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Anatomy and Biomechanics of the Knee

  • Anikar Chhabra
  • C. Curtis Elliott
  • Mark D. Miller

Abstract

Multiple ligament knee injuries, although rare, are severe injuries because they result in the loss of the passive and active knee stabilizers as well as often compromising neurovascular structures. Treatment of these injuries is controversial, and results after surgery are often poor. Because of the multiple ligament disruptions, the knee is at a biomechanical disadvantage. Surgeons performing reconstructions in patients with these injuries must have a complete understanding of the normal anatomy and biomechanics of the knee to optimize the timing of surgery, the order of ligamentous reconstruction, and the anatomic placement of grafts. This chapter outlines the osteology, the ligamentous stabilizers of the knee, the menisci, and the neurovasculature of the knee. The biomechanics of the knee are detailed by describing the roles of the anatomic structures and their relationships in the uninjured knee. In addition, commonly used grafts and surgical approaches are described. This knowledge is critical to surgeons attempting reconstruction of the multiple ligament injured knee.

Keywords

Anterior Cruciate Ligament Posterior Cruciate Ligament Medial Collateral Ligament Lateral Meniscus Medial Meniscus 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    Warren R, Arnoczky SP, Wickiewicz TL. Anatomy of the knee. In: Nicholas JA, Hershman EB, eds. The Lower Extremity and Spine in Sports Medicine. St. Louis, MO: CV Mosby; 1986: 657–694.Google Scholar
  2. 2.
    Insall JN, Kelly MA. Anatomy. In: Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti P, eds. Surgery of the Knee. 2nd ed. New York: Churchill Livingstone; 1993: 1–20.Google Scholar
  3. 3.
    Chapman MW, ed. Gray’s Anatomy. 30th American ed. Philadelphia: Lea & Febiger; 1985.Google Scholar
  4. 4.
    Feagin JA. Isolated anterior cruciate injury. In: Feagin JA, ed. The Cruciate Ligaments. New York: Churchill Livingstone; 1988: 15–23.Google Scholar
  5. 5.
    Smith BA, Livesay GA, Woo SL. Biology and biomechanics of the anterior cruciate ligament. Clin Sports Med 1993; 12: 637–670.PubMedGoogle Scholar
  6. 6.
    Arnoczky SP. Anatomy of the anterior cruciate ligament. Clin Orthop 1983; 172: 19–25.PubMedGoogle Scholar
  7. 7.
    Kennedy JC, Alexander IJ, Hayes KC. Nerve supply of the human knee and its functional importance. Am J Sports Med 1982; 10: 329–335.PubMedCrossRefGoogle Scholar
  8. 8.
    Shutte MJ, Dabezies EJ, Zimney ML, et al. Neural anatomy of the human anterior cruciate ligament. J Bone Joint Surg Am 1987; 69: 243–247.Google Scholar
  9. 9.
    Harner CD, Xerogeanes JW, Livesay GA, Carlin GJ, Smith BA, Kusayama T, Kashiwaguchi S, Woo SLY. The human posterior cruciate ligament complex: an interdisciplinary study. Am J Sports Med 1995; 23: 736–745.PubMedCrossRefGoogle Scholar
  10. 10.
    Johnson CJ, Bach BR. Current concepts review. Posterior cruciate ligament. Am J Knee Surg 1990; 3: 143–153.Google Scholar
  11. 11.
    Girgis FG, Marshall JL, Al Monajem ARS. The cruciate ligaments of the knee joint. Anatomic, functional, and experimental analysis. Clin Orthop 1975; 106: 216–231.PubMedCrossRefGoogle Scholar
  12. 12.
    Vladimirov B. Arterial sources of blood supply in the knee joint in man. Acta Med 1968; 47: 1–10.Google Scholar
