Computational biomechanics of the human knee joint : role of collagen fibrils networks

Functional anatomy -- Analysis of articular cartilage as a composite using nonlinear membrane elements for collagen fibrils -- Deep vertical collagen fibrils play a significant role in mechanics of articular cartilage -- Role of cartilage collagen fibrils networks in knee joint biomechanics under compression -- Analysis of partial meniscectomy and ACL reconstruction in knee joint biomechanics under combined loading -- Comparison with experimental measurements -- Clinical and biomechanical implications

Development of a finite element model of the knee using patient specific magnetic resonance imaging data and biomechanical testing of soft tissues

This thesis presents the findings of investigations carried out relating to the creation of full joint contact patient specific finite element models for correlation with biological studies in the study of Osteoarthritis (OA) development. To understand the relationship between altered loading and biological changes in articular cartilage (AC), a method for predicting stresses and strains experienced inside the tissues is required. An in-vitro study was conducted to explore the possibility of correlating finite element (FE) and gene expression study results. FE models were used to predict the stresses and strains inside the AC for explants subjected to different loading conditions. The study demonstrated that the accurate representation of AC surface geometry is crucial and current flat surface axisymmetric cylinder representations used in AC explant modelling introduces significant error in the prediction of tissue mechanical behaviour. Cutting of the AC explant to achieve a flat surface can affect the biological, mechanical and tribology behaviour of the tissue. Thus, a method for creating explant specific finite element models with the use of digital image correlation (DIC) was developed and is presented, allowing for surface layer preservation in AC explants for correlated gene expression and inverse FE. Reconstruction of tissue geometries from magnetic resonance (MR) imaging scan data of the knee was explored. It was possible to segment both hard and soft tissues from the same set of MR imaging scan data. Meshing of the geometries using a fundamentally voxel based algorithm proved to cause significant error in the segmented volume. An alternative contour based algorithm needs to be explored. Uncertainties concerning the presence and modelling of meniscotibial ligaments (MTLs) in full joint contact FE models found in literature were addressed. An anatomy study revealed that the MTLs are found in both the medial and lateral side of the joint around the periphery of the anterior, middle and posterior portion of the menisci. With the use of cross polarised light microscopy, it was established Page | VII that MTLs consist of Type I collagen orientated in the circumferential direction around the menisci. As a result, the MTLs were modelled as an anisotropic membrane. Using the full joint contact finite element model, the influence of MTLs on knee joint kinematics was investigated. It was found that the MTLs reinforce the function of the meniscal horns and circumferential fibres in the meniscus and help constrain the meniscus. Therefore, it was concluded that the MTLs are mechanically significant in the stabilisation of knee joints and should be included in knee models for accurate prediction of knee joint behaviour

Simulation of Subject-Specific Progression of Knee Osteoarthritis and Comparison to Experimental Follow-up Data : Data from the Osteoarthritis Initiative

Economic costs of osteoarthritis (OA) are considerable. However, there are no clinical tools to predict the progression of OA or guide patients to a correct treatment for preventing OA. We tested the ability of our cartilage degeneration algorithm to predict the subject-specific development of OA and separate groups with different OA levels. The algorithm was able to predict OA progression similarly with the experimental follow-up data and separate subjects with radiographical OA (Kellgren-Lawrence (KL) grade 2 and 3) from healthy subjects (KL0). Maximum degeneration and degenerated volumes within cartilage were significantly higher (p <0.05) in OA compared to healthy subjects, KL3 group showing the highest degeneration values. Presented algorithm shows a great potential to predict subjectspecific progression of knee OA and has a clinical potential by simulating the effect of interventions on the progression of OA, thus helping decision making in an attempt to delay or prevent further OA symptoms.Peer reviewe

Numerical and Experimental Characterisation of Articular Cartilage – A Study on Biomechanics and Biotribology, Osteoarthritis and Tissue Engineering Solutions

