A Methodology to Evaluate the Effects of Kinematic Measurement Uncertainties on Knee Ligament Properties Estimated From Laxity Measurements

2021 ◽  
Vol 143 (6) ◽  
Author(s):  
Michael Skipper Andersen ◽  
Christine Mary Dzialo ◽  
Marco Antonio Marra ◽  
Dennis Pedersen
Keyword(s):  
Reference Strain ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Random Noise ◽  
Lateral Collateral Ligament ◽  
Measurement Noise ◽  
Collateral Ligament ◽  
Knee Ligament ◽  
Kinematic Measurement ◽  
Anterior Cruciate

Abstract Ligaments are important joint stabilizers but assessing their mechanical properties remain challenging. We developed a methodology to investigate the effects of kinematic measurement uncertainty during laxity tests on optimization-based estimation of ligament properties. We applied this methodology to a subject-specific knee model with known ligament properties as inputs and compared the estimated to the known knee ligament properties under the influence of noise. Four different sets of laxity tests were simulated with an increasing number of load cases, capturing anterior/posterior, varus/valgus, and internal/external rotation loads at 0 deg and 30 deg of knee flexion. 20 samples of uniform random noise ([−0.5,0.5] mm and degrees) were added to each set and fed into an optimization routine that subsequently estimated the ligament properties based on the noise targets. We found a large range of estimated ligament properties (stiffness ranges of 5.97 kN, 7.64 kN, 8.72 kN, and 3.86 kN; reference strain ranges of 3.11%, 2.53%, 1.88%, and 1.58% for anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medical collateral ligament (MCL), and lateral collateral ligament (LCL), respectively) for three sets of laxity tests, including up to 22 load cases. A set of laxity tests with 60 load cases kept the stiffness and reference strain ranges below 470 N per unit strain and 0.85%, respectively. These results illustrate that kinematic measurement noise have a large impact on estimated ligament properties and we recommend that future studies assess and report both the estimated ligament properties and the associated uncertainties due to kinematic measurement noise.

scholarly journals Imaging Findings of Knee Trauma on Magnetic Resonance Imaging

2022 ◽  
Vol 8 (1) ◽  
pp. 12-23
Author(s):  
Poonam Ohri ◽  
Shreeji Goya ◽  
Niveditha C ◽  
Manasi Kohli
Keyword(s):  
Anterior Cruciate Ligament ◽  
Imaging Modality ◽  
Cruciate Ligament ◽  
Age Groups ◽  
Lateral Collateral Ligament ◽  
Cost Effective ◽  
Collateral Ligament ◽  
Imaging Evaluation ◽  
Young Males ◽  
Anterior Cruciate

Background: Knee is one of the major joints involved in kinesis. With increasing involvement in sports related activities especially in young people, Trauma related knee pathologies have increased. An accurate diagnosis regarding the type and extent of injuries is essential for early operative as well as non-operative treatment. Methods:This prospective study included total of 82 cases. The patients were referred to the department of Radiodiagnosis from indoor and outdoor departments of Guru Nanak Dev Hospital, Amritsar with suspicion of internal derangement of the knee and with history of knee trauma.Results:The most common age group involved was young males between 15-34 years. In all age groups most of the patients were males. Most common ligament to be injured was Anterior Cruciate Ligament (ACL). Partial tears were more common than complete tears. Posterior Cruciate Ligament (PCL) tears were less common. Medial Collateral Ligament (MCL) tears outnumbered Lateral Collateral Ligament (LCL) tears and grade 2 tears were more common in both. Among the meniscal injuries Medial Meniscus (MM) tears were more common than LM and grade 3 signal was more common in both. Most of the patellar retinaculum injuries were associated with Anterior Cruciate Ligament ACL tears.Conclusions:Post-traumatic pre-arthroscopic MR imaging evaluation has proved to be cost-effective. MRI is an accurate imaging modality complementing the clinical evaluation and providing a global intra-articular and extra-articular assessment of the knee.

