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Shimada M, Huang C, Yamakawa S, Fujie H, Murakami S, Kanno N, Hara Y. Biomechanical effects of cranial closing wedge osteotomy on joint stability in normal canine stifles: an ex vivo study. BMC Vet Res 2024; 20:72. [PMID: 38402170 PMCID: PMC10893735 DOI: 10.1186/s12917-024-03923-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND Cranial closing wedge osteotomy (CCWO) is a functional stabilisation technique for cranial cruciate ligament (CrCL) ruptures. This biomechanical study aimed to evaluate the influence of CCWO on the stability of the stifle joint. Eighteen Beagle stifle joints were divided into two groups: control and CCWO. The stifle joints were analyzed using a six-degree-of-freedom robotic joint biomechanical testing system. The joints were subjected to 30 N in the craniocaudal (CrCd) drawer and proximal compression tests and 1 Nm in the internal-external (IE) rotation test. Each test was performed with an extension position, 135°, and 120° of joint angle. RESULTS The stifle joints were tested while the CrCLs were intact and then transected. In the drawer test, the CCWO procedure, CrCL transection, and stifle joint flexion increased CrCd displacement. The CCWO procedure and CrCL transection showed an interaction effect. In the compression test, the CCWO procedure decreased and CrCL transection and stifle joint flexion increased displacement. In the IE rotation test, CCWO, CrCL transection, and stifle joint flexion increased the range of motion. CONCLUSIONS CCWO was expected to provide stability against compressive force but does not contribute to stability in the drawer or rotational tests. In the CCWO-treated stifle joint, instability during the drawer test worsened with CrCL transection. In other words, performing the CCWO procedure when the CrCL function is present is desirable for stabilizing the stifle joint.
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Affiliation(s)
- Masakazu Shimada
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan.
| | - Chenxu Huang
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Satoshi Yamakawa
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | - Hiromichi Fujie
- The Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Minamiosawa, Hachioji- shi, Tokyo, Japan
| | - Sawako Murakami
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Nobuo Kanno
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
| | - Yasushi Hara
- Division of Veterinary Surgery, Department of Veterinary Science, Faculty of Veterinary Medicine, Nippon Veterinary and Life Science University, 1-7-1 Kyonan-cho, Musashino, Tokyo, 180-8602, Japan
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Mattar LT, Mahboobin AB, Popchak AJ, Anderst WJ, Musahl V, Irrgang JJ, Debski RE. Individuals with rotator cuff tears unsuccessfully treated with exercise therapy have less inferiorly oriented net muscle forces during scapular plane abduction. J Biomech 2024; 162:111859. [PMID: 37989027 PMCID: PMC10843663 DOI: 10.1016/j.jbiomech.2023.111859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/29/2023] [Accepted: 11/03/2023] [Indexed: 11/23/2023]
Abstract
Exercise therapy for individuals with rotator cuff tears fails in approximately 25.0 % of cases. One reason for failure of exercise therapy may be the inability to strengthen and balance the muscle forces crossing the glenohumeral joint that act to center the humeral head on the glenoid. The objective of the current study was to compare the magnitude and orientation of the net muscle force pre- and post-exercise therapy between subjects successfully and unsuccessfully (e.g. eventually underwent surgery) treated with a 12-week individualized exercise therapy program. Twelve computational musculoskeletal models (n = 6 successful, n = 6 unsuccessful) were developed in OpenSim (v4.0) that incorporated subject specific tear characteristics, muscle peak isometric force, in-vivo kinematics and bony morphology. The models were driven with experimental kinematics and the magnitude and orientation of the net muscle force was determined during scapular plane abduction at pre- and post-exercise therapy timepoints. Subjects unsuccessfully treated had less inferiorly oriented net muscle forces pre- and post-exercise therapy compared to subjects successfully treated (p = 0.039 & 0.045, respectively). No differences were observed in the magnitude of the net muscle force (p > 0.05). The current study developed novel computational musculoskeletal models with subject specific inputs capable of distinguishing between subjects successfully and unsuccessfully treated with exercise therapy. A less inferiorly oriented net muscle force in subjects unsuccessfully treated may increase the risk of superior migration leading to impingement. Adjustments to exercise therapy programs may be warranted to avoid surgery in subjects at risk of unsuccessful treatment.
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Affiliation(s)
- Luke T Mattar
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Arash B Mahboobin
- Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States
| | - Adam J Popchak
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - William J Anderst
- Biodynamics Laboratory, University of Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States
| | - James J Irrgang
- UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States; Department of Physical Therapy, University of Pittsburgh, Pittsburgh, United States
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, University of Pittsburgh, United States; Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, United States; UPMC Freddie Fu Sports Medicine Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, United States.
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Ahsan ZS, Berube EE, Frondorf BJ, Bin Kim H, Marom N, Zayyad ZA, Fraychineaud TJ, Patel RM, Wickiewicz TL, Imhauser CW, Pearle AD, Nawabi DH. Role of Lateral Extra-articular Tenodesis in Restraining Internal Tibial Rotation: In Vitro Biomechanical Assessment of Lateral Tissue Engagement. Am J Sports Med 2024; 52:87-95. [PMID: 38164684 DOI: 10.1177/03635465231211534] [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] [Indexed: 01/03/2024]
Abstract
BACKGROUND The way in which force increases in the anterolateral tissues and the lateral extra-articular tenodesis (LET) tissue to resist internal rotation (IR) of the tibia after anterior cruciate ligament (ACL) reconstruction in isolation and after LET augmentation, respectively, is not well understood. PURPOSE (1) To compare in a cadaveric model how force increases (ie, engages) in the anterolateral tissues with IR of the tibia after isolated ACL reconstruction and in the LET tissue after augmentation of the ACL reconstruction with LET and (2) to determine whether IR of the tibia is related to engagement of the LET tissue. STUDY DESIGN Controlled laboratory study. METHODS IR moments were applied to 9 human cadaveric knees at 0°, 30°, 60°, and 90° of flexion using a robotic manipulator. Each knee was tested in 2 states: (1) after isolated ACL reconstruction with intact anterolateral tissues and (2) after LET was performed using a modified Lemaire technique with the LET tissue fixed at 60° of flexion under 44 N of tension. Resultant forces carried by the anterolateral tissues and the LET tissue were determined via superposition. The way force increased in these tissues was characterized via parameters of tissue engagement, namely in situ slack, in situ stiffness, and tissue force at peak applied IR moment, and then compared (α < .05). IR was related to parameters of engagement of the LET tissue via simple linear regression (α < .05). RESULTS The LET tissue exhibited less in situ slack than the anterolateral tissues at 30°, 60°, and 90° of flexion (P≤ .04) and greater in situ stiffness at 30° and 90° of flexion (P≤ .043). The LET tissue carried greater force at the peak applied IR moment at 0° and 30° of flexion (P≤ .01). IR was related to the in situ slack of the LET tissue (R2≥ 0.88; P≤ .0003). CONCLUSION LET increased restraint to IR of the tibia compared with the anterolateral tissue, particularly at 30°, 60°, and 90° of flexion. IR of the tibia was positively associated with in situ slack of the LET tissue. CLINICAL RELEVANCE Fixing the LET at 60° of flexion still provided IR restraint in the more functionally relevant flexion angle of 30°. Surgeons should pay close attention to the angle of internal and/or external tibial rotation when fixing the LET tissue intraoperatively because this surgical parameter is related to in situ slack of the LET tissue and, therefore, the amount of IR of the tibia.
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Affiliation(s)
- Zahab S Ahsan
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Erin E Berube
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Brian J Frondorf
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Ho Bin Kim
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Niv Marom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Zaid A Zayyad
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | | | - Ronak M Patel
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-Natal Castration Leads to Subtle Differences in Porcine Anterior Cruciate Ligament Morphology and Function in Adolescence. J Biomech Eng 2024; 146:011002. [PMID: 37831117 PMCID: PMC10680984 DOI: 10.1115/1.4063744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/14/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 2 weeks after birth or were left intact (boars). Posteuthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars. ACL cross-sectional area (CSA), length, volume, and in situ stiffness increased with age, as did the percent contribution of the ACL anteromedial (AM) bundle to resisting loads. Boar ACL, AM bundle, and PL bundle volumes were 19%, 25%, and 15% larger than barrows across ages. However, ACL CSA, in situ stiffness, and bundle contribution were similar between boars and barrows. The barrows had smaller temporal increases in AM bundle function than boars, but these data were highly variable. Early and sustained loss in testosterone leads to subtle differences in ACL morphology but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
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Affiliation(s)
- Jacob D. Thompson
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University, Raleigh, NC 27695
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University & University of North Carolina at Chapel Hill, 4130 Engineering Building III, 1840 Entrepreneur Drive, CB 7115, Raleigh, NC 27695; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695; Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599
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Nabeki S, Okada Y, Teramoto A, Shibata Y, Takahashi K, Shiwaku K, Kamiya T, Watanabe K, Fujimiya M, Fujie H, Yamashita T. The function of cruciate ligaments in bi-cruciate retaining Total knee arthroplasty with asymmetrical design. Clin Biomech (Bristol, Avon) 2023; 107:106038. [PMID: 37421831 DOI: 10.1016/j.clinbiomech.2023.106038] [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: 03/31/2022] [Revised: 06/28/2023] [Accepted: 07/03/2023] [Indexed: 07/10/2023]
Abstract
BACKGROUND Bi-cruciate retaining total knee arthroplasty with an asymmetrical design may improve knee function and clinical outcomes. This study aimed to compare the kinematics, anteroposterior laxity, and in situ forces of the anterior and posterior cruciate ligaments of knees subjected to this treatment with those of healthy knees. METHODS Seven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system. The kinematics during passive flexion-extension motion and anteroposterior laxity for native knee, treated knee, and treated knee with cruciate ligament transection states were investigated. The motions of the intact and treated knees during each test were repeated after anterior/posterior cruciate ligament transection to calculate the in situ force in the ligaments. FINDINGS The screw-home movement of normal knees disappeared after treatment. The in situ force of the anterior cruciate ligament in treated knees was higher than that in intact knees at ˃15° during flexion and at 60° and 90° against an anterior force. The in situ force of the posterior cruciate ligament in treated knees was higher at 0°, 15°, and 30° during flexion and at all flexion angles against a posterior force. INTERPRETATION The screw-home movement of normal knees decreased, and the in situ force of the anterior and posterior cruciate ligaments increased after treatment.
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Affiliation(s)
- Shogo Nabeki
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Yohei Okada
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan.
| | - Yasuraku Shibata
- Tokyo Metropolitan University, 1-1 Minamiosawa, Hachioji-shi, Tokyo 192-0397, Japan
| | - Katsunori Takahashi
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Kousuke Shiwaku
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Minami 1-jo Nishi 17-chome, Chuo-ku, Sapporo 060-8556, Japan
| | - Mineko Fujimiya
- 2nd Department of Anatomy, Sapporo Medical University, Minami 1-jo Nishi 17-chome, Chuo-ku, Sapporo 060-8556, Japan
| | - Hiromichi Fujie
- Tokyo Metropolitan University, 1-1 Minamiosawa, Hachioji-shi, Tokyo 192-0397, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University, Minami 1-jo Nishi 16-chome, Chuo-ku, Sapporo 060-8543, Japan
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Razu SS, Jahandar H, Zhu A, Berube EE, Manzi JE, Pearle AD, Nawabi DH, Wickiewicz TL, Santner TJ, Imhauser CW. Bayesian Calibration of Computational Knee Models to Estimate Subject-Specific Ligament Properties, Tibiofemoral Kinematics, and Anterior Cruciate Ligament Force With Uncertainty Quantification. J Biomech Eng 2023; 145:071003. [PMID: 36826392 PMCID: PMC10782874 DOI: 10.1115/1.4056968] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/26/2023] [Accepted: 02/05/2023] [Indexed: 02/25/2023]
Abstract
High-grade knee laxity is associated with early anterior cruciate ligament (ACL) graft failure, poor function, and compromised clinical outcome. Yet, the specific ligaments and ligament properties driving knee laxity remain poorly understood. We described a Bayesian calibration methodology for predicting unknown ligament properties in a computational knee model. Then, we applied the method to estimate unknown ligament properties with uncertainty bounds using tibiofemoral kinematics and ACL force measurements from two cadaver knees that spanned a range of laxities; these knees were tested using a robotic manipulator. The unknown ligament properties were from the Bayesian set of plausible ligament properties, as specified by their posterior distribution. Finally, we developed a calibrated predictor of tibiofemoral kinematics and ACL force with their own uncertainty bounds. The calibrated predictor was developed by first collecting the posterior draws of the kinematics and ACL force that are induced by the posterior draws of the ligament properties and model parameters. Bayesian calibration identified unique ligament slack lengths for the two knee models and produced ACL force and kinematic predictions that were closer to the corresponding in vitro measurement than those from a standard optimization technique. This Bayesian framework quantifies uncertainty in both ligament properties and model outputs; an important step towards developing subject-specific computational models to improve treatment for ACL injury.
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Affiliation(s)
- Swithin S. Razu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew Zhu
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Erin E. Berube
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Joseph E. Manzi
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Andrew D. Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | - Danyal H. Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, NY 10021
| | | | - Thomas J. Santner
- Department of Statistics, The Ohio State University, Columbus, OH 43210-1247
| | - Carl W. Imhauser
- Department of Biomechanics, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021
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He J, Kanto R, Fayed AM, Price TM, DiNenna MA, Linde MA, Smolinski P, van Eck CF. Augmenting ACL Repair With Suture Tape Improves Knee Laxity: A Biomechanical Study. Orthop J Sports Med 2023; 11:23259671221146013. [PMID: 37138945 PMCID: PMC10150432 DOI: 10.1177/23259671221146013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) repair is an alternative to reconstruction; however, suture tape support may be necessary to achieve adequate outcomes. Purposes To investigate the influence of suture tape augmentation (STA) of proximal ACL repair on knee kinematics and to evaluate the effect of the 2 flexion angles of suture tape fixation. Study Design Controlled laboratory study. Methods Fourteen cadaveric knees were tested using a 6 degrees of freedom robotic testing system under anterior tibial (AT) load, simulated pivot-shift (PS) load, and internal rotation (IR) and external rotation loads. Kinematics and in situ tissue forces were evaluated. Knee states tested were (1) ACL intact, (2) ACL cut, (3) ACL repair with suture only, (4) ACL repair with STA fixed at 0° of knee flexion, and (5) ACL repair with STA fixed at 20° of knee flexion. Results ACL repair alone did not restore the intact ACL AT translation at 0°, 15°, 30°, or 60° of flexion. Adding suture tape to the repair significantly decreased AT translation at 0°, 15°, and 30° of knee flexion but not to the level of the intact ACL. With PS and IR loadings, only ACL repair with STA fixed at 20° of flexion was not significantly different from the intact state at all knee flexion angles. ACL suture repair had significantly lower in situ forces than the intact ACL with AT, PS, and IR loadings. With AT, PS, and IR loadings, adding suture tape significantly increased the in situ force in the repaired ACL at all knee flexion angles to become closer to that of the intact ACL state. Conclusion For complete proximal ACL tears, suture repair alone did not restore normal knee laxity or normal ACL in situ force. However, adding suture tape to augment the repair resulted in knee laxity closer to that of the intact ACL. STA with fixation at 20° of knee flexion was superior to fixation with the knee in full extension. Clinical Relevance The study findings suggest that ACL repair with STA fixed at 20° could be considered in the treatment of femoral sided ACL tears in the appropriate patient population.
