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Demirtaş Y, Katı YA. A novel patella fracture fixation technique: finite element analysis. Arch Orthop Trauma Surg 2023:10.1007/s00402-023-04910-1. [PMID: 37233796 DOI: 10.1007/s00402-023-04910-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 05/10/2023] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Patella fractures account for approximately 1% of all bone fractures. The tension band wiring technique has been used in surgical treatment. However, there is no clear information about the location of the K-wires in sagittal plane. Thus, a transverse fracture line was created in the patella finite element model and fixed with Kirchner (k) wires and cerclage at different angles and compared with two different standard tension band models. MATERIALS AND METHODS A total of 10 finite element models were created to study AO/OTA 34-C1 patella fractures. Two models used the classical tension band method with either circumferential or 8-shaped cerclage wire. The other 8 models used K-wires placed at 45° or 60°, either alone or combination with cerclage wire. A force of 200 N, 400 N, and 800 N were applied at 45° knee angle and the resulting data fracture line opening, surface pressure and stress in the implants were analyzed through finite element analysis. RESULTS When all the results are considered, it was determined that the K-wires 60° crossing at the fracture line and with cerclage modeling was superior to the other models. The diagonal placement of the K-wires with cerclage (could be 45° or 60° medium) was superior to the reference models. CONCLUSIONS This study has shown that the new fixation method we propose could come to the fore as an alternative method to be used successfully in transverse patella fractures and lower complications. In transverse patellar fractures, the use of K-wires crossed at 60° may be a good alternative to the standard method.
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Affiliation(s)
- Yunus Demirtaş
- Department of Orthopedics and Traumatology, Faculty of Medicine, Private Liv Hospital Ankara, Yüksek İhtisas University, Kavaklıdere, Bestekar Cd No: 8, 06680, Çankaya, Ankara, Türkiye.
| | - Yusuf Alper Katı
- Antalya Training and Research Hospital Orthopedics and Traumatology Department, Antalya, Türkiye
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Bishop EL, Kuntze G, Clark ML, Ronsky JL. Tricompartment offloader knee brace reduces sagittal plane knee moments, quadriceps muscle activity, and pain during chair rise and lower in individuals with knee osteoarthritis. Med Eng Phys 2023; 114:103975. [PMID: 37030895 DOI: 10.1016/j.medengphy.2023.103975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 02/27/2023] [Accepted: 03/29/2023] [Indexed: 04/03/2023]
Abstract
The Levitation tricompartment offloader (TCO) knee brace provides an assistive knee extension moment with the goal of unloading all three compartments of the knee and reducing pain for individuals with multicompartment knee osteoarthritis (OA). This study aimed to determine the effect of the TCO brace on sagittal plane knee moments, quadriceps muscle activity, and pain in individuals with multicompartment knee OA. Lower limb kinematics, kinetics, and electromyography data were collected during a chair rise and lower to determine differences between bracing conditions. TCO brace use significantly decreased the peak net knee external flexion moment in high power mode, providing extension assistance during chair rise [p<0.001; mean difference (MD) (98.75% CI) -0.8 (-1.0, -0.6)%BWxH] and bodyweight support during chair lower [p<0.001; -1.1 (-1.6, -0.7)%BWxH]. Quadriceps activation intensity was significantly reduced with brace use by up to 67% for the vastus medialis [Z = -2.55, p = 0.008] and up to 39% for the vastus lateralis [Z = -2.67, p = 0.004]. Participants reported significantly reduced knee pain with the TCO brace worn in high power mode compared to the no brace condition [p = 0.014; MD (97.5% CI) -18.8 (-32.22, -2.34) mm]. These results support the intended mechanism of joint unloading via extension assistance with the TCO brace. The observed biomechanical changes were accompanied by immediate reductions in user reported pain levels, and support the use of the TCO for conservative management to reduce knee pain in patients with multicompartment knee OA.
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Affiliation(s)
- Emily L Bishop
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada.
| | - Gregor Kuntze
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | - Marcia L Clark
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada; Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Janet L Ronsky
- Department of Mechanical and Manufacturing Engineering, Schulich School of Engineering, University of Calgary, Calgary, Alberta, Canada; McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Alberta, Canada
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Watson R, Sullivan B, Stone AV, Jacobs C, Malone T, Heebner N, Noehren B. Lateral Patellar Dislocation: A Critical Review and Update of Evidence-Based Rehabilitation Practice Guidelines and Expected Outcomes. JBJS Rev 2022; 10:01874474-202205000-00004. [PMID: 35748823 DOI: 10.2106/jbjs.rvw.21.00159] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
» Nonoperative treatment of a lateral patellar dislocation produces favorable functional results, but as high as 35% of individuals experience recurrent dislocations. » Medial patellofemoral ligament reconstruction is an effective treatment to prevent recurrent dislocations and yield excellent outcomes with a high rate of return to sport. » Both nonoperative and postoperative rehabilitation should center on resolving pain and edema, restoring motion, and incorporating isolated and multijoint progressive strengthening exercises targeting the hip and knee. » Prior to return to sports, both functional and isolated knee strength measurements should be used to determine leg symmetry strength and to utilize patient-reported outcome measures to assess the patient's perceived physical abilities and patellofemoral joint stability.
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Affiliation(s)
- Richard Watson
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Breanna Sullivan
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Austin V Stone
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Cale Jacobs
- Department of Orthopaedic Surgery and Sports Medicine, University of Kentucky, Lexington, Kentucky
| | - Terry Malone
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
| | - Nicholas Heebner
- Department of Athletic Training, University of Kentucky, Lexington, Kentucky
| | - Brian Noehren
- Department of Physical Therapy, University of Kentucky, Lexington, Kentucky
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Wierer G, Winkler PW, Pomwenger W, Plachel F, Moroder P, Seitlinger G. Transpatellar bone tunnels perforating the lateral or anterior cortex increase the risk of patellar fracture in MPFL reconstruction: a finite element analysis and survey of the International Patellofemoral Study Group. Knee Surg Sports Traumatol Arthrosc 2022; 30:1620-1628. [PMID: 34333671 DOI: 10.1007/s00167-021-06682-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/22/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE (1) To determine applied patellar drilling techniques for medial patellofemoral ligament (MPFL) reconstruction among members of the International Patellofemoral Study Group (IPSG) and (2) to evaluate the risk of patellar fracture for various patellar bone tunnel locations based on a finite element analysis (FEA) model. METHODS In the first part of the study, an online survey on current MPFL reconstruction techniques was conducted among members of the IPSG. In the second part of the study, a three-dimensional FEA model of a healthy knee joint was created using a computed tomography scan. Patient-specific bone density was integrated into the patella, and cartilage of 3 mm thickness was modeled for the patellofemoral joint. According to the survey's results, two different types of patellar bone tunnels (bone socket and transpatellar bone tunnel) were simulated. The risk of patellar fracture was evaluated based on the fracture risk volume (FRV) obtained from the FEA. RESULTS Finite element analysis revealed that subchondral bone socket tunnel placement is associated with the lowest FRV but increased with an anterior offset (1-5 mm). Transpatellar bone tunnels violating the lateral or anterior cortex showed a higher FRV compared to bone socket, with the highest values observed when the anterior cortex was penetrated. CONCLUSION Violation of the anterior or lateral patellar cortex using transpatellar bone tunnels increased FRV compared to a subchondral patellar bone socket tunnel. In MPFL reconstruction, subchondral patellar bone socket tunnels should be considered for patellar graft fixation to avoid the risk of postoperative patellar fracture. LEVEL OF EVIDENCE Survey; Descriptive laboratory study/Level V.
