Knee Joint-1

LOWER LIMB
KNEE JOINT
ANATOMY
 The distal end of the femur is broadened and
has two large eminences: the larger medial
condyle and the smaller lateral condyle.
Anteriorly, the condyles are separated by the
patellar surface, a shallow, triangular
depression.
Posteriorly, the condyles are separated by a
deep depression called the intercondylar fossa
ARTICULAR SURFACE
• The lower end of femur presents a V-shaped articular surface
inhabiting the anterior, inferior, and posterior surfaces of both
condyles.
• The apex of ‘V’ is referred to as patellar surface which inhabits the

anterior surfaces of 2 condyles and articulates with the patella.
• The 2 connects of ’V’ create tibial surfaces which inhabit the inferior
and posterior surfaces of 2 condyles to come in contact with
corresponding articular surfaces of tibial condyles.
• The patellar surface is saddle-shaped. Its lateral portion is wider and

extends to a higher level in relation to the medial portion,
corresponding to articular outermost layer of the patella.
Patella
• The patella, or knee cap , is the largest and most
constant sesamoid bone in the body .
• Situated lla is at the distal anterior surface of the
femur.
• it has a triangular shape that resembles a
rounded arrowhead.
ANATOMY
Apex – The inferior (or bottom) portion of the
patella comes to a point, which is called the
apex (apex means point), and it always points
toward your foot – so that’s how you’ll know
the proper orientation of the bone.
 This apex allows for the attachment of the

patellar ligament, which connects to the tibial
tuberosity on the anterior (or front) surface of
the tibia bone.
ANATOMY
Base – Toward the superior portion (or top
border) of the patella, we have the base.
Lateral and medial border – the left and right

sides of the patella are called the lateral and
medial borders. The lateral border allows for the
attachment of the vastus lateralis, and the medial
border allows for the attachment of the vastus
medialis muscle.
KNEE RADIOGRAPH
KNEE AP
Position of patient
 Supine with the leg extended and the knee and
ankle joint in contact with the table.
 Adjust the patient’s body so that the pelvis and

knee are not rotated.
Provide a cushion for the head.
 Place sandbags by the foot and ankle for

stabilization, if needed.
KNEE AP WEIGHT-BEARING STANDING BILATERAL
Position of patient
Standing erect against an upright detector with the
back toward the vertical grid device.
The legs should be extended and the knee should

be in contact with the detector.
Adjust the patient’s body so that the limbs are in

neutral position and the knees are not rotated.
KNEE LATERAL
Patient position
The patient is lateral recumbent with the knee of
interest closest to the table and the other lower
limb rolled anteriorly
affected knee is flexed slightly ≈ 30° (to the best
of patient's ability)
anything more than 30° is less than ideal as the
patella will move inferiorly and the soft tissues
will begin to compress
KNEE SKYLINE
Patient position
 The skyline view of the knee, also known as the Laurin
or Sunrise view, is a projection that demonstrates
the patella and patellofemoral articulation
 patient is supine on the table with both knees flexed at

roughly 45°
 patient's feet should be very close to the detector end of

the bed (see technical factors)
TIBIAL ANATOMY
Tibia
The tibia (Latin: tibia), also known as the
shinbone, is the largest and strongest of two
lower leg bones.
It lies on the medial side of the leg, located
parallel to the other bone of the leg named the
fibula.
 Both bones extend between the knee and the
ankle joints.
The tibia participates in forming four joints -
the knee, ankle, superior tibiofibular
and inferior tibiofibular joints.
 It is a long bone, and as with every long bone,
the tibia also has three parts
a diaphysis or shaft and
two ends or epiphyses (proximal and distal).
Proximal end of tibia
• The proximal end or epiphysis is the upper end of the tibia
that is located closer to the body. It features the following
landmarks:
• Medial condyle
• Lateral condyle
• Intercondylar area
• Intercondylar eminence
• Anterior intercondylar area
• Posterior intercondylar area
• Superior articular surface
• Fibular articular surface
Medial Condyle And Lateral Condyle
The medial condyle of the tibia is a medial
expansion at the proximal end. In contrast,
the lateral condyle is a lateral expansion at the
proximal end of the bone.
Both condyles are separated by the intercondylar

