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Biomedical subjects

M S Hefzy

Publications and source records attributed to M S Hefzy.

At least 19 recordsLinked to original sources
PubMed2003

Kinematics of the human pelvis following open book injury.

The objective of this study is to determine the three dimensional kinematics of the human pelvis including both sacroiliac joints following a simulated open book injury induced on cadavers by applying anterior-posterior compressive loads to the pelvis. An electromagnetic digitizing and motion tracking system was utilized to measure the morphology of the pelvis and the relative movements of its bones during this simulated open book fracture. The screw displacement axis method was used to describe the relative motion between the sacrum and each hipbone. Morphologically, it was found that the articular surfaces forming the sacroiliac joints could be approximated with planar surfaces directed from proximal and lateral to distal and medial and from posteromedial to anterolateral. The kinematic data obtained from this study indicate that there is a direct correlation between the opening of the symphysis pubis and the opening of the sacroiliac joint (SIJ) during open book injury. This suggests that the extent of injury of the SIJ maybe estimated from the degree of opening of the symphysis pubis as demonstrated on anteroposterior (A-P) x-rays. The results obtained from this study also indicate that the motion of the hipbone with respect to the sacrum on the side of the sacroiliac joint opening is almost a pure rotation, which translates clinically on the A-P x-rays as pure opening of the SIJ without vertical displacement. The average axis of rotation was found to be almost parallel to the SIJ planar articular surface. Furthermore, the pubic bone on the side of SIJ opening was found to displace inferiorly and posteriorly. One can thus conclude that in open book pelvic injuries, the pubic bone on the side of injury displaces inferiorly on the outlet projection x-rays with no vertical displacement of the SIJ. This is important since the initial assessment of the open book injury in the emergency room includes outlet projection x-rays. From this study, the relative vertical positions of the pubic bones on these x-rays can help the surgeon in differentiating open book fracture injury from other pelvic injuries.

Cadaver↗
PubMed1998

Three-dimensional dynamic behaviour of the human knee joint under impact loading.

The objective of this study is to determine the three-dimensional dynamic response of the human knee joint. A three-dimensional anatomical dynamic model was thus developed and consists of two body segments in contact (the femur and tibia) executing a general three-dimensional dynamic motion within the constraints of the different ligamentous structures. Each of the articular surfaces at the tibio-femoral joint was represented mathematically by a separate mathematical function. The joint ligaments were modelled as nonlinear elastic springs. The six-degrees-of-freedom joint motions were characterized by using six kinematic parameters, and ligamentous forces were expressed in terms of these six parameters. Knee response was studied by considering sudden external forcing pulse loads applied to the tibia. Model equations consist of nonlinear second-order ordinary differential equations coupled with nonlinear algebraic constraint conditions. Constraint equations were written to maintain at least one-point contact throughout motion; one- and two-point contact versions of the model were developed. This Differential-Algebraic Equations (DAE) system was solved by employing a DAE solver: the Differential/Algebraic System Solver (DASSL) developed at Lawrence Livermore National Laboratory. A solution representing the response of this three-dimensional dynamic system was thus obtained for the first time. Earlier attempts to determine the system's response were unsuccessful owing to the inherent numerical instabilities in the system and the limitations of the solution techniques. Under the conditions tested, evidence of "femoral roll back" on both medial and lateral tibial plateaus was not observed from the model predictions. In the range of 20 degrees to 66 degrees of knee flexion, the lateral tibial contact point moved posteriorly while the medial tibial contact point moved anteriorly. In the range of 66 degrees to 90 degrees of knee flexion, contact was maintained only on the medial side and the tibial contact point (on the medial side) continued to move anteriorly. It was further found that increasing pulse amplitude and/or duration caused a decrease in the magnitude of the tibio-femoral contact force at a given flexion angle. These results suggest that increasing load level caused a decrease in joint stiffness. The results of this study also show that the anterior fibres of the posterior cruciate and the medial collateral ligaments are the primary restraints for a posterior forcing pulse in the range of 20 degrees to 90 degrees of knee flexion; this explains why most isolated posterior cruciate ligament injuries and combined injuries to the posterior cruciate and the medial collateral result from a posterior impact on a flexed knee.

