Does the femur roll-back with flexion?

Abstract

MRI studies of the knee were performed at intervals between full extension and 120° of flexion in six cadavers and also non-weight-bearing and weight-bearing in five volunteers. At each interval sagittal images were obtained through both compartments on which the position of the femoral condyle, identified by the centre of its posterior circular surface which is termed the flexion facet centre (FFC), and the point of closest approximation between the femoral and tibial subchondral plates, the contact point (CP), were identified relative to the posterior tibial cortex. The movements of the CP and FFC were essentially the same in the three groups but in all three the medial differed from the lateral compartment and the movement of the FFC differed from that of the CP. Medially from 30° to 120° the FFC and CP coincided and did not move anteroposteriorly. From 30° to 0° the anteroposterior position of the FFC remained unchanged but the CP moved forwards by about 15 mm. Laterally, the FFC and the CP moved backwards together by about 15 mm from 20° to 120°. From 20° to full extension both the FFC and CP moved forwards, but the latter moved more than the former. The differences between the movements of the FFC and the CP could be explained by the sagittal shapes of the bones, especially anteriorly. The term ‘roll-back’ can be applied to solid bodies, e.g. the condyles, but not to areas. The lateral femoral condyle does roll-back with flexion but the medial does not, i.e. the femur rotates externally around a medial centre. By contrast, both the medial and lateral contact points move back, roughly in parallel, from 0° to 120° but they cannot ‘roll’. Femoral roll-back with flexion, usually imagined as backward rolling of both condyles, does not occur.