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2. MOB TCD
Knee
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin

3. MOB TCD
Knee Joint
•
•
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•
•
Synovial condylar joint
Close pack
Full extension
Least pack
15 degree flexion

4. MOB TCD
Anatomy of Knee Joint

5. MOB TCD
Bones
• The articular surfaces are the
medial and lateral femoral
condyles (the intercondylar notch
in between)
• The medial condyle has a longer
articular surface
• The superior aspect of the medial
and lateral tibial condyles
• The posterior aspect of the patella

6. MOB TCD
Intercondylar Notch
• Average is 17 mm
• Narrow notch more likely to tear ACL

7. MOB TCD
Bones

8. MOB TCD
Patella
•
•
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•
•
Sesamoid bone
Thickest articular cartilage in body
Smaller medial facet
Q-angle
Controlled by Vastus Medialis
Obliquus (VMO) and Vastus Lateralis
Obliquus (VLO)

9. MOB TCD
Patella
• The patella is controlled by the oblique
portions of the vastus medialis and vastus
lateralis.
• The vastus medialis wastes within 24 hours
after an effusion of the knee
• If the oblique fibers of the vastus medialis
are wasted, the patella tends
to sublux laterally on extension
of the knee. This results in
retropatellar pain

10. MOB TCD
Patella

11. MOB TCD
Weak Vastus Medialis Obliquus
• Lower most fibres of vastus medialis
• Partly arise adductor magnus
• Straightens the pull on the quads
tendon and patella
• Controls patella tracking during
flexion extension of the knee
• Fibres atrophy quickly after knee
injury
• 10-15 ml of effusion inhibit VMO
• VMO rehabilitation strength and
timing of contraction

12. MOB TCD
Deficiency of Lateral Condyle

13. MOB TCD
Capsular Ligaments
•
•
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Quadriceps
Retinacular fibres
Patellar tendon
Coronary ligaments
Medial and lateral ligaments
Posterior oblique ligament

14. Capsule Attachments
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•
•
•
Quadriceps tendon
The patella
The patellar ligament
Retinacular fibres all form the
anterior part of the capsule
• The patellar ligament is the insertion
of the quadriceps tendon
MOB TCD

15. Patellar Ligament
• Antero-inferiorly is attached to the
tuberosity of the tibia
• On either side the retinacular fibres
pass upwards from the tuberosity in a
V-shaped manner to be attached just
below the articular margin
• The deep infrapatellar bursa and
infrapatellar pad of fat lie posterior to
it, separating it from the tibia
MOB TCD

16. Capsule Attachments
• Laterally, the attachment is just beyond
the articular margin
• Laterally, it is attached above the groove
for the popliteus, below the lateral
epicondyle
• There is a gap in the capsule to allow the
popliteus to emerge
MOB TCD

17. Capsule Attachments
• Posterior
• Superiorly, it is attached just beyond
the articular margin and to the lower
border of the popliteal surface of the
femur, above the intercondylar notch
MOB TCD

18. Capsule Attachments
• Postero-inferiorly, the capsule
is attached to the medial
condyle of the tibia
• By a line running above the
groove for the
semimembranosus tendon
• Below the attachment of the
posterior cruciate ligament
MOB TCD

19. Capsule Attachments
• Medially, the capsule is attached
to the femur just beyond the
articular margin of the condyle
• Below the medial epicondyle
MOB TCD

20. MOB TCD
Collateral Ligaments
Netter

21. Medial Structures
• Medial ligament
• Pes anserinus consists of:
– Sartorius
– Gracilis
– Semitendinosus
• Tibial inter-tendinous bursa
between them
MOB TCD

22. Medial Collateral Ligament (MCL)
or Tibial Collateral Ligament
• Is attached superiorly to the medial
•
•
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•
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epicondyle of the femur
It blends with the capsule
Attached to the upper third of the
tibia, as far down as the tibial
tuberosity
It has a superficial and deep portion
The deep portion, which is short,
fuses with the capsule
Attached to the medial meniscus
A bursa usually separates the two
parts
MOB TCD

23. Medial Collateral Ligament (MCL)
or Tibial Collateral Ligament
• The tendons of sartorius, gracilis
•
and semitendinosus cross its
tibial attachment where another
bursa is situated
The anterior part tightens during
the first 70–105°of flexion
MOB TCD

