1
|
Meuser AH, Henyš P, Höch A, Gänsslen A, Hammer N. Evaluating the stability of external fixators following pelvic injury: A systematic review of biomechanical testing methods. J Mech Behav Biomed Mater 2024; 153:106488. [PMID: 38437754 DOI: 10.1016/j.jmbbm.2024.106488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 10/31/2023] [Accepted: 02/26/2024] [Indexed: 03/06/2024]
Abstract
INTRODUCTION This systematic review aims to identify previously used techniques in biomechanics to assess pelvic instability following pelvic injury, focusing on external fixation constructs. METHODS A systematic literature search was conducted to include biomechanical studies and to exclude clinical trials. RESULTS Of an initial 4666 studies found, 38 met the inclusion criteria. 84% of the included studies were retrieved from PubMed, Scopus, and Web of Science. The studies analysed 106 postmortem specimens, 154 synthetic bones, and 103 computational models. Most specimens were male (97% synthetic, 70% postmortem specimens). Both the type of injury and the classification system employed varied across studies. About 82% of the injuries assessed were of type C. Two different fixators were tested for FFPII and type A injury, five for type B injury, and fifteen for type C injury. Large variability was observed for external fixation constructs concerning device type and configuration, pin size, and geometry. Biomechanical studies deployed various methods to assess injury displacement, deformation, stiffness, and motion. Thereby, loading protocols differed and inconsistent definitions of failure were determined. Measurement techniques applied in biomechanical test setups included strain gauges, force transducers, and motion tracking techniques. DISCUSSION AND CONCLUSION An ideal fixation method should be safe, stable, non-obstructive, and have low complication rates. Although biomechanical testing should ensure that the load applied during testing is representative of a physiological load, a high degree of variability was found in the current literature in both the loading and measurement equipment. The lack of a standardised test design for fixation constructs in pelvic injuries across the studies challenges comparisons between them. When interpreting the results of biomechanical studies, it seems crucial to consider the limitations in cross-study comparability, with implications on their applicability to the clinical setting.
Collapse
Affiliation(s)
- Annika Hela Meuser
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
| | - Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies, Technical University of Liberec, Liberec, Czech Republic
| | - Andreas Höch
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
| | - Axel Gänsslen
- Clinic for Trauma Surgery, Orthopaedics and Hand Surgery, Wolfsburg Hospital, Wolfsburg, Germany
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria; Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany; Division of Biomechatronics, Fraunhofer IWU, Dresden, Germany.
| |
Collapse
|
2
|
Toyohara R, Ohashi T. A literature review of biomechanical studies on physiological and pathological sacroiliac joints: Articular surface structure, joint motion, dysfunction and treatments. Clin Biomech (Bristol, Avon) 2024; 114:106233. [PMID: 38531152 DOI: 10.1016/j.clinbiomech.2024.106233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 03/28/2024]
Abstract
BACKGROUND Sacroiliac joints are affected by mechanical environments; the joints are formed under mechanical stimulation, receive impact of walking between the upper and lower parts of the bodies and can be a cause of pain due to non-physiological loads. However, there are so far very few studies that reviewed biomechanics of physiological and pathological sacroiliac joints. This review article aims to describe the current sacroiliac joint biomechanics. METHODS Previous original papers have been summarized based on three categories: articular surface structure, sacroiliac joint motion and sacroiliac joint dysfunction and treatments. FINDINGS Although the articular surface morphologies vary greatly from individual to individual, many researchers have tried to classify the joints into several types. It has been suggested that the surface morphologies may not change regardless of joint dysfunction, however, the relationship between the joint structure and pain are still unclear. The range of sacroiliac joint motion is demonstrated to be less than 1 mm and there is no difference between physiological and pathological joints. The sacroiliac joint absorbs shock within the pelvis by the joint structures of pelvic morphology, ligaments and fat tissues. The morphology and motion of the sacroiliac joints may be optimized for upright bipedal walking. INTERPRETATION There is no doubt that pelvic mechanical environments affect pain induction and treatment; however, no one has yet provided a concrete explanation. Future research could help develop treatments based on sacroiliac joint biomechanics to support joint function.
Collapse
Affiliation(s)
- Ryota Toyohara
- Faculty of Engineering, Hokkaido University, Japan; Creative Research Institution, Hokkaido University, Japan.
| | | |
Collapse
|
3
|
Hilliquin S, Zhukouskaya V, Fogel O, Cherifi C, Ibrahim K, Slimani L, Cornelis FMF, Storms L, Hens A, Briot K, Lories R, Chaussain C, Miceli-Richard C, Bardet C. The sacroiliac joint: An original and highly sensitive tool to highlight altered bone phenotype in murine models of skeletal disorders. Bone 2024; 178:116931. [PMID: 37839664 DOI: 10.1016/j.bone.2023.116931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/28/2023] [Accepted: 10/09/2023] [Indexed: 10/17/2023]
Abstract
Bone disorders may affect the skeleton in different ways, some bones being very impaired and others less severely. In translational studies using murine models of human skeletal diseases, the bone phenotype is mainly evaluated at the distal femur or proximal tibia. The sacroiliac joint (SIJ), which connects the spine to the pelvis, is involved in the balanced transfer of mechanical energy from the lumbar spine to the lower extremities. Because of its role in biomechanical stress, the SIJ is a region of particular interest in various bone diseases. Here we aimed to characterize the SIJ in several murine models to develop a highly reliable tool for studying skeletal disorders. We performed a 12-month in vivo micro-computed tomography (micro-CT) follow-up to characterize the SIJ in wild-type (WT) C57BL/J6 mice and compared the bone microarchitecture of the SIJ and the distal femur at 3 months by micro-CT and histology. To test the sensitivity of our methodology, the SIJ and distal femur were evaluated at 3 and 6 months, in 2 murine models of skeletal disorder, X-linked hypophosphatemia (Hyp mice) and HLA-B27 transgenic mice and compared to WT mice. A multimodal analysis was performed, using a combination of microCT and histological analysis. With the Hyp model, the SIJ displayed more bone microarchitecture alterations than the distal femur. Hyp mice showed a significant reduction in trabecular bone at both the distal femur and sacral slope as compared with WT mice, with a significant positive correlation between trabecular bone parameters of the distal femur and sacral side of the SIJ. Furthermore, trabecular bone parameters (Bone Volume/Total Volume (BV/TV), trabecular thickness (Tb.Th), trabecular separation (Tb.Sp), trabecular number (Tb.N), trabecular pattern factor (Tb.Pf)) were significantly increased compared to femoral parameters at the SIJ. The sacral articular cortical bone, which is indicative of osteoarticular lesions, was altered in Hyp mice. Interestingly, in accordance to previous studies, HLA-B27 transgenic mice did not show any osteoarticular lesions as compared with WT mice. Cortical bone parameters (thickness, porosity), as well as scoring performed with double blinding, did not show difference between the 2 genotypes. The characterization and evaluation of the SIJ surface appears very sensitive to emphasize alterations of bone and joint. The SIJ may represent a valuable tool to investigate both bone and local osteoarticular alterations in murine models of skeletal disorders and might be a relevant site for assessing the response to treatment of chronic bone diseases.
