Knee joint line related to bony landmarks of the knee: a radiologic study in a Thai population

( S. Tantavisut ),( C. Amarase ),( S. Ngarmukos ),( C. Tanavalee ),( A. Tanavalee1 ) 대한슬관절학회 2022 대한슬관절학회지 Vol.34 No.-

Background: During revision total knee arthroplasty (TKA), knee joint line restoration may be difficult due to bone loss or structural changes. Although bony landmarks are consistent and can be used as references, there are limited data in Asian patients. We studied the knee joint line related to bony landmarks of the knee in a Thai population. Materials and methods: Magnetic resonance imaging (MRI) of 140 healthy knees of Thai patients (70 males, 70 females) were investigated. In all knees, a perpendicular line from knee joint line to the medial epicondyle (distance A) and the lateral epicondyle (distance B) in the coronal plane were measured. In the sagittal plane, a perpendicular line from the knee joint line to the fibular head (distance C), the tibial tubercle (distance D), and the inferior patellar pole (distance E) were measured. The femoral transepicondylar width (FW) was measured along the transepicondylar axis. The ratios of distances A, B, C, D, and E related to FW were evaluated (epicondylar ratio). Results: The mean and standard deviation (SD) of distances A, B, C, D, E, and FW were 27.1 ± 2.7 mm, 21.7 ± 2.5 mm, 12.6 ± 3 mm, 21.3 ± 3.6 mm, 7.6 ± 4.8 mm, and 76.7 ± 3.99, respectively. There was wide variation of measured values, with statistically significant differences between genders in distances A, B, C, and FW. The mean and SD of epicondylar ratios A/FW, B/FW, C/FW, D/FW, and E/FW were 0.35 ± 0.02, 0.29 ± 0.02, 0.16 ± 0.05, 0.28 ± 0.04, and 0.09 ± 0.04, respectively. All epicondylar ratios demonstrated less variation than all measured distances, with statistical differences between genders in the A/FW and D/FW ratios. However, the B/FW ratio had the highest consistent mean value. In addition, it had narrower SD than the rest (0.29 ± 0.02; range, 0.22-0.33). Conclusions: In Thai knees, the measured distances from bony landmarks to the knee joint line had higher variation than the epicondylar ratio. Among all studied epicondylar ratios, the ratio between lateral epicondyle to joint line distance (distance B)/FW demonstrated the narrowest range of mean and SD values; therefore, this could be the most reliable landmark for intraoperative knee joint line verification by multiplying the FW of the patient by 0.29 to get distance B in that patient.

후방십자인대 보존형 Medial Pivot Knee

배대경(Dae Kyung Bae),윤경호(Kyoung Ho Yoon),김선구(Seon Goo Kim),박경준(Kyoung Jun Park) 대한정형외과학회 2007 대한정형외과학회지 Vol.42 No.1

목적: 후방십자인대 보존형 Medial pivot knee를 사용하여 슬관절 전치환술을 시행한 후 임상결과 및 방사선학적 결과를 분석하고 후방십자인대를 보존하는데 따른 수술 술기에 대해 알아보았다. 대상 및 방법: 2002년 3월부터 2003년 12월까지 후방십자인대 보존형 Medial pivot knee로 슬관절 전치환술을 시행 받은 28명(40예)을 대상으로 하였다. 평균 추시 기간은 2.8년(2년-3.7년)이었다. 술 전과 최종 추시 시의 임상결과를 관절운동범위, 슬관절 점수 및 기능 점수로 평가하였고 방사선학적 평가도 병행하였다. 결과: 굴곡구축은 술 전 평균 5.4°에서 최종 추시 시 평균 0.6°로 호전되었고 최대 굴곡은 숨 전 평균 126.1°, 최종 추시 시 평균 126.6°였다. 슬관절 점수는 술 전 평균 60.0에서 최종 추시 시 평균 94.8, 기능 접수는 술 전 평균 55.3에서 최종 추시 시 평균 87.0으로 향상되었다. 술 후 방사선학적 분석에서 평균 α각, β각, γ각, δ각은 각각 95.1°, 91.1°, 3.6°, 84.0°였다. 전 예에서 술 후 합병증은 없었다. 결론: 후방십자인대 보존형 Medial pivot knee를 사용한 슬관절 전치환술의 단기 추시결과는 양호하였다. Purpose: To analyze the clinical and radiographic results of patients who underwent total knee arthroplasty with a posterior cruciate retaining medial pivot knee, and to identify the technical aspects in preserving the posterior cruciate ligament. Materials and Methods: From March 2002 to Dec 2003, 40 total knee arthroplasties with a cruciate retaining medial pivot knee were implanted in 28 cases. The average follow-up period was 2.8 years (range, 2 to 3.7 years). The clinical and radiographic results were evaluated using the clinical and roentgenographic evaluation and scoring system of the American Knee Society. Results: The average flexion contracture before surgery was 5.4°, which improved to 0.6° at the last follow-up. The average preoperative knee flexion was 126.1° and 126.6° at the last follow-up. The average knee score improved from 60 points preoperatively to 94.8 points postoperatively, and the average functional score improved from 55.3 points to 87.0 points at the final evaluation. The average post operative α, β, γ and δ angles were 95.1°, 91.1°, 3.6° and 84.0°, respectively. There were no postoperative complications. Conclusion: The short term clinical results in patients who had undergone total knee arthroplasty with a cruciate retaining medial pivot knee was acceptable.

