Incidence and mechanism of the pivot shift. An in vitro study.

Accepted versio

Total ankle replacement design and positioning affect implant-bone micromotion and bone strains

Implant loosening - commonly linked with elevated initial micromotion - is the primary indication for total ankle replacement (TAR) revision. Finite element modelling (FEM) has not been used to assess micromotion of TAR implants; additionally, the biomech anical consequences of TAR malpositioning - previously linked with higher failure rates - remain unexplored. The aim of this study was to estimate implant - bone micromotion and peri - implant bone strains for optimally positioned and malpositioned TAR prosthe ses, and thereby identify fixation features and malpositioning scenarios increasing the risk of loosening. Computational models simulating three of the most commonly used TAR devices (BOX®, Mobility® and Salto®) implanted into the tibia/talus and subjected to physiological loads were developed. Mobility and Salto demonstrated the largest micromotion of all tibial and talar components, respectively. Any malpositioning of the implant creating a gap between it and the bone resulted in a considerable increase i n micromotion and bone strains. It was concluded that better primary stability can be achieved through fixation nearer to the joint line and/or while relying on more than a single peg. Incomplete seating on the bone may result in considerably elevated impl ant - bone micromotion and bone strains, thereby increasing the risk for TAR failure

The influence of muscle pennation angle and cross-sectional area on contact forces in the ankle joint

Data about a muscle’s fibre pennation angle and physiological cross-sectional area are used in musculoskeletal modelling to estimate muscle forces, which are used to calculate joint contact forces. For the leg, muscle architecture data are derived from studies that measured pennation angle at the muscle surface, but not deep within it. Musculoskeletal models developed to estimate joint contact loads have usually been based on the mean values of pennation angle and physiological cross-sectional area. Therefore, the first aim of this study was to investigate differences between superficial and deep pennation angles within each muscle acting over the ankle and predict how differences may influence muscle forces calculated in musculoskeletal modelling. The second aim was to investigate how inter-subject variability in physiological cross-sectional area and pennation angle affects calculated ankle contact forces. Eight cadaveric legs were dissected to excise the muscles acting over the ankle. The mean surface and deep pennation angles, fibre length and physiological cross-sectional area were measured. Cluster analysis was applied to group the muscles according to their architectural characteristics. A previously validated OpenSim model was used to estimate ankle muscle forces and contact loads using architecture data from all eight limbs. The mean surface pennation angle for soleus was significantly greater (54%) than the mean deep pennation angle. Cluster analysis revealed three groups of muscles with similar architecture and function: deep plantarflexors and peroneals, superficial plantarflexors and dorsiflexors. Peak ankle contact force was predicted to occur before toe-off, with magnitude greater than five times bodyweight. Inter-specimen variability in contact force was smallest at peak force. These findings will help improve the development of experimental and computational musculoskeletal models by providing data to estimate force based on both surface and deep pennation angles. Inter-subject variability in muscle architecture affected ankle muscle and contact loads only slightly. The link between muscle architecture and function contributes to the understanding of the relationship between muscle structure and function

A cadaveric model to evaluate the effect of unloading the medial quadriceps on patellar tracking and patellofemoral joint pressure and stability

Background Vastus Medialis Muscles (VMM) damage has been widely identified following patellar dislocation. Rehabilitation programmes have been suggested to strengthen the VMM and reduce clinical symptoms of pain and instability. This controlled laboratory study investigated the hypothesis that reduced Vastus Medialis Obliquus (VMO) and Vastus Medialis Longus (VML) muscle tension would alter patellar tracking, stability and PFJ contact pressures. Methods Nine fresh-frozen dissected cadaveric knees were mounted in a rig with the quadriceps and iliotibial band loaded to 205 N. An optical tracking system measured joint kinematics and pressure sensitive film between the patella and trochlea measured PFJ contact pressures. Measurements were repeated for three conditions: 1. With all quadriceps heads and iliotibial band (ITB) loaded; 2. as 1, but with the VMO muscle unloaded and 3. as 1, but with the VMO and VML unloaded. Measurements were also repeated for the three conditions with a 10 N lateral displacement force applied to the patella. Results Reduction of VMM tension resulted in significant increases in lateral patellar tilt (2.8°) and translation (4 mm), with elevated lateral and reduced medial joint contact pressures from 0.48 to 0.14 MPa, and reduced patellar stability (all p < 0.05). Conclusions These findings provide basic scientific rationale to support the role of quadriceps strengthening to resist patellar lateral maltracking and rebalance the articular contact pressure away from the lateral facet in patients with normal patellofemoral joint anatomy

Predicting freshwater habitat integrity using land-use surrogates

Freshwater biodiversity is globally threatened due to human disturbances, but freshwater ecosystems have been accorded lessprotection than their terrestrial and marine counterparts. Few criteria exist for assessing the habitat integrity of rivers and data used for such assessments are generally of limited geographical coverage. Here, we use a fine-scale dataset describing river integrity in north-western South Africa to explore the extent to which measures of freshwater habitat integrity can be predicted from remotely sensed data, which are readily available in many parts of the world. A spatial statistical model was built using broad land-cover variables to predict the habitat integrity (subdivided into riparian and instream integrity) of rivers.We also explored the importance of the spatial scale. Results showed that riparian and, to a lesser degree, instream habitat integrity of river systems could be predicted with reasonable accuracy. The total area under natural vegetation was the most significant predictor of riparian integrity, which is best predicted by land-use activities at catchment level, rather than more locally. Our GIS-based model thus provides a fine-scale approach to assessing river habitat integrity as a supplement to landscape-level conservation plans for river systems, and represents a significant contribution towards the monitoring componentof the River Health Programme (RHP), which reports on the state of rivers in South Africa

The attachments of the anteromedial and posterolateral fibre bundles of the anterior cruciate ligament: Part 1: tibial attachment.

Accepted versio