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Shi Q, Wang H, He K, Tao M, Cheng CK. Comparison of the morphology of the anterior cruciate ligament and related bony structures between pigs and humans. Front Vet Sci 2022; 9:1045785. [PMID: 36467640 PMCID: PMC9716283 DOI: 10.3389/fvets.2022.1045785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 11/03/2022] [Indexed: 07/20/2023] Open
Abstract
INTRODUCTION Pigs are widely used for clinical research on the anterior cruciate ligament (ACL) because of the similarity of the knee structure to the human knee. But evidence to support the suitability of using porcine samples to guide clinical practices is limited. This study aims to explore the qualitative and quantitative morphological features of the porcine knee and ACL, and to compare these with data on humans reported in literature. METHODS Nineteen porcine knees were used for this study. The bone structures were measured on coronal X-ray images. The length of the ACL was measured using a caliper. The ACL bone insertion sites were marked and measured on a digital photograph. The lengths of the long and short axis of the ACL isthmus were measured on the X-ray microscopy reconstructed images. The outcomes were compared with previously reported data on humans using an abstract independent-samples T test. RESULTS Qualitative observation indicated a similar location, orientation and general morphology of the porcine ACL to human ACLs. The major difference was the location of the ACL tibial insertion with respect to the anterior horn of the lateral meniscus (AHLM). The porcine ACL was split into AM and PL bundles by the AHLM, while the AHLM was adjacent to the anterolateral border of the ACL tibial insertion in human knees. The quantitative comparison showed no significant difference between the human and porcine ACL in terms of the length of the ACL, the width of the femoral condyle and tibial plateau, and the tibial interspinal width. However, the CSA, the lengths of the long and short axis of the ACL isthmus, and the femoral and tibial insertion areas of the porcine ACL were all significantly larger than the reported features in human knees. CONCLUSION The location, orientation and basic morphology of the porcine ACL and knee are similar to humans. However, the two-bundle structure is more distinct in a porcine ACL, and the dimensions of the porcine ACL are generally larger. This study may provide useful information to researchers when assessing the feasibility and limitations of using porcine samples for research on the human ACL and knee.
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Farshidfar SS, Cadman J, Deng D, Appleyard R, Dabirrahmani D. The effect of modelling parameters in the development and validation of knee joint models on ligament mechanics: A systematic review. PLoS One 2022; 17:e0262684. [PMID: 35085320 PMCID: PMC8794118 DOI: 10.1371/journal.pone.0262684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/30/2021] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient's daily activities and functional capacity. Musculoskeletal knee modelling provides a non-invasive tool for investigating ligament force-strain behaviour in various dynamic scenarios, as well as potentially complementing existing pre-planning tools to optimise surgical reconstructions. However, despite the development and validation of many musculoskeletal knee models, the effect of modelling parameters on ligament mechanics has not yet been systematically reviewed. OBJECTIVES This systematic review aimed to investigate the results of the most recent studies using musculoskeletal modelling techniques to create models of the native knee joint, focusing on ligament mechanics and modelling parameters in various simulated movements. DATA SOURCES PubMed, ScienceDirect, Google Scholar, and IEEE Xplore. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Databases were searched for articles containing any numerical ligament strain or force data on the intact, ACL-deficient, PCL-deficient, or lateral extra-articular reconstructed (LER) knee joints. The studies had to derive these results from musculoskeletal modelling methods. The dates of the publications were between 1 January 1995 and 30 November 2021. METHOD A customised data extraction form was created to extract each selected study's critical musculoskeletal model development parameters. Specific parameters of the musculoskeletal knee model development used in each eligible study were independently extracted, including the (1) musculoskeletal model definition (i.e., software used for modelling, knee type, source of geometry, the inclusion of cartilage and menisci, and articulating joints and joint boundary conditions (i.e., number of degrees of freedom (DoF), subjects, type of activity, collected data and type of simulation)), (2) specifically ligaments modelling techniques (i.e., ligament bundles, attachment points, pathway, wrapping surfaces and ligament material properties such as stiffness and reference length), (3) sensitivity analysis, (4) validation approaches, (5) predicted ligament mechanics (i.e., force, length or strain) and (6) clinical applications if available. The eligible papers were then discussed quantitatively and qualitatively with respect to the above parameters. RESULTS AND DISCUSSION From the 1004 articles retrieved by the initial electronic search, only 25 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that considerable variability in the predicted ligament mechanics is caused by differences in geometry, boundary conditions and ligament modelling parameters. CONCLUSION This systematic review revealed that there is currently a lack of consensus on knee ligament mechanics. Despite this lack of consensus, some papers highlight the potential of developing translational tools using musculoskeletal modelling. Greater consistency in model design, incorporation of sensitivity assessment of the model outcomes and more rigorous validation methods should lead to better agreement in predictions for ligament mechanics between studies. The resulting confidence in the musculoskeletal model outputs may lead to the development of clinical tools that could be used for patient-specific treatments.
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Affiliation(s)
- Sara Sadat Farshidfar
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Joseph Cadman
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Danny Deng
- Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Richard Appleyard
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Danè Dabirrahmani
- Macquarie Medical School, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
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Biomechanical Function and Size of the Anteromedial and Posterolateral Bundles of the ACL Change Differently with Skeletal Growth in the Pig Model. Clin Orthop Relat Res 2020. [PMID: 31373947 DOI: 10.1097/corr.0000000000000884.] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND ACL injuries are becoming increasingly common in children and adolescents, but little is known regarding age-specific ACL function in these patients. To improve our understanding of changes in musculoskeletal tissues during growth and given the limited availability of pediatric human cadaveric specimens, tissue structure and function can be assessed in large animal models, such as the pig. QUESTIONS/PURPOSES Using cadaveric porcine specimens ranging throughout skeletal growth, we aimed to assess age-dependent changes in (1) joint kinematics under applied AP loads and varus-valgus moments, (2) biomechanical function of the ACL under the same loads, (3) the relative biomechanical function of the anteromedial and posterolateral bundles of the ACL; and (4) size and orientation of the anteromedial and posterolateral bundles. METHODS Stifle joints (analogous to the human knee) were collected from female Yorkshire crossbreed pigs at five ages ranging from early youth to late adolescence (1.5, 3, 4.5, 6, and 18 months; n = 6 pigs per age group, 30 total), and MRIs were performed. A robotic testing system was used to determine joint kinematics (AP tibial translation and varus-valgus rotation) and in situ forces in the ACL and its bundles in response to applied anterior tibial loads and varus-valgus moments. To see if morphological changes to the ACL compared with biomechanical changes, ACL and bundle cross-sectional area, length, and orientation were calculated from MR images. RESULTS Joint kinematics decreased with increasing age. Normalized AP tibial translation decreased by 44% from 1.5 months (0.34 ± 0.08) to 18 months (0.19 ± 0.02) at 60° of flexion (p < 0.001) and varus-valgus rotation decreased from 25° ± 2° at 1.5 months to 6° ± 2° at 18 months (p < 0.001). The ACL provided the majority of the resistance to anterior tibial loading at all age groups (75% to 111% of the applied anterior force; p = 0.630 between ages). Anteromedial and posterolateral bundle function in response to anterior loading and varus torque were similar in pigs of young ages. During adolescence (4.5 to 18 months), the in situ force carried by the anteromedial bundle increased relative to that carried by the posterolateral bundle, shifting from 59% ± 22% at 4.5 months to 92% ± 12% at 18 months (data for 60° of flexion, p < 0.001 between 4.5 and 18 months). The cross-sectional area of the anteromedial bundle increased by 30 mm throughout growth from 1.5 months (5 ± 2 mm) through 18 months (35 ± 8 mm; p < 0.001 between 1.5 and 18 months), while the cross-sectional area of the posterolateral bundle increased by 12 mm from 1.5 months (7 ± 2 mm) to 4.5 months (19 ± 5 mm; p = 0.004 between 1.5 and 4.5 months), with no further growth (17 ± 7 mm at 18 months; p = 0.999 between 4.5 and 18 months). However, changes in length and orientation were similar between the bundles. CONCLUSION We showed that the stifle joint (knee equivalent) in the pig has greater translational and rotational laxity in early youth (1.5 to 3 months) compared with adolescence (4.5 to 18 months), that the ACL functions as a primary stabilizer throughout growth, and that the relative biomechanical function and size of the anteromedial and posterolateral bundles change differently with growth. CLINICAL RELEVANCE Given the large effects observed here, the age- and bundle-specific function, size, and orientation of the ACL may need to be considered regarding surgical timing, graft selection, and graft placement. In addition, the findings of this study will be used to motivate pre-clinical studies on the impact of partial and complete ACL injuries during skeletal growth.
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Cone SG, Lambeth EP, Piedrahita JA, Spang JT, Fisher MB. Joint laxity varies in response to partial and complete anterior cruciate ligament injuries throughout skeletal growth. J Biomech 2020; 101:109636. [PMID: 32005549 DOI: 10.1016/j.jbiomech.2020.109636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 01/01/2023]
Abstract
Anterior cruciate ligament (ACL) injuries are increasingly common in the skeletally immature population. As such there is a need to increase our understanding of the biomechanical function of the joint following partial and complete ACL injury during skeletal growth. In this work, we aimed to assess changes in knee kinematics and loading of the remaining soft tissues following both partial and complete ACL injury in a porcine model. To do so, we applied anterior-posterior tibial loads and varus-valgus moments to stifle joints of female pigs ranging from early juvenile to late adolescent ages and assessed both kinematics and in-situ loads carried in the bundles of the ACL and other soft tissues including the collateral ligaments and the menisci. Partial ACL injury led to increased anterior tibial translation only in late adolescence and small increases in varus-valgus rotation at all ages. Complete ACL injury led to substantial increases in translation and rotation at all ages. At all ages, the medial collateral ligament and the medial meniscus combined to resist the majority of applied anterior tibial load following complete ACL transection. Across all ages and flexion angles, the contribution of the MCL ranged from 45 to 90% of the anterior load and the contribution of the medial meniscus ranged from 14 to 35% of the anterior load. These findings add to our current understanding of age-specific functional properties of both healthy and injured knees during skeletal growth.
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Affiliation(s)
- Stephanie G Cone
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States
| | - Emily P Lambeth
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States
| | - Jorge A Piedrahita
- Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States
| | - Jeffrey T Spang
- Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC 27599, United States
| | - Matthew B Fisher
- Joint Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC 27695, United States; Comparative Medicine Institute, North Carolina State University, Raleigh, NC 27695, United States; Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC 27599, United States.
