RESUMO
PURPOSE: Ligament balancing is a prerequisite for good function and survival in total knee arthroplasty (TKA). Various balancing techniques exist, but none have shown superior results. The pie-crusting technique by Bellemans of the medial collateral ligament is commonly utilized; however, it can be difficult to achieve repeatable ligament lengthening with this technique. Therefore, we invented a novel instrument to standardize the pie-crusting technique of the superficial and deep medial collateral ligament (hereafter MCL). The purpose was to examine if pie-crusting with the instrument could produce repeatable ligament lengthening. METHODS: The MCL was isolated in 16 human cadaveric knees, and subjected to axial tension. The instrument was composed of a specific grid of holes in rows, used to guide sequential pie-crusting puncturing of the MCL with a Ø1.6 mm end-cutting cannula. Ligament lengthening was measured after each row of punctures. Regression analysis was performed on the results. RESULTS: Mean lengthening ± SD in human cadaveric MCL for puncturing of row 1 in the instrument was 0.06 ± 0.09 mm, 0.06 ± 0.04 mm for row 2, 0.09 ± 0.08 mm for row 3, 0.06 ± 0.05 mm for row 4 and 0.06 ± 0.04 mm for row 5, giving a mean total lengthening of 0.33 ± 0.20 mm. Linear regression revealed that MCLs were repeatably lengthened by 0.07 mm per row when punctured using the instrument. CONCLUSIONS: MCLs showed linear lengthening in human cadavers for subsequent use of the instrument. Our instrument shows promising results for repeatable ligament lengthening.
RESUMO
The Markforged Metal X (MfMX) printing machine (Markforged Inc., Massachusetts, USA) is one of the latest introduced additive manufacturing (AM) devices. It is getting popular because of its safety, simplicity, and ability to utilize various types of powders/filaments for printing. Despite this, only a few papers have so far reported the various properties and performances of the components fabricated by the MfMX printer. In this study, the microstructure and mechanical properties of MfMX-fabricated 17-4 stainless steel (ss) in the as-printed and heat-treated conditions were investigated. XRD and microscopy analyses revealed a dominant martensitic microstructure with some retained austenite phase. The microstructure is generally characterized by patterned voids that were unfilled due to a lack of fusion between the adjacent filaments. Disregarding these defects (voids), the porosity of the dense region was less than 4%. Depending on the heat treatment conditions, the hardness and tensile strength were enhanced by 17-28% and 21-27%, respectively. However, the tensile strength analyzed in this work was low compared with some previous reports for L-PBF-fabricated 17-4 ss. In contrast, the hardness of the as-printed (331 ± 28 HV) and heat-treated samples under the H900 condition (417 ± 29 HV) were comparable with (and even better than) some reports in the literature, despite the low material density. The results generally indicated that the Markforged printer is a promising technology when the printing processes are fully developed and optimized.
