Accurate assessment of 3D tibio-femoral kinematics is essential for understanding knee joint functionality, but also provides a basis for assessing joint pathologies and the efficacy of musculoskeletal interventions. Until now, however, the assessment of functional kinematics in healthy knees has been mostly restricted to the loaded stance phase of gait, and level walking only, but the most critical conditions for the surrounding soft tissues are known to occur during high-flexion activities. This study aimed to determine the ranges of tibio-femoral rotation and condylar translation as well as provide evidence on the location of the centre of rotation during multiple complete cycles of different gait activities. Based on radiographic images captured using moving fluoroscopy in ten healthy subjects during multiple cycles of level walking, downhill walking and stair descent, 3D femoral and tibial poses were reconstructed to provide a comprehensive description of tibio-femoral kinematics. Despite a significant increase in joint flexion, the condylar antero-posterior range of motion remained comparable across all activities, with mean translations of 6.3-8.3 mm and 7.3-9.3 mm for the medial and lateral condyles respectively. Only the swing phase of level walking and stair descent exhibited a significantly greater range of motion for the lateral over the medial compartment. Although intra-subject variability was low, considerable differences in joint kinematics were observed between subjects. The observed subject-specific movement patterns indicate that accurate assessment of individual pre-operative kinematics together with individual implant selection and/or surgical implantation decisions might be necessary before further improvement to joint replacement outcome can be achieved.

Balgrist University Hospital Zürich Switzerland

Human Performance Lab Schulthess Clinic Zürich Switzerland

Institute for Biomechanics ETH Zürich Zürich Switzerland

Medical Faculty Charles University Prague Czech Republic

Royal London Hospital London United Kingdom

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