Purpose: To test for a decrease in knee musculature co-activation at one- and two-year post total knee replacement (TKR) compared to pre-TKR values.

Method Thirty men and 35 women with knee osteoarthritis (OA), after providing informed consent, participated in this study. Surface electromyograms (EMG) recorded the activation of seven muscle sites (rectus femoris, vastus lateralis and medialis, lateral and medial hamstrings, lateral and medial gastrocnemius) while subjects ambulated, at a self-selected velocity, along a six-meter walkway; one week prior to TKR surgery, and one- and two-years post-TKR. Linear enveloped EMG waveforms, amplitude normalized to 100%MVIC and time normalized to 100% of the gait cycle, were entered into a principal component analysis model [1]. A two-factor (pre-post, muscle) repeated measures ANOVA was applied to test statistically significant main effects (pre-post, muscle) and interactions (alpha = 0.05).

Results: The mean age, mass and height pre-TKR were 63.4 years, 91.4 kg and 1.69 m, respectively. Forty seven and 25 subjects completed the one- and two-year follow up, respectively. Walking velocity increased from 0.9 m/s pre-TKR to 1.1 m/s for both one- and two-year post TKR. Four principal components explained 89% of the variance in the waveform data. PC1 (60% of the variance), associated with co-activation throughout the entire stance phase, was found to be statistically significant (p< 0.05). The post hoc analysis revealed no significant differences between one- and two-year post-TKR PC1 scores, but the two vasti muscles and lateral hamstring had significantly lower PC1 scores post-TKR compared to pre-TKR values. There were significant differences among muscles with the two vasti muscles higher pre-TKR compared to all other muscles, and lateral hamstring higher pre-TKR than the remaining four muscles.

Conclusion: PC1 captured a co-activation pattern illustrating muscle activation during the majority of the stance phase of gait for the vasti and lateral hamstring muscles. This pattern, previously shown in severe OA gait [1], is considered an adapted response to the pain and joint instability associated with latter stages of OA progression. These findings support that the neuromuscular control strategies are altered within one year with no additional change for the two year post-TKR measures. These results support a more efficient neuromuscular control strategy post-TKR and perhaps an associated decrease in metabolic cost and an improvement in function.

Patellofemoral Pain Syndrome is characterized by anterior knee pain during activities such as squatting that is thought to be caused by abnormal patellar motion. However, the causative role has yet to be verified since it is difficult to measure the three-dimensional kinematics of the patellofemoral joint (PFJ) in vivo. We developed a fluoroscopy-based method to measure patellar motion as it moves under load through a cycle of flexion and compared the results with those obtained using Roentgen Stereophotogrammetric Analysis (RSA). Our data suggest that the fluoroscopy-based method has sufficient accuracy to detect clinically significant differences in patterns of patellar motion.

The purpose of our study was to determine how accurately a fluoroscopy-based method measures patellar tracking.

Our method measures three-dimensional PFJ kinematics with sufficient accuracy to be of clinical value in assessing dynamic motion.

Patellar tracking can be assessed during aggravating activities to identify specific tracking abnormalities related to anterior knee pain.

Four cadaver knees were imaged using computed tomography (CT). Surface models were generated and the coordinates of implanted tantalum beads (in the femur, patella, and tibia) were determined. A series of fluoroscopic images were taken with the knees loaded in a rig at various flexion angles. Each calibrated fluoroscopic image was registered to the CT model using a point-based method such that the high-resolution CT model was matched to the position of knee flexion associated with each fluoroscopic image. The patellar orientation and position relative to the femur was then reconstructed and described using a gyroscopic joint coordinate system. Measurements were made under the same test conditions using the established uniplanar RSA technique. Fluoroscopy-based and RSA-based measures of patellar orientation and position were compared.

The mean measurement error (SD) for patellar flexion, spin, and tilt was 1.86 (1.55), 1.16 (1.14), and 1.15 (1.10) degrees, respectively. For proximal, lateral and anterior patellar translation, the mean measurement error (SD) was 2.11 (2.16), 0.59 (0.47), and 1.24 (1.18) mm, respectively.