  13. 13.
    Warren LF, Marshal JL. The supporting structures and layers of the medial side of the knee. J Bone Joint Surg Am 1979; 61: 56–62.PubMedGoogle Scholar
  14. 14.
    Chen FS, Rokito AS, Pitman MI. Acute and chronic posterolateral rotary instability of the knee. J Am Acad Orthop Surg 2000; 8: 97–110.PubMedGoogle Scholar
  15. 15.
    Seebacher JR, Ingilis AE, Marshal JL, et al. The structure of the posterolateral aspect of the knee. J Bone Joint Surg Am 1982; 64: 536–541.PubMedGoogle Scholar
  16. 16.
    Belzer JP, Cannon WD. Meniscal tears: treatment in the stable and unstable knee. J Am Acad Orthop Surg 1993; 1: 41–47.PubMedGoogle Scholar
  17. 17.
    Miller MD, Warner JJP, Harner CD. Meniscal repair. In: Fu FH, Harner CD, Vince KG, eds. Knee Surgery. Baltimore, MD: Williams & Wilkins, 1994.Google Scholar
  18. 18.
    Last RJ. The popliteus muscle and the lateral meniscus. J Bone Joint Surg Br 1950; 32: 93.Google Scholar
  19. 19.
    Miller MD, Gomez BA. Anatomy. In: Miller MD, ed. Review of Orthopaedics. 3rd ed. Philadelphia: WB Saunders; 2000: 519–583.Google Scholar
  20. 20.
    Miller MD. Sports medicine. In: Miller MD, ed. Review of Orthopaedics. 3rd ed. Philadelphia: WB Saunders; 2000: 195–240.Google Scholar
  21. 21.
    Burks RT, Schaffer JJ. A simplified approach to the tibial attachment of the posterior cruciate ligament. Clin Orthop 1990; 254: 216–219.PubMedGoogle Scholar
  22. 22.
    Woo SLY, Debski RE, Withrow JD, Janaushek MA. Biomechanics of knee ligaments. Am J Sports Med 1999; 27: 533–543.PubMedGoogle Scholar
  23. 23.
    Fu FH, Harner CD, Johnson DL, Miller MD, Woo SLY. Biomechanics of knee ligaments. J Bone Joint Surg Am 1993; 75: 1716–1727.Google Scholar
  24. 24.
    Lafortune MA, Cavanaugh PR, Sommer HJ III, Kalenak A. Three-dimensional kinematics of the human knee during walking. J Biomech 1992; 25: 347357.Google Scholar
  25. 25.
    Andriacchi TP. Knee joint, anatomy and biomechanics. In: Pellicci PM, Tria AJ, Garvin KL, eds. Orthopaedic Knowledge. Update Hip and Knee Reconstruction 2. Rosemont, IL: American Academy of Orthopaedic Surgeons; 2000: 239–249.Google Scholar
  26. 26.
    Mow VC, Ratcliffe A, Chern KY, Kelly MA. Structure and function relationships of the menisci of the knee. In: Mow VC, Arnoczky SP, Jackson DW, eds. Knee Meniscus: Basic and Clinical Foundations. New York: Raven Press; 1992: 37–57.Google Scholar
  27. 27.
    Procter CS, Schmidt MB, Whipple RR, Kelly MA, Mow VC. Material properties of the normal medial bovine meniscus. J Orthop Res 1989; 7: 771–782.CrossRefGoogle Scholar
  28. 28.
    Fithian DC, Kelly MA, Mow VC. Material properties and structure-function relationships in the menisci. Clin Orthop 1990; 252: 19–31.PubMedGoogle Scholar
  29. 29.
    Butler DL, Noyes FR, Grood ES. Ligamentous restraints to anterior-posterior drawer in the human knee. A biomechanical study. J Bone Joint Surg Am 1980; 62: 259–270.PubMedGoogle Scholar
  30. 30.
    Butler DL, Guan Y, Kay MD, et al. Location-dependent variations in the material properties of anterior cruciate ligament subunits. Trans Orthop Res Soc 1991; 16: 234.Google Scholar
  31. 31.
    Miller MD, Cooper DE, Warner JJP. Review of Sports Medicine and Arthroscopy. Philadelphia: WB Saunders; 1995: 3–71.Google Scholar
  32. 32.
