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Yang Y, Wang Y, Zheng N, Cheng R, Zou D, Zhao J, Tsai TY. Development and Validation of a Novel In Vitro Joint Testing System for Reproduction of In Vivo Dynamic Muscle Force. Bioengineering (Basel) 2023; 10:1006. [PMID: 37760108 PMCID: PMC10525521 DOI: 10.3390/bioengineering10091006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
In vitro biomechanical experiments utilizing cadaveric specimens are one of the most effective methods for rehearsing surgical procedures, testing implants, and guiding postoperative rehabilitation. Applying dynamic physiological muscle force to the specimens is a challenge to reconstructing the environment of bionic mechanics in vivo, which is often ignored in the in vitro experiment. The current work aims to establish a hardware platform and numerical computation methods to reproduce dynamic muscle forces that can be applied to mechanical testing on in vitro specimens. Dynamic muscle loading is simulated through numerical computation, and the inputs of the platform will be derived. Then, the accuracy and robustness of the platform will be evaluated through actual muscle loading tests in vitro. The tests were run on three muscles (gastrocnemius lateralis, the rectus femoris, and the semitendinosus) around the knee joint and the results showed that the platform can accurately reproduce the magnitude of muscle strength (errors range from -6.2% to 1.81%) and changing pattern (goodness-of-fit range coefficient ranges from 0.00 to 0.06) of target muscle forces. The robustness of the platform is mainly manifested in that the platform can still accurately reproduce muscle force after changing the hardware combination. Additionally, the standard deviation of repeated test results is very small (standard ranges of hardware combination 1: 0.34 N~2.79 N vs. hardware combination 2: 0.68 N~2.93 N). Thus, the platform can stably and accurately reproduce muscle forces in vitro, and it has great potential to be applied in the future musculoskeletal loading system.
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Affiliation(s)
- Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Yufan Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Jie Zhao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Salvatore G, Berton A, Orsi A, Egan J, Walley KC, Johns WL, Kheir N, Ramappa AJ, DeAngelis JP, Longo UG, Denaro V, Nazarian A. Lateral Release With Tibial Tuberosity Transfer Alters Patellofemoral Biomechanics Promoting Multidirectional Patellar Instability. Arthroscopy 2022; 38:953-964. [PMID: 34411682 DOI: 10.1016/j.arthro.2021.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/29/2021] [Accepted: 08/03/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to develop and validate a finite element (FE) model of the patellofemoral (PF) joint to characterize patellofemoral instability, and to highlight the effect of lateral retinacular release in combination with tibial tuberosity transfer with respect to contact pressures (CP), contact area (CA), and kinematics during knee flexion. METHODS A comprehensive, dynamic FE model of the knee joint was developed and validated through parametric comparison of PF kinematics, CP, and CA between FE simulations and in vitro, cadaveric experiments. Using this FE model, we characterized the effect of patellar instability, lateral retinacular release (LR), and tibial tuberosity transfer (TTT) in the setting of medial patellofemoral ligament injury during knee flexion. RESULTS There was a high level of agreement in CP, CA, lateral patellar displacement, anterior patellar displacement, and superior patellar displacement between the FE model and the in vitro data (P values 0.19, 0.16, 0.81, 0.10, and 0.36, respectively). Instability conditions demonstrated the greatest CP compared to all of the other conditions. During all degrees of flexion, TTT and concomitant lateral release (TTT + LR) decreased CP significantly. TTT alone shows a consistently lower CA compared to nonrelease conditions with subsequent lateral release further decreasing CA. CONCLUSIONS The results of this study demonstrate that the FE model described reliably simulates PF kinematics and CP within 1 SD in uncomplicated cadaveric specimens. The FE model is able to show that tibial tubercle transfer in combination with lateral retinacular release markedly decreases patellofemoral CP and CA and increases lateral patellar displacement that may decrease bony stabilization of the patella within the trochlear groove and promote lateral patellar instability. CLINICAL RELEVANCE The goal of surgical correction for patellar instability focuses on reestablishing normal PF kinematics. By developing an FE model that can demonstrate patient PF kinematics and the results of different surgical approaches, surgeons may tailor their treatment to the best possible outcome. Of the surgical approaches that have been described, the biomechanical effects of the combination of TTT with lateral retinacular release have not been studied. Thus, the FE analysis will help shed light on the effect of the combination of TTT with lateral retinacular release on PF kinematics.
