Strain rate effect on the mechanical behavior of the anterior cruciate ligament-bone complex

Mechanical properties of animal ligaments: a review and comparative study for the identification of the most suitable human ligament surrogates

The interest in the properties of animal soft tissues is often related to the desire to find an animal model to replace human counterparts due to the unsteady availability of human tissues for experimental purposes. Once the most appropriate animal model is identified, it is possible to carry out ex-vivo and in-vivo studies for the repair of ligamentous tissues and performance testing of replacement and support healing devices. This work aims to present a systematic review of the mechanical properties of ligaments reported in the scientific literature by considering different anatomical regions in humans and several animal species. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Moreover, considering the lack of a standard protocol for preconditioning of tissues, this aspect is also addressed. Ninety-six studies were selected for the systematic review and analysed. The mechanical properties of different animal species are reported and summarised in tables. Only results from studies reporting the strain rate parameter were considered for comparison with human ligaments, as they were deemed more reliable. Elastic modulus, ultimate tensile stress, and ultimate strain properties are graphically reported identifying the range of values for each animal species and to facilitate comparison between values reported in the scientific literature in animal and human ligaments. Useful similarities between the mechanical properties of swine, cow, and rat and human ligaments have been found.

Influence of walking on knee ligament response in car-to-pedestrian collisions

Pedestrians are likely to experience walking before accidents. The walking process imposes cyclic loading on knee ligaments and increases knee joint temperature. Both cyclic loading and temperature affect the material properties of ligaments, which further influence the risk of ligament injury. However, the effect of such walking-induced material property changes on pedestrian ligament response has not been considered. Therefore, in this study, we investigated the influence of walking on ligament response in car-to-pedestrian collisions. Using Total Human Model for Safety (THUMS) model, knee ligament responses (i.e., cross-sectional force and local strain) were evaluated under several crash scenarios (i.e., two impact speeds, two knee contact heights, and three pedestrian postures). In worst case scenarios, walking-induced changes in ligament material properties led to a 10% difference in maximum local strain and a 6% difference in maximum cross-sectional force. Further considering the material uncertainty caused by experimental dispersion, the ligament material property changes due to walking resulted in a 28% difference in maximum local strain and a 26% difference in maximum cross-sectional force. This study demonstrates the importance of accounting for walking-induced material property changes for the reliability of safety assessments and injury analysis.

Shear ground reaction force variation among equine arena surfaces

Shear forces at the surface-hoof interface affect hoof slide, surface grip, forces transferred to the limb, and injury risk. However, the variation in shear forces among surfaces with different compositions have not been quantified. Shear ground reaction forces were measured on five dirt and seven synthetic arena surfaces. Cohesion/adhesion and angle of internal friction/coefficient of friction were calculated. Surface composition, surface temperature, cushion depth, and moisture content were also measured. The effects of surface material (dirt/synthetic) on shear properties were assessed using analysis of variance (ANOVA; P < 0.05). The relationships between surface composition or management properties and shear properties were analyzed using linear correlation. Shear properties were not different between dirt and synthetic surface categories; however, surface fiber content was correlated with adhesion and coefficient of friction. These correlations predict that more fiber will decrease soil adhesion (r = -0.75; P < 0.01) and increase the coefficient of friction (r = 0.81; P < 0.01). Furthermore, maximum shear force was significantly correlated with cushion depth (r = 0.61; P < 0.01) and moisture content (r = 0.57; P < 0.01), where shear force was greater on surfaces with thicker cushion layers or higher moisture content. The findings suggest that shear mechanical behavior is more dependent on surface composition than surface material categories (dirt/synthetic) and also indicate that arena owners can influence shear forces by adjusting either surface composition or management.

Viscoelastic characteristics of the canine cranial cruciate ligament complex at slow strain rates

Ligaments including the cruciate ligaments support and transfer loads between bones applied to the knee joint organ. The functions of these ligaments can get compromised due to changes to their viscoelastic material properties. Currently there are discrepancies in the literature on the viscoelastic characteristics of knee ligaments which are thought to be due to tissue variability and different testing protocols.

The aim of this study was to characterise the viscoelastic properties of healthy cranial cruciate ligaments (CCLs), from the canine knee (stifle) joint, with a focus on the toe region of the stress-strain properties where any alterations in the extracellular matrix which would affect viscoelastic properties would be seen. Six paired CCLs, from skeletally mature and disease-free Staffordshire bull terrier stifle joints were retrieved as a femur-CCL-tibia complex and mechanically tested under uniaxial cyclic loading up to 10 N at three strain rates, namely 0.1%, 1% and 10%/min, to assess the viscoelastic property of strain rate dependency. The effect of strain history was also investigated by subjecting contralateral CCLs to an ascending (0.1%, 1% and 10%/min) or descending (10%, 1% and 0.1%/min) strain rate protocol. The differences between strain rates were not statistically significant. However, hysteresis and recovery of ligament lengths showed some dependency on strain rate. Only hysteresis was affected by the test protocol and lower strain rates resulted in higher hysteresis and lower recovery. These findings could be explained by the slow process of uncrimping of collagen fibres and the contribution of proteoglycans in the ligament extracellular matrix to intra-fibrillar gliding, which results in more tissue elongations and higher energy dissipation. This study further expands our understanding of canine CCL behaviour, providing data for material models of femur-CCL-tibia complexes, and demonstrating the challenges for engineering complex biomaterials such as knee joint ligaments.

Timing of Strain Response of the ACL and MCL Relative to Impulse Delivery During Simulated Landings Leading up to ACL Failure

Anterior cruciate ligament (ACL) injury videos estimate that rupture occurs within 50 milliseconds of initial contact, but are limited by imprecise timing and nondirect data acquisition. The objective of this study was to precisely quantify the timing associated with ligament strain during simulated landing and injury events. The hypotheses tested were that the timing of peak strain following initial contact would differ between ligaments and that peak strain timing would be independent of the injury-risk profile emulated during simulated landing. A mechanical impact simulator was used to perform landing simulations based on various injury-risk profiles that were applied to each specimen in a block-randomized order. The ACL and medial collateral ligament were instrumented with strain gauges that recorded continuously. The data from 35 lower-extremity specimens were included for analysis. Analysis of variance and Kruskal-Wallis tests were used to determine the differences between timing and profiles. The mean time to peak strain was 53 (24) milliseconds for the ACL and 58 (35) milliseconds for the medial collateral ligament. The time to peak ACL strain ranged from 48 to 61 milliseconds, but the timing differences were not significant between profiles. Strain timing was independent of injury-risk profile. Noncontact ACL injuries are expected to occur between 0 and 61 milliseconds after initial contact. Both ligaments reached peak strain within the same time frame.

Mechanical properties and collagen fiber orientation of tendon in young and elderly

BACKGROUND

The purpose of this study was to investigate differences in the mechanical properties and collagen fiber orientation of tendon structures between young and elderly groups.

METHODS

The mechanical properties of tendon structures in medial gastrocnemius muscle were measured using ultrasonography during ramp and ballistic contractions. Tendon collagen fiber orientation was estimated from coefficient of variation (CV) of echogenicity on transverse ultrasonic images of Achilles tendon.

