Knowledge of ligamentous contributions to joint stability is essential to restore normal joint range of motion and functionality through reconstruction procedures. Although, there has been numerous studies on the pathomechanics of the elbow joint, there have been very few rigorous and systematic attempts to characterize the roles of soft tissues during clinically relevant motions. Five fresh frozen cadaveric elbows from three male subjects were used for this study. In-vitro simulations were performed using a VIVO six degree-of-freedom (6-DOF) joint motion simulator (AMTI, Watertown, MA) capable of virtually simulating the effects of soft tissue constraints (virtual ligaments). This study introduces a unique, hybrid experimental-computational technique for measuring and simulating the biomechanical contributions of ligaments to elbow joint kinematics and stability. In vitro testing of cadaveric joints is enhanced by the incorporation of fully parametric virtual ligaments, which are used in place of the native joint stabilizers to characterize the contribution of elbow ligaments during simple flexion-extension motions using the principle of superposition. our results demonstrate the importance of AMCL and RCL structures as primary stabilizers under valgus and varus loading respectively. Virtual ligaments demonstrate the ability to restore the VV stability of the joint in the absence of any soft tissues attached to the osseous structures. This demonstrates the effectiveness of “virtual” ligaments for in vitro testing of elbow joint biomechanics, with applications in pre-clinical assessment of elbow implants.
Listed In: Biomechanical Engineering, Biomechanics, Mechanical Engineering, Orthopedic Research

Purpose: Anterior cruciate ligament (ACL) tear greatly increases the risk of knee osteoarthritis (OA), even when patients undergo ACL reconstruction surgery (ACLR). Changes to walking kinematics following ACLR have been suggested to play a role in this degenerative path to post-traumatic OA by shifting the location of repetitive joint contact loads that occur during walking to regions of cartilage not conditioned for altered loads. Recent work has shown that changes to the average knee center of rotation during walking (KCOR) between 2 and 4 years after ACLR are associated with long term changes in patient reported outcomes at 8 years. Changes to KCOR result in changes to contact patterns between the femur and the tibial plateau. However, it is unknown if changes to this kinematic measure are reflected by changes to cartilage as early as 2 years after surgery. Ultrashort TE-enhanced T2* (UTE-T2*) mapping has been shown to be sensitive to subsurface changes occurring in deep articular cartilage early after ACL injury and over 2 years after ACLR that were not detectable by standard morphological MRI. Thus, the purpose of this study was to test the hypothesis that side to side differences in KCOR correlate with side to side differences in UTE-T2* quantitative MRI (qMRI) in the central weight bearing regions of the medial and lateral tibial plateaus at 2 years following ACLR. Methods: Thirty-five human participants (18F, Age: 33.8±10.5 yrs, BMI: 24.1±3.3) with a history of unilateral ACL reconstruction (2.19±0.22 yrs post-surgery) and no other history of serious lower limb injury received bilateral examinations on a 3T MRI scanner. UTE-T2* maps were calculated via mono-exponential fitting on a series of T2*-weighted MR images acquired at eight TEs (32μs -16 ms, non-uniform echo spacing) using a radial out 3D cones acquisition. All subjects completed bilateral gait analysis. Medial-lateral (ML) and anterior-posterior (AP) coordinates of average KCOR during stance of walking were calculated for both knees. Side to side differences in KCOR were tested for correlations with side to side differences in mean full thickness UTE-T2* quantitative values in the central weight bearing regions of the medial and lateral tibial plateau using Pearson correlation coefficients. Results: There was a distribution in UTE-T2* values, with some subjects having higher UTE-T2* and some lower in the ACLR knee relative to the contralateral knee. A significant correlation (R=0.407, p=0.015, Figure 1A) was observed between UTE-T2* and the ML KCOR with a more lateral KCOR corresponding to higher values of UTE-T2* for the medial tibia. Similarly, for the lateral tibia, a lower UTE-T2* was correlated with a more posterior KCOR (R=0.363, p=0.032, Figure 1B). Significant correlations were not observed for UTE-T2* in the lateral tibia with the ML position of KCOR or for UTE-T2* in the medial tibia with the AP position of KCOR. Conclusions: The results of this study support the hypothesis that side to side differences in mean full thickness UTE-T2* qMRI correlate with side to side differences in knee kinematics at 2 years after ACLR. The finding that a more lateral KCOR in the ACLR knee correlates with UTE T2* values in the medial tibia that were higher than the contralateral side suggests that this kinematic change, which has been previously shown to result in more relative motion between the femur and tibia in the medial compartment, could be affecting subsurface matrix integrity, inducing changes detectable by UTE-T2* mapping. Additionally, the finding that a more posterior KCOR in the ACLR knee correlated with UTE-T2* values in the lateral tibia that were lower than the contralateral knee further suggests that the UTE-T2* metric may reflect early changes in cartilage health. When interpreted within the context of prior work showing that a posterior shift in KCOR from 2 to 4 years post-surgery correlated with improved clinical outcomes at 8 years, the observed lower UTE-T2* with a more posterior KCOR, which is reflective of improved quadriceps recruitment, suggests positive cartilage matrix properties. In spite of the limitations of this cross-sectional and exploratory study, and the difficulty accounting for changes in the contralateral knee, these results support future studies of the relationship between UTE-T2* and KCOR to provide new insight into predicting the risk for OA after ACLR.
Listed In: Biomechanical Engineering, Biomechanics, Gait, Mechanical Engineering, Orthopedic Research, Sports Science

