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Rao H, Bakker R, McLachlin S, Chandrashekar N. Computational study of extrinsic factors affecting ACL strain during single-leg jump landing. BMC Musculoskelet Disord 2024; 25:318. [PMID: 38654258 PMCID: PMC11036765 DOI: 10.1186/s12891-024-07372-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 03/21/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND Non-contact anterior cruciate ligament (ACL) injuries are a major concern in sport-related activities due to dynamic knee movements. There is a paucity of finite element (FE) studies that have accurately replicated the knee geometry, kinematics, and muscle forces during dynamic activities. The objective of this study was to develop and validate a knee FE model and use it to quantify the relationships between sagittal plane knee kinematics, kinetics and the resulting ACL strain. METHODS 3D images of a cadaver knee specimen were segmented (bones, cartilage, and meniscus) and meshed to develop the FE model. Knee ligament insertion sites were defined in the FE model via experimental digitization of the specimen's ligaments. The response of the model was validated against multiple physiological knee movements using published experimental data. Single-leg jump landing motions were then simulated on the validated model with muscle forces and kinematic inputs derived from motion capture and rigid body modelling of ten participants. RESULTS The maximum ACL strain measured with the model during jump landing was 3.5 ± 2.2%, comparable to published experimental results. Bivariate analysis showed no significant correlation between body weight, ground reaction force and sagittal plane parameters (such as joint flexion angles, joint moments, muscle forces, and joint velocity) and ACL strain. Multivariate regression analysis showed increasing trunk, hip and ankle flexion angles decreases ACL strain (R2 = 90.04%, p < 0.05). CONCLUSIONS Soft landing decreases ACL strain and the relationship could be presented through an empirical equation. The model and the empirical relation developed in this study could be used to better predict ACL injury risk and prevention strategies during dynamic activities.
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Affiliation(s)
- Harish Rao
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Ryan Bakker
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Stewart McLachlin
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
| | - Naveen Chandrashekar
- Mechanical and Mechatronics Engineering, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada.
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2
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Esrafilian A, Halonen KS, Dzialo CM, Mannisi M, Mononen ME, Tanska P, Woodburn J, Korhonen RK, Andersen MS. Effects of gait modifications on tissue-level knee mechanics in individuals with medial tibiofemoral osteoarthritis: A proof-of-concept study towards personalized interventions. J Orthop Res 2024; 42:326-338. [PMID: 37644668 PMCID: PMC10952410 DOI: 10.1002/jor.25686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 06/19/2023] [Accepted: 08/24/2023] [Indexed: 08/31/2023]
Abstract
Gait modification is a common nonsurgical approach to alter the mediolateral distribution of knee contact forces, intending to decelerate or postpone the progression of mechanically induced knee osteoarthritis (KOA). Nevertheless, the success rate of these approaches is controversial, with no studies conducted to assess alterations in tissue-level knee mechanics governing cartilage degradation response in KOA patients undertaking gait modifications. Thus, here we investigated the effect of different conventional gait conditions and modifications on tissue-level knee mechanics previously suggested as indicators of collagen network damage, cell death, and loss of proteoglycans in knee cartilage. Five participants with medial KOA were recruited and musculoskeletal finite element analyses were conducted to estimate subject-specific tissue mechanics of knee cartilages during two gait conditions (i.e., barefoot and shod) and six gait modifications (i.e., 0°, 5°, and 10° lateral wedge insoles, toe-in, toe-out, and wide stance). Based on our results, the optimal gait modification varied across the participants. Overall, toe-in, toe-out, and wide stance showed the greatest reduction in tissue mechanics within medial tibial and femoral cartilages. Gait modifications could effectually alter maximum principal stress (~20 ± 7%) and shear strain (~9 ± 4%) within the medial tibial cartilage. Nevertheless, lateral wedge insoles did not reduce joint- and tissue-level mechanics considerably. Significance: This proof-of-concept study emphasizes the importance of the personalized design of gait modifications to account for biomechanical risk factors associated with cartilage degradation.
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Affiliation(s)
- Amir Esrafilian
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Kimmo S. Halonen
- Central hospital of Päijät‐HämeLahtiFinland
- Department of Materials and ProductionAalborg UniversityAalborgDenmark
| | | | | | - Mika E. Mononen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Petri Tanska
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Jim Woodburn
- Griffith Centre of Biomedical and Rehabilitation Engineering, Menzies Health Institute QueenslandGriffith UniversityGold CoastQLDAustralia
| | - Rami K. Korhonen
- Department of Technical PhysicsUniversity of Eastern FinlandKuopioFinland
| | - Michael S. Andersen
- Department of Materials and ProductionAalborg UniversityAalborgDenmark
- Center for Mathematical Modeling of Knee Osteoarthritis (MathKOA), Department of Materials and ProductionAalborg UniversityAalborgDenmark
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3
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Klahr B, Lanzendorf JZ, Thiesen JLM, Pinto OT, Müller LG, Carniel TA, Fancello EA. On the contribution of solid and fluid behavior to the modeling of the time-dependent mechanics of tendons under semi-confined compression. J Mech Behav Biomed Mater 2023; 148:106220. [PMID: 37944227 DOI: 10.1016/j.jmbbm.2023.106220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/12/2023]
Abstract
The present work aims to investigate whether it is possible to identify and quantify the contributions of the interstitial fluid and the solid skeleton to the overall time-dependent behavior of tendons based on a single mechanical test. For this purpose, the capabilities of three different time-dependent models (a viscoelastic, a poroelastic and a poroviscoelastic) were investigated in the modeling of the experimental behavior obtained from semi-confined compression with stress relaxation tests transverse to collagen fibers. The main achieved result points out that the poroviscoelastic model was the only one capable to characterize both the experimental responses of the force and volume changes of the tissue samples. Moreover, further analysis of this model shows that while the kinematics of the sample are mainly governed by the fluid flow (pore pressure contribution of the model), the behavior intrinsically associated with the viscoelastic solid skeleton makes a significant contribution to the experimental force response. This study reinforces the importance of taking both the experimental kinematics and kinetics of tendon tissues into account during the constitutive characterization procedure.
