Tibial Force Research Articles

Increases in tibial force imbalance but not changes in tibiofemoral laxities are caused by varus-valgus malalignment of the femoral component in kinematically aligned TKA.

The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces)and changes in laxities caused by 2° and 4° of varus-valgus (V-V) malalignment of the femoral component in kinematically aligned total knee arthroplasty (TKA) and use the results to detemine sensitivities to errors in making the distal femoral resections. Because V-V malalignment would introduce the greatest changes in the alignment of the articular surfaces at 0° flexion, the hypotheses were that the greatest increases in tibial force imbalance would occur at 0° flexion, that primarily V-V laxity would significantly change at this flexion angle, and that the tibial force imbalance would increaseand laxities would change in proportion to the degree of V-V malalignment. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced V-V malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured during passive knee flexion-extension between 0° to 120° using a custom tibial force sensor. Eight laxities were measured from 0° to 120° flexion using a six degree-of-freedom load application system. With the tibial component kinematically aligned, the increase in the tibial force imbalance from that of the reference component at 0° of flexion was sensitive to the degree of V-V malalignment of the femoral component. Sensitivities were 54N/deg (medial tibial force increasing > lateral tibial force) (p < 0.0024) and 44N/deg (lateral tibial force increasing > medial tibial force) (p < 0.0077) for varus and valgus malalignments, respectively. Varus-valgus malalignment did not significantly change varus, internal-external rotation, anterior-posterior, and compression-distraction laxities from 0° to 120° flexion. At only 30° of flexion, 4° of varus malalignment increased valgus laxity 1° (p = 0.0014). At 0° flexion, V-V malalignment of the femoral component caused the tibial force imbalance to increase significantly, whereas the laxities were relatively unaffected. Because tibial force imbalance has the potential to adversely affect patient-reported outcomes andsatisfaction, surgeons should strive to limit errors in resecting the distal femoral condyles to within ± 0.5mm which in turn limits the average increase in tibial force imbalance to 68N. Because laxities were generally unaffected, instability resulting from large increases in laxity is not a clinical concern within the ± 4° range tested. Therapeutic, Level II.

Internal-external malalignment of the femoral component in kinematically aligned total knee arthroplasty increases tibial force imbalance but does not change laxities of the tibiofemoral joint.

The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by 2° and4° of internal-external (I-E) malalignment of the femoral component in kinematically aligned total knee arthroplasty. Because I-E malalignment would introduce the greatest changes to the articular surfaces near 90° of flexion, the hypotheses were that the tibial force imbalance would be significantly increased near 90° flexion and that primarily varus-valgus laxity would be affected near 90° flexion. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced I-E malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured from 0° to 120° flexion using a custom tibial force sensor. Bidirectional laxities in four degrees of freedom were measured from 0° to 120° flexion using a custom load application system. Tibial force imbalance increased the greatest at 60° flexion where a regression analysis against the degree of I-E malalignment yielded sensitivities (i.e. slopes) of 30N/° (medial tibial force > lateral tibial force) and 10N/° (lateral tibial force > medial tibial force) for internal and external malalignments, respectively. Valgus laxity increased significantly with the 4° external component with the greatest increase of 1.5° occurring at 90° flexion (p < 0.0001). With the tibial component correctly aligned,I-E malalignment of the femoral componentcaused significantincreases in tibial force imbalance. Minimizing I-E malalignment lowers the increase in thetibial force imbalance. By keeping the resection thickness of each posterior femoral condyle to within ± 0.5 mm of the thickness of the respective posterior region of the femoral component, the increase in imbalance can be effectively limited to 38 N. Generally laxities were unaffected within the ± 4º range tested indicating that instability is not a clinical concern and that manual testing of laxities is not useful to detect I-E malalignment.

Quadriceps force and anterior tibial force occur obviously later than vertical ground reaction force: a simulation study

