Arthur F. T. Mak

The Apparent Viscoelastic Behavior of Articular Cartilage—The Contributions From the Intrinsic Matrix Viscoelasticity and Interstitial Fluid Flows

Articular cartilage was modeled rheologically as a biphasic poroviscoelastic material. A specific integral-type linear viscoelastic model was used to describe the constitutive relation of the collagen-proteoglycan matrix in shear. For bulk deformation, the matrix was assumed either to be linearly elastic, or viscoelastic with an identical reduced relaxation spectrum as in shear. The interstitial fluid was considered to be incompressible and inviscid. The creep and the rate-controlled stress-relaxation experiments on articular cartilage under confined compression were analyzed using this model. Using the material data available in the literature, it was concluded that both the interstitial fluid flow and the intrinsic matrix viscoelasticity contribute significantly to the apparent viscoelastic behavior of this tissue under confined compression.

Estimating the effective Young's modulus of soft tissues from indentation tests—nonlinear finite element analysis of effects of friction and large deformation

A nonlinear finite element model was developed to investigate the biomechanics of indentation, particularly the influence of friction and large deformation on the calculation of the effective Youngs modulus from the cylindrical, flat-ended indentation test of soft tissues. A new kappa table was given for calculation of the effective Youngs modulus to account for the effects of layered geometry with consideration of the larger deformation. The results indicate that the effect of friction on the calculation of Youngs modulus becomes significant with a large aspect ratio and with a large Poissons ratio. It is found that the factor kappa increases almost proportionally to the increase of the indentation depth, especially obvious with a larger Poissons ratio v and a larger aspect ratio a/h.

An ultrasound indentation system for biomechanical properties assessment of soft tissues in-vivo

An ultrasound indentation system for biomechanical assessment of soft tissues in vivo was developed. The pen-size, hand-held probe was composed of an ultrasound transducer and a load cell. The ultrasound transducer was at the tip of the probe serving also as the indentor. The thickness and deformation of the soft tissue layer were determined from the ultrasound echo. A compressive load cell was connected in series with the ultrasound transducer to record the force response. A validation experiment was performed on porcine tissues. Force and deformation acquired with the present system was in good comparison with those obtained from a Housfield material testing machine. Material constants were obtained via a curve-fitting procedure by predicting the force transient response from the deformation-time data using a quasilinear viscoelastic model. In addition, deformation in the fat and in the muscle could be differentiated. The potential applications of this type of indentation probes are many. The specific application of this current development is for stump tissue assessment in the design of prosthetics.

BIOMECHANICAL ASSESSMENT OF PLANTAR FOOT TISSUE IN DIABETIC PATIENTS USING AN ULTRASOUND INDENTATION SYSTEM

The biomechanical properties of plantar tissues were investigated for four older neuropathic diabetic patients and four healthy younger subjects. Indentation tests were performed at four high-pressure areas with three postures in each subject. The tissue thickness and effective Youngs modulus were measured by an ultrasound (US) indentation system. The system comprised a pen-size probe having a US transducer at the tip and a load cell connected in series with it. Results showed that the plantar soft tissues of the elderly diabetic patients were significantly stiffer and thinner when compared with the healthy young subjects. For the diabetic subjects tested, the Youngs modulus at the 1st metatarsal head was significantly larger than those at the other three sites. This site-dependence was not observed in the healthy young subjects. The plantar tissue became significantly stiffer in the healthy young subjects as a result of posture changes. This posture-dependence of the Youngs modulus was not established for the elderly diabetic group.

Effective elastic properties for lower limb soft tissues from manual indentation experiment

Quantitative assessment of the biomechanical properties of limb soft tissues has become more important during the last decade because of the introduction of computer-aided design and computer-aided manufacturing (CAD/CAM) and finite element analysis to the prosthetic socket design. Because of the lack of a clinically easy-to-use apparatus, the site and posture dependences of the material properties of lower limb soft tissues have not been fully reported in the literature. In this study, an ultrasound indentation system with a pen-size hand-held probe developed earlier by the authors was used to obtain the indentation responses of lower limb soft tissues. Indentation tests were conducted on normal young subjects with four females and four males at four sites with three body postures. A linear elastic indentation solution was used to extract the effective Youngs modulus from the indentation responses. The determined modulus ranged from 10.4 to 89.2 kPa for the soft tissues tested. These results were in a similar range as those reported in the literature. The thickness of the lower limb soft tissues varied slightly with body posture changes. The Youngs modulus determined was demonstrated to be significantly dependent on site, posture, subject and gender. The overall mean modulus of male subjects was 40% larger than that of female subjects. No significant correlation was established between the effective Youngs modulus and the thickness of entire soft tissue layers.

Unconfined compression of hydrated viscoelastic tissues: a biphasic poroviscoelastic analysis.

