Ligament Forces Research Articles

The impact of anterior knee displacement on knee joint load during the forward bow step in Tai Chi.

While the forward bow step is a crucial component of Tai Chi (TC) practice, little research has been conducted on its impact on knee joint load and muscle coordination. This study aims to investigate the effects of three different knee forward positions during the TC forward bow step on knee joint loading. Twenty TC practitioners were recruited, and motion capture systems, force platforms, and surface electromyography were utilized to synchronously collect biomechanical parameters of three types of forward bow steps: knee joint not exceeding the tip of the foot (NETT), knee joint forward movement level with the tip of the foot (LTT), and knee joint forward movement exceeding the tip of the foot (ETT). Ligament and muscle forces were calculated using OpenSim software for musculoskeletal modeling and simulation. One-way ANOVA was used to analyze the variations of the indicators during the peak anterior displacement of the knee joint in three movements. Additionally, spm1d one-way ANOVA was employed to examine the variations in the one-dimensional curve of the indicators throughout the entire movement process. Compared with LTT and ETT, the NETT posture was associated with significantly decreased knee flexion angle (F = 27.445, p = 0.001), knee anterior-posterior translation (F = 36.07, p < 0.001), flexion-extension torque (F = 22.232, p = 0.001), ligament force (F = 9.055, p = 0.011). Additionally, there was also a significant reduction in muscle strength, including quadriceps (F = 62.9, p < 0.001), long biceps femoris (F = 18.631, p = 0.002), lateral gastrocnemius (F = 24.933, p = 0.001) and soleus (F = 7.637, p = 0.017). This study further confirms that in the forward lunge movement of Tai Chi, the knee joint load is mainly concentrated during the forward movement phase. Compared to the knee joint load at the NETT position, the load is greater at the LTT position; and compared to the LTT position, the load is even greater at the ETT position.

Anterior Slope-Modifying Osteotomies Alter the Length Change Behavior of the Superficial Medial Collateral Ligament: A Biomechanical Study.

Increased tibial slope has been shown to lead to higher rates of anterior cruciate ligament graft failure. A slope-decreasing osteotomy can reduce in situ anterior cruciate ligament force and may mitigate this risk. However, how this procedure may affect the length change behavior of the medial ligamentous structures is unknown. The purpose of this study was to examine the effect of anterior slope-modifying osteotomies on the medial ligamentous structures. It was hypothesized that (1) decreasing the tibial slope would lead to shortening of the superficial medial collateral ligament (sMCL), (2) while the fibers of the posterior oblique ligament (POL) would be unaffected. Descriptive laboratory study. Eight fresh-frozen cadaveric knee specimens underwent anatomic dissection to precisely identify the medial ligamentous structures. The knees were mounted in a custom-made kinematics rig with the quadriceps muscle and iliotibial tract loaded. An anterior slope-modifying osteotomy was performed and fixed using an external fixator, which allowed modification of the wedge height between -15 and +10 mm in 5-mm increments. Threads were mounted between pins positioned at the anterior, middle, and posterior parts of the tibial and femoral attachments of the sMCL and POL. For different tibial slope modifications, length changes between the tibiofemoral pin combinations were recorded using a rotary encoder as the knee was flexed between 0° and 120°. All sMCL fiber regions shortened with slope reduction (P < .001) and lengthened with slope increase (P < .001), with the anterior sMCL fibers more affected than the posterior sMCL fibers. A 15-mm anterior closing-wedge high tibial osteotomy (ACWHTO) resulted in a 6.9% ± 3.0% decrease in the length of the anterior sMCL fibers compared with a 3.6% ± 2.3% decrease for the posterior sMCL fibers. A 10-mm anterior opening-wedge high tibial osteotomy (AOWHTO) increased anterior sMCL fiber length by 5.9% ± 2.3% and posterior sMCL fiber length by 1.6% ± 1.0%. The POL fibers were not significantly affected by a slope-modifying osteotomy. Tibial slope-modifying osteotomies changed the length change pattern of the sMCL such that an AOWHTO increased whereas an ACWHTO decreased the sMCL strain. This effect was most pronounced for the anterior fibers of the sMCL. The length change pattern of the POL remained unaffected by slope-modifying osteotomy. Surgeons should be aware that anterior tibial slope-modifying osteotomies affect the biomechanics of the sMCL. After an extensive ACWHTO, patients may develop a medial or anteromedial instability, while an AOWHTO may overconstrain the medial compartment.

