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Biomedical subjects

S M Howell

Publications and source records attributed to S M Howell.

At least 19 recordsLinked to original sources
PubMed2006

Does a tensioning device pinned to the tibia improve knee anterior-posterior load-displacement compared to manual tensioning of the graft following anterior cruciate ligament reconstruction? A cadaveric study of two tibial fixation devices.

Devices that are pinned to the tibia to tension an anterior cruciate ligament (ACL) graft produce joint reaction loads that in turn can affect the maintenance of graft initial tension after tibial fixation and hence knee anterior-posterior (AP) load-displacement. However, the effect of these devices on AP load-displacement is unknown. Our objectives were to determine whether tensioning by device versus tensioning by hand causes differences in AP load-displacement and intraarticular graft tension for two commonly used tibial fixation devices: a bioresorbable interference screw and a WasherLoc. AP load-displacement and intraarticular graft tension were measured in 20 cadaveric knees using a custom arthrometer. An initial tension of 110 N was applied to a double-looped tendon graft with the knee at extension using a tensioning device pinned to the tibia and a simulated method of tensioning by hand. After inserting the tibial fixation device, the 134 N anterior limit (i.e., anterior position of the tibia with respect to the femur with a 134 N anterior force applied to the tibia) and 0 N posterior limit (i.e., AP position of the tibia relative to the femur with a 0 N force applied to the tibia) were measured with the knee in 25 degrees flexion. Intraarticular graft tension was measured at extension. These limits and intraarticular graft tension were also measured after cyclically loading the knee 300 times. Compared to a simulated method of tensioning by hand, tensioning with a device pinned to the tibia did not decrease the 134 N anterior limit and did not cause posterior tibial translation. However, intraarticular graft tension was maintained better with a tensioning device pinned to the tibia for the Washerloc, but not the interference screw. For two commonly used tibial fixation devices, a tensioning device pinned to the tibia does not improve AP load-displacement at 25 degrees flexion over tensioning by hand when the graft is tensioned at full extension, but does improve the maintenance of intraarticular graft tension for the Washerloc.

Absorbable Implants↗
PubMed2006

Lengthening of a single-loop tibialis tendon graft construct after cyclic loading: a study using Roentgen stereophotogrammetric analysis.

Although single-loop tibialis tendon allografts have increased in popularity owing to their many advantages over patellar tendon and double-loop hamstring tendon autografts, some percentage of the patient population do not have clinically stable knees following anterior cruciate ligament reconstruction with single-loop tibialis tendon allografts. Therefore, it would be advantageous to determine the causes of increased anterior laxity which ultimately must be traced to lengthening of the graft construct. One objective of this study was to demonstrate the feasibility of using Roentgen stereophotogrammetric analysis (RSA) to determine the causes of lengthening of a single-loop graft construct subjected to cyclic loading. A second objective was to determine which cause(s) contributes most to an increase in length of this graft construct. Radio-opaque markers were inserted into ten grafts to measure the lengthening at the sites of the tibial and femoral fixations and between the sites of fixation. Each graft was passed through a tibial tunnel in a calf tibia, looped around a rigid cross-pin, and fixed to the tibia with a Washerloc fixation device. The grafts were cyclically loaded for 225,000 cycles from 20 to 170 N. Prior to and at intervals during the cyclic loading, simultaneous radiographs were taken. RSA was used to determine the three-dimensional coordinates of the markers from which the lengthening at the sites of fixation and between the sites of fixation was computed at each interval. The sites of the femoral and tibial fixations were the largest contributors to the increase in length of the graft construct, with maximum average values of 0.68 and 0.55 mm, respectively, after 225,000 cycles. The graft substance between the sites of fixation contributed least to lengthening of the graft, with a maximum average value of 0.31 mm. Ninety percent of the maximum average values occurred before 100,000 cycles of loading for the largest contributors. RSA proved to be a useful method for measuring lengthening due to all three causes. Lengthening of the graft construct at the sites of both fixations is sufficiently large that the combined contributions may manifest as a clinically important increase in anterior laxity.

