Research Papers

Asymmetric Varus and Valgus Stability of the Anatomic Cadaver Knee and the Load Sharing Between Collateral Ligaments and Bearing Surfaces

[+] Author and Article Information
Xiaonan Wang

Physiology, Biophysics,
and Systems Biology Program,
Weill Cornell Graduate School
of Medical Sciences,
Hospital for Special Surgery,
New York, NY 10021

Aamer Malik, Thomas L. Wickiewicz

Department of Orthopaedic Surgery,
Hospital for Special Surgery,
New York, NY 10021

Donald L. Bartel

Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021

Timothy Wright

Department of Biomechanics,
Hospital for Special Surgery,
New York, NY 10021
e-mail: wrightt@hss.edu

1Corresponding author.

Manuscript received June 25, 2013; final manuscript received April 20, 2014; accepted manuscript posted May 14, 2014; published online June 3, 2014. Assoc. Editor: Tammy L. Haut Donahue.

J Biomech Eng 136(8), 081005 (Jun 03, 2014) (6 pages) Paper No: BIO-13-1278; doi: 10.1115/1.4027662 History: Received June 25, 2013; Revised April 20, 2014; Accepted May 14, 2014

Knee joint stability is important in maintaining normal joint motion during activities of daily living. Joint instability not only disrupts normal motion but also plays a crucial role in the initiation and progression of osteoarthritis. Our goal was to examine knee joint coronal plane stability under varus or valgus loading and to understand the relative contributions of the mechanisms that act to stabilize the knee in response to varus–valgus moments, namely, load distribution between the medial and lateral condyles and the ligaments. A robot testing system was used to determine joint stability in human cadaveric knees as described by the moment versus angular rotation behavior under varus and valgus loads at extension and at 30 deg and 90 deg of flexion. The anatomic knee joint was more stable in response to valgus than varus moments, and stability decreased with flexion angle. The primary mechanism for providing varus–valgus stability was the redistribution of the contact force on the articular surfaces from both condyles to a single condyle. Stretching of the collateral ligaments provided a secondary stabilizing mechanism after the lift-off of a condyle occurred. Compressive loads applied across the knee joint, such as would occur with the application of muscle forces, enhanced the ability of the articular surface to provide varus–valgus moment, and thus, helped stabilize the joint in the coronal plane. Coupled internal/external rotations and anteroposterior and medial–lateral translations were variable and in the case of the rotations were often as large as the varus–valgus rotations created by the applied moment.

Copyright © 2014 by ASME
Your Session has timed out. Please sign back in to continue.


