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Yang Y, Wang Y, Zheng N, Cheng R, Zou D, Zhao J, Tsai TY. Development and Validation of a Novel In Vitro Joint Testing System for Reproduction of In Vivo Dynamic Muscle Force. Bioengineering (Basel) 2023; 10:1006. [PMID: 37760108 PMCID: PMC10525521 DOI: 10.3390/bioengineering10091006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 07/28/2023] [Accepted: 08/15/2023] [Indexed: 09/29/2023] Open
Abstract
In vitro biomechanical experiments utilizing cadaveric specimens are one of the most effective methods for rehearsing surgical procedures, testing implants, and guiding postoperative rehabilitation. Applying dynamic physiological muscle force to the specimens is a challenge to reconstructing the environment of bionic mechanics in vivo, which is often ignored in the in vitro experiment. The current work aims to establish a hardware platform and numerical computation methods to reproduce dynamic muscle forces that can be applied to mechanical testing on in vitro specimens. Dynamic muscle loading is simulated through numerical computation, and the inputs of the platform will be derived. Then, the accuracy and robustness of the platform will be evaluated through actual muscle loading tests in vitro. The tests were run on three muscles (gastrocnemius lateralis, the rectus femoris, and the semitendinosus) around the knee joint and the results showed that the platform can accurately reproduce the magnitude of muscle strength (errors range from -6.2% to 1.81%) and changing pattern (goodness-of-fit range coefficient ranges from 0.00 to 0.06) of target muscle forces. The robustness of the platform is mainly manifested in that the platform can still accurately reproduce muscle force after changing the hardware combination. Additionally, the standard deviation of repeated test results is very small (standard ranges of hardware combination 1: 0.34 N~2.79 N vs. hardware combination 2: 0.68 N~2.93 N). Thus, the platform can stably and accurately reproduce muscle forces in vitro, and it has great potential to be applied in the future musculoskeletal loading system.
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Affiliation(s)
- Yangyang Yang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Yufan Wang
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Nan Zheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Rongshan Cheng
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Diyang Zou
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
| | - Jie Zhao
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
| | - Tsung-Yuan Tsai
- School of Biomedical Engineering & Med-X Research Institute, Shanghai Jiao Tong University, Shanghai 200230, China; (Y.Y.); (Y.W.); (N.Z.); (R.C.); (D.Z.)
- Department of Orthopedics, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
- Engineering Research Center for Digital Medicine, Ministry of Education, Shanghai 200230, China
- Shanghai Key Laboratory of Orthopaedic Implants & Clinical Translation R&D Center of 3D Printing Technology, Department of Orthopaedic Surgery, Shanghai Ninth People’s Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200011, China
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Sukopp M, Shemesh M, Pruech E, Linder-Ganz E, Hacker S, Condello V, Schwer J, Ignatius A, Dürselen L, Seitz AM. Free-floating medial meniscus implant kinematics do not change after simulation of medial open-wedge high tibial osteotomy and notchplasty. J Exp Orthop 2023; 10:13. [PMID: 36757624 PMCID: PMC9911568 DOI: 10.1186/s40634-023-00576-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/20/2023] [Indexed: 02/10/2023] Open
Abstract
PURPOSE The purpose of this in-vitro study was to examine the kinematics of an artificial, free-floating medial meniscus replacement device under dynamic loading situations and different knee joint states. METHODS A dynamic knee simulator was used to perform dynamic loading exercises on three neutrally aligned and three 10° valgus aligned (simulating a medial openwedge high tibial osteotomy - MOWHTO) left human cadaveric knee joints. The knee joints were tested in three states (intact, conventional notchplasty, extended notchplasty) while 11 randomised exercises were simulated (jump landing, squatting, tibial rotation and axial ground impacts at 10°, 30° and 60° knee joint flexion) to investigate the knee joint and implant kinematics by means of rigidly attached reflective marker sets and an according motion analysis. RESULTS The maximum implant translation relative to the tibial plateau was < 13 mm and the maximum implant rotation was < 19° for all exercises. Both, the notchplasties and the valgus knee alignment did not affect the device kinematics. CONCLUSIONS The results of the present in-vitro study showed that the non-anchored free-floating device remains within the medial knee joint gap under challenging dynamic loading situations without indicating any luxation tendencies. This also provides initial benchtop evidence that the device offers suitable stability and kinematic behaviour to be considered a potential alternative to meniscus allograft transplantation in combination with an MOWHTO, potentially expanding the patient collective in the future.
