Four-dimensional computed tomographic analysis of screw home movement in patients with anterior cruciate ligament deficient knee — a 3D-3D registration technique

Objective: The tibia externally rotates to the femur during the last 20° of the knee extension motion. This kinematic phenomenon is well known as screw home movement (SHM). The purpose was to clarify the SHM in anterior cruciate ligament deficient (ACLD) knee using four-dimensional computed tomography (4DCT). Materials and methods: Six patients with a unilateral isolated ACLD knee participated. In the static position, CT scan of the both limbs of the femur and tibia were performed. Then, 4DCT was performed around knee. In the CT gantry, subjects were positioned in supine position with 45° of knee flexion on a triangle pillow and were asked to extend the knee to full extension within 10 s on each limb. The CT data were accumulated in digital imaging and communication in medicine (DICOM) data format. From the static CT and 4DCT DICOM data, three-dimensional surfaces of the knee joint were reconstructed. The whole tibia surface was matched into the partial tibia surface of that frame using 3D-3D registration technique. After the assessment of coordination system of the whole leg, knee flexion, abduction, and external rotation angle were calculated. Results: Knee external rotation angle was significantly smaller on the ACLD side than on the contralateral unaffected side in 0–15° of knee flexion (P < 0.05 in 0, 5, 10, and 15 degrees), while the angle was similar during 15–60° of knee flexion. Conclusion: The absence of SHM in ACLD knee was detected using 3D-3D registration technique based on 4DCT.