Animals↗
PubMed2006

Empirical relationship between lengthening an anterior cruciate ligament graft and increases in knee anterior laxity: a human cadaveric study.

Lengthening of an anterior cruciate ligament (ACL) graft construct can occur as a result of lengthening at the sites of tibial and/or femoral fixation and manifests as an increase in anterior laxity. Although lengthening at the site of fixation has been measured for a variety of fixation devices, it is difficult to place these results in a clinical context because the mathematical relationship between lengthening of an ACL graft construct and anterior laxity is unknown. The purpose of our study was to determine empirically this relationship. Ten cadaveric knees were reconstructed with a double-looped tendon graft. With the knee in 25 degrees of flexion, the position of the proximal end of the graft inside the femoral tunnel was adjusted by moving the femoral fixation device until the anterior laxity at an applied anterior force of 134 N matched that of the intact knee. In random order, the graft construct was lengthened 1, 2, 3, 4, and 5 mm by moving the femoral fixation device distally along the femoral tunnel and anterior laxity was measured. The increase in the length of the graft construct was related to the increase in anterior laxity by a simple linear regression model. Lengthening the graft construct from 1 to 5 mm caused an equal increase in anterior laxity (slope=1.0 mmmm, r(2)=0.800, p<0.0001). Because an anterior laxity increase of 3 mm or greater in a reconstructed knee is considered unstable clinically and because many fixation devices in widespread use clinically allow 3 mm or greater of lengthening in in vitro tests, our empirical relationship indicates that lengthening at the site of fixation probably is an important cause of knee instability following ACL reconstructive surgery. Our empirical relation also indicates that an important criterion in the design of future fixation devices is that lengthening at the sites of fixation in in vitro tests should be limited to less than 3 mm.

Aged↗
PubMed2005

Tension in a double loop tendon anterior cruciate graft during a simulated open chain knee extension exercise.

Concerns exist regarding the tension developed in a reconstructed anterior cruciate ligament (ACL) during open chain knee extension exercises used to rehabilitate the knee. Therefore, the primary objective was to measure tension in an ACL graft during a simulated open chain knee extension exercise as a function of ankle weight. A secondary objective was to determine whether the graft tension was reduced with relatively high stiffness fixation. The open chain exercise was simulated in seven cadaveric specimens in which the ACL had been reconstructed with double loop tendon grafts. Graft tension was measured at 15 degrees of flexion as the effective ankle weight was increased from 22.5 to 67.5 and then to 112.5 N for three different fixation stiffnesses (25, 125, and 225 N/mm). The initial tension was set to restore the 225 N anterior limit of motion to that of the intact knee at 30 degrees of flexion. Increasing the ankle weight caused the graft tension to increase significantly (p<0.0001), but the increase with the highest ankle weight was only 62 N on average. Increasing the fixation stiffness caused the graft tension to decrease significantly (p<0.0001) because the initial tension decreased by 107 N as the fixation stiffness increased. Because the graft tension with the highest ankle weight was limited to 112 N on average, high stiffness fixation methods, which are also resistant to lengthening in the region of the fixation, may reduce the risk of graft construct lengthening during open chain knee extension exercises.

Aged↗
PubMed2005

A new tibial coordinate system improves the precision of anterior-posterior knee laxity measurements: a cadaveric study using Roentgen stereophotogrammetric analysis.

