Chisholm Institute
Department of Health and Community Care
Diploma of Remedial Massage HLT50307
Anatomy & Physiology 2
Session 27: The knee joint.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
1
The knee joint
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
2
Osteology of the knee joint
 Bony anatomy:
- femur
- medial & lateral condyles
- medial & lateral epicondyles
- adductor tubercle
- popliteal surface
- intercondylar ridge
- intercondylar groove (for patella)
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
3
Osteology of the knee joint
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
4
Osteology of the knee joint
 Tibia
- medial & lateral condyles
- intercondylar eminence
- tibial tuberosity
- superior tib-fib joint
 Patella
- base of the patella (superior)
- apex of the patella
 Fibula
- head of the fibula
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
5
Osteology of the knee joint
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
6
Osteology of the knee joint
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
7
Joints of the knee
Patellofemoral joint (PFJ):
 Articulation between the patella
and the anterior surface of the femur
 The PFJ is a plane type of synovial joint.
 The articular surfaces are the facets on the posterior
patella & the anterior aspect of the femoral condyles.
 The patella is a sesamoid bone.
 One role of the patella is to increase the leverage of
the quadriceps tendon, by keeping it away from the
axis of the joint.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
8
Joints of the knee
Patellofemoral joint:
• The patella is susceptible to dislocation due to
excessive pull of vastus lateralis.
 To counter this, protective
measures include:
- a raised lateral condyle
on the femur
- medial pull of
vastus medialis.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
9
Joints of the knee
Tibiofemoral joint: - “knee” joint
• The articulation between the femur and the tibia is
considered the true knee joint.
• Described as a modified synovial hinge joint as it has the
additional features of menisci and cruciate ligaments.
 This enables a slight gliding and rotation during locking
and unlocking of the knee.
 It is enclosed within a joint capsule, which facilitates
many functions and requirements of the knee joint.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
10
Joints of the knee
Superior tib-fib joint:
• Articulation between the head of the fibula & the
undersurface of the lateral tibial condyle
• Plane synovial joint
• Anterior & posterior ligaments of the head of the
fibula support the joint
• Slight movement at the joint to give greater flexibility
between the tibia & fibula during ankle movements
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
11
Supporting structures of the
knee
Menisci of the knee joint:
 The menisci are circular rims of fibrocartilage situated on
the articular surfaces of the head of the tibia that aid in
the congruency (fit) of the knee joint.
 Their functions include:
- enabling rotation to occur,
- acting as shock absorbers and
- assisting in the spread of synovial fluid.
 They attach to the periphery of their respective condyles
on the tibial plateau
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
12
Supporting structures of the
knee
Menisci of the knee joint:
 The medial meniscus is longer and more crescent in shape. It
blends with the medial collateral ligament and this predisposes it to
injury.
 The lateral meniscus is shorter and more circular in shape and is
separated from the lateral collateral ligament by popliteus.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
13
Supporting structures of the
knee
Ligaments of the the knee joint (extrinsic):
 Patellar ligament/tendon – this is a strong, flat ligament
connecting the lower margin of the patella with the tibial
tuberosity.
 The superficial fibres are continuations of the quadriceps
femoris tendon.
Chisholm Institute Diploma of Remedial
Massage & Myotherapy Version 1.12
14
Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Medial (Tibial) Collateral ligament
 otherwise known as the ‘MCL’, it extends from the medial
epicondyle of the femur to the medial condyle of the tibia and
medial shaft
 It is a strong, flat, band-like ligament and blends with medial
meniscus.
 It passes downwards and
slightly forwards from
origin to insertion
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
15
Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Lateral (Fibular) Collateral ligament
 otherwise known as the ‘LCL’, it extends from the lateral
epicondyle of the femur to the head of fibula.
 It is a thick, cord-like ligament that also splits the tendon of
biceps femoris.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
16
Supporting structures of the
knee
Ligaments of the knee joint (extrinsic):
 Oblique popliteal ligament
 this is a broad, flat ligament covering the back of the knee
joint.
 Medially, it blends with the semimembranosus tendon and
laterally with the lateral head of the gastrocnemius muscle.
 It protects the knee against hyperextension.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
17
Supporting structures of the
knee
Ligaments of the knee (extrinsic):
 Transverse ligament
 this is a short, slender ligament that connects from the anterior
margins of the lateral meniscus to the medial meniscus.
 Patellar retinaculum
 medial and lateral retinaculum
 provides support for the patella attaching to the femur and
tibia.
