1
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Adouni M, Aydelik H, Faisal TR, Hajji R. The effect of body weight on the knee joint biomechanics based on subject-specific finite element-musculoskeletal approach. Sci Rep 2024; 14:13777. [PMID: 38877075 PMCID: PMC11178890 DOI: 10.1038/s41598-024-63745-x] [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: 03/08/2024] [Accepted: 05/30/2024] [Indexed: 06/16/2024] Open
Abstract
Knee osteoarthritis (OA) and obesity are major public health concerns that are closely intertwined. This intimate relationship was documented by considering obesity as the most significant preventable risk factor associated with knee OA. To date, however, the effects of obesity on the knee joint's passive-active structure and cartilage loading have been inconclusive. Hence, this study investigates the intricate relationship between obesity and knee OA, centering on the biomechanical changes in knee joint active and passive reactions during the stance phase of gait. Using a subject-specific musculoskeletal and finite element approach, muscle forces, ligament stresses, and articular cartilage contact stresses were analyzed among 60 individuals with different body mass indices (BMI) classified under healthy weight, overweight, and obese categories. Our predicted results showed that obesity significantly influenced knee joint mechanical reaction, increasing muscle activations, ligament loading, and articular cartilage contact stresses, particularly during key instances of the gait cycle-first and second peak loading instances. The study underscores the critical role of excessive body weight in exacerbating knee joint stress distribution and cartilage damage. Hence, the insights gained provide a valuable biomechanical perspective on the interaction between body weight and knee joint health, offering a clinical utility in assessing the risks associated with obesity and knee OA.
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Affiliation(s)
- Malek Adouni
- Biomedical and Instrumentation Engineering, Abdullah Al Salem University, Khalidiya, Kuwait.
- Physical Medicine and Rehabilitation Department, Northwestern University, 345 East Superior Street, Chicago, IL, 60611, USA.
| | - Harun Aydelik
- Mathematics, College of Integrative Studies, Abdullah Al Salem University, Khalidiya, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, 70508, USA
| | - Raouf Hajji
- Internal Medicine Department, Medicine Faculty of Sousse, University of Sousse, Sousse, Tunisia
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2
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Adouni M, Alkhatib F, Gouissem A, Faisal TR. Knee joint biomechanics and cartilage damage prediction during landing: A hybrid MD-FE-musculoskeletal modeling. PLoS One 2023; 18:e0287479. [PMID: 37535559 PMCID: PMC10399834 DOI: 10.1371/journal.pone.0287479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 06/06/2023] [Indexed: 08/05/2023] Open
Abstract
Understanding the mechanics behind knee joint injuries and providing appropriate treatment is crucial for improving physical function, quality of life, and employability. In this study, we used a hybrid molecular dynamics-finite element-musculoskeletal model to determine the level of loads the knee can withstand when landing from different heights (20, 40, 60 cm), including the height at which cartilage damage occurs. The model was driven by kinematics-kinetics data of asymptomatic subjects at the peak loading instance of drop landing. Our analysis revealed that as landing height increased, the forces on the knee joint also increased, particularly in the vastus muscles and medial gastrocnemius. The patellar tendon experienced more stress than other ligaments, and the medial plateau supported most of the tibial cartilage contact forces and stresses. The load was mostly transmitted through cartilage-cartilage interaction and increased with landing height. The critical height of 126 cm, at which cartilage damage was initiated, was determined by extrapolating the collected data using an iterative approach. Damage initiation and propagation were mainly located in the superficial layers of the tibiofemoral and patellofemoral cartilage. Finally, this study provides valuable insights into the mechanisms of landing-associated cartilage damage and could help limit joint injuries and improve training programs.
