Squatting, lunging and kneeling provided similar kinematic profiles in healthy knees-A systematic review and meta-analysis of the literature on deep knee flexion kinematics.

Abstract

BACKGROUND:

Understanding healthy deep flexion kinematics will inform the design of conservative clinical rehabilitation strategies for knee osteoarthritis and contribute to improved knee prosthesis design. This study is a systematic review and meta-analysis of the kinematic outcomes measured at the healthy tibiofemoral joint during loaded deep knee flexion.

METHODS:

A computerised literature search and bibliography review without date restriction identified twelve studies with 164 participants aged 25-61 years in-vivo, and 69-93 years in-vitro. Flexion higher than 120° was achieved by squatting, lunging or kneeling. Measurement technologies in-vivo included radiographs, open MRI and 2D-3D MRI or CT image registration on fluoroscopy. Microscribe was used in-vitro.

RESULTS:

Outcomes were either six degrees-of-freedom based on femur movement or contact patterns on the tibial plateau. The meta-analysis demonstrated that in-vivo, between 120° and 135° of flexion, the tibia internally rotated (mean difference (MD) = 4.6°, 95% CI 3.55° to 5.64°). Both the medial-femoral-condyle and lateral-femoral-condyle translated posteriorly, (MD = 10.4 mm, 95% CI 6.9 to 13.9 mm) and (MD = 5.55 mm, 95% CI 4.64 to 6.46 mm) respectively. There was some evidence of femoral medial translation (3.8 mm) and adduction (1.9° to 3.3°), together with medial compression (1.7 mm) and lateral distraction (1.9) mm.

CONCLUSIONS:

Across the in-vivo studies, consistent kinematic patterns emerged; despite the various measurement technologies and reference methods. In contrast, in-vivo and in-vitro results were contradictory.

TRIAL REGISTRATION:

This systematic review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) on 25 February 2017 (registration number: 42017057614).

• Authors: Catherine R Galvin, Diana M Perriman, Phillip M Newman, Joseph T Lynch, Paul N Smith, Jennie M Scarvell
• Journal: The Knee (Knee) Vol. 25 Issue 4 Pg. 514-530 (Aug 2018) ISSN: 1873-5800 [Electronic] Netherlands
• PMID: 29802075 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2018 Elsevier B.V. All rights reserved.

Topics

• Adult
• Aged
• Aged, 80 and over
• Biomechanical Phenomena
• Female
• Femur (physiology)
• Fluoroscopy
• Humans
• Knee Joint (physiology)
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Prospective Studies
• Range of Motion, Articular (physiology)
• Tibia (physiology)
• Tomography, X-Ray Computed