Flexion Cycle Research Articles

Microscratching Characterization of the Wear-in of UHMW Polyethylene in Prostheses

A new measurement technique of prosthesis wear by microscratching has been demonstrated. The technique has been applied in a study of the backside wear of a UHMW polyethylene tibial insert of a rotating platform knee prosthesis. Four disc-shaped UHMW polyethylene plugs, prepared with 5-μm deep microscratches, were carefully recessed into the backside of the tibial insert. It was demonstrated that the scratches are not affected by creep under static load. A realistic in vitro wear simulation experiment was performed over 0.8 × 106 flexion cycles. SEM and AFM show that following the experiment the initial microscratches are effectively absent in all four locations with only residual depressions observed. This implies that typically at least 5 μm of polyethylene material was worn over the first 0.8 × 106 cycles by processes other than creep. Evidence from AFM and SEM indicates the in-fill and reintegration of polyethylene wear particles into residual scratch depressions. This supports a two-phase model of the wear process that has been independently confirmed by radioisotope tracing. For an initial wear-in phase, the model implies large, but rapidly decreasing, wear, resulting from abrasive wear and a competition between the loss and the reintegration of wear particles. The in vitro wear-in of the backside may typically produce a wear debris volume of 8.5 mm3. In addition to wear-in, the model assumes a much lower, constant long-term wear rate. The model has been used to correct published backside wear rates for the effects of the wear-in phase. A best estimate of 0.7 mm3/106 cycles has been determined for the long-term in vitro backside wear rate of a tibial insert in a rotating platform design.

Repair of Lateral Meniscus Posterior Horn Detachment Lesions

Background: Posterior horn detachment (PHD) lesions of the lateral meniscus are commonly associated with acute anterior cruciate ligament (ACL) tears. Multiple surgeons have advocated for repair of this lesion at the time of ACL reconstruction. However, the biomechanical consequences of this lesion and its subsequent repair have not been evaluated. Hypothesis: The PHD lesion of the lateral meniscus will lead to increased tibiofemoral contact pressures, and repair of this lesion to bone via a tibial tunnel can restore normal contact pressures during simulated gait. Study Design: Controlled laboratory study. Methods: Lateral compartment contact pressures were measured via a sensor on the tibial plateau in 8 cadaver knees with the knee intact, after sectioning the posterior horn of the lateral meniscus to simulate PHD, and after repairing the injury. The repair was performed using an ACL tunnel guide to drill a tunnel from the anteromedial tibia to the posterior horn attachment site. Dynamic pressure data were continuously collected using a conductive ink pressure sensing system while each knee was moved through a physiological gait flexion cycle. Results: Posterior horn detachment caused a significant increase in tibiofemoral peak contact pressure from 2.8 MPa to 4.2 MPa (P = .03). After repair of the lesion to bone was performed through a transtibial tunnel, the peak contact pressure was 2.9 MPa. Posterior horn detachment also significantly decreased the maximum contact area over which tibiofemoral pressure is distributed from 451 mm2 in the intact state to 304 mm2 in the detached state. Repair of the PHD lesion increased the maximum contact area to 386 mm2, however, this area was also significantly less than in the intact state (P = .05). Conclusion: Posterior horn detachment of the lateral meniscus causes increased peak tibiofemoral contact pressure. The peak pressure can be reduced to a normal level with repair of the lesion to bone via a transtibial tunnel. Clinical Relevance: Posterior horn detachment of the lateral meniscus is a lesion often associated with an acute ACL tear. Debate exists concerning the importance of repairing PHD lesions at the time of ACL reconstruction. The data provided in this study may influence surgeons’ management of the lesion.

