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Foody JN, Li GK, Bradley PX, Kuehn SJ, Spritzer CE, Kosinski AS, Wittstein JR, DeFrate LE. A comparison of three methods for establishing an ACL reference length in vivo. J Biomech 2024; 176:112337. [PMID: 39368320 DOI: 10.1016/j.jbiomech.2024.112337] [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: 05/06/2024] [Revised: 08/27/2024] [Accepted: 09/19/2024] [Indexed: 10/07/2024]
Abstract
As anterior cruciate ligament (ACL) injuries are highly prevalent among active individuals, it is vital to better understand the loading conditions which lead to injury. One method for doing so is through measurement of dynamic, in vivo ACL strain. To measure strain, it is necessary to normalize elongation of the ACL to a 'reference length' which corresponds to the point at which the ligament transitions from being unloaded to carrying tension. The purpose of this study was to compare the length of the ACL in three different positions to evaluate their utility for establishing a reference (or zero-strain) length of the ACL. ACL reference length was determined using three different methods for each of ten healthy participants. Using magnetic resonance and biplanar radiographic imaging techniques, we measured the length of the ACL during supine resting, quiet standing, and anterior/posterior (AP) drawer testing. During the AP drawer testing, the slack-taut transition point was defined as the inflection point of the AP translation vs ACL elongation curve. There was good consistency between the three ACL length measurements (ICC=0.80). Differences in mean ACL length between the three methods were within 1 mm. While determining the precise zero-strain length of the ACL in vivo remains a challenge, the reference positions utilized in this study produce consistent measurements of ACL length. These findings are important because reliable measurements of in vivo ACL strain have the potential to serve as indicators of propensity for injury.
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Affiliation(s)
- Jacqueline N Foody
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Grace K Li
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Patrick X Bradley
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
| | - Sally J Kuehn
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Andrzej S Kosinski
- Department of Biostatistics & Bioinformatics, Duke University School of Medicine, Durham, NC, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, NC, USA; Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA; Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA.
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Dan MJ, Wills DJ, Crowley JD, Cance N, Romandini I, Walsh WR, Dejour DH. Anterior cruciate ligament zoobiquity: Can man's best friend tell us we are being too cautious with the implementation of osteotomy to correct posterior tibial slope. Knee Surg Sports Traumatol Arthrosc 2024; 32:1071-1076. [PMID: 38509848 DOI: 10.1002/ksa.12109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 02/08/2024] [Accepted: 02/13/2024] [Indexed: 03/22/2024]
Abstract
Anterior cruciate ligament (ACL) reconstruction (ACLR) is used to treat clinical instability post ACL rupture, however, there is a high rate of incomplete return to sport and rerupture. There is increasing interest in posterior tibial slope as an intrinsic risk factor for ACLR failure and persistent instability. Zoobiquity describes the collaboration between the human and veterinary professions in order to advance the scientific understanding of both fields. Given the cranial cruciate ligament (CCL) in dogs is synonymous with the anterior cruciate ligament in humans, functioning to control internal rotation and anterior translation, but osteotomies, rather than ligament reconstruction, are the mainstay of treatment for CCL rupture, this editorial sort to gain insights into this form of treatment from the veterinary world. Level of Evidence: Level V, evidence.
