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McCrosson M, McKissack HM, Christie MC, Severson MN, Alexander B, Naranje SM. Patellar component positioning in total knee arthroplasty: a cadaver study and review of the literature. Arch Orthop Trauma Surg 2024; 144:1733-1740. [PMID: 38216740 DOI: 10.1007/s00402-023-05190-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 12/21/2023] [Indexed: 01/14/2024]
Affiliation(s)
- Matthew McCrosson
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA
| | - Haley M McKissack
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA
| | - Matthew C Christie
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA
| | - Megan N Severson
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA
| | - Bradley Alexander
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA
| | - Sameer M Naranje
- Department of Orthopaedic Surgery, School of Medicine, University of Alabama, 1313 13th Street South, Birmingham, AL, 35205, USA.
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Asayama A, Taniguchi M, Yagi M, Fukumoto Y, Hirono T, Yamagata M, Nakai R, Ichihashi N. Reliability and validity of quantitative ultrasound for evaluating patellar alignment: A pilot study. J Orthop Sci 2024; 29:602-608. [PMID: 36898946 DOI: 10.1016/j.jos.2023.02.020] [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: 07/17/2022] [Revised: 02/15/2023] [Accepted: 02/26/2023] [Indexed: 03/12/2023]
Abstract
BACKGROUND Patellar malalignment is a risk factor of patellofemoral pain. Evaluation of the patellar alignment have mostly used magnetic resonance imaging (MRI). Ultrasound (US) is a non-invasive instrument that can quickly evaluate patellar alignment. However, the method for evaluating patellar alignment via US has not been established. This study aimed to investigate the reliability and validity of evaluating patellar alignment via US. METHODS The sixteen right knees were imaged via US and MRI. US images were obtained at two sites of the knee to measure US-tilt as the index of patellar tilt. Using a single US image, we measured US-lateral distance and US-angle as the index of patellar shift. All US images were obtained three times each by two observers to evaluate reliabilities. Lateral patellar angle (LPA), as the indicators of patellar tilt, and lateral patella distance (LPD) and bisect offset (BO), as the indicators of patellar shift, were measured via MRI. RESULTS US measurements provided high intra- (within-day and between days) and interobserver reliabilities with exception of interobserver reliability of US-lateral distance. Pearson correlation coefficient indicated that US-tilt is significantly positively correlated with LPA (r = 0.79), and US-angle is significantly positively correlated with LPD (r = 0.71) and BO (r = 0.63). CONCLUSION Evaluating patellar alignment via US showed high reliabilities. US-tilt and US-angle showed moderate to strong correlation with MRI indices of patellar tilt and shift via MRI, respectively. US methods are useful for evaluating accurate and objective indices of patellar alignment.
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Affiliation(s)
- Akihiro Asayama
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Masashi Taniguchi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Masahide Yagi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Yoshihiro Fukumoto
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Department of Physical Medicine and Rehabilitation, Kansai Medical University, 2-5-1 Shinmachi, Hirakata, Osaka, 573-1010, Japan
| | - Tetsuya Hirono
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Research Fellow of Japan Society for the Promotion of Science Kojimachi Business Center Building, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan
| | - Momoko Yamagata
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan; Research Fellow of Japan Society for the Promotion of Science Kojimachi Business Center Building, 5-3-1 Kojimachi, Chiyoda-ku, Tokyo, 102-0083, Japan; Faculty of Human Development, Graduate School of Human Development and Environment, Kobe University, 3-11 Tsurukabuto, Nada-ku, Kobe, Hyogo, 657-0011, Japan
| | - Ryusuke Nakai
- Kokoro Research Center, Kyoto University, 46 Shimoadachi-cho, Yoshida Sakyo-ku, Kyoto, 606-8507, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Graduate School of Medicine, Kyoto University, 53 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Selkowitz DM, Beneck GJ, Powers CM. Persons with patellofemoral pain exhibit altered hip abductor muscle recruitment while performing hip abductor exercises. Physiother Theory Pract 2024; 40:11-20. [PMID: 35880404 DOI: 10.1080/09593985.2022.2101167] [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: 04/09/2022] [Accepted: 07/09/2022] [Indexed: 10/16/2022]
Abstract
INTRODUCTION Strengthening of the hip abductors has been advocated for persons with patellofemoral pain (PFP). It is not clear if these individuals activate the hip abductor muscles appropriately to achieve the desired therapeutic effects. OBJECTIVE To compare activation of the hip abductor muscles between persons with and without PFP during the performance of hip abductor exercises. METHODS Thirty-two individuals participated (12 with PFP and 20 without PFP). The average age (± standard deviation) was 29.7 ± 5.9 years for the PFP group and 28.1 ± 6.9 for the control group. Electromyographic (EMG) signals from the gluteus medius (GMED), superior gluteus maximus (SUP-GMAX), and tensor fascia lata (TFL) were obtained using fine-wire electrodes while participants performed 11 different exercises. Normalized EMG activity of each muscle was compared between groups across all exercises. RESULTS When averaged across all exercises, persons with PFP exhibited significantly greater EMG activity of TFL (mean = 25.3% MVIC; 95% CI = 19.2, 31.3) compared to those without PFP (mean = 17.6% MVIC; 95% CI = 12.8, 22.4) and significantly lower EMG activity of SUP-GMAX (mean = 16.4% MVIC; 95% CI = 11.0, 22.0) compared to those without PFP (mean = 25.4% MVIC; 95% CI = 21.0, 29.8). Persons with PFP exhibited lower EMG activity of GMED, but only for 3 out of the 11 exercises evaluated (hip abduction, hip hike, step-up). CONCLUSION Compared to persons without PFP, those with PFP exhibited activation differences during the performance of exercises used to target the hip abductors. Our results highlight the need for activation training prior to the initiation of strengthening exercises to achieve desired therapeutic effects.
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Affiliation(s)
- David M Selkowitz
- Department of Physical Therapy, MGH Institute of Health Professions, Boston, MA, USA
| | - George J Beneck
- Department of Physical Therapy, California State University, Long Beach, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Kim KC, Wakeman B, Wissman R. Functional Imaging of the Knee-A Comprehensive Review. J Knee Surg 2023. [PMID: 37992754 DOI: 10.1055/a-2216-5186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
Knee pain is a common presenting problem in the general population. Radiographs and magnetic resonance imaging (MRI) are the cornerstones of imaging in current clinical practice. With advancements in technology, there has been increasing utilization of other modalities to evaluate knee disorders. Dynamic assessment utilizing computed tomography and portable ultrasounds have demonstrated the capacity to accurately assess and reproducibly quantify kinematics of knee disorders. Cartilage physiology can be evaluated with MRI. Emerging research has even demonstrated novel musculoskeletal applications of positron emission tomography to evaluate anterior cruciate ligament graft metabolic activity following reconstruction. As technology continues to evolve and traditional ways are improved upon, future comparative studies will elucidate the distinct advantages of the various modalities. Although radiology is still primarily an anatomic specialty, there is immense potential for functional imaging to be the standard of care. This review focuses on the most common musculoskeletal applications of functional imaging as well as future utilization.
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Affiliation(s)
- Kenneth C Kim
- Department of Radiology, University of Missouri Health Care, Columbia, Missouri
| | - Brooke Wakeman
- Department of Radiology, University of Missouri Health Care, Columbia, Missouri
| | - Rob Wissman
- Musculoskeletal Imaging Division, Department of Radiology, Faculty of Clinical Radiology, University of Missouri System, Columbia, Missouri
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Buzzatti L, Keelson B, van der Voort JW, Segato L, Scheerlinck T, Héréus S, Van Gompel G, Vandemeulebroucke J, De Mey J, Buls N, Cattrysse E, Serrien B. Dynamic CT scanning of the knee: Combining weight bearing with real-time motion acquisition. Knee 2023; 44:130-141. [PMID: 37597475 DOI: 10.1016/j.knee.2023.07.014] [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: 07/27/2022] [Revised: 06/14/2023] [Accepted: 07/24/2023] [Indexed: 08/21/2023]
Abstract
BACKGROUND Imaging the lower limb during weight-bearing conditions is essential to acquire advanced functional joint information. The horizontal bed position of CT systems however hinders this process. The purpose of this study was to validate and test a device to simulate realistic knee weight-bearing motion in a horizontal position during dynamic CT acquisition and process the acquired images. METHODS "Orthostatic squats" was compared to "Horizontal squats" on a device with loads between 35% and 55% of the body weight (%BW) in 20 healthy volunteers. Intraclass Correlation Coefficient (ICC), and standard error of measurement (SEM), were computed as measures of the reliability of curve kinematic and surface EMG (sEMG) data. Afterwards, the device was tested during dynamic CT acquisitions on three healthy volunteers and three patients with patellofemoral pain syndrome. The respective images were processed to extract Tibial-Tuberosity Trochlear-Groove distance, Bisect Offset and Lateral Patellar Tilt metrics. RESULTS For sEMG, the highest average ICCs (SEM) of 0.80 (6.9), was found for the load corresponding to 42%BW. Kinematic analysis showed ICCs were the highest for loads of 42%BW during the eccentric phase (0.79-0.87) and from maximum flexion back to 20° (0.76). The device proved to be safe and reliable during the acquisition of dynamic CT images and the three metrics were computed, showing preliminary differences between healthy and pathological participants. CONCLUSIONS This device could simulate orthostatic squats in a horizontal position with good reliability. It also successfully provided dynamic CT scan images and kinematic parameters of healthy and pathological knees during weight-bearing movement.
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Affiliation(s)
- Luca Buzzatti
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium; School of Allied Health, Anglia Ruskin University (ARU), Young Street, CB1 1PT Cambridge, UK.
| | - Benyameen Keelson
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium; Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Joris Willem van der Voort
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Lorenzo Segato
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy
| | - Thierry Scheerlinck
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Orthopaedic Surgery and Traumatology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Savanah Héréus
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Gert Van Gompel
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Jef Vandemeulebroucke
- Vrije Universiteit Brussel (VUB), Department of Electronics and Informatics (ETRO), Pleinlaan 2, 1050 Brussel, Belgium; imec, Kapeldreef 75, 3001 Leuven, Belgium
| | - Johan De Mey
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Nico Buls
- Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Department of Radiology, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Erik Cattrysse
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
| | - Ben Serrien
- Vrije Universiteit Brussel (VUB), Experimental Anatomy Research Group (EXAN), Laarbeeklaan 103, 1090 Brussels, Belgium
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Kobayashi T, Tee SM, Morikawa M, Tashiro T, Arima S, Maeda N, Leung AKL. Effect of flexion-resist and extension-assist knee orthosis on electromyographic activities of quadriceps during lateral stepping. Prosthet Orthot Int 2023; 47:168-171. [PMID: 36459507 DOI: 10.1097/pxr.0000000000000202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 09/19/2022] [Indexed: 12/03/2022]
Abstract
Knee orthoses can potentially reduce muscular activities of the quadriceps. The aim of this study was to investigate the effect of a custom flexion-resist and extension-assist knee orthosis on electromyographic activities of quadriceps during lateral stepping (step-up and step-down). Flexion resistance and extension assistance mechanisms were set by a pair of linear springs built into the orthotic knee joints. Electromyography (EMG) signals were collected from rectus femoris (RF), vastus medialis obliquus (VMO), and vastus lateralis (VL) during lateral step-up and lateral step-down activities in 7 healthy young adults. Peak normalized root mean square (RMS) EMG signals of each muscle, as well as VMO:VL ratio, were compared between orthotic and nonorthotic conditions using the Wilcoxon signed-rank test. The knee orthosis significantly reduced the normalized RMS EMG signals of the RF and VL during lateral stepping ( p < 0.05). No significant difference was found in the VMO. The VMO:VL ratio significantly ( p < 0.05) increased under orthotic condition. The experiments demonstrated that the knee orthosis reduces the peak normalized RMS EMG signals of RF and VL, and alter the VMO:VL ratio of quadriceps in healthy young adults. Therefore, this study suggests that the flexion-resist and extension-assist knee orthosis may be effective in reducing muscular activities of RF and VL, which may alleviate patellofemoral loading. Future studies should delve into the effects of the knee orthosis in individuals with patellofemoral pain.