Evaluating knee replacement mechanics during ADL with PID-controlled dynamic finite element analysis

Validated computational knee simulations are valuable tools for design phase development of knee replacement devices. Recently, a dynamic finite element (FE) model of the Kansas knee simulator was kinematically validated during gait and deep flexion cycles. In order to operate the computational simulator in the same manner as the experiment, a proportional–integral–derivative (PID) controller was interfaced with the FE model to control the quadriceps actuator excursion and produce a target flexion profile regardless of implant geometry or alignment conditions. The controller was also expanded to operate multiple actuators simultaneously in order to produce in vivo loading conditions at the joint during dynamic activities. Subsequently, the fidelity of the computational model was improved through additional muscle representation and inclusion of relative hip–ankle anterior–posterior (A–P) motion. The PID-controlled model was able to successfully recreate in vivo loading conditions (flexion angle, compressive joint load, medial–lateral load distribution or varus-valgus torque, internal–external torque, A–P force) for deep knee bend, chair rise, stance-phase gait and step-down activities.

Computationally Efficient Finite Element Evaluation of Natural Patellofemoral Mechanics

Finite element methods have been applied to evaluate in vivo joint behavior, new devices, and surgical techniques but have typically been applied to a small or single subject cohort. Anatomic variability necessitates the use of many subject-specific models or probabilistic methods in order to adequately evaluate a device or procedure for a population. However, a fully deformable finite element model can be computationally expensive, prohibiting large multisubject or probabilistic analyses. The aim of this study was to develop a group of subject-specific models of the patellofemoral joint and evaluate trade-offs in analysis time and accuracy with fully deformable and rigid body articular cartilage representations. Finite element models of eight subjects were used to tune a pressure-overclosure relationship during a simulated deep flexion cycle. Patellofemoral kinematics and contact mechanics were evaluated and compared between a fully deformable and a rigid body analysis. Additional eight subjects were used to determine the validity of the rigid body pressure-overclosure relationship as a subject-independent parameter. There was good agreement in predicted kinematics and contact mechanics between deformable and rigid analyses for both the tuned and test groups. Root mean square differences in kinematics were less than 0.5 deg and 0.2 mm for both groups throughout flexion. Differences in contact area and peak and average contact pressures averaged 5.4%, 9.6%, and 3.8%, respectively, for the tuned group and 6.9%, 13.1%, and 6.4%, respectively, for the test group, with no significant differences between the two groups. There was a 95% reduction in computational time with the rigid body analysis as compared with the deformable analysis. The tuned pressure-overclosure relationship derived from the patellofemoral analysis was also applied to tibiofemoral (TF) articular cartilage in a group of eight subjects. Differences in contact area and peak and average contact pressures averaged 8.3%, 11.2%, and 5.7% between rigid and deformable analyses in the tibiofemoral joint. As statistical, probabilistic, and optimization techniques can require hundreds to thousands of analyses, a viable platform is crucial to component evaluation or clinical applications. The computationally efficient rigid body platform described in this study may be integrated with statistical and probabilistic methods and has potential clinical application in understanding in vivo joint mechanics on a subject-specific or population basis.

P145 Evaluation of a quadriceps muscle endurance leg lift test in patients with chronic obstructive pulmonary disease

Introduction and objectivesQuadriceps muscle strength is commonly used to assess patients with chronic obstructive pulmonary disease (COPD). However a simple endurance test is not routinely available. We wished to evaluate...

Effects of a surface matching articular resurfacing device on tibiofemoral contact pressure: results from continuous dynamic flexion–extension cycles

The application of a defect-size metal implant for the treatment of focal articular cartilage lesions of the femoral condyle is of potential concern resulting in cartilage damage to opposing biological structures. This in vitro study aims to determine the tibiofemoral contact pressure with a contoured articular partial femoral resurfacing device under continuous dynamic pressure loads. Peak and area contact pressures were determined in eight fresh-frozen cadaveric specimens using a pressure-sensitive sensor placed in the medial compartment above the menisci. All knees were tested in the untreated condition and after implantation of the prosthetic device in the weight-bearing area of the medial femoral condyle. A robotic knee simulator was used to test each knee under continuous pressure load for 400s during 40 dynamic knee bending cycles (5°-45° flexion) with body weight ground reaction force (GRF). The GRF was adjusted to the living body weight of the cadaver donor and maintained throughout all cycles. Comparison of the untreated condition to focal inlay resurfacing showed no statistically significant differences (P≤0.05) between all testing conditions. The average maximum peak contact pressure across all 40 flexion cycles increased by 5.1% after resurfacing compared to the untreated knees. The average area contact pressure essentially stayed the same (+0.9%). The data suggest that resurfacing with the contoured articular prosthetic device does not pose any immediate deleterious effects to the opposing surfaces based on peak and area contact pressure in a continuous dynamic in vitro application. However, long-term in vivo effects remain to be evaluated.

