Automated muscle wrapping using finite element contact detection

A numerical study of the contact geometry and pressure distribution along the glenoid track

The glenoid track geometry and the contact forces acting on the glenohumeral joint at static positions of 30°, 60°, 90° and 120° of abduction with 90° of external rotation were evaluated using a finite element model of the shoulder that, differently from most usual approximations, accounts the humeral head translations and the deformable-to-deformable non-spherical joint contact. The model was based on data acquired from clinical exams of a single subject, including the proximal humerus, scapula, their respective cartilages concerning the glenohumeral joint, and the rotator cuff and deltoid muscles. The forces acting on the glenohumeral joint were estimated using a simulation framework consisting of an optimization procedure allied with finite element analysis that seeks the minimum muscle forces that stabilize the joint. The joint reaction force magnitude increases up to 680.25 N at 90° of abduction and decreases at further positions. From 60° onward the articular contact remains at the anterior region of the glenoid cartilage and follows an inferior to superior path at the posterior region of the humeral head cartilage. The maximum contact pressure of 3.104 MPa occurs at 90° abduction. Although translating inferiorly throughout the movement, the projection of the humeral head center at the glenoid plane remains at the central region of the glenoid surface. The model results qualitatively matched the trends observed in the literature and supports the consideration of the translational degrees of freedom to evaluate the joint contact mechanics.

Moment arms of the deltoid, infraspinatus and teres minor muscles for movements with high range of motion: A cadaveric study

BACKGROUND

Moment arms are an indicator of the role of the muscles in joint actuation. An excursion method is often used to calculate them, even though it provides 1D results. As shoulder movement occurs in three dimensions (combination of flexion, abduction and axial rotation), moment arms should be given in 3D. Our objective was to assess the 3D moment arms of the rotator cuff (infraspinatus and teres minor) and deltoid muscles for movements with high arm elevation.

METHODS

The 3D moment arms (components in plane of elevation, elevation and axial rotation) were assessed using a geometric method, enabling to calculate the moment arms in 3D, on five fresh post-mortem human shoulders. Movement with high range of motion were performed (including overhead movement). The humerus was elevated until it reaches its maximal posture in different elevation plane (flexion, scaption, abduction and elevation in a plane 30° posterior to frontal plane).

FINDINGS

We found that the anterior deltoid was a depressor and contributes to move the elevation plane anteriorly. The median deltoid was a great elevator and the posterior deltoid mostly acted in moving the elevation plane posteriorly. The infraspinatus and teres minor were the greatest external rotator of the shoulder. The position of the glenohumeral joint induces changes in the muscular moment arms. The maximal shoulder elevation was 144° (performed in the scapular plane).

INTERPRETATION

The knowledge of 3D moment arms for different arm elevations might help surgeons in planning tendon reconstructive surgery and help validate musculoskeletal models.

An Automatic and Simplified Approach to Muscle Path Modeling

This paper aims at proposing an automatic method to design and adjust simplified muscle paths of a musculoskeletal model. These muscle paths are composed of straight lines described by a limited set of fixed active via points and an optimization routine is developed to place these via points on the model in order to fit moment arms and musculotendon lengths input data. The method has been applied to a forearm musculoskeletal model extracted from the literature, using theoretical input data as an example. Results showed that for 75% of the muscle set, the relative root-mean-square error between literature theoretical data and the results from optimized muscle path was under 29.23% for moment arms and of 1.09% for musculotendon lengths. These results confirm the ability of the method to automatically generate computationally efficient muscle paths for musculoskeletal simulations. Using only via points lowers computational expense compared to paths exhibiting wrapping objects. A proper balance between computational time and anatomical realism should be found to help those models being interpreted by practitioners.

Influence of rotator cuff integrity on loading and kinematics before and after reverse shoulder arthroplasty