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Affiliation(s)
- Michael J Dan
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
- East Coast Athletic Orthopaedics, Merewether, New South Wales, Australia
| | - Daniel J Wills
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
- Coast OrthoVet-Veterinary Orthopaedic Referral Services, Sydney, New South Wales, Australia
| | - James D Crowley
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - Nicolas Cance
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
| | | | - William R Walsh
- Surgical and Orthopaedic Research Laboratories (SORL), University of New South Wales (UNSW), Sydney, New South Wales, Australia
| | - David H Dejour
- Department of Knee Surgery, Lyon Ortho Clinic, Lyon, France
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Jin X, Wu X, Xu W, She C, Li L, Mao Y. Gender differences in the impact of anatomical factors on non-contact anterior cruciate ligament injuries: a magnetic resonance study. BMC Musculoskelet Disord 2024; 25:264. [PMID: 38575985 PMCID: PMC10996128 DOI: 10.1186/s12891-024-07390-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 03/27/2024] [Indexed: 04/06/2024] Open
Abstract
PURPOSE To identify MRI-detected anatomical risk factors for non-contact anterior cruciate ligament (ACL) injuries across genders. METHODS A retrospective analysis was performed on 141 ACL-reconstructed patients (35 females, 106 males) and 142 controls (37 females, 105 males) from January 2020 to April 2022. Inclusion criteria were primary non-contact ACL injuries. The tibial plateau slope, lateral femoral condyle index, Insall-Salvati index, and patellar tendon angle were measured, using binary logistic regression for gender-specific risk evaluation. RESULTS Increased lateral tibial plateau slope, reduced intercondylar notch width index, lateral femoral condyle index, and patellar tendon angle correlated with ACL injuries in both genders. The Insall-Salvati index was a significant risk factor in females but not in males. CONCLUSION This study identifies the lateral tibial plateau slope, notch width index, lateral femoral condyle index, and patellar tendon angle at near-extension as risk factors for ACL injuries in both genders, with the Insall-Salvati index also implicated in females.
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Affiliation(s)
- Xixin Jin
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Xujin Wu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Wei Xu
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Chang She
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Liubing Li
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China
| | - Yongtao Mao
- Department of Orthopedics, The Second Affiliated Hospital, Soochow University, 1055 Sanxiang Road, Suzhou, Jiangsu, 215004, P.R. China.
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Cance N, Dan MJ, Pineda T, Romandini I, Demey G, Dejour DH. Patellar tendon angle is not elevated in ACL-injured subjects, suggesting methods to correct should focus on prehabilitation and rehabilitation rather than surgery. J Exp Orthop 2024; 11:e12005. [PMID: 38455458 PMCID: PMC10866081 DOI: 10.1002/jeo2.12005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/12/2024] [Indexed: 03/09/2024] Open
Abstract
Purpose The aim of the study was to explore if the patellar tendon angles (PTAs) is an intrinsic risk factor for anterior cruciate ligament (ACL) rupture. We hypothesised that the PTAs will be increased in ACL rupture patients compared to matched controls. Methods We performed a retrospective radiographic cohort study. A cohort of ACL-injured patients between 2019 and 2022 was utilised. The control population, from the same time period, was a consecutive series of 100 patients without ligament or meniscal injuries which were prospectively added to our institutional registry. Posterior tibial slope (PTS), static anterior tibial translation (SATT), patellar tendon to tibial plateau angle (PT-TPA), patellar tendon-tibial shaft angle (PT-TSA) were measured. Results A total of 100 patients were included in the control cohort and 110 in the ACL cohort. The PT-TPA was significantly less in the ACL cohort compared to the control cohort, mean and SD of 15.33 (±5.74) versus 13.91 (±5.68), respectively (p = 0.01). PT-TSA was also less in the ACL cohort, mean and SD of 116.15 (±5.89) versus 114.27 (±4.81), however, this failed to reach statistical significance (p = 0.08). The PT-TPA was not correlated with PTS (p = 0.65) and the PT-TSA was inversely correlated with PTS; Pearson correlation coefficient of -0.28 (p < 0.01). The PT-TSA had a greater correlation -0.4 (p < 0.01) with SATT than PTS 0.37 (p < 0.01). Conclusion PTAs are not elevated in ACL-injured subjects. While anteriorisation of the tibial tubercle is utilised in dogs to decrease the anterior thrust resulting from the anteriorly directed vector of the quadriceps, this treatment in the humans is not warranted and methods to reduce the PTAs should focus on prehabilitation and rehabilitation. Level of Evidence Level III.