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Schall F, Seitz AM, Hacker S, van Drongelen S, Wolf SI, Ignatius A, Dürselen L. German Society of Biomechanics (DGfB) Young Investigator Award 2019: Proof-of-Concept of a Novel Knee Joint Simulator Allowing Rapid Motions at Physiological Muscle and Ground Reaction Forces. Front Bioeng Biotechnol 2019; 7:244. [PMID: 31612132 PMCID: PMC6776628 DOI: 10.3389/fbioe.2019.00244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 09/13/2019] [Indexed: 01/14/2023] Open
Abstract
The in vitro determination of realistic loads acting in knee ligaments, articular cartilage, menisci and their attachments during daily activities require the creation of physiological muscle forces, ground reaction force and unconstrained kinematics. However, no in vitro test setup is currently available that is able to simulate such physiological loads during squatting and jump landing exercises. Therefore, a novel knee joint simulator allowing such physiological loads in combination with realistic, rapid movements is presented. To gain realistic joint positions and muscle forces serving as input parameters for the simulator, a combined in vivo motion analysis and inverse dynamics (MAID) study was undertaken with 11 volunteers performing squatting and jump landing exercises. Subsequently, an in vitro study using nine human knee joint specimens was conducted to prove the functionality of the simulator. To do so, slow squatting without muscle force simulation representing quasi-static loading conditions and slow squatting and jump landing with physiological muscle force simulation were carried out. During all tests ground reaction force, tibiofemoral contact pressure, and tibial rotation characteristics were simultaneously recorded. The simulated muscle forces obtained were in good correlation (0.48 ≤ R ≤ 0.92) with those from the in vivo MAID study. The resulting vertical ground reaction force showed a correlation of R = 0.93. On the basis of the target parameters of ground reaction force, tibiofemoral contact pressure and tibial rotation, it could be concluded that the knee joint load was loaded physiologically. Therefore, this is the first in vitro knee joint simulator allowing squatting and jump landing exercises in combination with physiological muscle forces that finally result in realistic ground reaction forces and physiological joint loading conditions.
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Affiliation(s)
- Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
| | - Steffen Hacker
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
| | - Stefan van Drongelen
- Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany.,Dr. Rolf M. Schwiete Research Unit for Osteoarthritis, Orthopaedic University Hospital Friedrichsheim GmbH, Frankfurt/Main, Germany
| | - Sebastian I Wolf
- Clinic for Orthopaedics and Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre of Trauma Research, Medical Centre, Ulm University, Ulm, Germany
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Cone SG, Lambeth EP, Ru H, Fordham LA, Piedrahita JA, Spang JT, Fisher MB. Biomechanical Function and Size of the Anteromedial and Posterolateral Bundles of the ACL Change Differently with Skeletal Growth in the Pig Model. Clin Orthop Relat Res 2019; 477:2161-2174. [PMID: 31373947 PMCID: PMC7000103 DOI: 10.1097/corr.0000000000000884] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 06/13/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND ACL injuries are becoming increasingly common in children and adolescents, but little is known regarding age-specific ACL function in these patients. To improve our understanding of changes in musculoskeletal tissues during growth and given the limited availability of pediatric human cadaveric specimens, tissue structure and function can be assessed in large animal models, such as the pig. QUESTIONS/PURPOSES Using cadaveric porcine specimens ranging throughout skeletal growth, we aimed to assess age-dependent changes in (1) joint kinematics under applied AP loads and varus-valgus moments, (2) biomechanical function of the ACL under the same loads, (3) the relative biomechanical function of the anteromedial and posterolateral bundles of the ACL; and (4) size and orientation of the anteromedial and posterolateral bundles. METHODS Stifle joints (analogous to the human knee) were collected from female Yorkshire crossbreed pigs at five ages ranging from early youth to late adolescence (1.5, 3, 4.5, 6, and 18 months; n = 6 pigs per age group, 30 total), and MRIs were performed. A robotic testing system was used to determine joint kinematics (AP tibial translation and varus-valgus rotation) and in situ forces in the ACL and its bundles in response to applied anterior tibial loads and varus-valgus moments. To see if morphological changes to the ACL compared with biomechanical changes, ACL and bundle cross-sectional area, length, and orientation were calculated from MR images. RESULTS Joint kinematics decreased with increasing age. Normalized AP tibial translation decreased by 44% from 1.5 months (0.34 ± 0.08) to 18 months (0.19 ± 0.02) at 60° of flexion (p < 0.001) and varus-valgus rotation decreased from 25° ± 2° at 1.5 months to 6° ± 2° at 18 months (p < 0.001). The ACL provided the majority of the resistance to anterior tibial loading at all age groups (75% to 111% of the applied anterior force; p = 0.630 between ages). Anteromedial and posterolateral bundle function in response to anterior loading and varus torque were similar in pigs of young ages. During adolescence (4.5 to 18 months), the in situ force carried by the anteromedial bundle increased relative to that carried by the posterolateral bundle, shifting from 59% ± 22% at 4.5 months to 92% ± 12% at 18 months (data for 60° of flexion, p < 0.001 between 4.5 and 18 months). The cross-sectional area of the anteromedial bundle increased by 30 mm throughout growth from 1.5 months (5 ± 2 mm) through 18 months (35 ± 8 mm; p < 0.001 between 1.5 and 18 months), while the cross-sectional area of the posterolateral bundle increased by 12 mm from 1.5 months (7 ± 2 mm) to 4.5 months (19 ± 5 mm; p = 0.004 between 1.5 and 4.5 months), with no further growth (17 ± 7 mm at 18 months; p = 0.999 between 4.5 and 18 months). However, changes in length and orientation were similar between the bundles. CONCLUSION We showed that the stifle joint (knee equivalent) in the pig has greater translational and rotational laxity in early youth (1.5 to 3 months) compared with adolescence (4.5 to 18 months), that the ACL functions as a primary stabilizer throughout growth, and that the relative biomechanical function and size of the anteromedial and posterolateral bundles change differently with growth. CLINICAL RELEVANCE Given the large effects observed here, the age- and bundle-specific function, size, and orientation of the ACL may need to be considered regarding surgical timing, graft selection, and graft placement. In addition, the findings of this study will be used to motivate pre-clinical studies on the impact of partial and complete ACL injuries during skeletal growth.
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Affiliation(s)
- Stephanie G Cone
- S. G. Cone, E. P. Lambeth, M. B. Fisher, Department of Biomedical Engineering, North Carolina State University and the University of North Carolina - Chapel Hill, Raleigh, NC, USA S. G. Cone, J. A. Piedrahita, M. B. Fisher, Comparative Medicine Institute, North Carolina State University, Raleigh, NC, USA H. Ru, Department of Computational Biology and Bioinformatics, North Carolina State University, Raleigh, NC, USA L. A. Fordham, Department of Radiology, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA J. A. Piedrahita, Department of Molecular Biomedical Sciences, North Carolina State University, Raleigh, NC, USA J. T. Spang, M. B. Fisher, Department of Orthopaedics, University of North Carolina - Chapel Hill, Chapel Hill, NC, USA
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Cone SG, Warren PB, Fisher MB. Rise of the Pigs: Utilization of the Porcine Model to Study Musculoskeletal Biomechanics and Tissue Engineering During Skeletal Growth. Tissue Eng Part C Methods 2017; 23:763-780. [PMID: 28726574 PMCID: PMC5689129 DOI: 10.1089/ten.tec.2017.0227] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Accepted: 07/14/2017] [Indexed: 12/17/2022] Open
Abstract
Large animal models play an essential role in the study of tissue engineering and regenerative medicine (TERM), as well as biomechanics. The porcine model has been increasingly used to study the musculoskeletal system, including specific joints, such as the knee and temporomandibular joints, and tissues, such as bone, cartilage, and ligaments. In particular, pigs have been utilized to evaluate the role of skeletal growth on the biomechanics and engineered replacements of these joints and tissues. In this review, we explore the publication history of the use of pig models in biomechanics and TERM discuss interspecies comparative studies, highlight studies on the effect of skeletal growth and other biological considerations in the porcine model, and present challenges and emerging opportunities for using this model to study functional TERM.
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Affiliation(s)
- Stephanie G. Cone
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Paul B. Warren
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
| | - Matthew B. Fisher
- Department of Biomedical Engineering, North Carolina State University, Raleigh, North Carolina and University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
- Comparative Medicine Institute, North Carolina State University, Raleigh, North Carolina
- Department of Orthopaedics, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Debski RE, Yamakawa S, Musahl V, Fujie H. Use of Robotic Manipulators to Study Diarthrodial Joint Function. J Biomech Eng 2017; 139:2597610. [PMID: 28056127 DOI: 10.1115/1.4035644] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2016] [Indexed: 01/13/2023]
Abstract
Diarthrodial joint function is mediated by a complex interaction between bones, ligaments, capsules, articular cartilage, and muscles. To gain a better understanding of injury mechanisms and to improve surgical procedures, an improved understanding of the structure and function of diarthrodial joints needs to be obtained. Thus, robotic testing systems have been developed to measure the resulting kinematics of diarthrodial joints as well as the in situ forces in ligaments and their replacement grafts in response to external loading conditions. These six degrees-of-freedom (DOF) testing systems can be controlled in either position or force modes to simulate physiological loading conditions or clinical exams. Recent advances allow kinematic, in situ force, and strain data to be measured continuously throughout the range of joint motion using velocity-impedance control, and in vivo kinematic data to be reproduced on cadaveric specimens to determine in situ forces during physiologic motions. The principle of superposition can also be used to determine the in situ forces carried by capsular tissue in the longitudinal direction after separation from the rest of the capsule as well as the interaction forces with the surrounding tissue. Finally, robotic testing systems can be used to simulate soft tissue injury mechanisms, and computational models can be validated using the kinematic and force data to help predict in vivo stresses and strains present in these tissues. The goal of these analyses is to help improve surgical repair procedures and postoperative rehabilitation protocols. In the future, more information is needed regarding the complex in vivo loads applied to diarthrodial joints during clinical exams and activities of daily living to serve as input to the robotic testing systems. Improving the capability to accurately reproduce in vivo kinematics with robotic testing systems should also be examined.
