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Van Oevelen A, Duquesne K, Peiffer M, Grammens J, Burssens A, Chevalier A, Steenackers G, Victor J, Audenaert E. Personalized statistical modeling of soft tissue structures in the knee. Front Bioeng Biotechnol 2023; 11:1055860. [PMID: 36970632 PMCID: PMC10031007 DOI: 10.3389/fbioe.2023.1055860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/21/2023] [Indexed: 03/11/2023] Open
Abstract
Background and Objective: As in vivo measurements of knee joint contact forces remain challenging, computational musculoskeletal modeling has been popularized as an encouraging solution for non-invasive estimation of joint mechanical loading. Computational musculoskeletal modeling typically relies on laborious manual segmentation as it requires reliable osseous and soft tissue geometry. To improve on feasibility and accuracy of patient-specific geometry predictions, a generic computational approach that can easily be scaled, morphed and fitted to patient-specific knee joint anatomy is presented.Methods: A personalized prediction algorithm was established to derive soft tissue geometry of the knee, originating solely from skeletal anatomy. Based on a MRI dataset (n = 53), manual identification of soft-tissue anatomy and landmarks served as input for our model by use of geometric morphometrics. Topographic distance maps were generated for cartilage thickness predictions. Meniscal modeling relied on wrapping a triangular geometry with varying height and width from the anterior to the posterior root. Elastic mesh wrapping was applied for ligamentous and patellar tendon path modeling. Leave-one-out validation experiments were conducted for accuracy assessment.Results: The Root Mean Square Error (RMSE) for the cartilage layers of the medial tibial plateau, the lateral tibial plateau, the femur and the patella equaled respectively 0.32 mm (range 0.14–0.48), 0.35 mm (range 0.16–0.53), 0.39 mm (range 0.15–0.80) and 0.75 mm (range 0.16–1.11). Similarly, the RMSE equaled respectively 1.16 mm (range 0.99–1.59), 0.91 mm (0.75–1.33), 2.93 mm (range 1.85–4.66) and 2.04 mm (1.88–3.29), calculated over the course of the anterior cruciate ligament, posterior cruciate ligament, the medial and the lateral meniscus.Conclusion: A methodological workflow is presented for patient-specific, morphological knee joint modeling that avoids laborious segmentation. By allowing to accurately predict personalized geometry this method has the potential for generating large (virtual) sample sizes applicable for biomechanical research and improving personalized, computer-assisted medicine.
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Affiliation(s)
- A. Van Oevelen
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- InViLab research group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - K. Duquesne
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - M. Peiffer
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - J. Grammens
- Antwerp Surgical Training, Anatomy and Research Centre (ASTARC), University of Antwerp, Wilrijk, Belgium
- Imec-VisionLab, Department of Physics, University of Antwerp, Antwerp, Belgium
| | - A. Burssens
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - A. Chevalier
- Cosys-Lab research group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - G. Steenackers
- InViLab research group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
| | - J. Victor
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - E. Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- InViLab research group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
- Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
- *Correspondence: E. Audenaert,
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Peiffer M, Burssens A, De Mits S, Heintz T, Van Waeyenberge M, Buedts K, Victor J, Audenaert E. Statistical shape model-based tibiofibular assessment of syndesmotic ankle lesions using weight-bearing CT. J Orthop Res 2022; 40:2873-2884. [PMID: 35249244 DOI: 10.1002/jor.25318] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 02/03/2022] [Accepted: 03/01/2022] [Indexed: 02/04/2023]
Abstract
Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint (DTFJ) alignment. However, current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Therefore, our aim is threefold: (1) to construct an articulated statistical shape model of the normal DTFJ with the inclusion of ligamentous morphometry, (2) to investigate the effect of weight-bearing on the DTFJ alignment, and (3) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data comprised non-weight-bearing CT scans from asymptomatic controls (N = 76), weight-bearing CT scans from patients with syndesmotic ankle injury (N = 13), and their weight-bearing healthy contralateral side (N = 13). Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization, and compactness. The predicted ligament length in patients with syndesmotic lesions was compared with healthy controls. With respect to the first aim, our presented skeletal shape model described the training data with an accuracy of 0.23 ± 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 ± 0.12 mm. In accordance with the second aim, our results showed an increased tibiofibular diastasis in healthy ankles after weight-bearing. Concerning our third aim, a statistically significant difference in anterior syndesmotic ligament length was found between ankles with syndesmotic lesions and healthy controls (p = 0.017). There was a significant correlation between the presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001). Clinical Significance: Statistical shape modeling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmosic ankle lesions under weight-bearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an "anterior open-book injury" of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture.