    Woo SLY, Adams DJ. The tensile properties of the human anterior cruciate ligament and ACL graft tissues. In: Daniel DM, Akeson WH, O’Conner JJ, eds. Knee Ligaments, Structure, Function, Injury, and Repair. New York: Raven Press; 1990: 279–289.Google Scholar
  33. 33.
    Gollehon DL, Torzilli PA, Warren RE The role of posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 1987; 69: 233–242.PubMedGoogle Scholar
  34. 34.
    Covey DC, Sapega AA. Current concepts review. Injuries of the posterior cruciate ligament. J Bone Joint Surg 1993; 75: 1376–1386.PubMedGoogle Scholar
  35. 35.
    Fox RJ, Harner CD, Sakane M, Carlin GJ, Woo SLY. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology, a cadaveric study. Am J Sports Med 1998; 26: 395–401.PubMedCrossRefGoogle Scholar
  36. 36.
    Harner CD, Hoher J, Vogrin TM, Carlin GJ, Woo SLY. The effects of a popliteus muscle load on in situ forces of the posterior cruciate ligament and on knee kinematics. Am J Sports Med 1998; 26: 669–673.PubMedGoogle Scholar
  37. 37.
    Burstein AH, Wright TM. Biomechanics. In: Insall JN, Windsor RE, Scott WN, Kelly MA, Aglietti P, eds. Surgery of the Knee, 2nd ed. New York: Churchill Livingstone; 1993: 43–62.Google Scholar
  38. 38.
    Muller WD. Kinematics. In: Muller W, ed. The Knee, Form, Function, and Ligament Reconstruction. New York: Springer-Verlag; 1983: 8–28.Google Scholar
  39. 39.
    Morrison JB. The mechanics of the knee joint in relation to normal walking. J Biomech 1970; 3: 51.PubMedCrossRefGoogle Scholar
  40. 40.
    Elftman H. The forces exerted by the ground in walking. Arb Physiol 1939; 10: 485.Google Scholar
  41. 41.
    Satterwhite Y. The anatomy and biomechanics of the medial structures of the knee. In: Drez D, DeLee JC, eds. Operative Techniques in Sports Medicine. 1996; 4: 134–140.Google Scholar
  42. 42.
    Coffer H. Mechanical function of the patella. J Bone Joint Surg Am 1971; 53: 1551.Google Scholar
  43. 43.
    Goodfellow J, Hungerford D, Woods C. Patellofemoral joint mechanics and pathology of chondromalacia-patella. J Bone Joint Surg Br 1976; 59: 291.Google Scholar
  44. 44.
    Last RJ. Anatomy: Regional and Applied. 6th ed. Edinburgh: Churchill Livingstone; 1978.Google Scholar
  45. 45.
    Desio SM, Burks RT, Bachus KN. Soft tissue restraints to the lateral patellar translation in the human knee. Am J Sports Med 1998; 26: 59–65.PubMedGoogle Scholar
  46. 46.
    Prietto MP, Bain JR, Stonebrook SN, Settlage RA. Tensile strength of the human posterior cruciate ligament (PCL). Trans Orthop Res Soc 1988; 13: 195.Google Scholar
  47. 47.
    Woo SLY, Newton PO, MacKenna DA, Lyon RA. A comparative evaluation of the mechanical properties of the rabbit medial collateral and anterior cruciate ligaments. J Biomech 1992; 25: 377–386.PubMedCrossRefGoogle Scholar
  48. 48.
    Cooper DE, Deng XH, Burstein AL, Warren RE The strength of the central third patellar tendon graft, a biomechanical study. Am J Sports Med 1993; 21: 818–823.PubMedCrossRefGoogle Scholar
  49. 49.
    Meyers M, Harvey JJ. Traumatic dislocation of the knee joint: a study of eighteen cases. J Bone Joint Surg Am 1971; 53: 16–29.PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2004

Authors and Affiliations

  • Anikar Chhabra
  • C. Curtis Elliott
  • Mark D. Miller

There are no affiliations available

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