Geometry and motion of the knee for implant and orthotic design

By analysing sections of distal femurs in the computer, and by making direct measurements, the posterior femoral condyles were shown to closely fit spherical surfaces. The center of the spheres were then used as reference points and used to define reference axes in a motion study. In flexing from 0 to 120 degrees the medial femoral condyle moved little, the lateral moved posteriorly by 17 mm, and there was an axial rotation of 20 degrees. The data were applied to implant and orthotic design and evaluation.     

Repeatability,reproducibility, and agreement of three computational methods to approximate the functional flexion-extension axis of the tibiofemoral joint using 3D bone models of the femur

Abstract

Background: Closely approximating the functional flexion-extension (FE) axis of the tibiofemoral joint in 3D models of the femur is important when computing joint motions which are physiologic. The objectives were to 1) develop methods to approximate the functional FE axis based on fitting circles, a tapered cylinder, and spheres to the posterior condyles, 2) determine the repeatability and reproducibility of each method, and 3) determine limits of agreement between pairs of axes.

Methods: For each method, the respective axis was determined in forty 3D bone models of the distal femur. Varus-valgus angles and internal-external axial angles were computed relative to standard planes.

Results: Repeatability and reproducibility were comparable for the tapered cylinder-based and sphere-based methods and better than that for the circle-based method. Limits of agreement were tightest when comparing the sphere-based and tapered cylinder-based axes. However, limits of agreement for the internal-external axial angle were wide at +3.6° to ?3.9° whereas limits of agreement were tighter at +1.4° to ?0.7° for the varus-valgus angle.

Conclusion: The tapered cylinder-based and sphere-based methods offer advantages of better repeatability and reproducibility over the circle-based method. However, the sphere-based and tapered cylinder-based axes are not interchangeable owing to wide limits of agreement for the internal-external axial angle. The tapered cylinder-based axis is preferred intuitively over the sphere-based axis because the spheres require fitting in both the sagittal and coronal planes whereas the tapered cylinder requires fitting in the sagittal plane only which is the plane of motion in flexion-extension.     

Identifying the Functional Flexion-extension Axis of the Knee: An In-Vivo Kinematics Study

Purpose

This study aimed to calculate the flexion-extension axis (FEA) of the knee through in-vivo knee kinematics data, and then compare it with two major anatomical axes of the femoral condyles: the transepicondylar axis (TEA) defined by connecting the medial sulcus and lateral prominence, and the cylinder axis (CA) defined by connecting the centers of posterior condyles.

Methods

The knee kinematics data of 20 healthy subjects were acquired under weight-bearing condition using bi-planar x-ray imaging and 3D-2D registration techniques. By tracking the vertical coordinate change of all points on the surface of femur during knee flexion, the FEA was determined as the line connecting the points with the least vertical shift in the medial and lateral condyles respectively. Angular deviation and distance among the TEA, CA and FEA were measured.

Results

The TEA-FEA angular deviation was significantly larger than that of the CA-FEA in 3D and transverse plane (3.45° vs. 1.98°, p < 0.001; 2.72° vs. 1.19°, p = 0.002), but not in the coronal plane (1.61° vs. 0.83°, p = 0.076). The TEA-FEA distance was significantly greater than that of the CA-FEA in the medial side (6.7 mm vs. 1.9 mm, p < 0.001), but not in the lateral side (3.2 mm vs. 2.0 mm, p = 0.16).

Conclusion

The CA is closer to the FEA compared with the TEA; it can better serve as an anatomical surrogate for the functional knee axis.     

