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There are isoheight points that measure constant femoral condyle heights along the knee flexion path

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

It is a challenge to evaluate the maintenance of medial and lateral soft tissue balance in total knee arthroplasty (TKA). This study aimed to determine the “isoheight” points and the “isoheight” axis (IHA) that can measure constant medial/lateral condyle heights during flexion of the knee, and compare the IHA with two major anatomical axes, the transepicondylar axis (TEA) and the geometric center axis (GCA).

Methods

Twenty-two healthy human knees were imaged using a combined MRI and dual fluoroscopic imaging system while performing a single-legged lunge (0°–120°). The isoheight points of the medial and lateral femoral condyles were defined as the locations with the least amount of changes in heights during the knee flexion; an IHA is the line connecting the medial and lateral isoheight points. The measured changes of the condyle heights using the IHA were compared with those measured using the TEA and GCA.

Results

Overall, the IHA was posterior and distal to the TEA, and anterior to the GCA. The isoheight points measured condyle height changes within 1.2 ± 2.3 mm at the medial and 0.7 ± 3.3 mm at the lateral sides during the knee flexion. Between 0° and 45°, the condyle height changes measured using the GCA (medial: 3.0 ± 1.8 mm, lateral: 2.3 ± 2.0 mm) were significantly larger than those of the IHA and the TEA (p < 0.05). Between 90° and 120°, the changes of the condyle heights measured using the TEA (medial: 5.3 ± 1.8 mm, lateral: 3.3 ± 1.8 mm) were significantly larger than those of the IHA and GCA (p < 0.05).

Conclusion

There are isoheight points in the medial and lateral femoral condyles that can measure constant heights along the full range of knee flexion and could be used to formulate an “isoheight” axis (IHA) of the femur. The condyle height changes measured by the TEA and GCA were greater than the IHA measurements along the flexion path. These data could be used as a valuable reference to evaluate the condyle height changes after TKA surgeries and help achieve soft tissue balance and optimal knee kinematics along the flexion path.

Level of evidence

IV.

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Acknowledgements

We are grateful for the financial support of the National Institutes of Health (R01AR055612) and the Department of Orthopaedic Surgery at Newton-Wellesley Hospital.

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Authors and Affiliations

  1. Orthopaedic Bioengineering Research Center, Newton-Wellesley Hospital, 159 Wells Ave, Newton Centre, Newton, MA, 02459, USA

    Zhitao Rao, Chaochao Zhou, Qidong Zhang, Willem A. Kernkamp, Jianping Wang, Timothy E. Foster, Hany S. Bedair & Guoan Li

  2. Department of Orthopedics, Tongji Hospital, Tongji University School of Medicine, Shanghai, People’s Republic of China

    Zhitao Rao & Liming Cheng

  3. Department of Orthopaedics, China-Japan Friendship Hospital, Beijing, People’s Republic of China

    Qidong Zhang

  4. Department of Orthopedic Surgery, Newton-Wellesley Hospital/Harvard Medical School, Newton, MA, USA

    Timothy E. Foster, Hany S. Bedair & Guoan Li

  5. Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA

    Zhitao Rao, Chaochao Zhou, Qidong Zhang & Hany S. Bedair

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  1. Zhitao Rao
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Correspondence to Guoan Li.

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The authors declare that there is no conflict of interest.

Funding

This study was supported by a single funding: Funding source: National Institutes of Health, USA; Grant number: R01AR055612; Recipient: Guoan Li.

Ethical approval

This study was approved by our institutional review board (protocol number: 2003P000337/PHS).

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Written consent was obtained from each subject prior to participating in this study.

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Rao, Z., Zhou, C., Zhang, Q. et al. There are isoheight points that measure constant femoral condyle heights along the knee flexion path. Knee Surg Sports Traumatol Arthrosc 29, 600–607 (2021). https://doi.org/10.1007/s00167-020-05990-x

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  • DOI: https://doi.org/10.1007/s00167-020-05990-x

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