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Gesture and Posture As Important Factors in
3D Kinematic Assessment of the Knee Lavoie F1, Laplante M2, Parent G1, Duval N1,3,
Doré S1,2, de Guise J1,2
1. Laboratoire de recherche en imagerie en orthopédie du CRCHUM (LIO)
2. École de Technologie Supérieure (ÉTS)3. Pavillon des Charmilles
Introduction
Accurate 3D kinematic assessment combined with computer-assisted surgery will bring a whole new dimension to knee arthroplasty and ligament reconstruction
• Diagnosis and surgical indications
• Surgical technique
• Follow-up
Current problem
Three-dimensional kinematics of the normal knee are still ill-defined
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Flexion (degrees)
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•Differences between studies
•Differences between subjects of the same studies
Possible causes of kinematic differences between subjects and between studies
Artefact motionSkin-bone movement (up to 1 cm, Sati et al. 1996)Invasive methods not appliable to large populations
(Lafortune et al. 1992, Ishii et al. 1997)
Analysis of the movement recordedAxes system position (Marin et al. 2003)
Different Gesture = Different Movement?
Hypothesis
Knee kinematics are altered by the gesture accomplished when it is recorded
Knee-bend Standardizer
Knee-bend Standardizer
Purposes:Control the movement of the trunk along a fixed axis
Control the position of the feet
Rotation, DF/PF, AP position, Width
Allow to test in different predetermined positions
Weight-bearing normal, increased or decreased
Previous Findings
• Knee-bend standardization increases kinematic reproducibility
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Ascent phase Descent phase Ascent phase Descent phase
Tibial rotation Abduction/ adduction
CM
C
Unconstrained knee-bends
Wall-sliding knee-bends
Standardized knee-bends
Previous Findings
• Knee-bend standardization decreases between-subject kinematic variability
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Standardized Knee-bends Unconstrained Knee-bends
Objective of this Study
Evaluate the impact of different gesture parameters on measured knee kinematics:
Foot rotation Hip rotation
Knee excursionFoot A-P positionAnkle flexionWeight-bearingSpeed
Materials and Method
17 male participantsAvg 25.5 y.o. (21-30)No lower limb pathology
Optotrak position sensorsmounted on special harness
purpose: minimizing mvt between sensors and bone, allowing assessment of axial rotation at the knee
ref. Sati et al. 1996, Ganjika et al. 2000
Harness
Materials and Method
13 squat series for each subject
0-60 degrees of flexion
20 seconds recording
Speed controled
Left knee kinematics recorded
8 gesture parameters tested
Standard Gesture
Knee excursion
Knee In Knee Out
Foot Rotation
30 degreesinternal rotation
30 degreesexternal rotation
Hip Rotation
Ankle Flexion
30 degrees plantiflexion 10 degrees dorsiflexion
Foot A-P Position
Feet advanced (70% of femur length)
Ref.: Kvist et al. 2001
Load-bearing
25% weight increase
Ref.: Yack et al. 1994
25% weight decrease
Speed of gesture
Standard gesture: 2 seconds for each cycle
Slow gesture: 4 seconds for each cycle
Fast gesture: 1 second for each cycle
Analysis
3D Kinematics analyzed as rotationsTibial rotation vs Knee flexionLeg abduction/adduction vs Knee flexion
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Analysis
Comparison each gesture condition with standard gesture
Comparison with inverse gesture conditione.g. Slow pace vs Fast pace
Average of the differences were calculated
Results
Impact of Knee Excursion on Knee Kinematics
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Ex
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Knees Projected Inwards Standard Gesture Knees Projected Outwards
Impact of Foot Rotation on Knee Kinematics
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0 20 40 60 80Knee Flexion (degrees)
Tib
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xter
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External Rotation Standard Gesture Internal Rotation