24. MOB TCD
Medial Collateral Ligament (MCL)
• Medial ligament, tightens in
•
•
•
•
extension
And at the extremes of medial and
lateral rotation
A valgus stress will put a strain on
the ligament
If gapping occurs when the knee is
extended, this is due to a tear of
posterior medial part of capsule
If gapping only occurs at 15º flexion,
this is due to tear of medial ligament

25. MOB TCD
Medial Ligament
Netter

26. Posterior Medial Structures
• Semimembranosus into the
groove on posterior aspect of
medial tibial condyle and its
extensions
• Upwards and lateral is oblique
popliteal ligament
• Downwards and lateral forms
fascia covering popliteus
• Downwards and medially fuses
with medial ligament
MOB TCD

27. Oblique Popliteal Ligament
• Oblique popliteal ligament passes
upwards and laterally
• Fuses with the fabella if present
• Capsule above lateral femoral condyle
• Pierced by middle genicular vessels
and nerve
• Posterior division of obturator nerve
• Popliteal artery lies on it
MOB TCD

28. Oblique Popliteal Ligament
• Strengthens the posterior portion of the
capsule and prevents extreme lateral
rotation
• It is an expansion from the
semimembranosus tendon close to its
insertion to the tibia
• Branch from the posterior division of the
obturator nerve, pierces the ligament,
supplies cruciates and articular twig to
knee (referred pain from pelvic peritoneum
to knee)
MOB TCD

29. Lateral Structures
Netter
MOB TCD

30. Lateral Knee
•
•
•
Lateral ligament
Iliotibial tract
Arcuate complex
• Fabellofibular ligament
• Deep portion of capsule
• Meniscotibial ligaments
MOB TCD

31. MOB TCD
Poster Lateral Corner
• Posterior horn of lateral
meniscus
• Arcuate complex
• Popliteus
• Lateral head of
gastrocnemius

32. MOB TCD
Lateral Ligament
• Deep in interval between iliotibial
band and biceps
• Lateral epicondyle of femur
• Midpoint superior surface of
fibula and the styloid process of
the fibula
• It is a cord-like structure that is
separated from the capsule by
the tendon of the popliteus
• Surrounded by biceps
Fabbriciani & Oransky, 1992

33. MOB TCD
Lateral Collateral Ligament (LCL)
• Deep to lateral collateral ligament
• Popliteus
• Inferolateral genicular vessels and
nerve

34. Lateral Collateral Ligament (LCL)
or Fibular Collateral Ligament
• Taut in extension
• 20°flexion, lateral ligament complex
more lax than medial
• Primary lateral restraint to varus
loading
• Arcuate ligament is the edge of
capsule that arches above the
popliteus
MOB TCD

35. Arcuate Ligament
• Passes from the tip of the styloid
process
• Just posterior to the lateral ligament
• Blends origin of the lateral head of
gastrocnemius and oblique popliteal
ligament
• Edge of capsule arches over popliteus
and may give partial origin to popliteus
MOB TCD

36. MOB TCD
Fabella
• Fabella lies at point on the
poster lateral side of knee
• Where multidirectional
collagenous tensile stress
meet
• 8% - 10% osseous
• 90% - 92% cartilagenous
Fabbricani & Oransky, 1992

37. Coronary Ligament
• Connects the periphery of the
menisci to the tibia
• They are the portion of the
capsule that is stressed in rotary
movements of the knee
MOB TCD

38. MOB TCD
Popliteus
• Origin inferior, popliteal surface of
tibia, above the soleal line, fascia of
semimembranosus
• Deep to arcuate popliteal ligament
• Enters capsule
• Crosses lateral surface of lateral
meniscus
• Attached by popliteal-meniscal fibres
which bound hiatus

39. MOB TCD
Popliteus
• Enters hiatus
• Crosses femoral condyle
• Deep to lateral collateral
ligament
• Inserts into anterior part of
groove
• Superior popliteal recess
communicates joint

40. MOB TCD
Popliteus
• Femoral condyles rotate
medially around taut ACL during
the locking mechanism of the
knee
• Popliteus laterally rotates the
femur to unlock the knee so
flexion can occur

41. MOB TCD
Iliotibial Tract
• The iliotibial tract is a thickening of the
deep fascia of the thigh, fascia lata
• The tract is attached to Gerdy’s tubercle on
the anterolateral aspect of the lateral tibial
condyle
• The superficial three quarters of the gluteus
maximus end in a thick tendinous lamina
which is inserted into the iliotibial tract
• The tensor fascia lata is also inserted into
the tract
• Gives origin to the oblique fibres of the
vastus lateralis that help to stabilise the
patella

