Muscle and joint mechanics during maximum force biting following total temporomandibular joint replacement surgery

Total temporomandibular joint replacement (TMJR) surgery is the established treatment for severe temporomandibular joint disorders. While TMJR surgery is known to increase mouth-opening capacity, reduce pain and improve quality of life, little is known about post-surgical jaw function during activities of daily living such as biting and chewing. The aim of this study was to use subject-specific 3D bite force measurements to evaluate the magnitude and direction of joint loading in unilateral total TMJR patients and compare these data to those in healthy control subjects. An optoelectronic tracking system was used to measure jaw kinematics while biting a rubber sample for 5 unilateral total TMJR patients and 8 controls. Finite element simulations driven by the measured kinematics were employed to calculate the resultant bite force generated when compressing the rubber between teeth during biting tasks. Subject-specific musculoskeletal models were subsequently used to calculate muscle and TMJ loading. Unilateral total TMJR patients generated a bite force of 249.6 ± 24.4 N and 164.2 ± 62.3 N when biting on the contralateral and ipsilateral molars, respectively. In contrast, controls generated a bite force of 317.1 ± 206.6 N. Unilateral total TMJR patients biting on the contralateral molars had a significantly higher lateral TMJ force direction (median difference: 63.6°, p = 0.028) and a significantly lower ratio of working TMJ force to bite force (median difference: 0.17, p = 0.049) than controls. Results of this study may guide TMJ prosthesis design and evaluation of dental implants.

Biomechanical behavior of the lower limbs and of the joints when landing from different heights

Landing from a jump is a challenging task as the energy accumulated during the aerial phase of the jump must be fully dissipated by the lower limbs during landing; the higher the jump height, the greater the amount of energy to be dissipated. In the present study, we aim to understand (1) how the biomechanical behavior is tuned as a function of the mechanical demand, and (2) the relationship between the self-selected landing strategy and the behavior of the joints. Fourteen subjects were asked to drop off a box of 10 to 60 cm height and land on the ground. The ground reaction forces and the kinematics were recorded using force plates and a motion capture system. A model was used to estimate the properties, i.e. stiffness and damping, of the lower limbs and of the joints. Our results show that, whatever the amount of energy to be dissipated (i.e. height of the jump), the lower limbs and the anke and knee joints behave first as a spring, then as a spring-damper system. However each joint plays a specific role: during the spring phase, the behaviour of the lower limb is associated with the stiffness of the ankle and with the landing constraints (i.e. force peak and loading rate), while during the spring-damper phase, it is associated with the stiffness of the knee and with the amount of energy to be dissipated. Our findings suggest that constraints and performance result from a distinct control of biomechanical parameters at the joints.

A biomechanical model of a vehicle passenger in the sagittal plane

Musculoskeletal biomechanical models have wide applications in ergonomics, rehabilitation, and injury estimation. Their use can be extended to enable quantitatively explaining and estimating ride comfort for a vehicle's passenger. A biomechanical model of the upper body in the sagittal plane is constructed, which allows for curved motion to simulate the propagation of disturbance energy within a seated passenger aboard a moving vehicle. The dynamic predictions of the model are validated against experimental results within the literature. Frequency responses show that within the vehicular frequency range, the L4L5 and the L5S1 discs in the lower lumbar region are susceptible to the highest vibration transmission. It was also found that vibration transmission is maximized at around 4.5 Hz. The model provides analytical and geometric intuition into the motion of the various segments of the upper body using a few simple geometric assumptions and can be employed to develop a quantitative ride-comfort metric, such that the most comfortable ride would be that which would induce the least internal motion within the passenger model.

Constrained estimation of intracranial aneurysm surface deformation using 4D-CTA

BACKGROUND AND OBJECTIVE

Intracranial aneurysms are relatively common life-threatening diseases, and assessing aneurysm rupture risk and identifying the associated risk factors is essential. Parameters such as the Oscillatory Shear Index, Pressure Loss Coefficient, and Wall Shear Stress are reliable indicators of intracranial aneurysm development and rupture risk, but aneurysm surface irregular pulsation has also received attention in aneurysm rupture risk assessment.

METHODS

The present paper proposed a new approach to estimate aneurysm surface deformation. This method transforms the estimation of aneurysm surface deformation into a constrained optimization problem, which minimizes the error between the displacement estimated by the model and the sparse data point displacements from the four-dimensional CT angiography (4D-CTA) imaging data.

RESULTS

The effect of the number of sparse data points on the results has been discussed in both simulation and experimental results, and it shows that the proposed method can accurately estimate the surface deformation of intracranial aneurysms when using sufficient sparse data points.

CONCLUSIONS

Due to a potential association between aneurysm rupture and surface irregular pulsation, the estimation of aneurysm surface deformation is needed. This paper proposed a method based on 4D-CTA imaging data, offering a novel solution for the estimation of intracranial aneurysm surface deformation.

Quantitative validation of two model-based methods for the correction of probe pressure deformation in ultrasound

PURPOSE

The acquisition of good quality ultrasound (US) images requires good acoustic coupling between the ultrasound probe and the patient's skin. In practice, this good coupling is achieved by the operator applying a force to the skin through the probe. This force induces a deformation of the tissues underlying the probe. The distorted images deteriorate the quality of the reconstructed 3D US image.

METHODS

In this work, we propose two methods to correct these deformations. These methods are based on the construction of a biomechanical model to predict the mechanical behavior of the imaged soft tissues. The originality of the methods is that they do not use external information (force or position value from sensors, or elasticity value from the literature). The model is parameterized thanks to the information contained in the image. This is allowed thanks to the optimization of two key parameters for the model which are the indentation d and the elasticity ratio α.

RESULTS

The validation is performed on real images acquired on a gelatin-based phantom using an ultrasound probe inducing an increasing vertical indentation using a step motor. The results showed a good correction of the two methods for indentations less than 4 mm. For larger indentations, one of the two methods (guided by the similarity score) provides a better quality of correction, presenting a Euclidean distance between the contours of the reference image and the corrected image of 0.71 mm.

CONCLUSION

The proposed methods ensured the correction of the deformed images induced by a linear probe pressure without using any information coming from sensors (force or position), or generic information about the mechanical parameters. The corrected images can be used to obtain a corrected 3D US image.

New biomechanical models for cumulative plantar tissue stress assessment in people with diabetes at high risk of foot ulceration

To better understand stress-related foot ulceration in diabetes, the cumulative plantar tissue stress (CPTS) should be quantified accurately, but also feasibly for clinical use. We developed multiple CPTS models with varying complexity and investigated their agreement with the most comprehensive reference model available. We assessed 52 participants with diabetes and high foot ulcer risk for barefoot and in-shoe plantar pressures during overground walking at different speeds, standing, sit-to-stand transitions, and stair walking. Level of these weight-bearing activities along with footwear adherence were objectively measured over seven days. The reference CPTS-model included the pressure-time integrals of each walking stride (barefoot and shod), specified for speed; standing period (barefoot and shod); transition and stair walking stride. We compared four CPTS-models with increasing number of input parameters (models 1-4) with the reference model, using repeated measures ANOVA, Pearson's correlation and Bland-Altman plots. For the clinically-relevant metatarsal 1 region, calculated CPTS was lower for the four CPTS-models compared to reference (Δ770, Δ466, Δ24 and Δ12 MPa.s/day, respectively). CPTS associated moderately with the reference model for model 1 (r = 0.551) and very strongly for models 2-4 (r ≥ 0.937). Limits of agreement were large for models 1 and 2 (-728;2269 and -302;1233 MPa.s/day), and small for models 3 and 4 (-43;92 and -54;78 MPa.s/day). CPTS in models 3 and 4 best agreed with the reference model, where model 3 required fewer parameters, i.e., pressure-time integrals of each walking stride and standing period while barefoot and shod. These parameters need to be included for accurate and feasible CPTS assessment.

Breast simulation pipeline: From medical imaging to patient-specific simulations

BACKGROUND

Breast-conserving surgery is the most acceptable operation for breast cancer removal from an invasive and psychological point of view. Before the surgical procedure, a preoperative MRI is performed in the prone configuration, while the surgery is achieved in the supine position. This leads to a considerable movement of the breast, including the tumor, between the two poses, complicating the surgeon's task.

METHODS

In this work, a simulation pipeline allowing the computation of patient-specific geometry and the prediction of personalized breast material properties was put forward. Through image segmentation, a finite element model including the subject-specific geometry is established. By first computing an undeformed state of the breast, the geometrico-material model is calibrated by surface acquisition in the intra-operative stance.

