Effects of Patellar Tendon Adhesion to the Anterior Tibia on Knee                     Mechanics

Ahmad, Christopher S.; Kwak, S. D.; Ateshian, Gerard A.; Warden, William H.; Steadman, J. Richard; Mow, Van C.

doi:10.1177/03635465980260051901

Cited by 105 publications

(87 citation statements)

References 33 publications

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“…In addition, the lower tendon insertion associated with distalization resulted in a more-vertical line of pull of the patella tendon compared with distalization + tenodesis, thus effectively reducing the resultant (compressive) force of the quadriceps and patella tendon force vectors. This is in agreement with results reported by Ahmad et al [1] of an experimental study which tested the effects of different patella tendon length and insertion on patellofemoral biomechanics.…”

Section: Discussionsupporting

confidence: 93%

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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: Discussionsupporting

confidence: 93%

“…In addition, we sought to address the following questions: (1) Are there biomechanical differences between these two types of procedures? (2) Is there an ideal range to distalize the tibial tubercle?…”

Section: Introductionmentioning

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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“…This concept is consistent with research findings and treatment recommendations for the knee joint, which houses the largest sesamoid in the body (the patella). 2,20,37,44 The experimental group also had statistically significant improvement in flexor hallucis strength while the control group did not. There are several explanations for this difference.…”

Section: Discussionmentioning

confidence: 83%

The Effect of Sesamoid Mobilization, Flexor Hallucis Strengthening, and Gait Training on Reducing Pain and Restoring Function in Individuals With Hallux Limitus: A Clinical Trial

Shamus¹,

Shamus²,

Gugel³

et al. 2004

J Orthop Sports Phys Ther

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Study Design: Clinical trial. Objective: To determine the effect of 2 conservative intervention approaches for functional hallux limitus. Background: Metatarsophalangeal joint (MPJ) sprains are common and can result in long-term sequelae such as persistent pain and loss of range of motion (ROM) secondary to bony proliferation and articular degeneration. It is important to determine the most effective intervention for functional hallux limitus to decrease pain and restore function. Methods and Measures: Twenty individuals with first MPJ pain, loss of motion, and weakness participated in the study. All patients received whirlpool, ultrasound, first MPJ mobilizations, calf and hamstring stretching, marble pick-up exercise, cold packs, and electrical stimulation. Ten of the 20 patients (experimental group) also received sesamoid mobilizations, flexor hallucis strengthening exercises, and gait training. Treatment was provided 3 times a week for 4 weeks. Measurements of first MPJ extension ROM, flexor hallucis strength, and subjective pain level were performed on the first and last visits. Results: Following the 12 therapy sessions, the experimental group achieved significantly greater MPJ extension ROM and flexor hallucis strength and had significantly lower pain levels as compared to the control group (PϽ.001). Conclusions: These results suggest that sesamoid mobilization, flexor hallucis strengthening, and gait training should be included in the plan of care when treating an individual with functional hallux limitus.

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“…21,24,27,30 Others have measured and described in vivo or in vitro patellar motion relative to the femur during tibiofemoral extension while using various quadriceps loads. 1,8,14,17,21,22,24,25,27,30,33,40,43,46,47 To date, no standard methodology for measuring patellar motion has been adopted.…”

mentioning

confidence: 99%

Patellar Tracking During Simulated Quadriceps Contraction

Brunet

Brinker²,

Cook³

et al. 2003

Clinical Orthopaedics and Related Research

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The current study compared patella tracking during simulated concentric and eccentric quadriceps contractions in 12 knees from cadavers using a three-dimensional electromagnetic tracking system. The patella shifted (translated) and tilted medially during approximately the initial 22 degrees tibiofemoral flexion. The patella then shifted and tilted laterally for the remaining arc of tibiofemoral flexion (90 degrees). At 90 degrees tibiofemoral flexion, the patella had an orientation of lateral patella shift and lateral patella tilt. Patella shift was significantly more lateral between 40 degrees and 70 degrees tibiofemoral flexion during concentric quadriceps action than during eccentric contraction. Patella tilt was significantly more lateral between 45 degrees and 55 degrees tibiofemoral flexion during concentric quadriceps contraction than during eccentric action. No other significant differences were seen between the quadriceps contraction conditions. The current study supports the hypothesis that patellar instability is most likely a result of various anatomic and physiologic factors causing a failure of the extensor mechanism to deliver the patella into the femoral sulcus and that a patellar dislocation rarely would occur in a normal knee.

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Effects of Patellar Tendon Adhesion to the Anterior Tibia on Knee Mechanics

Cited by 105 publications

References 33 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

The Effect of Sesamoid Mobilization, Flexor Hallucis Strengthening, and Gait Training on Reducing Pain and Restoring Function in Individuals With Hallux Limitus: A Clinical Trial

Patellar Tracking During Simulated Quadriceps Contraction

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