title: Distal femoral condyle is more internally rotated to the patellar tendon at 90° of flexion in normal knees.
abstract: BACKGROUND
  The configuration of the distal surface of the femur would be more important in terms of the patellofemoral (PF) joint contact because the patella generally contacts with the distal surface of the femur in knee flexion. Some total knee arthroplasty (TKA) designs configurate medially prominent asymmetric femoral condyles. This difference in the design of distal femoral condyle may affect the PF joint congruity in knee flexion. Furthermore, some surgeons advocate a concept aligning the symmetric components parallel to the native joint inclination, not perpendicular to the mechanical axis. This concept would also make a difference on the PF joint congruity at the distal femur in knee flexion. However, no fundamental study has been reported on the PF congruity at the distal femur to discuss the theoretical priority of these concepts. The current study investigated the angular relationship between the tibial attachment of the patellar tendon and the distal surface of the femur at 90° of flexion in normal knees.
  
  
  METHODS
  The open magnetic resonance images of 45 normal knees at 90° of flexion were used to measure the angles between the tibial attachment of the patellar tendon, the equatorial line of the patella, and the distal surface of femoral condyles.
  
  
  RESULTS
  The distal surface of femoral condyles was internally rotated relative to the tibial attachment of the patellar tendon and the equatorial line of the patella in all the knees (8.2° ± 3.5° and 5.8° ± 2.5°, respectively), not parallel.
  
  
  CONCLUSIONS
  Distal femoral condyle is internally rotated to the patellar tendon at 90° of flexion in normal knees. When the symmetric femoral component is aligned perpendicular to the femoral mechanical axis, the patellar tendon would be possibly more twisted than the condition in normal knees, and the deviation of the PF contact force on the patellar component might be caused. The configuration and alignment of the distal condyle of the femoral component can affect the PF joint congruity in knee flexion. In this respect, our results provide important information in considering designs and alignment in the distal femur of TKA and the PF joint congruity in knee flexion.
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. kawahara@ortho.med.kyushu-u.ac.jp.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kawahara
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. okazaki@ortho.med.kyushu-u.ac.jp.
authors.forename: Ken
authors.initials: K
authors.lastname: Okazaki
authors.affiliation: Department of Orthopaedic Surgery, Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo, Kyoto, 606-8507, Japan. smat522@kuhp.kyoto-u.ac.jp.
authors.forename: Shuichi
authors.initials: S
authors.lastname: Matsuda
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. h-naka@ortho.med.kyushu-u.ac.jp.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nakahara
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. shige23@ortho.med.kyushu-u.ac.jp.
authors.forename: Shigetoshi
authors.initials: S
authors.lastname: Okamoto
authors.affiliation: Department of Orthopaedic Surgery, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. yiwamoto@ortho.med.kyushu-u.ac.jp.
authors.forename: Yukihide
authors.initials: Y
authors.lastname: Iwamoto
mesh_terms: D000328:Adult; D005260:Female; D005269:Femur / Q000502:physiology*; D006801:Humans; D007719:Knee Joint / Q000502:physiology*; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010329:Patella / Q000502:physiology; D017847:Patellar Ligament / Q000502:physiology*; D016059:Range of Motion, Articular / Q000502:physiology*; D012399:Rotation