Clinical Orthopaedics and Related Research®

, Volume 469, Issue 1, pp 95–106 | Cite as

In Vivo Normal Knee Kinematics: Is Ethnicity or Gender an Influencing Factor?

  • Filip Leszko
  • Kristen R. Hovinga
  • Amy L. Lerner
  • Richard D. KomistekEmail author
  • Mohamed R. Mahfouz
Symposium: Papers Presented at the Annual Meetings of the Knee Society



In vivo studies have suggested Caucasians achieve lower average knee flexion than non-Western populations. Some previous studies have also suggested gender may influence condylar AP translation and axial rotation, while others report an absence of such an influence.


We determined whether different ethnic and gender groups residing in the United States had different knee translations and rotations.


Three-dimensional knee rotations and translations were determined for 72 healthy subjects (24 Caucasian men, 24 Caucasian women, 13 Japanese men, 11 Japanese women) from full extension to maximum flexion using a fluoroscopic technique, under in vivo, weightbearing conditions.


Although we observed substantial variability in all groups, small differences between groups were found, especially in deep flexion. Japanese women and men and Caucasian women achieved higher maximum flexion (153°, 151°, and 152°, respectively) than Caucasian men (146°). External rotation was higher for these three groups than for Caucasian men. The medial condyle remained more anterior for Caucasian women and all Japanese subjects than for Caucasian men, possibly leading to greater axial rotation and flexion, observed for these three groups.


We identified small differences in maximum flexion between genders and ethnic groups. While no differences were identified in the lateral condyle translation, the medial condyle remained more stationary and more anterior for the groups that achieved highest (and similar) maximum flexion. Therefore, it may be important for future implant designs to incorporate these characteristics, such that only the lateral condyle experiences greater posterior femoral rollback, while the medial condyle remains more stationary throughout flexion.


Knee Flexion External Rotation Femoral Condyle Caucasian Woman Lateral Condyle 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We thank William Badger, Jason Horan, and Matthew Anderle for assistance with MR and fluoroscopic imaging.

