Models of the geometry of the human ankle bone pulley: two series of geometric models for demonstrating the biomechanics of the ankle joint

2 series of models demonstrate the geometrical shape of the human trochlea tali. We have changed step by step the shape of the 2 flanking articular facets of the trochlea, the course of the edges of the trochlea, and the length of their radii, and so we have found a model responding to the biomechanic conditions of the trochlea tali. The convex surface of this model (corresponding to the superior articular surface, i.e. the facies superior trochleae tali) is a torse, the medial flanking facet (corresponding to the medial articular facet of the trochlea, i.e. the facies malleolaris medialis) is a flat cone, the lateral flanking facet (corresponding to the lateral articular facet of the trochlea, i.e. the facies malleolaris lateralis) is a screwed (helicoidal) face. The resulting model shows the 2 completely different phases of motion in the ankle joint: During dorsiflexion (motion setting out from the neutral position towards the final position of dorsiflexion), the internal malleolus leads the talus, whereas the external malleolus is pushed outwards by the screwed lateral articular facet of the trocheal. The trochlea is moved like a hinge. In the final position of dorsiflexion, the malleoli tightly embrace the 2 flanking facets of the trochlea, whilst an obvious cleft appears dorsally and medially between the superior articular surface of the trochlea and the tibial roof (i.e. the facies articularis inferior tibiae). During plantarflexion (motion setting out from the neutral position towards the final position of plantarflexion), the external malleolus leads the talus, whereas the medial articular facet of the trochlea withdraws from the internal malleolus. The trochlea is moved like a screw. In the final position of plantarflexion, the superior articular surface of the trochlea closely contacts the tibial roof, whilst an obvious cleft appears between the medial articular facet of the trochlea and the internal malleolus.     

Articular contact at the tibiotalar joint in passive flexion

The knowledge of the contact areas at the tibiotalar articulating surfaces during passive flexion is fundamental for the understanding of ankle joint mobility. Traditional contact area reports are limited by the invasive measuring techniques used and by the complicated loading conditions applied. In the present study, passive flexion tests were performed on three anatomical preparations from lower leg amputation. Roentgen Stereophotogrammetric Analysis was used to accurately reconstruct the position of the tibia and the talus at a number of unconstrained flexion positions. A large number of points was collected on the surface of the tibial mortise and on the trochlea tali by a 3-D digitiser. Articular surfaces were modelled by thin plate splines approximating these points. Relative positions of these surfaces in all the flexion positions were obtained from corresponding bone position data. A distance threshold was chosen to define contact areas. A consistent pattern of contact was found on the articulating surfaces. The area moved anteriorly on both articular surfaces with dorsiflexion. The average position of the contact area centroid along the tibial mortise at maximum plantarflexion and at maximum dorsiflexion was respectively 58% posterior and 40% anterior of the entire antero-posterior length. For increasing dorsiflexion, the contact area moved from medial to lateral in all the specimens.     

Three-dimensional orientations of talar articular surfaces in humans and great apes

The morphology of the talus prescribes relative positions and movements of the calcaneus and navicular with respect to the tibia, hence determining the overall geometry, mobility and function of the foot that mechanically interacts with environments. Clarifying the variations of the articular surface orientations of the talus in humans and extant great apes is therefore of importance in understanding the evolution of bipedal locomotion in the human lineage. The aim of this study is to clarify the three-dimensional orientations of three articular surfaces of the talus (superior, posterior calcaneal and navicular articular surfaces) by means of the newly proposed surface approximation method. Thirty-two tali in humans, chimpanzees, gorillas and orangutans were scanned using a three-dimensional noncontact digitizer, and the articular surfaces were then approximated using a paraboloid or a plane to calculate the orientations of the surfaces with respect to the body of the talus. The results quantitatively demonstrated that the superior articular surfaces in humans were relatively more parallel with the horizontal plane of the talar body, while those in apes were more medially oriented. Furthermore, the cylindrical axis defined by the shape of the posterior calcaneal articular surface was directed less anteroposteriorly in humans than in apes, in contrast to the fact that the subtalar axis is more anteroposteriorly oriented in humans. It was also demonstrated that the navicular articular surface in humans was more plantarly oriented and axially twisted. These specialized features of the human talus seem to be functionally linked to obligate bipedal locomotion. The talar morphological differences among the great apes were prominent in the mediolateral and rotational orientations of the navicular articular surfaces, possibly reflecting the degree of arboreality among the great apes.     

