Difference In Tibial Rotation Research Articles

Comparison of screw-home movement between patients with knee osteoarthritis and normal adults.

Tibial rotation accompanying sagittal movement contains the phenomenon of screw-home movement (SHM) of the knee, which plays an important role in knee stability during extension. This study aimed to investigate the change of SHM in patients with knee osteoarthritis (OA). Thirty-one sex-matched patients with knee OA and 31 normal subjects were recruited. The total tibial rotation was obtained during knee sagittal movement (extension and flexion) using an inertial measurement unit. The acquired angle of tibial rotation was divided into eight periods. The total tibial rotation and the variation of each period were compared between the OA and control groups. The difference in tibial rotation according to Kellgren-Lawrence (KL) grade was compared. The total tibial rotation of the OA group decreased compared with the control group during knee extension and flexion (P< 0.001). Variations of tibial rotation were significantly different between groups in all periods (P< 0.001) except for knee extension at 70∘ to 45∘ (P= 0.081). There was no significant difference in tibial rotations among the KA grades of OA patients. We found a reduction in the total tibial rotation and loss of the SHM in the unloaded OA knee. It could be predicted that reduced SHM appeared early in knee OA.

Mobile-bearing insert reduced patellar contact force at knee flexion during posterior stabilized total knee arthroplasty

BackgroundThis study aimed to compare tibial rotation and patellar contact force between mobile- and fixed-bearing total knee arthroplasty from extension to flexion by using a navigation system and patellar contact force sensor on the same patients' knees. MethodsThirty-one consecutive patients who had undergone a primary posterior stabilized total knee arthroplasty were included. Patellar contact forces on the medial and lateral sides were measured at each flexion angle, and tibial rotation was assessed during 30–90°, and 90–120° knee flexion. The patellar contact force and tibial rotation were measured twice with the mobile- and fixed-platform trial components and compared between the two groups. FindingsThe patellar contact force was significantly lower with mobile than with fixed-bearing total knee arthroplasty on the medial side at 120° flexion (P = .0138) and lateral side at 60°, 90°, and 120° flexion (P = .0346, P = .0127, and P = .0376). There were no significant differences in tibial rotation between the mobile- and fixed-bearing inserts during both 30–90° and 90–120° knee flexion. InterpretationPatellar contact force was significantly lower, especially on the lateral side in mobile than in fixed-bearing total knee arthroplasty, whereas no significant difference in tibial internal rotation was found between the two inserts. Mobile-bearing inserts might reduce the patellar contact force by the bearing rotation, rather than natural tibial rotation during posterior stabilized total knee arthroplasty.

Is cocontraction a potential cause of tibial internal rotation restriction in patients with knee endoprostheses?

Aims and Objectives: The ischiocrural muscles play an important role in the rotation of the tibia. The main objective of the study was to examine the extent to which an increased cocontraction of the SEMITEN and BIZFEM in patients with bicondylar (TKA) and unicondylar prostheses (UKA) under the influence of everyday forms of stress restricts the tibial rotation. Materials and Methods: 3-D-motion analysis in patients after TKA or UKA was performed to record joint kinematics before and after knee prosthesis. Inclusion criteria: Age 50-70 years, no other prostheses, BMI &lt;31, no relevant diseases, surgery - period 04/2015 to 04/2016. Out of a total of 550 patients finally 22 patients (w:11/m:11) could be included: TKA (n = 11), UKA (n = 9). To imitate various movement patterns of ADL, a parcour was built with a ramp and a staircase with 3 steps. Kinematic data were recorded with 10 infrared 100 Hz cameras. Muscular activities were measured bilaterally with a wireless EMG system (1000 Hz, myon320, muon, CH). Walking speed was collected through a time-gate system (WEKO, Weitmann &amp; Konrad GmbH &amp; Co. KG, DE). Static analysis was performed by statistical nonparametric assignment (SnPM). The WOMAC score was used for subjective assessment of dysfunctions. Results: In normal walking, there was no difference in tibial rotation compared to the non-operated knee in either the TKA or the UKA group. In SnPM analysis, statistically significantly reduced tibial rotation was shown on the downturn of a ramp in the TKA group at the operated knee. The UKA group showed no significant differences on the ramp to the non-operated knee. Concerning co-contraction of the SEMITEN and BIZFEM in the EMG analysis in the operated knee joint, no deviation from the non-operated knee could be shown. When climbing stairs, the SnPM internal rotation analysis revealed significant differences between the TKA and the UKA group (stance phase). Similar to the group comparement a restricted axial rotational movement compared to an operated to non - operated knee joint in the TKA - group could be show.n Especially during the stairway, the knee internal rotation of the prosthesis was impaired compared to the non-operated knee. On the other hand, when climbing stairs, the internal rotation was mostly significantly reduced during the stance phase. The SnPM analysis showed statistically significant asymmetries in the UKA group during stairway walking. The disturbed internal rotational movement showed the UKA group in the operated knee joint compared to the un-operated knee joint to the same extent as the TKA group only during the run down from the ramp. Conclusion: The assumption that cocontractions between the SEMITEN and the BIZFEM contributes to the impairment of internal rotation can not be confirmed from the data available to us. Other influences must be the cause.