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Affiliation(s)
- Jinshen He
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Orthopaedic Surgery,
Third Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ryo Kanto
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Aly M. Fayed
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Taylor M. Price
- Department of Mechanical and Material
Science Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Michael A. DiNenna
- Department of Mechanical and Material
Science Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica A. Linde
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Department of Mechanical and Material
Science Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Carola F. van Eck
- Department of Orthopaedic Surgery,
University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
- Carola F. van Eck, MD, PhD,
Sequoia Institute for Surgical Services Inc, 2300 West Sunnyside Avenue,
Visalia, CA 93277, USA (
)
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Thompson JD, Howe D, Griffith EH, Fisher MB. Neo-natal castration leads to subtle differences in porcine anterior cruciate ligament morphology and function in adolescence. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.01.24.524954. [PMID: 36747760 PMCID: PMC9900825 DOI: 10.1101/2023.01.24.524954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Female adolescent athletes are at a higher risk of tearing their anterior cruciate ligament (ACL) than male counterparts. While most work related to hormones has focused on the effects of estrogen to understand the increased risk of ACL injury, there are other understudied factors, including testosterone. The purpose of this study was to determine how surgical castration in the male porcine model influences ACL size and function across skeletal growth. Thirty-six male Yorkshire crossbreed pigs were raised to 3 (juvenile), 4.5 (early adolescent), and 6 months (adolescent) of age. Animals were either castrated (barrows) within 1-2 weeks after birth or were left intact (boars). Post-euthanasia, joint and ACL size were assessed via MRI, and biomechanics were assessed via a robotic testing system. Joint size increased throughout age, yet barrows had smaller joints than boars (p<0.001 for all measures). ACL cross-sectional area (CSA), length, volume, and stiffness increased with age (p<0.0001), as did ACL anteromedial (AM) bundle percent contribution to resisting loads (p=0.012). Boar ACL, AM bundle, and PL bundle volumes were 19% (p=0.002), 25% (p=0.003), and 15% (p=0.04) larger than barrows across ages. However, CSA, stiffness, and bundle contribution were similar between boars and barrows (p>0.05). The barrows had smaller temporal increases in AM bundle percent function than boars, but these data were highly variable. Thus, early and sustained loss in testosterone leads to subtle differences in ACL morphology, but may not influence measures associated with increased injury risk, such as CSA or bundle forces in response to applied loads.
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9
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Brown JR, Hollenbeck JFM, Fossum BW, Melugin H, Tashman S, Vidal AF, Provencher MT. Direct measurement of three-dimensional forces at the medial meniscal root: A validation study. J Biomech 2023; 148:111429. [PMID: 36738626 DOI: 10.1016/j.jbiomech.2022.111429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 12/22/2022] [Accepted: 12/29/2022] [Indexed: 02/01/2023]
Abstract
The posterior medial meniscal root (PMMR) experiences variable and multiaxial forces during loading. Current methods to measure these forces are limited and fail to adequately characterize the loads in all three dimensions at the root. Our novel technique resolved these limitations with the installation of a 3-axis sensing construct that we hypothesized would not affect contact mechanics, would not impart extraneous loads onto the PMMR, would accurately measure forces, and would not deflect under joint loads. Six cadaveric specimens were dissected to the joint capsule and a sagittal-plane, femoral condyle osteotomy was performed to gain access to the root. The load sensor was placed below the PMMR and was validated across four tests. The contact mechanics test demonstrated a contact area precision of 44 mm2 and a contact pressure precision of 5.0 MPa between the pre-installation and post-installation states. The tibial displacement test indicated an average bone plug displacement of < 1 mm in all directions. The load validation test exhibited average precision values of 0.7 N in compression, 0.5 N in tension, 0.3 N in anterior-posterior shear, and 0.3 N in medial-lateral shear load. The bone plug deflection test confirmed < 2 mm of displacement in any direction when placed under a load. This is the first study to successfully validate a technique for measuring both magnitude and direction of forces experienced at the PMMR. This validated method has applications for improving surgical repair techniques and developing safer rehabilitation and postoperative protocols that decrease root loads.
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Affiliation(s)
- Justin R Brown
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA.
| | | | - Bradley W Fossum
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA
| | - Heath Melugin
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA; The Steadman Clinic. 180 W Meadow Dr. Vail, CO 81657, USA
| | - Scott Tashman
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA
| | - Armando F Vidal
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA; The Steadman Clinic. 180 W Meadow Dr. Vail, CO 81657, USA
| | - Matthew T Provencher
- Steadman Philippon Research Institute. 181 W Meadow Dr. Vail, CO 81657, USA; The Steadman Clinic. 180 W Meadow Dr. Vail, CO 81657, USA.
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10
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Shiwaku K, Suzuki T, Shino K, Yamakawa S, Otsubo H, Okimura S, Suzuki D, Nabeki S, Teramoto A, Ohnishi H, Fujie H, Yamashita T. A Biomechanical Comparison of 2 Over-the-Top Anterior Cruciate Ligament Reconstruction Techniques: A Cadaveric Study Using a Robotic Simulator. Orthop J Sports Med 2022; 10:23259671221139876. [PMID: 36545379 PMCID: PMC9761224 DOI: 10.1177/23259671221139876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/13/2022] [Indexed: 12/15/2022] Open
Abstract
Background For skeletally immature patients, over-the-top (OTT) anterior cruciate ligament (ACL) reconstruction (ACLR) is preferred. However, increased anterior laxity at deep knee flexion angles remains concerning. We modified the procedure to proximally shift the graft fixation site on the femur to prevent graft loosening at higher knee flexion angles and named it the supra-OTT procedure. Purpose To compare anterior laxity and in situ forces of the ACL graft between conventional OTT and supra-OTT ACLR in a cadaveric model. Study Design Controlled laboratory study. Methods A total of 11 fresh-frozen cadaveric knee specimens underwent 4 robotic testing conditions: ACL intact, ACL resected, conventional OTT, and supra-OTT. For each condition, a 100-N load was applied at 0°, 15°, 30°, 60°, and 90° of knee flexion to simulate the Lachman test or anterior drawer test. In addition, a combined load of 5-N·m internal tibial torque and 10-N·m valgus torque was applied at 15° and 30° of knee flexion as a simulated pivot-shift test. Anterior tibial translation and in situ graft forces were recorded. The only difference between conventional OTT and supra-OTT ACLR was the graft fixation site on the femur. For conventional OTT ACLR, graft fixation was performed just on the proximal and lateral ends of the posterior condyle. For supra-OTT ACLR, the fixation point was around the proximal insertion of the lateral head of the gastrocnemius and the lateral edge of the posterior cortex, approximately 2 cm proximal to the conventional OTT position. Results On the simulated anterior drawer test at 60° and 90° of knee flexion, anterior tibial translation after supra-OTT ACLR was significantly smaller than after conventional OTT ACLR (P < .01). However, no significant differences were noted at other flexion angles or on the simulated pivot-shift test between the conventional OTT and supra-OTT procedures. Some overconstraint and higher graft forces were noted with both techniques, but the supra-OTT technique caused even more overconstraint at higher flexion angles. Conclusion Supra-OTT ACLR showed better biomechanical performance to control anterior laxity than conventional OTT ACLR at higher knee flexion angles. Clinical Relevance The supra-OTT procedure may improve anterior stability at deep knee flexion angles.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Tomoyuki Suzuki
- Sapporo Maruyama Orthopedic Hospital, Sapporo, Japan.,Tomoyuki Suzuki, MD, PhD, Sapporo Maruyama Orthopedic Hospital,
North 7 West 27, Chuo-Ku, Sapporo, 060-0007 Japan (
)
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Osaka University Graduate
School of Medicine, Suita, Japan
| | | | - Shinichiro Okimura
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of
Rehabilitation, Chitose, Japan
| | - Shogo Nabeki
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of
Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Tokyo Metropolitan University
Graduate School of Science, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School
of Medicine, Sapporo, Japan
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11
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Fleming BC. Fifty Years of ACL Biomechanics: What's Next? Am J Sports Med 2022; 50:3745-3748. [PMID: 36472484 DOI: 10.1177/03635465221136834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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12
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Diermeier T, Tisherman RE, Wilson K, Takeuchi S, Suzuki T, Chan CK, Debski RE, Onishi K, Musahl V. The lateral meniscus extrudes with and without root tear evaluated using ultrasound. J ISAKOS 2022; 7:195-200. [PMID: 36182072 DOI: 10.1016/j.jisako.2022.08.001] [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: 03/05/2022] [Revised: 07/10/2022] [Accepted: 08/03/2022] [Indexed: 12/24/2022]
Abstract
PURPOSE The purpose of the current study was to measure extrusion of the intact lateral meniscus as a function of knee flexion angle and loading condition and to compare the changes in extrusion with a posterior root tear using a robotic testing system and ultrasound. STUDY DESIGN Controlled laboratory study. METHODS Eight fresh-frozen cadaveric knees were subjected to external loading conditions (passive path position (no external load), 200 axial compression, 5-N-m internal tibial torque, 5-N-m valgus torque) at full extension, 30°, 60° and 90° of flexion using a robotic testing system. A linear array transducer was placed in the longitudinal orientation. Extrusion and kinematics data were recorded for two meniscus states: intact and posterior lateral root deficiency. Therefore, a complete radial root tear in the lateral meniscus at 10 mm from the tibial insertion was made in all 8 cadaveric knees using arthroscopy. The resultant forces in the lateral meniscus were also quantified by reproducing recorded paths after the removal of the lateral meniscus. RESULTS A lateral meniscus root tear resulted in a statistically significant increase (up to 250%) of extrusion for the lateral meniscus (p < 0.05) in comparison to the intact lateral meniscus for all externally applied loads. Without external load (passive path position), significant differences were also found between the intact and posterior lateral root deficient meniscus except at full extension (1.0 ± 0.7 mm vs. 1.9 ± 0.4 mm) and 30° of flexion (1.4 ± 0.5 mm vs. 1.8 ± 0.5 mm). Overall, with increasing flexion angle, lateral meniscus extrusion decreased for the intact as well as for the posterior lateral root deficient meniscus, with the lowest measurements in response to internal tibial torque at 90° of flexion (-3.3 ± 1.1 mm). Knee kinematics were similar whether intact or posterior lateral root tear (n.s.). Ultrasound measurement of lateral meniscus extrusion showed good inter-rater (0.65 [0.30-0.97]-0.71 [0.34-0.94]) and excellent intra-rater reliability (0.81 [0.43-0.99]). CONCLUSION Dynamic Ultrasound is a reliable diagnostic modality to measure the lateral meniscus extrusion which can be helpful in the diagnosis and quantification of lateral meniscal root tears. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Theresa Diermeier
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Unfallkrankenhaus Berlin, Berlin, Germany
| | - Robert E Tisherman
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kevin Wilson
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Satoshi Takeuchi
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - Tomoyuki Suzuki
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan; Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Calvin K Chan
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Kentaro Onishi
- Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA; Department of Physical Medicine and Rehabilitation, Pittsburgh, PA, USA
| | - Volker Musahl
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, 15203, USA; Department of Orthopaedic Surgery, Center for Sports Medicine, University of Pittsburgh, Pittsburgh, PA, USA.
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13
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Winkler PW, Chan CK, Lucidi GA, Polamalu SK, Wagala NN, Hughes JD, Debski RE, Musahl V. Increasing the posterior tibial slope lowers in situ forces in the native ACL primarily at deep flexion angles. J Orthop Res 2022. [PMID: 36370132 DOI: 10.1002/jor.25484] [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: 06/14/2022] [Revised: 10/03/2022] [Accepted: 11/07/2022] [Indexed: 11/15/2022]
Abstract
High tibial osteotomy is becoming increasingly popular but can be associated with unintentional posterior tibial slope (PTS) increase and subsequent anterior cruciate ligament (ACL) degeneration. This study quantified the effect of increasing PTS on knee kinematics and in situ forces in the native ACL. A robotic testing system was used to apply external loads from full extension to 90° flexion to seven human cadaveric knees: (1) 200 N axial compressive load, (2) 5 Nm internal tibial + 10 Nm valgus torque, and (3) 5 Nm external tibial + 10 Nm varus torque. Kinematics and in situ forces in the ACL were acquired for the native and increased PTS state. Increasing PTS resulted in increased anterior tibial translation at 30° (1.8 mm), 60° (1.7 mm), and 90° (0.9 mm) flexion and reduced in situ force in the ACL at 30° (57.6%), 60° (69.8%), and 90° (75.0%) flexion in response to 200 N axial compressive load. In response to 5 Nm internal tibial + 10 Nm valgus torque, there was significantly less (39.0%) in situ force in the ACL at 90° flexion in the increased compared with the native PTS state. Significantly less in situ force in the ACL at 60° (62.8%) and 90° (67.0%) flexion was observed in the increased compared with the native PTS state in response to 5 Nm external tibial + 10 Nm varus torque. Increasing PTS affects knee kinematics and results in a reduction of in situ forces in the native ACL during compressive and rotatory loads at flexion angles exceeding 30°. In a controlled laboratory setting PTS increase unloads the ACL, affecting its natural function.
