Intact Joint Research Articles

Identifying the “unidentifiable” contributors to large-scale instability experienced at a UG2 mine along the Western Limb of the Bushveld Complex

The geology intersected by a mining excavation dictate the rockmass condition and stability of the excavation. The general geologic structure of the UG2 Reef horizon with regard to rock type, jointing and potential parting planes are well understood. Mining layouts and support applications are applied to control the anticipated rockmass behaviour. Case studies conducted at several instability sites have, however, revealed that in most cases the rockmass behaviour is controlled by the geologic structure which may appear as intact joints visible from scanline or borehole core mapping. The significance of these structures within the hangingwall is mostly not visible in a 3-dimensional space. The prominent structure is related to deformation processes which crosscut the strata and ramp to areas with strength competent contrasts (i.e. stringers or alteration layers). As a result large-scale instabilities may occur. The extent of these structures are only realised following large-scale instability. At the study site a combination of visual observations, scanline and borehole mapping, ground penetrating radar and high definition 3-dimentional laser scans were used to interrogate the geologic structure intersected along the hangingwall of a stope contributing to the instability experienced. The intent was to identify the precursors of these “unidentifiable” structures present in the unexposed hangingwall. The paper discusses the findings of the investigation conducted.

Impacts of tibial plateau levelling osteotomy on the tibial insertion of the medial collateral ligament of the canine stifle joint – A cadaveric study

ObjectiveThe aim of this study was to assess the potential consequences of tibial plateau levelling osteotomy (TPLO) for the medial collateral ligament (MCL) tibial insertion (TI) with a particular focus on the effects of the TPLO planning technique and of the size of saw blade. Study designEighty-six stifle joints were collected from 43 canine cadavers and dissected free of soft tissue to expose the MCL. The MCL insertion sites were first identified with Chinese ink on intact stifle joints, and then marked with radio-opaque barium sulfate after removal of the MCL. Mediolateral radiographs were made of each marked stifle joint and used for TPLO digital planning. For each stifle, planning the TPLO was performed by centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia in group 1, and at the top of the intercondylar tubercles in group 2. Whenever possible, two saw blade sizes were tested in each group. Measurements were taken after TPLO simulation to assess how the procedure would alter the MCL TI. ResultsIn group 1, the integrity of the MCL TI was affected by the TPLO planning in 87.2% of the cases with the small saw blade and in 59.3% of the cases with the large blade, and in group 2, in 94.2% of the cases with the small and 77.9% with the large saw blade. In group 1, the osteotomy line was located above the TI, completely severing the MCL in four cases versus in 11 cases in group 2, while severing occurred in 14/15 cases with the small saw blade. ConclusionDuring TPLO, the osteotomy line transected the MCL TI in the majority of dogs. Centring the osteotomy at the intersection of the tibial plateau and the mechanical axis of the tibia and using the largest saw size that preserves tibial tuberosity and patellar tendon insertion seems to be the best way to preserve the MCL TI as much as possible. Further research is needed to evaluate the clinical impact of MCL TI transection.

Radiographic and MRI evidence of indirect neural decompression after the anterior column realignment procedure for adult spinal deformity.

The anterior column realignment (ACR) procedure, which consists of sectioning the anterior longitudinal ligament/annulus and placing a hyperlordotic interbody cage, has emerged as a minimally invasive surgery (MIS) for achieving aggressive segmental lordosis enhancement to address adult spinal deformity (ASD). Although accumulated evidence has revealed indirect neural decompression after lateral lumbar interbody fusion (LLIF), whether ACR serves equally well for neural decompression remains to be proven. The current study intended to clarify this ambiguous issue. A series of 36 ASD patients with spinopelvic mismatch, defined as pelvic incidence (PI) minus lumbar lordosis (LL) > 10°, underwent a combination of ACR, LLIF, and percutaneous pedicle screw (PPS) fixation. This "MIS triad" procedure was applied over short segments with mean fusion length of 3.3 levels, and most patients underwent single-level ACR. The authors analyzed full-length standing radiographs, CT and MRI scans, and Oswestry Disability Index (ODI) scores in patients with minimum 1 year of follow-up (mean [range] 20.3 [12-39] months). Compared with the preoperative values, the radiographic and MRI measurements of the latest postoperative studies changed as follows. Segmental disc angle more than quadrupled at the ACR level and LL nearly doubled. MRI examinations at the ACR level revealed a significant (p < 0.0001) increase in the area of the dural sac that was accompanied by significant (p < 0.0001) decreases in area and thickness of the ligamentum flavum and in thickness of the disc bulge. The corresponding CT scans demonstrated significant (all p < 0.0001) increases in disc height to 280% of the preoperative value at the anterior edge, 224% at the middle edge, and 209% at the posterior edge, as well as in pedicle-to-pedicle distance to 122%. Mean ODI significantly (p < 0.0001) decreased from 46.3 to 26.0. The CT-based data showing vertebral column lengthening across the entire ACR segment with an increasingly greater degree anteriorly suggest that the corrective action of ACR relies on a lever mechanism, with the intact facet joints acting as the fulcrum. Whole-segment spine lengthening at the ACR level reduced the disc bulge anteriorly and the ligamentum flavum posteriorly, with eventual enlargement of the dural sac. ACR plays an important role in not only LL restoration but also stenotic spinal canal enlargement for ASD surgery.

