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Winslow E, Pan X, Hull ML. Analysis of Variation in Sagittal Curvature of the Femoral Condyles. J Biomech Eng 2024; 146:111004. [PMID: 38913074 DOI: 10.1115/1.4065813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 06/06/2024] [Indexed: 06/25/2024]
Abstract
In designing femoral components, which restore native (i.e., healthy) knee kinematics, the flexion-extension (F-E) axis of the tibiofemoral joint should match that of the native knee. Because the F-E axis is governed by the curvature of the femoral condyles in the sagittal plane, the primary objective was to determine the variation in radii of curvature. Eleven high accuracy three-dimensional (3D) femur models were generated from ultrahigh resolution CT scans. The sagittal profile of each condyle was created. The radii of curvature at 15 deg increments of arc length were determined based on segment circles best-fit to ±15 deg of arc at each increment. Results were standardized to the radius of the best-fit overall circle to 15 deg-105 deg for the femoral condyle having a radius closest to the mean radius. Medial and lateral femoral condyles exhibited multiradius of curvature sagittal profiles where the radius decreased at 30 deg flexion by 10 mm and at 15 deg flexion by 8 mm, respectively. On either side of the decrease, radii of segment circles were relatively constant. Beyond the transition angles where the radii decreased, the anterior-posterior (A-P) positions of the centers of curvature varied 4.8 mm and 2.3 mm for the medial and lateral condyles, respectively. A two-radius of curvature profile approximates the radii of curvature of both native femoral condyles, but the transition angles differ with the transition angle of the medial femoral condyle occurring about 15 deg later in flexion. Owing to variation in A-P positions of centers of curvature, the F-E axis is not strictly fixed in the femur.
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Affiliation(s)
- Eden Winslow
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616
- University of California, Davis
| | - Xuanbei Pan
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616
- University of California, Davis
| | - Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616; Department of Mechanical Engineering, University of California Davis, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis, Davis, CA 95616
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Hull ML. Critical Examination of Methods to Determine Tibiofemoral Kinematics and Tibial Contact Kinematics Based on Analysis of Fluoroscopic Images. J Biomech Eng 2024; 146:110801. [PMID: 38959087 DOI: 10.1115/1.4065878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2023] [Accepted: 07/02/2024] [Indexed: 07/05/2024]
Abstract
Goals of knee replacement surgery are to restore function and maximize implant longevity. To determine how well these goals are satisfied, tibial femoral kinematics and tibial contact kinematics are of interest. Tibiofemoral kinematics, which characterize function, is movement between the tibia and femur whereas tibial contact kinematics, which is relevant to implant wear, is movement of the location of contact by the femoral implant on the tibial articular surface. The purposes of this review article are to describe and critique relevant methods to guide correct implementation. For tibiofemoral kinematics, methods are categorized as those which determine (1) relative planar motions and (2) relative three-dimensional (3D) motions. Planar motions are determined by first finding anterior-posterior (A-P) positions of each femoral condyle relative to the tibia and tracking these positions during flexion. Of the lowest point (LP) and flexion facet center (FFC) methods, which are common, the lowest point method is preferred and the reasoning is explained. 3D motions are determined using the joint coordinate system (JCS) of Grood and Suntay. Previous applications of this JCS have resulted in motions which are largely in error due to "kinematic crosstalk." Requirements for minimizing kinematic crosstalk are outlined followed by an example, which demonstrates the method for identifying a JCS that minimizes kinematic crosstalk. Although kinematic crosstalk can be minimized, the need for a JCS to determine 3D motions is questionable based on anatomical constraints, which limit varus-valgus rotation and compression-distraction translation. Methods for analyzing tibial contact kinematics are summarized and validation of methods discussed.
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Affiliation(s)
- Maury L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616; Department of Mechanical Engineering, University of California Davis, Davis, CA 95616; Department of Orthopaedic Surgery, University of California Davis, Davis, CA 95616
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Vakili S, Vivacqua T, Getgood A, Willing R. In Vitro Assessment of Knee Joint Biomechanics Using a Virtual Anterior Cruciate Ligament Reconstruction. J Biomech Eng 2024; 146:101006. [PMID: 38683101 DOI: 10.1115/1.4065417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Abstract
Understanding the biomechanical impact of injuries and reconstruction of the anterior cruciate ligament (ACL) is vital for improving surgical treatments that restore normal knee function. The purpose of this study was to develop a technique that enables parametric analysis of the effect of the ACL reconstruction (ACLR) in cadaver knees, by replacing its contributions with that of a specimen-specific virtual ACLR that can be enabled, disabled, or modified. Twelve ACLR reconstructed knees were mounted onto a motion simulator. In situ ACLR graft forces were measured using superposition, and these data were used to design specimen-specific virtual ACLRs that would yield the same ligament force-elongation behaviors. Tests were then repeated using the virtual ACLR in place of the real ACLR and following that in ACL deficient knee by disabling the virtual ACLR. In comparison to the ACL deficient state, the virtual ACLRs were able to restore knee stability to the same extent as real ACLRs. The average differences between the anterior tibial translation (ATT) of the virtual ACLR versus the real ACLR were +1.6 ± 0.9 mm (p = 0.4), +2.1 ± 0.4 mm (p = 0.4), and +1.0 ± 0.9 mm (p = 0.4) during Anterior drawer, Lachman and Pivot-shift tests, respectively, which is small in comparison to the full ATT range of motion (ROM) of these knees. Therefore, we conclude that a virtual ACLR can be used in place of real ACLR during biomechanical testing of cadaveric knees. This capability opens the door for future studies that can leverage parameterization of the ACLR for surgical design optimization.