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Affiliation(s)
- Malek Adouni
- Physical Medicine and Rehabilitation Department, Northwestern University, Chicago, IL, United States of America
- Mechanical Engineering Department, Australian University, East Mushrif, Kuwait
| | - Fadi Alkhatib
- Mechanical Engineering Department, Australian University, East Mushrif, Kuwait
| | - Afif Gouissem
- Mechanical Engineering Department, Australian University, East Mushrif, Kuwait
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, Lafayette, LA, United States of America
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3
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Makani A, Shirazi-Adl SA, Ghezelbash F. Computational biomechanics of human knee joint in stair ascent: Muscle-ligament-contact forces and comparison with level walking. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3646. [PMID: 36054682 DOI: 10.1002/cnm.3646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 07/28/2022] [Accepted: 08/23/2022] [Indexed: 06/15/2023]
Abstract
About a third of knee joint disorders originate from the patellofemoral (PF) site that makes stair ascent a difficult activity for patients. A detailed finite element model of the knee joint is coupled to a lower extremity musculoskeletal model to simulate the stance phase of stair ascent. It is driven by the mean of measurements on the hip-knee-ankle moments-angles as well as ground reaction forces reported in healthy individuals. Predicted muscle activities compare well to the recorded electromyography data. Peak forces in quadriceps (3.87 BW, body weight, at 20% instance in our 607 N subject), medial hamstrings (0.77 BW at 20%), and gastrocnemii (1.21 BW at 80%) are estimated. Due to much greater flexion angles-moments in the first half of stance, large PF contact forces (peak of 3.1 BW at 20% stance) and stresses (peak of 4.83 MPa at 20% stance) are estimated that exceed their peaks in level walking by fourfold and twofold, respectively. Compared with level walking, ACL forces diminish in the first half of stance but substantially increase later in the second half (peak of 0.76 BW at 75% stance). Under nearly similar contact forces at 20% of stance, the contact stress on the tibiofemoral (TF) medial plateau reaches a peak (9.68 MPa) twice that on the PF joint suggesting the vulnerability of both joints. Compared with walking, stair ascent increases peak ACL force and both peak TF and PF contact stresses. Reductions in the knee flexion moment and/or angle appear as a viable strategy to mitigate internal loads and pain.
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Affiliation(s)
- Amirhossein Makani
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
| | - Saeed A Shirazi-Adl
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
| | - Farshid Ghezelbash
- Department of Mechanical Engineering, Polytechnique Montréal, Montreal, Québec, Canada
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4
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Rapid X-Ray-Based 3-D Finite Element Modeling of Medial Knee Joint Cartilage Biomechanics During Walking. Ann Biomed Eng 2022; 50:666-679. [PMID: 35262835 PMCID: PMC9079039 DOI: 10.1007/s10439-022-02941-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 02/23/2022] [Indexed: 11/30/2022]
Abstract
Finite element (FE) modeling is becoming an increasingly popular method for analyzing knee joint mechanics and biomechanical mechanisms leading to osteoarthritis (OA). The most common and widely available imaging method for knee OA diagnostics is planar X-ray imaging, while more sophisticated imaging methods, e.g., magnetic resonance imaging (MRI) and computed tomography (CT), are seldom used. Hence, the capability to produce accurate biomechanical knee joint models directly from X-ray imaging would bring FE modeling closer to clinical use. Here, we extend our atlas-based framework by generating FE knee models from X-ray images (N = 28). Based on measured anatomical landmarks from X-ray and MRI, knee joint templates were selected from the atlas library. The cartilage stresses and strains of the X-ray-based model were then compared with the MRI-based model during the stance phase of the gait. The biomechanical responses were statistically not different between MRI- vs. X-ray-based models when the template obtained from X-ray imaging was the same as the MRI template. However, if this was not the case, the peak values of biomechanical responses were statistically different between X-ray and MRI models. The developed X-ray-based framework may pave the way for a clinically feasible approach for knee joint FE modeling.
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5
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Lahkar BK, Rohan PY, Pillet H, Thoreux P, Skalli W. Development and evaluation of a new procedure for subject-specific tensioning of finite element knee ligaments. Comput Methods Biomech Biomed Engin 2021; 24:1195-1205. [PMID: 33427509 DOI: 10.1080/10255842.2020.1870220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Subject-specific tensioning of ligaments is essential for the stability of the knee joint and represents a challenging aspect in the development of finite element models. We aimed to introduce and evaluate a new procedure for the quantification of ligament prestrains from biplanar X-ray and CT data. Subject-specific model evaluation was performed by comparing predicted femorotibial kinematics with the in vitro response of six cadaveric specimens. The differences obtained using personalized models were comparable to those reported in similar studies in the literature. This study is the first step toward the use of simplified, personalized knee FE models in clinical context such as ligament balancing.
