Length Change Behavior of Virtual Medial Patellofemoral Ligament Fibers During In Vivo Knee Flexion

2015 ◽  
Vol 43 (5) ◽  
pp. 1165-1171 ◽  
Author(s):  
Si Young Song ◽  
Chae-Hyun Pang ◽  
Chan Hyoek Kim ◽  
Jeehyoung Kim ◽  
Mi Lim Choi ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Length Change ◽  
Change Behavior

The Medial Patellofemoral Ligament Is a Dynamic and Anisometric Structure: An In Vivo Study on Length Changes and Isometry

2019 ◽  
Vol 47 (7) ◽  
pp. 1645-1653 ◽  
Author(s):  
Willem A. Kernkamp ◽  
Cong Wang ◽  
Changzou Li ◽  
Hai Hu ◽  
Ewoud R.A. van Arkel ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Length Change ◽  
High Rate ◽  
Mpfl Reconstruction ◽  
Full Extension ◽  
3 Dimensional ◽  
Technical Errors ◽  
Length Changes

Background: Medial patellofemoral ligament (MPFL) reconstruction is associated with a high rate of complications, including recurrent instability and persistent knee pain. Technical errors are among the primary causes of these complications. Understanding the effect of adjusting patellofemoral attachments on length change patterns may help surgeons to optimize graft placement during MPFL reconstruction and to reduce graft failure rates. Purpose: To determine the in vivo length changes of the MPFL during dynamic, weightbearing motion and to map the isometry of the 3-dimensional wrapping paths from various attachments on the medial femoral epicondyle to the patella. Study Design: Descriptive laboratory study. Methods: Fifteen healthy participants were studied with a combined computed tomography and biplane fluoroscopic imaging technique during a lunge motion (full extension to ~110° of flexion). On the medial femoral epicondyle, 185 attachments were projected, including the anatomic MPFL footprint, which was divided into 5 attachments (central, proximal, distal, posterior, and anterior). The patellar MPFL area was divided into 3 possible attachments (proximal, central, and distal). The length changes of the shortest 3-dimensional wrapping paths of the various patellofemoral combinations were subsequently measured and mapped. Results: For the 3 patellar attachments, the most isometric attachment, with an approximate 4% length change, was located posterior and proximal to the anatomic femoral MPFL attachment, close to the adductor tubercle. Attachments proximal and anterior to the isometric area resulted in increasing lengths with increasing knee flexion, whereas distal and posterior attachments caused decreasing lengths with increasing knee flexion. The anatomic MPFL was tightest in extension, decreased in length until approximately 30° of flexion, and then stayed near isometric for the remainder of the motion. Changing both the femoral and patellar attachments significantly affected the length changes of the anatomic MPFL ( P < .001 for both). Conclusion: The most isometric location for MPFL reconstruction was posterior and proximal to the anatomic femoral MPFL attachment. The anatomic MPFL is a dynamic, anisometric structure that was tight in extension and early flexion and near isometric beyond 30° of flexion. Clinical Relevance: Proximal and anterior MPFL tunnel positioning should be avoided, and the importance of anatomic MPFL reconstruction is underscored with the results found in this study.

scholarly journals Automatic string generation for estimating in vivo length changes of the medial patellofemoral ligament during knee flexion

2014 ◽  
Vol 52 (6) ◽  
pp. 511-520 ◽  
Author(s):  
Matthias Graf ◽  
Salomon Diether ◽  
Lazaros Vlachopoulos ◽  
Sandro Fucentese ◽  
Philipp Fürnstahl
Keyword(s):  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Length Changes

scholarly journals Simulation of varying femoral attachment sites of medial patellofemoral ligament using a musculoskeletal multi-body model

2015 ◽  
Vol 1 (1) ◽  
pp. 547-551 ◽  
Author(s):  
A. Geier ◽  
T. Tischer ◽  
R. Bader
Keyword(s):  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Numerical Study ◽  
Patellofemoral Instability ◽  
Length Change ◽  
Systematic Evaluation ◽  
Parameter Study ◽  
Femoral Attachment ◽  
Attachment Sites ◽  
Length Changes

