1
|
Peez C, Zderic I, Deichsel A, Lodde M, Richards RG, Gueorguiev B, Kittl C, Raschke MJ, Herbst E. Fragment size of lateral Hoffa fractures determines screw fixation trajectory: a human cadaveric cohort study. Acta Orthop 2024; 95:290-297. [PMID: 38874493 DOI: 10.2340/17453674.2024.40841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND AND PURPOSE Recommendations regarding fragment-size-dependent screw fixation trajectory for coronal plane fractures of the posterior femoral condyles (Hoffa fractures) are lacking. The aim of this study was to compare the biomechanical properties of anteroposterior (AP) and crossed posteroanterior (PA) screw fixations across differently sized Hoffa fractures on human cadaveric femora. PATIENTS AND METHODS 4 different sizes of lateral Hoffa fractures (n = 12 x 4) were created in 48 distal human femora according to the Letenneur classification: (i) type I, (ii) type IIa, (ii) type IIb, and (iv) type IIc. Based on bone mineral density (BMD), specimens were assigned to the 4 fracture clusters and each cluster was further assigned to fixation with either AP (n = 6) or crossed PA screws (n = 6) to ensure homogeneity of BMD values and comparability between the different test conditions. All specimens were biomechanically tested under progressively increasing cyclic loading until failure, capturing the interfragmentary movements via motion tracking. RESULTS For Letenneur type I fractures, kilocycles to failure (mean difference [∆] 2.1, 95% confidence interval [CI] -1.3 to 5.5), failure load (∆ 105 N, CI -83 to 293), axial displacement (∆ 0.3 mm, CI -0.8 to 1.3), and fragment rotation (∆ 0.5°, CI -3.2 to 2.1) over 5.0 kilocycles did not differ significantly between the 2 screw trajectories. For each separate subtype of Letenneur type II fractures, fixation with crossed PA screws resulted in significantly higher kilocycles to failure (∆ 6.7, CI 3.3-10.1 to ∆ 8.9, CI 5.5-12.3) and failure load (∆ 275 N, CI 87-463 to ∆ 438, CI 250-626), as well as, less axial displacement from 3.0 kilocycles onwards (∆ 0.4°, CI 0.03-0.7 to ∆ 0.5°, CI 0.01-0.9) compared with AP screw fixation. CONCLUSION Irrespective of the size of Letenneur type II fractures, crossed PA screw fixation provided greater biomechanical stability than AP-configured screws, whereas both screw fixation techniques demonstrated comparable biomechanical competence for Letenneur type I fractures. Fragment-size-dependent treatment strategies might be helpful to determine not only the screw configuration but also the surgical approach.
Collapse
Affiliation(s)
- Christian Peez
- AO Research Institute Davos, Davos, Switzerland; Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany.
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Moritz Lodde
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | | | | | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| |
Collapse
|
2
|
Yañez R, Silvestre R, Roby M, Neira A, Azar C, Madera S, Ortiz-Bernardin A, Carpes FP, De la Fuente C. Finite element graft stress for anteromedial portal, transtibial, and hybrid transtibial femoral drillings under anterior translation and medial rotation: an exploratory study. Sci Rep 2024; 14:11922. [PMID: 38789542 PMCID: PMC11126698 DOI: 10.1038/s41598-024-61061-y] [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: 08/05/2023] [Accepted: 04/30/2024] [Indexed: 05/26/2024] Open
Abstract
Stress concentration on the Anterior Cruciate Ligament Reconstruction (ACLr) for femoral drillings is crucial to understanding failures. Therefore, we described the graft stress for transtibial (TT), the anteromedial portal (AM), and hybrid transtibial (HTT) techniques during the anterior tibial translation and medial knee rotation in a finite element model. A healthy participant with a non-medical record of Anterior Cruciate Ligament rupture with regular sports practice underwent finite element analysis. We modeled TT, HTT, AM drillings, and the ACLr as hyperelastic isotropic material. The maximum Von Mises principal stresses and distributions were obtained from anterior tibial translation and medial rotation. During the anterior tibia translation, the HTT, TT, and AM drilling were 31.5 MPa, 34.6 Mpa, and 35.0 MPa, respectively. During the medial knee rotation, the AM, TT, and HTT drilling were 17.3 MPa, 20.3 Mpa, and 21.6 MPa, respectively. The stress was concentrated at the lateral aspect of ACLr,near the femoral tunnel for all techniques independent of the knee movement. Meanwhile, the AM tunnel concentrates the stress at the medial aspect of the ACLr body under medial rotation. The HTT better constrains the anterior tibia translation than AM and TT drillings, while AM does for medial knee rotation.
Collapse
Affiliation(s)
- Roberto Yañez
- Biomechanics unit, Innovation centre, MEDS clinic, Santiago, Chile
- Orthopaedic knee service, MEDS clinic, Santiago, Chile
| | - Rony Silvestre
- Biomechanics unit, Innovation centre, MEDS clinic, Santiago, Chile
| | - Matias Roby
- Biomechanics unit, Innovation centre, MEDS clinic, Santiago, Chile
- Orthopaedic knee service, MEDS clinic, Santiago, Chile
| | - Alejandro Neira
- Escuela de Kinesiologia, Facultad de Medicina y Ciencias de la Salud, Universidad Mayor, Santiago, Chile
| | - Camilo Azar
- Orthopaedic knee service, MEDS clinic, Santiago, Chile
| | - Samuel Madera
- Ingenieria Civil Mecanica, Facultad de Igenieria, Universidad de Chile, Santiago, Chile
| | | | - Felipe P Carpes
- Laboratory of Neuromechanics, Universidade Federal do Pampa, Uruguaiana, Brazil
| | - Carlos De la Fuente
- Exercise and Rehabilitation Sciences Institute, Postgraduate, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, RM, Chile.
| |
Collapse
|
3
|
Pineda T, Cance N, Dan MJ, Demey G, Dejour DH. Evaluation of Anterior Tibial Translation Under Physiological Axial Load After ACL Reconstruction With Lateral Extra-articular Tenodesis. Orthop J Sports Med 2024; 12:23259671241246111. [PMID: 38774385 PMCID: PMC11107324 DOI: 10.1177/23259671241246111] [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: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 05/24/2024] Open
Abstract
Background Postoperative laxity correlates with negative clinical outcomes after anterior cruciate ligament reconstruction (ACLR). The influence of lateral extra-articular tenodesis (LET) on anteroposterior translation is unclear. Purpose/Hypothesis This study aimed to evaluate the reduction in radiographic static anterior tibial translation (SATT) and dynamic anterior tibial translation (DATT) after LET as an adjunctive procedure to ACLR. It was hypothesized that adding a LET procedure would have no effect on postoperative SATT and DATT. Study Design Cohort study; Level of evidence, 3. Methods Patients who underwent primary ACLR with hamstring tendon autografts between 2020 and 2022 were reviewed, and those who underwent ACLR and LET as an anterolateral associate procedure were paired 1 to 1 with those who underwent isolated ACLR (control) based on age, sex, preoperative SATT, and posterior tibial slope (PTS). The indications for LET were age <18 years and anterolateral rotary instability (grade ≥2 pivot shift). A previously validated technique was used to measure SATT, DATT, and PTS on lateral weightbearing and lateral stress knee radiographs. Preoperative and 9-month postoperative radiographs were compared between the 2 groups. Results A total of 72 patients were included in the analysis (n = 36 patients in each group). The inter- and intraobserver reliability of the SATT, DATT, and PTS measurements was excellent (intraclass correlation coefficients, 0.88-0.99). The mean pre- and postoperative SATT in the ACLR+LET group was 2.44 ± 2.90 mm and 2.44 ± 2.38 mm, respectively, compared with 2.60 ± 2.99 mm and 2.12 ± 2.74 mm, respectively, in the control group. The mean pre- and postoperative reduction in side-to-side DATT in the ACLR+LET group was 5.44 ± 4.65 mm and 1.13 ± 2.95 mm, respectively, compared with 5.03 ± 3.66 mm and 2 ± 3.12 mm, respectively, in the control group. There was no pre- to postoperative difference in SATT (P = .51). However, the side-to-side DATT was reduced by 3.66 ± 3.37 mm postoperatively (P < .001), without significant differences between groups (P = .24). Conclusion Including a LET procedure for patients undergoing ACLR did not reduce SATT; that is, it did not decrease the amount of tibial translation due to physiological axial load.
Collapse
Affiliation(s)
- Tomas Pineda
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Hospital el Carmen, Santiago, Chile
| | - Nicolas Cance
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - Michael J. Dan
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney, Australia
| | - Guillaume Demey
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| | - David H. Dejour
- Orthopedic Surgery Department, Lyon Ortho Clinic, Clinique de la Sauvegarde, Lyon, France
| |
Collapse
|
4
|
Deichsel A, Leibrandt L, Raschke MJ, Klimek M, Oeckenpöhler S, Herbst E, Kittl C, Glasbrenner J. Biomechanical Stability of Third-Generation Adjustable Suture Loop Devices Versus Continuous Loop Button Device for Cortical Fixation of ACL Tendon Grafts. Orthop J Sports Med 2024; 12:23259671241240375. [PMID: 38576875 PMCID: PMC10993678 DOI: 10.1177/23259671241240375] [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: 08/03/2023] [Accepted: 09/03/2023] [Indexed: 04/06/2024] Open
Abstract
Background Concerns regarding the primary stability of early adjustable loop button (ALB) devices for cortical fixation of tendon grafts in anterior cruciate ligament reconstruction (ACLR) have led to the development of new implant designs. Purpose To evaluate biomechanical stability of recent ALB implants in comparison with a continuous loop button (CLB) device. Study Design Controlled laboratory study. Methods ACLR was performed in a porcine model (n = 40) using 2-strand porcine flexor tendons with a diameter of 8 mm. Three ALB devices (Infinity Button [ALB1 group]; Tightrope II RT [ALB2 group]; A-TACK [ALB3 group]) and 1 CLB device (FlippTack with polyethylene suture) were used for cortical tendon graft fixation. Cyclic loading (1000 cycles up to 250 N) with complete unloading were applied to the free end of the tendon graft using a uniaxial testing machine, followed by load to failure. Elongation, stiffness, yield load, and ultimate failure load were recorded and compared between the groups using a Kruskal-Wallis test with post hoc Dunn correction. Results Elongation after 1000 cycles at 250 N was similar between groups (ALB1, 4.5 ± 0.7 mm; ALB2, 4.8 ± 0.8 mm; ALB3, 4.5 ± 0.6 mm; CLB, 4.5 ± 0.8 mm), as was load to failure (ALB1, 838 ± 109 N; ALB2, 930 ± 89 N; ALB3, 809 ± 103 N; CLB, 842 ± 80 N). Stiffness was significantly higher in the ALB1 group compared with the CLB group (262.3 ± 21.6 vs 229.3 ± 15.1 N/mm; P < .05). No significant difference was found between the 4 groups regarding yield load. Constructs failed either by rupture of the loop, breakage of the button, or rupture of the tendon. Conclusion The tested third-generation ALB devices for cortical fixation in ACLR withstood cyclic loading with complete unloading without significant differences to a CLB device. Clinical Relevance The third-generation ALB devices tested in the present study provided biomechanical stability comparable with that of a CLB device. Furthermore, ultimate failure loads of all tested implants exceeded the loads expected to occur in the postoperative period after ACLR.
Collapse
Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Lara Leibrandt
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Simon Oeckenpöhler
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| |
Collapse
|
5
|
Peez C, Deichsel A, Zderic I, Richards RG, Gueorguiev B, Kittl C, Raschke MJ, Herbst E. Valgus malalignment causes increased forces on a medial collateral ligament reconstruction under dynamic valgus loading: A biomechanical study. Knee Surg Sports Traumatol Arthrosc 2024; 32:864-871. [PMID: 38454816 DOI: 10.1002/ksa.12110] [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: 12/28/2023] [Revised: 02/02/2024] [Accepted: 02/08/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE To investigate the forces on a medial collateral ligament (MCL) reconstruction (MCLR) relative to the valgus alignment of the knee. METHODS Eight fresh-frozen human cadaveric knees were subjected to dynamic valgus loading at 400 N using a custom-made kinematics rig. After resection of the superficial medial collateral ligament, a single-bundle MCLR with a hamstring tendon autograft was performed. A medial opening wedge distal femoral osteotomy was performed and fixed with an external fixator to gradually adjust the alignment in 5° increments from 0° to 10° valgus. For each degree of valgus deformity, the resulting forces acting on the MCLR were measured through a force sensor and captured in 15° increments from 0° to 60° of knee flexion. RESULTS Irrespective of the degree of knee flexion, increasing valgus malalignment resulted in significantly increased forces acting on the MCLR compared to neutral alignment (p < 0.05). Dynamic loading at 5° valgus resulted in increased forces on the MCLR at all flexion angles ranging between 16.2 N and 18.5 N (p < 0.05 from 0° to 30°; p < 0.01 from 45° to 60°). A 10° valgus malalignment further increased the forces on the MCLR at all flexion angles ranging between 29.4 N and 40.0 N (p < 0.01 from 0° to 45°, p < 0.05 at 60°). CONCLUSION Valgus malalignment of the knee caused increased forces acting on the reconstructed MCL. In cases of chronic medial instabilities accompanied by a valgus deformity ≥ 5°, a realigning osteotomy should be considered concomitantly to the MCLR to protect the graft and potentially reduce graft failures. LEVEL OF EVIDENCE Level III.
