Bi-directional mechanical properties of the axillary pouch of the glenohumeral capsule: implications for modeling and surgical repair

Sex diferences in serum and synovial fluid C-reactive protein concentration in healthy dogs

Differences between serum C-reactive protein (SCRP) and synovial fluid C-reactive protein (SFCRP) concentrations in healthy animals may be influenced by the sex of the individual and associated with various factors. The objective of this study was to evaluate the disparities in SCRP and SFCRP concentrations between females and males, as well as within each sex. Sixty healthy dogs (N = 60), comprising both sexes, were enrolled in the study. Peripheral blood and knee synovial fluid samples were collected for SCRP and SFCRP analysis, respectively. Serum C-reactive protein (SCRP) and SFCRP concentrations were measured, with mean of 9.61 ± 4.96 mg/L for SCRP and 1.28 ± 3.05 mg/L for SFCRP. Notably, SFCRP concentrations were consistently lower than SCRP concentrations in both sexes. Statistically significant differences were observed between sexes for both SCRP (P = 0.021) and SFCRP (P = 0.007). Further analysis within females revealed statistically significant differences between SCRP and SFCRP concentrations (P = 0.002), whereas in males, such differences were not significant (P = 0.175). Additionally, weak correlations were found between SCRP and SFCRP concentrations for both sexes (females r = 0.07; males r = 0.29). Joint capsule thickness was assessed using ultrasonography, revealing thicker joint capsules in males. A robust positive association was noted between joint capsule thickness and the SFCRP concentration in both sexes. These findings offer valuable insights into the dynamics of CRP in the context of joint health in male and female patients, elucidating the underlying pathological mechanisms of joint disease and inflammation. Overall, this underscores the importance of considering sex-specific factors in the assessment and management of joint health, as well as in the design and interpretation of studies involving SFCRP concentrations.

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

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

Simulation of Vitreous Traction Force and Flow Rate of High Speed Dual-Pneumatic 7500 Cuts Per Minute Vitrectomy Probes

Purpose

To develop methods to simulate vitreous flow and traction during vitrectomy and qualify these methods using laboratory measurements.

Methods

Medium viscosity and phase treatment were adjusted to represent vitreous (Eulerian two-phase flow) or saline solution (single-phase Navier-Stokes flow). Retinal traction was approximated using a one-way fluid-structure interaction simulating cut vitreous volume coupled to a structural simulation of elastic stretching of a cylinder representing vitreous fibers entrained in the flow.

Results

Simulated saline solution flow decreased, but vitreous flow increased with increasing cut rate, consistent with experimental trends observed for the 50/50 duty cycle mode. Traction simulations reproduced all trends in variation of traction force with changes in conditions. Simulations reproduced the majority of traction measurements within experimental error.

Conclusions

A scientific basis is provided for understanding how flow and traction vary with operational parameters. This model-based analysis serves as a “virtual lab” to determine optimal system settings to maximize flow efficiency while reducing traction.

Translational Relevance

The model provides a better understanding regarding how instrument settings can help control a vitrectomy procedure so that it can be made as efficient as possible (maximizing the rate of vitreous removal) while at the same time being made as safe as possible (minimizing retinal traction).

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

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

Computer simulation of lumbar flexion shows shear of the facet capsular ligament

BACKGROUND CONTEXT

The lumbar facet capsular ligament (FCL) is a posterior spinal ligament with a complex structure and kinematic profile. The FCL has a curved geometry, multiple attachment sites, and preferentially aligned collagen fiber bundles on the posterior surface that are innervated with mechanoreceptive nerve endings. Spinal flexion induces three-dimensional (3D) deformations, requiring the FCL to maintain significant tensile and shear loads. Previous works aimed to study 3D facet joint kinematics during flexion, but to our knowledge none have reported localized FCL surface deformations likely created by this complex structure.

PURPOSE

The purpose of this study was to elucidate local deformations of both the posterior and anterior surfaces of the lumbar FCL to understand the distribution and magnitude of in-plane and through-plane deformations, including the prevalence of shear.

STUDY DESIGN/SETTING

The FCL anterior and posterior surface deformations were quantified through creation of a finite element model simulating facet joint flexion using a realistic geometry, physiological kinematics, and fitted constitutive material.