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Affiliation(s)
- Matthias Sukopp
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Maoz Shemesh
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Elena Pruech
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Eran Linder-Ganz
- grid.508891.d0000 0004 0628 7030Active Implants LLC, 6060 Primacy Parkway, Suite 460, Memphis, TN USA
| | - Scott Hacker
- Grossmont Orthopedic Medical Group, 5565 Grossmont Center Drive, Building 3, Suite 256, La Mesa, CA USA
| | - Vincenzo Condello
- grid.500617.5Humanitas Castelli Clinic, Via Mazzini, 11, Bergamo, Italy
| | - Jonas Schwer
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Anita Ignatius
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Lutz Dürselen
- grid.6582.90000 0004 1936 9748Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081 Ulm, Germany
| | - Andreas Martin Seitz
- Institute of Orthopedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University, Medical Center, Helmholtzstrasse 14, 89081, Ulm, Germany.
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Sukopp M, Schall F, Hacker SP, Ignatius A, Dürselen L, Seitz AM. Influence of Menisci on Tibiofemoral Contact Mechanics in Human Knees: A Systematic Review. Front Bioeng Biotechnol 2021; 9:765596. [PMID: 34926419 PMCID: PMC8681859 DOI: 10.3389/fbioe.2021.765596] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 10/21/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: Menisci transfer axial loads, while increasing the load-bearing tibiofemoral contact area and decreasing tibiofemoral contact pressure (CP). Numerous clinical and experimental studies agree that an increased CP is one predominant indicator for post-traumatic osteoarthritis (PTOA) of the knee joint. However, due to the immense variability in experimental test setups and wide range of treatment possibilities in meniscus surgery, it is difficult to objectively assess their impact on the CP determination, which is clearly crucial for knee joint health. Therefore, the aim of this systematic review is to investigate the influence of different meniscal injuries and their associated surgical treatments on the CP. Secondly, the influence of different test setups on CP measurements is assessed. On the basis of these results, we established the basis for recommendations for future investigations with the aim to determine CPs under different meniscal states. Methods: This review was conducted in accordance with the PRISMA guidelines. Studies were identified through a systematic literature search in Cochrane, PubMed and Web of Science databases. Literature was searched through pre-defined keywords and medical subject headings. Results: This review indicates a significant increase of up to 235% in peak CP when comparing healthy joints and intact menisci with impaired knee joints, injured or resected menisci. In addition, different test setups were indicated to have major influences on CP: The variety of test setups ranged from standard material testing machines, including customized setups via horizontal and vertical knee joint simulators, through to robotic systems. Differences in applied axial knee joint loads ranged from 0 N up to 2,700 N and resulted unsurprisingly in significantly different peak CPs of between 0.1 and 12.06 MPa. Conclusion: It was shown that untreated traumatic meniscal tears result in an increased CP. Surgical repair intervention were able to restore the CP comparable to the healthy, native condition. Test setup differences and particularly axial joint loading variability also led to major CP differences. In conclusion, when focusing on CP measurements in the knee joint, transparent and traceable in vitro testing conditions are essential to allow researchers to make a direct comparison between future biomechanical investigations.
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Affiliation(s)
- Matthias Sukopp
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Steffen P Hacker
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Anita Ignatius
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Andreas M Seitz
- Institute of Orthopaedic Research and Biomechanics, Center of Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
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Tenberg S, Kalo K, Niederer D, Vogt L. Effect of warm-up and muscle fatiguing exercise on knee joint sounds in motion by vibroarthrography: A randomized crossover trial. PLoS One 2021; 16:e0257652. [PMID: 34534253 PMCID: PMC8448316 DOI: 10.1371/journal.pone.0257652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 09/08/2021] [Indexed: 12/03/2022] Open
Abstract
Vibroarthrography measures joint sounds caused by sliding of the joint surfaces over each other. and can be affected by joint health, load and type of movement. Since both warm-up and muscle fatigue lead to local changes in the knee joint (e.g., temperature increase, lubrication of the joint, muscle activation), these may impact knee joint sounds. Therefore, this study investigates the effects of warm-up and muscle fatiguing exercise on knee joint sounds during an activity of daily living. Seventeen healthy, physically active volunteers (25.7 ± 2 years, 7 males) performed a control and an intervention session with a wash-out phase of one week. The control session consisted of sitting on a chair, while the intervention session contained a warm-up (walking on a treadmill) followed by a fatiguing exercise (modified sit-to-stand) protocol. Knee sounds were recorded by vibroarthrography (at the medial tibia plateau and at the patella) at three time points in each session during a sit-to-stand movement. The primary outcome was the mean signal amplitude (MSA, dB). Differences between sessions were determined by repeated measures ANOVA with intra-individual pre-post differences for the warm-up and for the muscle fatigue effect. We found a significant difference for MSA at the medial tibia plateau (intervention: mean 1.51 dB, standard deviation 2.51 dB; control: mean -1.28 dB, SD 2.61 dB; F = 9.5; p = .007; η2 = .37) during extension (from sit to stand) after the warm-up. There was no significant difference for any parameter after the muscle fatiguing exercise (p > .05). The increase in MSA may mostly be explained by an increase in internal knee load and joint friction. However, neuromuscular changes may also have played a role. It appears that the muscle fatiguing exercise has no impact on knee joint sounds in young, active, symptom-free participants during sit to stand.
