{"id":4123,"date":"2021-01-29T23:06:55","date_gmt":"2021-01-29T22:06:55","guid":{"rendered":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/knee-joint\/"},"modified":"2021-04-22T10:31:26","modified_gmt":"2021-04-22T08:31:26","slug":"knee-joint","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/knee-joint\/","title":{"rendered":"Knee joint"},"content":{"rendered":"\n

The joint which attaches the femur to tibia and fibula is called the knee joint.<\/p>\n\n\n\n

The knee joint consists of 3 separate parts, that together form a complex “hinge” joint which makes it into the largest synovial joint of the human body.
The unique structure of the hinge joint allows it to function as a fulcrum of both extensor and flexor muscles.<\/div><\/p>\n\n\n\n

Movements<\/h3>\n<\/span>\n\n\n

Most of the movements are controlled by the inferior part of the tibiofibular joint.
The main movements of the knee joints are flexion, extension and rotation (lateral and medial):<\/p>\n\n\n\n

  • Flexion- mostly by biceps femoris muscle<\/li>
  • Extension- mostly by quadriceps femoris muscle<\/li>
  • Rotation (when the knee is flexed)- lateral by biceps femoris muscle, medial by popliteus, sartorius and gracilis muscles.\u00a0<\/li><\/ul>\n\n\n\n

    The knee joint is stabilized by two joints:<\/p>\n\n\n\n

    • The patellofemoral joint<\/li>
    • The tibiofemoral joint\u00a0<\/li><\/ul>\n\n\n<\/span>\n

      Joints<\/h3>\n<\/span>\n\n\n

      The knee joint is composed of three small joints, all are incapsulated by the synovial membrane:<\/p>\n\n\n\n

      • The superior tibiofubular<\/strong> joint<\/strong> – formed between the lateral condyle of the tibia and the head of the fibula<\/li>
      • The patellofemora<\/strong>l joint<\/strong>– formed by the patella bone attached to the femur on its anterior surface<\/li>
      • The tibiofemoral<\/strong> joint<\/strong> – formed between the proximal surface of the tibia and the condyles of the femur <\/li><\/ul>\n\n\n<\/span>\n

        Superior tibiofibular joint<\/h4>\n<\/span>\n\n\n

        The superior tibiofemoral joint is a synovial joint between the superior planes of tibia and fibula. Cartilaginous site with articulating surfaces surrounded by a fibrous capsule.
        Articulating surfaces are different because the joint lining can be in an oblique or transverse position.\u00a0<\/p>\n\n\n\n

        There are two ligaments<\/strong> in the superior tibiofibular joint- anterior and posterior.<\/p>\n\n\n\n

        • The anterior ligament starts at the anterior side<\/strong> of the head of fibula and continues to the lateral side of tibial condyle.<\/li>
        • The posterior ligament starts at the posterior side<\/strong> of the head of fibula and continues to the lateral side of tibial condyle.<\/li><\/ul>\n\n\n\n

          These ligaments together with the tendon of the biceps muscle, the interosseous membrane and the capsule, maintain stability of the joint.<\/p>\n\n\n\n

          The superior tibifibular joint is supplied <\/strong>by the recurrent branches of the anterior tibial artery. <\/p>\n\n\n\n

          Lymphatic drainage<\/strong> is flowing to the popliteal nodes.<\/p>\n\n\n\n

          The superior tibiofibular joint is innervated<\/strong> by the branches of the common fibular nerve.<\/p>\n\n\n<\/span>\n

          Patellofemoral joint<\/h4>\n<\/span>\n\n\n

          The patellofemoral joint is a synovial joint, articulating with the femur.
          The exact articulation is with the femur condyles, it looks like the letter U.\u00a0
          When in flex, the contact points of the joint extend and moves proximally to avoid local stress.<\/p>\n\n\n\n

          The patellar ligament<\/strong> is also called patellar tendon. The tendon is attached from the patellar apex to the depression on its distal posterior side, proximally<\/strong>. And on the superior area of the tuberosity of tibia, distally<\/strong>. 
          The ligament lies in its own sheath, separated from the synovial membrane and bursae. <\/p>\n\n\n<\/span>\n

          Tibiofemoral joint<\/h4>\n<\/span>\n\n\n

          The tibiofemoral joint is a synovial complex joint. It has three main articulating surfaces:<\/p>\n\n\n\n

          • The proximal tibial<\/strong> surface<\/li>
          • The intercondylar<\/strong> area<\/li>
          • The femoral<\/strong> surface<\/li><\/ul>\n\n\n<\/span>\n

            Menisci<\/h3>\n<\/span>\n\n\n

            The menisci are fibrocartilaginous laminae in semilunar shape. They are intracapsular.
            Menisci are located on the proximal side of the tibia and condyles of the femur. Their main function is to stabilize the joint, lubricate it and enable a proper movement of the limb.
            The menisci have 3 parts: the peripheral, the inner part, and the distal.\u00a0<\/p>\n\n\n\n

