Zhitao Rao1,2,3, Chaochao Zhou1,3, Willem A Kernkamp1, Timothy E Foster1,4, Hany S Bedair1,4,3, Guoan Li5. 1. Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Harvard Medical School, 159 Wells Ave, Newton, MA, 02459, USA. 2. Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, China. 3. Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA. 4. Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA, USA. 5. Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital/Harvard Medical School, 159 Wells Ave, Newton, MA, 02459, USA. gli1@partners.org.
Abstract
PURPOSE: To investigate the in vivo femoral condyle motion and synergistic function of the ACL/PCL along the weight-bearing knee flexion. METHODS: Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging technique during a single-legged lunge (0°-120°). The medial and lateral femoral condyle translation and rotation (measured using geometric center axis-GCA), and the length changes of the ACL/PCL were analyzed at: low (0°-30°), mid-range (30°-90°) and high (90°-120°) flexion of the knee. RESULTS: At low flexion (0°-30°), the strains of the ACL and the posterior-medial bundle of the PCL decreased. The medial condyle showed anterior translation and lateral condyle posterior translation, accompanied with a sharp increase in external GCA rotation (internal tibial rotation). As the knee continued flexion in mid-range (30°-90°), both ACL and PCL were slack (with negative strain values). The medial condyle moved anteriorly before 60° of flexion and then posteriorly, accompanied with a slow increase of GCA rotation. As the knee flexed in high flexion (90°-120°), only the PCL had increasingly strains. Both medial and lateral condyles moved posteriorly with a rather constant GCA rotation. CONCLUSIONS: The ACL and PCL were shown to play a reciprocal and synergistic role during knee flexion. Mid-range reciprocal anterior-posterior femoral translation or laxity corresponds to minimal constraints of the ACL and PCL, and may represent a natural motion character of normal knees. The data could be used as a valuable reference when managing the mid-range "instability" and enhancing high flexion capability of the knee after TKAs. LEVEL OF EVIDENCE: Level IV.
PURPOSE: To investigate the in vivo femoral condyle motion and synergistic function of the ACL/PCL along the weight-bearing knee flexion. METHODS: Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging technique during a single-legged lunge (0°-120°). The medial and lateral femoral condyle translation and rotation (measured using geometric center axis-GCA), and the length changes of the ACL/PCL were analyzed at: low (0°-30°), mid-range (30°-90°) and high (90°-120°) flexion of the knee. RESULTS: At low flexion (0°-30°), the strains of the ACL and the posterior-medial bundle of the PCL decreased. The medial condyle showed anterior translation and lateral condyle posterior translation, accompanied with a sharp increase in external GCA rotation (internal tibial rotation). As the knee continued flexion in mid-range (30°-90°), both ACL and PCL were slack (with negative strain values). The medial condyle moved anteriorly before 60° of flexion and then posteriorly, accompanied with a slow increase of GCA rotation. As the knee flexed in high flexion (90°-120°), only the PCL had increasingly strains. Both medial and lateral condyles moved posteriorly with a rather constant GCA rotation. CONCLUSIONS: The ACL and PCL were shown to play a reciprocal and synergistic role during knee flexion. Mid-range reciprocal anterior-posterior femoral translation or laxity corresponds to minimal constraints of the ACL and PCL, and may represent a natural motion character of normal knees. The data could be used as a valuable reference when managing the mid-range "instability" and enhancing high flexion capability of the knee after TKAs. LEVEL OF EVIDENCE: Level IV.
Entities:
Keywords:
ACL; High flexion; In vivo knee kinematics; Mid-range instability; PCL; TKA
Authors: Louis E Defrate; Ramprasad Papannagari; Thomas J Gill; Jeremy M Moses; Neil P Pathare; Guoan Li Journal: Am J Sports Med Date: 2006-04-24 Impact factor: 6.202
Authors: K M Ghosh; A P Blain; L Longstaff; S Rushton; A A Amis; D J Deehan Journal: Knee Surg Sports Traumatol Arthrosc Date: 2013-07-06 Impact factor: 4.342
Authors: Sumesh M Zingde; Filip Leszko; Adrija Sharma; Mohamed R Mahfouz; Richard D Komistek; Douglas A Dennis Journal: Clin Orthop Relat Res Date: 2014-01 Impact factor: 4.176
Authors: Bing Yue; Kartik M Varadarajan; Angela L Moynihan; Fang Liu; Harry E Rubash; Guoan Li Journal: J Orthop Res Date: 2011-01 Impact factor: 3.494
Authors: Lena Marie Wilms; Karl Ludger Radke; David Latz; Thomas Andreas Thiel; Miriam Frenken; Benedikt Kamp; Timm Joachim Filler; Armin Michael Nagel; Anja Müller-Lutz; Daniel Benjamin Abrar; Sven Nebelung Journal: Quant Imaging Med Surg Date: 2022-08
Authors: Stephan Oehme; Philippe Moewis; Heide Boeth; Benjamin Bartek; Annika Lippert; Christoph von Tycowicz; Rainald Ehrig; Georg N Duda; Tobias Jung Journal: Sci Rep Date: 2022-08-02 Impact factor: 4.996