Biomechanics & Analysis

Principles of spinal load-sharing, coupled motion, and material properties to guide surgical planning and implant selection.

Overview

A foundational understanding of hip joint biomechanics is essential for diagnosing and treating hip disorders, enabling clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions [1]. Biomechanics integrates fundamental principles of physics, engineering, and biology to describe and predict the effects of energy and various types of forces on biologic systems [14]. This discipline aids in understanding forces acting on the human body and the design of orthopaedic instruments, implants, and prostheses [14].

Current evidence supports specific biomechanical applications across various pathologies, including the recommendation to combine musculoskeletal dynamics modelling and finite element analysis to comprehensively understand in vivo patient-specific biomechanics after high tibial osteotomy [2]. The biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify its clinical use [3], while a stand-alone two-part fusion cage offers a justifiable biomechanical benefit [56]. Additionally, a fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes in vascularized iliac bone flaps for treating femoral head necrosis [12].

Despite these advances, significant gaps remain requiring further investigation. More clinically relevant biomechanical and clinical studies are required to determine the best technique to address rotational instability [6], and further research is needed to define a precise motion analysis protocol for stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine [11]. Data on geometric deformations of the lumbar disc during axial body rotations can provide new insights into the biomechanics of the lumbar spine [9] and optimize the parameters of artificial lumbar spine devices [9]. However, further biomechanical tests and clinical studies are required to prove Tektona®'s capabilities for height and volume restoration in osteoporotic vertebral compression fractures [10], and ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations [18].

Anatomy & Pathophysiology

Kinematics and Spinal Mechanics

Geometric deformations of the lumbar disc occur during axial body rotations [9], while the position of the lumbar spine center of rotation changes with variations in load [15] and differs between movement types [15]. Distinct motion patterns exist in the lower lumbar spine [15], and motions of the lumbar intervertebral levels are coupled [45] with non-linear load-displacement curves [45]. Ranges of motion of the lumbar intervertebral levels compare favorably with reported in vivo values [45], though weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax exist at other intervertebral levels [44]. Walking speed affects spinal loads and trunk muscle forces [16], and loading in the anterior-oblique direction requires lower external force or moment to maintain the neutral position compared to vertical [49] or posterior-oblique directions [49]. Increasing load significantly impacts the coupled translational movement of lumbar facet joints [36], and asymmetry affects the facet joint response under follower preload [17]. The thoracic spine functions as a complex three-dimensional structure with coupled motion characteristics [37].

Structural Integrity and Pathology

Critical spinal lytic defects result in kinematic abnormalities [20] and lower the compressive strength of the spine [20]. Total laminectomy changes the biomechanics in both normal lumbar models [40] and spondylolisthesis models [40]. Patient-specific spine digital twins enhance the understanding of scoliosis biomechanics [23], facilitate risk assessment for disc prolapse [23], and aid in treatment selection for scoliosis [23]. Data on the posterior bony column of the lumbar spine can provide theoretical references for spinal implant materials [43].

Instrumentation and Surgical Impact

Understanding biomechanical principles of spinal instrumentation and motion coupling is essential for optimizing three-dimensional correction of thoracolumbar spinal deformities [35] and achieving favorable mechanical environments for fusion [35]. Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics [33] and significantly affects the ability to compensate in the standing-to-sitting transition [33]. Noncontinuous cervical disc arthroplasty could preserve intervertebral disc pressure and facet joint forces at the adjacent and intermediate levels [51] while maintaining the kinematics of the cervical spine near preoperative values [51]. Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels [53].

Regional Specifics

The segmental contributions of the cervical spine during lateral bending movement were described based on a validated radiographic protocol [25]. An appropriate correction range exists for cervical kyphosis correction, supported by the link between biomechanical data and complications [26].

Classification

Biomechanical Foundations: Understanding hip joint biomechanics is essential for diagnosing and treating hip disorders, enabling clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions [1]. Biomechanics combines fundamental principles of physics, engineering, and biology to describe and predict the effects of energy and various types of forces on biologic systems, aiding in the understanding of forces acting on the human body and the design of orthopaedic instruments, implants, and prostheses [14].

Spinal Mechanics: Data on geometric deformations of the lumbar disc during axial body rotations can provide new insights into the biomechanics of the lumbar spine and optimize the parameters of artificial lumbar spine devices [9]. The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine [15]. Data on the effect of walking speed on spinal loads and trunk muscle forces using subject-specific musculoskeletal modeling provide a useful reference for future research in spinal biomechanics and musculoskeletal modeling [16]. The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment [55].

Periacetabular and Hip Joint Analysis: Further investigation is required to elucidate the specific biomechanical mechanisms underlying biomechanical changes in the lumbar and hip joint after curved periacetabular osteotomy [27]. The anterior and posterior approach differentially affect postoperative biomechanical function of the capsular ligaments after hip arthroplasty [28].

Femoral Neck and Proximal Humerus Systems: The biomechanical performance of the femoral neck system is fracture-type-dependent, necessitating angle-specific optimisation [38]. Internal fixation system biomechanical properties are more suitable for valgus-intercalated femoral neck fractures with a valgus angle greater than 15° than the femoral neck system [50]. The biomechanical literature regarding proximal humerus fracture implants is diverse and heterogeneous [7].

Other Considerations: Combining musculoskeletal dynamics modelling and finite element analysis is recommended to comprehensively understand in vivo patient-specific biomechanics after high tibial osteotomy [2]. The biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify clinical use [3]. Finite element analysis marks the first application that may support one of the underlying biomechanical theories of proximal fibular osteotomy, providing a foundation for future clinical and in-silico studies [24]. Consistent nomenclature, advanced imaging, and the integration of artificial intelligence are needed to personalize care based on individual anatomy and biomechanics in spinopelvic mechanics [22].

