Bi-cruciate stabilized (BCS) TKA is the prosthesis that aims to substitute bi-cruciate ligament with post-cam engagement. We estimated to describe the in vivo kinematics during deep knee bending in BCS and Cruciate retaining (CR) TKA with the same articular geometry. We analyzed 26 knees who agreed to the current investigation under institutional review board approval. 17 knees were implanted with BCS (Journey ∥BCS, Smith & Nephew. Memphis, US) and 9 knees with CR (Journey∥CR). Each patient was asked to perform deep knee bending under weight-bearing condition. To estimate the spatial position and orientation of the TKA, 2D/3D registration technique with single fluoroscopy was used. We evaluated anteroposterior (AP) translation of the nearest point from femoral component to tibial axial plane for medial and lateral sides, femoral external rotation relative to tibial component and post-cam engagement in BCS. Measurement results were analyzed using Wilcoxon test. Values of P<0.05 were considered statistically significant. Medial AP translation indicated 11.7±5.1% posterior movement in BCS and 4.0±6.6% anterior movement in CR from minimum flexion to 130°. Lateral AP translation indicated 28.9±11.4% posterior movement in BCS and 18.3±6.2% posterior movement in CR from minimum flexion to 130°. Femoral external rotation were observed in both group and the amount of rotation were 5.2°±4.5° in BCS and 8.2°±4.0° in CR. Anterior post-cam engagement was not observed in all cases (76.5%). But medial AP translation in BCS was anteriorly in shallow flexion angles compared to CR. It suggested that anterior post-cam engagement couldn't work in valid.

Our aim was to investigate whether it is possible to predict post-operative kinematics (Post-Ope) from intra-operative kinematics (Intra-Ope) after total knee arthroplasty. Our study were performed for 11 patients (14 knees) who underwent primary PS TKA using CT-based navigation system between Sept.2012 and Sept.2014. The mean subject age was 71.5 ± 5.5 years at the time of surgery. Intra-Ope was measured using the navigation system after implantation during passive full extension and flexion imposed by the surgeon. Under fluoroscopic surveillance, each patient was asked to perform sequential deep knee flexion under both non-weight bearing (NWB) and weight bearing (WB) conditions from full extension to maximum flexion. To estimate the spatial position and orientation, we used a 2- to 3- dimensional (2D3D) registration technique. Intra-Ope and Post-Ope had a common coordinate axis for bones. Evaluations were range of motion (ROM), external rotation angles (ER). The level of statistical significant difference was set at 0.05. Mean ROM in Intra-Ope(130°± 7.9°) was statistically larger than both NWB(121.1°±10.5°) and WB(124.0°±14.7°). No Statistically significant difference was found in the mean ER from 10° to 120° among Intra-Ope (11.2°± 8.5°) and NWB(7.1°±6.0°) and WB(5.3°±3.2°). It is suggested that we could predict Post-Ope from Intra-Ope by considering the increase of the range of motion due to the muscle relaxation condition and the amount of change in the ER.

There are few studies that have compared between continuous flexion activities and extension activities of normal knees. The purpose of this study is to compare in vivo kinematic comparison of normal knees between flexion activities and extension activities. Total of 8 normal male knees were investigated. We evaluated in vivo three-dimensional kinematics using 2D/3D registration technique. We compared femoral rotation angle relative to tibia, anterior/posterior (AP) translation of medial femoral sulcus (medial side) and lateral femoral epicondyle (lateral side) onto tibial plane perpendicular to tibial functional axis between flexion activities (F groups) and extension activities (E groups). Femoral external rotation was observed with the knee bending during both groups. The external rotation angle of F group was larger than that of E group significantly from 20 to 30 degrees with flexion (p < 0.05). Regarding medial side, anterior translation was observed up to 40 degrees in F group. From 40 to 140 degrees, posterior translation was observed. In E group, anterior translation was observed from 140 to 40 degrees with extension. From 40 degrees, posterior translation was observed. From 30 to 40 degrees, F group located anterior than E group (p < 0.05). Regarding lateral side, posterior translation was observed with flexion in F group. On the other hand, anterior translation was observed with extension in E group. Regarding AP location with flexion angle, there was no significant difference between two groups. In conclusion, there were different kinematics between flexion activities and extension activities.

The purpose of this study is to investigate the three-dimensional (3D) kinematics of normal knees in deep knee-bending motions like squatting and kneeling.

Material & Methods: We investigated the in vivo kinematics of 4 Japanese healthy male volunteers (8 normal knees in squatting, 7 normal knees in kneeling). Each sequential motion was performed under fluoroscopic surveillance in the sagittal plane. Femorotibial motion was analyzed using 2D/3D registration technique, which uses computer-assisted design (CAD) models to reproduce the spatial position of the femur and tibia from single-view fluoroscopic images. We evaluated the femoral rotation relative to the tibia and anteroposterior (AP) translation of the femoral sulcus and lateral epicondyle on the plane perpendicular to the tibial mechanical axis. Student's t test was used to analyze differences in the absolute value of axial rotation and AP translation of the femoral sulcus and lateral epicondyle during squatting and kneeling. Values of P < 0.05 were considered statistically significant.

During squatting, knees were gradually flexed from −2.8 ± 1.3° to 145.5 ± 5.1° on average. Knees were gradually flexed from 100.8 ± 3.9° to 155.6 ± 3.2° on average during kneeling. Femurs during squatting displayed sharp external rotation relative to the tibia from 0° to 30° of flexion and it reached 12.5 ± 3.3° on average. From 30° to 130° of flexion, the femoral external rotation showed gradually, and it reached 19.1 ± 7.3° on average. From 130° to 140° of flexion, it was observed additionally, and reached 22.4 ± 6.1° on average. All kneeling knees displayed femoral external rotation relative to the tibia sharply from 100° to 150° of flexion, and it reached 20.7 ± 7.5° on average. From 100° to 120° of flexion, the femoral external rotation during squatting was larger than that during kneeling significantly. From 120° to 140° of flexion, there was no significant difference between squatting and kneeling. The sulcus during squatting moved 4.1 ± 4.8 mm anterior from 0° to 60° of flexion. From 60° of flexion it moved 13.6 ± 13.4 mm posterior. The sulcus during kneeling was not indicated significant movement with the knee flexion. The lateral epicondyle during squatting moved 39.4 ± 7.7 mm posterior from 0° to 140° of flexion. The lateral epicondyle during kneeling moved 22.0 ± 5.4 mm posterior movement from 100° to 150° of flexion. In AP translation of the sulcus from 100° to 140° of flexion, there was no significant difference between squatting and kneeling. However in that of the lateral epicondyle, squatting groups moved posterior significantly.

Even if they were same deep knee-bending, the kinematics were different because of the differences of daily motions. The results in this study demonstrated that in vivo kinematics of deep knee-bending were different between squatting and kneeling.