A new method to measure post-traumatic joint contractures in the rabbit knee

A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9 deg +/- 1.5 deg (mean +/- sd) with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6 deg +/- 7.1 deg, and of the four right knees (tested 26 times) was 12.0 deg +/- 10.9 deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint extension (flexion contracture) was demonstrated for the experimental knees using the new methodology where the maximum extension was 35 deg +/- 9 deg, compared to the unoperated knee maximum extension of 11 deg +/- 7 deg, 10 or 12 weeks after the immobilization was discontinued. The custom gripping device coupled to a materials testing machine will serve as a measurement test for future studies characterizing a rabbit knee model of post-traumatic joint contractures.     

Forces acting on the patella during maximal voluntary contraction of the quadriceps femoris muscle at different knee flexion/extension angles

From knee extension moments measured with a dynamometer, the quadriceps muscle force, the patellar ligament force and the reaction force in the patellofemoral joint at various knee angles (0-90 degrees) were estimated. The information needed to calculate the combined effect of both patellofemoral and tibiofemoral joint on the mechanical advantage of the muscle was obtained from lateral-view radiographs of autopsy knees. The results show that the smallest quadriceps force (2,000 N) is exerted at maximal extension, and the largest force (8,000 N) at about 75 degrees of flexion. The patellar ligament force reaches a maximum (5,000 N) at 60 degrees. The reaction force in the patellofemoral joint is the smallest (1,000 N) at extension and is of the same values as the muscle force in a range from 75 to 90 degrees. Especially at large flexion angles, the value of the estimated forces is considerably larger (by 100%) than reported in the literature. This difference is attributed to the influence of the patellofemoral joint on the mechanical advantage of the muscle, which has not been taken into account in other studies.     

Tibiofemoral joint contact force in deep knee flexion and its consideration in knee osteoarthritis and joint replacement

The aim of the study was to estimate the tibiofemoral joint force in deep flexion to consider how the mechanical load affects the knee. We hypothesize that the joint force should not become sufficiently large to damage the joint under normal contact area, but should become deleterious to the joint under the limited contact area. Sixteen healthy knees were analyzed using a motion capture system, a force plate, a surface electromyography, and a knee model, and then tibiofemoral joint contact forces were calculated. Also, a contact stress simulation using the contact areas from the literature was performed. The peak joint contact forces (M +/- SD) were 4566 +/- 1932 N at 140 degrees in rising from full squat and 4479 +/- 1478 N at 90 degrees in rising from kneeling. Under normal contact area, the tibiofemoral contact stresses in deep flexion were less than 5 MPa and did not exceed the stress to damage the cartilage. The contact stress simulation suggests that knee prosthesis having the contact area smaller than 200 mm2 may be problematic since the contact stress in deep flexion would become larger than 21 MPa, and it would lead damage or wear of the polyethylene.     

In vivo passive mechanical properties of the human gastrocnemius muscle belly

The purpose of the present study was to determine the in vivo passive mechanical properties, including the length below the slack length, of the gastrocnemius muscle (GAS) belly in humans. Transverse ultrasound images of the medial head of the GAS were taken in 11 subjects during passive knee extension from 80 degrees to 5 degrees with a constant ankle joint angle of 10 degrees (0 degrees is the neutral ankle position: positive values for dorsiflexion). The change in passive ankle joint moment (Mp), which is produced only by the GAS length change, was also measured during passive knee extension. The onset of Mp during passive knee extension was found to be 43+/-8 degrees (mean+/-SD) when the baseline of the Mp was set at the average Mp in the range of 55-60 degrees where the Mp was almost constant (SD<0.03 Nm). At this onset, the muscle fascicle length of the GAS (Lf) was 46+/-7 mm (slack length; Lfs). Lf at 80 degrees was 6+/-4 mm (13+/-6%) less than the Lfs, and Lf at 5 degrees was 12+/-5 mm (27+/-11%) greater than the Lfs. The passive force-resisting compression of the GAS did not produce a dorsiflexion moment in the joint angle range adopted. The passive ankle joint moment increased linearly with Lf (coefficient of determination (R2)=0.85-0.96), and the slopes of the relationships between Lf and Mp, and between the relative Lf to Lfs and Mp were 0.093+/-0.038 Nm/mm and 0.043+/-0.021 Nm/%Lfs. The findings of the present study can be implemented in musculoskeletal modeling, which would provide a more accurate evaluation of the passive mechanical properties of muscle during movement.     