A new one-DOF fully parallel mechanism for modelling passive motion at the human tibiotalar joint

Knowledge on how ligaments and articular surfaces guide passive motion at the human ankle joint complex is fundamental for the design of relevant surgical treatments. The paper presents a possible improvement of this knowledge by a new kinematic model of the tibiotalar articulation. Passive motion, i.e. in virtually unloaded conditions, was captured in vitro in four lower leg specimens by means of a surgical navigation system with cluster of active markers attached to the tibia and talus. The anatomical geometry of the passive structures, i.e. articular surfaces and attachment areas of the ligaments, were taken by digitisation with a pointer. An equivalent spatial mechanism for the passive motion simulation was defined by three sphere-to-sphere contact points and two rigid links. These contact points were identified at the lateral talo-fibular articulation and at the medial and lateral aspects of the articulation between tibial mortise and trochlea tali. The two rigid links were identified by the isometric fibres at the calcaneofibular and tibiocalcaneal ligaments. An optimisation algorithm was developed for the identification of the final geometrical parameters resulting from an iterative refining process, which targets best matching between model predictions and corresponding experimental measurements of the spatial motion. The specimen-specific equivalent spatial mechanisms replicated the original passive motion very well, with mean discrepancies in position smaller than 2.5 mm and in rotation smaller than 1°. The study demonstrates that the articular surfaces and the ligaments, acting together as a mechanism, control the passive kinematics of the ankle joint.     

Incidence of squatting facets on the talus of Indians (Agra region).

230 adult Indian tali (from Agra region) were studied for the incidence of squatting facets. Extension of medial articular facet was observed in all the cases. Medial extension of trochlea was observed in 37% of cases; lateral extension of trochlea in 71.6% of cases, lateral squatting facets in 43.5% of cases and medial squatting in 8.6% of cases. The present data are compared with that of other workers.     

The skeleton of early Eocene Cantius, oldest lemuriform primate

A recently discovered partial skeleton of the adapid Cantius trigonodus from the early Eocene Willwood Formation of the Bighorn Basin, Wyoming, documents substantial new information about the anatomy of the oldest lemuriform primates. It is very similar in all features to its descendant, middle Eocene Notharctus, and both exhibit numerous resemblances to certain extant Malagasy lemurs, particularly Lepilemur, Propithecus, Lemur, and Hapalemur griseus. Like these forms, Cantius had relatively long hind limbs and short forelimbs. Forelimb traits (prominent brachialis flange of the humerus, well-developed olecranon process of the ulna, and strong shafts of the ulna and radius) suggest active use of the forelimbs in progression. Specializations in the hind limb (e.g., expanded articular surface of the femoral head, narrow and elevated patellar trochlea and prominent lateral trochlear ridge, posteriorly oriented femoral and tibial condyles, narrow and elongate talus, and hallucal metatarsal with prominent peroneal tubercle) indicate capabilities for leaping and for powerful grasping with an opposable hallux. Cantius was presumably primitive in having a relatively long ischium and much more distal inferior tibial tuberosity than most extant lemurs--traits suggesting that powerful extension of the thigh and flexion at the knee were important in its locomotion and posture. We interpret Cantius as an active arboreal quadruped with a propensity for leaping. The existence of this skeletal structure in one of the oldest primates of modern aspect suggests that it represents the primitive lemuriform morphology.     

Kinematics of the human ankle complex in passive flexion; a single degree of freedom system

The restoration of original range and pattern of motion is the primary goal of joint replacement and ligament reconstruction. The objective of the present work is to investigate whether or not a preferred path of joint motion at the intact human ankle complex is exhibited during passive flexion. A rig was built to move the ankle complex through its range of flexion while applying only the minimum necessary load to drive ankle flexion. Joint motion was constrained only by the articular surfaces and the ligaments. The movements of the calcaneus, talus and fibula relative to the stationary tibia in seven cadaveric specimens were tracked with a stereophotogrammetric system. It was shown that the calcaneus follows a unique path of unresisted coupled motion relative to the tibia and that most of the motion occurred at the ankle, with little motion at the subtalar level. The calcaneofibular and the tibiocalcaneal ligaments showed near-isometric pattern of rotations. All specimens showed motion of the axis of rotation relative to the bones. Deviations from the unique path due to the application of load involved mostly subtalar motion and were resisted. The ankle complex exhibits one degree of unresisted freedom, the ankle behaving as a single degree of freedom mechanism and the subtalar as a flexible structure. We deduced that the calcaneofibular and tibiocalcaneal ligaments together with the articular surfaces guide ankle passive motion, other ligaments limit but do not guide motion.     