METHODS

Geometry was obtained from the micro-CT data of a healthy L3-L4 facet joint capsule (n=1); kinematics were extracted from sagittal plane fluoroscopic data of healthy volunteers (n=10) performing flexion; and average material properties were determined from planar biaxial extension tests of L4-L5 FCLs (n=6). All analyses were performed with the non-linear finite element solver, FEBio. A grid of equally spaced 3×3 nodes on the posterior surface identified regional differences within the strain fields and was used to create comparisons against previously published experimental data. This study was funded by the National Institutes of Health and the authors have no disclosures.

RESULTS

Inhomogeneous in-plane and through-plane shear deformations were prominent through the middle body of the FCL on both surfaces. Anterior surface deformations were more pronounced because of the small width of the joint space, whereas posterior surface deformations were more diffuse because the larger area increased deformability. We speculate these areas of large deformation may provide this proprioceptive system with an excellent measure of spinal motion.

CONCLUSIONS

We found that in-plane and through-plane shear deformations are widely present in finite element simulations of a lumbar FCL during flexion. Importantly, we conclude that future studies of the FCL must consider the effects of both shear and tensile deformations.

Empirical measurements of biomechanical anisotropy of the human vocal fold lamina propria

The vocal folds are known to be mechanically anisotropic due to the microstructural arrangement of fibrous proteins such as collagen and elastin in the lamina propria. Even though this has been known for many years, the biomechanical anisotropic properties have rarely been experimentally studied. We propose that an indentation procedure can be used with uniaxial tension in order to obtain an estimate of the biomechanical anisotropy within a single specimen. Experiments were performed on the lamina propria of three male and three female human vocal folds dissected from excised larynges. Two experiments were conducted: each specimen was subjected to cyclic uniaxial tensile loading in the longitudinal (i.e., anterior-posterior) direction, and then to cyclic indentation loading in the transverse (i.e., medial-lateral) direction. The indentation experiment was modeled as contact on a transversely isotropic half-space using the Barnett-Lothe tensors. The longitudinal elastic modulus E(L) was computed from the tensile test, and the transverse elastic modulus E(T) and longitudinal shear modulus G(L) were obtained by inverse analysis of the indentation force-displacement response. It was discovered that the average of E(L) /E(T) was 14 for the vocal ligament and 39 for the vocal fold cover specimens. Also, the average of E(L)/G(L), a parameter important for models of phonation, was 28 for the vocal ligament and 54 for the vocal fold cover specimens. These measurements of anisotropy could contribute to more accurate models of fundamental frequency regulation and provide potentially better insights into the mechanics of vocal fold vibration.

Transverse mechanical properties of collagen fibers from nanoindentation

The mechanical properties of collagenous tissues, such as tendon and ligaments, are of particular interest as they are found extensively in the human body. In the present study the transverse mechanical properties of collagen fibers are reported for the first time. The elastic modulus was found to be 63 ± 4 MPa, while the viscosity was estimated to be 14 GPa ≤ η ≤ 56 GPa s. Comparison with similar data in the literature, for bulk tendon and collagen fibrils, suggests that the apparent modulus of a network of interconnected building blocks is reduced as compared to the modulus of the individual building blocks; in particular E (tendon) < E (fiber) < E (fibril); this is due to the fact that as the scale of the microstructure increases (i) slippage and sliding between the respective building blocks (fibrils or fibers) increases, (ii) the volume fraction of the stiff collagen proteins decreases.

Effects of region and sex on the mechanical properties of the glenohumeral capsule during uniaxial extension

Surgical repair of the glenohumeral capsule after dislocation ignores regional boundaries of the capsule and is not sex specific. However, each region of the capsule functions to stabilize the joint in different positions, and differences in joint laxity between men and women have been found. The objectives of this research were to determine the effects of region (axillary pouch and posterior capsule) and sex on the material properties of the glenohumeral capsule. Boundary conditions derived from experiments were used to create finite-element models that applied tensile deformations to tissue samples from the capsule. The material coefficients of a hyperelastic constitutive model were determined via inverse finite-element optimization, which minimized the difference between the experimental and finite-element model-predicted load-elongation curve. These coefficients were then used to create stress-stretch curves representing the material properties of the capsule regions for each sex in response to uniaxial extension. For the axillary pouch, the C1 (men: 0.28+/-0.39 MPa and women: 0.23+/-0.12 MPa) and C2 (men: 8.2+/-4.1 and women: 7.7+/-3.0) material coefficients differed between men and women by only 0.05 MPa and 0.5, respectively. Similarly, the posterior capsule coefficients differed by 0.15 MPa (male: 0.49+/-0.26 MPa and female: 0.34+/-0.20 MPa) and 0.6 (male: 7.8+/-2.9 and female: 7.2+/-3.0), respectively. No differences could be detected in the material coefficients between regions or sexes. As a result, surgeons may not need to consider region- and sex-specific surgical repair techniques. Furthermore, finite-element models of the glenohumeral joint may not need region- or sex-specific material coefficients when using this constitutive model.

