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Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°

  • Anna Hirschmann
  • Florian M. Buck
  • Ramin Herschel
  • Christian W. A. Pfirrmann
  • Sandro F. Fucentese
Knee
  • 440 Downloads

Abstract

Purpose

To prospectively compare patellofemoral and tibiofemoral articulations in the upright weight-bearing position with different degrees of flexion using CT in order to gain a more thorough understanding of the development of diseases of the knee joint in a physiological position.

Materials and methods

CT scans of the knee in 0°, 30°, 60° flexion in the upright weight-bearing position and in 120° flexion upright without weight-bearing were obtained of 10 volunteers (mean age 33.7 ± 6.1 years; range 24–41) using a cone-beam extremity-CT. Two independent readers quantified tibiofemoral and patellofemoral rotation, tibial tuberosity–trochlear groove distance (TTTG) and patellofemoral distance. Tibiofemoral contact points were assessed in relation to the anteroposterior distance of the tibial plateau. Significant differences between degrees of flexion were sought using Wilcoxon signed-rank test (P < 0.05).

Results

With higher degrees of flexion, internal tibiofemoral rotation increased (0°/120° flexion; mean, 0.5° ± 4.5/22.4° ± 7.6); external patellofemoral rotation decreased (10.6° ± 7.6/1.6° ± 4.2); TTTG decreased (11.1 mm ±3.7/−2.4 mm ±6.4) and patellofemoral distance decreased (38.7 mm ±3.0/21.0 mm ±7.0). The CP shifted posterior, more pronounced laterally. Significant differences were found for all measurements at all degrees of flexion (P = 0.005–0.037), except between 30° and 60°. ICC was almost perfect (0.80–0.99), except for the assessment of the CP (0.20–0.96).

Conclusion

Knee joint articulations change significantly during flexion using upright weight-bearing CT. Progressive internal tibiofemoral rotation leads to a decrease in the TTTG and a posterior shift of the contact points in higher degrees of flexion. This elucidates patellar malalignment predominantly close to extension and meniscal tears commonly affecting the posterior horns.

Keywords

Upright weight-bearing CT Weight-bearing knee joint alignment Patellofemoral Tibiofemoral Contact point 

Notes

Compliance with ethical standards

Conflict of interest

No potential conflicts of interest to disclose.

