Effects of a surface matching articular resurfacing device on tibiofemoral contact pressure: results from continuous dynamic flexion-extension cycles.

INTRODUCTION: The application of a defect-size metal implant for the treatment of focal articular cartilage lesions of the femoral condyle is of potential concern resulting in cartilage damage to opposing biological structures. This in vitro study aims to determine the tibiofemoral contact pressure with a contoured articular partial femoral resurfacing device under continuous dynamic pressure loads. METHODS: Peak and area contact pressures were determined in eight fresh-frozen cadaveric specimens using a pressure-sensitive sensor placed in the medial compartment above the menisci. All knees were tested in the untreated condition and after implantation of the prosthetic device in the weight-bearing area of the medial femoral condyle. A robotic knee simulator was used to test each knee under continuous pressure load for 400 s during 40 dynamic knee bending cycles (5°-45° flexion) with body weight ground reaction force (GRF). The GRF was adjusted to the living body weight of the cadaver donor and maintained throughout all cycles. RESULTS: Comparison of the untreated condition to focal inlay resurfacing showed no statistically significant differences (P ≤ 0.05) between all testing conditions. The average maximum peak contact pressure across all 40 flexion cycles increased by 5.1% after resurfacing compared to the untreated knees. The average area contact pressure essentially stayed the same (+0.9%). CONCLUSION: The data suggest that resurfacing with the contoured articular prosthetic device does not pose any immediate deleterious effects to the opposing surfaces based on peak and area contact pressure in a continuous dynamic in vitro application. However, long-term in vivo effects remain to be evaluated.

Biomechanical stability of an arthroscopic anterior capsular shift and suture anchor repair in anterior shoulder instability: a human cadaveric shoulder model.

It was hypothesized that an arthroscopic Bankart repair with suture anchors supplies sufficient anterior shoulder stability, which cannot be improved by an additional capsular shift. In an experimental biomechanical human cadaver study, we tested ten fresh human cadaver shoulders in a robot-assisted shoulder simulator. External rotation and glenohumeral translation were measured at 0 degrees and 80 degrees of glenohumeral abduction. All measurements were performed under the following conditions: on the non-operated shoulder; following the setting of three arthroscopic portals; following an arthroscopic anterior capsular shift; following a simulated Bankart lesion; and following an arthroscopic Bankart repair. The application of three arthroscopic portals resulted in a significant increase of the anterior (P = 0.01) and antero-inferior translation (P = 0.03) at 0 degrees and 80 degrees abduction, as well as an increase in external rotation at 80 degrees abduction (P = 0.03). Capsular shift reduced external rotation (P = 0.03), but did not significantly decrease translation. Simulating anterior shoulder instability, glenohumeral translation significantly increased, ranging from 50 to 279% of physiological translation. Arthroscopic shoulder stabilization resulted in a decrease of translation in all tested directions to approximately physiologic levels. External rotation in 0 degrees abduction was thus decreased significantly (P = 0.003) to an average of 19 degrees . The study proved that an arthroscopic anterior capsular shift in a cadaveric model decreases external rotation without a significant influence on glenohumeral translation. Arthroscopic shoulder stabilization with suture anchors thus sufficiently restores increased glenohumeral translation, but also decreases external rotation in neutral abduction. An anatomic reconstruction of the Bankart lesion without overconstraining of the antero-inferior capsule should therefore be the aim in arthroscopic anterior shoulder stabilization.

Comparison of a manual and motorized stiffness meter to quantify bone regeneration in distraction osteogenesis.

To assess bone healing and investigate the influence of different pharmaceutics (e.g. growth factors) on bone stiffness and strength in-vivo, new quantitative methods are necessary. Therefore, a new manual and motorized stiffness meter to quantify bone regeneration in a model of distraction osteogenesis were compared. The design, equipment, and improvements of the measurement devices are described. Furthermore, their difference in precision and accuracy in comparison to tests from a material testing system, used as "gold standard", were evaluated. Both devices were able to assess regenerate stiffness: the accuracy ranged between +/- 9% for the manual and +/-5% for the motorized version for stiffness data over 0.1 Nm/ degrees; precision between +/- 3.8% for the manual and +/- 3.2% for the motorized device. In summary, the two stiffness measurement devices described in this study have the power to monitor the beginning of bone healing and therefore predict the load bearing capacity of regenerating bone. The motorized version showed advantages over the manual device when investigating and monitoring the stiffness of bone during a consolidation period: (1) better accuracy in both stiffness below and above 0.1 Nm/ degrees, (2) a better precision in the stiffness range of interest, (3) easier handling, and (4) standardisation of the measurement process using the stepper motor and definition of the maximums of torque, angulation and rotation speed.