Clinical Presentation

A foundational understanding of hip joint biomechanics is essential for the accurate diagnosis and treatment of hip disorders [1]. In young patients, the pathogenesis of knee osteoarthritis is predominantly driven by an unfavorable biomechanical environment where mechanical demand exceeds the joint's capacity for repair and maintenance, predisposing articular cartilage to premature degeneration [47].

In the context of gonarthrosis, measured biomechanical values demonstrate a direct correlation between histological changes and altered biomechanics [8]. Patients with bilateral varus gonarthrosis who undergo staged medial opening wedge high tibial osteotomy experience marked improvements in established biomechanical risk factors for disease progression bilaterally, alongside clinically important improvements in patient-important outcomes [5]. Similarly, surgical treatment of medial meniscus posterior root repair allows for the restoration of physiological knee joint biomechanics [21]. To comprehensively understand in vivo patient-specific biomechanics following high tibial osteotomy, combining musculoskeletal dynamics modelling with finite element analysis is recommended [2].

For patellofemoral pathology, analyzing the spatial multi-plane kinematic characteristics of the joint may assist in determining the etiology of patellofemoral pain [34]. Notably, severely dysplastic joints did not result in significantly increased patellofemoral contact forces or abnormal kinematics in 3D-printed cadaveric model simulations [19]. In patients with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy, results stress the importance of monitoring both symptomatic and asymptomatic tendon structures; however, the asymptomatic side should not be used as a reference in clinical practice [32].

Regarding spinal and low back assessment, rasterstereography serves as a valuable tool for the dynamic evaluation of spinal posture and pelvic position, as well as for quantifying spinal motion [39]. IMU-derived kinematic parameters provide objective measures of impaired movement control and may support the clinical identification of individuals at risk for chronic or recurrent low back pain [41]. The step-up task can be utilized to identify aberrant movements in people with low back pain to develop more focused functional interventions [46].

Finally, shockwave therapy (SWT) has been shown to alter the morphology of musculoskeletal conditions, with these morphological changes potentially reflecting shifts in underlying pathophysiological processes [42].

Investigations

Plain radiography: While joint space width serves as a tool for predicting articular cartilage pathology, it is unreliable for patients with joint spaces greater than 2 mm in width and requires adjunctive methods [59]. Abduction or adduction malalignment significantly alters mPTS measurements on lateral knee radiographs [69]. Cross-table lateral imaging provides acceptable assessment of general component position but has limited utility for precise analysis in research or failure determination due to variations exceeding 10° in 20% of patients [70]. Computer-assisted analysis of young adult hip radiographs generally demonstrates substantial to excellent interobserver reliability for most parameters [58].

MRI: Magnetic resonance imaging should be used in conjunction with radiographic joint space for predicting articular cartilage pathology [59]. Performing both quantitative T2 relaxation time and magnetic transfer ratio imaging modalities under the same conditions is helpful in the evaluation of disc degeneration [57]. Classification consistency between magnetic resonance and computed tomography for femoral version measurements is moderate to high [68].

CT: CT or other MRI sequences are strongly recommended to assess patients who are potential candidates for hip joint preservation surgery [60]. CT currently provides quantitative measures of bone structure and may be used for estimating bone strength mathematically [63]. Composite beam theory analysis with quantitative computed tomography-derived measures of rigidity can be used to prospectively predict the yield loads of vertebrae with lytic defects [62].

Other Considerations: Understanding hip joint biomechanics allows clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions [1]. Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine [20]. Specific hip osteoarthritic morphological characteristics alter spinopelvic motion to a greater extent than others [64]. Preoperative spinopelvic characteristics that contribute to abnormal mechanics can normalize after total hip arthroplasty following improvement in hip flexion [29]. The rotation of the pelvis changes one year postoperatively after total hip arthroplasty [66]. A deep learning model can accurately and automatically measure spinal alignment parameters with reliable results, significantly reducing diagnostic time [67]. The segmental contributions of the cervical spine during lateral bending movement were first described based on a validated radiographic protocol [25]. An algorithm showed a high degree of consistency in acetabular orientation measures with respect to a prior study of the same cohort [30]. There is a direct correlation between histological changes and altered biomechanics in gonarthrosis [8]. Consistent nomenclature, advanced imaging, and the integration of artificial intelligence are needed to personalize care based on individual anatomy and biomechanics [22]. More clinically relevant biomechanical and clinical studies are required to determine the best technique to address rotational instability [6].

Treatment

Non-Operative

Treatment selection for hallux rigidus and osteoarthrosis of the first metatarsophalangeal joint ranges from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis [80]. The choice of intervention depends on disease stage and patient factors [80]. For meniscal pathology, meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment [71]. In childhood coxa vara, moderate nonprogressive deformity often does not require surgery [74].

Operative

Indications: Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy in childhood coxa vara [74]. Patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally after staged medial opening wedge high tibial osteotomy (HTO) [5]. Surgical treatment of medial meniscus posterior root repair (MMPRA) allows restoration of physiological knee joint biomechanics [21].

Surgical Approach / Technique: A fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes for treating femoral head necrosis using vascularized iliac bone flaps [12]. Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods for the spring ligament [77]. More clinically relevant biomechanical and clinical studies are required to determine the best technique to address rotational instability [6].

Implant Selection: The biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify its clinical use [3]. Cerclage femoral wiring for prophylactic purposes during hip arthroplasty does not confer a significant biomechanical advantage over non-wiring techniques [81]. Results from a finite element study support the potential of a novel double-threaded dynamic stabilization system for reducing long-term mechanical failure risks in lumbar stabilization [13]. PDS (Dynesys® dynamic stabilization) can maintain surgical level ROM and has less influence on whole and non-surgical level ROM compared to fusion [75]. Further biomechanical tests and clinical studies are needed to prove Tektona®'s capabilities for height and volume restoration in osteoporotic vertebral compression fractures [10]. ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations [18].