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Affiliation(s)
- Nicolas Cance
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
| | - Michael J. Dan
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
- Surgical and Orthopaedic Research LaboratoryPrince of Wales Clinical School University of New South WalesSydneyNew South WalesAustralia
| | - Tomas Pineda
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
- Surgical and Orthopaedic Research LaboratoryPrince of Wales Clinical School University of New South WalesSydneyNew South WalesAustralia
- Hospital el CarmenSantiagoChile
| | - Iacopo Romandini
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
| | - Guillaume Demey
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
| | - David H. Dejour
- Orthopedic Surgery Department, Lyon Ortho ClinicClinique de la SauvegardeLyonFrance
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Sadeqi S, Norte GE, Murray A, Erbulut DU, Goel VK. Effect of Whole Body Parameters on Knee Joint Biomechanics: Implications for ACL Injury Prevention During Single-Leg Landings. Am J Sports Med 2023; 51:2098-2109. [PMID: 37259968 DOI: 10.1177/03635465231174899] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
BACKGROUND Previous studies have examined the effect of whole body (WB) parameters on anterior cruciate ligament (ACL) strain and loads, as well as knee joint kinetics and kinematics. However, articular cartilage damage occurs in relation to ACL failure, and the effect of WB parameters on ACL strain and articular cartilage biomechanics during dynamic tasks is unclear. PURPOSES (1) To investigate the effect of WB parameters on ACL strain, as well as articular cartilage stress and contact force, during a single-leg cross drop (SLCD) and single-leg drop (SLD). (2) To identify WB parameters predictive of high ACL strain during these tasks. STUDY DESIGN Descriptive laboratory study. METHODS Three-dimensional motion analysis data from 14 physically active men and women were recorded during an SLCD and SLD. OpenSim was used to obtain their kinematics, kinetics, and muscle forces for the WB model. Using these data in kinetically driven finite element simulations of the knee joint produced outputs of ACL strains and articular cartilage stresses and contact forces. Spearman correlation coefficients were used to assess relationships between WB parameters and ACL strain and cartilage biomechanics. Moreover, receiver operating characteristic curve analyses and multivariate binary logistic regressions were used to find the WB parameters that could discriminate high from low ACL strain trials. RESULTS Correlations showed that more lumbar rotation away from the stance limb at peak ACL strain had the strongest overall association (ρ = 0.877) with peak ACL strain. Higher knee anterior shear force (ρ = 0.895) and lower gluteus maximus muscle force (ρ = 0.89) at peak ACL strain demonstrated the strongest associations with peak articular cartilage stress or contact force in ≥1 of the analyzed tasks. The regression model that used muscle forces to predict high ACL strain trials during the dominant limb SLD yielded the highest accuracy (93.5%), sensitivity (0.881), and specificity (0.952) among all regression models. CONCLUSION WB parameters that were most consistently associated with and predictive of high ACL strain and poor articular cartilage biomechanics during the SLCD and SLD tasks included greater knee abduction angle at initial contact and higher anterior shear force at peak ACL strain, as well as lower gracilis, gluteus maximus, and medial gastrocnemius muscle forces. CLINICAL RELEVANCE Knowledge of which landing postures create a high risk for ACL or cartilage injury may help reduce injuries in athletes by avoiding those postures and practicing the tasks with reduced high-risk motions, as well as by strengthening the muscles that protect the knee during single-leg landings.
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Affiliation(s)
- Sara Sadeqi
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Grant E Norte
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Amanda Murray
- Motion Analysis and Integrative Neurophysiology Lab, Department of Exercise and Rehabilitation Sciences, College of Health and Human Services, University of Toledo, Toledo, Ohio, USA
| | - Deniz U Erbulut
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
| | - Vijay K Goel
- Engineering Center for Orthopaedic Research Excellence (E-CORE), Departments of Bioengineering and Orthopaedic Surgery, University of Toledo, Toledo, OH, USA
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI: Response. Am J Sports Med 2023; 51:NP22-NP24. [PMID: 37392078 DOI: 10.1177/03635465231172184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
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Kneifel P, Moewis P, Damm P, Schütz P, Dymke J, Taylor WR, Duda GN, Trepczynski A. Patellar tendon elastic properties derived from in vivo loading and kinematics. J Biomech 2023; 151:111549. [PMID: 36948000 DOI: 10.1016/j.jbiomech.2023.111549] [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: 07/07/2022] [Revised: 02/03/2023] [Accepted: 03/13/2023] [Indexed: 03/18/2023]
Abstract
Patellar complications frequently limit the success of total knee arthroplasty. In addition to the musculoskeletal forces themselves, patellar tendon elastic properties are essential for driving patellar loading. Elastic properties reported in the literature exhibit high variability and appear to differ according to the methodologies used. Specifically in total knee arthroplasty patients, only limited knowledge exists on in vivo elastic properties and their corresponding loads. For the first time, we report stiffness, Young's modulus, and forces of the patellar tendon, derived from four patients with telemetric total knee arthroplasties using a combined imaging and measurement approach. To achieve this, synchronous in vivo telemetric assessment of tibio-femoral contact forces and fluoroscopic assessment of knee kinematics, along with full body motion capture and ground reaction forces, fed musculoskeletal multi-body models to quantify patellar tendon loading and elongation. Mechanical patellar tendon properties were calculated during a squat and a sit-stand-sit activity, with resulting tendon stiffness and Young's modulus ranging from 511 to 1166 N/mm and 259 to 504 MPa, respectively. During these activities, the patellar tendon force reached peak values between 1.31 and 2.79 bodyweight, reaching levels of just ∼0.5 bodyweight below the tibio-femoral forces. The results of this study provide valuable input data for mechanical simulations of the patellar tendon and the whole resurfaced knee.