References

  1. 1.
    Amis AA, Firer P, Mountney J, Senavongse W, Thomas NP (2003) Anatomy and biomechanics of the medial patellofemoral ligament. Knee 10(3):215–220CrossRefPubMedGoogle Scholar
  2. 2.
    Camathias C, Pagenstert G, Stutz U, Barg A, Muller-Gerbl M, Nowakowski AM (2015) The effect of knee flexion and rotation on the tibial tuberosity-trochlear groove distance. Knee Surg Sports Traumatol Arthrosc. doi: 10.1007/s00167-015-3508-9 Google Scholar
  3. 3.
    Dejour H (1972) Posttraumatic laxity of the knee. Long-standing laxity. Physiopathology of chronic laxity of the knee. Rev Chir Orthop Reparatrice Appar Mot 58(Suppl 1):61–70Google Scholar
  4. 4.
    Dejour H, Walch G, Nove-Josserand L, Guier C (1994) Factors of patellar instability: an anatomic radiographic study. Knee Surg Sports Traumatol Arthrosc 2(1):19–26CrossRefPubMedGoogle Scholar
  5. 5.
    Delgado-Martinez AD, Rodriguez-Merchan EC, Ballesteros R, Luna JD (2000) Reproducibility of patellofemoral CT scan measurements. Int Orthop 24(1):5–8CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Dietrich TJ, Betz M, Pfirrmann CW, Koch PP, Fucentese SF (2014) End-stage extension of the knee and its influence on tibial tuberosity-trochlear groove distance (TTTG) in asymptomatic volunteers. Knee Surg Sports Traumatol Arthrosc 22(1):214–218CrossRefPubMedGoogle Scholar
  7. 7.
    Draper CE, Besier TF, Fredericson M, Santos JM, Beaupre GS, Delp SL, Gold GE (2011) Differences in patellofemoral kinematics between weight-bearing and non-weight-bearing conditions in patients with patellofemoral pain. J Orthop Res 29(3):312–317CrossRefPubMedGoogle Scholar
  8. 8.
    Feng Y et al (2015) Motion of the femoral condyles in flexion and extension during a continuous lunge. J Orthop Res 33(4):591–597CrossRefPubMedGoogle Scholar
  9. 9.
    Freeman MA, Pinskerova V (2005) The movement of the normal tibio-femoral joint. J Biomech 38(2):197–208CrossRefPubMedGoogle Scholar
  10. 10.
    Hamai S, Moro-oka TA, Dunbar NJ, Miura H, Iwamoto Y, Banks SA (2013) In vivo healthy knee kinematics during dynamic full flexion. Biomed Res Int 2013:717546Google Scholar
  11. 11.
    Heegaard J, Leyvraz PF, Curnier A, Rakotomanana L, Huiskes R (1995) The biomechanics of the human patella during passive knee flexion. J Biomech 28(11):1265–1279CrossRefPubMedGoogle Scholar
  12. 12.
    Hirschmann A, Buck FM, Fucentese SF, Pfirrmann CW (2015) Upright CT of the knee: the effect of weight-bearing on joint alignment. Eur Radiol 25(11):3398–3404CrossRefPubMedGoogle Scholar
  13. 13.
    Hirschmann A, Pfirrmann CW, Klammer G, Espinosa N, Buck FM (2014) Upright cone CT of the hindfoot: comparison of the non-weight-bearing with the upright weight-bearing position. Eur Radiol 24(3):553–558CrossRefPubMedGoogle Scholar
  14. 14.
    Iranpour F, Merican AM, Baena FR, Cobb JP, Amis AA (2010) Patellofemoral joint kinematics: the circular path of the patella around the trochlear axis. J Orthop Res 28(5):589–594PubMedGoogle Scholar
  15. 15.
    Izadpanah K, Weitzel E, Vicari M, Hennig J, Weigel M, Sudkamp NP, Niemeyer P (2014) Influence of knee flexion angle and weight bearing on the Tibial Tuberosity-Trochlear Groove (TTTG) distance for evaluation of patellofemoral alignment. Knee Surg Sports Traumatol Arthrosc 22(11):2655–2661CrossRefPubMedGoogle Scholar
  16. 16.
    Lin YF, Jan MH, Lin DH, Cheng CK (2008) Different effects of femoral and tibial rotation on the different measurements of patella tilting: an axial computed tomography study. J Orthop Surg Res 3:5CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    MacIntyre NJ, Hill NA, Fellows RA, Ellis RE, Wilson DR (2006) Patellofemoral joint kinematics in individuals with and without patellofemoral pain syndrome. J Bone Joint Surg Am 88(12):2596–2605PubMedGoogle Scholar
  18. 18.
    Miyanishi K, Nagamine R, Murayama S, Miura H, Urabe K, Matsuda S, Hirata G, Iwamoto Y (2000) Tibial tubercle malposition in patellar joint instability: a computed tomography study in full extension and at 30 degree flexion. Acta Orthop Scand 71(3):286–291CrossRefPubMedGoogle Scholar
  19. 19.
    Muhle C, Brossmann J, Heller M (1999) Kinematic CT and MR imaging of the patellofemoral joint. Eur Radiol 9(3):508–518CrossRefPubMedGoogle Scholar
  20. 20.
    Mueller W (1983) The knee: form, function, and ligament reconstruction. Springer, Berlin, pp 53–62CrossRefGoogle Scholar
  21. 21.
    Nha KW, Papannagari R, Gill TJ, Van de Velde SK, Freiberg AA, Rubash HE, Li G (2008) In vivo patellar tracking: clinical motions and patellofemoral indices. J Orthop Res 26(8):1067–1074CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Patel VV, Hall K, Ries M, Lindsey C, Ozhinsky E, Lu Y, Majumdar S (2003) Magnetic resonance imaging of patellofemoral kinematics with weight-bearing. J Bone Joint Surg Am 85-A(12):2419–2424CrossRefPubMedGoogle Scholar
