Simultaneous Measurement of Three-Dimensional Joint Kinematics and Ligament Strains With Optical Methods

Optical Measurement of Ligament Strain: Opportunities and Limitations for Intraoperative Application

A feasible and precise method to measure ligament strain during surgical interventions could significantly enhance the quality of ligament reconstructions. However, all existing scientific approaches to measure in vivo ligament strain possess at least one significant disadvantage, such as the impairment of the anatomical structure. Seeking a more advantageous method, this paper proposes defining medical and technical requirements for a non-destructive, optical measurement technique. Furthermore, we offer a comprehensive review of current optical endoscopic techniques which could potentially be suitable for in vivo ligament strain measurement, along with the most suitable optical measurement techniques. The most promising options are rated based on the defined explicit and implicit requirements. Three methods were identified as promising candidates for a precise optical measurement of the alteration of a ligaments strain: confocal chromatic imaging, shearography, and digital image correlation.

Increasing Dorsal Tilt in Distal Radius Fractures Does Not Increase Median Nerve Strain

Although extensive research shows an association between distal radius fractures and the development of median nerve related pathologies such as carpal tunnel syndrome, none directly track how the resulting angular deformity relates to likelihood of development of median nerve pathology.

The role of the interosseous ligament in forearm rotation: A bio-mechanical study

BACKGROUND

Management of longitudinal forearm instability remains challenging. Chronic forearm stability may be overcome by reconstruction of the interosseous ligament (IOL). Despite the bands of the IOL being inseparable, studies of the IOL have focused on the central band (CB), but have neglected the proximal (PB) and distal (DB) bands. The purpose of this study was to characterize the bio-mechanical properties of the IOL.

MATERIALS AND METHODS

Twelve frozen specimens from individuals of both sexes were bio-mechanically analyzed using a custom-designed jig operated at constant angular speed to simulate forearm rotation. Strain was measured during dynamic forearm simulation using a motion tracking system.

RESULTS

The average strain of the CB, PB, and DB during forearm simulation were 0.08 ± 0.04, 0.83 ± 0.47, and 0.65 ± 0.23 mm (p < 0.001). The IOL was generally shortest during maximal pronation and increased as the forearm was rotated to a neutral position. The strain of the CB remain constant during forearm rotation and was the lowest at full pronation to 20° pronation position. Throughout forearm rotation, the strain of the CB remained constant, whereas the strain of the PB and DB fluctuated.

CONCLUSIONS

The PB, CB, and DB of the forearm IOL have different bio-mechanical properties. CB maintained a constant rotational strain throughout forearm rotation. Strain on the CB was significantly lower than strains on the PB and DB. By contrast, strains on the PB and DB varied, suggesting that their roles differ from those of the CB. When CB reconstruction is needed, graft should be tensioned at 20° forearm pronation to gain optimum tension.

Wear testing of a canine hip resurfacing implant that uses highly cross-linked polyethylene

Hip resurfacing offers advantages for young, active patients afflicted with hip osteoarthritis and may also be a beneficial treatment for adult canines. Conventional hip resurfacing uses metal-on-metal bearings to preserve bone stock, but it may be feasible to use metal-on-polyethylene bearings to reduce metal wear debris while still preserving bone. This study characterized the short-term wear behavior of a novel hip resurfacing implant for canines that uses a 1.5 mm thick liner of highly cross-linked polyethylene in the acetabular component. This implant was tested in an orbital bearing machine that simulated canine gait for 1.1 million cycles. Wear of the liner was evaluated using gravimetric analysis and by measuring wear depth with an optical scanner. The liners had a steady-state mass wear rate of 0.99 ± 0.17 mg per million cycles and an average wear depth in the central liner region of 0.028 mm. No liners, shells, or femoral heads had any catastrophic failure due to yielding or fracture. These results suggest that the thin liners will not prematurely crack after implantation in canines. This is the first hip resurfacing device developed for canines, and this study is the first to characterize the in vitro wear of highly cross-linked polyethylene liners in a hip resurfacing implant. The canine implant developed in this study may be an attractive treatment option for canines afflicted with hip osteoarthritis, and since canines are the preferred animal model for human hip replacement, this implant can support the development of metal-on-polyethylene hip resurfacing technology for human patients. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1196-1205, 2018.

