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Carswell TMR, Hasan M, Giles JW. A scoping review and evaluation of open-source transtibial amputation musculoskeletal models for female populations. Prosthet Orthot Int 2024:00006479-990000000-00264. [PMID: 39259587 DOI: 10.1097/pxr.0000000000000372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 05/14/2024] [Indexed: 09/13/2024]
Abstract
Musculoskeletal modeling is often used to study people with transtibial amputations. Females in this population are of particular interest as they are underrepresented in research, experience unique challenges, and demonstrate gait biomechanics distinct from males. Because generic models often neglect innate variations between populations, it is important to determine whether data used to develop a model are representative of the population studied. The objective of this study was to review and analyze existing transtibial amputation musculoskeletal models, establish a database from the information compiled, and use the database to select the model most relevant for studying female populations. A scoping search was performed and a database was created based on data detailing the eligible models. Models were evaluated through a weighted decision process based on criteria of their representation of females with transtibial amputations, prosthetic functionality, development transparency, overall functionality, and experimental validation methods. The scoping review identified 3 studies, Willson et al., LaPrè et al., and Miller and Esposito. A database detailing these models was established. The Willson model scored highest on all criteria except overall functionality, where the LaPrè model outscored it. Based on the established weightings, the Willson model was classed most appropriate for the stated goals. The created database can be used by other researchers to guide their own modeling studies, irrespective of the population of focus. Of the 3, the Willson model was found most relevant for studying females with transtibial amputations. This model will be used in future work investigating and addressing challenges of females with transtibial amputations.
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Affiliation(s)
- Tess M R Carswell
- Orthopaedic Technologies and Biomechanics Laboratory, Department of Mechanical Engineering, University of Victoria, Victoria, Canada
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Dan MJ, Wills DJ, Crowley JD, Cance N, Romandini I, Walsh WR, Dejour DH. Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2024; 32:1071-1076. [PMID: 38509848 DOI: 10.1002/ksa.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) is used to treat clinical instability post ACL rupture, however, there is a high rate of incomplete return to sport and rerupture. There is increasing interest in posterior tibial slope as an intrinsic risk factor for ACLR failure and persistent instability. Zoobiquity describes the collaboration between the human and veterinary professions in order to advance the scientific understanding of both fields. Given the cranial cruciate ligament (CCL) in dogs is synonymous with the anterior cruciate ligament in humans, functioning to control internal rotation and anterior translation, but osteotomies, rather than ligament reconstruction, are the mainstay of treatment for CCL rupture, this editorial sort to gain insights into this form of treatment from the veterinary world. Level of Evidence: Level V, evidence.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
- East Coast Athletic Orthopaedics, Merewether, New South Wales, Australia
| | - Daniel J Wills
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Coast OrthoVet-Veterinary Orthopaedic Referral Services, Sydney, New South Wales, Australia
| | - James D Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Nicolas Cance
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
| | | | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - David H Dejour
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
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3
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Kang M, Seo S, Lee H, Han MW. Knee Measurement System with Osteoarthritis Levels Using Artificial Cartilage and Skeletons. Biomimetics (Basel) 2024; 9:166. [PMID: 38534851 DOI: 10.3390/biomimetics9030166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/28/2024] Open
Abstract
Knee osteoarthritis (OA), also known as degenerative arthritis, is a disease characterized by irreversible changes in the cartilage and bones comprising the joints, resulting in pain, impaired function, and deformity. Furthermore, independent of natural aging, the rate of change in joint cartilage has increased in recent years, which is mainly attributed to environmental factors. The rising incidence of knee-related disorders emphasizes the importance of analyzing the morphology and kinematics of knee structure. This study introduces a knee measurement system designed to replicate the motions of knee using 3D-printing technology, providing insights into knee mechanics with OA level. The research explores the stages of OA using the Kellgren-Lawrence (KL) grade scale, highlighting the variations in the force applied to the knee bone according to movement. The developed knee-simulation system, utilizing the four-bar-link theory, presents a novel approach to studying OA levels 0 to 4. As OA progresses, the cartilage deteriorates, affecting the movement of OA. The OA-based knee measurement system that incorporates soft tissues and skeletons can assist in developing a personalized diagnostic approach for knee disease. This will also help to enhance surgical effectiveness by facilitating the creation of personalized prosthetic joints for individual patients and offering a customized surgical simulation.
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Affiliation(s)
- Minchae Kang
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Suyeon Seo
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Hyewon Lee
- Department of Mechanical, Robotics and Energy Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
| | - Min-Woo Han
- Department of Mechanical Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
- Department of Mechanical, Robotics and Energy Engineering, Advanced Manufacturing & Soft Robotics Lab, Dongguk University, 30 Pildong-ro 1, Jung-gu, Seoul 04620, Republic of Korea
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Jahn J, Ehlen QT, Huang CY. Finding the Goldilocks Zone of Mechanical Loading: A Comprehensive Review of Mechanical Loading in the Prevention and Treatment of Knee Osteoarthritis. Bioengineering (Basel) 2024; 11:110. [PMID: 38391596 PMCID: PMC10886318 DOI: 10.3390/bioengineering11020110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/15/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
In this review, we discuss the interaction of mechanical factors influencing knee osteoarthritis (KOA) and post-traumatic osteoarthritis (PTOA) pathogenesis. Emphasizing the importance of mechanotransduction within inflammatory responses, we discuss its capacity for being utilized and harnessed within the context of prevention and rehabilitation of osteoarthritis (OA). Additionally, we introduce a discussion on the Goldilocks zone, which describes the necessity of maintaining a balance of adequate, but not excessive mechanical loading to maintain proper knee joint health. Expanding beyond these, we synthesize findings from current literature that explore the biomechanical loading of various rehabilitation exercises, in hopes of aiding future recommendations for physicians managing KOA and PTOA and athletic training staff strategically planning athlete loads to mitigate the risk of joint injury. The integration of these concepts provides a multifactorial analysis of the contributing factors of KOA and PTOA, in order to spur further research and illuminate the potential of utilizing the body's own physiological responses to mechanical stimuli in the management of OA.
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Affiliation(s)
- Jacob Jahn
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Quinn T Ehlen
- University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Chun-Yuh Huang
- Department of Biomedical Engineering, College of Engineering, University of Miami, Coral Gables, FL 33146, USA
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Miller L, Maritato KC, Kennedy SC. Prospective measurement of outcomes and complications of tibial tuberosity advancement using novel mini plates in small breed dogs. Front Vet Sci 2023; 10:1268681. [PMID: 37954667 PMCID: PMC10634372 DOI: 10.3389/fvets.2023.1268681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/15/2023] [Indexed: 11/14/2023] Open
Abstract
Cranial cruciate ligament (CrCL) disease is a common orthopedic disease in canine patients. Tibial osteotomy procedures for the treatment of cranial cruciate ligament disease in small breed dogs (<15 kg) have previously been limited. A total of 22 client-owned dogs, 26 stifles, with cranial cruciate ligament disease were treated with novel mini-tibial tuberosity advancement plates. The most common intraoperative complications included the need for plate-cage overlap in 7 stifles (26.92%) and screw head fracture in 1 (3.85%). Post-operative complications included tibial tuberosity fracture (3.85%), post-operative medial patella luxation (7.69%), and persistent lameness (7.69%). Of the 26 stifles evaluated in the medium term (>6-12 months) post-operatively, 92.3% had no lameness, with the remaining 7.7% having Grade 1 lameness. A good to excellent clinical outcome was noted in all 26 stifles that underwent TTA with novel mini plates.
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Affiliation(s)
- Leah Miller
- MedVet Pittsburgh, Surgery, McMurray, PA, United States
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Yair N, Yiapanis C, Ben-Amotz R, Milgram J. The effect of joint orientation on passive movement of the dog's stifle. Front Vet Sci 2023; 10:1207164. [PMID: 37448585 PMCID: PMC10336201 DOI: 10.3389/fvets.2023.1207164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 06/13/2023] [Indexed: 07/15/2023] Open
Abstract
Introduction The cranial cruciate ligament (CCL) is one of numerous structures which determine the path of the tibia relative to the femur when passively flexing/extending the stifle of the dog. The effect of cutting the CCL on passive motion with the hind limb in different orientations, is unknown. The aim of this study was to describe passive movement of the tibia relative to the femur in dogs, with the hind limb in three different orientations, and with CCL intact and cut. Methods Ten cadaveric hind limbs were obtained from dogs weighing between 20 kg and 25 kg and prepared for testing in a custom-built joint testing machine. Each hind limb was tested in three different orientations with data collected, using an electromagnetic tracking system, during 2 cycles of flexion/extension with the CCL intact and cut. Each cycle was initiated with the stifle in full extension (0°) and data was collected at 0°, 20°, 30°, 40°, 45°, and 55° of stifle flexion/extension. Results Flexion of the stifle resulted in caudal translation and internal rotation of the tibia relative to the femur, with cranial translation and external rotation occurring during extension along the identical path. Cutting the cranial cruciate ligament did not result in significant differences in translation or rotation when the stifle was orientated to approximated the standing position of a dog. Discussion Isometric points at the origin and insertion of the CCL can potentially be identified in CCL deficient stifles using a technique based on passive motion of an intact stifle.