Biomechanical Analysis of Posterior Open-Wedge Osteotomy and Glenoid Concavity Reconstruction Using an Implant-Free, J-Shaped Iliac Crest Bone Graft

Background: Posterior open-wedge osteotomy and glenoid reconstruction using a J-shaped iliac crest bone graft showed promising clinical results for the treatment of posterior instability with excessive glenoid retroversion and posteroinferior glenoid deficiency. Purpose: To evaluate the biomechanical performance of the posterior J-shaped graft to restore glenoid retroversion and posteroinferior deficiency in a cadaveric shoulder instability model. Study Design: Controlled laboratory study. Methods: A posterior glenoid open-wedge osteotomy was performed in 6 fresh-frozen shoulders, allowing the glenoid retroversion to be set at 0°, 10°, and 20°. At each of these 3 preset angles of glenoid retroversion, the following conditions were simulated: (1) intact joint, (2) posterior Bankart lesion, (3) 20% posteroinferior glenoid deficiency, and (4) posterior J-shaped graft (at 0° of retroversion). With the humerus in the Jerk position (60° of glenohumeral anteflexion, 60° of internal rotation), stability was evaluated by measuring posterior humeral head (HH) translation (in mm) and peak translational force (in N) to translate the HH over 25% of the glenoid width. Glenohumeral contact patterns were measured using pressure-sensitive sensors. Fixation of the posterior J-graft was analyzed by recording graft micromovements during 3000 cycles of 5-mm anteroposterior HH translations. Results: Reconstructing the glenoid with a posterior J-graft to 0° of retroversion significantly increased stability compared with a posterior Bankart lesion and posteroinferior glenoid deficiency in all 3 preset degrees of retroversion (P < .05). There was no significant difference in joint stability comparing the posterior J-graft with an intact joint at 0° of retroversion. The posterior J-graft restored mean contact area and contact pressure comparable with that of the intact condition with 0° of retroversion (222 vs 223 mm2, P = .980; and 0.450 vs 0.550 MPa, P = .203). The mean total graft displacement after 3000 cycles of loading was 43 ± 84 µm, and the mean maximal mediolateral graft bending was 508 ± 488 µm. Conclusion: Biomechanical analysis of the posterior J-graft demonstrated reliable restoration of initial glenohumeral joint stability, normalization of contact patterns comparable with that of an intact shoulder joint with neutral retroversion, and secure initial graft fixation in the cadaveric model. Clinical Relevance: This study confirms that the posterior J-graft can restore stability and glenohumeral loading conditions comparable with those of an intact shoulder.

High frame rate deformation analysis of knee cartilage by spiral dualMRI and relaxation mapping.

Daily activities including walking impose high-frequency cyclic forces on cartilage and repetitive compressive deformation. Analyzing cartilage deformation during walking would provide spatial maps of displacement and strain and enable viscoelastic characterization, which may serve as imaging biomarkers for early cartilage degeneration when the damage is still reversible. However, the time-dependent biomechanics of cartilage is not well described, and how defects in the joint impact the viscoelastic response is unclear. We used spiral acquisition with displacement-encoding MRI to quantify displacement and strain maps at a high frame rate (25 frames/s) in tibiofemoral joints. We also employed relaxometry methods (T1 , T1ρ , T2 , T2 *) on the cartilage. Normal and shear strains were concentrated on the bovine tibiofemoral contact area during loading, and the defected joint exhibited larger compressive strains. We also determined a positive correlation between the change of T1ρ in cartilage after cyclic loading and increased compressive strain on the defected joint. Viscoelastic behavior was quantified by the time-dependent displacement, where the damaged joint showed increased creep behavior compared to the intact joint. This technique was also successfully demonstrated on an in vivo human knee showing the gradual change of displacement during varus load. Our results indicate that spiral scanning with displacement encoding can quantitatively differentiate the damaged from intact joint using the strain and creep response. The viscoelastic response identified with this methodology could serve as biomarkers to detect defects in joints in vivo and facilitate the early diagnosis of joint diseases such as osteoarthritis.

