Effects of Capsular Reconstruction With an Iliotibial Band Allograft on Distractive Stability of the Hip Joint: A Biomechanical Study

2018 ◽  
Vol 46 (14) ◽  
pp. 3429-3436 ◽  
Author(s):  
Lorenzo Fagotti ◽  
Bryson R. Kemler ◽  
Hajime Utsunomiya ◽  
Hunter W. Storaci ◽  
Joseph J. Krob ◽  
...  
Keyword(s):  
Hip Joint ◽  
Biomechanical Study ◽  
Iliotibial Band ◽  
Displacement Curve ◽  
Neutral Position ◽  
Effective Treatment Option ◽  
Percentage Decrease ◽  
Fresh Frozen ◽  
Orthopaedic Community ◽  
Capsular Defect

Background: The capsular ligaments and the labral suction seal cooperatively manage distractive stability of the hip. Capsular reconstruction using an iliotibial band (ITB) allograft aims to address capsular insufficiency and iatrogenic instability. However, the extent to which this procedure may restore hip distractive stability after a capsular defect is unknown. Purpose: To evaluate the biomechanical effects of capsular reconstruction on distractive stability of the hip joint. Study Design: Controlled laboratory study. Methods: Eight fresh-frozen cadaveric hip specimens were dissected to the level of the capsule and axially distracted in 3 testing states: intact capsule, partial capsular defect, and capsular reconstruction with an ITB allograft. Each femur was compressed with 500 N of force and then distracted 6 mm relative to the neutral position at 0.5 mm/s. Distractive force was continuously recorded, and the first peak delineating 2 phases of hip distractive stability in the force-displacement curve was analyzed. Results: The median force at maximum distraction in the capsular reconstruction state (156 N) was significantly greater than that in the capsular defect state (89 N; P = .036) but not significantly different from that in the intact state (218 N; P = .054). Median values for distractive force at first peak (60 N, 72 N, and 61 N, respectively; P = .607), distraction at first peak (2.3 mm, 2.3 mm, and 2.5 mm, respectively; P = .846), and percentage decrease in distractive force (35%, 78%, and 63%, respectively; P = .072) after the first peak were not significantly different between the intact, defect, and reconstruction states. Conclusion: Capsular reconstruction with an ITB allograft significantly increased the force required to distract the hip compared with a capsular defect in a cadaveric model. To our knowledge, this is the first study to report an initial peak distractive force and to propose 2 distinct phases of hip distractive stability. Clinical Relevance: The consequences of a capsular defect on distractive stability of the hip may be underappreciated among the orthopaedic community; with that said, capsular reconstruction using an ITB allograft provided significantly increased distractive stability and should be considered an effective treatment option for patients with symptomatic capsular deficiency.

A Preliminary Biomechanical Study of Cyclic Preconditioning Effects on Canine Cadaveric Whole Femurs

2012 ◽  
Vol 134 (9) ◽  
Author(s):  
Rad Zdero ◽  
Chris H. Gallimore ◽  
Alison J. McConnell ◽  
Harshita Patel ◽  
Rosane Nisenbaum ◽  
...  
Keyword(s):  
Cyclic Loading ◽  
Biomechanical Study ◽  
Coefficient Of Determination ◽  
Displacement Curve ◽  
Matched Pairs ◽  
Cycle Number ◽  
Loading Cycle ◽  
Fresh Frozen ◽  
Practical Implications