Reverse Shoulder Arthroplasty has become a very common procedure for shoulder joint replacement, even for scenarios where an anatomical reconstruction would traditionally be used. Our hypothesis is that implanting a reverse prosthesis with a functional rotator cuff may lead to higher joint reaction force (JRF) and have a negative impact on the prosthesis. Available motion capture data during anterior flexion was input to a finite-element musculoskeletal shoulder model, and muscle activations were computed using inverse dynamics. Simulations were carried out for the intact joint as well as for various types of rotator cuff tears: superior (supraspinatus), superior-anterior (supraspinatus and subscapularis), and superior-posterior (supraspinatus, infraspinatus and teres minor). Each rotator cuff tear condition was repeated after shifting the humerus and the glenohumeral joint center of rotation to represent the effect of a reverse prosthesis. Changes in compressive, shear, and total JRF were analyzed. The model compared favorably to in vivo JRF measurements, and existing clinical and biomechanical knowledge. Implanting a reverse prosthesis with a functional rotator cuff or with an isolated supraspinatus tear led to more than 2 times higher compressive JRF than with massive rotator cuff tears (superior-anterior or superior-posterior), while the shear force remained comparable. The total JRF increased more than 1.5 times. While a lower shear to compressive ratio may reduce the risk of glenosphere loosening, higher JRF might increase the risk for other failure modes such as fracture or polyethylene wear of the reverse prosthesis.

Embodiment of intra-abdominal pressure in a flexible multibody model of the trunk and the spinal unloading effects during static lifting tasks

The role of intra-abdominal pressure (IAP) in spinal load reduction has remained controversial, partly because previous musculoskeletal models did not introduce the pressure generating mechanism. In this study, an integrated computational methodology is proposed to combine the IAP change with core muscle activations. An ideal gas relationship was introduced to calculate pressure distribution within the abdominal cavity. Additionally, based on flexible multibody dynamics, a muscle membrane element was developed by incorporating the muscular fiber deformation, inter-fiber stiffness, and volume constancy. This element was then utilized in discretizing the diaphragm and transversus abdominis, forming an IAP-muscle coupling system of the abdominal cavity. Based on this methodology, a forward dynamic simulation of spinal flexion was presented to examine the unloading effect of abdominal breathing. The results confirm that core muscle contraction during the abdominal breathing cycle can substantially reduce the forces of spinal compression together with trunk extensor muscles, and this effect is more pronounced when the IAP increase is produced by contraction of the transversus abdominis. This unloading effect still holds even with the co-activation of other abdominal muscles, providing a potential choice when designing trunk movements during weight-lifting tasks.

Surface-based modeling of muscles: Functional simulation of the shoulder

Musculoskeletal simulations are an essential tool for studying functional implications of pathologies and of potential surgical outcomes, e.g., for the complex shoulder anatomy. Most shoulder models rely on line-segment approximation of muscles with potential limitations. Comprehensive shoulder models based on continuum-mechanics are scarce due to their complexity in both modeling and computation. In this paper, we present a surface-based modeling approach for muscles, which simplifies the modeling process and is efficient for computation. We propose to use surface geometries for modeling muscles, and devise an automatic approach to generate such models, given the locations of the origin and insertion of tendons. The surfaces are expressed as higher-order tensor B-splines, which ensure smoothness of the geometrical representation. They are simulated as membrane elements within a finite element simulation. This is demonstrated on a comprehensive model of the upper limb, where muscle activations needed to perform desired motions are obtained by using inverse dynamics. In synthetic examples, we demonstrate our proposed surface elements both to be easy to customize (e.g., with spatially varying material properties) and to be substantially (up to 12 times) faster in simulation compared to their volumetric counterpart. With our presented automatic approach of muscle wrapping around bones, the humeral head is exemplified to be wrapped physiologically consistently with surface elements. Our functional simulation is shown to successfully replicate a tracked shoulder motion during activities of daily living. We demonstrate surface-based models to be a numerically stable and computationally efficient compromise between line-segment and volumetric models, enabling anatomical correctness, subject-specific customization, and fast simulations, for a comprehensive simulation of musculoskeletal motion.

Development and validation of a muscle wrapping model applied to intact and reverse total shoulder arthroplasty shoulders

Assessment and optimization of procedural outcomes, namely joint replacement, that rely heavily on muscle action necessitates a model capable of accurately and reliably predicting muscle paths in an automated setting. In this study, such a model was developed and validated for the anatomic shoulder and one implanted with reverse total shoulder arthroplasty (rTSA), as these scenarios present particularly complex ranges of motion and wrapping geometries. A finite element (FE) element model included a "string-of-pearls" representation of the four rotator cuff muscles and the three deltoid muscle bundles. Muscle bundles consisted of 15 rigid spheres connected by linearly elastic springs and attached to the bones at their origins. The free ends of the muscle bundles were pulled to their insertions, after which motions were applied to the shoulder. Muscle moment arms were calculated and compared to data available in the literature qualitatively and using Pearson rho values and root-mean-square errors. The process was repeated following implantation of an rTSA. The FE model captured muscle paths throughout 180° of motion in under seven minutes. Moment arms at 30° and 60° of scaption generally fell within the ranges predicted by previous experimental and computational studies. The FE model showed good qualitative agreement with previously published results for abduction, flexion, and axial rotation before and after rTSA. In conclusion, a model capable of predicting muscle paths in the presence of variable wrapping geometry was developed and validated without sacrificing enough computational efficiency to render its use impossible in numerical techniques such as design optimization. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:3308-3317, 2018.

