Development of a device for clinical kinematic evaluation of the knee

Ce travail rapporte le développement et la validation d’un système de mesure pour l’étude cinématique des rotations du genou en 3 dimensions. Pour cela, nous avons dans un premier temps étudié in‐vitro les avantages apportés par un système de mesure de référence par rapport à l’évaluation du clinicien. Dans un second temps, nous avons développé un outil de mesure optoélectronique utilisable dans un contexte clinique. Nous avons réalisé une étude de reproductibilité de ce système pour des mesures de rotation interne‐externe en charge sur une série de sujets sains. Enfin, nous avons utilisé le système en condition réelle lors d’une étude clinique de revue à 2 ans de recul. 16 sujets opérés d’une rupture partielle du LCA ont été revus lors d’une consultation. Des mesures de rotation interne‐externe du genou en charge ainsi que des mesures de proprioception ont été réalisées.The purpose of this work was to develop and to validate a new device for clinical 3D rotational kinematic evaluation of the knee. With this aim in view, we demonstrated in‐vitro the advantages of using a device for clinical evaluation of the knee. After, we developed a clinical opto‐electronic device. We validated it with a protocol for knee examination during an active weight bearing test of rotational laxity on healthy subjects. Last, the device was used in actual conditions for a clinical study. 16 patients were examined 2 years after an ACL partial reconstruction. Weight bearing tests of rotational laxity and proprioception evaluation were performed on the patients

Mise au point d’un outil de mesure de la cinématique du genou en contexte clinique

The purpose of this work was to develop and to validate a new device for clinical 3D rotational kinematic evaluation of the knee. With this aim in view, we demonstrated in‐vitro the advantages of using a device for clinical evaluation of the knee. After, we developed a clinical opto‐electronic device. We validated it with a protocol for knee examination during an active weight bearing test of rotational laxity on healthy subjects. Last, the device was used in actual conditions for a clinical study. 16 patients were examined 2 years after an ACL partial reconstruction. Weight bearing tests of rotational laxity and proprioception evaluation were performed on the patients.Ce travail rapporte le développement et la validation d’un système de mesure pour l’étude cinématique des rotations du genou en 3 dimensions. Pour cela, nous avons dans un premier temps étudié in‐vitro les avantages apportés par un système de mesure de référence par rapport à l’évaluation du clinicien. Dans un second temps, nous avons développé un outil de mesure optoélectronique utilisable dans un contexte clinique. Nous avons réalisé une étude de reproductibilité de ce système pour des mesures de rotation interne‐externe en charge sur une série de sujets sains. Enfin, nous avons utilisé le système en condition réelle lors d’une étude clinique de revue à 2 ans de recul. 16 sujets opérés d’une rupture partielle du LCA ont été revus lors d’une consultation. Des mesures de rotation interne‐externe du genou en charge ainsi que des mesures de proprioception ont été réalisées

In vitro analysis of patellar kinematics: validation of an opto-electronic cinematic analysis protocol

Opto-electronic cinematic analysis has already proven useful in the investigation of patients with a knee replacement; however, neither patellar tracking nor the various positional parameters relevant to instability such as patellar tilt and/or patellar shift have ever been specifically evaluated using this type of system. The aim of this research was to validate the relevance of this type of cinematic analysis in order to use it in the evaluation of the main factors underlying patellar instability. Six fresh-frozen anatomical specimens were studied. The data were acquired using the Motion Analysis system. Statistical analysis reveals a good reproducibility of measurements. Our protocol based on an opto-electronic acquisition system has an accuracy of 0.23 mm for shift and of 0.4 for rotation, which is calculated by integrating the various experimental parameters and instrumental features specific to the Motion Analysis system. The results are consistent with published results which further attests to the validity and the efficacy of the protocol and encourages us that this protocol is suitable for the in vitro study of patellar kinematics

The role of the medial ligamentous structures on patellar tracking during knee flexion