Alignment / Balancing Strategy: Understanding hip joint biomechanics allows clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions [1]. Combining musculoskeletal dynamics modelling and finite element analysis is recommended to comprehensively understand in vivo patient-specific biomechanics after high tibial osteotomy (HTO) [2]. Patient-specific spine digital twins modeling enhances the understanding of scoliosis biomechanics, facilitating risk assessment for disc prolapse and aiding in treatment selection [23].

Pain Management: Partial weight-bearing and range of motion limitation significantly reduce the loads at medial meniscus posterior root repair sutures in a cadaveric biomechanical model [21]. Increased motion between lumbar vertebrae after excision of the capsule and cartilage of the facets may increase tensile strain in a graft, potentially predisposing to non-union in lumbar arthrodesis without instrumentation [79].

Adjuncts: Results from 3D markerless asymmetry analysis lead to a more conservative approach in monitoring of scoliotic curves in clinical applications [61]. A more conservative approach in monitoring of scoliotic curves using 3D markerless asymmetry analysis results in a smaller number of radiographs being saved [61]. A more conservative approach in monitoring of scoliotic curves using 3D markerless asymmetry analysis decreases the risk of having non-measured curves with progression [61].

Other Considerations: Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance for multi-segmental kinematics of the thoracolumbar spine [11]. LSMDs (Lumbar segmental mobility disorders) are a valid means of defining sub-groups within non-specific LBP in a conservative care population of patients with RCLBP [78]. Patients with bilateral varus gonarthrosis experience clinically important improvements in patient-important outcomes after staged medial opening wedge HTO [5].

Complications

Other Considerations: Biomechanical understanding is critical for guiding interventions, as it allows clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint [1]. In gonarthrosis, a direct correlation exists between histological changes and altered biomechanics [8], while available literature provides clear insight into estimated stresses due to cam deformity and the assessment of risks leading to early joint degeneration [72]. Patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally after staged medial opening wedge high tibial osteotomy [5]. Finite element analysis supports one of the underlying biomechanical theories of proximal fibular osteotomy regarding joint pressure redistribution [24], and combining musculoskeletal dynamics modelling with finite element analysis is recommended to comprehensively understand in vivo patient-specific biomechanics after high tibial osteotomy [2].

Regarding implant and structural integrity, the biomechanical literature regarding proximal humerus fracture implants is diverse and heterogeneous [7]. Long-term use of cyclosporin-A can weaken the biomechanical properties of bone, thereby increasing the fracture rate of the lumbar vertebra and the proximal femur [31]. A fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes for treating femoral head necrosis [12]. The biomechanical characteristics of a new rigid biodegradable anchor for meniscus refixation justify clinical use [3], and a novel double-threaded dynamic stabilization system has potential for reducing long-term mechanical failure risks in lumbar stabilization [13]. Severely dysplastic joints did not result in significantly increased patellofemoral contact forces and abnormal kinematics in a cadaveric simulation [19].

In the context of spinal and pelvic corrections, the link between biomechanical data and complications after cervical kyphosis correction supported the existence of an appropriate correction range [26]. Preoperative spinopelvic characteristics that contribute to abnormal mechanics can normalize after total hip arthroplasty following improvement in hip flexion [29]. Further investigation is required to elucidate the specific biomechanical mechanisms underlying changes in the lumbar and hip joint after curved periacetabular osteotomy [27].

Recovery

Light activity (weeks): Evidence does not specify a discrete week range for light activity or driving. However, patients with bilateral varus gonarthrosis experience clinically important improvements in patient-important outcomes after staged medial opening wedge high tibial osteotomy [5]. In lumbar degenerative spondylolisthesis, deeper pedicle screw insertion within the safe range may better restore spino-pelvic sagittal balance and quality of life at an average follow-up time of 2 years [76].

Full activity (months): The evidence does not define a specific month range for full activity or return to sport. Patients with a preoperative duration of symptomatic medial knee overload or arthritis of two years or greater do not experience inferior patient-reported outcomes or clinical outcomes compared to patients with a symptom duration of less than 2 years at mid-term follow-up after high tibial osteotomy [82]. Bilateral varus gonarthrosis patients experience marked improvements in established biomechanical risk factors for disease progression bilaterally after staged medial opening wedge high tibial osteotomy [5].

Complete recovery / outcome plateau (months): Long-term use of cyclosporin-A can weaken the biomechanical properties of bone, thus increasing the fracture rate of the lumbar vertebra and the proximal femur [31]. Further studies with long-term follow-up are needed to determine whether the grafted area in autologous matrix-induced chondrogenesis will maintain structural and functional integrity over time [65]. Aging is associated with a loss of the consistent motion pattern observed in young asymptomatic individuals in the cervical spine [87].

Rehabilitation protocol: Combining musculoskeletal dynamics modelling and finite element analysis is recommended to comprehensively understand in vivo patient-specific biomechanics after high tibial osteotomy [2]. The anterior and posterior approach differentially affect postoperative biomechanical function of the capsular ligaments after hip arthroplasty [28]. Technique-dependent differences in tunnel features exist in ACL reconstruction, with changes in reaction forces and moments within the graft associated with smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling [86].

Functional milestones: The measured biomechanical values of human cartilage show a direct correlation between histological changes and altered biomechanics in gonarthrosis [8]. Mapping the hip center of rotation trajectory under common movements highlights the importance of hip translation on physiologic range of motion [83]. The pattern of patellar sagittal motion during the dynamic process was consistent between patellofemoral pain and control groups [84].

Other Considerations: The biomechanical concept of a cervical arthroplasty prosthesis has a significant impact on whether a near-physiological motion pattern can be achieved [73]. Flexible biomechanical properties in cervical arthroplasty shift the center of rotation toward normal [73], whereas fixed ball socket designs in cervical arthroplasty potentially worsen the motion pattern [73]. A novel double-threaded dynamic stabilization system has potential for reducing long-term mechanical failure risks in lumbar stabilization [13]. The effect of asymmetry on facet joint response should be fully considered in biomechanical studies of the lumbar spine, especially in post structures subjected to physiological loadings [17]. Longitudinal studies are required to establish the potential role of risk or prognostic shape phenotypes in lumbar disc degeneration [85].

