Comparison of nonlinear mechanical properties of bovine articular cartilage and meniscus

Mechano-adaptation: Exercise-driven Piezo1 & Piezo2 augmentation and chondroprotection in articular cartilage

Chondrocytes in adult joints are mechanosensitive post-mitotic quiescent cells with robustly expressed both Piezo1 and Piezo2 ion channels. Here, we examined the mechano-adaptation and Piezo modulations in articular chondrocytes using a mouse exercise model. We first found differential expression patterns of PIEZO1 and PIEZO2 in articular chondrocytes of healthy knee joints; chondrocytes in tibial cartilage (T) exhibit significantly higher PIEZO1 and PIEZO2 than femoral chondrocytes (F). Interestingly, a few weeks of exercise caused both PIEZO1 and PIEZO2 augmentation in F and T compared to the sedentary control group. Despite the increased expression levels of these mechanosensors, chondrocytes in exercised cartilage exhibit significantly reduced mechanical susceptibility against 1mJ impact. PIEZO1 modulation was relatively more rapid than PIEZO2 channels post-exercise. We tested the exercise-induced effect using Piezo1-conditional knockout (Pz1-cKO; Agc1 CreERT2 ;Piezo1 fl/fl ). Pz1-cKO mice exhibit diminished exercise-driven chondroprotection against 1mJ impact, suggesting essential roles of Piezo1-mediated mechanotransduction for physiologic-induced cartilage matrix homeostasis. In addition, using a mouse OA model, we further found the modulated PIEZO1 in chondrocytes, consistent with reports in Ren et al., but without PIEZO2 modulations over OA progression. In summary, our data reveal the distinctly tuned Piezo1 and Piezo2 channels in chondrocytes post-exercise and post-injury, in turn modulating the mechanical susceptibility of chondrocytes. We postulate that Piezo1 is a tightly-regulated biphasic biomarker ; Piezo1 antagonism may increase cellular survival post-injury and Piezo1 (with Piezo2) agonism to promote cartilage ECM restoration.

Tribomechanical Properties of PVA/Nomex® Composite Hydrogels for Articular Cartilage Repair

Due to the increasing prevalence of articular cartilage diseases and limitations faced by current therapeutic methodologies, there is an unmet need for new materials to replace damaged cartilage. In this work, poly(vinyl alcohol) (PVA) hydrogels were reinforced with different amounts of Nomex® (known for its high mechanical toughness, flexibility, and resilience) and sterilized by gamma irradiation. Samples were studied concerning morphology, chemical structure, thermal behavior, water content, wettability, mechanical properties, and rheological and tribological behavior. Overall, it was found that the incorporation of aramid nanostructures improved the hydrogel's mechanical performance, likely due to the reinforcement's intrinsic strength and hydrogen bonding to PVA chains. Additionally, the sterilization of the materials also led to superior mechanical properties, possibly related to the increased crosslinking density through the hydrogen bonding caused by the irradiation. The water content, wettability, and tribological performance of PVA hydrogels were not compromised by either the reinforcement or the sterilization process. The best-performing composite, containing 1.5% wt. of Nomex®, did not induce cytotoxicity in human chondrocytes. Plugs of this hydrogel were inserted in porcine femoral heads and tested in an anatomical hip simulator. No significant changes were observed in the hydrogel or cartilage, demonstrating the material's potential to be used in cartilage replacement.

Development and Characterization of Heparin-Containing Hydrogel/3D-Printed Scaffold Composites for Craniofacial Reconstruction

Regeneration of cartilage and bone tissues remains challenging in tissue engineering due to their complex structures, and the need for both mechanical support and delivery of biological repair stimuli. Therefore, the goal of this study was to develop a composite scaffold platform for anatomic chondral and osteochondral repair using heparin-based hydrogels to deliver small molecules within 3D-printed porous scaffolds that provide structure, stiffness, and controlled biologic delivery. We designed a mold-injection system to combine hydrolytically degradable hydrogels and 3D-printed scaffolds that could be employed rapidly (< 30 min) in operating room settings (~23 °C). Micro-CT analysis demonstrated the effectiveness of our injection system through homogeneously distributed hydrogel within the pores of the scaffolds. Hydrogels and composite scaffolds exhibited efficient loading (~94%) of a small positively charged heparin-binding molecule (crystal violet) with sustained release over 14 days and showed high viability of encapsulated porcine chondrocytes over 7 days. Compression testing demonstrated nonlinear viscoelastic behavior where tangent stiffness decreased with scaffold porosity (porous scaffold tangent stiffness: 70%: 4.9 MPa, 80%: 1.5 MPa, and 90%: 0.20 MPa) but relaxation was not affected. Lower-porosity scaffolds (70%) showed stiffness similar to lower ranges of trabecular bone (4-8 MPa) while higher-porosity scaffolds (80% and 90%) showed stiffness similar to auricular cartilage (0.16-2 MPa). Ultimately, this rapid composite scaffold fabrication method may be employed in the operating room and utilized to control biologic delivery within load-bearing scaffolds.

In Situ Loading and Time-Resolved Synchrotron-Based Phase Contrast Tomography for the Mechanical Investigation of Connective Knee Tissues: A Proof-of-Concept Study

Articular cartilage and meniscus transfer and distribute mechanical loads in the knee joint. Degeneration of these connective tissues occurs during the progression of knee osteoarthritis, which affects their composition, microstructure, and mechanical properties. A deeper understanding of disease progression can be obtained by studying them simultaneously. Time-resolved synchrotron-based X-ray phase-contrast tomography (SR-PhC-µCT) allows to capture the tissue dynamics. This proof-of-concept study presents a rheometer setup for simultaneous in situ unconfined compression and SR-PhC-µCT of connective knee tissues. The microstructural response of bovine cartilage (n = 16) and meniscus (n = 4) samples under axial continuously increased strain, or two steps of 15% strain (stress-relaxation) is studied. The chondrocyte distribution in cartilage and the collagen fiber orientation in the meniscus are assessed. Variations in chondrocyte density reveal an increase in the top 40% of the sample during loading, compared to the lower half. Meniscus collagen fibers reorient perpendicular to the loading direction during compression and partially redisperse during relaxation. Radiation damage, image repeatability, and image quality assessments show little to no effects on the results. In conclusion, this approach is highly promising for future studies of human knee tissues to understand their microstructure, mechanical response, and progression in degenerative diseases.

