0
Research Papers

Discrete Element Analysis for Characterizing the Patellofemoral Pressure Distribution: Model Evaluation

[+] Author and Article Information
John J. Elias

e-mail: john.elias@akrongeneral.org

Archana Saranathan

e-mail: archana.saranathan@akrongeneral.org
Calhoun Research Laboratory,
Akron General Medical Center,
400 Wabash Avenue,
Akron, OH 44307

Contributed by the Bioengineering Division of ASME for publication in the JOURNAL OF BIOMECHANICAL ENGINEERING. Manuscript received December 7, 2012; final manuscript received April 10, 2013; accepted manuscript posted April 22, 2013; published online June 12, 2013. Assoc. Editor: Kenneth Fischer.

J Biomech Eng 135(8), 081011 (Jun 12, 2013) (6 pages) Paper No: BIO-12-1600; doi: 10.1115/1.4024287 History: Received December 07, 2012; Revised April 10, 2013; Accepted April 22, 2013

The current study was performed to evaluate the accuracy of computational assessment of the influence of the orientation of the patellar tendon on the patellofemoral pressure distribution. Computational models were created to represent eight knees previously tested at 40 deg, 60 deg, and 80 deg of flexion to evaluate the influence of hamstrings loading on the patellofemoral pressure distribution. Hamstrings loading increased the lateral and posterior orientation of the patellar tendon, with the change for each test determined from experimentally measured variations in tibiofemoral alignment. The patellar tendon and the cartilage on the femur and patella were represented with springs. After loading the quadriceps, the total potential energy was minimized to determine the force within the patellar tendon. The forces applied by the quadriceps and patellar tendon produced patellar translation and rotation. The deformation of each cartilage spring was determined from overlap of the cartilage surfaces on the femur and patella and related to force using linear elastic theory. The patella was iteratively adjusted until the extension moment, tilt moment, compression, and lateral force acting on the patella were in equilibrium. For the maximum pressure applied to lateral cartilage and the ratio of the lateral compression to the total compression, paired t-tests were performed at each flexion angle to determine if the output varied significantly (p < 0.05) between the two loading conditions. For both the computational and experimental data, loading the hamstrings significantly increased the lateral force ratio and the maximum lateral pressure at multiple flexion angles. For the computational data, loading the hamstrings increased the average lateral force ratio and maximum lateral pressure by approximately 0.04 and 0.3 MPa, respectively, compared to experimental increases of 0.06 and 0.4 MPa, respectively. The computational modeling technique accurately characterized variations in the patellofemoral pressure distribution caused by altering the orientation of the patellar tendon.

FIGURES IN THIS ARTICLE
<>
Copyright © 2013 by ASME
Your Session has timed out. Please sign back in to continue.