BackgroundAlthough it is well known that quadriceps force generates anterior tibial force, it has been unclear whether quadriceps force causes great anterior tibial force during the early phase of a landing task. The purpose of the present study was to examine whether the quadriceps force induced great anterior tibial force during the early phase of a landing task.MethodsFourteen young, healthy, female subjects performed a single-leg landing task. Muscle force and anterior tibial force were estimated from motion capture data and synchronized force data from the force plate. One-way repeated measures analysis of variance and the post hoc Bonferroni test were conducted to compare the peak time of the vertical ground reaction force, quadriceps force and anterior tibial force during the single-leg landing. In addition, we examined the contribution of vertical and posterior ground reaction force, knee flexion angle and moment to peak quadriceps force using multiple linear regression.ResultsThe peak times of the estimated quadriceps force (96.0 ± 23.0 ms) and anterior tibial force (111.9 ± 18.9 ms) were significantly later than that of the vertical ground reaction force (63.5 ± 6.8 ms) during the single-leg landing. The peak quadriceps force was positively correlated with the peak anterior tibial force (R = 0.953, P < 0.001). Multiple linear regression analysis showed that the peak knee flexion moment contributed significantly to the peak quadriceps force (R2 = 0.778, P < 0.001).ConclusionThe peak times of the quadriceps force and the anterior tibial force were obviously later than that of the vertical ground reaction force for the female athletes during successful single-leg landings. Studies have reported that the peak time of the vertical ground reaction force was close to the time of anterior cruciate ligament (ACL) disruption in ACL injury cases. It is possible that early contraction of the quadriceps during landing might induce ACL disruption as a result of excessive anterior tibial force in unanticipated situations in ACL injury cases.

Errors in Calculating Anterior-Posterior Tibial Contact Locations in Total Knee Arthroplasty Using Three-Dimensional Model to Two-Dimensional Image Registration in Radiographs: An In Vitro Study of Two Methods.

Knowledge of anterior-posterior (A-P) tibial contact locations provides an objective assessment of the relative motion of the tibia on the femur following total knee arthroplasty (TKA), which can be used to compare the effects of different components, surgical techniques, and alignment goals on knee function in vivo. Both the lowest point method and the penetration method have been used to calculate A-P tibial contact locations using three-dimensional (3D) model to two-dimensional (2D) image registration. The primary objective of this study was to quantify errors in calculating the A-P tibial contact location using the lowest point and penetration methods because the errors in calculating the A-P tibial contact locations using these two methods are unknown. The A-P tibial contact locations were calculated with the two methods and simultaneously measured with a tibial force sensor in ten fresh-frozen cadaveric knee specimens with a TKA. Single-plane radiographs of the knee specimens were acquired at 0 deg, 30 deg, 60 deg, and 90 deg of flexion in neutrally, internally, and externally rotated orientations. While the radiographs were exposed, reference A-P tibial contact locations were simultaneously collected using the tibial force sensor to be compared to the calculated A-P tibial contact locations. The overall root-mean-squared-errors (RMSEs) in the A-P tibial contact location calculated with the lowest point method, the penetration method with penetration, and penetration method without penetration were 5.5 mm, 3.6 mm, and 8.9 mm, respectively. The overall RMSE was lowest for the penetration method with penetration, making it the superior method for calculating A-P tibial contact locations.

Evaluation of the effectiveness of toe board energy-absorbing material for foot, ankle, and lower leg injury reduction

ABSTRACTObjective: Since 2000, numerous improvements have been made to the National Association for Stock Car Auto Racing, Incorporated (NASCAR®) driver restraint system, resulting in improved crash protection for motorsports drivers. Advancements have included seats, head and neck restraints (HNRs), seat belt restraint systems, driver helmets, and others. These enhancements have increased protection for drivers from severe crash loading. Extending protection to the driver's extremities remains challenging. Though the drivers’ legs are well contained for lateral and vertical crashes, they remain largely unrestrained in frontal and frontal oblique crashes.Method: Sled testing was conducted for the evaluation of an energy-absorbing (EA) toe board material to be used as a countermeasure for leg and foot injuries. Testing included baseline rigid toe boards, tests with EA material–covered toe boards, and pretest positioning of the 50th percentile male frontal Hybrid III anthropomorphic test device (ATD) lower extremities. ATD leg and foot instrumentation included foot acceleration and tibia forces and moments.Results: The sled test data were evaluated using established injury criteria for tibial plateau fractures, leg shaft fractures, and calcaneus, talus, ankle, and midfoot fractures.Conclusion: A polyurethane EA foam was found to be effective in limiting axial tibia force and foot accelerations when subjected to frontal impacts using the NASCAR motorsport restraint system.

