Load Distribution After Serial Resection of the Posterior Horn of the Lateral Meniscus and Subsequent Meniscal Allograft Transplant: A Biomechanical Study.

BACKGROUND: Data are lacking as to when a meniscal allograft transplant (MAT) may be biomechanically superior to a partially resected lateral meniscus. HYPOTHESIS: Lateral MAT using a bone bridge technique would restore load distribution and contact pressures in the tibiofemoral joint to levels superior to those of a partial lateral meniscectomy. STUDY DESIGN: Controlled laboratory study. METHODS: Eleven fresh-frozen human cadaveric knees were evaluated in 5 lateral meniscal testing conditions (native, one-third posterior horn meniscectomy, two-thirds posterior horn meniscectomy, total meniscectomy, MAT) at 3 flexion angles (0°, 30°, and 60°) under a 1600-N axial load. Pressure sensors were used to acquire contact pressure, contact area, and peak contact pressure within the tibiofemoral joint. RESULTS: Limited (one-third and two-thirds) partial lateral posterior horn meniscectomy showed no significant increase in mean and peak contact pressures as well as no significant decrease in contact area compared with the intact state. Total meniscectomy significantly increased mean contact pressure at 0° and 30° (P = .008 and P < .001, respectively), increased peak contact pressure at 30° (P = .04), and decreased mean contact area in all flexion angles compared with the native condition (P < .01). Lateral MAT significantly improved mean contact pressure compared with total meniscectomy at 0° and 30° (P = .002 and P = .003, respectively) and increased contact area at 30° and 60° (P = .003 and P = .009, respectively), although contact area was still significantly smaller (24.1%) after MAT relative to the native meniscus (P = 0.015). However, allograft transplant did not result in better tibiofemoral contact biomechanics compared with limited partial meniscectomy (P > .05). CONCLUSION: The peripheral portion of the lateral meniscus provided the most important contribution to the distribution of contact pressure across the tibiofemoral joint in the cadaveric model. Total meniscectomy significantly increased mean and peak contact pressure in the cadaveric model and decreased contact area. Lateral MAT restored contact biomechanics close to normal but was not superior to the partially meniscectomized status. CLINICAL RELEVANCE: Surgeons should attempt to preserve a peripheral rim of the posterior lateral meniscus. Meniscal allograft transplant appears to improve but not normalize mean contact pressure and contact area relative to total lateral meniscectomy.

Bone-Plug Versus Soft Tissue Fixation of Medial Meniscal Allograft Transplants: A Biomechanical Study.

BACKGROUND: It is controversial whether soft tissue fixation only and bone-plug techniques for medial meniscal allograft transplantation provide equivalent fixation and restoration of load distribution. Prior studies on this topic did not re-create the clinical situation with use of size-, side-, and compartment-matched meniscal transplants. HYPOTHESIS: Both techniques will provide equivalent fixation of the meniscal transplant and restore load distribution and contact pressures similar to those of the native knee. STUDY DESIGN: Controlled laboratory study. METHODS: Nine fresh-frozen human cadaveric knees underwent mean contact pressure, mean contact area, and peak contact pressure evaluation in 4 medial meniscal testing conditions (native, total meniscectomy, bone-plug fixation, and soft tissue fixation) at 3 flexion angles (0°, 30°, and 60°) using Tekscan sensors under a 700-N axial load. RESULTS: Medial meniscectomy resulted in significantly decreased contact area and increased contact pressure compared with the native condition at all flexion angles (P < .0001). Compared with the native state, soft tissue fixation demonstrated significantly higher mean contact pressure and lower mean contact area at 0° and 30° of flexion (P < .05), while bone-plug fixation showed no significant difference. There was no significant difference in peak contact pressure between study conditions. CONCLUSION: Total medial meniscectomy leads to significantly worsened load distribution within the knee. Medial meniscal allograft transplantation can restore load parameters close to those of the native condition. The bone-plug technique demonstrated improved tibiofemoral contact pressures compared with soft tissue fixation. CLINICAL RELEVANCE: Medial meniscal allograft transplantation with bone-plug fixation is a viable option to restore biomechanics in patients with meniscal deficiency.

Evaluation of two wheelchair hand rim models: contact pressure distribution in straight line and curve trajectories.

