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Smith RDJ, Hanrahan M, Gerber A, Tanaka MJ. Patellofemoral Disorders in Soccer Players. Sports Med Arthrosc Rev 2024; 32:146-155. [PMID: 39087704 DOI: 10.1097/jsa.0000000000000390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Patellofemoral disorders are common in the world of soccer and impact players across all levels and ages of the sport. Patellofemoral disorders encompass a spectrum of conditions, from anterior knee pain to patellar instability, and are often influenced by complex biomechanical factors and anatomic variations that can predispose to these conditions. In recent years, there has been a growing emphasis on injury prevention strategies and data-driven approaches, championed by organizations like the Union of European Football Associations and individual professional clubs. Conservative management remains the initial approach for many players, including physical therapy and supportive devices. However, surgical intervention, particularly in cases of recurrent patellar dislocations, is often necessary. The understanding of patellofemoral biomechanics in soccer continues to evolve and offers opportunities for more effective injury prevention and tailored treatment strategies. Despite the challenges, a comprehensive approach to patellofemoral disorders in soccer is essential to preserve player health, enhance performance, and sustain the sport's vitality.
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Affiliation(s)
- Richard D J Smith
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
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Filardi V, Risitano G, Vaishya R. Numerical investigation of patellar instability during knee flexion due to an unbalanced medial retinaculum loading effect. J Orthop 2023; 36:57-64. [PMID: 36605460 PMCID: PMC9807748 DOI: 10.1016/j.jor.2022.12.009] [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: 10/07/2022] [Revised: 12/12/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background and aim Healthy patellofemoral (PF) joint mechanics are critical to optimal knee joint function. Patella plays a vital role in distributing quadriceps load during the knee extension. Patellar tracking, not physiological tracking, causes an increase of strains in PF ligaments, peaks of localized stress of soft tissues and articular cartilage and bony parts, and knee pain; these problems lead to complications such as bone abnormalities and osteoarthritis. This research aimed to develop a Finite Element (FE) model to evaluate patellar instability due to the medial retinaculum asymmetric loading effect. Methods A numerical model of the knee was obtained by matching nuclear magnetic resonance (MRI) for soft tissues and computerized tomography (CT) for bones, carried on a normal adult. Loading setup was chosen by using literature data. The intensity of the muscle forces was calculated by a static optimization taking into account ground reaction and knee flexion/extension during walking. The effect of patellar instability was obtained by gradually unbalancing this symmetry, one side was unloaded till 90 N, and the other loaded till 110 N. Results Unbalanced forces of 10 N acting on the retinaculum alone can produce a real difference in displacements of about 7 mm, and an increment of about 44% on patellar contact forces. Conclusion This research demonstrated how an unbalanced forces acting on the retinaculum can produce significant patellar instability. Patellar instability starts at 25-30° of the knee flexion angle but tends to appear at 15° when the unbalanced muscular loading conditions are acting.
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Affiliation(s)
- V. Filardi
- University of Messina, D.A. Research and Internationalization, V. C. Del Mare 41, 98100, Messina, Italy
| | - G. Risitano
- University of Messina, Department of Engineering, Contrada di Dio (S. Agata), 98166, Messina, Italy
| | - R. Vaishya
- Department of Orthopaedics, Indraprastha Apollo Hospital, New Delhi, 110076, India
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Greimel F, Maderbacher G, Baier C, Krieg B, Zeman F, Grifka J, Keshmiri A. Medial Open Wedge High tibial Osteotomy (MOWHTO) does not relevantly alter patellar kinematics: a cadaveric study. Arch Orthop Trauma Surg 2022; 142:13-21. [PMID: 32816055 PMCID: PMC8732930 DOI: 10.1007/s00402-020-03578-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 08/16/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study was to quantify the influence of medial open wedge high tibial osteotomy on patellar kinematics using optical computer navigation, as anterior knee pain infrequently occurs postoperatively and the reason is still being unknown. METHODS Ten medial open wedge high tibial osteotomies at supratuberosity level in 5 full body specimens were performed. The effect of the surgical procedure on patellar kinematics, measured at 5 and 10 degrees of leg alignment correction angle, was analyzed and compared to native patellar kinematics during passive motion-regarding patella shift, tilt, epicondylar distance and rotation. Linear mixed models were used for statistical analysis, a two-sided p value of ≤ 0.05 was considered statistically significant. RESULTS Tilt behavior, medial shift and epicondylar distance did not show a significant difference regarding natural patellar kinematics at both osteotomy levels. Both osteotomy correction angles showed a significant less external rotation of the patella (p < 0.001, respectively) compared to natural kinematics. CONCLUSIONS Except less external rotation of the patella, medial open wedge high tibial osteotomy does not seem to relevantly alter patellar alignment during passive motion. Future clinical studies have to prove the effect of MOWHTO on patellar kinematics measured in this experimental setup, especially regarding its influence on anterior knee pain.
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Affiliation(s)
- Felix Greimel
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany.
| | - Guenther Maderbacher
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Bernd Krieg
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Center for Clinical Studies, University Medical Center of Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopedics, University Medical Center Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V.-Allee 3, 93077, Bad Abbach, Germany
| | - Armin Keshmiri
- Orthopaedic Center in Helios, Helene-Weber-Allee 19, 80637, München, Germany
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Zhang L, Fan S, Ye J, Jiang X, Cai B. Gender differences in knee kinematics during weight-bearing knee flexion for patients with arthrofibrosis after anterior cruciate ligament reconstruction. J Orthop Surg Res 2021; 16:573. [PMID: 34565414 PMCID: PMC8474925 DOI: 10.1186/s13018-021-02729-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/15/2021] [Indexed: 11/10/2022] Open
Abstract
Background Knowledge of tibiofemoral and patellofemoral joint kinematics is important for understanding gender-related dimorphism in developing knee arthrofibrosis and advancement of related treatments. The objective of our study was to investigate gender differences existing in tibiofemoral kinematics and patellar tracking in patients with arthrofibrosis after anterior cruciate ligament (ACL) reconstruction during weight-bearing knee flexion. Methods The tibiofemoral and patellofemoral joint kinematics were measured in 30 patients (15 male and 15 female) with arthrofibrosis after ACL reconstruction during a lunge task, using computed tomography and dual fluoroscopic imaging system. These data were analyzed for gender differences. Results The range of tibial rotation, patellar inferior shift, tilt, and flexion were significantly decreased in the affected knee compared to the contralateral knee from 15° to 75° of knee flexion (P ≤ 0.04). Statistically significant difference was detected for medial tibial translation between male and female patients at 60° (P = 0.04) and 75° of knee flexion (P = 0.02). The tibial rotation was significantly decreased at 60° (P = 0.03) and 75° of knee flexion (P < 0.01) in females. The inferior patellar shift in females was significantly lower than that in males at 15° (P = 0.04) and 30° of knee flexion (P = 0.01). The patellar tilt was significantly lower at 60° (P = 0.02) and 75° of knee flexion (P < 0.01) in females compared to males. Conclusions The results indicated a significant effect of gender on knee kinematics in patients with arthrofibrosis after ACL reconstruction during weight-bearing knee flexion. These gender differences in tibiofemoral kinematics and patellar tracking may warrant further investigations to determine implications for making gender-specific surgical treatments and rehabilitation programs.