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Affiliation(s)
- Bhrigu K Lahkar
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Helene Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Patricia Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
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6
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Mohammadi A, Myller KAH, Tanska P, Hirvasniemi J, Saarakkala S, Töyräs J, Korhonen RK, Mononen ME. Rapid CT-based Estimation of Articular Cartilage Biomechanics in the Knee Joint Without Cartilage Segmentation. Ann Biomed Eng 2020; 48:2965-2975. [PMID: 33179182 PMCID: PMC7723937 DOI: 10.1007/s10439-020-02666-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 10/17/2020] [Indexed: 12/30/2022]
Abstract
Knee osteoarthritis (OA) is a painful joint disease, causing disabilities in daily activities. However, there is no known cure for OA, and the best treatment strategy might be prevention. Finite element (FE) modeling has demonstrated potential for evaluating personalized risks for the progression of OA. Current FE modeling approaches use primarily magnetic resonance imaging (MRI) to construct personalized knee joint models. However, MRI is expensive and has lower resolution than computed tomography (CT). In this study, we extend a previously presented atlas-based FE modeling framework for automatic model generation and simulation of knee joint tissue responses using contrast agent-free CT. In this method, based on certain anatomical dimensions measured from bone surfaces, an optimal template is selected and scaled to generate a personalized FE model. We compared the simulated tissue responses of the CT-based models with those of the MRI-based models. We show that the CT-based models are capable of producing similar tensile stresses, fibril strains, and fluid pressures of knee joint cartilage compared to those of the MRI-based models. This study provides a new methodology for the analysis of knee joint and cartilage mechanics based on measurement of bone dimensions from native CT scans.
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Affiliation(s)
- Ali Mohammadi
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.
| | - Katariina A H Myller
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Medical Physics, Turku University Central Hospital, 20500, Turku, Finland
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Jukka Hirvasniemi
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Juha Töyräs
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland.,Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,School of Information Technology and Electrical Engineering, The University of Queensland, Brisbane, Australia
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, POB 1627, 70211, Kuopio, Finland
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7
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Kalo K, Niederer D, Sus R, Sohrabi K, Banzer W, Groß V, Vogt L. Reprint of "The detection of knee joint sounds at defined loads by means of vibroarthrography". Clin Biomech (Bristol, Avon) 2020; 79:105175. [PMID: 32978020 DOI: 10.1016/j.clinbiomech.2020.105175] [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: 07/02/2019] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Crepitus of the knee may mirror structural and functional changes in the joint during motion. Although the magnitude of these sounds increases with greater cartilage damage, it is unclear whether knee joint sounds also reflect joint loading. METHODS Twelve healthy volunteers (mean 26 (SD 3.6) years, 7 females) participated in the randomized-balanced crossover study. Knee joint sounds were recorded (linear sampling, 5512 Hz) by means of two microphones, one placed on the medial tibial plateau and one on the patella. Two activities of daily living (standing up from/sitting down on a bench; descending stairs) and three open kinetic chain knee extension-flexion cycles (passive movement, 10% and 40% loading of the individual one repetition maximum) were performed. Each participant carried out three sets of five repetitions and three sets of 15 steps downwards (stairs), respectively. For data analysis, the mean sound amplitude and the median power frequency for each loading condition were determined. Friedman test and Bonferroni-Holm adjusted post-hoc test were performed to detect differences between conditions. FINDINGS We obtained significant differences between joint sound amplitudes for all movements, both measured at the medial tibial plateau (Chi2 = 20.7, p < 0.001) and at the patella (Chi2 = 27.6, p < 0.001). We showed a significant difference in the median power frequency of the patella between all movements (Chi2 = 17.8, p < 0.5). INTERPRETATION Overall, the larger the supposed knee joint loading was, the louder was the recorded knee crepitus. Consequently, vibroarthrographically assessed knee joint sounds can differ across knee joint loading conditions.
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Affiliation(s)
- Kristin Kalo
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany.
| | - Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
| | - Rainer Sus
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Winfried Banzer
- Department of Preventive and Sports Medicine, Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt am Main, Germany
| | - Volker Groß
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
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8
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Ołowiana E, Selkow N, Laudner K, Puciato D, Bączkowicz D. Vibroarthrographic analysis of patellofemoral joint arthrokinematics during squats with increasing external loads. BMC Sports Sci Med Rehabil 2020; 12:51. [PMID: 32874592 PMCID: PMC7457288 DOI: 10.1186/s13102-020-00201-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/24/2020] [Indexed: 12/20/2022]
Abstract
Background The patellofemoral joint (PFJ) provides extremely low kinetic friction, which results in optimal arthrokinematic motion quality. Previous research showed that these friction-reducing properties may be diminished due to the increase in articular contact forces. However, this phenomenon has not been analyzed in vivo during functional daily-living activities. The aim of this study was the vibroarthrographic assessment of changes in PFJ arthrokinematics during squats with variated loads. Methods 114 knees from 57 asymptomatic subjects (23 females and 34 males) whose ages ranged from 19 to 26 years were enrolled in this study. Participants were asked to perform 3 trials: 4 repetitions of bodyweight squats (L0), 4 repetitions of 10 kg barbell back loaded squats (L10), 4 repetitions of 20 kg barbell back loaded squats (L20). During the unloaded and loaded (L10, L20) squats, vibroarthrographic signals were collected using an accelerometer placed on the patella and were described by the following parameters: variation of mean square (VMS), mean range (R4), and power spectral density for frequency of 50–250 Hz (P1) and 250–450 Hz (P2). Results Obtained results showed that the lowest values were noted in the unloaded condition and that the increased applied loads had a significant concomitant increase in all the aforementioned parameters bilaterally (p < 0.05). Conclusion This phenomenon indicates that the application of increasing knee loads during squats corresponds to higher intensity of vibroacoustic emission, which might be related to higher contact stress and kinetic friction as well as diminished arthrokinematic motion quality.
