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Sun D, Shi G, Du K. Biomechanical study of different fixation methods for posterior malleolus fracture. Comput Methods Biomech Biomed Engin 2024; 27:1141-1149. [PMID: 37409849 DOI: 10.1080/10255842.2023.2231115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 06/25/2023] [Indexed: 07/07/2023]
Abstract
In this study, the biomechanical effect of six fixation methods for the treatment of posterior malleolus fracture (PMF) were analyzed by finite element method. Fixation models include five different cannulated screw fixation models (0°, 5°, 10°, 15°, 20°) and a posterior plate fixation model. The von Mises stress (VMS) and displacement were used as criteria to evaluate the biomechanical efficiency of the different fixation models. The results demonstrated that the VMS and displacement will increase as the load increases. The buttress plate has better fixed strength and biomechanics results than screws. When the screw fixation angle is 15°, the model has better fixed strength and biomechanical stability than other screws fixation models. Therefore, we recommend the screws fixation with angle of 15° for posterior malleolus fracture, which can be used to guide clinical operation.
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Affiliation(s)
- Dandan Sun
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Gengqiang Shi
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Kewei Du
- School of Health Science and Engineering, University of Shanghai for Science and Technology, Shanghai, China
- Department of Orthopedics, Shidong Hospital Affiliated to University of Shanghai for Science and Technology, Shanghai, China
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2
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Yamazaki T, Matsuura Y, Toguchi Y, Suzuki T, Ohtori S. Biomechanical characterization of the central fibrous region of the forearm interosseous Membrane: Implications for finite element modeling. J Biomech 2024; 172:112204. [PMID: 38950484 DOI: 10.1016/j.jbiomech.2024.112204] [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: 01/12/2024] [Revised: 06/14/2024] [Accepted: 06/20/2024] [Indexed: 07/03/2024]
Abstract
The interosseous membrane (IOM) of the forearm plays a crucial role in facilitating forearm function and mechanical load transmission between the radius and ulna. Accurate characterization of its biomechanical properties is essential for developing realistic finite element models of the forearm. This study aimed to investigate the mechanical behavior and material properties of the central fibrous regions of the IOM using fresh frozen cadavers. Ten forearms from five cadavers were dissected, preserving the IOM and identifying the distal accessory band (DAB), central band (CB), and proximal accessory band (PAB). Bone-ligament-bone specimens were prepared and subjected to uniaxial tensile testing, with the loading direction aligned with the fiber orientation. Force-displacement curves were obtained and converted to force-strain and stress-strain curves using premeasured fiber lengths and cross-sectional areas. The results demonstrated distinct mechanical responses among the IOM regions, with the PAB exhibiting significantly lower force-strain behavior compared to the DAB and CB. The derived force-strain and stress-strain relationships provide valuable insights into the regional variations in stiffness and strength of the IOM, highlighting the importance of considering these differences when modeling the IOM in finite element analysis. In conclusion, this study establishes a foundation for the development of advanced finite element models of the forearm that accurately capture the biomechanical behavior of the IOM.
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Affiliation(s)
- Takahiro Yamazaki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Yusuke Matsuura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Yasunari Toguchi
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Takane Suzuki
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
| | - Seiji Ohtori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Chiba University, 1-8-1 Inohana Chuo-ku, Chiba 260-8670, Japan.
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3
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Shiode R, Miyamura S, Kazui A, Yamamoto N, Miyake T, Iwahashi T, Tanaka H, Otake Y, Sato Y, Murase T, Abe S, Okada S, Oka K. Reproduction of forearm rotation dynamic using intensity-based biplane 2D-3D registration matching method. Sci Rep 2024; 14:5518. [PMID: 38448504 PMCID: PMC10918057 DOI: 10.1038/s41598-024-55956-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
This study aimed to reproduce and analyse the in vivo dynamic rotational motion of the forearm and to clarify forearm motion involvement and the anatomical function of the interosseous membrane (IOM). The dynamic forearm rotational motion of the radius and ulna was analysed in vivo using a novel image-matching method based on fluoroscopic and computed tomography images for intensity-based biplane two-dimensional-three-dimensional registration. Twenty upper limbs from 10 healthy volunteers were included in this study. The mean range of forearm rotation was 150 ± 26° for dominant hands and 151 ± 18° for non-dominant hands, with no significant difference observed between the two. The radius was most proximal to the maximum pronation relative to the ulna, moved distally toward 60% of the rotation range from maximum pronation, and again proximally toward supination. The mean axial translation of the radius relative to the ulna during forearm rotation was 1.8 ± 0.8 and 1.8 ± 0.9 mm for dominant and non-dominant hands, respectively. The lengths of the IOM components, excluding the central band (CB), changed rotation. The transverse CB length was maximal at approximately 50% of the rotation range from maximum pronation. Summarily, this study describes a detailed method for evaluating in vivo dynamic forearm motion and provides valuable insights into forearm kinematics and IOM function.
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Affiliation(s)
- Ryoya Shiode
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Satoshi Miyamura
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Arisa Kazui
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Natsuki Yamamoto
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Tasuku Miyake
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Toru Iwahashi
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Hiroyuki Tanaka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yoshito Otake
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Yoshinobu Sato
- Division of Information Science, Nara Institute of Science and Technology, 8916-5 Takayama, Ikoma, Nara, 630-0192, Japan
| | - Tsuyoshi Murase
- Department of Orthopaedic Surgery, Bell Land General Hospital, 500-3 Higashiyama, Naka-ku, Sakai, Osaka, 599-8247, Japan
| | - Shingo Abe
- Department of Orthopaedic Surgery, Toyonaka City Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan
| | - Seiji Okada
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Kunihiro Oka
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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4
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Mercan N, Yurteri A, Dere Y. Do lateral ankle ligaments contribute to syndesmotic stability: a finite element analysis study. Comput Methods Biomech Biomed Engin 2023:1-13. [PMID: 37728074 DOI: 10.1080/10255842.2023.2258251] [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: 07/27/2023] [Accepted: 09/07/2023] [Indexed: 09/21/2023]
Abstract
Whether the lateral ankle ligaments contribute to syndesmotic stability is still controversial and has been the subject of frequent research recently. In our study, we tried to elucidate this situation using the finite element analysis method. Intact model and thirteen different injury models were created to simulate injuries of the lateral ankle ligaments (ATFL, CFL, PTFL), injuries of the syndesmotic ligaments (AITFL, IOL, PITFL) and their combined injuries. The models were compared in terms of LFT, PFT and EFR. It was observed that 0.537 mm LFT, 0.626 mm PFT and 1.25° EFR occurred in the intact model (M#1), 0.539 mm LFT, 0.761 mm PFT and 2.31° EFR occurred in the isolated ATFL injury (M#2), 0.547 mm LFT, 0.791 mm PFT and 2.50° EFR occurred in the isolated AITFL injury (M#8). The LFT, PFT and EFR amounts were higher in the both M#2 and M#8 compared to the M#1. LFT, PFT and EFR amounts in M#2 and M#8 were found to be extremely close. In terms of LFT and PFT, when we compare models with (LFT: 0.650 mm, PFT: 1.104) and without (LFT: 0.457 mm, PFT: 1.150) IOL injury, it is seen that the amount of LFT increases and the amount of PFT decreases with IOL injury. We also observed that injuries to the CFL, PTFL and PITFL did not cause significant changes in fibular translations and PFT and EFR values show an almost linear correlation. Our results suggest that ATFL injury plays a crucial role in syndesmotic stability.
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Affiliation(s)
- Numan Mercan
- Department of Orthopaedic and Traumatology, Kahramanmaras Necip Fazıl City Hospital, Kahramanmaras, Turkey
| | - Ahmet Yurteri
- Department of Orthopaedic and Traumatology, Konya Sehir Hastanesi, Konya, Turkey
| | - Yunus Dere
- Department of Civil Engineering, Necmettin Erbakan University, Meram, Turkey
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Wu C, Wang X, Zhang H, Xie S, He J. Biomechanical analysis of different internal fixation methods for special Maisonneuve fracture of the ankle joint based on finite element analysis. Injury 2023:110917. [PMID: 37400327 DOI: 10.1016/j.injury.2023.110917] [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: 03/13/2023] [Revised: 06/15/2023] [Accepted: 06/25/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE The objective of this study was to evaluate the biomechanical properties of different internal fixation methods for Maisonneuve fractures under physiological loading conditions. METHODS Finite element analysis was used to numerically analyze various fixation methods. The study focused on high fibular fractures and included six groups of internal fixation: high fibular fracture without fixation + distal tibiofibular elastic fixation (group A), high fibular fracture without fixation + distal tibiofibular strong fixation (group B), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular elastic fixation (group C), high fibular fracture with 7-hole plate internal fixation + distal tibiofibular strong fixation (group D), high fibular fracture with 5-hole plate internal fixation + distal tibiofibular elastic fixation (group E), and high fibular fracture with 5-hole plate internal fixation + distal tibiofibular strong fixation (group F). The finite element method was employed to simulate and analyze the different internal fixation models for the six groups, generating overall structural displacement and Von Mises stress distribution maps during slow walking and external rotation motions. RESULTS Group A demonstrated the best ankle stability under slow walking and external rotation, with reduced tibial and fibular stress after fibular fracture fixation. Group D had the least displacement and most stability, while group A had the largest displacement and least stability. Overall, high fibular fracture fixation improved ankle stability. In slow walking, groups D and A had the least and greatest interosseous membrane stress. Comparing 5-hole plate (E/F) and 7-hole plate (C/D) fixation, no significant differences were found in ankle strength or displacement under slow walking or external rotation. CONCLUSION Combining internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula is optimal for orthopedic treatment. It yields superior outcomes compared to no fibular fracture fixation or strong fixation of the lower tibia and fibula, especially during slow walking and external rotation. To minimize nerve damage, a smaller plate is recommended. This study strongly advocates for the clinical use of 5-hole plate internal fixation for high fibular fractures with elastic fixation of the lower tibia and fibula (group E).
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Affiliation(s)
- Chaomeng Wu
- Jiangxi university of Traditional Chinese Medicine, Nanchang 33004, China
| | - Xingyu Wang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Hao Zhang
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Shuihua Xie
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China
| | - Jianhua He
- Jiangxi Provincial Hospital of Integrated Traditional Chinese and Western Medicine, Nanchang 33003, China.
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6
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Mercan N, Yıldırım A, Dere Y. Biomechanical Analysis of Tibiofibular Syndesmosis Injury Fixation Methods: A Finite Element Analysis. J Foot Ankle Surg 2022; 62:107-114. [PMID: 35732561 DOI: 10.1053/j.jfas.2022.05.007] [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: 02/10/2022] [Revised: 05/09/2022] [Accepted: 05/11/2022] [Indexed: 02/03/2023]
Abstract
The optimal treatment strategy after syndesmotic injuries is still controversial. In our study, we aimed to evaluate ideal fixation method in syndesmotic injury by using finite element analysis method. A 3D SolidWorks model file was created by taking computed tomography (CT) images of the area from the right foot base to the knee joint level of a healthy adult male. The intact model, injury model, and 8 different fixation models were created that 3.5 mm screw and suture-button were used in. The models were compared in terms of lateral fibular translation, posterior fibular translation and external rotation of fibula compared to tibia and stress values occurred on screws and suture-buttons. In the hybrid-1 model, lateral fibular translation and external fibular rotation values were obtained as close to the intact model. Von Mises stresses occurred in the screw (435.7 MPa) and suture-button (424.7 MPa) that used in hybrid-1 model was more than single screw at 4 cm model (316.8 MPa) and single suture-button at 2 cm model (160.7 MPa). In the Hybrid-1 model, the screw compensates for posterior fibular translation and external fibular rotation, while the suture-button compensates for lateral fibular translation. Also, the effect of the distal suture-button preventing diastasis in case of proximal screw failure, it was concluded that the hybrid-1 model can be used as a good treatment alternative in the surgical treatment of distal tibiofibular syndesmotic injuries.
