Knee

  • Anatomy
  • Conditions
  • Treatments

Knee Anatomy

The knee is a complex joint made up of different structures including bones, tendons, ligaments and muscles. They all work together to maintain normal function and provide stability to the knee during movement.

Having a well-functioning healthy knee is essential for our mobility and ability to participate in various activities. Understanding the anatomy of the knee enhances your ability to discuss and choose the right treatment procedure for knee problems with your doctor.

Bones of the Knee

The knee is a hinge joint made up of two bones, the thighbone (femur) and the shinbone (tibia). There are two round knobs at the end of the femur called femoral condyles which articulate with the flat surface of the tibia called the tibial plateau. The tibia plateau on the inside of the leg is called the medial tibial plateau, and on the outside of the leg it is called the lateral tibial plateau.

The two femoral condyles form a groove on the front (anterior) side of the knee called the patellofemoral groove. A small bone called the patella sits in this groove and forms the kneecap. It acts as a shield and protects the knee joint from direct trauma.

A fourth bone called the fibula is the other bone of the lower leg. This forms a small joint with the tibia. This joint has very little movement and is not considered a part of the main joint of the knee.

Articular Cartilage and Menisci of the Knee

Movement of the bones causes friction between the articulating surfaces. To reduce this friction, all articulating surfaces involved in movement are covered with a white, shiny, slippery layer called articular cartilage. The articulating surface of the femoral condyles, tibial plateaus and the back of the patella are covered with this cartilage. The cartilage provides a smooth surface that facilitates easy movement.

To further reduce friction between the articulating surfaces of the bones, the knee joint is lined by a synovial membrane which produces a thick clear fluid called synovial fluid. This fluid lubricates and nourishes the cartilage and bones inside the joint capsule.

Within the knee joint, between the femur and tibia, there are two C shaped cartilaginous structures called menisci. Menisci function to provide stability to the knee by spreading the weight of the upper body across the whole surface of the tibial plateau. The menisci help in load- bearing by preventing the weight from concentrating onto a small area, which could damage the articular cartilage. The menisci also act as a cushion between the femur and tibia by absorbing the shock produced by activities such as walking, running and jumping.

Ligaments of the Knee

Ligaments are tough bands of tissue that connect one bone to another bone. The ligaments of the knee function to stabilize the knee joint. There are two important groups of ligaments that hold the bones of the knee joint together, collateral ligaments and the cruciate ligament.

Collateral ligaments are present on either side of the knee. They function to prevent the knee from moving too far during side to side motion. The collateral ligament on the inside is called the medial collateral ligament (MCL) and the collateral ligament on the outside is called the lateral collateral ligament (LCL).

Cruciate ligaments, present inside the knee joint, control the back-and-forth motion of the knee. The cruciate ligament in the front of the knee is called anterior cruciate ligament or ACL and the cruciate ligament in the back of the knee is called posterior cruciate ligament or PCL.

Muscles of the Knee

Muscles: There are two major muscles, the quadriceps and the hamstrings, which enable movement of the knee joint. The quadriceps muscles are in the front of the thigh. When the quadriceps muscles contract, the knee straightens. The hamstrings are in the back of the thigh. When the hamstring muscles contract, the knee bends.

Tendons of the Knee

Tendons are structures that attach muscles to the bone. The quadriceps muscles of the knee meet just above the patella and attach to it through a tendon called the quadriceps tendon. The patella further attaches to the tibia through a tendon called the patella tendon. The quadriceps muscle, quadriceps tendon and patellar tendon all work together to straighten the knee. Similarly, the hamstring muscles at the back of the leg are attached to the knee joint with the hamstring tendon.

Meniscal Tears

Meniscal Tears

Meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knee causes the meniscus to tear. This is a traumatic meniscus tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age. The two wedge-shaped cartilage pieces present between the thighbone and the shinbone are called meniscus. They stabilize the knee joint and act as “shock absorbers”.

Knee Osteoarthritis

Knee Osteoarthritis

Knee osteoarthritis (OA) is a common form of arthritis that causes joint pain and stiffness. It is a progressive disease in which the joint cartilage gradually wears away and may lead to disability.

Patellar Dislocation

Patellar Dislocation

Patella (kneecap) is a protective bone attached to the quadriceps muscles of the thigh by quadriceps tendon. Patella attaches with the femur bone and forms a patellofemoral joint. Patella is protected by a ligament which secures the kneecap from gliding out and is called as medial patellofemoral ligament (MPFL).

Other Conditions

Knee Pain

Knee Pain

Knee pain is a common condition affecting individuals from different age groups. It not only affects movement but also impacts the quality of life of the individual. An injury or disease of the knee joint or any structure surrounding the knee can result in knee pain.