Biomechanical preconditioning of biological specimens by cyclic loading is routinely done presumably to stabilize properties prior to the main phase of a study. However, no prior studies have actually measured these effects for whole bone of any kind. The aim of this study, therefore, was to quantify these effects for whole bones. Fourteen matched pairs of fresh-frozen intact cadaveric canine femurs were sinusoidally loaded in 4-point bending from 50 N to 300 N at 1 Hz for 25 cycles. All femurs were tested in both anteroposterior (AP) and mediolateral (ML) bending planes. Bending stiffness (i.e., slope of the force-vs-displacement curve) and linearity R2 (i.e., coefficient of determination) of each loading cycle were measured and compared statistically to determine the effect of limb side, cycle number, and bending plane. Stiffnesses rose from 809.7 to 867.7 N/mm (AP, left), 847.3 to 915.6 N/mm (AP, right), 829.2 to 892.5 N/mm (AP, combined), 538.7 to 580.4 N/mm (ML, left), 568.9 to 613.8 N/mm (ML, right), and 553.8 to 597.1 N/mm (ML, combined). Linearity R2 rose from 0.96 to 0.99 (AP, left), 0.97 to 0.99 (AP, right), 0.96 to 0.99 (AP, combined), 0.95 to 0.98 (ML, left), 0.94 to 0.98 (ML, right), and 0.95 to 0.98 (ML, combined). Stiffness and linearity R2 versus cycle number were well-described by exponential curves whose values leveled off, respectively, starting at 12 and 5 cycles. For stiffness, there were no statistical differences for left versus right femurs (p = 0.166), but there were effects due to cycle number (p < 0.0001) and AP versus ML bending plane (p < 0.0001). Similarly, for linearity, no statistical differences were noted due to limb side (p = 0.533), but there were effects due to cycle number (p < 0.0001) and AP versus ML bending plane (p = 0.006). A minimum of 12 preconditioning cycles was needed to fully stabilize both the stiffness and linearity of the canine femurs. This is the first study to measure the effects of mechanical preconditioning on whole bones, having some practical implications on research practices.

scholarly journals The effect of posterior compression of the facet joints for initial stability and sagittal profile in the treatment of thoracolumbar fractures: a biomechanical study

2021 ◽  
Author(s):  
Michael Ruf ◽  
Tobias Pitzen ◽  
Ivo Nennstiel ◽  
David Volkheimer ◽  
Jörg Drumm ◽  
...  
Keyword(s):  
Axial Rotation ◽  
Biomechanical Study ◽  
Sagittal Profile ◽  
Posterior Fixation ◽  
Neutral Position ◽  
Intact State ◽  
Custom Made ◽  
Flexion Extension ◽  
Fresh Frozen ◽  
Anterior Support

Abstract Purpose Surgical treatment of thoracolumbar A3-fractures usually comprises posterior fixation—in neutral position or distraction—potentially followed by subsequent anterior support. We hypothesized that additional posterior compression in circumferential stabilization may increase stability by locking the facets, and better restore the sagittal profile. Methods Burst fractures Type A3 were created in six fresh frozen cadaver spine segments (T12–L2). Testing was performed in a custom-made spinal loading simulator. Loads were applied as pure bending moments of ± 3.75 Nm in all six movement axes. We checked range of motion, neutral zone and Cobb’s angle over the injured/treated segment within the following conditions: Intact, fractured, instrumented in neutral alignment, instrumented in distraction, with cage left in posterior distraction, with cage with posterior compression. Results We found that both types of instrumentation with cage stabilized the segment compared to the fractured state in all motion planes. For flexion/extension and lateral bending, flexibility was decreased even compared to the intact state, however, not in axial rotation, being the most critical movement axis. Additional posterior compression in the presence of a cage significantly decreased flexibility in axial rotation, thus achieving stability comparable to the intact state even in this movement axis. In addition, posterior compression with cage significantly increased lordosis compared to the distracted state. Conclusion Among different surgical modifications tested, circumferential fixation with final posterior compression as the last step resulted in superior stability and improved sagittal alignment. Thus, posterior compression as the last step is recommended in these pathologies.

scholarly journals Redefining Knee Balance in a Medially Stabilized Prosthesis: An In-Vitro Study