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Affiliation(s)
- Matthias Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Arne Burssens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Sophie De Mits
- Department of Reumatology, Ghent University Hospital, Ghent, Belgium.,Department of Podiatry, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Thibault Heintz
- Department of Orthopaedics, Ghent University Hospital, Ghent, Belgium
| | | | - Kris Buedts
- Department of Orthopaedics, ZNA Middelheim, Antwerpen, Belgium
| | - Jan Victor
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium
| | - Emmanuel Audenaert
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.,Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
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Luo X, Cai G, Ma K, Cai A. Construction and Simulation of Biomechanical Model of Human Hip Joint Muscle-Tendon Assisted by Elastic External Tendon by Hill Muscle Model. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:1987345. [PMID: 35958782 PMCID: PMC9363180 DOI: 10.1155/2022/1987345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 06/08/2022] [Accepted: 06/14/2022] [Indexed: 11/18/2022]
Abstract
Based on the Hill muscle model (HMM), a biomechanical model of human hip muscle tendon assisted by elastic external tendon (EET) was preliminarily established to investigate and analyze the biomechanical transition between the hip joint (HJ) and related muscle tendons. Using the HMM, the optimal muscle fiber length and muscle force scaling variables were introduced by means of constrained optimization problems and were optimized. The optimized HMM was constructed with human parameters of 170 cm and 70 kg. The biomechanical model simulation test of the hip muscle tendon was performed in the automatic dynamic analysis of mechanical systems (ADAMS) software to analyze and optimize the changes in the root mean square error (RMSE), biological moment, muscle moment distribution coefficient (MDC), muscle moment, muscle force, muscle power, and mechanical work of the activation curves of the hip major muscle, iliopsoas muscle, rectus femoris muscle, and hamstring muscle under analyzing the optimized HMM and under different EET auxiliary stiffnesses from the joint moment level, joint level, and muscle level, respectively. It was found that the trends of the output joint moment of the optimized HMM and the biological moment of the human HJ were basically the same, r 2 = 0.883 and RMSE = 0.18 Nm/kg, and the average metabolizable energy consumption of the HJ was (243.77 ± 1.59) J. In the range of 35%∼65% of gait cycle (GC), the auxiliary moment showed a significant downward trend with the increase of EET stiffness, when the EET stiffness of the human body was less than 200 Nm/rad, the biological moment of the human HJ gradually decreased with the increase of EET stiffness, and the MDC of the iliopsoas and hamstring muscles gradually decreased; when the EET stiffness was greater than 200 Nm/rad, the increase of the total moment of the extensor muscles significantly increased, the MDC of the gluteus maximus and rectus muscles gradually increased, and the gluteus maximus and hamstring muscle moments and muscle forces gradually increased; the results show that the optimized muscle model based on Hill can reflect the law of human movement and complete the simulation test of HJ movements, which provides a new idea for the analysis of energy migration in the musculoskeletal system of the lower limb.