Allometric and Group Differences in the Xenarthran Femur

The aim of this study is to analyze shape variation in the xenarthran femur to gain insights into their behavior and locomotion. Specimens of both Cingulata (armadillos and glyptodonts) and Pilosa (anteaters and sloths) were studied and within each group body mass varies by several orders of magnitude. The main focus of the analysis was allometric variation in femoral shape in the three groups studied, armadillos, glyptodonts, and pilosans. Three dimensional coordinates were recorded for 40 homologous landmarks on each of 51 xenarthran femurs. The data were analyzed by geometric morphometric methods, and form space analysis was used to identify the allometric variation in each of the three groups. Across all groups, larger specimens tended to have larger articular surfaces, more robust femora generally, and the shape of the femoral condyles was more suited to extended postures. In addition, in larger specimens the medial condyle was much larger than the lateral condyle and the third trochanter was located more distally. The larger armadillo femora had a greater trochanter located considerably proximal to the femoral head and this is thought to improve femoral extension, but in glyptodonts and pilosans the larger specimens had a greater trochanter that was far lateral to the femoral head and this is interpreted as enhancing femoral rotation.     

The evaluation of knee bone mineral density following open-wedge high tibial osteotomy

Examinations of bone density changes in selected knee bone ends were evaluated prospectively in a randomized group of 28 patients, aged from 41 to 65 (mean: 55.3 years), who had varus deformations of their mechanic limb axes, mean 8 degrees. The examinations were conducted during the preoperative period, 10 days, 3, 6, and 12 weeks, as well as 6 and 12 months after the procedure. A statistically significant increase in bone density was observed in the medial tibial condyle area, while a statistically insignificant decrease of bone density was noted in the medial femoral condyles. Bone density increased in the lateral tibial condyle area, whereas there were no density changes in the area of the lateral femoral condyles. The research results demonstrate that the relief achieved in ailments after high tibial osteotomies does not directly correspond to the bone density of the affected areas.     

Shape Ontogeny of the Distal Femur in the Hominidae with Implications for the Evolution of Bipedality

Heterochrony has been invoked to explain differences in the morphology of modern humans as compared to other great apes. The distal femur is one area where heterochrony has been hypothesized to explain morphological differentiation among Plio-Pleistocene hominins. This hypothesis is evaluated here using geometric morphometric data to describe the ontogenetic shape trajectories of extant hominine distal femora and place Plio-Pleistocene hominins within that context. Results of multivariate statistical analyses showed that in both Homo and Gorilla, the shape of the distal femur changes significantly over the course of development, whereas that of Pan changes very little. Development of the distal femur of Homo is characterized by an elongation of the condyles, and a greater degree of enlargement of the medial condyle relative to the lateral condyle, whereas Gorilla are characterized by a greater degree of enlargement of the lateral condyle, relative to the medial. Early Homo and Australopithecus africanus fossils fell on the modern human ontogenetic shape trajectory and were most similar to either adult or adolescent modern humans while specimens of Australopithecus afarensis were more similar to Gorilla/Pan. These results indicate that shape differences among the distal femora of Plio-Pleistocene hominins and humans cannot be accounted for by heterochrony alone; heterochrony could explain a transition from the distal femoral shape of early Homo/A. africanus to modern Homo, but not a transition from A. afarensis to Homo. That change could be the result of genetic or epigenetic factors.     

Stability of elliptical cylinders in two-dimensional channel flow

The flow around rigid cylinders of elliptical cross section placed transverse to Poiseuille flow between parallel plates was simulated to investigate issues related to the tumbling of red blood cells and other particles of moderate aspect ratio in the similar flow in a Field Flow Fractionation (FFF) channel. The torque and transverse force on the cylinder were calculated with the cylinder freely translating, but prevented from rotating, in the flow. The aspect ratios (long axis to short axis) of the elliptical cylinders were 2, 3, 4, and 5. The cylinder was placed transversely at locations of y0/H = 0.1, 0.2, 0.3, and 0.4, where y0 is the distance from the bottom of the channel and H is the height of the channel, and the orientation of the cylinder was varied from 0 to 10 deg with respect to the axis of the channel for a channel Reynolds number of 20. The results showed that equilibrium orientations (indicated by a zero net torque on the cylinder) were possible for high-aspect-ratio cylinders at transverse locations y0/H < 0.2. Otherwise, the net torque on the cylinder was positive, indicating that the cylinder would rotate. For cylinders with a stable orientation, however, a transverse lift forced existed up to about y0/H = 0.25. Thus, a cylinder of neutral or low buoyancy might be lifted with a stable orientation from an initial position near the wall until it reached y0/H < 0.2, whereupon it would begin to tumble or oscillate. The dependence of lift and torque on cylinder orientation suggested that neutral or low-buoyancy cylinders may oscillate in both transverse location and angular velocity. Cylinders more dense than the carrier fluid could be in equilibrium both in terms of orientation and transverse location if their sedimentation force matched their lift force for a location y0/H < 0.2.     