Collapse
Affiliation(s)
- Stéphane Hilliquin
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France; Department of Rheumatology, Cochin Hospital, Université Paris Cité, Paris, France
| | - Volha Zhukouskaya
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France; Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Olivier Fogel
- Department of Rheumatology, Cochin Hospital, Université Paris Cité, Paris, France
| | - Chahrazad Cherifi
- Laboratoire Gly-CREET, Université Paris-Est Créteil Val de Marne (UPEC) Faculté des sciences et technologies, France
| | - Karim Ibrahim
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
| | - Lotfi Slimani
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France
| | - Frederique M F Cornelis
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Lies Storms
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Ann Hens
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Karine Briot
- Department of Rheumatology, Cochin Hospital, Université Paris Cité, Paris, France; Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, Leuven, Belgium; Division of Rhumatology, University Hospitals Leuven, Leuven, Belgium
| | - Catherine Chaussain
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France; Centre de référence des maladies rares du métabolisme du calcium et du phosphate, Plateforme d'expertise maladies rares Paris Saclay, filière OSCAR, EndoRare and BOND ERN, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France; AP-HP Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN, 75018 Paris, France
| | | | - Claire Bardet
- Université Paris Cité, Institut des maladies musculo-squelettiques, Laboratory Orofacial Pathologies, Imaging and Biotherapies URP2496 and FHU-DDS-Net, Dental School, and Plateforme d'Imagerie du Vivant (PIV), Montrouge, France.
| |
Collapse
|
4
|
Toyohara R, Hammer N, Ohashi T. Experimental characterization of motion resistance of the sacroiliac joint. Biomed Mater Eng 2024; 35:53-63. [PMID: 37545208 DOI: 10.3233/bme-230041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023]
Abstract
BACKGROUND The human sacroiliac joint (SIJ) in vivo is exposed to compressive and shearing stress environment, given the joint lines are almost parallel to the direction of gravity. The SIJ supports efficient bipedal walking. Unexpected or unphysiological, repeated impacts are believed to cause joint misalignment and result in SIJ pain. In the anterior compartment of the SIJ being synovial, the articular surface presents fine irregularities, potentially restricting the motion of the joints. OBJECTIVE To clarify how the SIJ articular surface affects the resistance of the motion under physiological loading. METHODS SIJ surface models were created based on computed tomography data of three patients and subsequently 3D printed. Shear resistance was measured in four directions and three combined positions using a customized setup. In addition, repositionability of SIJs was investigated by unloading a shear force. RESULTS Shear resistance of the SIJ was the highest in the inferior direction. It changed depending on the direction of the shear and the alignment position of the articular surface. CONCLUSION SIJ articular surface morphology is likely designed to accommodate upright bipedal walking. Joint misalignment may in consequence increase the risk of subluxation.
Collapse
Affiliation(s)
- Ryota Toyohara
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| | - Niels Hammer
- Division of Clinical and Macroscopic Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Austria
- Department of Orthopedic and Trauma Surgery, University of Leipzig, Leipzig, Germany
- Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (IWU), Chemnitz, Germany
| | - Toshiro Ohashi
- Faculty of Engineering, Hokkaido University, Sapporo, Japan
| |
Collapse
|
5
|
Poilliot A, Hammer N, Toranelli M, Doyle T, Gay‐Dujak MH, Müller‐Gerbl M. Influence of size and shape of the auricular surfaces on subchondral bone density distribution in the sacroiliac joint. J Anat 2023; 243:475-485. [PMID: 36893752 PMCID: PMC10439371 DOI: 10.1111/joa.13857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 03/11/2023] Open
Abstract
The sacroiliac auricular surface has a variable morphology and size. The impact of such variations on subchondral mineralization distribution has not been investigated. Sixty-nine datasets were subjected to CT-osteoabsorptiometry for the qualitative visualization of chronic loading conditions of the subchondral bone plate using color-mapped densitograms based on Hounsfield Units in CT. Auricular surface morphologies were classified into three types based on posterior angle size: Type 1: >160°, Type 2: 130-160° and Type 3: <130°. Auricular surface size was categorized based on the mean value (15.4 cm2 ) separating the group into 'small' and 'large' joint surfaces. Subchondral bone density patterns were qualitatively classified into four color patterns: two marginal patterns (M1 and M2) and two non-marginal patterns (N1 and N2) and each iliac and sacral surface was subsequently categorized. 'Marginal' meant that 60-70% of the surface was less mineralized compared with the highly dense regions and vice versa for the 'non-marginal' patterns. M1 had anterior border mineralization and M2 had mineralization scattered around the borders. N1 had mineralization spread over the whole superior region, N2 had mineralization spread over the superior and anterior regions. Auricular surface area averaged 15.4 ± 3.6 cm2 , with a tendency for males to have larger joint surfaces. Type 2 was the most common (75%) and type 3 the least common morphology (9%). M1 was the most common pattern (62% of surfaces) by sex (males 60%, females 64%) with the anterior border as the densest region in all three morphologies. Sacra have a majority of surfaces with patterns from the marginal group (98%). Ilia have mineralization concentrated at the anterior border (patterns M1 and N2 combined: 83%). Load distribution differences related to auricular surface morphology seems to have little effect on long-term stress-related bone adaptation visualized with CT-osteoabsorptiometry. Higher iliac side mineralization was observed in larger joint surfaces and age-related morphomechanical size alterations were seen in males.
Collapse
Affiliation(s)
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research CenterMedical University of GrazGrazAustria
- Department of Orthopedic and Trauma SurgeryUniversity of LeipzigLeipzigGermany
- Division of BiomechatronicsFraunhofer Institute for Machine Tools and Forming TechnologyDresdenGermany
| | | | - Terence Doyle
- University of Otago School of MedicineDunedinNew Zealand
| | | | | |
Collapse
|
6
|
Cardwell MC, Martin JM, Meinerz C, Beck CJ, Wang M, Schmeling GJ. A cadaveric biomechanical evaluation of anterior posterior compression II injuries. Injury 2023; 54:834-840. [PMID: 36623999 DOI: 10.1016/j.injury.2022.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/29/2022] [Accepted: 12/31/2022] [Indexed: 01/04/2023]
Abstract
PURPOSE Pelvic fractures are associated with high morbidity and often require surgical intervention. An Anterior Posterior Compression (APC) II injury consists of disruption at the pubic symphysis and anterior sacroiliac joint. Studies investigating specific ligamentous contributions would aid in development of novel fixation techniques. The objective of this study is to determine the level of pelvic destabilization from progressive soft tissue disruptions associated with APC II injuries. METHODS Six fresh-frozen cadaveric pelvises were dissected of soft tissues, preserving joint capsules and ligaments. Each pelvis was secured in a double-leg stance and joint motion was tracked with the specimens cyclically loaded to 60% body weight. Each specimen was measured in the intact state and again following stepwise destabilization to an APC II injury model (PS: sectioned pubic symphysis, IPS JOINT: PS + ipsilateral anterior sacroiliac, sacrotuberous, sacrospinous ligaments sectioned, IPS LIGS: IPS JOINT + ipsilateral interosseous ligaments sectioned, IPS JOINT+CONT ASI: IPS LIGS + contralateral anterior sacroiliac ligament disruption). RESULTS Compared to the intact state, there was a statistically significant increase in movement in the IPS JOINT (ipsilateral 177%, p<0.001; contralateral 46%, p<0.005) and IPS JOINT+CONT ASI (ipsilateral 184%, p<0.002; and contralateral 62%, p<0.002) states bilaterally. No significant change was demonstrated in the PS or IPS LIGS state. CONCLUSION Disruption of ipsilateral ligamentous structures destabilized both sacroiliac joints. The interosseous and posterior sacroiliac ligaments provide the majority of stability of the sacroiliac joint and will likely benefit most from surgical stabilization. LEVEL OF EVIDENCE mechanism-based reasoning.