Pressure erosion of the femoral trochlea, patella baja, and altered patellar surfaces

As knee flexion increases, so do tendofemoral and patellofemoral compression forces. Three cases of long-standing uncorrected flexion contractures of the knees are presented that resulted in marked erosion of the femoral trochlea, patella baja, and remodeled patellar articular surfaces likely reflecting increased angles of flexion. It is probable that the deep femoral grooves are the result of adaptation under high-level persistent contact loads from the quadriceps tendon. These examples expand our knowledge of bone remodeling and offer information of potential use in studying ancient skeletal samples.     

Trabecular angle of the human talus is associated with the level of cartilage degeneration

The architecture of bone trabeculae is based on the direction of stresses applied to the bone. The human talar dome receives compressive forces from the tibia and, to a much lesser extent, the fibula when standing, walking, and running, and transmits the force downward to the calcaneus through the talar body and anterior to the navicular via the talar head. As a result, the body of the talus has predominately vertical trabeculae. However, here we hypothesize that cartilage degeneration at the articular surface is associated with trabecular angle within the associated bone, as a reflection of joint alignment and/or biomechanics (stability, congruence, angulation, etc). Through measurement of trabecular angle with Fast Fourier Transform Analysis, we show a positive correlation between the cartilage degeneration score of the articular surface of the talar dome and the angle of trabecular deviation from the perpendicular axis of the dome (right talus R=0.75, p<0.01; left talus R=0.79, p<0.01).     

In vivo kinematic evaluation and design considerations related to high flexion in total knee arthroplasty

In designing a posterior-stabilized total knee arthroplasty (TKA) it is preferable that when the cam engages the tibial spine the contact point of the cam move down the tibial spine. This provides greater stability in flexion by creating a greater jump distance and reduces the stress on the tibial spine. In order to eliminate edge loading of the femoral component on the posterior tibial articular surface, the posterior femoral condyles need to be extended. This provides an ideal femoral contact with the tibial articular surface during high flexion angles. To reduce extensor mechanism impingement in deep flexion, the anterior margin of the tibial articular component should be recessed. This provides clearance for the patella and patella tendon. An in vivo kinematic analysis that determined three dimensional motions of the femorotibial joint was performed during a deep knee bend using fluoroscopy for 20 subjects having a TKA designed for deep flexion. The average weight-bearing range-of-motion was 125 degrees . On average, TKA subjects experienced 4.9 degrees of normal axial rotation and all subjects experienced at least -4.4 mm of posterior femoral rollback. It is assumed that femorotibial kinematics can play a major role in patellofemoral kinematics. In this study, subjects implanted with a high-flexion TKA design experienced kinematic patterns that were similar to the normal knee. It can be hypothesized that forces acting on the patella were not substantially increased for TKA subjects compared with the normal subjects.     

Changes in talocrural joint contact stress characteristics after simulated rotationplasty

In order to assess the changes in talocrural joint contact stress after rotationplasty, 10 lower-leg cadaver specimens were axially loaded with 600 N and investigated in two loading situations: (1) Normal loading with a plantigrade foot; (2) in an equinus position of a simulated rotationplasty. Joint contact stress in the talar facet of the talocrural joint was determined with Fuji Prescale film cut to size and analyzed with digital image analysis for joint contact area, mean and peak pressure, contact force, and location of the load application on the trochlea tali. The results demonstrate a significant transfer on the loading zone to the posterior part of the talus (p = 0.005), a significant reduction of the contact area (p = 0.005) and force (p = 0.005), and a significant increase of the mean (p = 0.022) and maximum pressures (p = 0.013). These results indicate that the rotationplasty causes pronounced changes in joint loading characteristics.     

Talar articular facets (facies articulares talares) in human calcanei

The variations of the talar articular facets in 176 calcanei were studied and classified. Three types were considered: type A = calcanei with two articular facets for the talar head, with four subtypes; type B = calcanei with one articular facet for the talar head, and two subtypes, and type C = unique articular facies in the superior surface of the calcaneus for the talus. We found 53% (94 cases) type B calcanei and 46% (82 cases) type A calcanei. No calcanei of type C were seen.     

