Three-dimensional finite element study on combined proximal and distal knee extension rearrangement for recurrent patellar dislocation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CAI Guofeng , WANG Xu , NING Ziwen , JIA Di , LI Song , SONG En ,  LI Yanlin

Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming Yunnan, 650032, P. R. China;

Corresponding?author：

LI Yanlin, Email: 852387873@qq.com

Keywords：

Recurrent patellar dislocation; combined proximal and distal knee extension rearrangement surgery; three-dimensional finite element; biomechanics

DOI：

10.7507/1002-1892.202201015

Video：

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Objective To establish a three-dimensional finite element analysis model of the knee joint in fresh frozen cadavers, to verify the validity of the model and to simulate the stress distribution characteristics of the patellofemoral joint after combined proximal and distal knee extension rearrangement surgery for recurrent patellar dislocation. Methods One male and one female fresh frozen cadavers (4 knees in total), using voluntary body donations, were used to measure the maximum pressure on the patellofemoral articular surface at each passive flexion angle (0°, 30°, 60°, 90°, 120°) of the normal knee joint and the model after combined proximal and distal knee extension rearrangement surgery for recurrent patellar dislocation with tibial tuberosity-trochlear groove distance (TT-TG) value >2.00 cm using pressure-sensitive paper, respectively. Then, the 2 freshly frozen cadavers were used to construct three-dimensional finite element models of normal knee joints and postoperative knee joints, and the maximum pressure on the patellofemoral articular surface was measured at various passive flexion angles. The maximum pressure was compared with the measurement results of the pressure-sensitive paper to verify the validity of the three-dimensional finite element model. In addition, the maximum pressure on the patellofemoral joint surface measured by three-dimensional finite element was compared between the normal knee joint and the postoperative knee joint at various passive flexion angles, so as to obtain an effective three-dimensional finite element model for the simulation study of the stress distribution characteristics of the patellofemoral joint after combined proximal and distal knee extension rearrangement surgery for recurrent patellar dislocation. Results The maximum pressure on the patellofemoral joint surface measured by pressure-sensitive paper and three-dimensional finite element measurements were similar at all passive flexion angles in the normal knee joint, with a difference of ?0.08-0.06 MPa; the maximum pressure on the patellofemoral joint surface measured by pressure-sensitive paper and three-dimensional finite element measurements were also similar at all passive flexion angles in the knee after combined proximal and distal knee extension rearrangement surgery, with a difference of ?0.04-0.09 MPa. The maximum pressure on the patellofemoral joint surface measured by three-dimensional finite elements were also similar between the normal knee joint and the knee joint after combined proximal and distal knee extension rearrangement surgery at all passive flexion angles, with a difference of ?0.50-?0.03 MPa. Conclusion The three-dimensional finite element model of the normal knee joint and the knee joint after combined proximal and distal knee extension rearrangement surgery can accurately and effectively quantify the change in the maximum pressure on the patellofemoral joint surface; for recurrent patellar dislocations with TT-TG value>2.00 cm, the combined proximal and distal knee extension rearrangement surgery can achieve a maximum pressure of the patellofemoral joint surface similar to that of the normal knee joint.

Citation： CAI Guofeng, WANG Xu, NING Ziwen, JIA Di, LI Song, SONG En, LI Yanlin. Three-dimensional finite element study on combined proximal and distal knee extension rearrangement for recurrent patellar dislocation. Chinese Journal of Reparative and Reconstructive Surgery, 2022, 36(5): 573-581. doi: 10.7507/1002-1892.202201015 Copy