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Affiliation(s)
- Giuseppe Salvatore
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Alessandra Berton
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | | | - Jonathan Egan
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Kempland C Walley
- Department of Orthopaedic Surgery, University of Michigan
- Michigan Medicine, Ann Arbor, Michigan, U.S.A
| | - William L Johns
- Rothman Orthopaedic Institute, Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania, U.S.A
| | - Nadim Kheir
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Arun J Ramappa
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Joseph P DeAngelis
- Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Umile Giuseppe Longo
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Vincenzo Denaro
- Department of Orthopaedic and Trauma Surgery, Campus Bio-Medico University, Rome, Italy
| | - Ara Nazarian
- Musculoskeletal Translational Innovation Initiative, Carl J. Shapiro Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, U.S.A.; Department of Orthopaedic Surgery, Yerevan State Medical University, Yerevan, Armenia.
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Lee JH, Choi HS. Effects of balance taping using kinesiology tape in a female with patellofemoral pain syndrome: A case report. J Back Musculoskelet Rehabil 2020; 32:829-832. [PMID: 31771039 DOI: 10.3233/bmr-171004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Patellofemoral pain syndrome (PFPS) is one of the most common knee disorders affecting women. OBJECTIVE The purpose of this study was to investigate the effects of balance taping on PFPS. METHODS Balance taping using kinesiology tape was applied for 2.5 months (average of 16 h/day) to both knees in a 26-year-old female nurse with bilateral PFPS. RESULTS The congruence angle decreased in the right and left knees from 30∘ to 5∘ and from 20∘ to 5∘, respectively. The Patient Specific Functional Scale score increased from 17/50 to 50/50, indicating improved functional state of the knees, while the Numeric Pain Rating Scale scores for from sitting to standing, from standing to sitting, and kneeling improved from 6/10 and 0/10, indicating no pain in the knee joints. Application of repeated balance taping for 2.5 months reduced PFPS. CONCLUSION Considering the outcome of the study, we recommend balance taping as a complementary treatment method for PFPS.
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Affiliation(s)
- Jung-Hoon Lee
- Department of Physical Therapy, College of Nursing and Healthcare Sciences and Human Ecology, Dong-Eui University, Busan, Korea
| | - Hyun-Su Choi
- Department of Biomedical Health Science, Graduate School, Dong-Eui University, Busan, Korea
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Rezvanifar SC, Flesher BL, Jones KC, Elias JJ. Lateral patellar maltracking due to trochlear dysplasia: A computational study. Knee 2019; 26:1234-1242. [PMID: 31786000 PMCID: PMC6926151 DOI: 10.1016/j.knee.2019.11.006] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 11/01/2019] [Accepted: 11/11/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The study focuses on the influence of trochlear dysplasia on patellar tracking related to patellar instability. METHODS Knee extension against gravity and dual-limb squatting were simulated with seven models representing knees being treated for recurrent instability. Trochlear depth was altered to represent lateral trochlear inclination (LTI) values of 6°, 12° and 24°. Repeated measures analyses compared patellar lateral shift (bisect offset index) across different LTI values. Peak bisect offset index during extension and squatting was correlated with patella alta (Caton-Deschamps index) and maximum lateral position of the tibial tuberosity. RESULTS Bisect offset index varied significantly (p < 0.05) between different LTI values at multiple flexion angles throughout simulated knee extension and squatting. Average bisect offset values were 1.02, 0.95, and 0.86 for LTI = 6°, 12°, and 24°, respectively, at 0° of flexion for knee extension. The strongest correlation occurred between peak bisect offset index and lateral position of the tibial tuberosity for knee squatting with LTI = 6° (r2 = 0.81, p = 0.006). The strength of the correlation decreased as LTI increased. Caton-Deschamps was only significantly correlated with patellar tracking for LTI = 24° during knee squatting. CONCLUSIONS A shallow trochlear groove increases lateral patellar maltracking. A lateral tibial tuberosity in combination with trochlear dysplasia increases lateral patellar tracking and the risk of patellar instability. Patella alta has relatively little influence on patellar tracking in combination with trochlear dysplasia due to the limited articular constraint provided by the trochlear groove.