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Affiliation(s)
- Nadav Yair
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Ron Ben-Amotz
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Joshua Milgram
- The Robert H. Smith Faculty of Agriculture, Food and Environment, The Laboratory of Biomechanics, Koret School of Veterinary Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Estimation of Tibiofemoral Joint Contact Forces Using Foot Loads during Continuous Passive Motions. SENSORS 2022; 22:s22134947. [PMID: 35808441 PMCID: PMC9269803 DOI: 10.3390/s22134947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 02/04/2023]
Abstract
Continuous passive motion (CPM) machines are commonly used after various knee surgeries, but information on tibiofemoral forces (TFFs) during CPM cycles is limited. This study aimed to explore the changing trend of TFFs during CPM cycles under various ranges of motion (ROM) and body weights (BW) by establishing a two-dimensional mathematical model. TFFs were estimated by using joint angles, foot load, and leg−foot weight. Eleven healthy male participants were tested with ROM ranging from 0° to 120°. The values of the peak TFFs during knee flexion were higher than those during knee extension, varying nonlinearly with ROM. BW had a significant main effect on the peak TFFs and tibiofemoral shear forces, while ROM had a limited effect on the peak TFFs. No significant interaction effects were observed between BW and ROM for each peak TFF, whereas a strong linear correlation existed between the peak tibiofemoral compressive forces (TFCFs) and the peak resultant TFFs (R2 = 0.971, p < 0.01). The proposed method showed promise in serving as an input for optimizing rehabilitation devices.
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Effect of Assistance Using a Bilateral Robotic Knee Exoskeleton on Tibiofemoral Force Using a Neuromuscular Model. Ann Biomed Eng 2022; 50:716-727. [PMID: 35344119 DOI: 10.1007/s10439-022-02950-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 03/13/2022] [Indexed: 11/01/2022]
Abstract
Tibiofemoral compression forces present during locomotion can result in high stress and risk damage to the knee. Powered assistance using a knee exoskeleton may reduce the knee load by reducing the work required by the muscles. However, the exact effect of assistance on the tibiofemoral force is unknown. The goal of this study was to investigate the effect of knee extension assistance during the early stance phase on the tibiofemoral force. Nine able-bodied adults walked on an inclined treadmill with a bilateral knee exoskeleton with assistance and with no assistance. Using an EMG-informed neuromusculoskeletal model, muscle forces were estimated, then utilized to estimate the tibiofemoral contact force. Results showed a 28% reduction in the knee moment, which resulted in approximately a 15% decrease in knee extensor muscle activation and a 20% reduction in subsequent muscle force, leading to a significant 10% reduction in peak and 9% reduction in average tibiofemoral contact force during the early stance phase (p < 0.05). The results indicate the tibiofemoral force is highly dependent on the knee kinetics and quadricep muscle activation due to their influence on knee extensor muscle forces, the primary contributor to the knee load.
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9
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Mazdarani P, Pedram MS, Miles JE. Effect of center of angulation of rotation-based leveling osteotomy on ex vivo stifle joint stability following cranial cruciate ligament transection and medial meniscal release with and without a hamstring load. Vet Surg 2022; 51:940-951. [PMID: 35289413 PMCID: PMC9546295 DOI: 10.1111/vsu.13801] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 01/17/2022] [Accepted: 02/19/2022] [Indexed: 11/30/2022]
Abstract
Objective To evaluate the effect of center of rotation of angulation (CORA)‐based leveling osteotomy (CBLO) and hamstring load on stifle stability following cranial cruciate ligament transection (CCLx) and medial meniscal release (MMR). Study design Ex vivo experimental study. Sample population Cadaver hind limb preparations (n = 7). Methods After instrumentation, constant quadriceps and gastrocnemius loads with an optional hamstring load in a 3:1:0.6 ratio were applied, and stifles were extended from fully flexed using an electrical motor during fluoroscopic recording. The recording process was repeated after each of CCLx, MMR and CBLO and the extracted landmark coordinates were used for calculation of cranial tibial translation (CTT) and patellar ligament angle (PTA). Results Mean initial tibial plateau angle was 28.1°: post‐CBLO the mean was 9.7°. Cranial tibial translation developed from 50° and 75° with CCLx and MMR respectively (p < .04, < .02) without hamstring loading. Hamstring loading mitigated CTT due to CCLx and delayed CTT until 120° for MMR (P < .02) in this model. CBLO prevented CTT, except at 140° without hamstring loading (P = .01). Similar results were seen for PTA, but CBLO curves were parallel to and lower than intact values at all tested angles (P < .04), consistent with induced effective joint flexion. Conclusion CBLO to a target tibial plateau angle of 10° largely eliminated CTT induced by CCLx and MMR. Hamstring loads of 20% quadriceps load improved stifle stability in this model. Impact Stifle stability following CBLO appears to be multifactorial and depends on meniscal integrity, joint angle, and hamstring strength.
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Affiliation(s)
- Parisa Mazdarani
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Mir Sepehr Pedram
- Department of Surgery and Radiology, Faculty of Veterinary Medicine, University of Tehran, Tehran, Iran
| | - James E Miles
- Department of Veterinary Clinical Sciences, University of Copenhagen, Frederiksberg, Denmark
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Williams JR, Neal K, Alfayyadh A, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces after ACL reconstruction: A longitudinal study. J Biomech 2022; 134:110993. [PMID: 35182902 PMCID: PMC8976762 DOI: 10.1016/j.jbiomech.2022.110993] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) development after ACL reconstruction (ACLR) is common. Patellofemoral OA after ACLR is as prevalent as tibiofemoral OA; however, few have explored the mechanisms leading to disease development in this compartment. Biomechanical alterations may be one mechanism responsible for post-traumatic knee OA. Patellofemoral contact forces during dynamic tasks, such as running and single leg hops, have been assessed at return to sport and later time points. The results of these studies, however, contradict each other, are only cross-sectional in nature, and are limited to specific points in time within the movement pattern. The purpose of this study was to assess patellofemoral contact forces 3, 6, and 24 months after ACLR during level walking over the entirety of the movement pattern. Patellofemoral contact forces were calculated after determination of muscle forces from a validated, subject-specific, EMG-driven neuromusculoskeletal model. Statistical parametric mapping was used to compare patellofemoral contact forces between limbs and across time points. Patellofemoral underloading of the involved limb (vs. uninvolved) was present at 3 months (p < 0.001 from 7 to 30% of stance) and 6 months (p = 0.001 from 11 to 23% of stance and p = 0.025 from 27 to 32%) after ACLR but was resolved by 24 months. Both limbs' load increased from 3 to 6 months. The involved limb displayed relatively consistent loads from 6 months onward, while the uninvolved limb's decreased back down towards their 3-month values. Overall, these results suggest that early patellofemoral underloading exists after ACLR and may be leading to patellofemoral OA development.
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Affiliation(s)
- Jack R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
| | - Abdulmajeed Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Kurt Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States; Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Thomas S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
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11
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Radiographic measurement of canine stifle joint angles using four different landmark methods. ACTA VET BRNO 2021. [DOI: 10.2754/avb202190040399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
This study was conducted to compare angles physically set on the stifle joints of cadaveric limbs of dogs with the results by four different radiographic methods for stifle angle measurement. Thirteen pelvic limbs from various large breeds and skeletally-mature dogs were used. The stifles were fixed at four angles: 125°, 130°, 135° and 140°. Altogether 52 radiographs were done. Each stifle angle set on the cadaver limbs was radiographically measured using four sets of landmarks (the goniometric, long axis, eminence and kinematic methods). We found similarity between angles physically set on cadaver limbs and radiographically measured using the long axis method (P > 0.05). The goniometric method showed similarity in group of limbs with the stifle fixed at 140° (P > 0.05), and other measurements differed significantly (P < 0.05). Eminence and kinematic method measurements were different compared to the angle of fixation of the stifle on the cadaver (P < 0.05) but similar compared to each other (P > 0.05). The method of stifle joint angle measurement should be considered when comparing similar studies, and also in pre-operative measurements for some tibial osteotomies aimed at stabilizing the joint after cranial cruciate ligament rupture.
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Spinella G, Arcamone G, Valentini S. Cranial Cruciate Ligament Rupture in Dogs: Review on Biomechanics, Etiopathogenetic Factors and Rehabilitation. Vet Sci 2021; 8:vetsci8090186. [PMID: 34564580 PMCID: PMC8472898 DOI: 10.3390/vetsci8090186] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/01/2021] [Accepted: 09/03/2021] [Indexed: 01/13/2023] Open
Abstract
Cranial cruciate ligament (CrCL) rupture is one of the most common orthopaedic conditions in veterinary medicine. CrCL plays a fundamental role in the stability and biomechanics of the femoral-tibio-patellar joint, and its incorrect functionality severely impacts on the quality of life of patients. In dogs, the structural weakening of this joint due to the progressive degeneration of the ligament is the most accredited etiopathogenetic hypothesis in relation to the dog signalment (breed, sex and age) and the stifle joint conformation. In humans, this injury is often traumatic and generally occurs during sporting activities. CrCL rupture can be managed conservatively or surgically, and decisions regarding treatment are due to numerous factors: the patient’s age and health, the degree of stifle instability, and cost. Physiotherapy protocols play an important role in rehabilitation, with similar goals in humans and dogs: pain management, physiological articular range of motion recovery, periarticular and core muscle strengthening, and proprioceptive deficit correction. Physiotherapy, even if often neglected in veterinary medicine, is mandatory for the recovery of the correct functionality of the injured limb and for the return to normal daily and sporting activities.
