Changes in Tibiofemoral Kinematics and Kinetics During Stair Ascent After Partial Medial Meniscectomy

2008 ◽  
Author(s):  
Nathan A. Netravali ◽  
Thomas P. Andriacchi
Keyword(s):  
Cruciate Ligament ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Ligament Injury ◽  
Medial Meniscectomy ◽  
Surrogate Measure ◽  
Anterior Cruciate ◽  
Tibiofemoral Kinematics ◽  
Kinematics And Kinetics

Meniscectomy is a well-known risk factor for osteoarthritis (OA) in humans. It has been reported that total meniscectomy increases the risk of developing osteoarthritis radiographically by 14 times after 21 years [1] and that partial meniscectomy increases the risk of developing radiographic evidence of osteoarthritis within 16 years by a factor of four [2]. Two possible functional measures have been suggested as mechanisms for the development and progression of premature knee osteoarthritis: alterations in either kinematics or kinetics. Changes in kinematics, such as a shift in internal-external (IE) rotation after anterior cruciate ligament injury, have been suggested as a basis for an increased rate of cartilage thinning [3]. The other possible reason for the development of premature OA post-meniscectomy is a change in kinetics, the mechanical loading that occurs, particularly in the medial compartment [4]. The knee adduction moment has been associated with the rate of progression of osteoarthritis [5] and it has thus been suggested that the knee adduction moment is a good surrogate measure for in vivo load on the medial compartment osteoarthritis [6].

The effect of unloader knee braces on medial meniscal strain

2018 ◽  
Vol 43 (2) ◽  
pp. 132-139 ◽  
Author(s):  
Mayank Kalra ◽  
Ryan Bakker ◽  
Sebastian S Tomescu ◽  
Anna M Polak ◽  
Micah Nicholls ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Injury Risk ◽  
Medial Meniscus ◽  
Cruciate Ligament ◽  
Meniscal Tear ◽  
Compressive Force ◽  
Ligament Injury ◽  
Knee Braces ◽  
Anterior Cruciate

Background: A medial meniscal tear is a common knee injury, especially following an anterior cruciate ligament injury. Decreasing the compressive force on the medial meniscus during dynamic activities using an unloader knee brace could reduce meniscal strain, effectively reducing injury risk and/or severity. Objectives: To investigate the efficacy of two unloader knee braces on medial meniscus strain during dynamic activities in intact & deficient anterior cruciate ligament states. Study design: Combined in vivo/in vitro study. Methods: In vivo knee kinematics and muscle force profiles from a healthy individual performing single/doubleleg squats and walking motions were simulated on 10 cadaveric specimens using a dynamic knee simulator system. Simulations were performed on knees in unbraced and braced scenarios, with and without the anterior cruciate ligament. Anterior and posterior medial meniscal strains were measured. Results: Two different braces each showed a significant reduction in the posteromedial meniscal strain ( p ⩽ 0.01) in an intact anterior cruciate ligament state. Neither brace mirrored this result for the anteromedial strain ( p > 0.05). In the deficient anterior cruciate ligament state, the braces had no significant effect on strain ( p > 0.05). Conclusion: Two unloader knee braces effectively reduced strain in the medial meniscus with an intact anterior cruciate ligament during dynamic activities. Neither brace made a significant reduction in strain for anterior cruciate ligament-deficient knees. Clinical relevance Unloader knee braces could be used to reduce the medial meniscus strain following meniscal surgery and during rehabilitation in patients with an isolated medial meniscus injury. However, these braces cannot be recommended for this purpose in patients with an anterior cruciate ligament deficiency.

