Kaufman, Kenton R

Meniscal attachments serve to anchor and transfer loads from menisci to the tibia. These ligamentous tissues are composed of collagen fibers, elastin, ground substance and water. Ligaments have a time- and history-dependent viscoelastic behavior due in part to the interaction of the water and the ground substance [1]. The movement of water within ligamentous tissue is limited because of charged proteoglycan molecules. It has been shown that some exudation of water is present during cyclic loading of ligamentous tissue [2]. The movement and its inhibition could lead to changes of pressure within the meniscal attachments. Therefore, the purpose of this study was to quantify the internal pressure in human meniscal attachments subjected to physiological loading. Since it is thought that the posterior attachment is subjected to both tension and compression, while the anterior attachment is primarily subjected to tension [3–5], we hypothesized that the attachments mechanical environment is dictated by the external loads, and hence, the posterior attachment would elicit higher pressures.

A fully 3D, continuum mechanics based model of skeletal muscle, validated against experimental force data, can be used to computationally solve for individual muscle forces. A constitutive formulation, representing muscle as a transversely isotropic, hyperelastic, and isovolumetric material [1] has been implemented in a finite element model (FEM) of passive skeletal muscle and validated against experimental tension measurements [2]. Of further interest is an expanded formulation that will allow for the addition of muscle activation levels on the overall skeletal muscle force generation. The purpose of this study was to expand the FEA model to include muscle activation and validate it with tests of active skeletal muscle tissue at varied lengths.

The surgical goal in total knee arthroplasty (TKA) is to obtain neutral mechanical alignment within three degrees [4]. This has been considered necessary to achieve optimal function, produce balanced medial and lateral loading distributions, and prolong implant longevity [7]. Under static loading, tibial-femoral alignment angle deviations of 3° have been shown to greatly alter the distribution of pressure and load between the medial and lateral tibial plateaus [13]. However, other studies have challenged the practice that coronal tibiofemoral alignment improves implant longevity [9,10]. These studies did not show a statistical difference in the number of revision surgeries between well aligned knees and mechanical alignment outliers (varus/valgus knees). While it has been suggested that accurate alignment allows for improved joint kinematics and improved outcomes in TKA patients [6], no studies have evaluated the effect of tibial-femoral alignment on tibial plateau loading distribution during gait in the TKA population. Therefore, the purpose of this study was to assess tibial plateau loading following TKA.

ABSTRACTThis study investigated the internal fluid pressure of human cadaver meniscal root attachments. A pressure micro‐sensor was implanted inside each attachment site. Tibiofemoral joints were compressed to 2× body weight at various flexion angles and pressure recorded for 20 min. The anterior cruciate ligament (ACL) was then transected and joints retested. Lastly, a longitudinal incision of the lateral posterior (LP) horn was made and the joint retested. Ramp pressure was defined as the pressure when 2× body weight was reached, and equilibrium pressure was recorded at the end of the hold period. The medial posterior (MP) attachment was subjected to greater ramp pressure than the medial anterior (p = 0.002) and greater equilibrium pressure than all other root attachment sites (p < 0.001). Flexion angle had a significant effect on pressure as full extension was greatest at ramp (p = 0.040). Transection of the ACL decreased ramp pressure in the LP attachment (p = 0.025) and increased equilibrium pressure (p = 0.031) in the MP attachment. The results suggest that repair strategies should be developed which reconstruct the MP attachments to be sufficient to withstand large pressures. Furthermore, since meniscal pressure is highest at full extension, this fact should be considered when prescribing rehabilitation following repair of an attachment. © 2013 Orthopaedic Research Society Published by Wiley Periodicals, Inc. J Orthop Res 31:1507–1513, 2013

Background: Medial elbow injuries are common among baseball pitchers. Easily accessed methods to assess medial elbow stress may be useful in identifying individuals with increased injury risk. Hypothesis: Pitch velocity (PV) is positively associated with higher medial elbow adduction moments. Study Design: Cohort study; Level of evidence, 2. Methods: Participants included 26 uninjured high school pitchers, 15 to 18 years in age. Three-dimensional data and PV were collected as athletes threw 10 fastballs for strikes to a regulation-distance target. Variables of interest were the normalized peak internal elbow adduction moment and peak PV. Linear regression was performed to evaluate the influence of PV on the adduction moment. Results: For the group, mean PV was 71 mph (range, 58-81 mph), and the adduction moment was 0.558 Nm/Ht × mass (range, 0.378-0.723). PV was positively associated with the adduction moment ( P < 0.01, R 2 = 0.373). Conclusions: Talented young pitchers may be more susceptible to elbow injuries as a consequence of a biomechanical coupling between PV and upper extremity joint moments. Clinical Relevance: PV may be measured easily and serve as an indicator of medial elbow stress.

Background: Medial elbow distraction during pitching as the primary mechanism contributing to adaptations in ulnar collateral ligament (UCL) appearance during magnetic resonance imaging (MRI) evaluation has not been established. Hypothesis: Uninjured high school–aged pitchers with unilateral adaptations of the UCL exhibit a higher peak internal elbow adduction moment than those without UCL adaptations. Study Design: Cohort study (Prevalence); Level of evidence, 2. Methods: Twenty uninjured, asymptomatic high school–aged pitchers underwent bilateral elbow MRI examinations. Three-dimensional motion analysis testing was performed to collect throwing arm biomechanics as participants pitched from an indoor mound. Nonparametric tests were performed to compare peak internal elbow adduction moment in uninjured participants with and without adaptations in UCL appearance and to determine the nature of the relationship between the peak internal adduction moment and UCL appearance. Results: Uninjured participants with UCL thickening exhibited a higher peak internal elbow adduction moment of 53.3 ± 6.8 N·m compared with uninjured participants without adaptations in UCL appearance, 38.8 ± 10.9 N·m ( P = .05), as higher moments were correlated with ligament thickening (correlation coefficient, 0.45) ( P = .02). Conclusion: This study establishes the association between medial elbow distraction captured by the internal adduction moment during pitching and UCL adaptations visible during MRI evaluation.