FINDINGS

Using an elastic corotational formulation, the patient-specific mechanical properties of the breast and skin were identified to obtain the best estimates of the supine configuration. The final results are a shape-fitting closest point residual of 4.00 mm for the mechanical parameters Ebreast=0.32 kPa and Eskin=22.72 kPa, congruent with the current state-of-the-art. The Covariance Matrix Adaptation Evolution Strategy optimizer converges on average between 5 to 30 min depending on the initial parameters, reaching a simulation speed of 20 s. To our knowledge, our model offers one of the best compromises between accuracy and speed.

INTERPRETATION

Satisfactory results were obtained for the estimation of breast deformation from preoperative to intra-operative configuration. Furthermore, we have demonstrated the clinical feasibility of such applications using a simulation framework that aims at the smallest disturbance of the actual surgical pipeline.

A biomechanical evaluation of firefighters' musculoskeletal loads when carrying self-contained breathing apparatus in walking and running

INTRODUCTION

Musculoskeletal loading data are needed to design ergonomic intervention for firefighters. This study aimed to quantify the firefighters' musculoskeletal loads during self-contained breathing apparatus (SCBA) carriage and evaluate the effectiveness of shoulder strap length variation for the prevention of SCBA-related injuries.

METHOD

Twelve firefighters (height: 174.6 ± 2.4 cm, mass: 67 ± 3.5 kg, BMI = 22 ± 1 kg/m2) participated the walking and running protocols with no SCBA equipped and three varying-strapped SCBAs conditions. Joint range of motion and surface electromyography (sEMG) were synchronously measured. Subsequently, joint kinematics was inputted for subject-specific musculoskeletal modeling to estimate muscle forces and joint reaction forces, while the sEMG was used to validate the model. Repeated measures analysis of variance was used for the main effects (p < 0.05). Independent samples t-test was performed to determine differences between walking and running.

RESULTS

Walking with SCBA increased the rectus femoris force and hip reaction force by 34.92% [F = 53.629; p < 0.001; η2 = 0.317] and 34.71% [F = 53.653; p < 0.001; η2 = 0.517], the growth rate was 54.2% [F = 76.487; p < 0.001; η2 = 0.418] and 51.19% [F = 69.201; p < 0.001; η2 = 0.652] during running, respectively. Running with SCBA significantly increased the knee reaction force by 63.04% [F = 83.960; p < 0.001; η2 = 0.797], while only 18.49% increase during walking. Adjusting SCBA shoulder strap length significantly altered the rectus abdominis force and L4/L5 reaction force during walking and running.

CONCLUSIONS

Results revealed that rectus femoris activity, hip and knee exertion was sensitive to SCBA carriage. The variation of shoulder strap length has potential to influence the risk of low back pain (LBP).

PRACTICAL APPLICATIONS

The findings suggest that fire services promote targeting physical training at firefighters' hip and knee regions. Test firefighters in this study were not advisable to adjust their shoulder strap at loose-fitting condition. The compatibility design of the trunk morphology and SCBA back-mounted frame was suggested for the management of LBP.

Predicting stress and interstitial fluid pressure in tumors based on biphasic theory

The uncontrolled proliferation of cancer cells causes the growth of the tumor mass. Consequently, the normal surrounding tissue exerts a compressive force on the tumor mass to oppose its expansion. These stresses directly promote tumor metastasis and invasion and affect drug delivery. In the past, the mechanical behavior of solid tumors has been extensively studied using linear elastic and nonlinear hyperelastic constitutive models. In this study, we develop a two-dimensional biomechanical model based on the biphasic assumption of the solid matrix and fluid phase of the tissues. Heterogeneous vasculature and nonuniform blood perfusion are also investigated by incorporating in the model a necrotic core and a well-vascularized zone. The findings of our study demonstrate a significant difference between the linear and nonlinear tissue responses to stress, while the interstitial fluid pressure (IFP) distribution is found to be independent of the constitutive model. The proposed biphasic model may be useful for elasticity imaging techniques aiming at predicting stress and IFP in tumors.

A Dynamic Elbow Testing Apparatus for Simulating Elbow Joint Motion in Varying Shoulder Positions

Purpose

To develop and evaluate the capabilities of a dynamic elbow testing apparatus that simulates unconstrained elbow motion throughout the range of humerothoracic (HTA) abduction.

Methods

Elbow flexion was generated by six computer-controlled electromechanical actuators that simulated muscle action, while six degree-of-freedom joint motion was measured using an optical tracking device. Repeatability of joint kinematics was assessed at four HTA angles (0°, 45°, 90°, 135°) and with two muscle force combinations (A1-biceps brachialis, brachioradialis and A2-biceps, brachioradialis). Repeatability was determined by comparing kinematics at every 10° of flexion over five flexion-extension cycles (0° to 100°).

Results

Multiple muscle force combinations can be used at each HTA angle to generate elbow flexion. Trials showed that the testing apparatus produced highly repeatable joint motion at each HTA angle and with varying muscle force combinations. The intraclass correlation coefficient was greater than 0.95 for all conditions.

Conclusions

Repeatable smooth cadaveric elbow motion was created that mimicked the in vivo situation.

Clinical relevance

These results suggest that the dynamic elbow testing apparatus can be used to characterize elbow biomechanics in cadaver upper extremities.

Biomechanical properties of honeybee abdominal muscles during stretch activation

The mechanical properties of the honeybee's abdominal muscles endow its abdomen with movement flexibility to perform various activities. However, the biomechanical properties of abdominal muscles during stretch activation remain unclear. To clarify this issue, we observed the microstructures of the abdominal muscles to obtain structural information. The similarity and symmetry of abdominal muscle distribution contribute to the ability to drive abdominal movement. Combined with the segmented structure characteristics, an experimental device to measure muscle stretch measurement of honeybees was developed to investigate the mechanical properties of the abdominal muscles. During measurement, the muscles were kept in a solution to maintain a physiological environment. The mechanical properties of abdominal muscles included phases: the ascending phase with proportional increase, stable phase with slight fluctuation, and decay phase with parabolic decline. These findings indicate that the nonlinear and rate-sensitive mechanical properties of the abdominal muscles enable them to rapidly adapt to environmental changes. The stretch force and stiffness coefficient reached 0.660 ± 0.139 mN and 14.364 ± 2.961 N/m, respectively. A simplified biomechanical model of the muscle fiber considering the hierarchical microstructure was introduced, in which the mechanical properties were consistent with the experimental data. Further analysis of the effects of the activation probability and the effective range of binding sites on the mechanical properties demonstrated the critical role in force generation, revealing the mechanism of underlying muscle stretch activation in the honeybee abdomen. The findings can provide a new reference for studying the biomechanical properties of the muscles of other arthropod insects.

Computational lumbar spine models: A literature review

BACKGROUND

Computational spine models of various types have been employed to understand spine function, assess the risk that different activities pose to the spine, and evaluate techniques to prevent injury. The areas in which these models are applied has expanded greatly, potentially beyond the appropriate scope of each, given their capabilities. A comprehensive understanding of the components of these models provides insight into their current capabilities and limitations.

METHODS

The objective of this review was to provide a critical assessment of the different characteristics of model elements employed across the spectrum of lumbar spine modeling and in newer combined methodologies to help better evaluate existing studies and delineate areas for future research and refinement.

FINDINGS

A total of 155 studies met selection criteria and were included in this review. Most current studies use either highly detailed Finite Element models or simpler Musculoskeletal models driven with in vivo data. Many models feature significant geometric or loading simplifications that limit their realism and validity. Frequently, studies only create a single model and thus can't account for the impact of subject variability. The lack of model representation for certain subject cohorts leaves significant gaps in spine knowledge. Combining features from both types of modeling could result in more accurate and predictive models.

INTERPRETATION

Development of integrated models combining elements from different model types in a framework that enables the evaluation of larger populations of subjects could address existing voids and enable more realistic representation of the biomechanics of the lumbar spine.

Research on Robotic Humanoid Venipuncture Method Based on Biomechanical Model

Automatic venipuncture robots are expected to replace manual venipuncture methods owing to their high control precision, steady operation, and measurable perception. However, the lack of perception of the venipuncture status in the human body leads to an increased risk and failure rate, which further restricts the development of such robots. To address this, we propose a humanoid venipuncture method guided by a biomechanical model to imitate human sensations and feedback. This method intends to perceive the venipuncture status and improve the performance of the venipuncture robot. First, this study establishes a biomechanical venipuncture model, which thoroughly considers the elastic deformation, cutting, and friction of tissues and can be applied to different venipuncture conditions. Then, venipuncture simulations and in vitro phantom experiments are performed under various settings to analyze and validate the model. Finally, to evaluate the robotic humanoid venipuncture method, we apply the method to a self-developed six-degree-of-freedom venipuncture robot via rabbit ear veins with a success rate of approximately 90%. This work demonstrates that the humanoid venipuncture method based on the biomechanical model is practical and rapid in processing simple information in venipuncture robots.