AbstractThe medial patellofemoral ligament (MPFL) is a key structure in the treatment of habitual and traumatic patellofemoral instability. However, there exists little knowledge about its behaviour during deep knee flexion after femoral refixation. Since improper femoral attachment sites may lead to unnatural length change patterns in the ligament and consequently to osteoarthritis due to pathological femoro-patellar contact pressure, the understanding of the patella kinematics and MPFL behaviour is crucial.The purpose of this numerical study was to compute the six-degree-of-freedom motion pattern of the human patella during deep knee flexion for systematic analysis of varying landmarks for the femoral attachment in medial patellofemoral ligament reconstruction surgery by means of multibody simulation.Therefore, based on a previously presented musculoskeletal model [1] the dynamic pathways of the patella were computed. Then, the spatial motion was approximated by rheonomic polynomials and exploited for systematic evaluation of the MPFL length change patterns. Hence, 16 femoral attachment points at a radius of 5 mm and 10 mm around the radiographic centre point [2] were defined and the absolute length changes were recorded during deep knee flexion to 120 degree.This approach allows for a systematic evaluation of numerous MPFL attachment sites while exploiting the physiological patella kinematics. The patella kinematics including shift, flexion, tilt and rotation as well as the MPFL length change patterns were consistent to in vitro and in vivo data in the literature [3–7] and therefore indicate validity of the numerical approach. The parameter study on the femoral attachment site should enable to determine the most isometric point and non-isometric variations corresponding to patellofemoral instability, arthritis or high graft load.

scholarly journals Medial collateral ligament reconstruction graft isometry is effected by femoral position more than tibial position

2021 ◽  
Author(s):  
Christoph Kittl ◽  
James Robinson ◽  
Michael J. Raschke ◽  
Arne Olbrich ◽  
Andre Frank ◽  
...  
Keyword(s):  
Medial Collateral Ligament ◽  
Knee Flexion ◽  
Length Change ◽  
Collateral Ligament ◽  
Complex Behaviour ◽  
Femoral Attachment ◽  
Attachment Sites ◽  
Custom Made ◽  
Length Changes ◽  
Graft Length

Abstract Purpose The purpose of this study was to examine the length change patterns of the native medial structures of the knee and determine the effect on graft length change patterns for different tibial and femoral attachment points for previously described medial reconstructions. Methods Eight cadaveric knee specimens were prepared by removing the skin and subcutaneous fat. The sartorius fascia was divided to allow clear identification of the medial ligamentous structures. Knees were then mounted in a custom-made rig and the quadriceps muscle and the iliotibial tract were loaded, using cables and hanging weights. Threads were mounted between tibial and femoral pins positioned in the anterior, middle, and posterior parts of the attachment sites of the native superficial medial collateral ligament (sMCL) and posterior oblique ligament (POL). Pins were also placed at the attachment sites relating to two commonly used medial reconstructions (Bosworth/Lind and LaPrade). Length changes between the tibiofemoral pin combinations were measured using a rotary encoder as the knee was flexed through an arc of 0–120°. Results With knee flexion, the anterior fibres of the sMCL tightened (increased in length 7.4% ± 2.9%) whilst the posterior fibres slackened (decreased in length 8.3% ± 3.1%). All fibre regions of the POL displayed a uniform lengthening of approximately 25% between 0 and 120° knee flexion. The most isometric tibiofemoral combination was between pins placed representing the middle fibres of the sMCL (Length change = 5.4% ± 2.1% with knee flexion). The simulated sMCL reconstruction that produced the least length change was the Lind/Bosworth reconstruction with the tibial attachment at the insertion of the semitendinosus and the femoral attachment in the posterior part of the native sMCL attachment side (5.4 ± 2.2%). This appeared more isometric than using the attachment positions described for the LaPrade reconstruction (10.0 ± 4.8%). Conclusion The complex behaviour of the native MCL could not be imitated by a single point-to-point combination and surgeons should be aware that small changes in the femoral MCL graft attachment position will significantly effect graft length change patterns. Reconstructing the sMCL with a semitendinosus autograft, left attached distally to its tibial insertion, would appear to have a minimal effect on length change compared to detaching it and using the native tibial attachment site. A POL graft must always be tensioned near extension to avoid capturing the knee or graft failure.

