1
|
Laxity measurement of internal knee rotation after primary anterior cruciate ligament rupture versus rerupture. Arch Orthop Trauma Surg 2022; 142:2839-2847. [PMID: 34870728 PMCID: PMC9474331 DOI: 10.1007/s00402-021-04269-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/16/2021] [Indexed: 11/15/2022]
Abstract
PURPOSE The aim of the current study was to objectify the rotational laxity after primary anterior cruciate ligament (ACL) rupture and rerupture after ACL reconstruction by instrumented measurement. It was hypothesized that knees with recurrent instability feature a higher internal rotation laxity as compared to knees with a primary rupture of the native ACL. STUDY DESIGN Cross-sectional study, Level of evidence III. METHODS In a clinical cross-sectional study successive patients with primary ACL rupture and rerupture after ACL reconstruction were evaluated clinically and by instrumented measurement of the rotational and antero-posterior laxity with a validated instrument and the KT1000®, respectively. Clinical examination comprised IKDC 2000 forms, Lysholm Score, and Tegner Activity Scale. Power calculation and statistical analysis were performed (p value < 0.05). RESULTS 24 patients with primary ACL rupture and 23 patients with ACL rerupture were included. There was no significant side-to-side difference in anterior translation. A side-to side difference of internal rotational laxity ≥ 10° was found significantly more frequent in reruptures (53.6%) compared to primary ruptures (19.4%; p < 0.001). A highly significant relationship between the extent of the pivot-shift phenomenon and side-to-side difference of internal rotation laxity could be demonstrated (p < 0.001). IKDC 2000 subjective revealed significantly better scores in patients with primary ACL tear compared to patients with ACL rerupture (56.4 ± 7.8 vs. 50.8 ± 6.2; p = 0.01). Patients with primary ACL tears scored significantly better on the Tegner Activity Scale (p = 0.02). No significant differences were seen in the Lysholm Score (p = 0.78). CONCLUSION Patients with ACL rerupture feature significantly higher internal rotation laxity of the knee compared to primary ACL rupture. The extend of rotational laxity can be quantified by instrumented measurements. This can be valuable data for the indication of an anterolateral ligament reconstruction in ACL revision surgery.
Collapse
|
2
|
Rao L, Taylor WR, Horn N, List R, Preiss S, Schütz P. Can tibio-femoral kinematic and kinetic parameters reveal poor functionality and underlying deficits after total knee replacement? A systematic review. Knee 2022; 34:62-75. [PMID: 34883331 DOI: 10.1016/j.knee.2021.11.002] [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: 02/15/2021] [Revised: 09/13/2021] [Accepted: 11/04/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Extensive efforts have been made to understand joint kinematics and kinetics in total knee arthroplasty (TKA) in subjects with satisfactory outcomes during daily functional activities and clinical tests, but it remains unclear whether such movement characteristics hold the potential to indicate the underlying aetiology of unsatisfactory or bad TKA outcomes. PURPOSE To investigate which kinematic and kinetic parameters assessed during passive clinical tests and functional activities of daily living are associated with poor functionality and underlying deficits after total knee replacement. METHODS We focused on studies characterizing the kinematic or kinetic parameters of the knee joint that are associated with poor clinical outcome after TKA. Seventeen articles were included for the review, and kinematic and kinetic data from 719 patients with minimal follow up of 6 months were extracted and analyzed. RESULTS Passive posterior translation at 90°flexionexhibited good potential for differentiating stable and unstable TKAs. Anterior-posterior (A-P) translation of the medial condyle at 0-30° and 30-60° flexion, A-P translation of the lateral condyle at 60-90°during closed chain exercises, as well asknee extension moment during stair ascent and descent, knee abduction moment during stair descent, knee internal rotation moment and plantar flexion moment during walking, 2ndpeak ground reaction force during stair ascent and walkingshowed the greatest promise as functional biomarkers for a dissatisfied/poor outcome knee after TKA. CONCLUSION In this study, we systematically reviewed the state-of-the-art knowledge of kinematics and kinetics associated with functional deficits, and found 11 biomechanical parameters that showed promise for supportingdecision making in TKA.
