To discuss the knee joint: At the end of the presentation we should be able to note the following The type of joint. Bones and part of the bone that forms the joints Type of cartilage covering the articular surface. Attachment of fibrous capsule. The attachment or lining of the synovial membrane. Structures found outside the fibrous capsules (Extracapsular structures). Structures found within the capsules (Intracapsular structures). Movement and muscle causing the movement. Blood and Nerve supply. Applied Anatomy.

1. Dr. NDAYISABA CORNEILLE
CEO of CHG
MBChB,DCM,BCSIT,CCNA
Supported BY
ANATOMY OF THE
KNEE JOINT

2. PRESENTATION OBJECTIVES
• To discuss the knee joint: At the end of the presentation we should be able to note the following
 The type of joint.
 Bones and part of the bone that forms the joints
 Type of cartilage covering the articular surface.
 Attachment of fibrous capsule.
 The attachment or lining of the synovial membrane.
 Structures found outside the fibrous capsules (Extracapsular structures).
 Structures found within the capsules (Intracapsular structures).
 Movement and muscle causing the movement.
 Blood and Nerve supply.
– Applied Anatomy.
Dr Ndayisaba Corneille

3. THE KNEE JOINT: Introduction
• The knee joint is the largest
synovial joint in the body
and it is of the hinge variety
• Ordinarily it would have
been a highly unstable joint
but the articulating bones
are held by strong ligaments
and further fortified by the
tendons of adjoining
muscles
Dr Ndayisaba Corneille

4. ARTICULATIONS, ARTICULAR
SURFACES
It is formed by articulations between the
patella, distal end of the femur and the
proximal end of the tibia.
It consist of two articulations
– Tibiofemoral and
Patellofemoral.
•Tibiofemoral – medial and lateral condyles
of the femur articulate with the tibial condyles
•Patellofemoral – anterior aspect of the
distal femur articulates with the patella. It is a
gliding joint
•The joint surfaces are lined
with hyaline cartilage
Dr Ndayisaba Corneille

5. Articular surfaces……….
• The medial and lateral condyles
of the tibia are slightly concave
• The femoral condyles are slightly
convex, separated posteriorly by
a deep notch but fusing
anteriorly to form the trochlear
groove for articulation with the
patella
• Patella- It articulates with
the patellar surface of the
femur. It presents articular
surfaces for the medial and
lateral condyles of the femur
Dr Ndayisaba Corneille

6. FIBROUS CAPSULE OF KNEE JOINT
(FCKJ)
• The joint capsule consist of an external
fibrous layer of the capsule (fibrous
capsule)
• The fibrous layer attaches to the femur
superiorly, just proximal to the articular
margins of the condyles.
• Posteriorly, the fibrous layer encloses
the condyles and the intercondylar fossa.
• it is strengthened posteriorly by the
oblique popliteal ligament, a thickening
of semimebranosus muscle
Dr Ndayisaba Corneille

7. FCKJ
• Inferiorly, the fibrous layer
attaches to the margin of the
superior articular surface
(tibial plateau) of the tibia
Anteriorly the fibrous layer is
continuous with the lateral and medial
margins of quadriceps tendon, patella,
and patellar ligament
Dr Ndayisaba Corneille

8. Synovial membrane
• The synovial membrane of the knee is
the most extensive and complex in
the body
• The synovial membrane of the
capsule lines all surfaces within the
articular cavity that is not covered by
articular cartilage
• It is attached to the periphery of
– the articular cartilage covering the
femoral and tibial condyles;
– the posterior surface of the patella;
– and the edges of the menisci,
Dr Ndayisaba Corneille

9. synovial membrane………………….
• The synovial membrane lines
the internal surface of the
fibrous capsule laterally and
medially,
• Centrally it becomes
separated from the fibrous
capsule by extending into the
intercondylar region, where it
covers the cruciate ligaments
and the infrapatellar fat pad,
so that they are excluded from
the articular cavity
Dr Ndayisaba Corneille

10. EXTRACAPSULAR LIGAMENTS OF
KNEE JOINT
• The joint capsule is strengthened
by the following extracapsular
ligaments:
– Patellar ligament,
– Fibular (lateral) collateral ligament,
– Tibial (medial) collateral ligament,
• Other extracapsular ligaments
include:
– Quadriceps tendon,
– Oblique popliteal ligament
Dr Ndayisaba Corneille

11. The patellar ligament
• The patellar ligament, is the
distal part of the
quadriceps femoris tendon,
it is a strong, thick fibrous
band passing from the apex
and adjoining margins of
the patella to the tibial
tuberosity
• The patellar ligament is the
anterior ligament of the
knee joint.
Patella
lig.
Dr Ndayisaba Corneille

12. The fibular collateral ligament (FCL;
• The fibular collateral ligament
(FCL; lateral collateral ligament),
is a strong cord-like
extracapsular ligament,
• It extends inferiorly from the
lateral epicondyle of the femur
to the lateral surface of the
fibular head
• The tendon of the popliteus
passes deep to the FCL,
separating it from the lateral
meniscus.
FCL
Dr Ndayisaba Corneille

