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Anatomy of the Knee

Lateral View

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Anterior View

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Physiologic (Osteokinematic) Motions of the Knee

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Joint Normal ROM OPP CPP Normal End Feel(s) Capsular Pattern
Tibiofemoral

Flex >130°

Ext = 10°

Tibial rotation = 10°

25° flex Maximal ext & tibial ER

Flex = tissue approximation

Ext = elastic/firm

Flexion > ext
Patellofemoral

Distal glide = 5–7 cm

Medial-lateral glide is up to ½ the width of the patella

10°–20° flex

Full flex    

Accessory (Arthrokinematic) Motions of the Knee

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Arthrology Arthrokinematics

Concave surface:

Tibial plateau

Convex surface:

Femoral condyles

To facilitate knee extension:

OKC = Tibia rolls & glides anterior on femur

CKC = Femur rolls anterior & glides posterior on tibia

To facilitate knee flexion:

OKC = Tibia rolls & glides posterior on femur

CKC = Femur rolls posterior & glides anterior on tibia

Knee Mobilization Techniques

Patellofemoral (P/F) Glide & Tilt

Indications:

  • Superior & inferior glide is to improve knee ext & flex, respectively

  • Medial & lateral glide is to improve knee IR & ER, respectively

  • Tilt is to improve all physiologic knee motions

Patient:

  • Supine with knee in open-packed position

Clinician:

  • Stands to side of pt

  • Stabilization: Provided by the weight of the leg

  • Mobilizing hand: Patella is contacted with web space of hand

    • Superior or inferior glide: hand placed at inferior or superior poles of patella, respectively

    • Medial or lateral glide: hand placed at lateral or medial aspects of patella, respectively

    • Tilt: thumbs placed over superior, inferior, medial, or lateral aspect of patella

Accessory Motion Technique:

  • Glide: forearm aligned in direction in which force applied; other hand provides reinforcement

  • Tilt: force applied in a posterior direction through patellar contact with the goal of moving opposing pole of patella anteriorly

Accessory With Physiologic Motion Technique:

  • Superior or inferior glide can be performed during OKC or CKC active knee ext or flex, respectively

  • Medial or lateral glide can be performed during CKC tibial IR or ER, respectively, or during ext & flex as above

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Tibiofemoral (T/F) Distraction

Indications:

  • To improve all knee motions

Patient:

  • Supine with knee in open-packed position or prone with knee flexed to point of restriction

Clinician:

  • Stands at foot of pt facing cephalad

  • Stabilizing contact: In supine, distal thigh is stabilized over a bolster or mobilization straps can be used; in prone, stabilization provided through ...

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