The Journal of Bone and Joint Surgery, Vol 69, Issue 7 976-983, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
An evolutionary perspective of the knee
SF Dye
Davies Medical Center, San Francisco, California 94114.
The complex asymmetrical design of the human knee is ancient in origin. The
distinctive characteristics of this design were well established more than
300 million years ago. The knees of most classes of tetrapods exhibit
similar morphological characteristics, including a bicondylar cam-shaped
distal part of the femur, intra-articular ligaments, menisci, and
asymmetrical collateral ligaments. The functional characteristics are also
similar, with the dynamic point of femorotibial contact moving posteriorly
on the tibia in flexion, approximating a four-bar linkage system. The
common design and function among knees of tetrapods imply a profound
underlying similarity of kinematic principles. Despite the over-all
similarity of the design of knees in tetrapods, no ideal animal model
exists for the human knee. The human is the only known species that is both
plantigrade and biped. By taking into account the retained complex
asymmetry of motion of the human knee, such as the differentially greater
femoral rollback of the lateral compartment as compared with the medial
compartment, external bracing systems and designs for total knee
replacement might be improved.
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