Injuries to the knee anterior cruciate ligament (ACL) are common, with a known but poorly understood association with intrinsic and extrinsic risk factors. Some of these factors are enzymatically or mechanically mediated, creating acute focal injuries that may cause significant ligament damage. Understanding the relationship between the basic molecular structure and external loading of the ACL requires a hierarchical connection between the two levels. In the present study, a multi-domain frame was developed connecting the molecular dynamics of the collagen networks to the continuum mechanics of the ACL. The model was used to elucidate the effect of the two possible collagen degradation mechanisms on the aggregate ACL behaviour. Results indicated that collagen content and ACL stiffness were reduced significantly, regardless of the degradation mechanism. Furthermore, the volumetric degradation at the molecular level had a devastating effect on the mechanical behaviour of the ACL when it was compared with the superficial degradation. ACL damage initiation and propagation were clearly influenced by collagen degradation. To summarise, the new insights provided by the predicted results revealed the significance of the collagen network structural integrity to the aggregate mechanical response of the ACL and, hence, underlined the biomechanical factors that may help develop an engineering-based approach towards improving the therapeutic intervention for ACL pathologies.
Knee osteoarthritis (OA) is a growing source of pain and disability. Obesity is the most important avoidable risk factor underlying knee OA. The processes by which obesity impacts osteoarthritis are of tremendous interest to osteoarthritis researchers and physicians, where the joint mechanical load is one of the pathways generally thought to cause or intensify the disease process. In the current work, we developed a hybrid framework that simultaneously incorporates a detailed finite element model of the knee joint within a musculoskeletal model to compute lower extremity muscle forces and knee joint stresses in normal-weight (N) and obese (OB) subjects during the stance phase gait. This model accounts for the synergy between the active musculature and passive structures. In comparing OB subjects and normal ones, forces significantly increased in all muscle groups at most instances of stance. Mainly, much higher activation was computed with lateral hamstrings and medial gastrocnemius. Cartilage contact average pressure was mostly supported by the medial plateau and increased by 22%, with a larger portion of the load transmitted via menisci. This medial compartment experienced larger relative movement and cartilage stresses in the normal subjects and continued to do so with a higher level in the obese subjects. Finally, the developed bioengineering frame and the examined parameters during this investigation might be useful clinically in evaluating the initiation and propagation of knee OA.
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