ArticlePDF Available

Abstract and Figures

The purpose of the present study was to conduct direct measurements in a large sample of dried femori in order to record certain morphometric parameters of the femoral condyles and determine whether there are gender and side differences. Three hundred sixty (Greek) Caucasian dried femori (180 left and 180 right), from 192 males and 168 females, were measured using a digital caliper. The mean age was 67.52 years. The mean bicondylar width of the femur was 8.86 cm ± 0.42 cm in men and 7.85 cm ± 0.30 cm in women (P < 0.01). The relative values for the medial condylar depth were 6.11 cm ± 0.34 cm and 5.59 cm ± 0.29 cm (P < 0.05); for the lateral condylar depth were 6.11 cm ± 0.33 cm and 5.54 cm ± 0.21 cm (P < 0.01); for the intercondylar width were 2.20 cm ± 0.18 cm and 1.87 cm ± 0.10 cm (P < 0.001); for the intercondylar depth were 2.78 cm ± 0.16 cm and 2.37 cm ± 0.12 cm (P < 0.001). No significant side-to-side difference was observed in any parameter. The femoral condyles differences in anatomy between genders might be useful to the design of total knee prostheses. The contralateral healthy side can be safely used for preoperative templating since there were no significant side differences.
Content may be subject to copyright.
A preview of the PDF is not available
... Indirect morphometric studies done through X-ray, MRI, and CT scan are inaccurate in most instances and this may further increase the probability of occurrence of complications. Hence direct morphometric studies are more effective for better surgical outcomes [6]. ...
... This present study estimates six parameters from the lower end of the dry femur and the data has been collected using direct Vernier Calliper measurements as the indirect methods of measurements are found to be inaccurate in most cases. The data found in this study is in accordance with the study conducted by Terzidis et al. [6]. A study conducted by Neelima et al. found slightly lower values compared to our study with an anteroposterior length of the medial condyle as 57.83 mm, the width of the medial condyle as 21.33 mm, anteroposterior length of the lateral condyle as 58 mm, width of the lateral condyle as 21.08 mm, and ICNW as 22.83 mm [7]. ...
Article
Full-text available
Introduction The most vital joint for locomotion is the knee joint, which is a condylar, modified hinge joint. Osteoarthritis is a degenerative disease commonly affecting the knee joint, which can be successfully treated by joint replacement surgeries wherein the condyles of the affected knee joints are replaced based on the measurement of the condyles for which the accurate morphometric values of the tibia and femur play an important role thereby decreasing the complications post-surgery and improving the mobility and quality of life of patients. Aim The present study aims to evaluate the morphometric data of femoral condyles and compare the morphometric data of the left and right femurs using the direct method. Materials and methods One hundred femoral condyles of unidentified sex were used for the measurement in the study. Medial condylar anteroposterior distance (MCAPD), lateral condylar anteroposterior distance (LCAP), bicondylar width (BCW), medial condylar transverse distance (MCTD), lateral condylar transverse distance (LCTD), and intercondylar notch width (ICNW) were measured by Vernier Calliper and the values between the left and right femurs were compared. Results The mean MCAPD is 56.88 mm, the mean LCAP is 57.72 mm, the mean BCW is 72.22 mm, the mean MCTD is 22.88 mm, the mean LCTD is 22.99 mm, and the mean ICNW is 21.58 mm, respectively. Conclusion The morphometric data obtained by direct measurement using Vernier Callipers is more accurate than indirect measurements which in turn aid biomedical engineers in designing more accurate and apt prostheses for knee replacement surgeries which in turn decrease the post-surgical complications and result in better outcomes due to surgery.
... The three-dimensional nuances to each structure's path through space are of particular importance in ligament injury because the length changes that induce injury are often extremely subtle (on the mm scale) [44]. Additionally, factors such as age, anatomy, and sex differences are also difficult to capture in computational models, and yet have been proven to play a role in vulnerability to injury [45][46][47][48][49][50]. ...