Functional meniscus reconstruction with biological and biomechanical heterogeneities through topological self-induction of stem cells

Meniscus injury is one of the most common sports injuries within the knee joint, which is also a crucial pathogenic factor for osteoarthritis (OA). The current meniscus substitution products are far from able to restore meniscal biofunctions due to the inability to reconstruct the gradient heterogeneity of natural meniscus from biological and biomechanical perspectives. Here, inspired by the topology self-induced effect and native meniscus microstructure, we present an innovative tissue-engineered meniscus (TEM) with a unique gradient-sized diamond-pored microstructure (GSDP-TEM) through dual-stage temperature control 3D-printing system based on the mechanical/biocompatibility compatible high Mw poly(ε-caprolactone) (PCL). Biologically, the unique gradient microtopology allows the seeded mesenchymal stem cells with spatially heterogeneous differentiation, triggering gradient transition of the extracellular matrix (ECM) from the inside out. Biomechanically, GSDP-TEM presents excellent circumferential tensile modulus and load transmission ability similar to the natural meniscus. After implantation in rabbit knee, GSDP-TEM induces the regeneration of biomimetic heterogeneous neomeniscus and efficiently alleviates joint degeneration. This study provides an innovative strategy for functional meniscus reconstruction. Topological self-induced cell differentiation and biomechanical property also provides a simple and effective solution for other complex heterogeneous structure reconstructions in the human body and possesses high clinical translational potential.

FLRT2 mediates chondrogenesis of nasal septal cartilage and mandibular condyle cartilage

Nasal septal cartilages (NSCs) and mandibular condyle cartilages (MCCs) are two important cartilages for craniomaxillofacial development. However, the role of FLRT2 in the formation of NSCs and MCCs remains undiscovered. NSCs and MCCs were used for immunocytochemistry staining of collagen II, toluidine blue staining, and alcian blue staining. Quantitative reverse transcription‑PCR and western blot were used to detect mRNA and protein expressions of FLRT2, N-cadherin, collagen II, aggrecan, and SOX9. Cell proliferation of MCCs and NSCs was tested by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay and cell counting kit‑8 assay. Cell migration of MCCs and NSCs was examined by wound healing assay and Transwell. Chondrogenesis of MCCs and NSCs were similar in morphological characteristics, while different in cell proliferation, migration, and extracellular matrix. FLRT2 promotes the proliferation and migration of NSCs. There were up-regulation of N-cadherin and down-regulation of collagen II, aggrecan, and SOX9 in NSC with knock down FLRT2. The current study, as demonstrated by Xie et al., reveals that FLRT2 overexpression in Sprague-Dawley neonatal rats promotes the proliferation and migration of NSCs and MCCs, decreases N-cadherin while increases collagen II, aggrecan, and SOX9 in NSC and MCCs. Altogether, FLRT2 mediates chondrogenesis of NSCs and MCCs.

Comparison of constitutive models for meniscus and their effect on the knee joint biomechanics during gait

Mechanical behavior of meniscus can be modeled using constitutive material models of varying complexity, such as isotropic elastic or fibril reinforced poroelastic (FRPE). However, the FRPE material is complex to implement, computationally demanding in 3D geometries, and simulation is time-consuming. Hence, we aimed to quantify the most suitable and efficient constitutive model of meniscus for simulation of cartilage responses in the knee joint during walking. We showed that simpler constitutive material models can reproduce similar cartilage responses to a knee model with the FRPE meniscus, but only knee models that consider orthotropic elastic meniscus can also reproduce meniscus responses adequately.

Surrogate modeling of articular cartilage degradation to understand the synergistic role of MMP-1 and MMP-9: a case study

A characteristic feature of arthritic diseases is cartilage extracellular matrix (ECM) degradation, often orchestrated by the overexpression of matrix metalloproteinases (MMPs) and other proteases. The interplay between fibril level degradation and the tissue-level aggregate response to biomechanical loading was explored in this work by a computational multiscale cartilaginous model. We considered the relative abundance of collagenases (MMP-1) and gelatinases (MMP-9) in surrogate models, where the diffusion (spatial distribution) of these enzymes and the subsequent, co-localized fibrillar damage were spatially randomized with Latin Hypercube Sampling. The computational model was constructed by incorporating the results from prior molecular dynamics simulations (tensile test) of microfibril degradation into a hyper-elastoplastic fibril-reinforced cartilage model. Including MMPs-mediated collagen fibril-level degradation in computational models may help understand the ECM pathomechanics at the tissue level. The mechanics of cartilage tissue and fibril show variations in mechanical integrity depending on the different combinations of MMPs-1 and 9 with a concentration ratio of 1:1, 3:1, and 1:3 in simulated indentation tests. The fibril yield (local failure) was initiated at 20.2 ± 3.0 (%) and at 23.0 ± 2.8 (%) of bulk strain for col 1:gel 3 and col 3: gel 1, respectively. The reduction in failure stress (global response) was 39.8% for col 1:gel 3, 37.5% for col 1:gel 1, and 36.7% for col 3:gel 1 compared with the failure stress of the degradation free tissue. These findings indicate that cartilage's global and local mechanisms of failure largely depend on the relative abundance of the two key enzymes-collagenase (MMP-1) and gelatinase (MMP-9) and the spatial characteristics of diffusion across the layers of the cartilage ECM.

Dots-on-Plots: A Web Application to Analyze Stress-Strain Curves From Tensile Tests of Soft Tissue

The calculation of tensile mechanical properties from stress-strain curves is a fundamental step in characterizing material behavior, yet no standardized method exists to perform these calculations for soft tissue. To address this deficiency, we developed a free web application called Dots-on-Plots2 that fully automates the calculation of tensile mechanical properties from stress-strain curves. The analyzed mechanical properties include the strength, strain, and energy at four points of interest (transition, yield, ultimate, and rupture), and the linear modulus. Users of Dots-on-Plots can upload multiple files, view and download results, and adjust threshold settings. This study determined a threshold setting that minimized error when calculating the transition point, where the stress-strain curve "transitions" from a nonlinear "toe" region to a linear region. Using the optimal threshold (2% stress deviation from a linear region fit), Dots-on-Plots calculated the transition strains from twenty tensile experiments of human meniscus to be 0.049 ± 0.007, which nearly matched the known transition strain values of 0.050 ± 0.006 (determined using finite element parameter optimization). The sensitivity of the calculated transition strain to the shape of various stress-strain curves was analyzed using sets of model-generated synthetic data. This free web application offers a convenient and reliable tool to systematically enhance the speed, transparency, and consistency of mechanical analysis across biomedical research groups.

Cartilage biomechanics: From the basic facts to the challenges of tissue engineering

Articular cartilage (AC) is the thin tissue that covers the long bone ends in the joints and that ensures the transmission of forces between adjacent bones while allowing nearly frictionless movements between them. AC repair is a technologic and scientific challenge that has been addressed with numerous approaches. A major deadlock is the capacity to take in account its complex mechanical properties in repair strategies. In this review, we first describe the major mechanical behaviors of AC for the non-specialists. Then, we show how researchers have progressively identified specific mechanical parameters using mathematical models. There are still gaps in our understanding of some of the observations concerning AC biomechanical properties, particularly the differences in extracellular matrix stiffness measured at the microscale and at the millimetric scale. Nevertheless, for bioengineering applications, AC repair strategies must take into account what are commonly considered the main mechanical features of cartilage: its ability to withstand high stresses through three main behaviors (elasticity, poroelasticity and swelling). Finally, we emphasize that future studies need to investigate AC mechanical properties at different scales, particularly the gradient of mechanical properties around cells and across the cartilage depth, and the differences in mechanical properties at different scales. This multi-scale approach could greatly enhance the success of AC restorative approaches.