A general framework for application of prestrain to computational models of biological materials

It is often important to include prestress in computational models of biological tissues. The prestress can represent residual stresses (stresses that exist after the tissue is excised from the body) or in situ stresses (stresses that exist in vivo, in the absence of loading). A prestressed reference configuration may also be needed when modeling the reference geometry of biological tissues in vivo. This research developed a general framework for representing prestress in finite element models of biological materials. It is assumed that the material is elastic, allowing the prestress to be represented via a prestrain. For prestrain fields that are not compatible with the reference geometry, the computational framework provides an iterative algorithm for updating the prestrain until equilibrium is satisfied. The iterative framework allows for enforcement of two different constraints: elimination of distortion in order to address the incompatibility issue, and enforcing a specified in situ fiber strain field while allowing for distortion. The framework was implemented as a plugin in FEBio (www.febio.org), making it easy to maintain the software and to extend the framework if needed. Several examples illustrate the application and effectiveness of the approach, including the application of in situ strains to ligaments in the Open Knee model (simtk.org/home/openknee). A novel method for recovering the stress-free configuration from the prestrain deformation gradient is also presented. This general purpose theoretical and computational framework for applying prestrain will allow analysts to overcome the challenges in modeling this important aspect of biological tissue mechanics.

Effect of elastin digestion on the quasi-static tensile response of medial collateral ligament

Elastin is a structural protein that provides resilience to biological tissues. We examined the contributions of elastin to the quasi-static tensile response of porcine medial collateral ligament through targeted disruption of the elastin network with pancreatic elastase. Elastase concentration and treatment time were varied to determine a dose response. Whereas elastin content decreased with increasing elastase concentration and treatment time, the change in peak stress after cyclic loading reached a plateau above 1 U/ml elastase and 6 h treatment. For specimens treated with 2 U/ml elastase for 6 h, elastin content decreased approximately 35%. Mean peak tissue strain after cyclic loading (4.8%, p ≥ 0.300), modulus (275 MPa, p ≥ 0.114) and hysteresis (20%, p ≥ 0.553) were unaffected by elastase digestion, but stress decreased significantly after treatment (up to 2 MPa, p ≤ 0.049). Elastin degradation had no effect on failure properties, but tissue lengthened under the same pre-stress. Stiffness in the linear region was unaffected by elastase digestion, suggesting that enzyme treatment did not disrupt collagen. These results demonstrate that elastin primarily functions in the toe region of the stress-strain curve, yet contributes load support in the linear region. The increase in length after elastase digestion suggests that elastin may pre-stress and stabilize collagen crimp in ligaments.

3D video-based deformation measurement of the pelvis bone under dynamic cyclic loading

Background

Dynamic three-dimensional (3D) deformation of the pelvic bones is a crucial factor in the successful design and longevity of complex orthopaedic oncological implants. The current solutions are often not very promising for the patient; thus it would be interesting to measure the dynamic 3D-deformation of the whole pelvic bone in order to get a more realistic dataset for a better implant design. Therefore we hypothesis if it would be possible to combine a material testing machine with a 3D video motion capturing system, used in clinical gait analysis, to measure the sub millimetre deformation of a whole pelvis specimen.

Method

A pelvis specimen was placed in a standing position on a material testing machine. Passive reflective markers, traceable by the 3D video motion capturing system, were fixed to the bony surface of the pelvis specimen. While applying a dynamic sinusoidal load the 3D-movement of the markers was recorded by the cameras and afterwards the 3D-deformation of the pelvis specimen was computed. The accuracy of the 3D-movement of the markers was verified with 3D-displacement curve with a step function using a manual driven 3D micro-motion-stage.