Evaluation of DIR schemes on tumor/organ with progressive shrinkage: accuracy of tumor/organ internal tissue tracking during the radiation treatment

PURPOSE

Accuracy of intratumoral treatment dose accumulation and response assessment highly depends on the accuracy of a DIR method. However, achievable accuracy of the existing DIR methods for tumor/organ with large and progressive shrinkage during the radiotherapy course have not been explored. This study aimed to use a bio-tissue phantom to quantify the achievable accuracy of different DIR schemes.

MATERIALS /METHODS

A fresh porcine liver was used for phantom material. Sixty gold markers were implanted on the surface and inside of the liver. To simulate the progressive radiation-induced tumor/organ shrinkage, the phantom was heated using a microwave oven incrementally from 30s to 200s in 8 phases. For each phase, the phantom was scanned by CT. Two extra image sets were generated from the original images: 1) the image set with overriding the high-density gold markers (feature image); 2) the image set with overriding the entire phantom to the mean soft tissue intensity (featureless image). Ten DIR schemes were evaluated to mimic clinical treatment situations of tumor/critical organ with respect to their surface and internal condition of image features, availability of intermediate feedback images and DIR methods. The internal marker's positions were utilized to evaluate DIR accuracy quantified by target registration error (TRE).

RESULTS

Volume reduction was about 20% ∼ 40% of the initial volume after 90s ∼ 200s of the heating. Without image features on the surface and inside of the phantom, the hybrid-DIR (image-based DIR followed by biomechanical model-based refinement) with the surface constraint achieved the registration TRE from 2.6 ± 1.2mm to 5.3 ± 2.6mm proportional to the %volume shrinkage. Meanwhile, the hybrid-DIR with the surface-marker constraint achieved the TRE from 2.4 ± 1.2mm to 2.6 ± 1.0mm. If both the surface and internal image features would be viable on the feedback images, the achievable accuracy could be minimal with the TRE from 1.6±0.9mm to 1.9 ± 1.2mm.

CONCLUSIONS

Standard DIR methods cannot guarantee intratumoral tissue registration accuracy for tumor/organ with large progressive shrinkage. Achievable accuracy with using the hybrid DIR method is highly dependent on the surface registration accuracy. If the surface registration mean TRE can be controlled within 2mm, the mean TRE of internal tissue can be controlled within 3mm.

Study the biomechanical performance of the membranous semicircular canal based on bionic models

A BA (bionic ampulla) was designed and fabricated using an SMPF (Symmetric electrodes Metal core PVDF Fiber) sensor, which could imitate the sensory hair cells to sense the deformation of the cupula of the BA. Based on the BA, a bionic semicircular canal with membrane semicircular canal (MBSC) and a bionic semicircular canal without membrane semicircular canal (NBSC) were designed and fabricated. The biomechanical models of the MBSC and NBSC were established. The biomechanical models were verified through the perception experiments of the MBSC and the NBSC. The results showed that the SMPF could sense the deformation of the cupula. The MBSC and NBSC could sense the angular velocity and accelerations. What's more, it was speculated that in a human body, the endolymph probably had a function of liquid mass while the membranous semicircular canal and the cupula had a function similar to a spring in the human semicircular canal.

Automatic framework for patient-specific modelling of tumour resection-induced brain shift

Our motivation is to enable non-biomechanical engineering specialists to use sophisticated biomechanical models in the clinic to predict tumour resection-induced brain shift, and subsequently know the location of the residual tumour and its boundary. To achieve this goal, we developed a framework for automatically generating and solving patient-specific biomechanical models of the brain. This framework automatically determines patient-specific brain geometry from MRI data, generates patient-specific computational grid, assigns material properties, defines boundary conditions, applies external loads to the anatomical structures, and solves differential equations of nonlinear elasticity using Meshless Total Lagrangian Explicit Dynamics (MTLED) algorithm. We demonstrated the effectiveness and appropriateness of our framework on real clinical cases of tumour resection-induced brain shift.

Displacement voxelization to resolve mesh-image mismatch: Application in deriving dense white matter fiber strains

BACKGROUND AND OBJECTIVE

It is common to combine biomechanical modeling and medical images for multimodal analyses. However, mesh-image mismatch may occur that prevents direct information exchange. To eliminate mesh-image mismatch, we develop a simple but elegant displacement voxelization technique based on image voxel corner nodes to achieve voxel-wise strain. We then apply the technique to derive dense white matter fiber strains along whole-brain tractography (∼35 k fiber tracts consisting of ∼3.3 million sampling points) resulting from head impact.

METHODS

Displacements at image voxel corner nodes are first obtained from model simulation via scattered interpolation. Each voxel is then scaled linearly to form a unit hexahedral element. This allows convenient and efficient voxel-wise strain tensor calculation and displacement interpolation at arbitrary fiber sampling points via shape functions. Fiber strains from displacement interpolation are then compared with those from the commonly used strain tensor projection using either voxel- or element-wise strain tensors.

RESULTS

Based on a synthetic displacement field, fiber strains interpolated from voxelized displacement are considerably more accurate than those from strain tensor projection relative to the prescribed ground-truth (determinant of coefficient (R²) of 1.00 and root mean squared error (RMSE) of 0.01 vs. 0.87 and 0.10, respectively). For a set of real-world reconstructed head impacts (N = 53), the strain tensor projection method performs similarly poorly (R² of 0.80-0.90 and RMSE of 0.03-0.07), with overestimation strongly correlated with strain magnitude (Pearson correlation coefficient >0.9). Up to ∼15% of the fiber strains are overestimated by more than the lower bound of a conservative injury threshold of 0.09. The percentage increases to ∼37% when halving the threshold. Voxel interpolation is also significantly more efficient (15 s vs. 40 s for element strain tensor projection, without parallelization).

CONCLUSIONS

Voxelized displacement interpolation is considerably more accurate and efficient in deriving dense white matter fiber strains than strain tensor projection. The latter generally overestimates with overestimation magnitude strongly correlating with fiber strain magnitude. Displacement voxelization is an effective technique to eliminate mesh-image mismatch and generates a convenient image representation of tissue deformation. This technique can be generalized to broadly facilitate a diverse range of image-related biomechanical problems for multimodal analyses. The convenient image format may also promote and facilitate biomechanical data sharing in the future.

Conservative treatment of iliotibial band syndrome in runners: Are we targeting the right goals?

OBJECTIVE

Iliotibial band syndrome (ITBS) is presumably caused by excessive tension in the iliotibial band (ITB) leading to compression and inflammation of tissues lying beneath it. Usually managed conservatively, there is a lack of scientific evidence supporting the treatment recommendations, and high symptom recurrence rates cast doubt on their causal effectiveness. This review discusses the influence of common physiotherapeutic measures on risk factors contributing to tissue compression beneath the ITB.

METHODS

The potential pathogenic factors are presented on the basis of a simple biomechanical model showing the forces acting on the lateral aspect of the knee. Existent literature on the most commonly prescribed physiotherapeutic interventions is critically discussed against the background of this model. Practical recommendations for the optimization of physiotherapy are derived.

RESULTS

According to biomechanical considerations, ITBS may be promoted by anatomical predisposition, joint malalignments, aberrant activation of inserting muscles as well as excessive ITB stiffness. Hip abductor strengthening may correct excessive hip adduction but also increase ITB strain. Intermittent stretching interventions are unlikely to change the ITB's length or mechanical properties. Running retraining is a promising yet understudied intervention.

CONCLUSIONS

High-quality research directly testing different physiotherapeutic treatment approaches in randomized controlled trials is needed.

The effectiveness of EMG-driven neuromusculoskeletal model calibration is task dependent

Calibration of neuromusculoskeletal models using functional tasks is performed to calculate subject-specific musculotendon parameters, as well as coefficients describing the shape of muscle excitation and activation functions. The objective of the present study was to employ a neuromusculoskeletal model of the shoulder driven entirely from muscle electromyography (EMG) to quantify the influence of different model calibration strategies on muscle and joint force predictions. Three healthy adults performed dynamic shoulder abduction and flexion, followed by calibration tasks that included reaching, head touching as well as active and passive abduction, flexion and axial rotation, and submaximal isometric abduction, flexion and axial rotation contractions. EMG data were simultaneously measured from 16 shoulder muscles using surface and intramuscular electrodes, and joint motion evaluated using video motion analysis. Muscle and joint forces were calculated using subject-specific EMG-driven neuromusculoskeletal models that were uncalibrated and calibrated using (i) all calibration tasks (ii) sagittal plane calibration tasks, and (iii) scapular plane calibration tasks. Joint forces were compared to published instrumented implant data. Calibrating models across all tasks resulted in glenohumeral joint force magnitudes that were more similar to instrumented implant data than those derived from any other model calibration strategy. Muscles that generated greater torque were more sensitive to calibration than those that contributed less. This study demonstrates that extensive model calibration over a broad range of contrasting tasks produces the most accurate and physiologically relevant musculotendon and EMG-to-activation parameters. This study will assist in development and deployment of subject-specific neuromusculoskeletal models.