Collapse
Affiliation(s)
- Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
- AO Research Institute Davos, Davos, Switzerland
| | - Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Ivan Zderic
- AO Research Institute Davos, Davos, Switzerland
| | | | | | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| |
Collapse
|
6
|
Deichsel A, Glasbrenner J, Raschke MJ, Klimek M, Peez C, Briese T, Herbst E, Kittl C. Comparison of Time-Zero Primary Stability Between a Biodegradable Magnesium Bone Staple and Metal Bone Staples for Knee Ligament Fixation: A Biomechanical Study in a Porcine Model. Orthop J Sports Med 2024; 12:23259671241236783. [PMID: 38532766 PMCID: PMC10964459 DOI: 10.1177/23259671241236783] [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: 07/20/2023] [Accepted: 08/29/2023] [Indexed: 03/28/2024] Open
Abstract
Background Bone staples have been shown previously to be a viable modality for cortical tendon graft fixation in ligament knee surgery. However, soft tissue reactions have been reported, making implant removal necessary. Magnesium alloys are a promising material for biodegradable orthopaedic implants, with mechanical properties closely resembling those of human bone. Purpose To compare the primary stability of a biodegradable bone staple prototype made from magnesium to bone staples made from metal in the cortical fixation of tendon grafts during knee surgery. Study Design Controlled laboratory study. Methods Primary stability of peripheral tendon graft fixation was assessed in a porcine model of medial collateral ligament reconstruction. Two commercially available metal bone staples (Richards fixation staple with spikes [Me1] and spiked ligament staple [Me2]) were compared with a magnesium bone staple prototype for soft tissue fixation. Primary stability was assessed using a uniaxial materials testing machine. Cyclic loading at 50 and 100 N was applied for 500 cycles each, followed by load-to-failure testing. Results After 500 cycles at 50 N, elongation was 1.5 ± 0.5 mm in the Me1 group, 1.9 ± 0.5 mm in the Me2 group, and 1.8 ± 0.4 mm in the magnesium group. After 1000 cycles of loading (500 cycles at 50 N and 500 at 100 N), elongation was 3.6 ± 0.9 mm in the Me1 group, 3.5 ± 0.6 mm in the Me2 group, and 4.1 ± 1.0 mm in the magnesium group. No significant differences regarding elongation were found between the groups. Load to failure was 352 ± 115 N in the Me1 group, 373 ± 77 N in the Me2 group, and 449 ± 92 N in the magnesium group, with no significant difference between the groups. Conclusion In this study, the magnesium bone staples provided appropriate time-zero biomechanical primary stability in comparison with metal bone staples and may therefore be a feasible alternative for cortical fixation of tendon grafts in knee surgery. Clinical Relevance The biodegradability of magnesium bone staples would eliminate the need for later implant removal.
Collapse
Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Michael J. Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Münster, Germany
| |
Collapse
|
7
|
Dan MJ, Cance N, Pineda T, Demey G, Dejour DH. Four to 6° Is the Target Posterior Tibial Slope After Tibial Deflection Osteotomy According to the Knee Static Anterior Tibial Translation. Arthroscopy 2024; 40:846-854. [PMID: 37479151 DOI: 10.1016/j.arthro.2023.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 06/28/2023] [Accepted: 07/02/2023] [Indexed: 07/23/2023]
Abstract
PURPOSE To correlate changes in posterior tibial slope (PTS) with changes to static anterior tibial translation (SATT) with tibial deflexion osteotomy (TDO), in order to define a target postoperative tibial slope based on postoperative SATT. METHODS We reviewed a consecutive series of primary and revision anterior cruciate ligament reconstruction with TDO between 2011 and 2022. PTS and SATT were measured pre- and postoperatively directly from the radiographs by 2 independent reviewers. Regression analysis was performed to investigate the relationship of postoperative SATT with PTS, gender, graft type, and meniscal injury. RESULTS A total of 48 patients were included in this study. The mean (SD) decrease in PTS and SATT was 8.85° (3.03°; 12.5° to 3.59°, P < .01), and 7.93 mm (3.68; 5.37 to -2.55 mm, P < .01), respectively. Upon univariate analysis, the only factor influencing ΔSATT was ΔPTS. For each 1° of decreased slope, SATT was reduced by 0.46 mm. The mean (SD) PTS for a negative SATT was 2.81° (2.78°) compared to 5.09° (3.25°) for a SATT of 0 to 5mm (P < .01). CONCLUSIONS This study reports weightbearing SATT in association with PTS after TDO. The TDO successfully reduced the SATT, with the change in PTS the only significant predictor of postoperative SATT. Based on our results, our previously held target of 2° to 5° PTS overcorrected the SATT. Therefore, considering as a goal 0 to 5 mm of SATT, we suggest a new target of 4° to 6° PTS. LEVEL OF EVIDENCE Level IV, retrospective cohort study.
Collapse
Affiliation(s)
- Michael J Dan
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France; Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School University of New South Wales, Sydney, Australia
| | - Nicolas Cance
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France.
| | - Tomas Pineda
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France; Hospital el Carmen, Santiago, Chile
| | - Guillaume Demey
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
| | - David H Dejour
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
| |
Collapse
|
8
|
Cance N, Dan MJ, Pineda T, Demey G, Dejour DH. Radiographic Investigation of Differences in Static Anterior Tibial Translation With Axial Load Between Isolated ACL Injury and Controls. Am J Sports Med 2024; 52:338-343. [PMID: 38166410 DOI: 10.1177/03635465231214223] [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: 01/04/2024]
Abstract
BACKGROUND Static anterior tibial translation (SATT) is radiographically measured to show the amount of tibial translation during the single-leg stance, and thus it is representative of the physiological axial load subjected to the anterior cruciate ligament (ACL) during the stance. Increased SATT has been associated with increased posterior tibial slope (PTS) and is also associated with increased graft failure. PURPOSE To compare the SATT value in a control population with that in a population with an isolated ACL injury, as well as to compare the effect of tibial slope on SATT between the 2 groups. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A consecutive series of patients without ligamentous or meniscal injuries between 2019 and 2022 was reviewed. A matched consecutive cohort of patients with nonacute ACL injuries (surgery between 6 and 12 weeks after injury) without concomitant pathology was reviewed. Preoperative SATT and PTS were measured with a previously validated technique on lateral weightbearing knee radiographs. The SATT value was determined, and regression analysis was performed to investigate the relationship between SATT and PTS. RESULTS In total, 101 controls and 115 patients with an ACL injury were included in this study. The mean SATT was 1.31 mm (SD, 2.44 mm) and the mean PTS was 10.61° (SD, 3.28°) in the control cohort. The SATT was larger (mean, 2.27 mm; SD, 3.36 mm) in the ACL-injured cohort despite the tibial slope measurement being less in the ACL-injured cohort (mean, 9.46°; SD, 2.85°; P = .016). Linear regression analysis showed that for every 1° of increase in PTS, there was a 0.34-mm increase in SATT in the control cohort; however, there was a greater increase of 0.5 mm for every 1° of increase in PTS in the ACL-injured cohort. We found no significant differences in SATT when the cohorts were compared by age (P = .26) or sex (P = .10). CONCLUSION The present study reports a reference SATT value of 1.31 mm (SD, 2.44 mm) in a non-ACL-injured cohort, which was lower than in the ACL-injured cohort (mean, 2.27 mm; SD, 3.36 mm). The effect of slope on weightbearing anterior tibial translation was greater in the ACL-injured population than in the control cohort.
Collapse
Affiliation(s)
- Nicolas Cance
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
| | - Michael J Dan
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
- Surgical and Orthopaedic Research Laboratory, Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Tomas Pineda
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
- Hospital el Carmen, Santiago, Chile
| | - Guillaume Demey
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
| | - David H Dejour
- Lyon Ortho Clinic, Orthopedic Surgery Department, Clinique de la Sauvegarde, Lyon, France
| |
Collapse
|
9
|
Ivanov I, Ranchev S, Stoychev S. Experimental Ultrasound Approach for Studying Knee Intra-Articular Femur-Tibia Movements under Different Loads. J Funct Morphol Kinesiol 2023; 9:8. [PMID: 38249085 PMCID: PMC10801608 DOI: 10.3390/jfmk9010008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/11/2023] [Accepted: 12/19/2023] [Indexed: 01/23/2024] Open
Abstract
The purpose of the present study was to develop an experimental model for the study of intra-articular knee movements depending on the function of the knee joint and involved muscle groups under isometric stretching conditions with different loads. The experimental procedure included an ultrasound examination of a knee joint after isometric stretching in healthy men (n = 32). The changes (in millimeters) in the distances between the femur and tibia were measured using an ultrasound sonographer at three stages. The first stage was performed on ten (n = 10) healthy men in five different sitting and upright positions. In the second and third experimental model stages, lower limbs loading was applied to 22 participants. Our hypothesis, which was confirmed, was that as a result of increased loads on the participant's back, an intra-articular decrease in the femur-tibia cartilage surface distance would be observed. The accuracy of the created experimental model was improved over its three stages from 30% to 9%. Quantitative model data can help to create a mathematical model of the mechanical effects during the deformation of knee joint bone cartilage and it can also help outline some future tasks: increasing loading weights, enlarging participant groups, performing comparisons of men and women, and performing comparisons of healthy and pathological individuals.
Collapse
Affiliation(s)
- Ivan Ivanov
- National Sports Academy “Vassil Levski”, 1700 Sofia, Bulgaria
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Sergey Ranchev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| | - Stoyan Stoychev
- Institute of Mechanics, Bulgarian Academy of Sciences, 1113 Sofia, Bulgaria; (S.R.); (S.S.)
| |
Collapse
|
10
|
Deichsel A, Glasbrenner J, Raschke MJ, Klimek M, Peez C, Briese T, Herbst E, Kittl C. Interference screws manufactured from magnesium display similar primary stability for soft tissue anterior cruciate ligament graft fixation compared to a biocomposite material - a biomechanical study. J Exp Orthop 2023; 10:103. [PMID: 37815666 PMCID: PMC10564698 DOI: 10.1186/s40634-023-00663-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 09/20/2023] [Indexed: 10/11/2023] Open
Abstract
PURPOSE Biodegradable interference screws (IFS) can be manufactured from different biomaterials. Magnesium was previously shown to possess osteoinductive properties, making it a promising material to promote graft-bone healing in anterior cruciate ligament reconstruction (ACLR). The purpose of this study was to compare IFS made from magnesium to a contemporary biocomposite IFS. METHODS In a porcine model of ACL reconstruction, deep porcine flexor tendons were trimmed to a diameter of 8 mm, sutured in Krackow technique, and fixed with either 8 × 30 mm biocomposite IFS (Bc-IFS) or 8 × 30 mm magnesium IFS (Mg-IFS) in an 8 mm diameter bone tunnel in porcine tibiae. Cyclic loading for 1000 cycles from 0 to 250 N was applied, followed by load to failure testing. Elongation, load to failure and stiffness of the tested constructs was determined. RESULTS After 1000 cycles at 250 N, elongation was 4.8 mm ± 1.5 in the Bc-IFS group, and 4.9 mm ± 1.5 in the Mg-IFS group. Load to failure was 649.5 N ± 174.3 in the Bc-IFS group, and 683.8 N ± 116.5 in the Mg-IFS group. Stiffness was 125.3 N/mm ± 21.9 in the Bc-IFS group, and 122.5 N/mm ± 20.3 in the Mg-IFS group. No significant differences regarding elongation, load to failure and stiffness between Bc-IFS and Mg-IFS were observed. CONCLUSION Magnesium IFS show comparable biomechanical primary stability in comparison to biocomposite IFS and may therefore be an alternative to contemporary biodegradable IFS.
