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Bartsch A, Anderson FL, Fredericson M, Sherman SL. Biomechanical and biological factors of sexual dimorphism in anterior knee pain: Current concepts. J ISAKOS 2024; 9:788-793. [PMID: 38908481 DOI: 10.1016/j.jisako.2024.05.014] [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: 08/29/2023] [Revised: 05/22/2024] [Accepted: 05/24/2024] [Indexed: 06/24/2024]
Abstract
Female gender is one of the commonly mentioned risk factors for anterior knee pain (AKP), among a spectrum of other factors including anatomical, biomechanical, hormonal, behavioral and psychological elements contributing to its development. Despite the focus on individual risk factors, there's a notable gap in comprehending how gender influences and interacts with other risk factors. The objective of this review was to identify and emphasize the connections between these interactions, gender-related risk factors for AKP, and the potential mechanisms that explain their associations with other risk factors, aiming to aid in the creation of precise prevention and treatment approaches. Gender influences the majority of risk factors for AKP, including anatomical, biomechanical, hormonal, behavioral and psychological factors. Women have on average smaller patellae, higher patellofemoral cartilage stress and for AKP, disadvantageous trochlear morphology, ligament and muscle composition and unfavorable neuromuscular control pattern. In contrast, men show on average an increased ability to strengthen their hip external rotators, which are both protective against AKP. Particularly in kinetic and kinematic analysis, men have been shown to have a distinctly different risk factor profile than women. Sex hormones may also play a role in the risk of AKP, with estrogen potentially influencing ligamentous laxity, increasing midfoot loading and affecting neuromuscular control of the lower extremities and testosterone positively affecting muscle mass and strength. The higher incidence of AKP in women is likely due to a combination of slightly increased risk factors. Although all risk factors can be present in both men and women and the holistic evaluation of each individual's risk factor composition is imperative regardless of gender, knowing distinctive risk factors may help with focused evaluation, treatment and implementing preventive measures of AKP.
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Affiliation(s)
- Anna Bartsch
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Orthopedics and Trauma Surgery, University Hospital Basel, Spitalstrasse 21, 4031, Basel, Switzerland
| | - Forrest L Anderson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA; Department of Physical Medicine and Rehabilitation, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA
| | - Seth Lawrence Sherman
- Department of Orthopaedic Surgery, Stanford University School of Medicine, 430 Broadway, Pavilion C, Redwood City, CA 94063, USA.
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Klasan A, Anelli-Monti V, Putnis S, Neri T, Smekal V, Kammerlander C. Trochlea morphology demonstrates variability but no gender difference in osteoarthritic patients undergoing total knee arthroplasty. Knee 2024; 49:79-86. [PMID: 38876083 DOI: 10.1016/j.knee.2024.06.002] [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: 02/24/2024] [Revised: 03/23/2024] [Accepted: 06/03/2024] [Indexed: 06/16/2024]
Abstract
BACKGROUND In recent years, coronal lower leg alignment has received significant attention. Two classifications recently described the variability in both femoral and tibial morphology, resulting in differing native lower limb alignment. The native trochlea and the variability in morphology has received less attention. METHODS This is a prospective cohort study of 200 patients undergoing robotically assisted TKA. Preoperative transverse CT scans were used to determine the posterior condylar axis (PCA), transepicondylar axis (TEA), lateral trochlear inclination (LTI), the sulcus angle (SA) and the anterior trochlear line (ATL). Outliers were defined as values > 1.5 IQR from median value. Trochlea dysplasia was defined as LTI < 12°. Gender differences were compared. RESULTS In total, 99 patients were female (49.4%). SA had a median of 137.0° (IQR 12°), ATL 4° (IQR 4), LTI 18° (IQR 7°). Median TEA-PCA was 5° external (IQR 3°). There were 5.0% outliers in SA, 3.0% of outliers in ATL, 3.5% outliers in LTI and 4.5% outliers in the TEA-PCA. Trochlear dysplasia was present in 11.5% of the measurements. There was no difference in any of the angles between the genders. CONCLUSION The present study demonstrates no difference in trochlea morphology between the genders, rather a significant number of overall outliers in trochlear morphology. Larger cohorts but also, more investigations, are needed to better understand the trochlear morphology of patients undergoing total knee arthroplasty. The personalized alignment strategies and implants need to account for this variability in the population.
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Affiliation(s)
- Antonio Klasan
- AUVA UKH Steiermark, Graz, Austria; Johannes Kepler University Linz, Austria.
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Gattu N, Sutton M, Doherty DB, Lanfermeijer ND, Rodriguez-Quintana D, Ismaily SK, Pletka CA, Noble PC, Han S. Variations in Trochlear Morphology of Contemporary and Legacy Total Knee Arthroplasty Prostheses: A Review of 22 Designs. J Arthroplasty 2024; 39:1583-1588. [PMID: 38072096 DOI: 10.1016/j.arth.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2023] [Revised: 12/05/2023] [Accepted: 12/06/2023] [Indexed: 01/01/2024] Open
Abstract
BACKGROUND The morphology of the trochlear compartment of total knee arthroplasty (TKA) prostheses is a major determinant of postoperative patello-femoral kinematics, particularly with unresurfaced patellae. The objective of this study was to quantify and compare the trochlear morphology of a large series of contemporary and legacy TKA designs. METHODS The 3-dimensional surface models of 22 femoral components (13 contemporary and 9 legacy) were created using high-resolution laser scanning. The trochlear profile of each component was analyzed from proximal to distal in 15° increments around the trochlear axis. In each profile, the following variables were measured: sulcus angle, medio-lateral deviation of the sulcus, the height and width of the facets, and the trochlear groove orientation. RESULTS In the contemporary group, the sulcus angle decreased progressively along the trochlear arc to varying degrees, except for 2 symmetrical designs, whereas the sulcus angle of the legacy designs showed considerable variability. The height of the medial facet was very strongly correlated with that of the lateral facet in the contemporary group (R2 = 0.89), whereas the correlation was weak for the legacy designs (R2 = 0.36). Moreover, the trochlear sulcus deviated laterally from distal to proximal in 10 contemporary designs and 7 legacy designs, resulting in a trochlear groove orientation of 4.2 to 11.1° and 4.3 to 10.5°, respectively. In the remaining 5 designs (3 contemporary and 2 legacy), the sulcus was vertical. CONCLUSIONS There is more consistency in trochlear morphology of contemporary TKA designs compared to that of legacy designs, yet there are still large variations between different designs.
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Affiliation(s)
- Nikhil Gattu
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Marriah Sutton
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David B Doherty
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Nicholas D Lanfermeijer
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - David Rodriguez-Quintana
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sabir K Ismaily
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Camryn A Pletka
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Philip C Noble
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
| | - Shuyang Han
- Department of Orthopedic Surgery, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas
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Martinazzi BJ, Bertha N, Nam HH, Lorenz FJ, Bonaddio V, Ptasinski A, Gallo RA. Association of Systemic Hormonal Contraceptives With Reconstruction Procedures for Patellar Instability. Orthop J Sports Med 2023; 11:23259671231191786. [PMID: 37810739 PMCID: PMC10552454 DOI: 10.1177/23259671231191786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Accepted: 05/03/2023] [Indexed: 10/10/2023] Open
Abstract
Background Previous research suggests that estrogen plays a role in increased ligamentous laxity observed within the female population. Whereas many studies have sought to evaluate the impact of exogenous estrogen on anterior cruciate ligament injuries, research has not yet explored its impact on the medial patellofemoral ligament. Furthermore, less is known about the role of exogenous progesterone on ligamentous structures. Purpose To determine whether women prescribed systemic estrogen (ethinyl estradiol) or progesterone (norgestimate or etonogestrel) hormonal contraceptives had an increased risk of undergoing reconstruction surgery for patellar instability compared with women without a prescription for systemic hormonal contraceptives. Study Design Cross-sectional study; Level of evidence, 3. Methods The TriNetX Research Network database was queried using International Classification of Disease and Common Procedural Terminology codes for women aged 15 to 26 years who underwent reconstruction procedures for patellar instability between 2012 and 2022. Women were grouped according to whether they had a coded prescription for a systemic hormonal contraceptive containing either ethinyl estradiol or etonogestrel; controls were matched by age, sex, race, and ethnicity. The relative risk (RR) of undergoing reconstruction for patellar instability was determined for each contraceptive. Results After 1-to-1 propensity score matching, 0.054% (525/980,878) of women prescribed a systemic contraceptive containing ethinyl estradiol underwent reconstruction procedures for patellar instability compared with 0.043% (417/980,878) of controls (RR, 1.3; 95% CI, 1.1-1.4; P = .0004). Likewise, 0.058% (67/116,260) of women prescribed a form of systemic contraceptive containing only etonogestrel underwent reconstruction procedures for patellar instability compared with 0.026% (30/116,260) of controls (RR, 2.2; 95% CI, 1.5-3.4; P = .0002). Conclusion Female patients prescribed systemic contraceptives containing estrogen or progesterone had an increased rate of reconstruction procedures for patellar instability.
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Affiliation(s)
- Brandon J. Martinazzi
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Nicholas Bertha
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Hannah H. Nam
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - F. Jeffrey Lorenz
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Vincenzo Bonaddio
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Anna Ptasinski
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
| | - Robert A. Gallo
- Department of Orthopaedics and Rehabilitation, Penn State Health, Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
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Borukhov I, Esposito CI, Ismailidis P, LiArno S, Lyon JP, McCarthy TF, McEwen P. The trochlear sulcus of the native knee is consistently orientated close to the sagittal plane despite variation in distal condylar anatomy. Knee Surg Sports Traumatol Arthrosc 2023; 31:3618-3626. [PMID: 34291310 PMCID: PMC10435591 DOI: 10.1007/s00167-021-06667-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 07/09/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE The aim of this study was to describe the native trochlear orientation of non-arthritic knees in three planes and to quantify the relationship between trochlear and distal condylar anatomy across race and sex. METHODS Computed tomography scans of 1578 femora were included in this study. The mediolateral position of the trochlear sulcus, the distal trochlear sulcus angle (DTSA) the medial sulcus angle (MSA) and the lateral sulcus angle (LSA) as well as the mechanical lateral distal femoral angle (mLDFA) were measured relative to a standard reference coordinate system. Multiple linear regression analyses were performed to account for potential confounding variables. RESULTS The mediolateral position of the trochlear sulcus had minimal mean deviation of the sagittal femoral plane. The mean DTSA was 86.1° (SD 2.2°). Multilinear regression analysis found mLDFA, sex, and age all influence DTSA (p < 0.05), with mLDFA having by far the greatest influence (r2 = 0.55). The medial facet of the trochlear sulcus was found to be flat proximally and more prominent distally. The lateral facet was relatively uniform throughout the arc. CONCLUSION In non-arthritic knees, due to a strong positive correlation between the DTSA and the mLDFA, the trochlear sulcus is consistently orientated in the sagittal femoral plane regardless of distal condylar anatomy. Minor deviations from the sagittal plane occur in a lateral direction in the middle part and in a medial direction at the proximal and distal part of the trochlea. These findings have relevance regarding the biomimetic design of total knee implants.
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Affiliation(s)
| | | | - Petros Ismailidis
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia.
