An evaluation of anatomical and functional knee axis definition in the context of side-cutting

Side-cutting is commonly used to evaluate knee joint kinematics and kinetics in the context of anterior cruciate ligament injury risk. Many existing side-cutting studies fail to clearly define the orientation of the femoral frame and the knee axis, making comparisons between studies difficult. A femoral frame constructed using the ISB or existing functional methods does not necessarily have a medial-lateral axis that is aligned with the axis of the knee. A functional frame that directly aligns with the medial-lateral knee axis was compared to the ISB anatomical frame and the Besier functional frame (Besier et al., 2003) to determine whether the chosen frame would affect the interpretation of side-cutting data. Kinematic and kinetic variables were calculated during three side-cutting manoeuvres of 28 subjects. Differences in mean frame orientation were correlated with the differences in mean knee angle during side-cutting. The differences between the ISB anatomical frame and the functional frames were significantly correlated with the differences in superior-inferior and medial-lateral axis orientations. Coefficients of multiple correlation showed a good to high (CMCs≥0.74) similarity between frames for knee angles and moments. Using a femoral anatomical frame rather than a functional frame most significantly affected offset rather than cross talk in knee angles and moments measured during side-cutting. There were no significant differences in offset or cross talk between the two functional methods. Maximum differences of <4° for frontal plane knee angle requires cautious interpretation but differences <8Nm for knee joint moment were not thought to affect the interpretation of side-cutting data when comparing between studies.