The knee joint is comprised of the articulating surfaces of the femur and tibia bones, as well as the patella. It is surrounded by ligaments such as the ACL and PCL, and contains menisci that act as shock absorbers. Common clinical issues involving the knee include meniscal tears from twisting injuries, ligament sprains from excessive valgus or varus forces, and osteoarthritis over time. Special tests like Lachman, McMurray, and varus/valgus stress exams help evaluate specific ligament and meniscal injuries.

1. Anatomy and Clinical importance
of knee joint
Dr. Jiwan Pandey
Intern (SBH)

2. Content
• Anatomy
– Articulating surface
– Menisci
– Fibrous membrane and ligaments
– Neurovascular supply
• Clinical Importance
– Meniscal Tear
– Ligament Injury
– Osteoarthritis

3. • Articulates between femur and tibia.(wt
bearing) and patella and the femur( allows the
pull of quadriceps femoris muscle to be
directed anteriorly over knee to the tibia
without tendon wear.
• Articular surfaces(cover by Hyaline cartilage)
– Two femoral condyles
– Adjacent surfaces of the superior aspect of tibial condyles.
– The patella

4. Fig : patella
Fig: femur

11. Capsule
• Surrounds the sides and posterior aspect of
the joint
• On front side capsule is replaced by
quadriceps, patella and ligamentum patallae.

13. Ligaments
• 1. Extracapsular ligaments:
– Ligamentum patalae
– Lateral collateral ligament
– Medial collateral ligament
– Oblique popliteal ligament

16. Intracapsular Ligament
Anterior Cruciate ligament
attached to anterior intercondylar area of tibia to
lateral femoral condyle

17. Posterior Cruciate Ligament
attached to posterior intercondylar area of tibia
to medial femoral condyle.

18. Synovial Membrane
• Lines joint capsule except posteriorly where it
is reflected forward by cruciate ligaments.

19. Blood supply
1. Five genicular branches of the popliteal artery
2. Descending genicular branch of the femoral artery
3. Descending branch of lateral circumflex femoral
artery
4. Two recurrent branches of the anterior tibial artery
&
5. Circumflex fibular branch of posterior tibial artery

23. Nerve Supply
1. Femoral nerve
2. Sciatic nerve, through the genicular
branches of tibial & common peroneal
nerves.
3. Obturator nerve, through its posterior
division.

24. Clinical importance of knee joint
• Lesions Of The Menisci
– Meniscus tear
– Meniscal Degeneration
– Discoid Lateral meniscus
– Meniscal Cysts
• Ligamentous Injury
• Osteoarthritis
• Recurrent Dislocation of Patella
• Deformities of the knee
• Loose bodies
• Chronic Swelling of the joint

25. Meniscal tears
• Medial tear is more common
• Twisting force on partially flexed knee
• Features
– Pain, difficulty weight bearing, instability and
clicking
– Effusion(hemarthosis) 24-48h after injury
– Joint line tenderness
– Locking of Knee (portion of meniscus obstruct
extension)

26. Ligamentous injury
• Medial Collateral ligament
– Valgus force

27. • Lateral collateral Ligament
– Varus force

28. • Anterior Cruciate Ligament
– Twisting force on a semi flexed knee
– O’ Donoghue triad

31. • Posterior Cruciate Ligament
– Anterior aspect of tibia is struck with the knee
semi-flexed

32. Meniscus Vs Ligament Injury
Meniscus injury Ligament injury
H /o Locking Instability
Consistency Cystic Doughy
Swelling Gradual Immediate

33. ligament Tear
Complete Tear Partial Tear
Pain Little More
Swelling Little (diffused) More (confined)
ROM Painless Painful
Tenderness Diffused localised

34. ACL injury PCL injury
Instability Going down
stairs
Climbing stairs
Abnormal
movement
Present Absent

35. Special test :
• Apleys grinding & distraction test :
meniscus ligament

36. • Anterior cruciate ligament:
Anterior drawer test
Knee flexed to 90°

37. • Anterior cruciate ligament:
Lachman test
Knee flexed to 20° - 30°

38. • Posterior cruciate ligament :
Posterior Sag sign

39. • Valgus stress test :
• For medial collateral ligament
Flex knee to 30°

40. • Varus stress test :
• For lateral collateral ligament
Flex knee to 30°

41. • Mc Murray test for medial meniscus :
knee fully flexed Foot externally rotated leg abducted Extend knee

42. • Mc Murray test for lateral meniscus :
knee fully flexed Foot internally rotated Leg adducted Extend knee

43. • Thessaly test :
• For medial & lateral meniscus

44. Osteoarthritis
• Predisposing factors
– Injury to articular surfaces
– Torn meniscus
– Ligamentous instability
– Pre-existing deformity of hip or knee
Features
over 5o years old / overweight/
pain gets worse after use/ swelling

45. • X-Ray changes
– Decreased tibio-femoral joint space(one
compartment)
– Subchondral sclerosis
– Osteophytes
– Subchondral cysts
– Soft tissue calcification in suprapatellar region

46. Chronic swelling in knee joints
• Swelling in front of joint
– Prepatellar Bursitis(Housemaid’s Knee)
– Infrapatellar Bursitis
• Swelling at back of Knee
– Popliteal Cyst(Baker Cyst)
– Popliteal Aneurysm
– Semimembraneous bursa

48. Deformities of the knee
• Bow leg ( genu varum)
– If distance between two knees when child standing
and the heel touching is more then 6 cm.
• Knock knee( genu valgum)
– If distance between medial malleoli when knees are
touching with patella facing forwards is more then 8
cm.
• Hyperextension(genu recurvatum)
– Usually due to abnormal intrauterine posture; usually
recovers spontaneously
– Lax ligament

50. References
• Gray’s Anatomy for Students 3rd edition
• Human Anatomy (BD Chaurasia’s 5th edition)
• Apley’s System of Orthopedics and Fractures
9th edition
• Campbell’s Operative Orthopedics 11th edition

51. THANKYOU