Subject-specific biomechanical analysis to estimate locations susceptible to osteoarthritis-Finite element modeling and MRI follow-up of ACL reconstructed patients

The aims of this case-control study were to: (1) Identify cartilage locations and volumes at risk of osteoarthritis (OA) using subject-specific finite element (FE) models; (2) Quantify the relationships between the simulated biomechanical parameters and T₂ and T_1ρ relaxation times of magnetic resonance imaging (MRI). We created subject-specific FE models for seven patients with anterior cruciate ligament (ACL) reconstruction and six controls based on a previous proof-of-concept study. We identified locations and cartilage volumes susceptible to OA, based on maximum principal stresses and absolute maximum shear strains in cartilage exceeding thresholds of 7 MPa and 32%, respectively. The locations and volumes susceptible to OA were compared qualitatively and quantitatively against 2-year longitudinal changes in T₂ and T_1ρ relaxation times. The degeneration volumes predicted by the FE models, based on excessive maximum principal stresses, were significantly correlated (r = 0.711, p < 0.001) with the degeneration volumes determined from T₂ relaxation times. There was also a significant correlation between the predicted stress values and changes in T₂ relaxation time (r = 0.649, p < 0.001). Absolute maximum shear strains and changes in T_1ρ relaxation time were not significantly correlated. Five out of seven patients with ACL reconstruction showed excessive maximum principal stresses in either one or both tibial cartilage compartments, in agreement with follow-up information from MRI. Expectedly, for controls, the FE models and follow-up information showed no degenerative signs. Our results suggest that the presented modelling methodology could be applied to prospectively identify ACL reconstructed patients at risk of biomechanically driven OA, particularly by the analysis of maximum principal stresses of cartilage.

Experiments and hyperelastic modeling of porcine meniscus show heterogeneity at high strains

Constitutive modeling of the meniscus is critical in areas like knee surgery and tissue engineering. At low strain rates, the meniscus can be described using a hyperelastic model. Calibration of hyperelastic material models of the meniscus is challenging on many fronts due to material variability and friction. In this study, we present a framework to determine the hyperelastic material parameters of porcine meniscus (and similar soft tissues) using no-slip uniaxial compression experiments. Because of the nonhomogeneous deformation in the specimens, a finite element solution is required at each step of the iterative calibration process. We employ a Bayesian calibration approach to account for the inherent material variability and a Bayesian optimization approach to minimize the resulting cost function in the material parameter space. Cylindrical specimens of porcine meniscus from the anterior, middle and posterior regions are tested up to 30% compressive strain and the Yeoh form of hyperelastic strain energy density function is used to describe the material response. The results show that the Yeoh form is able to accurately describe the compressive response of porcine meniscus and that the Bayesian calibration and optimization approaches are able to calibrate the model in a computationally efficient manner while taking into account the inherent material variability. The results also show that the shear modulus or the initial stiffness is roughly uniform across the different areas of the meniscus, but there is significant spatial heterogeneity in the response at high strains. In particular, the middle region is considerably stiffer at high strains. This heterogeneity is important to consider in modeling the response of the meniscus for clinical applications.

A musculoskeletal finite element model of rat knee joint for evaluating cartilage biomechanics during gait

Abnormal loading of the knee due to injuries or obesity is thought to contribute to the development of osteoarthritis (OA). Small animal models have been used for studying OA progression mechanisms. However, numerical models to study cartilage responses under dynamic loading in preclinical animal models have not been developed. Here we present a musculoskeletal finite element model of a rat knee joint to evaluate cartilage biomechanical responses during a gait cycle. The rat knee joint geometries were obtained from a 3-D MRI dataset and the boundary conditions regarding loading in the joint were extracted from a musculoskeletal model of the rat hindlimb. The fibril-reinforced poroelastic (FRPE) properties of the rat cartilage were derived from data of mechanical indentation tests. Our numerical results showed the relevance of simulating anatomical and locomotion characteristics in the rat knee joint for estimating tissue responses such as contact pressures, stresses, strains, and fluid pressures. We found that the contact pressure and maximum principal strain were virtually constant in the medial compartment whereas they showed the highest values at the beginning of the gait cycle in the lateral compartment. Furthermore, we found that the maximum principal stress increased during the stance phase of gait, with the greatest values at midstance. We anticipate that our approach serves as a first step towards investigating the effects of gait abnormalities on the adaptation and degeneration of rat knee joint tissues and could be used to evaluate biomechanically-driven mechanisms of the progression of OA as a consequence of joint injury or obesity.

Osteoarthritis is a disease of the musculoskeletal system which is characterized by the degradation of articular cartilage. Changes in the knee loading after injuries or obesity contribute to the development of cartilage degeneration. Since injured cartilage cannot be reversed back to intact conditions, small animal models have been widely used for investigating osteoarthritis progression mechanisms. Moreover, experimental studies have been complemented with numerical models to overcome inherent limitations such as cost, difficulties to obtain accurate measures and replicate degenerative situations in the knee joint. However, computational models to study articular cartilage responses under dynamic loading in small animal models have not been developed. Thus, here we present a musculoskeletal finite element model (MSFE) of a rat knee joint to evaluate cartilage biomechanical responses during gait. Our computational model considers both the anatomical and locomotion characteristics of the rat knee joint for estimating mechanical responses in the articular cartilage. We suggest that our approach can be used to investigate tissue adaptations based on the mechanobiological responses of the cartilage to prevent the progression of osteoarthritis.

Torque- and Muscle-Driven Flexion Induce Disparate Risks of In Vitro Herniation: A Multiscale and Multiphasic Structure-Based Finite Element Study

The intervertebral disc is a complex structure that experiences multiaxial stresses regularly. Disc failure through herniation is a common cause of lower back pain, which causes reduced mobility and debilitating pain, resulting in heavy socioeconomic burdens. Unfortunately, herniation etiology is not well understood, partially due to challenges in replicating herniation in vitro. Previous studies suggest that flexion elevated risks of herniation. Thus, the objective of this study was to use a multiscale and multiphasic finite element model to evaluate the risk of failure under torque- or muscle-driven flexion. Models were developed to represent torque-driven flexion with the instantaneous center of rotation (ICR) located on the disc, and the more physiologically representative muscle-driven flexion with the ICR located anterior of the disc. Model predictions highlighted disparate disc mechanics regarding bulk deformation, stress-bearing mechanisms, and intradiscal stress-strain distributions. Specifically, failure was predicted to initiate at the bone-disc boundary under torque-driven flexion, which may explain why endplate junction failure, instead of herniation, has been the more common failure mode observed in vitro. By contrast, failure was predicted to initiate in the posterolateral annulus fibrosus under muscle-driven flexion, resulting in consistent herniation. Our findings also suggested that muscle-driven flexion combined with axial compression could be sufficient for provoking herniation in vitro and in silico. In conclusion, this study provided a computational framework for designing in vitro testing protocols that can advance the assessment of disc failure behavior and the performance of engineered disc implants.

