The role of menisci in knee contact mechanics and secondary kinematics during human walking

Chen

et al. 2020

Self Cite

Bi-cruciate retaining total knee arthroplasty has several potential advantages including improved anteroposterior knee stability compared to contemporary posterior cruciate-retaining total knee arthroplasty. However, few studies have explored whether there is significant differences of knee biomechanics following bi-cruciate retaining total knee arthroplasty compared to posterior cruciate-retaining total knee arthroplasty. In the present study, subject-specific lower extremity musculoskeletal multi-body dynamics models for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty were developed based on the musculoskeletal modeling framework using force-dependent kinematics method and validated against in vivo telemetric data. The experiment data of two subjects who underwent total knee arthroplasty were obtained for the SimTK “Grand Challenge Competition” repository, and integrated into the musculoskeletal model. Five walking gait trials for each subject were used as partial inputs for the model to predict the knee biomechanics for bi-cruciate retaining, bi-cruciate retaining without anterior cruciate ligament, and posterior cruciate-retaining total knee arthroplasty. The results revealed significantly greater range of anterior/posterior tibiofemoral translation, and significantly more posterior tibial location during the early phase of gait and more anterior tibial location during the late phase of gait were found in bi-cruciate retaining total knee arthroplasty without anterior cruciate ligament when compared to the bi-cruciate retaining total knee arthroplasty. No significant differences in tibiofemoral contact forces, rotations, translations, and ligament forces between bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty during normal walking gait, albeit slight differences in range of tibiofemoral internal/external rotation and anterior/posterior translation were observed. The present study revealed that anterior cruciate ligament retention has a positive effect on restoring normal knee kinematics in bi-cruciate retaining total knee arthroplasty. Preservation of anterior cruciate ligament in total knee arthroplasty and knee implant designs interplay each other and both contribute to restoring normal knee kinematics in different types of total knee arthroplasty. Further evaluation of more demanding activities and subject data from patients with bi-cruciate retaining and posterior cruciate-retaining total knee arthroplasty via musculoskeletal modeling may better highlight the role of the anterior cruciate ligament and its stabilizing influence.

Section: Methodsmentioning

confidence: 99%

“…23,24 The segments and isometric muscle strength of each muscle model were scaled using a length-mass-fat scaling method according to the subject’s weight and height. 22 Further details on MSK modeling of TKA can be found in previous studies. 18,25…”

Section: Methodsmentioning

confidence: 99%

Leveraging subject-specific musculoskeletal modeling to assess effect of anterior cruciate ligament retaining total knee arthroplasty during walking gait

Chen

et al. 2020

Self Cite

“…They pointed out that a subject-specific MSK modeling was essential to develop for clinical purpose with pathologic patients or altered kinetic properties. Recently, based on a subjectspecific MSK multibody dynamics (MD) model, 16 many studies [17][18][19] have been conducted to predict knee joint biomechanics. Sanford et al 17 used the Twente lower extremity model (TLEM) 20 to estimate the tibiofemoral joint (TFJ) forces of gait after ACL reconstruction.…”

Section: Introductionmentioning

confidence: 99%

“…Sanford et al 17 used the Twente lower extremity model (TLEM) 20 to estimate the tibiofemoral joint (TFJ) forces of gait after ACL reconstruction. Based on the generic model derived from the TLEM, Hu et al 18 developed two lower extremity MSK MD models with or without menisci to investigate the knee contact mechanics and secondary kinematics. The result showed that menisci played an important role in joint load distribution and kinematic constraints in posterior and medial direction.…”

Section: Introductionmentioning

confidence: 99%

Anterior cruciate ligament deficiency combined with lateral and/or medial meniscal injury results in abnormal kinematics and kinetics during level walking

