Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
Knee Surgery, Sports Traumatology, Arthroscopy
Published in: Knee Surgery, Sports Traumatology, Arthroscopy 8/2014

01-08-2014 | Knee

Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia

Authors: David F. Russell, Angela H. Deakin, Quentin A. Fogg, Frederic Picard

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 8/2014

Login to get access

Abstract

Purpose

The ability to quantify rotational laxity of the knee would increase understanding of functional rotatory instability, identify the best treatment methods for soft tissue injury, and have a role in diagnosis of soft tissue injury. This study aimed to report the reliability, repeatability and precision of a non-invasive adaptation of image-free navigation technology by comparing with a validated invasive system used for computer-assisted surgery.

Methods

Twelve cadaveric lower limbs were tested with a commercial image-free navigation system using passive trackers secured by bone screws. They were then tested a non-invasive fabric-strap system. Manual application of torque was used consistent with clinical examination to rotate the tibia to the end of internal rotation and external rotation range. Measurements were taken at 10° intervals from full extension to 90° flexion, and protocol was repeated twice using each system. Intraclass correlation coefficient (ICC) was used to reflect reliability of measurements. At each flexion interval, coefficient of repeatability (CR) was calculated for each system, and limits of agreement (LOA) were used to reflect agreement between the systems.

Results

The results for internal and external rotation were combined throughout flexion: ICC invasive; 0.94 (0.86–0.99), non-invasive; 0.92 (0.7–0.99), CR invasive; 2.4° (1.3–4.8°), non-invasive; 3.5° (1.8–6.6), LOA; 8.2° (4.3–13.5).

