Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies

Osborne, Jeffrey; Łuczak, Sylwia; Acker, William B.; Bicos, James

doi:10.3928/01477447-20190118-05

Cited by 6 publications

(5 citation statements)

References 45 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…However, despite the improvement of patella tracking, complete restoration to physiological alignment did not occur. The present results are in line with those of a variety of other studies, even though comparism of the actual values to those in the other studies is limited due to the use of diferent examination techniques [22,30,34]. Isometric muscle contractions revealed slightly larger patellofemoral contact areas than did the absence of muscular activity, conirming trends reported in previously published studies, although Gold et al reported considerably larger contact areas [6].…”

Section: Discussionsupporting

confidence: 91%

Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness

Pohlig

Lenze

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

Purpose Arthroscopic lateral retinacular release (LRR) has long been considered the gold standard for the treatment for anterior knee pain caused by lateral retinacular tightness (LRT). However, one-third of patients experience continuous pain postoperatively, which is thought to be related to persistent maltracking of the patella and altered femoro-tibial kinematics. Therefore, the aim of the present study was to simultaneously assess femoro-tibial and patello-femoral kinematics and identify the influence of arthroscopic LRR. Methods Sixteen healthy volunteers and 12 patients with unilateral, isolated LRT were prospectively included. Open MRI scans with and without isometric quadriceps contraction were performed in 0°, 30° and 90° of knee flexion preoperatively and at 12 months after surgery. Patellar shift, tilt angle, patello-femoral contact area and magnitude of femoro-tibial rotation were calculated by digital image processing. Results Postoperatively, patellar shift was significantly reduced at 90° of knee flexion compared to preoperative values. The postoperative patellar tilt angle was found to be significantly smaller at 30° of knee flexion compared to that preoperatively. Isometric muscle contractions did not considerably influence patellar shift or tilt in either group. The patello-femoral contact area increased after LRR over the full range of motion (ROM), with significant changes at 0° and 90°. Regarding femoro-tibial kinematics, significantly increased femoral internal rotation at 0° was observed in the patient group preoperatively, whereas the magnitude of rotation at 90° of knee flexion was comparable to that of healthy individuals. The pathologically increased femoral internal rotation at 30° without muscular activity could be significantly decreased by LRR. With isometric quadriceps contraction no considerable improvement of femoral internal rotation could be achieved by LRR at 30° of knee flexion. Conclusions Patello-femoral and femoro-tibial joint kinematics could be improved, making LRR a viable surgical option in carefully selected patients with isolated LRT. However, pathologically increased femoral internal rotation during early knee flexion remained unaffected by LRR and thus potentially accounts for persistent pain. Level of evidence II.

show abstract

Section: Discussionsupporting

confidence: 91%

Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness

Pohlig

Lenze

et al. 2021

Knee Surg Sports Traumatol Arthrosc

View full text Add to dashboard Cite

show abstract

“…By midflexion, concerns of instability caused by graft loosening were somewhat mitigated by the degree of constraint provided to the patella by the anatomy of the trochlear groove, although this can vary depending on the degree of patella alta and trochlea dysplasia. 20,36 The adductor sling and adductor transfer techniques were significantly more anisometric with these grafts tightening as the knee flexed. Graft tightening can lead to loss of ROM, pain, graft stretching, and, ultimately, graft failure with future recurrent instability.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

