Surgical Biomechanics of the Patellofemoral Joint

Feller, Julian A.; Amis, Andrew A.; Andrish, Jack T.; Arendt, Elizabeth A.; Erasmus, Pieter J.; Powers, Christopher M.

doi:10.1016/j.arthro.2007.03.006

Cited by 213 publications

(148 citation statements)

References 63 publications

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“…Over the remaining flexion/extension range, the mechanical advantage appears less than 1.0, indicating velocity rather than force is being amplified (Bishop, 1977; Ellis et al ., 1980; Feller et al ., 2007). As the knee does not extend fully during running, and only extends fully at the very beginning and end of the stance phase during walking (e.g.…”

Section: Introductionmentioning

confidence: 99%

Gearing effects of the patella (knee extensor muscle sesamoid) of the helmeted guineafowl during terrestrial locomotion

et al. 2017

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Human patellae (kneecaps) are thought to act as gears, altering the mechanical advantage of knee extensor muscles during running. Similar sesamoids have evolved in the knee extensor tendon independently in birds, but it is unknown if these also affect the mechanical advantage of knee extensors. Here, we examine the mechanics of the patellofemoral joint in the helmeted guineafowl Numida meleagris using a method based on muscle and tendon moment arms taken about the patella's rotation centre around the distal femur. Moment arms were estimated from a computer model representing hindlimb anatomy, using hip, knee and patellar kinematics acquired via marker‐based biplanar fluoroscopy from a subject running at 1.6 ms−1 on a treadmill. Our results support the inference that the patella of Numida does alter knee extensor leverage during running, but with a mechanical advantage generally greater than that seen in humans, implying relatively greater extension force but relatively lesser extension velocity.

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Section: Introductionmentioning

confidence: 99%

Gearing effects of the patella (knee extensor muscle sesamoid) of the helmeted guineafowl during terrestrial locomotion

et al. 2017

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“…Movement of the patellofemoral joint is complex and dependent on a multitude of factors, including skeletal geometry, dynamic muscle action, and soft tissue restraints [7]. Because of this, proper clinical and radiographic evaluations of patellar tracking require observation during active quadriceps contraction [3,9,13].…”

Section: Discussionmentioning

confidence: 99%

“…The tibial tubercle-trochlear groove (TT-TG) distance was measured at 20.3 mm (Fig. 2), exceeding a standard 20-mm threshold for surgery [5,7,10]. Because of the patient's symptoms, failure of nonoperative treatment, and imaging findings, which included an absence of abnormal femoral torsion, we recommended a medial tibial tubercle transfer with MPFL reconstruction through a semitendinosus allograft as originally described by McManus et al [11].…”

Section: Case Reportmentioning

confidence: 97%

Case Report: Quantitative MRI of Tibial Tubercle Transfer During Active Quadriceps Contraction

Duchman

Mellecker

El-Hattab

et al. 2011

Clinical Orthopaedics &Amp; Related Research

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Background The evaluation of distal transfer procedures relies primarily on qualitative clinical findings. Although quantitative MRI measurements provide an objective supplement to qualitative clinical findings, an association between qualitative clinical findings and quantitative patellofemoral indices has yet to be established. Case Description A 21-year-old man presented with frequent episodes of patellar dislocation. Clinical and radiographic findings identified the patient as a candidate for realignment. MR images were obtained with the quadriceps contracted at 30°flexion and in full extension preoperatively and postoperatively. The procedure eliminated the clinical J-sign, defined as lateral movement of the patella over the lateral femoral condyle during active leg extension, which was confirmed quantitatively using established patellofemoral indices in conjunction with MRI. Literature Review Movement of the patellofemoral joint is complex and dependent on many factors, including skeletal geometry, dynamic muscle action, and soft tissue restraints. Therefore, proper clinical and radiographic evaluation of patellar tracking requires observation during active quadriceps contraction. However, it is unclear whether there is any association between quantitative radiographic indices and qualitative clinical assessment during active quadriceps contraction. Purposes and Clinical Relevance We believe objective measurements are valuable in determining the radiographic assessment of patellar realignment procedures. Lateral patellar edge appears to quantify the clinical J-sign. The association between radiographic medialization of the patella and clinical improvement postoperatively in this patient warrants additional investigation in a larger group of patients with longer followup.

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“…O conhecimento das camadas profundas do joelho pode aprimorar a abordagem e melhorar os resultados cirúrgicos dessa articulação (22)(23) . Tais observações nos estimularam a realizar um estudo anatômico no joelho humano que enfocou a articulação patelofemoral.…”

Section: Discussionunclassified

“…Não expuseram trabalhos anatômicos para a utilização desses pontos, mas empregam um isômetro para determinar os pontos isométricos. Feller et al (22) e Andrikoula et al (33) citaram o LPFL como componente do retináculo lateral transverso profundo, mas não o descrevem com maiores minúcias. Terry et al (23) e Amis (34) descreveram o LPFL como uma estrutura originada no aspecto profundo do trato iliotibial e que se insere na região lateral média da patela, mas não o expõem anatomicamente com mais detalhes.…”

Section: Discussionunclassified