Collapse
Affiliation(s)
- Adrian Deichsel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Johannes Glasbrenner
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Michael J Raschke
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Matthias Klimek
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christian Peez
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Thorben Briese
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Elmar Herbst
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany
| | - Christoph Kittl
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Münster, Albert-Schweitzer-Campus, Building W1, 48149, Münster, Germany.
| |
Collapse
|
11
|
Tompkins MA, Williams H, Bechtold JE. An MCL internal brace can withstand cyclic fatigue loading and produce a valgus load to failure similar to that of intact knees. Knee Surg Sports Traumatol Arthrosc 2023; 31:3611-3617. [PMID: 37171604 DOI: 10.1007/s00167-023-07439-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 04/24/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE The purpose of this study is to report on the biomechanical durability and strength of an MCL internal brace construct. The null hypothesis is that there will be no difference between this construct and the intact MCL in terms of deflection during fatigue testing and the ultimate failure load. METHODS Eight cadaver knees were used. A grade 3 equivalent MCL tear was created with both the superficial and deep femoral MCL severed. An internal brace was created by placing a cortical button and loop through the center of the femoral MCL origin and secured on the lateral cortex of the distal femur. A FiberTape (Arthrex, Naples, FL) was looped through the cortical button loop and was secured in the center of the tibial insertion of the MCL. After pre-cycling, the specimens underwent 1000 cycles of compressive load between 100 and 300 N, using four point bending testing into direct valgus. Pre and post testing deflection was measured using three dimensional motion data from two sets of reflective markers. A load-to-failure test was then conducted with failure defined as the first significant decrease in the load-displacement curve. RESULTS The mean increase in deflection between pre- and post-testing was 0.6° (SD ± 0.3°). The mean failure bending moment was 122.4 Nm (SD ± 29 Nm). CONCLUSION The internal brace construct employed in this study was able to withstand cyclic fatigue loading and recorded a valgus load to failure similar to that of intact knees. It is important for clinicians who are considering using this commercially available technique to be aware of how the construct performs under cyclic loading compared to the intact MCL.
Collapse
Affiliation(s)
- Marc A Tompkins
- TRIA Orthopaedic Center, 8100 Northland Drive, 8100 Northland Drive, Bloomington, MN, 55431, USA.
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA.
| | - Hanna Williams
- Excelen Center for Bone and Joint Research and Education, 700 10Th Avenue South, Minneapolis, MN, 55415, USA
| | - Joan E Bechtold
- Department of Orthopedic Surgery, University of Minnesota, 2450 Riverside Avenue South, Suite R200, Minneapolis, MN, 55454, USA
- Excelen Center for Bone and Joint Research and Education, 700 10Th Avenue South, Minneapolis, MN, 55415, USA
| |
Collapse
|
12
|
Tsukamoto H, Saito K, Saito H, Kijima H, Akagawa M, Komatsu A, Iwami T, Miyakoshi N. A Novel Classification of Coronal Plane Knee Joint Instability Using Nine-Axis Inertial Measurement Units in Patients with Medial Knee Osteoarthritis. SENSORS (BASEL, SWITZERLAND) 2023; 23:2797. [PMID: 36905001 PMCID: PMC10007345 DOI: 10.3390/s23052797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/27/2023] [Accepted: 02/28/2023] [Indexed: 06/18/2023]
Abstract
The purpose of this study was to propose a novel classification of varus thrust based on gait analysis with inertial motion sensor units (IMUs) in patients with medial knee osteoarthritis (MKOA). We investigated thigh and shank acceleration using a nine-axis IMU in 69 knees with MKOA and 24 (control) knees. We classified varus thrust into four phenotypes according to the relative medial-lateral acceleration vector patterns of the thigh and shank segments: pattern A (thigh medial, shank medial), pattern B (medial, lateral), pattern C (lateral, medial), and pattern D (lateral, lateral). Quantitative varus thrust was calculated using an extended Kalman filter-based algorithm. We compared the differences between our proposed IMU classification and the Kellgren-Lawrence (KL) grades for quantitative varus thrust and visible varus thrust. Most of the varus thrust was not visually perceptible in early-stage OA. In advanced MKOA, increased proportions of patterns C and D with lateral thigh acceleration were observed. Quantitative varus thrust was significantly increased stepwise from patterns A to D. This novel IMU classification has better clinical utility due to its ability to detect subtle kinematic changes that cannot be captured with conventional motion analysis even in the early stage of MKOA.
Collapse
Affiliation(s)
- Hiroaki Tsukamoto
- Department of Orthopedic Surgery, Kita-Akita Municipal Hospital, Shimosugi, Kamishimizusawa 16-29, Kitaakita 018-4221, Japan
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita 010-8543, Japan
| | - Kimio Saito
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita 010-8543, Japan
| | - Hidetomo Saito
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita 010-8543, Japan
| | - Hiroaki Kijima
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita 010-8543, Japan
| | - Manabu Akagawa
- Department of Orthopedic Surgery, Omagari Kosei Medical Center, Omagari Torimachi 8-65, Senboku 014-0027, Japan
| | - Akira Komatsu
- National Institute of Technology, Sendai College, Natori 981-1239, Japan
| | - Takehiro Iwami
- Department of System Design Engineering, Faculty of Engineering Science, Graduate School of Engineering Science, Akita University, Akita 010-8502, Japan
| | - Naohisa Miyakoshi
- Department of Orthopedic Surgery, Graduate School of Medicine, Akita University, Hondo 1-1-1, Akita 010-8543, Japan
| |
Collapse
|
13
|
Biscarini A. Dynamics of Two-Link Musculoskeletal Chains during Fast Movements: Endpoint Force, Axial, and Shear Joint Reaction Forces. Bioengineering (Basel) 2023; 10:bioengineering10020240. [PMID: 36829734 PMCID: PMC9951971 DOI: 10.3390/bioengineering10020240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/04/2023] [Accepted: 02/08/2023] [Indexed: 02/16/2023] Open
Abstract
This study provides a dynamic model for a two-link musculoskeletal chain controlled by single-joint and two-joint muscles. The chain endpoint force, and the axial and shear components of the joint reaction forces, were expressed analytically as a function of the muscle forces or torques, the chain configuration, and the link angular velocities and accelerations. The model was applied to upper-limb ballistic push movements involving transverse plane shoulder flexion and elbow extension. The numerical simulation highlights that the shoulder flexion and elbow extension angular acceleration at the initial phase of the movement, and the elbow extension angular velocity and acceleration at the later phase of the movement, induce a proportional medial deviation in the endpoint force direction. The forearm angular velocity and acceleration selectively affect the value of the axial and shear components of the shoulder reaction force, depending on the chain configuration. The same goes for the upper arm and elbow. The combined contribution of the elbow extension angular velocity and acceleration may give rise to anterior shear force acting on the humerus and axial forearm traction force as high as 300 N. This information can help optimize the performance and estimate/control of the joint loads in ballistic sport activities and power-oriented resistance exercises.
Collapse
Affiliation(s)
- Andrea Biscarini
- Department of Medicine and Surgery, University of Perugia, 06132 Perugia, Italy
| |
Collapse
|
14
|
Escamilla RF. My Top Five Concepts for Selecting Lower Extremity Exercises For Cruciate Ligament and Patellofemoral Rehabilitation. Int J Sports Phys Ther 2023; 18:14-25. [PMID: 36793575 PMCID: PMC9897005 DOI: 10.26603/001c.65896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/02/2022] [Indexed: 02/04/2023] Open
Abstract
This clinical commentary will address five key concepts that can be used by clinicians as criteria for selecting lower extremity weight bearing exercises (WBE) and non-weight bearing exercises (NWBE) employed for cruciate ligament and patellofemoral rehabilitation. The following will be discussed for both cruciate ligament and patellofemoral rehabilitation: 1) Knee loading varies between WBE and NWBE; 2) Knee loading varies with technique variations within WBE and NWBE; 3) Knee loading varies between different WBE; 4) Knee loading varies as a function of knee angle; and 5) Knee loading increases with increased knee anterior translation beyond toes.
Collapse
Affiliation(s)
- Rafael F Escamilla
- Department of Physical Therapy California State University
- Results Physical Therapy and Training Center
| |
Collapse
|
15
|
Halloran JP, Abdollahi Nohouji N, Hafez MA, Besier TF, Chokhandre SK, Elmasry S, Hume DR, Imhauser CW, Rooks NB, Schneider MTY, Schwartz A, Shelburne KB, Zaylor W, Erdemir A. Assessment of reporting practices and reproducibility potential of a cohort of published studies in computational knee biomechanics. J Orthop Res 2023; 41:325-334. [PMID: 35502762 PMCID: PMC9630164 DOI: 10.1002/jor.25358] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/22/2022] [Accepted: 04/20/2022] [Indexed: 02/04/2023]
Abstract
Reproducible research serves as a pillar of the scientific method and is a foundation for scientific advancement. However, estimates for irreproducibility of preclinical science range from 75% to 90%. The importance of reproducible science has not been assessed in the context of mechanics-based modeling of human joints such as the knee, despite this being an area that has seen dramatic growth. Framed in the context of five experienced teams currently documenting knee modeling procedures, the aim of this study was to evaluate reporting and the perceived potential for reproducibility across studies the teams viewed as important contributions to the literature. A cohort of studies was selected by polling, which resulted in an assessment of nine studies as opposed to a broader analysis across the literature. Using a published checklist for reporting of modeling features, the cohort was evaluated for both "reporting" and their potential to be "reproduced," which was delineated into six major modeling categories and three subcategories. Logistic regression analysis revealed that for individual modeling categories, the proportion of "reported" occurrences ranged from 0.31, 95% confidence interval (CI) [0.23, 0.41] to 0.77, 95% CI: [0.68, 0.86]. The proportion of whether a category was perceived as "reproducible" ranged from 0.22, 95% CI: [0.15, 0.31] to 0.44, 95% CI: [0.35, 0.55]. The relatively low ratios highlight an opportunity to improve reporting and reproducibility of knee modeling studies. Ongoing efforts, including our findings, contribute to a dialogue that facilitates adoption of practices that provide both credibility and translation possibilities.
Collapse
Affiliation(s)
- Jason P Halloran
- Applied Sciences Laboratory, Institute for Shock Physics, Washington State University, Spokane, WA, USA,Corresponding author: Applied Sciences Laboratory, Institute for Shock Physics, 412 E Spokane Falls Blvd, Spokane, WA 99202, Phone: 509-358-7713,
| | - Neda Abdollahi Nohouji
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA,Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA
| | - Mhd Ammar Hafez
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Civil Engineering, Cleveland State University, Cleveland, OH, USA
| | - Thor F Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, NZ,Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, NZ
| | - Snehal K Chokhandre
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
| | - Shady Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Donald R Hume
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA,Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY, USA
| | - Nynke B Rooks
- Auckland Bioengineering Institute, University of Auckland, Auckland, NZ
| | | | - Ariel Schwartz
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, CO, USA,Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - William Zaylor
- Center for Human Machine Systems, Cleveland State University, Cleveland, OH, USA,Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OHIO, USA,Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, USA
| |
Collapse
|
16
|
Jones HSR, Stiles VH, Verheul J, Moore IS. Angular Velocities and Linear Accelerations Derived from Inertial Measurement Units Can Be Used as Proxy Measures of Knee Variables Associated with ACL Injury. SENSORS (BASEL, SWITZERLAND) 2022; 22:9286. [PMID: 36502001 PMCID: PMC9740759 DOI: 10.3390/s22239286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/25/2022] [Accepted: 11/26/2022] [Indexed: 06/17/2023]
Abstract
Given the high rates of both primary and secondary anterior cruciate ligament (ACL) injuries in multidirectional field sports, there is a need to develop easily accessible methods for practitioners to monitor ACL injury risk. Field-based methods to assess knee variables associated with ACL injury are of particular interest to practitioners for monitoring injury risk in applied sports settings. Knee variables or proxy measures derived from wearable inertial measurement units (IMUs) may thus provide a powerful tool for efficient injury risk management. Therefore, the aim of this study was to identify whether there were correlations between laboratory-derived knee variables (knee range of motion (RoM), change in knee moment, and knee stiffness) and metrics derived from IMUs (angular velocities and accelerations) placed on the tibia and thigh, across a range of movements performed in practitioner assessments used to monitor ACL injury risk. Ground reaction forces, three-dimensional kinematics, and triaxial IMU data were recorded from nineteen healthy male participants performing bilateral and unilateral drop jumps, and a 90° cutting task. Spearman's correlations were used to examine the correlations between knee variables and IMU-derived metrics. A significant strong positive correlation was observed between knee RoM and the area under the tibia angular velocity curve in all movements. Significant strong correlations were also observed in the unilateral drop jump between knee RoM, change in knee moment, and knee stiffness, and the area under the tibia acceleration curve (rs = 0.776, rs = -0.712, and rs = -0.765, respectively). A significant moderate correlation was observed between both knee RoM and knee stiffness, and the area under the thigh angular velocity curve (rs = 0.682 and rs = -0.641, respectively). The findings from this study suggest that it may be feasible to use IMU-derived angular velocities and acceleration measurements as proxy measures of knee variables in movements included in practitioner assessments used to monitor ACL injury risk.
