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Morales Avalos JE, Morales-Avalos R, Martínez-Guajardo KV, Pacheco-García LM, Perelli S, Monllau JC, Sánchez Egea AJ, Serrancoli G. How effective is proximal fibular osteotomy in redistributing joint pressures? Insights from an HTO comparative in-silico study. J Orthop Surg Res 2024; 19:333. [PMID: 38835085 DOI: 10.1186/s13018-024-04807-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 05/22/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) represents a widespread degenerative condition among adults that significantly affects quality of life. This study aims to elucidate the biomechanical implications of proximal fibular osteotomy (PFO), a proposed cost-effective and straightforward intervention for KOA, comparing its effects against traditional high tibial osteotomy (HTO) through in-silico analysis. METHODS Using medical imaging and finite element analysis (FEA), this research quantitatively evaluates the biomechanical outcomes of a simulated PFO procedure in patients with severe medial compartment genu-varum, who have undergone surgical correction with HTO. The study focused on evaluating changes in knee joint contact pressures, stress distribution, and anatomical positioning of the center of pressure (CoP). Three models are generated for each of the five patients investigated in this study, a preoperative original condition model, an in-silico PFO based on the same original condition data, and a reversed-engineered HTO in-silico model. RESULTS The novel contribution of this investigation is the quantitative analysis of the impact of PFO on the biomechanics of the knee joint. The results provide mechanical evidence that PFO can effectively redistribute and homogenize joint stresses, while also repositioning the CoP towards the center of the knee, similar to what is observed post HTO. The findings propose PFO as a potentially viable and simpler alternative to conventional surgical methods for managing severe KOA, specifically in patients with medial compartment genu-varum. CONCLUSION This research also marks the first application of FEA that may support one of the underlying biomechanical theories of PFO, providing a foundation for future clinical and in-silico studies.
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Affiliation(s)
- Jorge Eduardo Morales Avalos
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Eduard Maristany 16, 08019, Barcelona, Barcelona, Spain.
| | - Rodolfo Morales-Avalos
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Nuevo León, Mexico
| | - Karla V Martínez-Guajardo
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Nuevo León, Mexico
| | - Luis Miguel Pacheco-García
- Laboratory of Biomechanics, Articular Physiology and Experimental Orthopedic Surgery, Department of Physiology, School of Medicine, Universidad Autonoma de Nuevo Leon, 64460, Monterrey, Nuevo León, Mexico
| | - Simone Perelli
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Pg. Marítim de la Barceloneta, 25, 08003, Barcelona, Barcelona, Spain
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028, Barcelona, Barcelona, Spain
| | - Joan Carles Monllau
- Department of Orthopedic Surgery and Traumatology, Hospital del Mar, Universitat Autonoma de Barcelona, Pg. Marítim de la Barceloneta, 25, 08003, Barcelona, Barcelona, Spain
- ICATKnee (ICATME), Hospital Universitari Dexeus, Universitat Autònoma de Barcelona, 08028, Barcelona, Barcelona, Spain
| | - Antonio J Sánchez Egea
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Eduard Maristany 16, 08019, Barcelona, Barcelona, Spain
| | - Gil Serrancoli
- Department of Mechanical Engineering, Universitat Politècnica de Catalunya, Eduard Maristany 16, 08019, Barcelona, Barcelona, Spain
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2
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Zhang H, Ma J, Tian A, lu B, Bai H, Dai J, Wu Y, Chen J, Luo W, Ma X. Analysis of cartilage loading and injury correlation in knee varus deformity. Medicine (Baltimore) 2024; 103:e38065. [PMID: 38728521 PMCID: PMC11081555 DOI: 10.1097/md.0000000000038065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 04/09/2024] [Indexed: 05/12/2024] Open
Abstract
Knee varus (KV) deformity leads to abnormal forces in the different compartments of the joint cavity and abnormal mechanical loading thus leading to knee osteoarthritis (KOA). This study used computer-aided design to create 3-dimensional simulation models of KOA with varying varus angles to analyze stress distribution within the knee joint cavity using finite element analysis for different varus KOA models and to compare intra-articular loads among these models. Additionally, we developed a cartilage loading model of static KV deformity to correlate with dynamic clinical cases of cartilage injury. Different KV angle models were accurately simulated with computer-aided design, and the KV angles were divided into (0°, 3°, 6°, 9°, 12°, 15°, and 18°) 7 knee models, and then processed with finite element software, and the Von-Mises stress distribution and peak values of the cartilage of the femoral condyles, medial tibial plateau, and lateral plateau were obtained by simulating the human body weight in axial loading while performing the static extension position. Finally, intraoperative endoscopy visualization of cartilage injuries in clinical cases corresponding to KV deformity subgroups was combined to find cartilage loading and injury correlations. With increasing varus angle, there was a significant increase in lower limb mechanical axial inward excursion and peak Von-Mises stress in the medial interstitial compartment. Analysis of patients' clinical data demonstrated a significant correlation between varus deformity angle and cartilage damage in the knee, medial plateau, and patellofemoral intercompartment. Larger varus deformity angles could be associated with higher medial cartilage stress loads and increased cartilage damage in the corresponding peak stress area. When the varus angle exceeds 6°, there is an increased risk of cartilage damage, emphasizing the importance of early surgical correction to prevent further deformity and restore knee function.
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Affiliation(s)
- Hongjie Zhang
- Tianjin University of Traditional Chinese Medicine, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
- Kunming Medical University Affiliated Dehong Hospital/Dehongzhou People’s Hospital, Mangshi, China
| | - Jianxiong Ma
- Tianjin University Tianjin Hospital, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
| | - Aixian Tian
- Tianjin University Tianjin Hospital, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
| | - Bin lu
- Tianjin University Tianjin Hospital, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
| | - Haohao Bai
- Tianjin University Tianjin Hospital, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
| | - Jing Dai
- Tianjin Medical University, Tianjin, PR China
| | - Yanfei Wu
- Tianjin Medical University, Tianjin, PR China
| | - Jiahui Chen
- Tianjin Medical University, Tianjin, PR China
| | - Wei Luo
- Tianjin University Tianjin Hospital, Tianjin, PR China
| | - Xinlong Ma
- Tianjin University Tianjin Hospital, Tianjin, PR China
- Tianjin Orthopedic Research Institute, Tianjin, PR China
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3
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Iwasaki N, Karali A, Roldo M, Blunn G. Full-Field Strain Measurements of the Muscle-Tendon Junction Using X-ray Computed Tomography and Digital Volume Correlation. Bioengineering (Basel) 2024; 11:162. [PMID: 38391648 PMCID: PMC10886230 DOI: 10.3390/bioengineering11020162] [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: 01/08/2024] [Accepted: 02/01/2024] [Indexed: 02/24/2024] Open
Abstract
We report, for the first time, the full-field 3D strain distribution of the muscle-tendon junction (MTJ). Understanding the strain distribution at the junction is crucial for the treatment of injuries and to predict tear formation at this location. Three-dimensional full-field strain distribution of mouse MTJ was measured using X-ray computer tomography (XCT) combined with digital volume correlation (DVC) with the aim of understanding the mechanical behavior of the junction under tensile loading. The interface between the Achilles tendon and the gastrocnemius muscle was harvested from adult mice and stained using 1% phosphotungstic acid in 70% ethanol. In situ XCT combined with DVC was used to image and compute strain distribution at the MTJ under a tensile load (2.4 N). High strain measuring 120,000 µε, 160,000 µε, and 120,000 µε for the first principal stain (εp1), shear strain (γ), and von Mises strain (εVM), respectively, was measured at the MTJ and these values reduced into the body of the muscle or into the tendon. Strain is concentrated at the MTJ, which is at risk of being damaged in activities associated with excessive physical activity.