Anisotropy and inhomogeneity of permeability and fibrous network response in the pars intermedia of the human lateral meniscus

Within the human tibiofemoral joint, meniscus plays a key role due to its peculiar time-dependent mechanical characteristics, inhomogeneous structure and compositional features. To better understand the pathophysiological mechanisms underlying this essential component, it is mandatory to analyze in depth the relationship between its structure and the function it performs in the joint. Accordingly, the aim of this study was to evaluate the behavior of both solid and fluid phases of human meniscus in response to compressive loads, by integrating mechanical assessment and histological analysis. Cubic specimens were harvested from seven knee lateral menisci, specifically from anterior horn, pars intermedia and posterior horn; unconfined compressive tests were then performed according to three main loading directions (i.e., radial, circumferential and vertical). Fibril modulus, matrix modulus and hydraulic permeability of the tissue were thence estimated through a fibril-network-reinforced biphasic model. Tissue porosity and collagen fibers arrangement were assessed through histology for each region and related to the loading directions adopted during mechanical tests. Regional and strain-dependent constitutive parameters were finally proposed for the human lateral meniscus, suggesting an isotropic behavior of both the horns, and a transversely isotropic response of the pars intermedia. Furthermore, the histological findings supported the evidences highlighted by the compressive tests. Indeed, this study provided novel insights concerning the functional behavior of human menisci by integrating mechanical and histological characterizations and thus highlighting the key role of this component in knee contact mechanics and presenting fundamental information that can be used in the development of tissue-engineered substitutes. STATEMENT OF SIGNIFICANCE: This work presents an integration to the approaches currently used to model the mechanical behavior of the meniscal tissue. This study assessed in detail the regional and directional contributions of both the meniscal solid and fluid phases during compressive response, providing also complementary histological evidence. Within this updated perspective, both knee computational modeling and meniscal tissue engineering can be improved to have an effective impact on the clinical practice.

RATCHETING EVALUATION OF BIOLOGICAL TISSUES OVER ASYMMETRIC LOADING CYCLES

This study intends to evaluate the ratcheting response of biological samples prepared from bovine and porcine trabecular bone, articular cartilage, meniscus, and skin tissues and tested under asymmetric (nonzero mean stress) cycles. Meniscus and skin samples were tested with stress ratios of [Formula: see text] and [Formula: see text], respectively, while other tissues were tested at [Formula: see text]. Experimental ratcheting data and related influential parameters including stress level, stress rate, and testing frequency were discussed. A parametric ratcheting equation was further calibrated to estimate the ratcheting response of tissues. The predicted ratcheting data were found to be in close agreement with the reported experimental data.

Biomechanical, biochemical, and near infrared spectral data of bovine knee ligaments and patellar tendon

Knee joint ligaments and patellar tendon are rope-like tissues that enable the proper function of the knee by connecting the bones that form the joint. A better understanding of ligament structure-function relationships is needed to develop objective and reliable diagnostic methods for ligaments. Recently, arthroscopic near infrared spectroscopy (NIR) has shown the potential to quantitatively evaluate the health of the cartilages and menisci of the knee. In this dataset, we present a unique combination of NIR spectral data, biomechanical properties, and biochemical composition of bovine primary knee ligaments and patellar tendon (10 knees, 50 tissue samples). NIR spectral data were measured at 5 locations in each sample, biomechanical properties were obtained with tensile testing, and biochemical composition was quantified using colorimetric biochemical methods. The data can be reused for investigations of structure-function relationships of knee ligaments and patellar tendon, for the development of NIR spectroscopic methods to quantify the health of these tissues, and to develop new computational models to describe ligament and tendon biomechanics.

Comparison of material models for anterior cruciate ligament in tension: from poroelastic to a novel fibril-reinforced nonlinear composite model

Computational models of the knee joint are useful for evaluating stresses and strains within the joint tissues. However, the outcome of those models is sensitive to the material model and material properties chosen for ligaments, the collagen reinforced tissues connecting bone to bone. The purpose of this study was to investigate different compositionally motivated material models and further to develop a model that can accurately reproduce experimentally measured stress-relaxation data of bovine anterior cruciate ligament (ACL). Tensile testing samples were extracted from ACLs of bovine knee joints (N = 10) and subjected to a three-step stress-relaxation test at the toe region. Data from the experiments was averaged and one average finite element model was generated to replicate the experiment. Poroelastic and different fibril-reinforced poro(visco)elastic material models were applied, and their material parameters were optimized to reproduce the experimental force-time response. Material models with only fluid flow mediated relaxation were not able to capture the stress-relaxation behavior (R² = 0.806, 0.803 and 0.938). The inclusion of the viscoelasticity of the fibrillar network improved the model prediction (R² = 0.978 and 0.976), but the complex stress-relaxation behavior was best captured by a poroelastic model with a nonlinear two-relaxation-time strain-recruited viscoelastic fibrillar network (R² = 0.997). The results suggest that in order to replicate the multi-step stress-relaxation behavior of ACL in tension, the fibrillar network formulation should include the complex nonlinear viscoelastic phenomena.

Identification of locations susceptible to osteoarthritis in patients with anterior cruciate ligament reconstruction: Combining knee joint computational modelling with follow-up T1ρ and T2 imaging

BACKGROUND

Finite element modelling can be used to evaluate altered loading conditions and failure locations in knee joint tissues. One limitation of this modelling approach has been experimental comparison. The aims of this proof-of-concept study were: 1) identify areas susceptible to osteoarthritis progression in anterior cruciate ligament reconstructed patients using finite element modelling; 2) compare the identified areas against changes in T₂ and T_1ρ values between 1-year and 3-year follow-up timepoints.

METHODS

Two patient-specific finite element models of knee joints with anterior cruciate ligament reconstruction were created. The knee geometry was based on clinical magnetic resonance imaging and joint loading was obtained via motion capture. We evaluated biomechanical parameters linked with cartilage degeneration and compared the identified risk areas against T₂ and T_1ρ maps.

FINDINGS

The risk areas identified by the finite element models matched the follow-up magnetic resonance imaging findings. For Patient 1, excessive values of maximum principal stresses and shear strains were observed in the posterior side of the lateral tibial and femoral cartilage. For Patient 2, high values of maximum principal stresses and shear strains of cartilage were observed in the posterior side of the medial joint compartment. For both patients, increased T₂ and T_1ρ values between the follow-up times were observed in the same areas.