A biphasic poroviscoelastic theory was used to analyze the unconfined compression creep and stress relaxation of a hydrated viscoelastic tissue. The intrinsic shear properties of the tissue matrix was described by an integral-type viscoelastic constitutive law while the intrinsic bulk property of the matrix was assumed to be linearly elastic. Parametric data were presented to show how the two major energy dissipative mechanisms, namely the interstitial fluid flow and the intrinsic matrix viscoelasticity, may each contribute to the apparent viscoelastic behavior of the whole tissue under unconfined compression. The hydraulic permeability of the tissue was found to enter in only as a scaling factor for time.

Biomechanics of pressure ulcer in body tissues interacting with external forces during locomotion.

Forces acting on the body via various external surfaces during locomotion are needed to support the body under gravity, control posture, and overcome inertia. Examples include the forces acting on the body via the seating surfaces during wheelchair propulsion, the forces acting on the plantar foot tissues via the insole during gait, and the forces acting on the residual-limb tissues via the prosthetic socket during various movement activities. Excessive exposure to unwarranted stresses at the body-support interfaces could lead to tissue breakdowns commonly known as pressure ulcers, often presented as deep-tissue injuries around bony prominences or as surface damage on the skin. In this article, we review the literature that describes how the involved tissues respond to epidermal loading, taking into account both experimental and computational findings from in vivo and in vitro studies. In particular, we discuss related literature about internal tissue deformation and stresses, microcirculatory responses, and histological, cellular, and molecular observations.

A one-step method to fabricate PLLA scaffolds with deposition of bioactive hydroxyapatite and collagen using ice-based microporogens

Porous poly(l-lactic acid) (PLLA) scaffolds with bioactive coatings were prepared by a novel one-step method. In this process, ice-based microporogens containing bioactive molecules, such as hydroxyapatite (HA) and collagen, served as both porogens to form the porous structure and vehicles to transfer the bioactive molecules to the inside of PLLA scaffolds in a single step. Based on scanning electron microscopy, energy-dispersive X-ray spectroscopy, X-ray diffraction and Fourier transform infrared spectroscopy analysis, the bioactive components were found to be transferred successfully from the porogens to PLLA scaffolds evenly. Osteoblast cells were used to evaluate the cellular behaviors of the composite scaffolds. After culturing for 8days, MTT assay and alkaline phosphatase activity results suggested that HA/collagen could improve the interactions between osteoblast cells and the polymeric scaffold.

A Biphasic Poroelastic Analysis of the Flow Dependent Subcutaneous Tissue Pressure and Compaction Due to Epidermal Loadings: Issues in Pressure Sore

A layer of skin and subcutaneous tissue on a bony substratum was modeled as a homogeneous layer of biphasic poroelastic material with uniform thickness. The epidermal surface and the bony interface were taken to be impervious. The soft tissue on the bony interface was assumed either fully adhered or completely free to slide on the bone. The cases for surface pressure loadings and displacement controlled indentations were simulated. The resultant biomechanical responses of the layer, including the transient tissue hydrostatic pressure and the tissue compaction, were presented. A new hypothesis is offered to interpret the threshold pressure-time curve for pressure sores in term of the time required for a particular area in the tissue layer to reach a critical compaction for a given level of applied pressure.

Muscle apoptosis is induced in pressure-induced deep tissue injury.

Pressure ulcer is a complex and significant health problem. Although the factors including pressure, shear, and ischemia have been identified in the etiology of pressure ulcer, the cellular and molecular mechanisms that contribute to the development of pressure ulcer are unclear. This study tested the hypothesis that the early-onset molecular regulation of pressure ulcer involves apoptosis in muscle tissue. Adult Sprague-Dawley rats were subjected to an in vivo protocol to mimic pressure-induced deep tissue injury. Static pressure was applied to the tibialis region of the right limb of the rats for 6 h each day on two consecutive days. The compression force was continuously monitored by a three-axial force transducer equipped in the compression indentor. The contralateral uncompressed limb served as intra-animal control. Tissues underneath the compressed region were collected for histological analysis, terminal dUTP nick-end labeling (TUNEL), cell death ELISA, immunocytochemical staining, and real-time RT-PCR gene expression analysis. The compressed muscle tissue generally demonstrated degenerative characteristics. TUNEL/dystrophin labeling showed a significant increase in the apoptotic muscle-related nuclei, and cell death ELISA demonstrated a threefold elevation of apoptotic DNA fragmentation in the compressed muscle tissue relative to control. Positive immunoreactivities of cleaved caspase-3, Bax, and Bcl-2 were evident in compressed muscle. The mRNA contents of Bax, caspase-3, caspase-8, and caspase-9 were found to be higher in the compressed muscle tissue than control. These results demonstrated that apoptosis is activated in muscle tissue following prolonged moderate compression. The data are consistent with the hypothesis that muscle apoptosis is involved in the underlying mechanism of pressure-induced deep tissue injury.