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, 7 (4), 2325967119836164

Tibiofemoral Cartilage Contact Differences Between Level Walking and Downhill Running


Tibiofemoral Cartilage Contact Differences Between Level Walking and Downhill Running

Berkcan Akpinar et al. Orthop J Sports Med.


Background: Some studies have suggested that altered tibiofemoral cartilage contact behavior (arthrokinematics) may contribute to long-term cartilage degeneration, potentially leading to tibiofemoral osteoarthritis. However, few studies have assessed normal tibiofemoral arthrokinematics during dynamic activities.

Purpose: To characterize tibiofemoral arthrokinematics during the impact phase of level walking and downhill running.

Study design: Descriptive laboratory study.

Methods: Arthrokinematic data were collected on uninjured knees of 44 participants (mean age, 20.7 ± 6.6 years). Using a dynamic stereoradiographic imaging system with superimposed 3-dimensional bone models from computed tomography and magnetic resonance imaging of participant-specific tibiofemoral joints, arthrokinematics were assessed during the first 15% of the gait cycle during level walking and the first 10% of the gait cycle during downhill running.

Results: During level walking and downhill running, the medial compartment had a greater cartilage contact area versus the lateral compartment. Both compartments had a significantly less cartilage contact area during running versus walking (medial compartment gait cycle affected: 8%-10%; lateral compartment gait cycle affected: 5%-10%). Further, medial and lateral compartment tibiofemoral contact paths were significantly more posterior and longer during downhill running.

Conclusion: There was a decreased tibiofemoral cartilage contact area during downhill running compared with level walking, suggesting that underlying bone morphology may play a key role in determining the size of cartilage contact regions.

Clinical relevance: This study provides the first data characterizing tibiofemoral cartilage contact patterns during level walking and downhill running. These results provide evidence in support of performing biomechanical assessments during both level walking and downhill running to obtain a comprehensive picture of tibiofemoral cartilage behavior after clinical interventions.

Keywords: articular cartilage biomechanics; dynamic cartilage motion; gait analysis; knee.

Conflict of interest statement

One or more of the authors has declared the following potential conflict of interest or source of funding: This work was supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH; award No. R01 AR056630); the content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. F.H.F. has received educational support from Smith & Nephew. W.J.A. and S.T. are named on a patent for the biplane radiographic imaging system used in this study. AOSSM checks author disclosures against the Open Payments Database (OPD). AOSSM has not conducted an independent investigation on the OPD and disclaims any liability or responsibility relating thereto.


Figure 1.
Figure 1.
Data collection, processing, and analysis. (Left) A participant walking (top) and running (bottom) within the biplane radiography system. (Middle) The model-based tracking process. Each participant-specific 3-dimensional (3D) bone model was placed in a computer-generated reproduction of the biplane system. Simulated radiographs were passed through the 3D bone model to generate digitally reconstructed radiographs (DRRs). The bone position and orientation were determined by an optimization process that matched the DRRs to edge-enhanced radiographs. (Right) Tibiofemoral cartilage contact areas seen from superior and anterior views.
Figure 2.
Figure 2.
Tibiofemoral cartilage contact area (A) during level walking, (B) during downhill running, (C) in the medial compartment, and (D) in the lateral compartment. All contact areas are expressed as a percentage of the total tibial cartilage area in each compartment. Shaded regions indicate ±1 SD. **P < .001, *P < .01.
Figure 3.
Figure 3.
The path of the center of the cartilage contact region during walking and running. (Left) Medial and lateral tibial cartilage contact paths over the first 10% of the gait cycle during level walking and downhill running. (Right) Medial and lateral femoral cartilage contact paths over the first 10% of the gait cycle during level walking and downhill running. Negative x-axis = medial side; negative y-axis = posterior direction.
Figure 4.
Figure 4.
Knee flexion during downhill running versus level walking. Shaded regions indicate ±1 SD. **P < .001.

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