Muscles of

the knee
joint

Extensors Flexors

Quadriceps
Hamstrings Popliteus
femoris
 Rectus Femoris Origin:
Straight head: anterior inferior iliac spine (AIIS)
Reflected head: an area above the acetabulum.

Vastus Origin: lower part of intertrochanteric line, spiral

line, medial lip of linea aspera, and medial
medialis supracondylar ridge.

Origin: Root of greater trochanter, lateral lip of

Vastus lateralis gluteal tuberosity, and lateral lip of linea aspera.

Quadriceps
Vastus Origin: Upper 2/3 of anterolateral surface of the femur.
Femoris intermedius

Insertion: The 4 muscles fuse to form quadriceps tendon. It is inserted into the base of the patella, and
continue as ligamentum patellae to be inserted into the tibial tuberosity
Action : It is the main extensor of knee joint.
• Rectus femoris can flex the thigh at the hip joint.
Innervation: Femoral nerve
 Origin: long head: ischial tuberosity + sacrotuberous ligament.
Biceps femoris Short head: lower part of lateral lip of linea aspera + upper
part of lateral supracondylar ridge.
Insertion: Into the head of fibula.
Action: Flexion of the leg at the knee joint.Lateral rotation of
the semi-flexed leg at the knee joint.Extension of the thigh at
the hip joint (long head only). It is used in walking.

Hamstrings Semitendinosis Origin: Ischial tuberosity (with long head of biceps femoris).
Insertion: Into the SGS area (upper part of medial surface of
the tibia).

Origin: Ischial tuberosity.

Semimembranosis Insertion: Into a groove behind the medial tibial condyle.

Action of both semi: Flexion of the leg at the knee joint.Medial rotation of the semi-flexed leg at the knee
joint.Extension of the thigh at the hip joint (long head only). It is used in walking.

Innervation: All hamstring muscles are supplied by sciatic nerve through its tibial part EXCEPT short head of biceps
which is supplied by its common peroneal (common fibular) part.
 Origin : Lateral aspect of the lateral femoral condyle (popliteal
groove)
Insertion: Lateral aspect of the lateral femoral condyle
(popliteal groove)
Popliteus Action: Flexion of the leg at the knee joint. Medial rotation of
the tibia and lateral rotation of the femur at the knee joint.
• It is the un-locker of the knee joint

Innervation: tibial part of sciatic nerve

• Other muscles that act on the knee:
• Sartorius
• Gracilis
• Gastrocnemius
• Plantaris
• Flex the knee
• Tensor fascia lata
• Extends the knee
 Ligaments at the Knee
Medial collateral Lateral collateral Anterior cruciate Posterior cruciate
Posterior capsule
ligaments ligaments ligaments ligaments
Medial collateral
ligaments
The larger superficial part arise from the medial
epicondyle of the femur, course distally to blend
with medial patellar retinacular fibers before
attaching to the medial-proximal aspect of the
tibia. The fibers attach just posterior to the
distal attachments of the closely aligned tendons
of the sartorius and the gracilis.
The deep part of the MCL consists of a shorter and more
oblique set of fibers, lying immediately deep and
slightly, posterior and distal to the proximal
attachment of the superficial fibers. the deep
fibers attach distally to the posterior-medial joint
capsule, medial meniscus, and tendon of the
semimembranosus muscle.
Lateral collateral
ligaments
Relatively short, cord like structure that
runs nearly vertically between the
lateral epicondyle of the femur and the
head of the fibula the lateral collateral
ligament blends with the tendon of the
biceps femoris muscle. The lateral
collateral ligament typically does not
attach to the adjacent (lateral)
meniscus. As the tendon of the popliteus
courses between the lateral meniscus
and the lateral collateral ligament.
Anterior cruciate
ligaments
• Attaches along an impression on
the anterior intercondylar area of
the tibial plateau.
• The ligament runs obliquely in a
posterior, superior, and lateral
direction to attach on the medial
side of the lateral femoral condyle.
• It has two sets of fiber bundles
within the ACL: anterior-medial
and posterior-lateral, named
according to their relative
attachments to the tibia.
Posterior cruciate ligaments