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Affiliation(s)
- Numan Mercan
- Physician, Department of Orthopedics and Traumatology, Medical Faculty of Selcuk University, Konya, Turkey
| | - Ahmet Yıldırım
- Associate Professor, Department of Orthopedics and Traumatology, Medical Faculty of Selcuk University, Konya, Turkey.
| | - Yunus Dere
- Assistant Professor, Department of Civil Engineering, Necmettin Erbakan University, Konya, Turkey
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7
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Rougereau G, Marty-Diloy T, Vigan M, Vialle R, Soubeyrand M, Langlais T. Biomechanical assessment of the central band of the interosseous membrane using shear wave elastography: reliability and reproducibility. J Hand Surg Eur Vol 2022; 47:1134-1141. [PMID: 35953882 DOI: 10.1177/17531934221114301] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The interosseous membrane of the forearm is an essential structure for the stability of the forearm skeleton, the most important part being the central band. The purpose of this study was to determine if shear wave elastography, a non-invasive ultrasound technique, can be used to measure shear wave speed in the central band and quantify stiffness. Fifteen healthy adult subjects were included (30 forearms). The participants forearms were positioned on an articulated plate, with their hand in neutral, pronated and then supinated positions of 30°, 60° and 90°. The shear wave speed was highest in 90° pronation (4.4 m/s (SD 0.3)) and 90° supination (4.4 m/s (SD 0.27)) indicating maximum stiffness in these positions. Its minimum value was in the neutral position, and either in 30° pronation or supination (3.5 m/s (SD 0.3)). Intra- and interobserver agreement was excellent, regardless of probe positioning or forearm mobilization. This study presents a reliable shear wave elastography measurement protocol to describe the physiological function of the central band of the interosseous membrane in healthy adults.Level of evidence: IV.
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Affiliation(s)
- Grégoire Rougereau
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Adult Orthopedic Surgery, Sorbonne University, Pitié-Salpêtrière Hospital, APHP, Paris, France
| | - Thibault Marty-Diloy
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France
| | - Marie Vigan
- Unité de Recherche Clinique Hôpitaux Universitaires Paris Ile-de-France Ouest, APHP, Boulogne-Billancourt, France
| | - Raphaël Vialle
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,MAMUTH Hospital University Department for Innovative Therapies in Musculoskeletal Disease Sorbonne University, Paris
| | - Marc Soubeyrand
- Department of Orthopedics and Traumatology, Clinique Saint Jean l'Ermitage, Melun, France
| | - Tristan Langlais
- Department of Pediatric Orthopedic Surgery, Sorbonne University, Armand Trousseau Hospital, APHP, Paris, France.,Department of Pediatric Orthopedic Surgery, Toulouse University, Children's hospital, Purpan, Toulouse, France
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Wang S, Habet N, Rice OM, CarlLee TL, Moorman CT. Superiorly and transversely orienting the bicortical suspension device provides optimal anterolateral stability to the proximal tibiofibular joint: a finite-element study. Knee Surg Sports Traumatol Arthrosc 2022; 30:3767-3775. [PMID: 35585275 DOI: 10.1007/s00167-022-06991-8] [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: 01/31/2022] [Accepted: 04/21/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE Instability of the proximal tibiofibular joint (PTFJ) can be treated with bicortical suspension (BCS) fixation. However, the ideal location, orientation, and configuration to apply one or two BCS devices are not clear. METHODS A finite-element model of the PTFJ was created from a female adult's CT dataset. Anterior and posterior ligaments at the PTFJ were modeled and suppressed to simulate stable and unstable joints. Fifty-six models simulated 56 device placements along guiding tunnel lines that connect eight entry locations on the fibular head to seven exit points on the anteromedial tibia. Doubling device stiffness created 56 more models. Combing any two placements created 1176 double-device configurations which were categorized to be crossed, divergent or parallel. Displacement of the fibular head relative to the fixed tibia under 100 N anterolateral and posteromedial forces was assessed. RESULTS Different placements had 2.1-27.9 mm translation with 0.7-8.9° internal rotation under anterolateral loading, and 1.8-5.2 mm translation with 6.1-7.9° external rotation under posteromedial loading. More transverse and superior orientations were associated with smaller anterolateral translation; more posterior and superior entry locations were associated with smaller internal rotation. The median (IQR) reductions in anterolateral translation by doubling device stiffness and by adding a second device were 0.8 (IQR 0.5-1.0) and 0.8 (IQR 0-6.1) mm, respectively. The type of double-device configurations had no significant effect on fibular motion. CONCLUSION Surgeons should drill the guiding tunnel superiorly and transversely to ensure the optimal restoration of the PTFJ anterolateral stability.
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Affiliation(s)
- Shangcheng Wang
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd, Charlotte, NC, 28203, USA. .,OrthoCarolina Research Institute, Charlotte, NC, USA.
| | - Nahir Habet
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | - Olivia M Rice
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd, Charlotte, NC, 28203, USA
| | | | - Claude T Moorman
- Department of Orthopaedic Surgery, Atrium Health Musculoskeletal Institute, 1000 Blythe Blvd, Charlotte, NC, 28203, USA.,OrthoCarolina Sports Medicine, Charlotte, NC, USA
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9
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Ab Rashid AM, Ramlee MH, Gan HS, Rafiq Abdul Kadir M. Effects of badminton insole design on stress distribution, displacement and bone rotation of ankle joint during single-leg landing: a finite element analysis. Sports Biomech 2022:1-22. [PMID: 35722740 DOI: 10.1080/14763141.2022.2086168] [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: 11/02/2021] [Accepted: 05/31/2022] [Indexed: 10/18/2022]
Abstract
Previous research has reported that up to 92% of injuries amongst badminton players consist of lower limb, whereby 35% of foot fractures occurred at the metatarsal bone. In sports, insoles are widely used to increase athletes' performance and prevent many injuries. However, there is still a lack of badminton insole analysis and improvements. Therefore, this study aimed to biomechanically analyse three different insole designs. A validated and converged three-dimensional (3D) finite element model of ankle-foot complex was developed, which consisted of the skin, talus, calcaneus, navicular, three cuneiform, cuboid, five metatarsals and five phalanges. Three existing insoles from the market, (1) Yonex Active Pro Truactive, (2) Victor VT-XD 8 and (3) Li-Ning L6200LA, were scanned using a 3D scanner. For the analysis, single-leg landing was simulated. On the superior surface of the skin, 2.57 times of the bodyweight was axially applied, and the inferior surface of the outsole was fixed. The results showed that Insole 3 was the most optimum design to reduce peak stress on the metatarsals (3.807 MPa). In conclusion, the optimum design of Insole 3, based on the finite element analysis, could be a justification of athletes' choices to prevent injury and other complications.
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Affiliation(s)
- Amir Mustakim Ab Rashid
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Muhammad Hanif Ramlee
- Medical Devices and Technology Centre (MEDiTEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
| | - Hong Seng Gan
- Department of Data Science, Universiti Malaysia Kelantan, 16100 UMK City Campus, Pengkalan Chepa, Kelantan, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Bioinspired Devices and Tissue Engineering (BIOINSPIRA) Research Group, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor Bahru, Malaysia
- Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor Bahru, Malaysia
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10
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Ni M, Sun T, Zhang T, Jin J, Song Y. Quantitative initial safety range of early passive rehabilitation after ankle fracture surgery. Injury 2022; 53:2281-2286. [PMID: 35400487 DOI: 10.1016/j.injury.2022.03.067] [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: 10/13/2021] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND Early rehabilitation training after ankle fracture surgery is critical to healing and avoiding complications. Inappropriate or excessive motion may impede healing or even lead to secondary injury. Currently, there is a lack of scientific quantitative postoperative rehabilitation methods after ankle fracture. Our purpose was to develop a universal method of quantifying early passive rehabilitation training after surgery by finite element (FE) analysis. METHODS A three-dimensional (3D) FE model of normal ankle was reconstructed from a computed tomography scan of a healthy male adult. Six types of ankle fractures were considered based on AO classification. We exerted joint motion load to explore the effect of movement on ankle joint mechanics after surgery. The corresponding relationship between the Inter-bone displacement and range of motion was measured to quantifying the ankle range of motion. The 44A3.3 fracture was used as an example to describe the implementation process in detail. RESULTS During ankle movement, most of the stress was sustained by the internal fixation devices, and the ratio of stress borne by the implants ranged from 67.9 to 94.9%. Flexion/extension exercise did not cause extra stress on the ankle contact surfaces. Ligament traction was the reason for ankle load during flexion/extension motion. The range of early passive postoperative rehabilitation training for six types of ankle fractures (AO classification) were provided. CONCLUSION A quantitative method of early passive rehabilitation training after ankle fracture surgery was developed using FE analysis. This modeling method has universality for any fracture that can be reconstructed.
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Affiliation(s)
- Monan Ni
- Key Laboratory of Institutional Theory and Equipment Design, Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin 300354, China
| | - Tao Sun
- Key Laboratory of Institutional Theory and Equipment Design, Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin 300354, China.
| | - Tao Zhang
- Tianjin Hospital, Tianjin 300299, China
| | - Jiahao Jin
- Key Laboratory of Institutional Theory and Equipment Design, Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin 300354, China
| | - Yimin Song
- Key Laboratory of Institutional Theory and Equipment Design, Ministry of Education, School of Mechanical Engineering, Tianjin University, 135 Yaguan Road, Jinnan District, Tianjin 300354, China
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11
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Kholinne E, Kwak JM, Sun Y, Koh KH, Jeon IH. Forearm Interosseous Ligaments: Anatomical and Histological Analysis of the Proximal, Central, and Distal Bands. J Hand Surg Am 2021; 46:1029.e1-1029.e8. [PMID: 33892984 DOI: 10.1016/j.jhsa.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 12/23/2020] [Accepted: 03/05/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To characterize and compare the histological structure of the proximal, central, and distal bands of the interosseous membrane (IOM) of the human forearm in fresh-frozen specimens. METHODS The IOMs from 16 fresh-frozen left forearm specimens were carefully dissected and examined. The footprint areas of the proximal, central, and distal IOM bands were measured in 6 specimens. The histological characteristics of the IOM bands were evaluated using hematoxylin-eosin and Masson trichrome staining protocols in 10 specimens as histological analysis necessitated an intact footprint. The footprint areas of the IOM were measured using an image processing program. The insertion complex was assessed using a light microscope. RESULTS Histological assessment revealed that the IOM structure demonstrated similarities with ligament structure. The average footprint areas of the proximal, central, and distal bands at the radial site were 11.1 ± 0.8, 180.4 ± 30.4, and 10.7 ± 1.3 mm2, respectively. At the ulnar site, they were 11.0 ± 1.1, 171.8 ± 30.1, and 10.7 ± 1.2 mm2, respectively. The insertion complex of the IOM into the bone comprised 4 layers: (1) interwoven collagen, (2) oblique collagen, (3) mineralized fibrocartilage (tidemark), and (4) lamellar bone. The average tidemark zone thicknesses of the proximal, central, and distal bands were 20.1 ± 6.3, 107.8 ± 22.9, and 20.6 ± 4.7 μm, respectively at the radial site and 12.0 ± 4.5, 85.7 ± 23.2, and 13.5 ± 6.9 μm, respectively at the ulnar site. CONCLUSIONS In this study, we confirm that the histological characteristics of the IOM are similar to those of ligaments. Compared with the proximal and distal bands, the central band has a greater footprint area and thicker tidemark zone. CLINICAL RELEVANCE If surgical reconstruction is performed, the size and histological characteristics of the graft should be similar to those of the native ligaments.
