<h2>'The Middle Sister'</h2>
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<span style="font-weight: 400;">The knee joint is sometimes described as the ‘Middle Sister’ of the lower limb, a ‘triplet’ of joints so to speak!</span>

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<span style="font-weight: 400;">WHAT? WHY? HOW?</span>

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<span style="font-weight: 400;">Almost all common ‘knee problems’ are caused by the force from above, the force from below or maybe even both. </span>

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<span style="font-weight: 400;">So what...I hear ya?</span>

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<span style="font-weight: 400;">This means to help clients with knee problems we need to understand those forces &amp; how to improve them. In fact it would be a challenge to truly understand knee biomechanics without at least some recognition of the ascending &amp; descending influences of the pelvis &amp; foot…...bear with me!</span>

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<span style="font-weight: 400;">As the biggest synovial (</span><i><span style="font-weight: 400;">synovial - surrounded by a thick flexible membrane forming a sac into which is secreted a viscous fluid that lubricates)</span></i> <span style="font-weight: 400;">joint, the knee forms at the place where the distal (</span><i><span style="font-weight: 400;">distant</span></i><span style="font-weight: 400;">) end of the femur meets the proximal (</span><i><span style="font-weight: 400;">closest proximity</span></i><span style="font-weight: 400;">) end of the Tibia (</span><i><span style="font-weight: 400;">also from latin for pipe or flute</span></i><span style="font-weight: 400;">) meet.</span>

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<h2>Patella</h2>
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<img class="aligncenter wp-image-25975" src="https://biomechanicseducation.com/wp-content/uploads/2021/01/shutterstock_296166746-scaled-1.jpg" alt="" width="275" height="367" />

<span style="font-weight: 400;">Then the Patella (</span><i><span style="font-weight: 400;">patina or patena or paten, </span></i><b><i>meaning</i></b><i><span style="font-weight: 400;"> shallow dish</span></i><span style="font-weight: 400;">)</span> <span style="font-weight: 400;">sits at the front of the knee joint. With the Apex at the bottom &amp; the Base at the top - I HAVE ON IDEA WHY!?!? </span>

<span style="font-weight: 400;">Who on earth named this piece!? </span>

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<span style="font-weight: 400;">The inside surface of the patella has medial &amp; lateral facets (</span><i><span style="font-weight: 400;">flat surface</span></i><span style="font-weight: 400;">) that come into contact with the ‘knuckles’ of the femur. </span>

&nbsp;

<span style="font-weight: 400;">Now there are all sorts of names for other bony parts (</span><i><span style="font-weight: 400;">pars</span></i><span style="font-weight: 400;">) in the knee like….</span>

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<h2><strong>Bony Pars</strong></h2>
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<span style="font-weight: 400;">Plateau (</span><i><span style="font-weight: 400;">flat surface</span></i><span style="font-weight: 400;">)</span>

<span style="font-weight: 400;">Tuberosity (</span><i><span style="font-weight: 400;">rounded prominence</span></i><span style="font-weight: 400;">)</span>

<span style="font-weight: 400;">Tubercle (</span><i><span style="font-weight: 400;">small nobule</span></i><span style="font-weight: 400;">)</span>

<span style="font-weight: 400;">Epicondyle (</span><i><span style="font-weight: 400;">r</span></i><i><span style="font-weight: 400;">ounded eminence on a bone that lies upon a </span></i><b><i>condyle</i></b><span style="font-weight: 400;">)</span>

<span style="font-weight: 400;">Condyle (</span><i><span style="font-weight: 400;">knuckle</span></i><span style="font-weight: 400;">)</span>

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<span style="font-weight: 400;">These each relate to the anatomy / soft tissue etc that they are named by.</span>

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<h2>Meniscus</h2>
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<img class="aligncenter wp-image-25976" src="https://biomechanicseducation.com/wp-content/uploads/2021/01/shutterstock_1030913119-scaled-1.jpg" alt="" width="345" height="194" />

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The meniscus are effectively the top 2 'cups' of the tibia that the femur sits onto of!

The word meniscus derives from Greek <em>meniskos</em>, meaning 'crescent' The word was used for curved things in general, such as a necklace or a line of battle.

So when you think about your entire body resting AND moving on top of these menisci its easy to understand why they are commonly written onto medical reports after knee MRI's come back from the radiologist!

Poor menisci!

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<h2>Fibula</h2>
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<span style="font-weight: 400;">Then of course there is the Fibula (</span><i><span style="font-weight: 400;">Latin for “brooch”, because the inner bone, the tibia, and the fibula together resemble an ancient brooch, or pin</span></i><span style="font-weight: 400;">) ….Wow I learned this words history / origin while researching for this blog! </span>

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<span style="font-weight: 400;">See I am learning with you!</span>

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<img class="aligncenter wp-image-25977" src="https://biomechanicseducation.com/wp-content/uploads/2021/01/shutterstock_199824647-scaled-1.jpg" alt="" width="331" height="331" />
<h2>Tibia</h2>
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The shin or lower leg bone, from Latin also 'pipe, flute' - originally made from bone!

