The Effect of Medial Opening Wedge Proximal Tibial Osteotomy on Patellofemoral Contact

2012 ◽  
Vol 41 (1) ◽  
pp. 80-86 ◽  
Author(s):  
Pooya Javidan ◽  
Gregory J. Adamson ◽  
Jennifer R. Miller ◽  
Pierre Durand ◽  
Patrick A. Dawson ◽  
...  
Keyword(s):  
Contact Forces ◽  
Wedge Osteotomy ◽  
Materials Testing ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Proximal Tibial Osteotomy ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Significant Difference ◽  
Pressure Sensitive Film

Background: It has been suggested that patellofemoral contact pressures and contact forces may be altered secondary to an opening wedge high tibial osteotomy, yet few data are available that quantify the effect of varying degrees of medial opening wedge osteotomy on the patellofemoral joint contact characteristics. Hypothesis: Opening wedge medial proximal tibial osteotomy will increase patellofemoral contact force and pressure. Study Design: Controlled laboratory study. Methods: Nine human cadaver knees were used. Pressure-sensitive film was placed in the suprapatellar pouch, leaving the patellar tendon and medial and lateral retinacula intact. The quadriceps tendon was attached to a materials testing machine along the axis of the femur, whereby a pulley mechanism generated 950 N of force. Patellofemoral contact characteristics were measured with pressure-sensitive film at 30°, 60°, 90°, and 120° of flexion for the native knee and after subsequent 10-mm and 15-mm medial opening wedge proximal tibial osteotomies. The film was analyzed with imaging software. Results: There was a statistically significant increase ( P < .05) in mean contact pressure at 30° and 120° between the 10-mm osteotomy and native knee and across all flexion angles between the 15-mm osteotomy and native knee. Furthermore, a significant difference was seen in peak pressures when native knees were compared with 10-mm and 15-mm opening wedge osteotomies at all flexion angles. Conclusion: There was a significant increase in patellofemoral pressures at varying degrees of knee flexion after medial opening wedge proximal tibial osteotomies of only 10 mm; a larger osteotomy resulted in a greater increase. Clinical Relevance: When performing a medial opening wedge proximal tibial osteotomy, the surgeon should consider the negative effects of increased patellofemoral peak pressure.

Contact characteristics of the ankle joint. Part 1. The normal joint

1994 ◽  
Vol 84 (10) ◽  
pp. 491-498 ◽  
Author(s):  
HL Driscoll ◽  
JC Christensen ◽  
AF Tencer
Keyword(s):  
Ankle Joint ◽  
Sagittal Plane ◽  
Pressure Ratio ◽  
Materials Testing ◽  
Total Load ◽  
Pressure Sensitive ◽  
Fresh Cadaver ◽  
Sensitive Film ◽  
Pressure Sensitive Film ◽  
High Pressure Zone

The contact characteristics of ankle joints in 18 fresh cadaver specimens were studied by using pressure-sensitive film to provide baseline information for subsequent studies of various pathologic ankle conditions. Specimens, consisting of the distal half of the tibia and fibula and the intact ankle and foot, were mounted in a materials testing system on a loading frame that allowed positioning in neutral, and 20 degrees of plantarflexion and dorsiflexion. An 800 N load (1 body weight) was axially applied to the specimens through the tibia with 10% of the total load distributed through the fibula. Transducers made of pressure-sensitive film were used to make a contact print and were scanned along with calibration strips to form a digital image. The image was analyzed quantitatively to determine total contact area, mean contact pressure, ratio of contact to plafond areas, and high pressure zone centroid location as a function of sagittal plane foot position in the normal ankle joint. The results demonstrated significant changes in ankle joint contact characteristics with different foot positions.

The Use of Contact Biomechanics to Study the Intact, Proximal Row Carpectomy and Scaphoid Excision, Four Bone Fusion Wrist

2020 ◽  
Vol 16 (3) ◽  
pp. 189-193
Author(s):  
David H. Wei ◽  
Peter Tang
Keyword(s):  
Proximal Row Carpectomy ◽  
Scapholunate Ligament ◽  
Bone Fusion ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Radiocarpal Joint ◽  
Pressure Sensitive Film ◽  
Number Of Authors

The study of contact biomechanics of the wrist is a challenge. This is partly due to the relatively small size of the joint as well as the lack of space in the radiocarpal joint which makes the delivery of investigative materials such as pressure sensitive film without causing artifact, difficult. Fortunately, a number of authors have studied the intact wrist, the scapholunate ligament injured wrist, the proximal row carpectomy and the scaphoid excision, four bone fusion. Despite some contrasting findings, there are some general concepts that we understand about wrist mechanics.

