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TECHNICAL BRIEFS

The Coupled Motion of the Femur and Patella During In Vivo Weightbearing Knee Flexion

[+] Author and Article Information
Guoan Li1

 Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114gli1@partners.org

Ramprasad Papannagari, Thomas J. Gill, Harry E. Rubash

 Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114

Kyung Wook Nha

Department of Orthopaedic Surgery, Inje University and Ilsan Paik Hospital, 2240 Daehwa-dong, Ilsanseo-gu, Goyang 411-706, South Korea

Louis E. DeFrate2

 Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114

1

Corresponding author.

2

Present address: Orthopaedic Research Laboratories, Box 3093, Duke University Medical Center, Durham, NC 27710.

J Biomech Eng 129(6), 937-943 (Apr 19, 2007) (7 pages) doi:10.1115/1.2803267 History: Received December 12, 2006; Revised April 19, 2007

The movement of the knee joint consists of a coupled motion between the tibiofemoral and patellofemoral articulations. This study measured the six degrees-of-freedom kinematics of the tibia, femur, and patella using dual-orthogonal fluoroscopy and magnetic resonance imaging. Ten normal knees from ten living subjects were investigated during weightbearing flexion from full extension to maximum flexion. The femoral and the patellar motions were measured relative to the tibia. The femur externally rotated by 12.9deg and the patella tilted laterally by 16.3deg during the full range of knee flexion. Knee flexion was strongly correlated with patellar flexion (R2=0.91), posterior femoral translation was strongly correlated to the posterior patellar translation (R2=0.87), and internal-external rotation of the femur was correlated to patellar tilt (R2=0.73) and medial-lateral patellar translation (R2=0.63). These data quantitatively indicate a kinematic coupling between the tibia, femur, and patella, and provide base line information on normal knee joint kinematics throughout the full range of weightbearing flexion. The data also suggest that the kinematic coupling of tibia, femur, and patella should be considered when investigating patellar pathologies and when developing surgical techniques to treat knee joint diseases.

FIGURES IN THIS ARTICLE
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Copyright © 2007 by American Society of Mechanical Engineers
Topics: Kinematics , Motion , Knee , Rotation
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Figures

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Figure 1

Coordinate systems used to quantify motions of the patella and femur: Femoral coordinate system consisted of TEA and long axis intersecting at the origin of the femur (midpoint of TEA). A box was fitted to patella to determine patellar center. Patellar coordinate system consisted of superior-inferior (SI), anterior-posterior (AP), and medial-lateral (ML) axes. Patellar flexion, lateral shift, lateral tilt, and lateral rotation are considered positive, as shown in the figure.

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Figure 2

A scheme showing the single leg lunge performed by a subject within the dual-orthogonal fluoroscopic system (left) and the in vivo knee positions as a function of flexion (right)

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Figure 3

A virtual dual-orthogonal fluoroscopic system used to reproduce in vivo knee kinematics

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Figure 4

Translations of the femur with respect to the tibial coordinate system: (A) anterior-posterior (AP) translation, (B) medial-lateral (ML) translation, and (C) superior-inferior (SI) translation

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Figure 5

Rotations of the femur with respect to the tibial coordinate system: (A) internal-external (IE) rotation and (B) varus-valgus (VV) rotation

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Figure 6

Translations of the patella with respect to the tibial coordinate system: (A) anterior-posterior (AP) translation, (B) medial-lateral translation (ML), and (C) superior-inferior (SI) translation

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Figure 7

Rotations of the patella with respect to the tibial coordinate system: (A) flexion, (B) tilt, and (C) rotation (F-flexion, E-extension, L-lateral, and M-medial)

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Figure 8

Correlation of the femoral and patellar kinematics with respect to the tibial coordinate system: (A) patellar flexion versus femoral flexion, (B) patellar AP versus femoral AP translation, (C) patellar tilt versus femoral IE rotation, and (D) patellar ML translation versus femoral IE rotation

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