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In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion.
Clin Biomech (Bristol, Avon). 2016 Feb; 32:102-7.CB

Abstract

BACKGROUND

Transepicondylar axis and geometrical center axis are widely used for investigation of the knee kinematics and component alignment in total knee arthroplasty. However, the kinematic characteristics of these knee axes are not well defined in literature. This study investigated the femoral condylar motion during a dynamic flexion of the knee using different flexion axes.

METHODS

Twenty healthy knees (10 males and 10 females) were CT scanned to create 3D anatomic models. The subjects performed a single leg flexion from full extension to maximum flexion while the knees were imaged using fluoroscopes. The femoral condyle translations in anterior-posterior and proximal-distal directions were described using clinical transepicondylar axis, surgical transepicondylar axis and geometrical center axis.

FINDINGS

The subjects achieved -9.4° (SD 3.0°) hyperextension at full extension and 116.4° (SD 9.0°) at maximum flexion of the knee. The anterior-posterior translations of the three flexion axes were different for the medial condyle, but similar for the lateral condyle. Substantial variations of the condylar motion in proximal-distal direction were measured along the flexion path using these axes. While the surgical transepicondylar axis maintained condyle heights from full extension to 60° of flexion, geometrical center axis showed little changes in condyle heights from 30° to maximum knee flexion. The condyles moved distally beyond 90° flexion using both transepicondylar axes.

INTERPRETATION

The femoral condylar motion measurement is sensitive to the selection of flexion axis. The different kinematic features of these axes provide an insightful reference when selecting a flexion axis in total knee arthroplasty component alignment.

Links

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Authors+Show Affiliations

Feng Y
Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai 200233, China; Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Fengyongxsh@gmail.com.
Tsai TY
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Tsai.Tsung-Yuan@mgh.harvard.edu.
Li JS
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Li.Jing-Sheng@mgh.harvard.edu.
Rubash HE
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Hrubash@partners.org.
Li G
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Li.Guoan@mgh.harvard.edu.
Freiberg A
Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, United States. Electronic address: Afreiberg@mgh.harvard.edu.

MeSH

AdultArthroplasty, Replacement, KneeBiomechanical PhenomenaBody Mass IndexFemaleFemurFluoroscopyHumansImaging, Three-DimensionalKnee JointMaleModels, AnatomicMotionRange of Motion, ArticularYoung Adult

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26777272

Citation

Feng, Yong, et al. "In-vivo Analysis of Flexion Axes of the Knee: Femoral Condylar Motion During Dynamic Knee Flexion." Clinical Biomechanics (Bristol, Avon), vol. 32, 2016, pp. 102-7.
Feng Y, Tsai TY, Li JS, et al. In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion. Clin Biomech (Bristol, Avon). 2016;32:102-7.
Feng, Y., Tsai, T. Y., Li, J. S., Rubash, H. E., Li, G., & Freiberg, A. (2016). In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion. Clinical Biomechanics (Bristol, Avon), 32, 102-7. https://doi.org/10.1016/j.clinbiomech.2015.12.006
Feng Y, et al. In-vivo Analysis of Flexion Axes of the Knee: Femoral Condylar Motion During Dynamic Knee Flexion. Clin Biomech (Bristol, Avon). 2016;32:102-7. PubMed PMID: 26777272.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion. AU - Feng,Yong, AU - Tsai,Tsung-Yuan, AU - Li,Jing-Sheng, AU - Rubash,Harry E, AU - Li,Guoan, AU - Freiberg,Andrew, Y1 - 2015/12/24/ PY - 2015/06/22/received PY - 2015/12/17/revised PY - 2015/12/17/accepted PY - 2016/1/19/entrez PY - 2016/1/19/pubmed PY - 2016/11/1/medline KW - Clinical transepicondylar axis KW - Condylar motion KW - Fluoroscopy KW - Geometrical center axis KW - Knee kinematics KW - Surgical transepicondylar axis SP - 102 EP - 7 JF - Clinical biomechanics (Bristol, Avon) JO - Clin Biomech (Bristol, Avon) VL - 32 N2 - BACKGROUND: Transepicondylar axis and geometrical center axis are widely used for investigation of the knee kinematics and component alignment in total knee arthroplasty. However, the kinematic characteristics of these knee axes are not well defined in literature. This study investigated the femoral condylar motion during a dynamic flexion of the knee using different flexion axes. METHODS: Twenty healthy knees (10 males and 10 females) were CT scanned to create 3D anatomic models. The subjects performed a single leg flexion from full extension to maximum flexion while the knees were imaged using fluoroscopes. The femoral condyle translations in anterior-posterior and proximal-distal directions were described using clinical transepicondylar axis, surgical transepicondylar axis and geometrical center axis. FINDINGS: The subjects achieved -9.4° (SD 3.0°) hyperextension at full extension and 116.4° (SD 9.0°) at maximum flexion of the knee. The anterior-posterior translations of the three flexion axes were different for the medial condyle, but similar for the lateral condyle. Substantial variations of the condylar motion in proximal-distal direction were measured along the flexion path using these axes. While the surgical transepicondylar axis maintained condyle heights from full extension to 60° of flexion, geometrical center axis showed little changes in condyle heights from 30° to maximum knee flexion. The condyles moved distally beyond 90° flexion using both transepicondylar axes. INTERPRETATION: The femoral condylar motion measurement is sensitive to the selection of flexion axis. The different kinematic features of these axes provide an insightful reference when selecting a flexion axis in total knee arthroplasty component alignment. SN - 1879-1271 UR - https://www.unboundmedicine.com/medline/citation/26777272/In_vivo_analysis_of_flexion_axes_of_the_knee:_Femoral_condylar_motion_during_dynamic_knee_flexion_ DB - PRIME DP - Unbound Medicine ER -