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Affiliation(s)
- Erica Kholinne
- Faculty of Medicine, Universitas Trisakti, Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia; Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea; Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Korea.
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12
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Role of the interosseous membrane in post-traumatic forearm instability: instructional review. INTERNATIONAL ORTHOPAEDICS 2021; 45:2619-2633. [PMID: 34331102 DOI: 10.1007/s00264-021-05149-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 07/16/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In the last two decades, a strong interest on the interosseous membrane (IOM) has developed. METHODS The authors present a review of the new concepts regarding the understanding of forearm physiology and pathology, with current trends in the surgical management of these rare and debilitating injuries. RESULTS Anatomical and biomechanical studies have clarified the anatomy of forearm constrains and their role in forearm longitudinal and transverse stability. The radial pull test, a new intraoperative test, has been developed that might increase the detection on IOM injuries. The forearm is now considered a "functional unit" and, consequently, a new classification has been proposed. Uncommon variants and rare patterns of forearm fracture dislocations have been reported in the literature and could not be classified to those commonly referred to using eponyms (Monteggia, Galeazzi, Essex-Lopresti). The new Artiaco et al. classification includes all injury patterns, thus avoids confusion in the nomenclature, and helps surgeon with detection of lesions and guiding surgical treatment. CONCLUSION Based on the new classification and after current literature review, authors propose a management flowchart for treatment of forearm instability injuries.
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13
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Ramlee MH, Gan HS, Daud SA, Abdul Wahab A, Abdul Kadir MR. Stress Distributions and Micromovement of Fragment Bone of Pilon Fracture Treated With External Fixator: A Finite Element Analysis. J Foot Ankle Surg 2021; 59:664-672. [PMID: 32600559 DOI: 10.1053/j.jfas.2019.09.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/29/2019] [Accepted: 09/01/2019] [Indexed: 02/03/2023]
Abstract
Osteoporosis and osteoarthritis are common pathological problems of the human bone tissue. There are some cases of pilon fractures associated with these 2 pathological conditions. In terms of treatment, for a normal and healthy bone with pilon fracture, the use of the Delta external fixator is a favorable option because it can allow early mobilization for patients and provide stability for the healing process. However, the stability of the external fixator differs when there is low bone stiffness, which has not been previously investigated. Therefore, this study was conducted to determine the stability of the external fixator to treat pilon fracture associated with osteoporosis and osteoarthritis, particularly to differentiate the stress distribution and micromovement of fracture fragment. Three-dimensional finite element models of the ankle and foot bones were reconstructed based on the computed tomography datasets. The bones consisted of 5 metatarsal, 3 cuneiform, and 1 each of cuboid, navicular, calcaneus, talus, fibula, and tibia bones. They were assigned with linear isotropic behavior. The ankle joint consisted of ligament and cartilage, and they were assigned with the use of linear links and the Mooney-Rivlin model, respectively. During simulation of the gait cycle, 70 N and 350 N were applied axially to the tibia bone to represent the swing and stance phases, respectively. The metatarsal and calcaneus bones were fixed to prevent any movement of the rigid body. The study found that the greatest von Mises stress value was observed at the pin-bone interface for the osteoporosis (108 MPa) model, followed by the osteoarthritis (87 MPa) and normal (44 MPa) models, during the stance phase. For micromovement, the osteoporosis model had the largest value at 0.26 mm, followed by the osteoarthritis (0.09 mm) and normal (0.03 mm) models. In conclusion, the greatest magnitudes of stress and micromovement were observed for the osteoporosis bone and extra care should be taken to treat pilon fracture associated with this pathological condition.
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Affiliation(s)
- Muhammad Hanif Ramlee
- Deputy Director, Medical Devices and Technology Centre (MEDITEC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor, Malaysia.
| | - Hong Seng Gan
- Senior Lecturer, British Malaysian Institute, Universiti Kuala Lumpur, Gombak, Selangor
| | - Siti Asmah Daud
- Senior Lecturer, Centre for Intelligent Signal & Imaging Research (CISIR), Electric and Electronics Engineering Department, Faculty of Engineering, Universiti Teknologi PETRONAS, Perak, Malaysia
| | - Asnida Abdul Wahab
- Senior Lecturer, School of Biomedical Engineering and Health Sciences, Faculty of Engineering, Universiti Teknologi Malaysia, Johor, Malaysia
| | - Mohammed Rafiq Abdul Kadir
- Professor, Sports Innovation and Technology Centre (SITC), Institute of Human Centered Engineering (iHumEn), Universiti Teknologi Malaysia, Johor, Malaysia
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14
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Kholinne E, Kwak JM, Sun Y, Koh KH, Jeon IH. The role of the interosseous ligament in forearm rotation: A bio-mechanical study. J Orthop Surg (Hong Kong) 2021; 28:2309499020973481. [PMID: 33300440 DOI: 10.1177/2309499020973481] [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] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Management of longitudinal forearm instability remains challenging. Chronic forearm stability may be overcome by reconstruction of the interosseous ligament (IOL). Despite the bands of the IOL being inseparable, studies of the IOL have focused on the central band (CB), but have neglected the proximal (PB) and distal (DB) bands. The purpose of this study was to characterize the bio-mechanical properties of the IOL. MATERIALS AND METHODS Twelve frozen specimens from individuals of both sexes were bio-mechanically analyzed using a custom-designed jig operated at constant angular speed to simulate forearm rotation. Strain was measured during dynamic forearm simulation using a motion tracking system. RESULTS The average strain of the CB, PB, and DB during forearm simulation were 0.08 ± 0.04, 0.83 ± 0.47, and 0.65 ± 0.23 mm (p < 0.001). The IOL was generally shortest during maximal pronation and increased as the forearm was rotated to a neutral position. The strain of the CB remain constant during forearm rotation and was the lowest at full pronation to 20° pronation position. Throughout forearm rotation, the strain of the CB remained constant, whereas the strain of the PB and DB fluctuated. CONCLUSIONS The PB, CB, and DB of the forearm IOL have different bio-mechanical properties. CB maintained a constant rotational strain throughout forearm rotation. Strain on the CB was significantly lower than strains on the PB and DB. By contrast, strains on the PB and DB varied, suggesting that their roles differ from those of the CB. When CB reconstruction is needed, graft should be tensioned at 20° forearm pronation to gain optimum tension.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Faculty of Medicine, Trisakti University, Jakarta, Indonesia.,Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - Yucheng Sun
- Department of Hand Surgery, Affiliated Hospital of Nantong University, Nantong, Nantong University, Jiangsu, China
| | - Kyoung-Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Asan Medical Center, Seoul, Republic of Korea
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15
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Kholinne E, Kwak JM, Sun Y, Koh KH, Jeon IH. The forearm interosseous ligament: comparative mechanical properties of the proximal, central, and distal bands. J Hand Surg Eur Vol 2021; 46:184-187. [PMID: 32677496 DOI: 10.1177/1753193420939497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
We compared the mechanical properties of the three parts of interosseous membranes in 12 fresh-frozen specimens. The proximal, central and distal bands of interosseous membranes were tested in a universal testing machine. Tensile strength, ultimate strain, ultimate load and elastic modulus were measured and compared. The stress-strain relationship curves of these bands were similar to those of ligaments. Tensile strength, ultimate load and elastic modulus were significantly higher in the central band than in the proximal and distal bands. Ultimate strain was significantly lower in the central band than in proximal and distal bands. We conclude that the interosseous membrane is similar to ligaments in structure with each band having distinct characteristics. The findings may aid in clinical choice of proper grafts used for interosseous membrane reconstruction.
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Affiliation(s)
- Erica Kholinne
- Department of Orthopedic Surgery, St. Carolus Hospital, Jakarta, Indonesia.,Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
| | - Jae-Man Kwak
- Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
| | - Yucheng Sun
- Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea.,Department of Hand Surgery, Nantong University, Jiangsu, China
| | - Kyoung Hwan Koh
- Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
| | - In-Ho Jeon
- Department of Orthopedic Surgery, University of Ulsan, Seoul, Korea
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16
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Zhang N, Fang JH. Forearm Interosseous Membrane Maintains the Stability of Proximal Radioulnar Joint. Orthop Surg 2020; 13:168-174. [PMID: 33345369 PMCID: PMC7862152 DOI: 10.1111/os.12859] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 10/08/2020] [Accepted: 10/18/2020] [Indexed: 12/04/2022] Open
Abstract
Objective To evaluate the effect of the proximal and central bundles of the interosseous membrane on the stability of proximal radioulnar joint. Methods Twenty fresh samples of human forearm provided by the anatomy room of the Department of Human Anatomy of Nanjing Medical University were included in this study. They were used to explore the effect of proximal interosseous membrane bundle on the stability of proximal radioulnar joint. The proximal bundle was reconstructed along the original attachment point. The reconstructions of central bundle were divided into the reconstruction of original attachment point on radius‐midpoint of the ulnar original attachment point (reconstruction A) and original attachment point reconstruction (reconstruction B). The loads of the proximal radioulnar joint in different positions were measured. The load of the proximal radioulnar joint was analyzed in neutral, pronation, and supination positions. Results After resection of proximal and central fascicles, the loads of proximal radioulnar joint in neutral, pronation, and supination positions were significantly lower than those before resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05). After reconstruction, the loads of proximal radioulnar joint in neutral and supination positions were higher than those after resection (P < 0.05), and that after reconstruction B in pronation position was higher than that after resection (P < 0.05), while there was no significant difference between reconstruction A and after resection (P > 0.05). In supination position, the load of reconstruction B was higher than that of reconstruction A (P < 0.05). After reconstruction of the proximal and central bundles, the proximal radioulnar joint could not reached the same load as it could before resection (P < 0.05). Conclusion The stability of proximal radioulnar joint is affected by central bundle and proximal bundle. Reconstruction can increase the stability of proximal radioulnar joint.
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Affiliation(s)
- Ning Zhang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jia-Hu Fang
- The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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17
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Identification of Surgical Plan for Syndesmotic Fixation Procedure Based on Finite Element Method. APPLIED SCIENCES-BASEL 2020. [DOI: 10.3390/app10124349] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Syndesmosis injuries account for approximately 20% of ankle fractures that require surgery. Although multiple surgical options are available, all of them are based on metal screws. Serious complications that arise when applying metal screws include screw loosening or breakage. To prevent such complications, we applied a simulation method using a finite element (FE) analysis. We created a 3D FE model of an ankle joint and conducted an FE analysis focusing on syndesmosis in terms of the level, material, and diameter of the syndesmotic screw and the number of penetrated cortical bones. The magnitude and direction of the force applied to the tibia in the midstance state were considered for simulating the model. The maximum von-Mises stress and syndesmosis widening were analyzed in terms of different biomechanical parameters. We identified the characteristics of the most biomechanically stable syndesmotic screw and its fixation point on the basis of the two parameters. We demonstrated that the ideal syndesmotic screw fixation should be fixed at a level 20 to 25 mm above the ankle using a 4.5 mm titanium screw.