... The construction of a consistent coordinate system centered around the KFA enabled us to mathematically transform kinematic data from differing sources to reproduce the representative motions on each knee specimen (Supplemental Fig. 1). All trajectories were extracted and replicated exactly from each original source, with the exception that translations were scaled to each specimen by the width of each knee (distance between the medial and lateral femoral condyle points) divided by the average width of that measurement from the respective population (78.5 mm for women and 88.6 mm for men) [48]. For sources that reported kinematics in the commonly used Grood-Suntay joint coordinate system, these motions were replicated exactly in the original frame. ...
Article
Full-text available
Knee ligament injury is among the most common sports injuries and is associated with long recovery periods and low return-to-sport rates. Unfortunately, the mechanics of ligament injury are difficult to study in vivo, and computational studies provide limited insight. The objective of this study was to implement and validate a robotic system capable of reproducing natural six degree-of-freedom clamped-kinematic trajectories on human cadaver knees (meaning that positions and orientations are rigidly controlled and resultant loads are measured). To accomplish this, we leveraged the field’s recent access to high-fidelity bone kinematics from dynamic biplanar radiography (DBR), and implemented these kinematics in a coordinate frame built around the knee’s natural flexion–extension axis. We assessed our system’s capabilities in the context of ACL injury, by moving seven cadaveric knee specimens through kinematics derived from walking, running, drop jump, and ACL injury. We then used robotically simulated clinical stability tests to evaluate the hypothesis that knee stability would be only reduced by the motions intended to injure the knee. Our results show that the structural integrity of the knee was not compromised by non-injurious motions, while the injury motion produced a clinically relevant ACL injury with characteristic anterior and valgus instability. We also demonstrated that our robotic system can provide direct measurements of reaction loads during a variety of motions, and facilitate gross evaluation of ligament failure mechanisms. Clamped-kinematic robotic evaluation of cadaver knees has the potential to deepen understanding of the mechanics of knee ligament injury.
... However, this is not as widely utilized as other skeletal features for sex determination. The size and dimensions of the femoral condyles (the rounded prominences at the end of the femur) may show subtle differences between males and females [41]. ...
Article
In forensic anthropology, physical anthropological methods and expertise are used to medical and legal matters of importance. In most situations, the major goals are to assist in the identification of mortal remains and ascertain the circumstances surrounding the remains, especially when there is suspicion of foul conduct. Age and sex identification are often the most important criteria in forensic anthropology when creating a biological profile of an individual. In forensic anthropology, the application of knee bone measurements for sex and age demarcation is a fascinating field since it can provide invaluable insight into the inherent characteristics of individuals. The total knowledge of the conditions around mortal remains can be enhanced by this information, which can be crucial in forensic examinations. Morphological traits can identify probable matches in cases of missing persons by revealing information about an individual's likely ancestry or community affiliation. When examining bones, forensic anthropologists look for fractures, gunshot wounds, trauma marks, or other indications of violence. This data aids in the reconstruction of the incidents that resulted in harm or death. The employment of sophisticated imaging techniques enhances the accuracy of the anthropometric data gathering procedure, and the delicacy of these measures is crucial for reliable results. The field of forensic anthropology depends on establishing the natural profile, particularly age and sex, while sex is determined in part by sexual dimorphism, age assessment heavily depends on bone ossification.
... As shown in Figures 4 and 5, the tibial axis can be 5°more externally rotated or 9°more internally rotated than the Akagi line. Individual differences in the morphology of the lateral femoral condyles have been reported to be significant, which may be one of the reasons for the large variation in the present results [14,25]. The present results provide one criterion for the tibial rotation axis in KA-TKA, but it is not an index that applies to all individuals. ...
Article
Full-text available
Purpose It is not known where the anatomical axis of rotation on the tibial side will be in kinematic alignment (KA), a rapidly expanding area of total knee arthroplasty (TKA) alignment technique today. The purpose of this study was to define the tibial axis for KA‐TKA. Methods Fifty patients who underwent computed tomography (CT) examination of the lower extremities at a single institution were included. The posterior condylar axis (PCA) and surgical epicondylar axis (SEA) were identified in the CT axial view and projected onto the tibial slice. The respective perpendicular lines that pass through was attachment of the posterior cruciate ligament (PCL) were identified as the anatomic axis of rotation of the tibia relative to the PCA and SEA, and the position of each axis of rotation. Furthermore, the relationship of these perpendicular lines with the Akagi line was evaluated. Results The axis of tibial rotation to the SEA was similar to that of the Akagi line; the axis of tibial rotation to the PCA was located approximately 2.9° medial to the Akagi line, and when the origin of the tibial axis was set at the PCL attachment site, the intersection point of the tibial axis was approximately 2.5 mm medial to the medial border of the tibial tuberosity. The distribution of tibial axis had a wide range. Conclusion Although there is a large individual variation, the average tibial axis for KA‐TKA is 2.9° more internally rotated than the Akagi line. Level of Evidence Level IV.
