Effect of degeneration on the six degree of freedom mechanical properties of human lumbar spine segments.

While the effects of disc degeneration on compression and rotation motions have been studied, there is no data for shear loading. Clinical research has shown that those with low back pain (a potential consequence of degeneration) experience a 75% greater lateral shear force than those without it. Therefore, the aim was to compare the effect of degeneration on spine segment stiffness and phase angle in each of six degree of freedom (6DOF) loading directions. Fourteen intact functional spinal units (FSU) were dissected from human lumbar spines (mean (SD) age 76.2 (11) years, Thompson grades 3 (N = 5, mild), 4 (N = 6, moderate), 5 (N = 3, severe)). Each FSU was tested in ±6DOFs while subjected to a physiological preload, hydration, and temperature (37°C) conditions in a hexapod robot. A one-way ANOVA between degenerated groups was performed on stiffness and phase angle for each DOF. Significant differences in stiffness were found between mild and moderate degenerative groups in lateral shear (p = 0.001), and axial rotation (p = 0.001), where moderate degeneration had decreased stiffness. For phase angle, significant differences were seen in anterior shear (p = 0.017), and axial rotation (p = 0.026), where phase angle for mild degeneration was less than moderate. Trends of stiffness and phase angle changes between degenerative groups were similar within each DOF. Clinically, the identification of the DOFs that are most affected by degeneration could be used in rehabilitation to improve supplemental stabilization of core muscle groups. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1399-1409, 2016.

Effect of potting technique on the measurement of six degree-of-freedom viscoelastic properties of human lumbar spine segments.

Polymethyl methacrylate (PMMA) and Wood's Metal are fixation media for biomechanical testing; however, the effect of each potting medium on the measured six degree-of-freedom (DOF) mechanical properties of human lumbar intervertebral discs is unknown. The first aim of this study was to compare the measured 6DOF elastic and viscoelastic properties of the disc when embedded in PMMA compared to repotting in Wood's Metal. The second aim was to compare the surface temperature of the disc when potted with PMMA and Wood's Metal. Six human lumbar functional spinal units (FSUs) were first potted in PMMA, and subjected to overnight preload in a saline bath at 37 °C followed by five haversine loading cycles at 0.1 Hz in each of 6DOF loading directions (compression, left/right lateral bending, flexion, extension, left/right axial rotation, anterior/posterior, and lateral shear). Each specimen was then repotted in Wood's Metal and subjected to a 2-h re-equilibrating preload followed by repeating the same 6DOF tests. Outcome measures of stiffness and phase angle were calculated from the final loading cycle in each DOF and were expressed as normalized percentages relative to PMMA (100%). Disc surface temperatures (anterior, left/right lateral) were measured during potting. Paired t-tests (with alpha adjusted for multiple DOF) were conducted to compare the differences in each outcome parameter between PMMA and Wood's Metal. No significant differences in stiffness or phase angle were found between PMMA and Wood's Metal. On average, the largest trending differences were found in the shear DOFs for both stiffness (approximately 35% greater for Wood's Metal compared to PMMA) and phase angle (approximately 15% greater for Wood's Metal). A significant difference in disc temperature was found at the anterior surface after potting with Wood's Metal compared to PMMA, which did not exceed 26 °C. Wood's Metal is linear elastic, stiffer than PMMA and may reduce measurement artifact of potting medium, particularly in the shear directions. Furthermore, it is easier to remove than PMMA, reuseable, and cost effective.

A novel method to replicate the kinematics of the carpus using a six degree-of-freedom robot.

Understanding the kinematics of the carpus is essential to the understanding and treatment of wrist pathologies. However, many of the previous techniques presented are limited by non-functional motion or the interpolation of points from static images at different postures. We present a method that has the capability of replicating the kinematics of the wrist during activities of daily living using a unique mechanical testing system. To quantify the kinematics of the carpal bones, we used bone pin-mounted markers and optical motion capture methods. In this paper, we present a hammering motion as an example of an activity of daily living. However, the method can be applied to a wide variety of movements. Our method showed good accuracy (1.0-2.6°) of in vivo movement reproduction in our ex vivo model. Most carpal motion during wrist flexion-extension occurs at the radiocarpal level while in ulnar deviation the motion is more equally shared between radiocarpal and midcarpal joints, and in radial deviation the motion happens mainly at the midcarpal joint. For all rotations, there was more rotation of the midcarpal row relative to the lunate than relative to the scaphoid or triquetrum. For the functional motion studied (hammering), there was more midcarpal motion in wrist extension compared to pure wrist extension while radioulnar deviation patterns were similar to those observed in pure wrist radioulnar deviation. Finally, it was found that for the amplitudes studied the amount of carpal rotations was proportional to global wrist rotations.