Can athletic footwear design features reduce anterior cruciate ligament forces during single-leg landing in young females?

Can athletic footwear design features reduce anterior cruciate ligament forces during single-leg landing in young females?

Effect of changes in motor skill induced by educational video program to decrease lower-limb joint load during cutting maneuvers: based on musculoskeletal modeling

BackgroundThis study investigated the effects of changes in motor skills from an educational video program on the kinematic and kinetic variables of the lower extremity joints and knee ligament load.MethodsTwenty male participants (age: 22.2 ± 2.60 y; height: 1.70 ± 6.2 m; weight: 65.4 ± 7.01 kg; BMI: 23.32 ± 2.49 \\documentclass[12pt]{minimal} \\usepackage{amsmath} \\usepackage{wasysym} \\usepackage{amsfonts} \\usepackage{amssymb} \\usepackage{amsbsy} \\usepackage{mathrsfs} \\usepackage{upgreek} \\setlength{\\oddsidemargin}{-69pt} \\begin{document}$$kg/{m}^{2}$$\\end{document}) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their foot on the force plate, and perform the cutting maneuver on the left. The educational video program for cutting maneuvers consisted of preparatory posture, foot landing orientation, gaze and trunk directions, soft landing, and eversion angle. The measured variables were the angle, angular velocity of lower extremity joints, ground reaction force (GRF), moment, and anterior cruciate ligament (ACL) and medial collateral ligament (MCL) forces through musculoskeletal modeling.ResultsAfter the video feedback, the hip joint angles increased in flexion, abduction, and external rotation (p < 0.05), and the angular velocity increased in extension (p < 0.05). The ankle joint angles increased in dorsiflexion (p < 0.05), and the angular velocity decreased in dorsiflexion (p < 0.05) but increased in abduction (p < 0.05). The GRF increased in the anterior-posterior and medial-lateral directions and decreased vertically (p < 0.05). The hip joint moments decreased in extension and external rotation (p < 0.05) but increased in adduction (p < 0.05). The knee joint moments were decreased in extension, adduction, and external rotation (p < 0.05). The abduction moment of the ankle joint decreased (p < 0.001). There were differences in the support zone corresponding to 64‒87% of the hip frontal moment (p < 0.001) and 32‒100% of the hip horizontal moment (p < 0.001) and differences corresponding to 32‒100% of the knee frontal moment and 21‒100% of the knee horizontal moment (p < 0.001). The GRF varied in the support zone at 44‒95% in the medial-lateral direction and at 17‒43% and 73‒100% in the vertical direction (p < 0.001).ConclusionsInjury prevention feedback reduced the load on the lower extremity joints during cutting maneuvers, which reduced the knee ligament load, mainly on the MCL.

Predicting Forces in the Components of the Human Upper Limb through Multibody Dynamics and Optimization Techniques

Abstract An accurate model of the human upper limb is crucial for various applications, including prosthetic development, optimizing ergonomics, and rehabilitation. The novelty of this research is to obtain a model that predicts the forces of muscles, ligaments, and joint reactions under any loading conditions, thereby enabling the prediction of musculoskeletal forces during different daily activities. For this, a multibody three-dimensional dynamic model of the human upper limb is presented to study the upper limb musculoskeletal system. The model comprises 35 muscle elements, 11 ligaments, and 7 joints. Thirty equations of motion with 73 unknowns were obtained using Newton’s second law of motion. The Ariel Performance Analysis System (APAS) was utilized to record and analyze the motion of 16 bony landmarks using 8 digital video cameras with a sampling rate of 100 frames per second. The genetic algorithm (GA) and particle swarm optimization (PSO) are used to solve the redundant force problem of the model. The GA and PSO are implemented with two distinct objective functions; the first is the sum of the squared muscles’ stresses. The second one is the sum of the muscles’ energy consumption. The model was validated through EMG recordings of eight superficial muscles and with the available data in the literature. The results show that the inclusion of the ligaments at the GH and elbow joints in addition to the trapezoid and conoid ligaments in the model led to a more precise prediction of the muscles’ force. The PSO shows more accuracy and smoothness of the predicted muscles’ force, despite the GA taking more running time and requiring significant memory resources. The model also revealed that there is no great difference in the predicted muscles’ force when using any of the two cost functions.