Mechanical Evaluation of Knee Ligament Allografts for Thumb Metacarpophalangeal and Finger Proximal Interphalangeal Reconstruction

Purpose This study evaluated knee collateral ligaments for use as allografts in small joint reconstruction in the hand, specifically the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) and the index finger proximal interphalangeal (PIP) joint radial collateral ligament (RCL), and compared them to the current gold standard, tendon autograft. Methods Uniaxial tensile testing was performed on native thumb MCP UCLs and index finger PIP RCLs and 2.5-mm–diameter grafts prepared from hemi-flexor carpi radialis (hemi-FCR) tendons and knee medial collateral ligaments (MCLs) cadaveric allografts. In situ angular testing was performed in thumb MCP and index finger PIP joints. Each MCP/PIP joint was secured to a mechanical testing system and cyclically loaded. The UCL/RCL was resected and reconstructed with either an MCL or hemi-FCR. Cyclic loading was repeated, followed by angular load to failure. Results Uniaxial testing of MCL allografts demonstrated greater ultimate stress, ultimate load, and elastic modulus than hemi-FCR grafts and native UCLs/RCLs. The maximum angular deviation of the reconstructed MCP and PIP joints was not significantly different compared with the intact joint with either an MCL or hemi-FCR graft. In situ load to failure demonstrated no differences in failure torque or angular stiffness between MCPs reconstructed with a hemi-FCR and MCL allograft, whereas reconstructed PIP joints demonstrated improved angular stiffness with an MCL allograft compared with a hemi-FCR. Conclusions Medial collateral ligament allografts demonstrated improved mechanical properties compared with hemi-FCR tendon grafts during uniaxial testing, and grafts performed equivalently in in situ testing of reconstructed thumb/finger joints. Clinical relevance Prepared knee ligament allografts may provide a viable graft material for use in reconstruction of small hand ligaments. This new allograft material avoids the need to harvest a tendon autograft and has a biologic structure similar to native hand ligaments. This study evaluated knee collateral ligaments for use as allografts in small joint reconstruction in the hand, specifically the thumb metacarpophalangeal (MCP) joint ulnar collateral ligament (UCL) and the index finger proximal interphalangeal (PIP) joint radial collateral ligament (RCL), and compared them to the current gold standard, tendon autograft. Uniaxial tensile testing was performed on native thumb MCP UCLs and index finger PIP RCLs and 2.5-mm–diameter grafts prepared from hemi-flexor carpi radialis (hemi-FCR) tendons and knee medial collateral ligaments (MCLs) cadaveric allografts. In situ angular testing was performed in thumb MCP and index finger PIP joints. Each MCP/PIP joint was secured to a mechanical testing system and cyclically loaded. The UCL/RCL was resected and reconstructed with either an MCL or hemi-FCR. Cyclic loading was repeated, followed by angular load to failure. Uniaxial testing of MCL allografts demonstrated greater ultimate stress, ultimate load, and elastic modulus than hemi-FCR grafts and native UCLs/RCLs. The maximum angular deviation of the reconstructed MCP and PIP joints was not significantly different compared with the intact joint with either an MCL or hemi-FCR graft. In situ load to failure demonstrated no differences in failure torque or angular stiffness between MCPs reconstructed with a hemi-FCR and MCL allograft, whereas reconstructed PIP joints demonstrated improved angular stiffness with an MCL allograft compared with a hemi-FCR. Medial collateral ligament allografts demonstrated improved mechanical properties compared with hemi-FCR tendon grafts during uniaxial testing, and grafts performed equivalently in in situ testing of reconstructed thumb/finger joints.

Importance of posterior tibial slope in joint kinematics with an anterior cruciate ligament-deficient knee.

To fully quantify the effect of posterior tibial slope (PTS) angles on joint kinematics and contact mechanics of intact and anterior cruciate ligament-deficient (ACLD) knees during the gait cycle. In this controlled laboratory study, we developed an original multiscale subject-specific finite element musculoskeletal framework model and integrated it with the tibiofemoral and patellofemoral joints with high-fidelity joint motion representations, to investigate the effects of 2.5° increases in PTS angles on joint dynamics and contact mechanics during the gait cycle. The ACL tensile force in the intact knee was significantly affected with increasing PTS angle. Considerable differences were observed in kinematics and initial posterior femoral translation between the intact and ACLD joints as the PTS angles increased by more than 2.5° (beyond 11.4°). Additionally, a higher contact stress was detected in the peripheral posterior horn areas of the menisci with increasing PTS angle during the gait cycle. The maximum tensile force on the horn of the medial meniscus increased from 73.9 N to 172.4 N in the ACLD joint with increasing PTS angles. Knee joint instability and larger loading on the medial meniscus were found on the ACLD knee even at a 2.5° increase in PTS angle (larger than 11.4°). Our biomechanical findings support recent clinical evidence of a high risk of failure of ACL reconstruction with steeper PTS and the necessity of ACL reconstruction, which would prevent meniscus tear and thus the development or progression of osteoarthritis.Cite this article: Bone Joint Res2022;11(10):708-719.