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Affiliation(s)
- S. Cyrus Rezvanifar
- Department of Biomedical Engineering, The University of Akron, Akron, OH, USA
| | - Brett L. Flesher
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Kerwyn C. Jones
- Department of Orthopedic Surgery, Akron Children’s Hospital, Akron, OH, USA
| | - John J. Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
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Gustafson JA, Elias JJ, Debski RE, Farrokhi S. Development and validation of a kinematically-driven discrete element model of the patellofemoral joint. J Biomech 2019; 88:164-172. [PMID: 31003752 DOI: 10.1016/j.jbiomech.2019.03.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 03/22/2019] [Accepted: 03/26/2019] [Indexed: 12/27/2022]
Abstract
Quantifying the complex loads at the patellofemoral joint (PFJ) is vital to understanding the development of PFJ pain and osteoarthritis. Discrete element analysis (DEA) is a computationally efficient method to estimate cartilage contact stresses with potential application at the PFJ to better understand PFJ mechanics. The current study validated a DEA modeling framework driven by PFJ kinematics to predict experimentally-measured PFJ contact stress distributions. Two cadaveric knee specimens underwent quadriceps muscle [215 N] and joint compression [350 N] forces at ten discrete knee positions representing PFJ positions during early gait while measured PFJ kinematics were used to drive specimen-specific DEA models. DEA-computed contact stress and area were compared to experimentally-measured data. There was good agreement between computed and measured mean and peak stress across the specimens and positions (r = 0.63-0.85). DEA-computed mean stress was within an average of 12% (range: 1-47%) of the experimentally-measured mean stress while DEA-computed peak stress was within an average of 22% (range: 1-40%). Stress magnitudes were within the ranges measured (0.17-1.26 MPa computationally vs 0.12-1.13 MPa experimentally). DEA-computed areas overestimated measured areas (average error = 60%; range: 4-117%) with magnitudes ranging from 139 to 307 mm2 computationally vs 74-194 mm2 experimentally. DEA estimates of the ratio of lateral to medial patellofemoral stress distribution predicted the experimental data well (mean error = 15%) with minimal measurement bias. These results indicate that kinematically-driven DEA models can provide good estimates of relative changes in PFJ contact stress.
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Affiliation(s)
- Jonathan A Gustafson
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL, USA.
