Clinical Biomechanics最新文献

{"title":"Muscle synergies are largely unaffected in individuals with diabetes who do not have diabetic neuropathy","authors":"Roya Hoveizavi ,&nbsp;Simon J. Fisher ,&nbsp;Benjamin R. Shuman ,&nbsp;Joshua C. Joiner ,&nbsp;Fan Gao","doi":"10.1016/j.clinbiomech.2025.106520","DOIUrl":"10.1016/j.clinbiomech.2025.106520","url":null,"abstract":"<div><h3>Background</h3><div>Impaired neuromuscular function in individuals with diabetes can adversely affect gait kinematics, kinetics, and electromyography, potentially increasing the risk of serious complications such as plantar ulcers and amputations. However, it remains unclear whether these changes are associated with alterations in muscle synergies. This study aims to examine muscle synergies in individuals with diabetes.</div></div><div><h3>Methods</h3><div>Surface electromyography recordings were obtained from seven lower extremity muscles (vastus lateralis, rectus femoris, biceps femoris, semitendinosus, lateral gastrocnemius, soleus, and tibialis anterior) during 20 trials of barefoot walking. Eleven individuals with type 2 diabetes without diabetic neuropathy and ten age-matched controls were recruited. Variations in synergy complexity were assessed by the number of synergies needed to account for &gt;90 % of the total variance in the electromyography data, total variance accounted for by one synergy, and total variance accounted for by four synergies. Synergy weights and activations for a four-synergy solution were compared using cosine similarity. An electromyography co-contraction index was computed for agonist and antagonist pairs of muscles.</div></div><div><h3>Findings</h3><div>Those with diabetes did not significantly differ from controls in the number of synergies, total variance accounted for by one synergy, total variance accounted for by four synergies, or synergy composition. However, they demonstrated higher levels of variability in synergy composition similarity.</div></div><div><h3>Interpretation</h3><div>These results indicate that, at the group level, individuals with diabetes without neuropathy employ largely similar motor control strategies as their healthy counterparts while walking, and previously reported variations in gait biomechanics in this population may be attributed to peripheral neuromuscular dysfunction.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106520"},"PeriodicalIF":1.4,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870588","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparison of Thiel-fixed and fresh-frozen temporal bon biomechanics with dynamic synchrotron-based X-ray imaging","authors":"Margaux Schmeltz ,&nbsp;Aleksandra Ivanovic ,&nbsp;Christian M. Schlepütz ,&nbsp;Wilhelm Wimmer ,&nbsp;Anne Bonnin ,&nbsp;Lukas Anschuetz","doi":"10.1016/j.clinbiomech.2025.106522","DOIUrl":"10.1016/j.clinbiomech.2025.106522","url":null,"abstract":"<div><h3>Background</h3><div>The Thiel embalming method offers lifelike tissue preservation, yet its suitability for biomechanical studies remains debated.</div></div><div><h3>Methods</h3><div>Here, we investigated two human temporal bones, one Thiel-fixed and one fresh-frozen, using dynamic synchrotron-based X-ray imaging under acoustic stimulation.</div></div><div><h3>Findings</h3><div>Both specimens exhibited a linear response at the umbo, but the Thiel-fixed specimen displayed discontinuity after the incudo-malleolar joint, suggesting ossicular chain stiffening. Our findings align well with previous studies indicating potential tissue degradation induced by Thiel-embalming.</div></div><div><h3>Interpretation</h3><div>These observations question the use of Thiel-fixed human specimens for biomechanical measurements on the middle ear, especially using dynamic synchrotron-based X-ray imaging. They emphasize the need for further assessment of the impact of Thiel-embalming methods on tissue mechanics.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106522"},"PeriodicalIF":1.4,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143820566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quantifying voluntary knee strength deficits and muscular contribution to torque in an anterior cruciate ligament-injured adolescent population using a musculoskeletal model","authors":"Teresa E. Flaxman ,&nbsp;Mohammad S. Shourijeh ,&nbsp;Sasha Carsen ,&nbsp;Zachary A. Flahaut ,&nbsp;Nicholas Romanchuk ,&nbsp;Michael J. Del Bel ,&nbsp;Daniel L. Benoit","doi":"10.1016/j.clinbiomech.2025.106521","DOIUrl":"10.1016/j.clinbiomech.2025.106521","url":null,"abstract":"<div><h3>Background</h3><div>Surface electromyography is commonly used to elucidate the effect of anterior cruciate ligament injury on neuromuscular function. For comparisons, electromyography is normalized to a known value, such as peak activation during maximum voluntary isometric contractions. However, a knee injury may compromise one's ability to achieve a true maximal effort. A simple musculoskeletal model may provide insight into injury related strength deficits.