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Van Oevelen A, Peiffer M, Chevalier A, Victor J, Steenackers G, Audenaert E, Duquesne K. The relation between meniscal dynamics and tibiofemoral kinematics. Sci Rep 2024; 14:8829. [PMID: 38632378 PMCID: PMC11024146 DOI: 10.1038/s41598-024-59265-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Over the past 30 years, research on meniscal kinematics has been limited by challenges such as low-resolution imaging and capturing continuous motion from static data. This study aimed to develop a computational knee model that overcomes these limitations and enables the continuous assessment of meniscal dynamics. A high-resolution MRI dataset (n = 11) was acquired in 4 configurations of knee flexion. In each configuration, the menisci were modeled based on the underlying osseous anatomy. Principal Polynomial Shape Analysis (PPSA) was employed for continuous meniscal modeling. Maximal medial anterior horn displacement occurred in 60° of flexion, equaling 6.24 mm posteromedial, while the posterior horn remained relatively stable. At 90° of flexion, the lateral anterior and posterior horn displaced posteromedially, amounting 5.70 mm and 6.51 mm respectively. The maximal observed Average Surface Distance (ASD) equaled 0.70 mm for lateral meniscal modeling in 90° of flexion. Based on our results, a strong relation between meniscal dynamics and tibiofemoral kinematics was confirmed. Expanding on static meniscal modeling and employing PPSA, we derived and validated a standardized and systematic methodological workflow.
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Affiliation(s)
- A Van Oevelen
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - M Peiffer
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - A Chevalier
- Cosys-Lab Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - J Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - G Steenackers
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
| | - E Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
- Department of Electromechanics, InViLab research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium.
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
| | - K Duquesne
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, 9000, Ghent, Belgium
- imec-VisionLab, Department of Physics, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium
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Schwer J, Rahman MM, Stumpf K, Rasche V, Ignatius A, Dürselen L, Seitz AM. Degeneration Affects Three-Dimensional Strains in Human Menisci: In situ MRI Acquisition Combined With Image Registration. Front Bioeng Biotechnol 2020; 8:582055. [PMID: 33042980 PMCID: PMC7526678 DOI: 10.3389/fbioe.2020.582055] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Degenerative changes of menisci contribute to the evolution of osteoarthritis in the knee joint, because they alter the load transmission to the adjacent articular cartilage. Identifying alterations in the strain response of meniscal tissue under compression that are associated with progressive degeneration may uncover links between biomechanical function and meniscal degeneration. Therefore, the goal of this study was to investigate how degeneration effects the three-dimensional (3D; axial, circumferential, radial) strain in different anatomical regions of human menisci (anterior and posterior root attachment; anterior and posterior horn; pars intermedia) under simulated compression. Magnetic resonance imaging (MRI) was performed to acquire image sequences of 12 mild and 12 severe degenerated knee joints under unloaded and loaded [25%, 50% and 100% body weight (BW)] conditions using a customized loading device. Medial and lateral menisci as well as their root attachments were manually segmented. Intensity-based rigid and non-rigid image registration were performed to obtain 3D deformation fields under the respective load levels. Finally, the 3D voxels were transformed into hexahedral finite-element models and direction-dependent local strain distributions were determined. The axial compressive strain in menisci and meniscal root attachments significantly increased on average from 3.1% in mild degenerated joints to 7.3% in severe degenerated knees at 100% BW (p ≤ 0.021). In severe degenerated knee joints, the menisci displayed a mean circumferential strain of 0.45% (mild: 0.35%) and a mean radial strain of 0.41% (mild: 0.37%) at a load level of 100% BW. No significant changes were observed in the circumferential or radial directions between mild and severe degenerated knee joints for all load levels (p > 0.05). In conclusion, high-resolution MRI was successfully combined with image registration to investigate spatial strain distributions of the meniscus and its attachments in response to compression. The results of the current study highlight that the compressive integrity of the meniscus decreases with progressing tissue degeneration, whereas the tensile properties are maintained.
