The Movement of the Knee Studied by Magnetic Resonance Imaging

Freeman, Michael; Pinskerová, V.

doi:10.1097/01.blo.0000063598.67412.0d

Cited by 149 publications

(128 citation statements)

References 14 publications

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“…Individual differences of an average of 2.2°were found when looking at the absolute values, with differences up to 5°in some of our specimens. The larger DCA as compared to the PCA could be explained by the concept that the posterior and distal lateral femoral condyles share the same centre of curvature, as opposed to the medial condyle for which the radius of distal condyle is larger than the posterior condyle's radius [6,14]. Based on that theory, the distal medial condyle would be further from the medial epicondyle than the posterior condyle while the distances remain the same on the lateral side, therefore the DCA would be larger than the PCA.…”

Section: Implications For Tkamentioning

confidence: 99%

“…Some studies suggesting an interpretation of knee flexion based on the SEA also state that this model is not valid for flexion angles over 90°and in hyperextension [3,10], reinforcing our impression that it is an oversimplification. The kinematic analysis of the knee based on the various parts of the femoral condyles proposed by Freeman et al [14] appears more realistic as it applies to the whole range of knee motion. Therefore, the shape of the distal femur being more complex than two circular sagittal cross-sections centred on the SEA, positioning the femoral component relative to the SEA can only represent a compromise between the normal shape and function of the femur and what can be achieved with current TKA techniques and implants.…”

Section: Implications For Tkamentioning

confidence: 99%

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Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study

Lustig

Lavoie

Selmi

et al. 2008

Knee Surg Sports Traumatol Arthr

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Many authors presented the epicondylar axis as the fixed axis of rotation of the femoral condyles during flexion of the knee. Positioning of the femoral component of a total knee arthroplasty (TKA) based on the epicondyles has been proposed. This work is a critical analysis of this concept. Metallic bodies were inserted at the level of collateral ligament insertions on 16 dried femurs, allowing us to locate the surgical epicondylar axis. The dried femurs were studied using standard radiographs and CT-scan. CT cuts were made perpendicular to the epicondylar axis. The medial mechanical femoral angle and the epicondylar angle were measured on the radiographs. The posterior and distal epiphyseal rotations relative to the epicondylar axis (Posterior Condylar Angle, PCA, and Distal Condylar Angle, DCA, respectively) were measured on the CT-scans. PCA and DCA values were compared. The centre of the posterior femoral condyles was located on sagittal reconstructions using the tangent method and was confirmed with circular templates, and then compared to the location of the epicondyles. Circle-fitting of the entire femoral condylar contours centred on the epicondyles was also tried. The mechanical femoral axis was nearly perpendicular to the epicondylar axis but with important variations. The average PCA and DCA were 1.9 degrees +/- 1.8 degrees and 3.1 degrees +/- 2.1 degrees , respectively. No relationship could be established between the mechanical femoral angle and the PCA. The individual differences between the PCA and the DCA averaged 2.2 degrees . A significant distance was found between the centre of the condylar contours and the epicondyles: 6.5 mm in average on the lateral side (range 2.3-11.3 mm) and 8.4 mm on the medial side (range 4.0-11.6 mm). Circle-fitting of the entire medial or lateral femoral condylar contours centred on the epicondyles was not possible. The centre of the posterior femoral condyles is significantly different from the epicondylar axis, thus refuting the conclusions of previous authors. Furthermore, considering the differences between the distal and posterior condylar angles shown here, as well as the difficulty of repeatably locating the epicondyles during surgery, using the epicondylar axis as the only landmark to position the femoral component during a first intention TKA is not recommended. The surgical epicondylar axis does not appear to be an adequate basis for the understanding of the shape of the distal femur.

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Section: Implications For Tkamentioning

confidence: 99%

Section: Implications For Tkamentioning

confidence: 99%

Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study

Lustig

Lavoie

Selmi

et al. 2008

Knee Surg Sports Traumatol Arthr

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“…Only the interplay of the two bundles leads to physiological knee kinematics, with a lateral more than medial roll-back of the femur [8,9].…”

Section: Introductionmentioning

confidence: 99%

How much of the PCL is really preserved during the tibial cut?

Matziolis

Mehlhorn

Schattat

et al. 2011

Knee Surg Sports Traumatol Arthrosc

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“…This phenomenon is called "roll-back" and determines the AP contact position of the femur on the tibia. The contact point is maintained at approximately 2-5 mm posterior to the middle of the tibia plateau, located at 54-60% of the anteroposterior diameter of the medial tibia (Freeman andPinskerova 2003, Komistek et al 2003). Also, the PCL is the strongest ligament that prevents opening of the joint in flexion.…”

mentioning

confidence: 99%

Retention versus removal of the posterior cruciate ligament in total knee replacement: A systematic literature review within the Cochrane framework

2005

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Background There is no consensus as to whether to use a posterior cruciate ligament (PCL) retaining design or a posterior-stabilized design for total knee arthroplasty. The objective of this study was to establish the difference in functional, clinical, and radiological outcome between retention and removal of the PCL. MethodsWe conducted a search in Medline, EMBASE, the Cochrane database, and Current Contents, along with reference checks and citation tracking. Randomized controlled trials were selected and methodological quality was assessed with the van Tulder and Jadad checklists by 2 independent reviewers.Results We found 8 randomized controlled trials. 2 treatment options were compared against PCL retention: PCL removal without post and cam mechanism (2 studies), and posterior-stabilized design (5 studies). 1 study included all 3 options. Range of motion was found to be 8° higher (105° vs. 113°) in the posterior-stabilized group compared to the PCL retention group (p = 0.01, 95% CI (1.7, 15)).Interpretation These results should be interpreted with caution, as the methodological quality of the studies was highly variable. Suggestions are given to improve future research on this specific aspect of knee arthroplasty.

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The Movement of the Knee Studied by Magnetic Resonance Imaging

Cited by 149 publications

References 14 publications

Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study

Relationship between the surgical epicondylar axis and the articular surface of the distal femur: an anatomic study

How much of the PCL is really preserved during the tibial cut?

Retention versus removal of the posterior cruciate ligament in total knee replacement: A systematic literature review within the Cochrane framework

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