The progression of anterior translation after anterior cruciate ligament reconstruction in a caprine model.

Large post-operative anterior-posterior translations are frequently reported after quadruped anterior cruciate ligament (ACL) reconstructions. To determine when the translation increases occur and the mechanism responsible, we followed the anterior and posterior translation limits in 18 goat knees for six months. Reconstructions were performed using grafts 4 or 7 mm wide placed in initially tight or lax positions. The anterior and posterior translation limits at 50 N were monitored using Roentgen stereophotogrammetric analysis. Graft bone block stability and soft tissue segment lengths were also assessed. Large (> 2 mm) increases in anterior translation were noted in 71% of the subjects at two weeks, and in 88% at eight weeks. The translations in the lax and tight groups were indistinguishable after two weeks. Joints with wide grafts had less anterior translation compared to narrow grafts at all time periods, but were significant different only at 26 weeks. The posterior translation limit moved anteriorly over the 26 weeks. Eight of nine joints had stable graft bone markers and/or increases in graft soft tissue lengths. In conclusion, increased anterior translation occurred soon after ACL reconstruction, was associated with graft soft tissue changes, and appeared to be reduced by larger grafts. A post-surgical decrease in posterior translation limit was also observed.

Subject variation in caprine anterior cruciate ligament reconstruction.

We studied the subject and treatment contributions to anterior cruciate ligament (ACL) reconstruction biomechanics by reexaming the results of two bilateral reconstruction studies. Bilateral reconstruction allows a comparison between treatments exposed to the same subject related healing factors. The studies examined the effects of gamma irradiation and the effects of initial graft size and initial graft laxity. In both studies different treatments were applied to contralateral limbs. We found that the subject was the best predictor of outcome, while the surgical treatments had little influence on outcome. There was a large variation between subjects despite similar treatments, and little difference between contralateral limbs despite different surgical treatments. At 26 weeks, the graft cross sectional area and modulus were most strongly influenced (p < 0.002) by the subject. We interpret this as a subject related factor is regulating the quantity and quality of the healing tissue. Potential sources of subject related factors include the subject's pre-operative condition, the activity during the post-operative period, and an intrinsic biologic response. By better understanding the source of subject variation, more successful and consistent ACL reconstructions might be achieved.

The effects of graft width and graft laxity on the outcome of caprine anterior cruciate ligament reconstruction.

We studied how initial graft size and initial graft laxity affected the biomechanics of anterior cruciate ligament (ACL) reconstruction at six months. Sixteen goats had bilateral reconstructions staged eight weeks apart. Autografts 4 and 7 mm wide were taken from the central patellar tendon (PT). Lax grafts were created by adding 4 mm slack to the graft before fixing. We reconstructed each joint using a combination of width and laxity treatments. Both factors were changed for the contralateral joint and all combinations appeared with equal frequency. At six months we measured the joint extension limit, anterior-posterior (AP) translation, and osteoarthritic changes. The grafts were then tested to failure to determine their mechanical properties. After six months the difference in initial treatments had disappeared: there was no difference in graft cross-section due to the different initial widths and there was no difference in joint AP translation due to the initial graft laxity. We did observe that wide grafts were associated with a block to extension, decreased joint AP translation, and increased articular cartilage damage and osteophyte formation. While AP translation was reduced, it was correlated with decreased extension, possibly indicating an increase in scar tissue formation rather than a more functional graft. Neither graft width nor graft laxity produced differences in any graft mechanical properties. This suggests that the use of larger grafts to prevent increased AP translation has undesirable complications. Ultimately, we conclude that neither of these surgical treatments strongly affects the biomechanical result of caprine ACL reconstruction.

Cell alignment is induced by cyclic changes in cell length: studies of cells grown in cyclically stretched substrates.

Many types of cells, when grown on the surface of a cyclically stretched substrate, align away from the stretch direction. Although cell alignment has been described as an avoidance response to stretch, the specific deformation signal that causes a cell population to become aligned has not been identified. Planar surface deformation is characterized by three strains: two normal strains describe the length changes of two initially perpendicular lines and one shear strain describes the change in the angle between the two lines. The present study was designed to determine which, if any, of the three strains was the signal for cell alignment. Human fibroblasts and osteoblasts were grown in deformable, rectangular, silicone culture dishes coated with ProNectin, a biosynthetic polymer containing the RGD ligand of fibronectin. 24 h after plating the cells, the dishes were cyclically stretched at 1 Hz to peak dish stretches of 0% (control), 4%, 8%, and 12%. After 24 h of stretching, the cells were fixed, stained, and their orientations measured. The cell orientation distribution was determined by calculating the percent of cells whose orientation was within each of eighteen 5 degrees angular intervals. We found that the alignment response was primarily driven by the substrate strain which tended to lengthen the cell (axial strain). We also found that for each cell type there was an axial strain limit above which few cells were found. The axial strain limit for fibroblasts, 4.2 +/- 0.4%, (mean +/- 95% confidence), was lower than for osteoblasts, 6.4 +/- 0.6%. We suggest that the fibroblasts are more responsive to stretch because of their more highly developed actin cytoskeleton.