Key Evidence

• [L5] An understanding of hip joint biomechanics constitutes an important background for the diagnosis and treatment of hip disorders, allowing clinicians to assimilate the effects of motions and deformations resulting from forces acting on the joint to guide appropriate medical interventions. (10.1016/j.arthro.2010.01.027)
• [L4] Combining musculoskeletal dynamics modelling and finite element analysis is recommended to comprehensively understand in vivo patient-specific biomechanics after HTO. (10.1155/2019/8363128)
• [L5] These biomechanical characteristics of this new implant justify clinical use. (10.1007/s00167-003-0439-7)
• [L4] Patients with bilateral varus gonarthrosis experience marked improvements in established biomechanical risk factors for disease progression bilaterally, as well as clinically important improvements in patient-important outcomes, after staged medial opening wedge HTO. (10.1007/s00167-013-2559-z)
• [L5] More clinically relevant biomechanical and clinical studies are required to determine the best technique to address rotational instability, and the authors are currently in the process of performing a multicenter randomized controlled trial to validate these procedures. (10.1177/0363546515605808)
• [L4] The biomechanical literature was found to be both diverse and heterogeneous. (10.1186/s12891-015-0627-x)
• [L4] The measured biomechanical values showed a direct correlation between histological changes and altered biomechanics in gonarthrosis. (10.1186/s13018-019-1308-5)
• [L4] These data can provide new insights into the biomechanics of the lumbar spine and optimize the parameters of artificial lumbar spine devices. (10.1186/s12891-022-05160-9)
• [L5] Further biomechanical tests and clinical studies have to proof Tektona®'s capabilities. (10.1186/s12891-020-03899-7)
• [L1] Further research is needed to define a precise motion analysis protocol in terms of segment definition and clinical relevance. (10.1186/s12891-022-05925-2)
• [L4] A fenestration at the center of the femoral neck resulted in improved biomechanical gain and clinical outcomes. (10.1186/s13018-024-05390-8)
• [Paper] These results support its potential for reducing long-term mechanical failure risks in lumbar stabilization. (10.1186/s13018-025-06130-2)
• [L4] The position of the lumbar spine center of rotation changes with variations in load and differs between movement types, suggesting distinct motion patterns in the lower lumbar spine. (10.1186/s12891-025-08410-8)
• [L4] These data provide a useful reference for future research in spinal biomechanics and musculoskeletal modeling. (10.1186/s13018-025-06408-5)
• [Paper] The effect of asymmetry on facet joint response should be fully considered in biomechanical studies of lumbar spine, especially in post structures subjected to physiological loadings. (10.1186/s12891-016-0980-4)
• [L5] Consequently, ALL-reconstruction cannot be recommended at the moment without further biomechanical investigations. (10.1007/s00167-017-4472-3)
• [L5] Severely dysplastic joints did not result in significantly increased patellofemoral contact forces and abnormal kinematics in this cadaveric simulation. (10.1177/03635465211031427)
• [L5] Critical spinal lytic defects result in kinematic abnormalities and lower the compressive strength of the spine. (10.2106/jbjs.19.00419)
• [L5] Surgical treatment of MMPRA allows restoration of physiological knee joint biomechanics. (10.1002/ksa.12465)
• [L5] The review underscores the need for consistent nomenclature, advanced imaging, and the integration of artificial intelligence to personalize care based on individual anatomy and biomechanics. (10.1302/0301-620x.106b11.bjj-2024-0373)
• [L5] This modeling approach enhances the understanding of scoliosis biomechanics, facilitating risk assessment for disc prolapse and aiding in treatment selection. (10.1186/s13018-024-05417-0)
• [L5] This research marks the first application of finite element analysis that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies. (10.1186/s13018-024-04807-8)
• [L3] The segmental contributions of cervical spine during lateral bending movement were first described based on the validated radiographic protocol. (10.1186/1471-2474-15-273)
• [L5] The link between biomechanical data and complications after cervical kyphosis correction supported the existence of an appropriate correction range. (10.1186/s13018-025-06368-w)
• [L5] However, further investigation is required to elucidate the specific biomechanical mechanisms underlying these changes. (10.1186/s13018-024-05250-5)
• [L5] The anterior and posterior approach differentially affect postoperative biomechanical function of the capsular ligaments. (10.1302/0301-620x.101b4.bjj-2018-1321.r1)
• [L2] Preoperative spinopelvic characteristics that contribute to abnormal mechanics can normalize after THA following improvement in hip flexion. (10.2106/jbjs.21.01127)
• [L4] The algorithm showed a high degree of consistency in acetabular orientation measures with respect to a prior study of the same cohort. (10.2106/jbjs.20.00343)
• [L5] Long-term use of CsA can weaken the biomechanical properties and thus increase the fracture rate of the lumbar vertebra and the proximal femur. (10.1186/1471-2474-12-240)
• [L3] These results stress the importance of monitoring both symptomatic and asymptomatic tendon structures and in addition highlight that the asymptomatic side should not be used as reference in clinical practice. (10.1007/s00167-019-05495-2)
• [L3] Longer spinal fusion or inclusion of the pelvis in the fusion critically impacts hip-spine biomechanics and significantly affects the ability to compensate in the standing-to-sitting transition. (10.1016/j.arth.2017.04.051)
• [L3] Analyzing the spatial multi-plane kinematic characteristics of the patellofemoral joint may help in determining the etiology of PFP. (10.1186/s13018-025-05610-9)
• [L5] Understanding the biomechanical principles of spinal instrumentation and motion coupling is essential for optimizing three-dimensional correction of thoracolumbar spinal deformities and achieving favorable mechanical environments for fusion. (10.5435/jaaos-d-24-01156)
• [L5] Increasing the load has a significant impact on the coupled translational movement of lumbar facet joints. (10.1186/s13018-022-03016-5)
• [L5] The thoracic spine is a complex three-dimensional structure with coupled motion characteristics. (10.2106/00004623-197658050-00011)
• [Paper] The biomechanical performance of the FNS is fracture-type-dependent, necessitating angle-specific optimisation. (10.1186/s12891-026-09591-6)
• [L4] Rasterstereography is a valuable tool for the dynamic evaluation of spinal posture and pelvic position, which can also be used to quantify motion in the spine and therefore it has the potential to improve the understanding and treatment of spinal pathologies. (10.1186/s13018-020-01825-0)
• [L5] In addition, total laminectomy changes the biomechanics in both normal lumbar models and spondylolisthesis models. (10.1186/s13018-024-04681-4)
• [L4] IMU-derived kinematic parameters provide objective measures of impaired movement control and may support clinical identification of individuals at risk for chronic or recurrent LBP. (10.1186/s12891-026-09488-4)
• [L1] SWT altered the morphology of musculoskeletal conditions, potentially reflecting changes in underlying pathophysiological processes. (10.1186/s12891-020-03270-w)
• [L5] These data can be useful in future spinal biomechanics research leading to better biomechanical compatibility and provide theoretical references for spinal implant materials. (10.1186/s13018-017-0631-y)
• [L4] This study found weak to moderate effects of individual kinematic variables and lumbar lordosis on IV-RoMmax at other intervertebral levels. (10.1186/s12891-016-0975-1)
