In Vivo Three-dimensional Kinematics of Normal Knees During Sitting Sideways

Abstract Background The normal knee kinematics during asymmetrical kneeling such as the sitting sideways remains unknown. This study aimed to clarify in vivo kinematics during sitting sideways of normal knees. Methods Twelve knees from six volunteers were examined. Under fluoroscopy, each volunteer performed a sitting sideways. A two-dimensional/three-dimensional registration technique was used. The rotation angle, varus-valgus angle, anteroposterior translation of the medial and lateral sides of the femur relative to the tibia, and kinematic pathway in each flexion angle was evaluated. Results Bilateral knees during sitting sideways showed a femoral external rotation relative to the tibia with flexion. Whereas the ipsilateral knees showed valgus movement, and the contralateral knees showed varus movement. The medial side of the contralateral knees was more posteriorly located than that of the ipsilateral knees beyond 110° of flexion. The lateral side of the contralateral knees was more anteriorly located than that of the ipsilateral knees from 120° to 150° of flexion. In the ipsilateral knees, a medial pivot pattern followed by a bicondylar rollback was observed. In the contralateral knees, no significant movement followed by a bicondylar rollback was observed. Conclusion Even though the asymmetrical kneeling such as sitting sideways, the knees did not display asymmetrical movement.

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In vivo three-dimensional kinematics of normal knees during different high-flexion activities

The Bone & Joint Journal ◽

10.1302/0301-620x.100b1.bjj-2017-0553.r2 ◽

2018 ◽

Vol 100-B (1) ◽

pp. 50-55 ◽

Cited By ~ 16

Author(s):

K. Kono ◽

T. Tomita ◽

K. Futai ◽

T. Yamazaki ◽

S. Tanaka ◽

...

Keyword(s):

Computer Aided Design ◽

External Rotation ◽

Three Dimensional ◽

Lateral Side ◽

3D Registration ◽

High Flexion ◽

Valgus Angle ◽

Significant Difference ◽

Medial Pivot

Aims In Asia and the Middle-East, people often flex their knees deeply in order to perform activities of daily living. The purpose of this study was to investigate the 3D kinematics of normal knees during high-flexion activities. Our hypothesis was that the femorotibial rotation, varus-valgus angle, translations, and kinematic pathway of normal knees during high-flexion activities, varied according to activity. Materials and Methods We investigated the in vivo kinematics of eight normal knees in four male volunteers (mean age 41.8 years; 37 to 53) using 2D and 3D registration technique, and modelled the knees with a computer aided design program. Each subject squatted, kneeled, and sat cross-legged. We evaluated the femoral rotation and varus-valgus angle relative to the tibia and anteroposterior translation of the medial and lateral side, using the transepicodylar axis as our femoral reference relative to the perpendicular projection on to the tibial plateau. This method evaluates the femur medially from what has elsewhere been described as the extension facet centre, and differs from the method classically applied. Results During squatting and kneeling, the knees displayed femoral external rotation. When sitting cross-legged, femurs displayed internal rotation from 10° to 100°. From 100°, femoral external rotation was observed. No significant difference in varus-valgus angle was seen between squatting and kneeling, whereas a varus position was observed from 140° when sitting cross-legged. The measure kinematic pathway using our methodology found during squatting a medial pivoting pattern from 0° to 40° and bicondylar rollback from 40° to 150°. During kneeling, a medial pivot pattern was evident. When sitting cross-legged, a lateral pivot pattern was seen from 0° to 100°, and a medial pivot pattern beyond 100°. Conclusion The kinematics of normal knees during high flexion are variable according to activity. Nevertheless, our study was limited to a small number of male patients using a different technique to report the kinematics than previous publications. Accordingly, caution should be observed in generalizing our findings. Cite this article: Bone Joint J 2018;100-B:50–5.

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Patient-specific resurfacing implant knee surgery in subjects with early osteoarthritis results in medial pivot and lateral femoral rollback during flexion: a retrospective pilot study

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06749-8 ◽

2021 ◽

Author(s):

Philippe Moewis ◽

René Kaiser ◽

Adam Trepczynski ◽

Christoph von Tycowicz ◽

Leonie Krahl ◽

...