Results

The resulting accuracy of the measurement system depended on the number of cameras tracking a marker. The noise level for a marker seen by two cameras was during the stationary phase of the calibration procedure ± 0.036 mm, and ± 0.022 mm if tracked by 6 cameras. The detectable 3D-movement performed by the 3D-micro-motion-stage was smaller than the noise level of the 3D-video motion capturing system. Therefore the limiting factor of the setup was the noise level, which resulted in a measurement accuracy for the dynamic test setup of ± 0.036 mm.

Conclusion

This 3D test setup opens new possibilities in dynamic testing of wide range materials, like anatomical specimens, biomaterials, and its combinations. The resulting 3D-deformation dataset can be used for a better estimation of material characteristics of the underlying structures. This is an important factor in a reliable biomechanical modelling and simulation as well as in a successful design of complex implants.

Digital stereophotogrammetry based on circular markers and zooming cameras: evaluation of a method for 3D analysis of small motions in orthopaedic research

Background

Orthopaedic research projects focusing on small displacements in a small measurement volume require a radiation free, three dimensional motion analysis system. A stereophotogrammetrical motion analysis system can track wireless, small, light-weight markers attached to the objects. Thereby the disturbance of the measured objects through the marker tracking can be kept at minimum. The purpose of this study was to develop and evaluate a non-position fixed compact motion analysis system configured for a small measurement volume and able to zoom while tracking small round flat markers in respect to a fiducial marker which was used for the camera pose estimation.

Methods

The system consisted of two web cameras and the fiducial marker placed in front of them. The markers to track were black circles on a white background. The algorithm to detect a centre of the projected circle on the image plane was described and applied. In order to evaluate the accuracy (mean measurement error) and precision (standard deviation of the measurement error) of the optical measurement system, two experiments were performed: 1) inter-marker distance measurement and 2) marker displacement measurement.

Results

The first experiment of the 10 mm distances measurement showed a total accuracy of 0.0086 mm and precision of ± 0.1002 mm. In the second experiment, translations from 0.5 mm to 5 mm were measured with total accuracy of 0.0038 mm and precision of ± 0.0461 mm. The rotations of 2.25° amount were measured with the entire accuracy of 0.058° and the precision was of ± 0.172°.

Conclusions

The description of the non-proprietary measurement device with very good levels of accuracy and precision may provide opportunities for new, cost effective applications of stereophotogrammetrical analysis in musculoskeletal research projects, focusing on kinematics of small displacements in a small measurement volume.

Validation of finite element predictions of cartilage contact pressure in the human hip joint

Methods to predict contact stresses in the hip can provide an improved understanding of load distribution in the normal and pathologic joint. The objectives of this study were to develop and validate a three-dimensional finite element (FE) model for predicting cartilage contact stresses in the human hip using subject-specific geometry from computed tomography image data, and to assess the sensitivity of model predictions to boundary conditions, cartilage geometry, and cartilage material properties. Loads based on in vivo data were applied to a cadaveric hip joint to simulate walking, descending stairs, and stair-climbing. Contact pressures and areas were measured using pressure sensitive film. CT image data were segmented and discretized into FE meshes of bone and cartilage. FE boundary and loading conditions mimicked the experimental testing. Fair to good qualitative correspondence was obtained between FE predictions and experimental measurements for simulated walking and descending stairs, while excellent agreement was obtained for stair-climbing. Experimental peak pressures, average pressures, and contact areas were 10.0 MPa (limit of film detection), 4.4-5.0 MPa, and 321.9-425.1 mm(2), respectively, while FE-predicted peak pressures, average pressures, and contact areas were 10.8-12.7 MPa, 5.1-6.2 MPa, and 304.2-366.1 mm(2), respectively. Misalignment errors, determined as the difference in root mean squared error before and after alignment of FE results, were less than 10%. Magnitude errors, determined as the residual error following alignment, were approximately 30% but decreased to 10-15% when the regions of highest pressure were compared. Alterations to the cartilage shear modulus, bulk modulus, or thickness resulted in +/-25% change in peak pressures, while changes in average pressures and contact areas were minor (+/-10%). When the pelvis and proximal femur were represented as rigid, there were large changes, but the effect depended on the particular loading scenario. Overall, the subject-specific FE predictions compared favorably with pressure film measurements and were in good agreement with published experimental data. The validated modeling framework provides a foundation for development of patient-specific FE models to investigate the mechanics of normal and pathological hips.

