Optimal graft stiffness and pre-strain restore normal joint motion and cartilage responses in ACL reconstructed knee

Halonen, Kimmo; Mononen, Mika E.; Töyräs, Juha; Kröger, Heikki; Korhonen, Rami K.

doi:10.1016/j.jbiomech.2016.05.002

Cited by 49 publications

(62 citation statements)

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“…Although we did not perform ACL reconstruction in the current study, the variation in ACL stiffness after 24 weeks of healing, which also correlated with gross cartilage damage, adds support to the hypothesis that post‐operative ACL (and/or graft) stiffness modulates stifle contact mechanics. Recent work by Halonen et al further supports this view, whereby the authors used finite element modeling to demonstrate that ACL grafts with stiffness properties closest to those of the native ACL restored tibiofemoral contact mechanics, regardless of the reconstruction technique . That is, ACL graft stiffness had the greatest bearing on contact mechanics.…”

Section: Discussionmentioning

confidence: 92%

“…Recent work by Halonen et al further supports this view, whereby the authors used finite element modeling to demonstrate that ACL grafts with stiffness properties closest to those of the native ACL restored tibiofemoral contact mechanics, regardless of the reconstruction technique. 35 That is, ACL graft stiffness had the greatest bearing on contact mechanics. In light of the results by Halonen et al and those of our current study, recapitulating native ACL stiffness may be required to mitigate long-term degenerative changes in the ACL-injured joint.…”

Section: Discussionmentioning

confidence: 99%

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Cartilage Damage Is Related to ACL Stiffness in a Porcine Model of ACL Repair

Beveridge

Proffen

Karamchedu

et al. 2019

Journal Orthopaedic Research

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Inferior anterior cruciate ligament (ACL) structural properties may inadequately restrain tibiofemoral joint motion following surgery, contributing to the increased risk of post‐traumatic osteoarthritis. Using both a direct measure of ACL linear stiffness and an in vivo magnetic resonance imaging (MRI) T2*‐based prediction model, we hypothesized that cartilage damage and ACL stiffness would increase over time, and that an inverse relationship between cartilage damage and ACL stiffness would emerge at a later stage of healing. After either 6, 12, or 24 weeks (w) of healing after ACL repair, ACL linear stiffness was determined from the force–displacement relationship during tensile testing ex vivo and predicted in vivo from the MRI T2*‐based multiple linear regression model in 24 Yucatan minipigs. Tibiofemoral cartilage was graded postmortem. There was no relationship between cartilage damage and ACL stiffness at 6 w (R2 = 0.04; p = 0.65), 12 w (R2 = 0.02; p = 0.77), or when the data from all animals were pooled (R2 = 0.02; p = 0.47). A significant inverse relationship between cartilage damage and ACL stiffness based on both ex vivo measurement (R2 = 0.90; p < 0.001) and in vivo MRI prediction (R2 = 0.78; p = 0.004) of ACL stiffness emerged at 24 w. This result suggests that 90% of the variability in gross cartilage changes is associated with the repaired ACL linear stiffness at 6 months of healing. Clinical Significance: Techniques that provide a higher stiffness to the repaired ACL may be required to mitigate the post‐traumatic osteoarthritis commonly seen after ACL injury, and MRI T2* can be used as a noninvasive estimation of ligament stiffness. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2249–2257, 2019

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Cartilage Damage Is Related to ACL Stiffness in a Porcine Model of ACL Repair

Beveridge

Proffen

Karamchedu

et al. 2019

Journal Orthopaedic Research

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“…Other studies have included realistic geometries of ligaments, but cartilage and menisci were treated as linear elastic materials 14 , 20 . Models with more complicated properties for cartilage have not typically incorporated fibril-reinforced biphasic properties for ligaments during dynamic gait 21 , 22 .…”

Section: Introductionmentioning

confidence: 99%

The effect of constitutive representations and structural constituents of ligaments on knee joint mechanics