Morphologic analysis of the sublime tubercle: considerations in the approach to ulnar collateral ligament reconstruction.

Given the increased incidence of ulnar collateral ligament (UCL) injuries and the projected increase in reconstruction procedures, a robust understanding of the morphologic location of the sublime tubercle is paramount to anatomic reconstruction. There is limited research evaluating the morphology of the sublime tubercle of the proximal ulna in an anterior-to-posterior plane. Twenty-five computed tomography (CT) scans of intact proximal elbow joints for patients were selected using a de-identified database. Cases with history of fracture or surgical intervention to the elbow joint were excluded. These CT scans were then imported into the Mimics Innovation Suite 24.0 software to analyze the sublime tubercle angle from the midpoint of the trochlear notch. All left elbow angle and clock-face values were converted to right elbow values for analysis. The average sublime tubercle angle from the midpoint of the trochlear notch was 282.53 degrees. The angle was converted to a clock face descriptor which located the sublime tubercle at 9.42. Our findings demonstrate that, in the non-throwing population, the morphology of the sublime tubercle can be expected to have a consistent medial location between 9 and 10 o'clock or 2 and 3 o'clock on the contralateral elbow. In relation to the proximal ulnar landmarks, the sublime tubercle, in the non-throwing population, has a consistent relative location.

Contact ratio and adaptations in the maxillary and mandibular dentoalveolar joints in rats and human clinical analogs

Spatial maps of function-based contact areas and resulting mechanical strains in bones of intact fibrous joints in preclinical small-scale animal models are limited. Functional imaging in situ on intact dentoalveolar fibrous joints (DAJs) in hemimandibles and hemimaxillae harvested from 10 male Sprague-Dawley rats (N = 5 at 12 weeks, N = 5 at 20 weeks) was performed in this study. Physical features including bone volume fraction (BVF), bone pore diameter and pore density, and cementum fraction (CF) of the molars in the maxillary and mandibular joints were evaluated. Biomechanical testing in situ provided estimates of joint stiffness, changes in periodontal ligament spaces (PDL-space) between the molar and bony socket, and thereby localization of contact area in the respective joints. Contact area localization revealed mechanically stressed interradicular and apical regions in the joints. These anatomy-specific contact stresses in maxillary and mandibular joints were correlated with the physical features and resulting strains in interradicular and bony socket compartments.The mandibular joint spaces, in general, were higher than maxillary, and this trend was consistent with age (younger loaded: Mn - 134 ± 55 μm, Mx - 110 ± 47 μm; older loaded: Mn - 122 ± 49 μm, Mx - 105 ± 48 μm). However, a significant decrease (P < 0.05) in mandibular and maxillary joint spaces with age (younger unloaded: Mn - 147 ± 51 μm; Mx - 125 ± 42 μm; older unloaded: Mn - 134 ± 46 μm; Mx - 116 ± 44 μm) was observed. The bone volume fraction (BVF) of mandibular interradicular bone (IR bone) increased significantly with age (P < 0.05) with the percent porosity of coronal mandibular bone lower than its maxillary counterpart. The contact ratio (contact area to total surface area) of maxillary teeth was significantly greater (P < 0.05) than mandibular teeth; both maxillary interradicular and apical contact ratios (IR bone: 41%, 56%; Apical bone: 4%, 12%) increased with age, and were higher than the mandibular (IR bone: 19%, 44%; Apical bone: 1%, 4%) counterpart. Resulting higher but uniform strains in maxillary bone contrasted with lower but higher variance in mandibular strains at a younger age.Anatomy-specific colocalization of physical properties and functional strains in bone provided insights into form-guided adaptive dominance of the maxilla compared to material property-guided adaptive dominance of the mandible. These age-related trends from the preclinical animal model paralleled with age- and tooth position-specific variabilities in mandibular craniofacial bones of adolescent and adult patients following orthodontic treatment.

Spring-mass behavioural adaptations to acute changes in prosthetic blade stiffness during submaximal running in unilateral transtibial prosthesis users