2017 ◽  
Vol 11 (1) ◽  
pp. 1165-1172
Author(s):  
Philippe Van Overschelde ◽  
Vera Pinskerova ◽  
Peter P. Koch ◽  
Christophe Fornasieri ◽  
Sandro Fucentese
Keyword(s):  
Soft Tissue ◽  
Soft Tissues ◽  
In Vitro Study ◽  
Lateral Release ◽  
Soft Tissue Release ◽  
Iliotibial Band ◽  
Soft Tissue Envelope ◽  
Medial Side ◽  
Fresh Frozen

Background: To date, there is still no consensus on what soft tissues must be preserved and what structures can be safely released during total knee arthroplasty (TKA) with a medially stabilized implant. Objective: The aim of this study was to analyze the effect of a progressive selective release of the medial and lateral soft tissues in a knee implanted with a medially stabilized prosthesis. Method: Six cadaveric fresh-frozen full leg specimens were tested. In each case, kinematic pattern and mediolateral laxity were measured in three stages: firstly, prior to implantation; secondly, after the implantation of the trial components, but before any soft tissue release; and thirdly, progressively as soft tissue was released with the trial implant in place. The incremental impact of each selective release on knee balance was then analyzed. Results: In all cases sagittal stability was not affected by the progressive release of the lateral soft tissue envelope. It was possible to perform progressive lateral release provided the anterior one-third of the iliotibial band (ITB) remained intact. Progressive medial release could be performed on the medial side provided the anterior fibers of the superficial medial collateral ligament (sMCL) remained intact. Conclusion: The medially conforming implant remains stable provided the anterior fibers of sMCL and the anterior fibers of the ITB remain intact. The implant’s sagittal stability is mainly dependent on its medial ball-in-socket design.

scholarly journals Treatment of an extensive acetabular defect in a patient with aseptic instability of a total hip arthroplasty

2020 ◽  
Vol 27 (3) ◽  
pp. 60-66
Author(s):  
Hovakim A. Aleksanyan ◽  
Hamlet A. Chragyan ◽  
Sergey V. Kagramanov ◽  
Nikolay V. Zagorodniy
Keyword(s):  
Acetabular Component ◽  
Hip Joint ◽  
Revision Arthroplasty ◽  
Acetabular Defect ◽  
Total Arthroplasty ◽  
Total Endoprosthesis ◽  
Reconstructive Operations ◽  
Fresh Frozen ◽  
Joint Revision ◽  
The Right

The aim of the study is to demonstrate, using a clinical example, the possibility of treating a patient with a severe acetabular defect by performing a one-stage revision arthroplasty using an individual design. Materials and methods. A 45-year-old female patient was admitted with complaints of pain, limitation of movement in the right hip joint, and gait disturbance. From anamnesis at the age of 5 years, reconstructive operations of the hip joints were performed. In 1991, CITO performed primary total arthroplasty of the right hip joint with an endoprosthesis from ESKA Implants. In 1998, due to the instability of the acetabular component of the total endoprosthesis of the right hip joint, revision arthroplasty was performed, and the cup was placed with a cement fixation. In 2001, for left-sided dysplastic coxarthrosis, primary total arthroplasty of the left hip joint was performed. In 2012, due to the instability of the total endoprosthesis of the left hip joint, revision arthroplasty was performed using an ESI anti-protrusion ring (ENDOSERVICE) with a cement cup and a Zweimller-type femoral component; the femur defect was repaired using a fresh frozen cortical graft. In October 2019, instability of the total endoprosthesis of the right hip joint was revealed, for which revision endoprosthetics was performed using an individual acetabular component. Results. The HHS index before revision arthroplasty was 21 points, after 1 month after surgery 44 points, after 3 months after surgery 65, after 6 months 82. Quality of life was assessed according to the WOMAC scale: before surgery 73 points, after 1 month after surgery 54 points, after 3 months 31, after 6 months 15 points. At the time of the last consultation, the patient moves with a cane, lameness persists, associated with scar reconstruction and atrophy of the gluteal muscles. Conclusion. The use of individual structures allows to restore the support ability of the lower limb and the function of the hip joint in the case of an extensive defect of the pelvic bones of the pelvic discontinuity type.

