Anatomy of the Intermetatarsal Facets of the Fourth and Fifth Metatarsals

Background: The intermetatarsal joint between the fourth and fifth metatarsals (4-5 IM) is important in defining fifth metatarsal fractures. The purpose of the current study was to quantify this joint in order to determine the mean cartilage area, the percentage of the articulation that is cartilage, and to give the clinician data to help understand the joint anatomy as it relates to fifth metatarsal fracture classification. Methods: Twenty cadaver 4-5 IM joints were dissected. Digital images were taken and the articular cartilage was quantified by calibrated digital imaging software. Results: For the lateral fourth proximal intermetatarsal articulation, the mean area of articulation was 188 ± 49 mm2, with 49% of the area composed of articular cartilage. The shape of the articular cartilage had 3 variations: triangular, oval, and square. A triangular variant was the most common (80%, 16 of 20 specimens). For the medial fifth proximal intermetatarsal articulation, the mean area of articulation was 143 ± 30 mm2, with 48% of the joint surface being composed of articular cartilage. The shape of the articular surface was oval or triangular. An oval variant was the most common (75%, 15 of 20 specimens). Conclusion: This study supports the notion that the 4-5 IM joint is not completely articular and has both fibrous and cartilaginous components. Clinical Relevance: The clinical significance of this study is that it quantifies the articular surface area and shape. This information may be useful in understanding fifth metatarsal fracture extension into the articular surface and to inform implant design and also help guide surgeons intraoperatively in order to minimize articular damage.

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Feasibility of Transosseous Nonarticular Fixation of Lisfranc Injuries

Foot & Ankle International ◽

10.1177/1071100719830947 ◽

2019 ◽

Vol 40 (6) ◽

pp. 672-678 ◽

Cited By ~ 2

Author(s):

James R. Jastifer ◽

Eric R. Christianson ◽

Daniel J. VanZweden ◽

Peter A. Gustafson

Keyword(s):

Articular Cartilage ◽

Internal Fixation ◽

Articular Surface ◽

3D Models ◽

Joint Surface ◽

Articular Damage ◽

Fixation Techniques ◽

Ct Data ◽

Lisfranc Joints ◽

Lisfranc Injuries

Background: The optimal techniques for Lisfranc open reduction and internal fixation techniques remain debated. The purpose of the current study was to describe the joints involved in Lisfranc fixation and to determine if nonarticular transosseous internal fixation would be possible. Methods: Twenty cadaver Lisfranc joints were dissected and the articular cartilage was quantified by calibrated digital imaging software. Utilizing CT data, a computational model of the foot was developed and the mean joint surface was mapped and nonarticular screw paths between bones was determined. Results: For the medial-middle cuneiform (C1-C2) connection, 27.3% of the lateral face of C1 and 43.7% of the medial face of C2 was articular cartilage. Three variations of articular morphology were observed on C1 and 2 on C2. From the 3D models, it was determined that a joint-sparing, transosseous screw trajectory was possible between C1 and the second metatarsal and between C1 and C2. These screw paths were large enough to accommodate clinically useful screw diameters (>5 mm). The screw trajectories were roughly perpendicular to the long axis of the foot and take a plantar-medial to dorsal-lateral orientation. Conclusion: The articular surface of the Lisfranc joint was quantified for the first time and may be smaller than some surgeons realize. This study demonstrated the orientation required to minimize articular damage. Clinical Relevance: The clinical significance of the current study was that a nonarticular screw trajectory was possible, and this information may help guide the placement of these screws.

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Evaluating the Subtalar Joint in Tibiotalocalcaneal Nail

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00400 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0040

Author(s):

Megan Reilly ◽

Kurosh Darvish ◽

Soroush Assari ◽

John Cole ◽

Tyler Wilps ◽

...