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Affiliation(s)
- Nodoka Iwasaki
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
| | - Aikaterina Karali
- School of Mechanical and Design Engineering, University of Portsmouth, Portsmouth PO1 3DJ, UK
| | - Marta Roldo
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
| | - Gordon Blunn
- School of Pharmacy and Biomedical Sciences, University of Portsmouth, Portsmouth PO1 2DT, UK
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4
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Kakavand R, Palizi M, Tahghighi P, Ahmadi R, Gianchandani N, Adeeb S, Souza R, Edwards WB, Komeili A. Integration of Swin UNETR and statistical shape modeling for a semi-automated segmentation of the knee and biomechanical modeling of articular cartilage. Sci Rep 2024; 14:2748. [PMID: 38302524 PMCID: PMC10834430 DOI: 10.1038/s41598-024-52548-9] [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: 10/03/2023] [Accepted: 01/19/2024] [Indexed: 02/03/2024] Open
Abstract
Simulation studies, such as finite element (FE) modeling, provide insight into knee joint mechanics without patient involvement. Generic FE models mimic the biomechanical behavior of the tissue, but overlook variations in geometry, loading, and material properties of a population. Conversely, subject-specific models include these factors, resulting in enhanced predictive precision, but are laborious and time intensive. The present study aimed to enhance subject-specific knee joint FE modeling by incorporating a semi-automated segmentation algorithm using a 3D Swin UNETR for an initial segmentation of the femur and tibia, followed by a statistical shape model (SSM) adjustment to improve surface roughness and continuity. For comparison, a manual FE model was developed through manual segmentation (i.e., the de-facto standard approach). Both FE models were subjected to gait loading and the predicted mechanical response was compared. The semi-automated segmentation achieved a Dice similarity coefficient (DSC) of over 98% for both the femur and tibia. Hausdorff distance (mm) between the semi-automated and manual segmentation was 1.4 mm. The mechanical results (max principal stress and strain, fluid pressure, fibril strain, and contact area) showed no significant differences between the manual and semi-automated FE models, indicating the effectiveness of the proposed semi-automated segmentation in creating accurate knee joint FE models. We have made our semi-automated models publicly accessible to support and facilitate biomechanical modeling and medical image segmentation efforts ( https://data.mendeley.com/datasets/k5hdc9cz7w/1 ).
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Affiliation(s)
- Reza Kakavand
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Mehrdad Palizi
- Civil and Environmental Engineering Department, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Peyman Tahghighi
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Reza Ahmadi
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Neha Gianchandani
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Samer Adeeb
- Civil and Environmental Engineering Department, Faculty of Engineering, University of Alberta, Edmonton, Canada
| | - Roberto Souza
- Department of Electrical and Software Engineering, Schulich School of Engineering, University of Calgary, Calgary, Canada
- Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - W Brent Edwards
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada
| | - Amin Komeili
- Department of Biomedical Engineering, Schulich School of Engineering, University of Calgary, CCIT 216, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- McCaig Institute for Bone and Joint Health, University of Calgary, Calgary, Canada.
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, Canada.
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5
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Imhauser CW, Baumann AP, Liu XC, Bischoff JE, Verdonschot N, Fregly BJ, Elmasry SS, Abdollahi NN, Hume DR, Rooks NB, Schneider MTY, Zaylor W, Besier TF, Halloran JP, Shelburne KB, Erdemir A. Reproducibility in modeling and simulation of the knee: Academic, industry, and regulatory perspectives. J Orthop Res 2023; 41:2569-2578. [PMID: 37350016 DOI: 10.1002/jor.25652] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 04/23/2023] [Accepted: 05/30/2023] [Indexed: 06/24/2023]
Abstract
Stakeholders in the modeling and simulation (M&S) community organized a workshop at the 2019 Annual Meeting of the Orthopaedic Research Society (ORS) entitled "Reproducibility in Modeling and Simulation of the Knee: Academic, Industry, and Regulatory Perspectives." The goal was to discuss efforts among these stakeholders to address irreproducibility in M&S focusing on the knee joint. An academic representative from a leading orthopedic hospital in the United States described a multi-institutional, open effort funded by the National Institutes of Health to assess model reproducibility in computational knee biomechanics. A regulatory representative from the United States Food and Drug Administration indicated the necessity of standards for reproducibility to increase utility of M&S in the regulatory setting. An industry representative from a major orthopedic implant company emphasized improving reproducibility by addressing indeterminacy in personalized modeling through sensitivity analyses, thereby enhancing preclinical evaluation of joint replacement technology. Thought leaders in the M&S community stressed the importance of data sharing to minimize duplication of efforts. A survey comprised 103 attendees revealed strong support for the workshop and for increasing emphasis on computational modeling at future ORS meetings. Nearly all survey respondents (97%) considered reproducibility to be an important issue. Almost half of respondents (45%) tried and failed to reproduce the work of others. Two-thirds of respondents (67%) declared that individual laboratories are most responsible for ensuring reproducible research whereas 44% thought that journals are most responsible. Thought leaders and survey respondents emphasized that computational models must be reproducible and credible to advance knee M&S.
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Affiliation(s)
- Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
| | - Andrew P Baumann
- US Food and Drug Administration, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Division of Applied Mechanics, Silver Spring, Maryland, USA
| | | | | | - Nico Verdonschot
- Department of Biomechanical Engineering, Technical Medical Institute at University of Twente, Enschede, The Netherlands
- Orthopaedic Research Lab, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Benjamin J Fregly
- Department of Mechanical Engineering, Rice University, Houston, Texas, USA
| | - Shady S Elmasry
- Department of Biomechanics, Hospital for Special Surgery, New York, New York, USA
- Department of Mechanical Design and Production, Faculty of Engineering, Cairo University, Cairo, Egypt
| | - Neda N Abdollahi
- Center for Human Machine Systems, Cleveland State University, Cleveland, Ohio, USA
- Department of Mechanical Engineering, Cleveland State University, Cleveland, Ohio, USA
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
| | - Donald R Hume
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Nynke B Rooks
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Marco T-Y Schneider
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - William Zaylor
- Center for Human Machine Systems, Cleveland State University, Cleveland, Ohio, USA
- Department of Mechanical Engineering, Cleveland State University, Cleveland, Ohio, USA
| | - Thor F Besier
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
- Department of Engineering Science, Faculty of Engineering, University of Auckland, Auckland, New Zealand
| | - Jason P Halloran
- Applied Sciences Laboratory, Institute for Shock Physics, Washington State University, Spokane, Washington, USA
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
- Center for Orthopaedic Biomechanics, University of Denver, Denver, Colorado, USA
| | - Ahmet Erdemir
- Department of Biomedical Engineering, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
- Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, Cleveland, Ohio, USA
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6
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Milakovic L, Dandois F, Fehervary H, Scheys L. Calibration of Holzapfel-Gasser-Ogden collateral ligament properties in a hybrid post-arthroplasty knee joint model for laxity testing. Comput Methods Biomech Biomed Engin 2023:1-11. [PMID: 37668078 DOI: 10.1080/10255842.2023.2253950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/10/2023] [Accepted: 08/21/2023] [Indexed: 09/06/2023]
Abstract
Knee collateral ligaments play a vital role in providing frontal-plane stability in post-total knee arthroplasty (TKA) knees. Finite element models can utilize computationally efficient one-dimensional springs or more physiologically accurate three-dimensional continuum elements like the Holzapfel-Gasser-Ogden (HGO) formulation. However, there is limited literature defining subject-specific mechanical properties, particularly for the HGO model. In this study, we propose a co-simulation framework to obtain subject-specific material parameters for an HGO-based finite element ligament model integrated into a rigid-body model of the post-TKA knee. Our approach achieves comparable accuracy to spring formulations while significantly reducing coefficient calibration time and demonstrating improved correlation with reference knee kinematics and ligament strains throughout the tested loading range.
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Affiliation(s)
- Lucas Milakovic
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
| | - Félix Dandois
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
| | - Heleen Fehervary
- Biomechanics Section, Mechanical Engineering Department, KU Leuven, Leuven, Belgium
- FIBEr, KU Leuven Core Facility for Biomechanical Experimentation, Leuven, Belgium
| | - Lennart Scheys
- Department of Development and Regeneration, Institute for Orthopaedic Research and Training, Leuven, KU, Belgium
- Division of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
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7
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Castellarin G, Bori E, Rapallo L, Pianigiani S, Innocenti B. Biomechanical analysis of different levels of constraint in TKA during daily activities. ARTHROPLASTY (LONDON, ENGLAND) 2023; 5:3. [PMID: 36597168 PMCID: PMC9811790 DOI: 10.1186/s42836-022-00157-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 11/28/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Numerous total knee prosthetic implants are currently available on the orthopedic market, and this variety covers a set of different levels of constraint: among the various models available, a significant role is covered by mobile bearing cruciate-retaining design with an ultra-congruent insert, mobile bearing cruciate-retaining design, fixed-bearing posterior stabilized prosthesis and fixed-bearing constrained condylar knee. A biomechanical comparative study among them could therefore be helpful for the clinical decision-making process. This study aimed to compare the effect of these different levels of constraint in the knee biomechanics of a patient, in three different configurations representing the typical boundary conditions experienced by the knee joint during daily activities. METHOD The investigation was performed via finite element analysis with a knee model based on an already published and validated one. Four different types of prosthesis designs were analyzed: two mobile-bearing models and two fixed-bearing models, each one having a different level of constraint. The different designs were incorporated in to the 3D finite element model of the lower leg and analyzed in three different configurations reproducing the landing and the taking-off phases occurring during the gait cycle and chair-rising. Implant kinetics (in terms of polyethylene contact areas and contact pressure), polyethylene and tibial bone stresses were calculated under three different loading conditions for each design. RESULTS The tibial stress distribution in the different regions of interest of the tibia remains relatively homogeneous regardless of the type of design used. The main relevant difference was observed between the mobile and fixed-bearing models, as the contact areas were significantly different between these models in the different loading conditions. As a consequence, significant changes in the stress distribution were observed at the interface between the prosthetic components, but no significant changes were noted on the tibial bone. Moreover, the different models exhibited a symmetrical medial and lateral distribution of the contact areas, which was not always common among all the currently available prostheses (i.e. medial pivot designs). CONCLUSION The changes of the prosthetic implant did not induce a big variation of the stress distribution in the different regions of the tibial bone, while they significantly changed the distribution of stress at the interface between the prosthetic components.
