O objetivo desta dissertação foi avaliar biomecanicamente o ângulo de flexão do joelho em que a fixação do enxerto do Ligamento Patelofemoral Medial (LPFM) se mostrou mais adequada. Foram estudados 12 joelhos de cadáveres, sendo que seis peças foram utilizadas para ajustes necessários no sistema. Os joelhos foram preparados em uma máquina de ensaios desenvolvida no Laboratório de Biomecânica do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP) a qual permitiu a avaliação dinâmica do comportamento patelar, quantificando a sua lateralização entre 0° e 120° graus de flexão do joelho. A técnica utilizada para a reconstrução do LPFM foi a utilização do enxerto do ligamento patelar, como apresentada por Camanho et al. em 2007. Os joelhos foram submetidos a situações de intacto, lesado e reconstruído, com e sem carga aplicada lateralmente, simulando a força de luxação da patela. Com o sistema de fotogrametria, pôde-se avaliar a lateralização da patela entre os ângulos de 0° e 120° graus de flexão do joelho. Os dados encontrados foram calculados a partir de um programa de Software conectado à máquina de ensaios. O grau de flexão do joelho foi determinado a partir de um goniômetro digital. O tensionamento do enxerto foi padronizado em 1 Kgf com a utilização de um sistema digital acoplado a uma célula de carga de 20 Kgf. As diferenças entre as distâncias encontradas, com e sem carga aplicada na patela, foram agrupadas segundo o ângulo de fixação do enxerto reconstruído em 0º, 45º, 60º e 90º e situação do joelho íntegro e lesado. Os resultados foram tabulados a partir das médias das três repetições. Os dados foram inseridos e analisados no banco de dados dos programas estatísticos STATA versão 11.0 e SAS versão 8.0. Foi realizada a Análise de Variância (ANOVA) e comparações múltiplas de Tukey(96). Houve uma tendência em ocorrer menor desvio lateral em ângulos de fixação do enxerto reconstruído acima de 30° graus de flexão, principalmente com a reconstrução realizada no ângulo de flexão do joelho, em que o ligamento foi reconstruído, de 60°graus. Para os demais ângulos não houve significância estatística / The aim of this dissertation was to make a biomechanical assessment on the knee flexion angle at which fixation of grafts for the medial patellofemoral ligament (MPFL) is seen to be best. Twelve knees from cadavers have been studied, of which six specimens were used to make necessary adjustments to the system. The knees were prepared in a test machine developed in the Biomechanics Laboratory of the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo. This enabled dynamic evaluation of the patellar component, with quantification of its lateralization between 0 and 120 degrees of flexion angle. The technique used for reconstructing the MPFL consisted of using a graft from the patellar ligament, as presented by Camanho et al. in 2007. The knees were subjected to situations in intact, injured and reconstructed states, with and without loads applied laterally, to simulate the patella dislocation force. With a photogrammetry system, the lateralization of the patella could be assessed between the knee flexion angles of 90°, 60°, 45° and 0 degrees during the graft reconstruction. The results were calculated through software coupled to the test machine. The knee flexion angle could be determined from a digital goniometer. The graft tensioning was standardized at 1 kgf by using a digital system coupled to a 20-kgf load cell. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle of 0°, 45°, 60° e 90°, during the reconstruction, and knee situation of intact or injured. The results were tabulated taking the mean from three repetitions. There was a tendency for less lateral deviation to occur at fixation angles of the reconstructed graft greater than 30° degrees of flexion, mainly performed in the reconstruction of the knee flexion angle of 60° degrees

Diss. (sammanfattning) Umeå : Umeå universitet, 2009. / Härtill 5 uppsatser. Även tryckt utgåva.

