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A L, Elsen R, Nayak S. Artificial Intelligence-Based 3D Printing Strategies for Bone Scaffold Fabrication and Its Application in Preclinical and Clinical Investigations. ACS Biomater Sci Eng 2024; 10:677-696. [PMID: 38252807 DOI: 10.1021/acsbiomaterials.3c01368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
3D printing has become increasingly popular in the field of bone tissue engineering. However, the mechanical properties, biocompatibility, and porosity of the 3D printed bone scaffolds are major requirements for tissue regeneration and implantation as well. Designing the scaffold architecture in accordance with the need to create better mechanical and biological stimuli is necessary to achieve unique scaffold properties. To accomplish this, different 3D designing strategies can be utilized with the help of the scaffold design library and artificial intelligence (AI). The implementation of AI to assist the 3D printing process can enable it to predict, adapt, and control the parameters on its own, which lowers the risk of errors. This Review emphasizes 3D design and fabrication of bone scaffold using different materials and the use of AI-aided 3D printing strategies. Also, the adaption of AI to 3D printing helps to develop patient-specific scaffolds based on different requirements, thus providing feedback and adequate data for reproducibility, which can be improvised in the future. These printed scaffolds can also serve as an alternative to preclinical animal test models to cut costs and prevent immunological interference.
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Affiliation(s)
- Logeshwaran A
- School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Katpadi, Vellore, Tamil Nadu 632014, India
| | - Renold Elsen
- School of Mechanical Engineering, Vellore Institute of Technology (VIT), Katpadi, Vellore, Tamil Nadu 632014, India
| | - Sunita Nayak
- School of Bio Sciences and Technology, Vellore Institute of Technology (VIT), Katpadi, Vellore, Tamil Nadu 632014, India
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Rice H, Kurz M, Mai P, Robertz L, Bill K, Derrick TR, Willwacher S. Speed and surface steepness affect internal tibial loading during running. JOURNAL OF SPORT AND HEALTH SCIENCE 2024; 13:118-124. [PMID: 36931595 PMCID: PMC10818105 DOI: 10.1016/j.jshs.2023.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/08/2022] [Accepted: 02/13/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Internal tibial loading is influenced by modifiable factors with implications for the risk of stress injury. Runners encounter varied surface steepness (gradients) when running outdoors and may adapt their speed according to the gradient. This study aimed to quantify tibial bending moments and stress at the anterior and posterior peripheries when running at different speeds on surfaces of different gradients. METHODS Twenty recreational runners ran on a treadmill at 3 different speeds (2.5 m/s, 3.0 m/s, and 3.5 m/s) and gradients (level: 0%; uphill: +5%, +10%, and +15%; downhill: -5%, -10%, and -15%). Force and marker data were collected synchronously throughout. Bending moments were estimated at the distal third centroid of the tibia about the medial-lateral axis by ensuring static equilibrium at each 1% of stance. Stress was derived from bending moments at the anterior and posterior peripheries by modeling the tibia as a hollow ellipse. Two-way repeated-measures analysis of variance were conducted using both functional and discrete statistical analyses. RESULTS There were significant main effects for running speed and gradient on peak bending moments and peak anterior and posterior stress. Higher running speeds resulted in greater tibial loading. Running uphill at +10% and +15% resulted in greater tibial loading than level running. Running downhill at -10% and -15% resulted in reduced tibial loading compared to level running. There was no difference between +5% or -5% and level running. CONCLUSION Running at faster speeds and uphill on gradients ≥+10% increased internal tibial loading, whereas slower running and downhill running on gradients ≥-10% reduced internal loading. Adapting running speed according to the gradient could be a protective mechanism, providing runners with a strategy to minimize the risk of tibial stress injuries.
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Affiliation(s)
- Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo 0806, Norway.
| | - Markus Kurz
- Sports Tech Research Centre, Mid Sweden University, Östersund SE-831 25, Sweden; Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany
| | - Patrick Mai
- Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Leon Robertz
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Kevin Bill
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, Ames, IA 50011, USA
| | - Steffen Willwacher
- Department of Mechanical and Process Engineering, Offenburg University of Applied Sciences, Offenburg 77652, Germany; Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne 50933, Germany
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Ter Wee MA, Dobbe JGG, Buijs GS, Kievit AJ, Schafroth MU, Maas M, Blankevoort L, Streekstra GJ. Load-induced deformation of the tibia and its effect on implant loosening detection. Sci Rep 2023; 13:21769. [PMID: 38066256 PMCID: PMC10709436 DOI: 10.1038/s41598-023-49177-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 12/05/2023] [Indexed: 12/18/2023] Open
Abstract
CT imaging under external valgus and varus loading conditions and consecutive image analysis can be used to detect tibial implant loosening after total knee arthroplasty. However, the applied load causes the tibia to deform, which could result in an overestimation of implant displacement. This research evaluates the extent of tibia deformation and its effect on measuring implant displacement. Ten cadaver specimen with TKA were CT-scanned under valgus/varus loading (20 Nm), first implanted without bone cement fixation (mimicking a loose implant) and subsequently with bone cement fixation (mimicking a fixed implant). By means of image analysis, three relative displacements were assessed: (1) between the proximal and distal tibia (measure of deformation), (2) between the implant and the whole tibia (including potential deformation effect) and (3) between the implant and the proximal tibia (reduced deformation effect). Relative displacements were quantified in terms of translations along, and rotations about the axes of a local coordinate system. As a measure of deformation, the proximal tibia moved relative to the distal tibia by, on average 1.27 mm (± 0.50 mm) and 0.64° (± 0.25°). Deformation caused an overestimation of implant displacement in the cemented implant. The implant displaced with respect to the whole tibia by 0.45 mm (± 0.22 mm) and 0.79° (± 0.38°). Relative to the proximal tibia, the implant moved by 0.23 mm (± 0.10 mm) and 0.62° (± 0.34°). The differentiation between loose and fixed implants improved when tibia deformation was compensated for by using the proximal tibia rather than the whole tibia.
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Affiliation(s)
- M A Ter Wee
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands.
| | - J G G Dobbe
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - G S Buijs
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - A J Kievit
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M U Schafroth
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - M Maas
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - L Blankevoort
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Orthopedic Surgery and Sports Medicine, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
| | - G J Streekstra
- Department of Biomedical Engineering and Physics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
- Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
- Department of Radiology, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands
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Jafarnezhadgero AA, Jahangirpour A, Parsa H, Sajedi H, Granacher U, Souza Oliveira A. The Impact of Excessive Body Weight and Foot Pronation on Running Kinetics: A Cross-Sectional Study. SPORTS MEDICINE - OPEN 2023; 9:116. [PMID: 38055073 DOI: 10.1186/s40798-023-00663-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 11/23/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Running exercise is an effective means to enhance cardiorespiratory fitness and body composition. Besides these health benefits, running is also associated with musculoskeletal injuries that can be more prevalent in individuals with excessive body weight. Little is known regarding the specific effects of overweight and foot pronation on ground reaction force distribution during running. Therefore, this study aimed to investigate the effects of overweight/obesity and foot pronation on running kinetics. METHODS Eighty-four young adults were allocated to four experimental groups: non-excessive body weight/non-pronated feet; non-excessive body weight/pronated feet; overweight or obesity/ non-pronated feet and overweight or obesity/pronated feet. Biomechanical testing included participants to run at ~ 3.2 m/s over an 18-m walkway with an embedded force plate at its midpoint. Three-dimensional ground reaction forces were recorded and normalized to body mass to evaluate running kinetics from 20 running trials. Test-re-test reliability for running speed data demonstrated ICC > 0.94 for each group and in total. RESULTS The results indicated significantly lower vertical impact peak forces (p = 0.001, effect size = 0.12), shorter time to reach the vertical impact peak (p = 0.006, effect size = 0.08) and reduced vertical loading rate (p = 0.0007, effect size = 0.13) in individuals with excessive body weight (overweight or obesity/non-pronated feet group and overweight or obesity/pronated feet) compared with individuals non-excessive body weight (non-excessive body weight/non-pronated feet and non-excessive body weight/pronated feet). Moreover, the excessive body weight groups presented lower peak braking (p = 0.01, effect size = 0.06) and propulsion forces (p = 0.003, effect size = 0.09), lower medio-lateral loading rate (p = 0.0009, effect size = 0.12), and greater free moments (p = 0.01, effect size = 0.07) when compared to the non-overweight groups. Moreover, a significant body mass by foot pronation interaction was found for peak medio-lateral loading rate. Non-excessive body weight/pronated feet, excessive body weight/non-pronated feet and excessive body weight/pronation groups presented lower medio-lateral loading rates compared to non-excessive body weight/non-pronated feet (p = 0.0001, effect size = 0.13). CONCLUSIONS Our results suggest that excessive body weight has an impact on ground reaction forces during running. We particularly noted an increase in medio-lateral and torsional forces during the stance phase. Individuals with excessive body weight appear to adapt their running patterns in an effort to attenuate early vertical impact loading.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Sport Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Azin Jahangirpour
- Department of Sport Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Hamed Parsa
- Department of Sport Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Heidar Sajedi
- Department of Physical Education and Sports Science, İstanbul Esenyurt University, Istanbul, Turkey
| | - Urs Granacher
- Department of Sport and Sport Science, Exercise and Human Movement Science, University of Freiburg, Sandfangweg 4, 79102, Freiburg, Germany.
| | - Anderson Souza Oliveira
- Department of Materials and Production, Aalborg University, Fibigestræde 16, 9220, Aalborg, Denmark
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Rice H, Seynnes O, Werkhausen A. Effect of increased running speed and weight carriage on peak and cumulative tibial loading. Scand J Med Sci Sports 2023; 33:2516-2523. [PMID: 37642291 DOI: 10.1111/sms.14476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 07/11/2023] [Accepted: 08/16/2023] [Indexed: 08/31/2023]
Abstract
INTRODUCTION Tibial stress injuries are a burdensome injury among military recruits. Military activities include running and the carriage of additional weight, and this may be related to the high risk of bone stress injuries. The aim of this study was to quantify tibial loading when running at two different speeds, with and without additional weight, and to quantify their combined influence. METHODS Fourteen male distance runners who ran at least 40 km per week ran barefoot on a force-instrumented treadmill in four conditions representing preferred running speed (mean (SD) 3.1 (0.3) m/s) and 20% increased running speed (3.8 (0.4) m/s), with and without 20% of body weight carried in a weight vest. Kinematics and kinetics were synchronously collected. Bending moments were estimated about the medial-lateral axis of the tibial centroid located 1/3rd of the length from distal to proximal. Static equilibrium was ensured at each 1% of stance. Peak bending moments were obtained in addition to cumulative-weighted loading, where weighted loading accounted for the relative importance of the magnitude of the bending moment and the quantity of loading using a bone-dependent weighting factor. RESULTS There were no interaction effects for running speed and weight carriage on peak or cumulative tibial loading. Running at a 20% faster speed increased peak and cumulative loading per kilometer by 8.0% (p < 0.001) and 4.8% (p < 0.001), respectively. Carriage of an additional 20% of body weight increased peak and cumulative loading per kilometer by 6.6% (p < 0.001) and 8.5% (p < 0.001), respectively. INTERPRETATION Increasing the physical demand of running by increasing speed or weight carriage increased peak tibial loading and cumulative tibial loading per kilometer, and this may increase the risk of tibial stress injury. Running speed and weight carriage independently influenced tibial loading.
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Affiliation(s)
- Hannah Rice
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Olivier Seynnes
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
| | - Amelie Werkhausen
- Department of Physical Performance, Norwegian School of Sport Sciences, Oslo, Norway
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VAN MIDDELAAR ROBBERTP, ZHANG JUNHAO, VELTINK PETERH, REENALDA JASPER. 3D Tibial Acceleration and Consideration of 3D Angular Motion Using IMUs on Peak Tibial Acceleration and Impulse in Running. Med Sci Sports Exerc 2023; 55:2253-2262. [PMID: 37494829 PMCID: PMC10662620 DOI: 10.1249/mss.0000000000003269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
PURPOSE Peak tibial acceleration (PTA) is defined as the peak acceleration occurring shortly after initial contact, often used as an indirect measure of tibial load. As the tibia is a rotating segment around the ankle, angular velocity and angular acceleration should be included in PTA. This study aimed to quantify three-dimensional tibial acceleration components over two different sensor locations and three running speeds, to get a better understanding of the influence of centripetal and tangential accelerations on PTA typically measured in running. Furthermore, it explores tibial impulse as an alternative surrogate measure for tibial load. METHODS Fifteen participants ran 90 s on a treadmill at 2.8, 3.3, and 3.9 m·s -1 , with inertial measurement units (IMUs) located distally and proximally on the tibia. RESULTS Without the inclusion of rotational accelerations and gravity, no significant difference was found between axial PTA between both IMU locations, whereas in the tangential sagittal plane axis, there was a significant difference. Inclusion of rotational accelerations and gravity resulted in similar PTA estimates at the ankle for both IMU locations and caused a significant difference between PTA based on the distal IMU and PTA at the ankle. The impulse showed more consistent results between the proximal and distal IMU locations compared with axial PTA. CONCLUSIONS Rotational acceleration of the tibia during stance differently impacted PTA measured proximally and distally at the tibia, indicating that rotational acceleration and gravity should be included in PTA estimates. Furthermore, peak acceleration values (such as PTA) are not always reliable when using IMUs because of inconsistent PTA proximally compared with distally on an individual level. Instead, impulse seems to be a more consistent surrogate measure for the tibial load.
