Laurel Kuxhaus

Proprioception after total ankle arthroplasty.

Background: Total ankle arthroplasty (TAA) is becoming an effective treatment for end-stage ankle arthritis. It is unknown if TAA alters the patients ability to sense ankle joint position. Materials and Methods: Thirteen unilateral TAA patients with a minimum of 2-years followup completed proprioceptive testing of the TAA and the contralateral side. The task was to reproduce a given ankle angle using a joystick-driven device while the lower limb was obscured from view. Nine angles were tested, including two angles in dorsiflexion, three in plantarflexion, two in inversion, and two in eversion. A repeated-measures ANOVA was used to evaluate the results. Results: No statistically significant differences between the TAA ankle and the contralateral side were found. Conclusion: TAA does not cause a change in proprioceptive abilities in arthritis patients when compared to the contralateral, unaffected side in a small sample of unilateral patients. Surgeons and rehabilitation professionals may use this information when designing rehabilitation plans following the insertion of a TAA. Level of Evidence: III, Retrospective Case Series

Validation of a Feedback-Controlled Elbow Simulator Design: Elbow Muscle Moment Arm Measurement

The Allegheny General Hospital (AGH) elbow simulator was designed to be a closed-loop physiologic simulator actuating movement in cadaveric elbow specimens via servoelectric motors that attach to the tendons of the biceps, brachialis, triceps, and pronator teres muscles. A physiologic elbow simulator should recreate the appropriate moment arms throughout the elbows range of motion. To validate this design goal, muscle moment arms were measured in three cadaver elbow specimens using the simulator. Flexion-extension moment arms of four muscles were measured at three different pronation/supination angles: fully pronated, fully supinated, and neutral; pronation-supination moment arms were measured at three different flexion-extension angles: 30 deg, 60 deg, and 90 deg. The tendon-displacement method was used in these measurements, in which the ratio of the change in musculotendon length to the change in joint angle was computed. The numeric results compared well with those previously reported; the biceps and pronator teres flexion-extension moment arms varied with pronation-supination position, and vice versa. This is one of the few reports of both flexion-extension and pronation-supination moment arms in the same specimens, and represents the first use of closed-loop feedback control in the AGH elbow simulator. The simulator is now ready for use in clinical studies such as in analyses of radial head replacement and medial ulnar collateral ligament repair. Copyright

Effects of camera switching on fine accuracy in a motion capture system.

When using optical motion capture systems, increasing the number of cameras improves the visibility. However, the software used to deal with the information fusion from multiple cameras may compromise the accuracy of the system due to camera dropout, which can vary with time. In cadaver studies of radial head motion, increasing the number of cameras used by the motion capture system seemed to decrease the accuracy of the measurements. This study investigates the cause. The hypothesis was that errors in position can be induced when markers are obscured from and then restored to a cameras viewable range, as can happen in biomechanical studies. Accuracy studies quantified the capabilities of the motion capture system with precision translation and rotation movements. To illustrate the effect that abrupt perceived changes in a markers position can have on the calculation of radial head travel, simulated motion experiments were performed. In these studies, random noise was added to simulated data, which obscured the resultant path of motion. Finally, camera-blocking experiments were performed in which precise movements were measured with a six-camera Vicon system and the errors between the actual and perceived motion were computed. During measurement, cameras were selectively blocked and restored to view. The maximum errors in translation and rotation were 3.7 mm and 0.837 deg, respectively. Repeated measures analysis of variance (ANOVAs) (alpha=0.05) confirmed that the camera-blocking influenced the results. Taken together, these results indicate that camera-switching can affect the observation of fine movements using a motion analysis system with a large number of cameras. One solution is to offer opportunity for user interaction in the software to choose the cameras used for each instant of time.