Automatic methods for characterization of sexual dimorphism of adult femora: distal femur

Quantifying sex differences in femoral size and shape has extensive applications in forensics and prosthesis design. By applying strong statistical techniques such as principal component analysis (PCA), certain three-dimensional (3D) morphological variations of adult femora can be quantified over various femoral sizes. Coupling this statistical approach with a novel feature generation and extraction technique, localization of statistically significant (p < 0.05) features are automatically defined and measured. Also, predefined anatomical landmarks and surgical axes have been calculated automatically. In all methods, femoral scale is controlled as a possible parameter of shape. By extensively comparing measurements across 92 male and 74 female femora, the dimorphic characteristics of the distal femur are shown. These differences have not been accounted for in many prosthetic systems and consequently these systems have limited sizing accuracy.     

Transformation of the Golgi apparatus in the cell cycle,especially at the resting and earliest developmental stages of a green alga,Micrasterias americana

Summary Transformation of the Golgi apparatus inMicrasterias americana at various stages after full growth and at the earliest stage of cell growth was investigated using an electron microscope. Silver-hexamine staining and the acid phosphatase (ACPase) test were also carried out. In cells cultured for two days after full growth, dictyosomes began to produce hypertrophied vesicles (HVs) along their five peripheral reagions. The HVs contained fibrous material, which was stained by silver-hexamine, and small granules which reacted with ACPase. The HVs were pinched off the dictyosomes and fused with each other and with the vacuoles. In the earliest stage of cell growth, the cisternae of the dictyosomes were stretched in one direction, which modified the shape from circular to elliptical and the dictyosomes curved along the long axis of the ellipse. These curved dictyosomes which produced middle sized vesicles (MVs) from the distal networks, divided into two identical parts along the short axis of the ellipse.     

MEASURING THE HYDRAULIC DIAMETER OF A PORE OR CONDUIT

A method for estimating the hydraulic diameter of a pore or conduit having a noncircular opening is presented with special reference to plant anatomy. An ellipse or a rectangle is inscribed within the opening, and the length of the short axis (a) is measured. The hydraulic diameter (D_h) is estimated for the ellipse (D_h = 1.4a) or rectangle (D_h = 2a). Use of these equations often gives a more accurate estimate of the hydraulic diameter of a pore or conduit than does averaging the lengths of the short and long axes (D_h = [a + b]/2, b is the long axis) or assuming that the opening is circular (D_h = a). A table of the error in each method is included, and the errors inherent in the use of D_h are discussed. Because fewer measurements are required, estimation based on the measurement of one axis is much faster than calculation using both the short and long axes. The equations and table should permit anatomists and physiologists to rapidly determine the best method for estimating the hydraulic diameter of a pore or conduit, and to more accurately and quickly estimate the hydraulic diameters of large numbers of openings. However, because of potential pitfalls in applying theoretical fluid dynamics equations to real-world functional anatomy, botanists must ensure that their applications of hydraulic diameter are appropriate in each case.     

Laboratory scale photobioreactor

Summary A photobioreactor using three concentric glass cylinders, with a light source mounted on the axis within them is described. The space between two innermost cylinders is used as a waterjacket, while the culture of phototrophic microorganisms is in the chamber between the outer cylinder and the middle one. This chamber is also equipped with a stirrer. Rhodobacter capsulatus has been grown in the device at biomass concentration up to 550 mg/l without light limitation.     

Detection of numerous CC and Cc membranes in the femoral condyle

The authors (1,2) discovered a two-membrane system in the head of the femur and its distal condyles (Copf et al. ^1,2,3). The one membrane serves the hydrodynamic principle. It was termed the CC membrane. According to the provisional opinion of the authors, the second membrane, which is designated as Cc membrane, serves for exchange of fluid supply of energy and information flow in view of its original perforations. In contrast to the head of the femur, CC membranes are more numerous. The Cc membranes are also more numerous here, but in some cases differ in terms of their elongate form. The first impression indicates a very much more pronounced component of the hydrodynamic system in the region of the femoral condyle.     