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Affiliation(s)
- Ewelina Ołowiana
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
| | - Noelle Selkow
- Illinois State University, School of Kinesiology and Recreation, Normal, IL USA
| | - Kevin Laudner
- Beth El College of Nursing and Health Sciences, University of Colorado, Colorado Springs, CO USA
| | - Daniel Puciato
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
| | - Dawid Bączkowicz
- Faculty of Physical Education and Physiotherapy, Opole University of Technology, Prószkowska 76, PL-45-578 Opole, Poland
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9
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Samani A, Andersen RE, Arendt-Nielsen L, Madeleine P. Discrimination of knee osteoarthritis patients from asymptomatic individuals based on pain sensitivity and knee vibroarthrographic recordings. Physiol Meas 2020; 41:055002. [DOI: 10.1088/1361-6579/ab8857] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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10
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Sritharan P, Schache AG, Culvenor AG, Perraton LG, Bryant AL, Crossley KM. Between-Limb Differences in Patellofemoral Joint Forces During Running at 12 to 24 Months After Unilateral Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2020; 48:1711-1719. [PMID: 32374673 DOI: 10.1177/0363546520914628] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patellofemoral joint (PFJ) osteoarthritis may occur after anterior cruciate ligament reconstruction (ACLR). The mechanisms underpinning the development of PFJ osteoarthritis are not known but may relate to altered PFJ loading. Few studies have assessed PFJ loads during high-impact tasks, such as running, beyond the acute rehabilitation phase (ie, >12 months) after ACLR. PURPOSE/HYPOTHESIS The purpose was to compare between-limb joint angles, joint moments, and PFJ contact force during running in individuals at 12 to 24 months after unilateral ACLR. We hypothesized that peak knee flexion angle, knee extension moment, and PFJ contact force during stance would be lower in the ACLR limb compared with the uninjured limb. STUDY DESIGN Controlled laboratory study. METHODS A total of 55 participants (mean ± SD age, 28 ± 7 years), 12 to 24 months after ACLR, ran at a self-selected speed (2.9 ± 0.3 m/s). Measured kinematics and ground-reaction forces were input into musculoskeletal models to calculate joint moments and muscle forces. These values were subsequently input into a PFJ model to calculate contact force peak and impulse. Outcome measures were compared between the ACLR and uninjured limbs. RESULTS In the ACLR limb, compared with the uninjured limb, the PFJ contact force displayed a lower peak (ACLR, 6.1 ± 1.3 body weight [BW]; uninjured, 6.7 ± 1.4 BW; P < .001) and impulse (ACLR, 0.72 ± 0.17 BW*seconds [BWs]; uninjured, 0.81 ± 0.17 BWs; P < .001). At the time of the peak PFJ contact force, the knee extension moment was lower in the ACLR limb (ACLR, 14.0 ± 2.4 %BW*height [%BW*HT]; uninjured, 15.5 ± 2.5 %BW*HT; P < .001). The opposite was true for the ankle plantarflexion moment (ACLR, 12.1 ± 2.6 %BW*HT; uninjured, 11.5 ± 2.7 %BW*HT; P = .019) and the hip extension moment (ACLR, 2.3 ± 2.5 %BW*HT; uninjured, 1.6 ± 2.3 %BW*HT; P = .013). The foot-ground center of pressure was located more anteriorly with respect to the ankle joint center (ACLR, 5.8 ± 0.9 %height [%HT]; uninjured, 5.4 ± 1.0 %HT; P = .001). No differences were found for the sagittal plane hip, knee, and ankle angles. CONCLUSION The ACLR limb experienced lower peak PFJ loads during running, explained by a small anterior shift in the foot-ground center of pressure during stance that offloaded the torque demand away from the ACLR knee. CLINICAL RELEVANCE Lower net PFJ loading during running in the ACLR limb more than 12 months after ACLR suggests that underloading might play a role in the onset of PFJ osteoarthritis after ACLR.
