Ligaments of Knee Joint

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LIGAMENTS  OF  KNEE  JOINT 
  • Capsular Ligament
  • Synovial Membrane
  • Extra-capsular Ligaments
    1. Ligamentum Patellae
    2. Tibial Collateral Ligament
    3. Fibular Collateral Ligament
    4. Oblique Popliteal Ligament
    5. Arcuate Ligament

  • Intra-capsular Ligaments
    1. Anterior Cruciate Ligament 
    2. Posterior Cruciate Ligament 
    3. Medial Meniscus  
    4. Lateral Meniscus 
    5. Menisco-femoral Ligament 
    6. Transverse Ligament 
    7. Coronary Ligament

CAPSULAR  LIGAMENT :-

Anteriorly -

It is replaced by - Quadriceps femoris tendon, Patella, Ligamentum patellae

Above - It is deficient above the patellar surface of femur.

Below - It is attached to tibial tuberosity & patellar retinaculae.

Posteriorly -

Above -

  • It is attached to articular margins of femoral condyles & intercondylar notch.
  • It is deficient near the lateral condyle of femur for the passage of tendon of popliteus.
Below -

  • It is attached to articular margins of tibial condyles & intercondylar area.
  • It is deficient behind the lateral condyle of tibia for the passage of tendon of popliteus. 

Medially -

Above - It is attached to medial femoral condyle, 1cm above its articular margin.

Below - It is attached along the articular margin of medial tibial condyle.

Laterally -

Above - It is attached to lateral femoral condyle, 1cm above its articular margin, which includes the origin of popliteus muscle.

Below - It is attached along the articular margin of lateral tibial condyle.

SYNOVIAL  MEMBRANE :-

  • It lines the inner aspect of the capsule.

Anteriorly -

  • It passes above the patellar surface of femur through the capsular deficiency & forms Suprapatellar bursa.
  • It reflects back below the patella & forms Infrapatellar fold, its lateral margins  are called as Alar folds.

Posteriorly - 

  • It forms Popliteal bursa infero-laterally & Semimembranosus bursa infero-medially. 

LIGAMENTUM  PATELLAE :-

  • It is the terminal part of tendon of quadriceps femoris.
  • It is supported by the medial & lateral patellar retinaculae (which are the expansions from vasti muscles).
  • It strengthens the capsule antero-inferiorly.

TIBIAL (Medial)  COLLATERAL  LIGAMENT :-

  • It has 2 parts.. Superficial & Deep..

Superficial part - (a flat band)

Above - It is attached to medial epicondyle of the femur.

Below - It is attached to medial surface of shaft of the tibia.

Deep part - (a triangular band)

  • It is firmly attached to the capsule & medial meniscus.
Above - It is attached to medial epicondyle of the femur.

Below - It is attached to groove for semimembranosus on the medial condyle of tibia.


FIBULAR (Lateral)  COLLATERAL  LIGAMENT :-

  • Its a cord like ligament, separated from the capsule & lateral meniscus by tendon of popliteus.
Attachments -

Above - It is attached to lateral epicondyle of the femur.

Below - It is attached to head of the fibula.


OBLIQUE  POPLITEAL  LIGAMENT :-

  • It is an expansion of the Semimembranosus tendon.
  • It strengthens the capsule from posteriorly.
  • Forms the floor of popliteal fossa.
  • Pierced by middle genicular vessels & nerve.
Attachments - It extends from the medial condyle of tibia to intercondylar line of femur.


ARCUATE  LIGAMENT :-

  • It is a Y-shaped band.
  • Stem is attached to the styloid process of head of fibula.
  • Anterior band is attached to the lateral femoral condyle (usually absent).
  • Posterior band is attached to the lateral tibial condyle by arching over the popliteus tendon.

ANTERIOR  CRUCIATE  LIGAMENT :-

  • It is directed more obliquely upward, backward and laterally (from tibia to femur).
Attachments -

On the Tibia - It is attached to the anterior intercondylar area.

On the Femur - It is attached to the postero-superior part of medial surface of lateral condyle.

Functions -

  • Prevents anterior displacement of tibial condyles.
  • It is taut during extension & acts as a vertical axis around which femur rotates over the tibia.
  • Prevents hyper-extension & posterior displacement of femoral condyles.

POSTERIOR  CRUCIATE  LIGAMENT :-

  • It is directed less obliquely upward, forward and medially (from tibia to femur).
Attachments -

On the Tibia - It is attached to the posterior intercondylar area.

On the Femur - It is attached to the antero-inferior part of lateral surface of medial condyle.

Functions -

  • Prevents posterior displacement of tibial condyles.
  • It is taut during flexion & prevents anterior displacement of femoral condyles.



MENISCI :-

  • Menisci are C-shaped (semi-lunar) fibro cartilages.
  • There are 2 menisci - Medial meniscus & Lateral meniscus.
  • Located between the corresponding condyles of femur & tibia.
  • Named in relation to their tibial attachment.
  • They divide the joint cavity into 2 incomplete compartments..
    • Upper Menisco-femoral & 
    • Lower Menisco-tibial compartments.
Functions - They deepen the tibial articular surfaces & act as shock absorbers.

Parts -    
        Outer border- thick & convex 
        Inner border-  thin & concave
        Upper surface- concave 
        Lower surface-  flat 
        Anterior Horn- attached on the anterior intercondylar area of tibia through meniscal ligament. 
        Posterior Horn- attached on the posterior intercondylar area of tibia through meniscal ligament.
    
Medial Meniscus :-

  • Larger & crescentic in shape.
  • Its outer border firmly attached to the capsule & tibial collateral ligament.
Lateral Meniscus :-

  • Smaller & rounded in shape.
  • Its anterior and posterior horns lie within the horns of medial meniscus.
  • Its outer border is attached to the capsule but separated from the fibular collateral ligament by the tendon of popliteus.

MENISCO-FEMORAL  LIGAMENT :-

  • Connects the posterior horn of lateral meniscus to the medial condyle of femur.
  • Regulates forward gliding movement of the lateral meniscus during extension of the knee.

TRANSVERSE  LIGAMENT :-

  • Connect the anterior horns of medial & lateral menisci.
  • Present only in 40% of individuals.

CORONARY  LIGAMENTS :-

  • They are parts of the capsule.
  • Attach the outer borders of medial & lateral menisci to the capsule.

APPLIED  ASPECTS :-

Terrible Triad -

  • A blow to the lateral aspect of knee when the foot is on the ground may cause sprain in the tibial collateral ligament, tear in the attached medial meniscus & anterior cruciate ligament.

Injuries to the Menisci -

  • Occur in flexed knee due to forcible rotation or abduction.
  • Medial meniscus injuries are more frequent.
  • The injury may be a tear or peripheral margin may be detached from the capsule known as bucket-handle tear.

ACL Tears -

  • A blow to the anterior aspect of flexed knee may tear only the anterior cruciate ligament.
  • It is exhibited as anterior displacement of tibia from the femur.

Rupture of Cruciate Ligaments -

  • It is less common, ACL is occasionally affected.
  • If both the cruciate ligaments are torn, excessive forward & backward gliding of the tibia, abduction & adduction of the joint are noticed.








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