Contact stresses in the knee joint in deep flexion.

The contact stresses in the knee that arise from activities involving deep flexion have not been given due consideration in view of social and cultural practice amongst many Asians that frequently cause the engagement of these activities. Excessively large stresses (>25 MPa) can cause cartilage damage and may be the precursor to the development of degenerative disease of the joint. In this study, forces in the knee derived from previous studies of human walking and squatting were applied to five cadaver knees that underwent quasi-static mechanical testing. This was conducted using a materials-testing machine and a custom-made apparatus that allowed secure and consistent loading of the knee specimen in flexion beyond 120 degrees. A thin-film electronic pressure transducer was inserted into the cadaver tibiofemoral joint space to measure force and area. Throughout the various positions simulating specific phases of walking, it was found that stresses peaked to 14 MPa (standard deviation was 2.5 MPa). In deep flexion, the peak stresses were significantly larger by over 80%, reaching the damage limits of cartilage. The results from this biomechanical study suggest that the adequacy of articular cartilage to support loads in the knee joint during deep flexion may be questionable.

[1]  A. Yau,et al.  Osteoarthritis of the hip and other joints in southern Chinese in Hong Kong. , 1973, The Journal of bone and joint surgery. American volume.

[2]  J B Finlay,et al.  Survival of articular cartilage after controlled impact. , 1977, The Journal of bone and joint surgery. American volume.

[3]  David T Felson,et al.  Comparison of the prevalence of radiographic osteoarthritis of the knee and hand between Japan and the United States. , 2002, The Journal of rheumatology.

[4]  J B Morrison,et al.  The mechanics of the knee joint in relation to normal walking. , 1970, Journal of biomechanics.

[5]  P. Torzilli,et al.  Effect of impact load on articular cartilage: cell metabolism and viability, and matrix water content. , 1999, Journal of biomechanical engineering.

[6]  D Wirz,et al.  [Validation of the Tekscan system for statistic and dynamic pressure measurements of the human femorotibial joint]. , 2002, Biomedizinische Technik. Biomedical engineering.

[7]  J. O'Connor,et al.  The components of passive knee movement are coupled to flexion angle. , 2000, Journal of biomechanics.

[8]  V. Pinskerova,et al.  Tibiofemoral movement 1: the shapes and relative movements of the femur and tibia in the unloaded cadaver knee , 2000 .

[9]  T. Brown,et al.  In vitro contact stress distribution on the femoral condyles , 1984, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[10]  M. Kurosaka,et al.  Maximizing flexion after total knee arthroplasty: the need and the pitfalls. , 2002, The Journal of arthroplasty.

[11]  I. Kiviranta,et al.  In vivo characterization of indentation stiffness of articular cartilage in the normal human knee. , 1999, Journal of biomedical materials research.

[12]  S. Dekel,et al.  Joint changes after overuse and peak overloading of rabbit knees in vivo. , 1978, Acta orthopaedica Scandinavica.

[13]  U P Wyss,et al.  Activities of daily living in non-Western cultures: range of motion requirements for hip and knee joint implants , 2001, International journal of rehabilitation research. Internationale Zeitschrift fur Rehabilitationsforschung. Revue internationale de recherches de readaptation.

[14]  D. Dennis,et al.  An in vivo analysis of the effectiveness of the osteoarthritic knee brace during heel-strike of gait. , 1999, The Journal of arthroplasty.

[15]  M. Nevitt,et al.  Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: The Beijing Osteoarthritis Study. , 2001, Arthritis and rheumatism.

[16]  M S Hefzy,et al.  Kinematics of the knee joint in deep flexion: a radiographic assessment. , 1998, Medical engineering & physics.

[17]  J. Bertram,et al.  Swelling and fibronectin accumulation in articular cartilage explants after cyclical impact , 1996, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  I. Yoshimura,et al.  Analysis of the significance of the measurement of acceleration with respect to lateral laxity of the anterior cruciate ligament insufficient knee , 2000, International Orthopaedics.

[19]  A Gächter,et al.  Joint load considerations in total knee replacement. , 1997, The Journal of bone and joint surgery. British volume.

[20]  R. Haut,et al.  Contact pressures in the patellofemoral joint during impact loading on the human flexed knee , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[21]  B. Fregly,et al.  Estimation of discretization errors in contact pressure measurements. , 2003, Journal of biomechanics.

[22]  V. Pinskerova,et al.  Tibiofemoral movement 2: the loaded and unloaded living knee studied by MRI , 2000 .

[23]  J. Ihn,et al.  In vitro study of contact area and pressure distribution in the human knee after partial and total meniscectomy , 2004, International Orthopaedics.

[24]  J J Anderson,et al.  Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. , 1988, American journal of epidemiology.

[25]  T. Andriacchi.  Dynamics of knee malalignment. , 1994, The Orthopedic clinics of North America.

[26]  V C Mow,et al.  A stereophotogrammetric method for determining in situ contact areas in diarthrodial joints, and a comparison with other methods. , 1994, Journal of biomechanics.

[27]  G. Fleisig,et al.  A Comparison of Tibiofemoral Joint Forces and Electromyographic Activit During Open and Closed Kinetic Chain Exercises , 1996, The American journal of sports medicine.

[28]  R. Singerman,et al.  In vitro forces in the normal and cruciate-deficient knee during simulated squatting motion. , 1999, Journal of biomechanical engineering.

[29]  W. Norman Scott,et al.  Surgery of the knee , 2001 .

[30]  D Coggon,et al.  Occupational activity and osteoarthritis of the knee. , 1994, Annals of the rheumatic diseases.

[31]  W. Hayes,et al.  Tibiofemoral Contact Pressures in Degenerative Joint Disease , 1998, Clinical orthopaedics and related research.

[32]  J. Luck,et al.  The effect of simulated fracture-angulations of the tibia on cartilage pressures in the knee joint. , 1991, The Journal of bone and joint surgery. American volume.

[33]  W. Tang,et al.  Axial Alignment of the Lower Extremity in Chinese Adults* , 2000, The Journal of bone and joint surgery. American volume.

[34]  J. Steadman,et al.  Rehabilitation of the injured knee. , 1985, Clinics in sports medicine.

[35]  Welsh Rp,et al.  Knee joint structure and function. , 1980 .

[36]  T. Fukubayashi,et al.  The contact area and pressure distribution pattern of the knee. A study of normal and osteoarthrotic knee joints. , 1980, Acta orthopaedica Scandinavica.

[37]  T. Spector,et al.  The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. , 1993, The Journal of rheumatology.

[38]  T J Koh,et al.  In vivo tracking of the human patella. , 1992, Journal of biomechanics.

[39]  A. J. van den Bogert,et al.  Tibiocalcaneal motion during running, measured with external and bone markers. , 1997, Clinical biomechanics.

[40]  D. Hungerford,et al.  Biomechanics of the patellofemoral joint. , 1979, Clinical orthopaedics and related research.

[41]  P R Cavanagh,et al.  Three-dimensional kinematics of the human knee during walking. , 1992, Journal of biomechanics.

[42]  M. Harris,et al.  An improved method for measuring tibiofemoral contact areas in total knee arthroplasty: a comparison of K-scan sensor and Fuji film. , 1999, Journal of biomechanics.