Document Title: Boeckmann-EKLR-Ch02-2000.shtml
Article Title: Biomechanics
Author: Richard R. Boeckmann, PT, and Todd S. Ellenbecker, MS, PT, SCS, CSCS
Publication: Knee Ligament Rehabilitation, edited by Todd S. Ellenbecker. Philadelphia, Pennsylvania: Churchill Livingstone (Harcourt), 2000. (This book has 51 contributing authors and 465 pages.)
Pages: 16-23
Keywords: Knee biomechanics, ligament interdependency, ACL, PCL, MCL, LCL, tensile structures, knee motion governance.

(Reference-denoting numbers appear in the same font and point size as the document text. As with all Knee Library documents, this article is provided in full-text form, complete with all figures and tables. Although this article has been published as a book chapter, it can be read independently of the other chapters in the book. Other chapters from this book can be found here.)

Comments: This chapter discusses how the knee works internally, and focuses on the forces (biomechanics) borne by the ligaments during the range of motion. The authors note the importance of both cruciate ligaments in governing the roll-and-glide motion of the knee, and they note that all four primary ligaments (ACL, PCL, MCL, and LCL) play a role in limiting how far the knee extends. (No wonder severe hyperextension-type injuries result in massive, widespread ligament damage.) The authors also note that residual MCL laxity (from an insufficiently scarred-over torn MCL) means more stress on the ACL. The authors additionally describe the demands made on the secondary restraints in the event of chronic ligamentous damage. For example, a torn ACL results in the menisci being pressed into service (i.e. to prevent the tibia from sliding too far forwards). In general, damage to any knee structure means more stress on the remaining intact structures. Since the remaining intact structures are not intended to handle loadings they were not designed for, they eventually deteriorate. Ultimately, a knee left with an unaddressed chronic deficiency in any major structure can be counted on to self-destruct.

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Introduction

An understanding of the biomechanics of the human knee forms the basis for the design and progression of rehabilitation programs for the patient with knee ligament injury. Knowledge of the biomechanical principles of the tibiofemoral joint and surrounding ligamentous structures is of vital importance both to the clinical evaluation and treatment and to better understanding of the demands placed on the surgically reconstructed knee.

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