Numerical investigation of patellar instability during knee flexion due to an unbalanced medial retinaculum loading effect

Abstract

Background and aimHealthy patellofemoral (PF) joint mechanics are critical to optimal knee joint function. Patella plays a vital role in distributing quadriceps load during the knee extension. Patellar tracking, not physiological tracking, causes an increase of strains in PF ligaments, peaks of localized stress of soft tissues and articular cartilage and bony parts, and knee pain; these problems lead to complications such as bone abnormalities and osteoarthritis. This research aimed to develop a Finite Element (FE) model to evaluate patellar instability due to the medial retinaculum asymmetric loading effect. MethodsA numerical model of the knee was obtained by matching nuclear magnetic resonance (MRI) for soft tissues and computerized tomography (CT) for bones, carried on a normal adult. Loading setup was chosen by using literature data. The intensity of the muscle forces was calculated by a static optimization taking into account ground reaction and knee flexion/extension during walking. The effect of patellar instability was obtained by gradually unbalancing this symmetry, one side was unloaded till 90 N, and the other loaded till 110 N. ResultsUnbalanced forces of 10 N acting on the retinaculum alone can produce a real difference in displacements of about 7 mm, and an increment of about 44% on patellar contact forces. ConclusionThis research demonstrated how an unbalanced forces acting on the retinaculum can produce significant patellar instability. Patellar instability starts at 25–30° of the knee flexion angle but tends to appear at 15° when the unbalanced muscular loading conditions are acting.