Collapse
Affiliation(s)
- Maxwell C Cardwell
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States.
| | - Jill M Martin
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Carolyn Meinerz
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Chad J Beck
- Floyd Medical Center Orthoapedic Trauma Surgery, United States
| | - Mei Wang
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| | - Gregory J Schmeling
- Department of Orthopaedic Surgery, Medical College of Wisconsin, United States; Medical College of Wisconsin, United States
| |
Collapse
|
7
|
Guo Z, Peng Y, Shen Q, Li J, He P, Yuan P, Liu Y, Que Y, Guo W, Hu Y, Xu S. Reconstruction with 3D-printed prostheses after type I + II + III internal hemipelvectomy: Finite element analysis and preliminary outcomes. Front Bioeng Biotechnol 2023; 10:1036882. [PMID: 36698627 PMCID: PMC9868148 DOI: 10.3389/fbioe.2022.1036882] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Accepted: 12/20/2022] [Indexed: 01/10/2023] Open
Abstract
Background: Prosthetic reconstruction after type I + II+ III internal hemipelvectomy remains challenging due to the lack of osseointegration and presence of giant shear force at the sacroiliac joint. The purpose of this study was to evaluate the biomechanical properties of the novel 3D-printed, custom-made prosthesis with pedicle screw-rod system and sacral tray using finite element analysis. Methods: Four models that included one intact pelvis were established for validation. Forces of 500 N and 2,000 N were applied, respectively, to simulate static bipedal standing and the most loaded condition during a gait cycle. Biomechanical analysis was performed, and the results were compared; the preliminary outcomes of four patients were recorded. Results: For the reconstructed hemipelvis, stress was mainly concentrated on the sacral screws, bone-prosthesis interface, and upper endplate of the L5 vertebra. The optimization of the design with the sacral tray structure could decrease the peak stress of the sacral screws by 18.6%, while the maximal stress of the prosthesis increased by 60.7%. The addition of the lumbosacral pedicle-rod system further alleviated stress of the sacral screws and prosthesis by 30.2% and 19.4%, respectively. The site of peak stress was contemporaneously transferred to the connecting rods within an elastic range. In the retrospective clinical study, four patients who had undergone prosthetic reconstruction were included. During a follow-up of 16.6 ± 7.5 months, the walking ability was found preserved in all patients who are still alive and no prosthesis-related complications had occurred except for one hip dislocation. The Musculoskeletal Tumor Society (MSTS) score was found to be 19.5 ± 2.9. Conclusion: The novel reconstructive system yielded favorable biomechanical characteristics and demonstrated promising preliminary outcomes. The method can be used as a reference for reconstruction after type I + II + III hemipelvectomy.
Collapse
Affiliation(s)
- Zehao Guo
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yongjun Peng
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Qiling Shen
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Jian Li
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng He
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Peng Yuan
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yulei Liu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Yukang Que
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Wei Guo
- Musculoskeletal Tumor Center, Peking University People’s Hospital, Beijing, China
| | - Yong Hu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,*Correspondence: Yong Hu, ; Shenglin Xu,
| | - Shenglin Xu
- Department of Orthopedics, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China,*Correspondence: Yong Hu, ; Shenglin Xu,
| |
Collapse
|
8
|
Toyohara R, Hiramukai T, Kurosawa D, Hammer N, Ohashi T. Numerical analysis of the effects of padded pelvic belts as a treatment for sacroiliac joint dysfunction. Biomed Mater Eng 2022:BME221490. [DOI: 10.3233/bme-221490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND: Pain related to the sacroiliac joint (SIJ) accounts for low back pain in 15%–30% of patients. One of the most common treatment options is the use of pelvic belts. Various types of pelvic belts exist; however, the mechanisms underlying treatment and their effectiveness remain unclear to date. OBJECTIVE: To analyze stress distribution in the pelvis when a pelvic rubber belt or a padded pelvic belt is applied, to assess the effectiveness of treatment from a numerical biomechanical perspective. METHODS: The pressure distribution at the pelvic belts was measured using a device and subsequently modeled with the finite element method of a pelvis with soft tissues. The stress environment when wearing a pelvic belt in a double-leg stance was simulated. RESULTS: With the application of pelvic belts, the innominate bone rotated outward, which was termed an out-flare. This caused the SIJ to compress and cause reduction in sacrotuberous, sacrospinous, interosseous, and posterior sacroiliac ligament loading. Padded pelvic belts decreased the SIJ displacement to a greater extent than in pelvic rubber belts. CONCLUSION: Pelvic belts aid in compressing the SIJ and reduce its mobility.
Collapse
Affiliation(s)
| | | | | | - Niels Hammer
- , , Medical University of Graz, , Austria
- , University of Leipzig, , Germany
- , Fraunhofer Institute for Machine Tools and Forming Technology (IWU), , Germany
| | | |
Collapse
|
9
|
Steinke H, Saito T, Kuehner J, Reibetanz U, Heyde CE, Itoh M, Voelker A. Sacroiliac innervation. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:2831-2843. [PMID: 36029360 DOI: 10.1007/s00586-022-07353-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE To investigate the innervation pattern of the sacroiliac region, especially with regard to the sacroiliac joint (SIJ). Dorsal SIJ innervation was analyzed and described. Our main hypothesis was that nerves reach the SIJ dorsally, passing ligamental compartments, as this would explain dorsal SIJ pain. METHODS To examine sacroiliac innervation, we followed the nerves in over 50 specimens over several years. Plastinated slices were evaluated, nerves in the region were stained histologically, and the data were summarized as 3D models. RESULTS The Rami communicans and posterior branches of the spinal nerves and their branches that form a dorsal sacral plexus and communicating branches, together with corresponding vessels, were observed to form neurovascular bundles embedded by tiny fatty connectives in gaps and tunnels. Branches of L5-S1 pass the inner sacroiliac ligaments (the interosseous sacroiliac ligament and axial interosseous ligament). The outer sacroiliac ligaments (posterior sacroiliac ligaments, long posterior sacroiliac ligament, sacrotuberal ligament, thoracolumbar fascia) are passed by the S1-S4 branches. However, although the paths of these nerves are in the direction of the SIJ, they do not reach it. It is possible that impingement of the neurovascular bundles may result in pain. Moreover, the gaps and tunnels connect to the open dorsal SIJ. CONCLUSION Our findings suggest that Bogduk's term "sacroiliac pain" correlates to "sacroiliac innervation", which consists of "inner-" and "outer sacroiliac ligament innervation", and to ventral "SIJ pain". The watery gaps and tunnels observed could play a significant role in innervation and thus in the origins of SIJ pain. LEVEL OF EVIDENCE Individual cross-sectional studies with consistently applied reference standard and blinding.
