Relationship between varus-valgus alignment and patellar kinematics in individuals with knee osteoarthritis
ABSTRACT Abnormal varus-valgus alignment is a risk factor for patellofemoral osteoarthritis, but tibiofemoral alignment alone does not explain compartmental patellofemoral osteoarthritis progression. Other mechanical factors, such as patellar kinematics, probably play a role in the initiation and progression of the disease. The objective of this study was to determine which three-dimensional patellar kinematic parameters (patellar flexion, spin, and tilt and patellar proximal, lateral, and anterior translation) are associated with varus and valgus alignment in subjects with osteoarthritis.
Ten individuals with knee osteoarthritis and varus (five subjects) or valgus (five subjects) knee alignment underwent assessment of three-dimensional patellar kinematics. We used a validated magnetic resonance imaging-based method to measure three-dimensional patellar kinematics in knee flexion while the subjects pushed against a pedal with constant load (80 N). A linear random-effects model was used to test the null hypothesis that there was no difference in the relationship between tibiofemoral flexion and patellar kinematics between the varus and valgus groups.
Patellar spin was significantly different between groups (p = 0.0096), with the varus group having 2 degrees of constant internal spin and the valgus group having 4.5 degrees of constant external spin. In the varus group, the patellae tracked with a constant medial tilt of 9.6 degrees with flexion, which was significantly different (p = 0.0056) from the increasing medial tilt (at a rate of 1.8 degrees per 10 degrees of increasing knee flexion) in the valgus group. The patellae of the valgus group were 7.5 degrees more extended (p = 0.0093) and positioned 8.8 mm more proximally (p = 0.0155) than the varus group through the range of flexion that was studied. The pattern of anterior translation differed between the groups (p = 0.0011).
Our results suggest that authors of future large-scale studies of the relationships between knee mechanics and patellofemoral osteoarthritis should not rely solely on measurements of tibiofemoral alignment and should assess three-dimensional patellar kinematics directly.
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ABSTRACT: MR-based methods provide low risk, noninvasive assessment of joint kinematics; however, these methods often use static positions or require many identical cycles of movement. The study objective was to compare the 3D kinematic results approximated from a series of sequential static poses of the knee with the 3D kinematic results obtained from continuous dynamic movement of the knee. To accomplish this objective, we compared kinematic data from a validated static MR method to a fast static MR method, and compared kinematic data from both static methods to a newly developed dynamic MR method. Ten normal volunteers were imaged using the three kinematic methods (dynamic, static standard, and static fast). Results showed that the two sets of static results were in agreement, indicating that the sequences (standard and fast) may be used interchangeably. Dynamic kinematic results were significantly different from both static results in eight of 11 kinematic parameters: patellar flexion, patellar tilt, patellar proximal translation, patellar lateral translation, patellar anterior translation, tibial abduction, tibial internal rotation, and tibial anterior translation. Three-dimensional MR kinematics measured from dynamic knee motion are often different from those measured in a static knee at several positions, indicating that dynamic-based kinematics provides information that is not obtainable from static scans. Magn Reson Med, 2012. © 2012 Wiley Periodicals, Inc.Magnetic Resonance in Medicine 06/2013; 69(6). DOI:10.1002/mrm.24425 · 3.40 Impact Factor
- Clinical Rheumatology 03/2013; 32(7). DOI:10.1007/s10067-013-2222-6 · 1.77 Impact Factor
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ABSTRACT: PURPOSE: Lateral radiographic views can be easily taken and have reveal considerable information about the patella. The purpose of this study was to obtain sagittal plane patellar kinematics data through the entire range of knee flexion under weight-bearing conditions. METHODS: Patellar flexion angles relative to the femur and tibia and anterior-posterior and proximal-distal translations of the patella relative to the femur and tibia were measured from 0 to 165° knee flexion in nine healthy knees using dynamic radiographic images. RESULTS: The patella flexed relative to the femur and tibia by two thirds times and one third times the knee flexion angle, respectively. The patella translated in an arc relative to the femur and tibia as the knee flexed. In early flexion, the superior and centroid points translated anteriorly and then the patella translated posteriorly relative to the femur. All three points of the patella translated posteriorly relative to the tibia during a full range of flexion. An average of four and three millimetres proximal patellar translation relative to the tibia was demonstrated from 0 to 20° and 140 to 160° knee flexion, respectively. CONCLUSIONS: Physiological sagittal plane patellar kinematics, including patellar flexion angles and translations relative to the femur and tibia, showed generally similar patterns for each subject. Measurements of dynamic radiographic images under weight-bearing activities may enhance the opportunity to identify patellar pathological conditions.International Orthopaedics 06/2013; 37(8). DOI:10.1007/s00264-013-1958-6 · 2.02 Impact Factor