Algorithms↗
PubMed1998

Kinematics of the knee joint in deep flexion: a radiographic assessment.

The purpose of this study is to describe the kinematics of normal knees in vivo, assessed in deep flexion, using bi-planar radiographs. Antero-posterior and lateral views were obtained from five healthy males during three sequential positions of kneeling. In the first position, the subject knelt with the knees fully flexed (deep flexion between 150 and 165 degrees) and torso upright. In the second position, the subject bowed forward to an intermediate position (about 120 degrees of knee flexion). In the third position, the subject bowed further until his head touched the floor, supporting the upper torso with hands and with the knees flexed at about 90 degrees. The results show that past 135 degrees of knee flexion, the patella cleared the femoral groove and was in contact only with the condyles. For these particular postures, and during deep flexion, motion of the femur on the tibia did not reveal the classical femoral 'roll back'. Rather the lateral femoral condyle rolled further over the postero medial aspect of the lateral tibial plateau while contact of the medial femoral condyle occurred more anteriorly, but still in the posterior part of the medial plateau. This asymmetric rolling motion indicated an element of internal tibial rotation. Furthermore, the tibia was found to articulate with the femur at the most proximal points of the condyles in deep flexion. These data on the kinematics and contact characteristics of the tibio-femoral joint must be considered in any approach to design for a Deep Flexion Knee Implant.

Adult↗
PubMed1997

Comparison between two techniques for modeling interface conditions in a porous coated hip endoprosthesis.

The geometric and material non-linearities occurring at implant interfaces require a non-linear foate element analysis to simulate accurately the interface conditions. Reviewing the literature, it was found that mainly three different non-linear interface elements have been developed to simulate the interface bounding conditions. While these different types of interface elements have been used to predict micromotions and interface stresses for different geometrical configurations and under different loading conditions, no study has attempted to compare the performance of these elements under similar conditions. The objective of this study is to compare two non-linear interface modeling techniques using gap elements and joint/interface elements. A simplified three-dimensional geometrical model was developed to compare interface stresses and micromotions for both fully and partially coated models. The results show that both non-linear modeling techniques predict dissimilar results for the interface stresses in bone and prosthesis sides. For the fully coated model, and on the bone side, joint/interface elements predict a gradual decrease in stresses from distal end to proximal end. However, 'gap' elements predict almost constant stresses in the mid-stem region and higher stresses at the distal end. On the prosthesis side, small stress differences occur only at the distal and proximal ends. For the partially coated model, most significant stress dissimilarities occur in the uncoated section. The relative micromotions at the interface were also determined. It was found that micromotion patterns obtained using both techniques were similar with higher magnitudes in the case of the 'gap' elements.

Algorithms↗
PubMed1997

Co-activation of the hamstrings and quadriceps during the lunge exercise.

The anterior lunge exercise is a closed chain kinetic exercise that has been developed to improve the function of the lower limb and to strengthen the hamstrings and quadriceps, simultaneously. In this study, a three-dimensional biomechanical analysis of this exercise was conducted in order to understand the mechanics of this rehabilitation activity. Experimental conditions were recorded using an active optoelectronic kinematic data capture system (OPTOTRAK), two force plates (AMTI) and electromyography (EMG). Data were collected from healthy male subjects while performing several lunges. When the distance between the toe of the rear leg and the heel of the front leg (lunging distance) was maximum, a large net flexion moment was predicted in the front leg in the extented position. This moment was reversed to a large net extension moment in the flexed position. A large increase in the net extension moment in the rear leg was also predicted as the front knee was bent from 5 degrees to 90 degrees of flexion. These data suggest that quadriceps and hamstring muscles co-contraction occur during a maximum lunge in the front leg when it is in the flexed position.

Biomechanical Phenomena↗
PubMed1997

Knee kinematics in-vivo of kneeling in deep flexion examined by bi-planar radiographs.

