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

Shah, Kushal S.; Saranathan, Archana; Koya, Bharath; Elias, John J.

doi:10.1080/10255842.2014.921814

Cited by 18 publications

(18 citation statements)

References 28 publications

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“…Using the criteria of an Insall-Salvati ratio greater than 1.2, 10 subjects were identified. The sample size was estimated referring to similar studies [7,8,25], and because this was the number of female subjects we had available in our database. The mean age, height, body weight, and Insall-Salvati ratio of these individuals was For tibial tubercle distalization, the tibial tubercle is osteotomized as a bone block and then fixed in a distalized position.…”

Section: Methodsmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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Background Patellofemoral malalignment associated with patella alta may cause pain and arthritis; because of this, the condition sometimes is treated surgically. Two common procedures are tibial tubercle distalization with or without patellar tendon tenodesis. However, the biomechanical consequences of these interventions for patella alta are not clearly understood. Questions/purposes We evaluated changes in patellofemoral joint contact mechanics after tibial tubercle distalization and tibial tubercle distalization combined with patella tendon tenodesis. Specifically, we asked: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the patella? Methods Subject-specific finite-element models were created for 10 individuals with patella alta (mean InsallSalvati ratio of 1.34 ± 0.05). Input parameters for the finite-element models included subject-specific joint geometry, quadriceps muscle forces, and weightbearing patellofemoral joint kinematics. Virtual operations were conducted to simulate the two procedures. For distalization, the tibial tubercle and patella were displaced distally 4 mm to 20 mm in 4-mm increments based on the original model. At each level of distalization, the patella tendon was attached back to its original insertion to simulate the additional tenodesis procedure. Cartilage stress, contact area, and contact forces were quantified and compared between procedures and distalization levels. Results Distalization and distalization + tenodesis reduced patellofemoral joint stress compared with the baseline of 1.02 ± 0.11 MPa. Distalization led to lower cartilage stress than distalization + tenodesis, and the effect size was relatively large (0.88 ± 0. Conclusions Cartilage stress appears lower using distalization as opposed to distalization + tenodesis in this finite-element analysis simulation. An Insall-Salvati ratio of 0.95 may be an ideal level for distalization; further distalization does not show additional benefits. Clinical Relevance This study suggests that distalization may result in less stress than distalization + tenodesis,

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Section: Methodsmentioning

confidence: 99%

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Liao

Yang

et al. 2016

Clinical Orthopaedics &Amp; Related Research

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“…The tendon and ligament properties were taken from previous studies and are summarized in Table 1 [21,26,27]. The cartilages were modelled with an elastic modulus of 10 MPa and a Poisson's ratio of 0.45 [22,28,29]. A contact between both cartilage surfaces was defined with a friction coefficient of 0.02 [30].…”

Section: Parametric Fe Model Of the Pfjmentioning

confidence: 99%

“…Cartilage degeneration after a static MPFLr has been related to graft overtension or an incorrect femoral attachment point [16,17]. Several biomechanical studies based on the finite element (FE) method have evaluated the MPFLr [18][19][20][21][22][23][24]. Previous studies were mainly based on a single FE model of the knee.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Sanchis-Alfonso

Ginovart²,

Alastruey-López

et al. 2019

JCM

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Objectives: To evaluate the effect of various medial patellofemoral ligament (MPFL) fixation techniques on patellar pressure compared with the native knee. Methods: A finite element model of the patellofemoral joint consisting of approximately 30,700 nodes and 22,200 elements was created from computed tomography scans of 24 knees with chronic lateral patellar instability. Patellar contact pressures and maximum MPFL graft stress at five positions of flexion (0°, 30°, 60°, 90°, and 120°) were analyzed in three types of MPFL reconstruction (MPFLr): (1) static/anatomic, (2) dynamic, using the adductor magnus tendon (AMT) as the femoral fixation, and (3) dynamic, using the quadriceps tendon as the attachment (medial quadriceps tendon-femoral ligament (MQTFL) reconstruction). Results: In the static/anatomic technique, the patellar contact pressures at 0° and 30° were greater than in the native knee. As in a native knee, the contact pressures at 60°, 90°, and 120° were very low. The maximum MPFL graft stress at 0° and 30° was greater than in a native knee. However, the MPFL graft was loose at 60°, 90°, and 120°, meaning it had no tension. In the dynamic MPFLr using the AMT as a pulley, the patellar contact pressures were like those of a native knee throughout the entire range of motion. However, the maximum stress of the MPFL graft at 0° was less than that of a native ligament. Yet, the maximum MPFL graft stress was greater at 30° than in a native ligament. After 30° of flexion, the MPFL graft loosened, similarly to a native knee. In the dynamic MQTFL reconstruction, the maximum patellar contact pressure was slightly greater than in a normal knee. The maximum stress of the MPFL graft was much greater at 0° and 30° than that of a native MPFL. After 30° of flexion, the MQPFL graft loosened just as in the native knee. Conclusions: The patellar contact pressures after the dynamic MPFLr were like those of the native knee, whereas a static reconstruction resulted in greater pressures, potentially increasing the risk of patellofemoral osteoarthritis in the long term. Therefore, the dynamic MPFLr might be a safer option than a static reconstruction from a biomechanical perspective.

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“…[3][4][5][6] Computational models of this joint have also been developed to complement and extend these experimental measurements by performing parametric analyses to assess the influence of various factors on the contact stresses. 7 Thus, computational models have investigated the role of Q-angle and patella alta, 8,9 or muscle force imbalances 10,11 on contact forces and stresses. Other models have examined the potential outcome of various tuberosity transfer surgeries on PFJ contact forces and stresses, [12][13][14] or differences in the mechanics of open and closed kinetic chain exercises.…”

mentioning

confidence: 99%

“…11,16 Some of these prior computational models have used finite element analyses of the PFJ, where the stress-strain response of the articular layers is described using elastic materials under infinitesimal or finite strains. 10,[17][18][19] However, despite the ability of these models to provide the state of stress within the articular layers, these analyses often focus on reporting contact stresses and kinematics, since these parameters may also be measured experimentally, or stress within the bone.…”

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confidence: 99%

Biphasic Analysis of Cartilage Stresses in the Patellofemoral Joint

2015

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The objective of this study was to examine the state of stress within the solid matrix of articular cartilage in the patellofemoral joint, using anatomically faithful biphasic models of the articular layers, with the joint subjected to physiological muscle force magnitudes. Finite element models of five joints were created from human cadaver knees. Biphasic sliding contact analyses were performed using FEBio software to analyze the response of the joint from 30 to 60 degrees of knee flexion. Results demonstrated that the collagen matrix always sustains tensile stresses, despite the fact that the articular layers are loaded in compression. The principal direction of maximum solid stresses was consistent with the known orientation of collagen fibrils in cartilage. The magnitudes of these tensile stresses under muscle forces representative of activities of daily living were well below tensile failure stresses reported in the prior literature. Results also hinted that solid matrix stresses were higher in the patellar versus femoral superficial zone. These anatomically correct finite element models predicted outcomes consistent with our understanding of structure-function relationships in articular cartilage, while also producing solid matrix stress estimates not observable from experiments alone, yet highly relevant to our understanding of tissue degeneration.

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

Cited by 18 publications

References 28 publications

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Does Patella Tendon Tenodesis Improve Tibial Tubercle Distalization in Treating Patella Alta? A Computational Study

Evaluation of Patellar Contact Pressure Changes after Static versus Dynamic Medial Patellofemoral Ligament Reconstructions Using a Finite Element Model

Biphasic Analysis of Cartilage Stresses in the Patellofemoral Joint

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