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Kainz H, Schwartz MH. The importance of a consistent workflow to estimate muscle-tendon lengths based on joint angles from the conventional gait model. Gait Posture 2021; 88:1-9. [PMID: 33933913 DOI: 10.1016/j.gaitpost.2021.04.039] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Musculoskeletal models enable us to estimate muscle-tendon length, which has been shown to improve clinical decision-making and outcomes in children with cerebral palsy. Most clinical gait analysis services, however, do not include muscle-tendon length estimation in their clinical routine. This is due, in part, to a lack of knowledge and trust in the musculoskeletal models, and to the complexity involved in the workflow to obtain the muscle-tendon length. RESEARCH QUESTION Can the joint angles obtained with the conventional gait model (CGM) be used to generate accurate muscle-tendon length estimates? METHODS Three-dimensional motion capture data of 15 children with cerebral palsy and 15 typically developing children were retrospectively analyzed and used to estimate muscle-tendon length with the following four modelling frameworks: (1) 2392-OSM-IK-angles: standard OpenSim workflow including scaling, inverse kinematics and muscle analysis; (2) 2392-OSM-CGM-angle: generic 2392-OpenSim model driven with joint angles from the CGM; (3) modif-OSM-IK-angles: standard OpenSim workflow including inverse kinematics and a modified model with segment coordinate systems and joint degrees-of-freedom similar to the CGM; (4) modif-OSM-CGM-angles: modified model driven with joint angles from the CGM. Joint kinematics and muscle-tendon length were compared between the different modelling frameworks. RESULTS Large differences in hip joint kinematics were observed between the CGM and the 2392-OpenSim model. The modif-OSM showed similar kinematics as the CGM. Muscle-tendon length obtained with modif-OSM-IK-angles and modif-OSM-CGM-angles were similar, whereas large differences in some muscle-tendon length were observed between 2392-OSM-IK-angles and 2392-OSM-CGM-angles. SIGNIFICANCE The modif-OSM-CGM-angles framework enabled us to estimate muscle-tendon lengths without the need for scaling a musculoskeletal model and running inverse kinematics. Hence, muscle-tendon length estimates can be obtained simply, without the need for the complexity, knowledge and time required for musculoskeletal modeling and associated software. An instruction showing how the framework can be used in a clinical setting is provided on https://github.com/HansUniVie/MuscleLength.
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Affiliation(s)
- Hans Kainz
- Centre for Sport Science and University Sports, Department of Biomechanics, Kinesiology and Computer Science in Sport, Neuromechanics Research Group, University of Vienna, Vienna, Austria.
| | - Michael H Schwartz
- Center for Gait and Motion Analysis, Gillette Children's Specialty Healthcare, St Paul, MN, USA; Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN, USA
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14
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Mojaddarasil M, Sadigh MJ. On the impact force analysis of two-leg landing with a flexed knee. Comput Methods Biomech Biomed Engin 2021; 24:1862-1875. [PMID: 34027762 DOI: 10.1080/10255842.2021.1925257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
This article looks into the effects of the initial knee flexion angle at the contact time on the peak of the impulsive lower limb forces during landing, and how these effects are related to muscular activities. The impact dynamics of drop landing is studied via a musculoskeletal model with eight Hill-type lower-limb muscles. A method is proposed for the representation of two landing strategies: landing with high and low joint stiffness. Then, in each landing strategy, the effect of the initial knee flexion angle on the peak ground reaction force (GRF), the peak knee ligaments force and the peak tibiofemoral contact force is investigated by considering different initial contact postures. It is observed that while landing with a flexed knee decreases the peak GRF in both landing strategies, it decreases the peak tibiofemoral and knee ligaments forces only in landing with low joint stiffness. Specifically, by increasing the initial knee flexion from 0° to 70°, the peak tibiofemoral and knee ligaments forces decrease monotonically by 54% and 82%, in landing with low joint stiffness. For high joint stiffness, however, as the initial knee flexion increases from 10° to 70°, the peak tibiofemoral force is seen to increase monotonically by 42% and the peak knee ligaments force is seen to have a non-monotonic behavior, first decreasing by 42%, and then, increasing by 250%. These results can be considered in training landing strategies to reduce the risk of knee injury.
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Affiliation(s)
- Marzieh Mojaddarasil
- Department of Mechanical Engineering, Isfahan University of Technology, Isfahan 84156-83111, Iran
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Dierick F, Schreiber C, Lavallée P, Buisseret F. Asymptomatic Genu Recurvatum reshapes lower limb sagittal joint and elevation angles during gait at different speeds. Knee 2021; 29:457-468. [PMID: 33743261 DOI: 10.1016/j.knee.2021.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 01/28/2021] [Accepted: 02/08/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND Kinematic characteristics of walking with an asymptomatic genu recurvatum are currently unknown. The objective of this study is to characterize the lower limb sagittal joint and elevation angles during walking in participants with asymptomatic genu recurvatum and compare it with control participants without knee deformation at different speeds. METHODS The spatio-temporal parameters and kinematics of the lower limb were recorded using an optoelectronic motion capture system in 26 participants (n = 13 with genu recurvatum and n = 13 controls). The participants walked on an instrumented treadmill during five minutes at three different speeds: slow, medium and fast. RESULTS Participants with genu recurvatum showed several significant differences with controls: a narrower step width, a greater maximum hip joint extension angle, a greater knee joint extension angle at mid stance, a lower maximum knee joint flexion angle during the swing phase, and a greater ankle joint extension angle at the end of the gait cycle. Participants with genu recurvatum had a greater minimum thigh elevation angle, a greater maximum foot elevation angle, and a change in the orientation of the covariance plane. Walking speed had a significant effect on nearly all lower limb joint and elevation angles, and covariance plane parameters. CONCLUSION Our findings show that genu recurvatum reshapes lower limb sagittal joint and elevation angles during walking at different speeds but preserves the covariation of elevation angles along a plane during both stance and swing phases and the rotation of this plane with increasing speed.
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Affiliation(s)
- Frédéric Dierick
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg; CeREF, Haute Ecole Louvain en Hainaut, Mons, Belgium; Faculté des Sciences de la Motricité, Université catholique de Louvain, Louvain-la-Neuve, Belgium.
| | - Céline Schreiber
- Centre National de Rééducation Fonctionnelle et de Réadaptation - Rehazenter, Laboratoire d'Analyse du Mouvement et de la Posture (LAMP), Luxembourg, Luxembourg
| | - Pauline Lavallée
- Laboratoire Forme et Fonctionnement Humain, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium
| | - Fabien Buisseret
- CeREF, Haute Ecole Louvain en Hainaut, Mons, Belgium; Laboratoire Forme et Fonctionnement Humain, Haute Ecole Louvain en Hainaut, Montignies-sur-Sambre, Belgium; Service de Physique Nucléaire et Subnucléaire, Université de Mons, UMONS Research Institute for Complex Systems, Mons, Belgium
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16
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McGibbon CA, Brandon S, Bishop EL, Cowper-Smith C, Biden EN. Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis. Front Bioeng Biotechnol 2021; 8:604860. [PMID: 33585409 PMCID: PMC7876241 DOI: 10.3389/fbioe.2020.604860] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel "tricompartment unloader" (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint. Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models. Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30-50%) across all structures, at knee flexion angles >~30 degrees during DKB. Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.
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Affiliation(s)
- Chris A McGibbon
- Faculty of Kinesiology and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
| | - Scott Brandon
- School of Engineering, University of Guelph, Guelph, ON, Canada
| | - Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, University of Calgary, Calgary, AB, Canada
| | | | - Edmund N Biden
- Department of Mechanical Engineering and Institute of Biomedical Engineering, University of New Brunswick, Fredericton, NB, Canada
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17
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Hosseinzadeh S, Barzegari A, Taghipour M, Mehr Aein R, Gholinia H. Changes of the Patellar Tendon Moment rm Length in Different Knee Angles: A Biomechanical in Vivo Study. THE ARCHIVES OF BONE AND JOINT SURGERY 2020; 8:641-645. [PMID: 33088867 DOI: 10.22038/abjs.2020.42551.2158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patellar tendon moment arm length (PTma) changes at different knee flexion angles have not been determined in in vivo studies. We aimed to determine PTma in four different knee angles using Magnetic Resonance Imaging (MRI) to predict in vivo changes in the moment arm length from different knee angles during running. PTma was measured as the perpendicular distance from muscle-tendon line of action to the knee joint axis of rotation at 0° (full extension), 20°, 40°, and 60° flexion of knee by using MRI method. Repeated measure ANOVA method was applied to compare the moment arm length among four degrees of knee flexion (P<0.05). A regression analysis was used to predict the PTma during different knee joint angles. The PTma in the four angles at 0°, 20°, 40°, and 60° of knee flexion were 42.55±4.20, 39.91±2.98, 37.73±2.87, and 36.18±2.90 mm, respectively (P<0.05). The regression analysis provided an equation to predict the PTma from different knee joint angles during running. PTma values decreased from knee extension to flexion in a linear manner. These findings have important implications for estimating PTma using a regression equation model from different knee joint angles.