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Affiliation(s)
- Philipp W Winkler
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Sports Orthopaedics, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gian Andrea Lucidi
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sene K Polamalu
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Nyaluma N Wagala
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Jonathan D Hughes
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedics, University of Gothenburg, Gothenburg, Sweden
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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14
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Shiwaku K, Kamiya T, Suzuki D, Yamakawa S, Otsubo H, Suzuki T, Takahashi K, Okada Y, Teramoto A, Ohnishi H, Fujie H, Yamashita T. The Role of the Medial Meniscus in Anterior Knee Stability. Orthop J Sports Med 2022; 10:23259671221132845. [PMID: 36389621 PMCID: PMC9663633 DOI: 10.1177/23259671221132845] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/12/2022] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Few studies have compared the force distribution between the anterolateral, posterolateral, and medial structures of the knee. PURPOSE To investigate the important structures in an intact knee contributing to force distribution in response to anterior tibial load. STUDY DESIGN Controlled laboratory study. METHODS Nine fresh-frozen cadaveric knee specimens underwent robotic testing. First, 100 N of anterior tibial load was applied to the intact knee at 0°, 15°, 30°, 60°, and 90° of knee flexion. The anterior cruciate ligament (ACL), anterolateral capsule, lateral collateral ligament, popliteal tendon, posterior root of the lateral meniscus, superficial medial collateral ligament, posterior root of the medial meniscus (MM), and posterior cruciate ligament were then completely transected in sequential order. After each transection, the authors reproduced the intact knee motion when a 100-N anterior tibial load was applied. By applying the principle of superposition, the resultant force of each structure was determined based on the 6 degrees of freedom force/torque data of each state. RESULTS At every measured knee flexion angle, the resultant force of the ACL was the largest of the tested structures. At knee flexion angles of 60° and 90°, the resultant force of the MM was larger than that of all other structures with the exception of the ACL. CONCLUSION The MM was identified as playing an important role in response to anterior tibial load at 60° and 90° of flexion. CLINICAL RELEVANCE In clinical settings, the ACL of patients with a poorly functioning MM, such as tear of the MM posterior root, should be monitored considering the large resultant force in response to an anterior tibial load.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Osaka, Japan
| | | | | | - Katsunori Takahashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hirofumi Ohnishi
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Graduate School of Science and Engineering, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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15
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Shiwaku K, Kamiya T, Otsubo H, Suzuki T, Nabeki S, Yamakawa S, Okada Y, Teramoto A, Watanabe K, Iba K, Fujie H, Yamashita T. Effect of Anterior Horn Tears of the Lateral Meniscus on Knee Stability. Orthop J Sports Med 2022; 10:23259671221119173. [PMID: 36119121 PMCID: PMC9478715 DOI: 10.1177/23259671221119173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Accepted: 06/06/2022] [Indexed: 11/16/2022] Open
Abstract
Background Investigations on the biomechanical characteristics of the anterior horn of the lateral meniscus (AHLM) related to anterior cruciate ligament (ACL) tibial tunnel reaming have revealed increased contact pressure between the femur and tibia, decreased attachment area, and decreased ultimate failure strength. Purpose/Hypothesis The purpose of this study was to investigate the influence of a complete radial tear of the AHLM on force distribution in response to applied anterior and posterior drawer forces and internal and external rotation torques. We hypothesized that the AHLM plays an important role in knee stability, primarily at lower knee flexion angles. Study Design Controlled laboratory study. Methods A total of 9 fresh-frozen cadaveric knee specimens and a robotic testing system were used. Anterior and posterior drawer forces up to 89 N and internal and external rotation torques up to 4 N·m were applied at 0°, 30°, 60°, and 90° of knee flexion. A complete AHLM tear was then made 10 mm from the lateral border of the tibial attachment of the ACL, and the same tests performed in the intact state were repeated. Next, the recorded intact knee motion was reproduced in the AHLM-torn knee, and the change in the resultant force after an AHLM tear was determined by calculating the difference between the 2 states. Results In the torn AHLM, the reduction in the resultant force at 0° for external rotation torque (34.8 N) was larger than that at 60° (5.2 N; P < .01) and 90° (6.7 N; P < .01). Conclusion The AHLM played a role in facilitating knee stability against an applied posterior drawer force of 89 N and external rotation torque of 4 N·m, especially at lower knee flexion angles. Clinical Relevance This study provides information about the effects of AHLM injuries that may occur during single-bundle ACL reconstruction using a round tunnel.
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Affiliation(s)
- Kousuke Shiwaku
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | | | - Shogo Nabeki
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Satoshi Yamakawa
- Department of Sports Medical Biomechanics, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kota Watanabe
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kousuke Iba
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Department of Mechanical Engineering, Graduate School of Science, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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16
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Howe D, Cone SG, Piedrahita JA, Spang JT, Fisher MB. Age- and Sex-Specific Joint Biomechanics in Response to Partial and Complete Anterior Cruciate Ligament Injury in the Porcine Model. J Athl Train 2022; 57:978-989. [PMID: 34964874 PMCID: PMC9842119 DOI: 10.4085/1062-6050-565-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
CONTEXT Pediatric anterior cruciate ligament (ACL) injury rates are increasing and are highest in female adolescents. Complete ACL tears are typically surgically reconstructed, but few guidelines and very limited data exist regarding the need for surgical reconstruction or rehabilitation for partial ACL tears in skeletally immature patients. OBJECTIVE To evaluate the effects of partial (anteromedial bundle) and complete ACL transection on joint laxity and tissue forces under anterior and rotational loads in male and female stifle joints throughout skeletal growth in the porcine model. DESIGN Descriptive laboratory study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS We studied 60 male and female Yorkshire crossbreed pigs aged 1.5, 3, 4.5, 6, and 18 months (n = 6 pigs per age per sex). MAIN OUTCOME MEASURE(S) Joint laxity was measured in intact, anteromedial bundle-transected, and ACL-transected joints under applied anterior-posterior drawer and varus-valgus torque using a robotic testing system. Loading of the soft tissues in the stifle joint was measured under each condition. RESULTS Anterior-posterior joint laxity increased by 13% to 50% (P < .05) after anteromedial bundle transection and 75% to 178% (P < .05) after ACL transection. Destabilization after anteromedial bundle transection increased with age (P < .05) and was greater in late female than late male adolescents (P < .05). In anteromedial bundle-transected joints, the posterolateral bundle resisted the anterior load. In ACL-transected joints, the medial collateral ligament (MCL) contribution was largest, followed by the medial meniscus. The MCL contribution was larger and the medial meniscus contribution was smaller in male versus female specimens. CONCLUSIONS Partial ACL transection resulted in moderate increases in joint laxity, with the remaining bundle performing the primary ACL function. Destabilization due to partial ACL transection (anteromedial bundle) was largest in late adolescent joints, indicating that operative treatment should be considered in active, late-adolescent patients with this injury. Increased forces on the MCL and medial meniscus after ACL transection suggested that rehabilitation protocols may need to focus on protecting these tissues.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Mechanical Engineering, University of Wisconsin, Madison
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh
| | - Jeffrey T. Spang
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, University of North Carolina, Chapel Hill, and North Carolina State University, Raleigh
- Comparative Medicine Institute, North Carolina State University, Raleigh
- Department of Orthopaedics, School of Medicine, University of North Carolina, Chapel Hill
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17
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Shimada M, Takagi T, Kanno N, Yamakawa S, Fujie H, Hara Y. Influence of tibial plateau levelling osteotomy on the tensile forces sustained by ligaments in cranial cruciate ligament‐intact canine stifles: An ex vivo pilot study. Vet Med Sci 2022; 8:1904-1914. [PMID: 35947706 PMCID: PMC9514505 DOI: 10.1002/vms3.889] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Affiliation(s)
- Masakazu Shimada
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
| | - Nobuo Kanno
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
- Department of Sports Medical Biomechanics Graduate School of Medicine Osaka University Suita Osaka Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory Faculty of System Design Tokyo Metropolitan University Hachioji‐shi Tokyo Japan
| | - Yasushi Hara
- Faculty of Veterinary Medicine Division of Veterinary Surgery Department of Veterinary Science Nippon Veterinary and Life Science University Musashino‐shi Tokyo Japan
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18
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Howe D, Cone SG, Piedrahita JA, Collins B, Fordham LA, Griffith EH, Spang JT, Fisher MB. Sex-specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model. J Orthop Res 2022; 40:1853-1864. [PMID: 34751996 PMCID: PMC9081289 DOI: 10.1002/jor.25207] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 09/24/2021] [Accepted: 10/23/2021] [Indexed: 02/04/2023]
Abstract
Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex-specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior-posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross-sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross-sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex-specific surgical intervention strategies and suggests the need for human studies.
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Affiliation(s)
- Danielle Howe
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695
| | - Stephanie G. Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Mechanical Engineering, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Jorge A. Piedrahita
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Molecular Biomedical Sciences, North Carolina State University; Raleigh, NC 27695
| | - Bruce Collins
- Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Animal Science, North Carolina State University; Raleigh, NC 27695
| | - Lynn A. Fordham
- Department of Radiology, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Emily H. Griffith
- Department of Statistics, North Carolina State University; Raleigh, NC 27695
| | - Jeffrey T. Spang
- Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599
| | - Matthew B. Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina- Chapel Hill; Raleigh, NC 27695,Comparative Medicine Institute, North Carolina State University; Raleigh, NC 27695,Department of Orthopaedics, University of North Carolina- Chapel Hill; Chapel Hill, NC 27599,Corresponding Author Contact: Address: 4130 Engineering Building III, 911 Oval Drive, CB 7115, Raleigh, NC, 27695, Telephone: 919-515-5242, Fax: 919-513-3814,
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19
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Mayr R, Sigloch M, Coppola C, Hoermann R, Iltchev A, Schmoelz W. Modified Lemaire tenodesis reduces anterior cruciate ligament graft forces during internal tibial torque loading. J Exp Orthop 2022; 9:45. [PMID: 35583714 PMCID: PMC9117580 DOI: 10.1186/s40634-022-00484-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 05/06/2022] [Indexed: 11/10/2022] Open
Abstract
PURPOSE The aim of the study was to directly measure graft forces of an anterior cruciate ligament reconstruction (ACLR) and a lateral extra-articular tenodesis (LET) using the modified Lemaire technique in combined anterior cruciate ligament (ACL) deficient and anterolateral rotatory instable knees and to analyse the changes in knee joint motion resulting from combined ACLR + LET. METHODS On a knee joint test bench, six fresh-frozen cadaveric specimens were tested at 0°, 30°, 60°, and 90° of knee flexion in the following states: 1) intact; 2) with resected ACL; 3) with resected ACL combined with anterolateral rotatory instability; 4) with an isolated ACLR; and 5) with combined ACLR + LET. The specimens were examined under various external loads: 1) unloaded; 2) with an anterior tibial translation force (ATF) of 98 N; 3) with an internal tibial torque (IT) of 5 Nm; and 4) with a combined internal tibial torque of 5 Nm and an anterior tibial translation force of 98 N (IT + ATF). The graft forces of the ACLR and LET were recorded by load cells incorporated into custom devices, which were screwed into the femoral tunnels. Motion of the knee joint was analysed using a 3D camera system. RESULTS During IT and IT + ATF, the addition of a LET reduced the ACLR graft forces up to 61% between 0° and 60° of flexion (P = 0.028). During IT + ATF, the LET graft forces reached 112 N. ACLR alone did not restore native internal tibial rotation after combined ACL deficiency and anterolateral rotatory instability. Combined ACLR + LET was able to restore native internal tibial rotation values for 0°, 60° and 90° of knee flexion with decreased internal tibial rotation at 30° of flexion. CONCLUSION The study demonstrates that the addition of a LET decreases the forces seen by the ACLR graft and reduces residual rotational laxity after isolated ACLR during internal tibial torque loading. Due to load sharing, a LET could support the ACLR graft and perhaps be the reason for reduced repeat rupture rates seen in clinical studies. Care must be taken not to limit the internal tibial rotation when performing a LET.
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Affiliation(s)
- Raul Mayr
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Maximilian Sigloch
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Christian Coppola
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Romed Hoermann
- Institute for Clinical and Functional Anatomy, Medical University of Innsbruck, Innsbruck, Austria
| | - Alessandra Iltchev
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria
| | - Werner Schmoelz
- Department for Orthopaedics and Traumatology, Medical University of Innsbruck, Anichstraße 35, 6020, Innsbruck, Austria.
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20
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Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Shoji H, Okada Y, Kobayashi T, Kamiya T, Fujimiya M, Fujie H, Watanabe K, Yamashita T. Effects of the Ankle Flexion Angle During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft. Foot Ankle Int 2022; 43:725-732. [PMID: 35023381 DOI: 10.1177/10711007211069327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND This study aimed to evaluate the effects of the ankle flexion angle during anterior talofibular ligament (ATFL) reconstruction on ankle kinematics, laxity, and in situ force of a graft. METHODS Twelve cadaveric ankles were evaluated using a 6-degrees of freedom robotic system to apply passive plantar flexion and dorsiflexion motions and multidirectional loads. A repeated measures experiment was designed using the intact ATFL, transected ATFL, and reconstructed ATFL. During ATFL reconstruction (ATFLR), the graft was fixed at a neutral position (ATFLR 0 degrees), 15 degrees of plantar flexion (ATFLR PF15 degrees), and 30 degrees of plantar flexion (ATFLR PF30 degrees) with a constant initial tension of 10 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ force of the ATFL and reconstructed grafts were calculated using the principle of superposition. RESULTS The in situ forces of the reconstructed grafts in ATFLR 0 degrees and ATFLR PF 15 degrees were significantly higher than those of intact ankles. The ankle kinematics and laxity produced by ATFLR PF 30 degrees were not significantly different from those of intact ankles. The in situ force on the ATFL was 19.0 N at 30 degrees of plantar flexion. In situ forces of 41.0, 33.7, and 21.9 N were observed at 30 degrees of plantar flexion in ATFLR 0, 15, and 30 degrees, respectively. CONCLUSION ATFL reconstruction with the peroneus longus (PL) tendon was performed with the graft at 30 degrees of plantar flexion resulted in ankle kinematics, laxity, and in situ forces similar to those of intact ankles. ATFL reconstructions performed with the graft fixed at 0 and 15 degrees of the plantar flexion resulted in higher in situ forces on the reconstructed graft. CLINICAL RELEVANCE Fixing the ATFL tendon graft at 30 degrees of plantar flexion results in an in situ force closest to that of an intact ankle and avoids the excessive tension on the reconstructed graft.
