Strain measurement at the knee ligament insertion sites

We describe the modification of an existing method of ligament strain measurement at the knee joint in detail. At ten fresh joint specimens we used that technique where strain gauges are attached to the ligamentous insertions and origins. We both improved the preparation of the attachment site and the application of the strain gauges. In a special apparatus the specimens were moved from 0degrees extension to 100degrees flexion while simulating muscle strength and axial force. Testing was performed at the posterior cruciate ligament with both intact and transsected anterior cruciate ligament. In contrast to other existing techniques it does not affect the motion of the joint or the integrity and the function of the ligaments. Unlike the original description of that method we could register a loading behaviour of the posterior cruciate ligament that is similar to those reported in the literature

Non-invasive computer-assisted measurement of knee alignment

The quantification of knee alignment is a routine part of orthopaedic practice and is important for monitoring disease progression, planning interventional strategies, and follow-up of patients. Currently available technologies such as radiographic measurements have a number of drawbacks. The aim of this study was to validate a potentially improved technique for measuring knee alignment under different conditions. An image-free navigation system was adapted for non-invasive use through the development of external infrared tracker mountings. Stability was assessed by comparing the variance (F-test) of repeated mechanical femoro-tibial (MFT) angle measurements for a volunteer and a leg model. MFT angles were then measured supine, standing and with varus-valgus stress in asymptomatic volunteers who each underwent two separate registrations and repeated measurements for each condition. The mean difference and 95% limits of agreement were used to assess intra-registration and inter-registration repeatability. For multiple registrations the range of measurements for the external mountings was 1° larger than for the rigid model with statistically similar variance (p=0.34). Thirty volunteers were assessed (19 males, 11 females) with a mean age of 41 years (range: 20-65) and a mean BMI of 26 (range: 19-34). For intra-registration repeatability, consecutive coronal alignment readings agreed to almost ±1°, with up to ±0.5° loss of repeatability for coronal alignment measured before and after stress maneuvers, and a ±0.2° loss following stance trials. Sagittal alignment measurements were less repeatable overall by an approximate factor of two. Inter-registration agreement limits for coronal and sagittal supine MFT angles were ±1.6° and ±2.3°, respectively. Varus and valgus stress measurements agreed to within ±1.3° and ±1.1°, respectively. Agreement limits for standing MFT angles were ±2.9° (coronal) and ±5.0° (sagittal), which may have reflected a variation in stance between measurements. The system provided repeatable, real-time measurements of coronal and sagittal knee alignment under a number of dynamic, real-time conditions, offering a potential alternative to radiographs

Trends of mechanical consequences and modeling of a fibrous membrane around femoral hip prostheses

In the present study, the effects of a fibrous membrane between cement and bone in a femoral total hip replacement were investigated. The study involved the problem of modeling this fibrous membrane in finite-element analyses, and its global consequences for the load-transfer mechanism and its resulting stress patterns. A finite-element model was developed, suitable to describe nonlinear contact conditions in combination with nonlinear material properties of the fibrous membrane. The fibrous tissue layer was described as a highly compliant material with little resistance against tension and shear. The analysis showed that the load transfer mechanism from stem to bone changes drastically when such a membrane is present. These effects are predominantly caused by tensile loosening and slip at the interface, and are enhanced by the nonlinear membrane characteristics.\ud \ud Using parametric analysis, it was shown that these effects on the load-transfer mechanism cannot be described satisfactorily with linear elastic models.\ud \ud Most importantly, the fibrous tissue interposition causes excessive stress concentrations in bone and cement, and relatively high relative displacements between these materials

Effect of axial tibial torque direction on ACL relative strain and strain rate in an in vitro simulated pivot landing

Anterior cruciate ligament (ACL) injuries most frequently occur under the large loads associated with a unipedal jump landing involving a cutting or pivoting maneuver. We tested the hypotheses that internal tibial torque would increase the anteromedial (AM) bundle ACL relative strain and strain rate more than would the corresponding external tibial torque under the large impulsive loads associated with such landing maneuvers. Twelve cadaveric female knees [mean (SD) age: 65.0 (10.5) years] were tested. Pretensioned quadriceps, hamstring, and gastrocnemius muscle‐tendon unit forces maintained an initial knee flexion angle of 15°. A compound impulsive test load (compression, flexion moment, and internal or external tibial torque) was applied to the distal tibia while recording the 3D knee loads and tibofemoral kinematics. AM‐ACL relative strain was measured using a 3 mm DVRT. In this repeated measures experiment, the Wilcoxon signed‐rank test was used to test the null hypotheses with p  < 0.05 considered significant. The mean (±SD) peak AM‐ACL relative strains were 5.4 ± 3.7% and 3.1 ± 2.8% under internal and external tibial torque, respectively. The corresponding mean (± SD) peak AM‐ACL strain rates reached 254.4 ± 160.1%/s and 179.4 ± 109.9%/s, respectively. The hypotheses were supported in that the normalized mean peak AM‐ACL relative strain and strain rate were 70 and 42% greater under internal than under external tibial torque, respectively ( p  = 0.023, p  = 0.041). We conclude that internal tibial torque is a potent stressor of the ACL because it induces a considerably (70%) larger peak strain in the AM‐ACL than does a corresponding external tibial torque. © 2011 Orthopaedic Research Society. © 2011 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 30:528–534, 2012Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/90222/1/21572_ftp.pd