FINDINGS

Differences in elongation between ramp and ballistic contractions of elderly were significantly smaller than those of young group at 20-80% of MVC. During ramp contraction, hysteresis of elderly was significantly higher than that of young, whereas no difference in hysteresis during ballistic contraction was found between the two groups. Difference in hysteresis between ramp and ballistic contractions of elderly tended to be lower than that of young group. Mean echogenicity of elderly was significantly higher than that of young group, whereas no difference in CV of echogenicity was found between the two groups.

INTERPRETATION

These results suggest that smaller differences in elongation and hysteresis between ramp and ballistic contractions of elderly may be related to decreased water content within tendons. Furthermore, no difference in collagen fiber orientation of tendons was noted between the two groups.

Effects of the strain rate on mechanical properties of tendon structures in knee extensors and plantar flexors in vivo

The purpose of present study was to investigate site differences in the effects of strain rate on tendon properties between knee extensors and plantar flexors. Elongation of tendon structures (L) in vastus lateralis and medial gastrocnemius muscles was measured by ultrasonography while participants performed ramp and ballistic contractions to their voluntary maximum, followed by ramp and sudden relaxation. The relationship between muscle force (Fm) and L was fit to linear regression, the slope of which was defined as stiffness of tendon structures. Hysteresis of tendon structures was calculated as ratio of area within Fm-L loop to area beneath loading portion of curve. In knee extensors and plantar flexors, L values at all force levels were significantly lower during ballistic than ramp contractions. However, no significant differences were observed in stiffness of tendon structures between two contractions at both measured sites. Hysteresis of tendon structures was significantly higher during ballistic than ramp contractions for knee extensors and plantar flexors. In conclusion, elongation of tendon structures was lower and hysteresis was greater during ballistic than ramp contractions. Furthermore, site differences in the effects of strain rate on tendon properties were not found between knee extensors and plantar flexors.

An Analysis of the Mechanical Properties of the Ponseti Method in Clubfoot Treatment

Congenital clubfoot is a complex pediatric foot deformity, occurring in approximately 1 in 1000 live births and resulting in significant disability, deformity, and pain if left untreated. The Ponseti method of manipulation is widely recognized as the gold standard treatment for congenital clubfoot; however, its mechanical aspects have not yet been fully explored. During the multiple manipulation-casting cycles, the tendons and ligaments on the medial and posterior aspect of the foot and ankle, which are identified as the rate-limiting tissues, usually undergo weekly sequential stretches, with a plaster of Paris cast applied after the stretch to maintain the length gained. This triggers extracellular matrix remodeling and tissue growth, but due to the viscoelastic properties of tendons and ligaments, the initial strain size, rate, and loading history will affect the relaxation behavior and mechanical strength of the tissue. To increase the efficiency of the Ponseti treatment, we discuss the theoretical possibilities of decreasing the size of the strain step and interval of casting and/or increasing the overall number of casts. This modification may provide more tensile stimuli, allow more time for remodeling, and preserve the mechanical integrity of the soft tissues.

Biofabrication of Electrospun Scaffolds for the Regeneration of Tendons and Ligaments

Tendon and ligament tissue regeneration and replacement are complex since scaffolds need to guarantee an adequate hierarchical structured morphology, and non-linear mechanical properties. Moreover, to guide the cells' proliferation and tissue re-growth, scaffolds must provide a fibrous texture mimicking the typical of the arrangement of the collagen in the extracellular matrix of these tissues. Among the different techniques to produce scaffolds, electrospinning is one of the most promising, thanks to its ability to produce fibers of nanometric size. This manuscript aims to provide an overview to researchers approaching the field of repair and regeneration of tendons and ligaments. To clarify the general requirements of electrospun scaffolds, the first part of this manuscript presents a general overview concerning tendons' and ligaments' structure and mechanical properties. The different types of polymers, blends and particles most frequently used for tendon and ligament tissue engineering are summarized. Furthermore, the focus of the review is on describing the different possible electrospinning setups and processes to obtain different nanofibrous structures, such as mats, bundles, yarns and more complex hierarchical assemblies. Finally, an overview concerning how these technologies are exploited to produce electrospun scaffolds for tendon and ligament tissue applications is reported together with the main findings and outcomes.

A Review on Biomechanics of Anterior Cruciate Ligament and Materials for Reconstruction

The anterior cruciate ligament is one of the six ligaments in the human knee joint that provides stability during articulations. It is relatively prone to acute and chronic injuries as compared to other ligaments. Repair and self-healing of an injured anterior cruciate ligament are time-consuming processes. For personnel resuming an active sports life, surgical repair or replacement is essential. Untreated anterior cruciate ligament tear results frequently in osteoarthritis. Therefore, understanding of the biomechanics of injury and properties of the native ligament is crucial. An abridged summary of the prominent literature with a focus on key topics on kinematics and kinetics of the knee joint and various loads acting on the anterior cruciate ligament as a function of flexion angle is presented here with an emphasis on the gaps. Briefly, we also review mechanical characterization composition and anatomy of the anterior cruciate ligament as well as graft materials used for replacement/reconstruction surgeries. The key conclusions of this review are as follows: (a) the highest shear forces on the anterior cruciate ligament occur during hyperextension/low flexion angles of the knee joint; (b) the characterization of the anterior cruciate ligament at variable strain rates is critical to model a viscoelastic behavior; however, studies on human anterior cruciate ligament on variable strain rates are yet to be reported; (c) a significant disparity on maximum stress/strain pattern of the anterior cruciate ligament was observed in the earlier works; (d) nearly all synthetic grafts have been recalled from the market; and (e) bridge-enhanced repair developed by Murray is a promising technique for anterior cruciate ligament reconstruction, currently in clinical trials. It is important to note that full extension of the knee is not feasible in the case of most animals and hence the loading pattern of human ACL is different from animal models. Many of the published reviews on the ACL focus largely on animal ACL than human ACL. Further, this review article summarizes the issues with autografts and synthetic grafts used so far. Autografts (patellar tendon and hamstring tendon) remains the gold standard as nearly all synthetic grafts introduced for clinical use have been withdrawn from the market. The mechanical strength during the ligamentization of autografts is also highlighted in this work.

Effects of plyometric and isometric training on muscle and tendon stiffness in vivo

The purpose of this study was to compare the effects of plyometric and isometric training on tendon properties during ramp and ballistic contractions and muscle stiffness under passive and active conditions. Eleven subjects completed 12 weeks (3 days/week) of a unilateral training program for the plantar flexors. They performed plyometric training on one side (PLY) and isometric training on the other side (ISO). Active muscle stiffness in the medial gastrocnemius muscle was calculated according to changes in estimated muscle force and fascicle length during fast stretching after submaximal isometric contractions. Passive muscle stiffness was also calculated from estimated passive muscle force and fascicle length during slow passive stretching. Stiffness and hysteresis of tendon structures were measured using ultrasonography during ramp and ballistic contractions. Passive muscle stiffness and tendon hysteresis did not change for PLY or ISO. Active muscle stiffness significantly increased for PLY, but not for ISO. Tendon stiffness during ramp and ballistic contractions increased significantly for ISO, but not for PLY. In addition, tendon elongation values at force production levels beyond 100 N during ballistic contractions increased for PLY. These results suggest that plyometric training (but not isometric training) enhances the extensibility of tendon structures during ballistic contractions and active muscle stiffness during fast stretching, and these changes may be related to improved performances during stretch‐shortening cycle exercises.