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Affiliation(s)
- Jonas Schwer
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Muhammed Masudur Rahman
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany.,Department of Mechanical Engineering, University of Connecticut, Storrs, CT, United States
| | - Kilian Stumpf
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Volker Rasche
- Experimental Cardiovascular Imaging, Department of Internal Medicine II, University Hospital Ulm, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Centre, Ulm, Germany
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Andrews SHJ, Adesida AB, Abusara Z, Shrive NG. Current concepts on structure-function relationships in the menisci. Connect Tissue Res 2017; 58:271-281. [PMID: 28267400 DOI: 10.1080/03008207.2017.1303489] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The menisci are intricately organized structures that perform many tasks in the knee. We review their structure and function and introduce new data about their tibial and femoral surfaces. As the femur and tibia approach each other when the knee is bearing load, circumferential tension develops in the menisci, enabling the transmission of compressive load between the femoral and tibial cartilage layers. A low shear modulus is necessary for the tissue to adapt its shape to the changing radius of the femur as that bone moves relative to the tibia during joint articulation. The organization of the meniscus facilitates its functions. In the outer region of the menisci, intertwined collagen fibrils, fibers, and fascicles with predominantly circumferential orientation are prevalent; these structures are held together by radial tie fibers and sheets. Toward the inner portion of the menisci, there is more proteoglycan and the structure becomes more cartilage-like. The transition between these structural forms is gradual and seamless. The flexible roots, required for rigid body motion of the menisci, meld with both the tibia and the outer portion of the menisci to maintain continuity for resistance to the circumferential tension. Our new data demonstrate that the femoral and tibial surfaces of the menisci are structurally analogous to the surfaces of articular cartilage, enabling consistent modes of lubrication and load transfer to occur at the interfacing surfaces throughout motion. The structure and function of the menisci are thus shown to be strongly related to one another: form clearly complements function.
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Affiliation(s)
| | | | - Ziad Abusara
- b Faculty of Kinesiology , University of Calgary , Calgary , Canada
| | - Nigel G Shrive
- c McCaig Institute for Bone and Joint Health, and Department of Civil Engineering , University of Calgary , Calgary , Canada
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Nordmeyer-Massner JA, Pruessmann KP, Wyss M, Manoliu A, Hodler J, Andreisek G, Mamisch-Saupe N. MR imaging of healthy knees in varying degrees of flexion using a stretchable coil array provides comparable image quality compared to a standard knee coil array. Eur J Radiol 2016; 85:518-23. [PMID: 26860662 DOI: 10.1016/j.ejrad.2015.12.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 08/23/2015] [Accepted: 12/09/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Stretchable coils allow knee imaging at varying degrees of flexion. Purpose was to compare a new-developed stretchable 8-channel to a standard 8-channel knee coil array by means of quantitative and qualitative image analysis. MATERIAL AND METHODS IRB approved prospective study. Knee MR imaging in 10 healthy volunteers was performed at 3T using a standard 8-channel and a new-developed stretchable 8-channel coil array at 0°, 45°, and 60° of flexion and at 0° (standard coil). Image parameters were identical. Signal-to-noise ratio (SNR) was determined by combining the images with separately acquired noise data on a pixel-by-pixel basis using MATLAB routines (Natick, MA, USA). Images were qualitatively analysed by two independent radiologists who graded the visibility of several anatomic structures from 1=not visible to 5=excellent. ANOVA, Wilcoxon and kappa statistics were used. RESULTS Mean SNR±standarddeviation of bone was 54.7±10.4 and of muscle 28.0± 4.4 using the stretchable coil array and 54.6±8.2 and 33.4±4.5, respectively, using the standard knee coil array. No statistically significant SNR differences were found between both arrays (bone, p=0.960; muscle, p=0.132). SNR was not degraded at higher degrees of flexion. The qualitative image analysis did not reveal statistically significant differences between the stretchable and standard coil array with regard to the visibility of anatomic structures (p=0.026-1.000). Overall kappa was 0.714. CONCLUSION Stretchable 8-channel coil arrays provide similar SNR and visibility of anatomic structures compared to standard 8-channel knee coil arrays. MR imaging with high SNR will now be possible in flexed knees.
