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PubMed1998

A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 1: Theoretical Construct.

A three-dimensional model of the knee is developed to study the interactions between the muscles, ligaments, and bones during activity. The geometry of the distal femur, proximal tibia, and patella is based on cadaver data reported for an average-size knee. The shapes of the femoral condyles are represented by high-order polynomials; the tibial plateaux and patellar facets are approximated as flat surfaces. The contacting surfaces of the femur and tibia are modeled as deformable, while those of the femur and patella are assumed to be rigid. Interpenetration of the femur and tibia is taken into account by modeling cartilage as a thin, linear, elastic layer, mounted on rigid bone. Twelve elastic elements describe the geometry and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by thirteen musculotendinous units, each unit modeled as a three-element muscle in series with tendon. The path of each muscle is approximated as a straight line, except where it contacts and wraps around bone and other muscles; changes in muscle paths are taken into account using data obtained from MRI. In the first part of this paper, the model is used to simulate passive knee flexion. Quantitative comparisons of the model results with experimental data reported in the literature indicate that the relative movements of the bones and the geometry of the ligaments and muscles in the model are similar to those evident in the real knee. In Part II, the model is used to describe knee-ligament function during anterior-posterior draw, axial rotation, and isometric knee-extension and knee-flexion exercises.

Journal Article↗
PubMed1998

A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. Part 2: Analysis of Ligament Function.

A three-dimensional model of the knee is used to study ligament function during anterior-posterior (a-p) draw, axial rotation, and isometric contractions of the extensor and flexor muscles. The geometry of the model bones is based on cadaver data. The contacting surfaces of the femur and tibia are modeled as deformable; those of the femur and patella are assumed to be rigid. Twelve elastic elements are used to describe the geometry and mechanical properties of the cruciate ligaments, the collateral ligaments, and the posterior capsule. The model is actuated by thirteen musculotendinous units, each unit represented as a three-element muscle in series with tendon. The calculations show that the forces applied during a-p draw are substantially different from those applied by the muscles during activity. Principles of knee-ligament function based on the results of in vitro experiments may therefore be overstated. Knee-ligament forces during straight a-p draw are determined solely by the changing geometry of the ligaments relative to the bones: ACL force decreases with increasing flexion during anterior draw because the angle between the ACL and the tibial plateau decreases as knee flexion increases; PCL force increases with increasing flexion during posterior draw because the angle between the PCL and the tibial plateau increases. The pattern of ligament loading during activity is governed by the geometry of the muscles spanning the knee: the resultant force in the ACL during isometric knee extension is determined mainly by the changing orientation of the patellar tendon relative to the tibia in the sagittal plane; the resultant force in the PCL during isometric knee flexion is dominated by the angle at which the hamstrings meet the tibia in the sagittal plane.

Journal Article↗
PubMed2006

Surgical treatment of lateral posterolateral instability of the knee using biceps tendon procedures.

Posterolateral instability (PLI) is common with posterior cruciate ligament tears and is less common with anterior cruciate ligament tears, and isolated PLI is rare. There are varying degrees of PLI with respect to pathologic external tibial rotation, and varus laxity. Surgical treatment of PLI must address all components of the PLI (popliteus tendon, popliteofibular ligament, lateral collateral ligament, and the lateral-posterolateral capsule), and other structural injuries. Successful posterior cruciate ligament and anterior cruciate ligament surgery depends upon recognition and treatment of posterolateral corner injuries.

Biomechanical Phenomena↗
PubMedDate not supplied

Fractures of the sesamoid bones of the thumb.

Stability of the thumb metacarpophalangeal joint is provided by the collateral ligament proper, the accessory collateral ligament, the proximal and distal palmar ligaments, and the palmar plate. The adductor pollicis and flexor pollicis brevis muscles also provide soft tissue support and insert on the proximal phalanx of the thumb by way of the sesamoid bones. Fractures of the metacarpophalangeal joint sesamoid bones are uncommon but are often associated with sporting injuries during which the joint is acutely hyperextended. Routine anteroposterior and lateral radiographs may be unremarkable, and oblique views are often necessary to document the fracture. We report eight cases of fracture of the thumb metacarpophalangeal joint sesamoid. Seven were isolated sesamoid fractures, and one was associated with a metacarpophalangeal joint dislocation. None of the fractures were evident on anteroposterior radiographs, but all were seen in the oblique projection. Six fractures were treated with splint or cast immobilization for 2 to 3 weeks, and two were taped. Clinical followup of the seven patients with isolated sesamoid fracture at 6 to 8 weeks revealed pain-free normal function. One patient could not be reached for followup.