The glenohumeral capsule should be evaluated as a sheet of fibrous tissue: a validated finite element model

The function of the glenohumeral capsule has typically been evaluated by isolating several discrete, ligamentous regions during experimental and computational investigations. However, recent data suggests that the regions of the glenohumeral capsule have significant interactions and function multiaxially. Therefore, examining the function of the inferior glenohumeral ligament as a discrete structure may not be appropriate. The objective of this work was to validate the predicted strain distribution and deformed shape of the inferior glenohumeral ligament using experimental data for two subject-specific finite element models: (1) a continuous model including all capsular regions, and (2) a discrete model including only the inferior glenohumeral ligament. The distribution of maximum principal strain and deformed shape of the glenohumeral capsule was determined for a cadaveric shoulder in a joint position frequently associated with dislocation (60 degrees of glenohumeral abduction, 52 degrees of external rotation, and a 25 N anterior load applied to the humerus). The experimental kinematics were then applied to the two finite element models constructed from the geometry and material properties from the same cadaveric shoulder and the predicted strain distributions and deformed shapes were determined. For the continuous model, the average difference between predicted strains and experimental strains was less than 5%. The predicted deformed shape was also similar to experimental data, with the anterior band of the inferior glenohumeral ligament clearly wrapped around the humeral head. In contrast, large differences existed between the strains predicted by the discrete model when compared to the experimental strains for this joint position (average difference from experimental data was 20%). In addition, the predicted deformed shape of the inferior glenohumeral ligament did not wrap around the humeral head. These differences may be attributed to neglecting the complex interactions between the anterior band of the inferior glenohumeral ligament with the neighboring capsular regions. Thus, the glenohumeral capsule should not be evaluated as several discrete structures. Rather, it should be evaluated as a single sheet of fibrous tissue.

Relationships between total and non-recoverable strain fields in glenohumeral capsule during shoulder subluxation

Non-recoverable strain in the glenohumeral capsule is of prime clinical significance, but the factors that contribute to non-recoverable strain are largely unknown. This study examined the relationship between total and non-recoverable strain in the antero-inferior glenohumeral capsule using an experimental model. Maximum principal total strain alone explained up to 35% of the variance in non-recoverable strain. A multiple regression model, including variables for lateral position and specimen, explained 50% of the variance in non-recoverable strain. Both linear and quadratic terms for maximum principal total strain were significant predictors of non-recoverable strain. The correlation of total and non-recoverable strain directions exhibited a slope of nearly 1:1. The regression model showed that non-recoverable strain is likely to be low for small levels of total strain, and increase non-linearly with total strain. Non-recoverable strain tended to be higher closer to the glenoid, even when controlling for total strain. Minimum principal total strain was not a significant predictor of non-recoverable strain for the cases examined, indicating that the glenohumeral capsule may demonstrate uniaxial failure behavior even when loaded biaxially. These results are important toward prediction of non-recoverable strain in computational models of glenohumeral subluxation, as well as for theoretical models of ligament failure.

Role of biomechanics in the understanding of normal, injured, and healing ligaments and tendons

Ligaments and tendons are soft connective tissues which serve essential roles for biomechanical function of the musculoskeletal system by stabilizing and guiding the motion of diarthrodial joints. Nevertheless, these tissues are frequently injured due to repetition and overuse as well as quick cutting motions that involve acceleration and deceleration. These injuries often upset this balance between mobility and stability of the joint which causes damage to other soft tissues manifested as pain and other morbidity, such as osteoarthritis.