1.	Ambra LF, Franciozi CE, Phan A, et al. Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 793-799.
2.	Zumbansen N, Haupert A, Kohn D, et al. Selective bundle tensioning in double-bundle MPFL reconstruction to improve restoration of dynamic patellofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1144-1153.
3.	Kienle A, Graf N, Krais C, et al. The MOVE-C cervical artificial disc-design, materials, mechanical safety. Med Devices (Auckl), 2020, 13: 315-324.
4.	Yamamoto A, Massimini DF, DiStefano J, et al. Glenohumeral contact pressure with simulated anterior labral and osseous defects in cadaveric shoulders before and after soft tissue repair. Am J Sports Med, 2014, 42(8): 1947-1954.
5.	Koh YG, Son J, Kwon OR, et al. Effect of post-cam design for normal knee joint kinematic, ligament, and quadriceps force in patient-specific posterior-stabilized total knee arthroplasty by using finite element analysis. Biomed Res Int, 2018, 2018: 2438980. doi: 10.1155/2018/2438980.
6.	魏文興, 聶涌, 吳元剛, 等. 人工全膝關節置換術后假性低位髕骨對髕股關節影響的生物力學研究. 中國修復重建外科雜志, 2021, 35(7): 841-846.
7.	Dagneaux L, Allal R, Pithioux M, et al. Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study. Knee, 2018, 25(5): 807-813.
8.	Trad Z, Barkaoui A, Chafra M, et al. Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading. Proc Inst Mech Eng H, 2018, 232(6): 553-564.
9.	賈笛, 李彥林, 何川, 等. 點對點圖像配準技術虛擬膝關節單髁置換術后三維模型的構建. 中國運動醫學雜志, 2017, 36(9): 760-764, 772.
10.	Lorbach O, Zumbansen N, Kieb M, et al. Medial patellofemoral ligament reconstruction: Impact of knee flexion angle during graft fixation on dynamic patellofemoral contact pressure-A biomechanical study. Arthroscopy, 2018, 34(4): 1072-1082.
11.	紀剛. 脛骨結節轉移術對髕股關節接觸壓力影響的生物力學研究. 石家莊: 河北醫科大學, 2013.
12.	潘永謙, 李健, 高梁斌, 等. 改良Elmslie-Trillat術治療髕骨不穩定的生物力學與臨床研究. 中國臨床解剖學雜志, 2009, 27(5): 595-598.
13.	Xu H, Zhang C, Pei G, et al. Arthroscopic medial retinacular imbrication for the treatment of recurrent patellar instability: a simple and all-inside technique. Orthopedics, 2011, 34(7): 524-529.
14.	Marsh JS, Daigneault JP, Sethi P, et al. Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique. J Pediatr Orthop. 2006, 26(4): 461-465.
15.	Stephen JM, Kader D, Lumpaopong P, et al. Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics. J Orthop Res, 2013, 31(9): 1423-1429.
16.	Zaffagnini S, Colle F, Lopomo N, et al. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc, 2013, 21(9): 2164-2171.
17.	Richter DJ, Lyon R, Van Valin S, et al. Current strategies and future directions to optimize ACL reconstruction in adolescent patients. Front Surg, 2018, 5: 36. doi: 10.3389/fsurg.2018.00036.
18.	Ren D, Liu Y, Zhang X, et al. The evaluation of the role of medial collateral ligament maintaining knee stability by a finite element analysis. J Orthop Surg Res, 2017, 12(1): 64. doi: 10.1186/s13018-017-0566-3.
19.	Peters AE, Akhtar R, Comerford EJ, et al. Tissue material properties and computational modelling of the human tibiofemoral joint: a critical review. PeerJ, 2018, 6: e4298. doi: 10.7717/peerj.4298.
20.	Zevenbergen L, Smith CR, Van Rossom S, et al. Cartilage defect location and stiffness predispose the tibiofemoral joint to aberrant loading conditions during stance phase of gait. PLoS One, 2018, 13(10): e0205842. doi: 10.1371/journal.pone.0205842.
21.	Men YT, Li XM, Chen L, et al. Experimental study on the mechanical properties of porcine cartilage with microdefect under rolling load. J Healthc Eng, 2017, 2017: 2306160. doi: 10.1155/2017/2306160.
22.	Li J. Development and validation of a finite-element musculoskeletal model incorporating a deformable contact model of the hip joint during gait. J Mech Behav Biomed Mater, 2021, 113: 104136. doi: 10.1016/j.jmbbm.2020.104136.
23.	O’Rourke D, Beck BR, Harding AT, et al. Assessment of femoral neck strength and bone mineral density changes following exercise using 3D-DXA images. J Biomech, 2021, 119: 110315. doi: 10.1016/j.jbiomech.2021.110315.
24.	Elias JJ, Wilson DR, Adamson R, et al. Evaluation of a computational model used to predict the patellofemoral contact pressure distribution. J Biomech, 2004, 37(3): 295-302.