Collapse
Affiliation(s)
- Holly S. R. Jones
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| | - Victoria H. Stiles
- Sport and Health Sciences, University of Exeter, St Luke’s Campus, Exeter EX1 2LU, UK
| | - Jasper Verheul
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| | - Isabel S. Moore
- Cardiff School of Sport and Health Sciences, Cardiff Metropolitan University, Cyncoed Campus, Cardiff CF23 6XD, UK
| |
Collapse
|
17
|
Dataset of lower extremity joint angles, moments and forces in distance running. Heliyon 2022; 8:e11517. [DOI: 10.1016/j.heliyon.2022.e11517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 10/17/2022] [Accepted: 11/02/2022] [Indexed: 11/16/2022] Open
|
18
|
Thomeer LT, Guan S, Gray HA, Pandy MG. Articular contact motion at the knee during daily activities. J Orthop Res 2022; 40:1756-1769. [PMID: 34878691 DOI: 10.1002/jor.25222] [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: 03/26/2021] [Revised: 08/31/2021] [Accepted: 11/20/2021] [Indexed: 02/04/2023]
Abstract
We combined mobile biplane X-ray imaging and magnetic resonance imaging to measure the regions of articular cartilage contact and cartilage thickness at the tibiofemoral and patellofemoral joints during six functional activities: standing, level walking, downhill walking, stair ascent, stair descent, and open-chain (non-weight-bearing) knee flexion. The contact centers traced similar paths on the medial and lateral femoral condyles, femoral trochlea, and patellar facet in all activities while their locations on the tibial plateau were more varied. The translations of the contact centers on the femur and patella were tightly coupled to the tibiofemoral flexion angle in all activities (r2 > 0.95) whereas those on the tibia were only moderately related to the flexion angle (r2 > 0.62). The regions of contacting cartilage were significantly thicker than the regions of non-contacting cartilage on the patella, femoral trochlea, and the medial and lateral tibial plateaus in all activities (p < 0.001). There were no significant differences in thickness between contacting and non-contacting cartilage on the medial and lateral femoral condyles in all activities, except open-chain knee flexion. Our results provide partial support for the proposition that cartilage thickness is adapted to joint load and do not exclude the possibility that other factors, such as joint congruence, also play a role in regulating the structure and organization of healthy cartilage. The data obtained in this study may serve as a guide when evaluating articular contact motion in osteoarthritic and reconstructed knees.
Collapse
Affiliation(s)
- Lucas T Thomeer
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Shanyuanye Guan
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Hans A Gray
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| | - Marcus G Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
19
|
Khan MJ, Asif N, Aziz MH, Raza A, Anwar S, Nuhmani S, Alghadir AH, Khan M. Does an Adjustable-Loop Device Loosen following ACL Reconstruction with a Hamstring Graft? A Retrospective Study with a Follow-Up of Two Years. J Clin Med 2022; 11:jcm11133648. [PMID: 35806933 PMCID: PMC9267585 DOI: 10.3390/jcm11133648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 11/16/2022] Open
Abstract
Arthroscopic anatomic anterior cruciate ligament reconstruction (ACLR) is the gold standard treatment for an ACL tear and requires the use of fixed or adjustable-loop devices to fix a femoral-side graft. Although the adjustable mechanism is designed to provide one-way tensioning, there is a concern that the adjustable loop will loosen and lengthen during cyclic loads, creating graft laxity. The present paper is a retrospective study of patients who underwent ACLR with the fixation of a hamstring graft with an adjustable loop on the femoral side from November 2016 to October 2018. The knee’s functional outcome was evaluated using an International Knee Documentation Committee (IKDC) score, Lysholm score, Lachman test, and pivot shift test. The patients were assessed preoperatively and finally postoperatively after two years of surgery. Thirty-two patients were analyzed. Significant improvement was obtained in the final clinical outcome of the patients. Twenty-seven patients (84.4%) were Lachman negative, and twenty-eight patients (87.5%) were pivot shift test negative, the mean Lysholm score was 96.91, and the IKDC score was 91.47 (p < 0.001). There was no infection, graft failure, or flexion restriction. Arthroscopic ACLR with an adjustable-loop suspensory device is a successful fixation method for femoral-side graft fixation and offers a similar functional outcome as with fixed-loop devices.
Collapse
Affiliation(s)
- Mohammad Jesan Khan
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Naiyer Asif
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Mohd Hadi Aziz
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Ariz Raza
- Department of Orthopaedic Surgery, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India; (M.J.K.); (N.A.); (M.H.A.); (A.R.)
| | - Shahzad Anwar
- Department of TB and Chest, Jawaharlal Nehru Medical College Hospital, Aligarh Muslim University, Aligarh 202002, Uttar Pradesh, India;
| | - Shibili Nuhmani
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman bin Faisal University, Dammam 34221, Saudi Arabia;
| | - Ahmad H. Alghadir
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
| | - Masood Khan
- Rehabilitation Research Chair, Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia;
- Correspondence: or ; Tel.: +966-11-469-8544
| |
Collapse
|
20
|
A musculoskeletal finite element model of rat knee joint for evaluating cartilage biomechanics during gait. PLoS Comput Biol 2022; 18:e1009398. [PMID: 35657996 PMCID: PMC9166403 DOI: 10.1371/journal.pcbi.1009398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
Abnormal loading of the knee due to injuries or obesity is thought to contribute to the development of osteoarthritis (OA). Small animal models have been used for studying OA progression mechanisms. However, numerical models to study cartilage responses under dynamic loading in preclinical animal models have not been developed. Here we present a musculoskeletal finite element model of a rat knee joint to evaluate cartilage biomechanical responses during a gait cycle. The rat knee joint geometries were obtained from a 3-D MRI dataset and the boundary conditions regarding loading in the joint were extracted from a musculoskeletal model of the rat hindlimb. The fibril-reinforced poroelastic (FRPE) properties of the rat cartilage were derived from data of mechanical indentation tests. Our numerical results showed the relevance of simulating anatomical and locomotion characteristics in the rat knee joint for estimating tissue responses such as contact pressures, stresses, strains, and fluid pressures. We found that the contact pressure and maximum principal strain were virtually constant in the medial compartment whereas they showed the highest values at the beginning of the gait cycle in the lateral compartment. Furthermore, we found that the maximum principal stress increased during the stance phase of gait, with the greatest values at midstance. We anticipate that our approach serves as a first step towards investigating the effects of gait abnormalities on the adaptation and degeneration of rat knee joint tissues and could be used to evaluate biomechanically-driven mechanisms of the progression of OA as a consequence of joint injury or obesity. Osteoarthritis is a disease of the musculoskeletal system which is characterized by the degradation of articular cartilage. Changes in the knee loading after injuries or obesity contribute to the development of cartilage degeneration. Since injured cartilage cannot be reversed back to intact conditions, small animal models have been widely used for investigating osteoarthritis progression mechanisms. Moreover, experimental studies have been complemented with numerical models to overcome inherent limitations such as cost, difficulties to obtain accurate measures and replicate degenerative situations in the knee joint. However, computational models to study articular cartilage responses under dynamic loading in small animal models have not been developed. Thus, here we present a musculoskeletal finite element model (MSFE) of a rat knee joint to evaluate cartilage biomechanical responses during gait. Our computational model considers both the anatomical and locomotion characteristics of the rat knee joint for estimating mechanical responses in the articular cartilage. We suggest that our approach can be used to investigate tissue adaptations based on the mechanobiological responses of the cartilage to prevent the progression of osteoarthritis.
Collapse
|
21
|
Innocenti B, Bori E, Paszicsnyek T. Functional stability: an experimental knee joint cadaveric study on collateral ligaments tension. Arch Orthop Trauma Surg 2022; 142:1213-1220. [PMID: 34046716 DOI: 10.1007/s00402-021-03966-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Applying proper tension to collateral ligaments during total knee arthroplasty surgery is fundamental to achieve optimal implant performance: low tension could lead to joint instability, over-tensioning leads to pain and stiffness. A "functional stability" must be defined and achieved during surgery to guarantee optimal results. In this study, an experimental cadaveric activity was performed to measure the minimum tension required to achieve knee functional stability. MATERIALS AND METHODS Ten knee specimens were investigated; femur and tibia were fixed in specifically designed fixtures and clamped to a loading frame; constant displacement rate was applied and resulting tension force was measured. Joint stability was determined as the slope change in the force/displacement curve, representing the activation of both collateral ligaments elastic region; the tension required to reach joint functional stability is then the span between ligaments toe region and this point. Intact, ACL (anterior cruciate ligament)-resected and ACL & PCL (posterior cruciate ligament)-resected knees were tested. The test was performed at different flexion angles; each configuration was analyzed three times. RESULTS Results demonstrated an overall tension of 40-50 N to be enough to reach stability in intact knees. Similar values are sufficient in ACL-resected knees, while significantly higher tension is required (up to 60 N) after cruciate ligaments resection. The tension required was slightly higher at 60° of flexion. CONCLUSION Results agree with other experimental studies, showing that the tensions required to stabilize a knee joint are lower than the ones applied nowadays via surgical tensioners. To reach functional stability, surgeons should consider such results intraoperatively and avoid ligament laxity or over-tension.
Collapse
Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Bruxelles, Belgium.
| | - Edoardo Bori
- BEAMS Department, Bio Electro and Mechanical Systems, École Polytechnique de Bruxelles, Université Libre de Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050, Bruxelles, Belgium
| | | |
Collapse
|
22
|
Rupp MC, Mehl J, Feucht MJ, Imhoff AB. Biomechanical Rationale of Correction Osteotomy and Overcorrection. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Aghdam HA, Haghighat F, Rezaee MR, Kavyani M, Karimi MT. Comparison of the knee joint reaction force between individuals with and without acute anterior cruciate ligament rupture during walking. J Orthop Surg Res 2022; 17:250. [PMID: 35505440 PMCID: PMC9066915 DOI: 10.1186/s13018-022-03136-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 04/19/2022] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cruciate ligament plays a significant role in knee joint stability. It is claimed that the incidence of knee osteoarthritis increases in individuals with anterior cruciate ligament (ACL) rupture. The aim of this study was to evaluate the knee joints reaction force in ACL rupture group compared to normal subjects.
Method Fifteen patients with acute ACL rupture and 15 healthy subjects participated in this study. The ground reaction force (GRF) and kinematic data were collected at a sampling rate of 120 Hz during level-ground walking. Spatiotemporal parameters, joint angles, muscle forces and moments, and joint reaction force (JRF) of lower extremity were analyzed by OpenSIM software. Results The hip, knee and ankle joints reaction force at loading response and push-off intervals of the stance phase during walking was significantly higher in individuals with ACL rupture compared to healthy controls (p value < 0.05). Walking velocity (p value < 0.001), knee (p value = 0.065) and ankle (p value = 0.001) range of motion in the sagittal plane were significantly lower in the patients with ACL rupture compared to healthy subjects. The mean value of vertical GRF in the mid-stance, the peak of the hip adduction moment in loading response and push-off phases, the hip abductor, knee flexor and vastus intermedius part of quadriceps muscle forces were significantly higher compared to healthy subjects (p < 0.05) while vastus medialis and vastus lateralis produced significantly lower force (p < 0.001). Conclusions Based on results of this study, lower limb JRF was higher in those with ACL rupture compared to healthy subjects may be due to the compensatory mechanisms used by this group of subjects. An increase in knee JRF in patients with ACL rupture may be the reason for the high incidence of knee OA.
