Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using ‘interventional’ MRI

Johal, P.; Williams, Andrew M.; Wragg, P.; Hunt, David M.; Gedroyc, W.

doi:10.1016/j.jbiomech.2004.02.008

Cited by 319 publications

(243 citation statements)

References 30 publications

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“…Our data show subjects experienced PFR of their lateral condyle (mean 23 mm) and a lesser amount of PFR of their medial condyle (mean 14 mm) during a loaded deep knee bend. We observed greater medial condyle PFR than previously reported for the normal knee [23,25,29], leading to similar axial rotation patterns, but lower in magnitude than that of the normal knee (10.8°for the patients in this study versus 16.8°in the native knee). This greater medial PFR as compared with the normal knee raises concerns because it potentially can overload the medial structures of the knee.…”

Section: Discussionsupporting

confidence: 80%

“…Numerous kinematic analyses of the normal knee have documented greater mean posterior motion of the lateral condyle relative to the medial condyle, leading to a mean internal rotation of the tibia with progressive knee flexion [9,15,23,25,27,29]. Komistek et al reported the lateral condyle achieved more posterior motion than the medial condyle, 19.2 mm and 3.4 mm, respectively, with increasing knee flexion during a deep knee bend [25].…”

Section: Discussionmentioning

confidence: 99%

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In Vivo Kinematics after a Cruciate-substituting TKA

Victor

Mueller

Komistek

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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Patterns of motion in the native knee show substantial variability. Guided motion prosthetic designs offer stability but may limit natural variability. To assess these limits, we therefore determined the in vivo kinematic patterns for patients having a cruciate-substituting TKA of one design and determined the intersurgeon variability associated with a guided-motion prosthetic design. Threedimensional femorotibial contact positions were evaluated for 86 TKAs in 80 subjects from three different surgeons using fluoroscopy during a weightbearing deep knee bend. The average posterior femoral rollback of the medial and lateral condyles for all TKAs from full extension to maximum flexion was À14.0 mm and À23.0 mm, respectively. The average axial tibiofemoral rotation from full extension to maximum flexion for all TKAs was 10.8°. The average weightbearing range of motion (ROM) was 1098 (range, 608-1508; standard deviation, 18.78). Overall, the TKA showed axial rotation patterns similar to those of the normal knee, although less in magnitude. Surgeon-to-surgeon comparison revealed dissimilarities, showing the surgical technique and soft tissue handling influence kinematics in a guided-motion prosthetic design.

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Section: Discussionsupporting

confidence: 80%

Section: Discussionmentioning

confidence: 99%

In Vivo Kinematics after a Cruciate-substituting TKA

Victor

Mueller

Komistek

et al. 2010

Clinical Orthopaedics &Amp; Related Research

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“…A strong point is the correlation with knee kinematics, since there is, to our knowledge, only two previous study available that correlates the post-cam contact mechanics with knee kinematics during a squat movement [13]. Our results regarding femoral posterior motion of the nexGen LPS prosthesis in a cadaver model with static measurement of post-cam stresses are very similar.…”

Section: Discussionsupporting

confidence: 62%

Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs

Arnout

Vanlommel

et al. 2014

Knee Surg Sports Traumatol Arthrosc

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ResultsThe post-cam mechanisms analyzed in this study are very variable in terms of design features. This leads to large variations in terms of the flexion angle at which the post and cam engage maximal contact force, contact pressure and contact area. We found that more functional postcam mechanisms, which engage at lower flexion angle and have a similar behavior as normal PCL function, generally show more normal rollback and tibial rotation at the expense of higher contact forces and pressures. All designs show high contact forces. A positive correlation was found between contact force and initial contact angle. Conclusion Post-cam contact mechanics and kinematics were documented in a standardized setting. Post-cam contact mechanics are correlated with post-cam function. Outcomes of this study can help to develop more functional designs in future. nevertheless, a compromise will always be made between functional requirements and risk of failure. We assume that more normal knee kinematics leads to more patient satisfaction because of better mobility. Understanding of the post-cam mechanism, and knowing how this system really works, is maybe the clue in further development of new total knee designs.

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“…Another study [23] found lateral-but not medial-pivot motion, which we observed in our control group. Hill et al [8] and others [14] observed anterior translation of the medial condyle of 4 mm in 90°, which was slightly more than the findings by Johal et al [10].…”

Section: Discussionmentioning

confidence: 71%

“…Most but not all [18] published kinematic results are weightbearing, making it difficult to compare our nonweightbearing findings to prior literature. Johal et al [10] observed tibiofemoral movement in 10 weightbearing and nonweightbearing Caucasian knees using MRI and found tibial internal rotation with flexion was present in both groups but was a magnitude of rotation greater and occurred earlier with weightbearing. We may have seen even larger degrees of tibial internal rotation and lateral rollback in weightbearing films, and we will investigate this further.…”

Section: Discussionmentioning

confidence: 99%

Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study

Fitz¹,

Sodha

Reichmann

et al. 2012

Clinical Orthopaedics &Amp; Related Research

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Background Normal knee kinematics is characterized by posterior femorotibial rollback with tibial internal rotation and medial-pivot rotation in flexion. Cruciate-retaining TKAs (CR-TKAs) do not reproduce normal knee kinematics. Questions/purposes We hypothesized a more anatomic reconstruction of the medial femoral condyle, simultaneously preserving the tension of the PCL and medial collateral ligament, resulted in (1) medial-pivot rotation and tibial internal rotation, (2) lateral femoral rollback, and (3) reduced liftoff. Patients and Methods We compared 10 patients who underwent CR-TKA using the new technique at their 1-year followup to a matched control group of nine patients using a traditional gap-balancing technique at their 2-to 4-year followup. All patients received lateral radiographs in extension and flexion, which we utilized for threedimensional implant matching to calculate tibial internal rotation, lateral rollback, and lateral liftoff in extension and flexion. Results The new gap-balancing technique resulted in a median of 3.5°tibial internal rotation with 2.7-mm rollback of the lateral femoral condyle relative to the medial condyle in flexion, which was different from the control group. We found no differences in liftoff between the groups. Conclusions The new technique resulted in tibial internal rotation with flexion and lateral rollback comparing the lateral to the medial condyle in flexion, but no differences in condylar liftoff. These preliminary results were comparable to published kinematic results of an asymmetric CR-TKA or medial-pivot CR-TKA but not to symmetric CR-TKA.

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Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using ‘interventional’ MRI

Cited by 319 publications

References 30 publications

In Vivo Kinematics after a Cruciate-substituting TKA

In Vivo Kinematics after a Cruciate-substituting TKA

Post-cam mechanics and tibiofemoral kinematics: a dynamic in vitro analysis of eight posterior-stabilized total knee designs

Does a Modified Gap-balancing Technique Result in Medial-pivot Knee Kinematics in Cruciate-retaining Total Knee Arthroplasty?: A Pilot Study

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