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Affiliation(s)
| | | | - Adam G Culvenor
- School of Allied Health, La Trobe University, Victoria, Australia
| | - Luke G Perraton
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Adam L Bryant
- Centre for Health, Exercise & Sports Medicine, University of Melbourne, Victoria, Australia
| | - Kay M Crossley
- School of Allied Health, La Trobe University, Victoria, Australia
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11
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Kalo K, Niederer D, Sus R, Sohrabi K, Banzer W, Groß V, Vogt L. The detection of knee joint sounds at defined loads by means of vibroarthrography. Clin Biomech (Bristol, Avon) 2020; 74:1-7. [PMID: 32062324 DOI: 10.1016/j.clinbiomech.2020.01.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 01/13/2020] [Accepted: 01/30/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Crepitus of the knee may mirror structural and functional changes in the joint during motion. Although the magnitude of these sounds increases with greater cartilage damage, it is unclear whether knee joint sounds also reflect joint loading. METHODS Twelve healthy volunteers (mean 26 (SD 3.6) years, 7 females) participated in the randomized-balanced crossover study. Knee joint sounds were recorded (linear sampling, 5512 Hz) by means of two microphones, one placed on the medial tibial plateau and one on the patella. Two activities of daily living (standing up from/sitting down on a bench; descending stairs) and three open kinetic chain knee extension-flexion cycles (passive movement, 10% and 40% loading of the individual one repetition maximum) were performed. Each participant carried out three sets of five repetitions and three sets of 15 steps downwards (stairs), respectively. For data analysis, the mean sound amplitude and the median power frequency for each loading condition were determined. Friedman test and Bonferroni-Holm adjusted post-hoc test were performed to detect differences between conditions. FINDINGS We obtained significant differences between joint sound amplitudes for all movements, both measured at the medial tibial plateau (Chi2 = 20.7, p < 0.001) and at the patella (Chi2 = 27.6, p < 0.001). We showed a significant difference in the median power frequency of the patella between all movements (Chi2 = 17.8, p < 0.5). INTERPRETATION Overall, the larger the supposed knee joint loading was, the louder was the recorded knee crepitus. Consequently, vibroarthrographically assessed knee joint sounds can differ across knee joint loading conditions.
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Affiliation(s)
- Kristin Kalo
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany.
| | - Daniel Niederer
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
| | - Rainer Sus
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Keywan Sohrabi
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Winfried Banzer
- Department of Preventive and Sports Medicine, Institute for Occupational, Social and Environmental Medicine, Goethe University Frankfurt am Main, Germany
| | - Volker Groß
- Faculty of Health Sciences, University of Applied Sciences, Giessen, Germany
| | - Lutz Vogt
- Department of Sports Medicine, Goethe University Frankfurt am Main, Germany
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12
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Sharifi M, Shirazi-Adl A, Marouane H. Sensitivity of the knee joint response, muscle forces and stability to variations in gait kinematics-kinetics. J Biomech 2020; 99:109472. [DOI: 10.1016/j.jbiomech.2019.109472] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Revised: 10/24/2019] [Accepted: 10/26/2019] [Indexed: 10/25/2022]
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13
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Van Houcke J, Galibarov PE, Van Acker G, Fauconnier S, Allaert E, Van Hoof T, Almeida DF, Steenackers G, Pattyn C, Audenaert EA. Personalized hip joint kinetics during deep squatting in young, athletic adults. Comput Methods Biomech Biomed Engin 2019; 23:23-32. [DOI: 10.1080/10255842.2019.1699539] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Jan Van Houcke
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | | | - Gilles Van Acker
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Sigrid Fauconnier
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Ellen Allaert
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Tom Van Hoof
- Department of Anatomy and Embryology, Ghent University, Ghent, Belgium
| | - Diogo F. Almeida
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Gunther Steenackers
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerpen, Belgium
| | - Christophe Pattyn
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
| | - Emmanuel A. Audenaert
- Department of Orthopaedic Surgery and Traumatology, University Hospital Ghent, Ghent, Belgium
- Department of Electromechanics, Op3Mech Research Group, University of Antwerp, Antwerpen, Belgium
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14