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Affiliation(s)
- Samira Vakili
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5B9, Canada
| | - Thiago Vivacqua
- Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada
- Western University
| | - Alan Getgood
- Department of Orthopaedic Surgery, London Health Sciences Centre University Hospital, 339 Windermere Road, London, ON N6A 5A5, Canada;Fowler Kennedy Sport Medicine Clinic, Department of Surgery, Western University, 3M Centre, London, ON N5A 3K7, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
| | - Ryan Willing
- School of Biomedical Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Department of Mechanical & Materials Engineering, Western University, 1151 Richmond Street N, London, ON N6A 5B9, Canada;Western's Bone and Joint Institute, Western University, London, ON N6A 5A5, Canada
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Brendle SA, Krueger S, Grifka J, Müller PE, Grupp TM. A New Methodology for the Accurate Measurement of Tibiofemoral Kinematics in Human Cadaveric Knees: An Evaluation of the Anterior-Posterior Laxity Pre- and Post-Cruciate Ligament Resection. Life (Basel) 2024; 14:877. [PMID: 39063630 PMCID: PMC11278153 DOI: 10.3390/life14070877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/08/2024] [Accepted: 07/12/2024] [Indexed: 07/28/2024] Open
Abstract
Anterior-posterior (AP) stability is an important measure of knee performance after total knee arthroplasty (TKA). To improve the stabilizing effect of implants designed to compensate for the loss of the cruciate ligaments, it is important to understand the tibiofemoral contact situation within the native ligamentous situation of the knee and how it changes after cruciate ligament resection. This in vitro study introduces a new approach to accurately measure the tibiofemoral kinematics in a six-degrees-of-freedom joint motion simulator by tracking landmark-based coordinate systems and their corresponding bone geometries. The tibiofemoral contact situation was investigated by projecting the medial and lateral flexion facet centers onto the tibial plateau under AP shear forces across various flexion angles in thirteen knees. Tests were conducted pre- and post-cruciate ligament resection. Post-cruciate ligament resection, the femoral condyles shifted closer to or even exceeded the posterior border of the tibial plateau, but only slightly closer to the anterior border. This study presents a new methodology for measuring the tibiofemoral kinematics that can be applied to multiple loading profiles. It provides a basis for further investigations, including passive or active muscle forces, to enhance the design of total knee protheses and improve surgical outcomes.
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Affiliation(s)
- Saskia A. Brendle
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
| | - Sven Krueger
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
| | - Joachim Grifka
- Department of Orthopaedics, Asklepios Klinikum, 93077 Bad Abbach, Germany
| | - Peter E. Müller
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
| | - Thomas M. Grupp
- Research & Development, Aesculap AG, 78532 Tuttlingen, Germany
- Department of Orthopaedic and Trauma Surgery, Musculoskeletal University Center Munich (MUM), Campus Grosshadern, LMU Munich, 81377 Munich, Germany
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Yan Y, Gong R, Cao M, Han B, Li H, Liu G. The effect of different mechanism combinations on sliding between brace and lower limb during walking and leg-raising. Proc Inst Mech Eng H 2024; 238:500-507. [PMID: 38534031 DOI: 10.1177/09544119241241440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2024]
Abstract
Knee braces are commonly used to support the knee joint and improve function. However, brace sliding caused by the misalignment between brace and knee during motion is a common problem, which reduces the therapeutic effect and leads to brace abandonment. To investigate the effect of mechanism combinations on sliding, an experimental brace was designed to isolate the mechanism as the sole variable. Ten healthy participants were recruited, each of whom worn four combinations of lateral/medial mechanisms: lateral and medial single-axis (SA), lateral super gear (SG) and medial non-circular gear (NCG), lateral four-bar linkage (FL) and medial SG, and lateral FL and medial NCG. The knee flexion angle was collected using inertial measurement units, and brace sliding was measured by 3D motion capture system. All combinations had significant changes in peak sliding of thigh and shank compared to the SA combination (p < 0.05), but lateral FL and medial NCG combination had the lowest peak and final sliding during walking and leg-raising, with significant reductions of 40.7 and 85.3% in peak sliding of thigh, and significant reductions of 56.3 and 72.0% in peak sliding of shank, respectively (p < 0.05). Moreover, the mechanism combination did not significantly impact the knee range of motion (p > 0.05). The mechanism combination that fit the instantaneous center of rotation of lateral/medial condyle of knee joint demonstrates a significant reduction in brace sliding. Additionally, the peak sliding during motion is significantly higher than the final sliding.
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Affiliation(s)
- Yuzhou Yan
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
| | - Ruitao Gong
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
| | - Mengzhao Cao
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
| | - Bing Han
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
| | - Hui Li
- Joint Surgery Department, Xi'an Hong-hui Hospital, Xi'an Jiaotong University College of Medicine, Xi'an, Shaanxi, P.R. China
| | - Geng Liu
- Innovation Center of Bioengineering, Shaanxi Engineering Laboratory for Transmissions and Controls, Northwestern Polytechnical University, Xi'an, Shaanxi, P.R. China
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Dizdar A, Celik T, Ozkan A. Biomechanical evaluation of intramedullary retrograde nail and dynamic condylar screw used in unstable distal femoral fractures. Phys Eng Sci Med 2023; 46:1755-1764. [PMID: 37870727 DOI: 10.1007/s13246-023-01335-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 09/10/2023] [Indexed: 10/24/2023]
Abstract
Distal femur fractures are a common problem in orthopedics. Intramedullary retrograde nails (IRN) and dynamic condylar screws (DCS) are generally used for the treatment of these fractures. In this study, it was aimed to mechanically evaluate and compare these two implants used for the treatment of distal femur fractures. In this study, an AOOTA 33C1.3 fracture was created on the intact femur obtained from computed tomography images. The fractures were fixed with DCS and IRN. Then the created models were imported into the ANSYS Workbench for finite element analysis to determine the most convenient mechanical fixation type. The distal region of the femur was loaded considering 75 kg-f, and the created models were constrained in all directions from the femoral head. The intact femur was also analyzed to compare it with the DCS and IRN fixation models. The von Mises stress, strain, and displacement results were examined to determine the damage risk. According to the results, the risk of damage is lower in the model of fixation with IRN. The normal strain distribution in the model fixed with IRN is closer to the model of an intact femur. For this reason, the risk of stress shielding in IRN fixation is less than in DCS fixation. However, the fracture lines were more stable in the fixation with the DCS. In conclusion, fracture fixation with IRN is mechanically more suitable for distal femur fractures in terms of fracture healing.
