A multimedia package for patient understanding and rehabilitation of non-contact anterior cruciate ligament injuries

Non-contact anterior cruciate ligament (ACL) injury is one of the most common ligament injuries in the body. Many patients’ receive graft surgery to repair the damage, but have to undertake an extensive period of rehabilitation. However, non-compliance and lack of understanding of the injury, healing process and rehabilitation means patient’s return to activities before effective structural integrity of the graft has been reached. When clinicians educate the patient, to encourage compliance with treatment and rehabilitation, the only tools that are currently widely in use are static plastic models, line diagrams and pamphlets. As modern technology grows in use in anatomical education, we have developed a unique educational and training package for patient’s to use in gaining a better understanding of their injury and treatment plan. We have combined cadaveric dissections of the knee (and captured with high resolution digital images) with reconstructed 3D modules from the Visible Human dataset, computer generated animations, and images to produce a multimedia package, which can be used to educate the patient in their knee anatomy, the injury, the healing process and their rehabilitation, and how this links into key stages of improving graft integrity. It is hoped that this will improve patient compliance with their rehabilitation programme, and better long-term prognosis in returning to normal or near-normal activities. Feedback from healthcare professionals about this package has been positive and encouraging for its long-term use

A Principal Component Analysis Investigation of Drop Landings for Defining Anterior Cruciate Ligament Injury Risk Factors

Injury to the anterior cruciate ligament (ACL) has been widely investigated through observational video analysis and laboratory based cadaveric, motion capture and computer simulation models. With the greater incidence of injury in the female population, recent emphasis has been placed on understanding ACL injury mechanisms in females. By using our understanding of injury mechanisms and prospective studies, injury prediction methods can be created. Once injury can be reliably predicted, training methods can be implemented to reduce likelihood of injury and avoid devastating consequences. There is a need for a reliable way to reduce motion capture data obtained in a laboratory setting to viable measures that characterize the entire data set and correlate such measures to clinically relevant tests. The present study performed motion analysis on healthy active young adult females during drop jump landings to characterize normal jump landing dynamics. Kinematic and kinetic data was reduced using principal component analysis to objectively determine variables of importance. Five principal components represented a cumulative 87.41% of the data set variance. Using principal component scores, significant associations were identified between principal component four (base of support at initial contact, peak knee abduction moment and 100 ms after initial contact) and knee flexion to extension isokinetic strength ratio. Additional significant correlation was found between principal component five (initial contact coronal knee moment and transverse knee moment) and abduction to adduction isokinetic strength ratio tested at 90°/sec. These results suggest principal component analysis is a viable method to reducing dynamic motion capture data. Further, principal component scores are a possible way to predict isokinetic strength ratios obtained in the clinic

Contrast-enhanced micro-computed tomography and image processing integrated approach for microstructural analysis of biological soft fibrous tissues