Squatting and kneeling are important daily activities for Middle and Far East cultures that require positioning the knee in deep flexion. In these activities, the limb becomes fully flexed with a knee flexion angle reaching between 150 and 160 degrees and the heel reaching the posterior surface of the upper thigh. Existing knee prostheses do not allow a full return to normal activities for this large population since they are limited to achieving knee flexion of about 120 degrees. Also, there is very limited information on knee kinematics and/or forces in the range beyond 120 degrees. The purpose of this study is to describe the kinematics of normal knees in-vivo, assessed in deep flexion, using bi-planar radiographs. A-P and lateral views were obtained from 5 healthy subjects during three sequential positions of kneeling. In the 1st position, the subject knelt with the knees fully flexed (deep flexion between 150 degrees and 160 degrees) and torso upright. In the 2nd position, the subject bowed forward to an intermediate position (about 120 degrees of knee flexion). In the 3rd position, the subject bowed further until his/her head touched the floor, supporting the upper torso with hands and attaining a knee flexion of about 90 degrees. The results show that past 135 degrees of knee flexion, the patella was found to clear the femoral groove and was in contact only with the condyles. The results also show that the classical femoral "roll back" does not appear to occur in deep flexion. It seems that the lateral femoral condyle rolls over the postero medial aspect of the lateral tibial plateau while contact of the medial femoral condyle occurs more anteriorly, but still in the posterior aspect of the medial tibial plateau. This asymmetric rolling motion implies an element of internal tibial rotation. Furthermore, the tibia was found to articulate with the femur at the most proximal points of the condyles in deep flexion. These data on the kinematics and contact characteristics of the tibio-femoral joint must be considered in any approach to design for a Deep Flexion Knee Implant.

Biomechanical Phenomena↗
PubMed1996

Design and development of a pressure relief seating apparatus for individuals with quadriplegia.

Persons with spinal cord injury above C7 lack the ability to extend their elbows and grip with their hands. Consequently, when seated, they are unable to press down to shift their weight to relieve pressure on the ischial tuberosities. This can ultimately cause serious pressure sores to develop on the buttocks. Those with adequate insurance coverage can eliminate this problem with an electric power recliner wheelchair. With the touch of a button, the backrest will fold down to a laying position, thus relieving the pressure on the ischial tuberosity. Unfortunately, not all individuals with quadriplegia possess this type of coverage. Therefore, the problem requires an alternate design that will utilize mechanical rather than electrical power to produce a cost-effective solution. The purpose of this project was thus to design and build an affordable apparatus adaptable to wheelchairs that allows individuals with quadriplegia to shift their weight from one side to the other thus relieving the pressure on the ischial tuberosities. A pneumatic system that utilizes two inflatable air bladders was employed. One cushion is placed under each buttock and inflated separately to tilt the user from one side to the other. The inflated cushion elevates one side of the buttock, which relieves the pressure from the other side. The power required to operate the system is generated using repetitions of elbow flexion. The system was evaluated on an individual with C6 quadriplegia. The subject demonstrated independent pressure relief without intrusion on cosmesis or independence.

Cost-Benefit Analysis↗
PubMed1996

Posterior cruciate ligament anatomy and length-tension behavior of PCL surface fibers.

The location of the most nearly isometric region of the PCL has remained a controversial issue. Our data indicate that there is an entire region close to the PCL's proximal edge that is isometric; however, the majority of the PCL is anisometric. This concurs with the work of Grood et al, Ogata and McCarthy, and Sidles et al. However, other authors believe that the posterior-proximal region of the PCL contains the most isometric fibers. These differences could be explained in part through the differences in experimental design. It is important to note that all of these studies placed the most nearly isometric area within the substance of the ligament. What is equally important to understand from all of these studies is the complex length change pattern of fibers comprising the PCL. The function of PCL fibers is not accurately described by the traditional model of an anterolateral bundle and a posteromedial bundle that have reciprocal functions. Further kinematic studies testing potential femoral attachment sites are needed to ascertain the optimal placement for PCL graft substitutes. An earlier study performed in our laboratory suggested that PCl graft placement distal to the isometric region, 4 mm from the proximal edge (within the PCL footprint), provided the most optimal position for correcting abnormal posterior translation after PCL division. We reported that isometric placement at the time of surgery would lead to incorrect positioning of the graft. We are currently investigating alternative graft configurations (eg, two-bundle and multiple-bundle grafts) to determine if PCL function can be reproduced more ideally; however, more analysis is required before definitive recommendations can be made. At present, the ideal operative procedure for PCL reconstruction requires continued biomechanical analysis followed by carefully designed clinical trials.