</div></div><div><h3>Methods</h3><div>Thirty-nine anterior cruciate ligament injured adolescents (14-16 years; 25 females) and 39 matched controls (25 females) completed maximum voluntary isometric knee extension and flexion contractions on an isokinetic dynamometer. A participant-specific musculoskeletal model used normalized electromyography of knee joint muscles to determine a theoretically ideal torque for each contraction type, assuming agonist muscles were fully activated. Strength deficit ratios expressed peak experimental torque relative to theoretically ideal torque. Individual muscle contribution to experimental torque were also computed.</div></div><div><h3>Findings</h3><div>Injured participants demonstrated significantly lower experimental torque than controls, with percent group mean difference of 17.8 % for knee extension (Injured:2.33 ± 0.89 vs Controls:2.88 ± 0.56 Nm/kg) and 16.7 % for flexion (Injured:1.22 ± 0.44 vs Controls:1.49 ± 0.27 Nm/kg). Group mean differences in strength ratios reduced to 6.3 % for extension (Injured:0.69 ± 0.11 vs Controls:0.74 ± 0.08) and 10.0 % for flexion (Injured:0.56 ± 0.15 vs Controls:0.63 ± 0.12). No between-group differences in muscular contribution to peak experimental extension torque were observed. Injured participants had lower medial gastrocnemius percent contribution to peak experimental flexion torque.</div></div><div><h3>Interpretation</h3><div>Isometric strength tests may not adequately identify strength deficits in adolescent anterior cruciate injured populations. Simplified modelling frameworks may be more appropriate for evaluating the relationship between neuromuscular control and functional outcomes.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106521"},"PeriodicalIF":1.4,"publicationDate":"2025-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143879212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Perturbed walking balance recovery between premenopausal and postmenopausal females","authors":"Raneem Haddara ,&nbsp;Tanya D. Ivanova ,&nbsp;S. Jayne Garland","doi":"10.1016/j.clinbiomech.2025.106512","DOIUrl":"10.1016/j.clinbiomech.2025.106512","url":null,"abstract":"<div><h3>Background</h3><div>Early postmenopausal females are at increased risk for falls and fragility fractures, despite often not meeting the diagnostic criteria for osteoporosis or showing noticeable declines in gait and balance.</div></div><div><h3>Methods</h3><div>Fifteen premenopausal females (aged 35–53) and fifteen postmenopausal females (aged 50–66) participated in this study. The Gait Real-time Analysis Interactive Laboratory was utilized to simulate unexpected perturbations during walking. Variables comprising the number of contralateral limb steps, step length, width, height, stance time, and double support time were analysed and compared between the groups in both natural and perturbed gait using statistical parametric mapping.</div></div><div><h3>Findings</h3><div>During the swing phase of the contralateral, unperturbed limb, most premenopausal females completed the swing phase without prematurely lowering their legs and taking additional steps with it. Conversely, most postmenopausal participants lowered their contralateral, unperturbed leg and took one or two steps with it before fully entering the swing phase and proceeding to the heel strike of the next gait cycle. Moreover, a smaller step width and shorter step height were observed during the perturbed gait cycle in the postmenopausal group compared to the premenopausal group.</div></div><div><h3>Interpretation</h3><div>Menopausal status significantly impacted balance recovery strategies and gait spatial parameters during balance-challenging perturbed conditions. These findings highlight the importance of applying perturbations and using spatial parametric mapping in further research to better understand gait stability and its role in fall risk during early menopause.