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

Catherine R. Galvin, Diana M. Perriman, Phillip M. Newman, Joseph T. Lynch, Paul N. Smith, Jennie M. Scarvell

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    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).

    Original languageEnglish
    Pages (from-to)514-530
    Number of pages17
    JournalKnee
    Volume25
    Issue number4
    DOIs
    Publication statusPublished - 2018

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    Thigh
    Biomechanical Phenomena
    Meta-Analysis
    Knee
    Prosthesis Design
    Technology
    Knee Prosthesis
    Bone and Bones
    Knee Osteoarthritis
    Fluoroscopy
    Bibliography
    Tibia
    Femur
    Rehabilitation
    Joints
    In Vitro Techniques

    Cite this

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    title = "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).",
    keywords = "Deep knee flexion, Healthy population, Kinematics, Knee, Meta-analysis, Tibiofemoral joint",
    author = "Galvin, {Catherine R.} and Perriman, {Diana M.} and Newman, {Phillip M.} and Lynch, {Joseph T.} and Smith, {Paul N.} and Scarvell, {Jennie M.}",
    year = "2018",
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    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. / Galvin, Catherine R.; Perriman, Diana M.; Newman, Phillip M.; Lynch, Joseph T.; Smith, Paul N.; Scarvell, Jennie M.

    In: Knee, Vol. 25, No. 4, 2018, p. 514-530.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - 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

    AU - Galvin, Catherine R.

    AU - Perriman, Diana M.

    AU - Newman, Phillip M.

    AU - Lynch, Joseph T.

    AU - Smith, Paul N.

    AU - Scarvell, Jennie M.

    PY - 2018

    Y1 - 2018

    N2 - 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).

    AB - 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).

    KW - Deep knee flexion

    KW - Healthy population

    KW - Kinematics

    KW - Knee

    KW - Meta-analysis

    KW - Tibiofemoral joint

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    JO - The Knee

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