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Affiliation(s)
- Somayeh Hosseinzadeh
- Faculty of Sports sciences, University of Mazandaran, Babolsar, Iran.,Mobility Impairment Research Center, Babol University of Medical Sciences, Iran
| | - Ali Barzegari
- Department of Physical Education, Payame Noor University, Tehran, Iran
| | - Mohammad Taghipour
- Mobility Impairment Research Center, Babol University of Medical Sciences, Iran
| | - Raheleh Mehr Aein
- Mobility Impairment Research Center, Babol University of Medical Sciences, Iran
| | - Hemmat Gholinia
- Clinical Research Department, Shahid Beheshti Hospital, Babol University of Medical Sciences, Babol, Iran
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18
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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19
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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20
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Slater AA, Hullfish TJ, Baxter JR. The impact of thigh and shank marker quantity on lower extremity kinematics using a constrained model. BMC Musculoskelet Disord 2018; 19:399. [PMID: 30424811 PMCID: PMC6234533 DOI: 10.1186/s12891-018-2329-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 10/29/2018] [Indexed: 12/20/2022] Open
Abstract
Background Musculoskeletal models are commonly used to quantify joint motions and loads during human motion. Constraining joint kinematics simplifies these models but the implications of the placement and quantity of markers used during data acquisition remains unclear. The purpose of this study was to establish the effects of marker placement and quantity on lower extremity kinematics calculated using a constrained-kinematic model. We hypothesized that a constrained-kinematic model would produce lower-extremity kinematics errors that correlated with the number of tracking markers removed from the thigh and shank. Methods Healthy-young adults (N = 10) walked on a treadmill at slow, moderate, and fast speeds while skin-mounted markers were tracked using motion capture. Lower extremity kinematics were calculated for 256 combinations of leg and shank markers to establish the implications of marker placement and quantity on joint kinematics. Marker combinations that yielded differences greater than 5 degrees were tested with paired t-tests and the relationship between number of markers and kinematic errors were modeled with polynomials to determine goodness of fit (R2). Results Sagittal joint and hip coronal kinematics errors were smaller than documented errors caused by soft-tissue artifact, which tends to be approximately 5 degrees, when excluding thigh and shank markers. Joint angle and center kinematic errors negatively correlated with the number of markers included in the analyses (R2 > 0.97) and typically showed the greatest error reductions when two markers were included on the thigh or shank segments. Further, we demonstrated that a simplified marker set that included markers on the pelvis, lateral knee condyle, lateral malleolus, and shoes produced kinematics that strongly agreed with the traditional marker set that included 3 tracking markers for each segment. Conclusion Constrained-kinematic models are resilient to marker placement and quantity, which has implications on study design and post-processing workflows.
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Affiliation(s)
- Annelise A Slater
- Human Motion Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Suite 702, Philadelphia, PA, 19104, USA
| | - Todd J Hullfish
- Human Motion Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Suite 702, Philadelphia, PA, 19104, USA
| | - Josh R Baxter
- Human Motion Laboratory, Department of Orthopaedic Surgery, University of Pennsylvania, 3737 Market Street, Suite 702, Philadelphia, PA, 19104, USA.
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Zeighami A, Aissaoui R, Dumas R. Knee medial and lateral contact forces in a musculoskeletal model with subject-specific contact point trajectories. J Biomech 2018; 69:138-145. [PMID: 29397108 DOI: 10.1016/j.jbiomech.2018.01.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2017] [Revised: 01/08/2018] [Accepted: 01/14/2018] [Indexed: 01/27/2023]
Abstract
Contact point (CP) trajectory is a crucial parameter in estimating medial/lateral tibio-femoral contact forces from the musculoskeletal (MSK) models. The objective of the present study was to develop a method to incorporate the subject-specific CP trajectories into the MSK model. Ten healthy subjects performed 45 s treadmill gait trials. The subject-specific CP trajectories were constructed on the tibia and femur as a function of extension-flexion using low-dose bi-plane X-ray images during a quasi-static squat. At each extension-flexion position, the tibia and femur CPs were superimposed in the three directions on the medial side, and in the anterior-posterior and proximal-distal directions on the lateral side to form the five kinematic constraints of the knee joint. The Lagrange multipliers associated to these constraints directly yielded the medial/lateral contact forces. The results from the personalized CP trajectory model were compared against the linear CP trajectory and sphere-on-plane CP trajectory models which were adapted from the commonly used MSK models. Changing the CP trajectory had a remarkable impact on the knee kinematics and changed the medial and lateral contact forces by 1.03 BW and 0.65 BW respectively, in certain subjects. The direction and magnitude of the medial/lateral contact force were highly variable among the subjects and the medial-lateral shift of the CPs alone could not determine the increase/decrease pattern of the contact forces. The suggested kinematic constraints are adaptable to the CP trajectories derived from a variety of joint models and those experimentally measured from the 3D imaging techniques.
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Affiliation(s)
- A Zeighami
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Aissaoui
- Laboratoire de Recherche en Imagerie et Orthopédie (LIO), École de Technologie Supérieure (ÉTS), Center de Recherche du CHUM, Montréal, Québec, Canada.
| | - R Dumas
- Université Lyon, Université Claude Bernard Lyon 1, IFSTTAR, UMR_T9406, LBMC, F69622 Lyon, France.
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22
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Effect of tibial subluxation on the measurements for tibial tuberosity advancement in dogs with cranial cruciate ligament deficiency. Vet Comp Orthop Traumatol 2017; 27:470-7. [DOI: 10.3415/vcot-14-02-0018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 07/25/2014] [Indexed: 11/17/2022]
Abstract
SummaryObjectives: The main objectives were to evaluate the impact of femorotibial subluxation on the preoperative measurements for tibial tuberosity advancement (TTA) by defining radiographic landmarks and testing the repeatability for assessing cranial tibial subluxation (CTS). Also, we aimed at developing a formula to calculate the necessary adjustment in measurement of TTA in stifles with CTS.Methods: Forty stifles were used to examine the influence of CTS on preoperative TTA measurements before and after transection of the cranial cruciate ligament. Mediolateral radiographs were obtained and measurements performed by three investigators. The observed variabilities were assessed by interand intra-observer differences.Results: Measurements of CTS and preoperative TTA showed a good to excellent interand intra-observer correlation. We found a significant influence of CTS on TTA measurements and developed a formula to calculate the necessary adjustment in measurement of TTA in stifles with CTS.Conclusion: We found a correlation between the tibial subluxation and the measurements for TTA, with the latter decreasing with increasing subluxation. This has to be taken into account when measuring the advancement in stifles with complete rupture of the cranial cruciate ligament. We provided a formula to calculate the necessary addition to the measured advancement.
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Pillard P, Livet V, Cabon Q, Bismuth C, Sonet J, Remy D, Fau D, Carozzo C, Viguier E, Cachon T. Evaluation of a new method to determine the tibial tuberosity advancement distance required to reduce the patellar tendon-tibial plateau angle to 90° with the modified Maquet technique in dogs. Am J Vet Res 2017; 78:517-528. [PMID: 28345997 DOI: 10.2460/ajvr.78.4.517] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To assess use of a new radiographic method to determine the distance by which the tibial tuberosity should be advanced to reduce the patellar tendon-tibial plateau angle (PTA) to 90° by means of the modified Maquet technique (MMT) in dogs. SAMPLE 24 pelvic limbs from 12 adult medium-sized to large-breed canine cadavers. PROCEDURES Radiographs of stifle joints at 135° extension in true lateral position were used to determine tibial tuberosity advancement distances for use in the MMT. A method was devised to incorporate the planned osteotomy axis; distal patellar translations of 0, 3, 5, or 10 mm; and advancement cage implant application level along the osteotomy site in advancement planning measurements. Concordance correlation coefficients (CCCs) were calculated to compare these adjusted advancement measurements with true advancement measurements obtained for the same joints in another study after treatment by MMT. Intraobserver, interobserver, and total agreement for selected measurements were determined by assessment of CCCs for results obtained by 3 blinded observers. RESULTS Agreement between true advancement measurements and measurements obtained with osteotomy axis and cage position method calculations that incorporated a 5-mm distal patellar translation distance was excellent (CCC, 0.96). Intraobserver and interobserver agreements for the planning measurements evaluated were good to excellent (CCC, 0.83 to 0.96). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the osteotomy axis and cage position method incorporating a 5-mm distal patellar translation distance has the potential to improve success rates for achieving a PTA of 90° in medium-sized to large-breed dogs undergoing MMT for treatment of cranial cruciate ligament rupture. Further research is warranted.
