Internal-external Rotation Angles Research Articles

The effect of gastrocnemius resection on knee flexion in a total knee arthroplasty model.

Flexion contracture in knee arthritis and total knee arthroplasty (TKA) is a common and significant problem. An improvement in knee extension in patients with TKA and mild flexion contractures has been observed clinically when a gastrocnemius recession was performed for other concomitant conditions. The goal of this study was to quantify the effect of gastrocnemius recession on knee flexion in TKA cadaver model. Range of motion (ROM) of 23 cadaveric knees was determined with a navigation system before and after performing TKA using a medial parapetallar approach and after performing a gastrocnemius recession. Varus-valgus, flexion-extension, and internal-external rotation angles of the knee joint were recorded with leg in full extension and in 90°of knee flexion. Extension and flexion gaps were measured using a gap tensioning device. Dorsiflexion of the foot was measured with a goniometer when a torque moment of 10 Nm was applied to the ankle joint. A statistically significant improvement of 5° in knee extension was observed following gastrocnemius recession (P = 0.015). Varus and valgus angles, internal, and external rotation were unaffected by gastrocnemius recession. Ankle dorsiflexion increased by 9° following gastrocnemius recession (P ≤ 0.001). Performing a gastrocnemius recession improves the knee extension in TKA knees with flexion contractures. Gastrocnemius recession may be a useful technique to improve terminal extension in TKA.

Analysis of medial tibial plateau fracture injury patterns using quantitative 3D measurements

BackgroundThe Wahlquist system classifies tibial medial plateau fractures into three types based on the sagittal fracture line location, with type C at highest risk of complications. However, the injury mechanism of tibial medial plateau fractures, especially tibial rotation movement, remains unclear. The purpose of the present study was to determine the injury patterns of medial tibial plateau fractures using 3D model simulation and quantitative 3D measurements. MethodsSeventy-eight consecutive AO/OTA type 41-B tibial plateau fractures were retrospectively analyzed using CT-based 3D models and quantitative 3D measurements. The knee posture at the moment of fracture occurrence was simulated, and various knee angles in the sagittal, coronal, and axial planes were measured to evaluate the mechanism of medial tibial plateau fracture. The mean valgus-varus, hyperextension-flexion, and internal-external rotation angles were determined, and the chi-square test was used for comparisons of categorical varus and valgus force data to determine the main force direction in Wahlquist type C fractures. ResultsAngle measurements in the coronal planes showed that 28 (35.9%) medial tibial plateau fractures resulted from a varus injury pattern, while 50 fractures (64.1%) resulted from a valgus pattern. Valgus force produced significantly more Wahlquist type C fractures (37 of 50 fractures) than varus force (2 of 28 fractures) (p < 0.05). There was no significant difference in the cases of patients with type C fractures between the tibial internal and external rotation injury patterns(P > 0.05). ConclusionsValgus force was the cause of 64.1% of the medial tibia plateau fractures in the present cohort. Furthermore, valgus force produced more Wahlquist type C fractures than varus force. The present findings will help orthopedists understand the injury mechanism of the Wahlquist classification system, and will facilitate the identification of the common features of medial tibial plateau fractures induced by specific injury patterns.

Development and Application of a Novel Metric to Characterize Comprehensive Range of Motion of Reverse Total Shoulder Arthroplasty.

Active range of motion (ROM) of reverse total shoulder arthroplasty (rTSA) can be limited by bony impingement, muscle inability, and joint instability. The aim of this study was to develop a novel metric representative of comprehensive ROM of rTSA, which is evaluated in the context of all three factors. It was hypothesized that the metric, termed global circumduction ROM (GC-ROM), would capture differences resulting from directional changes in rTSA design parameters known to increase ROM. GC-ROM was calculated for a set of 18 rTSA configurations with humeral polyethylene cup depths of 6 and 8.1 mm, glenosphere lateralization (GLat) distances of 0, 5, and 10 mm, and neck-shaft angles (NSA) of 135°, 145°, and 155°. For any implant configuration, arm positions were defined by internal/external (IE) rotation angle and two spherical coordinates representing the elevation plane angle and elevation angle. At each IE rotation angle, incremental positions with variable elevation plane and elevation angles were checked for feasibility based on impingement, muscle ability, and risk of instability. Coordinates of feasible positions were mapped to unit spheres and connected to form regions, of which the surface area was calculated to represent allowable circumduction ROM. ROMs were averaged across all IE rotation angles to produce a single metric, GC-ROM. The results showed that decreasing cup depth and increasing GLat and NSA increased GC-ROM. In conclusion, a novel metric to characterize comprehensive ROM, evaluated based on several ROM-limiting factors, was developed as a performance metric through which rTSA designs can be compared. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:880-887, 2020.