- Department of Orthopaedics and Traumatology, University Hospital of Basel, Spitalstrasse 21, 4031, Basel, Switzerland.
| | | | | | | | - Peter McEwen
- The Orthopaedic Research Institute of Queensland (ORIQL), 7 Turner St, Pimlico Townsville, QLD, Australia
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Patellofemoral arthroplasty: obesity linked to high risk of revision and progression of medial tibiofemoral osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2022; 30:4115-4122. [PMID: 35348817 DOI: 10.1007/s00167-022-06947-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE The purpose of this study was to determine the effect of obesity on patient outcome, procedure failure rate and osteoarthritis (OA) progression in the tibiofemoral compartments in a series of isolated patellofemoral arthroplasty (PFA) performed with a third-generation implant. METHODS The study population was patients who had undergone third-generation PFA at a specialized orthopedic center between 2007 and 2017. Patients were categorized by body-mass index (BMI) as obese (O, BMI > 30 kg/m2) or nonobese (NO, BMI < 30 kg/m2). Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score (KSS), University of California Los Angeles (UCLA) Activity Score, Tegner Activity Level Scale, and visual analogue scale (VAS) for pain. Preoperative and postoperative radiographs were evaluated for progression of tibiofemoral compartment OA, changes in patellar height and in knee coronal alignment. Multiple logistic regression models were used to assess the effect of BMI on outcomes together with other covariates. RESULTS A total of 120 PFAs with a mean follow-up of 6.9 ± 2.5 years were included: 25 in the O group and 95 in the NO group. Significant improvement was noted in in knee range of motion (P < 0.001), clinical and functional KSS (P < 0.001), UCLA Activity Score (P < 0.001), Tegner score (P < 0.001) and VAS pain (P < 0.001) without inter-groups differences. Worsening of the medial Kellgren-Lawrence (KL) grade (but not the lateral KL grade) was more frequent in the O than the NO group during the follow-up period (P = 0.014). Failure occurred in 4.2% of NO and in 20% of O group patients; the difference was solely due to failure because of OA progression in the tibiofemoral compartment (16% in the O group). There were no between group differences in the failure rate for any cause other than OA progression (4.2% in the NO group, 4.0% in the O group). CONCLUSIONS An equal improvement in function after PFA was noted in both obese and nonobese patients; however, the high failure rate due to OA progression in the medial tibiofemoral compartment warrants caution when considering PFA in obese patients.
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Pinette MP, Molino J, Proffen BL, Murray MM, Fleming BC. Effects of Male and Female Sex on the Development of Posttraumatic Osteoarthritis in the Porcine Knee After Anterior Cruciate Ligament Surgery. Am J Sports Med 2022; 50:2417-2423. [PMID: 35722806 PMCID: PMC9473678 DOI: 10.1177/03635465221102118] [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: 01/31/2023]
Abstract
BACKGROUND Posttraumatic osteoarthritis (PTOA) is a common sequela of anterior cruciate ligament (ACL) injury, even when surgical treatment is selected. The effect of patient sex on cartilage health after ACL injury and surgical treatment has been less studied. PURPOSE/HYPOTHESIS The study objective was to compare the macroscopic cartilage damage that develops after ACL surgery in male and female Yucatan minipigs. It was hypothesized that after ACL surgery, the macroscopic cartilage damage of the tibiofemoral joints from female animals would be greater than that from male animals. Additionally, it was hypothesized that the effect of sex on the macroscopic cartilage damage would depend on surgical treatment. STUDY DESIGN Controlled laboratory study. METHODS Twelve-month follow-up data were obtained for 55 adolescent Yucatan minipigs (22 female/33 male) that were randomized to 1 of 3 experimental groups: no treatment (ACL transection [ACLT]), ACL reconstruction, and bridge-enhanced ACL restoration. The Osteoarthritis Research Society International guidelines were used to determine a standardized macroscopic cartilage damage score on 5 surfaces of the knee joint. RESULTS Females had significantly worse mean total macroscopic cartilage damage scores on the surgical side (adjusted P value [P adj] = .04) and significantly better scores on the contralateral side (P adj = .01) when compared with males. The trochlear damage scores were also significantly worse in females for surgical limbs (P adj = .009) and significantly better for the contralateral limbs (P adj < .001) when compared with males. Although there were no significant differences in total macroscopic cartilage damage scores between sexes within treatment groups on the surgical limbs (ACLT, P adj = 0.45; ACL reconstruction, P adj = .56; bridge-enhanced ACL restoration, P adj = .23), the mean trochlear scores on the surgical limb of females were significantly worse than those of the males in the ACLT group (P adj = .003). CONCLUSION Mean total macroscopic cartilage damage scores of Yucatan minipigs were significantly worse in females than males, regardless of treatment. These differences were predominantly found in the trochlear scores across all treatment groups. CLINICAL RELEVANCE These data suggest that patient sex could be more influential in the progression of PTOA than surgical treatment after ACL injury. Identifying factors responsible for this discrepancy may prove valuable to identify targets to slow PTOA progression in male and female ACL-injured populations.
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Affiliation(s)
- Megan P. Pinette
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Janine Molino
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Benedikt L. Proffen
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Martha M. Murray
- Department of Orthopaedic Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Braden C. Fleming
- Department of Orthopaedics, Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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Dandridge O, Garner A, Amis AA, Cobb JP, van Arkel RJ. Variation in the patellar tendon moment arm identified with an improved measurement framework. J Orthop Res 2022; 40:799-807. [PMID: 34191354 DOI: 10.1002/jor.25124] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/08/2021] [Accepted: 06/09/2021] [Indexed: 02/04/2023]
Abstract
The mechanical advantage of the knee extensor mechanism depends heavily on the patellar tendon moment arm (PTMA). Understanding which factors contribute to its variation may help improve functional outcomes following arthroplasty. This study optimized PTMA measurement, allowing us to quantify the contribution of different variables. The PTMA was calculated about the instantaneous helical axis of tibiofemoral rotation from optical tracked kinematics. A fabricated knee model facilitated calculation optimization, comparing four data smoothing techniques (raw, Butterworth filtering, generalized cross-validated cubic spline-interpolation and combined filtering/interpolation). The PTMA was then measured for 24 fresh-frozen cadaveric knees, under physiologically based loading and extension rates. Combined filtering/interpolation enabled sub-mm PTMA calculation accuracy throughout the range of motion (root-mean-squared error 0.2 mm, max error 0.4 mm), whereas large errors were measured for raw, filtered-only and interpolated-only techniques at terminal flexion/extension. Before scaling, the mean PTMA was 46 mm; PTMA magnitude was consistently larger in males (mean differences: 5 to 10 mm, p < .05) and was strongly related to knee size: larger knees have a larger PTMA. However, while scaling eliminated sex differences in PTMA magnitude, the peak PTMA occurred closer to terminal extension in females (female 15°, male 29°, p = .01). Knee size accounted for two-thirds of the variation in PTMA magnitude, but not the flexion angle where peak PTMA occurred. This substantial variation in angle of peak PTMA has implications for the design of musculoskeletal models and morphotype-specific arthroplasty. The developed calculation framework is applicable both in vivo and vitro for accurate PTMA measurement.
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Affiliation(s)
- Oliver Dandridge
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Amy Garner
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK.,MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK.,Royal College of Surgeons of England and Dunhill Medical Trust Clinical Research Fellowship. Royal College of Surgeons of England, London, UK.,Health Education Kent, Surrey and Sussex, Stewart House, London, UK
| | - Andrew A Amis
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
| | - Justin P Cobb
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Richard J van Arkel
- Biomechanics Group, Department of Mechanical Engineering, Imperial College London, London, UK
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Polamalu SK, Novaretti J, Musahl V, Debski RE. Tibiofemoral bony morphology impacts the knee kinematics after anterolateral capsule injury and lateral extraarticular tenodesis differently than intact state. J Biomech 2021; 139:110857. [PMID: 34809996 DOI: 10.1016/j.jbiomech.2021.110857] [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: 07/09/2021] [Revised: 10/21/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
Anterolateral capsule injury, often concomitant with anterior cruciate ligament (ACL) injuries, may result in high-grade rotatory instability. Lateral extraarticular tenodesis (LET) is sometimes added to ACL reconstruction to address this instability. However, LET is a non-anatomic procedure and concerns regarding increased tibiofemoral contact pressure and reduced internal rotation exist for some individuals which may be due to their tibiofemoral bony morphology. Therefore, the objective of this study was to analyze the effect of bony morphology on knee kinematic and contact pressure before and after anterolateral capsule injury and LET. A (1) 134-N anterior tibial load with 200-N axial compression and (2) a 7-Nm internal torque with a 200-N axial compression were applied to cadaveric knees (n = 8) using a 6 degree-of-freedom robotic testing system. Tibiofemoral bony morphology was captured with computed tomography scans and analyzed using 3D statistical shape modeling. Kinematics at each state were correlated with the results from the statistical shape model. Two femoral and three tibial modes of variation correlated with kinematic and contact pressure data before and after anterolateral capsule injury and LET. A decreased lateral tibial plateau elevation correlated with greater internal rotation and anterior tibial translation after anterolateral capsule deficiency and LET. Decreased notch width correlated with decreased contact area after anterolateral capsule deficiency and LET demonstrating it as a risk factor for ACL injury. The results of this study demonstrate that bony morphology if properly understood, could help improve the efficacy of LET procedures and that bony morphology has different effects after injury and repair.
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Affiliation(s)
- Sene K Polamalu
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - João Novaretti
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA; The Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
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Zhang L, Fan S, Ye J, Jiang X, Cai B. Gender differences in knee kinematics during weight-bearing knee flexion for patients with arthrofibrosis after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16:573. [PMID: 34565414 PMCID: PMC8474925 DOI: 10.1186/s13018-021-02729-3] [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: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge of tibiofemoral and patellofemoral joint kinematics is important for understanding gender-related dimorphism in developing knee arthrofibrosis and advancement of related treatments. The objective of our study was to investigate gender differences existing in tibiofemoral kinematics and patellar tracking in patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction during weight-bearing knee flexion. Methods The tibiofemoral and patellofemoral joint kinematics were measured in 30 patients (15 male and 15 female) with arthrofibrosis after ACL reconstruction during a lunge task, using computed tomography and dual fluoroscopic imaging system. These data were analyzed for gender differences. Results The range of tibial rotation, patellar inferior shift, tilt, and flexion were significantly decreased in the affected knee compared to the contralateral knee from 15° to 75° of knee flexion (P ≤ 0.04). Statistically significant difference was detected for medial tibial translation between male and female patients at 60° (P = 0.04) and 75° of knee flexion (P = 0.02). The tibial rotation was significantly decreased at 60° (P = 0.03) and 75° of knee flexion (P < 0.01) in females. The inferior patellar shift in females was significantly lower than that in males at 15° (P = 0.04) and 30° of knee flexion (P = 0.01). The patellar tilt was significantly lower at 60° (P = 0.02) and 75° of knee flexion (P < 0.01) in females compared to males. Conclusions The results indicated a significant effect of gender on knee kinematics in patients with arthrofibrosis after ACL reconstruction during weight-bearing knee flexion. These gender differences in tibiofemoral kinematics and patellar tracking may warrant further investigations to determine implications for making gender-specific surgical treatments and rehabilitation programs.
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Affiliation(s)
- Ling Zhang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Jiling Ye
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China.
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Cho BW, Hong HT, Koh YG, Choi J, Park KK, Kang KT. Analysis of Gender Differences in the Rotational Alignment of the Distal Femur in Kinematically Aligned and Mechanically Aligned Total Knee Arthroplasty. J Clin Med 2021; 10:jcm10163691. [PMID: 34441989 PMCID: PMC8396944 DOI: 10.3390/jcm10163691] [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] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 08/17/2021] [Accepted: 08/19/2021] [Indexed: 11/17/2022] Open
Abstract
To compare the angle between the external rotation references of the femoral components in the axial plane by gender and lower limb alignment in Korean patients with osteoarthritis (OA). Magnetic resonance (MR) images of 1273 patients were imported into a modeling software and segmented to develop three-dimensional femoral bony and cartilaginous models. The surgical transepicondylar axis (sTEA), posterior condylar axis (PCA), the kinematically aligned axis (KAA), and anteroposterior axis were used as rotational references in the axial plane for mechanically aligned (MA) TKA. The relationship among axes were investigated. Among 1273 patients, 942 were female and 331 were male. According to lower limb alignment, the varus and valgus knee groups comprised 848 and 425 patients, respectively. All measurements, except PCA-sTEA, differed significantly between men and women; all measurements, except PCA-sTEA, did not differ significantly between the varus and valgus knee groups. In elderly Korean patients with OA, rotational alignment of the distal femur showed gender differences, but no differences were seen according to lower limb alignment. The concern for malrotation of femoral components during kinematically aligned TKA is less in Koreans than in Caucasians and relatively less in women than in men. In MA TKA, malrotation of the femoral components can be avoided by setting different rotational alignments for the genders.
