scholarly journals The Effect of Anterolateral Complex Sectioning and a Macintosh Tenodesis on Patellofemoral Joint Contact Pressures and Kinematics

2017 ◽  
Vol 33 (10) ◽  
pp. e120-e121
Author(s):  
Eivind Inderhaug ◽  
Joanna M. Stephen ◽  
Andy Williams ◽  
Andrew A. Amis
2018 ◽  
Vol 46 (12) ◽  
pp. 2922-2928 ◽  
Author(s):  
Eivind Inderhaug ◽  
Joanna M. Stephen ◽  
Andy Williams ◽  
Andrew A. Amis

Background: Anterolateral complex injuries are becoming more recognized. While these are known to affect tibiofemoral mechanics, it is not known how they affect patellofemoral joint behavior. Purpose: To determine the effect of (1) sectioning the anterolateral complex and (2) performing a MacIntosh tenodesis under various conditions on patellofemoral contact mechanics and kinematics. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric knees were tested in a customized rig, with the femur fixed and tibia free to move, with optical tracking to record patellar kinematics and with thin pressure sensors to record patellofemoral contact pressures at 0°, 30°, 60°, and 90° of knee flexion. The quadriceps and iliotibial tract were loaded with 205 N throughout testing. Intact and anterolateral complex–sectioned states were tested, followed by 4 randomized tenodeses applying 20- and 80-N graft tension, each with the tibia in its neutral intact alignment or left free to rotate. Statistical analyses were undertaken with repeated measures analysis of variance, Bonferroni post hoc analysis, and paired samples t tests. Results: Patellar kinematics and contact pressures were not significantly altered after sectioning of the anterolateral complex (all: P > .05). Similarly, they were not significantly different from the intact knee in tenodeses performed when fixed tibial rotation was combined with 20- or 80-N graft tension (all: P > .05). However, grafts tensioned with 20 N and 80 N while the tibia was free hanging resulted in significant increases in lateral patellar tilt ( P < .05), and significantly elevated lateral peak patellofemoral pressures ( P < .05) were observed for 80 N. Conclusion: This work did not find that an anterolateral injury altered patellofemoral mechanics or kinematics, but adding a lateral tenodesis can elevate lateral contact pressures and induce lateral patellar tilting if the tibia is pulled into external rotation by the tenodesis. Although these in vitro changes were small and might not be relevant in a fully loaded knee, controlling the position of the tibia at graft fixation is effective in avoiding overconstraint at time zero in a lateral tenodesis. Clinical Relevance: Small changes in lateral patellar tilt and patellofemoral contact pressures were found at time zero with a MacIntosh tenodesis. These changes were eliminated when the tibia was held in neutral rotation at the time of graft fixation. The risk of overconstraint after a lateral tenodesis therefore seems low and in accordance with recent published reports.


Orthopedics ◽  
2019 ◽  
Vol 42 (2) ◽  
pp. e172-e179 ◽  
Author(s):  
Jeffrey D. Osborne ◽  
S. Brandon Luczak ◽  
William B. Acker ◽  
James Bicos

2012 ◽  
Vol 27 (6) ◽  
pp. 595-601 ◽  
Author(s):  
Andrew Sawatsky ◽  
Doug Bourne ◽  
Monika Horisberger ◽  
Azim Jinha ◽  
Walter Herzog

1993 ◽  
Vol 26 (3) ◽  
pp. 352 ◽  
Author(s):  
Janet L. Ronsky ◽  
Walter Herzog ◽  
Thomas D. Brown ◽  
Tim Leonard

2014 ◽  
Vol 136 (4) ◽  
Author(s):  
Joshua E. Johnson ◽  
Phil Lee ◽  
Terence E. McIff ◽  
E. Bruce Toby ◽  
Kenneth J. Fischer