• Slightly thicker than the ACL, the

posterior cruciate ligament (PCL)
attaches from the posterior intercondylar
area of the tibia to the lateral side of the
medial femoral condyle
• The specific anatomy of the PCL is
typically described as having two primary
bundles: a larger anterior set (anterior-
lateral), forming the bulk of the ligament,
and a smaller posterior set (posterior-
medial)
Acting together, the anterior and posterior cruciate ligaments
resist the extremes of essentially all knee movements
Posterior capsule
• The posterior capsule is reinforced by the oblique
popliteal ligament and the arcuate popliteal ligament
.
• The oblique popliteal ligament originates medially from the
posterior-medial capsule and the semimembranosus
tendon. Laterally and superiorly, the fibers blend
with the capsule adjacent to the lateral femoral
condyle. This ligament is pulled taut in full knee
extension, a position that naturally includes slight
external rotation of the tibia relative to the femur.
• The arcuate popliteal ligament originates from the fibular
head and divides into two limbs. The larger and more
prominent limb arches (hence the term "arcuate")
across the tendon of the popliteus muscle to attach to
the posterior intercondylar area of the tibia.
Capsule and Reinforcing Ligaments

Anterior capsule Lateral capsule

Posterior capsule Medial capsule
 MENISCI
• THE MEDIAL AND LATERAL
MENISCI ARE CRESCENT-SHAPED,
FIBROCARTILAGINOUS
STRUCTURES LOCATED WITHIN
THE KNEE JOINT.
• ACTING AS GASKETS, THE MENISCI
TRANSFORM THE ARTICULAR
SURFACES OF THE TIBIA INTO
SHALLOW SEATS FOR THE LARGER
CONVEX FEMORAL CONDYLES.
• THIS TRANSFORMATION IS MOST
IMPORTANT LATERALLY BECAUSE
OF THE FLAT TO SLIGHTLY
CONVEX SHAPE OF THE TIBIA'S
LATERAL ARTICULAR SURFACE.
• The primary function of the menisci
is to reduce the compressive stress* across the
tibiofemoral joint.

• Other functions of the menisci

1. Stabilizing the joint during motion
2. Lubricating the articular cartilage
3. Providing proprioception
4. Helping to guide the knee's
arthrokinematics.
• By nearly tripling the area of joint contact, the
menisci significantly reduce pressure (i.e., force
per unit area) on the articular cartilage.
OSTEOKINEMATICS AT
THE TIBIOFEMORAL JOINT

• Flexion and extension at the knee

occur about a medial-lateral axis of
rotation for both tibial-on-femoral and
femoral-on-tibial Situations. Range of
motion varies with age and gender, but in
general the healthy knee moves from 130
to 150 degrees of flexion to about 5 to 10
degrees beyond the 0-degree (straight)
position
OSTEOKINEMATICS AT THE
TIBIOFEMORAL JOINT
• Internal and External (Axial) Rotation
These kinematics occur as a rotation in
a plane located perpendicular to a
longitudinal axis that parallels the
shaft of the tibia. The precise location
of the axis of rotation as it parallels
the tibia is not clear, although it
appears to be influenced by the
accompanying sagittal plane rotation
of the knee.
ARTHROKINEMATICS
AT THE
TIBIOFEMORAL JOINT
"Screw-Home" Rotation of the Knee

• Locking the knee in full extension

requires about 10 degrees of external
rotation.
• The external rotation described here is
fundamentally different from the axial
rotation
Patellofemoral Joint

• The patellofemoral joint is the

interface between the articular
side of the patella and the
trochlear groove of the femur.
 Rectus Vastus
femoris medialis
EXTENSORS OF
THE KNEE:
QUADRICEPS
FEMORIS MUSCLE
Vastus Vastus
lateralis intermedius
 Functional Considerations

ISOMETRIC CONCENTRIC ECCENTRIC

External torque-
knee angle
relationships for
the two methods of
extending the knee
Internal Torque-Joint Angle
Relationship of the Quadriceps
Muscle

• Maximal knee extension

(internal) torque typically
occurs between 45 and 70
degrees of knee flexion, with
less torque produced at the
near extremes of flexion and
extension.
• Note the rapid decline in
internal torque potential as
the knee angle approaches
full extension
Functional Role of
the Patella
• The patella functions as
a "spacer" between the
femur and quadriceps
muscle, which increases
the internal moment
arm of the knee extensor
mechanism.
 The
patella

factors affect the

moment arm

The
medial The distal
lateral femur
axis
PATELLOFEMORAL KINJOINTETICS

The patellofemoral joint is routinely

exposed to high magnitudes of
compression force.