References

Balcarek, P., Jung, K., Frosch, K. H., and Stürmer, K. M., 2011, “Value of the Tibial Tuberosity-Trochlear Troove Distance in Patellar Instability in the Young Athlete,” Am. J. Sports Med., 39(8), pp. 1756–1761. [CrossRef] [PubMed]
Makhsous, M., Lin, F., Koh, J., Nuber, G., and Zhang, L., 2004, “In Vivo and Noninvasive Load Sharing Among the Vasti in Patellar Malalignment,” Med. Sci. Sports Exer., 36(10), pp. 1768–1775. [CrossRef]
Fulkerson, J. P., 2004, “Patellar Tilt Compression and the Excessive Lateral Pressure Syndrome,” Disorders of the Patellofemoral Joint, J. P.Fulkerson, ed., Lippincott, Williams and Wilkins, Phil, PA., pp. 160–184.
Fulkerson, J. P., 2002, “Diagnosis and Treatment of Patients With Patellofemoral Pain,” Am. J. Sports Med., 30(3), pp. 447–456. [PubMed]
Besier, T. F., Gold, G. E., Delp, S. L., Fredericson, M., and Beaupré, G. S., 2008, “The Influence of Femoral Internal and External Rotation on Cartilage Stresses Within the Patellofemoral Joint,” J. Orthop. Res., 26(12), pp. 1627–1635. [CrossRef] [PubMed]
Benvenuti, J. F., Rakotomanana, L., Leyvraz, P. F., Pioletti, D. P., Heegaard, J. H., and Genton, M. G., 1997, “Displacements of the Tibial Tuberosity. Effects of the Surgical Parameters,” Clin. Orthop. Relat. Res., 343, pp. 224–234. [CrossRef] [PubMed]
Farrokhi, S., Keyak, J. H., and Powers, C. M., 2011, “Individuals With Patellofemoral Pain Exhibit Greater Patellofemoral Joint Stress: A Finite Element Analysis Study,” Osteoarthritis Cartilage, 19(3), pp. 287–294. [CrossRef] [PubMed]
Fitzpatrick, C. K., Baldwin, M. A., Laz, P. J., Fitzpatrick, D. P., Lerner, A. L., and Rullkoetter, P. J., 2011, “Development of a Statistical Shape Model of the Patellofemoral Joint for Investigating Relationships Between Shape and Function,” J. Biomech., 44(13), pp. 2446–2452. [CrossRef] [PubMed]
Shirazi-Adl, A., and Mesfar, W., 2007, “Effect of Tibial Tubercle Elevation on Biomechanics of the Entire Knee Joint Under Muscle Loads,” Clin. Biomech., 22(3), pp. 344–351. [CrossRef]
Cohen, Z. A., Henry, J. H., McCarthy, D. M., Mow, V. C., and Ateshian, G. A., 2003, “Computer Simulations of Patellofemoral Joint Surgery: Patient-Specific Models for Tuberosity Transfer,” Am. J. Sports Med., 31(1), pp. 87–98. [PubMed]
Cohen, Z. A., Roglic, H., Grelsamer, R. P., Henry, J. H., Levine, W. N., Mow, V. C., and Ateshian, G. A., 2001, “Patellofemoral Stresses During Open and Closed Kinetic Chain Exercises. An Analysis Using Computer Simulation,” Am. J. Sports Med., 29(4), pp. 480–487. [PubMed]
Elias, J. J., Cech, J. A., Weinstein, D. M., and Cosgarea, A. J., 2004, “Reducing the Lateral Force Acting on the Patella Does Not Consistently Decrease Patellofemoral Pressures,” Am. J. Sports Med., 32(5), pp. 1202–1208. [CrossRef] [PubMed]
Elias, J. J., and Cosgarea, A. J., 2006, “Technical Errors During Medial Patellofemoral Ligament Reconstruction Could Overload Medial Patellofemoral Cartilage: A Computational Analysis,” Am. J. Sports Med., 34(9), pp. 1478–1485. [CrossRef] [PubMed]
Elias, J. J., Kilambi, S., and Cosgarea, A. J., 2010, “Computational Assessment of the Influence of Vastus Medialis Obliquus Function on Patellofemoral Pressures: Model Evaluation,” J. Biomech., 43(4), pp. 612–617. [CrossRef] [PubMed]
Elias, J. J., Wilson, D. R., Adamson, R., and Cosgarea, A. J., 2004, “Evaluation of a Computational Model used to Predict the Patellofemoral Contact Pressure Distribution,” J. Biomech., 37(3), pp. 295–302. [CrossRef] [PubMed]
Beck, P. R., Thomas, A. L., Farr, J., Lewis, P. B., and Cole, B. J., 2005, “Trochlear Contact Pressures After Anteromedialization of the Tibial Tubercle,” Am. J. Sports Med., 33(11), pp. 1710–1715. [CrossRef] [PubMed]
Ramappa, A. J., Apreleva, M., Harrold, F. R., Fitzgibbons, P. G., Wilson, D. R., and Gill, T. J., 2006, “The Effects of Medialization and Anteromedialization of the Tibial Tubercle on Patellofemoral Mechanics and Kinematics,” Am. J. Sports Med., 34(5), pp. 749–756. [CrossRef] [PubMed]
Saranathan, A., Kirkpatrick, M. S., Mani, S., Smith, L. G., Cosgarea, A. J., Tan, J. S., and Elias, J. J., 2012, “The Effect of Tibial Tuberosity Realignment Procedures on the Patellofemoral Pressure Distribution,” Knee Surg. Sports Traumatol. Arthrosc., 20(10), pp. 2054–2061. [CrossRef] [PubMed]
Elias, J. J., Kirkpatrick, M. S., Saranathan, A., Mani, S., Smith, L. G., and Tanaka, M. J., 2011, “Hamstrings Loading Contributes to Lateral Patellofemoral Malalignment and Elevated Cartilage Pressures: An In Vitro Study,” Clin. Biomech., 26(8), pp. 841–846. [CrossRef]
Mani, S., Kirkpatrick, M. S., Saranathan, A., Smith, L. G., Cosgarea, A. J., and Elias, J. J., 2011, “Tibial Tuberosity Osteotomy for Patellofemoral Realignment Alters Tibiofemoral Kinematics,” Am. J. Sports Med., 39(5), pp. 1024–1031. [CrossRef] [PubMed]
Elias, J. J., Kilambi, S., Goerke, D. R., and Cosgarea, A. J., 2009, “Improving Vastus Medialis Obliquus Function Reduces Pressure Applied to Lateral Patellofemoral Cartilage,” J. Orthop. Res., 27(5), pp. 578–583. [CrossRef] [PubMed]
Grood, E. S., and Suntay, W. J., 1983, “A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee,” ASME, J. Biomech. Eng., 105(2), pp. 136–144. [CrossRef]
Kwak, S. D., Blankevoort, L., and Ateshian, G. A., 2000, “A Mathematical Formulation for 3D Quasi-Static Multibody Models of Diarthrodial Joints,” Comput. Methods Biomech. Biomed. Eng., 3(1), pp. 41–64. [CrossRef]
Genda, E., Iwasaki, N., Li, G., MacWilliams, B. A., Barrance, P. J., and Chao, E. Y., 2001, “Normal Hip Joint Contact Pressure Distribution in Single-Leg Standing–Effect of Gender and Anatomic Parameters,” J. Biomech., 34(7), pp. 895–905. [CrossRef] [PubMed]
Hosseini, A., Van de Velde, S. K., Kozanek, M., Gill, T. J., Grodzinsky, A. J., Rubash, H. E., and Li, G., 2010, “In-Vivo Time-Dependent Articular Cartilage Contact Behavior of the Tibiofemoral Joint,” Osteoarthritis Cartilage, 18(7), pp. 909–916. [CrossRef] [PubMed]
Van de Velde, S. K., Bingham, J. T., Gill, T. J., and Li, G., 2009, “Analysis of Tibiofemoral Cartilage Deformation in the Posterior Cruciate Ligament-Deficient Knee,” J. Bone Joint Surg. Am., 91(1), pp. 167–175. [CrossRef] [PubMed]
Besier, T. F., Gold, G. E., Beaupré, G. S., and Delp, S. L., 2005, “A Modeling Framework to Estimate Patellofemoral Joint Cartilage Stress In Vivo,” Med. Sci. Sports Exer., 37(11) pp. 1924–1930. [CrossRef]
Baldwin, M. A., Clary, C., Maletsky, L. P., and Rullkoetter, P. J., 2009, “Verification of Predicted Specimen-Specific Natural and Implanted Patellofemoral Kinematics during Simulated Deep Knee Bend,” J. Biomech., 42(14), pp. 2341–2348. [CrossRef] [PubMed]
Fitzpatrick, C. K., Baldwin, M. A., and Rullkoetter, P. J., 2010, “Computationally Efficient Finite Element Evaluation of Natural Patellofemoral Mechanics,” ASME, J. Biomech. Eng., 132(12), pp. 1210–1213. [CrossRef]
Heegaard, J., Leyvraz, P. F., Curnier, A., Rakotomanana, L., and Huiskes, R., 1995, “The Biomechanics of the Human Patella During Passive Knee Flexion,” J. Biomech., 28(11), pp. 1265–1279. [CrossRef] [PubMed]
Wu, J. Z., Herzog, W., and Epstein, M., 1998, “Effects of Inserting a Pressensor Film into Articular Joints on the Actual Contact Mechanics,” ASME, J. Biomech. Eng., 120(5), pp. 655–659. [CrossRef]
Wilson, D. R., Apreleva, M. V., Eichler, M. J., and Harrold, F. R., 2003, “Accuracy and Repeatability of a Pressure Measurement System in the Patellofemoral Joint,” J. Biomech., 36(12), pp. 1909–1915. [CrossRef] [PubMed]