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Affiliation(s)
| | - Edoardo Bori
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Laurence Rapallo
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
| | - Silvia Pianigiani
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium ,Adler Ortho, Cormano, 20032 Milan, Italy
| | - Bernardo Innocenti
- grid.4989.c0000 0001 2348 0746BEAMS Department, Université Libre de Bruxelles, 1050 Bruxelles, Belgium
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8
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Chen W, Tang J, Shen W, Zhou Q. Influence of walking on knee ligament response in car-to-pedestrian collisions. Front Bioeng Biotechnol 2023; 11:1141390. [PMID: 37122854 PMCID: PMC10140625 DOI: 10.3389/fbioe.2023.1141390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 04/03/2023] [Indexed: 05/02/2023] Open
Abstract
Pedestrians are likely to experience walking before accidents. The walking process imposes cyclic loading on knee ligaments and increases knee joint temperature. Both cyclic loading and temperature affect the material properties of ligaments, which further influence the risk of ligament injury. However, the effect of such walking-induced material property changes on pedestrian ligament response has not been considered. Therefore, in this study, we investigated the influence of walking on ligament response in car-to-pedestrian collisions. Using Total Human Model for Safety (THUMS) model, knee ligament responses (i.e., cross-sectional force and local strain) were evaluated under several crash scenarios (i.e., two impact speeds, two knee contact heights, and three pedestrian postures). In worst case scenarios, walking-induced changes in ligament material properties led to a 10% difference in maximum local strain and a 6% difference in maximum cross-sectional force. Further considering the material uncertainty caused by experimental dispersion, the ligament material property changes due to walking resulted in a 28% difference in maximum local strain and a 26% difference in maximum cross-sectional force. This study demonstrates the importance of accounting for walking-induced material property changes for the reliability of safety assessments and injury analysis.
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9
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Wu Y, Jin X, Zhao X, Wang Y, Bai H, Lu B, Tong X, Ma J, Ma X. Computer-aided Design of Distal Femoral Osteotomy for the Valgus Knee and Effect of Correction Angle on Joint Loading by Finite Element Analysis. Orthop Surg 2022; 14:2904-2913. [PMID: 36151783 PMCID: PMC9627055 DOI: 10.1111/os.13440] [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: 03/14/2022] [Revised: 07/15/2022] [Accepted: 07/16/2022] [Indexed: 11/30/2022] Open
Abstract
Objective Lateral open‐wedge distal femoral osteotomy (DFO) has been used to treat valgus deformity of the knee, with good clinical outcomes. However, there is a lack of biomechanical studies regarding the angle of correction. The objective of this study was to apply computer‐aided design (CAD) for osteotomy planning in a three‐dimensional (3D) anatomical model and to assess the biomechanical differences among the varying correction angles on joint loading by finite element analysis (FEA). Methods To model different angles of lateral open‐wedge DFO correction, the CAD software package Mimics 21.0 was used to accurately simulate the operated knee. The femur was cut to 0°, 2°, 4°, 6°, 8°, and 10° of varus (equivalent to hip‐knee‐ankle angles of 180°, 178°, 176°, 174°, 172°, and 170°, respectively). The original knee model and the corrected models were processed by FE software. Then, the FE models were subjected to an axial force to obtain the von Mises stress (VMS) and shear stress distributions within the femoral cartilages and menisci. Results Under a compressive load of 740 N, the highest VMS in lateral and medial compartments of the intact knee model was 3.418 and 3.303 MPa. The maximum value of both the VMS and the shear stress in the lateral compartment decreased as the varus angle increased, but the corresponding values in the medial compartment increased. When the hip‐knee‐ankle (HKA) angle was 180°, the VMS in the lateral and medial compartments was balanced (3.418 and 3.303 MPa, respectively). Meanwhile, when the HKA angle was 178° (3.488 and 3.625 MPa, respectively), the shear stress in the lateral and medial compartments was balanced. In addition, the magnitude of change in the stress was significantly higher in the medial compartment (90.9%) than in the lateral compartment (19.3%). Conclusion The optimal correction angle of the valgus knee is close to neutral alignment or slightly varus (0° ‐ 2°). Overcorrection is not recommended, as it can result in a steep increase of the stress within the medial compartment and may accelerate the process of medial compartment OA.
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Affiliation(s)
- Yanfei Wu
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xin Jin
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xingwen Zhao
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
| | - Ying Wang
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Haohao Bai
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Bin Lu
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xue Tong
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Jianxiong Ma
- Tianjin Hospital, Tianjin University, Tianjin, China
| | - Xinlong Ma
- Clinical College of Orthopedics, Tianjin Medical University, Tianjin, China.,Tianjin Hospital, Tianjin University, Tianjin, China
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10
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Liu W, Sun X, Liu W, Liu H, Zhai H, Zhang D, Tian F. Finite element study of a partial meniscectomy of a complete discoid lateral meniscus in adults. Med Eng Phys 2022; 107:103855. [DOI: 10.1016/j.medengphy.2022.103855] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 06/02/2022] [Accepted: 07/18/2022] [Indexed: 11/30/2022]
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11
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Innocenti B, Bori E, Pianigiani S. Biomechanical Analysis of the Use of Stems in Revision Total Knee Arthroplasty. Bioengineering (Basel) 2022; 9:bioengineering9060259. [PMID: 35735502 PMCID: PMC9220056 DOI: 10.3390/bioengineering9060259] [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: 05/24/2022] [Revised: 06/11/2022] [Accepted: 06/16/2022] [Indexed: 11/16/2022] Open
Abstract
Adequate fixation is fundamental in revision total knee arthroplasty; consequently, surgeons must determine the correct set-up for each patient, choosing from numerous stem solutions. Several designs are currently available on the market, but there are no evidence-based quantitative biomechanical guideline yet. Therefore, several stems were designed and analyzed using a previously-validated finite-element model. The following parameters were studied: stem design characteristics (length and shape), added features (straight/bowed stem), fixation technique, and effect of slots/flutes. Bone stress and Risk of Fracture (RF) were analyzed in different regions of interest during a squat (up to 120°). For the femoral stem, the results indicated that all parameters influenced the bone stress distribution. The maximum von Mises stress and RF were always located near the tip of the stem. The long stems generated stress-shielding in the distal bone. Regarding the tibial stem, cemented stems showed lower micromotions at the bone-tibial tray interface and at the stem tip compared to press-fit stems, reducing the risk of implant loosening. The results demonstrated that anatomical shapes and slots reduce bone stress and risk of fracture, whereas flutes have the opposite effect; no relevant differences were found in this regard when alternating cemented and press-fit stem configurations. Cemented tibial stems reduce antero-posterior micromotions, preventing implant loosening.
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Lv ML, Ni M, Sun W, Wong DWC, Zhou S, Jia Y, Zhang M. Biomechanical Analysis of a Novel Double-Point Fixation Method for Displaced Intra-Articular Calcaneal Fractures. Front Bioeng Biotechnol 2022; 10:791554. [PMID: 35356772 PMCID: PMC8959616 DOI: 10.3389/fbioe.2022.791554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 01/04/2022] [Indexed: 11/23/2022] Open
Abstract
The development of minimally invasive procedures and implant materials has improved the fixation strength of implants and is less traumatic in surgery. The purpose of this study was to propose a novel “double-point fixation” for calcaneal fractures and compare its biomechanical stability with the traditional “three-point fixation.” A three-dimensional finite element foot model with a Sanders type IIIAB calcaneal fracture was developed based on clinical images comprising bones, plantar fascia, ligaments, and encapsulated soft tissue. Double-point and three-point fixation resembled the surgical procedure with a volar distal radius plate and calcaneal locking plate, respectively. The stress distribution, fracture displacement, and change of the Böhler angle and Gissane’s angle were estimated by a walking simulation using the model, and the predictions between the double-point and three-point fixation were compared at heel-strike, midstance, and push-off instants. Double-point fixation demonstrated lower bone stress (103.3 vs. 199.4 MPa), but higher implant stress (1,084.0 vs. 577.9 MPa). The model displacement of double-point fixation was higher than that of three-point fixation (3.68 vs. 2.53 mm). The displacement of the posterior joint facet (0.127 vs. 0.150 mm) and the changes of the Böhler angle (0.9° vs. 1.4°) and Gissane’s angle (0.7° vs. 0.9°) in double-point fixation were comparably lower. Double-point fixation by volar distal radius plates demonstrated sufficient and favorable fixation stability and a lower risk of postoperative stress fracture, which may potentially serve as a new fixation modality for the treatment of displaced intra-articular calcaneal fractures.
