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Howell SM, Sappey-Marinier E, Niesen AE, Nedopil AJ, Hull ML. Better forgotten joint scores when the angle of the prosthetic trochlea is lateral to the quadriceps vector in kinematically aligned total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2023; 31:5438-5445. [PMID: 37792084 DOI: 10.1007/s00167-023-07598-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 09/15/2023] [Indexed: 10/05/2023]
Abstract
PURPOSE The primary aim was to analyze unrestricted kinematic alignment (unKA) total knee arthroplasty (TKA) and determine the frequency of medial deviation of the prosthetic trochlear angle (PTA) of the femoral component relative to the quadriceps vector (QV) that terminates at the anterior inferior iliac spine (AIIS), and whether patients with medial deviation had a worse Forgotten Joint Score (FJS) and Oxford Knee Score (OKS) relative to those with lateral deviation. The secondary aim was to determine the frequency of medial deviation for mechanical alignment (MA) TKA simulations. METHODS From a database of a single surgeon, the study extracted de-identified data on 147 patients with a CT scanogram showing the pelvis and AIIS, a limb with an unKA TKA, and a native (i.e., healthy) opposite limb. On the scanogram, an examiner, blinded to the PROMs, measured the PTA-QV angle on the unKA TKA and on the opposite limb simulated MA TKA by drawing the PTA at 6° valgus relative to the femoral mechanical axis and measuring the PTA-QV angle. RESULTS Medial deviation of the PTA occurred in 86% of patients with unKA TKA, and the 126 with medial deviation had a 17/1 point worse median FJS/OKS than the 21 with lateral deviation at a mean follow-up of 47 ± 8 months, respectively (p < 0.0001, p = 0.0053). In addition, 21%, 17%, and 8% of MA TKA had medial deviation after radiographic simulation using reported surgical errors for manual, patient-specific, and robotic instrumentation, respectively. CONCLUSION In most patients with unKA TKA and a smaller proportion with MA TKA, a PTA of 6° valgus was medial to the QV, which, by excluding the patient's Q-angle, might alter patellofemoral kinematics like an incorrectly oriented trochleoplasty. The 17-point worse FJS in the patients with an unKA TKA and medial deviation of the PTA suggests the surgical target should be to orient the PTA lateral to the QV. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Stephen M Howell
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Elliot Sappey-Marinier
- Department of Orthopaedic Surgery, University of California, San Francisco, CA, 94143, USA.
- Department of Orthopaedic Surgery, Ramsay Santé, Hôpital Privé Jean Mermoz, Centre Orthopédique Santy, 69008, Lyon, France.
| | - Abigail E Niesen
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
| | - Alexander J Nedopil
- Orthopädische Klinik König-Ludwig-Haus, Lehrstuhl für Orthopädie der Universität Würzburg, 97074, Würzburg, Germany
| | - Maury L Hull
- Department of Biomedical Engineering, University of California, Davis, CA, 95616, USA
- Department of Orthopedic Surgery, University of California, Davis Medical Center, Sacramento, CA, 95817, USA
- Department of Mechanical Engineering, University of California, Davis, CA, 95616, USA
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Takagi S, Blaha JD, Mochizuki T. Medial-pivot design improved knee symptoms from anteroposterior instability in early-range flexion and resolved anterior knee pain in revision total knee arthroplasty. J Arthroplasty 2023; 38:S284-S289. [PMID: 36958715 DOI: 10.1016/j.arth.2023.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/10/2023] [Accepted: 03/13/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Instability can lead to poor functional results after tricompartmental total knee arthroplasty (TKA). We identified a group of patients who appeared to have antero-posterior (AP) instability in early-range flexion (i.e., 20 to 30° range) associated with anterior knee pain and feelings of instability. The purpose of this study was to assess the clinical results in terms of stability and anterior knee pain after revision TKA with a medial-pivot implant and to assess the effect of the implant positioning used in the revision technique. METHODS There were 45 patients (45 knees) evaluated retrospectively to assess standing lower extremity alignment and functional results by generating a knee stability score after revision TKA with medial pivot implant design. RESULTS Revision TKA using the medial-pivot TKA lowered the joint line by 3.6 millimeters (mm) (P<0.001) and positioned the tibia anteriorly by 3.5 mm (P<0.001) on radiographic measurements as compared with results after primary TKA. Moreover, medial pivot revision TKA improved AP stability by a 56-point change in score (P<0.001). CONCLUSIONS Revision TKA using a medial pivot design improved AP stability and anterior knee pain after failed primary procedures.
