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Akron, OH, United States

Elias J.J.,Calhoun Research Laboratory | Elias J.J.,Medical Education and Research Institute of Colorado | Kilambi S.,Medical Education and Research Institute of Colorado | Cosgarea A.J.,Johns Hopkins University
Journal of Biomechanics

A study was performed to evaluate a computational model used to characterize the influence of vastus medialis obliquus (VMO) function on the patellofemoral pressure distribution. Ten knees were tested in vitro at 40°, 60° and 80° of knee flexion with quadriceps loads applied to represent a normal VMO, and with the VMO force decreased by approximately 50% to represent a weak VMO. The tests were performed with the cartilage intact and with a full thickness cartilage lesion centered on the lateral facet of the patella. The experimental tests were replicated computationally by applying discrete element analysis to a model of each knee constructed from MRI images. Repeated measures statistical comparisons were used to compare computational to experimental data and identify significant (p<0.05) differences due to the lesion and the applied VMO force. Neither the lateral force percentage nor the maximum lateral pressure varied significantly between the computational and experimental data. Creating a lesion significantly increased the maximum lateral pressure for all comparisons, except for the experimental data at 40°. Both computationally and experimentally, decrease in the VMO force increased the lateral force percentage by approximately 10% for all cases, and each increase was statistically significant. The maximum lateral pressure increase was typically less than 10% but was still significant for the majority of comparisons focused on the VMO strength. The results indicate that computational modeling can be used to characterize how varying quadriceps loading influences the patellofemoral force and pressure distributions while varying the condition of cartilage. © 2009 Elsevier Ltd. Source

Elias J.J.,Calhoun Research Laboratory | Saranathan A.,Calhoun Research Laboratory
Journal of Biomechanical Engineering

The current study was performed to evaluate the accuracy of computational assessment of the influence of the orientation of the patellar tendon on the patellofemoral pressure distribution. Computational models were created to represent eight knees previously tested at 40 deg, 60 deg, and 80 deg of flexion to evaluate the influence of hamstrings loading on the patellofemoral pressure distribution. Hamstrings loading increased the lateral and posterior orientation of the patellar tendon, with the change for each test determined from experimentally measured variations in tibiofemoral alignment. The patellar tendon and the cartilage on the femur and patella were represented with springs. After loading the quadriceps, the total potential energy was minimized to determine the force within the patellar tendon. The forces applied by the quadriceps and patellar tendon produced patellar translation and rotation. The deformation of each cartilage spring was determined from overlap of the cartilage surfaces on the femur and patella and related to force using linear elastic theory. The patella was iteratively adjusted until the extension moment, tilt moment, compression, and lateral force acting on the patella were in equilibrium. For the maximum pressure applied to lateral cartilage and the ratio of the lateral compression to the total compression, paired t-tests were performed at each flexion angle to determine if the output varied significantly (p < 0.05) between the two loading conditions. For both the computational and experimental data, loading the hamstrings significantly increased the lateral force ratio and the maximum lateral pressure at multiple flexion angles. For the computational data, loading the hamstrings increased the average lateral force ratio and maximum lateral pressure by approximately 0.04 and 0.3 MPa, respectively, compared to experimental increases of 0.06 and 0.4 MPa, respectively. The computational modeling technique accurately characterized variations in the patellofemoral pressure distribution caused by altering the orientation of the patellar tendon. Copyright © 2013 by ASME. Source

Policastro G.M.,University of Akron | Lin F.,University of Akron | Smith Callahan L.A.,University of Akron | Esterle A.,Calhoun Research Laboratory | And 3 more authors.

Amino acid-based poly(ester urea)s (PEU) are high modulus, resorbable polymers with many potential uses, including the surgical repair of bone defects. In vitro and in vivo studies have previously shown that phenylalanine-based PEUs have nontoxic hydrolytic byproducts and tunable degradation times. Phenylalanine PEUs (poly(1-PHE-6)) have been further modified by tethering osteogenic growth peptide (OGP) to tyrosine-based monomer subunits. These OGP-tethered PEUs have been fabricated into porous scaffolds and cultured in vitro to examine their effect on differentiation of human mesenchymal stem cells (hMSCs) toward the osteogenic lineage. The influence of tethered OGP on the hMSC proliferation and differentiation profile was measured using immunohistochemistry, biochemistry, and quantitative real time polymerase chain reaction (qRT-PCR). In vitro data indicated an enhanced expression of BSP by 130-160% for hMSCs on OGP-tethered scaffolds compared to controls. By 4 weeks, there was a significant drop (60-85% decrease) in BSP expression on OGP-functionalized scaffolds, which is characteristic of osteogenic differentiation. ALP and OSC expression was significantly enhanced for OGP-functionalized scaffolds by week 4, with values reaching 145% and 300% greater, respectively, compared to nonfunctionalized controls. In vivo subcutaneous implantation of poly(1-PHE-6) scaffolds revealed significant tissue-scaffold integration, as well as the promotion of both osteogenesis and angiogenesis. (Graph Presented). © 2015 American Chemical Society. Source