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Affiliation(s)
- Toshiki Kobayashi
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
| | - See Moon Tee
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
- Department of Prosthetics and Orthotics, Tuen Mun Hospital, Hong Kong, China
| | - Masanori Morikawa
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
- Department of Preventive Gerontology, Center for Gerontology and Social Science, National Center for Geriatrics and Gerontology, Obu, Japan
| | - Tsubasa Tashiro
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Satoshi Arima
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Noriaki Maeda
- Division of Sport Rehabilitation, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Aaron K L Leung
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China
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Dunning H, van de Groes SAW, Buckens CF, Prokop M, Verdonschot N, Janssen D. Fully automatic extraction of knee kinematics from dynamic CT imaging; normative tibiofemoral and patellofemoral kinematics of 100 healthy volunteers. Knee 2023; 41:9-17. [PMID: 36608361 DOI: 10.1016/j.knee.2022.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/23/2022] [Accepted: 12/14/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Accurate assessment of knee kinematics is important in the diagnosis and quantification of knee disorders and to determine the effect of orthopaedic interventions. Despite previous studies showing the usefulness of dynamic imaging and providing valuable insights in knee kinematics, dynamic imaging is not widely used in clinics due to a variety of causes. In this study normative knee kinematics of 100 healthy subjects is established using a fully automatic workflow feasible for use in the clinic. METHODS One-hundred volunteers were recruited and a dynamic CT scan was made during a flexion extension movement. Image data was automatically segmented and dynamic and static images were superimposed using image registration. Coordinate systems for the femur, patella and tibia were automatically calculated as well as their dynamic position and orientation. RESULTS Dynamic CT scans weremade withan effective radiation dose of 0.08 mSv. The median tibial internal rotation was 4° and valgus rotation is 5° at full flexion. Femoral rollback of the lateral condyle was 7 mm versus 2 mm of the medial condyle. The median patella flexion reached 65% of tibiofemoral flexion and the median tilt and rotation were 5° and 0° at full flexion, respectively. The median mediolateral translation of the patella was 3 mm (medially) in the first 30° of flexion. CONCLUSION The current study presents TF and PF kinematic data of 97 healthy individuals, providing a unique dataset of normative knee kinematics. The short scanning time, simple motion and, automatic analysis make the methods presented suitable for daily clinical practice.
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Affiliation(s)
- Hans Dunning
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.
| | - S A W van de Groes
- Department of Orthopaedics, Radboud University Medical Center, Nijmegen, the Netherlands
| | - C F Buckens
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Mathias Prokop
- Department of Radiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; University of Twente, Laboratory for Biomechanical Engineering, Faculty of Engineering Technology, Enschede, the Netherlands
| | - Dennis Janssen
- Orthopaedic Research Laboratory, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
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Zhang Z, She C, Li L, Mao Y, Jin Z, Fan Z, Dong Q, Zhou H, Xu W. Mid-term study on the effects of arthroscopic discoid lateral meniscus plasty on patellofemoral joint: An observational study. Medicine (Baltimore) 2022; 101:e31760. [PMID: 36397384 PMCID: PMC9666187 DOI: 10.1097/md.0000000000031760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
In the present study, we aimed to investigate the clinical outcomes of arthroscopic discoid lateral meniscus (DLM) plasty and the adaptive changes in the patellofemoral joint after surgery. From September 2010 to March 2012, 25 patients with DLM injuries who underwent arthroscopic meniscus plasty were enrolled in the prospective study. All patients underwent clinical evaluation before the operation and at the last follow-up, and imaging evaluation was performed by upright magnetic resonance imaging before and 1 month after the operation as well as at the last follow-up. Clinical evaluation included Lysholm score, Kujala score, McMurray's sign, patellar mobility, patella grind test, and quadriceps atrophy. Imaging evaluation included bisect offset index, patella tilt angle (PTA), and cartilage damage. Lysholm score, Kujala score, McMurray's sign, and quadriceps atrophy at the last follow-up were significantly improved compared with the preoperative levels (P < .05). At the last follow-up, there were no statistical differences in patella mobility and patella grind test compared with the preoperative levels. In addition, bisect offset index and PTA showed a dynamic trend of rising and then falling over time (P < .05). At 1 month after the operation, bisect offset index and PTA were significantly increased compared with the preoperative levels or the values at the last follow-up (P < .05), while there were no differences between the preoperation and the last follow-up. Cartilage damage became worse with time (P < 0.05), and the 2 were positively correlated (Spearman = 0.368). At the last follow-up, the degree of cartilage damage was significantly increased compared with the preoperative level (P < .017), while there was no significant difference between the 1-month postoperative grade and the preoperational grade or the last follow-up grade. The effect of arthroscopic DLM plasty on the patellofemoral joint was dynamic, with the position of the patella deviating in the early stages and recovering in the mid-term, especially when the knee was in the biomechanical standing position. In addition, the patellofemoral joint cartilage might undergo accelerated degeneration after the operation, while the mid-term effect of the operation was positive, and the patellofemoral joint function was acceptable.
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Affiliation(s)
- Zaihang Zhang
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- Department of Orthopedics, Suqian First Hospital, Suqian, Jiangsu Province, China
| | - Chang She
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Liubing Li
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Yongtao Mao
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhigao Jin
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Zhiying Fan
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Qirong Dong
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Haibin Zhou
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
| | - Wei Xu
- Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, China
- * Correspondence: Wei Xu, Department of Orthopedics, the Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province 215004, China (e-mail: )
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9
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Pal S, Choi JH, Delp SL, Fredericson M. Botulinum neurotoxin type A improves vasti muscle balance, patellar tracking, and pain in patients with chronic patellofemoral pain. J Orthop Res 2022; 41:962-972. [PMID: 36031589 DOI: 10.1002/jor.25435] [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: 04/20/2022] [Revised: 08/10/2022] [Accepted: 08/22/2022] [Indexed: 02/04/2023]
Abstract
The purpose of this study was to determine the effects of botulinum neurotoxin type A (BoNT-A) on vastus lateralis:vastus medialis (VL:VM) muscle balance, patellar tracking, and pain in patients with chronic patellofemoral (PF) pain. We recruited 13 participants (9 females, 4 males) with recalcitrant PF pain who underwent ultrasound-guided BoNT-A injections into the distal third of the VL muscle, followed by a 6-week home exercise program to strengthen their VM muscle. We imaged the participants in a C-arm computed tomography (CT) scanner before and after the intervention. We calculated VL:VM ratios from CT images from a supine, nonweight-bearing condition. We obtained patellar tilt and bisect offset values from CT images from an upright, weight-bearing condition. We recorded functional pain scores before, immediately after, and 2-4 years after the intervention. We classified the participants into normal tracking and maltracking groups based on their patellar tilt and bisect offset values. BoNT-A with home exercise reduced VL:VM ratio (18%; p < 0.001), patellar tilt (19%; p = 0.020), and bisect offset (5%; p = 0.025). Four participants classified as maltrackers before the intervention transitioned to normal tracking after the intervention. Functional pain scores improved immediately after the intervention (13%, p < 0.001) and remained improved at 2-year follow-up (12%, p = 0.011). Statement of Clinical Significance: This study provides new evidence in support of BoNT-A for treatment of PF pain. Classification of patients under weight-bearing conditions may identify individuals who will most benefit from a BoNT-A treatment.
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Affiliation(s)
- Saikat Pal
- Department of Biomedical Engineering, New Jersey Institute of Technology, Newark, New Jersey, USA
| | - Jang-Hwan Choi
- Division of Mechanical and Biomedical Engineering, Graduate Program in System Health Science and Engineering, Ewha Womans University, Seoul, South Korea
| | - Scott L Delp
- Department of Bioengineering, Stanford University, Stanford, California, USA.,Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Michael Fredericson
- Department of Orthopaedic Surgery, Stanford University, Stanford, California, USA
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10
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Elias JJ, Rezvanifar SC, Koh JL. Groove-deepening trochleoplasty reduces lateral patellar maltracking and increases patellofemoral contact pressures: Dynamic simulation. J Orthop Res 2022; 40:1529-1537. [PMID: 34559438 DOI: 10.1002/jor.25181] [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: 03/04/2021] [Revised: 08/10/2021] [Accepted: 09/07/2021] [Indexed: 02/04/2023]
Abstract
Groove-deepening trochleoplasty is performed to restore patellar stability by increasing the lateral constraint applied to the patella by the trochlear groove. Multibody dynamic simulation of knee function was used to characterize the influence of groove-deepening trochleoplasty on patellar tracking and patellofemoral contact pressures. Computational models were created to represent seven knees with trochlear dysplasia, indicated by a flat trochlear groove and supratrochlear spur. The models were manipulated to remove the spur and deepen the trochlear groove to represent the average shape following a trochleoplasty. Knee squatting was simulated for the preoperative and postoperative conditions. Statistically significant (p < 0.05) differences in output parameters were identified with repeated measures comparisons at every 5° of knee flexion. Trochleoplasty significantly decreased lateral patellar tracking, particularly at low knee flexion angles. Trochleoplasty decreased the peak lateral shift of the patella (bisect offset index) with the knee extended from 0.87 ± 0.14 to 0.75 ± 0.12. Trochleoplasty also significantly decreased the contact area and increased the maximum contact pressure at multiple flexion angles. Trochleoplasty decreased the average contact area by approximately 10% in mid-flexion, with a corresponding increase in the average maximum contact pressure of 13%-23%. Decreased contact area and increased contact pressures are related to altered patellofemoral congruity due to reshaping the femur without a corresponding change to the patella. Clinical significance: The results indicate groove-deepening trochleoplasty decreases lateral patellar maltracking, reducing the risk of patellar dislocations, but can elevate patellofemoral contact pressures, which could contribute to long-term degradation of cartilage.
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Affiliation(s)
- John J Elias
- Department of Research, Cleveland Clinic Akron General, Akron, Ohio, USA
| | - Sayed C Rezvanifar
- Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, Minnesota, USA.,Department of Biomedical Engineering, University of Akron, Akron, Ohio, USA
| | - Jason L Koh
- Department of Orthopedic Surgery, NorthShore University HealthSystem, Evanston, Illinois, USA
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11
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Kefala V, Ali AA, Hamilton LD, Mannen EM, Shelburne KB. Effects of Weight-Bearing on Tibiofemoral, Patellofemoral, and Patellar Tendon Kinematics in Older Adults. Front Bioeng Biotechnol 2022; 10:820196. [PMID: 35497367 PMCID: PMC9048742 DOI: 10.3389/fbioe.2022.820196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 03/08/2022] [Indexed: 11/26/2022] Open
Abstract
Quantification of natural knee kinematics is essential for the assessment of joint function in the diagnosis of pathologies. Combined measurements of tibiofemoral and patellofemoral joint kinematics are necessary because knee pathologies, such as progression of osteoarthritis and patellar instability, are a frequent concern in both articulations. Combined measurement of tibiofemoral and patellofemoral kinematics also enables calculation of important quantities, specifically patellar tendon angle, which partly determines the loading vector at the tibiofemoral joint and patellar tendon moment arm. The goals of this research were to measure the differences in tibiofemoral and patellofemoral kinematics, patellar tendon angle (PTA), and patellar tendon moment arm (PTMA) that occur during non-weight-bearing and weight-bearing activities in older adults. Methods: High-speed stereo radiography was used to measure the kinematics of the tibiofemoral and patellofemoral joints in subjects as they performed seated, non-weight-bearing knee extension and two weight-bearing activities: lunge and chair rise. PTA and PTMA were extracted from the subject’s patellofemoral and tibiofemoral kinematics. Kinematics and the root mean square difference (RMSD) between non-weight-bearing and weight-bearing activities were compared across subjects and activities. Results: Internal rotation increased with weight-bearing (mean RMSD from knee extension was 4.2 ± 2.4° for lunge and 3.6 ± 1.8° for chair rise), and anterior translation was also greater (mean RMSD from knee extension was 2.2 ± 1.2 mm for lunge and 2.3 ± 1.4 mm for chair rise). Patellar tilt and medial–lateral translation changed from non-weight-bearing to weight-bearing. Changes of the patellar tendon from non-weight-bearing to weight-bearing were significant only for PTMA. Conclusions: While weight-bearing elicited changes in knee kinematics, in most degrees of freedoms, these differences were exceeded by intersubject differences. These results provide comparative kinematics for the evaluation of knee pathology and treatment in older adults.
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Affiliation(s)
- Vasiliki Kefala
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Azhar A Ali
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Stryker Orthopedics, Kalamazoo, MI, United States
| | - Landon D Hamilton
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
| | - Erin M Mannen
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
- Department of Mechanical and Biomedical Engineering, Boise State University, Boise, ID, United States
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, United States
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12
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Brisson NM, Krämer M, Krahl LA, Schill A, Duda GN, Reichenbach JR. A novel multipurpose device for guided knee motion and loading during dynamic magnetic resonance imaging. Z Med Phys 2022; 32:500-513. [PMID: 35221155 PMCID: PMC9948850 DOI: 10.1016/j.zemedi.2021.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 11/21/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This work aimed to develop a novel multipurpose device for guided knee flexion-extension, both passively using a motorized pneumatic system and actively (muscle-driven) with the joint unloaded or loaded during dynamic MRI. Secondary objectives were to characterize the participant experience during device use, and present preliminary dynamic MRI data to demonstrate the different device capabilities. MATERIAL AND METHODS Self-reported outcomes were used to characterize the pain, physical exertion and discomfort levels experienced by 10 healthy male participants during four different active knee motion and loading protocols using the novel device. Knee angular data were recorded during the protocols to determine the maximum knee range of motion achievable. Dynamic MRI was acquired for three healthy volunteers during passive, unloaded knee motion using 2D Cartesian TSE, 2D radial GRE and 3D UTE sequences; and during active, unloaded and loaded knee motion using 2D radial GRE imaging. Because of the different MRI sequences used, spatial resolution was inherently lower for active knee motion than for passive motion acquisitions. RESULTS Depending on the protocol, some participants reported slight pain, mild discomfort and varying levels of physical exertion. On average, participants achieved ∼40° of knee flexion; loaded conditions can create knee moments up to 27Nm. High quality imaging data were obtained during different motion and loading conditions. Dynamic 3D data allowed to retrospectively extract arbitrarily oriented slices. CONCLUSION A novel multipurpose device for guided, physiologically relevant knee motion and loading during dynamic MRI was developed. Device use was well tolerated and suitable for acquiring high quality images during different motion and loading conditions. Different bone positions between loaded and unloaded conditions were likely due to out-of-plane motion, particularly because image registration was not performed. Ultimately, this device could be used to advance our understanding of physiological and pathological joint mechanics.