scholarly journals In-vivo analysis of flexion axes of the knee: Femoral condylar motion during dynamic knee flexion

2016 ◽  
Vol 32 ◽  
pp. 102-107 ◽  
Author(s):  
Yong Feng ◽  
Tsung-Yuan Tsai ◽  
Jing-Sheng Li ◽  
Harry E. Rubash ◽  
Guoan Li ◽  
...  
Keyword(s):  
Knee Flexion ◽  
In Vivo Analysis

scholarly journals Validation of an MRI-based method to assess patellofemoral joint contact areas in loaded knee flexion in vivo

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

scholarly journals In vivo stiffness assessment of patellar and quadriceps tendons by strain ultrasound elastography

2021 ◽  
pp. 1-10
Author(s):  
Surangika Wadugodapitiya ◽  
Makoto Sakamoto ◽  
Sayaka Suzuki ◽  
Yusuke Morise ◽  
Koichi Kobayashi
Keyword(s):  
Knee Flexion ◽  
Quadriceps Tendon ◽  
Strain Ratio ◽  
Ultrasound Elastography ◽  
Return To Sports ◽  
Target Tissue ◽  
Relative Stiffness ◽  
Extension Mechanism ◽  
Significant Difference

BACKGROUND: The patellar and quadriceps tendons are responsible for the extension mechanism of the knee joint and frequently become inflamed during sports. Diagnosis and determination of when an athlete can return to sports following these injuries are usually performed by assessing morphological features and functional outcomes. Nevertheless, mechanical properties are not being assessed. OBJECTIVE: To describe the stiffness characteristics of these two tendons over the range of knee flexion and to test the feasibility of using strain ultrasound elastography (SE). METHODS: SE with an acoustic coupler as the reference was performed for nine healthy males. Relative stiffness measurements were obtained using the strain ratio (SR = target tissue strain/reference strain) by placing the knee in five different flexion angles. Lower SR indicates higher relative stiffness. RESULTS: This study showed reliable measurement with good intra- and inter-rater agreement for SR at 30°. SR of the quadriceps tendon decreases as knee flexion increases, indicating increased relative stiffness. In the patellar tendon, no significant difference was observed between 30° and 60°. Beyond 60°, relative stiffness increased constantly. CONCLUSIONS: SE is a reproducible and feasible tool to monitor relative stiffness of the patellar and quadriceps tendons in routine clinical settings.

Muscle function during jumping in frogs. I. Sarcomere length change, EMG pattern, and jumping performance

1996 ◽  
Vol 271 (2) ◽  
pp. C563-C570 ◽  
Author(s):  
G. J. Lutz ◽  
L. C. Rome
Keyword(s):  
Mechanical Properties ◽  
Muscle Function ◽  
Length Change ◽  
Operating Conditions ◽  
Mechanical Power ◽  
Shortening Velocity ◽  
Jumping Performance ◽  
Angular Velocities ◽  
High Level

We determined the influence of temperature on muscle function during jumping to better understand how the frog muscular system is designed to generate a high level of mechanical power. Maximal jumping performance and the in vivo operating conditions of the semimembranosus muscle (SM), a hip extensor, were measured and related to the mechanical properties of the isolated SM in the accompanying paper [Muscle function during jumping in frogs. II. Mechanical properties of muscle: implication for system design. Am. J. Physiol. 271 (Cell Physiol. 40): C571-C578, 1996]. Reducing temperature from 25 to 15 degrees C caused a 1.75-fold decline in peak mechanical power generation and a proportional decline in aerial jump distance. The hip and knee joint excursions were nearly the same at both temperatures. Accordingly, sarcomeres shortened over the same range (2.4 to 1.9 microns) at both temperatures, corresponding to myofilament overlap at least 90% of maximal. At the low temperature, however, movements were made more slowly. Angular velocities were 1.2- to 1.4-fold lower, and ground contact time was increased by 1.33-fold at 15 degrees C. Average shortening velocity of the SM was only 1.2-fold lower at 15 degrees C than at 25 degrees C. The low Q10 of velocity is in agreement with that predicted for muscles shortening against an inertial load.

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