O objetivo desta dissertação foi avaliar biomecanicamente o ângulo de flexão do joelho em que a fixação do enxerto do Ligamento Patelofemoral Medial (LPFM) se mostrou mais adequada. Foram estudados 12 joelhos de cadáveres, sendo que seis peças foram utilizadas para ajustes necessários no sistema. Os joelhos foram preparados em uma máquina de ensaios desenvolvida no Laboratório de Biomecânica do Instituto de Ortopedia e Traumatologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (IOT-HCFMUSP) a qual permitiu a avaliação dinâmica do comportamento patelar, quantificando a sua lateralização entre 0° e 120° graus de flexão do joelho. A técnica utilizada para a reconstrução do LPFM foi a utilização do enxerto do ligamento patelar, como apresentada por Camanho et al. em 2007. Os joelhos foram submetidos a situações de intacto, lesado e reconstruído, com e sem carga aplicada lateralmente, simulando a força de luxação da patela. Com o sistema de fotogrametria, pôde-se avaliar a lateralização da patela entre os ângulos de 0° e 120° graus de flexão do joelho. Os dados encontrados foram calculados a partir de um programa de Software conectado à máquina de ensaios. O grau de flexão do joelho foi determinado a partir de um goniômetro digital. O tensionamento do enxerto foi padronizado em 1 Kgf com a utilização de um sistema digital acoplado a uma célula de carga de 20 Kgf. As diferenças entre as distâncias encontradas, com e sem carga aplicada na patela, foram agrupadas segundo o ângulo de fixação do enxerto reconstruído em 0º, 45º, 60º e 90º e situação do joelho íntegro e lesado. Os resultados foram tabulados a partir das médias das três repetições. Os dados foram inseridos e analisados no banco de dados dos programas estatísticos STATA versão 11.0 e SAS versão 8.0. Foi realizada a Análise de Variância (ANOVA) e comparações múltiplas de Tukey(96). Houve uma tendência em ocorrer menor desvio lateral em ângulos de fixação do enxerto reconstruído acima de 30° graus de flexão, principalmente com a reconstrução realizada no ângulo de flexão do joelho, em que o ligamento foi reconstruído, de 60°graus. Para os demais ângulos não houve significância estatística / The aim of this dissertation was to make a biomechanical assessment on the knee flexion angle at which fixation of grafts for the medial patellofemoral ligament (MPFL) is seen to be best. Twelve knees from cadavers have been studied, of which six specimens were used to make necessary adjustments to the system. The knees were prepared in a test machine developed in the Biomechanics Laboratory of the Institute of Orthopedics and Traumatology, Hospital das Clínicas, School of Medicine, University of São Paulo. This enabled dynamic evaluation of the patellar component, with quantification of its lateralization between 0 and 120 degrees of flexion angle. The technique used for reconstructing the MPFL consisted of using a graft from the patellar ligament, as presented by Camanho et al. in 2007. The knees were subjected to situations in intact, injured and reconstructed states, with and without loads applied laterally, to simulate the patella dislocation force. With a photogrammetry system, the lateralization of the patella could be assessed between the knee flexion angles of 90°, 60°, 45° and 0 degrees during the graft reconstruction. The results were calculated through software coupled to the test machine. The knee flexion angle could be determined from a digital goniometer. The graft tensioning was standardized at 1 kgf by using a digital system coupled to a 20-kgf load cell. The differences between the distances found with and without load applied to the patella were grouped according to the graft fixation angle of 0°, 45°, 60° e 90°, during the reconstruction, and knee situation of intact or injured. The results were tabulated taking the mean from three repetitions. There was a tendency for less lateral deviation to occur at fixation angles of the reconstructed graft greater than 30° degrees of flexion, mainly performed in the reconstruction of the knee flexion angle of 60° degrees