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Affiliation(s)
- Ling Zhang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Shuai Fan
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Jiling Ye
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Xin Jiang
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China
| | - Bin Cai
- Department of Rehabilitation Medicine, Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 500th. Quxi Road, Shanghai, 200010, China.
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Otto A, Tscholl PM, Pääsuke R, Herbst E, Willinger L, Imhoff AB, Brucker PU. Neither lateral patellar facet nor patellar size are altered in patellofemoral unstable patients: a comparative magnetic resonance imaging analysis. Knee Surg Sports Traumatol Arthrosc 2020; 28:1064-1071. [PMID: 31456062 DOI: 10.1007/s00167-019-05660-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 08/05/2019] [Indexed: 02/07/2023]
Abstract
PURPOSE It remains unclear if morphologic patterns of the patella itself predispose to patellar instability. This study examined established patellar landmarks in relation to the femoral condyle width to clarify differences of patellar morphologies in patellofemoral stable and unstable patients. METHODS Magnetic Resonance Imaging of 50 subjects (20.7 ± 4.4 years; 17 males, 33 females) with patellofemoral instability (study group, SG) and 50 subjects (25.3 ± 5.8 years; 31 males, 19 females) with anterior cruciate ligament rupture (control group, CG) were analyzed. Corresponding patellar value indices (PW-I; LPF-I 1; LPF-I 2) in relation to the femoral condyle width (FCW) were evaluated after the measurement of absolute patellar dimension [patellar width (PW); direct length of the lateral patellar facet (LPF-1); projected length of the lateral patellar facet (LPF-2)]. The patellar shape according to Wiberg, trochlear dysplasia, patellar height, and tibial tubercle-trochlear groove (TT-TG) distance were determined. RESULTS The SG showed a significantly longer absolute (LPF 2) (P = 0.041) and relative (LPF-I 1, LPF-I 2) (P < 0.001) lateral facet of the patella. No significant differences were evaluable for the relative patellar width (PW-I) (ns). A patellar shape type 3 (P = 0.001) as well as a higher position of the patella and TT-TG-distance (P < 0.001) were significantly more often present in the SG. CONCLUSION There are several bony alterations associated with patellofemoral instability, but our data did not show a significantly smaller lateral patellar facet or relative patellar width that could facilitate a patellar dislocation. This helps surgeons, that are considering to surgically address the patella in cases of patellofemoral instability, to better understand its morphologic pattern. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Alexander Otto
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany.,Department of Trauma, Orthopaedic, Plastic and Hand Surgery, University Hospital of Augsburg, Augsburg, Germany.,Department of Orthopaedic Surgery, UConn Musculoskeletal Institute, University of Connecticut, Farmington, CT, USA
| | - Philippe M Tscholl
- Division of Orthopaedics and Trauma Surgery, Geneva University Hospital, Geneva, Switzerland.,Department of Orthopaedic Surgery, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Reedik Pääsuke
- Department of Traumatology and Orthopaedics, Tartu University Hospital, Tartu, Estonia
| | - Elmar Herbst
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Lukas Willinger
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
| | - Andreas B Imhoff
- Department of Orthopaedic Sports Medicine, Technical University of Munich, Munich, Germany
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Rezvanifar SC, Flesher BL, Jones KC, Elias JJ. Lateral patellar maltracking due to trochlear dysplasia: A computational study. Knee 2019; 26:1234-1242. [PMID: 31786000 PMCID: PMC6926151 DOI: 10.1016/j.knee.2019.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The study focuses on the influence of trochlear dysplasia on patellar tracking related to patellar instability. METHODS Knee extension against gravity and dual-limb squatting were simulated with seven models representing knees being treated for recurrent instability. Trochlear depth was altered to represent lateral trochlear inclination (LTI) values of 6°, 12° and 24°. Repeated measures analyses compared patellar lateral shift (bisect offset index) across different LTI values. Peak bisect offset index during extension and squatting was correlated with patella alta (Caton-Deschamps index) and maximum lateral position of the tibial tuberosity. RESULTS Bisect offset index varied significantly (p < 0.05) between different LTI values at multiple flexion angles throughout simulated knee extension and squatting. Average bisect offset values were 1.02, 0.95, and 0.86 for LTI = 6°, 12°, and 24°, respectively, at 0° of flexion for knee extension. The strongest correlation occurred between peak bisect offset index and lateral position of the tibial tuberosity for knee squatting with LTI = 6° (r2 = 0.81, p = 0.006). The strength of the correlation decreased as LTI increased. Caton-Deschamps was only significantly correlated with patellar tracking for LTI = 24° during knee squatting. CONCLUSIONS A shallow trochlear groove increases lateral patellar maltracking. A lateral tibial tuberosity in combination with trochlear dysplasia increases lateral patellar tracking and the risk of patellar instability. Patella alta has relatively little influence on patellar tracking in combination with trochlear dysplasia due to the limited articular constraint provided by the trochlear groove.
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Affiliation(s)
- S. Cyrus Rezvanifar
- Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Brett L. Flesher
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kerwyn C. Jones
- Department of Orthopedic Surgery, Akron Children’s Hospital, Akron, OH, USA
| | - John J. Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
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TKA design-integrated trochlea groove rotation reduces patellofemoral pressure. Knee Surg Sports Traumatol Arthrosc 2019; 27:1680-1692. [PMID: 30564858 DOI: 10.1007/s00167-018-5324-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 12/07/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE Total knee arthroplasty (TKA) leaves 11-25% of the patients unsatisfied, and patellofemoral joint pain is one cause. This study aimed to compare the differences between kinematics and load transfer in the same knee with axial internal/external rotation of the femoral component (CoRo) versus a separate axial internal/external trochlear groove rotation (TrRo) which is included in the TKA trochlea design. METHODS A validated weight-bearing finite element model with modifications of the TKA axial femoral component rotation (CoRo) and a modified trochlear rotation (TrRo) was calculated and analysed. RESULTS Compared to the neutrally implanted TKA at 105° of flexion, a 6° external rotation of the trochlear groove reduced the retropatellar stress by 7%, whereas a 3° internal trochlear groove rotation increased the retropatellar stress by 7%. With femoral component rotation, the tibia inlay stress of 6.7 MPa at 60° of flexion was two times higher both with a 3° internal component rotation and a 6° external rotation. CONCLUSION These results demonstrate in the tested TKA design that a trochlear groove rotation can reduce retropatellar stress. Additionally, during the TKA operation, the surgeon should be aware of the significant influence of axial femoral component rotation on mechanical inlay stress during flexion and of the fact that even small changes in the patellofemoral joint may influence the tibiofemoral joint. These results support that an external rotation of the femoral component should be preferred in TKA to avoid anterior knee pain. Furthermore, new developed TKA designs should integrate an externally rotated trochlea groove.