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Castilho M, Rodrigues J, Vorndran E, Gbureck U, Quental C, Folgado J, Fernandes PR. Computational design and fabrication of a novel bioresorbable cage for tibial tuberosity advancement application. J Mech Behav Biomed Mater 2017; 65:344-355. [DOI: 10.1016/j.jmbbm.2016.08.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/11/2016] [Accepted: 08/26/2016] [Indexed: 10/21/2022]
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Pillard P, Livet V, Cabon Q, Bismuth C, Sonet J, Remy D, Fau D, Carozzo C, Viguier E, Cachon T. Comparison of desired radiographic advancement distance and true advancement distance required for patellar tendon-tibial plateau angle reduction to the ideal 90° in dogs by use of the modified Maquet technique. Am J Vet Res 2016; 77:1401-1410. [PMID: 27901393 DOI: 10.2460/ajvr.77.12.1401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To evaluate the validity of 2 radiographic methods for measurement of the tibial tuberosity advancement distance required to achieve a reduction in patellar tendon-tibial plateau angle (PTA) to the ideal 90° in dogs by use of the modified Maquet technique (MMT). SAMPLE 24 stifle joints harvested from 12 canine cadavers. PROCEDURES Radiographs of stifle joints placed at 135° in the true lateral position were used to measure the required tibial tuberosity advancement distance with the conventional (AM) and correction (AE) methods. The MMT was used to successively advance the tibial crest to AM and AE. Postoperative PTA was measured on a mediolateral radiograph for each advancement measurement method. If none of the measurements were close to 90°, the advancement distance was modified until the PTA was equal to 90° within 0.1°, and the true advancement distance (TA) was measured. Results were used to determine the optimal commercially available size of cage implant that would be used in a clinical situation. RESULTS Median AM and AE were 10.6 mm and 11.5 mm, respectively. Mean PTAs for the conventional and correction methods were 93.4° and 92.3°, respectively, and differed significantly from 90°. Median TA was 13.5 mm. The AM and AE led to the same cage size recommendations as for TA for only 1 and 4 stifle joints, respectively. CONCLUSIONS AND CLINICAL RELEVANCE Both radiographic methods of measuring the distance required to advance the tibial tuberosity in dogs led to an under-reduction in postoperative PTA when the MMT was used. A new, more accurate radiographic method needs to be developed.
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Hashizume S, Fukutani A, Kusumoto K, Kurihara T, Yanagiya T. Comparison of the Achilles tendon moment arms determined using the tendon excursion and three-dimensional methods. Physiol Rep 2016. [PMCID: PMC5064132 DOI: 10.14814/phy2.12967] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The moment arm of muscle‐tendon force is a key parameter for calculating muscle and tendon properties. The tendon excursion method was used for determining the Achilles tendon moment arm (ATMA). However, the accuracy of this method remains unclear. This study aimed to investigate the magnitude of error introduced in determining the ATMA using the tendon excursion method by comparing it with the reference three‐dimensional (3D) method. The tendon excursion method determined the ATMA as the ratio between the Achilles tendon displacement during foot rotation from 15° of dorsiflexion to 15° of plantarflexion and the joint rotation angle. A series of foot images was obtained at 15° of dorsiflexion, the neutral position, and 15° of plantarflexion. The 3D value of the ATMA was determined as the shortest distance between the talocrural joint axis and the line of action of the Achilles tendon force. The ATMA determined by the tendon excursion method was smaller by 3.8 mm than that determined using the 3D method. This error may be explained mainly by the length change in the Achilles tendon due to the change in the force applied to it, as passive plantarflexion torque was different by 11 Nm between 15° of dorsiflexion and 15° of plantarflexion. Furthermore, the ATMAs determined using the 3D and tendon excursion methods were significantly correlated but the coefficient of determination was not large (R2 = 0.352). This result suggests that the tendon excursion method may not be feasible to evaluate the individual variability of the ATMA.
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Affiliation(s)
- Satoru Hashizume
- Human Informatics Research Institute; National Institute of Advanced Industrial Science and Technology; Tokyo Japan
- Faculty of Health and Sports Science; Juntendo University; Chiba Japan
- Japan Society for the Promotion of Science; Tokyo Japan
| | - Atsuki Fukutani
- Japan Society for the Promotion of Science; Tokyo Japan
- The Research Organization of Science and Technology; Ritsumeikan University; Shiga Japan
| | - Kazuki Kusumoto
- Faculty of Science and Industrial Technology; Kurashiki University of Science and the Arts; Okayama Japan
| | - Toshiyuki Kurihara
- Faculty of Sport and Health Science; Ritsumeikan University; Shiga Japan
| | - Toshio Yanagiya
- Faculty of Health and Sports Science; Juntendo University; Chiba Japan
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Alterations in knee contact forces and centers in stance phase of gait: A detailed lower extremity musculoskeletal model. J Biomech 2015; 49:185-92. [PMID: 26708962 DOI: 10.1016/j.jbiomech.2015.12.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Revised: 11/13/2015] [Accepted: 12/03/2015] [Indexed: 11/21/2022]
Abstract
Evaluation of contact forces-centers of the tibiofemoral joint in gait has crucial biomechanical and pathological consequences. It involves however difficulties and limitations in in vitro cadaver and in vivo imaging studies. The goal is to estimate total contact forces (CF) and location of contact centers (CC) on the medial and lateral plateaus using results computed by a validated finite element model simulating the stance phase of gait for normal as well as osteoarthritis, varus-valgus and posterior tibial slope altered subjects. Using foregoing contact results, six methods commonly used in the literature are also applied to estimate and compare locations of CC at 6 periods of stance phase (0%, 5%, 25%, 50%, 75% and 100%). TF joint contact forces are greater on the lateral plateau very early in stance and on the medial plateau thereafter during 25-100% stance periods. Large excursions in the location of CC (>17mm), especially on the medial plateau in the mediolateral direction, are computed. Various reported models estimate quite different CCs with much greater variations (~15mm) in the mediolateral direction on both plateaus. Compared to our accurately computed CCs taken as the gold standard, the centroid of contact area algorithm yielded least differences (except in the mediolateral direction on the medial plateau at ~5mm) whereas the contact point and weighted center of proximity algorithms resulted overall in greatest differences. Large movements in the location of CC should be considered when attempting to estimate TF compartmental contact forces in gait.
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28
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Niederhäuser SK, Tepic S, Tepic I, Weber U. Tibial Tuberosity Crown for the treatment of cranial cruciate ligament deficiency in three dogs. VETERINARY RECORD CASE REPORTS 2015. [DOI: 10.1136/vetreccr-2015-000199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | | | | | - Urs Weber
- Tierärztliches ÜberweisungszentrumTennikenSwitzerland
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On the role of the patella, ACL and joint contact forces in the extension of the knee. PLoS One 2014; 9:e115670. [PMID: 25536067 PMCID: PMC4275277 DOI: 10.1371/journal.pone.0115670] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 11/28/2014] [Indexed: 11/19/2022] Open
Abstract
Traditional descriptions of the knee suggest that the function of the patella is to facilitate knee extension by increasing the moment arm of the quadriceps muscles. Through modelling and evidence from the literature it is shown in this paper that the presence of the patella makes the ability of the quadriceps to rotate the thigh greater than their ability to rotate the tibia. Furthermore, this difference increases as the knee is flexed, thus demonstrating a pattern that is consistent with many human movements. This paper also shows that the anterior cruciate ligament plays a previously unheralded role in extending the shank and that translation at the tibiofemoral and patellofemoral joints is important in improving the capacity for thigh rotation when the knee is flexed. This study provides new insights as to how the structure of the knee is adapted to its purpose and illustrates how the functional anatomy of the knee contributes to its extension function.
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Effect of tibial plateau levelling osteotomy on patellar tendon angle: a prospective clinical study. Vet Comp Orthop Traumatol 2014; 27:346-50. [PMID: 25213030 DOI: 10.3415/vcot-14-01-0013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2014] [Accepted: 07/09/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate the effect of the tibial plateau levelling osteotomy (TPLO) procedure on the patellar tendon angle (PTA) in dogs with naturally occurring cranial cruciate ligament rupture. STUDY DESIGN Prospective observational clinical study. ANIMALS Dogs with naturally occurring CrCL rupture that had a TPLO performed (n = 40). METHODS Preoperative tibial plateau angle (TPA) and PTA were measured on radiographic images of affected stifle joints at 90° and standing angle (135°) respectively. The TPA and PTA were measured after TPLO was performed. Regression analysis was performed to evaluate the effect of preoperative TPA and PTA and postoperative TPA on postoperative PTA. Linear regression analysis was performed to evaluate the correlation between postoperative TPA and PTA. RESULTS The mean (± SD) preoperative TPA and PTA were 26.5 ± 3.8° and 105.7 ± 3.8° respectively. The postoperative TPA and PTA values were 7.6 ± 3.3° and 91.4 ± 5.5°, respectively. Regression analysis showed that higher preoperative PTA and postoperative TPA are associated with a larger difference between the postoperative PTA and 90°. There was a positive correlation between postoperative TPA and PTA. CONCLUSION The TPLO procedure alters the PTA to 90° in dogs with cranial cruciate ligament rupture similar to tibial tuberosity advancement (TTA). CLINICAL SIGNIFICANCE The TPLO may provide dynamic stability to the cranial cruciate deficient stifle by altering the TPA relative to the patellar tendon and creating a PTA of 90°. The biomechanical principle and mechanism of action of TPLO may be similar to TTA.