| | - John J Elias
- Department of Research, Cleveland Clinic Akron General, Akron, OH, USA
| | - Richard E Debski
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Shawn Farrokhi
- DOD-VA Extremity Trauma and Amputation Center of Excellence, Naval Medical Center San Diego, CA, USA
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Elias JJ, Jones KC, Rezvanifar SC, Gabra JN, Morscher MA, Cosgarea AJ. Dynamic tracking influenced by anatomy following medial patellofemoral ligament reconstruction: Computational simulation. Knee 2018; 25:262-270. [PMID: 29544985 PMCID: PMC5878740 DOI: 10.1016/j.knee.2018.02.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/29/2017] [Accepted: 02/12/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Continued patellar instability can occur following medial patellofemoral ligament (MPFL) reconstruction. Computational simulation of function was used to investigate the influence of the lateral position of the tibial tuberosity, trochlear dysplasia and patella alta on lateral patellar tracking following MPFL reconstruction. METHODS Multibody dynamic simulation models were developed to represent nine knees being treated for recurrent patellar instability. Knee extension against gravity and dual limb squatting were simulated with and without simulated MPFL reconstruction. Graft resting lengths were set to allow 10mm and five millimeters of patellar lateral translation at 30° of knee flexion. The bisect offset index, lateral tibial tuberosity to posterior cruciate ligament tibial attachment (TT-PCL) distance, lateral trochlear inclination, and Caton-Deschamps index were quantified at every five degrees of knee flexion to characterize lateral tracking, lateral position of the tibial tuberosity, trochlear dysplasia, and patella alta, respectively. For the pre-operative and post-operative conditions and each type of motion, bisect offset index was correlated with the anatomical parameters using stepwise multivariate linear regression. RESULTS For both motions, the pre-operative and post-operative bisect offset indices were significantly correlated with lateral trochlear inclination and lateral TT-PCL distance. For both motions, the adjusted r2 decreased with MPFL reconstruction, but was still approximately 0.5 for MPFL reconstruction allowing five millimeters of lateral translation. CONCLUSION MPFL reconstruction decreases but does not eliminate lateral maltracking related to trochlear dysplasia and a lateralized tibial tuberosity. Patients with these pathologies are likely at the highest risk for instability related to maltracking following MPFL reconstruction.
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Affiliation(s)
- John J. Elias
- Department of Research, Cleveland Clinic Akron General, 1 Akron
General Ave, Akron, OH 44307
| | - Kerwyn C. Jones
- Department of Orthopedic Surgery, Akron Children’s Hospital,
214 W Bowery St, Akron, OH 44308
| | - S. Cyrus Rezvanifar
- Department of Biomedical Engineering, The University of Akron,
Akron, OH 44325
| | - Joseph N. Gabra
- Department of Research, Cleveland Clinic Akron General, 1 Akron
General Ave, Akron, OH 44307
| | - Melanie A. Morscher
- Department of Orthopedic Surgery, Akron Children’s Hospital,
214 W Bowery St, Akron, OH 44308
| | - Andrew J. Cosgarea
- Department of Orthopaedic Surgery, Johns Hopkins University, 10753
Falls Rd., Suite 215, Baltimore, MD, USA 21093
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Verstraete MA, Victor J. Possibilities and limitations of novel in-vitro knee simulator. J Biomech 2015; 48:3377-82. [DOI: 10.1016/j.jbiomech.2015.06.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/14/2015] [Accepted: 06/15/2015] [Indexed: 10/23/2022]
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Range of motion, postural alignment, and LESS score differences of those with and without excessive medial knee displacement. Clin J Sport Med 2015; 25:61-6. [PMID: 24926910 DOI: 10.1097/jsm.0000000000000106] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine range of motion (ROM), postural alignment, and dynamic motion differences between those with and without medial knee displacement (MKD) during the overhead squat (OHS). We hypothesized those with MKD would have restricted ROM, differing postural alignment, and poorer quality dynamic motion than those without MKD. DESIGN Observational. SETTING University Research Laboratory. PARTICIPANTS Ninety-seven healthy recreationally active college-aged individuals. INDEPENDENT VARIABLES Groups were determined by the presence (MKD group) or absence (control group) of MKD during an OHS. MAIN OUTCOME MEASURES Range of motion measures were active and passive ankle dorsiflexion with the knee straight and bent, hip internal and external rotation, and hip abduction. Postural alignment measures were Q angle, navicular drop, and genu recurvatum. Quality of dynamic motion was measured using total Landing Error Scoring System (LESS) score. RESULTS The MKD group had significantly less active (P = 0.017) and passive (P = 0.045) ankle dorsiflexion with the knee straight, as well as significantly increased Q angle (P = 0.004) and decreased navicular drop (P = 0.009). There were no significant differences in total LESS score or the other outcome measures. CONCLUSIONS There is select ROM, such as ankle dorsiflexion, and postural measures clinicians can screen for that may be related to increased MKD and theoretically elevated risk of injury.