Anterior Cruciate Ligament Force and Strain in Males and Females during Anticipated and Unanticipated Side-Stepping

Females have a greater number of Anterior Cruciate Ligament (ACL) injuries per activity hours than males. The cause of this injury rate is speculated to be an increased strain on the ACL in performing a side-stepping manoeuvre. The purpose of this study was to determine the magnitude of ACL force and strain and the knee angle at initial foot contact during anticipated and unanticipated side-stepping. 12 male and 12 female, young, healthy, college-age, athletes were recruited for this study. 3D kinematics and kinetics were collected in each of anticipated and unanticipated conditions. A computational musculo-skeletal model was used to estimate the ACL force and strain. No differences were found between males and females in any of the ACL or knee angle parameters (P&gt;0.05). However, there was a significant difference in ACL force and strain between anticipated and unanticipated side-stepping conditions with unanticipated force and strain greater than in the anticipated condition (P&lt;0.05). These results support previous evidence that athletes may be at greater risk of injury during sidestepping tasks where planning time is reduced due to greater elongation of the ACL. Future research should focus upon investigating tasks to mitigate the high-risk strategies athletes use during unanticipated sports tasks.

Pulsed lavage is associated with better quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA) compared to syringe lavage in vitro; however, clinical data are missing: A systematic review.

The purpose of this systematic review is to analyse the available literature to ascertain the optimal method of bone preparation to improve the quality of bone-cement-implant interface with either pulsed lavage or syringe lavage in both total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKA). A comprehensive search was conducted across MEDLINE, Scopus and Embase databases until July 2023. Both inclusion and exclusion criteria were clearly stated and used to identify all the published studies. Subsequent screening throughout the title, abstract and full text was made, followed by complete critical appraisal and data extraction. This sequential process was performed by two reviewers independently and summarised following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines). A quality assessment of the systematic review was performed according to the Quality Appraisal for Cadaveric Studies scale (QUACS), reaching a quality level ranging from 69% to 85%. A total of 10 articles, out of 47, nine biomechanical cadaveric studies and one human clinical study were analysed. A total of 196 UKA tibial components, 74 patellar components, 36 TKA tibial components and 24 UKA femoral components were retrieved, and a high level of heterogeneity resulted overall. The pulsed lavage group showed better cement penetration and higher pull-out force than the syringe lavage group; a higher interface temperature was also found in the pulsed lavage group. No differences were found regarding tension ligament forces between the groups. Our systematic review suggests that pulsed lavage is superior to syringe lavage in terms of the quality of bone-cement-implant interface in knee arthroplasties (TKA/UKA). However, translation of these results from cadaveric studies to individual clinical settings may be hazardous; therefore, clinical in vivo prospective studies are highly needed. PROSPERO CRD number CRD42023432399. Level III.

Impact of Structural Compliance of a Six Degree of Freedom Joint Simulator on Virtual Ligament Force Calculation in Total Knee Endoprosthesis Testing.

The AMTI VIVO™ six degree of freedom joint simulator allows reproducible preclinical testing of joint endoprostheses under specific kinematic and loading conditions. When testing total knee endoprosthesis, the articulating femoral and tibial components are each mounted on an actuator with two and four degrees of freedom, respectively. To approximate realistic physiological conditions with respect to soft tissues, the joint simulator features an integrated virtual ligament model that calculates the restoring forces of the ligament apparatus to be applied by the actuators. During joint motion, the locations of the ligament insertion points are calculated depending on both actuators' coordinates. In the present study, we demonstrate that unintended elastic deformations of the actuators due to the specifically high contact forces in the artificial knee joint have a considerable impact on the calculated ligament forces. This study aims to investigate the effect of this structural compliance on experimental results. While the built-in algorithm for calculating the ligament forces cannot be altered by the user, a reduction of the ligament force deviations due to the elastic deformations could be achieved by preloading the articulating implant components in the reference configuration. As a proof of concept, a knee flexion motion with varying ligament conditions was simulated on the VIVO simulator and compared to data derived from a musculoskeletal multibody model of a total knee endoprosthesis.

Posterior tibial slope influences joint mechanics and soft tissue loading after total knee arthroplasty.