EFFECTS OF SINGLE CROUCH WALKING GAITS ON FATIGUE DAMAGES OF LOWER EXTREMITY MAIN MUSCLES

Single crouch walking gait (SCWG) is one of the main walking gaits when one of the legs is injured. However, the research on movement biomechanical characteristics (MBC) of lower extremity in SCWG has not been reported. So, the aim of this study is to analyze kinematics and main muscle fatigue damages of lower extremity in SCWG. Gaits data were collected with functional assessment biomechanics (FAB) system which applies the real-time wireless gait phase detection system, the movement function relations of joints of lower extremity were obtained by fitting the collected data in normal walking gait (NWG) and SCWG with Fourier series, the fitted movement functions were input to 3D human musculoskeletal model as driving functions for human movement to analyze the differences of MBC between SCWG and NWG. Finally, the muscle contractions were used to evaluate muscle fatigue damage. Compared with NWG, the result shows that the movement range of the joint angles of lower extremity are reduced in SCWG, the change law of hip internal/external rotation angle (IERA) has a significant difference, and the change laws of other joint angles are similarly between SCWG and NWG. The muscle contractions of Gluteus maximum (GMAX) 2, Gluteus meddle (GMED) 1, GMED2, Iliacus (ILI), Rectus femoris (RFEM), Soleus (SOL), Gastrocnemius (GAS) and Vastus lateralis (VLAT) are significantly larger in SCWG than in NWG (except GlutMed2 which is about 20–40% and VLAT which is about 63.8–76.1% of gait cycle), namely, these muscles easily cause muscle damages in SCWG. The contraction change of Adductor magnus (AMAG) is dispersed, so AMAG is prone to muscle fatigue in SCWG. The study results will fill in the gaps in the MBC of lower extremity in SCWG and provide data for Rehabilitation Medical Technology (RMT) and development of rehabilitation equipment of lower extremity.

Age-Related Changes in In-Vivo 3D Knee Kinematics during Knee Joint Flexion Observed using 2D/3D Registration Technique

We aimed to identify 3D motion differences in knee joint articular surface kinematics in healthy young and old participants during weight-bearing knee flexion. Twelve healthy male volunteers, six in their 60s and six in their 20s, without any musculoskeletal system disease involving the knees participated. 3D bone models of the femur and tibia were obtained using CT and matched into the fluoroscopic images captured during split squatting. Translation and rotation of the tibia to the femur during weight-bearing flexion were compared between the groups. Translation of the nearest medial-lateral articular surface location and rotational angle of medial-lateral connecting lines were also compared. As the tibial internal-external rotation angle and medial contact point anterior-posterior translation were significantly correlated between the groups, they could not represent the characteristics of age-related changes. Similar to lateral contact point translation and contact points line angles were significantly different during the initial 10° flexion period. At the 40°-45° knee flexion period, a significant difference was detected in the contact point line angle and in the tibial superior-inferior translation. 3D knee joint kinematic differences between participants in their 20s and 60s, especially during initial and 40°-45° periods, can predict kinematic effects on age-related disease.

Variation in Graft Bending Angle During Range of Motion in Single-Bundle Posterior Cruciate Ligament Reconstruction: A 3-Dimensional Computed Tomography Analysis of 2 Techniques

To compare variations in femoral graft bending angle during range of motion (ROM) of the knee between inside-out (IO) and retro-socket outside-in (OI) techniques in posterior cruciate ligament (PCL) reconstruction using invivo 3-dimensional (3D) computed tomography analysis. Ten patients underwent PCL reconstruction by the IO technique (5 patients) or the retro-socket OI technique (5 patients) for suspensory femoral fixation. After PCL reconstruction, 3D computed tomography was performed in 0° extension and 90° flexion to reconstruct 3D femur and tibia bone models using Mimics software. Positions of femur and tibia at 30°, 45°, and 60° flexion were reproduced by determining the kinematic factors of anteroposterior translation, mediolateral translation, and internal-external rotation angle of each patient based on previously measured kinematic data. Variation in graft bending angle according to the flexion range of the knee was calculated by the difference in graft angulation measured at each flexion angle. The results were compared between the 2 techniques. There was significant difference in variation of femoral graft bending angle between IO and retro-socket OI techniques from 0° to 90° flexion of the knee (P= .008). Significant difference was also noticed at 30° to 45° (P= .008), 45° to 60° (P= .008), and 60° to 90° (P= .016) ROM of the knee between the 2 groups. The retro-socket OI technique resulted in less variation in femoral graft bending angle compared with the IO technique during knee ROM. We recommend the retro-socket OI technique for femoral tunnel placement to reduce the graft motion at the intra-articular femoral tunnel aperture. The retro-socket OI technique produces significantly less variation in femoral graft bending angle when compared with the IO technique. Such reduction in variation of femoral graft bending angle might be related to lower stress at the femoral tunnel aperture.