Interconnectable Dynamic Compression Bioreactors for Combinatorial Screening of Cell Mechanobiology in Three Dimensions

Biophysical cues can potently direct a cell's or tissue's behavior. Cells interpret their biophysical surroundings, such as matrix stiffness or dynamic mechanical stimulation, through mechanotransduction. However, our understanding of the various aspects of mechanotransduction has been limited by the lack of proper analysis platforms capable of screening three-dimensional (3D) cellular behaviors in response to biophysical cues. Here, we developed a dynamic compression bioreactor to study the combinational effects of biomaterial composition and dynamic mechanical compression on cellular behavior in 3D hydrogels. The bioreactor contained multiple actuating posts that could apply cyclic compressive strains ranging from 0 to 42% to arrays of cell-encapsulated hydrogels. The bioreactor could be interconnected with other compressive bioreactors, which enabled the combinatorial screenings of 3D cellular behaviors simultaneously. As an application of the screening platform, cell spreading, and osteogenic differentiation of human mesenchymal stem cells (hMSCs) were characterized in 3D gelatin methacryloyl (GelMA) hydrogels. Increasing hydrogel concentration from 5 to 10% restricted the cell spreading, however, dynamic compressive strain increased cell spreading. Osteogenic differentiation of hMSCs was also affected by dynamic compressive strains. hMSCs in 5% GelMA hydrogel were more sensitive to strains, and the 42% strain group showed a significant increase in osteogenic differentiation compared to other groups. The interconnectable dynamic compression bioreactor provides an efficient way to study the interactions of cells and their physical microenvironments in three dimensions.

Quasi-static tensile properties of the Cranial Cruciate Ligament (CrCL) in adult cattle: towards the design of a prosthetic CrCL

Mechanical properties of the Cranial Cruciate Ligament (CrCL) in adult cattle are not well documented and protocols used in the literature focus on testing a full femur-CrCL-tibia complex rather than an isolated CrCL. The aim of this study was to assess a wider range of tensile properties of the CrCL along its anatomic axis with experimental measurements of the global elongation, displacement and strain fields, in order to provide guidelines for the design of CrCL prosthetic surrogates. Fourteen bovine CrCL were harvested from seven mature cows (5.1 ± 1.3 years) weighing 631 ± 90kg. The mean CrCL length was 41.4 ± 1.5mm and its mean cross-section was 103.9 ± 23.8mm². Pre-conditioning was achieved with 30 cycles of loading from 30 to 200N at a strain rate of 0.02s^-1. Specimens were then loaded to failure at the same strain rate. The following results were obtained: the mean ultimate tensile load (UTL) 4372 ± 1485N and the median [quartiles] maximal global elongation 19.3 [17.8; 21.4] %. At first physical signs of tearing, the mean load was 3315 ± 1336N and mean elongation 13.5 ± 4.9%. The mean absorbed energy at failure was 5.23 ± 2.08 MJ.mm^-3 and the mean stiffness at various levels of elongation was: 220 ± 195N.%^-1 (5%), 285 ± 162N.%^-1 (10%), 239 ± 200N.%^-1 (15%), 146 ± 59N.%^-1 (20%), 153 ± 136N.%^-1 (25%). None of these properties were related to the bovine weight, age and side of the body (p > 0.05). An ideal prosthetic surrogate should then follow these sets of properties and the experimental data suggest that the in-vivo maximal elongation is below 13.5%.

Damage Accumulation Modeling and Rate Dependency of Spinal Dura Mater

As the strongest of the meningeal tissues, the spinal dura mater plays an important role in the overall behavior of the spinal cord-meningeal complex (SCM). It follows that the accumulation of damage affects the dura mater's ability to protect the cord from excessive mechanical loads. Unfortunately, current computational investigations of spinal cord injury (SCI) etiology typically do not include postyield behavior. Therefore, a more detailed description of the material behavior of the spinal dura mater, including characterization of damage accumulation, is required to comprehensively study SCI. Continuum mechanics-based viscoelastic damage theories have been previously applied to other biological tissues; however, the current work is the first to report damage accumulation modeling in a tissue of the SCM complex. Longitudinal (i.e., cranial-to-caudal long-axis) samples of ovine cervical dura mater were tensioned-to-failure at one of three strain rates (quasi-static, 0.05/s, and 0.3/s). The resulting stress–strain data were fit to a hyperelastic continuum damage model to characterize the strain-rate-dependent subfailure and failure behavior. The results show that the damage behavior of the fibrous and matrix components of the dura mater are strain-rate dependent, with distinct behaviors when exposed to strain rates above that experienced during normal voluntary neck motion suggesting the possible existence of a protective mechanism.

The effect of strain and age on the mechanical properties of rat Achilles tendons

BACKGROUND

Achilles tendon (AT) ruptures are common in the middle age population; however, the pathophysiology and influence of age on AT ruptures is not fully understood. This study evaluates the effect and interactions between, strain and age on the in vitro biomechanical properties of ATs.

METHODS

Bilateral ATs were harvested from 17 young (8 months) and 14 middle-aged (24 months) rats and underwent stress-relaxation using Fung's quasilinear viscoelastic (QLV) modeling and load-to-failure testing.

RESULTS

The initial viscoelastic response (parameter B) in middle-age animals was dependent on the amount of strain applied to the tendon and was significantly increased in middle-aged animals at higher strain. Higher strain in older animals led to a prolonged relaxation time (parameter tau 2). There was a trend toward an increased magnitude of the relaxation response (parameter C) at higher strain in the middle-aged animals. Middle-aged animals had a significantly lower mean stress at ultimate failure (p=0.01), while Young's modulus was similar in both groups (p=0.46).

CONCLUSIONS

The passive biomechanical properties of the rat AT change with age and the influence stress-relaxation response of the AT, thereby possibly predisposing the AT of older animals to fail at lower loads compared to younger animals.

LEVEL OF EVIDENCE

Not applicable, this is a basic science study.

Digital image correlation-aided mechanical characterization of the anteromedial and posterolateral bundles of the anterior cruciate ligament

The anterior cruciate ligament (ACL) is one of the most commonly injured soft tissue structures in the articular knee joint, often requiring invasive surgery for patients to restore pre-injury knee kinematics. There is a pressing need to understand the role of the ACL in knee function, in order to select proper replacements. Digital image correlation (DIC), a non-contact full field displacement measurement technique, is an established tool for evaluating non-biological materials. The application of DIC to soft tissues has been in the nascent stages, largely due to patterning challenges of such materials. The ACL is notoriously difficult to mechanically characterize, due to the complex geometry of its two bundles and their insertions. This paper examines the use of DIC to determine the tensile mechanical properties of the AM and PL bundles of ovine ACLs in a well-known loading state. Homogenous loading in the mid-substance of the bundles provides for accurate development of stress/strain curves using DIC. Animal to animal variability is reduced, and the bundles are stiffer than previously thought when tissue-level strains are accurately measured.

