The Tibiofemoral Jointsflanagan/KIN 337/04-05/knee 337a.pdfTriplanar Knee Motion • A simple hinge...
Transcript of The Tibiofemoral Jointsflanagan/KIN 337/04-05/knee 337a.pdfTriplanar Knee Motion • A simple hinge...
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The Knee
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The Knee
• Two Joints:
–Tibiofemoral
–Patellofemoral
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Normal alingment due to difference between femoral condyles
The medial condyleextends further distally
Oatis, 2004
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Osteochondral Defects
• Fractures of articular cartilage and underlying bone
• Shear and compressive forces
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TibioFemoral AlignmentWhat are the
consequences of faulty alignment?
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Triplanar Knee Motion
• A simple hinge joint would simply flex and extend
• This is not a simple hinge joint!!
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Tibia on a fixed Femur
• FLEXION
– Backward Rolling
– Internal Rotation
– Varus
– Posterior Translation
• EXTENSION
– Forward Rolling
– External Rotation
– Valgus
– Anterior Translation
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Femur on a fixed Tibia
• FLEXION
– Backward Rolling
– External Rotation
– Varus
– Anterior Translation
• EXTENSION
– Forward Rolling
– Internal Rotation
– Valgus
– Posterior Translation
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Knee Motion
• Bony Geometry
• Soft Tissue Constraints
• Muscle Forces
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Bony Factors
• Different size of the medial and lateral femoral condyles
• Different size of the articular surfaces of the femoral condyles and the tibialcondyles
• Variation in curvature from anterior to posterior
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Medial Condyle is larger than the Lateral Condyle
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Larger Femoral Condyles
What’s the consequence
of larger femoral
condyles?
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Convex-Concave Rule
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The Menisci
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The Menisci
• Tibiofemoral load transmission• Shock absorption• Lubrication• Prevent synovial impingement• Distribute synovial fluid• Contribute to joint stability• Assist in gliding motion
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My Third Law
Lev
angi
ean
d N
orki
n, 2
001
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Movements of menisci• during flexion -
move posteriorly
• during extension -move anteriorly
…… the menisci follow, or stay with the, femoral condylesthe menisci follow, or stay with the, femoral condyles
extended flexing… menisci moveposteriorly unequally
R
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Movements of menisci
• during lateral rotation of the tibia – the menisci follow the femoral condyles, e.g.
they remain with the femoral condyles while the tibia rotates
• during medial rotation (compare to lateral rotation)
Lateral rot. Medial rot.Neutral
R
…… the menisci follow, or stay with the, femoral condylesthe menisci follow, or stay with the, femoral condyles
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The menisci attach to the tibia, but move with the femur.
What are the consequences?
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LongitudinalHorizontal
Oblique Radial
Whiting and Zernicke, 1998
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Let’s Review…
• Different sizes of femoral condyles means triplanar motion.
• Different sizes of the femoral and tibialcondyles means that gliding must accompany rolling.
• The meniscal reaction force is partially responsible for this gliding.
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Anterior Cruciate Ligament
• Prevents anterior translation of the tibia with respect to the femur
• Or…• Stabilize in other
directions as well
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Posterior Cruciate Ligament
• Prevents posterior translation of the tibia with respect to the femur
• Or…• Provides stability in
other directions as well
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The Cruciates & Knee Motion
ACL assists in anteriorglide during flexion
PCL assists in posteriorglide during extension
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Tibial:
•Anterior Translation
•Internal Rotation
•Valgus or Varus
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PCL injuries…direct impact
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Let’s Review…
• Larger medial condyle produces triplanarmotion
• Larger femoral condyles require a combination of rolling and gliding
• The menisci and cruciates are largely responsible for these gliding motions
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Medial Collateral Ligament
• Restrains valgusloading
• Checks lateral tibial rotation
• Back-up anterior displacement
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Lateral Collateral Ligament
• Resists varusstress
• Also limits lateral rotation
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Why do we have a patella?
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Patellar Motions
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The Effect of the Quads on the Patella
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Patellofemoral Pain
Force
AreaStress =
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Trochlear Depth – 60° Flexion
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Trochlear Depth – Full Extension
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The knee is part of a kinetic chain.
Don’t look at it in isolation!
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It’s not my fault!!
Heh! Heh!
Heh! Heh!