosus
• Semitendinosus Pes Anserinus

• Sartorius
• Gracilis
• Popliteus
• Gastrocnemius
Jump to Muscles, 10, Appendix
 Quadriceps Muscles

Rectus Femoris, Vastus Medialis, Vastus Intermedius,

& Vastus Lateralis

• All attach to patella & to the tibial tuberosity via the

patellar tendon

• All are superficial & palpable, except vastus

intermedius, which is under rectus femoris
 Quadriceps Muscles

• Strength or power may be indicated by vertical jump

test

• Generally desired to be 25% to 33% stronger than

the hamstring muscle group

• Quads are particularly prone to atrophy when

injuries occur
 Quadriceps Muscles
• May be developed by resisted knee extension
activities from a seated position

• Functional weight-bearing activities such as step-ups

or squats are particularly useful for strengthening &
endurance
 Rectus Femoris Muscle

• Flexion of hip

• Extension of knee

• Anterior pelvic rotation

 Vastus Lateralis Muscle

Extension of knee
 Vastus Intermedius Muscle

Extension of knee
 Vastus Medialis Muscle

Extension of knee
 Hamstring Muscles

Hamstring Muscle Group

• Semitendinosus
• Biceps Femoris
• Semimembranosus

Jump to Hamstring Muscles, 1, Appendix

 Hamstring Muscles

• Strains very common

• Referred to as running muscles bc/ of its function in

acceleration

• Antagonists to quadriceps muscles at the knee

• Named for their cordlike attachments at the knee

 Hamstring Muscles

• All originate on the ischial tuberosity of the pelvic

bone

• Semitendinosus inserts on the anteromedial side of

tibia, & semimembranosus inserts on the
posteromedial side of tibia

• Biceps femoris inserts on lateral tibial condyle & head

of fibula
 Semitendinosus Muscle

Flexion of knee

Extension of hip

Internal rotation of hip

Internal rotation of knee

Posterior pelvic rotation

 Semimembranosus Muscle

Flexion of knee

Extension of hip

Internal rotation of hip

Internal rotation of knee

Posterior pelvic rotation

 Biceps Femoris Muscle

Flexion of knee

Extension of hip

Internal rotation of hip

Internal rotation of knee

Posterior pelvic rotation

 Popliteus Muscle

Flexion of knee

Internal rotation of knee as it flexes

 Knee Extension

Agonists

• Rectus Femoris
• Vastus Lateralis
• Vastus Intermedius
• Vastus Medialis
 Knee Flexion

Agonists

• Biceps Femoris c/ long &

short heads
• Semitendinosus
• Semimembranosus
• Popliteus
 Knee Internal Rotation

Agonists

• Semitendinosus
• Semimembranosus
• Popliteus
 Knee External Rotation

Agonists

• Biceps Femoris
 Nerves

Femoral Nerve innervates Knee Extensors

• Rectus Femoris
• Vastus Medialis
• Vastus Intermedius
• Vastus Lateralis
 Nerves
Sciatic Nerve - Tibial Division

• Innervates knee flexors: semitendinosus,

semimembranosus, & long head of biceps femoris

Common Peroneal / Fibular Nerve

• Supplies short head of biceps femoris