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Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Hiroaki Shoji
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Yohei Okada
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Takuma Kobayashi
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Tomoaki Kamiya
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Hachioji, Tokyo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan
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21
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Novaretti JV, Herbst E, Chan CK, Debski RE, Musahl V. Small lateral meniscus tears propagate over time in ACL intact and deficient knees. Knee Surg Sports Traumatol Arthrosc 2021; 29:3068-3076. [PMID: 33165635 DOI: 10.1007/s00167-020-06356-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 10/26/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE To quantify propagation of small longitudinal tears in the lateral meniscus in ACL intact and deficient knees. METHODS Using a robotic testing system, 5-Nm of external tibial torque + 5-Nm of valgus torque + 250-N of axial compression was applied to 14 fresh-frozen cadaveric knees while the knees were flexed from 30° to 90°. Knees were divided into two groups: intact (N = 8) and ACL deficient (N = 6). Kinematic data was recorded for four knee states: intact or ACL deficient knee, after posterior arthrotomy, meniscus tear at baseline, and after 500 cycles of the applied loading condition. RESULTS Lateral meniscus tear length increased throughout the 500 cycles regardless of the ACL integrity (p < 0.001). Overall, an increase of 28.7% and 26.1% was observed in intact and ACL deficient knees, respectively. In intact knees, external tibial rotation increased with meniscus tear propagation at all flexion angles by up to 45.5% (p = 0.019). In contrast, knee kinematics in ACL deficient knees were not affected by meniscus tear propagation (n.s.). In ACL deficient knees, resultant forces in the lateral meniscus increased at all flexion angles by up to 116.5% (p = 0.012). No differences in forces were observed in the intact knees (n.s.). CONCLUSION The data of this study show that small longitudinal tears in the lateral meniscus propagate significantly regardless of the integrity of the ACL and even after only 100 cycles of knee loading. The propagation of such tears altered kinematics and forces in the knee. Therefore, small, longitudinal lateral meniscus tears that are untreated in current clinical practices may propagate when loaded.
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Affiliation(s)
- João V Novaretti
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.
- Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, Rua Estado de Israel 636, São Paulo, SP, 04022-001, Brazil.
| | - Elmar Herbst
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Muenster, Muenster, Germany
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
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22
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Suzuki D, Yamakawa S, Iijima M, Fujie H. Function of the crocodilian anterior cruciate ligaments. J Morphol 2021; 282:1514-1522. [PMID: 34309054 DOI: 10.1002/jmor.21401] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 12/18/2022]
Abstract
The anterior cruciate ligament (ACL) is an important knee stabilizer that prevents the anterior subluxation of the tibia. Extant crocodiles have two ACLs, the ACL major and minor, yet their functional roles are unclear. We here examined in-situ forces within the ACL major and minor in saltwater crocodiles (Crocodylus porosus) with a 6-degree-of-freedom robotic testing system under the following loading conditions: (a) 30 N anterior tibial load at 150°, 120°, and 90° knee extension; (b) 1 Nm internal/external torque at 150° and 120° knee extension; (c) 30 N anterior tibial load +1 Nm internal/external torque at 150° and 120° knee extension. The In-situ force in the ACL minor was significantly higher than that of the ACL major in response to anterior tibial load at 90° knee extension, and anterior tibial load + external torque at both 150° and 120° knee extension. Meanwhile, the force in the ACL major was significantly higher than that of the ACL minor in response to internal torque at 120° knee extension, and anterior tibial load + internal torque at 150° knee extension. The present results showed that the ACL minor and major of saltwater crocodiles have different functions. In response to anterior tibial load + internal/external torques, either of two ACLs reacted to opposing directions of knee rotation. These suggest that two ACLs are essential for walking with long axis rotation of the knee in crocodiles.
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Affiliation(s)
- Daisuke Suzuki
- Department of Musculoskeletal Biomechanics and Surgical Development, Sapporo Medical University, Sapporo, Japan.,Department of Health Sciences, Hokkaido Chitose Collage of Rehabilitation, Chitose, Japan
| | - Satoshi Yamakawa
- Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan.,Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masaya Iijima
- Department of Biological Sciences, Clemson University, Clemson, South Carolina, USA.,School of Resources and Environmental Engineering, Hefei University of Technology, Hefei, Anhui, China
| | - Hiromichi Fujie
- Faculty of Systems Design, Tokyo Metropolitan University, Hachioji, Japan
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23
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Chalmers BP, Elmasry SS, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Imhauser CW, Sculco PK, Cross MB. Additional distal femoral resection increases mid-flexion coronal laxity in posterior-stabilized total knee arthroplasty with flexion contracture : a computational study. Bone Joint J 2021; 103-B:87-93. [PMID: 34053287 DOI: 10.1302/0301-620x.103b6.bjj-2020-2444.r1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
AIMS Surgeons commonly resect additional distal femur during primary total knee arthroplasty (TKA) to correct a flexion contracture, which leads to femoral joint line elevation. There is a paucity of data describing the effect of joint line elevation on mid-flexion stability and knee kinematics. Thus, the goal of this study was to quantify the effect of joint line elevation on mid-flexion laxity. METHODS Six computational knee models with cadaver-specific capsular and collateral ligament properties were implanted with a posterior-stabilized (PS) TKA. A 10° flexion contracture was created in each model to simulate a capsular contracture. Distal femoral resections of + 2 mm and + 4 mm were then simulated for each knee. The knee models were then extended under a standard moment. Subsequently, varus and valgus moments of 10 Nm were applied as the knee was flexed from 0° to 90° at baseline and repeated after each of the two distal resections. Coronal laxity (the sum of varus and valgus angulation with respective maximum moments) was measured throughout flexion. RESULTS With + 2 mm resection at 30° and 45° of flexion, mean coronal laxity increased by a mean of 3.1° (SD 0.18°) (p < 0.001) and 2.7° (SD 0.30°) (p < 0.001), respectively. With + 4 mm resection at 30° and 45° of flexion, mean coronal laxity increased by 6.5° (SD 0.56°) (p < 0.001) and 5.5° (SD 0.72°) (p < 0.001), respectively. Maximum increased coronal laxity for a + 4 mm resection occurred at a mean 15.7° (11° to 33°) of flexion with a mean increase of 7.8° (SD 0.2°) from baseline. CONCLUSION With joint line elevation in primary PS TKA, coronal laxity peaks early (about 16°) with a maximum laxity of 8°. Surgeons should restore the joint line if possible; however, if joint line elevation is necessary, we recommend assessment of coronal laxity at 15° to 30° of knee flexion to assess for mid-flexion instability. Further in vivo studies are warranted to understand if this mid-flexion coronal laxity has negative clinical implications. Cite this article: Bone Joint J 2021;103-B(6 Supple A):87-93.
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Affiliation(s)
- Brian P Chalmers
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
| | - Michael B Cross
- Department of Orthopedic Surgery, Adult Reconstruction and Joint Replacement, Hospital for Special Surgery, New York, New York, USA
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24
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Ichinohe T, Yamakawa S, Shimada M, Kanno N, Fujita Y, Harada Y, Fujie H, Hara Y. Investigation of the effects of excessive tibial plateau angle and changes in load on ligament tensile forces in the stifle joints of dogs. Am J Vet Res 2021; 82:459-466. [PMID: 34032480 DOI: 10.2460/ajvr.82.6.459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the effect of an excessive tibial plateau angle (TPA) and change in compressive load on tensile forces experienced by the cranial cruciate, medial collateral, and lateral collateral ligaments (CCL, MCL, and LCL, respectively) of canine stifle joints. SAMPLE 16 cadaveric stifle joints from 16 orthopedically normal Beagles. PROCEDURES Stifle joints were categorized into unchanged (mean TPA, 30.4°) and excessive (mean TPA before and after modification, 31.2° and 41.1°, respectively) TPA groups. The excessive TPA group underwent a TPA-increasing procedure (curvilinear osteotomy of the proximal aspect of the tibia) to achieve the desired TPA. A robotic system was used to apply a 30- and 60-N compressive load to specimens. The craniomedial band of the CCL, caudolateral band of the CCL, MCL, and LCL were sequentially transected; load application was repeated after each transection. Orthogonal force components were measured in situ. Forces on ligaments were calculated after repeated output force measurements as the contribution of each component was eliminated. RESULTS Increasing the compressive load increased tensile forces on the craniomedial and caudolateral bands of the CCL, but not on the MCL or LCL, in specimens of both groups. At the 60-N load, tensile force on the craniomedial band, but not other ligaments, was greater for the excessive TPA group than for the unchanged TPA group. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that stress on the CCL may increase when the compressive load increases. The TPA-increasing procedure resulted in increased tensile force on the CCL at a 60-N compressive load without affecting forces on the MCL or LCL.
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25
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Sasaki Y, Fujii M, Araki D, Marshall BD, Linde MA, Smolinski P, Fu FH. Effect of Percentage of Femoral Anterior Cruciate Ligament Insertion Site Reconstructed With Hamstring Tendon on Knee Kinematics and Graft Force. Am J Sports Med 2021; 49:1279-1285. [PMID: 33656943 DOI: 10.1177/0363546521995199] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have stated that closely matching the size of the anterior cruciate ligament (ACL) insertion site footprint is important for biomechanical function and clinical stability after ACL reconstruction. However, the ACL varies widely regarding the area of femoral insertion, tibial insertion, and midsubstance of ACL, and reconstructing the insertion site area with a uniform diameter graft can result in a cross-sectional area that is greater than that of the midsubstance of the native ACL. Therefore, understanding the effect of relative graft size in ACL reconstruction on knee biomechanics is important for surgical planning. PURPOSE To assess how the percentage of femoral insertion site affects knee biomechanics in single- and double-bundle ACL reconstruction. STUDY DESIGN Controlled laboratory study. METHODS A total of 14 human cadaveric knees were scanned with magnetic resonance imaging and tested using a robotic system under an anterior tibial load and a combined rotational load. In total, 7 knee states were evaluated: intact ACL; deficient ACL; single-bundle ACL reconstruction with approximate graft sizes 25% (small), 50% (medium), and 75% (large) of the femoral insertion site; and double-bundle reconstruction of approximately 50% (medium) and 75% (large) of the femoral insertion site, based on the ratio of the cross-sectional area of the graft to the area of the femoral ACL insertion site determined by magnetic resonance imaging. RESULTS Anterior tibial translation was not significantly larger than the intact state in single-bundle and double-bundle medium graft reconstructions (P > .05) and was significantly greater in the single-bundle small graft reconstruction (P < .05). Anterior knee translation in single-bundle medium graft and large graft reconstructions was not statistically different (P > .05). In contrast, the anterior tibial translation for double-bundle large graft reconstruction was significantly smaller than for double-bundle medium graft reconstruction at low flexion angles (P < .05). The single-bundle small graft force was significantly different from the intact ACL in situ force (P < .05). The graft force with double-bundle large reconstruction was significantly greater than that with the double-bundle medium reconstruction (P < .05) but was not significantly different from that of the intact ACL (P > .05). CONCLUSION Knee biomechanics with a single-bundle small graft tended to be significantly different from those of the intact knee. In the kinematic and kinetic data for the single- and double-bundle medium graft reconstruction, only the anterior translation at full extension for the single-bundle reconstruction was significantly different (lower) from that of intact knee. This was a time zero study. CLINICAL RELEVANCE This study can provide surgeons with guidance in selecting the graft size for ACL reconstruction.
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Affiliation(s)
- Yusuke Sasaki
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Masataka Fujii
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Daisuke Araki
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Brandon D Marshall
- Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Monica A Linde
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick Smolinski
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Mechanical Engineering and Material Science, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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26
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Elmasry SS, Chalmers BP, Kahlenberg CA, Mayman DJ, Wright TM, Westrich GH, Cross MB, Sculco PK, Imhauser CW. Simulation of preoperative flexion contracture in a computational model of total knee arthroplasty: Development and evaluation. J Biomech 2021; 120:110367. [PMID: 33887615 PMCID: PMC8183383 DOI: 10.1016/j.jbiomech.2021.110367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 01/29/2021] [Accepted: 03/01/2021] [Indexed: 02/07/2023]
Abstract
Preoperative flexion contracture is a risk factor for patient dissatisfaction following primary total knee arthroplasty (TKA). Previous studies utilizing surgical navigation technology and cadaveric models attempted to identify operative techniques to correct knees with flexion contracture and minimize undesirable outcomes such as knee instability. However, no consensus has emerged on a surgical strategy to treat this clinical condition. Therefore, the purpose of this study was to develop and evaluate a computational model of TKA with flexion contracture that can be used to devise surgical strategies that restore knee extension and to understand factors that cause negative outcomes. We developed six computational models of knees implanted with a posteriorly stabilized TKA using a measured resection technique. We incorporated tensions in the collateral ligaments representative of those achieved in TKA using reference data from a cadaveric experiment and determined tensions in the posterior capsule elements in knees with flexion contracture by simulating a passive extension exam. Subject-specific extension moments were calculated and used to evaluate the amount of knee extension that would be restored after incrementally resecting the distal femur. Model predictions of the extension angle after resecting the distal femur by 2 and 4 mm were within 1.2° (p ≥ 0.32) and 1.6° (p ≥ 0.25), respectively, of previous studies. Accordingly, the presented computational method could be a credible surrogate to study the mechanical impact of flexion contracture in TKA and to evaluate its surgical treatment.
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Affiliation(s)
- Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA; Department of Mechanical Design and Production, Faculty of Engineering, Cairo University, Egypt.
| | - Brian P Chalmers
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Cynthia A Kahlenberg
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - David J Mayman
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Timothy M Wright
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Geoffrey H Westrich
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Michael B Cross
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Peter K Sculco
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Cornell Medicine of Cornell University, New York, NY, USA
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27
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Ohori T, Mae T, Shino K, Fujie H, Hirose T, Tachibana Y, Yoshikawa H, Nakata K. Different effects of the lateral meniscus complete radial tear on the load distribution and transmission functions depending on the tear site. Knee Surg Sports Traumatol Arthrosc 2021; 29:342-351. [PMID: 32152692 DOI: 10.1007/s00167-020-05915-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 02/24/2020] [Indexed: 01/13/2023]
Abstract
PURPOSE To compare the effect of the lateral meniscus (LM) complete radial tear at different tear sites on the load distribution and transmission functions. METHODS A compressive load of 300 N was applied to the intact porcine knees (n = 30) at 15°, 30°, 60°, 90°, and 120° of flexion. The LM complete radial tears were created at the middle portion (group M), the posterior portion (group P), or the posterior root (group R) (n = 10, each group), and the same loading procedure was followed. Finally, the recorded three-dimensional paths were reproduced on the LM-removed knees. The peak contact pressure (contact area) in the lateral compartment and the calculated in situ force of the LM under the principle of superposition were compared among the four groups (intact, group M, group P, and group R). RESULTS At all the flexion angles, the peak contact pressure (contact area) was significantly higher (lower) after creating the LM complete radial tear as compared to that in the intact state (p < 0.01). At 120° of flexion, group R represented the highest peak contact pressure (lowest contact area), followed by group P and group M (p < 0.05). The results of the in situ force carried by the LM were similar to those of the tibiofemoral contact mechanics. CONCLUSION The detrimental effect of the LM complete radial tear on the load distribution and transmission functions was greatest in the posterior root tear, followed by the posterior portion tear and the middle portion tear in the deep-flexed position. Complete radial tars of the meniscus, especially at the posterior root, should be repaired to restore the biomechanical function.