Collapse
Affiliation(s)
- L Rao
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| | - W R Taylor
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland.
| | - N Horn
- Schulthess Clinic, Zürich, Switzerland
| | - R List
- Schulthess Clinic, Zürich, Switzerland
| | - S Preiss
- Schulthess Clinic, Zürich, Switzerland
| | - P Schütz
- Institute for Biomechanics, ETH Zurich, Zürich, Switzerland
| |
Collapse
|
3
|
Lower extremity range of motion and alignment: A reliability and concurrent validity study of goniometric and three-dimensional motion analysis measurement. Heliyon 2020; 6:e04713. [PMID: 32904291 PMCID: PMC7452543 DOI: 10.1016/j.heliyon.2020.e04713] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 06/26/2020] [Accepted: 08/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background Knowing correlations between passive goniometric and dynamic three-dimensional motion analysis measurements of lower extremity range of motion and alignment would benefit knee injury risk assessment. Purpose To investigate reliability and concurrent validity of lower extremity assessment with goniometry and three-dimensional motion analysis. Methods Thirty-eight participants (76 limbs) were examined in standardized positions by two physiotherapists with simultaneous goniometric and three-dimensional motion analysis measurements of passive range of motion and alignment. Intra-class correlation coefficient (ICC) and median differences were calculated. Results Hip rotation reliability, ICC 0.74–0.89 and validity 0.74–0.94. Tibial rotation reliability, ICC 0.24–0.75 and validity 0.08–0.61. Knee extension reliability, ICC 0.44–0.73 and validity 0.22–0.60. Knee valgus/varus reliability, ICC 0.36–0.68 and validity 0.25–0.62. Tibial torsion reliability, ICC 0.52–0.77 and validity 0.58–0.81. Ankle dorsiflexion reliability, ICC 0.12–0.73 and validity 0.51–0.83. Median differences in reliability and validity ranged from -2.0° to 3.0° and from -6.6° to 7.5° respectively. Conclusion Goniometric and three-dimensional motion analysis methods define the lower body segments differently making some degree of discrepancy in the measurements inevitable. Nevertheless, the variables chosen in this study are all strongly associated with anterior cruciate ligament rupture and some may prove useful to identify individuals at risk of knee injury during sport activities. Study design Cross-sectional laboratory study.
Collapse
|
4
|
Ding Z, Güdel M, Smith SHL, Ademefun RA, Bull AMJ. A Femoral Clamp to Reduce Soft Tissue Artifact: Accuracy and Reliability in Measuring Three-Dimensional Knee Kinematics During Gait. J Biomech Eng 2020; 142:044501. [PMID: 31596924 DOI: 10.1115/1.4045115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Indexed: 11/08/2022]
Abstract
The accurate measurement of full six degrees-of-freedom (6DOFs) knee joint kinematics is prohibited by soft tissue artifact (STA), which remains the greatest source of error. The purpose of this study was to present and assess a new femoral clamp to reduce STA at the thigh. It was hypothesized that the device can preserve the natural knee joint kinematics pattern and outperform a conventional marker mounted rigid cluster during gait. Six healthy subjects were asked to walk barefoot on level ground with a cluster marker set (cluster gait) followed by a cluster-clamp-merged marker set (clamp gait) and their kinematics was measured using the cluster method in cluster gait and the cluster and clamp methods simultaneously in clamp gait. Two operators performed the gait measurement. A 6DOFs knee joint model was developed to enable comparison with the gold standard knee joint kinematics measured using a dual fluoroscopic imaging technique. One-dimensional (1D) paired t-tests were used to compare the knee joint kinematics waveforms between cluster gait and clamp gait. The accuracy was assessed in terms of the root-mean-square error (RMSE), coefficient of determination, and Bland-Altman plots. Interoperator reliability was assessed using the intraclass correlation coefficient (ICC). The result showed that the femoral clamp did not change the walking speed and knee joint kinematics waveforms. Additionally, clamp gait reduced the rotation and translation errors in the transverse plane and improved the interoperator reliability when compared to the rigid cluster method, suggesting a more accurate and reliable measurement of knee joint kinematics.