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Affiliation(s)
- Bruno Klahr
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Jonas Zin Lanzendorf
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - José Luís Medeiros Thiesen
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Otávio Teixeira Pinto
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
| | - Liz Girardi Müller
- Graduate Program in Environmental Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil
| | - Thiago André Carniel
- Graduate Program in Health Sciences, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil; Polytechnic School, Community University of Chapecó Region, Chapecó, Santa Catarina, Brazil.
| | - Eduardo Alberto Fancello
- Department of Mechanical Engineering, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil; University Hospital, Federal University of Santa Catarina, Florianópolis, Santa Catarina, Brazil
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4
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Karimi Dastgerdi A, Esrafilian A, Carty CP, Nasseri A, Yahyaiee Bavil A, Barzan M, Korhonen RK, Astori I, Hall W, Saxby DJ. Validation and evaluation of subject-specific finite element models of the pediatric knee. Sci Rep 2023; 13:18328. [PMID: 37884632 PMCID: PMC10603053 DOI: 10.1038/s41598-023-45408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Finite element (FE) models have been widely used to investigate knee joint biomechanics. Most of these models have been developed to study adult knees, neglecting pediatric populations. In this study, an atlas-based approach was employed to develop subject-specific FE models of the knee for eight typically developing pediatric individuals. Initially, validation simulations were performed at four passive tibiofemoral joint (TFJ) flexion angles, and the resulting TFJ and patellofemoral joint (PFJ) kinematics were compared to corresponding patient-matched measurements derived from magnetic resonance imaging (MRI). A neuromusculoskeletal-(NMSK)-FE pipeline was then used to simulate knee biomechanics during stance phase of walking gait for each participant to evaluate model simulation of a common motor task. Validation simulations demonstrated minimal error and strong correlations between FE-predicted and MRI-measured TFJ and PFJ kinematics (ensemble average of root mean square errors < 5 mm for translations and < 4.1° for rotations). The FE-predicted kinematics were strongly correlated with published reports (ensemble average of Pearson's correlation coefficients (ρ) > 0.9 for translations and ρ > 0.8 for rotations), except for TFJ mediolateral translation and abduction/adduction rotation. For walking gait, NMSK-FE model-predicted knee kinematics, contact areas, and contact pressures were consistent with experimental reports from literature. The strong agreement between model predictions and experimental reports underscores the capability of sequentially linked NMSK-FE models to accurately predict pediatric knee kinematics, as well as complex contact pressure distributions across the TFJ articulations. These models hold promise as effective tools for parametric analyses, population-based clinical studies, and enhancing our understanding of various pediatric knee injury mechanisms. They also support intervention design and prediction of surgical outcomes in pediatric populations.
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Affiliation(s)
- Ayda Karimi Dastgerdi
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia.
| | - Amir Esrafilian
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Christopher P Carty
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Azadeh Nasseri
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Alireza Yahyaiee Bavil
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Martina Barzan
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
| | - Rami K Korhonen
- Department of Technical Physics, University of Eastern Finland, Kuopio, Finland
| | - Ivan Astori
- Department of Orthopedics, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Wayne Hall
- School of Engineering and Built Environment, Mechanical Engineering and Industrial Design, Griffith University, Gold Coast, QLD, Australia
| | - David John Saxby
- Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE), Menzies Health Institute Queensland and the Advanced Design and Prototyping Technologies Institute (ADAPT), Griffith University, Gold Coast, QLD, Australia
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Simkheada T, Orozco GA, Korhonen RK, Tanska P, Mononen ME. Comparison of constitutive models for meniscus and their effect on the knee joint biomechanics during gait. Comput Methods Biomech Biomed Engin 2023; 26:2008-2021. [PMID: 36645841 DOI: 10.1080/10255842.2022.2163587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 11/25/2022] [Accepted: 12/20/2022] [Indexed: 01/18/2023]
Abstract
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.
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Affiliation(s)
- Tulashi Simkheada
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Gustavo A Orozco
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
- Department of Biomedical Engineering, Lund University, Lund, Sweden
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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6
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Halvorsen S, Wang R, Zhang Y. Contribution of Elastic and Collagen Fibers to the Mechanical Behavior of Bovine Nuchal Ligament. Ann Biomed Eng 2023; 51:2204-2215. [PMID: 37284997 PMCID: PMC10528717 DOI: 10.1007/s10439-023-03254-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 05/16/2023] [Indexed: 06/08/2023]
Abstract
Ligamentum nuchae is a highly elastic tissue commonly used to study the structure and mechanics of elastin. This study combines imaging, mechanical testing, and constitutive modeling to examine the structural organization of elastic and collagen fibers and their contributions to the nonlinear stress-strain behavior of the tissue. Rectangular samples of bovine ligamentum nuchae cut in both longitudinal and transverse directions were tested in uniaxial tension. Purified elastin samples were also obtained and tested. It was observed that the stress-stretch response of purified elastin tissue follows a similar curve as the intact tissue initially, but the intact tissue shows a significant stiffening behavior for stretches above 1.29 with collagen engagement. Multiphoton and histology images confirm the elastin-dominated bulk of ligamentum nuchae interspersed with small bundles of collagen fibrils and sporadic collagen-rich regions with cellular components and ground substance. A transversely isotropic constitutive model that considers the longitudinal organization of elastic and collagen fibers was developed to describe the mechanical behavior of both intact and purified elastin tissue under uniaxial tension. These findings shed light on the unique structural and mechanical roles of elastic and collagen fibers in tissue mechanics and may aid in future use of ligamentum nuchae in tissue grafting.
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Affiliation(s)
- Samuel Halvorsen
- Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Ruizhi Wang
- Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA
| | - Yanhang Zhang
- Mechanical Engineering, Boston University, 110 Cummington Mall, Boston, MA, 02215, USA.
- Biomedical Engineering, Boston University, Boston, MA, USA.
- Division of Materials Science & Engineering, Boston University, Boston, MA, USA.
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7
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Milakovic L, Dandois F, Fehervary H, Scheys L. Calibration of Holzapfel-Gasser-Ogden collateral ligament properties in a hybrid post-arthroplasty knee joint model for laxity testing. Comput Methods Biomech Biomed Engin 2023:1-11. [PMID: 37668078 DOI: 10.1080/10255842.2023.2253950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
Knee collateral ligaments play a vital role in providing frontal-plane stability in post-total knee arthroplasty (TKA) knees. Finite element models can utilize computationally efficient one-dimensional springs or more physiologically accurate three-dimensional continuum elements like the Holzapfel-Gasser-Ogden (HGO) formulation. However, there is limited literature defining subject-specific mechanical properties, particularly for the HGO model. In this study, we propose a co-simulation framework to obtain subject-specific material parameters for an HGO-based finite element ligament model integrated into a rigid-body model of the post-TKA knee. Our approach achieves comparable accuracy to spring formulations while significantly reducing coefficient calibration time and demonstrating improved correlation with reference knee kinematics and ligament strains throughout the tested loading range.
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Affiliation(s)
- Lucas Milakovic
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
| | - Félix Dandois
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
| | - Heleen Fehervary
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
- FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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8
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Lu Z, Sun D, Kovács B, Radák Z, Gu Y. Case study: The influence of Achilles tendon rupture on knee joint stress during counter-movement jump - Combining musculoskeletal modeling and finite element analysis. Heliyon 2023; 9:e18410. [PMID: 37560628 PMCID: PMC10407047 DOI: 10.1016/j.heliyon.2023.e18410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 07/15/2023] [Accepted: 07/17/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Presently, the current research concerning Achilles tendon rupture repair (ATR) is predominantly centered on the ankle joint, with a paucity of evidence regarding its impact on the knee joint. ATR has the potential to significantly impede athletic performance and increase tibiofemoral contact forces in athletes. The purpose of this study was to prognosticate the distribution of stress within the knee joint during a countermovement jump through the use of a simulation method that amalgamated a musculoskeletal model of a patient who underwent Achilles tendon rupture repair with a finite element model of the knee joint. METHODS A male elite badminton player who had suffered an acute Achilles tendon rupture in his right leg one year prior was selected as our study subject. In order to analyze his biomechanical data, we employed both the OpenSim musculoskeletal model and finite element model to compute various parameters such as joint angles, joint moments, joint contact forces, and the distribution of knee joint stress. RESULTS During the jumping phase, a significantly lower knee extension angle (p < 0.001), ankle dorsiflexion angle (p = 0.002), peak vertical ground reaction force (p < 0.001), and peak tibiofemoral contact force (p = 0.009) were observed on the injured side than on the uninjured side. During the landing phase, the ankle range of motion (ROM) was significantly lower on the injured side than on the uninjured side (p = 0.009), and higher peak vertical ground reaction forces were observed (p = 0.012). Additionally, it is logical that an injured person will put higher load on the uninjured limb, but the finite element analysis indicated that the stresses on the injured side of medial meniscus and medial cartilage were significantly greater than the uninjured side. CONCLUSIONS An Achilles tendon rupture can limit ankle range of motion and lead to greater joint stress on the affected area during countermovement jumps, especially during the landing phase. This increased joint stress may also transfer more stress to the soft tissues of the medial knee, thereby increasing the risk of knee injury. It is worth noting that this study only involves the average knee flexion angle and load after ATR in one athlete. Caution should be exercised when applying the conclusions, and in the future, more participants should be recruited to establish personalized knee finite element models to validate the results.
