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Kathryn E. Keenan, Saikat Pal, Derek P. Lindsey, Thor F. Besier and Gary S. Beaupre

Cartilage material properties provide important insights into joint health, and cartilage material models are used in whole-joint finite element models. Although the biphasic model representing experimental creep indentation tests is commonly used to characterize cartilage, cartilage short-term response to loading is generally not characterized using the biphasic model. The purpose of this study was to determine the short-term and equilibrium material properties of human patella cartilage using a viscoelastic model representation of creep indentation tests. We performed 24 experimental creep indentation tests from 14 human patellar specimens ranging in age from 20 to 90 years (median age 61 years). We used a finite element model to reproduce the experimental tests and determined cartilage material properties from viscoelastic and biphasic representations of cartilage. The viscoelastic model consistently provided excellent representation of the short-term and equilibrium creep displacements. We determined initial elastic modulus, equilibrium elastic modulus, and equilibrium Poisson’s ratio using the viscoelastic model. The viscoelastic model can represent the short-term and equilibrium response of cartilage and may easily be implemented in whole-joint finite element models.

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Nicholas M. Brisson, Paul W. Stratford, Saara Totterman, José G. Tamez-Peña, Karen A. Beattie, Jonathan D. Adachi and Monica R. Maly

Investigations of joint loading in knee osteoarthritis (OA) typically normalize the knee adduction moment to global measures of body size (eg, body mass, height) to allow comparison between individuals. However, such measurements may not reflect knee size. This study used a morphometric measurement of the cartilage surface area on the medial tibial plateau, which better represents medial knee size. This study aimed to determine whether normalizing the peak knee adduction moment and knee adduction moment impulse during gait to the medial tibial bone–cartilage interface could classify radiographic knee OA severity more accurately than traditional normalization techniques. Individuals with mild (N = 22) and severe (N = 17) radiographic knee OA participated. The medial tibial bone–cartilage interface was quantified from magnetic resonance imaging scans. Gait analysis was performed, and the peak knee adduction moment and knee adduction moment impulse were calculated in nonnormalized units and normalized to body mass, body weight × height, and the medial tibial bone–cartilage interface. Receiver operating characteristic curves compared the ability of each knee adduction moment normalization technique to classify participants according to radiographic disease severity. No normalization technique was superior at distinguishing between OA severities. Knee adduction moments normalized to medial knee size were not more sensitive to OA severity.

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Tzu-Chieh Liao, Joyce H. Keyak and Christopher M. Powers

patellofemoral joint stress during walking and greater cartilage and bone stress during squatting when compared with pain-free individuals. 5 , 6 However, the finding of elevated stress in persons with PFP has not been consistent across studies that have examined higher-demand activities, such as stair climbing

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Rebecca L. Lambach, Jay W. Young, David C. Flanigan, Robert A. Siston and Ajit M.W. Chaudhari

Linemen are at high risk for knee cartilage injuries and osteoarthritis. High-intensity movements from squatting positions (eg, 3-point stance) may produce high joint loads, increasing the risk for cartilage damage. We hypothesized that knee moments and joint reaction forces during lineman-specific activities would be greater than during walking or jogging. Data were collected using standard motion analysis techniques. Fifteen NCAA linemen (mean ± SD: height = 1.86 ± 0.07 m, mass = 121.45 ± 12.78 kg) walked, jogged, and performed 3 unloaded lineman-specific blocking movements from a 3-point stance. External 3-dimensional knee moments and joint reaction forces were calculated using inverse dynamics equations. MANOVA with subsequent univariate ANOVA and post hoc Tukey comparisons were used to determine differences in peak kinetic variables and the flexion angles at which they occurred. All peak moments and joint reaction forces were significantly higher during jogging than during all blocking drills (all P < .001). Peak moments occurred at average knee flexion angles > 70° during blocking versus < 44° in walking or jogging. The magnitude of moments and joint reaction forces when initiating movement from a 3-point stance do not appear to increase risk for cartilage damage, but the high flexion angles at which they occur may increase risk on the posterior femoral condyles.