The Contribution of Partial Meniscectomy to Preoperative Laxity and Laxity After Anatomic Single-Bundle Anterior Cruciate Ligament Reconstruction: In Vivo Kinematics With Navigation

2019 ◽  
Vol 47 (13) ◽  
pp. 3203-3211
Author(s):  
Alberto Grassi ◽  
Stefano Di Paolo ◽  
Gian Andrea Lucidi ◽  
Luca Macchiarola ◽  
Federico Raggi ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Acl Reconstruction ◽  
Knee Flexion ◽  
Cruciate Ligament ◽  
Single Bundle ◽  
Anatomic Acl Reconstruction ◽  
Medial Meniscectomy ◽  
Lateral Meniscectomy ◽  
Anterior Cruciate

Background: Limited in vivo kinematic information exists on the effect of clinical-based partial medial and lateral meniscectomy in the context of anterior cruciate ligament (ACL) reconstruction. Hypothesis: In patients with ACL deficiency, partial medial meniscus removal increases the anteroposterior (AP) laxity with compared with those with intact menisci, while partial lateral meniscus removal increases dynamic laxity. In addition, greater postoperative laxity would be identified in patients with partial medial meniscectomy. Study design: Cross-sectional study; Level of evidence, 3. Methods: A total of 164 patients with ACL tears were included in the present study and divided into 4 groups according to the meniscus treatment they underwent: patients with partial lateral meniscectomy (LM group), patients with partial medial meniscectomy (MM group), patients with partial medial and lateral meniscectomy (MLM group), and patients with intact menisci who did not undergo any meniscus treatment (IM group). A further division in 2 new homogeneous groups was made based on the surgical technique: 46 had an isolated single-bundle anatomic ACL reconstruction (ACL group), while 13 underwent a combined single-bundle anatomic ACL reconstruction and partial medial meniscectomy (MM-ACL group). Standard clinical laxities (AP translation at 30° of knee flexion, AP translation at 90° of knee flexion) and pivot-shift (PS) tests were quantified before and after surgery by means of a surgical navigation system dedicated to kinematic assessment. The PS test was quantified through 3 different parameters: the anterior displacement of the lateral tibial compartment (lateral AP); the posterior acceleration of the lateral AP during tibial reduction (posterior acceleration); and finally, the area included by the lateral AP translation with respect to the flexion/extension angle (area). Results: In the ACL-deficient status, the MM group showed a significantly greater tibial translation compared with the IM group ( P < .0001 for AP displacement at 30° [AP30] and 90° [AP90] of flexion) and the LM group ( P = .002 for AP30 and P < .0001 for AP90). In the PS test, the area of LM group was significantly larger (57%; P = .0175) than the one of the IM group. After ACL reconstruction, AP translation at 30° was restored, while the AP90 remained significantly greater at 1.3 mm ( P = .0262) in the MM-ACL group compared with those with intact menisci. Conclusion: Before ACL reconstruction, partial medial meniscectomy increased AP laxity at 30° and 90° and lateral meniscectomy increased dynamic PS laxity with respect to intact menisci. Anatomic single-bundle ACL reconstruction decreased laxities, but a residual anterior translation of 1.3 mm at 90° remained in patients with partial medial meniscectomy, with respect to those with intact menisci.

Muscle Forces May Explain Paradoxical Knee Loads During Different Gait Patterns

2010 ◽  
Author(s):  
Jonathan P. Walter ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Disease Progression ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Gait Patterns ◽  
Common Assumption ◽  
Clinical Disorder ◽  
Surrogate Measure ◽  
Gait Modification ◽  
External Knee Adduction Moment

Medial compartment knee osteoarthritis is a common clinical disorder [1] in which the articular cartilage in the medial compartment progressively deteriorates. To slow disease progression without surgical intervention, researchers have proposed gait modifications to offload the medial compartment. Since knee medial contact force (MCF) cannot be measured non-invasively in vivo, researchers have identified the external knee adduction moment (KAM) as a surrogate measure that is easy to calculate [2]. A common assumption has been that reducing the peak KAM will result in a corresponding reduction in peak MCF. While the magnitude of the peak KAM has been correlated with disease severity and rate of disease progression [3,4], it is not clear that reduction of this external load via gait modification will always result in a decrease in internal MCF.

Does the Curved Nature of the Tibia Influence the Non-Contact ACL Injury?