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Affiliation(s)
- Zhenghui Lu
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Dong Sun
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
| | - Bálint Kovács
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
- Research Institute of Sport Science, Hungarian University of Sport Science, Budapest, 1123, Hungary
| | - Zsolt Radák
- Research Institute of Sport Science, Hungarian University of Sport Science, Budapest, 1123, Hungary
| | - Yaodong Gu
- Faculty of Sports Science, Ningbo University, Ningbo, 315211, China
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9
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Raju V, Koorata PK. Computational assessment on the impact of collagen fiber orientation in cartilages on healthy and arthritic knee kinetics/kinematics. Med Eng Phys 2023; 117:103997. [PMID: 37331751 DOI: 10.1016/j.medengphy.2023.103997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 05/15/2023] [Accepted: 05/17/2023] [Indexed: 06/20/2023]
Abstract
BACKGROUND The inhomogeneous distribution of collagen fiber in cartilage can substantially influence the knee kinematics. This becomes vital for understanding the mechanical response of soft tissues, and cartilage deterioration including osteoarthritis (OA). Though the conventional computational models consider geometrical heterogeneity along with fiber reinforcements in the cartilage model as material heterogeneity, the influence of fiber orientation on knee kinetics and kinematics is not fully explored. This work examines how the collagen fiber orientation in the cartilage affects the healthy (intact knee) and arthritic knee response over multiple gait activities like running and walking. METHODS A 3D finite element knee joint model is used to compute the articular cartilage response during the gait cycle. A fiber-reinforced porous hyper elastic (FRPHE) material is used to model the soft tissue. A split-line pattern is used to implement the fiber orientation in femoral and tibial cartilage. Four distinct intact cartilage models and three OA models are simulated to assess the impact of the orientation of collagen fibers in a depth wise direction. The cartilage models with fibers oriented in parallel, perpendicular, and inclined to the articular surface are investigated for multiple knee kinematics and kinetics. FINDINGS The comparison of models with fiber orientation parallel to articulating surface for walking and running gait has the highest elastic stress and fluid pressure compared with inclined and perpendicular fiber-oriented models. Also, the maximum contact pressure is observed to be higher in the case of intact models during the walking cycle than for OA models. In contrast, the maximum contact pressure is higher during running in OA models than in intact models. Additionally, parallel-oriented models produce higher maximum stresses and fluid pressure for walking and running gait than proximal-distal-oriented models. Interestingly, during the walking cycle, the maximum contact pressure with intact models is approximately three times higher than on OA models. In contrast, the OA models exhibit higher contact pressure during the running cycle. INTERPRETATION Overall, the study indicates that collagen orientation is crucial for tissue responsiveness. This investigation provides insights into the development of tailored implants.
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Affiliation(s)
- Vaishakh Raju
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, 575025, India
| | - Poornesh Kumar Koorata
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, 575025, India.
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10
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Orozco GA, Ristaniemi A, Haghighatnejad M, Mohammadi A, Finnilä MAJ, Saarakkala S, Herzog W, Isaksson H, Korhonen RK. Adaptation of Fibril-Reinforced Poroviscoelastic Properties in Rabbit Collateral Ligaments 8 Weeks After Anterior Cruciate Ligament Transection. Ann Biomed Eng 2023; 51:726-740. [PMID: 36129552 PMCID: PMC10023629 DOI: 10.1007/s10439-022-03081-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 09/07/2022] [Indexed: 11/30/2022]
Abstract
Ligaments of the knee provide stability and prevent excessive motions of the joint. Rupture of the anterior cruciate ligament (ACL), a common sports injury, results in an altered loading environment for other tissues in the joint, likely leading to their mechanical adaptation. In the collateral ligaments, the patterns and mechanisms of biomechanical adaptation following ACL transection (ACLT) remain unknown. We aimed to characterize the adaptation of elastic and viscoelastic properties of the lateral and medial collateral ligaments eight weeks after ACLT. Unilateral ACLT was performed in six rabbits, and collateral ligaments were harvested from transected and contralateral knee joints after eight weeks, and from an intact control group (eight knees from four animals). The cross-sectional areas were measured with micro-computed tomography. Stepwise tensile stress-relaxation testing was conducted up to 6% final strain, and the elastic and viscoelastic properties were characterized with a fibril-reinforced poroviscoelastic material model. We found that the cross-sectional area of the collateral ligaments in the ACL transected knees increased, the nonlinear elastic collagen network modulus of the LCL decreased, and the amount of fast relaxation in the MCL decreased. Our results indicate that rupture of the ACL leads to an early adaptation of the elastic and viscoelastic properties of the collagen fibrillar network in the collateral ligaments. These adaptations may be important to consider when evaluating whole knee joint mechanics after ACL rupture, and the results aid in understanding the consequences of ACL rupture on other tissues.
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Affiliation(s)
- Gustavo A Orozco
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland.
- Department of Biomedical Engineering, Lund University, Box 188, 221 00, Lund, Sweden.
| | - Aapo Ristaniemi
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
- AO Research Institute Davos, Davos, Switzerland
| | - Mehrnoush Haghighatnejad
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
| | - Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
| | - Mikko A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Walter Herzog
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Hanna Isaksson
- Department of Biomedical Engineering, Lund University, Box 188, 221 00, Lund, Sweden
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Yliopistonranta 1, 70210, Kuopio, Finland
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11
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Sander IL, Dvorak N, Stebbins JA, Carr AJ, Mouthuy PA. Advanced Robotics to Address the Translational Gap in Tendon Engineering. CYBORG AND BIONIC SYSTEMS 2022; 2022:9842169. [PMID: 36285305 PMCID: PMC9508494 DOI: 10.34133/2022/9842169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 08/25/2022] [Indexed: 12/02/2022] Open
Abstract
Tendon disease is a significant and growing burden to healthcare systems. One strategy to address this challenge is tissue engineering. A widely held view in this field is that mechanical stimulation provided to constructs should replicate the mechanical environment of native tissue as closely as possible. We review recent tendon tissue engineering studies in this article and highlight limitations of conventional uniaxial tensile bioreactors used in current literature. Advanced robotic platforms such as musculoskeletal humanoid robots and soft robotic actuators are promising technologies which may help address translational gaps in tendon tissue engineering. We suggest the proposed benefits of these technologies and identify recent studies which have worked to implement these technologies in tissue engineering. Lastly, key challenges to address in adapting these robotic technologies and proposed future research directions for tendon tissue engineering are discussed.