Combined probabilistic and principal component analysis approach for multivariate sensitivity evaluation and application to implanted patellofemoral mechanics

Many aspects of biomechanics are variable in nature, including patient geometry, joint mechanics, implant alignment and clinical outcomes. Probabilistic methods have been applied in computational models to predict distributions of performance given uncertain or variable parameters. Sensitivity analysis is commonly used in conjunction with probabilistic methods to identify the parameters that most significantly affect the performance outcome; however, it does not consider coupled relationships for multiple output measures. Principal component analysis (PCA) has been applied to characterize common modes of variation in shape and kinematics. In this study, a novel, combined probabilistic and PCA approach was developed to characterize relationships between multiple input parameters and output measures. To demonstrate the benefits of the approach, it was applied to implanted patellofemoral (PF) mechanics to characterize relationships between femoral and patellar component alignment and loading and the resulting joint mechanics. Prior studies assessing PF sensitivity have performed individual perturbation of alignment parameters. However, the probabilistic and PCA approach enabled a more holistic evaluation of sensitivity, including identification of combinations of alignment parameters that most significantly contributed to kinematic and contact mechanics outcomes throughout the flexion cycle, and the predictive capability to estimate joint mechanics based on alignment conditions without requiring additional analysis. The approach showed comparable results for Monte Carlo sampling with 500 trials and the more efficient Latin Hypercube sampling with 50 trials. The probabilistic and PCA approach has broad applicability to biomechanical analysis and can provide insight into the interdependencies between implant design, alignment and the resulting mechanics.

Knee Arthrotomy Repair With a Continuous Barbed Suture: A Biomechanical Study

We compared knee arthrotomy closures using interrupted biodegradable sutures and running bidirectionally barbed sutures in cadaveric specimens subjected to cyclic loading. During the initial 2000 flexion cycles, both groups maintained closure and no suture ruptured. Suture throws were then sequentially cut to weaken the repairs, and the knees were cyclically flexed after each cut. Both types of suture repairs survived the cutting of the first throw or stitch and subsequent cyclical testing. However, there was a significant difference in the repairs after multiple cuts (log-rank test, P < .003). None of the knees in the interrupted suture group survived more than 3 cuts, whereas in the barbed repair group, it took the severing of as many as 7 throws for failure to occur.

Pretensioning of quadruple flexor tendon grafts in two types of femoral fixation: quasi-randomised controlled pilot study

Pretensioning of the flexor tendon graft of the knee is used to improve the stability of anterior cruciate ligament (ACL) reconstructions. The objective was to demonstrate the pretensioning of grafts of the semitendinosus and gracilis in situ with range of flexion and extension of 0-110°, and determine the appropriate number of cycles in two types of femoral fixation. ACL reconstruction was performed in 60 patients, aged 16-48 years, 90% male, with 50% right knees and 50% left knees, divided into two groups of 30 patients: One with the femur fixed using interference screws (direct form) and the other with the transcondylar cross-pin screw (from a distance). Total length of the grafts, their circumference and the measurements on the radiographs of length of the grafts submitted to pretensioning and the measurements with ten, 25 and 50 cycles of flexion and extension were determined. There was no significant difference in relation to the total tendon lengths and their circumferences. The lengths of the portions submitted to pretensioning were significantly different: 7.90 cm for the interference and 10.92 cm for the transcondylar (mean). After tensioning, in the interference and transcondylar groups, respectively, lengthening was 3.57 mm/3.97 mm with ten, 6.30 mm/7.03 mm with 25, and 6.83 mm/7.7 mm with 50 cycles. The greater the length of the graft, the greater the lengthening on pretensioning throughout the substance; the shorter the length, the earlier the end of the lengthening was achieved, close to 25 cycles; more than ten cycles were necessary, 25 being sufficient.