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Affiliation(s)
- Paul Kneifel
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany.
| | - Philippe Moewis
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Philipp Damm
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Pascal Schütz
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Jörn Dymke
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - William R Taylor
- Laboratory for Movement Biomechanics, ETH Zürich, Zürich, Switzerland
| | - Georg N Duda
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
| | - Adam Trepczynski
- Berlin Institute of Health at Charité - Universitätsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
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Prelanding Knee Kinematics and Landing Kinetics During Single-Leg and Double-Leg Landings in Male and Female Recreational Athletes. J Appl Biomech 2023; 39:34-41. [PMID: 36649716 DOI: 10.1123/jab.2022-0147] [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: 06/02/2022] [Revised: 11/23/2022] [Accepted: 11/29/2022] [Indexed: 01/19/2023]
Abstract
Biomechanical behavior prior to landing likely contributes to anterior cruciate ligament (ACL) injuries during jump-landing tasks. This study examined prelanding knee kinematics and landing ground reaction forces (GRFs) during single-leg and double-leg landings in males and females. Participants performed landings with the dominant leg or both legs while kinematic and GRF data were collected. Single-leg landings demonstrated less time between prelanding minimal knee flexion and initial ground contact, decreased prelanding and early-landing knee flexion angles and velocities, and increased peak vertical and posterior GRFs compared with double-leg landings. Increased prelanding knee flexion velocities and knee flexion excursion correlated with decreased peak posterior GRFs during both double-leg and single-leg landings. No significant differences were observed between males and females. Prelanding knee kinematics may contribute to the increased risk of ACL injuries in single-leg landings compared with double-leg landings. Future studies are encouraged to incorporate prelanding knee mechanics to understand ACL injury mechanisms and predict future ACL injury risks. Studies of the feasibility of increasing prelanding knee flexion are needed to understand the potential role of prelanding kinematics in decreasing ACL injury risk.