Kinematically aligned total knee arthroplasty limits high tibial forces, differences in tibial forces between compartments, and abnormal tibial contact kinematics during passive flexion

Following total knee arthroplasty (TKA), high tibial forces, large differences in tibial forces between the medial and lateral compartments, and anterior translation of the contact locations of the femoral component on the tibial component during passive flexion indicate abnormal knee function. Because the goal of kinematically aligned TKA is to restore native knee function without soft tissue release, the objectives were to determine how well kinematically aligned TKA limits high tibial forces, differences in tibial forces between compartments, and anterior translation of the contact locations of the femoral component on the tibial component during passive flexion. Using cruciate retaining components, kinematically aligned TKA was performed on thirteen human cadaveric knee specimens with use of manual instruments without soft tissue release. The tibial forces and tibial contact locations were measured in both the medial and lateral compartments from 0° to 120° of passive flexion using a custom tibial force sensor. The average total tibial force (i.e. sum of medial+lateral) ranged from 5 to 116N. The only significant average differences in tibial force between compartments occurred at 0° of flexion (29N, p=0.0008). The contact locations in both compartments translated posteriorly in all thirteen kinematically aligned TKAs by an average of 14mm (p<0.0001) and 18mm (p<0.0001) in the medial and lateral compartments, respectively, from 0° to 120° of flexion. After kinematically aligned TKA, average total tibial forces due to the soft tissue restraints were limited to 116N, average differences in tibial forces between compartments were limited to 29N, and a net posterior translation of the tibial contact locations was observed in all kinematically aligned TKAs during passive flexion from 0° to 120°, which are similar to what has been measured previously in native knees. While confirmation in vivo is warranted, these findings give surgeons who perform kinematically aligned TKA confidence that the alignment method and surgical technique limit high tibial forces, differences in tibial forces between compartments, and anterior translation of the tibial contact locations during passive flexion.

ACL Force and Knee Kinematics After Posterior Tibial Slope-Reducing Osteotomy

Objectives:Although many patients have a good outcome after anterior cruciate ligament (ACL) reconstruction, a number of individuals will experience continued instability. There is evidence that the posterior tibial slope (PTS) of the tibial plateau may play a role in ACL injury. Theoretically, under tibiofemoral compression (TFC) a steeper PTS would induce greater anterior tibial translation, thus increasing ACL force. The objective of this study was to evaluate if a PTS-reducing osteotomy would reduce ACL force.Methods:Eleven fresh-frozen cadaveric knees were tested (mean age 27 years). The femoral attachment of the ACL was mechanically isolated and attached to a custom designed load cell to measure resultant ACL force. Using a six-degree-of-freedom robot, each knee was flexed from 0°-50° while maintaining 200N TFC combined with the following loading conditions: 45N anterior tibial force (AF), 5Nm valgus moment (VM), 2Nm internal tibial torque (IT), and all loads combined. After testing the normal knee, a 10° PTS-reducing osteotomy was performed. An anterior wedge of bone was removed distal to the plateau, which was then lowered and secured with external fixators. The knee was then re-tested. A paired t-test was used to analyze statistical significance between normal and osteotomized knees every 5° of flexion.Results:Osteotomy reduced PTS by 10.0° ± 0.2° (mean ± SD), resulting in a relative change in tibiofemoral position at full extension, in effect hyperextending the knee 9.4°±1.9° and shifting the tibia 7.9 ± 1.6 mm posteriorly, 3.2° ± 2.3° internally, and 3.2° ± 1.5° into valgus. Compared to the normal knee, the osteotomy significantly reduced resultant ACL force when loaded with 200N TFC + 45N AF and 200N TFC + 5Nm VM. However, ACL force was not reduced under 200N TFC + 2Nm IT or 200N TFC + all loading conditions combined (Figure 1).Conclusion:Our data shows in the absence of applied internal torque, the posterior tibial slope-reducing osteotomy altered knee kinematics which corresponded to a significant reduction in ACL force. However, this protective effect was lost when internal torque was applied.

Repeatability testing of a new Hybrid III 6-year-old ATD lower extremity

ABSTRACTObjective: Vehicle safety is improving, thus decreasing the number of life-threatening injuries and increasing the need for research in other areas of the body. The current child anthropomorphic test device (ATD) does not have the capabilities or instrumentation to measure many of the potential interactions between the lower extremity and the vehicle interior. A prototype Hybrid III 6-year-old ATD lower extremity (ATD-LE) was developed and contains a tibia load cell and a more biofidelic ankle. The repeatability of the device has not yet been assessed; thus, the objective was to evaluate the repeatability of the ATD-LE. Additionally, a dynamic assessment was conducted to quantify injury threshold values.Methods: A pneumatic ram impactor was used at 2 velocities to evaluate repeatability. The ATD-LE was fixed to a table and impacted on the plantar aspect of the forefoot. Three repeated trials at 1.3 and 2.3 m/s without shoes and 2.3 m/s with shoes were conducted. The consistency of tibia force (N), bending moment (Nm), ankle range of motion (ROM, °), and stiffness (Nm/°) were quantified. A dynamic assessment using knee bolster airbag (KBA) tests was also conducted. The ATD-LE was positioned to mimic 3 worst-case scenarios: toes touching the mid-dashboard, touching the lower dashboard, and flat on the floor prior to airbag deployment. The impact responses in the femur and tibia were directly collected and compared with published injury threshold values.Results: Ram impact testing indicated primarily excellent repeatability for the variables tested. For all 3 conditions the coefficients of variance (CV) were as follows: tibia force, 1.9–2.7%; tibia moment, 1.0–2.2%; ROM, 1.3–1.4%; ankle stiffness, 4.8–15.6%. The shoe-on condition resulted in a 25% reduction in tibia force and a 56% reduction in tibia bending moment. The KBA tests indicate that the highest injury risk may be when the toes touch the lower dashboard, due to the high bending moments recorded in the tibia at 76.2 Nm, which was above the injury threshold.Conclusions: The above work has demonstrated that the repeatability of the ATD-LE was excellent for tibia force, bending moment, and ankle ROM. The ATD-LE has the ability to provide new information to engineers and researchers due to its ability to directly evaluate the crash response of the ankle and leg. New information on injury mechanism and injury tolerance may lead to injury reduction and thus help advance the safety of children.