Nel sistema muscolo-scheletrico, tendini e legamenti svolgono un ruolo importante al fine di garantire mobilità e stabilità. Questi tessuti sono composti principalmente da collagene e presentano una struttura altamente fibrosa. Evidenziare i componenti della microstruttura di legamenti e tendini in immagini tridimensionali (3D) è di fondamentale importanza per estrarre informazioni significative che posso anvere ripercussioni sulla scienza di base e sulle applicazioni ortopediche. In particolare, le proprietà meccaniche delle microstrutture fibrose sono fortemente influenzate da alcune caratteristiche geometriche, come la volume fraction, l’orientamento e il diametro; tuttavia, determinare l'orientamento e il diametro della fibra 3D è impegnativo. In questa prospettiva, questa tesi mirava ad unire tomografia microcomputerizzata (microCT) ed elaborazione delle immagini in un approccio integrato al fine di identificare e migliorare le informazioni microstrutturali sui tessuti biologici fibrosi, includendo i dati di volume e orientamento. La procedura complessiva è stata applicata per la prima volta su campioni di tendine del ginocchio umano e su legamento collaterale bovino. In una prima fase, sono state testate preparazioni specifiche del campione, inclusa una disidratazione chimica o soluzioni di acido fosfotungstico (PTA) al 2 % in acqua (H2O) o in soluzione di etanolo al 70% (EtOH), così da migliorare il contrasto dell'immagine di questi specifici tessuti. Inoltre, utilizzando i dati scansionati, è stata sviluppata una nuova tecnica di elaborazione delle immagini basata sul filtro 3D hessiano multiscala per evidenziare le strutture fibrose ed ottenere informazioni quantitative sulle fibre. È interessante notare che, per qualsiasi strategia di preparazione del campione di tendini/legamenti, l'approccio proposto è risultato adeguato per rilevare e caratterizzare le proprietà del fascicolo. I risultati del test hanno mostrato che la disposizione delle fibre è fortemente allineata lungo la direzione longitudinale principale nel tendine del tendine, più delle fibre del legamento collaterale bovino. Inoltre, questa tecnica è stata ulteriormente applicata al fine di determinare come il Legamento Crociato Anteriore (LCA) umano risponda a carichi uniassiali rispetto a valori crescenti di deformazione, considerando sia un tessuto sano che uno in condizioni patologiche, cioè acquisito da un paziente con l'artrosi. Anche in questi casi, l'approccio integrato si è rivelato valido ed affidabile nell'individuare orientamento e dimensione dei fascicoli presenti e, quindi, attraverso un modello meccanico strutturale - basato su specifiche leggi costitutive - nello stimare il modulo elastico di questi tessuti. Sono state infatti stimate le curve sforzo-deformazione, ottenendo un valore di modulo elastico di 60.8 MPa e 7.7 MPa rispettivamente per il LCA sano e patologico. In conclusione, è stato progettato e validato in via preliminare un nuovo protocollo microCT per il miglioramento del contrasto dedicato all'analisi microstrutturale dei tessuti molli biologici con caratteristiche fibrose. In una peculiare applicazione al LCA, le informazioni ottenute con il protocollo sono state utilizzate per implementare un modello meccanico dei tessuti fibrosi, stimando così il comportamento biomeccanico dei tessuti sani e patologici.ABSTRACT In the musculoskeletal system, tendons and ligaments play an important role in ensuring mobility and stability. These tissues are primarily composed of collagen and present a highly fibrous structure. Highlighting the microstructure components of ligaments and tendons in three-dimensional (3D) images is crucial for extracting meaningful information impacting basic science and orthopaedic applications. In particular, the mechanical properties of the fibrous microstructures are strongly influenced by their volume fraction, orientation, and diameter. However, determining the 3D fibre orientation and diameter is challenging. In this picture, this thesis aimed at integrating microcomputed tomography (microCT) and image processing approach to identify and enhance microstructural information about biological soft fibrous tissues, including volume and orientation. The overall procedure was first applied on human hamstring tendon and bovine collateral ligament samples. In a first phase specific sample preparations – including either a chemical dehydration, or by 2% of phosphotungstic acid (PTA) in water (H2O) or in 70% ethanol (EtOH) solution – were tested to enhance image contrast of these specific soft tissues. Further, using the scanned data, a novel image processing technique based on 3D Hessian multiscale filter for highlighting fibrous structures was developed to obtain quantitative fibre information. Interestingly, for any strategy of tendon/ligament sample preparation, the proposed approach was adequate for detecting and characterizing fascicle features. The test results showed the fibre arrangement strongly aligned along the main longitudinal direction in the human hamstring tendon more than fibres on the bovine collateral ligament. Moreover, this technique was further applied in order to determine how the human Anterior Cruciate Ligament (ACL) responds to uniaxial loads with respect to increasing values of strain, considering both a healthy tissue and a one under pathological conditions, i.e., acquired from a patient with osteoarthritis. Also in these cases, the integrated approach was valuable and reliable in identifying orientation and size of present fascicles and, thus, through a structural mechanical model - based on specific constitutive law - to estimate the elastic modulus of these tissues. In fact, stress-strain curves were estimated, obtaining a value of elastic modulus of 60.8 MPa and 7.7 MPa for the healthy and pathological ACLs, respectively. In conclusion, a novel contrast enhancement microCT protocol was designed and preliminarily validated for the microstructural analysis of biological soft fibrous tissues. In a peculiar application to ACL, the information obtained with the protocol was used to implement a mechanical model of fibrous tissues, thus estimating the biomechanical behaviour of the healthy and pathological tissues