Anthropometry of Nonarthritic Asian Knees: Is It Time for a Race-Specific Knee Implant?

Mohan Hariharan,Chhabria Prasidh,Bagaria Vaibhav,Tadepalli Kalyan,Naik Lokesh,Kulkarni Rajiv 대한정형외과학회 2020 Clinics in Orthopedic Surgery Vol.12 No.2

Background: This study was done to study the anthropometry of nonarthritic Asian knees; to determine the differences in morphology between knees of different ethnicities and to compare the knee anthropometry values with sizes of available knee implants. Methods: Magnetic resonance imaging scans of 100 nonarthritic Indian knees were analyzed. Anteroposterior (AP) length, mediolateral (ML) length, and aspect ratio of the distal femur and proximal tibia, patellar length, and patellar tendon length were measured. These values were compared with values of other ethnicities from literature. The values were also compared with sizes of available knee implants and evaluated for mismatch. Results: All the parameters of female knees were significantly smaller than those of male knees (p < 0.05). The distal femur of Indian knees resembled that of Chinese knees with similar AP and ML lengths and aspect ratio. The distal femur of Indian knees had a significantly smaller AP, ML, and aspect ratio than those of Hispanic knees did. In comparison to Caucasian distal femur, Indian knees had smaller AP and ML lengths and larger aspect ratio. In terms of the proximal tibia, the Indian knees were smaller than Chinese (only ML), Caucasian (AP and ML) and Hispanic (AP and ML) knees. On comparison with implant sizes, there was a mismatch between the distal femur morphology and the dimensions of all implants. For a given AP length, the ML dimensions of all implants were smaller than the measured ML length of the knee. However, the tibial components of all the studied implants correlated well with the tibial morphology. Conclusions: Distinct anthropometric differences exist between knees of different ethnicities. The knees of females were smaller than the knees of males. In Indian knees, the ML-AP aspect ratio of the distal femur was higher than that of the currently available femoral components. These results suggest the need for race-specific knee implants.

슬관절 골관절염 환자의 슬관절 주위근의 근력비와 Q-각과의 관계

김선엽(Suhn-yeop Kim) 한국전문물리치료학회 2005 한국전문물리치료학회지 Vol.12 No.1

The quadriceps-angle (Q-angle) and the ratio of hamstring/quadriceps (H/Q) are important for the stability of the knee and for protection from excessive stress. The aim of this study was to examine the association between Q-angle and H/Q ratio with and without knee osteoarthritis. We compared knee osteoarthritis patients with symptom-free women. The mean age of the patients in the arthritis group (25 women, osteoarthritis) was 59.7 years. The non-arthritis group consisted of 25 women with a mean age of 55.2 years. of the 25 women with osteoarthritis, 5 had the condition in their left knee, 5 had it in their right knee, and 15 had it on both sides. There was no significant difference in the knee Q-angle of the left and right knees of the arthritis group and the non-arthritis-group (p>.05). The strength of all the muscles around the involved right knee in the arthritis group was significantly weaker than that of the non-arthritis group (p<.05). However, in the left knee, only the strength of the knee extensors and internal rotators was significantly weaker than that of the non-arthritis group (p<.05). The Q-angle was not associated with the H/Q ratio and internal rotators/external rotators ratio of the involved knee in the arthritis group (p>.05). Neither was the Q-angle associated with the pain level of an involved knee in the arthritis group (p>.05). The knee pain was not associated with the H/Q ratio of the involved knee in the arthritis group (p>.05). The Q-angle was not associated with the ratio of H/Q and pain level of the involved knee in the osteoarthritis women.

