Computer Simulations of Patellofemoral Joint Surgery

Cohen, Zohara A.; Henry, Jack; McCarthy, Denise M.; Mow, Van C.; Ateshian, Gerard A.

doi:10.1177/03635465030310012701

Cited by 103 publications

(20 citation statements)

References 30 publications

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“…The pressure applied to lateral cartilage increases with the lateral position of the patellar tendon attachment at the tibial tuberosity (Ramappa et al 2006; Saranathan et al 2012), and medialization of the tibial tuberosity is a common approach for surgical patellar realignment. Multiple computational models have characterized the influence of the orientation of the patellar tendon on the patellofemoral pressure distribution without specifically validating the models for variations in the orientation of the patellar tendon (Benvenuti et al 1997; Cohen et al 2003; Fernandez and Hunter, 2005; Shirazi-Adl and Mesfar 2007). A modeling system that represented cartilage with elastic springs was shown to accurately characterize how varying the orientation of the patellar tendon influences patellofemoral contact pressures (Elias and Saranathan 2013), but that system cannot characterize how pressure varies throughout the thickness of cartilage or produce other relevant pressure output, such as hydrostatic pressure and octahedral shear stress.…”

Section: Discussionmentioning

confidence: 99%

Finite element analysis to characterize how varying patellar loading influences pressure applied to cartilage: model evaluation

Shah

Saranathan

Koya

et al. 2014

Computer Methods in Biomechanics and Biomedical Engineering

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A finite element analysis (FEA) modeling technique has been developed to characterize how varying the orientation of the patellar tendon influences the patellofemoral pressure distribution. To evaluate the accuracy of the technique, models were created from MRI images to represent five knees that were previously tested in vitro to determine the influence of hamstrings loading on patellofemoral contact pressures. Hamstrings loading increased the lateral and posterior orientation of the patellar tendon. Each model was loaded at 40°, 60° and 80° of flexion with quadriceps force vectors representing the experimental loading conditions. The orientation of the patellar tendon was represented for the loaded and unloaded hamstrings conditions based on experimental measures of tibiofemoral alignment. Similar to the experimental data, simulated loading of the hamstrings within the FEA models shifted the center of pressure laterally and increased the maximum lateral pressure. Significant (p < 0.05) differences were identified for the center of pressure and maximum lateral pressure from paired t-tests performed at the individual flexion angles. The ability to replicate experimental trends indicates that the FEA models can be used for future studies focused on determining how variations in the orientation of the patellar tendon related to anatomical or loading variations or surgical procedures influence the patellofemoral pressure distribution.

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Section: Discussionmentioning

confidence: 99%

Finite element analysis to characterize how varying patellar loading influences pressure applied to cartilage: model evaluation

Shah

Saranathan

Koya

et al. 2014

Computer Methods in Biomechanics and Biomedical Engineering

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“…Validated computational models can be used to overcome some of the limitations of in vivo and in vitro experiments; multiple procedures can be virtually performed on the same knee and compared under repeated loading conditions. Similar models have been used to evaluate cartilage damage in osteoarthritic patients (Cohen et al, 2003b), and simulate PF joint surgery (Cohen et al, 2003a), but typically are not validated under both healthy and altered conditions.…”

Section: Introductionmentioning

confidence: 99%

Validation of predicted patellofemoral mechanics in a finite element model of the healthy and cruciate-deficient knee

Ali

Shalhoub

Cyr

et al. 2016

Journal of Biomechanics

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Healthy patellofemoral (PF) joint mechanics are critical to optimal function of the knee joint. Patellar maltracking may lead to large joint reaction loads and high stresses on the articular cartilage, increasing the risk of cartilage wear and the onset of osteoarthritis. While the mechanical sources of PF joint dysfunction are not well understood, links have been established between PF tracking and abnormal kinematics of the tibiofemoral (TF) joint, specifically following cruciate ligament injury and repair. The objective of this study was to create a validated finite element (FE) representation of the PF joint in order to predict PF kinematics and quadriceps force across healthy and pathological specimens. Measurements from a series of dynamic in-vitro cadaveric experiments were used to develop finite element models of the knee for three specimens. Specimens were loaded under intact, ACL-resected, and both ACL and PCL-resected conditions. Finite element models of each specimen were constructed and calibrated to the outputs of the intact knee condition, and subsequently used to predict PF kinematics, contact mechanics, quadriceps force, patellar tendon moment arm, and patellar tendon angle of the cruciate resected conditions. Model results for the intact and cruciate resected trials successfully matched experimental kinematics (avg. RMSE 4.0°, 3.1 mm) and peak quadriceps forces (avg. difference 5.6%). Cruciate resections demonstrated either increased patellar tendon loads or increased joint reaction forces. The current study advances the standard for evaluation of PF mechanics through direct validation of cruciate-resected conditions including specimen-specific representations of PF anatomy.

