JXH2019 Kinesiology

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JXH2019 Kinesiology

• Lecture 4 The knee joint

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Learning outcomes

• To describe the osseous structures of the knee
  joint and their articulations
• To describe the cartilaginous and ligamentous
  structures of the knee
• To demonstrate surface anatomy of the knee
• To demonstrate knee joint range of motion
• To understand knee joint stability and sporting
  actions that may put the knee at risk of injury

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Bony structures

• Largest joint in the body
• Double condyloid joint (hinge-like)
• Distal femur, proximal tibia and patella are
  involved

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Bony structures

• Medial and lateral femoral condyles
• Intercondylar notch
• Patella (trochlea) groove
• Medial and lateral tibial condyles (plateaux)
• Intercondylar eminence/ridge
• Patella

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Knee ligaments

• Collateral
• medial (tibial)
• lateral (fibular)
• Cruciates
• anterior
• posterior

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Anterior cruciate ligament

• Med. surface of lat. Femoral condyle-gt ant. I-C
  eminence
• Resists excessive ant. movement of tibia on femur
• Prevents hyperext.
• Controls tibia in screw home mechanism
• Aids resistance of excesisve valgus stress

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Posterior cruciate ligament

• Anterior part of lat. aspect of med.fem condyle
  -gt IC ridge (behind meniscal attachments)
• Prevents excessive posterior displacement of
  tibia on femur

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Menisci

• Medial and Lateral
• Lateral circular, mobile, attached to popliteus
• Medial C shaped, less mobile
• Pressure absorbers
• Joint stability
• Lubrication

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Surface Anatomy - Anterior
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Surface Anatomy - Medial
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Surface Anatomy - Lateral
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Surface Anatomy - Posterior
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Movements of the knee

• 135 deg of extension plus 5-10 deg of
  hyperextension
• 140 deg of flexion
• With knee flexed gt35 deg
• 30 deg int rotation
• 45 deg ext rotation

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Knee stability

• Ligaments provide static stability
• Quads and hamstring contractions provide dynamic
  stability
• Congruency of the knee joint is provided by
• shape of articular surfaces of tibia and femur
• menisci deepen the tibial fossae

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Phantom Foot / ACL Injury

• Skier falls backwards
• Hips below knees
• Uphill ski unweighted
• Weight on inside edge of downhill ski tail
• Upper body facing downhill ski
• Anterior force on tibia vs
• Body weight moving post. over rigid boot femur
  rotates on tibia

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Phantom Foot
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References

• Nicholl J.P., Coleman P., Williams B.T. Injuries
  in sport and exercise, Sports Council, 1991.
• Kujala U.M., Taimela S., Antti-poika I. Acute
  injuries in soccer, ice hockey, volleyball,
  basketball, judo and karate an analysis of
  national registry data. BMJ 19953111465-8
• Trent, P.S., Walker, P.A., wolf, B. Ligament
  length patterns, strength and rotational axes of
  the knee joint. Clin Orthop 1976117263-270.

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References

• Andriachhi, T.P., Birac, D. Functional testing
  in the anterior cruciate ligament deficient knee.
  Clin Orthop 1993 28840-47
• Fukubayashi, T., Kurosawa, H. The contact area
  and pressure distribution pattern of the knee. A
  study of normal and osteoarthritic knee joints.
  Acta Orthop Scand 198051871-879
• Shoemaker, S., Marklolf, K. Effects of joint
  load on the stiffness and laxity of ligament
  deficient knees. Journal of Bone and Joint
  Surgery 198567A136-146