New parameters describing how knee ligaments carry force in situ predict interspecimen variations in laxity during simulated clinical exams

Imhauser, Carl W.; Kent, Robert N.; Boorman-Padgett, James; Thein, Ran; Wickiewicz, Thomas L.; Pearle, Andrew D.

doi:10.1016/j.jbiomech.2017.09.032

Cited by 18 publications

(31 citation statements)

References 49 publications

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“…In line with our findings, previous work has shown that the engagement point of the ACL, and not the resultant force carried by the ACL at the peak applied load, predicts anterior laxity of the ACL-intact knee. 14 Moreover, we observed that the secondary ligaments and medial meniscus engaged simultaneously with the secondary soft tissues in 11 of 17 knees but engaged asynchronously in the remaining 6 knees. Engagement of the secondary stabilizers relative to each other could also provide a novel outcome measure.…”

Section: Discussionmentioning

confidence: 66%

“…Third, the sample size (n = 17) limited our statistical analysis to simple linear regression models. Now that we have established the utility of relative engagement in predicting variations in knee laxity, future work with a larger sample size could incorporate stepwise multiple linear regression, 14 as well as analysis of individual ligaments. Fourth, the increment of applied anterior load does not affect our conclusions, because the average relative engagement point of the medial meniscus was 2.5 times larger than the maximum variation in engagement point of the medial meniscus caused by the load increment (see Appendix 1, available in the online version of the article).…”

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The center of the AP laxity profile was defined as the midpoint of these inflection points, and this served as the neutral position from which AP translations were described for each specimen. 14 Anterior loads were applied with the ACL intact and sectioned, and the resulting tibiofemoral kinematics were measured. ACL-intact kinematics were repeated before and after serial sectioning of (1) the ACL, (2) all remaining secondary ligaments, (3) the medial meniscus, and (4) the lateral meniscus.…”

Section: Methodsmentioning

confidence: 99%

“…One potential biomechanical explanation for the highly variable increase in side-to-side anterior laxity caused by ACL deficiency may lie in the biomechanical function of the ACL and the secondary anterior restraints to the Lachman test (including the remaining ligaments and the menisci). 9,14 This explanation stems from a previous cadaveric study that reported a relationship between the anterior laxity during a simulated Lachman test of the ACL-intact knee and the tibial position at which the ACL begins to carry force (ie, the engagement point of the ACL) but, surprisingly, not the force that it carried at the peak applied load. 14 Accordingly, the engagement points of secondary ligamentous and meniscal stabilizers relative to that of the ACL may help explain preoperative side-to-side differences in anterior laxity after unilateral ACL rupture.…”

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confidence: 99%

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Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity

et al. 2019

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Background: Patients with high-grade preoperative side-to-side differences in anterior laxity as assessed via the Lachman test after unilateral anterior cruciate ligament (ACL) rupture are at heightened risk of early ACL graft failure. Biomechanical factors that predict preoperative side-to-side differences in anterior laxity are poorly understood. Purpose: To assess, in a cadaveric model, whether the increase in anterior laxity caused by sectioning the ACL (a surrogate for preoperative side-to-side differences in anterior laxity) during a simulated Lachman test is associated with two biomechanical factors: (1) the tibial translation at which the secondary anterior stabilizers, including the remaining ligaments and the menisci, begin to carry force, or engage, relative to that of the ACL or (2) the forces carried by the ACL and secondary stabilizers at the peak applied anterior load. Study Design: Controlled laboratory study. Methods: Seventeen fresh-frozen human cadaveric knees underwent Lachman tests simulated through a robotic manipulator with the ACL intact and sectioned. The net forces carried by the ACL and secondary soft tissue stabilizers (the medial meniscus and all remaining ligaments, measured as a whole) were characterized as a function of anterior tibial translation. The engagement points of the ACL (with the ACL intact) and each secondary stabilizer (with the ACL sectioned) were defined as the anterior translation at which they began to carry force, or engaged, during a simulated Lachman test. Then, the relative engagement point of each secondary stabilizer was defined as the difference between the engagement point of each secondary stabilizer and that of the ACL. Linear regressions were performed to test each association ( P < .05). Results: The increase in anterior laxity caused by ACL sectioning was associated with increased relative engagement points of both the secondary ligaments (β = 0.87; P < .001; R2 = 0.75) and the medial meniscus (β = 0.66; P < .001; R2 = 0.58). Smaller changes in anterior laxity were also associated with increased in situ medial meniscal force at the peak applied load when the ACL was intact (β = −0.06; P < .001; R2 = 0.53). Conclusion: The secondary ligaments and the medial meniscus require greater anterior tibial translation to engage (ie, begin to carry force) relative to the ACL in knees with greater changes in anterior laxity after ACL sectioning. Moreover, with the ACL intact, the medial meniscus carries more force in knees with smaller changes in anterior laxity after ACL sectioning. Clinical Relevance: Relative tissue engagement is a new biomechanical measure to characterize in situ function of the ligaments and menisci. This measure may aid in developing more personalized surgical approaches to reduce high rates of ACL graft revision in patients with high-grade laxity.