1. Ambra LF, Franciozi CE, Phan A, et al. Isolated MPTL reconstruction fails to restore lateral patellar stability when compared to MPFL reconstruction. Knee Surg Sports Traumatol Arthrosc, 2021, 29(3): 793-799.
2. Zumbansen N, Haupert A, Kohn D, et al. Selective bundle tensioning in double-bundle MPFL reconstruction to improve restoration of dynamic patellofemoral contact pressure. Knee Surg Sports Traumatol Arthrosc, 2020, 28(4): 1144-1153.
3. Kienle A, Graf N, Krais C, et al. The MOVE-C cervical artificial disc-design, materials, mechanical safety. Med Devices (Auckl), 2020, 13: 315-324.
4. Yamamoto A, Massimini DF, DiStefano J, et al. Glenohumeral contact pressure with simulated anterior labral and osseous defects in cadaveric shoulders before and after soft tissue repair. Am J Sports Med, 2014, 42(8): 1947-1954.
5. Koh YG, Son J, Kwon OR, et al. Effect of post-cam design for normal knee joint kinematic, ligament, and quadriceps force in patient-specific posterior-stabilized total knee arthroplasty by using finite element analysis. Biomed Res Int, 2018, 2018: 2438980. doi: 10.1155/2018/2438980.
6. 魏文興, 聶涌, 吳元剛, 等. 人工全膝關節置換術后假性低位髕骨對髕股關節影響的生物力學研究. 中國修復重建外科雜志, 2021, 35(7): 841-846.
7. Dagneaux L, Allal R, Pithioux M, et al. Femoral malrotation from diaphyseal fractures results in changes in patellofemoral alignment and higher patellofemoral stress from a finite element model study. Knee, 2018, 25(5): 807-813.
8. Trad Z, Barkaoui A, Chafra M, et al. Finite element analysis of the effect of high tibial osteotomy correction angle on articular cartilage loading. Proc Inst Mech Eng H, 2018, 232(6): 553-564.
9. 賈笛, 李彥林, 何川, 等. 點對點圖像配準技術虛擬膝關節單髁置換術后三維模型的構建. 中國運動醫學雜志, 2017, 36(9): 760-764, 772.
10. Lorbach O, Zumbansen N, Kieb M, et al. Medial patellofemoral ligament reconstruction: Impact of knee flexion angle during graft fixation on dynamic patellofemoral contact pressure-A biomechanical study. Arthroscopy, 2018, 34(4): 1072-1082.
11. 紀剛. 脛骨結節轉移術對髕股關節接觸壓力影響的生物力學研究. 石家莊: 河北醫科大學, 2013.
12. 潘永謙, 李健, 高梁斌, 等. 改良Elmslie-Trillat術治療髕骨不穩定的生物力學與臨床研究. 中國臨床解剖學雜志, 2009, 27(5): 595-598.
13. Xu H, Zhang C, Pei G, et al. Arthroscopic medial retinacular imbrication for the treatment of recurrent patellar instability: a simple and all-inside technique. Orthopedics, 2011, 34(7): 524-529.
14. Marsh JS, Daigneault JP, Sethi P, et al. Treatment of recurrent patellar instability with a modification of the Roux-Goldthwait technique. J Pediatr Orthop. 2006, 26(4): 461-465.
15. Stephen JM, Kader D, Lumpaopong P, et al. Sectioning the medial patellofemoral ligament alters patellofemoral joint kinematics and contact mechanics. J Orthop Res, 2013, 31(9): 1423-1429.
16. Zaffagnini S, Colle F, Lopomo N, et al. The influence of medial patellofemoral ligament on patellofemoral joint kinematics and patellar stability. Knee Surg Sports Traumatol Arthrosc, 2013, 21(9): 2164-2171.
17. Richter DJ, Lyon R, Van Valin S, et al. Current strategies and future directions to optimize ACL reconstruction in adolescent patients. Front Surg, 2018, 5: 36. doi: 10.3389/fsurg.2018.00036.
18. Ren D, Liu Y, Zhang X, et al. The evaluation of the role of medial collateral ligament maintaining knee stability by a finite element analysis. J Orthop Surg Res, 2017, 12(1): 64. doi: 10.1186/s13018-017-0566-3.
19. Peters AE, Akhtar R, Comerford EJ, et al. Tissue material properties and computational modelling of the human tibiofemoral joint: a critical review. PeerJ, 2018, 6: e4298. doi: 10.7717/peerj.4298.
20. Zevenbergen L, Smith CR, Van Rossom S, et al. Cartilage defect location and stiffness predispose the tibiofemoral joint to aberrant loading conditions during stance phase of gait. PLoS One, 2018, 13(10): e0205842. doi: 10.1371/journal.pone.0205842.
21. Men YT, Li XM, Chen L, et al. Experimental study on the mechanical properties of porcine cartilage with microdefect under rolling load. J Healthc Eng, 2017, 2017: 2306160. doi: 10.1155/2017/2306160.
22. Li J. Development and validation of a finite-element musculoskeletal model incorporating a deformable contact model of the hip joint during gait. J Mech Behav Biomed Mater, 2021, 113: 104136. doi: 10.1016/j.jmbbm.2020.104136.
23. O’Rourke D, Beck BR, Harding AT, et al. Assessment of femoral neck strength and bone mineral density changes following exercise using 3D-DXA images. J Biomech, 2021, 119: 110315. doi: 10.1016/j.jbiomech.2021.110315.
24. Elias JJ, Wilson DR, Adamson R, et al. Evaluation of a computational model used to predict the patellofemoral contact pressure distribution. J Biomech, 2004, 37(3): 295-302.

Chinese Journal of Reparative and Reconstructive Surgery

Three-dimensional finite element study on combined proximal and distal knee extension rearrangement for recurrent patellar dislocation

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