Supplementary material

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  1. 1.
    Ahlberg A, Moussa M, Al-Nahdi M. On geographical variations in the normal range of joint motion. Clin Orthop Relat Res. 1988;234:229–231.PubMedGoogle Scholar
  2. 2.
    Anderson B, Burke E. Scientific, medical, and practical aspects of stretching. Clin Sports Med. 1991;10:63–86.PubMedGoogle Scholar
  3. 3.
    Andriacchi TP, Dyrby CO, Johnson TS. The use of functional analysis in evaluating knee kinematics. Clin Orthop Relat Res. 2003;410:44–53.CrossRefPubMedGoogle Scholar
  4. 4.
    Asano T, Akagi M, Tanaka K, Tamura J, Nakamura T. In vivo three-dimensional knee kinematics using a biplanar image-matching technique. Clin Orthop Relat Res. 2001;388:157–166.CrossRefPubMedGoogle Scholar
  5. 5.
    Austin B. Physical activity/exercise. In: Olshansky E, ed. Integrated Women’s Health: Holistic Approaches for Comprehensive Care. Gaithersburg, MD: Aspen Publishers, Inc; 2000:103.Google Scholar
  6. 6.
    Barnett C. Locking at the knee joint. J Anat. 1953;87:91–95.PubMedGoogle Scholar
  7. 7.
    Blaha J, Wojtys E. Motion and stability of the knee. In: Scott WN, ed. Surgery of the Knee. 4th ed. New York, NY: Churchill Livingstone; 2005:227–239.Google Scholar
  8. 8.
    Cates HE, Komistek RD, Mahfouz MR, Schmidt MA, Anderle M. In vivo comparison of knee kinematics for subjects having either a posterior stabilized or cruciate retaining high-flexion total knee arthroplasty. J Arthroplasty. 2008;23:1057–1067.CrossRefPubMedGoogle Scholar
  9. 9.
    Chappell JD, Yu B, Kirkendall DT, Garrett WE. A comparison of knee kinetics between male and female recreational athletes in stop-jump tasks. Am J Sports Med. 2002;30:261–267.PubMedGoogle Scholar
  10. 10.
    Decker MJ, Torry MR, Wyland DJ, Sterett WI, Richard Steadman J. Gender differences in lower extremity kinematics, kinetics and energy absorption during landing. Clin Biomech (Bristol, Avon). 2003;18:662–669.CrossRefGoogle Scholar
  11. 11.
    DeFrate LE, Sun H, Gill TJ, Rubash HE, Li G. In vivo tibiofemoral contact analysis using 3D MRI-based knee models. J Biomech. 2004;37:1499–1504.CrossRefPubMedGoogle Scholar
  12. 12.
    Dennis DA, Komistek RD, Colwell CE Jr, Ranawat CS, Scott RD, Thornhill TS, Lapp MA. In vivo anteroposterior femorotibial translation of total knee arthroplasty: a multicenter analysis. Clin Orthop Relat Res. 1998;356:47–57.CrossRefPubMedGoogle Scholar
  13. 13.
    Dennis DA, Komistek RD, Hoff WA, Gabriel SM. In vivo knee kinematics derived using an inverse perspective technique. Clin Orthop Relat Res. 1996;331:107–117.CrossRefPubMedGoogle Scholar
  14. 14.
    Dennis DA, Mahfouz MR, Komistek RD, Hoff W. In vivo determination of normal and anterior cruciate ligament-deficient knee kinematics. J Biomech. 2005;38:241–253.CrossRefPubMedGoogle Scholar
  15. 15.
    Freeman MA. How the knee moves. Curr Orthop. 2001;15:444–450.CrossRefGoogle Scholar
  16. 16.
    Freeman MA, Pinskerova V. The movement of the knee studied by magnetic resonance imaging. Clin Orthop Relat Res. 2003;410:35–43.CrossRefPubMedGoogle Scholar
  17. 17.
    Freeman MA, Pinskerova V. The movement of the normal tibio-femoral joint. J Biomech. 2005;38:197–208.CrossRefPubMedGoogle Scholar
  18. 18.
    Fuss F. Principles and mechanisms of automatic rotation during terminal extension in the human knee joint. J Anat. 1992;180(Pt 2):297–304.PubMedGoogle Scholar
  19. 19.
    Grood ES, Suntay WJ. A joint coordinate system for the clinical description of three-dimensional motions: application to the knee. J Biomech Eng. 1983;105:136–144.CrossRefPubMedGoogle Scholar
  20. 20.
    Hallen L, Lindahl O. The “screw-home” movement in the knee joint. Acta Orthop Scand, 1966;37:97–106.CrossRefPubMedGoogle Scholar
  21. 21.
    Hayter A. A proof of the conjecture that the Tukey-Kramer multiple comparisons procedure is conservative. Ann Stat. 1984;12:61–75.CrossRefGoogle Scholar
  22. 22.
    Hefzy MS, Kelly BP, Cooke TD. Kinematics of the knee joint in deep flexion: a radiographic assessment. Med Eng Phys. 1998;20:302–307.CrossRefPubMedGoogle Scholar
  23. 23.
    Heitz NA, Eisenman PA, Beck CL, Walker JA. Hormonal changes throughout the menstrual cycle and increased anterior cruciate ligament laxity in females. J Athl Train. 1999;34:144–149.PubMedGoogle Scholar
  24. 24.
    Hemmerich A, Brown H, Smith S, Marthandam SS, Wyss UP. Hip, knee, and ankle kinematics of high range of motion activities of daily living, J Orthop Res. 2006;24:770–781.CrossRefPubMedGoogle Scholar
  25. 25.
    Hoff WA, Komistek RD, Dennis DA, Gabrietl SM, Walker SA. Three-dimensional determination of femoral-tibial contact positions under in vivo conditions using fluoroscopy. Clin Biomech (Bristol, Avon). 1998;13:455–472.CrossRefGoogle Scholar
  26. 26.
    Hollman JH, Deusinger RH, Van Dillen LR, Matava MJ. Gender differences in surface rolling and gliding kinematics of the knee. Clin Orthop Relat Res. 2003;413:208–221.CrossRefPubMedGoogle Scholar
  27. 27.
    Hovinga KR, Lerner AL. Anatomic variations between Japanese and Caucasian populations in the healthy young adult knee joint. J Orthop Res. 2009;27:1191–1196.CrossRefPubMedGoogle Scholar
  28. 28.
    Hsu WH, Fisk JA, Yamamoto Y, Debski RE, Woo SL. Differences in torsional joint stiffness of the knee between genders. Am J Sports Med. 2006;34:765–770.CrossRefPubMedGoogle Scholar
  29. 29.
