Computer simulations of patellofemoral joint surgery. Patient-specific models for tuberosity transfer.
BACKGROUND
Variable clinical outcomes of tibial tuberosity transfer surgery have been reported.


OBJECTIVE
The biomechanical outcome of surgery is patient-specific; no single procedure produces superior results for all patients. Use of patient-specific computer models can optimize choice of procedure.


METHODS
Computer simulation study using clinical data.


METHODS
We used patient-specific multibody models of the patellofemoral joints of 20 patients with a diagnosis of patellar subluxation and osteoarthritis. Four tibial tuberosity transfer procedures (two anterior and two anteromedial) were simulated for each patient and compared with their preoperative model.


RESULTS
When results for all patients were averaged, all simulated operations produced a statistically significant decrease in surface-wide mean contact stress, although no significant difference was found among them.


CONCLUSIONS
The simulated surgical outcomes were patient-specific: no single procedure was consistently superior at decreasing peak or mean stress and each procedure produced a potentially detrimental outcome, an increase in either mean stress or peak stress, in at least one patient.


CONCLUSIONS
Computer simulation may serve as a valuable tool for tailoring procedures to specific patients.
Cohen
Zohara A
ZA
Department of Mechanical Engineering and Biomedical Engineering, Columbia University, New York, New York, USA.
Henry
Jack H
JH
McCarthy
Denise M
DM
Mow
Van C
VC
Ateshian
Gerard A
GA
D001696:Biomechanical Phenomena; D002358:Cartilage, Articular / Q000473:pathology; D003198:Computer Simulation; D006801:Humans; D007719:Knee Joint / Q000473:pathology / Q000601:surgery*; D008954:Models, Biological; D020370:Osteoarthritis, Knee / Q000473:pathology / Q000601:surgery; D010329:Patella / Q000473:pathology / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D016059:Range of Motion, Articular; D012399:Rotation; D013314:Stress, Mechanical; D025321:Surgery, Computer-Assisted; D013977:Tibia / Q000473:pathology / Q000601:surgery