Glenohumeral joint reconstruction using statistical shape modeling

Evaluation of the bony anatomy of the glenohumeral joint is frequently required for surgical planning and subject-specific computational modeling and simulation. The three-dimensional geometry of bones is traditionally obtained by segmenting medical image datasets, but this can be time-consuming and may not be practical in the clinical setting. The aims of this study were twofold. Firstly, to develop and validate a statistical shape modeling approach to rapidly reconstruct the complete scapular and humeral geometries using discrete morphometric measurements that can be quickly and easily measured directly from CT, and secondly, to assess the effectiveness of statistical shape modeling in reconstruction of the entire humerus using just the landmarks in the immediate vicinity of the glenohumeral joint. The most representative shape prediction models presented in this study achieved complete scapular and humeral geometry prediction from seven or fewer morphometric measurements and yielded a mean surface root mean square (RMS) error under 2 mm. Reconstruction of the entire humerus was achieved using information of only proximal humerus bony landmarks and yielding mean surface RMS errors under 3 mm. The proposed statistical shape modeling facilitates rapid generation of 3D anatomical models of the shoulder, which may be useful in rapid development of personalized musculoskeletal models.

Virtual preoperative planning of acetabular fractures using patient-specific biomechanical simulation: A case-control study

INTRODUCTION

The first patient-specific biomechanical model for planning the surgical reduction of acetabular fractures was developed in our institution and validated retrospectively. There are no prior studies showing its effectiveness in terms of reduction quality, operative duration and intraoperative bleeding. Therefore, we performed a case control study aiming to: 1) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the operating time and intraoperative bleeding; 2) evaluate the effect of preoperative simulation by patient-specific biomechanical simulator on the quality of reduction.

METHOD

All patients operated on between January 2019 and June 2019 after planning by biomechanical simulation were included in this case-control study. Each patient included was matched to 2 controls from our database (2015-2018) according to age and fracture-type. DICOM data were extracted from the preoperative high-resolution scanners to build a three-dimensional model of the fracture by semi-automatic segmentation. A biomechanical model was built to virtually simulate the different stages of surgical reduction. Surgery was then performed according to simulation data. Surgical duration, blood loss, radiological findings and intraoperative complications were recorded, analysed and compared.

RESULTS

Thirty patients were included, 10 in the simulation group and 20 in the control group. The two groups were comparable in terms of age, time from accident to surgery, fracture-type and surgical approach. The mean operative time was significantly reduced in the simulation group: 113min±33 (60-180) versus 196min±32 (60-260) (p=0.01). Mean blood loss was significantly reduced in the simulation group: 505mL±189 (100-750) versus 745mL±130 (200-850) (p<0.01). However, no significant difference was found in the radiological results according to Matta's criteria, although an anatomical reduction was obtained for 9 patients in the simulation group (90%) versus 12 patients in the control group (60%) (p=0.26). A postoperative neurological complication was recorded in the control group (sensory deficit of the lateral cutaneous nerve of thigh).

CONCLUSION

This study confirms the promising results of preoperative planning in acetabular trauma surgery based on patient-specific biomechanical simulation as well as its feasibility in routine clinical practice. By providing a better understanding of the fracture and its behavior, a reduction in intraoperative bleeding and in operative duration is achieved.

LEVEL OF EVIDENCE

III; case-control study.

Nonlinear postural control paradigm for larger perturbations in the presence of neural delays

Maintaining balance is an essential skill regulated by the central nervous system (CNS) that helps humans to function effectively. Developing a physiologically motivated computational model of a neural controller with good performance is a central component for a large range of potential applications, such as the development of therapeutic and assistive devices, diagnosis of balance disorders, and designing robotic control systems. In this paper, we characterize the biomechanics of postural control system by considering the musculoskeletal dynamics in the sagittal plane, proprioceptive feedback, and a neural controller. The model includes several physiological structures, such as the feedforward and feedback mechanism, sensory noise, and proprioceptive feedback delays. A high-gain observer (HGO)-based feedback linearization controller represents the CNS analog in the modeling paradigm. The HGO gives an estimation of delayed states and the feedback linearization control law generates the feedback torques at joints to execute postural recovery movements. The whole scheme is simulated in MATLAB/Simulink. The simulation results show that our proposed scheme is robust against larger perturbations, sensory noises, feedback delays and retains a strong disturbance rejection and trajectory tracking capability. Overall, these results demonstrate that the nonlinear system dynamics, the feedforward and feedback mechanism, and physiological latencies play a key role in shaping the motor control process.

Real-time conversion of inertial measurement unit data to ankle joint angles using deep neural networks

Joint angle quantification from inertial measurement units (IMUs) is commonly performed using kinematic modelling, which depends on anatomical sensor placement and/or functional joint calibration; however, accurate three-dimensional joint motion measurement remains challenging to achieve. The aims of this study were firstly to employ deep neural networks to convert IMU data to ankle joint angles that are indistinguishable from those derived from motion capture-based inverse kinematics (IK) - the reference standard; and secondly, to validate the robustness of this approach across contrasting walking speeds in healthy individuals. Kinematics data were simultaneously calculated using IMUs and IK from 9 subjects during walking on a treadmill at 0.5 m/s, 1.0 m/s and 1.5 m/s. A generative adversarial network was trained using gait data at two of the walking speeds to predict ankle kinematics from IMU data alone for the third walking speed. There were significant differences between IK and IMU joint angle predictions for ankle eversion and internal rotation during walking at 0.5 m/s and 1.0 m/s (p < 0.001); however, no significant differences in joint angles were observed between the generative adversarial network prediction and IK at any speed or plane of joint motion (p < 0.05). The RMS difference in ankle joint kinematics between the generative adversarial network and IK for walking at 1.0 m/s was 3.8°, 2.1° and 3.5° for dorsiflexion, inversion and axial rotation, respectively. The modeling approach presented for real-time IMU to ankle joint angle conversion, which can be readily expanded to other joints, may provide enhanced IMU capability in applications such as telemedicine, remote monitoring and rehabilitation.

How influential is the stiffness of the foam dressing on soft tissue loads in negative pressure wound therapy?

Negative pressure wound therapy (NPWT) is an established adjunctive modality for treatment of both acute and chronic wounds. However, little is known about the optimal settings and combination of treatment parameters and importantly, how these translate to target tissue strains and stresses that would result the fastest healing and buildup of good-quality tissues. Here we have used a three-dimensional open wound computational (finite element) model that contains viscoelastic skin, adipose and skeletal muscle tissue components for determining the states of tissue strains and stresses in and around the wound when subjected to NPWT with foam dressings of varying stiffnesses. We found that the skin strain state is considerably more sensitive to the pressure level than to the stiffness of the foam dressing within a 8.25 to 99 kPa range which covers the current industry standard. Accordingly, peri-wound skin strains and stresses which stimulate cell proliferation/migration and angiogenesis and thereby, healing of the wound, can be more effectively controlled by adjusting the pressure level than by varying the stiffness of the foam dressing.

Investigation of 3D dynamic and quasistatic models for spinal moments during combined manual material handling tasks

Digital human modeling software uses biomechanical models to compute workers' risk of injury during industrial work processes. In many cases, the biomechanics are calculated using quasistatic models, which neglect the body's dynamics and therefore might be erroneous. This study investigated the differential effect of using a dynamic vs. a quasistatic model on spinal loading during combined manual material handling tasks that are prevalent in industry. An experiment was conducted involving nine male and nine female participants performing a total of 3402 cycles of a box-conveying task (removing, carrying and depositing) for different box masses and shelf heights. Using motion capture data, the peak and cumulative moments acting on the L5/S1 joint were calculated using 3D dynamic and quasistatic models. This revealed that neglecting the dynamic movements (i.e., using a quasistatic model) results in an on average underestimation of 19.7% in the peak spinal moment and 3.6% in the cumulative moment that in some cases exceeds the maximal limit for the compression forces acting on the lower back.