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Affiliation(s)
- Ayberk Dizdar
- Department of Biomedical Engineering, Umuttepe Campus, Kocaeli University, 41001, İzmit, Kocaeli, Turkey.
| | - Talip Celik
- Department of Biomedical Engineering, Umuttepe Campus, Kocaeli University, 41001, İzmit, Kocaeli, Turkey
| | - Arif Ozkan
- Department of Biomedical Engineering, Umuttepe Campus, Kocaeli University, 41001, İzmit, Kocaeli, Turkey
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Çakır GH, Mutlu İ. A comparison of stress, contact pressure, and contact area on menisci in re-injury mechanisms after reconstruction of the anterior cruciate ligament with autograft and synthetic graft: a finite element study. INTERNATIONAL ORTHOPAEDICS 2023; 47:2487-2496. [PMID: 37449986 DOI: 10.1007/s00264-023-05881-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 06/27/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The anterior cruciate ligament (ACL) is crucial in maintaining knee stability. Some motion mechanisms, which are common in sports, cause excessive load to be passed on the ACL. In non-contact ACL injuries, the ACL cannot sustain the high stress and becomes injured or ruptures in the valgus-external rotation mechanism (VERM) and varus-internal rotation mechanism (VIRM). The mechanical strength of the grafts used to repair the torn ligament varies. The purpose of this study is to look at the alterations in the menisci after anterior cruciate ligament repair with autografts and synthetic grafts in cases of non-contact re-injury mechanisms. METHODS In the finite element analysis, VERM and VIRM motions of the injury were simulated with different ACL graft materials. During the simulations of these mechanism motions with polyethylene terephthalate (PET) and patellar tendon (PT), the contact pressures, contact areas, and von mises stress values created in the medial and lateral meniscus were compared. RESULTS The peak contact pressures on the menisci during the VERM are higher than the peak contact pressures during the VIRM, except for one variation. The peak contact pressure of the medial meniscus is almost the same for both graft materials and mechanisms. Furthermore, the peak contact pressures in the menisci are higher than in the VERM. For all injury mechanisms, the peak contact stresses on the lateral meniscus are higher than on the medial meniscus. CONCLUSIONS The findings suggest that VERM can induce further knee joint injury. It was found that the PET will lessen the pressure on the menisci even more. It is also advantageous since it does not damage the anterior extremities and transmits less pressure to the menisci. In conclusion, using a high-strength ACL is healthier for the menisci. Even though synthetic grafts are not clinically preferred, the study demonstrates that enhancing the material properties of synthetic grafts will increase the chance of their use in the future, based on the current results.
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Affiliation(s)
- Gül Hilal Çakır
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey.
| | - İbrahim Mutlu
- Department of Biomedical Engineering, Kocaeli University, Umuttepe Campus, Izmit, Kocaeli, Turkey
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Thorhauer E, French M, Kimura T, Ledoux WR. A Cadaveric Comparison of the Kinematic and Anatomical Axes and Arthrokinematics of the Metatarsosesamoidal and First Metatarsophalangeal Joints. J Biomech Eng 2023; 145:1148497. [PMID: 36301250 DOI: 10.1115/1.4056060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 10/23/2022] [Indexed: 12/13/2022]
Abstract
Presently, developments in weightbearing computed tomography and biplanar fluoroscopy technologies offer exciting avenues for investigating normative and pathologic foot function with increasing precision. Still, data quantifying sesamoid bone and proximal phalange motion are currently sparse. To express joint kinematics and compare various clinical cohorts, future studies of first ray motion will necessitate robust coordinate frames that respect the variations in underlying anatomy while also aligning closely with the functional, physiological axes of motion. These activity-dependent functional axes may be represented by a mean helical axis of the joint motion. Our cadaveric study quantified joint kinematics from weightbearing computed tomography scans during simulated toe lift and heel rise tasks. We compared the spatial orientations of the mean finite helical axes of the metatarsosesamoidal and metatarsophalangeal joints to the primary joint axis of two relevant methods for defining metatarsal coordinate frames: inertial axes and fitting of geometric primitives. The resultant kinematics exhibited less crosstalk when using a metatarsal coordinate system based on fitting cylindrical primitives to the bony anatomy compared to using principal component axes. Respective metatarsophalangeal and metatarsosesamoidal arthrokinematic contact paths and instantaneous centers of rotation were similar between activities and agree well with currently published data. This study outlines a methodology for quantitatively assessing the efficacy and utility of various anatomical joint coordinate system definitions. Improvements in our ability to characterize the shape and motion of foot bones in the context of functional tasks will elucidate their biomechanical roles and aid clinicians in refining treatment strategies.