... In Fig. 2c, a geometric model of the ACL autograft with a diameter of 7.5 mm [45], the cross-sectional area of 1225.34 mm 2 , length of 23.56 mm, and the connecting fixators to the bone tissue with a length of 25 mm and a diameter of 8 mm [41,46] in the ACLR-BPTB model are shown, with the capability of adjusting their position, angle, as well as their diameter and length within the bone tissue of the femur and tibia [47][48][49][50][51][52]. The construction of the real 3D model (Fig. 2a) in this phase is merely for extracting geometric data of various knee joint components for designing an optimal parametric 3D model. ...
Article
The anterior cruciate ligament plays a crucial role in maintaining stability within the knee joint, particularly for athletes who frequently experience its rupture. This study presents a novel approach using personalized three-dimensional (3D) parametric finite element modeling of the knee joint to simulate the treatment following anterior cruciate ligament reconstruction (ACLR) in both forward walking (FW) and drop landing (DL) tasks. The study encompasses two distinct cohorts: five healthy athletes and five ACLR patients. Biomechanical motion analysis was conducted on both cohorts, with the ACLR patient group evaluated at 6 and 9 months post-surgery. A comprehensive 3D parametric model of the knee joint was meticulously crafted. The findings reveal a notable reduction in stress on crucial knee structures such as the autograft, meniscus, and cartilages over time for both FW and DL tasks following ACLR, with a reduction in tissue tension of approximately 9.5% and 37% for FW and DL, respectively. This personalized model not only facilitates the investigation of knee joint tissue biomechanics post-ACLR but also aids in estimating the return-to-sports timeline for patients. By accommodating individual tissue geometries and incorporating patient-specific kinetic data, this model enhances our comprehension of post-ACLR biomechanics across various functional tasks, thereby optimizing rehabilitation strategies.
Article
Statistical shape models (SSMs) are widely used for morphological assessment of anatomical structures. However, a key limitation is the need for a clear relationship between the model’s shape coefficients and clinically relevant anatomical parameters. To address this limitation, this paper proposes a novel deep learning-based anatomically parameterized SSM (DL-ANATSSM) by introducing a nonlinear relationship between anatomical parameters and bone shape information. Our approach utilizes a multilayer perceptron model trained on a synthetic femoral bone population to learn the nonlinear mapping between anatomical measurements and shape parameters. The trained model is then fine-tuned on a real bone dataset. We compare the performance of DL-ANATSSM with a linear ANATSSM generated using least-squares regression for baseline evaluation. When applied to a previously unseen femoral bone dataset, DL-ANATSSM demonstrated superior performance in predicting 3D bone shape based on anatomical parameters compared to the linear baseline model. The impact of fine-tuning was also investigated, with results indicating improved model performance after this process. The proposed DL-ANATSSM is therefore a more precise and interpretable SSM, which is directly controlled by clinically relevant parameters. The proposed method holds promise for applications in both morphometry analysis and patient-specific 3D model generation without preoperative images.
