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Oxford Textbook of Rheumatology (4 ed.)

Roger Wolman


The knee is a large, synovial, weightbearing joint. It is therefore exposed to considerable mechanical stress as a result of walking and other weightbearing activities which can lead to injury. Biomechanical factors that influence lower limb alignment will have a considerable impact on the knee and will determine the risk of injury. The knee is composed of two different articulations, the tibiofemoral and the patellofemoral joints. The diagnosis of knee problems can be enhanced by understanding the anatomy of the knee and identifying the site of the pain. The anterior knee is the most common site of pain and is usually due to the patellofemoral joint problems. It is often caused by malalignment of the patella as it moves through the trochlear groove. Extra-articular pathology involves the tendons, bones, and bursa and is often the result of an overuse injury. Tendinopathies around the knee are particularly common and are influenced by biomechanical factors. Intra-articular pathology can result from disorders involving the synovium. This includes inflammatory arthritis as well as other less common synovial diseases. Intra-articular pathology can also involve the menisci, the articular cartilage, and the ligaments and these often occur as a result of a twisting injury. Injury to these structures, in particular the anterior cruciate ligament, increases the risk of developing osteoarthritis in later life. Imaging, especially MRI, has enhanced the ability to distinguish between these disorders.

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