Effect of decrease in radial inclination of distal radius fractures on distal radioulnar joint stability: a biomechanical study

2018 ◽  
Vol 43 (9) ◽  
pp. 967-973 ◽  
Author(s):  
Yuki Bessho ◽  
Toshiyasu Nakamura ◽  
Masao Nishiwaki ◽  
Takeo Nagura ◽  
Morio Matsumoto ◽  
...  
Keyword(s):  
Distal Radius ◽  
Joint Stiffness ◽  
Distal Radioulnar Joint ◽  
Biomechanical Study ◽  
Joint Stability ◽  
Radius Fractures ◽  
Radioulnar Joint ◽  
Radial Inclination ◽  
Fresh Frozen ◽  
The Relationship

We investigated the relationship between the radial inclination of the distal radius and distal radioulnar joint stability. Six fresh-frozen upper extremities were used. Radial inclination was decreased by 10° and 20° and increased by 10° from the original radial inclination. Distal radioulnar joint stiffness was assessed with an intact radioulnar ligament and after partial and then complete sectioning of the radioulnar ligament. Radial angulation deformities significantly increased distal radioulnar joint stiffness when the radioulnar ligament is totally or partially attached to the ulnar fovea. After complete sectioning of the radioulnar ligament, distal radioulnar joint stiffness decreased significantly; additional radial angulation deformity slightly increased distal radioulnar joint stiffness, but the distal radioulnar joint never recovered to the original stiffness. Based on the results, radial angulation deformities of the distal radius should be corrected within 10° when the radioulnar ligament is intact, to reduce the risk of symptomatic distal radioulnar joint instability.

The Peroneal Groove Deepening Procedure: A Biomechanical Study of Pressure Reduction

2005 ◽  
Vol 26 (6) ◽  
pp. 442-448 ◽  
Author(s):  
Craig I. Title ◽  
Hung-Geun Jung ◽  
Brent G. Parks ◽  
Lew C. Schon
Keyword(s):  
Biomechanical Study ◽  
Posterior Tibial Tendon ◽  
Peroneal Tendon ◽  
Foot And Ankle ◽  
Calcaneofibular Ligament ◽  
Significant Difference ◽  
Mean Pressure ◽  
Fresh Frozen ◽  
The Mean ◽  
Pressure Changes

Background: The goal of this study was to identify pressure changes throughout the peroneal groove after a groove deepening procedure. We hypothesized that pressures would decrease. Methods: Twelve fresh-frozen foot and ankle specimens were used. A thin pressure strip containing four sensor pads was secured within the peroneal groove with pads 1 through 4 positioned at the calcaneofibular ligament (CFL) and at the distal, middle, and proximal groove, respectively. The midstance phase of gait was simulated with loads applied to the plantar foot and posterior tibial tendon and to the peroneus longus and brevis tendons. Pressures were recorded with the ankle in neutral, plantarflexion, dorsiflexion, inversion, and eversion. Groove deepening was done by osteotomizing the posterior fibular wall. Pressure readings were then recorded. Average pressures for each of the four sensor pads after the procedure were compared to those obtained before the procedure. Results: The mean pressure overlying the CFL increased at all five ankle positions; however, these changes were not significant. Significant decreases in pressure were noted within the distal and middle groove at all ankle positions after the peroneal groove deepening procedure. Pressure within the proximal groove increased at all but one position, with a significant difference noted in neutral and plantarflexion. Conclusion: Pressures within the middle and distal peroneal groove significantly decreased after a groove deepening procedure. Combining this technique with peroneal tendon debridement may be advantageous for treatment of partial peroneal tendon tears or recalcitrant peroneal tendinitis.