As a solution to restore knee function and reduce pain, the demand for Total Knee Arthroplasty (TKA) has dramatically increased in recent decades. The high rates of dissatisfaction and revision makes it crucially important to understand the relationships between surgical factors and post-surgery knee performance. Tibial implant alignment in the sagittal plane (i.e., posterior tibia slope, PTS) is thought to play a key role in quadriceps muscle forces and contact conditions of the joint, but the underlying mechanisms and potential consequences are poorly understood. To address this biomechanical challenge, we developed a subject-specific musculoskeletal model based on the bone anatomy and precise implantation data provided within the CAMS-Knee datasets. Using the novel COMAK algorithm that concurrently optimizes joint kinematics, together with contact mechanics, and muscle and ligament forces, enabled highly accurate estimations of the knee joint biomechanics (RMSE <0.16 BW of joint contact force) throughout level walking and squatting. Once confirmed for accuracy, this baseline modelling framework was then used to systematically explore the influence of PTS on knee joint biomechanics. Our results indicate that PTS can greatly influence tibio-femoral translations (mainly in the anterior-posterior direction), while also suggesting an elevated risk of patellar mal-tracking and instability. Importantly, however, an increased PTS was found to reduce the maximum tibio-femoral contact force and improve efficiency of the quadriceps muscles, while also reducing the patellofemoral contact force (by approximately 1.5% for each additional degree of PTS during walking). This study presents valuable findings regarding the impact of PTS variations on the biomechanics of the TKA joint and thereby provides potential guidance for surgically optimizing implant alignment in the sagittal plane, tailored to the implant design and the individual deficits of each patient.

Contribution of Soft Tissue Passive Forces in Thumb Carpometacarpal Joint Distraction.

Thumb carpometacarpal joint space changes when the surrounding soft tissues including the capsule, ligaments, and tendons are stretched or pulled away. When at rest, joint forces originate from passive contraction of muscles and the involvement of joint capsule and ligaments. Previous biomechanical models of hand and finger joints have mostly focused on the assessment of joint properties when muscles were active. This study aims to present an experimental-numerical biomechanical model of thumb carpometacarpal joint to explore the contribution of tendons, ligaments, and other soft tissues in the passive forces during distraction. Five fresh cadaveric specimens were tested using a distractor device to measure the applied forces upon gradual distraction of the intact joint. The subsequent step involved inserting a minuscule sensor into the joint capsule through a small incision, while preserving the integrity of tendons and ligaments, in order to accurately measure the fundamental intra-articular forces. A numerical model was also used to calculate the passive forces of tendons and ligaments. Before the separation of bones, the forces exerted by tendons and ligaments were relatively small compared to the capsule force, which accounted for approximately 92% of the total applied force. Contribution of tendons and ligaments, however, increased by further distraction. The passive force contribution by tendons at 2-mm distraction was determined less than 11%, whereas it reached up to 74% for the ligaments. The present study demonstrated that the ligament-capsule complex plays significant contribution in passive forces of thumb carpometacarpal joint during distraction.

In Vivo Kinematics and Cruciate Ligament Tension Are Not Restored to Normal After Bicruciate-Preserving Arthroplasty

BackgroundWhether cruciate ligament forces in cruciate-preserving designs, such as unicompartmental knee arthroplasty (UKA) or bi-cruciate-retaining total knee arthroplasty (BCR-TKA), differ from those in normal knees remains unknown. The purpose of this study was to compare the in vivo kinematics and cruciate ligament force in knees before and after UKA or BCR-TKA to those in normal knees during high-flexion activity. MethodsOverall, twenty normal knees, 17 knees with medial UKA, and 15 knees with BCR-TKA were fluoroscopically examined while performing a squatting activity. A 2-dimensional or 3-dimensional registration technique was employed to measure tibio-femoral kinematics. Ligament strains and tensions in the anteromedial bundle of the anterior cruciate ligament and posterolateral bundle of the anterior cruciate ligament and the anterolateral bundle of the posterior cruciate ligament (aPCL) and posteromedial bundle of the posterior cruciate ligament (pPCL) during knee flexion were analyzed. ResultsTension in both bundles of the anterior cruciate ligament decreased with flexion. At 60° of flexion, anteromedial bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. At 30° of flexion, posterolateral bundle of the anterior cruciate ligament tension in postoperative UKA knees was greater than that in normal knees. On the other hand, aPCL and pPCL tensions increased with flexion. From 40 to 110° of flexion, the postoperative aPCL tension in UKA knees was greater than that in normal knees. At 110° of flexion, the preoperative pPCL tension in UKA knees was greater than that in normal knees. In addition, the postoperative pPCL tension in UKA knees was larger than that in normal knees beyond 20° of flexion. Furthermore, the pPCL tension of postoperative BCR-TKA knees was larger than that in normal knees from 20 to 50° and beyond 90° of flexion. ConclusionsThe cruciate ligament tensions, especially posterior cruciate ligament tension in knees after UKA, were greater than those in the normal knees. Surgeons performing bi-cruciat-preserving knee arthroplasties should therefore balance cruciate ligament tension more carefully in flexion and extension.