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Affiliation(s)
- Iain L. Sander
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Tebbit Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Nicole Dvorak
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Julie A. Stebbins
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
- Oxford Gait Laboratory, Nuffield Orthopaedic Centre, Tebbit Centre, Windmill Road, Oxford OX3 7HE, UK
| | - Andrew J. Carr
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
| | - Pierre-Alexis Mouthuy
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology, and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, UK
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12
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Raju V, Koorata PK. Influence of material heterogeneity on the mechanical response of articulated cartilages in a knee joint. Proc Inst Mech Eng H 2022; 236:1340-1348. [DOI: 10.1177/09544119221116263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Structurally, the articular cartilages are heterogeneous owing to nonuniform distribution and orientation of its constituents. The oversimplification of this soft tissue as a homogeneous material is generally considered in the simulation domain to estimate contact pressure along with other physical responses. Hence, there is a need for investigating knee cartilages for their actual response to external stimuli. In this article, impact of material and geometrical heterogeneity of the cartilage is resolved using well known material models. The findings are compared with conventional homogeneous models. The results indicate vital differences in contact pressure distribution and tissue deformation. Further, this study paves way for standardizing material models to extract maximum information possible for investigating knee mechanics with variable geometry and case specific parameters.
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Affiliation(s)
- Vaishakh Raju
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, Karnataka, India
| | - Poornesh Kumar Koorata
- Applied Solid Mechanics Laboratory, Department of Mechanical Engineering, National Institute of Technology Karnataka, Surathkal, Karnataka, India
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13
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Bolcos PO, Mononen ME, Roach KE, Tanaka MS, Suomalainen JS, Mikkonen S, Nissi MJ, Töyräs J, Link TM, Souza R, Majumdar S, Ma B, Li X, Korhonen RK. Subject-specific biomechanical analysis to estimate locations susceptible to osteoarthritis-Finite element modeling and MRI follow-up of ACL reconstructed patients. J Orthop Res 2022; 40:1744-1755. [PMID: 34820897 PMCID: PMC9127000 DOI: 10.1002/jor.25218] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 09/16/2021] [Accepted: 11/09/2021] [Indexed: 02/04/2023]
Abstract
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 T1ρ 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 T1ρ 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 T1ρ 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.
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Affiliation(s)
- Paul O. Bolcos
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Corresponding author: Paul Octavian Bolcos, Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211 Kuopio, Finland, Tel. +358 45 2290653,
| | - Mika E. Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Koren E. Roach
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | - Matthew S. Tanaka
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | | | - Santtu Mikkonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mikko J. Nissi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia,Diagnostic Imaging Centre, Kuopio University Hospital, Kuopio Finland
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | - Richard Souza
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | - Sharmila Majumdar
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | - Benjamin Ma
- Department of Radiology and Biomedical Imaging, University of California San Francisco, San Francisco, Unites States of America
| | - Xiaojuan Li
- Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Unites States of America
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland,Department of Clinical Radiology, Kuopio University Hospital, Kuopio, Finland
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14
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Shao B, Xing J, Zhao B, Wang T, Mu W. Role of the proximal tibiofibular joint on the biomechanics of the knee joint: A three-dimensional finite element analysis. Injury 2022; 53:2446-2453. [PMID: 35610073 DOI: 10.1016/j.injury.2022.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 04/21/2022] [Accepted: 05/17/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE The proximal tibiofibular joint (PTFJ) is easily ignored, although many diseases of the knee are caused by PTFJ injuries. Therefore, studying PTFJ biomechanics is very important. The effects of PTFJ injury on ankle function have been reported. However, few studies have assessed the effects of PTFJ injury on the knee joint. This study was performed to describe the biomechanical effects of PTFJ on the knee joint according to a three-dimensional finite element model. METHODS The knee joint of a healthy volunteer was scanned by CT and MRI. CT and MRI scanning data in DICOM format were imported into Mimics software. Subsequently, 3D models of the normal and PTFJ injured knee, including the bone, cartilage, meniscus and ligament structures were established, and their validity was verified on the basis of available studies in literature. The biomechanical changes in the two knee models under different conditions were compared. RESULTS The validity of the intact model was verified. No significant difference was observed in tibial mobility in the two models under the conditions of 134 N forward, 10 N·m internal rotation and 10 N·m valgus load. After application of 134 N backward, 10 N·m varus and external rotation load with respect to the tibia, the posterior movement of the tibia and the varus and external rotation angles of the tibia were 3.583±0.892 mm, 4.799±0.092° and 18.963±0.027° in the normal knee model, and 5.127±1.224 mm, 5.277±0.104° and 21.399±0.031° in the PTFJ injury model, respectively, and a significant statistical difference was observed. CONCLUSIONS PTFJ played an important role in maintaining the posterolateral stability of the knee joint and thus deserves more attention in clinical operations.
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Affiliation(s)
- Bin Shao
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China; Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Jianqiang Xing
- Department of Orthopaedics, Binzhou Medical University Hospital, Binzhou, Shandong, China
| | - Bei Zhao
- Department of Orthopaedics, Liaocheng People's Hospital, Liaocheng, Shandong, China
| | - Tingguang Wang
- Department of Orthopaedics, The People's Hospital of Zouping City, Zouping, Shandong, China
| | - Weidong Mu
- Department of Traumatic Orthopaedics, Shandong Provincial Hospital, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China.
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15
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A musculoskeletal finite element model of rat knee joint for evaluating cartilage biomechanics during gait. PLoS Comput Biol 2022; 18:e1009398. [PMID: 35657996 PMCID: PMC9166403 DOI: 10.1371/journal.pcbi.1009398] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 04/26/2022] [Indexed: 12/02/2022] Open
Abstract
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.
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16
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Evaluation of anterior cruciate ligament surgical reconstruction through finite element analysis. Sci Rep 2022; 12:8044. [PMID: 35577879 PMCID: PMC9110399 DOI: 10.1038/s41598-022-11601-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 04/21/2022] [Indexed: 11/08/2022] Open
Abstract
Anterior cruciate ligament (ACL) tear is one of the most common knee injuries. The ACL reconstruction surgery aims to restore healthy knee function by replacing the injured ligament with a graft. Proper selection of the optimal surgery parameters is a complex task. To this end, we developed an automated modeling framework that accepts subject-specific geometries and produces finite element knee models incorporating different surgical techniques. Initially, we developed a reference model of the intact knee, validated with data provided by the Open Knee(s) project. This helped us evaluate the effectiveness of estimating ligament stiffness directly from MRI. Next, we performed a plethora of “what-if” simulations, comparing responses with the reference model. We found that (a) increasing graft pretension and radius reduces relative knee displacement, (b) the correlation of graft radius and tension should not be neglected, (c) graft fixation angle of 20\documentclass[12pt]{minimal}
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\begin{document}$$^{\circ }$$\end{document}∘ can reduce knee laxity, and (d) single-versus double-bundle techniques demonstrate comparable performance in restraining knee translation. In most cases, these findings confirm reported values from comparative clinical studies. The numerical models are made publicly available, allowing for experimental reuse and lowering the barriers for meta-studies. The modeling approach proposed here can complement orthopedic surgeons in their decision-making.