Ability of Medial Patellofemoral Ligament Reconstruction to Overcome Lateral Patellar Motion in the Presence of Trochlear Flattening: A Cadaveric Biomechanical Study

2021 ◽  
pp. 036354652110410
Author(s):  
Amrit V. Vinod ◽  
Alex M. Hollenberg ◽  
Melissa A. Kluczynski ◽  
John M. Marzo
Keyword(s):  
Repeated Measures ◽  
Knee Flexion ◽  
Medial Patellofemoral Ligament ◽  
Operative Procedure ◽  
Biomechanical Study ◽  
Mpfl Reconstruction ◽  
Trochlear Groove ◽  
Sulcus Angle ◽  
Fresh Frozen ◽  
Patellar Stability

Background: Medial patellofemoral ligament (MPFL) reconstruction is an established operative procedure to restore medial restraining force in patients with patellar instability. In the setting of a shallow sulcus, it is unclear whether an isolated MPFL reconstruction is sufficient to restore patellofemoral stability. Hypothesis: Progressively increasing the sulcus angle would have an adverse effect on the ability of an MPFL reconstruction to restrain lateral patellar motion. Study Design: Controlled laboratory study. Methods: Seven fresh-frozen human cadaveric knees were harvested and prepared for experimentation. Each specimen was run through the following test conditions: native, lateral retinacular release, lateral retinacular repair, MPFL release, MPFL reconstruction, and MPFL reconstruction with trochlear flattening. Four 3-dimensional printed wedges (10°, 20°, 30°, and 40°) were created to insert beneath the native trochlea to raise the sulcus angle incrementally and simulate progressive trochlear flattening. For each test condition, the knee was positioned at 0°, 15°, 30°, and 45° of flexion, and the force required to displace the patella 1 cm laterally at 10 mm/s was measured. Group comparisons were made with repeated measures analysis of variance. Results: In the setting of an MPFL reconstruction, as the trochlear groove was incrementally flattened, the force required to laterally displace the patella progressively decreased. A 10° increase in the sulcus angle significantly reduced the force at 15° ( P = .01) and 30° ( P = .03) of knee flexion. The force required to laterally displace the patella was also significantly lower at all knee flexion angles after the addition of the 20°, 30°, and 40° wedges ( P≤ .05). Specifically, a 20° increase in the sulcus angle reduced the force by 29% to 36%; a 30° increase, by 35% to 43%; and a 40° increase, by 40% to 47%. Conclusion: Despite an MPFL reconstruction, the force required to laterally displace the patella decreased as the sulcus angle was increased in our cadaveric model. Clinical Relevance: An isolated MPFL reconstruction may not be sufficient to restore patellar stability in the setting of a shallow or flat trochlea. Patients with an abnormal sulcus angle may have recurrent instability postoperatively if treated with an isolated MPFL reconstruction.

Physiological Elongation of Ligamentous Complex Surrounding the Hindfoot Joints: In Vitro Biomechanical Study

1997 ◽  
Vol 18 (5) ◽  
pp. 277-283 ◽  
Author(s):  
Zong-Ping Luo ◽  
Harold B. Kitaoka ◽  
Horng-Chaung Hsu ◽  
Hideji Kura ◽  
Kai-Nan An
Keyword(s):  
In Vitro Study ◽  
Biomechanical Study ◽  
Vitro Study ◽  
Ligament Length ◽  
Neutral Position

Ligaments surrounding the hindfoot joints play an important role in hindfoot stability. This in vitro study investigated anatomical and biomechanical characteristics of nine major ligamentous structures, including length and orientation at neutral position and physiological elongation with the foot in five different positions relative to the neutral position. The results showed that ligament elongation depended on the ligament length, orientation in neutral position, and movement of bones to which they were attached.

scholarly journals A T-capsulotomy provides increased hip joint visualization compared with an extended interportal capsulotomy

