Skip to main content
Erschienen in: Clinical Orthopaedics and Related Research® 3/2013

01.03.2013 | Basic Research

The Vector of Quadriceps Pull is Directed From the Patella to the Femoral Neck

verfasst von: Osamu Tanifuji, MD, John David Blaha, MD, Shin Kai, PhD

Erschienen in: Clinical Orthopaedics and Related Research® | Ausgabe 3/2013

Einloggen, um Zugang zu erhalten

Abstract

Background

The quadriceps is the primary extensor of the knee. Its vector, which is perpendicular to the flexion axis of the knee, is important in understanding knee function and properly aligning total knee components. Three-dimensional (3-D) imaging enables evaluation using a 3-D model of each quadriceps component.

Questions/purposes

We calculated the direction and magnitude of the quadriceps vector (QV) and the precision of the measurement, and asked whether the QV bears a constant relationship to the femur and is aligned with an anatomically based axis on the femur.

Methods

Using CT data of 14 subjects, we created a 3-D solid model of each quadriceps muscle component. Vectors (3-D direction and length) for each quadriceps component were determined using principal component analysis for muscle direction and volume for magnitude; vector addition established the directional vector of the combined muscle. The combined vector originating in the center of the patella was compared with the shaft, mechanical, and spherical (center femoral head to center medial side of the knee) axes.

Results

The QV passed from the patella center proximally crossing the femoral neck between the femoral head and greater trochanter and was most closely aligned with the spherical axis.

Conclusions

The QV axis may be an important reference for alignment of total knee components.