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Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Takehito Hirose
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Yuta Tachibana
- Department of Sports Orthopaedics, Osaka Rosai Hospital, Osaka, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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28
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A longitudinal tear in the medial meniscal body decreased the in situ meniscus force under an axial load. Knee Surg Sports Traumatol Arthrosc 2020; 28:3457-3465. [PMID: 31650310 DOI: 10.1007/s00167-019-05735-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2019] [Accepted: 09/26/2019] [Indexed: 01/14/2023]
Abstract
PURPOSE To clarify the effect of longitudinal tears of the medial meniscus on the in situ meniscus force and the tibiofemoral relationship under axial load. METHODS Twenty-one intact porcine knees were mounted on a 6-degrees of freedom robotic system, and the force and three-dimensional path of the knee joints were recorded during three cycles under a 250-N axial load at 30°, 60°, 90° and 120° of knee flexion. They were divided into three groups of seven knees with longitudinal tears in the middle to the posterior segment of the medial meniscus based on the tear site: rim, outer one-third and inner one-third of the meniscal body. After creating tears, the same tests were performed. Finally, all paths were reproduced after total medial meniscectomy, and the in situ force of the medial meniscus was calculated based on the principle of superposition. RESULTS With a longitudinal tear, the in situ force of the medial meniscus was significantly decreased at 60°, 90° and 120° of knee flexion, regardless of the tear site. The decrement was greater with a tear in the meniscal body than a tear in the rim. A longitudinal tear in the meniscal body caused a significantly greater tibial varus rotation than a tear in the rim at all flexion angles. CONCLUSION Longitudinal tears significantly decreased the in situ force of the medial meniscus. Tears in the meniscal body caused a larger decrease of the in situ meniscus force and greater varus tibial rotation than tears in the rim.
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Marom N, Ouanezar H, Jahandar H, Zayyad ZA, Fraychineaud T, Hurwit D, Imhauser CW, Wickiewicz TL, Pearle AD, Nawabi DH. Lateral Extra-articular Tenodesis Reduces Anterior Cruciate Ligament Graft Force and Anterior Tibial Translation in Response to Applied Pivoting and Anterior Drawer Loads. Am J Sports Med 2020; 48:3183-3193. [PMID: 33017168 DOI: 10.1177/0363546520959322] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The biomechanical effect of lateral extra-articular tenodesis (LET) performed in conjunction with anterior cruciate ligament (ACL) reconstruction (ACLR) on load sharing between the ACL graft and the LET and on knee kinematics is not clear. PURPOSE/HYPOTHESIS The purpose was to quantify the effect of LET on (1) forces carried by both the ACL graft and the LET and (2) tibiofemoral kinematics in response to simulated pivot shift and anterior laxity tests. We hypothesized that LET would decrease forces carried by the ACL graft and anterior tibial translation (ATT) in response to simulated pivoting maneuvers and during simulated tests of anterior laxity. STUDY DESIGN Controlled laboratory study. METHODS Seven cadaveric knees (mean age, 39 ± 12 years [range, 28-54 years]; 4 male) were mounted to a robotic manipulator. The robot simulated clinical pivoting maneuvers and tests of anterior laxity: namely, the Lachman and anterior drawer tests. Each knee was assessed in the following states: ACL intact, ACL sectioned, ACL reconstructed (using a bone-patellar tendon-bone autograft), and after performing LET (the modified Lemaire technique after sectioning of the anterolateral ligament and Kaplan fibers). Resultant forces carried by the ACL graft and LET at the peak applied loads were determined via superposition. ATT was determined in response to the applied loads. RESULTS With the applied pivoting loads, performing LET decreased ACL graft force up to 80% (44 ± 12 N; P < .001) and decreased ATT of the lateral compartment compared with that of the intact knee up to 7.6 ± 2.9 mm (P < .001). The LET carried up to 91% of the force generated in the ACL graft during isolated ACLR (without LET). For simulated tests of anterior laxity, performing LET decreased ACL graft force by 70% (40 ± 20 N; P = .001) for the anterior drawer test with no significant difference detected for the Lachman test. No differences in ATT were deteced between ACLR with LET and the intact knee on both the Lachman and the anterior drawer tests (P = .409). LET reduced ATT compared with isolated ACLR on the simulated anterior drawer test by 2.4 ± 1.8 mm (P = .032) but not on the simulated Lachman test. CONCLUSION In a cadaveric model, LET in combination with ACLR transferred loads from the ACL graft to the LET and reduced ATT with applied pivoting loads and during the simulated anterior drawer test. The effect of LET on ACL graft force and ATT was less pronounced on the simulated Lachman test. CLINICAL RELEVANCE LET in addition to ACLR may be a suitable option to offload the ACL graft and to reduce ATT in the lateral compartment to magnitudes less than that of the intact knee with clinical pivoting maneuvers. In contrast, LET did not offload the ACL graft or add to the anterior restraint provided by the ACL graft during the Lachman test.
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Affiliation(s)
- Niv Marom
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hervé Ouanezar
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Hamidreza Jahandar
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Zaid A Zayyad
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas Fraychineaud
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Daniel Hurwit
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Thomas L Wickiewicz
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Pearle
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
| | - Danyal H Nawabi
- Sports Medicine Institute, Hospital for Special Surgery, New York, New York, USA
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Adouni M, Faisal TR, Dhaher YY. Computational frame of ligament in situ strain in a full knee model. Comput Biol Med 2020; 126:104012. [PMID: 33045650 DOI: 10.1016/j.compbiomed.2020.104012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 01/12/2023]
Abstract
The biomechanical function of connective tissues in a knee joint is to stabilize the kinematics-kinetics of the joint by augmenting its stiffness and limiting excessive coupled motion. The connective tissues are characterized by an in vivo reference configuration (in situ strain) that would significantly contribute to the mechanical response of the knee joint. In this work, a novel iterative method for computing the in situ strain at reference configuration was presented. The framework used an in situ strain gradient approach (deformed reference configuration) and a detailed finite element (FE) model of the knee joint. The effect of the predicted initial configuration on the mechanical response of the joint was then investigated under joint axial compression, passive flexion, and coupled rotations (adduction and internal), and during the stance phase of gait. The inclusion of the reference configuration has a minimal effect on the knee joint mechanics under axial compression, passive flexion, and at two instances (0% and 50%) of the stance phase of gait. However, the presence of the ligaments in situ strains significantly increased the joint stiffness under passive adduction and internal rotations, as well as during the other simulated instances (25%, 75% and 100%) of the stance phase of gait. Also, these parameters substantially altered the local loading state of the ligaments and resulted in better agreement with the literature during joint flexion. Therefore, the proposed computational framework of ligament in situ strain will help to overcome the challenges in considering this crucial biological aspect during knee joint modeling. Besides, the current construct is advantageous for a better understanding of the mechanical behavior of knee ligaments under physiological and pathological states and provide relevant information in the design of reconstructive treatments and artificial grafts.
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Affiliation(s)
- Malek Adouni
- Northwestern University, Physical Medicine and Rehabilitation Department, 345 East Superior Street, Chicago, IL, 60611, United States; Australian College of Kuwait, Mechanical Engineering Department, East Meshrif, P.O. Box 1411, Kuwait.
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, LA, 70508, USA
| | - Yasin Y Dhaher
- Northwestern University, Physical Medicine and Rehabilitation Department, 345 East Superior Street, Chicago, IL, 60611, United States; Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, United States; Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, United States; Bioengineering, University of Texas Southwest, Dallas, TX, United States
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Novaretti JV, Arner JW, Chan CK, Polamalu S, Harner CD, Debski RE, Lesniak BP. Does Lateral Extra-articular Tenodesis of the Knee Affect Anterior Cruciate Ligament Graft In Situ Forces and Tibiofemoral Contact Pressures? Arthroscopy 2020; 36:1365-1373. [PMID: 32057987 DOI: 10.1016/j.arthro.2020.01.051] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 01/17/2020] [Accepted: 01/19/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To quantify the effects of lateral extra-articular tenodesis (LET) on tibiofemoral compartment contact area and pressures, knee kinematics, and forces. METHODS Nine cadaveric knees were tested using a robotic testing system. Two loading conditions, (1) anterior tibial translational load coupled with axial compression and (2) internal tibial torque coupled with axial compression, were applied for each knee state at full extension and 30°, 60°, and 90° of knee flexion. Kinematic data was recorded for 3 knee states: anterolateral capsule (ALC) competent, ALC deficient, and post-LET using a 6-mm semitendinosus graft. In situ force in the anterior cruciate ligament (ACL) was quantified using the principle of superposition by comparing the change in force measured before and after the removal of the ALC. Contact area and pressures in each tibiofemoral compartment were measured by replaying kinematics after soft tissues were removed and pressure sensors were inserted. RESULTS In response to an anterior tibial translational load, mean contact area in the medial compartment decreased by 33.1% from the ALC-competent to post-LET knee states at 90° of knee flexion (P = .042). No significant differences in lateral compartment contact pressure were found between knee states. In situ force in the ACL in response to an anterior tibial translational load decreased by 43.4% and 50% from the ALC-deficient to post-LET knee states at 60° (P = .02) and 90° (P = .006). No significant difference in kinematics was observed between the ALC-competent and post-LET knee states in each of the loading conditions at all knee flexion angles (P > .05). CONCLUSIONS In this in vitro model, LET with a semitendinosus graft did not significantly overconstrain the knee or increase pressure in the lateral compartment. Additionally, LET reduced the in situ force in the ACL in the setting of ALC injury. CLINICAL RELEVANCE The lack of knee overconstraint without significant increases in lateral compartment pressures indicates that if an LET with semitendinosus graft is not overtensioned, accelerated degenerative changes in the lateral compartment may not be expected after this procedure.
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Affiliation(s)
- João V Novaretti
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A.; Department of Orthopaedics and Traumatology, Orthopaedics and Traumatology Sports Center, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Justin W Arner
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Calvin K Chan
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Sene Polamalu
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Christopher D Harner
- Department of Orthopaedic Surgery, The University of Texas Health Science Center at Houston, McGovern Medical School, Houston, Texas, U.S.A
| | - Richard E Debski
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A
| | - Bryson P Lesniak
- Departments of Orthopaedic Surgery and Bioengineering, Orthopaedic Robotics Laboratory, University of Pittsburgh, Pittsburgh, Pennsylvania, U.S.A..
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Novaretti JV, Lian J, Patel NK, Chan CK, Cohen M, Musahl V, Debski RE. Partial Lateral Meniscectomy Affects Knee Stability Even in Anterior Cruciate Ligament-Intact Knees. J Bone Joint Surg Am 2020; 102:567-573. [PMID: 31985506 DOI: 10.2106/jbjs.19.00712] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The effects of a partial lateral meniscectomy on knee kinematics and forces in the lateral meniscus are critical to understand. The purpose of this study was to quantify the effects of varying sizes of partial lateral meniscectomies of the posterior horn and a total lateral meniscectomy on knee kinematics and resultant forces in the lateral meniscus. METHODS Using a robotic testing system, loads (134-N anterior tibial load + 200-N axial compression, 5-Nm internal tibial torque + 5-Nm valgus torque, and 5-Nm external tibial torque + 5-Nm valgus torque) were applied to 10 fresh-frozen cadaveric knees. The resulting joint motion and resultant forces in the lateral meniscus were determined for 4 knee states: intact, one-third and two-thirds partial lateral meniscectomies of the posterior horn, and total lateral meniscectomy. RESULTS A decrease in lateral translation of the tibia (up to 166.7%) was observed after one-third partial lateral meniscectomies of the posterior horn compared with the intact knee, in response to an anterior load at all knee flexion angles tested (p < 0.05). One-third partial lateral meniscectomies of the posterior horn decreased the resultant forces in the lateral meniscus compared with the intact knee at all knee flexion angles tested in response to an anterior load (p < 0.05) and to an internal tibial torque (p < 0.05). The results of two-thirds partial lateral meniscectomies of the posterior horn were similar to those of one-third partial meniscectomies (p > 0.05). Total lateral meniscectomies further decreased the lateral translation of the tibia (up to 316.6%) compared with the intact knee in response to an anterior load (p < 0.05). CONCLUSIONS The changes in joint motion and meniscal forces observed in this study after even small partial lateral meniscectomies may predispose knees to further injury. CLINICAL RELEVANCE Surgeons should always consider repairing and minimizing the resection of even small lateral meniscal tears to prevent the potential deleterious effects of partial meniscectomy reported in this cadaveric study.
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Affiliation(s)
- João V Novaretti
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Jayson Lian
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,Albert Einstein College of Medicine, Bronx, New York
| | - Neel K Patel
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Moises Cohen
- Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania
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Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Shoji H, Okada Y, Kobayashi T, Kamiya T, Fujimiya M, Fujie H, Watanabe K, Yamashita T. Effect of Initial Graft Tension During Anterior Talofibular Ligament Reconstruction on Ankle Kinematics, Laxity, and In Situ Forces of the Reconstructed Graft. Am J Sports Med 2020; 48:916-922. [PMID: 32053397 DOI: 10.1177/0363546520902725] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although a variety of surgical procedures for anterior talofibular ligament (ATFL) reconstruction have been reported, the effect of initial graft tension during ATFL reconstruction remains unclear. PURPOSE/HYPOTHESIS This study investigated the effects of initial graft tension on ATFL reconstruction. We hypothesized that a high degree of initial graft tension would cause abnormal kinematics and laxity. STUDY DESIGN Controlled laboratory study. METHODS Twelve cadaveric ankles were tested with a robotic system with 6 degrees of freedom to apply passive plantarflexion and dorsiflexion motions and a multidirectional load. A repeated measures experiment was designed with the intact ATFL, transected ATFL, and reconstructed ATFL at initial tension conditions of 10, 30, 50, and 70 N. The 3-dimensional path and reconstructed graft tension were simultaneously recorded, and the in situ forces of the ATFL and reconstructed graft were calculated with the principle of superposition. RESULTS Initial tension of 10 N was sufficient to imitate normal ankle kinematics and laxity, which were not significantly different when compared with those of the intact ankles. The in situ force on the reconstructed graft tended to increase as the initial tension increased. In situ force on the reconstructed graft >30 N was significantly greater than that of intact ankles. The in situ force on the ATFL was 19 N at 30° of plantarflexion. In situ forces of 21.9, 30.4, 38.2, and 46.8 N were observed at initial tensions of 10, 30, 50, and 70 N, respectively, at 30° of plantarflexion. CONCLUSION Approximate ankle kinematic patterns and sufficient laxity, even with an initial tension of 10 N, could be obtained immediately after ATFL reconstruction. Moreover, excessive initial graft tension during ATFL reconstruction caused excessive in situ force on the reconstructed graft. CLINICAL RELEVANCE This study revealed the effects of initial graft tension during ATFL reconstruction. These data suggest that excessive tension during ATFL reconstruction should be avoided to ensure restoration of normal ankle motion.
