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Tomlinson JCL, Zwirner J, Oorschot DE, Morawski M, Ondruschka B, Zhang M, Hammer N. Microstructural analysis on the innervation of the anterior, medial, and lateral human hip capsule: Preliminary evidence on its neuromechanical contribution. Osteoarthritis Cartilage 2023; 31:1469-1480. [PMID: 37574111 DOI: 10.1016/j.joca.2023.07.009] [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: 12/16/2022] [Revised: 06/16/2023] [Accepted: 07/05/2023] [Indexed: 08/15/2023]
Abstract
OBJECTIVE Capsular repair aims to minimize damage to the hip joint capsular complex (HJCC) and subsequent dislocation risk following total hip arthroplasty (THA). Numerous explanations for its success have been advocated, including neuromuscular feedback loops originating from within the intact HJCC. This research investigates the hypothesis that the HJCC contributes to hip joint stability by analyzing HJCC innervation. METHOD Twenty-nine samples from the anterior, medial, and lateral aspects of the midportion HJCC of 29 individuals were investigated stereologically and immunohistochemically to identify encapsulated mechanoreceptors according to a modified Freeman and Wyke classification, totaling 11,745 sections. Consecutive slices were observed to determine the nerve course within the HJCC. RESULTS Few encapsulated mechanoreceptors were found in the HJCC subregions and overlying tissues across the cohort studied. Of regions studied, no significant regional differences in the density of mechanoreceptors were found. No significant difference in mechanoreceptor density was found between sides (left, 10.2×10-4/mm3, 4.0×10-4 - 19.0×10-4/mm3; right 12.9×10-4/mm3, 5.0×10-4 - 22.0×10-4/mm3; mean, 95% confidence intervals) sexes (female 10.4×10-4/mm3, 4.0×10-4 - 18.0×10-4/mm3; male 11.6×10-4/mm3, 5.0×10-4 - 20.0×10-4/mm3; mean, 95% confidence intervals), nor in correlation with age demographics. Myelinated nerves coursed consistently within the HJCC in various orientations. CONCLUSION Sparse mechanoreceptor density suggests that the HJCC contributes to a limited extent to hip joint stabilization. HJCC nerve terminals may potentially contribute to neuromuscular feedback loops with associated muscles to mediate joint stability in tandem with the active and passive components of the joint.
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Affiliation(s)
- Joanna C L Tomlinson
- School of Anatomy, University of Bristol, Bristol, United Kingdom; Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand.
| | - Johann Zwirner
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Oral Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Dorothy E Oorschot
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Markus Morawski
- Paul Flechsig Institute for Brain Research, Medical Faculty, University of Leipzig, Leipzig, Saxony, Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ming Zhang
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Niels Hammer
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center, Medical University of Graz, Graz, Styria, Austria; Division of Biomechatronics, Fraunhofer Institute for Machine Tools and Forming Technology (Fraunhofer IWU), Dresden, Saxony, Germany; Department of Orthopaedic and Trauma Surgery, University of Leipzig, Germany
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2
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St‐Pierre M, Effatparvar MR, Begon M, Sobczak S. Differentiation of strains in the lateral and medial bands of the iliofemoral ligament: A segmental approach. J Anat 2023; 243:674-683. [PMID: 37248724 PMCID: PMC10485585 DOI: 10.1111/joa.13893] [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: 02/03/2023] [Revised: 04/13/2023] [Accepted: 05/17/2023] [Indexed: 05/31/2023] Open
Abstract
Iliofemoral ligament strains have been assessed in a circumscribed portion, limiting the information regarding the strains in the proximal, mid and distal portions. The purpose of this study is to describe the longitudinal and transversal strain within the proximal, mid and distal portions of the lateral and medial bands of the iliofemoral ligament. Ten fresh cadaveric specimens were assessed. The iliofemoral ligaments were divided into medial and lateral bands. Hemispherical beads (2.6 mm) were placed on the lateral and medial borders of each band. Four positions were assessed: abduction, extension, internal and external rotations combined with extension. The hemispherical beads were scanned at the end range of motion using a laser scanner. The three-dimensional position of each bead was used to estimate longitudinal and transversal strains. A three-factor ANOVA was used to compare movements, borders, and portions within each ligament for longitudinal strains. A one-way ANOVA was used to compare transversal strains between portions. This technique showed mean reliability (ICC: 2, 1) of 0.90 ± 0.06. The external rotation showed the highest strains in both ligaments (p < 0.05). Abduction showed a significant difference between the lateral and medial borders in both bands (p = 0.001). Eight movement-border combinations showed a significant difference between proximal, medial, and lateral portions (p < 0.005). According to our results, there is a clear effect of portions (proximal, mid and distal) within the ligament and movements. Abduction shows the lowest strains longitudinally but the largest strains transversally. Although we do not know the impact of this phenomenon, future studies should assess the strains following hip arthroscopies. The latter might improve the impact of this procedure on hip biomechanics. Lastly, the iliofemoral ligament should be assessed using a segmental approach rather than as a complete unit.