Bendjaballah, M. Z., Shirazi-Adl, A., and Zukor, D. J., 1997, “Finite Element Analysis of Human Knee Joint in Varus-Valgus,” Clin. Biomech. Bristol, UK, 12(3), pp. 139–148. [CrossRef]
Andriacchi, T. P., Sharma, L., Hurwitz, D. E., Thonar, E. I., Sum, J. A., Lenz, M. E., Dunlop, D. D., Schnitzer, T. J., and Kirwan-Mellis, G., 1981, “Knee Adduction Moment, Serum Hyaluronic Acid Level, and Disease Severity in Medial Tibiofemoral Osteoarthritis,” Arthritis Rheum., 41, pp. 1233–1240. [CrossRef]
Buchanan, T. S., and Lloyd, D. G., 1996, “A Model of Load Sharing Between Muscles and Soft Tissues at the Human Knee During Static Tasks,” ASME J. Biomech. Eng., 118(4), pp. 367–376. [CrossRef]
Brown, T. D., Tochigi, Y., Vaseenon, T., Heiner, A. D., Fredericks, D. C., Martin, J. A., Rudert, M. J., Hillis, S. L., and Mckinley, T. O., 2011, “Instability Dependency of Osteoarthritis Development in a Rabbit Model of Graded Anterior Cruciate Ligament Transaction,” J. Bone Joint Surg. Am., 93, pp. 640–647. [CrossRef]
Burstein, A. H., and Wright, T. M., 1994, Fundamentals of Orthopaedic Biomechanics, Williams & Wilkins, Baltimore, pp. 73–86.
Markolf, K. L., Bargar, W. L., Shoemaker, S. C., and Amstutz, H. C., 1981, “The Role of Joint Load in Knee Stability,” J. Bone Joint Surg. Am., 63, pp. 570–585.
Wilson, W. T., Deakin, A. H., Payne, A. P., Picard, F., and Wearing, S. C., 2012, “Comparative Analysis of the Structural Properties of the Collateral Ligaments of the Human Knee,” J. Orthop. Sports Phys. Ther., 42, pp. 345–351. [CrossRef]
Robinson, J. R., Bull, A. M., and Amis, A. A., 2005, “Structural Properties of the Medial Collateral Ligament Complex of the Human Knee,” J. Biomech., 38, pp. 1067–1074. [CrossRef]
Wijdicks, C. A., Ewart, D. T., Nuckley, D. J., Johansen, S., Engebretsen, L., and Laprade, R. F., 2010, “Structural Properties of the Primary Medial Knee Ligaments,” Am. J. Sports Med., 38, pp. 1638–1646. [CrossRef]
LaPrade, R. F., Engebretsen, A. H., Ly, T. V., Johansen, S., Wentorf, F. A., and Engebretsen, L., 2007, “The Anatomy of the Medial Part of the Knee,” J. Bone Joint Surg. Am., 89, pp. 2000–2010. [CrossRef]
LaPrade, R. F., Bollom, T. S., Wentorf, F. A., Wills, N. J., and Meister, K., 2005, “Mechanical Properties of the Posterolateral Structures of the Knee,” Am. J. Sports Med., 33, pp. 1386–1391. [CrossRef]
LaPrade, R. F., Morgan, P. M., Wentorf, F. A., Johansen, S., and Engebretsen, L., 2007, “The Anatomy of the Posterior Aspect of the Knee—An Anatomic Study,” J. Bone Joint Surg. Am., 89, pp. 758–764. [CrossRef]
Dye, S. F., 2001, “Functional Morphologic Features of the Human Knee: An Evolutionary Perspective,” Clin. Orthop. Relat. Res., 410, pp. 19–24. [CrossRef]
Shultz, S. J., Shimokochi, Y., Nguyen, A. D., Schmitz, R. J., Beynnon, B. D., and Perrin, D. H., 2007, “Measurement of Varus-Valgus and Internal-External Rotational Knee Laxities in Vivo—Part II: Relationship With Anterior-Posterior and General Joint Laxity in Males and Females,” J. Orthop. Res., 25, pp. 989–996. [CrossRef]
Fujie, H., Livesay, G. A., Fujita, M., and Woo, S. L., 1996, “Forces and Moments in Six DOF at the Human Knee Joint: Mathematical Description for Control,” J. Biomech., 29, pp. 1577–1585. [CrossRef]
Imhauser, C., Mauro, C., Choi, D., Rosenberg, E., Mathew, S., Nguyen, J., Ma, Y., and Wickiewicz, T., 2013, “Abnormal Tibiofemoral Contact Stress and its Association With Altered Kinematics After Center-Center Anterior Cruciate Ligament Reconstruction: An in Vitro Study,” Am. J. Sports Med., 41, pp. 815–825. [CrossRef]
Grood, E. S., and Sunday, W. J., 1983, “A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee,” ASME J. Biomech. Eng., 105(2), pp. 136–144. [CrossRef]
Andriacchi, T. P., Mündermann, A., Dyrby, C. O., D'Lima, D. D., and Colwell, C. W., Jr., 2008, “In Vivo Knee Loading Characteristics During Activities of Daily Living as Measured by an Instrumented Total Knee Replacement,” J. Orthop. Res., 26, pp. 1167–1172. [CrossRef]
Heinlein, B., Kutzner, I., Graichen, F., Bender, A., Rohlmann, A., Halder, A. M., Beier, A., and Bergmann, G., 2009, “Complete Data of Total Knee Replacement Loading for Level Walking and Stair Climbing Measured In Vivo With a Follow-Up of 6–10 Months,” Clin. Biomech., 24, pp. 315–326. [CrossRef]
Sugar, D. A., Hurwitz, D. E., Sumner, D. R., and Andriacchi, T. P., 1998, “Dynamic Knee Loads During Gait Predict Proximal Tibial Bone Distribution,” J. Biomech., 31, pp. 423–430. [CrossRef]
Li, G., Varadarajan, K. M., Moynihan, A. L., D'Lima, D., and Colwell, C. W., 2008, “In Vivo Contact Kinematics and Contact Forces of the Knee After Total Knee Arthroplasty During Dynamic Weight-Bearing Activities,” J. Biomech., 41, pp. 2159–2168. [CrossRef]
Bogert, A. J., Barsoum, W. K., Lee, H. H., Murray, T. G., Golbrunn, R., Klika, A. K., and Sutler, S., 2011, “Robotic Testing of Proximal Tibio-Fibular Joint Kinematics for Measuring Instability Following Total Knee Arthroplasty,” J. Orthop. Res., 29, pp. 47–52. [CrossRef]
Woo, S. L., Debski, R. E., Withrow, J. D., and Janaushek, M. A., 1999, “Biomechanics of Knee Ligaments,” Am. J. Sports Med., 27, pp. 533–543.
Gardiner, J. C., Weiss, J. A., and Rosenberg, T. D., 2001, “Strain in the Human Medial Collateral Ligament During Valgus Loading of the Knee,” Clin. Orthop. Relat. Res., 391, pp. 266–274. [CrossRef]
Li, G., DeFrate, L. E., Zayontz, S., Park, S. E., and Gill, T. J., 2004, “The Effect of Tibiofemoral Joint Kinematics on Patellofemoral Contact Pressures Under Simulated Muscle Loads,” J. Orthop. Res., 22, pp. 801–806. [CrossRef]


Grahic Jump Location
Fig. 1

Robot testing system. (a) Robotic arm and the load cell. (b) Digitizer, and (c) Digitization points and tibial and femoral coordinate systems.

Grahic Jump Location
Fig. 2

(a) Schema of a moment versus angular rotation curve of the intact knee joint describing the initial high stiffness region, intermediate low stiffness region, and final high stiffness region that occurred as the applied moment increased. (b) A typical curve of one of the specimens at full extension.

Grahic Jump Location
Fig. 3

Average angular rotations under 200 N compression and 10 N m varus and valgus moment at 0 deg, 30 deg, and 90 deg of flexion (n = 11)

Grahic Jump Location
Fig. 4.

Average (±standard deviation) of load sharing on the articular surfaces and the ligaments (n = 7) at 10 N m moment with 200 N compression. (a) At 0 deg of flexion; (b) at 30 deg of flexion, and (c) at 90 deg of flexion.

Grahic Jump Location
Fig. 5

(a) Varus and valgus stability of intact cadaver knees with 200 N and 10 N compressive load. The target moments were 10 N m and 6 N m, respectively (n = 7). (b) The averages (±standard deviation) for angular rotation at the 6 N m moment with different compression forces across the joint at full extension (n = 11). (c) Average load sharing at 6 N m moment with 200 N and 10 N compression.




Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In