In vivo tibiofemoral contact analysis using 3D MRI-based knee models

DeFrate, Louis E.; Sun, Hao; Gill, Thomas J.; Rubash, Harry E.; Li, Guoan

doi:10.1016/j.jbiomech.2004.01.012

Cited by 165 publications

(152 citation statements)

References 35 publications

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“…1). 20,21 The outline of each bone was extracted on the fluoroscopic images, and then the projection of each 3D bone model was matched to the corresponding outline to reproduce the 3D position of the model in space. This technique has an accuracy of <0.1 mm for the measurement of tibiofemoral joint kinematics, 22 0.09 AE 0.16 mm in measuring patellar shift, 0.13 AE 0.328 in patellar rotation, and 0.12 AE 0.218 in patellar tilt.…”

Section: Methodsmentioning

confidence: 99%

“…Bone surfaces of the femur, tibia, and patella and articular cartilage surfaces were segmented in each image. 20 The patellar tendon insertion sites at the tibial tubercle and the distal patella were also segmented. 18 After MRI, each subject performed single leg knee bend up to maximum flexion in the field of view of two orthogonally positioned fluoroscopes (BV Pulsera; Philips, Bothell, WA).…”

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confidence: 99%

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In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

Kobayashi

Sakamoto

Hosseini

et al. 2012

Journal Orthopaedic Research

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This study quantified in-vivo 3D patellar tendon kinematics during weight-bearing deep knee bend beyond 1508. Each knee was MRI scanned to create 3D bony models of the patella, tibia, femur, and the attachment sites of the patellar tendon on the distal patella and the tibial tubercle. Each attachment site was divided into lateral, central, and medial thirds. The subjects were then imaged using a dual fluoroscopic image system while performing a deep knee bend. The knee positions were determined using the bony models and the fluoroscopic images. The patellar tendon kinematics was analyzed using the relative positions of its patellar and tibial attachment sites. The relative elongations of all three portions of the patellar tendon increased similarly up to 608. Beyond 608, the relative elongation of the medial portion of the patellar tendon decreased as the knee flexed from 608 to 1508 while those of the lateral and central portions showed continuous increases from 1208 to 1508. At 1508, the relative elongation of the medial portion was significantly lower than that of the central portion. In four of seven knees, the patellar tendon impinged on the tibial bony surface at 1208 and 1508 of knee flexion. These data may provide useful insight into the intrinsic patellar tendon biomechanics during a weight-bearing deep knee bend and could provide biomechanical guidelines for future development of total knee arthroplasties that are intended to restore normal knee function. ß 2012 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 30: [1596][1597][1598][1599][1600][1601][1602][1603] 2012 Keywords: patellar tendon elongation; patellar tendon orientation; deep knee flexion; weight-bearing activity; knee kinematics Maximum flexion of the knee reaches beyond 1508. 12 Restoration of knee function in the entire flexion range after total knee arthroplasty (TKA) has been challenging. 3 While most follow-up studies reported that knee flexion after TKA of between 110 to 1208, 4 many studies investigated knee biomechanics in deep flexion to understand the biomechanical factors that may affect flexion capabilities. 1,2,5-9 Among these factors, the function of the patellar tendon, an essential component of the extensor mechanism, plays a critical role.Numerous in vitro studies reported the material properties, 10,11 orientation, and/or moment arms of the patellar tendon. 12 In vivo studies measured patellar tendon elongation using ultrasound 13 and MRI. 14 MRI was also used to determine the orientation and moment arms of the patellar tendon. 15,16 Foil strain gages were used to measure the mid-point patellar tendon strain intra-operatively. 17 Recently, DeFrate et al. 18 investigated patellar tendon kinematics using a combined MRI and dual fluoroscopic image technique. However, most of these studies examined patellar tendon biomechanics within the range of knee flexion up to 1108. 18,19 Quantitative data on the patellar tendon function in deep knee flexion are still unclear.Our objective was ...