2019 ◽  
Vol 6 (2) ◽  
pp. 157-163 ◽  
Author(s):  
Gregory L Cvetanovich ◽  
David M Levy ◽  
Edward C Beck ◽  
Alexander E Weber ◽  
Benjamin D Kuhns ◽  
...  
Keyword(s):  
High Resolution ◽  
Hip Joint ◽  
Cross Sectional Area ◽  
T Test ◽  
Sectional Area ◽  
Cross Sectional ◽  
Digital Photograph ◽  
Fresh Frozen ◽  
The Cross ◽  
Cadaveric Model

Abstract The purpose of this study was to compare the cross-sectional area (CSA) of joint visualization between extended interportal and T-capsulotomies. Twenty fresh-frozen cadaveric hips were dissected to their capsuloligamentous complexes and fixed in a custom apparatus in neutral hip position. Ten hips underwent sequential interportal capsulotomies at lengths of 2, 4, 6, and 8 cm. Ten hips underwent sequential T-capsulotomies starting from a 4 cm interportal capsulotomy, creating a 2 cm T-capsulotomy (Half-T), and finally a 4 cm T-capsulotomy (Full-T). Following each sequential capsule change in both groups, a high-resolution digital photograph was taken to measure the visualized intra-articular cross-sectional area (CSA). Independent t-test was used to compare CSA interportal and T-capsulotomy groups. Analysis demonstrated a statistically significant increase in CSA visualization with each sequential increase in interportal capsulotomy length up to 6 cm (2cm: 0.6 ± 0.2 cm2; 4cm: 2.1 ± 0.5 cm2 (p<0.001); 6cm: 3.6 ± 1.0 cm2 (p=0.001)), and no difference at 8cm (4.2 ± 1.2 cm2 (p=0.20)). For the T-capsulotomy group the average CSA visualization significantly increased from 3.2 ± 0.9 cm2 for the Half-T to 7.1 ± 1.0 cm2 for the Full-T (p<0.001). The Half-T CSA visualization was not statistically different from the 6 cm capsulotomy (p=0.4) and the 8cm capsulotomy (p=0.05). The Full-T had significantly superior CSA visualization area as compared to the 6 cm and 8 cm interportal capsulotomies (p<0.001 for both). In conclusion, T-capsulotomy resulted in improved cross-sectional area of joint visualization compared to an extended (8cm) interportal capsulotomy in a cadaveric model. Surgeons must weigh the benefits of greater visualization from T-capsulotomy that may help to avoid residual FAI while ensuring to completely repair the capsulotomy to avoid iatrogenic instability.

Musculoskeletal Demands on Flamenco Dancers: A Clinical and Biomechanical Study

Foot & Ankle ◽  
1988 ◽  
Vol 8 (5) ◽  
pp. 254-263 ◽  
Author(s):  
F. J. Bejjani ◽  
N. Halpern ◽  
A. Pio ◽  
R. Dominguez ◽  
A. Voloshin ◽  
...  
Keyword(s):  
Neck Pain ◽  
Pressure Distribution ◽  
Clinical Evaluation ◽  
Hip Joint ◽  
Musculoskeletal System ◽  
Clinical Findings ◽  
Biomechanical Study ◽  
Health Questionnaire ◽  
Biomechanical Behavior ◽  
Acceleration Data

The flamenco dancer acts on the floor like a drummer. The percussive footwork and vibration patterns created during dancing impose unusual demands on the musculoskeletal system. This study investigated the clinical and biomechanical aspects of this task. Using the electrodynogram and skin-mounted accelerometers, foot pressures as well as hip and knee vibrations were recorded in 10 female dancers after a thorough clinical evaluation. A health questionnaire was also distributed to 29 dancers. Foot pressures and acceleration data reveal the percussive nature of the dance. Some clinical findings, like calluses, are related to pressure distribution. Urogenital disorders, as well as back and neck pain, may be related to the vibrations generated by the flamenco dance form. The hip joint seems to absorb most of the impacts. “Vibration-pressure” diagrams are suggested as a useful tool for evaluating a dancer's biomechanical behavior, as well as the effect of floors and footwear on this behavior.

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