Abstract

The relationship between three-dimensional shape and patellofemoral mechanics is complicated. The Wiberg patella classification is a method of distinguishing shape differences in the axial plane of the patella that can be used to connect shape differences to observed mechanics. This study uses the Wiberg patella classification to differentiate variance in a statistical shape model describing changes in patella morphology and height. We investigate how patella morphology influences force distribution within the patellofemoral joint. The Wiberg type I patella has a more symmetrical medial and lateral facet while the type III patella has a larger lateral facet compared to medial. The second principal component of the statistical shape model described shape variation that qualitatively resembled the different Wiberg patellas. We generated patellofemoral morphologies from the statistical shape model and integrated them into a musculoskeletal model with a twelve degrees-of-freedom knee. We simulated an overground walking trial with these morphologies and recorded patellofemoral mechanics and ligament forces. An increase in patellar ligament force corresponded with an increase in patella height. Wiberg type III patellas had a sharper patella apex which related to lower ratios of quadriceps tendon forces to patellar ligament forces. The change in pivot point of the patella affects the ratio of forces as well as the patellofemoral reaction force. This study provides a better understanding of how patella morphology affects fundamental patella mechanics which may help identify at-risk populations for pathology development.

References

1.
Clouthier
,
A. L.
,
Smith
,
C. R.
,
Vignos
,
M. F.
,
Thelen
,
D. G.
,
Deluzio
,
K. J.
, and
Rainbow
,
M. J.
,
2019
, “
The Effect of Articular Geometry Features Identified Using Statistical Shape Modelling on Knee Biomechanics
,”
Med. Eng. Phys.
,
66
, pp.
47
55
.10.1016/j.medengphy.2019.02.009
2.
Fitzpatrick
,
C. K.
,
Baldwin
,
M. A.
,
Laz
,
P. J.
,
FitzPatrick
,
D. P.
,
Lerner
,
A. L.
, and
Rullkoetter
,
P. J.
,
2011
, “
Development of a Statistical Shape Model of the Patellofemoral Joint for Investigating Relationships Between Shape and Function
,”
J. Biomech.
,
44
(
13
), pp.
2446
2452
.10.1016/j.jbiomech.2011.06.025
3.
Biyani
,
R.
,
Elias
,
J. J.
,
Saranathan
,
A.
,
Feng
,
H.
,
Guseila
,
L. M.
,
Morscher
,
M. A.
, and
Jones
,
K. C.
,
2014
, “
Anatomical Factors Influencing Patellar Tracking in the Unstable Patellofemoral Joint
,”
Knee Surg. Sports Traumatol. Arthrosc.
,
22
(
10
), pp.
2334
2341
.10.1007/s00167-014-3195-y
4.
Powers
,
C. M.
,
2000
, “
Patellar Kinematics, Part II: The Influence of the Depth of the Trochlear Groove in Subjects With and Without Patellofemoral Pain
,”
Phys. Ther.
,
80
(
10
), pp.
965
973
.10.1093/ptj/80.10.965
5.
Fitzpatrick
,
C. K.
,
Steensen
,
R. N.
,
Tumuluri
,
A.
,
Trinh
,
T.
,
Bentley
,
J.
, and
Rullkoetter
,
P. J.
,
2016
, “
Computational Analysis of Factors Contributing to Patellar Dislocation
,”
J. Orthop. Res.
,
34
(
3
), pp.
444
453
.10.1002/jor.23041
6.
Wiberg
,
G.
,
1941
, “
Roentgenographs and Anatomic Studies on the Femoropatellar Joint: With Special Reference to Chondromalacia Patellae
,”
Acta Orthop. Scand.
,
12
(
1–4
), pp.
319
410
.10.3109/17453674108988818
7.
Grelsamer
,
R. P.
,
Proctor
,
C. S.
, and
Bazos
,
A. N.
,
1994
, “
Evaluation of Patellar Shape in the Sagittal Plane: A Clinical Analysis
,”
Am. J. Sports Med.
,
22
(
1
), pp.
61
66
.10.1177/036354659402200111
8.
Maldague
,
B.