Orozco

Tanska

Mononen

et al. 2018

Sci Rep

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Ligaments provide stability to the human knee joint and play an essential role in restraining motion during daily activities. Compression-tension nonlinearity is a well-known characteristic of ligaments. Moreover, simpler material representations without this feature might give reasonable results because ligaments are primarily in tension during loading. However, the biomechanical role of different constitutive representations and their fibril-reinforced poroelastic properties is unknown. A numerical knee model which considers geometric and material nonlinearities of meniscus and cartilages was applied. Five different constitutive models for the ligaments (spring, elastic, hyperelastic, porohyperelastic, and fibril-reinforced porohyperelastic (FRPHE)) were implemented. Knee joint forces for the models with elastic, hyperelastic and porohyperelastic properties showed similar behavior throughout the stance, while the model with FRPHE properties exhibited lower joint forces during the last 50% of the stance phase. The model with ligaments as springs produced the lowest joint forces at this same stance phase. The results also showed that the fibril network contributed substantially to the knee joint forces, while the nonfibrillar matrix and fluid had small effects. Our results indicate that simpler material models of ligaments with similar properties in compression and tension can be used when the loading is directed primarily along the ligament axis in tension.

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“…), the pathogenesis of osteoarthritis (OA) is influenced by the local biomechanical loading environment of the joint . With regard to the knee joint, anterior cruciate ligament (ACL) rupture, meniscectomy, malalignment, or overweight have been shown to change knee joint mechanics and to highly increase the prevalence and progression of gonarthrosis . Unfortunately, until today we are unable to distinguish between functional and pathomechanical joint loading patterns or to detect early critical events in cartilage metabolism.…”

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confidence: 99%

Effect of increased mechanical knee joint loading during running on the serum concentration of cartilage oligomeric matrix protein (COMP)

Firner

Willwacher

Marées

et al. 2018

Journal Orthopaedic Research

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The purpose of the study was to investigate the effect of an increase in mechanical knee joint loading during running on the serum COMP level. On two different test days, 20 healthy men ran with knee orthoses for 30 min on a treadmill (v = 2.2 m/s). On day 1, the orthoses were passive, whereas on day 2 they were pneumatically driven (active) and thus increased the external knee flexion moments (+30.9 Nm) during stance phase. Lower-limb mechanics and serum COMP levels (baseline; 0, 0.5, 1, 2 h post running) were analyzed. COMP levels increased immediately after running with passive (+35%; pre: 7.5 U/l, 95%CI: 6.4, 8.7, post: 9.8 U/l, 95%CI: 8.8, 10.8, p < 0.001) and active orthoses (+45%; pre: 7.6 U/l; 95%CI: 6.4, 8.8, post: 10.3 U/l, 95%CI: 9.2, 11.5, p < 0.001), but they did not differ between interventions. While running with active orthoses, greater ankle dorsiflexion angles, knee flexion angles, and moments occurred (p < 0.05). Comparing both interventions, the Δ COMP pre-post, meaning the difference (Δ) between running with active and passive orthoses in pre to post COMP level change (=level after (post) running minus level before (pre) running), correlated negatively with Δ COMP baseline (difference between the baseline COMP level before running with active and passive orthoses, r = -0.616; p = 0.004), and with a positive tendence with the Δ maximum knee flexion (r = 0.388; p = 0.091). Therefore, changes in COMP concentration after physical activity seem to be highly influenced by the COMP baseline level. In addition, correlation analysis indicates that modifications in knee joint kinematics have a greater effect on cartilage metabolism than an increase in joint moments. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1937-1946, 2018.

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Optimal graft stiffness and pre-strain restore normal joint motion and cartilage responses in ACL reconstructed knee

Cited by 49 publications

References 50 publications

Cartilage Damage Is Related to ACL Stiffness in a Porcine Model of ACL Repair

Cartilage Damage Is Related to ACL Stiffness in a Porcine Model of ACL Repair

The effect of constitutive representations and structural constituents of ligaments on knee joint mechanics

Effect of increased mechanical knee joint loading during running on the serum concentration of cartilage oligomeric matrix protein (COMP)

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