Clin Orthop Surg.  2015 Sep;7(3):303-309. 10.4055/cios.2015.7.3.303.

Screw-Home Movement of the Tibiofemoral Joint during Normal Gait: Three-Dimensional Analysis

• Kim HY
• Kim KJ
• Yang DS
• Jeung SW
• Choi HG
• Choy WS

• KMID: 2234083
• DOI: http://doi.org/10.4055/cios.2015.7.3.303

Abstract

BACKGROUND
The purpose of this study was to evaluate the screw-home movement at the tibiofemoral joint during normal gait by utilizing the 3-dimensional motion capture technique.
METHODS
Fifteen young males and fifteen young females (total 60 knee joints) who had no history of musculoskeletal disease or a particular gait problem were included in this study. Two more markers were attached to the subject in addition to the Helen-Hayes marker set. Thus, two virtual planes, femoral coronal plane (P(f)) and tibial coronal plane (P(t)), were created by Skeletal Builder software. This study measured the 3-dimensional knee joint movement in the sagittal, coronal, and transverse planes of these two virtual planes (P(f) and P(t)) during normal gait.
RESULTS
With respect to kinematics and kinetics, both males and females showed normal adult gait patterns, and the mean difference in the temporal gait parameters was not statistically significant (p > 0.05). In the transverse plane, the screw-home movement occurred as expected during the pre-swing phase and the late-swing phase at an angle of about 17degrees. However, the tibia rotated externally with respect to the femur, rather than internally, while the knee joint started to flex during the loading response (paradoxical screw-home movement), and the angle was 6degrees.
CONCLUSIONS
Paradoxical screw-home movement may be an important mechanism that provides stability to the knee joint during the remaining stance phase. Obtaining the kinematic values of the knee joint during gait can be useful in diagnosing and treating the pathological knee joints.

Keyword

Gait; Kinematics; Kinetics

MeSH Terms

Adolescent
Adult
Biomechanical Phenomena/physiology
Female
Fiducial Markers
Gait/*physiology
Humans
Imaging, Three-Dimensional
Knee Joint/*physiology
Male
Range of Motion, Articular/*physiology
Sex Factors
Walking/physiology
Young Adult

Figure

• 

  Fig. 1 Anterior (A) and posterior (B) photographs show that 9-mm passive reflective markers were attached by using the Helen-Hayes method, and additional markers were attached to the medial and lateral condyles of the proximal tibia, on which the medial and lateral collateral ligaments are attached.

• 

  Fig. 2 Anteroposterior (A) and lateral (B) radiographs show that the marker was attached to the medial and lateral condyles of the femur and the tibia. The marker on the lateral tibial condyle was positioned just over the top of the fibular head while the marker on the medial tibial condyle was positioned over the bony surface on which the medial collateral ligament is inserted. It was mostly at the same level as that of the lateral tibial condyle marker.

• 

  Fig. 3 This schematic image shows the two virtual planes (the femoral coronal plane and tibial coronal plane) created using the SKB program. A: distal thigh, B: medial femoral epicondyle, C: lateral femoral epicondyle, L: shank, M: medial tibial condyle, N: fibular head.

• 

  Fig. 4 These graphs show kinematics of the knee joint during gait. (A) While the knee joint was flexed approximately 15° during the loading response, the tibia was externally rotated around the femur about 6° (green line and black arrow). (B) This amount of tibial rotation was maintained during the mid-stance phase (green line and black arrow). (C) As the knee reached full extension in the late-swing phase, the tibia was then rotated externally by 17°; thus, it almost reached the neutral position (green line and black arrow). Rz: rotational degrees in the sagittal plane, negative value is the extension angle and positive value is the flexion angle, Rx: rotational degrees in the coronal plane, negative value is the extension angle and positive value is the flexion angle, negative value is the valgus angle and positive value is the varus angle, Ry: rotational degrees in the transverse plane, negative value is the external rotation angle and positive value is the internal rotation angle.

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