The healing of ligament and tendon injuries varies from tissue to tissue. Tendinopathies are ubiquitous and can take up to 12 months for the pain to subside before one could return to normal activity. A ruptured medial collateral ligament (MCL) can generally heal spontaneously; however, its remodeling process takes years and its biomechanical properties remain inferior when compared to the normal MCL. It is also known that a midsubstance anterior cruciate ligament (ACL) tear has limited healing capability, and reconstruction by soft tissue grafts has been regularly performed to regain knee function. However, long term follow-up studies have revealed that 20–25% of patients experience unsatisfactory results. Thus, a better understanding of the function of ligaments and tendons, together with knowledge on their healing potential, may help investigators to develop novel strategies to accelerate and improve the healing process of ligaments and tendons.

With thousands of new papers published in the last ten years that involve biomechanics of ligaments and tendons, there is an increasing appreciation of this subject area. Such attention has positively impacted clinical practice. On the other hand, biomechanical data are complex in nature, and there is a danger of misinterpreting them. Thus, in these review, we will provide the readers with a brief overview of ligaments and tendons and refer them to appropriate methodologies used to obtain their biomechanical properties. Specifically, we hope the reader will pay attention to how the properties of these tissues can be altered due to various experimental and biologic factors. Following this background material, we will present how biomechanics can be applied to gain an understanding of the mechanisms as well as clinical management of various ligament and tendon ailments. To conclude, new technology, including imaging and robotics as well as functional tissue engineering, that could form novel treatment strategies to enhance healing of ligament and tendon are presented.

Material properties of the axillary pouch of the glenohumeral capsule: is isotropic material symmetry appropriate?

Inconclusive findings regarding the collagen fiber architecture and the material properties of the glenohumeral capsule make it unclear whether the material symmetry of the glenohumeral capsule is isotropic or anisotropic. The overall objective of this work was to use a combined experimental and computational protocol to characterize the mechanical properties of the axillary pouch of the glenohumeral capsule and to determine the appropriate material symmetry. Two perpendicular tensile and finite simple shear deformations were applied to a series of tissue samples from the axillary pouch of the glenohumeral capsule. An inverse finite element optimization routine was then used to determine the material coefficients for an isotropic hyperelastic constitutive model by simulating the experimental conditions. There were no significant differences between the material coefficients obtained from the two perpendicular tensile deformations or finite simple shear deformations. Furthermore, stress-stretch relationships predicted by utilizing the material coefficients from one direction were able to predict the responses of the same tissue sample in the perpendicular direction. These similarities between the longitudinal and transverse material behaviors of the tissue imply that the capsule may be considered an isotropic material. However, differences did exist between the material coefficients obtained from the tensile and shear loading conditions. Therefore, a more advanced constitutive model is needed to predict both the tensile and shear responses of the material.

Methodology and sensitivity studies for finite element modeling of the inferior glenohumeral ligament complex

The objectives of this research were to develop a methodology for three-dimensional finite element (FE) modeling of the inferior glenohumeral ligament complex (IGHL complex) as a continuous structure, to determine optimal mesh density for FE simulations, to examine strains and forces in the IGHL complex in clinically relevant joint positions, and to perform sensitivity studies to assess the effects of assumed material properties. A simple translation test in the anterior direction was performed on a cadaveric shoulder, with the humerus oriented at 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension, at 0 degrees , 30 degrees and 60 degrees of humeral external rotation. The geometries of the relevant structures were extracted from volumetric CT data to create a FE model. Experimentally measured kinematics were applied to the FE model to simulate the simple translation test. First principal strains, insertion site forces and contact forces were analyzed. At maximum anterior humeral translation, strains in the IGHL complex were highly inhomogeneous for all external rotation angles. The motion of the humerus with respect to the glenoid during the simple translation test produced a tangential load at the proximal and distal edges of the IGHL complex. This loading was primarily in the plane of the inferior glenohumeral ligament complex, producing an in-plane shear-loading pattern. There was a significant increase in strain with increasing angle of external rotation. The largest insertion site forces occurred at the axillary pouch insertion to the humerus (36.7N at 60 degrees of external rotation) and the highest contact forces were between the anterior band of the IGHL complex and the humeral cartilage (7.3N at 60 degrees of external rotation). Strain predictions were highly sensitive to changes in the ratio of bulk to shear modulus of the IGHL complex, while predictions were moderately sensitive to changes in elastic modulus of the IGHL complex. Changes to the material properties of the humeral cartilage had little effect on predicted strains. The methodologies developed in this research and the results of the mesh convergence and sensitivity studies provide a basis for the subject-specific modeling of the mechanics of the IGHL complex.