Effect of core suture technique and type on the gliding resistance during cyclic motion following flexor tendon repair: A cadaveric study

We investigated the effects of two suture techniques using three suture types in a human model in vitro. We obtained 60 flexor digitorum profundus (FDP) tendons from cadavers and measured the gliding resistance during 1,000 cycles of simulated flexion-extension motion and load to failure of six groups: the modified Kessler (MK) repair using 3-0 coated, braided polyester (Ethibond, Ethicon, Somerville, NJ), 3-0 coated, braided polyester/monofilament polyethylene composite (FiberWire®; Arthrex, Naples, FL), or 4-0 FiberWire; and the Massachusetts General Hospital (MGH) repair using 3-0 Ethibond, 3-0 FiberWire, or 4-0 FiberWire. The 3-0 Ethibond MGH suture had significantly higher ultimate load to failure than the 3-0 or 4-0 FiberWire MK suture. The 3-0 and 4-0 FiberWire MGH sutures had significantly higher load to failure than the three MK groups. The gliding resistances of the three MGH groups were significantly higher than that of the three corresponding MK groups. The MGH repair had more gliding resistance than an MK repair, even when comparing large diameter suture in the MK repair with smaller diameter suture in the MGH repair. In this study, suture technique was more important in predicting repair load to failure and gliding resistance than the nature or caliber of the suture material that was used.

Numerical analysis of variations in posterior cruciate ligament properties and balancing techniques on total knee arthroplasty loading

Total knee arthroplasty (TKA) is a widely used and successful orthopaedic procedure. During TKA, the posterior cruciate ligament (PCL) can either be retained or substituted by a post-cam mechanism. One of the main functions of the PCL is to facilitate femoral rollback during knee flexion. For adequate PCL functioning, the PCL should be balanced correctly after TKA. A tight PCL leads to more femoral rollback at the expense of a higher joint compression and potential polyethylene wear. Frequently used surgical techniques to balance a tight PCL are PCL release and increasing the posterior tibial slope. The objective of this study was to evaluate the effects of variations in PCL properties and balancing techniques on the mechanical outcome of a total knee replacement during a weight-bearing squatting movement (flexion range = 45–150°). For this purpose, a prosthetic finite element knee model was developed including a PCL having adjustable properties. Varying the PCL stiffness and PCL steepness (elevation angle) with respect to the tibial plateau considerably affected the TKA loading characteristics. Both a relatively high PCL stiffness and a low elevation angle at the start of the flexion cycle led to a high PCL force (1400–1500 N) and a high peak polyethylene contact stress of roughly 52 MPa during deeper knee flexion (120°). Releasing the PCL with roughly 4 mm or increasing the posterior tibial slope to 7° reduced the PCL force to 300–400 N and the polyethylene peak contact stress to 35–42 MPa at 120° of flexion. The femoral rollback patterns during deep knee flexion were only marginally affected when extra posterior tibial slope was added, whereas additional PCL release resulted in paradoxical anterior movement of the femur.

Biomechanical evaluation of stability and three-dimensional movements of the atlantoaxial joint after artificial atlanto-odontoid joint arthroplasty

To investigate the stability and three-dimensional movements of the atlantoaxial joint after artificial atlanto-odontoid joint (AAOJ) arthroplasty. Ten sets of AAOJ implanted in bony specimens from 10 adults were used to test the pull-out strength of the atlas-axis components with a MTS858 Mini Bionix machine. Another twelve human cadaveric specimens including C(0)-C(4) were used to evaluate the three-dimensional movements of C(1)-C(2) under five different conditions in sequence, that is, the complete specimen, anterior decompression, posterior transarticular screws fixation, AAOJ arthroplasty and fatigue test. There were significant differences between atlas and axis components in the maximum pull-out strength and trajectory length, however the yield length was not significantly different. The maximum pull-out strength of the atlas and axis was positively correlated with trajectory length (r(1)= 0.880, P < 0.05) and yield length (r(2)= 0.606, P < 0.05), respectively. After AAOJ arthroplasty, the range of movement (ROM) with respect to rotation and the neutral zone of the atlantoaxial joint were close to normal (P > 0.05), but the ROM in flexion-extension and lateral bending was significantly smaller compared with the specimens which underwent anterior decompression (P < 0.05). No abrasion and abnormal mobilization were observed after 2000 cycles of flexion, extension, lateral bending and axial rotation in the fatigue test. The self-designed AAOJ has excellent biomechanical performance, and AAOJ arthroplasty can restore excellent instant stability and preserve the movement of the atlantoaxial joint.