The influence of the medial patellar ligamentous structures on patellar tracking has rarely been studied. Thus the main purpose of this cadaveric biomechanical study was to determine the influence of the medial patellofemoral (MPFL), medial patellomeniscal (MPML) and medial patellotibial (MPTL) ligaments on the three-dimensional patellar tracking during knee flexion. This study was conducted using a validated cadaveric optoelectronic protocol for analysis of patellar kinematics. Methods For each cadaveric knee study, four successive acquisitions were performed; first was studied patellar tracking in healthy knees, then the junction between MPFL and vastus medialis obliquus (VMO) was sectioned, the MPFL was released at its patellar attachment and finally was released the insertion of the MPML and MPTL. Results In this study, the MPFL accounts for 50-60% of the medial stabilization forces of the lateral patellar shift during patellar engagement in the femoral trochlea. This work confirm and clarify the role of the MPFL as the primary stabilizer of the patella during the initial 30° of knee flexion. Moreover, this study shows no significant results regarding the stabilizing action of the VMO on the patella during knee flexion. Conclusion This in vitro study, conducted with an experimental protocol previously validated in the literature, helps quantify the actions of the MPFL, the VMO, and the MPML/MPTL respectively, and identify areas of joint motion where these structures have the most significant influence. This confirms the importance of reconstruction in the treatment of chronic patellar instability. During its reconstruction, care should be taken to adjust the MPFL balance during the initial 20°-30° of flexion

Study of patellar kinematics after reconstruction of the medial patellofemoral ligament

Background: Medial patellofemoral ligament reconstruction is currently the technique of choice for the treatment of patellar instability. But what should be the most appropriate graft tension for optimal restoration of patellofemoral kinematics? Methods: Six freshly frozen cadaveric knees were studied, the three bone segments were respectively equipped with opto-reflective markers. The acquisitions were made using the Motion Analysis System®. Six successive acquisitions were performed for each knee under different levels of graft tension. Findings: With an intact medial patellofemoral ligament, the medial patellar tilt increased up to a mean value of 2.02° (SD 3.1), the medial patellar translation gradually increased up to a mean value of 3.3 mm (SD 2.25) with a slight lateral rotation over the first 30° of knee flexion with a maximum mean value of 1.22° (SD 0.8) at 20° of knee flexion. Reconstruction of the medial patellofemoral ligament was performed using different levels of tension applied to the graft. Only 10 N of graft tension could restore normal patellar tilt, lateral shift and rotation, with results approximating those measured on healthy knee. Interpretation: This study confirms the role of the medial patellofemoral ligament in providing adequate patellar stability during the first 30° of knee flexion. According to our findings, a 10 N tension applied to the graft appears sufficient to ensure proper control of patellar tracking whereas 20, 30 and 40 N of tension are excessive tension values inducing a major overcorrection in all studied parameters. Medial patello-femoral ligament reconstruction Patellar tilt - Patellar rotation - Patellar translation - Patellar instabilit

The Acute Effect of Local Vibration As a Recovery Modality from Exercise-Induced Increased Muscle Stiffness

Exercise involving eccentric muscle contractions is known to decrease range of motion and increase passive muscle stiffness. This study aimed at using ultrasound shear wave elastography to investigate acute changes in biceps brachii passive stiffness following intense barbell curl exercise involving both concentric and eccentric contractions. The effect of local vibration (LV) as a recovery modality from exercise-induced increased stiffness was further investigated. Eleven subjects performed 4 bouts of 10 bilateral barbell curl movements at 70% of the one-rep maximal flexion force. An arm-to-arm comparison model was then used with one arm randomly assigned to the passive recovery condition and the other arm assigned to the LV recovery condition (10 min of 55-Hz vibration frequency and 0.9-mm amplitude). Biceps brachii shear elastic modulus measurements were performed prior to exercise (PRE), immediately after exercise (POST-EX) and 5 min after the recovery period (POST-REC). Biceps brachii shear elastic modulus was significantly increased at POST-EX (+53 ± 48%; p < 0.001) and POST-REC (+31 ± 46%; p = 0.025) when compared to PRE. No differences were found between passive and LV recovery (p = 0.210). LV as a recovery strategy from exercise-induced increased muscle stiffness was not beneficial, probably due to an insufficient mechanical action of vibrations

Sagittal Laxity After Posterior Cruciate Ligament-Retaining Mobile-Bearing Total Knee Arthroplasty