Age-related changes of bone mineral density in human calcaneus, talus, and scaphoid bone

To examine whether the bone mineral density (BMD) decreases uniformly with aging in any spongy bones, the authors investigated age-related changes of BMD in the calcaneus, talus, and scaphoid bone. After the ordinary dissection by medical students was finished, calcanei, tali, and scaphoid bones were resected from the subjects, and BMDs were measured by dual-energy X-ray absorptiometry. Their BMDs seemed to decrease gradually with aging in the calcanei, tali, and scaphoid bones. It was found that there were statistically significant relationships between age and BMD in the men’s and women’s scaphoid bones, women’s tali, and women’s calcanei, but not in the men’s tali and calcanei. It should be noted that there were significant relationships between age and BMD in both men’s and women’s scaphoid bones. In regard to relationship in BMD between the bones of the upper and lower limbs in individuals, it was found that the relationship between the calcaneus and talus was higher than that between the calcaneus and scaphoid bone. This suggests that there is a higher relationship in BMD between the two tarsal bones compared with that between the tarsal and carpal bones.     

Morphometrics of the Neandertal talus.

A number of morphometric analyses of Neandertal tali since the turn of the century have failed to reach a consensus on the functional affinities of these fossil foot bones. To clarify the problem a univariate and multivariate analysis of the available Neandertal and Skhūl tali in relation to those of modern humans was performed using nine linear dimensions and four angles. Our analysis indicates that Neandertal tali are indistinguishable from modern human tali in the implied locomotor capabilities and similar in overall size and proportions. The primary differences between the fossil and modern tali involve the greater articular robustness of the fossils, probably to compensate for higher levels of biomechanical stress.     

A geometric model of the human ankle joint.

A two-dimensional four-bar linkage model of the ankle joint is formulated to describe dorsi/plantarflexion in unloaded conditions as observed in passive tests on ankle complex specimens. The experiments demonstrated that the human ankle joint complex behaves as a single-degree-of-freedom system during passive motion, with a moving axis of rotation. The bulk of the movement occurred at the level of the ankle. Fibres within the calcaneofibular and tibiocalcaneal ligaments remained approximately isometric. The experiments showed that passive kinematics of the ankle complex is governed only by the articular surfaces and the ligaments. It was deduced that the ankle is a single-degree-of-freedom mechanism where mobility is allowed by the sliding of the articular surfaces upon each other and the isometric rotation of two ligaments about their origins and insertions, without tissue deformation. The linkage model is formed by the tibia/fibula and talus/calcaneus bone segments and by the calcaneofibular and tibiocalcaneal ligament segments. The model predicts the path of calcaneus motion, ligament orientations, instantaneous axis of rotation, and conjugate talus surface profile as observed in the experiments. Many features of ankle kinematics such as rolling and multiaxial rotation are elucidated. The geometrical model is a necessary preliminary step to the study of ankle joint stability in response to applied loads and can be used to predict the effects of changes to the original geometry of the intact joint. Careful reconstruction of the original geometry of the ligaments is necessary after injury or during total ankle replacement.     

In vivo tibiofemoral contact analysis using 3D MRI-based knee models

This paper quantified the motion of the tibiofemoral contact points during in vivo weight bearing flexion using MRI- based 3D knee models and two orthogonal fluoroscopic images. The contact points on the medial and lateral tibial plateau were calculated by finding the centroid of the intersection of the tibial and femoral cartilage layers and by using the bony geometry alone. Our results indicate that the medial femoral condyle remains in the central portion of the tibial plateau and the lateral condyle translates posteriorly with increasing flexion. Using the bony contact model increased the total translation of the medial and lateral condyles by 250 and 55%, respectively, compared to the cartilage contact model. These results suggest that using the bony geometry alone may not accurately represent the articular surfaces of the knee. Articular cartilage geometry may have to be used to accurately quantify tibiofemoral contact.     

The Treatment Effect of Porous Titanium Alloy Rod on the Early Stage Talar Osteonecrosis of Sheep

Osteonecrosis of the talus (ONT) may severely affect the function of the ankle joint. Most orthopedists believe that ONT should be treated at an early stage, but a concise and effective surgical treatment is lacking. In this study, porous titanium alloy rods were prepared and implanted into the tali of sheep with early-stage ONT (IM group). The curative effect of the rods was compared to treatment by core decompression (DC group). No significant differences in bone reconstruction were observed between the two groups at 1 month after intervention. After 3 months, the macroscopic view of gross specimens of the IM group showed ordinary contours, but the specimens of the DC group showed obvious partial bone defects and cartilage degeneration. Quantitative analysis of the reconstructed trabeculae by micro-CT and histological study suggested that the curative effect of the IM group was superior to that of the DC group at 3 months after intervention. These favorable short-term results of the implantation of porous titanium alloy rods into the tali of sheep with early-stage ONT may provide insight into an innovative surgical treatment for ONT.     