BackgroundIndividuals with lower-limb amputation can use running specific prostheses (RSP) that store and then return elastic energy during stance. However, it is unclear whether varying the stiffness category of the same RSP affects spring-mass behaviour during self-selected, submaximal speed running in individuals with unilateral transtibial amputation. Research questionThe current study investigates how varying RSP stiffness affects limb stiffness, running performance, and associated joint kinetics in individuals with a unilateral transtibial amputation. MethodsKinematic and ground reaction force data were collected from eight males with unilateral transtibial amputation who ran at self-selected submaximal speeds along a 15 m runway in three RSP stiffness conditions; recommended habitual stiffness (HAB) and, following 10-minutes of familiarisation, stiffness categories above (+1) and below (-1) the HAB. Stance-phase centre of mass velocity, contact time, limb stiffness’ and joint/RSP work were computed for each limb across RSP stiffness conditions. ResultsWith increased RSP stiffness, prosthetic limb stiffness increased, whilst intact limb stiffness decreased slightly (p<0.03). Centre of mass forward velocity during stance-phase (p<0.02) and contact time (p<0.04) were higher in the intact limb and lower in the prosthetic limb but were unaffected by RSP stiffness. Intact limb hip joint positive work increased for both the +1 and -1 conditions but remained unchanged across conditions in the prosthetic limb (p<0.02). SignificanceIn response to changes in RSP stiffness, there were acute increased mechanical demands on the intact limb, reflecting a reliance on the intact limb during running. However, overall running speed was unaffected, suggesting participants acutely adapted to an RSP of a non-prescribed stiffness.

Validation of a biomechanical testing protocol of craniodorsal hip luxation in feline cadavers and comparison of two ultra-high molecular weight polyethylene materials used for extra-articular hip stabilisation.

The aim of our study was to describe a biomechanical testing protocol to reproduce ex vivo craniodorsal hip luxation specific to the feline model, and evaluate the biomechanical properties of an intact hip joint compared with the fixation strength of two different techniques of extra-articular hip stabilisation. Eighteen hip joints (femur and hemipelvis) were harvested from nine mature feline cadavers. CT was performed for each hip joint so that a biomechanical base specific to each joint morphotype could be created using computer-aided design. The biomechanical bases were then produced using a three-dimensional printer to secure the hip joints during testing. A total of 34 biomechanical compression tests were performed. Eighteen compression tests were performed in the control group, of which two fractured. The remaining 16 hip joints were then randomly assigned either to group A (hip joints stabilised with an extra-articular ultra-high molecular weight polyethylene (UHMWPE) implant secured by an interference screw [n = 8]) or to group B (hip joints stabilised with a UHMWPE iliofemoral suture [n = 8]). Mean ± SD yield, failure load and linear stiffness in the control group were 616 ± 168 N, 666 ± 158 N and 231 ± 50 N/mm, respectively. The relative fixation strength (% of intact joint) before hip luxation in groups A and B was 43.8% and 34.7%, respectively. No statistical difference was found between groups A and B for yield and failure load. However, the reoccurrence of craniodorsal hip luxation was higher in group B than in group A, in 5/8 and 0/8 tests, respectively. Moreover, in group A, the extra-articular UHMWPE implant induced caudodorsal hip luxation, reported as failure mode in 7/8 cases. This modified biomechanical protocol for testing craniodorsal hip luxation in a feline model was validated as repeatable and with acceptable variance. The extra-articular UHMWPE implant stabilisation technique proved to be more efficient in avoiding reoccurrence of craniodorsal hip luxation than UHMWPE iliofemoral suture.

High Prevalence of Isolated Antero-medial Osteoarthritis (AMOA) in Indian Patients Undergoing Primary Total Knee Arthroplasty.

Isolated antero-medial osteoarthritis (AMOA) of the knee is a distinct pattern of arthritis. Medial arthritis of the knee in select patients can be managed with uni-compartmental arthroplasty (UKA), with studies showing shorter hospital stay, faster rehabilitation and reduced medical complications in the post-operative period compared to TKA. However, the prevalence of AMOA in Indian patients with osteoarthritis of the knee is unknown. The aim of this study was to evaluate the prevalence of AMOA in patients undergoing primary TKA for OA. This was a prospective evaluation of 2518 knees in 1936 patients who were selected for primary TKA. Pre-operative radiographs were screened based on the Oxford UKA Radiological decision aid and diagnosis of AMOA was established. All 2518 knees underwent primary total knee arthroplasty and cases of AMOA were confirmed intra-operatively based on ACL integrity, lateral compartment wear and medial compartment wear pattern. Cases with AMOA arthritic wear pattern were considered amenable for UKA if radiographs showed intact lateral joint space, intra-operatively those with intact and functional ACL, acceptable patellofemoral wear (Outerbridge I-II). We report a prevalence of 46.94% of AMOA, who were amenable for UKA. Obese patients were more likely to have a damaged or non-functional ACL and more likely to have a high degree of wear, not amenable for UKA (p < 0.05). Non-functional ACL was associated with higher prevalence of posterior extension of arthritic wear. This study demonstrated a high prevalence (46.94%) of antero-medial osteoarthritis (AMOA), amenable for UKA. Patient selection is important for improving outcomes after TKA or UKA. Future studies are warranted to compare outcomes of both UKA and TKA in patients with isolated AMOA of the knee.