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Increase in the Tibial Slope in Unicondylar Knee Replacement: Analysis of the Effect on the Kinematics and Ligaments in a Weight-Bearing Finite Element Model. BIOMED RESEARCH INTERNATIONAL 2018; 2018:8743604. [PMID: 30069483 PMCID: PMC6057393 DOI: 10.1155/2018/8743604] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022]
Abstract
Introduction Unicompartmental arthroplasty (UKA) of the knee in patients with isolated medial osteoarthritis yields adequate results; however, the survival rate is inferior to that of total knee arthroplasty (TKA). A key factor in the longevity of the implant is the positioning; however, the optimal tibial slope in UKA has not been determined. The aim of this study was to establish a finite element (FE) model and investigate the effect of the tibial slope on the strain of the ligaments, kinematics, inlay movement, and load in the nonreplaced patellofemoral compartment in a medial mobile bearing UKA. Materials and Methods An FE model of a leg was established with a virtual UKA implantation with three different tibial slopes (0°, 5°, and 10°). Subsequently, the knee was flexed from 14–73°. In addition, the ground reaction force and the muscles were simulated. Results With a higher tibial slope, there was more external rotation of the tibia. An increased tibial slope provided a lateral shift of the patella in the trochlear groove and a more anterior position of the inlay. The ligament strains were also changed, specifically, the anterior portion of the medial collateral ligament and the posterior cruciate ligament (PCL). Discussion This study established the first model of a quasidynamic mobile bearing UKA in a leg under weight-bearing conditions. With an increasing tibial slope, there was a higher external rotation of the tibia that created different femorotibial and retropatellar kinematics and different strains in the ligaments. This knowledge adds important information for the optimal tibial slope that has to be determined individually depending on the patient's preoperative kinematics, desired postoperative kinematics, ligament status, and location of the retropatellar chondral damage.
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Esfandiarpour F, Lebrun CM, Dhillon S, Boulanger P. In-vivo patellar tracking in individuals with patellofemoral pain and healthy individuals. J Orthop Res 2018; 36:2193-2201. [PMID: 29488245 DOI: 10.1002/jor.23887] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 02/16/2018] [Indexed: 02/04/2023]
Abstract
Understanding of the exact cause of patellofemoral pain has been limited by methodological challenges to evaluate in-vivo joint motion. This study compared six degree-of-freedom patellar motion during a dynamic lunge task between individuals with patellofemoral pain and healthy individuals. Knee joints of eight females with patellofemoral pain and ten healthy females were imaged using a CT scanner in supine lying position, then by a dual-orthogonal fluoroscope while they performed a lunge. To quantify patellar motion, the three-dimensional models of the knee bones, reconstructed from CT scans, were registered on the fluoroscopy images using the Fluomotion registration software. At full knee extension, the patella was in a significantly laterally tilted (PFP: 11.77° ± 7.58° vs. healthy: 0.86° ± 4.90°; p = 0.002) and superiorly shifted (PFP: 17.49 ± 8.44 mm vs. healthy: 9.47 ± 6.16 mm, p = 0. 033) position in the patellofemoral pain group compared with the healthy group. There were also significant differences between the groups for patellar tilt at 45°, 60°, and 75° of knee flexion, and for superior-inferior shift of the patella at 30° flexion (p ≤ 0.031). In the non-weight-bearing knee extended position, the patella was in a significantly laterally tilted position in the patellofemoral pain group (7.44° ± 6.53°) compared with the healthy group (0.71° ± 4.99°). These findings suggest the critical role of passive and active patellar stabilizers as potential causative factors for patellar malalignment/maltracking. Future studies should investigate the associations between patellar kinematics with joint morphology, muscle activity, and tendon function in a same sample for a thorough understanding of the causes of patellofemoral pain. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Fateme Esfandiarpour
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
- Musculoskeletal Rehabilitation Research Center, School of Rehabilitation Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Constance M Lebrun
- Department of Family Medicine, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Sukhvinder Dhillon
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Canada
| | - Pierre Boulanger
- Department of Computing Science, University of Alberta, Edmonton, Canada
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Matz J, Howard JL, Sisko ZW, Teeter MG, Lanting BA. Differences in Trochlear Surface Damage and Wear Between Three Different Total Knee Arthroplasty Designs. J Arthroplasty 2017; 32:3763-3770. [PMID: 28750858 DOI: 10.1016/j.arth.2017.06.037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 06/22/2017] [Accepted: 06/26/2017] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Trochlear design plays a role in patellofemoral kinematics. Little is known regarding differences in the contact properties between modern designs. The purpose of the present study was to analyze patellofemoral joint contact by identifying areas of joint surface damage and wear in retrieved femoral components of 3 modern designs. MATERIALS Eighteen retrieved femoral components featuring 3 different modern designs (Triathlon, SIGMA, and GENESIS II) were matched based on time-in-vivo, age, gender, and body mass index. Trochlear wear and surface damage were assessed using visual inspection, light microscopy, and light profilometry. RESULTS Visual inspection of the femoral components showed evidence of surface damage in all implant types. No significant differences between the groups were found with respect to surface damage and wear on visual inspection. Light profilometry of retrieved components showed that retrieved Triathlon (P = .002) and SIGMA (P = .009) components were significantly rougher than the corresponding reference components. The GENESIS II retrieved components were not substantially rougher than the reference components (P = .48). Light profilometry analysis showed significantly increased roughness of retrieved SIGMA components compared with Triathlon or GENESIS II components, particularly in the proximal trochlear groove and the medial trochlea. CONCLUSION As the volume and patient demands for total knee arthroplasty increase, a greater understanding of the patellofemoral joint is warranted. Patellofemoral kinematics can have an effect on the surface characteristics of total knee arthroplasty components. Retrieved SIGMA components appeared to have increased roughness compared with Triathlon or GENESIS II components. The etiology and long-term effects of increased trochlear roughness require further investigation.