STATEMENT OF SIGNIFICANCE

The anterior cruciate ligament (ACL), a major stabilizing ligament of the articular knee joint, is one of the most commonly injured soft tissue structures in the knee. Often, invasive surgery is required to restore pre-injury knee kinematics, and there are several long-term consequences of ACL reconstructions, including early-onset osteoarthritis. The role of the ACL in knee stability and motion has received much attention in the biomechanics community. This paper examines the use of a non-contact full-field displacement measurement technique, digital image correlation, to determine the tensile mechanical properties of the ACL. The focus of this work is to investigate the intrinsic mechanical properties of the ACL, as new knowledge in these areas will aid clinicians in selecting ACL replacements.

Finite element models of the human shoulder complex: a review of their clinical implications and modelling techniques

The human shoulder is a complicated musculoskeletal structure and is a perfect compromise between mobility and stability. The objective of this paper is to provide a thorough review of previous finite element (FE) studies in biomechanics of the human shoulder complex. Those FE studies to investigate shoulder biomechanics have been reviewed according to the physiological and clinical problems addressed: glenohumeral joint stability, rotator cuff tears, joint capsular and labral defects and shoulder arthroplasty. The major findings, limitations, potential clinical applications and modelling techniques of those FE studies are critically discussed. The main challenges faced in order to accurately represent the realistic physiological functions of the shoulder mechanism in FE simulations involve (1) subject-specific representation of the anisotropic nonhomogeneous material properties of the shoulder tissues in both healthy and pathological conditions; (2) definition of boundary and loading conditions based on individualised physiological data; (3) more comprehensive modelling describing the whole shoulder complex including appropriate three-dimensional (3D) representation of all major shoulder hard tissues and soft tissues and their delicate interactions; (4) rigorous in vivo experimental validation of FE simulation results. Fully validated shoulder FE models would greatly enhance our understanding of the aetiology of shoulder disorders, and hence facilitate the development of more efficient clinical diagnoses, non-surgical and surgical treatments, as well as shoulder orthotics and prosthetics. © 2016 The Authors. International Journal for Numerical Methods in Biomedical Engineering published by John Wiley & Sons Ltd.

Effect of sagittal plane mechanics on ACL strain during jump landing

The relationships between non-contact anterior cruciate ligament injuries and the underlying biomechanics are still unclear, despite large quantities of academic research. The purpose of this research was to study anterior cruciate ligament strain during jump landing by investigating its correlation with sagittal plane kinetic/kinematic parameters and by creating an empirical model to estimate the maximum strain. Whole-body kinematics and ground reaction forces were measured from seven subjects performing single leg jump landing and were used to drive a musculoskeletal model that estimated lower limb muscle forces. These muscle forces and kinematics were then applied on five instrumented cadaver knees using a dynamic knee simulator system. Correlation analysis revealed that higher ground reaction force, lower hip flexion angle and higher hip extension moment among others were correlated with higher peak strain (p < 0.05). Multivariate regression analyses revealed that intrinsic anatomic factors account for most of the variance in strain. Among the extrinsic variables, hip and trunk flexion angles significantly contributed to the strain. The empirical relationship developed in this study could be used to predict the relative strain between jumps of a participant and may be beneficial in developing training programs designed to reduce an athlete's risk of injury. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1636-1644, 2016.

Strain-rate-dependent non-linear tensile properties of the superficial zone of articular cartilage

AIM OF THE STUDY

The tensile properties of articular cartilage play an important role in the compressive behavior and integrity of the tissue. The stress-strain relationship of cartilage in compression was observed previously to depend on the strain-rate. This strain-rate dependence has been thought to originate mainly from fluid pressurization. However, it was not clear to what extent the tensile properties of cartilage contribute to the strain-rate dependence in compressive behavior of cartilage. The aim of the present study was to quantify the strain-rate dependent stress-strain relationship and hysteresis of articular cartilage in tension.

METHODS

Uniaxial tensile tests were performed to examine the strain-rate dependent non-linear tensile properties of the superficial zone of bovine knee cartilage. Tensile specimens were oriented in the fiber direction indicated by the India ink method. Seven strain-rates were used in the measurement ranging from 0.1 to 80%/s, which corresponded to nearly static to impact joint loadings.

RESULTS

The experimental data showed substantial strain-rate and strain-magnitude dependent load response: for a given strain-magnitude, the tensile stress could vary by a factor of 1.95 while the modulus by a factor of 1.58 with strain-rate; for a given strain-rate, the modulus at 15% strain could be over four times the initial modulus at no strain. The energy loss in cartilage tension upon unloading exhibited a complex variation with the strain-rate.

CONCLUSION

The strain-rate dependence of cartilage in tension observed from the present study is relatively weaker than that in compression observed previously, but is considerable to contribute to the strain-rate dependent load response in compression.

Risk of anterior cruciate ligament fatigue failure is increased by limited internal femoral rotation during in vitro repeated pivot landings

BACKGROUND

A reduced range of hip internal rotation is associated with increased peak anterior cruciate ligament (ACL) strain and risk for injury. It is unknown, however, whether limiting the available range of internal femoral rotation increases the susceptibility of the ACL to fatigue failure.

HYPOTHESIS

Risk of ACL failure is significantly greater in female knee specimens with a limited range of internal femoral rotation, smaller femoral-ACL attachment angle, and smaller tibial eminence volume during repeated in vitro simulated single-leg pivot landings.

STUDY DESIGN

Controlled laboratory study.

METHODS

A custom-built testing apparatus was used to simulate repeated single-leg pivot landings with a 4×-body weight impulsive load that induces knee compression, knee flexion, and internal tibial torque in 32 paired human knee specimens from 8 male and 8 female donors. These test loads were applied to each pair of specimens, in one knee with limited internal femoral rotation and in the contralateral knee with femoral rotation resisted by 2 springs to simulate the active hip rotator muscles' resistance to stretch. The landings were repeated until ACL failure occurred or until a minimum of 100 trials were executed. The angle at which the ACL originates from the femur and the tibial eminence volume were measured on magnetic resonance images.

RESULTS

The final Cox regression model (P = .024) revealed that range of internal femoral rotation and sex of donor were significant factors in determining risk of ACL fatigue failure. The specimens with limited range of internal femoral rotation had a failure risk 17.1 times higher than did the specimens with free rotation (P = .016). The female knee specimens had a risk of ACL failure 26.9 times higher than the male specimens (P = .055).

CONCLUSION

Limiting the range of internal femoral rotation during repetitive pivot landings increases the risk of an ACL fatigue failure in comparison with free rotation in a cadaveric model.

CLINICAL RELEVANCE

Screening for restricted internal rotation at the hip in ACL injury prevention programs as well as in individuals with ACL injuries and/or reconstructions is warranted.

