Implanted Passive Engineering Mechanism Improves Hand Function after Tendon Transfer Surgery: A Cadaver-Based Study

Mardula, Katherine L.; Balasubramanian, R.; Allan, Christopher H.

doi:10.1007/s11552-014-9676-0

Cited by 13 publications

(11 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Rigs and measurement techniques similar to those described for the knee are also being used in research of the spine, [75][76][77] shoulder, 78,79 and forearm. 80 Depending on the complexity and aims of these studies, the equipment and practices described provide a solid basis for a range of research. Current areas of interest in the knee include the effect of osteoarthritis on bone mechanics, 81,82 the effect of ligament injuries and repair techniques, 29,83,84 and characterization and evaluation of TKR implants, 25,85 the menisci and other soft tissue mechanical properties.…”

Section: Discussionmentioning

confidence: 99%

In Vitro Experimental Testing of the Human Knee: A Concise Review

et al. 2015

View full text Add to dashboard Cite

In vitro testing of the human knee provides valuable insight that contributes to further understanding knee biomechanics. Cadaveric testing correlates well with clinical trials because the tissue has similar properties to that of live subjects. In addition, in vitro testing allows studies to be performed that would otherwise be unethical to evaluate in vivo. Due to their many advantages, cadaveric testing has been utilized to evaluate many of medical devices and surgical techniques that have been developed in recent decades. This article aims to review the current technologies and methodologies utilized in experimental in vitro testing of the human knee. The article provides a summary of the different rigs and machines that are currently used to examine the biomechanics of the knee. It also highlights the variable experimental techniques and measurement systems that are used to collect the kinematics and kinetics of the knee joint. As technologies advance so do the measurement systems and equipment in the experimental biomechanics field. The influence of improvements to these testing equipment and measurement devices on in vitro testing of the knee will also be discussed in this review.

show abstract

Section: Discussionmentioning

confidence: 99%

In Vitro Experimental Testing of the Human Knee: A Concise Review

et al. 2015

View full text Add to dashboard Cite

show abstract

“…7) [1], [3]. However, it is logistically difficult and expensive to do extensive studies and optimize different embodiments of the implants using cadavers.…”

Section: Discussionmentioning

confidence: 99%

“…While we have conducted pilot cadaver studies for Application 1 that demonstrate the feasibility of using one embodiment of a differential mechanism (namely a hierarchical pulley mechanism) [3], this paper presents how the implants are modeled in a biomechanical simulation platform (in particular, the OpenSim platform [4], [5]) and how the improvement in postsurgery function provided by the implants may be quantified (when compared with using the suture in current surgical procedure) through biomechanical simulations. Section II presents a background on relevant biomedical devices, OpenSim, and other biomechanical simulation platforms, and the two surgeries that are the current focus of our implant development work.…”

mentioning

confidence: 99%

Modeling Implantable Passive Mechanisms for Modifying the Transmission of Forces and Movements Between Muscle and Tendons

Homayouni

Underwood

Beyer

et al. 2015

IEEE Trans. Biomed. Eng.

Self Cite

View full text Add to dashboard Cite

Abstract-This paper explores the development of biomechanical models for evaluating a new class of passive mechanical implants for orthopedic surgery. The proposed implants take the form of passive engineered mechanisms, and will be used to improve the functional attachment of muscles to tendons and bone by modifying the transmission of forces and movement inside the body. Specifically, we present how two types of implantable mechanisms may be modeled in the open-source biomechanical software OpenSim. The first implant, which is proposed for hand tendon-transfer surgery, differentially distributes the forces and movement from one muscle across multiple tendons. The second implant, which is proposed for knee-replacement surgery, scales up the forces applied to the knee joint by the quadriceps muscle. This paper's key innovation is that such mechanisms have never been considered before in biomechanical simulation modeling and in surgery. When compared with joint function enabled by the current surgical practice of using sutures to make the attachment, biomechanical simulations show that the surgery with 1) the differential mechanism (tendon network) implant improves the fingers' ability to passively adapt to an object's shape significantly during grasping tasks (2.74× as measured by the extent of finger flexion) for the same muscle force, and 2) the force-scaling implant increases knee-joint torque by 84% for the same muscle force. The critical significance of this study is to provide a methodology for the design and inclusion of the implants into biomechanical models and validating the improvement in joint function they enable when compared with current surgical practice.Index Terms-Biomechanical modeling, implant design, orthopedic surgery.

show abstract

“…To address the limitations that arise in orthopedic surgery from using direct attachments, such as sutures, bone screws, and suture anchors, our group has previously developed a separate rod-shaped implantable mechanism that improves grasp function for patients with high median-ulnar nerve palsy [ 9 , 10 ]. The device is implanted in the forearm between hand flexor tendons and redistributes the movement generated by a single muscle to multiple tendons by creating a “differential” tendon network.…”

Section: Introductionmentioning

confidence: 99%

A novel implantable mechanism-based tendon transfer surgery for adult acquired flatfoot deformity: Evaluating feasibility in biomechanical simulation

Ling

Balasubramanian

2022

PLoS ONE

Self Cite

View full text Add to dashboard Cite

Adult acquired flatfoot deformity becomes permanent with stage III posterior tibialis tendon dysfunction and results in foot pain and difficulty walking and balancing. To prevent progression to stage III posterior tibialis tendon dysfunction when conservative treatment fails, a flexor digitorum longus to posterior tibialis tendon transfer is often conducted. However, since the flexor digitorum longus only has one-third the force-capability of the posterior tibialis, an osteotomy is typically also required. We propose the use of a novel implantable mechanism to replace the direct attachment of the tendon transfer with a sliding pulley to amplify the force transferred from the donor flexor digitorum longus to the foot arch. In this work, we created four OpenSim models of an arched foot, a flatfoot, a flatfoot with traditional tendon transfer, and a flatfoot with implant-modified tendon transfer. Paired with these models, we developed a forward dynamic simulation of the stance phase of gait that reproduces the medial/lateral distribution of vertical ground reaction forces. The simulation couples the use of a fixed tibia, moving ground plane methodology with simultaneous activation of nine extrinsic lower limb muscles. The arched foot and flatfoot models produced vertical ground reaction forces with the characteristic double-peak profile of gait, and the medial/lateral distribution of these forces compared well with the literature. The flatfoot model with implant-modified tendon transfer produced a 94.2% restoration of the medial/lateral distribution of vertical ground reaction forces generated by our arched foot model, which also represents a 2.1X improvement upon our tendon transfer model. This result demonstrates the feasibility of a pulley-like implant to improve functional outcomes for surgical treatment of adult acquired flatfoot deformity with ideal biomechanics in simulation. The real-world efficacy and feasibility of such a device will require further exploration of factors such as surgical variability, soft tissue interactions and healing response.

show abstract

Implanted Passive Engineering Mechanism Improves Hand Function after Tendon Transfer Surgery: A Cadaver-Based Study

Abstract: The cadaver study showed that the implanted engineering mechanism for attaching multiple tendons to one muscle significantly improved hand function in grasping tasks when compared with the current procedure.

Cited by 13 publications

References 23 publications

In Vitro Experimental Testing of the Human Knee: A Concise Review

In Vitro Experimental Testing of the Human Knee: A Concise Review

Modeling Implantable Passive Mechanisms for Modifying the Transmission of Forces and Movements Between Muscle and Tendons

A novel implantable mechanism-based tendon transfer surgery for adult acquired flatfoot deformity: Evaluating feasibility in biomechanical simulation

Contact Info

Product

Resources

About