Collapse
Affiliation(s)
- Hossein Akbari Aghdam
- Department of Orthopedic Surgery, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Farzaneh Haghighat
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mohammad Reza Rezaee
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mahsa Kavyani
- Musculoskeletal Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammad Taghi Karimi
- Rehabilitation Sciences Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
24
|
Abstract
Anterior cruciate ligament (ACL) injuries are one of the most common knee pathologies sustained during athletic participation and are characterised by long convalescence periods and associated financial burden. Muscles have the ability to increase or decrease the mechanical loads on the ACL, and thus are viable targets for preventative interventions. However, the relationship between muscle forces and ACL loading has been investigated by many different studies, often with differing methods and conclusions. Subsequently, this review aimed to summarise the evidence of the relationship between muscle force and ACL loading. A range of studies were found that investigated muscle and ACL loading during controlled knee flexion, as well as a range of weightbearing tasks such as walking, lunging, sidestep cutting, landing and jumping. The quadriceps and the gastrocnemius were found to increase load on the ACL by inducing anterior shear forces at the tibia, particularly when the knee is extended. The hamstrings and soleus appeared to unload the ACL by generating posterior tibial shear force; however, for the hamstrings, this effect was contingent on the knee being flexed greater than ~ 20° to 30°. The gluteus medius was consistently shown to oppose the knee valgus moment (thus unloading the ACL) to a magnitude greater than any other muscle. Very little evidence was found for other muscle groups with respect to their contribution to the loading or unloading of the ACL. It is recommended that interventions aiming to reduce the risk of ACL injury consider specifically targeting the function of the hamstrings, soleus and gluteus medius.
Collapse
|
25
|
Prado-Novoa M, Perez-Sanchez L, Estebanez B, Moreno-Vegas S, Perez-Blanca A. Influence of Loading Conditions on the Mechanical Performance of Multifilament Coreless UHMWPE Sutures Used in Orthopaedic Surgery. MATERIALS 2022; 15:ma15072573. [PMID: 35407907 PMCID: PMC9000354 DOI: 10.3390/ma15072573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 03/28/2022] [Accepted: 03/30/2022] [Indexed: 02/05/2023]
Abstract
This work studies the influence of loading velocity and previous cyclic loading history on the stiffness and strength of a multifilament coreless ultra-high-molecular-weight polyethylene (UHMWPE) surgical suture. Thread samples (n = 8) were subjected to a load-to-failure test at 0.1, 0.5, 1, 5, and 10 mm/s without previous loading history and after 10 cycles of loading at 1-10 N, 1-30 N, and 1-50 N. The experimental data were fitted to mathematical models to compute the stress-strain relation and the strength of the suture. The bilinear model involving two stress-strain ratios for low- and high-strain intervals was the best fit. The ratio in the low-strain range rose with loading speed, showing mean increases of 5.9%, 6.5%, 7.9%, and 7.3% between successive loading speeds. Without a previous loading history, this ratio was less than half than that at high strain. However, 10 cycles of 1-30 N or 1-50 N significantly increased the stress-strain ratio at a low strain level by 135% and 228%, respectively. The effect persisted after 2 min but vanished after 24 h. No influence was found on the suture strength. In conclusion, the stiffness of the studied suture was influenced by the strain level, loading velocity, and recent cyclic loading history. Conversely, the suture strength was not affected.
Collapse
Affiliation(s)
- Maria Prado-Novoa
- Clinical Biomechanics Laboratory of Andalusia, University of Malaga, Calle Dr. Ortiz Ramos s/n, 29071 Malaga, Spain; (L.P.-S.); (B.E.); (S.M.-V.); (A.P.-B.)
- Correspondence:
| | - Laura Perez-Sanchez
- Clinical Biomechanics Laboratory of Andalusia, University of Malaga, Calle Dr. Ortiz Ramos s/n, 29071 Malaga, Spain; (L.P.-S.); (B.E.); (S.M.-V.); (A.P.-B.)
- Telecomunication Research Institute (TELMA), University of Malaga, E.T.S. Ingenieria de Telecomunicaciones, Bulevar Louis Pasteur 35, 29010 Malaga, Spain
| | - Belen Estebanez
- Clinical Biomechanics Laboratory of Andalusia, University of Malaga, Calle Dr. Ortiz Ramos s/n, 29071 Malaga, Spain; (L.P.-S.); (B.E.); (S.M.-V.); (A.P.-B.)
| | - Salvador Moreno-Vegas
- Clinical Biomechanics Laboratory of Andalusia, University of Malaga, Calle Dr. Ortiz Ramos s/n, 29071 Malaga, Spain; (L.P.-S.); (B.E.); (S.M.-V.); (A.P.-B.)
- Biomedical Research Institute of Malaga, Calle Dr. Miguel Díaz Recio, 28, 29010 Malaga, Spain
| | - Ana Perez-Blanca
- Clinical Biomechanics Laboratory of Andalusia, University of Malaga, Calle Dr. Ortiz Ramos s/n, 29071 Malaga, Spain; (L.P.-S.); (B.E.); (S.M.-V.); (A.P.-B.)
| |
Collapse
|
26
|
Williams JR, Neal K, Alfayyadh A, Khandha A, Manal K, Snyder-Mackler L, Buchanan TS. Patellofemoral contact forces after ACL reconstruction: A longitudinal study. J Biomech 2022; 134:110993. [PMID: 35182902 PMCID: PMC8976762 DOI: 10.1016/j.jbiomech.2022.110993] [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] [Received: 07/29/2021] [Revised: 12/13/2021] [Accepted: 02/07/2022] [Indexed: 11/17/2022]
Abstract
Osteoarthritis (OA) development after ACL reconstruction (ACLR) is common. Patellofemoral OA after ACLR is as prevalent as tibiofemoral OA; however, few have explored the mechanisms leading to disease development in this compartment. Biomechanical alterations may be one mechanism responsible for post-traumatic knee OA. Patellofemoral contact forces during dynamic tasks, such as running and single leg hops, have been assessed at return to sport and later time points. The results of these studies, however, contradict each other, are only cross-sectional in nature, and are limited to specific points in time within the movement pattern. The purpose of this study was to assess patellofemoral contact forces 3, 6, and 24 months after ACLR during level walking over the entirety of the movement pattern. Patellofemoral contact forces were calculated after determination of muscle forces from a validated, subject-specific, EMG-driven neuromusculoskeletal model. Statistical parametric mapping was used to compare patellofemoral contact forces between limbs and across time points. Patellofemoral underloading of the involved limb (vs. uninvolved) was present at 3 months (p < 0.001 from 7 to 30% of stance) and 6 months (p = 0.001 from 11 to 23% of stance and p = 0.025 from 27 to 32%) after ACLR but was resolved by 24 months. Both limbs' load increased from 3 to 6 months. The involved limb displayed relatively consistent loads from 6 months onward, while the uninvolved limb's decreased back down towards their 3-month values. Overall, these results suggest that early patellofemoral underloading exists after ACLR and may be leading to patellofemoral OA development.
Collapse
Affiliation(s)
- Jack R Williams
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States.
| | - Kelsey Neal
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States
| | - Abdulmajeed Alfayyadh
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States
| | - Ashutosh Khandha
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| | - Kurt Manal
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Kinesiology and Applied Physiology, University of Delaware, Newark, DE, United States
| | - Lynn Snyder-Mackler
- Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States; Department of Physical Therapy, University of Delaware, Newark, DE, United States
| | - Thomas S Buchanan
- Department of Mechanical Engineering, University of Delaware, Newark, DE, United States; Biomechanics and Movement Science, University of Delaware, Newark, DE, United States; Department of Biomedical Engineering, University of Delaware, Newark, DE, United States
| |
Collapse
|
27
|
Monson JK, Schoenecker J, Matheson JW, O'Keefe J, Schwery N, Hickmann A. Modern Principles for Rehabilitation for Medial and Lateral Knee Ligament Surgery: How to Optimize Outcomes. OPER TECHN SPORT MED 2022. [DOI: 10.1016/j.otsm.2022.150915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
28
|
Fusion of Wearable Kinetic and Kinematic Sensors to Estimate Triceps Surae Work during Outdoor Locomotion on Slopes. SENSORS 2022; 22:s22041589. [PMID: 35214491 PMCID: PMC8880119 DOI: 10.3390/s22041589] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/07/2022] [Accepted: 02/15/2022] [Indexed: 02/04/2023]
Abstract
Muscle–tendon power output is commonly assessed in the laboratory through the work loop, a paired analysis of muscle force and length during a cyclic task. Work-loop analysis of muscle–tendon function in out-of-lab conditions has been elusive due to methodological limitations. In this work, we combined kinetic and kinematic measures from shear wave tensiometry and inertial measurement units, respectively, to establish a wearable system for estimating work and power output from the soleus and gastrocnemius muscles during outdoor locomotion. Across 11 healthy young adults, we amassed 4777 strides of walking on slopes from −10° to +10°. Results showed that soleus work scales with incline, while gastrocnemius work is relatively insensitive to incline. These findings agree with previous results from laboratory-based studies while expanding technological capabilities by enabling wearable analysis of muscle–tendon kinetics. Applying this system in additional settings and activities could improve biomechanical knowledge and evaluation of protocols in scenarios such as rehabilitation, device design, athletics, and military training.
Collapse
|
29
|
Al Khatib F, Gouissem A, Mbarki R, Adouni M. Biomechanical Characteristics of the Knee Joint during Gait in Obese versus Normal Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:989. [PMID: 35055810 PMCID: PMC8775559 DOI: 10.3390/ijerph19020989] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis (OA) is a growing source of pain and disability. Obesity is the most important avoidable risk factor underlying knee OA. The processes by which obesity impacts osteoarthritis are of tremendous interest to osteoarthritis researchers and physicians, where the joint mechanical load is one of the pathways generally thought to cause or intensify the disease process. In the current work, we developed a hybrid framework that simultaneously incorporates a detailed finite element model of the knee joint within a musculoskeletal model to compute lower extremity muscle forces and knee joint stresses in normal-weight (N) and obese (OB) subjects during the stance phase gait. This model accounts for the synergy between the active musculature and passive structures. In comparing OB subjects and normal ones, forces significantly increased in all muscle groups at most instances of stance. Mainly, much higher activation was computed with lateral hamstrings and medial gastrocnemius. Cartilage contact average pressure was mostly supported by the medial plateau and increased by 22%, with a larger portion of the load transmitted via menisci. This medial compartment experienced larger relative movement and cartilage stresses in the normal subjects and continued to do so with a higher level in the obese subjects. Finally, the developed bioengineering frame and the examined parameters during this investigation might be useful clinically in evaluating the initiation and propagation of knee OA.
Collapse
Affiliation(s)
- Fadi Al Khatib
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Afif Gouissem
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Raouf Mbarki
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Malek Adouni
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
- Physical Medicine and Rehabilitation Department, Northwestern University, 345 East Superior Street, Chicago, IL 60611, USA
| |
Collapse
|
30
|
Wang S, Hase K, Ota S. A Computationally Efficient Lower Limb Finite Element Musculoskeletal Framework Directly Driven Solely by Inertial Measurement Unit Sensors. J Biomech Eng 2021; 144:1129236. [PMID: 34897395 DOI: 10.1115/1.4053211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Indexed: 11/08/2022]
Abstract
Finite element musculoskeletal (FEMS) approaches using concurrent musculoskeletal and finite element models driven by motion data such as marker-based motion trajectory can provide insight into the interactions between the knee joint secondary kinematics, contact mechanics, and muscle forces in subject-specific biomechanical investigations. However, these data-driven FEMS systems have two major disadvantages that make them challenging to apply in clinical environments: they are computationally expensive and they require expensive and inconvenient equipment for data acquisition. In this study, we developed an FEMS model of the lower limb driven solely by inertial measurement unit sensors that includes the tissue geometries of the entire knee joint and combines muscle modeling and elastic foundation theory-based contact analysis of knee into a single framework. The model requires only the angular velocities and accelerations measured by the sensors as input, and the target outputs (knee contact mechanics, secondary kinematics, and muscle forces) are predicted from the convergence results of iterative calculations of muscle force optimization and knee contact mechanics. To evaluate its accuracy, the model was compared with in vivo experimental data during gait. The maximum contact pressure (12.6 MPa) in the rigid body contact analysis occurred on the medial side of the cartilage at the maximum loading response. The proposed computationally efficient framework drastically reduced the computational time (97.5% reduction) in comparison with the conventional deformable finite element analysis. The developed framework combines measurement convenience and computational efficiency and shows promise for clinical applications.