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Affiliation(s)
- Eric Thorhauer
- Department of Mechanical Engineering, University of Washington, Stevens Way, Box 352600, Seattle, WA 98195; RR&D Center for Limb Loss and Mobility (CLiMB) Veterans Affairs Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108
| | - Mackenzie French
- School of Medicine, Department of Mechanical Engineering, University of Washington, 1959 NE Pacific Street, Seattle, WA 98195
| | - Tadashi Kimura
- Department of Orthopaedic Surgery, School of Medicine, The Jikei University, Minato City, 3 Chome-25-8 Nishishinbashi, Tokyo 105-8461, Japan
| | - William R Ledoux
- Departments of Mechanical Engineering, Orthopaedics & Sports Medicine, University of Washington, Stevens Way, Box 352600, Seattle, WA 98195; RR&D Center for Limb Loss and Mobility (CLiMB) Veterans Affairs Puget Sound Health Care System, ms 151, 1660 South Columbian Way, Seattle, WA 98108
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Lineham B, van Duren B, Harwood P, Pandit H. The Feasibility of Hinged Knee Arthrodiastasis for Cartilage Regeneration: A Systematic Review of the Literature. Strategies Trauma Limb Reconstr 2023; 18:37-43. [PMID: 38033931 PMCID: PMC10682560 DOI: 10.5005/jp-journals-10080-1578] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 04/20/2023] [Indexed: 12/02/2023] Open
Abstract
Introduction Knee joint distraction (KJD) is a potential technique for cartilage regeneration in young patients with osteoarthritis of the knee. Static distraction has been utilised typically; however, a significant proportion of patients complain of knee stiffness post-distractor removal. The use of a hinged distractor may reduce the duration and severity of post-treatment knee stiffness by maintaining the range of motion during distraction. Furthermore, improved cartilage regeneration has been demonstrated in hinged ankle joint distraction as compared to static, and this may also be demonstrated at the knee. An evidence review was undertaken to inform further research and a potential change in practice. Aim A systematic review of all primary research on hinged knee joint distraction for cartilage regeneration. Methods An online systematic search of citation databases was conducted. Quality assessment and data extraction were undertaken by two separate researchers. Results The literature search returned a small number of relevant studies, of which 7 were included. Three of these were animal studies, two cadaveric and two case series. The study quality was low or very low. There was significant methodological heterogeneity with difficulties encountered in the transfer of constructs from animal and cadaveric studies to humans. Issues faced included difficulties with hinge placement and pin site pain in motion. Conclusion The feasibility of hinged knee joint distraction has yet to be proven. Any further research attempting to establish the benefits of hinged-over static knee distraction will have to take construct design considerations into account. How to cite this article Lineham B, van Duren B, Harwood P, et al. The Feasibility of Hinged Knee Arthrodiastasis for Cartilage Regeneration: A Systematic Review of the Literature. Strategies Trauma Limb Reconstr 2023;18(1):37-43.
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Affiliation(s)
- Beth Lineham
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Bernard van Duren
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
| | - Paul Harwood
- Department of Trauma and Orthopaedics, Leeds Teaching Hospitals, Leeds, United Kingdom
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom
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Larson D, Lorenz D, Melton B. Can Clinician-Stabilization with Hand-Held Dynamometry Yield a Reliable Measure of Knee Flexion Torque? Int J Sports Phys Ther 2022; 17:1095-1103. [PMID: 36237659 PMCID: PMC9528694 DOI: 10.26603/001c.37907] [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: 03/17/2022] [Accepted: 06/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background Assessment of knee flexion torque is a relevant clinical measure following various injuries and surgeries to determine progress in rehabilitation and inform decision making. A variety of methods using hand-held dynamometry have been shown to be reliable in obtaining this measure, and typically require a means of external fixation or stabilization. Clinically efficient methods of reliable clinician-stabilization are sparse in the literature. Hypothesis/Purpose Determine inter and intra-rater reliability of two clinically efficient methods of assessing isometric knee flexion torque using hand-held dynamometry with clinician-stabilization. The hypothesis was that each method would yield good to excellent reliability. Study Design Cross-Sectional Study. Methods Twenty healthy individuals were assessed by two clinicians on two separate days. During each session, knee flexion torque was assessed with hand-held dynamometry with two methods: 1) in the seated position with the hip and knee flexed to 90 degrees while the clinician stabilized the dynamometer between the participant's leg and table and 2) in prone with the hip at 0 degrees and knee at 90 degrees while the clinician assumed a stride stance with elbows locked in extension to stabilize the dynamometer on the participant's leg. Inter and intra-rater reliability were determined for each method. Results ICC values were 0.88-0.94 and 0.77-0.90 for inter and intra-rater reliability respectively with the seated method. The prone method yielded ICC values of 0.84-0.96 and 0.89-0.94 for inter and intra-rater reliability respectively. MDC values ranged from 30-62% with the seated method and 21-40% with the prone method. Conclusion Inter and intra-rater reliability were good to excellent for assessing knee flexion torque with hand-held dynamometry using both the seated and prone methods with clinically efficient clinician-stabilization approaches. The prone method may be more sensitive to detecting change over time due to lower MDC values. Level of Evidence 2b.
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Affiliation(s)
- Daniel Larson
- Physical Therapy, OrthoKansas/Lawrence Memorial Hospital
| | - Daniel Lorenz
- Physical Therapy, OrthoKansas/Lawrence Memorial Hospital
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Hull ML. Errors in using fixed flexion facet centers to determine tibiofemoral kinematics increase fourfold for multi-radius femoral component designs with early versus late decreases in the radius of curvature. Knee 2022; 35:183-191. [PMID: 35366617 DOI: 10.1016/j.knee.2022.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 01/20/2022] [Accepted: 02/25/2022] [Indexed: 02/02/2023]
Abstract
BACKGROUND One method to determine tibiofemoral joint kinematics following total knee arthroplasty (TKA) is to quantify movement of the anterior-posterior (AP) position of the flexion facet center (FFC) on each femoral condyle relative to the tibia during knee flexion. The primary objective was to determine how closely AP positions of fixed FFCs approximate AP positions of variable FFCs of multi-radius femoral component designs with early versus late initial transition angles (i.e. earliest flexion angle where the radius of curvature decreases markedly). METHODS Variable FFCs were determined for each femoral condyle as centers of best-fit circles to 20° segments of the sagittal profile from 0° to 120° of flexion in 15° increments. The fixed FFC of each condyle was the center of the best-fit circle from 0° to 120° of flexion. Errors in AP positions were differences between AP positions of fixed FFCs and variable FFCs. RESULTS For profiles with a late initial transition angle of 120° of flexion, the root mean square error (RMSE) was limited to 0.7 mm. For profiles with an early initial transition angle of 60° of flexion, the RMSE was 2.7 mm, nearly a fourfold increase. CONCLUSIONS To determine whether fixed FFCs can be used to indicate AP positions of femoral condyles with minimal RMSE < 1 mm, the initial transition angle should be found as an important first step. Condylar AP positions for designs with an early initial transition angle should not be approximated by AP positions of fixed FFCs when determining tibiofemoral kinematics.