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Affiliation(s)
| | - Klaas P Pruessmann
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
| | - Michael Wyss
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland
| | - Andrei Manoliu
- Institute for Biomedical Engineering, University and ETH Zurich, Switzerland; Institute for Diagnostic and Interventional Radiology, Department of Radiology, University Hospital Zurich, Switzerland.
| | - Jürg Hodler
- Institute for Diagnostic and Interventional Radiology, Department of Radiology, University Hospital Zurich, Switzerland
| | - Gustav Andreisek
- Institute for Diagnostic and Interventional Radiology, Department of Radiology, University Hospital Zurich, Switzerland
| | - Nadja Mamisch-Saupe
- Institute for Diagnostic and Interventional Radiology, Department of Radiology, University Hospital Zurich, Switzerland
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Magnetic resonance analysis of loaded meniscus deformation: a novel technique comparing participants with and without radiographic knee osteoarthritis. Skeletal Radiol 2015; 44:125-35. [PMID: 25296900 PMCID: PMC4256123 DOI: 10.1007/s00256-014-2022-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 09/22/2014] [Accepted: 09/25/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish a novel method of quantifying meniscal deformation using loaded MRI. More specifically, the goals were to evaluate the (1) accuracy, (2) inter-rater reliability, (3) intra-rater reliability, and (4) scan-rescan reliability. The secondary purpose of this experiment was to evaluate group differences in meniscal deformation in participants with and without radiographic knee OA. MATERIALS AND METHODS Weight-bearing 3-T MRIs of the knee in full extension and 30° of flexion were processed to create 3D models of meniscal deformation. Accuracy was assessed using a custom-designed phantom. Twenty-one participants either with or without signs of OA were evaluated, and another six participants (14 knees, one subject was scanned twice) underwent repeated imaging to assess scan-rescan reproducibility. Intraclass correlation coefficient (ICC), root-mean squared error (RMSE), and root-mean-square percent coefficient-of-variation (RMS%CV) analyses were performed. Exploratory comparisons were made between those with and without OA to evaluate potential group differences. RESULTS All variables were found to be accurate with RMSE ranging from 0.08 to 0.35 mm and 5.99 to 14.63 mm(2). Reproducibility of peak anterior-posterior meniscal deformation was excellent (ICC > 0.821; p < 0.013) with RMS%CV for intra-rater ranging from 0.06 to 1.53 % and 0.17 to 1.97 %, inter-rater ranging from 0.10 to 7.20 % and 3.95 to 18.53 %, and scan-rescan reliability ranging from 1.531 to 7.890 % and 4.894 to 9.142 %, for distance and area metric, respectively. Participants with OA were found to have significantly greater anterior horn movement of both the medial (p = 0.039) and lateral meniscus (p = 0.015), and smaller flexed medial meniscus outer area (p = 0.048) when compared to controls. CONCLUSIONS MRI-based variables of meniscus deformation were found to be valid in participants with and without OA. Significant differences were found between those with and without radiographic OA; further study is warranted.
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Freutel M, Seitz AM, Galbusera F, Bornstedt A, Rasche V, Knothe Tate ML, Ignatius A, Dürselen L. Medial meniscal displacement and strain in three dimensions under compressive loads: MR assessment. J Magn Reson Imaging 2013; 40:1181-8. [PMID: 24323799 DOI: 10.1002/jmri.24461] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 09/16/2013] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To investigate the 3D displacement and the local strain of the medial meniscus and its attachments under compressive loading. MATERIALS AND METHODS Magnetic resonance imaging (MRI) scans of six porcine knee joints were performed under unloaded and loaded conditions (100% and 200% body weight [BW]). Volumes were registered to obtain a 3D displacement field of the medial meniscus and its attachments, which were divided into five anatomic compartments. Finally, displacements of the center of mass of each compartment and the local strain were analyzed. RESULTS The meniscus and its attachments significantly displaced by up to 2.6 ± 1.2 mm (P < 0.01) under knee joint loads of 200% BW. An increase of 0.9 mm in the distance between posterior and anterior horn (P < 0.001) was observed. The meniscus and its attachment showed an average radial stretch of 0.6%, an average circumferential stretch of 0.9%, and an average axial compression of 11.6% at 200% BW. CONCLUSION High-resolution MRI was successfully combined with image registration to investigate the displacement and strain of the meniscus and its attachments under compression. The results of this study contribute to the basic understanding of meniscal movement which may impact the design of meniscal implants and the validation of finite element models in the future.
