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Screw Home Mechanism of the Knee 

The Biomechanist
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In this video, I describe the screw home mechanism of the knee (tibiofemoral joint). The screw home mechanism is defined as concurrent external rotation of the knee during the last 25-30 degrees of extension. This is driven primarily by the shapes of the condyles of femur and secondarily by passive tension in the ACL near the fully extended position.
The locked position of the knee is a very stable position, but there is nothing that prevents the knee from going back into flexion. Any muscle or external force pulling or pushing into flexion can "unlock" the knee. Popliteus specifically is not required to unlock the knee, but it may plan a small role maintaining joint congruency during active knee flexion. However, gracilis, semimembranosus, semitendinosus, and the lateral head of the gastrocnemius have some ability to guide internal rotation of the knee when coupled with knee flexion when starting from full extension. I do not think sartorius has the ability to help, as I incorrectly stated in the video, as it does not gain the ability for internal rotation until the knee has been flexed. I did not address knee extensors' roles in rotation in this video, but vastus medialis can contribute to medial rotation of the knee and vastus lateralis can contribute to lateral rotation. Please note that this information is based on looking at images of cadavers. Many artistic images of these muscles have slight variations that are misleading.

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18 сен 2024

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Комментарии : 39   
@vats8087
@vats8087 Год назад
this is a godsend . i have my biomechanics finals tomorrow, this saved me. anyway, this was an amazing explanation
@kikoware4721
@kikoware4721 11 месяцев назад
Great video! Thank you!!!
@mayankmayan1831
@mayankmayan1831 3 года назад
Omg where were you all these days You are a life saver Thank you
@user-tb4vx5kp1q
@user-tb4vx5kp1q 3 года назад
The best explanation of locking mechanism. Thank you very much
@karleegreer4511
@karleegreer4511 6 месяцев назад
This was so helpful! Thank you!
@cooolpeace5923
@cooolpeace5923 Год назад
Thank you. Your explanation really helps me a lot.
@muath7962
@muath7962 2 года назад
Thank you so much, finally I understand knee lock mechanism
@needcoffeerightnow
@needcoffeerightnow Год назад
this is a literal gem, thank you!!!!!
@crystalmael.4482
@crystalmael.4482 2 года назад
Wow, this video helped so much break down the screw home mechanism for me. Thank you so so much! -A future DPT
@junyeongpark-g5j
@junyeongpark-g5j 4 года назад
thank you Professor Fish! this video is really helpful and easy to understand!
@thiagovivacqua9105
@thiagovivacqua9105 Год назад
Very nice and clear description! Thank you.
@thebestornothin3666
@thebestornothin3666 3 года назад
Thank you very much ... appreciate the effort prof
@nidhidhakad9384
@nidhidhakad9384 3 года назад
It's just awesome explaination
@thebiomechanist4995
@thebiomechanist4995 3 года назад
Thank you! I appreciate the feedback.
@mixedinformation8634
@mixedinformation8634 3 года назад
Thank you very much ALL appreciations from here in Egypt . I do not understand it till i watched this video 😃 Hoping to contact with you 💕 Thanks
@akshayshibu3842
@akshayshibu3842 2 года назад
Thank you so much
@samakhaled3577
@samakhaled3577 2 года назад
Thank you prof. 💕
@ems9097
@ems9097 4 года назад
This video really helped! thank you :)
@Djejnxxnd1
@Djejnxxnd1 2 года назад
very helpful
@sathyanarayananmpt250
@sathyanarayananmpt250 3 года назад
When tibia fixed with moving femur , end range produce medial rotation in femur? How it rotate latrally
@denisshostak626
@denisshostak626 3 года назад
Great explanation! I was hoping you would elaborate more about why the popliteous unlocking the knee is a myth
@denisshostak626
@denisshostak626 3 года назад
popliteus*
@thebiomechanist4995
@thebiomechanist4995 3 года назад
Simply put, there is nothing that truly locks the knee in a position of full extension. Any muscle the flexes the knee, or external forces such as gravity, is capable of creating knee flexion from a fully extended position. Popliteus may be involved and may even help guide the component of internal rotation, but it is not a necessary factor in this scenario. Also, there are different variations of popliteus and some of these variation may actually be weak knee extensors. But that is a topic for another video.
@jerrysegal2903
@jerrysegal2903 24 дня назад
does that mean that when using the leg extension machine, we should never lock out at the top so as not to create friction as the condyls screw home?
@elmanahmed6117
@elmanahmed6117 Год назад
That's a great explaination. I just want to point out one thing, you might feel that popliteus has no role when it comes to unlocking the knee, but in all the books it's mentioned the other way around. For example, I will be taking my NPTE (Physical therapy board exam) and for all the med students when they take their licensure exam the examiner can ONLY ask questions based on the book. Maybe you can give it a try and publish something about popliteus. But for now, we have to rely on what is published.
@thebiomechanist4995
@thebiomechanist4995 Год назад