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Affiliation(s)
- M L Hull
- Department of Biomedical Engineering, University of California Davis, Davis, CA 95616 United States; Department of Mechanical Engineering, University of California Davis, Davis, CA 95616 United States & Department of Orthopaedic Surgery, University of California Davis Medical Center, Sacramento, CA 95817 United States.
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Simileysky A, Hull M. Agreement Between Two Methods for Computing the Anterior-Posterior Positions of Native Femoral Condyles Using 3D Bone Models with and Without Articular Cartilage and Smoothing. J Biomech Eng 2022; 144:1137720. [PMID: 35199157 DOI: 10.1115/1.4053914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 11/08/2022]
Abstract
Knowledge of anterior-posterior (AP) movement of the femoral condyles on the tibia in healthy knees serves to assess whether an artificial knee restores natural movement. Two methods for identifying AP positions and hence condylar movements include: 1) the flexion facet center (FFC), and 2) the lowest point (LP) methods. The objectives were to determine 1) agreement between the two methods, and 2) whether addition of articular cartilage and/or smoothing significantly affects AP positions. MR images of healthy knees were obtained from eleven subjects, who performed a deep knee bend under fluoroscopy. Four different MR models of the distal femur were created: femur bone, smoothed femur bone, femur bone with cartilage, and femur bone with smoothed cartilage. In the medial and lateral compartments for the femur bone with smoothed cartilage at 0 degrees flexion, mean AP positions of the LPs were 7.7 mm and 5.4 mm more anterior than those of the FFCs, respectively (p = 0.0001, p = 0.0002) and limits of agreement were plus/minus 5.5 mm. At 30 - 90 degrees flexion, the difference in mean AP positions was 1.5 mm or less and limits of agreement were plus/minus 2.4 mm. Differences in mean AP positions between model types were less than 1.3 mm for LPs and FFCs. Since adding cartilage to 3D bone models is not required to accurately determine AP positions, faster and less expensive imaging techniques such as CT can be used to generate 3D bone models.
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Affiliation(s)
| | - Maury Hull
- Department of Biomedical Engineering, Department of Mechanical Engineering, Department of Orthopaedic Surgery, University of California Davis
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Xiao Y, Feng X, Song Y, Chen G, Liu F, Leung FKL, Chen B. The Effect of Knee Flexion on Length Changes and Stress Distribution of Ligaments: A Displacement Controlled Finite Element Analysis. Orthopedics 2021; 44:e61-e67. [PMID: 33141235 DOI: 10.3928/01477447-20201028-01] [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: 09/19/2019] [Accepted: 01/20/2020] [Indexed: 02/03/2023]
Abstract
The use of dynamic finite element analysis to investigate the biomechanical behavior of the knee joint is mainly based on movement of the joint. Challenges are associated with simulation of knee joint flexion-extension activity. This study investigated changes in the length and stress state of ligaments during lunge with a displacement controlled finite element analysis of the knee joint based on in vivo fluoroscopic kinematic data. The geometric center axis (GCA) was used to represent knee kinematics to quantify femoral motion relative to the tibia. Because the GCA was considered as a functional flexion axis, 2 degrees of freedom could be reduced. Published data on the in vivo fluoroscopic kinematic features of the GCA were used to establish the equations for degrees of freedom. Data for 4 degrees of freedom were obtained simultaneously at every 5° of knee flexion. Displacement and rotation were applied to the femur and tibia to produce relative displacement, and the elongation and stress state of the knee ligaments were computed. The predictions confirmed that lunge affected the biomechanical behavior of ligaments. Displacement controlled finite element analysis of knee flexion can be simulated on the basis of fluoroscopic kinematic data to achieve physiologic movement. [Orthopedics. 2021;44(1):e61-e67.].
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De Smet A, Verrewaere D, Sys G. Enhancing rotational placement of reconstruction prostheses of the distal femur after sarcoma resection. Med Eng Phys 2020; 81:47-57. [PMID: 32507678 DOI: 10.1016/j.medengphy.2020.05.001] [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: 11/29/2019] [Revised: 04/15/2020] [Accepted: 05/05/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Currently there are no accepted international guidelines for the correct placement of reconstruction prostheses in the axial plane of the femur after en bloc resection. The most accepted method is based on the linea aspera as an intraoperative landmark, indicating posterior. This study was conducted to address the reliability of the linea aspera as a landmark for rotational alignment. MATERIAL AND METHODS 50 CT angiographies of the right limb were used for this purpose. These 2D images were reconstructed into 3D models using proprietary software (materialize NV, Leuven, Belgium). The posterior condylar line was used as a reference axis. The orientation of the linea aspera was described as the angle between the perpendicular line to the PCL, through the center of the diaphysis, and the lateral (α) and medial labium (β). RESULTS The linear mixed model shows that the α- and β-angles are significantly associated with the distance from the joint line (p<0.001) and vary significantly between subjects (p<0.001). The α-angle has the lowest variance and approximates more closely true posterior, while the median β-angle never overlaps true posterior. DISCUSSION When a surgeon would blindly rely on the linea aspera as a posterior landmark roughly 78% of the femoral implants would exceed the accepted ±3° deviation around the surgical transepicondylar axis (sTEA) as defined in total knee replacement. The linea aspera is not a reliable landmark for axial rotation of femoral implants. The position is highly dependent on the osteotomy height and in addition differs between individual patients. Preoperative assessment of the linea aspera is advocated in order to reduce the risk of malrotation. As the height of the osteotomy cannot always be determined correctly preoperatively, a table was designed as a guideline for how much a deviation from the planned resection height will affect the rotation of the implant.