Collapse
Affiliation(s)
- Sentong Wang
- Graduate School of Systems Design, Tokyo Metropolitan University, Tokyo, Japan; 1-1 Minami-Osawa, Hachioji, Tokyo 192-0397, Japan
| | - Kazunori Hase
- Faculty of Systems Design, Tokyo Metropolitan University, Tokyo, Japan; 1-1 Minami-Osawa, Hachioji, Tokyo 192-0397, Japan
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Aichi, Japan; 2-172 Fukinodai, Tokai City 476-8588, Japan
| |
Collapse
|
31
|
van Vijven M, van Groningen B, Janssen RPA, van der Steen MC, van Doeselaar M, Stefanoska D, van Donkelaar CC, Ito K, Foolen J. Local variations in mechanical properties of human hamstring tendon autografts for anterior cruciate ligament reconstruction do not translate to a mechanically inferior strand. J Mech Behav Biomed Mater 2021; 126:105010. [PMID: 34896765 DOI: 10.1016/j.jmbbm.2021.105010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 11/17/2021] [Accepted: 11/25/2021] [Indexed: 11/25/2022]
Abstract
A ruptured anterior cruciate ligament (ACL) is often reconstructed with a multiple-strand autograft of a semitendinosus tendon alone or combined with a gracilis tendon. Up to 10% of patients experience graft rupture. This potentially results from excessive local tissue strains under physiological loading which could either result in direct mechanical failure of the graft or induce mechanobiological weakening. Since the original location in the hamstring tendon cannot be traced back from an autograft rupture site, this study explored whether clinical outcome could be further improved by avoiding specific locations or regions of human semitendinosus and/or gracilis tendons in ACL grafts due to potential mechanical or biochemical inferiority. Additionally, it examined numerically which clinically relevant graft configurations experience the lowest strains - and therefore the lowest rupture risk - when loaded with equal force. Remnant full-length gracilis tendons from human ACL reconstructions and full-length semitendinosus- and ipsilateral gracilis tendons of human cadaveric specimens were subjected to a stress-relaxation test. Locations at high risk of mechanical failure were identified using particle tracking to calculate local axial strains. As biochemical properties, the water-, collagen-, glycosaminoglycan- and DNA content per tissue region (representing graft strands) were determined. A viscoelastic lumped parameter model per tendon region was calculated. These models were applied in clinically relevant virtual graft configurations, which were exposed to physiological loading. Configurations that provided lower stiffness - i.e., experiencing higher strains under equal force - were assumed to be at higher risk of failure. Suitability of the gracilis tendon proper to replace semitendinosus muscle-tendon junction strands was examined. Deviations in local axial strains from the globally applied strain were of similar magnitude as the applied strain. Locations of maximum strains were uniformly distributed over tendon lengths. Biochemical compositions varied between tissue regions, but no trends were detected. Viscoelastic parameters were not significantly different between regions within a tendon, although semitendinosus tendons were stiffer than gracilis tendons. Virtual grafts with a full-length semitendinosus tendon alone or combined with a gracilis tendon displayed the lowest strains, whereas strains increased when gracilis tendon strands were tested for their suitability to replace semitendinosus muscle-tendon junction strands. Locations experiencing high local axial strains - which could increase risk of rupture - were present, but no specific region within any of the investigated graft configurations was found to be mechanically or biochemically deviant. Consequently, no specific tendon region could be indicated to provide a higher risk of rupture for mechanical or biochemical reasons. The semitendinosus tendon provided superior stiffness to a graft compared to the gracilis tendon. Therefore, based on our results it would be recommended to use the semitendinosus tendon, and use the gracilis tendon in cases where further reinforcement of the graft is needed to attain the desired length and cross-sectional area. All these data support current clinical standards.
Collapse
Affiliation(s)
- M van Vijven
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - B van Groningen
- Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands
| | - R P A Janssen
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands; Value-Based Health Care, Department of Paramedical Sciences, Fontys University of Applied Sciences, Postbus 347, 5600, AH, Eindhoven, the Netherlands
| | - M C van der Steen
- Department of Orthopaedic Surgery & Trauma, Máxima MC: Dominee Theodor Fliednerstraat 1, 5631, BM, Eindhoven, the Netherlands; Department of Orthopaedic Surgery & Trauma, Catharina Hospital Eindhoven, Michelangelolaan 2, 5623, EJ, Eindhoven, the Netherlands
| | - M van Doeselaar
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - D Stefanoska
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - C C van Donkelaar
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - K Ito
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands
| | - J Foolen
- Regenerative Engineering & Materials, Department of Biomedical Engineering, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands; Institute for Complex Molecular Systems, Eindhoven University of Technology, PO Box 513, 5600, MB, Eindhoven, the Netherlands.
| |
Collapse
|
32
|
Deichsel A, Glasbrenner J, Raschke MJ, Frank A, Peez C, Briese T, Herbst E, Kittl C. Bieten Knochenklammern eine gute Primärstabilität zur kortikalen Fixierung von Sehnentransplantaten? ARTHROSKOPIE 2021. [DOI: 10.1007/s00142-021-00496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
33
|
Logerstedt DS, Ebert JR, MacLeod TD, Heiderscheit BC, Gabbett TJ, Eckenrode BJ. Effects of and Response to Mechanical Loading on the Knee. Sports Med 2021; 52:201-235. [PMID: 34669175 DOI: 10.1007/s40279-021-01579-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/03/2021] [Indexed: 11/30/2022]
Abstract
Mechanical loading to the knee joint results in a differential response based on the local capacity of the tissues (ligament, tendon, meniscus, cartilage, and bone) and how those tissues subsequently adapt to that load at the molecular and cellular level. Participation in cutting, pivoting, and jumping sports predisposes the knee to the risk of injury. In this narrative review, we describe different mechanisms of loading that can result in excessive loads to the knee, leading to ligamentous, musculotendinous, meniscal, and chondral injuries or maladaptations. Following injury (or surgery) to structures around the knee, the primary goal of rehabilitation is to maximize the patient's response to exercise at the current level of function, while minimizing the risk of re-injury to the healing tissue. Clinicians should have a clear understanding of the specific injured tissue(s), and rehabilitation should be driven by knowledge of tissue-healing constraints, knee complex and lower extremity biomechanics, neuromuscular physiology, task-specific activities involving weight-bearing and non-weight-bearing conditions, and training principles. We provide a practical application for prescribing loading progressions of exercises, functional activities, and mobility tasks based on their mechanical load profile to knee-specific structures during the rehabilitation process. Various loading interventions can be used by clinicians to produce physical stress to address body function, physical impairments, activity limitations, and participation restrictions. By modifying the mechanical load elements, clinicians can alter the tissue adaptations, facilitate motor learning, and resolve corresponding physical impairments. Providing different loads that create variable tensile, compressive, and shear deformation on the tissue through mechanotransduction and specificity can promote the appropriate stress adaptations to increase tissue capacity and injury tolerance. Tools for monitoring rehabilitation training loads to the knee are proposed to assess the reactivity of the knee joint to mechanical loading to monitor excessive mechanical loads and facilitate optimal rehabilitation.
Collapse
Affiliation(s)
- David S Logerstedt
- Department of Physical Therapy, University of the Sciences in Philadelphia, Philadelphia, PA, USA.
| | - Jay R Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, WA, Australia.,Orthopaedic Research Foundation of Western Australia, Perth, WA, Australia.,Perth Orthopaedic and Sports Medicine Research Institute, Perth, WA, Australia
| | - Toran D MacLeod
- Department of Physical Therapy, Sacramento State University, Sacramento, CA, USA
| | - Bryan C Heiderscheit
- Orthopedics and Rehabilitation, University of Wisconsin-Madison, Madison, WI, USA
| | - Tim J Gabbett
- Gabbett Performance Solutions, Brisbane, QLD, Australia.,Centre for Health Research, University of Southern Queensland, Ipswich, QLD, Australia
| | - Brian J Eckenrode
- Department of Physical Therapy, Arcadia University, Glenside, PA, USA
| |
Collapse
|
34
|
Mitchell PK, Moffit TJ, Montgomery MM, Pamukoff DN. Running kinetics and femoral trochlea cartilage characteristics in recreational and collegiate distance runners. J Sports Sci 2021; 40:89-95. [PMID: 34494939 DOI: 10.1080/02640414.2021.1976492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Recreational running can benefit knee cartilage, but the relationship between competitive running and knee cartilage is unclear. We compared femoral cartilage between collegiate runners, recreational runners, and controls; and evaluated the association between running amount, running kinetics and femoral cartilage characteristics. Thirty collegiate runners, 30 recreational runners, and 30 controls completed ultrasound imaging of the femoral cartilage and running gait analysis. Outcomes included cartilage thickness, and echo-intensity from the medial and lateral femoral condyles; and the peak external knee flexion (KFM) and knee adduction moments. Cartilage outcomes were compared via one-way MANOVA. The associations between running kinetics, running amount, and femoral cartilage characteristics were assessed via linear regression models adjusted for sex. No differences were found in cartilage outcomes between groups (p = 0.067). Among recreational runners, a larger peak KFM was associated with lower medial femoral cartilage echo-intensity (ΔR2 = 0.176, Δp = 0.014). In collegiate runners, a greater self-reported running amount was associated with higher medial femoral cartilage (ΔR2 = 0.117, Δp = 0.046) and lateral cartilage (ΔR2 = 0.121, Δp = 0.042) echo-intensity. Cartilage did not differ between groups, but the association between running kinetics, running amount, and knee cartilage may vary between collegiate and recreational runners.
Collapse
Affiliation(s)
- Peter K Mitchell
- Department of Kinesiology, California State University, Fullerton, CA, USA
| | - Tyler J Moffit
- Department of Kinesiology, California State University, Bakersfield, CA, USA
| | | | | |
Collapse
|
35
|
Nasseri A, Lloyd DG, Bryant AL, Headrick J, Sayer TA, Saxby DJ. Mechanism of Anterior Cruciate Ligament Loading during Dynamic Motor Tasks. Med Sci Sports Exerc 2021; 53:1235-1244. [PMID: 33731661 DOI: 10.1249/mss.0000000000002589] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION This study determined anterior cruciate ligament (ACL) force and its contributors during a standardized drop-land-lateral jump task using a validated computational model. METHODS Three-dimensional whole-body kinematics, ground reaction forces, and muscle activation patterns from eight knee-spanning muscles were collected during dynamic tasks performed by healthy recreationally active females (n = 24). These data were used in a combined neuromusculoskeletal and ACL force model to determine lower limb muscle and ACL forces. RESULTS Peak ACL force (2.3 ± 0.5 bodyweight) was observed at ~14% of stance during the drop-land-lateral jump. The ACL force was primarily generated through the sagittal plane, and muscle was the dominant source of ACL loading. The main ACL antagonists (i.e., loaders) were the gastrocnemii and quadriceps, whereas the hamstrings were the main ACL agonists (i.e., supporters). CONCLUSION Combining neuromusculoskeletal and ACL force models, the roles of muscle in ACL loading and support were determined during a challenging motor task. Results highlighted the importance of the gastrocnemius in ACL loading, which could be considered more prominently in ACL injury prevention and rehabilitation programs.
Collapse
Affiliation(s)
| | | | - Adam L Bryant
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
| | | | - Timothy A Sayer
- Centre for Exercise, Health & Sports Medicine, University of Melbourne, Melbourne, AUSTRALIA
| | | |
Collapse
|
36
|
Gray HA, Guan S, Thomeer LT, Pandy MG. Moment arm of the knee-extensor mechanism measured in vivo across a range of daily activities. J Biomech 2021; 123:110484. [PMID: 34062347 DOI: 10.1016/j.jbiomech.2021.110484] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/19/2021] [Accepted: 04/20/2021] [Indexed: 11/27/2022]
Abstract
We measured the moment arm of the knee-extensor mechanism as ten healthy young individuals performed six functional activities: level walking, downhill walking, stair ascent, stair descent, open-chain (non-weight-bearing) knee flexion, and open-chain knee extension. The moment arm of the knee-extensor mechanism was described by the moment arm of the patellar-tendon force, which acts to rotate the tibia about the instantaneous axis of rotation (screw axis) of the knee. A mobile biplane X-ray imaging system enabled simultaneous measurements of the three-dimensional movements of the femur, tibia and patella during each activity, from which the position and orientation of the screw axis and the patellar-tendon moment arm (PTMA) were determined. Mean PTMA across all activities and all participants remained nearly constant (~46 mm) from 0° to 70° of knee flexion and decreased by no more than 20% at higher flexion angles. The magnitude of the PTMA varied more substantially across individuals than across activities, indicating that the moment arm is more heavily influenced by differences in knee-joint geometry than muscle loading. Hence, PTMA measurements obtained for a given activity performed by one individual may be used with good confidence to describe the PTMA for any other activity performed by the same individual. Caution is advised when using PTMA measurements obtained from one individual to describe the moment arm in another individual even once the data are normalized by knee bone size, as the PTMA varied by as much as 13% from the mean across individuals.