Two-bundle posterior cruciate ligament reconstruction. An in vitro analysis of graft placement and tension.

This study had two purposes: first, to determine how femoral attachment location affects the load sharing between the two bundles of a Y-type posterior cruciate ligament reconstruction, and second, to determine how the bundles, separately and in combination, control posterior tibial translation throughout the full range of knee flexion. One and two-bundle reconstructions were performed in 12 cadaveric knees. The one-bundle reconstructions were attached within the femoral posterior cruciate ligament footprint at one of three locations, high and shallow (S1), mid and shallow (S2), or mid and deep (D). The two-bundle reconstructions comprised an S1 bundle with either an S2 or a D bundle. Posterior translation and bundle tension were measured as the knee was flexed from full extension to 1,200 of flexion while a posterior force of either 50 or 100 N was applied to the proximal tibia. The shallow one-bundle reconstruction restored posterior translation to within 2 mm of that of the intact knee over the entire range of knee flexion. The deep reconstruction did not control abnormal posterior translation above 45 degrees. The tension in the shallow bundles increased with knee flexion, and the deep bundle tension remained nearly constant throughout knee flexion. Both two-bundle reconstructions controlled posterior translation, but with different load-sharing characteristics. The S1-S2 configuration resisted posterior tibial translation as both bundles became taut in flexion. In contrast, the S1-D configuration resisted posterior translation in a reciprocal fashion with the D bundle tension being the greatest in extension and the S1 bundle tension being the greatest tension in flexion.

The strain magnitude and contact guidance determine orientation response of fibroblasts to cyclic substrate strains.

When grown in a substrate subjected to cyclic stretching, most types of cells change orientations. This cell orientation response (COR) has been shown to be driven by axial substrate strain (the strain beneath and along a cell's long axis). However, it remains unclear whether COR depends on the strain direction (tension vs compression). Furthermore, in vitro COR is paradoxical, since in vivo fibroblasts align along collagen fibers and hence the stretch direction. We hypothesized that COR does not depend on the surface strain direction, and that contact guidance provided by microgrooves can maintain cell alignment in the presence of cyclic stretching. Human skin fibroblasts were cultured on compliant smooth and microgrooved surfaces in silicone dishes. Cyclic uniaxial tensile and compressive strains (4%, 8% and 12%) were applied on the dishes at 1 Hz for 24 h. Cell orientation distributions were determined and compared using the Kolmogorov-Smirnov test. Significant differences were found between each of cell orientation distributions with the applied strains and that without strains (p < 0.05). Nevertheless, no significant differences were found between two cell orientation distributions for each pair of opposite strains applied (for 4%, p = 0.33; for 8%, p = 0.18; and for 12%, p = 0.32). Moreover, fibroblasts grown in microgrooves aligned in the groove direction and remained so after 8% cyclic stretch. Thus, this study showed that COR is the cells' avoidance to substrate deformation (i.e., strain-direction independent). It also suggested that the failure of fibroblasts to change orientations in vivo may result from the contact guidance provided by collagen fibers.

Alignment and proliferation of MC3T3-E1 osteoblasts in microgrooved silicone substrata subjected to cyclic stretching.

Previous studies have shown that many types of cells align in microgrooves in static cultures. However, whether cells remain aligned and also proliferate in microgrooves under stretching conditions has not been determined. We grew MC3T3-E1 osteoblasts in deformable silicone dishes containing microgrooves oriented in the stretch direction. We found that with or without 4% stretching, cells aligned in microgrooves of all sizes, with the groove and ridge widths ranged from 1 to 6microm, but the same groove depth of about 1.6microm. In addition, actin cytoskeleton and nuclei became highly aligned in the microgrooves with and without 4% cyclic stretching. To further examine whether MC3T3-E1 osteoblasts proliferate in microgrooves with cyclic stretching, we grew the cells in six-well silicone dishes containing microgrooves in three wells and smooth surfaces in other three wells. After 4% cyclic stretching for 3, 4, and 7 days, we found that cell numbers in the microgrooves were not significantly different (p>0.05) from those on the smooth surface (p>0.05). Taken together, these results show that MC3T3-E1 osteoblasts can align and proliferate in microgrooves with 4% cyclic stretching. We suggest that the silicone microgrooves can be a useful tool to study the phenotype of MC3T3-E1 osteoblasts under controlled substrate strains. The silicone microgrooves can also be useful for delivering defined substrate strains to other adherent cells in cultures.