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Castilho M, Dias M, Vorndran E, Gbureck U, Fernandes P, Pires I, Gouveia B, Armés H, Pires E, Rodrigues J. Application of a 3D printed customized implant for canine cruciate ligament treatment by tibial tuberosity advancement. Biofabrication 2014; 6:025005. [DOI: 10.1088/1758-5082/6/2/025005] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Pozzi A, Kim SE, Conrad BP, Horodyski M, Banks SA. Ex vivo pathomechanics of the canine Pond-Nuki model. PLoS One 2013; 8:e81383. [PMID: 24349061 PMCID: PMC3862477 DOI: 10.1371/journal.pone.0081383] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Accepted: 10/13/2013] [Indexed: 11/19/2022] Open
Abstract
Background Transection of the canine cranial cruciate ligament (CCL) is a well-established osteoarthritis (OA) model. The effect of CCL loss on contact pressure and joint alignment has not been quantified for stifle loading in standing. The purposes of the study were to measure femorotibial contact areas and stresses and joint alignment following transection of the CCL in an ex vivo model. We hypothesized that transection of the CCL would lead to abnormal kinematics, as well as alterations in contact mechanics of the femorotibial joint. Methodology/Principal Findings Eight canine hindlimbs were tested in a servo-hydraulic materials testing machine using a custom made femoral jig. Contact area and pressure measurements, and femorotibial rotations and translations were measured in the normal and the CCL–deficient stifle in both standing and deep flexion angles. We found that at standing angle, transection of the CCL caused cranial translation and internal rotation of the tibia with a concurrent caudal shift of the contact area, an increase in peak pressure and a decrease in contact area. These changes were not noted in deep flexion. At standing, loss of CCL caused a redistribution of the joint pressure, with the caudal region of the compartment being overloaded and the rest of the joint being underloaded. Conclusion In the Pond-Nuki model alterations in joint alignment are correlated with shifting of the contact points to infrequently loaded areas of the tibial plateau. The results of this study suggest that this cadaveric Pond-Nuki model simulates the biomechanical changes previously reported in the in-vivo Pond-Nuki model.
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Affiliation(s)
- Antonio Pozzi
- Comparative Orthopaedics Biomechanics Laboratory, Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, United States of America
- * E-mail:
| | - Stanley E. Kim
- Comparative Orthopaedics Biomechanics Laboratory, Department of Small Animal Clinical Sciences, University of Florida, Gainesville, Florida, United States of America
| | - Bryan P. Conrad
- Comparative Orthopaedics Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, United States of America
| | - MaryBeth Horodyski
- Comparative Orthopaedics Biomechanics Laboratory, Department of Orthopaedics and Rehabilitation, University of Florida, Gainesville, Florida, United States of America
| | - Scott A. Banks
- Comparative Orthopaedics Biomechanics Laboratory, Department of Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, United States of America
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Oxley B, Gemmill TJ, Renwick AR, Clements DN, McKee WM. Comparison of Complication Rates and Clinical Outcome Between Tibial Plateau Leveling Osteotomy and a Modified Cranial Closing Wedge Osteotomy for Treatment of Cranial Cruciate Ligament Disease in Dogs. Vet Surg 2013; 42:739-50. [DOI: 10.1111/j.1532-950x.2013.12033.x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 05/19/2012] [Indexed: 11/29/2022]
Affiliation(s)
- Bill Oxley
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | - Toby J. Gemmill
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
| | | | - Dylan N. Clements
- Division of Veterinary Clinical Sciences; Royal (Dick) School of Veterinary Studies and The Roslin Institute, Hospital for Small Animals, The University of Edinburgh, Easter Bush Veterinary Centre; Roslin; Midlothian, Scotland
| | - W. Malcolm McKee
- Department of Orthopaedics; Willows Referral Service; Solihull; United Kingdom
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Blajer W, Dziewiecki K, Mazur Z. An improved inverse dynamics formulation for estimation of external and internal loads during human sagittal plane movements. Comput Methods Biomech Biomed Engin 2013; 18:362-75. [PMID: 23758087 DOI: 10.1080/10255842.2013.799147] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Planar musculoskeletal models are common in the inverse dynamics analysis of human movements such as walking, running and jumping. The continued interest in such models is justified by their simplicity and computational efficiency. Related to a human planar model, a unified formulation for both the flying and support phases of the sagittal plane movements is developed. The actuation involves muscle forces in the lower limbs and the resultant muscle torques in the other body joints. The dynamic equations, introduced in absolute coordinates of the segments, are converted into useful compact forms using the projective technique. The solution to a determinate inverse dynamics problem allows for the explicit determination of the external reactions (presumed to vanish during the flying phases) and the resultant muscle torques in all the model joints. The indeterminate inverse dynamics problem is then focused on the assessment of muscle forces and joint reaction forces selectively in the supporting lower limb. Numerical results of the inverse dynamics simulation of sample sagittal plane movements are reported to illustrate the validity and effectiveness of the improved formulation.
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Affiliation(s)
- Wojciech Blajer
- a Faculty of Mechanical Engineering, Institute of Applied Mechanics and Power Engineering, University of Technology and Humanities in Radom , ul. Krasickiego 54, 26-600 Radom , Poland
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In vivo femorotibial subluxation during weight-bearing and clinical outcome following tibial tuberosity advancement for cranial cruciate ligament insufficiency in dogs. Vet J 2013; 196:86-91. [DOI: 10.1016/j.tvjl.2012.08.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2012] [Revised: 06/27/2012] [Accepted: 08/01/2012] [Indexed: 12/26/2022]
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Alkjaer T, Wieland MR, Andersen MS, Simonsen EB, Rasmussen J. Computational modeling of a forward lunge: towards a better understanding of the function of the cruciate ligaments. J Anat 2012; 221:590-7. [PMID: 23057673 DOI: 10.1111/j.1469-7580.2012.01569.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2012] [Indexed: 11/27/2022] Open
Abstract
This study investigated the function of the cruciate ligaments during a forward lunge movement. The mechanical roles of the anterior and posterior cruciate ligament (ACL, PCL) during sagittal plane movements, such as forward lunging, are unclear. A forward lunge movement contains a knee joint flexion and extension that is controlled by the quadriceps muscle. The contraction of the quadriceps can cause anterior tibial translation, which may strain the ACL at knee joint positions close to full extension. However, recent findings suggest that it is the PCL rather than the ACL which is strained during forward lunging. Thus, the purpose of the present study was to establish a musculoskeletal model of the forward lunge to computationally investigate the complete mechanical force equilibrium of the tibia during the movement to examine the loading pattern of the cruciate ligaments. A healthy female was selected from a group of healthy subjects who all performed a forward lunge on a force platform, targeting a knee flexion angle of 90°. Skin-markers were placed on anatomical landmarks on the subject and the movement was recorded by five video cameras. The three-dimensional kinematic data describing the forward lunge movement were extracted and used to develop a biomechanical model of the lunge movement. The model comprised two legs including femur, crus, rigid foot segments and the pelvis. Each leg had 35 independent muscle units, which were recruited according to a minimum fatigue criterion. This approach allowed a full understanding of the mechanical equilibrium of the knee joint, which revealed that the PCL had an important stabilizing role in the forward lunge movement. In contrast, the ACL did not have any significant mechanical function during the lunge movement. Furthermore, the results showed that m. gluteus maximus may play a role as a knee stabilizer in addition to the hamstring muscles.
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Affiliation(s)
- Tine Alkjaer
- Department of Neuroscience and Pharmacology, University of Copenhagen, Denmark.
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Efficacy of gait training with real-time biofeedback in correcting knee hyperextension patterns in young women. J Orthop Sports Phys Ther 2011; 41:948-52. [PMID: 22030469 DOI: 10.2519/jospt.2011.3660] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Single cohort study. OBJECTIVES To investigate the efficacy of real-time biofeedback provided during treadmill gait training to correct knee hyperextension in asymptomatic females while walking. BACKGROUND Knee hyperextension is associated with increased stress to the posterior capsule of the knee joint, anterior cruciate ligament, and the anterior compartment of the tibiofemoral joint. Previous methods aimed at correcting knee hyperextension have shown limited success. METHODS Ten women, ages 18 to 39 years, with asymptomatic knee hyperextension during ambulation, were provided with 6 sessions of real-time feedback of kinematic data (Visual 3D) during treadmill training. Gait evaluations were performed pretraining, posttraining, and 1 month after the last training session. RESULTS Participants showed improved control of knee hyperextension during overground walking at 1.3 m/s at posttraining and at 1 month posttraining. CONCLUSION The present study demonstrated that knee sagittal plane kinematics may be influenced by gait retraining using real-time biofeedback.