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Affiliation(s)
| | | | | | - JASPER REENALDA
- University of Twente, Enschede, THE NETHERLANDS
- Roessingh Research & Development, Enschede, THE NETHERLANDS
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Zdero R, Brzozowski P, Schemitsch EH. Biomechanical stress analysis using thermography: A review. J Biomech 2023; 160:111822. [PMID: 37793203 DOI: 10.1016/j.jbiomech.2023.111822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 09/08/2023] [Accepted: 09/26/2023] [Indexed: 10/06/2023]
Abstract
Biomechanics investigators are interested in experimentally measuring stresses experienced by dental structures, whole bones, joint replacements, soft tissues, normal limbs, etc. To do so, various experimental methods have been used that are based on acoustic, optical, piezo-resistive, or other principles, like digital image correlation, fiber optic sensors, photo-elasticity, strain gages, ultrasound, etc. Several biomechanical review papers have surveyed these research technologies, but they do not mention thermography. Thermography can identify temperature anomalies indicating low- or high-stress areas on a bone, implant, prosthesis, etc., which may need to be repaired, replaced, or redesigned to avoid damage, degradation, or failure. In addition, thermography can accurately predict a structure's cyclic fatigue strength. Consequently, this article gives an up-to-date survey of the scientific literature on thermography for biomechanical stress analysis. This review (i) describes the basic physics of thermography, thermo-elastic properties of biomaterials, experimental protocols for thermography, advantages, and disadvantages, (ii) surveys published studies on various applications that used thermography for biomechanical stress measurements, and (iii) discusses general findings and future work. This article is intended to inform biomechanics investigators about the potential of thermography for stress analysis.
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Affiliation(s)
- Radovan Zdero
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
| | - Pawel Brzozowski
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada.
| | - Emil H Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada; Division of Orthopaedic Surgery, Western University, London, ON, Canada.
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Wallace IJ, Toya C, Peña Muñoz MA, Meyer JV, Busby T, Reynolds AZ, Martinez J, Thompson TT, Miller-Moore M, Harris AR, Rios R, Martinez A, Jashashvili T, Ruff CB. Effects of the energy balance transition on bone mass and strength. Sci Rep 2023; 13:15204. [PMID: 37709850 PMCID: PMC10502131 DOI: 10.1038/s41598-023-42467-6] [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: 05/09/2023] [Accepted: 09/11/2023] [Indexed: 09/16/2023] Open
Abstract
Chronic positive energy balance has surged among societies worldwide due to increasing dietary energy intake and decreasing physical activity, a phenomenon called the energy balance transition. Here, we investigate the effects of this transition on bone mass and strength. We focus on the Indigenous peoples of New Mexico in the United States, a rare case of a group for which data can be compared between individuals living before and after the start of the transition. We show that since the transition began, bone strength in the leg has markedly decreased, even though bone mass has apparently increased. Decreased bone strength, coupled with a high prevalence of obesity, has resulted in many people today having weaker bones that must sustain excessively heavy loads, potentially heightening their risk of a bone fracture. These findings may provide insight into more widespread upward trends in bone fragility and fracture risk among societies undergoing the energy balance transition.
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Affiliation(s)
- Ian J Wallace
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA.
| | | | | | - Jana Valesca Meyer
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Taylor Busby
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Adam Z Reynolds
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Jordan Martinez
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | | | - Marcus Miller-Moore
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Alexandra R Harris
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Roberto Rios
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Alexis Martinez
- Department of Anthropology, University of New Mexico, Albuquerque, NM, 87131, USA
| | - Tea Jashashvili
- Department of Integrative Anatomical Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, 90033, USA
| | - Christopher B Ruff
- Center for Functional Anatomy and Evolution, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
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Tang L, Guo H, Wang K, Zhou Y, Wu T, Fan X, Guo J, Sun L, Ta D. Low-intensity pulsed ultrasound enhances the positive effects of high-intensity treadmill exercise on bone in rats. J Bone Miner Metab 2023; 41:592-605. [PMID: 37270713 DOI: 10.1007/s00774-023-01439-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 05/09/2023] [Indexed: 06/05/2023]
Abstract
INTRODUCTION Moderate exercise benefits bone health, but excessive loading leads to bone fatigue and a decline in mechanical properties. Low-intensity pulsed ultrasound (LIPUS) can stimulate bone formation. The purpose of this study was to explore whether LIPUS could augment the skeletal benefits of high-intensity exercise. MATERIALS AND METHODS MC3T3-E1 osteoblasts were treated with LIPUS at 80 mW/cm2 or 30 mW/cm2 for 20 min/day. Forty rats were divided into sham treatment normal control (Sham-NC), sham treatment high-intensity exercise (Sham-HIE), 80 mW/cm2 LIPUS (LIPUS80), and high-intensity exercise combined with 80 mW/cm2 LIPUS (LIPUS80-HIE). The rats in HIE group were subjected to 30 m/min slope treadmill exercise for 90 min/day, 6 days/week for 12 weeks. The LIPUS80-HIE rats were irradiated with LIPUS (1 MHz, 80 mW/cm2) for 20 min/day at bilateral hind limb after exercise. RESULTS LIPUS significantly accelerated the proliferation, differentiation, mineralization, and migration of MC3T3-E1 cells. Compared to 30 mW/cm2 LIPUS, 80 mW/cm2 LIPUS got better promotion effect. 12 weeks of high-intensity exercise significantly reduced the muscle force, which was significantly reversed by LIPUS. Compared with the Sham-NC group, Sham-HIE group significantly optimized bone microstructure and enhanced mechanical properties of femur, and LIPUS80-HIE further enhanced the improvement effect on bone. The mechanisms may be related to activate Wnt/β-catenin signal pathway and then up-regulate the protein expression of Runx2 and VEGF, the key factors of osteogenesis and angiogenesis. CONCLUSION LIPUS could augment the skeletal benefits of high-intensity exercise through Wnt/β-catenin signal pathway.
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Affiliation(s)
- Liang Tang
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Hao Guo
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
- School of Physical Education, Bohai University, Jinzhou, 121013, China
| | - Keyi Wang
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Yaling Zhou
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Tianpei Wu
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Xiushan Fan
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China
| | - Jianzhong Guo
- Shaanxi Key Laboratory of Ultrasonics, Shaanxi Normal University, Xi'an, 710119, China
| | - Lijun Sun
- Institute of Sports Biology, Shaanxi Normal University, Xi'an, 710119, China.
| | - Dean Ta
- Department of Electronic Engineering, Fudan University, Shanghai, 200433, China.
- Academy for Engineering and Technology, Fudan University, Shanghai, 201203, China.
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Moritz N, Liesmäki O, Plyusnin A, Keränen P, Kulkova J. Load-bearing composite fracture-fixation devices with tailored fibre placement for toy-breed dogs. Res Vet Sci 2023; 156:66-80. [PMID: 36791579 DOI: 10.1016/j.rvsc.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 10/31/2022] [Accepted: 02/06/2023] [Indexed: 02/11/2023]
Abstract
Fibre reinforced composites are attractive materials for hard tissue reconstructions, due to the high strength and low flexural modulus. However, lack of contourability in the operation theatre inhibits their clinical applications. The study presents a novel in situ contourable composite implant system for load-bearing conditions. The implant system consists of a thin bioresorbable shell with several cavities, much like bubble-wrap. The central cavity contains a semi-flexible glass fibre preform prepared using Tailored Fibre Placement method. The preform is either pre-impregnated with a light curable resin, or the resin is injected into the cavity during the surgical procedure, followed by light curing. The semi-flexible glass fibre preforms were also examined as separate devices, "miniplates". Two types of miniplates were scrutinized, a simplified pilot design and a spatially refined, "optimized" design. The optimized miniplates were implemented as biostable and bioresorbable versions. The feasibility of the in situ contourable composite implant system was demonstrated. The potential of Tailored Fibre Placement for the semi-flexible glass fibre preforms and miniplates was confirmed in a series of biomechanical tests. However, structural optimization is required. Antebrachial fractures in toy-breeds of dogs are exemplar veterinary applications of the devices; further applications in veterinary and human patients are foreseen.
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Affiliation(s)
- Niko Moritz
- Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland; Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland
| | - Oliver Liesmäki
- Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland; Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland
| | - Artem Plyusnin
- Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland; Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland
| | - Pauli Keränen
- Department of Equine and Small Animal Medicine, Faculty of Veterinary Medicine, University of Helsinki, Helsinki, Finland
| | - Julia Kulkova
- Biomedical Engineering Research Group, Biomaterials and Medical Device Research Program, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland; Department of Biomaterials Science and Turku Clinical Biomaterials Centre - TCBC, Institute of Dentistry, University of Turku, Itäinen Pitkäkatu 4B (PharmaCity), 20520 Turku, Finland.
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O'Leary TJ, Wardle SL, Rawcliffe AJ, Chapman S, Mole J, Greeves JP. Understanding the musculoskeletal injury risk of women in combat: the effect of infantry training and sex on musculoskeletal injury incidence during British Army basic training. BMJ Mil Health 2023; 169:57-61. [PMID: 32111683 DOI: 10.1136/jramc-2019-001347] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 12/11/2019] [Accepted: 12/13/2019] [Indexed: 01/26/2023]
Abstract
INTRODUCTION Until recently, women were excluded from British combat roles. Their risk for musculoskeletal injury during basic training is two to three times higher than men. To better understand the musculoskeletal injury risk of women in British Army infantry basic training, we compared injury incidence between (1) men in standard entry training and men in infantry training, to assess the risk of infantry training; and (2) men and women in both standard entry and officer basic training, to assess the risk in women compared with men. METHODS The incidence of musculoskeletal injury was determined from defence medical records for all men entering infantry training, and for all men and women entering standard entry and officer training, between April 2015 and March 2016. RESULTS 7390 men (standard entry, n=4229; infantry, n=2683; officer, n=478) and 696 women (standard entry, n=626; officer, n=70) entered basic training. Men in infantry training had a lower incidence of musculoskeletal injury (391 vs 417 per 1000 personnel, OR 0.90 (95% CI 0.81 to 0.99), p=0.028) and a higher incidence of stress fracture (14 vs 5 per 1000 personnel, OR 2.80 (95% CI 1.64 to 4.80), p<0.001) than men in standard entry training. Women had a higher incidence of musculoskeletal injury than men in standard entry training (522 vs 417 per 1000 personnel, OR 1.53 (95% CI 1.29 to 1.81), p<0.001) and a higher incidence of stress fracture than men in officer training (114 vs 19 per 1000 personnel, OR 6.72 (95% CI 2.50 to 18.07), p<0.001). CONCLUSION Women in infantry training may be at similar risk for musculoskeletal injury, but at higher risk for stress fracture, compared with their non-infantry counterparts. Women in infantry training may be at higher risk for musculoskeletal injury and stress fracture compared with men in infantry training.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, British Army, Andover, Hampshire, UK
| | - S L Wardle
- Army Health and Performance Research, British Army, Andover, Hampshire, UK
| | - A J Rawcliffe
- Army Recruiting and Initial Training Command, British Army, Upavon, Wiltshire, UK
| | - S Chapman
- Army Recruiting and Initial Training Command, British Army, Upavon, Wiltshire, UK
| | - J Mole
- Defence Statistics (Health), Defence Statistics, Abbey Wood, Bristol, UK
| | - J P Greeves
- Army Health and Performance Research, British Army, Andover, Hampshire, UK.,Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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12
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Orth M, Ganse B, Andres A, Wickert K, Warmerdam E, Müller M, Diebels S, Roland M, Pohlemann T. Simulation-based prediction of bone healing and treatment recommendations for lower leg fractures: Effects of motion, weight-bearing and fibular mechanics. Front Bioeng Biotechnol 2023; 11:1067845. [PMID: 36890916 PMCID: PMC9986461 DOI: 10.3389/fbioe.2023.1067845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 02/10/2023] [Indexed: 02/22/2023] Open
Abstract
Despite recent experimental and clinical progress in the treatment of tibial and fibular fractures, in clinical practice rates of delayed bone healing and non-union remain high. The aim of this study was to simulate and compare different mechanical conditions after lower leg fractures to assess the effects of postoperative motion, weight-bearing restrictions and fibular mechanics on the strain distribution and the clinical course. Based on the computed tomography (CT) data set of a real clinical case with a distal diaphyseal tibial fracture, a proximal and a distal fibular fracture, finite element simulations were run. Early postoperative motion data, recorded via an inertial measuring unit system and pressure insoles were recorded and processed to study strain. The simulations were used to compute interfragmentary strain and the von Mises stress distribution of the intramedullary nail for different treatments of the fibula, as well as several walking velocities (1.0 km/h; 1.5 km/h; 2.0 km/h) and levels of weight-bearing restriction. The simulation of the real treatment was compared to the clinical course. The results show that a high postoperative walking speed was associated with higher loads in the fracture zone. In addition, a larger number of areas in the fracture gap with forces that exceeded beneficial mechanical properties longer was observed. Moreover, the simulations showed that surgical treatment of the distal fibular fracture had an impact on the healing course, whereas the proximal fibular fracture barely mattered. Weight-bearing restrictions were beneficial in reducing excessive mechanical conditions, while it is known that it is difficult for patients to adhere to partial weight-bearing recommendations. In conclusion, it is likely that motion, weight bearing and fibular mechanics influence the biomechanical milieu in the fracture gap. Simulations may improve decisions on the choice and location of surgical implants, as well as give recommendations for loading in the postoperative course of the individual patient.