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Affiliation(s)
- Xi Luo
- Faculty of Civil Engineering and Mechanics, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Guofeng Cai
- Department of Sports Medicine, First Affiliated Hospital of Kunming Medical University, Kunming 650032, Yunnan, China
| | - Kun Ma
- Faculty of Civil Engineering and Mechanics, Kunming University of Science and Technology, Kunming 650500, Yunnan, China
| | - Aiqi Cai
- Department of Medical Genetics, First People's Hospital of Yunnan Province (The Affiliated Hospital of Kunming University of Science and Technology), Kunming 650032, Yunnan, China
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Lin B, Bartlett J, Lloyd TD, Challoumas D, Brassett C, Khanduja V. Multiple iliopsoas tendons: a cadaveric study and treatment implications for internal snapping hip syndrome. Arch Orthop Trauma Surg 2022; 142:1147-1154. [PMID: 34347120 PMCID: PMC9110434 DOI: 10.1007/s00402-021-04009-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 06/18/2021] [Indexed: 11/24/2022]
Abstract
PURPOSE This cadaveric study aimed at describing the anatomical variations of the iliopsoas complex. METHODS The iliopsoas complex was dissected unilaterally in 28 formalin-embalmed cadavers-13 males and 15 females with a mean age of 85.6 years. The number, courses and widths of the iliacus and psoas major tendons were determined. Patients with previous hip surgery were excluded. The following measurements were taken from the mid-inguinal point: the distance to the point of union of the psoas major and iliacus tendon; and the distance to the most distal insertion of iliopsoas. RESULTS The presence of single, double and triple tendon insertions of iliopsoas were found in 12, 12 and 4 of the 28 specimens, respectively. When present, double and triple tendons inserted separately onto the lesser trochanter. The average length of the iliopsoas tendon from the mid-inguinal point to the most distal attachment at the lesser trochanter was 122.3 ± 13.0 mm. The iliacus muscle bulk merged with psoas major at an average distance of 24.9 ± 17.9 mm proximal to the mid-inguinal point. In all cases, the lateral-most fibres of iliacus yielded a non-tendinous, muscular insertion on to the anterior surface of the lesser trochanter and the femoral shaft, rather than joining onto the main iliopsoas tendon(s). The average total width of the psoas major tendon decreased with an increasing number of tendons: 14.6 ± 2.2 mm (single tendon), 8.2 ± 3.0 mm (2 tendons present) and 5.9 ± 1.1 mm (3 tendons present) (P < 0.001). CONCLUSIONS The results of this study suggest that multiple tendinous insertions of iliopsoas are present as an anatomical variant in more than 50% of the population. The non-tendinous muscular insertion of the iliopsoas on to the anterior surface of the lesser trochanter and femoral shaft found represents a novel anatomical variant not previously described. LEVEL OF EVIDENCE Level V.
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Affiliation(s)
- Benjamin Lin
- School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | | | - Thomas D Lloyd
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Dimitris Challoumas
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Cecilia Brassett
- Department of Physiology, Development and Neuroscience, University of Cambridge, Cambridge, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedics, Addenbrooke's - Cambridge University Hospital, Cambridge, CB2 0QQ, UK.
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Peiffer M, Burssens A, Duquesne K, Last M, De Mits S, Victor J, Audenaert EA. Personalised statistical modelling of soft tissue structures in the ankle. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 218:106701. [PMID: 35259673 DOI: 10.1016/j.cmpb.2022.106701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 01/20/2022] [Accepted: 02/11/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Revealing the complexity behind subject-specific ankle joint mechanics requires simultaneous analysis of three-dimensional bony and soft-tissue structures. 3D musculoskeletal models have become pivotal in orthopedic treatment planning and biomechanical research. Since manual segmentation of these models is time-consuming and subject to manual errors, (semi-) automatic methods could improve the accuracy and enlarge the sample size of personalised 'in silico' biomechanical experiments and computer-assisted treatment planning. Therefore, our aim was to automatically predict ligament paths, cartilage topography and thickness in the ankle joint based on statistical shape modelling. METHODS A personalised cartilage and ligamentous prediction algorithm was established using geometric morphometrics, based on an 'in-house' generated lower limb skeletal model (N = 542), tibiotalar cartilage (N = 60) and ankle ligament segmentations (N = 10). For cartilage, a population-averaged thickness map was determined by use of partial least-squares regression. Ligaments were wrapped around bony contours based on iterative shortest path calculation. Accuracy of ligament path and cartilage thickness prediction was quantified using leave-one-out experiments. The novel personalised thickness prediction was compared with a constant cartilage thickness of 1.50 mm by use of a paired sample T-test. RESULTS Mean distance error of cartilage and ligament prediction was 0.12 mm (SD 0.04 mm) and 0.54 mm (SD 0.05 mm), respectively. No significant differences were found between the personalised thickness cartilage and segmented cartilage of the tibia (p = 0.73, CI [-1.60 .10-17, 1.13 .10-17]) and talus (p = 0.95, CI[ -1.35 .10-17, 1.28 .10-17]). For the constant thickness cartilage, a statistically significant difference was found in 89% and 92% of the tibial (p < 0.001, CI [0.51, 0.58]) and talar (p < 0.001, CI [0.33, 0.40]) cartilage area. CONCLUSIONS In this study, we described a personalised prediction algorithm of cartilage and ligaments in the ankle joint. We were able to predict cartilage and main ankle ligaments with submillimeter accuracy. The proposed method has a high potential for generating large (virtual) sample sizes in biomechanical research and mitigates technological advances in computer-assisted orthopaedic surgery.