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Affiliation(s)
- Arne De Smet
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium; Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Belgium.
| | - Dries Verrewaere
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Belgium.
| | - Gwen Sys
- Department of Orthopaedic Surgery and Traumatology, Ghent University Hospital, Belgium; Faculty of Medicine and Health Sciences, Ghent University, Belgium.
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Manning W, Ghosh M, Wilson I, Hide G, Longstaff L, Deehan D. Improved mediolateral load distribution without adverse laxity pattern in robot-assisted knee arthroplasty compared to a standard manual measured resection technique. Knee Surg Sports Traumatol Arthrosc 2020; 28:2835-2845. [PMID: 31352497 PMCID: PMC7471111 DOI: 10.1007/s00167-019-05631-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Accepted: 07/15/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE Robot-assisted total knee arthroplasty (rTKA) remains in its infancy, is expensive but offers the promise of improved kinematic performance through precise bone cuts, with minimal soft tissue disruption, based on pre-resection soft tissue behaviour. This cadaveric study examined load transfer, soft tissue performance and radiographic indices for conventional (sTKA) versus rTKA. The null hypothesis was there would be no difference between the two modes of implantation. METHODS Whole (ten) cadaveric limbs were randomised to receive either robotic (rTKA, N = 5) or conventional measured resection (sTKA, N = 5) knee arthroplasty. Laxity patterns were established using validated fixed sensors (Verasense) with manual maximum displacement for six degrees of freedom. Tibiofemoral load and contact points were determined dynamically using remote sensor technology for medial and lateral compartments through a functional arc of motion (0-110 degrees of motion). Final component position was assessed using pre- and post-implantation CT. RESULTS No significant intergroup differences for laxity were found (n.s.). The rTKA group exhibited consistently balanced mediolateral load throughout the full arc with significantly reduced overall total load across the joint (for distinct points of measurement, p < 0.05). Despite using flexion-extension and mediolateral gap balancing with measured resection, the sTKA group failed to achieve balance in at least three points of the flexion arc. Post-operative CT confirmed satisfactory component alignment with no significant differences for positioning between the two groups. CONCLUSION This work found improved load sharing for rTKA when compared to conventional surgery for same donor knees. Laxity and CT determined final component positioning was not significantly different. The work supports the contention that robot-assisted TKA delivers improved tibiofemoral load sharing in time zero studies under defined conditions but such offers the promise of improved clinical performance and reduced implant wear.
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Affiliation(s)
- William Manning
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Milton Ghosh
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK ,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Ian Wilson
- Institute of Genetic Medicine, Newcastle University International Centre for Life, Central Parkway, Newcastle upon Tyne, NE1 3BZ UK
| | - Geoff Hide
- Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN UK
| | - Lee Longstaff
- University Hospital of North Durham, Durham, DH1 5TW England, UK
| | - David Deehan
- Newcastle Surgical Training Centre Research Unit Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK. .,Freeman Hospital, High Heaton, Newcastle upon Tyne, NE7 7DN, UK.
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16
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Markolf KL, Yang PR, Joshi NB, Petrigliano FA, McAllister DR. In vitro determination of the passive knee flexion axis: Effects of axis alignment on coupled tibiofemoral motions. Med Eng Phys 2019; 67:73-77. [PMID: 30917910 DOI: 10.1016/j.medengphy.2019.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 01/09/2019] [Accepted: 03/17/2019] [Indexed: 10/27/2022]
Abstract
The natural passive flexion axis of human cadaveric knees was determined using a technique that minimized coupled tibiofemoral motions (translations and rotations), and the kinematic effects of mal-positioned flexion axes were determined. The femur was clamped in an apparatus that allowed unconstrained tibial motions as the knee was flexed from 0° to 90°. To establish the natural flexion axis, the femur's position was adjusted such that coupled tibiofemoral motions were minimized. Tests were repeated, first with the femur rotated internally and externally from its original position, and again after positioning the femur to flex the knee about the transepicondylar axis. Compared to the transepicondylar axis, flexion about the natural axis significantly reduced mean tibial translation by 66.4% (p < 0.01) and varus-valgus rotation by 70.1% (p <0.01). Mean varus-valgus rotation increased by 3.4° (factor of 4) when the femur was rotated 3° internally or externally from the optimum position. Differences in condylar location coordinates between the transepicondylar and natural flexion axes most likely indistinguishable clinically. Knee flexion about an axis that minimizes coupled tibiofemoral motions could be important for placement and orientation of a femoral total knee component and for specimen alignment during biomechanical knee testing.
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Affiliation(s)
- Keith L Markolf
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1000 Veteran Avenue, Room 21-67, Los Angeles, CA 90024, USA.