Radiological Identification of Injury to the Kaplan Fibers of the Iliotibial Band in Association With Anterior Cruciate Ligament Injury

2020 ◽  
Vol 48 (9) ◽  
pp. 2213-2220
Author(s):  
Lachlan M. Batty ◽  
Jerome Murgier ◽  
Julian A. Feller ◽  
Richard O’Sullivan ◽  
Kate E. Webster ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Acl Injury ◽  
Iliotibial Band ◽  
Time Interval ◽  
Collateral Ligament ◽  
Tibial Bone ◽  
Mri Scans ◽  
Anterior Cruciate

Background: Recent biomechanical studies have demonstrated that the Kaplan fibers (KFs) of the iliotibial band play a role in the control of anterolateral rotation of the knee. However, controversy exists regarding whether the KFs are injured in conjunction with anterior cruciate ligament (ACL) injury. Purpose: To establish the prevalence of radiological injury to the KFs in the ACL-injured knee; to evaluate the effect of the time interval between injury and magnetic resonance imaging (MRI) on diagnosis of KF injury; and to assess for any association between KF injury and other qualitative radiological findings. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: Preoperative MRI scans were reviewed for 161 patients with ACL injury. Specific diagnostic criteria were developed and applied to identify KF injury. Chi-square testing was performed to look for associations among KF injury, the time from injury to MRI, and associated radiological knee injuries. Results: Radiological evidence of KF injury was identified in 30 (18.6%) patients. The diagnosis of KF injury was higher in patients who had MRI scans performed within 90 days of injury as compared with ≥90 days after injury (23.7 vs 6.4%; P = .010). Patients with an MRI diagnosis of KF injury had significantly higher rates of lateral meniscal injury (40% vs 18%; P = .007), posteromedial tibial bone marrow edema (73% vs 44%; P = .003), and injury to the lateral collateral ligament (13% vs 3%; P = .019) or medial collateral ligament (23% vs 8%; P = .019). Conclusion: The prevalence of injury to the KF in patients with ACL injury as diagnosed by MRI was relatively low (18.6% of patients). However, the time interval from injury to MRI was relevant to diagnosis, with significantly higher rates of injury identification in patients with early (within 90 days) versus delayed (≥90 days) MRI. KF injury was associated with higher rates of injury to the lateral meniscal and collateral ligaments, as well as posteromedial tibial bone bruising.

Returning a Division I Hurdler to Sport After Multiple Knee Ligament Injuries

2020 ◽  
pp. 1-6
Author(s):  
Xavier D. Thompson ◽  
Brianna DiAntonio
Keyword(s):  
Cruciate Ligament ◽  
Lateral Collateral Ligament ◽  
Neuromuscular Control ◽  
Biceps Femoris ◽  
Patient Reported Outcome ◽  
Return To Play ◽  
Knee Ligament ◽  
Patient Reported ◽  
Anterior Cruciate ◽  
Knee Ligament Injuries

An 18-year-old male hurdler reported to preparticipation physicals, with a history of anterior cruciate ligament, lateral collateral ligament, and posterior cruciate ligament sprain; medial meniscocapsular sprain; and biceps femoris tendon avulsion. The patient received full clearance from his surgeon, despite functional deficits. Rehabilitation and return-to-play decision making included analysis of patient-reported outcome scores and tests of symmetry and neuromuscular control. After graduated intervention and multiple batteries of assessments, the patient was allowed to return to full participation. The nature of this sport and the time between surgery and the intervention made thorough evaluation of function and graduated progression a necessity.

scholarly journals TÉCNICA DE LARSON ORIGINAL MODIFICADA PARA LA RECONSTRUCCIÓN DEL LIGAMENTO COLATERAL LATERAL DE LA RODILLA, REPORTE DE UN CASO.

2021 ◽  
Vol 31 (2) ◽  
pp. 107-113
Author(s):  
Mario Carlos Morales Viteri ◽  
Luis Francisco Llerena Freire ◽  
Karen Estefanía Benavides Vargas ◽  
Daniel Alejandro Álvarez Guerrero ◽  
Cristina Elizabeth Heredia Montenegro ◽  
...  
Keyword(s):  
External Rotation ◽  
Cruciate Ligament ◽  
Functional Limitation ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Sports Activity ◽  
Posterolateral Complex ◽  
The Right ◽  
Static Stabilizer ◽  
Important Structure