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Padua DA, Bell DR, Clark MA. Neuromuscular characteristics of individuals displaying excessive medial knee displacement. J Athl Train 2013; 47:525-36. [PMID: 23068590 DOI: 10.4085/1062-6050-47.5.10] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Knee-valgus motion is a potential risk factor for certain lower extremity injuries, including anterior cruciate ligament injury and patellofemoral pain. Identifying neuromuscular characteristics associated with knee-valgus motion, such as hip and lower leg muscle activation, may improve our ability to prevent lower extremity injuries. OBJECTIVE We hypothesized that hip and lower leg muscle-activation amplitude would differ among individuals displaying knee valgus (medial knee displacement) during a double-legged squat compared with those who did not display knee valgus. We further suggested that the use of a heel lift would alter lower leg muscle activation and frontal-plane knee motion in those demonstrating medial knee displacement. DESIGN Descriptive laboratory study. SETTING Research laboratory. PATIENTS OR OTHER PARTICIPANTS A total of 37 healthy participants were assigned to the control (n = 19) or medial-knee-displacement (n = 18) group based on their double-legged squat performance. MAIN OUTCOME MEASURE(S) Muscle-activation amplitude for the gluteus maximus, gluteus medius, adductor magnus, medial and lateral gastrocnemius, and tibialis anterior was measured during 2 double-legged squat tasks. The first task consisted of performing a double-legged squat without a heel lift; the second consisted of performing a double-legged squat task with a 2-in (5.08-cm) lift under the heels. RESULTS Muscle-activation amplitude for the hip adductor, gastrocnemius, and tibialis anterior was greater in those who displayed knee valgus than in those who did not (P < .05). Also, use of heel lifts resulted in decreased activation of the gluteus maximus, hip adductor, gastrocnemius, and tibialis anterior muscles (P < .05). Use of heel lifts also eliminated medially directed frontal-plane knee motion in those displaying medial knee displacement. CONCLUSIONS Medial knee displacement during squatting tasks appears to be associated with increased hip-adductor activation and increased co-activation of the gastrocnemius and tibialis anterior muscles.
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Affiliation(s)
- Darin A Padua
- University of North Carolina at Chapel Hill, Department of Exercise and Sport Science, 216 Fetzer Gym, CB#8700, Chapel Hill, NC, USA.
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Baldwin MA, Clary C, Maletsky LP, Rullkoetter PJ. Verification of predicted specimen-specific natural and implanted patellofemoral kinematics during simulated deep knee bend. J Biomech 2009; 42:2341-8. [DOI: 10.1016/j.jbiomech.2009.06.028] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 06/15/2009] [Accepted: 06/15/2009] [Indexed: 11/25/2022]
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Prins MR, van der Wurff P. Females with patellofemoral pain syndrome have weak hip muscles: a systematic review. ACTA ACUST UNITED AC 2009; 55:9-15. [DOI: 10.1016/s0004-9514(09)70055-8] [Citation(s) in RCA: 114] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Ostermeier S, Holst M, Hurschler C, Windhagen H, Stukenborg-Colsman C. Dynamic measurement of patellofemoral kinematics and contact pressure after lateral retinacular release: an in vitro study. Knee Surg Sports Traumatol Arthrosc 2007; 15:547-54. [PMID: 17225178 DOI: 10.1007/s00167-006-0261-0] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2006] [Accepted: 11/22/2006] [Indexed: 10/23/2022]
Abstract
The purpose of this study was to investigate the influence of lateral retinacular release and medial and lateral retinacular deficiency on patellofemoral position and retropatellar contact pressure. Human knee specimens (n = 8, mean age = 65 SD 7 years, all male) were tested in a kinematic knee-simulating machine. During simulation of an isokinetic knee extension cycle from 120 degrees to full extension, a hydraulic cylinder applied sufficient force to the quadriceps tendon to produce an extension moment of 31 Nm. The position of the patella was measured using an ultrasound based motion analysis system (CMS 100, Zebris). The amount of patellofemoral contact pressure and its pressure distribution was measured