Abstract
Since the early years of orthopaedics, it is a well-known fact that anatomy follows function. During the evolution of mankind, the knee has been optimally adapted to the forces and loads acting at and through the knee joint. However, anatomy of the knee joint is variable and the only constant is its complex function. In contrast to the time of open surgery, nowadays the majority of reconstructive knee surgery is done arthroscopically. Keyhole surgery is less invasive, but on the backside, the knee surgeon lacks daily visualisation of the complex open anatomy. As open anatomical knowledge is less present in our daily practice, it is even more important to highlight this complex anatomy and function of the knee. It is the purpose of this review to perform a systematic review of knee anatomy, highlight the complex function of the knee joint and present an overview about recent and current knowledge about knee function.
Level of evidence Systematic review, Level IV.
Similar content being viewed by others
References
Arnold MP, Duthon V, Neyret P, Hirschmann MT (2013) Double incision iso-anatomical ACL reconstruction: the freedom to place the femoral tunnel within the anatomical attachment site without exception. Int Orthop 37:247–251
Arnold MP, Kooloos J, van Kampen A (2001) Single-incision technique misses the anatomical femoral anterior cruciate ligament insertion: a cadaver study. Knee Surg Sports Traumatol Arthrosc 9:194–199
Claes S, Luyckx T, Vereecke E, Bellemans J (2014) The Segond fracture: a bony injury of the anterolateral ligament of the knee. Arthroscopy 30:1475–1482
Claes S, Vereecke E, Maes M, Victor J, Verdonk P, Bellemans J (2013) Anatomy of the anterolateral ligament of the knee. J Anat 223:321–328
Feagin JA Jr, Curl WW (1976) Isolated tear of the anterior cruciate ligament: 5-year follow-up study. Am J Sports Med 4:95–100
Felmet G (2010) Implant-free press-fit fixation for bone-patellar tendon-bone ACL reconstruction: 10-year results. Arch Orthop Trauma Surg 130:985–992
Friederich NF (1993) Knee joint function and the cruciate ligaments. Biomechanical principles for reconstruction and rehabilitation. Orthopade 22:334–342
Friederich NF, Muller W, O’Brien WR (1992) Clinical application of biomechanic and functional anatomical findings of the knee joint. Orthopade 21:41–50
Fu FH, Ranawat A (2007) Tensioning in double-bundle ACL reconstruction. Arthroscopy 23:1027–1028
Gerhard P, Bolt R, Duck K, Mayer R, Friederich NF, Hirschmann MT (2013) Long-term results of arthroscopically assisted anatomical single-bundle anterior cruciate ligament reconstruction using patellar tendon autograft: are there any predictors for the development of osteoarthritis? Knee Surg Sports Traumatol Arthrosc 21:957–964
Haviv B, Bronak S, Kosashvili Y, Thein R (2015) Which patients are less likely to improve during the first year after arthroscopic partial meniscectomy? A multivariate analysis of 201 patients with prospective follow-up. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-015-3590-z
Hertel P, Behrend H, Cierpinski T, Musahl V, Widjaja G (2005) ACL reconstruction using bone-patellar tendon-bone press-fit fixation: 10-year clinical results. Knee Surg Sports Traumatol Arthrosc 13:248–255
Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part I. The medial compartment and cruciate ligaments. J Bone Joint Surg Am 58:159–172
Hughston JC, Andrews JR, Cross MJ, Moschi A (1976) Classification of knee ligament instabilities. Part II. The lateral compartment. J Bone Joint Surg Am 58:173–179
Jarvela T, Suomalainen P (2011) ACL reconstruction with double-bundle technique: a review of clinical results. Phys Sportsmed 39:85–92
Kapandji IA (1999) Funktionelle Anatomie der Gelenke, vol 2. Hippokrates Verlag GmbH, Stuttgart, Untere Extremität
Kennedy NI, Wijdicks CA, Goldsmith MT, Michalski MP, Devitt BM, Aroen A, Engebretsen L, LaPrade RF (2013) Kinematic analysis of the posterior cruciate ligament, part 1: the individual and collective function of the anterolateral and posteromedial bundles. Am J Sports Med 41:2828–2838
Kohl S, Evangelopoulos DS, Kohlhof H, Hartel M, Bonel H, Henle P, von Rechenberg B, Eggli S (2013) Anterior crucial ligament rupture: self-healing through dynamic intraligamentary stabilization technique. Knee Surg Sports Traumatol Arthrosc 21:599–605
Kondo E, Merican AM, Yasuda K, Amis AA (2010) Biomechanical comparisons of knee stability after anterior cruciate ligament reconstruction between 2 clinically available transtibial procedures: anatomic double bundle versus single bundle. Am J Sports Med 38:1349–1358
Lind M, Menhert F, Pedersen AB (2009) The first results from the Danish ACL reconstruction registry: epidemiologic and 2 year follow-up results from 5818 knee ligament reconstructions. Knee Surg Sports Traumatol Arthrosc 17:117–124
Menschik A (1974) Mechanik des Kniegelenkes. Z Orthop 112:481–495
Mommersteeg TJ, Kooloos JG, Blankevoort L, Kauer JM, Huiskes R, Roeling FQ (1995) The fibre bundle anatomy of human cruciate ligaments. J Anat 187:461–471
Mueller W (1982) The knee: form, function, and ligament reconstruction. Springer, New York