Interaction analysis of a pregnant female uterus and fetus in a vehicle passing a speed bump

Pregnant vehicle occupants experience relatively large acceleration when the vehicle passes a speed-bump. In this paper, the effect of such sudden acceleration on a pregnant uterus is investigated. A biomechanical model representing the fundamental dynamic behaviors of a pregnant uterus has been developed. The model relates to the 32nd week of gestation when the fetus is in head-down, occipito-anterior position. Considering the drag and squeeze effects of the amniotic fluid, we derive a comprehensive differential equation that represents the interaction of the uterus and fetus. Solving the governing equation, we obtain the system response to different speed-bump excitations. Using the fetal head injury criterion (HIC = 390), we evaluate the model response. Three risk zones (Low, Medium, and High) are introduced, and the effects of excitation characteristics on HIC are investigated. HIC enhances, sub-exponentially, as the excitation amplitude (width) increases (decreases). Three risk-bounds, corresponding to 25%, 75%, and 100% risk of injury, are developed in the "width-amplitude" and the "frequency-amplitude" planes. Considering a typical speed-bump of width and excitation amplitude of 0.5 m and 0.12 m, respectively, the driver should not hit the speed-bump at 42 km/h or more. We advise hitting such speed-bumps under 25 km/h, based on this paper's findings. According to the risk-bounds, the injury risk of an arbitrary speed-bump excitation, at any desired vehicle speed, can be determined. The findings can help to understand how a pregnant uterus and fetus are subjected to risk caused by a vehicle passing a speed-bump and to expand our knowledge to improve safety during pregnancy.

Low-Profile Electromagnetic Field Sensors in the Measurement and Modelling of Three-Dimensional Jaw Kinematics and Occlusal Loading

Dynamic occlusal loading during mastication is clinically relevant in the design and functional assessment of dental restorations and removable dentures, and in evaluating temporomandibular joint dysfunction. The aim of this study was to develop a modelling framework to evaluate subject-specific dynamic occlusal loading during chewing and biting over the entire dental arch. Measurements of jaw motion were performed on one healthy male adult using low-profile electromagnetic field sensors attached to the teeth, and occlusal anatomy quantified using an intra-oral scanner. During testing, the subject chewed and maximally compressed a piece of rubber between both second molars, first molars, premolars and their central incisors. The occlusal anatomy, rubber geometry and experimentally measured rubber material properties were combined in a finite element model. The measured mandibular motion was used to kinematically drive model simulations of chewing and biting of the rubber sample. Three-dimensional dynamic bite forces and contact pressures across the occlusal surfaces were then calculated. Both chewing and biting on the first molars produced the highest bite forces across the dental arch, and a large amount of anterior shear force was produced at the incisors and the second molars. During chewing, the initial tooth-rubber contact evolved from the buccal sides of the molars to the lingual sides at full mouth closure. Low-profile electromagnetic field sensors were shown to provide a clinically relevant measure of jaw kinematics with sufficient accuracy to drive finite element models of occlusal loading during chewing and biting. The modelling framework presented provides a basis for calculation of physiological, dynamic occlusal loading across the dental arch.

The moment arms and leverage of the human finger muscles

The moment arm of a muscle's force represents the muscle's leverage or mechanical advantage in producing a joint moment. It is indicative of the muscle's potential to contribute to actuation of a joint in a particular joint motion direction and defines the role of the muscle, for example, as a joint flexor or abductor. The aims of this study were, firstly, to measure the moment arms of the flexor and extensor muscles of the metacarpophalangeal (MCP), proximal interphalangeal (PIP) and distal interphalangeal (DIP) joints, and the moment arms of the major abductor and adductor muscles of the metacarpophalangeal (MCP) joint of each finger in the hand; secondly, to assess the effect of change in joint angle on these moment arms; and thirdly, to determine if there are differences in a given flexor or extensor's muscle moment arms between the joints it spans on a given finger, and across its tendon slips to multiple fingers. The tendon-excursion method was used to measure instantaneous muscle moment arms in nine fresh-frozen entire forearm cadaver specimens. Joint flexion angle was found to have significant effects on the moment arms of the extensor muscles at the MCP and PIP joints (p < 0.05). In contrast, the digital flexor muscles maintained relatively constant moment arms through the range of joint flexion. The moment arms of the digital flexors and extensors spanning multiple joints in a finger were largest at the MCP joints and smallest at the DIP joints. The findings demonstrate greater torque generating capacity for tasks such as grasping at the proximal interphalangeal joints, and smaller torque capacity for finer movement control at the distal interphalangeal joints. The dataset generated in this study may be useful in the development and validation of computational models used in surgical planning, and rehabilitation.

Importance of the epiphyseal ring in OLIF stand-alone surgery: a biomechanical study on cadaveric spines

PURPOSES

To explore the function of endplate epiphyseal ring in OLIF stand-alone surgery using a biomechanical model to reduce the complications of endplate collapse and cage subsidence.

METHODS

In total, 24 human cadaveric lumbar function units (L1-2 and L3-4 segments) were randomly assigned to two groups. The first group was implanted with long fusion cages which engaged with both inner and outer regions of epiphyseal ring (Complete Span-Epiphyseal Ring, CSER). Those engaged with only the inner half of epiphyseal ring were the second group (Half Span-Epiphyseal Ring, HSER). Each group was divided into two subgroups [higher cage-height (HH) and normal cage-height (NH)]. Specimens were fixed in testing cups and compressed at approximately 2.5 mm/s, until the first sign of structural failure. Trabecular structural damage was analyzed by Micro-CT, as well as the difference of bone volume fraction (BV/TV), trabecular thickness (Tb.Th) et al. in different regions.

RESULTS

Endplate collapse was mainly evident in the inner region of epiphyseal ring, where trabecular injury of sub-endplate bone was most concentrated. Endplate collapse incidence was significantly higher in HSER than CSER specimens (P = 0.017). A structural failure occurred at a lower force in HSER (1.41 ± 0.34 KN) compared with CSER (2.44 ± 0.59 KN). HH subgroups failed at a lower average force than NH subgroups. Micro-CT results showed a more extensive trabecular fracture in HSER specimens compared to CSER specimens, especially in HH subgroup.

CONCLUSIONS

Endplate collapse is more likely to occur with short half span cages than complete span cages, and taller cages compared with normal height cages. During OLIF surgery, we should choose cages matching intervertebral disc space height and place the cages spanning over the whole epiphyseal ring to improve support strength.

Biomechanics of infarcted left ventricle: a review of modelling

Mathematical modelling in biomechanics of infarcted left ventricle (LV) serves as an indispensable tool for remodelling mechanism exploration, LV biomechanical property estimation and therapy assessment after myocardial infarction (MI). However, a review of mathematical modelling after MI has not been seen in the literature so far. In the paper, a systematic review of mathematical models in biomechanics of infarcted LV was established. The models include comprehensive cardiovascular system model, essential LV pressure-volume and stress-stretch models, constitutive laws for passive myocardium and scars, tension models for active myocardium, collagen fibre orientation optimization models, fibroblast and collagen fibre growth/degradation models and integrated growth-electro-mechanical model after MI. The primary idea, unique characteristics and key equations of each model were identified and extracted. Discussions on the models were provided and followed research issues on them were addressed. Considerable improvements in the cardiovascular system model, LV aneurysm model, coupled agent-based models and integrated electro-mechanical-growth LV model are encouraged. Substantial attention should be paid to new constitutive laws with respect to stress-stretch curve and strain energy function for infarcted passive myocardium, collagen fibre orientation optimization in scar, cardiac rupture and tissue damage and viscoelastic effect post-MI in the future.

Modeling of the neural mechanism underlying the terrestrial turning of the salamander

In order to explore the neural mechanism underlying salamander terrestrial turning, an improved biomechanical model is proposed by modifying the forelimb structure of the existing biomechanical model. Based on the proposed improved biomechanical model, a new spinal locomotor network model is constructed which contains the interneuron networks and motoneuron pool. Control methods are also developed for the new model which increase its transient response speed, control the initial swing order of the forelimbs, and generate different walking turning gait and turning on the spot (turning without moving forward). The simulation results show that the biomechanical model controlled by the new spinal locomotor network model can generate different walking turning and turning on the spot, and can control posture and the initial swing order of the forelimbs. Moreover, the transient response speed of the proposed model is very rapid. This paper thus provides a useful tool for exploring the operational mechanism of the spinal circuitry of the salamander. In addition, the research results presented here may inspire the construction of artificial spinal control networks for bionic robots.

Load response of an osseointegrated implant used in the treatment of unilateral transfemoral amputation: An early implant loosening case study

BACKGROUND

Osseointegrated implants for transfemoral amputees facilitate direct load transfer between the prosthetic limb and femur; however, implant loosening is a common complication, and the associated implant-bone loads remain poorly understood. This case study aimed to use patient-specific computational modeling to evaluate bone-implant interface loading during standing and walking in a transfemoral amputee with an osseointegrated implant prior to prosthesis loosening and revision surgery.