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Affiliation(s)
- M Peiffer
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium.
| | - A Burssens
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - K Duquesne
- Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - M Last
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - S De Mits
- Department of Reumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Podiatry, Artevelde University of Applied Sciences, Voetweg 66, Ghent 9000, Belgium
| | - J Victor
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium
| | - E A Audenaert
- Department of Orthopaedics and Traumatology, Ghent University Hospital, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Human Structure and Repair, Ghent University, Corneel Heymanslaan 10, Ghent 9000, Belgium; Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge CB2 0QQ, UK; Department of Electromechanics, Op3Mech research group, University of Antwerp, Groenenborgerlaan 171, 2020, Antwerp, Belgium
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Duquesne K, Pattyn C, Vanderstraeten B, Audenaert EA. Handle With Care: The Anterior Hip Capsule Plays a Key Role in Daily Hip Performance. Orthop J Sports Med 2022; 10:23259671221078254. [PMID: 35356307 PMCID: PMC8958691 DOI: 10.1177/23259671221078254] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Passive energy storage and return has long been recognized as one of the central mechanisms for minimizing the energy cost needed for terrestrial locomotion. Although the iliofemoral ligament (IFL) is the strongest ligament in the body, its potential role in energy-efficient walking remains unexplored. Purpose: To identify the contribution of the IFL to the amount of work performed by the hip muscles for normal, straight-level walking. Study Design: Controlled laboratory study. Methods: Straight-level walking of 50 healthy and injury-free adults was simulated using the AnyBody Modeling System. For each participant, the bone morphology and soft tissue properties were nonuniformly scaled. The superior and inferior parts of the IFL were represented by 2 springs each, and a linear force-strain relation was defined. A parameter study was conducted to account for the uncertainty surrounding the mechanical properties of the IFL. The work required from the gluteus, quadriceps, iliopsoas, and sartorius with and without inclusion of the IFL was calculated. Analysis of variance with subsequent post hoc paired t test was used to test the significance of IFL presence on the required mechanical work. Results: During walking, the strain in the IFL reached a median of 18.7% (95% CI, 8.0%-26.5%), with the largest values obtained at toe-off. With the IFL undamaged and fully operational, the effort required by the hip flexor muscles was reduced by a median of 54% (99% CI, 45%-62%) for the iliopsoas and by a median of 41% (99% CI, 27%-54%) for the sartorius muscles. The inclusion of the IFL did not significantly alter the work required by the gluteus and the quadriceps. Conclusion: The findings emphasized the key role the IFL plays in hip flexion by working synergistically with the hip musculature. Clinical Relevance: The importance of the contribution of the IFL to the hip flexors warrants careful handling and repair of these ligaments in cases of surgery and structural damage.
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Affiliation(s)
- Kate Duquesne
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Christophe Pattyn
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
| | | | - Emmanuel A. Audenaert
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium
- Department of Trauma and Orthopedics, Addenbrooke’s Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerp, Belgium
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Roux A, Lecompte J, Iordanoff I, Laporte S. Modeling of muscular activation of the muscle-tendon complex using discrete element method. Comput Methods Biomech Biomed Engin 2021; 24:1184-1194. [PMID: 33416406 DOI: 10.1080/10255842.2020.1870039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
The tearing of a muscle-tendon complex (MTC) is caused by an eccentric contraction; however, the structures involved and the mechanisms of rupture are not clearly identified. The passive mechanical behavior the MTC has already been modeled and validated with the discrete element method. The muscular activation is the next needed step. The aim of this study is to model the muscle fiber activation and the muscular activation of the MTC to validate their active mechanical behaviors. Each point of the force/length relationship of the MTC (using a parabolic law for the force/length relationship of muscle fibers) is obtained with two steps: 1) a passive tensile (or contractile) test until the desired elongation is reached and 2) fiber activation during a position holding that can be managed thanks to the Discrete Element model. The muscular activation is controlled by the activation of muscle fiber. The global force/length relationship of a single fiber and of the complete MTC during muscular activation is in agreement with literature. The influence of the external shape of the structure and the pennation angle are also investigated. Results show that the different constituents of the MTC (extracellular matrix, tendon), and the geometry, play an important role during the muscular activation and enable to decrease the maximal isometric force of the MTC. Moreover, the maximal isometric force decreases when the pennation angle increases. Further studies will combine muscular activation with a stretching of the MTC, until rupture, in order to numerically reproduce the tearing of the MTC.