Keyword(s):

Knee Arthroplasty ◽

External Rotation ◽

Knee Kinematics ◽

Axial Rotation ◽

Patient Specific ◽

Post Surgery ◽

Flexion Extension ◽

Medial Pivot ◽

Femoral Rollback

Abstract Purpose Metallic resurfacing implants have been developed for the treatment of early, small, condylar and trochlear osteoarthritis (OA) lesions. They represent an option for patients who do not fulfill the criteria for unicompartmental knee arthroplasty (UKA) or total knee arthroplasty (TKA) or are too old for biological treatment. Although clinical evidence has been collected for different resurfacing types, the in vivo post-operative knee kinematics remain unknown. The present study aims to analyze the knee kinematics in subjects with patient-specific episealer implants. This study hypothesized that patient-specific resurfacing implants would lead to knee kinematics close to healthy knees, resulting in medial pivot and a high degree of femoral rollback during flexion. Methods Retrospective study design. Fluoroscopic analysis during unloaded flexion–extension and loaded lunge was conducted at > 12 months post-surgery in ten episealer knees, and compared to ten healthy knees. Pre- and post-operative clinical data of the episealer knees were collected using a visual analog scale (VAS), the EQ 5d Health, and the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaires. Results A consistent medial pivot was observed in both episealer and healthy knees. Non-significant differences were found in the unloaded (p = 0.15) and loaded (p = 0.51) activities. Although lateral rollback was observed in both groups, it was significantly higher for the episealer knees in both the unloaded (p = 0.02) and loaded (p = 0.01) activities. Coupled axial rotation was significantly higher in the unloaded (p = 0.001) but not in the loaded (p = 0.06) activity in the episealer knees. Improved scores were observed at 1-year post-surgery in the episealer subjects for the VAS (p = 0.001), KOOS (p = 0.001) and EQ Health (p = 0.004). Conclusion At 12 month follow-up, a clear physiological knee kinematics pattern of medial pivot, lateral femoral rollback and coupled axial external femoral rotation during flexion was observed in patients treated with an episealer resurfacing procedure. However, higher femoral rollback and axial external rotation in comparison to healthy knees was observed, suggesting possible post-operative muscle weakness and consequent insufficient stabilization at high flexion.

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Biomechanical Comparison of Kinematic and Mechanical Knee Alignment Techniques in a Computer Simulation Medial Pivot Total Knee Arthroplasty Model

The Journal of Knee Surgery ◽

10.1055/s-0041-1740392 ◽

2021 ◽

Author(s):

Young Dong Song ◽

Shinichiro Nakamura ◽

Shinichi Kuriyama ◽

Kohei Nishitani ◽

Hiromu Ito ◽

...

Keyword(s):

Femoral Component ◽

Knee Flexion ◽

External Rotation ◽

Knee Kinematics ◽

Lateral Compartment ◽

Contact Stresses ◽

Contact Forces ◽

Medial Compartment ◽

Tibial Insert ◽

Medial Pivot

AbstractSeveral concepts may be used to restore normal knee kinematics after total knee arthroplasty. One is a kinematically aligned (KA) technique, which restores the native joint line and limb alignment, and the other is the use of a medial pivot knee (MPK) design, with a ball and socket joint in the medial compartment. This study aimed to compare motions, contact forces, and contact stress between mechanically aligned (MA) and KA (medial tilt 3° [KA3] and 5° [KA5]) models in MPK. An MPK design was virtually implanted with MA, KA3, and KA5 in a validated musculoskeletal computer model of a healthy knee, and the simulation of motion and contact forces was implemented. Anteroposterior (AP) positions, mediolateral positions, external rotation angles of the femoral component relative to the tibial insert, and tibiofemoral contact forces were evaluated at different knee flexion angles. Contact stresses on the tibial insert were calculated using finite element analysis. The AP position at the medial compartment was consistent for all models. From 0° to 120°, the femoral component in KA models showed larger posterior movement at the lateral compartment (0.3, 6.8, and 17.7 mm in MA, KA3, and KA5 models, respectively) and larger external rotation (4.2°, 12.0°, and 16.8° in the MA, KA3, and KA5 models, respectively) relative to the tibial component. Concerning the mediolateral position of the femoral component, the KA5 model was positioned more medially. The contact forces at the lateral compartment of all models were larger than those at the medial compartment at >60° of knee flexion. The peak contact stresses on the tibiofemoral joint at 90° and 120° of knee flexion were higher in the KA models. However, the peak contact stresses of the KA models at every flexion angle were <20 MPa. The KA technique in MPK can successfully achieve near-normal knee kinematics; however, there may be a concern for higher contact stresses on the tibial insert.