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Affiliation(s)
- Marc‐Olivier St‐Pierre
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
| | - Mohammad Reza Effatparvar
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
| | - Mickaël Begon
- École de Kinésiologie et des Sciences de l'Activité Physique, Faculté de MédecineUniversité de MontréalLavalCanada
- Centre de recherche du CHU Sainte‐JustineMontrealCanada
| | - Stéphane Sobczak
- Chaire de Recherche en Anatomie FonctionnelleUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
- Département d'anatomieUniversité du Québec à Trois‐RivièresTrois‐RivièresCanada
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3
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Burgio V, Casari S, Milizia M, Sanna F, Spezia G, Civera M, Rodriguez Reinoso M, Bertuglia A, Surace C. Mechanical properties of animal ligaments: a review and comparative study for the identification of the most suitable human ligament surrogates. Biomech Model Mechanobiol 2023; 22:1645-1683. [PMID: 37169958 PMCID: PMC10511400 DOI: 10.1007/s10237-023-01718-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 03/29/2023] [Indexed: 05/13/2023]
Abstract
The interest in the properties of animal soft tissues is often related to the desire to find an animal model to replace human counterparts due to the unsteady availability of human tissues for experimental purposes. Once the most appropriate animal model is identified, it is possible to carry out ex-vivo and in-vivo studies for the repair of ligamentous tissues and performance testing of replacement and support healing devices. This work aims to present a systematic review of the mechanical properties of ligaments reported in the scientific literature by considering different anatomical regions in humans and several animal species. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Moreover, considering the lack of a standard protocol for preconditioning of tissues, this aspect is also addressed. Ninety-six studies were selected for the systematic review and analysed. The mechanical properties of different animal species are reported and summarised in tables. Only results from studies reporting the strain rate parameter were considered for comparison with human ligaments, as they were deemed more reliable. Elastic modulus, ultimate tensile stress, and ultimate strain properties are graphically reported identifying the range of values for each animal species and to facilitate comparison between values reported in the scientific literature in animal and human ligaments. Useful similarities between the mechanical properties of swine, cow, and rat and human ligaments have been found.
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Affiliation(s)
- V. Burgio
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - S. Casari
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Milizia
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - F. Sanna
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - G. Spezia
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Civera
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - M. Rodriguez Reinoso
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
| | - A. Bertuglia
- Department of Veterinary Science, University of Turin, Largo Paolo Braccini 2-5, 10095 Grugliasco, Italy
| | - C. Surace
- Department of Structural, Building and Geotechnical Engineering, Politecnico di Torino, 10129 Turin, Italy
- Department of Structural, Geotechnical and Building Engineering, Laboratory of Bio-Inspired Nanomechanics, Politecnico di Torino, Corso Duca Degli Abruzzi 24, 10129 Turin, Italy
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Henyš P, Ramezani M, Schewitz D, Höch A, Möbius D, Ondruschka B, Hammer N. Sacrospinous and sacrotuberous ligaments influence in pelvis kinematics. J Anat 2022; 241:928-937. [PMID: 35986644 PMCID: PMC9482702 DOI: 10.1111/joa.13739] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 06/24/2022] [Accepted: 07/25/2022] [Indexed: 11/30/2022] Open
Abstract
The alteration in mechanical properties of posterior pelvis ligaments may cause a biased pelvis deformation which, in turn, may contribute to hip and spine instability and malfunction. Here, the effect of different mechanical properties of ligaments on lumbopelvic deformation is analyzed via the finite element method. First, the improved finite element model was validated using experimental data from previous studies and then used to calculate the sensitivity of lumbopelvic deformation to changes in ligament mechanical properties, load magnitude, and unilateral ligament resection. The deformation of the lumbopelvic complex relative to a given load was predominant in the medial plane. The effect of unilateral resection on deformation appeared to be counterintuitive, suggesting that ligaments have the ability to redistribute load and that they play an important role in the mechanics of the lumbopelvic complex.