    Iwaki H, Pinskerova V, Freeman MA. Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee. J Bone Joint Surg Br. 2000;82:1189–1195.CrossRefPubMedGoogle Scholar
  30. 30.
    Johal P, Williams A, Wragg P, Hunt D, Gedroyc W. Tibio-femoral movement in the living knee. a study of weight bearing and non-weight bearing knee kinematics using “interventional” MRI. J Biomech. 2005;38:269–276.CrossRefPubMedGoogle Scholar
  31. 31.
    Komistek RD, Dennis DA, Mahfouz MR. In vivo fluoroscopic analysis of the normal human knee. Clin Orthop Relat Res. 2003;410:69–81.CrossRefPubMedGoogle Scholar
  32. 32.
    Komistek RD, Scott RD, Dennis DA, Yasgur D, Anderson DT, Hajner ME. In vivo comparison of femorotibial contact positions for Press-Fit posterior stabilized and posterior cruciate-retaining total knee arthroplasties. J Arthroplasty. 2002;17:209–216.CrossRefPubMedGoogle Scholar
  33. 33.
    Mahfouz MR, Hoff WA, Komistek RD, Dennis DA. A robust method for registration of three-dimensional knee implant models to two-dimensional fluoroscopy images. IEEE Trans Med Imaging. 2003;22:1561–1574.CrossRefPubMedGoogle Scholar
  34. 34.
    Mahfouz MR, Komistek RD, Dennis DA, Hoff WA. In vivo assessment of the kinematics in normal and anterior cruciate ligament-deficient knees. J Bone Joint Surg Am. 2004;86:56–61.PubMedGoogle Scholar
  35. 35.
    Malinzak RA, Colby SM, Kirkendall DT, Yu B, Garrett WE. A comparison of knee joint motion patterns between men and women in selected athletic tasks. Clin Biomech (Bristol, Avon) 2001;16:438–445.CrossRefGoogle Scholar
  36. 36.
    Martelli S, Pinskerova V. The shapes of the tibial and femoral articular surfaces in relation to tibiofemoral movement. J Bone Joint Surg Br. 2002;84:607–613.CrossRefPubMedGoogle Scholar
  37. 37.
    Nakagawa S, Kadoya Y, Todo S, Kobayashi A, Sakamoto H, Freeman MA, Yamano Y. Tibiofemoral movement 3: full flexion in the living knee studied by MRI. J Bone Joint Surg Br. 2000;82:1199–1200.CrossRefPubMedGoogle Scholar
  38. 38.
    Noble PC, Gordon MJ, Weiss JM, Reddix RN, Conditt MA, Mathis KB. Does total knee replacement restore normal knee function? Clin Orthop Relat Res. 2005;431:157–165.CrossRefPubMedGoogle Scholar
  39. 39.
    Pollard CD, Braun B, Hamill J. Influence of gender, estrogen and exercise on anterior knee laxity. Clin Biomech (Bristol, Avon). 2006;21:1060–1066.Google Scholar
  40. 40.
    Roaas A, Andersson GB. Normal range of motion of the hip, knee and ankle joints in male subjects, 30–40 years of age. Acta Orthop Scand. 1982;53:205–208.CrossRefPubMedGoogle Scholar
  41. 41.
    Scarvell JM, Smith PN, Refshauge KM, Galloway H, Woods K. Comparison of kinematics in the healthy and ACL injured knee using MRI. J Biomech. 2005;38:255–262.CrossRefPubMedGoogle Scholar
  42. 42.
    Sernert N, Kartus JT Jr, Ejerhed L, Karlsson J. Right and left knee laxity measurements: a prospective study of patients with anterior cruciate ligament injuries and normal control subjects. Arthroscopy. 2004;20:564–571.CrossRefPubMedGoogle Scholar
  43. 43.
    Sharma L, Lou C, Felson DT, Dunlop DD, Kirwan-Mellis G, Hayes KW, Weinrach D, Buchanan TS. Laxity in healthy and osteoarthritic knees. Arthritis Rheum. 1999;42:861–870.CrossRefPubMedGoogle Scholar
  44. 44.
    Sorrells RB, Stiehl JB, Voorhorst PE. Midterm results of mobile-bearing total knee arthroplasty in patients younger than 65 years. Clin Orthop Relat Res. 2001;390:182–189.CrossRefPubMedGoogle Scholar
  45. 45.
    Stern SH, Insall JN. Posterior stabilized prosthesis: results after follow-up of nine to twelve years. J Bone Joint Surg Am. 1992;74:980–986.PubMedGoogle Scholar
  46. 46.
    Varadarajan KM, Gill TJ, Freiberg AA, Rubash HE, Li G. Gender differences in trochlear groove orientation and rotational kinematics of human knees. J Orthop Res. 2009;27:871–878.CrossRefPubMedGoogle Scholar
  47. 47.
    Villar RN, Solomon VK, Rangam J. Knee surgery and the Indian knee. The importance of the preservation of flexion. Trop Doct. 1989;19:21–24.PubMedGoogle Scholar
  48. 48.
    Wojtys EM, Ashton-Miller JA, Huston LJ. A gender-related difference in the contribution of the knee musculature to sagittal-plane shear stiffness in subjects with similar knee laxity. J Bone Joint Surg Am. 2002;84:10–16.PubMedGoogle Scholar
  49. 49.
    Wojtys EM, Huston LJ, Schock HJ, Boylan JP, Ashton-Miller JA. Gender differences in muscular protection of the knee in torsion in size-matched athletes. J Bone Joint Surg Am. 2003;85:782–789.PubMedGoogle Scholar
  50. 50.
    Yoshiya S, Matsui N, Komistek RD, Dennis DA, Mahfouz M, Kurosaka M. In vivo kinematic comparison of posterior cruciate-retaining and posterior stabilized total knee arthroplasties under passive and weight-bearing conditions. J Arthroplasty. 2005;20:777–783.CrossRefPubMedGoogle Scholar
  51. 51.
    Zeller BL, McCrory JL, Kibler WB, Uhl TL. Differences in kinematics and electromyographic activity between men and women during the single-legged squat. Am J Sports Med. 2003;31:449–456.PubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons® 2010

Authors and Affiliations

  • Filip Leszko
    • 1
  • Kristen R. Hovinga
    • 2
  • Amy L. Lerner
    • 2
  • Richard D. Komistek
    • 1
    Email author
  • Mohamed R. Mahfouz
    • 1
  1. 1.University of Tennessee301 Perkins HallKnoxvilleUSA
  2. 2.Department of Biomedical EngineeringUniversity of RochesterRochesterUSA

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