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Affiliation(s)
- Richard E Debski
- Orthopaedic Robotics Laboratory, Departments of Bioengineering and Orthopaedic Surgery, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219 e-mail:
| | - Satoshi Yamakawa
- Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
| | - Volker Musahl
- Orthopaedic Robotics Laboratory, Departments of Orthopaedic Surgery and Bioengineering, University of Pittsburgh, 408 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219
| | - Hiromichi Fujie
- Tokyo Metropolitan University, 6-6 Asahigaoka, Hino, Tokyo 191-0065, Japan
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Farraro KF, Sasaki N, Woo SLY, Kim KE, Tei MM, Speziali A, McMahon PJ. Magnesium ring device to restore function of a transected anterior cruciate ligament in the goat stifle joint. J Orthop Res 2016; 34:2001-2008. [PMID: 26916011 PMCID: PMC9583724 DOI: 10.1002/jor.23210] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 02/18/2016] [Indexed: 02/04/2023]
Abstract
A bioresorbable, mono-crystalline magnesium (Mg) ring device and suture implantation technique were designed to connect the ends of a transected anterior cruciate ligament (ACL) to restabilize the knee and load the ACL to prevent disuse atrophy of its insertion sites and facilitate its healing. To test its application, cadaveric goat stifle joints were evaluated using a robotic/universal force-moment sensor testing system in three states: Intact, ACL-deficient, and after Mg ring repair, at 30°, 60°, and 90° of joint flexion. Under a 67-N anterior tibial load simulating that used in clinical examinations, the corresponding anterior tibial translation (ATT) and in-situ forces in the ACL and medial meniscus for 0 and 100 N of axial compression were obtained and compared with a control group treated with suture repair. In all cases, Mg ring repair reduced the ATT by over 50% compared to the ACL-deficient joint, and in-situ forces in the ACL and medial meniscus were restored to near normal levels, showing significant improvement over suture repair. These findings suggest that Mg ring repair could successfully stabilize the joint and load the ACL immediately after surgery, laying the framework for future in vivo studies to assess its utility for ACL healing. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:2001-2008, 2016.
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Affiliation(s)
- Kathryn F. Farraro
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Norihiro Sasaki
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Savio L-Y. Woo
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Kwang E. Kim
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Matteo M. Tei
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Andrea Speziali
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
| | - Patrick J. McMahon
- Department of Bioengineering, Musculoskeletal Research Center; Swanson School of Engineering, University of Pittsburgh; 405 Center for Bioengineering, 300 Technology Drive Pittsburgh Pennsylvania 15219
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Hinckel BB, Demange MK, Gobbi RG, Pécora JR, Camanho GL. The Effect of Mechanical Varus on Anterior Cruciate Ligament and Lateral Collateral Ligament Stress: Finite Element Analyses. Orthopedics 2016; 39:e729-36. [PMID: 27111082 DOI: 10.3928/01477447-20160421-02] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023]
Abstract
The current study analyzed changes in anterior cruciate ligament (ACL) and lateral collateral ligament stress as a result of mechanical varus. In an exploratory pilot study, progressive mechanical varus was introduced to a male finite element model of the lower limb at different knee flexion angles. Nine situations were analyzed (combinations of 0°, 30°, and 60° knee flexion and 0°, 5°, and 10° varus). The ACL stress was measured via changes in section force, von Mises stress, and fiber stress. Lateral collateral ligament stress was measured via changes in section force. For all 3 measures of the ACL, maximum stress values were found in extension, stress decreased with flexion, and the effect of varus introduction was most significant at 30° flexion. With 60° flexion, varus introduction produced a decrease in section force and von Mises stress and a small increase in fiber stress. In all situations and stress measures except fiber stress at 60° flexion, stress was concentrated at the posterolateral bundle. For the lateral collateral ligament, the introduction of 5° and 10° varus caused an increase in section force at all degrees of flexion. Stress in the ligament decreased with flexion. Mechanical varus of less than 10° was responsible for increased ACL stress, particularly at 0° and 30° knee flexion, and for increased lateral collateral ligament stress at all degrees of flexion. Stress was mostly concentrated on the posterolateral bundle of the ACL. [Orthopedics. 2016; 39(4):e729-e736.].
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Bell KM, Arilla FV, Rahnemai-Azar AA, Fu FH, Musahl V, Debski RE. Novel technique for evaluation of knee function continuously through the range of flexion. J Biomech 2015; 48:3728-31. [DOI: 10.1016/j.jbiomech.2015.08.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Revised: 08/13/2015] [Accepted: 08/14/2015] [Indexed: 11/28/2022]
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12
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McLean SG, Mallett KF, Arruda EM. Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics. J Biomech Eng 2015; 137:020906. [DOI: 10.1115/1.4029278] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Indexed: 12/20/2022]
Abstract
Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.
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Affiliation(s)
- Scott G. McLean
- Human Performance Innovation Laboratory, School of Kinesiology, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Kaitlyn F. Mallett
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
| | - Ellen M. Arruda
- Department of Mechanical Engineering, Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109 e-mail:
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13
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Affiliation(s)
- P Christel
- Institut de l'Appareil Locomoteur Nollet, 23, rue Brochant, 75017 Paris
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14
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Atarod M, Rosvold JM, Frank CB, Shrive NG. Functional Activity of the Anterior and Posterior Cruciate Ligaments Under In Vivo Gait and Static Physiological Loads. Ann Biomed Eng 2013; 41:2067-76. [DOI: 10.1007/s10439-013-0826-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 05/08/2013] [Indexed: 10/26/2022]
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Atarod Pilambaraei M, O'Brien EJO, Frank CB, Shrive NG. There is significant load sharing and physical interaction between the anteromedial and posterolateral bundles of the ovine ACL under anterior tibial loads. Knee 2012; 19:797-803. [PMID: 22465820 DOI: 10.1016/j.knee.2012.03.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 02/23/2012] [Accepted: 03/06/2012] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The ovine stifle joint is an ideal preclinical model to test the ability of double-bundle reconstruction techniques in providing superior joint stability and less osteoarthritis (OA) compared with single-bundle techniques. However, knowledge of the normal ovine ACL and more specifically the load sharing and physical interaction between the two main bundles of the ovine ACL is currently limited. METHODS Six ovine stifle joints were tested using a robotic testing system. Each joint was cyclically loaded to 200N in the anterior tibial direction between 30° and 90° flexion and the force-displacement data were recorded for both the intact ACL, and when the anteromedial (AM, n=3) or the posterolateral bundle (PL, n=3) was transected. RESULTS The load shared by the AM bundle increased from 30° to 75° of flexion at all loading levels (25-200N); whereas, the load shared by the PL bundle decreased between full extension and mid flexion (60°) and then increased again. The load borne by the AM bundle did not change in response to increasing Anterior Tibial Loads (ATL) at each flexion angle, in contrast to the PL bundle (P=0.004). Physical interaction between bundles was greatest at 60° and under 50N ATL. CONCLUSION These data will help create double-bundle ACL reconstructions in sheep which are functionally similar to intact native ACL. In turn, this model can be used to examine the success of anatomically accurate double-bundle reconstructions to prevent the development of OA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- M Atarod Pilambaraei
- McCaig Institute for Bone & Joint Health, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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16
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Kongtharvonskul J, Attia J, Thamakaison S, Kijkunasathian C, Woratanarat P, Thakkinstian A. Clinical outcomes of double- vs single-bundle anterior cruciate ligament reconstruction: a systematic review of randomized control trials. Scand J Med Sci Sports 2012; 23:1-14. [PMID: 22288837 DOI: 10.1111/j.1600-0838.2011.01439.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2011] [Indexed: 12/12/2022]
Abstract
Clinical outcomes of anterior cruciate ligament (ACL) reconstruction with double-bundle and single-bundle techniques are still controversial. We therefore performed a systematic review to compare postoperative outcomes between the two techniques. Randomized control trials comparing the outcomes between the two techniques were identified from Medline and EMBASE since inception to April 27, 2011. Data were independently extracted by two reviewers. Thirteen of 318 studies were eligible; 9, 11, 7, and 8 studies were pooled for rotation, translation, function, and complication outcomes, respectively. The double-bundle technique was approximately four times (95% CI: 2.65, 11.99) and two times (95% CI: 1.16, 5.21) more likely to show a normal pivot shift and normal International Knee Documentation Committee (IKDC) grading compared with the single-bundle technique. However, there were nonsignificant differences in KT grading (OR = 1.66, 95% CI: 0.77, 3.82), IKDC score (0.29, 95% CI: -1.17, 1.75), Lysholm knee score (-0.87, 95% CI: -2.66, 0.93), Tegner activity score (0.37, 95% CI: -0.05, 0.79), and complications (OR = 1.11, 95% CI: 0.48, 2.57). Heterogeneity was present in some outcomes but there was no evidence of publication bias for any outcome. The double-bundle may be better than the single-bundle ACL reconstruction technique in rotational stability but not for function, translation, and complications.
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Affiliation(s)
- J Kongtharvonskul
- Section for Clinical Epidemiology and Biostatistics, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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Herfat ST, Shearn JT, Bailey DL, Greiwe RM, Galloway MT, Gooch C, Butler DL. Effect of surgery to implant motion and force sensors on vertical ground reaction forces in the ovine model. J Biomech Eng 2011; 133:021010. [PMID: 21280882 DOI: 10.1115/1.4003322] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Activities of daily living (ADLs) generate complex, multidirectional forces in the anterior cruciate ligament (ACL). While calibration problems preclude direct measurement in patients, ACL forces can conceivably be measured in animals after technical challenges are overcome. For example, motion and force sensors can be implanted in the animal but investigators must determine the extent to which these sensors and surgery affect normal gait. Our objectives in this study were to determine (1) if surgically implanting knee motion sensors and an ACL force sensor significantly alter normal ovine gait and (2) how increasing gait speed and grade on a treadmill affect ovine gait before and after surgery. Ten skeletally mature, female sheep were used to test four hypotheses: (1) surgical implantation of sensors would significantly decrease average and peak vertical ground reaction forces (VGRFs) in the operated limb, (2) surgical implantation would significantly decrease single limb stance duration for the operated limb, (3) increasing treadmill speed would increase VGRFs pre- and post operatively, and (4) increasing treadmill grade would increase the hind limb VGRFs pre- and post operatively. An instrumented treadmill with two force plates was used to record fore and hind limb VGRFs during four combinations of two speeds (1.0 m/s and 1.3 m/s) and two grades (0 deg and 6 deg). Sensor implantation decreased average and peak VGRFs less than 10% and 20%, respectively, across all combinations of speed and grade. Sensor implantation significantly decreased the single limb stance duration in the operated hind limb during inclined walking at 1.3 m/s but had no effect on single limb stance duration in the operated limb during other activities. Increasing treadmill speed increased hind limb peak (but not average) VGRFs before surgery and peak VGRF only in the unoperated hind limb during level walking after surgery. Increasing treadmill grade (at 1 m/s) significantly increased hind limb average and peak VGRFs before surgery but increasing treadmill grade post op did not significantly affect any response measure. Since VGRF values exceeded 80% of presurgery levels, we conclude that animal gait post op is near normal. Thus, we can assume normal gait when conducting experiments following sensor implantation. Ultimately, we seek to measure ACL forces for ADLs to provide design criteria and evaluation benchmarks for traditional and tissue engineered ACL repairs and reconstructions.