Collapse
Affiliation(s)
- Hanno Steinke
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany.
| | - Toshiyuki Saito
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Janne Kuehner
- Department of Anatomy, University Leipzig, Liebigstr. 13, 04103, Leipzig, Germany
| | - Uta Reibetanz
- Department of Biophysics, University Leipzig, Härtelstr. 16-18, 04107, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| | - Masahiro Itoh
- Department of Anatomy, Tokyo Medical University, 6-1-1 Shinjuku-ku, Tokyo, 160-8402, Japan
| | - Anna Voelker
- Department of Orthopeadics, Trauma and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, 04103, Leipzig, Germany
| |
Collapse
|
10
|
Li J, Li Y, Ping R, Zhang Q, Chen HY, Lin D, Qi J. Biomechanical analysis of sacroiliac joint motion following oblique-pulling manipulation with or without pubic symphysis injury. Front Bioeng Biotechnol 2022; 10:960090. [PMID: 36204470 PMCID: PMC9530983 DOI: 10.3389/fbioe.2022.960090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Accepted: 08/22/2022] [Indexed: 11/20/2022] Open
Abstract
Background: Oblique-pulling manipulation has been widely applied in treating sacroiliac joint (SIJ) dysfunction. However, little is known about the biomechanical mechanism of the manipulation. This study aims to analyze the SIJ motion under oblique-pulling manipulation, in comparison with compression and traction loads. Methods/Study Design: A total of six specimens of embalmed human pelvis cadavers were dissected to expose the SIJ and surrounding ligaments. Through a servo-hydraulic testing system, biomechanical tests were performed on the stable pelvis and the unstable pelvis with pubic symphysis injury (PSI). A three-dimensional (3D) photogrammetry system was employed to determine the separation and nutation in three tests: axial compression (test A), axial traction (test B), and oblique-pulling manipulation (test C). Results: After applying the testing loads, the range of nutation was no more than 0.3° (without PSI) and 0.5°(with PSI), separately. Except for test B, a greater nutation was found with PSI (p < 0.05). Under both conditions, nutation following test A was significantly greater than that of other tests (p < 0.05). SIJ narrowed in test A and separated in tests B and C, where the range of motion did not exceed 0.1 mm (without PSI) or 0.3 mm (with PSI) separately. Under both conditions, the separation of SIJ in test C was not as apparent as the narrowness of SIJ in test A (p < 0.05). Compared to SIJ, a more significant increasing displacement was found at the site of the iliolumbar ligament (p < 0.05). Nevertheless, when the force was withdrawn in all tests, the range of nutation and separation of SIJ nearly decreased to the origin. Conclusion: Pubic symphysis is essential to restrict SIJ motion, and the oblique-pulling manipulation could cause a weak nutation and separation of SIJ. However, the resulting SIJ motion might be neutralized by regular standing and weight-bearing load. Also, the effect on SIJ seems to disappear at the end of manipulation. Therefore, the stretching and loosening of surrounding ligaments need to be paid more attention to.
Collapse
Affiliation(s)
- Jing Li
- Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yikai Li
- School of Traditional Chinese Medicine, Southern Medical University, Guangzhou, China
| | - Ruiyue Ping
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Dermatology, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Qing Zhang
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
| | - Hai-Yun Chen
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Dingkun Lin
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| | - Ji Qi
- Guangzhou University of Chinese Medicine, Guangzhou, China
- Wang Jing Hospital of China Academy of Chinese Medical Sciences, Beijing, China
- Department of Orthopedics, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- Postdoctoral Research Station, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
- *Correspondence: Hai-Yun Chen, ; Dingkun Lin, ; Ji Qi,
| |
Collapse
|
11
|
ZORLULAR A, AYGUN POLAT E, KAFA N, ATALAY GÜZEL N. THE RELATIONSHIP BETWEEN TRUNK MUSCLE STRENGTH AND PELVIC OSCILLATION IN HEALTHY ADULTS. TÜRK FIZYOTERAPI VE REHABILITASYON DERGISI 2022. [DOI: 10.21653/tjpr.998024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose: Pelvis and trunk structure are body segments that are integrated with each other. Collaboration between pelvic mobility and trunk muscles plays a significant role in walking and energy consumption. The aim of this study is to investigate the relationship between trunk muscle strength and pelvic oscillations. Methods: Twenty-eight healthy individuals volunteered for the study (16 women, 12 man; mean age 24.46 ± 2.97 yrs., height 172.03 ± 9.41cm, weight 67.78 ± 16.31 kg). Gait characteristics and pelvic oscillation were measured by using wireless tri-axial accelerometer. Trunk muscle strength were evaluated with Isokinetic Dynamometer (Cybex Humac Norm Testing & Rehabilitation System, USA). The trunk extensors and flexors were tested concentrically at 60°s. Statistically, the direction and level of the relationship were examined by using Spearman Correlation Analysis. Results: Correlation analysis showed significant relationships between concentric strength of trunk flexion and anterior-posterior pelvic tilt (r=-0.419), lateral pelvic tilt (r=-0.768) and hip rotation (r=-0.382). A statistically significant relationship was not observed between concentric strength of trunk extension and anterior-posterior pelvic tilt, hip rotation (p>0.05). Conclusion: The current study reports that trunk muscle strength is associated with pelvic oscillations. Also, these results suggest that maintaining optimal levels of trunk muscle strength prepares a healthful basis for the pelvis during walking. Therefore, it contributes to the prevention of possible pathologies related to lower extremity. Although trunk muscle strength and pelvic mobility are important determinants of gait, these factors are insufficient to evaluate the whole gait cycle and energy expenditure of individuals.