area, subdivided into two smaller areas - the
anterior and posterior intercondylar areas.
Between both is the intercondylar eminence.
Distal end of tibia
 The distal end or epiphysis is the lower end of
the bone that forms articulations with the bones
of the foot.
 It contains several landmarks, and they include
the following:
 Medial malleolus, containing
– Malleolar articular surface
– Malleolar groove
 Fibular notch
 Inferior articular surface
RADIOGRAPHS
Tibia Fibula
TIBIA FIBULA AP
Purpose and Structures Shown
To view the entire tibia and fibula and

demonstrate the lower limb in its natural
anatomical position.
Position of patient
For the AP view of the tibia-fibula, the leg is
extended while ensuring no rotation of the knee
or ankle.
For medial rotation, ensure that the whole leg is
turned inward and not just the foot.
 Place a support under the greater trochanter if

needed.
Position of patient
 Lateral recumbent position with the lateral
aspect of the knee and ankle in contact with the
table so that the tibia is parallel to the table.
The opposite leg should be placed behind the

affected leg to avoid over-rotation.
Purpose and Structures Shown
 Lateral view of the entire tibia and fibula in
mediolateral projection, including the knee and ankle
joint.
This is one of two radiographs in the tib/fib series
comprising an AP and lateral view.
 It is performed to evaluate trauma, deformity,
inflammation (osteomyelitis), foreign bodies, and
inability to bear weight.
The lateral projection is at 90 degrees to the AP
projection.
It must include the knee and ankle joints both.
Tibial Hemimelia
Tibial hemimelia (also known as tibial deficiency)
is a condition in which a child is born with a tibia
(shinbone) that is shorter than normal or missing
altogether.
Tibial hemimelia usually affects only one leg but,
in about one-third of cases, both legs have the
condition.
When one leg is affected, it is usually the right leg,
although doctors do not know why this is.
Types of Tibial Hemimelia
Type I. In this type, the tibia is completely
missing. As a result, the child’s knee and ankle
joints do not usually work.
Type II. In this type, the lower half of the tibia

is missing. The knee joint usually works
somewhat normally, but the ankle joint does
not work.
Type III. In this type, the upper half of the tibia is
missing. The knee joint does not usually work,
but the ankle joint may work somewhat normally.
This type of tibial hemimelia is extremely rare.
Type IV. In this type, the child has a shortened
tibia and the lower ends of the tibia and fibula
bones, near the ankle joint, are separated from
each other. This causes the ankle joint to be very
abnormal.
Other Medical Problems
 Many children with tibial hemimelia are born
with other problems involving their feet and legs,
such as:
A shortened femur (thighbone)
A bifid femur (the bottom end of the thighbone is

split into two)
Other Medical Problems
An absent extensor mechanism (the muscles,
ligaments, and other structures that help the knee to
straighten are missing)
Clubfoot (the foot is turned inward)
Absent toes or too many toes
Some children with tibial hemimelia may also have

conditions that affect the arms.
Congenital Bowing of Tibia and Fibula
A congenital anomaly in which there is both
posterior and medial bowing of the tibia and
fibula.
The deformity is obvious at birth.
 The foot assumes a calcaneovalgus position

and is typically in extreme dorsiflexion.

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LOWER LIMB

• The apex of ‘V’ is referred to as patellar surface which inhabits the

• The patellar surface is saddle-shaped. Its lateral portion is wider and

 This apex allows for the attachment of the

Lateral and medial border – the left and right

 Adjust the patient’s body so that the pelvis and

Provide a cushion for the head.

 Place sandbags by the foot and ankle for

The legs should be extended and the knee should

Adjust the patient’s body so that the limbs are in

 patient is supine on the table with both knees flexed at

 patient's feet should be very close to the detector end of

Both condyles are separated by the intercondylar

To view the entire tibia and fibula and

 Place a support under the greater trochanter if

The opposite leg should be placed behind the

Type II. In this type, the lower half of the tibia

A shortened femur (thighbone)

A bifid femur (the bottom end of the thighbone is

Clubfoot (the foot is turned inward)

Absent toes or too many toes

Some children with tibial hemimelia may also have

 The foot assumes a calcaneovalgus position

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