Saranathan A.,Calhoun Research Laboratory | Saranathan A.,University of Akron | Kirkpatrick M.S.,Calhoun Research Laboratory | Mani S.,Calhoun Research Laboratory | And 6 more authors.
Knee Surgery, Sports Traumatology, Arthroscopy

Purpose: The study was performed to characterize the influence of tibial tuberosity realignment on the pressure applied to cartilage on the patella in the intact condition and with lesions on the lateral and medial facets. Methods: Ten knees were loaded in vitro through the quadriceps (586 N) and hamstrings (200 N) at 40°, 60°, and 80° of flexion while measuring patellofemoral contact pressures with a pressure sensor. The tibial tuberosity was positioned 5 mm lateral of the normal position to represent lateral malalignment, 5 mm medial of the normal position to represent tuberosity medialization, and 10 mm anterior of the medial position to represent tuberosity anteromedialization. The knees were tested with intact cartilage, with a 12-mm-diameter lesion created within the lateral patellar cartilage, and with the lateral lesion repaired with silicone combined with a medial lesion. A repeated measures ANOVA and post hoc tests were used to identify significant (P < 0. 05) differences in the maximum lateral and medial pressure between the tuberosity positions. Results: Tuberosity medialization and anteromedialization significantly decreased the maximum lateral pressure by approximately 15% at 60° and 80° for intact cartilage and cartilage with a lateral lesion. Tuberosity medialization significantly increased the maximum medial pressure for intact cartilage at 80°, but the maximum medial pressure did not exceed the maximum lateral pressure for any testing condition. Conclusions: The results indicate that medializing the tibial tuberosity by 10 mm reduces the pressure applied to lateral patellar cartilage for intact cartilage and cartilage with lateral lesions, but does not overload medial cartilage. © 2011 Springer-Verlag. Source

Mani S.,Akron General Medical Center | Mani S.,University of Akron | Kirkpatrick M.S.,Akron General Medical Center | Saranathan A.,Akron General Medical Center | And 6 more authors.
American Journal of Sports Medicine

Background: Tibial tuberosity realignment surgery is performed to improve patellofemoral alignment, but it could also alter tibiofemoral kinematics. Hypothesis: After tuberosity realignment in the malaligned knee, the reoriented patellar tendon will pull the tuberosity back toward the preoperative position, thereby altering tibiofemoral kinematics. Study Design: Controlled laboratory study. Methods: Ten knees were tested at 40°, 60°, and 80° of flexion in vitro. The knees were loaded with a quadriceps force of 586 N, with 200 N divided between the medial and lateral hamstrings. The position of the tuberosity was varied to represent lateral malalignment, with the tuberosity 5 mm lateral to the normal position; tuberosity medialization, with the tuberosity 5 mm medial to the normal position; and tuberosity anteromedialization, with the tuberosity 10 mm anterior to the medial position. Tibiofemoral kinematics were measured using magnetic sensors secured to the femur and tibia. A repeated measures analysis of variance with a post hoc Student-Newman-Keuls test was used to identify significant (P <.05) differences in the kinematic data between the tuberosity positions at each flexion angle. Results: Medializing the tibial tuberosity primarily rotated the tibia externally compared with the lateral malalignment condition. The largest average increase in external rotation was 13° at 40° of flexion, with the increase significant at each flexion angle. The varus orientation also increased significantly by an average of 1.5° at 40° and 80°. The tibia shifted significantly posteriorly at 40° and 60° by an average of 4 mm and 2 mm, respectively. Shifting the tuberosity from the medial to the anteromedial position translated the tibia significantly posteriorly by an average of 2 mm at 40°. Conclusion: After tibial tuberosity realignment in the malaligned knee, the altered orientation of the patellar tendon alters tibiofemoral kinematics. Clinical Relevance: The kinematic changes reduce the correction applied to the orientation of the patellar tendon and could alter the pressure applied to tibiofemoral cartilage. © 2011 The Author(s). Source

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