Experimental study of eigenstrains in temporomandibular joint discs using digital image analysis

The temporomandibular joint is one of the most frequently used joints of the human body. Its malfunction can severely influence patient’s well-being. Since the temporomandibular joint disc plays a major role in its functioning, especially in load distribution within the joint, it appears to be a crucial element to understand. This paper aims to improve understanding of the tissues within close in vivo conditions (i.e. hydrated at 37 ° C) by (i) comforting literature by revealing the presence of residual stresses within the temporomandibular joint disc, (ii) quantifying eigenstrains through a relaxation process and finally (iii) evaluating the internal mechanical state in intact temporomandibular joint discs central part, considering the tissue as a thin layer. Both global specimen size measurements and local digital image correlation were used to quantify 6 samples’ deformation through a detailed analysis of approximately 30 images, recorded for approximately one hour, per disc. Thanks to a backward time approach combined to an analytical model, eigenstrains were assessed on discs. For the first time, the presence of complex initial strain fields within cylindrical specimens of porcine temporomandibular joint discs was quantified, confirming indications from literature. Digital image analysis revealed the partial internal stress release through specimen self-deformation. Close to zero in central part, it reached approximately 13% radial strain in the outer ring within a characteristic relaxation time close to 530s. The principal strains’ distribution agrees with the alignment of the collagen fibers in the central part of the discs revealed in many works. It led to deduce that, in the central area of the discs, the matrix undergoes a radial compression within physiological conditions to compensate the daily loading stresses. Therefore, this work improves understanding of the tissues in vivo conditions highlighting extraction cut effect on temporomandibular joint disc’s tissues mechanical state.

Disbond contour estimation in aluminum/CFRP adhesive joint based on the phase velocity variation of Lamb waves

Adhesive lap joints between composite and metal plates have been widely used in industrial fields including the automotive industry, marine manufacturing and aerospace engineering. Low quality of operation, harsh environment, adhesive aging and other disadvantages may lead to disbonding. To assess the disbond contour at an adhesive interface, this study proposes a detection method based on the phase velocity variation of Lamb waves. First, the dispersion curves of Lamb waves in both single-layer and bonded multi-layer areas are acquired using the semi-analytical finite element (FE) method. Subsequently, numerical models of Lamb wave propagation in intact and disbonded joints are established. Due to the difference in phase velocity between relevant modes, the phase difference of Lamb wave between disbonded and intact joints is quantitatively linear with the disbond length under specific excitation, which is verified by the simulated signals based on FEs. Then, a probabilistic reconstruction algorithm based on phase delay is employed to localize the disbond center. On this basis, the edge points of the disbond are acquired, and the convex envelope of these points is sketched for disbond contour estimation. As a result, both the location and shape of the disbond can be obtained, thereby providing information for subsequent assessment. The experiment is carried out on an adhesive lap joint specimen composed of an aluminum plate and a quasi-isotropic carbon fiber reinforced plastic laminate, and the results demonstrate the effectiveness of the proposed method.

Morphometric assessment of the medial collateral ligament of the canine stifle joint

ObjectiveThe study provides a morphometric assessment of the medial collateral ligament (MCL) of the canine stifle joint. Study designEighty-six stifle joints were collected from 43 canine cadavers and dissected to free them of soft tissue and expose the collateral ligaments. The MCL insertion sites were identified with Chinese ink on intact stifle joints and also marked with radiopaque paste after removal of the MCL. Mediolateral photographs and radiographs of each stifle joint were taken after MCL was removed for morphometric assessment. Measurements were taken in two groups: a group of Beagles (group 1), and a group composed of different breeds (group 2). ResultsIn all stifle joints, the MCL had an hourglass shape. It inserted in the distal femur and the proximal tibia, and was also intimately attached to the medial meniscus and more loosely to the proximal tibial epiphysis in its central portion. The MCL tibial insertion (TI) site had the largest surface area. Its proximal and distal position relative to the tibial plateau was located at 8.24 ± 1.17% and 15.54 ± 1.50% respectively of the total tibial length in group 1, and at 8.86 ± 1.93% and 15.53 ± 2.11% respectively, of the total tibial length in group 2. These values were not statistically different. ConclusionThe MCL of the canine stifle joint has an insertion site on the femur and on the tibia and is also attached on the medial meniscus. The location of the MCL TI site seems to be relatively homogeneous in dogs.