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Affiliation(s)
- Byung-Woo Cho
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Hyoung-Taek Hong
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
| | - Yong-Gon Koh
- Joint Reconstruction Center, Department of Orthopaedic Surgery, Yonsei Sarang Hospital, 10 Hyoryeong-ro, Seocho-gu, Seoul 06698, Korea;
| | - Jeehoon Choi
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
| | - Kwan-Kyu Park
- Department of Orthopaedic Surgery, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea; (B.-W.C.); (J.C.)
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
| | - Kyoung-Tak Kang
- Department of Mechanical Engineering, Yonsei University, 50 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea;
- Correspondence: (K.-K.P.); (K.-T.K.); Tel.: +82-2-1599-1004 (K.-K.P.); +82-2-588-1006 (K.-T.K.)
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Li Z, Liu G, Tian R, Kong N, Li Y, Li Y, Wang K, Yang P. The patellofemoral morphology and the normal predicted value of tibial tuberosity-trochlear groove distance in the Chinese population. BMC Musculoskelet Disord 2021; 22:575. [PMID: 34162383 PMCID: PMC8223279 DOI: 10.1186/s12891-021-04454-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Accepted: 04/08/2021] [Indexed: 01/11/2023] Open
Abstract
Background Our objective was to obtain normal patellofemoral measurements to analyse sex and individual differences. In addition, the absolute values and indices of tibial tuberosity-trochlear groove (TT-TG) distances are still controversial in clinical application. A better method to enable precise prediction is still needed. Methods Seventy-eight knees of 78 participants without knee pathologies were included in this cross-sectional study. A CT scan was conducted for all participants and three-dimensional knee models were constructed using Mimics and SolidWorks software. We measured and analysed 19 parameters including the TT-TG distance and dimensions and shapes of the patella, femur, tibia, and trochlea. LASSO regression was used to predict the normal TT-TG distances. Results The dimensional parameters, TT-TG distance, and femoral aspect ratio of the men were significantly larger than those of women (all p values < 0.05). However, after controlling for the bias from age, height, and weight, there were no significant differences in TT-TG distances and anterior-posterior dimensions between the sexes (all p values > 0.05). The Pearson correlation coefficients between the anterior femoral offset and other indexes were consistently below 0.3, indicating no relationship or a weak relationship. Similar results were observed for the sulcus angle and the Wiberg index. Using LASSO regression, we obtained four parameters to predict the TT-TG distance (R2 = 0.5612, p < 0.01) to achieve the optimal accuracy and convenience. Conclusions Normative data of patellofemoral morphology were provided for the Chinese population. The anterior-posterior dimensions of the women were thicker than those of men for the same medial-lateral dimensions. More attention should be paid to not only sex differences but also individual differences, especially the anterior condyle and trochlea. In addition, this study provided a new method to predict TT-TG distances accurately. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04454-8.
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Affiliation(s)
- Zhe Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Guanzhi Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Ning Kong
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Yue Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Yiyang Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Medical College, Xi'an Jiaotong University, Shaanxi, 710004, Xi'an, People's Republic of China.
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Dagneaux L, Dufrenot M, Bernasconi A, Bedard NA, de Cesar Netto C, Lintz F. Three-Dimensional Biometrics to Correlate Hindfoot and Knee Coronal Alignments Using Modern Weightbearing Imaging. Foot Ankle Int 2020; 41:1411-1418. [PMID: 32698631 DOI: 10.1177/1071100720938333] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Previous studies focusing on the effects of knee surgery on hindfoot alignment have suggested some degree of compensation between the knee and the hindfoot. However, these studies did not investigate a preoperative relationship in patients without end-stage knee osteoarthritis using 3-dimensional (3D) biometrics. The purpose of this study was to investigate the relationship between knee and hindfoot alignment using 3D weightbearing imaging. METHODS This retrospective comparative study included 95 lower limbs with weightbearing computed tomography and low-dose biplanar radiograph investigations. Cases with a history that may have caused a change in lower limb alignment were excluded. Hindfoot and knee alignments were measured using foot ankle offset (FAO) and hip-knee-ankle (HKA) angle, respectively. Patients were separated into 3 groups according to the knee deformity to investigate the distribution of FAO in each group. RESULTS The mean (SD) FAO was 2% (7%) for the knee varus group, 1% (6%) for the neutral knee group, and 4% (5%) for the valgus knee group (P = .12). Fifty-three percent of patients with knee valgus showed a pathological hindfoot valgus (P = .04). We found a positive but moderate correlation between hindfoot valgus and HKA (ρ = 0.53; P = .01). Female sex was associated with higher FAO (3% ± 4% vs 0.6% ± 6%; P = .009). CONCLUSION This feasibility study suggests a new opportunity using 3D biometrics to understand the relationship between knee and hindfoot alignment and to highlight different patterns of combined deformities in further investigations. LEVEL OF EVIDENCE Level III, comparative study.
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Affiliation(s)
- Louis Dagneaux
- Department of Orthopaedic Surgery, Lower Limb Surgery Unit, Lapeyronie University Hospital, Montpellier, France.,Montpellier University, Montpellier, France
| | | | - Alessio Bernasconi
- Trauma and Orthopaedics, University of Naples Federico II, Naples, Italy
| | - Nicholas A Bedard
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, IA, USA
| | - Cesar de Cesar Netto
- Department of Foot and Ankle Surgery, Hospital for Special Surgery, New York, NY, USA
| | - François Lintz
- Department of Foot and Ankle Surgery, Union Private Hospital, Saint Jean, Toulouse, France
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Dejtiar DL, Dzialo CM, Pedersen PH, Jensen KK, Fleron MK, Andersen MS. Development and Evaluation of a Subject-Specific Lower Limb Model With an Eleven-Degrees-of-Freedom Natural Knee Model Using Magnetic Resonance and Biplanar X-Ray Imaging During a Quasi-Static Lunge. J Biomech Eng 2020; 142:061001. [PMID: 31314894 DOI: 10.1115/1.4044245] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Indexed: 12/31/2022]
Abstract
Musculoskeletal (MS) models can be used to study the muscle, ligament, and joint mechanics of natural knees. However, models that both capture subject-specific geometry and contain a detailed joint model do not currently exist. This study aims to first develop magnetic resonance image (MRI)-based subject-specific models with a detailed natural knee joint capable of simultaneously estimating in vivo ligament, muscle, tibiofemoral (TF), and patellofemoral (PF) joint contact forces and secondary joint kinematics. Then, to evaluate the models, the predicted secondary joint kinematics were compared to in vivo joint kinematics extracted from biplanar X-ray images (acquired using slot scanning technology) during a quasi-static lunge. To construct the models, bone, ligament, and cartilage structures were segmented from MRI scans of four subjects. The models were then used to simulate lunges based on motion capture and force place data. Accurate estimates of TF secondary joint kinematics and PF translations were found: translations were predicted with a mean difference (MD) and standard error (SE) of 2.13 ± 0.22 mm between all trials and measures, while rotations had a MD ± SE of 8.57 ± 0.63 deg. Ligament and contact forces were also reported. The presented modeling workflow and the resulting knee joint model have potential to aid in the understanding of subject-specific biomechanics and simulating the effects of surgical treatment and/or external devices on functional knee mechanics on an individual level.
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Affiliation(s)
- David Leandro Dejtiar
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark
| | - Christine Mary Dzialo
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark; Anybody Technology A/S, Niels Jernes Vej 10, Aalborg DK-9220, Denmark
| | - Peter Heide Pedersen
- Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, Aalborg DK-9000, Denmark
| | - Kenneth Krogh Jensen
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, Aalborg DK-9000, Denmark
| | - Martin Kokholm Fleron
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 7, Aalborg DK-9220, Denmark
| | - Michael Skipper Andersen
- Department of Materials and Production, Aalborg University, Fibigestræde 16, Aalborg DK-9220, Denmark
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Tibiofemoral kinematics in healthy and osteoarthritic knees during twisting. J Orthop 2020; 21:213-217. [PMID: 32273659 DOI: 10.1016/j.jor.2020.03.051] [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] [Received: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 11/22/2022] Open
Abstract
Purpose The purpose of this study was to determine the in vivo kinematics of healthy knees and those with osteoarthritis (OA), during twisting using density-based image-matching techniques. Methods Five healthy subjects and 26 patients with medial knee OA performed twisting under periodic X-ray imaging. Results The tibiofemoral rotation at the ipsilateral/contralateral twist in healthy and OA knees were 11° ± 9.3° externally/9.5° ± 5.6° internally (p < 0.05) and 4.4° ± 7.2° externally/2.7° ± 8° internally (p < 0.05), respectively. Conclusions The kinematic analysis of OA knees during twisting revealed significantly smaller tibiofemoral rotation than those of healthy knees.
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Twiggs JG, Wakelin EA, Roe JP, Dickison DM, Fritsch BA, Miles BP, Ruys AJ. Patient-Specific Simulated Dynamics After Total Knee Arthroplasty Correlate With Patient-Reported Outcomes. J Arthroplasty 2018; 33:2843-2850. [PMID: 29807792 DOI: 10.1016/j.arth.2018.04.035] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 04/16/2018] [Accepted: 04/20/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Component alignment variation following total knee arthroplasty (TKA) does not fully explain the instance of long-term postoperative pain. Joint dynamics following TKA vary with component alignment and patient-specific musculoskeletal anatomy. Computational simulations allow joint dynamics outcomes to be studied across populations. This study aims to determine if simulated postoperative TKA joint dynamics correlate with patient-reported outcomes. METHODS Landmarking and 3D registration of implants was performed on 96 segmented postoperative computed tomography scans of TKAs. A cadaver rig-validated platform for generating patient-specific simulation of deep knee bend kinematics was run for each patient. Resultant dynamic outcomes were correlated with a 12-month postoperative Knee Injury and Osteoarthritis Outcome Score (KOOS). A Classification and Regression Tree (CART) was used for determining nonlinear relationships. RESULTS Nonlinear relationships between the KOOS pain score and rollback and dynamic coronal alignment were found to be significant. Combining a dynamic coronal angular change from extension to full flexion between 0° and 4° varus (long leg axis) and measured rollback of no more than 6 mm without rollforward formed a "kinematic safe zone" of outcomes in which the postoperative KOOS score is 10.5 points higher (P = .013). CONCLUSION The study showed statistically significant correlations between kinematic factors in a simulation of postoperative TKA and postoperative KOOS scores. The presence of a dynamic safe zone in the data suggests a potential optimal target for any given individual patient's joint dynamics and the opportunity to preoperatively determine a patient-specific alignment target to achieve those joint dynamics.
