In vivo contact biomechanics in the trapeziometacarpal joint using finite deformation biphasic theory and mathematical modelling

Effects of micropipette handle diameter and inclusion of finger rest on basilar thumb joint contact mechanics

Micropipette users commonly experience problems in the hand and upper limbs. Mechanical factors are thought to contribute to osteoarthritis (OA) initiation and progression in the basilar thumb joint. Finite element analysis can be used to examine the effects of micropipette design on contact mechanics measures within the basilar thumb joint. This pilot study examined the effect of micropipette handle diameter (12 mm, 25 mm, and 40 mm) and the presence of a finger rest on contact area, contact force, and peak contact pressure in the basilar thumb joint. All contact mechanics measures decreased with increasing handle diameter with significant differences between the 12 mm diameter and the 40 mm diameter handles (contact area down about 30 mm², contact force down about 15 N, and peak pressure down about 1 MPa). Decreasing contact mechanics measures with increasing diameter matched our expectations that contact measures would decrease with a more open grip. Contact mechanics measures were higher (p < 0.05) with a finger rest for contact area and force. We expected peak contact pressure and contact area to decrease with the presence of a finger rest. The unexpected outcome may have been due to non-randomized testing order and fatigue during testing.

Using a finite element model of the thumb to study Trapeziometacarpal joint contact during lateral pinch

BACKGROUND

Finite element (FE) analysis is widely used in different fields of orthopaedic surgery, however, its application to the trapeziometacarpal joint has been limited due to the small size, complex biconcave-convex joint geometry, and complex musculature. The goal of this study was to improve upon existing models by creating a muscle-driven FE thumb model and use the model to simulate the biomechanical effect of hand therapy exercises and ligament reconstructive surgeries.

METHODS

Bone and cartilage geometry were based on a CT dataset of a subject performing a static lateral pinch task. A previously validated musculoskeletal model was utilized to extract electromyography (EMG)-driven muscle forces. Five ligaments with biomechanical significance were modeled as springs using literature values and attached according to their anatomical landmarks.

FINDINGS

The biomechanical consequence of various interventions was proxied as a change in the maximum cartilage stress. The result shows tightening the dorsal ligament complex (dorsal radial ligament, dorsal central ligament, posterior oblique ligament) is the most effective, achieving a stress reduction of 4.8%. Five exercises used in hand therapies were modeled, among which thenar eminence strengthening showed the most prominent stress reduction of 4.0%. Four ligament reconstructive surgeries were modeled, with Eaton-Littler reconstruction showed the most significant stress reduction of 25.0%.

INTERPRETATION

Among the routinely utilized treatment options for early thumb osteoarthritis, we found that three methods: dorsal ligament imbrication, thenar eminence exercise, and the Eaton-Littler method may confer biomechanical advantages cartilage loading. These advantages align with the clinically observed favorable outcomes.

Automated Segmentation of Spinal Muscles From Upright Open MRI Using a Multiscale Pyramid 2D Convolutional Neural Network

STUDY DESIGN

Randomized trial.

OBJECTIVE

To implement an algorithm enabling the automated segmentation of spinal muscles from open magnetic resonance images in healthy volunteers and patients with adult spinal deformity (ASD).

SUMMARY OF BACKGROUND DATA

Understanding spinal muscle anatomy is critical to diagnosing and treating spinal deformity.Muscle boundaries can be extrapolated from medical images using segmentation, which is usually done manually by clinical experts and remains complicated and time-consuming.

METHODS

Three groups were examined: two healthy volunteer groups (N = 6 for each group) and one ASD group (N = 8 patients) were imaged at the lumbar and thoracic regions of the spine in an upright open magnetic resonance imaging scanner while maintaining different postures (various seated, standing, and supine). For each group and region, a selection of regions of interest (ROIs) was manually segmented. A multiscale pyramid two-dimensional convolutional neural network was implemented to automatically segment all defined ROIs. A five-fold crossvalidation method was applied and distinct models were trained for each resulting set and group and evaluated using Dice coefficients calculated between the model output and the manually segmented target.

RESULTS

Good to excellent results were found across all ROIs for the ASD (Dice coefficient >0.76) and healthy (dice coefficient > 0.86) groups.