동일 환자에서 시행한 슬관절 부분치환술과 전치환술의 비교

김경태(Kyung Tae Kim),이송(Song Lee),박훈석(Hoon Seok Park),조근호(Kun Ho Cho),김관수(Kwan Soo Kim) 대한정형외과학회 2008 대한정형외과학회지 Vol.43 No.4

목적: 양측 슬관절에 부분치환술과 전치환술을 각각 시행한 환자에서 수술의 결과를 비교 분석하고 각 수술에 대한 환자들의 주관적 선호도와 만족도 등을 알아 보고자 하였다. 대상 및 방법: 2002년 1월부터 2004년 12월까지 한 쪽 슬관절에는 부분치환술을, 반대쪽에는 전치환술을 시행 받았던 51명의 퇴행성 슬관절염 환자를 대상으로 평균 4년의 추시 결과를 분석하였다. 결과: 슬관절 점수는 부분치환술의 경우 술 전 평균 53.5점에서 최종 추시 시 90.7점으로 증가하였고, 전치환술에서는 술 전 평균 50.4점에서 89.8점으로 향상되었다. 슬관절 운동 범위는 부분치환술에서 술 전 평균 124.7°에서 133.2°로, 전치환술에서 술 전 평균 122.5°에서 127.1°로 증가되었다. 대퇴 경골각은 부분치환술에서는 수술 전 평균 0.3° 내반에서 5.6° 외반으로, 전치환술에서는 수술 전 평균 2.4° 내반에서 5.8° 외반으로 교정되었다. 환자의 선호도는 23명(45%)은 부분치환술이, 19명(37%)은 전치환술이 더 좋다고 하였으며, 환자의 만족도는 양측 모두 42명(82%)에서 매우 만족 또는 만족의 결과를 보였다. 결론: 동일 환자의 양측 슬관절에 시행한 부분치환술과 전치환술의 결과는 평균 4년 추시 상 두 수술 모두 매우 양호하였으며, 부분치환술에서 관절 운동 범위가 좀 더 증가하였으나 그 외에는 유의한 차이가 없었다. Purpose: To compare the clinical and radiographic results of unicompartmental knee arthroplasty(UKA) and total knee arthroplasty (TKA) in the same patient, and to investigate patient preference and satisfaction. Materials and Methods: Among the 56 patients who underwent a UKA in one knee and a TKA in the opposite knee between January 2002 and December 2004, 51 patients were followed up. The average follow-up period was 4 years. Results: The average Knee Society Score (KSS) improved from 53.5 preoperatively to 90.7 at last follow-up in the UKA knee, and from 50.4 to 89.8 in the TKA knee. The mean range of knee motion also improved from 124.7° to 133.2° in the UKA knee, and from 122.5° to 127.1° in the TKA knee. The tibiofemoral angle changed from 0.3° of varus to 5.6° of valgus in the UKA knee, and from 2.4° of varus to 5.8° of valgus in the TKA knee. For patient preference, 23 patients (45%) preferred the UKA knee and 19 patients (37%) preferred the TKA knee. Most patients (42 patients, 82%) reported being 'very satisfied' or 'satisfied' with both knees. Conclusion: The clinical and radiographic results of both the UKA and the TKA in the same patient were satisfactory at the 4-year follow-up. The UKA knee had a slightly better range of knee motion, but there was essentially no difference between the UKA knee and the TKA knee.