Altered kinematics after anterior cruciate ligament reconstruction, and their role in the prevention of osteoarthritis

Background/Aims: Anterior cruciate ligament injury is common, and anterior cruciate ligament reconstruction has become the standard of care that aims to restore knee stability, return to activity, and prevent secondary injury. Methods: A literature review was carried out using PubMed and Science Direct databases from 1998 through 2017. Search terms included: anterior cruciate ligament reconstruction and knee osteoarthritis; kinematics after anterior cruciate ligament reconstruction; and prevention of knee osteoarthritis. A total of 356 studies matched the search terms. After removing duplicates and any studies that were not relevant, 73 studies remained. Findings: Individuals usually have impaired neuromuscular control after reconstruction, and abnormal biomechanical patterns may lead to loading of cartilage areas that are not commonly loaded and that, longitudinally, can lead to osteoarthritis. The knee adduction moment indicates loading of the knee joint and has been associated with the development of osteoarthritis and altered gait mechanics have also been implicated in the increased rate of osteoarthritis after anterior cruciate ligament reconstruction, including differences in tibial rotation during walking. Furthermore, altered ankle joint mechanics may be the result of deviations in ankle joint alignment secondary to the structural changes at the knee. It is clear that abnormal mechanical stimulation may cause dysfunction of articular chondrocytes and breakdown of cartilage extracellular matrix, leading to articular cartilage degradation and chondrocyte death. The affected joint will progress to post-traumatic osteoarthritis. Conclusions: The restoration of normal knee anatomy and mechanics, such as returning the joint to normal function, improving muscle strength, functional movement prevention programmes, restoring gait symmetry and weight management are recommended.

Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction

BackgroundThe aim of our study was to evaluate the effects of gender on recovery of knee joint biomechanics over the stance phase of gait after reconstruction of the anterior cruciate ligament (ACL). MethodsGait parameters and knee joint kinematics and kinetics were compared in 32 patients (16 male and 16 female) who underwent ACL reconstruction for a unilateral ACL deficiency, with comparison to an age-, height-, and weight-matched Control group. Knee flexion, adduction and tibial rotation angles were measured and knee extension and abduction moment was calculated by inverse dynamics methods. ResultsFemales exhibited more tibial external rotation, in both the Control and ACL groups (P<0.05), which was not changed after ACL reconstruction. Prior to reconstruction, sagittal plane biomechanics were changed, in both males and females, compared to the Control groups (P<0.05). These abnormal sagittal plane mechanics were recovered at 12months, but not six months post-reconstruction. ConclusionsWe identified gender-based differences in tibial rotation that influenced the kinematics and kinetics of the knee over the stance phase of gait, both pre-operatively and post-ACL reconstruction. Evaluation of biomechanical effects of ACL injury, before and after reconstruction, should be separately evaluated for females and males.