The influence of posterior medial meniscocapsular lesions on tibiofemoral joint laxity with ACL deficiency and reconstruction

Introduction:Injury to the posterior medial meniscocapsular junction (the ‘ramp’ lesion) occurs at the time of anterior cruciate ligament (ACL) rupture (10-24% of cases); however there is a lack of objective evidence investigating how this affects knee kinematics. It is often missed when viewed arthroscopically from the front of the medial compartment as it can only be seen with the arthroscope in the posteromedial recess.Objectives:To investigate the biomechanical impact of the ‘ramp lesion’ on the ACL deficient and ACL reconstructed knee and the impact of suture repair of the lesion on the same knee states.Methods:Nine fresh frozen cadaveric knees were mounted in a 6 degrees of freedom rig where knee kinematics were recorded at 10° intervals from 0°-100° using an optical tracking system. Measurements were recorded using the following loading conditions: 90 N anterior and posterior tibial forces, 5 Nm internal and external tibial rotation torques, and a combined 90 N anterior tibial force and 5 Nm external tibial rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following order: (1) intact, (2) ACL deficient, (3) ACL deficient + posterior meniscocapsule sectioned, (4) ACL deficient + posterior meniscocapsule repaired, (5) ACL patellar tendon reconstruction with posterior meniscocapsule repair and (6) ACL reconstructed + capsular lesion re-created. Statistical analysis was undertaken using repeated-measures ANOVA and post-hoc paired t-tests with Bonferonni correction.Results:Tibial anterior translation and external rotational laxities were both significantly increased compared to the ACL deficient knee following posterior meniscocapsular sectioning (P < 0.05). These were both restored following ACL reconstruction and meniscocapsular lesion repair (P > 0.05). Significant changes in anterior tibial translation between the different knee states were identified with the Rolimeter, indicating these changes are clinically detectable (P < 0.05).Conclusion:Anterior and external rotational laxities were significantly increased after mimicking the ‘ramp lesion’ by sectioning of the posteromedial meniscocapsular junction in an ACL-deficient knee. These were not restored after ACL reconstruction alone but were restored with ACL reconstruction combined with posterior meniscocapsular repair. Tibial anterior translation changes were clinically detectable by use of the Rolimeter. This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage but also adding avoidable extra strain on an ACL graft, which may yield.

Effects of dietary supplementation of inorganic, organic or nano zinc forms on performance, eggshell quality, and bone characteristics in laying hens

Abstract This study was conducted to evaluate the efficiency of dietary zinc forms and dosages on egg production performance, egg quality, and bone characteristics in laying hens. Forty-two-week-old, 144 Lohmann LSL-Lite laying hens were allocated to 12 experimental groups in a 4 (forms) × 3 (dosages) factorial arrangement. Four zinc forms including zinc-sulphate and zinc-oxide as inorganic forms, zinc-glycine as organic form and nano zinc-oxide powder as nano form at different dosages (50, 75 and 100 mg per kg diet) were tested. Compared to the inorganic (zinc-sulphate) form, the zinc-glycine supplementation significantly depressed the egg weight, egg mass and feed conversion ratio. The eggshell thickness was significantly decreased by supplementation with nano zinc-oxide. The shear force of tibia was significantly decreased by zinc-glycine or nano zinc-oxide supplemented in the diet when compared to inorganic forms of zinc. On the other hand, the dietary 50 mg/kg dosage of zinc was sufficient for optimum performance and the dietary 75 mg/kg dosage of zinc significantly improved shear force of tibia in laying hens. Tibia zinc content increased with the dietary 100 mg/kg dosage of zinc. The interactions between zinc forms and dosages had a significant effect on egg weight, feed intake, feed conversion ratio, eggshell thickness, shear force and shear stress of bone, and tibia calcium concentration. The highest egg weight and the lowest eggshell thickness were observed for the group fed with nano Zn-oxide at 100 mg/kg in the diet. These results showed that nano zinc form supplementation negatively affects the eggshell thickness and bone mechanical properties. The zinc in nano form may not be suggested for feeding laying hens, but other forms of zinc could be used safely in layer diets.