Collapse
Affiliation(s)
- Ali ZORLULAR
- GAZİ ÜNİVERSİTESİ, SAĞLIK BİLİMLERİ ENSTİTÜSÜ, FİZYOTERAPİ VE REHABİLİTASYON (DR)
| | | | - Nihan KAFA
- GAZI UNIVERSITY, FACULTY OF HEALTH SCIENCES
| | | |
Collapse
|
12
|
Henyš P, Ramezani M, Schewitz D, Höch A, Möbius D, Ondruschka B, Hammer N. Sacrospinous and sacrotuberous ligaments influence in pelvis kinematics. J Anat 2022; 241:928-937. [PMID: 35986644 PMCID: PMC9482702 DOI: 10.1111/joa.13739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
The alteration in mechanical properties of posterior pelvis ligaments may cause a biased pelvis deformation which, in turn, may contribute to hip and spine instability and malfunction. Here, the effect of different mechanical properties of ligaments on lumbopelvic deformation is analyzed via the finite element method. First, the improved finite element model was validated using experimental data from previous studies and then used to calculate the sensitivity of lumbopelvic deformation to changes in ligament mechanical properties, load magnitude, and unilateral ligament resection. The deformation of the lumbopelvic complex relative to a given load was predominant in the medial plane. The effect of unilateral resection on deformation appeared to be counterintuitive, suggesting that ligaments have the ability to redistribute load and that they play an important role in the mechanics of the lumbopelvic complex.
Collapse
Affiliation(s)
- Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies Technical University of Liberec Liberec Czech Republic
| | - Maziar Ramezani
- Department of Mechanical Engineering Auckland University of Technology Auckland New Zealand
| | - Daniel Schewitz
- Department of Mechanical Engineering Auckland University of Technology Auckland New Zealand
| | - Andreas Höch
- Department of Trauma, Orthopedic and Plastic Surgery University Hospital of Leipzig Leipzig Germany
| | - Dustin Möbius
- Institute of Legal Medicine University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Niels Hammer
- Department of Trauma, Orthopedic and Plastic Surgery University Hospital of Leipzig Leipzig Germany
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center Medical University of Graz Graz Austria
- Fraunhofer Institute for Machine Tools and Forming Technology Dresden Germany
| |
Collapse
|
13
|
Höch A, Reise R, Pieroh P, Heyde CE, Fakler JKM, Schleifenbaum S. Primary stability of multi-hole cups compared to plate osteosynthesis in osteoporotic anterior column and posterior hemi-transverse acetabular fractures—A biomechanical comparison. PLoS One 2022; 17:e0270866. [PMID: 35895744 PMCID: PMC9328528 DOI: 10.1371/journal.pone.0270866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 06/19/2022] [Indexed: 11/18/2022] Open
Abstract
Introduction
Acetabular fractures pose high demands on the surgeon and in the case of osteosynthetic treatment, anatomical reconstruction has the highest priority to achieve a good outcome. However, especially in older patients with poor bone quality, even anatomical reconstruction is no guarantee for a good clinical outcome and may nevertheless end in early osteoarthritis. Primary arthroplasty therefore has an increasing importance in the treatment of these patients. The aim of this study was to biomechanically compare fracture gap displacement and failure load as an assessment measure of the primary stability of conventional plate osteosynthesis with the treatment using a sole multi-hole cup for acetabular fractures.
Methods
Six hemi-pelvises each with anterior column and posterior hemi-transverse (ACPHT) fracture were treated with either plate osteosynthesis or a multi-hole cup. The tests were carried out in a standardised test set-up with cyclic loading in various stages between 150 N and 2500 N. The fracture gap displacement was recorded with optical 3D measuring and the failure load was determined after the cyclic measurement.
Results
With increasing force, the fracture gap displacement increased in both procedures. In each group there was one treatment which failed at the cyclic loading test and a bone fragment was broken out. The primary stability in arthroplasty was comparable to that of the standard osteosynthesis.
Conclusions
The results found seem promising that the primary arthroplasty with a sole multi-hole cup and corresponding screw fixation achieves an initial stability comparable to osteosynthesis for typical ACPHT fractures. However, further clinical studies are needed to prove that the cups heal solidly into the bone.
Collapse
Affiliation(s)
- Andreas Höch
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Rebekka Reise
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
- ZESBO–Center for Research on Musculoskeletal System, Leipzig University, Leipzig, Germany
- * E-mail:
| | - Philipp Pieroh
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Christoph-Eckhard Heyde
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Johannes Karl Maria Fakler
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
| | - Stefan Schleifenbaum
- Department of Orthopaedic Surgery, Traumatology and Plastic Surgery, University of Leipzig Medical Center, Leipzig, Germany
- ZESBO–Center for Research on Musculoskeletal System, Leipzig University, Leipzig, Germany
| |
Collapse
|
14
|
The sacrotuberous ligament is preloaded in situ. J Mech Behav Biomed Mater 2022; 134:105368. [DOI: 10.1016/j.jmbbm.2022.105368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 07/06/2022] [Accepted: 07/09/2022] [Indexed: 11/19/2022]
|
15
|
Cunningham BW, Brooks DM. Comparative Analysis of Optoelectronic Accuracy in the Laboratory Setting Versus Clinical Operative Environment: A Systematic Review. Global Spine J 2022; 12:59S-74S. [PMID: 35393881 PMCID: PMC8998481 DOI: 10.1177/21925682211035083] [Citation(s) in RCA: 2] [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] [Indexed: 01/02/2023] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVES The optoelectronic camera source and data interpolation process serve as the foundation for navigational integrity in robotic-assisted surgical platforms. The current systematic review serves to provide a basis for the numerical disparity observed when comparing the intrinsic accuracy of optoelectronic cameras versus accuracy in the laboratory setting and clinical operative environments. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 465 references were vetted and 137 comprise the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy equaled or was less than 0.1 mm translation and 0.1 degrees rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm translation and 0.1 to 1.0 degrees rotation per array. Accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm translation and 1.5 to 5.0 degrees rotation when comparing planned to final implant position. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration and intra-operative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position.
Collapse
Affiliation(s)
- Bryan W. Cunningham
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, DC, USA
| | - Daina M. Brooks
- Department of Orthopaedic Surgery, Musculoskeletal Research and Innovation Institute, MedStar Union Memorial Hospital, Baltimore, MD, USA
| |
Collapse
|
16
|
Nordberg RC, Espinosa MG, Hu JC, Athanasiou KA. A Tribological Comparison of Facet Joint, Sacroiliac Joint, and Knee Cartilage in the Yucatan Minipig. Cartilage 2021; 13:346S-355S. [PMID: 34105385 PMCID: PMC8804757 DOI: 10.1177/19476035211021906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE Pathology of the facet and sacroiliac (SI) joints contributes to 15% to 45% and 10% to 27% of lower back pain cases, respectively. Although tissue engineering may offer novel treatment options to patients suffering from cartilage degeneration in these joints, the tribological characteristics of the facet and SI joints have not been studied in either the human or relevant large animal models, which hinders the development of joint-specific cartilage implants. DESIGN Cartilage was isolated from the knee, cervical facet, thoracic facet, lumbar facet, and SI joints of 6 skeletally mature Yucatan minipigs (Sus scrofa). Tribological characteristics were assessed via coefficient of friction testing, interferometry, and immunohistochemistry for lubricin organization. RESULTS Compared with the knee, the coefficient of friction was higher by 43% in the cervical facet, 77% in the thoracic facet, 37% in the lumbar facet, and 28% in the SI joint. Likewise, topographical features of the facet and SI joints varied significantly, ranging from a 114% to 384% increase and a 48% to 107% increase in global and local surface roughness measures, respectively, compared with the knee. Additionally, the amount of lubricin in the SI joint was substantially greater than in the knee. Statistical correlations among the various tribological parameters revealed that there was a significant correlation between local roughness and coefficient of friction, but not global roughness or the presence of lubricin. CONCLUSION These location-specific tribological characteristics of the articular cartilages of the spine will need to be taken into consideration during the development of physiologically relevant, functional, and durable tissue-engineered replacements for these joints.