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Affiliation(s)
- Petr Henyš
- Institute of New Technologies and Applied Informatics, Faculty of Mechatronics, Informatics and Interdisciplinary Studies Technical University of Liberec Liberec Czech Republic
| | - Maziar Ramezani
- Department of Mechanical Engineering Auckland University of Technology Auckland New Zealand
| | - Daniel Schewitz
- Department of Mechanical Engineering Auckland University of Technology Auckland New Zealand
| | - Andreas Höch
- Department of Trauma, Orthopedic and Plastic Surgery University Hospital of Leipzig Leipzig Germany
| | - Dustin Möbius
- Institute of Legal Medicine University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Benjamin Ondruschka
- Institute of Legal Medicine University Medical Centre Hamburg‐Eppendorf Hamburg Germany
| | - Niels Hammer
- Department of Trauma, Orthopedic and Plastic Surgery University Hospital of Leipzig Leipzig Germany
- Division of Macroscopic and Clinical Anatomy, Gottfried Schatz Research Center Medical University of Graz Graz Austria
- Fraunhofer Institute for Machine Tools and Forming Technology Dresden Germany
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5
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Duquesne K, Pattyn C, Vanderstraeten B, Audenaert EA. Handle With Care: The Anterior Hip Capsule Plays a Key Role in Daily Hip Performance. Orthop J Sports Med 2022; 10:23259671221078254. [PMID: 35356307 PMCID: PMC8958691 DOI: 10.1177/23259671221078254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Passive energy storage and return has long been recognized as one of the central mechanisms for minimizing the energy cost needed for terrestrial locomotion. Although the iliofemoral ligament (IFL) is the strongest ligament in the body, its potential role in energy-efficient walking remains unexplored. Purpose: To identify the contribution of the IFL to the amount of work performed by the hip muscles for normal, straight-level walking. Study Design: Controlled laboratory study. Methods: Straight-level walking of 50 healthy and injury-free adults was simulated using the AnyBody Modeling System. For each participant, the bone morphology and soft tissue properties were nonuniformly scaled. The superior and inferior parts of the IFL were represented by 2 springs each, and a linear force-strain relation was defined. A parameter study was conducted to account for the uncertainty surrounding the mechanical properties of the IFL. The work required from the gluteus, quadriceps, iliopsoas, and sartorius with and without inclusion of the IFL was calculated. Analysis of variance with subsequent post hoc paired t test was used to test the significance of IFL presence on the required mechanical work. Results: During walking, the strain in the IFL reached a median of 18.7% (95% CI, 8.0%-26.5%), with the largest values obtained at toe-off. With the IFL undamaged and fully operational, the effort required by the hip flexor muscles was reduced by a median of 54% (99% CI, 45%-62%) for the iliopsoas and by a median of 41% (99% CI, 27%-54%) for the sartorius muscles. The inclusion of the IFL did not significantly alter the work required by the gluteus and the quadriceps. Conclusion: The findings emphasized the key role the IFL plays in hip flexion by working synergistically with the hip musculature. Clinical Relevance: The importance of the contribution of the IFL to the hip flexors warrants careful handling and repair of these ligaments in cases of surgery and structural damage.