Roentgen stereophotogrammetric analysis (RSA) can be used to measure changes in anterior-posterior (A-P) knee laxity after anterior cruciate ligament (ACL) reconstruction. Previous measurements of A-P knee laxity using RSA have employed a tibial coordinate system with the origin placed midway between the tips of the tibial-eminences. However, the precision in measuring A-P knee laxity might be improved if the origin was placed on the flexion-extension axis of rotation of the knee. The purpose of this study was to determine whether a center-of-rotation tibial coordinate system with the origin placed midway between the centers of the posterior femoral condyles, which closely approximates the flexion-extension center-of-rotation of the knee, improves the precision in measuring A-P knee laxity compared to the tibial-eminence-based coordinate system. A-P knee laxity was measured using each coordinate system six times in three human cadaveric knees implanted with 0.8-mm diameter tantalum markers. For each laxity measurement, the knee was placed in a custom loading apparatus and biplanar radiographs were obtained while the knee resisted a 44 N posterior shear force and 136 N anterior shear force. A-P knee laxity was determined from the change in position of the tibia, with respect to the femur, resulting from the posterior and anterior shear forces. The precision for each coordinate system was calculated as the pooled standard deviation of A-P knee laxity measurements. The precision of the center-of-rotation coordinate system was 0.33 mm, which was about a factor of 2 better than the 0.62 mm precision of the tibial-eminence coordinate system (p=0.006). The 0.33 mm precision with the center-of-rotation coordinate system suggests that an observed change of either 0.56 mm (i.e. 1.7 standard deviations) or greater in A-P knee laxity over time is a real change and not due to measurement error when the new tibial coordinate system is used and other factors contributing to variability are controlled as was done in this study. Accordingly, clinicians and researchers should consider the use of this alternate tibial coordinate system when making serial measurements of A-P knee laxity using RSA because the improved precision allows for the observation of smaller differences.

Adult↗
PubMed2005

Migration of radio-opaque markers injected into tendon grafts: a study using roentgen stereophotogrammetric analysis (RSA).

An increase in anterior laxity following reconstruction of the anterior cruciate ligament (ACL) can result from lengthening of the graft construct either at the sites of fixation and/or between the sites of fixation (i.e., graft substance). Roentgen stereophotogrammetric analysis (RSA), which requires that radio-opaque markers be attached to the graft, has been shown to be a useful technique in determining lengthening in these regions. Previous methods have been used for attaching radio-opaque markers to the graft, but they all have limitations particularly for single-loop grafts. Therefore, the objective of this study was to evaluate injecting markers directly into the substance of a tendon as a viable method for measuring lengthening of single-loop graft constructs by determining the maximum amount of migration after cyclic loading. Tantalum spheres of 0.8 mm diameter were used as tendon markers. Ten single-loop tendon grafts were passed through tibial tunnels drilled in calf tibias and fixed with a tibial fixation device. Two tendon markers were inserted in one tendon bundle of each graft and the grafts were cyclically loaded for 225,000 cycles from 20 N to 170 N. At specified intervals, simultaneous radiographs were obtained of the tendon markers. Marker migration was computed as the change in distance between the two tendon markers parallel to the axis of the tibial tunnel. Marker migration had a root mean square (RMS) value of less than 0.1 mm. Because the RMS value indicates the error introduced into measurements of lengthening and because this error is negligible, the method described for attaching markers to single-loop ACL grafts has the potential to be useful for determining lengthening of single-loop ACL graft constructs in in vivo studies in humans.

Animals↗
PubMed2004

How the fixation method stiffness and initial tension affect anterior load-displacement of the knee and tension in anterior cruciate ligament grafts: a study in cadaveric knees using a double-loop hamstrings graft.