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Affiliation(s)
- Marcel Orth
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Saarbrücken, Germany
| | - Bergita Ganse
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Saarbrücken, Germany.,Werner Siemens Endowed Chair of Innovative Implant Development (Fracture Healing), Saarland University, Saarbrücken, Germany
| | | | - Kerstin Wickert
- Chair of Applied Mechanics, Saarland University, Saarbrücken, Germany
| | - Elke Warmerdam
- Werner Siemens Endowed Chair of Innovative Implant Development (Fracture Healing), Saarland University, Saarbrücken, Germany
| | - Max Müller
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Saarbrücken, Germany
| | - Stefan Diebels
- Chair of Applied Mechanics, Saarland University, Saarbrücken, Germany
| | - Michael Roland
- Chair of Applied Mechanics, Saarland University, Saarbrücken, Germany
| | - Tim Pohlemann
- Department of Trauma, Hand and Reconstructive Surgery, Saarland University, Saarbrücken, Germany
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13
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Wong KK, Hsu HC, Wu SC, Hung TL, Ho WF. Structure, Properties, and Corrosion Behavior of Ti-Rich TiZrNbTa Medium-Entropy Alloys with β+α″+α' for Biomedical Application. MATERIALS (BASEL, SWITZERLAND) 2022; 15:7953. [PMID: 36431438 PMCID: PMC9696250 DOI: 10.3390/ma15227953] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 11/07/2022] [Accepted: 11/09/2022] [Indexed: 06/16/2023]
Abstract
Five Ti-rich β+α″+α′ Ti−Zr−Nb−Ta biomedical medium-entropy alloys with excellent mechanical properties and corrosion resistance were developed by considering thermodynamic parameters and using the valence electron concentration formula. The results of this study demonstrated that the traditional valence electron concentration formula for predicting phases is not entirely applicable to medium-entropy alloys. All solution-treated samples with homogeneous compositions were obtained at a low temperature (900 °C) and within a short period (20 min). All solution-treated samples exhibited low elastic moduli ranging from 49 to 57 GPa, which were significantly lower than those of high-entropy alloys with β phase. Solution-treated Ti65−Zr29−Nb3−Ta3 exhibited an ultra-high bending strength (1102 MPa), an elastic recovery angle (>30°), and an ultra-low elastic modulus (49 GPa), which are attributed to its α″ volume fraction as high as more than 60%. The pitting potentials of all samples were higher than 1.8 V, and their corrosion current densities were lower than 10−5 A/cm3 in artificially simulated body fluid at 37 °C. The surface oxide layers on Ti65−Zr29−Nb3−Ta3 comprised TiO2, ZrO2, Nb2O5, and Ta2O5 (as discovered through X-ray photoelectron spectroscopy) and provided the alloy with excellent corrosion and pitting resistance.
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Affiliation(s)
- Ka-Kin Wong
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
| | - Hsueh-Chuan Hsu
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan
| | - Shih-Ching Wu
- Department of Dental Technology and Materials Science, Central Taiwan University of Science and Technology, Taichung 40601, Taiwan
| | - Tun-Li Hung
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
| | - Wen-Fu Ho
- Department of Chemical and Materials Engineering, National University of Kaohsiung, Kaohsiung 81148, Taiwan
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14
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Saunders WB, Dejardin LM, Soltys-Niemann EV, Kaulfus CN, Eichelberger BM, Dobson LK, Weeks BR, Kerwin SC, Gregory CA. Angle-stable interlocking nailing in a canine critical-sized femoral defect model for bone regeneration studies: In pursuit of the principle of the 3R’s. Front Bioeng Biotechnol 2022; 10:921486. [PMID: 36118571 PMCID: PMC9479202 DOI: 10.3389/fbioe.2022.921486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 07/19/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction: Critical-sized long bone defects represent a major therapeutic challenge and current treatment strategies are not without complication. Tissue engineering holds much promise for these debilitating injuries; however, these strategies often fail to successfully translate from rodent studies to the clinical setting. The dog represents a strong model for translational orthopedic studies, however such studies should be optimized in pursuit of the Principle of the 3R’s of animal research (replace, reduce, refine). The objective of this study was to refine a canine critical-sized femoral defect model using an angle-stable interlocking nail (AS-ILN) and reduce total animal numbers by performing imaging, biomechanics, and histology on the same cohort of dogs. Methods: Six skeletally mature hounds underwent a 4 cm mid-diaphyseal femoral ostectomy followed by stabilization with an AS-ILN. Dogs were assigned to autograft (n = 3) or negative control (n = 3) treatment groups. At 6, 12, and 18 weeks, healing was quantified by ordinal radiographic scoring and quantified CT. After euthanasia, femurs from the autograft group were mechanically evaluated using an established torsional loading protocol. Femurs were subsequently assessed histologically. Results: Surgery was performed without complication and the AS-ILN provided appropriate fixation for the duration of the study. Dogs assigned to the autograft group achieved radiographic union by 12 weeks, whereas the negative control group experienced non-union. At 18 weeks, median bone and soft tissue callus volume were 9,001 mm3 (range: 4,939–10,061) for the autograft group and 3,469 mm3 (range: 3,085–3,854) for the negative control group. Median torsional stiffness for the operated, autograft treatment group was 0.19 Nm/° (range: 0.19–1.67) and torque at failure was 12.0 Nm (range: 1.7–14.0). Histologically, callus formation and associated endochondral ossification were identified in the autograft treatment group, whereas fibrovascular tissue occupied the critical-sized defect in negative controls. Conclusion: In a canine critical-sized defect model, the AS-ILN and described outcome measures allowed refinement and reduction consistent with the Principle of the 3R’s of ethical animal research. This model is well-suited for future canine translational bone tissue engineering studies.
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Affiliation(s)
- W. B. Saunders
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
- *Correspondence: W. B. Saunders,
| | - L. M. Dejardin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, United States
| | - E. V. Soltys-Niemann
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - C. N. Kaulfus
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - B. M. Eichelberger
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - L. K. Dobson
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - B. R. Weeks
- Department of Veterinary Pathobiology, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - S. C. Kerwin
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences, Texas A & M University, College Station, TX, United States
| | - C. A. Gregory
- Department of Molecular and Cellular Medicine, Institute for Regenerative Medicine, School of Medicine, Texas A & M Health Science Center, College Station, TX, United States
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15
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The probability of whole-bone fatigue fracture can be accurately predicted using specimen-specific finite element analysis incorporating a stochastic failure model. J Biomech 2022; 143:111273. [PMID: 36049387 DOI: 10.1016/j.jbiomech.2022.111273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/09/2022] [Accepted: 08/22/2022] [Indexed: 11/21/2022]
Abstract
A better understanding of the mechanisms of mechanical fatigue in bone could help improve understanding of the etiology of stress fractures. Investigations of small material samples of bone have identified a nonlinear relationship between strain magnitude, strained volume, and fatigue life, but it is non-trivial to extend these principles to predict the fatigue-life of whole bones which experience complex loading and non-uniform strain distribution. The purpose of this investigation was to experimentally validate a specimen-specific finite element (FE) model that predicts whole-bone fatigue failure using a stochastic model based on strain magnitude and volume. Thirty-four rabbit tibiae were previously tested to failure under cyclic compression, torsion, or both. Strain distribution during the test was estimated from computed-tomography based specimen-specific FE models, and a stochastic failure model based on strain magnitude and volume was used to predict the probability of failure as a function of loading cycles. Model predicted fracture risk matched experimental observations. Respectively, for the 25%, 50%, 75%, and 95% probabilistic predictions, we observed experimental failure ≤ model predicted values in 41%, 53%, 76%, and 80% of the tested specimens. A Brier scoring rule further demonstrated that this model, using strain magnitude and volume, more accurately predicted failure probability compared to two reference models that considered strain magnitude only. In conclusion, the stochastic model may be a powerful tool in future studies to assess mechanical factors that influence stress fracture risk.
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16
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Baggaley M, Derrick TR, Edwards WB. Sensitivity of Internal Tibial Forces and Moments to Static Optimization Moment Constraints At the Subtalar and Ankle Joints. J Biomech Eng 2022; 145:1143324. [PMID: 35864788 DOI: 10.1115/1.4055036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Indexed: 11/08/2022]
Abstract
We examined the sensitivity of internal tibial forces and moments during running to different subtalar/ankle moment constraints in a static optimization routine. Seventeen participants ran at 2.20, 3.33, and 4.17 ms-1 while force and motion data were collected. Ankle joint contact force was estimated using inverse-dynamics-based static optimization. Three sets of joint moment constraints were tested. All sets included the flexion-extension and abduction-adduction moments at the hip and the flexion-extension moment at the knee, but differed in the constraints used at the subtalar/ankle: 1) flexion-extension at the ankle (Sag), 2) flexion-extension and inversion-eversion at ankle (Sag+Front), and 3) flexion-extension at the ankle and supination-pronation at the subtalar (Sag+SubT). Internal tibial forces and moments were quantified at the distal one-third of the tibia, by ensuring static equilibrium with applied forces and moments. No interaction was observed between running speed and constraint for internal tibial forces or moments. Sag+SubT resulted in larger internal mediolateral force (+41%), frontal (+79%), and transverse (+29%) plane moments, compared to Sag and Sag+Front. Internal axial force was greatest in Sag+Front, compared to Sag and Sag+SubT (+37%). Faster running speeds resulted in greater internal tibial forces and moments in all directions (=+6%). Internal tibial forces and moments at the distal one-third of the tibia were sensitive to the subtalar and ankle joint moment constraints used in the static optimization routine, independent of running speed.
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Affiliation(s)
- Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada T2N 1N4
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, 0111L Forker, 534 Wallace Rd, Ames, IA, 50011-4008
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary, Alberta, Canada T2N 1N4
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17
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Smotrova E, Li S, Silberschmidt VV. Mechanoregulated trabecular bone adaptation: Progress report on in silico approaches. BIOMATERIALS AND BIOSYSTEMS 2022; 7:100058. [PMID: 36824485 PMCID: PMC9934474 DOI: 10.1016/j.bbiosy.2022.100058] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/28/2022] [Accepted: 07/14/2022] [Indexed: 10/17/2022] Open
Abstract
Adaptation is the process by which bone responds to changes in loading environment and modulates its properties and spatial organization to meet the mechanical demands. Adaptation in trabecular bone is achieved through increase in bone mass and alignment of trabecular-bone morphology along the loading direction. This transformation of internal microstructure is governed by mechanical stimuli sensed by mechanosensory cells in the bone matrix. Realisation of adaptation in the form of local bone-resorption and -formation activities as a function of mechanical stimuli is still debated. In silico modelling is a useful tool for simulation of various scenarios that cannot be investigated in vivo and particularly well suited for prediction of trabecular bone adaptation. This progress report presents the recent advances in in silico modelling of mechanoregulated adaptation at the scale of trabecular bone tissue. Four well-established bone-adaptation models are reviewed in terms of their recent improvements and validation. They consider various mechanical factors: (i) strain energy density, (ii) strain and damage, (iii) stress nonuniformity and (iv) daily stress. Contradictions of these models are discussed and their ability to describe adequately a real-life mechanoregulation process in bone is compared.
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18
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O'Leary TJ, Izard RM, Tang JCY, Fraser WD, Greeves JP. Sex differences in tibial adaptations to arduous training: An observational cohort study. Bone 2022; 160:116426. [PMID: 35470123 DOI: 10.1016/j.bone.2022.116426] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 04/12/2022] [Accepted: 04/19/2022] [Indexed: 12/31/2022]
Abstract
Military training increases tibial density and size, but it is unknown if men and women adapt similarly to the same arduous training. Seventy-seven men and 57 women not using hormonal contraceptives completed this study. Tibial volumetric bone mineral density (vBMD) and geometry were measured by peripheral quantitative computed tomography (4%, 14%, 38%, and 66% sites) at the start (week 1) and end (week 14) of British Army basic training. Training increased trabecular vBMD (4% site in men; 4% and 14% sites in women), cortical vBMD (38% site), total area (14% and 38% sites), trabecular area (14% site), cortical area and thickness (14%, 38%, and 66% sites), periosteal perimeter (14%, 38%, and 66% sites), and all indices of estimated strength (14%, 38%, and 66% sites); and, decreased endosteal perimeter (66% site) in men and women (all p ≤ 0.045). The increase in trabecular vBMD (4% and 14% sites) was greater in women and the increases in cortical area and strength (38% site) were greater in men (sex × time interactions, all p ≤ 0.047). P1NP increased and βCTX and sclerostin decreased during training in men and women, consistent with adaptive bone formation. PTH decreased in men but increased in women. Arduous weight-bearing activity increased the density and size of the tibia after 14 weeks. Women experienced similar tibial adaptations as men, however, a greater increase in trabecular vBMD in women compared with men could be due to higher loading at this skeletal site in women, whereas the small increase in cortical area could be due to inhibitory effects of oestradiol.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army HQ, Andover, UK; Division of Surgery and Interventional Science, UCL, London, UK
| | | | | | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich, UK; Norfolk and Norwich University Hospital, Norwich, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army HQ, Andover, UK; Division of Surgery and Interventional Science, UCL, London, UK; Norwich Medical School, University of East Anglia, Norwich, UK.
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19
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Ganse B, Orth M, Roland M, Diebels S, Motzki P, Seelecke S, Kirsch SM, Welsch F, Andres A, Wickert K, Braun BJ, Pohlemann T. Concepts and clinical aspects of active implants for the treatment of bone fractures. Acta Biomater 2022; 146:1-9. [PMID: 35537678 DOI: 10.1016/j.actbio.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Revised: 04/24/2022] [Accepted: 05/02/2022] [Indexed: 12/17/2022]
Abstract
Nonunion is a complication of long bone fractures that leads to disability, morbidity and high costs. Early detection is difficult and treatment through external stimulation and revision surgery is often a lengthy process. Therefore, alternative diagnostic and therapeutic options are currently being explored, including the use of external and internal sensors. Apart from monitoring fracture stiffness and displacement directly at the fracture site, it would be desirable if an implant could also vary its stiffness and apply an intervention to promote healing, if needed. This could be achieved either by a predetermined protocol, by remote control, or even by processing data and triggering the intervention itself (self-regulated 'intelligent' or 'smart' implant). So-called active or smart materials like shape memory alloys (SMA) have opened up opportunities to build active implants. For example, implants could stimulate fracture healing by active shortening and lengthening via SMA actuator wires; by emitting pulses, waves, or electromagnetic fields. However, it remains undefined which modes of application, forces, frequencies, force directions, time durations and periods, or other stimuli such implants should ideally deliver for the best result. The present paper reviews the literature on active implants and interventions for nonunion, discusses possible mechanisms of active implants and points out where further research and development are needed to build an active implant that applies the most ideal intervention. STATEMENT OF SIGNIFICANCE: Early detection of delays during fracture healing and timely intervention are difficult due to limitations of the current diagnostic strategies. New diagnostic options are under evaluation, including the use of external and internal sensors. In addition, it would be desirable if an implant could actively facilitate healing ('Intelligent' or 'smart' implant). Implants could stimulate fracture healing via active shortening and lengthening; by emitting pulses, waves, or electromagnetic fields. No such implants exist to date, but new composite materials and alloys have opened up opportunities to build such active implants, and several groups across the globe are currently working on their development. The present paper is the first review on this topic to date.