The effects of knee ligament load using simulated hip abductor and hamstring muscle strengthening during cutting maneuver.

This study aimed to analyze knee ligament of load and joint moment to simulate the strengthening of the hip abductor and hamstring muscles using musculoskeletal modeling, thereby contributing to decrease of knee ligament load. Forty participants (age: 21.85 ± 1.90 years; height: 1.76 ± 0.06 m; body mass: 68.5 ± 7.06 kg) were instructed to run at 4.5 ± 0.2 m/s from a 5 m distance posterior to the force plate, land their feet on the force plate, and perform the cutting maneuver on the left. In the musculoskeletal modeling, the hip abductor and hamstring muscles were targeted to construct a model with a 30% increase in the contraction force of the hip abductor, hamstring, and both 2 muscles. The variables were the ligament force and knee joint moment. One-way repeated measure ANOVA and Bonferroni test were used to compare the abductor/hamstring, abductor, hamstring and control models. There were significant differences in anterior bundle of the anterior cruciate ligament (ACL) (P = .001), inferior bundle of the superficial layer of the medial collateral ligament (MCL) (P = .016), and posterior bundle of the superficial layer of the MCL (P = .022) force. The post hoc showed that the hamstring model had lower anterior bundle of the ACL and inferior bundle of the superficial layer of the MCL than the abductor/hamstring and abductor models (P < .05) and lower posterior bundle of the superficial layer of the MCL than the abductor and control models (P < .05). There was a significant difference in the adduction (P = .028) and internal rotation moments (P = .014). The post hoc showed that both moments were lower in the hamstring model than in the other models (P < .05). The hamstring strengthening may contribute significantly to preventing ACL or MCL injury by reducing knee ligament load.

Comparison of knee kinematics and ligament forces in single and multi-radius cruciate-retaining total knee arthroplasty: A computer simulation study

BackgroundThe single-radius design in total knee arthroplasty has been designed to develop a more fixed flexion–extension axis without mid-flexion instability compared with the multi-radius design. It remains unclear whether differences between the multi-radius and single-radius designs can affect kinematics and collateral ligament forces. This study aimed to simulate knee kinematics and kinetics between single-radius and multi-radius models using a musculoskeletal computer model. MethodsThe single-radius and multi-radius femoral components were virtually implanted in a computer simulation using the same tibial insert. The effects of implant design on kinematics and medial collateral ligament forces during squatting and gait activities were analyzed. ResultsDuring squatting, the multi-radius model exhibited paradoxical anterior translation on both the medial and lateral flexion facet center where peak anterior translation was 2.4 mm for medial flexion facet center and 2.2 mm for the lateral flexion facet center, while the peak anterior translation of the single-radius model was less than 1 mm at early flexion. A rapid decrease in medial collateral ligament tension was observed in the early flexion phase in the multi-radius model, which occurred simultaneously with paradoxical anterior translation, whereas the relatively constant medial collateral ligament tension was observed in the single-radius model. During gait activity, the single-radius model exhibited a more posterior position than the multi-radius model. ConclusionThese suggest that abrupt changes in the medial collateral ligament force influence anterior sliding of the femur, and that the single-radius design is a reasonable choice for prevention of mid-flexion instability.

