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CHAPTER OBJECTIVES

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Chapter Objectives

At the conclusion of this chapter, the reader will be able to:

  • Identify the key anatomical and biomechanical features of the knee and their impact on examination and intervention.

  • List and perform key procedures used in the orthopaedic manual physical therapy (OMPT) examination of the knee.

  • Demonstrate sound clinical decision-making in evaluating the results of the OMPT examination.

  • Use pertinent examination findings to reach a differential diagnosis and prognosis.

  • Discuss issues related to the safe performance of OMPT interventions for the knee.

  • Demonstrate basic competence in the performance of an essential skill set of joint mobilization techniques for the knee.

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FUNCTIONAL ANATOMY AND KINEMATICS

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Introduction

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At first glance, the knee joint appears to be a simple hinge joint with two degrees of freedom that provides motion in the sagittal plane. Upon closer inspection, however, it is appreciated that motion is available within the other two cardinal planes as well. Further adding to its complexity is the fact that the knee is comprised of the tibiofemoral joint, or knee joint proper, and the patellofemoral joint, a planar joint that is involved in most cases of anterior knee pain (Fig. 26–1). Pain originating from the knee is present in approximately 20% of the population.1

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FIGURE 26–1

The tibiofemoral and patellofemoral joints comprising the knee joint complex including the cruciate ligaments and menisci.

Graphic Jump Location
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The knee joint complex is uniquely positioned between the multiplanar hip and the equally mobile foot and ankle joints. Impairments of either the hip and/or the foot and ankle often contribute to the onset of knee pain and must routinely be considered in the management of these conditions. Likewise, pathology of the knee may lead to impairments both proximally and/or distally.

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The Tibiofemoral Joint

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The distal shaft of the femur culminates as two substantial condyles interposed by an intercondylar fossa, posteriorly. It is within this fossa that the cruciate ligaments reside. The lateral femoral condyle extends more posteriorly than its medial counterpart.2 The medial femoral condyle extends more distally and is curved in the transverse plane. Disparity in the size and shape of the femoral condyles contribute to the triplanar motion that is characteristic of this joint.

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The proximal tibia consists of both a medial and lateral plateau corresponding to its respective femoral condyle. Both plateaus are concave from medial to lateral; however, the lateral plateau is slightly convex from anterior to posterior. These plateaus are generally considered to be only slightly concave, with a much larger radius of curvature than their corresponding condyles. Due to this incongruity, the knee lacks the stability that is required from osseous structures alone, thus requiring assistance, namely from the menisci, in order to achieve optimum stability. ...

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