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Simulation of anterior cruciate ligament deficiency in a musculoskeletal model with anatomical knees.

ABSTRACT: Abnormal knee kinematics and meniscus injury resulting from anterior cruciate ligament (ACL) deficiency are often implicated in joint degeneration even though changes in tibio-femoral contact location after injury are small, typically only a few millimeters. Ligament reconstruction surgery does not significantly reduce the incidence of early onset osteoarthritis. Increased knowledge of knee contact mechanics would increase our understanding of the effects of ACL injury and help guide ACL reconstruction methods. Presented here is a cadaver specific computational knee model combined with a body-level musculoskeletal model from a subject of similar height and weight as the cadaver donor. The knee model was developed in the multi-body framework and includes representation of the menisci. Experimental body-level measurements provided input to the musculoskeletal model. The location of tibio-menisco-femoral contact as well as contact pressures were compared for models with an intact ACL, partial ACL transection (posterolateral bundle transection), and full ACL transection during a muscle driven forward dynamics simulation of a dual limb squat. During the squat, small changes in femur motion relative to the tibia for both partial and full ACL transection push the lateral meniscus in the posterior direction at extension. The central-anterior region of the lateral meniscus then becomes "wedged" between the tibia and femur during knee flexion. This "wedging" effect does not occur for the intact knee. Peak contact pressure and contact locations are similar for the partial tear and complete ACL transection during the deep flexion portion of the squat, particularly on the lateral side. The tibio-femoral contact location on the tibia plateau shifts slightly to the posterior and lateral direction with ACL transection.

SUBMITTER: Guess TM

PROVIDER: S-EPMC3314869 | biostudies-other | 2012

REPOSITORIES: biostudies-other

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Simulation of anterior cruciate ligament deficiency in a musculoskeletal model with anatomical knees.

Guess Trent M TM Stylianou Antonis A

The open biomedical engineering journal 20120309

Abnormal knee kinematics and meniscus injury resulting from anterior cruciate ligament (ACL) deficiency are often implicated in joint degeneration even though changes in tibio-femoral contact location after injury are small, typically only a few millimeters. Ligament reconstruction surgery does not significantly reduce the incidence of early onset osteoarthritis. Increased knowledge of knee contact mechanics would increase our understanding of the effects of ACL injury and help guide ACL reconst ...[more]

PMID: 22470411

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Project description:PurposeThe consequence of tunnel widening after ACL reconstructions is foremost of importance in case of revision surgery. Tunnel expansion leads to bone loss close to the joint, and additional surgery with bone grafting prior to revision surgery might be necessary. The purpose of the study was to measure widening of the tunnels in single-bundle (SB) and double-bundle (DB) ACL reconstructed knees during the first year after surgery, detected by a novel, semi-automated 3D CT imaging modality. Our hypothesis was that there would be a difference between the initial tunnel size and the size measured one year post-operatively due to the tunnel widening process. Further, the purpose was to evaluate whether there were any differences in the amount of tunnel widening between the two surgical techniques.MethodsTwenty patients who underwent DB ACL reconstruction, and 22 patients who underwent SB ACL reconstruction, performed a CT scan of the bony tunnels, during their first days after surgery and one year post-operatively. The CT scans were transformed into 3D CT reconstructions, and the tunnels were measured with the "best-fit cylinder" method, measurements at the level of tunnel aperture and 10.0 mm from the joint line.ResultsAll tunnels in the DB and SB ACL reconstructed knees exhibited widening during the first year after the operation (p < 0.001). The SB femoral tunnels showed more widening compared to the DB femoral AM tunnels (1.4 ± 0.9 vs. 0.5 ± 0.6 mm) (p < 0.001), and the SB tibial tunnels widened more compared to the DB tibial PL tunnels (1.0 ± 1.0 vs. 0.5 ± 0.6) (p < 0.043).ConclusionAll tunnels widened during the first year after the ACL reconstruction with a larger amount of widening in the SB tunnels compared to the DB femoral AM tunnels and the DB tibial PL tunnels. This is the first study to detect tunnel widening in DB reconstructed knees through a semi-automated 3D CT imaging modality.Level of evidenceProspective cohort study, Level III.

Project description:BACKGROUND:It is not known whether the human anterior cruciate ligament (ACL) is susceptible to fatigue failure as a result of repetitive loading or whether certain knee morphologic characteristics increase that risk. HYPOTHESES:The number of knee loading cycles required to fail an ACL by fatigue failure is unaffected by the magnitude of the external load delivered to the knee joint. Furthermore, sex, ACL cross-sectional area, and lateral tibial slope will not affect the number of loading cycles to ACL failure. STUDY DESIGN:Controlled laboratory study. METHODS:Knee pairs from 10 cadaveric donors (5 female) of similar age, height, and weight were imaged with 3-T magnetic resonance imaging to measure lateral tibial slope and ACL cross-sectional area. One knee from each pair was then subjected to repeated application of a load of 3 times body weight (3*BW), while the other knee was subjected to a 4*BW load, both involving impulsive compression force, knee flexion moment, and internal tibial torque combined with realistic trans-knee muscle forces. The resulting 3-dimensional tibiofemoral kinematics and kinetics were recorded, along with ACL relative strain and quadriceps, hamstring, and gastrocnemius muscle forces. The loading cycle was repeated until the ACL ruptured, a 3-mm increase in cumulative anterior tibial translation occurred, or a minimum of 50 trials was reached. RESULTS:Eight of 10 knees failed under the 4*BW load (mean ± SD cycles to failure, 21 ± 18), while 5 of 10 knees failed under the 3*BW load (mean ± SD cycles to failure, 52 ± 10). Four knees exhibited a 3-mm increase in anterior tibial translation, 7 knees developed partial or complete visible ACL tears, and 2 knees developed complete ACL tibial avulsions. A Cox regression showed that the number of cycles to ACL failure was influenced by the simulated landing force (P = .012) and ACL cross-sectional area (P = .022). Donor sex and lateral tibial slope did not influence the number of cycles to ACL failure. CONCLUSION:The human ACL is susceptible to fatigue failure when pivot landings of 3*BW or more load the knee repeatedly within a short time span. An ACL with a smaller cross-sectional area is at greater risk for this type of failure. CLINICAL RELEVANCE:The results show that the human knee can only withstand a certain number of 3*BW or greater jump loading cycles within a short time period before the ACL will fail. Therefore, limiting the increase in the number and severity of pivot landing maneuvers performed over a week of training would make sense from an injury prevention viewpoint.

Dataset Information

Simulation of anterior cruciate ligament deficiency in a musculoskeletal model with anatomical knees.

Publications

Simulation of anterior cruciate ligament deficiency in a musculoskeletal model with anatomical knees.

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