Clinical Anatomy of the Knee: An Atlas

Preface
Contents
1: Functional Anatomy of Knee
	1.1	 Introduction
	1.2	 Bones
		1.2.1	 Distal End of the Femur
		1.2.2	 Proximal End of the Tibia
		1.2.3	 Proximal End of the Fibula
		1.2.4	 Patella
	1.3	 Lateral and Medial Sides of the Knee
		1.3.1	 The Medial Side of the Knee
		1.3.2	 The Lateral Side of the Knee
			1.3.2.1	 Popliteus and Popliteus Complex
	1.4	 The Anterior Side of the Knee
	1.5	 The Popliteal Fossa and Posterior Side of the Knee
	1.6	 Intra-Articular Structures of Knee
		1.6.1	 Menisci
		1.6.2	 Cruciate Ligaments
			1.6.2.1	 Anterior Cruciate Ligament (ACL)
			1.6.2.2	 Posterior Cruciate Ligament (PCL)
	References
2: Arthroscopic Anatomy of the Knee
	2.1	 Introduction
	2.2	 Suprapatellar Pouch
	2.3	 Patellofemoral Joint
	2.4	 Lateral Gutter
	2.5	 Medial Gutter
	2.6	 Intercondylar Notch
	2.7	 Medial Compartment
	2.8	 Lateral Compartment
	2.9	 Posterior Medial Compartment
	2.10	 Posterior Lateral Compartment
	References
3: Knee Radiology
	3.1	 Plain Film Radiography of the Knee
	3.2	 Computed Tomography of the Knee
	3.3	 Magnetic Resonance Imaging of the Knee
	References
4: Physical Examination of the Knee
	4.1	 Introduction
	4.2	 Examination
		4.2.1	 Inspection
		4.2.2	 Range of Joint Movement
		4.2.3	 Palpation
		4.2.4	 Specific Pathologies and Examination Tests
			4.2.4.1	 Patellofemoral Joint and Extensor Mechanism
				Q Angle
				Patellofemoral Grinding Test
				Patellar Glide Test (Sage Sign)
				Patellar (Fairbanks) Apprehension Test
			4.2.4.2	 Meniscal Tests
				McMurray Test
				Apley Test
				Childress’ Sign (Squat Test)
			4.2.4.3	 Varus and Valgus Stability Tests
			4.2.4.4	 Tests for the Anterior Cruciate Ligament
				Anterior Drawer Test
				Lachman Test
				Pivot Shift Test
			4.2.4.5	 Tests for the Posterior Cruciate Ligament
				Posterior Drawer Test
				Quadriceps Active Test
			4.2.4.6	 Posterolateral Corner Tests
				External Rotation Test (Dial Test)
				Varus Recurvatum Test
				Posterolateral Drawer Test
	References
5: Patient Position and Setup
	5.1	 Introduction
	5.2	 Operating Room Setup
		5.2.1	 Patient and Operating Table Position
		5.2.2	 Anesthesia
		5.2.3	 Tourniquet
		5.2.4	 Supports
		5.2.5	 Equipment
		5.2.6	 Imaging Systems
		5.2.7	 Punches
		5.2.8	 Shavers and Electrosurgical Instruments
		5.2.9	 Chisels
		5.2.10	 Curettes
	5.3	 Portals
		5.3.1	 Anterolateral Portal
		5.3.2	 Superomedial Portal
		5.3.3	 Posteromedial Portal
		5.3.4	 Posterolateral Portal
		5.3.5	 Accessory Anterior Medial and Lateral Portals
	References
6: Anatomical Meniscal Repair
	6.1	 Introduction
	6.2	 Meniscal Repair
	6.3	 The All-Inside Technique
		6.3.1	 Technique
	6.4	 Inside-Out Technique
		6.4.1	 Technique
	6.5	 Outside-In Technique
		6.5.1	 Technique
	6.6	 Peripheral Meniscal Tears
	6.7	 Ramp Lesions
	6.8	 Radial Tears
	6.9	 Horizontal Tears
	6.10	 Biologic Augmentation
		6.10.1	 Mechanical Stimulation
		6.10.2	 Marrow Venting Procedures
		6.10.3	 Use of Fibrin Clots
		6.10.4	 Stem Cell–Based Therapy
		6.10.5	 Platelet-Rich Plasma Injections
	References
7: Arthroscopic Anterior Cruciate Ligament Reconstruction: Six Bundle Hamstring Tendon Autograft for Anterior Cruciate Ligament Reconstruction
	7.1	 Introduction
	7.2	 Diagnosis
	7.3	 Imaging
	7.4	 Graft Choice
	7.5	 Surgical Technique
		7.5.1	 Anesthesia and Positioning
		7.5.2	 Hamstring Tendon Graft Harvest
		7.5.3	 Preparation of the Six Bundle Hamstring Tendon Graft
		7.5.4	 Fibertape