Knee Trauma

Knee Trauma

Pain, swelling and stiffness are the common symptoms of any damage or trauma to the knee. If care is not taken during the initial phases of trauma, it may lead to joint damage that may end up destroying your knee.

ACL Tears

ACL Tears

An ACL injury is a sports-related injury that occurs when the knee is forcefully twisted or hyperextended. An ACL tear usually occurs with an abrupt directional change with the foot fixed on the ground or when the deceleration force crosses the knee.

Multiligament Instability

Multiligament Instability

The four major ligaments of the knee are anterior cruciate ligament, posterior cruciate ligament, medial collateral ligament and lateral collateral ligament. They play an important role in maintaining the stability of the knee. A multiligament injury is a tear in one or more ligaments of the knee, thus affecting the knee stability.

Knee Arthritis

Knee Arthritis

Arthritis is a general term covering numerous conditions where the joint surface or cartilage wears out. The joint surface is covered by a smooth articular surface that allows pain-free movement in the joint. This surface can wear out for several reasons; often the definite cause is not known. Arthritis often affects the knee joint.

MCL Tears

MCL Tears

Medial collateral ligament (MCL) injury can result in a stretch, partial tear, or complete tear of the ligament. Injuries to the MCL commonly occur because of pressure or stress on the outside part of the knee.

Osteochondritis Dissecans

Osteochondritis Dissecans

The knee, mostly the femoral condyles are most commonly affected. The two femoral condyles make up for the rounded end of femur (thighbone). Each knee has two femoral condyles, the medial femoral condyle on the inside of the knee and the lateral femoral condyle on the outside of the knee. Osteochondritis dissecans occurs within the lateral aspect of the medial femoral condyle. The condition can also occur in other joints, including your elbows, ankles, shoulders and hips.

Non-surgical Treatments

Pharmacological

Pharmacological

The knee is a complex joint which consists of bone, cartilage, ligaments and tendons that make joint movements easy and at the same time more susceptible to various kinds of injuries. Knee problems may arise if any of these structures get injured by overuse or suddenly during sports activities. Injuries to the knee can be caused by degenerative disease such as arthritis, traumatic injuries and sports injuries. These conditions may affect the bones & joints and impair the mobility as well as the quality of life of the patients.

Cortisone Injection

Cortisone Injection

Cortisone is a corticosteroid released by the adrenal gland in response to stress and is a potent anti-inflammatory agent.Cortisone injections are recommended in injuries that cause pain and inflammation, and those that don’t require surgical treatment. One such condition is frozen shoulder.

Viscosupplementation

Viscosupplementation

Viscosupplementation refers to the injection of a hyaluronan preparation into the joint. Hyaluronan is a natural substance present in the joint fluid that assists in lubrication. It allows smooth movement of the cartilage covered articulating surfaces of the joint.

Physiotherapy

Physiotherapy

Physiotherapy or physical therapy is an exercise program that helps you to improve movement, relieve pain, encourage blood flow for faster healing, and restore your physical function and fitness level. It can be prescribed as an individual treatment program or combined with other treatments. It involves a combination of education, manual therapy, exercises and techniques such as water, heat, cold, electrical stimulation and ultrasound.

Surgical Treatment

Knee Arthroscopy

Knee Arthroscopy

The knee joint is one of the most complex joints of the body. The lower end of the thighbone (femur) meets the upper end of the shinbone (tibia) at the knee joint. A small bone called the patella (kneecap) rests on a groove on the front side of the femoral end. A bone of the lower leg (fibula) forms a joint with the shinbone.

Meniscal Surgery

Meniscal Surgery

A meniscus tear is the commonest knee injury in athletes, especially those involved in contact sports. A sudden bend or twist in your knee can cause the meniscus to tear. This is a traumatic meniscal tear. Elderly people are more prone to degenerative meniscal tears as the cartilage wears out and weakens with age.

Partial Meniscectomy

Partial Meniscectomy

Partial meniscectomy is a surgical procedure to remove the torn portion of the meniscus from the knee joint. Meniscus is the C-shaped cartilage located in the knee that lubricates the knee joint, acts as a shock-absorber, and controls the flexion and extension of the joint.

Patellar Tendon Repair

Patellar Tendon Repair

Patella tendon rupture is the rupture of the tendon that connects the patella (knee cap) to the top portion of the tibia (shin bone). The patellar tendon works together with the quadriceps muscle and the quadriceps tendon to allow your knee to straighten out.