Three-dimensional kinematic and kinetic analysis of knee rotational stability in ACL-deficient patients during walking, running and pivoting

BackgroundAnterior cruciate ligament (ACL) deficiency leads to altered stability of the knee. The purpose of this study was to compare the dynamic, rotational stability of the knee, expressed as rotational stiffness, between anterior cruciate ligament-deficient (ACLD) knees, their contralateral intact knees (ACLI) and a knee healthy control group during walking, running and 90° pivoting. We hypothesized a larger tibial internal rotation, a smaller knee joint external moment and a lower rotational stiffness in the ACLD group compared to the ACLI and the control group.MethodsKinematic and kinetic data were collected from both legs of 44 ACLD patients and 16 healthy controls during walking, running and a pivoting maneuver (descending a staircase and immediately pivoting 90° on the landing leg). Motion data were captured using 8 high-speed cameras and a force-plate. Reflective markers were attached to bony landmarks of the lower limb and rigid clusters on the shank and thigh (CASH model). Maximum internal tibial rotation and the corresponding rotational moment were identified for all tasks and groups and used to calculate rotational stiffness (= Δmoment /Δrotation) of the knee.ResultsThe tibial internal rotation of the ACLD knee was not significantly different from the ACLI knee during all three tasks. During walking and running, the tibial rotation of the control group was significantly different from both legs of the ACL-injured patient. For pivoting, no difference in tibial rotation between knees of the ACLD, ACLI and the control group was found. Knee joint external moments were not significantly different between the three groups during walking and pivoting. During running, the moments of the ACLI group were significantly higher than both the knees of the ACLD and the control group. Rotational stiffness did not differ significantly between groups in any of the three tasks.ConclusionA high-intensity activity combining stair descent and pivoting produces similar angular rotations, knee joint external moments and rotational stiffness in ACLD knees compared to ACLI knees and the control group. During running, the ACLI knee displayed a higher external moment than the ACLD and the healthy control group. This could indicate some type of protective strategy or muscular adaptation in the ACL-injured patients.

Anterior translation and rotational stability of anterior cruciate ligament-deficient knees during walking: speed and turning direction.

Anterior cruciate ligament (ACL) rupture is one of the most common injuries associated with the knee. After ACL injury, knee joint stability can be altered, resulting in abnormal loading during functional activities. Since ACL-deficient (ACLD) knees are also vulnerable to translational and rotational instability, patients need to be wary of certain motions encountered in daily life. The present study investigated the effect of walking speed and pivoting directional change during gait on knee joint kinematics of ACLD knees. We hypothesized that faster walking and crossover turning would induce severe kinematic changes. Thirty-five patients (22 males and 13 females) having a unilateral isolated subacute ACLD knee (from 1 to 3 months after injury) and contralateral intact (CLI) knee participated in this study. Spatiotemporal parameters, three-dimensional (3D) knee joint angles, and anterior-posterior (AP) translation were obtained by a 3D high-speed motion-capturing system. The CLI knee of each patient served as the control. The calculated AP stability and knee joint angles were used to test the research hypothesis. Mixed two-way repeated measures analysis of variance was performed to clarify the effects of walking speed and pivoting direction with a significance of 0.05. When a significance of mean comparison was detected, a post hoc test was performed. Significant and consistent increased AP translation of the tibia relative to the femur at the whole stance phase of the gait cycle was evident in ACLD knees compared to CLI knees for normal and faster (20 % greater than normal) walking speeds. Faster walking speed did not induce significantly more anterior location of the tibia. In addition, ACLD knees were significantly less extended than CLI knees during a large portion of midstance. Although there was a consistent varus offset between the curves of ACLD and CLI knees, the difference did not reach statistical significance during the stance phase. Also, ACLD knees did not show any significant difference in tibial rotation compared to CLI knees during the entire stance phase of the gait cycle. For pivoting turns, ACLD knees showed significantly less extended and varus offset than CLI knees only during the cutting turn. ACLD knees exhibited less tibial internal rotation during the crossover turn and less tibial external rotation during the cutting turn than CLI knees. In ACLD knees, the tibia tended to shift more anteriorly and changed with less extension at walking. However, faster walking speed did not induce any significant difference compared with normal-speed walking. In addition, ACLD knees displayed kinematic changes during pivoting, but not the crossover turn.