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17
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Sequential damage assessment of the posterolateral complex of the knee joint: a finite element study. J Orthop Surg Res 2022; 17:185. [PMID: 35346281 PMCID: PMC8962527 DOI: 10.1186/s13018-022-03034-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 02/22/2022] [Indexed: 12/27/2022] Open
Abstract
Background The posterolateral complex (PLC), which consists of the popliteus tendon (PT), lateral collateral ligament (LCL), and popliteofibular ligament (PFL), is an indispensable structure of the knee joint. The aim of this study was to explore the functionality of the PLC by determining the specific role of each component in maintaining posterolateral knee stability. Methods A finite element (FE) model was generated based on previous material property data and magnetic resonance imaging of a volunteer’s knee joint. The injury order of the PLC was set as LCL, PFL, and PT. A combined compressive load of 1150 N and an anterior tibial load of 134 N was applied to the tibia to investigate tibial displacement (TD). Tibial external rotation (TER) and tibial varus angulation (TVA) were measured under bending motions of 5 and 10 Nm. The instantaneous axis of rotation (IAR) of the knee joint under different rotation motions was also recorded. Results The TD of the intact knee under a combined compressive load of 1150 N and an anterior tibial load of 134 N matched the values determined in previous studies. Our model showed consistent increases in TD, TVA, and TER after sequential damage of the PLC. In addition, sequential disruption caused the IAR to shift superiorly and laterally during varus rotation and medially and anteriorly during external rotation. In the dynamic damage of the PLC, LCL injury had the largest effect on TD, TVA, TER, and IAR. Conclusions Sequential injury of the PLC caused considerable loss of stability of the knee joint according to an FE model. The most significant structure of the PLC was the LCL.
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18
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Al Khatib F, Gouissem A, Mbarki R, Adouni M. Biomechanical Characteristics of the Knee Joint during Gait in Obese versus Normal Subjects. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:989. [PMID: 35055810 PMCID: PMC8775559 DOI: 10.3390/ijerph19020989] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 01/09/2022] [Accepted: 01/13/2022] [Indexed: 02/04/2023]
Abstract
Knee osteoarthritis (OA) is a growing source of pain and disability. Obesity is the most important avoidable risk factor underlying knee OA. The processes by which obesity impacts osteoarthritis are of tremendous interest to osteoarthritis researchers and physicians, where the joint mechanical load is one of the pathways generally thought to cause or intensify the disease process. In the current work, we developed a hybrid framework that simultaneously incorporates a detailed finite element model of the knee joint within a musculoskeletal model to compute lower extremity muscle forces and knee joint stresses in normal-weight (N) and obese (OB) subjects during the stance phase gait. This model accounts for the synergy between the active musculature and passive structures. In comparing OB subjects and normal ones, forces significantly increased in all muscle groups at most instances of stance. Mainly, much higher activation was computed with lateral hamstrings and medial gastrocnemius. Cartilage contact average pressure was mostly supported by the medial plateau and increased by 22%, with a larger portion of the load transmitted via menisci. This medial compartment experienced larger relative movement and cartilage stresses in the normal subjects and continued to do so with a higher level in the obese subjects. Finally, the developed bioengineering frame and the examined parameters during this investigation might be useful clinically in evaluating the initiation and propagation of knee OA.
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Affiliation(s)
- Fadi Al Khatib
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Afif Gouissem
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Raouf Mbarki
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
| | - Malek Adouni
- Mechanical Engineering Department, Australian College of Kuwait, East Mishref, P.O. Box 1411, Safat 12000, Kuwait; (F.A.K.); (A.G.); (R.M.)
- Physical Medicine and Rehabilitation Department, Northwestern University, 345 East Superior Street, Chicago, IL 60611, USA
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19
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Second Generation of Tissue-Engineered Ligament Substitutes for Torn ACL Replacement: Adaptations for Clinical Applications. Bioengineering (Basel) 2021; 8:bioengineering8120206. [PMID: 34940359 PMCID: PMC8698634 DOI: 10.3390/bioengineering8120206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/03/2021] [Accepted: 12/08/2021] [Indexed: 11/16/2022] Open
Abstract
The anterior cruciate ligament (ACL) of the knee joint is one of the strongest ligaments of the body and is often the target of traumatic injuries. Unfortunately, its healing potential is limited, and the surgical options for its replacement are frequently associated with clinical issues. A bioengineered ACL (bACL) was developed using a collagen matrix, seeded with autologous cells and successfully grafted and integrated into goat knee joints. We hypothesize that, in order to reduce the cost and simplify the model, an acellular bACL can be used as a substitute for a torn ACL, and bone plugs can be replaced by endobuttons to fix the bACL in situ. First, acellular bACLs were successfully grafted in the goat model with 18% recovery of ultimate tensile strength 6 months after implantation (94 N/mm2 vs. 520). Second, a bACL with endobuttons was produced and tested in an exvivo bovine knee model. The natural collagen scaffold of the bACL contributes to supporting host cell migration, growth and differentiation in situ post-implantation. Bone plugs were replaced by endobuttons to design a second generation of bACLs that offer more versatility as biocompatible grafts for torn ACL replacement in humans. A robust collagen bACL will allow solving therapeutic issues currently encountered by orthopedic surgeons such as donor-site morbidity, graft failure and post-traumatic osteoarthritis.
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20
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Bartolin PB, Boixadera R, Hudetz D. Experimental testing and finite element method analysis of the anterior cruciate ligament primary repair with internal brace augmentation. Med Eng Phys 2021; 95:76-83. [PMID: 34479695 DOI: 10.1016/j.medengphy.2021.07.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/15/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
The internal brace (IB) technique is a promising treatment option for repairing the proximal rupture of the anterior cruciate ligament (ACL). This paper presents a biomechanical evaluation of the IB technique. Sixteen cadaveric sheep knees underwent monotonic tensile tests, cyclic loading, and passive flexion-extension testing. Data were compared in a series of eight control specimens with an intact ACL and eight repaired specimens where the ACL was cut and repaired using the IB. In parallel with the mechanical testing, finite element analysis (FEA) was performed to investigate the influence of IB loading on the femur-ACL-tibia complex (FATC). The 3D geometry of the FATC was reconstructed from CT scans of the sheep. The IB 3D model was integrated with the 3D FATC for FEA to obtain the femur-repaired ACL with IB - tibia complex (FRA-IB-TC) group. For the intact specimens, the mean (±SD) failure load in the tensile testing was 937 N (±192 N), while for the FRA-IB-TC specimens, it was 519 N (±52 N). The FRA-IB-TC remained biomechanically stable during the cyclic loading testing. The FEA demonstrated an increase in ACL stress to 24.59 MPa and displacement values of 0.391 mm. The IB construct exhibited shear and notch effects at the button-suture-bone fixation site. Testing on this sheep model allowed us a parametric analysis of the impact of the IB repair technique. However, the results will need to be confirmed in a human model. In conclusion, although the IB technique has biomechanical drawbacks, the mechanical properties of the technique are satisfactory.