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Steinberg EJ, Prata RG, Palazzini K, Brown DC. Tibial Tuberosity Advancement for Treatment of CrCL Injury: Complications and Owner Satisfaction. J Am Anim Hosp Assoc 2011; 47:250-7. [DOI: 10.5326/jaaha-ms-5574] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The purpose of this retrospective study of 171 dogs that underwent 193 tibial tuberosity advancement (TTA) surgeries was to describe complications and owner satisfaction associated with the procedure. Complications occurred in 21 cases (11%). Subsequent meniscal tear was the most common complication (10/193, 5.2%). Increasing body weight (P=0.02–0.04) and small cage size (P=0.06) were significantly associated with postsurgical complications. Ninety-two percent of owners were satisfied with the outcome of the TTA procedure, but only 84% stated that they would be willing to have the procedure performed again. The authors concluded that TTA had a complication rate and owner satisfaction similar to other tibial osteotomies for the surgical correction of cranial cruciate ligament disease.
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Affiliation(s)
- Ezra J. Steinberg
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Raymond G. Prata
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Karen Palazzini
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
| | - Dorothy C. Brown
- Valley Central Veterinary Referral Center, Allentown, PA (E.S.); Veterinary and Emergency Referral Group, Brooklyn, NY (R.P.); Veterinary Specialty and Emergency Center, Langhorne, PA (K.P.); and Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania, Philadelphia, PA (D.B.)
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Shao Q, MacLeod TD, Manal K, Buchanan TS. Estimation of ligament loading and anterior tibial translation in healthy and ACL-deficient knees during gait and the influence of increasing tibial slope using EMG-driven approach. Ann Biomed Eng 2010; 39:110-21. [PMID: 20683675 PMCID: PMC3010217 DOI: 10.1007/s10439-010-0131-2] [Citation(s) in RCA: 71] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 07/12/2010] [Indexed: 01/14/2023]
Abstract
The purpose of this study was to develop a biomechanical model to estimate anterior tibial translation (ATT), anterior shear forces, and ligament loading in the healthy and anterior cruciate ligament (ACL)-deficient knee joint during gait. This model used electromyography (EMG), joint position, and force plate data as inputs to calculate ligament loading during stance phase. First, an EMG-driven model was used to calculate forces for the major muscles crossing the knee joint. The calculated muscle forces were used as inputs to a knee model that incorporated a knee–ligament model in order to solve for ATT and ligament forces. The model took advantage of using EMGs as inputs, and could account for the abnormal muscle activation patterns of ACL-deficient gait. We validated our model by comparing the calculated results with previous in vitro, in vivo, and numerical studies of healthy and ACL-deficient knees, and this gave us confidence on the accuracy of our model calculations. Our model predicted that ATT increased throughout stance phase for the ACL-deficient knee compared with the healthy knee. The medial collateral ligament functioned as the main passive restraint to anterior shear force in the ACL-deficient knee. Although strong co-contraction of knee flexors was found to help restrain ATT in the ACL-deficient knee, it did not counteract the effect of ACL rupture. Posterior inclination angle of the tibial plateau was found to be a crucial parameter in determining knee mechanics, and increasing the tibial slope inclination in our model would increase the resulting ATT and ligament forces in both healthy and ACL-deficient knees.
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Affiliation(s)
- Qi Shao
- Department of Mechanical Engineering, Center for Biomedical Engineering Research, University of Delaware, 126 Spencer Laboratory, Newark, DE 19716 USA
| | - Toran D. MacLeod
- Department of Mechanical Engineering, Center for Biomedical Engineering Research, University of Delaware, 126 Spencer Laboratory, Newark, DE 19716 USA
| | - Kurt Manal
- Department of Mechanical Engineering, Center for Biomedical Engineering Research, University of Delaware, 126 Spencer Laboratory, Newark, DE 19716 USA
| | - Thomas S. Buchanan
- Department of Mechanical Engineering, Center for Biomedical Engineering Research, University of Delaware, 126 Spencer Laboratory, Newark, DE 19716 USA
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40
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Stagni R, Fantozzi S, Catani F, Leardini A. Can Patellar Tendon Angle reveal sagittal kinematics in total knee arthroplasty? Knee Surg Sports Traumatol Arthrosc 2010; 18:949-54. [PMID: 20162258 DOI: 10.1007/s00167-010-1075-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 01/20/2010] [Indexed: 11/25/2022]
Abstract
The Patellar Tendon Angle is strongly correlated with both patello-femoral and tibio-femoral joint kinematics. Thus, the Patellar Tendon Angle might be regarded as a concise indicator of the antero-posterior translation of the femur with respect to the tibia. Twelve subjects, who had undergone total knee arthroplasty, were investigated by video-fluoroscopy during step-up/down. The kinematics at the replaced knee was reconstructed by means of 3D fluoroscopy. The Patellar Tendon Angle and the knee-flexion angle were measured on sagittal fluoroscopic images with software designed for the purpose. The slope of the linear trend of the Patellar Tendon Angle versus knee-flexion angle relationship correlated significantly with the mean (p = 0.001), most anterior (p = 0.001), and most posterior (p = 0.016) position reached by the femur over the tibia. The Patellar Tendon Angle versus knee-flexion angle relationship provides relevant information about the anterior or posterior positioning of the femur over the tibia, but it cannot be interpreted as quantification of the actual antero-posterior translation of the femur over the tibia.
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Affiliation(s)
- R Stagni
- Department of Electronics, Computer Sciences and Systems, Università degli Studi di Bologna, Viale Risorgimento 2, 40136 Bologna, Italy.
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41
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Catalfamo PF, Aguiar G, Curi J, Braidot A. Anterior Cruciate Ligament Injury: Compensation during Gait using Hamstring Muscle Activity. Open Biomed Eng J 2010; 4:99-106. [PMID: 20721326 PMCID: PMC2923375 DOI: 10.2174/1874120701004010099] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2009] [Revised: 03/25/2010] [Accepted: 04/10/2010] [Indexed: 11/22/2022] Open
Abstract
Previous research has shown that an increase in hamstring activation may compensate for anterior tibial transalation (ATT) in patients with anterior cruciate ligament deficient knee (ACLd); however, the effects of this compensation still remain unclear. The goals of this study were to quantify the activation of the hamstring muscles needed to compensate the ATT in ACLd knee during the complete gait cycle and to evaluate the effect of this compensation on quadriceps activation and joint contact forces. A two dimensional model of the knee was used, which included the tibiofemoral and patellofemoral joints, knee ligaments, the medial capsule and two muscles units. Simulations were conducted to determine the ATT in healthy and ACLd knee and the hamstring activation needed to correct the abnormal ATT to normal levels (100% compensation) and to 50% compensation. Then, the quadriceps activation and the joint contact forces were calculated. Results showed that 100% compensation would require hamstring and quadriceps activations larger than their maximum isometric force, and would generate an increment in the peak contact force at the tibiofemoral (115%) and patellofemoral (48%) joint with respect to the healthy knee. On the other hand, 50% compensation would require less force generated by the muscles (less than 0.85 of maximum isometric force) and smaller contact forces (peak tibiofemoral contact force increased 23% and peak patellofemoral contact force decreased 7.5% with respect to the healthy knee). Total compensation of ATT by means of increased hamstring activity is possible; however, partial compensation represents a less deleterious strategy.
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42
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Cleather DJ, Bull AMJ. Lower-extremity musculoskeletal geometry affects the calculation of patellofemoral forces in vertical jumping and weightlifting. Proc Inst Mech Eng H 2010; 224:1073-83. [DOI: 10.1243/09544119jeim731] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The calculation of the patellofemoral joint contact force using three-dimensional (3D) modelling techniques requires a description of the musculoskeletal geometry of the lower limb. In this study, the influence of the complexity of the muscle model was studied by considering two different muscle models, the Delp and Horsman models. Both models were used to calculate the patellofemoral force during standing, vertical jumping, and Olympic-style weightlifting. The patellofemoral forces predicted by the Horsman model were markedly lower than those predicted by the Delp model in all activities and represented more realistic values when compared with previous work. This was found to be a result of a lower level of redundancy in the Delp model, which forced a higher level of muscular activation in order to allow a viable solution. The higher level of complexity in the Horsman model resulted in a greater degree of redundancy and consequently lower activation and patellofemoral forces. The results of this work demonstrate that a well-posed muscle model must have an adequate degree of complexity to create a sufficient independence, variability, and number of moment arms in order to ensure adequate redundancy of the force-sharing problem such that muscle forces are not overstated.