Keyword(s):

Surface Area ◽

Subtalar Joint ◽

Articular Surface ◽

Joint Surface ◽

Central Dome ◽

Below The Knee ◽

Joint Surfaces ◽

Circular Surface ◽

The Mean ◽

Pass Through

Category: Hindfoot Introduction/Purpose: In tibiotalocalcaneal nails for arthrodesis, the path of the nail through the subtalar joint has not been well documented. Ideally, the defect caused by reaming and the nail does not pass through the joint surface so that the amount of bony contact between the talus and calcaneus is maintained in order to optimize fusion. Our hypothesis is that the TTC nail does not destroy a significant amount contact area between the talus and calcaneus. However, using larger diameter nails (which are inherently stronger) will have more of an effect on the contact surface. Methods: Five cadaveric below the knee specimens were obtained. The ankle was disarticulated on each specimen. Subsequently, a guidepin was drilled from the central dome of the talus down to the calcaneus. The 11 mm reamer was then passed over the guidepin through the calcaneus to simulate retrograde reaming of a TTC nail. Then, the subtalar joint was dissected open and the articular surface was documented in comparison with the area that was reamed out. Measurements were then made, using software that calculated two dimensional surface area to determine the percentage of actual subtalar joint area that was reamed out. The mean percentage of articular area that was removed with the reamer was then calculated. Results: Among the five specimens, in the calcaneus, the mean total articular area was 599mm2±113 and the mean drilled articular area was 21mm2±16. The percentage of the calcaneal articular surface that was removed with the reamer was 3.4%±1.9. In the talus, the mean total articular area was 782mm2±130 and the mean drilled articular area was 39mm2±18. The percentage of the talar articular surface that was removed with the reamer was 5.0%±2.3. Additionally, an 11 mm reamer makes a circular surface area of 95mm2, and the statistics above indicate that a significant portion of the reamed area is nonarticular, within the calcaneal sulcus or the talar sulcus. Conclusion: In a tibiotalocalcaneal nail the subtalar joint is typically incompletely visualized, however this anatomic study demonstrates that the 11 mm reamer eliminates about 3.4% of the calcaneal articular surface and about 5% of the talar articular surface. Therefore, the majority of the articular surface is left intact, which is ideal in optimizing arthrodesis outcomes. Furthermore, this study could extrapolate the effects of a larger nail on the availability of joint surface. It could also be used to argue for cartilage stripping of the affected joint surfaces in arthrodesis preparation, because the majority of the articular surface is, in fact, left intact.

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Ultrasound Versus Arthrography in Diagnosing the Stability of Minimally Displaced Lateral Humeral Condyle Fractures in Children

10.21203/rs.3.rs-61559/v1 ◽

2020 ◽

Author(s):

Xing Wu ◽

Xiongtao Li ◽

Shaowei Yang ◽

Si Wang ◽

Jingdong Xia ◽

...

Keyword(s):

Articular Cartilage ◽

Articular Surface ◽

Level Of Evidence ◽

Fractures In Children ◽

Pearson Coefficient ◽

The Mean ◽

Pre Treatment ◽

The Stability ◽

Humeral Condyle ◽

Humeral Epiphysis

Abstract Background: The evaluation of the articular cartilage status of the distal humeral epiphysis is difficult. Ultrasound of the elbow is increasingly used to confirm the integrity of the articular cartilage of minimally displaced lateral humeral condyle fractures in children in minimally displaced fractures. The aim of this study was to assess the correlation between ultrasound with arthrography for predicting the integrity of the cartilage hinge and describe the utility of ultrasound in directing the need for pre-treatment. Methods: 39 patients with minimally displaced lateral humeral condyle fractures and underwent ultrasound and arthrography examinations before operation from May 2018 to December 2019 were included in this study. The ultrasound and arthrography predictors of the cartilage hinge status were independently measured. Result of ultrasound and arthrography were compared.Results: The mean displacement of fractures was 3.1 mm (range, 2.0～5.0 cm). The arthrography showed an incomplete fracture in 24 patients (61.5%) and complete in 15 patients (38.5%). The ultrasound showed an incomplete fracture in 25 patients (64.1%) and complete in 14 patients (35.9%). The ultrasound and arthrography evaluations of the integrity of the articular surface were consistent in 92.3% of the cases, including 23 were predicted to have an intact articular surface, and 13 were predicted to have incongruity articular surface. There was no correlation between displacement and the fracture being complete on ultrasound. The Pearson coefficient value of ultrasound and arthrography for assessing the integrity of the articular surface was 0.837. Conclusions: Ultrasound and arthrography assessments of the integrity of the cartilage hinge status appear to be highly consistent. Ultrasound can be used as a complementary tool with arthrography to predict the integrity of the cartilage hinge status of patients with minimally displaced lateral humeral condyle fractures in children.Level of evidence: Retrospective study; level Ⅳ.

