Sagittal knee kinematics in relation with the posterior tibia slope during jump landing after an anterior cruciate ligament reconstruction

Abstract

Purpose: An increased posterior tibia plateau angle is associated with increased risk for anterior cruciate ligament injury and re-rupture after reconstruction. The aims of this study were to determine whether the tibia plateau angle correlates with dynamic anterior tibia translation (ATT) after an anterior cruciate ligament reconstruction and whether the tibia plateau angle correlates with aspects of knee kinematics and kinetics during jump landing.

Methods: Thirty-seven patients after anterior cruciate ligament reconstruction with autograft hamstring tendon were included. Knee flexion angle and knee extension moment during single leg hops for distance were determined using a motion capture system and the dynamic ATT with its embedded method. The medial and lateral posterior tibia plateau angle were measured using MRI. Moreover, passive ATT was measured using the KT-1000 arthrometer.

Results: A weak negative correlation was found between the maximal dynamic ATT and the medial tibia plateau angle (p = 0.028, r = - 0.36) and between the maximal knee flexion angle and the lateral tibia plateau angle (p = 0.025, r = - 0.37) during landing. Patients with a smaller lateral tibia plateau angle show larger maximal knee flexion angle during landing than the patients with larger lateral tibia plateau angle. Also, the lateral tibia plateau angle is associated the amount of with muscle activity.

Conclusion: The posterior medical tibia plateau angle is associated with dynamic ATT. The maximal knee flexion angle and muscle activity are associated with the posterior lateral tibia plateau angle.

Level of evidence: III.

Keywords: Anatomy; In-vivo knee kinematics; Knee; Tibia plateau.

Fig. 1

Marker placement. Markers were attached on the right and left anterior and posterior superior iliac spine, the right and left iliac crest, the greater trochanter, the medial and lateral epicondyles of the knee, the medial and lateral malleoli of the ankle, the heel, anterior of the talus bone and the first and fifth metatarsophalangeal joints. Besides, two additional markers were attached to the pelvis, two to the thigh, and six additional markers were attached to the shank (adapted from Boeth et al. [3])

Fig. 2

Determination of the medial and lateral PTPA using MRI and the circle method [12, 20]. First, the central sagittal MRI image was found (left image). This image was determined using the following criteria: the anterior and posterior proximal tibia cortices were visible in concave shape and the intercondylar eminence and the posterior cruciate ligament attachment were visible in the image. In this image, a circle was fitted to the proximal tibia, tangential to the cortices. A second circle was fitted distally in the tibia with its centre placed on the first circle. The longitudinal axis was determined by the line connecting the centres of the two circles. Then, the mid-sagittal images of the medial and lateral femoral condyles were selected (middle and right image). The angle between the line connecting the anterior and posterior articular surface of the posterior tibia plateau and the line at right angles to the longitudinal axis of the tibia on both medial and lateral images were the MPTPA and LPTPA respectively

Fig. 3

Correlations between MPTPA and the maximal dynamic ATT (a), knee flexion angle (c) and knee extension moment (e), and between LPTPA and the maximal dynamic ATT (b), knee flexion angle (d) and knee extension moment (f). *: significant

Fig. 4

SPM{X²} canonical correlation analysis between muscle activity and the LPTPA (a). Pos-hoc SPM{t} regression analysis between LPTPA and the medial hamstrings (b), biceps femoris (c), vastus lateralis (d), vastus medialis (e), rectus femoris (f), gastrocnemius lateralis (g) and gastrocnemius medialis (h) activation. X2* and t* are the significant boundaries of the analysis

Fig. 5

SPM{X²} canonical correlation analysis between muscle activity and the MPTPA (a). Pos-hoc SPM{t} regression analysis between MPTPA and the medial hamstrings (b), biceps femoris (c), vastus lateralis (d), vastus medialis (e), rectus femoris (f), gastrocnemius lateralis (g) and gastrocnemius medialis (h) activation. X2* and t* are the significant boundaries of the analysis