13. Dr Ndayisaba Corneille

14. The tibial collateral ligament (TCL
• The tibial collateral ligament
(TCL; medial collateral
ligament) is strong, flat, and
extends from the medial
epicondyle of the femur to
the medial condyle and the
superior part of the medial
surface of the tibia
• . At its midpoint, the deep
fibers of the TCL are firmly
attached to the medial
meniscus.
TCL.
Dr Ndayisaba Corneille

15. Dr Ndayisaba Corneille

16. Quadriceps femoris tendon
Connects the quadriceps
femoris muscles to the
superior aspects of the
patella. Controls knee flexion
and extension
Dr Ndayisaba Corneille

17. OBLIQUE POPLITEAL LIGAMENT
A strong broad flat fibrous ligament
that pass obliquely across and
strengthens the posterior part of the
knee.
It is a reflected expansion of the
tendon of semimembranosus
Arises from the post. surface of the
medial tibial condyle and blends with
the posterior aspect of the joint
capsule
Dr Ndayisaba Corneille

18. INTRA-ARTICULAR LIGAMENTS OF
KNEE JOINT
• The intra-articular
ligaments within the knee
joint consist of:
– the Anterior and Posterior
cruciate ligaments and
– Medial and Lateral menisci.
• The tendon of the popliteus
is also intra-articular during
part of its course
Dr Ndayisaba Corneille

19. The cruciate ligaments
• The cruciate ligaments are
located in the center of the joint
and cross each other obliquely,
like the letter X.
• They crisscross within the fibrous
capsule of the joint but outside
the synovial cavity
• They described as intracapsular
and extrasynovial
Dr Ndayisaba Corneille

20. The anterior cruciate
ligament
• The anterior
cruciate ligament
(ACL) arises from
the anterior
intercondylar area
of the tibia, just
posterior to the
attachment of the
medial meniscus
Dr Ndayisaba Corneille

21. ACL
• It extends superiorly,
posteriorly, and laterally to
attach to the posterior part
of the medial side of the
lateral condyle of the femur
• It limits posterior rolling of
the femoral condyles on the
tibial plateau during flexion
AC
L
Dr Ndayisaba Corneille

22. ACL
• It also prevents posterior
displacement of the femur
on the tibia and
hyperextension of the knee
joint.
• When the joint is flexed at
a right angle, the tibia
cannot be pulled anteriorly
(like pulling out a drawer)
because it is held by the
ACL
Dr Ndayisaba Corneille

23. The posterior cruciate ligament (PCL),
• The posterior cruciate
ligament (PCL) arises
from the posterior
intercondylar area of
the tibia
Dr Ndayisaba Corneille

24. PCL
• The PCL passes
superiorly and
anteriorly on the
medial side of the ACL
to attach to the anterior
part of the lateral
surface of the medial
condyle of the femur
PCL
Dr Ndayisaba Corneille

25. PCL
• The PCL limits anterior rolling of
the femur on the tibial plateau
during extension.
• It also prevents anterior
displacement of the femur on
the tibia or posterior
displacement of the tibia on the
femur and helps prevent
hyperflexion of the knee joint
Dr Ndayisaba Corneille

26. Dr Ndayisaba Corneille

27. The menisci of the knee
joint
• The menisci are
crescentic plates of
fibrocartilage lying on
the articular surface of
the tibia
• They are firmly attached
at their ends to the
intercondylar area of
the tibia.
Dr Ndayisaba Corneille

28. They comprises of the Medial and
Lateral Menisci
The main purpose of the Menisci are:
1) Equalize weight distribution across
the knee joint.
2) Act as Shock absorbers.
3) They serve to widen and deepen
the tibial articular surfaces that
receive the femoral condyles.
Dr Ndayisaba Corneille

29. BURSAE AROUND KNEE JOINT
• A bursa is a fluid-filled sac. It helps
cushion the muscles, tendons, and
bones around a joint.
• The bursae around the knee joint include:
• The prepatellar and infrapatellar bursae
– They are subcutaneous and lie in relation to
the patella, allowing the skin to be able to
move freely during movements of the knee
• The large suprapatellar bursa lies posterior to
the quadriceps tendon and it is especially
important because it communicates with the
joint cavity so any infection in it may spread to
the knee joint cavity
Dr Ndayisaba Corneille

30. BURSAE AROUND KNEE JOINT
• Other bursae around the
knee joint include:
– popliteus bursa (deep to
the popliteus tendon),
– Pes anserine bursa
(deep to the tendinous
distal attachments of the
sartorius, gracilis, and
semitendinosus), and
– Gastrocnemius bursae
– Semimembranosus
bursa
Dr Ndayisaba Corneille

31. Movements at the Knee Joint
• There are four main movements that the knee
joint permits:
• Extension: Produced by the quadriceps
femoris, which inserts into the tibial tuberosity.
• Flexion: Produced by the hamstrings, gracilis,
sartorius and popliteus.
• Lateral rotation: Produced by the biceps
femoris.
• Medial rotation: Produced by five muscles;
semimembranosus, semitendinosus, gracilis,
• NB: Lateral and medial rotation can only occur
when the knee is flexed (if the knee is not
flexed, the medial/lateral rotation occurs at the
hip joint).
Dr Ndayisaba Corneille