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106512"},"PeriodicalIF":1.4,"publicationDate":"2025-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143823653","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Construct stability in anterior open wedge osteotomy: Assessing 3D-printed polylactic acid wedges against cortical bone","authors":"Kai Hoffeld ,&nbsp;Jan P. Hockmann ,&nbsp;Christopher Wahlers ,&nbsp;Peer Eysel ,&nbsp;Michael Hackl ,&nbsp;Johannes Oppermann","doi":"10.1016/j.clinbiomech.2025.106509","DOIUrl":"10.1016/j.clinbiomech.2025.106509","url":null,"abstract":"<div><h3>Background</h3><div>This in-vitro biomechanical study aimed to assess whether using a wedge as a gap filler in anterior open wedge osteotomy of the proximal tibia reduces load on the screw-plate construct and to evaluate if a 3D-printed polylactic acid wedge offers similar biomechanical stability like a bone wedge.</div></div><div><h3>Methods</h3><div>Twenty-four cadaveric proximal tibiae were randomly assigned to one of three groups: TomoFix plate alone as control group, TomoFix plate with a bone wedge, and TomoFix plate with a 3D-printed polylactic acid wedge. The specimens were subjected to axial loads of 400 N, 800 N, and 1200 N for 1000 cycles. Compression depth and axial stiffness were measured to assess stability.</div></div><div><h3>Findings</h3><div>There were no significant differences in overall compression depth or axial stiffness between the groups (<em>p</em> &gt; 0.05). At 1200 N, hinge fractures occurred in 6 of 8 specimens in the control group, compared to 0 of 8 in the wedge groups. Both bone and polylactic acid wedges improved construct stability, with the polylactic acid wedge performing comparably to the bone wedge.</div></div><div><h3>Interpretation</h3><div>Gap fillers, whether bone or polylactic acid wedges, may contribute construct stability in anterior open wedge osteotomy of the proximal tibia. The 3D-printed polylactic acid wedge may be biomechanically comparable to the bone wedge, suggesting its potential as an alternative in clinical applications.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106509"},"PeriodicalIF":1.4,"publicationDate":"2025-04-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143769253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial longitudinal arch variations and extrinsic foot muscle elasticity: Analysis of mobile, neutral, and rigid arch mobilities","authors":"David J. Kempfert ,&nbsp;Katy Mitchell ,&nbsp;Wayne Brewer ,&nbsp;Christina Bickley","doi":"10.1016/j.clinbiomech.2025.106505","DOIUrl":"10.1016/j.clinbiomech.2025.106505","url":null,"abstract":"<div><h3>Background</h3><div>The mobility of the medial longitudinal arch contributes to foot function by accommodating to varying loads during dynamic weight-bearing activities. Physiologically, an external load, or stress, causes deformation in response to the application of load. Elasticity measures may offer insight into how load is distributed amongst synergistic muscles of the foot. The study's objective was to compare elasticity of extrinsic foot muscles across different categories of medial longitudinal arch mobility.</div></div><div><h3>Methods</h3><div>In this within- and between-subjects exploratory design, shear wave elastography was used to measure elasticity of the tibialis anterior, tibialis posterior, peroneal longus, and peroneal brevis in a non-weight-bearing and weight-bearing condition. Participants (<em>N</em> = 109) were classified into mobile, neutral, and rigid arch categories using the Arch Height Index Measurement System.</div></div><div><h3>Findings</h3><div>In non-weight-bearing, a significant interaction (<em>p</em> = 0.049) revealed elasticity of the tibialis posterior was significantly (<em>p</em> = 0.003, <em>d</em> = 0.90) greater in the rigid arch group when compared to the mobile arch group. In weight-bearing, a significant main effect (<em>p</em> = ≤0.001) for elasticity revealed all muscles, except the tibialis anterior and peroneal brevis comparison, were significantly (<em>p</em> = ≤0.001) different from one another (<em>d</em> = 0.75–3.09).</div></div><div><h3>Interpretation</h3><div>This study presents a new approach to clinical measures of muscle elasticity using shear wave elastography. The findings offer valuable insight into the mechanical properties of extrinsic foot muscle elasticity across medial longitudinal arch mobility categories and the potential load sharing between synergistic muscles. Results showed elasticity of the tibialis posterior differed between mobile and rigid arches. This information may help inform future research in biomechanics and rehabilitation.