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<h2><b>The Knee Action/s</b></h2>
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<span style="font-weight: 400;">When I ruptured (snapped) my ACL during landing from a jumping roundhouse kick I spent a lot of time researching knee anatomy, function &amp; biomechanics. I read </span><b><i>Brunnstrom’s Clinical Kinesiology</i></b><span style="font-weight: 400;"> section about the knee….WOW!!</span>

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<span style="font-weight: 400;">When flexing, the knee does not simply hinge through single action…..oh no! It will glide, roll &amp; twist to produce what we call knee flexion. Movement produced by our wonderful integrated system is really quite stunning in its complexity that can be made so simple for application. However when building knee implants or replacement joints this level of fluidity in motion is just not possible, no matter how fabulous these implants are these days!</span>

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<b><i>During knee flexion</i></b><i><span style="font-weight: 400;">, tibia glides posteriorly on femur and from full </span></i><b><i>knee</i></b><i><span style="font-weight: 400;"> extension to 20</span></i><i><span style="font-weight: 400;">o</span></i> <b><i>flexion</i></b><i><span style="font-weight: 400;">, tibia rotates internally. Closed kinetic chain - </span></i><b><i>During knee</i></b><i><span style="font-weight: 400;"> extension, femur glides posteriorly on tibia. To be more specific, from 20</span></i><i><span style="font-weight: 400;">o</span></i> <b><i>knee flexion</i></b><i><span style="font-weight: 400;"> to full extension, femur rotates internally on stable tibia.</span></i>

<i><span style="font-weight: 400;">(Physio-pedia.com)</span></i>

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<span style="font-weight: 400;">This is why I LOVE STUDYING THE BODY &amp; MOVEMENT SO MUCH!</span>

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(Did you notice the emphasis there!?!?)

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<h2><b>Knee Ligaments </b></h2>
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<img class="aligncenter wp-image-25978" src="https://biomechanicseducation.com/wp-content/uploads/2021/01/Screenshot-2021-01-26-at-15.10.33-1.png" alt="" width="366" height="272" />

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<span style="font-weight: 400;">Now we should also mention ligaments when discussing knee biomechanics since they play a huge role in there….</span>

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<span style="font-weight: 400;">MCL - medial (</span><i><span style="font-weight: 400;">inside</span></i><span style="font-weight: 400;">) collateral (</span><i><span style="font-weight: 400;">together with</span></i><span style="font-weight: 400;">) ligament (</span><i><span style="font-weight: 400;">bond)</span></i>

<span style="font-weight: 400;">LCL - lateral (</span><i><span style="font-weight: 400;">outside</span></i><span style="font-weight: 400;">) collateral (</span><i><span style="font-weight: 400;">together with</span></i><span style="font-weight: 400;">) ligament (</span><i><span style="font-weight: 400;">bond)</span></i>

<span style="font-weight: 400;">ACL - anterior </span><i><span style="font-weight: 400;">(front</span></i><span style="font-weight: 400;">) cruciate (</span><i><span style="font-weight: 400;">cross shaped</span></i><span style="font-weight: 400;">) ligament (</span><i><span style="font-weight: 400;">bond)</span></i>

<span style="font-weight: 400;">PCL - posterior (</span><i><span style="font-weight: 400;">back</span></i><span style="font-weight: 400;">) cruciate (</span><i><span style="font-weight: 400;">cross shaped</span></i><span style="font-weight: 400;">) ligament (</span><i><span style="font-weight: 400;">bond</span></i><span style="font-weight: 400;">)</span>

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<span style="font-weight: 400;">These </span><i><span style="font-weight: 400;">bonds </span></i><span style="font-weight: 400;">play a key role in knee stability, as you can imagine, with the amount of force we repeatedly put through &amp; across our knee joint. </span>

<span style="font-weight: 400;">These ligamentous structures connect bone to bone &amp; so are (&amp; need to be) stronger than tendons that connect muscle to bone. It does however mean they are also less elastic than tendons.</span>

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<span style="font-weight: 400;">A brief &amp; special mention to the Patella </span><i><span style="font-weight: 400;">tendon</span></i><span style="font-weight: 400;">! </span>

<span style="font-weight: 400;">WHOOP WHOOP!</span>

<span style="font-weight: 400;">This bad boy will get another mention in the next of this series Part 8 - ‘</span><b>Muscles of the Knee’</b>

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<h1><b>Interesting Facts About Your Knees </b></h1>
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<img class="aligncenter wp-image-25979" src="https://biomechanicseducation.com/wp-content/uploads/2021/01/Screenshot-2021-01-26-at-15.10.45-1.png" alt="" width="366" height="363" />

<i><span style="font-weight: 400;">Walking up &amp; down stairs can put 600lbs of pressure on the patella BUT has the protection of the thickest layer of cartilage on the posterior surface of the patella </span></i>

<i><span style="font-weight: 400;">(Andrew Biel)</span></i>

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<h1><b>Babies are born without kneecaps!</b></h1>
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<h4><span style="font-weight: 400;">When we are born we have soft cartilage where our kneecaps will eventually develop. However they do not ossify or show up on x rays until around 2-6yrs</span></h4>
<h1><b>You can walk without a kneecap.</b></h1>
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<h4><span style="font-weight: 400;">If you break your kneecap badly enough, it is likely to have to be</span><span style="font-weight: 400;"> removed surgically. Surgeons do not fit a kneecap prostheses—because you can walk without a kneecap!</span></h4>
<h4><span style="font-weight: 400;">Kneeling, however, may be uncomfortable without one, meaning you may require a protective padding.</span></h4>
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<h1>ACL Reconstruction ?</h1>
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<span style="font-weight: 400;">ACL reconstruction can be done using either a portion from your hamstring or your patella tendon - patella tendon grafts are prone to leave patients with knee pain when kneeling. So top knee surgeon Dr Hahn, offered me a hamstring graft instead - I decided against it, some may not have such a choice but I really didn't fancy also rehabbing my wonderful hammies. They are the envy of some &amp; I knew from my MRI that I had a little proprioception where my ACL had latched onto the PCL….said Dr Hahn!</span>

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<span style="font-weight: 400;">This super pair of hams have stood me in good stead so far &amp; allowed me to live with a ruptured ACL in my left knee with absolutely no detriment my lifestyle whatsoever. </span>

&nbsp;
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<h2>KNEE ANATOMY &gt;&gt; Coming Soon!!</h2>