Bankart Repair With Remplissage Restores Better Shoulder Stability Than Bankart Repair Alone, and Medial or Two Remplissage Anchors Increase Stability but Decrease Range of Motion: A Finite Element Analysis

To investigate the effects of the number and location of anchors for remplissage on postoperative glenohumeral biomechanics. A biomechanical study was conducted involving finite element model constructed based on data from the intact glenohumeral joint. Seven models were established, including a normal model, a model of Bankart lesion combined with "off-track" Hill-Sachs lesion, a model of Bankart repair alone, and 4 models of Bankart repair with remplissage based on different remplissage anchor numbers and locations. The effects of the number and location of the remplissage anchors on glenohumeral stability were studied through calculation and comparison of (1) the stress and its distribution on the joint capsule, cartilage, labrum and anchors as well as (2) the displacement of the humeral head. Finite element analysis demonstrated that contact stress on the glenohumeral cartilage decreased when medial or 2 anchors were used and was minimized in the combined repair model with 2 medial anchors. The stress on remplissage anchors was greater when the anchors were placed medially. The humeral head displacement was maximized in the combined lesion model. The combined repair models with 2 medially placed anchors showed the largest slope on the force-displacement curve, indicating the largest strain on the humeral head. Based on a finite element analysis, Bankart repair with remplissage restored better shoulder stability compared with Bankart repair alone in the treatment of anterior shoulder instability involving Bankart lesion combined with "off-track" Hill-Sachs lesion. When the anchor for remplissage was medially placed or 2 anchors were used, the stability of the glenohumeral joint increased but with a loss of range of motion. The results of this study will assist in choosing the number and location of anchors for remplissage during shoulder stabilization surgery although with some limitations.

Experimental and Numerical Investigation of Intact, Defective and Repaired Countersunk Composite Joints under Tensile Loading.

Bolted joints are commonly used for assembling carbon fiber/resin composite structures. Since drilling may generate defects at hole edges which affect mechanical properties, it is of great engineering significance to develop proper repair methods to restore the mechanical properties of the defective parts. However, there are few studies on hole edge defects and their repair methods. Therefore, a novelty short fiber filling repair method was proposed to repair defective holes in this study. The mechanical properties of intact, defective and repaired countersunk composite joints were compared and investigated. Experimental tensile tests showed that defective joints had lower initial stiffness and failure loads compared to intact joints, while the mechanical properties were effectively restored after repair. Three-dimensional finite element models were also established to analyze the damage process of the joints. Results of numerical modelling were consistent with the experimental results. The simulations showed that changes in contact behaviors and local deformations caused by hole edge defects led to the low initial stiffness and stiffness transition point of the joint, while this phenomenon was reduced after repair. Additionally, despite different joint types, laminate failure mainly occurred around the hole and countersink.

Paper 93: Biomechanical Comparison of Tibiotalar Contact Pressures After Syndesmosis Injury With or Without Deltoid Ligament Repair

Objectives:Recent studies have stressed the important role of the deltoid ligament in maintaining global ankle stability. However, controversy remains around whether deltoid ligament repair is necessary in addition to syndesmotic repair when addressing injuries that disrupt both the syndesmosis and deltoid ligament. The purpose of this study was to measure differences in tibiotalar joint contact pressures and tibio-talar torsional stability in the presence of deltoid ligament injury, syndesmotic injury, and after their respective repairs using a cadaveric model. Our hypotheseis were 1) injury to the syndesmoosis and deltoid would increase contact pressures and decrease torsional stability, 2) repaired injuries would restore biomechanics to near native state, and 3)that there would be similar tibiotalar contact pressures and torsional stability with syndesmosis repair alone compared to syndesmosis and deltoid ligament repair.Methods:Twelve fresh-frozen human cadaveric lower extremity specimens with intact ankle joints were randomized and tested under a series of conditions: 1) intact syndesmosis and deltoid, 2) sectioning of syndesmosis or deltoid, 3) sectioning of both the syndesmosis and deltoid, 4) repair of syndesmosis or deltoid, 5) repair of both the syndesmosis and deltoid. In one group, the syndesmosis was sectioned and repaired first and in the other the deltoid was sectioned and repaired first. The syndesmosis was repaired with a single high-tensile strength suture mechanism (TightRope, Arthrex), and deltoid ligament repairs were performed with a single suture anchor (FiberTak, Arthrex). Specimens were tested under each condition with 800 N axial compression load, followed by cyclic torsional preconditioning of 5 Nm internal tibial torque (i.e., external foot rotation) at a rate of 2.5 Nm/s, and then a single rotation test of 7.5 Nm internal tibial torque at 1 Nm/s under 800 N axial compression load on a servohydraulic mechanical testing system. Contact pressures within the tibiotalar joint were measured with a digitized pressure sensor film (Tekscan, Boston MA), and coronal plane motion about the tibia was measured in angular displacement.Results:There was no significant difference in peak contact pressures between conditions except when the comparing an isolated deltoid ligament injury to a combined deltoid and syndesmosis injury (4.43±1.33MPa vs 2.67±0.45MPa, p=0.038). Total contact area was less following syndesmosis repair in isolation (609.55±312.37mm2) and combined syndesmosis and deltoid repair (598.28±181.47mm2) compared to all other conditions (p<0.001). There was also a decrease in total contact area compared to native state when the deltoid was repaired in isolation (951.51±72.79mm2 vs 888.72±105.74mm2, p=0.027). The mean external rotation angle was greater when the syndesmosis (15.67±5.39°), deltoid (13.21±3.28°), and both injuries combined (16.59±4.01°) compared to native state (8.55±2.02°), however these values did not achieve statistical significance. Additionally, There was no statistically significant difference in external rotation angle between isolated syndesmosis, isolated deltoid, or combined repairs.Conclusions:These findings demonstrate that ankle contact pressures and torsional stability do not differ significantly when a deltoid ligament repair is performed in conjunction with a syndesmosis repair for a purely ligamentous injury. However, the change in contact area following syndesmosis repair may play a role in the development of post-traumatic arthritis. This finding reinforces the importance of striving for an anatomic syndesmotic reduction, and care should be taken not to over-reduce the syndesmosis during repair.