Changes in knee kinematics after application of an articulated external fixator in normal and posterior cruciate ligament-deficient knees.

We studied how the location of an articulated external fixator, the EBI-Orthofix (EBI Corp, Persippany, NJ), affects the kinematics of the posterior cruciate ligament (PCL)-deficient knee. Ten unembalmed cadaver whole lower limbs were randomly divided into two groups of five limbs each: (1) fixator hinge located near the average knee flexion axis (the anatomic position group); and (2) fixator hinge located distal to the joint line and posterior to the flexion axis (the fibular styloid position group). Three loading conditions, passive flexion/extension, flexion/extension with anterior force of 100 N, and flexion/extension with posterior force of 100 N were used for each knee with the PCL intact and with the PCL cut. With the fixator located in the anatomic position, and after cutting of the PCL, posterior translation was reduced to normal limits only at flexion angles < or = 15 degrees. In this configuration, the fixator was ineffective at minimizing posterior translation at flexion angles > or = 30 degrees. With the fixator located at the fibular styloid position, however, posterior translation of the tibia in the PCL deficient knees was reduced to near normal limits at all flexion angles. These results were statistically different than the anatomic position group at all flexion angles > or = 30 degrees (P < .01). The external fixator appears to allow normal range of motion while effectively shielding the PCL graft from stress caused by posterior translational forces. Issues related to the potential complications and patient acceptance must be addressed thoroughly before this technique is applied in clinical practice.

Posterior cruciate ligament reconstruction. An in vitro study of femoral and tibial graft placement.

We studied posterior cruciate ligament reconstruction in a cadaveric model using two substitutes: a 1-mm diameter flexible cable and an 11-mm diameter Achilles tendon autograft. The thin cable allowed us to study five femoral and five tibial attachments in each knee. A nearly isometric attachment was located after cutting the posterior cruciate ligament while the tibia was reduced with a 100 N anterior force. The five femoral locations studied were the isometric location and four locations centered around this isometric point. The Achilles tendon reconstruction was used with both an isometric and a nonisometric femoral site, allowing us to confirm the results with the wire cable. Posterior motion limits were measured under a 100 N posterior force in the intact, posterior cruciate ligament-deficient, and posterior cruciate ligament-reconstructed knees. We found that the restoration of knee stability in flexion depended strongly on the femoral attachment location. A femoral attachment that was nonisometric by intraoperative measurement, but within the posterior cruciate ligament anatomic footprint, most closely reproduced the intact knee's posterior motion limits. Variations in the tibial attachment site produced only minor changes in the posterior motion limits. We concluded that the proximal-distal location selected for the femoral attachment of a posterior cruciate ligament substitute was particularly important in the restoration of normal posterior motion limits.

Effect of tibial attachment location on the healing of the anterior cruciate ligament freeze model.

We studied the healing response of a devitalized anterior cruciate ligament to a treatment of initial anterior-posterior joint translation in goats. Devitalization and devascularization were achieved by five successive freeze-thaw cycles. Anterior-posterior translation was surgically altered by an osteotomy of the tibial attachment of the devitalized ligament and its reattachment either in the anatomical position or in a position 5 mm posterior. Six weeks after the first surgery, the same procedure was performed on the contralateral limb, except that the ligament was reattached in the alternate position. Six months after the initial surgery, femur-anterior cruciate ligament-tibia specimens were tested to determine their structural and mechanical material properties. Anatomic ligament placement resulted in reduced anterior-posterior translation (p < 0.05) and greater anterior joint stiffness (p < 0.05). Maximum load (p < 0.05) and ligament stiffness (p < 0.01) also were greater for the anatomically placed anterior cruciate ligaments. The maximum load for anatomically placed ligaments averaged 1.625 +/- 211 N (SEM). The strength of the posteriorly placed anterior cruciate ligament, 895 +/- 164 N was similar to results of historical anterior cruciate autograft reconstructions. Ligament failure occurred near the tibial insertion in the posteriorly placed ligaments more often than in the anatomically placed ligaments (four of five times compared with one of five times). Ligament failure near the tibial insertion occurred with lower mean maximum load than failure at the midsubstance or by bone avulsion (796 compared with 1.592 N: p < 0.05). These data support the hypothesis that ligament laxity is important to the healing and remodeling of anterior cruciate ligament grafts.