42. MOB TCD
Iliotibial Tract
• In full knee extension the tract lies
anteriorly to the line of flexion of the
knee,
• As it is free of bony attachments
between the lateral femoral
epicondyle and Gerdy’s tubercle
• It is free to move posteriorly to this
axis on flexion of the knee
Standish & Wood, 1996.
• As the tract crosses the lateral
epicondyle of the femur a bursitis
may develop as the result of a
‘long-leg syndrome’

43. MOB TCD
Iliotibial Tract
• The iliotibial band acts as an
extensor of the knee when the knee
is flexed from 0°to 30°and as a
flexor when the knee is flexed more
than 40°, due to the change in the
transverse axis which occurs at
30–40°flexion.
• The pelvic tilt is a mechanism for
tightening the iliotibial band. The
pull of the band stabilises the knee
in extension, as well as helping to
resist extension and adduction of
the hip of the weight-bearing leg

44. MOB TCD
Movements of the Knee Joint
• Flexion and extension take place
between the femoral condyles
and the upper surface of the
menisci
• Rotation occurs between lower
surface of the menisci and upper
surface of the tibia

45. MOB TCD
Extension Screw Home
• Contraction of the quadriceps results
in extension
• The anterior cruciate becomes taut
• And medial rotation of the femur
occurs around the taut anterior
cruciate to accommodate the longer
surface of the medial condyle

46. Flexion
• Femoral condyles rotate
medially around taut ACL during
the locking mechanism of the
knee
• Popliteus laterally rotates the
femur to unlock the knee
• So flexion can occur
• Then the hamstrings flex the
knee
MOB TCD

47. Functional Anatomy of
Patellofemoral Joint (PFJ)
MOB TCD

48. MOB TCD
Functional Anatomy of PFJ

49. Anterior and Posterior Cruciates
• Anatomically named by their
tibial attachments
• Clinically femoral are called
lateral
origin
• Covered by synovial membrane
on anterior and on both sides
which is reflected from capsule,
• I.e. oblique popliteal ligament
• Bursa between them on lateral
aspect
anterior
MOB TCD

50. Anterior and Posterior
Cruciates Ligament
• Synovial membrane covers the
anterior and sides of the
cruciates
• Not covered on posterior aspect
MOB TCD

51. Anterior Cruciate
• Anterior cruciate is attached
to anterior aspect of the
superior surface of the tibia
behind
• Anterior horn of medial
meniscus in front of the
anterior horn of the lateral
meniscus
• Passes upwards and
laterally to the posterior
aspect of medial surface of
lateral femoral condyle
MOB TCD

52. Superior Aspect of
Tibial Plateau Menisci
Anterior cruciate
ligament
PCL
Posterior meniscofemoral
ligament
MOB TCD

53. Anterior Cruciate Ligament (ACL)
• Three dimensional fan shaped
• Multiple non-parallel interlacing
collagenous fascicles
MOB TCD

54. Anterior Cruciate Ligament
anterior
MOB TCD

55. Anterior Cruciate Ligament
• Tibial attachment is in anteroposterior axis of tibia
• Femoral attachment is in
longitudinal axis of femur
• Forms 40°with its long axis
• 90°twist of fibres from extension
to flexion
MOB TCD

56. Anterior Cruciate Ligament
• Anteromedial fibres have
the most proximal femoral
attachment
• Contribute to anteromedial
stability
• Intermediate to straight and
anteromedial
• Posterolateral aids in
anteromedial stability
MOB TCD

57. Anterior Cruciate Ligament
• ACL are vertical in
extension
• 90°flexion are horizontal
• PCL are more vertical in
90°flexion
MOB TCD

58. Cruciate
• At 0°of flexion the fibres of the ACL
are more vertical
• At 90°flexion they are in the
horizontal plane
• Fibres of the PCL are more vertical
with flexion and increasing flexion,
> 90°becomes pivot
• PCL is least affective at 30°flexion
Hunziker et al 1992, Covey 2001
MOB TCD

59. MOB TCD
ACL in Extension and 45°

60. Anterior and Posterior Cruciate
• PCL
• Provides 94% of restraint
to posterior displacement
• ACL
• Provides 86% of restraint
to anterior displacement
MOB TCD