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Sakurai A, Harato K, Morishige Y, Kobayashi S, Niki Y, Nagura T. The effects of toe direction on three-dimensional knee kinematics during closed kinetic chain exercise in patients with anterior cruciate ligament deficient knee. ASIA-PACIFIC JOURNAL OF SPORT MEDICINE ARTHROSCOPY REHABILITATION AND TECHNOLOGY 2019; 18:1-5. [PMID: 31516838 PMCID: PMC6728610 DOI: 10.1016/j.asmart.2019.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/20/2019] [Accepted: 07/22/2019] [Indexed: 01/14/2023]
Abstract
Background/Objective Closed Kinetic Chain Exercise (CKC Ex) is a safe rehabilitation method for anterior cruciate ligament deficient (ACLD) and reconstructed knees. However, CKC Ex can be risky based on abnormal toe directions. The purpose was to investigate knee kinematics during CKC Ex under three toe directions in ACLD. Methods Twenty patients with unilateral ACL injury participated. The subjects performed five weight-bearing-static lunge tests on each limb under three toe directions, including 0 degrees (TN), 20 degrees (TI), and -20 degrees (TO). Three-dimensional knee kinematics were calculated using three-dimensional motion analysis system and were compared among three different toe directions. Results Among three different toe directions, peak values of knee valgus and external rotation on ACLD side were significantly larger in TO than in TN and TI. In addition, the total excursion in the coronal plane on ACLD side was significantly larger in TO than in TN and TI. Regarding the differences between ACLD and ACLI, peak values of internal rotation angle was significantly smaller in ACLD than in ACLI. Conclusion From the present results, tibial rotation and knee abduction were strongly affected by toe direction. When considering a safe rehabilitation, it would be better to avoid TI and TO in CKC Ex in patients with unilateral ACL injury.
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Affiliation(s)
- Aiko Sakurai
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kengo Harato
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.,Institute for Integrated Sports Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Yutaro Morishige
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Shu Kobayashi
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Yasuo Niki
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Nagura
- Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan
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A multiscale synthesis: characterizing acute cartilage failure under an aggregate tibiofemoral joint loading. Biomech Model Mechanobiol 2019; 18:1563-1575. [DOI: 10.1007/s10237-019-01159-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 04/26/2019] [Indexed: 02/02/2023]
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16
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Analysis of patellofemoral arthrokinematic motion quality in open and closed kinetic chains using vibroarthrography. BMC Musculoskelet Disord 2019; 20:48. [PMID: 30704430 PMCID: PMC6357468 DOI: 10.1186/s12891-019-2429-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Knee movements performed in open (OKC) and closed (CKC) kinetic chains generate various patterns of muscle activities and especially distinct contact stresses in the patellofemoral joint (PFJ). In contrast to these features, the arthrokinematic motion quality (AMQ) of the PFJ has not been compared between mentioned conditions. In this study we performed vibroarthrographic analysis of AMQ in movements performed in OKC and CKC, in healthy subjects and individuals with chondromalacia patellae, to assess which of the test conditions is more efficient in differentiation between healthy and deteriorated joints. Moreover, our analysis will broaden the knowledge related to behavior of normal and pathological synovial joints during motion with and without weight bearing. It is an essential issue, due to the recently observed significant interest in comparing potential benefits and limitations of CKC and OKC exercises as they relate to lower extremity rehabilitation. Methods 100 subjects (62 healthy controls and 38 subjects with PFJ chondromalacia) were enrolled. During repeated knee flexion/extension motions performed in OKC (in a sitting position) and CKC (sit-to-stand movements), the vibroarthrographic signals were collected using an accelerometer and described by variability (VMS), amplitude (R4), and spectral power in 50–250 Hz (P1) and 250–450 Hz (P2) bands. Results Significant differences in VMS [V], R4 [V], P1 [V2/Hz] and P2 [V2/Hz] between OKC and CKC were found (0.0001, 0.969. 0.800 0.041 vs 0.013, 3.973, 6.790, 0.768, respectively, P < 0.001). Moreover, in both analyzed load-related conditions the subjects with chondromalacia were characterized by significantly higher values of all parameters, when compared to controls (P < 0.001), with effect size values over 0.6. Conclusions We showed that motion of the physiological, unloaded PFJ articular surfaces in OKC is nearly vibrationless, which corresponds with optimal AMQ of PFJ, while loaded movements in CKC are characterized by a higher vibroacoustic emission level. Moreover, chondral lesions should be considered as an increased friction-related, aggravating factor of AMQ, which is critical in CKC movements under load. Nonetheless, OKC and CKC conditions are characterized by large effect sizes, and provide an efficient test frame for differentiating physiological knees and joints with chondral lesions.
