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International Experience With Autologous Chondrocyte Implantation With Periosteum (Autologous Chondrocyte Implantation) Including Scaffold Guided Techniques and Tissue Engineered Matrix Support

Articular cartilage is a unique tissue with no vascular, nerve, or lymphatic supply. The lack of vascular and lymphatic circulation may be one of the reasons why articular cartilage has such a poor intrinsic capacity to heal. There is no inflammatory response to tissue damage unless there is involvement of subchondral bone in the damaged area. Subsequently, there will be no macrophage invasion to phagocytose and…

Articular Cartilage Injury and Adult Osteochondritis Dissecans: Treatment Options and Decision Making

Osteochondritis dissecans (OCD) is a pathologic process in which the subchondral bone and the overlying articular cartilage detach from the underlying bony surface. The disease results in subchondral bone loss and destabilization of the overlying articular cartilage, leading to separation and increased susceptibility to stress and shear. Fragmentation of both cartilage and bone leads to early degenerative changes and loss of function in the affected compartment.…

Articular Cartilage: Biology, Biomechanics, and Healing Response

Articular cartilage is a remarkable tissue with a unique functional architecture that supports multiplanar motion under a wide variety of loading conditions. In the absence of injury, and when allowed to function within its “zone of homeostasis,” human articular cartilage can provide a lifetime of pain-free motion. However, all too frequently, premature tissue failure occurs as a result of trauma, disease, or altered loading. Although articular…

Mobile Fluoroscopy: Determination of Natural, Unrestricted Knee Motion

Introduction Over the past two decades, fluoroscopy has been used as a tool to perform in vivo analysis of postoperative total joint replacement (TJR) results, primarily knees. The fluoroscope digital images frames when computationally combined with three-dimensional (3D) graphical models of the joint implants allow the 3D kinematics of the implanted joint motion to be revealed. Furthermore, the concept of inverse dynamics can then be used…

The Asian Knee

Introduction Five decades of knee arthroplasty in the Western world have seen periodic modifications in implant design and technique to suit and match the requirements of the white population. The past two decades have seen an unprecedented surge in the demand for this surgery in Asian populations. In Asian populations knee arthroplasty is being performed using the same implants as in the Western world. With experience,…

Knee Wear

* Acknowledgments: We especially appreciate the work of the many surgeons who dedicated time and effort to collaborating with the Dartmouth Biomedical Engineering Center Implant Retrieval Laboratory by sending retrieved devices. Without their commitment to this enterprise of continuing study and improvement, none of this work would be possible. We also gratefully acknowledge the leadership and teachings of Professor John P. Collier, Director of the Dartmouth…

Wear Simulation of Knee Implants

Wear simulation testing of knee replacements allows the influence of various design and condition variables on the wear performance to be examined in a controlled environment. One million cycles is considered to represent a full year in vivo; however, this value is conservative for younger and more active patients, who may achieve over 2 million steps per year. This chapter examines the progression of experimental and…

Does Strain in the Patella Change After Total Knee Arthroplasty? A Finite Element Investigation of Natural and Implanted Patellae

Patellar fracture and anterior knee pain remain as significant complications following total knee replacement (TKR). In several TKR studies reported in the literature the average incidence of anterior knee pain was 12%. Long-term, large-cohort studies have reported patellar fracture rates of 0.68%, 1.14%, 3.8%, and 5.2% in TKR populations involving 12,424, 1494, 4583, and 8530 knees, respectively. Even at these relatively low incidence rates, the number…

In Vivo Mechanics and Vibration of the Knee Joint

Knee joint injuries are among the most prevalent musculoskeletal problems, and there are a number of potential reasons for these injuries. In younger adults, sports tend to be a major cause of injury, whereas arthritic degeneration, such as rheumatoid arthritis and osteoarthritis, tend to affect older adults. Traumatic injuries acquired as young adults tend to exacerbate degenerative injuries later in life. To restore function and quality…

Contact Mechanics of the Human Knee

Total knee arthroplasty (TKA) has evolved to be a very successful and reliable procedure reducing pain because of osteoarthritis, correcting deformities, and improving disability associated with other pathologic knee conditions. The excellent outcomes of TKA, strong marketing by implant companies worldwide, and better patient education have encouraged surgeons to perform TKA surgeries on younger and culturally diverse patients who have increased activity demands that require increased…