Three-dimensional finite element modeling of ligaments: technical aspects

The objective of this paper is to describe strategies for addressing technical aspects of the computational modeling of ligaments with the finite element (FE) method. Strategies for FE modeling of ligament mechanics are described, differentiating between whole-joint models and models of individual ligaments. Common approaches to obtain three-dimensional ligament geometry are reviewed, with an emphasis on techniques that rely on volumetric medical image data. Considerations for the three-dimensional constitutive modeling of ligaments are reviewed in the context of ligament composition and structure. A novel approach to apply in situ strain to FE models of ligaments is described, and test problems are presented that demonstrate the efficacy of the approach. Approaches for the verification and validation of ligament FE models are outlined. The paper concludes with a discussion of future research directions.

Bi-directional mechanical properties of the posterior region of the glenohumeral capsule

The objective of this study was to determine the mechanical properties of the posterior region of the glenohumeral capsule in the directions perpendicular (transverse) and parallel (longitudinal) to the longitudinal axis of the posterior band of the inferior glenohumeral ligament. A punch was used to excise one transverse and one longitudinal tissue sample from the posterior capsule of 11 cadaveric shoulders. All tissue samples exhibited the typical nonlinear behavior reported for ligaments and tendons. Significant differences (p < 0.05) were detected between the transverse and longitudinal tissue samples for ultimate stress (1.5+/-1.4 and 4.9+/-2.9 MPa, respectively) and tangent modulus (10.3+/-6.6 and 31.5+/-12.7 MPa, respectively). No significant differences (p > 0.05) were observed between the ultimate strain (transverse: 22.3+/-12.5%, longitudinal: 22.8+/-11.1%) and strain energy density (transverse: 27.2+/-52.8 MPa, longitudinal: 67.5+/-88.2 MPa) of the transverse and longitudinal tissue samples. The ratio of the longitudinal to transverse moduli (4.8+/-4.2) was similar to that found for the axillary pouch (3.3+/-2.8) in a previous study. Thus, both the axillary pouch and the posterior capsule function to stabilize the joint multi-axially. Future analytical models of the glenohumeral joint should consider the properties of the posterior capsule in its transverse and longitudinal directions to fully describe the behavior of the glenohumeral capsule. These models will be clinically important by providing a more accurate representation of the intact capsule as well as simulated capsular injuries and surgical repair procedures.

Stress and strain in the anterior band of the inferior glenohumeral ligament during a simulated clinical examination

The objective of this research was to predict, with a finite-element model, the stress and strain fields in the anterior band of the inferior glenohumeral ligament (AB-IGHL) during application of an anterior load with the humerus abducted. The stress and strain in the AB-IGHL were determined during a simulated simple translation test of a single intact shoulder. A 6-degree-of-freedom magnetic tracking system was used to measure the kinematics of the humerus with respect to the scapula. A clinician applied an anterior load to the humerus until a manual maximum was achieved at 60 degrees of glenohumeral abduction and 0 degrees of flexion/extension and external rotation. For the computational analysis, the experimentally measured joint kinematics were used to prescribe the motion of the humerus with respect to the scapula, whereas the material properties of the AB-IGHL were based on published experimental data. The geometry of the AB-IGHL, humerus, and scapula was acquired by use of a volumetric computed tomography scan, which was used to define the reference configuration of the AB-IGHL. Strains reached 12% along the inferior edge and 15% near the scapular insertion site at the position of maximum anterior translation. During this motion, the AB-IGHL wrapped around the humerus and transferred load to the bone via contact. Predicted values for von Mises stress in the ligament reached 4.3 MPa at the point of contact with the humeral head and 6.4 MPa near the scapular insertion site. A comparison of these results to the literature suggests that the computational approach provided reasonable predictions of fiber strain in the AB-IGHL when specimen-specific geometry and kinematics with average material properties were used. The complex stress and strain distribution throughout the AB-IGHL suggests that the continuous nature of the glenohumeral capsule should be considered in biomechanical analyses. In the future, this combined experimental and computational approach will be used for subject-specific studies of capsular function and could provide quantitative data to help surgeons improve methods for the diagnosis and treatment of glenohumeral instability.