Conclusion

Non-invasive optical tracker fixation gives improved agreement with a validated method of measurement compared with devices measuring tibial rotation by foot position. This system gives the added possibility of dynamic, weight-bearing testing in the clinically important range of 0°–30° knee flexion without the need for any limb restraint.
Literature
1.
Alam M, Bull AM, Thomas R, Amis AA (2013) A clinical device for measuring internal-external rotational laxity of the knee. Am J Sports Med 41(1):87–94PubMedCrossRef
2.
Alam M, Bull AM, Thomas R, Amis AA (2011) Measurement of rotational laxity of the knee: in vitro comparison of accuracy between the tibia, overlying skin, and foot. Am J Sports Med 39(12):2575–2581PubMedCrossRef
3.
Alentorn-Geli E, Myer GD, Silvers HJ, Samitier G, Romero D, Lazaro-Haro C, Cugat R (2009) Prevention of non-contact anterior cruciate ligament injuries in soccer players. Part 1: mechanisms of injury and underlying risk factors. Knee Surg Sports Traumatol Arthrosc 17(7):705–729PubMedCrossRef
4.
Almquist PO, Arnbjornsson A, Zatterstrom R, Ryd L, Ekdahl C, Friden T (2002) Evaluation of an external device measuring knee joint rotation: an in vivo study with simultaneous Roentgen stereometric analysis. J Orthop Res 20(3):427–432PubMedCrossRef
5.
Almquist PO, Ekdahl C, Isberg PE, Friden T (2013) Knee rotation in healthy individuals related to age and gender. J Orthop Res 31(1):23–28PubMedCrossRef
6.
Almquist PO, Ekdahl C, Isberg PE, Friden T (2011) Measurements of knee rotation-reliability of an external device in vivo. BMC Musculoskelet Disord 12:291PubMedCentralPubMedCrossRef
7.
Amis AA, Gupta CM, Hijazi I, Race A, Robinson JR (2003) Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments. Knee Surg Sports Traumatol Arthrosc 11:271–281PubMedCrossRef
8.
Astephen JL, Deluzio KJ (2005) Changes in frontal plane dynamics and the loading response phase of the gait cycle are characteristic of severe knee osteoarthritis application of a multidimensional analysis technique. Clin Biomech 20(2):209–217CrossRef
9.
Bathis H, Perlick L, Tingart M, Luring C, Zurakowski D, Grifka J (2004) Alignment in total knee arthroplasty. A comparison of computer-assisted surgery with the conventional technique. J Bone Joint Surg Br 86(5):682–687PubMedCrossRef
10.
Bauwens K, Matthes G, Wich M, Gebhard F, Hanson B, Ekkernkamp A, Stengel D (2007) Navigated total knee replacement. A meta-analysis. J Bone Joint Surg Am 89(2):261–269PubMedCrossRef
11.
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1(8476):307–310PubMedCrossRef
12.
13.
Branch TP, Browne JE, Campbell JD, Siebold R, Freedberg HI, Arendt EA, Lavoie F, Neyret P, Jacobs CA (2010) Rotational laxity greater in patients with contralateral anterior cruciate ligament injury than healthy volunteers. Knee Surg Sports Traumatol Arthrosc 18(10):1379–1384PubMedCrossRef
14.
Branch TP, Mayr HO, Browne JE, Campbell JC, Stoehr A, Jacobs CA (2010) Instrumented examination of anterior cruciate ligament injuries: minimizing flaws of the manual clinical examination. Arthroscopy 26(7):997–1004PubMedCrossRef
15.
Brin YS, Nikolaou VS, Joseph L, Zukor DJ, Antoniou J (2011) Imageless computer assisted versus conventional total knee replacement. A Bayesian meta-analysis of 23 comparative studies. Int Orthop 35(3):331–339PubMedCentralPubMedCrossRef
16.
Carson WG Jr (1988) The role of lateral extra-articular procedures for anterolateral rotatory instability. Clin Sports Med 7(4):751–772PubMed
17.
Clarke JV (2012) The non-invasive measurement of knee kinematics in normal, osteoarthritic and prosthetic knees, in Bioengineering 2012, University of Strathclyde: Strathprints: The University of Strathclyde institutional repository
18.
Clarke JV, Riches PE, Picard F, Deakin AH (2012) Non-invasive computer-assisted measurement of knee alignment. Comput Aided Surg 17(1):29–39PubMedCrossRef
19.
Clarke JV, Wilson WT, Wearing SC, Picard F, Riches PE, Deakin AH (2012) Standardising the clinical assessment of coronal knee laxity. Proc Inst Mech Eng H 226(9):699–708PubMedCrossRef
20.
Czurda T, Fennema P, Baumgartner M, Ritschl P (2010) The association between component malalignment and post-operative pain following navigation-assisted total knee arthroplasty: results of a cohort/nested case-control study. Knee Surg Sports Traumatol Arthrosc 18(7):863–869PubMedCrossRef
21.
22.
Donaldson WF 3rd, Warren RF, Wickiewicz T (1985) A comparison of acute anterior cruciate ligament examinations. Initial versus examination under anesthesia. Am J Sports Med 13(1):5–10PubMedCrossRef