et al. 2020

View full text Add to dashboard Cite

Background: Adult medial patellofemoral ligament (MPFL) reconstruction techniques are not appropriate for the skeletally immature patient given the proximity of the distal femoral physis. Biomechanical consequences of reconstructions aimed at avoiding the physis have not been adequately studied. Purpose: To quantify the biomechanical effects of MPFL reconstruction techniques intended for skeletally immature patients. Study Design: Controlled laboratory study Methods: Four MPFL reconstruction techniques were evaluated using a computationally augmented cadaveric model: (1) Schoettle point: adult-type reconstruction; (2) epiphyseal: socket distal to the femoral physis; (3) adductor sling: graft wrapped around the adductor tendon; (4) adductor transfer: adductor tendon transferred to patella. A custom testing frame was used to cycle 8 knees for each technique from 10° to 110° of flexion. Patellofemoral kinematics were recorded using a motion camera system, contact stresses were recorded using Tekscan pressure sensors, and MPFL length was computed using an inverse kinematics computational model. Change in MPFL length, patellar facet forces, and patellar kinematics were compared using generalized estimating equation modeling. Results: Schoettle point reconstruction was the most isometric, demonstrating isometry from 10° to 100°. The epiphyseal technique was isometric until 60°, after which the graft loosened with increasing flexion. The adductor sling and adductor transfer techniques were significantly more anisometric from 40° to 110°. Both grafts tightened with knee flexion and resulted in significantly more lateral patellar tilt versus the intact state in early flexion and significantly higher contact forces on the medial facet versus the epiphyseal technique in late flexion. Conclusion: In this cadaveric simulation, the epiphyseal technique allowed for a more isometric ligament until midflexion, when the patella engaged within the trochlear groove. The adductor sling and adductor transfer grafts became tighter in flexion, resulting in potential loss of motion, pain, graft stretching, and failure. Marginal between-condition differences in patellofemoral contact mechanics and patellar kinematics were observed in late flexion. Clinical Relevance: In the skeletally immature patient, using an epiphyseal type MPFL reconstruction with the femoral attachment site distal to the physis results in a more isometric graft compared with techniques with attachment sites proximal to the physis.

show abstract

“…The increased access to the joint in this approach greatly simplifies measurements of patellar kinematics using optical [32,33] or other [34,35] motion tracking techniques. Contact forces and pressure can be measured in vitro through the use of pressure-sensitive films [36][37][38]. Mechanical stability of the patellofemoral joint can also be quantified by applying a force to the patella and measuring the resulting displacement [35,39,40].…”

Section: In Vitromentioning

confidence: 99%

Patellofemoral Mechanics: a Review of Pathomechanics and Research Approaches

Wheatley

Rainbow

Clouthier

2020

Curr Rev Musculoskelet Med

View full text Add to dashboard Cite

Purpose of ReviewThe patellofemoral joint is a complicated articulation of the patella and femur that is prone to pathologies. The purpose of this review is to report on the current methods of investigating patellofemoral mechanics, factors that affect joint function, and future directions in patellofemoral joint research with emerging technologies and techniques. Recent Findings While previous hypotheses have suggested that the patella is only a moment arm extender, recent literature has suggested that the patella influences the control of knee moments and forces acting on the tibia as well as contributes to various aspects of patellar function with minimal neural input. With advancements in simulating a six-degrees-of-freedom patellofemoral joint, we have gained a better understanding of patella motion and have shown that geometry and muscle activations impact patella mechanics. Research into influences on patella mechanics from other joints such as the hip and foot has become more prevalent. Summary In this review, we report current in vivo, in vitro, and in silico approaches to studying the patellofemoral joint. Kinematic and anatomical factors that affect patellofemoral joint function such as patella alta and tilt or bone morphology and ligaments are discussed. Moving forward, we suggest that advanced in vivo dynamic imaging methods coupled to musculoskeletal simulation will provide further understanding of patellofemoral pathomechanics and allow engineers and clinicians to design interventions to mitigate or prevent patellofemoral pathologies.

show abstract

Patellofemoral Joint Contact Pressures: Current Concepts and Use in Patellar Instability Studies

Cited by 6 publications

References 45 publications

Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness

Arthroscopic lateral retinacular release improves patello-femoral and femoro-tibial kinematics in patients with isolated lateral retinacular tightness

Comparison of Ligament Isometry and Patellofemoral Contact Pressures for Medial Patellofemoral Ligament Reconstruction Techniques in Skeletally Immature Patients

Patellofemoral Mechanics: a Review of Pathomechanics and Research Approaches

Contact Info

Product

Resources

About