Patellofemoral interactions in walking, stair ascent, and stair descent using a virtual patella model

Bischoff, Jeffrey E.; Hertzler, Justin S.; Mason, Joshua

doi:10.1016/j.jbiomech.2009.04.018

Cited by 13 publications

(6 citation statements)

References 36 publications

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“…Once we investigated how the patella is loaded during gait, we utilized these loads to perform a contact stress analysis on the resurfaced knee joint. Our calculations of stress on the resurfaced patella were consistent with the results of an earlier study, which found a maximum stress of 20MPa on the intact patella during gait [25]. Button positioning produced insignificant changes in stress on the residual patellar bone, with values of 12.45-12.57MPa.…”

Section: Oproj000631 6(2)2019supporting

confidence: 89%

The Effect of Patellar Button Placement on Gait and Patellar Stresses Following Total Knee Arthroplasty

Peresada¹

2019

OPROJ

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Background: In total knee arthroplasty with patellar resurfacing, surgeons are often faced with a choice of where to position the patellar button. Patellar button positioning has been studied in relation to patellar tracking and risk of subluxation. Consequently, medial placement has been recommended. However, postoperative gait and risk of periprosthetic complications have not been thoroughly addressed in relation to patellar button positioning.Objective: To establish a generalized criterion for patellar button positioning during total knee replacement (TKA) to reduce the risk of postoperative gait abnormalities, patellar fracture, pain, and stress wear.Methods: Five distinct button positions were analyzed. A previously-validated gait model was customized with data obtained from cadaveric patellae to evaluate individual quadriceps forces. The maximal combined quadriceps force during gait was applied to a finite element analysis model to calculate patellar von Mises stresses for all button positions, as well as for a large diameter button covering most of the patellar resurfaced area.Results: Significant differences were found in average forces exercised by individual quadriceps muscles during gait. Distal and medial configurations produced the lowest individual quadriceps muscle forces. Bone stress ranged from 12.45MPa to 12.57MPa. The button stress ranged from 11.27MPa to 17.20 MPa, with distal and centered placement, respectively. Conclusion:Patellar button positioning influences muscle forces during gait and affects the stress on the patellar button itself. Distal and medial button positions are more likely to optimize postoperative gait kinematics, while the distal position may reduce button wear. These findings provide further insight into patellar button placement..

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Section: Oproj000631 6(2)2019supporting

confidence: 89%

The Effect of Patellar Button Placement on Gait and Patellar Stresses Following Total Knee Arthroplasty

Peresada¹

2019

OPROJ

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“…The advantage of this study is very accurate measurements of patellofemoral pressure with various patella component thicknesses. There are various methods for measuring patellofemoral joint pressure [8][9][10][11][12][13][14][15][16]. In the method of measuring pressure by placing a sensor between the patellofemoral joint, the pressure sensor may shift, and the patellofemoral joint pressure may be increased due to the thickness of the pressure sensor [8,9,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…With respect to patellofemoral joint pressure, it is still in its infancy and no commercially available device capable of measuring patellofemoral joint pressure is available on the market to date. Various studies have been conducted on patellofemoral joint pressure by incorporating thin pressure sensors into implants and using nite element methods and inverse dynamics to analyze the pressure at the patellofemoral joint [8][9][10][11][12][13][14][15][16]. The clinical signi cance of patellofemoral joint pressure remains unclear, but it may be associated with, for example, implant wear, loosening, and anterior knee joint pain [5,6,14].…”

Section: Introductionmentioning

confidence: 99%

Influence of Patella Thickness on Patellofemoral Pressure in Total Knee Arthroplasty

Tanikawa¹,

Tada

Ogawa

et al. 2020

Preprint

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Background: Patellofemoral complications are one of the major issues after total knee arthroplasty (TKA). Excessive patellofemoral joint pressure is associated with complications after TKA surgery, and the amount of patellar osteotomy has a direct effect on patellofemoral joint pressure. The purpose of this study was to evaluate the influence of patella thickness on patellofemoral pressure in TKA.Methods. Five freshly frozen cadavers were operated with a custom-made Stryker posterior stabilizing type knee joint prosthesis. Patellofemoral joint pressure was measured using a pressure sensor, with the knee joint flexed from 90 to 110 degrees, and with patellar thickness of -2mm to +4mm.Results: Increasing or decreasing patellar thickness significantly increased or decreased patellofemoral pressure. Regarding knee flexion angle, patellofemoral pressure increased with increasing patellar thickness at all flexion angles, but the pressure increase was greatest at 90 degrees of knee flexion and smallest at 110 degrees.Conclusions: The amount of patellar osteotomy influences the patellofemoral pressure. Surgeons should avoid increasing patella thickness, since the resulting increased patellofemoral pressure may reduce knee joint function.

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“…[17][18][19] In contrast, however, PF joint experiences much greater forces in activities with large quadriceps exertion and knee flexion angles; for example, squat lifts, stair ascent, and extension exercises. [20][21][22][23][24][25][26][27] Accurate quantification of knee joint biomechanics in such activities is of help not only in the injury and degeneration prevention but also in the improved design of implants, rehabilitation, and treatment strategies when managing knee joint disorders.…”

Section: Introductionmentioning

confidence: 99%

Computational biomechanics of human knee joint in stair ascent: Muscle‐ligament‐contact forces and comparison with level walking

Makani

Shirazi‐Adl

Ghezelbash

2022

Numer Methods Biomed Eng

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About a third of knee joint disorders originate from the patellofemoral (PF) site that makes stair ascent a difficult activity for patients. A detailed finite element model of the knee joint is coupled to a lower extremity musculoskeletal model to simulate the stance phase of stair ascent. It is driven by the mean of measurements on the hip-knee-ankle moments-angles as well as ground reaction forces reported in healthy individuals. Predicted muscle activities compare well to the recorded electromyography data. Peak forces in quadriceps (3.87 BW, body weight, at 20% instance in our 607 N subject), medial hamstrings (0.77 BW at 20%), and gastrocnemii (1.21 BW at 80%) are estimated. Due to much greater flexion angles-moments in the first half of stance, large PF contact forces (peak of 3.1 BW at 20% stance) and stresses (peak of 4.83 MPa at 20% stance) are estimated that exceed their peaks in level walking by fourfold and twofold, respectively. Compared with level walking, ACL forces diminish in the first half of stance but substantially increase later in the second half (peak of 0.76 BW at 75% stance). Under nearly similar contact forces at 20% of stance, the contact stress on the tibiofemoral (TF) medial plateau reaches a peak (9.68 MPa) twice that on the PF joint suggesting the vulnerability of both joints. Compared with walking, stair ascent increases peak ACL force and both peak TF and PF contact stresses. Reductions in the knee flexion moment and/or angle appear as a viable strategy to mitigate internal loads and pain.

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Patellofemoral interactions in walking, stair ascent, and stair descent using a virtual patella model

Cited by 13 publications

References 36 publications

The Effect of Patellar Button Placement on Gait and Patellar Stresses Following Total Knee Arthroplasty

The Effect of Patellar Button Placement on Gait and Patellar Stresses Following Total Knee Arthroplasty

Influence of Patella Thickness on Patellofemoral Pressure in Total Knee Arthroplasty

Computational biomechanics of human knee joint in stair ascent: Muscle‐ligament‐contact forces and comparison with level walking

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