INTERPRETATION

Finite element models with patient-specific geometries and motions and relatively simple material models of tissues were able to identify areas susceptible to post-traumatic knee osteoarthritis. We suggest that the methodology presented here may be applied in large cohort studies.

Material properties of human patellar-ligament grafts from the elderly population

The aim of the presented study was to estimate the material properties of human patellar ligaments from the elderly population by means of tensile tests. The experimental part was conducted on a custom tensile-testing device, with a built-in enclosure to simulate in-vivo conditions, using 25 (15 female, 10 male) bone-ligament-bone samples from elderly (age 83 (8)) human donors. During the tensile tests, the resultant force and displacement of the sample attachments were recorded. With this data and the values of the initial length and the initial cross-sectional area of the samples, the engineering stress and strain, the Young's modulus and the toughness at rupture were calculated for each sample. The results were then averaged and presented for all the samples together and for the female and male populations separately. The measured Young's modulus and the failure stress values were found to be significantly higher for the female samples compared to the male (p < 0.05). All the other measured properties did not show a significant difference. The toe region's material properties for the patellar ligament were also presented as valuable information for the anterior cruciate ligament reconstruction. The tensile-test results were compared to other research carried on human patellar ligaments using samples from younger donors. The comparison showed that the samples from the elderly population exhibit lower values of strain at the end of the toe region and have a lower failure strain for the patellar ligament. The Young's modulus and the failure stress of the samples in this study were in the range of other research conducted on patellar ligaments.

A comprehensive testing protocol for macro-scale mechanical characterization of knee articular cartilage with documented experimental repeatability

Articular cartilage mechanics has been extensively studied with various approaches and mechanical characterization strategies. However testing protocols can be highly varying and difficult to reproduce, particularly for specimen-specific analyses. Detailed knowledge of testing protocols is important for reliable use in concordant finite element analyses. This study presents a detailed, robust procedure for cartilage testing-with multiple regions and per sample repeatability data. Samples were taken from femur, tibia and patella of a human cadaver knee and tested in unconfined compression, confined compression and uniaxial tension. Each test was repeated three times. The testing protocols provide elastic and time dependent characterization data. Results, for example equilibrium modulus of 0.28 (0.0024) MPa for patella under unconfined compression indicate that variability is well controlled and that protocol(s) presented here can generate repeatable specimen-specific data. As per the authors' knowledge this is the first study to report in-depth uncertainty assessment of the experimental procedures for multi-region knee cartilage characterization.

Constitutive modeling of menisci tissue: a critical review of analytical and numerical approaches

Menisci are fibrocartilaginous disks consisting of soft tissue with a complex biomechanical structure. They are critical determinants of the kinematics as well as the stability of the knee joint. Several studies have been carried out to formulate tissue mechanical behavior, leading to the development of a wide spectrum of constitutive laws. In addition to developing analytical tools, extensive numerical studies have been conducted on menisci modeling. This study reviews the developments of the most widely used continuum models of the meniscus mechanical properties in conjunction with emerging analytical and numerical models used to study the meniscus. The review presents relevant approaches and assumptions used to develop the models and includes discussions regarding strengths, weaknesses, and discrepancies involved in the presented models. The study presents a comprehensive coverage of relevant publications included in Compendex, EMBASE, MEDLINE, PubMed, ScienceDirect, Springer, and Scopus databases. This review aims at opening novel avenues for improving menisci modeling within the framework of constitutive modeling through highlighting the needs for further research directed toward determining key factors in gaining insight into the biomechanics of menisci which is crucial for the elaborate design of meniscal replacements.

EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci

Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.

EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci

Abnormal mechanical loading is essential in the onset and progression of knee osteoarthritis. Combined musculoskeletal (MS) and finite element (FE) modeling is a typical method to estimate load distribution and tissue responses in the knee joint. However, earlier combined models mostly utilize static-optimization based MS models and muscle force driven FE models typically use elastic materials for soft tissues or analyze specific time points of gait. Therefore, here we develop an electromyography-assisted muscle force driven FE model with fibril-reinforced poro(visco)elastic cartilages and menisci to analyze knee joint loading during the stance phase of gait. Moreover, since ligament pre-strains are one of the important uncertainties in joint modeling, we conducted a sensitivity analysis on the pre-strains of anterior and posterior cruciate ligaments (ACL and PCL) as well as medial and lateral collateral ligaments (MCL and LCL). The model produced kinematics and kinetics consistent with previous experimental data. Joint contact forces and contact areas were highly sensitive to ACL and PCL pre-strains, while those changed less cartilage stresses, fibril strains, and fluid pressures. The presented workflow could be used in a wide range of applications related to the aetiology of cartilage degeneration, optimization of rehabilitation exercises, and simulation of knee surgeries.

Superstrong and Tough Hydrogel through Physical Cross-Linking and Molecular Alignment

Hydrogels are attracting increasing attention due to their potential use in various fields. However, most of the existing hydrogels have limitations in either dissipating mechanical energy or maintaining high stretchability under deformation, thus do not possess high mechanical properties. Herein, poly(vinyl alcohol) (PVA)-tannic acid (TA) hydrogels with both high mechanical strength and stretchability were obtained via a step-by-step physical cross-linking and molecular alignment method. Saline-triggered physical interactions serve as "sacrifice domains" to dissipate energy and endow PVA-based hydrogel with high mechanical strength (≈16 MPa) and stretchability (≈1000%). Due to the reversible arranging and disassociating property of physical interactions, PVA-TA hydrogels show excellent shape memory performance. We further demonstrated an effective approach to fabricate strong and aligned PVA-TA thread. The resultant well-aligned PVA-TA dry thread reveals an ultrahigh mechanical tensile strength of up to 750 MPa, nearly 45 times higher than PVA-TA thread with no alignment. Wide-angle X-ray two-dimensional diffraction images further confirmed the alignment of PVA fibers in stretching direction. In addition, we applied the PVA-TA hydrogel as suture and evaluated the cytotoxicity and biocompatibility of the PVA-TA suture.

Evaluation of the Effect of Bariatric Surgery-Induced Weight Loss on Knee Gait and Cartilage Degeneration

The objective of the study was to investigate the effects of bariatric surgery-induced weight loss on knee gait and cartilage degeneration in osteoarthritis (OA) by combining magnetic resonance imaging (MRI), gait analysis, finite element (FE) modeling, and cartilage degeneration algorithm. Gait analyses were performed for obese subjects before and one-year after the bariatric surgery. FE models were created before and after weight loss for those subjects who did not have severe tibio-femoral knee cartilage loss. Knee cartilage degenerations were predicted using an adaptive cartilage degeneration algorithm which is based on cumulative overloading of cartilage, leading to iteratively altered cartilage properties during OA. The average weight loss was 25.7±11.0 kg corresponding to a 9.2±3.9 kg/m2 decrease in body mass index (BMI). External knee rotation moment increased, and minimum knee flexion angle decreased significantly (p < 0.05) after weight loss. Moreover, weight loss decreased maximum cartilage degeneration by 5±23% and 13±11% on the medial and lateral tibial cartilage surfaces, respectively. Average degenerated volumes in the medial and lateral tibial cartilage decreased by 3±31% and 7±32%, respectively, after weight loss. However, increased degeneration levels could also be observed due to altered knee kinetics. The present results suggest that moderate weight loss changes knee kinetics and kinematics and can slow-down cartilage degeneration for certain patients. Simulation results also suggest that prediction of cartilage degeneration is subject-specific and highly depend on the altered gait loading, not just the patient's weight.

