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THE KNEE: DIAGNOSIS AND MANAGEMENT Gaetano P. Monteleone, Jr., M.D. Director, Division Sports Medicine Dept Family Medicine West VirginiaUniversity School of Medicine monteleoneg@rcbhsc.wvu.edu I. The KNEE A. Anatomy and Biomechanics

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from DeLee, Drez, Orthopedic Sports Medicine, 1994

• BONES 1. Femur- The trochlear groove of the femur is the "valley" within which, the patella glides. The lateral femoral condyle in most patients is higher and wider than the medial femoral condyle. The articular cartilage lining the femur is considerably less than that of the patella. The femur transmits forces from the lower leg to the pelvis and L-spine. It also facilitates ambulation. 2. Patella- One of the largest sesamoid bones of the body. It is located within the quadriceps/patellar tendon. There are facets on the posterior surface of the patella (in contact with the femur): medial, lateral and odd. The cartilage overlying these facets are the thickest cartilage in the body (especially the medial facet). 3. Tibia- serves as the distal-most attachment of the extensor mechanism. The patellar tendon inserts onto the tibial tubercle (apophysis). This apophysis may become inflamed to result in Osgood-Schlatter "disease". The tibial plateau supports the femur from above and the menisci. • SOFT TISSUE

2 1. Quadriceps- the quadriceps musculature allows knee extension. • Vastus lateralis • Vastus medialis (VMO) • Vastus intermedius • Rectus femoris 2. Quadriceps and patellar tendons-provide superior and inferior stabilizing forces to the patella. 3. Medial and lateral retinacula- primary stabilizers on either side of the patella. 4. Patellofemoral ligaments- other major soft tissue restraints to mobility of the patella. 5. Bursae- multiple bursae, especially the prepatellar bursa. Acute inflammation may lead to anterior knee pain. 6. The hamstring muscles cause flexion of the knee and assist with flexion of the hip. They insert medial and lateral knee and contribute...