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18
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Jamieson RP, Ek ET. Isolated Proximal Radioulnar Joint Instability: Anatomy, Clinical Presentation, and Current Treatment Options. JBJS Rev 2020; 8:e0169. [PMID: 32539266 DOI: 10.2106/jbjs.rvw.19.00169] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Isolated proximal radioulnar joint instability is an uncommon and often challenging problem that may manifest as recurrent instability of the proximal aspect of the radius, usually during forearm pronation and supination. Instability is due to deficiency of the stabilizing structures around the proximal aspect of the radius, and biomechanical studies have highlighted the importance of the annular ligament and the interosseous membrane in both transverse and longitudinal plane stability. Reconstruction of the stabilizing structures around the radial head often is indicated in cases of recurrent instability and includes joint-preserving procedures such as annular ligament reconstruction, proximal ulnar osteotomy, and interosseous membrane reconstruction. Rarely, salvage procedures such as interpositional arthroplasty or 1-bone forearm reconstruction are necessary. A thorough understanding of the anatomic structures that stabilize the proximal aspect of the radius and the complexities of forearm biomechanics is required in order to successfully diagnose and manage this condition.
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Affiliation(s)
| | - Eugene T Ek
- Melbourne Orthopaedic Group, Melbourne, Victoria, Australia.,Division of Hand Surgery, Department of Orthopaedic Surgery, Dandenong Hospital, Melbourne, Victoria, Australia.,Department of Surgery, Monash Medical Centre, Monash University, Melbourne, Victoria, Australia
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19
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Masouros PT, Apergis EP, Mavrogenis AF, Babis GC, Artemi DK, Nikolaou VS. Reconstruction of the forearm interosseous membrane: a biomechanical study of three different techniques. J Hand Surg Eur Vol 2020; 45:360-368. [PMID: 31399010 DOI: 10.1177/1753193419866382] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Reconstruction of the interosseous membrane has the potential to re-establish a normal loading pattern through the forearm and enhance stability after an Essex-Lopresti lesion. The aim of our study was to assess the capacity of three different techniques, which all use a regionally harvested autograft, to restore longitudinal stability. Simulation of the Essex-Lopresti lesion was done by excising the radial head and sectioning the interosseous membrane in seven cadaveric specimens. Each technique was used in each specimen consecutively, using the pronator teres, the brachioradialis and the flexor carpi radialis tendons, respectively. The specimens were submitted to mechanical testing by applying proximally migratory forces to the radius and radioulnar displacement was assessed fluroscopically at wrist level. The pronator teres tendon achieved the greatest reduction (94% correction with respect to the intact interosseous membrane/radial head out state, followed by brachioradialis (92%) and flexor carpi radialis (85%). However, no statistically significant differences in displacement data or strength were detected between the techniques.
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Affiliation(s)
| | | | - Andreas F Mavrogenis
- 1st Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - George C Babis
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
| | - Dendi K Artemi
- Department of Anesthesiology, Children Hospital "Agia Sofia", Athens, Greece
| | - Vasileios S Nikolaou
- 2nd Department of Orthopaedics, National and Kapodistrian University of Athens, Athens, Greece
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20
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Carrillo F, Suter S, Casari FA, Sutter R, Nagy L, Snedeker JG, Fürnstahl P. Digitalization of the IOM: A comprehensive cadaveric study for obtaining three-dimensional models and morphological properties of the forearm's interosseous membrane. Sci Rep 2020; 10:6401. [PMID: 32286490 PMCID: PMC7156465 DOI: 10.1038/s41598-020-63436-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 03/31/2020] [Indexed: 11/15/2022] Open
Abstract
State-of-the-art of preoperative planning for forearm orthopaedic surgeries is currently limited to simple bone procedures. The increasing interest of clinicians for more comprehensive analysis of complex pathologies often requires dynamic models, able to include the soft tissue influence into the preoperative process. Previous studies have shown that the interosseous membrane (IOM) influences forearm motion and stability, but due to the lack of morphological and biomechanical data, existing simulation models of the IOM are either too simple or clinically unreliable. This work aims to address this problematic by generating 3D morphological and tensile properties of the individual IOM structures. First, micro- and standard-CT acquisitions were performed on five fresh-frozen annotated cadaveric forearms for the generation of 3D models of the radius, ulna and each of the individual ligaments of the IOM. Afterwards, novel 3D methods were developed for the measurement of common morphological features, which were validated against established optical ex-vivo measurements. Finally, we investigated the individual tensile properties of each IOM ligament. The generated 3D morphological features can provide the basis for the future development of functional planning simulation of the forearm.
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Affiliation(s)
- Fabio Carrillo
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland. .,Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, CH-8008, Zurich, Switzerland.
| | - Simon Suter
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Fabio A Casari
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland.,Department of Orthopaedics, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Reto Sutter
- Radiology, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Ladislav Nagy
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland.,Department of Orthopaedics, Balgrist University Hospital, CH-8008, Zurich, Switzerland
| | - Jess G Snedeker
- Laboratory for Orthopaedic Biomechanics, Institute for Biomechanics, ETH Zurich, CH-8008, Zurich, Switzerland
| | - Philipp Fürnstahl
- Research in Orthopedic Computer Science, Balgrist University Hospital, CH-8008, Zurich, Switzerland
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21
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Biomechanical features of six design of the delta external fixator for treating Pilon fracture: a finite element study. Med Biol Eng Comput 2018; 56:1925-1938. [DOI: 10.1007/s11517-018-1830-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Accepted: 04/11/2018] [Indexed: 02/06/2023]
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22
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Purevsuren T, Kim K, Batbaatar M, Lee S, Kim YH. Influence of ankle joint plantarflexion and dorsiflexion on lateral ankle sprain: A computational study. Proc Inst Mech Eng H 2018. [DOI: 10.1177/0954411918762955] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Understanding the mechanism of injury involved in lateral ankle sprain is essential to prevent injury, to establish surgical repair and reconstruction, and to plan reliable rehabilitation protocols. Most studies for lateral ankle sprain posit that ankle inversion, internal rotation, and plantarflexion are involved in the mechanism of injury. However, recent studies indicated that ankle dorsiflexion also plays an important role in the lateral ankle sprain mechanism. In this study, the contributions of ankle plantarflexion and dorsiflexion on the ankle joint were evaluated under complex combinations of internal and inversion moments. A multibody ankle joint model including 24 ligaments was developed and validated against two experimental cadaveric studies. The effects of ankle plantarflexion (up to 60°) and dorsiflexion (up to 30°) on the lateral ankle sprain mechanism under ankle inversion moment coupled with internal rotational moment were investigated using the validated model. Lateral ankle sprain injuries can occur during ankle dorsiflexion, in which the calcaneofibular ligament and anterior talofibular ligament tears may occur associated with excessive inversion and internal rotational moment, respectively. Various combinations of inversion and internal moment may lead to anterior talofibular ligament injuries at early ankle plantarflexion, while the inversion moment acts as a primary factor to tear the anterior talofibular ligament in early plantarflexion. It is better to consider inversion and internal rotation as primary factors of the lateral ankle sprain mechanism, while plantarflexion or dorsiflexion can be secondary factor. This information will help to clarify the lateral ankle sprain mechanism of injury.
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Affiliation(s)
| | - Kyungsoo Kim
- Department of Applied Mathematics, Kyung Hee University, Yongin, Korea
| | | | - SuKyoung Lee
- Department of Computer Science, Yonsei University, Seoul, Korea
| | - Yoon Hyuk Kim
- Department of Mechanical Engineering, Kyung Hee University, Yongin, Korea
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23
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Mondal S, Ghosh R. A numerical study on stress distribution across the ankle joint: Effects of material distribution of bone, muscle force and ligaments. J Orthop 2017; 14:329-335. [PMID: 28559650 DOI: 10.1016/j.jor.2017.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/14/2017] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The goal of this study is to develop a realistic three dimensional FE model of intact ankle joint. METHODS Three dimensional FE model of the intact ankle joint was developed using computed tomography data sets. The effect of muscle force, ligaments and proper material property distribution of bone on stress distribution across the intact ankle joint was studied separately. RESULTS Present study indicates bone material property, ligaments and muscle force have influence on stress distribution across the ankle joint. CONCLUSION Proper bone material, ligaments and muscle must be considered in the computational model for pre-clinical analysis of ankle prosthesis.
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Affiliation(s)
- Subrata Mondal
- School of Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175005, Himachal Pradesh, India
| | - Rajesh Ghosh
- School of Engineering, Indian Institute of Technology Mandi, Kamand, Mandi, 175005, Himachal Pradesh, India
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24
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Hackl M, Andermahr J, Staat M, Bremer I, Borggrefe J, Prescher A, Müller LP, Wegmann K. Suture button reconstruction of the central band of the interosseous membrane in Essex-Lopresti lesions: a comparative biomechanical investigation. J Hand Surg Eur Vol 2017; 42:370-376. [PMID: 27573130 DOI: 10.1177/1753193416665943] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
UNLABELLED Surgical reconstruction of the interosseous membrane may restore longitudinal forearm stability in Essex-Lopresti lesions. This study aimed to compare the longitudinal stability of the intact forearm with a single-bundle and a double-bundle reconstruction of the central band of the interosseous membrane using digital image correlation with a three-dimensional camera system. Single and cyclic axial loading of eight fresh-frozen forearm specimens was carried out in the intact state, after creation of an Essex-Lopresti lesion, after a single-bundle and after a double-bundle reconstruction of the central band using a TightRope® (Arthrex GmbH, Munich, Germany) construct. Instability significantly increased after creation of an Essex-Lopresti lesion. The stability of intact specimens was similar to both reconstruction techniques. The results of this study suggest that TightRope® reconstruction of the central band restores longitudinal forearm stability. However, the single-bundle technique may be less reliable than double-bundle reconstruction. LEVEL OF EVIDENCE Basic Science Study.
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Affiliation(s)
- M Hackl
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - J Andermahr
- 3 Department of Orthopedic and Trauma Surgery, Hospital of the University of Bonn, Bonn, Germany
| | - M Staat
- 4 Institute of Bioengineering, Aachen University of Applied Sciences, Jülich, Germany
| | - I Bremer
- 3 Department of Orthopedic and Trauma Surgery, Hospital of the University of Bonn, Bonn, Germany
| | - J Borggrefe
- 5 Department of Radiology, University Medical Center of Cologne, Cologne, Germany
| | - A Prescher
- 6 Institute of Molecular and Cellular Anatomy, Medical Faculty of RWTH-Aachen, Aachen, Germany
| | - L P Müller
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
| | - K Wegmann
- 1 Center for Orthopedic and Trauma Surgery, University Medical Center of Cologne, Cologne, Germany.,2 Cologne Center for Musculoskeletal Biomechanics (CCMB), University of Cologne, Cologne, Germany
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Effects of inferior tibiofibular syndesmosis injury and screw stabilization on motion of the ankle: a finite element study. Knee Surg Sports Traumatol Arthrosc 2016; 24:1228-35. [PMID: 25236683 DOI: 10.1007/s00167-014-3320-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2013] [Accepted: 09/10/2014] [Indexed: 12/21/2022]
Abstract
PURPOSE Traditional studies of syndesmosis injury and screw stabilization have been conducted in cadaveric models, which cannot yield sufficient and exact biomechanical data about the interior of the ankle. The purpose of this study was to evaluate the effects of inferior tibiofibular syndesmosis injury (ITSI) and screw stabilization on the motion of the ankle with finite element analysis. METHODS Three-dimensional models of the ankle complex were created with CT images of a volunteer's right ankle in three states: normal, post-ITSI, and stabilization with a screw 2.5 cm above (parallel to) the ankle. Simulated loads were applied under three conditions: neutral position with single foot standing, internal rotation, and external rotation of the ankle. RESULTS Compared with the normal state, ITSI increased the relative displacement between the lower extremes of the tibia and fibula in the anteroposterior and mediolateral directions and the angular motion of the tibia, fibula, and talus at internal and external rotations (ERs). However, when stabilized with syndesmotic screws, the range of motion (ROM) and all these parameters significantly decreased. CONCLUSION ITSI can lead to internal and ER instability of the ankle joint. Screw stabilization is effective in controlling the instability, but may reduce markedly the ROM of the ankle joint. Through this study, it can be proposed that the screws should be removed once the healing is gained in order to restore normal function of the ankle joint as soon as possible.