The lever arm ratio of the rotator cuff to deltoid muscle explains and predicts pseudoparalysis of the shoulder

Aims

In patients with a rotator cuff tear, tear pattern and tendon involvement are known risk factors for the development of pseudoparalysis of the shoulder. It remains unclear, however, why similar tears often have very different functional consequences. The present study hypothesizes that individual shoulder anatomy, specifically the moment arms (MAs) of the rotator cuff (RC) and the deltoid muscle, as well as their relative recruitment during shoulder abduction, plays a central role in pseudoparalysis.

Materials and Methods

Biomechanical and clinical analyses of the pseudoparalytic shoulder were conducted based on the ratio of the RC/deltoid MAs, which were used to define a novel anatomical descriptor called the Shoulder Abduction Moment (SAM) index. The SAM index is the ratio of the radii of two concentric spheres based on the centre of rotation of the joint. One sphere captures the humeral head (numerator) and the other the deltoid origin of the acromion (denominator). A computational rigid body simulation was used to establish the functional link between the SAM index and a potential predisposition for pseudoparalysis. A retrospective radiological validation study based on these measures was also undertaken using two cohorts with and without pseudoparalysis and massive RC tears.

Results

Decreased RC activity and improved glenohumeral stability was predicted by simulations of SAM indices with larger diameters of the humeral head, being consequently beneficial for joint stability. Clinical investigation of the SAM index showed significant risk of pseudoparalysis in patients with massive tears and a SAM < 0.77 (odds ratio (OR) 11).

Conclusion

The SAM index, which represents individual biomechanical characteristics of shoulder morphology, plays a determinant role in the presence or absence of pseudoparalysis in shoulders with massive RC tears.

Implementation and validation of the extended Hill-type muscle model with robust routing capabilities in LS-DYNA for active human body models

BACKGROUND

In the state of the art finite element AHBMs for car crash analysis in the LS-DYNA software material named *MAT_MUSCLE (*MAT_156) is used for active muscles modeling. It has three elements in parallel configuration, which has several major drawbacks: restraint approximation of the physical reality, complicated parameterization and absence of the integrated activation dynamics. This study presents implementation of the extended four element Hill-type muscle model with serial damping and eccentric force-velocity relation including [Formula: see text] dependent activation dynamics and internal method for physiological muscle routing.

RESULTS

Proposed model was implemented into the general-purpose finite element (FE) simulation software LSDYNA as a user material for truss elements. This material model is verified and validated with three different sets of mammalian experimental data, taken from the literature. It is compared to the *MAT_MUSCLE (*MAT_156) Hill-type muscle model already existing in LS-DYNA, which is currently used in finite element human body models (HBMs). An application example with an arm model extracted from the FE ViVA OpenHBM is given, taking into account physiological muscle paths.

CONCLUSION

The simulation results show better material model accuracy, calculation robustness and improved muscle routing capability compared to *MAT_156. The FORTRAN source code for the user material subroutine dyn21.f and the muscle parameters for all simulations, conducted in the study, are given at https://zenodo.org/record/826209 under an open source license. This enables a quick application of the proposed material model in LS-DYNA, especially in active human body models (AHBMs) for applications in automotive safety.

The Effect of Mechanical Varus on Anterior Cruciate Ligament and Lateral Collateral Ligament Stress: Finite Element Analyses

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.].