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Affiliation(s)
- Sarah Tenberg
- Department of Computer Science / Therapy Sciences, University of Applied Sciences Trier, Trier, Germany
| | - Kristin Kalo
- Department of Sports Medicine, Disease Prevention and Rehabilitation, Institute of Sport Science, Johannes Gutenberg University Mainz, Mainz, Germany
- Institute of Occupational, Social and Environmental Medicine, University Medical Center of the University of Mainz, Mainz, Germany
| | - Daniel Niederer
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Frankfurt, Germany
- * E-mail:
| | - Lutz Vogt
- Department of Sports Medicine and Exercise Physiology, Goethe University Frankfurt am Main, Frankfurt, Germany
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Seitz AM, Schall F, Hacker SP, van Drongelen S, Wolf S, Dürselen L. Forces at the Anterior Meniscus Attachments Strongly Increase Under Dynamic Knee Joint Loading. Am J Sports Med 2021; 49:994-1004. [PMID: 33560867 DOI: 10.1177/0363546520988039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The anatomic appearance and biomechanical and clinical importance of the anterior meniscus roots are well described. However, little is known about the loads that act on these attachment structures under physiological joint loads and movements. HYPOTHESES As compared with uniaxial loading conditions under static knee flexion angles or at very low flexion-extension speeds, more realistic continuous movement simulations in combination with physiological muscle force simulations lead to significantly higher anterior meniscus attachment forces. This increase is even more pronounced in combination with a longitudinal meniscal tear or after total medial meniscectomy. STUDY DESIGN Controlled laboratory study. METHODS A validated Oxford Rig-like knee simulator was used to perform a slow squat, a fast squat, and jump landing maneuvers on 9 cadaveric human knee joints, with and without muscle force simulation. The strains in the anterior medial and lateral meniscal periphery and the respective attachments were determined in 3 states: intact meniscus, medial longitudinal tear, and total medial meniscectomy. To determine the attachment forces, a subsequent in situ tensile test was performed. RESULTS Muscle force simulation resulted in a significant strain increase at the anterior meniscus attachments of up to 308% (P < .038) and the anterior meniscal periphery of up to 276%. This corresponded to significantly increased forces (P < .038) acting in the anteromedial attachment with a maximum force of 140 N, as determined during the jump landing simulation. Meniscus attachment strains and forces were significantly influenced (P = .008) by the longitudinal tear and meniscectomy during the drop jump simulation. CONCLUSION Medial and lateral anterior meniscus attachment strains and forces were significantly increased with physiological muscle force simulation, corroborating our hypothesis. Therefore, in vitro tests applying uniaxial loads combined with static knee flexion angles or very low flexion-extension speeds appear to underestimate meniscus attachment forces. CLINICAL RELEVANCE The data of the present study might help to optimize the anchoring of meniscal allografts and artificial meniscal substitutes to the tibial plateau. Furthermore, this is the first in vitro study to indicate reasonable minimum stability requirements regarding the reattachment of torn anterior meniscus roots.
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Affiliation(s)
- Andreas Martin Seitz
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Florian Schall
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Steffen Paul Hacker
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
| | - Stefan van Drongelen
- Motion Analysis, Orthopaedic University Hospital Heidelberg, Heidelberg, Germany.,Dr Rolf M. Schwiete Research Unit for Arthrosis, Orthopaedic University Hospital Friedrichsheim gGmbH, Frankfurt am Main, Germany
| | - Sebastian Wolf
- Motion Analysis, Orthopaedic University Hospital Heidelberg, Heidelberg, Germany
| | - Lutz Dürselen
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research Ulm, Ulm University Medical Center, Ulm, Germany
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