Humans↗
PubMed1994

Determination of wrist kinematics using a magnetic tracking device.

The objective of this work is to present a method to determine the three-dimensional kinematics of the human wrist joint under physiological loading conditions using a magnetic tracking device. Euler angles were used to determine wrist extension-flexion, radial-ulnar deviation and supination-pronation. The screw displacement axis (SDA) method was used to describe the relative motion between carpal bones. Computer graphics were also used to obtain a better visualization of the three-dimensional motions of the carpal bones. This was accomplished by combining motion data and digitization data describing the geometry of the articular surfaces of the carpal bones. Geometric data included the locations of several points located on the articular surfaces forming the radio-scaphoid and radio-lunate joints. The SDA axes describing the motions of the capitate or the lunate or the scaphoid with respect to the radius during flexion-extension were found almost parallel to the medial-lateral direction. Translations along any SDA did not exceed 2 mm. One can thus consider the motion of each carpal bone as a pure rotation about a screw axis. Also, the SDA axis describing the motion of the capitate with respect to the radius was found to pass through the proximal end of the capitate. The graphical display of carpal motions shows that, as the wrist is flexed, the surface of the lunate within the radio-lunate articulation moves from palmar to dorsal. On the other hand, the palmar-dorsal location of the proximal surface of the scaphoid within the radio-scaphoid articulation remains almost unchanged.

Biomechanical Phenomena↗
PubMed1993

A three-dimensional anatomical model of the human patello-femoral joint, for the determination of patello-femoral motions and contact characteristics.

The object of this study is to develop a three-dimensional mathematical model of the patello-femoral joint, which is modelled as two rigid bodies representing a moving patella and a fixed femur. Two-point contact was assumed between the femur and patella at the medial and lateral sides and in the analysis, the femoral and patellar articular surfaces were mathematically represented using Coons' bicubic surface patches. Model equations include six equilibrium equations and eleven constraints: six contact conditions, four geometric compatibility conditions, and the condition of a rigid patellar ligament; the model required the solution of a system of 17 nonlinear equations in 17 unknowns, its response describing the six-degrees-of-freedom patellar motions and the forces acting on the patella. Patellar motions are described by six motion parameters representing the translations and rotations of the patella with respect to the femur. The forces acting on the patella include the medial and lateral component of patello-femoral contact and the patellar ligament force, all of which were represented as ratios to the quadriceps tendon force. The model response also includes the locations of the medial and lateral contact points on the femur and the patella. A graphical display of its response was produced in order to visualize better the motion of the components of the extensor mechanism. Model calculations show good agreement with experimental results available from the literature. The patella was found to move distally and posteriorly on the femoral condyles as the knee was flexed from full extension. Results indicate that the relative orientation of the patellar ligament with respect to the patella remains unchanged during this motion. The model also predicts a patellar flexion which always lagged knee flexion. Our calculations show that as the angle of knee flexion increased, the lateral contact point moved distally on the femur without moving significantly either medially or laterally. The medial contact point also moved distally on the femur but moved medially from full extension to about 40 degrees of knee flexion, then laterally as the knee flexion angle increased. The lateral contact point on the patella did not change significantly in the medial and lateral direction as the knee was flexed; however, this point moved proximally toward the basis of the patella with knee flexion. The medial contact point also moved proximally on the patella with knee flexion, and in a similar manner the medial contact point on the patella moved distally with flexion from full extension to about 40 degrees of flexion.(ABSTRACT TRUNCATED AT 400 WORDS)

Biomechanical Phenomena↗
PubMed1993

A two-dimensional dynamic anatomical model of the human knee joint.