Biomechanical properties of tendons during lower-leg lengthening in dogs using the Ilizarov method.

Ten dogs were provided with a circular fixator. Segment resection of the fibula and tibial osteotomy in the right lower leg was performed. 5 days after surgery, a lengthening of the right lower leg by 2.5 cm was performed on 6 dogs using a distraction rate of 0.5 mm, twice per day. 3 dogs with leg lengthening and 2 dogs of the control group without leg lengthening were sacrificed at the end of the distraction phase of 25 days and the remaining dogs after another 25 days. Postmortally the tendons of the tibialis anterior, extensor digitorum longus, peroneus longus and the achilles tendon were taken from the operated right side and the left non-operated control side and were examined biomechanically in cyclic tests. The control group without lengthening showed no changes in the biomechanical properties in the tendons of either side nor in those of the unlengthened left side of the operated dogs. In contrast the biomechanical tests revealed a marked decrease of the elastic modulus, an increase of distraction length and an increase of modulus reduction on the lengthened side compared to the non-operated left side.     

Effects of gender and foot-landing techniques on lower extremity kinematics during drop-jump landings

The purpose of this study was to assess kinematic lower extremity motion patterns (hip flexion, knee flexion, knee valgus, and ankle dorsiflexion) during various foot-landing techniques (self-preferred, forefoot, and rear foot) between genders. 3-D kinematics were collected on 50 (25 male and 25 female) college-age recreational athletes selected from a sample of convenience. Separate repeated-measures ANOVAs were used to analyze each variable at three time instants (initial contact, peak vertical ground reaction force, and maximum knee flexion angle). There were no significant differences found between genders at the three instants for each variable. At initial contact, the forefoot technique (35.79 degrees +/- 11.78 degrees ) resulted in significantly (p = .001) less hip flexion than did the self-preferred (41.25 degrees +/- 12.89 degrees ) and rear foot (43.15 degrees +/- 11.77 degrees ) techniques. At peak vertical ground reaction force, the rear foot technique (26.77 degrees +/- 9.49 degrees ) presented significantly lower (p = .001) knee flexion angles as compared with forefoot (58.77 degrees +/- 20.00 degrees ) and self-preferred (54.21 degrees +/- 23.78 degrees ) techniques. A significant difference for knee valgus angles (p = .001) was also found between landing techniques at peak vertical ground reaction force. The self-preferred (4.12 degrees +/- 7.51 degrees ) and forefoot (4.97 degrees +/- 7.90 degrees ) techniques presented greater knee varus angles as compared with the rear foot technique (0.08 degrees +/- 6.52 degrees ). The rear foot technique created more ankle dorsiflexion and less knee flexion than did the other techniques. The lack of gender differences can mean that lower extremity injuries (e.g., ACL tears) may not be related solely to gender but may instead be associated with the landing technique used and, consequently, the way each individual absorbs jump-landing energy.     

Empirical relationship between lengthening an anterior cruciate ligament graft and increases in knee anterior laxity: a human cadaveric study

Lengthening of an anterior cruciate ligament (ACL) graft construct can occur as a result of lengthening at the sites of tibial and/or femoral fixation and manifests as an increase in anterior laxity. Although lengthening at the site of fixation has been measured for a variety of fixation devices, it is difficult to place these results in a clinical context because the mathematical relationship between lengthening of an ACL graft construct and anterior laxity is unknown. The purpose of our study was to determine empirically this relationship. Ten cadaveric knees were reconstructed with a double-looped tendon graft. With the knee in 25 degrees of flexion, the position of the proximal end of the graft inside the femoral tunnel was adjusted by moving the femoral fixation device until the anterior laxity at an applied anterior force of 134 N matched that of the intact knee. In random order, the graft construct was lengthened 1, 2, 3, 4, and 5 mm by moving the femoral fixation device distally along the femoral tunnel and anterior laxity was measured. The increase in the length of the graft construct was related to the increase in anterior laxity by a simple linear regression model. Lengthening the graft construct from 1 to 5 mm caused an equal increase in anterior laxity (slope=1.0 mmmm, r(2)=0.800, p<0.0001). Because an anterior laxity increase of 3 mm or greater in a reconstructed knee is considered unstable clinically and because many fixation devices in widespread use clinically allow 3 mm or greater of lengthening in in vitro tests, our empirical relationship indicates that lengthening at the site of fixation probably is an important cause of knee instability following ACL reconstructive surgery. Our empirical relation also indicates that an important criterion in the design of future fixation devices is that lengthening at the sites of fixation in in vitro tests should be limited to less than 3 mm.     