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Affiliation(s)
- Kate Duquesne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Christophe Pattyn
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | | | - Emmanuel A. Audenaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
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6
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Zhang S, Song J, Wu Q, Fang J, Ning B. Collagen I in the Hip Capsule Plays a Role in Postoperative Clinical Function in Patients With Developmental Dysplasia of the Hip. Front Pediatr 2022; 10:918660. [PMID: 35633968 PMCID: PMC9130651 DOI: 10.3389/fped.2022.918660] [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: 04/12/2022] [Accepted: 04/22/2022] [Indexed: 11/13/2022] Open
Abstract
The aims of the present study is to evaluate the roles of collagen I and III in the hip capsule in the postoperative clinical function of patients with developmental dysplasia of the hip (DDH). Hip capsules from 155 hips of 120 patients were collected during surgery. The patients were divided into three groups according to age: I: 2-3.5 years; II: 3.5-5 years; and III: 5-6 years. Patient clinical function and radiographic outcomes were evaluated with the McKay scores and Severin classification. The expression of collagen I and III was detected through immunohistochemistry and quantitative reverse transcription polymerase chain reaction (RT-PCR) and analyzed according to age, sex, degree of dislocation and McKay classification. All patients received open reduction and pelvic osteotomy and/or femoral shortening osteotomy and achieved good results on the basis of postoperative X-ray imaging. The average follow-up time was 3.4 years (range 2-4.3 years). There were no changes in the expression of collagen III in the different groups. The expression of collagen I according to age and sex was not significantly different. Lower expression of collagen I was observed in DDH patients with a higher degree of dislocation according to the Tonnis grade. The highest expression of collagen I was detected in the group with poor clinical function according to the McKay classification. Collagen I is correlated with the degree of dislocation and is a risk factor for poor clinical function in DDH patients. Collagen I is correlated with the degree of hip dislocation and poor clinical function in DDH patients.
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Affiliation(s)
- Sicheng Zhang
- Department of Pediatric Orthopaedic, Anhui Provincial Children's Hospital, Hefei, China
| | - Jun Song
- Children's Hospital, Fudan University, Shanghai, China
| | - Qingjie Wu
- Anhui Provincial Children's Hospital, Hefei, China
| | - Jihong Fang
- Anhui Provincial Children's Hospital, Hefei, China
| | - Bo Ning
- Children's Hospital, Fudan University, Shanghai, China
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7
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Spartacus V, Shojaeizadeh M, Raffault V, Shoults J, Van Wieren K, Sparrey CJ. In vivo soft tissue compressive properties of the human hand. PLoS One 2021; 16:e0261008. [PMID: 34898632 PMCID: PMC8668133 DOI: 10.1371/journal.pone.0261008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 11/22/2021] [Indexed: 12/25/2022] Open
Abstract
Background/Purpose Falls onto outstretched hands are the second most common sports injury and one of the leading causes of upper extremity injury. Injury risk and severity depends on forces being transmitted through the palmar surface to the upper extremity. Although the magnitude and distribution of forces depend on the soft tissue response of the palm, the in vivo properties of palmar tissue have not been characterized. The purpose of this study was to characterize the large deformation palmar soft tissue properties. Methods In vivo dynamic indentations were conducted on 15 young adults (21–29 years) to quantify the soft tissue characteristics of over the trapezium. The effects of loading rate, joint position, tissue thickness and sex on soft tissue responses were assessed. Results Energy absorbed by the soft tissue and peak force were affected by loading rate and joint angle. Energy absorbed was 1.7–2.8 times higher and the peak force was 2–2.75 times higher at high rate loading than quasistatic rates. Males had greater energy absorbed than females but not at all wrist positions. Damping characteristics were the highest in the group with the thickest soft tissue while damping characteristics were the lowest in group with the thinnest soft tissues. Conclusion Palmar tissue response changes with joint position, loading rate, sex, and tissue thickness. Accurately capturing these tissue responses is important for developing effective simulations of fall and injury biomechanics and assessing the effectiveness of injury prevention strategies.
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Affiliation(s)
- Victoria Spartacus
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- * E-mail:
| | - Maedeh Shojaeizadeh
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - Vincent Raffault
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
| | - James Shoults
- Science Technical Center, Simon Fraser University, Burnaby, BC, Canada
| | - Ken Van Wieren
- Science Technical Center, Simon Fraser University, Burnaby, BC, Canada
| | - Carolyn J. Sparrey
- Mechatronic Systems Engineering, Simon Fraser University, Surrey, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), Vancouver, British Columbia, Canada
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8
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D'Ambrosi R, Ursino N, Messina C, Della Rocca F, Hirschmann MT. The role of the iliofemoral ligament as a stabilizer of the hip joint. EFORT Open Rev 2021; 6:545-555. [PMID: 34377546 PMCID: PMC8335960 DOI: 10.1302/2058-5241.6.200112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
The purpose of this systematic literature review is to analyse the role of the iliofemoral ligament (ILFL) as a hip joint stabilizer in the current literature. A total of 26 articles were included in the review. The ILFL is the largest hip ligament consisting of two distinct arms and is highly variable, both in its location and overall size, and plays a primary role in hip stability; in the case of hip dislocation, the iliofemoral ligament tear does not heal, resulting in a persistent anterior capsule defect. Clinically, the ILFL is felt to limit external rotation in flexion and both internal and external rotation in extension. The abduction–hyperextension–external rotation (AB-HEER) test is overall the most accurate test to detect ILFL lesions. Injuries of the ILFL could be iatrogenic or a consequence of traumatic hip instability, and can be accurately studied with magnetic resonance imaging. Different arthroscopic and open techniques have been described in order to preserve the ILFL during surgery and, in case of lesions, several procedures with good to excellent results have been reported in the existing literature. The current systematic review, focusing only on the ILFL of the hip, summarizes the existing knowledge on anatomy, imaging and function and contributes to the further understanding of the ILFL, confirming its key role in anterior hip stability. Future studies will have to develop clinical tests to evaluate the functionality and stability of the ILFL.