The effect of sensory stimulation on recovery of an evoked motor behavior after neuronal injury

Event Abstract Back to Event The effect of sensory stimulation on recovery of an evoked motor behavior after neuronal injury Arianna Tamvacakis1* and Paul S. Katz1 1 Georgia State University, Neuroscience Institute, United States Neural circuits can undergo spontaneous or training-induced changes that allow them to recover from neuronal injury. We have been studying the neural basis for recovery from injury in the escape swim response of the nudibranch mollusc, Tritonia diomedea (Sakurai and Katz, J.Neurosci., v29, 2009). In response to noxious sensory stimuli, such as 0.5ml 5M NaCl, Tritonia produces a swim response consisting of a series of dorsal and ventral whole body flexions. The swim response is disabled by cutting a commissure that connects the two halves of the brain. The animal can recover the ability to swim after commissure cut, but what role sensory stimuli play in the ability to recover is unknown. To determine the extent to which the recovery is dependent upon stimulation that might elicit a response, we tested animals with salt stimuli at the following intervals: every 2 hours, 4 hours, 12 hours, and 24 hours. Animals were paired with sham controls of similar size and swimming tendency. The experimenter was blind to the identity of the experimental animal. All sham controls recovered by 6 hours as judged by the number of body flexion cycles. Experimental animals that were tested every 24 hours exhibited no apparent loss (i.e. the swim response recovered spontaneously in the interval between surgery and the first test.) Stimulating animals every 12 hours delayed the recovery until 36 hours. Animals that were stimulated every 4 hours recovered within 24 hours, but animals that were stimulated every 2 hours did not fully recover by 24 hours. These results show that sensory stimulation is not necessary for recovery from injury; however, it may interact with the recovery process in a complicated fashion. Conference: 2010 South East Nerve Net (SENN) and Georgia/South Carolina Neuroscience Consortium (GASCNC) conferences, Atlanta , United States, 5 Mar - 7 Mar, 2010. Presentation Type: Poster Presentation Topic: Posters Citation: Tamvacakis A and Katz PS (2010). The effect of sensory stimulation on recovery of an evoked motor behavior after neuronal injury. Front. Neurosci. Conference Abstract: 2010 South East Nerve Net (SENN) and Georgia/South Carolina Neuroscience Consortium (GASCNC) conferences. doi: 10.3389/conf.fnins.2010.04.00080 Copyright: The abstracts in this collection have not been subject to any Frontiers peer review or checks, and are not endorsed by Frontiers. They are made available through the Frontiers publishing platform as a service to conference organizers and presenters. The copyright in the individual abstracts is owned by the author of each abstract or his/her employer unless otherwise stated. Each abstract, as well as the collection of abstracts, are published under a Creative Commons CC-BY 4.0 (attribution) licence (https://creativecommons.org/licenses/by/4.0/) and may thus be reproduced, translated, adapted and be the subject of derivative works provided the authors and Frontiers are attributed. For Frontiers’ terms and conditions please see https://www.frontiersin.org/legal/terms-and-conditions. Received: 18 Mar 2010; Published Online: 18 Mar 2010. * Correspondence: Arianna Tamvacakis, Georgia State University, Neuroscience Institute, Atlanta, United States, ariannat@student.gsu.edu Login Required This action requires you to be registered with Frontiers and logged in. To register or login click here. Abstract Info Abstract The Authors in Frontiers Arianna Tamvacakis Paul S Katz Google Arianna Tamvacakis Paul S Katz Google Scholar Arianna Tamvacakis Paul S Katz PubMed Arianna Tamvacakis Paul S Katz Related Article in Frontiers Google Scholar PubMed Abstract Close Back to top Javascript is disabled. Please enable Javascript in your browser settings in order to see all the content on this page.

