A numerical method for improving the reliability of knee translation measurement in skin marker-based motion analysis

In skin-marker based motion analysis, knee translation measurement is highly dependent on a pre-selected reference point (functional center) on each segment determined by the location of anatomical landmarks. However, the placement of skin markers on palpable anatomical landmarks (i.e., femoral epicondyles) has limited reproducibility. Thus, it produces large variances in knee translation measurement among different subjects, as well as across studies. In order improve the repeatability of knee translation measurement, in this study an optimization method was introduced, by which the femoral functional center was numerically determined. At that point the knee anteroposterior translation during the stance phase of walking was minimized. This new method was tested on 30 healthy subjects during walking in gait lab with motion capture system. Using this new method, the impact of skin marker position (at anatomical landmarks) on the knee translation measurement has been minimized. In addition, the ranges of anteroposterior knee translations during stance phase were significantly (p<0.001) smaller than those measured by conventional method which relies on a pre-selected functional center ( 11.1±3.5mm vs. 19.9±5.5mm ). The results of anteroposterior translation using this new method were very close to a previously reported knee translation (12.4 mm) from dual fluoroscopic imaging technique. Moreover, this new method increased the reproducibility of knee translation measurement by 50%.