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20
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Djuricic A, Gee A, Schemitsch EH, Quenneville CE, Zdero R. Biomechanical design of a new percutaneous locked plate for comminuted proximal tibia fractures. Med Eng Phys 2022; 104:103801. [DOI: 10.1016/j.medengphy.2022.103801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/14/2022] [Accepted: 04/12/2022] [Indexed: 11/25/2022]
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21
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Yan C, Bice RJ, Frame JW, Warden SJ, Kersh ME. Multidirectional basketball activities load different regions of the tibia: A subject-specific muscle-driven finite element study. Bone 2022; 159:116392. [PMID: 35314384 PMCID: PMC10201946 DOI: 10.1016/j.bone.2022.116392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 11/20/2022]
Abstract
The tibia is a common site for bone stress injuries, which are believed to develop from microdamage accumulation to repetitive sub-yield strains. There is a need to understand how the tibia is loaded in vivo to understand how bone stress injuries develop and design exercises to build a more robust bone. Here, we use subject-specific, muscle-driven, finite element simulations of 11 basketball players to calculate strain and strain rate distributions at the midshaft and distal tibia during six activities: walking, sprinting, lateral cut, jumping after landing, changing direction from forward-to-backward sprinting, and changing direction while side shuffling. Maximum compressive strains were at least double maximum tensile strains during the stance phase of all activities. Sprinting and lateral cut had the highest compressive (-2,862 ± 662 με and -2,697 ± 495 με, respectively) and tensile (973 ± 208 με and 942 ± 223 με, respectively) strains. These activities also had the highest strains rates (peak compressive strain rate = 64,602 ± 19,068 με/s and 37,961 ± 14,210 με/s, respectively). Compressive strains principally occurred in the posterior tibia for all activities; however, tensile strain location varied. Activities involving a change in direction increased tensile loads in the anterior tibia. These observations may guide preventative and management strategies for tibial bone stress injuries. In terms of prevention, the strain distributions suggest individuals should perform activities involving changes in direction during growth to adapt different parts of the tibia and develop a more fatigue resistant bone. In terms of management, the greater strain and strain rates during sprinting than jumping suggests jumping activities may be commenced earlier than full pace running. The greater anterior tensile strains during changes in direction suggest introduction of these types of activities should be delayed during recovery from an anterior tibial bone stress injury, which have a high-risk of healing complications.
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Affiliation(s)
- Chenxi Yan
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America
| | - Ryan J Bice
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Jeff W Frame
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America
| | - Stuart J Warden
- Department of Physical Therapy, Indiana University School of Health and Human Sciences, United States of America; Indiana Center for Musculoskeletal Health, Indiana University School of Medicine, United States of America; La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - Mariana E Kersh
- Department of Mechanical Science and Engineering, University of Illinois Urbana-Champaign, United States of America; Beckman Institute for Advanced Science and Technology, University of Illinois Urbana-Champaign, United States of America; Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, United States of America.
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22
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Bionic Design of the Vertical Bracket of Wide Angle Auroral Imager by Additive Manufacturing. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12105274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
In the aerospace field, lightweight design is a never-ending pursuit. By integrating structural bionics and structural optimization, the vertical bracket of a wide angle auroral imager is designed and manufactured by additive manufacturing technology in this work. Initially, the classical topology optimization is utilized for the vertical bracket to find the optimal material layout and primary load carrying paths. Drawing on the width-to-diameter ratio and the bone mineral density distribution of human femur, the vertical support is designed as a bionic structure with a solid middle section and thin wall in other parts. Afterwards, size optimization is maintained for the bionic design model to obtain the optimal model. The simulation results show that the three-way eigenfrequencies of bionic optimized structure are 320 Hz, 303 Hz, and 765 Hz, respectively, which are closely approximate to the original structure. However, the mass of bionic optimized structure is reduced by 23%. Benefiting from Selective laser melting, the complex optimized design can be rapidly manufactured. The three-way eigenfrequencies of the optimized structure measured by the 0.2 g sweep tests are 307 Hz, 292 Hz, and 736 Hz, respectively. The vibration test of bionic optimized structure verifies the accuracy of the simulation results. This study indicates that the combination of structural bionics and structural optimization provides a powerful tool kit to the design of similar support structure for space applications.
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23
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Skammer S, Halvorson J, Becker J. Using an external focus of attention for gait retraining in runners: A case report. Physiother Theory Pract 2022; 39:1083-1094. [PMID: 35129062 DOI: 10.1080/09593985.2022.2035032] [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
INTRODUCTION Many gait retraining studies use cues that promote internal focus of attention. However, the motor control literature clearly shows the beneficial effects of using cues that promote an external focus of attention (EFOA) when teaching new movements. This case report seeks to illustrate the outcomes of using an EFOA for running gait retraining. It also examines whether retrained mechanics transfer across different running speeds. CASE DESCRIPTIONS A 22-year-old female competitive runner with a history of tibial stress injuries was the participant. PATIENT MANAGEMENT Baseline assessments of flexibility, strength, and running biomechanics were performed after which an eight-session gait retraining protocol was implemented. Visual (mirror) and verbal feedback (EFOA) cues were provided during the retraining protocol. Outcomes showed improved hip, knee, and ankle kinematics, reduced ground reaction forces, and earlier onset and longer durations of muscle activity following retraining. These improvements transferred across running speeds. DISCUSSION AND CONCLUSION In this participant, EFOA cues were effective for the gait retraining protocol and the benefits were transferable across running speeds. Clinicians should consider how EFOA cues may be incorporated to improve gait retraining outcomes.
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Affiliation(s)
- Sara Skammer
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
| | - Justin Halvorson
- Department of Athletics, Montana State University, Bozeman, MT, USA
| | - James Becker
- Department of Health and Human Development, Montana State University, Bozeman, MT, USA
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Baleani M, Erani P, Blaise M, Fognani R, Palmas M, Manfrini M. Intercalary reconstruction of long bones by massive allograft: Comparison of construct stability ensured by three different host-graft junctions and two types of fixations in a synthetic femur model. Front Pediatr 2022; 10:868299. [PMID: 35989989 PMCID: PMC9382195 DOI: 10.3389/fped.2022.868299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 07/04/2022] [Indexed: 11/24/2022] Open
Abstract
An intercalary segmental allograft is an option for limb salvage in bone tumours. Stable and congruent intercalary reconstructions are a prerequisite for achieving host-graft union. However, a too rigid fixation could increase the risk of late complications correlated with negative bone remodelling. This study compared the reconstruction stiffness achieved by three different host-graft junctions, namely, end-to-end, modified step-cut, and taper. A low-stiffness bone plate was used as the fixation method, except for the taper junction where a low-stiffness intramedullary nail was also used to investigate the effects of different types of fixation on construct stiffness. Composite femora were tested under four loading conditions to determine coronal and sagittal bending stiffness, as well as torsional stiffness in opposite directions. Stiffness values were expressed as a percentage of intact host bone stiffness (%IBS). While a reduction of coronal bending stiffness was found with taper junctions (76%IBS) compared with the high values ensured by end-to-end (96%IBS) and modified step-cut junctions (92%IBS), taper junctions significantly increased stiffness under sagittal bending and torsion in intra- and extra-direction: end-to-end 29%IBS, 7%IBS, 7%IBS, modified step-cut 38%IBS, 20%IBS, 21%IBS, and taper junction 52%IBS, 55%IBS, 56%IBS, respectively. Construct stiffness with taper junctions was decreased by 11-41%IBS by replacing the bone plate with an intramedullary nail. Taper junctions can be an alternative to achieve intercalary reconstructions with more homogeneous and, in three out of four loading conditions, significantly higher construct stability without increasing bone plate stiffness. The risk of instability under high torsional loads increases when taper junctions are associated with a low-stiffness intramedullary nail.
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Affiliation(s)
- Massimiliano Baleani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Erani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Manon Blaise
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Roberta Fognani
- Laboratorio di Tecnologia Medica, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Palmas
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Manfrini
- Clinica Ortopedica e Traumatologica III a Prevalente Indirizzo Oncologico, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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25
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Jafarnezhadgero AA, Fakhri E, Granacher U. Effects of nail softness and stiffness with distance running shoes on ground reaction forces and vertical loading rates in male elite long-distance runners with pronated feet. BMC Sports Sci Med Rehabil 2021; 13:120. [PMID: 34627372 PMCID: PMC8501533 DOI: 10.1186/s13102-021-00352-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 09/21/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND To improve propulsion during running, athletes often wear spike shoes designed for training and/or competition. Running with spike shoes may cause pain and/or injuries. To address this problem, a modified spike shoe was tested. This study aimed to evaluate the effects of running with dual-versus single-stiffness spike running shoes on running mechanics in long-distance runners with pronated feet. METHODS Sixteen male elite (national competitive level) runners (5000 or 10,000 m) aged 28.2 ± 2.5 years with pronated feet volunteered to participate in this study. To be included, participants had to have achieved personal best race times over 5- and/or 10-km races under 17 or 34 min during official running competitions. All participants were heel strikers and had a history of 11.2 ± 4.2 years of training. For the assessment of running kinetics, a force plate was imbedded into a walkway. Running kinematics were recorded using a Vicon-motion-capture system. Nike Zoom Rival shoes (Nike, Nike Zoom Rival, USA) were selected and adapted according to spike softness and stiffness. Participants ran at a constant speed of ~4.0 m/s across the walkway with both shoe conditions in randomized order. Six trials were recorded per condition. The main outcomes included peak ground reaction forces and their time-to-peak, average and instantaneous vertical loading rates, free moments, and peak ankle eversion angles. RESULTS Paired t-tests revealed significantly lower lateral (p = 0.021, d = 0.95) and vertical (p = 0.010, d = 1.40) forces at heel contact during running with dual-stiffness spike shoes. Running with dual-stiffness spike shoes resulted in a significantly longer time-to-peak vertical (p = 0.004, d = 1.40) force at heel contact. The analysis revealed significantly lower average (p = 0.005, d = 0.46) and instantaneous (p = 0.021, d = 0.49) loading rates and peak negative free moment amplitudes (p = 0.016, d = 0.81) when running with dual-stiffness spike shoes. Finally, significantly lower peak ankle eversion angles were observed with dual-stiffness spike shoes (p < 0.001, d = 1.29). CONCLUSIONS Running in dual- compared with single-stiffness spike distance running shoes resulted in lower loading rates, free moment amplitudes, and peak ankle eversion angles of long-distance runners with pronated feet.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Sport Managements and Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Ehsan Fakhri
- Department of Sport Managements and Biomechanics, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Urs Granacher
- Division of Training and Movement Sciences, Research Focus Cognition Sciences, University of Potsdam, Potsdam, Germany.
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26
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Drapal V, Gamble JM, Robinson JL, Tamerler C, Arnold PM, Friis EA. Integration of clinical perspective into biomimetic bioreactor design for orthopedics. J Biomed Mater Res B Appl Biomater 2021; 110:321-337. [PMID: 34510706 PMCID: PMC9292211 DOI: 10.1002/jbm.b.34929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/09/2021] [Accepted: 08/12/2021] [Indexed: 12/30/2022]
Abstract
The challenges to accommodate multiple tissue formation metrics in conventional bioreactors have resulted in an increased interest to explore novel bioreactor designs. Bioreactors allow researchers to isolate variables in controlled environments to quantify cell response. While current bioreactor designs can effectively provide either mechanical, electrical, or chemical stimuli to the controlled environment, these systems lack the ability to combine all these stimuli simultaneously to better recapitulate the physiological environment. Introducing a dynamic and systematic combination of biomimetic stimuli bioreactor systems could tremendously enhance its clinical relevance in research. Thus, cues from different tissue responses should be studied collectively and included in the design of a biomimetic bioreactor platform. This review begins by providing a summary on the progression of bioreactors from simple to complex designs, focusing on the major advances in bioreactor technology and the approaches employed to better simulate in vivo conditions. The current state of bioreactors in terms of their clinical relevance is also analyzed. Finally, this review provides a comprehensive overview of individual biophysical stimuli and their role in establishing a biomimetic microenvironment for tissue engineering. To date, the most advanced bioreactor designs only incorporate one or two stimuli. Thus, the cell response measured is likely unrelated to the actual clinical performance. Integrating clinically relevant stimuli in bioreactor designs to study cell response can further advance the understanding of physical phenomenon naturally occurring in the body. In the future, the clinically informed biomimetic bioreactor could yield more efficiently translatable results for improved patient care.
