Biomechanical techniques to evaluate tibial rotation: a systematic review

Purpose: This article systematically reviewed the biomechanical techniques to quantify tibial rotation, for an overview of how to choose a suitable technique for specific clinical application. Methods: A systematic search was conducted and finally 110 articles were included in this study. The articles were categorized by the conditions of how the knee was examined: external load application, physical examination and dynamic task. Results: The results showed that two-thirds of the included studies measured tibial rotation under external load application, of which over 80% of the experiments employed a cadaveric model. The common techniques used included direct displacement measurement, motion sensor, optical tracking system and universal force moment sensor. Intra-operative navigation system was used to document tibial rotation when the knee was examined by clinical tests. For dynamic assessment of knee rotational stability, motion analysis with skin reflective markers was frequently used although this technique is less accurate due to the skin movement when compared with radiographic measurement. Conclusion: This study reports various biomechanical measurement techniques to quantify tibial rotation in the literatures. To choose a suitable measurement technique for a specific clinical application, it is suggested to quantify the effectiveness of a new designed surgical technique by using a cadaveric model before applying to living human subjects for intra-operative evaluation or long-time functional stability assessment. Attention should also be paid on the study's purpose, whether to employ a cadaveric model and the way of stress applied to the knee. Level of evidence: IV.