Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HE Renjie , NING Ziwen , SHI Zhengliang , GU Ziming , LI Yanlin , WANG Guoliang ,  HE Chuan

Department of Sports Medicine, the First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

HE Chuan, Email: hczraul@sina.com

Keywords：

Knee joint; anterior cruciate ligament; femoral positioner; femoral tunnel; gait analysis

DOI：

10.7507/1002-1892.202303001

Video：

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Objective To investigate the changes of knee joint kinematics after anterior cruciate ligament (ACL) reconstruction assisted by personalized femoral positioner based on the apex of deep cartilage (ADC). Methods Between January 2021 and January 2022, a total of 40 patients with initial ACL rupture who met the selection criteria were randomly divided into the study group (using the personalized femoral positioner based on ADC design to assist ACL reconstruction) and the control group (not using the personalized femoral positioner to assist ACL reconstruction), with 20 patients in each group. Another 20 volunteers with normal knee were collected as a healthy group. There was no significant difference in gender, age, body mass index, and affected side between groups (P>0.05). Gait analysis was performed at 3, 6, and 12 months after operation using Opti _ Knee three-dimensional knee joint motion measurement and analysis system, and the 6 degrees of freedom (flexion and extension angle, varus and valgus angle, internal and external rotation angle, anteroposterior displacement, superior and inferior displacement, internal and external displacement) and motion cycle (maximum step length, minimum step length, and step frequency) of the knee joint were recorded. The patients’ data was compared to the data of healthy group. Results In the healthy group, the flexion and extension angle was (57.80±3.45)°, the varus and valgus angle was (10.54±1.05)°, the internal and external rotation angle was (13.02±1.66)°, and the anteroposterior displacement was (1.44±0.39) cm, the superior and inferior displacement was (0.86±0.20) cm, and the internal and external displacement was (1.38±0.39) cm. The maximum step length was (51.24±1.29) cm, the minimum step length was (45.69±2.28) cm, and the step frequency was (12.45±0.47) step/minute. Compared with the healthy group, the flexion and extension angles and internal and external rotation angles of the patients in the study group and the control group decreased at 3 months after operation, and the flexion and extension angles of the patients in the control group decreased at 6 months after operation, and the differences were significant (P<0.05); there was no significant difference in the other time points and other indicators when compared with healthy group (P>0.05). In the study group, the flexion and extension angles and internal and external rotation angles at 6 and 12 months after operation were significantly greater than those at 3 months after operation (P<0.05), while there was no significant difference in the other indicators at other time points (P>0.05). There was a significant difference in flexion and extension angle between the study group and the control group at 6 months after operation (P<0.05), but there was no significant difference of the indicators between the two groups at other time points (P>0.05).Conclusion Compared with conventional surgery, ACL reconstruction assisted by personalized femoral positioner based on ADC design can help patients achieve more satisfactory early postoperative kinematic results, and three-dimensional kinematic analysis can more objectively and dynamically evaluate the postoperative recovery of knee joint.

Citation： HE Renjie, NING Ziwen, SHI Zhengliang, GU Ziming, LI Yanlin, WANG Guoliang, HE Chuan. Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(6): 663-669. doi: 10.7507/1002-1892.202303001 Copy

1.	劉日許, 陳藝, 陳玉書, 等. 步態分析在膝關節疾病中的應用. 中華關節外科雜志 (電子版), 2018, 12(6): 53-58.
2.	Zantop T, Wellmann M, Fu FH, et al. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med, 2008, 36(1): 65-72.
3.	Sasaki N, Ishibashi Y, Tsuda E, et al. The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy, 2012, 28(8): 1135-1146.
4.	Komzák M, Hart R, Feranec M, et al. In vivo knee rotational stability 2 years after double-bundle and anatomic single-bundle ACL reconstruction. Eur J Trauma Emerg Surg, 2018, 44(1): 105-111.
5.	Noyes FR, Jetter AW, Grood ES, et al. Anterior cruciate ligament function in providing rotational stability assessed by medial and lateral tibiofemoral compartment translations and subluxations. Am J Sports Med, 2015, 43(3): 683-692.
6.	Adouni M, Shirazi-Adl A, Marouane H. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist. Comput Methods Biomech Biomed Engin, 2016, 19(4): 376-385.
7.	Schrijvers JC, van den Noort JC, van der Esch M, et al. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture, 2019, 70: 235-253.
8.	Capin JJ, Zarzycki R, Ito N, et al. Gait Mechanics in women of the ACL-SPORTS randomized control trial: Interlimb symmetry improves over time regardless of treatment group. J Orthop Res, 2019, 37(8): 1743-1753.
9.	Hart A, Han Y, Martineau PA. The apex of the deep cartilage: A landmark and new technique to help identify femoral tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy, 2015, 31(9): 1777-1783.
10.	Luque-Seron JA, Medina-Porqueres I. Anterior cruciate ligament strain in vivo: A systematic review. Sports Health, 2016, 8(5): 451-455.
11.	Weiske F, B?hme M, J?kel J, et al. Stair ascent comparison of lower limb kinematics with differing time normalization techniques. J Biomech, 2021, 119: 110316. doi: 10.1016/j.jbiomech.2021.110316.
12.	Ismail SA, Button K, Simic M, et al. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2016, 35: 68-80.
13.	Simon SR. Quantification of human motion: gait analysis-benefits and limitations to its application to clinical problems. J Biomech, 2004, 37(12): 1869-1880.
14.	Zeng X, Yang T, Kong L, et al. Changes in 6DOF knee kinematics during gait with decreasing gait speed. Gait Posture, 2022, 91: 52-58.
15.	Goetschius J, Hertel J, Saliba SA, et al. Gait biomechanics in anterior cruciate ligament-reconstructed knees at different time frames postsurgery. Med Sci Sports Exerc, 2018, 50(11): 2209-2216.
16.	Mouarbes D, Menetrey J, Marot V, et al. Anterior cruciate ligament reconstruction: A systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med, 2019, 47(14): 3531-3540.