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Affiliation(s)
- D J Cleather
- School of Human Sciences, St Mary's University College, and Department of Bioengineering, Imperial College London, UK
| | - A M J Bull
- Department of Bioengineering, Imperial College London, UK
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43
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Farhat N, Mata V, Rosa D, Fayos J. A procedure for estimating the relevant forces in the human knee using a four-bar mechanism. Comput Methods Biomech Biomed Engin 2010; 13:577-87. [PMID: 20204911 DOI: 10.1080/10255840903352540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Knee injuries, especially those that affect the cruciate and lateral ligaments, are one of the most serious and frequent pathologies that affect the lower human extremity. Hence, the aim of this study is to develop a dynamic model for the lower extremity capable of estimating forces, forces in the cruciate and collateral ligaments and those normal to the articular cartilage, generated in the knee. The proposed model considers a four-bar mechanism in the knee, a spherical joint in the pelvis and a revolute one in the ankle. The four-bar mechanism is obtained by a synthesis process. The dynamic model includes the inertial properties of the femur, tibia, patella and the foot, the ground reaction force and the most important muscles in the knee. Muscle forces are estimated using an optimisation technique. Results from the application of the model on a real human task are presented.
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Affiliation(s)
- Nidal Farhat
- Centro de Investigación de Tecnología de Vehículos (CITV), Universidad Politécnica de Valencia, Camino de Vera S/N, 46022 Valencia, Spain.
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44
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Arnold AS, Salinas S, Hakawa DJ, Delp SL. Accuracy of Muscle Moment Arms Estimated from MRI-Based Musculoskeletal Models of the Lower Extremity. ACTA ACUST UNITED AC 2010. [DOI: 10.3109/10929080009148877] [Citation(s) in RCA: 192] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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45
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Renwick AIC, McKee WM, Emmerson TD, House AK. Preliminary experiences of the triple tibial osteotomy procedure: tibial morphology and complications. J Small Anim Pract 2009; 50:212-21. [DOI: 10.1111/j.1748-5827.2008.00698.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Blazevich AJ, Coleman DR, Horne S, Cannavan D. Anatomical predictors of maximum isometric and concentric knee extensor moment. Eur J Appl Physiol 2009; 105:869-78. [PMID: 19153760 DOI: 10.1007/s00421-008-0972-7] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2008] [Indexed: 11/28/2022]
Affiliation(s)
- Anthony J Blazevich
- Centre for Sports Medicine and Human Performance, School of Sport and Education, Brunel University, Middlesex, UK.
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47
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A comparison of different two-dimensional approaches for the determination of the patellar tendon moment arm length. Eur J Appl Physiol 2009; 105:809-14. [PMID: 19125279 DOI: 10.1007/s00421-008-0968-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/04/2008] [Indexed: 10/21/2022]
Abstract
The purpose of this study was to estimate and compare the moment arm length of the patellar tendon (d) during passive knee extension using three different reference landmarks; instant centre of rotation (ICR), tibiofemoral contact point (TFCP) and geometrical centre of the posterior femoral condyles (GCFC). Measurements were taken on the right leg on seven healthy males during passive knee rotation performed by the motor of a Cybex Norm isokinetic dynamometer. Moment arms lengths were obtained by analysing lateral X-ray images recorded using a GE FlexiView 8800 C-arm videofluoroscopy system. The d-knee joint angle relations with respect to GCFC and ICR were similar, with decreasing values from full knee extension (~5.8 cm for d (GCFC) and ~5.9 cm for d (ICR)) to 90 degrees of knee flexion (~4.8 cm for both d (GCFC) and d (ICR)). However, the d (TFCP)-knee joint angle relation had an ascending-descending shape, with the highest d (TFCP) value (~5 cm) at 60 degrees of knee flexion. There was no significant difference between the GCFC and ICR methods at any knee joint angle. In contrast, there were significant differences (P < 0.01) between d (ICR) and d (TFCP) at 0 degrees , 15 degrees , 30 degrees and 45 degrees of knee flexion and between d (GCFC) and d (TFCP) at 0 degrees , 15 degrees and 30 degrees of knee flexion (P < 0.01). This study shows that when using different knee joint rotation centre definitions, there are significant differences in the estimates of the patellar tendon moment arm length, especially in more extended knee joint positions. These differences can have serious implications for joint modelling and loading applications.
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48
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Stein S, Schmoekel H. Short-term and eight to 12 months results of a tibial tuberosity advancement as treatment of canine cranial cruciate ligament damage. J Small Anim Pract 2008; 49:398-404. [PMID: 18631216 DOI: 10.1111/j.1748-5827.2008.00592.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- S Stein
- Great Western Referrals, Shrivenham Road, Swindon SN1 2NR, UK
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Lafaver S, Miller NA, Stubbs WP, Taylor RA, Boudrieau RJ. Tibial Tuberosity Advancement for Stabilization of the Canine Cranial Cruciate Ligament-Deficient Stifle Joint: Surgical Technique, Early Results, and Complications in 101 Dogs. Vet Surg 2007; 36:573-86. [PMID: 17686132 DOI: 10.1111/j.1532-950x.2007.00307.x] [Citation(s) in RCA: 133] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe the surgical technique, early results and complications of tibial tuberosity advancement (TTA) for treatment for cranial cruciate ligament (CrCL)-deficient stifle joints in dogs. STUDY DESIGN Retrospective clinical study. ANIMALS Dogs (n=101) with CrCL-deficient stifles (114). METHODS Medical records of 101 dogs that had TTA were reviewed. Complications were recorded and separated into either major or minor complications based on the need for additional surgery. In-hospital re-evaluation of limb function and time to radiographic healing were reviewed. Further follow-up was obtained by telephone interview of owners. RESULTS Complications occurred in 31.5% of the dogs (12.3% major, 19.3% minor). Major complications included subsequent meniscal tear, tibial fracture, implant failure, infection, lick granuloma, incisional trauma, and medial patellar luxation; all major complications were treated with successful outcomes. All but 2 minor complications resolved. The mean time to documented radiographic healing was 11.3 weeks. Final in-hospital re-evaluation of limb function (mean, 13.5 weeks), was recorded for 93 dogs with lameness categorized as none (74.5%), mild (23.5%), moderate (2%), and severe (1%). All but 2 owners interviewed were satisfied with outcome and 83.1% reported a marked improvement or a return to pre-injury status. CONCLUSIONS TTA is a procedure comparable with alternate methods of CrCL repair with expected good to excellent functional outcome. CLINICAL RELEVANCE TTA procedure can be successfully used to obtain the dynamic stability of a CrCL-deficient stifle joint in dogs.
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Apelt D, Kowaleski MP, Boudrieau RJ. Effect of tibial tuberosity advancement on cranial tibial subluxation in canine cranial cruciate-deficient stifle joints: an in vitro experimental study. Vet Surg 2007; 36:170-7. [PMID: 17335425 DOI: 10.1111/j.1532-950x.2007.00250.x] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the effect of tibial tuberosity advancement (TTA) on tibiofemoral shear force as reflected by measurement of cranial tibial subluxation (CTS) and patella tendon angle (PTA) in the canine cranial cruciate ligament (CrCL) deficient stifle joint. STUDY DESIGN In vitro cadaver study. ANIMALS Canine cadaveric hind limbs (n=10). METHODS CTS and PTA were evaluated from lateral radiographic projections in axially loaded intact CrCL stifle joints, after transection of the CrCL, at a maximally advanced tibial tuberosity position, and at a critical point position. A custom-designed hinge plate allowed alteration of the tibia to tibial tuberosity distance (Ti-TT) under axial load. Digitized radiographic images were used to quantify CTS, PTA, and Ti-TT. Comparisons within groups were made using 1-way repeated measures ANOVA. A post hoc Tukey's HSD test was used to determine post-ANOVA pair-wise comparison within these groups. Significance was set at a value of P<.05. RESULTS CTS occurred after CrCL transection, which was significantly different from the intact position (P<.01). Subsequent stability of the stifle joint was obtained by advancing the tibial tuberosity. In the maximally advanced tibial tuberosity position, caudal tibial thrust was generated resulting in caudal tibial subluxation that was significantly different from the transected CrCL position (P<.01) and from the intact CrCL position (P<.01). Despite a stable joint, there was slight CTS at the critical point position, which was significantly different from the intact CrCL position (P<.05). The PTA at the maximally advanced position was significantly different from the intact, critical point and reference 90 degrees PTAs (P<.01). The PTA at the critical point position was significantly different from the intact and maximally advanced tibial tuberosity PTAs (P<.01), but not different (P>.05) from the reference 90 degrees PTA. CONCLUSION We demonstrated that advancement of the tibial tuberosity neutralized cranial tibial thrust, and converted cranial tibial thrust into caudal tibial thrust. Neutralization of tibiofemoral shear forces occurred at a PTA of 90.3+/-9.0 degrees. CLINICAL RELEVANCE TTA can effectively change the magnitude and direction of the tibiofemoral shear force, and thus may be used to prevent craniotibial translation in a CrCL deficient stifle joint.
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Affiliation(s)
- Detlef Apelt
- College of Veterinary Medicine, The Ohio State University, Columbus, OH, USA
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