Posterior cruciate ligament stretching after posterior cruciate ligament-retaining (CR) total knee arthroplasty (TKA) can lead to an increase in sagittal laxity, knee dysfunction, or accelerated damage to the tibial bearing surface. We conducted a prospective study on 74 consecutive mobile-bearing CR TKA to determine if knee laxity changed with time or if knees with large initial laxity experienced greater increases in laxity. Patients were studied with radiographic posterior and anterior drawer examinations at 3 and 23 months. Model-based shape-matching techniques were used to measure TKA kinematics. We found a 1-mm increase in posterior drawer. Knees with large postoperative drawers did not exhibit increased laxity at last follow-up. The use of a mobile-bearing CR TKA did not significantly modify the midterm knee sagittal laxity

Reproducibility of an optical measurement system for the clinical evaluation of active knee rotation in weight-bearing, healthy subjects

A knee is typically evaluated passively by a clinician during an office visit, without using dedicated measurement tools. When the knee is evaluated with the patient standing and actively participating in the movement, the results will differ than when the knee is passively moved through its range-of-motion by the surgeon. If a precise measurement system was available, it could provide additional information to the clinician during this evaluation. Hypothesis: The goal of this study was to verify the reproducibility of a fast, flexible optical measurement system to measure rotational knee laxity during weight-bearing. Material and methods: Two passive reflective targets were placed on the legs of 11 subjects to monitor femur and tibia displacements in three dimensions. Subjects performed internal and external rotation movements with the knee extended or flexed 30◦. During each movement, seven variables were measured: internal rotation, external rotation and overall laxity in extension and 30◦ flexion, along with neutral rotation value in 30◦ flexion. Measurement accuracy was also assessed and the right and left knees were compared. Reproducibility was assessed over two measurements sessions. Results: The calculated intra-class correlation coefficient (ICC) for reproducibility was above 0.9 for five of the seven variables measured. The calculated ICC for the right/left comparison was above 0.75 for five of the seven variables measured. Discussion: These results confirmed that the proposed system provides reproducible measurements. Our right/left comparison results were consistent with the published literature. This system is fast, reproducible and flexible, which makes it suitable for assessing various weightbearing movements during clinical evaluations Knee; Rotation; Laxity; Measurement system; Optical; Kinematics; Gait analysi

In vitro analysis of varus-valgus laxity of the knee joint: Comparison of clinical evaluation with measurements using a reference motion analysis system

De nombreux systèmes existent pour aider le clinicien lors de l'examen du genou. Toutefois, l'examen manuel est encore couramment utilisé pour l'évaluation des laxités. La présente étude a évalué quelle était la précision du clinicien lors d'un test standard de varus-valgus forcé. Nous avons comparé l'évaluation du clinicien par rapport aux mouvements réels du genou. Nous avons utilisé six pièces anatomiques de membres inférieurs récemment congelés. Le clinicien a réalisé un test de varus-valgus forcé en extension, puis à 25◦ de flexion. Les membres étaient équipés de broches fixées dans le fémur et dans le tibia. Des sphères rétro-réfléchissantes étaient collées sur ces broches. Les mouvements du genou étaient obtenus à l'aide d'un système Motion Analysis® (Motion Analysis Corporation,

Medial patellofemoral ligament anatomy: implications for its surgical reconstruction

The purpose of the present study, based on 23 cadaveric knees, was to perform a detailed anatomical analysis of the medial patellofemoral ligament (MPFL), especially its femoral attachment, its relationships with the vastus medialis obliquus (VMO) and the medial collateral ligament, with the objective of improving its surgical reconstruction. The femoral insertion of the MPFL was defined using an orthonormal frame centered on the middle of the femoral MPFL insertion. The whole measurements were taken using a millimetric compass with a precision of +/-1 mm. The MPFL was always observed, its length was 57.7 +/- 5.8 mm, the junction between the VMO and the MPFL always present measured 25.7 +/- 6.0 mm. When it comes to MPFL reconstruction, the key point is its positioning in the femoral insertion because it is this insertion that is going to restore isometry. By using the orthonormal frame it has to be positioned 10 mm behind the medial epicondyle and 10 mm distal to the adductor tubercle