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Knee Surgery, Sports Traumatology, Arthroscopy

Published in:

01-03-2017 | Knee

Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°

Authors: Anna Hirschmann, Florian M. Buck, Ramin Herschel, Christian W. A. Pfirrmann, Sandro F. Fucentese

Published in: Knee Surgery, Sports Traumatology, Arthroscopy | Issue 3/2017

Abstract

Purpose

To prospectively compare patellofemoral and tibiofemoral articulations in the upright weight-bearing position with different degrees of flexion using CT in order to gain a more thorough understanding of the development of diseases of the knee joint in a physiological position.

Materials and methods

CT scans of the knee in 0°, 30°, 60° flexion in the upright weight-bearing position and in 120° flexion upright without weight-bearing were obtained of 10 volunteers (mean age 33.7 ± 6.1 years; range 24–41) using a cone-beam extremity-CT. Two independent readers quantified tibiofemoral and patellofemoral rotation, tibial tuberosity–trochlear groove distance (TTTG) and patellofemoral distance. Tibiofemoral contact points were assessed in relation to the anteroposterior distance of the tibial plateau. Significant differences between degrees of flexion were sought using Wilcoxon signed-rank test (P < 0.05).

Results

With higher degrees of flexion, internal tibiofemoral rotation increased (0°/120° flexion; mean, 0.5° ± 4.5/22.4° ± 7.6); external patellofemoral rotation decreased (10.6° ± 7.6/1.6° ± 4.2); TTTG decreased (11.1 mm ±3.7/−2.4 mm ±6.4) and patellofemoral distance decreased (38.7 mm ±3.0/21.0 mm ±7.0). The CP shifted posterior, more pronounced laterally. Significant differences were found for all measurements at all degrees of flexion (P = 0.005–0.037), except between 30° and 60°. ICC was almost perfect (0.80–0.99), except for the assessment of the CP (0.20–0.96).

Conclusion

Knee joint articulations change significantly during flexion using upright weight-bearing CT. Progressive internal tibiofemoral rotation leads to a decrease in the TTTG and a posterior shift of the contact points in higher degrees of flexion. This elucidates patellar malalignment predominantly close to extension and meniscal tears commonly affecting the posterior horns.

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Title: Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°
Authors: Anna Hirschmann
Florian M. Buck
Ramin Herschel
Christian W. A. Pfirrmann
Sandro F. Fucentese
Publication date: 01-03-2017
Publisher: Springer Berlin Heidelberg
Published in: Knee Surgery, Sports Traumatology, Arthroscopy / Issue 3/2017
Print ISSN: 0942-2056
Electronic ISSN: 1433-7347
DOI: https://doi.org/10.1007/s00167-015-3853-8

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Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°

Abstract

Purpose

Materials and methods

Results

Conclusion

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Springer Medicine

Abstract

Purpose

Materials and methods

Results

Conclusion

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