In vivo three-dimensional kinematics of normal knees during different high-flexion activities

Aims In Asia and the Middle‐East, people often flex their knees deeply in order to perform activities of daily living. The purpose of this study was to investigate the 3D kinematics of normal knees during high‐flexion activities. Our hypothesis was that the femorotibial rotation, varus‐valgus angle, translations, and kinematic pathway of normal knees during high‐flexion activities, varied according to activity. Materials and Methods We investigated the in vivo kinematics of eight normal knees in four male volunteers (mean age 41.8 years; 37 to 53) using 2D and 3D registration technique, and modelled the knees with a computer aided design program. Each subject squatted, kneeled, and sat crosslegged. We evaluated the femoral rotation and varus‐valgus angle relative to the tibia and anteroposterior translation of the medial and lateral side, using the transepicodylar axis as our femoral reference relative to the perpendicular projection on to the tibial plateau. This method evaluates the femur medially from what has elsewhere been described as the extension facet centre, and differs from the method classically applied. Results During squatting and kneeling, the knees displayed femoral external rotation. When sitting cross‐legged, femurs displayed internal rotation from 10° to 100°. From 100°, femoral external rotation was observed. No significant difference in varus‐valgus angle was seen between squatting and kneeling, whereas a varus position was observed from 140° when sitting cross‐legged. The measure kinematic pathway using our methodology found during squatting a medial pivoting pattern from 0° to 40° and bicondylar rollback from 40° to 150°. During kneeling, a medial pivot pattern was evident. When sitting cross‐legged, a lateral pivot pattern was seen from 0° to 100°, and a medial pivot pattern beyond 100°. Conclusion The kinematics of normal knees during high flexion are variable according to activity. Nevertheless, our study was limited to a small number of male patients using a different technique to report the kinematics than previous publications. Accordingly, caution should be observed in generalizing our findings.