Assessment of the initial viscoelastic properties of a critical segmental long bone defect reconstructed with impaction bone grafting and intramedullary nailing.

INTRODUCTION: This study compared the initial viscoelastic properties of a segmental tibial defect stabilized with intramedullary nailing and impaction bone grafting to that of a transverse fracture stabilized with intramedullary nailing. MATERIALS AND METHODS: Seven sheep tibiae were tested in compression (1000N), bending and torsion (6Nm) in a six degree-of-freedom hexapod robot. Tests were repeated across three groups: intact tibia (Intact), transverse fracture stabilized by intramedullary nailing (Fracture), and segmental defect stabilized with a nail and impaction bone grafting (Defect). Repeated measures ANOVA on the effect of group on stiffness/phase angle were conducted for each loading direction. RESULTS: The Intact group was significantly stiffer than the Fracture and Defect groups in bending and torsion (p<0.022 for both loading directions), and was marginal for the Defect group in compression (p=0.052). No significant differences were found between the Fracture and Defect groups (p>0.246 for all loading directions) for stiffness/phase angle. In compression and bending, phase angles were significantly greater for the Fracture and Defect groups compared to Intact (p<0.025), with no significant differences between groups in torsion (p=0.13). Sensitivity analyses conducted between the Fracture and Defect group differences found that they were not of clinical significance. CONCLUSION: The initial properties of a segmental defect stabilized with intramedullary nailing and impaction bone grafting was not clinically significantly different to that of a transverse fracture stabilized with intramedullary nailing.

Stem micromotion after femoral impaction grafting using irradiated allograft bone: a time zero in vitro study.

BACKGROUND: A gamma irradiation dose of 15kGy has been shown to adequately sterilise allograft bone, commonly used in femoral impaction bone grafting to treat bone loss at revision hip replacement, without significantly affecting its mechanical properties. The objective of this study was to evaluate whether use of 15kGy irradiated bone affects the initial mechanical stability of the femoral stem prosthesis, as determined by micromotion in a comprehensive testing apparatus, in a clinically relevant time zero in vitro model of revision hip replacement. METHODS: Morselised ovine bone was nonirradiated (control), or irradiated at 15kGy or 60kGy. For each dose, six ovine femurs were implanted with a cemented polished taper stem following femoral impaction bone grafting. Using testing apparatus that reproduces stem loading, stems were cyclically loaded and triaxial micromotion of the stem relative to the bone was measured at the proximal and distal stem regions using non-contact laser transducers and linear variable differential transformers. FINDINGS: There were no significant differences in proximal or distal stem micromotion between groups for all directions (p≤0.80), apart for significantly greater distal stem medial-lateral micromotion in the 60kGy group compared to the 15kGy group (P=0.03), and near-significance in the anterior-posterior direction (P=0.08, power=0.85). INTERPRETATION: Using a clinically relevant model and loading apparatus, irradiation of bone at 15kGy does not affect initial femoral stem stability following femoral impaction bone grafting.

The impact of tensioning device mal-positioning on strand tension during anterior cruciate ligament reconstruction.

BACKGROUND: In order to confer optimal strength and stiffness to the graft in Anterior Cruciate Ligament (ACL) reconstruction, the maintenance of equal strand tension prior to fixation, is desired; positioning of the tensioning device can significantly affect strand tension This study aimed to determine the effect of tensioning device mal-positioning on individual strand tension in simulated cadaveric ACL reconstructions. METHODS: Twenty cadaveric specimens, comprising bovine tibia and tendon harvested from sheep, were used to simulate ACL reconstruction with a looped four-strand tendon graft. A proprietary tensioning device was used to tension the graft during tibial component fixation with graft tension recorded using load cells. The effects of the tensioning device at extreme angles, and in various locking states, was evaluated. RESULTS: Strand tension varied significantly when the tensioning device was held at extreme angles (p < 0.001) or in 'locked' configurations of the tensioning device (p < 0.046). Tendon position also produced significant effects (p < 0.016) on the resultant strand tension. CONCLUSION: An even distribution of tension among individual graft strands is obtained by maintaining the tensioning device in an unlocked state, aligned with the longitudinal axis of the tibial tunnel. If the maintenance of equal strand tension during tibial fixation of grafts is important, close attention must be paid to positioning of the tensioning device in order to optimize the resultant graft tension and, by implication, the strength and stiffness of the graft and ultimately, surgical outcome.

