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Pavl0009@gold.tc.umn.edu
06-14-1994, 01:57 AM
The following includes responses to my two inquiries on this topic. Since
there was a lot of interest, I'm posting the responses to the list. I
didn't worry about formatting, but tried to edit out duplication and,
to be brief, didn't include the names of all who responded.

I didn't get many responses from people with personal experience
at inserting and anchoring sensors in a joint. *I would still appreciate
responses of this nature* (see question 1).

On the other hand, there is a wealth of information to answer my second
question! Thanks to everyone for your input.

My first question was:

>We're using Tekscan K-Scan sensors to measure intra-articular
>(t-f and p-f) pressures in cadaver knees. We dynamically load the
>knees on a 6 dof knee simulation machine with pneumatic muscle loads. The
>sensors inserted in the joints are exposed to body fluids and a wide range
>of physiologic loads, including shear forces.

>Our concerns regarding these sensors include durability, hysteresis,
>accuracy, and repeatability. We have done tests to characterize all
>of the above. Our main concerns presently are anchoring and locating the
>sensors relative to the tibia and implant (PCL retaining). This is
>especially difficult for the natural knee, in which the ligaments must be
>left intact and access is difficult. I would appreciate input from those
>of you who have inserted any type of sensor in a joint. 1. How did you
>attach the sensor? Would this method work well for a dynamic loading
>situation in which the sensor must not move relative the the reference
>bone? 2. How did you locate the sensor relative to the bone (or implant)?

>Thanks for your input. It may be most appropriate to respond to me
>directly, in which case I will summarize the responses.

>Jenny Pavlovic, MSME, PE
>Research Engineer
>Orthopaedic Biomechanics Lab
>Hennepin County Medical Center
>Minneapolis, MN

My second inquiry was:

> My next question: Does anyone know of a good reference for intra-articular
> (tibiofemoral and patellofemoral) contact areas in the *natural* knee?
> Ideally, I would like to find dynamically measured contact areas, but
> statically measured contact areas would be helpful too. I've seen many
> references for contact areas of implants, but not for the natural knee
> (I know how difficult this is to measure!).
>
> Thanks for your help.
>
> Jenny Pavlovic, MSME, PE

Your responses:

List of recommended papers (from Biomech-L):

Aglietti, P, Insall, JN, Walker, PS, Trent, P. A new patella
prosthesis. Clin Orthop 1975;107:175-187.

Ahmed, AM, Burke, DL, Yu A. In vitro measurement of static pressure
distribution in synovial joints--Part I: Tibial Surface of the Knee, J.
Biomech (or Biomed?)Engng 1983:105:216-225.

Ahmed, AM, Burke, DL In vitro measurement of static pressure
distribution in synovial joints--Part II: Retropatellar Surface, J. Biomech
Engng 1983:105:226-236.

Baratz ME, Rehak DC, Fu FH, Rudert MJ. Peripheral tears of
open versus arthroscopic repair on intraarticular contact stresses in the
human knee. Am JSports Med 1988;16:1-6.

Boszotta H., Helperstorfer W., Jusner A., Hoffmann K.,
Physiopathology of the knee joint after distal iliotibial band transfer,
Archives of Orthopaedic and TraumaSurgery, 111, pp213-219 (1992).

Brown TD, Anderson DD, Nepola JV, Singerman RJ, Pedersen DR,
Brand RA. Contact stress aberrations following imprecise reduction of
simpletibial plateau fractures. J Orthop Res 1988;6:851-862.

Brown TD, Shaw DT. In vitro contact stress distribution on
the femoral condyles. J Orthop Res 1984;2:190-199.

Deane G. Contact print studies in the human knee joint
[Thesis]. Surrey, University of Surrey, 1970.

Ferguson AB, Brown TD, Fu FH, Rutkowski R. Relief of
patellofemoral contact stress by anterior displacement of the tibial
tubercle. J Bone and JointSurg 1979;61A:159-166.

Fujikawa K, Seedhom BB, Wright V. Biomechanics of the patello-femoral joint
part I: a studyof the effect of simulated femoro-tibial varus deformity on
thecongruity of the patello-femoral compartment and movement of the
patella. Eng Med 1983;12:3-11.

Fujikawa K, Seedhom BB, Wright V. Biomechanics of the
patello-femoral joint part II: a study of the effect of simulated
femoro-tibial varus deformity on the congruity of the patello-femoral
compartment and movement of the patella. Eng Med 1983;12:13-21.

Fukubayashi T, Kurosawa H. The contact area and pressure
distribution pattern of the knee. Acta Orthop Scand 1980; 51:871-879.

Fulkerson, JP, Hungerford, DS Disorders of the Patello-femoral
Joint, 2nd ed. Baltimore, Williams & Wilkins, 1990: 294.

Goodfellow J, Hungerford DS, Zindel M Patello-femoral joint
mechanics and pathology. JBJS 1976;58B:287-290.

Haut RC. Contact pressures in the patellofemoral joint during
impact loading of the human flexed knee. J Orthop Res 1989;7:272-280.

Henche HR, Kunzi HU, Morscher E. The areas of contact pressure in
the patello-femoral joint. Int Orthop 1981;4:279-281.