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Foody JN, Bradley PX, Spritzer CE, Wittstein JR, DeFrate LE, Englander ZA. Elevated In Vivo ACL Strain Is Associated With a Straight Knee in Both the Sagittal and the Coronal Planes. Am J Sports Med 2023; 51:422-428. [PMID: 36625427 DOI: 10.1177/03635465221141876] [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] [Indexed: 01/11/2023]
Abstract
BACKGROUND Noncontact anterior cruciate ligament (ACL) injuries typically occur during deceleration movements such as landing or cutting. However, conflicting data have left the kinematic mechanisms leading to these injuries unclear. Quantifying the influence of sagittal and coronal plane knee kinematics on in vivo ACL strain may help to elucidate noncontact ACL injury mechanisms. PURPOSE/HYPOTHESIS The purpose of this study was to measure in vivo sagittal and coronal plane knee kinematics and ACL strain during a single-leg jump. We hypothesized that ACL strain would be modulated primarily by motion in the sagittal plane and that limited coronal plane motion would be measured during this activity. STUDY DESIGN Descriptive laboratory study. METHODS Seventeen healthy participants (8 male/9 female) underwent magnetic resonance imaging (MRI) followed by high-speed biplanar radiography, obtained as participants performed a single-leg jump. Three-dimensional models of the femur, tibia, and associated ACL attachment site footprints were created from the MRIs and registered to the radiographs to reproduce the position of the knee during the jump. ACL strain, knee flexion/extension angles, and varus/valgus angles were measured throughout the jump. Spearman rank correlations were used to assess relationships between mean ACL strain and kinematic variables. RESULTS Mean ACL strain increased with decreasing knee flexion angle (ρ = -0.3; P = .002), and local maxima in ACL strain occurred with the knee in a straight position in both the sagittal and the coronal planes. In addition, limited coronal plane motion (varus/valgus angle) was measured during this activity (mean ± SD, -0.5°± 0.3°). Furthermore, we did not detect a statistically significant relationship between ACL strain and varus/valgus angle (ρ = -0.01; P = .9). CONCLUSION ACL strain was maximized when the knee was in a straight position in both the sagittal and coronal planes. Participants remained in <1° of varus/valgus position on average throughout the jump. As a ligament under elevated strain is more vulnerable to injury, landing on a straight knee may be an important risk factor for ACL rupture. CLINICAL RELEVANCE These data may improve understanding of risk factors for noncontact ACL injury, which may be useful in designing ACL injury prevention programs.
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Affiliation(s)
- Jacqueline N Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Patrick X Bradley
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | | | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
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Kim-Wang SY, Spritzer CE, Owusu-Akyaw K, Coppock JA, Goode AP, Englander ZA, Wittstein JR, DeFrate LE. The Predicted Position of the Knee Near the Time of ACL Rupture Is Similar Between 2 Commonly Observed Patterns of Bone Bruising on MRI. Am J Sports Med 2023; 51:58-65. [PMID: 36440714 DOI: 10.1177/03635465221131551] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Bone bruises observed on magnetic resonance imaging (MRI) can provide insight into the mechanisms of noncontact anterior cruciate ligament (ACL) injury. However, it remains unclear whether the position of the knee near the time of injury differs between patients evaluated with different patterns of bone bruising, particularly with regard to valgus angles. HYPOTHESIS The position of the knee near the time of injury is similar between patients evaluated with 2 commonly occurring patterns of bone bruising. STUDY DESIGN Descriptive laboratory study. METHODS Clinical T2- and T1-weighted MRI scans obtained within 6 weeks of noncontact ACL rupture were reviewed. Patients had either 3 (n = 20) or 4 (n = 30) bone bruises. Patients in the 4-bone bruise group had bruising of the medial and lateral compartments of the femur and tibia, whereas patients in the 3-bone bruise group did not have a bruise on the medial femoral condyle. The outer contours of the bones and associated bruises were segmented from the MRI scans and used to create 3-dimensional surface models. For each patient, the position of the knee near the time of injury was predicted by moving the tibial model relative to the femoral model to maximize the overlap of the tibiofemoral bone bruises. Logistic regressions (adjusted for sex, age, and presence of medial collateral ligament injury) were used to assess relationships between predicted injury position (quantified in terms of knee flexion angle, valgus angle, internal rotation angle, and anterior tibial translation) and bone bruise group. RESULTS The predicted injury position for patients in both groups involved a flexion angle <20°, anterior translation >20 mm, valgus angle <10°, and internal rotation angle <10°. The injury position for the 3-bone bruise group involved less flexion (odds ratio [OR], 0.914; 95% CI, 0.846-0.987; P = .02) and internal rotation (OR, 0.832; 95% CI, 0.739-0.937; P = .002) as compared with patients with 4 bone bruises. CONCLUSION The predicted position of injury for patients displaying both 3 and 4 bone bruises involved substantial anterior tibial translation (>20 mm), with the knee in a straight position in both the sagittal (<20°) and the coronal (<10°) planes. CLINICAL RELEVANCE Landing on a straight knee with subsequent anterior tibial translation is a potential mechanism of noncontact ACL injury.