| | - Paul R Yang
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1000 Veteran Avenue, Room 21-67, Los Angeles, CA 90024, USA
| | - Nirav B Joshi
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1000 Veteran Avenue, Room 21-67, Los Angeles, CA 90024, USA
| | - Frank A Petrigliano
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1000 Veteran Avenue, Room 21-67, Los Angeles, CA 90024, USA
| | - David R McAllister
- Biomechanics Research Section, Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, 1000 Veteran Avenue, Room 21-67, Los Angeles, CA 90024, USA
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Modenese L, Montefiori E, Wang A, Wesarg S, Viceconti M, Mazzà C. Investigation of the dependence of joint contact forces on musculotendon parameters using a codified workflow for image-based modelling. J Biomech 2018; 73:108-118. [DOI: 10.1016/j.jbiomech.2018.03.039] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/09/2018] [Accepted: 03/21/2018] [Indexed: 11/24/2022]
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Passmore E, Graham HK, Sangeux M. Defining the medial-lateral axis of the femur: Medical imaging, conventional and functional calibration methods lead to differences in hip rotation kinematics for children with torsional deformities. J Biomech 2018; 69:156-163. [DOI: 10.1016/j.jbiomech.2018.01.018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/09/2018] [Accepted: 01/14/2018] [Indexed: 11/29/2022]
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Hösl M, Böhm H, Seltmann M, Dussa CU, Döderlein L. Relationship between radiographic patella-alta pathology and walking dysfunction in children with bilateral spastic Cerebral Palsy. Gait Posture 2018; 60:28-34. [PMID: 29149666 DOI: 10.1016/j.gaitpost.2017.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Revised: 11/02/2017] [Accepted: 11/09/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Patella-alta is very common in patients with Cerebral Palsy (CP). While several diagnostic x-ray indices have been developed for patella-alta in general, the specific relationship with walking dysfunction in CP is only partly understood. METHODS 33 participants with bilateral spastic CP between 4 and 20 years (GMFCS I-II without previous surgery) that underwent 3D gait analysis as well as a radiographic exam within 0.8 (SD 1.2) months were retrospectively included. The Caton-Deschamps, the Insall-Salvati and the Koshino-Index, as well as the moment-arms of the quadriceps, the pattelar-tendon length and patellar tilt angle were analyzed from x-rays. During gait, tempo-spatial parameters, the knee flexion kinematics, the knee moments and the moment impulse were calculated and correlated to x-ray parameters. RESULTS Smaller quadriceps moment-arms were related to slower walking speed (r=0.48, P=0.005) and less knee extension during stance (r=0.68 P<0.001). Smaller quadriceps moment arms and longer patellar-tendons were also significantly related to a larger knee flexion moment impulse in the second half of the stance phase (r=-0.36, P=0.045 and r=0.39, P=0.028) and hence to more abnormal knee loads. Yet, none of the traditional indices was related to any parameter of gait. INTERPRETATION Traditional radiographic indices for patella-alta possess little to no informative value for walking dysfunction in individuals with CP suspected to have knee pathology. Smaller moment-arms are a key feature of patellofemoral pathology in CP reducing the knee extensor mechanism, an aspect which is not sufficiently picked up by traditional indices.
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Affiliation(s)
- Matthias Hösl
- Schön Klinik Bad Aibling, Hospital for Neurology and Neurological Rehabilitation, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany.
| | - Harald Böhm
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
| | - Michaela Seltmann
- Department of Sport and Health Sciences, Technische Universität München, Uptown München-Campus D, Georg-Brauchle-Ring 60/62, 80992, München, Germany; Schön Klinik München Harlaching, Harlachinger Straße 51, 81547, München, Germany
| | - Chakravarthy Ugandhar Dussa
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
| | - Leonhard Döderlein
- Orthopaedic Hospital for Children, Behandlungszentrum Aschau GmbH, Bernauer Str. 18, 83229, Aschau im Chiemgau, Germany
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20
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Mechanically aligned total knee arthroplasty carries a risk of bony gap changes and flexion-extension axis displacement. Knee Surg Sports Traumatol Arthrosc 2017; 25:3452-3458. [PMID: 28224199 DOI: 10.1007/s00167-017-4459-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Accepted: 01/30/2017] [Indexed: 10/20/2022]
Abstract
PURPOSE The flexion-extension axis (FEA) of the femur is substantially changed after mechanically aligned total knee arthroplasty (TKA) due to a discrepancy in bone cut thickness between the posterior and distal femoral regions. This study assessed the bony gap changes and FEA displacement caused by this problem in osteoarthritis patients. METHODS The study enrolled 60 knees from 60 patients for whom primary TKA was planned due to medial knee osteoarthritis. All patients underwent computed tomography, and 3-dimensional (3D) bone models were reconstructed on 3D-planning software. Bone cuts of the distal femur and proximal tibia were simulated to be perpendicular to each mechanical axis. Bony gap change was computed as the difference in bone cut thickness between medial and lateral compartments. Each femoral condyle was assessed for potential FEA displacement, as the difference in bone cut thickness between posterior and distal femoral regions. RESULTS The mean magnitude of bony gap discrepancy necessary for mediolateral balancing was 1.6 ± 3.3 mm (range -7 to 8.2 mm) at 0° extension and -0.2 ± 2.6 mm (range -6.4 to 4.3 mm) at 90° flexion. At least 2 mm of bony gap discrepancy at 0° extension and 90° flexion was found in 40 patients (67%) and 26 patients (43%), respectively. In terms of femoral bone cut, posterior bone cut thickness was significantly larger than distal bone cut thickness in the medial compartment (p < 0.001). Bony gap discrepancy between distal and posterior regions of the femoral condyle was ≥2 mm in 28 patients (47%). CONCLUSIONS This study focused on two flaws of mechanically aligned TKA in OA patients. Substantial numbers of patients inevitably required >2 mm of medial collateral ligament release at 0° extension and showed a bone cut discrepancy between distal and posterior regions, carrying a risk of FEA displacement and subsequent unnatural knee motions during knee extension and flexion. Level of evidence IV.
