The Knee
This chapter will discuss the anatomy, biomechanics, and pathology of the knee. The function of the knee is provided primarily by the soft tissue. Therefore, injury to these soft tissue structures will have significant impact upon the stability of the kne
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The Knee Brian G. Evans and Mark W. Zawadsky
This chapter will discuss the anatomy, biomechanics, and pathology of the knee. The function of the knee is provided primarily by the soft tissue. Therefore, injury to these soft tissue structures will have significant impact upon the stability of the knee.
Anatomy The osseous anatomy of the knee consists of the proximal tibia, the distal femur, and the patella (Fig. 12.1). The distal femur consists of the medial and lateral condyles, the medical and lateral epicondyles, femoral trochlear groove, and the intercondylar notch. The medial condyle is larger and extends slightly distal compared to the lateral condyle. Both condyles are covered with articular cartilage. The trochlear groove lies on the anterior aspect of the distal femur between the medial and lateral femoral condyles. This surface is also covered by the articular cartilage and serves as the site of articulation of the patella. The lateral rim of the trochlear groove is frequently more prominent than the medial side to allow for proper patellar tracking along the femur. The epicondyles serve as the site of insertion of several important structures. The deep and superficial medial collateral ligaments (MCL) attach to the medial epicondyle. The proximal margin of the medial epicondyle is enlarged and serves as the site of insertion of the adductor magnus (the adductor tubercle). The lateral or fibular collateral ligament (LCL) attaches to the lateral epicondyle. Inferior to the attachment of the LCL is the insertion of the popliteous muscle at the junction
B.G. Evans (B) Department of Orthopedic Surgery, Georgetown University Medical Center, Washington, DC 20007, USA e-mail: [email protected]
S.W. Wiesel, J.N. Delahay (eds.), Essentials of Orthopedic Surgery, C Springer Science+Business Media, LLC 2010 DOI 10.1007/978-1-4419-1389-0_12,
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B.G. Evans and M.W. Zawadsky
Fig. 12.1 Bony anatomy and major ligamentous structures of the flexed knee joint (anterior view)
of the lateral condyle and epicondyle. The medial and lateral heads of the gastrocnemius muscle originate from the medial and lateral posterior femoral condyles. The intercondylar notch is the site of the femoral attachment of the cruciate ligaments. The anterior cruciate ligament (ACL) attaches in the posterior lateral aspect of the notch and the posterior cruciate ligament (PCL) attaches in the anterior medial aspect of the notch. The proximal tibial surface is composed of the medial and lateral plateaus and the intercondylar eminence. The medial plateau is larger and extends further posterior compared to the lateral plateau. The surface of the medial plateau is slightly concave. The lateral tibial plateau is in fact slightly convex. Both of the tibial plateaus are covered with articular cartilage. The intercondylar eminence is the site of attachment menisci and the cruciate ligaments. The patella is a sesamoid bone within the tendon of the quadriceps mechanism. There are two major facets on the patella, the medial and later
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