Importance of Patella, Quadriceps Forces, and Depthwise Cartilage Structure on Knee Joint Motion and Cartilage Response During Gait

Halonen, Kimmo; Mononen, Mika E.; Jurvelin, Jukka S.; Töyräs, Juha; Kłodowski, Adam; Kulmala, Juha-Pekka; Korhonen, Rami K.

doi:10.1115/1.4033516

Cited by 38 publications

(62 citation statements)

References 61 publications

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“…4b)52 and resulted in compressive deformation of the healthy tissue ranging from 10% to 18%. This behavior is comparable to previously determined in vivo cartilage deformations (ranging from 7% to 23%) during the stance phase of gait53.…”

Section: Discussionmentioning

confidence: 99%

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Quantitative Evaluation of the Mechanical Risks Caused by Focal Cartilage Defects in the Knee

Venäläinen

Mononen

Salo

et al. 2016

Sci Rep

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Focal cartilage lesions can proceed to severe osteoarthritis or remain unaltered even for years. A method to identify high risk defects would be of utmost importance to guide clinical decision making and to identify the patients that are at the highest risk for the onset and progression of osteoarthritis. Based on cone beam computed tomography arthrography, we present a novel computational model for evaluating changes in local mechanical responses around cartilage defects. Our model, based on data obtained from a human knee in vivo, demonstrated that the most substantial alterations around the defect, as compared to the intact tissue, were observed in minimum principal (compressive) strains and shear strains. Both strain values experienced up to 3-fold increase, exceeding levels previously associated with chondrocyte apoptosis and failure of collagen crosslinks. Furthermore, defects at the central regions of medial tibial cartilage with direct cartilage-cartilage contact were the most vulnerable to loading. Also locations under the meniscus experienced substantially increased minimum principal strains. We suggest that during knee joint loading particularly minimum principal and shear strains are increased above tissue failure limits around cartilage defects which might lead to osteoarthritis. However, this increase in strains is highly location-specific on the joint surface.

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Section: Discussionmentioning

confidence: 99%

“…( b ) Corresponding maximum contact pressures and experimental contact values from the literature52 as a function of stance phase.…”

Section: Figurementioning

confidence: 99%

Quantitative Evaluation of the Mechanical Risks Caused by Focal Cartilage Defects in the Knee

Venäläinen

Mononen

Salo

et al. 2016

Sci Rep

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“…However, it should be noted that our models were driven by flexion-extension angles and axial forces with free varus-valgus rotations, not by forces and moments. In models driven mainly by forces and moments, the effects of other tissues and structures would be more important (Halonen et al, 2016; Tanska et al, 2015). …”

Section: Discussionmentioning

confidence: 99%

Comparison of different material models of articular cartilage in 3D computational modeling of the knee: Data from the Osteoarthritis Initiative (OAI)

Klets

Mononen

Tanska

et al. 2016

Journal of Biomechanics

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The intricate properties of articular cartilage and the complexity of the loading environment are some of the key challenges in developing models for biomechanical analysis of the knee joint. Fibril-reinforced poroelastic (FRPE) material models have been reported to accurately capture characteristic responses of cartilage during dynamic and static loadings. However, high computational and time costs associated with such advanced models limit applicability of FRPE models when multiple subjects need to be analyzed. If choosing simpler material models, it is important to show that they can still produce truthful predictions. Therefore, the aim of this study was to compare depth-dependent maximum principal stresses and strains within articular cartilage in the 3D knee joint between FRPE material models and simpler isotropic elastic (IE), isotropic poroelastic (IPE) and transversely isotropic poroelastic (TIPE) material models during simulated gait cycle. When cartilage-cartilage contact pressures were matched between the models (15% allowed difference), maximum principal stresses in the IE, IPE and TIPE models were substantially lower than those in the FRPE model (by more than 50%, TIPE model being closest to the FRPE model), and stresses occurred only in compression in the IE model. Additional simulations were performed to find material parameters for the TIPE model (due to its anisotropic nature) that would yield maximum principal stresses similar to the FRPE model. The modified homogeneous TIPE model was in a better agreement with the homogeneous FRPE model, and the average and maximum differences in maximum principal stresses throughout the depth of cartilage were 7% and 9%, respectively, in the lateral compartment and 9% and 11% in the medial compartment. This study revealed that it is possible to match simultaneously maximum principal stresses and strains of cartilage between non-fibril-reinforced and fibril-reinforced knee joint models during gait. Depending on the research question (such as analysis of fibril strain necessitates the use of fibril-reinforced material models) or clinical demand (fast simulations with simpler material models), the choice of the material model should be done carefully.

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“…Furthermore, the model did not include the patella, patella ligament, or the quadriceps tendon. The I–E rotation of the native knee can be overestimated by excluding these structures . Despite uncertainty regarding the tibiofemoral joint transverse kinematics, the predicted damping effect of the Atlas™ would likely remain the same.…”

Section: Discussionmentioning

confidence: 99%

“…The I-E rotation of the native knee can be overestimated by excluding these structures. 21 Despite uncertainty regarding the tibiofemoral joint transverse kinematics, the predicted damping effect of the Atlas™ would likely remain the same. Mean I-E rotation of 0.3°post-Atlas™ contrasted with normal average I-E rotation of 4.6°m easured across stance by biplane fluoroscopy.…”

Section: Discussionmentioning

confidence: 99%

Effects of a Medial Knee Unloading Implant on Tibiofemoral Joint Mechanics During Walking

Morgan

Hillstrom

Ranawat

et al. 2019

Journal Orthopaedic Research

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The Atlas™ unicompartmental knee system is a second‐generation extra‐articular unloading implant for patients with mild to moderate medial knee osteoarthritis. The technology acts to reduce a portion of the weight‐bearing load exerted on the medial knee during physical activity thereby, reducing the mechanical stress imposed on a degenerative joint. The purpose of the present study was to evaluate the effects of the Atlas™ on tibiofemoral joint mechanics during walking. A computer‐aided design assembly of the Atlas™ was virtually implanted on the medial aspect of a previously validated finite element tibiofemoral joint model. Data for knee joint forces and moments from an anthropometrically matched male were applied to the model to quasi‐statically simulate the stance phase of gait. Predictions of tibiofemoral joint mechanics were computed pre‐ and post‐virtual implantation of the Atlas™. Compressive force in the medial tibiofemoral compartment was reduced by a mean of 53%, resulting in the decrement of mean cartilage–cartilage and cartilage–meniscus von Mises stress by 31% and 32%, respectively. The Atlas™ was not predicted to transfer net loading to the lateral compartment. The tibiofemoral joint model exhibited less internal–external rotation and anterior–posterior translation post‐Atlas™, indicating a change in the kinematic environment of the knee. From a biomechanical perspective, extra‐articular joint unloading may serve as a treatment option for patients recalcitrant to conservative care. Evaluation of mechanical changes in the tibiofemoral joint demonstrate the potential treatment mechanism of the Atlas™, in accordance with the available clinical data. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2149–2156, 2019

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Importance of Patella, Quadriceps Forces, and Depthwise Cartilage Structure on Knee Joint Motion and Cartilage Response During Gait

Cited by 38 publications

References 61 publications

Quantitative Evaluation of the Mechanical Risks Caused by Focal Cartilage Defects in the Knee

Quantitative Evaluation of the Mechanical Risks Caused by Focal Cartilage Defects in the Knee

Comparison of different material models of articular cartilage in 3D computational modeling of the knee: Data from the Osteoarthritis Initiative (OAI)

Effects of a Medial Knee Unloading Implant on Tibiofemoral Joint Mechanics During Walking

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