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Affiliation(s)
- Shigeru Takagi
- Department of Orthopaedic Surgery, University of Michigan, Michigan, USA;; Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - John David Blaha
- Department of Orthopaedic Surgery, University of Michigan, Michigan, USA
| | - Tomoharu Mochizuki
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, Michigan, USA
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Mochizuki T, Blaha JD, Tanifuji O, Yamagiwa H, Kai S, Kawashima H. The three-dimensional quadriceps vector is most parallel to the spherical axis in Japanese varus osteoarthritic knees. Knee 2021; 33:200-209. [PMID: 34666288 DOI: 10.1016/j.knee.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/26/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The quadriceps femoris may be a reliable reference to proper alignment in total knee arthroplasty (TKA). We previously showed the quadriceps vector (QV) to be the most parallel to the spherical axis (SA-center hip to center medial condyle) for healthy knees. The purpose of this study was to determine whether the QV is the most parallel to the SA in knees with varus osteoarthritis (OA). METHODS CT imaging for 35 varus OA and 40 healthy Japanese knees was used to construct 3D models of the femur, patella and each quadriceps component for each subject. The QV was calculated using principal component analysis for direction and was compared with the relationship of the QV to the measurement axes of the lower extremity, including the anatomical, mechanical and spherical axes. RESULTS The direction of the QV for the OA knee group was different from that for the healthy knee group in 3D space (medio-lateral direction: women, p = 0.532, men, p = 0.540; antero-posterior direction: women, p = 0.141, men, p < 0.001). However, the angle of the QV in relation to measurement axes in the coronal plane was closest to the SA in both groups (around 1°), with no difference between the groups (women, p = 0.382, men, p = 0.943). CONCLUSION In the coronal plane, the SA most closely approximates the QV for both healthy and OA knees. The more posterior QV position in the 3D space may affect the patellofemoral joint.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, MI, USA.
| | - John David Blaha
- Department of Orthopaedic Surgery, University of Michigan, MI, USA.
| | - Osamu Tanifuji
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Yamagiwa
- Deparment of Orthopaedic Surgery, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shin Kai
- Center for Fostering Innovative Leadership, Institute for Research Collaboration and Promotion, Niigata University, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Tibial tuberosity-tibial intercondylar midpoint distance measured on computed tomography scanner is not biased during knee rotation and could be clinically more relevant than current measurement systems. INTERNATIONAL ORTHOPAEDICS 2020; 45:959-970. [PMID: 33037445 DOI: 10.1007/s00264-020-04820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this retrospective cross-sectional case-control study was to evaluate an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation. METHODS On axial CT images of 129 knees, classified as cases (two or more patellar luxations) and controls (no patellar luxations), two raters gauged the standard tibial tuberosity-trochlear groove (TT-TG) distance, tibial tuberosity-femoral intercondylar midpoint (TT-FIM) distance, and new tibial tuberosity-tibial intercondylar midpoint (TT-TIM) distance singly, and knee longitudinal rotation angles (LRAs), and the presence of femoral trochlear dysplasia (FTD) jointly. RESULTS All imaging tests intercorrelated and discriminated between stability groups. TT-TIM had the lowest values with the highest precision. Though poorly, TT-TG and TT-FIM negatively correlated with age and LRAs regarding femur, but positively with presence of FTD, whereas TT-TIM was unbiased. The accuracy of TT-TG (> 20 mm), TT-FIM (> 20 mm), and TT-TIM (> 13 mm) was good with almost perfect reproducibility. Only TT-TIM was sex-biased (p = 0.009), with > 12 mm cut-off in females and (presumably) > 14 mm in males. CONCLUSION TT-TIM is an alternative imaging test for lateralization of the tibial tuberosity, unbiased towards knee rotation.