Article
Background: The medial condyle is wider and having larger surface area for articulation than lateral femoral condyle however anteroposteriorly lateral femoral condyle is larger. The aim of this study was to find normal dimensions of lateral femoral condyle in Pakistani population. Methods: This Cross-sectional descriptive study, carried out from September 2023 to May 2024 in Radiology department of Peshawar General Hospital, Peshawar with sample size of 385. Non probability convenience sampling technique was used. All healthy adult, intact femur with clear features were included and scanned through magnetic resonance imaging. Data analysis was done through SPSS version 22, descriptive analysis was done and association was assessed by applying independent sample t-test and ANOVA. P-value ≤ 0.05 considered statistically significant. Results: About 54% (n=149) male participants and 60% (n=67) of females had right knee measurements, whereas 46% (n=125) males and 40% (n=44) females had measurements of their left knee. There was no significant relationship between gender and the measured side (p=0.169). Age and size of the lateral femoral condyle were shown to be significantly correlated (p=0.027). Males exhibited greater femoral condyle dimensions, notch widths, and heights compared to females (p<0.001). Furthermore, ANOVA showed statistically significant variations in parameters of lateral femoral condyle, notch width, and height with age (p<0.001). Conclusions: This study demonstrates that the femoral condyles parameters depend on several variables and differ by gender and region. Considering this study, accurate tunnel in lateral femoral condyle can be made for anterior cruciate ligament graft in ACL injury.
Article
Introduction The femur is known as the longest weight-bearing bone in the body. Its length is around 45 cm in an average adult. The morphometric studies related to the distal end of the femur in the South Indian population are sparse. The present morphometric study was undertaken to compare and contrast the various measurements of the distal end of the femur in the South Indian population. Materials and Methods In this study, 111 adult dry femora (56 from the right and 55 from the left side) were used for distal anthropometric measurements. Bicondylar width, medial condylar anteroposterior diameter, lateral condylar anteroposterior diameter, medial condylar transverse diameter, lateral condylar transverse diameter, width of intercondylar notch, and diameter of femur were measured using digital Vernier caliper. Results The mean bicondylar width on the right and left sides were 70.43 mm, respectively. The average medial condylar anteroposterior distance for the right and left sides were 53.87 mm and 54.84 mm, whereas, the lateral condylar anteroposterior distance for the right and left sides was 55.33 mm and 55.44 mm. The medial condylar transverse distance for the right and left sides were 25.35 mm and 25.52 mm, and that of the lateral condylar transverse distance on the right and left sides were 26.87 mm and 26.71 mm. The intercondylar notch width was measured to be 18.26 mm and 18.43 mm on the right and left femora, respectively. The differences in the bilateral measurements were found to be statistically not significant between the right and left femora. Conclusion The morphometric evaluation of the lower end of the femur would help the orthopedic surgeon, radiologist, and anthropology practitioner to a great extent, especially in dealing with knee joint-related disorders, and placing various implants in the reconstruction of femoral fragments among South Indian populations.
Article
Full-text available
Among the anthropometric factors to be considered , anatomic differences in the distal femur and intercondylar notch have been implicated as a cause of the different rates of anterior cruciate ligament (ACL) rupture between men and women; therefore, in this study our aim was to evaluate a number of morpho-metric measurements in the distal part of the femur. Two hundred knee MRI examinations were analyzed: 56 male right, 44 male left, 42 female right and 58 female left. Measurements of the intercondylar height (ICH), intercondylar width (ICW), medial condylar width (MCW), lateral condylar width (LCW) and epicondylar width (EW) were obtained. The notch shape index (NSI) was also calculated. Statistical analysis for comparisons was done by Student's t-test. Correlations between the parameters studied were calculated by Pearson correlation coefficients. Significant bilateral differences were not found (p>0.05). In all measurements, males showed significantly greater values than females (p<0.001). No difference was seen in the NSI between males and females (p>0.05). Conversely a significant association was obtained between age and all parameters. We conclude that the results of this study may be useful for anatomic evaluation of the distal femur region prior to orthopaedic operations.
Article
Full-text available
The purpose of this study was to reveal the association whether the distal morphometry of femur had a relation with femur height or width. Sixty-six adult (35 right and 31 left) dry femurs from Caucasians were used in this study. Computed tomography (CT) imaging was applied to obtain measurement values of the femur. Femur height (413.29 ± 28.40 mm) and width (29.86 ± 2.72 mm) were all checked one by one to determine the correlation with the parameters obtained. Both values exposed high rates of correlation with height (26 ± 2.34 mm) and width (20.85 ± 2.76 mm) of femur notch; also, measures of epicondylar, bicondylar and condylar diameters of femur were obtained. Measures were checked if there was a correlation with femur height and width. Differences displayed in distal morphometry of femur according to race and sex are due to other morphometric measures of femur rather than race and sex. We believe that displaying the high rates of correlation of distal morphometry of femur with femur height and width will be the factor which determines the selection and production of prosthesis among the long or short individuals of folks.