The PCL Index Is Correlated With the Control of Rotational Kinematics That Is Achieved After Anatomic Anterior Cruciate Ligament Reconstruction

Background: The posterior cruciate ligament (PCL) index quantifies the curvature of the PCL seen on magnetic resonance imaging (MRI) that is caused by a change in tibiofemoral alignment in the anterior cruciate ligament (ACL)–deficient knee. It has been proposed that the PCL index may be useful in assessing the success of ACL reconstruction (ACLR). Hypothesis/Purpose: The purpose of this study was to test if the PCL index is predictive of in vivo rotational kinematics and joint laxity measures in knees of patients after single-bundle ACLR. The hypothesis was that the PCL index is predictive of rotational knee kinematics and objective laxity scores. Study Design: Controlled laboratory study. Methods: At a mean of 18.1 months postoperatively, the PCL index was defined on MRI in 16 patients prospectively followed up after anatomic single-bundle ACLR and in 16 matched controls. The patients were evaluated with 3-dimensional motion analysis during (1) descending and pivoting as well as (2) landing and pivoting tasks. The side-to-side difference in tibial rotation range of motion between the reconstructed knee and the contralateral intact knee was calculated. The side-to-side difference in anterior tibial translation was measured with a KT-1000 arthrometer. Linear regression models were used with the PCL index as a predictor of the side-to-side difference in tibial rotation for each task and the side-to-side difference in anterior tibial translation. Results: The PCL index of the reconstructed knees was significantly lower compared with that of the control knees (P < .001). The index was predictive of the side-to-side difference in tibial rotation during both tasks (R2 = 0.472 and 0.477, P = .003), with a lower index being indicative of increased rotational laxity. It was not predictive of anterior tibial translation (at 134 N: R2 = 0.13, P = .17; at maximum force: R2 = 0.009, P = .726). Conclusion: The PCL index after anatomic single-bundle ACLR using a bone–patellar tendon–bone graft is predictive of rotational kinematics during in vivo dynamic pivoting activities. The results show that the PCL index is correlated with the postoperative ability to control rotational kinematics of the knee joint. Clinical Relevance: This study provides evidence regarding the interplay between restoration of the native ACL’s anatomy and the PCL’s appearance and suggests that the effective restoration of tibiofemoral alignment after ACLR that is reflected in the PCL index translates into better functional outcomes as measured by tibial rotation during pivoting activities.

Evaluating rotational kinematics of the knee in ACL reconstructed patients using 3.0 Tesla magnetic resonance imaging

