This study demonstrates that clinical MRI can provide accurate measurements of cartilage topography, thickness, contact areas and surface curvatures of the knee.

Many clinical studies have emphasized the role of the hamstrings and the iliotibial band on knee mechanics, although few biomechanical studies have investigated it. This study therefore examined two hypotheses: (a) with loading of the hamstrings, the tibia translates posteriorly and rotates externally and the tibial contact pattern shifts anteriorly; furthermore, the changes in tibial kinematics alter patellar kinematics and contact; and (b) loading the iliotibial band alters the kinematics and contact pattern of the tibiofemoral joint similarly to loading the hamstrings, and loading the iliotibial band laterally translates the patella and its contact location. Five cadaveric knee specimens were tested with a specially designed knee-joint testing machine in an open-chain configuration. At various flexion angles, the knees were tested always with a quadriceps force but with and without a hamstrings force and with and without an iliotibial band force. The results support the first hypothesis. Hence, the hamstrings may be important anterior and rotational stabilizers of the tibia, a role similar to that of the anterior cruciate ligament. The results also support the second hypothesis, although the iliotibial band force had a smaller effect on the tibia than did the hamstrings force. Both forces also changed patellar kinematics and contact, demonstrating that these structures should also be considered during the clinical management of patellar disorders.

The effects of patellar tendon adhesion on the knee extensor mechanism and on the kinematics and contact areas for both the patellofemoral and tibiofemoral joints were determined for five cadaveric knees in an open kinetic chain testing configuration. Patellar tendon adhesion decreased the distance from the inferior patellar pole to the tibial tuberosity, effectively creating patella infera. When compared with the controls, knees with adhesion had medial and distal translation of the patella, as well as increased patellar flexion. Although the patellar articular contact location shifted distally, the overall contact area did not change significantly. For the tibia, adhesion resulted in significant medial, proximal, and anterior translation, and internal rotation. Adhesion also resulted in a posterior shift of the tibial contact location. For the extensor mechanism, adhesion decreased the knee extension force created by the quadriceps muscle on the tibia, indicating a decrease in the effective moment arm of the extensor mechanism. Furthermore, as a result of patellar tendon adhesion, the angle formed by the quadriceps and patellar tendons decreased, suggesting an increase in patellofemoral joint reaction force with adhesion. The increased patellofemoral joint reaction force and the altered contact location may be related to anterior knee pain after knee trauma and knee surgery. Therefore, patients should be observed for subtle patella infera, which may indicate patellar tendon adhesion.

This study describes a general set of equations for quasi-static analysis of three-dimensional multibody systems, with a particular emphasis on modeling of diarthrodial joints. The model includes articular contact, muscle forces, tendons and tendon pulleys, ligaments, and the wrapping of soft tissue structures around bone and cartilage surfaces. The general set of equations governing this problem are derived using a consistent notation for all types of links, which can be converted conveniently into efficient computer codes. The computational efficiency of the model is enhanced by the use of analytical Jacobians, particularly in the analysis of articular surface contact and wrapping of soft tissue structures around bone and cartilage surfaces. The usefulness of the multibody model is demonstrated by modeling the patellofemoral joint of six cadaver knees, using cadaver-specific data for the articular surface and bone geometries, as well as tendon and ligament insertions and muscle lines of actions. Good accuracy was observed when comparing the model patellar kinematic predictions to experimental data (mean +/- stand. dev. error in translation: 0.63 +/- 1.19 mm, 0.10 +/- 0.71 mm, -0.29 +/- 0.84 mm along medial, proximal, and anterior directions, respectively; in rotation: -1.41 +/- 1.71 degrees, 0.27 +/- 2.38 degrees, -1.13 +/- 1.83 degrees in flexion, tilt and rotation, respectively). The accuracy which can be achieved with this type of model, and the computational efficiency of the algorithm employed in this study may serve in many applications such as computer-aided surgical planning, and real-time computer-assisted surgery in the operating room.

Many clinical studies have emphasized the role of the hamstrings and the iliotibial band on knee mechanics, although few biomechanical studies have investigated it. This study therefore examined two hypotheses: (a) with loading of the hamstrings. the tibia translates posteriorly and rotates externally and thc tibial contact pattern shifts anteriorly; furthermore, the changcs in tibial kinematics alter patellar kinematics and contact; and (b) loading the iliotibial band alters the kinematics and contact pattern of the tibiofemoral joint similarly to loading the hamstrings, and loading the iliotibial band laterally translates the patella and its contact location. Five cadavcric knee specimens were tested wilh a specially designed knee-joint testing machine in an open-chain configuration. At various flexion angles, the knees were tested always with a quadriceps forcc but with and without a hamstrings Porce and with and without an iliotibial band forcc. The results support the first hypothcsis. Hence, the hamstrings may be important anterior and rotational stabilizers of the tibia, a role similar tu that of the anterior cruciate ligament. The results also support the second hypothesis, although the iliotibial band force had a smaller effect on the tibia than did the hamstrings force. Both forces also changed patellar kinematics and contact, dcrnonstrating that these structures should also he considered during the clinical managcrnent of patellar disorders.