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Joint Preservation Techniques in Orthopaedic Surgery

Sports Health A Multidisciplinary Approach ◽

10.1177/1941738117712203 ◽

2017 ◽

Vol 9 (6) ◽

pp. 545-554 ◽

Cited By ~ 4

Author(s):

Philip J. York ◽

Frank B. Wydra ◽

Matthew E. Belton ◽

Armando F. Vidal

Keyword(s):

Articular Cartilage ◽

Autologous Chondrocyte Implantation ◽

Hyaline Cartilage ◽

Articular Surface ◽

Joint Surface ◽

Level Of Evidence ◽

Joint Preservation ◽

The Past ◽

Chondrocyte Implantation ◽

Autologous Chondrocyte

Context: With increasing life expectancy, there is growing demand for preservation of native articular cartilage to delay joint arthroplasties, especially in younger, active patients. Damage to the hyaline cartilage of a joint has a limited intrinsic capacity to heal. This can lead to accelerated degeneration of the joint and early-onset osteoarthritis. Treatment in the past was limited, however, and surgical treatment options continue to evolve that may allow restoration of the natural biology of the articular cartilage. This article reviews the most current literature with regard to indications, techniques, and outcomes of these restorative procedures. Evidence Acquisition: MEDLINE and PubMed searches relevant to the topic were performed for articles published between 1995 and 2016. Older articles were used for historical reference. This paper places emphasis on evidence published within the past 5 years. Study Design: Clinical review. Level of Evidence: Level 4. Results: Autologous chondrocyte implantation and osteochondral allografts (OCAs) for the treatment of articular cartilage injury allow restoration of hyaline cartilage to the joint surface, which is advantageous over options such as microfracture, which heal with less favorable fibrocartilage. Studies show that these techniques are useful for larger chondral defects where there is no alternative. Additionally, meniscal transplantation can be a valuable isolated or adjunctive procedure to prolong the health of the articular surface. Conclusion: Newer techniques such as autologous chondrocyte implantation and OCAs may safely produce encouraging outcomes in joint preservation.

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Comparison of Computed Tomography Articular Surface Geometry of Male Versus Female Thumb Carpometacarpal Joints

Hand ◽

10.1177/1558944716688528 ◽

2017 ◽

Vol 13 (1) ◽

pp. 33-39

Author(s):

Jessica G. Shih ◽

James G. Mainprize ◽

Paul A. Binhammer

Keyword(s):

Sex Differences ◽

Articular Surface ◽

Joint Space ◽

Joint Surface ◽

Surface Geometry ◽

Significant Difference ◽

The Mean ◽

Joint Congruence ◽

Cmc Joint ◽

Space Volume

Background: Given the predilection of first carpometacarpal (CMC) joint osteoarthritis in women compared with men, we aim to determine the differences in first CMC joint surface geometry and congruence between young healthy males and females. Methods: Wrist computed tomographic scan data of 11 men and 11 women aged 20 to 35 years were imported into 3-dimensional software programs. The first metacarpal and the trapezium were aligned in a standardized position according to landmarks at key points on Gaussian and maximum curvature maps. Measurements of joint congruence and surface geometry were analyzed, including joint space volume, distance between the bones at the articular surface edges, area of the joint space, and radii of curvature in the radial-ulnar and volar-dorsal planes. Results: The mean thumb CMC articular space volume was 104.02 ± 30.96 mm3 for females and 138.63 ± 50.36 mm3 for males. The mean first metacarpal articular surface area was 144.9 ± 10.9 mm2 for females and 175.4 ± 25.3 mm2 for males. After normalizing for size, the mean thumb CMC articular space volume was 119.4 ± 24.6 mm3 for females and 117.86 ± 28.5 mm3 for males. There was also no significant difference for the articular space volume, articular surface distances, articular space, and mean radii of curvatures. Conclusions: This study found that there are sex differences in the first CMC joint articular volume without normalizing for size; however, there are no sex differences in first CMC joint articular volume, curvature characteristics, or joint congruence of young, healthy patients after normalizing for joint size.