Results of total knee arthroplasty for painless, stiff knees

Choi Young-Joon,Seo Dong-Kyo,Lee Ki Won,Ra Ho Jong,Kang Hyun Wook,Kim Jin Kyung 대한슬관절학회 2020 대한슬관절학회지 Vol.32 No.-

Stiff knees, like completely ankylosed or arthrodesed knees, can be painless. Total knee arthroplasty (TKA) for these painless, stiff knees is technically demanding. However, it can correct the alignment and advance the range of motion to improve quality of life. So, we reviewed the preoperative and postoperative results of functional and pain scores, range of motion (ROM) and complications in painless, stiff knees treated by TKA.Fifteen painless, stiff knees underwent TKA from January 1998 to January 2017. The mean follow-up period was 15.4 (2.4–22.2) years. All the knees were completely ankylosed or arthrodesed. Clinical outcome and complications were evaluated using medical record review, serial plan radiography, ROM assessment, Knee Society score (KSS), Knee Society function score (FS), and a visual analog scale for pain (VAS). All patients were satisfied with their operated knees. Mean KSS and FS scores were improved from 36 and 50.9 to 76.9 and 67.2, respectively ( P < 0.001 and P = 0.01). The mean ROM increased from 0º preoperatively to 77.6º (15–130) at the final follow-up ( P < 0.001). The mean VAS had worsened from 0 preoperatively to 0.2 postoperatively, however it was not significant ( P = 0.1). Major postoperative complications were reported in five of the knees (33.3%). The results of TKA for painless, stiff knees were satisfactory with improved ROM and quality of life. Although some patients had mild pain and complications postoperatively, they were satisfied with the result. However, our study recommends that surgeons should consider the high rate of complications in the completely ankylosed or arthrodesed knees.A retrospective case series, Level IV.

후방십자인대 대치형 Medial Pivot Knee를 이용한 슬관절 전치환술 -단기 추시 결과-

조성도 ( Sung Do Cho ),염윤석 ( Yoon Seok Youm ),정지영 ( Ji Young Jeong ),박기봉 ( Ki Bong Park ) 대한슬관절학회 2009 대한슬관절학회지 Vol.21 No.1

목적: 후방 십자 인대 대치형 Medial Pivot Knee를 사용한 슬관절 전치환술 후 최소 2년 이상 추시 가능하였던 환자들의 임상적 및 방사선학적 결과에 대해 알아보고자 하였다. 대상 및 방법: 2004년 10월부터 2006년 2월까지 PS Advance(R) Medial Pivot Knee 슬관절 전치환술을 시행 받고 최소 2년 이상 추시가 가능하였던 48명(70예)을 대상으로 하였다. 술전 및 술후 슬관절의 관절운동 범위, 대퇴 경골간 각, Knee Society (KS) 슬관절 점수 및 합병증에 대해 조사하였다. 결과: 슬관절의 관절 운동 범위는 술전 굴곡 구축 6.3°, 후속 굴곡 116.4°에서 술후 굴곡 구축 1.9°, 후속굴곡 120.5°로 호전되었다. 대퇴 경골간 각은 술전 내반 4°에서 술후 외반 5.5°로 호전되었다. 슬관절 점수는 술전 46점에서 술후 87점으로, 슬관절 기능 점수는 술전 37점에서 술후 83점으로 향상되었다. 합병증으로는 치환물 주위 골절 2예와 경골 삽입물의 실패가 1예에서 발생하였다. 결론: 후방 십자 인대 대치형 Medial Pivot Knee를 사용한 슬관절 전치환술을 시행하고 최소 2년 추시 결과 만족할 만한 임상적, 방사선학적 결과를 보였다. Purpose: To evaluate minimum 2-year follow-up clinical and radiological results after total knee arthroplasty (TKA) with a posterior cruciate ligament (PCL) substituting (PS) Medial Pivot Knee. Materials and Methods: Seventy knees in 48 patients, who could be followed up more than 2 years after TKA with PS Advance(R) Medial Pivot Knee from October 2004 to February 2006, were evaluated retrospectively. The evaluations included the preoperative and postoperative range of motion (ROM), tibiofemoral angle, Knee Society (KS) knee and function score and postoperative complications. Results: The ROM increased from preoperative mean flexion contracture of 6.3° and further flexion of 116.4° to a postoperative mean flexion contracture of 1.9° and further flexion of 120.5°. The tibiofemoral angle changed from preoperative varus 4° to postoperative valgus 5.5°. The KS knee and function score improved from 46 and 37 before surgery to 87 and 83 after surgery, respectively (p<0.05). The complications were 2 cases of periprosthetic patellar fracture and 1 case of early failure of the tibial component. Conclusion: The minimum 2 year follow-up results after TKA with PS Medial Pivot Knee were satisfactory.