The use of an implantable force transducer to measure patellar tendon forces in goats.

Patellar tendon (PT) force was measured during activity with an implantable force transducer (IFT) in adult goats. PT force, vertical ground reaction force (VGRF) and the animal's speed were recorded for standing, walking and trotting. Following data collection, animals were euthanized and the IFT calibrated in vitro. Standing PT force averaged 207 N. Maximum PT force was approximately 800 N for walking and 1000 N for trotting and occurred at mid-stance. PT force dropped from 200 N at toe-off to 0 N by mid-swing. For each activity, the PT force increased with increases in VGRF. Maximum in vivo PT stress occurred during trotting and measured 29 MPa. This study demonstrates the IFT's usefulness in measuring tendon force directly.

Posterior cruciate ligament anatomy and length-tension behavior of PCL surface fibers.

The location of the most nearly isometric region of the PCL has remained a controversial issue. Our data indicate that there is an entire region close to the PCL's proximal edge that is isometric; however, the majority of the PCL is anisometric. This concurs with the work of Grood et al, Ogata and McCarthy, and Sidles et al. However, other authors believe that the posterior-proximal region of the PCL contains the most isometric fibers. These differences could be explained in part through the differences in experimental design. It is important to note that all of these studies placed the most nearly isometric area within the substance of the ligament. What is equally important to understand from all of these studies is the complex length change pattern of fibers comprising the PCL. The function of PCL fibers is not accurately described by the traditional model of an anterolateral bundle and a posteromedial bundle that have reciprocal functions. Further kinematic studies testing potential femoral attachment sites are needed to ascertain the optimal placement for PCL graft substitutes. An earlier study performed in our laboratory suggested that PCl graft placement distal to the isometric region, 4 mm from the proximal edge (within the PCL footprint), provided the most optimal position for correcting abnormal posterior translation after PCL division. We reported that isometric placement at the time of surgery would lead to incorrect positioning of the graft. We are currently investigating alternative graft configurations (eg, two-bundle and multiple-bundle grafts) to determine if PCL function can be reproduced more ideally; however, more analysis is required before definitive recommendations can be made. At present, the ideal operative procedure for PCL reconstruction requires continued biomechanical analysis followed by carefully designed clinical trials.

Uniaxial tension inhibits tendon collagen degradation by collagenase in vitro.

Tendon structure is governed largely by factors regulating the anabolic and catabolic phases of tenocyte metabolism. Little is known about the mechanisms that regulate the synthesis, activation, and action of metalloproteinases, which are key enzymes in a multifactorial cascade controlling homeostasis of the extracellular matrix. In the present study, we investigated the effect of tension on collagenase-induced degradation of the tendon in vitro by assessing changes in structural and material properties measured during tensile failure tests. Devitalized right-left pairs of rabbit patella-patellar tendon-tibia units were maintained under culture conditions in the presence of 60 U/ml highly purified collagenase for 20 hours. One randomly selected unit from each animal was subjected to a tension that produced a constant 4% elongation or strain (n = 10); the contralateral unit served as a slack comparison (n = 10). In one series of experiments (immediate, n = 5), the tension was applied immediately prior to collagenase exposure. In a second series (delayed, n = 5), it was delayed for 4 hours to allow time for the collagenase to diffuse into the tendon. Additional devitalized and nonincubated units (n = 6) were used as normal controls. Collagenase exposure caused large decreases in stiffness and elongation to failure in slack units. This resulted in greater than 80% reductions in both maximum failure force and energy to failure. In contrast, the loaded unit in both experimental protocols had significantly greater stiffness than control units. In both the immediate and the delayed protocols, the loaded tendons had significantly higher stiffness and failed at significantly higher elongations and maximum forces than the slack tendons. Diffusion studies with and without tension showed the tension did not inhibit diffusion of collagenase into the tendon but did significantly decrease the water content from 64.6 to 57.8%. The data suggest that stresses and strains of the extracellular matrix may modify the kinetics of the bacterial collagenase-collagen interaction. Matrix stress and strain may be an important and overlooked factor that modulates the susceptibility of collagen to proteolytic degradation.