23.
Engle RP, Canner GC (1989) Rehabilitation of symptomatic anterolateral knee instability. J Orthop Sports Phys Ther 11(6):237–244PubMedCrossRef
24.
Espregueira-Mendes J, Pereira H, Sevivas N, Passos C, Vasconcelos JC, Monteiro A, Oliveira JM, Reis RL (2012) Assessment of rotatory laxity in anterior cruciate ligament-deficient knees using magnetic resonance imaging with Porto-knee testing device. Knee Surg Sports Traumatol Arthrosc 20(4):671–678PubMed
25.
Fleiss JL (1981) Statistical methods for rates and proportions, 2nd edn. Wiley series in probability and mathematical statistics. Wiley, New York, xviii, 321 p
26.
Fu FH, Harner CD, Johnson DL, Miller MD, Woo SL (1994) Biomechanics of knee ligaments: basic concepts and clinical application. Instr Course Lect 43:137–148PubMed
27.
Gollehon DL, Torzilli PA, Warren RF (1987) The role of the posterolateral and cruciate ligaments in the stability of the human knee. A biomechanical study. J Bone Joint Surg Am 69(2):233–242PubMed
28.
Grood ES, Stowers SF, Noyes FR (1988) Limits of movement in the human knee. Effect of sectioning the posterior cruciate ligament and posterolateral structures. J Bone Joint Surg Am 70(1):88–97PubMed
29.
Kim YH, Park JW, Kim JS (2012) Computer-navigated versus conventional total knee arthroplasty: a prospective randomized trial. J Bone Joint Surg Am 94(22):2017–2024
30.
Kocher MS, Steadman JR, Briggs KK, Sterett WI, Hawkins RJ (2004) Relationships between objective assessment of ligament stability and subjective assessment of symptoms and function after anterior cruciate ligament reconstruction. Am J Sports Med 32(3):629–634PubMedCrossRef
31.
Lane CG, Warren RF, Stanford FC, Kendoff D, Pearle AD (2008) In vivo analysis of the pivot shift phenomenon during computer navigated ACL reconstruction. Knee Surg Sports Traumatol Arthrosc 16(5):487–492PubMed
32.
Lipke JM, Janecki CJ, Nelson CL, McLeod P, Thompson C, Thompson J, Haynes DW (1981) The role of incompetence of the anterior cruciate and lateral ligaments in anterolateral and anteromedial instability. A biomechanical study of cadaver knees. J Bone Joint Surg Am 63(6):954–960PubMed
33.
Liu SH, Osti L, Henry M, Bocchi L (1995) The diagnosis of acute complete tears of the anterior cruciate ligament. Comparison of MRI, arthrometry and clinical examination. J Bone Joint Surg Br 77(4):586–588PubMed
34.
Lorbach O, Brockmeyer M, Kieb M, Zerbe T, Pape D, Seil R (2012) Objective measurement devices to assess static rotational knee laxity: focus on the Rotameter. Knee Surg Sports Traumatol Arthrosc 20(4):639–644PubMed
35.
Lorbach O, Wilmes P, Maas S, Zerbe T, Busch L, Kohn D, Seil R (2009) A non-invasive device to objectively measure tibial rotation: verification of the device. Knee Surg Sports Traumatol Arthrosc 17(7):756–762PubMedCrossRef
36.
Louie JK, Mote CD Jr (1987) Contribution of the musculature to rotatory laxity and torsional stiffness at the knee. J Biomech 20(3):281–300PubMedCrossRef
37.
Markolf KL, Mensch JS, Amstutz HC (1976) Stiffness and laxity of the knee–the contributions of the supporting structures. A quantitative in vitro study. J Bone Joint Surg Am 58(5):583–594PubMed
38.
Mason JB, Fehring TK, Estok R, Banel D, Fahrbach K (2007) Meta-analysis of alignment outcomes in computer-assisted total knee arthroplasty surgery. J Arthroplasty 22(8):1097–1106PubMedCrossRef
39.
Matziolis G, Krocker D, Weiss U, Tohtz S, Perka C (2007) A prospective, randomized study of computer-assisted and conventional total knee arthroplasty. Three-dimensional evaluation of implant alignment and rotation. J Bone Joint Surg Am 89(2):236–243PubMedCrossRef
40.
Mitsou A, Vallianatos P (1988) Clinical diagnosis of ruptures of the anterior cruciate ligament: a comparison between the Lachman test and the anterior drawer sign. Injury 19(6):427–428PubMedCrossRef
41.
More RC, Karras BT, Neiman R, Fritschy D, Woo SL, Daniel DM (1993) Hamstrings–an anterior cruciate ligament protagonist. An in vitro study. Am J Sports Med 21(2):231–237PubMedCrossRef
42.
Park HS, Wilson NA, Zhang LQ (2008) Gender differences in passive knee biomechanical properties in tibial rotation. J Orthop Res 26(7):937–944PubMedCrossRef
43.
Pearle AD, Solomon DJ, Wanich T, Moreau-Gaudry A, Granchi CC, Wickiewicz TL, Warren RF (2007) Reliability of navigated knee stability examination: a cadaveric evaluation. Am J Sports Med 35(8):1315–1320PubMedCrossRef
44.