Myofascial force transmission: muscle relative position and length determine agonist and synergist muscle force.

Equal proximal and distal lengthening of rat extensor digitorum longus (EDL) were studied. Tibialis anterior, extensor hallucis longus, and EDL were active maximally. The connective tissues around these muscle bellies were left intact. Proximal EDL forces differed from distal forces, indicating myofascial force transmission to structures other than the tendons. Higher EDL distal force was exerted (ratio approximately 118%) after distal than after equal proximal lengthening. For proximal force, the reverse occurred (ratio approximately 157%). Passive EDL force exerted at the lengthened end was 7-10 times the force exerted at the nonlengthened end. While kept at constant length, synergists (tibialis anterior + extensor hallucis longus: active muscle force difference approximately -10%) significantly decreased in force by distal EDL lengthening, but not by proximal EDL lengthening. We conclude that force exerted at the tendon at the lengthened end of a muscle is higher because of the extra load imposed by myofascial force transmission on parts of the muscle belly. This is mediated by changes of the relative position of most parts of the lengthened muscle with respect to neighboring muscles and to compartment connective tissues. As a consequence, muscle relative position is a major codeterminant of muscle force for muscle with connectivity of its belly close to in vivo conditions.     

"Psyching-up" enhances force production during the bench press exercise

We investigated the effect of "psyching-up" on force production during the bench press. Twelve men (mean age +/- SD: 27.4 +/- 11.2 years) and 8 women (20.9 +/- 2.5 years) with strength-training experience performed 5 bench press repetitions on a modified Biodex isokinetic dynamometer during 3 interventions. The interventions were counterbalanced and included a free-choice psych-up, a cognitive distraction, and an attention-placebo. Peak force recorded after psyching-up (mean +/- SD: 764 +/- 269 N.m) was significantly different from both distraction (703 +/- 282 N.m, p = 0.003) and attention-placebo (708 +/- 248 N.m, p = 0.01). The mean percentage increase in peak force from distraction to psyching-up was 11.8% (6 to 18%, 95% confidence interval [CI]) and 8.1% from placebo to psyching-up (3 to 13%, 95% CI). The results of the present study indicate that psyching-up may increase force production during the bench press exercise in participants with at least 1 year strength-training experience.     

Kinematic quantitation of the patellar tendon reflex using a tri-axial accelerometer

We designed a simple procedure based on the angular speed of the knee joint for quantitating the patellar tendon reflex. The angular speed of the knee joint is calculated from acceleration data generated in response to the tapping force applied to the patellar tendon with a customized tendon hammer and measured using a tri-axial accelerometer placed at the ankle joint. Data were collected and processed using a signal analyzer and a notebook PC. The results obtained using standard equipment were similar to those generated by more elaborate devices. For instance, the time delay (29.6+/-6.0 ms) and the acceleration time (150.8+/-19.5 ms) of the speed response were quite constant for all participants within the range of tapping forces normally applied during physical examinations. Representative relationships between the peak tapping force and the peak angular speed also closely fit with the exponential model (the average coefficient of determination, 0.70; range, 0.43-0.97). In contrast, the mean asymptotic value of the peak angular speed (Omega(pas)) was 160+/-67 degrees/s for spastic individuals, compared with only 72+/-21 degrees/s for healthy individuals. The important features of this method are portability, ease of use, and non-constraint of solicited reflex responses.     