Collapse
Affiliation(s)
- Ziyun Ding
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Manuela Güdel
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Samuel H L Smith
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Richard A Ademefun
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| | - Anthony M J Bull
- Department of Bioengineering, Imperial College London, London SW7 2AZ, UK
| |
Collapse
|
5
|
Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. A novel test for assessment of anterolateral rotatory instability of the knee: the tibial internal rotation test (TIR test). J Exp Orthop 2018; 5:29. [PMID: 30094573 PMCID: PMC6085217 DOI: 10.1186/s40634-018-0141-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/22/2018] [Indexed: 01/26/2023] Open
Abstract
Background Rotational instability of the knee may persist after anterior cruciate ligament (ACL) reconstruction, which may be due to insufficiency of anterolateral stabilizing structures. However, no reliable diagnostic tool or physical examination test is available for identifying patients with anterolateral rotatory instability (ALRI). As shown in cadaveric studies, static internal rotation of the knee is increased in higher flexion angles of the knee after severing the anterolateral structures. This might also be the case in patients with an ACL-deficient knee and concomitant damage to the anterolateral structures. The objective of this study is to assess anterolateral rotatory instability of the knee during physical examination with a tibial internal rotation test. Methods ACL-injured knees of 52 patients were examined by two examiners and side-to-side differences were compared. Both lower legs were internally rotated by applying manual internal rotation torque to both feet in prone position with the knees in 30°, 60° and 90° of flexion. For quantification of the amount of rotation in degrees, a torque adapter on a booth was used. Intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the tibial internal rotation test. Results Tibial internal rotation is increased in 19.2% of the patients with ACL injury according to the tibial internal rotation test. Good intra-rater agreement was found for the tibial internal rotation test, κC = 0.63 (95%CI -0.02-1.28), p = 0.015. Fair inter-rater agreement was found, κF = 0.29 (95%CI 0.02–0.57), p = 0.038. Good rater-device agreement was found, κC = 0.62 (95%CI 0.15–1.10), p = 0.001. Conclusion The tibial internal rotation test shows increased tibial internal rotation in a small amount of patients with ACL injury. Even though no gold standard for assessment of increased tibial internal rotation of the knee is available yet, the test can be of additional value. It can be used for assessment of internal rotatory laxity of the knee as part of ALRI in addition to the pivot shift test. No clinical implications should yet be based on this test alone. Electronic supplementary material The online version of this article (10.1186/s40634-018-0141-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius hospital, P.O. Box 2500, 3430 EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000 CA, Rotterdam, the Netherlands.
| |
Collapse
|
6
|
Norris R, Kopkow C, McNicholas MJ. Interpretations of the dial test should be reconsidered. A diagnostic accuracy study reporting sensitivity, specificity, predictive values and likelihood ratios. J ISAKOS 2018. [DOI: 10.1136/jisakos-2018-000197] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
7
|
Slichter ME, Wolterbeek N, Auw Yang KG, Zijl JAC, Piscaer TM. Rater agreement reliability of the dial test in the ACL-deficient knee. J Exp Orthop 2018; 5:18. [PMID: 29900519 PMCID: PMC5999596 DOI: 10.1186/s40634-018-0131-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/17/2018] [Indexed: 01/13/2023] Open
Abstract
Background Posterolateral rotatory instability (PLRI) of the knee can easily be missed, because attention is paid to injury of the cruciate ligaments. If left untreated this clinical instability may persist after reconstruction of the cruciate ligaments and may put the graft at risk of failure. Even though the dial test is widely used to diagnose PLRI, no validity and reliability studies of the manual dial test are yet performed in patients. This study focuses on the reliability of the manual dial test by determining the rater agreement. Methods Two independent examiners performed the dial test in knees of 52 patients after knee distorsion with a suspicion on ACL rupture. The dial test was performed in prone position in 30°, 60° and 90° of flexion of the knees. ≥10° side-to-side difference was considered a positive dial test. For quantification of the amount of rotation in degrees, a measuring device was used with a standardized 6 Nm force, using a digital torque adapter on a booth. The intra-rater, inter-rater and rater-device agreement were determined by calculating kappa (κ) for the dial test. Results A positive dial test was found in 21.2% and 18.0% of the patients as assessed by a blinded examiner and orthopaedic surgeon respectively. Fair inter-rater agreement was found in 30° of flexion, κF = 0.29 (95% CI: 0.01 to 0.56), p = 0.044 and 90° of flexion, κF = 0.38 (95% CI: 0.10 to 0.66), p = 0.007. Almost perfect rater-device agreement was found in 30° of flexion, κC = 0.84 (95% CI: 0.52 to 1.15), p < 0.001. Moderate rater-device agreement was found in 30° and 90° combined, κC = 0.50 (95% CI: 0.13 to 0.86), p = 0.008. No significant intra-rater agreement was found. Conclusions Rater agreement reliability of the manual dial test is questionable. It has a fair inter-rater agreement in 30° and 90° of flexion.