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Affiliation(s)
- Joshua G Twiggs
- 360 Knee Systems, Sydney, Australia; Department of Biomedical Engineering, University of Sydney, Sydney, Australia
| | | | - Justin P Roe
- North Sydney Orthopaedic and Sports Medicine Centre, The Mater Hospital, North Sydney, Australia
| | | | | | | | - Andrew J Ruys
- Department of Biomedical Engineering, University of Sydney, Sydney, Australia
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Female sex is associated with greater rotatory knee laxity in collegiate athletes. Knee Surg Sports Traumatol Arthrosc 2018; 26:1319-1325. [PMID: 28823037 DOI: 10.1007/s00167-017-4684-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 08/16/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE/HYPOTHESIS The purpose of this observational study was to determine which factors, including sex, are associated with increased rotatory knee laxity in collegiate athletes with no history of knee injuries. It was hypothesized that increased rotatory knee laxity, measured by a quantitative pivot shift test, would correlate with female sex, increased anterior translation during the Lachman test, generalized ligamentous laxity, and knee hyperextension. METHODS Ninety-eight collegiate athletes with a median age of 20 (range 18-25) years with no history of knee injuries were tested. IKDC and Marx activity scores were obtained and subjects underwent measurement of anterior translation during the Lachman test with a Rolimeter and measurement of knee hyperextension with a goniometer for both knees. A standardized pivot shift test was performed in both knees and quantified using image analysis technology. Generalized ligamentous laxity was assessed using the modified Beighton score. RESULTS The average anterior translation of the lateral compartment during the pivot shift test was 1.6 mm (range 0.1-7.1) with a mean side-to-side difference of 0.6 mm (range 0-2.7). The average anterior translation during the Lachman test was 9.0 (range 2-15). The anterior translation of the lateral compartment during the pivot shift test was significantly higher in females (median, 1.6; range 0.3-4.9) than in males (1.1, 0.1-7.1 mm) (p < 0.05). Anterior translation of the lateral compartment during the pivot shift test was significantly correlated with anterior translation during the Lachman test (r = 0.34; p < 0.05). There was no significant correlation between anterior translation of the lateral compartment during the pivot shift test and knee hyperextension or modified Beighton score (n.s). CONCLUSION The data from this study show that female sex is associated with increased rotatory knee laxity measured during the pivot shift test and anterior translation during the Lachman test in collegiate athletes. In the future, these data may be helpful in diagnosing and managing ACL injuries in athletes and could be used in the clinic as a baseline by which to compare and identify patients who might exhibit increased rotatory laxity. LEVEL OF EVIDENCE Diagnostic level II.
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Development and validation of a subject-specific moving-axis tibiofemoral joint model using MRI and EOS imaging during a quasi-static lunge. J Biomech 2018; 72:71-80. [DOI: 10.1016/j.jbiomech.2018.02.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 02/21/2018] [Accepted: 02/23/2018] [Indexed: 11/18/2022]
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Romagnoli S, Marullo M. Mid-Term Clinical, Functional, and Radiographic Outcomes of 105 Gender-Specific Patellofemoral Arthroplasties, With or Without the Association of Medial Unicompartmental Knee Arthroplasty. J Arthroplasty 2018; 33:688-695. [PMID: 29129614 DOI: 10.1016/j.arth.2017.10.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2017] [Revised: 10/10/2017] [Accepted: 10/13/2017] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The purpose of this study is to evaluate clinical and radiographic outcomes after gender-specific patellofemoral arthroplasty (PFA) either isolated or combined with unicompartmental knee arthroplasty (UKA). METHODS A total of 105 PFAs in 85 patients were reviewed: 64 knees had isolated patellofemoral osteoarthritis and received an isolated PFA, and 41 knees with bicompartmental osteoarthritis were treated with medial UKA and PFA. Preoperative and postoperative clinical and functional assessment included knee range of motion, Knee Society Score, University of California Los Angeles Activity Score, Tegner Activity Level Scale, and visual analogue scale pain. Preoperative and postoperative radiographs were evaluated for patellofemoral and tibiofemoral compartment osteoarthritis, trochlear dysplasia, changes in patellar height, and signs of osteolysis. RESULTS At a mean follow-up of 5.5 ± 1.6 years, both groups showed improvement in knee joint range of motion (P < .001), clinical and functional Knee Society Score (P < .001), University of California Los Angeles Activity Score (P < .001 in the PFA group and P = .004 in the UKA + PFA group), and visual analogue scale pain (P < .001). There were no statistically significant postoperative differences between the 2 groups. No signs of osteolysis or subsidence were recorded. Survivorship of these 105 implants was 95.2%. CONCLUSION Excellent clinical and radiographic outcomes were achieved after PFA with a gender-specific implant both as isolated replacement and when combined with medial UKA. Bicompartmental replacement with small implants can be considered in patients with bicompartmental osteoarthritis and intact anterior cruciate ligament.
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Affiliation(s)
- Sergio Romagnoli
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
| | - Matteo Marullo
- Joint Replacement Department, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
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Sato T, Sato N, Sasaki T, Sato K, Gorniak GC. Patterns of patellofemoral articular cartilage wear in Japanese cadavers. J ANAT SOC INDIA 2017. [DOI: 10.1016/j.jasi.2017.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Morphological classification of the femoral trochlear groove based on a quantitative measurement of computed tomographic models. Knee Surg Sports Traumatol Arthrosc 2017; 25:3163-3170. [PMID: 27395356 DOI: 10.1007/s00167-016-4236-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE This study aimed to investigate the natural morphology of the femoral trochlear groove based on quantitative measurement. METHODS Computed tomographic femur models of 50 male and 50 female healthy Chinese adults (30-60 years) were analysed using three-dimensional software. Coaxial cutting planes (15° increments) rotating about the trochlear groove axis from the proximal to distal point were created, followed by the deepest point of the trochlear groove marked at each cross section. The shape, position, and orientation of the trochlear groove were analysed. RESULTS The trochlear groove was located laterally relative to the mechanical axis and consisted of the laterally oriented proximal part and medially oriented distal part. Based on the turning points located on different cross sections, the trochlear groove was classified into four types: types 45°, 60°, 75°, and 90°. The mediolateral position relative to the mechanical axis was types 45°, 60°, 75°, and 90°, from the lateral to medial side, while the distal parts of them extended along the same path. The orientation of the trochlear groove was relatively consistent and smooth, which oriented at approximately 1° medially between two adjacent segments, except at approximately 10° medially at the turning point. CONCLUSION The trochlear groove tracking varies greatly amongst a population that is mainly categorized into four types. This study may be helpful for better understanding of the natural trochlear groove anatomy, prosthetic design modification, and provide the reference value for studying patellofemoral diseases such as patellar maltracking and trochlear dysplasia. LEVEL OF EVIDENCE Prospective study, Level II.
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Murakami K, Hamai S, Okazaki K, Ikebe S, Nakahara H, Higaki H, Shimoto T, Mizu-Uchi H, Kuwashima U, Iwamoto Y. Kinematic analysis of stair climbing in rotating platform cruciate-retaining and posterior-stabilized mobile-bearing total knee arthroplasties. Arch Orthop Trauma Surg 2017; 137:701-711. [PMID: 28289890 DOI: 10.1007/s00402-017-2662-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The aim of our study was to compare and contrast the effects of two types of mobile-bearing total knee arthroplasties (TKA), namely, the cruciate-retaining (CR) and posterior-stabilized (PS) TKAs, on clinical outcomes and in vivo kinematics during stair climbing. MATERIALS AND METHODS The Press-Fit Condylar Sigma rotating platform was used for both CR and PS TKAs. Patient-reported outcomes were assessed using the 2011 Knee Society Score. Quadriceps muscle strength was evaluated by isokinetic dynamometry. In vivo kinematics were evaluated using periodic sagittal plane radiographic images obtained during stair climbing to quantify anteroposterior (AP) tibiofemoral translation, implant flexion and axial rotation angles using image-matching techniques. Outcomes were evaluated in 20 TKAs, which had been undergone with clinical success, including ten knees with CR types and ten knees with PS types. RESULTS There were no significant differences between the CR and PS TKA groups (p > 0.05) in isometric extensor torque (1.0 ± 0.2 and 1.1 ± 0.6 N m/kg, respectively) or patient-reported score for stair climbing function (4.0 ± 0.5 and 3.8 ± 0.9, respectively). Both types of TKAs showed stable AP translation in the mid range of knee flexion and paradoxical translation in the low range of flexion, with limited rotation, during stair climbing. There were no significant differences between the CR and PS TKA groups (P > 0.05) in anterior translation from 80° to 40° of knee flexion (4.2 ± 1.2 and 3.5 ± 1.6 mm, respectively), posterior translation from 40° to 10° of knee flexion (2.3 ± 1.9 and 2.0 ± 1.5 mm, respectively), and total external rotation (2.8° ± 4.9° and 0.5° ± 5.0°, respectively). CONCLUSIONS Both CR and PS types of rotating platform mobile-bearing TKAs provided reproducible knee joint kinematics during stair climbing and equivalent clinical outcomes. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan.,Katai Orthopaedic Hospital, 132-1 Okuma Kasuya-machi, Kasuya-gun, Fukuoka, 811-2302, Japan
| | - Satoru Ikebe
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Hiroyuki Nakahara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Hidehiko Higaki
- Department of Biorobotics, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka, 813-8583, Japan
| | - Takeshi Shimoto
- Department of Information and Systems Engineering, Faculty of Information Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka, 811-0295, Japan
| | - Hideki Mizu-Uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Umito Kuwashima
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan
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Weinberg DS, Williamson DFK, Gebhart JJ, Knapik DM, Voos JE. Differences in Medial and Lateral Posterior Tibial Slope: An Osteological Review of 1090 Tibiae Comparing Age, Sex, and Race. Am J Sports Med 2017; 45:106-113. [PMID: 27587744 DOI: 10.1177/0363546516662449] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Injuries to the anterior cruciate ligament (ACL) are common, and a number of knee morphological variables have been identified as risk factors for an ACL injury, including the posterior tibial slope (TS). However, limited data exist regarding innate population differences in the TS. PURPOSE To (1) establish normative values for the medial and lateral posterior TS; (2) determine what differences exist between ages, sexes, and races; and (3) determine how internal or external tibial rotation (as occurs during sagittal knee motion) influences the stereotactic perception of the TS. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS A total of 545 cadaveric specimens (1090 tibiae) were obtained from the Hamann-Todd osteological collection. Specimens were leveled in the coronal, sagittal, and axial planes using a digital laser. Virtual representations of each bone were created with a 3-dimensional digitizer apparatus. The TS of the medial and lateral tibial plateaus were measured using techniques adapted from previous radiographic protocols. Medial and lateral TS were then again measured on 200 tibiae that were internally and externally rotated by 10° (axially). RESULTS The mean (±SD) medial TS was 6.9° ± 3.7° posterior, which was greater than the mean lateral TS of 4.7° ± 3.6° posterior ( P < .001). Neither the medial nor lateral TS changed with age. Women had a greater mean TS compared with men on both the medial (7.5° ± 3.8° vs 6.8° ± 3.7°, respectively; P = .03) and lateral (5.2° ± 3.5° vs 4.6° ± 3.5°, respectively; P = .04) sides. Black specimens had a greater mean medial TS (8.7° ± 3.6° vs 5.8° ± 3.3°, respectively; P < .001) and lateral TS (5.9° ± 3.3° vs 3.8° ± 3.5°, respectively; P < .001) compared with white specimens. Axial rotation was shown to increase the perception of the medial and lateral TS ( P < .001). CONCLUSION The medial TS was shown to be greater than the lateral TS. Important sex- and race-based differences exist in the TS. This study also highlights the role of axial rotation in measuring the TS.