Encircling the Tendon Repair Site with Collagen-GAG Reduces the Formation of Postoperative Tendon Adhesions in a Chicken Flexor Tendon Model

Tendon healing is a complex and coordinated event involving the activation of extrinsic mechanisms as in classic reparative skin wound healing as well as intrinsic mechanisms characteristic of regenerative wound healing. Despite improvements in surgical and rehabilitative techniques, tendon adhesions remain the most frequent cause of disability following tendon surgery. In this animal model, we evaluated the use of a clinically available, biocompatible collagen- glycosaminoglycan (GAG) material as an adjunct to surgical tendon repair. Thirty-two white leghorn chickens underwent surgical tendon repair of their left second and fourth digits. Digits were randomized to study and control groups. In both groups, the long flexor tendon was divided and repaired using a modified Kessler's repair. In the study group, collagen-GAG membrane was wrapped around the repair site. Animals were immobilized with a plaster cast and sacrificed at 3 wk. Sixteen animals had their tendon repair sites histologically assessed and graded for healing and adhesion formation. Eight animals had their tendon repairs assessed for quantification of the work associated with flexion, employing a specifically designed biomechanical apparatus. Eight animals had their repair sites tested for bursting strength. Control (untreated) tendons showed fibrous tissue surrounding the repair sites with approximately 50% of the circumference of the repair site adherent to surrounding tissue elements. The mean histologic grades for control and study group were 3.1+/-0.2 and 1.9+/-0.2, respectively. The difference between mean grades for control and study group samples was statistically significant (paired t-test: P<0.01). The work of flexion (WOF) for flexion cycles 1, 2, 3, and 4 for the control group was 0.58, 0.55, 0.46, and 0.44N/mm, respectively. The study (collagen-GAG wrapped) group had WOF values 0.16, 0.14, 0.10, 0.09N/mm, and the difference between the groups was statistically significant (paired t-test, P<0.01). The mean bursting strength of repaired tendons for control and study groups were 14.3+/-1.87N and 11.5+/-1.85N, respectively. There was no significant difference in bursting strength between the groups (paired t-test, P=0.71). Collagen-GAG reduces formation of early postoperative tendon adhesions in this chicken flexor tendon repair model. Collagen-GAG wrapped tendons healed with minimal peritendinous adhesion formation and required less effort for flexion. The investing collagen-GAG membrane did not appear to interfere with either the quality or strength of healing.

Age- and sex-associated differences in isokinetic knee muscle endurance between young children and adults

The purpose of this study was to examine the age- and sex-associated differences of repeated isokinetic knee extension and flexion. Fifty one participants, 30 young children (16 boys and 14 girls; aged 11 and 12 years) and 21 adults (9 males and 12 females; aged 18-35 years), agreed to participate in the study. Isokinetic concentric peak knee extension (PET) and flexion (PFT) torque were measured using a calibrated Biodex System 3. Participants performed 4 concentric extension-flexion cycles with maximum effort; after a 2 min rest, 50 continuous concentric cycles were performed at 1.56 rad.s-1. Total work of the extensors (WKEX) and flexors (WKFL) for the complete 50 repetitions was recorded. Average peak torque and average work for the first and last 3 repetitions were calculated to represent the percentage decline in torque and work. There were no significant differences between groups in the peak torque generated during the pretrial and endurance task, suggesting that participants gave a maximal effort at the start of the endurance task. There was a significant interaction effect in the total work done for both extensors and flexors, with adult males producing the greatest amount of work (6622 and 3444 J, respectively). When total work was divided by body mass, there were no significant sex effects, only main effects for group. The percentage decline for PET (40% vs. 60%), PFT (50% vs. 65%), WKET (43% vs. 61%), and WKFL (60% vs. 69%) demonstrated significant main effects for group, with greater fatigue in adults. We found no significant sex effect for fatigue. This study concludes that females do not resist fatigue from repeated isokinetic muscle actions to a greater extent than males, and that the greater fatigue in adults than in children is probably a product of greater initial torque production and work performed.