Articular Cartilage (AC) is a soft tissue covering the articulating surface of human and animal joints. The tissue has remarkable and highly complex mechanical and wear properties allowing the joint to undergo complex kinematics and function correctly for several decades. However, trauma and degenerative joint diseases such as osteoarthritis (OA) can cause damage and excessive wear of the tissue and due to its limited regenerative capabilities, can severely compromise joint movement and impair the quality of life. OA is the most common type of degenerative joint disease and the primary cause of joint replacement surgery leading to high associated healthcare costs. Although the exact cause of this pathology remains unknown, it is thought to be mechanically induced via excessive and abnormal stresses and strains in AC which cause altered biochemical properties and a gradual decrease in the mechanical quality of the tissue. There is currently no available cure for OA and the disease is currently being diagnosed only via imaging techniques which are based upon morphological changes of the tissue, when the pathology is already in its advanced stages and has caused irreversible changes to the AC. In this respect, one of the greatest challenges to now remains the early diagnosis of OA, potentially by assessing biochemical and mechanical changes, allowing early treatments and prevention of disability thus improving the patient’s life. Hence, there is a need to apply fundamental engineering principles to the medical world in order to shed light on the pathogenesis and progression of OA. Furthermore, the need for artificial substitutes of AC has called for a deep understanding of the mechanical behaviour of the tissue in order to design and mimic the response of the real tissue in the most accurate manner. In this research a combination of numerical (finite element) and experimental techniques involving mechanical and tribological tests were used to fully characterise the mechanical behaviour of the tissue. Selective degradation of the AC constituents was then induced to simulate OA (OA-like AC) and the effect of different stages of degradation on the mechanical and tribological response as well as the wear properties of the tissue was investigated. The mechanical properties of osteoarthritic AC were then evaluated and compared to the OA-like AC in order to correlate similarities in the variations to the structure and the mechanical response as a result of degradation. Quantifying the mechanical response of the tissue at different stages of OA and different levels of degradation was done to ensure both a thorough understanding of the effect of the pathology’s progression on AC as well as to provide a potential map of mechanical quality and degradation, contributing to the potential future diagnosis of OA via mechanical parameters rather than morphological alone. Having investigated structural and mechanical variation in early OA, a promising solution to treat localised early OA and AC defects was also investigated as part of this research. In particular, novel micro fibrous tissue engineered scaffolds have been mechanically and tribologically assessed and compared to AC demonstrating the strong potential of matrix-assisted autologous chondrocyte implantation (MACI). Finally, the numerical models developed to characterise the AC using numerical – experimental methods, namely advanced biphasic models incorporating fine material descriptions such as intrinsic viscoelasticity as well as transverse isotropy, were applied to a patient specific 3D menisectomised tibio-femoral joint contact model in order to demonstrate the implications that the implementation of different AC models have for the prediction of the joint response to repeated walking cycles. The results obtained from the models were then used to predict the most likely location for the origin of mechanical damage and OA

Modélisation et analyse par éléments finis d'un genou humain

Le genou humain : de l'anatomie à la biomécanique -- Étude biomécanique du genou humain en compression : reconstruction, génération de maillage, et analyse par éléments finis -- Biomechanics of the human knee joint in compression : reconstruction, mesh generation, and finite element analysis -- Analyse par éléments finis d'un genou humain en varusvalgus -- Finite element analysis of human knee joint in varus-valgus -- Réponse biomécanique d'un genou humain assujetti à des forces antérieures et postérieures -- Biomechanical response of human knee joint under anterior-posterior forces

Biomécanique de l'articulation du genou humain durant la marche - un modèle musculosquelettique hybride

