Can a finite set of knee extension in supine position be used for a knee functional examination?

doi:10.1016/j.jbiomech.2004.11.025

Journal of Biomechanics

Volume 39, Issue 2, 2006, Pages 359-363

https://doi.org/10.1016/j.jbiomech.2004.11.025 Get rights and content

Abstract

The kinematic magnetic resonance imaging technique has been developed to provide a functional examination of the knee. Technical limitations require this examination to be performed in supine position, and the knee motion is represented by an assembly of static positions at different knee angles. However, the main knee function is to support the body weight and perform continuous motion, e.g. parallel squat. Our study quantified the knee kinematics of 20 healthy subjects in different motion conditions (finite and continuous) and in different mechanical conditions (continuous unloaded and continuous loaded). We evaluated the angular and localisation difference of a finite helical axis of the knee motion for parallel squat, continuous knee extension in supine position and the finite set of knee extension in supine position. We found large inter-individual dispersion. The majority of subjects had equivalent knee kinematics between continuous knee extension and the finite set of knee extension in supine position, but not between continuous knee extension in supine position and the parallel squat. Therefore, results from a functional examination of a finite set of knee extensions in supine position do not represent the knee motion in a parallel squat. Our results suggest that functional examination of the knee from magnetic resonance imaging do not necessarily reflect the physiological kinematics of the knee. Further investigation should focus on a new magnetic resonance imaging acquisition protocol that allows image acquisition during weight bearing or includes a special device which reproduces the loaded condition.

Introduction

The use of the magnetic resonance imaging (MRI) has increased for non-invasive in vivo studies of the knee joint (Lerner et al., 2003). MRI is primarily used to obtain anatomic and geometric information. However, developments in MRI technology permit using MRI for functional examination of the knee (Shellock et al., 1991).

A functional examination of the knee consists of analysing the kinematics of the joint in order to detect impaired joint mechanisms (Nakanishi et al., 1997). As the main functions of anatomical knee structures are to stabilize and to move the knee joint under weight-bearing condition (Watkins, 1999), most of the knee functional examination are performed under weight-bearing conditions (Andriacchi et al., 2003). The squat exercise is often used to quantify the knee function or regain function in rehabilitation programs (Escamilla, 2001; Beynnon et al., 2002).

However, due to technical limitations (e.g. MRI signal calculation), a functional examination by MRI consists of a set of static joint positions (Muhle et al., 1996; Niitsu, 2001). Moreover, to obtain high-quality images with a short-time acquisition, a closed MRI unit with high magnetic field (1.5 T) is used (Maubon et al., 1999), requiring the acquisition to be made in a supine position. It has been assumed that a set of static positions in the supine position can be used to represent the function of the knee joint (Muhle et al., 1996; Niitsu, 2001).

The aim of this study is to determine if a finite set of knee extension in a supine position is representative of the load-bearing knee function (e.g. knee squat) by quantifying the kinematic difference between:

(1)
a knee extension in supine position from continuous motion and from a finite set of static positions (finite vs. continous),
(2)
a knee extension in supine position and the ascent phase of a squat exercise (continuous unloaded vs. continuous loaded).

Section snippets

Material and method

Twenty healthy subjects (7 females, 13 males, average 30.6 years old, range 24–54 year) without ligament laxity or disorders were selected. All subjects were examined by an experienced surgeon of the Saint Côme hospital. The subjects performed three knee extension exercises: a parallel squat and two knee extensions in supine position. In supine position, the knee extension was guided with the help of a drive device (Fig. 1). The drive device is a modification of that presented by Scarvell et

Results

The results presented large inter-individual variations (Fig. 2). Eight subjects had an average angle deviation $Ω_{1}$ and distance difference $Δ_{1}$ smaller than 5° and 5 mm, respectively, indicating a good correlation between the kinematics of the finite set of static positions and the continuous motion in supine position. Eight subjects had $Ω_{1}$ smaller than 5° or $Δ_{1}$ less than 5 mm. Finally, 4 subjects had $Δ_{1}$ larger than 5° and $Ω_{1}$ larger than 5 mm. For these subjects, kinematics of the two exercises were

Discussion and conclusion

Our study is based on the comparison of the motion using the screw motion theory by calculating of the finite helical axis (FHA). In the beginning of the 19th century, Chasles proved that any rigid body displacement can be realized by a rotation about an axis combined with a translation along this axis (Charles, 1880). In the particular case of the knee joint analysis the translation is negligible (Blankevoort et al., 1990). The complete description of the knee motion is the localization in

Acknowledgements

This work is supported by the Procope Program, German-French exchange program (French ministry of foreign affairs—German Academic Exchange Service).

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Short communicationCan a finite set of knee extension in supine position be used for a knee functional examination?

Abstract

Introduction

Section snippets

Material and method

Results

Discussion and conclusion

Acknowledgements

Journal of Biomechanics

Human Movement Science

Journal of Orthopaedic Research

Human Movement Science

Journal of Biomechanics

The use of functional analysis in evaluating knee kinematics

Clinical Orthopaedics

The science of anterior cruciate ligament rehabilitation

Clinical Orthopaedics

The whole leg radiographstanding versus supine for determining axial alignment

Acta Orthopaedica Scandinavica

Short communication
Can a finite set of knee extension in supine position be used for a knee functional examination?