The lateral collateral ligament (LCL), which is part of the knee stabilizers, constitutes an important structure within the posterolateral complex of the same (CPL), which restricts the varus, in the flexion angles of this, especially at 30°, in addition to controlling external rotation. Lesions that affect this complex are infrequent, etiologically between 50-90% are associated with other ligamentous injuries with a predominance of 60% damage to the posterior cruciate ligament. The Larson technique is based on the reconstruction of the LCL and the popliteal complex, using a single proximal insertion in the femoral epicondyle.We present the case of a 28-year-old male patient, with no medical history, who attended due to a forced varus of the limb while performing sports activity and after receiving a direct impact on the internal lateral region of the right calf, after which he presented pain to passive movements and inability to ambulation. In addition, he presents ecchymosis, edema, superficial abrasions on the external lateral aspect and pain on acupressure in the course of the external collateral ligament. A knee examination maneuvers: positive varus yawn sign, positive patellar brushing, positive patella hyperpressure, functional limitation to flexion and extension of the joint.This modified Larson technique turns out to be one of the most promising due to its various characteristics, as the least demanding and at the same time providing encouraging results. This procedure is based on the reconstruction of the LCL and the popliteal tendon (PT) as a whole, thus summarizing the reconstruction of the Peroneal Popliteal Ligament (LPP) as a static stabilizer of the PT, with its insertion at the level of the head of the fibula in conjunction with the of the LCL and the restitution of both attachments in the femoral epicondyle, taking into account the morphology of the fibula and the angles of movement of the knee.

The Joint Biomechanics Change by Different Anterior Cruciate Ligament Constitutive Models Under Axial Torque Load

2012 ◽  
Author(s):  
Chao Wan ◽  
Zhixiu Hao ◽  
Shizhu Wen
Keyword(s):  
Knee Joint ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Constitutive Models ◽  
Collateral Ligament ◽  
Torque Load ◽  
Joint Biomechanics ◽  
Hyperelastic Model ◽  
Anterior Cruciate ◽  
Anterior Posterior

According to the previous papers, it was demonstrated that anterior cruciate ligament (ACL) played an important role in resisting the coupled anterior-posterior laxity rather than the rotation laxity under axial torque load of knee joint. In the biomechanics simulation research of knee joint, some different ligament constitutive models were presented to describe the ACL material behavior. However, there is few published paper to study the effect of variable ligament constitutive model on the joint biomechanics under axial torque load. In this paper, a 3-dimension finite element model of an intact tibiofemoral joint including all the main anatomical structures was reconstructed and two ACL constitutive models were compared under 10 Nm femur external torque load. The two ACL constitutive models corresponded to an isotropic hyperelastic model and a transversely isotropic hyperelastic model considering fiber effect, respectively. All the ACL material properties of the two constitutive models were defined by fitting the same stress-strain data. Another model with ACL resected was also analyzed under the same load to estimate the function ACL played under joint axial torque load. It was found that the resection of ACL changed the knee joint deformations significantly in all directions except the distal-proximal translation. In the ACL resected joint model, the internal-external rotation, anterior-posterior and medial-lateral translations increased by about 20%, 500% and 600%, respectively. Comparing to the ACL intact joint model, the Mises stress values of medial collateral ligament decreased while that on lateral collateral ligament increased greatly (from 35 MPa to 61 MPa). In the comparison of the two different ACL constitutive models, the internal-external rotation, as the highest deformation of the knee joint, changed by about 11% and the maximal deformation alteration was obtained in the anterior-posterior translation (about 80%). Both the highest stress value and distribution on ACL have altered mostly while the Mises stress distributions of other ligaments and menisci have changed slightly. The alteration of joint kinematics and ligament biomechanics by different ACL constitutive models would be due to the different descriptions of the material transverse behavior and the real complex ACL stress distribution under an axial torque load, although the longitudinal material behaviors described by different ACL constitutive models were almost the same based on the same experiment data.