Mathematical reconstruction of human femoral condyles

There is a direct correlation between ligament function and the articulating surface of the normal knee, and changes to any of these structures can affect the other. This is also true for knee replacements, where the articulating surface is greatly changed compared to the natural knee. This study investigated the morphometry of healthy knees and proposes a method to predict original normal knee profiles. A variety of mathematical techniques are compared in terms of the accuracy with which they can represent the original knee joint geometry. Additionally, a method of predicting the irregular femoral condyle geometry for an individual knee is described by making use of the mathematical techniques presented, and the accuracy of this method is also investigated. The mathematical approach using B-splines provides flexibility and can accurately describe the complex geometry of the femoral condyles in both the sagittal and transverse planes. It was further found that the condyles are highly asymmetrical; therefore simpler methods cannot portray the condyles sufficiently and are especially inaccurate in representing the lateral condyle. The study proposes a method for predicting the geometry of the femoral condyles with good accuracy. The B-spline model showed best results.     

Geometric morphometric analyses of hominid proximal femora: Taxonomic and phylogenetic considerations

The proximal femur has long been used to distinguish fossil hominin taxa. Specifically, the genus Homo is said to be characterized by larger femoral heads, shorter femoral necks, and more lateral flare of the greater trochanter than are members of the genera Australopithecus or Paranthropus. Here, a digitizing arm was used to collect landmark data on recent human (n=82), chimpanzee (n=16), and gorilla (n=20) femora and casts of six fossil hominin femora in order to test whether one can discriminate extant and fossil hominid (sensu lato) femora into different taxa using three-dimensional (3D) geometric morphometric analyses. Twenty proximal femoral landmarks were chosen to best quantify the shape differences between hominin genera. These data were first subjected to Procrustes analysis. The resultant fitted coordinate values were then subjected to PCA. PC scores were used to compute a dissimilarity matrix that was subjected to cluster analyses. Results indicate that one can easily distinguish Homo, Pan, and Gorilla from each other based on proximal femur shape, and one can distinguish Pliocene and Early Pleistocene hominin femora from those of recent Homo. It is more difficult to distinguish Early Pleistocene Homo proximal femora from those of Australopithecus or Paranthropus, but cluster analyses appear to separate the fossil hominins into four groups: an early australopith cluster that is an outlier from other fossil hominins; and two clusters that are sister taxa to each other: a late australopith/Paranthropus group and an early Homo group.     

New Australopithecus femora from East Rudolf, Kenya

New fossil femora attributed to Australopithecus from East Rudolf, Kenya, form the basis for a three-dimensional reconstruction of a complete femur. The reconstruction and the known fossils are compared with the femora of Homo sapiens. Although many of the features of the fossil bones fall within the overall ranges to be found in modern man, there seems, nevertheless, to be a distinctive total pattern in the femoral anatomy of Australopithecus. Biomechanical explanations for this pattern may be possible when other postcranial bones can be reconstructed with the same degree of certainty as the femur.     

The 5.5-year results of MegaOATS--autologous transfer of the posterior femoral condyle: a case-series study

Introduction

Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones.

Methods

Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm², in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%.

Results

The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts.

Conclusion

Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight-bearing zone of the femoral condyle.     

The 5.5-year results of MegaOATS – autologous transfer of the posterior femoral condyle: a case-series study

Introduction

Large osteochondral defects of the weight-bearing zones of femoral condyles in young and active patients were treated by autologous transfer of the posterior femoral condyle (large osteochondral autogenous transplantation system (MegaOATS)). The technique presented is a sound and feasible salvage procedure to address large osteochondral defects in weight-bearing zones.