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Affiliation(s)
- Guido Wierer
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria. .,Research Unit for Orthopaedic Sports Medicine and Injury Prevention, Institute for Sports Medicine, Alpine Medicine and Health Tourism (ISAG), UMIT, Eduard-Wallnöfer-Zentrum 1, 6060, Hall in Tirol, Austria.
| | - Philipp W Winkler
- Department for Orthopaedic Sports Medicine, Klinikum Rechts Der Isar, Technical University of Munich, Ismaninger Str. 22, 81675, Munich, Germany
| | - Werner Pomwenger
- Department of Information Technology & Systems, Salzburg University of Applied Sciences, Urstein Süd 1, 5412, Puch bei Salzburg, Austria
| | - Fabian Plachel
- Department of Orthopedics and Traumatology, Paracelsus Medical University Salzburg, Müllner Hauptstraße 48, 5020, Salzburg, Austria.,Center for Musculoskeletal Surgery, Charité -Universitatsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Philipp Moroder
- Center for Musculoskeletal Surgery, Charité -Universitatsmedizin Berlin, Augustenburgerplatz 1, 13353, Berlin, Germany
| | - Gerd Seitlinger
- Orthofocus, Guggenbichlerstrasse 20, 5026, Salzburg, Austria
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Salvatore G, Berton A, Orsi A, Egan J, Walley KC, Johns WL, Kheir N, Ramappa AJ, DeAngelis JP, Longo UG, Denaro V, Nazarian A. Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability. Arthroscopy 2022; 38:953-964. [PMID: 34411682 DOI: 10.1016/j.arthro.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and validate a finite element (FE) model of the patellofemoral (PF) joint to characterize patellofemoral instability, and to highlight the effect of lateral retinacular release in combination with tibial tuberosity transfer with respect to contact pressures (CP), contact area (CA), and kinematics during knee flexion. METHODS A comprehensive, dynamic FE model of the knee joint was developed and validated through parametric comparison of PF kinematics, CP, and CA between FE simulations and in vitro, cadaveric experiments. Using this FE model, we characterized the effect of patellar instability, lateral retinacular release (LR), and tibial tuberosity transfer (TTT) in the setting of medial patellofemoral ligament injury during knee flexion. RESULTS There was a high level of agreement in CP, CA, lateral patellar displacement, anterior patellar displacement, and superior patellar displacement between the FE model and the in vitro data (P values 0.19, 0.16, 0.81, 0.10, and 0.36, respectively). Instability conditions demonstrated the greatest CP compared to all of the other conditions. During all degrees of flexion, TTT and concomitant lateral release (TTT + LR) decreased CP significantly. TTT alone shows a consistently lower CA compared to nonrelease conditions with subsequent lateral release further decreasing CA. CONCLUSIONS The results of this study demonstrate that the FE model described reliably simulates PF kinematics and CP within 1 SD in uncomplicated cadaveric specimens. The FE model is able to show that tibial tubercle transfer in combination with lateral retinacular release markedly decreases patellofemoral CP and CA and increases lateral patellar displacement that may decrease bony stabilization of the patella within the trochlear groove and promote lateral patellar instability. CLINICAL RELEVANCE The goal of surgical correction for patellar instability focuses on reestablishing normal PF kinematics. By developing an FE model that can demonstrate patient PF kinematics and the results of different surgical approaches, surgeons may tailor their treatment to the best possible outcome. Of the surgical approaches that have been described, the biomechanical effects of the combination of TTT with lateral retinacular release have not been studied. Thus, the FE analysis will help shed light on the effect of the combination of TTT with lateral retinacular release on PF kinematics.
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Affiliation(s)
- Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Jonathan Egan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan
- Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Mochizuki T, Blaha JD, Tanifuji O, Yamagiwa H, Kai S, Kawashima H. The three-dimensional quadriceps vector is most parallel to the spherical axis in Japanese varus osteoarthritic knees. Knee 2021; 33:200-209. [PMID: 34666288 DOI: 10.1016/j.knee.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 06/26/2021] [Accepted: 09/05/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The quadriceps femoris may be a reliable reference to proper alignment in total knee arthroplasty (TKA). We previously showed the quadriceps vector (QV) to be the most parallel to the spherical axis (SA-center hip to center medial condyle) for healthy knees. The purpose of this study was to determine whether the QV is the most parallel to the SA in knees with varus osteoarthritis (OA). METHODS CT imaging for 35 varus OA and 40 healthy Japanese knees was used to construct 3D models of the femur, patella and each quadriceps component for each subject. The QV was calculated using principal component analysis for direction and was compared with the relationship of the QV to the measurement axes of the lower extremity, including the anatomical, mechanical and spherical axes. RESULTS The direction of the QV for the OA knee group was different from that for the healthy knee group in 3D space (medio-lateral direction: women, p = 0.532, men, p = 0.540; antero-posterior direction: women, p = 0.141, men, p < 0.001). However, the angle of the QV in relation to measurement axes in the coronal plane was closest to the SA in both groups (around 1°), with no difference between the groups (women, p = 0.382, men, p = 0.943). CONCLUSION In the coronal plane, the SA most closely approximates the QV for both healthy and OA knees. The more posterior QV position in the 3D space may affect the patellofemoral joint.
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Affiliation(s)
- Tomoharu Mochizuki
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan; Department of Orthopaedic Surgery, University of Michigan, MI, USA.
| | - John David Blaha
- Department of Orthopaedic Surgery, University of Michigan, MI, USA.
| | - Osamu Tanifuji
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hiroshi Yamagiwa
- Deparment of Orthopaedic Surgery, Saiseikai Niigata Hospital, Niigata, Japan
| | - Shin Kai
- Center for Fostering Innovative Leadership, Institute for Research Collaboration and Promotion, Niigata University, Niigata, Japan
| | - Hiroyuki Kawashima
- Division of Orthopaedic Surgery, Department of Regenerative and Transplant Medicine, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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The effect of stretch-shortening magnitude and muscle-tendon unit length on performance enhancement in a stretch-shortening cycle. Sci Rep 2021; 11:14605. [PMID: 34272461 PMCID: PMC8285374 DOI: 10.1038/s41598-021-94046-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 07/06/2021] [Indexed: 12/02/2022] Open
Abstract
Stretch-induced residual force enhancement (rFE) is associated with increased performance in a stretch–shortening cycle (SSC). Although the influence of different range of motions and muscle–tendon unit lengths has been investigated in pure stretch-hold experiments in vivo, the contribution to a SSC movement in human muscles remains unclear. In two sessions, 25 healthy participants performed isometric reference (ISO), shortening hold (SHO) and SSC contractions on an isokinetic dynamometer. We measured the net knee-joint torque, rotational mechanical work, knee kinematics and fascicle behavior (m. vastus lateralis) of the upper right leg.
In session 1 the SHO- and SSC-magnitude was changed respectively (SHO: 50°–20°, 80°–20° and 110°–20°; SSC: 20°–50°–20°, 20°–80°–20° and 20°–110°–20°) and in session 2 the muscle–tendon unit length (SHO: 50°–20°, 80°–50° and 110°–80°; SSC: 20°–50°–20°, 50°–80°–50° and 80°–110°–80°; straight leg = 0°). In both sessions, rotational work was significantly (p < 0.05) increased in the SSC compared to the SHO contractions (in the range of 8.1–17.9%). No significant difference of joint torque was found in the steady-state for all SSC-magnitudes compared to the corresponding SHO contractions in session 1. In session 2, we found only significantly (p < 0.05) less depressed joint torque in the SSC at the longest muscle–tendon unit length compared to the corresponding SHO condition, without any differences in knee kinematics and fascicle behavior. Therefore, the physiological relevance of rFE might be particularly important for movements at greater muscle–tendon unit lengths.
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Akbar M, Farahmand F, Arjmand N. Mechanical characterization of the ligaments in subject-specific models of the patellofemoral joint using in vivo laxity tests. Knee 2019; 26:1220-1233. [PMID: 30948304 DOI: 10.1016/j.knee.2018.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 06/22/2018] [Accepted: 10/02/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND The purpose of this study was to propose a methodology for mechanical characterization of the ligaments in subject-specific models of the patellofemoral joint (PFJ) of living individuals. METHOD PFJ laxity tests were performed on a healthy volunteer using a specially designed loading apparatus under biplane fluoroscopy. A three-dimensional (3D) parametric model of the PFJ was developed in the framework of the rigid body spring model using the geometrical data acquired from the subject's computed tomography and magnetic resonance images. The stiffness and pre-strains of the medial and lateral PFJ ligaments were characterized using a two-step optimization procedure which minimized the deviation between the model predictions and the calibration test results. Sensitivity analyses were performed to investigate the effect of mechanical properties of the non-characterized model components on the characterization procedure and its results. RESULTS The overall findings indicate that the proposed methodology is applicable and can improve the model predictions effectively. For the subject under study, ligament characterization reduced the root mean square of the deviations between the patellar shift and tilt predicted by the model and obtained experimentally for the validation laxity test (from 6.2 mm to 0.5 mm, and from 8.4° to 1.5°, respectively) and passive knee flexion test (from 1.4 mm to 0.3 mm, and from 2.3° to 1.3°, respectively). The non-characterized mechanical properties were found to have a minimal effect on the characterization procedure and its results. CONCLUSION The proposed methodology can help in developing truly patient-specific models of the PFJ, to be used for personalized preplanning of the clinical interventions.