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Begonia MT, Dallas M, Vizcarra B, Liu Y, Johnson ML, Thiagarajan G. Non-contact strain measurement in the mouse forearm loading model using digital image correlation (DIC). Bone 2015; 81:593-601. [PMID: 26388521 PMCID: PMC4640949 DOI: 10.1016/j.bone.2015.09.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 08/26/2015] [Accepted: 09/14/2015] [Indexed: 01/17/2023]
Abstract
This study investigates the use of a non-contact method known as digital image correlation (DIC) to measure strains in the mouse forearm during axial compressive loading. A two camera system was adapted to analyze the medial and lateral forearm displacements simultaneously, and the derived DIC strain measurements were compared to strain gage readings from both the ulna and radius. Factors such as region-of-interest (ROI) location, lens magnification, noise, and out-of-plane motion were examined to determine their influence on the DIC strain measurements. We confirmed that our DIC system can differentiate ROI locations since it detected higher average strains in the ulna compared to the radius and detected compressive strains on medial bone surfaces vs. tensile strains on lateral bone surfaces. Interestingly, the DIC method also captured heterogeneity in surface strain fields which are not detectable by strain gage based methods. A separate analysis of the noise intrinsic to the DIC system also revealed that the noise constituted less than 4.5% of all DIC strain measurements. Furthermore, finite element (FE) simulations of the forearm showed that out-of-plane motion was not a significant factor that influenced DIC measurements. Finally, we observed that average DIC strain measurements can be up to 1.5-2 times greater than average strain gage readings on the medial bone surfaces. These findings suggest that strain experienced in the mouse forearm model by loading is better captured through DIC as opposed to strain gages, which as a result of being glued to the bone surface artificially stiffen the bone and lead to an underestimation of the strain response.
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Affiliation(s)
- Mark T Begonia
- University of Missouri-Kansas City, Department of Civil and Mechanical Engineering, 350K Robert H. Flarsheim Hall, 5110 Rockhill Road, Kansas City, MO 64110, USA
| | - Mark Dallas
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - Bruno Vizcarra
- University of Missouri-Kansas City, Department of Civil and Mechanical Engineering, 350K Robert H. Flarsheim Hall, 5110 Rockhill Road, Kansas City, MO 64110, USA
| | - Ying Liu
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - Mark L Johnson
- University of Missouri-Kansas City, School of Dentistry, Department of Oral and Craniofacial Sciences, Room 3143, 650 E 25th Street, Kansas City, MO 64108, USA
| | - Ganesh Thiagarajan
- University of Missouri-Kansas City, Department of Civil and Mechanical Engineering, 350K Robert H. Flarsheim Hall, 5110 Rockhill Road, Kansas City, MO 64110, USA.
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Malone PSC, Cooley J, Morris J, Terenghi G, Lees VC. The biomechanical and functional relationships of the proximal radioulnar joint, distal radioulnar joint, and interosseous ligament. J Hand Surg Eur Vol 2015; 40:485-93. [PMID: 24835480 DOI: 10.1177/1753193414532807] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 02/18/2014] [Indexed: 02/03/2023]
Abstract
This biomechanical study assessed integrated function of the proximal radioulnar joint (PRUJ), interosseous ligament (IOL), and distal radioulnar joint (DRUJ). Tekscan™ pressure sensors were inserted into the DRUJ and PRUJ of 15 cadaveric specimens. MicroStrain(®) sensors were mounted onto the IOL on nine of these specimens. A customized biomechanical jig was used to apply axial loads and take measurements through pronosupination. The PRUJ, IOL, and DRUJ were shown to function as an integrated osseoligamentous system distributing applied load. The PRUJ has transmitted pressure profiles similar to those of the DRUJ. Different IOL components support loading at different stages of pronosupination. The IOL is lax during pronation. Mid-IOL tension peaks in the midrange of forearm rotation; distal-IOL tension peaks in supination. Axial loading consistently increases IOL strain in a non-linear fashion. There are clinical implications of this work: disease or surgical modification of any of these structures may compromise normal biomechanics and function.
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Affiliation(s)
- P S C Malone
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - J Cooley
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - J Morris
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - G Terenghi
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
| | - V C Lees
- Department of Plastic Surgery, University Hospital South Manchester NHS Trust, Wythenshawe Hospital, Manchester, UK
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Pavan PG, Pachera P, Natali AN. Numerical modelling of crural fascia mechanical interaction with muscular compartments. Proc Inst Mech Eng H 2015; 229:395-402. [PMID: 25991717 DOI: 10.1177/0954411915584963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The interaction of the crural fascia with muscular compartments and surrounding tissues can be at the origin of different pathologies, such as compartment syndrome. This pathology consists in the onset of excessive intracompartmental pressure, which can have serious consequences for the patient, compromising blood circulation. The investigation of compartment syndrome etiology also takes into account the alteration of crural fascia mechanical properties as a cause of the syndrome, where the fascial stiffening would result in the rise of intracompartmental pressure. This work presents a computational approach toward evaluating some biomechanical aspects of the problem, within the context of a more global viewpoint. Finite element analyses of the interaction phenomena of the crural fascia with adjacent regions are reported here. This study includes the effects of a fascial stiffness increase along the proximal-distal direction and their possible clinical implications. Furthermore, the relationship between different pre-strain levels of the crural fascia in the proximal-distal direction and the rise of internal pressure in muscular compartments are considered. The numerical analyses can clarify which aspects could be directly implied in the rise of compartment syndrome, leading to greater insight into muscle-fascia mechanical phenomena, as well as promoting experimental investigation and clinical analysis of the syndrome.
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Affiliation(s)
- Piero G Pavan
- Department of Industrial Engineering, University of Padova, Padova, Italy Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Paola Pachera
- Department of Industrial Engineering, University of Padova, Padova, Italy Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Arturo N Natali
- Department of Industrial Engineering, University of Padova, Padova, Italy Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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Pavan PG, Pachera P, Stecco C, Natali AN. Biomechanical behavior of human crural fascia in anterior and posterior regions of the lower limb. Med Biol Eng Comput 2015; 53:951-9. [PMID: 25980504 DOI: 10.1007/s11517-015-1308-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Accepted: 05/04/2015] [Indexed: 12/11/2022]
Abstract
The present work focuses on the numerical modeling of the mechanical behavior of the crural fascia, the deep fascia enwrapping the lower limb muscles. This fascia has an important biomechanical role, due to its interaction with muscles during contraction and its association with pathological events, such as compartment syndrome. The mechanical response of the crural fascia is described by assuming a hyperelastic fiber-reinforced constitutive model, with families of fibers disposed according to the spatial disposition of the collagen network, as shown in histological analyses. A two-dimensional finite element model of a lower limb transversal section has been developed to analyze deformational behavior, with particular attention on interaction phenomena between crural fascia and enwrapped muscles. The constitutive model adopted for the crural fascia well fits experimental data taken along the proximal-distal and medial-lateral directions. The finite element analysis allows for interpreting the relation between change in volume and pressure of muscle compartments and the crural fascia deformation.
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Affiliation(s)
- Piero G Pavan
- Department of Industrial Engineering, University of Padova, Via G. Marzolo 9, 35131, Padova, Italia, Italy. .,Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, 35131, Padova, Italy.
| | - Paola Pachera
- Department of Industrial Engineering, University of Padova, Via G. Marzolo 9, 35131, Padova, Italia, Italy.,Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, 35131, Padova, Italy
| | - Carla Stecco
- Department of Molecular Medicine, University of Padova, via A. Gabelli 63 3, 35131, Padova, Italy.,Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, 35131, Padova, Italy
| | - Arturo N Natali
- Department of Industrial Engineering, University of Padova, Via G. Marzolo 9, 35131, Padova, Italia, Italy.,Centre of Mechanics of Biological Materials, University of Padova, Via G. Colombo 3, 35131, Padova, Italy
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Thiagarajan G, Lu Y, Dallas M, Johnson ML. Experimental and finite element analysis of dynamic loading of the mouse forearm. J Orthop Res 2014; 32:1580-8. [PMID: 25196694 PMCID: PMC4356248 DOI: 10.1002/jor.22720] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 07/22/2014] [Indexed: 02/04/2023]
Abstract
Bone formation is reported to initiate in osteocytes by mechanotransduction due to dynamic loading of bone. The first step towards this is to characterize the dynamic strain fields in the overall bone. Here, the previously developed mouse forearm ulna-radius model, subjected to static loading, has been further enhanced by incorporating a loading cap and applying a cyclic dynamic load to more closely approximate experimental biological conditions. This study also incorporates data obtained from strain gauging both the ulna and radius simultaneously. Based on separate experiments, the elastic modulus of the ulna and radius were determined to be 13.8 and 9.9 GPa, respectively. Another novel aspect of the numerical model is the inclusion of the interosseous membrane in the FE model with membrane stiffness ranging from 5-15 N/mm that have been found to give strain values closer to that from the experiments. Interestingly, the inclusion of the interosseous membrane helped to equalize the peak strain magnitudes in the ulna and radius (∼1800 at 2 N load and ∼3200 at 3.5 N), which was also observed experimentally. This model represents a significant advance towards being able to simulate through FE analysis the strain fields generated in vivo upon mechanical loading of the mouse forearm.
