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Research Papers

In Vivo Kinematics of the Extensor Mechanism of the Knee During Deep Flexion

[+] Author and Article Information
Koichi Kobayashi

Bioengineering Lab,
Department of Orthopedic Surgery,
Harvard Medical School/Massachusetts
General Hospital,
Boston, MA 02114;
Department of Health Sciences,
Niigata University School of Medicine,
Niigata, Japan

Ali Hosseini

Bioengineering Lab,
Department of Orthopedic Surgery,
Harvard Medical School/Massachusetts
General Hospital
Boston, MA 02114

Makoto Sakamoto

Department of Health Sciences,
Niigata University School of Medicine,
Niigata, Japan

Guoan Li

e-mail: gli1@partners.org
Bioengineering Lab,
Department of Orthopedic Surgery,
Harvard Medical School/Massachusetts
General Hospital,
Boston, MA 02114

1Corresponding author.

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received June 8, 2012; final manuscript received March 25, 2013; accepted manuscript posted April 22, 2013; published online June 12, 2013. Assoc. Editor: Mohamed Samir Hefzy.

J Biomech Eng 135(8), 081002 (Jun 12, 2013) (7 pages) Paper No: BIO-12-1227; doi: 10.1115/1.4024284 History: Received June 08, 2012; Revised March 25, 2013; Accepted April 22, 2013

While various factors have been assumed to affect knee joint biomechanics, few data have been reported on the function of the extensor mechanism in deep flexion of the knee. This study analyzed the patellofemoral joint contact kinematics and the ratio of the quadriceps and patellar tendon forces in living subjects when they performed a single leg lunge up to 150 deg of flexion. The data revealed that in the proximal-distal direction, the patellofemoral articular contact points were in the central one-third of the patellar cartilage. Beyond 90 deg of flexion, the contact points moved towards the medial-lateral edges of the patellar surface. At low flexion angles, the patellar tendon and quadriceps force ratio was approximately 1.0 but reduced to about 0.7 after 60 deg of knee flexion, implying that the patella tendon carries lower loads than the quadriceps. These data may be valuable for improvement of contemporary surgical treatments of diseased knees that are aimed to achieve deep knee flexion.

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Figures

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Fig. 1

A virtual dual fluoroscopic image system

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Fig. 2

(a) Intersection of the patellar and femoral cartilage models. (b) The coordinate system on the patellar articular surface to determine the patellofemoral contact locations.

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Fig. 3

Definitions of the angle between the quadriceps and the direction of the patellofemoral joint reaction force (θQF) and the angle between the patellar tendon and the direction of the patellofemoral joint reaction force (θPF)

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Fig. 4

Definitions of the contact position angle (α) and the notch angle (β)

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Fig. 5

Average locations of the contact points of the seven subjects on the surface of the patellar cartilage at different flexion angles. The data of each subject were normalized to the proximal-distal and medial-lateral dimensions of its patella. The contact started to separate on medial-lateral facets beyond 90 deg of knee flexion.

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Fig. 6

The contact position angle and the notch angle. The contact position angle monotonically increased as the knee flexed.

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Fig. 7

(a) The angle between the quadriceps and the direction of the patellofemoral joint reaction force. (b) The angle between the patellar tendon and the direction of the patellofemoral joint reaction force.

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Fig. 8

The ratio of the patellar tendon and the quadriceps forces. At 15 deg of knee flexion, the patellar tendon and quadriceps have similar forces. Beyond 60 deg, the patellar tendon carries about 70% of the forces of that in the quadriceps.

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