Cite this article: EFORT Open Rev 2021;6:545-555. DOI: 10.1302/2058-5241.6.200112
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Affiliation(s)
| | | | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.,Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milano, Italy
| | | | - Michael Tobias Hirschmann
- Department of Orthopaedic Surgery and Traumatology Kantonsspital Baselland (Bruderholz, Liestal, Laufen) Switzerland
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9
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Burkhart TA, Baha P, Blokker A, Petrov I, Holdsworth DW, Drangova M, Getgood A, Degen RM. Hip capsular strain varies between ligaments dependent on both hip position- and applied rotational force. Knee Surg Sports Traumatol Arthrosc 2020; 28:3393-3399. [PMID: 32363474 DOI: 10.1007/s00167-020-06035-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 04/27/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE To noninvasively characterize the ligament strain in the hip capsule using a novel CT-based imaging technique. METHODS The superior iliofemoral ligament (SIFL), inferior iliofemoral ligament (IIFL), ischiofemoral ligament (IFL) and pubofemoral ligament (PFL) were identified and beaded in seven cadavers. Specimens were mounted on a joint motion simulator within an O-arm CT scanner in - 15°, 0°, 30°, 60°, and 90° of flexion. 3 Nm of internal rotation (IR) and external rotation (ER) were applied and CT scans obtained. Strains were calculated by comparing bead separation in loaded and unloaded conditions. Repeated-measures ANOVA was used to evaluate differences in strain within ligaments between hip positions. RESULTS For the SIFL, strain significantly decreased in IR at 30° (p = 0.045) and 60° (p = 0.043) versus 0°. For ER, there were no significant position-specific changes in strain (n.s.). For the IIFL, strain decreased in IR and increased in ER with no significant position-specific differences. For the IFL, strain increased with IR and decreased with ER with no significant position-specific differences. Finally, in the PFL there was a significant flexion angle-by-load interaction (p < 0.001; ES = 0.566), with peak strains noted at 60˚, however pair-wise comparisons failed to identify significant differences between positions (n.s.). Strain decreased in ER, with no significant position-specific differences. CONCLUSION The SIFL and IIFL limit hip external rotation with greater effect in higher flexion angles, while the IFL and PFL limit hip internal rotation. Following hip arthroscopy, consideration should be given to restricting external rotation as traditional capsulotomies cause injury to the SIFL and IIFL.
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Affiliation(s)
- Timothy A Burkhart
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Bone and Joint Institute, Western University, London, ON, Canada
| | - Pardis Baha
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Alexandra Blokker
- Department of Mechanical and Materials Engineering, Western University, London, ON, Canada
| | - Ivailo Petrov
- Bone and Joint Institute, Western University, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada
| | - David W Holdsworth
- Bone and Joint Institute, Western University, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Maria Drangova
- Bone and Joint Institute, Western University, London, ON, Canada.,Imaging Research Laboratories, Robarts Research Institute, Western University, London, ON, Canada.,Department of Medical Biophysics, Western University, London, ON, Canada
| | - Alan Getgood
- Bone and Joint Institute, Western University, London, ON, Canada.,Department of Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada
| | - Ryan M Degen
- Bone and Joint Institute, Western University, London, ON, Canada. .,Department of Surgery, Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
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10
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Myers CA, Fitzpatrick CK, Huff DN, Laz PJ, Rullkoetter PJ. Development and calibration of a probabilistic finite element hip capsule representation. Comput Methods Biomech Biomed Engin 2020; 23:755-764. [PMID: 32432892 DOI: 10.1080/10255842.2020.1764543] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The objective of this study was to develop a probabilistic representation of the hip capsule, which is calibrated to experimental capsular torque-rotation behavior and captures the observed variability for use in population-based studies. A finite element model of the hip capsule was developed with structures composed of a fiber-reinforced membrane, represented by 2D quadrilateral elements embedded with tension-only non-linear spring. An average capsule representation was developed by calibrating ligament properties (linear stiffness, reference strain) so that torque-rotation behavior matched mean cadaveric data. A probabilistic capsule was produced by determining the ligament property variability which represented ±2 SD measured in the experiment. Differences between experimental and model kinematics across all positions had RMS error of 4.7°. Output bounds from the optimized probabilistic capsule representation were consistent with ±2 SD of experimental data; the overall RMS error was 5.1°. This model can be employed in population-based finite element studies of THA to assess mechanics in realistic scenarios considering implant design, as well as surgical and patient factors.