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Affiliation(s)
- Mohammad Akbar
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
| | - Farzam Farahmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran; RCBTR, Tehran University of Medical Sciences, Tehran, Iran.
| | - Navid Arjmand
- Mechanical Engineering Department, Sharif University of Technology, Tehran, Iran
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Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model. J Clin Med 2019; 8:jcm8122093. [PMID: 31805708 PMCID: PMC6947356 DOI: 10.3390/jcm8122093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 11/26/2019] [Accepted: 11/29/2019] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee. METHODS A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction). RESULTS In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee. CONCLUSIONS The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.
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Sanchis-Alfonso V, Alastruey-López D, Ginovart G, Montesinos-Berry E, García-Castro F, Ramírez-Fuentes C, Monllau JC, Alberich-Bayarri A, Pérez MA. Parametric finite element model of medial patellofemoral ligament reconstruction model development and clinical validation. J Exp Orthop 2019; 6:32. [PMID: 31278510 PMCID: PMC6611858 DOI: 10.1186/s40634-019-0200-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 06/21/2019] [Indexed: 11/10/2022] Open
Abstract
Background Currently, there is uncertainty regarding the long-term outcome of medial patellofemoral ligament reconstructions (MPFLr). Our objectives were: (1) to develop a parametric model of the patellofemoral joint (PFJ) enabling us to simulate different surgical techniques for MPFLr; (2) to determine the negative effects on the PFJ associated with each technique, which could be related to long-term deterioration of the PFJ. Methods A finite element model of the PFJ was created based on CT data from 24 knees with chronic lateral patellar instability. Patella contact pressure and maximum MPFL-graft stress at five angles of knee flexion (0, 30, 60, 90 and 120°) were analysed in three types of MPFLr: anatomic, non-anatomic with physiometric behaviour, and non-anatomic with non-physiometric behaviour. Results An increase in patella contact pressure was observed at 0 and 30° of knee flexion after both anatomic and non-anatomic MPFLr with physiometric behaviour. In both reconstructions, the ligament was tense between 0 and 30° of knee flexion, but at 60, 90 and 120°, it had no tension. In the third reconstruction, the behaviour was completely the opposite. Conclusion A parametric model of the PFJ enables us to evaluate different types of MPFLr throughout the full range of motion of the knee, regarding the effect on the patellofemoral contact pressure, as well as the kinematic behaviour of the MPFL-graft and the maximum MPFL-graft stress. Electronic supplementary material The online version of this article (10.1186/s40634-019-0200-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Vicente Sanchis-Alfonso
- Department of Orthopaedic Surgery, Hospital Arnau de Vilanova, C/Sant Climent, 12, 46015, Valencia, Spain.
| | - Diego Alastruey-López
- Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
| | - Gerad Ginovart
- Department of Orthopaedic Surgery, Hospital Terres de l'Ebre, Tortosa, Spain
| | | | | | - Cristina Ramírez-Fuentes
- Hospital Universitario y Politécnico La Fe and Biomedical Imaging Research Group (GIBI230), IIS La Fe Research Group, Valencia, Spain
| | - Joan Carles Monllau
- Department of Orthopaedic Surgery and Traumatology, Hospital del Mar, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Angel Alberich-Bayarri
- QUIBIM SL, Quantitative Imaging Biomarkers in Medicine, GIBI230, Biomedical Imaging Research Group, La Fe Health Research Institute, Valencia, Spain
| | - María Angeles Pérez
- Multiscale in Mechanical and Biological Engineering (M2BE), Aragón Institute of Engineering Research (I3A), Department of Mechanical Engineering, University of Zaragoza, Zaragoza, Spain
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Nettrour JF, Razu SS, Keeney JA, Guess TM. Femoral Component Malrotation Produces Quadriceps Weakness and Impaired Ambulatory Function following Total Knee Arthroplasty: Results of a Forward-Dynamic Computer Model. J Knee Surg 2019; 33:1121-1127. [PMID: 31269527 DOI: 10.1055/s-0039-1692486] [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: 02/07/2023]
Abstract
Proper placement of the prosthetic components is believed to be an important factor in successful total knee arthroplasty (TKA). Implant positioning errors have been associated with postoperative pain, suboptimal function, and inferior patient-reported outcome measures. The purpose of this study was to investigate the biomechanical effects of femoral component malrotation on quadriceps function and normal ambulation. For the investigation, publicly available data were used to create a validated forward-dynamic, patient-specific computer model. The incorporated data included medical imaging, gait laboratory measurements, knee loading information, electromyographic data, strength testing, and information from the surgical procedure. The ideal femoral component rotation was set to the surgical transepicondylar axis and walking simulations were subsequently performed with increasing degrees of internal and external rotation of the femoral component. The muscle force outputs were then recorded for the quadriceps musculature as a whole, as well as for the individual constituent muscles. The quadriceps work requirements during walking were then calculated for the different rotational simulations. The highest forces generated by the quadriceps were seen during single-limb stance phase as increasing degrees of femoral internal rotation produced proportional increases in quadriceps force requirements. The individual muscles of the quadriceps displayed different sensitivities to the rotational variations introduced into the simulations with the vastus lateralis showing the greatest changes with rotational positioning. Increasing degrees of internal rotation of femoral component were also seen to demand increasing quadriceps work to support normal ambulation. In conclusion, internal malrotation of the femoral component during TKA produces a mechanically disadvantaged state which is characterized by greater required quadriceps forces (especially the vastus lateralis) and greater quadriceps work to support normal ambulation.
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Affiliation(s)
- John F Nettrour
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Swithin S Razu
- Department of Bioengineering, University of Missouri, Columbia, Missouri
| | - James A Keeney
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
| | - Trent M Guess
- Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri
- Department of Physical Therapy, University of Missouri, Columbia, Missouri
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Visscher RM, Rossi D, Friesenbichler B, Dohm‐Acker M, Rosenheck T, Maffiuletti NA. Vastus medialis and lateralis activity during voluntary and stimulated contractions. Muscle Nerve 2017; 56:968-974. [DOI: 10.1002/mus.25542] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 12/22/2016] [Accepted: 12/24/2016] [Indexed: 12/27/2022]
Affiliation(s)
- Rosa M.S. Visscher
- Human Performance Lab, Schulthess ClinicLengghalde 2, 8008Zurich Switzerland
| | - Diego Rossi
- Human Performance Lab, Schulthess ClinicLengghalde 2, 8008Zurich Switzerland
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Reduced activation in isometric muscle action after lengthening contractions is not accompanied by reduced performance fatigability. Sci Rep 2016; 6:39052. [PMID: 27966620 PMCID: PMC5155269 DOI: 10.1038/srep39052] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 11/16/2016] [Indexed: 01/16/2023] Open
Abstract
After active lengthening contractions, a given amount of force can be maintained with less muscle activation compared to pure isometric contractions at the same muscle length and intensity. This increase in neuromuscular efficiency is associated with mechanisms of stretch-induced residual force enhancement. We hypothesized that stretch-related increase in neuromuscular efficiency reduces fatigability of a muscle during submaximal contractions. 13 subjects performed 60 s isometric knee extensions at 60% of maximum voluntary contraction (MVC) with and without prior stretch (60°/s, 20°). Each 60 s trial was preceded and followed by neuromuscular tests consisting of MVCs, voluntary activation (VA) and resting twitches (RT), and there was 4 h rest between sets. We found a significant (p = 0.036) 10% reduction of quadriceps net-EMG after lengthening compared to pure isometric trials. However, increase in neuromuscular efficiency did not influence the development of fatigue. Albeit we found severe reduction of MVC (30%), RT (30%) and VA (5%) after fatiguing trials, there were no differences between conditions with and without lengthening. As the number of subjects showing no activation reduction increased with increasing contraction time, intensity may have been too strenuous in both types of contractions, such that a distinction between different states of fatigue was not possible anymore.