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Affiliation(s)
- Petra Bonačić Bartolin
- PhD Student/Teaching Assistant at the Faculty of Mechanical Engineering and Naval Architecture, University of Zagreb, Zagreb, Croatia.
| | - Rachel Boixadera
- Medical Student at University of Cambridge, Cambridge, United Kingdom
| | - Damir Hudetz
- Faculty of Medicine, Assistant Professor at the University of Osijek, Osijek, Croatia
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21
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Orozco GA, Bolcos P, Mohammadi A, Tanaka MS, Yang M, Link TM, Ma B, Li X, Tanska P, Korhonen RK. Prediction of local fixed charge density loss in cartilage following ACL injury and reconstruction: A computational proof-of-concept study with MRI follow-up. J Orthop Res 2021; 39:1064-1081. [PMID: 32639603 PMCID: PMC7790898 DOI: 10.1002/jor.24797] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 06/15/2020] [Accepted: 06/25/2020] [Indexed: 02/04/2023]
Abstract
The purpose of this proof-of-concept study was to develop three-dimensional patient-specific mechanobiological knee joint models to simulate alterations in the fixed charged density (FCD) around cartilage lesions during the stance phase of the walking gait. Two patients with anterior cruciate ligament (ACL) reconstructed knees were imaged at 1 and 3 years after surgery. The magnetic resonance imaging (MRI) data were used for segmenting the knee geometries, including the cartilage lesions. Based on these geometries, finite element (FE) models were developed. The gait of the patients was obtained using a motion capture system. Musculoskeletal modeling was utilized to calculate knee joint contact and lower extremity muscle forces for the FE models. Finally, a cartilage adaptation algorithm was implemented in both FE models. In the algorithm, it was assumed that excessive maximum shear and deviatoric strains (calculated as the combination of principal strains), and fluid velocity, are responsible for the FCD loss. Changes in the longitudinal T1ρ and T2 relaxation times were postulated to be related to changes in the cartilage composition and were compared with the numerical predictions. In patient 1 model, both the excessive fluid velocity and strain caused the FCD loss primarily near the cartilage lesion. T1ρ and T2 relaxation times increased during the follow-up in the same location. In contrast, in patient 2 model, only the excessive fluid velocity led to a slight FCD loss near the lesion, where MRI parameters did not show evidence of alterations. Significance: This novel proof-of-concept study suggests mechanisms through which a local FCD loss might occur near cartilage lesions. In order to obtain statistical evidence for these findings, the method should be investigated with a larger cohort of subjects.
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Affiliation(s)
- Gustavo A. Orozco
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland Yliopistonranta 1, FI-70210 Kuopio, Finland.,Corresponding author: Gustavo A. Orozco, Department of Applied Physics, University of Eastern Finland, Kuopio, Finland, Yliopistonranta 1, 70210 Kuopio, FI, Tel: +358 50 3485018,
| | - Paul Bolcos
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland Yliopistonranta 1, FI-70210 Kuopio, Finland
| | - Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland Yliopistonranta 1, FI-70210 Kuopio, Finland
| | - Matthew S. Tanaka
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1500 Owens St, San Francisco, CA 94158, USA
| | - Mingrui Yang
- Department of Biomedical Engineering, Lerner Research Institute, Program of Advanced Musculoskeletal Imaging (PAMI), 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1500 Owens St, San Francisco, CA 94158, USA
| | - Benjamin Ma
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, 1500 Owens St, San Francisco, CA 94158, USA
| | - Xiaojuan Li
- Department of Biomedical Engineering, Lerner Research Institute, Program of Advanced Musculoskeletal Imaging (PAMI), 9500 Euclid Avenue, Cleveland Clinic, Cleveland, OH 44195, USA
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland Yliopistonranta 1, FI-70210 Kuopio, Finland
| | - Rami K. Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland Yliopistonranta 1, FI-70210 Kuopio, Finland
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22
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Borges M, Moura R, Oliveira D, Parente M, Mascarenhas T, Natal R. Effect of the birthing position on its evolution from a biomechanical point of view. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105921. [PMID: 33422852 DOI: 10.1016/j.cmpb.2020.105921] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 12/23/2020] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE During vaginal delivery, several positions can be adopted by the mother to be more comfortable and to help the labor process. The positions chosen are very influenced by factors such as monitoring and intervention during the second stage of labor. However, there is limited evidence to support the most ideal birthing position. This work aims at contributing to a better knowledge associated with the widening of the pubic symphysis and the biomechanics of flexible and non-flexible sacrum positions that can be adopted during the second stage of labor, as well as their resulting pathophysiological consequences. METHODS A validated computational model composed by the pelvic floor muscles attached to the bones, and a fetus head was used to simulate vaginal deliveries. This model was modified to mimic two birthing positions: one that allows the free movement of the coccyx as in flexible sacrum positions and other in which this movement is more restricted as in non-flexible sacrum positions. The widening of the pubic symphysis was also considered to facilitate the passage of the fetus head. RESULTS The results obtained showed that, in non-flexible sacrum positions, where the coccyx movement is restricted, occur a rotation of 3.6° of the coccyx and a widening of 6 mm of the pubic symphysis. In contrast, in flexible sacrum positions, where the coccyx is free to move, occur a rotation of 15.7° of the coccyx and a widening of the pubic symphysis of 3 mm, appearing to be more beneficial for the mother's pelvis, but slightly higher stresses were detected in the pelvic floor muscles. CONCLUSIONS Globally, the results obtained allow to conclude that different birthing positions lead to changes in the female pelvic space, so certain positions can be adopted by the mother during the second stage of labor to reduce the risk of obstructed labor and the development of several dysfunctions. More specifically, flexible sacrum positions, such as kneeling, standing, squatting and sitting positions, are more beneficial for the bone structure of her pelvis as they allow a higher coccyx movement and lower widening of the pubic symphysis.
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Affiliation(s)
- Margarida Borges
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal.
| | - Rita Moura
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Dulce Oliveira
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Marco Parente
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
| | - Teresa Mascarenhas
- Centro Hospitalar Universitário de São João, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Renato Natal
- INEGI-LAETA, Faculty of Engineering, University of Porto, Campus FEUP, Rua Dr. Roberto Frias, 400, 4600-465 Porto, Portugal
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23
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Rosario R, Marchi BC, Arruda EM, Coleman RM. The Influence of Anterior Cruciate Ligament Matrix Mechanical Properties on Simulated Whole-Knee Biomechanics. J Biomech Eng 2020; 142:1084898. [PMID: 32601691 DOI: 10.1115/1.4047658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Indexed: 11/08/2022]
Abstract
Knee finite element (FE) models are used to study tissue deformation in response to complex loads. Typically, ligaments are modeled using transversely isotropic, hyperelastic material models fitted to tension data along the predominant fiber direction (longitudinal) and, less commonly, to tension data orthogonal to the fiber direction (transverse). Currently, the shear and bulk responses of the anterior cruciate ligament (ACL) are not fitted to experimental data. In this study, a newly proposed material model was fitted to longitudinal tension, transverse tension, and shear experimental data. The matrix transverse tensile, shear, and bulk stiffnesses were then varied independently to determine the impact of each property on knee kinematics and tissue deformation in a whole-knee FE model. The range of values for each parameter was chosen based on published FE studies of the knee. For a knee at full extension under 134 N anterior tibial force (ATF), increasing matrix transverse tensile stiffness, shear stiffness, or bulk stiffness decreased anterior tibial translation (ATT), ACL longitudinal strain, and ACL shear strain. For a knee under 134 N ATF and 1600 N compression, changing the ACL matrix mechanical properties caused variations in ATT and thus changed cartilage deformation contours by changing the point of contact between the femoral and the tibial cartilage. These findings indicate that material models for the ACL must describe matrix material properties to best predict the in vivo response to applied loads.
