Articular cartilage covers the articulating ends of diarthrodial joints. It plays a vital role in the function of the musculoskeletal system by allowing almost frictionless motion to occur between the articular surfaces of a diarthrodial joint. Study of cartilage contact behavior will help to understand the intrinsic biomechanical properties related to cartilage degeneration and related pathology. In order to study the mechanical behavior of the cartilage a FEM based computational model of the knee-joint was developed from MRI data. A heuristic algorithm was developed based on Image processing techniques using Evolve2D toolbox and edge detection. An indigenous path following algorithm to capture minute details of bone and soft tissue curvature was developed using Image Processing Toolbox of Matlab. Parts including femur, tibia, femoral and tibial cartilages, lateral & medial menisci were extracted as a point cloud from each of the slices and rendered into a 3D model using GUI driven CAD package RHINOCEROS 4.0. Commercial FE software HYPERMESH 9.0 was used to develop FE model from geometric model. Cartilage and Menisci were modeled using eight node hexahedral elements and bones were modeled using four node quadrilateral elements. Bones were assumed to be rigid. Cartilage and menisci were assumed to be linearly elastic, isotropic and homogenous. The knee joint was subjected to a uniaxial compressive load with tibia remaining fixed and femur subjected to two primary boundary conditions: 1.Flexion - extension and Varus - Valgus rotation constrained; 2.Only Varus - Valgus rotation constrained. Parameters such as contact area, contact pressure, contact force, centre of contact pressure, mises stress distribution; maximum and minimum principal stresses were studied at maximum compressive load condition and also in intermittent steps. This model considered both geometric and contact non-linearity. From the FE analysis, it was observed that peak contact deformation and contact area on both femoral and tibial medial cartilage was found to be greater than the lateral side under full extension condition. More than 50% of the load transmission was through the medial side - which could be an indication of cartilage degeneration. Deformation of lateral meniscus was more than the medial meniscus under angular constrained conditions. Loading history during intermittent steps suggested that contact area on lateral tibial cartilage increased with load, indicating joint asymmetry. These results indicate the importance of the rotational constraints (boundary conditions) and represent more accurate physiological behavior of knee joint. Role of menisci in this study was analyzed, which indicated that consideration of menisci is essential in biomechanical estimation of load transmission. In conclusion, detailed segmentation to develop geometric model, precise boundary conditions & time dependent behavior of cartilage and menisci helped in understanding knee joint load bearing capacity to a better accuracy and can potentially give rise to designing better cartilage implants.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 5 uppsatser.

Anterior cruciate ligament injury leads to increased sagittal tibial translation, and perceptions of instability and low confidence in the knee joint are common. Many patients have remaining problems despite treatment and are forced to lower their activity level and prematurely end their career in sports. The effect of ACL reconstruction and/or rehabilitation on dynamic knee stability is not completely understood. The overall aim of this thesis was to study the dynamic knee stability during and after rehabilitation in individuals with ACL injury. More specific aims were 1) to elaborate an evaluation method for muscle strength, 2) to evaluate the effect of exercises in closed and open kinetic chain, and 3) to evaluate dynamic knee stability in patients with ACL deficiency or ACL reconstruction. Sagittal tibial translation and knee flexion angle were measured using the CA‐4000 computerised goniometer linkage. Muscle activation was registered with electromyography. The intra‐ and inter‐rater reliability of 1 repetition maximum (RM) of seated knee extension was clinically acceptable. The inter‐rater reliability of 1RM of squat was also acceptable, but the intra‐rater reliability was lower. The systematic procedure for the establishment of 1RM that was developed can be recommended for use in the clinic. One specific exercise session including cycling and a maximum number of knee extensions and heel raises did not influence static or dynamic sagittal tibial translation in uninjured individuals. A comprehensive rehabilitation program with isolated quadriceps training in OKC led to significantly greater isokinetic quadriceps strength compared to CKC rehabilitation in patients with ACL deficiency. Hamstring strength, static and dynamic translation, and functional outcome were similar between groups. Five weeks after ACL reconstruction, seated knee extension produced more anterior tibial translation compared to the straight leg raise and standing on one leg. All exercises produced less or equal amount of anterior tibial translation as the 90N Lachman test. Five weeks after the ACL reconstruction the static and dynamic tibial translation in the ACL reconstructed knee did not differ from the tibial translation on the uninjured leg. Patients in the early phase after ACL injury or ACL reconstruction used a joint stiffening strategy including a reduced peak knee extension angle during gait and increased hamstring activation during activity, which reduces the dynamic tibial translation. Patients with ACL deficiency that completed a four months rehabilitation program used a movement pattern that was more close to normal.

