Noninvasive imaging predicts failure load of the spine with simulated osteolytic defects.

BACKGROUND: The clinical management of lytic tumors of the spine is currently based on geometric measurements of the defect. However, the mechanical behavior of a structure depends on both its material and its geometric properties. Quantitative computed tomography and dual-energy x-ray absorptiometry were investigated as noninvasive tools for measuring the material and geometric properties of vertebrae with a simulated lytic defect. From these measures, yield loads were predicted with use of composite beam theory. METHODS: Thirty-four fresh-frozen cadaveric spines were segmented into functional spinal units of three vertebral bodies with two intervertebral discs at the thoracic and lumbar levels. Lytic defects of equal size were created in one of three locations: the anterior, lateral, or posterior region of the vertebra. Each spinal unit was scanned with use of computed tomography and dual-energy x-ray absorptiometry, and axial and bending rigidities were calculated from the image data. Each specimen was brought to failure under combined compression and forward flexion, and the axial load and bending moment at yield were recorded. RESULTS: Although the relative defect size was nearly constant, measured yield loads had a large dispersion, suggesting that defect size alone was a poor predictor of failure. However, image-derived measures of structural rigidity correlated moderately well with measured yield loads. Furthermore, with use of composite beam theory with quantitative computed tomography-derived rigidities, vertebral yield loads were predicted on a one-to-one basis (concordance, r(c) = 0.74). CONCLUSIONS: Although current clinical guidelines for predicting fracture risk are based on geometric measurements of the defect, we have shown that the relative size of the defect alone does not account for the variation in vertebral yield loads. However, composite beam theory analysis with quantitative computed tomography-derived measures of rigidity can be used to prospectively predict the yield loads of vertebrae with lytic defects. CLINICAL RELEVANCE: Image-predicted vertebral yield loads and analytical models that approximate loads applied to the spine during activities of daily living can be used to calculate a factor of fracture risk that can be employed by physicians to plan appropriate treatment or intervention.

Expression of pituitary adenylate cyclase activating polypeptide (PACAP) and PACAP type I A receptor mRNAs in granulosa cells of preovulatory follicles of the rat ovary.

Pituitary adenylate cyclase activating polypeptide (PACAP) was isolated from ovine hypothalamus and known to stimulate the production of cAMP in anterior pituitary cells. In the recent report, the expression of PACAP was detected in preovulatory follicles, and treatment with PACAP stimulated the production of progesterone and prostaglandin E(2) through the action of AC and PLC pathways in the ovary. PACAP binds to three type receptors. Type I A receptor is coupled to adenylate cyclase (AC) and phospholipase C (PLC) pathways, while type I B and type II receptors are only coupled to AC. Thus, the present study aimed to evaluate the temporal expression of PACAP and its type I A receptor mRNAs in the rat ovary after treatment with pregnant mare's serum gonadotropin and human chorionic gonadotropin (hCG). Northern blot analysis showed that PACAP transcripts were transiently expressed from 3-9 hr after hCG treatment, reaching a maximum at 6 hr. During these time points, PACAP mRNAs were specifically and strongly expressed in granulosa cells and cumulus cells of large preovulatory follicles and interstitial glandular cells. Type I A receptor mRNAs were also transiently expressed in granulosa cells of large preovulatory follicles from 3-9 hr after hCG treatment. PACAP and its type I A receptor mRNAs were expressed in the same preovulatory follicles. These results demonstrate that PACAP acts as an autoregulator or pararegulator through type I A receptor in granulosa cells and cumulus cells of large preovulatory follicles. Thus, we suggest that PACAP may have a critical role in granulosa cells of preovulatory follicles for the preparation of ovulation.

Hamstrings and iliotibial band forces affect knee kinematics and contact pattern.