In vitro comparison between cortical and cortico-cancellous femoral suspension devices for anterior cruciate ligament reconstruction: implications for mobilization

PURPOSE

To analyse the capability of cortical and cortical-cancellous suspension devices to provide a strong fixation in order to follow an aggressive early mobilization protocol.

METHODS

Anterior cruciate ligament (ACL) reconstruction was performed in vitro on 40 porcine femurs employing a high-strength braided cord as a graft. Four femoral suspension devices were analysed: the cortical suspension devices Endobutton and XO Button and the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL. Two kinds of biomechanical testing were carried out: static and post-fatigue failure strength tests. Stiffness, failure load, elongation at failure load, elongation after 20 cycles and elongation after 1,000 cycles were assessed. The bones were cut after testing to analyse the failure pattern.

RESULTS

All of the devices exceed 50 % of total elongation in the first 20 cycles of fatigue. In the static failure tests, there were significant differences (p < 0.05) in elongation to failure between the cortical-cancellous suspension devices Biosteon Cross-pin and Cross-pin ACL and the cortical suspension device Endobutton. No significant differences were found in the failure tests after 1,000 cycles of loading. The failure mode of the cortical devices comprised breakage of the cortical bone, accompanied by introduction of the device into the tunnel. The failure mode of the cortical-cancellous devices was pin breakage accompanied by tunnel enlargement.

CONCLUSION

The first cycles of mobilization are critical for elongation. This mobilization process does not significantly diminish the mechanical characteristics of the reconstructions. All the fixations support an intensive early mobilization protocol, with loads of over 500 N.

"Surprise" Loading in Flexion Increases the Risk of Disc Herniation Due to Annulus-Endplate Junction Failure: A Mechanical and Microstructural Investigation

STUDY DESIGN

Microstructural investigation of compression-induced herniation of the flexed lumbar disc.

OBJECTIVE

To provide a microstructural analysis of the mechanisms of annular wall failure in healthy discs subjected to flexion and a rate of compression comparable with the maximum rate at which the muscles of the spinal column can generate a force.

SUMMARY OF BACKGROUND DATA

Clinical evidence indicates the involvement of the endplate in herniation. It is known that both an elevated rate of compression and a flexed posture are necessary to cause disc failure either within the midspan of the annulus or at the annular-endplate interface. However, the question of what effect a sudden or "surprise" loading might have on the mode of failure is, as yet, unanswered.

METHODS

Twenty-four healthy mature ovine lumbar motion segments were compressed to failure in high physiological flexion (10º). This occurred over approximately 5 mm of crosshead displacement in 0.75 seconds that resulted in a displacement rate of 400 mm/min (defined as a "surprise" rate) and was intended to simulate the maximum rate at which the muscles of the spinal column can generate a force. The damaged discs were then analyzed microstructurally.

RESULTS

Fifty-eight percent of discs suffered annular-endplate junction rupture, 25% suffered midspan annular rupture, and the balance of 17% endplate fracture. Microstructural analysis indicated that annular rupture initiated at the endplate apical ridge in the mid-to-outer region of the annulus in both annular-endplate and midspan annulus rupture.

CONCLUSION

Motion segments subjected to a "surprise" loading rate are likely to fail via some form of annular rupture. Failure under such sudden loading occurs mostly via rupture of the annular-endplate junction and is thought to arise from a rate-induced mechanostructural imbalance between the annulus and the endplate.

LEVEL OF EVIDENCE

N/A.

The effect of changing toe direction on knee kinematics during drop vertical jump: a possible risk factor for anterior cruciate ligament injury

PURPOSE

The purpose of this study was to examine the effect of changing toe direction on knee kinetics and kinematics associated with anterior cruciate ligament injury during drop vertical jumps.

METHODS

Fourteen females performed drop vertical jumps under three toe conditions (natural, toe-in, and toe-out). The knee kinetics and kinematics during landing were evaluated using a motion analysis system. Results under three toe conditions were compared using a one-way repeated measures analysis of variance and a post hoc Bonferroni test.

RESULTS

Toe-in landing was associated with a significantly greater knee abduction angle, tibial internal rotation angle, and knee abduction moment than the natural and toe-out conditions. Toe-out landing was associated with significantly greater tibial internal rotational angular velocity.

CONCLUSIONS

Changing toe direction significantly affects knee kinetics and kinematics during landing. It is important to avoid changing toe direction excessively inward or outward during landing to prevent the increases in knee abduction and tibial internal rotation which might increase the risk of ACL injury.

LEVEL OF EVIDENCE

Prognosis, Level IV.

Differences in the microstructural properties of the anteromedial and posterolateral bundles of the anterior cruciate ligament

BACKGROUND

Tissue properties of the anteromedial (AM) and posterolateral (PL) bundles of the anterior cruciate ligament (ACL) have not been previously characterized with real-time dynamic testing. The current study used a novel polarized light technique to measure the material and microstructural properties of the ACL.

HYPOTHESIS

The AM and PL bundles of the ACL have similar material and microstructural properties.

STUDY DESIGN

Controlled laboratory study.

METHODS

The AM and PL bundles were isolated from 16 human cadaveric ACLs (11 male, 5 female; average age, 41 years [range, 24-53 years]). Three samples from each bundle were loaded in uniaxial tension, and a custom-built polarized light imaging camera was used to quantify collagen fiber alignment in real time. A bilinear curve fit was applied to the stress-strain data of a quasistatic ramp-to-failure to quantify the moduli in the toe and linear regions. Fiber alignment was quantified at zero strain, the transition point of the bilinear fit, and in the linear portion of the stress-strain curve by computing the degree of linear polarization (DoLP) and angle of polarization (AoP), which are measures of the strength and direction of collagen alignment, respectively. Data were compared using t tests.

RESULTS

The AM bundle exhibited significantly larger toe-region (AM 7.2 MPa vs. PL 4.2 MPa; P < .001) and linear-region moduli (AM 27.0 MPa vs. PL 16.1 MPa; P = .017) compared with the PL bundle. Average DoLP values were similar at low strain but were significantly larger (ie, more uniform alignment) for the AM bundle in the linear region of the stress-strain curve (AM 0.22 vs. PL 0.19; P = .036) compared with the PL bundle. The standard deviation AoP values was larger for the PL bundle at both transition (P = .041) and linear-region strain (P = .014), indicating more disperse orientation.

CONCLUSION

Material and microstructural properties of the AM and PL bundles of the ACL differ during loading. The AM bundle possessed higher tissue modulus and failure stress, as well as more uniform fiber alignment under load.

CLINICAL RELEVANCE

These insights into native ligament microstructure can be used to assess graft options for ACL reconstruction and optimize surgical reconstruction techniques.