The goal of this thesis is summarize the current knowledge about Jumper's knee. It also includes a brief summary of the anatomy and kinesiology of the knee and then a separate chapter is devoted to the etiology, clinical picture, investigations and treatment of Jumper's knee. On these findings has been prepared and compiled research project hypotheses. This research is to determine whcther, and what affects Jumper's knee in the human musculoskeletal system. To this end, we chose a method of surface electromyography and dynamic plantography for analysis of pressure distribution and reaction forces during foot contact with the plate. Attention was focused on the comparison of side differences and timing muscle trunk and legs during dynamic activities sdccted. The results were compared with a control group that consisted of healthy individuals. Powered by TCPDF (www.tcpdf.org)

Author: Bc. Aneta Vránová Title: Changes of rheological properties during various degrees of knee flexion Aim of the thesis: To find out if there is a difference in rheological properties in varoius degrees of flexion in the knee with meniscal tear and compare the results with measurement after physical aktivity. To compare changes of the reological properties of patients who have undegone meniscectomy a few years ago with patients with recent meniscectomy. Method: Experimental measurements were done by using the method of biorheometry which detects the passive resistance of the knee in movement from flexion to extension. Patients completed case history and a special questionnaire relevant to clinical changes connected to meniscal tear. Measuring data were evaluated and converted in the form of biorheogramme. We measured 6 persons. At first were done measurements in three different sequences for both lower extremities, the same measurement was repeated after the physical activity (50 squats). Results: We found changes of rheological properties in higher degrees of knee flexion with typical rising followed by fall of biorheogramme around flexion of 80ř. They were more remarkable after physical activity. Changes of rheological properies were more expressive in patients who have undergone meniscectomy...

Title: The influence of ACL plastic surgery in relation to the knee joint stability by female handball players and the posibility to influence this topic during training sessions The concept of the problem: One of the most common injuries of lower extremities during a handball game is the tear of the anterior cruciate ligament (ACL) often leading to instability and early offset of degeneration of the knee joint. In order to be able to continue the athletic carier, the patient may require surgery of the cruciate ligament. Usually 6-8 months after the operation, the patient should be able to return to her full extand of the athletic competition. Never-the-less, functional deficit of the operated knee is not uncommon. Often times, patients post ACL surgery experience secondary injuries such as the injury of the oposite knee joint or recurring defects of the prior injured ACL. Objectives: To evaluate the conditions of knee joints by female players (2-5 years) post ACL plastic surgery and to attest the efectivity of the exercise program for improving knee joint stability by those players. Methods: The theoretical part follows up the given issue as a research and theoretical overview of the current findings based on czech and also foreign literature. The practical part is dedicated to the application of...