Characterization and Correction of Errors in Computing Contact Location Between Curved Articular Surfaces: Application to Total Knee Arthroplasty.

In total knee arthroplasty (TKA), one common metric used to evaluate innovations in component designs, methods of component alignment, and surgical techniques aimed at decreasing the high rate of patient-reported dissatisfaction is tibiofemoral contact kinematics. Tibiofemoral contact kinematics are determined based on the movement of the contact locations in the medial and lateral compartments of the tibia during knee flexion. A tibial force sensor is a useful instrument to determine the contact locations, because it can simultaneously determine contact forces and contact locations. Previous reports of tibial force sensors have neither characterized nor corrected errors in the computed contact location (i.e., center of pressure) between the femoral and tibial components in TKA that, based on a static analysis, are caused by the curved articular surface of the tibial component. The objectives were to experimentally characterize these errors and to develop and validate an error correction algorithm. The errors were characterized by calculating the difference between the errors in the computed contact locations when forces were applied normal to the tibial articular surface and those when forces were applied normal to the tibial baseplate. The algorithm generated error correction functions to minimize these errors and was validated by determining how much the error correction functions reduced the errors in the computed contact location caused by the curved articular surface. The curved articular surface primarily caused bias (i.e., average or systematic error) which ranged from 1.0 to 2.7 mm in regions of high curvature. The error correction functions reduced the bias in these regions to negligible levels ranging from 0.0 to 0.6 mm (p < 0.001). Bias in the computed contact locations caused by the curved articular surface of the tibial component as small as 1 mm needs to be accounted for, because it might inflate the computed internal-external rotation and anterior-posterior translation of femur on the tibia leading to false identifications of clinically undesirable contact kinematics (e.g., internal rotation and anterior translation during flexion). Our novel error correction algorithm is an effective method to account for this bias to more accurately compute contact kinematics.

An Improved Tibial Force Sensor to Compute Contact Forces and Contact Locations In Vitro After Total Knee Arthroplasty.

Contact force imbalance and contact kinematics (i.e., motion of the contact location in each compartment during flexion) of the tibiofemoral joint are both important predictors of a patient's outcome following total knee arthroplasty (TKA). Previous tibial force sensors have limitations in that they either did not determine contact forces and contact locations independently in the medial and lateral compartments or only did so within restricted areas of the tibial insert, which prevented them from thoroughly evaluating contact force imbalance and contact kinematics in vitro. Accordingly, the primary objective of this study was to present the design and verification of an improved tibial force sensor which overcomes these limitations. The improved tibial force sensor consists of a modified tibial baseplate which houses independent medial and lateral arrays of three custom tension-compression transducers each. This sensor is interchangeable with a standard tibial component because it accommodates tibial articular surface inserts with a range of sizes and thicknesses. This sensor was verified by applying known loads at known locations over the entire surface of the tibial insert to determine the errors in the computed contact force and contact location in each compartment. The root-mean-square errors (RMSEs) in contact force are ≤ 6.1 N which is 1.4% of the 450 N full-scale output. The RMSEs in contact location are ≤ 1.6 mm. This improved tibial force sensor overcomes the limitations of the previous sensors and therefore should be useful for in vitro evaluation of new alignment goals, new surgical techniques, and new component designs in TKA.

Loading of the medial meniscus in the ACL deficient knee: A multibody computational study

The menisci of the knee reduce tibiofemoral contact pressures and aid in knee lubrication and nourishment. Meniscal injury occurs in half of knees sustaining anterior cruciate ligament injury and the vast majority of tears in the medial meniscus transpire in the posterior horn region. In this study, computational multibody models of the knee were derived from medical images and passive leg motion for two female subjects. The models were validated against experimental measures available in the literature and then used to evaluate medial meniscus contact force and internal hoop tension. The models predicted that the loss of anterior cruciate ligament (ACL) constraint increased contact and hoop forces in the medial menisci by a factor of 4 when a 100N anterior tibial force was applied. Contact forces were concentrated in the posterior horn and hoop forces were also greater in this region. No differences were found in contact or hoop tension between the intact and ACL deficient (ACLd) knees when only a 5Nm external tibial torque was applied about the long axis of the tibia. Combining a 100N anterior tibial force and a 5Nm external tibial torque increased posterior horn contact and hoop forces, even in the intact knee. The results of this study show that the posterior horn region of the medial meniscus experiences higher contact forces and hoop tension, making this region more susceptible to injury, especially with the loss of anterior tibia motion constraint provided by the ACL. The contribution of the dMCL in constraining posterior medial meniscus motion, at the cost of higher posterior horn hoop tension, is also demonstrated.