• [L5] The study documented the complete three-dimensional elastic physical properties of each lumbar intervertebral level, finding that load-displacement curves are non-linear and motions are coupled, with ranges of motion comparing favorably with reported in vivo values. (10.2106/00004623-199403000-00012)
• [L4] Clinically, the step-up task can be used to identify these aberrant movements to develop more focused functional interventions for patients with LBP. (10.1186/s12891-017-1721-z)
• [L4] In the young patient, the pathogenesis of knee osteoarthritis is predominantly related to an unfavorable biomechanical environment at the joint, which results in mechanical demand that exceeds the ability of a joint to repair and maintain itself, predisposing the articular cartilage to premature degeneration. (10.1007/s00167-011-1818-0)
• [L5] Loading in the anterior-oblique direction required lower external force or moment to keep the lumbar spine in the neutral position compared to vertical or posterior-oblique directions. (10.1155/2018/4517471)
• [L5] Additionally, ICS biomechanical properties are more suitable for this fracture type than FNS. (10.1186/s12891-024-07180-z)
• [L5] Noncontinuous CDA could preserve IDP and facet joint forces at the adjacent and intermediate levels to maintain the kinematics of cervical spine near preoperative values. (10.1186/s13018-020-1549-3)
• [L5] Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels. (10.1186/s12891-016-0942-x)
• [L2] The T4-L1-Hip axis is conceptually aligned with the description of spinal shapes in the Roussouly classification but with the advantage of utilizing continuous measures of spinal alignment. (10.2106/jbjs.24.01489)
• [L5] The biomechanical benefit of a stand-alone two-part fusion cage can be justified. (10.1186/1471-2474-9-88)
• [L5] Performing both imaging modalities under the same conditions would be helpful in the evaluation of disc degeneration. (10.1186/s12891-015-0610-6)
• [L3] A computer-assisted analysis of young adult hip radiographs generally demonstrates substantial to excellent levels of interobserver reliability for most parameters. (10.1177/0363546514542797)
• [Commentary] Predicting articular cartilage pathology in the hip with radiographic joint space has been unreliable for patients having joint spaces >2 mm in width; joint space width is a tool that can be used, but with some limitation, and other methods of investigation such as magnetic resonance imaging should be used in conjunction with radiographic joint space. (10.1016/j.arthro.2020.03.014)
• [L2] The authors strongly recommend using CT (or other MRI sequences) to assess patients who are potential candidates for hip joint preservation surgery. (10.1177/23259671261430756)
• [L3] These results lead to a more conservative approach in monitoring of scoliotic curves in clinical applications; smaller number of radiographs would be saved, however the risk of having non-measured curves with progression would be decreased. (10.1186/s12891-018-2303-4)
• [L5] Composite beam theory analysis with quantitative computed tomography-derived measures of rigidity can be used to prospectively predict the yield loads of vertebrae with lytic defects. (10.2106/00004623-200009000-00004)
• [L4] CT currently provides quantitative measures of bone structure and may be used for estimating bone strength mathematically. (10.1007/s11999-010-1766-x)
• [L3] These data suggest that specific hip osteoarthritic morphological characteristics listed above alter spinopelvic motion to a greater extent than others. (10.1302/0301-620x.105b5.bjj-2022-0945.r1)
• [L4] However, further studies with long-term follow-up are needed to determine whether the grafted area will maintain structural and functional integrity over time. (10.1007/s00167-010-1042-3)
• [L4] Surgeons who individualize the acetabular component placement based on preoperative functional radiographs should consider that the rotation of the pelvis changes one year postoperatively. (10.1302/0301-620x.102b7.bjj-2019-1614.r2)
• [L4] This deep learning model can accurately and automatically measure spinal alignment parameters with reliable results, significantly reducing diagnostic time, and might provide the potential to assist clinicians. (10.1186/s13018-025-05620-7)
• [L3] Classification consistency between the modalities was moderate to high. (10.1016/j.arthro.2023.12.025)
• [L3] Abduction/adduction malalignment significantly alters mPTS measurements on lateral knee radiographs. (10.1002/ksa.70127)
• [L3] Although CL imaging provides acceptable assessment of general component position, it has limited use for precise analysis in research, outcome reporting, or determination of cause of implant failure due to variation exceeding 10° in 20% of patients. (10.1016/j.arth.2011.03.039)
• [L5] Meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci. (10.1007/s00167-018-5090-4)
• [L1] The available literature provides clear insight into the estimated stresses due to the cam deformity and provides an assessment of its risks leading to early joint degeneration. (10.1371/journal.pone.0147813)
• [L4] The biomechanical concept of the prosthesis has a significant impact on whether a near-physiological motion pattern can be achieved, with flexible biomechanical properties shifting the center of rotation toward normal and fixed ball socket designs potentially worsening the motion pattern. (10.1186/s13018-020-01908-y)
• [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
• [L3] PDS can maintain surgical level ROM and had less influence on whole and non-surgical level ROM. (10.1186/s13018-017-0597-9)
• [L3] In terms of outcomes with an average follow-up time of 2 years, the deeper the screw depth is within the safe range, the better the spino-pelvic sagittal balance may be restored and the better the quality of life may be. (10.1186/s12891-021-04736-1)
• [L5] Severe deformities with large amounts of midfoot pronation and hindfoot valgus may be better treated with nonanatomic reconstruction methods. (10.1186/s13018-019-1154-5)
• [L3] LSMDs are a valid means of defining sub-groups within non-specific LBP, in a conservative care population of patients with RCLBP. (10.1186/1471-2474-7-45)
• [L5] This increased motion may increase tensile strain in a graft, potentially predisposing to non-union in lumbar arthrodesis without instrumentation. (10.2106/00004623-199412000-00012)
• [L5] Treatment options range from non-operative measures to various surgical procedures including cheilectomy, arthroplasty, and arthrodesis, with selection depending on disease stage and patient factors. (10.2106/00004623-199806000-00015)
• [L5] Cerclage femoral wiring for prophylactic purposes during hip arthroplasty does not confer a significant biomechanical advantage over non-wiring techniques. (10.1186/s42836-025-00331-0)
• [L4] Patients with a preoperative duration of symptomatic medial knee overload/arthritis of two years or greater do not experience inferior PRO or clinical outcomes than patients with a symptom duration of less than 2 years at mid-term follow-up. (10.1016/j.jisako.2022.03.003)
• [L4] This study is the first to map the hip center of rotation trajectory under common movements in a large cohort, highlighting the importance of hip translation on physiologic range of motion. (10.1177/2325967124s00166)
• [L3] The pattern of patellar sagittal motion during dynamic process was consistent between PFP and control groups. (10.1186/s12891-025-08394-5)
• [L4] Longitudinal studies are required to establish the potential role of these risk or prognostic shape phenotypes. (10.1186/s12891-020-03346-7)
• [L2] This study indicates important, technique-dependent differences in tunnel features with changes in reaction forces and moments within the graft. (10.1007/s00167-018-5272-0)
• [L4] This study shows that aging is associated with loss of the consistent motion pattern that was observed in young asymptomatic individuals. (10.1186/s12891-024-07423-z)