METHODS

One male transfemoral amputee with an osseointegrated implant was recruited (age: 59-yrs, weight: 83 kg) and computed tomography (CT) performed on the residual limb approximately 3 months prior to implant failure. Gait analyses were performed, and the CT images used to develop a finite element model of the patient's implant and surrounding bone. Simulations of static weight bearing, and over-ground walking were then performed.

FINDINGS

During standing, maximum and minimum principal strains in trabecular bone adjacent to the implant were 0.26% and -0.30%, respectively. Strains generated at the instant of contralateral toe-off and contralateral heel strike during walking were substantially higher and resulted in local trabecular bone yielding. Specifically, the maximum and minimum principal strains in the thin layer of trabecular bone surrounding the distal end of the implant were 1.15% and -0.98%, respectively.

INTERPRETATION

Localised yielding of trabecular bone at the interface between the femur and implant in transfemoral amputee osseointegrated prosthesis recipients may present a risk of implant loosening due to periprosthetic bone fracture during walking. Rehabilitation exercises should aim to produce implant-bone loading that stimulates bone remodelling to provide effective bone conditioning prior to ambulation.

Load response of the natural tooth and dental implant: A comparative biomechanics study

PURPOSE

While dental implants have displayed high success rates, poor mechanical fixation is a common complication, and their biomechanical response to occlusal loading remains poorly understood. This study aimed to develop and validate a computational model of a natural first premolar and a dental implant with matching crown morphology, and quantify their mechanical response to loading at the occlusal surface.

MATERIALS AND METHODS

A finite-element model of the stomatognathic system comprising the mandible, first premolar and periodontal ligament (PDL) was developed based on a natural human tooth, and a model of a dental implant of identical occlusal geometry was also created. Occlusal loading was simulated using point forces applied at seven landmarks on each crown. Model predictions were validated using strain gauge measurements acquired during loading of matched physical models of the tooth and implant assemblies.

RESULTS

For the natural tooth, the maximum vonMises stress (6.4 MPa) and maximal principal strains at the mandible (1.8 mε, −1.7 mε) were lower than those observed at the prosthetic tooth (12.5 MPa, 3.2 mε, and −4.4 mε, respectively). As occlusal load was applied more bucally relative to the tooth central axis, stress and strain magnitudes increased.

CONCLUSION

Occlusal loading of the natural tooth results in lower stress-strain magnitudes in the underlying alveolar bone than those associated with a dental implant of matched occlusal anatomy. The PDL may function to mitigate axial and bending stress intensities resulting from off-centered occlusal loads. The findings may be useful in dental implant design, restoration material selection, and surgical planning.

Position-based modeling of lesion displacement in ultrasound-guided breast biopsy

PURPOSE

Although ultrasound (US) images represent the most popular modality for guiding breast biopsy, malignant regions are often missed by sonography, thus preventing accurate lesion localization which is essential for a successful procedure. Biomechanical models can support the localization of suspicious areas identified on a preoperative image during US scanning since they are able to account for anatomical deformations resulting from US probe pressure. We propose a deformation model which relies on position-based dynamics (PBD) approach to predict the displacement of internal targets induced by probe interaction during US acquisition.

METHODS

The PBD implementation available in NVIDIA FleX is exploited to create an anatomical model capable of deforming online. Simulation parameters are initialized on a calibration phantom under different levels of probe-induced deformations; then, they are fine-tuned by minimizing the localization error of a US-visible landmark of a realistic breast phantom. The updated model is used to estimate the displacement of other internal lesions due to probe-tissue interaction.

RESULTS

The localization error obtained when applying the PBD model remains below 11 mm for all the tumors even for input displacements in the order of 30 mm. This proposed method obtains results aligned with FE models with faster computational performance, suitable for real-time applications. In addition, it outperforms rigid model used to track lesion position in US-guided breast biopsies, at least halving the localization error for all the displacement ranges considered.

CONCLUSION

Position-based dynamics approach has proved to be successful in modeling breast tissue deformations during US acquisition. Its stability, accuracy and real-time performance make such model suitable for tracking lesions displacement during US-guided breast biopsy.

A biomechanical test model for evaluating osseous and osteochondral tissue adhesives

Background

Currently there are no standard models with which to evaluate the biomechanical performance of calcified tissue adhesives, in vivo. We present, herein, a pre-clinical murine distal femoral bone model for evaluating tissue adhesives intended for use in both osseous and osteochondral tissue reconstruction.

Results

Cylindrical cores (diameter (Ø) 2 mm (mm) × 2 mm depth), containing both cancellous and cortical bone, were fractured out from the distal femur and then reattached using one of two tissue adhesives. The adhesiveness of fibrin glue (Tisseel^tm), and a novel, biocompatible, calcium phosphate-based tissue adhesive (OsStic^tm) were evaluated by pullout testing, in which glued cores were extracted and the peak force at failure recorded. The results show that Tisseel weakly bonded the metaphyseal bone cores, while OsStic produced > 30-fold higher mean peak forces at failure (7.64 Newtons (N) vs. 0.21 N). The failure modes were consistently disparate, with Tisseel failing gradually, while OsStic failed abruptly, as would be expected with a calcium-based material. Imaging of the bone/adhesive interface with microcomputed tomography revealed that, for OsStic, failure occurred more often within cancellous bone (75% of tested samples) rather than at the adhesive interface.

Conclusions

Despite the challenges associated with biomechanical testing in small rodent models the preclinical ex-vivo test model presented herein is both sensitive and accurate. It enabled differences in tissue adhesive strength to be quantified even for very small osseous fragments (<Ø4mm). Importantly, this model can easily be scaled to larger animals and adapted to fracture fragment fixation in human bone. The present model is also compatible with other long-term in vivo evaluation methods (i.e. in vivo imaging, histological analysis, etc.).

Learning soft tissue behavior of organs for surgical navigation with convolutional neural networks

PURPOSE

In surgical navigation, pre-operative organ models are presented to surgeons during the intervention to help them in efficiently finding their target. In the case of soft tissue, these models need to be deformed and adapted to the current situation by using intra-operative sensor data. A promising method to realize this are real-time capable biomechanical models.

METHODS

We train a fully convolutional neural network to estimate a displacement field of all points inside an organ when given only the displacement of a part of the organ's surface. The network trains on entirely synthetic data of random organ-like meshes, which allows us to use much more data than is otherwise available. The input and output data are discretized into a regular grid, allowing us to fully utilize the capabilities of convolutional operators and to train and infer in a highly parallelized manner.

RESULTS

The system is evaluated on in-silico liver models, phantom liver data and human in-vivo breathing data. We test the performance with varying material parameters, organ shapes and amount of visible surface. Even though the network is only trained on synthetic data, it adapts well to the various cases and gives a good estimation of the internal organ displacement. The inference runs at over 50 frames per second.

CONCLUSION

We present a novel method for training a data-driven, real-time capable deformation model. The accuracy is comparable to other registration methods, it adapts very well to previously unseen organs and does not need to be re-trained for every patient. The high inferring speed makes this method useful for many applications such as surgical navigation and real-time simulation.

Hip abductor muscle volumes are smaller in individuals affected by patellofemoral joint osteoarthritis

OBJECTIVE

The aims of this study were twofold: firstly, to compare hip abductor muscle volumes in individuals with patellofemoral joint (PFJ) osteoarthritis (PFJ OA) against those of healthy controls; and secondly, to determine whether hip muscle volumes and hip kinematics during walking are related in individuals with PFJ OA and healthy controls.

METHODS

Fifty-one individuals with PFJ OA and thirteen asymptomatic, age-matched healthy controls ≥40 years were recruited. Volumes of the gluteus medius, gluteus minimus and tensor fasciae latae were obtained from magnetic resonance (MR) images. Video motion capture was used to measure three-dimensional hip joint kinematics during overground walking.

RESULTS

Significantly smaller gluteus medius (P = 0.017), gluteus minimus (P = 0.001) and tensor fasciae latae (P = 0.027) muscle volumes were observed in PFJ OA participants compared to controls. Weak correlations were observed between smaller gluteus minimus volume and larger hip flexion angle at contralateral heel strike (CHS) (r = -0.279, P = 0.038) as well as between smaller gluteus minimus volume and increased hip adduction angle at CHS (r = -0.286, P = 0.046).

CONCLUSION

Reduced hip abductor muscle volume is a feature of PFJ OA and is associated with increased hip flexion and adduction angles during the late stance phase of walking for PFJ OA participants and healthy controls.