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Affiliation(s)
- Douglas S Weinberg
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Drew F K Williamson
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeremy J Gebhart
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Derrick M Knapik
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - James E Voos
- Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, Ohio, USA
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Karkousha RN. Sex differences of knee joint repositioning accuracy in healthy adolescents. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2016. [DOI: 10.4103/1110-6611.188029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Besier TF, Pal S, Draper CE, Fredericson M, Gold GE, Delp SL, Beaupré GS. The Role of Cartilage Stress in Patellofemoral Pain. Med Sci Sports Exerc 2016; 47:2416-22. [PMID: 25899103 DOI: 10.1249/mss.0000000000000685] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE Elevated cartilage stress has been identified as a potential mechanism for retropatellar pain; however, there are limited data in the literature to support this mechanism. Females are more likely to develop patellofemoral pain than males, yet the causes of this dimorphism are unclear. We used experimental data and computational modeling to determine whether patients with patellofemoral pain had elevated cartilage stress compared with pain-free controls and test the hypothesis that females exhibit greater cartilage stress than males. METHODS We created finite element models of 24 patients with patellofemoral pain (11 males and 13 females) and 16 pain-free controls (8 males and 8 females) to estimate peak patellar cartilage stress (strain energy density) during a stair climb activity. Simulations took into account cartilage morphology from magnetic resonance imaging, joint posture from weight-bearing magnetic resonance imaging, and muscle forces from an EMG-driven model. RESULTS We found no difference in peak patellar strain energy density between those with patellofemoral pain (1.9 ± 1.23 J·m(-3)) and control subjects (1.66 ± 0.75 J·m(-3), P = 0.52). Females exhibited greater cartilage stress compared with males (2.2 vs 1.3 J·m(-3), respectively; P = 0.0075), with large quadriceps muscle forces (3.7 body weight in females vs 3.3 body weight in males) and 23% smaller joint contact area (females, 467 ± 59 mm2, vs males, 608 ± 95 mm2). CONCLUSIONS Patients with patellofemoral pain did not display significantly greater patellar cartilage stress compared with pain-free controls; however, there was a great deal of subject variation. Females exhibited greater peak cartilage stress compared with males, which might explain the greater prevalence of patellofemoral pain in females compared with that in males, but other mechanical and biological factors are clearly involved in this complex pathway to pain.
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Affiliation(s)
- Thor F Besier
- 1Auckland Bioengineering Institute, University of Auckland, Auckland, NEW ZEALAND; 2Department of Engineering Science, University of Auckland, Auckland, NEW ZEALAND; 3College of Engineering, California Polytechnic State University, San Luis Obispo, CA; 4Department of Bioengineering, Stanford University, Stanford, CA; 5Department of Orthopaedics, Stanford University, Stanford, CA; 6Department of Radiology, Stanford University, Stanford, CA; and 7VA Palo Alto Rehabilitation Research and Development Center, Palo Alto, CA
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Murakami K, Hamai S, Okazaki K, Ikebe S, Shimoto T, Hara D, Mizu-uchi H, Higaki H, Iwamoto Y. In vivo kinematics of healthy male knees during squat and golf swing using image-matching techniques. Knee 2016; 23:221-6. [PMID: 26783190 DOI: 10.1016/j.knee.2015.08.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2015] [Revised: 06/30/2015] [Accepted: 08/07/2015] [Indexed: 02/07/2023]
Abstract
PURPOSE Participation in specific activities requires complex ranges of knee movements and activity-dependent kinematics. The purpose of this study was to investigate dynamic knee kinematics during squat and golf swing using image-matching techniques. METHODS Five healthy males performed squats and golf swings under periodic X-ray images at 10 frames per second. We analyzed the in vivo three-dimensional kinematic parameters of subjects' knees, namely the tibiofemoral flexion angle, anteroposterior (AP) translation, and internal-external rotation, using serial X-ray images and computed tomography-derived, digitally reconstructed radiographs. RESULTS During squat from 0° to 140° of flexion, the femur moved about 25 mm posteriorly and rotated 19° externally relative to the tibia. Screw-home movement near extension, bicondylar rollback between 20° and 120° of flexion, and medial pivot motion at further flexion were observed. During golf swing, the leading and trailing knees (the left and right knees respectively in the right-handed golfer) showed approximately five millimeters and four millimeters of AP translation with 18° and 26° of axial rotation, respectively. A central pivot motion from set-up to top of the backswing, lateral pivot motion from top to ball impact, and medial pivot motion from impact to the end of follow-through were observed. CONCLUSIONS The medial pivot motion was not always recognized during both activities, but a large range of axial rotation with bilateral condylar AP translations occurs during golf swing. This finding has important implications regarding the amount of acceptable AP translation and axial rotation at low flexion in replaced knees. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Koji Murakami
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoshi Hamai
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
| | - Ken Okazaki
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Satoru Ikebe
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
| | - Takeshi Shimoto
- Department of Mechanical Engineering, Faculty of Engineering, Fukuoka Institute of Technology, 3-30-1 Wajiro-higashi, Higashi-ku, Fukuoka 811-0295, Japan
| | - Daisuke Hara
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hideki Mizu-uchi
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
| | - Hidehiko Higaki
- Department of Mechanical Engineering, Faculty of Engineering, Kyushu Sangyo University, 2-3-1 Matsugadai, Higashi-ku, Fukuoka 813-8583, Japan
| | - Yukihide Iwamoto
- Department of Orthopaedic Surgery, Faculty of Medical Sciences, Kyushu University, 1-3-3 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan
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Saffarini M, Demey G, Nover L, Dejour D. Evolution of trochlear compartment geometry in total knee arthroplasty. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:7. [PMID: 26855943 DOI: 10.3978/j.issn.2305-5839.2015.12.53] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND The study aimed to compare trochlear profiles in recent total knee arthroplasty (TKA) models and to determine whether they feature improvements compared to their predecessors. The hypothesis was that recent TKA models have more anatomic trochlear compartments and would display no signs of trochlear dysplasia. METHODS The authors analyzed the geometry of the 6 following TKA models using engineering software: PFC and Attune (DePuy), NexGen and Persona (Zimmer), Noetos and KneeTec (Tornier). The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the sulcus angle. RESULTS Analysis of sulcus angles reveals general convergence of recent designs towards anatomic values. At 0° of flexion, sulcus angles of recent implant models were between 156.0-157.4°, while those of previous generation models between 154.5-165.5°. At 30° of flexion, sulcus angles of recent models also lie within 145.7-148.6°, but those of previous models are between 149.5-152.0°. All three manufacturers deepened their trochlear profile at 30° of flexion in recent models compared to earlier designs. Sulcus angles converge towards anatomic values but still exceed radiologic signs of dysplasia by 2-5°. CONCLUSIONS Recent TKA designs have more anatomic trochlear geometries than earlier TKA models by the same manufacturers, but trochlear compartments still exceed radiologic signs of trochlear dysplasia by 2° to 5°. The hypothesis that recent TKA models display no signs of trochlear dysplasia is therefore refuted. Surgeons should be aware of design limitations to optimize choice of implant and extensor mechanisms alignment. LEVEL OF EVIDENCE IV geometric implant analysis.
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Affiliation(s)
- Mo Saffarini
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - Guillaume Demey
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - Luca Nover
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
| | - David Dejour
- 1 Department of Medical Technology, Accelerate Innovation Management SA, 1704 Geneva, Switzerland ; 2 Lyon-Ortho-Clinic, Clinique de la Sauvegarde, 8 Avenue Ben Gourion, 69009 Lyon, France
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Feng Y, Tsai TY, Li JS, Wang S, Hu H, Zhang C, Rubash HE, Li G. Motion of the femoral condyles in flexion and extension during a continuous lunge. J Orthop Res 2015; 33:591-7. [PMID: 25641056 DOI: 10.1002/jor.22826] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 01/07/2015] [Indexed: 02/04/2023]
Abstract
Numerous studies have reported on in-vivo posterior femoral condyle translations during various activities of the knee. However, no data has been reported on the knee motion during a continuous flexion-extension cycle. Further, few studies have investigated the gender variations on the knee kinematics. This study quantitatively determined femoral condylar motion of 10 male and 10 female knees during a continuous weightbearing flexion-extension cycle using two-dimensional to three-dimensional fluoroscopic tracking technique. The knees were CT-scanned to create three-dimensional models of the tibia and femur. Continuous images of each subject were taken using a single-fluoroscopic imaging system. The knee kinematics were measured along the motion path using geometric center axis of the femur. The results indicated that statistical differences between the flexion and extension motions were only found in internal-external tibial rotation and lateral femoral condylar motion at the middle range of flexion angles. At low flexion angles, male knees have greater external tibial rotation and more posteriorly positioned medial femoral condyle than females. The knee did not show a specific pivoting type of rotation with flexion. Axial rotation center varied from lateral to medial compartments of the knee. These data could provide useful information for understanding physiological motion of normal knees.
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Affiliation(s)
- Yong Feng
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, 600 Yishan Road, Shanghai, 200233, China; Department of Orthopaedic Surgery, Bioengineering Laboratory, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts, 02114
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Zhang Y, Yao Z, Wang S, Huang W, Ma L, Huang H, Xia H. Motion analysis of Chinese normal knees during gait based on a novel portable system. Gait Posture 2015; 41:763-8. [PMID: 25743776 DOI: 10.1016/j.gaitpost.2015.01.020] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 12/26/2014] [Accepted: 01/19/2015] [Indexed: 02/02/2023]
Abstract
Normative tibiofemoral data of Chinese or Asian subjects during gait is rarely reported. This study is aimed at investigating the six-degree-of-freedom (6DOF) knee kinematics of adult Chinese during gait, based on a novel portable system. Twenty-eight healthy Chinese subjects (56 knees) were studied during their treadmill gaits. A set of optical marker clusters were attached to the thighs and shanks of each subject, who was tracked by an optical joint kinematics measurement system. Knee landmarks were initially digitized with respect to the marker cluster sets to determine the local coordinate systems for calculation of 6DOF knee joint kinematics. The range of motion (ROM) in 6DOF and 5 kinematic parameters were calculated and compared between bilateral knees and genders. We discovered that knee rotations, as well as motion in proximodistal and mediolateral translations, showed similar patterns in flexion and extension. However, the anteroposterior translations did not show a clear pattern. The results of ROM in 6DOF obtained in this study are comparable with those reported in existing literature. No statistical difference was found between left and right knees either in the ROMs or in the 5 kinematic parameters. However, the ROM in the mediolateral direction during gait was found to be higher in men than women (P=0.014). In addition, the femurs of female subjects rotated more internally than the femurs of male during the stance phase (P=0.011). We concluded that normal Chinese knees exhibited distinct gait patterns, except for anteroposterior motion. Women and men exhibit different axial rotations and mediolateral translation patterns during their treadmill gait.
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Affiliation(s)
- Yu Zhang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China.
| | - Zilong Yao
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China; Graduate School, Southern Medical University, Guangzhou, Guangdong, China
| | | | - Wenhan Huang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China; Graduate School, Southern Medical University, Guangzhou, Guangdong, China
| | - Limin Ma
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China
| | - Huayang Huang
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China
| | - Hong Xia
- Department of Orthopaedic Surgery, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, Guangdong 510010, China
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Dejour D, Ntagiopoulos PG, Saffarini M. Evidence of trochlear dysplasia in femoral component designs. Knee Surg Sports Traumatol Arthrosc 2014; 22:2599-607. [PMID: 23229383 DOI: 10.1007/s00167-012-2268-z] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 10/19/2012] [Indexed: 01/25/2023]
Abstract
PURPOSE The study aimed to compare trochlear profiles of various total knee arthroplasty (TKA) models to anatomic profiles observed in healthy and pathologic knees and to evaluate trochlear designs against radiologic indicators for PF disorders and trochlear dysplasia. METHODS The trochlear profiles of 14 different TKA models were digitized using a coordinate measurement machine at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, trochlear groove orientation, height of lateral facet, and mediolateral groove position. The effect of externally rotating the femoral component on those variables was simulated. RESULTS The sulcus angle was greater than the indicators for trochlear dysplasia of 144° in 11 implants at 45° flexion, and in 13 implants at 30° flexion. The lateral facet height was less than average anatomic values of 5 mm in eight specimens through the entire range of early flexion (0°-30°). The trochlear groove was oriented laterally in 13 specimens (3.3°-11.7°) and was vertical in one specimen (0.3°). Applying an external rotation up to 6° resulted in noticeable lateral translation of the trochlear groove and facets, but negligible posterior translation. CONCLUSIONS The study presented a detailed description of previously overlooked TKA design parameters and revealed that some femoral components exhibit characteristics of trochlear dysplasia. The clinical relevance of this descriptive study is that surgeons should be aware of such design limitations to improve choice of implant for patients with history of PF disorders and to adapt surgical techniques as necessary to optimize PF tracking. LEVEL OF EVIDENCE Case-control study, Level III.
