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Mena A, Wollstein R, Baus J, Yang J. Finite Element Modeling of the Human Wrist: A Review. J Wrist Surg 2023; 12:478-487. [PMID: 38213568 PMCID: PMC10781520 DOI: 10.1055/s-0043-1768930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 04/13/2023] [Indexed: 01/13/2024]
Abstract
Background Understanding wrist biomechanics is important to appreciate and treat the wrist joint. Numerical methods, specifically, finite element method (FEM), have been used to overcome experimental methods' limitations. Due to the complexity of the wrist and difficulty in modeling, there is heterogeneity and lack of consistent methodology in the published studies, challenging our ability to incorporate information gleaned from the various studies. Questions/Purposes This study summarizes the use of FEM to study the wrist in the last decade. Methods We included studies published from 2012 to 2022 from databases: EBSCO, Research4Life, ScienceDirect, and Scopus. Twenty-two studies were included. Results FEM used to study wrist in general, pathology, and treatment include diverse topics and are difficult to compare directly. Most studies evaluate normal wrist mechanics, all modeling the bones, with fewer studies including cartilage and ligamentous structures in the model. The dynamic effect of the tendons on wrist mechanics is rarely accounted for. Conclusion Due to the complexity of wrist mechanics, the current literature remains incomplete. Considering published strategies and modeling techniques may aid in the development of more comprehensive and improved wrist model fidelity.
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Affiliation(s)
- Andres Mena
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
| | - Ronit Wollstein
- Department of Orthopedic Surgery, School of Medicine, New York University, New York, New York
| | - Juan Baus
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
| | - James Yang
- Human-Centric Design Research Laboratory, Department of Mechanical Engineering, Texas Tech University, Lubbock, Texas
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Yan H, Sato K, Takahashi G, Mimata Y, Murakami K, Doita M. Load Distribution in Dorsally-Angulated Distal Radius Deformity Using Finite Element Analysis. J Hand Surg Am 2023; 48:1062.e1-1062.e6. [PMID: 35973880 DOI: 10.1016/j.jhsa.2022.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/16/2021] [Accepted: 02/28/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The load axis of the carpals is located on the volar side of the normal distal radius. A volar lunate facet fracture (VLFF) is exposed to volar-shearing stress, which can cause volar displacement of the carpus. A previous biomechanical study reported that the load at the scaphoid fossa was located more dorsally and the pressure at the lunate fossa decreased in a dorsally-angulated model. However, the distal radius load distribution for various volar tilts remains unclear. We speculate that if the volar tilt decreases, the load distribution moves dorsally and decreases the stress on the VLFF. Therefore, we analyzed a dorsally-angulated distal radius model to evaluate changes in the load distribution using finite element analysis. METHODS A 3-dimensional finite element wrist model was developed using computed tomography images. The ligaments were modeled as tension-only spring elements. We considered the intact wrist model for a volar tilt of 15° and created 5 additional models for volar tilts of 10°, 5°, 0°, -5°, and -10°. RESULTS As the dorsal angulation increased, the stress distribution moved from volar to dorsal and from the lunate fossa toward the scaphoid fossa. The maximum stress on the volar lunate facet was reduced as volar tilt decreased. The maximum stress was higher on the lunate fossa for volar tilts from 15° to 5°. In contrast, the maximum stress was higher on the scaphoid fossa for volar tilts of ≤0°. CONCLUSIONS Load transmission moved from volar to dorsal and from the lunate fossa to the scaphoid fossa when the volar tilt decreased. Therefore, a decrease in the volar tilt would reduce the load on the VLFF. CLINICAL RELEVANCE This study provides surgeons accurate knowledge regarding load distribution of the distal radius for various volar tilts that could be helpful in treating patients with VLFFs.