Collapse
Affiliation(s)
- Rachel C. Nordberg
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | | | - Jerry C. Hu
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA
| | - Kyriacos A. Athanasiou
- Department of Biomedical Engineering,
University of California, Irvine, CA, USA,Kyriacos A. Athanasiou, Department of
Biomedical Engineering, University of California, 3418 Engineering Hall, Irvine,
CA 92617, USA.
| |
Collapse
|
17
|
Cunningham BW, Brooks DM, McAfee PC. Accuracy of Robotic-Assisted Spinal Surgery-Comparison to TJR Robotics, da Vinci Robotics, and Optoelectronic Laboratory Robotics. Int J Spine Surg 2021; 15:S38-S55. [PMID: 34607917 PMCID: PMC8532535 DOI: 10.14444/8139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The optoelectronic camera source and data interpolation serve as the foundation for navigational integrity in the robotic-assisted surgical platform. The objective of the current systematic review serves to provide a basis for the numerical disparity that exists when comparing the intrinsic accuracy of optoelectronic cameras: accuracy observed in the laboratory setting versus accuracy in the clinical operative environment. It is postulated that there exists a greater number of connections in the optoelectronic kinematic chain when analyzing the clinical operative environment to the laboratory setting. This increase in data interpolation, coupled with intraoperative workflow challenges, reduces the degree of accuracy based on surgical application and to that observed in controlled musculoskeletal kinematic laboratory investigations. METHODS Review of the PubMed and Cochrane Library research databases was performed. The exhaustive literature compilation obtained was then vetted to reduce redundancies and categorized into topics of intrinsic optoelectronic accuracy, registration accuracy, musculoskeletal kinematic platforms, and clinical operative platforms. RESULTS A total of 147 references make up the basis for the current analysis. Regardless of application, the common denominators affecting overall optoelectronic accuracy are intrinsic accuracy, registration accuracy, and application accuracy. Intrinsic accuracy of optoelectronic tracking equaled or was less than 0.1 mm of translation and 0.1° of rotation per fiducial. Controlled laboratory platforms reported 0.1 to 0.5 mm of translation and 0.1°-1.0° of rotation per array. There is a huge falloff in clinical applications: accuracy in robotic-assisted spinal surgery reported 1.5 to 6.0 mm of translation and 1.5° to 5.0° of rotation when comparing planned to final implant position. Total Joint Robotics and da Vinci urologic robotics computed accuracy, as predicted, lies between these two extremes-1.02 mm for da Vinci and 2 mm for MAKO. CONCLUSIONS Navigational integrity and maintenance of fidelity of optoelectronic data is the cornerstone of robotic-assisted spinal surgery. Transitioning from controlled laboratory to clinical operative environments requires an increased number of steps in the optoelectronic kinematic chain and error potential. Diligence in planning, fiducial positioning, system registration, and intraoperative workflow have the potential to improve accuracy and decrease disparity between planned and final implant position. The key determining factors limiting navigation resolution accuracy are highlighted by this Cochrane research analysis.
Collapse
Affiliation(s)
- Bryan W. Cunningham
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
| | - Daina M. Brooks
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
| | - Paul C. McAfee
- Musculoskeletal Education Center, Department of Orthopaedic Surgery, MedStar Union Memorial Hospital, Baltimore, Maryland
- Department of Orthopaedic Surgery, Georgetown University School of Medicine, Washington, D.C
| |
Collapse
|
18
|
Dubé-Cyr R, Aubin CÉ, Villemure I, Arnoux PJ. Biomechanical analysis of the number of implants for the immediate sacroiliac joint fixation. Spine Deform 2021; 9:1267-1273. [PMID: 33755927 DOI: 10.1007/s43390-021-00325-3] [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: 09/02/2020] [Accepted: 03/01/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The fusion of the sacroiliac joint (SIJ) is the last treatment option for chronic pain resulting from sacroiliitis. With the various implant systems available, there are different possible surgical strategies in terms of the type and number of implants and trajectories. The aim was to quantify the effect of the number of cylindrical threaded implants on SIJ stabilization. METHODS Six cadaveric pelvises were embedded in resin simulating a double-leg stance. Compression loads were applied to the sacral plate. The pelvises were tested non-instrumented and instrumented progressively with up to three cylindrical threaded implants (12-mm diameter, 60-mm length) with a posterior oblique trajectory. Vertical (VD) and angular (AD) displacements of the SIJ were measured locally using high-precision cameras and digital image correlation. RESULTS Compared to the non-instrumented initial state, instrumentation with one implant significantly decreased the VD (- 24% ± 15%, p = 0.028), while the AD decreased on average by - 9% (± 15%; p = 0.345). When compared to the one-implant configuration, adding a second implant further statistically decreased VD (- 10% ± 7%, p = 0.046) and AD (- 19% ± 15, p = 0.046). Adding a third implant did not lead to additional stabilization for VD nor AD (p > 0.5). CONCLUSION Compared to the non-instrumented initial state, the two-implant configuration reduces both vertical and angular displacements the most, while minimizing the number of implants.
Collapse
Affiliation(s)
- Roxanne Dubé-Cyr
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Aix-Marseille Université, Boulevard Pierre Dramard, Marseille Cedex, France
| | - Carl-Éric Aubin
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada. .,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada. .,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada.
| | - Isabelle Villemure
- Department of Mechanical Engineering, Polytechnique Montréal, P.O. Box 6079, Downtown Station, Montreal, QC, H3C 3A7, Canada.,Sainte-Justine University Hospital Center, 3175 Cote Sainte-Catherine Road, Montreal, QC, H3T 1C5, Canada.,iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Montreal, Canada
| | - Pierre-Jean Arnoux
- iLab-Spine (International Laboratory-Spine Imaging and Biomechanics), Marseille, France.,Laboratoire de Biomécanique Appliquée, IFSTTAR, LBA UMR T24, Aix-Marseille Université, Boulevard Pierre Dramard, Marseille Cedex, France
| |
Collapse
|
19
|
Cho HJ, Kwak DS. Movement of the sacroiliac joint: Anatomy, systematic review, and biomechanical considerations. Proc Inst Mech Eng H 2020; 235:357-364. [PMID: 33256545 DOI: 10.1177/0954411920978021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Several researchers investigated the anatomy and biomechanics of the sacroiliac joint (SIJ) to understand the relationship between lower back pain and the SIJ. Many studies concluded that the SIJ has little movement; however, some studies using spinopelvic parameters mentioned high change in pelvic incidence (PI). In this study, SIJ movement and PI change reported in previous studies were reviewed according to position and posture changes. Literature on SIJ movement was reviewed by searching through the publication databases. In biomechanical studies, the result of the rotational angle in the sagittal plane was mainly investigated to compare with the results of PI change. From the results of SIJ movement studies, the minimum movement of nutation and count-nutation was 0.01°, and maximum movement was 2.27°. From the results of PI change studies with different positions and movements, the highest change was 9°, and the lowest change was 0°. Movement of the SIJ was limited by its anatomical structure; maximum movement of the SIJ was 9° in a previous study. Therefore, SIJ movement should be studied more intensely as biomechanical perspective to understand its movement.