A Technique for Measuring Absolute Toe Pressures: Evaluation of Pressure-Sensitive Film Techniques

Foot & Ankle ◽  
1992 ◽  
Vol 13 (4) ◽  
pp. 220-223 ◽  
Author(s):  
Alan S. Tuckman ◽  
Frederick W. Werner ◽  
Maria D. Fortino ◽  
Joseph A. Spadaro
Keyword(s):  
Soft Tissues ◽  
Flat Surface ◽  
Imaging System ◽  
Accurate Method ◽  
Total Force ◽  
Confined Space ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Pressure Sensitive Film ◽  
Deforming Forces

Although a number of pathologies of the forefoot in ballet dancers on pointe have been described, pressures and deforming forces have not been adequately measured. To evaluate the possible use of pressure-sensitive film (PSF) in measuring the pressures on the external soft tissues in such a confined space as the dancer's toe shoe, it was tested and calibrated with 20 cadaver toes. Each cadaver toe was internally stabilized and loaded longitudinally against PSF on a flat surface. The resultant films were analyzed with a video imaging system and the pressures and total forces were determined. Results showed that the linearity of the PSF to pressure had a regression value of 0.98. By using two sensitivity ranges of films, the total force measured by the PSF was found to be within 10% of the known applied force on each toe. The PSF, therefore, may very well be a useful and accurate method of measuring external soft tissue pressures on the forefoot.

Biomechanics of the wrist after proximal row carpectomy in cadavers

2009 ◽  
Vol 35 (1) ◽  
pp. 43-45 ◽  
Author(s):  
Y.-L. Zhu ◽  
Y.-Q. Xu ◽  
J. Ding ◽  
J. Li ◽  
B. Chen ◽  
...  
Keyword(s):  
Sharp Decrease ◽  
Material Testing ◽  
Testing System ◽  
Average Pressure ◽  
Proximal Row Carpectomy ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Fresh Frozen ◽  
Pressure Sensitive Film ◽  
Lunate Fossa

We investigated the biomechanics of the radiocapitate joint after a proximal row carpectomy in six fresh-frozen cadaver wrists using super-low-pressure-sensitive film on a material testing system. The average pressure within the lunate fossa increased significantly from 23.2 to 136.4 N/cm2 with a sharp decrease in the contact area from 2.08 to 0.30 cm2 after a proximal row carpectomy. The cartilage of the proximal capitate had four sub-facets and therefore was not as smooth as the normal proximal lunate. We found that the wrist was overloaded after a proximal row carpectomy and the main cause was the anatomical mismatch of the radiocapitate articulation.

scholarly journals 20 Degree Post Traumatic Ankle Valgus and Distal Lateral Tibial Osteonecrosis Treated with Staged Deformity Correction and Total Ankle Arthroplasty

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0001
Author(s):  
Lawrence DiDomenico ◽  
Danielle Butto
Keyword(s):  
Ankle Joint ◽  
Deformity Correction ◽  
Total Ankle Arthroplasty ◽  
Wedge Osteotomy ◽  
Tibial Osteotomy ◽  
Opening Wedge ◽  
Ankle Arthroplasty ◽  
Initial Surgery ◽  
Post Traumatic ◽  
Ankle Valgus

Category: Ankle, Ankle Arthritis Introduction/Purpose: The purpose of this review is to present a case of post-traumatic ankle valgus and distal lateral tibial osteonecrosis successfully treated with staged deltoid repair, opening wedge tibial osteotomy, fibular lengthening, syndesmotic fusion and total ankle arthroplasty. Methods: Initial surgery consisted of ankle joint arthrotomy and deltoid imbrication. The second surgery consisted of a tibial opening wedge osteotomy with autogenous cortical fibular bone graft superior to the area of osteonecrosis to correct the 20 degree ankle valgus. Fibular lengthening osteotomy and fusion of the distal syndesmosis were also performed. CT scan confirmed bony consolidation at the distal tibiofibular syndesmosis as well as union of the allograft opening wedge. The final surgery was total ankle joint replacement with bone grafting of the area of osteonecrosis. Results: After 5 years of follow up the patient has progressed out of his AFO to full weightbearing. He reports no ankle pain, improved function and range of motion and is ambulating independently with no assistive devices. Conclusion: We successfully treated a case of distal lateral tibial osteonecrosis, and a 20 degree ankle valgus with staged deformity correction and ankle replacement. Radiographs demonstrate a well seated and positioned implant. We believe that with proper alignment that total ankle arthroplasty is a safe treatment option in the face of bone infarction.