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Yin L, Liao TC, Yang L, Powers CM. Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study. Clin Orthop Relat Res 2016; 474:2451-2461. [PMID: 27577067 PMCID: PMC5052208 DOI: 10.1007/s11999-016-5027-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 08/05/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. QUESTIONS/PURPOSES We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? METHODS Subject-specific finite-element models were created for 10 individuals with patella alta (mean Insall-Salvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. RESULTS Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0.10 MPa vs 0.92 ± 0.10 MPa; mean difference, 0.04 MPa [95% CI, 0.02 MPa-0.05 MPa], p < 0.01; effect size of 1.64 [Cohen's d], with Insall-Salvati ratio decreased to 0.95). For both procedures, the trend of stress reduction plateaued when the Install-Salvati ratio approached 0.95. CONCLUSIONS Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. CLINICAL RELEVANCE This study suggests that distalization may result in less stress than distalization + tenodesis, therefore future clinical research might be preferentially directed toward evaluating isolated distalization procedures.
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Affiliation(s)
- Li Yin
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA
| | - Tzu-Chieh Liao
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA
| | - Liu Yang
- Center for Joint Surgery, Southwest Hospital, The Third Military Medical University, Chongqing, China
| | - Christopher M Powers
- Jacquelin Perry Musculoskeletal Biomechanics Research Lab, Division of Biokinesiology and Physical Therapy, University of Southern California, 1540 E Alcazar Street, CHP-155, Los Angeles, CA, 90089-9006, USA.
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Dagneaux L, Thoreux P, Eustache B, Canovas F, Skalli W. Sequential 3D analysis of patellofemoral kinematics from biplanar x-rays: In vitro validation protocol. Orthop Traumatol Surg Res 2015; 101:811-8. [PMID: 26514850 DOI: 10.1016/j.otsr.2015.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2015] [Revised: 07/19/2015] [Accepted: 07/23/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Developing criteria for assessing patellofemoral kinematics is crucial to understand, evaluate, and monitor patellofemoral function. The objective of this study was to assess a sequential 3D analysis method based on biplanar radiographs, using an in vitro protocol. HYPOTHESIS Biplanar radiography combined with novel 3D reconstruction methods provides a reliable evaluation of patellofemoral function, without previous imaging. MATERIAL AND METHODS Eight cadaver specimens were studied during knee flexion cycles from 0° to 60° induced by an in vitro simulator. The protocol was validated by investigating sequential and continuous motion using an optoelectronic system, evaluating measurement accuracy and reproducibility using metallic beads embedded in the patella, and comparing the 3D patellar geometry to computed tomography (CT) images. RESULTS The differences in position between the sequential and continuous kinematic analyses were less than 1mm and 1°. The protocol proved reliable for tracking several components of knee movements, including patellar translations, flexion, and tilt. In this analysis, uncertainty was less than 2 mm for translations and less than 3° for rotations, except rotation in the coronal plane. For patellar tilt, uncertainty was 5°. Mean difference in geometry was 0.49 mm. DISCUSSION Sequential analysis results are consistent with continuous kinematics. This analysis method provides patellar position parameters without requiring previous CT or magnetic resonance imaging. A clinical study may deserve consideration to identify patellofemoral kinematic profiles and position criteria in vivo. LEVEL OF EVIDENCE IV, experimental study.
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Affiliation(s)
- L Dagneaux
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France; Département de chirurgie orthopédique et traumatologie, unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France.
| | - P Thoreux
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France; Hôpital Avicenne, université Paris 13, Sorbonne Paris Cité, AP-HP, 93017 Bobigny, France
| | - B Eustache
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France
| | - F Canovas
- Département de chirurgie orthopédique et traumatologie, unité de chirurgie du membre inférieur, hôpital Lapeyronie, CHRU Montpellier, 371, avenue Gaston-Giraud, 34295 Montpellier cedex 5, France
| | - W Skalli
- Institut de biomécanique humaine Georges-Charpak, arts et metiers ParisTech (ENSAM), 151, boulevard de l'Hôpital, 75013 Paris, France
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16
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Ho KY, Keyak JH, Powers CM. Comparison of patella bone strain between females with and without patellofemoral pain: a finite element analysis study. J Biomech 2013; 47:230-6. [PMID: 24188973 DOI: 10.1016/j.jbiomech.2013.09.010] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2013] [Revised: 08/27/2013] [Accepted: 09/10/2013] [Indexed: 11/27/2022]
Abstract
Elevated bone principal strain (an indicator of potential bone injury) resulting from reduced cartilage thickness has been suggested to contribute to patellofemoral symptoms. However, research linking patella bone strain, articular cartilage thickness, and patellofemoral pain (PFP) remains limited. The primary purpose was to determine whether females with PFP exhibit elevated patella bone strain when compared to pain-free controls. A secondary objective was to determine the influence of patella cartilage thickness on patella bone strain. Ten females with PFP and 10 gender, age, and activity-matched pain-free controls participated. Patella bone strain fields were quantified utilizing subject-specific finite element (FE) models of the patellofemoral joint (PFJ). Input parameters for the FE model included (1) PFJ geometry, (2) elastic moduli of the patella bone, (3) weight-bearing PFJ kinematics, and (4) quadriceps muscle forces. Using quasi-static simulations, peak and average minimum principal strains as well as peak and average maximum principal strains were quantified. Cartilage thickness was quantified by computing the perpendicular distance between opposing voxels defining the cartilage edges on axial plane magnetic resonance images. Compared to the pain-free controls, individuals with PFP exhibited increased peak and average minimum and maximum principal strain magnitudes in the patella. Additionally, patella cartilage thickness was negatively associated with peak minimum principal patella strain and peak maximum principal patella strain. The elevated bone strain magnitudes resulting from reduced cartilage thickness may contribute to patellofemoral symptoms and bone injury in persons with PFP.
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Affiliation(s)
- Kai-Yu Ho
- Department of Physical Therapy, University of Nevada, Las Vegas, NV, USA
| | - Joyce H Keyak
- Department of Radiological Sciences, University of California, Irvine, CA, USA; Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA
| | - Christopher M Powers
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA.
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Schiefer MA, Freeberg M, Pinault GJC, Anderson J, Hoyen H, Tyler DJ, Triolo RJ. Selective activation of the human tibial and common peroneal nerves with a flat interface nerve electrode. J Neural Eng 2013; 10:056006. [PMID: 23918148 DOI: 10.1088/1741-2560/10/5/056006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Electrical stimulation has been shown effective in restoring basic lower extremity motor function in individuals with paralysis. We tested the hypothesis that a flat interface nerve electrode (FINE) placed around the human tibial or common peroneal nerve above the knee can selectively activate each of the most important muscles these nerves innervate for use in a neuroprosthesis to control ankle motion. APPROACH During intraoperative trials involving three subjects, an eight-contact FINE was placed around the tibial and/or common peroneal nerve, proximal to the popliteal fossa. The FINE's ability to selectively recruit muscles innervated by these nerves was assessed. Data were used to estimate the potential to restore active plantarflexion or dorsiflexion while balancing inversion and eversion using a biomechanical simulation. MAIN RESULTS With minimal spillover to non-targets, at least three of the four targets in the tibial nerve, including two of the three muscles constituting the triceps surae, were independently and selectively recruited in all subjects. As acceptable levels of spillover increased, recruitment of the target muscles increased. Selective activation of muscles innervated by the peroneal nerve was more challenging. SIGNIFICANCE Estimated joint moments suggest that plantarflexion sufficient for propulsion during stance phase of gait and dorsiflexion sufficient to prevent foot drop during swing can be achieved, accompanied by a small but tolerable inversion or eversion moment.