Collapse
Affiliation(s)
- Ho-Jung Cho
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Dai-Soon Kwak
- Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
20
|
Finite element analysis of load transition on sacroiliac joint during bipedal walking. Sci Rep 2020; 10:13683. [PMID: 32792529 PMCID: PMC7426964 DOI: 10.1038/s41598-020-70676-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 08/03/2020] [Indexed: 11/24/2022] Open
Abstract
The sacroiliac joint (SIJ) is burdened with variant loads. However, no methods have allowed to measure objectively how the SIJ deforms during bipedal walking. In this study, in-vivo walking conditions were replicated in a kinematic model combining the finite element method with 3D walking analysis data divided into five phases in order to visualize the load transition on the SIJ and clarify the role of the SIJ. Both models with and without inclusion of the SIJ were investigated. In models with bilateral SIJs, the displacement differed greatly between the sacrum and both hip bones on the SIJ as the boundary. The movements of the sacrum involved a nutation movement in the stance phase and a counter-nutation in the swing phase relative to the ilium. In models without SIJs, the displacement of the pelvis and loads of pelvic ligaments decreased, and the equivalent stress of the SIJs increased compared to the model with SIJs. The walking loads cause distortion of the entire pelvis, and stress concentration at the SIJ are seen due to the morphology of the pelvic ring. However, the SIJs help dissipate the resulting stresses, and the surrounding ligaments are likewise involved in load transmission.
Collapse
|
21
|
Biomechanical analysis of two insertion sites for the fixation of the sacroiliac joint via an oblique lateral approach. Clin Biomech (Bristol, Avon) 2020; 74:118-123. [PMID: 32192993 DOI: 10.1016/j.clinbiomech.2020.02.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 02/12/2020] [Accepted: 02/17/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND The sacroiliac joint is an important source of low back pain. In severe cases, sacroiliac joint fusion is used to reduce pain, but revision rates can reach 30%. The lack of initial mechanical stability may lead to pseudarthrosis, thus not alleviating the patient's symptoms. This could be due to the damage induced to the interosseous ligament during implant insertion. Decoupling instrumentation steps (drilling-tapping and implant insertion) would allow verifying this hypothesis. Moreover, no biomechanical studies have been published on sacroiliac joint fixation with an oblique lateral approach, while it has important clinical advantages over the direct lateral approach. METHODS Eight cadaveric human pelves with both ischia embedded were tested in three sequential states: intact, drilled-tapped and instrumented with one cylindrical threaded implant with an oblique lateral trajectory. Specimens were assigned one of two insertion sites (distal point; near the posterior superior iliac spine, and proximal point; anterosuperior to the distal point) and tested in compression and flexion-extension. Vertical and angular displacements of the sacroiliac joint were measured locally using digital image correlation methods. FINDINGS In compression, instrumentation significantly reduced vertical displacements (17% (SD 22%), P = 0.04) but no difference was found for angular displacements or flexion-extension loads (P > 0.05). Drilling-tapping did not change the stability of the sacroiliac joint (P > 0.05); there was no statistical difference between the insertion sites (P > 0.05). INTERPRETATIONS Insertion of one implant through either the distal or proximal insertion site with an oblique lateral approach significantly reduced vertical displacements of the sacroiliac joint in compression, a predominant load of this joint. RESEARCH ETHICS COMMITTEE Polytechnique Montreal: CÉR-1617-30.
Collapse
|
22
|
Casaroli G, Bassani T, Brayda-Bruno M, Luca A, Galbusera F. What do we know about the biomechanics of the sacroiliac joint and of sacropelvic fixation? A literature review. Med Eng Phys 2019; 76:1-12. [PMID: 31866118 DOI: 10.1016/j.medengphy.2019.10.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 10/15/2019] [Accepted: 10/20/2019] [Indexed: 01/25/2023]
Abstract
The purpose of this review is to summarize the general knowledge about the biomechanics of the sacroiliac joint and sacropelvic fixation techniques. Additionally, this study aims to support biomechanical investigations in defining experimental protocols as well as numerical modeling of the sacropelvic structures. The sacroiliac joint is characterized by a large variability of shape and ranges of motion among individuals. Although the ligament network and the anatomical features strongly limit the joint movements, sacroiliac displacements and rotations are not negligible. Currently available treatments for sacroiliac joint dysfunction include physical therapy, steroid injections, Radio-frequency ablation of specific neural structures, and open or minimally invasive SIJ fusion. In long posterior construct, the most common solutions are the iliac screws and the S2 alar - iliac screws, whereas for the joint fixation alone, mini - invasive alternative system can be used. Several studies reported the clinical outcomes of the different techniques and investigated the biomechanical stability of the relative construct, but the effect of sacropelvic fixation techniques on the joint flexibility and on the stress generated into the bone is still unknown. In our opinion, more biomechanical analyses on the behavior of the sacroiliac joint may be performed in order to better predict the risk of failure or instability of the joint.
Collapse
Affiliation(s)
- Gloria Casaroli
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Tito Bassani
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Marco Brayda-Bruno
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| | - Andrea Luca
- III Spine Surgery - Scoliosis Department, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Fabio Galbusera
- LABS, Laboratory of Biological Structures Mechanics, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
| |
Collapse
|
23
|
Palsson TS, Gibson W, Darlow B, Bunzli S, Lehman G, Rabey M, Moloney N, Vaegter HB, Bagg MK, Travers M. Changing the Narrative in Diagnosis and Management of Pain in the Sacroiliac Joint Area. Phys Ther 2019; 99:1511-1519. [PMID: 31355883 DOI: 10.1093/ptj/pzz108] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Revised: 12/18/2018] [Accepted: 03/10/2019] [Indexed: 02/09/2023]
Abstract
The sacroiliac joint (SIJ) is often considered to be involved when people present for care with low back pain where SIJ is located. However, determining why the pain has arisen can be challenging, especially in the absence of a specific cause such as pregnancy, disease, or trauma, when the SIJ might be identified as a source of symptoms with the help of manual clinical tests. Nonspecific SIJ-related pain is commonly suggested to be causally associated with movement problems in the SIJ(s)-a diagnosis traditionally derived from manual assessment of movements of the SIJ complex. Management choices often consist of patient education, manual treatment, and exercise. Although some elements of management are consistent with guidelines, this Perspective article argues that the assumptions on which these diagnoses and treatments are based are problematic, particularly if they reinforce unhelpful, pathoanatomical beliefs. This article reviews the evidence regarding the clinical detection and diagnosis of SIJ movement dysfunction. In particular, it questions the continued use of assessing movement dysfunction despite mounting evidence undermining the biological plausibility and subsequent treatment paradigms based on such diagnoses. Clinicians are encouraged to align their assessment methods and explanatory models with contemporary science to reduce the risk of their diagnoses and choice of intervention negatively affecting clinical outcomes.