It is in every textbook I have every seen that talks about unlocking the knee. It is frustrating. I am not sure of a reliable source in which I could publish an article on this, but I would love two. I am currently working on my master's degree, so maybe I will have an opportunity to publish a study or at least a research article. I am working on self publishing a musculoskeletal anatomy book, so I hope that gets some notice. I've had great response to this topic, so I plan on making one on popliteus. There is actually some research that supports what I said, but it is ignored or misunderstood. I appreciate your feedback!
@andrewsayer1530
@andrewsayer1530 2 года назад
would it be wrong to say that the popliteus is still somewhat involved in the internal rotation of the knee as flexion starts?
@markpellman4941
@markpellman4941 3 года назад
Thanks for the video. My question is similar to Sathya’s: why do you say concurrent lateral rotation? I’m confused because during terminal knee extension, if the tibia is rotating laterally on the femur, the femur is rotating medially on the tibia. Can you help clear this up for me?
@thebiomechanist4995
@thebiomechanist4995 3 года назад
The phrase "concurrent lateral rotation" of the knee implies that the rotation that I am talking about only occurs simultaneously with knee extension. During standard action lateral rotation of the knee, the tibia rotates relative to the femur. If the femur is moving on a fixed tibia during knee extension, then the femur does in fact rotate medially relative to the tibia. However, this is still lateral rotation of the knee. As a comparison, consider flexion of the elbow joint. Flexion the elbow can be defined simply as a bending of the elbow joint. If the forearm moves relative to the humerus, it is considered standard action elbow flexion. If the humerus moves relative to the forearm, this is considered reverse action elbow flexion. But they are both equally accurate descriptions of elbow flexion. Likewise, internal rotation of the knee is named with a distal segment bias. Standard action lateral rotation of the knee occurs when the tibia rotates on a fixed femur. Reverse action lateral rotation of the knee occurs when the femur rotates laterally relative to a fixed tibia, but this is still lateral knee rotation. The relative motion of one bone to the other is the same in both instances.
@markpellman4941
@markpellman4941 3 года назад
@@thebiomechanist4995 Thanks for the reply. Now I understand the concurrency is in relation to the knee extending. Is there a way to accurately assess/measure the screw home mechanism manually? Is it even meaningful to asses it? Or do you assess it more indirectly by looking at things like ligament integrity since that plays a roll?
@thebiomechanist4995
@thebiomechanist4995 3 года назад
@@markpellman4941 Great question. I will answer this from my personal perspective as a personal trainer and massage therapist. I do not try to measure the external rotation of the tibia on femur during knee extension; I am unsure how much clinical value this would have. Although if another practitioner sees value in it, that's great. I would not make an argument against their point of view. Due to individual differences in structure, people will have varying degrees or rotation associated with extension so one would have to be careful about drawing conclusions. In my professional opinion, I think that a range of motion assessment of knee extension is more valuable with an emphasis on end-feel and pain-free motion. I would also look the range of motion of internal and external knee rotation with the knee bent at 90 degrees. It is much easier to assess the overall ROM of rotation with this time of assessment, and restriction or pain with this type of assessment may also be related to inability to fully extend the knee. Finally, ligament integrity/laxity tests are very valuable, but outside my scope of practice. My guess is most athletic trainers and physical therapists would find ligament tests far more valuable than trying to measure concurrent lateral rotation of the knee with knee extension. This was a bit of a rambling answer, but I hope this helps!
@markpellman4941
@markpellman4941 3 года назад
@@thebiomechanist4995 Thank you, that is helpful. I really appreciate your time on this topic. As a student PT, I'm always looking to learn more about arthokinematics and such!
@azhharry4234
@azhharry4234 3 года назад
hi how to unlock knee, my knee cant bend it properly I can only bend it about 30 degre
@denisshostak626
@denisshostak626 3 года назад
Hi, I believe that the screw home mechanism only happens for the first few degrees. If you can bend your knee 30 degrees, I think it might be related to some other issue. You should probably consult an orthopedist, physical therapist, or athletic trainer about it
@thebiomechanist4995
@thebiomechanist4995 3 года назад
@@denisshostak626 I agree. Please see a health professional about your specific issue.
@carrickcolin
@carrickcolin Год назад
I experience pain during what feels like lateral rotation. This discomfort has prevented me from running."
@carrickcolin
@carrickcolin Год назад
I would greatly appreciate any suggestions for addressing my knee pain. I've been diagnosed with grade 4 chondromalacia at the lateral condyle. Despite undergoing extensive physiotherapy, steroid, and HA injections, I'm still unable to run. The issue began suddenly in October 2022. I maintain a high level of fitness and used to play regularly for my Over 35s soccer team, but currently, I'm sidelined due to my inability to run. It's incredibly frustrating. thanks
@AsifTushar
@AsifTushar Год назад
Hello, my knee didn’t fold bcoz of accident. Please help me. Give me your email, that's why I'll send my xray report of my Knee
@Mayank-u4s
@Mayank-u4s 3 месяца назад
Not clear in ur video It makes it more complex.... Kindly don't confuse Not able to show rotation Just in words
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