2D-3D registration for 3D analysis of lower limb alignment in a weight-bearing condition

X-ray imaging is the conventional method for diagnosing the orthopedic condition of a patient. Computerized Tomography(CT) scanning is another diagnostic method that provides patient’s 3D anatomical information. However, both methods have limitations when diagnosing the whole leg; X-ray imaging does not provide 3D information, and normal CT scanning cannot be performed with a standing posture. Obtaining 3D data regarding the whole leg in a standing posture is clinically important because it enables 3D analysis in the weight bearing condition. Based on these clinical needs, a hardware-based bi-plane X-ray imaging system has been developed; it uses two orthogonal X-ray images. However, such methods have not been made available in general clinics because of the hight cost. Therefore, we proposed a widely adaptive method for 2D X-ray image and 3D CT scan data. By this method, it is possible to threedimensionally analyze the whole leg in standing posture. The optimal position that generates the most similar image is the captured X-ray image. The algorithm verifies the similarity using the performance of the proposed method by simulation-based experiments. Then, we analyzed the internal-external rotation angle of the femur using real patient data. Approximately 10.55 degrees of internal rotations were found relative to the defined anterior-posterior direction. In this paper, we present a useful registration method using the conventional X-ray image and 3D CT scan data to analyze the whole leg in the weight-bearing condition.

Are knee biomechanics different in those with and without patellofemoral osteoarthritis after anterior cruciate ligament reconstruction?

Patellofemoral (PF) osteoarthritis (OA) is prevalent following anterior cruciate ligament reconstruction (ACLR). This study aimed to investigate differences in transverse plane rotation between knees with varus and valgus alignment during gait in people with and without PFOA after ACLR. Thirty-six individuals who were mean ± SD 9 ± 2 years post-ACLR (18 radiographic PFOA and 18 no knee OA) participated in this cross-sectional study. Knee internal-external rotation angles were measured using a 3-dimensional motion analysis system during walking and running. Weight-bearing frontal plane knee alignment, measured with an inclinometer, was used to classify participants as having varus or valgus alignment. Two-way analysis of covariance was used to assess the effect of both PFOA and frontal plane knee alignment on dynamic knee internal-external rotation. Significant interactions were found between PFOA status and frontal plane alignment on knee internal-external rotation angles during walking (P = 0.019) and running (P = 0.002). Tests of simple effects revealed that during walking, individuals with valgus alignment and PFOA demonstrated a mean 3.9° (95% confidence interval [95% CI] 0.7, 7.1) less knee internal rotation than those with valgus alignment and no OA. During running this difference increased to 6.1° (95% CI 1.8, 10.4). For individuals with varus alignment, no significant effects were observed. Less knee internal rotation during gait was found in individuals with PFOA and valgus alignment. A rotational shift of this magnitude may be sufficient to initiate or accelerate patellofemoral cartilage degeneration. Prospective studies are required to determine if these altered kinematic patterns result from, or contribute to, PFOA development after reconstruction.

Biotribology of a mobile bearing posterior stabilised knee design - Effect of motion restraint on wear, tibio-femoral kinematics and particles

The objective of our study was to evaluate the impact of a biphaseal anterior–posterior (AP) and internal–external (IE) motion restraint system on the wear behaviour, tibio-femoral kinematics and particle release of a mobile bearing posterior stabilised knee design in comparison to the widely used linear restraint.in vitro wear simulation was performed using a posterior stabilised total knee replacement with a mobile rotating platform gliding surface design to compare the standard ISO 14243-1:2002 (E) protocol with a linear AP and IE motion restraint and the new ISO 14243-1:2009 (E) protocol with a biphaseal AP and IE motion restraint.For the mobile gliding surfaces, an increase in wear rate by more than a magnitude was measured applying the biphaseal protocol (8.5±1.6mg/million cycles) in a direct comparison to the linear protocol (0.33±0.07mg/million cycles), with statistically significant difference. The amplitudes of AP displacement were 3.22±0.47mm for the biphaseal test, compared to 1.97±0.22mm in the linear test and the amplitudes of the IE rotation angle had mean values of 7.32°±0.91° under the biphaseal setup, compared to 1.97°±0.14° under linear motion restraint test conditions.From our observations, we conclude that the changes in AP translation and IE rotation motion restraints from ISO linear to ISO biphaseal test conditions highly impact the knee joint kinematics and wear behaviour of a mobile bearing posterior stabilised knee design.