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Affiliation(s)
- Jacob Matz
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - James L Howard
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Zachary W Sisko
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
| | - Matthew G Teeter
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada; Surgical Innovation Program, Lawson Health Research Institute, London, Ontario, Canada
| | - Brent A Lanting
- Division of Orthopedic Surgery, London Health Sciences Center, University Hospital, London, Ontario, Canada
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Abstract
Patellofemoral pain is a common knee pathology that affects a wide range of active individuals. These individuals often seek medical care, with 25% of all patients seen in sports medicine clinics being treated for patellofemoral pain. While conservative treatment produce beneficial short-term results, individuals with patellofemoral pain often have long-term pain and decreased quality of life for many years following their diagnosis. One of the challenges for treating this chronic condition is the heterogeneous presentation of impairments across patients, ranging from soft tissue restriction, muscle weakness, altered movement patterns during functional tasks, and weak core stability. Clinicians need to identify these impairments and develop an individualized impairment-based model for treating patients with PFP. The aim of this review it to provide guidance and recommendations for clinicians who treat PFP in hopes to improve long-term outcomes for the conservative treatment of PFP.
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Affiliation(s)
- Neal R Glaviano
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
| | - Susan Saliba
- a Department of Kinesiology , University of Virginia Ringgold standard institution , Charlottesville , VA , USA
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Keshmiri A, Maderbacher G, Baier C, Zeman F, Grifka J, Springorum HR. Significant influence of rotational limb alignment parameters on patellar kinematics: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2016; 24:2407-14. [PMID: 25399346 DOI: 10.1007/s00167-014-3434-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 11/10/2014] [Indexed: 01/17/2023]
Abstract
PURPOSE Component malrotation has a major impact on patellar kinematics in total knee arthroplasty. The influence of natural rotational limb alignment on patellar kinematics is unclear so far. Based on recent clinical investigations, we hypothesized that rotational limb alignment significantly influences patellar kinematics. METHODS Patellar kinematics of ten cadaveric knees was measured using computer navigation during passive motion. Data were correlated with different rotational limb alignment parameters of preoperative CT scans. RESULTS Femoral antetorsion showed a significant influence on patellar rotation, while tibial tubercle-posterior cruciate ligament distance additionally displayed a significant influence on patellar mediolateral shift (p < 0.05). Femoral posterior condylar angle was sensitive to patellar epicondylar distance, rotation and tilt (p < 0.05). Patellar rotation was influenced by five out of eight rotational limb alignment parameters (p < 0.05). CONCLUSIONS Rotational limb alignment should be paid more attention in terms of clinical evaluation of patellar tracking and future biomechanical and clinical investigations.
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Affiliation(s)
- Armin Keshmiri
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany.
| | - Günther Maderbacher
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany
| | - Clemens Baier
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany
| | - Florian Zeman
- Centre for Clinical Studies, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany
| | - Joachim Grifka
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany
| | - Hans Robert Springorum
- Department of Orthopaedic Surgery, University of Regensburg, Kaiser-Karl-V Allee 3, 93077, Bad Abbach, Germany
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Steinbrück A, Schröder C, Woiczinski M, Fottner A, Müller PE, Jansson V. The effect of trochlea tilting on patellofemoral contact patterns after total knee arthroplasty: an in vitro study. Arch Orthop Trauma Surg 2014; 134:867-72. [PMID: 24522864 DOI: 10.1007/s00402-014-1956-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2013] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Patellofemoral complications are one major concern after total knee arthroplasty (TKA). Anterior knee pain is one of these complications and to a high percentage responsible for unsatisfied patients after TKA. Malrotation of the femoral component can contribute to retropatellar peak pressure and consequently to anterior knee pain. MATERIALS AND METHODS Eight fresh frozen cadavers were tested in a force-controlled knee rig after TKA during isokinetic flexing of the knee from 20° to 120° under constant load. By tilting the trochlea in the material of the created femoral component replicas, a rotation of the femoral component by 3° internal, 0° (neutral), 3° and 6° external rotation to transepicondylar line was simulated without changing flexion or extension gap. Retropatellar pressure distribution was measured during flexion and extension of the knee while quadriceps muscles and hamstring forces were applied. RESULTS Maximum peak pressure for internal rotation of the trochlea was 7.32 ± 2.31 MPa, in neutral position the pressure reduced slightly to 7.31 ± 2.12 MPa and during further external rotation of trochlea rotation a decrease from 3° with 7.18 ± 2.14 MPa to 6° with 6.22 ± 1.83 MPa was observed (p < 0.01). There was a tendency of lower quadriceps force with increasing external rotation of the trochlea (p = 0.08). CONCLUSIONS The implantation of the femoral component by 3° internal trochlea rotation to transepicondylar line resulted in a highly significant increase of the mean maximal retropatellar pressure compared to 6° external rotation of the trochlea of the femoral component (p < 0.01). A higher retropatellar pressure might lead to anterior knee pain after TKA. We recommend an external rotation of the femoral component between 3° and 6° to anatomical transepicondylar line to reduce the maximal retropatellar pressure, but only if adequate soft tissue balancing and stable knee kinematics are provided.
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Affiliation(s)
- Arnd Steinbrück
- Department of Orthopedic Surgery, Physical Medicine and Rehabilitation, University Hospital of Munich (LMU), Campus Grosshadern, Marchioninistr. 15, 81377, Munich, Germany,
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Wilson DR, McWalter EJ, Johnston JD. The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Rheum Dis Clin North Am 2013; 39:21-44. [PMID: 23312409 DOI: 10.1016/j.rdc.2012.11.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Mechanics play a role in the initiation and progression of osteoarthritis. However, our understanding of which mechanical parameters are most important, and what their impact is on the disease, is limited by the challenge of measuring the most important mechanical quantities in living subjects. Consequently, comprehensive statements cannot be made about how mechanics should be modified to prevent, slow or arrest osteoarthritis. Our current understanding is based largely on studies of deviations from normal mechanics caused by malalignment, injury, and deformity. Some treatments for osteoarthritis focus on correcting mechanics, but there appears to be scope for more mechanically based interventions.
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Affiliation(s)
- David R Wilson
- Department of Orthopaedics, Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, British Columbia, Canada.