61. Anterior Cruciate Ligament
Blood Supply
• Middle genicular artery
• Inferior medial genicular
• Inferior lateral genicular
arteries via infrapatellar
fat pad
• Only one main artery
• Middle genicular enters
upper third
MOB TCD

62. Posterior Cruciate
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Strongest ligament
Shorter
More vertical
Less oblique
Twice as strong as ACL
Posterior
MOB TCD

63. Posterior Cruciate
• PCL is the strongest
ligament of the knee
• It is shorter
• More vertical
• Less oblique
• Twice as strong as ACL
• Closely applied to the
centre of rotation of knee
• It is the principal stabiliser
Hunziker et al.,1992
MOB TCD

64. Attachment of PCL
• The tibial attachment of the
PCL was on the sloping
posterior portion of the
tibial intercondylar area
• Anterior to tibial articular
margin
• Blends with periosteum
and capsule
• Extended 11.5-17.3 mm
distal to the tibial plateau
Javadpour & O’Brien, 1992
MOB TCD

65. Tibial Attachment of the PCL
Frazer, 1965
MOB TCD

66. Posterior Cruciate
• Anatomically the fibres pass
anteriorly and medially and
proximally
• It is attached on the anteroinferior part of the lateral
surface of the medial femoral
condyle
• The area for the PCL is larger
than the ACL
• It expands, more on the apex of
the intercondylar notch than on
the inner wall
Hunziker et al.1992
MOB TCD

67. Posterior Cruciate Ligament
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Three functional bands
Names vary
Anterior or anterolateral is larger
Central
Taut in flexion
Posterior or posteromedial taut in
extension
• Posterior oblique bundle
Hunziker et al 1992
MOB TCD

68. Attachment of PCL
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•
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•
•
Insertions of the PCL
Passes through four zones
Ligament
Fibrocartilage
Tidemark of mineralised
fibrocartilage
• Bone in less than 1 mm
Cooper & Misol, 1970; Fabbriciani & Oransky, 1992
MOB TCD

69. Posterior Cruciate Ligament
• Posterior oblique bundle
• Most posterior fibres
• Attached to posterosuperior part
of femur
• Posterior medial part on
intercondylar area of tibia
• Longest fibres
• Tense in full extension
Fredrick & O’Brien, 1992; Hunziker et al.,1992
MOB TCD

70. Posterior Cruciate
• Proximal fibres on femur
• Posterior fibres on the tibia are
longest
• Undergo least change
MOB TCD

71. Posterior Cruciate
• The PCL is located near the
longitudinal axis of the knee
• Medial to the centre of the
knee
• Vertical in frontal plane
• 30°to 35°in sagittal
• More horizontal in sagittal
with increased flexion
MOB TCD

72. Posterior Cruciate
• PCL provides 94% of restraint to
posterior displacement of the tibia
• Prevents external rotation of tibia
more at 90°than at 30°
• ACL 86% of restraint to anterior
displacement
MOB TCD

73. Blood Supply of Cruciates
MOB TCD

74. Blood Supply of Cruciates
• Posterior cruciate is
supplied by four branches
• Distributed fairly evenly over
its course
• Subcortical vascular
network at bony
attachments
• Don’t contribute much to
ligaments
Sick & Koritke, 1960
MOB TCD

75. Blood Supply of PCL
• Main is middle genicular
artery enters upper third
of PCL
• Synovium surrounding
PCL also supplies the PCL
• Contributions inferior
medial, inferior lateral
genicular arteries via
infrapatellar fat pad
• Periligamentous and intra-ligamentous plexus
• Very little from bony attachment
Arnoczky 1987
MOB TCD

76. Posterior Cruciate Ligament
Nerve Supply
• Branches of tibial and
obturator nerves
• Mechanoreceptors
• Proprioceptive action
MOB TCD

77. Nerve Supply of Cruciates
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•
•
•
Branches of tibial nerve
Middle genicular nerve
Obturator nerve (post)
Branches of the tibial nerve
enter via the femoral
attachment of each ligament
• Nerve fibres are found with
the vessels in the
intravascular spaces
MOB TCD

78. MOB TCD
Mechanoreceptors
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•
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Three types
Found near the femoral attachment
Around periphery
Superficially, but well below the
synovial lining.
Where maximum bending occurs
Ruffini endings
And ones resemble golgi tendon
organs
Paccinian
Proprioceptive function