 This region may contribute to knee pathologies and is useful to
treat using DIP.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
18
Supporting structures of the
knee
Ligaments of the knee (extrinsic):
 Iliotibial band (ITB)
 otherwise known as the ‘iliotibial tract’, this strong
ligamentous like structure, which attaches to the tensor fascia
latae muscle, provides stabilisation for the lateral aspect of the
knee joint
Chisholm Institute - Diploma of Remedial Massage &
Myotherapy - Version 1.12
19
Supporting structures of the
knee
Ligaments of the knee (extrinsic):
The infrapatella ligament (deep) lies between the patella
ligament and the anterior surface of the tibia, superior to the
tibial tuberosity
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
20
Supporting structures of the
knee
Ligaments of the knee (intrinsic):
 Anterior cruciate ligament
 otherwise known as the ‘ACL’, this ligament arises anteriorly,
from the intercondylar ridge of the tibia.
 It passes upward & backward to the intercondylar notch of the
femur (on the medial side of the lateral condyle).
 The ACL prevents anterior displacement of the tibia and therefore is
taut in extension of the knee.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
21
Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Anterior cruciate ligament:
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
22
Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Anterior cruciate ligament
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
23
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
24
Supporting structures of the
knee
Ligaments of the knee (intrinsic):
 Posterior cruciate ligament
 otherwise known as the ‘PCL’, this ligament arises posteriorly,
from the intercondylar ridge of the tibia.
 It passes upward & forward to the intercondylar notch of the
femur (on the medial condyle).
 The PCL prevents posterior displacement of the tibia.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
25
Supporting structures of the
knee
Ligaments of the knee (intrinsic):
Posterior cruciate ligament:
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
26
Supporting structures of the
knee
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
27
 Lateral (Fibular) Collateral ligament
 otherwise known as the ‘LCL’, it extends from the
lateral epicondyle of the femur to the head of fibula.
 It is a thick, cord-like ligament that also splits the
tendon of biceps femoris.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
28
Supporting structures of the
knee
Bursae surrounding the knee joint:
 There are many bursae within the knee joint.
 The suprapatella bursa is one of the largest in the body.
- It extends upward from the knee joint under the
quadriceps muscle.
 The prepatellar bursa is located deep to the skin overlying
the patella.
 The infrapatella bursa (subcutaneous) lies directly over the
tibia, deep to the distal aspect of the patella ligament and tibial
tuberosity.
 Bursae also lie in the regions of popliteus, pes anserine,
gastrocnemius and semimembranosus.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
29
 Bursae also lie in the regions of popliteus, pes anserine,
gastrocnemius and semimembranosus.
Chisholm Institute - Diploma of Remedial Massage & Myotherapy Version 1.12
30
Movements of the knee joint
 The knee can usually extend to 180 deg’s although it is
not uncommon for some knees to hyperextend up to 10
deg’s or more. When recorded, this is listed as 0 degrees
 When the knee is in full extension, it can move to about
140 deg’s of flexion.
 With the knee flexed (30 deg’s or more), approximately
30 deg’s of tibial IR, and 45 deg’s of tibial ER can occur.
 Knee ROM:
flexion
= 0-140*
extension
= 0* (hyperE -10*)
tibial IR at 30* F
= 30*
tibial ER at 30* F = 45*
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
31
Muscles about the knee joint
Name
Quads:
Rectus femoris
Vastus lateralis
Vastus medialis
Vastus intermedius
Hamstrings:
Biceps femoris
Origin
AIIS
Lateral fem
Medial fem
Anterior fem
Insertion
Patellar
tendon/
ligament
Head of
fibula
Med tib cond
Med tib cond
Action
Innervation
Knee
extension
L2-L4
Femoral nerve
Knee
flexion
L5-S2
+ common
peroneal n.
Tibial portion
sciatic nerve
Semitendinosus
Semimembranosus
Ischial tub +
linea aspera
Ischial tub
Ischial tub
Popliteus
Lat fem cond Posterior tib
Lat rot fem
L5 tibial nerve
Gracilis
Inf pubic
ramus
Medial surf
tibial shaft
Knee
flexion
L2-L3
obturator n
Sartorius
ASIS
Med tib shaft
Lat rot fem
L2-3 femoral n
Gastrocemius
Med + lat
cond
Achilles
tendon
Knee flex
S1-2 tibial n
Biomechanical application
 1. Analyse the movements associated with mogul
skiing. What structures surrounding the knee joint
would be most susceptible to injury in this type of
sport?
 2. Describe the structures most at risk if an AFL
football player is tackled from in front and his
opponent lands across his outstretched leg.
 3. Determine which structures will be most affected in
a client who walks with a genu valgum gait pattern
Chisholm Institute - Diploma of Remedial Massage & Myotherapy - Version 1.12
33