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106505"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760539","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plantar pressure measurements to investigate the offloading effect of total contact softcast and total contact cast for plantar diabetic foot ulcers","authors":"Kor H. Hutting ,&nbsp;Bastiaan P. Vierhout ,&nbsp;Rene Visser ,&nbsp;Richte C.L. Schuurmann ,&nbsp;Mostafa El Moumni ,&nbsp;Jeff G. van Baal ,&nbsp;Jaap J. van Netten ,&nbsp;Jean-Paul P.M. de Vries","doi":"10.1016/j.clinbiomech.2025.106511","DOIUrl":"10.1016/j.clinbiomech.2025.106511","url":null,"abstract":"<div><h3>Background</h3><div>Total contact softcast is an offloading device for plantar diabetic foot ulcers. Compared with conventional knee-high total contact casts, the total contact softcast is shorter, lighter, and partially flexible. However, its pressure offloading effects are unknown.</div></div><div><h3>Methods</h3><div>In patients with plantar diabetic foot ulcers, mean peak plantar pressure was measured at the ulcer and 6 plantar foot regions in total contact softcast, total contact cast, and patient's own footwear. Patient-reported comfort was investigated using a visual analogue scale.</div></div><div><h3>Findings</h3><div>We included 20 patients. Mean peak plantar pressure at the ulcer site was significantly higher in total contact softcast (median, 505 kilopascal; interquartile range, 319;628 kilopascal) than in total contact cast (median, 320 kilopascal; interquartile range, 182;606 kilopascal; <em>p</em> = 0.011). Mean peak plantar pressure in total contact softcast was higher in all plantar regions except for the hindfoot. Peak plantar pressures were lower in total contact softcast than in patient's own footwear at the hallux, toes, and midfoot. Patient-reported comfort visual analogue scale scores during walking were significantly better in total contact softcast (median, 8.8; interquartile range, 6.8;9.4) than in total contact cast (median, 3.8; interquartile range, 1.7;4.9; <em>p</em> &lt; 0.001).</div></div><div><h3>Interpretation</h3><div>Peak plantar pressure was significantly higher in total contact softcast than in total contact cast at the diabetic foot ulcer site and all plantar foot regions, except the hindfoot. Patient-reported comfort was better in total contact softcast. Because reported clinical outcomes of total contact softcast are favorable, further prospective investigation is warranted.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106511"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143776808","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effect of internal rotation of the hindfoot on diagnosis of anterior talofibular ligament injury: An in vitro simulation study","authors":"Yutaro Nakao ,&nbsp;Hisayoshi Yoshizuka ,&nbsp;Akio Kuraoka","doi":"10.1016/j.clinbiomech.2025.106510","DOIUrl":"10.1016/j.clinbiomech.2025.106510","url":null,"abstract":"<div><h3>Background</h3><div>The anterior drawer test of the ankle is widely used to diagnose anterior talofibular ligament injuries caused by ankle sprains; however, low sensitivity has been reported. The braking effect of the deltoid ligament is likely responsible for this low sensitivity. This study aimed to examine the effect of consistent and mandated internal rotation of the hindfoot, which leads to relaxation of the deltoid ligament, on the conventional anterior drawer test.</div></div><div><h3>Methods</h3><div>Seven cadaveric ankle specimens were subjected to quantitative analysis with a stretchable strain sensor at 30° plantarflexion, with or without 10° internal rotations, under accurate three-axial joint angle monitoring using inertial measurement units. The anterior drawer distance (mm) was calculated from the measured change in the capacitance value (picofarad) detected using the stretchable strain sensor and compared with that measured with the anterior talofibular ligament detached.</div></div><div><h3>Findings</h3><div>A two-way repeated measures analysis of variance and post-hoc pairwise analysis revealed that the anterior drawer test with internal rotation revealed a significantly greater mean value than the conventional anterior drawer test (4.7 ± 1.6 mm <em>vs.</em> 2.2 ± 1.5 mm) in anterior talofibular ligament-detached samples (<em>P</em> &lt; 0.001). The capacitance data revealed an intraclass correlation coefficient (1,1) of 0.903.</div></div><div><h3>Interpretation</h3><div>Present findings suggest that our modified anterior drawer test with consistent and mandatory internal rotation, prevents the braking effect of the deltoid ligament and is expected to improve the sensitivity in assessing anterior talofibular ligament injuries.