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Affiliation(s)
- Ganesh Thiagarajan
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 350L Flarsheim Hall, 5100 Rockhill Road, Kansas City, Missouri 64110
| | - Yunkai Lu
- Department of Civil and Mechanical Engineering, University of Missouri-Kansas City, 350L Flarsheim Hall, 5100 Rockhill Road, Kansas City, Missouri 64110
| | - Mark Dallas
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Room 3143, 650 E 25th Street, Kansas City, Missouri 64108
| | - Mark L. Johnson
- Department of Oral and Craniofacial Sciences, School of Dentistry, University of Missouri-Kansas City, Room 3143, 650 E 25th Street, Kansas City, Missouri 64108
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Ramlee MH, Kadir MRA, Murali MR, Kamarul T. Finite element analysis of three commonly used external fixation devices for treating Type III pilon fractures. Med Eng Phys 2014; 36:1322-30. [PMID: 25127377 DOI: 10.1016/j.medengphy.2014.05.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 05/19/2014] [Accepted: 05/24/2014] [Indexed: 11/15/2022]
Abstract
Pilon fractures are commonly caused by high energy trauma and can result in long-term immobilization of patients. The use of an external fixator i.e. the (1) Delta, (2) Mitkovic or (3) Unilateral frame for treating type III pilon fractures is generally recommended by many experts owing to the stability provided by these constructs. This allows this type of fracture to heal quickly whilst permitting early mobilization. However, the stability of one fixator over the other has not been previously demonstrated. This study was conducted to determine the biomechanical stability of these external fixators in type III pilon fractures using finite element modelling. Three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones were reconstructed from previously obtained CT datasets. Bones were assigned with isotropic material properties, while the cartilage was assigned as hyperelastic springs with Mooney-Rivlin properties. Axial loads of 350 N and 70 N were applied at the tibia to simulate the stance and the swing phase of a gait cycle. To prevent rigid body motion, the calcaneus and metatarsals were fixed distally in all degrees of freedom. The results indicate that the model with the Delta frame produced the lowest relative micromovement (0.03 mm) compared to the Mitkovic (0.05 mm) and Unilateral (0.42 mm) fixators during the stance phase. The highest stress concentrations were found at the pin of the Unilateral external fixator (509.2 MPa) compared to the Mitkovic (286.0 MPa) and the Delta (266.7 MPa) frames. In conclusion, the Delta external fixator was found to be the most stable external fixator for treating type III pilon fractures.
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Affiliation(s)
- Muhammad Hanif Ramlee
- Medical Devices and Technology Group (MEDITEG), Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.
| | - Mohammed Rafiq Abdul Kadir
- Medical Devices and Technology Group (MEDITEG), Faculty of Biosciences and Medical Engineering, Universiti Teknologi Malaysia, 81310 Johor Bahru, Johor, Malaysia.
| | - Malliga Raman Murali
- Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty ofMedicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
| | - Tunku Kamarul
- Tissue Engineering Group (TEG), National Orthopaedic Centre of Excellence in Research and Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty ofMedicine, University of Malaya, 50603 Lembah Pantai, Kuala Lumpur, Malaysia.
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Biomechanical evaluation of two commonly used external fixators in the treatment of open subtalar dislocation--a finite element analysis. Med Eng Phys 2014; 36:1358-66. [PMID: 25092623 DOI: 10.1016/j.medengphy.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2013] [Revised: 06/02/2014] [Accepted: 07/02/2014] [Indexed: 01/12/2023]
Abstract
Subtalar dislocation is a rare injury caused by high-energy trauma. Current treatment strategies include leg casts, internal fixation and external fixation. Among these, external fixators are the most commonly used as this method is believed to provide better stabilization. However, the biomechanical stability provided by these fixators has not been demonstrated. This biomechanical study compares two commonly used external fixators, i.e. Mitkovic and Delta. CT imaging data were used to reconstruct three-dimensional models of the tibia, fibula, talus, calcaneus, navicular, cuboid, three cuneiforms and five metatarsal bones. The 3D models of the bones and cartilages were then converted into four-noded linear tetrahedral elements, whilst the ligaments were modelled with linear spring elements. Bones and cartilage were idealized as homogeneous, isotropic and linear. To simulate loading during walking, axial loading (70 N during the swing and 350 N during the stance phase) was applied at the end of diaphyseal tibia. The results demonstrate that the Mitkovic fixator produced greater displacement (peak 3.0mm and 15.6mm) compared to the Delta fixator (peak 0.8mm and 3.9 mm), in both the swing and stance phase, respectively. This study demonstrates that the Delta external fixator provides superior stability over the Mitkovic fixator. The Delta fixator may be more effective in treating subtalar dislocation.
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Liu Q, Zhang K, Zhuang Y, Li Z, Yu B, Pei G. Analysis of the stress and displacement distribution of inferior tibiofibular syndesmosis injuries repaired with screw fixation: a finite element study. PLoS One 2013; 8:e80236. [PMID: 24312464 PMCID: PMC3848989 DOI: 10.1371/journal.pone.0080236] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 10/01/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Studies of syndesmosis injuries have concentrated on cadaver models. However, they are unable to obtain exact data regarding the stress and displacement distribution of various tissues, and it is difficult to compare models. We investigated the biomechanical effects of inferior tibiofibular syndesmosis injuries (ITSIs) and screw fixation on the ankle using the finite element (FE) method. METHODOLOGY/PRINCIPAL FINDINGS A three-dimensional model of a healthy ankle complex was developed using computed tomography (CT) images. We established models of an ITSI and of screw fixation at the plane 2.5 cm above and parallel to the tibiotalar joint surface of the injured syndesmosis. Simulated loads were applied under three conditions: neutral position with single-foot standing and internal and external rotation of the ankle. ITSI reduced contact forces between the talus and fibula, helped periarticular ankle ligaments withstand more load-resisting movement, and increased the magnitude of displacement at the lower extreme of the tibia and fibula. ITSI fixation with a syndesmotic screw reduced contact forces in all joints, decreased the magnitude of displacement at the lower extreme of the tibia and fibula, and increased crural interosseous membrane stress. CONCLUSIONS/SIGNIFICANCE Severe syndesmosis injuries cause stress and displacement distribution of the ankle to change multidirectional ankle instability and should be treated by internal fixation. Though the transverse syndesmotic screw effectively stabilizes syndesmotic diastasis, it also changes stress distribution around the ankle and decreases the joint's range of motion (ROM). Therefore, fixation should not be performed for a long period of time because it is not physiologically suitable for the ankle joint.
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Affiliation(s)
- Qinghua Liu
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Kun Zhang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Yan Zhuang
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
| | - Zhong Li
- Department of Orthopaedic Trauma, Hong-Hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, China
- * E-mail: (ZL); (BY)
| | - Bin Yu
- Department of Orthopaedic Trauma, Nanfang Hospital, Southern Medical University, Guangzhou, China
- * E-mail: (ZL); (BY)
| | - Guoxian Pei
- Xijing Hospital, The Fourth Military Medical University, Xi'an, China
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Wei F, Fong DTP, Chan KM, Haut RC. Estimation of ligament strains and joint moments in the ankle during a supination sprain injury. Comput Methods Biomech Biomed Engin 2013; 18:243-8. [DOI: 10.1080/10255842.2013.792809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Werner FW, Taormina JL, Sutton LG, Harley BJ. Structural properties of 6 forearm ligaments. J Hand Surg Am 2011; 36:1981-7. [PMID: 22100813 DOI: 10.1016/j.jhsa.2011.09.026] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2010] [Revised: 09/19/2011] [Accepted: 09/22/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE To first determine the structural properties of 6 forearm ligaments and then to create linear and nonlinear analytical models of each ligament from these properties. METHODS We nondestructively tested the annular ligament, dorsal and palmar radioulnar ligaments, and the distal, central, and proximal bands of the interosseous ligament from 7 fresh cadaver forearms in a servohydraulic testing apparatus. We performed testing with the bone-ligament-bone constructs positioned corresponding to neutral forearm rotation as well as in 45° of supination and 45° of pronation. Based on a mechanical creep test of each ligament, we computed a linear and nonlinear ligament stiffness value for each ligament. We then compared these computed analytical responses to loading with loading data when each ligament was tested at 1.0 and 0.05 mm/s. We analyzed differences among ligaments and forearm positions using 1-way and 2-way analyses of variance. RESULTS The stiffnesses for the distal band and the dorsal radioulnar ligament were statistically less when the constructs were positioned in supination compared with neutral forearm rotation. At all forearm positions, the linear stiffness of the central band was greater than that for the distal band of the interosseous ligament, the proximal band of the interosseous ligament, and the dorsal radioulnar and palmar radioulnar ligaments. In neutral forearm rotation, the linear stiffness of the central band was statistically greater than the annular ligament. The experimental loading behavior of each ligament was better modeled by a nonlinear stiffness than a linear one. CONCLUSIONS The central band of the interosseous membrane is the stiffest stabilizing structure of the forearm. Any structure used to replace the central band or other forearm ligaments should demonstrate a nonlinear response to loading. CLINICAL RELEVANCE In considering a reconstruction for the forearm, the graft used should have a nonlinear response to loading and be one that is similar to the normal, original ligament.
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Affiliation(s)
- Frederick W Werner
- Department of Orthopedic Surgery, SUNY Upstate Medical University, Syracuse, NY 13210, USA.
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Development and Validation of a Computational Model to Study the Effect of Foot Constraint on Ankle Injury due to External Rotation. Ann Biomed Eng 2010; 39:756-65. [DOI: 10.1007/s10439-010-0234-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2010] [Accepted: 10/14/2010] [Indexed: 01/13/2023]
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Computational model of the human elbow and forearm: application to complex varus instability. Ann Biomed Eng 2010; 39:1084-91. [PMID: 21132368 DOI: 10.1007/s10439-010-0224-y] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2010] [Accepted: 11/24/2010] [Indexed: 11/27/2022]
Abstract
Computational modeling is an effective way to predict the response of complex systems to perturbations that are difficult or impossible to measure experimentally. A computational model of the human elbow was developed wherein joint function was dictated by three-dimensional osteoarticular interactions, soft tissue constraints, muscle action, and external loading. The model was validated against two cadaveric experiments that examined the significance of coronoid process (CP) fractures, lateral ulnar collateral ligament (LUCL) ruptures, and radial head (RH) resection in varus stability. The model was able to accurately reproduce the trend of decreasing resistance to varus displacement with increased CP resection, with a significant drop in stability observed at >50% resection. In addition, the model showed that isolated repair of either the LUCL or RH conferred significant varus stability to the joint in the presence of a deficient coronoid, with the ligament responsible for the greatest increase in stability. Predicted magnitudes of joint contact force support claims that the ulnohumeral articulation is the most significant osseous stabilizer of the joint in varus, with the radiohumeral articulation having an increased role with increasing coronoid resection at low flexion angles. With confidence in the predictive ability of this computational model, future simulations could further investigate joint function under other loading scenarios and injury states.
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Iaquinto JM, Wayne JS. Computational Model of the Lower Leg and Foot/Ankle Complex: Application to Arch Stability. J Biomech Eng 2010; 132:021009. [DOI: 10.1115/1.4000939] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The aim of this work was the design and evaluation of a computational model to predict the functional behavior of the lower leg and foot/ankle complex whereby joint behavior was dictated by three-dimensional articular contact, ligamentous constraints, muscle loading, and external perturbation. Three-dimensional bony anatomy was generated from stacked CT images after which ligament mimicking elements were attached and muscle/body loading added to recreate the experimental conditions of selected cadaveric studies. Comparisons of model predictions to results from two different experimental studies were performed for the function of the medial arch in weight bearing stance and the contributions of soft tissue structures to arch stability. Sensitivity simulations evaluated selected in situ strain and stiffness values for ligament tissue. The greatest contributor to arch stability was the plantar fascia, which provided 79.5% of the resistance to arch collapse, followed by the plantar ligaments (12.5%), and finally the spring ligament (8.0%). Strains measured after plantar fasciotomy increased in the remaining plantar ligament by ∼300% and spring ligament by ∼200%. Sensitivity tests varying both in situ strain and stiffness across reported standard deviations showed that functional trends remained the same and true to experimental data, although absolute magnitudes changed. While not measured experimentally, the model also predicted that load can increase dramatically in the remaining plantar tissues when one of such tissues is removed. Overall, computational predictions of stability and soft tissue load sharing compared well with experimental findings. The strength of this simulation approach lies in its capacity to predict biomechanical behavior of modeled structures and to capture physical parameters of interest not measurable in experimental simulations or in vivo.
