Analysis of Tibiofemoral Cartilage Deformation in the Posterior Cruciate Ligament-Deficient Knee

Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School, 55 Fruit Street, GRJ 1215, Boston, MA 02114, USA.
The Journal of Bone and Joint Surgery (Impact Factor: 5.28). 02/2009; 91(1):167-75. DOI: 10.2106/JBJS.H.00177
Source: PubMed


Degeneration of the tibiofemoral articular cartilage often develops in patients with posterior cruciate ligament deficiency, yet little research has focused on the etiology of this specific type of cartilage degeneration. In this study, we hypothesized that posterior cruciate ligament deficiency changes the location and magnitude of cartilage deformation in the tibiofemoral joint.
Fourteen patients with a posterior cruciate ligament injury in one knee and the contralateral side intact participated in the study. First, both knees were imaged with use of a specific magnetic resonance imaging sequence to create three-dimensional knee models of the surfaces of the bone and cartilage. Next, each patient performed a single leg lunge as images were recorded with a dual fluoroscopic system at 0 degrees, 30 degrees, 60 degrees, 75 degrees, 90 degrees, 105 degrees, and 120 degrees of knee flexion. Finally, the three-dimensional knee models and fluoroscopic images were used to reproduce the in vivo knee position at each flexion angle with use of a previously described image-matching method. With use of these series of knee models, the location and magnitude of peak tibiofemoral cartilage deformation at each flexion angle were compared between the intact contralateral and posterior cruciate ligament-deficient knees.
In the medial compartment of the posterior cruciate ligament-deficient knees, the location and magnitude of peak cartilage deformation were significantly changed, compared with those in the intact contralateral knees, between 75 degrees and 120 degrees of flexion, with a more anterior and medial location of peak cartilage deformation on the tibial plateau as well as increased deformation of the cartilage. In the lateral compartment, no significant differences in the location or magnitude of peak cartilage deformation were found between the intact and posterior cruciate ligament-deficient knees.
The altered kinematics associated with posterior cruciate ligament deficiency resulted in a shift of the tibiofemoral contact location and an increase in cartilage deformation in the medial compartment beyond 75 degrees of knee flexion. The magnitude of the medial contact shift in the posterior cruciate ligament-deficient knee was on the same order as that of the anterior contact shift.

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Available from: Samuel K Van de Velde, Apr 15, 2014
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    • "The results from this study show that in subjects in chronic PCL injuries the contralateral knee maintains a similar articulation profile to a healthy knee suggesting there is no adaptation. This is an important finding as abnormal articulation in the medial compartment has been associated with increased chondral and meniscal deformation forces[10]. "
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    ABSTRACT: The aim of the present study was to compare the in vivo articulation of the healthy knee to the contralateral knee of subjects with acute and chronic PCL injuries. Magnetic resonance was used to generate sagittal images of 10 healthy knees and 10 knees with isolated PCL injuries (5 acute and 5 chronic). The subjects performed a supine leg press against a 150 N load. Images were generated at 15 degree intervals as the knee flexed from 0 to 90 degrees. The tibiofemoral contact (TFC), and the centre of the femoral condyle (as defined by the flexion facet centre (FFC)), were measured from the posterior tibial cortex. There was no significant difference in the TFC and FFC between the healthy knee and contralateral knee of subjects with acute and chronic PCL injuries in the medial and lateral compartments of the knee. The findings of this study suggest there is no predisposing articulation abnormality to PCL injury, in the setting of chronic injury the contralateral knee does not modify its articulation profile and the contralateral knee can be used as a valid control when evaluating the articulation of the PCL deficient knee.
    Full-text · Article · Mar 2012 · Journal of Orthopaedic Surgery and Research
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    • "Short-term results of nonoperative treatment have been reported successful in many studies. However, there are studies showing unfavorable long-term results including degeneration of the tibiofemoral cartilage in the medial compartment and increased tibiofemoral pressure and meniscal strain25-27), which eventually led to arthritis. In the study of Dejour et al.28), osteoarthritis occurred eventually in the patients in whom the isolated rupture of the PCL was functionally well tolerated for 3 to 18 months. "
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    ABSTRACT: Posterior cruciate ligament (PCL) injuries associated with multiple ligament injuries can be easily diagnosed, but isolated PCL tears are less symptomatic, very difficult to diagnose, and frequently misdiagnosed. If a detailed investigation of the history of illness suggests a PCL injury, careful physical examinations including the posterior drawer test, dial test, varus and valgus test should be done especially if the patient complains of severe posterior knee pain in >90° of flexion. Vascular assessment and treatment should be done to avoid critical complications. An individualized treatment plan should be established after consideration of the type of tear, time after injury, associated collateral ligament injuries, bony alignment, and status of remnant. The rehabilitation should be carried out slower than that after anterior cruciate ligament reconstruction.
    Full-text · Article · Sep 2011
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    • "In response to physiologic loading, knee cartilage deforms, and resulting strain magnitudes vary with joint location and tissue depth. Following various physical activities such as knee bending, impact loading, and running, cartilage compresses ~3-20% of the overall thickness (Eckstein, et al., 2006, Kersting, et al., 2005, Van De Velde, et al., 2009) with compression typically being higher in tibial than femoral cartilage (Eckstein, et al., 2006, Kersting, et al., 2005). Such differences in deformation between cartilage regions reflect differences in stiffness, with femoral cartilage being stiffer than tibial cartilage (Lyyra, et al., 1999). "
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    ABSTRACT: During knee movement, femoral cartilage articulates against cartilage from the tibial plateau, and the resulting mechanical behavior is yet to be fully characterized. The objectives of this study were to determine (1) the overall and depth-varying axial and shear strains and (2) the associated moduli, of femoral and tibial cartilages during the compression and shearing of apposing tibial and femoral samples. Osteochondral blocks from human femoral condyles (FCs) characterized as normal and donor-matched lateral tibial plateau (TP) were apposed, compressed 13%, and subjected to relative lateral motion. When surfaces began to slide, axial (-E(zz)) and shear (E(xz)) strains and compressive (E) and shear (G) moduli, overall and as a function of depth, were determined for femoral and tibial cartilages. Tibial -E(zz) was approximately 2-fold greater than FC -E(zz) near the surface (0.38 versus 0.22) and overall (0.16 versus 0.07). Near the surface, E(xz) of TP was 8-fold higher than that of FC (0.41 versus 0.05), while overall E(xz) was 4-fold higher (0.09 versus 0.02). For TP and FC, -E(zz) and E(xz) were greatest near the surface and decreased monotonically with depth. E for FC was 1.7-fold greater than TP, both near the surface (0.40 versus 0.24MPa) and overall (0.76 versus 0.47MPa). Similarly, G was 7-fold greater for FC (0.22MPa) than TP near the surface (0.03MPa) and 3-fold higher for FC (0.38MPa) than TP (0.13MPa) overall. These results indicate that tibial cartilage deforms and strains more axially and in shear than the apposing femoral cartilage during tibial-femoral articulation, reflecting their respective moduli.
    Preview · Article · Jun 2010 · Journal of Biomechanics
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