Biomechanical comparison of graft structures in anterior cruciate ligament reconstruction

PurposeDouble-bundle (DB) anterior cruciate ligament (ACL) reconstruction may offer kinematic restoration superior to anatomic single bundle (SB), but it remains technically challenging. The femoral attachment site has the most effect on ACL graft isometry, so a simplified three-socket (3S) construct which still uses two sockets to cover the femoral ACL attachment is attractive. It was hypothesised that ACL reconstruction using three- and four-socket techniques would more closely restore native knee kinematics compared to anatomic two-socket (SB) surgery.MethodsNine cadaveric knees were used to evaluate the kinematics of ACL-intact, ACL-deficient, anatomic SB, three-socket, and DB arthroscopic ACL reconstructions. Suspensory fixation was used, and grafts were tensioned to match the anterior draw of the intact knee at 20°. A six-degree-of-freedom robotic system measured knee laxity under 90 N anterior tibial force and rotational laxity under 5 N-m torque. Combined moments were applied to simulate the pivot-shift subluxation: 4 N-m internal rotation and 8 N-m valgus.ResultsSignificant differences between reconstructions were not found during anterior tibial loading, apart from SB being more lax than DB at 60° flexion. All reconstructions produced comparable laxity to the intact state, apart from SB at 60°. Significant differences between reconstructions were not found at any flexion angle during tibial internal/external applied torques. Under combined loading, DB produced significantly less laxity than SB constructs apart from anterior tibial translation at 0° and internal rotation at 45°. 3S and DB were comparable to the native knee throughout.ConclusionAlthough 3S restored laxities to a similar extent to DB, significant superiority over SB surgery was not observed. Although statistically significant differences were found between SB and DB surgery during anterior tibial and simulated pivot-shift loading, both remained similar to the native knee. The clinical relevance is that this study did not support an ACL graft construct more complex than an anatomic single bundle.

Changing Sagittal-Plane Landing Styles to Modulate Impact and Tibiofemoral Force Magnitude and Directions Relative to the Tibia.

Ground reaction force (GRF) and tibiofemoral force magnitudes and directions have been shown to affect anterior cruciate ligament loading during landing. However, the kinematic and kinetic factors modifying these 2 forces during landing are unknown. To clarify the intersegmental kinematic and kinetic links underlying the alteration of the GRF and tibiofemoral force vectors secondary to changes in the sagittal-plane body position during single-legged landing. Crossover study. Laboratory. Twenty recreationally active participants (age = 23.4 ± 3.6 years, height = 171.0 ± 9.4 cm, mass = 73.3 ± 12.7 kg). Participants performed single-legged landings using 3 landing styles: self-selected landing (SSL), body leaning forward and landing on the toes (LFL), and body upright with flat-footed landing (URL). Three-dimensional kinetics and kinematics were recorded. Sagittal-plane tibial inclination and knee-flexion angles, GRF magnitude and inclination angles relative to the tibia, and proximal tibial forces at peak tibial axial forces. The URL resulted in less time to peak tibial axial forces, smaller knee-flexion angles, and greater magnitude and a more anteriorly inclined GRF vector relative to the tibia than did the SSL. These changes led to the greatest peak tibial axial and anterior shear forces in the URL among the 3 landing styles. Conversely, the LFL resulted in longer time to peak tibial axial forces, greater knee-flexion angles, and reduced magnitude and a more posteriorly inclined GRF vector relative to the tibia than the SSL. These changes in LFL resulted in the lowest peak tibial axial and largest posterior shear forces among the 3 landing styles. Sagittal-plane intersegmental kinematic and kinetic links strongly affected the magnitude and direction of GRF and tibiofemoral forces during the impact phase of single-legged landing. Therefore, improving sagittal-plane landing mechanics is important in reducing harmful magnitudes and directions of impact forces on the anterior cruciate ligament.