CONCLUSION

This study represents a fundamental step toward the development of an automated spinal muscle properties extraction pipeline, which will ultimately allow clinicians to have easier access to patient-specific simulations, diagnosis, and treatment.

A Modular MRI-Compatible Pipette Simulator to Evaluate How Design Effects the Basilar Thumb Joint Mechanics

People who frequently use micropipettes experience hand and upper limb disorders. The basilar thumb joint, also known as the first carpometacarpal or trapeziometacarpal joint, is commonly affected by osteoarthritis (OA). Mechanical factors are associated with OA initiation and progression. We developed a MRI-compatible modular micropipette simulator to improve understanding of how micropipette design affects basilar thumb joint contact mechanics. The micropipette simulator also addresses limitations of current techniques for studying pipetting and basilar thumb joint mechanics. Its modularity will allow future studies to examine handle design parameters such as handle diameter, cross-sectional shape, and other features. A micropipette simulator with a cylindrical handle (length 127 mm, diameter 25 mm) was used with one subject to demonstrate the system's feasibility. Contact areas were within the range of prior data from basilar thumb joint models in power grasp and lateral pinch, and contact pressures were the same order of magnitude.

Stress distribution in the bonobo (Pan paniscus) trapeziometacarpal joint during grasping

The primate thumb plays a central role in grasping and the basal trapeziometacarpal (TMC) joint is critical to its function. The TMC joint morphology varies across primates, yet little is known about form-function interaction within in the TMC joint. The purpose of this study was to investigate how stress distributions within the joint differ between five grasping types commonly employed by bonobos (Pan paniscus). Five cadaveric bonobo forearms were CT scanned in five standardized positions of the hand as a basis for the generation of parametric finite element models to compare grasps. We have developed a finite element analysis (FEA) approach to investigate stress distribution patterns in the TMC joint associated with each grasp type. We hypothesized that the simulated stress distributions for each position would correspond with the patterns expected from a saddle-shaped joint. However, we also expected differences in stress patterns arising from instraspecific variations in morphology. The models showed a high agreement between simulated and expected stress patterns for each of the five grasps (86% of successful simulations), while partially (52%) and fully (14%) diverging patterns were also encountered. We identified individual variations of key morphological features in the bonobo TMC joint that account for the diverging stress patterns and emphasized the effect of interindividual morphological variation on joint functioning. This study gives unprecedented insight in the form-function interactions in the TMC joint of the bonobo and provides an innovative FEA approach to modelling intra-articular stress distributions, a valuable tool for the study of the primate thumb biomechanics.

Anatomy and biomechanics of healthy and arthritic trapeziometacarpal joints

Understanding the biomechanics of the trapeziometacarpal (TMC) or first carpometacarpal (CMC1) joint, the pathophysiology of basal thumb arthritis, the design and performance of surgical procedures require a solid anatomical basis. This review of literature summarizes the most recent data on the descriptive, functional, and comparative anatomy of healthy and arthritic TMC joints.

Osteotomies around the thumb base in CMC 1 arthritis

The trapeziometacarpal joint (TMC) is a saddle joint that is subjected to tremendous repetitive loads through our lifetime. This joint is apparently congruent, but only a small part of the articular surface is loaded during pinch grips. This design implies a perfect bony anatomy, high quality articular cartilage and no ligament laxity. Under certain circumstances, where these different anatomical variables are imperfect, symptoms and pain can start at a very early stage in life. They are mainly acquired, but can be posttraumatic in origin. High quality radiographic views are needed: these radiographs must be done methodically by well-trained radiologists. The symptoms and radiographic changes may not match, such as when radiographic changes are minimal but functional impairment is significant. The primary goal of treatment is conservative. This cannot be stressed enough since conservative treatment can be successful with good follow-up by the hand surgeon: resting splint, good postures at work and if necessary, anti-inflammatory drugs and paracetamol. If this fails after a minimum of 6 months, different osteotomies can be proposed, combined with ligament augmentation in some cases. These osteotomies are mainly extra-articular, can be at the level of the base of the first metacarpal and the trapezium, or can be solely at the base of the first metacarpal. Isolated osteotomies of the trapezium should be avoided since they tend to close the first web space. In certain posttraumatic cases, intra-articular osteotomy of the malunion can be done to restore congruency and provide pain relief.

