Effect of Anterolateral Complex Sectioning and Tenodesis on Patellar Kinematics and Patellofemoral Joint Contact Pressures

2018 ◽  
Vol 46 (12) ◽  
pp. 2922-2928 ◽  
Author(s):  
Eivind Inderhaug ◽  
Joanna M. Stephen ◽  
Andy Williams ◽  
Andrew A. Amis
Keyword(s):  
Patellofemoral Joint ◽  
Graft Fixation ◽  
Tibial Rotation ◽  
Patellar Tilt ◽  
Patellar Kinematics ◽  
Graft Tension ◽  
Time Zero ◽  
Anterolateral Complex ◽  
Lateral Tenodesis ◽  
Contact Pressures

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.

scholarly journals The effect of distal tibial tuberosity high tibial osteotomy on postoperative patellar height and patellofemoral joint degeneration

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Changxiao Han ◽  
Xia Li ◽  
Xiangdong Tian ◽  
Jiping Zhao ◽  
Liqun Zhou ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Weight Bearing ◽  
Patellar Height ◽  
Tibial Tuberosity ◽  
Tibial Osteotomy ◽  
Patellar Tilt ◽  
Femoral Trochlea ◽  
Second Look ◽  
Joint Congruity

Abstract Background Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patellar infera. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA. Methods Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant was removed between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51 to 78 years old. The Caton-Deschamps index (CDI), congruence angle (CA), and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weight-bearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18–24 months after surgery. The Hospital for Special Surgery (HSS) scale was used to evaluate knee joint function. Results Twenty-nine patients were followed up for 18–28 months. The preoperative CDI, CA, and LPT changed from 0.92 ± 0.16 to 0.89 ± 0.14, from 5.52 ± 2.19 to 5.44 ± 2.27, and from 6.95 ± 2.88 to 6.54 ± 2.42, respectively, and the differences were not statistically significant (p > 0.05). The preoperative WBLR significantly increased from 16.72 ± 6.77 to 58.77 ± 7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p > 0.05). The HSS score significantly improved from 50.64 ± 19.18 preoperatively to 67.33 ± 14.72, 81.63 ± 11.92, and 82.73 ± 8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001). Conclusion DTT-HTO can effectively prevent patellar infera, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patellar infera or patellofemoral joint OA.

scholarly journals Patellar Kinematics, Part II: The Influence of the Depth of the Trochlear Groove in Subjects With and Without Patellofemoral Pain

2000 ◽  
Vol 80 (10) ◽  
pp. 965-973 ◽  
Author(s):  
Christopher M Powers
Keyword(s):  
Knee Flexion ◽  
Important Determinant ◽  
Knee Extension ◽  
Patellofemoral Pain ◽  
Trochlear Groove ◽  
Resonance Imaging ◽  
Patellar Tilt ◽  
Patellar Kinematics ◽  
Sulcus Angle ◽  
Kinematic Magnetic Resonance Imaging

Abstract Background and Purpose. A shallow intercondylar groove has been implicated as being contributory to abnormal patellar alignment. The purpose of this study was to assess the influence of the depth of the intercondylar groove on patellar kinematics. Subjects. Twenty-three women (mean age=26.8 years, SD=8.5, range=14–46) with a diagnosis of patellofemoral pain and 12 women (mean age=29.1 years, SD=5.0, range=24–38) without patellofemoral pain participated. Only female subjects were studied because of potential biomechanical differences between sexes. Methods. Patellar kinematics were assessed during resisted knee extension using kinematic magnetic resonance imaging. Measurements of medial and lateral patellar displacement and tilt were correlated with the depth of the trochlear groove (sulcus angle) at 45, 36, 27, 18, 9, and 0 degrees of knee flexion using regression analysis. Results. The depth of the trochlear groove was found to be correlated with patellar kinematics, with increased shallowness being predictive of lateral patellar tilt at 27, 18, 9, and 0 degrees of flexion and of lateral patellar displacement at 9 and 0 degrees of flexion (r=.51–.76). Conclusions and Discussion. The results of this study indicate that bony structure is an important determinant of patellar kinematics at end-range knee extension (0°–30°).