Numerical simulations of the effect of lateral malleolus fracture malunion on ankle biomechanics: Different offset directions and offsets

IntroductionAnkle fractures account for approximately 10 % of all fractures. Approximately 5–68 % of patients with ankle fractures may suffer from malunion. Besides, suboptimal reduction of fracture fragments can affect the biomechanics of the ankle joint, ultimately leading to damage to the ankle joint. However, there are certain controversies over the conclusion of previous cadaveric studies. MethodsIn this study, a three-dimensional model of the ankle joint was established based on CT image data. In addition, the effects of backward offset (1–2 mm) and outward offset (0.5–1 mm) of the fracture fragment on the contact area, contact pressure, and ligament force of the ankle joint were investigated via the finite element method. Moreover, lateral malleolus fracture malunion in five ankle positions (neutral, 10° dorsiflexion, 10° plantarflexion, 20° dorsiflexion, and 20° plantarflexion) was investigated. ResultsThis model predicted an overall increased contact area in the ankle joint in patients with lateral malleolus fracture malunion compared with the normal ankle joint. The results demonstrated that the outward offset had a more significant effect than the backward one. The larger the dorsiflexion-plantarflexion angle, the more pronounced the effect of malunion. Further, an outward offset can cause the fibula to lose its function. ConclusionPost-traumatic osteoarthritis occurs under the action of unaccustomed cartilage forces due to altered tibial talar joint contact patterns, rather than increased contact pressure reported in previous studies. Malunion leads to an increase or decrease in force on the affected ligament, while the cause of malunion can be envisioned based on a decrease in the force on the ligaments.

The Impact of Tendon Lengthening Following Achilles Tendon Repair on Foot Kinetics, a Finite Element Analysis

Category: Midfoot/Forefoot; Hindfoot Introduction/Purpose: Triceps surae muscle force is transferred through the Achilles tendon to the calcaneus and from the calcaneus to the plantar fascia and then to the metatarsal heads and the toes which exert force on the ground. Achilles tendon ruptures occur in tendons that have reached a critical point of intrasubstance degeneration. The Achilles tendon almost always heals but frequently lengthens during the healing process, leading to an alteration in the triceps surae force production profile. We hypothesized that Achilles tendon overlengthening has implications not only for force generation but likely has many other impacts throughout the foot. The goal of this work was to evaluate the effect of a lengthened Achilles tendon following tendon repair on the kinetics of the foot. Methods: A validated finite element model of the foot was used to compare foot biomechanics between the foot with a functional and non-functional Achilles tendon. The model of the foot constructed from CT scan images of a female cadaveric foot weighing 60 kg included all 28 bones, 72 ligaments, cartilage, and an encapsulating soft tissue. The model was loaded with 0.5 body weight applied at the center of mass and 0.25 body weight applied to the Achilles tendon simulating quiet stance. The tendon forces were applied using force vectors in the direction of their lines of action. The foot with a non-functional Achilles tendon was created by unloading the Achilles tendon since triceps surae muscle shortening due to tendon lengthening significantly decreases force production. The force transmitted through the joints, force in the ligaments, and plantar pressure were determined for both the foot with a functional and non-functional Achilles tendon. Results: We found that the force transmitted through all the joints decreased when the Achilles tendon force was removed (Figure 1a). In addition, removing the Achilles tendon decreased the force within the plantar fascia, long and short plantar ligaments, and deep deltoid ligament, while it increased the force within the spring and superficial deltoid ligaments (Figure 1b). The plantar fascia experienced the greatest reduction in ligament force after unloading of the Achilles tendon (from 93 N to 26 N). Moreover, the maximum plantar pressure in the heel fat pad increased from 164 kPa to 231 kPa when the Achilles tendon was removed. Conclusion: The varying changes in the force in the ligaments and joints due to Achilles lengthening suggest that Achilles tendon rupture with sequent healing with overlengthening can alter the force distribution throughout the entire foot. A major implication of this work is that in treating Achilles ruptures, an extended period of protection with heel wedges beyond the customary six weeks may be needed to prevent over lengthening of the Achilles. Moreover, this study supports the efficiency of surgical lengthening of the Achilles in the treatment of diabetic forefoot foot ulcers by shifting the plantar pressure towards the calcaneus.