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Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hiroaki Shoji
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Takuma Kobayashi
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Mineko Fujimiya
- Department of Anatomy, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, Sapporo Medical University School of Health Science, Sapporo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan
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Kent RN, Imhauser CW, Thein R, Marom N, Wickiewicz TL, Nawabi DH, Pearle AD. Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity. Am J Sports Med 2020; 48:109-116. [PMID: 31765242 DOI: 10.1177/0363546519888488] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with high-grade preoperative side-to-side differences in anterior laxity as assessed via the Lachman test after unilateral anterior cruciate ligament (ACL) rupture are at heightened risk of early ACL graft failure. Biomechanical factors that predict preoperative side-to-side differences in anterior laxity are poorly understood. PURPOSE To assess, in a cadaveric model, whether the increase in anterior laxity caused by sectioning the ACL (a surrogate for preoperative side-to-side differences in anterior laxity) during a simulated Lachman test is associated with two biomechanical factors: (1) the tibial translation at which the secondary anterior stabilizers, including the remaining ligaments and the menisci, begin to carry force, or engage, relative to that of the ACL or (2) the forces carried by the ACL and secondary stabilizers at the peak applied anterior load. STUDY DESIGN Controlled laboratory study. METHODS Seventeen fresh-frozen human cadaveric knees underwent Lachman tests simulated through a robotic manipulator with the ACL intact and sectioned. The net forces carried by the ACL and secondary soft tissue stabilizers (the medial meniscus and all remaining ligaments, measured as a whole) were characterized as a function of anterior tibial translation. The engagement points of the ACL (with the ACL intact) and each secondary stabilizer (with the ACL sectioned) were defined as the anterior translation at which they began to carry force, or engaged, during a simulated Lachman test. Then, the relative engagement point of each secondary stabilizer was defined as the difference between the engagement point of each secondary stabilizer and that of the ACL. Linear regressions were performed to test each association (P < .05). RESULTS The increase in anterior laxity caused by ACL sectioning was associated with increased relative engagement points of both the secondary ligaments (β = 0.87; P < .001; R2 = 0.75) and the medial meniscus (β = 0.66; P < .001; R2 = 0.58). Smaller changes in anterior laxity were also associated with increased in situ medial meniscal force at the peak applied load when the ACL was intact (β = -0.06; P < .001; R2 = 0.53). CONCLUSION The secondary ligaments and the medial meniscus require greater anterior tibial translation to engage (ie, begin to carry force) relative to the ACL in knees with greater changes in anterior laxity after ACL sectioning. Moreover, with the ACL intact, the medial meniscus carries more force in knees with smaller changes in anterior laxity after ACL sectioning. CLINICAL RELEVANCE Relative tissue engagement is a new biomechanical measure to characterize in situ function of the ligaments and menisci. This measure may aid in developing more personalized surgical approaches to reduce high rates of ACL graft revision in patients with high-grade laxity.
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Affiliation(s)
- Robert N Kent
- Hospital for Special Surgery, New York, New York, USA
| | | | - Ran Thein
- Chaim Sheba Medical Center, Kadima, Israel
| | - Niv Marom
- Hospital for Special Surgery, New York, New York, USA
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Naendrup JH, Pfeiffer TR, Chan C, Nagai K, Novaretti JV, Sheean AJ, Shafizadeh ST, Debski RE, Musahl V. Effect of Meniscal Ramp Lesion Repair on Knee Kinematics, Bony Contact Forces, and In Situ Forces in the Anterior Cruciate Ligament. Am J Sports Med 2019; 47:3195-3202. [PMID: 31560563 DOI: 10.1177/0363546519872964] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meniscal ramp lesions are possible concomitant injuries in cases of anterior cruciate ligament (ACL) deficiency. Although recent studies have investigated the influence of ramp lesions on knee kinematics, the effect on the ACL reconstruction graft remains unknown. PURPOSE/HYPOTHESIS The purpose was to determine the effects of ramp lesion and ramp lesion repair on knee kinematics, the in situ forces in the ACL, and bony contact forces. It was hypothesized that ramp lesions will significantly increase in situ forces in the native ACL and bony contact forces and that ramp lesion repair will restore these conditions comparably with those forces of the intact knee. STUDY DESIGN Controlled laboratory study. METHODS Investigators tested 9 human cadaveric knee specimens using a 6 degrees of freedom robotic testing system. The knee was continuously flexed from full extension to 90° while the following loads were applied: (1) 90-N anterior load, (2) 5 N·m of external-rotation torque, (3) 134-N anterior load + 200-N compression load, (4) 4 N·m of external-rotation torque + 200-N compression load, and (5) 4 N·m of internal-rotation torque + 200-N compression load. Loading conditions were applied to the intact knee, a knee with an arthroscopically induced 25-mm ramp lesion, and a knee with an all-inside repaired ramp lesion. In situ forces in the ACL, bony contact forces in the medial compartment, and bony contact forces in the lateral compartment were quantified. RESULTS In response to all loading conditions, no differences were found with respect to kinematics, in situ forces in the ACL, and bony contact forces between intact knees and knees with a ramp lesion. However, compared with intact knees, knees with a ramp lesion repair had significantly reduced anterior translation at flexion angles from full extension to 40° in response to a 90-N anterior load (P < .05). In addition, a significant decrease in the in situ forces in the ACL after ramp repair was detected only for higher flexion angles when 4 N·m of external-rotation torque combined with a 200-N compression load (P < .05) and 4 N·m of internal-rotation torque combined with a 200-N compression load were applied (P < .05). CONCLUSION In this biomechanical study, ramp lesions did not significantly affect knee biomechanics at the time of surgery. CLINICAL RELEVANCE From a biomechanical time-zero perspective, the indications for ramp lesion repair may be limited.
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Affiliation(s)
- Jan-Hendrik Naendrup
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Thomas R Pfeiffer
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Cologne Merheim Medical Centre, Cologne, Germany
| | - Calvin Chan
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kanto Nagai
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - João V Novaretti
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Orthopaedics and Traumatology Sports Center (CETE), Department of Orthopaedics and Traumatology, Paulista School of Medicine (EPM), Federal University of São Paulo, São Paulo, Brazil
| | - Andrew J Sheean
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sven T Shafizadeh
- Department of Trauma Surgery, Orthopaedic Surgery and Sports Traumatology, Witten/Herdecke University, Sana Medical Centre Cologne, Cologne, Germany
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery, Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Novaretti JV, Lian J, Sheean AJ, Chan CK, Wang JH, Cohen M, Debski RE, Musahl V. Lateral Meniscal Allograft Transplantation With Bone Block and Suture-Only Techniques Partially Restores Knee Kinematics and Forces. Am J Sports Med 2019; 47:2427-2436. [PMID: 31251657 DOI: 10.1177/0363546519858085] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The ability of lateral meniscal allograft transplantation (MAT) to improve knee stability and the meniscal load-bearing function in patients after meniscectomy is critical for surgical success. PURPOSE To compare the effects of 2 lateral MAT fixation techniques-bone block and suture only-on knee kinematics and forces. STUDY DESIGN Controlled laboratory study. METHODS With a robotic testing system, loads were applied during flexion on 10 fresh-frozen cadaveric knees: 134-N anterior tibial load + 200-N axial compression, 5-N·m internal tibial + 5-N·m valgus torques, and 5-N·m external tibial + 5-N·m valgus torques. Kinematic data were recorded for 4 knee states: intact, total lateral meniscectomy, lateral MAT bone block, and lateral MAT suture-only fixation. In situ force in the anterior cruciate ligament and resultant forces in the lateral meniscus and in the meniscal allograft were quantified via the principle of superposition. A repeated measures analysis of variance was used to analyze variations in kinematics and forces at 0°, 30°, 60°, and 90° of knee flexion. Significance was set at P < .05. RESULTS When anterior loads were applied, a decrease in medial translation of the tibia that was increased after total lateral meniscectomy was observed at 30°, 60°, and 90° of knee flexion for both the lateral MAT bone block (54.2%, 48.0%, and 50.0%) and the MAT suture-only (50.0%, 40.0%, and 34.6%) fixation techniques (P < .05). Yet, most of the increases in knee kinematics after lateral meniscectomy were not significantly reduced by either lateral MAT technique (P > .05 for each MAT technique vs the total lateral meniscectomy state). Resultant forces in the meniscal allograft were 50% to 60% of the resultant forces in the intact lateral meniscus in response to all loading conditions at all flexion angles (P < .05). Overall, no significant differences between lateral MAT techniques were observed regarding kinematics and forces (P > .05). CONCLUSION Lateral MAT partially restored medial translation of the tibia, and the resultant forces in the meniscal allograft were only 50% to 60% of the intact lateral meniscus forces in the cadaver model. In the majority of testing conditions, no significant changes of the in situ force in the anterior cruciate ligament were observed. Surgeons should consider the potential benefits of lateral MAT when deciding the appropriate treatment for symptomatic patients after lateral meniscectomies. Both lateral MAT techniques functioned similarly. CLINICAL RELEVANCE The load-bearing function of the meniscal allograft observed in this study may be beneficial in ameliorating the short- and long-term disability associated with lateral meniscal deficiency.
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Affiliation(s)
- João V Novaretti
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Orthopaedics and Traumatology Sports Center, Department of Orthopaedics and Traumatology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Jayson Lian
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Albert Einstein College of Medicine, Bronx, New York, USA
| | - Andrew J Sheean
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Calvin K Chan
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joon H Wang
- Department of Orthopaedic Surgery, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, Republic of Korea
| | - Moises Cohen
- Orthopaedics and Traumatology Sports Center, Department of Orthopaedics and Traumatology, Paulista School of Medicine, Federal University of São Paulo, São Paulo, Brazil
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Suzuki T, Shino K, Yamakawa S, Otsubo H, Suzuki D, Matsumura T, Fujimiya M, Fujie H, Yamashita T. A Biomechanical Comparison of Single-, Double-, and Triple-Bundle Anterior Cruciate Ligament Reconstructions Using a Hamstring Tendon Graft. Arthroscopy 2019; 35:896-905. [PMID: 30733036 DOI: 10.1016/j.arthro.2018.10.124] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Revised: 10/22/2018] [Accepted: 10/25/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The first objective of our cadaveric study was to perform a biomechanical comparison of single-bundle (SB), double-bundle (DB), and triple-bundle (TB) anterior cruciate ligament (ACL) reconstructions using a hamstring tendon graft to determine the laxity match pre-tension (LMP) value, which is the tension within the graft required to re-create the same anterior laxity as the ACL-intact knee. The second objective was to determine the anterior laxity and force distribution during the application of both an anterior force and a simulated pivot-shift test. METHODS Eleven fresh-frozen cadaveric knees were tested using a robotic/universal force-moment sensor system in the intact state, TB-reconstructed knee, DB-reconstructed knee, and SB-reconstructed knee. The LMP in each reconstruction was recorded. Each reconstructed knee was tested with an external load of 100-N anterior drawer and combined rotatory loads of 10-Nm valgus moment and 5-Nm internal rotation. The anterior tibial translation and tensile forces of each graft bundle were measured. RESULTS The LMP values for the TB reconstruction were 1.7 N for the anteromedial-medial graft, 1.7 N for the anteromedial-lateral graft, and 3.4 N for the posterolateral graft (PLG). The LMP value was 5.6 N for the anteromedial graft and PLG in the DB reconstruction. The LMP value was 26.3 N for the whole graft in the SB reconstruction. No statistically significant difference in stability was found between TB and DB reconstructions during the anterior load and the combined rotatory load test. For force distribution, the PLG tension in the TB reconstruction was statistically lower than that in the DB reconstruction. CONCLUSIONS Anatomic TB ACL reconstruction with the lowest initial tension on the graft stabilized the knee equally to DB or SB reconstruction, which required greater initial tension. CLINICAL RELEVANCE Although SB, DB, and TB ACL reconstructions through the anatomic tunnel position could equally restore stability, the initial tension on the graft required to restore stability was less in the latter 2 multi-tunnel reconstructions.
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Affiliation(s)
- Tomoyuki Suzuki
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan.
| | - Konsei Shino
- Sports Orthopaedic Center, Yukioka Hospital, Osaka, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hidenori Otsubo
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Daisuke Suzuki
- Department of Health Science, Hokkaido Chitose College of Rehabilitation, Chitose, Japan
| | - Takashi Matsumura
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Mineko Fujimiya
- Second Department of Anatomy, Sapporo Medical University, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Shoji H, Teramoto A, Sakakibara Y, Kamiya T, Watanabe K, Fujie H, Yamashita T. Kinematics and Laxity of the Ankle Joint in Anatomic and Nonanatomic Anterior Talofibular Ligament Repair: A Biomechanical Cadaveric Study. Am J Sports Med 2019; 47:667-673. [PMID: 30681886 DOI: 10.1177/0363546518820527] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although it is crucial to accurately identify the anterior talofibular ligament (ATFL) attachment site, it may not be feasible to fully observe the ATFL attachment site during arthroscopic surgery. As a result, the repair position might often be an unintentionally nonanatomic ATFL attachment site. HYPOTHESIS Anatomic ATFL repair restores kinematics and laxity to the ankle joint, while nonanatomic ATFL repair does not. STUDY DESIGN Controlled laboratory study. METHODS Seven normal fresh-frozen human cadaveric ankles were used. The ankles were tested with a 6 degrees of freedom robotic system. The following ankle states were evaluated: intact, ATFL injured, ATFL anatomic repair, and ATFL nonanatomic repair. The ATFL nonanatomic repair position was set 8 mm proximal from the center of the ATFL attachment site of the fibula. For each state, a passive plantarflexion (PF)-dorsiflexion (DF) kinematics test and a multidirectional loading test (anterior forces, inversion moment, and internal rotation moment) were performed. RESULTS The kinematics and laxity of the anatomic repair were not significantly different from those of the intact state. In nonanatomic repair, the inversion-eversion angle showed significant inversion (3.0°-3.4°) from 5° to 15° of DF, and the internal rotation-external rotation angle showed significant internal rotation (2.0°) at neutral PF-DF versus the intact state. In addition, internal rotation laxity was significantly increased (5.5°-5.8°) relative to the intact state in the nonanatomic repair at 30° and 15° of PF. There were no significant differences in anterior-posterior translation between the repairs. CONCLUSION Although the anatomic ATFL repair state did not show significant differences in kinematics and laxity relative to the intact state, the nonanatomic ATFL repair state demonstrated significant inversion and internal rotation kinematics and internal rotation laxity when compared with the intact state. CLINICAL RELEVANCE Nonanatomic repair alters kinematics and laxity from the intact condition.