Forward Solution Modeling: An In Vivo Theoretical Simulator of the Knee

What Is Mathematical Modeling? Mathematical modeling pertains to any simulation of a physical system using a computer. In practice, mathematical modeling is an extremely diverse field, which can be applied to any system, ranging from modeling weather patterns to analyzing artificial knees. In this chapter, mathematical modeling focuses on physics simulations of the human knee. Therefore total knee arthroplasty (TKA) mathematical models are used to analyze…

In Vivo Kinematics of the Patellofemoral Joint

The patellofemoral joint is an integral aspect of the knee that enhances flexion and extension. Any disturbance in the joint, such as injury, muscle weakness, and congenital or developmental abnormalities, can greatly affect the overall functionality of the joint and inherently decrease the effectiveness of one's ability to flex and extend the lower leg. Patellofemoral disorders are often difficult to diagnose and may be related to…

Fluoroscopic Analysis of Total Knee Replacement

Analysis Methods The ongoing goal of improving the outcomes of total knee arthroplasty (TKA) yields the continuing need for accurate in vivo kinematic analyses. Popular kinematic study techniques include in vivo fluoroscopic analyses, in vitro analyses using cadavers, noninvasive analyses using motion tracking surface markers, more invasive in vivo analyses using roentgen stereophotogrammetric analysis (RSA), and quasidynamic magnetic resonance imaging (MRI) testing. Unfortunately, the mechanical actuators…

Three-Dimensional Morphology of the Knee

Introduction Of primary interest to the author of this chapter is the analysis of the intrinsic shape differences of the knee joint between different ethnic populations for development of implantable orthopedic devices. The research presented is thus threefold: by developing a novel automatic feature-detection algorithm, a set of automated measurements can be defined based on highly morphometric variant regions, which then allows for a statistical framework…

Ultrasound-Guided Procedures

Introduction The use of ultrasound guidance for knee procedures has become increasingly popular in recent years due to recognized increased accuracy compared with those performed blind, as well as an expansion in the range of both intra-articular and extra-articular knee therapies. * Indeed, in addition to aiding knee joint injections and aspirations, ultrasound guidance is widely considered the gold standard for localization in a range of…

Tumors in the Knee

Introduction Tumors involving the knee can be subdivided into osseous and soft tissue neoplasms, with either benign or malignant histology. This chapter describes the patient demographics and multimodality imaging characteristics of the most common tumors about the knee, organized by the classification set forth by the World Health Organization. The imaging features of these tumors are described based upon their characteristics exhibited on radiographs, computed tomography…

Imaging of Total Knee Arthroplasty

Total knee arthroplasty (TKA) results in improvement in overall quality of life in more than 90% of patients. This remarkable success and factors such as an aging population have led to a dramatic increase in the number of procedures performed and to a corresponding increase in the number of imaging studies obtained for assessment. In addition to radiography, computed tomography (CT), magnetic resonance imaging (MRI), ultrasonography…

Imaging of the Extensor Mechanism

Imaging of the Extensor Mechanism The extensor mechanism of the knee plays an important role in normal lower extremity function. It is a complex of interconnected structures in the anterior knee that includes the quadriceps muscle group, quadriceps tendon, patella, patellar tendon, tibial tubercle, retinaculum, and adjacent soft tissues. Functionally, the extensor mechanism allows for knee extension when the leg is elevated, and acts as a…

Medial Supporting Structures: Medial Collateral Ligament and Posteromedial Corner

Introduction The posteromedial corner of the knee (PMC) is a significant anatomic structure that is as important as the posterolateral corner in multiligamentous injuries. Even though it is easily seen on modern high-field magnetic resonance (MR) imaging systems, it is often unnoticed and there is a lack of knowledge of its complex anatomy and function. Appropriate understanding of its structures, including knowledge about its normal appearance…

Lateral Supporting Structures: Posterolateral Corner Structures and Iliotibial Band

Introduction The lateral supporting structures, including the posterolateral corner and iliotibial band, are important for knee stability and injuries to these structures are more common than historically recognized. Using magnetic resonance imaging (MRI) exams in patients presenting with acute knee trauma, authors have recently found that injuries to the posterolateral corner structures occur in up to 21% of cases and injuries to the iliotibial band occur…