79. MOB TCD
Mechanoreceptors
• Mechanoreceptors
resembling golgi tendons
• Running parallel to the long
axis of the ligament
• Found near the femoral
attachment
• Around the periphery, where
maximum bending occurs
• Posterior division of obturator
nerve

80. Posterior Cruciate Ligament
Bony Attachment
• There is a gradual change in
stiffness between the flexible
ligamentous tissue and bone
• There is a transitional zone of
fibrocartilage between collagen
and bone
• This helps to prevent the
concentration of stress at the
attachment site
Beynnon, 2000; Hunziker et al.,1992
MOB TCD

81. MOB TCD
Anatomy of Menisci
• Menisci are made of fibro
cartilage
• Wedge shaped on cross
section
• Medial is comma shaped with
the wide portion posteriorly
• Lateral is smaller, two horns
closer together round
• They are intracapsular and
intra synovial
anterior

82. MOB TCD
Anatomy of Menisci
• Anterior to posterior
• Medial, anterior horn is
attached to the intercondylar
area in front of the ACL and
the anterior horn of the
lateral meniscus
• Posterior horn of lateral,
posterior horn of medial and
PCL
• Medial is more fixed
• Lateral more mobile
anterior

83. MOB TCD
Anatomy of Menisci
• Medial is attached to the
deep portion of medial
collateral ligament
• Lateral is separated from
lateral ligament by the
inferolateral genicular
vessels and nerve
• The popliteus, which is
attached to lateral meniscus
• Posterior horn gives origin
to meniscofemoral ligament

84. MOB TCD
Anatomy of Menisci
• Coronary ligaments are the
portion of the capsule
attached to the periphery of
meniscus, which connects it
to the tibia
• Synovial membrane, stops
at the upper border of the
meniscus
• Lines the deep aspect of the
coronary ligament

85. MOB TCD
Anatomy of Menisci
• Blood supply at the
periphery only
• Flexion and extension
takes place at the upper
surface of the menisci
• Rotation occurs between
the lower surface of the
menisci and the tibia
anterior

86. MOB TCD
Function of Menisci
•
•
•
•
•
•
•
•
Shock absorption
Redistributes forces
Spread synovial fluid
Minimal effect on stability
On rotation menisci move with femur
Lateral moves 20 - 24 mm
Medial less mobile 10 -15 mm
Lateral meniscus bears more load

87. MOB TCD
Meniscofemoral Ligaments
• Anterior and posterior arise from
posterior horn of lateral meniscus
• Anterior attached to femur anterior to
PCL
• Posterior attached posterior to PCL
• More variations in posterior

88. MOB TCD
Meniscofemoral Ligaments
• The Anterior meniscofemoral
(Humphrey) is attached to lateral
aspect of the medial femoral condyle in
front of the PCL
• The posterior (Wrisberg) is attached
posterior to the PCL
• The posterior meniscofemoral ligament
is usually present
• Vary in size

89. MOB TCD
Vessels and Nerves

90. MOB TCD
Articular Fat Pads
•
•
•
•
•
Increase with age
Compact lobules
With fibro-elastic interlobular septa
Septa well vascularised
Provide firmness, deformability and
elastic recoil
Williams & Warick,1980

91. MOB TCD
Infrapatellar Fat Pad (IFP)
• Superiorly
• Fills the space between the inferior
pole of the patella
• The ligamentum patella and deep
infrapatella bursa
• Attached to intercondylar notch via
ligamentum mucosum
Williams & Warick,1980

92. MOB TCD
Infrapatellar Fat Pad
• Posteriorly
• Covered by synovial
membrane
• Forms alar folds
• Femoral condyles
• Intercondylar notch by
ligamentum mucosum
• Attached to anterior
horns of menisci
• Proximal tibia
Williams & Warick,1980

93. MOB TCD
Infrapatellar Fat Pad
• Blood supply inferior
genicular arteries
• Also supply the lower part
of the ACL from network of
synovial membrane of fat
pad
• Centre of fat pad limited
blood supply
• Lateral arthroscopic
approach to avoid injury
Kohn et al., 1995; Eriksson et al., 1980

94. MOB TCD
Infrapatellar Fat Pad
• Can only expand anteriorly
• Inflammation of IFP
• Bulges on either side of patellar
tendon
• Synovial membrane is compressed
by femoral condyles
• Pain and inflammation