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Affiliation(s)
- Safa T Herfat
- Department of Biomedical Engineering, Tissue Engineering and Biomechanics Laboratories, University of Cincinnati, Mail Location 0048, Cincinnati, OH 45221-0048, USA.
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Boguszewski DV, Shearn JT, Wagner CT, Butler DL. Investigating the effects of anterior tibial translation on anterior knee force in the porcine model: is the porcine knee ACL dependent? J Orthop Res 2011; 29:641-6. [PMID: 21437942 DOI: 10.1002/jor.21298] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2009] [Accepted: 10/05/2010] [Indexed: 02/04/2023]
Abstract
This study sought to determine anterior force in the porcine knee during simulated 6-degree-of-freedom (DOF) motion to establish the role of the anterior cruciate ligament (ACL). Using a 6-DOF robot, a simulated ovine motion was applied to porcine hind limbs while recording the corresponding forces. Since the porcine knee is more lax than the ovine knee, anterior tibial translations were superimposed on the simulated motion in 2 mm increments from 0 mm to 10 mm to find a condition that would load the ACL. Increments through 8 mm increased anterior knee force, while the 10 mm increment decreased the force. Beyond 4 mm, anterior force increases were non-linear and less than the increases at 2 and 4 mm, which may indicate early structural damage. At 4 mm, the average anterior force was 76.9 ± 10.6 N (mean ± SEM; p < 0.025). The ACL was the primary restraint, accounting for 80-125% of anterior force throughout the range of motion. These results demonstrate the ACL dependence of the porcine knee for the simulated motion, suggesting this model as a candidate for studying ACL function. With reproducible testing conditions that challenge the ACL, this model could be used in developing and screening possible reconstruction strategies.
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Affiliation(s)
- Daniel V Boguszewski
- Department of Biomedical Engineering, Tissue Engineering and Biomechanics Laboratories, 2901 Campus Drive, 852 Engineering Research Center, University of Cincinnati, Cincinnati, Ohio, USA
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19
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Suture augmentation following ACL injury to restore the function of the ACL, MCL, and medial meniscus in the goat stifle joint. J Biomech 2011; 44:1530-5. [PMID: 21470612 DOI: 10.1016/j.jbiomech.2011.02.141] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/21/2011] [Accepted: 02/27/2011] [Indexed: 01/14/2023]
Abstract
Functional tissue engineering (FTE) approaches have shown promise in healing an injured anterior cruciate ligament (ACL) of the knee. Nevertheless, additional mechanical augmentation is needed to maintain joint stability and appropriate loading of the joint while the ACL heals. The objective of this study was to quantitatively evaluate how mechanical augmentation using sutures restores the joint kinematics as well as the distribution of loading among the ACL, medial collateral ligament, and medial meniscus (MM) in response to externally applied loads. Eight goat stifle joints were tested on a robotic/universal force-moment sensor testing system under two loading conditions: (1) a 67N anterior tibial load (ATL) and (2) a 67N ATL with 100N axial compression. For each joint, four experimental conditions were tested at 30°, 60°, and 90° of flexion: the (1) intact and (2) ACL-deficient joint, as well as following (3) suture repair of the transected ACL, and (4) augmentation using sutures passed from the femur to the tibia. Under the 67N ATL, suture augmentation could restore the anterior tibial translation (ATT) to within 3mm of the intact joint (p>0.05), representing a 54-76% improvement over suture repair (p<0.05). With the additional axial compression, the ATT and in-situ forces of the sutures following suture augmentation remained 2-3 times closer to normal (p<0.05). Also, the in-situ forces in the MM were 58-73% lower (p<0.05). Thus, suture augmentation may be helpful in combination with FTE approaches for ACL healing by providing the needed initial joint stability while lowering the loads on the MM.
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Belvedere C, Leardini A, Giannini S, Ensini A, Bianchi L, Catani F. Does medio-lateral motion occur in the normal knee? An in-vitro study in passive motion. J Biomech 2011; 44:877-84. [DOI: 10.1016/j.jbiomech.2010.12.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Revised: 12/03/2010] [Accepted: 12/03/2010] [Indexed: 11/25/2022]
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Xu Y, Liu J, Kramer S, Martins C, Kato Y, Linde-Rosen M, Smolinski P, Fu FH. Comparison of in situ forces and knee kinematics in anteromedial and high anteromedial bundle augmentation for partially ruptured anterior cruciate ligament. Am J Sports Med 2011; 39:272-8. [PMID: 21131679 DOI: 10.1177/0363546510383479] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND High tunnel placement is common in single- and double-bundle anterior cruciate ligament (ACL) reconstructions. Similar nonanatomic tunnel placement may also occur in ACL augmentation surgery. PURPOSE In this study, in situ forces and knee kinematics were compared between nonanatomic high anteromedial (AM) and anatomic AM augmentation in a knee with isolated AM bundle injury. STUDY DESIGN Controlled laboratory study. METHODS Seven fresh-frozen cadaver knees were used (age, 48 ± 12.5 years). First, intact knee kinematics was tested with a robotic-universal force sensor testing system under 2 loading conditions. An 89-N anterior load was applied, and an anterior tibial translation was measured at knee flexion angles of 0°, 30°, 60°, and 90°. Then, combined rotatory loads of 7-N·m valgus and 5-N·m internal tibial rotation were applied at 15° and 30° of knee flexion angles, which mimic the pivot shift. Afterward, only the AM bundle of the ACL was cut arthroscopically, keeping the posterolateral bundle intact. The knee was again tested using the intact knee kinematics to measure the in situ force of the AM bundle. Then, arthroscopic anatomic AM bundle reconstruction was performed with an allograft, and the knee was tested to give the in situ force of the reconstructed AM bundle. Knee kinematics under the 3 conditions (intact, anatomic AM augmentation, and nonanatomic high AM augmentation) and the in situ force were compared and analyzed. RESULT The high AM graft had significantly lower in situ force than the intact and anatomic reconstructed AM bundle at 0° of knee flexion (P < .05) and the intact AM bundle at 30° of knee flexion under anterior tibial loading. There were no differences between anatomic graft and intact AM bundle. The high AM graft also had a significantly lower in situ force than the intact and anatomic reconstructed AM with simulated pivot-shift loading at 15° and 30° of flexion (P < .05). Under anterior tibial and rotatory loading, there was a difference in tibial displacement between anatomic and high AM reconstructions and between the high AM graft and intact ACL under rotational loading with the knee at 15° of flexion. CLINICAL RELEVANCE Anatomic AM augmentation can lead to biomechanical advantages at time zero when compared with the nonanatomic (high AM) augmentation. Anatomic AM augmentation better restores the knee kinematics to the intact ACL state.
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Affiliation(s)
- Yan Xu
- University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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22
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Germscheid NM, Thornton GM, Hart DA, Hildebrand KA. A biomechanical assessment to evaluate breed differences in normal porcine medial collateral ligaments. J Biomech 2011; 44:725-31. [DOI: 10.1016/j.jbiomech.2010.10.036] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2010] [Revised: 10/20/2010] [Accepted: 10/25/2010] [Indexed: 01/13/2023]
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Jung HJ, Fisher MB, Woo SLY. Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons. BMC Sports Sci Med Rehabil 2009; 1:9. [PMID: 19457264 PMCID: PMC2695438 DOI: 10.1186/1758-2555-1-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2009] [Accepted: 05/20/2009] [Indexed: 12/19/2022]
Abstract
Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis. The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons. With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented.
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Affiliation(s)
- Ho-Joong Jung
- Musculoskeletal Research Center, Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, USA.
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Bontempi M. Probabilistic model of ligaments and tendons: quasistatic linear stretching. PHYSICAL REVIEW. E, STATISTICAL, NONLINEAR, AND SOFT MATTER PHYSICS 2009; 79:030903. [PMID: 19391892 DOI: 10.1103/physreve.79.030903] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 02/11/2009] [Indexed: 05/27/2023]
Abstract
Ligaments and tendons have a significant role in the musculoskeletal system and are frequently subjected to injury. This study presents a model of collagen fibers, based on the study of a statistical distribution of fibers when they are subjected to quasistatic linear stretching. With respect to other methodologies, this model is able to describe the behavior of the bundle using less ad hoc hypotheses and is able to describe all the quasistatic stretch-load responses of the bundle, including the yield and failure regions described in the literature. It has two other important results: the first is that it is able to correlate the mechanical behavior of the bundle with its internal structure, and it suggests a methodology to deduce the fibers population distribution directly from the tensile-test data. The second is that it can follow fibers' structure evolution during the stretching and it is possible to study the internal adaptation of fibers in physiological and pathological conditions.
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Affiliation(s)
- M Bontempi
- Biomechanics Laboratory, Istituti Ortopedici Rizzoli, via di Barbiano 1/10, 40136 Bologna, Italy.
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Abstract
In our research center, we have developed and utilized a novel robotic/universal force-moment sensor testing system to gain quantitative data on multiple-degree-of-freedom kinematics of the knee simultaneously with data on the in situ forces in normal and repaired soft tissues. In particular, we have investigated the complex interaction of the anteromedial and posterolateral bundles of the anterior cruciate ligament as well as several key biomechanical variables in anterior cruciate ligament reconstruction, such as graft selection and femoral tunnel placement (both of which impact knee stability). For example, both the bone-patellar tendon-bone and quadrupled hamstrings tendon autografts restored anterior stability but were insufficient in gaining rotatory stability. In a follow-up study, we have shown that a more laterally placed graft was beneficial and could improve these outcomes. Such findings led to additional investigation in which the biomechanical advantages of double-bundle anterior cruciate ligament reconstruction were demonstrated. However, a more laterally placed autograft at the femoral insertion of the posterolateral bundle also worked well, especially when the knee was nearly at full extension (a position in which the anterior cruciate ligament is needed most). At present, we are moving forward by obtaining in vivo kinematics data and then repeating those kinematics exactly to obtain new data with use of the robotic/universal force-moment sensor testing system in order to gain further insight regarding the function of the anterior cruciate ligament and anterior cruciate ligament replacement grafts in vivo. In parallel, we are developing a mathematical model of the knee and validating the computational model with experimental data. The combined approach will yield new and relevant information, including the stress and strain distribution in the anterior cruciate ligament and anterior cruciate ligament grafts. This will facilitate a better understanding of the function of the anterior cruciate ligament and a scientifically based design of surgical procedures and postoperative rehabilitation protocols that will lead to better patient outcomes.