Creating Physiologically Realistic Vertebral Fractures in a Cervine Model

Approximately 50% of women and 25% of men will have an osteoporosis-related fracture after the age of 50, yet the micromechanical origin of these fractures remains unclear. Preventing these fractures requires an understanding of compression fracture formation in vertebral cancellous bone. The immediate research goal was to create clinically relevant (midvertebral body and endplate) fractures in three-vertebrae motion segments subject to physiologically realistic compressional loading conditions. Six three-vertebrae motion segments (five cervine, one cadaver) were potted to ensure physiologic alignment with the compressive load. A 3D microcomputed tomography (microCT) image of each motion segment was generated. The motion segments were then preconditioned and monotonically compressed until failure, as identified by a notable load drop (48-66% of peak load in this study). A second microCT image was then generated. These three-dimensional images of the cancellous bone structure were inspected after loading to qualitatively identify fracture location and type. The microCT images show that the trabeculae in the cervine specimens are oriented similarly to those in the cadaver specimen. In the cervine specimens, the peak load prior to failure is highest for the L4-L6 motion segment, and decreases for each cranially adjacent motion segment. Three motion segments formed endplate fractures and three formed midvertebral body fractures; these two fracture types correspond to clinically observed fracture modes. Examination of normalized-load versus normalized-displacement curves suggests that the size (e.g., cross-sectional area) of a vertebra is not the only factor in the mechanical response in healthy vertebral specimens. Furthermore, these normalized-load versus normalized-displacement data appear to be grouped by the fracture type. Taken together, these results show that (1) the loading protocol creates fractures that appear physiologically realistic in vertebrae, (2) cervine vertebrae fracture similarly to the cadaver specimen under these loading conditions, and (3) that the prefracture load response may predict the impending fracture mode under the loading conditions used in this study.

Dependence of elbow joint stiffness measurements on speed, angle, and muscle contraction level.

Elbow joint stiffness is critical to positioning the hand. Abnormal elbow joint stiffness may affect a persons ability to participate in activities of daily living. In this work, elbow joint stiffness was measured in ten healthy young adults with a device adapted from one previously used to measure stiffness in other joints. Measurements of elbow stiffness involved applying a constant-velocity rotational movement to the elbow and measuring the resultant displacement, torque, and acceleration. Elbow stiffness was then computed using a previously-established model for joint stiffness. Measurements were made at two unique elbow joint angles, two speeds, and two forearm muscle contraction levels. The results indicate that the elbow joint stiffness is significantly affected by both rotational speed and forearm muscle contraction level.

The Odocoileus virginianus Femur: Mechanical Behavior and Morphology

Biomechanical research relies heavily on laboratory evaluation and testing with osseous animal structures. While many femora models are currently in use, including those of the European red deer (Cervus elaphus), the Odocoileus virginianus femur remains undocumented, despite its regional abundance in North America. The objective of this study was to compare biomechanical and morphological properties of the Odocoileus virginianus femur with those of the human and commonly used animal models. Sixteen pairs of fresh-frozen cervine femora (10 male, 6 female, aged 2.1 ± 0.9 years) were used for this study. Axial and torsional stiffnesses (whole bone) were calculated following compression and torsion to failure tests (at rates of 0.1 mm/sec and 0.2°/sec). Lengths, angles, femoral head diameter and position, periosteal and endosteal diaphyseal dimensions, and condylar dimensions were measured. The results show that the cervine femur is closer in length, axial and torsional stiffness, torsional strength, and overall morphology to the human femur than many other commonly used animal femora models; additional morphological measurements are comparable to many other species’ femora. The distal bicondylar width of 59.3mm suggests that cervine femora may be excellent models for use in total knee replacement simulations. Furthermore, the cervine femoral head is more ovoid than other commonly-used models for hip research, making it a more suitable model for studies of hip implants. Thus, with further, more application-specific investigations, the cervine femur could be a suitable model for biomechanical research, including the study of ballistic injuries and orthopaedic device development.

Classroom Journal Club: Collaborative Study of Contemporary Primary Literature in the Biomechanics Classroom

Current engineering pedagogy primarily focuses on developing technical proficiency and problem solving skills; the peer-review process for sharing new research results is often overlooked. The use of a collaborative classroom journal club can engage students with the excitement of scientific discovery and the process of dissemination of research results, which are also important lifelong learning skills. In this work, a classroom journal club was implemented and a survey of student perceptions spanning three student cohorts was collected. In this collaborative learning activity, students regularly chose and discussed a recent biomechanics journal article, and were assessed based on specific, individual preparation tasks. Most student-chosen journal articles were relevant to topics discussed in the regular class lecture. Surveys assessed student perceptions of the activity. The survey responses show that, across all cohorts, students both enjoyed the classroom journal club and recognized it as an important learning experience. Many reported discussing their journal articles with others outside of the classroom, indicating good engagement. The results demonstrate that student engagement with primary literature can foster both technical knowledge and lifelong learning skills.

