Sacroiliac joint stability: Finite element analysis of implant number, orientation, and superior implant length

AIM To analyze how various implants placement variables affect sacroiliac(SI) joint range of motion. METHODS An experimentally validated finite element model of the lumbar spine and pelvis was used to simulate a fusion of the SI joint using various placement configurations of triangular implants(iF use Implant System~?). Placement configurations were varied by changing implant orientation, superior implant length, and number of implants. The range of motion of the SI joint was calculated using a constant moment of 10 N-m with a follower load of 400 N. The changes in motion were compared between the treatment groups to assess how the different variables affected the overall motion of the SI joint. RESULTS Transarticular placement of 3 implants with superior implants that end in the middle of the sacrum resulted in the greatest reduction in range of motion(flexion/extension = 73%, lateral bending = 42%, axial rotation = 72%). The range of motions of the SI joints were reduced with use of transarticular orientation(9%-18%) when compared with an inline orientation. The use of a superior implant that ended mid-sacrum resulted in median reductions of(8%-14%) when compared with a superior implant that ended in the middle of the ala. Reducing the number of implants, resulted in increased SI joint range of motions for the 1 and 2 implant models of 29%-133% and 2%-39%, respectively,when compared with the 3 implant model.CONCLUSION Using a validated finite element model we demonstrated that placement of 3 implants across the SI joint using a transarticular orientation with superior implant reaching the sacral midline resulted in the most stable construct. Additional clinical studies may be required to confirm these results.

The Effect of Ligament Modeling Technique on Knee Joint Kinematics: A Finite Element Study

Finite element (FE) analysis has become an increasingly popular technique in the study of human joint biomechanics, as it allows for detailed analysis of the joint/tissue behavior under complex, clinically relevant loading conditions. A wide variety of modeling techniques have been utilized to model knee joint ligaments. However, the effect of a selected constitutive model to simulate the ligaments on knee kinematics remains unclear. The purpose of the current study was to determine the effect of two most common techniques utilized to model knee ligaments on joint kinematics under functional loading conditions. We hypothesized that anatomic representations of the knee ligaments with anisotropic hyperelastic properties will result in more realistic kinematics. A previously developed, extensively validated anatomic FE model of the knee developed from a healthy, young female athlete was used. FE models with 3D anatomic and simplified uniaxial representations of main knee ligaments were used to simulate four functional loading conditions. Model predictions of tibiofemoral joint kinematics were compared to experimental measures. Results demonstrated the ability of the anatomic representation of the knee ligaments (3D geometry along with anisotropic hyperelastic material) in more physiologic prediction of the human knee motion with strong correlation (r ≥ 0.9 for all comparisons) and minimum deviation (0.9° ≤ RMSE ≤ 2.29°) from experimental findings. In contrast, non-physiologic uniaxial elastic representation of the ligaments resulted in lower correlations (r ≤ 0.6 for all comparisons) and substantially higher deviation (2.6°≤ RMSE ≤ 4.2°) from experimental results. Findings of the current study support our hypothesis and highlight the critical role of soft tissue modeling technique on the resultant FE predicted joint kinematics.

The Endplate Morphology Changes with Change in Biomechanical Environment Following Discectomy

Bone is a dynamic structure and is known to respond to changes in the load over time, in accordance with Wolff’s law. It states that the bone changes its shape and internal architecture in response to stresses acting on it [1]. Therefore, any structural changes in the spine may lead to bone remodeling due to changes in the optimal stress pattern. The changes in apparent density and thickness of the endplates following discectomy of varying amounts were analyzed. The study design coupled a bone remodeling algorithm based on strain energy density theory of adaptive remodeling with an experimentally validated 3D ligamentous finite element model of the spine. The apparent density and thickness of the index level endplates decreased above and below the region of discectomy. On the other hand, these parameters showed increases at the remaining regions of the endplate. There were no correlations between the amount of nucleus removed and the average percentage changes in apparent density and thickness of endplate above and below the discectomy region. However, the average percentage changes in apparent density and thickness at endplate in the other region increased with increase in amount of nucleus removed. These predictions are in agreement with the clinical observations [2-6].