Viscoelastic characterization of mesenchymal gap tissue and consequences for tension accumulation during distraction

Nonlinear viscoelastic analysis was used to characterize the time-dependent behavior of mesenchymal gap tissue generated during distraction osteogenesis. Six (n = 6) lengthened tibiae were harvested from New Zealand white rabbits at 18 days. This gap tissue was subjected to a series of step displacement tests of increasing magnitude, and force relaxation behavior was monitored. Isochrones in stress-strain space were fit to odd cubic functions of strain. An analytic expression, linear in both e and e3, was developed to predict stress accumulation within the gap tissue as a function of time during distraction. Stress relaxation functions were described well by two-term Prony series. The two time constants determined from mechanical testing results were consistent, suggesting the presence of two fundamental physiologic relaxation processes. Gap tissue stresses were predicted to rise considerably during early stages of lengthening when distraction magnitudes exceeded the clinical norm of 0.25 mm. These differences in tension accumulation were less pronounced by the time lengthening was completed. Specifically, these results may in part explain clinical observations of decreased bone regeneration and altered tissue proliferation and differentiation at higher distraction rates. More generally, this work provides a framework for the rigorous characterization of the viscoelastic properties of biologic tissues ordinarily exposed to step strains.     

Osseous expansion of the cranial vault by craniotasis.

A study of cranial vault lengthening using a custom expandable fixation-distraction (craniotatic) appliance was performed in the young-adult rabbit model. Ten 24-week-old rabbits underwent circumferential suturectomy plus expansion (expanded group), 10 underwent circumferential suturectomy without expansion (sham control group), and 10 served as normal controls. The appliance was lengthened at a rate of 2.5 mm per week for 5 weeks. Serial lateral cephalometry, comparative dry-skull anthropometric measurements, and histologic examinations were performed. The expanded group demonstrated a significantly longer skull, cranial vault, anterior cranial base, posterior face, and orbit as compared with the control groups (p less than 0.05). Callus bone filled the distracted suturectomy and united the frontofacial complex to the posterior cranium. In conclusion, skull lengthening by distraction osteogenesis is possible in the rabbit model and offers a new technique for future investigation in the treatment of coronal synostosis.     

Temperature-related development of the parasitoid wasp Nasonia vitripennis as forensic indicator

Development times of the forensically significant parasitic wasp Nasonia vitripennis (Walker) (Hymenoptera: Pteromalidae) from oviposition to pupation, and from oviposition to adult emergence, were studied in the laboratory at temperatures of 15-35 degrees C using host pupae of the blowfly Protophormia terraenovae (Robineau-Desvoidy) (Diptera: Calliphoridae). Total developmental time of N. vitripennis from oviposition to adult emergence (mean+/-SD) was 43.5+/-2.4, 22.5+/-1.1, 14.8+/-1.7 and 11.3+/-0.9 days when reared at 15, 20, 25 and 30 degrees C, respectively. At 35 degrees C, N. vitripennis did not develop successfully. The rate of total immature development (1/days) increased with temperature. From linear regression of development rates, it was determined that the minimum threshold (tL) for total immature development was 9.8 degrees C (approximately 10 degrees C). Above this threshold, the overall thermal constant (K) for N. vitripennis was found to be 224.3+/-1.7 degree-days.     

Differences in sleep, light, and circadian phase in offshore 18:00-06:00 h and 19:00-07:00 h shift workers

Complaints concerning sleep are high among those who work night shifts; this is in part due to the disturbed relationship between circadian phase and the timing of the sleep-wake cycle. Shift schedule, light exposure, and age are all known to affect adaptation to the night shift. This study investigated circadian phase, sleep, and light exposure in subjects working 18:00-06:00 h and 19:00-07:00 h schedules during summer (May-August). Ten men, aged 46+/-10 yrs (mean+/-SD), worked the 19:00-07:00 h shift schedule for two or three weeks offshore (58 degrees N). Seven men, mean age 41+/-12 yrs, worked the 18:00-06:00 h shift schedule for two weeks offshore (61 degrees N). Circadian phase was assessed by calculating the peak (acrophase) of the 6-sulphatoxymelatonin rhythm measured by radioimmunoassay of sequential urine samples collected for 72 h at the end of the night shift. Objective sleep and light exposure were assessed by actigraphy and subjective sleep diaries. Subjects working 18:00-06:00 h had a 6-sulphatoxymelatonin acrophase of 11.7+/-0.77 h (mean+/-SEM, decimal hours), whereas it was significantly later, 14.6+/-0.55 h (p=0.01), for adapted subjects working 19:00-07:00 h. Two subjects did not adapt to the 19:00-07:00 h night shift (6-sulphatoxymelatonin acrophases being 4.3+/-0.22 and 5.3+/-0.29 h). Actigraphy analysis of sleep duration showed significant differences (p=0.03), with a mean sleep duration for those working 19:00-07:00 h of 5.71+/-0.31 h compared to those working 18:00-06:00 h whose mean sleep duration was 6.64+/-0.33 h. There was a trend to higher morning light exposure (p=0.07) in the 19:00-07:00 h group. Circadian phase was later (delayed on average by 3 h) and objective sleep was shorter with the 19:00-07:00 h than the 18:00-06:00 h shift schedule. In these offshore conditions in summer, the earlier shift start and end time appears to favor daytime sleep.     