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Affiliation(s)
- M A Schiefer
- Louis Stokes Cleveland Department of Veterans' Affairs Medical Center, Cleveland OH, USA. Department of Biomedical Engineering, Case Western Reserve University, Cleveland OH, USA. MetroHealth Medical Center, Cleveland OH, USA
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The vector of quadriceps pull is directed from the patella to the femoral neck. Clin Orthop Relat Res 2013; 471:1014-20. [PMID: 23263931 PMCID: PMC3563781 DOI: 10.1007/s11999-012-2741-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2012] [Accepted: 12/03/2012] [Indexed: 01/31/2023]
Abstract
BACKGROUND The quadriceps is the primary extensor of the knee. Its vector, which is perpendicular to the flexion axis of the knee, is important in understanding knee function and properly aligning total knee components. Three-dimensional (3-D) imaging enables evaluation using a 3-D model of each quadriceps component. QUESTIONS/PURPOSES We calculated the direction and magnitude of the quadriceps vector (QV) and the precision of the measurement, and asked whether the QV bears a constant relationship to the femur and is aligned with an anatomically based axis on the femur. METHODS Using CT data of 14 subjects, we created a 3-D solid model of each quadriceps muscle component. Vectors (3-D direction and length) for each quadriceps component were determined using principal component analysis for muscle direction and volume for magnitude; vector addition established the directional vector of the combined muscle. The combined vector originating in the center of the patella was compared with the shaft, mechanical, and spherical (center femoral head to center medial side of the knee) axes. RESULTS The QV passed from the patella center proximally crossing the femoral neck between the femoral head and greater trochanter and was most closely aligned with the spherical axis. CONCLUSIONS The QV axis may be an important reference for alignment of total knee components. CLINICAL RELEVANCE The spherical axis can be used in aligning total knee components to the flexion axis of the knee.
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Akbar M, Farahmand F, Jafari A, Foumani MS. A detailed and validated three dimensional dynamic model of the patellofemoral joint. J Biomech Eng 2012; 134:041005. [PMID: 22667680 DOI: 10.1115/1.4006403] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
A detailed 3D anatomical model of the patellofemoral joint was developed to study the tracking, force, contact and stability characteristics of the joint. The quadriceps was considered to include six components represented by 15 force vectors. The patellar tendon was modeled using four bundles of viscoelastic tensile elements. Each of the lateral and medial retinaculum was modeled by a three-bundle nonlinear spring. The femur and patella were considered as rigid bodies with their articular cartilage layers represented by an isotropic viscoelastic material. The geometrical and tracking data needed for model simulation, as well as validation of its results, were obtained from an in vivo experiment, involving MR imaging of a normal knee while performing isometric leg press against a constant 140 N force. The model was formulated within the framework of a rigid body spring model and solved using forth-order Runge-Kutta, for knee flexion angles between zero and 50 degrees. Results indicated a good agreement between the model predictions for patellar tracking and the experimental results with RMS deviations of about 2 mm for translations (less than 0.7 mm for patellar mediolateral shift), and 4 degrees for rotations (less than 3 degrees for patellar tilt). The contact pattern predicted by the model was also consistent with the results of the experiment and the literature. The joint contact force increased linearly with progressive knee flexion from 80 N to 210 N. The medial retinaculum experienced a peak force of 18 N at full extension that decreased with knee flexion and disappeared entirely at 20 degrees flexion. Analysis of the patellar time response to the quadriceps contraction suggested that the muscle activation most affected the patellar shift and tilt. These results are consistent with the recent observations in the literature concerning the significance of retinaculum and quadriceps in the patellar stability.
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Affiliation(s)
- Mohammad Akbar
- School of Mechanical Engineering, Sharif University of Technology, Azadi Avenue, Tehran 11155, Iran
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A viscoelastic constitutive model can accurately represent entire creep indentation tests of human patella cartilage. J Appl Biomech 2012; 29:292-302. [PMID: 23027200 DOI: 10.1123/jab.29.3.292] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cartilage material properties provide important insights into joint health, and cartilage material models are used in whole-joint finite element models. Although the biphasic model representing experimental creep indentation tests is commonly used to characterize cartilage, cartilage short-term response to loading is generally not characterized using the biphasic model. The purpose of this study was to determine the short-term and equilibrium material properties of human patella cartilage using a viscoelastic model representation of creep indentation tests. We performed 24 experimental creep indentation tests from 14 human patellar specimens ranging in age from 20 to 90 years (median age 61 years). We used a finite element model to reproduce the experimental tests and determined cartilage material properties from viscoelastic and biphasic representations of cartilage. The viscoelastic model consistently provided excellent representation of the short-term and equilibrium creep displacements. We determined initial elastic modulus, equilibrium elastic modulus, and equilibrium Poisson's ratio using the viscoelastic model. The viscoelastic model can represent the short-term and equilibrium response of cartilage and may easily be implemented in whole-joint finite element models.
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Fitzpatrick CK, Baldwin MA, Clary CW, Wright A, Laz PJ, Rullkoetter PJ. Identifying alignment parameters affecting implanted patellofemoral mechanics. J Orthop Res 2012; 30:1167-75. [PMID: 22570224 DOI: 10.1002/jor.22055] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Accepted: 12/07/2011] [Indexed: 02/04/2023]
Abstract
Complications of the patellofemoral (PF) joint remain a common cause for revision of total knee replacements. PF complications, such as patellar maltracking, subluxation, and implant failure, have been linked to femoral and patellar component alignment. In this study, a dynamic finite element model of an implanted PF joint was applied in conjunction with a probabilistic simulation to establish relationships between alignment parameters and PF kinematics, contact mechanics, and internal stresses. Both traditional sensitivity analysis and a coupled probabilistic and principal component analysis approach were applied to characterize relationships between implant alignment and resulting joint mechanics. Critical alignment parameters, and combinations of parameters, affecting PF mechanics were identified for three patellar designs (dome, modified dome, and anatomic). Femoral internal-external (I-E) alignment was identified as a critical alignment factor for all component designs, influencing medial-lateral contact force and anterior-posterior translation. The anatomic design was sensitive to patellar flexion-extension (F-E) alignment, while the dome, as expected, was less influenced by rotational alignment, and more by translational position. The modified dome was sensitive to a combination of superior-inferior, F-E, and I-E alignments. Understanding the relationships and design-specific dependencies between alignment parameters can aid preoperative planning, and help focus instrumentation design on those alignment parameters of primary concern.
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Affiliation(s)
- Clare K Fitzpatrick
- Computational Biomechanics Lab, University of Denver, 2390 S. York St., Denver, Colorado, USA
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Feedback controlled force enhancement and activation reduction of voluntarily activated quadriceps femoris during sub-maximal muscle action. J Electromyogr Kinesiol 2012; 22:117-23. [DOI: 10.1016/j.jelekin.2011.10.010] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 09/23/2011] [Accepted: 10/24/2011] [Indexed: 11/18/2022] Open
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Mani S, Kirkpatrick MS, Saranathan A, Smith LG, Cosgarea AJ, Elias JJ. Tibial tuberosity osteotomy for patellofemoral realignment alters tibiofemoral kinematics. Am J Sports Med 2011; 39:1024-31. [PMID: 21233407 PMCID: PMC3090523 DOI: 10.1177/0363546510390188] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tibial tuberosity realignment surgery is performed to improve patellofemoral alignment, but it could also alter tibiofemoral kinematics. HYPOTHESIS After tuberosity realignment in the malaligned knee, the reoriented patellar tendon will pull the tuberosity back toward the preoperative position, thereby altering tibiofemoral kinematics. STUDY DESIGN Controlled laboratory study. METHODS Ten knees were tested at 40°, 60°, and 80° of flexion in vitro. The knees were loaded with a quadriceps force of 586 N, with 200 N divided between the medial and lateral hamstrings. The position of the tuberosity was varied to represent lateral malalignment, with the tuberosity 5 mm lateral to the normal position; tuberosity medialization, with the tuberosity 5 mm medial to the normal position; and tuberosity anteromedialization, with the tuberosity 10 mm anterior to the medial position. Tibiofemoral kinematics were measured using magnetic sensors secured to the femur and tibia. A repeated measures analysis of variance with a post hoc Student-Newman-Keuls test was used to identify significant (P < .05) differences in the kinematic data between the tuberosity positions at each flexion angle. RESULTS Medializing the tibial tuberosity primarily rotated the tibia externally compared with the lateral malalignment condition. The largest average increase in external rotation was 13° at 40° of flexion, with the increase significant at each flexion angle. The varus orientation also increased significantly by an average of 1.5° at 40° and 80°. The tibia shifted significantly posteriorly at 40° and 60° by an average of 4 mm and 2 mm, respectively. Shifting the tuberosity from the medial to the anteromedial position translated the tibia significantly posteriorly by an average of 2 mm at 40°. CONCLUSION After tibial tuberosity realignment in the malaligned knee, the altered orientation of the patellar tendon alters tibiofemoral kinematics. CLINICAL RELEVANCE The kinematic changes reduce the correction applied to the orientation of the patellar tendon and could alter the pressure applied to tibiofemoral cartilage.