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Affiliation(s)
- Maren Freutel
- Institute of Orthopaedic Research and Biomechanics, Centre of Musculoskeletal Research, Ulm, University of Ulm, Germany
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Lustig S, Scholes CJ, Balestro JC, Parker DA. In vivo assessment of weight-bearing knee flexion reveals compartment-specific alterations in meniscal slope. Arthroscopy 2013; 29:1653-60. [PMID: 23993055 DOI: 10.1016/j.arthro.2013.07.260] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Revised: 07/09/2013] [Accepted: 07/10/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to determine the effects of flexion angle on meniscal slope during partial weight-bearing knee flexion. METHODS Forty-eight sagittal sequences were performed on 12 patients (6 male patients, 6 female patients; 25.7 ± 10.5 years) during partial weight bearing in an open magnetic resonance imaging (MRI) scanner at full extension, 60°, 90°, and maximum knee flexion. A previously published method was used to measure the meniscal slope for each compartment using manual digitalization. A general linear model was used to test for effects of compartment and flexion angle on meniscal slope. RESULTS The mean maximum flexion angle achieved was 125° ± 10.5°. A significant main effect of compartment (P < .01) and flexion angle (P < .01) on meniscal slope was observed. A significant interaction between compartment and angle was also detected (P < .01). Specifically, the lateral meniscal slope was significantly more horizontal than the medial meniscus slope at full extension (P = .017) but significantly more posterior at all other angles. In addition, the lateral meniscus displayed a greater change in posterior slope across the range of motion compared with the medial meniscus. Significant correlations were found in medial meniscal slope at full extension and at maximum knee flexion (P = .031). CONCLUSIONS The results showed that meniscal slope in healthy knees increased significantly with knee flexion for both menisci, with significantly greater changes in the lateral meniscus. Furthermore, a lack of correlation was observed between the meniscal slope in extension and the meniscal slope at increasing flexion angles, questioning the efficacy of measuring the meniscal slope only in extension as commonly described. Overall, this study has provided valuable insight into how meniscal slope changes with knee motion.
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Affiliation(s)
- Sebastien Lustig
- Sydney Orthopaedic Research Institute, Chatswood, New South Wales, Australia; Albert Trillat Center, Lyon North University, Lyon, France.
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Abstract
Magnetic resonance imaging-based methods for measuring the mechanics of human joints have been successfully applied to quantitatively evaluate biomechanics in a wide variety of joints, pathologies, and interventions. The objective of this review was to provide a detailed overview of methods in the literature for measuring joint kinematics, meniscal and ligament movement, and cartilage strain using MRI.
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Systematic review of the concurrent and predictive validity of MRI biomarkers in OA. Osteoarthritis Cartilage 2011; 19:557-88. [PMID: 21396463 PMCID: PMC3268360 DOI: 10.1016/j.joca.2010.10.029] [Citation(s) in RCA: 148] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Revised: 09/14/2010] [Accepted: 10/17/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize literature on the concurrent and predictive validity of MRI-based measures of osteoarthritis (OA) structural change. METHODS An online literature search was conducted of the OVID, EMBASE, CINAHL, PsychInfo and Cochrane databases of articles published up to the time of the search, April 2009. 1338 abstracts obtained with this search were preliminarily screened for relevance by two reviewers. Of these, 243 were selected for data extraction for this analysis on validity as well as separate reviews on discriminate validity and diagnostic performance. Of these 142 manuscripts included data pertinent to concurrent validity and 61 manuscripts for the predictive validity review. For this analysis we extracted data on criterion (concurrent and predictive) validity from both longitudinal and cross-sectional studies for all synovial joint tissues as it relates to MRI measurement in OA. RESULTS Concurrent validity of MRI in OA has been examined compared to symptoms, radiography, histology/pathology, arthroscopy, CT, and alignment. The relation of bone marrow lesions, synovitis and effusion to pain was moderate to strong. There was a weak or no relation of cartilage morphology or meniscal tears to pain. The relation of cartilage morphology to radiographic OA and radiographic joint space was inconsistent. There was a higher frequency of meniscal tears, synovitis and other features in persons with radiographic OA. The relation of cartilage to other constructs including histology and arthroscopy was stronger. Predictive validity of MRI in OA has been examined for ability to predict total knee replacement (TKR), change in symptoms, radiographic progression as well as MRI progression. Quantitative cartilage volume change and presence of cartilage defects or bone marrow lesions are potential predictors of TKR. CONCLUSION MRI has inherent strengths and unique advantages in its ability to visualize multiple individual tissue pathologies relating to pain and also predict clinical outcome. The complex disease of OA which involves an array of tissue abnormalities is best imaged using this imaging tool.
