Use of embedded strain gages for the in-vitro study of proximal tibial cancellous bone deformation during knee flexion-extension movement: development, reproducibility and preliminary results of feasibility after frontal low femoral osteotomy

Abstract

Background: This paper reports the development of an in-vitro technique allowing quantification of relative (not absolute) deformations measured at the level of the cancellous bone of the tibial proximal epiphysis (CB(TPE)) during knee flexion-extension. This method has been developed to allow a future study of the effects of low femoral osteotomies consequence on the CB(TPE).

Methods: Six strain gages were encapsulated in an epoxy resin solution to form, after resin polymerisation, six measurement elements (ME). The latter were inserted into the CB(TPE) of six unembalmed specimens, just below the tibial plateau. Knee motion data were collected by three-dimensional (3D) electrogoniometry during several cycles of knee flexion-extension. Intra- and inter-observer reproducibility was estimated on one specimen for all MEs. Intra-specimen repeatability was calculated to determine specimen's variability and the error of measurement. A varum and valgum chirurgical procedure was realised on another specimen to observed CB(TPE) deformation after these kind of procedure.

Results: Average intra-observer variation of the deformation ranged from 8% to 9% (mean coefficient of variation, MCV) respectively for extension and flexion movement. The coefficient of multiple correlations (CMC) ranged from 0.93 to 0.96 for flexion and extension. No phase shift of maximum strain peaks was observed. Inter-observer MCV averaged 23% and 28% for flexion and extension. The CMC were 0.82 and 0.87 respectively for extension and flexion. For the intra-specimen repeatability, the average of mean RMS difference and the mean ICC were calculated only for flexion movement. The mean RMS variability ranged from 7 to 10% and the mean ICC was 0.98 (0.95-0.99). A Pearson's correlation coefficient was calculated showing that RMS was independent of signal intensity. For the chirurgical procedure, valgum and varum deviation seems be in agree with the frontal misalignment theory.

Conclusions: Results show that the methodology is reproducible within a range of 10%. This method has been developed to allow analysis the indirect reflect of deformation variations in CB(TPE) before and after distal femoral osteotomies. The first results of the valgum and varum deformation show that our methodology allows this kind of measurement and are encourageant for latter studies. It will therefore allow quantification and enhance the understanding of the effects of this kind of surgery on the CB(TPE) loading.

Figure 1

Schematic view of the experimental setting. Schematic view of the experimental setting showing a specimen mounted rigidly on the experimental jig in anatomical position. A: representation of the LVDT placed in the prolongation of the action line of different muscles. B: tibial 3D electrogoniometer. C: illustration of the loading muscles, RF, VL and VM by cerclage with metallic wires. D: representation of the fixation of the other muscles according to the bull's method.

Figure 2

Representation and location of measurement element. Schematic view and location of MEs. A1 and A2: Schematic view of the ME. A3: ME used in this study including a Strain Gage. B and C: 3D representation (obtained from medical imaging) of ME locations in the proximal epiphysis of the tibia. ME1 and ME6: most anterior edge of the medial and lateral condyles, respectively; ME2: most medial point of the medial condyle, ME3 and ME4 = most posterior edge of the medial and lateral condyles, respectively. M5: most lateral point of the lateral condyle (tunnels were drilled 10 mm below these landmarks, see text for further details).

Figure 3

Intra-operator reproducibility. Intra-operator variability during flexion and extension motion. ME 1: antero-medial strain gage; ME 2: medial strain gage; ME 3: postero-medial strain gage; ME 4: postero-lateral strain gage; ME 5: lateral strain gage; ME 6: antero-lateral strain gage.

Figure 4

Inter-operator reproducibility. Inter-operator variability during flexion and extension motion. ME 1: antero-medial strain gage; ME 2: medial strain gage; ME 3: postero-medial strain gage; ME 4: postero-lateral strain gage; ME 5: lateral strain gage; ME 6: antero-lateral strain gage.

Figure 5

Deformation repeatability for ME 6. Repeatability measurement for all specimens to the ME 6. ME 1: antero-medial strain gage; ME 2: medial strain gage; ME 3: postero-medial strain gage; ME 4: postero-lateral strain gage; ME 5: lateral strain gage; ME 6: antero-lateral strain gage.

Figure 6

Valgum and varum deviation on the cancellous bone deformation for ME 2. Representation of cancellous bone deformation for ME2 after varum and valgum procedure during knee flexion. INT: intact; Var 6°: varum 6°; Var 12°: varum 12°; Val 6°: valgum 6°; Val 12°: valgum 12°.