See Also

• Deformities
• Disc Degeneration
• Pain Management
• Biomechanical Studies

References

[1] A Clinically Relevant Review of Hip Biomechanics. Arthroscopy. 2010. DOI: 10.1016/j.arthro.2010.01.027

[2] High Tibial Osteotomy: Review of Techniques and Biomechanics. Journal of Healthcare Engineering. 2019. DOI: 10.1155/2019/8363128

[3] A new rigid biodegradable anchor for meniscus refixation: biomechanical evaluation. Knee Surgery, Sports Traumatology, Arthroscopy. 2003. DOI: 10.1007/s00167-003-0439-7

[5] Staged medial opening wedge high tibial osteotomy for bilateral varus gonarthrosis: biomechanical and clinical outcomes. Knee Surgery, Sports Traumatology, Arthroscopy. 2013. DOI: 10.1007/s00167-013-2559-z

[6] Biomechanical Analysis of Simulated Clinical Testing and Reconstruction of the ALL: Letter to the Editor. The American Journal of Sports Medicine. 2015. DOI: 10.1177/0363546515605808

[7] A scoping review of biomechanical testing for proximal humerus fracture implants. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0627-x

[8] Viscoelasticity and histology of the human cartilage in healthy and degenerated conditions of the knee. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1308-5

[9] Investigation of geometric deformations of the lumbar disc during axial body rotations. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05160-9

[10] Height and volume restoration in osteoporotic vertebral compression fractures: a biomechanical comparison of standard balloon kyphoplasty versus Tektona® in a cadaveric fracture model. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-020-03899-7

[11] Stereophotogrammetric approaches to multi-segmental kinematics of the thoracolumbar spine: a systematic review. BMC Musculoskeletal Disorders. 2022. DOI: 10.1186/s12891-022-05925-2

[12] Biomechanical and clinically controlled study of different fenestration positions in vascularized iliac bone flaps for treating femoral head necrosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05390-8

[13] Evaluating the performance of a novel double-threaded dynamic stabilization system: a finite element study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06130-2

[14] Chapter 57 Biomechanics. 2019.

[15] In vivo kinematic study of lumbar center of rotation under different loads. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08410-8

[16] The effect of walking speed on spinal loads and trunk muscle forces using subject-specific musculoskeletal modeling: A database for clinical and modeling applications. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06408-5

[17] Biomechanical response of lumbar facet joints under follower preload: a finite element study. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0980-4

[18] Function and strain of the anterolateral ligament part I: biomechanical analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2017. DOI: 10.1007/s00167-017-4472-3

[19] Dysplastic Patellofemoral Joints Lead to a Shift in Contact Forces: A 3D-Printed Cadaveric Model. The American Journal of Sports Medicine. 2021. DOI: 10.1177/03635465211031427

[20] Large Lytic Defects Produce Kinematic Instability and Loss of Compressive Strength in Human Spines. Journal of Bone and Joint Surgery. 2021. DOI: 10.2106/jbjs.19.00419

[21] Partial weight‐bearing and range of motion limitation significantly reduce the loads at medial meniscus posterior root repair sutures in a cadaveric biomechanical model. Knee Surgery, Sports Traumatology, Arthroscopy. 2024. DOI: 10.1002/ksa.12465

[22] Contemporary insights into spinopelvic mechanics. The Bone & Joint Journal. 2024. DOI: 10.1302/0301-620x.106b11.bjj-2024-0373