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16
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Bertollo N, Pelletier MH, Walsh WR. Relationship between patellar tendon shortening and in vitro kinematics in the ovine stifle joint. Proc Inst Mech Eng H 2012; 227:438-47. [DOI: 10.1177/0954411912466352] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-operative patellar tendon shortening induces a distal positioning of the patella in the femoral trochlear groove, which has been associated with pain and impeded mobility. An idealized in vitro model was used to examine the effects of shortening on patellar kinematics. The PT length was progressively reduced by up to 5 mm (1-mm instalments) using a device secured onto the tendon in n = 9 ovine stifles. In vitro 6 degrees-of-freedom motion data for the patellofemoral and tibiofemoral joints under conditions of passively induced flexion–extension was acquired electromagnetically. Patellar motion was analysed as a function of both tibial and patellar flexion angles relative to the femoral co-ordinate frame. Linear regression with contrasts was used to compare kinematic changes for each shortening level, with significance set at P<0.01. A mean maximum percentage length reduction of 8.2% was achieved. Patellar flexion was linearly correlated with tibial flexion angle in the intact joint, and this correlation persisted after tendon shortening (R = 0.977, P < 0.01). Patellar kinematics expressed as a function of tibial flexion angle were significantly altered by a mean length decrease of 8.2%, while flexion and proximo-distal shift patterns were significantly affected at lesser shortening levels of 3.1% and 4.7%, respectively. Patellar kinematics expressed as a function of patellar flexion angle remained unchanged. These results suggest that patellar motion within the trochlear groove in the ovine stifle joint follows a repeatable three-dimensional path and that patellar tendon shortening advances the position of the patella along this path, without significantly altering it.
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Affiliation(s)
- Nicky Bertollo
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - Matthew H Pelletier
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | - William R Walsh
- Surgical and Orthopaedic Research Laboratories, Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
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17
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Herrmann S, Lenz R, Geier A, Lehner S, Souffrant R, Woernle C, Tischer T, Bader R. [Musculoskeletal modeling of the patellofemoral joint. Dynamic analysis of patellar tracking]. DER ORTHOPADE 2012; 41:252-9. [PMID: 22476415 DOI: 10.1007/s00132-011-1851-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Numerical simulations contribute to the understanding of patellofemoral diseases. Whereas cadaveric studies are limited with respect to reproducibility of results, the impact of different operative approaches can be systematically evaluated based on mathematical models. The objective of this study was to introduce a musculoskeletal model which is capable of describing the dynamic interactions within the patellofemoral joint. It contains major bony and soft tissue structures of the right leg including the medial patellofemoral ligament (MPFL). Two operative approaches were considered based on the model to illustrate the effect on patellofemoral biomechanics during active knee flexion: On the one hand the effect of femoral insertion during MPFL reconstruction on medial soft tissue tension, and on the other hand the difference in patella kinematics before and after total knee arthroplasty. Finally, the potential of musculoskeletal models is discussed.
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Affiliation(s)
- S Herrmann
- Orthopädische Klinik und Poliklinik, Universität Rostock, Doberaner Str. 142, 18057, Rostock, Deutschland.
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18
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Steinbrück A, Milz S, Woiczinski M, Schröder C, Utzschneider S, Jansson V, Fottner A. [Anatomy and biomechanics of the patellofemoral joint: physiological conditions and changes after total knee arthroplasty]. DER ORTHOPADE 2012; 40:848, 850-2, 854. [PMID: 21938492 DOI: 10.1007/s00132-011-1773-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
The patellofemoral joint constitutes a complex anatomical and functional entity. The tensile force of the quadriceps femoris muscle is transmitted through the patella and patellar ligament onto the tibial tuberosity. This particular three-dimensional arrangement increases the torsional moment acting on the knee joint. Dynamic alignment of the patella is determined by trochlear geometry and is supported by active muscular and passive connective tissue stabilizers. In addition to the retinaculum of the patella, the medial patellofemoral ligament is attracting increasing clinical attention. Multidirectional motion of the patella is closely connected to retropatellar pressure distribution which can be modulated by moving the patellar ligament insertion. Implantation of a knee endoprosthesis changes the joint surface geometry and consequently patella kinematics and retropatellar pressure distribution. Finite element analysis provides the possibility to assess retropatellar pressure distribution before and after implantation of prostheses.
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Affiliation(s)
- A Steinbrück
- Orthopädische Klinik und Poliklinik, Klinikum der Ludwig-Maximilians-Universität, Campus Grosshadern, München, Deutschland.
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19
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The relationship between trochlear dysplasia and medial patellofemoral ligament rupture location after patellar dislocation: an MRI evaluation. Knee 2011; 18:185-8. [PMID: 20494581 DOI: 10.1016/j.knee.2010.04.002] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Revised: 03/29/2010] [Accepted: 04/18/2010] [Indexed: 02/02/2023]
Abstract
The medial patellofemoral ligament (MPFL) and the native trochlear geometry represent two of the most critical components of patellofemoral stability. We sought to define the relationship between trochlear dysplasia and MPFL rupture location in patients with documented patellar dislocations. We hypothesized that patients with lower grades of trochlear dysplasia would have patellar based MPFL ruptures, while patients with higher grade dysplasia would have femoral-sided ruptures. We reviewed post-injury MRIs of 59 patients with documented patella dislocation. Information gathered included: type of trochlear dysplasia in the axial plane MRI, location of MPFL rupture, patellar height ratio, tibial tuberosity to trochlear groove distance (TTTG), number of dislocations prior to MRI, and time between the latest patella dislocation and the MRI. Statistical calculations utilized the Chi-Square-Test. We classified 11 cases as a dysplasia type A, 35 as a type B, 11 as a type C, and 2 cases as a trochlear dysplasia type D. In 7 patients (12%) the MPFL rupture was patella based, in 18 patients (31%) intra-ligamentous, in 33 cases (56%) femoral sided and in one case no MPFL could be identified. In contrast to our original hypothesis, the type of trochlear dysplasia does not appear to be related to the rupture location of the MPFL after patellar dislocation. According to our results, it is not possible to presume the location of the MPFL rupture based on assessment of the trochlear morphology. Therefore, a MRI is mandatory for final indication of any surgery.