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Affiliation(s)
- Savio L-Y. Woo
- Musculoskeletal Research Center, Swanson School of Engineering, Department of Bioengineering, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for S.L-Y. Woo:
| | - Matthew B. Fisher
- Musculoskeletal Research Center, Swanson School of Engineering, Department of Bioengineering, 405 Center for Bioengineering, 300 Technology Drive, Pittsburgh, PA 15219. E-mail address for S.L-Y. Woo:
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Moore SM, Stehle JH, Rainis EJ, McMahon PJ, Debski RE. The current anatomical description of the inferior glenohumeral ligament does not correlate with its functional role in positions of external rotation. J Orthop Res 2008; 26:1598-604. [PMID: 18524007 DOI: 10.1002/jor.20685] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The objective of this study was to determine the strain distribution in the inferior glenohumeral ligament at 0 degree, 30 degrees, and 60 degrees of external rotation with an anterior load applied to the joint. Five cadaver shoulders were dissected free of all soft tissue except the glenohumeral capsule and a 7 x 11 grid of strain markers were affixed to the inferior glenohumeral ligament. The location of these strain markers was then determined for a reference strain configuration and while a 25 N anterior load was applied to simulate a clinical exam for instability. The magnitude and direction of the maximum principal strains were then determined at each joint position. For all specimens, the magnitude of the maximum principal strains were significantly greater for 30 degrees and 60 degrees of external rotation when compared to 0 degree of external rotation. Furthermore, when comparing 30 degrees to 60 degrees of external rotation, three of the five specimens were significantly different. Additionally, the previously described regions of the inferior glenohumeral ligament could not be identified with a qualitative evaluation of the strain distribution pattern for each specimen at all external rotation angles. This indicates that our current description of the three regions of the inferior glenohumeral ligament does not correspond to its functional role. Additionally, the directions of the maximum principal strains across the inferior glenohumeral ligament became more aligned with one another as external rotation was increased. The complex strain distributions observed indicates that future studies should treat the inferior glenohumeral capsule as a continuous sheet of fibrous tissue.
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Affiliation(s)
- Susan M Moore
- Department of Bioengineering, 405 Center for Bioengineering, 300 Technology Drive, University of Pittsburgh, Pittsburgh, Pennsylvania 15219, USA
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Darcy SP, Rosvold JM, Beveridge JE, Corr DT, Brown JJ, Sutherland CA, Marchuk LL, Frank CB, Shrive NG. A comparison of passive flexion–extension to normal gait in the ovine stifle joint. J Biomech 2008; 41:854-60. [DOI: 10.1016/j.jbiomech.2007.10.025] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Revised: 10/25/2007] [Accepted: 10/30/2007] [Indexed: 10/22/2022]
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Garbelotti Júnior SA, Pelozo Júnior O, Caldana RP, Ramalho A, Smith RL. Experimental evaluation of 3-dimensional kinematic behavior of the cruciate ligaments. Clinics (Sao Paulo) 2007; 62:619-26. [PMID: 17952324 DOI: 10.1590/s1807-59322007000500014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Accepted: 07/07/2007] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate a low-cost and easily reproducible technique for biomechanical studies in cadavers. In this kind of study, the natural effect of loading of the joint and shear forces are not taken into account. The objective is to describe the plastic deformation of the ligaments into 3-dimensional space. METHOD For 18 intact human cadaver knees, the cruciate ligaments were divided into 3 fiber bundles, the tibial or femoral fixation points were marked, and 2 perpendicular different x-ray exposures were performed, thus obtaining radiographs of spatial projections of the bundle in 3 anatomic planes (frontal, sagittal, and transversal). From the measurements made on the x-ray films, we obtained the average distance between the 2 fixation points of the cruciate ligaments on the tibia and the femur at 4 different flexion angles. RESULTS The distance between the fixation points of the medial and lateral fiber bundles of the cruciate ligaments did not change significantly during movement. There were, however, significant variations (P < .05) in the distance between the fixation points of the posterior fiber bundles of the anterior cruciate ligament and the anterior fiber bundles of the posterior cruciate ligament. CONCLUSIONS This technique was efficient for demonstrating the plastic deformability of the cruciate ligaments. The results proceeding from this type of study can assist in the planning of physical rehabilitation programs.
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Li G, Papannagari R, DeFrate LE, Yoo JD, Park SE, Gill TJ. The effects of ACL deficiency on mediolateral translation and varus-valgus rotation. Acta Orthop 2007; 78:355-60. [PMID: 17611849 DOI: 10.1080/17453670710013924] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND The anterior cruciate ligament (ACL) constrains the anterior translation and axial rotation of the tibia. However, the effect of ACL injury on the mediolateral translation and varus-valgus rotation of the tibia is unknown. Because of the oblique orientation of the ACL, we hypothesized that ACL deficiency alters mediolateral translation and varus-valgus rotation. METHODS The kinematics of 9 cadavers from full extension to 90 degrees of flexion under various loading conditions were measured before and after ACL resection using a robotic testing system. RESULTS ACL deficiency increased the medial translation of the tibia and valgus rotation, especially at 15 degrees and 30 degrees of flexion. For example, at 15 degrees, ACL deficiency increased the medial translation from 1.2 (SD 0.9) mm to 1.8 (SD 1.1) mm in response to a quadriceps load. The valgus rotation also increased from 0.8 degrees (SD 0.6) to 1.7 degrees (SD 0.8). INTERPRETATION ACL deficiency altered both the mediolateral tibial translation and valgus-varus rotation under various loading conditions. The increased medial tibial translation could shift the contact in the medial compartment towards the medial tibial spine, a region where degeneration is observed in ACL-deficient patients. In addition to restoring anterior laxity, ACL reconstruction might need to restore the mediolateral translation of the tibia and varus-valgus rotation of the knee.
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Affiliation(s)
- Guoan Li
- Bioengineering Laboratory, Department of Orthopaedic Surgery, Massachusetts General Hospital/Harvard Medical School. Boston, MA, USA.
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Petersen W, Lenschow S, Weimann A, Strobel MJ, Raschke MJ, Zantop T. Importance of femoral tunnel placement in double-bundle posterior cruciate ligament reconstruction: biomechanical analysis using a robotic/universal force-moment sensor testing system. Am J Sports Med 2006; 34:456-63. [PMID: 16303880 DOI: 10.1177/0363546505281239] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous studies have identified the femoral attachment of the posterior cruciate ligament fibers as one of the primary determinants of fiber tension behavior. In addition, a double-bundle posterior cruciate ligament reconstruction has been shown to restore the intact knee kinematics more closely than does a single-bundle reconstruction. HYPOTHESIS An anterior tunnel position in double-bundle posterior cruciate ligament reconstruction restores the biomechanics of the normal knee more closely than does a posterior tunnel position. STUDY DESIGN Controlled laboratory study. METHODS Kinematics and in situ forces of human knees after double-bundle posterior cruciate ligament reconstruction with 2 different femoral tunnel positions (anterior vs posterior) were evaluated using a robotic/universal force-moment sensor testing system. Within the same specimen, the resulting knee kinematics and in situ forces were compared. For statistical analysis, 2-way analysis of variance repeated measures were performed. RESULTS The femoral tunnel position of the double-bundle hamstring graft had significant effect on the resulting posterior tibial displacement and in situ forces of the hamstring grafts. The anterior femoral tunnel position provided significantly less posterior tibial translation than did the posterior tunnel position. There was a tendency toward higher in situ forces of grafts fixed in the anterior tunnel when compared to the posterior position, but this difference was statistically not significant. CONCLUSION An anterior position of the bone tunnels in double-bundle posterior cruciate ligament reconstruction restores the normal knee kinematics more closely than does a posterior position of the tunnels. CLINICAL RELEVANCE In double-bundle posterior cruciate ligament reconstruction, posterior placement of the tunnel should be avoided.
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Affiliation(s)
- Wolf Petersen
- Department of Trauma-, Hand-, and Reconstructive Surgery, Wilhelms University Muenster, Waldeyerstr. 1, D-48149 Muenster, Germany
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Woo SLY, Thomas M, Chan Saw SS. Contribution of biomechanics, orthopaedics and rehabilitation: the past present and future. Surgeon 2005; 2:125-36. [PMID: 15570813 DOI: 10.1016/s1479-666x(04)80072-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Biomechanics is a field that has a very long history. From its beginnings in ancient Chinese and Greek literature, the field of orthopaedic biomechanics has grown in the areas of biomechanics of bone, articular cartilage, soft tissues, upper extremities, spine and so on. Bioengineers in collaboration with orthopaedic surgeons have applied biomechanical principles to study clinically relevant problems, improving patient treatment and outcome. In the past 30 years, my colleagues and I have focused our research on the biomechanics of musculoskeletal soft tissues, ligaments and tendons in particular. Therefore, in this review article, the function of the knee ligaments and the associated homeostatic responses secondary to immobilisation and exercise will be described. Research on healing of the medial collateral ligament (MCL) of the knee and possible future approaches in improving the healing of the knee ligaments will be presented. Finally, improvement of the understanding of ligament reconstruction, specifically of the anterior cruciate ligament (ACL), through the use of robotics technology will be included. Throughout the manuscript, specific scientific findings that have guided or changed the clinical management of injury to these soft tissues will be emphasised.
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Affiliation(s)
- S L Y Woo
- Musculosketetal Research Centre, Department of Bioengineering Surgery, University of Pittsburgh, E1641 Biomedical Science Tower, 210 Lothrop Street, PA 15213, USA
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Zantop T, Lenschow S, Lemburg T, Weimann A, Petersen W. Soft-tissue graft fixation in posterior cruciate ligament reconstruction: evaluation of the effect of tibial insertion site on joint kinematics and in situ forces using a robotic/UFS testing system. Arch Orthop Trauma Surg 2004; 124:614-20. [PMID: 15372279 DOI: 10.1007/s00402-004-0741-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Indexed: 02/09/2023]
Abstract
INTRODUCTION Surgical reconstruction of the posterior cruciate ligament (PCL) is recommended in acute injuries that result in severe tibial subluxation and instability. The surgical outcome level may be affected by the tibial fixation site. In response to a 110-N posterior tibial load, kinematics and in situ forces of anatomical soft-tissue graft fixation in single-bundle PCL reconstruction using an interference screw fixation are significantly closer to those in the intact knee than with extracortical fixation with two staples. MATERIALS AND METHODS Using a robotic/universal force moment sensor (UFS) testing system, we examined joint kinematics and in situ forces of porcine knees following single-bundle PCL reconstruction fixed at two different tibial fixation sites: anatomical interference screw and extracortical fixation. RESULTS The site of the tibial graft fixation had significant effect on the resulting posterior displacement and in situ forces of the graft. Both PCL reconstruction techniques reduced the posterior tibial translation significantly. Proximal fixation techniques provided significantly less posterior tibial translation than extracortical fixation. Single-bundle PCL reconstruction with an interference screw showed higher in situ forces of the graft than the extracortical fixation. CONCLUSIONS The kinematics and in situ forces of a single-bundle PCL reconstruction using an interference screw fixation technique are superior to the primary stability of an extracortical fixation with staples.