Name: Influence of a rupture and reconstruction of an anterior cruciate ligament on the postural activity of an individual Aim: The aim of my thesis is to find out whether a rupture and the following rupture recinstruction of an anterior cruciate ligament has an influence on the postural activity of an individual namely after a longer period ( at least one year) from the undergone operation. Methods: The thesis has been worked out by a form of an analytical comparative study where it deals with measuring of two groups of probands - healthy and those after anterior cruciate ligament operation. The postural behaviour of individuals was tested after deflection by impact of a pendulum at a free standing position with and without visual control and also when standing on one leg. Results: The results of the measuring denote that when a person after anterior cruciate ligament rupture and following rupture recinstruction is deflected by an external impact while standing on both legs he/she will rather rely on the leg without surgery but the side difference will not be very distinctive. This fact will not change much even without visual control. While standing on one leg though the individual after surgery will have a more serious problem to stabilize his/her position (the period of time to stabilize will...

A articulação do joelho tem sido vastamente estudada nas ultimas décadas. Este intenso interesse pode ser visto sob o foco da complexidade desta articulação e de sua importância clínica. No entanto, nota-se escassa informação a respeito de aspectos morfológicos e ultraestruturais sobre o desenvolvimento desta articulação, em fetos humanos de diferentes faixas etárias, o que poderia servir de base teórica para estratégias de reparo da cartilagem e engenharia de tecidos, bem como contribuir para uma melhor compreensão de doenças e malformações ao longo do desenvolvimento dos componentes articulares. Desse modo, considerando-se a importância do conhecimento sobre aspectos morfofuncionais do desenvolvimento normal dos tecidos cartilagíneos na articulação do joelho humano, realizou-se a presente pesquisa com fetos humanos abrangendo a faixa etária da 16ª a 31ª semanas de vida intrauterina. Foram utilizados 20 fetos, os quais foram divididos em 4 grupos (n=5) da seguinte forma: grupo 1 (G1): 16-19 semanas de vida intrauterina (VIU); grupo 2 (G2): 20-23 semanas VIU; grupo 3 (G3): 24-27 semanas VIU e grupo 4 (G4): 28-31 semanas VIU, em que foram realizadas análises morfométricas da cartilagem das epífises do fêmur e tíbia na articulação do joelho, para os parâmetros: área dos condrócitos, densidade de condrócitos e matriz extracelular, análise estereológica para o volume dos condrócitos, e análise qualitativa da distribuição, organização e tipificação de fibras colágenas com uso de Picro-sirius sob análise com luz polarizada. Também se analisou a ultraestrutura através de microscopia eletrônica de varredura (MEV). Frente à metodologia proposta e os resultados obtidos a respeito da avaliação morfofuncional, concluiu-se que a área e o volume dos condrócitos, bem como a densidade da matriz extracelular, na região média das epífises cartilagíneas, tanto do fêmur quanto da tíbia, aumentaram com o avançar da faixa etária, enquanto a densidade dos condrócitos diminuiu. Na região média das epífises, a cartilagem imatura dos fetos mais jovens, inicialmente com características de uma zona de proliferação, passa a apresentar, em fetos com idade mais avançada, características de uma zona de maturação, com condrócitos maiores e mais distantes uns dos outros. Na camada superficial da epífise a organização e orientação das fibras de colágeno modificam-se nos diferentes grupos, passando de uma orientação irregular no grupo dos fetos mais jovens, para uma organização pantográfica no grupo de fetos mais desenvolvidos. Finalmente, verifica-se a clara relação entre o amadurecimento da cartilagem e as alterações na organização e orientação das fibras colágenas, as quais contribuem para as propriedades requeridas na cartilagem em cada fase de seu desenvolvimento, tais como resistência à tensão, resistência à compressão e habilidade para distribuir cargas / The knee joint has been widely studied in recent decades. This intense interest can be seen from the perspective of the joint complexity and its clinical importance. However, there is little information about morphological and ultrastructural aspects of the development of this joint, particularly in human