IntroductionInjury to the anterior cruciate ligament (ACL) is common. While prior studies have shown that surgical reconstruction of the ACL can restore anterior–posterior kinematics, ACL-injured and reconstructed knees have been shown to have significant differences in tibial rotation when compared to uninjured knees. Our laboratory has developed an MR compatible rotational loading device to objectively quantify rotational stability of the knee following ACL injuries and reconstructions. Previous work from our group demonstrated a significant increase in total tibial rotation following ACL injuries. The current study is a prospective study on the same cohort of patients who have now undergone ACL reconstruction. We hypothesize that ACL reconstructed knees will have less tibial rotation relative to the pre-operative ACL deficient condition. We also hypothesize that ACL reconstructed knees will have greater rotational laxity when compared to healthy contralateral knees. MethodsPatients. Six of the ACL injured patients from our initial study who had subsequently undergone ACL reconstruction were evaluated 8.1±2.9 months after surgery. All patients underwent single-bundle ACL reconstruction using anteromedial portal drilling of the femoral tunnel with identical post-operative regimens.Magnetic Resonance (MR) Imaging. Patients were placed in a supine position in the MR scanner on a custom-built loading device. Once secured in the scanner bore, an internal/external torque was applied to the foot. The tibiae were semi-automatically segmented with in-house software. Tibial rotation comparisons were made within subjects (i.e. side-to-side comparison between reconstructed and contralateral knees) and differences were explored using paired sample t-tests with significance set at p=0.05. ResultsRegarding tibial rotation, in the ACL deficient state, these patients experienced an average of 5.9±4.1° difference in tibial rotation between their ACL deficient and contralateral knees. However, there was a −0.2±6.1° difference in tibial rotation of the ACL reconstructed knee when compared to the contralateral uninjured knee. Regarding tibial translation, ACL deficient patients showed a difference of 0.75±1.4mm of anterior tibial translation between injured and healthy knees. After ACL reconstruction, there was a 0.2±1.1mm difference in coupled anterior tibial translation of the ACL reconstructed knee compared to the contralateral knee. No significant differences in contact area between the two time points could be discerned. DiscussionThe objective of our study was to assess the rotational laxity present in ACL reconstructed knees using a previously validated MRI-compatible rotational loading device. Our study demonstrated that ACL reconstruction can restore rotational laxity under load. This may speak to the benefit of an anteromedial drilling technique, which allows for a more horizontal and anatomically appropriate graft position.

Tibial Rotation Under Combined In Vivo Loading After Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction

To evaluate in vivo the differences in tibial rotation between single- and double-bundle anterior cruciate ligament (ACL)-reconstructed knees under combined loading conditions. An 8-camera optoelectronic system and a force plate were used to collect kinematic and kinetic data from 14 patients with double-bundle ACL reconstruction, 14 patients with single-bundle reconstruction, 12 ACL-deficient subjects, and 12 healthy control individuals while performing 2 tasks. The first included walking, 60° pivoting, and stair ascending, and the second included stair descending, 60° pivoting, and walking. The 2 variables evaluated were the maximum range of internal-external tibial rotation and the maximum knee rotational moment. Tibial rotation angles were not significantly different across the 4 groups (P = .331 and P = .851, respectively) or when side-to-side differences were compared within groups (P = .216 and P = .371, respectively) for the ascending and descending maneuvers, nor were rotational moments among the 4 groups (P = .418 and P = .290, respectively). Similarly, for the descending maneuver, the rotational moments were not significantly different between sides (P = .192). However, for the ascending maneuver, rotational moments of the affected sides were significantly lower by 20.5% and 18.7% compared with their intact counterparts in the single-bundle (P = .015) and double-bundle (P = .05) groups, respectively. High-intensity activities combining stair ascending or descending with pivoting produce similar tibial rotation in single- and double-bundle ACL-reconstructed patients. During such maneuvers, the reconstructed knee may be subjected to significantly lower rotational loads compared with the intact knee. Level III, retrospective comparative study.

Evaluation of tibial rotational stability of single-bundle vs. anatomical double-bundle anterior cruciate ligament reconstruction during a high-demand activity — A quasi-randomized trial

The purpose of this study was to compare the tibial rotational stability of anatomical double-bundle anterior cruciate ligament reconstructed knees with single-bundle anterior cruciate ligament reconstructed knees during a high-demand activity. Total of 66 subjects, (22 with double-bundle anterior cruciate ligament reconstruction, 22 with single-bundle anterior cruciate ligament reconstruction, and 22 healthy control individuals) were examined in this study. Using a 9-camera motion analysis system, motion subjects were recorded performing during a drop landing and cutting. Using the point cluster technique, the internal-external tibial rotation of both knees was calculated. The mean maximum range of motion for each knee was evaluated for 3 groups (double-bundle group, single-bundle group, and control group). Clinical assessment, including Tegner score, Lysholm score, and knee arthrometric measurement, revealed restoration of the reconstructed knee stability with no differences between the two anterior cruciate ligament reconstruction groups. The results showed that both groups resulted in tibial rotation values that were significantly smaller than those in the intact legs and those in the healthy controls. There were no significant differences in tibial rotation between the DB group and the SB group. Therefore anatomical double-bundle reconstruction restores normal tibial rotation no more than single-bundle reconstruction during this high-demand dynamic activity. These results suggest a trend towards dynamic overcorrection after the ACL reconstruction.