Article
Full-text available
Recently, gender-specific designs of total knee replacement have been developed to accommodate anatomical differences between males and females. We examined a group of male and female distal femora matched for age and height, to determine if there was a difference in the aspect ratio (mediolateral distance versus anteroposterior distance) and the height of the anterior flange between the genders. The Hamann-Todd Collection provided 1207 skeletally mature cadaver femora. The femoral length, the anteroposterior height, height of the lateral and medial flanges and the mediolateral width were measured in all the specimens. The mechanical axis of the femur, the cut articular width and the aspect ratio were assessed. Statistical analysis of the effect of gender upon the aspect ratio and the lateral and medial flanges was undertaken, controlling for age, height and race. The mean aspect ratio of male femora was 1.21 (sd 0.07) and of female femora it was 1.16 (sd 0.06) (p < 0.001). There was no significant difference between male and female specimens in the mean size of the lateral flange (6.57 mm (sd 2.57) and 7.02 mm (sd 2.36), respectively; p = 0.099) or of the medial flange (3.03 mm (sd 2.47) and 3.56 mm (sd 2.32), respectively; p = 0.67). Future work in the design of knee prostheses should take into account the overall variability of the anatomy of the distal femur.
Article
Background The value of femoral notch size and the notch width index in predicting anterior cruciate ligament injury has been debated. This study examined the relationship between the notch width index and anterior cruciate ligament injury in professional basketball players. Hypothesis No significant difference exists between the notch width index of anterior cruciate ligament–injured and noninjured professional basketball players. Study Design Case-control study; Level of evidence, 3. Methods Using a notch view radiograph, the authors prospectively measured the femoral notch and the condylar widths and then calculated the notch width index of 615 male athletes who participated in the National Basketball Association's combine workouts between 1992 and 1999. Players who participated in at least 1 professional game were included. After an 11-year follow-up period, the National Basketball Association's leaguewide injury database was reviewed to identify injured players. The players were then categorized into anterior cruciate ligament–injured or noninjured groups. Notch width, condylar width, and notch width index were compared between the 2 groups. Results A total of 305 players were followed for a period of up to 11 years. Anterior cruciate ligament trauma was suffered by 14 (4.6%) of the subjects. The average notch width index was 0.235 ± 0.031 for anterior cruciate ligament–injured players and 0.242 ± 0.041 for noninjured players (t305 –0.623, P=. 534). This difference was not significantly different. Two (3.9%) of the subjects with critical notch stenosis (notch width index 0.20) had noncontact anterior cruciate ligament injuries. Conclusions The notch width index did not predict the rate of anterior cruciate ligament injury. A level of critical notch stenosis was not detected. Anterior cruciate ligament injury could not be predicted by the absolute measurement of the femoral intercondylar notch. Use of a preparticipation notch view radiograph in male professional basketball players as a predictor of anterior cruciate ligament injury is not recommended.
Article
The femur remains an important bone in palaeoanthropology and this paper reports various analyses of measurements taken from long-cassette radiographs of adult femurs of a reference population from the south of England (n=81, males 33, females 48). Discriminant analysis confirmed that the male femur is usually larger than the female femur, and that a femur may be sexed with some confidence. Discriminant scores have been derived to permit estimates to be made, from the whole or a part of a femur, of the probability of the male gender. Outcomes from a principal component analysis suggest: that the female proximal femur is a morphological unit; that neck length and shaft length are dissociated and there is no common factor representing linearity; and that the male bicondylar width is anomalous, a finding that is confirmed by other analyses. An estimate of the robusticity of the complete female, but not male, bone may sometimes be made from a proximal fragment. The robusticity of the complete bone may be made confidently from the shaft for both genders. The two width variables relating to a distal fragment cannot be used to predict the robusticity of the complete bone for either gender. A method of defining the position of the waist in terms of displacement in deciles down the shaft is described. The position of the waist seems to have a bimodal distribution. The positive association between age and distal displacement may be due to remoulding of the shaft with age or to a cohort (generational) effect. There is a weak correlation between a small neck–shaft angle and the distal displacement of the waist, two archaic phenotypic traits. Ten statements in the literature relating to the femur have been examined and tested; six are confirmed and four are unconfirmed, and it is suggested that there is a need for further studies relating to the morphology of the femur.