ACL Fibers Near the Lateral Intercondylar Ridge Are the Most Load Bearing During Stability Examinations and Isometric Through Passive Flexion

Background: The femoral insertion of the anterior cruciate ligament (ACL) has direct and indirect fiber types located within the respective high (anterior) and low (posterior) regions of the femoral footprint. Hypothesis: The fibers in the high region of the ACL footprint carry more force and are more isometric than the fibers in the low region of the ACL footprint. Study Design: Controlled laboratory study. Methods: Ten fresh-frozen cadaveric knees were mounted to a robotic manipulator. A 134-N anterior force at 30° and 90° of flexion and combined valgus (8 N·m) and internal (4 N·m) rotation torques at 15° of flexion were applied simulating tests of anterior and rotatory stability. The ACL was sectioned at the femoral footprint by detaching either the higher band of fibers neighboring the lateral intercondylar ridge in the region of the direct insertion or the posterior, crescent-shaped fibers in the region of the indirect insertion, followed by the remainder of the ACL. The kinematics of the ACL-intact knee was replayed, and the reduction in force due to each sectioned portion of insertion fibers was measured. Isometry was assessed at anteromedial, center, and posterolateral locations within the high and low regions of the femoral footprint. Results: With an anterior tibial force at 30° of flexion, the high fibers carried 83.9% of the total anterior ACL load compared with 16.1% in the low fibers (P < .001). The high fibers also carried more anterior force than the low fibers at 90° of flexion (95.2% vs 4.8%; P < .001). Under combined torques at 15° of flexion, the high fibers carried 84.2% of the anterior ACL force compared with 15.8% in the low fibers (P < .001). Virtual ACL fibers placed at the anteromedial portion of the high region of the femoral footprint were the most isometric, with a maximum length change of 3.9 ± 1.5 mm. Conclusion: ACL fibers located high within the femoral footprint bear more force during stability testing and are more isometric during flexion than low fibers. Clinical Relevance: It may be advantageous to create a “higher” femoral tunnel during ACL reconstruction at the lateral intercondylar ridge.

Evaluation of Knee Ligament Mechanics Using Computational Models.

The steady maturation of computational biomechanics is providing the musculoskeletal health community with exciting avenues for enhancing orthopedic practice and rehabilitation. Computational knee models deliver tools that may improve the efficiency and outcomes of orthopedic research and methods through analysis of virtual surgeries and devices. They also provide insight into the interaction of knee structures and can predict what cannot be directly measured such as loading on our cartilage and ligaments during movement. This project created subject-specific computational knee models of two young adult females using magnetic resonance imaging-derived knee geometries and passive leg motion measured by a motion capture system. The knee models produced passive ligament lengthening patterns similar to experimental measurements available in the literature. The models also predicted cruciate ligament forces during passive flexion with and without applying anterior-posterior tibia forces that were similar to experimental measurements available in the literature. The biomechanics of the posterior oblique ligament (POL) and the anterior cruciate ligament bundles during combined tibia internal-external rotation torque and anterior-posterior forces through deep flexion were then examined. The study showed that the central arm of the POL: (1) produces a maximum constraining force when the knee is at full extension, (2) constrains internal tibial rotation at extension, and (3) constrains posterior tibial translation at extension. The POL reinforces the constraint of the anterior cruciate ligament to internal rotation at extension and provides constraint for posterior tibial translation at extension, a position where the posterior cruciate ligament provides minimal posterior translation constraint.

Lower Extremity Injuries of Volleyball Players During Moving Spike Landing

Volleyball games worldwide have developed into aggressive volleyball games involving various types of attacking techniques. Among the various attacking techniques, the moving spike is most likely to cause body imbalance. When volleyball players perform a moving spike, to acquire more time and space when hitting the ball, they typically change their attack angle, timing, and position continually. Previous studies on run-up and landing have typically focused on vertical or forward landing. However, in actual sports scenarios, the directions of an attack landing may vary according to situations. To clarify the various sports injuries of volleyball players may sustain from landing after performing a moving spike, 10 male open level volleyball players were recruited from universities to perform 72-cm moving spike landing maneuvers. In the experiment, 11 digital motion cameras were used for 3D image capture, reflective markers were applied to track the locations of the body joints, and two AMTI 3D force plates were used to collect ground reaction force generated by the landing. The results revealed that the participant with the highest risk of sustaining a cruciate ligament tear was 172-cm tall and weighed 63 kg. The negative tibial shear force and horizontal reaction force generated from performing a moving spike were deduced to cause collateral ligament injuries to the participants who had played volleyball for 9–10 yrs. Therefore, we deduced that when volleyball players continually perform moving spike landing maneuvers without appropriate cushioning maneuvers and gear protection during training or competition, their collateral ligaments may develop chronic tendinitis.