Adult↗
PubMed2006

Classification of postaxial polydactyly of the foot.

BACKGROUND: The origins and shapes of accessory digits in postaxial polydactyly of the foot were analyzed morphologically and radiographically, and their characteristics were determined. A simple classification method was then devised to assist in determining the most appropriate treatment options. METHODS: We evaluated 113 feet of 95 patients who had surgery for the treatment of postaxial polydactyly between 1998 and 2002. Based on the morphologic, radiographic, and operative findings, the cases were classified according to the origin of the accessory digit: middle phalangeal, proximal phalangeal, floating, fifth metatarsal, or fourth metatarsal. The proximal phalangeal type was further divided into three subtypes: proximal phalangeal lateral type, proximal phalangeal medial, and proximal phalangeal head. RESULTS: Of the 113 feet, 36 were middle phalangeal type, 45 were proximal phalangeal type, 5 were floating type, 15 were fifth metatarsal type, and 12 were fourth metatarsal type. Of the proximal phalangeal types, 15 were laterally duplicated supernumerary sixth digits, and 17 were medially duplicated supernumerary fifth digits. The duplicated digits of the remaining 13 originated at the distal portion of the proximal phalanx. In the middle phalangeal, proximal phalangeal head, proximal phalangeal medial, and fourth metatarsal types, the medial accessory fifth digit was an abnormally duplicated digit, which was excised. In the proximal phalangeal lateral, floating, and fifth metatarsal types, the lat eral accessory sixth digit was excised. For the children in this study, we did not perform reconstruction of the deep transverse metatarsal ligament or collateral ligament. Also, we did not use longitudinal pin fixation. Skin necrosis occurred in 10 feet that resolved, and in five of the 15 feet of the 5th metatarsal medial deviation occurred. CONCLUSIONS: Based on the morphologic, radiographic, and operative findings, we suggest a classification method of postaxial polydactyly of the foot. We believe this is a straightforward and useful method for the treatment of postaxial polydactyly.

Adolescent↗
PubMed2005

Selection of cell source for ligament tissue engineering.

Use of appropriate types of cells could potentially improve the functionality and structure of tissue engineered constructs, but little is known about the optimal cell source for ligament tissue engineering. The object of this study was to determine the optimal cell source for anterior cruciate ligament (ACL) tissue engineering. Fibroblasts isolated from anterior cruciate ligament, medial collateral ligament (MCL), as well as bone marrow mesenchymal stem cells (MSC) were compared using the following parameters: proliferation rate, collagen excretion, expression of collagen type I, II, and III, as well as alpha-smooth muscle actin. Green fluorescent protein (GFP) transfected MSCs were used to trace their fate in the knee joints. MSC, ACL, and MCL fibroblasts were all highly stained with antibodies for collagen types I and III and alpha-smooth muscle actin while negatively stained with collagen type II. Proliferation rate and collagen excretion of MSCs were higher than ACL and MCL fibroblasts (p < 0.05), and MSCs could survive for at least 6 weeks in knee joints. In summary, MSC is potentially a better cell source than ACL and MCL fibroblasts for anterior cruciate ligament tissue engineering.

Animals↗
PubMed2003

The incidence of pathology detected by magnetic resonance imaging of the knee: differences based on the specialty of the requesting physician.

The usage patterns of magnetic resonance imaging (MRI) by orthopedic and nonorthopedic surgeons were studied. A sample consisting of the radiologist reports from all knee MRIs in a single year at our institution were reviewed. Studies to evaluate tumors or infections were excluded. Reports were classified as normal or demonstrating degenerative joint disease, meniscal tears, cruciate ligament pathology, collateral ligament pathology, focal chondral defects, chondromalacia patella, cysts, extensor mechanism dysfunction, intraosseous edema, or fractures. Six hundred eighteen reports were reviewed. The combined incidence of a normal study or one that found only degenerative joint disease was 45% for nonorthopedic surgeons and 27.6% for orthopedic surgeons (P<.00001). Given the higher incidence of normal findings in studies ordered by nonorthopedic surgeons, these physicians probably use MRI more for screening whereas orthopedic surgeons are more apt to use it for confirmation. Therefore, if clinical guidelines for using MRI are to be established, differences in use as a function of specialty must be acknowledged.

Hospitals, University↗
PubMed1992

Metacarpophalangeal joint injuries of the thumb.

Dorsal capsular injuries, volar plate injuries, ulnar collateral ligament injuries, and radial collateral ligament injuries are all discussed in this article. Treatment is both discussed and illustrated for ease of comprehension.

Acute Disease↗
PubMed2004

[Ganglion cysts of the knee originating from tendons and ligaments].