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Pilon Fractures of the Wrist

Journal of Hand Surgery (European Volume) ◽

10.1016/0266-7681(92)90013-r ◽

1992 ◽

Vol 17 (1) ◽

pp. 63-68 ◽

Cited By ~ 30

Author(s):

M. L. PORTER ◽

R. M. TILLMAN

Keyword(s):

Articular Surface ◽

High Energy ◽

Joint Line ◽

Joint Surface ◽

Wrist Injuries ◽

Associated Injuries ◽

Prognostic Feature ◽

The Mean ◽

Complex Injuries

22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radio-ulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2½ years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radio-ulnar joint were also important.

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A Review of the Collagen Orientation in the Articular Cartilage

Cartilage ◽

10.1177/1947603520988770 ◽

2021 ◽

pp. 194760352098877

Author(s):

Roy D. Bloebaum ◽

Andrew S. Wilson ◽

William N. Martin

Keyword(s):

Surface Layer ◽

Articular Cartilage ◽

Fiber Orientation ◽

Collagen Fiber ◽

Articular Surface ◽

Imaging Techniques ◽

Collagen Fibers ◽

Deep Zone ◽

Collagen Fiber Orientation ◽

Critical Point Drying

Objective There has been a debate as to the alignment of the collagen fibers. Using a hand lens, Sir William Hunter demonstrated that the collagen fibers ran perpendicular and later aspects were supported by Benninghoff. Despite these 2 historical studies, modern technology has conflicting data on the collagen alignment. Design Ten mature New Zealand rabbits were used to obtain 40 condyle specimens. The specimens were passed through ascending grades of alcohol, subjected to critical point drying (CPD), and viewed in the scanning electron microscope. Specimens revealed splits from the dehydration process. When observing the fibers exposed within the opening of the splits, parallel fibers were observed to run in a radial direction, normal to the surface of the articular cartilage, radiating from the deep zone and arcading as they approach the surface layer. After these observations, the same samples were mechanically fractured and damaged by scalpel. Results The splits in the articular surface created deep fissures, exposing parallel bundles of collagen fibers, radiating from the deep zone and arcading as they approach the surface layer. On higher magnification, individual fibers were observed to run parallel to one another, traversing radially toward the surface of the articular cartilage and arcading. Mechanical fracturing and scalpel damage induced on the same specimens with the splits showed randomly oriented fibers. Conclusion Collagen fiber orientation corroborates aspects of Hunter’s findings and compliments Benninghoff. Investigators must be aware of the limits of their processing and imaging techniques in order to interpret collagen fiber orientation in cartilage.

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On the Natural Lubrication of Synovial Joints: Normal and Degenerate

Journal of Lubrication Technology ◽

10.1115/1.3453003 ◽

1977 ◽

Vol 99 (2) ◽

pp. 163-172 ◽

Cited By ~ 28

Author(s):

Joseph M. Mansour ◽

Van C. Mow

Keyword(s):

Articular Cartilage ◽

Solid Phase ◽

Articular Surface ◽

Moving Load ◽

Frictional Resistance ◽

Elastic Solid ◽

Surface Load ◽

Two Phase ◽

Tissue Properties ◽

Synovial Joints

Fluid flow and mass transport mechanisms associated with articular cartilage function are important biomechanical processes of normal and pathological synovial joints. A three-layer permeable, two-phase medium of an incompressible fluid and a linear elastic solid are used to model the flow and deformational behavior of articular cartilage. The frictional resistance of the relative motion of the fluid phase with respect to the solid phase is given by a linear diffusive dissipation term. The subchondral bony substrate is represented by an elastic solid. The three-layer model of articular cartilage is chosen because of the known histological, ultrastructural, and biomechanical variations of the tissue properties. The calculated flow field shows that for material properties of normal healthy articular cartilage the tissue creates a naturally lubricated surface. The movement of the interstitial fluid at the surface is circulatory in manner, being exuded in front and near the leading half of the moving surface load and imbibed behind and near the trailing half of the moving load. The flow fields of healthy tissues are capable of sustaining a film of fluid at the articular surface whereas pathological tissues cannot.