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17
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Gatti G. Conceptual design and implantation of an external fixator with improved mobility for knee rehabilitation. Comput Methods Biomech Biomed Engin 2017; 20:884-892. [PMID: 28332404 DOI: 10.1080/10255842.2017.1307342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A hinged external fixator is used to allow early knee rehabilitation in case of injury or trauma, as an alternative approach to immobilization. It is mainly adopted for the treatment of dislocations, which involve tearing of the ligaments, and it basically consists of two links connected to each other by a revolute joint. Each link is fixed to the femur and tibia via pin fixation, and the revolute joint is approximately aligned to the knee flexion-extension (FE) axis. The advantage in its implantation is to protect ligament reconstruction, while allowing for an aggressive rehabilitation. Traditional fixators only accommodate the functional flexion movement in a limited range, i.e. where the anatomical movement is closer to a planar circular trajectory. This paper presents the conceptual design and implantation procedure of a double-axis fixator, which accommodates both FE and longitudinal internal-external rotation. The procedure is based on accurate knee kinematics measurements and on computer-aided multibody simulations to assist clinicians in the implantation. An experimental test is presented using an artificial knee, and guidelines are given for in vitro studies. The proposed technique may allow for a better understanding of knee kinematics and have the potential advantage to increase the range of motion in postoperative rehabilitation.
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Affiliation(s)
- Gianluca Gatti
- a Department of Mechanical, Energy and Management Engineering , University of Calabria , Arcavacata di Rende (CS) , Italy
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18
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Schoenfeld BJ. In Reply. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e318291c37e] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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19
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Cleather DJ. Letter to the Editor. Strength Cond J 2013. [DOI: 10.1519/ssc.0b013e3182953510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Marouane H, Shirazi-Adl A, Adouni M. Knee joint passive stiffness and moment in sagittal and frontal planes markedly increase with compression. Comput Methods Biomech Biomed Engin 2013; 18:339-50. [PMID: 23682906 DOI: 10.1080/10255842.2013.795555] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Knee joints are subject to large compression forces in daily activities. Due to artefact moments and instability under large compression loads, biomechanical studies impose additional constraints to circumvent the compression position-dependency in response. To quantify the effect of compression on passive knee moment resistance and stiffness, two validated finite element models of the tibiofemoral (TF) joint, one refined with depth-dependent fibril-reinforced cartilage and the other less refined with homogeneous isotropic cartilage, are used. The unconstrained TF joint response in sagittal and frontal planes is investigated at different flexion angles (0°, 15°, 30° and 45°) up to 1800 N compression preloads. The compression is applied at a novel joint mechanical balance point (MBP) identified as a point at which the compression does not cause any coupled rotations in sagittal and frontal planes. The MBP of the unconstrained joint is located at the lateral plateau in small compressions and shifts medially towards the inter-compartmental area at larger compression forces. The compression force substantially increases the joint moment-bearing capacities and instantaneous angular rigidities in both frontal and sagittal planes. The varus-valgus laxities diminish with compression preloads despite concomitant substantial reductions in collateral ligament forces. While the angular rigidity would enhance the joint stability, the augmented passive moment resistance under compression preloads plays a role in supporting external moments and should as such be considered in the knee joint musculoskeletal models.
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Affiliation(s)
- H Marouane
- a Division of Applied Mechanics, Department of Mechanical Engineering , École Polytechnique , P.O. Box 6079, Station 'Centre-Ville', Montréal , Québec , Canada H3C 3A7
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21
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A review of the combination of experimental measurements and fibril-reinforced modeling for investigation of articular cartilage and chondrocyte response to loading. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2013; 2013:326150. [PMID: 23653665 PMCID: PMC3638701 DOI: 10.1155/2013/326150] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Revised: 01/11/2013] [Accepted: 02/23/2013] [Indexed: 11/17/2022]
Abstract
The function of articular cartilage depends on its structure and composition, sensitively impaired in disease (e.g. osteoarthritis, OA). Responses of chondrocytes to tissue loading are modulated by the structure. Altered cell responses as an effect of OA may regulate cartilage mechanotransduction and cell biosynthesis. To be able to evaluate cell responses and factors affecting the onset and progression of OA, local tissue and cell stresses and strains in cartilage need to be characterized. This is extremely challenging with the presently available experimental techniques and therefore computational modeling is required. Modern models of articular cartilage are inhomogeneous and anisotropic, and they include many aspects of the real tissue structure and composition. In this paper, we provide an overview of the computational applications that have been developed for modeling the mechanics of articular cartilage at the tissue and cellular level. We concentrate on the use of fibril-reinforced models of cartilage. Furthermore, we introduce practical considerations for modeling applications, including also experimental tests that can be combined with the modeling approach. At the end, we discuss the prospects for patient-specific models when aiming to use finite element modeling analysis and evaluation of articular cartilage function, cellular responses, failure points, OA progression, and rehabilitation.