Liu

Huang

Yin

et al. 2019

Anterior cruciate ligament injuries are commonly combined with meniscal tears. This study was performed to analyze the kinematics and kinetics of knees with anterior cruciate ligament deficiency with or without a combined medial or/and lateral meniscal injury during level walking. In all, 29 patients with unilateral anterior cruciate ligament deficiency and 15 healthy male volunteers were recruited. Among these patients, 12 had isolated unilateral anterior cruciate ligament injuries (ACLD group), 5 had combined anterior cruciate ligament and lateral meniscal injuries (ACLDL group), 5 had combined anterior cruciate ligament and medial meniscal injuries (ACLDM group), and 7 had combined anterior cruciate ligament and medial/lateral meniscal injuries (ACLDML group). A subject-specific musculoskeletal multibody dynamics model was utilized to estimate the tibiofemoral joint kinematic and kinetic behaviors based on the experimental data measured by using an optical tracking system. Regardless of the presence or absence of meniscal injury, the knees with anterior cruciate ligament deficiency exhibited significantly less extension than the control knees at the terminal stance (range of extension: ACLD, 4.84° ± 4.31°; ACLDL, 6.65° ± 5.73°; ACLDM, 5.21° ± 4.77°; ACLDML, 6.91° ± 4.30°; control, 12.35° ± 5.52°; P < 0.05). A lower extension moment and adduction moment in all anterior cruciate ligament deficiency affected knees were detected during the terminal stance when compared with control knees ( P < 0.05). The ACLDML group showed significantly lower proximal-distal compressive forces and anterior-posterior shear forces (approximately 0.5–1.5 body weight; P < 0.05) compared to the other 4 groups, while the anterior-posterior and medial-lateral shear forces tended to increase in the ACLD, ACLDL, and ACLDM groups at the mid to terminal stance. Significant lower adduction-abduction and internal-external moment peaks were observed in ACLDML groups, but not in the ACLD, ACLDL and ACLDM groups. These results indicate that the combination of an anterior cruciate ligament injury and meniscal injury could alter the kinematics and kinetics of anterior cruciate ligament deficiency affected knees depending on the presence and type of the meniscal tear.

“…25,32,33 A length-mass-fat scaling method according to the subject's weight and height was used for scaling the segments and isometric muscle strength of each muscle model. 25,34 Further modeling details can be found in previous studies. 25,35 A new knee joint model with 11 degrees of freedoms and deformable contact models of the artificial knee joint were used based on the force-dependent kinematics (FDK) method instead of the simplified knee joint in the generic MSK model.…”

Section: Methodsmentioning

confidence: 99%

Patient-specific musculoskeletal models as a framework for comparing ACL function in unicompartmental versus bicruciate retaining arthroplasty

Chen

et al. 2021

Self Cite

Unicompartmental knee arthroplasty has been shown to provide superior functional outcomes compared to total knee arthroplasty and have motivated development of advanced implant designs including bicruciate retaining knee arthroplasty. However, few validated frameworks are available to directly compare the effect of implant design and surgical techniques on ligament function and joint kinematics. In the present study, the subject-specific lower extremity models were developed based on musculoskeletal modeling framework using force-dependent kinematics method, and validated against in vivo telemetric data. The experiment data of two subjects who underwent TKA were obtained from the SimTK “Grand Challenge Competition” repository, and integrated into the subject-specific lower extremity model. Five walking gait trials and three different knee implant models for each subject were used as partial inputs for the model to predict knee biomechanics for unicompartmental, bicruciate retaining, and total knee arthroplasty. The results showed no significant differences in the tibiofemoral contact forces or angular kinematic parameters between three groups. However, unicompartmental knee arthroplasty demonstrated significantly more posterior tibial location between 0% and 40% of the gait cycle ( p < 0.017). Significant differences in range of tibiofemoral anterior/posterior translation and medial/lateral translation were also observed between unicompartmental and bicruciate retaining arthroplasty ( p < 0.017). Peak values of anterior cruciate ligament forces differed between unicompartmental and bicruciate retaining arthroplasty from 10% to 30% of the gait cycle. Findings of this study indicate that unicompartmental and bicruciate retaining arthroplasty do not have identical biomechanics and point to the complementary role of anterior cruciate ligament and articular geometry in guiding knee function. Further, the patient-specific musculoskeletal model developed provides a reliable framework for assessing new implant designs, and effect of surgical techniques on knee biomechanics following arthroplasty.