PURPOSE: To investigate the clinical features and MR imaging findings of the ganglion cysts arising from the tendons and ligaments of the knee. MATERIALS AND METHODS: One thousand six hundred and twenty knee MR examinations that had been performed in a three-year period were evaluated retrospectively for the presence of ganglion cysts originating from tendons or ligaments. Clinical findings and MRI features of the lesions were noted. RESULTS: Twenty-three patients had a ganglion cyst originating from a tendon or a ganglion, with an incidence of 1.4%. Six lesions were associated with the anterior cruciate ligament, six with the posterior cruciate ligament, six with the medial collateral ligament, two with the lateral collateral ligament, two with the transverse ligament, and one with the patellar tendon. The most common clinical finding was knee pain. There were swelling at the medial side of the knee in two patients, swelling at the lateral side of the knee in one patient and swelling in the popliteal region in one patient. CONCLUSION: MR appearance of ganglion cysts arising from the tendons and ligaments of the knee is characteristic. Meniscal cysts, pigmented villonodular synovitis, and synovial hemangioma should be considered in the differential diagnosis.

Adult↗
PubMed1986

On the biomechanics of cycling. A study of joint and muscle load during exercise on the bicycle ergometer.

The aim of the study was to quantify the load induced in the lower limb joints and muscles during exercise on a bicycle ergometer and to study how these loads changed with adjustments of the bicycle ergometer or cycling technique. The forces, load moments and muscular power output acting on and about the hip, knee and ankle joints during cycling were determined using cine-film, pedal force measurements and biomechanical calculations based upon static and dynamic mechanics. The muscular activity of eleven lower limb muscles was recorded and quantified using EMG. The load moments acting about the bilateral hip, knee and ankle joint axes were found to be generally lower than those induced during normal level walking. The varus and valgus load moments acting about the antero-posterior knee joint axis were approximately the same as those induced during walking. The tibio-femoral compressive joint force and the anteriorly directed tibio-femoral shear force mainly stressing the anterior cruciate ligament were low. The talocrural joint compressive force and achilles tendon tensile force were low compared to those in level walking. The magnitude of lower limb muscular activity during cycling approximated that obtained during walking, with three major exceptions. M. vastus medialis et lateralis were more activated during cycling than during walking, and tibialis anterior was less activated. The hip extensor muscles produced 27%, hip flexors 4%, knee extensors 39%, knee flexors 10% and ankle plantar flexors 20% of the total positive mechanical work. Of the four parameters studied (workload, pedalling rate, saddle height, pedal foot position) workload was the most important adjustment factor for change of joint load and muscular activity. An increased pedalling rate increased the muscular activity in most of the muscles investigated, generally without changing the joint load. Increased saddle height decreased the maximum flexing knee load moment, but did not significantly change the flexing hip or dorsiflexing ankle load moment. Muscular activity in most of the muscles investigated was not generally changed by different saddle heights. Use of a posterior foot position instead of an anterior decreased the dorsiflexing ankle load moment, increased the gluteus medius and rectus femoris activity, and decreased soleus muscular activity but did not significantly change the hip or knee moments. It is suggested that cycling might be a useful exercise in the rehabilitation of patients with injuries to the anterior cruciate ligament, medial collateral ligament of the knee or achilles tendon.(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗
PubMed1986

An autoradiographic study of the distribution of sensory nerve endings in the knee joint of the rat.

The distribution of sensory nerve endings of the knee joint in rats has been investigated by autoradiography of 3H-leucine. Sections were made and each section was examined by autoradiography and silver impregnation staining. Free nerve endings were found only in the synovial membrane, the menisci and their synovial junction. In the joint capsule, capsulated sensory nerve endings were sparsely distributed. Numerous sensory nerve endings were found at the insertion of the patellar ligament, the collateral ligament and the cruciate ligament. These resembling Golgi-Mazzoni nerve endings or capsulated sensory nerve endings are thought to be proprioceptors. Radioactivity, which would indicate the presence of sensory nerve endings, was not recognized in the osseous tissue. It is hypothesized that proprioceptor at the insertion of ligaments plays an important role as monitor of joint motion by the reflex pathway.

Animals↗
PubMed1985

Correlative biomechanical and histologic study of the cranial cruciate ligament in dogs.