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Affiliation(s)
- Thore Zantop
- Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, PA, USA
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Sbihi A, Franceschi JP, Christel P, Colombet P, Djian P, Bellier G. Reconstruction du ligament croisé antérieur par greffe de tendons de la patte d’oie à un ou à deux faisceaux. ACTA ACUST UNITED AC 2004; 90:643-50. [PMID: 15625515 DOI: 10.1016/s0035-1040(04)70725-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE OF THE STUDY We worked with cadaver specimens to evaluate control of anterior knee laxity after reconstruction of the anterior cruciate ligament (ACL) comparing double two-strand anterolateral and posteromedial reconstruction with the classical four-strand technique. We hypothesized that the double reconstruction would provide better control of anterior laxity in both flexion and extension. MATERIAL AND METHODS Sixteen cadaver knees were randomly assigned to reconstruction technique. Anterior tibial translation was measured with an arthrometer (Rolimeter) at maximal manual tension at 20 degrees, 60 degrees and 90 degrees flexion on the intact knee, after section of the ACL and after arthroscopic reconstruction using either the classical four-strand hamstring technique or a double two-strand anteromedial and posterolateral technique. An EndoButtonCL was used for the femoral fixation and a interference screw with staples for the tibial fixation. Variation in the length of each construct was measured between 0 degrees and 90 degrees flexion. RESULTS In the single reconstruction group, the length of the graft varied by 0.5 +/- 0.7 mm between 0 degrees and 90 degrees flexion. In the double reconstruction group, the length varied by 0.5 +/- 0.9 mm for the anteromedial construct and 3.4 +/- 0.5 mm for the posterolateral construct. When studied with an intact ACL, anterior laxity of the 16 knees was 3.2 +/- 1.1, 3.5 +/- 1.5 and 2.6 +/- 1.1 mm at 20 degrees, 60 degrees, and 90 degrees respectively. After section of the ACL, laxity increased significantly at all angles: 9.4 +/- 3.3, 6.1 +/- 2.5 and 6.8 +/- 2.9 at 20 degrees, 60 degrees, and 90 degrees respectively. After classical four-strand single graft reconstruction, the residual anterior laxity was 3.7 +/- 0.9, 3.1 +/- 1.1, and 2.3 +/- 1.6 mm at 20 degrees, 60 degrees, and 90 degrees flexion. Statistical analysis using parametric or non-parametric tests as appropriate showed a significant difference in laxity at 20 degrees, 60 degrees, and 90 degrees of flexion between knees with a cut ACL and knees with reconstructed ACL. At 20 degrees flexion, residual laxity was greater after single-construct reconstruction. At 60 degrees and 90 degrees there was no significant difference in anterior translation of the tibia in knees with intact or reconstructed ACL. After reconstruction with the dual-construct technique, laxity was 3.4 +/- 1.3, 2.6 +/- 1.5, and 2.4 +/- 1.2 mm at 20 degrees, 60 degrees and 90 degrees flexion respectively. Laxity was significantly greater with a cut ACL than after reconstruction at 20 degrees, 60 degrees, and 90 degrees flexion, but there was no significant difference in anterior translation of the tibia at 20 degrees, 60 degrees, and 90 degrees flexion between knees with an intact and a reconstructed ACL. DISCUSSION These results based on a clinical evaluation measuring anterior translation of the tibia with an arthrometer are in agreement with results in the literature using robots. Compared with the classical technique, reconstruction of the ACL with a dual-construct technique provides a statistically significant improvement in control of anterior tibial translation at 20 degrees of flexion. The advantage of the dual anteromedial and posteriolateral construct technique is thus not found in the control of anterior laxity but rather in control of rotation laxity. CONCLUSION Reconstruction of the ACL with a two-bundle graft technique provides control of anterior laxity at 20 degrees, 60 degrees, and 90 degrees flexion similar to that observed in knees with an intact ACL while the single construct technique re-establishes physiological laxity at 60 degrees and 90 degrees only. This improved control of anterior laxity with the two-bundle reconstruction is a small improvement regarding anterior laxity, the more potential advantage concerning rotational stability.
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Affiliation(s)
- A Sbihi
- Service de Chirurgie Orthopédique, Hôpital de la Conception, 147, boulevard Baille, 13385 Marseille 5
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Butler DL, Shearn JT, Juncosa N, Dressler MR, Hunter SA. Functional tissue engineering parameters toward designing repair and replacement strategies. Clin Orthop Relat Res 2004:S190-9. [PMID: 15480066 DOI: 10.1097/01.blo.0000144858.65450.d2] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Abnormal joint kinematics and loads induced after soft tissue injuries are assumed to contribute to long-term degenerative joint disease and osteoarthritis. Controlling abnormal kinematics after repair and reconstruction of these injured structures would seem to be important for limiting wear of the articular cartilage surfaces. In this paper, we propose to expand the paradigm of functional tissue engineering to more fully characterize normal joint function and to establish design parameters for soft tissue repair and reconstruction to ultimately protect joint surfaces after surgery. Structure-function relationships are examined for tissues of increasing complexity, from tendons to menisci. Emphasis is placed on understanding normal in vivo function of tissues by conducting biomechanical experiments in vitro that better mimic in vivo conditions. This process yields nine classes of functional tissue engineering parameters: differential fiber length, in vivo force and displacement, variations in relative attachment site locations, loading from adjacent structures, fiber interactions, types of insertion, regional variations in material properties, nonparallel fiber orientations, and complex loading within the structure. These functional tissue engineering parameters are useful not only for understanding the function of normal tissues but for more effectively designing their repair and replacement. This paper concludes with a discussion of research directions that investigators might take to establish tissue-specific functional tissue engineering parameters for improving joint function and reducing articular surface degradation and osteoarthritis.
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Affiliation(s)
- David L Butler
- Department of Biomedical Engineering, University of Cincinnati, Cincinnati, OH 45221, USA.
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Fujie H, Sekito T, Orita A. A Novel Robotic System for Joint Biomechanical Tests: Application to the Human Knee Joint. J Biomech Eng 2004; 126:54-61. [PMID: 15171129 DOI: 10.1115/1.1644567] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
The objectives of the work reported in this article were to develop a novel 6-degree-of-freedom (DOF) robotic system for knee joint biomechanics, to complete a hybrid force-position control scheme, to evaluate the system performance, and to demonstrate a combined loading test. The manipulator of the system utilizes two mechanisms; the upper mechanism has two translational axes and three rotational axes while the lower mechanism has only a single translational axis. All axes were driven with AC servo-motors. This unique configuration results in a simple kinematic description of manipulator motion. Jacobian transformation was used to calculate both the displacement and force/moment, which allowed for a hybrid control of the displacement of, and force/moment applied to, the human knee joint. The control and data acquisition were performed on a personal computer in the C-language programming environment with a multi-tasking operating system. Preliminary tests revealed that the clamp-to-clamp compliance of the system was smaller in the vertical (Z) and longitudinal (Y) directions (0.001 mm/N) than in lateral (X) direction (0.003 mm/N). The displacement error under the application of 500 N of load was smallest in the vertical direction (0.001±0.003 mm (mean±SD), and largest in the lateral direction (0.084±0.027 mm). Using this test system, it was possible to simulate multiple loading conditions in a human knee joint in which a cyclic anterior force was applied together with a coupled, joint compressive force, while allowing natural knee motion. The developed system seems to be a useful tool for studies of knee joint biomechanics.
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Affiliation(s)
- Hiromichi Fujie
- Biomechanics Laboratory, Department of Mechanical Engineering, Faculty of Engineering, Kogakuin University, Hachioji, Tokyo 192-0015, Japan.
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Song Y, Debski RE, Musahl V, Thomas M, Woo SLY. A three-dimensional finite element model of the human anterior cruciate ligament: a computational analysis with experimental validation. J Biomech 2004; 37:383-90. [PMID: 14757458 DOI: 10.1016/s0021-9290(03)00261-6] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In this study, the force and stress distribution within the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) in response to an anterior tibial load with the knee at full extension was calculated using a validated three-dimensional finite element model (FEM) of a human ACL. The interaction between the AM and PL bundles, as well as the contact and friction caused by the ACL wrapping around the bone during knee motion, were included in the model. The AM and PL bundles of the ACL were simulated as incompressible homogeneous and isotropic hyperelastic materials. The multiple-degrees-of-freedom (DOF) knee kinematics of a cadaveric knee were first obtained using a robotic/universal force-moment sensor testing system. These data were used as the boundary conditions for the FEM of the ACL to calculate the forces in the ACL. The calculated forces were compared to the in situ force in the ACL, determined experimentally, to validate the model. The validated FEM was then used to calculate the force and stress distribution within the ACL under an anterior tibial load at full extension. The AM and PL bundles shared the force, and the stress distribution was non-uniform within both bundles with the highest stress localized near the femoral insertion site. The contact and friction caused by the ACL wrapping around the bone during knee motion played the role of transferring the force from the ACL to the bone, and had a direct effect on the force and stress distribution of the ACL. This validated model will enable the analysis of force and stress distribution in the ACL in response to more complex loading conditions and has the potential to help design improved surgical procedures following ACL injuries.