Manual wheelchairs are essential for people with disabilities or limited mobility. However, manual propulsion causes biomechanical loads, including contact pressures on the palms of the hands. The hand rim design has received little attention over time, remaining almost unchanged since its creation. This study investigated how two different designs of such devices - one standard and another with a contoured design - influence the contact pressure on the surface of the hands. The procedures included a figure-of-eight shape propulsion task on a regular floor, using both models on a wheelchair. A pressure-mapping system coupled with a pair of fabric gloves recorded the data. The results show that the contoured hand rim provides lower pressure in most of the analysed regions. Considering that manual propulsion is performed during a considerable part of the day as a routine activity, improving the hand rim interface may benefit the user's comfort and safety during wheelchair use. Practitioner summary: The design of the hand rim used in wheelchair propulsion influences the contact pressure on the hands. Conventional round tube rims tend to concentrate high levels of pressure on the distal phalanges and metacarpal regions. A contoured design generally provides better stability and promotes the distribution of pressure. Abbreviations: AT: assistive technology; kPa: kilopascal.

Análisis numérico sobre esfuerzos y áreas de contacto en una PTR Scorpio II® Stryker®. Base para el diseño de PTR personalizada al fenotipo Mexicano / Numerical analysis on stresses and contact areas in a TKR Scorpio II® of Stryker®. Basis to design of customized TKR in accordance to Mexican Phenotype

El desgaste de los insertos de Polietileno de Ultra-Alto Peso Molecular (UHMWPE pos sus siglas en inglés) continúa afectando la longevidad de las prótesis totales de rodilla (PTR) junto con el aflojamiento aséptico, y ambos constituyen las dos principales causas de falla de las prótesis. Considerando esto, es necesario encontrar soluciones adecuadas para evitar el desgaste excesivo y hasta la ruptura de los insertos de polietileno. En este trabajo se realizó el estudio mediante simulación numérica de una PTR Scorpio II® Stryker®, la cual se retiró por desgaste del inserto de UHMWPE en el Hospital 1° de Octubre del ISSSTE en México. Se utilizaron las hipótesis de Bartel et al. (1995) y Chillag et al. (1991) para la validación del método numérico utilizado, las cuales establecen que el desgaste del polietileno puede reducirse utilizando insertos tibiales de mayor espesor, lo cual disminuye las presiones de contacto. Los análisis se realizaron mediante MEF variando el espesor del inserto de 6, 8, 10, 12 y 14 mm, suponiendo cargas axiales de tipo cuasi-estático en la articulación a cero grados de flexión, para 1.33 veces el peso de un individuo de 75 kg (736 N) empleando el ciclo normalizado de marcha. Los resultados obtenidos muestran similitud con los reportados por Bei et al. (2004) y Deen et al. (2006). Después de validar el método, se desarrolló el modelo de MEF de la PTR y se determinaron las curvas de esfuerzo y de áreas de contacto del inserto de UHMWPE, con lo que se obtuvo información importante para modificar el diseño y obtener una prótesis de geometría conforme en los planos coronal y sagital del inserto femoral y el inserto de polietileno, de acuerdo con el fenotipo mexicano.

Wear of UHMWPE inserts continues affecting the longevity of total knee replacements (TKR) together with septic loosening, and both constitute two main causes of prosthesis failure. It is necessary to find appropriate solutions to avoid excessive wear and failure of polyethylene inserts. In this work a study was carried out by means of numeric simulation of a Scorpio II® Stryker® TKR, which was retired due to wear of UHMWPE in the Hospital 1° de Octubre of ISSSTE in Mexico city. Hypotheses of Bartel et al. (1995) and Chillag et al. (1991) were used, which settle down that wear of polyethylene can decrease using thicker tibial inserts, which can be reduced contact pressures. Analyses of this work was carried out by means of FEM varying insert thickness of 6, 8, 10, 12 and 14 mm, considered quasi-static axial loads actuating on the articulation with zero degrees of flexion and loads equivalent to 1.33 times of bodyweight of a subject of 75 kg (736 N) was considered. Normalized gait cycle was employed and results obtained are similar to those reported by Bei et al. (2004) and Deen et al. (2006). After validating the method, a model of study case of TKR in FEM was developed and the curves of stress and contact areas of UHMWPE were determined, with which important information was obtained to modify the design, as well as to obtain a prosthesis of optimal conformity in both coronal and sagital planes of the femoral and UHMWPE inserts, in agreement with characteristics of the Mexican phenotype.