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21
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Evaluation of knee functional calibration with and without the effect of soft tissue artefact. J Biomech 2017; 62:53-59. [DOI: 10.1016/j.jbiomech.2016.10.049] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2016] [Revised: 10/27/2016] [Accepted: 10/28/2016] [Indexed: 11/18/2022]
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22
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Wu XD, Xiang BY, Schotanus MGM, Liu ZH, Chen Y, Huang W. CT- versus MRI-based patient-specific instrumentation for total knee arthroplasty: A systematic review and meta-analysis. Surgeon 2017; 15:336-348. [PMID: 28756064 DOI: 10.1016/j.surge.2017.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 06/06/2017] [Accepted: 06/12/2017] [Indexed: 01/23/2023]
Abstract
BACKGROUND To determine whether computed tomography (CT) or magnetic resonance imaging (MRI) is more suitable for the patient-specific instrumentation (PSI) systems for total knee arthroplasty (TKA). METHODS PubMed, Embase, and the Cochrane Library were searched from inception to June 2016 for prospective comparative trials that compared CT- versus MRI-based PSI systems for TKA. Our predefined primary outcome was the outliers incidence of coronal overall limb alignment. RESULTS Six studies with a total of 336 knees meeting the eligibility criteria, and four trials were included in the meta-analysis. Compared with MRI-based PSI systems, CT-based PSI systems were associated with a higher outliers incidence of coronal overall limb alignment (risk ratio: 1.67; 95% confidence interval (CI): 1.03-2.72; P = 0.04), more angular errors of coronal overall limb alignment (mean difference (MD): 1.01°; 95% CI: 0.47-1.56; P = 0.0003), and longer operation time (MD: 5.02 min; 95% CI: 1.26-8.79; P = 0.009). While no significant differences in the coronal/sagittal alignment of the femoral/tibial component outliers, the angular errors of coronal overall limb alignment, the angular errors of the femoral/tibial component in coronal plane, or incidence of change of implant size of the femoral/tibial component were observed. CONCLUSIONS The current limited evidence suggests that MRI-based PSI systems exhibit higher accuracy for TKA regarding the coronal limb axis than CT-based PSI systems. However, well-designed studies comparing CT-versus MRI-based PSI systems for TKA are warrant to confirm these results before widespread use of this technique can be recommended.
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Affiliation(s)
- Xiang-Dong Wu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; Evidence-Based Perioperative Medicine 07 Collaboration Group, China
| | - Bing-Yan Xiang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China; Department of Orthopaedic Surgery, The First People's Hospital of Zunyi City, Zunyi, 563000, Guizhou Province, China
| | - Martijn G M Schotanus
- Department of Orthopedics, Zuyderland Medical Center, Sittard-Geleen, 6162 BG, The Netherlands
| | - Zun-Han Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Yu Chen
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China
| | - Wei Huang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, 400016, China.
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Sartori M, Fernandez JW, Modenese L, Carty CP, Barber LA, Oberhofer K, Zhang J, Handsfield GG, Stott NS, Besier TF, Farina D, Lloyd DG. Toward modeling locomotion using electromyography-informed 3D models: application to cerebral palsy. WILEY INTERDISCIPLINARY REVIEWS-SYSTEMS BIOLOGY AND MEDICINE 2016; 9. [DOI: 10.1002/wsbm.1368] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Revised: 10/11/2016] [Accepted: 10/18/2016] [Indexed: 01/17/2023]
Affiliation(s)
- M. Sartori
- Department of Trauma Surgery; Orthopedics and Plastic Surgery, Neurorehabilitation Systems Research Group, University Medical Center Göttingen; Göttingen Germany
| | - J. W. Fernandez
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - L. Modenese
- Department of Mechanical Engineering; The University of Sheffield; Sheffield UK
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
| | - C. P. Carty
- Queensland Children's Motion Analysis Service, Queensland Paediatric Rehabilitation Service; Children's Health Queensland; Brisbane Australia
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
| | - L. A. Barber
- Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, Faculty of Medicine; The University of Queensland; Brisbane Australia
| | - K. Oberhofer
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - J. Zhang
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - G. G. Handsfield
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
| | - N. S. Stott
- School of Medicine; University of Auckland; Auckland New Zealand
| | - T. F. Besier
- Auckland Bioengineering Institute; University of Auckland; Auckland New Zealand
- Department of Engineering Science; University of Auckland; Auckland New Zealand
| | - D. Farina
- Department of Bioengineering; Imperial College London; London UK
| | - D. G. Lloyd
- Menzies Health Institute Queensland; Griffith University; Queensland Australia
- School of Allied Health Sciences; Griffith University; Queensland Australia
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Kainz H, Modenese L, Lloyd D, Maine S, Walsh H, Carty C. Joint kinematic calculation based on clinical direct kinematic versus inverse kinematic gait models. J Biomech 2016; 49:1658-1669. [DOI: 10.1016/j.jbiomech.2016.03.052] [Citation(s) in RCA: 88] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 12/31/2015] [Accepted: 03/28/2016] [Indexed: 11/28/2022]
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Defining the medial-lateral axis of an anatomical femur coordinate system using freehand 3D ultrasound imaging. Gait Posture 2016; 45:211-6. [PMID: 26979908 DOI: 10.1016/j.gaitpost.2016.02.006] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 02/02/2023]
Abstract
Hip rotation from gait analysis informs clinical decisions regarding correction of femoral torsional deformities. However, it is among the least repeatable due to discrepancies in determining the medial-lateral axis of the femur. Conventional or functional calibration methods may be used to define the axis but there is no benchmark to evaluate these methods. Freehand 3D ultrasound, the coupling of ultrasound with 3D motion capture, may provide such a benchmark. We measured the accuracy in vitro and repeatability in vivo of determining the femur condylar axis from freehand 3D ultrasound. The condylar axis provided the reference medial-lateral axis of the femur and was used to evaluate one conventional method and three functional calibration methods, applied to three calibration movements. Ten healthy subjects (20 limbs) underwent 3D gait analysis and freehand 3D ultrasound. The functional calibration methods were a transformation technique, a geometrical method and a method that minimises variance of knee varus-valgus kinematics (DynaKAD). The conventional method used markers over the femoral epicondyles. The condylar axis determined by 3D ultrasound showed good accuracy in vitro, 1.6° (SD: 0.3°) and good repeatability in vivo, 0.2° (RSMD: 2.3°). The DynaKAD method applied to the walking calibration movement determined the medial-lateral axis closest to the ultrasound reference. The average angular difference in the transverse plane was 3.1° (SD: 6.1°). Freehand 3D ultrasound offers an accurate, non-invasive and relatively fast method to locate the medial-lateral axis of the femur for gait analysis.
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