Joint injuries and the resulting posttraumatic osteoarthritis (OA) are a significant problem. There is still a need for tools to evaluate joint injuries, their effect on joint mechanics, and the relationship between altered mechanics and OA. Better understanding of injuries and their relationship to OA may aid in the development or refinement of treatment methods. This may be partially achieved by monitoring changes in joint mechanics that are a direct consequence of injury. Techniques such as image-based finite element modeling can provide in vivo joint mechanics data but can also be laborious and computationally expensive. Alternate modeling techniques that can provide similar results in a computationally efficient manner are an attractive prospect. It is likely possible to estimate risk of OA due to injury from surface contact mechanics data alone. The objective of this study was to compare joint contact mechanics from image-based surface contact modeling (SCM) and finite element modeling (FEM) in normal, injured (scapholunate ligament tear), and surgically repaired radiocarpal joints. Since FEM is accepted as the gold standard to evaluate joint contact stresses, our assumption was that results obtained using this method would accurately represent the true value. Magnetic resonance images (MRI) of the normal, injured, and postoperative wrists of three subjects were acquired when relaxed and during functional grasp. Surface and volumetric models of the radiolunate and radioscaphoid articulations were constructed from the relaxed images for SCM and FEM analyses, respectively. Kinematic boundary conditions were acquired from image registration between the relaxed and grasp images. For the SCM technique, a linear contact relationship was used to estimate contact outcomes based on interactions of the rigid articular surfaces in contact. For FEM, a pressure-overclosure relationship was used to estimate outcomes based on deformable body contact interactions. The SCM technique was able to evaluate variations in contact outcomes arising from scapholunate ligament injury and also the effects of surgical repair, with similar accuracy to the FEM gold standard. At least 80% of contact forces, peak contact pressures, mean contact pressures and contact areas from SCM were within 10 N, 0.5 MPa, 0.2 MPa, and 15 mm2, respectively, of the results from FEM, regardless of the state of the wrist. Depending on the application, the MRI-based SCM technique has the potential to provide clinically relevant subject-specific results in a computationally efficient manner compared to FEM.


2013 ◽  
Vol 39 (4) ◽  
pp. 978-987 ◽  
Author(s):  
Emily J. McWalter ◽  
Colm M. O'Kane ◽  
David P. FitzPatrick ◽  
David R. Wilson

Author(s):  
Andrew E. Anderson ◽  
Steve A. Maas ◽  
Benjamin J. Ellis ◽  
Jeffrey A. Weiss

Simplified analytical approaches to estimate hip joint contact pressures using perfectly spherical geometry have been described in the literature (rigid body spring models); however, estimations based on these simulations have not corresponded well with experimental in vitro data. Recent evidence from our laboratory suggests that finite element (FE) models of the hip joint that incorporate detailed geometry for cartilage and bone can predict cartilage pressures in good agreement with experimental data [1]. However, it is unknown whether this degree of model complexity is necessary. The objective of this study was to compare cartilage contact pressure predictions from FE models with varying degrees of simplicity to elucidate which aspects of hip morphology are required to obtain accurate predictions of cartilage contact pressure. Models based on 1) subject-specific (SS) geometry, 2) spheres, and 3) rotational conchoids were analyzed.


2009 ◽  
Vol 30 (8) ◽  
pp. 767-772 ◽  
Author(s):  
Dong Gil Lee ◽  
Brian L. Davis

Background: One of the more serious diabetic complications is Charcot neuroarthropathy (CN), a disease that results in arch collapse and permanent foot deformity. However, very little is known about the etiology of CN. From a mechanical standpoint, it is likely that there is a “vicious circle” in terms of (i) arch collapse causing increased midfoot joint pressures, and (ii) increased joint contact pressures exacerbating the collapse of midfoot bones. This study focused on assessment of peak joint pressure difference between diabetic and non-diabetic cadaver feet during simulated walking. We hypothesized that joint pressures are higher for diabetics than normal population. Materials and Methods: Sixteen cadaver foot specimens (eight control and eight diabetic specimens) were used in this study. Human gait at 25% of typical walking speed (averaged stance duration of 3.2s) was simulated by a custom-designed Universal Musculoskeletal Simulator. Four medial midfoot joint pressures (the first metatarsocuneiform, the medial naviculocuneiform, the middle naviculocuneiform, and the first intercuneiform) were measured dynamically during full stance. Results: The pressures in each of the four measured midfoot joints were significantly greater in the diabetic feet ( p = 0.015, p = 0.025, p < 0.001, and p = 0.545, respectively). Conclusion: Across all four tested joints, the diabetic cadaver specimens had, on average, 46% higher peak pressures than the control cadaver feet during the simulated stance phase. Clinical Relevance: This finding suggests that diabetic patients could be predisposed to arch collapse even before there are visible signs of bone or joint abnormalities.


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