The objective of this study is to develop a two-dimensional dynamic model of the knee joint to simulate its response under sudden impact. The knee joint is modeled as two rigid bodies, representing a fixed femur and a moving tibia, connected by 10 nonlinear springs representing the different fibers of the anterior and posterior cruciate ligaments, the medial and lateral collateral ligaments, and the posterior part of the capsule. In the analysis, the joint profiles were represented by polynomials. Model equations include three nonlinear differential equations of motion and three nonlinear algebraic equations representing the geometric constraints. A single point contact was assumed to exist at all times. Numerical solutions were obtained by applying Newmark constant-average-acceleration scheme of differential approximation to transform the motion equations into a set of nonlinear simultaneous algebraic equations. The equations reduced thus to six nonlinear algebraic equations in six unknowns. The Newton-Raphson iteration technique was then used to obtain the solution. Knee response was determined under sudden rectangular pulsing posterior forces applied to the tibia and having different amplitudes and durations. The results indicate that increasing pulse amplitude and/or duration produced a decrease in the magnitude of the tibio-femoral contact force, indicating thus a reduction in the joint stiffness.(ABSTRACT TRUNCATED AT 250 WORDS)

Biomechanical Phenomena↗
PubMed1992

Effects of tibial rotations on patellar tracking and patello-femoral contact areas.

The object of this study is to determine the effect of tibial rotations on the three-dimensional patello-femoral motions and contact areas during a physiological loading condition, the knee-extension exercise. A commercially available device, the 3-SPACE digitizer and tracker system, was used to collect the motion data, utilizing cadaveric human lower limbs as well as the geometric measurements describing the articular surfaces at the patello-femoral joint. It was found that tibial rotations caused statistically significant differences, at the 0.05 level, in patellar tilt, patellar rotation and patellar medial-lateral shift. It was also found that while the magnitude of the total contact area at a given knee flexion angle did not change significantly with tibial rotations, medial and lateral components of the total contact areas were affected by tibial rotations. Medical femoral contact areas increased with internal tibial rotations at all flexion angles; lateral femoral contact areas increased with external tibial rotations at all flexion angles. This correlates well with the kinematic data since it was found that the patella shifted medially with internal tibial rotations at all flexion angles, and titled more medially near full-extension causing an increase in the medial contact areas and a decrease in the lateral contact areas.

Biomechanical Phenomena↗
PubMed1992

A three-dimensional morphometrical study of the distal human femur.

The objective of this paper is to present a method to describe the three-dimensional variations of the geometry of the three portions forming the distal part of the human femur: the medial and lateral femoral condyles and the intercondylar fossa. The contours of equally spaced sagittal slices were digitized on the distal femur to determine its surface topography. Data collection was performed using a digitizer system which utilizes low-frequency, magnetic field technology to determine the position and orientation of a magnetic field sensor in relation to a specified reference frame. The generalized reduced gradient optimization method was used to reconstruct the profile of each slice utilizing two primitives: straight-line segments and circular arcs. The profile of each slice within the medial femoral condyle was reconstructed using two circular arcs: posterior and distal. The profile of each slice within the lateral femoral condyle was reconstructed using three circular arcs: posterior, distal and anterior. Finally, the profile of each slice within the intercondylar fossa was reconstructed using two circular arcs: proximal-posterior and anterior, and a distal-posterior straight-line segment tangent to the proximal-posterior circular arc. Combining the data describing the profiles of the different slices forming the distal femur, the posterior portions of each of the medial and lateral femoral condyles were modelled using parts of spheres having an average radius of 20 mm. The anterior portion of the lateral condyle was approximated to a right cylinder having its circular base parallel to the sagittal plane with an average radius of 26 mm. The anterior portion of the intercondylar fossa was modelled using an oblique cylinder having its circular base parallel to the sagittal plane with an average radius of 22 mm. Furthermore, it is suggested that the distal portion of the lateral femoral condyle could be modelled using parts of two oblique cones while the distal portion of the medial femoral condyle could be modelled using a part of a single oblique cone, all cones having their circular bases parallel to the sagittal plane. It is also suggested that the posterior portion of the intercondylar fossa could be modelled using two oblique cones: a proximal cone having its base parallel to the sagittal plane and a distal cone having its base parallel to the frontal plane.