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“…The common techniques include image-based FEM [4][5][6][7][8][9][10][11][12][13], rigid body spring modeling/discrete element analysis (RBSM) [14][15][16], or SCM [17][18][19]. The models are either displacement driven or force driven.…”

Section: Introductionmentioning

confidence: 99%

“…The models are either displacement driven or force driven. Generally, model geometries are acquired from modalities such as computed tomography (CT) [4][5][6][7][8]14,15,19] or MRI [9][10][11]17,18]. Kinematics are determined through external (surface markers) or internal (biplanar radiography) measures, while tendon forces are estimated from corresponding musculature electromyography (EMG) and cross-sectional area, and ground reaction forces are measured using force platforms [11,20].…”

Section: Introductionmentioning

confidence: 99%

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Computationally Efficient Magnetic Resonance Imaging Based Surface Contact Modeling as a Tool to Evaluate Joint Injuries and Outcomes of Surgical Interventions Compared to Finite Element Modeling

Johnson

Lee

McIff

et al. 2014

Journal of Biomechanical Engineering

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Joint injuries and the resulting posttraumatic osteoarthritis (OA) are a significant problem. There is still a need for tools to evaluate joint injuries, their effect on joint mechanics, and the relationship between altered mechanics and OA. Better understanding of injuries and their relationship to OA may aid in the development or refinement of treatment methods. This may be partially achieved by monitoring changes in joint mechanics that are a direct consequence of injury. Techniques such as image-based finite element modeling can provide in vivo joint mechanics data but can also be laborious and computationally expensive. Alternate modeling techniques that can provide similar results in a computationally efficient manner are an attractive prospect. It is likely possible to estimate risk of OA due to injury from surface contact mechanics data alone. The objective of this study was to compare joint contact mechanics from image-based surface contact modeling (SCM) and finite element modeling (FEM) in normal, injured (scapholunate ligament tear), and surgically repaired radiocarpal joints. Since FEM is accepted as the gold standard to evaluate joint contact stresses, our assumption was that results obtained using this method would accurately represent the true value. Magnetic resonance images (MRI) of the normal, injured, and postoperative wrists of three subjects were acquired when relaxed and during functional grasp. Surface and volumetric models of the radiolunate and radioscaphoid articulations were constructed from the relaxed images for SCM and FEM analyses, respectively. Kinematic boundary conditions were acquired from image registration between the relaxed and grasp images. For the SCM technique, a linear contact relationship was used to estimate contact outcomes based on interactions of the rigid articular surfaces in contact. For FEM, a pressure-overclosure relationship was used to estimate outcomes based on deformable body contact interactions. The SCM technique was able to evaluate variations in contact outcomes arising from scapholunate ligament injury and also the effects of surgical repair, with similar accuracy to the FEM gold standard. At least 80% of contact forces, peak contact pressures, mean contact pressures and contact areas from SCM were within 10 N, 0.5 MPa, 0.2 MPa, and 15 mm2, respectively, of the results from FEM, regardless of the state of the wrist. Depending on the application, the MRI-based SCM technique has the potential to provide clinically relevant subject-specific results in a computationally efficient manner compared to FEM.

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Computer Simulations of Patellofemoral Joint Surgery

Abstract: Computer simulation may serve as a valuable tool for tailoring procedures to specific patients.

Cited by 103 publications

References 30 publications

Finite element analysis to characterize how varying patellar loading influences pressure applied to cartilage: model evaluation

Finite element analysis to characterize how varying patellar loading influences pressure applied to cartilage: model evaluation

Validation of predicted patellofemoral mechanics in a finite element model of the healthy and cruciate-deficient knee

Computationally Efficient Magnetic Resonance Imaging Based Surface Contact Modeling as a Tool to Evaluate Joint Injuries and Outcomes of Surgical Interventions Compared to Finite Element Modeling

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