2012 ◽  
Author(s):  
Ariful I. Bhuiyan ◽  
Javad Hashemi ◽  
James R. Slauterbeck
Keyword(s):  
Anterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Magnetic Resonance Images ◽  
Medial Compartment ◽  
Ligament Injury ◽  
Increased Risk ◽  
Anterior Cruciate ◽  
Matlab Programming

The geometry of the tibial plateau and the femoral condyles are emerging as key parameters to be studied as anterior cruciate ligament (ACL) injury risk factors. In this paper, we study the role of curved profile of the medial compartment of the tibia in a sagittal plane as a critical risk factor for the anterior cruciate ligament (ACL) injuries. The curvature of the mid-medial compartment of Tibia in 40 uninjured controls (21 women and 19 men) and 44 anterior cruciate ligament-injured cases (23 women and 21 men) were measured using magnetic resonance images and in-house matlab programming. We hypothesized that the Individuals with a less curved profile in the medial compartment of the tibia are at increased risk of suffering an anterior cruciate ligament injury compared to those with larger curved profiles. Based on t-tests, we established that the uninjured controls had larger curvature (p<0.05) compared to the injured cases. Biomechanically speaking a larger curvature of the tibia could prevent excessive sliding movement of femur with respect to the tibia, and thus could reduce the ACL strain. We suggest that future studies are needed to confirm this relationship and to evaluate the potential role of this curved profile of tibia in the risk of ACL injury.

Prediction of Internal Contact Forces at the Knee From External Measurements

2008 ◽  
Author(s):  
Jonathan P. Walter ◽  
Scott A. Banks ◽  
Darryl D. D’Lima ◽  
Benjamin J. Fregly
Keyword(s):  
Stance Phase ◽  
Cartilage Damage ◽  
Contact Forces ◽  
Medial Compartment ◽  
Knee Adduction Moment ◽  
Baby Boomer Generation ◽  
Risk Of Disease ◽  
Surrogate Measure ◽  
External Knee Adduction Moment

As the baby boomer generation ages, knee osteoarthritis (OA) will become increasingly prevalent in our society. Articular cartilage damage in the knee is highly dependent upon subject-specific kinematics and load distribution inside the joint. In particular, researchers have hypothesized that overloading of the medial compartment is a primary contributing factor to the development of the disease [1]. However, since medial compartment load cannot be measured non-invasively in vivo, researchers typically use the external knee adduction moment during stance phase as a surrogate measure. This quantity has been correlated with the medial tibial contact force measured from an instrumented knee implant [2] and with the risk of disease progression over time [3].

scholarly journals The Contralateral Knee Joint in Cruciate Ligament Deficiency

2008 ◽  
Vol 36 (11) ◽  
pp. 2151-2157 ◽  
Author(s):  
Michal Kozanek ◽  
Samuel K. Van de Velde ◽  
Thomas J. Gill ◽  
Guoan Li
Keyword(s):  
Anterior Cruciate Ligament ◽  
Posterior Cruciate Ligament ◽  
Cruciate Ligament ◽  
Knee Kinematics ◽  
Ligament Injury ◽  
Joint Injury ◽  
Kinematic Control ◽  
Contralateral Knee ◽  
Anterior Cruciate

Background Patients with unilateral ligament deficiency are believed to have altered kinematics of the contralateral knee, increasing the risk of contralateral joint injury. Therefore, the contralateral knees might not be a reliable normal kinematic control. Purpose To compare the in vivo kinematics of the uninjured contralateral knees of patients with anterior or posterior cruciate ligament deficiency with knee kinematics of age-matched patients without joint injury. Study Design Controlled laboratory study. Methods Ten subjects with bilateral healthy knees, 10 patients with acute unilateral anterior cruciate ligament injury, and 10 with acute unilateral posterior cruciate ligament injury participated in this study. Kinematics were measured from 0° to 90° of flexion using imaging and 3-dimensional modeling. Results No significant differences were found across the groups in all rotations and translations during weightbearing flexion (P > .9). Conclusion Patients with unilateral cruciate ligament deficiency did not alter kinematics of the contralateral uninjured knee during weightbearing flexion. In addition, these findings suggest that the included patients with anterior cruciate ligament or posterior cruciate ligament deficiency did not have preexisting abnormal kinematics of the knee. Clinical Relevance As the contralateral joint kinematics of the injured patients were not affected by the ipsilateral ligament injury in the short term, physicians and researchers might use the contralateral knee as a reliable normal kinematic control.

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