  23. 23.
    Pinskerova V, Johal P, Nakagawa S, Sosna A, Williams A, Gedroyc W, Freeman MA (2004) Does the femur roll-back with flexion? J Bone Joint Surg Br 86(6):925–931CrossRefPubMedGoogle Scholar
  24. 24.
    Powers CM, Shellock FG, Pfaff M (1998) Quantification of patellar tracking using kinematic MRI. J Magn Reson Imaging 8(3):724–732CrossRefPubMedGoogle Scholar
  25. 25.
    Powers CM, Ward SR, Fredericson M, Guillet M, Shellock FG (2003) Patellofemoral kinematics during weight-bearing and non-weight-bearing knee extension in persons with lateral subluxation of the patella: a preliminary study. J Orthop Sports Phys Ther 33(11):677–685CrossRefPubMedGoogle Scholar
  26. 26.
    Qi W, Hosseini A, Tsai TY, Li JS, Rubash HE, Li G (2013) In vivo kinematics of the knee during weight bearing high flexion. J Biomech 46(9):1576–1582CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Rosner B (2011) The intraclass correlation coefficient. In: Rosner B (ed) Fundamentals of biostatistics, 7th edn. Brooks/Cole, Cengage Learning, Boston, pp 568–571Google Scholar
  28. 28.
    Schoettle PB, Zanetti M, Seifert B, Pfirrmann CW, Fucentese SF, Romero J (2006) The tibial tuberosity-trochlear groove distance; a comparative study between CT and MRI scanning. Knee 13(1):26–31CrossRefPubMedGoogle Scholar
  29. 29.
    Seitlinger G, Scheurecker G, Hogler R, Labey L, Innocenti B, Hofmann S (2014) The position of the tibia tubercle in 0 degrees −90 degrees flexion: comparing patients with patella dislocation to healthy volunteers. Knee Surg Sports Traumatol Arthrosc 22(10):2396–2400CrossRefPubMedGoogle Scholar
  30. 30.
    Souza RB, Draper CE, Fredericson M, Powers CM (2010) Femur rotation and patellofemoral joint kinematics: a weight-bearing magnetic resonance imaging analysis. J Orthop Sports Phys Ther 40(5):277–285CrossRefPubMedGoogle Scholar
  31. 31.
    Tanaka MJ, Elias JJ, Williams AA, Carrino JA, Cosgarea AJ (2015) Correlation between changes in tibial tuberosity-trochlear groove distance and patellar position during active knee extension on dynamic kinematic computed tomographic imaging. Arthroscopy. doi: 10.1016/j.arthro.2015.03.015 Google Scholar
  32. 32.
    Tecklenburg K, Feller JA, Whitehead TS, Webster KE, Elzarka A (2010) Outcome of surgery for recurrent patellar dislocation based on the distance of the tibial tuberosity to the trochlear groove. J Bone Joint Surg Br 92(10):1376–1380CrossRefPubMedGoogle Scholar
  33. 33.
    Teng HL, Chen YJ, Powers CM (2014) Predictors of patellar alignment during weight bearing: an examination of patellar height and trochlear geometry. Knee 21(1):142–146CrossRefPubMedGoogle Scholar
  34. 34.
    Tennant S, Williams A, Vedi V, Kinmont C, Gedroyc W, Hunt DM (2001) Patello-femoral tracking in the weight-bearing knee: a study of asymptomatic volunteers utilising dynamic magnetic resonance imaging: a preliminary report. Knee Surg Sports Traumatol Arthrosc 9(3):155–162CrossRefPubMedGoogle Scholar
  35. 35.
    Tuominen EK, Kankare J, Koskinen SK, Mattila KT (2013) Weight-bearing CT imaging of the lower extremity. AJR Am J Roentgenol 200(1):146–148CrossRefPubMedGoogle Scholar
  36. 36.
    Vandenneucker H, Labey L, Victor J, Vander Sloten J, Desloovere K, Bellemans J (2014) Patellofemoral arthroplasty influences tibiofemoral kinematics: the effect of patellar thickness. Knee Surg Sports Traumatol Arthrosc 22:2560–2568CrossRefPubMedGoogle Scholar
  37. 37.
    Ward SR, Terk MR, Powers CM (2007) Patella alta: association with patellofemoral alignment and changes in contact area during weight-bearing. J Bone Joint Surg Am 89(8):1749–1755PubMedGoogle Scholar
  38. 38.
    Wunschel M, Leichtle U, Obloh C, Wulker N, Muller O (2011) The effect of different quadriceps loading patterns on tibiofemoral joint kinematics and patellofemoral contact pressure during simulated partial weight-bearing knee flexion. Knee Surg Sports Traumatol Arthrosc 19(7):1099–1106CrossRefPubMedGoogle Scholar

Copyright information

© European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2015

Authors and Affiliations

  • Anna Hirschmann
    • 1
    • 3
  • Florian M. Buck
    • 1
  • Ramin Herschel
    • 2
  • Christian W. A. Pfirrmann
    • 1
  • Sandro F. Fucentese
    • 2
  1. 1.Department of Radiology, Orthopedic University Hospital BalgristUniversity of ZurichZurichSwitzerland
  2. 2.Department of Orthopedic Surgery, Orthopedic University Hospital BalgristUniversity of ZurichZurichSwitzerland
  3. 3.Clinic of Radiology and Nuclear MedicineUniversity of Basel HospitalBaselSwitzerland

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