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Stress-Distribution Pattern Across the Glenohumeral Joint in Collegiate and Professional Baseball Players: A Computed Tomography Osteoabsorptiometry Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/23259671211009185 ◽

2021 ◽

Vol 9 (6) ◽

pp. 232596712110091

Author(s):

Kyosuke Numaguchi ◽

Daisuke Momma ◽

Yuki Matsui ◽

Masashi Yokota ◽

Jun Oohinata ◽

...

Keyword(s):

Bone Density ◽

Stress Distribution ◽

Glenohumeral Joint ◽

Distribution Patterns ◽

Joint Surface ◽

Baseball Players ◽

Articular Surfaces ◽

Head Surface ◽

The Mean ◽

Dominant Side

Background: The influence of long-term loading conditions on the articular surfaces of the glenohumeral joint can be determined by measuring stress-distribution patterns. Long-term pitching activity changes the stress distribution across the glenohumeral joint surface; however, the influence of competitive level on stress-distribution patterns remains unclear. Purpose: To use computed tomography (CT) osteoabsorptiometry (CTOAM) to evaluate the distribution of subchondral bone density across the glenohumeral joint in collegiate and professional baseball players as well as to determine the effects of pitching activity on the articular surfaces. Study Design: Descriptive laboratory study. Methods: We evaluated 73 shoulders in 50 baseball players. CT imaging data were obtained from the dominant-side shoulder of 12 professional pitchers (PP group) and 15 professional fielders (PF group). CT imaging data were also obtained from both shoulders of 12 asymptomatic collegiate pitchers (CP group) and 11 collegiate fielders (CF group). The pattern of distribution of subchondral bone density across the articular surfaces of each glenohumeral joint was assessed by CTOAM. As a measure of bone density, the mean Hounsfield units (HU) were obtained for each joint surface, and the absolute values of the dominant shoulder were compared for each group. Results: Stress-distribution patterns over the articular surfaces differed between the dominant and nondominant sides in the CP group as well as between both collegiate groups versus the PP group. In the CP group, the mean HU of the humeral head surface were greater on the nondominant versus dominant side ( P = .035). On the dominant side, the mean HU of the humeral head surface and glenoid were greater in the CP versus the PP group ( P = .001 and .027, respectively). Conclusion: Stress distribution on the articular surface of the glenohumeral joint was affected by pitching ability and competitive level. Our analysis indicates that the traction force on the glenohumeral joint surface might be greater than compression force during pitching. Clinical Relevance: The present findings suggest that pitching activity results in low stress to the articular surfaces of the glenohumeral joint. This supports the notion that mechanical conditions play a crucial role in the etiology of disorders specific to pitching activity.

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Human Joint Performance and the Roughness of Articular Cartilage

Journal of Biomechanical Engineering ◽

10.1115/1.3138198 ◽

1980 ◽

Vol 102 (1) ◽

pp. 50-56 ◽

Cited By ~ 3

Author(s):

T. R. Thomas ◽

R. S. Sayles ◽

I. Haslock

Keyword(s):

Articular Cartilage ◽

Heel Strike ◽

Height Distribution ◽

Normal Walking ◽

Cartilage Surface ◽

Real Area Of Contact ◽

The Mean ◽

Human Joints ◽

Human Joint ◽

Real Area

It is known that the surface of articular cartilage is rough and it has been suggested that this is likely to affect the lubrication of human joints. This paper describes the direct measurement of a cartilage surface with a stylus instrument. It is found that the height distribution is Gaussian with an inverse-square power spectrum. It is thus possible to calculate the elastic deflection of the surface under normal walking loads and it is shown that the mean separation of the cartilage surfaces in a human joint varies rather slowly with load. In one particular hip joint at heel strike the real area of contact was calculated to be about 1.3 cm2, the mean gap to be about 60 μm and the trapped volume to be about 80 percent of that when standing.

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