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Affiliation(s)
- David Dejour
- Lyon-Ortho-Clinic, Clinique de la Sauvegarde, Avenue Ben Gourion, Lyon, France,
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Saffarini M, Ntagiopoulos PG, Demey G, Le Negaret B, Dejour DH. Evidence of trochlear dysplasia in patellofemoral arthroplasty designs. Knee Surg Sports Traumatol Arthrosc 2014; 22:2574-81. [PMID: 24696005 DOI: 10.1007/s00167-014-2967-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2013] [Accepted: 03/19/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE The design of the trochlear compartment is crucial in patellofemoral arthroplasty (PFA), because 78% of patients with isolated patellofemoral arthritis present concomitant trochlear dysplasia with patellar maltracking and therefore remain predisposed to post-operative patellar subluxation and dislocation. The study investigated whether current PFA implants are designed with anatomic trochlear parameters such as the sulcus angle, lateral facet height and groove orientation. METHODS Five trochlear components of commercially available PFA implants were scanned, and the generated three-dimensional surfaces were measured using engineering design software. The mediolateral trochlear profiles were plotted at various flexion angles (0°, 15°, 30° and 45°) to deduce the following variables: sulcus angle, height of lateral facet and trochlear groove orientation. RESULTS Four specimens had sulcus angle>144° in the 45° of flexion, and all five specimens had sulcus angle>143° in 30° of flexion. Three specimens had a facet<5 mm high through the entire range of early flexion (0°-30°), and two specimens had a facet<5 mm high beyond early flexion (30°-45°). The trochlear groove was oriented laterally in all specimens (range 1.6°-13.5°). CONCLUSION Current PFA trochlear components are not always designed with anatomic parameters, and some models exhibit characteristics of trochlear dysplasia. Surgeons are therefore advised to implant components with a deep sulcus, particularly in patients with history of patellofemoral disorders, and to adapt the surgical technique and extensor mechanism if the component implanted has a shallow sulcus, to ensure normal patellar tracking. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Mo Saffarini
- Accelerate Innovation Management SA, 1 Rue de la Navigation, 1201, Geneva, Switzerland,
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Suganuma J, Mochizuki R, Inoue Y, Kitamura K, Honda A. Arthroscopic evaluation of patellofemoral congruence with rotation of the knee joint and electrical stimulation of the quadriceps. Arthroscopy 2014; 30:214-21. [PMID: 24388453 DOI: 10.1016/j.arthro.2013.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2013] [Revised: 11/06/2013] [Accepted: 11/07/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The aim of this study was to investigate the pathoanatomic features of patellar instability by arthroscopically comparing patellofemoral congruence with rotation of the knee joint and/or electrical stimulation of the quadriceps (ESQ) between knees with and without patellar instability. METHODS We retrospectively examined 83 knee joints in 83 patients. The joints were classified into 2 groups: group 1 comprised those without a history of patellar dislocation and included 59 patients (25 male and 34 female patients), and group 2 comprised those with a history of patellar dislocation and included 24 patients (9 male and 15 female patients). Evaluation of patellofemoral congruence at 30° of flexion of the knee joint was conducted based on an axial radiograph and arthroscopic findings. The congruence angle was measured on the radiograph. The position of the patellar central ridge (PPCR) on the trochlear groove during arthroscopy was measured using still video frames of knee joints with rotational stress and/or ESQ. Statistical differences in the measurements between the 2 groups were assessed with the unpaired t test and the area under the receiver operating characteristic curve of each measurement. RESULTS There were significant differences (P < .0001) between the 2 groups in the congruence angle on radiographs and PPCR in knee joints with rotational stress and/or ESQ on arthroscopy. External and internal rotation of the knee joint caused lateral and medial patellar shift, respectively, in both groups, but the shift was significantly larger in group 2. ESQ in addition to rotation caused further patellar shift in group 2 but reduced patellar shift in group 1. Measurement of PPCR with external rotation of the knee and ESQ was the only method to show an area under the receiver operating characteristic curve of 1. CONCLUSIONS There were significant differences in the effects of rotation of the knee joint and/or ESQ on patellofemoral congruence at 30° of flexion of the knee joint on arthroscopy between knees with and without patellar instability. LEVEL OF EVIDENCE Level III, diagnostic study of nonconsecutive patients.
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Affiliation(s)
- Jun Suganuma
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan.
| | - Ryuta Mochizuki
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Yutaka Inoue
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Kazuya Kitamura
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
| | - Akio Honda
- Department of Orthopaedic Surgery, Hiratsuka City Hospital, Hiratsuka, Japan
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King JJ, Chakravarty R, Cerynik DL, Black A, Johanson NA. Decreased ratios of lateral to medial patellofemoral forces and pressures after lateral retinacular release and gender knees in total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2013; 21:2770-8. [PMID: 23052108 DOI: 10.1007/s00167-012-2200-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2012] [Accepted: 08/30/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE To demonstrate that lateral to medial patellofemoral force and pressure ratios could be a surrogate marker of retinacular tension and patellar tracking. METHODS The patellofemoral forces of six knees from three fresh-frozen half-body female cadavers were evaluated with a capacitive sensor under simulated operative conditions in six staged clinical scenarios: native knees, knee arthroplasty without patellar resurfacing, resurfaced knee and patella, resurfaced knee and patella with lateral release, gender-specific knee arthroplasty with patella resurfacing, and gender-specific knee arthroplasty with lateral release. Maximum force and peak pressure were simultaneously recorded during three to four ranges of motion. Average values were compared between lateral and medial patellofemoral compartments as an objective measure of patellar tracking for the different settings. RESULTS Significant differences in lateral and medial force and pressure differentials were seen in most scenarios despite clinically normal patellar tracking. Lateral to medial ratios of maximum force and peak pressure significantly increased after TKA (2.9, 2.1) and after patella resurfacing (2.8, 2.6) compared to the native knee (1.6, 1.8). Addition of a lateral release in resurfaced knees decreased the ratio of lateral to medial patellofemoral forces and pressures as did gender knee arthroplasty (1.5 and 1.1, 2 and 1.3, respectively). Pressure and force values most closely resembled the native knee in the resurfaced knee/resurfaced patella with lateral release and in the gender knee arthroplasty scenarios. CONCLUSIONS Use of lateral to medial patellofemoral force ratios as a surrogate objective marker for patellar tracking was validated in this study by decreasing ratios observed after lateral release in TKA and with gender-specific implants.
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Affiliation(s)
- Joseph J King
- Department of Orthopaedic Surgery, Drexel University College of Medicine, 215 North Broad Street, MS 420, Philadelphia, PA, 19106, USA
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Wünschel M, Wülker N, Müller O. Gender differences in tibio-femoral kinematics and quadriceps muscle force during weight-bearing knee flexion in vitro. Knee Surg Sports Traumatol Arthrosc 2013; 21:2557-63. [PMID: 22696143 DOI: 10.1007/s00167-012-2082-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2011] [Accepted: 05/29/2012] [Indexed: 11/26/2022]
Abstract
PURPOSE Females have a higher risk in terms of anterior cruciate ligament injuries during sports than males. Reasons for this fact may be different anatomy and muscle recruitment patterns leading to less protection for the cruciate- and collateral-ligaments. This in vitro study aims to evaluate gender differences in knee joint kinematics and muscle force during weight-bearing knee flexions. METHODS Thirty-four human knee specimens (17 females/17 males) were mounted on a dynamic knee simulator. Weight-bearing single-leg knee flexions were performed with different amounts of simulated body weight (BW). Gender-specific kinematics was measured with an ultrasonic motion capture system and different loading conditions were examined. RESULTS Knee joint kinematics did not show significant differences regarding anteroposterior and medial-lateral movement as well as tibial varus-valgus and internal-external rotation. This applied to all simulated amounts of BW. Simulating 100 N BW in contrast to AF50 led to a significant higher quadriceps overall force in female knees from 45° to 85° of flexion in contrast to BW 50 N. In these female specimens, the quadriceps overall force was about 20 % higher than in male knees being constant in higher flexion angles. CONCLUSIONS It is indicated by our results that in a squatting movement females compared with males produce higher muscle forces, suggesting an increased demand for muscular stabilization, whereas tibio-femoral kinematics was similar for both genders.
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Affiliation(s)
- Markus Wünschel
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Str. 3, 72076, Tübingen, Germany,
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Kreuz PC, Müller S, von Keudell A, Tischer T, Kaps C, Niemeyer P, Erggelet C. Influence of sex on the outcome of autologous chondrocyte implantation in chondral defects of the knee. Am J Sports Med 2013; 41:1541-8. [PMID: 23729686 DOI: 10.1177/0363546513489262] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Sex-specific outcomes have been reported in anterior cruciate ligament reconstruction as well as in osteoarthrosis progression, but there are currently no related published data on autologous chondrocyte implantation (ACI). The present prospective study was performed to investigate sex-dependent differences in the results after ACI. HYPOTHESIS The clinical and magnetic resonance imaging (MRI) results after ACI of the knee are influenced by the patient's sex. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS The midterm clinical and MRI results of a cell-based fibrin-polymer graft for the treatment of full-thickness cartilage defects were evaluated preoperatively and 6, 12, and 48 months after surgery in 52 patients (male:female ratio, 25:27; average age, 35.6 years). Depending on the sex and the location of the defects (femoral condyles, n = 32; patellofemoral compartment, n = 20), patients were assigned to 4 different groups. Baseline clinical scores were compared with follow-up data by paired Wilcoxon tests for the Lysholm score and the International Knee Documentation Committee (IKDC) scoring system. Sex-specific differences were evaluated with the Mann-Whitney U test. The MRI evaluation was performed with the Henderson score at final follow-up. RESULTS Clinical scores improved in all groups over the whole study period (P < .05). Compared with female patients, male patients achieved significantly better results in the Lysholm score at all time intervals and in the IKDC score at 6 and 12 months after surgery (P < .05). In a subgroup analysis, female patients with patellar defects had the worst results in both clinical scores. With the available number of patients, MRI evaluation at 48 months after surgery revealed no significant difference in defect fill between male and female patients (P > .05). The Pearson correlation coefficient between both clinical scores and the MRI parameters of defect fill and cartilage signal was significant (P < .05). CONCLUSION Autologous chondrocyte implantation is a promising treatment option for full-thickness cartilage defects of male and female knee joints. Female patients with patellar defects have worse prognostic factors.
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Affiliation(s)
- Peter C Kreuz
- Department of Orthopaedic Surgery, University Medical Center Rostock, Doberanerstr. 142, 18057 Rostock, Germany.