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Affiliation(s)
- Nicholas M. Brisson
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany,Corresponding author: Nicholas Brisson, Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Philippstrasse 13, Haus 11, Raum 2.18, 10115 Berlin, Germany, Tel.: +49 (0)30 2093 46122; fax: +49 (0)30 450 55996.
| | - Martin Krämer
- Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany,Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany
| | - Leonie A.N. Krahl
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany
| | - Alexander Schill
- Research Workshop, Charité – Universitätsmedizin Berlin, Germany
| | - Georg N. Duda
- Julius Wolff Institute, Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Germany
| | - Jürgen R. Reichenbach
- Medical Physics Group, Institute of Diagnostic and Interventional Radiology, Jena University Hospital, Friedrich Schiller University Jena, Germany
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13
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Nayak KS, Lim Y, Campbell-Washburn AE, Steeden J. Real-Time Magnetic Resonance Imaging. J Magn Reson Imaging 2022; 55:81-99. [PMID: 33295674 PMCID: PMC8435094 DOI: 10.1002/jmri.27411] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 10/06/2020] [Accepted: 10/09/2020] [Indexed: 01/03/2023] Open
Abstract
Real-time magnetic resonance imaging (RT-MRI) allows for imaging dynamic processes as they occur, without relying on any repetition or synchronization. This is made possible by modern MRI technology such as fast-switching gradients and parallel imaging. It is compatible with many (but not all) MRI sequences, including spoiled gradient echo, balanced steady-state free precession, and single-shot rapid acquisition with relaxation enhancement. RT-MRI has earned an important role in both diagnostic imaging and image guidance of invasive procedures. Its unique diagnostic value is prominent in areas of the body that undergo substantial and often irregular motion, such as the heart, gastrointestinal system, upper airway vocal tract, and joints. Its value in interventional procedure guidance is prominent for procedures that require multiple forms of soft-tissue contrast, as well as flow information. In this review, we discuss the history of RT-MRI, fundamental tradeoffs, enabling technology, established applications, and current trends. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY STAGE: 1.
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Affiliation(s)
- Krishna S. Nayak
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA,Address reprint requests to: K.S.N., 3740 McClintock Ave, EEB 400C, Los Angeles, CA 90089-2564, USA.
| | - Yongwan Lim
- Ming Hsieh Department of Electrical and Computer Engineering, University of Southern California, Los Angeles, California, USA
| | - Adrienne E. Campbell-Washburn
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, Maryland, USA
| | - Jennifer Steeden
- Institute of Cardiovascular Science, Centre for Cardiovascular Imaging, University College London, London, UK
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14
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Segal NA, Murphy MT, Everist BM, Brown KD, He J, Lynch JA, Nevitt MC. Clinical value of weight-bearing CT and radiographs for detecting patellofemoral cartilage visualized by MRI in the MOST study. Osteoarthritis Cartilage 2021; 29:1540-1548. [PMID: 34332048 PMCID: PMC8542599 DOI: 10.1016/j.joca.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilage damage on MRI. DESIGN A convenience sample of 60 right knees from the MOST cohort were analyzed. WBCT and XR were read for OARSI JSN score and MRI for MOAKS cartilage score by two experienced musculoskeletal radiologists blinded to participant. Using MOAKS scoring on MRI (referent standard), the sensitivity, specificity and accuracy of patellofemoral OARSI JSN scores based on WBCT and XR were compared. RESULTS The mean ± SD age and BMI for the participants included (66.7% women) were 67.6 ± 9.8 years and 30.0 ± 5.3 kg/m2 respectively. WBCT demonstrated significantly greater sensitivity (0.85-0.97 on WBCT vs 0.47-0.57 on XR) and accuracy (0.85-0.92 on WBCT vs 0.48-0.57 on XR) for all parameters except lateral full-thickness cartilage loss (McNemar's test p-values all <0.001). There was moderate-to-strong and low-to-moderate agreement between PFOA findings on WBCT and XR, respectively, and semi-quantitative scores of PF cartilage on MRI. Inter-rater reliability for XR JSN [weighted kappa = 0.83 (0.64, 1.0)], WBCT JSN [kappa = 0.60 (0.48, 0.72)] and MRI MOAKS-CM [kappa = 0.70 (0.61, 0.79)] readings were good. CONCLUSION WBCT demonstrates significantly greater sensitivity and accuracy than radiographs for identification of PFOA. Given the same Relative Radiation Level as XR and improved visualization, WBCT holds promise to improve understanding of the weight-bearing patellofemoral joint.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160
| | - Michael T. Murphy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian M. Everist
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin D. Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
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15
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Leiprecht J, Mauch F, Huth J, Ambros LP, Best R. Weight-bearing MRI with a knee flexion angle of 20°: a study on additional MRI investigation modalities to support a more accurate understanding of patellofemoral instability. BMC Musculoskelet Disord 2021; 22:902. [PMID: 34696737 PMCID: PMC8546952 DOI: 10.1186/s12891-021-04733-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 09/24/2021] [Indexed: 11/30/2022] Open
Abstract
Background Diagnosing patellofemoral instability disorders correctly, weight-bearing MRI (WB-MRI) has become an option. Aiming for a best possible accuracy in displaying potentially underlying causes, the named MRI modalities were sporadically even investigated in different knee flexion angles. However, despite confirmed MRI-outcome-differences between WB-MRI and non-WB-MRI, none of the described MRI modalities have so far established themselves. Mainly this is due to an unfeasibility in daily clinical routine in regard to time and economic aspects. Thus, we intended to evaluate an additional but reduced patellofemoral MR-imaging solely in a relevant 20° of knee flexion under WB- and non-WB-MRI conditions. Methods Seventy-three subjects with and without patellofemoral instability were investigated under supine as well as under WB-MRI conditions in a 20° of knee flexion angle. Patellofemoral risk indices in the sagittal plane (Insall-Salvati-Index, Caton-Deschamps-Index, Patellotrochlear Index) and the axial plane (Patella tilt of Fulkerson and Sasaki) were detected and compared between the different MRI conditions. Significance, reliability and Cohen’s effect size was calculated. Results Nearly all assessed indices showed significant differences between patients and controls in the different MRI positions. Comparing pairwise, all measured indices failed to show significant differences between the two MRI positions. However, patella tilt angles of the patient group showed an elevation from supine to WB-MRI (14.00 ± 7.54° to 15.97 ± 9.10° and 16.34 ± 7.84° to 18.54 ± 9.43°). Here, Cohen’s d showed small to medium effects between supine and WB-MRI. Conclusion In comparison to standard MRI in supine position, axial risk indices seem to be accentuated under WB-MRI and a knee flexion angle of 20°. In particular, symptomatic cases with inconspicuous conventional MRI imaging, additional MRI imaging only in the axial plane in a 20° of knee flexion could be beneficious and useful in clinical daily routine.
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Affiliation(s)
- J Leiprecht
- Department of Orthopaedics, University of Ulm, Oberer Eselberg 45, 89081, Ulm, Germany
| | - F Mauch
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | - J Huth
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany
| | - L P Ambros
- Department of Surgery and Orthopaedics, St. Vinzenz Hospital, Kirchenweg 15, 87459, Pfronten, Germany
| | - R Best
- Department of Orthopaedics, Sportklinik Stuttgart GmbH, Taubenheimstraße 8, 70372, Stuttgart, Germany. .,Department of Orthopedic Sports Medicine, University of Tuebingen, Hoppe Seyler Strasse 6, 72076, Tuebingen, Germany.
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16
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Sonographic evaluation of patellar tendon displacement and its correlation with patellofemoral pain syndrome. JOURNAL OF ORTHOPAEDICS, TRAUMA AND REHABILITATION 2021. [DOI: 10.1177/22104917211035555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Patellofemoral pain syndrome is the most common knee condition and is associated with patellar maltracking. Ultrasound is used in studying patellar maltracking. The objective is to determine if the technique which analyzes the displacement of the patellar tendon in the trochlear sulcus is associated with patellofemoral pain syndrome. Methods In total, 68 knees of 34 football players (males = 20, females = 14) were included. Patellar tendon displacement was assessed in supine and standing positions. Patellar tendon displacement difference in the two positions was determined. Results There was a significant difference in the lateral patellar tendon displacement during standing which was larger in patellofemoral pain syndrome than without patellofemoral pain syndrome (Mean Rank = 39.20 vs. 30.32, p = 0.02). There was no significant difference between the two groups for lateral patellar tendon displacement in supine and the difference in patellar tendon displacement from supine to standing. Conclusion The technique could be a potential method in assessing patellar maltracking. It could be used to have a comprehensive understanding of the pathomechanics and treatment of patellofemoral pain syndrome.
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17
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Jogi SP, Thaha R, Rajan S, Mahajan V, Venugopal VK, Mehndiratta A, Singh A. Device for Assessing Knee Joint Dynamics During Magnetic Resonance Imaging. J Magn Reson Imaging 2021; 55:895-907. [PMID: 34369633 DOI: 10.1002/jmri.27877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 07/23/2021] [Accepted: 07/27/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Knee assessment with and without load using magnetic resonance imaging (MRI) can provide information on knee joint dynamics and improve the diagnosis of knee joint diseases. Performing such studies on a routine MRI-scanner require a load-exerting device during scanning. There is a need for more studies on developing loading devices and evaluating their clinical potential. PURPOSE Design and develop a portable and easy-to-use axial loading device to evaluate the knee joint dynamics during the MRI study. STUDY TYPE Prospective study. SUBJECTS Nine healthy subjects. FIELD STRENGTH/SEQUENCE A 0.25 T standing-open MRI and 3.0 T MRI. PD-T2 -weighted FSE, 3D-fast-spoiled-gradient-echo, FS-PD, and CartiGram sequences. ASSESSMENT Design and development of loading device, calibration of loads, MR safety assessment (using projectile angular displacement, torque, and temperature tests). Scoring system for ease of doing. Qualitative (by radiologist) and quantitative (using structural similarity index measure [SSIM]) image-artifact assessment. Evaluation of repeatability, comparison with various standing stances load, and loading effect on knee MR parameters (tibiofemoral bone gap [TFBG], femoral cartilage thickness [FCT], tibial cartilage thickness [TCT], femoral cartilage T2 -value [FCT2], and tibia cartilage T2 -value [TCT2]). The relative percentage change (RPC) in parameters due to the device load was computed. STATISTICAL TEST Pearson's correlation coefficient (r). RESULTS The developed device is conditional-MR safe (details in the manuscript and supplementary materials), 15 × 15 × 45 cm3 dimension, and <3 kg. The ease of using the device was 4.9/5. The device introduced no visible image artifacts, and SSIM of 0.9889 ± 0.0153 was observed. The TFBG intraobserver variability (absolute difference) was <0.1 mm. Interobserver variability of all regions of interest was <0.1 mm. The load exerted by the device was close to the load during standing on both legs in 0.25 T scanner with r > 0.9. Loading resulted in RPC of 1.5%-11.0%, 7.9%-8.5%, and -1.5% to 13.0% in the TFBG, FCT, and TCT, respectively. FCT2 and TCT2 were reduced in range of 1.5-2.7 msec and 0.5-2.3 msec due to load. DATA CONCLUSION The proposed device is conditionally MR safe, low cost (material cost < INR 6000), portable, and effective in loading the knee joint with up to 50% of body weight. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Sandeep P Jogi
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, ASET, Amity University Haryana, Gurgaon, Haryana, India
| | - Rafeek Thaha
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India
| | | | | | | | - Amit Mehndiratta
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
| | - Anup Singh
- Centre for Biomedical Engineering, Indian Institute of Technology Delhi, New Delhi, India.,Department of Biomedical Engineering, All India Institute of Medical Sciences, New Delhi, India
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Conry KT, Cosgarea AJ, Tanaka MJ, Elias JJ. Influence of tibial tuberosity position and trochlear depth on patellar tracking in patellar instability: Variations with Patella Alta. Clin Biomech (Bristol, Avon) 2021; 87:105406. [PMID: 34116451 DOI: 10.1016/j.clinbiomech.2021.105406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 05/18/2021] [Accepted: 06/01/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Patella alta reduces articular constraints acting on the patella from the trochlear groove with the knee extended. The current study was performed to address how patella alta alters the influence of tibial tuberosity position and trochlear depth on patellar tracking in patients being treated for patellar instability. METHODS Fifteen subjects with recurrent patellar instability participated in knee extension within a dynamic CT scanner. Computational models were reconstructed from the motions to characterize patellar lateral shift, patellar tilt, patellar height, trochlear depth and lateral position of the tibial tuberosity at 0° and 30° of knee flexion. Linear regressions were used to correlate patellar tracking with anatomy for an alta group (7 knees, Caton-Deschamps index > 1.2) and a non-alta group. FINDINGS For the alta group, lateral patellar shift and tilt increased with increasing lateral position of the tibial tuberosity at 0° (r2 > 0.8, P < 0.005). For the non-alta group, lateral patellar shift and tilt increased as depth of the groove decreased at 0° (r2 > 0.8, P = 0.001). Lateral patellar tilt also increased with increasing lateral position of the tibial tuberosity at 30° for the non-alta group (r2 = 0.55, P = 0.04). INTERPRETATION For patients with patellar instability, lateral patellar maltracking with the knee extended can be largely attributed to either a shallow trochlear groove or a combination of patella alta and a lateral position of the tibial tuberosity. These relationships should be considered in both conservative and surgical treatment planning.