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Affiliation(s)
- Hiroaki Shoji
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Yuzuru Sakakibara
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Tomoaki Kamiya
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, School of Health Sciences, Sapporo Medical University, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Japan
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Ohori T, Mae T, Shino K, Tachibana Y, Fujie H, Yoshikawa H, Nakata K. Complementary Function of the Meniscofemoral Ligament and Lateral Meniscus Posterior Root to Stabilize the Lateral Meniscus Posterior Horn: A Biomechanical Study in a Porcine Knee Model. Orthop J Sports Med 2019; 7:2325967118821605. [PMID: 30719478 PMCID: PMC6348525 DOI: 10.1177/2325967118821605] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: It has been demonstrated that the load distribution function of the lateral meniscus (LM) is compromised by resecting both the meniscofemoral ligament (MFL) and LM posterior root (LMPR). However, the effect of resecting these fibers on load transmission through the LM needs to be investigated. Purpose: To evaluate using a porcine knee model (1) the in situ forces of the MFL and LMPR and (2) the effect of resecting these fibers on the in situ force of the LM under a compressive load and valgus torque to the lateral knee compartment. Study Design: Controlled laboratory study. Methods: Twenty fresh-frozen porcine knees and a 6 degrees of freedom robotic system were utilized. An axial compressive load of 250 N and 5 N·m of valgus torque were applied to intact, MFL-deficient, LMPR-deficient, and MFL/LMPR-deficient knees at 30°, 60°, and 90° of flexion. The valgus angles under the applied loads were compared among the 4 states. The in situ forces of the MFL and LMPR under the applied loads were calculated under the principle of superposition. The in situ forces of the LM under the applied loads were also calculated and compared among the 4 conditions (intact, without the MFL, without LMPR, and without the MFL/LMPR). Results: The valgus angles significantly increased after resecting both the MFL and LMPR at all the flexion angles. The in situ forces of the MFL and LMPR changed reciprocally as the knee flexed. The in situ forces of the LM significantly decreased after resecting both the MFL and LMPR, although resecting only the MFL or LMPR represented no significant effect. Conclusion: The MFL and LMPR functioned complementarily as the posterior attachments of the LM against a compressive load and valgus torque to the lateral knee compartment in porcine knee joints. Clinical Relevance: If the LMPR is completely detached and needs to be repaired, the MFL should be preserved because it may provide some stability to the LM posterior horn and protect the repaired LMPR.
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Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Yuta Tachibana
- Sports Orthopaedic Surgery Center, Yukioka Hospital, Osaka, Japan
| | - Hiromichi Fujie
- Department of Intelligent Mechanical Systems, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Osaka University, Suita, Japan
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Sakakibara Y, Teramoto A, Takagi T, Yamakawa S, Okada Y, Shoji H, Kobayashi T, Fujimiya M, Fujie H, Watanabe K, Yamashita T. Effect of Initial Graft Tension During Calcaneofibular Ligament Reconstruction on Ankle Kinematics and Laxity. Am J Sports Med 2018; 46:2935-2941. [PMID: 30125125 DOI: 10.1177/0363546518790254] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although a variety of surgical procedures for lateral ankle ligament reconstruction have frequently been reported, little is known about the effects of initial graft tension. Purpose/Hypothesis: The purpose was to investigate the effects of initial graft tension in calcaneofibular ligament (CFL) reconstruction. It was hypothesized that a high degree of initial graft tension would cause abnormal kinematics, laxity, and excessive graft tension. STUDY DESIGN Controlled laboratory study. METHODS Twelve cadaveric ankles were tested with a 6 degrees of freedom robotic system to apply passive plantarflexion-dorsiflexion motion and multidirectional loads. A repeated-measures experiment was designed with the CFL intact, CFL transected, and CFL reconstructed with 4 initial tension conditions (10, 30, 50, and 70 N). The 3-dimensional path and reconstructed graft tension were simultaneously recorded. RESULTS The calcaneus in CFL reconstruction with an initial tension of 70 N had the most eversion relative to the intact condition (mean eversion translations of 1.2, 3.0, 5.0, and 6.2 mm were observed at initial tensions of 10, 30, 50, and 70 N, respectively). The calcaneus also moved more posteriorly with external rotation as the initial tension increased. The reconstructed graft tension tended to increase as the initial tension increased. CONCLUSION Ankle kinematic patterns and laxity after CFL reconstruction tended to become more abnormal as the initial graft tension increased at the time of surgery. Moreover, excessive initial graft tension caused excessive tension on the reconstructed graft. CLINICAL RELEVANCE This study indicated the importance of initial graft tension during CFL reconstruction. Overtensioning during CFL reconstruction should be avoided to imitate a normal ankle.
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Affiliation(s)
- Yuzuru Sakakibara
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Atsushi Teramoto
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Yohei Okada
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Hiroaki Shoji
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Takuma Kobayashi
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Mineko Fujimiya
- Department of Anatomy, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Kota Watanabe
- Department of Physical Therapy, School of Health Science, Sapporo Medical University, Sapporo, Hokkaido, Japan
| | - Toshihiko Yamashita
- Department of Orthopaedic Surgery, School of Medicine, Sapporo Medical University, Sapporo, Hokkaido, Japan
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Okada Y, Teramoto A, Takagi T, Yamakawa S, Sakakibara Y, Shoji H, Watanabe K, Fujimiya M, Fujie H, Yamashita T. ACL Function in Bicruciate-Retaining Total Knee Arthroplasty. J Bone Joint Surg Am 2018; 100:e114. [PMID: 30180063 DOI: 10.2106/jbjs.18.00099] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Bicruciate-retaining total knee arthroplasty (BCR-TKA) is attracting attention because of the functional and satisfaction outcomes associated with keeping the anterior cruciate ligament (ACL) intact. However, knowledge of the functional importance of the ACL after BCR-TKA is limited. We performed a biomechanical investigation of ACL function following BCR-TKA compared with that in the intact knee. METHODS We investigated 8 fresh-frozen human cadaveric knees using a 6-degrees-of-freedom robotic system that allowed natural joint motion. Three knee states-intact knee, BCR-TKA, and BCR-TKA with ACL transection (BCR-TKA + ACLT)-were evaluated. For each knee state, the kinematics during passive flexion-extension motion (from 0° to 120°) and anteroposterior laxity at 0°, 15°, 30°, 60°, and 90° of flexion in response to a 100-N load were investigated. The recorded knee motions of the intact and BCR-TKA knees during each test were repeated after ACLT to calculate the ACL in situ force. RESULTS The femur in the BCR-TKA group translated posteriorly and rotated externally during passive knee flexion and was in an anterior position compared with the femur in the intact-knee state. After ACLT, the femur translated posteriorly, compared with the BCR-TKA group, at 0° and 10° (p < 0.05). The anteroposterior laxities of the BCR-TKA and intact knees were comparable at all flexion angles and increased 2-fold or more after ACLT (p < 0.01). The ACL in situ force in the BCR-TKA knees was 2-fold to 6-fold higher than that in the intact knees at 0°, 15°, 90°, and 120° during a passive path (p < 0.05) and equivalent to that in the intact knees under anterior loading. CONCLUSIONS The preserved ACL in the BCR-TKA knees was functional, like the ACL in the intact knees, under anterior tibial loading and contributed to good anteroposterior stability. However, the kinematics and ACL in situ force differed between the intact and BCR-TKA knees during passive flexion-extension movements. CLINICAL RELEVANCE Surgeons may not be able to prevent overtensioning of the ACL during a standardized BCR-TKA procedure, which could potentially limit range of motion.
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Affiliation(s)
- Yohei Okada
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Atsushi Teramoto
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tetsuya Takagi
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Satoshi Yamakawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Yuzuru Sakakibara
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroaki Shoji
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Kota Watanabe
- Second Division of Physical Therapy, Sapporo Medical University School of Health Sciences, Sapporo, Japan
| | - Mineko Fujimiya
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiromichi Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, Tokyo, Japan
| | - Toshihiko Yamashita
- Department of Orthopedic Surgery (Y.O., A.T., Y.S., H.S., and T.Y.) and Second Department of Anatomy (M.F.), Sapporo Medical University School of Medicine, Sapporo, Japan
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Kent RN, Amirtharaj MJ, Hardy BM, Pearle AD, Wickiewicz TL, Imhauser CW. Anterior laxity, lateral tibial slope, and in situ ACL force differentiate knees exhibiting distinct patterns of motion during a pivoting event: A human cadaveric study. J Biomech 2018; 74:9-15. [PMID: 29752053 DOI: 10.1016/j.jbiomech.2018.04.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2017] [Revised: 03/26/2018] [Accepted: 04/01/2018] [Indexed: 01/13/2023]
Abstract
Knee instability following anterior cruciate ligament (ACL) rupture compromises function and increases risk of injury to the cartilage and menisci. To understand the biomechanical function of the ACL, previous studies have primarily reported the net change in tibial position in response to multiplanar torques, which generate knee instability. In contrast, we retrospectively analyzed a cohort of 13 consecutively tested cadaveric knees and found distinct motion patterns, defined as the motion of the tibia as it translates and rotates from its unloaded, initial position to its loaded, final position. Specifically, ACL-sectioned knees either subluxated anteriorly under valgus torque (VL-subluxating) (5 knees) or under a combination of valgus and internal rotational torques (VL/IR-subluxating) (8 knees), which were applied at 15 and 30° flexion using a robotic manipulator. The purpose of this study was to identify differences between these knees that could be driving the two distinct motion patterns. Therefore, we asked whether parameters of bony geometry and tibiofemoral laxity (known risk factors of non-contact ACL injury) as well as in situ ACL force, when it was intact, differentiate knees in these two groups. VL-subluxating knees exhibited greater sagittal slope of the lateral tibia by 3.6 ± 2.4° (p = 0.003); less change in anterior laxity after ACL-sectioning during a simulated Lachman test by 3.2 ± 3.2 mm (p = 0.006); and, at the peak applied valgus torque (no internal rotation torque), higher posteriorly directed, in situ ACL force by 13.4 ± 11.3 N and 12.0 ± 11.6 N at 15° and 30° of flexion, respectively (both p ≤ 0.03). These results may suggest that subgroups of knees depend more on their ACL to control lateral tibial subluxation in response to uniplanar valgus and multiplanar valgus and internal rotation torques as mediated by anterior laxity and bony morphology.
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Affiliation(s)
- Robert N Kent
- Department of Biomechanics, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States.
| | - Mark J Amirtharaj
- Department of Biomechanics, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Brendan M Hardy
- Department of Biomechanics, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Andrew D Pearle
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Thomas L Wickiewicz
- Department of Orthopedic Surgery, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY, United States
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Bell KM, Rahnemai-Azar AA, Irarrazaval S, Guenther D, Fu FH, Musahl V, Debski RE. In situ force in the anterior cruciate ligament, the lateral collateral ligament, and the anterolateral capsule complex during a simulated pivot shift test. J Orthop Res 2018; 36:847-853. [PMID: 28782837 DOI: 10.1002/jor.23676] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 07/24/2017] [Indexed: 02/04/2023]
Abstract
The role of the anterolateral capsule complex in knee rotatory stability remains controversial. Therefore, the objective of this study was to determine the in situ forces in the anterior cruciate ligament (ACL), the anterolateral capsule, the lateral collateral ligament (LCL), and the forces transmitted between each region of the anterolateral capsule in response to a simulated pivot shift test. A robotic testing system applied a simulated pivot shift test continuously from full extension to 90° of flexion to intact cadaveric knees (n = 7). To determine the magnitude of the in situ forces, kinematics of the intact knee were replayed in position control mode after the following procedures were performed: (i) ACL transection; (ii) capsule separation; (iii) anterolateral capsule transection; and (iii) LCL transection. A repeated measures ANOVA was performed to compare in situ forces between each knee state (*p < 0.05). The in situ force in the ACL was significantly greater than the forces transmitted between each region of the anterolateral capsule at 5° and 15° of flexion but significantly lower at 60°, 75°, and 90° of flexion. This study demonstrated that the ACL is the primary rotatory stabilizer at low flexion angles during a simulated pivot shift test in the intact knee, but the anterolateral capsule plays an important secondary role at flexion angles greater than 60°. Furthermore, the contribution of the "anterolateral ligament" to rotatory knee stability in this study was negligible during a simulated pivot shift test. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:847-853, 2018.
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Affiliation(s)
- Kevin M Bell
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Ata A Rahnemai-Azar
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Sebastian Irarrazaval
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Daniel Guenther
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Freddie H Fu
- Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania
| | - Richard E Debski
- Orthopaedic Robotics Laboratory, Department of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 300 Technology Drive, Pittsburgh, 15219, Pennsylvania.,Department of Orthopaedic Surgery, University of Pittsburgh, Kaufman Building Suite 1011, 3471 Fifth Avenue, Pittsburgh, 15213, Pennsylvania.,Department of Bioengineering, University of Pittsburgh, 302 Benedum Hall, 3700 O'Hara Street, Pittsburgh, 15260, Pennsylvania
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Adaptation of a clinical fixation device for biomechanical testing of the lumbar spine. J Biomech 2018; 69:164-168. [PMID: 29397109 DOI: 10.1016/j.jbiomech.2017.12.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 12/15/2017] [Accepted: 12/28/2017] [Indexed: 11/23/2022]
Abstract
In-vitro biomechanical testing is widely performed for characterizing the load-displacement characteristics of intact, injured, degenerated, and surgically repaired osteoligamentous spine specimens. Traditional specimen fixture devices offer an unspecified rigidity of fixation, while varying in the associated amounts and reversibility of damage to and "coverage" of a specimen - factors that can limit surgical access to structures of interest during testing as well as preclude the possibility of testing certain segments of a specimen. Therefore, the objective of this study was to develop a specimen fixture system for spine biomechanical testing that uses components of clinically available spinal fixation hardware and determine whether the new system provides sufficient rigidity for spine biomechanical testing. Custom testing blocks were mounted into a robotic testing system and the angular deflection of the upper fixture was measured indirectly using linear variable differential transformers. The fixture system had an overall stiffness 37.0, 16.7 and 13.3 times greater than a typical human functional spine unit for the flexion/extension, axial rotation and lateral bending directions respectively - sufficient rigidity for biomechanical testing. Fixture motion when mounted to a lumbar spine specimen revealed average motion of 0.6, 0.6, and 1.5° in each direction. This specimen fixture method causes only minimal damage to a specimen, permits testing of all levels of a specimen, and provides for surgical access during testing.