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Affiliation(s)
- Casey A Myers
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Clare K Fitzpatrick
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA.,Mechanical and Biomedical Engineering, Boise State University, Boise, ID, USA
| | | | - Peter J Laz
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
| | - Paul J Rullkoetter
- Center for Orthopaedic Biomechanics, University of Denver, Denver, CO, USA
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Tomlinson J, Zwirner J, Ondruschka B, Prietzel T, Hammer N. Innervation of the hip joint capsular complex: A systematic review of histological and immunohistochemical studies and their clinical implications for contemporary treatment strategies in total hip arthroplasty. PLoS One 2020; 15:e0229128. [PMID: 32101545 PMCID: PMC7043757 DOI: 10.1371/journal.pone.0229128] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 01/30/2020] [Indexed: 01/17/2023] Open
Abstract
The hip joint capsule contributes to the stability of the hip joint and lower extremity, yet this structure is incised and often removed during total hip arthroplasty (THA). Increasing incidence of osteoarthritis is accompanied by a dramatic rise in THAs over the last few decades. Consequently, to improve this treatment, THA with capsular repair has evolved. This partial restoration of physiological hip stability has resulted in a substantial reduction in post-operative dislocation rates compared to conventional THA without capsular repair. A further reason for the success of this procedure is thought to be the preservation of the innervation of the capsule. A systematic review of studies investigating the innervation of the hip joint capsular complex and pseudocapsule with histological techniques was performed, as this is not well established. The literature was sought from databases Amed, Embase and Medline via OVID, PubMed, ScienceDirect, Scopus and Web of Science; excluding articles without a histological component and those involving animals. A total of 21 articles on the topic were identified. The literature indicates two primary outcomes and potential clinical implications of the innervation of the capsule. Firstly, a role in the mechanics of the hip joint, as mechanoreceptors may be present in the capsule. However, the nomenclature used to describe the distribution of the innervation is inconsistent. Furthermore, the current literature is unable to reliably confirm the proprioceptive role of the capsule, as no immunohistochemical study to date has reported type I-III mechanoreceptors in the capsule. Secondly, the capsule may play a role in pain perception, as the density of innervation appears to be altered in painful individuals. Also, increasing age may indicate requirements for different strategies to surgically manage the hip capsule. However, this requires further study, as well as the role of innervation according to sex, specific pathology and other morphometric variables. Increased understanding may highlight the requirement for capsular repair following THA, how this technique may be developed and the contribution of the capsule to joint function and stability.
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Affiliation(s)
- Joanna Tomlinson
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Johann Zwirner
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
| | - Benjamin Ondruschka
- Institute of Legal Medicine, Faculty of Medicine, University of Leipzig, Leipzig, Saxony, Germany
| | - Torsten Prietzel
- Department of Orthopaedics, Trauma and Reconstructive Surgery, Zeisigwaldkliniken Bethanien, Chemnitz, Saxony, Germany
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Saxony, Germany
| | - Niels Hammer
- Department of Anatomy, School of Biomedical Sciences, University of Otago, Dunedin, Otago, New Zealand
- Department of Orthopaedic, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Saxony, Germany
- Division of Medical Technology, Fraunhofer Institute for Machine Tools and Forming Technology (Fraunhofer IWU), Dresden, Saxony, Germany
- Institute of Macroscopic and Clinical Anatomy, University of Graz, Graz, Styria, Austria
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Abstract
➤Hip joint capsular ligaments (iliofemoral, ischiofemoral, and pubofemoral) play a predominant role in functional mobility and joint stability. ➤The zona orbicularis resists joint distraction (during neutral positions), and its aperture mechanism stabilizes the hip from adverse edge-loading (during extreme hip flexion-extension). ➤To preserve joint function and stability, it is important to minimize capsulotomy size and avoid disrupting the zona orbicularis, preserve the femoral head size and neck length, and only repair when or as necessary without altering capsular tensions. ➤It is not fully understood what the role of capsular tightness is in patients who have cam femoroacetabular impingement and if partial capsular release could be beneficial and/or therapeutic. ➤During arthroplasty surgery, a femoral head implant that is nearly equivalent to the native head size with an optimal neck-length offset can optimize capsular tension and decrease dislocation risk where an intact posterior hip capsule plays a critical role in maintaining hip stability.