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Affiliation(s)
- Miko Lin Lv
- School of Medical Instrument and Food Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Ming Ni
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Wanju Sun
- Department of Orthopedics, Pudong New Area People’s Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China
| | - Duo Wai-Chi Wong
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Shuren Zhou
- School of Computer and Communication Engineering, Changsha University of Science and Technology, Changsha, China
| | - Yongwei Jia
- Department of Spine Surgery, Guanghua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, China
- *Correspondence: Yongwei Jia,
| | - Ming Zhang
- Department of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
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Rodarte RRP, Guimarães JAM, Duarte BT, Kenedi PP, Pinho WR. ANALYSIS OF THE MECHANICAL BEHAVIOR OF THE POSTERIOR CRUCIATE LIGAMENT IN A PORCINE MODEL. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e236261. [PMID: 36092176 PMCID: PMC9425957 DOI: 10.1590/1413-785220223004e236261] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2021] [Indexed: 05/01/2023]
Abstract
INTRODUCTION The knee has shown a significant increase in the frequency of injury due to sports practice. This increase and the improvement of surgical techniques of ligament reconstruction have led to a greater indication of this treatment to achieve a function close to normal. OBJECTIVE To conduct a preliminary analysis of the ligament behavior. METHODS The study consisted of the validation of an anatomical model of the pig, in which five models were subjected to mechanical tests. The data on the loads of the in situ model and the strains of the posterior cruciate ligament were collected. RESULTS The analysis of the tensile load showed, at first, a nonlinear increase in stresses. Subsequently, the pig's knee showed a relatively linear intermediate response until failure around 1,200 N. Strain × time showed a response of the posterior cruciate ligament, which also has a relatively linear response. CONCLUSION We observed a linear behavior in the range of 1,000 to 5,000 microstrains in the strain of the posterior cruciate ligament. We suggest further studies to understand knee ligaments regarding their behavior in their function. Level of Evidence IV, Biomechanical Study.
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Affiliation(s)
- Rodrigo Ribeiro Pinho Rodarte
- Hospital Central da Polícia Militar, Rio de Janeiro, RJ, Brazil
- Instituto Nacional de Traumatologia e Ortopedia, Rio de Janeiro, RJ, Brazil
- Centro Federal de Educação Tecnológica Celso Suckow da Fonseca, Graduate Program in Mechanical Engineering and Materials Technology, Rio de Janeiro, RJ, Brazil
| | | | - Brenno Tavares Duarte
- Centro Federal de Educação Tecnológica Celso Suckow da Fonseca, Graduate Program in Mechanical Engineering and Materials Technology, Rio de Janeiro, RJ, Brazil
| | - Paulo Pedro Kenedi
- Centro Federal de Educação Tecnológica Celso Suckow da Fonseca, Graduate Program in Mechanical Engineering and Materials Technology, Rio de Janeiro, RJ, Brazil
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Loi I, Stanev D, Moustakas K. Total Knee Replacement: Subject-Specific Modeling, Finite Element Analysis, and Evaluation of Dynamic Activities. Front Bioeng Biotechnol 2021; 9:648356. [PMID: 33937216 PMCID: PMC8085535 DOI: 10.3389/fbioe.2021.648356] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 02/23/2021] [Indexed: 11/24/2022] Open
Abstract
This study presents a semi-automatic framework to create subject-specific total knee replacement finite element models, which can be used to analyze locomotion patterns and evaluate knee dynamics. In recent years, much scientific attention was attracted to pre-clinical optimization of customized total knee replacement operations through computational modeling to minimize post-operational adverse effects. However, the time-consuming and laborious process of developing a subject-specific finite element model poses an obstacle to the latter. One of this work's main goals is to automate the finite element model development process, which speeds up the proposed framework and makes it viable for practical applications. This pipeline's reliability was ratified by developing and validating a subject-specific total knee replacement model based on the 6th SimTK Grand Challenge data set. The model was validated by analyzing contact pressures on the tibial insert in relation to the patient's gait and analysis of tibial contact forces, which were found to be in accordance with the ones provided by the Grand Challenge data set. Subsequently, a sensitivity analysis was carried out to assess the influence of modeling choices on tibial insert's contact pressures and determine possible uncertainties on the models produced by the framework. Parameters, such as the position of ligament origin points, ligament stiffness, reference strain, and implant-bone alignment were used for the sensitivity study. Notably, it was found that changes in the alignment of the femoral component in reference to the knee bones significantly affect the load distribution at the tibiofemoral joint, with an increase of 206.48% to be observed at contact pressures during 5° internal rotation. Overall, the models produced by this pipeline can be further used to optimize and personalize surgery by evaluating the best surgical parameters in a simulated manner before the actual surgery.
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Affiliation(s)
- Iliana Loi
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece
| | - Dimitar Stanev
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece.,School of Engineering, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
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15
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Lahkar BK, Rohan PY, Pillet H, Thoreux P, Skalli W. Development and evaluation of a new procedure for subject-specific tensioning of finite element knee ligaments. Comput Methods Biomech Biomed Engin 2021; 24:1195-1205. [PMID: 33427509 DOI: 10.1080/10255842.2020.1870220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Subject-specific tensioning of ligaments is essential for the stability of the knee joint and represents a challenging aspect in the development of finite element models. We aimed to introduce and evaluate a new procedure for the quantification of ligament prestrains from biplanar X-ray and CT data. Subject-specific model evaluation was performed by comparing predicted femorotibial kinematics with the in vitro response of six cadaveric specimens. The differences obtained using personalized models were comparable to those reported in similar studies in the literature. This study is the first step toward the use of simplified, personalized knee FE models in clinical context such as ligament balancing.
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Affiliation(s)
- Bhrigu K Lahkar
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Pierre-Yves Rohan
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Helene Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
| | - Patricia Thoreux
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France.,Université Sorbonne Paris Nord, Bobigny, France
| | - Wafa Skalli
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Sciences et Technologies, Paris, France
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16
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Adouni M, Faisal TR, Dhaher YY. Computational frame of ligament in situ strain in a full knee model. Comput Biol Med 2020; 126:104012. [PMID: 33045650 DOI: 10.1016/j.compbiomed.2020.104012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 09/14/2020] [Accepted: 09/17/2020] [Indexed: 01/12/2023]
Abstract
The biomechanical function of connective tissues in a knee joint is to stabilize the kinematics-kinetics of the joint by augmenting its stiffness and limiting excessive coupled motion. The connective tissues are characterized by an in vivo reference configuration (in situ strain) that would significantly contribute to the mechanical response of the knee joint. In this work, a novel iterative method for computing the in situ strain at reference configuration was presented. The framework used an in situ strain gradient approach (deformed reference configuration) and a detailed finite element (FE) model of the knee joint. The effect of the predicted initial configuration on the mechanical response of the joint was then investigated under joint axial compression, passive flexion, and coupled rotations (adduction and internal), and during the stance phase of gait. The inclusion of the reference configuration has a minimal effect on the knee joint mechanics under axial compression, passive flexion, and at two instances (0% and 50%) of the stance phase of gait. However, the presence of the ligaments in situ strains significantly increased the joint stiffness under passive adduction and internal rotations, as well as during the other simulated instances (25%, 75% and 100%) of the stance phase of gait. Also, these parameters substantially altered the local loading state of the ligaments and resulted in better agreement with the literature during joint flexion. Therefore, the proposed computational framework of ligament in situ strain will help to overcome the challenges in considering this crucial biological aspect during knee joint modeling. Besides, the current construct is advantageous for a better understanding of the mechanical behavior of knee ligaments under physiological and pathological states and provide relevant information in the design of reconstructive treatments and artificial grafts.