Impact of Hip Rotation on Knee Kinematics
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0 20 40 60 80
Knee Flexion (degrees)
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Hips Externally Rotated Standard Gesture
Average Kinematic Differences Between Gesture Conditions
Gesture Parameter
ComparisonTranslations (mm) Rotations (degrees)
AP ML PD AdductionExternal Rotation
Knee excursion
Knee In vs Knee Out 1.37 -1.75 0.12 -1.68 4.70
Knee In 0.69 -0.85 0.33 -0.48 3.12
Knee Out -0.49 0.93 0.02 1.19 -1.31
Hip rotation External Rotation (Knee Neutral) 0.59 -0.02 -0.94 2.18 5.38
Foot rotation
External Rotation (Knee Neutral) vs External Rotation (Knee-In)
2.12 -2.34 -0.08 -1.26 6.16
External Rotation (Knee In) vs Internal Rotation
4.73 -2.75 -2.44 1.02 16.01
External Rotation (Knee In) 2.71 -1.95 -0.75 0.92 10.96
Internal Rotation -1.82 0.88 1.29 -0.17 -5.25
= Statistically Significant
= Scientifically Significant (>2mm or >2degrees)
Average Kinematic Differences Between Gesture Conditions
Gesture Parameter
ComparisonTranslations (mm) Rotations (degrees)
AP ML PD AdductionExternal Rotation
Knee excursion
Knee In vs Knee Out 1.37 -1.75 0.12 -1.68 4.70
Knee In 0.69 -0.85 0.33 -0.48 3.12
Knee Out -0.49 0.93 0.02 1.19 -1.31
Hip rotation External Rotation (Knee Neutral) 0.59 -0.02 -0.94 2.18 5.38
Foot rotation
External Rotation (Knee Neutral) vs External Rotation (Knee-In)
2.12 -2.34 -0.08 -1.26 6.16
External Rotation (Knee In) vs Internal Rotation
4.73 -2.75 -2.44 1.02 16.01
External Rotation (Knee In) 2.71 -1.95 -0.75 0.92 10.96
Internal Rotation -1.82 0.88 1.29 -0.17 -5.25
= Statistically Significant
= Scientifically Significant (>2mm or >2degrees)
Average Kinematic Differences Between Gesture Conditions
Gesture Parameter
ComparisonTranslations (mm) Rotations (degrees)
AP ML PD AdductionExternal Rotation
Knee excursion
Knee In vs Knee Out 1.37 -1.75 0.12 -1.68 4.70
Knee In 0.69 -0.85 0.33 -0.48 3.12
Knee Out -0.49 0.93 0.02 1.19 -1.31
Hip rotation External Rotation (Knee Neutral) 0.59 -0.02 -0.94 2.18 5.38
Foot rotation
External Rotation (Knee Neutral) vs External Rotation (Knee-In)
2.12 -2.34 -0.08 -1.26 6.16
External Rotation (Knee In) vs Internal Rotation
4.73 -2.75 -2.44 1.02 16.01
External Rotation (Knee In) 2.71 -1.95 -0.75 0.92 10.96
Internal Rotation -1.82 0.88 1.29 -0.17 -5.25
= Statistically Significant
= Scientifically Significant (>2mm or >2degrees)
Average Kinematic Differences Between Gesture Conditions
Gesture Parameter
ComparisonTranslations (mm) Rotations (degrees)
AP ML PD AdductionExternal Rotation
Knee excursion
Knee In vs Knee Out 1.37 -1.75 0.12 -1.68 4.70
Knee In 0.69 -0.85 0.33 -0.48 3.12
Knee Out -0.49 0.93 0.02 1.19 -1.31
Hip rotation External Rotation (Knee Neutral) 0.59 -0.02 -0.94 2.18 5.38
Foot rotation
External Rotation (Knee Neutral) vs External Rotation (Knee-In)
2.12 -2.34 -0.08 -1.26 6.16
External Rotation (Knee In) vs Internal Rotation
4.73 -2.75 -2.44 1.02 16.01
External Rotation (Knee In) 2.71 -1.95 -0.75 0.92 10.96
Internal Rotation -1.82 0.88 1.29 -0.17 -5.25
= Statistically Significant
= Scientifically Significant (>2mm or >2degrees)
Discussion
In the studied population, no significant effect found for:
Foot A-P positionAnkle flexionWeight-bearingSpeed
Discussion
Current studies of knee kinematics during a knee bend gesture don’t control for foot position, knee excursion and hip rotation
Our results show that these parameters affect knee kinematics
> 15 degrees of impact on tibial rotation for a ROM of 5-10 degrees
Conclusion
Gesture needs to be controled in kinematic studies of the knee:
Better reproducibility
Comparisons between studies
Follow-up comparisons
Financial Help
IRSC (Programme MENTOR) Fondation de Recherche et d’Éducation en Orthopédie
de Montréal (FRÉOM) Département de Chirurgie de l’Université de Montréal
CRSNGFonds Québécois pour la Recherche Nature et
Technologie (FQRNT)Chaire de recherche du Canada
Future Directions
Characterization of normal knee kinematicsAxes system
Residual skin movement
ACL-deficient participants:Kinematic effect of injury
Impact of ACL reconstruction on knee kinematics