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Affiliation(s)
- Sophia Y Kim-Wang
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kwadwo Owusu-Akyaw
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - James A Coppock
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Adam P Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | - Zoë A Englander
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Jocelyn R Wittstein
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA
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11
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Hu Z, Kim Y, Zhang Y, Zhang Y, Li J, Tang X, Sohn J, Kim S. Correlation of Lower Limb Muscle Activity with Knee Joint Kinematics and Kinetics during Badminton Landing Tasks. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192416587. [PMID: 36554467 PMCID: PMC9778979 DOI: 10.3390/ijerph192416587] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 11/30/2022] [Accepted: 12/06/2022] [Indexed: 05/27/2023]
Abstract
A study on a single-leg landing task after an overhead stroke in badminton suggests that poor knee biomechanical indicators may be a risk factor for anterior cruciate ligament (ACL) injury. A preventive program targeting neuromuscular control strategies is said to alter the biomechanics of the knee joint and have a beneficial effect on reducing ACL injury. However, the relationship between muscle activity around the knee joint and knee biomechanical risk factors in the badminton landing task is unclear. The purpose of this study was to investigate the relationship between this movement pattern of muscle activity and knee kinematics and kinetics. This experiment analyzed knee muscle activity and biomechanical information in a sample of 34 badminton players (17 male, 17 female) during a badminton landing task. We assessed the relationship between the rectus femoris (RF), medial hamstring (MHAM), lateral hamstring (LHAM), medial gastrocnemius (MGAS), lateral gastrocnemius (LGAS), medial and lateral hamstring to quadriceps co-contraction ratio (MH/Q and LH/Q) with the knee flexion angle, valgus angle, extension moment, valgus moment, and proximal tibial anterior shear force. A moderate negative correlation was found between the peak knee flexion angle and electromyography (EMG) activity in LGAS (r = 0.47, p = 0.0046, R2 = 0.23, 95% CI: 0.16 to 0.70). Peak proximal tibial shear force showed strong and positive correlations with RF EMG activity (r = 0.52, p = 0.0016, R2 = 0.27, 95% CI: 0.22 to 0.73) and strong and negative correlations with MH/Q (r = 0.50, p = 0.0023, R2 = 0.25, 95% CI: 0.20 to 0.72). The knee extension moment showed moderate and positive correlations with RF EMG activity (r = 0.48, p = 0.0042, R2 = 0.23, 95% CI: 0.17 to 0.70) and strong and negative correlations with MH/Q (r = 0.57, p = 0.0004, R2 = 0.33, 95% CI: 0.29 to 0.76). The peak knee valgus moment showed strong and positive correlations with LH/Q (r = 0.55, p = 0.0007, R2 = 0.31, 95% CI: 0.26 to 0.75). Our findings suggest that there is a correlation between lower extremity muscle activity and knee kinematics and kinetics during the single-leg landing task in badminton; therefore, lower extremity muscle activity should be considered when developing rehabilitation or injury prevention programs.
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Affiliation(s)
- Zhe Hu
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Youngsuk Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Yanan Zhang
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Yuxi Zhang
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Jiaying Li
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Xuan Tang
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
| | - Jeehoon Sohn
- Department of Physical Education, Jeonju University, Jeonju 55069, Republic of Korea
| | - Sukwon Kim
- Department of Physical Education, Jeonbuk National University, Jeonju 54896, Republic of Korea
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Englander ZA, Foody JN, Cutcliffe HC, Wittstein JR, Spritzer CE, DeFrate LE. Use of a Novel Multimodal Imaging Technique to Model In Vivo Quadriceps Force and ACL Strain During Dynamic Activity. Am J Sports Med 2022; 50:2688-2697. [PMID: 35853157 PMCID: PMC9875882 DOI: 10.1177/03635465221107085] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Quadriceps loading of the anterior cruciate ligament (ACL) may play a role in the noncontact mechanism of ACL injury. Musculoskeletal modeling techniques are used to estimate the intrinsic force of the quadriceps acting at the knee joint. PURPOSE/HYPOTHESIS The purpose of this paper was to develop a novel musculoskeletal model of in vivo quadriceps force during dynamic activity. We used the model to estimate quadriceps force in relation to ACL strain during a single-leg jump. We hypothesized that quadriceps loading of the ACL would reach a local maximum before initial ground contact with the knee positioned in extension. STUDY DESIGN Descriptive laboratory study. METHODS Six male participants underwent magnetic resonance imaging in addition to high-speed biplanar radiography during a single-leg jump. Three-dimensional models of the knee joint, including the femur, tibia, patellofemoral cartilage surfaces, and attachment-site footprints of the patellar tendon, quadriceps tendon, and ACL, were created from the magnetic resonance imaging scans. The bone models were registered to the biplanar radiographs, thereby reproducing the positions of the knee joint at the time of radiographic imaging. The magnitude of quadriceps force was determined for each knee position based on a 3-dimensional balance of the forces and moments of the patellar tendon and the patellofemoral cartilage contact acting on the patella. Knee kinematics and ACL strain were determined for each knee position. RESULTS A local maximum in average quadriceps force of approximately 6500 N (8.4× body weight) occurred before initial ground contact. ACL strain increased concurrently with quadriceps force when the knee was positioned in extension. CONCLUSION This novel participant-specific modeling technique provides estimates of in vivo quadriceps force during physiologic dynamic loading. A local maximum in quadriceps force before initial ground contact may tension the ACL when the knee is positioned in extension. CLINICAL RELEVANCE These data contribute to understanding noncontact ACL injury mechanisms and the potential role of quadriceps activation in these injuries.