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Suzuki T, Hosseini A, Li JS, Gill TJ, Li G. In vivo patellar tracking and patellofemoral cartilage contacts during dynamic stair ascending. J Biomech 2012; 45:2432-7. [PMID: 22840488 DOI: 10.1016/j.jbiomech.2012.06.034] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2012] [Revised: 06/21/2012] [Accepted: 06/26/2012] [Indexed: 11/18/2022]
Abstract
The knowledge of normal patellar tracking is essential for understanding the knee joint function and for diagnosis of patellar instabilities. This paper investigated the patellar tracking and patellofemoral joint contact locations during a stair ascending activity using a validated dual-fluoroscopic imaging system. The results showed that the patellar flexion angle decreased from 41.9° to 7.5° with knee extension during stair ascending. During first 80% of the activity, the patella shifted medially about 3.9 mm and then slightly shifted laterally during the last 20% of the ascending activity. Anterior translation of 13 mm of the patella was measured at the early 80% of the activity and the patella slightly moved posteriorly by about 2mm at the last 20% of the activity. The path of cartilage contact points was slightly lateral on the cartilage surfaces of patella and femur. On the patellar cartilage surface, the cartilage contact locations were about 2mm laterally from heel strike to 60% of the stair ascending activity and moved laterally and reached 5.3mm at full extension. However, the cartilage contact locations were relatively constant on the femoral cartilage surface (∼5mm lateral). The patellar tracking pattern was consistent with the patellofemoral cartilage contact location pattern. These data could provide baseline knowledge for understanding of normal physiology of the patellofemoral joint and can be used as a reference for clinical evaluation of patellofemoral disorders.
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Affiliation(s)
- Takashi Suzuki
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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Hoshino Y, Wang JH, Lorenz S, Fu FH, Tashman S. The effect of distal femur bony morphology on in vivo knee translational and rotational kinematics. Knee Surg Sports Traumatol Arthrosc 2012; 20:1331-8. [PMID: 21909723 PMCID: PMC3269529 DOI: 10.1007/s00167-011-1661-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Accepted: 08/30/2011] [Indexed: 01/12/2023]
Abstract
PURPOSE Tibio-femoral kinematics are clearly influenced by the bony morphology of the femur. Previous morphological studies have not directly evaluated relationships between morphology and knee kinematics. Therefore, the purpose of this study was to examine the relationship between distal femur bony morphology and in vivo knee kinematics during running. It was hypothesized that the posterior offset of the transcondylar axis would be related to the magnitude of anterior/posterior tibio-femoral translation and that the rotational angle of the transcondylar axis would be related to the magnitude of internal/external knee rotation. METHODS Seventeen contralateral (uninjured) knees of ACL-reconstructed patients were used. Distal femoral geometry was analyzed from 3D-CT data by determining the anteroposterior location (condyle offset ratio--COR) and rotational angle (condylar twist angle--CTA) of the femoral transcondylar axis. Six degree-of-freedom knee kinematics were obtained during running using a dynamic stereo radiograph system. Knee kinematics were correlated with the femoral morphologic measures (COR and CTA) to investigate the influence of femoral geometry on dynamic knee function. RESULTS Significant correlations were identified between distal femur morphology and knee kinematics. Anterior tibial translation was positively correlated with the condyle offset ratio (R(2) = 0.41, P < 0.01). Internal tibial rotation was positively correlated with the condylar twist angle (R(2) = 0.48, P < 0.01). CONCLUSIONS Correlations between knee kinematics and morphologic measures describing the position and orientation of the femoral transcondylar axis suggest that these specific measures are valuable for characterizing the influence of femur shape on dynamic knee function. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yuichi Hoshino
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Joon Ho Wang
- Department of Orthopedic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Ilwon-Dong, Kangnam-Ku, Seoul 135-720, South Korea
| | - Stephan Lorenz
- Department of Orthopaedic Sports Medicine, Klinikum rechts der Isar, Technical University of Munich, Ismaninger Str. 22, 81675 Munich, Germany
| | - Freddie H. Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA
| | - Scott Tashman
- Department of Orthopaedic Surgery, University of Pittsburgh, 3471 Fifth Avenue, Pittsburgh, PA 15213, USA. Orthopaedic Research Laboratories, 3820 South Water St., Pittsburgh, PA 15203, USA
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Zietz C, Bergschmidt P, Fritsche A, Kluess D, Mittelmeier W, Bader R. Comparison of cross-sections of different femoral components for revision total knee replacement. J Orthop Surg (Hong Kong) 2012; 20:32-6. [PMID: 22535808 DOI: 10.1177/230949901202000107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
UNLABELLED PURPOSE. To compare the inner contour of the femoral component of 10 total knee replacement (TKR) designs for possible exchange in use. METHODS Inner contours of the femoral components of 10 cemented, cruciate-retaining TKR designs (e.motion, Genesis, Genia, Innex, LCS, Multigen Plus, NexGen, PFC, Scorpio, Vanguard) were scanned and reconstructed to 2-dimensional contours. Their cross-sections were compared by superimposition and aligning at the distal and anterior cuts. The patellar notch and outer contour were not analysed. RESULTS The maximum deviation was 5 mm in the posterior and posterior oblique cuts and 10 mm in the anterior oblique cut. Based on similarity of the inner contour, LCS and Innex was classified as group I, e.motion, Genesis, Scorpio, Vanguard, and Multigen Plus as group II, and Genia, NexGen, and PFC as group III. All 2 designs in group I were not compatible with the other 8 designs. Four of the 5 designs in group II showed good compatibility. All 3 designs in group III significantly differed in the posterior and oblique cuts. CONCLUSION A standardised inner contour of the femoral component can increase compatibility of different TKR systems in revision surgery and reduces the extent of bone resection.
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Affiliation(s)
- Carmen Zietz
- Department of Orthopaedics, University of Rostock, Rostock, Germany.
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Evaluating rotational kinematics of the knee in ACL-ruptured and healthy patients using 3.0 Tesla magnetic resonance imaging. Knee Surg Sports Traumatol Arthrosc 2012; 20:663-70. [PMID: 22159520 PMCID: PMC7322766 DOI: 10.1007/s00167-011-1809-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2011] [Accepted: 11/22/2011] [Indexed: 01/15/2023]
Abstract
PURPOSE Rotational knee laxity is an important measure in restoring knee stability following anterior cruciate ligament (ACL) injury, but is difficult to quantify with current clinical tools. The hypothesis of the study is that there is greater tibial rotation (TR) in women than men, and also in ACL-deficient than healthy knees. METHODS Sixteen healthy (8 men, 26.8 ± 6.4 years; 8 women, 26.9 ± 3.8 years) and ten ACL-deficient (5 men, 33.6 ± 10.5 years; 5 women, 36.3 ± 10.7 years) subjects received bilateral knee MRI in 15° of flexion using a custom device to apply a constant axial compressive load (44 N). A rotational torque (3.35 Nm) was sequentially applied to obtain images at internal and external rotation positions. T (2)-weighted images were acquired in internal and external rotation. Images were segmented and TR was calculated. To assess reproducibility, six knees were scanned twice on separate days. Group comparisons were made with unpaired t tests, while intrasubject comparisons were made using paired t tests. RESULTS Healthy women demonstrated greater TR than men (13.6° ± 4.7° vs. 8.3° ± 3.6°; P = 0.001). Male ACL-deficient knees showed greater TR than the contralateral knee (15.7° ± 6.9° vs. 7.7° ± 5.6°; P = 0.003), and compared to male controls (P = 0.002). ACL-deficient women showed greater TR compared to their contralateral leg (15.1° ± 2.3° vs. 10.0° ± 4.3°; P = 0.01). The intraclass correlation coefficient of the TR measurement was 0.913, and the SEM = 1.1°. CONCLUSIONS Kinematic MRI is a reproducible method to quantify total knee rotation. Women have more rotational laxity than men, particularly in the external rotation position. ACL rupture leads to increased rotational laxity of the knee. LEVEL OF EVIDENCE Retrospective case-control series, Level III.
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White SH, Roberts S, Jones PW. The Twin Peg Oxford partial knee replacement: the first 100 cases. Knee 2012; 19:36-40. [PMID: 21251839 DOI: 10.1016/j.knee.2010.12.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2010] [Revised: 12/14/2010] [Accepted: 12/15/2010] [Indexed: 02/02/2023]
Abstract
We present the clinical results of the first 100 patients who received the Twin Peg Oxford partial knee replacement which has a 15° extra femoral surface for contact in deep flexion, and has two pegs for more secure fixation. We measured the clinical outcome 2 years after the medial unicompartmental arthroplasty using patient and surgeon derived outcome measures. The results showed a mean Oxford Knee Score of 41, a mean American Knee Society Objective Score of 93 and a Functional Score of 84, a mean range of motion of 130° and a high satisfaction rate. Results were significantly better in male patients. There were no deaths, infections, dislocations, fractures or revisions. There were no pathological radiolucencies suggestive of early loosening. We conclude that the Twin Peg Oxford partial knee replacement shows excellent clinical and radiological results at 2 years. For surgeons who have concern over the risk of femoral loosening with the single peg Oxford knee, or seek an improved surface area of contact in full flexion, this implant offers an excellent alternative.
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Affiliation(s)
- Stephen H White
- Department of Orthopaedic Surgery, The Robert Jones and Agnes Hunt Orthopaedic and District NHS Trust, Oswestry, Shropshire. SY10 7AG, United Kingdom.
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Schairer WW, Haughom BD, Morse LJ, Li X, Ma CB. Magnetic resonance imaging evaluation of knee kinematics after anterior cruciate ligament reconstruction with anteromedial and transtibial femoral tunnel drilling techniques. Arthroscopy 2011; 27:1663-70. [PMID: 21958672 DOI: 10.1016/j.arthro.2011.06.032] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2011] [Revised: 05/20/2011] [Accepted: 06/24/2011] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to use magnetic resonance (MR) imaging to evaluate the translational and rotational kinematics of anterior cruciate ligament (ACL) reconstructed knees with transtibial (TT) and anteromedial (AM) femoral tunnel drilling. METHODS ACL reconstruction was performed in 21 subjects: 12 with AM drilling (5 men and 7 women; mean age, 33 ± 9 years; imaged 18 ± 5 months after surgery) and 9 with TT drilling (5 men and 4 women; mean age, 32 ± 9 years; imaged 12 ± 8 months after surgery). Three-tesla MR imaging was obtained bilaterally at extension and 30° to 40° of flexion under simulated loading (125 N). MR images were segmented and kinematic calculations done with in-house MATLAB software (The MathWorks, Natick, MA). Translation and rotation of the tibia and the tibiofemoral contact area were measured. Statistical analysis treated reconstructed and contralateral knees as independent groups. Reconstructed groups were compared with analysis of covariance using contralateral knees as baseline. P < .05 indicated significance. RESULTS All kinematic measures in the AM group were similar to contralateral knees. The TT group showed significantly more total tibial rotation than contralateral knees (TT, 8.4° ± 3.9°; contralateral, 2.9° ± 6.8°) (P = .03), whereas the AM group did not (AM, 3.1° ± 5.6°; contralateral, 2.3° ± 5.4°) (P = .36). At knee extension, the tibia was more externally rotated in the TT group than in controls. Medial tibial translation was greater in the TT group than in controls. The AM group showed increased contact area in the lateral compartment compared with controls; no differences were seen in the TT group. CONCLUSIONS Using an MR-based approach, we found that knee kinematics were better restored with the AM femoral tunnel drilling ACL reconstruction than with the TT femoral tunnel drilling approach, which resulted in increased knee laxity. Our in vivo results support previous cadaveric and clinical studies that have found AM ACL reconstruction to restore anatomy and stability better than the TT approach. However, the clinical significance of increased contact area in the AM group remains unclear. LEVEL OF EVIDENCE Level III, retrospective comparative study.