Collapse
Affiliation(s)
- Hans A Gray
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Shanyuanye Guan
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Lucas T Thomeer
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia
| | - Marcus G Pandy
- Dept of Mechanical Engineering, University of Melbourne, Victoria 3010, Australia.
| |
Collapse
|
37
|
Knee loading in OA subjects is correlated to flexion and adduction moments and to contact point locations. Sci Rep 2021; 11:8594. [PMID: 33883591 PMCID: PMC8060429 DOI: 10.1038/s41598-021-87978-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 03/29/2021] [Indexed: 11/29/2022] Open
Abstract
This study evaluated the association of contact point locations with the knee medial and lateral contact force (Fmed, Flat) alterations in OA and healthy subjects. A musculoskeletal model of the lower limb with subject-specific tibiofemoral contact point trajectories was used to estimate the Fmed and Flat in ten healthy and twelve OA subjects during treadmill gait. Regression analyses were performed to evaluate the correlation of the contact point locations, knee adduction moment (KAM), knee flexion moment (KFM), frontal plane alignment, and gait speed with the Fmed and Flat. Medial contact point locations in the medial–lateral direction showed a poor correlation with the Fmed in OA (R2 = 0.13, p = 0.01) and healthy (R2 = 0.24, p = 0.001) subjects. Anterior–posterior location of the contact points also showed a poor correlation with the Fmed of OA subjects (R2 = 0.32, p < 0.001). Across all subjects, KAM and KFM remained the best predictors of the Fmed and Flat, respectively (R2 between 0.62 and 0.69). Results suggest different mechanisms of contact force distribution in OA joints. The variations in the location of the contact points participate partially to explains the Fmed variations in OA subjects together with the KFM and KAM.
Collapse
|
38
|
Bodden J, Ok AH, Joseph GB, Nevitt MC, McCulloch CE, Lane NE, Link TM. Joint-adjacent Adipose Tissue by MRI is Associated With Prevalence and Progression of Knee Degenerative Changes: Data from the Osteoarthritis Initiative. J Magn Reson Imaging 2021; 54:155-165. [PMID: 33644919 DOI: 10.1002/jmri.27574] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2020] [Revised: 02/06/2021] [Accepted: 02/09/2021] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Adipose tissue has recently gained interest as an independent imaging biomarker for osteoarthritis. PURPOSE To explore 1) cross-sectional associations between local subcutaneous fat (SCF) thickness at the knee and the extent of degenerative changes in overweight and obese individuals and 2) associations between local fat distribution and progression of osteoarthritis over 4 years. STUDY TYPE Retrospective cohort study. POPULATION 338 obese and overweight participants from the Osteoarthritis Initiative cohort without radiographic evidence of osteoarthritis. FIELD STRENGTH 3T: 3D-FLASH-WE; 3D-DESS-WE; T1w-SE; MSME. ASSESSMENT Baseline SCF thickness was measured in standardized locations medial, lateral and anterior to the knee and the average joint-adjacent SCF (ajSCF) was calculated. Right thigh SCF cross-sectional area was assessed. Quantitative cartilage T2 relaxation times and semi-quantitative whole organ MRI scores (WORMS) were obtained at baseline and 4-year follow-up. WORMSsum was calculated as sum of cartilage, bone marrow edema, subchondral cyst, and meniscal scores. STATISTICAL TESTS Associations of SCF measures with baseline, and 4-year change in T2 and WORMS were analyzed using regression models. SCF measurements were standardized using the equation Value Participant - Mean Cohort Standard deviation . Analyses were adjusted for age, sex, physical activity, and BMI. RESULTS Cross-sectionally, significant associations between lateral SCF, lateral compartment WORMS and T2 were found ( Δ WORMS sum 1 SD change in lateral SCF , [95% CI]: 0.53, [0.12-0.95], P < 0.05; ΔT2 : 0.50, [0.02-0.98], P < 0.05). Moreover, greater lateral SCF was associated with faster progression of lateral WORMSsum gradings (OR = 1.50, [1.05-2.15], P < 0.05). No significant positive associations were found for thigh SCF and WORMSsum (P = 0.44) or T2 measurements (medial: P = 0.15, lateral: 0.39, patellar: P = 0.75). DATA CONCLUSION Joint-adjacent SCF thickness was associated with imaging parameters of knee osteoarthritis, both cross-sectionally and longitudinally, while thigh SCF was not, suggesting a spatial association of SCF and knee osteoarthritis. Based on these findings, joint-adjacent SCF may play a role in the development and progression of knee osteoarthritis. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 5.
Collapse
Affiliation(s)
- Jannis Bodden
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA.,Department of Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Ahmet H Ok
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Nancy E Lane
- Center for Musculoskeletal Health and Department of Medicine, University of California, Davis, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, California, USA
| |
Collapse
|
39
|
Ekeland A, Nerhus TK, Dimmen S, Heir S. Better functional results of opening wedge HTO for varus knees with medial osteoarthritis than opening wedge LFO for valgus knees with lateral osteoarthritis. Bone Jt Open 2020; 1:346-354. [PMID: 33215123 PMCID: PMC7659673 DOI: 10.1302/2633-1462.17.bjo-2020-0081.r1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/16/2020] [Indexed: 11/05/2022] Open
Abstract
Aims To compare time dependent functional improvement for patients with medial, respectively lateral knee osteoarthritis (OA) after treatment with opening wedge osteotomy relieving the pressure on the osteoarthritic part of the knee. Methods In all, 49 patients (52 knees) with a mean age of 47 years (31 to 64) underwent high tibial osteotomies (HTO), and 24 patients with a mean age of 48 years (31 to 62) low femoral osteotomies (LFO) with opening wedge technique due to medial, respectively lateral knee OA with malalignment. All osteotomies were stabilized with a Puddu plate and bone grafting performed in the same time period (2000 to 2008). The patients were evaluated by the Knee Injury and Osteoarthritis Outcome Score (KOOS) pre-operatively and at six months, and at one, two, five, and ten years postoperatively. The knee OA was graded according to the Ahlbäck and Kellgren-Lawrence radiological scoring systems. Results The mean angular corrections were 8.0° (4° to 12°) for the HTO and 9.6° (4° to 20°) for the LFO. Both the pre-operative KOOS and the osteoarthritic gradings were similar for the two patient groups. The five subscores of KOOS increased significantly during the postoperative period (p < 0.001 to 0.029) levelling out after one year in both groups. The KOOS subscore symptoms was significantly higher for patients with HTO than those with LFO at all follow-up times, for sport and recreation in the period one to five years, and for pain and quality of life at two to five years (p < 0.001 to 0.009). Eight HTOs (15%) and five LFOs (21%) were converted to total knee arthroplasty after mean 6.7 years (2.0 to 9.8) and 5.4 years (4.0 to 8.0) respectively. The ten-year osteotomy survival rates were 88% for the HTO and 79% for the LFO (p = 0.745). Conclusion Patients with unicompartmental knee OA improved after a corrective opening wedge osteotomy, but four of the five subscores of KOOS were significantly higher for those with medial than those with lateral OA in most of the ten-year follow-up period. Cite this article: Bone Joint Open 2020;1-7:346–354.
Collapse
Affiliation(s)
| | | | | | - Stig Heir
- Martina Hansens Hospital, Sandvika, Norway
| |
Collapse
|
40
|
Load Distribution at the Patellofemoral Joint During Walking. Ann Biomed Eng 2020; 48:2821-2835. [DOI: 10.1007/s10439-020-02672-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 10/21/2020] [Indexed: 12/24/2022]
|
41
|
Deveza L, Hajizadeh K, Song B, Park I. Neutral boundary alignment in total knee arthroplasty: a novel concept. J Exp Orthop 2020; 7:62. [PMID: 32864722 PMCID: PMC7456625 DOI: 10.1186/s40634-020-00280-4] [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: 05/08/2020] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
The goal of total knee arthroplasty (TKA) surgery is to provide a stable and functional knee joint using current implant designs. Several alignment philosophies and surgical techniques have been introduced to provide a stable and functional knee joint, such as mechanical alignment (MA), kinematic alignment (KA), and anatomical alignment (AA). Recently, functional alignment (FA) is proposed. In this concept article, we propose a TKA approach, which we termed “Neutral Boundary Alignment (NBA).” The proposed approach seeks to establish the overall limb alignment in the direction of gravity at the midstance of gait cycle; consequently, a potential native knee can be restored from an arthritic state by establishing the joint line parallel to the ground. Herein, the NBA approach is described, and an iterative algorithm of structural layout patterns of truss is developed. The following three hypotheses are proposed: 1) The joint line should be parallel to the ground during the midstance of gait as an important initial condition for stability when transitioning toward gait propulsion in the gait cycle; 2) The NBA stability criteria purports that the leg is stable when the direction of gravity is simultaneously situated within the hip, knee and ankle during the midstance of gait, which generally agrees with the Varus/Valgus 3 degree envelope of MA; 3) Femoral and tibial resections that are made parallel to the ground remain within 1.5 degrees of traditional mechanical alignment resections.
Collapse
Affiliation(s)
- Lorenzo Deveza
- Department of Orthopaedic Surgery, Baylor College of Medicine, 7200 Cambridge Ste 10A, Houston, TX, 77030, USA.
| | | | - Benjamin Song
- CHA Hollywood Presbyterian Medical Center, Los Angeles, CA, USA
| | - Ilwhan Park
- Lento Medical Innovation, Inc, Houston, TX, USA
| |
Collapse
|
42
|
Abstract
PURPOSE OF REVIEW The patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. RECENT FINDINGS While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.
Collapse
|
43
|
Kaplan JT, Ramsay JW, Cameron SE, Seymore KD, Brehler M, Thawait GK, Zbijewski WB, Siewerdsen JH, Brown TN. Association Between Knee Anatomic Metrics and Biomechanics for Male Soldiers Landing With Load. Am J Sports Med 2020; 48:1389-1397. [PMID: 32255657 DOI: 10.1177/0363546520911608] [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: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a military occupational hazard that may be attributed to an individual's knee biomechanics and joint anatomy. This study sought to determine if greater flexion when landing with load resulted in knee biomechanics thought to decrease ACL injury risk and whether knee biomechanics during landing relate to knee anatomic metrics. HYPOTHESIS Anatomic metrics regarding the slope and concavity of the tibial plateau will exhibit a significant relation to the increased anterior shear force on the knee and decreased knee flexion posture during landing with body-borne load. STUDY DESIGN Descriptive laboratory study. METHODS Twenty male military personnel completed a drop landing task with 3 load conditions: light (~6 kg), medium (15% body weight), and heavy (30% body weight). Participants were divided into groups based on knee flexion exhibited when landing with the heavy load (high- and low-Δflexion). Tibial slopes and depth were measured on weightbearing volumetric images of the knee obtained with a prototype cone beam computed tomography system. Knee biomechanics were submitted to a linear mixed model to evaluate the effect of landing group and load, with the anatomic metrics considered covariates. RESULTS Load increased peak proximal anterior tibial shear force (P = .034), knee flexion angle (P = .024), and moment (P = .001) during landing. Only the high flexion group increased knee flexion (P < .001) during weighted landings with medium and heavy loads. The low flexion group used greater knee abduction angle (P = .030) and peak proximal anterior tibial shear force (P = .034) when landing with load. Anatomic metrics did not differ between groups, but ratio of medial-to-lateral tibial slope and medial tibial depth predicted peak proximal anterior tibial shear force (P = .009) and knee flexion (P = .034) during landing, respectively. CONCLUSION Increasing knee flexion is an attainable strategy to mitigate risk of ACL injury, but certain individuals may be predisposed to knee forces and biomechanics that load the ACL during weighted landings. CLINICAL RELEVANCE The ability to screen individuals for anatomic metrics that predict knee flexion may identify soldiers and athletes who require additional training to mitigate the risk of lower extremity injury.