In situ-forming, mechanically resilient hydrogels for cell delivery

Injectable, in situ-forming hydrogels can improve cell delivery in tissue engineering applications by facilitating minimally invasive delivery to irregular defect sites and improving cell retention and survival. Tissues targeted for cell delivery often undergo diverse mechanical loading including high stress, high strain, and repetitive loading conditions. This review focuses on the development of hydrogel systems that meet the requirements of mechanical resiliency, cytocompatibility, and injectability for such applications. First, we describe the most important design considerations for maintaining the viability and function of encapsulated cells, for reproducing the target tissue morphology, and for achieving degradation profiles that facilitate tissue replacement. Models describing the relationships between hydrogel structure and mechanical properties are described, focusing on design principles necessary for producing mechanically resilient hydrogels. The advantages and limitations of current strategies for preparing cytocompatible, injectable, and mechanically resilient hydrogels are reviewed, including double networks, nanocomposites, and high molecular weight amphiphilic copolymer networks. Finally, challenges and opportunities are outlined to guide future research in this developing field.

Maximum shear strain-based algorithm can predict proteoglycan loss in damaged articular cartilage

Post-traumatic osteoarthritis (PTOA) is a common disease, where the mechanical integrity of articular cartilage is compromised. PTOA can be a result of chondral defects formed due to injurious loading. One of the first changes around defects is proteoglycan depletion. Since there are no methods to restore injured cartilage fully back to its healthy state, preventing the onset and progression of the disease is advisable. However, this is problematic if the disease progression cannot be predicted. Thus, we developed an algorithm to predict proteoglycan loss of injured cartilage by decreasing the fixed charge density (FCD) concentration. We tested several mechanisms based on the local strains or stresses in the tissue for the FCD loss. By choosing the degeneration threshold suggested for inducing chondrocyte apoptosis and cartilage matrix damage, the algorithm driven by the maximum shear strain showed the most substantial FCD losses around the lesion. This is consistent with experimental findings in the literature. We also observed that by using coordinate system-independent strain measures and selecting the degeneration threshold in an ad hoc manner, all the resulting FCD distributions would appear qualitatively similar, i.e., the greatest FCD losses are found at the tissue adjacent to the lesion. The proposed strain-based FCD degeneration algorithm shows a great potential for predicting the progression of PTOA via biomechanical stimuli. This could allow identification of high-risk defects with an increased risk of PTOA progression.

Comparison between kinetic and kinetic-kinematic driven knee joint finite element models

Use of knee joint finite element models for diagnostic purposes is challenging due to their complexity. Therefore, simpler models are needed for studies where a high number of patients need to be analyzed, without compromising the results of the model. In this study, more complex, kinetic (forces and moments) and simpler, kinetic-kinematic (forces and angles) driven finite element models were compared during the stance phase of gait. Patella and tendons were included in the most complex model, while they were absent in the simplest model. The greatest difference between the most complex and simplest models was observed in the internal-external rotation and axial joint reaction force, while all other rotations, translations and joint reaction forces were similar to one another. In terms of cartilage stresses and strains, the simpler models behaved similarly with the more complex models in the lateral joint compartment, while minor differences were observed in the medial compartment at the beginning of the stance phase. We suggest that it is feasible to use kinetic-kinematic driven knee joint models with a simpler geometry in studies with a large cohort size, particularly when analyzing cartilage responses and failures related to potential overloads.

Short cracks in knee meniscus tissue cause strain concentrations, but do not reduce ultimate stress, in single-cycle uniaxial tension

Tears are central to knee meniscus pathology and, from a mechanical perspective, are crack-like defects (cracks). In many materials, cracks create stress concentrations that cause progressive local rupture and reduce effective strength. It is currently unknown if cracks in meniscus have these consequences; if they do, this would have repercussions for management of meniscus pathology. The objective of this study was to determine if a short crack in meniscus tissue, which mimics a preclinical meniscus tear, (a) causes crack growth and reduces effective strength, (b) creates a near-tip strain concentration and (c) creates unloaded regions on either side of the crack. Specimens with and without cracks were tested in uniaxial tension and compared in terms of macroscopic stress-strain curves and digital image correlation strain fields. The strain fields were used as an indicator of stress concentrations and unloaded regions. Effective strength was found to be insensitive to the presence of a crack (potential effect < 0.86 s.d.; β = 0.2), but significant strain concentrations, which have the potential to lead to long-term accumulation of tissue or cell damage, were observed near the crack tip.

Composition, structure and tensile biomechanical properties of equine articular cartilage during growth and maturation

Articular cartilage undergoes structural and biochemical changes during maturation, but the knowledge on how these changes relate to articular cartilage function at different stages of maturation is lacking. Equine articular cartilage samples of four different maturation levels (newborn, 5-month-old, 11-month-old and adult) were collected (N = 25). Biomechanical tensile testing, Fourier transform infrared microspectroscopy (FTIR-MS) and polarized light microscopy were used to study the tensile, biochemical and structural properties of articular cartilage, respectively. The tensile modulus was highest and the breaking energy lowest in the newborn group. The collagen and the proteoglycan contents increased with age. The collagen orientation developed with age into an arcade-like orientation. The collagen content, proteoglycan content, and collagen orientation were important predictors of the tensile modulus (p < 0.05 in multivariable regression) and correlated significantly also with the breaking energy (p < 0.05 in multivariable regression). Partial least squares regression analysis of FTIR-MS data provided accurate predictions for the tensile modulus (r = 0.79) and the breaking energy (r = 0.65). To conclude, the composition and structure of equine articular cartilage undergoes changes with depth that alter functional properties during maturation, with the typical properties of mature tissue reached at the age of 5-11 months.