Cervine Tibia Morphology and Mechanical Strength: A Suitable Tibia Model?

Animal models for orthopaedic implant testing are well-established but morphologically dissimilar to human tibiae; notably, most are shorter. The purpose of this study was to quantitatively evaluate the morphology and mechanical properties of the cervine tibia, particularly with regard to its suitability for testing orthopaedic implants. Two endosteal and eleven periosteal measurements were made on 15 cervine tibiae. The mechanical strength in axial compression and torsion was measured using 11 tibiae. The cervine tibia is morphologically similar to the human tibia and more closely matches the length of the human tibia than current tibia models (ovine, porcine, and caprine). The distal epiphysis dimensions are notably different, but no more so than the current tibia models. The torsional stiffness of the cervine tibia is within the range of previously reported values for human tibiae. Furthermore, in many regions, cervine tibiae are abundant and locally available at a low cost. Given these mechanical and morphological data, coupled with potential cost savings if regionally available, the cervine tibia may be an appropriate model for orthopaedic implant testing.

Ring apophysis fractures induced by low-load low-angle repetitive flexion in an ex-vivo cervine model

Ring apophysis fractures of the spine occur in physically-active adolescents causing low back pain and the potential for chronic pain. Many of these fractures occur without memorable trauma, suggesting that the fractures occur during everyday movements and activities. The benign nature of this poorly understood potential mechanism of injury hampers appropriate diagnosis and early treatment. The purpose of this study was to establish an ex-vivo model of ring apophysis fracture and demonstrate that these fractures can be initiated by repetitive non-traumatic loading. Six 5-vertebra cervine lumbar (L1-L5) motion segments were cyclically loaded in low-angle low-load flexion (to 15° flexion, with peak load of 230±50N), a representative movement component of daily activities for both human and deer lumbar spines. Pinned end conditions replicated physiologically realistic loading. Ring apophysis fractures were created under low-load low-angle conditions in healthy vertebrae of similar bone mineral density and a similar degree of skeletal maturity to adolescent humans. All specimens developed ring apophysis fractures, some as early as 1400 cycles. The load-displacement data, and hysteresis loops during the cyclic loading, suggest that the fractures occurred gradually, i.e., without trauma. The ease at which these fractures were created suggests that ring apophysis fractures may be more prevalent than current diagnosis rates. Therefore, clinically, healthcare providers should include the potential for ring apophysis fracture in the differential diagnosis of all physically-active adolescents who present with back pain.

Cyclic cryopreservation affects the nanoscale material properties of trabecular bone

Tissues such as bone are often stored via freezing, or cryopreservation. During an experimental protocol, bone may be frozen and thawed a number of times. For whole bone, the mechanical properties (strength and modulus) do not significantly change throughout five freeze-thaw cycles. Material properties at the trabecular and lamellar scales are distinct from whole bone properties, thus the impact of freeze-thaw cycling at this scale is unknown. To address this, the effect of repeated freezing on viscoelastic material properties of trabecular bone was quantified via dynamic nanoindentation. Vertebrae from five cervine spines (1.5-year-old, male) were semi-randomly assigned, three-to-a-cycle, to 0-10 freeze-thaw cycles. After freeze-thaw cycling, the vertebrae were dissected, prepared and tested. ANOVA (factors cycle, frequency, and donor) on storage modulus, loss modulus, and loss tangent, were conducted. Results revealed significant changes between cycles for all material properties for most cycles, no significant difference across most of the dynamic range, and significant differences between some donors. Regression analysis showed a moderate positive correlation between cycles and material property for loss modulus and loss tangent, and weak negative correlation for storage modulus, all correlations were significant. These results indicate that not only is elasticity unpredictably altered, but also that damping and viscoelasticity tend to increase with additional freeze-thaw cycling.