Cartilage wear patterns in severe osteoarthritis of the trapeziometacarpal joint: a quantitative analysis

OBJECTIVE

The present quantitative study aimed to assess the three-dimensional (3-D) cartilage wear patterns of the first metacarpal and trapezium in the advanced stage of osteoarthritis (OA) and compare cartilage measurements with radiographic severity.

DESIGN

Using 19 cadaveric trapeziometacarpal (TMC) joints, 3-D cartilage surface models of the first metacarpal and trapezium were created with a laser scanner, and 3-D bone surface model counterparts were similarly created after dissolving the cartilage. These two models were superimposed, and the interval distance on the articular surface as the cartilage thickness was measured. All measurements were obtained in categorized anatomic regions on the articular surface of the respective bone, and we analyzed the 3-D wear patterns on the entire cartilage surface. Furthermore, we compared measurements of cartilage thickness with radiographic OA severity according to the Eaton grading system using Pearson correlation coefficients (r).

RESULTS

In the first metacarpal, the cartilage thickness declined volarly (the mean cartilage thickness of the volar region was 0.32 ± 0.16 mm, whereas that of the dorsal region was 0.53 ± 0.18 mm). Conversely, the cartilage evenly degenerated throughout the articular surface of the trapezium. Measurements of the categorized regions where cartilage thinning was remarkable exhibited statistical correlations with radiographic staging (r = -0.48 to -0.72).

CONCLUSIONS

Our findings indicate that cartilage wear patterns differ between the first metacarpal and trapezium in the late stage of OA. There is a need for further studies on cartilage degeneration leading to symptomatic OA in the TMC joint.

Assessment of healthy trapeziometacarpal cartilage properties using indentation testing and contrast-enhanced computed tomography

BACKGROUND

The trapeziometacarpal joint is a common site for osteoarthritis development in the hand. When osteoarthritis is present, it results in significant functional disabilities due to the broad range of activities performed by this joint. However, our understanding of osteoarthritis initiation and progression at this joint is limited because of the current lack of knowledge regarding the properties and structure of the corresponding cartilage layers. The objective of this study is to assess the morphological and mechanical properties of trapeziometacarpal cartilage via the combination of indentation testing and contrast-enhanced computed tomography. Such research may lead to the development of medical imaging-based approaches to measure cartilage properties in vivo.

METHODS

Intact first metacarpals and trapezia were extracted from 16 fresh-frozen human cadaver hands. For each specimen, load-displacement behavior was measured at 9 testing sites using a standardized indentation testing device to calculate the normal force and Young's modulus of the cartilage sub-regions. The specimens were then immersed in CA4+ contrast agent solution for 48 h and subsequently scanned with a resolution of 41 μm in a HR-pQCT scanner to measure cartilage thickness and attenuation. Finally, correlations between compressive Young's modulus and contrast-enhanced computed tomography attenuation of the cartilage were assessed.

FINDINGS

No significant difference was found in cartilage thickness between the trapezium and first metacarpal, but the comparison between articular regions showed thinner cartilage around the volar aspect of both the first metacarpal and the trapezium. The first metacarpal cartilage was stiffer than the trapezial cartilage. A significant positive correlation was observed between Young's modulus and mean contrast-enhanced CT attenuations in superficial and full-depth cartilage in both the first metacarpal and the trapezium cartilage.

INTERPRETATION

The quantitative measurements of trapeziometacarpal thickness and stiffness as well as a correlation between Young's modulus and contrast-enhanced computed tomography attenuation provides a method for the non-destructive in vivo assessment of cartilage properties, a greater understanding of thumb cartilage behavior, and a dataset for the development of more accurate computer models.