태권도 선수와 일반인의 등척성 무릎신전 토크-각도 관계 특성 비교 분석

조계훈 ( Gye Hun Jo ),오정훈 ( Jeong Hoon Oh ),이해동 ( Hae Dong Lee ) 한국운동역학회 2015 한국운동역학회지 Vol.25 No.3

Objective : In order for Taekwondo athletes to perform destructive kicking performance, they are expected to have Taekwondo-specific muscle properties such as high muscle strength and power. The purpose of this study was to investigate the joint angle-dependent force-producing property of Taekwondo athletes’ knee extensor muscles, which is one of the primary muscle groups involved in kicking performance. Method : Ten Taekwondo male athletes (age: 19.9±0.7 yrs, height: 180.6±6.2 cm, body mass: 75.9±8.9 kg, career: 9.2±2.9 yrs.) and 10 healthy male non-athletes (age: 26.3±2.6 yrs, height: 174.2±4.8 cm, body mass: 72.8±7.7 kg) participated in this study. Subjects performed maximum isometric knee extension at knee joint angles of 40°, 60°, 80°, and 100° (the full knee extension was set to 0°) with the hip joint angles of 0° and 80° (the full extension was set to 0°). During the contractions, knee extension torque using an isokinetic dynamometer simultaneously with muscle activities of the rectus femoris (RF), and the vastus lateralis (VL) and vastus medialis (VM) using surface electromyography were recorded. Based on the torque values at systematically different knee-hip joint angles, the joint torque-angle relationships were established and then the optimal joint angle for the knee extensor was estimated. Results : The results of this study showed that the isometric knee extension torque values were greater for the Taekwondo athletes compared with the non-athlete group at all hip-knee joint angle combinations (p<.05). When the hip joint was set at 80°, the peak isometric torque was greater for the Taekwondo athletes compared with the non-athlete group (313.61±36.79 Nm and 221.43±35.92 Nm, respectively; p <.05) but the estimated optimum knee joint angles were similar (62.33±5.71° and 62.30±4.67° for the Taekwondo athletes and non-athlete group, respectively). When the hip joint was set at 0°, the peak isometric torque was greater for the Taekwondo athletes compared with the non-athlete group (296.29±45.13 Nm and 199.58±25.23 Nm, respectively; p<.05) and the estimated optimum knee joint angle was larger for the Taekwondo athletes compared with the non-athlete group (78.47±5.14° and 67.54±5.77°, respectively; p<.05). Conclusion : The results of this study suggests that, compared with non-athletes, Taekwondo athletes have stronger knee extensor strength at all hip-knee joint angle combinations as well as longer optimum muscle length, which might be optimized for the event-specific required performance through prolonged training period.

간격 차이(90° 굴곡 간격-신전 간격)와 슬관절 전 치환술 1년 후의 무릎 기능과의 관계

조명래(Myung-Rae Cho),도정석(Jung-Suk Do),김경태(Kyung-Tae Kim),최원기(Won-Kee Choi) 대한정형외과학회 2019 대한정형외과학회지 Vol.54 No.3