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Affiliation(s)
- Victoria Drapal
- Bioengineering Program, University of Kansas, Lawrence, Kansas, USA
| | - Jordan M Gamble
- Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Jennifer L Robinson
- Bioengineering Program, University of Kansas, Lawrence, Kansas, USA.,Department of Chemical and Petroleum Engineering, University of Kansas, Lawrence, Kansas, USA
| | - Candan Tamerler
- Bioengineering Program, University of Kansas, Lawrence, Kansas, USA.,Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA.,Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas, USA
| | - Paul M Arnold
- Carle School of Medicine, University of Illinois-Champaign Urbana, Champaign, Illinois, USA
| | - Elizabeth A Friis
- Bioengineering Program, University of Kansas, Lawrence, Kansas, USA.,Department of Mechanical Engineering, University of Kansas, Lawrence, Kansas, USA.,Institute for Bioengineering Research, University of Kansas, Lawrence, Kansas, USA
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27
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Baggaley M, Derrick TR, Vernillo G, Millet GY, Edwards WB. Internal Tibial Forces and Moments During Graded Running. J Biomech Eng 2021; 144:1115052. [PMID: 34318310 DOI: 10.1115/1.4051924] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Indexed: 11/08/2022]
Abstract
The stress experienced by the tibia has contributions from the forces and moments acting on the tibia. We sought to quantify the influence of running grade on internal tibial forces and moments. Seventeen participants ran at 3.33 m/s on an instrumented treadmill at 0 deg, ±5 deg, and ±10 deg while motion data were captured. Ankle joint contact force was estimated from an anthropometrically-scaled musculoskeletal model using inverse dynamics-based static optimization. Internal tibial forces and moments were quantified at the distal 1/3rd of the tibia, by ensuring static equilibrium with all applied forces and moments. Downhill running conditions resulted in lower peak internal axial force (range of mean differences: -9% to -16%, p < 0.001), lower peak internal anteroposterior force (-14% to -21%, p < 0.001), and lower peak internal mediolateral force (-14% to -15%, p < 0.001), compared to 0 deg and +5 deg. Furthermore, downhill conditions resulted in lower peak internal mediolateral moment (-11%to -21%, p < 0.001), lower peak internal anteroposterior moment (-13% to -14%, p < 0.001), and lower peak internal torsional moment (-9% to -21%, p < 0.001), compared to 0 deg, +5 deg, and +10 deg. The +10 deg condition resulted in lower peak internal axial force (-7% to -9%, p < 0.001) and lower peak internal mediolateral force (-9%, p = 0.004), compared to 0 deg and +5 deg. These findings suggest that downhill running may be associated with lower tibial stresses than either level or uphill running.
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Affiliation(s)
- Michael Baggaley
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary AB T2N 1N4, Canada
| | - Timothy R Derrick
- Department of Kinesiology, Iowa State University, 0111 L Forker, 534 Wallace Rd, Ames, IA 50011-4008
| | - Gianluca Vernillo
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Via Colombo, 71, Milano 20133, Italy
| | - Guillaume Y Millet
- Univ Lyon, UJM Saint-Etienne, Inter-University Laboratory of Human Movement Biology, 10 rue de la Marandière, Saint Priest en Jarez 42270, France
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, 2500 University Dr. NW, Calgary AB T2N 1N4, Canada
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28
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O'Leary TJ, Wardle SL, Gifford RM, Double RL, Reynolds RM, Woods DR, Greeves JP. Tibial Macrostructure and Microarchitecture Adaptations in Women During 44 Weeks of Arduous Military Training. J Bone Miner Res 2021; 36:1300-1315. [PMID: 33856703 DOI: 10.1002/jbmr.4290] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/01/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
Bone adapts to unaccustomed, high-impact loading but loses mechanosensitivity quickly. Short periods of military training (≤12 weeks) increase the density and size of the tibia in women. The effect of longer periods of military training, where the incidence of stress fracture is high, on tibial macrostructure and microarchitecture in women is unknown. This observational study recruited 51 women (age 19 to 30 years) at the start of 44 weeks of British Army Officer training. Tibial volumetric bone mineral density (vBMD), geometry, and microarchitecture were measured by high-resolution peripheral quantitative computed tomography (HRpQCT). Scans of the right tibial metaphysis (4% site) and diaphysis (30% site) were performed at weeks 1, 14, 28, and 44. Measures of whole-body areal bone mineral density (aBMD) were obtained using dual-energy X-ray absorptiometry (DXA). Blood samples were taken at weeks 1, 28, and 44, and were analyzed for markers of bone formation and resorption. Trabecular vBMD increased from week 1 to 44 at the 4% site (3.0%, p < .001). Cortical vBMD decreased from week 1 to 14 at the 30% site (-0.3%, p < .001). Trabecular area decreased at the 4% site (-0.4%); trabecular bone volume fraction (3.5%), cortical area (4.8%), and cortical thickness (4.0%) increased at the 4% site; and, cortical perimeter increased at the 30% site (0.5%) from week 1 to 44 (p ≤ .005). Trabecular number (3.5%) and thickness (2.1%) increased, and trabecular separation decreased (-3.1%), at the 4% site from week 1 to 44 (p < .001). Training increased failure load at the 30% site from week 1 to 44 (2.5%, p < .001). Training had no effect on aBMD or markers of bone formation or resorption. Tibial macrostructure and microarchitecture continued to adapt across 44 weeks of military training in young women. Temporal decreases in cortical density support a role of intracortical remodeling in the pathogenesis of stress fracture. © 2021 Crown copyright. Journal of Bone and Mineral Research © 2021 American Society for Bone and Mineral Research (ASBMR). This article is published with the permission of the Controller of HMSO and the Queen's Printer for Scotland.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Sophie L Wardle
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK
| | - Robert M Gifford
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK.,Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK
| | - Rebecca L Double
- Army Health and Performance Research, Army Headquarters, Andover, UK
| | - Rebecca M Reynolds
- University/British Heart Foundation Centre for Cardiovascular Science, Queen's Medical Research Institute, University of Edinburgh, Edinburgh, UK
| | - David R Woods
- Research and Clinical Innovation, Royal Centre for Defence Medicine, Birmingham, UK.,Research Institute for Sport, Physical Activity and Leisure, Leeds Beckett University, Leeds, UK.,Northumbria and Newcastle National Health Service (NHS) Trusts, Wansbeck General and Royal Victoria Infirmary, Newcastle, UK.,University of Newcastle, Newcastle, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, UK.,Division of Surgery and Interventional Science, University College London (UCL), London, UK.,Norwich Medical School, University of East Anglia, Norwich, UK
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29
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Maghami E, Josephson TO, Moore JP, Rezaee T, Freeman TA, Karim L, Najafi AR. Fracture behavior of human cortical bone: Role of advanced glycation end-products and microstructural features. J Biomech 2021; 125:110600. [PMID: 34246065 DOI: 10.1016/j.jbiomech.2021.110600] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 06/21/2021] [Accepted: 06/24/2021] [Indexed: 01/22/2023]
Abstract
Diabetes is associated with increased fracture risk in human bone, especially in the elderly population. In the present study, we investigate how simulated advanced glycation end-products (AGEs) and materials heterogeneity affect crack growth trajectory in human cortical bone. We used a phase field fracture framework on 2D models of cortical microstructure created from human tibias to analyze crack propagation. The increased AGEs level results in a higher rate of crack formation. The simulations also indicate that the mismatch between the fracture properties (e.g., critical energy release rate) of osteons and interstitial tissue can alter the post-yielding behavior. The results show that if the critical energy release rate of cement lines is lower than that of osteons and the surrounding interstitial matrix, cracks can be arrested by cement lines. Additionally, activation of toughening mechanisms such as crack merging and branching depends on bone microstructural morphology (i.e., osteons geometrical parameters, canals, and lacunae porosities). In conclusion, the present findings suggest that materials heterogeneity of microstructural features and the crack-microstructure interactions can play important roles in bone fragility.
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Affiliation(s)
- Ebrahim Maghami
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA 19104, USA
| | - Timothy O Josephson
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA 19104, USA
| | - Jason P Moore
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA 19104, USA
| | - Taraneh Rezaee
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Theresa A Freeman
- Thomas Jefferson University Division of Orthopaedic Research, Philadelphia, PA 19107, USA
| | - Lamya Karim
- Department of Bioengineering, University of Massachusetts Dartmouth, 285 Old Westport Road, Dartmouth, MA 02747, USA
| | - Ahmad R Najafi
- Department of Mechanical Engineering and Mechanics, Drexel University, Philadelphia, PA 19104, USA.
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30
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Meardon SA, Derrick TR, Willson JD, Baggaley M, Steinbaker CR, Marshall M, Willy RW. Peak and Per-Step Tibial Bone Stress During Walking and Running in Female and Male Recreational Runners. Am J Sports Med 2021; 49:2227-2237. [PMID: 34077287 DOI: 10.1177/03635465211014854] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Athletes, especially female athletes, experience high rates of tibial bone stress injuries (BSIs). Knowledge of tibial loads during walking and running is needed to understand injury mechanisms and design safe running progression programs. PURPOSE To examine tibial loads as a function of gait speed in male and female runners. STUDY DESIGN Controlled laboratory study. METHODS Kinematic and kinetic data were collected on 40 recreational runners (20 female, 20 male) during 4 instrumented gait speed conditions on a treadmill (walk, preferred run, slow run, fast run). Musculoskeletal modeling, using participant-specific magnetic resonance imaging and motion data, was used to estimate tibial stress. Peak tibial stress and stress-time impulse were analyzed using 2-factor multivariate analyses of variance (speed*sex) and post hoc comparisons (α = .05). Bone geometry and tibial forces and moments were examined. RESULTS Peak compression was influenced by speed (P < .001); increasing speed generally increased tibial compression in both sexes. Women displayed greater increases in peak tension (P = .001) and shear (P < .001) than men when transitioning from walking to running. Further, women displayed greater peak tibial stress overall (P < .001). Compressive and tensile stress-time impulse varied by speed (P < .001) and sex (P = .006); impulse was lower during running than walking and greater in women. A shear stress-time impulse interaction (P < .001) indicated that women displayed greater impulse relative to men when changing from a walk to a run. Compared with men, women displayed smaller tibiae (P < .001) and disproportionately lower tibial forces (P≤ .001-.035). CONCLUSION Peak tibial stress increased with gait speed, with a 2-fold increase in running relative to walking. Women displayed greater tibial stress than men and greater increases in stress when shifting from walking to running. Sex differences appear to be the result of smaller bone geometry in women and tibial forces that were not proportionately lower, given the womens' smaller stature and lower mass relative to men. CLINICAL RELEVANCE These results may inform interventions to regulate running-related training loads and highlight a need to increase bone strength in women. Lower relative bone strength in women may contribute to a sex bias in tibial BSIs, and female runners may benefit from a slower progression when initiating a running program.
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Affiliation(s)
- Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | | | - John D Willson
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Michael Baggaley
- Faculty of Kinesiology, University of Calgary, Calgary, Alberta, Canada
| | | | - Margaret Marshall
- Department of Physical Therapy, East Carolina University, Greenville, North Carolina, USA
| | - Richard W Willy
- School of Physical Therapy and Rehabilitation Science, University of Montana, Missoula, Montana, USA
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31
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Ozmen GC, Safaei M, Semiz B, Whittingslow DC, Hunnicutt JL, Prahalad S, Hash R, Xerogeanes JW, Inan OT. Detection of Meniscal Tear Effects on Tibial Vibration Using Passive Knee Sound Measurements. IEEE Trans Biomed Eng 2021; 68:2241-2250. [PMID: 33400643 PMCID: PMC8284919 DOI: 10.1109/tbme.2020.3048930] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To evaluate whether non-invasive knee sound measurements can provide information related to the underlying structural changes in the knee following meniscal tear. These changes are explained using an equivalent vibrational model of the knee-tibia structure. METHODS First, we formed an analytical model by modeling the tibia as a cantilever beam with the fixed end being the knee. The knee end was supported by three lumped components with features corresponding with tibial stiffnesses, and meniscal damping effect. Second, we recorded knee sounds from 46 healthy legs and 9 legs with acute meniscal tears (n = 34 subjects). We developed an acoustic event ("click") detection algorithm to find patterns in the recordings, and used the instrumental variable continuous-time transfer function estimation algorithm to model them. RESULTS The knee sound measurements yielded consistently lower fundamental mode decay rate in legs with meniscal tears ( 16 ±13 s - 1) compared to healthy legs ( 182 ±128 s - 1), p < 0.05. When we performed an intra-subject analysis of the injured versus contralateral legs for the 9 subjects with meniscus tears, we observed significantly lower natural frequency and damping ratio (first mode results for healthy: [Formula: see text]injured: [Formula: see text]) for the first three vibration modes (p < 0.05). These results agreed with the theoretical expectations gleaned from the vibrational model. SIGNIFICANCE This combined analytical and experimental method improves our understanding of how vibrations can describe the underlying structural changes in the knee following meniscal tear, and supports their use as a tool for future efforts in non-invasively diagnosing meniscal tear injuries.
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Affiliation(s)
- Goktug C. Ozmen
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Mohsen Safaei
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Beren Semiz
- School of Electrical and Computer Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
| | - Daniel C. Whittingslow
- Emory University School of Medicine and Georgia Institute of Technology Coulter Department of Biomedical Engineering under the MD/PhD program
| | | | | | - Regina Hash
- Emory University School of Medicine, Atlanta, GA 30329, USA
| | | | - Omer T. Inan
- School of Electrical and Computer Engineering and, by courtesy, the Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA 30332, USA
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Warden SJ, Edwards WB, Willy RW. Preventing Bone Stress Injuries in Runners with Optimal Workload. Curr Osteoporos Rep 2021; 19:298-307. [PMID: 33635519 PMCID: PMC8316280 DOI: 10.1007/s11914-021-00666-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 02/07/2023]
Abstract
Bone stress injuries (BSIs) occur at inopportune times to invariably interrupt training. All BSIs in runners occur due to an "error" in workload wherein the interaction between the number and magnitude of bone tissue loading cycles exceeds the ability of the tissue to resist the repetitive loads. There is not a single optimal bone workload, rather a range which is influenced by the prevailing scenario. In prepubertal athletes, optimal bone workload consists of low-repetitions of fast, high-magnitude, multidirectional loads introduced a few times per day to induce bone adaptation. Premature sports specialization should be avoided so as to develop a robust skeleton that is structurally optimized to withstand multidirectional loading. In the mature skeleton, optimal workload enables gains in running performance but minimizes bone damage accumulation by sensibly progressing training, particularly training intensity. When indicated (e.g., following repeated BSIs), attempts to reduce bone loading magnitude should be considered, such as increasing running cadence. Determining the optimal bone workload for an individual athlete to prevent and manage BSIs requires consistent monitoring. In the future, it may be possible to clinically determine bone loads at the tissue level to facilitate workload progressions and prescriptions.