fetuses within different age, which could serve as a theoretical basis for cartilage repair strategies and tissue engineering, as well as contributing for a better understanding of diseases and malformation during the development of joint components. Thus, considering the importance of morphological and functional aspects of normal cartilaginous tissue development in the human knee joint, this research was performed with human fetuses covering the age range 16 to 31 weeks of intrauterine life. Twenty (20) fetuses were divided into 4 groups (n = 5) as follows: Group 1 (G1): 16-19 weeks, Group 2 (G2): 20-23 weeks, Group 3 (G3): 24-27 weeks and Group 4 (G4): 28-31 weeks. For the femoral and tibial epiphysis cartilage in the knee joint, it was performed morphometric analysis regarding area of chondrocytes, percent density of chondrocytes and extracellular matrix, stereological analysis of the chondrocytes volume and qualitative analysis of the distribution, organization and characterization of collagen fibers using picrosirius staining under analysis with polarized light. It was also analyzed the ultrastructure by scanning electron microscopy. Facing the proposed methodology and the results regarding the morphological evaluation of the middle region of both femur and tibia epiphysis, it was concluded that the area and the volume of the chondrocytes, as well as the density of extracellular matrix increased with advancing age, while the percent density of chondrocytes decreased. In the middle region of the epiphysis, immature cartilage of younger fetuses, initially with characteristics of a proliferation zone starts to present, in older fetuses, characteristics of maturation zone, presenting larger chondrocytes and more distant from each other. In the epiphysis cartilage surface, the organization and orientation of the collagen fibers changed in different groups, from an irregular orientation in the younger fetuses group, to a pantograph organization in the most developed fetuses group. Finally, it was observed the relationship between the cartilage development and the changes in the collagen fibers organization and orientation in order to obtain the cartilage properties required at each stage of the development, such as tensile strength, resistance to compression and ability to distribute loads

Um dos fatores que podem contribuir para as lesões na articulação do joelho é a incapacidade do indivíduo em manter durante atividades funcionais, um bom alinhamento entre os segmentos corporais tais como tronco, quadril e joelho. Na maioria das vezes o aumento do valgo dinâmico de joelho é apontado como um fator etiológico de lesões nessa articulação e sua identificação precoceé importante, bem como de outros fatores biomecânicos. Os testes funcionais para avaliação do valgo são importantes ferramentas para analisar o alinhamento dinâmico entre os segmentos corporais, porém ainda não há na literatura subsídios cinesiológicos que comparem a amplitude articular do joelho, quadril e tronco nas principais tarefas funcionais e utilizadas na prática clínica. Da mesma forma, a relação da cinemática desses segmentos com o torque dos músculos estabilizadores do quadril e joelho ainda é controverso. Objetivos: Comparar os valores angulares dados pela cinemática de tronco, quadril e joelho em cinco diferentes tarefas funcionais utilizadas para avaliação do valgo dinâmicoe correlacionar com o pico de torque de joelho e quadril. Materiais e Métodos: 30 voluntários saudáveis sem historia de dor ou disfunção em membros inferiores, de ambos os sexos (15 homens e 15 mulheres) com idade de 18 a 35 anos realizaram os testes de força muscular isométrica para todos os grupos musculares de joelho e quadril utilizando o Dinamômetro isocinéticoBiodex®. Entre 3 a 7 dias após o teste de força muscular foi realizada a análise cinemática de tronco, quadril e joelho utilizando o Sistema VICON (Centennial, CO, EUA) durante a realização de cinco diferentes tarefas funcionais para avaliação do valgo dinâmico de joelho, sendo elas: descida de degrau, singlelegstepdown, agachamento unipodal, aterrissagem unipodal, drop vertical jump. Resultados: A tarefa dedrop vertical jump apresentou os maiores valores de pico de valgo(média: 20,1º p<=0,04), rotação interna de joelho(média: 9,7º p<=0,003), flexão de quadril(média: 38,8º p<=0,001) e menores valores de rotação de tronco (média: 0,07º p<=0,009). A tarefa de single legstepdown apresentou maiores valores de flexão de tronco (média: 10,2º p<=0,002) em relação às outras tarefas funcionais. Foi observada uma correlação negativa e fraca do pico de torque de rotadores externos de quadril e inclinação ipsilateral de tronco(R= - 0,36; p=0,049) na tarefa de descida de degrau. Não houve evidências de correlação entre o pico de torque de abdutores, adutores, rotadores internos,rotadores externos, flexores, extensores de quadril e flexores e extensores de joelho com a cinemática de joelho, quadril e tronco nas tarefas funcionais de agachamento unipodal, aterrissagem unipodal, drop vertical jump e singlelegstepdown. Conclusão:A compreensão das variáveis cinesiológicas de joelho, quadril e troncoé fundamental para direcionar o clínico na escolha do teste funcional para avaliação do valgo dinâmico.Todas as tarefas analisadas são efetivas para avaliar o valgo dinâmico, porém adrop vertical jumpparece demandar mais estratégias de joelho e quadril, e a tarefasingle legstepdown apresentou maiores alterações cinesiológicasde tronco. Além disso, o pico de torque de quadril e joelho não exerceu influência no desempenho dos testes em indivíduos saudáveis / One of the factors that can contribute to injuries in the knee joint is the individual\'s inability to maintain an alignment between the body segments such as trunk, hip and knee during functional activities. Most of the time the dynamic knee valgus has been suggested as an etiologic factor that contributefor this joint injuries and early identification along with biomechanical factors associated with knee joint injuries is important. The functional tests for knee valgus evaluation are important tools for assessing the dynamic alignment between body segments, but there is no kinesiological subsidies in the literature that compare knee, hip and trunk in most of the described functional tasks used in the clinical practice and their relationship with the hip and knee strengthin healthy subjects. This study aimsto compare the angle values by the trunk, hip and knee kinematics in five different functional tasks used to evaluate the dynamic valgus and correlate this with the muscle\'s torque of the hip and knee. A sample of 30 healthy volunteers (15 men and 15 women) aged 18 to 35, with no history of pain or dysfunction in the lower limbs, performed a isometric muscle strength tests for all theknee and hip groups muscles using an isokinetic dynamometer Biodex®. Between 3 and 7 days after the muscle strength testing trunk, hip and knee kinematic analysis was performedduring five different functional tasks for evaluating the dynamic knee valgus using the Vicon system (Centennial, CO, USA).The functional tests were: stair descent, single-leg step down, single leg squat, single leg landing, drop vertical jump. ANOVA repeated measures was used to verify the differencesin the tasks for knee, hip and trunk kinematics and Pearson\'s correlation was used to verify correlations between hip and knee muscle\'s torque and knee, hip and trunk kinematics. The drop vertical jump task showed the highest peak values of valgus (average: 20.1º p<=0,04), internal rotation of the knee (average: 9,7º p<=0,003), hip flexion (mean: 38,8º p<=0,001) and lower trunk rotation values (mean 0,07º p<=0,009). The single leg step down task showed greater trunk flexion values (mean: 10,2º p<=0,002) in relation to all functional tasks. It was observed a negative and weak correlation of thehip external rotators torque and ipsilateral trunk lean (R = - 0.36, p = 0.049) in stair descent task. There was no evidence of correlation between peak torque of the hip abductors, adductors, internal rotators, external rotators, flexors and extensors and flexors, extensors of the knee with knee, hip and trunk kinematics in the single leg squat, landing, drop vertical jump and single-leg step down. For choosing a functional task to evaluate the dynamic valgus is crucial to the clinicians understand the kinesiological variables of knee, hip and trunk. All assessed tasks are effective to evaluate the dynamic knee valgus, although the drop vertical jump task requires more adjustments in the knee and hip, and the single leg step down task has higher kinesiological changes in the trunk.In addition, knee and hip peak of torque had no influence on the performance of the tests in healthy individuals

by Lo Ming Yip. / "July 1998." / Thesis (Ph.D.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (p. 208-247). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstract in Chinese.