Many clinical studies have emphasized the role of the hamstrings and the iliotibial band on knee mechanics, although few biomechanical studies have investigated it. This study therefore examined two hypotheses: (a) with loading of the hamstrings, the tibia translates posteriorly and rotates externally and the tibial contact pattern shifts anteriorly; furthermore, the changes in tibial kinematics alter patellar kinematics and contact; and (b) loading the iliotibial band alters the kinematics and contact pattern of the tibiofemoral joint similarly to loading the hamstrings, and loading the iliotibial band laterally translates the patella and its contact location. Five cadaveric knee specimens were tested with a specially designed knee-joint testing machine in an open-chain configuration. At various flexion angles, the knees were tested always with a quadriceps force but with and without a hamstrings force and with and without an iliotibial band force. The results support the first hypothesis. Hence, the hamstrings may be important anterior and rotational stabilizers of the tibia, a role similar to that of the anterior cruciate ligament. The results also support the second hypothesis, although the iliotibial band force had a smaller effect on the tibia than did the hamstrings force. Both forces also changed patellar kinematics and contact, demonstrating that these structures should also be considered during the clinical management of patellar disorders.

A Mathematical Formulation for 3D Quasi-Static Multibody Models of Diarthrodial Joints.

This study describes a general set of equations for quasi-static analysis of three-dimensional multibody systems, with a particular emphasis on modeling of diarthrodial joints. The model includes articular contact, muscle forces, tendons and tendon pulleys, ligaments, and the wrapping of soft tissue structures around bone and cartilage surfaces. The general set of equations governing this problem are derived using a consistent notation for all types of links, which can be converted conveniently into efficient computer codes. The computational efficiency of the model is enhanced by the use of analytical Jacobians, particularly in the analysis of articular surface contact and wrapping of soft tissue structures around bone and cartilage surfaces. The usefulness of the multibody model is demonstrated by modeling the patellofemoral joint of six cadaver knees, using cadaver-specific data for the articular surface and bone geometries, as well as tendon and ligament insertions and muscle lines of actions. Good accuracy was observed when comparing the model patellar kinematic predictions to experimental data (mean +/- stand. dev. error in translation: 0.63 +/- 1.19 mm, 0.10 +/- 0.71 mm, -0.29 +/- 0.84 mm along medial, proximal, and anterior directions, respectively; in rotation: -1.41 +/- 1.71 degrees, 0.27 +/- 2.38 degrees, -1.13 +/- 1.83 degrees in flexion, tilt and rotation, respectively). The accuracy which can be achieved with this type of model, and the computational efficiency of the algorithm employed in this study may serve in many applications such as computer-aided surgical planning, and real-time computer-assisted surgery in the operating room.

Knee cartilage topography, thickness, and contact areas from MRI: in-vitro calibration and in-vivo measurements.

OBJECTIVE: This study assessed the three-dimensional accuracy of magnetic resonance imaging (MRI) for measuring articular surface topographies and cartilage thicknesses of human cadaveric knee joints, by comparison with the calibrated stereophotogrammetric (SPG) method. METHODS: Six fresh frozen cadaveric knees and the knees of four volunteers were imaged with a three-dimensional spoiled gradient-recalled acquisition with fat suppression using a linear extremity coil in a 1.5 T superconducting magnet. The imaging voxel size was 0.47 x 0.47 x 1.0 mm. Both a manual and a semi-automated segmentation method were employed to extract topographic measurements from MRI. Following MRI, each of the six cadaveric knees was dissected and its articular surfaces quantified using stereophotogrammetry. The MRI surface measurements were compared numerically with the SPG measurements. RESULTS: For six cadaveric knees, the average accuracies of cartilage and subchondral bone surface measurements were found to be 0.22 mm and 0.14 mm respectively and the thickness measurements demonstrated an average accuracy of 0.31 mm. It was found that while most of the error may be attributed to random measurement error, the accuracy was somewhat affected by systematic errors. For each bone of the knee, accuracies were most favorable in the patella, followed by the femur and then the tibia. The more efficient semi-automated method provided equally good and sometimes better accuracies than manual segmentation. CONCLUSIONS: This study demonstrates that clinical MRI can provide accurate measurements of cartilage topography, thickness, contact areas and surface curvatures of the knee.