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Abstract
Recent technical developments in high-field magnetic resonance (MR) scanners, improvement in radio frequency coil design and gradient performance along with the development of efficient pulse sequences and new methods of enhancing contrast have made high-quality imaging of animal arthritis models feasible. MR can provide high-resolution structural information about the osteoarthritic changes in animal models, and also information about the biophysical properties of cartilage. This paper reviews the MR techniques available for animal knee imaging, and the various MR-derived readouts of knee osteoarthritis in animal models. Pitfalls in interpreting animal joint anatomy and joint composition are highlighted.
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Affiliation(s)
- Yi-Xiang Wang
- Department of Radiology, The Chinese University of Hong Kong, Hong Kong, China.
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Amiri S, Cooke D, Kim IY, Wyss U. Mechanics of the passive knee joint. Part 1: The role of the tibial articular surfaces in guiding the passive motion. Proc Inst Mech Eng H 2007; 220:813-22. [PMID: 17236515 DOI: 10.1243/09544119jeim180] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The motion of the unloaded knee is associated with tibial internal rotation and femoral posterior translation. Although it is known that the passive motion is the result of the interaction between the articular surfaces and the ligaments, the mechanism through which the particular pattern of motion is guided is not completely understood. The goal of this study was to focus on the tibial geometry and to identify the roles that its geometric features have in guiding the passive knee motion. The method used in this study simplified the geometry of the tibial plateaux and the menisci into basic features that could be eliminated individually. The generated tibial geometry was implemented in a computer model to simulate the passive motion. Different parts of the geometry were eliminated individually and the comparison between the simulation results was used to identify the role that each part of the geometry had in guiding the passive motion. The medial meniscus was found as the feature that promoted the tibial internal rotation and restrained the femoral posterior translation. The lateral meniscus and the medial aspect of the tibial eminence, on the other hand, were found as the elements that confined the tibial internal rotation.
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Affiliation(s)
- S Amiri
- Department of Mechanical and Materials Engineering, Queen's University, 130 Stuart St, Kingston, Ontario K7L3N6, Canada.
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Yao J, Funkenbusch PD, Snibbe J, Maloney M, Lerner AL. Sensitivities of medial meniscal motion and deformation to material properties of articular cartilage, meniscus and meniscal attachments using design of experiments methods. J Biomech Eng 2006; 128:399-408. [PMID: 16706589 DOI: 10.1115/1.2191077] [Citation(s) in RCA: 64] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study investigated the role of the material properties assumed for articular cartilage, meniscus and meniscal attachments on the fit of a finite element model (FEM) to experimental data for meniscal motion and deformation due to an anterior tibial loading of 45 N in the anterior cruciate ligament-deficient knee. Taguchi style L18 orthogonal arrays were used to identify the most significant factors for further examination. A central composite design was then employed to develop a mathematical model for predicting the fit of the FEM to the experimental data as a function of the material properties and to identify the material property selections that optimize the fit. The cartilage was modeled as isotropic elastic material, the meniscus was modeled as transversely isotropic elastic material, and meniscal horn and the peripheral attachments were modeled as noncompressive and nonlinear in tension spring elements. The ability of the FEM to reproduce the experimentally measured meniscal motion and deformation was most strongly dependent on the initial strain of the meniscal horn attachments (epsilon(1H)), the linear modulus of the meniscal peripheral attachments (E(P)) and the ratio of meniscal moduli in the circumferential and transverse directions (E(theta)E(R)). Our study also successfully identified values for these critical material properties (epsilon(1H) = -5%, E(P) = 5.6 MPa, E(theta)E(R) = 20) to minimize the error in the FEM analysis of experimental results. This study illustrates the most important material properties for future experimental studies, and suggests that modeling work of meniscus, while retaining transverse isotropy, should also focus on the potential influence of nonlinear properties and inhomogeneity.