Huberti HH, Hayes WC. Patellofemoral contact pressures. The
influence of Q-Angle and tendofemoral contact. J Bone Joint Surg
1984;66A:715-724.

Huberti et al., J. Orthop. Res. 2:49-54, 1984.

Huberti HH, Hayes WC. Contact pressures in chondromalacia
patellae and the effects of capsular reconstructive procedures. J Orthop
Res 1988;6:499-508.

Kettelkamp, DB, Jacobs, AW Tibiofemoral contact area--determination
and implications. JBJS 1972;54(A):349-356.

Kurosawa H, Fukubayashi T, Nakajima H. Load-bearing mode of the
knee joint. Clin Orthop 1980;149:283-290.

Lewallen DG, Riegger CL, Myers ER, Hayes WC. Effects of
retinacular release and tibial tubercle elevation in patellofemoral
degenerative joint disease.J Orthop Res 1990;8:856-862.

Maquet, P.G.J. "Biomechanics of the Knee"

Maquet PG, Van de Berg A, Simonet J. Femorotibial
weight-bearing areas. J Bone and Joint Surg 1975;57A:766-771.

Matthews LS, Sonstegard DA, Hanke JA. Load bearing
characteristics of the patello-femoral joint. Acta Orthop Scand
1977;48:511-516.

McKellop HA, Sigholm G, Redfern FC, Doyle B, Sarmiento A, Luck
JV. The effect of simulated fracture-angulations of the tibia on
cartilage pressures in the knee joint. JBJS 1991;73A:1382-1391.

Nakamura N, Ellis M, Seedhom B. Advancement of the tibial
tuberosity. a biomechanical study. JBJS 1985;67B:255-260.

Seedhom BB, Takeda T, Tsubuku M, Wright V. Mechanical factors
and patellofemoral osteoarthrosis. Ann Rheum Dis 1979;38:307-316.

Seedhom BB, ( Terayama, K OR Tsubuku M) A technique for the study
of contact between visco-elastic bodies with special reference to the
patello-femoraljoint. J Biomechanics 1977;10:253-260.

Soslowsky, LJ, Ateshian, GA, Mow, VC, Stereophotogrammetric
Determination of Joint Anatomy and Contact Areas. In: Mow, VC, Ratcliffe
A, and Woo SLY(eds.) Biomechanics of Diarthrodial Joints, Vol. II, chapter
26, pp 243-268, Springer 1990.

Takeuchi et al "Patellofemoral Contact Exceed the Compressive Yield
Strength of UHMWPE in Total Knee Replacements, J. Arthroplasty, in press
(Toby Hayes)

Walker PS, Erkman MJ. The role of the menisci in force transmission
across the knee. Clin Orthop 1975;109:184-192.

Walker PS, Hajek JV. The Load-bearing area in the knee joint. J
Biomechanics, 1972;5:581-589.

Yao, J.Q., Seedhom, BB A new Technique for measuring contact areas
in human joints--the '3S technique', Proc. Inst. Mech. Engrs., Part H, 205,
69-72, 1991.

.................................................. ..............
At a conference the other week someone showed a video of a
moving cross-section of the knee (in vitro). The video showed
that the contact points of the medial and lateral condyles
of the knee joint undergo different translation when the knee
is flexed. The person showing the video may know more (or may
have published) about the contact points. His name is :

Andri Bdhler
Orthopddie-Technik-Consulting
Kapfsteig 44a
CH/8032 Zuerich
Switzerland
Tel. 01/3812115


Edsko Hekman
Twente University
Fac. Werktuigbouwkunde - BW
Postbus 217
7500AE Enschede
The Netherlands
.................................................. ..............

With respect to in-vitro measurements, you might do a search for
literature by Bylski-Austrow, Donita Ph.S. She has done work in this area
although I am not familiar with it. It would be affiliated with the
University of Cincinnati's Noyes-Gainnestras Biomechanics Laboratories.
.................................................. .............
Here are a few papers which discuss contact areas in the knee:

The first uses a mathematical model to determine knee movement and compares
the resulting contact areas to the literature:

"Prediction of total knee motion using three-dimesional computer-graphics
model" Garg A. and Walker P.S. J. Biomechanics Vol. 23 No. 1, pp. 45-58, 1990.

The above paper compares its contact results to:

"Interaction between intrinsic knee mechanics and the knee extensor mechanism"
Draganich L.F. et al. Journal of Orthopaedic Research 5:539-547, 1987.

and

Ahmed et al. "In vitro measurement of static pressure distribution in synovial
joints-Part II. Retropatellar Surface" J. Biomech. Engng 105:226-236, 1983.
.................................................. .........................
Here at MSU we have done research using pressure sensitive films
to measure not only the area but also the pressure distribution
across the patellofemoral joint (work done by Dr. Haut).
Note: This goes along with the reference from above:
Haut RC. Contact pressures in the patellofemoral joint during
impact loading of the human flexed knee. J Orthop Res 1989;7:272-280.
.................................................. .........................

Again, thanks to everyone for your responses. I hope this compiled list is
also useful to you.

Jenny pavl0009@gold.tc.umn.edu