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Affiliation(s)
- Saandeep Mani
- Department of Orthopaedic Surgery Akron General Medical Center Akron, OH,Department of Biomedical Engineering University of Akron Akron, OH
| | | | - Archana Saranathan
- Department of Orthopaedic Surgery Akron General Medical Center Akron, OH,Department of Biomedical Engineering University of Akron Akron, OH
| | - Laura G. Smith
- Department of Orthopaedic Surgery Akron General Medical Center Akron, OH,Department of Biomedical Engineering University of Akron Akron, OH
| | - Andrew J. Cosgarea
- Department of Orthopaedic Surgery Johns Hopkins University Baltimore, MD
| | - John J. Elias
- Department of Orthopaedic Surgery Akron General Medical Center Akron, OH
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Farrokhi S, Keyak J, Powers C. Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study. Osteoarthritis Cartilage 2011; 19:287-94. [PMID: 21172445 PMCID: PMC4890159 DOI: 10.1016/j.joca.2010.12.001] [Citation(s) in RCA: 178] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2009] [Revised: 11/24/2010] [Accepted: 12/03/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To test the hypothesis that individuals with patellofemoral pain (PFP) exhibit greater patellofemoral joint stress profiles compared to persons who are pain-free. METHODS Ten females with PFP and ten gender, age, and activity-matched pain-free controls participated. Patella and femur stress profiles were quantified utilizing subject-specific finite element (FE) models of the patellofemoral joint at 15° and 45° of knee flexion. Input parameters for the FE model included: (1) joint geometry, (2) quadriceps muscle forces, and (3) weight-bearing patellofemoral joint kinematics. Using a nonlinear FE solver, quasi-static loading simulations were performed to quantify each subject's patellofemoral joint stress profile during a static squatting maneuver. The patella and femur peak and mean hydrostatic pressure as well as the peak and mean octahedral shear stress for the elements representing the chondro-osseous interface were quantified. RESULTS Compared to the pain-free controls, individuals with PFP consistently exhibited greater peak and mean hydrostatic pressure as well as peak and mean octahedral shear stress for the elements representing the patella and femur chondro-osseous interface across the two knee flexion angles tested (15° and 45°). CONCLUSIONS The combined finding of elevated hydrostatic pressure and octahedral shear stress across the two knee flexion angles supports the premise that PFP may be associated with elevated joint stress. Therefore, treatments aimed at decreasing patellofemoral joint stress may be indicated in this patient population.
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Affiliation(s)
- S. Farrokhi
- Department of Physical Therapy, University of Pittsburgh, PA, USA
| | - J.H. Keyak
- Department of Orthopaedic Surgery, University of California, Irvine, CA, USA,Department of Biomedical Engineering, University of California, Irvine, CA, USA,Department of Mechanical and Aerospace Engineering, University of California, Irvine, CA, USA
| | - C.M. Powers
- Musculoskeletal Biomechanics Research Laboratory, Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Fitzpatrick CK, Baldwin MA, Rullkoetter PJ, Laz PJ. Combined probabilistic and principal component analysis approach for multivariate sensitivity evaluation and application to implanted patellofemoral mechanics. J Biomech 2011; 44:13-21. [DOI: 10.1016/j.jbiomech.2010.08.016] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 08/11/2010] [Accepted: 08/12/2010] [Indexed: 10/19/2022]
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Wilson NA, Sheehan FT. Dynamic in vivo quadriceps lines-of-action. J Biomech 2010; 43:2106-13. [PMID: 20451912 DOI: 10.1016/j.jbiomech.2010.04.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 04/06/2010] [Accepted: 04/07/2010] [Indexed: 11/18/2022]
Abstract
Tissue stresses and quadriceps forces are crucial factors when considering knee joint biomechanics. However, it is difficult to obtain direct, in vivo, measurements of these quantities. The primary purpose of this study was to provide the first complete description of quadriceps geometry (force directions and moment arms) of individual quadriceps components using in vivo, 3D data collected during volitional knee extension. A secondary purpose was to determine if 3D quadriceps geometry is altered in patients with patellofemoral pain and maltracking. After obtaining informed consent, cine-phase contrast (PC) MRI sets (x,y,z velocity and anatomic images) were acquired from 25 asymptomatic knees and 15 knees with patellofemoral pain during active knee extension. Using a sagittal-oblique and two coronal-oblique imaging planes, the origins and insertions of each quadriceps line-of-action were identified and tracked throughout the motion by integrating the cine-PC velocity data. The force direction and relative moment (RM) were calculated for each line-of-action. All quadriceps lines-of-action were oriented primarily in the superior direction. There were no significant differences in quadriceps geometry between asymptomatic and subjects with patellofemoral pain. However, patellofemoral kinematics were significantly different between the two populations. This study will improve the ability of musculoskeletal models to closely match in vivo human performance by providing accurate 3D quadriceps geometry and associated patellofemoral kinematics during dynamic knee motion. Furthermore, determination that quadriceps geometry is not altered in patellofemoral pain supports the use of generalized a knee model based on asymptomatic quadriceps architecture.
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Affiliation(s)
- Nicole A Wilson
- Functional and Applied Biomechanics Section, Rehabilitation Medicine Department, National Institutes of Health, Bethesda, MD 20892-1604, USA
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Heyse TJ, Becher C, Kron N, Ostermeier S, Hurschler C, Schofer MD, Fuchs-Winkelmann S, Tibesku CO. Quadriceps force in relation of intrinsic anteroposterior stability of TKA design. Arch Orthop Trauma Surg 2010; 130:1-9. [PMID: 19578862 DOI: 10.1007/s00402-009-0927-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2008] [Indexed: 11/29/2022]
Abstract
PURPOSE Decreased quadriceps strength and fatigue is suspected to be one of the contributing factors for anterior knee pain and malfunction after total knee arthroplasty (TKA). The purpose of this in vitro study was to investigate the amount of quadriceps force required to extend the knee isokinetically after TKA in dependence of different prosthesis designs and the state of the posterior cruciate ligament (PCL). MATERIALS AND METHODS Eight fresh frozen human knee specimens underwent testing in a kinematic device simulating an isokinetic knee extension cycle from 120° of flexion to full extension. The quadriceps force was measured after implantation of a cruciate retaining (CR) TKA (Genesis II, Smith&Nephew, Memphis, TN, USA) applying a conventional CR (11 mm) and a highly conforming (deep dished, DD) polyethylene (PE) inlay consecutively before and after resection of the PCL. Finally, tests were repeated with a posterior-stabilized (PS) design. RESULTS Simulating a physiological knee extension, no significant differences in the average quadriceps force were detected between the cruciate preserving inlays (CR 1,146.57 ± 88.04 N, DD 1,150.19 ± 97.54 N, P = 0.86) as long as the PCL was intact. After resection of the PCL, the required quadriceps force increased significantly for both designs (CR 1,203.17 ± 91.51 N, P < 0.01 and DD 1,191.88 ± 80.07 N, P < 0.03). After implantation of the posterior stabilized femoral component quad force decreased to its initial levels with forces significantly lower compared to the PCL deficient knees provided with a CR or DD (PS 1,130.91 ± 107.88 N, P < 0.01) inlay. With a deficient PCL there were no statistical differences for the DD design in comparison with CR in mean quad forces (CR 1,203.17 ± 91.51 N vs. DD 1,191.88 ± 80.07 N, P = 0.50) nor in peak forces (CR 1,729.44 ± 161.86 N, DD 1,688.66 ± 123.18 N, P = 0.17). DISCUSSION At intact PCL peak quad forces and mean forces beyond 70° of flexion could be shown to be significantly lower with a PS TKA design in comparison with cruciate preserving designs such as CR and DD. In the PCL deficient knee quad forces with a highly conforming implant (DD) and CR were significantly higher than with a PS TKA. The use of PS implants in all PCL deficient knees seems to be advisable
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Affiliation(s)
- Thomas Jan Heyse
- Department of Orthopedics and Rheumatology, University Hospital Marburg, Baldingerstrasse, 35043 Marburg, Germany.