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Affiliation(s)
- Ryan Rosario
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Benjamin C Marchi
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Ellen M Arruda
- Department of Mechanical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109; Department of Biomedical Engineering, Program in Macromolecular Science and Engineering, University of Michigan, Ann Arbor, MI 48109
| | - Rhima M Coleman
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109; Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI 48109
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24
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Ristaniemi A, Tanska P, Stenroth L, Finnilä MAJ, Korhonen RK. Comparison of material models for anterior cruciate ligament in tension: from poroelastic to a novel fibril-reinforced nonlinear composite model. J Biomech 2020; 114:110141. [PMID: 33302181 DOI: 10.1016/j.jbiomech.2020.110141] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 11/05/2020] [Accepted: 11/12/2020] [Indexed: 12/15/2022]
Abstract
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.
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Affiliation(s)
- A Ristaniemi
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M A J Finnilä
- Research Unit of Medical Imaging, Physics and Technology, University of Oulu, Oulu, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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25
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Haris A, Beng Chye Tan V. Stress response envelopes of intact tibiofemoral joint and knee osteoarthritis. Proc Inst Mech Eng H 2020; 234:1151-1161. [DOI: 10.1177/0954411920944078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The purpose of this study was to determine stress envelopes for an intact tibiofemoral joint and to study how they vary with knee loading, external–internal rotation, varus–valgus rotation and cartilage degradation (osteoarthritis) using the finite element method. The envelopes were presented in terms of knee flexion angle. The maximum von Mises stress for all tibiofemoral joint components increased with increasing the axial compressive force magnitude. Menisci exhibited the highest magnitude of maximum von Mises stress as compared to the femoral and tibial cartilages. In a range of flexion angles between 0° and 100°, the medial meniscus exhibited the highest maximum von Mises stress than the lateral meniscus and the stress in medial meniscus tended to increase with increasing the flexion angle. External–internal and varus–valgus rotations changed the stress distribution: higher stress on lateral compartment but lower stress on medial compartment, and conversely. The internal rotation provided more extreme effect than the external rotation. For the knee osteoarthritis, cartilage degradation (early stage) caused maximum von Mises stress to increase on the intact menisci revealing that knee osteoarthritis could also cause meniscal tear. The late osteoarthritis caused the maximum von Mises stress to increase on the calcified cartilage and subchondral bone.
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Affiliation(s)
- Andi Haris
- Department of Mechanical Engineering, National University of Singapore, Singapore
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26
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Identification of locations susceptible to osteoarthritis in patients with anterior cruciate ligament reconstruction: Combining knee joint computational modelling with follow-up T 1ρ and T 2 imaging. Clin Biomech (Bristol, Avon) 2020; 79:104844. [PMID: 31439361 DOI: 10.1016/j.clinbiomech.2019.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Revised: 06/28/2019] [Accepted: 08/07/2019] [Indexed: 02/07/2023]
Abstract
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 T1ρ 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 T1ρ 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 T1ρ 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.
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27
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Sizeland KH, Wells HC, Kirby NM, Hawley A, Mudie ST, Ryan TM, Haverkamp RG. Bovine Meniscus Middle Zone Tissue: Measurement of Collagen Fibril Behavior During Compression. Int J Nanomedicine 2020; 15:5289-5298. [PMID: 32821095 PMCID: PMC7419642 DOI: 10.2147/ijn.s261298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/09/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type I collagen is the major component of the extracellular matrix of the knee's meniscus and plays a central role in that joint's biomechanical properties. Repair and reconstruction of tissue damage often requires a scaffold to assist the body to rebuild. The middle zone of bovine meniscus is a material that may be useful for the preparation of extracellular matrix scaffolds. METHODS Here, synchrotron-based small-angle X-ray scattering (SAXS) patterns of bovine meniscus were collected during unconfined compression. Collagen fibril orientation, D-spacing, compression distance and force were measured. RESULTS The collagen fibrils in middle zone meniscal fibrocartilage become more highly oriented perpendicular to the direction of compression. The D-spacing also increases, from 65.0 to 66.3 nm with compression up to 0.43 MPa, representing a 1.8% elongation of collagen fibrils perpendicular to the compression. CONCLUSION The elasticity of the collagen fibrils under tension along their length when the meniscus is compressed, therefore, contributes to the overall elastic response of the meniscus only under loads that exceed those likely to be experienced physiologically.
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Affiliation(s)
| | - Hannah C Wells
- School of Food and Advanced Technology, Massey University, Palmerston North4472, New Zealand
| | - Nigel M Kirby
- SAXS/WAXS Beamline, Australian Synchrotron, ANSTO, Clayton, Melbourne, VIC3168, Australia
| | - Adrian Hawley
- SAXS/WAXS Beamline, Australian Synchrotron, ANSTO, Clayton, Melbourne, VIC3168, Australia
| | - Stephen T Mudie
- SAXS/WAXS Beamline, Australian Synchrotron, ANSTO, Clayton, Melbourne, VIC3168, Australia
| | - Tim M Ryan
- SAXS/WAXS Beamline, Australian Synchrotron, ANSTO, Clayton, Melbourne, VIC3168, Australia
| | - Richard G Haverkamp
- School of Food and Advanced Technology, Massey University, Palmerston North4472, New Zealand
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28
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Fontanella CG, Macchi V, Porzionato A, Arduino A, Fotso Fongang JV, De Caro R, Natali AN, Carniel EL. A numerical investigation of the infrapatellar fat pad. Proc Inst Mech Eng H 2020; 234:1113-1121. [PMID: 32650701 DOI: 10.1177/0954411920940839] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The infrapatellar fat pad is an adipose tissue in the knee that facilitates the distribution of synovial fluid and absorbs impulsive actions generated through the joint. The correlation between morphological configuration and mechanical properties is analyzed by a computational approach. The microscopic anatomy of the infrapatellar fat pad is studied aiming to measure the dimension of adipose lobules and the thickness of connective septa. Results from histomorphometric investigations show that the infrapatellar fat pad is an inhomogeneous tissue, constituted by large lobules in the superficial part and smaller lobules in the deepest one. Finite element models of the infrapatellar fat pad are developed. The first model considers the inhomogeneous conformation of the infrapatellar fat pad, composed of micro- and macro-chambers, while the second model considers a homogeneous distribution of adipose lobules with similar dimensions. Computational analyses are performed considering the static standing configuration and the passive flexion-extension movement. The computational results allow us to identify the different stress and strain fields within the tissue and to appreciate the variation of the mechanical performance of the overall system considering the distribution of adipose lobules. Results show that the distribution of adipose lobules in macro- and micro-chambers allows major deformation of the infrapatellar fat pad, decreasing the stress inside the tissues.