Collapse
Affiliation(s)
- Malou E Slichter
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - K Gie Auw Yang
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Jacco A C Zijl
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands
| | - Tom M Piscaer
- Department of Orthopaedic Surgery, St. Antonius Hospital, P.O. Box 2500, 3430, EM, Nieuwegein, The Netherlands. .,Department of Orthopaedic Surgery, Erasmus Medical Center, P.O. Box 2040, 3000, CA, Rotterdam, The Netherlands.
| |
Collapse
|
8
|
Sirisena D, Papi E, Tillett E. Clinical assessment of antero-medial rotational knee laxity: a systematic review. Knee Surg Sports Traumatol Arthrosc 2017; 25:1068-1077. [PMID: 27787588 DOI: 10.1007/s00167-016-4362-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2016] [Accepted: 10/13/2016] [Indexed: 12/26/2022]
Abstract
PURPOSE To inventory the examination methods available to assess antero-medial rotational laxity (AMRL) of the knee following medial collateral ligament injury. METHODS Searches were conducted in accordance with the PRISMA guidelines and using four online databases: WEB OF SCIENCE, MEDLINE, EMBASE, and AMED. The Critical Appraisal Skills Programme guidelines for Diagnostic Test Studies were used for the quality assessment of the articles. RESULTS A total of 2241 articles were identified from the database searches. From this, four articles were included in the final review. All were case-control studies, considered a combined ACL/MCL injury and had small study populations. Specialised equipment was required in all studies, and one needed additional imaging support before measurements could be taken. Two employed commercially available measuring equipment as part of the assessment process. CONCLUSION Clinical assessment of AMRL in relation to a MCL injury remains challenging. Although methods have been developed to support clinical examination, they are limited by a number of factors, including the need for additional time in the clinical environment when setting up equipment, the need for specific equipment to produce and measure rotational movement and imaging support. In addition, there are patient safety concerns from the repeated imaging. A reliable and valid clinical examination remains to be found to truly assess antero-medial rotational laxity of the knee. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Dinesh Sirisena
- Institute for Sport, Exercise and Health, University College London, London, UK. .,Khoo Teck Puat Hospital, 90 Yishun Central, Yishun, 768828, Singapore.
| | - Enrica Papi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Eleanor Tillett
- Institute for Sport, Exercise and Health, University College London, London, UK
| |
Collapse
|
9
|
Mouton C, Theisen D, Seil R. Objective measurements of static anterior and rotational knee laxity. Curr Rev Musculoskelet Med 2016; 9:139-47. [PMID: 26970758 PMCID: PMC4896875 DOI: 10.1007/s12178-016-9332-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Several devices allow to measure anterior and rotational static knee laxity. To date, the use of rotational laxity measurements in the daily clinical practice however remains to be improved. These measurements may be systematically integrated to the follow-up of knee injuries. Physiologic laxity measurements may particularly be of interest for the identification of risk factors in athletes. Furthermore, knee laxity measurements help to improve the diagnosis of knee soft tissue injuries and to follow up reconstructions. Further prospective follow-ups of knee laxity in the injured/reconstructed knees are however required to conclude on the best treatment strategy for knee soft tissue injuries.
Collapse
Affiliation(s)
- Caroline Mouton
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Daniel Theisen
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg
| | - Romain Seil
- Sports Medicine Research Laboratory, Luxembourg Institute of Health, Luxembourg City, Luxembourg.
- Department of Orthopaedic Surgery, Centre Hospitalier de Luxembourg-Clinique d'Eich, 76, rue d'Eich, L-1460, Luxembourg City, Luxembourg.