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Blatnik JA, Skinner JW, McBride JM. Effect of Supportive Equipment on Force, Velocity, and Power in the Squat. J Strength Cond Res 2012; 26:3204-8. [DOI: 10.1519/jsc.0b013e3182736641] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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23
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Computational biodynamics of human knee joint in gait: From muscle forces to cartilage stresses. J Biomech 2012; 45:2149-56. [DOI: 10.1016/j.jbiomech.2012.05.040] [Citation(s) in RCA: 94] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2011] [Revised: 05/17/2012] [Accepted: 05/19/2012] [Indexed: 11/22/2022]
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Halloran JP, Sibole S, van Donkelaar CC, van Turnhout MC, Oomens CWJ, Weiss JA, Guilak F, Erdemir A. Multiscale mechanics of articular cartilage: potentials and challenges of coupling musculoskeletal, joint, and microscale computational models. Ann Biomed Eng 2012; 40:2456-74. [PMID: 22648577 DOI: 10.1007/s10439-012-0598-0] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 05/16/2012] [Indexed: 11/27/2022]
Abstract
Articular cartilage experiences significant mechanical loads during daily activities. Healthy cartilage provides the capacity for load bearing and regulates the mechanobiological processes for tissue development, maintenance, and repair. Experimental studies at multiple scales have provided a fundamental understanding of macroscopic mechanical function, evaluation of the micromechanical environment of chondrocytes, and the foundations for mechanobiological response. In addition, computational models of cartilage have offered a concise description of experimental data at many spatial levels under healthy and diseased conditions, and have served to generate hypotheses for the mechanical and biological function. Further, modeling and simulation provides a platform for predictive risk assessment, management of dysfunction, as well as a means to relate multiple spatial scales. Simulation-based investigation of cartilage comes with many challenges including both the computational burden and often insufficient availability of data for model development and validation. This review outlines recent modeling and simulation approaches to understand cartilage function from a mechanical systems perspective, and illustrates pathways to associate mechanics with biological function. Computational representations at single scales are provided from the body down to the microstructure, along with attempts to explore multiscale mechanisms of load sharing that dictate the mechanical environment of the cartilage and chondrocytes.
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Affiliation(s)
- J P Halloran
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA
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Current concepts for rehabilitation and return to sport after knee articular cartilage repair in the athlete. J Orthop Sports Phys Ther 2012; 42:254-73. [PMID: 22383103 DOI: 10.2519/jospt.2012.3665] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Articular cartilage injury is observed with increasing frequency in both elite and amateur athletes and results from the significant acute and chronic joint stress associated with impact sports. Left untreated, articular cartilage defects can lead to chronic joint degeneration and athletic and functional disability. Treatment of articular cartilage defects in the athletic population presents a therapeutic challenge due to the high mechanical demands of athletic activity. Several articular cartilage repair techniques have been shown to successfully restore articular cartilage surfaces and allow athletes to return to high-impact sports. Postoperative rehabilitation is a critical component of the treatment process for athletic articular cartilage injury and should take into consideration the biology of the cartilage repair technique, cartilage defect characteristics, and each athlete's sport-specific demands to optimize functional outcome. Systematic, stepwise rehabilitation with criteria-based progression is recommended for an individualized rehabilitation of each athlete not only to achieve initial return to sport at the preinjury level but also to continue sports participation and reduce risk for reinjury or joint degeneration under the high mechanical demands of athletic activity.
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Goudakos IG, König C, Schöttle PB, Taylor WR, Hoffmann JE, Pöpplau BM, Singh NB, Duda GN, Heller MO. Regulation of the patellofemoral contact area: An essential mechanism in patellofemoral joint mechanics? J Biomech 2010; 43:3237-9. [DOI: 10.1016/j.jbiomech.2010.07.029] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 07/27/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
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