The mechanical properties of the cranial cruciate ligament were determined, using unilateral bone-ligament-bone preparations from 65 dogs of various ages and body sizes. Tensile loading of the cranial cruciate ligament from 1 of each pair of stifle joints demonstrated a decrease in material properties (modulus, maximum stress, strain energy) with aging. The decreases in maximum stress and strain energy with age were significantly less (P less than 0.05 and P less than 0.05, respectively) in the cranial cruciate ligament from dogs weighing less than 15 kg, compared with those weighing 15 kg or more. The cranial cruciate ligament and remaining femorotibial ligaments were collected from the opposite stifle joints and examined microscopically. By 5 years of age, the cranial cruciate ligaments of dogs weighing greater than 15 kg consistently had microscopic evidence of degenerative disease (loss of ligamentocytes, metaplasia of surviving ligamentocytes to chondrocytes, and failure to maintain collagen fibers and primary collagen bundles) which progressed in severity with age. The caudal cruciate ligaments were similarly affected, although the degenerative changes were rarely as severe as in the cranial cruciate ligament. The collateral ligaments underwent minimal degeneration. Sex differences had no bearing on degeneration. The cranial cruciate ligaments in dogs weighing less than 15 kg generally had less severe alterations than those in heavier dogs, and the onset of the degenerative process was delayed by several years. Cranial cruciate ligaments removed from dogs after ligament failure not only had degenerative disease, but also had undergone unsuccessful attempts at repair. In contrast, fibrous repair was rarely present in intact ligaments of asymptomatic dogs with degenerative disease of the cranial cruciate ligament.

Age Factors↗
PubMed1981

Factors influencing elbow instability.

Stability or instability of the elbow is contingent upon three distinct but interrelated conditions: radiocapitellar articular continuity, coronoid process integrity and medial collateral ligament competency through an intact anterior oblique ligament. The latter, the anterior oblique ligament of the medial collateral ligament both in anatomic experimentation and clinical cases appears to be the most critical factor in elbow stability. The reconstruction of the unstable elbow must focus on this medial supporting ligament for a predictable result.

Athletic Injuries↗
PubMed1976

Repair of the ligaments about the knee.

The evolution of techniques used to repair torn ligaments about the knee is described. A combination of repairs of the anterior cruciate ligament, medial collateral ligament, and posterior joint capsule along with transfer of the medial half of the semimembranosus tendon and transfer of the pes anserinus is described. The surgical procedures have been evolved over a three year period in an orthopedic practice in a skiing and resort community. These combinations of surgical techniques can insure stable knees for active persons without the need to resort to more formal and more extensive surgical procedures. It is also thought that repair of both fresh and old ligament tears in the manner described gives the athletic individual a better chance for continuing in recreational and competitive sports, as well as reducing the possibility of lateral degenerative joint changes.

Athletic Injuries↗
PubMed1996

[Biomechanical correlations of lesions associated with traumatic diseases of the anterior cruciate ligament. Analysis with magnetic resonance].

To investigate the correlations between traumatic injuries of the anterior cruciate ligament and other ligamentous, meniscal and bone traumatic injuries, a series of 193 patients with anterior cruciate ligament injuries studied with MRI between January 1992 and December 1994, was retrospectively reviewed. MR results were compared with arthroscopic and/or surgical findings in most (181) patients; in the remaining 12 patients, clinical follow-up was performed. We used two 0.5 superconductive MR units, with dedicated coils and T1-weighted spin-echo and T2*-weighted gradient-echo sequences on the axial, sagittal and coronal planes. Anterior cruciate ligament injuries were associated with other ligamentous, meniscal and bone injuries in 78% of patients. The patients were classified in 5 groups depending on biomechanics and the association of injuries: -group I: isolated injury of the anterior cruciate ligament (41 patients), most frequently caused by forced extension stress associated with "kissing contusions" of the anterior portion of the lateral femoral condyle and of the lateral tibial plateau; this type of injury is less frequently caused by forced flexion stress associated with avulsion fracture of the tibial eminence; -group II: associated injury of the anterior cruciate ligament and medial compartment (62 patients), caused by forced flexion-external rotation stress (abduction, valgism and external rotation). The classic association of this mechanism was the injury of the anterior cruciate ligament, medial collateral ligament and medial meniscus (O'Donoghue triad) (9 patients). Valgus stress and the pivot-shift phenomenon can impact the tibial and femoral articular surfaces, with consequent osteochondral contusion; -group III: associated injury of the anterior cruciate ligament and lateral compartment (26 patients), caused by forced flexion-internal rotation stress (adduction, varism and internal rotation). This mechanism can cause, as a typical bone lesion, Segond fractures; -group IV: associated injury of the anterior cruciate ligament, lateral and medial compartments observed in 52 patients with different associations of varus-valgus and rotatory stress; -group V: in 5 patients, anterior cruciate ligament injury was associated with traumatic injury of the posterior cruciate ligament; in this case, posterior displacement of the tibia and knee hyperextension were the most common mechanisms of injury. In conclusion, our results demonstrate that anterior cruciate ligament injuries due to traumatic sprains of the knee are rarely isolated (21%). Thus, it is important to know the biomechanics of knee trauma to read MR images in order to detect possibly associated injuries. The final goal is to assess the actual extent of the traumatic damage for best subsequent clinical-therapeutic management.