Picard F (2007) Computer assisted orthopaedics: the image free concept. Proc BUSINESS GnbH, Berlin
45.
Portney LG, Watkins MP (1993) Foundations of clinical research: applications to practice. Appleton & Lange, Norwalk, xxvii, 722 p
46.
Robinson JR, Sanchez-Ballester J, Bull AM, Thomas W, Rde W, Amis AA (2004) The posteromedial corner revisited. An anatomical description of the passive restraining structures of the medial aspect of the human knee. J Bone Joint Surg Br 86(5):674–681PubMedCrossRef
47.
Rudolph T, Ebert L, Kowal J (2010) Comparison of three optical tracking systems in a complex navigation scenario. Comput Aided Surg 15(4–6):104–109PubMedCrossRef
48.
Russell DF, Deakin AH, Fogg QA, Picard F (2013) Non-invasive, non-radiological quantification of anteroposterior knee joint ligamentous laxity: a study in cadavers. Bone Joint Res 2(11):233–237PubMedCentralPubMedCrossRef
49.
Saragaglia D, Mercier N, Colle PE (2010) Computer-assisted osteotomies for genu varum deformity: which osteotomy for which varus? Int Orthop 34(2):185–190PubMedCentralPubMedCrossRef
50.
Saragaglia D, Roberts J (2005) Navigated osteotomies around the knee in 170 patients with osteoarthritis secondary to genu varum. Orthopedics 28(10 Suppl):s1269–s1274PubMed
51.
Shoemaker SC, Markolf KL (1985) Effects of joint load on the stiffness and laxity of ligament-deficient knees. An in vitro study of the anterior cruciate and medial collateral ligaments. J Bone Joint Surg Am 67(1):136–146PubMed
52.
Shrout PE, Fleiss JL (1979) Intraclass correlations: uses in assessing rater reliability. Psychol Bull 86(2):420–428PubMedCrossRef
53.
Shultz SJ, Schmitz RJ, Beynnon BD (2011) Variations in varus/valgus and internal/external rotational knee laxity and stiffness across the menstrual cycle. J Orthop Res 29(3):318–325PubMedCentralPubMedCrossRef
54.
Song EK, Seon JK, Park SJ (2007) How to avoid unintended increase of posterior slope in navigation-assisted open-wedge high tibial osteotomy. Orthopedics 30(10 Suppl):S127–S131PubMed
55.
Song EK, Seon JK, Park SJ, Seo HY (2008) Navigated open wedge high tibial osteotomy. Sports Med Arthrosc 16(2):84–90PubMedCrossRef
56.
Sparmann M, Wolke B, Czupalla H, Banzer D, Zink A (2003) Positioning of total knee arthroplasty with and without navigation support. A prospective, randomised study. J Bone Joint Surg Br 85(6):830–835PubMed
57.
Stergiou N, Ristanis S, Moraiti C, Georgoulis AD (2007) Tibial rotation in anterior cruciate ligament (ACL)-deficient and ACL-reconstructed knees: a theoretical proposition for the development of osteoarthritis. Sports Med 37(7):601–613PubMedCrossRef
58.
Stockl B, Nogler M, Rosiek R, Fischer M, Krismer M, Kessler O (2004) Navigation improves accuracy of rotational alignment in total knee arthroplasty. Clin Orthop Relat Res 426:180–186PubMedCrossRef
59.
Torg JS, Conrad W, Kalen V (1976) Clinical diagnosis of anterior cruciate ligament instability in the athlete. Am J Sports Med 4(2):84–93PubMedCrossRef
60.
Wiles DW, Thompson DG, Frantz DD (2004) Accuracy assessment and interpretation for optical tracking systems. Medical Imaging. Proc SPIE 5367(421):1–12
61.
Zarins B, Rowe CR (1986) Combined anterior cruciate-ligament reconstruction using semitendinosus tendon and iliotibial tract. J Bone Joint Surg Am 68(2):160–177PubMed
Metadata
Title
Repeatability and accuracy of a non-invasive method of measuring internal and external rotation of the tibia
Authors
David F. Russell
Angela H. Deakin
Quentin A. Fogg
Frederic Picard
Publication date
01-08-2014
Publisher
Springer Berlin Heidelberg
Published in
Knee Surgery, Sports Traumatology, Arthroscopy / Issue 8/2014
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI
https://doi.org/10.1007/s00167-013-2812-5

Other articles of this Issue 8/2014

Knee Surgery, Sports Traumatology, Arthroscopy 8/2014 Go to the issue

Knee

How to improve femoral component rotational alignment in computer-assisted TKA

Knee

Better quadriceps recovery after minimally invasive total knee arthroplasty

Knee

Trans-patella tendon approach for domed lateral unicompartmental knee arthroplasty does not increase the risk of patella tendon shortening

Editorial

Does implant design and surgical technique improve the clinical outcome in total knee arthroplasty?

Knee

The minimal clinically important difference in the Oxford knee score and Short Form 12 score after total knee arthroplasty

Knee

Causes of revision following Oxford phase 3 unicompartmental knee arthroplasty