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Affiliation(s)
- Keegan T Conry
- Department of Orthopedic Surgery, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307, United States.
| | - Andrew J Cosgarea
- Department of Orthopaedic Surgery, Johns Hopkins University, 10803 Falls Road, Suite 2100, Lutherville, MD 21093, United States.
| | - Miho J Tanaka
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Medical School, 175 Cambridge St. Suite 400, Boston, MA 02114, United States.
| | - John J Elias
- Department of Research, Cleveland Clinic Akron General, 1 Akron General Ave, Akron, OH 44307, United States.
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Weight bearing versus conventional CT for the measurement of patellar alignment and stability in patients after surgical treatment for patellar recurrent dislocation. LA RADIOLOGIA MEDICA 2021; 126:869-877. [PMID: 33660189 PMCID: PMC8154791 DOI: 10.1007/s11547-021-01339-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 02/14/2021] [Indexed: 10/27/2022]
Abstract
PURPOSE To compare weight-bearing cone-beam computer tomography (CBCT) and conventional computer tomography (CT)-based measurements of patellofemoral alignment and stability in patients surgically treated for recurrent patellar dislocation. These scans implied respectively single-leg up-right posture, the knee flexed, and lower limb muscles activation, versus supine position with the knee extended. METHODS A total of 17 patients (11 males/6 females) after surgical reconstruction with fascia lata allograft for recurrent patellofemoral dislocation were analyzed at 60-month follow-up. Tilt and congruence angles and tibial tuberosity-trochlear groove (TT-TG) offset were measured on images obtained from CBCT and conventional CT scans by three independent and expert radiologists. Paired t tests were performed to compare measurements obtained from the two scans. Inter-rater reliability was assessed using a two-way mixed-effects model intra-class correlation coefficient (ICC). RESULTS Only TT-TG offset was found significantly smaller (p < 0.001) in CBCT (mean 9.9 ± 5.3 mm) than in conventional CT (mean 15.9 ± 4.9 mm) scans. ICC for tilt and congruence angles and for TT-TG offset ranged between 0.80-0.94 with measurements in CBCT scans, between 0.52 and0.78 in conventional CT. CONCLUSION In patients surgically treated for recurrent patellar dislocation, TT-TG offset was found overestimated with conventional CT. All measurements of patellofemoral stability and alignment were found more consistent when obtained with weight-bearing CBCT compared to conventional CT.
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20
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Shu L, Yang X, He H, Chen B, Chen L, Ni Q. Morphological study of the vastus medialis oblique in recurrent patellar dislocation based on magnetic resonance images. BMC Med Imaging 2021; 21:3. [PMID: 33407236 PMCID: PMC7788929 DOI: 10.1186/s12880-020-00542-8] [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: 07/29/2020] [Accepted: 12/22/2020] [Indexed: 11/11/2022] Open
Abstract
Background To investigate the morphological parameters of the vastus medialis obliquus (VMO) muscle and delineate its importance in the maintenance of patellofemoral joint stability. Methods The magnetic resonance imaging data of seventy-five knees (fifty-four patients) with recurrent lateral patella dislocation (LPD) and seventy-five knees (seventy patients) without recurrent LPD were retrospectively analysed. Five morphological parameters related to the VMO (elevation in the sagittal plane and coronal plane, craniocaudal extent, muscle-fibre angulation, cross-sectional area ratio) and two patella tilt parameters (patella tilt angle, bisect offset ratio) were measured in MR images. The independent-samples t test or chi-square test was used for statistical comparisons. Results The mean ages of the patients in the recurrent LPD group and control group were 22.1 ± 9.9 years and 24.0 ± 6.5 years, respectively. Eighteen out of seventy-five (24%) patients MRI showed VMO injuries. Compared with the control group, the patients with recurrent LPD showed significantly higher sagittal VMO elevation (10.4 ± 2.3 mm vs. 4.1 ± 1.9 mm), coronal VMO elevation (15.9 ± 5.7 mm vs. 3.9 ± 3.7 mm), muscle-fibre angulation (35.4 ± 8.0° vs. 27.9 ± 6.3°), patella tilt angle (25.9 ± 10.7° vs. 9.1 ± 5.2°), and bisect offset ratio values (0.9 ± 0.3 vs. 0.5 ± 0.1) and significantly lower craniocaudal extent (13.7 ± 5.3 mm vs. 16.7 ± 5.1 mm) and cross-sectional area ratio values (0.05 ± 0.02 vs. 0.07 ± 0.02). Conclusions The results showed that abnormalities in the VMO and patella tilt were clearly present in recurrent LPD patients compared with normal people.
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Affiliation(s)
- Lei Shu
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Xu Yang
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Hangyuan He
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Biao Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Liaobin Chen
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
| | - Qubo Ni
- Department of Orthopedic Surgery, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China.
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21
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Han SW, Sawatsky A, Jinha A, Herzog W. Effect of Vastus Medialis Loss on Rabbit Patellofemoral Joint Contact Pressure Distribution. J Appl Biomech 2020; 36:390-396. [PMID: 32843582 DOI: 10.1123/jab.2020-0056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/20/2020] [Accepted: 06/17/2020] [Indexed: 11/18/2022]
Abstract
Vastus medialis (VM) weakness is thought to alter patellar tracking, thereby changing the loading of the patellofemoral joint (PFJ), resulting in patellofemoral pain. However, it is challenging to measure VM force and weakness in human studies, nor is it possible to measure the associated mechanical changes in the PFJ. To obtain fundamental insight into VM weakness and its effects on PFJ mechanics, the authors determined PFJ loading in the presence of experimentally simulated VM weakness. Skeletally mature New Zealand White rabbits were used (n = 6), and the vastus lateralis, VM, and rectus femoris were stimulated individually through 3 custom-built nerve cuff electrodes. Muscle torque and PFJ pressure distribution were measured while activating all muscles simultaneously, or when the vastus lateralis and rectus femoris were activated, while VM was not, to simulate a quadriceps muscle strength imbalance. For a given muscular joint torque, peak pressures were greater and joint contact areas were smaller when simulating VM weakness compared with the condition where all muscles were activated simultaneously. The results in the rabbit model support that VM weakness results in altered PFJ loading, which may cause patellofemoral pain, often associated with a strength imbalance of the knee extensor muscle group.
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Affiliation(s)
| | | | | | - Walter Herzog
- University of Calgary
- Federal University of Santa Catarina
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22
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The effect of patellofemoral pain syndrome on patellofemoral joint kinematics under upright weight-bearing conditions. PLoS One 2020; 15:e0239907. [PMID: 32997727 PMCID: PMC7526904 DOI: 10.1371/journal.pone.0239907] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 09/15/2020] [Indexed: 12/02/2022] Open
Abstract
Patellofemoral pain (PFP) is commonly caused by abnormal pressure on the knee due to excessive load while standing, squatting, or going up or down stairs. To better understand the pathophysiology of PFP, we conducted a noninvasive patellar tracking study using a C-arm computed tomography (CT) scanner to assess the non-weight-bearing condition at 0° knee flexion (NWB0°) in supine, weight-bearing at 0° (WB0°) when upright, and at 30° (WB30°) in a squat. Three-dimensional (3D) CT images were obtained from patients with PFP (12 women, 6 men; mean age, 31 ± 9 years; mean weight, 68 ± 9 kg) and control subjects (8 women, 10 men; mean age, 39 ± 15 years; mean weight, 71 ± 13 kg). Six 3D-landmarks on the patella and femur were used to establish a joint coordinate system (JCS) and kinematic degrees of freedom (DoF) values on the JCS were obtained: patellar tilt (PT, °), patellar flexion (PF, °), patellar rotation (PR, °), patellar lateral-medial shift (PTx, mm), patellar proximal-distal shift (PTy, mm), and patellar anterior-posterior shift (PTz, mm). Tests for statistical significance (p < 0.05) showed that the PF during WB30°, the PTy during NWB0°, and the PTz during NWB0°, WB0°, and WB30° showed clear differences between the patients with PFP and healthy controls. In particular, the PF during WB30° (17.62°, extension) and the PTz during WB0° (72.50 mm, posterior) had the largest rotational and translational differences (JCS Δ = patients with PFP—controls), respectively. The JCS coordinates with statistically significant difference can serve as key biomarkers of patellar motion when evaluating a patient suspected of having PFP. The proposed method could reveal diagnostic biomarkers for accurately identifying PFP patients and be an effective addition to clinical diagnosis before surgery and to help plan rehabilitation strategies.
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23
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Little RD, Smith SE, Cicuttini FM, Tanamas SK, Wluka AE, Hussain SM, Urquhart DM, Jones G, Wang Y. Association between increased signal intensity at the proximal patellar tendon and patellofemoral geometry in community-based asymptomatic middle-aged adults: a cross-sectional study. BMC Musculoskelet Disord 2020; 21:571. [PMID: 32828128 PMCID: PMC7443287 DOI: 10.1186/s12891-020-03589-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 08/13/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Histological and epidemiological data suggest that increased signal intensity at the proximal patellar tendon on magnetic resonance imaging is a response to tendon loading. As patellofemoral geometry is a mediator of loading, we examined the association between patellofemoral geometry and the prevalence of increased signal intensity at the patellar tendon in community-based middle-aged adults. METHODS Two hundred-one adults aged 25-60 years in a study of obesity and musculoskeletal health had the patellar tendon assessed from magnetic resonance imaging. Increased signal intensity at the proximal patellar tendon was defined as hyper-intense regions of characteristic pattern, size and distribution on both T1- and T2-weighted sequences. Indices of patellofemoral geometry, including Insall-Salvati ratio, patellofemoral congruence angle, sulcus angle, and lateral condyle-patella angle, were measured from magnetic resonance imaging using validated methods. Binary logistic regression was used to examine the association between patellofemoral geometrical indices and the prevalence of increased signal intensity at the patellar tendon. RESULTS The prevalence of increased signal intensity at the patellar tendon was 37.3%. A greater Insall-Salvati ratio (odds ratio 0.80, 95% confidence interval 0.66-0.97 per 0.1 change in the ratio, p = 0.02), indicative of a higher-riding patella, and a larger patellofemoral congruence angle (odds ratio 0.91, 95% confidence interval 0.85-0.98 per 5 degree change in the angle, p = 0.01), indicating a more laterally placed patella, were associated with reduced odds of increased signal intensity at the patellar tendon. Sulcus angle and lateral condyle-patella angle were not significantly associated with the odds of increased signal intensity at the patellar tendon. CONCLUSIONS In community-based asymptomatic middle-aged adults, increased signal intensity at the patellar tendon was common and associated with Insall-Salvati ratio and patellofemoral congruence angle, suggesting a biomechanical mechanism. Such work is likely to inform tissue engineering and cell regeneration approaches to improving outcomes in those with tendon pathology.