Este trabalho objetivou avaliar através do exame clínico, radiográfico e ultra-sonográfico a articulação fêmuro-tíbio-patelar pós desmotomia patelar medial. Foram utilizados oito equinos, machos e fêmeas, de peso, raça e idade variáveis. Todos animais foram submetidos a desmotomia patelar medial no membro pélvico direito. Os exames clínico e ultra-sonográfico foram realizados no 7º, 14º, 21º, 28º, 43º, 58º, 88º e 118º dia do pós-operatório. Os exames radiográficos e do líquido sinovial foram realizados no 15º, 30º, 60º, 90º e 120º dia do pós-operatório. No pós-operatório foi observado durante exame radiográfico do joelho direito, aumento do ângulo entre a superfície articular proximal da patela e a superfície cranial distal do fêmur, formação óssea na crista tibial, entesofitos na patela, deslocamento da patela e irregularidade óssea na superfície patelar lateral. No exame ultra-sonográfico foi observado aumento da espessura (p<0,05) no segmento proximal e médio do ligamento patelar intermédio do membro pélvico direito, desmite do patelar intermédio, enteseofitos na patela, distensão do recesso articular medial do fêmur, efusão articular e irregularidade da cartilagem do sulco troclear femoral. Conclui-se que a desmotomia patelar medial causa alterações no joelho devido a instbilidade articular e deve ser indicada apenas nos casos que não responderam a outras forma de tratamento. / This study aimed the evaluation of the femurotibiopatellar joint trough clinical, radiographic and ultrasonographic examinations after experimental medial patellar desmotomy. Medial patellar desmotomy was performed on the right hindlimb in eight mixed-breed horses. The clinical and ultrasonographic evaluation was performed on day 7, 14, 21, 28, 43, 58, 88 e 118 after surgery. The radiographic and synovial fluid evaluation was performed on day 15, 30, 60, 90 e 120 after surgery. It was observed during radiographic evaluation of the right stifle, an increase of the angle between the patellar proximal articular surface and the cranial distal femur surface. During ultrasonographic evaluation it was observed thickening (p<0,05) on the proximal and midlle segment of the midlle patellar ligament on the right hindlimb, entesophyte at the patella, femoral medial joint recess distending, joint effusion and cartilage irregularity of the femoral troclear groove. The medial patellar desmotomy causes stifle changes and must be performed only in animals non responsive to other treatment.

No description available.

Dissertation submitted in partial compliance with the requirements for a Master's Degree in Technology: Chiropractic, Durban University of Technology, 2010. / Motion palpation is used to assess the functional status of a joint and is defined as “The manual palpation of bony structures and soft tissues, through pressure applied in various directions of joint motion to ascertain areas of joint hypomobility and hypermobility.” Motion palpation is a collection of manual examination procedures, used to identify the site and characteristics of altered joint motion and which has been an important part of chiropractic since its inception. One of the most important goals for any clinical instrument is for it to have good reliability and reproducibility, this is because the clinical value of a test must be demonstrated before the results are considered valid. The extent to which a repeated test will produce the same result when evaluating an unchanged characteristic is its reliability. Reliability is evaluated by multiple blinded measurements performed on a sample of subjects. Inter-examiner reliability evaluates the consistency of different examiners and is determined through repeated assessment by two or more raters. Objective The aim of this study was to determine the inter-examiner reliability of motion palpation of knee joints with patellofemoral pain syndrome and asymptomatic knee joints, and to compare the inter-examiner reliability of motion palpation between the two groups. Method This quantitative, inter-examiner, clinical reliability study, included 30 patients each with one knee with patellofemoral pain syndrome and one asymptomatic knee. Each patient had both of their knees motion palpated by three independent examiners blinded to which was the symptomatic knee. The examiners were senior student interns at the DUT Chiropractic Clinic. The motion palpation findings were recorded and statistically analyzed through the SPSS statistical package. Fleiss Kappa statistic was used to give a Kappa score for each direction of motion palpation and these scores evaluated the inter-examiner reliability of motion palpation in the symptomatic and the asymptomatic knee. A comparison of the inter-examiner reliability of motion palpation between the two groups was performed using a paired Wilcoxin signed ranks test. Results The Kappa scores for motion palpation ranged from -0.2081 to 0.1802 for the symptomatic knee joint and -0.2836 to 0.0339 for the asymptomatic knee. This shows poor agreement in both cases. There was no significant difference in Kappa values (p= 0.609) for the two groups for the Wilcoxin signed ranks test and the number of positive and negative ranks were similar. This indicates that the reliability of motion palpation in both groups was similar. Conclusion It was concluded that inter-examiner reliability of motion palpation of the knee joint was poor in knees with patellofemoral pain syndrome and in knees that were asymptomatic. Motion palpation was found to be equally reliable in both groups, indicating that motion palpation of a symptomatic joint does not improve its reliability. This research suggests that motion palpation should be used together with other diagnostic tests to identify patellofemoral pain syndrome as it is not a reliable tool when used in isolation.