Adolescent↗
PubMed1996

Gene transfer to the rabbit patellar tendon: potential for genetic enhancement of tendon and ligament healing.

Injuries to ligaments and tendons occur very commonly, but often heal very poorly. A number of growth factors show promise as biological agents with which to augment the reparative responses of these tissues, but they are extremely difficult to deliver clinically. We have suggested the use of gene transfer as a possible way to obviate this limitation. Here we have used the lacZ marker gene to evaluate methods for gene delivery to ligaments and tendons. Cell cultures were established from the following tissues of the New Zealand white rabbit: anterior and posterior cruciate ligaments, medial collateral ligament, patellar tendon and semitendionsus. In vitro experiments confirmed that these cells were very efficiently transduced by an E1- E3- adenoviral vector carrying the lacZ gene. Cells derived from ligaments and tendons also proved readily susceptible to retroviral transduction and, following transfer of the ned gene, selection in G418. To determine whether these cells could be genetically altered in situ, gene transfer to the patellar tendons of rabbits' knee joints was attempted using an adenovirus for in vivo delivery and a retrovirus for ex vivo delivery. Direct, percutaneous injection of the adenovirus resulted in high levels of lacZ expression, but this was limited to the area of tendon immediately adjacent to the injection site, and preferentially labeled cells in the epitenon sheath. An unexpected finding of these studies was the in vivo adenoviral transduction of bone cells in areas where the tendon insertion site had been accidentally injected. Allotransplantation of tendon fibroblasts into which the lacZ gene had been retrovirally introduced led to lacZ expression throughout the body of the tendon itself. The genetically altered cells appeared able to migrate from the site of injection and to integrate themselves into the crimp pattern of the tissue. Both in vivo and ex vivo methods led to gene expression for at least 6 weeks, which may be long enough for clinical purposes.

Adenoviridae↗
PubMed1997

[Scanning electron microscopic investigations on the anatomy of the fetlock joint in horses].

Striking synovial structures were taken and their surface was investigated by scanning electron microscopy. Depending where the probes were taken from, the stratum synovial was arranged in a different way. The synovial intima seems to miss under the tendon of the long/commune extensor muscle, the collateral ligaments and the sesamoidean collateral ligaments. That is why the subsynovial tissue forms the superficial layer. The surface of the probes taken sidewards to the tendon of the extensor muscle and of the synovial fold, which is situated between the metacarpus/metatarsus and the proximal phalanx as well as from the palmar/plantar recess is dominated by synovial intima. Synovial cells are mainly arranged as monolayer. Synovial cells are variable in their appearance. Some resemble blackberrys, others show a quite undulating surface. The length of processes of synovial cells differs from 2-10 microns, the diameter of the synovial cells from 5-10 microns. The space between two cells amounts to 2-10 microns. The intercellular gap is put in relation to the length of the cells' processes. The synovial intima is supposed to form a barrier between the articular cavity and the surrounding structures.

Animals↗
PubMed1996

Influence of steroid injection on ligament healing in the rat.

The effect of a single local injection of long acting corticosteroid on the healing of acute rat medial collateral ligament injuries was studied. The medial collateral ligaments of 81 adult female rats were exposed surgically. In 32 rats, the ligament was transected sharply, the overlying muscle was closed, and a human equivalent dose of dexamethasone was injected under the muscle layer, bathing the injured ligament. The identical operation with no corticosteroid injection was done in 32 additional rats: in the remaining 17 animals, the incision was closed without ligament transection or injection. The rats were divided into 3 groups of 25. Each group consisted of 10 rats that were injected, 10 that were not injected, and 5 that underwent sham operations. One group was euthanized 6 days after surgery, 1 group after 10 days, and 1 group after 20 days. Histologic evaluation and biomechanical testing were performed for each subgroup. A cellular pathologist examined a smaller group of 6 rats (2 from each group) for histologic changes 40 days after surgery. No histologic differences were noted between the injected and noninjected ligaments 6, 10, or 20 days after injury. At 40 days, the injected specimens showed a slightly more mature crimp pattern than the noninjected specimens. Mechanical testing demonstrated no significant difference in ultimate load or ultimate stress between the injected and noninjected groups. There were no detrimental effects of a single dose administration of dexamethasone on the histologic appearance or biomechanical strength of healing rat medial collateral ligaments.

Animals↗