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Affiliation(s)
- Jiang Yao
- Department of Mechanical Engineering, University of Rochester, Rochester, NY 14627, USA
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Shefelbine SJ, Ma CB, Lee KY, Schrumpf MA, Patel P, Safran MR, Slavinsky JP, Majumdar S. MRI analysis of in vivo meniscal and tibiofemoral kinematics in ACL-deficient and normal knees. J Orthop Res 2006; 24:1208-17. [PMID: 16652339 DOI: 10.1002/jor.20139] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objectives of this study were to analyze simultaneously meniscal and tibiofemoral kinematics in healthy volunteers and anterior cruciate ligament (ACL)-deficient patients under axial load-bearing conditions using magnetic resonance imaging (MRI). Ten healthy volunteers and eight ACL-deficient patients were examined with a high-field, closed MRI system. For each group, both knees were imaged at full extension and partial flexion ( approximately 45 degrees ) with a 125N compressive load applied to the foot. Anteroposterior and medial/lateral femoral and meniscal translations were analyzed following three-dimensional, landmark-matching registration. Interobserver and intraobserver reproducibilities were less than 0.8 mm for femoral translation for image processing and data analysis. The position of the femur relative to the tibia in the ACL-deficient knee was 2.6 mm posterior to that of the contralateral, normal knee at extension. During flexion from 0 degrees to 45 degrees , the femur in ACL-deficient knees translated 4.3 mm anteriorly, whereas no significant translation occurred in uninjured knees. The contact area centroid on the tibia in ACL-deficient knees at extension was posterior to that of uninjured knees. Consequently, significantly less posterior translation of the contact centroid occurred in the medial tibial condyle in ACL-deficient knees during flexion. Meniscal translation, however, was nearly the same in both groups. Axial load-bearing MRI is a noninvasive and reproducible method for evaluating tibiofemoral and meniscal kinematics. The results demonstrated that ACL deficiency led to significant changes in bone kinematics, but negligible changes in the movement of the menisci. These results help explain the increased risk of meniscal tears and osteoarthritis in chronic ACL deficient knees.
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Affiliation(s)
- Sandra J Shefelbine
- Department of Orthopaedic Surgery, University of California, San Francisco, 500 Parnassus Avenue, MU 320W, San Francisco, California 94143-0728, USA
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Conaghan PG, Felson D, Gold G, Lohmander S, Totterman S, Altman R. MRI and non-cartilaginous structures in knee osteoarthritis. Osteoarthritis Cartilage 2006; 14 Suppl A:A87-94. [PMID: 16713722 DOI: 10.1016/j.joca.2006.02.028] [Citation(s) in RCA: 86] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2004] [Accepted: 02/26/2006] [Indexed: 02/07/2023]
Abstract
Magnetic resonance imaging (MRI) provides a sensitive tool for examining all the structures involved in the osteoarthritis (OA) process. While much of the MRI literature previously focussed on cartilage, there is increasing research on whole-organ evaluation and including features such as synovitis, bone marrow edema, and meniscal and ligamentous pathology. The aim of this session at the Outcome Measures in Rheumatology Clinical Trials (OMERACT)-Osteoarthritis Research Society International (OARSI) Workshop for Consensus in Osteoarthritis Imaging was to describe the current MRI methods for identifying and quantifying non-cartilaginous structures and review their associations with both OA symptoms and structural progression. Although there is much experience in measuring synovitis (derived from the rheumatoid arthritis literature), only one study has reported an association of MRI-detected synovitis and effusions with OA pain. Bone marrow edema lesions, which may represent areas of trabecular remodelling, have been associated with pain and compartment-specific structural deterioration. MRI studies have confirmed the frequency and importance of meniscal damage in progressive cartilage loss, but not related such damage to symptoms. Osteophytes have been associated with cartilage loss and malalignment to the side of the osteophyte. Ligament damage, including anterior cruciate ligament tears, has been found more commonly than expected in painful OA knees. Improvements in quantitative and semi-quantitative assessments of non-cartilage features will greatly assist understanding of the OA process and its response to therapy.