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Bori E, Innocenti B. Development and validation of an in-silico virtual testing rig for analyzing total knee arthroplasty performance during passive deep flexion: A feasibility study. Med Eng Phys 2020; 84:21-27. [PMID: 32977919 DOI: 10.1016/j.medengphy.2020.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 07/22/2020] [Accepted: 07/26/2020] [Indexed: 12/19/2022]
Abstract
The use of in-silico finite element (FE) models has become more common in orthopedic applications and in the design of biomedical devices, since they can provide results comparable to in vitro experiments while maintaining lower cost. The main downside of this kind of analysis is the high computing time, as it can reach hours or even days to complete; this limitation makes it then not suitable for time-sensitive applications, such as probabilistic analyses or helping clinicians in surgical pre-planning or intra-operative setting. In-silico multibody (MB) simulations, on the other hand, are significantly faster than FE simulations (considering each component of the model as a rigid body); although deformability of each model component is a necessary feature in some applications (e.g. simulation of implant-bone micromotions), several outputs of interest in orthopedic applications, such as implant kinematics and contact forces, do not require a fully deformable model. Therefore, this feasibility study aimed to develop a MB model of a human knee joint implanted with a Total Knee Arthroplasty; a 10 second flexion movement up to 105° was then simulated and the results compared with validated FE models results (under similar boundary conditions) from literature, to perform a preliminary validation in terms of kinematic and kinetic results between the two methods. The agreement and relatively low computing time obtaining with this approach represent a promising starting point for subsequent studies and applications of such techniques in the clinical field.
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Affiliation(s)
- Edoardo Bori
- BEAMS Engineering Department, Université Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Av. F.D. Roosevelt 50 - CP165/56 1050 Brussels, Belgium.
| | - Bernardo Innocenti
- BEAMS Engineering Department, Université Libre de Bruxelles, Ecole Polytechnique de Bruxelles, Av. F.D. Roosevelt 50 - CP165/56 1050 Brussels, Belgium
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Distalising tibial tubercle osteotomy decreases patellar tendon force - A treatment rationale for recalcitrant patellar tendinopathy. Knee 2020; 27:871-877. [PMID: 32220536 DOI: 10.1016/j.knee.2020.02.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 12/19/2019] [Accepted: 02/27/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patellar tendinopathy is an overuse condition affecting athletes, often with a high morbidity if left untreated. High-level evidence fails to support the use of surgery. A tibial tubercle osteotomy (TTO) has been suggested as a surgical option to improve patient outcomes. Our aim was to explore whether a distalising TTO will alter the patellar tendon to quadriceps tendon force ratio and the sagittal patellar tilt. METHODS Six cadaver limbs were placed in a custom jig with a mechanical testing machine applying cyclical loads of 200-500 N to the quadriceps tendon. The knee was fixed at 0, 15, 30, 45, 60, 75 and 90° of flexion and a buckle transducer recorded the resultant patellar tendon force. Testing was performed with the native tibial tubercle position and with the tubercle distalised by 11 mm. Testing was also performed with the tubercle anteriorised by 10 mm at both of these tubercle positions, a total of four different testing positions. RESULTS There was a significant decrease in the patellar tendon to quadriceps tendon force ratio from 30-60° of knee flexion. There was a significant increase in the sagittal patellar tilt at 30° of knee flexion with distalisation. CONCLUSION This biomechanical study shows that the patellar tendon to quadriceps tendon force ratio can be altered with a distalising tibial tubercle osteotomy. A tibial tubercle osteotomy may be a biomechanical treatment option for recalcitrant patellar tendinopathy by decreasing the load through the patellar tendon, allowing the athlete to maintain higher training volumes and loads.
