The knee in full flexion: an anatomical study

There has been only one limited report dating from 1941 using dissection which has described the tibiofemoral joint between 120 degrees and 160 degrees of flexion despite the relevance of this arc to total knee replacement. We now provide a full description having examined one living and eight cadaver knees using MRI, dissection and previously published cryosections in one knee. In the range of flexion from 120 degrees to 160 degrees the flexion facet centre of the medial femoral condyle moves back 5 mm and rises up on to the posterior horn of the medial meniscus. At 160 degrees the posterior horn is compressed in a synovial recess between the femoral cortex and the tibia. This limits flexion. The lateral femoral condyle also rolls back with the posterior horn of the lateral meniscus moving with the condyle. Both move down over the posterior tibia at 160 degrees of flexion. Neither the events between 120 degrees and 160 degrees nor the anatomy at 160 degrees could result from a continuation of the kinematics up to 120 degrees . Therefore hyperflexion is a separate arc. The anatomical and functional features of this arc suggest that it would be difficult to design an implant for total knee replacement giving physiological movement from 0 degrees to 160 degrees .