Deconstructing the Anterior Cruciate Ligament: What We Know and Do Not Know About Function, Material Properties, and Injury Mechanics

Anterior cruciate ligament (ACL) injury is a common and potentially catastrophic knee joint injury, afflicting a large number of males and particularly females annually. Apart from the obvious acute injury events, it also presents with significant long-term morbidities, in which osteoarthritis (OA) is a frequent and debilitative outcome. With these facts in mind, a vast amount of research has been undertaken over the past five decades geared toward characterizing the structural and mechanical behaviors of the native ACL tissue under various external load applications. While these efforts have afforded important insights, both in terms of understanding treating and rehabilitating ACL injuries; injury rates, their well-established sex-based disparity, and long-term sequelae have endured. In reviewing the expanse of literature conducted to date in this area, this paper identifies important knowledge gaps that contribute directly to this long-standing clinical dilemma. In particular, the following limitations remain. First, minimal data exist that accurately describe native ACL mechanics under the extreme loading rates synonymous with actual injury. Second, current ACL mechanical data are typically derived from isolated and oversimplified strain estimates that fail to adequately capture the true 3D mechanical response of this anatomically complex structure. Third, graft tissues commonly chosen to reconstruct the ruptured ACL are mechanically suboptimal, being overdesigned for stiffness compared to the native tissue. The net result is an increased risk of rerupture and a modified and potentially hazardous habitual joint contact profile. These major limitations appear to warrant explicit research attention moving forward in order to successfully maintain/restore optimal knee joint function and long-term life quality in a large number of otherwise healthy individuals.

Electrospun microcrimped fibers with nonlinear mechanical properties enhance ligament fibroblast phenotype

Fiber structure and order greatly impact the mechanical behavior of fibrous materials. In biological tissues, the nonlinear mechanics of fibrous scaffolds contribute to the functionality of the material. The nonlinear mechanical properties of the wavy structure (crimp) in collagen allow tissue flexibility while preventing over-extension. A number of approaches have tried to recreate this complex mechanical functionality. We generated microcrimped fibers by briefly heating electrospun parallel fibers over the glass transition temperature or by ethanol treatment. The crimp structure is similar to those of collagen fibers found in native aorta, intestines, or ligaments. Using poly-L-lactic acid fibers, we demonstrated that the bulk materials exhibit changed stress-strain behaviors with a significant increase in the toe region in correlation to the degree of crimp, similar to those observed in collagenous tissues. In addition to mimicking the stress-strain behavior of biological tissues, the microcrimped fibers are instructive in cell morphology and promote ligament phenotypic gene expression. This effect can be further enhanced by dynamic tensile loading, a physiological perturbation in vivo. This rapid and economical approach for microcrimped fiber production provides an accessible platform to study structure-function relationships and a novel functional scaffold for tissue engineering and cell mechanobiology studies.

Design Considerations for a Prosthetic Anterior Cruciate Ligament

Anterior cruciate ligament (ACL) tearing is a common knee injury often requiring reconstruction with an autograft or an allograft. A prosthetic ligament replacement with off-the-shelf availability could potentially provide significant advantages over the current options for both patients and surgeons. Limitations of previous prosthetics include lack of biocompatibility and susceptibility to fatigue, creep, and failure of bony incorporation. This paper describes design considerations and possible improvements for the next generation prosthetic ACL. Design controls, as mandated by the FDA, are a systematic set of practices within the design and development process used to ensure that a new medical device meets the needs of the intended users. The specified requirements, called the design inputs, for a prosthetic ACL are discussed pertaining to material and structural properties, resistance to creep and fatigue, ability to support secure initial fixation, biocompatibility, and long-term osseointegration. Design innovations to satisfy the design inputs are discussed with regards to material selection, textile pattern, bone tunnel features, and short term fixation. A risk analysis is presented along with descriptions of proposed testing. Design control methodology and tissue engineering may be used to develop a next generation prosthetic ligament, solving multiple problems, simultaneously, on a holistic level, providing major improvements over earlier devices and current treatment options.

CROSS-SECTIONAL AREA MEASUREMENT OF SOFT TISSUES IN VITRO: A NON-CONTACT LASER SCAN METHOD

Measurements of cross-sectional areas (CSAs) of soft tissues such as tendons and ligaments allow for the evaluation of the biomechanical properties of the tissue. Underlying in vitro techniques are data reduction approaches for determining the average thickness of the tissue and the assumption of the geometry of the cross-section, i.e. circular or elliptical. However, tissue distortions, sagging, and concavities could affect the reliability of these techniques, since these features may not be accounted for adequately. To address some of the concerns faced by these techniques, a non-contact (non-destructive) laser scan technique has been developed. In this technique, a laser scans along the axis of the tissue, a coordinate measuring machine simultaneously locates the corresponding point on the tissue based on the detection of reflected (attenuated) intensity, and, finally, computerized image analysis reconstructs the morphology of the tissue. This technique was applied to patellar tendons (PTs) from New Zealand rabbits. The scanning time for each PT was less than 2 minutes. Reconstructed three-dimensional surface plots revealed microconcavities consistent with images seen under optical microscopy. CSAs of these PTs were determined for repeatability and precision; results from a conventional approach which estimated the corresponding CSAs based on the average thickness and the assumption of ellipsoidal cross-sectional geometry were also determined for the purpose of comparison. Based on the standard cuboid model, the error between the laser technique and the conventional approach was within 0.4%; the reproducibility of the laser technique was within 2%.

Technical Issues in Using Robots to Reproduce Joint Specific Gait

Reproduction of the in vivo motions of joints has become possible with improvements in robot technology and in vivo measuring techniques. A motion analysis system has been used to measure the motions of the tibia and femur of the ovine stifle joint during normal gait. These in vivo motions are then reproduced with a parallel robot. To ensure that the motion of the joint is accurately reproduced and that the resulting data are reliable, the testing frame, the data acquisition system, and the effects of limitations of the testing platform need to be considered. Of the latter, the stiffness of the robot and the ability of the control system to process sequential points on the path of motion in a timely fashion for repeatable path accuracy are of particular importance. Use of the system developed will lead to a better understanding of the mechanical environment of joints and ligaments in vivo.

A linear laser scanner to measure cross-sectional shape and area of biological specimens during mechanical testing

Measure of the cross-sectional area (CSA) of biological specimens is a primary concern for many biomechanical tests. Different procedures are presented in literature but besides the fact that noncontact techniques are required during mechanical testing, most of these procedures lack accuracy or speed. Moreover, they often require a precise positioning of the specimen, which is not always feasible, and do not enable the measure of the same section during tension. The objective of this study was to design a noncontact, fast, and accurate device capable of acquiring CSA of specimens mounted on a testing machine. A system based on the horizontal linear displacement of two charge-coupled device reflectance laser devices next to the specimen, one for each side, was chosen. The whole measuring block is mounted on a vertical linear guide to allow following the measured zone during sample tension (or compression). The device was validated by measuring the CSA of metallic rods machined with geometrical shapes (circular, hexagonal, semicircular, and triangular) as well as an equine superficial digital flexor tendon (SDFT) in static condition. We also performed measurements during mechanical testing of three SDFTs, obtaining the CSA variations until tendon rupture. The system was revealed to be very fast with acquisition times in the order of 0.1 s and interacquisition time of about 1.5 s. Measurements of the geometrical shapes yielded mean errors lower than 1.4% (n=20 for each shape) while the tendon CSA at rest was 90.29 ± 1.69 mm(2) (n=20). As for the tendons that underwent tension, a mean of 60 measures were performed for each test, which lasted about 2 min until rupture (at 20 mm/min), finding CSA variations linear with stress (R(2)>0.85). The proposed device was revealed to be accurate and repeatable. It is easy to assemble and operate and capable of moving to follow a defined zone on the specimen during testing. The system does not need precise centering of the sample and can perform noncontact measures during mechanical testing; therefore, it can be used to measure variations of the specimen CSA during a tension (or compression) test in order to determine, for instance, the true stress and transverse deformations.

