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LEARNING OBJECTIVES

LEARNING OBJECTIVES

Upon completion of this chapter, the student should be able to demonstrate the following competencies and proficiencies concerning the tibiofemoral joint:

  • Have basic knowledge and understanding of the anatomy

  • Understand the normal arthrokinematics and osteokinematics of the tibiofemoral joint

  • Understand the normal biomechanics of the tibiofemoral joint

  • Recognize the pathomechanics and its relation to dysfunction at the tibiofemoral joint

  • Have a general understanding of common tibiofemoral joint disorders

  • Demonstrate a general understanding of surgical procedures used to address tibiofemoral joint disorders

  • Design a rehabilitation plan with the understanding of surgical precautions

  • Implement a rehabilitation plan including proper stretching, strengthening, proprioception, and exercise technique in accordance with principles of basic exercise

  • Perform manual treatment techniques including basic stretching, joint mobilization, and soft tissue mobilization

  • Demonstrate and educate athlete on a comprehensive home exercise program

  • Utilize adjunct treatment interventions such as pain control modalities, bracing, taping, neuromuscular electrical stimulation, and orthotic prescription

INTRODUCTION

Rehabilitation of the knee requires a thorough understanding of the structure and function of its components. The knee joint is the largest joint in the body1,2 and is made up of two joints: the patellofemoral joint and the tibiofemoral joint. The tibiofemoral joint is considered the knee joint proper and serves to transfer ground reaction forces, absorb shock, provide stability during weight-bearing, and allow the lower extremity to move in space by shortening and lengthening the lever arm.3 With the complicated functions of the knee, it is no wonder it is one the most frequently injured joints in sports.4

ANATOMY

Bones

The anatomy of the tibiofemoral joint provides mobility and stability for the lower extremity. The bony anatomy of the tibiofemoral joint comprises the tibia and the femur (Fig. 15-1). Both are long bones; the femur is the longest, strongest bone in the body, and the tibia is the second.5 The convex condyles of the distal femur rest on the relatively flat plateaus of the proximal tibia that form two condyloid articulations.1,5 The tibial plateaus slope slightly posteriorly and laterally with an intercondylar eminence positioned in the sagittal plane between the medial and lateral plateaus.5,6 This orientation causes an instability that is countered through the soft tissues.

Figure 15-1.

Bony anatomy of the tibiofemoral joint.

Clinical Pearl 15-1

The articulation of the femur on the tibia is not congruent and is unstable. The muscles, capsule, and ligaments around the knee have to provide stability.

Cartilage

The surfaces of the femur and the tibia are covered by articular cartilage and the fibrocartilage called the meniscus (Fig. 15-2). The articular cartilage serves to smooth the articulation between the tibia and the ...

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