7.8 times body

1.3 times body 2.6 times body
3.3 times body weight during
weight during weight during
weight during performance of
walking on level performance of a
climbing of stairs deep "knee bends"
surfaces straight leg raise
or squats.
• Two Interrelated Factors Associated with Joint
Compression Force on the Patellofemoral Joint

1. Force within the quadriceps

muscle
2. Knee flexion angle
FACTORS AFFECTING THE TRACKING OF THE
PATELLA ACROSS THE PATELLOFEMORAL JOINT

A joint with less than optimal congruity

Abnormal "tracking" of the patella

Higher joint contact stress

Increasing its risk for developing degenerative lesions and pain

Lead to patellofemoral pain syndrome or potentially trigger

osteoarthritis
A. Role of the Quadriceps Muscle in
Patellar Tracking

• Among the most important influences on

patellofemoral joint biomechanics are the
magnitude and direction of force produced by
the overlying quadriceps muscle
• Assessing the overall lateral line of pull of the
quadriceps relative to the patella is a
meaningful clinical measure. Such a measure is
referred to as the quadriceps angle, or more
commonly the Q-angle
B. Factors That Naturally Oppose the Lateral Pull of the
Quadriceps on the Patella
OPTIMAL TRACKING
• is defined as movement between the
patella and femur across the greatest
possible area of articular surface with the
least possible stress.

Local factors
• act directly on the patellofemoral joint.

Global factors
• related to the alignment of the bones
and joints of the lower limb.

Although these factors are described as separate entities, in reality, their effectiveness in
optimizing patellar tracking is based on the sum of their combined influences.
 A large lateral
Biomechanically, the
bowstringing force has
overall lateral pull of the
the tendency to pull the
quadriceps produces a
patella laterally over a
lateral "bowstringing"
region of reduced contact
force on the patella
area

Local Factors
Potentially increasing the Increasing the stress on
likelihood of dislocation. its articular surfaces
 The lateral facet of the
trochlear groove

Structures that oppose

The oblique fibers of the
the lateral vastus medialis
bowstringing force

the medial patellar

retinacular fibers
Global Factors
• The magnitude of the lateral bowstringing force applied to the patella
is strongly influenced by the frontal and horizontal plane alignment of
the bones associated with the knee extensor mechanism.
• factors that resist excessive valgus or the extremes of axial rotation of
the tibiofemoral joint favor optimal tracking of the patellofemoral
joint. These factors are referred to as "global" in the sense that they
are associated with joints distant to the patellofemoral joint, as far
removed as the hip and the subtalar joint of the foot.
A. Excessive genu valgum
1. laxity of or injury to the MCL of the knee
2. Weakness of the hip abductor muscles or tightness of the hip adductor
3. excessive pronation (eversion) of the subtalar joint
B. External rotation of the knee
• Excessive external rotation of the knee is expressed in a weight-bearing position, as the
femur is internally rotated
1. Reduced strength or neuromuscular control of the external rotator muscles of the hip
2. Tightness of the hip internal rotator muscles
3. Compensation for excessive femoral anteversion or excessive tibial (external) torsion
C. Excessive internal rotation of the knee
• Data show that females experience a greater incidence of abnormal
kinematics and related pathology at the patellofemoral joint than males.
84' 312 Data collected at a large sports medicine clinic, for instance,
showed that recurrent lateral dislocation of the patella accounted for
58.4% of all joint dislocations in women, compared with only 14% in
men.65 It has been speculated that the gender bias in chronic patellar
dislocation may in some persons be biomechanically associated with the 3
to 4 degrees of greater Q-angle often measured in females. 136 A greater
Q-angle may reflect a greater pelvic width-to-femoral length ratio in
females. 244 Whether the apparent greater Q-angle in females (and
assumed greater lateral bowstringing force on the patella) alters patellar
tracking and stress to a point of actually causing an increased incidence in
dislocation and stress-related pain is difficult to prove, although this is a
logical point to consider
• Abnormal tracking of the patella is a complicated topic for a number
of reasons. First, tracking kinematics are subtle, highly variable, and
difficult to measure. Second, the link between abnormal tracking and
pathology is not well established or universally agreed upon.