As a treatment for end-stage elbow joint arthritis, total elbow replacement (TER) results in joint motions similar to the intact joint; however, bearing wear, excessive deformations and/or early fracture may necessitate early revision of failed implant components. A finite element model of a TER assembly was developed based on measurements from a Coonrad-Morrey implant (Zimmer, Inc., Warsaw, IN) using nonlinear elasto-plastic UHMWPE material properties and a frictional penalty contact formulation. The loading scenario applied to the model includes a flexion-extension motion, a joint force reaction with variable magnitude and direction and a time varying varus-valgus (VV) moment with a maximum magnitude of 13 N.m, simulating a chair-rise scenario as an extreme loading condition. Model results were compared directly with corresponding experimental data. Experimental wear tests were performed on the abovementioned implants using a VIVO (AMTI, Watertown, MA) six degree-of-freedom (6-DOF) joint motion simulator apparatus. The worn TER bushings were scanned after the test using micro computed tomography (μCT) imaging techniques, and reconstructed as 3D models. Contact pressure distributions on the humeral and ulnar bushings correlate with the sites of damage as represented by the μCT data and gross observation of clinical retrievals. The results demonstrate UHMWPE bushing damage due to different loading protocols. Numerical results demonstrate strong agreement with experimental data based on the location of deformation and creep on bushings and exhibit promising capabilities for predicting the damage and failure mechanisms of TER implants.
Listed In: Biomechanical Engineering, Biomechanics, Biotribology, Mechanical Engineering, Orthopedic Research

Victims of improvised explosive devices (IEDs) that have presented spinal injury in recent conflicts have been shown to have a high incidence of lumbar spine fractures. Previous studies have shown that the initial positioning of spinal bone-disc-bone complexes affects their biomechanical response when loaded quasi-statically; such a correlation, however, has not been explored at appropriate high loading rate scenarios that simulate injury. This study aims to investigate the response of lumbar spine cadaveric segments in different postures under axial impact conditions. Three T11-L1 bi-segments were dissected and tested destructively in a drop tower under flexed/neutral/extended postures. Strains were measured on the vertebral body and the spinous process of T12. Forces were measured cranially using a 6-axis load cell, and a high-speed camera was used to capture displacements and fracture. The impacted specimens were CT-scanned to identify the fracture pattern. Whilst axial force to failure was similar for flexed and extended postures, the non-axial forces and the bending moments, however, were dissimilar between postures. Although all specimens showed a burst fracture pattern, the extended posture failed more posteriorly. This suggests that axial force alone is not adequate to predict injury severity in the lumbar spine. This insight would not have been possible without the use of the 6-axis load cell. As metrics for spinal injury in surrogates take into account only the axial force, this programme of work may provide data for a better injury criterion and allow for a mechanistic understanding of the effects of posture on injury risk.
Listed In: Biomechanical Engineering, Biomechanics, Mechanical Engineering, Orthopedic Research

The inherent reduction in mechanical loading associated with microgravity has been shown to result in dramatic decreases in the bone mineral density (BMD) and mechanical strength of skeletal tissue. Importantly, there is a concomitant increase in fracture risk during long-duration spaceflight missions. Thus, the objective of this study was to investigate the effects of microgravity loading on long-bone fracture healing in a previously-developed Haversian bone model of simulated microgravity over a 4-week period. For in vivo mechanical evaluation, strains of an implanted orthopaedic fixation plate were quantified for known hindlimb ground reaction forces with a six degree-of-freedom load cell (AMTI, Watertown, MA). In vivo strain measurements demonstrated significantly higher orthopaedic plate strains in the Microgravity Group as compared to the Control Group following the 28-day healing period due to inhibited healing in the microgravity environment. DEXA BMD in the treated metatarsus of the Microgravity Group decreased 17.6% at the time of the ostectomy surgery and decreased an additional 5.4% during the 28-day healing period. Four-point bending stiffness of the Microgravity Group was 4.4 times lower than that of the Control Group (p<0.01), while µCT and histomorphometry demonstrated reduced periosteal callus area, mineralizing surface, mineral apposition rate (p<0.001), bone formation rate, and periosteal/endosteal osteoblast numbers as well as increased periosteal osteoclast number. These data provide strong evidence that the mechanical loading environment dramatically affects the fracture healing cascade and resultant mineralized tissue strength, and that the microgravity loading environment has negative effects on fracture healing in Haversian systems.
Listed In: Biomechanical Engineering, Biomechanics, Mechanical Engineering, Orthopedic Research