Tibiofemoral contact mechanics with a femoral resurfacing prosthesis and a non-functional meniscus

Background Increased contact stress with a femoral resurfacing prosthesis implanted in the medial femoral condyle and a non-functional meniscus is of concern for potential deleterious effects on tibiofemoral contact mechanics. Methods Peak contact pressures were determined in seven fresh frozen human cadaveric specimens using a pressure sensitive sensor placed in the medial compartment above the menisci. A knee simulator was used to test each knee in static stance positions (5°/15°/30°/45°) and through 10 dynamic knee flexion cycles (5–45°) with single body weight ground reaction force which was adjusted to the living body weight of the cadaver donor. All specimens were tested in three different conditions: untreated knee (A); flush implantation of a 20 mm resurfacing prosthesis (HemiCAP ®) in the weight bearing area of the medial femoral condyle (B); complete radial tear at the posterior horn of the medial meniscus with the femoral resurfacing device in place (C). Findings On average, flush device implantation resulted in no statistically significant differences when compared to the untreated normal knee. The meniscal tear resulted in a significant increase of the mean maximum peak contact pressures by 63%, 57%, and 57% (all P ⩽ 0.05) at 15°, 30° and 45° static stance positions and 78% ( P ⩽ 0.05) through the dynamic knee flexion cycle. No significant different maximum peak contact pressures were observed at 5° stance position. Interpretation Although the condition of a meniscal tear without the resurfacing device could not be compared, possible effects of reduced meniscal tissue and biomechanical integrity of the meniscus must be considered in an in vivo application.

The Effect of Surface Treatment Using Hyaluronic Acid and Lubricin on the Gliding Resistance of Human Extrasynovial Tendons In Vitro

To investigate the effects of tendon surface treatment using hyaluronic acid (HA) and lubricin on the gliding resistance of human extrasynovial palmaris longus (PL) tendon in vitro. Thirty-two fresh-frozen cadaver human fingers and 16 ipsilateral PL tendons were used. Each PL tendon was divided into 2 pieces, which were randomly assigned into 4 experimental groups. After the gliding resistance of the normal PL tendon segments were measured, the tendons were treated with either saline, carbodiimide derivatized (cd) gelatin and HA (cd-HA gelatin), cd gelatin with lubricin added (cd gelatin plus lubricin), or cd-HA gelatin plus lubricin. After treatment, tendon gliding resistance was measured during up to 1000 cycles of simulated flexion and extension motion. The gliding resistance of the PL tendons in the cd-HA gelatin, cd gelatin plus lubricin, and cd-HA gelatin plus lubricin groups was significantly lower than that of the saline-treated control after 1000 cycles. The gliding resistance in these treatment groups decreased within the first 50 cycles and then increased at a much more gradual rate over the 1000 cycles, with the cd-HA gelatin plus lubricin group being most stable. The results suggest that tendon surface treatment using HA and lubricin can improve the gliding of human PL tendon in vitro. If validated in vivo, tendon surface treatment has the potential to improve the gliding ability of tendon grafts clinically.

Iliotibial band tension affects patellofemoral and tibiofemoral kinematics

The iliotibial band (ITB) has an important role in knee mechanics and tightness can cause patellofemoral maltracking. This study investigated the effects of increasing ITB tension on knee kinematics. Nine fresh-frozen cadaveric knees had the components of the quadriceps loaded with 175N. A Polaris optical tracking system was used to acquire joint kinematics during extension from 100° to 0° flexion. This was repeated after the following ITB loads: 30, 60 and 90N. There was no change with 30N load for patellar translation. On average, at 60 and 90N, the patella translated laterally by 0.8 and 1.4mm in the mid flexion range compared to the ITB unloaded condition. The patella became more laterally tilted with increasing ITB loads by 0.7°, 1.2° and 1.5° for 30, 60 and 90N, respectively. There were comparable increases in patellar lateral rotation (distal patella moves laterally) towards the end of the flexion cycle. Increased external rotation of the tibia occurred from early flexion onwards and was maximal between 60° and 75° flexion. The increase was 5.2°, 9.5° and 13° in this range for 30, 60 and 90N, respectively. Increased tibial abduction with ITB loads was not observed. The combination of increased patellar lateral translation and tilt suggests increased lateral cartilage pressure. Additionally, the increased tibial external rotation would increase the Q angle. The clinical consequences and their relationship to lateral retinacular releases may be examined, now that the effects of a tight ITB are known.