Article
An analysis of the anterior patellar groove of the human femur shows considerable variation in its medial and lateral spects. The groove itself, measured by the angle it encloses, shows considerably less variation than its individual components. The suggested functional relationship between bicondylar angle and lateral elevation of the patellar groove does not obtain for this sample.
Article
Sixty-two male and 290 female knees from the Singapore population were measured intraoperatively for anteroposterior (AP) height of both medial and lateral femoral condyles, mediolateral (ML) width, and AP/ML ratio (aspect ratio). Median AP/ML ratio for the medial condyle was 1.00 (range, 0.91-1.18) in men and 1.09 (range, 0.92-1.39) in women. Median AP/ML ratio for the lateral condyle was 0.98 (range, 0.84-1.14) in men and 1.06 (range, 0.89-1.36) in women. Both aspect ratios showed significant differences according to sex (P < .001). We conclude that women generally have narrower femurs than men for any given AP height. The aspect ratios of Asians also appear narrower than that reported in white populations.
Article
The goal of this study was to characterize the geometry of the distal femur and proximal tibia in the Chinese population. Three-dimensional models of twenty female and twenty male knees were constructed using CT images. The morphologic measurements of the distal femur included mediolateral (ML) and anteroposterior dimension of medial and lateral condyles (MAP, LAP), femoral aspect ratio (ML/LAP), medial and lateral condylar width, intercondylar notch width, notch width index (NWI), and trochlear groove orientation. The sagittal profiles of the medial and lateral femoral condyles and tibial plateaus were also characterized. The results showed that the size of the distal femur of the females was significantly smaller than that of the males. Furthermore, when normalized by LAP, the females had a significantly narrower distal femur (ML), and a shorter MAP compared to the males. In the sagittal plane, the radius of the lateral distal circle of the femur was significantly smaller than that of the medial condyle in both genders. There were no significant gender differences in the proximal tibial geometry. The data of the present study may enable suitable modification of total knee prosthesis sizing/geometry for Asia-Pacific patients.
Article
This study investigates differences in the anatomy of male and female knee joints to contribute to the current debate on sex-specific total knee implants. Morphometric data were obtained from 60 human cadaver knees, and sex differences were calculated. All data were corrected for height, and male and female specimens presenting with an identical length of the femur were analyzed as matched pairs. Male linear knee joint dimensions were significantly larger when compared with females. When corrected for differences in height, medial-lateral dimensions of male knees were significantly larger than female; however, matched paired analysis did not prove these differences to be consistent. Although implant design should focus interindividual variations in knee joint anatomy, our data do not support the concept of a female-specific implant design.
Article
Side-to-side comparison of anatomical or functional parameters in the evaluation of unilateral pathologies of the human knee joint is common practice, although the amount of symmetry is unknown. The aim of this study was to test the hypothesis that there are no significant differences in the morphometric knee joint dimensions between the right and the left knee of a human subject and that side differences within subjects are smaller than intersubject variability. In 20 pairs of human cadaver knees, the morphometry of the articulating osseous structures of the femorotibial joint, the cruciate ligaments, and the menisci were measured using established measurement methods. Data were analyzed for overall side differences and the ratio between within-subject side differences and intersubject variability was calculated. In three out of 71 morphometric dimensions there was a significant side difference, including the posterior tibial slope, the anatomical valgus alignment of the distal femur, and the position of the femoral insertion area of the ACL. In two additional parameters, including the cross-sectional area of the ACL and PCL, within-subject side differences were larger than intersubject variability. In general, there was a positive correlation in morphometric dimensions between right and left knees in one subject. It is concluded that a good correlation in the morphometric dimensions of a human knee joint exists between the right and the left side. This study supports the concepts of obtaining morphometric reference data from the contralateral uninjured side in the evaluation of unilateral pathologies of the knee joint.