Muller W (1977) Current aspects of functional anatomy of the knee joint. Hefte Unfallheilkd 129:131–137
Müller W (1977) Verletzungen der Kreuzbänder. Zentralbl Chir 102:974–981
Nawabi DH, Cro S, Hamid IP, Williams A (2014) Return to play after lateral meniscectomy compared with medial meniscectomy in elite professional soccer players. Am J Sports Med 42:2193–2198
Noyes FR, Cummings JF, Grood ES, Walz-Hasselfeld KA, Wroble RR (1991) The diagnosis of knee motion limits, subluxations, and ligament injury. Am J Sports Med 19:163–171
O’Donoghue DH (1950) Surgical treatment of fresh injuries to the major ligaments of the knee. J Bone Joint Surg Am 32:721–738
Pena E, Calvo B, Martinez MA, Palanca D, Doblare M (2006) Why lateral meniscectomy is more dangerous than medial meniscectomy. A finite element study. J Orthop Res 24:1001–1010
Purnell ML, Larson AI, Clancy W (2008) Anterior cruciate ligament insertions on the tibia and femur and their relationships to critical bony landmarks using high-resolution volume-rendering computed tomography. Am J Sports Med 36:2083–2090
Schindler OS (2012) Surgery for anterior cruciate ligament deficiency: a historical perspective. Knee Surg Sports Traumatol Arthrosc 20:5–47
Segond P (1879) Recherches cliniques et expérimentales sur les épanchements sanguins du genou par entorse. Prog Med (Paris) 7:297–299, 319–321, 340–341
Siebold R (2011) The concept of complete footprint restoration with guidelines for single- and double-bundle ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 19:699–706
Siebold R, Ellert T, Metz S, Metz J (2008) Tibial insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: morphometry, arthroscopic landmarks, and orientation model for bone tunnel placement. Arthroscopy 24:154–161
Siebold R, Schuhmacher P, Fernandez F, Smigielski R, Fink C, Brehmer A, Kirsch J (2014) Flat midsubstance of the anterior cruciate ligament with tibial “C”-shaped insertion site. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3058-6
Smigielski R, Zdanowicz U, Drwiega M, Ciszek B, Ciszkowska-Lyson B, Siebold R (2014) Ribbon like appearance of the midsubstance fibres of the anterior cruciate ligament close to its femoral insertion site: a cadaveric study including 111 knees. Knee Surg Sports Traumatol Arthrosc. doi:10.1007/s00167-014-3146-7
Sonnery-Cottet B, Lavoie F, Ogassawara R, Scussiato RG, Kidder JF, Chambat P (2010) Selective anteromedial bundle reconstruction in partial ACL tears: a series of 36 patients with mean 24 months follow-up. Knee Surg Sports Traumatol Arthrosc 18:47–51
Steadman JR, Cameron-Donaldson ML, Briggs KK, Rodkey WG (2006) A minimally invasive technique (“healing response”) to treat proximal ACL injuries in skeletally immature athletes. J Knee Surg 19:8–13
Steckel H, Musahl V, Fu FH (2010) The femoral insertions of the anteromedial and posterolateral bundles of the anterior cruciate ligament: a radiographic evaluation. Knee Surg Sports Traumatol Arthrosc 18:52–55
Steckel H, Starman JS, Baums MH, Klinger HM, Schultz W, Fu FH (2007) Anatomy of the anterior cruciate ligament double bundle structure: a macroscopic evaluation. Scand J Med Sci Sports 17:387–392
Tashman S, Kopf S, Fu FH (2008) The kinematic basis of ACL reconstruction. Oper Tech Sports Med 16:116–118
Thaunat M, Pioger C, Chatellard R, Conteduca J, Khaleel A, Sonnery-Cottet B (2014) The arcuate ligament revisited: role of the posterolateral structures in providing static stability in the knee joint. Knee Surg Sports Traumatol Arthrosc 22:2121–2127
Tsukada H, Ishibashi Y, Tsuda E, Fukuda A, Toh S (2008) Anatomical analysis of the anterior cruciate ligament femoral and tibial footprints. J Orthop Sci 13:122–129
Vincent JP, Magnussen RA, Gezmez F, Uguen A, Jacobi M, Weppe F, Al-Saati MF, Lustig S, Demey G, Servien E, Neyret P (2012) The anterolateral ligament of the human knee: an anatomic and histologic study. Knee Surg Sports Traumatol Arthrosc 20:147–152
Wijdicks CA, Kennedy NI, Goldsmith MT, Devitt BM, Michalski MP, Aroen A, Engebretsen L, LaPrade RF (2013) Kinematic analysis of the posterior cruciate ligament, part 2: a comparison of anatomic single- versus double-bundle reconstruction. Am J Sports Med 41:2839–2848
Zaffagnini S, Bruni D, Russo A, Takazawa Y, Lo Presti M, Giordano G, Marcacci M (2008) ST/G ACL reconstruction: double strand plus extra-articular sling versus double bundle, randomized study at 3-year follow-up. Scand J Med Sci Sports 18:573–581
Zantop T, Diermann N, Schumacher T, Schanz S, Fu FH, Petersen W (2008) Anatomical and nonanatomical double-bundle anterior cruciate ligament reconstruction: importance of femoral tunnel location on knee kinematics. Am J Sports Med 36:678–685
Zantop T, Petersen W, Sekiya JK, Musahl V, Fu FH (2006) Anterior cruciate ligament anatomy and function relating to anatomical reconstruction. Knee Surg Sports Traumatol Arthrosc 14:982–992
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Hirschmann, M.T., Müller, W. Complex function of the knee joint: the current understanding of the knee. Knee Surg Sports Traumatol Arthrosc 23, 2780–2788 (2015). https://doi.org/10.1007/s00167-015-3619-3
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00167-015-3619-3