PHASED MULTI-JOINT MOVEMENT OF THE INDEX FINGER DURING A FULL FLEXION CYCLE

Flexion of the index finger is a fairly complex process requiring the coordination of different joints. This study is the first attempt to investigate how the angular velocity profile of the three right index joints (DIP, PIP, and MCP) varies with respect to time during the course of flexion. Ten right-handed subjects (healthy college students between 21 and 23 years old) were recruited to participate in the experiment. Each of these human subjects was instructed to perform a flexion task with his/her right hand. Five miniaturized (5-mm diameter) reflective markers were applied to each human subject: three placed at the DIP, PIP, and MCP joints of the index finger on the side close to thumb, and the rest at the predetermined landmarks on dorsum of thumb. A high-speed camera was used to record the motion of the index finger during a paced flexion, and the instantaneous angular velocity of each joint was determined by relating the marker displacement to the frame frequency (~5 ms between two consecutive frames). Opposite to the general belief that the speed is constant throughout a flexion cycle, to our best knowledge, this study, for the first time, has revealed that the speed of multi-joint movement actually varies with time. It has been identified that during one full flexion cycle, the angular velocity of the three joints of interest undergoes five distinguishable phases, referred as phases P1 (slow), P2 (fast), P3 (slow), P4 (fast), and P5 (slow), respectively. It has also been observed that duration of each of phases P1, P2, P4, or P5 accounts for approximately 10–15% of the whole flexion cycle, while P3 lasts for nearly half a cycle. Furthermore, although the flexions of DIP, PIP, and MCP joints cycle through the same five phases, the starts of their respective phases tend to vary. In P2 and P5, flexion of MCP takes place considerably later than those of PIP and DIP, whereas DIP flexes earlier than PIP in P2. The angular velocity of each joint reaches its peaks in P2 and P4; the peak velocity of DIP occurs earlier than that of PIP or MCP in P2, whereas peak of MCP is reached later than that of PIP. Moreover, the three joints of index finger flex with different angular velocities in each of the five phases: PIP moves significantly faster than MCP in P2, whereas DIP moves faster than MCP in P4. The results from our study indicate that the multi-joint motion of index finger is an uneven course, i.e. different joints flex with different angular velocities during the flexion. The temporal features of the velocity due to a single joint or multi-joint motion provide useful information to further clarify the dexterity of finger movement.

Assistive Control System Using Continuous Myoelectric Signal in Robot-Aided Arm Training for Patients After Stroke

In some stroke rehabilitation programs, robotic systems have been used to aid the patient to train. In this study, a myoelectrically controlled robotic system with 1 degree-of-freedom was developed to assist elbow training in a horizontal plane with intention involvement for people after stroke. The system could provide continuous assistance in extension torque, which was proportional to the amplitude of the subject's electromyographic (EMG) signal from the triceps, and could provide resistive torques during movement. This study investigated the system's effect on restoring the upper limb functions of eight subjects after chronic stroke in a twenty-session rehabilitation training program. In each session, there were 18 trials comprising different combinations of assistive and resistive torques and an evaluation trial. Each trial consisted of five cycles of repetitive elbow flexion and extension between 90 degrees and 0 degrees at a constant velocity of 10 degrees/s. With the assistive extension torque, subjects could reach a more extended position in the first session. After 20 sessions of training, there were statistically significant improvements in the modified Ashworth scale, Fugl-Meyer scale for shoulder and elbow, motor status scale, elbow extension range, muscle strength, and root mean square error between actual elbow angle and target angle. The results showed that the twenty-session training program improved upper limb functions.