Proteomic differences between native and tissue-engineered tendon and ligament

Tendons and ligaments (T/Ls) play key roles in the musculoskeletal system, but they are susceptible to traumatic or age‐related rupture, leading to severe morbidity as well as increased susceptibility to degenerative joint diseases such as osteoarthritis. Tissue engineering represents an attractive therapeutic approach to treating T/L injury but it is hampered by our poor understanding of the defining characteristics of the two tissues. The present study aimed to determine differences in the proteomic profile between native T/Ls and tissue engineered (TE) T/L constructs. The canine long digital extensor tendon and anterior cruciate ligament were analyzed along with 3D TE fibrin‐based constructs created from their cells. Native tendon and ligament differed in their content of key structural proteins, with the ligament being more abundant in fibrocartilaginous proteins. 3D T/L TE constructs contained less extracellular matrix (ECM) proteins and had a greater proportion of cellular‐associated proteins than native tissue, corresponding to their low collagen and high DNA content. Constructs were able to recapitulate native T/L tissue characteristics particularly with regard to ECM proteins. However, 3D T/L TE constructs had similar ECM and cellular protein compositions indicating that cell source may not be an important factor for T/L tissue engineering

Parameterization of a Next Generation In-Vivo Forward Solution Physiological Model of the Human Lower Limb to Simulate and Predict Demographic and Pathology Specific Knee Mechanics

The human knee from a mechanical perspective is arguably one of the more complex of the joints of the human body and for this very reason there are a number of pathological factors that can adversely affect knee function, leading to pain, stiffness and an overall reduced quality of life. To rectify these disease conditions, a variety of intervention techniques exist, all of which are predicated on a thorough understanding of the forces and motions that occur at the knee.Various techniques have been developed to further the understanding of how the knee functions; however, many of these strategies involve time and cost consuming processes in order to assess functionality of the knee. Mathematical modeling is a methodology that uses mathematical equations of motion to solve for forces, or in the case of forward modeling, motions given a known set of forces. Such a model is capable of replicating the functionality of the knee in vivo.One application of such a model is in the context of total knee arthroplasty design. Intended for the restoration of functionality after late stage osteoarthritis, total knee arthroplasty devices are highly dependent on their associated design features and the use of a theoretical model affords the opportunity to test the performance of a device without ever needing to manufacture or implant it.In addition, there are also surgical applications where a mathematical model can test joints that otherwise cannot be evaluated under conventional means. This includes modeling of the healthy knee, as well as various functionality-limiting pathological conditions. Perhaps more importantly is the ability to evaluate different intervention techniques to determine the effectiveness in doing so identify which technique most effectively resolves the pathological issues.Advances to the model have focused on parameterization while contributing to a validated normal knee model, an enhancement on the efficiency of the muscles that drive flexion, facilitated methods to evaluate articular geometries and enhancements providing more realistic physiological motions. The model has also been enhanced to account for demographics, as well as abnormal pathology with additional parameters added to better understand gait mechanics at the knee

Mechanical properties of animal ligaments: a review and comparative study for the identification of the most suitable human ligament surrogates

: The interest in the properties of animal soft tissues is often related to the desire to find an animal model to replace human counterparts due to the unsteady availability of human tissues for experimental purposes. Once the most appropriate animal model is identified, it is possible to carry out ex-vivo and in-vivo studies for the repair of ligamentous tissues and performance testing of replacement and support healing devices. This work aims to present a systematic review of the mechanical properties of ligaments reported in the scientific literature by considering different anatomical regions in humans and several animal species. This study was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. Moreover, considering the lack of a standard protocol for preconditioning of tissues, this aspect is also addressed. Ninety-six studies were selected for the systematic review and analysed. The mechanical properties of different animal species are reported and summarised in tables. Only results from studies reporting the strain rate parameter were considered for comparison with human ligaments, as they were deemed more reliable. Elastic modulus, ultimate tensile stress, and ultimate strain properties are graphically reported identifying the range of values for each animal species and to facilitate comparison between values reported in the scientific literature in animal and human ligaments. Useful similarities between the mechanical properties of swine, cow, and rat and human ligaments have been found