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Baldwin MA, Clary C, Maletsky LP, Rullkoetter PJ. Verification of predicted specimen-specific natural and implanted patellofemoral kinematics during simulated deep knee bend. J Biomech 2009; 42:2341-8. [DOI: 10.1016/j.jbiomech.2009.06.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 11/25/2022]
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A rotating inlay decreases contact pressure on inlay post after posterior cruciate substituting total knee arthroplasty. Clin Biomech (Bristol, Avon) 2009; 24:446-50. [PMID: 19361899 DOI: 10.1016/j.clinbiomech.2009.03.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2008] [Revised: 03/06/2009] [Accepted: 03/12/2009] [Indexed: 02/07/2023]
Abstract
BACKGROUND The post/cam mechanism of posterior cruciate substituting total knee arthroplasty, which is intended to achieve maximum range of flexion, offers the risk of failure due to mechanical overload. The purpose of this in vitro study was to investigate load and contact pressure on the inlay post of posterior substituting knee prosthesis with different designs. METHODS Isokinetic extension/flexion motions of seven fresh frozen left knee specimens were simulated dynamically in a specially designed knee simulator with an extension moment of 31 Nm. After implantation of the knee prosthesis system, which provides a fixed and a rotating posterior cruciate substituting inlay, a pressure sensitive film was fixed on the inlay post surface to measure maximum load and contact pressure. FINDINGS Both types of inlays showed nearly the same contact load of up to 480 N on the posterior surface of the inlay post at 120 degrees knee flexion. Contact pressure was measured to be up to 19.7 MPa at 120 degrees flexion on the posterior surface of the post of the fixed inlay, whereas contact pressure was measured to be significantly lower (6.8 MPa, p=0.04) on the inlay post of the rotating inlay. INTERPRETATION The modification of a rotating posterior cruciate substituting inlay could not decrease the horizontal load, but offers the possibility to decrease contact pressure on the inlay post to avoid mechanical overload of the polyethylene inlay.
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Besier TF, Fredericson M, Gold GE, Beaupré GS, Delp SL. Knee muscle forces during walking and running in patellofemoral pain patients and pain-free controls. J Biomech 2009; 42:898-905. [PMID: 19268945 DOI: 10.1016/j.jbiomech.2009.01.032] [Citation(s) in RCA: 141] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2008] [Revised: 01/16/2009] [Accepted: 01/19/2009] [Indexed: 10/21/2022]
Abstract
One proposed mechanism of patellofemoral pain, increased stress in the joint, is dependent on forces generated by the quadriceps muscles. Describing causal relationships between muscle forces, tissue stresses, and pain is difficult due to the inability to directly measure these variables in vivo. The purpose of this study was to estimate quadriceps forces during walking and running in a group of male and female patients with patellofemoral pain (n = 27, 16 female; 11 male) and compare these to pain-free controls (n = 16, 8 female; 8 male). Subjects walked and ran at self-selected speeds in a gait laboratory. Lower limb kinematics and electromyography (EMG) data were input to an EMG-driven musculoskeletal model of the knee, which was scaled and calibrated to each individual to estimate forces in 10 muscles surrounding the joint. Compared to controls, the patellofemoral pain group had greater co-contraction of quadriceps and hamstrings (p = 0.025) and greater normalized muscle forces during walking, even though the net knee moment was similar between groups. Muscle forces during running were similar between groups, but the net knee extension moment was less in the patellofemoral pain group compared to controls. Females displayed 30-50% greater normalized hamstring and gastrocnemius muscle forces during both walking and running compared to males (p<0.05). These results suggest that some patellofemoral pain patients might experience greater joint contact forces and joint stresses than pain-free subjects. The muscle force data are available as supplementary material.
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Affiliation(s)
- Thor F Besier
- Department of Orthopaedics, Stanford University, Stanford, CA 94305-6175, USA.
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Amin S, Baker K, Niu J, Clancy M, Goggins J, Guermazi A, Grigoryan M, Hunter DJ, Felson DT. Quadriceps strength and the risk of cartilage loss and symptom progression in knee osteoarthritis. ACTA ACUST UNITED AC 2009; 60:189-98. [PMID: 19116936 DOI: 10.1002/art.24182] [Citation(s) in RCA: 199] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE To determine the effect of quadriceps strength in individuals with knee osteoarthritis (OA) on loss of cartilage at the tibiofemoral and patellofemoral joints (assessed by magnetic resonance imaging [MRI]) and on knee pain and function. METHODS We studied 265 subjects (154 men and 111 women, mean+/-SD age 67+/-9 years) who met the American College of Rheumatology criteria for symptomatic knee OA and who were participating in a prospective, 30-month natural history study of knee OA. Quadriceps strength was measured at baseline, isokinetically, during concentric knee extension. MRI of the knee at baseline and at 15 and 30 months was used to assess cartilage loss at the tibiofemoral and patellofemoral joints, with medial and lateral compartments assessed separately. At baseline and at followup visits, knee pain was assessed using a visual analog scale, and physical function was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index. RESULTS There was no association between quadriceps strength and cartilage loss at the tibiofemoral joint. Results were similar in malaligned knees. However, greater quadriceps strength was protective against cartilage loss at the lateral compartment of the patellofemoral joint (for highest versus lowest tertile of strength, odds ratio 0.4 [95% confidence interval 0.2, 0.9]). Those with greater quadriceps strength had less knee pain and better physical function over followup (P<0.001). CONCLUSION Greater quadriceps strength had no influence on cartilage loss at the tibiofemoral joint, including in malaligned knees. We report for the first time that greater quadriceps strength protected against cartilage loss at the lateral compartment of the patellofemoral joint, a finding that requires confirmation. Subjects with greater quadriceps strength also had less knee pain and better physical function over followup.
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Affiliation(s)
- Shreyasee Amin
- College of Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
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de Ruiter CJ, Hoddenbach JG, Huurnink A, de Haan A. Relative torque contribution of vastus medialis muscle at different knee angles. Acta Physiol (Oxf) 2008; 194:223-37. [PMID: 18691348 DOI: 10.1111/j.1748-1716.2008.01888.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM We investigated the relative contribution of the vastus medialis (VM) muscle to total isometric knee extension torque at 10 degrees , 30 degrees , 60 degrees and 90 degrees knee flexion. In the past a more prominent role of the VM muscle at more extended knee angles has been put forward. However, different components of the quadriceps muscle converge via a common distal tendon. We therefore hypothesized that the relative contribution of the VM to total knee extension torque would be similar across angles. METHODS At each knee angle the EMG isometric torque relations [20%, 25%, 30%, 35% maximal voluntary contraction (MVC)] of the rectus femoris (RF), vastus lateralis (VL) and VM muscle were established in 10 healthy male subjects; rectified surface EMG was normalized to M-wave area. Subsequently, the VM was functionally eliminated by selective electrical surface stimulation with occluded blood flow. RESULTS There was no evidence for preferential activation of VM at any of the knee angles. Following VM elimination, total knee extension torque during maximal femoral nerve stimulation (three pulses at 300 Hz) at 10 degrees , 30 degrees , 60 degrees and 90 degrees , respectively, decreased (P < 0.05) to (mean +/- SD): 75.7 +/- 12.2, 75.1 +/- 9.3, 78.2 +/- 7.2 and 76.0 +/- 5.8% (P > 0.05 among knee angles). In addition, during voluntary contractions at 20% MVC the increases in torque output of RF and VL compensating for the loss of VM function were calculated from the increases in EMG and found to be similar (P > 0.05) at 10 degrees , 30 degrees , 60 degrees and 90 degrees values (%MVC), respectively, were: 9.1 +/- 6.8, 7.5 +/- 2.9, 5.9 +/- 3.7 and 6.9 +/- 3.4. CONCLUSION The present findings support our hypothesis that the VM contributes similarly to total knee extension torque at different knee angles.
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Affiliation(s)
- C J de Ruiter
- Research Institute MOVE, Faculty of Human Movement Sciences, VU University Amsterdam, Amsterdam, the Netherlands. c_ j
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Smith CD, Masouros S, Hill AM, Wallace AL, Amis AA, Bull AM. Mechanical testing of intra-articular tissues. Relating experiments to physiological function. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.cuor.2008.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Elias JJ, Cosgarea AJ. Computational modeling: an alternative approach for investigating patellofemoral mechanics. Sports Med Arthrosc Rev 2007; 15:89-94. [PMID: 17505324 DOI: 10.1097/jsa.0b013e31804bbe4d] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Computational modeling is commonly used in all engineering disciplines to represent complex systems. A computational model of the patellofemoral joint is a graphical representation of joint anatomy that can be manipulated to simulate knee function. Current models are typically reconstructed from magnetic resonance imaging scans of knees. Force vectors are applied to the patella to represent the quadriceps muscles, while the patella tendon is modeled with force vectors or deformable elements. Although the femur, tibia, and patella are typically modeled as rigid structures, the cartilage is represented with springs or modeled using finite element analysis. Computational models can be created to represent individual patients or general pathologic conditions. The quadriceps muscles and patella tendon can be manipulated to simulate patellofemoral pathology or surgical or nonsurgical treatment methods. The models can be used to characterize patellofemoral loading during knee flexion and characterize the distribution of force and pressure within the patellofemoral joint.