scholarly journals The Effect of Distal Tibial Tuberosity High Tibial Osteotomy on Postoperative Patellar Height and Patellofemoral Joint Degeneration

2020 ◽  
Author(s):  
Changxiao Han ◽  
Xia Li ◽  
Xiangdong Tian ◽  
Jiping Zhao ◽  
Liqun Zhou ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Patellofemoral Joint ◽  
Patellar Height ◽  
Tibial Tuberosity ◽  
Implant Removal ◽  
Tibial Osteotomy ◽  
Patellar Tilt ◽  
Femoral Trochlea ◽  
Second Look ◽  
Joint Congruity

Abstract Background: Distal tibial tuberosity high tibial osteotomy (DTT-HTO) can prevent distalization of the tibial tuberosity and thus patella infra. However, no studies on the clinical and radiological effects of DTT-HTO on the patellofemoral joint have been conducted. The purpose of the study was to evaluate the effect of DTT-HTO on patella height and patellofemoral joint congruity based on the severity of patellofemoral joint OA.Methods: Twenty-nine patients (33 knees) who underwent DTT-HTO and second-look arthroscopy when implant removal between January 2018 and May 2020 were eligible for the study. Among them, 6 were males, and 23 were females, with ages from 51-78 years old. The Caton-Deschamps index (CDI), congruence angle (CA) and lateral patellar tilt (LPT) were measured to evaluate the effect of surgery on patellar height and patellofemoral joint congruity. The weightbearing line ratio (WBLR) was measured to assess lower limb alignment. The cartilage lesion in the patellofemoral joint was assessed arthroscopically during surgery and implant removal by the International Cartilage Repair Society (ICRS) grading system at 18-24 months after surgery. The Hospital for Special Surgery scale (HSS) was used to evaluate knee joint function.Results: Twenty-nine patients were followed up for 18-28 months. The preoperative CDI, CA and LPT changed from 0.92±0.16 to 0.89±0.14, from 5.52±2.19 to 5.44±2.27 and from 6.95±2.88 to 6.54±2.42, respectively, and the differences were not statistically significant (p＞0.05). The preoperative WBLR significantly increased from 16.72±6.77% to 58.77±7.69% (p < 0.001). The cartilage lesions in the patella and femoral trochlea did not progress significantly from the first- to the second-look arthroscopy, according to the ICRS grades (p＞0.05). The HSS score significantly improved from 50.64±19.18 preoperatively to 67.33±14.72, 81.63±11.92 and 82.73±8.05 at the 3-month, 12-month, and last follow-up after surgery (p < 0.001).Conclusion: DTT-HTO can effectively prevent patellar infra, and its effects on postoperative patellofemoral joint congruity and patellofemoral joint OA progression are inconspicuous. It can be recommended as a treatment of varus knee combined with patella infra or patellofemoral joint OA.

The effect of distal tibial rotation during high tibial osteotomy on the contact pressures in the knee and ankle joints

2015 ◽  
Vol 25 (1) ◽  
pp. 299-305 ◽  
Author(s):  
Eduardo M. Suero ◽  
Nael Hawi ◽  
Ralf Westphal ◽  
Yaman Sabbagh ◽  
Musa Citak ◽  
...  
Keyword(s):  
High Tibial Osteotomy ◽  
Tibial Rotation ◽  
Tibial Osteotomy ◽  
Ankle Joints ◽  
Contact Pressures

A Detailed and Validated Three Dimensional Dynamic Model of the Patellofemoral Joint

