عنوان

Biomechanics of the knee :

364261731X

9783642617317

b537564

Biomechanics of the knee :

[Book]

with application to the pathogenesis and the surgical treatment of ...

P G J Maquet

[Place of publication not identified]

Springer

2012

I. Aims and Limitations of the Work.- II. Review of the Literature.- III. Methods.- I. Mathematical Analysis.- II. Experiments on Anatomical Specimens.- III. Photoelastic Models.- A. Theoretical Basis.- B. Historical.- C. Application and Limitation of the Photoelastic Technique.- IV. Clinical and Radiological Material.- IV. Mechanics of the Knee.- I. Load and Mechanical Stresses.- A. Concept of Load and Stresses. Rigid Models.- B. Articulated Models.- 1. Forces.- 2. Contact Stresses.- II. Mechanical Stress in the Knee.- A. Forces Exerted on the Knee.- 1. Force Exerted on the Knee During Symmetrical Stance on Both Legs.- 2. Forces Exerted on the Knee in Standing on One Leg.- a) Coronal Plane.- b) Sagittal Plane.- 3. Forces Exerted on the Knee During Gait.- a) Displacement of the Centre of Gravity S7.- b) Forces of Inertia Due to the Accelerations of S7.- c) Force P Exerted on the Knee by the Partial Mass S7 of the Body.- d) Position in Space of Point G Which Lies Centrally on the Axis of Flexion of the Knee.- e) Position of the Knee in Relation to the Partial Centre of Gravity S7.- f) Distance a Between the Line of Action of Force P and Point G.- g) Muscular and Ligamentous Forces Balancing Force P.- ?) Formularization.- ?) Calculation.- ?) Critical Analysis of the Chosen Solution.- h.) Curves Illustrating the Forces Transmitted Across the Femoro-Tibial Joint.- i) Patello-Femoral Compressive Force.- B. Weight-Bearing Surfaces of the Joint.- 1. Femoro-Tibial Joint.- a) Technique.- b) Results.- 2. Patello-Femoral Joint.- C. Contact Articular Stresses.- 1. Femoro-Tibial Joint.- 2. Patello-Femoral Joint.- III. Conclusion.- V. The Pathomechanics of Osteoarthritis of the Knee.- I. Theoretical Analysis of the Causes of Knee Osteoarthritis.- A. Medial Displacement of Force R.- B. Lateral Displacement of Force R.- C. Unstable Knees.- D. Evolution of the Maximum Stress in Relation to Several Parameters.- 1. Varus or Valgus Deformity.- a) Magnitude and Line of Action of R.- b) Articular Compressive Stresses.- 2. Strengthening or Weakening of the Muscular Force L.- 3. Cumulative Effect of a Change of the Force L and a Deformity of the Leg.- 4. Modification of Force P.- 5. Horizontal Displacement of S7 in the Coronal Plane.- 6. Conclusion.- E. Posterior Displacement of Force R.- F. Anterior Displacement of Force R.- G. Increase of the Patello-Femoral Compressive Force.- H. Lateral Displacement of the Patello-Femoral Compressive Force.- II. Radiographic Examination of the Osteoarthritic Knee with Demonstration of the Effect of Changes in the Compressive Force on the Stress Distribution.- A. Demonstration of Joint Stresses.- 1. A.-P. View.- 2. Lateral View.- 3. Tangential View.- B. Utility of X-Rays in the Standing Position.- C. Arthrography.- D. Computerized Axial Tomography.- VII. The Use of Photoelastic Models to Illustrate How the Position of Compressive Femoro-Tibial and Patello-Femoral Forces Affects the Distribution of Articular Stresses.- A. Femoro-Tibial Joint.- 1. Normal Load, Centred.- 2. Normal Load, Off Centre.- 3. Inclined Load, Centred.- 4. Inclined Load, Off Centre.- B. Patello-Femoral Joint.- 1. Directional Distribution of the Stresses.- 2. Quantitative Distribution of the Stresses.- IV. Osteoarthritis of the Knee of Mechanical Origin.- VI. Instinctive Mechanisms Which Reduce Stress in the Knee.- I. Effects of Limping.- II. Use of a Walking Stick.- III. Comment and Conclusion.- VII. Biomechanical Treatment of Osteoarthritis of the Knee.- I. Rationale of Biomechanical Treatment.- II. Biomechanical Treatment of Osteoarthritis of the Knee.- A. Correction of Flexion Contracture.