Contribution of glycosaminoglycans to viscoelastic tensile behavior of human ligament

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

A Low-Cost Instrumented Spatial Linkage Accurately Determines ASIS Position during Cycle Ergometry

The purpose of this study was to develop and evaluate an alternative method for determining the position of the anterior superior iliac spine (ASIS) during cycling. The approach used in this study employed an instrumented spatial linkage (ISL) system to determine the position of the ASIS in the parasagittal plane. A two-segment ISL constructed using aluminum segments, bearings, and digital encoders was tested statically against a calibration plate and dynamically against a video-based motion capture system. Four well-trained cyclists provided data at three pedaling rates. Statically, the ISL had a mean horizontal error of 0.03 ± 0.21 mm and a mean vertical error of −0.13 ± 0.59 mm. Compared with the video-based motion capture system, the agreement of the location of the ASIS had a mean error of 0.30 ± 0.55 mm for the horizontal dimension and −0.27 ± 0.60 mm for the vertical dimension. The ISL system is a cost-effective, accurate, and valid measure for two-dimensional kinematic data within a range of motion typical for cycling.

Effect of ACL deficiency on MCL strains and joint kinematics

The knee joint is partially stabilized by the interaction of multiple ligament structures. This study tested the interdependent functions of the anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) by evaluating the effects of ACL deficiency on local MCL strain while simultaneously measuring joint kinematics under specific loading scenarios. A structural testing machine applied anterior translation and valgus rotation (limits 100 N and 10 N m, respectively) to the tibia of ten human cadaveric knees with the ACL intact or severed. A three-dimensional motion analysis system measured joint kinematics and MCL tissue strain in 18 regions of the superficial MCL. ACL deficiency significantly increased MCL strains by 1.8% (p<0.05) during anterior translation, bringing ligament fibers to strain levels characteristic of microtrauma. In contrast, ACL transection had no effect on MCL strains during valgus rotation (increase of only 0.1%). Therefore, isolated valgus rotation in the ACL-deficient knee was nondetrimental to the MCL. The ACL was also found to promote internal tibial rotation during anterior translation, which in turn decreased strains near the femoral insertion of the MCL. These data advance the basic structure-function understanding of the MCL, and may benefit the treatment of ACL injuries by improving the knowledge of ACL function and clarifying motions that are potentially harmful to secondary stabilizers.

Effect of dermatan sulfate glycosaminoglycans on the quasi-static material properties of the human medial collateral ligament

The glycosaminoglycan of decorin, dermatan sulfate (DS), has been suggested to contribute to the mechanical properties of soft connective tissues such as ligaments and tendons. This study investigated the mechanical function of DS in human medial collateral ligaments (MCL) using nondestructive shear and tensile material tests performed before and after targeted removal of DS with chondroitinase B (ChB). The quasi-static elastic material properties of human MCL were unchanged after DS removal. At peak deformation, tensile and shear stresses in ChB treated tissue were within 0.5% (p>0.70) and 2.0% (p>0.30) of pre-treatment values, respectively. From pre- to post-ChB treatment under tensile loading, the tensile tangent modulus went from 242+/-64 to 233+/-57 MPa (p=0.44), and tissue strain at peak deformation went from 4.3+/-0.3% to 4.4+/-0.3% (p=0.54). Tissue hysteresis was unaffected by DS removal for both tensile and shear loading. Biochemical analysis confirmed that 90% of DS was removed by ChB treatment when compared to control samples, and transmission electron microscopy (TEM) imaging further verified the degradation of DS by showing an 88% reduction (p<.001) of sulfated glycosaminoglycans in ChB treated tissue. These results demonstrate that DS in mature knee MCL tissue does not resist tensile or shear deformation under quasi-static loading conditions, challenging the theory that decorin proteoglycans contribute to the elastic material behavior of ligament.