Die klinischen Langzeitergebnisse des vorderen Kreuzbandersatz mit dem Patellarsehnentransplantat nach durchschnittlich 13,8 Jahren waren nicht zufriedenstellend. Hauptursachen hierfür waren operativ-technische Mängel, wie Fehlpositionierung der Bohrkanäle und die Fixierung der Transplantate in einer zu hohen Kniebeugestellung. Diese Abweichungen führten zu signifikant schlechteren Bewegungsausmaßen sowohl in der Streckung als auch in der Beugung. Insbesondere bei zu weit ventral positionierter femoraler Bohrkanalanlage resultierte ein erhebliches Beugedefizit mit Stressbelastung auf das femorotibiale Kompartiment, ähnlich einem Nußknackerphänomen. Bei zu weit ventral positioniertem tibialen Bohrkanal wurde eine signifikante Verringerung der Extension beobachtet. Die Patienten mit gleichzeitiger Meniskusresektion hatten signifikant höhere arthrotische Veränderungen. Sowohl die zum damaligen Zeitpunkt allgemein anerkannte Operationstechnik als auch die postoperative Rehabilitation ist zeitlich überholt und entspricht nicht den gegenwärtigen internationalen Standards. In der experimentellen Untersuchung zum Einwachsverhalten einer autologen vorderen Kreuzbandplastik am Kaninchenmodell konnte der Einfluss und die Wirkung von manipulativ wirkenden Faktoren auf die Ausbildung eines stabilen Bindegewebsregenerates belegt werden. Sowohl der fibrinstabilisierende Faktor XIII als auch die eingesetzte Transplantat-Splitting-Technik zeigten eine positive Wirkung auf den Ein- und Umbau sowie den biomechanischen Ausrissfestigkeiten der Transplantate. Die alleinige Wirkung des Faktor XIII spielt vor allem in der Frühphase eine stimulierende Rolle auf die Initiierung der Umbauvorgänge und der ossären Intergration der Knochenblöcke. Mittel- und langfristig wird die Ausbildung von belastungsstabilen Kollagenfibrillen durch andere weitestgehend unbekannte Einflussfaktoren bestimmt. Die neuartig entwickelte Transplantat-Splitting-Technik erwies sich für den Transplantatumbau ebenfalls als vorteilhaft. Mit dieser Transplantatbearbeitung wurde die Grundlage für eine frühzeitige synoviale Ernährung der Bündel gewährleistet. Durch die artifizielle Gewebsläsion werden reparative Vorgänge beschleunigt. Auf der Grundlage der experimentell gewonnenen Daten kann die Transplantat-Splitting- Technik für die klinische Erprobung und Praxiseinführung empfohlen werden. / The clinical long term results mean 13,8 years after anterior cruciate ligament reconstructions with bone-patellar tendon-bone transplant were not satisfied. Main reasons were technical errors, malpositioning of the bone tunnels and fixation of the transplant in a too high degree of flexion. As a result the patients had significant reductions of motion in extension as well as in flexion. Especially in cases with an anterior femoral bone tunnel position the patients had a loss of flexion and high degree of shear forces in the femoro-tibial compartment similar a nutcracker phenomenon. In ACL reconstructions with an anterior tibial bone tunnel position could be observed a loss of extension. Patients with concomitant meniscal resection showed significant higher rate of osteoarthrotic changes. Both, the former operative technique and the postoperative rehabilitation programme had no clinical relevance today and are replaced by new standards. In an experimental study regarding to the remodeling process of an autologous anterior cruciate ligament plasty in a rabbit model could be examined factors which influencing the maturation process of the graft. The fibrin stabilizing factor XIII as well as the transplant splitting technique showed a positive effect in the remodelling process and the pull-out strength of the transplants. In the early phase the factor XIII activated the initial remodeling and the osseous ingrowth of the bone blocks. In middle and long term period of remodeling there plays unknown factors an important role for building of force restraint collagen fibrils. The new developed splitting technique had some additional advantages. Using these technique the basis of early synovial nutrition could be realized. The artificial tissue lesion leads to an acceleration of the reparative response. On the basis of the experimental data the transplant splitting technique can be recommended and introduce in the clinical trial.