, and
Malghem
,
J.
,
1985
, “
Apport Du Cliché de Profil Du Genou Dans Le Dépistage Des Instabilités Rotuliennes: Rapport Préliminaire
,”
Apport Du Cliché de Profil Du Genou Dans Le Dépistage Des Instabilités Rotuliennes: Rapport Préliminaire
,
71
, pp.
5
13
. https://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=8416872
9.
Servien
,
E.
,
Si Selmi Ait
,
T.
, and
Neyret
,
P.
,
2003
, “
Study of the Patellar Apex in Objective Patellar Dislocation
,”
Revue de Chirurgie Orthopedique et Reparatrice de L'appareil Moteur
,
89
(
7
), pp.
605
612
. https://europepmc.org/article/med/14699306
10.
Panni
,
A. S.
,
Cerciello
,
S.
,
Maffulli
,
N.
,
Di Cesare
,
M.
,
Servien
,
E.
, and
Neyret
,
P.
,
2011
, “
Patellar Shape Can Be a Predisposing Factor in Patellar Instability
,”
Knee Surg. Sports Traumatol. Arthrosc.
,
19
(
4
), pp.
663
670
.10.1007/s00167-010-1329-4
11.
Harbaugh
,
C. M.
,
Wilson
,
N. A.
, and
Sheehan
,
F. T.
,
2010
, “
Correlating Femoral Shape With Patellar Kinematics in Patients With Patellofemoral Pain
,”
J. Orthop. Res.
,
28
(
7
), pp.
865
872
.10.1002/jor.21101
12.
Miranda
,
D. L.
,
Rainbow
,
M. J.
,
Leventhal
,
E. L.
,
Crisco
,
J. J.
, and
Fleming
,
B. C.
,
2010
, “
Automatic Determination of Anatomical Coordinate Systems for Three-Dimensional Bone Models of the Isolated Human Knee
,”
J. Biomech.
,
43
(
8
), pp.
1623
1626
.10.1016/j.jbiomech.2010.01.036
13.
Rainbow
,
M. J.
,
Miranda
,
D. L.
,
Cheung
,
R. T. H.
,
Schwartz
,
J. B.
,
Crisco
,
J. J.
,
Davis
,
I. S.
, and
Fleming
,
B. C.
,
2013
, “
Automatic Determination of an Anatomical Coordinate System for a Three-Dimensional Model of the Human Patella
,”
J. Biomech.
,
46
(
12
), pp.
2093
2096
.10.1016/j.jbiomech.2013.05.024
14.
Gower
,
J. C.
,
1975
, “
Generalized Procrustes Analysis
,”
Psychometrika
,
40
(
1
), pp.
33
51
.10.1007/BF02291478
15.
Lenhart
,
R. L.
,
Kaiser
,
J.
,
Smith
,
C. R.
, and
Thelen
,
D. G.
,
2015
, “
Prediction and Validation of Load-Dependent Behavior of the Tibiofemoral and Patellofemoral Joints During Movement
,”
Ann. Biomed. Eng.
,
43
(
11
), pp.
2675
2685
.10.1007/s10439-015-1326-3
16.
Delp
,
S. L.
, and
Loan
,
J. P.
,
2000
, “
A Computational Framework for Simulating and Analyzing Human and Animal Movement
,”
IEEE Comput. Sci. Eng.
,
2
(
5
), pp.
46
55
.10.1109/5992.877394
17.
Myronenko
,
A.
,
Song
,
X.
, and
Carreira-Perpinán
,
M. A.
,
2007
, “
Non-Rigid Point Set Registration: Coherent Point Drift
,”
Adv. Neural Inf. Process. Syst.
,
19
, p.
1009
.https://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.85.493&rep=rep1&type=pdf
18.
Smith
,
C. R.
,
Choi
,
K. W.
,
Negrut
,
D.
, and
Thelen
,
D. G.
,
2018
, “
Efficient Computation of Cartilage Contact Pressures Within Dynamic Simulations of Movement
,”
Comput. Methods Biomech. Biomed. Eng. Imag. Visual.
,
6
(
5
), pp.