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Affiliation(s)
- P G Conaghan
- Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
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Kaeding CC, Pedroza AD, Parker RD, Spindler KP, McCarty EC, Andrish JT. Intra-articular findings in the reconstructed multiligament-injured knee. Arthroscopy 2005; 21:424-30. [PMID: 15800522 DOI: 10.1016/j.arthro.2004.12.012] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Intra-articular chondral and meniscal injury in the multiligament-injured knee has not been examined. The purpose of this study was to determine the pattern of intra-articular chondral and meniscal damage in subjects with multiligament knee injuries undergoing surgery. TYPE OF STUDY Prospective cohort study. METHODS Analysis was performed on prospectively collected data for the presence of meniscal tears and significant chondral injury on subjects who underwent knee ligament surgery. Subjects were grouped by their multiligament injury combination. Chondral injury was graded using the Modified Outerbridge Classification system. Criteria for significant chondral defect were any grade 2 lesion involving 50% or more of condylar width and all grade 3 or 4 lesions. Groups with more than 10 subjects were compared against the anterior cruciate ligament (ACL)-only group. RESULTS Data were collected on 2,265 subjects. The ACL/medial collateral ligament (MCL) injury pattern was the most common multiligament injury, comprising 70.5% of all multiligament injuries. Lateral meniscal damage was significantly higher in the ACL/MCL group (P < .01). Medial meniscal damage was significantly lower in the ACL/MCL group (P < .01). Medial and lateral meniscal damage was significantly lower in the ACL/lateral collateral ligament (LCL) group (P < .01). Articular damage to the medial tibial plateau was significantly lower in the ACL/MCL group (P < .01). All other multiligament injury patterns showed chondral damage similar to the ACL-only group. Ligament injuries repaired acutely had significantly less articular and medial meniscal damage than chronic repairs (P < .01). CONCLUSIONS The ACL/MCL injury pattern was the most common multiligament injury pattern and showed a high incidence of lateral meniscal tears. ACL/LCL injuries had fewer meniscal injuries. Multiligament-injured knees showed increased risk of a torn medial meniscus as chronicity increased. LEVEL OF EVIDENCE Level IV.
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Abstract
RATIONALE AND OBJECTIVES To evaluate position related changes of the menisci in asymptomatic volunteers based on MR imaging of the knee in different positions. METHODS Twenty-two knees from 22 asymptomatic volunteers with no history of knee injury and no evidence of meniscal tears were examined with a 0.5-T open-configuration MR system. Sagittal and coronal images were obtained with the knee supine in neutral, supine in 90-degree flexion with external and internal rotation, as well as in upright weight-bearing positions. The position of the menisci from the outer inferior edge of the meniscus to the outermost edge of the articular cartilage of the tibial plateau was measured, and meniscal movement was calculated. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS Meniscal movement in the sagittal plane was greatest in the anterior horn of the medial meniscus upon position change from supine neutral to supine in 90-degree flexion with external rotation (mean, 10.5 millimeters). The least meniscal movement was observed in the anterior horn of the lateral meniscus when changing from the supine neutral to the upright knee position (mean, 0.6 millimeters). Meniscal protrusion (ie, protrusion of any part of the meniscus beyond the tibial plateau) was noted most frequently for the anterior horn of the medial meniscus (14/22 instances; 63.6%) in the sagittal plane with the knee in neutral position (mean, 2.6 millimeters, range, 1.8-2.8 millimeters). In the coronal plane, medial meniscal protrusion was most frequently present in the upright weight-bearing position (11/22 instances (50%; mean, 2 millimeters; range, 1.2-2.6 millimeters). CONCLUSIONS : Meniscal movement is most prominent in the anterior horn of the medial meniscus with the knee in the supine position in 90-degree flexion with external rotation. Meniscal protrusion is more frequently present in the medial meniscus and averaged less than 3 millimeters in normal volunteers in either the sagittal or coronal MR imaging plane.