New algorithm for simulation of proteoglycan loss and collagen degeneration in the knee joint: Data from the osteoarthritis initiative

Osteoarthritis is a harmful joint disease but prediction of disease progression is problematic. Currently, there is only one modeling framework which can be applied to predict the progression of knee osteoarthritis but it only considers degenerative changes in the collagen fibril network. Here, we have developed the framework further by considering all of the major tissue changes (proteoglycan content, fluid flow, and collagen fibril network) occurring in osteoarthritis. While excessive levels of tissue stresses controlled degeneration of the collagen fibril network, excessive levels of tissue strains controlled the decrease in proteoglycan content and the increase in permeability. We created four knee joint models with increasing degrees of complexity based on the depth-wise composition. Models were tested for normal and abnormal, physiologically relevant, loading conditions in the knee. Finally, the predicted depth-wise compositional changes from each model were compared against experimentally observed compositional changes in vitro. The model incorporating the typical depth-wise composition of cartilage produced the best match with experimental observations. Consistent with earlier in vitro experiments, this model simulated the greatest proteoglycan depletion in the superficial and middle zones, while the collagen fibril degeneration was located mostly in the superficial zone. The presented algorithm can be used for predicting simultaneous collagen degeneration and proteoglycan loss during the development of knee osteoarthritis. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1673-1683, 2018.

The effect of constitutive representations and structural constituents of ligaments on knee joint mechanics

Ligaments provide stability to the human knee joint and play an essential role in restraining motion during daily activities. Compression-tension nonlinearity is a well-known characteristic of ligaments. Moreover, simpler material representations without this feature might give reasonable results because ligaments are primarily in tension during loading. However, the biomechanical role of different constitutive representations and their fibril-reinforced poroelastic properties is unknown. A numerical knee model which considers geometric and material nonlinearities of meniscus and cartilages was applied. Five different constitutive models for the ligaments (spring, elastic, hyperelastic, porohyperelastic, and fibril-reinforced porohyperelastic (FRPHE)) were implemented. Knee joint forces for the models with elastic, hyperelastic and porohyperelastic properties showed similar behavior throughout the stance, while the model with FRPHE properties exhibited lower joint forces during the last 50% of the stance phase. The model with ligaments as springs produced the lowest joint forces at this same stance phase. The results also showed that the fibril network contributed substantially to the knee joint forces, while the nonfibrillar matrix and fluid had small effects. Our results indicate that simpler material models of ligaments with similar properties in compression and tension can be used when the loading is directed primarily along the ligament axis in tension.

Estimation of the Effect of Body Weight on the Development of Osteoarthritis Based on Cumulative Stresses in Cartilage: Data from the Osteoarthritis Initiative

Evaluation of the subject-specific biomechanical effects of obesity on the progression of OA is challenging. The aim of this study was to create 3D MRI-based finite element models of the knee joints of seven obese subjects, who had developed OA at 4-year follow-up, and of seven normal weight subjects, who had not developed OA at 4-year follow-up, to test the sensitivity of cumulative maximum principal stresses in cartilage in quantitative risk evaluation of the initiation and progression of knee OA. Volumes of elements with cumulative stresses over 5 MPa in tibial cartilage were significantly (p < 0.05) larger in obese subjects as compared to normal weight subjects. Locations of high peak cumulative stresses at the baseline in most of the obese subjects showed a good agreement with the locations of the cartilage loss and MRI scoring at follow-up. Simulated weight loss (to body mass index 24 kg/m2) in obese subjects led to significant reduction of the highest cumulative stresses in tibial and femoral cartilages. The modeling results suggest that an analysis of cumulative stresses could be used to evaluate subject-specific effects of obesity and weight loss on cartilage responses and potential risks for the progression of knee OA.

Super-strong and tough poly(vinyl alcohol)/poly(acrylic acid) hydrogels reinforced by hydrogen bonding

Super-strong and tough poly(vinyl alcohol)/poly(acrylic acid) hydrogels based on hydrogen bonding are prepared by the strategy of immersing and cold-drawing.

Micromechanical anisotropy and heterogeneity of the meniscus extracellular matrix

To understand how the complex biomechanical functions of the meniscus are endowed by the nanostructure of its extracellular matrix (ECM), we studied the anisotropy and heterogeneity in the micromechanical properties of the meniscus ECM. We used atomic force microscopy (AFM) to quantify the time-dependent mechanical properties of juvenile bovine meniscus at deformation length scales corresponding to the diameters of collagen fibrils. At this scale, anisotropy in the elastic modulus of the circumferential fibers, the major ECM structural unit, can be attributed to differences in fibril deformation modes: uncrimping when normal to the fiber axis, and laterally constrained compression when parallel to the fiber axis. Heterogeneity among different structural units is mainly associated with their variations in microscale fiber orientation, while heterogeneity across anatomical zones is due to alterations in collagen fibril diameter and alignment at the nanoscale. Unlike the elastic modulus, the time-dependent properties are more homogeneous and isotropic throughout the ECM. These results enable a detailed understanding of the meniscus structure-mechanics at the nanoscale, and can serve as a benchmark for understanding meniscus biomechanical functions, documenting disease progression and designing tissue repair strategies.

STATEMENT OF SIGNIFICANCE

Meniscal damage is a common cause of joint injury, which can lead to the development of post-traumatic osteoarthritis among young adults. Restoration of meniscus function requires repairing its highly heterogeneous and complex extracellular matrix. Employing AFM, this study quantifies the anisotropic and heterogeneous features of the meniscus ECM structure and mechanics. The micromechanical properties are interpreted within the context of the collagen fibril nanostructure and its variation with tissue anatomical locations. These results provide a fundamental structure-mechanics knowledge benchmark, against which, repair and regeneration strategies can be developed and evaluated with respect to the specialized structural and functional complexity of the native tissue.

Regeneration of meniscus tissue using adipose mesenchymal stem cells-chondrocytes co-culture on a hybrid scaffold: In vivo study

The meniscus has poor intrinsic regenerative capacity and its damage inevitably leads to articular cartilage degeneration. We focused on evaluating the effects of Polyvinyl alcohol/Chitosan (PVA/Ch) scaffold seeded by adipose-derived mesenchymal stem cell (ASC) and articular chondrocytes (AC) in meniscus regeneration. The PVA/Ch scaffolds with different molar contents of Ch (Ch1, Ch2, Ch4 and Ch8) were cross-linked by pre-polyurethane chains. By increasing amount of Ch tensile modulus was increased from 83.51 MPa for Ch1 to 110 MPa for Ch8 while toughness showed decrease from 0.33 mJ/mm³ in Ch1 to 0.11 mJ/mm³ in Ch8 constructs. Moreover, swelling ratio and degradation rate increased with an increase in Ch amount. Scanning electron microscopy imaging was performed for pore size measurement and cell attachment. At day 21, Ch4 construct seeded by AC showed the highest expression with 24.3 and 22.64 folds increase in collagen II and aggrecan (p ≤ 0.05), respectively. Since, the mechanical properties, water uptake and degradation rate of Ch4 and Ch8 compositions had no statistically significant differences, Ch4 was selected for in vivo study. New Zealand rabbits were underwent unilateral total medial meniscectomy and AC/scaffold, ASC/scaffold, AC-ASC (co-culture)/scaffold and cell-free scaffold were engrafted. At 7 months post-implantation, macroscopic, histologic, and immunofluorescent studies for regenerated meniscus revealed better results in AC/scaffold group followed by AC-ASC/scaffold and ASC/scaffold groups. In the cell-free scaffold group, there was no obvious meniscus regeneration. Articular cartilages were best preserved in AC/scaffold group. The best histological score was observed in AC/scaffold group. Our results support that Ch4 scaffold seeded by AC alone can successfully regenerate meniscus in tearing injury and ASC has no significant contribution in the healing process.

