The axes of rotation of the knee

Knee motion is believed to occur about a variable flexion-extension (FE) axis perpendicular to the sagittal plane and a longitudinal rotation (LR) axis. The authors used a mechanical device to locate the FE and the LR axes of six fresh anatomic specimen knees. The motion of points on the LR axis produced circular, planar paths about the fixed FE axis. Magnetic resonance (MR) images in planes perpendicular to the FE axis showed a circular profile for the femoral condyles. The FE axis is constant and directed from anterosuperior on the medial side to posteroinferior on the lateral side, passing through the origins of the medial and lateral collateral ligaments and superior to the crossing point of the cruciates. The LR axis is anterior and not perpendicular to the FE axis, the anatomic planes. This offset produces the valgus and external rotation observed with extension. The implications of two fixed offset axes for knee motion on prosthetic design, braces, gait analysis, and reconstructive surgery are profound.