[23] Patient-specific spine digital twins: a computational characterization of the idiopathic scoliosis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-024-05417-0

[24] How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04807-8

[25] The shift of segmental contribution ratio in patients with herniated disc during cervical lateral bending. BMC Musculoskeletal Disorders. 2014. DOI: 10.1186/1471-2474-15-273

[26] Biomechanical analysis of the patient-specific appropriate correction angle for cervical kyphosis in multilevel anterior cervical discectomy and fusion: a finite element analysis. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-06368-w

[27] Biomechanical changes in the lumbar and hip joint after curved periacetabular osteotomy. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-05250-5

[28] Hip capsule biomechanics after arthroplasty. The Bone & Joint Journal. 2019. DOI: 10.1302/0301-620x.101b4.bjj-2018-1321.r1

[29] Spinopelvic Characteristics Normalize 1 Year After Total Hip Arthroplasty. Journal of Bone and Joint Surgery. 2022. DOI: 10.2106/jbjs.21.01127

[30] Automatic Characterization of Pelvic and Sacral Measures from 200 Subjects. Journal of Bone and Joint Surgery. 2020. DOI: 10.2106/jbjs.20.00343

[31] Effects of cyclosporin-a on rat skeletal biomechanical properties. BMC Musculoskeletal Disorders. 2011. DOI: 10.1186/1471-2474-12-240

[32] Bilateral changes in tendon structure of patients diagnosed with unilateral insertional or midportion achilles tendinopathy or patellar tendinopathy. Knee Surgery, Sports Traumatology, Arthroscopy. 2019. DOI: 10.1007/s00167-019-05495-2

[33] What is the Impact of a Spinal Fusion on Acetabular Implant Orientation in Functional Standing and Sitting Positions?. The Journal of Arthroplasty. 2017. DOI: 10.1016/j.arth.2017.04.051

[34] Abnormal patellar sagittal spatial kinematics in patients with patellofemoral pain: an in vivo dynamic CT study. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05610-9

[35] Biomechanical Principles of Spinal Deformity Correction in the Thoracolumbar Spine. Journal of the American Academy of Orthopaedic Surgeons. 2025. DOI: 10.5435/jaaos-d-24-01156

[36] The effect of various weight-bearing activities on the motion of lumbar facet joints in vivo. Journal of Orthopaedic Surgery and Research. 2022. DOI: 10.1186/s13018-022-03016-5

[37] Mechanical properties of the human thoracic spine as shown by three-dimensional load-displacement curves. The Journal of Bone & Joint Surgery. 1976. DOI: 10.2106/00004623-197658050-00011

[38] Finite element analysis of the influence of femoral neck system implantation angle on biomechanical stability in femoral neck fractures: a mechanistic exploration. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09591-6

[39] Dynamic spinal posture and pelvic position analysis using a rasterstereographic device. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01825-0

[40] Biomechanical response of decompression alone in lower grade lumbar degenerative spondylolisthesis--A finite element analysis. Journal of Orthopaedic Surgery and Research. 2024. DOI: 10.1186/s13018-024-04681-4

[41] A predictive model for classifying low back pain status based on lumbopelvic kinematics measured using inertial measurement units: a cross-sectional study. BMC Musculoskeletal Disorders. 2026. DOI: 10.1186/s12891-026-09488-4

[42] The effects of shockwave therapy on musculoskeletal conditions based on changes in imaging: a systematic review and meta-analysis with meta-regression. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03270-w

[43] Biomechanical analysis of the posterior bony column of the lumbar spine. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0631-y

[44] Relationships between lumbar inter-vertebral motion and lordosis in healthy adult males: a cross sectional cohort study. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0975-1

[45] Mechanical behavior of the human lumbar and lumbosacral spine as shown by three-dimensional load-displacement curves.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199403000-00012

[46] Differences in lumbar spine and lower extremity kinematics in people with and without low back pain during a step-up task: a cross-sectional study. BMC Musculoskeletal Disorders. 2017. DOI: 10.1186/s12891-017-1721-z

[47] Biomechanical considerations in the pathogenesis of osteoarthritis of the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2011. DOI: 10.1007/s00167-011-1818-0

[49] The Effect of Muscle Direction on the Predictions of Finite Element Model of Human Lumbar Spine. BioMed Research International. 2018. DOI: 10.1155/2018/4517471

[50] The significance of reduction of valgus-intercalated femoral neck fracture with valgus angle > 15°and the selection of internal fixation by finite element analysis. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07180-z

[51] Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-1549-3

[53] A numerical study to determine the effect of ligament stiffness on kinematics of the lumbar spine during flexion. BMC Musculoskeletal Disorders. 2016. DOI: 10.1186/s12891-016-0942-x

[55] The T4-L1-Hip Axis Objectifies the Roussouly Classification Using Continuous Measures. Journal of Bone and Joint Surgery. 2025. DOI: 10.2106/jbjs.24.01489

[56] Biomechanical comparison of a new stand-alone anterior lumbar interbody fusion cage with established fixation techniques – a three-dimensional finite element analysis. BMC Musculoskeletal Disorders. 2008. DOI: 10.1186/1471-2474-9-88

[57] Quantitative T2 relaxation time and magnetic transfer ratio predict endplate biochemical content of intervertebral disc degeneration in a canine model. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0610-6

[58] Interobserver and Intraobserver Reliability of the Radiographic Analysis of Femoroacetabular Impingement and Dysplasia Using Computer-Assisted Measurements. The American Journal of Sports Medicine. 2014. DOI: 10.1177/0363546514542797

[59] Editorial Commentary: Hip Joint Space as a Predictor of Cartilage Pathology: A Basic Tool for a Complex Task. Arthroscopy: The Journal of Arthroscopic & Related Surgery. 2020. DOI: 10.1016/j.arthro.2020.03.014

[60] Fast Field Echo Magnetic Resonance Imaging For Quantifying Acetabular Wall Coverage: A Validation Study With Computed Tomography. Orthopaedic Journal of Sports Medicine. 2026. DOI: 10.1177/23259671261430756