A larger critical shoulder angle requires more rotator cuff activity to preserve joint stability

Shoulders with rotator cuff tears (RCT) tears are associated with significantly larger critical shoulder angles (CSA) (RCT CSA = 38.2°) than shoulders without RCT (CSA = 32.9°). We hypothesized that larger CSAs increase the ratio of glenohumeral joint shear to joint compression forces, requiring substantially increased compensatory supraspinatus loads to stabilize the arm in abduction. A previously established three dimensional (3D) finite element (FE) model was used. Two acromion shapes mimicked the mean CSA of 38.2° found in patients with RCT and that of a normal CSA (32.9°). In a first step, the moment arms for each muscle segment were obtained for 21 different thoracohumeral abduction angles to simulate a quasi-static abduction in the scapular plane. In a second step, the muscle forces were calculated by minimizing the range of muscle stresses able to compensate an external joint moment caused by the arm weight. If the joint became unstable, additional force was applied by the rotator cuff muscles to restore joint stability. The model showed a higher joint shear to joint compressive force for the RCT CSA (38.2°) for thoracohumeral abduction angles between 40° and 90° with a peak difference of 23% at 50° of abduction. To achieve stability in this case additional rotator cuff forces exceeding physiological values were required. Our results document that a higher CSA tends to destabilize the glenohumeral joint such that higher than normal supraspinatus forces are required to maintain modeled stability during active abduction. This lends strong support to the concept that a high CSA can induce supraspinatus (SSP) overload. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:961-968, 2016.

How muscle relaxation and laterotrusion resolve open locks of the temporomandibular joint. Forward dynamic 3D-modeling of the human masticatory system

Patients with symptomatic hypermobility of the temporomandibular joint report problems with the closing movement of their jaw. Some are even unable to close their mouth opening wide (open lock). Clinical experience suggests that relaxing the jaw muscles or performing a jaw movement to one side (laterotrusion) might be a solution. The aim of our study was to assess the potential of these strategies for resolving an open lock and we hypothesised that both strategies work equally well in resolving open locks. We assessed the interplay of muscle forces, joint reaction forces and their moments during closing of mouth, following maximal mouth opening. We used a 3D biomechanical model of the masticatory system with a joint shape and muscle orientation that predispose for an open lock. In a forward dynamics approach, the effect of relaxation and laterotrusion strategies was assessed. Performing a laterotrusion movement was predicted to release an open lock for a steeper anterior slope of the articular eminence than relaxing the jaw-closing muscles, herewith we rejected our hypothesis. Both strategies could provide a net jaw closing moment, but only the laterotrusion strategy was able to provide a net posterior force for steeper anterior slope angles. For both strategies, the temporalis muscle appeared pivotal to retrieve the mandibular condyles to the glenoid fossa, due to its' more dorsally oriented working lines.

Musculoskeletal shoulder models: A technical review and proposals for research foci

Musculoskeletal shoulder models allow non-invasive prediction of parameters that cannot be measured, particularly the loading applied to morphological structures and neurological control. This insight improves treatment and avoidance of pathology and performance evaluation and optimisation. A lack of appropriate validation and knowledge of model parameters’ accuracy may cause reduced clinical success for these models. Instrumented implants have recently been used to validate musculoskeletal models, adding important information to the literature. This development along with increasing prevalence of shoulder models necessitates a fresh review of available models and their utility. The practical uses of models are described. Accuracy of model inputs, modelling techniques and model sensitivity is the main technical review undertaken. Collection and comparison of these parameters are vital to understanding disagreement between model outputs. Trends in shoulder modelling are highlighted: validation through instrumented prostheses, increasing openness and strictly constrained, optimised, measured kinematics. Future directions are recommended: validation through focus on model sub-sections, increased subject specificity with imaging techniques determining muscle and body segment parameters and through different scaling and kinematics optimisation approaches.

The development of lower limb musculoskeletal models with clinical relevance is dependent upon the fidelity of the mathematical description of the lower limb. Part 2: patient-specific geometry

Musculoskeletal models have the potential to evolve into sensitive clinical tools that provide relevant therapeutic guidance. A key impediment to this is the lack of understanding as to the function of such models. In order to improve this it is useful to recognise that musculoskeletal modelling is the mathematical description of musculoskeletal movement – a process that involves the construction and solution of equations of motion. These equations are derived from standard mechanical considerations and the mathematical representation of anatomy. The fidelity of musculoskeletal models is highly dependent on the assumption that such representations also describe the function of the musculoskeletal geometry. In addition, it is important to understand the sensitivity of such representations to patient-specific variations in anatomy. The exploration of these twin considerations will be fundamental to the creation of musculoskeletal modelling tools with clinical relevance and a systematic enquiry of these key parameters is recommended.