The Geometrical Arrangement of Knee Constraints That Makes Natural Motion Possible: Theoretical and Experimental...

The study of the knee natural motion, namely the unresisted motion that the knee exhibits in the absence of external loads, provides insights into the physiology of this articulation. The natural motion represents the baseline condition upon which deformations of its passive structures (i.e., ligaments and cartilage) take place when loads are applied. Moreover, during natural motion, the strain energy density stored within ligaments and cartilage is minimized. This reduces the chance of microdamage occurrences and the corresponding metabolic cost for tissue repairing. The study of the knee natural motion is thus fundamental in understanding the joint physiology. This paper shows that the line of action of resultant forces of all the knee constraints provided by the passive structures must intersect the instantaneous helical axis (IHA) to make the knee natural motion possible. In other words, the lines of action of all these constraints must cross the same line at each flexion angle to guarantee the natural motion of the joint. This geometrical property is first proven theoretically and then verified in four in vitro and one in vivo experiments. The geometrical characterization of the knee natural motion presented in this study provides a fundamental property that must be satisfied to allow the correct joint mobility. The knowledge of this property may thus allow the definition of better models, treatments, and devices.