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Affiliation(s)
- Stuart J Warden
- Department of Physical Therapy, School of Health & Human Sciences, Indiana University, 1140 W. Michigan St., CF-124, Indianapolis, IN, 46202, USA.
- Indiana Center for Musculoskeletal Health, Indiana University, Indianapolis, IN, USA.
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Bundoora, Victoria, Australia.
| | - W Brent Edwards
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
| | - Richard W Willy
- School of Physical Therapy & Health Sciences, University of Montana, Missoula, MT, USA
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33
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O'Leary TJ, Rice HM, Greeves JP. Biomechanical Basis of Predicting and Preventing Lower Limb Stress Fractures During Arduous Training. Curr Osteoporos Rep 2021; 19:308-317. [PMID: 33635518 DOI: 10.1007/s11914-021-00671-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/12/2021] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Stress fractures at weight-bearing sites, particularly the tibia, are common in military recruits and athletes. This review presents recent findings from human imaging and biomechanics studies aimed at predicting and preventing stress fractures. RECENT FINDINGS Peripheral quantitative computed tomography (pQCT) provides evidence that cortical bone geometry (tibial width and area) is associated with tibial stress fracture risk during weight-bearing exercise. The contribution of bone trabecular microarchitecture, cortical porosity, and bone material properties in the pathophysiology of stress fractures is less clear, but high-resolution pQCT and new techniques such as impact microindentation may improve our understanding of the role of microarchitecture and material properties in stress fracture prediction. Military studies demonstrate osteogenic outcomes from high impact, repetitive tibial loading during training. Kinetic and kinematic characteristics may influence stress fracture risk, but there is no evidence that interventions to modify biomechanics can reduce the incidence of stress fracture. Strategies to promote adaptive bone formation, in combination with improved techniques to assess bone strength, present exciting opportunities for future research to prevent stress fractures.
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Affiliation(s)
- Thomas J O'Leary
- Army Health and Performance Research, Army Headquarters, Andover, Hampshire, UK
- Division of Surgery and Interventional Science, UCL, London, UK
| | - Hannah M Rice
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Julie P Greeves
- Army Health and Performance Research, Army Headquarters, Andover, Hampshire, UK.
- Division of Surgery and Interventional Science, UCL, London, UK.
- Norwich Medical School, University of East Anglia, Norwich, UK.
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Suominen TH, Alén M, Törmäkangas T, Degens H, Rittweger J, Heinonen A, Suominen H, Korhonen MT. Regular Strength and Sprint Training Counteracts Bone Aging: A 10-Year Follow-Up in Male Masters Athletes. JBMR Plus 2021; 5:e10513. [PMID: 34258508 PMCID: PMC8260815 DOI: 10.1002/jbm4.10513] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/06/2022] Open
Abstract
Cross-sectional and interventional studies suggest that high-intensity strength and impact-type training provide a powerful osteogenic stimulus even in old age. However, longitudinal evidence on the ability of high-intensity training to attenuate age-related bone deterioration is currently lacking. This follow-up study assessed the role of continued strength and sprint training on bone aging in 40- to 85-year-old male sprinters (n = 69) with a long-term training background. Peripheral quantitative computed tomography (pQCT)-derived bone structural, strength, and densitometric parameters of the distal tibia and tibia midshaft were assessed at baseline and 10 years later. The groups of well-trained (actively competing, sprint training including strength training ≥2 times/week; n = 36) and less-trained (<2 times/week, no strength training, switched to endurance training; n = 33) athletes were formed according to self-reports at follow-up. Longitudinal changes in bone traits in the two groups were examined using linear mixed models. Over the 10-year period, group-by-time interactions were found for distal tibia total bone mineral content (BMC), trabecular volumetric bone mineral density (vBMD), and compressive strength index, and for mid-tibia cortical cross-sectional area, medullary area, total BMC, and BMC at the anterior and posterior sites (polar mass distribution analysis) (p < 0.05). These interactions reflected maintained (distal tibia) or improved (mid-tibia) bone properties in the well-trained and decreased bone properties in the less-trained athletes over the 10-year period. Depending on the bone variable, the difference in change in favor of the well-trained group ranged from 2% to 5%. The greatest differences were found in distal tibia trabecular vBMD and mid-tibia posterior BMC, which remained significant (p < 0.05) after adjustment for multiple testing. In conclusion, our longitudinal findings indicate that continued strength and sprint training is associated with maintained or even improved tibial properties in middle-aged and older male sprint athletes, suggesting that regular, intensive exercise counteracts bone aging. © 2021 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.
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Affiliation(s)
- Tuuli H Suominen
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Markku Alén
- Department of Medical Rehabilitation, Oulu University Hospital and Center for Life Course Health Research University of Oulu Oulu Finland
| | - Timo Törmäkangas
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Hans Degens
- Department of Life Sciences, Musculoskeletal Science, and Sports Medicine Research Centre Manchester Metropolitan University Manchester UK.,Institute of Sport Science and Innovations Lithuanian Sports University Kaunas Lithuania
| | - Jörn Rittweger
- Institute of Aerospace Medicine German Aerospace Center (DLR) Cologne Germany.,Department of Pediatrics and Adolescent Medicine University of Cologne Cologne Germany
| | - Ari Heinonen
- Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Harri Suominen
- Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
| | - Marko T Korhonen
- Gerontology Research Center, Faculty of Sport and Health Sciences University of Jyväskylä Jyväskylä Finland
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Grzeskowiak RM, Rifkin RE, Croy EG, Steiner RC, Seddighi R, Mulon PY, Adair HS, Anderson DE. Temporal Changes in Reverse Torque of Locking-Head Screws Used in the Locking Plate in Segmental Tibial Defect in Goat Model. Front Surg 2021; 8:637268. [PMID: 33987199 PMCID: PMC8111000 DOI: 10.3389/fsurg.2021.637268] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 03/29/2021] [Indexed: 11/13/2022] Open
Abstract
The objective of this study was to evaluate changes in peak reverse torque (PRT) of the locking head screws that occur over time. A locking plate construct, consisting of an 8-hole locking plate and 8 locking screws, was used to stabilize a tibia segmental bone defect in a goat model. PRT was measured after periods of 3, 6, 9, and 12 months of ambulation. PRT for each screw was determined during plate removal. Statistical analysis revealed that after 6 months of loading, locking screws placed in position no. 4 had significantly less PRT as compared with screws placed in position no. 5 (p < 0.05). There were no statistically significant differences in PRT between groups as a factor of time (p > 0.05). Intracortical fractures occurred during the placement of 151 out of 664 screws (22.7%) and were significantly more common in the screw positions closest to the osteotomy (positions 4 and 5, p < 0.05). Periosteal and endosteal bone reactions and locking screw backout occurred significantly more often in the proximal bone segments (p < 0.05). Screw backout significantly, negatively influenced the PRT of the screws placed in positions no. 3, 4, and 5 (p < 0.05). The locking plate-screw constructs provided stable fixation of 2.5-cm segmental tibia defects in a goat animal model for up to 12 months.
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Affiliation(s)
- Remigiusz M Grzeskowiak
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Rebecca E Rifkin
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Elizabeth G Croy
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Richard C Steiner
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Reza Seddighi
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Pierre-Yves Mulon
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - Henry S Adair
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
| | - David E Anderson
- Department of Large Animal Clinical Sciences, College of Veterinary Medicine, The University of Tennessee, Knoxville, Knoxville, TN, United States
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Abstract
AIMS The aim of this study was to determine the immediate post-fixation stability of a distal tibial fracture fixed with an intramedullary nail using a biomechanical model. This was used as a surrogate for immediate weight-bearing postoperatively. The goal was to help inform postoperative protocols. METHODS A biomechanical model of distal metaphyseal tibial fractures was created using a fourth-generation composite bone model. Three fracture patterns were tested: spiral, oblique, and multifragmented. Each fracture extended to within 4 cm to 5 cm of the plafond. The models were nearly-anatomically reduced and stabilized with an intramedullary nail and three distal locking screws. Cyclic loading was performed to simulate normal gait. Loading was completed in compression at 3,000 N at 1 Hz for a total of 70,000 cycles. Displacement (shortening, coronal and sagittal angulation) was measured at regular intervals. RESULTS The spiral and oblique fracture patterns withstood simulated weight-bearing with minimal displacement. The multifragmented model had early implant failure with breaking of the distal locking screws. The spiral fracture model shortened by a mean of 0.3 mm (SD 0.2), and developed a mean coronal angulation of 2.0° (SD 1.9°) and a mean sagittal angulation of 1.2° (SD 1.1°). On average, 88% of the shortening, 74% of the change in coronal alignment, and 75% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. The oblique fracture model shortened by a mean of 0.2 mm (SD 0.1) and developed a mean coronal angulation of 2.4° (SD 1.6°) and a mean sagittal angulation of 2.6° (SD 1.4°). On average, 44% of the shortening, 39% of the change in coronal alignment, and 79% of the change in sagittal alignment occurred in the first 2,500 cycles. No late acceleration of displacement was noted. CONCLUSION For spiral and oblique fracture patterns, simulated weight-bearing resulted in a clinically acceptable degree of displacement. Most displacement occurred early in the test period, and the rate of displacement decreased over time. Based on this model, we offer evidence that early weight-bearing appears safe for well reduced oblique and spiral fractures, but not in multifragmented patterns that have poor bone contact. Cite this article: Bone Joint J 2021;103-B(2):294-298.
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Affiliation(s)
- Michael M Hadeed
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hans Prakash
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - Seth R Yarboro
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
| | - David B Weiss
- Department of Orthopaedic Surgery, University of Virginia, Charlottesville, Virginia, USA
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Abdelrahman S, Ireland A, Winter EM, Purcell M, Coupaud S. Osteoporosis after spinal cord injury: aetiology, effects and therapeutic approaches. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2021; 21:26-50. [PMID: 33657753 PMCID: PMC8020025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Osteoporosis is a long-term consequence of spinal cord injury (SCI) that leads to a high risk of fragility fractures. The fracture rate in people with SCI is twice that of the general population. At least 50% of these fractures are associated with clinical complications such as infections. This review article presents key features of osteoporosis after SCI, starting with its aetiology, a description of temporal and spatial changes in the long bones and the subsequent fragility fractures. It then describes the physical and pharmacological approaches that have been used to attenuate the bone loss. Bone loss after SCI has been found to be highly site-specific and characterised by large inter-variability and site-specific changes. The assessment of the available interventions is limited by the quality of the studies and the lack of information on their effect on fractures, but this evaluation suggests that current approaches do not appear to be effective. More studies are required to identify factors influencing rate and magnitude of bone loss following SCI. In addition, it is important to test these interventions at the sites that are most prone to fracture, using detailed imaging techniques, and to associate bone changes with fracture risk. In summary, bone loss following SCI presents a substantial clinical problem. Identification of at-risk individuals and development of more effective interventions are urgently required to reduce this burden.