Effects of patellar tendon adhesion to the anterior tibia on knee mechanics.

The effects of patellar tendon adhesion on the knee extensor mechanism and on the kinematics and contact areas for both the patellofemoral and tibiofemoral joints were determined for five cadaveric knees in an open kinetic chain testing configuration. Patellar tendon adhesion decreased the distance from the inferior patellar pole to the tibial tuberosity, effectively creating patella infera. When compared with the controls, knees with adhesion had medial and distal translation of the patella, as well as increased patellar flexion. Although the patellar articular contact location shifted distally, the overall contact area did not change significantly. For the tibia, adhesion resulted in significant medial, proximal, and anterior translation, and internal rotation. Adhesion also resulted in a posterior shift of the tibial contact location. For the extensor mechanism, adhesion decreased the knee extension force created by the quadriceps muscle on the tibia, indicating a decrease in the effective moment arm of the extensor mechanism. Furthermore, as a result of patellar tendon adhesion, the angle formed by the quadriceps and patellar tendons decreased, suggesting an increase in patellofemoral joint reaction force with adhesion. The increased patellofemoral joint reaction force and the altered contact location may be related to anterior knee pain after knee trauma and knee surgery. Therefore, patients should be observed for subtle patella infera, which may indicate patellar tendon adhesion.

Anatomy of the human patellofemoral joint articular cartilage: surface curvature analysis.

Articular cartilage surfaces of 49 human patellae and 24 distal femora were characterized by identifying distinctive features with surface curvature analysis. Paired specimens from the same donor generally exhibited natural symmetry, so only results from nonpaired specimens were considered (39 patellae and 19 femora). In 23 of 39 patellae, proximal median and lateral transverse ridges extended to form an oblique ridge resembling a skewed lambda (lambda). Most of the unpaired patellae (37 of 39) exhibited only a single lateral transverse ridge, and most (32 of 39) had an odd facet. All but one patella exhibited a concave depression in the lateral and medial facets and a sellar area in the proximal region. All distal femoral surfaces exhibited a sellar trochlea. The concavity of the trochlea was greatest in the posterior aspect, near the intercondylar notch.

A stereophotogrammetric method for determining in situ contact areas in diarthrodial joints, and a comparison with other methods.

Determination of contact areas in diarthrodial joints is necessary for understanding the state of stress within the articular cartilage layers and the supporting bony structures. The present study describes the use of a stereophotogrammetry (SPG) system [Huiskes et al., J. Biomechanics 18, 559-570 (1985) and Ateshian et al., J. Biomechanics 24, 761-776 (1991)] for determining contact areas in diarthrodial joints, using a surface proximity concept similar to the one used by Scherrer et al. [ASME J. biomech. Engng 101, 271-278 (1979)]. This method consists of evaluating the proximity of the articular surfaces to determine joint contact areas using precise geometric models of the joint surfaces obtained from the SPG system, and precise kinematic data, also obtained from SPG. In this study, the SPG method for determining contact areas is compared to other commonly used methods such as dye staining, silicone rubber casting and Fuji film contact measurement techniques which have been often used and reported by other investigators. The bovine glenohumeral joint and the bovine lateral tibiofemoral articulation (without the meniscus) were used to represent congruent and incongruent joints, respectively. While all the methods yielded consistent contact patterns for the incongruent tibiofemoral articulations, the results for the congruent bovine glenohumeral joints showed that the SPG and Fuji film methods were in better agreement than those obtained from the dye staining and silicone rubber casting methods. The advantages of the new SPG method are that it can be used for intact joints, and used repeatedly and quickly thus making contact-area movement analyses possible [Soslowsky et al., J. orthop. Res. 10, 524-534 (1992)]. The results of this comparison study show that the SPG technique is a reliable and versatile method for determining contact areas in diarthrodial joints.