Noninvasive determination of ligament strain with deformable image registration

Ligament function and propensity for injury are directly related to regional stresses and strains. However, noninvasive techniques for measurement of strain are currently limited. This study validated the use of Hyperelastic Warping, a deformable image registration technique, for noninvasive strain measurement in the human medial collateral ligament using direct comparisons with optical measurements. Hyperelastic Warping determines the deformation map that aligns consecutive images of a deforming material, allowing calculation of strain. Diffeomorphic deformations are ensured by representing the deformable image as a hyperelastic material. Ten cadaveric knees were subjected to six loading scenarios each. Tissue deformation was documented with magnetic resonance imaging (MRI) and video-based experimental measurements. MRI datasets were analyzed using Hyperelastic Warping, representing the medial collateral ligament (MCL) with a hexahedral finite element (FE) model projected to a manually segmented ligament surface. The material behavior was transversely isotropic hyperelastic. Warping predictions of fiber stretch were strongly correlated with experimentally measured strains (R (2) = 0.81). Both sets of measurements were in agreement with previous ex vivo studies. Warping predictions of fiber stretch were insensitive to bulk:shear modulus ratio, fiber stiffness, and shear modulus in the range of +2.5SD to -1.0SD. Correlations degraded when the shear modulus was decreased to 2.5SD below the mean (R (2) = 0.56), and when an isotropic constitutive model was substituted for the transversely isotropic model (R (2) = 0.65). MCL strains in the transitional region near the joint line, where the material behavior and material symmetry are more complex, showed the most sensitivity to changes in shear modulus. These results demonstrate that Hyperelastic Warping requires the use of a constitutive model that reflects the material symmetry, but not subject-specific material properties for accurate strain predictions for this application. Hyperelastic Warping represents a powerful technique for noninvasive strain measurement of musculoskeletal tissues and has many advantages over other image-based strain measurement techniques.

Medial collateral ligament insertion site and contact forces in the ACL-deficient knee

The objectives of this research were to determine the effects of anterior cruciate ligament (ACL) deficiency on medial collateral ligament (MCL) insertion site and contact forces during anterior tibial loading and valgus loading using a combined experimental-finite element (FE) approach. Our hypothesis was that ACL deficiency would increase MCL insertion site forces at the attachments to the tibia and femur and increase contact forces between the MCL and these bones. Six male knees were subjected to varus-valgus and anterior-posterior loading at flexion angles of 0 degrees and 30 degrees. Three-dimensional joint kinematics and MCL strains were recorded during kinematic testing. Following testing, the MCL of each knee was removed to establish a stress-free reference configuration. An FE model of the femur-MCL-tibia complex was constructed for each knee to simulate valgus rotation and anterior translation at 0 degrees and 30 degrees, using subject-specific bone and ligament geometry and joint kinematics. A transversely isotropic hyperelastic material model with average material coefficients taken from a previous study was used to represent the MCL. Subject-specific MCL in situ strain distributions were used in each model. Insertion site and contact forces were determined from the FE analyses. FE predictions were validated by comparing MCL fiber strains to experimental measurements. The subject-specific FE predictions of MCL fiber stretch correlated well with the experimentally measured values (R2 = 0.95). ACL deficiency caused a significant increase in MCL insertion site and contact forces in response to anterior tibial loading. In contrast, ACL deficiency did not significantly increase MCL insertion site and contact forces in response to valgus loading, demonstrating that the ACL is not a restraint to valgus rotation in knees that have an intact MCL. When evaluating valgus laxity in the ACL-deficient knee, increased valgus laxity indicates a compromised MCL.

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.