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Affiliation(s)
- William W Schairer
- School of Medicine, University of California, San Francisco, 94143-0728, USA
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Haines TL, McBride JM, Triplett NT, Skinner JW, Fairbrother KR, Kirby TJ. A comparison of men's and women's strength to body mass ratio and varus/valgus knee angle during jump landings. J Sports Sci 2011; 29:1435-42. [DOI: 10.1080/02640414.2011.599039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Tracie L Haines
- Neuromuscular Laboratory, Department of Health, Leisure and Exercise Science, Appalachian State University, Boone, North Carolina, USA
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Homyk A, Orsi A, Wibby S, Yang N, Nayeb-Hashemi H, Canavan PK. Failure locus of the anterior cruciate ligament: 3D finite element analysis. Comput Methods Biomech Biomed Engin 2011; 15:865-74. [PMID: 21590555 DOI: 10.1080/10255842.2011.565412] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Anterior cruciate ligament (ACL) disruption is a common injury that is detrimental to an athlete's quality of life. Determining the mechanisms that cause ACL injury is important in order to develop proper interventions. A failure locus defined as various combinations of loadings and movements, internal/external rotation of femur and valgus and varus moments at a 25(o) knee flexion angle leading to ACL failure was obtained. The results indicated that varus and valgus movements were more dominant to the ACL injury than femoral rotation. Also, Von Mises stress in the lateral tibial cartilage during the valgus ACL injury mechanism was 83% greater than that of the medial cartilage during the varus mechanism of ACL injury. The results of this study could be used to develop training programmes focused on the avoidance of the described combination of movements which may lead to ACL injury.
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Affiliation(s)
- Andrew Homyk
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA.
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Han H, Xia Y, Yun X, Wu M. Anatomical transverse patella double tunnel reconstruction of medial patellofemoral ligament with a hamstring tendon autograft for recurrent patellar dislocation. Arch Orthop Trauma Surg 2011; 131:343-51. [PMID: 20714901 DOI: 10.1007/s00402-010-1173-5] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2010] [Indexed: 01/25/2023]
Abstract
INTRODUCTION The purpose of this study was to describe our transverse patella double tunnel technique to reconstruct the medial patellofemoral ligament (MPFL) with a hamstring tendon autograft in patients who suffered recurrent dislocation of the patella, and to evaluate the intermediate-term outcomes of reconstruction treatment. MATERIALS AND METHODS Fifty-nine consecutive knees (52 patients) with recurrent dislocation of the patella without marked predisposing anatomic abnormalities and radiographically documented moderate/severe osteochondral lesions were included in the study. Outcomes were assessed with physical and radiographic examination, the Kujala and the modified Cincinnati scores preoperatively and postoperatively at 3, 6, 12, 36, 60 and 84 months. RESULTS There were 19 male and 33 female patients with up to 7.1-year follow-up (mean 5.7 years). The mean age was 24.3 years. A comparison of preoperative scores with those obtained at most recent follow-up revealed a significant improvement for all outcomes measured: range of motion (30 ± 2° vs. 125 ± 5°, P < 0.01), the mean Kujala scores (41.4 vs. 82.6, P < 0.001), the mean modified Cincinnati scores (50.6 vs. 88.7, P < 0.01), the mean congruence angle (12.2° vs. -2.4°, P < 0.01) and the mean tilt angle (11.4° vs. 8.4°, P < 0.05). No recurrent episodes of dislocation or subluxation were postoperatively reported, although there were seven knees with an occasional unstable feeling without redislocation. CONCLUSIONS MPFL reconstruction with the double-transverse tunnels technique is safe and effective in patients of all ages, without marked predisposing anatomic abnormalities and moderate/severe osteochondral lesions, who suffered recurrent dislocation of the patella.
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Affiliation(s)
- Hua Han
- Institute of Orthopaedics, The 2nd Hospital of Lanzhou University, Cuiyingmen Road 82, Lanzhou, 730030, People's Republic of China
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Varadarajan KM, Freiberg AA, Gill TJ, Rubash HE, Li G. Relationship between three-dimensional geometry of the trochlear groove and in vivo patellar tracking during weight-bearing knee flexion. J Biomech Eng 2011; 132:061008. [PMID: 20887033 DOI: 10.1115/1.4001360] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is widely recognized that the tracking of patella is strongly influenced by the geometry of the trochlear groove. Nonetheless, quantitative baseline data regarding correlation between the three-dimensional geometry of the trochlear groove and patellar tracking under in vivo weight-bearing conditions are not available. A combined magnetic resonance and dual fluoroscopic imaging technique, coupled with multivariate regression analysis, was used to quantify the relationship between trochlear groove geometry (sulcus location, bisector angle, and coronal plane angle) and in vivo patellar tracking (shift, tilt, and rotation) during weight-bearing knee flexion. The results showed that in the transverse plane, patellar shift was strongly correlated (correlation coefficient R=0.86, p<0.001) to mediolateral location of the trochlear sulcus (raw regression coefficient β(raw)=0.62) and the trochlear bisector angle (β(raw)=0.31). Similarly, patellar tilt showed a significant association with the trochlear bisector angle (R=0.45, p<0.001, and β(raw)=0.60). However, in the coronal plane patellar rotation was poorly correlated with its matching geometric parameter, namely, the coronal plane angle of the trochlea (R=0.26, p=0.01, β(raw)=0.08). The geometry of the trochlear groove in the transverse plane of the femur had significant effect on the transverse plane motion of the patella (patellar shift and tilt) under in vivo weight-bearing conditions. However, patellar rotation in the coronal plane was weakly correlated with the trochlear geometry.
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Affiliation(s)
- Kartik M Varadarajan
- Bioengineering Laboratory, Orthopaedic Surgery, MGH/Harvard Medical School, Boston, MA 02114, USA
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Shelburne KB, Kim HJ, Sterett WI, Pandy MG. Effect of posterior tibial slope on knee biomechanics during functional activity. J Orthop Res 2011; 29:223-31. [PMID: 20857489 DOI: 10.1002/jor.21242] [Citation(s) in RCA: 172] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Accepted: 07/12/2010] [Indexed: 02/04/2023]
Abstract
Treatment of medial compartment knee osteoarthritis with high tibial osteotomy can produce an unintended change in the slope of the tibial plateau in the sagittal plane. The effect of changing posterior tibial slope (PTS) on cruciate ligament forces has not been quantified for knee loading in activities of daily living. The purpose of this study was to determine how changes in PTS affect tibial shear force, anterior tibial translation (ATT), and knee-ligament loading during daily physical activity. We hypothesized that tibial shear force, ATT, and ACL force all increase as PTS increases. A previously validated computer model was used to calculate ATT, tibial shear force, and cruciate-ligament forces for the normal knee during three common load-bearing tasks: standing, squatting, and walking. The model calculations were repeated with PTS altered in 1° increments up to a maximum change in tibial slope of 10°. Tibial shear force and ATT increased as PTS was increased. For standing and walking, ACL force increased as tibial slope was increased; for squatting, PCL force decreased as tibial slope was increased. The effect of changing PTS on ACL force was greatest for walking. The true effect of changing tibial slope on knee-joint biomechanics may only be evident under physiologic loading conditions which include muscle forces.
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Wünschel M, Lo J, Dilger T, Wülker N, Müller O. Influence of bi- and tri-compartmental knee arthroplasty on the kinematics of the knee joint. BMC Musculoskelet Disord 2011; 12:29. [PMID: 21272328 PMCID: PMC3224381 DOI: 10.1186/1471-2474-12-29] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 01/27/2011] [Indexed: 12/05/2022] Open
Abstract
Background The cruciate ligaments are important stabilizers of the knee joint and determine joint kinematics in the natural knee and after cruciate retaining arthroplasty. No in vitro data is available to biomechanically evaluate the ability of the anterior cruciate ligament (ACL) to maintain knee joint kinematics after bicruciate-retaining bi-compartmental knee arthroplasty (BKA). Therefore, the objective of the current study was to investigate the kinematics of the natural knee joint, before and after installing bicruciate-retaining BKA and posterior cruciate retaining total knee arthroplasty. Specifically, we incorporated a dynamic knee simulator to simulate weight-bearing flexions on cadaveric knee specimen before and after surgical manipulations. Methods In this cadaveric study we investigated rotational and translational tibiofemoral kinematics during simulated weight-bearing flexions of the intact knee, after bi-compartmental knee arthroplasty (BKA+), after resecting the ACL in BKA (BKA-), and after posterior cruciate retaining total knee arthroplasty (TKA). Results Rotation of BKA+ is closest to the intact knee joint, whereas TKA shows significant differences from 30 to 90 degree of flexion. Within the tested flexion range (15 to 90 degree of flexion), there was no significant difference in the anterior-posterior translation among intact, BKA+, and TKA knees. Resecting the ACL in BKA leads to a significant anterior tibial translation. Conclusions BKA with intact cruciate ligaments resembles rotation and translation of the natural knee during a simulated weight-bearing flexion. It is a suitable treatment option for medial and patellofemoral osteoarthritis with advantages in rotational characteristics compared to TKA.
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Affiliation(s)
- Markus Wünschel
- Department of Orthopaedic Surgery, University Hospital Tübingen, Hoppe-Seyler-Str, 3, 72076 Tübingen, Germany.
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Differences of knee anthropometry between Chinese and white men and women. J Arthroplasty 2011; 26:124-30. [PMID: 20149574 PMCID: PMC3740371 DOI: 10.1016/j.arth.2009.11.020] [Citation(s) in RCA: 159] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 11/22/2009] [Indexed: 02/01/2023] Open
Abstract
Whether there are differences in knee anthropometry between Asian and white knees remains unclear. Three-dimensional knee models were constructed using computed tomography or magnetic resonance imaging of healthy Chinese and white subjects. The morphologic measurements of the femur included mediolateral, anteroposterior dimensions, and aspect ratio. The tibial measurements included mediolateral, medial/lateral anteroposterior dimension, aspect ratio, and posterior slope of medial/lateral plateau. The results showed that Chinese knees were generally smaller than white knees. In addition, the femoral aspect ratio of Chinese females was significantly smaller than that of white females (1.24 ± 0.04 vs 1.28 ± 0.06). Tibial aspect ratio differences between Chinese and white males (1.82 ± 0.07 vs 1.75 ± 0.11), though significant, were likely a reflection of differences in knee size between races. These racial differences should be considered in the design of total knee arthroplasty prosthesis for Asian population.
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Yue B, Varadarajan KM, Moynihan AL, Liu F, Rubash HE, Li G. Kinematics of medial osteoarthritic knees before and after posterior cruciate ligament retaining total knee arthroplasty. J Orthop Res 2011; 29:40-6. [PMID: 20607694 DOI: 10.1002/jor.21203] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Total knee arthroplasty (TKA) is a widely accepted surgical procedure for the treatment of patients with end-stage osteoarthritis (OA). However, the function of the knee is not always fully recovered after TKA. We used a dual fluoroscopic imaging system to evaluate the in vivo kinematics of the knee with medial compartment OA before and after a posterior cruciate ligament-retaining TKA (PCR-TKA) during weight-bearing knee flexion, and compared the results to those of normal knees. The OA knees displayed similar internal/external tibial rotation to normal knees. However, the OA knees had less overall posterior femoral translation relative to the tibia between 0° and 105° flexion and more varus knee rotation between 0° and 45° flexion, than in the normal knees. Additionally, in the OA knees the femur was located more medially than in the normal knees, particularly between 30° and 60° flexion. After PCR-TKA, the knee kinematics were not restored to normal. The overall internal tibial rotation and posterior femoral translation between 0° and 105° knee flexion were dramatically reduced. Additionally, PCR-TKA introduced an abnormal anterior femoral translation during early knee flexion, and the femur was located lateral to the tibia throughout weight-bearing flexion. The data help understand the biomechanical functions of the knee with medial compartment OA before and after contemporary PCR-TKA. They may also be useful for improvement of future prostheses designs and surgical techniques in treatment of knees with end-stage OA.
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Affiliation(s)
- Bing Yue
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit St, GRJ 1215, Boston, Massachusetts 02114, USA
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