Upper blepharoplasty with bony anatomical landmarks to avoid injury to trochlea and superior oblique muscle tendon with fat resection.

The trochlea and superior oblique muscle tendon separate the medial and central fat compartments in the upper lid. The purpose of this study was to determine anatomical landmarks to predict the location of and avoid injuring the trochlea and superior oblique muscle tendon with orbital fat resection during upper blepharoplasty. The trochlea and superior oblique muscle tendon were identified in 14 cadaver heads. Bony anatomical landmarks were identified to predict the oblique vector along which the trochlea and superior oblique tendon lie. The trochlea was measured in millimeters from the palpable superior orbital foramen. The oblique course of the superior oblique muscle tendon was measured from its medial location in the lateral direction in millimeters from the frontozygomatic suture. These measurements were obtained with 4.0-power loupe magnification. The trochlea was identified 10.0 +/- 0.9 mm inferior to the palpable superior orbital foramen. The superior oblique muscle tendon coursed laterally along an oblique vector to within 1 mm of the frontozygomatic suture for all 14 dissections. The vertical vector of the superior orbital foramen was measured 15.9 +/- 1.1 mm lateral to the medial canthus. The width of the bony orbit measured 42.2 +/- 1.6 mm. In two dissections, the superior orbital foramen could not be palpated, and the latter measurements were used to predict the superior orbital foramen. This anatomical study showed that when performing orbital fat resection with upper blepharoplasty, the trochlea and superior oblique muscle tendon can be identified and avoided with the above-described bony landmarks.     

Tibio-femoral movement in the living knee. A study of weight bearing and non-weight bearing knee kinematics using 'interventional' MRI

The aim of this study was to image tibio-femoral movement during flexion in the living knee. Ten loaded male Caucasian knees were initially studied using MRI, and the relative tibio-femoral motions, through the full flexion arc in neutral tibial rotation, were measured. On knee flexion from hyperextension to 120 degrees , the lateral femoral condyle moved posteriorly 22 mm. From 120 degrees to full squatting there was another 10 mm of posterior translation, with the lateral femoral condyle appearing almost to sublux posteriorly. The medial femoral condyle demonstrated minimal posterior translation until 120 degrees . Thereafter, it moved 9 mm posteriorly to lie on the superior surface of the medial meniscal posterior horn. Thus, during flexion of the knee to 120 degrees , the femur rotated externally through an angle of 20 degrees . However, on flexion beyond 120 degrees , both femoral condyles moved posteriorly to a similar degree. The second part of this study investigated the effect of gender, side, load and longitudinal rotation. The pattern of relative tibio-femoral movement during knee flexion appears to be independent of gender and side. Femoral external rotation (or tibial internal rotation) occurs with knee flexion under loaded and unloaded conditions, but the magnitude of rotation is greater and occurs earlier on weight bearing. With flexion plus tibial internal rotation, the pattern of movement follows that in neutral. With flexion in tibial external rotation, the lateral femoral condyle adopts a more anterior position relative to the tibia and, particularly in the non-weight bearing knee, much of the femoral external rotation that occurs with flexion is reversed.     

The movement of the normal tibio-femoral joint

This review describes the anatomy of the articular surfaces and their movement in the normal tibio-femoral joint, together with methods of measurement in volunteers. Forces and soft tissues are excluded. To measure movement, the articular surfaces and natural or inserted movement markers must be imaged by some combination of MRI, CT, RSA or fluoroscopy. With the aid of computer-imaging, the movements can then be related to an anatomy-based co-ordinate system to avoid kinematic cross-talk. Methods of depicting these movements which are understandable to engineers and clinicians are discussed. The shapes of the articular surfaces are reported. They are relevant to landmarks and co-ordinate systems and form a basis for inferring the nature of the movements which take place in the knee. The movements of the condyles are described from hyperextension to full passive flexion. Medially the condyle hardly moves antero-posteriorly from 0 degrees to 120 degrees but the contact area transfers from an anterior pair of tibio-femoral surfaces at 10 degrees to a posterior pair at about 30 degrees . Thus because of the shapes of the bones, the medial contact area moves backwards with flexion to 30 degrees but the condyle does not. Laterally the femoral condyle and the contact area move posteriorly but to a variable extent in the mid-range causing tibial internal rotation to occur with flexion around a medial axis. From 120 degrees to full flexion both condyles roll back onto the posterior horn so that the tibio-femoral joint subluxes.