The Role of the Plantar Fascia in Supporting the Arch in Flatfoot Deformity

Category: Hindfoot; Midfoot/Forefoot Introduction/Purpose: The osseous structure of the foot has been described as an arch-like triangular structure or truss where the plantar fascia (PF) functions as the tensile element, maintaining the overall length of the arch. The importance of the PF in maintaining the arch has likely been underestimated because only minor abnormalities in its structure are seen on MRI studies in patients with flatfoot deformity. However, the importance of a ligament in preventing deformity may not be correlated with its attenuation seen on MRI. We hypothesized that the degenerative elongation of the plantar fascia would be a necessary precursor of arch collapse. The goal of this study was to evaluate the role of the plantar fascia in arch stability in flatfoot deformity. Methods: We used a validated finite element model of the foot reconstructed from CT scan of a female cadaveric foot weighing 60 kg. The model included 28 bones, 72 ligaments, cartilage, and an encapsulating soft tissue. The flatfoot model was created by simulated transection of the ligaments and unloading of the posterior tibial tendon. The model was used to assess the impact of isolated PF failure on the development of flatfoot deformity, evaluate the capability of the PF when reconstructed to restore foot alignment, and determine the amount of progressive strain that constitutes failure for each ligament. Foot alignment angles were used to evaluate the foot alignment. For comparison, the angles were also evaluated for other ligament tears. The impact of PF failure on force changes in the remaining ligaments was also investigated by quantifying ligament force changes during simulated PF cutting in the foot model. Results: When compared to the intact and flatfoot models, we found that the individual release of the PF cannot cause deformity (Figure 1). However, it significantly increased the force in the long (142%) and short plantar (156%), deltoid (45%), and spring ligaments (60%), potentially putting the foot at risk of arch instability over time. Moreover, we found that the PF was the structure most able to restore the arch (Figure 1a). The PF was also found to play a secondary role in reducing hindfoot valgus and forefoot abduction deformities (Figures 1b,1c). Moreover, to produce deformity, a considerable amount of attenuation in the spring (strain= 41%) and interosseous talocalcaneal ligament (strain= 27%), but only a small amount in the plantar fascia (strain= 10%) was needed. Conclusion: In comparing normal to flatfoot models of the foot, we found that isolated PF release did not cause arch collapse, but that arch collapse could not occur without elongation of the PF. While the progressive strain in the PF needed to enable arch collapse was small, the PF is a very long ligament, thus even small strain within the PF corresponds to substantial change in overall length of the arch. Chronic degeneration of the PF leading to plantar fasciitis may be an early sign of impending flatfoot deformity.

Ligaments Laxity and Elongation at Injuryin Flexed knees during Lateral Impact Conditions.

The knee is one of the regions of interest for pedestrian safety assessment. Past testing to study knee ligament injuries for pedestrian impact only included knees in full extension and mostly focused on global responses. As the knee flexion angle and the initial ligament laxity may affect the elongation at which ligaments fail, the objectives of this study were (1) to design an experimental protocol to assess the laxity of knee ligaments before measuring their elongation at failure, (2) to apply it in paired knee tests at two flexion angles (10 and 45 degrees). The laxity tests combined strain gauges to measure bone strains near insertions that would result from ligament forces and a custom machine to exercise the knee in all directions. Failure was assessed using a four-point bending setup with additional degrees of freedom on the axial rotation and displacement of the femur. A template was designed to ensure that the two setups used the exact same starting position. The protocol was applied to six pairs of knees which were tested until the failure of all ligaments. In the laxity tests, a higher compliance of the knee was observed at 45 degrees compared to 10 degrees. Minimum lengths associated with the beginning of bone loading were also successfully identified for the collateral ligaments, but the process was less successful for the cruciate ligaments. The failure tests suggested increased elongation and length at failure for the ligaments and their bundles at 45°. This could be consistent with the higher compliance in static test, but the minimum lengths identified on the collaterals did not explain this difference during failure. The results highlight the possible relationship between position, laxity and elongation at failure in a lateral loading and provide a dataset including 3D coordinates of insertions to continue the investigation using a modelling approach. Perspectives are also outlined to improve upon the laxity determination protocol.

Musculoskeletal multibody dynamics investigation for the different medial-lateral installation position of the femoral component in unicompartmental knee arthroplasty