Collapse
Affiliation(s)
- Jonathan T Kaplan
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | - John W Ramsay
- Combat Capabilities Development Command Soldier Center, Natick, Massachusetts, USA
| | | | - Kayla D Seymore
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
| | - Michael Brehler
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Gaurav K Thawait
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA
| | - Wojciech B Zbijewski
- Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jeffrey H Siewerdsen
- Russel H. Morgan Department of Radiology, Johns Hopkins University, Baltimore, Maryland, USA.,Department of Biomedical Engineering, Johns Hopkins University, Baltimore, Maryland, USA
| | - Tyler N Brown
- Department of Kinesiology, Boise State University, Boise, Idaho, USA
| |
Collapse
|
44
|
Naghibi H, Janssen D, van den Boogaard T, van Tienen T, Verdonschot N. The implications of non-anatomical positioning of a meniscus prosthesis on predicted human knee joint biomechanics. Med Biol Eng Comput 2020; 58:1341-1355. [PMID: 32279202 PMCID: PMC7211793 DOI: 10.1007/s11517-020-02158-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 03/12/2020] [Indexed: 11/26/2022]
Abstract
Despite all the efforts to optimize the meniscus prosthesis system (geometry, material, and fixation type), the success of the prosthesis in clinical practice will depend on surgical factors such as intra-operative positioning of the prosthesis. In this study, the aim was therefore to assess the implications of positional changes of the medial meniscus prosthesis for knee biomechanics. A detailed validated finite element (FE) model of human intact and meniscal implanted knees was developed based on a series of in vitro experiments. Different non-anatomical prosthesis positions were applied in the FE model, and the biomechanical response during the gait stance phase compared with an anatomically positioned prosthesis, as well as meniscectomized and also the intact knee model. The results showed that an anatomical positioning of the medial meniscus prosthesis could better recover the intact knee biomechanics, while a non-anatomical positioning of the prosthesis to a limited extent alters the knee kinematics and articular contact pressure and increases the implantation failure risk. The outcomes indicate that a medial or anterior positioning of the meniscus prosthesis may be more forgiving than a posteriorly or laterally positioned prosthesis. The outcome of this study may provide a better insight into the possible consequences of meniscus prosthesis positioning errors for the patient and the prosthesis functionality. Graphical abstract ![]()
Collapse
Affiliation(s)
- Hamid Naghibi
- Robotics and Mechatronics Lab, Technical Medical (TechMed) Centre, University of Twente, Building Carré, Room CR 3607, P.O. Box 217, 7500 AE, Enschede, The Netherlands.
- Radboud Institute for Health Sciences, Orthopaedic Research Lab, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands.
| | - Dennis Janssen
- Radboud Institute for Health Sciences, Orthopaedic Research Lab, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Ton van den Boogaard
- Nonlinear Solid Mechanics, Faculty of Engineering Technology, University of Twente, 7522 NB, Enschede, The Netherlands
| | - Tony van Tienen
- Radboud Institute for Health Sciences, Orthopaedic Research Lab, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
| | - Nico Verdonschot
- Radboud Institute for Health Sciences, Orthopaedic Research Lab, Radboud University Medical Center, 6525 GA, Nijmegen, The Netherlands
- Laboratory of Biomechanical Engineering, University of Twente, 7522 NB, Enschede, The Netherlands
| |
Collapse
|
45
|
Naghibi H, Janssen D, Van Tienen T, Van de Groes S, Van de Boogaard T, Verdonschot N. A novel approach for optimal graft positioning and tensioning in anterior cruciate ligament reconstructive surgery based on the finite element modeling technique. Knee 2020; 27:384-396. [PMID: 32024608 DOI: 10.1016/j.knee.2020.01.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 11/26/2019] [Accepted: 01/20/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND In ACL-reconstructed patients the postoperative knee biomechanics may differ from the intact knee biomechanical behavior which can alter knee kinematics and kinetics, and as a result lead to the progression of knee osteoarthritis. The aim of this study was to demonstrate the potential of finite element models to define the optimal choices in surgical parameters in terms of optimal graft positioning in combination with graft type in order to restore the kinematic and kinetic behavior of the knee as best as possible. METHODS A workflow was proposed based on cadaveric experiments in order to restore the injured knee to a near normal physiological condition. Femoral and tibial graft insertion sites and graft fixation tension were optimized to obtain similar intact knee laxity, for three common single-bundle and one double-bundle reconstructions. To verify the success of the surgery with the variables calculated using the proposed workflow, a full walking cycle was simulated with the intact, ACL-ruptured, optimal ACL-reconstructed and non-optimal reconstructed knees. RESULTS Our results suggested that for patellar tendon and hamstring tendon grafts, anatomical positioning (fixation force: 40 N), and for quadriceps tendon graft, isometric positioning (fixation tension: 85 N) could recover the intact joint kinematics and kinetics. Also for double-bundle reconstruction, with the numerically calculated optimal insertion sites, both bundles needed 50-N fixation force. CONCLUSIONS With optimal graft positioning parameters, following the proposed workflow in this study, any of the single-bundle graft types and surgical techniques (single vs. double-bundle) may be used to acceptably recover the intact knee joint biomechanical behavior.
Collapse
Affiliation(s)
- Hamid Naghibi
- Robotics and Mechatronics Lab, University of Twente, Enschede, the Netherlands.
| | - Dennis Janssen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Tony Van Tienen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Sebastiaan Van de Groes
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands
| | - Ton Van de Boogaard
- Nonlinear Solid Mechanics, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
| | - Nico Verdonschot
- Radboud University Medical Center, Radboud Institute for Health Sciences, Orthopaedic Research Lab, 6525, GA, Nijmegen, the Netherlands; Laboratory of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
| |
Collapse
|
46
|
Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
Collapse
Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
47
|
Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.
Collapse
Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| |
Collapse
|
48
|
Karabulut D, Dogru SC, Lin YC, Pandy MG, Herzog W, Arslan YZ. Direct Validation of Model-Predicted Muscle Forces in the Cat Hindlimb During Locomotion. J Biomech Eng 2020; 142:1071854. [DOI: 10.1115/1.4045660] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Indexed: 11/08/2022]
Abstract
Abstract
Various methods are available for simulating the movement patterns of musculoskeletal systems and determining individual muscle forces, but the results obtained from these methods have not been rigorously validated against experiment. The aim of this study was to compare model predictions of muscle force derived for a cat hindlimb during locomotion against direct measurements of muscle force obtained in vivo. The cat hindlimb was represented as a 5-segment, 13-degrees-of-freedom (DOF), articulated linkage actuated by 25 Hill-type muscle-tendon units (MTUs). Individual muscle forces were determined by combining gait data with two widely used computational methods—static optimization and computed muscle control (CMC)—available in opensim, an open-source musculoskeletal modeling and simulation environment. The forces developed by the soleus, medial gastrocnemius (MG), and tibialis anterior muscles during free locomotion were measured using buckle transducers attached to the tendons. Muscle electromyographic activity and MTU length changes were also measured and compared against the corresponding data predicted by the model. Model-predicted muscle forces, activation levels, and MTU length changes were consistent with the corresponding quantities obtained from experiment. The calculated values of muscle force obtained from static optimization agreed more closely with experiment than those derived from CMC.
Collapse
Affiliation(s)
- Derya Karabulut
- Department of Mechanical Engineering, Faculty of Engineering, Istanbul University-Cerrahpasa, Avcilar, Istanbul 34320, Turkey
| | - Suzan Cansel Dogru
- Department of Mechanical Engineering, Faculty of Engineering, Istanbul University-Cerrahpasa, Avcilar, Istanbul 34320, Turkey
| | - Yi-Chung Lin
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Marcus G. Pandy
- Department of Mechanical Engineering, University of Melbourne, Parkville, Victoria 3010, Australia
| | - Walter Herzog
- Human Performance Laboratory, The University of Calgary, Calgary, AB T2N 1N4, Canada
| | - Yunus Ziya Arslan
- Department of Mechanical Engineering, Faculty of Engineering, Istanbul University-Cerrahpasa, Avcilar, Istanbul 34320, Turkey
| |
Collapse
|
49
|
Singh S, Shaunak S, Shaw SCK, Anderson JL, Mandalia V. Adjustable Loop Femoral Cortical Suspension Devices for Anterior Cruciate Ligament Reconstruction: A Systematic Review. Indian J Orthop 2020; 54:426-443. [PMID: 32549958 PMCID: PMC7270319 DOI: 10.1007/s43465-019-00022-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 09/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) injury is a common sports injury. Symptomatic knee instability after this injury is usually treated operatively through ACL reconstruction. The surgery involves a tendon graft being fixed in bony tunnels drilled through femur and tibia. The fixation of the graft is of critical importance to achieving good results. One of the commonest devices used to fix the graft in the femoral bony tunnel is a fixed loop cortical suspensory device. More recently, adjustable loop cortical suspension devices have been introduced, and have gained popularity for ACL reconstruction. These allow for adjusting the length of the suspension loop after insertion. There is currently much debate concerning whether the adjustable loop devices are superior or inferior to the fixed loop devices. PURPOSE To critique and review the current biomechanical and clinical evidence on the use of adjustable loop devices in hamstring ACL reconstruction. To our knowledge, there have been no previous reviews of this topic. STUDY DESIGN Systematic review. METHODS This systematic review was conducted in accordance with PRISMA. Five databases were searched using multiple search terms and MeSH terms where possible. The following limits were applied: papers published in English and papers published in the last 21 years. RESULTS Eleven laboratory and six clinical studies were reviewed. The laboratory-based studies have frequently shown elongation of adjustable loop devices to more than 3 mm under loading protocols, whereas the clinical studies have not shown any significant differences between the patients with fixed loop and the ones with adjustable loop devices. CLINICAL SIGNIFICANCE This review shows a discrepancy between laboratory-based and clinical studies. The review of clinical studies in our paper would give future researchers confidence and act as a prompt to construct randomised clinical trials to investigate these devices further. CONCLUSION We feel that more robust clinical randomised studies and trials are needed to evaluate these new devices.
Collapse
Affiliation(s)
- Sarvpreet Singh
- Department of Trauma and Orthopaedics, North West Anglia NHS Foundation Trust, Cambridgeshire, UK
| | | | - Sebastian C. K. Shaw
- Department of Medical Education, Brighton and Sussex Medical School, Brighton, East Sussex UK
| | | | - Vipul Mandalia
- Western Sussex Hospitals NHS Foundation Trust, West Sussex, UK
| |
Collapse
|
50
|
Sarpong NO, Sonnenfeld JJ, LiArno S, Rajaravivarma R, Donde S, Sneddon E, Kaverina T, Cooper HJ, Shah RP, Geller JA. Virtual reconstruction of the posterior cruciate ligament for mechanical testing of total knee arthroplasty implants. Knee 2020; 27:151-156. [PMID: 31761707 DOI: 10.1016/j.knee.2019.10.023] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 08/26/2019] [Accepted: 10/26/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Total knee arthroplasty (TKA) design continues to be refined. As part of the pre-clinical design process, kinematic evaluation under ideal circumstances must be simulated. Previously, this was accomplished mechanically through the use of elastomeric bumpers and human cadaver models, which can be costly and time-intensive. With improved technology, a six-axis joint simulator now allows for virtual ligament reconstruction. The aim of this study was to create and evaluate a virtual posterior cruciate ligament (PCL) model to simulate native knee kinematics for component testing in TKA. METHODS Three human cadaveric knee specimens were utilized, each mounted in a six-axis joint simulator and the femoral and tibial ligament insertion points digitized. Ligament stiffness and kinematics were first tested with the intact knee, followed by retesting after PCL transection. Knee kinematic testing was then repeated, and the virtual PCL was reconstructed until it approximated that of the intact knee by achieving less than 10% random mean square (RMS) error. RESULTS A virtual three-bundle PCL was created. The RMS error in anterior-posterior motion between the virtually reconstructed PCL and the intact knee ranged from six to eight percent for simulated stair climbing in the three knee specimens tested, all within our target goal of less than 10%. CONCLUSION This study indicated that a virtually reconstructed three-bundle PCL with a joint simulator can replicate knee kinematics. Such an approach is valuable to obtain clinically relevant kinematics when testing cruciate-retaining total knee arthroplasty under force control.
Collapse
Affiliation(s)
- Nana O Sarpong
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America.
| | - Julian J Sonnenfeld
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Sally LiArno
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Raga Rajaravivarma
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Sonia Donde
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Emily Sneddon
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - Tatyana Kaverina
- Stryker, 325 Corporate Drive, Mahwah, NJ 07430, United States of America
| | - H John Cooper
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Roshan P Shah
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| | - Jeffrey A Geller
- Center for Hip and Knee Replacement, Department of Orthopedic Surgery, Columbia University Irving Medical Center, 622 West 168th Street PH 1138, New York, NY 10032, United States of America
| |
Collapse
|