Clinical Relevance

The spherical axis can be used in aligning total knee components to the flexion axis of the knee.
Literatur
1.
Zurück zum Zitat Asano T, Akagi M, Tanaka K, Tamura J, Nakamura T. In vivo three-dimensional knee kinematics using a biplanar image-matching technique. Clin Orthop Relat Res. 2001;388:157–166.PubMedCrossRef Asano T, Akagi M, Tanaka K, Tamura J, Nakamura T. In vivo three-dimensional knee kinematics using a biplanar image-matching technique. Clin Orthop Relat Res. 2001;388:157–166.PubMedCrossRef
2.
Zurück zum Zitat Blaha JD. The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty. 2004;19(suppl 1):22–26.PubMedCrossRef Blaha JD. The rationale for a total knee implant that confers anteroposterior stability throughout range of motion. J Arthroplasty. 2004;19(suppl 1):22–26.PubMedCrossRef
3.
Zurück zum Zitat Bordor M. Quadriceps protects the anterior cruciate ligament. J Orthop Res. 2001;19:629–633.CrossRef Bordor M. Quadriceps protects the anterior cruciate ligament. J Orthop Res. 2001;19:629–633.CrossRef
4.
Zurück zum Zitat Churchill DL, Incavo SJ, Johnson CC, Beynnon BD. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res. 1998:356:111–118.PubMedCrossRef Churchill DL, Incavo SJ, Johnson CC, Beynnon BD. The transepicondylar axis approximates the optimal flexion axis of the knee. Clin Orthop Relat Res. 1998:356:111–118.PubMedCrossRef
5.
Zurück zum Zitat Eckhoff DG, Burke BJ, Dwyer TF, Pring ME, Spitzer VM, VanGerwen DP. The Ranawat Award: Sulcus morphology of the distal femur. Clin Orthop Relat Res. 1996;331:23–28.PubMedCrossRef Eckhoff DG, Burke BJ, Dwyer TF, Pring ME, Spitzer VM, VanGerwen DP. The Ranawat Award: Sulcus morphology of the distal femur. Clin Orthop Relat Res. 1996;331:23–28.PubMedCrossRef
6.
Zurück zum Zitat Eckhoff DG, Dwyer TF, Bach JM, Spitzer VM, Reinig KD. Three-dimensional morphology of the distal part of the femur viewed in virtual reality. J Bone Joint Surg Am. 2001;83(suppl 2):43–50.PubMed Eckhoff DG, Dwyer TF, Bach JM, Spitzer VM, Reinig KD. Three-dimensional morphology of the distal part of the femur viewed in virtual reality. J Bone Joint Surg Am. 2001;83(suppl 2):43–50.PubMed
7.
Zurück zum Zitat Elias JJ, Bratton DR, Weinstein DM, Cosgarea AJ. Comparing two estimations of the quadriceps force distribution for use during patellofemoral simulation. J Biomech. 2006;39:865–872.PubMedCrossRef Elias JJ, Bratton DR, Weinstein DM, Cosgarea AJ. Comparing two estimations of the quadriceps force distribution for use during patellofemoral simulation. J Biomech. 2006;39:865–872.PubMedCrossRef
8.
Zurück zum Zitat Farahmand F, Senavongse W, Amis AA. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res. 1998;16:136–143.PubMedCrossRef Farahmand F, Senavongse W, Amis AA. Quantitative study of the quadriceps muscles and trochlear groove geometry related to instability of the patellofemoral joint. J Orthop Res. 1998;16:136–143.PubMedCrossRef
9.
Zurück zum Zitat Hollister A. Hollister total knee endoprosthesis with fixed flexion-extension axis of rotation. Patent 5,133,758. Jul 28, 1992. Hollister A. Hollister total knee endoprosthesis with fixed flexion-extension axis of rotation. Patent 5,133,758. Jul 28, 1992.
10.
Zurück zum Zitat Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res. 1993;290:259–268.PubMed Hollister AM, Jatana S, Singh AK, Sullivan WW, Lupichuk AG. The axes of rotation of the knee. Clin Orthop Relat Res. 1993;290:259–268.PubMed
11.
Zurück zum Zitat Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther. 1989;69:897–901.PubMed Horton MG, Hall TL. Quadriceps femoris muscle angle: normal values and relationships with gender and selected skeletal measures. Phys Ther. 1989;69:897–901.PubMed
12.
Zurück zum Zitat Janssen YJ, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone (GH) therapy in adults with GH deficiency. J Clin Endocrinol Metab. 1999;84:279–284.PubMedCrossRef Janssen YJ, Doornbos J, Roelfsema F. Changes in muscle volume, strength, and bioenergetics during recombinant human growth hormone (GH) therapy in adults with GH deficiency. J Clin Endocrinol Metab. 1999;84:279–284.PubMedCrossRef
13.
Zurück zum Zitat Kan JH, Heemskerk AM, Ding Z, Gregory A, Mencio G, Spindler K, Damon BM. DTI-based muscle fiber tracking of the quadriceps mechanism in lateral patellar dislocation. J Magn Reson Imaging. 2009;29:663–670.PubMedCrossRef Kan JH, Heemskerk AM, Ding Z, Gregory A, Mencio G, Spindler K, Damon BM. DTI-based muscle fiber tracking of the quadriceps mechanism in lateral patellar dislocation. J Magn Reson Imaging. 2009;29:663–670.PubMedCrossRef
14.
Zurück zum Zitat Lieb FJ, Perry J. Quadriceps function: an anatomical and mechanical study using amputated limbs. J Bone Joint Surg Am. 1968;50:1535–1548.PubMed Lieb FJ, Perry J. Quadriceps function: an anatomical and mechanical study using amputated limbs. J Bone Joint Surg Am. 1968;50:1535–1548.PubMed
15.
Zurück zum Zitat Moro-oka T, Hamai S, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA. Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res. 2008;26:428–434.PubMedCrossRef Moro-oka T, Hamai S, Miura H, Shimoto T, Higaki H, Fregly BJ, Iwamoto Y, Banks SA. Dynamic activity dependence of in vivo normal knee kinematics. J Orthop Res. 2008;26:428–434.PubMedCrossRef
16.
Zurück zum Zitat Most E, Axe J, Rubash H, Li G. Sensitivity of the knee joint kinematics calculation to selection of flexion axes. J Biomech. 2004;37:1743–1748.PubMedCrossRef Most E, Axe J, Rubash H, Li G. Sensitivity of the knee joint kinematics calculation to selection of flexion axes. J Biomech. 2004;37:1743–1748.PubMedCrossRef
17.
Zurück zum Zitat O’Brien TD, Reeves ND, Baltzopoulos V, Jones DA, Maganaris CN. Strong relationships exist between muscle volume, joint power and whole-body external mechanical power in adults and children. Exp Physiol. 2009;94:731–738.PubMedCrossRef O’Brien TD, Reeves ND, Baltzopoulos V, Jones DA, Maganaris CN. Strong relationships exist between muscle volume, joint power and whole-body external mechanical power in adults and children. Exp Physiol. 2009;94:731–738.PubMedCrossRef
18.
Zurück zum Zitat Pincivero DM, Gandhi V, Timmons MK, Coelho AJ. Quadriceps femoris electromyogram during concentric, isometric, and eccentric phases of fatiguing dynamic knee extensions. J Biomech. 2006;39:246–254.PubMedCrossRef Pincivero DM, Gandhi V, Timmons MK, Coelho AJ. Quadriceps femoris electromyogram during concentric, isometric, and eccentric phases of fatiguing dynamic knee extensions. J Biomech. 2006;39:246–254.PubMedCrossRef
19.
Zurück zum Zitat Powers CM, Chen YJ, Scher IS, Lee TQ. Multiplane loading of the extensor mechanism alters the patellar ligament force/quadriceps force ratio. J Biomech Eng. 2010;132:024503.PubMedCrossRef Powers CM, Chen YJ, Scher IS, Lee TQ. Multiplane loading of the extensor mechanism alters the patellar ligament force/quadriceps force ratio. J Biomech Eng. 2010;132:024503.PubMedCrossRef
20.
Zurück zum Zitat Powers CM, Lilley JC, Lee TQ. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint. Clin Biomech (Bristol, Avon). 1998;13:616–624.CrossRef Powers CM, Lilley JC, Lee TQ. The effects of axial and multi-plane loading of the extensor mechanism on the patellofemoral joint. Clin Biomech (Bristol, Avon). 1998;13:616–624.CrossRef
21.
Zurück zum Zitat Sato T, Koga Y, Omori G. Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty. J Arthroplasty. 2004;19:620–628.PubMedCrossRef Sato T, Koga Y, Omori G. Three-dimensional lower extremity alignment assessment system: application to evaluation of component position after total knee arthroplasty. J Arthroplasty. 2004;19:620–628.PubMedCrossRef
22.
Zurück zum Zitat Schulthies SS, Francis RS, Fisher AG, Van de Graaff KM. Does the Q angle reflect the force on the patella in the frontal plane. Phys Ther. 1995;75:24–30.PubMed Schulthies SS, Francis RS, Fisher AG, Van de Graaff KM. Does the Q angle reflect the force on the patella in the frontal plane. Phys Ther. 1995;75:24–30.PubMed
23.
Zurück zum Zitat Walker PS, Kurosawa H, Rovick JS, Zimmerman RA. External knee joint design based on normal motion. J Rehabil Res Dev. 1985;22:9–22.PubMedCrossRef Walker PS, Kurosawa H, Rovick JS, Zimmerman RA. External knee joint design based on normal motion. J Rehabil Res Dev. 1985;22:9–22.PubMedCrossRef
24.
Zurück zum Zitat Weinstabl R, Scharf W, Firbas W. The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance. Surg Radiol Anat. 1989;11:17–22.PubMedCrossRef Weinstabl R, Scharf W, Firbas W. The extensor apparatus of the knee joint and its peripheral vasti: anatomic investigation and clinical relevance. Surg Radiol Anat. 1989;11:17–22.PubMedCrossRef
25.
Zurück zum Zitat Wilson NA, Sheehan FT. Dynamic in vivo quadriceps lines-of-action. J Biomech. 2010;43:2106–2113.PubMedCrossRef Wilson NA, Sheehan FT. Dynamic in vivo quadriceps lines-of-action. J Biomech. 2010;43:2106–2113.PubMedCrossRef
26.
Zurück zum Zitat Zhang LQ, Wang G, Nuber GW, Press JM, Koh JL. In vivo load sharing among the quadriceps component. J Orthop Res. 2003;21:565–571.PubMedCrossRef Zhang LQ, Wang G, Nuber GW, Press JM, Koh JL. In vivo load sharing among the quadriceps component. J Orthop Res. 2003;21:565–571.PubMedCrossRef
Metadaten
Titel
The Vector of Quadriceps Pull is Directed From the Patella to the Femoral Neck
verfasst von
Osamu Tanifuji, MD
John David Blaha, MD
Shin Kai, PhD
Publikationsdatum
01.03.2013
Verlag
Springer-Verlag
Erschienen in
Clinical Orthopaedics and Related Research® / Ausgabe 3/2013
Print ISSN: 0009-921X
Elektronische ISSN: 1528-1132
DOI
https://doi.org/10.1007/s11999-012-2741-5