Figures

Grahic Jump Location
Fig. 1

(A) Initially, the forces representing the vastus lateralis (VL), the combination of the vastus intermedius/vastus medialis longus/rectus femoris (VI), and vastus medialis obliquus (VMO) are applied to the patella. The reaction forces in the springs representing the patellar tendon are calculated. (B) The resultant force and moment from the quadriceps and patellar tendon are applied to the patella. (C) The patella (transparent) translates and rotates in response to the applied force and moment producing overlap between the cartilage on the patella and femur (dark). The reaction force and moment acting on the patella from the cartilage is quantified from the overlap of the cartilage surfaces.

Grahic Jump Location
Fig. 2

Contact pressure patterns from the DEA model and the in vitro experimental measurements superimposed over the patella for two knees at 60 deg of flexion. Pressure shifts laterally when loading the hamstrings increases the lateral and posterior orientation of the patellar tendon.

Grahic Jump Location
Fig. 3

The average (±standard deviation) lateral force ratio from the DEA models (no border) and the in vitro experimental data (border). Significant increases at a flexion angle due to increasing the lateral and posterior orientation of the patellar tendon by loading the hamstrings are marked with an asterisk (*).

Grahic Jump Location
Fig. 4

The average (±standard deviation) lateral distance from the center of force to the patellar ridge from the DEA models (no border) and the in vitro experimental data (border). Significant increases at a flexion angle due to increasing the lateral and posterior orientation of the patellar tendon by loading the hamstrings are marked with an asterisk (*).

Grahic Jump Location
Fig. 5

The average (±standard deviation) maximum lateral pressure from the DEA models (no border) and the in vitro experimental data (border). Significant increases at a flexion angle due to increasing the lateral and posterior orientation of the patellar tendon by loading the hamstrings are marked with an asterisk (*).

Grahic Jump Location
Fig. 6

The average (±standard deviation) maximum medial pressure from the DEA models (no border) and the in vitro experimental data (border). No significant differences were identified due to loading the hamstrings.

Grahic Jump Location
Fig. 7

The average (±standard deviation) contact area from the DEA models (no border) and the in vitro experimental data (border). No significant differences were identified due to loading the hamstrings.

Tables

Errata

Discussions

Some tools below are only available to our subscribers or users with an online account.

Related Content

Customize your page view by dragging and repositioning the boxes below.

Related Journal Articles
Related eBook Content
Topic Collections

Sorry! You do not have access to this content. For assistance or to subscribe, please contact us:

  • TELEPHONE: 1-800-843-2763 (Toll-free in the USA)
  • EMAIL: asmedigitalcollection@asme.org
Sign In