		7.5.5	 Arthroscopic Portal Placement
		7.5.6	 Diagnostic Arthroscopy
		7.5.7	 Femoral Tunnel
		7.5.8	 Femoral Rigidfix Curve Guide
		7.5.9	 Tibial Tunnel
		7.5.10	 Graft Fixation
		7.5.11	 Calculation of EndoButton CL Length and Graft Preparation
		7.5.12	 Graft Passage and Femoral Fixation
		7.5.13	 Graft Tensioning
		7.5.14	 Tibial Fixation
		7.5.15	 Closure
		7.5.16	 Postoperative Management
			7.5.16.1	 Follow-Up
			7.5.16.2	 Complications
	References
8: Arthroscopic Revision of Anterior Cruciate Ligament Reconstruction
	8.1	 Introduction
	8.2	 Failure Analysis
		8.2.1	 History
		8.2.2	 Clinical Symptoms
		8.2.3	 Physical Examination
		8.2.4	 Radiological Evaluation
		8.2.5	 Concomitant Pathologies
	8.3	 Surgical Steps for ACL Revision
		8.3.1	 The Method Used in the Old Implants
		8.3.2	 Tunnel Planning
			8.3.2.1	 Tunnels Opened in the Appropriate Position
			8.3.2.2	 Tunnels Opened in Partial Malposition
			8.3.2.3	 Tunnels Opened in Malposition
		8.3.3	 Surgical Method
	8.4	 Graft Selection and Fixation
		8.4.1	 Graft Selection
		8.4.2	 Graft Fixation
	References
9: Posterior Cruciate Ligament Anatomical Reconstruction
	9.1	 Introduction
	9.2	 Physical Examination
	9.3	 Imaging
	9.4	 Treatment
		9.4.1	 Nonoperative Treatment
		9.4.2	 Operative Treatment
			9.4.2.1	 Arthroscopic Single-Bundle Technique
			9.4.2.2	 Arthroscopic Double-Bundle Technique
			9.4.2.3	 Single-Bundle Open Tibial Inlay Technique with Bone–Patellar Tendon–Bone (BPTB) Autograft
	9.5	 Postoperative Rehabilitation
	9.6	 Complications
	References
10: Medial Patellofemoral Ligament Reconstruction Techniques
	10.1	 Introduction
	10.2	 Anatomy
		10.2.1	 Patella and Trochlea of the Femur
		10.2.2	 Medial Patellar Ligamentous Complex
	10.3	 Biomechanics of the MPFL
	10.4	 Indications for MPFL Reconstruction
	10.5	 Surgical Techniques of the MPFL Reconstruction
		10.5.1	 MPFL Reconstruction with the Gracilis or Semitendinosus Tendon
			10.5.1.1	 Gracilis and Hamstring Tendon Harvest
			10.5.1.2	 Patellar Insertion
			10.5.1.3	 Fixation with the Anchors
			10.5.1.4	 Transosseous Tunnels
			10.5.1.5	 Transosseous Suture Technique
			10.5.1.6	 Intraosseous Fixation with Interference Screw
			10.5.1.7	 Passing the Graft through Medial Patellar Complex
				Femoral Insertion Site
		10.5.2	 Femoral Tunnel Fixation with Interference Screw
		10.5.3	 Femoral Tunnel Fixation with Extracortical Button
		10.5.4	 MPFL Reconstruction Technique Using Quadriceps Tendon Graft
		10.5.5	 Complications
	10.6	 MPFL Reconstruction in Skeletally Immature Patients
		10.6.1	 MPFL Reconstruction with the Adductor Tendon
		10.6.2	 Modified Adductor Sling Technique
	References
11: Medial Collateral Ligament Anatomical Repair and Reconstructions
	11.1	 Surgical Treatment
	11.2	 Approach
	11.3	 Primary Repair
	11.4	 Reconstruction of the Torn MCL
	11.5	 Modified Bosworth Technique
	11.6	 LaPrade Technique
	11.7	 Postoperative Rehabilitation
	References
12: Anatomic Posterolateral Reconstruction
	12.1	 Introduction
	12.2	 Anatomy of the Posterolateral Corner of the Knee
		12.2.1	 Fibular Collateral Ligament
		12.2.2	 Popliteus Tendon Muscle
		12.2.3	 Popliteofibular Ligament
	12.3	 Biomechanics
	12.4	 Mechanism of Injury
	12.5	 Diagnostics
		12.5.1	 Clinical Picture
		12.5.2	 Clinical Examination
		12.5.3	 Imaging
		12.5.4	 Arthroscopy
	12.6	 Classification of Posterolateral Instability
	12.7	 Treatment Options
		12.7.1	 A Guide of Choosing the Appropriate Surgical Technique
		12.7.2	 Surgical Approach