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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

Kobayashi

Sakamoto

Hosseini

et al. 2012

Journal Orthopaedic Research

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“…Full extension was defined as the position where the subject was standing in an upright, relaxed position. These orthogonal images were used to quantify the in vivo knee position at each of the targeted flexion angles [5,23].…”

Section: Tibia1 Insertionmentioning

confidence: 99%

“…The virtual C-arm therefore allowed the knee model to be viewed from two orthogonal directions corresponding to the views of the fluoroscope during imaging. The model was manipulated in 6" of freedom inside the virtual C-arm, until the projections of the model matched the outline of the two orthogonal knee images [5,23]. When the projections matched the outlines of the images taken during in vivo knee flexion, the model reproduced the kinematics of the knee.…”

Section: Tibia1 Insertionmentioning

confidence: 99%

In vivo kinematics of the ACL during weight‐bearing knee flexion

DeFrate

Rubash

et al. 2005

Journal Orthopaedic Research

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170

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No study has investigated the three-dimensional morphological changes of the anterior cruciate ligament (ACL) during functional activities in vivo. The purpose of this study was to analyze the elongation, rotation (twist), and orientation of the ACL during weight-bearing flexion in five human subjects using dual-orthogonal fluoroscopic images and MR image-based computer models. The ACL consistently decreased in length with flexion. At 90", the length decreased by 10% compared to its length at full extension. The ACL twisted internally by only 20" at 30" of flexion. The ACL was oriented more vertically (approximately 60") and slightly laterally (approximately 10' ) at low flexion angles. These data on in vivo ligament elongation demonstrate that the ACL plays a more important role in lower flexion angles than at higher flexion angles during weight-bearing flexion. These data also suggest that successful ACL reconstruction should not only restore the ligament's elongation behavior, but also its rotational and orientation characteristics, so that normal ACL biomechanics are restored.

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“…With use of cartilage contact models of the healthy knee, the medial femoral condyle was shown to remain within the central portion of the tibial plateau from 0°to 90°of flexion during weight-bearing flexion. The lateral articular contact point was 4 mm anterior to the centerline of the tibial plateau at 0°, and it consistently moved posteriorly with flexion 38 . Both the medial and lateral tibiofemoral contact points were located on the inner portions of the tibial plateau and femoral condyles (close to the tibial spine), indicating that the tibial spine may play an important role in knee stability 39 .…”

Section: Normal Cartilage Contact Characteristicsmentioning

confidence: 89%

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics

Velde

Gill

2009

Journal of Bone and Joint Surgery

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Measuring knee biomechanics in six degrees of freedom with acceptable accuracy has been proven to be technically challenging. At our bioengineering laboratory, we have employed both an in vitro robotic testing system and an in vivo combined dual fluoroscopic and magnetic resonance imaging technique to analyze the impact of anterior cruciate ligament rupture on the knee joint.When measuring the tibiofemoral kinematics of nine cadavers with the robotic testing system, we found that anterior cruciate ligament deficiency not only altered anterior translation and axial rotation of the tibia, but it also increased the medial translation of the tibia as well. The in vivo dual fluoroscopic imaging analysis of tibiofemoral kinematics in ten anterior cruciate ligament-deficient patients revealed analogous findings: an increased medial translation of the tibia of approximately 1 mm between 15°and 90°of flexion was found in anterior cruciate ligament-deficient knees, in addition to an increased anterior translation (approximately 3 mm) and internal rotation (approximately 2°) of the tibia at low flexion angles. In a subsequent study of tibiofemoral cartilage contact, we found that the cartilage contact points shifted posteriorly-as was expected on the basis of the increased anterior tibial translation-as well as laterally on the surface of the tibial plateau.The data demonstrate how rupture of the anterior cruciate ligament initiates a cascade of events that eventually results in abnormal tibiofemoral cartilage contact in both the anteroposterior and mediolateral directions. If the restoration of normal knee homeostasis is the ultimate goal of ligament reconstruction, the normal function of the anterior cruciate ligament should be restored as closely as possible in all degrees of freedom.

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In vivo tibiofemoral contact analysis using 3D MRI-based knee models

Cited by 165 publications

References 35 publications

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

In‐vivo patellar tendon kinematics during weight‐bearing deep knee flexion

In vivo kinematics of the ACL during weight‐bearing knee flexion

Evaluation of Kinematics of Anterior Cruciate Ligament-Deficient Knees with Use of Advanced Imaging Techniques, Three-Dimensional Modeling Techniques, and Robotics

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