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Affiliation(s)
- Anthony Roux
- Arts et Métiers-Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, LBM, Paris, France.,Arts et Métiers-Institute of Technology, I2M Bordeaux, France
| | - Jennyfer Lecompte
- Arts et Métiers-Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, LBM, Paris, France
| | - Ivan Iordanoff
- Arts et Métiers-Institute of Technology, I2M Bordeaux, France
| | - Sébastien Laporte
- Arts et Métiers-Institute of Technology, Institut de Biomécanique Humaine Georges Charpak, LBM, Paris, France
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Van Houcke J, Khanduja V, Audenaert EA. Accurate Arthroscopic Cam Resection Normalizes Contact Stresses in Patients With Femoroacetabular Impingement. Am J Sports Med 2021; 49:42-48. [PMID: 33237821 DOI: 10.1177/0363546520974378] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Femoroacetabular impingement (FAI) is increasingly recognized as a cause of hip pain in young adults. The condition leads to chondrolabral separation and chondral delamination and eventually predisposes to osteoarthritis of the hip. FAI that inflicts cartilage damage has been observed in hips with abnormal morphological characteristics and is related to a long-term evolution toward osteoarthritis. Arthroscopic surgery, which allows for correction of morphological characteristics and restores impingement-free motions, is the current standard of treatment. HYPOTHESIS Arthroscopic cam resection can restore the normal mechanical environment of the hip joint in cam-type FAI. STUDY DESIGN Descriptive laboratory study. METHODS Patient-specific discrete element models from 10 patients with cam-type FAI (all male; age, 18-40 years) were defined based on preoperative computed tomography scans and postoperative magnetic resonance imaging (MRI) scans. Complete cam resection postoperatively on MRI was confirmed with alpha angles <55°. The preoperative and postoperative peak contact stress findings during impingement testing were compared against a matched control group. RESULTS Peak contact stress was significantly elevated in patients with cam-type FAI during impingement testing, with increasing amounts of internal hip rotation (26.6 ± 11.64 MPa in cam patients preoperatively, 12.1 ± 4.62 MPa in those same patients postoperatively, and 11.4 ± 1.72 MPa in the virtual control group during impingement testing at 20° of internal hip rotation; P < .01). This effect was normalized after arthroscopic cam resection and loading patterns matched those of the control group. CONCLUSION Accurate arthroscopic cam resection restored the normal peak joint contact stresses in the hip joint. This highlights the importance of early and complete cam resections in the face of a positive diagnosis of cam-type FAI. CLINICAL RELEVANCE Treatment of cam-type FAI effectively normalizes hip joint contact mechanics.
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Affiliation(s)
- Jan Van Houcke
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium
| | - Vikas Khanduja
- Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium.,Department of Electromechanics, Op3Mech research group, University of Antwerp, Antwerp, Belgium.,Young Adult Hip Service, Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Abstract
OBJECTIVE Musculoskeletal models play an important role in surgical planning and clinical assessment of gait and movement. Faster and more accurate simulation of muscle paths in such models can result in better predictions of forces and facilitate real-time clinical applications, such as rehabilitation with real-time feedback. We propose a novel and efficient method for computing wrapping paths across arbitrary surfaces, such as those defined by bone geometry. METHODS A muscle path is modeled as a massless, frictionless elastic strand that uses artificial forces, applied independently of the dynamic simulation, to wrap tightly around intervening obstacles. Contact with arbitrary surfaces is computed quickly using a distance grid, which is interpolated quadratically to provide smoother results. RESULTS Evaluation of the method demonstrates good accuracy, with mean relative errors of 0.002 or better when compared against simple cases with exact solutions. The method is also fast, with strand update times of around 0.5 msec for a variety of bone shaped obstacles. CONCLUSION Our method has been implemented in the open source simulation system ArtiSynth (www.artisynth.org) and helps solve the problem of muscle wrapping around bones and other structures. SIGNIFICANCE Muscle wrapping on arbitrary surfaces opens up new possibilities for patient-specific musculoskeletal models where muscle paths can directly conform to shapes extracted from medical image data.