There were two objectives to this study. The first was to investigate the relationship of graft fixation stiffness and graft initial tension on the anterior load-displacement behavior of knees reconstructed with a double-loop hamstrings tendon graft. The second was to determine the corresponding graft tensions at 225 N of anterior force applied to the knee. To satisfy these objectives, the anterior-load displacement curves were measured for seven cadaveric knees with the ACL intact at flexion angles ranging from 0 degrees to 90 degrees. The ACL was reconstructed in the same knees using a double-loop hamstrings graft. A/P load-displacement curves of the knee and graft tension were measured as the fixation method stiffness and the initial tension applied at full extension were varied (25-326 N/mm and 25-300 N). The 0 N posterior limit (unloaded position of tibia) and the anterior laxity (difference between the 0 N posterior limit and 225 N anterior limit) were computed to characterize the A/P load-displacement of the intact and reconstructed knees. The key results were that the 0 N posterior limit of the tibia was insensitive to changes in stiffness (p>0.6503) but that increasing initial tension caused increasing posterior subluxation of the tibia with respect to the femur (p=0.0001). The tibia was subluxed posteriorly by 5-6 mm on average at high levels of initial tension. Both initial tension and stiffness significantly affected the anterior laxity (p=0.0001 for both factors). Anterior laxity was restored closely to normal (i.e. <1 mm difference) by relatively high initial tension of 200 N in combination with low stiffness of 25 N/mm and by low initial tension of 25 N in combination with higher stiffness ranging between 94 and 326 N/mm. When anterior laxity is restored to normal using a high initial tension-low stiffness combination however, the tibia undergoes a large posterior subluxation with respect to the femur in the unloaded state (approximately 5 mm) and a relatively high graft tension of 275 N is developed at 225 N of anterior force. Both the tibial subluxation and graft tension are reduced substantially with low initial tension-higher stiffness combinations because the amount of initial tension required to restore anterior laxity to normal is reduced by about 200 N.

Aged↗
PubMed2004

Lengthening of double-looped tendon graft constructs in three regions after cyclic loading: a study using Roentgen stereophotogrammetric analysis.

Lengthening of a double-looped tendon graft construct used to reconstruct the anterior cruciate ligament (ACL) can result in an increase in anterior knee laxity and affect the stability of the reconstructed knee. Three possible regions where lengthening of the construct can occur are (1) the region of the tibial fixation, (2) the region of the femoral fixation, and (3) the region of the graft between the fixations. One objective of this study was to demonstrate the feasibility of using Roentgen stereophotogrammetric analysis (RSA) to determine the lengthening in each region of a double-looped graft construct subjected to cyclic loading. A second objective was to determine which region(s) contributes most to an increase in length of this graft construct. Radio-opaque markers were attached to ten grafts to measure the lengthening in each of the three regions. Each graft was passed through a tibial tunnel in a bovine tibia, looped around a rigid cross-pin, and fixed to the tibia with a Washerloc fixation device. The grafts were cyclically loaded for 225,000 cycles from 20 to 170 N. Prior to and at intervals during the cyclic loading, simultaneous radiographs were taken of the tibia and graft. RSA was used to determine the 3-dimensional coordinates of the markers from which the lengthening in each region was computed at each interval. The regions of the tibial and femoral fixations were the largest contributors to the increase in length of the graft, with maximum average values of 0.91 and 0.76 mm respectively after 225,000 cycles. The region between the fixations contributed least to lengthening of the graft, with a maximum average value of 0.23 mm. More than 90% of the lengthening in each region occurred before 100,000 cycles of loading. RSA proved to be a useful method for measuring lengthening in all three regions of the graft construct. Lengthening of the graft construct in both regions of fixation is sufficiently large that the combined contributions may cause a recurrence of instability in some knees.

Animals↗
PubMed2004

How cyclic loading affects the migration of radio-opaque markers attached to tendon grafts using a new method: a study using roentgen stereophotogrammetric analysis (RSA).

An increase in anterior laxity following reconstruction of the anterior cruciate ligament (ACL) can result from lengthening of the graft construct in either the regions of fixation and/or the region of the graft substance between the fixations. RSA could be a useful technique to determine lengthening in these regions if a method can be devised for attaching radio-opaque markers to soft tissue grafts so that marker migration from repeated loading of the graft is limited. Therefore, the objectives of this study were 1) to develop a method for attaching radio-opaque markers to an ACL graft that limits marker migration within the graft, 2) to characterize the error of an RSA system used to study migration, and 3) to determine the maximum amount of migration and the time when it occurs during cyclic loading of ACL grafts. Tendon markers were constructed from a 0.8-mm tantalum ball and a stainless steel suture. Ten double-looped tendon grafts were passed through tibial tunnels drilled in bovine tibias and fixed with a tibial fixation device. Two tendon markers were sewn to one tendon bundle of each graft and the grafts were cyclically loaded for 225,000 cycles from 20 N to 170 N. At specified intervals, simultaneous radiographs were obtained of the tendon markers and a radiographic standard of known length. The bias and imprecision in measuring the length of the radiographic standard were 0.0 and 0.046 mm respectively. Marker migration was computed as the change in distance between the two tendon markers along the axis of the tibial tunnel. Marker migration was greatest after 225,000 cycles with a root mean square (RMS) value of less than 0.2 mm. Because the RMS value indicates the error introduced into measurements of lengthening and because this error is small, the method described for attaching markers to an ACL graft has the potential to be useful for determining lengthening of ACL graft constructs in in vivo studies in humans.