1. 劉日許, 陳藝, 陳玉書, 等. 步態分析在膝關節疾病中的應用. 中華關節外科雜志 (電子版), 2018, 12(6): 53-58.
2. Zantop T, Wellmann M, Fu FH, et al. Tunnel positioning of anteromedial and posterolateral bundles in anatomic anterior cruciate ligament reconstruction: anatomic and radiographic findings. Am J Sports Med, 2008, 36(1): 65-72.
3. Sasaki N, Ishibashi Y, Tsuda E, et al. The femoral insertion of the anterior cruciate ligament: discrepancy between macroscopic and histological observations. Arthroscopy, 2012, 28(8): 1135-1146.
4. Komzák M, Hart R, Feranec M, et al. In vivo knee rotational stability 2 years after double-bundle and anatomic single-bundle ACL reconstruction. Eur J Trauma Emerg Surg, 2018, 44(1): 105-111.
5. Noyes FR, Jetter AW, Grood ES, et al. Anterior cruciate ligament function in providing rotational stability assessed by medial and lateral tibiofemoral compartment translations and subluxations. Am J Sports Med, 2015, 43(3): 683-692.
6. Adouni M, Shirazi-Adl A, Marouane H. Role of gastrocnemius activation in knee joint biomechanics: gastrocnemius acts as an ACL antagonist. Comput Methods Biomech Biomed Engin, 2016, 19(4): 376-385.
7. Schrijvers JC, van den Noort JC, van der Esch M, et al. Objective parameters to measure (in)stability of the knee joint during gait: A review of literature. Gait Posture, 2019, 70: 235-253.
8. Capin JJ, Zarzycki R, Ito N, et al. Gait Mechanics in women of the ACL-SPORTS randomized control trial: Interlimb symmetry improves over time regardless of treatment group. J Orthop Res, 2019, 37(8): 1743-1753.
9. Hart A, Han Y, Martineau PA. The apex of the deep cartilage: A landmark and new technique to help identify femoral tunnel placement in anterior cruciate ligament reconstruction. Arthroscopy, 2015, 31(9): 1777-1783.
10. Luque-Seron JA, Medina-Porqueres I. Anterior cruciate ligament strain in vivo: A systematic review. Sports Health, 2016, 8(5): 451-455.
11. Weiske F, B?hme M, J?kel J, et al. Stair ascent comparison of lower limb kinematics with differing time normalization techniques. J Biomech, 2021, 119: 110316. doi: 10.1016/j.jbiomech.2021.110316.
12. Ismail SA, Button K, Simic M, et al. Three-dimensional kinematic and kinetic gait deviations in individuals with chronic anterior cruciate ligament deficient knee: A systematic review and meta-analysis. Clin Biomech (Bristol, Avon), 2016, 35: 68-80.
13. Simon SR. Quantification of human motion: gait analysis-benefits and limitations to its application to clinical problems. J Biomech, 2004, 37(12): 1869-1880.
14. Zeng X, Yang T, Kong L, et al. Changes in 6DOF knee kinematics during gait with decreasing gait speed. Gait Posture, 2022, 91: 52-58.
15. Goetschius J, Hertel J, Saliba SA, et al. Gait biomechanics in anterior cruciate ligament-reconstructed knees at different time frames postsurgery. Med Sci Sports Exerc, 2018, 50(11): 2209-2216.
16. Mouarbes D, Menetrey J, Marot V, et al. Anterior cruciate ligament reconstruction: A systematic review and meta-analysis of outcomes for quadriceps tendon autograft versus bone-patellar tendon-bone and hamstring-tendon autografts. Am J Sports Med, 2019, 47(14): 3531-3540.

Chinese Journal of Reparative and Reconstructive Surgery

Three-dimensional kinematic analysis of knee joint after anterior cruciate ligament reconstruction with personalized femoral positioner based on apex of deep cartilage

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