| |
Collapse
|
10
|
The use of a robotic tibial rotation device and an electromagnetic tracking system to accurately reproduce the clinical dial test. Knee Surg Sports Traumatol Arthrosc 2016; 24:815-22. [PMID: 26891963 PMCID: PMC4769317 DOI: 10.1007/s00167-016-4042-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/29/2016] [Indexed: 12/18/2022]
Abstract
PURPOSE The purpose of this study was to: (1) determine whether a robotic tibial rotation device and an electromagnetic tracking system could accurately reproduce the clinical dial test at 30° of knee flexion; (2) compare rotation data captured at the footplates of the robotic device to tibial rotation data measured using an electromagnetic sensor on the proximal tibia. METHODS Thirty-two unilateral ACL-reconstructed patients were examined using a robotic tibial rotation device that mimicked the dial test. The data reported in this study is only from the healthy legs of these patients. Torque was applied through footplates and was measured using servomotors. Lower leg motion was measured at the foot using the motors. Tibial motion was also measured through an electromagnetic tracking system and a sensor on the proximal tibia. Load-deformation curves representing rotational motion of the foot and tibia were compared using Pearson's correlation coefficients. Off-axis motions including medial-lateral translation and anterior-posterior translation were also measured using the electromagnetic system. RESULTS The robotic device and electromagnetic system were able to provide axial rotation data and translational data for the tibia during the dial test. Motion measured at the foot was not correlated to motion of the tibial tubercle in internal rotation or in external rotation. The position of the tibial tubercle was 26.9° ± 11.6° more internally rotated than the foot at torque 0 Nm. Medial-lateral translation and anterior-posterior translation were combined to show the path of the tubercle in the coronal plane during tibial rotation. CONCLUSIONS The information captured during a manual dial test includes both rotation of the tibia and proximal tibia translation. All of this information can be captured using a robotic tibial axial rotation device with an electromagnetic tracking system. The pathway of the tibial tubercle during tibial axial rotation can provide additional information about knee instability without relying on side-to-side comparison between knees. The translation of the proximal tibia is important information that must be considered in addition to axial rotation of the tibia when performing a dial test whether done manually or with a robotic device. Instrumented foot position cannot provide the same information. LEVEL OF EVIDENCE IV.
Collapse
|
11
|
Cavaignac E, Carpentier K, Pailhé R, Luyckx T, Bellemans J. The role of the deep medial collateral ligament in controlling rotational stability of the knee. Knee Surg Sports Traumatol Arthrosc 2015; 23:3101-7. [PMID: 24894123 DOI: 10.1007/s00167-014-3095-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2013] [Accepted: 05/22/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE The tibial insertion of the deep medial collateral ligament (dMCL) is frequently sacrificed when the proximal tibial cut is performed during total knee arthroplasty. The role of the dMCL in controlling the knee's rotational stability is still controversial. The aim of this study was to quantify the rotational laxity induced by an isolated lesion of the dMCL as it occurs during tibial preparation for knee arthroplasty. METHODS An isolated resection of the deep MCL was performed in 10 fresh-frozen cadaver knees. Rotational laxity was measured during application of a standard 5.0 N.m rotational torque. Maximal tibial rotation was measured at different knee flexion angles using an image-guided navigation system (Medivision Surgetics system, Praxim, Grenoble, France) before and after dMCL resection. RESULTS In all cases, internal and external tibial rotation increased after dMCL resection. Total rotational laxity increased significantly for all knee flexion angles, with an average difference of +7.8° (SD 5.7) with the knee in extension, +8.9° (SD 1.9) in 30° flexion, +7° (SD 2.9) in 60° flexion and +5.3° (SD 2.8) in 90° flexion. CONCLUSIONS Sacrificing the tibial insertion of the deep MCL increases rotational laxity of the knee by 5°-9°, depending on the knee flexion angle. Based on our findings, new surgical techniques and implants that preserve the dMCL insertion such as tibial inlay components should be developed. Further clinical evaluations are necessary.
Collapse
Affiliation(s)
- Etienne Cavaignac
- Institut de l'appareil locomoteur, CHU Rangueil, 1, Avenue Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France.