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Khasawneh RR, Allouh MZ, Abu-El-Rub E. Measurement of the quadriceps (Q) angle with respect to various body parameters in young Arab population. PLoS One 2019; 14:e0218387. [PMID: 31194851 PMCID: PMC6564690 DOI: 10.1371/journal.pone.0218387] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Accepted: 05/23/2019] [Indexed: 11/19/2022] Open
Abstract
The quadriceps angle (Q angle), formed between the quadriceps muscles and the patella tendon, is considered clinically as a very important parameter which displays the biomechanical effect of the quadriceps muscle on the knee, and it is also regarded a crucial factor for the proper posture and movement of the knee patella. The Q angle is routinely and regularly used as an assessment parameter during the diagnosis of many knee-related problems, including the anterior knee pain, osteoarthritis, and degenerative knee disorders. This study had been conducted so as to measure the normal Q angle values range in the Arab nationalities and determine the correlation between Q angle values and several body parameters, including gender, height, weight, dominant side, and the condylar distance of the femur. The study includes 500 healthy young Arab students from the Yarmouk University and Jordan University of Science and Technology. The Q angle of those volunteers was measured using a universal manual Goniometer with the subjects in the upright weight-bearing position. It was found that Q angle was greater in young women than young men. Also, the analysis of the data revealed an insignificant increase in the dominant side of the Q angle. In addition, the Q angle was significantly higher in the taller people of both sexes. However, the Q angle did not present any considerable correlation with weight in the study population; conversely, it was clearly observed that there was a link with the condylar distance of the femur in both sexes. It was also noticed that the Q angle increased remarkably when there was an increase in the condylar distance. Consequently, it turned out that the gender, height, and the condylar distance were momentous factors that had impact on the Q angle in our study samples. However, weight and dominancy factors did not show to have any influence on the values in our study.
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Affiliation(s)
- Ramada R. Khasawneh
- Department of Basic Medical Sciences, Faculty of Medicine, Yarmouk university, Irbid, Jordan
| | - Mohammed Z. Allouh
- Department of Anatomy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Ejlal Abu-El-Rub
- Department of Physiology and Pathophysiology, University of Manitoba, Winnipeg, Canada
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Nodzo SR, Kasparek M, Rueckl K, Boettner F. The location of the medial parapatellar arthrotomy influences intraoperative patella tracking. Knee Surg Sports Traumatol Arthrosc 2018; 26:1786-1791. [PMID: 29128877 DOI: 10.1007/s00167-017-4779-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2017] [Accepted: 10/30/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE The medial parapatellar arthrotomy (MPPA) is a commonly utilized surgical approach; however, the placement of the arthrotomy and its influence on intraoperative patellar tracking has not been evaluated. METHODS Six knees from three fresh frozen cadavers with transthoracic amputations were operated on. All underwent standard posterior stabilized total knee arthroplasty using a medial parapatellar approach placed at the border of the vastus medialis oblique (VMO)-quadriceps junction. Patellae were resurfaced in the standard fashion. All patellae tracked normally with the first arthrotomy placed at the junction of the VMO-quadriceps tendon using the "no touch" technique. Measurement of patellar lift-off from the implant surface of the medial aspect of the trochlea on the femoral component was made at 50°, 75°, and 90° of flexion and a merchant view radiograph taken to evaluate radiographic patellar tilt. To simulate a more lateral placement of the MPPA, a 5-6 mm slice of quadriceps tendon was then removed from the lateral aspect of the tendon from the patellar insertion to the most proximal portion of the arthrotomy. This simulated a 5-6 mm more lateral placement of the parapatellar arthrotomy. The same measurements and radiographs were taken as described previously. Two more times the same size slices was removed from the quadriceps tendon with subsequent measurements and radiographs obtained. RESULTS The mean patellar lift-off with the first arthrotomy was 0 ± 0 mm for 50°, 75°, and 90° of flexion. The mean lift with the second arthrotomy was 2 ± 2, 3 ± 3, and 4 ± 3 mm respectively. The third arthrotomy had a mean patellar lift-off of 3 ± 2, 4 ± 3, and 8 ± 2 mm respectively, while the fourth arthrotomy had a mean lift-off of 6 ± 2, 8 ± 2, and 9 ± 4 mm. There was a significant correlation between percentage of quadriceps cut at 1 cm above the superior pole of the patella and patellar lift-off at 50° (R 2 = 0.70; p < 0.0001), 75° (R 2 = 0.68; p < 0.0001), and 90° (R 2 = 0.68; p < 0.0001) of flexion. CONCLUSION The location of the MPPA has a significant influence on intraoperative assessment of patellar tracking. An MPPA more lateral in the quadriceps tendon may independently influence the patellar tilt observed intraoperatively and should be taken into consideration when evaluating intraoperative patella tracking. An understanding of the independent influence the MPPA has on patellar tracking may decrease the need for lateral release if the surgeon notes the MPPA was made more than 5-10 mm from the junction of the VMO-quadriceps tendon junction.