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Affiliation(s)
- Zoë A. Englander
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA
| | - Jacqueline N. Foody
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | - Hattie C. Cutcliffe
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA
| | | | | | - Louis E. DeFrate
- Department of Biomedical Engineering, Duke University, Durham, North Carolina, USA.,Department of Orthopaedic Surgery, Duke University, Durham, North Carolina, USA.,Department of Mechanical Engineering and Materials Science, Duke University, Durham, North Carolina, USA.,Address correspondence to Louis E. DeFrate, ScD, Duke University Medical Center, Room 379, Medical Sciences Research Bldg, Box 3093, Durham, NC 27710, USA ()
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13
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Heckelman LN, Soher BJ, Spritzer CE, Lewis BD, DeFrate LE. Design and validation of a semi-automatic bone segmentation algorithm from MRI to improve research efficiency. Sci Rep 2022; 12:7825. [PMID: 35551485 PMCID: PMC9098419 DOI: 10.1038/s41598-022-11785-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 04/22/2022] [Indexed: 11/24/2022] Open
Abstract
Segmentation of medical images into different tissue types is essential for many advancements in orthopaedic research; however, manual segmentation techniques can be time- and cost-prohibitive. The purpose of this work was to develop a semi-automatic segmentation algorithm that leverages gradients in spatial intensity to isolate the patella bone from magnetic resonance (MR) images of the knee that does not require a training set. The developed algorithm was validated in a sample of four human participants (in vivo) and three porcine stifle joints (ex vivo) using both magnetic resonance imaging (MRI) and computed tomography (CT). We assessed the repeatability (expressed as mean ± standard deviation) of the semi-automatic segmentation technique on: (1) the same MRI scan twice (Dice similarity coefficient = 0.988 ± 0.002; surface distance = - 0.01 ± 0.001 mm), (2) the scan/re-scan repeatability of the segmentation technique (surface distance = - 0.02 ± 0.03 mm), (3) how the semi-automatic segmentation technique compared to manual MRI segmentation (surface distance = - 0.02 ± 0.08 mm), and (4) how the semi-automatic segmentation technique compared when applied to both MRI and CT images of the same specimens (surface distance = - 0.02 ± 0.06 mm). Mean surface distances perpendicular to the cartilage surface were computed between pairs of patellar bone models. Critically, the semi-automatic segmentation algorithm developed in this work reduced segmentation time by approximately 75%. This method is promising for improving research throughput and potentially for use in generating training data for deep learning algorithms.
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Affiliation(s)
- Lauren N Heckelman
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA
| | - Brian J Soher
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Charles E Spritzer
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Brian D Lewis
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA
| | - Louis E DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, DUMC Box 3093, Durham, NC, 27710, USA.
- Department of Biomedical Engineering, Pratt School of Engineering, Duke University, Durham, NC, USA.
- Department of Mechanical Engineering & Materials Science, Pratt School of Engineering, Duke University, Durham, NC, USA.
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