Cell orientation response to cyclically deformed substrates: experimental validation of a cell model.

We have developed a stochastic model that describes the orientation response of bipolar cells grown on a cyclically deformed substrate. The model was based on the following hypotheses regarding the behavior of individual cells: (a) the mechanical signal responsible for cell reorientation is the peak to peak surface strain along the cell's major axis (p-p axial strain); (b) each cell has an axial strain threshold and the threshold is normally distributed in the cell population; (c) the cell will avoid any direction where the p-p axial strain is above its threshold; and (d) the cell will randomly orient within the range of directions where the p-p axial strains are less than the cell's threshold. These hypotheses were tested by comparing model predictions with experimental observations from stretch experiments conducted with human melanocytes. The cells were grown on elastic rectangular culture dishes subjected to unidirectional cyclic (1 Hz) stretching with amplitudes of 0, 4, 8, and 12%. After 24 h of stimulation, the distribution of cell orientations was determined by measuring the orientations of 300-400 randomly selected cells. The 12% stretch experiment was used to determine the mean, 3.5%, and the standard deviation, 1.0% of the strain threshold for the cell population. The Kolmogorov-Smirnov test was then used to determine if the orientation distributions predicted by the model were different from experimentally measured distributions for the 4 and 8% stretches. No significant differences were found between the predicted and experimental distributions (4%: p = 0.70; and 8%: p = 0.71). These results support the hypothesis that cells randomly orient, but avoid directions where the p-p axial strains are above their thresholds.

In vivo quantification of the cat patellofemoral joint contact stresses and areas.

A new method for in vivo measurement of patellofemoral joint contact areas, stresses, and patellar displacements, with joint loading approximating physiologic conditions was developed. Joint contact measurements were obtained using pressure sensitive film inserted directly between articular joint surfaces. Two-dimensional joint kinematics were measured using a high-speed video based motion analysis system. Joint loading, provided by quadriceps muscle stimulation, was measured with an implantable force transducer (IFT). Variations in joint mechanics as a function of joint flexion angle, joint loading and joint stability (anterior cruciate ligament intact or transected) were determined for four adult male cats. The contact measurements obtained with the pressure sensitive film displayed high repeatability with a standard error of +/- 6.8% of the mean value of the median pressure and +/- 4.4% of the mean contact area value. Substantial differences in joint mechanics were reliably detected with the new technique. The influence of experimental procedures, such as incisions in the joint capsule and insertion of pressure sensitive film between the articular surfaces, produced minimal changes in the joint kinematics during muscular contraction.

Factors affecting sensitivity of a transducer for measuring anterior cruciate ligament force.

In order to determine the measurements and calibration methods necessary to accurately measure in vivo forces in the anterior cruciate ligament (ACL) of the goat, an in vitro study was conducted to evaluate the effect of several factors that could influence the sensitivity of a transducer implanted within the ligament. Four factors were studied in six specimens: flexion angle [0 degrees, 10 degrees, 30 degrees, 50 degrees, and 70 degrees from full extension (FFE)]; tibial rotation (0 degrees and 10 degrees of internal rotation at 30 degrees, 50 degrees, and 70 degrees flexion FFE); loading rate (cycling frequencies of 0.2, 0.5, 1.0, and 2.0 Hz); and temperature (22 degrees C and 37 degrees C). Anteroposterior tibial displacements were applied to the specimens following tissue resection to isolate the ACL. The resultant ACL force magnitude was measured with a multi-component load cell, and transducer sensitivity was calculated as the slope of the output vs force curve in the linear response region. Transducer sensitivity varied with joint position in each specimen, but there was no consistent trend from specimen to specimen in how the sensitivity changed. As a result, there were no statistically significant mean differences (p > 0.05). There were no significant differences and little variation in sensitivity due to changes in either loading rate or tissue temperature, although the latter produced a voltage offset. The results show that the transducer output with zero force on the ligament must be determined in vivo, after which in vitro calibrations may be conducted at room temperature.(ABSTRACT TRUNCATED AT 250 WORDS)

In vivo forces in the anterior cruciate ligament: direct measurements during walking and trotting in a quadruped.