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Affiliation(s)
- Shima Abdelrahman
- Department of Biomedical Engineering, Wolfson Building, University of Strathclyde, Glasgow, United Kingdom,Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom,Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom,Corresponding author: Shima Abdelrahman, Department of Biomedical Engineering, University of Strathclyde, Wolfson Building, Glasgow G4 0NW E-mail:
| | - Alex Ireland
- Research Centre for Musculoskeletal Science & Sports Medicine, Department of Life Sciences, Manchester Metropolitan University, Manchester, United Kingdom
| | - Elizabeth M. Winter
- Leiden University Medical Center, Department of Internal Medicine, Division of Endocrinology and Centre for Bone Quality, The Netherlands
| | - Mariel Purcell
- Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom
| | - Sylvie Coupaud
- Department of Biomedical Engineering, Wolfson Building, University of Strathclyde, Glasgow, United Kingdom,Scottish Centre for Innovation in Spinal Cord Injury, Queen Elizabeth National Spinal Injuries Unit, Queen Elizabeth University Hospital, United Kingdom
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Marturello DM, von Pfeil DJF, Déjardin LM. Evaluation of a Feline Bone Surrogate and In Vitro Mechanical Comparison of Small Interlocking Nail Systems in Mediolateral Bending. Vet Comp Orthop Traumatol 2020; 34:223-233. [PMID: 33368055 DOI: 10.1055/s-0040-1721708] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this study was to (1) evaluate bending structural properties of a machined short fibre epoxy (SFE) feline bone surrogate (FBS), (2) compare the bending behaviour of small angle-stable interlocking nails (I-Loc; Targon) and locking compression plates (LCP) and (3) evaluate the effect of implant removal on FBS bending strength. METHODS Part 1: Feline cadaveric femurs (n = 10) and FBS (n = 4) underwent cyclic four-point bending and load to failure. Part 2: Fracture gap FBS constructs (n = 4/group) were stabilized in a bridging fashion with either I-Loc 3 and 4, Targon 2.5 and 3.0, LCP 2.0 and 2.4, then cyclically bent. Part 3: Intact FBS with pilot holes, simulating explantation, (n = 4/group) underwent destructive bending tests. Bending compliance, angular deformation and failure moment (FM) were statistically compared (p < 0.05). RESULTS Native bone and FBS were similar for all outcome measures (p > 0.05). The smallest and largest bending compliance and angular deformation were seen in the I-Loc 4 and LCP 2.0 respectively (p < 0.05). While explanted Targon FBS had the lowest FM (p < 0.05), I-Loc and LCP constructs FM were not different (p > 0.05). CONCLUSION The similar bending properties of short fibre epoxy made FBS and native feline femurs suggest that this model could be used for mechanical testing of implants designed for feline long bone osteosynthesis. The I-Loc constructs smaller angular deformation which also suggests that these implants represent a valid alternative to size-matched Targon and LCP for feline fracture osteosynthesis. The significantly lower FM of explanted Targon may increase the risk of secondary fracture following implant removal.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Dirsko J F von Pfeil
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan, United States
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Matijevich ES, Scott LR, Volgyesi P, Derry KH, Zelik KE. Combining wearable sensor signals, machine learning and biomechanics to estimate tibial bone force and damage during running. Hum Mov Sci 2020; 74:102690. [PMID: 33132194 PMCID: PMC9827619 DOI: 10.1016/j.humov.2020.102690] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 09/28/2020] [Accepted: 10/02/2020] [Indexed: 01/11/2023]
Abstract
There are tremendous opportunities to advance science, clinical care, sports performance, and societal health if we are able to develop tools for monitoring musculoskeletal loading (e.g., forces on bones or muscles) outside the lab. While wearable sensors enable non-invasive monitoring of human movement in applied situations, current commercial wearables do not estimate tissue-level loading on structures inside the body. Here we explore the feasibility of using wearable sensors to estimate tibial bone force during running. First, we used lab-based data and musculoskeletal modeling to estimate tibial force for ten participants running across a range of speeds and slopes. Next, we converted lab-based data to signals feasibly measured with wearables (inertial measurement units on the foot and shank, and pressure-sensing insoles) and used these data to develop two multi-sensor algorithms for estimating peak tibial force: one physics-based and one machine learning. Additionally, to reflect current running wearables that utilize running impact metrics to infer musculoskeletal loading or injury risk, we estimated tibial force using a commonly measured impact metric, the ground reaction force vertical average loading rate (VALR). Using VALR to estimate peak tibial force resulted in a mean absolute percent error of 9.9%, which was no more accurate than a theoretical step counter that assumed the same peak force for every running stride. Our physics-based algorithm reduced error to 5.2%, and our machine learning algorithm reduced error to 2.6%. Further, to gain insights into how force estimation accuracy relates to overuse injury risk, we computed bone damage expected due to a given loading cycle. We found that modest errors in tibial force translated into large errors in bone damage estimates. For example, a 9.9% error in tibial force using VALR translated into 104% error in estimated bone damage. Encouragingly, the physics-based and machine learning algorithms reduced damage errors to 41% and 18%, respectively. This study highlights the exciting potential to combine wearables, musculoskeletal biomechanics and machine learning to develop more accurate tools for monitoring musculoskeletal loading in applied situations.
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Affiliation(s)
- Emily S. Matijevich
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA,Corresponding author: , Dept. of Mechanical Engineering, Vanderbilt University, 101 Olin Hall, 2400 Highland Avenue, Nashville, TN 37212
| | - Leon R. Scott
- Department of Orthopaedics, Vanderbilt University, Nashville, TN, USA
| | - Peter Volgyesi
- Institute for Software Integrated Systems, Vanderbilt University, Nashville, TN, USA
| | - Kendall H. Derry
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA
| | - Karl E. Zelik
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN, USA,Department of Biomedical Engineering, Vanderbilt University, Nashville, TN, USA,Department of Physical Medicine & Rehabilitation, Vanderbilt University, Nashville, TN, USA
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Rice HM, Kenny M, Ellison MA, Fulford J, Meardon SA, Derrick TR, Hamill J. Tibial stress during running following a repeated calf-raise protocol. Scand J Med Sci Sports 2020; 30:2382-2389. [PMID: 32757284 DOI: 10.1111/sms.13794] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/13/2020] [Accepted: 07/30/2020] [Indexed: 12/11/2022]
Abstract
Tibial stress fractures are a problematic injury among runners. Increased loading of the tibia has been observed following prolonged weight-bearing activity and is suggested to be the result of reduced activity of the plantar flexor muscles. The musculature that spans the tibia contributes to bending of the bone and influences the magnitude of stress on the tibia during running. Participant-specific models of the tibia can be used as a non-invasive estimate of tibial stress. This study aimed to quantify tibial stress during running using participant-specific bone geometry and to compare tibial stress before and after a protocol of repeated muscular contractions of the plantar flexor muscle group. Fourteen participants who run recreationally were included in the final analysis of the study. Synchronized force and kinematic data were collected during overground running before and after an exhaustive, weighted calf-raise protocol. Bending moments and stress at the distal third of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modeling. Bone geometry was obtained from magnetic resonance images. There was no difference in stress at the anterior, posterior, medial, or lateral peripheries of the tibia after the calf-raise protocol compared with before. These findings suggest that an exhaustive, repeated calf-raise protocol did not alter tibial stress during running.
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Affiliation(s)
- Hannah M Rice
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | - Megan Kenny
- Sport and Health Sciences, University of Exeter, Exeter, UK
| | | | - Jon Fulford
- NIHR Exeter Clinical Research Facility, University of Exeter Medical School, Exeter, UK
| | - Stacey A Meardon
- Department of Physical Therapy, East Carolina University, Greenville, NC, USA
| | | | - Joseph Hamill
- Department of Kinesiology, University of Massachusetts, Amherst, MA, USA
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Naderi A, Moen MH, Degens H. Is high soleus muscle activity during the stance phase of the running cycle a potential risk factor for the development of medial tibial stress syndrome? A prospective study. J Sports Sci 2020; 38:2350-2358. [PMID: 32615855 DOI: 10.1080/02640414.2020.1785186] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
To assess the impact of lower-leg muscle activity during the stance phase of running on the development of medial tibial stress syndrome (MTSS), in 123 healthy participants (18.2 ± 0.8 years), dynamic and static foot posture, and soleus and tibialis anterior muscle activity during the stance phase of running were measured before a 17-week track- and field-course. After the course, MTSS was identified in 20.5% of the participants. MTSS participants had a higher body mass (ES = 1.13), body mass index (BMI) (ES = 1.31), lower previous vigorous physical activity level (ES = 0.84) and VO2max (ES = 0.61), greater dynamic foot pronation (ES = 0.66), higher soleus peak EMG amplitude during the absorption (ES = 0.60) and propulsion phases (ES = 0.56) of running, and a history of MTSS (OR = 6.38) (p < 0.05). Stepwise logistic regression showed BMI, dynamic foot index, soleus peak EMG amplitude during propulsion, MTSS history and previous vigorous physical activity were predictors of MTSS. The model predicted 96.6% of the healthy participants and 56.5% of the MTSS participants and correctly classified 88.4% of overall cases. Coaches and sports-medicine professionals that screen for injury risk should consider adopting a comprehensive evaluation that includes these parameters.
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Affiliation(s)
- Aynollah Naderi
- School of Sport Science, Shahrood University of Technology , Shahrood, Iran
| | - Maarten H Moen
- Bergman Clinics , Naarden, The Netherlands.,The Sport Physician Group, OLVG West , Amsterdam, The Netherlands.,Department of Elite Sports, National Olympic Committee and National Sports Federation , Arnhem, The Netherlands
| | - Hans Degens
- Department of Life SciencesResearch Centre for Musculoskeletal Science & Sports Medicine, Manchester Metropolitan University , Manchester, UK.,Institute of Sport Science & Innovations, Lithuanian Sports University , Kaunas, Lithuania.,University of Medicine & Pharmacy of Targu Mures , Targu Mures, Rumania
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Rice H, Weir G, Trudeau MB, Meardon S, Derrick T, Hamill J. Estimating Tibial Stress throughout the Duration of a Treadmill Run. Med Sci Sports Exerc 2020; 51:2257-2264. [PMID: 31634292 DOI: 10.1249/mss.0000000000002039] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Stress fractures of the tibia are a problematic injury among runners of all levels. Quantifying tibial stress using a modeling approach provides an alternative to invasive assessments that may be used to detect changes in tibial stress during running. This study aimed to assess the repeatability of a tibial stress model and to use this model to quantify changes in tibial stress that occur throughout the course of a 40-min prolonged treadmill run. METHODS Synchronized force and kinematic data were collected during prolonged treadmill running from 14 recreational male rearfoot runners on two separate occasions. During each session, participants ran at their preferred speed for two consecutive 20-min runs, separated by a 2-min pause. The tibia was modeled as a hollow ellipse and bending moments and stresses at the distal third of the tibia were estimated using beam theory combined with inverse dynamics and musculoskeletal modeling. RESULTS Intraclass correlation coefficients indicated good-to-excellent repeatability for peak stress values between sessions. Peak anterior and posterior stresses increased after 20 min of prolonged treadmill running and were 15% and 12% greater, respectively, after 40 min of running compared with the start of the run. CONCLUSION The hollow elliptical tibial model presented is a repeatable tool that can be utilized to assess within-participant changes in peak tibial stress during running. The increased stresses observed during a prolonged treadmill run may have implications for the development of tibial stress fracture.
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Affiliation(s)
- Hannah Rice
- Sport and Health Sciences, University of Exeter, Exeter, UNITED KINGDOM.,Biomechanics Laboratory, University of Massachusetts, Amherst, MA
| | - Gillian Weir
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA
| | | | - Stacey Meardon
- Department of Physical Therapy, East Carolina University, NC
| | | | - Joseph Hamill
- Biomechanics Laboratory, University of Massachusetts, Amherst, MA
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DeBaun MR, Swinford ST, Chen MJ, Thio T, Behn AA, Lucas JF, Bishop JA, Gardner MJ. Biomechanical comparison of bone-screw-fasteners versus traditional locked screws in plating female geriatric bone. Injury 2020; 51:193-198. [PMID: 31703961 DOI: 10.1016/j.injury.2019.10.032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 10/07/2019] [Accepted: 10/14/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To biomechanically compare plated constructs using nonlocking bone-screw-fasteners with interlocking threads versus locking screws with traditional buttress threads in geriatric female bone. METHODS Eleven matched pairs of proximal and distal segments of geriatric female cadaveric tibias were used to create a diaphyseal fracture model. Nonlocking bone-screw-fasteners or locking buttress threaded screws were applied to a locking compression plate on the anterolateral aspect of the tibia placed in bridge mode. Specimens were subjected to incrementally increasing cyclic axial load combined with constant cyclic torsion. Total cycles to failure served as a primary outcome measure, with failure defined as 2 mm of displacement or 10 degrees of rotation. Secondary outcome measures included initial stiffness in compression and torsion determined from preconditioning testing and overall rigidity as determined by maximum peak-to-peak axial and rotational motion at 500 cycle intervals during cyclic testing. Group comparisons were made using paired Student's t-tests. Significance was set at p < 0.05. RESULTS Bone-screw-fastener constructs failed at an average of 40,636 ± 22,151 cycles and locking screw constructs failed at an average of 37,773 ± 8433 cycles, without difference between groups (p = =0.610). Total cycles to failure was higher in the bone-screw-fasteners group for 7 tibiae out of the eleven matched pairs tested. During static and cyclic testing, bone-screw-fastener constructs demonstrated increased initial torsional stiffness (7.6%) and less peak-to-peak displacement and rotation throughout the testing cycle(p < 0.05). CONCLUSIONS In female geriatric bone, constructs fixed with bone-screw-fasteners incorporate multiplanar interlocking thread geometry and performed similarly to traditional locked plating. These novel devices may combine the benefits of both nonlocking and locking screws when plating geriatric bone.
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Affiliation(s)
- Malcolm R DeBaun
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | - Steven T Swinford
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | - Michael J Chen
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | - Timothy Thio
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | - Anthony A Behn
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | | | - Julius A Bishop
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States
| | - Michael J Gardner
- Department of Orthopaedics, School of Medicine, Stanford University, 450 Broadway St., MC 6342, Redwood City, CA 94063, United States.
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Creecy A, Damrath JG, Wallace JM. Control of Bone Matrix Properties by Osteocytes. Front Endocrinol (Lausanne) 2020; 11:578477. [PMID: 33537002 PMCID: PMC7848033 DOI: 10.3389/fendo.2020.578477] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022] Open
Abstract
Osteocytes make up 90-95% of the cellular content of bone and form a rich dendritic network with a vastly greater surface area than either osteoblasts or osteoclasts. Osteocytes are well positioned to play a role in bone homeostasis by interacting directly with the matrix; however, the ability for these cells to modify bone matrix remains incompletely understood. With techniques for examining the nano- and microstructure of bone matrix components including hydroxyapatite and type I collagen becoming more widespread, there is great potential to uncover novel roles for the osteocyte in maintaining bone quality. In this review, we begin with an overview of osteocyte biology and the lacunar-canalicular system. Next, we describe recent findings from in vitro models of osteocytes, focusing on the transitions in cellular phenotype as they mature. Finally, we describe historical and current research on matrix alteration by osteocytes in vivo, focusing on the exciting potential for osteocytes to directly form, degrade, and modify the mineral and collagen in their surrounding matrix.