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20
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Varadarajan KM, Freiberg AA, Gill TJ, Rubash HE, Li G. Relationship between three-dimensional geometry of the trochlear groove and in vivo patellar tracking during weight-bearing knee flexion. J Biomech Eng 2011; 132:061008. [PMID: 20887033 DOI: 10.1115/1.4001360] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
It is widely recognized that the tracking of patella is strongly influenced by the geometry of the trochlear groove. Nonetheless, quantitative baseline data regarding correlation between the three-dimensional geometry of the trochlear groove and patellar tracking under in vivo weight-bearing conditions are not available. A combined magnetic resonance and dual fluoroscopic imaging technique, coupled with multivariate regression analysis, was used to quantify the relationship between trochlear groove geometry (sulcus location, bisector angle, and coronal plane angle) and in vivo patellar tracking (shift, tilt, and rotation) during weight-bearing knee flexion. The results showed that in the transverse plane, patellar shift was strongly correlated (correlation coefficient R=0.86, p<0.001) to mediolateral location of the trochlear sulcus (raw regression coefficient β(raw)=0.62) and the trochlear bisector angle (β(raw)=0.31). Similarly, patellar tilt showed a significant association with the trochlear bisector angle (R=0.45, p<0.001, and β(raw)=0.60). However, in the coronal plane patellar rotation was poorly correlated with its matching geometric parameter, namely, the coronal plane angle of the trochlea (R=0.26, p=0.01, β(raw)=0.08). The geometry of the trochlear groove in the transverse plane of the femur had significant effect on the transverse plane motion of the patella (patellar shift and tilt) under in vivo weight-bearing conditions. However, patellar rotation in the coronal plane was weakly correlated with the trochlear geometry.
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Affiliation(s)
- Kartik M Varadarajan
- Bioengineering Laboratory, Orthopaedic Surgery, MGH/Harvard Medical School, Boston, MA 02114, USA
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21
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Varadarajan KM, Rubash HE, Li G. Are current total knee arthroplasty implants designed to restore normal trochlear groove anatomy? J Arthroplasty 2011; 26:274-81. [PMID: 20171042 DOI: 10.1016/j.arth.2009.12.009] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2009] [Accepted: 12/08/2009] [Indexed: 02/01/2023] Open
Abstract
Biomechanical studies have shown that external rotation of the femoral TKA component improves patellar tracking but does not restore it to physiologic values. We hypothesized that this could be due to differences in the trochlear groove geometry of TKA and normal knees. This was investigated via a virtual TKA procedure that mounted femoral components on to 3-dimensional models of healthy femurs, followed by measurement of the trochlear geometry before and after the simulated TKA. The results showed that (1) external rotation of the component brought the trochlear groove closer to normal anatomy than no external rotation; (2) however, even with external rotation, the trochlear anatomy was only partially restored to normal. Further work is needed to determine implications for patellofemoral complications observed with current TKA designs.
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Affiliation(s)
- Kartik M Varadarajan
- Bioengineering Laboratory, Orthopedic Surgery, MGH/Harvard Medical School, Boston, Massachusetts 02114, USA
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22
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Abstract
Trochlear dysplasia is characterized by abnormal trochlear morphology and a shallow groove. It is associated with recurrent patellar dislocation, but it is unclear whether the dysplasia is congenital, the result of lateral tracking and chronic instability, or caused by a combination of factors. Lateral radiographs elucidate the crossing sign and characteristic trochlear prominence. Recurrent patellofemoral instability is multifactorial, and each component must be considered in determining treatment. Managing other factors associated with recurrent instability may compensate for a deficient trochlea and provide stability. Medial patellofemoral ligament reconstruction is recommended for patellofemoral instability in the presence of trochlear dysplasia in patients without patella alta or increased tibial tubercle-trochlear groove distance. Trochleoplasty should be reserved for severe dysplasia in which patellofemoral stability cannot otherwise be obtained.
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23
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Hensler D, Schöttle P. Erweiterte Indikationen für die Rekonstruktion des medialen patellofemoralen Ligaments. ARTHROSKOPIE 2010. [DOI: 10.1007/s00142-010-0568-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Iranpour F, Merican AM, Baena FRY, Cobb JP, Amis AA. Patellofemoral joint kinematics: the circular path of the patella around the trochlear axis. J Orthop Res 2010; 28:589-94. [PMID: 19950364 DOI: 10.1002/jor.21051] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Differing descriptions of patellar motion relative to the femur have resulted from previous studies. We hypothesized that patellar kinematics would correlate to the trochlear geometry and that differing descriptions could be reconciled by accounting for differing alignments of measurement axes. Seven normal fresh-frozen knees were CT scanned, and their kinematics with quadriceps loading was measured by an optical tracker system. Kinematics was calculated in relation to the femoral epicondylar, anatomic, and mechanical axes. A novel trochlear axis was defined, between the centers of spheres best fitted to the medial and lateral trochlear articular surfaces. The path of the center of the patella was circular and uniplanar (root-mean-square error 0.3 mm) above 16+/-3 degrees (mean+/-SD) knee flexion. In the coronal plane, this circle was aligned 6+/-2 degrees from the femoral anatomical axis, close to the mechanical axis alignment. It was 91+/-3 degrees from the epicondylar axis, and 88+/-3 degrees from the trochlear axis. In the transverse plane it was 91+/-3 degrees and 88+/-3 degrees from the epicondylar and trochlear axes, respectively. Manipulation of the data to different axis alignments showed that differing previously published data could be reconciled. The circular path of patellar motion around the trochlea, aligned with the mechanical axis of the leg, is easily visualized and understood.
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Affiliation(s)
- Farhad Iranpour
- Orthopaedic Surgery, Charing Cross Hospital, and Mechanical Engineering Department, Imperial College, London, United Kingdom
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25
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Varadarajan KM, Gill TJ, Freiberg AA, Rubash HE, Li G. Patellar tendon orientation and patellar tracking in male and female knees. J Orthop Res 2010; 28:322-8. [PMID: 19777466 PMCID: PMC3831286 DOI: 10.1002/jor.20977] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Knowledge of patellofemoral joint biomechanics is important for understanding sex-related dimorphism in patellofemoral pathologies and advancement of related treatments. We evaluated the hypotheses that sex differences exist in patellar tendon (PT) orientation and patellar tracking during weight-bearing knee flexion and that they relate to differences in tibiofemoral rotation. The PT orientation and patellar tracking were measured in healthy subjects (18 male, 13 female) during weight-bearing knee flexion, using magnetic resonance and dual fluoroscopic imaging. These data were analyzed for sex differences and correlation with previously reported tibiofemoral rotation data. The results indicated a significant effect of sex on PT orientation, particularly at low flexion angles. In females, the PT was oriented more anteriorly in the sagittal plane, more medially in the coronal plane, and showed greater external tilt in the transverse plane of the tibia (p < 0.05). Significant correlations between tibiofemoral rotation and PT orientation (p < 0.01) indicated that sex differences in coronal and transverse plane orientation of the PT relate to differences in tibiofemoral rotation. Patellar tracking did not show significant sex differences or correlation to tibiofemoral rotation. Further studies are warranted to determine implications for patellofemoral pathologies and treatments like total knee arthroplasty.