The accuracy of the fluoroscopy-based method of measuring PFJ kinematics was poorer than the reported accuracy of RSA but appears to be sufficiently low to be of clinical value.

Funding: Supported by an operating grant from the Canadian Institutes for Health Research and a Strategic Grant from the Natural Sciences and Engineering Research Council. NJM is supported by TAS/CIHR Partnership Fund.

We evaluated the accuracy of a Magnetic Resonance Imaging (MRI)-based method to measure three-dimensional patellar tracking during loaded knee flexion. This method determines the relative positions of the knee bones by shape matching high-resolution three-dimensional geometric models of these bones to fast low-resolution scans taken during loaded flexion.

The accuracy of the method’s assessment of patellar position and orientation was determined by comparing test measurements in four cadaver specimens to measurements made in the same specimens using Roentgen Stereophotogrammetric Analysis (RSA). This MRI-based method is more accurate than current two-dimensional imaging methods.

The purpose of this study was to determine the accuracy of a MRI-based technique for measuring patellar tracking in loaded flexion.

This novel, noninvasive, MRI-based method measures three-dimensional patellar tracking during loaded knee flexion with sufficient accuracy to detect clinically significant changes.

Although abnormal patellar tracking is widely believed to be associated with pain and cartilage degeneration at the patella, these relationships have not been clearly established because most current methods assess only the two-dimensional alignment of the patella at one position. Measurements possible with this method should be sufficiently accurate to yield new insights into these relationships.

Four cadaver knee specimens were flexed through seventy-five degrees of flexion in an MRI-compatible knee loading rig. A high-resolution image was acquired with each knee in extension and then a series of low-resolution scans (in two slice directions: axial and sagittal) were acquired through a flexion cycle. Segmenting bone outlines from high-resolution scans generated models of the femur, tibia and patella. These models were shape matched to the segmented bone outlines in the low resolution scans. Patellar attitude and position were determined and compared to measurements made using RSA.

The mean measurement error in every kinematic parameter was lower for “fast” sagittal plane slices than for “fast” axial plane slices. In general, the mean measurement error was increased by decreasing the number of low-resolution slices.

This method is more accurate than many two-dimensional methods, exposes participants to no ionizing radiation, and can be used through a large range of loaded knee flexion.

Funding: Supported by an operating grant from the Canadian Institutes for Health Research and a Strategic Grant from the Natural Sciences and Engineering Research Council. NJM is supported by the Arthritis Society/CIHR Partnership Fund.

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Introduction and Aims: High tibial osteotomy (HTO) is a corrective surgical procedure used to treat medial compartment osteoarthritis (OA). In HTO a bone wedge is resected from the upper tibia to realign the lower limb. In this study, we investigated the effect of HTO on patellofemoral joint motion using a validated new technique.

Method: We assessed patellar tracking in four subjects before and after high tibial osteotomy surgery. A high-resolution MR image was acquired of each subject’s knee. Each subject then loaded his/her knee in a custom test rig in the MR scanner, while fast, low-resolution MRI scans were acquired. This was repeated at five flexion angles. Bone outlines were identified (image segmentation) and processed (meshed) to yield bone models. Knee kinematics were determined by matching (registering) the high-resolution bone models to the low-resolution bony outlines. We compared the pre- and post-operative tracking patterns using a two-way repeated measures ANOVA.

Results: The resultant patellar tracking patterns were expressed as a function of knee flexion. Mean values for each quantity were calculated over the flexion range. High tibial osteotomy decreased patellar flexion by a mean of 5.06 degrees (p < 0.003), decreased internal patellar spin by a mean of 1.25 degrees (p < 0.001) and increased medial patellar tilt by a mean of 1.59 degrees (p < 0.001). High tibial osteotomy increased proximal patellar translation by a mean of 4.19mm (p < 0.008), but, for the number of specimens tested, we found no significant change in anterior or medial translation.

Conclusion: Our finding that HTO translated the patella proximally is consistent with findings of elevated patellae in the literature. The significant changes in patellar movement caused by high tibial osteotomy surgery suggest that the post-operative anterior knee pain associated with these procedures is due to mechanical changes at the patellofemoral joint.