Osteoarthritis Management

Osteoarthritis Management

Osteoarthritis, also called degenerative joint disease is the most common form of arthritis. It occurs most often in older people. This disease affects the tissue covering the ends of bones in a joint (cartilage). Osteoarthritis is characterized by damaged articular cartilage, cartilage lining the hip joint. Advanced age is one of the most common reasons for osteoarthritis of hip. You may also develop osteoarthritis if you had hip injury or fracture in the past, if you have family history of osteoarthritis, suffering from hip diseases such as avascular necrosis and other congenital or developmental hip diseases.

Arthroscopic Debridement

Arthroscopic Debridement – Knee

Osteoarthritis is a most common form of arthritis which affects the articular cartilage (tissue covering the ends of the bones) of the knee and also other joints such as shoulder, hip, ankle and foot. The articular cartilage cushions the joint so that there is smooth and pain-free movement between the bones in the joint. In this condition, the articular cartilage is completely worn off, as a result the ends of the bones rub against each other causing pain and inflammation.

Knee Reconstruction

Knee Reconstruction

The surgical repair of the completely torn ligament involves reconstruction of the torn ligament using a tissue graft taken from another part of the body or from a donor. The damaged ligament is replaced by the graft and fixed to the femur and tibia using metallic screws. Gradually, over a period of a few months, the graft heals.

ACL Reconstruction

ACL Reconstruction

The anterior cruciate ligament is one of the major stabilizing ligaments in the knee. It is a strong rope- like structure located in the centre of the knee running from the femur to the tibia. When this ligament tears unfortunately, it does not heal and often leads to the feeling of instability in the knee.

Knee Replacement

Revision Knee Replacement

Revision Knee Replacement

Revision knee replacement surgery involves replacing part or all your previous knee prosthesis with a new prosthesis. Although total knee replacement surgery is successful, sometimes the procedure can fail due to various reasons and may require a second revision surgery.

Computer Navigation for Total Knee Replacement

Computer Navigation for Total Knee Replacement

Coming soon

Unicompartmental Knee Replacement

Unicompartmental Knee Replacement

Arthritis is inflammation of a joint causing pain, swelling (inflammation), and stiffness.

Osteoarthritis is the most common form of knee arthritis in which the joint cartilage gradually wears away. It most often affects older people. In a normal joint, articular cartilage allows for smooth movement within the joint, where as in an arthritic knee the cartilage itself becomes thinner or completely absent. In addition, the bones become thicker around the edges of the joint and may form bony “spurs”. These factors can cause pain and restricted range of motion in the joint.

Patellofemoral Knee Replacement

Patellofemoral Knee Replacement

Traditionally, a patient with only one compartment of knee arthritis would undergo a total knee replacement surgery. Patellofemoral knee replacement is a minimally invasive surgical option that preserves the knee parts not damaged by arthritis as well as the stabilizing anterior and posterior cruciate ligaments, ACL and PCL.

Distal Realignment Procedures

Distal Realignment Procedures

Distal realignment procedures, also known as TTT or tibial tubercle transfer procedures, are performed to reposition the kneecap by realigning the tendon under the kneecap to the underlying tibial tubercle. Tibia tubercle is the bony lump on the tibia (bone in the lower leg) below the kneecap. This serves as an attachment point for the patellar ligaments, tendons and muscles. These procedures are done to prevent patellar subluxation or dislocation.

What is New in Knee Replacement

What is New in Knee Replacement

If you are considering knee replacement surgery, there are new developments under study which can help enhance the quality of life.

Minimally Invasive Knee Joint Replacement

Minimally Invasive Knee Joint Replacement

Total knee replacement is a very successful surgical treatment for knee arthritis. Over the years, minimally invasive knee replacement surgical techniques have been developed to lessen tissue trauma and improve patient outcomes. This minimally invasive approach involves much smaller incisions than the usual 10-12 inch incisions used in the traditional knee replacement and spares the quadriceps muscle and tendon, which control bending of the knee, from being cut to access the knee joint.

Customized Knee Replacement System

Customized Knee Replacement System

Custom- fitted total knee arthroplasty is a newer technology in total knee replacement surgery. It is an advanced procedure using an individualized patient-specific knee implant for replacement of all three components of the knee. The difference with custom knee replacement from other knee replacement surgeries is the use of an MRI scan prior to the surgery that provides a clear view of the shape and structure of the different components of the joint. The implants are then designed specifically to match the natural shape of the articulating surfaces of the patient’s knee based upon the MRI. Unlike other knee replacement surgeries, custom- fitted total knee replacement can also be used for severe knee arthritis.

Cartilage Reconstruction

Cartilage Reconstruction

Coming soon