The effect of screw taper on interference fit during load to failure at the soft tissue/bone interface.

The effect of screw geometry on the pullout strength of an anterior cruciate ligament reconstruction is well documented. The effect of a truly tapered screw has not been previously investigated. Thirty bovine knees in right and left knee pairs were collected. Superficial digital flexors from the hind legs of sheep were harvested to form a quadruple tendon graft. For each knee pair, one tendon graft was fixed using a tapered screw (n=15) and the other with a non-tapered screw (n=15). Interference screws were manufactured from stainless steel, and apart from the tapered or non-tapered profile were identical. The screws were inserted into a tibial tunnel already containing the tendon graft. The interference fit was tested by extensile load to failure tests. The insertion torque of the screws and first sign of load to failure (by pullout) of the interference fit were recorded. Results were analysed using paired t-tests. The results indicated that tapered screws have significantly higher resistance to interference failure (p=0.007) and insertion torque (p<0.001) than non-tapered screws. The improved biomechanical performance of tapered screws demonstrated in this study may translate into superior clinical results, particularly at the tibial attachment of hamstring anterior cruciate ligament reconstruction, and also of hamstring fixation to the medial femoral condyle for patella instability.

An evaluation of interface contact profiles in two low contact bone plates.

Bone plate design has evolved dramatically in recent years. The Dynamic Compression Plate (DCP) has been superseded by bi- and uni-cortical plates that claim a reduced interface contact between the plate and the underlying bone. It is believed that contact reduction ameliorates the localised ischaemia that develops subsequent to plate application. In this study, the interface characteristics of the Limited Contact-Dynamic Compression Plate (LC-DCP) and the Contour Plus (CP) plating systems have been quantitated using Fuji prescale pressure sensitive film interposed between the plate and the bone. Ten-hole plates were applied to the same aspect of either the humeral, radial or ulnar diaphysis of human cadaveric bone in a reproducible manner. The average pressure, force and interface contact area were calculated using Interactive Data Language (IDL) image analysis software. The CP system was consistently lower, in terms of interface contact, than the LC-DCP in each of the specimen locations tested (P<0.0001). The CP system displayed a 'point-contact' configuration along the interface with high pressures recorded at these points, the significance of which is unknown.

Suture characteristics following incubation in synovial fluid or phosphate buffered saline.

Selection of an appropriate suture requires a knowledge of many factors. These include its mechanical characteristics, its durability, the period of mechanical effectiveness and the tissue reactivity to the material. Absorbable suture materials were incubated in synovial fluid or phosphate buffered saline, at 37 degrees C, for periods up to 12 weeks. Mechanical testing was performed to determine the yield strength, percentage elongation and stiffness of each material in response to incubation. Significant differences were observed in response to time of incubation, material size ('0' or '2-0'), incubation medium and material properties (P < 0.001). Based on the results obtained Vicryl and PDS appear ideal for short-term and medium term apposition, respectively. Panacryl has more durable mechanical features and may well be suited to long-term tissue apposition, such as tendon repair or arthroplasty.

Biceps tenodesis: a biomechanical study of fixation methods.

Rupture of the biceps tendon occurs predominantly in the middle-aged and elderly, being predisposed through bicipital tendinitis and rotator cuff lesions. Surgical repair may be an option for those requiring strength in supination. This study compared the initial fixation strength of keyhole tenodesis (n = 7) and interference screw fixation by use of cadaveric specimens. Two interference screws were evaluated (n = 7 x 2): the round-headed cannulated interference screw (RCI) and a bioresorbable screw (Sysorb). All specimens failed at the fixation site but one. This study found that overall there was a significant effect as a result of study group (keyhole vs Sysorb vs RCI, P =.034). The post hoc comparisons revealed that the keyhole was significantly stronger than the RCI screw (P =.033) but not significantly different compared with the Sysorb screw (P =.129). No significant difference was observed between the Sysorb and RCI screws (P =.762). Interference screw fixation failed by tendon slippage at the screw-tendon-bone interface; keyhole fixation failed by tendon splitting and slippage out of the restraining keyhole. Keyhole tenodesis may permit earlier postoperative mobilization when compared with tenodesis by use of interference screw fixation.