Femur↗
PubMed1990

Anterior cruciate ligament replacements: a mechanical study of femoral attachment location, flexion angle at tensioning, and initial tension.

We examined three surgical variables that affect the ability of an anterior cruciate ligament replacement to restore the limit of anterior tibial translation. These were the placement site of the substitute on the femur, the initial tension applied to the replacement, and the flexion angle of the knee at the time of tensioning. An anterior load of 100 N was applied to the tibia. As the knee was flexed, we measured the tensile force in the substitute and the anteroposterior position of the femur relative to the tibia. Placement largely determined whether the force in the replacement increased or decreased with flexion. Placement also largely determined whether the tibia moved anteriorly or posteriorly with flexion compared to its position in the intact knee. The initial tension and the flexion angle at tensioning affected the magnitude of force in the substitute and the magnitude of the change in AP position. They did not affect how force and AP position changed with flexion. Greater increases in force and greater posterior shifts in tibial position were produced by changing the flexion angle at tensioning from 0 degrees to 30 degrees than by increasing the initial tension from 22 to 44 N.

Adult↗
PubMed1986

Sensitivity of insertion locations on length patterns of anterior cruciate ligament fibers.

A technique is demonstrated, employing an instrumented spatial linkage, for the determination of the length patterns of discrete fiber bundles within a ligament under controlled loading conditions. The instrumented spatial linkage was used to measure the three-dimensional joint motion. The linkage was also used as a three-dimensional coordinate digitizer to determine the spatial location of bony landmarks and the ligament's insertion areas. The length of pseudo fiber bundles was determined as the straight line distance between bone attachments. A comparison is presented, showing good agreement, between elongation patterns obtained from this method and those measured using an instrumented fine wire cable fiber. A sensitivity analysis was performed to evaluate the influence of tibial and femoral attachment location on the length pattern of fiber bundles of the anterior cruciate ligament. It was found that the relationship between fiber elongation and knee flexion depended strongly on the fibers femoral attachment location but not on its tibial attachment location.

Bone and Bones↗
PubMed1984

Strain topography of human tendon and fascia.

Discretized surface strains for human tendon and fascia were photogrammetrically determined with high-speed cinematography and were displayed topographically using three-dimensional computer graphics. Substantial differences were found between estimates of tissue strain measured from grip motion versus discretized strain estimates from high-speed films. The computer-generated contour maps also provide a useful technique for analyzing the nonhomogeneity of tendon and fascial strains during high rate tests.

Adult↗
PubMed1984

Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions.

Virtually all types of collagenous tissues have been transferred in and around the knee joint for intra-articular and extra-articular ligament reconstructions. However, the mechanical properties (in particular, strength) of such grafts have not been determined in tissues from young adult donors, where age and disuse-related effects have been excluded. To provide this information, we subjected ligament graft tissues to high-strain-rate failure tests to determine their strength and elongation properties. The results were compared with the mechanical properties of anterior cruciate ligaments from a similar young-adult donor population. The study indicated that some graft tissues used in ligament reconstructions are markedly weak and therefore are at risk for elongation and failure at low forces. Grafts utilizing prepatellar retinacular tissues (as in certain anterior-cruciate reconstructions) and others in which a somewhat narrow width of fascia lata or distal iliotibial tract is utilized are included in this at-risk group. Wider grafts from the iliotibial tract or fascia lata would of course proportionally increase ultimate strength. The semitendinosus and gracilis tendons are stronger, having 70 and 49 per cent, respectively, of the initial strength of anterior cruciate ligaments. The bone-patellar tendon-bone graft (fourteen to fifteen millimeters wide, medial or central portion) was the strongest, with a mean strength of 159 to 168 per cent of that of anterior cruciate ligaments. Patellar tendon-bone units, based on grip-to-grip motions, were found to be three to four times stiffer than similarly gripped anterior cruciate ligaments, while gracilis and semitendinosus tendon preparations had values that were nearly identical to those of anterior cruciate ligaments.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