Animals↗
PubMed2004

Initial tension and anterior load-displacement behavior of high-stiffness anterior cruciate ligament graft constructs.

BACKGROUND: Because the tension that exists in an anterior cruciate ligament graft when the knee is unloaded (the initial tension) affects the surgical outcome and because high initial tension has a number of adverse consequences, the primary purpose of this study was to determine quantitatively how much less initial tension was required for a high-stiffness construct than for a low-stiffness construct. A secondary purpose was to determine how the stiffness of the graft construct affects the anterior load-displacement behavior of the knee from 0 degrees to 90 degrees of flexion. METHODS: Anterior-posterior load-displacement was measured in each of ten intact cadaveric knee specimens, the anterior cruciate ligament was excised, and the anterior cruciate ligament was reconstructed with a double-loop bovine tendon graft. Graft constructs of different stiffness were created with use of six springs, ranging in stiffness from 25 to 275 N/mm to simulate the fixation stiffness. After adjusting the initial tension of the graft so that the anterior-posterior laxity of the reconstructed knee matched that of the intact knee, the 0-N posterior limit and the 225-N anterior limit were measured at 0 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion. RESULTS: The highest stiffness fixation (275 N/mm) required an average of 73 N of initial tension, which was more than three times less than the average of 242 N of initial tension required by the lowest stiffness fixation (25 N/mm). The 225-N anterior limit was overconstrained an average of 1.0 mm with the highest stiffness fixation (275 N/mm), which was 3.6 mm less than the overconstraint with the lowest stiffness fixation (25 N/mm). Likewise, the posterior limit was overconstrained an average of 2.6 mm with the highest stiffness fixation (275 N/mm), which was 3.8 mm less than the overconstraint with the lowest stiffness fixation (25 N/mm). CONCLUSIONS: The initial tension for a high-stiffness graft construct is more than three times less than that for a low-stiffness construct. The initial tension for a high-stiffness graft construct better restores both the 225-N anterior limit and the 0-N posterior limit to normal than the initial tension for a low-stiffness graft construct over the range of flexion from 0 degrees to 90 degrees.

Adult↗
PubMed2001

A method for quantifying the anterior load-displacement behavior of the human knee in both the low and high stiffness regions.

The anterior load-displacement behavior of the human knee with an intact ACL is characterized by a very low stiffness region initially and a high stiffness region that develops as anterior load is increased. Although this behavior has been well recognized for some time, a method for quantitatively describing the behavior in these two regions based on limits of motion at specific values of anterior/posterior force has not yet been developed. Thus, the purposes of this study were to describe and justify such a method for measuring the laxity and stiffness in both of these regions in the intact knee. Unique to this study, low stiffness and high stiffness laxities were computed based on three limits of motion for seven cadaveric knees tested at flexion angles ranging from 0 degrees to 90 degrees. Defining the reference position of the tibia relative to the femur, one limit was the 0 N posterior limit which was determined using a specially designed load cycle to reduce uncertainty in establishing a reference position. Defining the upper bound of the load-displacement curve, a second limit was the 225 N anterior limit. A third intermediate limit was the 45 N anterior limit, which was the load that represented the transition from the low stiffness to the high stiffness region. Stiffnesses corresponding to each of the two regions were computed using regression analysis and also estimated based on the laxities. Comparison between the computed and estimated stiffnesses demonstrated that the stiffnesses in both the low and high stiffness regions can be estimated reasonably accurately based on the laxities. Therefore, the 0 N posterior limit and the two laxities are the three quantities needed to describe the load-displacement behavior of the normal knee.