Excessive compression of the human tibio-femoral joint causes ACL rupture

The knee is one of the most frequently injured joints in the human body. A recent study suggests that axial compressive loads on the knee may play a role in injury to the anterior cruciate ligament (ACL) for the flexed knee, because of an approximate 10 degrees posterior tilt in the tibial plateau (J. Orthop. Res. 16 (1998) 122-127). The hypothesis of the current study was that excessive axial compressive loads in the human tibio-femoral (TF) joint would cause relative displacement and rotation of the tibia with respect to the femur, and result in isolated injury to the ACL when the knee is flexed to 60 degrees , 90 degrees or 120 degrees . Sixteen isolated knees from eleven fresh cadaver donors (74.3+/-10.5 yr) were exposed to repetitive TF compressive loads increasing in intensity until catastrophic injury. ACL rupture was documented in 14/16 cases. The maximum TF joint compressive force for ACL failure was 5.1+/-2.1 kN for all flexion angles combined. For the 90 degrees flexed knee, the injury occurred with a relative anterior displacement of 5.4+/-3.8mm, a lateral displacement of 4.1+/-1.4mm, and a 7.8+/-7.0 degrees internal rotation of the tibia with respect to the femur.     

Relationship between cycling mechanics and core stability

Core stability has received considerable attention with regards to functional training in sports. Core stability provides the foundation from which power is generated in cycling. No research has described the relationship between core stability and cycling mechanics of the lower extremity. The purpose of this study was to determine the relationship between cycling mechanics and core stability. Hip, knee, and ankle joint kinematic and pedal force data were collected on 15 competitive cyclists while cycling untethered on a high-speed treadmill. The exhaustive cycling protocol consisted of cycling at 25.8 km x h(-1) while the grade was increased 1% every 3 minutes. A core fatigue workout was performed before the second treadmill test. Total frontal plane knee motion (test 1: 15.1 +/- 6.0 degrees ; test 2: 23.3 +/- 12.5 degrees), sagittal plane knee motion (test 1: 69.9 +/- 4.9 degrees ; test 2: 79.3 +/- 10.1 degrees), and sagittal plane ankle motion (test 1: 29.0 +/- 8.5 degrees ; test 2: 43.0 +/- 22.9 degrees) increased after the core fatigue protocol. No significant differences were demonstrated for pedaling forces. Core fatigue resulted in altered cycling mechanics that might increase the risk of injury because the knee joint is potentially exposed to greater stress. Improved core stability and endurance could promote greater alignment of the lower extremity when riding for extended durations as the core is more resistant to fatigue.     

Mechanical and myoelectric manifestations of fatigue in subjects with anorexia nervosa.

PURPOSE: Aim of this work is to compare mechanical and myoelectric manifestations of fatigue during an isometric contraction at 80% of maximal voluntary contraction (MVC) in a population of eight anorexic female patients (AN: 24.9+/-6.5 years, mean+/-SD) with respect to a group of seven healthy female subjects (CO: 30.0+/-6.6 years, mean+/-SD). METHODS: sEMG signals were recorded, using a linear electrode array (eight channels, 10mm apart), from vastus lateralis muscle of the dominant side. MVC, endurance time, initial value and rate of change of the EMG variables [conduction velocity (CV), mean power frequency (MNF), average rectified value (ARV)] were studied during the fatiguing contractions. RESULTS: Absolute and relative (normalized with respect to the body weight) knee torque values and endurance times were found not statistically different between the two groups. Similarly, EMG amplitude initial values and rate of change and MNF initial values were found not significantly different between the two groups. CV initial values and CV rate of change were found greater in healthy than in pathological subjects (AN CV: 3.74+/-0.86m/s, CO CV: 4.96+/-0.64m/s, p=0.004; AN CV rate of change: 0.006+/-0.015m/s2, CO CV rate of change: -0.006+/-0.007m/s2, p=0.006, mean+/-SD). Contrary to expectations MNF rate of changes in the AN group (-0.35+/-0.16Hz/s) was found greater than in the CO group (-0.17+/-0.13Hz/s, p=0.004, Mann-Whitney U test, mean+/-SD). CONCLUSIONS: CV values and their rate of change were compatible with a predominance of type I fibres (and/or with an hypotrophy of type II fibres) and/or with a lower sub-cutaneous tissue thickness with respect to CO group, as described in the literature with this pathology. The behaviour of MNF during sustained contractions, opposite to that of CV, suggests an altered central control strategy aimed to increase mechanical force output increasing the level of synchronization of motor units. This study confirms the capability of sEMG to assess muscle condition during severe malnutrition suggesting further studies to assess if sEMG can be used to monitor the effect of re-feeding and rehabilitation treatments.     