Effect of motion control running shoes compared with neutral shoes on tibial rotation during running

Objective To determine whether a motion control running shoe reduces tibial rotation in the transverse plane during treadmill running. Design An experimental study measuring tibial rotation in volunteer participants using a repeated measures design. Setting Human Movement Laboratory, School of Health Professions, University of Brighton. Participants Twenty-four healthy participants were tested. The group comprised males and females with size 6, 7, 9 and 11 feet. The age range for participants was 19 to 31 years. Main outcome measures The total range of proximal tibial rotation was measured using the Codamotion 3-D Movement Analysis System. Results A one-tailed paired t-test indicated a statistically significant decrease in the total range of proximal tibial rotation when a motion control shoe was worn (mean difference 1.38°, 95% confidence interval 0.03 to 2.73, P = 0.04). Conclusions There is a difference in tibial rotation in the transverse plane between a motion control running shoe and a neutral running shoe. The results from this study have implications for the use of supportive running shoes as a form of injury prevention.

Alterations in joint kinematics during walking following hamstring and patellar tendon anterior cruciate ligament reconstruction surgery

Background Previous research has shown that patients with anterior cruciate ligament reconstruction have altered movement patterns in the reconstructed knee during walking. In the sagittal plane, graft specific changes in knee joint motion have been reported between hamstring and patellar tendon anterior cruciate ligament reconstruction grafts. This study examined the secondary planes of movement during walking in anterior cruciate ligament reconstructed knees to evaluate the influences of graft type (hamstring or patellar tendon) and control condition (control group or contralateral knee). Methods In 54 participants (18 patellar tendon graft, 18 hamstring graft and 18 controls) varus–valgus and internal–external rotation was measured during level walking in a gait laboratory at mean of 10 months after surgery. All patients had undergone primary unilateral anterior cruciate ligament reconstruction within 12 months of injury. Findings For internal–external rotation there was no difference between the graft types and both patient groups had reduced internal rotation (an external rotation offset) and reduced internal rotation range when compared to the control group and contralateral knee. For 31 of 36 patients, internal rotation values were less than the control group mean. The hamstring group had reduced varus rotation compared to both the patellar tendon and control groups, but not when compared to the contralateral knee. Interpretation The results show that there are differences in tibial rotation during walking in anterior cruciate ligament reconstructed knees compared to both the contralateral knee and uninjured control group. These kinematic alterations may relate to the high incidence of knee osteoarthritis observed in this population over time. Reduced varus in the hamstring group may relate to the graft harvest.

In Vivo Knee Kinematics in Patients With Bilateral Total Knee Arthroplasty of 2 Designs

Many younger and highly active patients desire to achieve high flexion after total knee arthroplasty. This study's purpose was to determine if a contemporary total knee arthroplasty design improved functional knee flexion compared with a traditional total knee arthroplasty in patients living a Western lifestyle. Ten patients with bilateral total knee arthroplasty of 2 types were studied during weight-bearing lunge, kneeling, and stair activities using fluoroscopic imaging. There were no differences in maximum knee flexion during lunging or kneeling. Statistically significant differences in tibial rotation and condylar translation were observed during the 3 activities. Although several joint kinematic differences were observed, no important functional differences were observed in clinically excellent, high performing subjects with bilateral total knee arthroplasty of 2 types.