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Affiliation(s)
- Yuhua Song
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh, E1641 Biomedical Science Tower, 210 Lothrop St., PO Box 71199, Pittsburgh, PA 15213, USA
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Mikami S, Yasuda K, Katsuragi R, Aoki Y, Minami A, Tohyama H. Reduction of initial tension in the in situ frozen anterior cruciate ligament. Clin Orthop Relat Res 2004:207-13. [PMID: 15021156 DOI: 10.1097/00003086-200402000-00034] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
The purposes of this study were to develop a new method to measure in situ tension in the anterior cruciate ligament, and to show degradation changes in the tension applied to the in situ frozen-thawed anterior cruciate ligament during a 12-week period postoperatively. Eighteen mature Beagles were used in the current study. Each dog had the in situ freeze and thaw treatment to its anterior cruciate ligament, and an initial tension of 20 N was applied to the anterior cruciate ligament. The in situ tension in the anterior cruciate ligament was measured immediately after surgery (n = 4) and at 6 and 12 weeks (n = 5, respectively) with a method developed specifically for this study. A commercially available force transducer, the utility and the validity of which were established in previous studies, was inserted into the anterior cruciate ligament, and the transducer was calibrated in situ using a tensile tester after sacrifice. The four remaining animals were used for histologic examinations. The average tension in the anterior cruciate ligament decreased from 19.1 N immediately after surgery to 14.2 N and 4.7 N at 6 and 12 weeks, respectively. There were significant differences among the times. At 12 weeks, histologically, degenerative changes were seen with asteroid-shaped cells and vacuoles in the anterior cruciate ligament. The current study showed that the high initial tension applied to the in situ frozen anterior cruciate ligament gradually decreased with time until 12 weeks.
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Affiliation(s)
- Susumu Mikami
- Departments of Orthopaedic Surgery and Sports Medicine, Hokkaido University School of Medicine, Kita-ku, Sapporo, Japan
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Weiss JA, Gardiner JC, Bonifasi-Lista C. Ligament material behavior is nonlinear, viscoelastic and rate-independent under shear loading. J Biomech 2002; 35:943-50. [PMID: 12052396 DOI: 10.1016/s0021-9290(02)00041-6] [Citation(s) in RCA: 154] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The material behavior of ligament is determined by its constituents, their organization and their interaction with each other. To elucidate the origins of the multiaxial material behavior of ligaments, we investigated ligament response to shear loading under both quasi-static and rate-dependent loading conditions. Stress relaxation tests demonstrated that the tissue was highly viscoelastic in shear, with peak loads dropping over 40% during 30 min of stress relaxation. The stress relaxation response was unaffected by three decades of change in shear strain rate (1.3, 13 and 130%/s). A novel parameter estimation technique was developed to determine material coefficients that best described the experimental response of each test specimen to shear. The experimentally measured clamp displacements and reaction forces from the simple shear tests were used with a nonlinear optimization strategy based around function evaluations from a finite element program. A transversely isotropic material with an exponential matrix strain energy provided an excellent fit to experimental load-displacement curves. The shear modulus of human MCL showed a significant increase with increasing shear strain (p<0.001), reaching a maximum of 1.72+/-0.4871 MPa. The results obtained from this study suggest that viscoelasticity in shear does not likely result from fluid flow. Gradual loading of transversely oriented microstructural features such as intermolecular collagen crosslinks or collagen-proteoglycan crosslinking may be responsible for the stiffening response under shear loading.
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Affiliation(s)
- Jeffrey A Weiss
- Department of Bioengineering, The University of Utah, 50 S Central Campus Drive, Rm #2480, Salt Lake City, UT 84112, USA.
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Woo SL, Debski RE, Zeminski J, Abramowitch SD, Saw SS, Fenwick JA. Injury and repair of ligaments and tendons. Annu Rev Biomed Eng 2002; 2:83-118. [PMID: 11701508 DOI: 10.1146/annurev.bioeng.2.1.83] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
In this chapter, biomechanical methods used to analyze healing and repair of ligaments and tendons are initially described such that the tensile properties of these soft tissues as well as their contribution to joint motion can be determined. The focus then turns to the important mechanical and biological factors that improve the healing process of ligaments. The biomechanics of surgical reconstruction of the anterior cruciate ligament and the key surgical parameters that affect the performance of the replacement grafts are subsequently reviewed. Finally, injury mechanisms and the biomechanical analysis of various treatment techniques for various types of tendon injuries are described.
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Affiliation(s)
- S L Woo
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania 15213, USA
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Mae T, Shino K, Miyama T, Shinjo H, Ochi T, Yoshikawa H, Fujie H. Single- versus two-femoral socket anterior cruciate ligament reconstruction technique: Biomechanical analysis using a robotic simulator. Arthroscopy 2001; 17:708-16. [PMID: 11536089 DOI: 10.1053/jars.2001.25250] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
PURPOSE Although anterior cruciate ligament (ACL) reconstruction with multistrand autogenous hamstring tendons has been widely performed using a single femoral socket (SS), it is currently advocated to individually reconstruct 2 bundles of the ACL using 2 femoral sockets (TS). However, the difference in biomechanical characteristics between them is unknown. The objective of this study was to clarify their biomechanical differences. TYPE OF STUDY This is a cross-over trial using cadaveric knees. METHODS Seven intact human cadaveric knees were mounted in a robotic simulator developed in our laboratory. By applying anterior and posterior tibial load up to +/- 100 N at 0 degrees, 15 degrees, 30 degrees, 60 degrees, and 90 degrees of flexion, tibial displacement and load were recorded. After cutting the ACL, the knees underwent ACL reconstruction using TS, followed by that using SS, with 44 or 88 N of initial grafts tension at 20 degrees of flexion. The above-mentioned tests were performed on each reconstructed knee. RESULTS The tibial displacement in the TS technique was significantly smaller than that in the SS at smaller flexion angles in response to anterior and posterior tibial load of +/- 100 N, and the in situ force in the former was significantly greater than that in the latter at smaller flexion angles. Furthermore, in the TS technique, the posterolateral graft acted dominantly in extension, while the anteromedial graft mainly resisted against anterior tibial load in flexion. However, in the SS technique, the anteriorly located graft functioned more predominantly than the posteriorly located graft at all flexion angles. CONCLUSIONS The ACL reconstruction via TS using quadrupled hamstring tendons provides better anterior-posterior stability compared with the conventional reconstruction using a single socket.
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Affiliation(s)
- T Mae
- Department of Orthopaedic Surgery, Osaka University Medical School, Suita, Osaka, Japan.
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Abstract
BACKGROUND Traumatic disruption of the acromioclavicular joint capsule is associated with pain and instability after the injury and may lead to degenerative joint disease. The objective of this study was to quantify the effect of transection of the acromioclavicular joint capsule on the kinematics and the in situ forces in the coracoclavicular ligaments in response to external loading conditions. METHODS Eleven fresh-frozen human cadaveric shoulders were tested with use of a robotic/universal force-moment sensor testing system. The shoulders were subjected to three loading conditions (an anterior, posterior, and superior load of 70 N) in their intact state and after transection of the acromioclavicular joint capsule. RESULTS Transection of the capsule resulted in a significant (p < 0.05) increase in anterior translation (6.4 mm) and posterior translation (3.6 mm) but not in superior translation (1.6 mm). The effect of capsule transection on the forces in the coracoclavicular ligaments was also significant (p < 0.05) in response to anterior and posterior loading but not in response to superior loading. However, differences were found between the forces in the trapezoid and conoid ligaments. Under an anterior load, the mean in situ force (and standard deviation) in the trapezoid increased from 14 +/- 14 N to 25 +/- 19 N, while the mean force in the conoid increased from 15 +/- 14 N to 49 +/- 23 N, or 227%. In contrast, in response to a posterior load, the mean in situ force in the trapezoid increased from 23 +/- 15 N to 38 +/- 23 N, or 66% (p < 0.05), while the mean force in the conoid increased only 9%. CONCLUSIONS AND CLINICAL RELEVANCE The large differences in the change of force in the conoid and trapezoid ligaments suggest that these ligaments should not be considered as one structure when surgical treatment is considered. Furthermore, transection of the capsule resulted in a shift of load to the coracoclavicular ligaments, which may render the intact coracoclavicular ligaments more likely to fail with anterior or posterior loading. The results of the present study also suggest that the intact coracoclavicular ligaments cannot compensate for the loss of capsular function during anterior-posterior loading as occurs in type-II acromioclavicular joint injuries.
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Affiliation(s)
- R E Debski
- Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh, Pennsylvania 15213, USA.
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Butler DL, Goldstein SA, Guilak F. Functional tissue engineering: the role of biomechanics. J Biomech Eng 2000; 122:570-5. [PMID: 11192376 DOI: 10.1115/1.1318906] [Citation(s) in RCA: 367] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
"Tissue engineering" uses implanted cells, scaffolds, DNA, protein, and/or protein fragments to replace or repair injured or diseased tissues and organs. Despite its early success, tissue engineers have faced challenges in repairing or replacing tissues that serve a predominantly biomechanical function. An evolving discipline called "functional tissue engineering" (FTE) seeks to address these challenges. In this paper, the authors present principles of functional tissue engineering that should be addressed when engineering repairs and replacements for load-bearing structures. First, in vivo stress/strain histories need to be measured for a variety of activities. These in vivo data provide mechanical thresholds that tissue repairs/replacements will likely encounter after surgery. Second, the mechanical properties of the native tissues must be established for subfailure and failure conditions. These "baseline data" provide parameters within the expected thresholds for different in vivo activities and beyond these levels if safety factors are to be incorporated. Third, a subset of these mechanical properties must be selected and prioritized. This subset is important, given that the mechanical properties of the designs are not expected to completely duplicate the properties of the native tissues. Fourth, standards must be set when evaluating the repairs/replacements after surgery so as to determine, "how good is good enough?" Some aspects of the repair outcome may be inferior, but other mechanical characteristics of the repairs and replacements might be suitable. New and improved methods must also be developed for assessing the function of engineered tissues. Fifth, the effects of physical factors on cellular activity must be determined in engineered tissues. Knowing these signals may shorten the iterations required to replace a tissue successfully and direct cellular activity and phenotype toward a desired end goal. Finally, to effect a better repair outcome, cell-matrix implants may benefit from being mechanically stimulated using in vitro "bioreactors" prior to implantation. Increasing evidence suggests that mechanical stress, as well as other physical factors, may significantly increase the biosynthetic activity of cells in bioartificial matrices. Incorporating each of these principles of functional tissue engineering should result in safer and more efficacious repairs and replacements for the surgeon and patient.