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Affiliation(s)
- Larissa Boxheimer
- Institute of Diagnostic Radiology, University Hospital Zurich, Raemistrasse 100, CH-8091 Zurich, Switzerland
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Peterfy CG, Guermazi A, Zaim S, Tirman PFJ, Miaux Y, White D, Kothari M, Lu Y, Fye K, Zhao S, Genant HK. Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the knee in osteoarthritis. Osteoarthritis Cartilage 2004; 12:177-90. [PMID: 14972335 DOI: 10.1016/j.joca.2003.11.003] [Citation(s) in RCA: 1063] [Impact Index Per Article: 53.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2003] [Accepted: 11/02/2003] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To describe a semi-quantitative scoring method for multi-feature, whole-organ evaluation of the knee in osteoarthritis (OA) based on magnetic resonance imaging (MRI) findings. To determine the inter-observer agreement of this scoring method. To examine associations among the features included in the scoring method. METHODS Nineteen knees of 19 patients with knee OA were imaged with MRI using conventional pulse sequences and a clinical 1.5 T MRI system. Images were independently analyzed by two musculoskeletal radiologists using a whole-organ MRI scoring method (WORMS) that incorporated 14 features: articular cartilage integrity, subarticular bone marrow abnormality, subarticular cysts, subarticular bone attrition, marginal osteophytes, medial and lateral meniscal integrity, anterior and posterior cruciate ligament integrity, medial and lateral collateral ligament integrity, synovitis/effusion, intraarticular loose bodies, and periarticular cysts/bursitis. Intraclass correlation coefficients (ICC) were determined for each feature as a measure of inter-observer agreement. Associations among the scores for different features were expressed as Spearman Rho. RESULTS All knees showed structural abnormalities with MRI. Cartilage loss and osteophytes were the most prevalent features (98% and 92%, respectively). One of the least common features was ligament abnormality (8%). Inter-observer agreement for WORMS scores was high (most ICC values were >0.80). The individual features showed strong inter-associations. CONCLUSION The WORMS method described in this report provides multi-feature, whole-organ assessment of the knee in OA using conventional MR images, and shows high inter-observer agreement among trained readers. This method may be useful in epidemiological studies and clinical trials of OA.
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Hamamoto K, Tobimatsu Y, Zabinska-Uroda K. Magnetic Resonance Imaging Evaluation of the Movement and Morphological Changes of the Menisci during Deep Knee Flexion. J Phys Ther Sci 2004. [DOI: 10.1589/jpts.16.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Koichi Hamamoto
- Department of Rehabilitation Medicine for People with Disabilities, Tohoku University Graduate School of Medicine
- Department of Rehabilitation, Sapporo Lilac Hospital
| | - Yoshiko Tobimatsu
- Department of Rehabilitation Medicine for People with Disabilities, Tohoku University Graduate School of Medicine
| | - Katarzyna Zabinska-Uroda
- Department of Rehabilitation Medicine for People with Disabilities, Tohoku University Graduate School of Medicine
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Affiliation(s)
- D R Jeffrey
- Department of Clinical Radiology, Bristol Royal Infirmary, Bristol BS2 8HW, UK
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Abstract
Until recently, imaging evaluation of osteoarthritis (OA) has relied primarily on conventional radiography. Using radiography in clinical practice or clinical research, however, has been fraught with difficulty. Techniques for reproducibly acquiring serial radiographs of joints have improved considerably over the past several years. However, the greatest promise for advancing knowledge about OA and its treatment lies in magnetic resonance imaging (MRI) and its unique ability to examine the joint as a whole organ. In contrast to conventional radiography, MRI can directly visualize the articular cartilage, synovium, menisci, and other intra-articular structures important to the functional integrity of joints. There have been considerable advances in MRI of articular cartilage in particular over the past several years. However, much of this has come from small cross-sectional studies, and published longitudinal studies remain quite scant. The following discussion reviews the current status of imaging in OA and points to where changes might be anticipated in the future.
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