목적: 슬관절 전 치환술 시, 90° 굴곡과 신전 시의 간격(gap) 차이와 술 후 1년째의 슬관절 기능과의 관계를 알아보고자 하였다. 대상 및 방법: 2017년 3월부터 6월까지 골관절염 환자를 대상으로 하여 시행된 내비게이션을 이용한 전치환술의 연속된 82예를 대상으로 시행된 전향적 연구이다. 간격 측정은 내비게이션을 이용하였으며, 슬개골을 towel clip을 이용하여 정복한 이후 간격을 측정하였다. 신전 시의 내측과 외측 간격의 평균과 90° 굴곡 시의 내측과 외측 간격의 평균값을 구한 이후 간격 차이(90° 굴곡 시의 간격-신전 간격)를 계산하였다. 간격 차이<0 mm, 0 mm≤간격 차이<2 mm, 2 mm≤간격 차이를 각각 1군, 2군, 3군으로 나누었다. 술 후 1년째, Knee Society score (KSS)와 함께 무릎의 최대 굴곡 각도를 측정한 이후, 각 군 간의 값을 비교하였다. 결과: 간격 차이의 값에 따라 나눈 군의 수는 1군이 37예, 2군이 29예, 3군이 16예였다. 술 후 1년째의 KSS knee는 평균 81.21±8.31, KSS function은 71.34±9.84, 그리고 무릎의 최대 굴곡 각도는 126.48°±7.28°였다. 간격 차이에 따른 1년 후의 KSS의 값은 통계적으로 유의한 차이가 없었다. Mann-Whitney test를 이용한 두 군 간의 비교에서 2 mm≤간격 차이를 보이는 3군이 1군과 2군에 비하여 통계적으로 유의하게 큰 최대 무릎 굴곡 각도를 보였다. 결론: 슬관절 전 치환술 시, 90° 굴곡 시의 간격이 신전 시의 간격보다 2 mm 이상 큰 경우에서 다른 군에 비하여 술 후 1년째의 최대 무릎 굴곡 각도가 통계적으로 유의하게 높았다. Purpose: To evaluate the relationship between the knee function at 1 year postoperation and the gap difference (90˚ flexion gap–extension gap) in total knee replacement. Materials and Methods: Eighty-two consecutive osteoarthritis knees that underwent primary total knee replacement using navigation from March 2017 June 2017 were evaluated prospectively. The gap was measured using navigation after reducing the patella with towel clips. After checking the average values of the medial and lateral gaps at extension and 90˚ flexion knee, the gap difference (90˚ flexion gap–extension gap) was calculated. The knees were divided into three groups according to the gap difference (gap difference<0 mm, 0 mm≤gap difference<2 mm, 2 mm≤gap difference). The Knee Society score (KSS) and maximal knee flexion were compared at 1 year postoperation among three groups. Results: The numbers of knees according to groups were 37, 29, and 16 knees in regular order. The average of the KSS knee, KSS function, and maximal knee flexion at the 1-year follow-up were 81.21±8.31, 71.34±9.84, and 126.48˚±7.28˚, respectively. No statistically significant difference in KSS was observed among the 3 groups. The third group (2 mm≤gap difference) showed a larger maximal knee flexion than the other groups in the Mann–Whitney test. Conclusion: The group of total knee replacement (2 mm≤90˚ flexion gap–extension gap) showed larger maximal knee flexion than the other groups at the 1-year follow-up in statistics.

Effects of Lumbar Mobilization and Transcutaneous Electrical Nerve Stimulation on Proprioception and Muscular Strength in Volleyball Players with Chronic Knee Pain

Ahn, Ilhwan,An, Hojung International Academy of Physical Therapy Research 2021 Journal of International Academy of Physical Ther Vol.12 No.1

Background: The spinal nerves, which start at the lumbar level, are connected to the nerve innervation in the knees. Currently, there is a lack of research on the treatment of knee pain through lumbar mobilization. Objectives: To investigate the effects of lumbar joint mobilization (LJM) and transcutaneous electronic nerve stimulation (TENS) on proprioception and muscular strength in volleyball players with chronic knee pain. Design: Two group pre-posttest. Methods: A total of 26 professional volleyball players with chronic knee pain were allocated to the LJM (n=13) and TENS (n=13) groups. In the LJM group, grade III - IV amplitude was applied 3 times for 1 minute (80 times per minute) at the affected lumbar (L2-3) facet joint in the prone position. In the TENS group, the TENS treatment device was used to directly apply or 15 minutes to the area of chronic knee pain (100 Hz, 150 ㎲). Proprioception was measured by knee flexion and extension angles, and muscle strength was evaluated using an isokinetic test. Measurements were taken before and after interventions. Results: In the eye opened conditiond, proprioception significantly increased during both knee extension and flexion after LJM, while only knee extension was significantly increased in the TENS group. There was also a significant difference in knee extension between the two groups. In the eye close conditiond, proprioception was significantly improved only during knee extension in the LJM group, and the difference in knee extension between the groups was also significant (P<.05). The maximum torque of the affected knee joint was significantly improved at 60°/sec in both groups (P<.05); however, there was no difference between the two groups. There was no significant difference in the maximum flexion torque within or between the groups. Conclusion: This study suggests that LJM improved proprioception and muscular strength in volleyball players with chronic knee pain.