2012 ◽  
Vol 134 (4) ◽  
Author(s):  
Mohammad Akbar ◽  
Farzam Farahmand ◽  
Ali Jafari ◽  
Mahmoud Saadat Foumani
Keyword(s):  
Knee Flexion ◽  
Patellofemoral Joint ◽  
Muscle Activation ◽  
Model Simulation ◽  
Three Dimensional ◽  
Rigid Bodies ◽  
Patellar Tilt ◽  
Full Extension ◽  
Patellar Stability

A detailed 3D anatomical model of the patellofemoral joint was developed to study the tracking, force, contact and stability characteristics of the joint. The quadriceps was considered to include six components represented by 15 force vectors. The patellar tendon was modeled using four bundles of viscoelastic tensile elements. Each of the lateral and medial retinaculum was modeled by a three-bundle nonlinear spring. The femur and patella were considered as rigid bodies with their articular cartilage layers represented by an isotropic viscoelastic material. The geometrical and tracking data needed for model simulation, as well as validation of its results, were obtained from an in vivo experiment, involving MR imaging of a normal knee while performing isometric leg press against a constant 140 N force. The model was formulated within the framework of a rigid body spring model and solved using forth-order Runge-Kutta, for knee flexion angles between zero and 50 degrees. Results indicated a good agreement between the model predictions for patellar tracking and the experimental results with RMS deviations of about 2 mm for translations (less than 0.7 mm for patellar mediolateral shift), and 4 degrees for rotations (less than 3 degrees for patellar tilt). The contact pattern predicted by the model was also consistent with the results of the experiment and the literature. The joint contact force increased linearly with progressive knee flexion from 80 N to 210 N. The medial retinaculum experienced a peak force of 18 N at full extension that decreased with knee flexion and disappeared entirely at 20 degrees flexion. Analysis of the patellar time response to the quadriceps contraction suggested that the muscle activation most affected the patellar shift and tilt. These results are consistent with the recent observations in the literature concerning the significance of retinaculum and quadriceps in the patellar stability.

scholarly journals The Influence of Mathematical Definitions on Patellar Kinematics Representations

Materials ◽  
2021 ◽  
Vol 14 (24) ◽  
pp. 7644
Author(s):  
Adrian Sauer ◽  
Maeruan Kebbach ◽  
Allan Maas ◽  
William M. Mihalko ◽  
Thomas M. Grupp
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Mean Squared Error ◽  
Patellar Tilt ◽  
Patellar Kinematics ◽  
Kinematic Data ◽  
Squared Error ◽  
Considerable Impact ◽  
Mathematical Definitions ◽  
Anterior Knee

A correlation between patellar kinematics and anterior knee pain is widely accepted. However, there is no consensus on how they are connected or what profile of patellar kinematics would minimize anterior knee pain. Nevertheless, answering this question by merging existing studies is further complicated by the variety of ways to describe patellar kinematics. Therefore, this study describes the most frequently used conventions for defining patellar kinematics, focusing on the rotations. The similarities and differences between the Cardan sequences and angles calculated by projecting axes are analyzed. Additionally, a tool is provided to enable the conversion of kinematic data between definitions in different studies. The choice of convention has a considerable impact on the absolute values and the clinical characteristics of the patello-femoral angles. In fact, the angles that result from using different mathematical conventions to describe a given patello-femoral rotation from our analyses differ up to a Root Mean Squared Error of 111.49° for patellar flexion, 55.72° for patellar spin and 35.39° for patellar tilt. To compare clinical kinematic patello-femoral results, every dataset must follow the same convention. Furthermore, researchers should be aware of the used convention’s implications to ensure reproducibility when interpreting and comparing such data.

Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies

Orthopedics ◽  
2019 ◽  
Vol 42 (2) ◽  
pp. e172-e179 ◽  
Author(s):  
Jeffrey D. Osborne ◽  
S. Brandon Luczak ◽  
William B. Acker ◽  
James Bicos
Keyword(s):  
Patellofemoral Joint ◽  
Patellar Instability ◽  
Joint Contact ◽  
Contact Pressures
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