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"124 ","pages":"Article 106510"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143760540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Biomechanical properties of lenticules in the ReLEx® SMILE® minimally invasive surgery: Do the age and degree of myopia matter?","authors":"V.S. Kukanova ,&nbsp;A.K. Dzamikhova ,&nbsp;A.A. Akovantseva ,&nbsp;A.A. Frolova ,&nbsp;Yu.M. Efremov ,&nbsp;T. Yu Shilova ,&nbsp;A.A. Svistunov ,&nbsp;S.E. Avetisov ,&nbsp;P.S. Timashev ,&nbsp;S.L. Kotova","doi":"10.1016/j.clinbiomech.2025.106508","DOIUrl":"10.1016/j.clinbiomech.2025.106508","url":null,"abstract":"<div><h3>Background</h3><div>Myopia is currently the most common refractive disorder of the eye. The important role of the cornea's biomechanical parameters in relation to myopia has long been acknowledged, and ReLEx® SMILE minimally invasive refractive surgery offers new possibilities in the corneal biomechanical studies. The reported data on the role of the age and myopia degree in the corneal biomechanics are inconsistent.</div></div><div><h3>Methods</h3><div>We have examined a considerable number (122 in total) of SMILE-derived lenticules from patients of different ages and with different severity of myopia, using atomic force microscopy, microtester and tensile testing.</div></div><div><h3>Findings</h3><div>The mechanical properties of lenticules varied in a wide range and differed for the different techniques used. No differences between the Young's moduli of the anterior and posterior sides of lenticules were observed. The age-related stiffening of the cornea found in some studies was not registered in our study, with &gt;150 samples of patients aged from 17 to 47 years. Significantly lower tensile moduli of lenticules from moderate and high myopic eyes were measured by tensile testing in high-strain conditions, while no correlation was found using other techniques. The structural atomic force microscopy imaging studies demonstrated a mostly chaotic 3D network of collagen fibrils, while the roughness was independent of the myopia severity.</div></div><div><h3>Interpretation</h3><div>No fundamental effect of the age and myopia degree on the corneal mechanical properties and morphology has been shown. The inconsistency of findings reported in the literature are due to the high dispersion of experimental data and specifics of the measurement techniques.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106508"},"PeriodicalIF":1.4,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143791460","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A modular cage may prevent endplate damage and improve spinal deformity correction","authors":"Jan Ulrich Jansen ,&nbsp;Vincenza Sciortino ,&nbsp;Frank Heuer ,&nbsp;Hans-Joachim Wilke","doi":"10.1016/j.clinbiomech.2025.106502","DOIUrl":"10.1016/j.clinbiomech.2025.106502","url":null,"abstract":"<div><h3>Background</h3><div>Anterior lumbar interbody fusion is performed to fuse pathological spinal segments, generally, with a monobloc cage inserted by impact forces. Recently developed three-part modular cages attempt to reduce the impact forces, minimize the damage to the endplates and allow more lordosis angle correction.</div></div><div><h3>Methods</h3><div>Human lumbar motion segments (L2–3, L4–5) were used to simulate the implantation procedure of monobloc vs. modular stand-alone cages (<em>n</em> = 12). After preparing and embedding, a discectomy was performed followed by the two different types of cage implantation. Macroscopic images, microcomputed tomography scans and Artificial-Intelligence-based lordosis angle measurements were conducted and analyzed in the intact and implanted state and endplate damage was evaluated.</div></div><div><h3>Findings</h3><div>The modular and monobloc group had similar impact on three defined damage classes both groups fell into the mid-damage class (29 %); the modular group fell to 13 % in the low-damage class while the monobloc one to 17 % in the high-damage class. Fragmentation appeared more in the monobloc group (71 %), while defects appeared equally. The modular implantation achieved a median lordosis of 21.3° versus 19.5° for the monobloc (<em>P</em> = 0.132) leading to 34 % higher increase for the modular procedure.</div></div><div><h3>Interpretation</h3><div>Endplate damage occurs in both procedures but severe damage like bone fragmentation can be avoided with modular implantation. Bone fragmentation seems to affect and minimize the desired lordosis angle after cage implantation. This in vitro study underlines the need of new implantation procedures to achieve increased lordosis with anterior lumbar interbody fusion to restore the patients sagittal balance successfully.</div></div>","PeriodicalId":50992,"journal":{"name":"Clinical Biomechanics","volume":"125 ","pages":"Article 106502"},"PeriodicalIF":1.4,"publicationDate":"2025-03-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143870587","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}