ANATOMY

1. Clinical Anatomy
of the knee
Mr CM Gupte
Mr Alvin Chen

2. Overview
• Knee joint function
• Surface anatomy
• Bones
• Ligaments
• Tendons
• Examination
• Disease processes

3. The Knee Joint
• Poorly constructed in terms of
stability - femur round, tibia flat.
• Comprised of four bones.
• Femur
• Tibia
• Fibula
• Patella

4. The knee joint
• Load bearing / Force transmission
• Locomotion
• Proprioception

5. Surface Anatomy

6. Bones
• Patella: femur
= patellofemoral
joint
• Femur: tibia =
medial and lateral
tibiofemoral joints

7. Knee Arthroscopy Surface
Landmarks

8. Patella
• Medial facet
• Lateral facet
• Articular cartilage

9. Femur
• Medial femoral
condyle
• Lateral femoral
condyle (protrudes
more)
• Trochlea
• Articular cartilage

10. Femoral ligament insertions
• PCL inner aspect medial
femoral condyle
• ACL inner aspect lateral
femoral condyle

11. Tibia
• Medial and lateral
plateau
• Insertions of
menisci and
cruciate ligaments
• MCL/
semimembranosus

12. Tibial plateau
• Insertions of menisci/
• Cruciate ligaments

13. Ligaments
• Extracapsular: MCL/
LCL
• Intracapsular: ACL/PCL
Functions:
• Stabilise
• Proprioception

14. ACL
• Two bundles
• Prevents
anterior drawer
and pivot

15. ACL Injury

16. MRI
Normal ACL in RED Torn ACL

17. Tests for ACL
Lachman’s Anterior Draw

18. Arthroscopy
Intact ACL Torn ACL

19. ACL Reconstruction

20. PCL
• Stronger than
ACL
• Prevents
posterior
drawer

21. PCL injury
• Direct Blow onto
Tibia on a
flexed knee

22. MRI PCL
Normal PCL PCL torn

23. Posterior Sag from PCL rupture

24. MCL
• Medial
• Prevents valgus stress
• Deep and superficial parts
• Heals well

25. MCL Injury

26. LCL
• Lateral
• Prevents varus stress
• Cord like –weakest of the
ligaments but rarely torn in
isolation

27. Multiple Injuries

28. Extensor mechanism
• Quadriceps
• Patella
• Patellar tendon

29. Quadriceps
• VMO
• Rectus femoris
• Vastus intermedius
• Vastus lateralis
• Extend knee

30. VMO
• Medial most quad
• Helps prevent lateral
dislocation of the patella

31. Extensor Mechanism injuries I

32. Extensor Tendon Injuries II

33. Extensor Tendon Injuries III

34. Hamstrings
• Biceps laterally
• Semitendinosus/semimembranosus
medially
• Flex knee

35. Pes
• Sartorius
• Gracilis
• Semitendinosus
• G and T used for ACL
reconstruction

36. Movements of the Knee
The principal muscles acting on
the knee:
• Extensors - quadriceps femoris
• Flexors - hamstrings assisted by
gracilis, gastrocnemius
and sartorius.
• Medial rotators- popliteus.

37. Movements of the Knee
• The principal knee movements are flexion
and extension, but rotation of the knee is
possible when the joint is in flexed position
.

38. Examination
• Look
• Feel
• Move
• Think about structures and what you’re
dong to them

39. Diseases
• OA
• Meniscal tears
• Ligament injuries
• Patellofemoral tracking
• Tendon injuries
• Inflammatory arthritis
• Infection/tumours

40. Arthritic Knee X-ray

41. Knee Arthritis

42. Knee OA on arthroscopy

43. Total Knee Replacement

44. Patellofemoral Knee Replacement

45. Unicondylar Knee Replacement

46. Meniscal Tears

47. Treatment of Meniscal Tears
Suture/ Repair Debridement

48. Other Pathologies
Patella Maltracking Bone Tumour

49. Any Questions ?