The Coming of Iron in a Comparative Perspective

The paper deals with the introduction of iron as a new raw material in the transition period between the outgoing Bronze Age and the Early Iron Age. Objective of the paper is to introduce the interdisciplinary research group A5: Iron as a new raw material of the Excellence Cluster Topoi. The Formation and Transformation of Space and Knowledge in Ancient Civilizations. After a short overview of the history of the spread of iron technology after the decline of the Hittite empire, the central research categories of the group: space, knowledge, innovation and resource are introduced. The interdisciplinary composition of the group enables the integration of different methodological approaches from the archaeological sciences, ancient oriental studies and physical geography. Furthermore, the spatio-temporal potentials and limitations of the single disciplinary methodological approaches are discussed and a brief overview of the regions under investigation is given. The introduction of iron as a new raw material is in detail presented in the light of two case study regions: the Ancient Orient and the Teltow region

The role of co-morbidity in the selection of antidiabetic pharmacotherapy in type-2 diabetes

Metformin is, if not contraindicated and if tolerated, usually preferred over other antidiabetic drugs for the first line treatment of type-2 diabetes. The particular decision on which antidiabetic agent to use is based on variables such as efficacy, cost, potential side effects, effects on weight, comorbidities, hypoglycemia, risk, and patient preferences. However, there is no guidance how to consider these in the selection of antidiabetic drug treatment. In this work, we aimed to summarize available evidence and tried to give pragmatic treatment recommendations from a clinical practice perspective. There are clear contraindications for some drugs in those with impaired renal and liver function and precautions in those with heart failure for the use of metformin (NYHA III-IV) and glitazones. On the other hand, GLP-1 analogs, DPP-4 inhibitors and acarbose are generally less critical and can be used in the majority of patients. We identified the following gaps with respect to the selection of antidiabetic drug treatment in patients with co-morbid disease conditions: 1) Guidelines fail to give advice on the use of specific antidiabetic drugs in patients with co-morbidity. 2) The literature is deficient in studies documenting antidiabetic drug use in patients with severely impaired renal function, diabetic retinopathy, cerebrovascular disease and systolic heart failure. 3) Further there are no specific data on patients with multiple of these co-morbid disease conditions. We postulate that differential use of antidiabetic drugs in patients with co-morbid disease constellations will help to reduce treatment related complications and might improve prognosis

Effects of a prophylactic knee sleeve on anterior cruciate ligament loading during sport specific movements

CONTEXT: Prophylactic knee bracing is extensively utilized in athletic populations, to reduce the high risk from knee injuries, but their role in the attenuation of anterior cruciate ligament (ACL) pathologies is not well understood. OBJECTIVE: The aim of the current investigation was to investigate the effects of a prophylactic knee sleeve on ACL loading parameters linked to the aetiology of injury in recreational athletes. SETTING: Laboratory. DESIGN: Repeated measures. PARTICIPANTS: Thirteen healthy male recreational athletes. Intervention Participants performed run, cut and single leg hop movements under two conditions; prophylactic knee sleeve and no-sleeve. MAIN OUTCOME MEASURES: Biomechanical data was captured using an eight-camera 3D motion capture system and a force platform. Peak ACL force, average ACL load rate and instantaneous ACL load rate were quantified using a musculoskeletal modelling approach. RESULTS: The results showed that both average and instantaneous ACL load rates were significantly reduced when wearing the knee sleeve in the hop (sleeve = 612.45/ 1286.39N/kg/s & no-sleeve = 743.91/ 1471.42 N/kg/s) and cut (sleeve = 222.55/ 1058.02 N/kg/s & no-sleeve = 377.38/ 1183.01 N/kg/s) movements. CONCLUSIONS: Given the biomechanical association between ACL loading and the aetiology of ACL injuries, it is proposed that athletes may be able to attenuate their risk from injury during cut and hop movements through utilization of a prophylactic knee sleeve

Peripheral Electrical and Magnetic Stimulation to Augment Resistance Training

Electrical stimulation (ES) and magnetic stimulation (MS), applied peripherally, may be used to elicit muscle contractions to increase muscle hypertrophy, increase muscle strength and reduce knee laxity in rehabilitation following injury. We aimed to examine the effect of a three-week exercise programme designed to induce muscle hypertrophy augmented by peripheral ES and MS. We hypothesised that the use of peripheral stimulation to augment voluntary drive during a resistance-training protocol would induce more repetitions thus leading to increased thigh circumference, muscle layer thickness, and quadriceps strength whilst decreasing knee laxity. Thirty healthy participants were divided randomly into either ES, MS or Control groups. Five resistance training sessions were carried out, consisting of four sets of quadriceps extensions. During the first three sets the participants performed eight repetitions at 85% of their 1-repetition maximum (1-RM). On the last set, the participants were instructed to perform the exercise until failure. The augmentation of peripheral stimuli allowed the MS and ES groups to continue to exercise producing, on average, 4 ± 2 and 7 ± 6 additional repetitions with ES and MS, respectively. Following the training, significant increases were observed for both 1-RM (p = 0.005) and muscle layer thickness (p = 0.031) whilst no change was observed in thigh circumference (p = 0.365). Knee laxity decreased (p = 0.005). However, there were no significant differences in the stimulation groups compared with control for any of these measurements. The additional repetitions elicited by stimulation after the point of failure suggests that peripheral electrical and/or magnetic stimulation may be useful as an adjunct for resistance training. However, this effect of resistance training augmented by peripheral stimulation on hypertrophy, strength and knee laxity may be small

Receding-Horizon Control of Constrained Switched Systems with Neural Networks as Parametric Function Approximators

Gefördert im Rahmen des Projekts DEA