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Affiliation(s)
- Robert D Little
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Samuel E Smith
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Stephanie K Tanamas
- Institute of Vector-Borne Disease, Monash University, Clayton, VIC, 3800, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Sultana Monira Hussain
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Donna M Urquhart
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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24
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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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25
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Garetier M, Borotikar B, Makki K, Brochard S, Rousseau F, Ben Salem D. Dynamic MRI for articulating joint evaluation on 1.5 T and 3.0 T scanners: setup, protocols, and real-time sequences. Insights Imaging 2020; 11:66. [PMID: 32430739 PMCID: PMC7237553 DOI: 10.1186/s13244-020-00868-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Accepted: 04/02/2020] [Indexed: 01/31/2023] Open
Abstract
Dynamic magnetic resonance imaging (MRI) is a non-invasive method that can be used to increase the understanding of the pathomechanics of joints. Various types of real-time gradient echo sequences used for dynamic MRI acquisition of joints include balanced steady-state free precession sequence, radiofrequency-spoiled sequence, and ultra-fast gradient echo sequence. Due to their short repetition time and echo time, these sequences provide high temporal resolution, a good signal-to-noise ratio and spatial resolution, and soft tissue contrast. The prerequisites of the evaluation of joints with dynamic MRI include suitable patient installation and optimal positioning of the joint in the coil to allow joint movement, sometimes with dedicated coil support. There are currently few recommendations in the literature regarding appropriate protocol, sequence standardizations, and diagnostic criteria for the use of real-time dynamic MRI to evaluate joints. This article summarizes the technical parameters of these sequences from various manufacturers on 1.5 T and 3.0 T MRI scanners. We have reviewed pertinent details of the patient and coil positioning for dynamic MRI of various joints. The indications and limitations of dynamic MRI of joints are discussed.
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Affiliation(s)
- Marc Garetier
- Department of Radiology, Military Teaching Hospital Clermont-Tonnerre, Rue du colonel Fonferrier, 29240, Brest, Cedex 9, France. .,Department of Radiology, University Hospital Morvan, Brest, France. .,Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.
| | - Bhushan Borotikar
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,University Hospital, Brest, France
| | - Karim Makki
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Sylvain Brochard
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Physical and Medical Rehabilitation, University Hospital Morvan, Brest, France.,Department of Paediatric Physical and Medical Rehabilitation, Fondation Ildys, Brest, France
| | - François Rousseau
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,IMT Atlantique, UBL, Brest, France
| | - Douraïed Ben Salem
- Laboratory of Medical Information Processing (LATIM), INSERM-UMR 1101, Brest, France.,University of Western Brittany (UBO), Brest, France.,Department of Radiology, University Hospital La Cavale Blanche, Brest, France
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26
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Jerban S, Chang EY, Du J. Magnetic resonance imaging (MRI) studies of knee joint under mechanical loading: Review. Magn Reson Imaging 2019; 65:27-36. [PMID: 31670237 DOI: 10.1016/j.mri.2019.09.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 08/17/2019] [Accepted: 09/15/2019] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) is a very common disease that affects the human knee joint, particularly the articular cartilage and meniscus components which are regularly under compressive mechanical loads. Early-stage OA diagnosis is essential as it allows for timely intervention. The primary non-invasive approaches currently available for OA diagnosis include magnetic resonance imaging (MRI), which provides excellent soft tissue contrast at high spatial resolution. MRI-based knee investigation is usually performed on joints at rest or in a non-weight-bearing condition that does not mimic the actual physiological condition of the joint. This discrepancy may lead to missed detections of early-stage OA or of minor lesions. The mechanical properties of degenerated musculoskeletal (MSK) tissues may vary markedly before any significant morphological or structural changes detectable by MRI. Recognizing distinct deformation characteristics of these tissues under known mechanical loads may reveal crucial joint lesions or mechanical malfunctions which result from early-stage OA. This review article summarizes the large number of MRI-based investigations on knee joints under mechanical loading which have been reported in the literature including the corresponding MRI measures, the MRI-compatible devices employed, and potential challenges due to the limitations of clinical MRI sequences.
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Affiliation(s)
- Saeed Jerban
- Department of Radiology, University of California, San Diego, CA, USA.
| | - Eric Y Chang
- Department of Radiology, University of California, San Diego, CA, USA; Radiology Service, VA San Diego Healthcare System, San Diego, CA, USA
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
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27
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Dzialo CM, Pedersen PH, Jensen KK, de Zee M, Andersen MS. Evaluation of predicted patellofemoral joint kinematics with a moving-axis joint model. Med Eng Phys 2019; 73:85-91. [PMID: 31474509 DOI: 10.1016/j.medengphy.2019.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 07/27/2019] [Accepted: 08/15/2019] [Indexed: 10/26/2022]
Abstract
The main objectives of this study were to expand the moving-axis joint model concept to the patellofemoral joint and evaluate the patellar motion against experimental patellofemoral kinematics. The experimental data was obtained through 2D-to-3D bone reconstruction of EOS images and segmented MRI data utilizing an iterative closest point optimization technique. Six knee model variations were developed using the AnyBody Modeling System and subject-specific bone geometries. These models consisted of various combinations of tibiofemoral (hinge, moving-axis, and interpolated) and patellofemoral (hinge and moving-axis) joint types. The newly introduced interpolated tibiofemoral joint is calibrated from the five EOS quasi-static lunge positions. The patellofemoral axis of the hinge model was defined by performing surface fits to the patellofemoral contact area; and the moving-axis model was defined based upon the position of the patellofemoral joint at 0° and 90° tibiofemoral-flexion. In between these angles, the patellofemoral axis moved linearly as a function of tibiofemoral-flexion, while outside these angles, the axis remained fixed. When using a moving-axis tibiofemoral joint, a hinge patellofemoral joint offers (-5.12 ± 1.23 mm, 5.81 ± 0.97 mm, 14.98 ± 2.30°, -4.35 ± 1.95°) mean differences (compared to EOS) while a moving-axis patellofemoral model provides (-2.69 ± 1.04 mm, 1.13 ± 0.80 mm, 12.63 ± 2.03°, 1.74 ± 1.46°) in terms of lateral-shift, superior translation, patellofemoral-flexion, and patellar-rotation, respectively. Furthermore, the model predictive capabilities increased as a direct result of adding more calibrated positions to the tibiofemoral model (hinge-1, moving-axis-2, and interpolated-5). Overall, a novel subject-specific moving-axis patellofemoral model has been established; that produces realistic patellar motion and is computationally fast enough for clinical applications.
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Affiliation(s)
- C M Dzialo
- AnyBody Technology, A/S Niels Jernes Vej 10, DK 9220 Aalborg, Denmark; Department of Materials and Production, Aalborg University, Fibigerstræde 16, DK-9220 Aalborg, Denmark.
| | - P H Pedersen
- Department of Orthopedic Surgery, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - K K Jensen
- Department of Radiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000 Aalborg, Denmark
| | - M de Zee
- Department of Health Science and Technology, Sport Sciences, Aalborg University, Fredrik Bajers Vej 7D, DK-9220 Aalborg, Denmark
| | - M S Andersen
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, DK-9220 Aalborg, Denmark
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28
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Gruskay JA, Strickland SM, Casey E, Chiaia TA, Green DW, Gomoll AH. Team Approach: Patellofemoral Instability in the Skeletally Immature. JBJS Rev 2019; 7:e10. [PMID: 31365447 DOI: 10.2106/jbjs.rvw.18.00159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Affiliation(s)
- Jordan A Gruskay
- Departments of Orthopedics (J.A.G., S.M.S., D.W.G., and A.H.G.), Physiatry (E.C.), and Sports Rehabilitation (T.A.C.), Hospital for Special Surgery, New York, NY
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29
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Ambra LF, Hinckel BB, Arendt EA, Farr J, Gomoll AH. Anatomic Risk Factors for Focal Cartilage Lesions in the Patella and Trochlea: A Case-Control Study. Am J Sports Med 2019; 47:2444-2453. [PMID: 31287712 DOI: 10.1177/0363546519859320] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Focal cartilage lesions in the patellofemoral (PF) joint are common. Several studies correlated PF risk factors with PF instability, anterior knee pain, and PF arthritis; however, there is a lack of evidence correlating those factors to PF focal cartilage lesions. PURPOSE To evaluate the influence of the anatomic PF risk factors in patients with isolated focal PF cartilage lesions. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients with isolated PF focal cartilage lesions were included in the cartilage lesion group, and patients with other pathologies and normal PF cartilage were included in the control group. Multiple PF risk factors were accessed on magnetic resonance imaging scans: patellar morphology (patellar width, patellar thickness, and patellar angle), trochlear morphology (trochlear sulcus angle, lateral condyle index, and trochlear sulcus depth), patellar height (Insall-Salvati ratio and Caton-Deschamps index), axial patellar positioning (patellar tilt, angle of Fulkerson), and quadriceps vector (tibial tuberosity-trochlear groove distance). RESULTS A total of 135 patients were included in the cartilage lesion group and 100 in the control group. As compared with the control group, the cartilage lesion group had a higher sulcus angle (P = .0007), lower trochlear sulcus depth (P < .0001), lower angle of Fulkerson (P < .0001), lower patellar width (P = .0003), and higher Insall-Salvati ratio (P < .0001). From the patients in the cartilage lesion group, 36% had trochlear dysplasia; 27.6%, patella alta; and 24.7%, abnormal patellar tilt. These parameters were more frequent in the cartilage lesion group (P < .0001). Trochlear lesions were more frequent in men, presented at an older age, and had fewer associated anatomic risk factors. Patellar lesions, conversely, were more frequent in women, presented at younger age, and were more closely associated with anatomic risk factors. CONCLUSION PF anatomic abnormalities are significantly more common in patients with full-thickness PF cartilage lesions. Trochlear dysplasia, patella alta, and excessive lateral patellar tilt are the most common correlated factors, especially in patellar lesions.
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Affiliation(s)
- Luiz Felipe Ambra
- Universidade Federal de São Paulo Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina/UNIFESP, São Paulo, Brazil.,Center for Regenerative Medicine and Center of Cartilage Repair, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Betina B Hinckel
- Department of Orthopedic Surgery, Brigham and Women's Hospital and Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Elizabeth A Arendt
- Department of Orthopedic Surgery, Medical School, University of Minnesota, Minneapolis, Minnesota, USA
| | - Jack Farr
- School of Medicine, Indiana University, OrthoIndy and OrthoIndy Hospital, Greenwood and Indianapolis, Indiana, USA
| | - Andreas H Gomoll
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
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30
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Toward the Development of Data-Driven Diagnostic Subgroups for People With Patellofemoral Pain Using Modifiable Clinical, Biomechanical, and Imaging Features. J Orthop Sports Phys Ther 2019; 49:536-547. [PMID: 31213159 DOI: 10.2519/jospt.2019.8607] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Unfavorable treatment outcomes for people with patellofemoral pain (PFP) have been attributed to the potential existence of subgroups that respond differently to treatment. OBJECTIVES This study aimed to identify subgroups within PFP by combining modifiable clinical, biomechanical, and imaging features and exploring the prognosis of these subgroups. METHODS This was a longitudinal cohort study, with baseline cluster analyses. Baseline data were analyzed using a 2-stage cluster analysis; 10 features were analyzed within 4 health domains before being combined at the second stage. Prognosis of the subgroups was assessed at 12 months, with subgroup differences reported as global rating of change and analyzed with an exploratory logistic regression adjusted for known confounders. RESULTS Seventy participants were included (mean age, 31 years; 43 [61%] female). Cluster analysis revealed 4 subgroups: "strong," "pronation and malalignment," "weak," and "active and flexible." Descriptively, compared to the strong subgroup (55% favorable), the odds of a favorable outcome were lower in the weak subgroup (31% favorable; adjusted odds ratio [OR] = 0.30; 95% confidence interval [CI]: 0.07, 1.36) and the pronation and malalignment subgroup (50%; OR = 0.64; 95% CI: 0.11, 3.66), and higher in the active and flexible subgroup (63%; OR = 1.24; 95% CI: 0.20, 7.51). After adjustment, compared to the strong subgroup, differences between some subgroups remained substantive, but none were statistically significant. CONCLUSION In this relatively small cohort, 4 PFP subgroups were identified that show potentially different outcomes at 12 months. Further research is required to determine whether a stratified treatment approach using these subgroups would improve outcomes for people with PFP. LEVEL OF EVIDENCE Diagnosis, level 2b. J Orthop Sports Phys Ther 2019;49(7):536-547. doi:10.2519/jospt.2019.8607.
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31
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Macri EM, d'Entremont AG, Crossley KM, Hart HF, Forster BB, Wilson DR, Ratzlaff CR, Goldsmith CH, Khan KM. Alignment differs between patellofemoral osteoarthritis cases and matched controls: An upright 3D MRI study. J Orthop Res 2019; 37:640-648. [PMID: 30690776 PMCID: PMC6593798 DOI: 10.1002/jor.24237] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 01/11/2019] [Indexed: 02/04/2023]
Abstract
Patellofemoral (PF) osteoarthritis (OA) is a prevalent and clinically important knee OA subgroup. Malalignment may be an important risk factor for PF OA. However, little is known about alignment in PF OA, particularly in an upright, weightbearing environment. Using a vertically-oriented open-bore MR scanner, we evaluated 3D knee alignment in 15 PF OA cases and 15 individually matched asymptomatic controls. We imaged one knee per participant while they stood two-legged at four flexion angles (0°, 15°, 30°, 45°), and also while they stood one-legged at 30° knee flexion. We calculated 3D patellofemoral and tibiofemoral alignment. Using mixed effects models, four of the five patellofemoral measures differed by group. For key measures, PF OA patellae were 6.6° [95%CI 5.0, 8.2] more laterally tilted, 2.4 mm [1.3, 3.5] more laterally translated, and at least 3.7 mm [0.2, 7.2] more proximally translated compared to controls (more with knees flexed). Alignment did not differ between two-legged stance and one-legged stance in either group. Statement of Clinical Significance: Our study demonstrated significant and clinically relevant differences in alignment between PF OA cases and controls in upright standing and squatting positions. Our findings were similar to those in previous studies of PF OA using traditional MR scanners in supine positions, supporting the clinical usefulness of existing methods aimed at identifying individuals who may benefit from interventions designed to correct malalignment. © 2019 The Authors. Journal of Orthopaedic Research® Published by Wiley Periodicals, Inc. on behalf of the Orthopaedic Research Society. 9999:1-9, 2019.