Aged↗
PubMed2001

Comparison of viscoelastic, structural, and material properties of double-looped anterior cruciate ligament grafts made from bovine digital extensor and human hamstring tendons.

Due to ready availability, decreased cost, and freedom from transmissible diseases in humans such as hepatitis and AIDS, it would be advantageous to use tendon grafts from farm animals as a substitute for human tendon grafts in in vitro experiments aimed at improving the outcome of anterior cruciate ligament (ACL) reconstructive surgery. Thus the objective of this study was to determine whether an anterior cruciate ligament (ACL) graft composed of two loops of bovine common digital extensor tendon has the same viscoelastic, structural, and material properties as a graft composed of a double loop of semitendinosus and gracilis tendons from humans. To satisfy this objective, grafts were constructed from each tissue source. The cross-sectional area was measured using an area micrometer, and each graft was then pulled using a materials testing system while submerged in a saline bath. Using two groups of tendon grafts (n = 10), viscoelastic tests were conducted over a three-day period during which a constant displacement load relaxation test was followed by a constant amplitude, cyclic load creep test (first day), a constant load creep test (second day), and an incremental cyclic load creep test (third day). Load-to-failure tests were performed on two different groups of grafts (n = 8). When the viscoelastic behavior was compared, there were no significant differences in the rate of load decay or the final load (relaxation test) and rates of displacement increase or final displacements (creep tests) (p > 0.115). To compare both the structural and material properties in the toe region (i.e., < 250 N) of the load-elongation curve, the tangent stiffness and modulus functions were computed from parameters used in an exponential model fit to the load (stress)-elongation (strain) data. Although one of the two parameters in the functions was different statistically, this difference translated into a difference of only 0.03 mm in displacement at 250 N of load. In the linear region (i.e., 50-75 percent of ultimate load) of the load-elongation curve, the linear stiffness of the two graft types compared closely (444 N/mm for bovine and 418 N/mm for human) (p = 0.341). At failure, the ultimate loads (2901 N and 2914 N for bovine and human, respectively) and the ultimate stresses (71.8 MPa and 65.6 MPa for bovine and human, respectively) were not significantly different (p > 0.261). The theoretical effect of any differences in properties between these two grafts on the results of two types of in vitro experiments (i.e., effect of surgical variables on knee laxity and structural properties of fixation devices) are discussed. Despite some statistical differences in the properties evaluated, these differences do not translate into important effects on the dependent variables of interest in the experiments. Thus the bovine tendon graft can be substituted for the human tendon graft in both types of experiments.

Animals↗
PubMed2001

In vivo calibration of a femoral fixation device transducer for measuring anterior cruciate ligament graft tension: a study in an ovine model.

Toward developing a transducer for measuring in vivo tension in anterior cruciate ligament grafts in humans, the objectives of this study were to determine the following: (1) whether the calibration of a previously reported femoral fixation device transducer (FDT) (Ventura et al., 1998) is affected by the presence of the graft when implanted in the tibial metaphysis of an ovine model, (2) whether the FDT remains calibrated at 4 weeks postoperatively, and (3) whether the biological incorporation of the graft occurs prior to a change in the FDT calibration. The FDT was implanted in the hind limb of five sheep using an extra-articular procedure. Both the proximal common digital extensor tendon (i.e., graft) and a Teflon-coated wire were looped around the FDT inside a tunnel in the tibial metaphysis. The FDT was calibrated on three occasions using the loop of wire: once intraoperatively before graft insertion, once intraoperatively after graft insertion, and once postoperatively after the animals had been sacrificed at 4 weeks. Following sacrifice, the load transmitted to the FDT by the graft was also determined. The FDT exhibited linear calibration intraoperatively both before and after graft insertion with an average error relative to the calibration before insertion of the graft of -4.6 percent of full-scale load (150 N) and this average relative error was not significantly different from zero (p = 0.183). After 4 weeks of implantation, the average relative percent error was -5.0 percent and was not significantly different from zero (p = 0.434) indicating that the FDT remained calibrated in the in vivo environment. Because only 15 percent of the graft tension was transmitted to the FDT after 4 weeks, biological incorporation of the graft preceded the loss of calibration. In light of these findings, the FDT offers the capability of measuring the intra-articular ACL graft tension in vivo in animal models and possibly humans before the biological bond develops and also of monitoring the formation and maturation of the biological bond between a graft and bone tunnel.