Incidence of Associated Knee Lesions with Torn Anterior Cruciate Ligament: Retrospective Cohort Assessment

1998 ◽  
Vol 7 (1) ◽  
pp. 1-8 ◽  
Author(s):  
George A. Arangio ◽  
Edward W. Cohen
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
Cruciate Ligament ◽  
Lateral Meniscus ◽  
Lateral Collateral Ligament ◽  
Collateral Ligament ◽  
Posterior Oblique Ligament ◽  
Anterior Cruciate Ligament Injuries ◽  
Arcuate Ligament ◽  
Anterior Cruciate

The records of 141 consecutive patients with confirmed complete anterior cruciate ligament injuries were reviewed retrospectively. One hundred and sixty-two associated injuries were divided into 25 injury complexes. Isolated injuries to the anterior cruciate ligament occurred in 40 cases (28.4%). Injuries of the medial meniscus occurred in 62 cases (38.2%), while injuries of the lateral meniscus occurred in 37 cases (22.8%). Injuries to the medial collateral ligament complex occurred in 42 cases (25.9%). Injuries to the lateral collateral ligament, posterior deep popliteus-arcuate ligament complex, and posterior cruciate ligament were found to be positively correlated (rho = .81, p = .001, and rho = .77, p = .001, N = 141, respectively). Injuries to the medial collateral ligament and the posterior oblique ligament were likewise positively correlated (rho = .45, p = .001, N = 141).

The Effect of Hamstring Tendon Autograft Harvest on the Restoration of Knee Stability in the Setting of Concurrent Anterior Cruciate Ligament and Medial Collateral Ligament Injuries

2017 ◽  
Vol 46 (1) ◽  
pp. 163-170 ◽  
Author(s):  
Thomas J. Kremen ◽  
Landon S. Polakof ◽  
Sean S. Rajaee ◽  
Trevor J. Nelson ◽  
Melodie F. Metzger
Keyword(s):  
Anterior Cruciate Ligament ◽  
Medial Collateral Ligament ◽  
External Rotation ◽  
Cruciate Ligament ◽  
Knee Stability ◽  
Hamstring Autograft ◽  
Collateral Ligament ◽  
Intact State ◽  
Anterior Cruciate ◽  
Acl Deficient

Background: A hamstring autograft is commonly used in anterior cruciate ligament (ACL) reconstruction (ACLR); however, there is evidence to suggest that the tendons harvested may contribute to medial knee instability. Hypothesis: We tested the hypothesis that the gracilis (G) and semitendinosus (ST) tendons significantly contribute to sagittal, coronal, and/or rotational knee stability in the setting of ACLR with a concurrent partial medial collateral ligament (MCL) injury. Study Design: Controlled laboratory study. Methods: Twelve human cadaveric knees were subject to static forces applied to the tibia including an anterior-directed force as well as varus, valgus, and internal and external rotation moments to quantify laxity at 0°, 30°, 60°, and 90° of flexion. The following ligament conditions were tested on each specimen: (1) ACL intact/MCL intact, (2) ACL deficient/MCL intact, (3) ACL deficient/partial MCL injury, and (4) ACLR/partial MCL injury. To quantify the effect of muscle loads, the quadriceps, semimembranosus, biceps femoris, sartorius (SR), ST, and G muscles were subjected to static loads. The loads on the G, ST, and SR could be added or removed during various test conditions. For each ligament condition, the responses to loading and unloading the G/ST and SR were determined. Three-dimensional positional data of the tibia relative to the femur were recorded to determine tibiofemoral rotations and translations. Results: ACLR restored anterior stability regardless of whether static muscle loads were applied. There was no significant increase in valgus motion after ACL transection. However, when a partial MCL tear was added to the ACL injury, there was a 30% increase in valgus rotation ( P < .05). ACLR restored valgus stability toward that of the intact state when the G/ST muscles were loaded. A load on the SR muscle without a load on the G/ST muscles restored 19% of valgus rotation; however, it was still significantly less stable than the intact state. Conclusion: After ACLR in knees with a concurrent partial MCL injury, the absence of loading on the G/ST did not significantly alter anterior stability. Simulated G/ST harvest did lead to increased valgus motion. These results may have important clinical implications and warrant further investigation to better outline the role of the medial hamstrings, particularly among patients with a concomitant ACL and MCL injury. Clinical Relevance: A concurrent ACL and MCL injury is a commonly encountered clinical problem. Knowledge regarding the implications of hamstring autograft harvest techniques on joint kinematics may help guide management decisions.

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