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Affiliation(s)
- K C Geoffrey Ng
- MSk Lab, Department of Surgery and Cancer, Imperial College London, London, United Kingdom
| | - Jonathan R T Jeffers
- Department of Mechanical Engineering, Imperial College London, London, United Kingdom
| | - Paul E Beaulé
- Division of Orthopaedic Surgery, University of Ottawa, Ottawa, Ontario, Canada
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13
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Abstract
PURPOSE: Choice of the best mini invasive surgical approach for total hip replacement remains a controversial topic. The posterior approach is traditionally associated with a higher dislocation rate and the obligation of postoperative restrictions. Soft tissue repair reduces the risk of dislocation yet, posterior closure it is often challenging because of capsular and external rotator contractures. In this article, an original procedure of capsular lengthening and tension-free closure is described and the results of a retrospective single surgeon series of minimally invasive posterior total hip replacement (THR) with capsular repair are presented. METHODS: A total of 925 mini posterior total hip replacements performed between 2009 and 2015 were retrospectively reviewed. 2 original types of capsulorrhaphy to decrease tension of the repaired tissues were employed. Absence of posterior envelope stretch during flexion and internal rotation was confirmed intraoperatively with a dynamic test. No postoperative restrictions were used. RESULTS: Capsular lengthening with 1 of the described techniques was required in over 50% of cases for a tension-free closure. 3 patients dislocated in the 867 reviewed procedures (0.35%), 1 requiring revision for instability (0.11%). CONCLUSIONS: This soft tissue repair technique after mini posterior approach THR is technically easy, provides a tension-free closure and a low dislocation rate.
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Zhang K, de Sa D, Yu H, Choudur HN, Simunovic N, Ayeni OR. Hip capsular thickness correlates with range of motion limitations in femoroacetabular impingement. Knee Surg Sports Traumatol Arthrosc 2018; 26:3178-3187. [PMID: 29574547 DOI: 10.1007/s00167-018-4915-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 03/20/2018] [Indexed: 10/17/2022]
Abstract
PURPOSE Femoroacetabular impingement (FAI) is a clinical entity of the hip causing derangements in range of motion, pain, gait, and function. Computer-assisted modeling and clinical studies suggest that patients with FAI have increased capsular thickness compared to those without.A retrospective chart review was performed to assess relationships between capsular thickness, hip range of motion, and demographic factors in patients with FAI. METHODS Local Research Ethics Board approval was obtained to extract electronic medical records for 188 patients at a single institution who had undergone hip arthroscopy. Procedures were performed from 2009 to 2017 by a single, fellowship-trained, board-certified sports medicine orthopaedic surgeon. Inclusion criteria were preoperative hip range of motion testing, positive clinical impingement testing, and magnetic resonance imaging (MRI) of the affected hip. Patient demographics, hip range of motion, and time to surgery were recorded. MRIs were reviewed by a board-certified musculoskeletal radiologist blinded to clinical data. Maximum thickness of the anterior hip capsule was measured in axial, axial oblique, and sagittal oblique sequences. Anterior capsular thickness was also measured at the level of the femoral head-neck junction in axial sequences (axial midline). RESULTS Axial midline capsular thickness was negatively correlated with hip flexion (r = - 0.196, p = 0.0042) and internal rotation (r = - 0.143, p = 0.0278). Significant differences were seen between genders in axial midline thickness (5.3 ± 1.4 mm males/4.8 ± 1.3 mm females, p = 0.0079), flexion (113° ± 18° males/120° ± 17° females, p = 0.0029), and internal rotation (23° ± 13° males/29° ± 12° females, p = 0.0155). Significant differences also existed between side affected in flexion (116° ± 17° right/119° ± 17° left, p = 0.0396) and internal rotation (26° ± 12° right/29° ± 13° left, p = 0.0029). Positive correlation was observed between axial oblique capsular thickness and flexion (r = 0.2345) (p = 0.0229). CONCLUSIONS Increased anterior hip capsular thickness at the femoral head-neck correlates with limitations in hip range of motion in FAI. The strength of this relationship may be affected between pathologies, genders, and affected side. Pathologic thickening of the hip capsule may contribute to restricted hip mobility on clinical examination, and elucidation of this relationship may provide guidance into capsular management during hip arthroscopy. LEVEL OF EVIDENCE 4, retrospective case series.