Naturally occurring osteochondrosis latens lesions identified by quantitative and morphological 10.5 T MRI in pigs.

Juvenile osteochondritis dissecans (JOCD) is a pediatric orthopedic disorder that involves the articular-epiphyseal cartilage complex and underlying bone. Clinical disease is often characterized by the presence of radiographically apparent osteochondral flaps and fragments. The existence of early JOCD lesions (osteochondrosis latens [OCL] and osteochondrosis manifesta [OCM]) that precede the development of osteochondral flaps and fragments is also well recognized. However, identification of naturally occurring OCL lesions (confined to cartilage) using noninvasive imaging techniques has not yet been accomplished. We hypothesized that 10.5 T magnetic resonance imaging(MRI) can identify naturally occurring OCL lesions at predilection sites in intact joints of juvenile pigs. Unilateral elbows and knees (stifles) were harvested from three pigs aged 4, 8, and 12 weeks, and scanned in a 10.5 T MRI to obtain morphological 3D DESS images, and quantitative T2 and T1ρ relaxation time maps. Areas with increased T2 and T1ρ relaxation times in the articular-epiphyseal cartilage complex were identified in 1/3 distal femora and 3/3 distal humeri and were considered suspicious for OCL or OCM lesions. Histological assessment confirmed the presence of OCL or OCM lesions at each of these sites and failed to identify additional lesions. Histological findings included necrotic vascular profiles associated with areas of chondronecrosis either confined to the epiphyseal cartilage (OCL, 4- and 8-week-old specimens) or resulting in a delay in endochondral ossification (OCM, 12-week-old specimen). Future studies with clinical MR systems (≤7 T) are needed to determine whether these MRI methods are suitable for the in vivo diagnosis of early JOCD lesions in humans.

Closed isolated anterolateral calcaneal dislocation: a case report

BackgroundComplete isolated calcaneal dislocation, defined as dislocation of talocalcaneal and calcaneocuboid joints with intact talonavicular joint without significant fracture, is an exceedingly rare injury.Case presentationA 49-year-old man, after a motor vehicle collision, presented with a closed isolated anterolateral dislocation of the calcaneus associated with fracture of the sustentaculum tali, cuboid, lateral process of the talus, and avulsion fracture of superior peroneal retinaculum. Urgent successful closed reduction was immediately performed in the emergency room under sedation. Two days later, through sinus tarsi approach extended proximally to posterior of the lateral malleolus and distally to the calcaneocuboid joint, peroneal tendons were reduced in the retromalleolar groove and avulsion fracture of the superior peroneal retinaculum was reduced and fixed by a suture anchor. A chondral lesion (6 × 8 mm) was seen in the posterior facet of the calcaneus for that chondroplasty and microfracture were performed. Also, small bony fragments from the cuboid were excised. The reduced calcaneocuboid joint was fixed by two Kirschner wires. In the second stage, 10 days later, through medial approach to the talocalcaneal joint, multiple free bony fragments were excised. Then sustentaculum tali was reduced and fixed using a lag screw. Postoperatively, a non-weight bearing short leg cast was applied for six weeks. The patient had permission to start partial weight bearing 6 weeks after removal of K-wires. Finally, at the 10th postoperative week, he had full weight-bearing without any aid instrument. He was able to return to his regular activities about 6 months after the injury. At 34 months, the American Orthopaedic Foot and Ankle Society ankle-hindfoot scale was 92 from 100. The foot function index percentile was 7% and the visual analogue score for pain was 1.9. The last radiographs revealed normal configuration of talocalcaneal, calcaneocuboid, and talonavicular joints with a little joint space narrowing in posterior part of the subtalar joint.ConclusionPatients with isolated anterolateral calcaneal dislocations, even with multiple associated fractures, can have acceptable outcomes, if it is urgently diagnosed and properly managed.