[61] 3D Markerless asymmetry analysis in the management of adolescent idiopathic scoliosis. BMC Musculoskeletal Disorders. 2018. DOI: 10.1186/s12891-018-2303-4

[62] Noninvasive Imaging Predicts Failure Load of the Spine with Simulated Osteolytic Defects†. The Journal of Bone and Joint Surgery-American Volume*. 2000. DOI: 10.2106/00004623-200009000-00004

[63] High-resolution Computed Tomography for Clinical Imaging of Bone Microarchitecture. Clinical Orthopaedics & Related Research. 2011. DOI: 10.1007/s11999-010-1766-x

[64] Anteroposterior pelvic radiograph findings correlate with sagittal spinopelvic motion. The Bone & Joint Journal. 2023. DOI: 10.1302/0301-620x.105b5.bjj-2022-0945.r1

[65] Mid‐term results of Autologous Matrix‐Induced Chondrogenesis for treatment of focal cartilage defects in the knee. Knee Surgery, Sports Traumatology, Arthroscopy. 2010. DOI: 10.1007/s00167-010-1042-3

[66] Pelvic rotation after total hip arthroplasty is dynamic and variable. The Bone & Joint Journal. 2020. DOI: 10.1302/0301-620x.102b7.bjj-2019-1614.r2

[67] A deep learning model for radiological measurement of adolescent idiopathic scoliosis using biplanar radiographs. Journal of Orthopaedic Surgery and Research. 2025. DOI: 10.1186/s13018-025-05620-7

[68] Discrepancies in Magnetic Resonance– and Computed Tomography–Based Femoral Version Measurements Despite Strong Correlations. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.12.025

[69] Abduction and adduction malpositioned lateral radiographs cannot be used for proper assessment of the posterior tibial slope. Knee Surgery, Sports Traumatology, Arthroscopy. 2025. DOI: 10.1002/ksa.70127

[70] The Reliability and Variation of Acetabular Component Anteversion Measurements From Cross-Table Lateral Radiographs. The Journal of Arthroplasty. 2011. DOI: 10.1016/j.arth.2011.03.039

[71] Predicting meniscal tear stability across knee‐joint flexion using finite‐element analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5090-4

[72] Hip Joint Stresses Due to Cam-Type Femoroacetabular Impingement: A Systematic Review of Finite Element Simulations. PLOS ONE. 2016. DOI: 10.1371/journal.pone.0147813

[73] In cervical arthroplasty, only prosthesis with flexible biomechanical properties should be used for achieving a near-physiological motion pattern. Journal of Orthopaedic Surgery and Research. 2020. DOI: 10.1186/s13018-020-01908-y

[74] Coxa Vara in Childhood: Evaluation and Management. Journal of the American Academy of Orthopaedic Surgeons. 1998. DOI: 10.5435/00124635-199803000-00003

[75] The influence of L4–S1 Dynesys® dynamic stabilization versus fusion on lumbar motion and its relationship with lumbar degeneration: a retrospective study. Journal of Orthopaedic Surgery and Research. 2017. DOI: 10.1186/s13018-017-0597-9

[76] Effects of different pedicle screw insertion depths on sagittal balance of lumbar degenerative spondylolisthesis, a retrospective comparative study. BMC Musculoskeletal Disorders. 2021. DOI: 10.1186/s12891-021-04736-1

[77] Nonanatomic versus anatomic techniques in spring ligament reconstruction: biomechanical assessment via a finite element model. Journal of Orthopaedic Surgery and Research. 2019. DOI: 10.1186/s13018-019-1154-5

[78] Lumbar segmental mobility disorders: comparison of two methods of defining abnormal displacement kinematics in a cohort of patients with non-specific mechanical low back pain. BMC Musculoskeletal Disorders. 2006. DOI: 10.1186/1471-2474-7-45

[79] Increase of motion between lumbar vertebrae after excision of the capsule and cartilage of the facets. A cadaver study.. The Journal of Bone & Joint Surgery. 1994. DOI: 10.2106/00004623-199412000-00012

[80] Current Concepts Review - Hallux Rigidus and Osteoarthrosis of the First Metatarsophalangeal Joint. The Journal of Bone & Joint Surgery*. 1998. DOI: 10.2106/00004623-199806000-00015

[81] Prophylactic wiring vs. non-wiring in hip arthroplasty: finite element and cadaveric analysis of proximal femur biomechanics. Arthroplasty. 2025. DOI: 10.1186/s42836-025-00331-0

[82] Preoperative symptom duration does not affect clinical outcomes after high tibial osteotomy at a minimum of 2-year follow-up. Journal of ISAKOS. 2022. DOI: 10.1016/j.jisako.2022.03.003

[83] Poster 197: A 3D Analysis of Hip Center of Rotation Trajectory and its Effects on Impingement-Free Range of Motion: A Dynamic Analysis of 1222 Hips. Orthopaedic Journal of Sports Medicine. 2024. DOI: 10.1177/2325967124s00166

[84] Abnormal sagittal patellar tilt during active knee flexion and extension on 4DCT might be associated with patellofemoral pain. BMC Musculoskeletal Disorders. 2025. DOI: 10.1186/s12891-025-08394-5

[85] Is intrinsic lumbar spine shape associated with lumbar disc degeneration? An exploratory study. BMC Musculoskeletal Disorders. 2020. DOI: 10.1186/s12891-020-03346-7

[86] Tunnel placement in ACL reconstruction surgery: smaller inter-tunnel angles and higher peak forces at the femoral tunnel using anteromedial portal femoral drilling—a 3D and finite element analysis. Knee Surgery, Sports Traumatology, Arthroscopy. 2018. DOI: 10.1007/s00167-018-5272-0

[87] An observational study of quality of motion in the aging cervical spine: sequence of segmental contributions in dynamic fluoroscopy recordings. BMC Musculoskeletal Disorders. 2024. DOI: 10.1186/s12891-024-07423-z