Collapse
Affiliation(s)
- Thorvaldur S Palsson
- Department of Health Science and Technology, SMI, Aalborg University, Frederik Bajers Vej 7A-205, Aalborg 9220, Denmark
| | - William Gibson
- School of Physiotherapy, The University of Notre Dame, Fremantle, Australia
| | - Ben Darlow
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
| | - Samantha Bunzli
- Department of Surgery, University of Melbourne, Melbourne, Australia
| | | | | | - Niamh Moloney
- Thrive Physiotherapy; and Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Henrik B Vaegter
- Pain Research Group, Pain Center South, Odense University Hospital, Odense, Denmark; and Institute of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Matthew K Bagg
- Neuroscience Research Australia, Sydney, Australia; Prince of Wales Clinical School, University of New South Wales, Sydney, Australia; and New College Village, University of New South Wales
| | - Mervyn Travers
- School of Physiotherapy, The University of Notre Dame; and School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| |
Collapse
|
24
|
Coudert P, Dubé-Cyr R, Chaumoitre K, Gille O, Vital JM, Jouve JL, Arnoux PJ, Panuel M, Evin M. Sacroiliac joint morphologic changes from infancy to adulthood. Spine J 2019; 19:1730-1738. [PMID: 31125692 DOI: 10.1016/j.spinee.2019.05.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Revised: 05/14/2019] [Accepted: 05/14/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Report of sacroiliac morphology changes during growth is limited in the literature and the interest of such morphology and its consequence for surgery is increasing. PURPOSE Aims of this work are (1) to anatomically define the sacroiliac joint (SIJ), and (2) to assess the influence of growth on the sacroiliac morphology and the pelvic parameters. STUDY DESIGN Forty-nine young subjects from 6 months to 18 years old (y/o) and 20 adults aged from 18 to 50 y/o were selected from our institutional patient database. METHODS They underwent a computed tomography (CT) examination on a 128-MDCT (GE Healthcare Optima CT660). Transverse CT image datasets were reconstructed, anonymized, and segmented with ITK-SNAP. Landmarks and surfaces were selected and a SIJ orientation analysis was performed using costumed Python scripts. RESULTS The subjects were divided into four groups: infants (1.9±1 y/o), children (6.9±1.7 y/o), adolescents (13.7±1.8 y/o), and adults (27.3±5.6 y/o). Differences between SIJ orientation were found significant between young subject groups for synovial sacrum SIJ orientation (p<.001) and iliac total SIJ orientation (p=.036). Both orientations of younger subjects were found significantly different from the adult group (p<.035). SIJ synovial sacrum and iliac total orientations correlated significantly with age (p<.03). All orientations correlated with pelvic incidence (p<.04) except for synovial sacrum SIJ orientation (p=.2). No gender or symmetrical differences were found significant in any group. CONCLUSIONS Morphologic definition of the SIJ confirmed the independency of the gender during growth. Such results will be beneficial for the analysis and management of vertebral pathology.
Collapse
Affiliation(s)
- Pierre Coudert
- Service d'Orthopédie Traumatologie, Spine Unit 1, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Roxanne Dubé-Cyr
- École Polytechnique de Montréal, Montréal, Canada; Laboratoire de Biomécanique Appliquée, UMRT24 AMU/IFSTTAR, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Kathia Chaumoitre
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France; Service d'Imagerie Medicale, Hopital Nord, CHU de Marseille, Marseille, France
| | - Olivier Gille
- Service d'Orthopédie Traumatologie, Spine Unit 1, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Jean-Marc Vital
- Service d'Orthopédie Traumatologie, Spine Unit 1, CHU de Bordeaux, Hôpital Pellegrin, Bordeaux, France
| | - Jean-Luc Jouve
- Service de Chirurgie Orthopédique et Traumatologique Pédiatrique, Hôpital de la Timone, CHU de Marseille, Marseille, France
| | - Pierre-Jean Arnoux
- Laboratoire de Biomécanique Appliquée, UMRT24 AMU/IFSTTAR, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France
| | - Michel Panuel
- Aix-Marseille University, CNRS, EFS, ADES, Marseille, France; Service d'Imagerie Medicale, Hopital Nord, CHU de Marseille, Marseille, France
| | - Morgane Evin
- Laboratoire de Biomécanique Appliquée, UMRT24 AMU/IFSTTAR, Marseille, France; iLab-Spine - Laboratoire International en Imagerie et Biomécanique du Rachis, Marseille, France.
| |
Collapse
|
25
|
In Silico Pelvis and Sacroiliac Joint Motion: Refining a Model of the Human Osteoligamentous Pelvis for Assessing Physiological Load Deformation Using an Inverted Validation Approach. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3973170. [PMID: 30729122 PMCID: PMC6343175 DOI: 10.1155/2019/3973170] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 12/04/2018] [Indexed: 01/01/2023]
Abstract
Introduction. Computational modeling of the human pelvis using the finite elements (FE) method has become increasingly important to understand the mechanisms of load distribution under both healthy and pathologically altered conditions and to develop and assess novel treatment strategies. The number of accurate and validated FE models is however small, and given models fail resembling the physiologic joint motion in particular of the sacroiliac joint. This study is aimed at using an inverted validation approach, using in vitro load deformation data to refine an existing FE model under the same mode of load application and to parametrically assess the influence of altered morphology and mechanical data on the kinematics of the model. Materials and Methods. An osteoligamentous FE model of the pelvis including the fifth lumbar vertebra was used, with highly accurate representations of ligament orientations. Material properties were altered parametrically for bone, cartilage, and ligaments, followed by changes in bone geometry (solid versus 3 and 2 mm shell) and material models (linear elastic, viscoelastic, and hyperelastic isotropic), and the effects of varying ligament fiber orientations were assessed. Results. Elastic modulus changes were more decisive in both linear elastic and viscoelastic bone, cartilage, and ligaments models, especially if shell geometries were used for the pelvic bones. Viscoelastic material properties gave more realistic results. Surprisingly little change was observed as a consequence of altering SIJ ligament orientations. Validation with in vitro experiments using cadavers showed close correlations for movements especially for 3 mm shell viscoelastic model. Discussion. This study has used an inverted validation approach to refine an existing FE model, to give realistic and accurate load deformation data of the osteoligamentous pelvis and showed which variation in the outcomes of the models are attributed to altered material properties and models. The given approach furthermore shows the value of accurate validation and of using the validation data to fine tune FE models.
Collapse
|