Three dimensional, radiosteriometric analysis (RSA) of equine stifle kinematics and articular surface contact: A cadaveric study

Studies examining the effect of stifle joint angle on tibial rotation, adduction-abduction angle and articular contact area are lacking. To test the hypothesis that tibial rotation, adduction-abduction angle and articular contact area change with stifle joint angle. Descriptive study of normal kinematics and articular contact patterns of the equine stifle through the functional range of motion using 3 dimensional (3D) radiosteriometric analysis (RSA) and equine cadaver stifles. Multiple, radiopaque markers were embedded in the distal femur and proximal tibia and sequential, biplanar x-rays captured as the stifle was passively extended from 110° to full extension. Computer-programmed RSA was used to determine changes in abduction-adduction and internal-external rotation angles of the tibia during stifle extension as well as articular contact patterns (total area and areas of high contact) through the range of motion. The tibia rotated externally (P < 0.001) as the stifle was extended. Tibial abduction occurred from 110-135° of extension (P < 0.001) and tibial adduction occurred from 135° through full extension (P = 0.009). The centre of joint contact moved cranially on both tibial condyles during extension with the lateral moving a greater distance than the medial (P = 0.003). Articular contact area decreased (P = 0.001) in the medial compartment but not in the lateral compartment (P = 0.285) as the stifle was extended. The area of highest joint contact increased on the lateral tibial condyle (P < 0.001) with extension but decreased (P = 0.001) on the medial tibial condyle. Significant changes occur in tibial rotation, adduction-abduction angle and articular contact area of the equine stifle through the functional range of motion. Understanding the normal kinematics of the equine stifle and the relationship between joint positions and articular contact areas may provide important insight into the aetiology and location of common stifle joint pathologies (articular cartilage and meniscal lesions).

Contact Analysis of Knee Prosthesis Using A 3D Mathematical Model (Analysis for PS Type Prosthesis at Level Walking and Ascending Stairs)

The objective of this study is to analyze contact conditions of the posterior stabilizer (PS) type knee prosthesis at level walking and ascending stairs using a 3D mathematical model. Our 3D model made it possible to reproduce comprehensive knee motion, since it included not only the tibiofemoral joint but also the patellofemoral joint. In the model, the forces of major muscles, ligaments and tendons were all taken into account. If we input the data of muscle forces, floor reaction forces and knee flexion angles into the model, then we could determine such variables as the relative positions between the two components, contact points and stresses between the articulating surfaces and valusvalgus and internal-external rotation angles between the tibio-femoral components. Simulation was conducted and the following results were introduced. On the patellofemoral joint, the maximum contact stress at ascending stairs was 2 times higher that that at level walking. On the tibiofemoral joint, the maximum contact stress at ascending stairs was 1.7 times higher that that at level walking. The post/cam contact occurred only at ascending stairs and the contact stress reached as much as 67.1 MPa.

Femoral anatomical frame: assessment of various definitions

The reliability of the estimate of joint kinematic variables and the relevant functional interpretation are affected by the uncertainty with which bony anatomical landmarks and underlying bony segment anatomical frames are determined. When a stereo-photogrammetric system is used for in vivo studies, minimising and compensating for this uncertainty is crucial. This paper deals with the propagation of the errors associated with the location of both internal and palpable femoral anatomical landmarks to the estimation of the orientation of the femoral anatomical frame and to the knee joint angles during movement. Given eight anatomical landmarks, and the precision with which they can be identified experimentally, 12 different rules were defined for the construction of the anatomical frame and submitted to comparative assessment. Results showed that using more than three landmarks allows for more repeatable anatomical frame orientation and knee joint kinematics estimation. Novel rules are proposed that use optimization algorithms. On the average, the femoral frame orientation dispersion had a standard deviation of 2, 2.5 and 1.5 ° for the frontal, transverse, and sagittal plane, respectively. However, a proper choice of the relevant construction rule allowed for a reduction of these inaccuracies in selected planes to 1 ° rms. The dispersion of the knee adduction-abduction and internal-external rotation angles could also be limited to 1 ° rms irrespective of the flexion angle value.