using a pressure sensitive film (Tekscan, Boston). Patellar position and contact pressure were first investigated in intact knee conditions, after a lateral retinacular release and a release of the medial and lateral retinaculum. After lateral retinacular release the patella continuously moved from a significant medialised position at flexion (P = 0.01) to a lateralised position (P = 0.02) at full knee extension compared to intact conditions, the centre of patellofemoral contact pressure was significantly medialised (0.04) between 120 degrees and 60 degrees knee flexion. Patellofemoral contact pressure did not change significantly. In the deficient knee conditions the patella moved on a significant lateralised track (P = 0.04) through the entire extension cycle with a lateralised centre of patellofemoral pressure (P = 0.04) with a trend (P = 0.08) towards increased patellofemoral pressure. The results suggest that lateral retinacular release did not inevitably stabilise or medialise patellar tracking through the entire knee extension cycle, but could decrease pressure on the lateral patellar facet in knee flexion. Therefore lateral retinacular release should be considered carefully in cases of patellar instability.
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Affiliation(s)
- Sven Ostermeier
- Orthopaedics Department, Hannover Medical School, Anna-von-Borries-Str. 1-7, 30625, Hannover, Germany.
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Ostermeier S, Holst M, Bohnsack M, Hurschler C, Stukenborg-Colsman C, Wirth CJ. Dynamic measurement of patellofemoral contact pressure following reconstruction of the medial patellofemoral ligament: an in vitro study. Clin Biomech (Bristol, Avon) 2007; 22:327-35. [PMID: 17118499 DOI: 10.1016/j.clinbiomech.2006.10.002] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Revised: 10/06/2006] [Accepted: 10/10/2006] [Indexed: 02/07/2023]
Abstract
BACKGROUND Surgical reconstruction of the medial patellofemoral ligament used to stabilize the patella against lateral dislocation may concomitantly produce alteration of the patellofemoral contact pressure distribution. Two different tendon transfer techniques of reconstructing the medial patellofemoral ligament, one dynamic and one static, as well as a proximal soft tissue realignment of the patella were investigated. METHODS Eight human knee specimens were mounted in a kinematic knee simulator and isokinetic extension motion was simulated. Patellofemoral pressure was measured using a pressure sensitive film while a 100 N laterally directed dislocation load was applied to the patella. The specimens were evaluated in a physiologic state, as well as after dynamic reconstruction of the medial patellofemoral ligament using a distal transfer of the semitendinosus tendon, following static reconstruction using a semitendinosus autograft, and following proximal soft tissue realignment of the patella. FINDINGS Following both reconstruction techniques of the medial patellofemoral ligament patellofemoral contact pressure was not significantly (P=0.49) altered. In contrast, after proximal realignment a trend (P=0.07) towards higher contact pressure near knee extension was observed. In the absence of a lateral dislocation load dynamic and static reconstruction resulted in a medialization (P=0.04) of the center of pressure, whereas under the application of a 100 N dislocation load the center of pressure showed no significant alteration. Following proximal realignment the center of pressure was significantly medialized without (P<0.01) and with a dislocation load (P=0.01) throughout the entire range of knee motion. INTERPRETATION Static and dynamic ligament reconstruction of the medial patellofemoral ligament did not alter patellofemoral pressure. Proximal realignment, on the other hand, resulted in a constant medialization of the patellofemoral pressure. The data suggest that the reconstruction techniques would be associated with a low risk of causing premature cartilage degeneration due to excessive patellofemoral contact pressure, whereas proximal realignment could cause medial overload of the patellofemoral joint.
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Affiliation(s)
- Sven Ostermeier
- Department of Orthopaedic Surgery, Hannover Medical School (MHH), Anna-von.-Borries-Str. 1-7, 30625 Hannover, Germany.
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