491
498
.10.1080/21681163.2016.1172346
19.
Teng
,
H.
,
MacLeod
,
T. D.
,
Kumar
,
D.
,
Link
,
T. M.
,
Majumdar
,
S.
, and
Souza
,
R. B.
,
2015
, “
Individuals With Isolated Patellofemoral Joint Osteoarthritis Exhibit Higher Mechanical Loading at the Knee During the Second Half of the Stance Phase
,”
Clin. Biomech.
,
30
(
4
), pp.
383
390
.10.1016/j.clinbiomech.2015.02.008
20.
Ward
,
S. R.
, and
Powers
,
C. M.
,
2004
, “
The Influence of Patella Alta on Patellofemoral Joint Stress During Normal and Fast Walking
,”
Clin. Biomech.
,
19
(
10
), pp.
1040
1047
.10.1016/j.clinbiomech.2004.07.009
21.
Bei
,
T.
, and
Fregly
,
B. J.
,
2004
, “
Multibody Dynamic Simulation of Knee Contact Mechanics
,”
Med. Eng. Phys.
,
26
(
9
), pp.
777
789
.10.1016/j.medengphy.2004.07.004
22.
Buff
,
H.
,
Jones
,
L. C.
, and
Hungerford
,
D. S.
,
1988
, “
Experimental Determination of Forces Transmitted Through the Patello-Femoral Joint
,”
J. Biomech.
,
21
(
1
), pp.
17
23
.10.1016/0021-9290(88)90187-X
23.
Schindler
,
O. S.
, and
Scott
,
W. N.
,
2011
, “
Basic Kinematics and Biomechanics of the Patello-Femoral Joint. Part 1: The Native Patella
,”
Acta Orthop. Belgica
,
77
(
4
), pp.
421
31
.https://pubmed.ncbi.nlm.nih.gov/21954748/
24.
Huberti
,
H. H.
,
Hayes
,
W. C.
,
Stone
,
J. L.
, and
Shybut
,
G. T.
,
1984
, “
Force Ratios in the Quadriceps Tendon and Ligamentum Patellae
,”
J. Orthop. Res.
,
2
(
1
), pp.
49
54
.10.1002/jor.1100020108
25.
Ward
,
S. R.
,
Terk
,
M. R.
, and
Powers
,
C. M.
,
2005
, “
Influence of Patella Alta on Knee Extensor Mechanics
,”
J. Biomech.
,
38
(
12
), pp.
2415
2422
.10.1016/j.jbiomech.2004.10.010
26.
Van Eijden
,
T. M. G. J.
,
Kouwenhoven
,
E.
, and
Weijs
,
W. A.
,
1987
, “
Mechanics of the Patellar Articulation Effects of Patellar Ligament Length Studied With a Mathematical Model
,”
Acta Orthop. Scand.
,
58
(
5
), pp.
560
566
.10.3109/17453678709146400
27.
Van Eijden
,
T. M. G. J.
,
Kouwenhoven
,
E.
,
Verburg
,
J.
, and
Weijs
,
W. A.
,
1986
, “
A Mathematical Model of the Patellofemoral Joint
,”
J. Biomech.
,
19
(
3
), pp.
219
229
.10.1016/0021-9290(86)90154-5
28.
Gill
,
H. S.
, and
O'Connor
,
J. J.
,
1996
, “
Biarticulating Two-Dimensional Computer Model of the Human Patellofemoral Joint
,”
Clin. Biomech.
,
11
(
2
), pp.
81
89
.10.1016/0268-0033(95)00021-6
29.
Bishop
,
R. E. D.
, and
Denham
,
R. A.
,
1977
, “
A Note on the Ratio Between Tensions in the Quadriceps Tendon and Infra-Patellar Ligament
,”
Eng. Med.
,
6
(
2
), pp.
53
54
.10.1243/EMED_JOUR_1977_006_013_02
30.
Sharma
,
A.
,
Leszko
,
F.
,
Komistek
,
R. D.
,
Scuderi
,
G. R.
,
Cates
,
H. E.
, and
Liu
,
F.