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Three-dimensional In Vivo Quantification of Knee Kinematics in Cerebral Palsy

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-007-0004-7 ◽

2008 ◽

Vol 466 (2) ◽

pp. 450-458 ◽

Cited By ~ 8

Author(s):

Frances T. Sheehan ◽

Andrea R. Seisler ◽

Katharine E. Alter

Keyword(s):

Cerebral Palsy ◽

Three Dimensional ◽

Knee Kinematics

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Analysis of three-dimensional in vivo knee kinematics using dynamic magnetic resonance imaging

Operative Techniques in Orthopaedics ◽

10.1053/j.oto.2004.10.013 ◽

2005 ◽

Vol 15 (1) ◽

pp. 57-63 ◽

Cited By ~ 4

Author(s):

C. Benjamin Ma ◽

Keh-yang Lee ◽

Mark A. Schrumpf ◽

Sharmila Majumdar

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Three Dimensional ◽

Knee Kinematics ◽

Dynamic Magnetic Resonance Imaging ◽

Resonance Imaging ◽

Dynamic Magnetic Resonance ◽

In Vivo Knee Kinematics

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In Vivo Kinematics of the Tibiotalar and Subtalar Joints in Asymptomatic Subjects: A High-Speed Dual Fluoroscopy Study

Journal of Biomechanical Engineering ◽

10.1115/1.4034263 ◽

2016 ◽

Vol 138 (9) ◽

Cited By ~ 13

Author(s):

Koren E. Roach ◽

Bibo Wang ◽

Ashley L. Kapron ◽

Niccolo M. Fiorentino ◽

Charles L. Saltzman ◽

...

Keyword(s):

Subtalar Joint ◽

High Speed ◽

External Rotation ◽

Translational Motion ◽

Three Dimensional ◽

Tibiotalar Joint ◽

In Vivo Kinematics ◽

Asymptomatic Subjects ◽

Capture Techniques

Measurements of joint kinematics are essential to understand the pathomechanics of ankle disease and the effects of treatment. Traditional motion capture techniques do not provide measurements of independent tibiotalar and subtalar joint motion. In this study, high-speed dual fluoroscopy images of ten asymptomatic adults were acquired during treadmill walking at 0.5 m/s and 1.0 m/s and a single-leg, balanced heel-rise. Three-dimensional (3D) CT models of each bone and dual fluoroscopy images were used to quantify in vivo kinematics for the tibiotalar and subtalar joints. Dynamic tibiotalar and subtalar mean joint angles often exhibited opposing trends during captured stance. During both speeds of walking, the tibiotalar joint had significantly greater dorsi/plantarflexion (D/P) angular ROM than the subtalar joint while the subtalar joint demonstrated greater inversion/eversion (In/Ev) and internal/external rotation (IR/ER) than the tibiotalar joint. During balanced heel-rise, only D/P and In/Ev were significantly different between the tibiotalar and subtalar joints. Translational ROM in the anterior/posterior (AP) direction was significantly greater in the subtalar than the tibiotalar joint during walking at 0.5 m/s. Overall, our results support the long-held belief that the tibiotalar joint is primarily responsible for D/P, while the subtalar joint facilitates In/Ev and IR/ER. However, the subtalar joint provided considerable D/P rotation, and the tibiotalar joint rotated about all three axes, which, along with translational motion, suggests that each joint undergoes complex, 3D motion.

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