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59 KNEE INSTABILITY
Alex J Kline, BA
Mark D Miller, MDINTRODUCTION- The bony structure of the knee provides relatively
little inherent stability to the joint. In turn, knee sta-
bility depends on the intact functioning of the four
major knee ligaments as well as the supporting liga-
mentous structures. Injuries to these structures lead to
varying degrees of functional instability in the knee
joint.
ANATOMY AND BIOMECHANICS
OF KNEE LIGAMENTSACL- The anterior cruciate ligament(ACL) originates on
the posteromedial aspect of the lateral femoral
condyle. From there, it courses anteromedially to
insert in a wide, depressed area just anterior to and
between the intercondylar eminences of the tibia. - The ACL is approximately 33-mm long and 11-mm in
diameter (Miller, 2000). The blood supply is from the
middle geniculate artery. Innervation is via branches
of the tibial nerve. - Often described as having two distinct bundles. The
anteromedial bundle is tight in flexion. The postero-
lateral bundle is tight in extension. - The primary function of the ACL is to resist anterior
translation of the tibia on the femur. Secondary func-
tions include stabilization against excessive varus and
valgus stress, stabilizer to hyperextension, proprio-
ception, and the screw homemechanism.
PCL- The posterior cruciate ligament (PCL) originates in a
comma shaped area on the posterolateral surface of
the medial femoral condyle. It runs posterolaterally to
insert the tibia in a sulcus approximately 1 cm below
the articular surface. - The PCL is approximately 38-mm long and 13-mm in
diameter (Girgis, Marshall, and Al Monajem, 1975).
The blood supply is from branches of the middle
geniculate and innervation is via branches of the tibial
nerve.
•Like the ACL, the PCL is described as having two dis-
tinct bundles. The anterolateral bundle is tight in flex-
ion. The posteromedial bundle is tight in extension.
350 SECTION 4 • MUSCULOSKELETAL PROBLEMS IN THE ATHLETE