Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Tischer, Thomas; Geier, Andreas; Lenz, Robert; Woernle, Christoph; Bader, Rainer

doi:10.1007/s00167-016-4190-2

Cited by 31 publications

(38 citation statements)

References 42 publications

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“…In order to account for physiological force exertion, large muscles were divided into several force elements and wrapping as well as deflection phenomena were considered by deploying segment‐fixed via‐points. In particular, the deflection of the quadriceps tendon by the trochlear groove was realized by identifying the via‐points by means of a previously presented model of the patellofemoral joint . Passive forces due to capsular tissue have been neglected.…”

Section: Methodsmentioning

confidence: 99%

Dynamical analysis of dislocation‐associated factors in total hip replacements by hardware‐in‐the‐loop simulation

Geier¹,

Kluess²,

Grawe

et al. 2017

Journal Orthopaedic Research

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Since dislocation of total hip replacements (THR) remains a clinical problem, its mechanisms are still in the focus of research. Previous studies ignored the impact of soft tissue structures and dynamic processes or relied on simplified joint contact mechanics, thus, hindered a thorough understanding. Therefore, the purpose of the present study was to use hardware-in-the-loop (HiL) simulation to analyze systematically the impact of varying implant positions and designs as well as gluteal and posterior muscle function on THR instability under physiological-like loading conditions during dynamic movements. A musculoskeletal multibody model emulated the in situ environment of the lower extremity during deep sit-to-stand with femoral adduction maneuver while a six-axis robot moved and loaded a THR accordingly to feed physical measurements back to the multibody model. Commercial THRs with hard-soft bearings were used in the simulation with three different head diameters (28, 36, 44 mm) and two offsets (M, XL). Cup inclination of 45°, cup anteversion of 20°, and stem anteversion of 10° revealed to be outstandingly robust against any instability-related parameter variation. For the flexion motion, higher combined anteversion angles of cup and stem seemed generally favorable. Total hip instability was either deferred or even avoided even in the presence of higher cup inclination. Larger head diameters (>36 mm) and femoral head offsets (8 mm) deferred occurrence of prosthetic and bone impingement associated with increasing resisting torques. In summary, implant positioning had a much higher impact on total hip stability than gluteal insufficiency and impaired muscle function. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2557-2566, 2017.

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Section: Methodsmentioning

confidence: 99%

Dynamical analysis of dislocation‐associated factors in total hip replacements by hardware‐in‐the‐loop simulation

Geier¹,

Kluess²,

Grawe

et al. 2017

Journal Orthopaedic Research

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“…Based on cadaveric studies applying an isolated lateral force to the patella, the MPFL provides more than 50% of the passive resistance to lateral translation [7, 8]. A cadaveric study and computational simulation study focused on the path length of the normal MPFL as a function of the flexion angle indicated that the length tends to decrease beyond 60° of knee flexion [9, 10], although another in vitro study indicated the MPFL length tends to increase beyond 60° of knee flexion [5]. Several in vitro simulation studies have evaluated the influence of the native MPFL on patellar tracking.…”

Section: Mpfl Reconstructionmentioning

confidence: 99%

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Elias¹,

Smith

Daney

2017

Sports Medicine and Arthroscopy Review

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Biomechanical studies are commonly performed to evaluate the influence of medial patellofemoral ligament (MPFL) reconstruction and tibial tuberosity medialization on patellar tracking and patellofemoral contact pressures. The most common method is in vitro simulation of knee function, but computational simulation of knee function and computational reconstruction of in vivo motion can also be utilized. The current review of the biomechanical literature indicates that MPFL reconstruction and tibial tuberosity medialization reduce lateral patellar tracking. Decreased lateral patellofemoral contact pressures have also been noted. For MPFL reconstruction, the most commonly noted biomechanical concerns are graft over-tensioning and non-anatomical attachment on the femur leading to over-constraint of the patella and elevated medial contact pressures. For tuberosity medialization, the influence of altered tibiofemoral kinematics on post-operative function is unknown. Future biomechanical studies should emphasize inclusion of anatomical features and tracking patterns related to patellar instability, with comparison between the surgical approaches for continued development of treatment guidelines.

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“…The Schöttle point has been used as a reference standard to assess the accuracy of MPFL femoral tunnel placement after reconstructive surgery. 2 , 11 , 18 , 22 , 28 , 46 …”

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confidence: 99%

Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

Hiemstra

Kerslake

Lafave

2017

Orthopaedic Journal of Sports Medicine

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Background:Medial patellofemoral ligament (MPFL) reconstruction is a procedure aimed to reestablish the checkrein to lateral patellar translation in patients with symptomatic patellofemoral instability. Correct femoral tunnel position is thought to be crucial to successful MPFL reconstruction, but the accuracy of this statement in terms of patient outcomes has not been tested.Purpose:To assess the accuracy of femoral tunnel placement in an MPFL reconstruction cohort and to determine the correlation between tunnel accuracy and a validated disease-specific, patient-reported quality-of-life outcome measure.Study Design:Case series; Level of evidence, 4.Methods:Between June 2008 and February 2014, a total of 206 subjects underwent an MPFL reconstruction. Lateral radiographs were measured to determine the accuracy of the femoral tunnel by measuring the distance from the center of the femoral tunnel to the Schöttle point. Banff Patella Instability Instrument (BPII) scores were collected a mean 24 months postoperatively.Results:A total of 155 (79.5%) subjects had adequate postoperative lateral radiographs and complete BPII scores. The mean duration of follow-up (±SD) was 24.4 ± 8.2 months (range, 12-74 months). Measurement from the center of the femoral tunnel to the Schöttle point resulted in 143 (92.3%) tunnels being categorized as “good” or “ideal.” There were 8 failures in the cohort, none of which occurred in malpositioned tunnels. The mean distance from the center of the MPFL tunnel to the center of the Schöttle point was 5.9 ± 4.2 mm (range, 0.5-25.9 mm). The mean postoperative BPII score was 65.2 ± 22.5 (range, 9.2-100). Pearson r correlation demonstrated no statistically significant relationship between accuracy of femoral tunnel position and BPII score (r = –0.08; 95% CI, –0.24 to 0.08).Conclusion:There was no evidence of a correlation between the accuracy of MPFL reconstruction femoral tunnel in relation to the Schöttle point and disease-specific quality-of-life scores. Graft failure was not related to femoral tunnel placement. The patellofemoral instability population is complex, and patients present with multiple risk factors that, in addition to the accuracy of femoral tunnel position, contribute to quality of life and warrant further investigation.

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Impact of the patella height on the strain pattern of the medial patellofemoral ligament after reconstruction: a computer model-based study

Cited by 31 publications

References 42 publications

Dynamical analysis of dislocation‐associated factors in total hip replacements by hardware‐in‐the‐loop simulation

Dynamical analysis of dislocation‐associated factors in total hip replacements by hardware‐in‐the‐loop simulation

Biomechanical Analysis of Tibial Tuberosity Medialization and Medial Patellofemoral Ligament Reconstruction

Medial Patellofemoral Ligament Reconstruction Femoral Tunnel Accuracy

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