The surgical installation accuracy of the components in unicompartmental knee arthroplasty (UKA) is an important factor affecting the joint function and the implant life. Taking the ratio of the medial-lateral position of the femoral component relative to the tibial insert (a/A) as a parameter, and considering nine installation conditions of the femoral component, this study established the musculoskeletal multibody dynamics models of UKA to simulate the patients' walking gait, and investigated the influences of the medial-lateral installation positions of the femoral component in UKA on the contact force, joint motion and ligament force of the knee joint. The results showed that, with the increase of a/A ratio, the medial contact force of the UKA implant was decreased and the lateral contact force of the cartilage was increased; the varus rotation, external rotation and posterior translation of the knee joint were increased; and the anterior cruciate ligament force, posterior cruciate ligament force and medial collateral ligament force were decreased. The medial-lateral installation positions of the femoral component in UKA had little effect on knee flexion-extension movement and lateral collateral ligament force. When the a/A ratio was less than or equalled to 0.375, the femoral component collided with the tibia. In order to prevent the overload on the medial implant and lateral cartilage, the excessive ligament force, and the collision between the femoral component and the tibia, it is suggested that the a/A ratio should be controlled within the range of 0.427-0.688 when the femoral component is installed in UKA. This study provides a reference for the accurate installation of the femoral component in UKA.

Method for Using IMU-Based Experimental Motion Data in BVH Format for Musculoskeletal Simulations via OpenSim

Biomechanical simulation allows for in silico estimations of biomechanical parameters such as muscle, joint and ligament forces. Experimental kinematic measurements are a prerequisite for musculoskeletal simulations using the inverse kinematics approach. Marker-based optical motion capture systems are frequently used to collect this motion data. As an alternative, IMU-based motion capture systems can be used. These systems allow flexible motion collection without nearly any restriction regarding the environment. However, one limitation with these systems is that there is no universal way to transfer IMU data from arbitrary full-body IMU measurement systems into musculoskeletal simulation software such as OpenSim. Thus, the objective of this study was to enable the transfer of collected motion data, stored as a BVH file, to OpenSim 4.4 to visualize and analyse the motion using musculoskeletal models. By using the concept of virtual markers, the motion saved in the BVH file is transferred to a musculoskeletal model. An experimental study with three participants was conducted to verify our method’s performance. Results show that the present method is capable of (1) transferring body dimensions saved in the BVH file to a generic musculoskeletal model and (2) correctly transferring the motion data saved in the BVH file to a musculoskeletal model in OpenSim 4.4.

Posterior-stabilized versus mid-level constraint polyethylene components in total knee arthroplasty.

Mid-level constraint designs for total knee arthroplasty (TKA) are intended to reduce coronal plane laxity. Our aims were to compare kinematics and ligament forces of the Zimmer Biomet Persona posterior-stabilized (PS) and mid-level designs in the coronal, sagittal, and axial planes under loads simulating clinical exams of the knee in a cadaver model. We performed TKA on eight cadaveric knees and loaded them using a robotic manipulator. We tested both PS and mid-level designs under loads simulating clinical exams via applied varus and valgus moments, internal-external (IE) rotation moments, and anteroposterior forces at 0°, 30°, and 90° of flexion. We measured the resulting tibiofemoral angulations and translations. We also quantified the forces carried by the medial and lateral collateral ligaments (MCL/LCL) via serial sectioning of these structures and use of the principle of superposition. Mid-level inserts reduced varus angulations compared to PS inserts by a median of 0.4°, 0.9°, and 1.5° at 0°, 30°, and 90° of flexion, respectively, and reduced valgus angulations by a median of 0.3°, 1.0°, and 1.2° (p ≤ 0.027 for all comparisons). Mid-level inserts reduced net IE rotations by a median of 5.6°, 14.7°, and 17.5° at 0°, 30°, and 90°, respectively (p = 0.012). Mid-level inserts reduced anterior tibial translation only at 90° of flexion by a median of 3.0 millimetres (p = 0.036). With an applied varus moment, the mid-level insert decreased LCL force compared to the PS insert at all three flexion angles that were tested (p ≤ 0.036). In contrast, with a valgus moment the mid-level insert did not reduce MCL force. With an applied internal rotation moment, the mid-level insert decreased LCL force at 30° and 90° by a median of 25.7 N and 31.7 N, respectively (p = 0.017 and p = 0.012). With an external rotation moment, the mid-level insert decreased MCL force at 30° and 90° by a median of 45.7 N and 20.0 N, respectively (p ≤ 0.017 for all comparisons). With an applied anterior load, MCL and LCL forces showed no differences between the two inserts at 30° and 90° of flexion. The mid-level insert used in this study decreased coronal and axial plane laxities compared to the PS insert, but its stabilizing benefit in the sagittal plane was limited. Both mid-level and PS inserts depended on the MCL to resist anterior loads during a simulated clinical exam of anterior laxity.