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Affiliation(s)
- Kartik M. Varadarajan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114,Department of Mechanical Engineering, Massachusetts Institute of Technology, 77 Massachusetts Avenue, Cambridge, Massachusetts 02139
| | - Thomas J. Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114
| | - Andrew A. Freiberg
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114
| | - Harry E. Rubash
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, Massachusetts 02114
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Abstract
Osteoarthritis is widely believed to result from local mechanical factors acting within the context of systemic susceptibility. This narrative review delineates current understanding of the etiopathogenesis of osteoarthritis and more specifically examines the critical role of biomechanics in disease pathogenesis. There are several ways the mechanical forces across the joint can be measured, including some that rely heavily on imaging methods. These are described and methods to advance the field are proposed.
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27
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Varadarajan KM, Gill TJ, Freiberg AA, Rubash HE, Li G. Gender differences in trochlear groove orientation and rotational kinematics of human knees. J Orthop Res 2009; 27:871-8. [PMID: 19127520 PMCID: PMC2716056 DOI: 10.1002/jor.20844] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Knowledge of the morphology and kinematics of the male and female knees is important for understanding gender-related dimorphism in knee pathology and improvement of related surgical treatments. Twelve male and 12 female subjects with healthy knees were recruited, and each subject performed a single leg lunge while images of the knee were recorded by two fluoroscopes. Tibiofemoral joint motion was then reproduced using bony models matched to the fluoroscopic images. Femoral trochlear groove orientation was also measured in each knee. While many of the measured parameters were found to be similar between the genders, a few interesting differences were also noted. Females showed greater external tibial rotation at 0 degrees flexion (-5.4 degrees vs. -1.3 degrees, p = 0.03), smaller internal rotation at 30 degrees flexion (1.7 degrees vs. 6.4 degrees, p = 0.04) and greater range of tibial rotation (18.2 degrees vs. 12.4 degrees, p = 0.01) compared to males. Female knees also had a more medially oriented proximal trochlear groove (10.0 degrees vs. 4.5 degrees, p = 0.04). These gender differences in rotational kinematics and trochlear groove orientation may warrant further studies to determine implications for surgical treatments such as total knee arthroplasty, and gender-related dimorphism in certain knee injuries and pathologies, like anterior cruciate ligament injury and patellofemoral problems.
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Affiliation(s)
- Kartik M. Varadarajan
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA,Department of Mechanical Engineering, Massachusetts Institute of Technology, Cambridge, MA
| | - Thomas J. Gill
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Andrew A. Freiberg
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Harry E. Rubash
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
| | - Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital and Harvard Medical School, Boston, MA
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Role of Alignment and Biomechanics in Osteoarthritis and Implications for Imaging. Radiol Clin North Am 2009; 47:553-66. [DOI: 10.1016/j.rcl.2009.04.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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29
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Erasmus PJ. [The medial patellofemoral ligament: function, injury, and treatment]. DER ORTHOPADE 2009; 37:858, 860-3. [PMID: 18682914 DOI: 10.1007/s00132-008-1292-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The medial patellofemoral ligament or MPFL is the prime soft tissue stabilizer of the patella. The MPFL is a non-isometric ligament lying in the second fascial layer of the knee; it is tight in extension and lax in flexion. The ligament is always torn in acute patellar dislocations. As "form follows function" we believe that the MPFL should be reconstructed in such a way that it stabilizes the patella without changing its movement pattern.
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Affiliation(s)
- P J Erasmus
- Mediclinic, Strand Road, 7600 Stellenbosch, Süd-Afrika.
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Wilson DR, McWalter EJ, Johnston JD. The measurement of joint mechanics and their role in osteoarthritis genesis and progression. Med Clin North Am 2009; 93:67-82, x. [PMID: 19059022 DOI: 10.1016/j.mcna.2008.08.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Mechanics play a role in the initiation, progression, and successful treatment of osteoarthritis. However, we don't yet know enough about which specific mechanical parameters are most important and what their impact is on the disease process to make comprehensive statements about how mechanics should be modified to prevent, slow, or arrest the disease process. The objectives of this review are (1) to summarize methods for assessing joint mechanics and their relative merits and limitations, (2) to describe current evidence for the role of mechanics in osteoarthritis initiation and progression, and (3) to describe some current treatment approaches that focus on modifying joint mechanics.
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Affiliation(s)
- David R Wilson
- Department of Orthopaedics, University of British Columbia, UBC Orthopaedics, Room 3114, 910 West 10th Avenue, Vancouver, BC, V5Z 4E3 Canada.
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31
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Wilson DR, McWalter EJ, Johnston JD. The Measurement of Joint Mechanics and their Role in Osteoarthritis Genesis and Progression. Rheum Dis Clin North Am 2008; 34:605-22. [DOI: 10.1016/j.rdc.2008.05.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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32
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Abstract
Acute and chronic trauma, chronic abnormal joint loading conditions, and hemarthroses have been implicated in the development of degenerative joint disease. Patellar instability with acute and recurrent patellar dislocation provides all of these ingredients. This article describes an approach to the treatment of recurrent patellar instability that considers the unique features and expectations of the patient rather than using a generic algorithm.
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Affiliation(s)
- Jack Andrish
- Department of Orthopaedic Surgery, Cleveland Clinic Foundation, Desk A-41, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Intraoperative vs. weightbearing patellar kinematics in total knee arthroplasty: a cadaveric study. Clin Biomech (Bristol, Avon) 2008; 23:60-70. [PMID: 17950965 DOI: 10.1016/j.clinbiomech.2007.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Revised: 08/04/2007] [Accepted: 08/08/2007] [Indexed: 02/07/2023]
Abstract
BACKGROUND During knee replacement surgery, surgeons optimize intraoperative patellar tracking with the aim of optimizing postoperative tracking. This link has not been investigated to date. Our research questions were: (1) How well do patellar kinematics correlate between passive and weightbearing flexion across numerous changes in component placement? (2) How do the kinematics differ between the two loading configurations? METHODS Eight cadaveric knee joints with modified knee components that allowed 11 different femoral, tibial and patellar placements were tested in two experimental rigs simulating intraoperative and weightbearing dynamic flexion. Baseline placement had all components in neutral position. Pearson correlation coefficients were calculated for absolute baseline kinematics and for relative kinematics due to changes in component position (i.e., the 10 altered positions vs. baseline). FINDINGS Correlations between intraoperative and weightbearing rigs for absolute baseline kinematics were unpredictable, ranging from poor to excellent (mean 0.56 for tilt and mean 0.50 for shift). Correlations between rigs for changes in tilt and shift, i.e. relative kinematics, were strong (>0.8) or very strong (>0.9), with the exception of shift in early flexion (0.54). Differences in relative kinematics, which averaged 2.2 degrees in tilt (standard deviation 1.8 degrees ) and 1.6mm in shift (standard deviation 1.7mm), were notably smaller and less variable than differences in absolute kinematics, which averaged 4.2 degrees in tilt (standard deviation 3.6 degrees ) and 4.3mm in shift (standard deviation 3.9mm). INTERPRETATION The results of this study suggest that, while absolute kinematics may differ between conditions, if a surgeon adjusts a component position to improve patellar kinematics intraoperatively, the effects of such a geometric change will likely carry through to the postoperative joint.