| | - Karel Carpentier
- Department of Orthopedic Surgery and Traumatology, University Hospitals Leuven, Louvain, Belgium
| | - Regis Pailhé
- Institut de l'appareil locomoteur, CHU Rangueil, 1, Avenue Jean Poulhès TSA 50032, 31059, Toulouse Cedex 9, France
| | - Thomas Luyckx
- Department of Orthopedic Surgery and Traumatology, University Hospitals Leuven, Louvain, Belgium
| | - Johan Bellemans
- Department of Orthopedic Surgery and Traumatology, University Hospitals Leuven, Louvain, Belgium
| |
Collapse
|
12
|
Zens M, Niemeyer P, Bernstein A, Feucht MJ, Kühle J, Südkamp NP, Woias P, Mayr HO. Novel approach to dynamic knee laxity measurement using capacitive strain gauges. Knee Surg Sports Traumatol Arthrosc 2015; 23:2868-75. [PMID: 26328800 DOI: 10.1007/s00167-015-3771-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/21/2015] [Indexed: 01/26/2023]
Abstract
PURPOSE Knee joint laxities are observed in patients after severe trauma to the joint, resulting in ligament tears. Specifically, injuries to the anterior cruciate ligament may cause a significant instability. The degree of these laxities is essential in diagnostics and may affect which treatment option is suggested. METHODS Polydimethylsiloxane (PDMS) strain gauges are proposed as a non-invasive, highly accurate and easy-to-use measurement method to quantify anterolateral and rotational laxities of the knee joint during active and passive motion. In this work, proof-of-concept measurements and a prototype of the proposed device are displayed. The measurements were taken using a knee test rig, which has specifically been designed for this purpose. This apparatus allows the simulation of isolated knee joint instabilities with a motor-controlled model of a human knee. RESULTS The absolute sensitivity [Formula: see text] of an exemplary sensor was determined to be 2.038 [Formula: see text]; the relative sensitivity [Formula: see text] was 1.121 [Formula: see text]. Optimal positions of sensors to capture bone-to-bone displacement as projected displacement on the skin were identified. CONCLUSION PDMS strain gauges are capable of measuring bone-to-bone displacements on the skin. We present an experimental in vitro study using an artificial knee test rig to simulate knee joint laxities and display the feasibility of our novel measurement approach.
Collapse
Affiliation(s)
- Martin Zens
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany.
- Department of Microsystems Engineering (IMTEK), Albert-Ludwigs-Universität Freiburg, Georges-Koehler-Allee 102, 79110, Freiburg, Germany.
| | - Philipp Niemeyer
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| | - Anke Bernstein
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| | - Matthias J Feucht
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| | - Jan Kühle
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| | - Norbert P Südkamp
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| | - Peter Woias
- Department of Microsystems Engineering (IMTEK), Albert-Ludwigs-Universität Freiburg, Georges-Koehler-Allee 102, 79110, Freiburg, Germany
| | - Herrmann O Mayr
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, 79106, Freiburg, Germany
| |
Collapse
|
13
|
An analysis of normative data on the knee rotatory profile and the usefulness of the Rotatometer, a new instrument for measuring tibiofemoral rotation: the reliability of the knee Rotatometer. Knee Surg Sports Traumatol Arthrosc 2015; 23:2727-33. [PMID: 24817107 DOI: 10.1007/s00167-014-3039-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2013] [Accepted: 04/23/2014] [Indexed: 12/22/2022]
Abstract
PURPOSE This study proposes a simple and noninvasive instrument called the "Rotatometer" to measure tibiofemoral rotation and investigates its clinical applicability to the assessment of static rotational knee laxity. METHODS The degree of tibiofemoral rotation was measured for a sample of 94 healthy volunteers with 188 knees by using the Rotatometer. The measurement was made by two independent and blinded examiners in three sessions at one-month intervals. The normative rotational profile and its relationship with gender and age were evaluated, and inter-observer reliability and intra-observer reliability were calculated. RESULTS Males showed 62° ± 5° of external rotation, whereas females, 64° ± 5°. Males showed 44° ± 5° of internal rotation, whereas females, 49° ± 4°. Females showed significantly higher degrees of rotation than males. Tibiofemoral rotation was not correlated with age, and external rotation and internal rotation had a moderate positive relationship. Inter-observer reliability ranged from 0.84 to 0.91 for external rotation and 0.90 to 0.95 for internal rotation, and intra-observer reliability ranged from 0.69 to 0.89 for external rotation and 0.87 to 0.95 for internal rotation. CONCLUSIONS The results suggest the Rotatometer to be a simple and noninvasive device with high inter- and intra-observer reliability. The device can provide a normative rotational profile for reference purposes and thus can be used to determine the preoperative and postoperative rotational status of knees with anterior cruciate ligament injuries and compare results from different reconstruction techniques.