,
2008
, “
In Vivo Patellofemoral Forces in High Flexion Total Knee Arthroplasty
,”
J. Biomech.
,
41
(
3
), pp.
642
648
.10.1016/j.jbiomech.2007.09.027
31.
Mason
,
J. J.
,
Leszko
,
F.
,
Johnson
,
T.
, and
Komistek
,
R. D.
,
2008
, “
Patellofemoral Joint Forces
,”
J. Biomech.
,
41
(
11
), pp.
2337
2348
.10.1016/j.jbiomech.2008.04.039
32.
Bandi
,
W.
,
1972
, “
Chondromalacia Patellae and Femoro-Patellar Arthrosis, Etiology, Clinical Aspects and Therapy
,”
Helv. Chir. Acta
,
39
(
Suppl 11
), pp.
1
70
.https://pubmed.ncbi.nlm.nih.gov/4644859/
33.
Hungerford
,
D. S.
, and
Barry
,
M.
,
1979
, “
Biomechanics of the Patellofemoral Joint
,”
Clin. Orthop. Relat. Res.
,
144
, pp.
9
15
. https://pubmed.ncbi.nlm.nih.gov/535256/
34.
Smidt
,
G. L.
,
1973
, “
Biomechanical Analysis of Knee Flexion and Extension
,”
J. Biomech.
,
6
(
1
), pp.
79
80
.10.1016/0021-9290(73)90040-7
35.
Maquet
,
P.
,
1969
,
Biomechanics and Osteoarthritis of the Knee
,
SICOT. XI Congress
,
Mexico
.
36.
Stefanik
,
J. J.
,
Zhu
,
Y.
,
Zumwalt
,
A. C.
,
Gross
,
K. D.
,
Clancy
,
M.
,
Lynch
,
J. A.
,
Frey Law
,
L. A.
,
Lewis
,
C. E.
,
Roemer
,
F. W.
,
Powers
,
C. M.
,
Guermazi
,
A.
, and
Felson
,
D. T.
,
2010
, “
Association Between Patella Alta and the Prevalence and Worsening of Structural Features of Patellofemoral Joint Osteoarthritis: The Multicenter Osteoarthritis Study
,”
Arthritis Care Res.
,
62
(
9
), pp.
1258
1265
.10.1002/acr.20214
37.
Dejour
,
H.
,
Walch
,
G.
,
Nove-Josserand
,
L.
, and
Guier
,
C.
,
1994
, “
Factors of Patellar Instability: An Anatomic Radiographic Study
,”
Knee Surg. Sports Traumatol. Arthrosc.
,
2
(
1
), pp.
19
26
.10.1007/BF01552649
38.
Steiner
,
T. M.
,
Torga-Spak
,
R.
, and
Teitge
,
R. A.
,
2006
, “
Medial Patellofemoral Ligament Reconstruction in Patients With Lateral Patellar Instability and Trochlear Dysplasia
,”
Am. J. Sports Med.
,
34
(
8
), pp.
1254
61
.10.1177/0363546505285584
39.
Sheehan
,
F. T.
,
Derasari
,
A.
,
Brindle
,
T. J.
, and
Alter
,
K. E.
,
2009
, “
Understanding Patellofemoral Pain With Maltracking in the Presence of Joint Laxity: Complete 3D In Vivo Patellofemoral and Tibiofemoral Kinematics
,”
J. Orthop. Res.
,
27
(
5
), pp.
561
570
.10.1002/jor.20783
40.
Roddy
,
K. A.
,
Prendergast
,
P. J.
, and
Murphy
,
P.
,
2011
, “
Mechanical Influences on Morphogenesis of the Knee Joint Revealed Through Morphological, Molecular and Computational Analysis of Immobilised Embryos
,”
PLos One
,
6
(
2
), p.
e17526
.10.1371/journal.pone.0017526
41.
O'Neill
,
D. B.
,
Micheli
,
L. J.
, and
Warner
,
J. P.
,
1992
, “
Patellofemoral Stress: A Prospective Analysis of Exercise Treatment in Adolescents and Adults
,”
Am. J. Sports Med.
,
20
(
2
), pp.
151
156
.10.1177/036354659202000210
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