Catherine R Galvin1, Diana M Perriman2, Phillip M Newman3, Joseph T Lynch4, Paul N Smith5, Jennie M Scarvell6. 1. Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia. Electronic address: catherine.galvin@canberra.edu.au. 2. Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; The Australian National University, Acton, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia. Electronic address: diana.perriman@act.gov.au. 3. Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; University of Canberra Research Institute for Sport and Exercise (UCRISE). Electronic address: phillip.newman@canberra.edu.au. 4. The Australian National University, Acton, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia. Electronic address: joe.lynch@act.gov.au. 5. The Australian National University, Acton, ACT 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia. Electronic address: psmith@orthoact.com.au. 6. Faculty of Health, University of Canberra, Locked Bag 1, 2601, Australia; Trauma and Orthopaedic Research Unit, Canberra Hospital, Garran, ACT, 2605, Australia. Electronic address: jennie.scarvell@canberra.edu.au.
Abstract
BACKGROUND: Understanding healthy deep flexion kinematics will inform the design of conservative clinical rehabilitation strategies for knee osteoarthritis and contribute to improved knee prosthesis design. This study is a systematic review and meta-analysis of the kinematic outcomes measured at the healthy tibiofemoral joint during loaded deep knee flexion. METHODS: A computerised literature search and bibliography review without date restriction identified twelve studies with 164 participants aged 25-61 years in-vivo, and 69-93 years in-vitro. Flexion higher than 120° was achieved by squatting, lunging or kneeling. Measurement technologies in-vivo included radiographs, open MRI and 2D-3D MRI or CT image registration on fluoroscopy. Microscribe was used in-vitro. RESULTS: Outcomes were either six degrees-of-freedom based on femur movement or contact patterns on the tibial plateau. The meta-analysis demonstrated that in-vivo, between 120° and 135° of flexion, the tibia internally rotated (mean difference (MD) = 4.6°, 95% CI 3.55° to 5.64°). Both the medial-femoral-condyle and lateral-femoral-condyle translated posteriorly, (MD = 10.4 mm, 95% CI 6.9 to 13.9 mm) and (MD = 5.55 mm, 95% CI 4.64 to 6.46 mm) respectively. There was some evidence of femoral medial translation (3.8 mm) and adduction (1.9° to 3.3°), together with medial compression (1.7 mm) and lateral distraction (1.9) mm. CONCLUSIONS: Across the in-vivo studies, consistent kinematic patterns emerged; despite the various measurement technologies and reference methods. In contrast, in-vivo and in-vitro results were contradictory. TRIAL REGISTRATION: This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25 February 2017 (registration number: 42017057614).
BACKGROUND: Understanding healthy deep flexion kinematics will inform the design of conservative clinical rehabilitation strategies for knee osteoarthritis and contribute to improved knee prosthesis design. This study is a systematic review and meta-analysis of the kinematic outcomes measured at the healthy tibiofemoral joint during loaded deep knee flexion. METHODS: A computerised literature search and bibliography review without date restriction identified twelve studies with 164 participants aged 25-61 years in-vivo, and 69-93 years in-vitro. Flexion higher than 120° was achieved by squatting, lunging or kneeling. Measurement technologies in-vivo included radiographs, open MRI and 2D-3D MRI or CT image registration on fluoroscopy. Microscribe was used in-vitro. RESULTS: Outcomes were either six degrees-of-freedom based on femur movement or contact patterns on the tibial plateau. The meta-analysis demonstrated that in-vivo, between 120° and 135° of flexion, the tibia internally rotated (mean difference (MD) = 4.6°, 95% CI 3.55° to 5.64°). Both the medial-femoral-condyle and lateral-femoral-condyle translated posteriorly, (MD = 10.4 mm, 95% CI 6.9 to 13.9 mm) and (MD = 5.55 mm, 95% CI 4.64 to 6.46 mm) respectively. There was some evidence of femoral medial translation (3.8 mm) and adduction (1.9° to 3.3°), together with medial compression (1.7 mm) and lateral distraction (1.9) mm. CONCLUSIONS: Across the in-vivo studies, consistent kinematic patterns emerged; despite the various measurement technologies and reference methods. In contrast, in-vivo and in-vitro results were contradictory. TRIAL REGISTRATION: This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25 February 2017 (registration number: 42017057614).
Authors: Joseph T Lynch; Jennie M Scarvell; Catherine R Galvin; Paul N Smith; Diana M Perriman Journal: Knee Surg Sports Traumatol Arthrosc Date: 2020-04-03 Impact factor: 4.342