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Affiliation(s)
- Hirotaka Yan
- Department of Orthopaedic Surgery, Iwate Medical University, Iwate, Japan
| | - Kotaro Sato
- Department of Orthopaedic Surgery, Iwate Medical University, Iwate, Japan.
| | - Gaku Takahashi
- Department of Critical Care Medicine, Iwate Medical University, Iwate, Japan
| | - Yoshikuni Mimata
- Department of Orthopaedic Surgery, Iwate Medical University, Iwate, Japan
| | - Kenya Murakami
- Department of Orthopaedic Surgery, Iwate Medical University, Iwate, Japan
| | - Minoru Doita
- Department of Orthopaedic Surgery, Iwate Medical University, Iwate, Japan
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Chan AHW, Padmore CE, Langhor DG, Grewal R, Johnson JA, Suh N. A Biomechanical Evaluation of the ECRL Tenodesis for Reconstruction of the Scapholunate Ligament. J Hand Surg Am 2021; 46:244.e1-244.e11. [PMID: 33162272 DOI: 10.1016/j.jhsa.2020.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/03/2020] [Accepted: 08/28/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE Reconstruction of the scapholunate ligament (SLL) in the setting of dynamic instability remains a surgical challenge, with lack of consensus on the best reconstructive procedure. Reconstruction of only the dorsal component may lead to volar gapping and abnormal wrist kinematics. This cadaveric active motion simulation study determined whether scapholunate (SL) motion, angulation, and contact are restored following open reconstruction using the extensor carpi radialis longus (ECRL) tenodesis, which reconstructs both the volar and the dorsal SLL components. METHODS Seven fresh-frozen cadaveric upper limbs (mean age, 68 ± 10.1 years) underwent a 4-stage protocol of cyclic dart-throw motion and flexion-extension motion (utilizing an active wrist motion simulator that used tendon load/motion-controlled actuation. Scaphoid and lunate motion, relative scaphoid translation, SL angle, and dorsal-volar SL diastasis were measured with (1) wrist ligaments intact, (2) following complete sectioning of the SLL, and (3) following SL reconstruction using the ECRL tenodesis technique. RESULTS Complete SLL sectioning resulted in a typical pattern of SL instability. Following the ECRL tenodesis, lunate extension was not corrected. Scaphoid flexion, however, was not significantly different from the native state in FEM but remained significantly flexed during dart-throw motion. Differential dorsal and volar gapping did not significantly improve following ECRL tenodesis (dorsal, 1.2-2.3 mm; volar, 1.1-1.7 mm). CONCLUSIONS This biomechanical study demonstrates that the ECRL tenodesis did not fully restore native carpal kinematics, despite dorsal and volar SLL, and scaphotrapeziotrapezoid reconstruction. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic IV.
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Affiliation(s)
- Andrea H W Chan
- Divisions of Plastics and Orthopaedic Surgery, Toronto Western Hospital Hand Clinic, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Clare E Padmore
- Department of Biomedical Engineering, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Daniel G Langhor
- Department of Mechanical and Materials Engineering, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Ruby Grewal
- Division of Orthopaedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - James A Johnson
- Department of Mechanical and Materials Engineering, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada
| | - Nina Suh
- Division of Orthopaedic Surgery, Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, Western University, London, Ontario, Canada.
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Wang K, Hosseinnejad SH, Jabran A, Baltzopoulos V, Ren L, Qian Z. A biomechanical analysis of 3D stress and strain patterns in patellar tendon during knee flexion. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3379. [PMID: 32564478 DOI: 10.1002/cnm.3379] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 01/19/2020] [Accepted: 06/07/2020] [Indexed: 06/11/2023]
Abstract
Patellar tendinopathy is among the most widespread patellar tendon diseases in athletes that participate in activities involving running and jumping. Although their symptoms can be detected, especially at the inferior pole of the patella, their biomechanical cause remains unknown. In this study, a three-dimensional finite element model of knee complex was developed to investigate principal stress and strain distributions in the patellar tendon during 0° to 90° knee flexion and slow and fast level-ground walking. Results indicate that the patellar tendon is subjected to tensile stress and strains during all three activities. During flexion, its central proximal posterior region exhibited highest peak stress and strain, followed by central distal posterior, central distal anterior and central proximal anterior region. Similar trends and magnitudes were reported during slow and fast walking. The region with highest principal stresses and strains, central proximal anterior region, also corresponds to the most commonly reported patellar tendinopathy lesion site, suggesting that principal stress and strain are good indicators of lesion site location. Additional factors such as regional variations in material properties and frequency and duration of cyclic loading also need to be considered when determining the biomechanical aetiology of patellar tendinopathy.