32. MOVEMENTS OF KNEE JOINT…………
• When the knee is fully extended with
the foot on the ground, the knee
passively “locks” because of medial
rotation of the femoral condyles on the
tibial plateau (the “screw-home
mechanism”).
• This position makes the lower limb a
solid column and more adapted for
weight-bearing.
• To unlock the knee, the popliteus
contracts, rotating the femur laterally
about 5° on the tibial plateau so that
flexion of the knee can occur.
Dr Ndayisaba Corneille

33. BLOOD SUPPLY OF KNEE JOINT
• The arteries supplying the
knee joint are the vessels
that form the genicular
anastomoses around the
knee. The vessels involved are:
– the superior, middle and inferior
genicular branches of the popliteal
artery;
– descending genicular branches of the
femoral artery and
– descending branch of the lateral
circumflex femoral artery;
– circumflex fibular artery; and
– anterior and posterior tibial recurrent
arteries.
Dr Ndayisaba Corneille

34. INNERVATION OF KNEE JOINT
• Reflecting Hilton’s law, the nerves
supplying the muscles crossing (acting on)
the knee joint also supply the joint; thus
the joint is supplied by articular branches
arising from:
• The femoral (the branches to the vasti)
– Supply its anterior aspect
• Tibial, and common fibular nerves supply
– posterior, and lateral aspects,
respectively.
• The obturator and saphenous (cutaneous)
nerves
– supply its medial aspect.
Dr Ndayisaba Corneille

35. APPLIED ANATOMY OF
THE KNEE JOINT
Dr Ndayisaba Corneille

36. Due to forced abduction of tibia on
femur. Cc: tenderness over
attachments of ligament.
Dr Ndayisaba Corneille

37. Dr Ndayisaba Corneille

38. ANTERIOR
CRUCIATE
LIGAMENT
DAMAGE
Dr Ndayisaba Corneille

39. Dr Ndayisaba Corneille

40. TORN ANTERIOR CRUCIATE LIG
Dr Ndayisaba Corneille

41. ANTERIOR
DRAWER’S
SIGN:
POSITIVE
FOR
ANTERIOR
CRUCIATE
LIGAMENT
DAMAGE
Dr Ndayisaba Corneille

42. POSTERIOR
CRUCIATE
LIGAMENT
DAMAGE
Dr Ndayisaba Corneille

43. Dr Ndayisaba Corneille

44. POSTERIOR
DRAWER’S
SIGN:
POSITIVE
FOR
POSTERIOR
CRUCIATE
LIGAMENT
DAMAGE
Dr Ndayisaba Corneille

45. MENISCAL INJURY
Medial Meniscus:
excessive external
rotation of the
tibia.
Lateral Meniscus:
excessive flexion of
the knee.
Dr Ndayisaba Corneille

46. The “unhappy
triad”
• The “unhappy triad” refers
to a sprain injury that
involves three structures of
the knee. These structures
are:
– the medial collateral
ligament,
– anterior cruciate ligament,
and
– the medial meniscus.
Dr Ndayisaba Corneille

47. The “unhappy triad”………………………….
Dr Ndayisaba Corneille

48. Bursitis of the Knee Joint
• When a bursa becomes
inflamed, it’s called bursitis.
• Common symptoms are
pain, (tenderness), and
swelling that limits
movement of the joint.
• Bursitis is most often caused
by overuse of a joint due to
repeated movements.
Dr Ndayisaba Corneille

49. PREPATELLAR
BURSITIS
also called housemaid’s
knee or coal miner’s
knee. These names
arose because people
whose jobs require
frequent kneeling are
prone to prepatellar
bursitis.
Dr Ndayisaba Corneille

50. INFRAPATELLAR BURSITIS (IB):
Infrapatellar bursa is located below the
patella in relation to the patella tendon. It
is commonly associated with repetitive
jumping injury called “jumper's knee. It is
also referred to as the Vicars knee
SUPRAPATELLAR
BURSITIS:
located between
the distal femur
and the
quadriceps
tendon.
It can be irritated
by a direct blow or
from repeated
stress or motions.
(IB
)
Dr Ndayisaba Corneille

51. The stability of the knee joint
• The stability of the knee joint depends on (
– 1) the strength and actions of the surrounding muscles and
their tendons, and
– (2) the ligaments that connect the femur and tibia. Of
these supports, the muscles are most important;
therefore, many sport injuries are preventable through
appropriate conditioning and training.
• The most important muscle in stabilizing the knee joint
is
– the large quadriceps femoris, particularly the inferior fibers
of the vastus medialis and lateralis . The knee joint
functions surprisingly well after a ligament strain if the
quadriceps is well conditioned
Dr Ndayisaba Corneille

52. Knee replacement
Dr Ndayisaba Corneille

53. END
Dr Ndayisaba Corneille
THANKS FOR LISTENING
By
DR NDAYISABA CORNEILLE
MBChB,DCM,BCSIT,CCNA
Contact us:
amentalhealths@gmail.com/
ndayicoll@gmail.com
whatsaps :+256772497591
/+250788958241