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Affiliation(s)
- John J Elias
- Medical Education and Research Institute of Colorado, Colorado Springs, CO 80907, USA.
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Ostermeier S, Holst M, Hurschler C, Windhagen H, Stukenborg-Colsman C. Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2007; 15:547-54. [PMID: 17225178 DOI: 10.1007/s00167-006-0261-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to investigate the influence of lateral retinacular release and medial and lateral retinacular deficiency on patellofemoral position and retropatellar contact pressure. Human knee specimens (n = 8, mean age = 65 SD 7 years, all male) were tested in a kinematic knee-simulating machine. During simulation of an isokinetic knee extension cycle from 120 degrees to full extension, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The position of the patella was measured using an ultrasound based motion analysis system (CMS 100, Zebris). The amount of patellofemoral contact pressure and its pressure distribution was measured using a pressure sensitive film (Tekscan, Boston). Patellar position and contact pressure were first investigated in intact knee conditions, after a lateral retinacular release and a release of the medial and lateral retinaculum. After lateral retinacular release the patella continuously moved from a significant medialised position at flexion (P = 0.01) to a lateralised position (P = 0.02) at full knee extension compared to intact conditions, the centre of patellofemoral contact pressure was significantly medialised (0.04) between 120 degrees and 60 degrees knee flexion. Patellofemoral contact pressure did not change significantly. In the deficient knee conditions the patella moved on a significant lateralised track (P = 0.04) through the entire extension cycle with a lateralised centre of patellofemoral pressure (P = 0.04) with a trend (P = 0.08) towards increased patellofemoral pressure. The results suggest that lateral retinacular release did not inevitably stabilise or medialise patellar tracking through the entire knee extension cycle, but could decrease pressure on the lateral patellar facet in knee flexion. Therefore lateral retinacular release should be considered carefully in cases of patellar instability.
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Affiliation(s)
- Sven Ostermeier
- Orthopaedics Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ. In vitro measurement of patellar kinematics following reconstruction of the medial patellofemoral ligament. Knee Surg Sports Traumatol Arthrosc 2007; 15:276-85. [PMID: 17031614 DOI: 10.1007/s00167-006-0200-0] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Accepted: 08/10/2006] [Indexed: 01/11/2023]
Abstract
This study compares the effects of two different techniques of medial patellofemoral ligament (MPFL) reconstruction, and proximal soft tissue realignment on patellar stabilization against lateral dislocation. Eight human cadaver knee specimens with no radiological pathomorpholgy on a straight lateral view, contributing to patellofemoral instability, were mounted in a kinematic knee simulator and isokinetic extension was simulated. Patellar kinematics were measured with an ultrasound positioning system (zebris) while a 100 N laterally directed force was applied to the patella. The kinematics were compared with intact knee conditions under MPFL deficient conditions, as well as following dynamic reconstruction of the MPFL using a distal transfer of the semitendinosus tendon, following static reconstruction by a semitendinosus autograft, and following proximal soft tissue realignment of the patella (Insall procedure). Dynamic reconstruction of the MPFL resulted in no significant alteration (P = 0.16) of patellar kinematics. Static reconstruction of the MPFL significantly medialized (P < 0.01) the patellar movement without, but restored intact knee kinematics under the laterally directed force. In contrast, following proximal soft tissue realignment, the patellar movement was constantly medialized and internally tilted (P = 0.04). Dynamic and static reconstruction of the MPFL create sufficient stabilization of the patella. Following proximal soft tissue realignment, the patellar position was over-medialized relative to intact knee conditions, which could lead to an overuse of the medial retropatellar cartilage.
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Affiliation(s)
- Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School (MHH), Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ. Dynamic measurement of patellofemoral contact pressure following reconstruction of the medial patellofemoral ligament: an in vitro study. Clin Biomech (Bristol, Avon) 2007; 22:327-35. [PMID: 17118499 DOI: 10.1016/j.clinbiomech.2006.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 10/06/2006] [Accepted: 10/10/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical reconstruction of the medial patellofemoral ligament used to stabilize the patella against lateral dislocation may concomitantly produce alteration of the patellofemoral contact pressure distribution. Two different tendon transfer techniques of reconstructing the medial patellofemoral ligament, one dynamic and one static, as well as a proximal soft tissue realignment of the patella were investigated. METHODS Eight human knee specimens were mounted in a kinematic knee simulator and isokinetic extension motion was simulated. Patellofemoral pressure was measured using a pressure sensitive film while a 100 N laterally directed dislocation load was applied to the patella. The specimens were evaluated in a physiologic state, as well as after dynamic reconstruction of the medial patellofemoral ligament using a distal transfer of the semitendinosus tendon, following static reconstruction using a semitendinosus autograft, and following proximal soft tissue realignment of the patella. FINDINGS Following both reconstruction techniques of the medial patellofemoral ligament patellofemoral contact pressure was not significantly (P=0.49) altered. In contrast, after proximal realignment a trend (P=0.07) towards higher contact pressure near knee extension was observed. In the absence of a lateral dislocation load dynamic and static reconstruction resulted in a medialization (P=0.04) of the center of pressure, whereas under the application of a 100 N dislocation load the center of pressure showed no significant alteration. Following proximal realignment the center of pressure was significantly medialized without (P<0.01) and with a dislocation load (P=0.01) throughout the entire range of knee motion. INTERPRETATION Static and dynamic ligament reconstruction of the medial patellofemoral ligament did not alter patellofemoral pressure. Proximal realignment, on the other hand, resulted in a constant medialization of the patellofemoral pressure. The data suggest that the reconstruction techniques would be associated with a low risk of causing premature cartilage degeneration due to excessive patellofemoral contact pressure, whereas proximal realignment could cause medial overload of the patellofemoral joint.
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Affiliation(s)
- Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School (MHH), Anna-von.-Borries-Str. 1-7, 30625 Hannover, Germany.
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Elias JJ, Cosgarea AJ. Technical errors during medial patellofemoral ligament reconstruction could overload medial patellofemoral cartilage: a computational analysis. Am J Sports Med 2006; 34:1478-85. [PMID: 16685097 DOI: 10.1177/0363546506287486] [Citation(s) in RCA: 245] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The influence of reconstruction of the medial patellofemoral ligament on the patellofemoral force and pressure distributions has not yet been investigated. HYPOTHESIS Technical errors can cause tension to develop within a reconstructed medial patellofemoral ligament, which will adversely alter the normal patellofemoral force distribution by increasing the load applied to the medial cartilage. STUDY DESIGN Controlled laboratory study. METHODS Four computational knee models were used to simulate knee function from 30 degrees to 90 degrees of flexion with (1) an intact medial patellofemoral ligament, (2) an anatomically correct reconstruction using a double hamstring tendon autograft, (3) a 5-mm proximally malpositioned femoral attachment site, (4) a graft that is 3 mm shorter than the intact medial patellofemoral ligament, and (5) combined proximal malpositioning and a short graft. RESULTS The results were similar for the intact and anatomically reconstructed medial patellofemoral ligament. Proximal malpositioning of the femoral attachment and using a short graft increased the graft tension during flexion, which decreased the lateral force and the lateral tilt moment acting on the patella. When a short graft was combined with proximal malpositioning, the compressive force applied to the medial cartilage at least doubled at low flexion angles, which increased the peak medial pressure by more than 50% at low flexion angles. CONCLUSION When the medial patellofemoral ligament is reconstructed, small errors in graft length and position can dramatically increase the force and pressure applied to medial patellofemoral cartilage. CLINICAL RELEVANCE Overloading the medial cartilage after medial patellofemoral ligament reconstruction could lead to degradation, pain, and arthrosis.
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