- 1. Rationale.- 2. Operative Procedure.- a) Capsulotomy Alone.- b) Capsulotomy Associated with Other Procedures.- 3) Results.- B. Anterior Displacement of the Tibial Tuberosity.- 1. Rationale.- 2. Operative Procedures.- a) Anterior Displacement of the Tibial Tuberosity by Elevating the Tibial Crest.- b) Anterior and Medial Displacement of the Tibial Tuberosity.- c) Anterior Displacement of the Tibial Tuberosity Combined with Upper Tibial Osteotomy.- d) Anterior Displacement of the Tibial Tuberosity Combined with Osteotomy of the Lower End of the Femur.- 3. Anterior Displacement of the Tibial Tuberosity After Patellectomy.- 4. Changes at Arthroscopy.- C. Recentring the Load.- 1. Osteoarthritis of the Knee with a Varus Deformity.- a) Necessity of Overcorrecting the Varus Deformity.- b) Accurate Estimation of Overcorrection.- c) Choice of Procedure: Tibial or Femoral Osteotomy?.- d) Previous Operative Procedures.- e) The Barrel-Vault-Osteotomy for Varus Deformity.- ?) Planning.- ?) Instruments.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Comments and Examples.- f) Cases Requiring a Derotation of the Leg.- g) Revisions.- ?) Revision After Undercorrection.- ?) Revision After Exaggerated Overcorrection.- h) The Exceptions. Femoral Osteotomy for a Varus Deformity of the Knee.- ?) Planning.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Second Example.- 2. Osteoarthritis of the Knee with Varus and Flexion Deformity.- 3. Osteoarthritis with a Valgus Deformity.- a) Necessity of Overcorrection.- b) Choice of Procedure: Femoral or Tibial Osteotomy?.- c) Previous Techniques.- d) Distal Femoral Osteotomy with Fixation by Four Steinmann Pins and Two Compression Clamps.- ?) Planning.- ?) Surgical Procedure.- ?) Postoperative Care.- ?) Comments and Examples.- e) Distal Femoral Osteotomy Combined with Anterior Displacement of the Tibial Tuberosity.- f) Revisions.- ?) Revision After Exaggerated Overcorrection.- ?) Revision After Miscorrection.- 4. Bilateral Osteoarthritis with a Valgus Deformity on One Side and a Varus Deformity on the Other Side.- 5. Osteoarthritis with Genu Recurvatum.- 6. Osteoarthritis of the Knee Due to a Distant Deformity.- 7. Rheumatoid Arthritis.- 8. Osteoarthritis of the Knee in Haemophiliacs.- 9. Osteonecrosis of the Medial Condyle of the Femur.- 10. Widespread Osteoarthritis without Deformity.- 11. Histological Confirmation of the Regenerative Process.- D. Critical Analysis of Patellectomy and Other Procedures on the Patella.- 1. Standard Patellectomy.- 2. Coronal Patellectomy.- 3. Sagittal Osteotomy of the Patella.- E. Operative Indications.- VIII. Results.- A. Femoro-Tibial Osteoarthritis.- 1. Osteoarthritis with a Varus Deformity.- a) Valgus Tibial Osteotomy.- b) Valgus Femoral Osteotomy.- 2. Osteoarthritis with a Valgus Deformity.- 3. Correction of a Deformity at a Distance from the Affected Knee.- 4. Complications and Unsatisfactory Results.- 5. Conclusions.- B. Patello-Femoral Osteoarthritis.- 1. Division of the Lateral Retinaculum.- 2. Anterior Displacement of the Tibial Tuberosity.- 3. Complications of the Anterior Displacement of the Tibial Tuberosity.- 4. Conclusions.- IX. Conclusions.- Appendix. Remarks About the Accuracy of the Calculation of Forces and Stresses in the Knee Joint.- A. Introduction.- 1. The Weights.- 2. Formularization.- 3. The Laws.- 4. Direct Personal Measurements.- B. Analysis of the Influence of the Variation of Time Between Two Successive Phases.- C. Influence of a Systematic Error of 10% in All the Measurements of Braune and Fischer.- D. Theory of Cumulated Errors, a Variation of 0.2 mm Being Assumed for All the Measurements.- E. Influence of a Variation of the Weight-Bearing Surfaces.- G. Direct Measurements.- H. Conclusion.- References.

P G J Maquet

P G J Maquet

[Book]

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