Collapse
|
14
|
Dynamic quantification of tibio-femoral rotation in postero-lateral bundle insufficiency of the anterior cruciate ligament: a cadaver study. INTERNATIONAL ORTHOPAEDICS 2014; 39:865-70. [DOI: 10.1007/s00264-014-2537-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Accepted: 09/11/2014] [Indexed: 10/24/2022]
|
15
|
Rotational profile alterations after anatomic posterolateral corner reconstructions in multiligament injured knees. Knee Surg Sports Traumatol Arthrosc 2014; 22:2173-80. [PMID: 24005333 DOI: 10.1007/s00167-013-2655-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Accepted: 08/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE Injuries of the posterolateral corner (PLC) are rare and severe knee injuries, resulting in posterolateral rotatory instability and an increase in external rotation. Surgical reconstruction techniques reproducing the normal anatomy showed promising results. In vivo evaluations of static rotational knee laxity at 30° of knee flexion have not been reported so far. The purpose of this study was to evaluate static rotational knee laxity after anatomic PLC reconstructions. METHODS This is a retrospective clinical cohort study. Twenty patients with PLC reconstructions with an average follow-up time of 39 ± 22 months and no history of knee trauma or surgery of the contralateral knee were included in the study. They underwent a routine clinical examination and static rotational laxity measurements at 30° of knee flexion in the prone position. Side-to-side differences were recorded and compared to a group of matched controls. RESULTS The postoperative IKDC score was graded A for 8 patients, B for 16, C for 6 and D for one patient. The primary goal of the surgical procedure which consists in reducing excessive external tibiofemoral rotation could be reached in 18 of the 20 patients (90%). Anatomic PLC reconstructions yielded a comparable rotational profile in operated and healthy knees in 7 patients (35%). Thirteen patients (65%) presented a significantly altered rotational profile in comparison with a healthy control group. Unexpected increases in internal rotation were found in 8 patients (40%). CONCLUSION Anatomic PLC reconstructions reduced excessive external tibiofemoral rotation in a vast majority of patients. Static rotational laxity measurements allowed for a determination of the patients' individual rotational profile after PLC reconstructions. This profile was normalised in only one-third of the patients. The understanding of this finding needs further investigation as well as the clinical impact of rotational profile alterations on knee function. LEVEL OF EVIDENCE Diagnostic studies, Level III.
Collapse
|
16
|
Russell DF, Deakin AH, Fogg QA, Picard F. Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia. Knee Surg Sports Traumatol Arthrosc 2014; 22:1771-7. [PMID: 24370989 DOI: 10.1007/s00167-013-2812-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 12/02/2013] [Indexed: 01/16/2023]
Abstract
PURPOSE The ability to quantify rotational laxity of the knee would increase understanding of functional rotatory instability, identify the best treatment methods for soft tissue injury, and have a role in diagnosis of soft tissue injury. This study aimed to report the reliability, repeatability and precision of a non-invasive adaptation of image-free navigation technology by comparing with a validated invasive system used for computer-assisted surgery. METHODS Twelve cadaveric lower limbs were tested with a commercial image-free navigation system using passive trackers secured by bone screws. They were then tested a non-invasive fabric-strap system. Manual application of torque was used consistent with clinical examination to rotate the tibia to the end of internal rotation and external rotation range. Measurements were taken at 10° intervals from full extension to 90° flexion, and protocol was repeated twice using each system. Intraclass correlation coefficient (ICC) was used to reflect reliability of measurements. At each flexion interval, coefficient of repeatability (CR) was calculated for each system, and limits of agreement (LOA) were used to reflect agreement between the systems. RESULTS The results for internal and external rotation were combined throughout flexion: ICC invasive; 0.94 (0.86-0.99), non-invasive; 0.92 (0.7-0.99), CR invasive; 2.4° (1.3-4.8°), non-invasive; 3.5° (1.8-6.6), LOA; 8.2° (4.3-13.5). CONCLUSION Non-invasive optical tracker fixation gives improved agreement with a validated method of measurement compared with devices measuring tibial rotation by foot position. This system gives the added possibility of dynamic, weight-bearing testing in the clinically important range of 0°-30° knee flexion without the need for any limb restraint.
Collapse
Affiliation(s)
- David F Russell
- Faculty of Biomedical and Life Sciences, Thomson Building, University of Glasgow, University Avenue, Glasgow, G12 8QQ, UK,
| | | | | | | |
Collapse
|