Trapeziometacarpal stabilization through dorsoradial ligament reconstruction: An early post-surgery in vivo biomechanical analyses

Ligament reconstruction can provide pain relief in patients with a painful, unstable, pre-arthritic trapeziometacarpal (TMC) joint. Imbrication of the dorsoradial ligament (DRL) has been proposed as a minimal invasive stabilization technique. It requires less invasive surgery than an Eaton-Littler technique and shows promising long-term clinical outcome. We used dynamic CT to objectively review the effects of the imbrication. Four patients with pain and laxity at the TMC joint, but without radiographic signs of osteoarthritis, were recruited. Dynamic CT scans were made during active thumb abduction-adduction, flexion-extension, and two functional grip tasks using a radiolucent jig. Scans of the patients were acquired before and 3 to 6 months after DRL reconstruction. Motion of each bone in the articular chain of the thumb was quantified. In addition, we mapped changes in the contact patterns between the articular facets during the entire thumb motion. After DRL imbrication, we found no overall decrease in MC1 movement in three out of four patients. Furthermore, no increase in TMC joint congruency, defined as proximity area size, was found for three out of four patients. Pre- and post-operative differences in congruency across different tasks were patient-dependent and relatively small. We demonstrated that, from a biomechanical perspective, there is high variability in post-operative outcome between patients that undergo identical surgical procedures performed by the same surgeon. A post-operative decrease in range of motion, increase in joint congruency or decrease in proximity area shift during thumb motion is not omnipresent. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:2851-2864, 2018.

Impact of Osteoarthritis and Total Joint Arthroplasty on the Kinematics of the Trapeziometacarpal Joint: A Pilot Study

PURPOSE

To quantify the effect of osteoarthritis (OA) and total trapeziometacarpal (TMC) joint replacement on thumb kinematics during the primary physiological motions of the thumb.

METHODS

We included 4 female patients with stage III TMC OA. A computed tomography-based markerless method was used to quantify the 3-dimensional thumb kinematics in patients before and after TMC joint replacement surgery with the Arpe implant.

RESULTS

Trapeziometacarpal OA led to a marked decrease of internal rotation and abduction of the first metacarpal (MC1) during thumb flexion and a decrease of MC1 adduction during thumb adduction. As a compensatory phenomenon, the trapezium displayed increased abduction. The absence of MC1 translation in the ball-and-socket implant seems to induce a decrease of MC1 adduction as well as a decrease of trapezium adduction during thumb adduction, compared with OA and healthy joints. Implant replacement displayed an unchanged MC1 flexion during thumb flexion and seemed to slightly increase MC1 axial rotation during thumb flexion and adduction. Abduction and adduction of the MC1 are limited and compensated by this somewhat increased axial rotation, allowing more efficient thumb opposition.

CONCLUSIONS

The study highlights that advanced TMC OA mainly restricts the MC1 mobility. We also showed that, whereas total joint arthroplasty is able to restore thumb function, it cannot fully replicate the kinematics of the healthy TMC joint.

CLINICAL RELEVANCE

The quantification of TMC joint kinematics in OA and implanted patients is essential to improve our understanding of TMC OA as well as to enhance the functionality of implant designs.

In vivo biomechanical behavior of the trapeziometacarpal joint in healthy and osteoarthritic subjects

BACKGROUND

The contact biomechanics of the trapeziometacarpal joint have been investigated in several studies. However, these led to conflicting results and were mostly performed in vitro. The purpose of this study was to provide further insight on the contact biomechanics of the trapeziometacarpal joint by in vivo assessment of healthy and osteoarthritic subjects.

METHODS

The hands of 16 healthy women and 6 women with trapeziometacarpal osteoarthritis were scanned in positions of maximal thumb extension, flexion, abduction and adduction during three isometric tasks (lateral key pinch, power grasp and jar twist) and in thumb rest posture (relaxed neutral). Three-dimensional surface models of the trapezium and first metacarpal were created for each thumb configuration. The articular surface of each bone was measured in the neutral posture. A computed tomography-based proximity mapping algorithm was developed to calculate the distance between opposing joint surfaces, which was used as a surrogate for intra-articular stress.

FINDINGS

Distinct proximity patterns were observed across tasks with a recurrent pattern reported on the volar aspect of the first metacarpal. The comparison between healthy and arthritic subjects showed a significantly larger articular area, in parallel with a significant joint space narrowing and an increase in proximity area in arthritic subjects. We also observed severe articular deformations in subjects with late stage osteoarthritis.

INTERPRETATION

This study has increased our insight in the contact biomechanics of the trapeziometacarpal joint during tasks and positions of daily life in healthy and arthritic subjects, which might contribute to a better understanding of the occurrence mechanisms of degenerative diseases such as osteoarthritis.