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Affiliation(s)
- Erin M. Macri
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Agnes G. d'Entremont
- Centre for Hip Health and Mobility, Department of Mechanical EngineeringThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia
| | - Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and EngineeringLa Trobe UniversityMelbourneAustralia,Department of Physical TherapyWestern UniversityLondonOntarioCanada
| | - Bruce B. Forster
- Centre for Hip Health and Mobility, Department of RadiologyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - David R. Wilson
- Centre for Hip Health and Mobility, Department of OrthopaedicsThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Charlie H. Goldsmith
- Faculty of Health SciencesSimon Fraser UniversityBurnabyBritish ColumbiaCanada,Department of Occupational Science and Occupational TherapyThe University of British ColumbiaVancouverBritish ColumbiaCanada
| | - Karim M. Khan
- Centre for Hip Health and Mobility, Department of Family PracticeThe University of British ColumbiaVancouverBritish ColumbiaCanada
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32
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Pal S, Besier TF, Gold GE, Fredericson M, Delp SL, Beaupre GS. Patellofemoral cartilage stresses are most sensitive to variations in vastus medialis muscle forces. Comput Methods Biomech Biomed Engin 2018; 22:206-216. [PMID: 30596523 DOI: 10.1080/10255842.2018.1544629] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The purpose of this study was to evaluate the effects of variations in quadriceps muscle forces on patellofemoral stress. We created subject-specific finite element models for 21 individuals with chronic patellofemoral pain and 16 pain-free control subjects. We extracted three-dimensional geometries from high resolution magnetic resonance images and registered the geometries to magnetic resonance images from an upright weight bearing squat with the knees flexed at 60°. We estimated quadriceps muscle forces corresponding to 60° knee flexion during a stair climb task from motion analysis and electromyography-driven musculoskeletal modelling. We applied the quadriceps muscle forces to our finite element models and evaluated patellofemoral cartilage stress. We quantified cartilage stress using an energy-based effective stress, a scalar quantity representing the local stress intensity in the tissue. We used probabilistic methods to evaluate the effects of variations in quadriceps muscle forces from five trials of the stair climb task for each subject. Patellofemoral effective stress was most sensitive to variations in forces in the two branches of the vastus medialis muscle. Femur cartilage effective stress was most sensitive to variations in vastus medialis forces in 29/37 (78%) subjects, and patella cartilage effective stress was most sensitive to variations in vastus medialis forces in 21/37 (57%) subjects. Femur cartilage effective stress was more sensitive to variations in vastus medialis longus forces in subjects classified as maltrackers compared to normal tracking subjects (p = 0.006). This study provides new evidence of the importance of the vastus medialis muscle in the treatment of patellofemoral pain.
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Affiliation(s)
- Saikat Pal
- a Department of Biomedical Engineering , New Jersey Institute of Technology , Newark , NJ , USA
| | - Thor F Besier
- b Auckland Bioengineering Institute & Department of Engineering Science , University of Auckland , Auckland , New Zealand
| | - Garry E Gold
- c Department of Bioengineering , Stanford University , Stanford , CA , USA.,d Department of Radiology , Stanford University , Stanford , CA , USA.,e Department of Orthopaedic Surgery , Stanford University , Stanford , CA , USA
| | - Michael Fredericson
- e Department of Orthopaedic Surgery , Stanford University , Stanford , CA , USA
| | - Scott L Delp
- c Department of Bioengineering , Stanford University , Stanford , CA , USA.,e Department of Orthopaedic Surgery , Stanford University , Stanford , CA , USA.,f Mechanical Engineering Department , Stanford University , Stanford , CA , USA
| | - Gary S Beaupre
- c Department of Bioengineering , Stanford University , Stanford , CA , USA.,g Musculoskeletal Research Laboratory , VA Palo Alto Health Care System , Palo Alto , CA , USA
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Evaluation of the patellofemoral joint in total knee arthroplasty: Validation of the weight bearing merchant radiographic view. Knee 2018; 25:1262-1271. [PMID: 30409497 DOI: 10.1016/j.knee.2018.08.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Revised: 08/06/2018] [Accepted: 08/18/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Standard radiographic views for patellofemoral joint assessment do not reflect loading at which TKA patients may describe post-operative anterior symptoms. A novel weight bearing (WB) Merchant view has been described and demonstrated a number of tracking changes that correlated with clinical outcomes. In this study, we aim to validate the WB Merchant view and assess relationships with patient outcome scores. METHODS Patients were randomly allocated to receive one of the three commonly used patellar implants with a single TKA prosthesis. Patients were evaluated at six months post-operatively using both NWB and WB Merchant views. Indicators of patellar tracking were correlated with improvement in KOOS, WOMAC and Kujala scores. For reliability assessment, radiographs were assessed twice by two readers. RESULTS The WB Merchant view showed a reduction in the percentage of outliers of tracking indices in comparison to the NWB view (Congruence angle: NWB = 37%, WB = 24%; Displacement: NWB = 2%, WB = 0%; Tilt angle: NWB = 60%, WB = 56%). There was an increase in the lateral contact state with the WB Merchant view (Type I: NWB = 19%, WB = 28%; Type II: NWB = 3%, WB = 4%). The state of lateral contact had a consistent and statistically significant correlation with the improvement in KOOS, WOMAC and Kujala scores (p value = 0.01, 0.01 and 0.03, respectively). All radiographic indices had good reliability with accepted variability. CONCLUSION The WB Merchant radiograph is an easy to perform and reliable view for the evaluation of patellar tracking and may provide additional information to the routinely used NWB view.
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Joint Moment-Angle Properties of the Hip Extensors in Subjects With and Without Patellofemoral Pain. J Appl Biomech 2018; 34:159-166. [PMID: 29140144 DOI: 10.1123/jab.2017-0131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Strength deficits of hip extension in individuals with patellofemoral syndrome are commonly reported in literature. No literature to date has examined these deficits with variable positions of the knee and hip; altering knee angle alters the length and therefore potentially the force produced by the biarticular muscles. Beyond strength, neuromuscular control can also be assessed through the analysis of isometric joint moment steadiness. Subjects consisted of a group of individuals with patellofemoral syndrome (n = 9), and a group of age- and size-matched controls with no symptoms (n = 9). Maximum isometric joint moments for hip extension were measured at 4 points within the joint's range of motion, at 2 different knee positions (0° and 90°) for each group. The joint moment signals were analyzed by computing signal Coefficient of Variation (CV). The results indicate that no significant differences were found between the groups of subjects for the hip extension moments when the knee was extended. However, there was a significant difference between the groups for the joint moments of hip extension with the knee flexed at all 4 hip positions. Results also showed hip extension CV values to be significantly higher in the patellofemoral group compared with the control group, indicating greater signal noise and therefore poorer neuromuscular control of the hip extensor musculature. This study demonstrated that individuals with patellofemoral syndrome have reduced hip extension strength and reduced neuromuscular control with the knee flexed compared with a control group. These results have implications for the etiology of patellofemoral syndrome and its rehabilitation.
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Esfandiarpour F, Lebrun CM, Dhillon S, Boulanger P. In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals. J Orthop Res 2018; 36:2193-2201. [PMID: 29488245 DOI: 10.1002/jor.23887] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 02/16/2018] [Indexed: 02/04/2023]
Abstract
Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Fateme Esfandiarpour
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Musculoskeletal Rehabilitation Research Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Constance M Lebrun
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Sukhvinder Dhillon
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, Canada
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Bruno F, Barile A, Arrigoni F, Laporta A, Russo A, Carotti M, Splendiani A, Di Cesare E, Masciocchi C. Weight-bearing MRI of the knee: a review of advantages and limits. ACTA BIO-MEDICA : ATENEI PARMENSIS 2018; 89:78-88. [PMID: 29350638 PMCID: PMC6179065 DOI: 10.23750/abm.v89i1-s.7011] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 01/11/2018] [Indexed: 12/20/2022]
Abstract
Standard knee imaging with MRI is usually performed with patient in recumbent position under non-weight-bearing conditions. Recently, magnetic resonance imaging systems to scan the knee joint under weight bearing conditions has been proposed as an approach to improve the clinical utility of musculoskeletal MRI. Imaging under loading can be useful to understand the natural motion behavior of the knee joint and to identify conditions that are challenging to diagnose by using standard position. We reviewed the literature on weight-bearing MR imaging of the knee to describe the current state of use of such MRI technologies, evaluating the advantages and the potential limitations of these technologies.
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Borotikar B, Lempereur M, Lelievre M, Burdin V, Ben Salem D, Brochard S. Dynamic MRI to quantify musculoskeletal motion: A systematic review of concurrent validity and reliability, and perspectives for evaluation of musculoskeletal disorders. PLoS One 2017; 12:e0189587. [PMID: 29232401 PMCID: PMC5726646 DOI: 10.1371/journal.pone.0189587] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 11/29/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose To report evidence for the concurrent validity and reliability of dynamic MRI techniques to evaluate in vivo joint and muscle mechanics, and to propose recommendations for their use in the assessment of normal and impaired musculoskeletal function. Materials and methods The search was conducted on articles published in Web of science, PubMed, Scopus, Academic search Premier, and Cochrane Library between 1990 and August 2017. Studies that reported the concurrent validity and/or reliability of dynamic MRI techniques for in vivo evaluation of joint or muscle mechanics were included after assessment by two independent reviewers. Selected articles were assessed using an adapted quality assessment tool and a data extraction process. Results for concurrent validity and reliability were categorized as poor, moderate, or excellent. Results Twenty articles fulfilled the inclusion criteria with a mean quality assessment score of 66% (±10.4%). Concurrent validity and/or reliability of eight dynamic MRI techniques were reported, with the knee being the most evaluated joint (seven studies). Moderate to excellent concurrent validity and reliability were reported for seven out of eight dynamic MRI techniques. Cine phase contrast and real-time MRI appeared to be the most valid and reliable techniques to evaluate joint motion, and spin tag for muscle motion. Conclusion Dynamic MRI techniques are promising for the in vivo evaluation of musculoskeletal mechanics; however results should be evaluated with caution since validity and reliability have not been determined for all joints and muscles, nor for many pathological conditions.
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Affiliation(s)
- Bhushan Borotikar
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
- * E-mail:
| | - Mathieu Lempereur
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
| | | | - Valérie Burdin
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- IMT Atlantique, Brest, France
| | - Douraied Ben Salem
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- Université de Bretagne Occidentale, Brest, France
- CHRU de Brest, Neuroradiologie, Imagerie Médico-Légale, Brest, France
| | - Sylvain Brochard
- Laboratoire de Traitement de l’Information Médicale, INSERM U1101, Brest, France
- CHRU de Brest, Hôpital Morvan, Service de Médecine Physique et de Réadaptation, Brest, France
- Université de Bretagne Occidentale, Brest, France
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Mazzoli V, Schoormans J, Froeling M, Sprengers AM, Coolen BF, Verdonschot N, Strijkers GJ, Nederveen AJ. Accelerated 4D self-gated MRI of tibiofemoral kinematics. NMR IN BIOMEDICINE 2017; 30:e3791. [PMID: 28873255 DOI: 10.1002/nbm.3791] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 06/07/2023]
Abstract
Anatomical (static) magnetic resonance imaging (MRI) is the most useful imaging technique for the evaluation and assessment of internal derangement of the knee, but does not provide dynamic information and does not allow the study of the interaction of the different tissues during motion. As knee pain is often only experienced during dynamic tasks, the ability to obtain four-dimensional (4D) images of the knee during motion could improve the diagnosis and provide a deeper understanding of the knee joint. In this work, we present a novel approach for dynamic, high-resolution, 4D imaging of the freely moving knee without the need for external triggering. The dominant knee of five healthy volunteers was scanned during a flexion/extension task. To evaluate the effects of non-uniform motion and poor coordination skills on the quality of the reconstructed images, we performed a comparison between fully free movement and movement instructed by a visual cue. The trigger signal for self-gating was extracted using principal component analysis (PCA), and the images were reconstructed using a parallel imaging and compressed sensing reconstruction pipeline. The reconstructed 4D movies were scored for image quality and used to derive bone kinematics through image registration. Using our method, we were able to obtain 4D high-resolution movies of the knee without the need for external triggering hardware. The movies obtained with and without instruction did not differ significantly in terms of image scoring and quantitative values for tibiofemoral kinematics. Our method showed to be robust for the extraction of the self-gating signal even for uninstructed motion. This can make the technique suitable for patients who, as a result of pain, may find it difficult to comply exactly with instructions. Furthermore, bone kinematics can be derived from accelerated MRI without the need for additional hardware for triggering.