Methods

Thirty-six patients between July 1996 and December 2000 were included. Thirty-three patients (10 females, 23 males) were evaluated by the Lysholm score and X-ray scans. A random sample of 16 individuals underwent magnetic resonance imaging analysis. The average age at the date of surgery was 34.3 (15 to 59) years, and the mean follow up was 66.4 (46 to 98) months. The mean defect size was 6.2 (2 to 10.5) cm², in 27 patients affecting the medial femoral condyle and in six patients affecting the lateral femoral condyle. Trauma or osteochondrosis dissecans were pathogenetic in 82%.

Results

The Lysholm score in all 33 individuals showed a highly significant increase from a preoperative median 49.0 points to a median 86.0 points (P ≤ 0.001). Twenty-seven patients returned to recreational sports. X-ray scans showed a rounding of the osteotomy edge in 24 patients, interpreted as a partial remodelling of the posterior femoral condyle. Preoperative osteoarthritis in 17 individuals was related to significant lower Lysholm scores (P = 0.014), but progression in 17 patients did not significantly influence the score results (P = 0.143). All 16 magnetic resonance imaging examinations showed vital and congruent grafts.

Conclusion

Patients significantly improve in the Lysholm score, in daily-life activity levels and in return to recreational sports. Thirty-one out of 33 patients were comfortable with the results and would undergo the procedure again. The MegaOATS technique is therefore recommended as a salvage procedure for young individuals with large osteochondral defects in the weight-bearing zone of the femoral condyle.     

Articular-surface-based automatic anatomical coordinate systems for the knee bones

Increasing use of patient-specific surgical procedures in orthopaedics means that patient-specific anatomical coordinate systems (ACSs) need to be determined. For knee bones, automatic algorithms constructing ACSs exist and are assumed to be more reliable than manual methods, although both approaches are based on non-unique numerical reconstructions of true bone geometries. Furthermore, determining the best algorithms is difficult, as algorithms are evaluated on different datasets. Thus, in this study, we developed 3 algorithms, each with 3 variants, and compared them with 5 from the literature on a dataset comprising 24 lower-limb CT-scans. To evaluate algorithms’ sensitivity to the operator-dependent reconstruction procedure, the tibia, patella and femur of each CT-scan were each reconstructed once by three different operators.Our algorithms use principal inertia axis (PIA), cross-sectional area, surface normal orientations and curvature data to identify the bone region underneath articular surfaces (ASs). Then geometric primitives are fitted to ASs, and the ACSs are constructed from the geometric primitive points and/or axes. For each bone type, the algorithm displaying the least inter-operator variability is identified. The best femur algorithm fits a cylinder to posterior condyle ASs and a sphere to the femoral head, average axis deviations: 0.12°, position differences: 0.20 mm. The best patella algorithm identifies the AS PIAs, average axis deviations: 0.91°, position differences: 0.19 mm. The best tibia algorithm finds the ankle AS center and the 1st PIA of a layer around a plane fitted to condyle ASs, average axis deviations: 0.38°, position differences: 0.27 mm.     

Thylakoid centers: Structures associated with the cyanobacterial photosynthetic membrane system

An ultrastructural study of four cyanobacteria (Anabaena cylindrica, Dermocarpa violaceae, Gleocapsa alpicola, Pleurocapsa minor) indicates the presence of previously undescribed thylakoid centers from which photosynthetic membranes (thylakoids) radiate. These peripherally located thylakoid centers are cylinders 30 nm wide by 320 nm long, consisting of globular subunits oriented in nonparallel stacked arrays. Thylakoids are attached to the outer surface of the cylinder along its longitudinal axis. Thylakoid centers appear to be functionally significant due to their structure, location and thylakoid association.     

Hypsilophodontid dinosaurs from Lightning Ridge,New South Wales,Australia

The Lower Cretaceous (Albian) Griman Creek Fm. at Lightning Ridge, New South Wales, Australia, has yielded seven partial femora of hypsilophodontid ornithopods. Six of these femora represent a member of the hypsilophodont group of the Hypsilophodontidae. Similarities of the structure of the medial condyle and popliteal region indicate reference to Fulgurotherium australe. The seventh femur appears to derive from a second, unnamed hypsilophodontid species. These specimens confirm the presence of hypsilophodontids in Australia.