KNEE JOINT ANATOMY
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The bones articulating at the knee are large and complex. The femur has a slight medial slant, while the tibia is nearly vertical. The patella is a sesamoid bone—the largest in the body—occupying the anterior part of the knee. It is the distal attachment point of the quadriceps tendon. The patella also protects the anterior articular surface of the distal femur. The fibula is not part of the knee joint.
The surfaces articulating at the knee are the following:
Lateral and medial condylar surfaces of the femur and tibia
Anteroposterior articulation between the patella and femur
Quadriceps femoris: a 4-component muscle complex that attaches to the patella via the quadriceps tendon
Fibrous capsule: attaches to the femur proximally, the tibia distally, and the intercondylar fossa posteriorly; deficient on the lateral condylar area, where the tendon of the popliteus exits the joint to insert on the tibia; has a synovial membrane lining
Extracapsular ligaments, which include the following:
Patellar ligament: extends inferiorly from the patella and attaches distally to the anterosuperior aspect of the tibia; reinforces the capsule anteriorly
Fibular collateral ligament or lateral collateral ligament (LCL): runs inferiorly from the lateral femoral epicondyle to the fibular head's lateral surface; prevents varus stress on the knee (bowed knees)
Tibial collateral ligament or medial collateral ligament (MCL): extends from the medial femoral epicondyle to the medial condyle and superomedial tibial surface; typically firmly attached to the medial meniscus; prevents valgus stress on the knee (knocked knees)
Oblique popliteal ligament: a continuation of the semimembranosus tendon; reinforces the fibrous capsule posteriorly
Arcuate popliteal ligament: originates from the fibular head's posterior margin, extends superomedially over the tendon of the popliteus, and occupies the posterior aspect of the knee joint
Intraarticular ligaments, which include the following (see Image. Intraarticular Ligaments Of The Right Knee, Anterior View):
Anterior cruciate ligament (ACL): emerges from the anterior tibial intercondylar area posterior to the medial meniscal attachment and inserts on the posteromedial surface of the lateral femoral condyle; prevents knee hyperextension, posterior femoral displacement, and anterior tibial displacement in the flexed knee; is the weaker cruciate ligament with poor circulation
Posterior cruciate ligament (PCL): originates from the posterior tibial intercondylar region and inserts on the anterolateral aspect of the medial femoral condyle; tightens during knee flexion and prevents hyperflexion and posterior tibial displacement; stronger cruciate ligament; supports the body weight when the knee is flexed
Medial and lateral menisci: fibrocartilaginous structures lying between the tibiofemoral articular surfaces; function as shock absorbers, static stabilizers, and friction reducers during articulation.
Bursae are small sacs surrounding the joints. They are lined with synovial membranes and contain synovial fluid. The bursae around the knee reduce friction between its different components during movement. These structures also help stabilize the knee. There are at least 12 knee bursae, but the notable ones are the following:
Suprapatellar bursa: extension of the knee joint cavity; located deep to the quadriceps femoris tendon
Popliteus bursa: between the popliteal tendon and lateral tibial condyle
Anserine bursa: located between the sartorius, gracilis, and semitendinosus tendons
Gastrocnemius bursa: deep to the superior attachment of the gastrocnemius' medial head
Prepatellar bursa: a subcutaneous bursa protecting the anterior patellar surface
Deep and subcutaneous infrapatellar bursae: lie inferior to the patella posterior to the patellar ligament
Medial collateral ligament bursa: lies within the superficial and deep parts of the MCL
Iliotibial bursa: situated in the distal iliotibial band close to its insertion on the Gerdy tubercle.
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