		12.7.3	 Preparation of Grafts
	12.8	 Techniques
		12.8.1	 LaPrade’s Surgical Technique
		12.8.2	 Modified Arciero’s Surgical Technique
		12.8.3	 Modified Larson’s Surgical Technique
		12.8.4	 Arthroscopic Reconstruction by Frosch
	12.9	 The Role of High Tibial Osteotomy
	12.10	 Complications
	12.11	 Minimizing Technical Problems
	12.12	 Rehabilitation
	References
13: Anatomic Knee Joint Realignment
	13.1	 Introduction
	13.2	 Biomechanical Aspect
		13.2.1	 Physiological Axes and Angles of the Leg
		13.2.2	 Leg Deformities
		13.2.3	 Basic Principles of Knee Joint Realignment
	13.3	 Indications and Planning
		13.3.1	 Indications for Osteotomy and Physical Examination
		13.3.2	 Radiological Diagnostics
		13.3.3	 Localization of Deformity
		13.3.4	 Type and Level of Osteotomy
		13.3.5	 Size of Correction
	13.4	 Surgical Techniques: Tibial Osteotomies
		13.4.1	 High Tibial Osteotomy (HTO) for Varus Knee Malalignment
			13.4.1.1	 Medial Open-Wedge High Tibial Osteotomy
			13.4.1.2	 Lateral Closed-Wedge High Tibial Osteotomy
		13.4.2	 High Tibial Osteotomy (HTO) for Valgus Knee Malalignment
			13.4.2.1	 Medial Closed-Wedge High Tibial Osteotomy
	13.5	 Surgical Techniques: Femoral Osteotomies
		13.5.1	 Distal Femoral Osteotomy (DFO) for Varus Knee Malalignment
			13.5.1.1	 Lateral Closed-Wedge Distal Femoral Osteotomy
		13.5.2	 Distal Femoral Osteotomy (DFO) for Valgus Knee Malalignment
			13.5.2.1	 Medial Closed-Wedge Distal Femoral Osteotomy
			13.5.2.2	 Lateral Open-Wedge Distal Femoral Osteotomy
	13.6	 Double-Level Osteotomies around the Knee
		13.6.1	 Double-Level Osteotomy in Varus Knee Malalignment
		13.6.2	 Double-Level Osteotomy in Valgus Knee Malalignment
	13.7	 Computer-Assisted Navigation and Patient-Specific Instruments in Knee Joint Realignment Surgery
		13.7.1	 Computer-Assisted Navigation
		13.7.2	 Patient-Specific Instruments (PSI)
	13.8	 Complications Associated with Osteotomies around the Knee
		13.8.1	 Intraoperative Complications
		13.8.2	 Postoperative Complications
	References
14: Meniscal Implants and Transplantations
	14.1	 Introduction
	14.2	 Meniscus Implants
	14.3	 Types of Meniscus Implants
		14.3.1	 Collagen Meniscus Implants (CMI)
	14.4	 Synthetic Biocompatible Polyurethane Meniscus Implants
	14.5	 Surgery Indications and Contra-Indications
	14.6	 Surgical Procedure
	14.7	 Meniscus Transplantation
		14.7.1	 Surgery Indications and Contra-Indications
			14.7.1.1	 Indications
			14.7.1.2	 Contra-Indications
		14.7.2	 Surgical Procedure
			14.7.2.1	 Bone Tunnel
			14.7.2.2	 Bone Bridge
	14.8	 Conclusion
	References
15: Cartilage Treatment Techniques
	15.1	 Introduction
	15.2	 Diagnosis
	15.3	 Classification
	15.4	 Treatment
		15.4.1	 Bone Marrow Stimulating Technique
		15.4.2	 Mosaicplasty-Osteochondral Autograft Transfer System (OATS)
		15.4.3	 Osteochondral Allografts
		15.4.4	 Cell-Based Treatments
			15.4.4.1	 Autologous Chondrocyte Implantation (ACI)
			15.4.4.2	 Matrix-Induced Autologous Chondrocyte Implantation (MACI)
				Surgical Technique
				Clinical Results
				Complications
	References
16: Posterior Knee Arthroscopy
	16.1	 Introduction
	16.2	 Background
	16.3	 Posterior Anatomy of the Knee
		16.3.1	 Osseous Structures
		16.3.2	 Extraosseous Structures
			16.3.2.1	 Synovia and Joint Capsule
			16.3.2.2	 Menisci
			16.3.2.3	 Posterior Cruciate Ligament
			16.3.2.4	 Posteromedial Area
			16.3.2.5	 Posterolateral Area
			16.3.2.6	 Blood Vessel Anatomy
				Popliteal Artery (a. poplitea)
