Patellofemoral Anatomy and Biomechanics

Sherman, Seth L.; Plackis, Andreas C.; Nuelle, Clayton W.

doi:10.1016/j.csm.2014.03.008

Cited by 60 publications

(51 citation statements)

References 28 publications

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“…The repetitive loading results in stress concentrations which are influenced by the complex interaction of anthropometric factors, distribution of external (e.g., ground reaction) and internal (e.g., muscle) forces acting about the site, as well as the state of the tissue (i.e., morphology and material properties) [ 6 ]. For example, patellofemoral pain can result from deterioration of cartilage under the patella following intense periods of physical activity [ 7 ], while high medial compartment knee loading has been linked to increased medial compartment knee osteoarthritis progression in patients already with the disease [ 8 , 9 ]. Characterizing internal loads related to the development of MSI during commonly performed military tasks (e.g., load carriage) may help identify the mechanisms of common lower-limb MSI.…”

Section: Introductionmentioning

confidence: 99%

Tibiofemoral joint contact forces increase with load magnitude and walking speed but remain almost unchanged with different types of carried load

et al. 2018

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Musculoskeletal injuries (MSI) in the military reduce soldier capability and impose substantial costs. Characterizing biomechanical surrogates of MSI during commonly performed military tasks (e.g., load carriage) is necessary for evaluating the effectiveness of possible interventions to reduce MSI risk. This study determined the effects of body-borne load distribution, load magnitude, and walking speed on tibiofemoral contact forces. Twenty-one Australian Army Reserve soldiers completed a treadmill walking protocol in an unloaded condition and wearing four armor types (standard-issue and three prototypes) with two load configurations (15 and 30 kg) for a total of 8 armor x load ensembles. In each ensemble, participants completed a 5-minute warm-up, and then walked for 10 minutes at both moderate (1.53 m⋅s-1) and fast (1.81 m⋅s-1) speeds. During treadmill walking, three-dimensional kinematics, ground reaction forces, and muscle activity from nine lower-limb muscles were collected in the final minute of each speed. These data were used as inputs into a neuromusculoskeletal model, which estimated medial, lateral and total tibiofemoral contact forces. Repeated measures analyses of variance revealed no differences for any variables between armor types, but peak medial compartment contact forces increased when progressing from moderate to fast walking and with increased load (p<0.001). Acute exposure to load carriage increased estimated tibiofemoral contact forces 10.1 and 19.9% with 15 and 30kg of carried load, respectively, compared to unloaded walking. These results suggest that soldiers carrying loads in excess of 15 kg for prolonged periods could be at greater risk of knee MSI than those with less exposure.

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Section: Introductionmentioning

confidence: 99%

Tibiofemoral joint contact forces increase with load magnitude and walking speed but remain almost unchanged with different types of carried load

et al. 2018

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“…Even though the cause of the patella tendon shortening is not completely understood, the clinical impacts are well documented, with a change in patella height representing a primary cause of altered patellofemoral biomechanics. This potentially results in anterior knee pain, poor functional outcomes, decreased ROM, extensor lag and polyethylene impingement and subsequent wear …”

Section: Discussionmentioning

confidence: 99%

“…Despite improvements in operative technique and implant design, patellofemoral knee pain and restricted range of motion (ROM) continue to burden a significant proportion of patients . These issues have been linked to decreased patella height and subsequent decreased functional outcome scores in the early postoperative period . A number of studies have attributed this phenomenon to knee position during wound closure, reporting improved results when wound closure is performed in flexion.…”

Section: Introductionmentioning

confidence: 99%

Does knee position during wound closure alter patella height following total knee arthroplasty?

Clark¹,

Tee²,

Sutherland³

2019

ANZ Journal of Surgery

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Background: Patella infera is a known complication of total knee arthroplasty, and the method of soft tissue closure is a possible contributing factor. The aim of our study was to evaluate the effect of knee position during surgical closure of capsule, subcutaneous tissue and skin on patella tendon length after total knee arthroplasty. Methods: A three arm retrospective cohort study was conducted in a single institution over a 3-year period; 75 patients were divided, by surgeon preference, into three groups (Flexed, Extended and Hybrid) of 25 patients. All groups had standardized prosthesis, intraoperative and postoperative protocols, and differed in knee position at closure. Patellar tendon length was assessed radiologically using Insall Salvati ratio (ISR) and modified Insall Salvati ratio, with a 12-month follow-up. Intraclass correlation coefficients were used to assess intraobserver variability. Results: There was a small but significant difference in preoperative to initial postoperative ISR change between Flexed and Extended groups (Extended group mean ISR change = −0.05; t = −2.31, P = 0.025, independent samples t-test), which was not sustained at 12 months. The incidence of patella infera was similar in Flexed and Extended groups at 12 months with only one case seen in the Hybrid group. Conclusion: Our study suggests that knee position during soft tissue closure does not have a sustained impact on patella tendon length after knee replacement. A small but statistically significant reduction in patella height was found in the Extended group initially after surgery but this effect was not sustained at 12 months.

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“…Die Bewegungsqualität ist das Kernelement einer jeden Rehabilitationsbehandlung. Aus biomechanischer Sicht spielt dabei insbesondere die kongruente Gelenkstellung eine entscheidende Rolle, um die Überlastung von anderen Geweben zu vermeiden [28].…”

Section: Phase 2 Verbesserung Der Bewegungsqualitätunclassified

Leistungsorientierte, zeitlich unabhängige Rehabilitationsprogression, ein Vier-Phasenmodel

Riepenhof

Glaesener

2018

Phys Med Rehab Kuror

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ZusammenfassungNachbehandlungsschemata und Rehabilitationsprotokolle nach muskuloskelettalen Verletzungen unterliegen in der Literatur fast ausschließlich einem rein zeitorientierten Schema. Der Heilungsprozess ist allerdings von diversen Faktoren abhängig. Insbesondere konstitutionelle Eigenschaften, Vorerkrankungen, eine große Varianz der Trainierbarkeit und die Ausprägung der unfallabhängigen oder unfallunabhängigen Dekonditionierung von Patienten sind entscheidend. Das Paradigma der zeitlichen Steuerung der Rehabilitation ist daher eher nachteilig und eine zeitlich unabhängige, leistungsorientierte Rehabilitationsprogression erscheint sinnvoller. Die Autoren beschreiben ein 4-Phasenmodell postoperativer Behandlungen. Beginnend unmittelbar nach der Operation und endend mit dem Abschluss des Heilverfahrens soll so dargestellt werden, welche Leistungsfähigkeiten zu welchem Zeitpunkt erreicht sein müssen, um frei von Überlastungsschäden, Folgeverletzungen oder Rückfällen den Verlauf einer Rehabilitationsbehandlung zu gestalten.

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Patellofemoral Anatomy and Biomechanics

Cited by 60 publications

References 28 publications

Tibiofemoral joint contact forces increase with load magnitude and walking speed but remain almost unchanged with different types of carried load

Tibiofemoral joint contact forces increase with load magnitude and walking speed but remain almost unchanged with different types of carried load

Does knee position during wound closure alter patella height following total knee arthroplasty?

Leistungsorientierte, zeitlich unabhängige Rehabilitationsprogression, ein Vier-Phasenmodel

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