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Affiliation(s)
- Amy Creecy
- Department of Biomedical Engineering, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, United States
| | - John G. Damrath
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, United States
| | - Joseph M. Wallace
- Department of Biomedical Engineering, Indiana University-Purdue University at Indianapolis, Indianapolis, IN, United States
- *Correspondence: Joseph M. Wallace,
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Jiang H, Robinson DL, Yates CJ, Lee PVS, Wark JD. Peripheral quantitative computed tomography (pQCT)-based finite element analysis provides enhanced diagnostic performance in identifying non-vertebral fracture patients compared with dual-energy X-ray absorptiometry. Osteoporos Int 2020; 31:141-151. [PMID: 31720708 DOI: 10.1007/s00198-019-05213-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 10/28/2019] [Indexed: 12/24/2022]
Abstract
UNLABELLED Due to limitations of the predominant clinical method for diagnosing osteoporosis, an engineering model based on a dedicated CT scanner for bone density and structure was applied in fracture patients and controls. Improved diagnostic performance was observed, which supports its potential use in future research and clinical practice. INTRODUCTION Dual-energy X-ray absorptiometry (DXA), the predominant clinical method for diagnosing osteoporosis, has limitations in identifying individuals with increased fracture risk. Peripheral quantitative computed tomography (pQCT) provides additional information and can be used to generate finite element (FE) models from which bone strength properties can be estimated. We investigated the ability of pQCT-FE properties to distinguish peripheral low-trauma fracture patients from healthy controls, by comparison with DXA and standard pQCT. METHODS One hundred and eight fracture patients (77 females aged 67.7 ± 7.9 years, 31 males aged 69.7 ± 8.9 years) were recruited from a hospital fracture liaison service. One hundred and twenty healthy community controls (85 females aged 69.8 ± 8.5 years, 35 males aged 68.9 ± 7.2 years) were recruited. RESULTS Significant differences between groups were observed in pQCT-FE properties, especially at the 4% tibia site. Fracture odds increased most per standard deviation decrease in pQCT-FE at this location [shear stiffness estimate, kshear, in females, OR = 10.34, 95% CI (1.91, 43.98); bending stiffness estimate, kbend, in males, OR = 8.32, 95% CI (4.15, 33.84)]. Area under the receiver operating characteristics curve (AUROC) was observed to be highest with pQCT-FE properties at 4% the tibia site. In females, this was 0.83 for the pQCT-FE variable kshear, compared with 0.72 for DXA total hip bone density (TH aBMD) and 0.76 for pQCT tibia trabecular density (Trb vBMD); in males, this was 0.81 for the pQCT-FE variable kbend at the 4% tibia site, compared with 0.62 for TH aBMD and 0.71 for Trb vBMD. There were significant differences in AUROC between DXA and pQCT-FE variables in both females (p = 0.02) and males (p = 0.03), while no difference was observed in AUROC between primary pQCT and pQCT-FE variables. CONCLUSIONS pQCT-FE modeling can provide enhanced diagnostic performance compared with DXA and, given its moderate cost, may be useful in clinical settings.
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Affiliation(s)
- H Jiang
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia
| | - D L Robinson
- Department of Biomedical Engineering, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - C J Yates
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia
- Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia
| | - P V S Lee
- Department of Biomedical Engineering, University of Melbourne, Melbourne, 3052, Victoria, Australia
| | - J D Wark
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, 3052, Australia.
- Bone and Mineral Medicine, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia.
- Department of Diabetes and Endocrinology, Royal Melbourne Hospital, Melbourne, 3052, Victoria, Australia.
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Tanaka H, Tarumi T, Rittweger J. Aging and Physiological Lessons from Master Athletes. Compr Physiol 2019; 10:261-296. [PMID: 31853968 DOI: 10.1002/cphy.c180041] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Sedentary aging is often characterized by physical dysfunction and chronic degenerative diseases. In contrast, masters athletes demonstrate markedly greater physiological function and more favorable levels of risk factors for cardiovascular disease, osteoporosis, frailty, and cognitive dysfunction than their sedentary counterparts. In many cases, age-related deteriorations of physiological functions as well as elevations in risk factors that are typically observed in sedentary adults are substantially attenuated or even absent in masters athletes. Older masters athletes possess greater functional capacity at any given age than their sedentary peers. Impressive profiles of older athletes provide insight into what is possible in human aging and place aging back into the domain of "physiology" rather than under the jurisdiction of "clinical medicine." In addition, these exceptional aging athletes can serve as a role model for the promotion of physical activity at all ages. The study of masters athletes has provided useful insight into the positive example of successful aging. To further establish and propagate masters athletics as a role model for our aging society, future research and action are needed. © 2020 American Physiological Society. Compr Physiol 10:261-296, 2020.
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Affiliation(s)
- Hirofumi Tanaka
- Department of Kinesiology and Health Education, The University of Texas at Austin, Austin, Texas, USA
| | - Takashi Tarumi
- Human Informatics Research Institute, National Institute of Advanced Industrial Science and Technology, Tsukuba, Ibaraki, Japan.,Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas, Dallas, Texas, USA
| | - Jörn Rittweger
- German Aerospace Center (DLR), Institute of Aerospace Medicine, Cologne, Germany.,Department of Pediatrics and Adolescent Medicine, University of Cologne, Cologne, Germany
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Marturello DM, von Pfeil DJF, Déjardin LM. Mechanical comparison of two small interlocking nails in torsion using a feline bone surrogate. Vet Surg 2019; 49:380-389. [PMID: 31828811 DOI: 10.1111/vsu.13364] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/14/2019] [Accepted: 11/15/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To compare the torsional behavior of two small angle-stable interlocking nails (I-Loc and Targon) with that of locking compression plates (LCP). To evaluate the effect of implant removal on the torsional strength of feline bone surrogates. STUDY DESIGN Experimental. SAMPLE POPULATION Fracture gap constructs and intact explanted bone surrogates. METHODS Fracture gap constructs were stabilized with one of six implants (I-Loc 3 and 4, Targon 2.5 and 3.0, LCP 2.0 and 2.4) and then cyclically tested in torsion (n = 4/group). To simulate implant removal, intact surrogates with implant-specific pilot holes were then twisted to failure (n = 4/group). Torsional compliance (TC; °/Nm), angular deformation (AD; °), and failure torque (FT ; Nm) were statistically compared (P < .05). RESULTS The I-Loc 4 had the smallest TC and AD of all constructs (P < .05). The largest TC (P < .05) was seen with the LCP 2.0. The Targon 2.5 had the largest AD (P < .05) secondary to locking interface slippage. Targon surrogates FT were the lowest of all groups (P < .05). Conversely, there was no difference between the FT of the I-Loc, LCP, and intact surrogates (P > .05). CONCLUSION We showed that I-Loc nails provided greater torsional stability than size-matched Targon nails and LCPs. Conversely, Targon 2.5 locking interface slippage may jeopardize that construct's stability. Furthermore, the significantly reduced bone surrogate torsional strength provided evidence that the large Targon bolt holes increased the risk of postexplantation iatrogenic fracture. CLINICAL SIGNIFICANCE Our results provide evidence to conclude that the small I-Loc nails may be valid alternatives to other osteosynthesis options for feline fracture repair.
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Affiliation(s)
- Danielle M Marturello
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Dirsko J F von Pfeil
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
| | - Loïc M Déjardin
- Department of Small Animal Clinical Sciences, Michigan State University, East Lansing, Michigan
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Jafarnezhadgero AA, Sorkhe E, Oliveira AS. Motion-control shoes help maintaining low loading rate levels during fatiguing running in pronated female runners. Gait Posture 2019; 73:65-70. [PMID: 31299505 DOI: 10.1016/j.gaitpost.2019.07.133] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 06/29/2019] [Accepted: 07/05/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND The use of motion-control shoes may assist pronated runners to maintain their stability throughout a fatiguing running. However, there are no studies describing the effects of fatigue on running biomechanics of runners with pronated feet. RESEARCH QUESTION Whether motion-control shoes can assist pronated recreational female runners to maintain impact loading patterns following a fatiguing protocol? METHODS Twenty-two female rearfoot runners with foot pronation were asked to perform a fatiguing treadmill running protocol using a neutral shoe or a motion-control shoe in two separate occasions. Before (Pre-fatigue) and after the fatiguing protocol (Post-fatigue), participants were asked to run overground on a track that contained two force platforms to record ground reaction forces and moments. Running speed were 3.3 m s-1 (±2.5% variability). The effects of shoe type and fatigue were investigated on the peak vertical impact ground reaction force (pvIGRF), time to reach pvIGRF, vertical loading rate (LR) and peak negative foot free moments (FM). RESULTS Pronated runners presented lower LR with motion-control shoes compared to neutral shoes Pre- (p < 0.005; -18 ± 25%) and Post-fatigue (p < 0.001; -27 ± 15%). This change in LR was predominantly driven by a longer time to reach pvIGRF with motion-control shoes (p < 0.001, 39%). The pvIGRF and LR increased after fatiguing running with neutral shoes (pvIGRF: p < 0.05; 18 ± 28%; LR: p < 0.05; 15 ± 22%), but not with motion-control shoes. Furthermore, there were strong correlations between FM and LR for both Pre-fatigue (r=-0.61, p < 0.005) and Post-fatigue measurements (r=-0.66, p < 0.01), but only for the motion-control shoes. SIGNIFICANCE These results suggest that motion-control shoes prevent exacerbated fatigue-related increases in mechanical loading following initial contact in pronated female runners.
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Affiliation(s)
- Amir Ali Jafarnezhadgero
- Department of Physical Education and Sport Sciences, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran.
| | - Elham Sorkhe
- Department of Physical Education and Sport Sciences, Faculty of Educational Sciences and Psychology, University of Mohaghegh Ardabili, Ardabil, Iran
| | - Anderson S Oliveira
- Department of Materials and Production, Aalborg University, Fibigerstræde 16, Building 4, DK-9220 Aalborg E, Denmark
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O'Leary TJ, Izard RM, Walsh NP, Tang JCY, Fraser WD, Greeves JP. Skeletal macro- and microstructure adaptations in men undergoing arduous military training. Bone 2019; 125:54-60. [PMID: 31077851 DOI: 10.1016/j.bone.2019.05.009] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Short periods of basic military training increase the density and size of the tibia, but the adaptive response of bone microarchitecture, a key component of bone strength, is not fully understood. METHODS Tibial volumetric bone mineral density (vBMD), geometry, microarchitecture and mechanical properties were measured using high-resolution peripheral quantitative computed tomography in 43 male British Army infantry recruits (mean ± SD, age 21 ± 3 years, height 1.76 ± 0.06 m, body mass 76.5 ± 9.4 kg). Bilateral scans were performed at the distal tibia at the start (week 1) and end (week 13) of basic military training. Concurrent measures were obtained for whole-body areal bone mineral density (aBMD) using DXA, and markers of bone metabolism (βCTX, P1NP, PTH, total 25(OH)D and ACa) from venous blood. RESULTS Training increased areal BMD for total body (1.4%) and arms (5.2%) (P ≤ 0.031), but not legs and trunk (P ≥ 0.094). Training increased trabecular (1.3 to 1.9%) and cortical vBMD (0.6 to 0.9%), trabecular volume (1.3 to 1.9%), cortical thickness (3.2 to 5.2%) and cortical area (2.6 to 2.8%), and reduced trabecular area (-0.4 to -0.5%) in both legs (P < 0.001). No changes in trabecular number, thickness and separation, cortical porosity, stiffness or failure load were observed (P ≥ 0.188). βCTX decreased (-0.11 μg∙l-1, P < 0.001) and total 25(OH)D increased (9.4 nmol∙l-1, P = 0.029), but no differences in P1NP, PTH or ACa were observed between timepoints (P ≥ 0.233). CONCLUSION A short period of basic military training increased density and altered geometry of the distal tibia in male military recruits. The osteogenic effects of basic military training are likely due to an increase in unaccustomed, dynamic and high-impact loading.
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Affiliation(s)
- Thomas J O'Leary
- Army Personnel Research Capability, Army Headquarters, Andover, United Kingdom.
| | - Rachel M Izard
- Department of Occupational Medicine, HQ Army Recruiting and Initial Training Command, Upavon, United Kingdom.
| | - Neil P Walsh
- Extremes Research Group, Bangor University, Bangor, United Kingdom.
| | - John C Y Tang
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - William D Fraser
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom; Norfolk and Norwich University Hospital, Norwich, United Kingdom.
| | - Julie P Greeves
- Army Personnel Research Capability, Army Headquarters, Andover, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
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Wang J, Yin B, Liu G, Li S, Zhang X, Hu Z, Wu W, Zhang Y. Microhardness distribution of the tibial diaphysis and test site selection for reference point indentation technique. Medicine (Baltimore) 2019; 98:e16523. [PMID: 31335730 PMCID: PMC6708845 DOI: 10.1097/md.0000000000016523] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Indentation hardness test is a good in vitro method of bone quality assessment. The purpose of this study is to explore the distribution characteristics of bone tissue microhardness in tibial diaphysis and provide theoretical support for the test site selection of the reference point indentation technique.Three fresh right tibias were obtained from 3 cadaver donors. The tibial diaphysis was evenly divided into 6 sections. Bone specimens with a thickness of 3 mm were cut from each part. After appropriate management, micro-indentation tests were performed in various regions of the specimens to acquire the microhardness values of the tibial diaphysis. Statistical analysis was performed by randomized block design variance analysis to study the distribution characteristics of bone microhardness.72 regions were selected for 360 effective indentations. We found that the bone microhardness is inhomogeneous in tibia diaphysis. Mean hardness value of the anterior, medial, posterior, lateral region of tibia diaphysis was 45.58 ± 4.39 Vickers hardness (HV), 52.33 ± 3.93 HV, 54.00 ± 4.21 HV, 52.89 ± 4.44 HV, respectively. The anterior cortex exhibits lower microhardness value than the other regions (P < .001). Within the same region, microhardness varies significantly with positions in the tibial diaphysis. The variations in indentation hardness are bound to have a significant impact on the comparability of different reference point indentation (RPI) studies.The results of this study indicated the regional microhardness difference in the human tibia diaphysis. The microhardness of different planes in the same region is also inconsistent. Inhomogeneous distribution of indentation microhardness would have considerable influence in the test site selection of RPI technique. The data collected in our study would contribute to the design of highly precise 3D printing implants and bionic bones with gradient elastic modulus.
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Affiliation(s)
- Jianzhao Wang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Bing Yin
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Guobin Liu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Sheng Li
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Xiaojuan Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Zusheng Hu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Weiwei Wu
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, Hebei, P.R. China
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