Altered Tibiofemoral Kinematics in the Affected Knee and Compensatory Changes in the Contralateral Knee After Anterior Cruciate Ligament Reconstruction

Hofbauer, Marcus; Thorhauer, Eric; Abebe, Ermias; Bey, Michael J.; Tashman, Scott

doi:10.1177/0363546514549444

Cited by 56 publications

(63 citation statements)

References 35 publications

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“…One common criterion in evaluating a patients’ response is bilateral symmetry wherein the contralateral uninjured side serves as standard for evaluating the injured or repaired side . For example, when evaluating knee kinematics after anterior cruciate reconstruction, the operated leg is often compared to the contralateral uninjured leg . These side‐to‐side comparisons assume that prior to injury, the left and right side joint kinematics were identical, and any post‐treatment differences are due to the injury, imperfect surgical repair, or insufficient rehabilitation.…”

Section: Previous Studies Using Biplane Radiographs To Compare Patholmentioning

confidence: 99%

“…In contrast, biplane radiography can track bone motion during dynamic activities with an accuracy on the order of 1 mm and 1° . Biplane radiography has been used to compare the affected knee and contralateral knees after ACL/PCL injury and after ACL reconstruction (Table ) . What is missing from all of these previous studies is evidence to indicate that the observed symmetry (or asymmetry) after surgery and rehabilitation is within (or outside) the normal side‐to‐side differences in kinematics that are found in healthy individuals.…”

Section: Previous Studies Using Biplane Radiographs To Compare Patholmentioning

confidence: 99%

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Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle

Gale

Anderst

2019

Journal Orthopaedic Research

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One commonly used criterion in evaluating a patients’ response to knee surgery or rehabilitation is bilateral symmetry. However, the natural symmetry in uninjured healthy adult knee kinematics remains relatively unknown, making it challenging to determine if clinical treatment has adequately restored bilateral symmetry. The primary purpose of this study was to determine the typical side‐to‐side differences in 6 degree of freedom (DOF) knee kinematics over the entire gait cycle in healthy adults using biplane radiography. Six DOF tibiofemoral kinematics were measured during treadmill walking in 19 participants using a validated volumetric model‐based tracking process that matched subject‐specific bone models to biplane radiographs collected at 100 images/s. Average absolute side‐to‐side differences in knee kinematics at foot strike were 1.3 mm or less in translation and 3.8° or less in rotation. Peak side‐to‐side differences in knee kinematics occurred during the swing phase and were up to 2.2 mm in translation and 7.1° in rotation. Dominant versus non‐dominant leg differences were 0.8 mm and 2.8° or less at foot strike and reached maximum values of 0.8 mm and 7.2° over the full gait cycle. Statement of Clinical Significance: This study quantifies the inherent asymmetry of knee kinematics in healthy individuals over the entire gait cycle. The values of asymmetry presented here may serve as a guide for evaluating functional outcomes and restoration of so‐called “normal” kinematics after injury and clinical intervention. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res

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Section: Previous Studies Using Biplane Radiographs To Compare Patholmentioning

confidence: 99%

Section: Previous Studies Using Biplane Radiographs To Compare Patholmentioning

confidence: 99%

Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle

Gale

Anderst

2019

Journal Orthopaedic Research

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“…For example, a small, but significant, shift toward external tibia rotation and medial tibia translation has been observed during locomotion in ACLR knees (Carpenter et al, 2009; Scanlan et al, 2010; Tashman, 2004), along with a potential progressive increase in anterior tibia translation (Hofbauer et al, 2014). It has been theorized that these abnormal kinematic patterns may alter cartilage loading patterns and thereby initiate a cyclic catabolic response that eventually leads to OA (Andriacchi and Mündermann, 2006; Chaudhari et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament

Kaiser

Vignos

Liu

et al. 2016

Clinical Biomechanics

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Background The pathogenesis of osteoarthritis following anterior cruciate ligament (ACL) reconstruction is currently unknown. The study purpose was to leverage recent advances in quantitative and dynamic MRI to test the hypothesis that abnormal joint mechanics within four years of reconstruction is accompanied by evidence of early compositional changes in cartilage. Methods Static MR imaging was performed bilaterally on eleven subjects with an ACL reconstruction (1-4 years post-surgery) and on twelve healthy subjects to obtain tibial cartilage thickness maps. Quantitative imaging (mcDESPOT) was performed unilaterally on all subjects to assess the fraction of bound water in the tibial plateau cartilage. Finally, volumetric dynamic imaging was performed to assess cartilage contact patterns during an active knee flexion-extension task. A repeated-measures ANOVA was used to test for the effect of surgical reconstruction and location on cartilage thickness, bound water fractions, and contact across the medial and lateral tibia plateau. Findings No significant differences in cartilage thickness were found between groups. However, there was a significant reduction in the fraction of water bound by proteoglycan in the ACL reconstructed knees, most notably along the anterior portion of the medial plateau and the weight-bearing lateral plateau. During movement, reconstructed knees exhibited greater contact along the medial spine in the medial plateau and along the posterior aspect of the lateral plateau, when compared with their healthy contralateral knees and healthy controls. Interpretation This study provides evidence that abnormal mechanics in anterior cruciate ligament reconstructed knees are present coincidently with early biomarkers of cartilage degeneration.

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“…57 In particular, a number of publications report a shift toward external tibial rotation and medial translation in ACLR knees compared with healthy knees. 23,26 …”

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confidence: 99%

“…28,29 This sequence improves upon previous MRI efforts by allowing full volumetric co-registration for tracking skeletal motion, minimizing kinematic errors due to out-of-plane motion in planar images, and reducing numerical integration drift in phase contrast images. 28,38,42 However, it remains unclear whether abnormal ACLR knee motions seen in complex tasks 23,55 can be induced in an isolated task, particularly given the physical range of motion and loading constraints associated with motion in a standard MRI scanner bore.…”

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confidence: 99%

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

et al. 2017

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Background Although knees that have undergone anterior cruciate ligament reconstruction (ACLR) often exhibit normal laxity on clinical examination, abnormal kinematic patterns have been observed when the joint is dynamically loaded during whole body activity. This study investigated whether abnormal knee kinematics arise with loading under isolated dynamic movements. Hypothesis Tibiofemoral and patellofemoral kinematics of ACLR knees will be similar to those of the contralateral uninjured control knee during passive flexion-extension, with bilateral differences emerging when an inertial load is applied. Study Design Controlled laboratory study. Methods The bilateral knees of 18 subjects who had undergone unilateral ACLR within the past 4 years were imaged by use of magnetic resonance imaging (MRI). Their knees were cyclically (0.5 Hz) flexed passively. Subjects then actively flexed and extended their knees against an inertial load that induced stretch-shortening quadriceps contractions, as seen during the load acceptance phase of gait. A dynamic, volumetric, MRI sequence was used to track tibiofemoral and patellofemoral kinematics through 6 degrees of freedom. A repeated-measures analysis of variance was used to compare secondary tibiofemoral and patellofemoral kinematics between ACLR and healthy contralateral knees during the passive and active extension phases of the cyclic motion. Results Relative to the passive motion, inertial loading induced significant shifts in anterior and superior tibial translation, internal tibial rotation, and all patellofemoral degrees of freedom. As hypothesized, tibiofemoral and patellofemoral kinematics were bilaterally symmetric during the passive condition. However, inertial loading induced bilateral differences, with the ACLR knees exhibiting a significant shift toward external tibial rotation. A trend toward greater medial and anterior tibial translation was seen in the ACLR knees. Conclusion This study demonstrates that abnormal knee kinematic patterns in ACLR knees emerge during a simple, active knee flexion-extension task that can be performed in an MRI scanner. Clinical Relevance It is hypothesized that abnormal knee kinematics may alter cartilage loading patterns and thereby contribute to increased risk for osteoarthritis. Recent advances in quantitative MRI can be used to detect early cartilage degeneration in ACLR knees. This study demonstrates the feasibility of identifying abnormal ACLR kinematics by use of dynamic MRI, supporting the combined use of dynamic and quantitative MRI to investigate the proposed link between knee motion, cartilage contact, and early biomarkers of cartilage degeneration.

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Altered Tibiofemoral Kinematics in the Affected Knee and Compensatory Changes in the Contralateral Knee After Anterior Cruciate Ligament Reconstruction

Cited by 56 publications

References 35 publications

Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle

Asymmetry in healthy adult knee kinematics revealed through biplane radiography of the full gait cycle

American Society of Biomechanics Clinical Biomechanics Award 2015: MRI assessments of cartilage mechanics, morphology and composition following reconstruction of the anterior cruciate ligament

Effect of Loading on In Vivo Tibiofemoral and Patellofemoral Kinematics of Healthy and ACL-Reconstructed Knees

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