The evaluation of a hybrid biomechanical deformable registration method on a multistage physical phantom with reproducible deformation

BACKGROUND

Advanced clinical applications, such as dose accumulation and adaptive radiation therapy, require deformable image registration (DIR) algorithms capable of voxel-wise accurate mapping of treatment dose or functional imaging. By utilizing a multistage deformable phantom, the authors investigated scenarios where biomechanical refinement method (BM-DIR) may be better than the pure image intensity based deformable registration (IM-DIR).

METHODS

The authors developed a biomechanical-model based DIR refinement method (BM-DIR) to refine the deformable vector field (DVF) from any initial intensity-based DIR (IM-DIR). The BM-DIR method was quantitatively evaluated on a novel phantom capable of ten reproducible gradually-increasing deformation stages using the urethra tube as a surrogate. The internal DIR accuracy was inspected in term of the Dice similarity coefficient (DSC), Hausdorff and mean surface distance as defined in of the urethra structure inside the phantom and compared with that of the initial IM-DIR under various stages of deformation. Voxel-wise deformation vector discrepancy and Jacobian regularity were also inspected to evaluate the output DVFs. In addition to phantom, two pairs of Head&Neck patient MR images with expert-defined landmarks inside parotids were utilized to evaluate the BM-DIR accuracy with target registration error (TRE).

RESULTS

The DSC and surface distance measures of the inner urethra tube indicated the BM-DIR method can improve the internal DVF accuracy on masked MR images for the phases of a large degree of deformation. The smoother Jacobian distribution from the BM-DIR suggests more physically-plausible internal deformation. For H&N cancer patients, the BM-DIR improved the TRE from 0.339 cm to 0.210 cm for the landmarks inside parotid on the masked MR images.

CONCLUSIONS

We have quantitatively demonstrated on a multi-stage physical phantom and limited patient data that the proposed BM-DIR can improve the accuracy inside solid organs with large deformation where distinctive image features are absent.

A new model of the spinal locomotor networks of a salamander and its properties

A salamander is an ideal animal for studying the spinal locomotor network mechanism of vertebrates from an evolutionary perspective since it represents the transition from an aquatic to a terrestrial animal. However, little is known about the spinal locomotor network of a salamander. A spinal locomotor network model is a useful tool for exploring the working mechanism of the spinal networks of salamanders. A new spinal locomotor network model for a salamander is built for a three-dimensional (3D) biomechanical model of the salamander using a novel locomotion-controlled neural network model. Based on recent experimental data on the spinal circuitry and observational results of gaits of vertebrates, we assume that different interneuron sets recruited for mediating the frequency of spinal circuits are also related to the generation of different gaits. The spinal locomotor networks of salamanders are divided into low-frequency networks for walking and high-frequency networks for swimming. Additionally, a new topological structure between the body networks and limb networks is built, which only uses the body networks to coordinate the motion of limbs. There are no direct synaptic connections among limb networks. These techniques differ from existing salamander spinal locomotor network models. A simulation is performed and analyzed to validate the properties of the new spinal locomotor networks of salamanders. The simulation results show that the new spinal locomotor networks can generate a forward walking gait, a backward walking gait, a swimming gait, and a turning gait during swimming and walking. These gaits can be switched smoothly by changing external inputs from the brainstem. These properties are consistent with those of a real salamander. However, it is still difficult for the new spinal locomotor networks to generate highly efficient turning during walking, 3D swimming, nonrhythmic movements, and so on. New experimental data are required for further validation.

Effectiveness of a vacuum lifting system in reducing spinal load during airline baggage handling

Information on spinal loading for using lift assist systems for airport baggage handling is lacking. We conducted a laboratory study to evaluate a vacuum lift system for reducing lumbar spinal loads during baggage loading/unloading tasks. Ten subjects performed the tasks using the industry average baggage weight of 14.5 kg on a typical two-shelved baggage cart with or without using the lift system (i.e. lifting technique). Repeated measures analysis of variance (2 tasks × 2 shelf heights x 2 techniques) was used. Spinal loads were estimated by an electromyography-driven biomechanical model. On average, the vacuum lift system reduced spinal compressive forces on the lumbar spine by 39% and below the 3400 N damage threshold. The system also resulted in a 25% reduction in the anterior-posterior shear force at the L5/S1 inferior endplate level. This study provides evidence for the potential to reduce spinal loads when using a vacuum lift system.

A novel stability-based EMG-assisted optimization method for the spine

Traditional electromyography-assisted optimization (TEMG) models are commonly employed to compute trunk muscle forces and spinal loads for the design of clinical/treatment and ergonomics/prevention programs. These models calculate muscle forces solely based on moment equilibrium requirements at spinal joints. Due to simplifications/assumptions in the measurement/processing of surface EMG activities and in the presumed muscle EMG-force relationship, these models fail to satisfy stability requirements. Hence, the present study aimed to develop a novel stability-based EMG-assisted optimization (SEMG) method applied to a musculoskeletal spine model in which trunk muscle forces were estimated by enforcing equilibrium conditions constrained to stability requirements. That is, second-order partial derivatives of the potential energy of the musculoskeletal model with respect to its generalized coordinates were enforced to be positive semi-definite. Fifteen static tasks in upright and flexed postures with and without a hand load at different heights were simulated. The SEMG model predicted different muscle recruitments/forces (generally larger global and local muscle forces) and spinal loads (slightly larger) compared to the TEMG model. Such task-specific differences were dependant on the assumed magnitude of the muscle stiffness coefficient in the SEMG model. The SEMG model-predicted and measured L4-L5 intradiscal pressures were in satisfactory agreement during simulated activities.

Computer-assisted surgery in acetabular fractures: Virtual reduction of acetabular fracture using the first patient-specific biomechanical model simulator

Preoperative planning for the management of acetabular fracture is founded on geometric models allowing virtual repositioning of the bone fragments, but not taking account of soft tissue and the realities of the surgical procedure. The present technical note reports results using the first simulator to be based on a patient-specific biomechanical model, simulating the action of forces on the fragments and also the interactions between soft issue and bone: muscles, capsules, ligaments, and bone contacts. In all 14 cases, biomechanical simulation faithfully reproduced the intraoperative behavior of the various bone fragments and reduction quality. On Matta's criteria, anatomic reduction was achieved in 12 of the 14 patients (86%; 0.25mm±0.45 [range: 0-1]) and in the 12 corresponding simulations (86%; 0.42mm±0.51 [range: 0-1]). Mean semi-automatic segmentation time was 156min±37.9 [range: 120-180]. Mean simulation time was 23min±9 [range: 16-38]. The model needs larger-scale prospective validation, but offers a new tool suitable for teaching purposes and for assessment of surgical results in acetabular fracture.

LEVEL OF EVIDENCE

IV: retrospective study.

Development of an in vitro model to study the biological effects of blinking

PURPOSE

To develop a mechanical model in which a contact lens is swept over ocular surface cells under conditions that mimic the force and speed of the blink, and to investigate the resulting biological changes.

METHODS

A computer controlled mechanical instrument was developed to hold a dish containing 3D cultured stratified human ocular surface epithelial cells, across which an arm bearing a contact lens was swept back and forth repeatedly at a speed and force mimicking the human blink. Cells were subjected to repeated sweep cycles for up to 1 h at a speed of 120 mm/s with or without an applied force of 19.6 mN (to mimic pressure exerted by upper eyelid), after which the cell layer thickness was measured, the cell layer integrity was investigated using fluorescent quantum dots (6 and 13 nm) and the phosphorylation levels of various protein kinases were analyzed by human phospho-kinase arrays. Data for selected kinases were further quantitated by enzyme immunoassays.

RESULTS

The thickness of the cell layers did not change after exposure to sweep cycles with or without applied force. Quantum dots (6 and 13 nm) were able to penetrate the layers of cells exposed to sweep cycles but not layers of untreated control cells. The phosphorylation levels of HSP27 and JNK1/2/3 increased for cells exposed to sweep cycles with applied force compared to untreated control cells.

CONCLUSIONS

The in vitro mechanical instrument is a useful tool to investigate the effects of blinking on the ocular surface.

Biomechanical model based evaluation of Total Hip Arthroplasty therapy outcome

OBJECTIVE

Total-hip-arthroplasties are performed to treat patients with osteoarthritis. Surgical planning is usually based on specific radiographs. These information could also be used as data for biomechanical modelling.

METHODS

Models are rarely used during clinical practice. Our aim was to analyze model-based the pre- and postoperatively hip-biomechanic. Pre- and postoperative X-rays of 30 patients were examined by using 4 biomechanical-models.

RESULTS

The received results showed variations e.g. an increase and decrease of hip-load pre- and postoperative.

