Normative Three-Dimensional Patellofemoral and Tibiofemoral Kinematics: a Dynamic, in Vivo Study

Topics: Knee, Joint, Anterior cruciate ligament Pages: 19 (6731 words) Published: June 19, 2013


Normative Three-Dimensional Patellofemoral and Tibiofemoral Kinematics: A Dynamic, in Vivo Study Andrea R. Seisler and Frances T. Sheehan*
Abstract—In order to advance biomechanical modeling, knee joint implant design and clinical treatment of knee joint pathology, accurate in vivo kinematic data of the combined patellofemoral and tibiofemoral joint during volitional activity are critical. For example, one cause of the increased prevalence of anterior knee pain in the female population is hypothesized to be altered tibiofemoral kinematics, resulting in pathological patellofemoral kinematics. Thus, the objectives of this paper were to test the hypothesis that knee joint kinematics vary based on gender and to explore the correlation between the 3-D kinematics of the patellofemoral and tibiofemoral joints. In order to accomplish these goals, a large (n = 34) normative database of combined six degree of freedom patellofemoral and tibiofemoral kinematics, acquired noninvasively during volitional knee extension-flexion using fast-PC (dynamic) magnetic resonance imaging, was established. In this normative database, few correlations between tibiofemoral and patellofemoral kinematics were found. Specifically, tibial external rotation did not predict lateral patellar tilt, as has been stated in previous studies. In general, significant differences could not be found based on gender. Further investigation into these relationships in the presence of pathology is warranted. Index Terms—Femur, gender, healthy, kinematics, knee, patella, patellofemoral, tibia, tibiofemoral.

I. INTRODUCTION HE quality of biomechanical models, accuracy of clinical diagnosis, and fidelity of joint implants are all dependent upon the quality of the in vivo experimental data used in their creation. For this reason there have been a host of experimental and modeling studies focused on knee joint dynamics. Yet, current knowledge of this joint is limited by the fact that complete six degree of freedom kinematics of this joint, inclusive of both the patellofemoral (PF) and tibiofemoral (TF) joints, have been presented for only 5 knee joints [1], [2]. Since alterations in TF kinematics have been hypothesized to result in pathological PF kinematics [3], a combined PF and TF joint study is key to understanding pathologies such as anterior knee pain and patellar maltracking. For the TF joint, past research has focused on the finite helical axis direction and location [4], [5], the existence of the screw home mechanism [6], [7], the effects of ligament loss [5],


Manuscript received March 23, 2006; revised November 1, 2006. Asterisk indicates corresponding author. A. R. Seisler is with the National Institutes of Health, Physical Disabilities Branch (a collaboration between the National Institute of Child Health and Human Development and the Clinicall Center, NIH), Bethesda, MD 20892 USA. *F. T. Sheehan is with the National Institutes of Health, Physical Disabilities Branch, CRC Rm. 1-1469, 10 Center Drive, MSC 1604, Bethesda, MD 208921604 USA (e-mail: Digital Object Identifier 10.1109/TBME.2007.890735

[6], total knee arthroplasty [8], [9] and cartilage contact patterns [10]. Gait analysis is commonly used to collect in vivo data, but is susceptible to errors based on well documented skin motion artifacts [11]. Biplane radiography [12] has proven to be an accurate tool for studying TF kinematics. However, the required tracking of beads, implanted within the bone, narrows the populations that can be studied. Further, accurate in vivo patellar tracking is difficult with this technique. Single-plane fluoroscopy has provided strong results for sagittal-plane kinematics of total TF knee replacement [8], but tracking motion in the other cardinal planes is not as accurate [13]. Recent studies registering fluoroscopic images to CT bone models were able to eliminate the...

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