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. The influence of internal and external tibial rotation offsets on knee joint and ligament biomechanics during simulated athletic tasks. Clin Biomech (Bristol, Avon) 2018; 52:109-116. [PMID: 29425835 PMCID: PMC5835205 DOI: 10.1016/j.clinbiomech.2018.01.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 01/16/2018] [Accepted: 01/22/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Following anterior cruciate ligament injury and subsequent reconstruction transverse plane tibiofemoral rotation becomes underconstrained and overconstrained, respectively. Conflicting reports exist on how rotations influence loading at the knee. This investigation aimed to determine the mechanical effects of internal and external tibial rotation offsets on knee kinematics and ligament strains during in vitro simulations of in vivo recorded kinematics. METHOD A 6-degree-of-freedom robotic manipulator arm was used to articulate 11 cadaveric tibiofemoral joint specimens through simulations of four athletic tasks produced from in vivo recorded kinematics. These simulations were then repeated with 4° tibial rotation offsets applied to the baseline joint orientation. FINDINGS Rotational offsets had a significant effect on peak posterior force for female motion simulations (P < 0.01), peak lateral force for most simulated tasks (P < 0.01), and peak anterior force, internal torque, and flexion torque for sidestep cutting tasks (P ≤ 0.01). Rotational offsets did not exhibit statistically significant effects on peak anterior cruciate ligament strain (P > 0.05) or medial collateral ligament strain (P > 0.05) for any task. INTERPRETATION Transverse plane rotational offsets comparable to those observed in anterior cruciate ligament deficient and reconstructed patients alter knee kinetics without significantly altering anterior cruciate ligament strain. As knee degeneration is attributed to abnormal knee loading profiles, altered transverse plane kinematics may contribute to this. However, altered transverse plane rotations likely play a limited role in anterior cruciate ligament injury risk as physiologic offsets failed to significantly influence anterior cruciate ligament strain during athletic tasks.
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Affiliation(s)
- Nathaniel A. Bates
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH, USA
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, OH, USA,Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Timothy E. Hewett
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA,Department of Biomedical Engineering and Physiology, Mayo Clinic, Rochester, MN, USA,Sports Medicine Center, Mayo Clinic, Rochester, MN, USA,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
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Imhauser CW, Kent RN, Boorman-Padgett J, Thein R, Wickiewicz TL, Pearle AD. New parameters describing how knee ligaments carry force in situ predict interspecimen variations in laxity during simulated clinical exams. J Biomech 2017; 64:212-218. [DOI: 10.1016/j.jbiomech.2017.09.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 09/05/2017] [Accepted: 09/25/2017] [Indexed: 10/18/2022]
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Bates NA, Nesbitt RJ, Shearn JT, Myer GD, Hewett TE. Knee Abduction Affects Greater Magnitude of Change in ACL and MCL Strains Than Matched Internal Tibial Rotation In Vitro. Clin Orthop Relat Res 2017; 475:2385-2396. [PMID: 28455730 PMCID: PMC5599390 DOI: 10.1007/s11999-017-5367-9] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injures incur over USD 2 billion in annual medical costs and prevention has become a topic of interest in biomechanics. However, literature conflicts persist over how knee rotations contribute to ACL strain and ligament injury. To maximize the efficacy of ACL injury prevention, the effects of underlying mechanics need to be better understood. QUESTIONS/PURPOSES We applied robotically controlled, in vivo-derived kinematic stimuli to the knee to assess ligament biomechanics in a cadaver model. We asked: (1) Does the application of abduction rotation increase ACL and medial collateral ligament (MCL) strain relative to the normal condition? (2) Does the application of internal tibial rotation impact ACL strain relative to the neutral condition? (3) Does combined abduction and internal tibial rotation increase ligament strain more than either individual contribution? METHODS A six-degree-of-freedom robotic manipulator was used to position 17 cadaveric specimens free from knee pathology outside of low-grade osteoarthritis (age, 47 ± 8 years; 13 males, four females) into orientations that mimic initial contact recorded from in vivo male and female drop vertical jump and sidestep cutting activities. Four-degree rotational perturbations were applied in both directions from the neutral alignment position (creating an 8° range) for each frontal, transverse, and combined planes while ACL and MCL strains were continuously recorded with DVRT strain gauges implanted directly on each ligament. Analysis of variance models with least significant difference post hoc analysis were used to assess differences in ligament strain and joint loading between sex, ligament condition, or motion task and rotation type. RESULTS For the female drop vertical jump simulation in the intact knee, isolated abduction and combined abduction/internal rotational stimuli produced the greatest change in strain from the neutral position as compared with all other stimuli within the ACL (1.5% ± 1.0%, p ≤ 0.035; 1.8% ± 1.3%, p ≤ 0.005) and MCL (1.8% ± 1.0%, p < 0.001; 1.6% ± 1.3%, p < 0.001) compared with all other applied stimuli. There were no differences in mean peak ACL strain between any rotational stimuli (largest mean difference = 2.0%; 95% confidence interval [CI], -0.9% to 5.0%; p = 0.070). These trends were consistent for all four simulated tasks. Peak ACL strain in the intact knee was larger than peak MCL strain for all applied rotational stimuli in the drop vertical jump simulations (smallest mean difference = 2.1%; 95% CI, -0.4% to 4.5%; p = 0.047). CONCLUSIONS Kinematically constrained cadaveric knee models using peak strain as an outcome variable require greater than 4° rotational perturbations to elicit changes in intraarticular ligaments. CLINICAL RELEVANCE Because combined rotations and isolated abduction produced greater change in strain relative to the neutral position for the ACL and MCL than any other rotational stimuli in this cadaver study, hypotheses for in vivo investigations aimed toward injury prevention that focuses on the reduction of frontal plane knee motion should be considered. Furthermore, reduced strain in the MCL versus the ACL may help explain why only 30% of ACL ruptures exhibit concomitant MCL injuries.
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Affiliation(s)
- Nathaniel A. Bates
- Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55902 USA
| | - Rebecca J. Nesbitt
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH USA
| | - Jason T. Shearn
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH USA
| | - Gregory D. Myer
- Division of Sports Medicine, Cincinnati Children’s Hospital Medical Center, USA; and the Departments of Pediatrics and Orthopedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH USA
| | - Timothy E. Hewett
- Departments of Orthopedic Surgery and Physiology and Biomedical Engineering, Mayo Clinic, 200 First Street SW, Rochester, MN 55902 USA ,Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN USA
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Ohori T, Mae T, Shino K, Tachibana Y, Fujie H, Yoshikawa H, Nakata K. Varus-valgus instability in the anterior cruciate ligament-deficient knee: effect of posterior tibial load. J Exp Orthop 2017; 4:24. [PMID: 28656567 PMCID: PMC5487314 DOI: 10.1186/s40634-017-0087-3] [Citation(s) in RCA: 2] [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: 01/19/2017] [Accepted: 04/11/2017] [Indexed: 01/13/2023] Open
Abstract
Background Anterior cruciate ligament (ACL) injury is often accompanied with medial collateral ligament (MCL) injury. Assessment of varus-valgus (V-V) instability in the ACL-deficient knee is crucial for the management of the concomitant ACL-collateral ligaments injury. We evaluated the V-V laxity and investigated the effect of additional posterior tibial load on the laxity in the ACL-deficient knee. Our hypothesis was that the V-V laxity in the ACL-deficient knee was greater than that in the intact knee and attenuated by additional posterior tibial load. Methods Eight fresh-frozen porcine knees were used, and a 6°-of-freedom (DOF) robotic system was utilized. A 5 Nm of V-V torque was applied to the intact knee, the ACL-deficient knee, and the ACL-deficient knee with 30 N of constant posterior tibial load, at 30° and 60° of flexion. Then, the 3D path in the intact knee was reproduced on the ACL-deficient knee. The total V-V angle under 5 Nm of V-V torque was assessed and compared among the three statuses. The in situ forces of the ACL under 5 Nm of varus and valgus torques, respectively, were also calculated. Results The total V-V angle in the ACL-deficient knee under 5 Nm of V-V torque was significantly greater than that in the intact knee, whereas the angle in the ACL-deficient knee with 30 N of posterior tibial load was significantly smaller than that in the ACL-deficient knee and approached that in the intact knee, at both 30° and 60° of flexion. The in situ force of the ACL was approximately 30 N at 30° and 16 N at 60° of flexion under 5 Nm of both varus and valgus torques. Conclusions The V-V laxity in the isolated ACL-deficient knee was greater than that in the intact knee. The increased laxity was attenuated and approached that in the intact knee by adding posterior tibial load. Application of posterior tibial load is necessary for accurate assessment of V-V instability in the ACL-deficient knee. Clinically, the V-V laxity in the combined ACL-MCL or ACL-LCL injured knee may be overestimated without posterior tibial load.
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Affiliation(s)
- Tomoki Ohori
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Tatsuo Mae
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan.
| | - Konsei Shino
- Sports Orthopaedic Surgery Center, Yukioka Hospital, 2-2-3, Ukita, Kita-ku, Osaka, 530-0021, Japan
| | - Yuta Tachibana
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Hiromichi Fujie
- Intelligent Mechanical Systems, Graduate School of System Design, Tokyo Metropolitan University, 6-6, Asahiga-oka, Hino, Tokyo, 191-0065, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
| | - Ken Nakata
- Department of Orthopaedic Surgery, Osaka University Graduate School of Medicine, 2-2, Yamada-oka, Suita, Osaka, 565-0871, Japan
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Mutsuzaki H, Fujie H, Nakajima H, Fukagawa M, Nomura S, Sakane M. Comparison of postoperative biomechanical function between anatomic double-bundle and single-bundle ACL reconstructions using calcium phosphate-hybridized tendon grafts in goats. Orthop Traumatol Surg Res 2017; 103:239-243. [PMID: 28089795 DOI: 10.1016/j.otsr.2016.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/03/2016] [Accepted: 11/24/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND Calcium phosphate (CaP)-hybridized tendon grafts improved biomechanical function compared with untreated grafts after single-bundle (SB) anterior cruciate ligament (ACL) reconstruction. The purpose of this study was to compare the biomechanical function between anatomic double-bundle (DB) and single-bundle (SB) ACL reconstructions using CaP-hybridized tendon grafts at 6 months postoperatively in goats. HYPOTHESIS We hypothesized that the postoperative biomechanical function in the DB group will be better than that in the SB group. MATERIALS AND METHODS Knee kinematics and in situ forces in the grafts under applied anterior tibial load (ATL) of 50N and internal tibial torque (ITT) of 2.0 Nm at full extension, and 60° and 90° of knee flexion, and the histology of the tendon-bone interface were compared between the DB group (n=6) and SB group (n=6). RESULTS The in situ forces under ATL in the DB group at full extension and 90°of knee flexion were greater than those in the SB group. The in situ forces under ITT in the DB group at full extension and 60°of knee flexion were greater than those in the SB group. The in situ forces on the posterolateral bundle of the grafts under ATL and ITT in the DB group at full knee extension were greater than those on the posterior half of the grafts in the SB group. The histology did not differ significantly between the groups. CONCLUSIONS Although CaP-hybridized tendon grafts were used in both groups, the in situ forces under ATL and ITT in the DB group were greater than those in the SB group at 6 months postoperatively. The posterolateral bundle of the grafts in the DB group acted effectively against both ATL and ITT at full extension. The tendon-to-bone healing was similar in both groups. STUDY DESIGN Controlled laboratory study. Level 2.
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Affiliation(s)
- H Mutsuzaki
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami Ami-Machi, Inashiki-gun, Ibaraki 300-0394, Japan.
| | - H Fujie
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
| | - H Nakajima
- Department of Agriculture, Ibaraki University, 3-21-1 Chuuou, Ami, Ibaraki 300-0393, Japan
| | - M Fukagawa
- Biomechanics Laboratory, Faculty of System Design, Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
| | - S Nomura
- Department of Agriculture, Ibaraki University, 3-21-1 Chuuou, Ami, Ibaraki 300-0393, Japan
| | - M Sakane
- Department of Rehabilitation Medicine, Tsukuba Gakuen Hospital, 2573-1 Kamiyokoba, Tsukuba, Ibaraki 305-0854, Japan
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The effect of anterior cruciate ligament graft rotation on knee biomechanics. Knee Surg Sports Traumatol Arthrosc 2017; 25:1093-1100. [PMID: 27858117 DOI: 10.1007/s00167-016-4381-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 11/09/2016] [Indexed: 01/13/2023]
Abstract
PURPOSE The purpose of this study was to evaluate the effects on knee biomechanics of rotating the distal end of the bone-patellar tendon graft 90° in anatomic single-bundle (SB) anterior cruciate ligament (ACL) reconstruction with a porcine model. METHODS Twenty (n = 20) porcine knees were evaluated using a robotic testing system. Two groups and three knee states were compared: (1) intact ACL, (2) deficient ACL and (3) anatomic SB ACL reconstruction with (a) non-rotated graft or (b) rotated graft (anatomic external fibre rotation). Anterior tibial translation (ATT), internal (IR) and external rotation (ER) and the in situ tissue force were measured under an 89-N anterior tibial (AT) load and 4-N m internal and external tibial torques. RESULTS A significant difference from the intact ACL was found in ATT at 60° and 90° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There was a significant difference in the in situ force from the intact ACL with AT loading for rotated and non-rotated graft reconstructions at 60° and 90° of knee flexion (p < 0.05). Under IR loading, the in situ force was significantly different from the intact ACL at 30° and 60° of knee flexion for rotated and non-rotated graft reconstructions (p < 0.05). There were no significant differences in ATT, IR, ER and the in situ force between rotated and non-rotated reconstructions. CONCLUSION Graft rotation can be used with anatomic SB ACL reconstruction and not have a deleterious effect on knee anterior and rotational biomechanics. This study has clinical relevance in regard to the use of graft rotation to better reproduce the native ACL fibre orientation in ACL reconstruction.
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