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Affiliation(s)
- Kailai Zhang
- Michael G. DeGroote School of Medicine, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Darren de Sa
- UPMC Center for Sports Medicine, 3200 S. Water St, Pittsburgh, PA, 15203, USA
| | - Hang Yu
- Michael G. DeGroote School of Medicine, 1280 Main St W, Hamilton, ON, L8S 4K1, Canada
| | - Hema Nalini Choudur
- Department of Radiology, Hamilton General Hospital, 237 Barton St E, Hamilton, ON, L8L 2X2, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada
| | - Olufemi Rolland Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main St West, 4E15, Hamilton, ON, L8N 3Z5, Canada. .,Department of Orthopedic Surgery, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
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15
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Schleifenbaum S, Prietzel T, Hädrich C, Möbius R, Sichting F, Hammer N. Tensile properties of the hip joint ligaments are largely variable and age-dependent - An in-vitro analysis in an age range of 14-93 years. J Biomech 2016; 49:3437-3443. [PMID: 27667477 DOI: 10.1016/j.jbiomech.2016.09.001] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2016] [Revised: 09/02/2016] [Accepted: 09/07/2016] [Indexed: 01/12/2023]
Abstract
INTRODUCTION Hip joint stability is maintained by the surrounding ligaments, muscles, and the atmospheric pressure exerted via these structures. It is unclear whether the ligaments are capable of preventing dislocation solely due to their tensile properties, and to what extent they undergo age-related changes. This study aimed to obtain stress-strain data of the hip ligaments over a large age range. METHODS Stress-strain data of the iliofemoral (IL), ischiofemoral (IS) and pubofemoral ligament (PF) were obtained from cadavers ranging between 14 and 93 years using a highly standardized setting. Maximum strains were compared to the distances required for dislocation. RESULTS Elastic modulus was 24.4 (IL), 22.4 (IS) and 24.9N/mm2 (PF) respectively. Maximum strain was 84.5%, 86.1%, 72.4% and ultimate stress 10.0, 7.7 and 6.5N/mm2 for the IL, IS and PF respectively. None of these values varied significantly between ligaments or sides. The IS' elastic modulus was higher and maximum strain lower in males. Lower elastic moduli of the PF and higher maximum strains for the IS and PF were revealed in the ≥55 compared to the <55 population. Maximum strain exceeded the dislocation distance of the IS without external hip joint rotation in females, and of the IS and cranial IL under external rotation in both genders. DISCUSSION Tensile and failure load properties of the hip joint ligaments are largely variable. The IS and PF change age-dependently. Though the hip ligaments contribute to hip stability, the IS and cranial IL may not prevent dislocation due to their elasticity.
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Affiliation(s)
- Stefan Schleifenbaum
- Department of Anatomy, University of Otago, Dunedin, New Zealand; Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany
| | - Torsten Prietzel
- Department of Orthopedics, Trauma and Plastic Surgery, University of Leipzig, Leipzig, Germany; Department of Orthopedics and Trauma Surgery, HELIOS Clinic Blankenhain, Blankenhain, Germany
| | - Carsten Hädrich
- Institute of Forensic Medicine, University of Leipzig, Germany
| | - Robert Möbius
- Institute of Anatomy, University of Leipzig, Leipzig, Germany
| | - Freddy Sichting
- Institute of Sport Science, Department Human Locomotion, Chemnitz University of Technology, Chemnitz, Germany
| | - Niels Hammer
- Department of Anatomy, University of Otago, Dunedin, New Zealand.
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