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Affiliation(s)
- Malek Adouni
- Northwestern University, Physical Medicine and Rehabilitation Department, 345 East Superior Street, Chicago, IL, 60611, United States; Australian College of Kuwait, Mechanical Engineering Department, East Meshrif, P.O. Box 1411, Kuwait.
| | - Tanvir R Faisal
- Department of Mechanical Engineering, University of Louisiana at Lafayette, LA, 70508, USA
| | - Yasin Y Dhaher
- Northwestern University, Physical Medicine and Rehabilitation Department, 345 East Superior Street, Chicago, IL, 60611, United States; Department of Physical Medicine and Rehabilitation, University of Texas Southwest, Dallas, TX, United States; Department of Orthopedic Surgery, University of Texas Southwest, Dallas, TX, United States; Bioengineering, University of Texas Southwest, Dallas, TX, United States
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17
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Benos L, Stanev D, Spyrou L, Moustakas K, Tsaopoulos DE. A Review on Finite Element Modeling and Simulation of the Anterior Cruciate Ligament Reconstruction. Front Bioeng Biotechnol 2020; 8:967. [PMID: 32974307 PMCID: PMC7468435 DOI: 10.3389/fbioe.2020.00967] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/27/2020] [Indexed: 01/22/2023] Open
Abstract
The anterior cruciate ligament (ACL) constitutes one of the most important stabilizing tissues of the knee joint whose rapture is very prevalent. ACL reconstruction (ACLR) from a graft is a surgery which yields the best outcome. Taking into account the complicated nature of this operation and the high cost of experiments, finite element (FE) simulations can become a valuable tool for evaluating the surgery in a pre-clinical setting. The present study summarizes, for the first time, the current advancement in ACLR in both clinical and computational level. It also emphasizes on the material modeling and properties of the most popular grafts as well as modeling of different surgery techniques. It can be concluded that more effort is needed to be put toward more realistic simulation of the surgery, including also the use of two bundles for graft representation, graft pretension and artificial grafts. Furthermore, muscles and synovial fluid need to be included, while patellofemoral joint is an important bone that is rarely used. More realistic models are also required for soft tissues, as most articles used isotropic linear elastic models and springs. In summary, accurate and realistic FE analysis in conjunction with multidisciplinary collaboration could contribute to ACLR improvement provided that several important aspects are carefully considered.
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Affiliation(s)
- Lefteris Benos
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | - Dimitar Stanev
- Department of Electrical and Computer Engineering, University of Patras, Patras, Greece.,School of Engineering, Institute of Bioengineering, École Polytechnique Fédérale de Lausanne, Lausanne, Switzerland
| | - Leonidas Spyrou
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
| | | | - Dimitrios E Tsaopoulos
- Institute for Bio-Economy and Agri-Technology, Centre for Research and Technology-Hellas, Thessaloniki, Greece
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18
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Erdemir A, Besier TF, Halloran JP, Imhauser CW, Laz PJ, Morrison TM, Shelburne KB. Deciphering the "Art" in Modeling and Simulation of the Knee Joint: Overall Strategy. J Biomech Eng 2020; 141:2730179. [PMID: 31166589 DOI: 10.1115/1.4043346] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Indexed: 12/26/2022]
Abstract
Recent explorations of knee biomechanics have benefited from computational modeling, specifically leveraging advancements in finite element analysis and rigid body dynamics of joint and tissue mechanics. A large number of models have emerged with different levels of fidelity in anatomical and mechanical representation. Adapted modeling and simulation processes vary widely, based on justifiable choices in relation to anticipated use of the model. However, there are situations where modelers' decisions seem to be subjective, arbitrary, and difficult to rationalize. Regardless of the basis, these decisions form the "art" of modeling, which impact the conclusions of simulation-based studies on knee function. These decisions may also hinder the reproducibility of models and simulations, impeding their broader use in areas such as clinical decision making and personalized medicine. This document summarizes an ongoing project that aims to capture the modeling and simulation workflow in its entirety-operation procedures, deviations, models, by-products of modeling, simulation results, and comparative evaluations of case studies and applications. The ultimate goal of the project is to delineate the art of a cohort of knee modeling teams through a publicly accessible, transparent approach and begin to unravel the complex array of factors that may lead to a lack of reproducibility. This manuscript outlines our approach along with progress made so far. Potential implications on reproducibility, on science, engineering, and training of modeling and simulation, on modeling standards, and on regulatory affairs are also noted.
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Affiliation(s)
- Ahmet Erdemir
- Department of Biomedical Engineering and Computational Biomodeling (CoBi) Core, Lerner Research Institute, Cleveland Clinic, 9500 Euclid Avenue (ND20), Cleveland, OH 44195 e-mail:
| | - Thor F Besier
- Department of Engineering Science, Auckland Bioengineering Institute, University of Auckland, Auckland 1010, New Zealand
| | - Jason P Halloran
- Department of Mechanical Engineering, Center for Human Machine Systems, Cleveland State University, Cleveland, OH 44115
| | - Carl W Imhauser
- Department of Biomechanics, Hospital for Special Surgery, New York, NY 10021
| | - Peter J Laz
- Department of Mechanical and Materials Engineering, Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80210
| | - Tina M Morrison
- Division of Applied Mechanics, Office of Science and Engineering Laboratories, Center for Devices and Radiological Health, Food and Drug Administration, Silver Spring, MD 20993
| | - Kevin B Shelburne
- Department of Mechanical and Materials Engineering, Center for Orthopaedic Biomechanics, University of Denver, Denver, CO 80210
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Palazzi E, Siegler S, Balakrishnan V, Leardini A, Caravaggi P, Belvedere C. Estimating the stabilizing function of ankle and subtalar ligaments via a morphology-specific three-dimensional dynamic model. J Biomech 2020; 98:109421. [PMID: 31653506 DOI: 10.1016/j.jbiomech.2019.109421] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 10/05/2019] [Accepted: 10/13/2019] [Indexed: 10/25/2022]
Abstract
Knowledge of the stabilizing role of the ankle and subtalar ligaments is important for improving clinical techniques such as ligament repair and reconstruction. However, this knowledge is incomplete. The goal of this study was to expand this knowledge by investigating the stabilizing function of the ligaments using multiple morphologically subject-specific computational models. Nine models were created from the lower extremities of nine donors. Each model consisted of the articulating bones, articular cartilage, and ligaments. Simulations were conducted in ADAMS™ - a dynamic simulation program. During simulation, tibia and fibula were fixed while cyclic moments in all three anatomical planes were applied to the calcaneus one-at-a-time. The resulting displacements between the bones and the forces in each ligament were computed. Simulations were conducted with all ligaments intact and after simulated ligament serial sectioning. Each model was validated by comparing the simulation results to experimental data obtained from the specimen used to construct the model. From the results the stabilizing role of each ligament was established and the effect of ligament sectioning on Range of Motion and Overall Laxity was identified. On the lateral side, ATFL provided stabilization in supination, CFL restrained inversion, external rotation and dorsiflexion and PTFL limited dorsiflexion and external rotation. On the medial side, PTTL restrained dorsiflexion and internal rotation, ATTL limited plantarflexion and external rotation, and TCL limited dorsiflexion, eversion and external rotation. At the subtalar joint, ITCL limited plantarflexion and its posterior-lateral bundle restrained subtalar inversion. CL restrained plantarflexion/dorsiflexion, and internal and external rotation. The large inter-model variability observed in the results indicate the importance of using multiple subject-specific models rather than relying on one "representative" model.
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Affiliation(s)
- Emanuele Palazzi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy; Department of Industrial Engineering, University of Bologna, Italy; Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA
| | - Sorin Siegler
- Department of Mechanical Engineering, Drexel University, Philadelphia, PA, USA.
| | | | - Alberto Leardini
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Paolo Caravaggi
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Claudio Belvedere
- Movement Analysis Laboratory, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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Cooper RJ, Wilcox RK, Jones AC. Finite element models of the tibiofemoral joint: A review of validation approaches and modelling challenges. Med Eng Phys 2019; 74:1-12. [DOI: 10.1016/j.medengphy.2019.08.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 08/05/2019] [Accepted: 08/21/2019] [Indexed: 12/20/2022]
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21
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Jiang D, Ao YF, Jiao C, Guo QW, Xie X, Zhao F, Li N, Wang XX, Hu YL. The effect of cyclic knee motion on the elongation of four-strand hamstring autograft in anterior cruciate ligament reconstruction: an in-situ pilot study. BMC Musculoskelet Disord 2019; 20:321. [PMID: 31288779 PMCID: PMC6615292 DOI: 10.1186/s12891-019-2699-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Accepted: 06/27/2019] [Indexed: 01/26/2023] Open
Abstract
Background Pretension of the viscoelastic graft by cyclic knee motion has been confirmed to decrease the graft creep and improve the outcome of anterior cruciate ligament (ACL) reconstruction. The purpose of the present study was to investigate the effect of cyclic knee motion on the elongation of the four-strand hamstring tendon autograft in situ and to explore the stable level cycle, in which the tendon length achieved a stable level. Methods The study was performed with 53 consecutive patients undergoing transtibial ACL reconstruction with four strand hamstring tendon from Aug 2013 to Apr 2015. 43 males and 10 females were included with mean age of 29 ± 10 years. The pretension of the tendons was operated by cyclical knee motion ranging from 0 to 110°after the femoral fixation with Endo-button. The tendon length after 10, 20, 30 and 40 cycles was measured respectively and compared by repeated measure ANOVA. Then multivariate logistic regression was used to investigate the effect of the patients’ parameters (age, gender, height, body weight, tendon length, etc.) on the elongation of the graft and the stable level cycle. Results The mean lengthening of the graft at 10, 20, 30 and 40 times was 3.0 ± 1.4 mm, 4.3 ± 1.5 mm, 4.8 ± 1.7 mm and 4.8 ± 1.8 mm respectively. No significant correlation was found between the elongation and the patients’ parameters. There was significant difference of the tendon length from 0 to 30 cycles (F = 264.8, df = 1.95, p<0.001). However, the tendon length achieved a stable level after 30 cycles and the median elongation from 30 cycles to 40 cycles was 0 (0–1) mm with no significant difference (F = 2.039, p = 0.159). The male and female tendon length achieved to a stable level at 20 cycles and 30 cycles respectively but with no significant difference (p = 0.074). Conclusions The four-strand hamstring tendon was elongated after cyclic knee motion and the elongation achieved a stable level after 30 cycles for the transtibial technique. Both of the tendon elongation and the stable level cycle were not correlated with patients’ gender, age, preoperative duration, graft diameter and length.