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Affiliation(s)
- D L Butler
- Noyes-Giannestras Biomechanics Laboratories, Department of Aerospace Engineering and Engineering Mechanics, University of Cincinnati, Cincinnati, OH 45221-0070, USA
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Rudy TW, Sakane M, Debski RE, Woo SL. The effect of the point of application of anterior tibial loads on human knee kinematics. J Biomech 2000; 33:1147-52. [PMID: 10854889 DOI: 10.1016/s0021-9290(00)00065-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Coupled axial tibial rotation in response to an anterior tibial load has been used as a common diagnostic measurement and as a means to load the ligamentous structures during laboratory tests. However, the exact location of the point of application of these loads as well as the corresponding sensitivity of the coupled tibial rotation to this point can have an effect on the function of the soft tissues at the joint. Therefore, the purpose of this study was to determine the effects of four different points of application of the anterior tibial load on the anterior tibial translation and coupled axial tibial rotation. The four points include: (1) geometric point - midway between the collateral ligament insertion sites on the tibia, (2) clinical point - a position that attempts to simulate clinical diagnostic tests, (3) medial point - a position medial to the geometric point and (4) lateral point - a position lateral to the clinical point. A robotic/universal force-moment sensor testing system was used to apply the anterior tibial load at the four points of application and to record the resulting joint motion. Anterior tibial translation in response to an anterior tibial load of 100N was found not to vary between the four points of application of the anterior tibial load at all flexion angles examined. However, internal tibial rotation was found for the lateral point (13+/-10 degrees at 30 degrees of knee flexion) in all specimens and clinical point (8+/-10 degrees at 30 degrees of knee flexion) while external rotation resulted when the load was applied at the medial point (-8+/-7 degrees at 30 degrees of knee flexion). Both internal and external tibial rotations occurred throughout the range of flexion when the tibial load was applied at the geometric point. The results suggest that the clinical point should be used as the point of application of the anterior tibial load whenever clinical examinations are simulated and multi-degree-of-freedom joint and soft tissue function are examined.
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Affiliation(s)
- T W Rudy
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA
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Woo SLY, Debski RE, Vangura AJ, Withrow JD, Vogrin TM, Wong EK, Fu FH. Use of robotic technology to study the biomechanics of ligaments and their replacements. ACTA ACUST UNITED AC 2000. [DOI: 10.1016/s1048-6666(00)80048-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Höher J, Harner CD, Vogrin TM, Baek GH, Carlin GJ, Woo SL. In situ forces in the posterolateral structures of the knee under posterior tibial loading in the intact and posterior cruciate ligament-deficient knee. J Orthop Res 1998; 16:675-81. [PMID: 9877391 DOI: 10.1002/jor.1100160608] [Citation(s) in RCA: 85] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The posterolateral structures of the knee consist of a complex anatomical architecture that includes several components with both static and dynamic functions. Injuries of the posterolateral structures occur frequently in conjunction with ruptures of the posterior cruciate ligament. To investigate the role of the posterolateral structures in maintaining posterior knee stability, we measured the in situ forces in the posterolateral structures and the distribution of force within the structures' major components, i.e., the popliteus complex and the lateral collateral ligament, in response to a posterior tibial load. Eight cadaveric knees were tested. With use of a robotic/universal force-moment sensor testing system, a posterior tibial load of 110 N was applied to the knee, and the resulting five-degree-of-freedom kinematics were measured at flexion angles of 0, 30, 60, 75, and 90 degrees. The knees were tested first in the intact state and then after the posterior cruciate ligament had been resected. These tests were also performed with an additional load of 44 N applied at the aponeurosis to simulate contraction of the popliteus muscle. In the intact knee, the in situ forces in the posterolateral structures were found to decrease with increasing knee flexion. After the posterior cruciate ligament was sectioned, these forces increased significantly at all angles of flexion. With no load applied to the popliteus muscle, the in situ forces in the popliteus complex were similar to those in the lateral collateral ligament. However, with a load of 44 N applied to the popliteus muscle, in situ forces in the popliteus complex were three to five times higher than those in the lateral collateral ligament. These results reveal that in response to posterior tibial loads, the posterolateral structures play an important role at full extension in intact knees and at all angles of flexion in posterior cruciate ligament-deficient knees. The popliteus muscle appears to be a major stabilizer under this loading condition; thus, the inability to restore its function may be a cause of unsatisfactory results in reconstructive procedures of the posterolateral structures of the knee.
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Affiliation(s)
- J Höher
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania 15213, USA
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Fox RJ, Harner CD, Sakane M, Carlin GJ, Woo SL. Determination of the in situ forces in the human posterior cruciate ligament using robotic technology. A cadaveric study. Am J Sports Med 1998; 26:395-401. [PMID: 9617402 DOI: 10.1177/03635465980260030901] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
We examined the in situ forces in the posterior cruciate ligament as well as the force distribution between its anterolateral and posteromedial bundles. Using a robotic manipulator in conjunction with a universal force-moment sensor system, we applied posterior tibial loads from 22 to 110 N to the joint at 0 degrees to 90 degrees of knee flexion. The magnitude of the in situ force in the posterior cruciate ligament and its bundles was significantly affected by knee flexion angle and posterior tibial loading. In situ forces in the posterior cruciate ligament ranged from 6.1 +/- 6.0 N under a 22-N posterior tibial load at 0 degree of knee flexion to 112.3 +/- 28.5 N under a 110-N load at 90 degrees. The force in the posteromedial bundle reached a maximum of 67.9 +/- 31.5 N at 90 degrees of knee flexion, and the force in the anterolateral bundle reached a maximum of 47.8 +/- 23.0 N at 60 degrees of knee flexion under a 110-N load. No significant differences existed between the in situ forces in the two bundles at any knee flexion angle. This study provides insight into the knee flexion angle at which each bundle of the posterior cruciate ligament experiences the highest in situ forces under posterior tibial loading. This information can help guide us in more accurate graft placement, fixation, and tensioning, and serve as an assessment of graft performance.
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Affiliation(s)
- R J Fox
- Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania, USA
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Li G, Rudy TW, Allen C, Sakane M, Woo SL. Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: a porcine study. J Orthop Res 1998; 16:122-7. [PMID: 9565084 DOI: 10.1002/jor.1100160121] [Citation(s) in RCA: 93] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study investigated the impact of a combination of axial compressive and anterior-posterior tibial loads on the in situ forces in the anterior cruciate ligament. An axial compressive load is believed to contribute to increased stability of the knee joint; however, its effect on in situ forces in the anterior cruciate ligament has not been clearly defined, to our knowledge. It was hypothesized that the application of an axial compressive load, when combined with an anterior tibial load, would result in larger in situ forces in the anterior cruciate ligament than those caused by an isolated anterior tibial load. With use of a porcine knee model, the results confirmed this hypothesis; the addition of a 200 N axial compressive load to a 100 N anterior tibial load increased knee stability by reducing anterior-posterior tibial translation and internal-external tibial rotation and also caused a significant increase in in situ forces in the anterior cruciate ligament (p < 0.05). Specifically, there was a 34% increase in the in situ force at 30 degrees of flexion, a 68% increase at 60 degrees of flexion, and an 84% increase at 90 degrees of flexion compared with those for an isolated anterior tibial load of 100 N. Additionally, there was a statistically significant increase of the in situ forces in the anterior cruciate ligament at 60 and 90 degrees as compared with those at 30 degrees. These results suggest that axial compressive loads on the knee may play a role in injury of the anterior cruciate ligament when the knee is flexed.
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Affiliation(s)
- G Li
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, Pennsylvania 15213, USA
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Abstract
Injuries of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are common, accounting for 90% of all knee ligament injuries in young and active individuals. During the last decade, our research center has focused on MCL healing and ACL reconstruction. We have found that the MCL heals without intervention after an isolated injury, and that primary repair offers no apparent advantage. After a combined injury of the ACL and MCL, the ACL requires reconstruction, whereas primary repair again contributes little or nothing toward MCL healing. Midsubstance ACL injuries have limited healing ability. Hence, the treatment of choice for a torn ACL in a young, active patient is generally reconstruction with an autograft or allograft. However, the appropriate replacement graft and reconstruction technique to use are still debated. Current research efforts have been placed on investigating the magnitude and direction of in situ forces in the human ACL. We use a six-component universal force moment sensor combined with a six-degree-of-freedom (DOF) robotic manipulator to learn as well as to reproduce the six-DOF motion of the knee before and after ACL injury. This way, the in situ force in the ACL under an anterior posterior tibial load of 110 N was obtained. This methodology should make it possible to obtain the needed data to aid in better understanding of ACL reconstruction and possible development of improved clinical management.
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Affiliation(s)
- S L Woo
- Musculoskeletal Research Center, Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA
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Sakane M, Fox RJ, Woo SL, Livesay GA, Li G, Fu FH. In situ forces in the anterior cruciate ligament and its bundles in response to anterior tibial loads. J Orthop Res 1997; 15:285-93. [PMID: 9167633 DOI: 10.1002/jor.1100150219] [Citation(s) in RCA: 459] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The anterior cruciate ligament has a complex fiber anatomy and is not considered to be a uniform structure. Current anterior cruciate ligament reconstructions succeed in stabilizing the knee, but they neither fully restore normal knee kinematics nor reproduce normal ligament function. To improve the outcome of the reconstruction, it may be necessary to reproduce the complex function of the intact anterior cruciate ligament in the replacement graft. We examined the in situ forces in nine human anterior cruciate ligaments as well as the force distribution between the anteromedial and posterolateral bundles of the ligament in response to applied anterior tibial loads ranging from 22 to 110 N at knee flexion angles of 0-90 degrees. The analysis was performed using a robotic manipulator in conjunction with a universal force-moment sensor. The in situ forces were determined with no device attached to the ligament, while the knee was permitted to move freely in response to the applied loads. We found that the in situ forces in the anterior cruciate ligament ranged from 12.8 +/- 7.3 N under 22 N of anterior tibial load applied at 90 degrees of knee flexion to 110.6 +/- 14.8 N under 110 N of applied load at 15 degrees of flexion. The magnitude of the in situ force in the posterolateral bundle was larger than that in the anteromedial bundle at knee flexion angles between 0 and 45 degrees, reaching a maximum of 75.2 +/- 18.3 N at 15 degrees of knee flexion under an anterior tibial load of 110 N. The magnitude of the in situ force in the posterolateral bundle was significantly affected by knee flexion angle and anterior tibial load in a fashion remarkably similar to that seen in the anterior cruciate ligament. The magnitude of the in situ force in the anteromedial bundle, in contrast, remained relatively constant, not changing with flexion angle. Significant differences in the direction of the in situ force between the anteromedial bundle and the posterolateral bundle were found only at flexion angles of 0 and 60 degrees and only under applied anterior tibial loads greater than 66 N. We have demonstrated the nonuniformity of the anterior cruciate ligament under unconstrained anterior tibial loads. Our data further suggest that in order for the anterior cruciate ligament replacement graft to reproduce the in situ forces of the normal anterior cruciate ligament, reconstruction techniques should take into account the role of the posterolateral bundle in addition to that of the anteromedial bundle.
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Affiliation(s)
- M Sakane
- Department of Orthopaedic Surgery, University of Pittsburgh, PA 15213, USA
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