Contact Stress and Linearized Modal Predictions of As-Built Preloaded Assembly

2020 ◽  
Vol 142 (5) ◽  
Author(s):  
Adam R. Brink ◽  
Robert J. Kuether ◽  
Matthew D. Fronk ◽  
Bryan L. Witt ◽  
Brendan L. Nation
Keyword(s):  
Finite Element ◽  
Finite Element Model ◽  
Contact Area ◽  
Element Model ◽  
High Fidelity ◽  
Vibration Modes ◽  
Low Level ◽  
Pressure Sensitive ◽  
Sensitive Film ◽  
Pressure Sensitive Film

Abstract The member stiffness and pressure distribution in a bolted joint is significantly influenced by the contact area of the mechanical interface under a prescribed preload force. This research explores the influence of as-built surface profiles for nominally flat interfaces of a C-Beam assembly with two well-defined contact regions. A high-fidelity finite element model is created such that the model uncertainty is minimized by updating and calibrating the piece parts prior to the preload assembly procedure. The model is then assembled and preloaded to evaluate the contact stresses and contact area for both nominally flat and perturbed non-flat surfaces based on three-dimensional surface topography measurements. The predicted pressures are validated with digitized pressure-sensitive film measurements. The high-fidelity modeling reveals how the compliance and thickness of the pressure-sensitive film alter the measured pressures, leading to incorrect evaluations of the stresses and contact area in the joint. The resulting low-level dynamic behavior of the preloaded assembly is shown to be sensitive to the true contact area by linearizing the nonlinear finite element model about the preloaded equilibrium and performing a computational modal analysis. The resonant frequencies are validated with experimental measurements to demonstrate the effect of the contact area on the modal characteristics of the bolted assembly. Vibration modes and loading patterns exhibit varying levels of sensitivity to the contact area in the joint, leading to an improved physical understanding of the influence of contact mechanics on the low-level linear vibration modes of jointed assemblies.

scholarly journals Surgical Anatomy of the Medial Cuneiform (Cotton) Osteotomy

2019 ◽  
Vol 4 (4) ◽  
pp. 247301141988534
Author(s):  
Baofu Wei ◽  
Brian C. Lau ◽  
Annunziato Amendola
Keyword(s):  
Tilt Angle ◽  
Tibialis Anterior ◽  
Articular Surface ◽  
Wedge Osteotomy ◽  
Opening Wedge ◽  
Small Branch ◽  
Medial Cuneiform ◽  
Significant Difference ◽  
Oblique Incision ◽  
Distal Articular Surface

Background: The Cotton osteotomy, or dorsal-opening wedge osteotomy of the medial cuneiform (MC), is used to address medial column alignment to restore the static-triangle of support. There are many described techniques regarding the incision and osteotomy. Successful completion of the osteotomy requires knowledge of the anatomy, particularly the location of the medial dorsal cutaneous nerve (MDCN). This study describes the relationship between MDCN, tibialis anterior, extensor-hallucis-longus tendon, and ligamentous attachments to the MC. A technique to determine a safe location for the osteotomy is also described. Methods: Twelve fresh-frozen adult foot specimens were used for this study (7 male and 5 female). The MDCN and its branches were dissected and its relationship with the MC was documented. Osteotomy tilt angle and relationship to structures around the MC were measured. Results: MDCN traveled medially and distally over the dorsum of the MC, and a small branch to the MC was observed. The tilt angle was 80.1 ±1.4 degrees. There was no significant difference between the distance from the distal-articular surface to the midline of the cuneiform and to the interosseous ligament ( P = .69), or between the distance from the distal-articular surface to the second tarsometatarsal joint and to the origin of the Lisfranc ligament ( P = .12). Conclusions: The dorsal-medial-oblique incision effectively protected MDCN and the MC. We believe the osteotomy should be performed in the safe zone to maintain the stability of the opening wedge. Clinical relevance: The dorsal-medial-oblique incision could reduce the risk of injury to the MDCN and the tibialis-anterior tendon.

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