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Affiliation(s)
- Valentina Mazzoli
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
- Orthopedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
| | - Jasper Schoormans
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Martijn Froeling
- Department of Radiology, University Medical Center, Utrecht, the Netherlands
| | - Andre M Sprengers
- Orthopedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands
- Laboratory for Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Bram F Coolen
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Nico Verdonschot
- Orthopedic Research Laboratory, Radboud University Medical Center, Nijmegen, the Netherlands
- Laboratory for Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| | - Gustav J Strijkers
- Biomedical NMR, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, the Netherlands
- Department of Biomedical Engineering and Physics, Academic Medical Center, Amsterdam, the Netherlands
| | - Aart J Nederveen
- Department of Radiology, Academic Medical Center, Amsterdam, the Netherlands
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Marzo JM, Kluczynski MA, Notino A, Bisson LJ. Measurement of Tibial Tuberosity-Trochlear Groove Offset Distance by Weightbearing Cone-Beam Computed Tomography Scan. Orthop J Sports Med 2017; 5:2325967117734158. [PMID: 29094053 PMCID: PMC5652661 DOI: 10.1177/2325967117734158] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Computed tomography (CT) scans are useful for objectively measuring bone alignment because they show bone detail particularly well, and these scans have been used extensively to assess patellar orientation. The tibial tubercle-trochlear groove (TT-TG) offset distance has been shown to be influenced by knee flexion and weightbearing, yet conventional CT scans are obtained with the subject relaxed, supine, and with the knee in full extension. A new cone-beam CT scanner has been designed to allow for weightbearing images, potentially providing a more physiologically relevant assessment of patellofemoral alignment. PURPOSE/HYPOTHESIS The purpose of this study was to measure the TT-TG offset in healthy individuals without any history of knee complaints when CT scans were obtained while fully weightbearing on a flexed knee. Our hypothesis was that the TT-TG offset measurement in these healthy knees would be reproducible and less than the historically reported normal range. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Twenty healthy volunteers without any history of knee complaint were recruited to undergo a weightbearing cone-beam CT scan of the knee flexed at 30°. The scans were reviewed by a radiologist and an orthopaedic surgeon, and TT-TG offset was measured using the digital tools of a picture archiving and communication system. Paired t tests were used to compare TT-TG offset on 2 separate occasions for both raters. Inter- and intrarater reliability were assessed using a 2-way mixed-effects model intraclass correlation coefficient with corresponding 95% confidence intervals for TT-TG offset. RESULTS The mean TT-TG offset was 2.7 mm. There were no statistically significant differences in TT-TG offset between raters (Prater1 = .70; Prater2 = .49) and time of read (Ptime1 = .83; Ptime2 = .19). Good to moderate interrater reliability was found at the time of both reads, and good intrarater reliability was found for both raters. CONCLUSION When measured by CT scan and obtained from a subject while weightbearing on a flexed knee, the TT-TG offset is reproducible and the distance is less than that obtained via a conventional CT scan.
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Affiliation(s)
- John M. Marzo
- State University of New York at Buffalo, Buffalo, New York, USA
| | | | - Anthony Notino
- State University of New York at Buffalo, Buffalo, New York, USA
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Asai H, Odashiro Y, Inaoka PT. Patellar movement perception related to a backward-leaning standing position. J Phys Ther Sci 2017; 29:1372-1376. [PMID: 28878465 PMCID: PMC5574362 DOI: 10.1589/jpts.29.1372] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 05/24/2017] [Indexed: 01/28/2023] Open
Abstract
[Purpose] To investigate the patellar movement perception related to backward-leaning
standing. [Subjects and Methods] Both the patellar range of motion during backward-leaning
standing and perception related to patellar movement were analyzed using television-x
irradiation images in 12 randomly selected healthy young individuals. [Results] Starting
in a relaxed condition, two types of patellar movements were confirmed: those where the
patella moves (patellar movement trials) and those where the patella does not move
(patellar non-movement trials) during backward-leaning standing. The rate of the perceived
patellar motion in the patellar movement trials was significantly higher (90.9%) than that
in the patellar non-movement trials (66.7%). When starting in a quadriceps-contracted
condition, the rate of perceived trials (77.0%) was significantly lower than that of the
trials started in a relaxed condition. [Conclusion] The perception of patellar movement
while backward-leaning standing may contribute to the perception of a backward standing
position especially when the patella really moves.
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Affiliation(s)
- Hitoshi Asai
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Japan
| | - Yuito Odashiro
- Department of Physical Therapy, Medical Technology Part, Tokachi Rehabilitation Center, Hokuto Social Medical Corporation, Japan
| | - Pleiades Tiharu Inaoka
- Department of Physical Therapy, Graduate Course of Rehabilitation Science, School of Health Sciences, College of Medical, Pharmaceutical, and Health Sciences, Kanazawa University, Japan
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Macri EM, Crossley KM, d'Entremont AG, Hart HF, Forster BB, Wilson DR, Ratzlaff CR, Walsh AM, Khan KM. Patellofemoral and tibiofemoral alignment in a fully weight-bearing upright MR: Implementation and repeatability. J Magn Reson Imaging 2017; 47:841-847. [PMID: 28833914 DOI: 10.1002/jmri.25823] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Accepted: 07/05/2017] [Indexed: 12/25/2022] Open
Abstract
PURPOSE To develop methods for evaluating 3D patellofemoral and tibiofemoral alignment in vertical open-bore magnetic resonance (MR) scanners, with participants upright and fully weight-bearing; and to evaluate the repeatability of these methods in individuals with patellofemoral osteoarthritis (OA) and in asymptomatic knees. MATERIALS AND METHODS Our methods extend previously validated, reliable methods for evaluating alignment into an upright MR environment. In 10 participants with early patellofemoral OA and 10 with asymptomatic knees, we acquired sagittal T1 -weighted turbo spin echo images in a 3T scanner to create accurate participant-specific 3D anatomical surface models. In a vertical open-bore 0.5T MR scanner, we obtained lower-resolution sagittal gradient echo images to capture bony position and orientation data. Participants were scanned in a position of squatting with the knees flexed 30°, three separate times to evaluate repeatability. Bone segmentation was performed manually, surface models were registered to data from the 0.5T scanner, and 3D patellofemoral and tibiofemoral alignment was calculated in all six degrees of freedom (three rotations and three translations). RESULTS Intraclass correlation coefficients (ICCs) were ≥0.94, with the exception of patellar spin (0.79). Standard errors of measure (SEM) were <2° rotation and <0.9 mm translation. Repeatability remained adequate when stratified by group, with the exception of patellar spin (ICC 0.57 for asymptomatic knees vs. 0.91 for OA knees). CONCLUSION We demonstrate methods for evaluating 3D alignment in upright fully weight-bearing participant positions in a vertical open-bore MR scanner. With the exception of patellar spin, repeatability was good to excellent. LEVEL OF EVIDENCE 3 Technical Efficacy: Stage 1 J. Magn. Reson. Imaging 2018;47:841-847.
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Affiliation(s)
- Erin M Macri
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Kay M Crossley
- College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Agnes G d'Entremont
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Mechanical Engineering, University of British Columbia, Vancouver, Canada
| | - Harvi F Hart
- College of Science Health and Engineering, School of Allied Health, La Trobe University, Melbourne, Australia
| | - Bruce B Forster
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Radiology, University of British Columbia, Vancouver, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, Canada
| | - Charles R Ratzlaff
- Department of Medicine, College of Medicine Tucson, University of Arizona Health Sciences, Tucson, Arizona, USA
| | - Anne M Walsh
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Karim M Khan
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, Canada.,Department of Family Practice, University of British Columbia, Vancouver, Canada
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Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability. Knee Surg Sports Traumatol Arthrosc 2017; 25:2405-2413. [PMID: 26482535 DOI: 10.1007/s00167-015-3829-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 10/06/2015] [Indexed: 12/19/2022]
Abstract
PURPOSE This study analysed the effects of upright weight bearing and the knee flexion angle on patellofemoral indices, determined using magnetic resonance imaging (MRI), in patients with patellofemoral instability (PI). METHODS Healthy volunteers (control group, n = 9) and PI patients (PI group, n = 16) were scanned in an open-configuration MRI scanner during upright weight bearing and supine non-weight bearing positions at full extension (0° flexion) and at 15°, 30°, and 45° flexion. Patellofemoral indices included the Insall-Salvati Index, Caton-Deschamp Index, and Patellotrochlear Index (PTI) to determine patellar height and the patellar tilt angle (PTA), bisect offset (BO), and the tibial tubercle-trochlear groove (TT-TG) distance to assess patellar rotation and translation with respect to the femur and alignment of the extensor mechanism. RESULTS A significant interaction effect of weight bearing by flexion angle was observed for the PTI, PTA, and BO for subjects with PI. At full extension, post hoc pairwise comparisons revealed a significant effect of weight bearing on the indices, with increased patellar height and increased PTA and BO in the PI group. Except for the BO, no such changes were seen in the control group. Independent of weight bearing, flexing the knee caused the PTA, BO, and TT-TG distance to be significantly reduced. CONCLUSIONS Upright weight bearing and the knee flexion angle affected patellofemoral MRI indices in PI patients, with significantly increased values at full extension. The observations of this study provide a caution to be considered by professionals when treating PI patients. These patients should be evaluated clinically and radiographically at full extension and various flexion angles in context with quadriceps engagement. LEVEL OF EVIDENCE Explorative case-control study, Level III.
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Skou N, Egund N. Patellar position in weight-bearing radiographs compared with non-weight-bearing: significance for the detection of osteoarthritis. Acta Radiol 2017; 58:331-337. [PMID: 27287401 DOI: 10.1177/0284185116652013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Diagnosis and treatment of patellofemoral disorders including osteoarthritis are currently often based on imaging and clinical assessment with patients in the supine position. Purpose To evaluate differences in patellar position in the trochlear groove and to assess the detection of medial and lateral patellofemoral (PF) osteoarthritis (OA) on axial radiographs in supine and standing positions, respectively. Material and Methods Thirty-five women and 23 men (mean age, 56 years; age range, 18-87 years) referred for routine radiographic examinations of the knees were included. Axial radiographs of the PF joint in both supine non-weight-bearing and standing weight-bearing position in 30° knee flexion were obtained of 111 knees. Measurements performed on the radiographs: patellar tilt, patellar displacement, joint space width, and grade of OA according to Ahlbäck. Results From supine to standing position the patella moved medially and medial joint space width and lateral patellar tilt angle decreased ( P < 0.0001 for the three measured parameters). In the standing position, medial PF OA was observed in 19 knees compared to three knees in the supine position. Fourteen knees had lateral PF OA with almost unchanged grade of OA irrespective of position. Conclusion In weight-bearing positions, the patella is positioned medially in the trochlear groove compared to supine non-weight-bearing positions. Therefore, this study suggests that the common occurrence of medial PF OA can generally not be detected on axial radiographs in supine non-weight-bearing positions and confirms the importance of imaging the PF joint in standing weight-bearing positions.
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Affiliation(s)
- Nikolaj Skou
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Egund
- Department of Radiology, Aarhus University Hospital, Aarhus, Denmark
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Hirschmann A, Buck FM, Herschel R, Pfirrmann CWA, Fucentese SF. Upright weight-bearing CT of the knee during flexion: changes of the patellofemoral and tibiofemoral articulations between 0° and 120°. Knee Surg Sports Traumatol Arthrosc 2017; 25:853-862. [PMID: 26537597 DOI: 10.1007/s00167-015-3853-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/27/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE To prospectively compare patellofemoral and tibiofemoral articulations in the upright weight-bearing position with different degrees of flexion using CT in order to gain a more thorough understanding of the development of diseases of the knee joint in a physiological position. MATERIALS AND METHODS CT scans of the knee in 0°, 30°, 60° flexion in the upright weight-bearing position and in 120° flexion upright without weight-bearing were obtained of 10 volunteers (mean age 33.7 ± 6.1 years; range 24-41) using a cone-beam extremity-CT. Two independent readers quantified tibiofemoral and patellofemoral rotation, tibial tuberosity-trochlear groove distance (TTTG) and patellofemoral distance. Tibiofemoral contact points were assessed in relation to the anteroposterior distance of the tibial plateau. Significant differences between degrees of flexion were sought using Wilcoxon signed-rank test (P < 0.05). RESULTS With higher degrees of flexion, internal tibiofemoral rotation increased (0°/120° flexion; mean, 0.5° ± 4.5/22.4° ± 7.6); external patellofemoral rotation decreased (10.6° ± 7.6/1.6° ± 4.2); TTTG decreased (11.1 mm ±3.7/-2.4 mm ±6.4) and patellofemoral distance decreased (38.7 mm ±3.0/21.0 mm ±7.0). The CP shifted posterior, more pronounced laterally. Significant differences were found for all measurements at all degrees of flexion (P = 0.005-0.037), except between 30° and 60°. ICC was almost perfect (0.80-0.99), except for the assessment of the CP (0.20-0.96). CONCLUSION Knee joint articulations change significantly during flexion using upright weight-bearing CT. Progressive internal tibiofemoral rotation leads to a decrease in the TTTG and a posterior shift of the contact points in higher degrees of flexion. This elucidates patellar malalignment predominantly close to extension and meniscal tears commonly affecting the posterior horns.