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Section: Discussionmentioning

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity

et al. 2019

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Sex‐specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model

Howe

Cone

Piedrahita

et al. 2021

Journal Orthopaedic Research

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Pediatric anterior cruciate ligament (ACL) injuries are on the rise, and females experience higher ACL injury risk than males during adolescence. Studies in skeletally immature patients indicate differences in ACL size and joint laxity between males and females after the onset of adolescence. However, functional data regarding the ACL and its anteromedial and posterolateral bundles in the pediatric population remain rare. Therefore, this study uses a porcine model to investigate the sex‐specific morphology and biomechanics of the ACL and its bundles throughout skeletal growth. Hind limbs from male and female Yorkshire pigs aged early youth to late adolescence were imaged using magnetic resonance imaging to measure the size and orientation of the ACL and its bundles, then biomechanically tested under anterior‐posterior drawer using a robotic testing system. Joint laxity decreased (p < 0.001) while joint stiffness increased (p < 0.001) throughout skeletal growth in both sexes. The ACL was the primary stabilizer against anterior tibial loading, while the functional role of the anteromedial bundle increased with age (p < 0.001), with an earlier increase in males. ACL and posterolateral bundle cross‐sectional area and ACL and anteromedial bundle length were larger in males than females during adolescence (p < 0.01 for all), while ACL and bundle sagittal angle remained similar between sexes. Additionally, in situ ACL stiffness versus cross‐sectional area regressions were significant across skeletal growth (r2 = 0.75, p < 0.001 in males and r2 = 0.64, p < 0.001 in females), but not within age groups. This study has implications for age and sex‐specific surgical intervention strategies and suggests the need for human studies.

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Reproducibility in modeling and simulation of the knee: Academic, industry, and regulatory perspectives

Imhauser

Baumann

Liu

et al. 2023

Journal Orthopaedic Research

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Stakeholders in the modeling and simulation (M&S) community organized a workshop at the 2019 Annual Meeting of the Orthopaedic Research Society (ORS) entitled “Reproducibility in Modeling and Simulation of the Knee: Academic, Industry, and Regulatory Perspectives.” The goal was to discuss efforts among these stakeholders to address irreproducibility in M&S focusing on the knee joint. An academic representative from a leading orthopedic hospital in the United States described a multi‐institutional, open effort funded by the National Institutes of Health to assess model reproducibility in computational knee biomechanics. A regulatory representative from the United States Food and Drug Administration indicated the necessity of standards for reproducibility to increase utility of M&S in the regulatory setting. An industry representative from a major orthopedic implant company emphasized improving reproducibility by addressing indeterminacy in personalized modeling through sensitivity analyses, thereby enhancing preclinical evaluation of joint replacement technology. Thought leaders in the M&S community stressed the importance of data sharing to minimize duplication of efforts. A survey comprised 103 attendees revealed strong support for the workshop and for increasing emphasis on computational modeling at future ORS meetings. Nearly all survey respondents (97%) considered reproducibility to be an important issue. Almost half of respondents (45%) tried and failed to reproduce the work of others. Two‐thirds of respondents (67%) declared that individual laboratories are most responsible for ensuring reproducible research whereas 44% thought that journals are most responsible. Thought leaders and survey respondents emphasized that computational models must be reproducible and credible to advance knee M&S.

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New parameters describing how knee ligaments carry force in situ predict interspecimen variations in laxity during simulated clinical exams

Cited by 18 publications

References 49 publications

Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity

Engagement of the Secondary Ligamentous and Meniscal Restraints Relative to the Anterior Cruciate Ligament Predicts Anterior Knee Laxity

Sex‐specific biomechanics and morphology of the anterior cruciate ligament during skeletal growth in a porcine model

Reproducibility in modeling and simulation of the knee: Academic, industry, and regulatory perspectives

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