Animals↗
PubMed2000

Use of roentgenography and magnetic resonance imaging to predict meniscal geometry determined with a three-dimensional coordinate digitizing system.

To evaluate and improve on the procedures used by a tissue bank in selecting donor menisci for transplantation, this study was designed to fulfill four objectives: (a) define and quantify a set of independent parameters for describing the geometry of the medial and lateral menisci, (b) determine how well the sizing protocol of the tissue bank (i.e., two transverse roentgenographic measurements obtained from the injured knee or six transverse magnetic resonance imaging measurements obtained from the contralateral knee) predicts the four standard transverse parameters of the menisci, (c) determine if including one additional transverse roentgenographic measurement for each compartment improves the ability of roentgenograms to predict transverse meniscal parameters, and (d) determine if five magnetic resonance imaging measurements at three different meniscal cross sections of the contralateral knee predict the 15 standard cross-sectional parameters of the meniscus in the injured knee. A laser-based, noncontacting three-dimensional coordinate digitizing system was used to determine surface coordinates from which menisci were reconstructed in a computer. For each reconstructed meniscus, four parameters in the transverse plane and five cross-sectional parameters in each of three regions (i.e., anterior, middle, and posterior) were defined, yielding a set of 19 standard parameters to describe the geometry. Through a correlation analysis, these standard parameters were shown to be largely unrelated to one another, thus confirming that the parameters form an independent set describing the three-dimensional geometry of the menisci. The two roentgenographic measurements were poor predictors of transverse standard meniscal parameters, predicting only one of four standard parameters for the medial meniscus and none of four standard parameters for the lateral meniscus with coefficients of determination greater than or equal to 0.5. Including one additional roentgenographic measurement to the tissue bank protocol increased the number of standard transverse parameters predicted to three of four for the medial meniscus and two of four for the lateral meniscus. Magnetic resonance imaging was better than roentgenography for predicting the three-dimensional meniscal geometry. The transverse measurements from magnetic resonance imaging predicted three of four standard transverse parameters for the medial meniscus and all four for the lateral meniscus. With the addition of the cross-sectional measurements by magnetic resonance imaging, seven of 15 standard cross-sectional parameters were predicted for both the medial and lateral menisci. Assuming that a successful clinical outcome depends on how well an allograft matches the size and shape of the original meniscus, magnetic resonance imaging rather than roentgenography should be used for allograft size-matching by tissue banks.

Adult↗
PubMed2000

Is the circumferential tensile modulus within a human medial meniscus affected by the test sample location and cross-sectional area?

Quantifying the material properties of the human menisci is paramount to understanding their biomechanical functions within the knee. One important intrinsic material property governing the biomechanical functions of the meniscus is the circumferential tensile modulus. The purpose of this study was to determine if the circumferential tensile modulus of the human medial meniscus depends on the location and thickness of the sample tested. The following three hypotheses were tested: (a) the circumferential location (anterior, central, and posterior) does not significantly affect the tensile modulus, (b) the radial location (inner to outer) significantly affects the tensile modulus, and (c) the thickness (cross-sectional area) significantly affects the tensile modulus. Test samples, whose length was oriented in parallel with the circumferential collagen fibers, were collected from different circumferential and radial locations throughout 30 human medial menisci. Samples of three different thicknesses (0.5, 1.5, and 3.0 mm) were taken from three equal groups of 10 menisci (i.e., one thickness per group). The circumferential tensile modulus was measured under quasi-static loading. Statistical analysis showed no significant effect of the circumferential or radial location of the sample on the circumferential tensile modulus. This indicates that an overall circumferential tensile modulus may be calculated for the human medial meniscus by averaging the values determined at the various locations. However, the thickness of the test sample had a significant effect on the measured circumferential tensile modulus; the modulus varied inversely with the thickness. Thus, moduli determined from test samples that are too small in cross-sectional area overestimate the effective modulus of the tissue on the whole, and the cross-sectional area of the sample must be considered when determining a representative circumferential tensile modulus for the medial meniscus in a human knee.