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Nicholas H. Yang, Paul K. Canavan and Hamid Nayeb-Hashemi

Subject-specific models were developed and finite element analysis was performed to observe the effect of the frontal plane tibiofemoral angle on the normal stress, Tresca shear stress and normal strain at the surface of the knee cartilage. Finite element models were created for three subjects with different tibiofemoral angle and physiological loading conditions were defined from motion analysis and muscle force mathematical models to simulate static single-leg stance. The results showed that the greatest magnitude of the normal stress, Tresca shear stress and normal strain at the medial compartment was for the varus aligned individual. Considering the lateral knee compartment, the individual with valgus alignment had the largest stress and strain at the cartilage. The present investigation is the first known attempt to analyze the effects of tibiofemoral alignment during single-leg support on the contact variables of the cartilage at the knee joint. The method could be potentially used to help identify individuals most susceptible to osteoarthritis and to prescribe preventive measures.

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Daniël M. van Leeuwen, Fabian van de Bunt, Cornelis J. de Ruiter, Natasja M. van Schoor, Dorly J.H. Deeg and Kaj S. Emanuel

present, a sensitive performance battery can detect a clinically meaningful difference in functional performance related to knee OA. For functioning without cartilage, older people with radiographic knee OA who self-report no functional limitations do score lower on a performance battery. Acknowledgments

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Zeike A. Taylor and Karol Miller

An important and longstanding field of research in orthopedic biomechanics is the elucidation and mathematical modeling of the mechanical response of cartilaginous tissues. Traditional approaches have treated such tissues as continua and have described their mechanical response in terms of macroscopic models borrowed from solid mechanics. The most important of such models are the biphasic and single-phase viscoelastic models, and the many variations thereof. These models have reached a high level of maturity and have been successful in describing a wide range of phenomena. An alternative approach that has received considerable recent interest, both in orthopedic biomechanics and in other fields, is the description of mechanical response based on consideration of a tissue's structure—so-called microstructural modeling. Examples of microstructurally based approaches include fibril-reinforced biphasic models and homogenization approaches. A review of both macroscopic and microstructural constitutive models is given in the present work.

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Richard B. Souza, Shruti Arya, Christine D. Pollard, George Salem and Kornelia Kulig

The purpose of the current investigation was to test the hypothesis that subjects with patellar tendinopathy would demonstrate altered sagittal plane joint moment contributions during hopping tasks. Fourteen subjects (7 patellar tendinopathy, 7 controls) participated. Sagittal net joint moments of the lower extremity, total support moment, and joint contributions to the total support moment were calculated while subjects hopped continuously at a self-selected frequency and at 1.67 Hz. Significant differences were observed for contributions to the total support moment (p = .022). When averaged across hopping frequencies, subjects with patellar tendinopathy demonstrated greater hip contribution (p = .030) and lesser knee contribution (p = .006) compared with the control subjects. Shifting the workload away from the knee and toward the hip may result in a detrimental increase in hip demand and potentially harmful long-term effects on the articular cartilage of the hip.

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Benno M. Nigg, Gerald K. Cole and Gert-Peter Brüggemann

Impact forces have been speculated to be associated with the development of musculoskeletal injuries. However, several findings indicate that the concepts of “impact forces” and the paradigms of their “cushioning” may not be well understood in relation to the etiology of running injuries and that complex mechanisms may be responsible for injury development during running. The purposes of this paper are (a) to review impact mechanics during locomotion, (b) to review injuries and changes of biological tissue due to impact loading, and (c) to synthesize the mechanical and biological findings. In addition, directions for future research are discussed. Future research should address the development of noninvasive techniques to assess changes in the morphology and biochemistry of bone, cartilage, tendon, and ligaments; researchers should also try to simulate impact loading during activities such as running, focusing on the interaction of the various loading parameters that determine the acceptable windows of loading for biological tissues.

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Hana Debevec, Douglas R. Pedersen, Aleš Iglic̆ and Matej Daniel

It was shown in several clinical studies that static one-legged stance may be a relevant body position to describe the loads acting at the hip. However, the stress distribution averaged during movement may better describe hip load than hip contact stress distribution in the static body position. Using data on the resultant hip force during walking taken from the measurements of Bergmann (2001), spatial distribution of contact stress over the articular surface was calculated by the HIPSTRESS method and compared with the stress distribution in one-legged stance. It is shown, that the shape of the contact stress distribution during one-legged stance closely resembled the averaged contact stress distribution during the walking cycle (Pearson’s correlation coefficient R 2 = .986; p < .001). This finding presents a link between the hypothesis that the averaged contact stress distribution during a walking cycle is crucial for cartilage development and the results of clinical studies in which the calculated distribution of contact stress in one-legged stance was successfully used to predict the clinical status of the hip.