Toe-out gait in patients with knee osteoarthritis partially transforms external knee adduction moment into flexion moment during early stance phase of gait: a tri-planar kinetic mechanism

Altered gait kinematics and kinetics are observed in patients with medial compartment knee osteoarthritis. Although various kinematic adaptations are proposed to be compensatory mechanisms that unload the knee, the nature of these mechanisms is presently unclear. We hypothesized that an increased toe-out angle during early stance phase of gait shifts load away from the knee medial compartment, quantified as the external adduction moment about the knee. Specifically, we hypothesized that by externally rotating the lower limb anatomy, primarily about the hip joint, toe-out gait alters the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes and transforms a portion of knee adduction moment into flexion moment. To test this hypothesis, gait data from 180 subjects diagnosed with medial compartment knee osteoarthritis were examined using two frames of reference. The first frame was attached to the tibia (reporting actual toe-out) and the second frame was attached to the laboratory (simulating no-toe-out). Four measures were compared within subjects in both frames of reference: the lengths of ground reaction force lever arms acting about the knee joint in the frontal and sagittal planes, and the adduction and flexion components of the external knee moment. The mean toe-out angle was 11.4 degrees (S.D. 7.8 degrees , range -2.2 degrees to 28.4 degrees ). Toe-out resulted in significant reductions in the frontal plane lever arm (-6.7%) and the adduction moment (-11.7%) in early stance phase when compared to the simulated no-toe-out values. These reductions were coincident with significant increases in the sagittal plane lever arm (+33.7%) and flexion moment (+25.0%). Peak adduction lever arm and moment were also reduced significantly in late stance phase (by -22.9% and -34.4%, respectively) without a corresponding increase in sagittal plane lever arm or flexion moment. These results indicate that toe-out gait in patients with medial compartment knee osteoarthritis transforms a portion of the adduction moment into flexion moment in early stance phase, suggesting that load is partially shifted away from the medial compartment to other structures.     

A method of calculating physiologically relevant joint reaction forces during forward dynamic simulations of movement from an existing knee model

In the commonly used SIMM software, which includes a complete musculoskeletal model of the lower limbs, the reaction forces at the knee are computed. These reaction forces represent the bone-on-bone contact forces and the soft tissue forces (e.g. ligaments) other than muscles acting at the joint. In the knee model integrated into this software, a patellotibial joint rather than a patellofemoral joint is defined, and a force acting along the direction of the patellar ligament is not included. Although this knee model results in valid kinematics and muscle moment arms, the reaction forces at the knee calculated do not represent physiologic knee joint reaction forces. Hence our objectives were to develop a method of calculating physiologic knee joint reaction forces using the knee model incorporated into the SIMM software and to demonstrate the differences in the forces returned by SIMM and the physiologic forces in an example. Our method converts the anatomically fictional patellotibial joint into a patellofemoral joint and computes the force in an inextensible patellar ligament. In our example, the rectus femoris was fully excited isometrically, with the knee and hip flexed to 90 degrees . The resulting SIMM tibiofemoral joint reaction force was primarily shear, because the quadriceps force was applied to the tibia via the fictional patellotibial joint. In contrast the physiologic tibiofemoral joint reaction force was primarily compression, because the quadriceps force was applied through the patellar ligament. This result illustrates that the physiologic knee joint reaction forces are profoundly different than the forces returned by SIMM. However physiologic knee joint reaction forces can be computed with postprocessing of SIMM results.