Background: Tissue adaptations in response to pitching are an expected finding during magnetic resonance imaging (MRI) evaluation of the throwing elbow of adult pitchers. These changes are considered normal in the absence of symptom complaints. It is unclear when during the playing career these tissue adaptations are initiated. Hypothesis: Abnormalities in the appearance of the throwing elbow compared with the nonthrowing elbow would be visible during MRI assessment of this asymptomatic population of high school–aged throwers. Study Design: Cross-sectional study; Level of evidence, 3. Methods: Twenty-three uninjured, asymptomatic male high school–aged baseball pitchers (mean age, 16 years) with no history of elbow injury were recruited for the study. Participants had a minimum of 3 years’ experience with pitching as their primary position (mean experience, 6 years). Bilateral elbow MRI examinations were performed using a standardized protocol including fast spin-echo proton-density (axial and coronal), T1-weighted (sagittal), and T2-weighted fat-saturated (axial, sagittal, and coronal) sequences. Osteoarticular, ligamentous, musculotendinous, and neural structures were evaluated and compared bilaterally. The images were reviewed by a musculoskeletal radiologist who was blinded to all the gathered data on these athletes, including limb dominance. Results: Three participants (13%) had no abnormalities. Fifteen individuals (65%) had asymmetrical anterior band ulnar collateral ligament thickening, including 4 individuals who also had mild sublime tubercle/anteromedial facet edema. Fourteen participants (61%) had posteromedial subchondral sclerosis of the ulnotrochlear articulation, including 8 (35%) with a posteromedial ulnotrochlear osteophyte, and 4 (17%) with mild posteromedial ulnotrochlear chondromalacia. Ten individuals (43%) had multiple abnormal findings in the throwing elbow. Conclusion: Thickening of the anterior band of the ulnar collateral ligament and posteromedial subchondral sclerosis of the trochlea are common findings in the high school–aged pitcher and may be considered normal clinical findings in the absence of symptom complaints. Other changes in tissue appearance of the throwing elbow are uncommon in this age group and should be regarded with a higher level of caution when evaluating for the presence of injury. An understanding of the MRI appearance of the uninjured youth pitcher is necessary for clinicians to distinguish between normal adaptations and the presence of injury.

Background: There is an assumption that baseball athletes who reside in warm-weather climates experience larger magnitude adaptations in throwing shoulder motion and strength compared with their peers who reside in cold-weather climates. Hypotheses: (1) The warm-weather climate (WWC) group would exhibit more pronounced shoulder motion and strength adaptations than the cold-weather climate (CWC) group, and (2) the WWC group would participate in pitching activities for a greater proportion of the year than the CWC group, with the time spent pitching predicting throwing shoulder motion and strength in both groups. Study Design: Cross-sectional study; Level of evidence, 3. Methods: One hundred uninjured high school pitchers (50 each WWC, CWC) were recruited. Rotational shoulder motion and isometric strength were measured and participants reported the number of months per year they pitched. To identify differences between groups, t tests were performed; linear regression was used to determine the influence of pitching volume on shoulder motion and strength. Results: The WWC group pitched more months per year than athletes from the CWC group, with the number of months spent pitching negatively related to internal rotation motion and external rotation strength. The WWC group exhibited greater shoulder range of motion in all planes compared with the CWC group, as well as significantly lower external rotation strength and external/internal rotation strength ratios. There was no difference in internal rotation strength between groups, nor a difference in the magnitude of side-to-side differences for strength or motion measures. Conclusion: Athletes who reside in cold- and warm-weather climates exhibit differences in throwing shoulder motion and strength, related in part to the number of months spent participating in pitching activities. The amount of time spent participating in pitching activities and the magnitude of range of motion and strength adaptations in athletes who reside in warm-weather climates may make these athletes more susceptible to throwing-related injuries.

The purpose of this study was to evaluate a magnetic resonance imaging (MRI) compatible knee positioning device to aid in minimizing intratechnologist and intertechnologist differences of minimum joint space width (JSW) measurements. Five subjects were scanned by two separate technologists, with and without an MRI-compatible positioning device. A semi-automated program calculated the minimum JSW of the tibiofemoral and patellofemoral joints. The scan-to-scan repeatability was evaluated from measurements between serial scans without subject repositioning, and the intratechnologist and intertechnologist repeatabilities were evaluated when the subject was removed from the magnet and repositioned by an individual technologist. The root mean square (RMS) error of the JSW measurements was also calculated. All measures of scan-to-scan repeatability and intratechnologist repeatability were unchanged with the MRI-compatible positioning device. The intertechnologist repeatability decreased from 0.70 to 0.42 mm, and the RMS error was significantly reduced ( P = 0.0006) from 0.26 to 0.15 mm for the tibiofemoral joint. The variability of patellofemoral JSW measurements increased when using the positioning device; however, the increases were not statistically significant. The intertechnologist repeatability increased from 1.55 to 1.79 mm, and the RMS error increased from 0.58 to 0.73 mm. The MRI-compatible positioning device was successful at reducing JSW measurement variability at the tibiofemoral joint. The increase in measurement variability at the patellofemoral joint may be due to local incongruities of the articular surfaces. An MRI-compatible positioning device may be beneficial for quantitative longitudinal studies evaluating knee joint health.