Determination of contact areas in diarthrodial joints is necessary for understanding the state of stress within the articular cartilage layers and the supporting bony structures. The present study describes the use of a stereophotogrammetry (SPG) system [Huiskes et al., J. Biomechanics 18, 559-570 (1985) and Ateshian et al., J. Biomechanics 24, 761-776 (1991)] for determining contact areas in diarthrodial joints, using a surface proximity concept similar to the one used by Scherrer et al. [ASME J. biomech. Engng 101, 271-278 (1979)]. This method consists of evaluating the proximity of the articular surfaces to determine joint contact areas using precise geometric models of the joint surfaces obtained from the SPG system, and precise kinematic data, also obtained from SPG. In this study, the SPG method for determining contact areas is compared to other commonly used methods such as dye staining, silicone rubber casting and Fuji film contact measurement techniques which have been often used and reported by other investigators. The bovine glenohumeral joint and the bovine lateral tibiofemoral articulation (without the meniscus) were used to represent congruent and incongruent joints, respectively. While all the methods yielded consistent contact patterns for the incongruent tibiofemoral articulations, the results for the congruent bovine glenohumeral joints showed that the SPG and Fuji film methods were in better agreement than those obtained from the dye staining and silicone rubber casting methods. The advantages of the new SPG method are that it can be used for intact joints, and used repeatedly and quickly thus making contact-area movement analyses possible [Soslowsky et al., J. orthop. Res. 10, 524-534 (1992)]. The results of this comparison study show that the SPG technique is a reliable and versatile method for determining contact areas in diarthrodial joints.

Magnetic Resonance Imaging (MRI) is increasingly being used in children to quantify adipose tissue (AT) and skeletal muscle (SM) in vivo. it is unclear whether the every 5 cm whole body MRI protocol used in adults is appropriate when applied in children. Whole body MRI continuous 1 cm thick slices were acquired in 73, aged 5-17-year-old healthy children. images were segmented into subcutaneous (SAT), visceral (VAT), intermuscular At (IMAT), and SM. the percentage difference between volumes measured by the continuous protocol and volumes estimated with protocols of different between-slice intervals (i.e., interval = 2, 3, 4 and 5 cm) was larger with an increase in interval size, depot size, weight and body mass index percentile. For group comparisons, studies will require less than 5.4% more subjects if an every 5 cm protocol is used for equivalent power as the every 1 cm protocol. For individual subject comparisons, interval protocols can be used to reliably distinguish between subjects who differ in SM or SAT volume by 0.14 to 0.64 l (i.e., 1 to 5% of SM or SAT volume) or more, or in VAT or IMAT volume by 0.06 to 0.21 l (i.e., 10 to 30% of VAT or IMAT volume) or more. the every 5 cm image acquisition protocol can be considered as accurate as the contiguous protocol for group comparisons in children, as well as for comparison of SM and SAT among individual children. however, a smaller slice interval protocol would be more accurate for comparison of VAT or IMAT among individual children.

Following knee surgery, especially after anterior cruciate ligament (ACL) reconstruction, a small percentage of patients complain about significantly decreased patellar mobility accompanied by anterior knee pain, sometimes severe. The limited mobility and knee pain usually do not disappear even with aggressive physical therapy. Arthroscopic exploration of these knees reveals a closure of the patellar tendon-tibial (PTT) interval, i.e., severe fibrous adhesion of the patellar tendon to the anterior aspect of the tibia, the formation of fibrous tissue between the quadriceps tendon and the femur, and a ‘closed-off’ suprapatellar pouch. Other investigators have also noted such adhesion (Paulos et al., 1987 & 1994; Jacobson et al., 1989), and Hughston (1985) attributed the tendon adhesion to the scarring of infrapatellar and suprapatellar fat pad caused by the surgery. While the adhesions are important clinical problems associated with knee surgery, no study to date, other than our experimental study on patellar tendon contracture, has quantitatively investigated the effect of these adhesions on knee kinematics and contact forces (Ahmad et al., 1997). In this study, we use a 3-D mathematical model of the knee joint to analyze the effects of the patellar tendon adhesion (PA) to the anterior tibia, and the quadriceps tendon adhesion (QA) to the anterior femur. Our objective, therefore, is to demonstrate the effects of these types of post-operative adhesions on patellofemoral joint mechanics.