In vivo forces in the anterior cruciate ligament (ACL) were measured in three adult goats during quiet standing and during gait (walking or trotting). A modified pressure transducer (MPT) was implanted within the anteromedial band of the ligament to make direct measurements of ACL force. One or two days following implantation, measurements were made of ACL force, knee joint flexion angle, ground reaction forces, and speed of locomotion. MPT calibration was performed in vitro using anteroposterior displacement tests at six flexion angles. The ACL was loaded during quiet standing (30-61 N) and during the stance phase of gait. Peak ACL forces were achieved within the first 40% of stance, with magnitudes ranging from 63 to 124 N during walking and from 102 to 150 N during trotting. The average ACL force during the stance phase ranged from 34 to 68 N while walking and from 46 to 69 N while trotting. The partial correlations between peak ACL force and speed, and between average ACL force and speed, were both statistically different from zero (p < 0.01). ACL forces dropped to zero during the swing phase in all trials. ACL forces were less than 15 N throughout swing in two of the animals, both of which did not extend their knees during gait beyond 20 degrees from full extension. In the animal which did show knee extension beyond 40 degrees (20 degrees from full extension), ACL loading occurred during late swing. The magnitude of the peak ACL force during late swing was significantly correlated with the extent of knee extension in this animal.

Role of the medial structures in the intact and anterior cruciate ligament-deficient knee. Limits of motion in the human knee.

We measured motion limits in human cadaveric knees before and after sectioning the anterior cruciate ligament and the medial structures. Sectioning the medial collateral ligament in an anterior cruciate ligament-deficient knee increased the anterior translation limit at 90 degrees of flexion but not at 30 degrees of flexion. The tibia displaced straight anteriorly without exhibiting the coupled internal rotation that occurred in intact and anterior cruciate ligament-deficient knees. A lateral 15 N-m abduction moment produced a coupled external rotation in the medial collateral ligament-deficient knee. This was in marked contrast to intact, anterior cruciate ligament-deficient, or combined medial collateral ligament and anterior cruciate ligament-deficient knees, in which an abduction moment produced a coupled internal rotation. Sectioning only the medial collateral ligament caused a small but significant increase in the abduction rotation limit, whereas larger increases in the abduction rotation limit occurred when the posterior oblique ligament and posterior medial capsule were cut in addition to the medial collateral ligament. Cutting the medial collateral ligament increased the external rotation limit. The increase was independent of whether the anterior cruciate ligament was intact or sectioned. Subsequent cutting of the posterior oblique ligament and posterior medial capsule further increased the external rotation limit.

Knee joint contact pressure decreases after chronic meniscectomy relative to the acutely meniscectomized joint: a mechanical study in the goat.

Several studies have shown that meniscectomy causes an immediate, acute increase in knee joint contact pressure and that changes in pressure distribution cause remodeling of bone and soft tissue. Presumably, this remodeling in turn affects contact pressures. This study tested the hypothesis that medial compartment contact pressure increases immediately after medial meniscectomy and then decreases with time. Supporting hypotheses regarding medial compartment contact area and lateral compartment pressures also were tested. Unilateral medial meniscectomy was performed on seven adult goats. Four or 8 months later, contact pressure and area were measured in vitro in the involved joints, as well as in the contralateral joints, before and after removal of the meniscus. The medial compartment pressures of the chronically meniscectomized joints were significantly less than those of the acutely meniscectomized paired joints but remained significantly greater than those of the intact joints. For the 4 and 8 month groups combined, the mean pressures of the acutely and chronically meniscectomized joints were greater than the pressures of the paired intact joints by 70 and 42%, respectively. The mean medial compartment contact areas of the acute and chronic joints were lower than those of the intact joints by 60 and 50%, respectively; mean lateral compartment pressures remained the same. This study indicates that joint remodeling reduces joint contact pressures. It also suggests that the effectiveness of a treatment to reduce pressure concentrations may be determined only by comparison, at the same postoperative time, of the pressure with that of the chronically meniscectomized joint, since pressures decreased with time without treatment.

In vitro evaluation of an implantable force transducer (IFT) in a patellar tendon model.

A new implantable transducer has been developed for in situ evaluation of ligament and tendon forces. Unlike previous devices, this sensor is placed within the specimen, minimizing measurement errors due to impingement on surrounding soft tissues and bone. In this study, we present the sensor design details as well as test results from initial in vitro trials in the goat patellar tendon model. Device performance and influence of the device on the specimen were evaluated under several loading conditions. In all cases, device output had a strong correlation with induced tissue load. Significant variations in device performance were only noted at high tissue deformation rates. More extensive investigations will be conducted to assess how changes in transducer design might alter performance characteristics.