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Affiliation(s)
- Anna Hirschmann
- Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland. .,Clinic of Radiology and Nuclear Medicine, University of Basel Hospital, Petersgraben 4, 4031, Basel, Switzerland.
| | - Florian M Buck
- Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Ramin Herschel
- Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Christian W A Pfirrmann
- Department of Radiology, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
| | - Sandro F Fucentese
- Department of Orthopedic Surgery, Orthopedic University Hospital Balgrist, University of Zurich, Forchstrasse 340, 8008, Zurich, Switzerland
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Leibbrandt D, Louw Q. Kinematic factors associated with anterior knee pain during common aggravating activities: a systematic review. PHYSICAL THERAPY REVIEWS 2017. [DOI: 10.1080/10833196.2017.1283832] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Dominique Leibbrandt
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
| | - Quinette Louw
- Faculty of Medicine and Health Sciences, University of Stellenbosch, Physiotherapy Division/FNB-3D Movement Analysis Laboratory , Tygerberg, South Africa
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Wang Q, Huang W, Cai D, Huang H. Biomechanical comparison of single- and double-bundle medial patellofemoral ligament reconstruction. J Orthop Surg Res 2017; 12:29. [PMID: 28193295 PMCID: PMC5304392 DOI: 10.1186/s13018-017-0530-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2016] [Accepted: 02/05/2017] [Indexed: 01/28/2023] Open
Abstract
Background Recurrent patellar dislocation is common clinically, primarily in adolescents. However, the biomechanical properties of single- and double-bundle medial patellofemoral ligament (MPFL) reconstruction remain poorly understood. Methods Six fresh frozen adult cadaveric knee specimens were obtained for this study. Each specimen was fixed at 0° to test the force needed when the patella was laterally shifted 10 mm at a speed of 0.5 mm/s, and the test was repeated three times. This test was repeated when knee flexion was at 0°, 15°, 30°, 45°, 60°, and 90°. All six specimens were tested in four statuses, including MPFL intact, MPFL torn, single-bundle MPFL reconstruction, and double-bundle MPFL reconstruction. Results Similar force is required in these MPFL statuses at 0° of flexion, except for the MPFL torn group with a smaller force (45.5 ± 9.6 N, p < 0.05). The force required in the MPFL torn group reduced from 12.8 to 38.8% compared to other groups, at 0°, 15°, 30°, and 45° of flexion angles. At the flexion of 15°, the double-bundle reconstruction group required a statistically greater force (85.9 ± 10.1 N) compared to the single-bundle reconstruction group (74.0 ± 7.9 N). Interestingly, no statistical difference was found at flexions of 60° and 90° in these four groups. Conclusions Both single-bundle and double-bundle MPFL reconstruction can restore the stability of the patella. The double-bundle reconstruction has an angular synergy effect that simulates the MPFL wide footprint in the patella, which enables it to have greater capacity to resist patellar dislocation before the patella entering the femoral trochlea at a smaller flexion angle.
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Affiliation(s)
- Qing Wang
- Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China.,Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, 111 Liu-hua Avenue, Guangzhou, 510010, China
| | - Wenhan Huang
- Department of Orthopaedics and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, China
| | - Daozhang Cai
- Department of Orthopedics, Academy of Orthopedics Guangdong Province, The Third Affiliated Hospital of Southern Medical University, 183 Zhongshan Avenue West, Guangzhou, 510665, China.
| | - Huayang Huang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, 111 Liu-hua Avenue, Guangzhou, 510010, China.
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Stryker LS, Odum SM, Springer BD, Fehring TK. Role of Patellofemoral Offset in Total Knee Arthroplasty: A Randomized Trial. Orthop Clin North Am 2017; 48:1-7. [PMID: 27886678 DOI: 10.1016/j.ocl.2016.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Total knee arthroplasty occasionally does not meet expectations. This randomized clinical trial assessed the effect of restoration of the native patellofemoral height on clinical outcomes. Group I underwent standard patellar bone resection; group II underwent modified patellar bone resection that adjusted the amount of anterior condylar bone removed and the anterior flange thickness. There were no differences in anterior knee pain, Western Ontario and McMaster Universities Arthritis Index scores, or Knee Injury and Osteoarthritis Outcome Score scores. Patellofemoral compartment height restoration versus patellar height alone does not appear to significantly reduce pain or improve function.
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Affiliation(s)
- Louis S Stryker
- Joint Reconstruction, Department of Orthopaedic Surgery and Rehabilitation, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Drive, MSC-7774, San Antonio, TX 78229, USA
| | - Susan M Odum
- OrthoCarolina Research Institute, 2001 Vail Avenue, Suite 300, Charlotte, NC 28207, USA
| | - Bryan D Springer
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA.
| | - Thomas K Fehring
- OrthoCarolina Hip & Knee Center, 2001 Vail Avenue, Suite 200A, Charlotte, NC 28207, USA
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48
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Willy RW, Meira EP. CURRENT CONCEPTS IN BIOMECHANICAL INTERVENTIONS FOR PATELLOFEMORAL PAIN. Int J Sports Phys Ther 2016; 11:877-890. [PMID: 27904791 PMCID: PMC5095941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
Abstract
UNLABELLED Patellofemoral pain (PFP) has historically been a complex and enigmatic issue. Many of the factors thought to relate to PFP remain after patients' symptoms have resolved making their clinical importance difficult to determine. The tissue homeostasis model proposed by Dye in 2005 can assist with understanding and implementing biomechanical interventions for PFP. Under this model, the goal of interventions for PFP should be to re-establish patellofemoral joint (PFJ) homeostasis through a temporary alteration of load to the offended tissue, followed by incrementally restoring the envelope of function to the baseline level or higher. High levels of PFJ loads, particularly in the presence of an altered PFJ environment, are thought to be a factor in the development of PFP. Clinical interventions often aim to alter the biomechanical patterns that are thought to result in elevated PFJ loads while concurrently increasing the load tolerance capabilities of the tissue through therapeutic exercise. Biomechanics may play a role in PFJ load modification not only when addressing proximal and distal components, but also when considering the involvement of more local factors such as the quadriceps musculature. Biomechanical considerations should consider the entire kinetic chain including the hip and the foot/ankle complex, however the beneficial effects of these interventions may not be the result of long-term biomechanical changes. Biomechanical alterations may be achieved through movement retraining, but the interventions likely need to be task-specific to alter movement patterns. The purpose of this commentary is to describe biomechanical interventions for the athlete with PFP to encourage a safe and complete return to sport. LEVEL OF EVIDENCE 5.
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Affiliation(s)
- Richard W Willy
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | - Erik P Meira
- Black Diamond Physical Therapy, Portland, OR, USA
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Laugharne E, Bali N, Purushothamdas S, Almallah F, Kundra R. Variability of Measurement of Patellofemoral Indices with Knee Flexion and Quadriceps Contraction: An MRI-Based Anatomical Study. Knee Surg Relat Res 2016; 28:297-301. [PMID: 27894177 PMCID: PMC5134784 DOI: 10.5792/ksrr.16.032] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/02/2016] [Accepted: 09/20/2016] [Indexed: 10/31/2022] Open
Abstract
PURPOSE The purpose of this study was to investigate the impact of varying knee flexion and quadriceps activity on patellofemoral indices measured on magnetic resonance imaging (MRI). MATERIALS AND METHODS MRI of the knee was performed in 20 patients for indications other than patellar or patellofemoral pathology. Axial and sagittal sequences were performed in full extension of the knee with the quadriceps relaxed, full extension of the knee with the quadriceps contracted, 30° flexion of the knee with the quadriceps relaxed, and 30° flexion with the quadriceps contracted. Bisect offset, patella tilt angle, Insall-Salvati ratio and Caton-Deschamps index were measured. RESULTS With the knee flexed to 30° and quadriceps relaxed, the mean values of patellar tilt angle, bisect offset, Insall-Salvati ratio and Caton-Deschamps index were all within normal limits. With the knee extended and quadriceps contracted, the mean patellar tilt angle (normal value, <15°) was 14.6° and the bisect offset (normal value, <65%) was 65%, while the Caton-Deschamps index was 1.34 (normal range, 0.6 to 1.3). With the knee extended and quadriceps relaxed, the mean Caton-Deschamps index was 1.31. CONCLUSIONS MRI scanning of the knee in extension with the quadriceps contracted leads to elevated patellofemoral indices. MRI taken with the knee in 30° of flexion allows more reliable assessment of the patellofemoral joint and minimises the confounding effect of quadriceps contraction.
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Affiliation(s)
- Edward Laugharne
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham,
UK
| | - Navi Bali
- Department of Orthopaedics, Royal Orthopaedic Hospital, Birmingham,
UK
| | | | - Faris Almallah
- Department of Orthopaedics, Walsall Manor Hospital, Walsall,
UK
| | - Rik Kundra
- Department of Orthopaedics, Walsall Manor Hospital, Walsall,
UK
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50
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Marzo J, Kluczynski M, Notino A, Bisson L. Comparison of a Novel Weightbearing Cone Beam Computed Tomography Scanner Versus a Conventional Computed Tomography Scanner for Measuring Patellar Instability. Orthop J Sports Med 2016; 4:2325967116673560. [PMID: 28050572 PMCID: PMC5175415 DOI: 10.1177/2325967116673560] [Citation(s) in RCA: 18] [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] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Conventional computed tomography (CT) images are routinely used for diagnosing patellofemoral instability and are obtained with the patient in a supine position, nonweightbearing, with the knee in full extension, and with leg muscles relaxed. A new portable extremity cone beam CT (CBCT) scanner has been developed that may allow for more accurate diagnosis, as imaging can be performed with the patient standing, the knee flexed, and with leg muscles active. PURPOSE/HYPOTHESIS The purpose of this study was to compare CT measurements of patellar alignment on a prototype scanner versus conventional scanner in patients with known patellar instability. The hypothesis was that the measurements obtained with the knee flexed and the patient weightbearing would be less than those obtained from the conventional CT scan. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Twenty patients with a diagnosis of lateral patellar instability were imaged on both a conventional CT scanner and on a prototype CBCT scanner. Objective measures of patellofemoral alignment (tilt angle, congruence angle, tibial tuberosity-trochlear groove [TT-TG] offset) were assessed on images obtained from the prototype and conventional CT scans by 2 independent reviewers. Paired t tests were calculated to compare the mean measurement of patellofemoral alignment obtained from the prototype versus conventional CT. Interrater reliability was assessed using a 2-way mixed-effects model intraclass correlation coefficient (ICC) for tilt angle, congruence angle, and TT-TG offset on the prototype and conventional CT scans. RESULTS Measurements of patellofemoral alignment were significantly less when acquired by the new prototype CBCT scanner while subjects were weightbearing on a flexed knee. On the images from the prototype CBCT scan, the tilt angle averaged 18.2° ± 11.6° compared with 28.1° ± 7.1° on the conventional CT scan (P < .0001). The congruence angle was 3.0° ± 30.1° compared with 26.7° ± 18.1° on the conventional CT scan (P = .0002). Finally, the TT-TG offset distance averaged 12.3 ± 6.3 mm when measured on the CBCT scan compared with 20.1 ± 4.2 mm on the conventional CT scan (P < .0001). Good interrater reliability was found for tilt angle, congruence angle, and TT-TG offset on conventional and CBCT scans (ICC range, 0.79-0.96). CONCLUSION In patients with patellar instability, measurements of patellofemoral alignment are reduced on images obtained from a new weightbearing extremity CBCT scanner on a flexed knee versus conventional CT in the supine position with a fully extended knee. Improvement in objective measurements of patellar alignment should lead to improved clinical and surgical care of patients with this condition.
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Affiliation(s)
- John Marzo
- Department of Orthopaedics, The Jacobs School of Medicine & Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Melissa Kluczynski
- Department of Orthopaedics, The Jacobs School of Medicine & Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Anthony Notino
- Department of Orthopaedics, The Jacobs School of Medicine & Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
| | - Leslie Bisson
- Department of Orthopaedics, The Jacobs School of Medicine & Biomedical Sciences, The State University of New York, University at Buffalo, Buffalo, New York, USA
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