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Mulford JS, Wakeley CJ, Eldridge JDJ. Assessment and management of chronic patellofemoral instability. ACTA ACUST UNITED AC 2007; 89:709-16. [PMID: 17613491 DOI: 10.1302/0301-620x.89b6.19064] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Chronic patellofemoral instability can be a disabling condition. Management of patients with this condition has improved owing to our increased knowledge of the functional anatomy of the patellofemoral joint. Accurate assessment of the underlying pathology in the unstable joint enables the formulation of appropriate treatment. The surgical technique employed in patients for whom non-operative management has failed should address the diagnosed abnormality. We have reviewed the literature on the stabilising features of the patellofemoral joint, the recommended investigations and the appropriate forms of treatment.
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Affiliation(s)
- J S Mulford
- Avon Orthopaedic Centre, Southmead Hospital, Southmead Road, Westbury-on-Trym, Bristol BS10 5NB, UK
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Barink M, Meijerink H, Verdonschot N, van Kampen A, de Waal Malefijt M. Asymmetrical total knee arthroplasty does not improve patella tracking: a study without patella resurfacing. Knee Surg Sports Traumatol Arthrosc 2007; 15:184-91. [PMID: 16909300 DOI: 10.1007/s00167-006-0158-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Accepted: 04/12/2006] [Indexed: 10/24/2022]
Abstract
It is often suggested that patella tracking after total knee arthroplasty (TKA) with an asymmetrical patella groove is more physiological than with a symmetrical patella groove. Therefore, this study tried to address two questions: what is the effect of TKA on patella tracking, and is patella tracking after asymmetrical TKA more physiological than patella tracking after symmetrical TKA? The patellar and tibial kinematics of five cadaveric knee specimens were measured in the intact situation, after the incision and suturing of a zipper, and after placement of a symmetrical TKA and an asymmetrical TKA, respectively. The patellae were not resurfaced. The flexion-extension kinematics were measured with an internal and external tibial moment to determine the envelope of motion (laxity bandwidth) of the tibio-femoral and patello-femoral articulation. The kinematics after TKA showed statistically significant changes in comparison to the intact situation: patellar medio-lateral translation, patellar tilt and tibial rotation were significantly affected. No statistically significant differences in knee kinematics were found between the symmetrical and the asymmetrical TKAs. We conclude that conventional TKA significantly changes physiological patello-femoral kinematics, and TKA with an asymmetrical patella groove does not improve the non-physiological tracking of the patella.
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Affiliation(s)
- Marco Barink
- Orthopaedic Research Laboratory, Radboud University Nijmegen Medical Center, P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Andrish J. Luxación rotuliana recidivante. Rev Esp Cir Ortop Traumatol (Engl Ed) 2006. [DOI: 10.1016/s1888-4415(06)76377-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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Farahmand F, Naghi Tahmasbi M, Amis A. The contribution of the medial retinaculum and quadriceps muscles to patellar lateral stability--an in-vitro study. Knee 2004; 11:89-94. [PMID: 15066616 DOI: 10.1016/j.knee.2003.10.004] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2003] [Revised: 10/22/2003] [Accepted: 10/31/2003] [Indexed: 02/02/2023]
Abstract
Patellofemoral joint stability is a result of the restraining effects of the quadriceps muscles, the retinacular structures, and engagement of the bones. The role and significance of these mechanisms in restraining patellar lateral displacement was investigated in this study by measuring the force needed to cause 5 mm lateral displacement (i.e. the mechanical stability, or 'stabilising force') of the patella. Six cadaver knees had 175 N quadriceps load distributed among three muscle groups. With a force ratio matching the muscles physiological cross sectional areas, no significant change occurred in the patellar stabilising force between 0 and 60 degrees knee flexion, but a significant increase occurred between 60 and 90 degrees, presumably reflecting the contribution of the femoral groove. Variation of the quadriceps force distribution changed the stability significantly. Relaxing the vastus lateralis increased the patellar lateral stabilising force 52+/-8%, while relaxing vastus medialis reduced the stabilising force 47+/-9%. The minimum stabilising force was at 30 degrees knee flexion. Transection of the medial retinaculum reduced the lateral stabilising force 34% in the extended knee. This effect disappeared by 45 degrees knee flexion. It was concluded that the quadriceps muscles had a significant and consistent effect across the whole range of knee flexion, but the contribution of the medial retinaculum was restricted to extended knee postures.
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Affiliation(s)
- Farzam Farahmand
- Department of Mechanical Engineering, Sharif University of Technology, Azadi Avenue, Tehran, Iran.
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Brunet ME, Brinker MR, Cook SD, Christakis P, Fong B, Patron L, O'Connor DP. Patellar tracking during simulated quadriceps contraction. Clin Orthop Relat Res 2003:266-75. [PMID: 12966302 DOI: 10.1097/01.blo.0000079266.91782.11] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The current study compared patella tracking during simulated concentric and eccentric quadriceps contractions in 12 knees from cadavers using a three-dimensional electromagnetic tracking system. The patella shifted (translated) and tilted medially during approximately the initial 22 degrees tibiofemoral flexion. The patella then shifted and tilted laterally for the remaining arc of tibiofemoral flexion (90 degrees). At 90 degrees tibiofemoral flexion, the patella had an orientation of lateral patella shift and lateral patella tilt. Patella shift was significantly more lateral between 40 degrees and 70 degrees tibiofemoral flexion during concentric quadriceps action than during eccentric contraction. Patella tilt was significantly more lateral between 45 degrees and 55 degrees tibiofemoral flexion during concentric quadriceps contraction than during eccentric action. No other significant differences were seen between the quadriceps contraction conditions. The current study supports the hypothesis that patellar instability is most likely a result of various anatomic and physiologic factors causing a failure of the extensor mechanism to deliver the patella into the femoral sulcus and that a patellar dislocation rarely would occur in a normal knee.
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Affiliation(s)
- Michael E Brunet
- Department of Orthopaedic Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
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