RÉSUMÉ L’articulation du genou est l’une des articulations les plus complexes du corps humain. Elle est exposée à des charges et des mouvements de grandeurs importantes pendant les activités professionnelles, récréatives et même quotidiennes. Cet environnement mécanique exigeant l’expose à diverses contraintes et déformations excessives, des blessures impliquant à la fois les articulations patello-fémorales (PF) et tibio-fémorales (TF). L'arthrose (OA) est l'un des troubles musculo-squelettiques les plus répandus touchant environ 27 millions d'adultes aux États-Unis seulement. La rupture du ligament croisé antérieur (LCA) est également une lésion articulaire commune avec une prévalence beaucoup plus élevée chez les sujets féminins que chez les sujets masculins. Une bonne connaissance de la biomécanique fonctionnelle de l’articulation du genou et des facteurs qui l'affectent, dans des conditions saines et pathologiques, est une condition préalable pour élaborer des stratégies efficaces pour la prévention et le traitement de ces blessures. Les modèles musculo-squelettiques (MS) de l'extrémité inférieure promettent d'améliorer notre compréhension de la fonction articulaire du genou, de ses blessures et aussi des programmes de prévention et des traitements associés. Plusieurs modèles analytiques et d'éléments finis (EF) avec différents degrés de précision et de raffinement ont été développés. Ils se sont présentés comme une alternative fiable aux méthodes expérimentales qui ont des limitations majeures, principalement liées à leurs coûts élevés, aux difficultés liées aux précisions des mesures et à la reproduction parfois impossible de certaines situations physiologiques. Cependant, de nombreuses hypothèses sont souvent formulées dans certains modèles MS (lors de l'estimation des forces musculaires et des forces de contacts articulaires). Le genou est généralement idéalisé comme une articulation 2D avec son mouvement contraint dans le plan sagittal, négligeant ainsi les déplacements et les équations d'équilibre dans les plans restants. Avec les forces musculaires estimées, l'équilibre statique dans le plan frontal est donc considéré pour estimer les forces du plateau tibial négligeant la résistance passive du genou, la géométrie articulaire, et en supposant des centres de contact médial/latéral fixes. Pour évaluer les effets de telles hypothèses, un modèle MS hybride de l'extrémité inférieure incluant un modèle élément finis (EF) du genou 3D a été utilisé pour simuler la phase d’appui de la marche.----------ABSTRACT Human knee joints experience loads and movements of substantial magnitudes during occupational, recreational and even regular daily living activities. This demanding mechanical environment exposes them to a host of painful and debilitating deformities, injuries and degenerations involving both patellofemoral (PF) and tibiofemoral (TF) articulations. Osteoarthritis (OA) is one of the most prevalent musculoskeletal (MS) disorders affecting approximately 27 million adults in the US alone. ACL rupture is, also, a common joint injury with much higher prevalence reported in female athletes compared to their male counterparts. Effective preventive measures and treatment managements of such disorders require a sound knowledge of the joint behavior in both healthy and pathologic conditions. MS modeling of the lower extremity is promising to improve the current understanding of the knee joint function and injuries and consequently associated prevention and treatment programs. Several analytical and finite element (FE) models with different degrees of precision and refinement have been developed. They are considered as a reliable alternative to experimental methods that have major limitations, mainly related to their high costs, difficulties related to measurement accuracy and reproduction of some physiological situations. However, numerous assumptions are often made in some MS models (when estimating muscle forces and joint contact loads). The knee is commonly idealized as a planar (2D) joint with its motion constrained to remain in the sagittal plane, neglecting thus both displacements and equilibrium equations in remaining planes. With muscle forces predicted, the static equilibrium in the frontal plane is consequently considered to estimate tibial compartmental loads neglecting the knee joint passive resistance, the knee geometry, and assuming medial/lateral contact centers. To evaluate the effects of such assumptions, a hybrid MS model of the lower extremity incorporating a detailed validated 3D knee FE model was used to simulate the stance phase of gait. This model of the knee joint is made of bony structures (tibia, femur and patella) and their compliant cartilage layers as well as menisci, major TF (anterior cruciate ligament, ACL; posterior cruciate ligament, PCL; lateral collateral ligament, LCL; medial collateral ligament, MCL) and PF (medial PF ligament, MPFL; lateral PF ligament, LPFL) ligaments, patellar tendon (PT), and lower extremity muscles (e.g., quadriceps, hamstrings and gastrocnemius)