Examinando por Autor "Madera, Samuel"

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    Exploratory Anterior Cruciate Ligament Graft Stress during Medial Knee Rotation with and without Iliotibial Band–Intermuscular Septum Lateral Extra-Articular Tenodesis for Transtibial and Anteromedial Femoral Tunnels
    (Multidisciplinary Digital Publishing Institute (MDPI), 2024-06) Yañez, Roberto; Silvestre, Rony; Roby, Matias; Neira, Alejandro; Madera, Samuel; De la Fuente, Carlos
    Traditional lateral extra-articular tenodesis (LET) using fixation elements constrains medial knee rotation laxity after anterior cruciate ligament reconstruction (ACLr). However, the mechanical behavior of an LET made with an iliotibial band–intermuscular septum is unknown using different anterior cruciate ligament (ACL) reconstruction drillings and would be crucial for constraining the rotatory components of direction change movements. Thus, this study aimed to explore the maximum principal stresses and their distribution in grafts during medial knee rotation with and without iliotibial band–intermuscular septum lateral extra-articular tenodesis for the transtibial technique (TT), hybrid transtibial technique (HTT), and anteromedial portal technique (AM) in single-bundle ACLr. The maximum von Mises principal stresses and their distribution under medial knee rotation were described using a finite element model generated from a healthy knee. LET with HTT, TT, and AM decreases stress by 97%, 93%, and 86% during medial rotation compared to each technique without LET, respectively. The stress concentration for the AM portal and TT techniques was located at the femoral tunnel, and for HTT with LET, it was located across the distal thirds of the anterior aspect of the graft. In conclusion, the HTT with LET diminishes graft stress more than the HTT, TT, and AM without LET, and the TT and AM with LET during medial knee rotation. The AM portal, HTT, and TT techniques without LET show higher stress concentration patterns at the femoral tunnel, establishing a biomechanical risk of femoral tunnel enlargement when LET is not performed.
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    Finite element graft stress for anteromedial portal, transtibial, and hybrid transtibial femoral drillings under anterior translation and medial rotation: an exploratory study
    (Scientific Reports, Volume 14, Issue 1 December 2024 Article number 11922, 2024-12) Yañez, Roberto; Silvestre, Rony; Roby, Matias; Neira, Alejandro; Azar, Camilo; Madera, Samuel; Ortiz-Bernardin, Alejandro; Carpes, Felipe P.; De la Fuente, Carlos
    Stress concentration on the Anterior Cruciate Ligament Reconstruction (ACLr) for femoral drillings is crucial to understanding failures. Therefore, we described the graft stress for transtibial (TT), the anteromedial portal (AM), and hybrid transtibial (HTT) techniques during the anterior tibial translation and medial knee rotation in a finite element model. A healthy participant with a non-medical record of Anterior Cruciate Ligament rupture with regular sports practice underwent finite element analysis. We modeled TT, HTT, AM drillings, and the ACLr as hyperelastic isotropic material. The maximum Von Mises principal stresses and distributions were obtained from anterior tibial translation and medial rotation. During the anterior tibia translation, the HTT, TT, and AM drilling were 31.5 MPa, 34.6 Mpa, and 35.0 MPa, respectively. During the medial knee rotation, the AM, TT, and HTT drilling were 17.3 MPa, 20.3 Mpa, and 21.6 MPa, respectively. The stress was concentrated at the lateral aspect of ACLr,near the femoral tunnel for all techniques independent of the knee movement. Meanwhile, the AM tunnel concentrates the stress at the medial aspect of the ACLr body under medial rotation. The HTT better constrains the anterior tibia translation than AM and TT drillings, while AM does for medial knee rotation. © The Author(s) 2024.