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Affiliation(s)
- Dong Jiang
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Ying-Fang Ao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Chen Jiao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Qin-Wei Guo
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Xing Xie
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Feng Zhao
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China
| | - Nan Li
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Xiao-Xiao Wang
- Research Center of Clinical Epidemiology, Peking University Third Hospital, No.49 North Garden Road, Haidian, Beijing, 100191, China
| | - Yue-Lin Hu
- Institute of Sports Medicine, Peking University Third Hospital, Beijing Key Laboratory of Sports Injuries, Beijing, 100191, China.
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22
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Karathanasopoulos N, Ganghoffer JF. Exploiting Viscoelastic Experimental Observations and Numerical Simulations to Infer Biomimetic Artificial Tendon Fiber Designs. Front Bioeng Biotechnol 2019; 7:85. [PMID: 31134193 PMCID: PMC6513967 DOI: 10.3389/fbioe.2019.00085] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/05/2019] [Indexed: 11/18/2022] Open
Abstract
Designing biomimetic artificial tendons requires a thorough, data-based understanding of the tendon's inner material properties. The current work exploits viscoelastic experimental observations at the tendon fascicle scale, making use of mechanical and data analysis methods. More specifically, based on reported elastic, volumetric and relaxation fascicle scale properties, we infer most probable, mechanically compatible material attributes at the fiber scale. In particular, the work provides pairs of elastic and viscous fiber-scale moduli, which can reproduce the upper scale tendon mechanics. The computed range of values for the fiber-scale tendon viscosity attest to the substantial stress relaxation capabilities of tendons. More importantly, the reported mechanical parameters constitute a basis for the design of tendon-specific restoration materials, such as fiber-based, engineering scaffolds.
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Wang HM, Shultz SJ, Ross SE, Henson RA, Perrin DH, Kraft RA, Schmitz RJ. Sex Comparisons of In Vivo Anterior Cruciate Ligament Morphometry. J Athl Train 2019; 54:513-518. [PMID: 31058539 DOI: 10.4085/1062-6050-371-17] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
CONTEXT Females have consistently higher anterior cruciate ligament (ACL) injury rates than males. The reasons for this disparity are not fully understood. Whereas ACL morphometric characteristics are associated with injury risk and females have a smaller absolute ACL size, comprehensive sex comparisons that adequately account for sex differences in body mass index (BMI) have been limited. OBJECTIVE To investigate sex differences among in vivo ACL morphometric measures before and after controlling for femoral notch width and BMI. DESIGN Cross-sectional study. SETTING Laboratory. PATIENTS OR OTHER PARTICIPANTS Twenty recreationally active men (age = 23.2 ± 2.9 years, height = 180.4 ± 6.7 cm, mass = 84.0 ± 10.9 kg) and 20 recreationally active women (age = 21.3 ± 2.3 years, height = 166.9 ± 7.7 cm, mass = 61.9 ± 7.2 kg) participated. MAIN OUTCOME MEASURE(S) Structural magnetic resonance imaging sequences were performed on the left knee. Anterior cruciate ligament volume, width, and cross-sectional area measures were obtained from T2-weighted images and normalized to femoral notch width and BMI. Femoral notch width was measured from T1-weighted images. We used independent-samples t tests to examine sex differences in absolute and normalized measures. RESULTS Men had greater absolute ACL volume (1712.2 ± 356.3 versus 1200.1 ± 337.8 mm3; t38 = -4.67, P < .001) and ACL width (8.5 ± 2.3 versus 7.0 ± 1.2 mm; t38 = -2.53, P = .02) than women. The ACL volume remained greater in men than in women after controlling for femoral notch width (89.31 ± 15.63 versus 72.42 ± 16.82 mm3/mm; t38 = -3.29, P = .002) and BMI (67.13 ± 15.40 versus 54.69 ± 16.39 mm3/kg/m2; t38 = -2.47, P = .02). CONCLUSIONS Whereas men had greater ACL volume and width than women, only ACL volume remained different when we accounted for femoral notch width and BMI. This suggests that ACL volume may be an appropriate measure of ACL anatomy in investigations of ACL morphometry and ACL injury risk that include sex comparisons.
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Affiliation(s)
- Hsin-Min Wang
- Department of Sports, National Changhua University of Education, Taiwan
| | - Sandra J Shultz
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Scott E Ross
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Robert A Henson
- Department of Educational Research Methodology, University of North Carolina at Greensboro
| | - David H Perrin
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City
| | - Robert A Kraft
- Department of Kinesiology, University of North Carolina at Greensboro
| | - Randy J Schmitz
- Department of Kinesiology, University of North Carolina at Greensboro
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Castellarin G, Pianigiani S, Innocenti B. Asymmetric polyethylene inserts promote favorable kinematics and better clinical outcome compared to symmetric inserts in a mobile bearing total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2019; 27:1096-1105. [PMID: 30306242 DOI: 10.1007/s00167-018-5207-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 10/04/2018] [Indexed: 01/17/2023]
Abstract
PURPOSE This study aims at comparing the effects of symmetric and asymmetric designs for the polyethylene insert currently available and also for mobile bearing total knee arthroplasty (TKA). The investigation was performed both clinically and biomechanically through finite element analysis. METHODS 303 patients, with a mobile bearing TKA, were analyzed retrospectively. All patients received the same femoral and tibial components; for the insert, 151 patients received a symmetric design (SD) and 152 an asymmetric design (AD). Additionally, a 3D finite element model of a lower leg was developed, resurfaced with the same TKAs and analysed during gait and squat activities. TKA kinematics, and bone-stresses were investigated for the two insert solutions. RESULTS After surgery, patients' average flexion improved from 105°, with 5° of preoperative extension deficit, to 120° (AD-group) and 115° (SD-group) at the latest follow-up. There was no postoperative extension deficit. No pain affected the AD-group, while an antero-lateral pain was reported in some patients of the SD-group. Patients of the AD-group presented a better ability to perform certain physical routines. Biomechanically, the SD induced higher tibial-bone stresses than the AD. Both designs replicated similar kinematics, comparable to literature. However, SD rotates more on the tray, reducing the motion between femoral and polyethylene components, while AD permits greater insert rotation. CONCLUSION The biomechanical analysis justifies the clinical findings. TKA kinematics is similar for the two designs, although the asymmetric solution shows less bone stress, thus resulting as more suitable to be cemented, avoiding lift-off issues, inducing less pain. Clinically, and biomechanically, an asymmetric mobile bearing insert could be a valid alternative to symmetric mobile bearing insert. LEVEL OF EVIDENCE Case-control study retrospective comparative study, III.
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Affiliation(s)
| | - Silvia Pianigiani
- BEAMS Department, École polytechnique de Bruxelles, Université Libre de Bruxelles, Av F. Roosevelt 50, Brussels, 1050, Belgium
| | - Bernardo Innocenti
- BEAMS Department, École polytechnique de Bruxelles, Université Libre de Bruxelles, Av F. Roosevelt 50, Brussels, 1050, Belgium.
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25
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Wilson S, Hausselle J, Guess TM, Gonzalez RV. Rigid-body modeling of knee cartilage and meniscus using experimental pressure-strain curves. Comput Methods Biomech Biomed Engin 2019; 22:574-584. [PMID: 30821502 DOI: 10.1080/10255842.2019.1569639] [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: 10/27/2022]
Abstract
Rigid-body knee models have gained popularity thanks to computational speed and ease of setup compared to finite element models-showing exciting potential for clinical patient-specific models in the future. However, Rigid-body studies in general have encountered difficulty in modeling cartilage and especially meniscus material properties, often relying on computationally costly optimization techniques. This paper presents two new methods to alleviate the difficulty-one to define model contact pressure and one to define meniscus internal forces-and is the first to our knowledge to use experimental pressure-strain curves from the literature to simulate cartilage and meniscus behavior in a rigid body model. This paper describes the methodology to derive the proof of concept model and preliminary results from a gait simulation based on ISO 14243-1.
