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Review
. 2018 Jan;37(1):127-136.
doi: 10.1016/j.csm.2017.07.012. Epub 2017 Sep 6.

The Influence of Tibial and Femoral Bone Morphology on Knee Kinematics in the Anterior Cruciate Ligament Injured Knee

Drew Lansdown  1 , Chunbong Benjamin Ma  2
Affiliations
Review

The Influence of Tibial and Femoral Bone Morphology on Knee Kinematics in the Anterior Cruciate Ligament Injured Knee

Drew Lansdown et al. Clin Sports Med. 2018 Jan.

Abstract

Bone morphology is one feature that contributes to knee kinematics. The geometry of the tibia and femur vary across individuals, and these differences can influence the risk of anterior cruciate ligament (ACL) injury and of failure after isolated ACL reconstruction. There has been renewed interest in lateral extra-articular stabilization procedures to supplement an ACL reconstruction, although which patients benefit most from these procedures remains unclear. This article reviews the impact of bone morphology on knee kinematics, including tibial slope, depth of the medial tibial plateau, intercondylar notch shape, tibial eminence volume, and sphericity of the femoral condyles.

Keywords: Anterior cruciate ligament injuries; Bone morphology; Intercondylar notch shape; Knee kinematics; Tibial slope.

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Figures

Figure 1
Figure 1
The posterior tibial slope is defined on the lateral radiograph by measuring the angle between the diaphyseal axis (blue line) of the tibia and the tibial plateau (solid green line). An increased posterior tibial slope (dotted yellow line) is associated with increased anterior tibial translation and increased force across the anterior cruciate ligament.
Figure 2
Figure 2
The depth of the medial plateau was shown by Hashemi et al to be associated with the risk of ACL injury. A shallow medial tibial plateau, measured as shown here on a sagittal MRI, may be associated with less articular congruity and greater risk of ACL injury.
Figure 3
Figure 3
The intercondylar notch shape has been implicated as a risk factor for ACL injury. A pyramidal shape notch shape, present in this patient and outlined in blue, may lead to greater bony congruity of the knee and was found to be associated with better knee stability scores at two years after non-operatively treated ACL injuries as compared to a dome-shaped notch, outlined in green.
Figure 4
Figure 4
Two shapes identified through statistical shape modeling that were identified to be associated with abnormal post-ACL injury and post-reconstruction knee kinematics were the slope of the medial tibial plateau and the sphericity of the medial femoral condyle. A flatter medial tibial slope (A) was associated with knee kinematics that were more similar to the patient’s contralateral knee, while a steeper medial tibial slope was associated with greater anterior tibial translation. A more ovoid-shaped medial femoral condyle (B) was associated with more similar kinematics compared to the patient’s contralateral knee, while a more spherical-shaped medial femoral condyle was associated with greater anterior tibial translation. S – superior; I – inferior; A – anterior; P – posterior; M – medial; L – lateral.
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