Fatigue life of bovine meniscus under longitudinal and transverse tensile loading

The knee meniscus is composed of a fibrous extracellular matrix that is subjected to large and repeated loads. Consequently, the meniscus is frequently torn, and a potential mechanism for failure is fatigue. The objective of this study was to measure the fatigue life of bovine meniscus when applying cyclic tensile loads either longitudinal or transverse to the principal fiber direction. Fatigue experiments consisted of cyclic loads to 60%, 70%, 80% or 90% of the predicted ultimate tensile strength until failure occurred or 20,000 cycles was reached. The fatigue data in each group was fit with a Weibull distribution to generate plots of stress level vs. cycles to failure (S-N curve). Results showed that loading transverse to the principal fiber direction gave a two-fold increase in failure strain, a three-fold increase in creep, and a nearly four-fold increase in cycles to failure (not significant), compared to loading longitudinal to the principal fiber direction. The S-N curves had strong negative correlations between the stress level and the mean cycles to failure for both loading directions, where the slope of the transverse S-N curve was 11% less than the longitudinal S-N curve (longitudinal: S=108-5.9ln(N); transverse: S=112-5.2ln(N)). Collectively, these results suggest that the non-fibrillar matrix is more resistant to fatigue failure than the collagen fibers. Results from this study are relevant to understanding the etiology of atraumatic radial and horizontal meniscal tears, and can be utilized by research groups that are working to develop meniscus implants with fatigue properties that mimic healthy tissue.

Quantitative Evaluation of the Mechanical Risks Caused by Focal Cartilage Defects in the Knee

Focal cartilage lesions can proceed to severe osteoarthritis or remain unaltered even for years. A method to identify high risk defects would be of utmost importance to guide clinical decision making and to identify the patients that are at the highest risk for the onset and progression of osteoarthritis. Based on cone beam computed tomography arthrography, we present a novel computational model for evaluating changes in local mechanical responses around cartilage defects. Our model, based on data obtained from a human knee in vivo, demonstrated that the most substantial alterations around the defect, as compared to the intact tissue, were observed in minimum principal (compressive) strains and shear strains. Both strain values experienced up to 3-fold increase, exceeding levels previously associated with chondrocyte apoptosis and failure of collagen crosslinks. Furthermore, defects at the central regions of medial tibial cartilage with direct cartilage-cartilage contact were the most vulnerable to loading. Also locations under the meniscus experienced substantially increased minimum principal strains. We suggest that during knee joint loading particularly minimum principal and shear strains are increased above tissue failure limits around cartilage defects which might lead to osteoarthritis. However, this increase in strains is highly location-specific on the joint surface.

Comparison of different material models of articular cartilage in 3D computational modeling of the knee: Data from the Osteoarthritis Initiative (OAI)

The intricate properties of articular cartilage and the complexity of the loading environment are some of the key challenges in developing models for biomechanical analysis of the knee joint. Fibril-reinforced poroelastic (FRPE) material models have been reported to accurately capture characteristic responses of cartilage during dynamic and static loadings. However, high computational and time costs associated with such advanced models limit applicability of FRPE models when multiple subjects need to be analyzed. If choosing simpler material models, it is important to show that they can still produce truthful predictions. Therefore, the aim of this study was to compare depth-dependent maximum principal stresses and strains within articular cartilage in the 3D knee joint between FRPE material models and simpler isotropic elastic (IE), isotropic poroelastic (IPE) and transversely isotropic poroelastic (TIPE) material models during simulated gait cycle. When cartilage-cartilage contact pressures were matched between the models (15% allowed difference), maximum principal stresses in the IE, IPE and TIPE models were substantially lower than those in the FRPE model (by more than 50%, TIPE model being closest to the FRPE model), and stresses occurred only in compression in the IE model. Additional simulations were performed to find material parameters for the TIPE model (due to its anisotropic nature) that would yield maximum principal stresses similar to the FRPE model. The modified homogeneous TIPE model was in a better agreement with the homogeneous FRPE model, and the average and maximum differences in maximum principal stresses throughout the depth of cartilage were 7% and 9%, respectively, in the lateral compartment and 9% and 11% in the medial compartment. This study revealed that it is possible to match simultaneously maximum principal stresses and strains of cartilage between non-fibril-reinforced and fibril-reinforced knee joint models during gait. Depending on the research question (such as analysis of fibril strain necessitates the use of fibril-reinforced material models) or clinical demand (fast simulations with simpler material models), the choice of the material model should be done carefully.

Advances in Quantification of Meniscus Tensile Mechanics Including Nonlinearity, Yield, and Failure

The meniscus provides crucial knee function and damage to it leads to osteoarthritis of the articular cartilage. Accurate measurement of its mechanical properties is therefore important, but there is uncertainty about how the test procedure affects the results, and some key mechanical properties are reported using ad hoc criteria (modulus) or not reported at all (yield). This study quantifies the meniscus' stress-strain curve in circumferential and radial uniaxial tension. A fiber recruitment model was used to represent the toe region of the stress-strain curve, and new reproducible and objective procedures were implemented for identifying the yield point and measuring the elastic modulus. Patterns of strain heterogeneity were identified using strain field measurements. To resolve uncertainty regarding whether rupture location (i.e., midsubstance rupture versus at-grip rupture) influences the measured mechanical properties, types of rupture were classified in detail and compared. Dogbone (DB)-shaped specimens are often used to promote midsubstance rupture; to determine if this is effective, we compared DB and rectangle (R) specimens in both the radial and circumferential directions. In circumferential testing, we also compared expanded tab (ET) specimens under the hypothesis that this shape would more effectively secure the meniscus' curved fibers and thus produce a stiffer response. The fiber recruitment model produced excellent fits to the data. Full fiber recruitment occurred approximately at the yield point, strongly supporting the model's physical interpretation. The strain fields, especially shear and transverse strain, were extremely heterogeneous. The shear strain field was arranged in pronounced bands of alternating positive and negative strain in a pattern similar to the fascicle structure. The site and extent of failure showed great variation, but did not affect the measured mechanical properties. In circumferential tension, ET specimens underwent earlier and more rapid fiber recruitment, had less stretch at yield, and had greater elastic modulus and peak stress. No significant differences were observed between R and DB specimens in either circumferential or radial tension. Based on these results, ET specimens are recommended for circumferential tests and R specimens for radial tests. In addition to the data obtained, the procedural and modeling advances made in this study are a significant step forward for meniscus research and are applicable to other fibrous soft tissues.