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Affiliation(s)
- S Wilson
- a Joint Lab , The University of Texas at El Paso , El Paso , Texas , USA
| | - J Hausselle
- b BAMM Lab , Oklahoma State University , Stillwater , Oklahoma , USA
| | - T M Guess
- c The University of Missouri , Columbia , Missouri , USA
| | - R V Gonzalez
- a Joint Lab , The University of Texas at El Paso , El Paso , Texas , USA
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26
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Naghibi H, Mazzoli V, Gijsbertse K, Hannink G, Sprengers A, Janssen D, Van den Boogaard T, Verdonschot N. A noninvasive MRI based approach to estimate the mechanical properties of human knee ligaments. J Mech Behav Biomed Mater 2019; 93:43-51. [PMID: 30769233 DOI: 10.1016/j.jmbbm.2019.01.022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 01/03/2019] [Accepted: 01/30/2019] [Indexed: 01/31/2023]
Abstract
Characterization of the main tibiofemoral ligaments is an essential step in developing patient-specific computational models of the knee joint for personalized surgery pre-planning. Tensile tests are commonly performed in-vitro to characterize the mechanical stiffness and rupture force of the knee ligaments which makes the technique unsuitable for in-vivo application. The time required for the limited noninvasive approaches for properties estimation based on knee laxity remained the main obstacle in clinical implementation. Magnetic resonance imaging (MRI) technique can be a platform to noninvasively assess the knee ligaments. In this study the aim was to explore the potential role of quantitative MRI and dimensional properties, in characterizing the mechanical properties of the main tibiofemoral ligaments. After MR scanning of six cadaveric legs, all 24 main tibiofemoral bone-ligaments-bone specimens were tested in vitro. During the tensile test cross sectional area of the specimens was captured using ultrasound and force-displacement curve was extracted. Digital image correlation technique was implemented to check the strain behavior of the specimen and rupture region and to assure the fixation of ligament bony block during the test. The volume of the specimen was measured using manual segmentation data, and quantitative MR parameters as T2*, T1ρ, and T2 were calculated. Linear mixed statistical models for repeated measures were used to examine the association of MRI parameters and dimensional measurements with the mechanical properties (stiffness and rupture force). The results shows that while the mechanical properties were mostly correlated to the volume, inclusion of the MR parameters increased the correlation strength for stiffness (R2 ≈ 0.48) and partial rupture force (R2 = 0.53). Inclusion of ligament type in the statistical analysis enhanced the correlation of mechanical properties with MR parameters and volume as for stiffness (R2 = 0.60) and partial rupture (R2 = 0.57). In conclusion, this study revealed the potentials in using quantitative MR parameters, T1ρ, T2 and T2*, combined with specimen volume to estimate the essential mechanical properties of all main tibiofemoral ligaments required for subject-specific computational modeling of human knee joint.
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Affiliation(s)
- Hamid Naghibi
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Robotics and Mechatronics Group, The Faculty of Electrical Engineering Mathematics and Computer Science, Technical Medical Centre, University of Twente, Enschede, the Netherlands.
| | - Valentina Mazzoli
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Department of Radiology, Stanford University, Stanford, CA, USA
| | - Kaj Gijsbertse
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Gerjon Hannink
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Andre Sprengers
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dennis Janssen
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Ton Van den Boogaard
- Nonlinear Solid Mechanics, Faculty of Engineering Technology, University of Twente, Enschede, the Netherlands
| | - Nico Verdonschot
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands; Laboratory of Biomechanical Engineering, University of Twente, Enschede, the Netherlands
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Innocenti B, Fekete G, Pianigiani S. Biomechanical Analysis of Augments in Revision Total Knee Arthroplasty. J Biomech Eng 2018; 140:2694847. [PMID: 30098138 DOI: 10.1115/1.4040966] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Indexed: 11/08/2022]
Abstract
Augments are a common solution for treating bone loss in revision total knee arthroplasty and industry is providing to surgeons several options, in terms of material, thickness and shapes. Actually, while the choice of the shape and the thickness is mainly dictated by the bone defect, no proper guidelines are currently available to select the optimal material for a specific clinical situation. Nevertheless, different materials could induce different bone responses and, later, potentially compromise implant stability and performances. Therefore, in this study, a biomechanical analysis is performed by means of finite element modelling about existing features for augment designs. Based upon a review of available products at present, the following augments features were analyzed: position (distal/proximal and posterior), thickness (5, 10 and 15 mm) and material (bone cement, porous and solid metal). For all analyzed configurations, bone stresses were investigated in different regions and compared among all configurations and the control model for which no augments were used. Results show that the use of any kind of augment usually induces a change in bone stresses, especially in the region close to the bone cut. The porous metal presents result very close to cement ones; thus it could be considered as a good alternative for defects of any size. Solid metal has the least satisfying results inducing the highest changes in bone stress. The results of this study demonstrate that material stiffness of the augment should be as close as possible to bone properties for allowing the best implant performances.
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Affiliation(s)
- Bernardo Innocenti
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
| | - Gusztáv Fekete
- Savaria Institute of Technology, Faculty of Informatics, Eötvös Loránd University, Károlyi Gáspár 4, 9700 Szombathely, Hungary
| | - Silvia Pianigiani
- BEAMS Department, Université Libre De Bruxelles, Av. F. Roosevelt, 50 CP165/56, 1050 Bruxelles, Belgium
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28
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Fontanella CG, Macchi V, Carniel EL, Frigo A, Porzionato A, Picardi EEE, Favero M, Ruggieri P, de Caro R, Natali AN. Biomechanical behavior of Hoffa’s fat pad in healthy and osteoarthritic conditions: histological and mechanical investigations. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 41:657-667. [DOI: 10.1007/s13246-018-0661-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 06/18/2018] [Indexed: 12/30/2022]
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29
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Richter DJ, Lyon R, Van Valin S, Liu XC. Current Strategies and Future Directions to Optimize ACL Reconstruction in Adolescent Patients. Front Surg 2018; 5:36. [PMID: 29761106 PMCID: PMC5937439 DOI: 10.3389/fsurg.2018.00036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Accepted: 04/19/2018] [Indexed: 11/13/2022] Open
Abstract
The incidence of anterior cruciate ligament (ACL) injuries in the pediatric population has risen in recent years. These injuries have historically presented a management dilemma in skeletally immature patients with open physes and significant growth remaining at time of injury. While those nearing skeletal maturity may be treated with traditional, transphyseal adult techniques, these same procedures risk iatrogenic damage to the growth plates and resultant growth disturbances in younger patients with open physes. Moreover, conservative management is non-optimal as significant instabilities of the knee remain. Despite the development of physeal-sparing reconstructive techniques for younger patients, there remains debate over which procedure may be most suitable on a patient to patient basis. Meanwhile, the drivers behind clinical and functional outcomes following ACL reconstruction remain poorly understood. Therefore, current strategies are not yet capable of optimizing surgical ACL reconstruction on an individualized basis with absolute confidence. Instead, aims to improve surgical treatment of ACL tears in skeletally immature patients will rely on additional approaches in the near future. Namely, finite element models have emerged as a tool to model complex knee joint biomechanics. The inclusion of several individualized variables such as bone age, three dimensional geometries around the knee joint, tunnel positioning, and graft tension collectively present a possible means of better understanding and even predicting how to enhance surgical decision-making. Such a tool would serve surgeons in optimizing ACL reconstruction in the skeletally immature individuals, in order to improve clinical outcomes as well as reduce the rate of post-operative complications.