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Affiliation(s)
- Kunyang Wang
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Soroosh H Hosseinnejad
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Ali Jabran
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Vasilios Baltzopoulos
- Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Lei Ren
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
- School of Mechanical, Aerospace and Civil Engineering, University of Manchester, Manchester, UK
| | - Zhihui Qian
- Key Laboratory of Bionic Engineering, Ministry of Education, Jilin University, Changchun, People's Republic of China
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Leonardo-Diaz R, Alonso-Rasgado T, Jimenez-Cruz D, Bailey CG, Talwalkar S. Performance evaluation of surgical techniques for treatment of scapholunate instability in a type II wrist. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2020; 36:e3278. [PMID: 31680425 DOI: 10.1002/cnm.3278] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 08/18/2019] [Accepted: 10/19/2019] [Indexed: 06/10/2023]
Abstract
We investigated the performance of three tenodesis techniques, modified Brunelli, Corella, and scapholunate axis (SLAM) methods in repairing scapholunate interosseous ligament (SLIL) disruption for a type II wrist using finite element-based virtual surgery and compared the results with those of a previous investigation for a type I wrist. In addition, a comparison of the carpal mechanics of type I and type II wrists was undertaken in order to elucidate the difference between the two types. For the type II wrist, following simulated SLIL disruption, the Corella reconstruction technique provided a superior outcome, restoring dorsal gap, volar gap, and SL angle to within 3.5%, 7.1%, and 8.4%, respectively, of the intact wrist. Moreover, application of the ligament reconstruction techniques did not significantly alter the motion pattern of the type II and type I wrists. For the type I wrist, SLIL disruption resulted in no contact between scaphoid-lunate cartilage articulation, whereas for the type II wrist, some contact was maintained. We conclude that the Corella ligamentous reconstruction technique is best able to restore SL gap, angle, and stability following SL ligament injury for both type II and type I wrists and is able to do so without altering wrist kinematics. Our findings also support the view that type I wrists exhibit row behaviour and type II wrists column behaviour. In addition, our analysis suggests that the extra articulation between the lunate and hamate in a type II wrist may help improve stability following SL ligament injury.
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Affiliation(s)
| | - Teresa Alonso-Rasgado
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | | | - Colin G Bailey
- School of Engineering and Materials Science, Queen Mary University of London, London, UK
| | - Sumedh Talwalkar
- Wrightington Hospital, Wrightington Wigan and Leigh NHS Foundation Trust, Lancashire, UK
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Alonso-Rasgado T, Zhang QH, Jimenez-Cruz D, Bailey C, Pinder E, Mandaleson A, Talwalkar S. Evaluation of the performance of three tenodesis techniques for the treatment of scapholunate instability: flexion-extension and radial-ulnar deviation. Med Biol Eng Comput 2017; 56:1091-1105. [PMID: 29178063 PMCID: PMC5978813 DOI: 10.1007/s11517-017-1748-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 11/03/2017] [Indexed: 11/25/2022]
Abstract
Chronic scapholunate ligament (SL) injuries are difficult to treat and can lead to wrist dysfunction. Whilst several tendon reconstruction techniques have been employed in the management of SL instability, SL gap reappearance after surgery has been reported. Using a finite element model and cadaveric study data, we investigated the performance of the Corella, scapholunate axis (SLAM) and modified Brunelli tenodesis (MBT) techniques. Scapholunate dorsal and volar gap and angle were obtained following virtual surgery undertaken using each of the three reconstruction methods with the wrist positioned in flexion, extension, ulnar deviation and radial deviation, in addition to the ulnar-deviated clenched fist and neutral positions. From the study, it was found that, following simulated scapholunate interosseous ligament rupture, the Corella technique was better able to restore the SL gap and angle close to the intact ligament for all wrist positions investigated, followed by SLAM and MBT. The results suggest that for the tendon reconstruction techniques, the use of multiple junction points between scaphoid and lunate may be of benefit. The use of multiple junction points between scaphoid and lunate may be of benefit for tendon reconstruction techniques. ![]()
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Affiliation(s)
- Teresa Alonso-Rasgado
- Bioengineering Research Group, School of Materials, University of Manchester, Manchester, M13 9PL, UK.
| | - Qing-Hang Zhang
- Bioengineering Research Group, School of Materials, University of Manchester, Manchester, M13 9PL, UK
| | - David Jimenez-Cruz
- Bioengineering Research Group, School of Materials, University of Manchester, Manchester, M13 9PL, UK
| | | | - Elizabeth Pinder
- Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Lancashire, UK
| | - Avanthi Mandaleson
- Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Lancashire, UK
| | - Sumedh Talwalkar
- Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Lancashire, UK
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