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Affiliation(s)
- Chiara Giulia Fontanella
- Department of Industrial Engineering, University of Padova, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Veronica Macchi
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.,Institute of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Andrea Porzionato
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.,Institute of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Alessandro Arduino
- Department of Civil, Environmental and Architectural Engineering, University of Padova, Padova, Italy
| | | | - Raffaele De Caro
- Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy.,Institute of Human Anatomy, Department of Neuroscience, University of Padova, Padova, Italy
| | - Arturo Nicola Natali
- Department of Industrial Engineering, University of Padova, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
| | - Emanuele Luigi Carniel
- Department of Industrial Engineering, University of Padova, Padova, Italy.,Centre for Mechanics of Biological Materials, University of Padova, Padova, Italy
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29
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Constitutive modeling of menisci tissue: a critical review of analytical and numerical approaches. Biomech Model Mechanobiol 2020; 19:1979-1996. [PMID: 32572727 DOI: 10.1007/s10237-020-01352-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Accepted: 05/28/2020] [Indexed: 02/07/2023]
Abstract
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.
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30
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Ristaniemi A, Torniainen J, Stenroth L, Finnilä M, Paakkonen T, Töyräs J, Korhonen R. Comparison of water, hydroxyproline, uronic acid and elastin contents of bovine knee ligaments and patellar tendon and their relationships with biomechanical properties. J Mech Behav Biomed Mater 2020; 104:103639. [DOI: 10.1016/j.jmbbm.2020.103639] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Revised: 01/13/2020] [Accepted: 01/13/2020] [Indexed: 12/13/2022]
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31
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2 10.1109/tnsre.2022.3159685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
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.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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32
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Esrafilian A, Stenroth L, Mononen ME, Tanska P, Avela J, Korhonen RK. EMG-Assisted Muscle Force Driven Finite Element Model of the Knee Joint with Fibril-Reinforced Poroelastic Cartilages and Menisci. Sci Rep 2020; 10:3026. [PMID: 32080233 PMCID: PMC7033219 DOI: 10.1038/s41598-020-59602-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 01/31/2020] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- A Esrafilian
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - L Stenroth
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - M E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - P Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - J Avela
- NeuroMuscular Research Center, Unit of Biology of Physical Activity, Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - R K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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33
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Ardestani MM, ZhenXian C, Noori-Dokht H, Moazen M, Jin Z. Computational analysis of knee joint stability following total knee arthroplasty. J Biomech 2019; 86:17-26. [PMID: 30718067 DOI: 10.1016/j.jbiomech.2019.01.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 01/14/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
The overall objective of this study was to introduce knee joint power as a potential measure to investigate knee joint stability following total knee arthroplasty (TKA). Specific aims were to investigate whether weakened knee joint stabilizers cause abnormal kinematics and how it influences the knee joint kinetic (i.e., power) in response to perturbation. Patient-specific musculoskeletal models were simulated with experimental gait data from six TKA patients (baseline models). Muscle strength and ligament force parameter were reduced by up to 30% to simulate weak knee joint stabilizers (weak models). Two different muscle recruitment criteria were tested to examine whether altered muscle recruitment pattern can mask the influence of weakened stabilizers on the knee joint kinematics and kinetics. Level-walking knee joint kinematics and kinetics were calculated though force-dependent kinematic and inverse dynamic analyses. Bode analysis was then recruited to estimate the knee joint power in response to a simulated perturbation. Weak models resulted in larger anterior-posterior (A-P) displacement and internal-external (I-E) rotation compared to baseline (I-E: 18.4 ± 8.5 vs. 11.6 ± 5.7 (deg), A-P: 9.7 ± 5.6 vs. 5.5 ± 4.1 (mm)). Changes in muscle recruitment criterion however altered the results such that A-P and I-E were not notably different from baseline models. In response to the simulated perturbation, weak models versus baseline models generated a delayed power response with unbounded magnitudes. Perturbed power behavior of the knee remained unaltered regardless of the muscle recruitment criteria. In conclusion, impairment at the knee joint stabilizers may or may not lead to excessive joint motions but it notably affects the knee joint power in response to a perturbation. Whether perturbed knee joint power is associated with the patient-reported outcome requires further investigation.
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Affiliation(s)
- Marzieh M Ardestani
- Department of Physical Medicine and Rehabilitation, School of Medicine, Indiana University, IN, USA.
| | - Chen ZhenXian
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China
| | - Hessam Noori-Dokht
- School of Mechanical and Energy Engineering, Purdue University, Indianapolis, IN, USA
| | - Mehran Moazen
- Department of Mechanical Engineering, University College London, Torrington Place, London WC1E 7JE, UK
| | - Zhongmin Jin
- School of Mechanical Engineering, Southwest Jiaotong University, Chengdu, China; School of Mechanical Engineering, Xian Jiaotong University, Xian, China; School of Mechanical Engineering, University of Leeds, Leeds LS2 9JT, UK
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34
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Bolcos PO, Mononen ME, Mohammadi A, Ebrahimi M, Tanaka MS, Samaan MA, Souza RB, Li X, Suomalainen JS, Jurvelin JS, Töyräs J, Korhonen RK. Comparison between kinetic and kinetic-kinematic driven knee joint finite element models. Sci Rep 2018; 8:17351. [PMID: 30478347 PMCID: PMC6255758 DOI: 10.1038/s41598-018-35628-5] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 11/08/2018] [Indexed: 12/11/2022] Open
Abstract
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.
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Affiliation(s)
- Paul O Bolcos
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland.
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - Mohammadhossein Ebrahimi
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - Matthew S Tanaka
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, 94158, San Francisco, USA
| | - Michael A Samaan
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, 94158, San Francisco, USA
- Dept. of Kinesiology & Health Promotion, University of Kentucky, Lexington, KY, 40506, USA
| | - Richard B Souza
- Department of Physical Therapy and Rehabilitation Science, University of California, San Francisco, CA, 94158, USA
| | - Xiaojuan Li
- Department of Radiology and Biomedical Imaging, University of California San Francisco, CA, 94158, San Francisco, USA
- Program of Advanced Musculoskeletal Imaging (PAMI), Department of Biomedical Engineering, Cleveland Clinic, OH, 44195, Cleveland, USA
| | - Juha-Sampo Suomalainen
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, FI-70029, KUH, Kuopio, Finland
| | - Jukka S Jurvelin
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, FI-70029, KUH, Kuopio, Finland
- School of Information Technology and Electrical Engineering, The University of Queensland, QLD-4072, Brisbane, Australia
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, FI-70211, Kuopio, Finland
- Diagnostic Imaging Centre, Kuopio University Hospital, POB 100, FI-70029, KUH, Kuopio, Finland
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