Influence of the crosshead rate on the mechanical properties of fixation systems of ACL tendon grafts

Anterior cruciate ligament (ACL) reconstruction is one of the most important aspects of knee surgery. For this purpose, several fixation devices have been developed, although the interference screw is the most frequently used. The most typical biomechanical test of these devices consists of placing them in a testing machine and subjecting them to a pull-out test. However, insufficient attention has been paid to the influence of the displacement test rate on the mechanical properties of the fixation system. The aim of this study is to compare the influence of the crosshead rate in the biomechanical test of two different devices for the fixation of ACL tendon grafts. One hundred in vitro tests were performed using porcine tibiae and bovine tendons. The fixation devices used were (1) an interference screw and (2) a new expansion device. All ACL reconstructions were subjected to pull-out test to failure. Five crosshead rates were employed in a range from 30 mm/min to 4000 mm/min. Statistical analyses of the results show that, for the two devices, the rate has a significant effect on both maximum force and stiffness. Moreover, the new expansion device showed lesser dependency on the crosshead rate than the interference screw.

A biomechanical investigation of the anteromedial and posterolateral bands of the porcine anterior cruciate ligament

The bipartite nature of the porcine anterior cruciate ligament has been documented, but its biomechanics have not been investigated. The need for such knowledge has recently been heightened with xenografting advances such as the introduction of the porcine patellar tendon as a human anterior cruciate ligament graft. The aim of this study is to compare the biomechanical properties of the intact anterior cruciate ligament with that of its two bands. 15 intact porcine anterior cruciate ligament-bone, 15 anteromedial band-bone, and 15 posterolateral band-bone complexes were prepared for tensile testing at 0.33 mm/s. Structural (load, deformation, stiffness, and energy absorbed) and material (stress, strain, modulus, and strain energy density) properties were analysed. Analysis of variance identified significantly higher ultimate load, stiffness, and energy absorbance in the intact porcine ligament when compared with its anteromedial band (p = 0.028). However, the intact ligament was only significantly higher in ultimate load when compared to its posterolateral band (p = 0.031). All ligament-bone complexes failed at similar deformations and strains, suggesting a strain-dependent failure mechanism. The intact porcine anterior cruciate ligament exhibited higher ultimate load, stiffness, and energy absorption than its two bands in isolation. The posterolateral band of the porcine anterior cruciate ligament constitutes a large proportion of the overall restraining function of the entire anterior cruciate ligament.

Tissue Engineering Options for Ligament Healing

The anterior cruciate ligament (ACL) is one of five ligaments in the knee that are important for stability and kinematics. It is also the most commonly injured ligament of the knee and due to its poor healing potential, severe damage warrants surgical intervention including complete replacement. Ligaments are longitudinally arranged, complex tissues; the mechanical properties of ligaments are a direct result of their components and the arrangement of these components in the tissue. It is these mechanics that have made ligaments so difficult to replace. Past ACL replacements have had many limitations that prevented their extensive use. These limitations range from mechanical fatigue over time to fraying of the device after implantation. In light of these problems, investigators have begun to pursue a host of new techniques to create a range of viable options for the repair, replacement, and/or regeneration of the ACL. These options include tissue engineered scaffolds with novel designs and specially treated transplanted tissues. In this article, the composition, arrangement, and mechanics of the ACL will be discussed in order to elucidate important aspects of ACL repair; past replacements will also be discussed. Afterwards, novel replacement options that look to solve problems faced by older replacement options will be presented. These devices use a wide variety of materials and designs to replicate ligament mechanics and allow for new tissue regeneration.

Contribution of glycosaminoglycans to viscoelastic tensile behavior of human ligament

The viscoelastic properties of human ligament potentially guard against structural failure, yet the microstructural origins of these transient behaviors are unknown. Glycosaminoglycans (GAGs) are widely suspected to affect ligament viscoelasticity by forming molecular bridges between neighboring collagen fibrils. This study investigated whether GAGs directly affect viscoelastic material behavior in human medial collateral ligament (MCL) by using nondestructive tensile tests before and after degradation of GAGs with chondroitinase ABC (ChABC). Control and ChABC treatment (83% GAG removal) produced similar alterations to ligament viscoelasticity. This finding was consistent at different levels of collagen fiber stretch and tissue hydration. On average, stress relaxation increased after incubation by 2.2% (control) and 2.1% (ChABC), dynamic modulus increased after incubation by 3.6% (control) and 3.8% (ChABC), and phase shift increased after incubation by 8.5% (control) and 8.4% (ChABC). The changes in viscoelastic behavior after treatment were significantly more pronounced at lower clamp-to-clamp strain levels. A 10% difference in the water content of tested specimens had minor influence on ligament viscoelastic properties. The major finding of this study is that mechanical interactions between collagen fibrils and GAGs are unrelated to tissue-level viscoelastic mechanics in mature human MCL. These findings narrow the possible number of extracellular matrix molecules that have a direct contribution to ligament viscoelasticity.

Anomalous rate dependence of the preconditioned response of soft tissue during load controlled deformation

It has been observed in load controlled laboratory tests of myocardium and skin that the tissues can exhibit a decrease in nonlinear stiffness with an increase in loading rate: the faster a test is performed, the more compliant is the preconditioned material behavior. This response seems to conflict with what is generally expected of soft tissues based on stretch or strain controlled tests, in which an increased rate of deformation results in a stiffer material response. It is hypothesized that this anomalous behavior has not been observed previously due to the small number of cyclic load controlled mechanical characterization tests that are geared specifically towards viscoelastic tissue response. The goal of this paper is to examine the preconditioned response of soft tissue to load controlled deformation using nonlinear viscoelastic material models including quasi-linear viscoelasticity, and to determine under what conditions this anomalous behavior becomes apparent. Results from this study suggest that this behavior is a true phenomenon unique to load controlled deformations that results from the interplay of nonlinear effects and creep behavior. These results call for increased attention to experimental parameters when testing and modeling nonlinear viscoelastic material behavior.