Three-Dimensional Kinematic and Kinetic Analysis of Knee Rotational Stability After Single- and Double-Bundle Anterior Cruciate Ligament Reconstruction

To investigate whether anatomic restoration of the anterior cruciate ligament (ACL) functional bundles results in significant reduction in transverse-plane instability compared with the conventional single-bundle technique during a dynamic 60 degrees pivoting maneuver with the supporting knee in extension. Using an 8-camera optoelectronic system and a force plate, we examined 10 patients with double-bundle ACL reconstruction, 12 patients with single-bundle reconstruction, 10 ACL-deficient subjects, and 10 healthy control individuals. The 4 groups did not differ in terms of age, body mass index, duration of follow-up, and number of meniscectomies performed. Kinematic and kinetic data were collected from these subjects while performing a pivoting maneuver on each side with the supporting knee in extension. Maximum range of motion for internal-external knee rotation and maximum knee rotational moment were examined. There was no significant difference in tibial rotation either between the 4 groups or between sides. The mean knee rotation for the single- and double-bundle groups was lower than the control group. Rotational moment values were substantially reduced on the affected side of the reconstructed and the ACL-deficient groups. However, rotational moment was not found to affect the degree of angular displacement significantly. Double-bundle ACL reconstruction does not reduce knee rotation further compared with the single-bundle reconstruction technique. The affected side of ACL-deficient or -reconstructed individuals is subjected to reduced knee rotational moments compared with the intact side during stressful functional maneuvers. Level III, retrospective comparative study.

Differences in tibial rotation during walking in ACL reconstructed and healthy contralateral knees

This study tested the hypotheses that in patients with a successful anterior cruciate ligament (ACL) reconstruction, the internal–external rotation, varus–valgus, and knee flexion position of reconstructed knees would be different from uninjured contralateral knees during walking. Twenty-six subjects with unilateral ACL reconstructions (avg 31 years, 1.7 m, 68 kg, 15 female, 24 months past reconstruction) and no other history of serious lower limb injury walked at a self-selected speed in the gait laboratory, with the uninjured contralateral knee as a matched control. Kinematic measurements of tibiofemoral motion were made using a previously-described point-cluster technique. Repeated-measures ANOVA ( α=0.017) was used to compare ACL-reconstructed knees to their contralateral knees at four distinct points during the stance phase of walking. An offset towards external tibial rotation in ACL-reconstructed knees was maintained over all time points (95%CI 2.3±1.3°). Twenty-two out of twenty-six individuals experienced an average external tibial rotation offset throughout stance phase. Varus–valgus rotation and knee flexion were not significantly different between reconstructed and contralateral knees. These findings show that differences in tibial rotation during walking exist in ACL reconstructed knees compared to healthy contralateral knees, providing a potential explanation why these patients are at higher risk of knee osteoarthritis in the long-term.

Estudo do desvio rotacional da tíbia

OBJETIVO: avaliar o desvio rotacional pós-operatório das fraturas diafisárias da tíbia de pacientes tratadas com haste intramedular bloqueada não-fresada e placa em ponte, utilizando a tomografia computadorizada. MÉTODOS: foram tratados 113 pacientes com fraturas diafisárias da tíbia, sendo que em 42 fraturas os autores utilizaram haste intramedular bloqueada e em 71 foram utilizadas placa em ponte. O método tomográfico utilizado ara se obter as medidas da rotação tibial. Foi empregada a classificação AO das fraturas; à exposição: fechadas e expostas e a percentagem de desvios em rotação interna e externa. RESULTADOS: foi demonstrado não haver diferença significativa de rotação tibial nos seguintes parâmetros analisados: localização, rotação interna ou externa e nos tipos A e B da classificação AO. Porém, nas fraturas do tipo C e nas fraturas expostas, a haste intramedular bloqueada apresentou diferença rotacional significativamente menor (p = 0,028) e (p = 0,05), quando comparada à placa em ponte. CONCLUSÃO: independente da localização das fraturas diafisárias da tíbia, os desvios rotacionais estão relacionados à energia do trauma, apresentando uma maior dificuldade de controle com a técnica placa em ponte.