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Affiliation(s)
- Joseph M. Iaquinto
- Departments of Biomedical Engineering and Orthopaedic Surgery, Orthopaedic Research Laboratory, Virginia Commonwealth University, Richmond, VA 23284
| | - Jennifer S. Wayne
- Departments of Biomedical Engineering and Orthopaedic Surgery, Orthopaedic Research Laboratory, Virginia Commonwealth University, Richmond, VA 23284
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Haraguchi N, Armiger RS, Myerson MS, Campbell JT, Chao EYS. Prediction of three-dimensional contact stress and ligament tension in the ankle during stance determined from computational modeling. Foot Ankle Int 2009; 30:177-85. [PMID: 19254515 DOI: 10.3113/fai-2009-0177] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Our goal was to quantify and visualize the three-dimensional loading relationship between the ligaments and articular surfaces of the ankle to identify and determine the stabilizing roles of these anatomical structures during the stance phase of gait. MATERIALS AND METHODS We applied discrete element analysis to computationally model the three-dimensional contact characteristics and ligament loading of the ankle joint. Physiologic loads approximating those at five positions in the stance phase of a normal walk cycle were applied. We analyzed joint contact pressures and periankle ligament tension concurrently. RESULTS Most ankle joint loading during the stance phase occurred across the articular surfaces of the joint, and the amount of ligament tension was small. The tibiotalar articulation showed full congruency throughout most of the stance phase, with peak pressure developing anteriorly toward the toe-off frame. Of the periankle ligaments, the deep deltoid ligament transferred the most force during the stance phase (57.2%); the superficial deltoid ligament transferred the second-most force (26.1%). The anterior talofibular ligament transferred force between the talus and fibula continuously, whereas the calcaneofibular ligament did not carry force during gait. The distal tibiofibular ligaments and the interosseous membrane were loaded throughout the stance phase. CONCLUSION Force transmission through the ankle joint during the stance phase is predominantly through the articular surfaces, and the periankle ligaments do not play a major stabilizing role in constraining ankle motion. The medial ligaments have a more important role than do the lateral ligaments in stabilizing the ankle joint. CLINICAL RELEVANCE In addition to ligament insufficiency, other factors, such as varus tilt of the tibial plafond, may be important in the development of recurrent instability. Continuous loading of syndesmosis ligaments provides a theoretical basis for evidence of syndesmosis screw breakage or loosening. The analysis method has potential applications for clarifying ankle joint function and providing a basis for comparison between normal and abnormal joint conditions.
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Affiliation(s)
- Naoki Haraguchi
- Department of Orthopaedic Surgery, West Tokyo Metropolitan Police Hospital, 4-8-1 Nishimotomachi, Kokubunji-shi, Tokyo 185-0023, Japan.
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Liacouras PC, Wayne JS. Computational modeling to predict mechanical function of joints: application to the lower leg with simulation of two cadaver studies. J Biomech Eng 2008; 129:811-17. [PMID: 18067384 DOI: 10.1115/1.2800763] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Computational models of musculoskeletal joints and limbs can provide useful information about joint mechanics. Validated models can be used as predictive devices for understanding joint function and serve as clinical tools for predicting the outcome of surgical procedures. A new computational modeling approach was developed for simulating joint kinematics that are dictated by bone/joint anatomy, ligamentous constraints, and applied loading. Three-dimensional computational models of the lower leg were created to illustrate the application of this new approach. Model development began with generating three-dimensional surfaces of each bone from CT images and then importing into the three-dimensional solid modeling software SOLIDWORKS and motion simulation package COSMOSMOTION. Through SOLIDWORKS and COSMOSMOTION, each bone surface file was filled to create a solid object and positioned necessary components added, and simulations executed. Three-dimensional contacts were added to inhibit intersection of the bones during motion. Ligaments were represented as linear springs. Model predictions were then validated by comparison to two different cadaver studies, syndesmotic injury and repair and ankle inversion following ligament transection. The syndesmotic injury model was able to predict tibial rotation, fibular rotation, and anterior/posterior displacement. In the inversion simulation, calcaneofibular ligament extension and angles of inversion compared well. Some experimental data proved harder to simulate accurately, due to certain software limitations and lack of complete experimental data. Other parameters that could not be easily obtained experimentally can be predicted and analyzed by the computational simulations. In the syndesmotic injury study, the force generated in the tibionavicular and calcaneofibular ligaments reduced with the insertion of the staple, indicating how this repair technique changes joint function. After transection of the calcaneofibular ligament in the inversion stability study, a major increase in force was seen in several of the ligaments on the lateral aspect of the foot and ankle, indicating the recruitment of other structures to permit function after injury. Overall, the computational models were able to predict joint kinematics of the lower leg with particular focus on the ankle complex. This same approach can be taken to create models of other limb segments such as the elbow and wrist. Additional parameters can be calculated in the models that are not easily obtained experimentally such as ligament forces, force transmission across joints, and three-dimensional movement of all bones. Muscle activation can be incorporated in the model through the action of applied forces within the software for future studies.
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Affiliation(s)
- Peter C Liacouras
- Orthopaedic Research Laboratory, Departments of Biomedical Engineering & Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA 23298-0694, USA
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Soubeyrand M, Lafont C, De Georges R, Dumontier C. [Traumatic pathology of antibrachial interosseous membrane of forearm]. ACTA ACUST UNITED AC 2007; 26:255-77. [PMID: 18023237 DOI: 10.1016/j.main.2007.09.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
The antibrachial interosseous membrane (IOM) is taught over an average length of 10.6cm between the diaphyses of the radius and ulna bone. It looks like a stitch with fibers running from the ulna to the radius and from proximal to distal and fibers running from distal to proximal. The central band, which is the middle part of the fibers directed from distal to proximal has mechanical properties similar to those of a ligament and act as a ligamentous structure embedded in the larger membranous complex of the IOM. The interosseous membrane has a double function: it stabilizes transversally the forearm's two bones and stabilizes longitudinally the two bones by transferring loads from the radius to the ulna. Load transmission varies according to the prono-supination position, the varus-valgus constraints on the elbow and the inclination of the wrist, making interpretation of the experimental data difficult. One should consider the forearm as a whole and the interosseous membrane with the two diaphyses should be regarded as a middle radio-ulnar joint, intercalated between the proximal and distal radio-ulnar joint. Those three articulations or links between radius and ulna act synergistically to stabilize and optimize repartition of loads. Functional loss of one of these links, and of course of more than one, will severely modify the forearm function. Essex-Lopresti lesion, which represents the functional loss of all three links, is the most destabilizing forearm lesion. Imaging of the interosseous membrane is difficult. MRI allows for static imaging of the interosseous membrane but there are often artifacts due to previous trauma or surgical procedures. Dynamic sonography helps to visualize all the lesions and will probably be part of the evaluation of every severe forearm injury. Surgical treatment depends on the gravity of the lesions of the different links. Interosseous membrane reconstruction is still the most difficult technique and most of the previously reported ligamentoplasties cannot answer all the biomechanical constraints. We describe a ligamentoplasty based on the biomechanics whose technique has been validated by cadaveric experiments. First surgical cases are promising.
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Affiliation(s)
- Marc Soubeyrand
- Service d'orthopédie, hôpital du Kremlin-Bicêtre, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
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Polikeit A, Ferguson SJ, Schawalder P. [Elbow dysplasia in the dog: finite element analysis]. BIOMED ENG-BIOMED TE 2007; 52:308-14. [PMID: 17691865 DOI: 10.1515/bmt.2007.052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
For young active dogs of large, fast-growing breeds, diseases of the elbow represent an increasing important disorder. Genetic predisposition, overweight and joint overload have been proposed as possible causes of elbow dysplasia. In this study, the influence of various biomechanical parameters on load transfer in healthy and pathological dog elbows has been analysed by means of a two-dimensional finite element model. Pathological changes in the elbow structure, such as altered material properties or asynchronous bone growth, have a distinct influence on the contact pressure in the joint articulation, internal bone deformation and stresses in the bones. The results obtained support empirical observations made during years of experience and offer explanations for clinical findings that are not yet well understood.
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Affiliation(s)
- Anne Polikeit
- Zürcher Hochschule Winterthur, Departement Technik, Informatik und Naturwissenschaften, Institut für mechanische Systeme, Winterthur, Switzerland
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Tubbs RS, O'Neil JT, Key CD, Zarzour JG, Fulghum SB, Kim EJ, Lyerly MJ, Shoja MM, George Salter E, Jerry Oakes W. The oblique cord of the forearm in man. Clin Anat 2007; 20:411-5. [PMID: 16683244 DOI: 10.1002/ca.20346] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is minimal and often conflicting data in the literature regarding the oblique cord of the forearm. The current study seeks to elucidate further the anatomy of this structure of the upper extremity. In adult cadavers, the oblique cord was observed for and, when found, measurements were made of it. Ranges of motion were carried out while observation of the oblique cord was made. An oblique cord was found on 52.6% of sides. Gantzer's muscle was found on 55% of sides and, when present, had attachment into the oblique cord on five sides. The oblique cord was present on 13 sides with a Gantzer's muscle. Of the 20 sides with an oblique cord, no Gantzer's muscle was found on 10. The mean length of the oblique cord was 3.4 cm. In the majority of specimens, this cord tapered from proximal to distal. The proximal, middle, and distal widths of this structure had means 9, 7, and 4 mm, respectively. The oblique cord was found to travel approximately 45 degrees from a line drawn through the ulna and more or less traveled perpendicular to the insertion site of the bicipital tendon. This ligament was lax in the neutral position and with pronation became lax in all specimens. The oblique cord progressively became taut with increased supination from the neutral position and was maximally taut with the forearm fully supinated. Tautness of this cord was also found with distal distraction of the radius. Following the transection of the oblique cord, no discernable difference was observed in regard to maximal supination of the forearm or distal distraction of the radius. No obvious instability of the proximal forearm was found following transection of the oblique cord. Functionally, although the oblique cord may resist supination, it is unlikely that this structure affords significant stability to the proximal forearm, as it was often absent, of a very small caliber, and based on our observations, following its transection, the amount of supination of the forearm did not increase. Moreover, one would expect that this structure would never resist supination alone, as the larger overlying muscles would become taut prior to calling upon the action of this cord. Based on our findings, the function of the oblique cord appears insignificant in providing significant stability to the proximal forearm; however, further investigative studies are now necessary to confirm these data.
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Affiliation(s)
- R Shane Tubbs
- Section of Pediatric Neurosurgery, Children's Hospital, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA.
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Piedade SR, Dal Fabbro IM, Mischan MM. Cyclic-loading of the human gracilis and semitendinosus muscle tendons: study of young adult cadavers. Artif Organs 2006; 30:680-5. [PMID: 16934096 DOI: 10.1111/j.1525-1594.2006.00284.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
During knee ligament reconstruction, the tendon graft is tensioned to prevent the occurrence of excessive graft elongation during the postoperative period. Tensioning may be achieved by applying a cyclic or static load to the graft during fixation. Although this procedure is part of the surgery, there is no consensus in international literature regarding ideal tension levels to be used in this procedure. This study was conducted on 10 tendons of the human gracilis muscle and 10 tendons of semitendinosus muscle removed from five male cadavers whose mean age was 20.8 years. These tendons underwent 10 in vitro strain cycles at three levels of deformation (2.5, 3, and 4%) and the value of the deforming load used for each cycle was recorded. The statistical analysis demonstrated that in order to attain the same level of deformation during the 10 cycles there was a reduction in the value of strain applied to the graft, observed at the three levels of deformation. It was concluded that the semitendinosus tendon presents a more uniform mechanical behavior and that there is a need for new graft tensioning protocols that consider the force associated with deformation.