Weitere Artikel der Ausgabe 3/2013

Clinical Orthopaedics and Related Research® 3/2013 Zur Ausgabe

Symposium: Papers Presented at the 2011 ISOLS Meeting in Beijing, China

Joint-preserving Tumor Resection and Reconstruction Using Image-guided Computer Navigation

Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

A Novel Imaging System Permits Real-time in Vivo Tumor Bed Assessment After Resection of Naturally Occurring Sarcomas in Dogs

Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

Using the CUSUM Test to Control the Proportion of Inadequate Open Biopsies of Musculoskeletal Tumors

Symposium: Highlights from the First Combined 2011 Meeting of the Musculoskeletal Tumor Society and Connective Tissue Oncology Society

Lipid-functionalized Dextran Nanosystems to Overcome Multidrug Resistance in Cancer: A Pilot Study

Arthropedia

Grundlagenwissen der Arthroskopie und Gelenkchirurgie. Erweitert durch Fallbeispiele, Videos und Abbildungen. 
» Jetzt entdecken

Notfall-TEP der Hüfte ist auch bei 90-Jährigen machbar

26.04.2024 Hüft-TEP Nachrichten

Ob bei einer Notfalloperation nach Schenkelhalsfraktur eine Hemiarthroplastik oder eine totale Endoprothese (TEP) eingebaut wird, sollte nicht allein vom Alter der Patientinnen und Patienten abhängen. Auch über 90-Jährige können von der TEP profitieren.

Arthroskopie kann Knieprothese nicht hinauszögern

25.04.2024 Gonarthrose Nachrichten

Ein arthroskopischer Eingriff bei Kniearthrose macht im Hinblick darauf, ob und wann ein Gelenkersatz fällig wird, offenbar keinen Unterschied.

Therapiestart mit Blutdrucksenkern erhöht Frakturrisiko

25.04.2024 Hypertonie Nachrichten

Beginnen ältere Männer im Pflegeheim eine Antihypertensiva-Therapie, dann ist die Frakturrate in den folgenden 30 Tagen mehr als verdoppelt. Besonders häufig stürzen Demenzkranke und Männer, die erstmals Blutdrucksenker nehmen. Dafür spricht eine Analyse unter US-Veteranen.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Update Orthopädie und Unfallchirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.