            • The inner<\/strong> part of the menisci is thin, concave, and avascular.\u00a0<\/li>
            • The peripheral<\/strong> part is thick, convex, and vascular.<\/li>
            • The distal<\/strong> part lies on the tibial articulations, it is flat and smooth.<\/li><\/ul>\n\n\n\n

              The most common rupture of the menisci occurs in the inner region. Since it is not vascularized, the healing process is short, and it is easier to repair in a surgery.\u00a0<\/p>\n\n\n<\/span>\n

              Medial meniscus<\/h4>\n<\/span>\n\n\n

              The medial meniscus <\/strong>is semicircle in shape and lies posteriorly.\u00a0The medial meniscus is attached to the ligaments by its anterior and posterior horns.<\/p>\n\n\n\n

              The anterior horn\u00a0<\/strong>has anterior and posterior attachment points.\u00a0<\/p>\n\n\n\n

              • Anteriorly the horn is attached to the tibial anterior intercondylar area<\/li>
              • Posteriorly it is continuing with the transverse ligament.<\/li><\/ul>\n\n\n\n

                The posterior horn<\/strong> has posterior and peripheral attachment points. <\/p>\n\n\n\n

                • Peripherally, the attachment starts from the fibrous capsule and it ends at the middle collateral ligament, on its deep surface. <\/li>
                • Posteriorly, attached to the posterior intercondylar area of the tibia, it ends in the middle point of posterior cruciate ligament and the lateral meniscus.<\/li><\/ul>\n\n\n<\/span>\n

                  Lateral meniscus<\/h4>\n<\/span>\n\n\n

                  The lateral meniscus<\/strong> is almost a complete circle and covers larger area than the medial meniscus by its shape, it remains almost 4\/5 of the circle.\u00a0
                  The lateral meniscus has a few points of attachment- tendon popliteus, anterior horn, posterior horn, and meniscofemoral ligament.<\/p>\n\n\n\n

                  • The anterior horn<\/strong> is attachment is from the front side of the intercondylar eminence to the anterior circulate ligament. <\/li>
                  • The posterior horn<\/strong> attachment is from behind the intercondylar eminence to the posterior horn of the medial meniscus, on the anterior side of it. <\/li>
                  • Popliteal tendon<\/strong> is covering the posterolateral side of the lateral meniscus. <\/li>
                  • Meniscofemoral ligament<\/strong> is attached from the posterior horn to the medial condyle of the femur.<\/li><\/ul>\n\n\n\n

                    The popliteal tendon and the meniscofemoral ligament together are allowing the movement of the posterior horn.\u00a0<\/p>\n\n\n<\/span>\n

                    Ligaments<\/h3>\n<\/span>\n\n\n

                    Three main ligaments in the knee joint:<\/p>\n\n\n\n

                    • The transverse ligament <\/li>
                    • The meniscofemoral ligaments<\/li>
                    • The cruciate ligaments <\/li><\/ul>\n\n\n<\/span>\n

                      Transverse ligament<\/h4>\n<\/span>\n\n\n

                      Is also called the\u00a0intermeniscal<\/strong>. It connects the anterior side of the medial meniscus to the lateral meniscus.<\/p>\n\n\n<\/span>\n

                      Meniscofemoral ligaments <\/h4>\n<\/span>\n\n\n

                      There are two meniscofemoral ligaments<\/strong> in the knee joint. The anterior and the posterior<\/strong> meniscofemoral ligaments:<\/p>\n\n\n\n

                      • The anterior<\/strong> ligament passes from the anterior to the posterior side of the cruciate ligament. <\/li>
                      • The posterior<\/strong> ligament starts at the end of the attachment point of the anterior ligament and ends at the margin of the posterior cruciate ligament.\u00a0<\/li><\/ul>\n\n\n\n

                        As mentioned previously, these ligaments together with popliteal ligament, allow the movement of the lateral meniscus.<\/p>\n\n\n<\/span>\n

                        Cruciate ligaments<\/h4>\n<\/span>\n\n\n

                        There are two cruciate ligaments<\/strong>, anterior and posterior. Each of them is relatively attached to the tibia. They are surrounded by the synovial membrane almost completely, except of the intercondylar part of the posterior side.
                        The cruciate ligaments are crossing each other and are therefore called cruciate.<\/p>\n\n\n\n

                        • The\u00a0anterior<\/strong>\u00a0cruciate ligament starts at the anterior intercondylar region of the tibial bone, continue to ascend until it reaches the lateral condyle of the femur.\u00a0
                          It has 3 functional bundles, all are connected to the tibia, also named relatively to the attachment points (posterolateral, intermediate, and anteromedial).<\/li><\/ul>\n\n\n\n
                          • The\u00a0posterior\u00a0<\/strong>cruciate ligament is attached to the medial condyle of the femur (on its lateral side) and continues until reaches the intercondylar notch.\u00a0
                            • The inner fibers of the ligaments are creating functional bundles, and there are called relatively to the attachment areas to the femur.\u00a0<\/li><\/ul><\/li>
                            • The posterior cruciate ligament is larger than the anterior cruciate ligament, thus the posterior ligament is stronger. In case of a trauma to the ligaments, the posterior cruciate ligament can be tolerated better.<\/li><\/ul>\n\n\n<\/span>\n