Adult↗
PubMed2000

Static and fatigue strength of a fixation device transducer for measuring anterior cruciate ligament graft tension.

To determine which exercises do not overload the graft-fixation complex during intensive rehabilitation from reconstructive surgery of the anterior cruciate ligament (ACL), it would be useful to measure ACL graft loads during rehabilitative activities in vivo in humans. A previous paper by Ventura et al. (1998) reported on the design of an implantable transducer integrated into a femoral fixation device and demonstrated that the transducer could be calibrated to measure graft loads to better than 10 percent full-scale error in cadaveric knees. By measuring both the static and fatigue strengths of the transducer, the purpose of the present study was to determine whether the transducer could be safely implanted in humans without risk of structural failure. Eight devices were loaded to failure statically. Additionally, seven devices were tested using the up-and-down method to estimate the median fatigue strength at a life of 225,000 cycles. The average ultimate strength was 1856 +/- 74 N and the median fatigue strength was 441 N at a life of 225,000 cycles. The maximum graft load during normal daily activities is estimated to be 500 N and the 225,000 cycle life corresponds to that of the average healthy individual during a 12-week period. Considering that patients who have had an ACL reconstruction are less ambulatory than normal immediately following surgery and that biologic incorporation of the graft should be well developed by 12 weeks thus decreasing the load transmitted to the fixation device, the FDT can be safely implanted in humans without undue risk of structural failure.

Activities of Daily Living↗
PubMed1999

Contributions of femoral fixation methods to the stiffness of anterior cruciate ligament replacements at implantation.

One purpose of this study was to determine the stiffness of three femoral fixation methods used commonly in anterior cruciate ligament (ACL) reconstruction to secure a double-looped semitendinosus and gracilis (DLSTG) graft and then assess how the stiffness of these methods affects the stiffness of the young human femur-fixation method-graft complex at the time of reconstruction. A second purpose was to define principles for adjusting the stiffness of the ACL replacement (defined as the femoral fixation method plus DLSTG graft plus tibial fixation method) to match that of the native ACL. The stiffness of a DLSTG graft and the stiffness of the femur-fixation method-DLSTG graft complex for three endoscopic fixation methods were measured. Fixations of the DLSTG graft to a button, anchor, and post, both with and without compaction of bone, were tested in young, human femur. The stiffness of each fixation was calculated by modeling the DLSTG graft and fixation method as a series of springs. The stiffness of the DLSTG graft averaged 954+/-292 N/mm. The stiffness of the DLSTG graft-fixation complex was lowered fourfold to 40-fold by adding fixation. The method of fixation determined the reduction in stiffness. The stiffness of the femur-button-DLSTG graft complex averaged 23+/-2 N/mm, the femur-anchor-DLSTG graft complex averaged 25+/-3 N/mm, and the femur-post with bone graft-DLSTG graft complex averaged 225+/-23 N/mm (P = .0001). The knot in the suture loop was the least stiff component and determined the stiffness when the DLSTG graft was fixed with both the button and anchor. Compaction of bone significantly increased stiffness by an average of 41+/-14 N/mm (P = .027). Because the stiffness of femoral fixation methods are 4 to 40 times less than the stiffness of the graft, increasing the stiffness of an ACL replacement would be best achieved by selecting fixation methods with higher stiffness and not by either shortening the graft or increasing the cross-sectional area of the graft.

Adult↗