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Affiliation(s)
- Dustin Jon Richter
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States
| | - Roger Lyon
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Scott Van Valin
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
| | - Xue-Cheng Liu
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI, United States.,Department of Orthopaedic Surgery, Children's Hospital of Wisconsin, Milwaukee, WI, United States
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30
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Innocenti B, Larrieu JC, Lambert P, Pianigiani S. Automatic characterization of soft tissues material properties during mechanical tests. Muscles Ligaments Tendons J 2018; 7:529-537. [PMID: 29721454 DOI: 10.11138/mltj/2017.7.4.529] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The estimation of the non-linear viscoelastic characteristics of human soft tissues, such as ligaments and tendon, is often affected by the implemented procedure. This study aims at developing and validating a protocol, associated with a contactless and automatic procedure, enabling the determination of the material behavior and properties of any soft tissues. Methods Several markers were drawn onto the soft tissue specimen analyzed under uniaxial tensile test. An automatic contactless procedure, that uses a camera for recording the position of the markers during the test, was developed to compute the displacement, and the force applied, enabling the calculation of the true-stress/strain curve of the material. Young's modulus and Poisson's ratio can be calculated, on demand, for selected regions of interest of the soft tissues. The repeatability and reproducibility of the procedure were analyzed. The procedure was initially tested and verified on an artificial silicone material and later applied for investigating the mechanical behavior of a pig Achilles tendon and of a human patellar tendon. Results The procedure show a high repeatability, independent by the operator, reliability and accuracy for the tested synthetic material (with a maximum error of 3.7% for Young's modulus). Additionally, the developed protocol was also suitable for the analysis of animal and human soft tissues. Conclusion A protocol to automatically and accurately determine material properties in soft tissues was developed, tested and validated. Such approach could successfully be implemented for the mechanical characterization of any biological soft-tissue. Level of evidence V.
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Affiliation(s)
| | | | - Pierre Lambert
- BEAMS Department, Université Libre de Bruxelles, Bruxelles, Belgium
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31
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Pianigiani S, Croce D, D'Aiuto M, Pascale W, Innocenti B. Sensitivity analysis of the material properties of different soft-tissues: implications for a subject-specific knee arthroplasty. Muscles Ligaments Tendons J 2018; 7:546-557. [PMID: 29721456 DOI: 10.11138/mltj/2017.7.4.546] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction While developing a subject-specific knee model, different kinds of data-inputs are required. If information about geometries can be definitely obtained from images, more effort is necessary for the in vivo properties. Consequently, such information are recruited from the literature as common habit. However, the effects of the combined sources still need to be evaluated. Methods This work aims at developing an intact native subject-specific knee model for performing a sensitivity analysis on soft-tissues. The impacts on the biomechanical outputs were analysed during a daily activity for which articular knee kinetics and kinematics were compared among the different configurations. Prior to the sensitivity analysis, experimental and literature data were checked for the model reliability. Results Average values of mixed sources allowed the agreement with experimental data for personalized outputs. From the sensitivity analysis, knee kinematics did not significantly change in the selected ranges of properties for the soft-tissues (in rotation less than 0.5°), while contact stresses were greatly affected, especially for the articular cartilage (with differences in the results more than 100%). Conclusion In conclusion, during the development of a personalized knee model, the selection of the correct material properties is fundamental because wrong values could highly affect the numerical results. Level of evidence III a.
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Affiliation(s)
- Silvia Pianigiani
- BEAMS Department, École polytechnique de Bruxelles, Université Libre de Bruxelles, Belgium.,IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Davide Croce
- Dipartimento di Chimica, Materiali ed Ingegneria Chimica "G. Natta", Politecnico di Milano, Milan, Italy
| | - Marta D'Aiuto
- Dipartimento di Chimica, Materiali ed Ingegneria Chimica "G. Natta", Politecnico di Milano, Milan, Italy
| | | | - Bernardo Innocenti
- BEAMS Department, École polytechnique de Bruxelles, Université Libre de Bruxelles, Belgium
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32
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Orozco GA, Tanska P, Mononen ME, Halonen KS, Korhonen RK. The effect of constitutive representations and structural constituents of ligaments on knee joint mechanics. Sci Rep 2018; 8:2323. [PMID: 29396466 PMCID: PMC5797142 DOI: 10.1038/s41598-018-20739-w] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 01/23/2018] [Indexed: 12/26/2022] Open
Abstract
Ligaments provide stability to the human knee joint and play an essential role in restraining motion during daily activities. Compression-tension nonlinearity is a well-known characteristic of ligaments. Moreover, simpler material representations without this feature might give reasonable results because ligaments are primarily in tension during loading. However, the biomechanical role of different constitutive representations and their fibril-reinforced poroelastic properties is unknown. A numerical knee model which considers geometric and material nonlinearities of meniscus and cartilages was applied. Five different constitutive models for the ligaments (spring, elastic, hyperelastic, porohyperelastic, and fibril-reinforced porohyperelastic (FRPHE)) were implemented. Knee joint forces for the models with elastic, hyperelastic and porohyperelastic properties showed similar behavior throughout the stance, while the model with FRPHE properties exhibited lower joint forces during the last 50% of the stance phase. The model with ligaments as springs produced the lowest joint forces at this same stance phase. The results also showed that the fibril network contributed substantially to the knee joint forces, while the nonfibrillar matrix and fluid had small effects. Our results indicate that simpler material models of ligaments with similar properties in compression and tension can be used when the loading is directed primarily along the ligament axis in tension.
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Affiliation(s)
- Gustavo A Orozco
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.
| | - Petri Tanska
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Mika E Mononen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Kimmo S Halonen
- Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Rami K Korhonen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
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33
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Wong DWC, Wang Y, Leung AKL, Yang M, Zhang M. Finite element simulation on posterior tibial tendinopathy: Load transfer alteration and implications to the onset of pes planus. Clin Biomech (Bristol, Avon) 2018; 51:10-16. [PMID: 29144991 DOI: 10.1016/j.clinbiomech.2017.11.001] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/31/2017] [Accepted: 11/01/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior tibial tendinopathy is a challenging foot condition resulting in pes planus, which is difficult to diagnose in the early stage. Prior to the deformity, abnormal internal load transfer and soft tissue attenuation are anticipated. The objective of this study was to investigate the internal load transfer and strain of the ligaments with posterior tibial tendinopathy, and the implications to pes planus and other deformities. METHODS A three-dimensional finite element model of the foot and ankle was reconstructed from magnetic resonance images of a 28-year-old normal female. Thirty bones, plantar fascia, ligaments and tendons were reconstructed. With the gait analysis data of the model subject, walking stance was simulated. The onset of posterior tibial tendinopathy was resembled by unloading the tibialis posterior and compared to the normal condition. FINDINGS The load transfer of the joints at the proximal medial column was weaken by posterior tibial tendinopathy, which was compromised by the increase along the lateral column and the intercuneiforms during late stance. Besides, the plantar tarsometatarsal and cuboideonavicular ligaments were consistently over-stretched during stance. Particularly, the maximum tensile strain of the plantar tarsometatarsal ligament was about 3-fold higher than normal at initial push-off. INTERPRETATION Posterior tibial tendinopathy altered load transfer of the medial column and unbalanced the load between the proximal and distal side of the medial longitudinal arch. Posterior tibial tendinopathy also stretched the midfoot plantar ligaments that jeopardized midfoot stability, and attenuated the transverse arch. All these factors potentially contributed to the progress of pes planus and other foot deformities.
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Affiliation(s)
- Duo Wai-Chi Wong
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Yan Wang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Aaron Kam-Lun Leung
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China
| | - Ming Yang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; Department of Pediatric Orthopedics, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China
| | - Ming Zhang
- Interdisciplinary Division of Biomedical Engineering, Faculty of Engineering, The Hong Kong Polytechnic University, Hong Kong, China; The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, China.
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Naghibi Beidokhti H, Janssen D, van de Groes S, Hazrati J, Van den Boogaard T, Verdonschot N. The influence of ligament modelling strategies on the predictive capability of finite element models of the human knee joint. J Biomech 2017; 65:1-11. [DOI: 10.1016/j.jbiomech.2017.08.030] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 07/12/2017] [Accepted: 08/25/2017] [Indexed: 10/18/2022]
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35
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Innocenti B, Bellemans J, Catani F. Deviations From Optimal Alignment in TKA: Is There a Biomechanical Difference Between Femoral or Tibial Component Alignment? J Arthroplasty 2016; 31:295-301. [PMID: 26321075 DOI: 10.1016/j.arth.2015.07.038] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 07/03/2015] [Accepted: 07/27/2015] [Indexed: 02/01/2023] Open
Abstract
Restoration of neutral mechanical alignment is one of the prerequisites for long-term TKA survival. This study aimed to investigate the effect of deviations from neutral alignment on bone and implant stress and on ligament strain. Using a previously validated finite element model, a neutrally aligned TKA model was compared to 3 different varus and valgus configurations induced by tibial or by femoral component only and by both component simultaneously. Each model underwent a 2500 N vertical load simulating the peak walking force. Varus and valgus alignment increased polyethylene and bone stress, and altered ligament strains, as compared to the neutral aligned model. Changes in alignment of the tibial component were always associated with more detrimental effects compared to the one of the femoral component.
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Affiliation(s)
| | - Johan Bellemans
- Department of Orthopedic Surgery, Ziekenhuis Oost-Limburg, Genk, Belgium
| | - Fabio Catani
- Orthopaedics and Traumatology Department, Modena Policlinic, Modena, Italy
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