                              The capsule<\/h3>\n<\/span>\n\n\n

                              The knee joint capsule consists of a fibrous membrane. Anteriorly and posteriorly.\u00a0
                              Anteriorly made of the patellar tendon.\u00a0
                              Posteriorly made of vertical fibers arise from femoral condyles and the proximal region of the tibia.\u00a0<\/p>\n\n\n<\/span>\n

                              Synovial membrane, plicae and fat pads<\/h4>\n<\/span>\n\n\n

                              The synovial membrane of the knee forms a few other structures which protect and lubricate the knee joint during motions and physical load.\u00a0\u00a0<\/p>\n\n\n\n

                              • Formation of\u00a0bursa<\/strong>– an extension arises from the joint cavity. Between the quadriceps muscle, the patella and femoral shaft.\u00a0<\/li><\/ul>\n\n\n\n
                                • Formation of a\u00a0pad<\/strong>– between the infrapatellar region and patellar tendon. According to this structure, the synovial membrane can project inside the joint and it creates folds. <\/li><\/ul>\n\n\n\n
                                  • These folds create a\u00a0plica<\/strong>, which is a mucosa of a ligament. The medial plica extends to the pouch at the suprapatellar region. This location might be complicated because it might easily inflame.\u00a0<\/li><\/ul>\n\n\n\n

                                    In the menisci area, synovial membrane does not present. The membrane forms niche for the menisci and the tendons in the posterior area.<\/p>\n\n\n<\/span>\n

                                    Bursae<\/h3>\n<\/span>\n\n\n

                                    Bursa (singular bursae) is a synovial fluid-filled sac, extends from the joint cavity. Its role is to decrease friction between hard tissues.
                                    In the knee joint there are two main bursae:<\/p>\n\n\n\n

                                    • The pes bursa<\/strong><\/li>
                                    • The semimembranosus bursa<\/strong><\/li><\/ul>\n\n\n<\/span>\n

                                      Patella<\/h3>\n<\/span>\n\n\n

                                      The patella is one of the bones creating the knee joint.
                                      It remines on the anterior side of the distal part of the femur bone.\u00a0
                                      Structurally the patella is made of trabecular bone, it is mostly flat, covered by lamina, and curved on its proximal region.\u00a0

                                      The anterior region of the patella- on the superior<\/strong> area the patella is attached to the quadriceps femoris muscle, on the inferior<\/strong> area it is attached to the rectus femoris muscle. \u00a0

                                      The patella vascular supply<\/strong> is done by two main arteries from the vehicular anastemoses:<\/p>\n\n\n\n

                                      • Anterior tibial recurrent artery<\/li>
                                      • Branches of popliteal artery<\/li><\/ul>\n\n\n<\/span>\n

                                        Clinical information<\/h3>\n<\/span>\n\n\n

                                        Discoid lateral meniscus<\/strong> is when the meniscus in an abnormal shape. A part of the discoid lateral meniscus is wider than it should be in normal cases. Patients usually are not aware of this issue and can figure it out by doing an arthroscopy. Although, some may \u201csuffer\u201d from \u2018clunking knee\u2019 symptom, which is a loud noise created by the knee joint. <\/p>\n\n\n\n

                                        Absent anterior cruciate ligament<\/strong> is a congenital condition. As the name implies, an absence of the anterior cruciate ligament in newborns. This condition causes instability and dysplasia of the lower limb.<\/p>\n<\/span>

                                        Movements<\/h3>

                                        Joints<\/h3>

                                        Superior tibiofibular joint<\/h4>

                                        Patellofemoral joint<\/h4>

                                        Tibiofemoral joint<\/h4>

                                        Menisci<\/h3>

                                        Medial meniscus<\/h4>

                                        Lateral meniscus<\/h4>

                                        Ligaments<\/h3>

                                        Transverse ligament<\/h4>

                                        Meniscofemoral ligaments <\/h4>

                                        Cruciate ligaments<\/h4>

                                        The capsule<\/h3>

                                        Synovial membrane, plicae and fat pads<\/h4>

                                        Bursae<\/h3>

                                        Patella<\/h3>

                                        Clinical information<\/h3><\/div>","protected":false},"excerpt":{"rendered":"

                                        Movements Most of the movements are controlled by the inferior part of the tibiofibular joint. The main movements of the knee joints are flexion, extension and rotation (lateral and medial): Flexion- mostly by biceps femoris muscle Extension- mostly by quadriceps femoris muscle Rotation (when the knee is flexed)- lateral by biceps femoris muscle, medial by […]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":3965,"menu_order":3,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-4123","page","type-page","status-publish","hentry"],"yoast_head":"\nKnee joint – Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/pre-clinical\/anatomy\/lower-limb\/leg\/knee-joint\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"7 minutes\" \/>\n<script type=\"application\/ld+json\" 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