The purposes of the present study were to resolve a number of major inconsistencies found in the literature on the structure of the quadriceps femoris muscle and to extend knowledge of its structure using descriptive, qualitative methodology. The quadriceps femoris muscle was investigated in 41 cats, and the findings were confirmed in 6 human cadavers. Two aponeuroses with major biomechanical functions (rectus-vastus and vastus aponeurosis), neither of which had been previously described in the literature, were characterized in both species. The study also resolved many major inconsistencies in the literature: The muscle sometimes described as vastus intermedius (VI) was found to be the articularis genu, the muscle sometimes described as vastus medialis (VM) was found to be the VI, the rectus femoris head was found to have an additional proximal nerve branch not previously recognized, no anomalous 5th head was ever found, and the distal VM were not found to have 2 heads (in either cats or humans). The authors’ anatomical descriptions and bimechanical models of the muscles, tendons, and neurovascular should provide a helpful foundation for future studies on the quadriceps. Two general recommendations are made: 1) that the feline model be considered a viable model to elucidate human knee pathomechanics; and 2) that regardless of the anatomical structure of interest, orthopedic nurses, orthopedic surgeons, and research investigators should routinely use the research literature for anatomical guidance instead of standard anatomical textbooks. © 2002, Sage Publications. All rights reserved.

No description available.

[Truncated abstract] In this work a computer simulation program, similar to a finite element program, is used to study the relationship between skeletal tissue structure and function. Though other factors affect the shape of bone (e.g., genetics, hormones, blood supply), the skeleton adapts its shape mainly in response to the mechanical environment to which it is exposed throughout life. The specific relationship between the mechanical environment and the mechanical adaptation response of the skeleton is reviewed. Theories of mechanical adaptation are applied to the sites of tendon attachment to bone (entheses), the adaptation of generalised trabecular bone (i.e., Wolff’s Law of trabecular architecture), sesamoid bones that are often found where a tendon wraps around a bony pulley, and the internal trabecular structure of a whole bony sesamoid such as the patella. The relative importance of compression rather than tension in bone adaptation theories is still not fully understood. Some mechanical adaptation theories suggest that an overwhelming tensile stress at a skeletal location does not stimulate bone deposition, but would instead lead to bone resorption. The skeletal locations studied in this work were chosen because they have been proposed to be in tension. Computer simulations involving models are an ideal method to analyse the mechanical environment of a skeletal location. They are able to determine the mechanical stresses at, and the stress patterns around, complex biological situations. This study uses a two dimensional computer simulation program, Fast Lagrangian Analysis of Continua (Flac), to analyse the stress at the skeletal locations, and to test theories of mechanical adaptation over time by simulating physiological adaptation. The initial purpose of this study is to examine the stress in the skeletal tissue in generalised trabeculae, anatomical sites where a tendon wraps around a bony pulley, in the trabecular networks that fill the patella, and at tendon attachments. A secondary purpose, that follows directly from the first, is to relate the results of these initial stress analyses to existing and hypothetical skeletal tissue remodelling theories, to suggest how the complex skeletal structures might be generated solely in response to their mechanical environment. The term “remodelling” is used throughout this work to refer to mechanical adaptation of bone, usually at a surface of bone, rather than the internal regeneration of osteons (Haversion systems)