Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study

Farrokhi, Shawn; Keyak, Joyce H.; Powers, Christopher M.

doi:10.1016/j.joca.2010.12.001

Cited by 217 publications

(232 citation statements)

References 47 publications

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“…Finally, high-resolution images of the thigh in the sagittal, axial, and coronal planes (3-D SPGR sequence; repetition time, 9.4 ms; echo time, 4.1 ms; flip angle, 20; matrix, 384 9 384; field of view, 46 cm; slice thickness, 2 mm) then were acquired. These images were used to estimate the 3-D fiber orientation and the cross-sectional area of each of the quadriceps muscles [9].…”

Section: Mr Imaging and Patella Height Assessmentmentioning

confidence: 99%

“…Subjects were instrumented for kinematic and EMG analysis as described in previous studies [9,12,30]. After a standing calibration trial, subjects were asked to hold a bilateral squat position at 45°knee flexion with the trunk-maintained upright.…”

Section: Biomechanical Testingmentioning

confidence: 99%

“…2), acquired following procedures established in previous studies [9,12]. Briefly, individual subject joint geometry was obtained from the high-resolution MR images using a commercial software package (sliceOmatic TM ; TomoVision TM , Magog, Canada).…”

Section: Individual Input Variablesmentioning

confidence: 99%

“…The articular cartilage of the femur and patella was modeled using homogeneous isotropic tetrahedral continuum elements with an elastic modulus of 4.0 MPa [6] and a Poisson ratio of 0.47 [3]. The element size was set to 0.75 mm based on a previous mesh convergence analysis, which showed that a smaller element size did not result in meaningful change in the results but increased the computational time [9].…”

Section: Finite-element Modelingmentioning

confidence: 99%

“…Patellofemoral joint contact was simulated with a surface coefficient of friction of 0.02 between cartilage [3,9]. Because the soft tissues controlling the rotation of the patellofemoral joint were not included in the models (such as ligaments and peripatellar retinaculum), the rotational degrees of freedom of the patella were constrained in the frontal and transverse planes.…”

Section: Finite-element Modelingmentioning

confidence: 99%

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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: Mr Imaging and Patella Height Assessmentmentioning

confidence: 99%

Section: Biomechanical Testingmentioning

confidence: 99%

Section: Individual Input Variablesmentioning

confidence: 99%

Section: Finite-element Modelingmentioning

confidence: 99%

Section: Finite-element Modelingmentioning

confidence: 99%

See 3 more Smart Citations

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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Is Patellofemoral Osteoarthritis Common in Middle‐Aged People With Chronic Patellofemoral Pain?

Hinman

Lentzos

Vicenzino

et al. 2014

Arthritis Care & Research

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Relation of Patellofemoral Joint Alignment, Morphology, and Radiographic Osteoarthritis to Frequent Anterior Knee Pain: Data from the Multicenter Osteoarthritis Study

Macri

Neogi

Tolstykh

et al. 2020

Arthritis Care & Research

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Objective. Patellofemoral (PF) alignment and trochlear morphology are associated with PF osteoarthritis (OA) and knee pain, but whether they are associated with localized anterior knee pain is unknown, which is believed to be a symptom specific to PF joint pathology. We therefore aimed to evaluate the relation of PF alignment and morphology, as well as PFOA and tibiofemoral OA, to anterior knee pain.Methods. The Multicenter Osteoarthritis Study is a cohort study of individuals with, or at risk for, knee OA. We evaluated cross-sectional associations of PF alignment, trochlear morphology, and PF and tibiofemoral radiographic OA, with localized anterior knee pain (defined with a pain map). We used 2 approaches: a within-person kneematched evaluation of participants with unilateral anterior knee pain (conditional logistic regression), and a cohort approach comparing those with anterior knee pain to those without (binomial regression).Results. With the within-person knee-matched approach (n = 110; 64% women, mean age 70 years, body mass index [BMI] 30.9), PF alignment, morphology, and tibiofemoral OA were not associated with unilateral anterior knee pain. Radiographic PFOA was associated with pain, odds ratio 5.3 (95% confidence interval [95% CI] 1.6-18.3). Using the cohort approach (n = 1,818; 7% of knees with anterior knee pain, 59% women, mean age 68 years, BMI 30.4), results were similar: only PFOA was associated with pain, with a prevalence ratio of 2.2 (95% CI 1.4-3.4).Conclusion. PF alignment and trochlear morphology were not associated with anterior knee pain in individuals with, or at risk for, knee OA. Radiographic PFOA, however, was associated with pain, suggesting that features of OA, more so than mechanical features, may contribute to localized symptoms.

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Individuals with patellofemoral pain exhibit greater patellofemoral joint stress: a finite element analysis study

Cited by 217 publications

References 47 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

Is Patellofemoral Osteoarthritis Common in Middle‐Aged People With Chronic Patellofemoral Pain?

Relation of Patellofemoral Joint Alignment, Morphology, and Radiographic Osteoarthritis to Frequent Anterior Knee Pain: Data from the Multicenter Osteoarthritis Study

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