				Popliteal Vein
				Lymph Nodes
			16.3.2.7	 Nerve Anatomy
	16.4	 Technique
		16.4.1	 Trans-Septal Portal
		16.4.2	 Double Posteromedial Portal
	16.5	 Fields of Application and Advantages of Posterior Knee Arthroscopy
	16.6	 Complications
	16.7	 Conclusion
	References
17: Physiotherapy in Orthopedic Knee Injuries: Rehabilitation After Articular Cartilage Repair of the Knee
	17.1	 Introduction
	17.2	 Principles of Articular Cartilage Rehabilitation
	17.3	 Rehabilitation of Pain and Edema
	17.4	 Rehabilitation Phases After Cartilage Repair of the Knee
		17.4.1	 Phase I: Early Protection Phase
		17.4.2	 Phase II: Transition Phase
		17.4.3	 Phase III: Remodeling Phase
		17.4.4	 Phase IV: Maturation Phase
			17.4.4.1	 Rehabilitation After Debridement and Chondroplasty
			17.4.4.2	 Rehabilitation After Microfracture
			17.4.4.3	 Rehabilitation After Osteochondral Autograft Transplantation (OAT) Procedure
			17.4.4.4	 Rehabilitation After Autologous Chondrocyte Implantation (ACI)
	17.5	 Conclusion
	References
18: Physiotherapy in Orthopedic Knee Injuries: Rehabilitation Program Following Treatment of Meniscus Repair
	18.1	 Introduction
	18.2	 Early Postoperative Management
	18.3	 Brace and Crutch Support
	18.4	 Range of Knee Motion
	18.5	 Balance, Proprioception, and Neuromuscular Training
	18.6	 Strengthening
	18.7	 Conditioning
	18.8	 Running Program
	18.9	 Plyometric Training
	18.10	 Return to Sports Activities
	References
19: Physiotherapy in Orthopedic Knee Injuries: Rehabilitation Program Following Treatment of Posterior Cruciate Ligament Rupture
	19.1	 Introduction
	19.2	 Brace Support
	19.3	 The Range of Knee Motion
	19.4	 Weight-Bearing
	19.5	 Patellar Mobilization
	19.6	 Flexibility
	19.7	 Strengthening
	19.8	 Balance, Proprioceptive, and Perturbation Training
	19.9	 Conditioning
	19.10	 Running Program
	19.11	 Plyometric Training
	References
20: Physiotherapy in Orthopedic Knee Injuries: Rehabilitation Program Following Primary and Revision Anterior Cruciate Ligament Reconstruction
	20.1	 Introduction
	20.2	 Rehabilitation Protocol
	20.3	 Postoperative Bracing
	20.4	 Range of Knee Motion (ROM)
	20.5	 Patellar Mobilization
	20.6	 Weight Bearing
	20.7	 Flexibility
	20.8	 Strengthening
	20.9	 Balance, Proprioceptive, and Perturbation Training
	20.10	 Return to Sports Activities
	20.11	 Rehabilitation Protocol with Delayed Parameters for Revision ACL Reconstruction, Allografts, and Complex Knees
	References
21: Physiotherapy in Orthopedic Knee Injuries: Rehabilitation Program Following Tibial and Femoral Osteotomies
	21.1	 Introduction
	21.2	 Postoperative Rehabilitation Protocol
	21.3	 Postoperative Bracing and Weight-Bearing
	21.4	 Range of Knee Motion
	21.5	 Patellar Mobilization
	21.6	 Flexibility
	21.7	 Strengthening
	References
22: Morphometric Analysis of the Knee: A Comprehensive Evaluation of Knee Morphology in Designing Arthroplasties of Knee
	22.1	 Introduction
	22.2	 Morphological Analysis in Knee Arthroplasty
	22.3	 Gender Variations in Knee Morphology
	22.4	 Ethnic Variations in Knee Morphology
	22.5	 Additional Considerations Regarding Knee Morphology
	22.6	 Conclusion
	References
23: The Biomechanics of the Knee Joint
	23.1	 Musculoskeletal Mechanics
	23.2	 Knee Kinematics
	23.3	 Knee Stability
	23.4	 Tibiofemoral Joint Kinematics and Forces
	23.5	 Patellofemoral Joint Kinematics and Forces
	23.6	 Joint Tribology
	23.7	 Biomechanical Causes of Knee Degeneration
	23.8	 Biomechanics of Implant Design
	References