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Affiliation(s)
- Sérgio Rocha Piedade
- Department of Orthopedics and Traumatology, School of Medical Sciences, State University of Campinas, UNICAMP, Cidade Universitária, São Paulo, Campinas 6111, Brazil.
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Pfaeffle HJ, Fischer KJ, Srinivasa A, Manson T, Woo SLY, Tomaino M. A Model of Stress and Strain in the Interosseous Ligament of the Forearm Based on Fiber Network Theory. J Biomech Eng 2006; 128:725-32. [PMID: 16995759 DOI: 10.1115/1.2241730] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Abstract
Fiber network theory was developed to describe cloth, a thin material with strength in the fiber directions. The interosseous ligament (IOL) of the forearm is a broad, thin ligament with highly aligned fibers. The objectives of this study were to develop a model of the stress and strain distributions in the IOL, based on fiber network theory, to compare the strains from the model with the experimentally measured strains, and to evaluate the force distribution across the ligament fibers from the model. The geometries of the radius, ulna, and IOL were reconstructed from CT scans. Position and orientation of IOL insertion sites and force in the IOL were measured during a forearm compression experiment in pronation, neutral rotation, and supination. An optical image-based technique was used to directly measure strain in two regions of the IOL in neutral rotation. For the network model, the IOL was represented as a parametric ruled three-dimensional surface, with rulings along local fiber directions. Fiber strains were calculated from the deformation field, and fiber stresses were calculated from the strains using average IOL tensile properties from a previous study. The in situ strain in the IOL was assumed uniform and was calculated so that the net force predicted by the network model in neutral rotation matched the experimental result. The net force in the IOL was comparable to experimental results in supination and pronation. The model predicted higher stress and strain in fibers near the elbow in neutral rotation, and higher stresses in fibers near the wrist in supination. Strains in neutral forearm rotation followed the same trends as those measured experimentally. In this study, a model of stress and strain in the IOL utilizing fiber network theory was successfully implemented. The model illustrates variations in the stress and strain distribution in the IOL. This model can be used to show surgeons how different fibers are taut in different forearm rotation positions—this information is important for understanding the biomechanical role of the IOL and for planning an IOL reconstruction.
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Affiliation(s)
- H James Pfaeffle
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA.
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Soubeyrand M, Oberlin C, Dumontier C, Belkheyar Z, Lafont C, Degeorges R. Ligamentoplasty of the forearm interosseous membrane using the semitendinosus tendon: anatomical study and surgical procedure. Surg Radiol Anat 2006; 28:300-7. [PMID: 16474924 DOI: 10.1007/s00276-006-0086-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2005] [Accepted: 01/16/2006] [Indexed: 11/25/2022]
Abstract
Total longitudinal disruptions of the interosseous membrane can allow proximal radius migration and are seen in Essex-Lopresti lesions. We propose an original technique of ligamentoplasty using the semitendinosus tendon. The graft corresponds to the forearm rotation axis for an optimized isometry and longitudinal stabilization. Our ligamentoplasty technique was performed on ten fresh frozen right forearms. We successively assessed the innocuousness, efficiency and resistance of the ligamentoplasty. The ligamentoplasty induced neither passive limitation of pronation-supination nor neurovascular lesions. It prevented from radius proximal migration. The mean load to failure was 28 kg at both ulnar and radial sides of the graft. Our technique is original for the type and position of the graft. It seems safe, efficient and resistant enough for in vivo procedures. This technique decreases longitudinal loads on the radius. It should be indicated in patients with Essex-Lopresti syndrome, in association with radial head internal fixation or arthroplasty.
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Affiliation(s)
- M Soubeyrand
- Service d'Orthopédie et Traumatologie, Hôpital Bichat Claude Bernard, 46, rue Henri Huchard, 75018, Paris, France
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Stabile KJ, Pfaeffle J, Saris I, Li ZM, Tomaino MM. Structural properties of reconstruction constructs for the interosseous ligament of the forearm. J Hand Surg Am 2005; 30:312-8. [PMID: 15781354 DOI: 10.1016/j.jhsa.2004.11.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2004] [Accepted: 11/09/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE The Essex-Lopresti fracture-dislocation, also termed longitudinal radioulnar dissociation (LRUD), results in major functional impairment from pain and limitation of motion at the wrist and elbow. Interosseous ligament (IOL) reconstruction has been proposed to help treat LRUD and restore forearm stability. The objective of this study was to evaluate the biomechanical structural properties of 3 different IOL reconstruction constructs and of the intact IOL for comparison. METHODS Structural tensile testing was performed on 24 fresh-frozen cadaveric forearms with 4 different forearm conditions: IOL intact and IOL reconstructed with Achilles tendon, flexor carpi radialis (FCR) tendon, and bone-patellar tendon-bone. Isolated radius-IOL-ulna constructs were loaded to failure in a materials testing machine with force applied along the local fiber direction. RESULTS Stiffness in the intact IOL was 129 +/- 31 N/mm, which was significantly stiffer than any of the constructs tested. The intact IOL was 8 times stiffer than the Achilles tendon construct, 7 times stiffer than the FCR construct, and 3 times stiffer than the bone-patellar tendon-bone construct. The Achilles tendon and FCR constructs were similar to each other biomechanically but the bone-patellar tendon-bone construct was slightly stiffer than the Achilles tendon and FCR constructs. CONCLUSIONS All graft constructs tested were inferior structurally to the intact IOL. The results of this study provide a biomechanical basis for graft selection for reconstruction of the IOL.
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Affiliation(s)
- Kathryne J Stabile
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Tejwani SG, Markolf KL, Benhaim P. Reconstruction of the interosseous membrane of the forearm with a graft substitute: a cadaveric study. J Hand Surg Am 2005; 30:326-34. [PMID: 15781356 DOI: 10.1016/j.jhsa.2004.05.017] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2003] [Accepted: 05/10/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE Longitudinal radioulnar dissociation occurs when traumatic axial loading through the wrist disrupts the interosseous membrane (IOM) of the forearm and fractures the radial head (Essex-Lopresti injury). Proximal migration of the radius results in a wrist with a positive ulnar variance, which leads ultimately to painful ulnar-sided wrist degeneration and wrist pain during grasping activities that involve axial loading or ulnar deviation of the wrist. In theory reconstruction of the IOM with a graft substitute can limit proximal migration of the radius, thereby preserving wrist function. The objective of this study was to measure the abilities of 3 graft tissues to limit proximal radial displacement compared with the native IOM in a radial head-deficient cadaver model. METHODS Sixteen fresh-frozen cadaveric forearms were loaded axially to 134 N through the potted central 3 metacarpals; the elbow was flexed to 90 degrees with the wrist in neutral rotation. Proximal displacement of the radius relative to the capitellum was measured. With the radial head excised specimens were first tested with the IOM intact. The IOM was then sectioned and central band IOM reconstructions were performed on each specimen using the following tissues: palmaris longus tendon, flexor carpi radialis (FCR) tendon, and a 1-cm- wide bone-patellar tendon-bone (BPTB) onlay allograft. Ten loading cycles were performed with each test configuration. Proximal radial displacement between 13.4 N and 134 N of applied wrist force was analyzed for the 10th loading cycle. The increase in proximal displacement between the first and 10th loading cycles (recorded at 134 N of wrist force) represented permanent elongation of the graft. RESULTS Mean cross-sectional areas were 5.11 mm2 for the palmaris longus tendon, 15.23 mm2 for the FCR tendon, and 51.59 mm2 for the BPTB allograft. Mean proximal radial displacements were 3.04 mm (intact IOM), 4.37 mm (BPTB), 4.92 mm (FCR tendon), and 6.43 mm (palmaris tendon); all means were significantly different from each other. Mean permanent graft elongations were 0.06 mm (IOM), 0.36 mm (BPTB), 1.25 mm (FCR tendon), and 1.80 mm (palmaris tendon); all means were significantly different from each other with the exception of means for palmaris longus vs FCR and BPTB vs IOM. CONCLUSIONS No graft reconstruction limited proximal radial displacement as effectively as the native IOM. Of the 3 graft tissues tested the BPTB allograft had the greatest cross-sectional area, allowed the least proximal radial displacement, and displayed the least permanent elongation after 10 cycles of loading. The relatively thin and narrow palmaris longus tendon appears to be the least desirable choice for IOM reconstruction because of its relatively low stiffness and tendency to elongate permanently after cyclic loading. When the radial head is absent rupture of the IOM allows unopposed proximal displacement of the radius relative to the ulna as the wrist is loaded axially. In the present tests all 3 graft tissues used to reconstruct the IOM limited proximal radial displacement. The choice of graft material is an important variable if IOM reconstruction is considered for treatment of an Essex-Lopresti injury.
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Affiliation(s)
- Samir G Tejwani
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, University of California at Los Angeles, Los Angeles, CA, USA
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Abstract
Radio-ulnar dissociation can result from high-injury trauma that the compressive forces traverse the wrist forearm and elbow. This injury can be thought of as an "unhappy triad" of radial head fracture, triangular fibrocartilage complex failure, and a tear of the interosseous membrane. The radius is the primary stabilizer of the forearm with the forearm interosseous membrane enabling load sharing between the radius and the ulna. The central one-third of the interosseous membrane is 3 times stronger than the membranous portion and approaches the strength of the anterior cruciate ligament for determining interosseous membrane injury. Imaging studies with proven diagnostic efficacy include magnetic resonance imaging and ultrasound. Surgical treatment should be considered when circumstances imply longitudinal instability of the forearm. Surgical treatment includes open reduction/internal fixation or prosthetic replacement of the radial head as well as repair of the disrupted triangular fibrocartilage complex. Successful treatment of radioulnar dissociation is predicated on early diagnosis of the condition.
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Affiliation(s)
- Peter M Murray
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Graduate School of Medicine Mayo Clinic, Jacksonville, FL 32225, USA.
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Piedade SR, Dal Fabbro IM, Mischan MM. Elongamento do enxerto de tendões do músculo grácial e semitendinoso humanos: estudo realizado em cadáveres de adultos jovens. ACTA ORTOPEDICA BRASILEIRA 2005. [DOI: 10.1590/s1413-78522005000100007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Na cirurgia de reconstrução do ligamento cruzado anterior do joelho, os enxertos de tendões autólogos são a principal opção como substitutos ligamentares. Entretanto, uma das razões da falha da reconstrução ligamentar com tecidos moles é o estiramento ou elongamento do enxerto com o tempo. Neste trabalho, foram ensaiados oito tendões do músculo grácil e oito do músculo semitendinoso humanos, obtidos de quatro cadáveres do sexo masculino, com idade média de 24,5 anos. Cada tendão foi submetido a uma deformação relativa constante de 2,5% durante 600 s, com registro contínuo do relaxamento de força. A seguir, o tendão retornava ao seu comprimento inicial e era mantido num período de repouso de 300 s. Após este intervalo, um segundo ensaio, semelhante ao primeiro, era realizado. A velocidade de carregamento empregada foi de 10% do comprimento inicial do corpo de prova por segundo. Foram obtidos valores de força inicial, com 300 s e 600 s nos dois ensaios. A análise estatística sugere um comportamento mecânico mais uniforme para o tendão do músculo semitendinoso quando comparado ao tendão do músculo grácil.
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