Evaluation of driver lower extremity injuries in 16 oblique crashes with THOR

Injuries to the lower extremity (LE) continue to occur in frontal crashes despite increased attention on the vehicle structure and restraint design. This study focuses on thigh, leg, foot, and ankle injuries as well as occupant factors and intrusion levels. Sixteen vehicles, including three same types, with same moving deformable barriers of the same mass, velocity, and barrier face properties, and the same occupant Test Device for Human Occupant Restraint (THOR) 50th percentile adult male in the driver's seat were used to conduct oblique impact test. Data from the left (driver side) oblique crash tests conducted by National Highway Traffic Safety Administration (NHTSA) were used in this paper to analyse the detailed intrusion characteristics and the driver side THOR injuries from head to foot in these 16 tests. Different regions of the THOR dummy were analysed. Maximum values of all lower extremity injury criteria were obtained and analysed. Intrusion and lower extremity injuries correlation was found, knee airbag and lower extremity injury correlation was also analysed. The foot-well X and Y intrusions in the 16 tests rank from minimum 14 to maximum 309 mm and from −7 to 184 mm, independently. Sixty-nine per cent right knee displacement is greater than the left knee displacement. Thirty-one per cent knee displacement and 44% left upper tibia force of the 16 tests have values that exceed injury assessment reference values. Left upper tibia force was generally greater than other tibia forces. Half of the left upper tibia index (TI) and 37.5% of the right lower TI do not meet the standard value. The foot/ankle complex is generally at a higher risk than the other parts of the leg. Same vehicle reproducibility and injury were also analysed. Right knee displacement, left femur force, left upper tibia force, left upper TI, and left ankle rotation are the most critical injuries in the respective regions of the lower extremity. Intrusion may be more prominent in some frontal damage types than in others, but not the only reason for lower extremity injuries. Other factors that influence LE injuries are the position of driver foot, the geometry of the foot-well area, the direction of intrusion, the impact energy, and acceleration of the floor. Lower extremity is the most frequently injured body region with respect to more serious injuries in the analysed test data.

Posteromedial Meniscocapsular Lesions Increase Tibiofemoral Joint Laxity With Anterior Cruciate Ligament Deficiency, and Their Repair Reduces Laxity

Background: Injury to the posteromedial meniscocapsular junction has been identified after anterior cruciate ligament (ACL) rupture; however, there is a lack of objective evidence investigating how this affects knee kinematics or whether increased laxity can be restored by repair. Such injury is often overlooked at surgery, with possible compromise to results. Hypotheses: (1) Sectioning the posteromedial meniscocapsular junction in an ACL-deficient knee will result in increased anterior tibial translation and rotation. (2) Isolated ACL reconstruction in the presence of a posteromedial meniscocapsular junction lesion will not restore intact knee laxity. (3) Repair of the posteromedial capsule at the time of ACL reconstruction will reduce tibial translation and rotation to normal. (4) These changes will be clinically detectable. Study Design: Controlled laboratory study. Methods: Nine cadaveric knees were mounted in a test rig where knee kinematics were recorded from 0° to 100° of flexion by use of an optical tracking system. Measurements were recorded with the following loads: 90-N anterior-posterior tibial forces, 5-N·m internal-external tibial rotation torques, and combined 90-N anterior force and 5-N·m external rotation torque. Manual Rolimeter readings of anterior translation were taken at 30° and 90°. The knees were tested in the following conditions: intact, ACL deficient, ACL deficient and posteromedial meniscocapsular junction sectioned, ACL deficient and posteromedial meniscocapsular junction repaired, ACL patellar tendon reconstruction with posteromedial meniscocapsular junction repair, and ACL reconstructed and capsular lesion re-created. Statistical analysis used repeated-measures analysis of variance and post hoc paired t tests with Bonferroni correction. Results: Tibial anterior translation and external rotation were both significantly increased compared with the ACL-deficient knee after posterior meniscocapsular sectioning (P < .05). These parameters were restored after ACL reconstruction and meniscocapsular lesion repair (P > .05). Conclusion: Anterior and external rotational laxities were significantly increased after sectioning of the posteromedial meniscocapsular junction in an ACL-deficient knee. These were not restored after ACL reconstruction alone but were restored with ACL reconstruction combined with posterior meniscocapsular repair. Tibial anterior translation changes were clinically detectable by use of the Rolimeter. Clinical Relevance: This study suggests that unrepaired posteromedial meniscocapsular lesions will allow abnormal meniscal and tibiofemoral laxity to persist postoperatively, predisposing the knee to meniscal and articular damage.