Tissue engineering of the anterior cruciate ligament using a braid-twist scaffold design

The anterior cruciate ligament (ACL) is the most commonly injured intra-articular ligament of the knee. The insufficient vascularization of this tissue prevents it from healing completely after extreme tearing or rupture, creating a need for ACL grafts for reconstruction. The limitations of existing grafts have motivated the investigation of tissue-engineered ACL grafts. A successful tissue-engineered graft must possess mechanical properties similar to the ACL; to date no commercially available synthetic graft has achieved this. To accomplish this goal we have combined the techniques of polymer fiber braiding and twisting to design a novel poly L-lactic acid (PLLA) braid-twist scaffold for ACL tissue engineering. The scaffold is designed to accurately mimic the biomechanical profile and mechanical properties of the ACL. In this study, braid-twist scaffolds were constructed and compared to braided scaffolds and twisted fiber scaffolds. The addition of fiber twisting to the braided scaffold resulted in a significant increase in the ultimate tensile strength, an increase in ultimate strain, and an increase in the length of the toe region in these constructs over scaffolds that were braided. Based on the findings of this study, the braid-twist scaffold studied was found to be a promising construct for tissue engineering of the ACL.

Three-Dimensional Finite Element Models of the Human Pubic Symphysis with Viscohyperelastic Soft Tissues

Three-dimensional finite element (FE) models of human pubic symphyses were constructed from computed tomography image data of one male and one female cadaver pelvis. The pubic bones, interpubic fibrocartilaginous disc and four pubic ligaments were segmented semi-automatically and meshed with hexahedral elements using automatic mesh generation schemes. A two-term viscoelastic Prony series, determined by curve fitting results of compressive creep experiments, was used to model the rate-dependent effects of the interpubic disc and the pubic ligaments. Three-parameter Mooney-Rivlin material coefficients were calculated for the discs using a heuristic FE approach based on average experimental joint compression data. Similarly, a transversely isotropic hyperelastic material model was applied to the ligaments to capture average tensile responses. Linear elastic isotropic properties were assigned to bone. The applicability of the resulting models was tested in bending simulations in four directions and in tensile tests of varying load rates. The model-predicted results correlated reasonably with the joint bending stiffnesses and rate-dependent tensile responses measured in experiments, supporting the validity of the estimated material coefficients and overall modeling approach. This study represents an important and necessary step in the eventual development of biofidelic pelvis models to investigate symphysis response under high-energy impact conditions, such as motor vehicle collisions.

The Changes in the Tensile Properties of Tendons after Freeze Storage in Saline Solution

The objective of this study is to evaluate the influence of saline solution (0.9 per cent NaCl) on the tensile properties of freeze-stored tendons. Firstly, 170 pieces of chicken flexor digitorum profundus tendons were retrieved and wrapped in saline-soaked gauze before they were stored at -40 °. Then specimens were tensile tested at various time points over 360 days, scanning electron microscopy (SEM) was performed on fresh specimens, and specimens were freeze-stored for 233 days to investigate microstructure change after freeze storage. The mean values of strain ultimate tensile strength (UTS) did not deviate significantly (analysis of variance; p = 0.249) following freeze storage while the UTS and elastic modulus increased gradually with the duration of freeze storage and the growth became significant ( p < 0.01) for durations longer than 70 and 40 days respectively. The SEM study showed that the collagen fibre density of specimens stored for 233 days decreased because of porosity growth. These findings suggested that the saline increased the tensile strength and modulus of the collagen.

Mechanics of the anterior drawer test at the ankle: the effects of ligament viscoelasticity

The anterior drawer test at the human ankle joint is a routine clinical examination. The relationship between the mechanical response of this joint and the flexion angle was elucidated by a recent mathematical model, using purely elastic mechanical characteristics for the ligament fibres. The objective of the present work was to assess the effect of ligament viscoelasticity on the force response of the ankle joint for anterior displacements of the foot relative to the tibia, at different ankle flexion positions. A viscoelastic model of the ligaments from the literature was included in the recently proposed mathematical model. Drawer tests were simulated at several flexion angles and for increasing velocities of the imposed anterior displacement. The stiffness of the model ankle joint increased only modestly with velocity. The response force found for a 6mm displacement at 20 degrees plantarflexion increased by only 13% for a one hundred-fold increase in velocity from 0.1 to 10 mm/s. The flexion angle was confirmed as the most influential parameter in the mechanical response of the ankle to anterior drawer test.

Strain-Rate Sensitive Mechanical Properties of Tendon Fascicles From Mice With Genetically Engineered Alterations in Collagen and Decorin

Tendons have complex mechanical behaviors that are nonlinear and time dependent. It is widely held that these behaviors are provided by the tissue’s composition and structure. It is generally thought that type I collagen provides the primary elastic strength to tendon while proteoglycans, such as decorin, play a role in failure and viscoelastic properties. This study sought to quantify such structure-function relationships by comparing tendon mechanical properties between normal mice and mice genetically engineered for altered type I collagen content and absence of decorin. Uniaxial tensile ramp to failure experiments were performed on tail tendon fascicles at two strain rates, 0.5%/s and 50%/s. Mutations in type I collagen led to reduced failure load and stiffness with no changes in failure stress, modulus or strain rate sensitivity. Fascicles without decorin had similar elastic properties to normal fascicles, but reduced strain rate sensitivity. Fascicles from immature mice, with increased decorin content compared to adult fascicles, had inferior elastic properties but higher strain rate sensitivity. These results showed that tendon viscoelasticity is affected by decorin content but not by collagen alterations. This study provides quantitative evidence for structure-function relationships in tendon, including the role of proteoglycan in viscoelasticity.

Rate of force application during knee arthrometer testing affects stiffness but not displacement measurements

STUDY DESIGN

Repeated-measures counterbalanced design.

OBJECTIVES

To determine the effect of rate of force application on anterior tibial displacement and anterior tibial stiffness when measured with the KT-2000 knee arthrometer.

BACKGROUND

Clinicians and researchers frequently use the KT-2000 to quantify anterior tibial displacement and stiffness. While many factors (ie, tibial rotation, alignment of the arthrometer, etc) have been identified to affect KT-2000 measurements, the effect of the rate of force application has not been studied.

METHODS AND MEASURES

Seventeen recreationally active males between the ages of 19 and 36 years (mean age +/- SD, 27.8 +/- 5.3 years) with no previous history of knee injury participated. With the knee in 25 degrees of flexion, the KT-2000 was applied to the participants' anterior tibia. While the distal femur was stabilized, the first author applied a posterior-to-anterior force at a fast and slow rate. Three trials for the slow and fast rates of force application were averaged and used for statistical analysis. Anterior tibial displacement (mm) was measured at 133 N and the related anterior tibial stiffness (N/mm) values were calculated between 89 and 133 N. Separate paired t tests with Bonferroni adjustment were used to determine if differences in displacement and stiffness between rates of force application were present.

RESULTS

Stiffness was significantly greater in the slow (mean +/- SD, 58 +/- 22 N/mm) as compared to the fast trials (mean +/- SD, 47 +/- 19 N/mm) (P = .005). Differences in displacement, however, were small and not significant (P = .132) between the slow (mean +/- SD, 3.9 +/- 1.5 mm) and fast (mean +/- SD, 4.0 +/- 1.6 mm) trials.

CONCLUSION

The rate of force application affects anterior tibial stiffness but not anterior tibial displacement when measured with the KT-2000. This suggests that to ensure reliable results when using the KT-2000, the rate of force application must be controlled when measuring stiffness between 89 and 133 N, but not when measuring anterior tibial displacement at 133 N.