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Affiliation(s)
- Scott R Nodzo
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA.
| | - Maximilian Kasparek
- Department of Orthopedic Surgery, Vienna General Hospital, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Kilian Rueckl
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
| | - Friedrich Boettner
- Adult Reconstruction and Joint Replacement Division, Hospital for Special Surgery, 535 East 70th Street, New York, NY, 10021, USA
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Mochizuki T, Blaha JD, Tanifuji O, Kai S, Sato T, Yamagiwa H. The Quadriceps Vector is Most Parallel to the Spherical Axis With Minimal Difference for Gender or Ethnicity. J Arthroplasty 2016; 31:2031-7. [PMID: 27067163 DOI: 10.1016/j.arth.2016.02.044] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/17/2016] [Accepted: 02/19/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The extensor mechanism may be the key to kinematic alignment of total knee arthroplasty. The purpose of this study was to determine any differences in the direction of the quadriceps vector based on gender or ethnicity and to determine which anatomically derived alignment axis is closest to the quadriceps vector. METHODS Computed tomography scans and patient records for 14 Caucasians (9 men and 5 women) and 40 Japanese (19 men and 21 women) were evaluated. Three axes of alignment-anatomic, mechanical, and spherical-were identified, measured, and compared to the quadriceps vector in each case. Principal component analysis was used to determine the quadriceps vector by using 3-dimensional models of muscles on computed tomography scans. RESULTS No statistically significant differences in the orientation of the quadriceps vector were found based on gender or ethnicity, and the quadriceps vector was most closely aligned with the spherical axis. CONCLUSION Because the quadriceps is the primary knee extensor, the spherical axis therefore may be a ubiquitous guide to alignment of the arthroplasty knee based on motion.
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Affiliation(s)
- Tomoharu Mochizuki
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - J David Blaha
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, Michigan
| | - Osamu Tanifuji
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
| | - Shin Kai
- Center for Fostering Innovative Leadership, Institute for Research Collaboration and Promotion, Niigata University, Niigata, Japan
| | - Takashi Sato
- Department of Orthopaedic Surgery, Niigata Medical Center, Niigata, Japan
| | - Hiroshi Yamagiwa
- Department of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan; Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Science, Niigata, Japan
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Yin L, Chen K, Guo L, Cheng L, Wang F, Yang L. Identifying the Functional Flexion-extension Axis of the Knee: An In-Vivo Kinematics Study. PLoS One 2015; 10:e0128877. [PMID: 26039711 PMCID: PMC4454551 DOI: 10.1371/journal.pone.0128877] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 05/03/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to calculate the flexion-extension axis (FEA) of the knee through in-vivo knee kinematics data, and then compare it with two major anatomical axes of the femoral condyles: the transepicondylar axis (TEA) defined by connecting the medial sulcus and lateral prominence, and the cylinder axis (CA) defined by connecting the centers of posterior condyles. Methods The knee kinematics data of 20 healthy subjects were acquired under weight-bearing condition using bi-planar x-ray imaging and 3D-2D registration techniques. By tracking the vertical coordinate change of all points on the surface of femur during knee flexion, the FEA was determined as the line connecting the points with the least vertical shift in the medial and lateral condyles respectively. Angular deviation and distance among the TEA, CA and FEA were measured. Results The TEA-FEA angular deviation was significantly larger than that of the CA-FEA in 3D and transverse plane (3.45° vs. 1.98°, p < 0.001; 2.72° vs. 1.19°, p = 0.002), but not in the coronal plane (1.61° vs. 0.83°, p = 0.076). The TEA-FEA distance was significantly greater than that of the CA-FEA in the medial side (6.7 mm vs. 1.9 mm, p < 0.001), but not in the lateral side (3.2 mm vs. 2.0 mm, p = 0.16). Conclusion The CA is closer to the FEA compared with the TEA; it can better serve as an anatomical surrogate for the functional knee axis.
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Affiliation(s)
- Li Yin
- Center for Joint Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
| | - Kaining Chen
- Center for Joint Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
| | - Lin Guo
- Center for Joint Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
| | - Liangjun Cheng
- Department of Radiology, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
| | - Fuyou Wang
- Center for Joint Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, the Third Military Medical University, Chongqing, People’s Republic of China
- * E-mail:
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