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Audenaert EA, Khanduja V, Claes P, Malviya A, Steenackers G. Mechanics of Psoas Tendon Snapping. A Virtual Population Study. Front Bioeng Biotechnol 2020; 8:264. [PMID: 32292780 PMCID: PMC7118580 DOI: 10.3389/fbioe.2020.00264] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/13/2020] [Indexed: 12/24/2022] Open
Abstract
Internal snapping of the psoas tendon is a frequently reported condition, especially in young adolescents involved in sports. It is defined as an increased tendon excursion over bony or soft tissue prominence causing local irritation and inflammation of the tendon leading to groin pain and often is accompanied by an audible snap. Due to the lack of detailed dynamic visualization means, the exact mechanism of the condition remains poorly understood and different theories have been postulated related to the etiology and its location about the hip. In the present study we simulated psoas tendon behavior in a virtual population of 40,000 anatomies and compared tendon movement during combined abduction, flexion and external rotation and back to neutral extension and adduction. At risk phenotyopes for tendon snapping were defined as the morphologies presenting with excess tendon movement. There were little differences in tendon movement between the male and female models. In both populations, abnormal tendon excursion correlated with changes in mainly the femoral anatomy (male r = 0.72, p < 0.001, female r = 0.66, p < 0.001): increased anteversion and valgus as well as a decreasing femoral offset and ischiofemoral distance. The observed combination of shape components correlating with excess tendon movement in essence presented with a medial positioning of the minor trochanter. This finding suggest that psoas snapping and ischiofemoral impingement are possibly two presentations of a similar underlying rotational dysplasia of the femur.
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Affiliation(s)
- Emmanuel A Audenaert
- Department of Orthopedic Surgery and Traumatology, Ghent University Hospital, Ghent, Belgium.,Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom.,Op3Mech Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium.,Department of Human Structure and Repair, Ghent University, Ghent, Belgium
| | - Vikas Khanduja
- Department of Trauma and Orthopedics, Addenbrooke's Hospital, Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Peter Claes
- Medical Imaging Research Center (MIRC), University Hospitals Leuven, Leuven, Belgium.,Department of Electrical Engineering/Processing Speech and Images, KU Leuven, Leuven, Belgium.,Department of Human Genetics, KU Leuven, Leuven, Belgium.,Murdoch Children's Research Institute, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Ajay Malviya
- Department of Orthopedic Surgery and Traumatology, Northumbria National Health Service Foundation Trust, Newcastle upon Tyne, United Kingdom.,Department of Regenerative Medicine, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, United Kingdom
| | - Gunther Steenackers
- Op3Mech Research Group, Department of Electromechanics, University of Antwerp, Antwerp, Belgium
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Kuroda Y, Rai A, Saito M, Khanduja V. Anatomical variation of the Psoas Valley: a scoping review. BMC Musculoskelet Disord 2020; 21:219. [PMID: 32276620 PMCID: PMC7149878 DOI: 10.1186/s12891-020-03241-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/26/2020] [Indexed: 12/27/2022] Open
Abstract
Background This scoping review aimed to investigate the literature on the anatomy of the psoas valley, an anterior depression on the acetabular rim, and propose a unified definition of the anatomical structure, describe its dimensions, anatomical variations and clinical implications. Methods A systematic computer search of EMBASE, PubMed and Cochrane for literature related to the psoas valley was undertaken using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. Clinical outcome studies, prospective/retrospective case series, case reports and review articles that described the psoas valley and its synonyms were included. Studies on animals as well as book chapters were excluded. Results Of the 313 articles, the filtered literature search identified 14 papers describing the psoas valley and its synonyms such as iliopsoas notch, a notch between anterior inferior iliac spine and the iliopubic eminence, Psoas-U and anterior wall depression. Most of these were cross-sectional studies that mainly analyzed normal skeletal hips. In terms of anatomical variation, 4 different configurations of the anterior acetabular rim have been identified and it was found that the curved type was the most frequent while the straight type may be nonexistent. Additionally, the psoas valley tended to be deeper in males as compared with females. Several papers established the psoas valley, or Psoas-U in a consistent location at approximately 3 o’clock on the acetabular rim which may have implications with labral pathology. Conclusion This review highlights the importance of the anatomy of the psoas valley which is a consistent bony landmark. The anatomy and the anatomical variations of the psoas valley need to be well-appreciated by surgeons involved in the management of young adults with hip pathology and also joint replacement surgeons to ensure appropriate seating of the acetabular component.
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Affiliation(s)
- Yuichi Kuroda
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
| | - Ankit Rai
- University of Cambridge, Cambridge, UK
| | - Masayoshi Saito
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK
| | - Vikas Khanduja
- Young Adult Hip Service, Department of Trauma and Orthopaedic Surgery, Addenbrooke's-Cambridge University Hospitals NHS Foundation Trust, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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