CONCLUSION

With the data of these models it would be possible to integrate the amplitude and orientation of the hip-joint-resultant-force into the therapeutical approach.

Qualitative analysis of the Dix-Hallpike maneuver in multi-canal BPPV using a biomechanical model: Introduction of an expanded Dix-Hallpike maneuver for enhanced diagnosis of multi-canal BPPV

INTRODUCTION/OBJECTIVE

Multiple canal BPPV can be a diagnostic challenge to the clinician. This is due in part to the complex anatomy of the labyrinth but also to complex and often simultaneous ocular responses that result from stimulation of multiple canals during traditional diagnostic testing. Our objective was to analyze the Dix-Hallpike maneuver used in the diagnosis of BPPV to look for patterns of simultaneous canal response and to develop a diagnostic maneuver that will allow separation of canal responses in multiple canal BPPV.

METHODS

A previously created and published 3D biomechanical model of the human labyrinths for the study of BPPV was used to analyze and compare the position and movement of otoliths in the Dix-Hallpike maneuver as well as in a proposed expanded version of the traditional Dix-Hallpike maneuver.

RESULTS

The traditional Dix-Hallpike maneuver with the head hanging may promote movement of otoliths in 5 of the six semicircular canals. The Dix-Hallpike maneuver with the head lowered only to the horizontal position allows for otoconia in only the lowermost posterior canal to fall to the most gravity dependent position. This position allows for minimal or no movement of otoconia in the contralateral posterior canal, or in either superior canal. Turning the head ninety degrees to the opposite side while still in the horizontal position will provoke otolith movement in only the contralateral posterior canal. The superior canals can then be examined for free otolith debris by extending the neck to a head-hanging position. These positions may be assumed directly from one to the next in the lying position. There seems to be no advantage to sitting up between positions.

CONCLUSION

The Dix-Hallpike maneuver may cause simultaneous movement of otoliths present in multiple canals and create an obstacle to accurate diagnosis in multi-canal BPPV. An expanded Dix-Hallpike maneuver is described which adds intermediate steps with the head positioned to the right and left in the horizontal position before head-hanging. This expanded maneuver has helped to isolate affected semi-circular canals for individual assessment in multiple canal BPPV.

Three-dimensional motion analysis for validation of shoulder internal rotation

BACKGROUND

10% of the points for the Constant-Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks.

METHODS

Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis.

RESULTS

Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3-6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2.

CONCLUSION

Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.

In-vivo quantification of dynamic hip joint center errors and soft tissue artifact

Hip joint center (HJC) measurement error can adversely affect predictions from biomechanical models. Soft tissue artifact (STA) may exacerbate HJC errors during dynamic motions. We quantified HJC error and the effect of STA in 11 young, asymptomatic adults during six activities. Subjects were imaged simultaneously with reflective skin markers (SM) and dual fluoroscopy (DF), an x-ray based technique with submillimeter accuracy that does not suffer from STA. Five HJCs were defined from locations of SM using three predictive (i.e., based on regression) and two functional methods; these calculations were repeated using the DF solutions. Hip joint center motion was analyzed during six degrees-of-freedom (default) and three degrees-of-freedom hip joint kinematics. The position of the DF-measured femoral head center (FHC), served as the reference to calculate HJC error. The effect of STA was quantified with mean absolute deviation. HJC errors were (mean±SD) 16.6±8.4mm and 11.7±11.0mm using SM and DF solutions, respectively. HJC errors from SM measurements were all significantly different from the FHC in at least one anatomical direction during multiple activities. The mean absolute deviation of SM-based HJCs was 2.8±0.7mm, which was greater than that for the FHC (0.6±0.1mm), suggesting that STA caused approximately 2.2mm of spurious HJC motion. Constraining the hip joint to three degrees-of-freedom led to approximately 3.1mm of spurious HJC motion. Our results indicate that STA-induced motion of the HJC contributes to the overall error, but inaccuracies inherent with predictive and functional methods appear to be a larger source of error.

Subject-specific musculoskeletal modeling in the evaluation of shoulder muscle and joint function

Upper limb muscle force estimation using Hill-type muscle models depends on musculotendon parameter values, which cannot be readily measured non-invasively. Generic and scaled-generic parameters may be quickly and easily employed, but these approaches do not account for an individual subject's joint torque capacity. The objective of the present study was to develop a subject-specific experimental testing and modeling framework to evaluate shoulder muscle and joint function during activities of daily living, and to assess the capacity of generic and scaled-generic musculotendon parameters to predict muscle and joint function. Three-dimensional musculoskeletal models of the shoulders of 6 healthy subjects were developed to calculate muscle and glenohumeral joint loading during abduction, flexion, horizontal flexion, nose touching and reaching using subject-specific, scaled-generic and generic musculotendon parameters. Muscle and glenohumeral joint forces calculated using generic and scaled-generic models were significantly different to those of subject-specific models (p<0.05), and task dependent; however, scaled-generic model calculations of shoulder glenohumeral joint force demonstrated better agreement with those of subject-specific models during abduction and flexion. Muscles in generic musculoskeletal models operated further from the plateau of their force-length curves than those of scaled-generic and subject-specific models, while muscles in subject-specific models operated over a wider region of their force length curves than those of the generic or scaled-generic models, reflecting diversity of subject shoulder strength. The findings of this study suggest that generic and scaled-generic musculotendon parameters may not provide sufficient accuracy in prediction of shoulder muscle and joint loading when compared to models that employ subject-specific parameter-estimation approaches.

Study of sex differences in the association between hip fracture risk and body parameters by DXA-based biomechanical modeling

There is controversy about whether or not body parameters affect hip fracture in men and women in the same way. In addition, although bone mineral density (BMD) is currently the most important single discriminator of hip fracture, it is unclear if BMD alone is equally effective for men and women. The objective of this study was to quantify and compare the associations of hip fracture risk with BMD and body parameters in men and women using our recently developed two-level biomechanical model that combines a whole-body dynamics model with a proximal-femur finite element model. Sideways fall induced impact force of 130 Chinese clinical cases, including 50 males and 80 females, were determined by subject-specific dynamics modeling. Then, a DXA-based finite element model was used to simulate the femur bone under the fall-induced loading conditions and calculate the hip fracture risk. Body weight, body height, body mass index, trochanteric soft tissue thickness, and hip bone mineral density were determined for each subject and their associations with impact force and hip fracture risk were quantified. Results showed that the association between impact force and hip fracture risk was not strong enough in both men (r=-0.31,p<0.05) and women (r=0.42,p<0.001) to consider the force as a sole indicator of hip fracture risk. The correlation between hip BMD and hip fracture risk in men (r=-0.83,p<0.001) was notably stronger than that in women (r=-0.68,p<0.001). Increased body mass index was not a protective factor against hip fracture in men (r=-0.13,p>0.05), but it can be considered as a protective factor among women (r=-0.28,p<0.05). In contrast to men, trochanteric soft tissue thickness can be considered as a protective factor against hip fracture in women (r=-0.50,p<0.001). This study suggested that the biomechanical risk/protective factors for hip fracture are sex-specific. Therefore, the effect of body parameters should be considered differently for men and women in hip fracture risk assessment tools. These findings support further exploration of sex-specific preventive and protective measurements to reduce the incidence of hip fractures.

A biologically-assisted curved muscle model of the lumbar spine: Model validation

BACKGROUND

Biomechanical models have been developed to predict spinal loads in vivo to assess potential risk of injury in workplaces. Most models represent trunk muscles with straight-lines. Even though straight-line muscles behave reasonably well in simple exertions, they could be less reliable during complex dynamic exertions. A curved muscle representation was developed to overcome this issue. However, most curved muscle models have not been validated during dynamic exertions. Thus, the objective of this study was to investigate the fidelity of a curved muscle model during complex dynamic lifting tasks, and to investigate the changes in spine tissue loads.

METHODS

Twelve subjects (7 males and 5 females) participated in this study. Subjects performed lifting tasks as a function of load weight, load origin, and load height to simulate complex exertions. Moment matching measures were recorded to evaluate how well the model predicted spinal moments compared to measured spinal moments from T12/L1 to L5/S1 levels.

FINDINGS

The biologically-assisted curved muscle model demonstrated better model performance than the straight-line muscle model between various experimental conditions. In general, the curved muscle model predicted at least 80% of the variability in spinal moments, and less than 15% of average absolute error across levels. The model predicted that the compression and anterior-posterior shear load significantly increased as trunk flexion increased, whereas the lateral shear load significantly increased as trunk twisted more asymmetric during lifting tasks.

INTERPRETATION

A curved muscle representation in a biologically-assisted model is an empirically reasonable approach to accurately predict spinal moments and spinal tissue loads of the lumbar spine.