95. Clinical Conditions Affecting
Infrapatellar Fat Pad
•
•
•
•
•
•
•
Intrinsic
Hoffa’s disease
Intracapsular chondroma
Localised nodular synovitis
Post-arthroscopy / post-surgery fibrosis
Shear injury
Torsion
MOB TCD

96. Hoffa’s Disease
Fat Pad Impingement
• Hyperextension injury
• Genu recurvatum and tilted inferior
pole of patella
• Tenderness distal to patella
• Beyond margins of the patella
Brukner & Khan, 2000; Garret et al., 2000
MOB TCD

97. Clinical Conditions Affecting IFP
• Anterior extra capsular
disorders
• Patellar fracture
• Patellar tendon rupture
• Deep infrapatellar bursitis
• Patellar tendonosis
MOB TCD

98. Clinical Conditions Affecting IFP
Osgood-Schlatter Disease
Sinding-Larsen Johanssen Disease
MOB TCD

99. MOB TCD
Infrapatellar Fat Pad
• ACL repair with patellar tendon may
result in fibrosis of fat pad and pain
• Delays rehabilitation
• Inflammation of IFP may be process
leading to fibrosis
Murakami et al., 1995

100. MOB TCD
Synovial Membrane

101. MOB TCD
Synovial Membrane
• The synovial membrane is
very extensive
• It lines the inner aspect of
the capsule and the nonarticular structures inside
the capsule, except
posteriorly where it is
carried forwards to cover
the anterior and sides of the
cruciate ligaments

102. MOB TCD
Synovial Membrane
• It covers the infrapatellar pad of fat,
forming the alar folds
• The ligamentum mucosum is attached
to the intercondylar notch at the apex
of the alar fold
• The alar folds increase the surface
area of the synovial membrane via the
infrapatellar pad of fat,
• Which fill the changing spaces during
movement of the joint and help to
redistribute the synovial fluid

103. MOB TCD
Synovial Membrane
• The synovial membrane is
continuous with:
• The suprapatellar bursa which
extends a hand’s breadth
above the patella. This bursa
always appears distended
when there is a haemarthrosis
or traumatic synovitis in the
knee joint
• Many other bursae, e.g.
around the popliteus and under
the medial head of the
gastrocnemius

104. MOB TCD
Plica
• A suprapatellar plica may separate
the suprapatellar bursa from the
synovial membrane of the knee joint
• Plicae folds may also be found on
either side of the patella

105. MOB TCD
Bursa

106. MOB TCD
Pathological Anatomy of AKP
Patellofemoral syndrome
Prepatellar bursitis
Fractures & Instability
Synovial plica
Patellar Tendinitis / SLJ
Fat pad impingement
Infrapatellar Bursitis
Traction Apophysitis

107. Abnormal Lower Limb Biomechanics
•
•
•
•
•
•
•
Anatomical anomalies
Femoral torsion
Genu valgum
Increased Q-angle
High (alta) patella
Tibial torsion
Overpronation
Q Angles
Males 140 Females 170
> 200 greater problems
MOB TCD

108. MOB TCD
Knee Injuries
•
•
•
•
•
Anterior cruciate tear
Bone bruising
Posterior cruciate tear
Osteochondritis
Synovial plica

109. MOB TCD
Knee Injuries
Traumatic
• Meniscal tears
• Ligament tears
• Cruciates
• Collaterals
• Patellar dislocations
• Fractures
• Patella
• Tibial plateau
• Articular cartilage damage
Atraumatic
• Patellofemoral syndrome
• Malalignment
• Dislocations
• Subluxations
• Iliotibial band syndrome
• Popliteus tendinopathy
• Patellar tendinitis
• Osgood-Schlatter’s
• Fat pad impingement

110. O’Donoghue’s Triad
• Medial ligament tear
• Anterior cruciate tear
• Torn medial meniscus
MOB TCD

111. MOB TCD
Mechanisms of Injury
• Valgus / External rotation
• Posterior horn of medial meniscus
trapped by posterior condyles

112. MOB TCD
Osteochondritis

113. MOB TCD
Meniscal Tears
•
•
•
•
•
Medial meniscus has higher incidence but less morbidity
Traumatic tears
Twisting on a planted, flexed knee
Atraumatic tears
Degenerative wear and tear

114. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved.”