Shizhu Wen

The effect of the variation in ACL constitutive model on joint kinematics and biomechanics under different loads: a finite element study.

The biomechanics and function of the anterior cruciate ligament (ACL) have been widely studied using both experimental and simulation methods. It is known that a constitutive model of joint tissue is a critical factor in the numerical simulation. Some different ligament constitutive models have been presented to describe the ACL material behavior. However, the effect of the variation in the ligament constitutive model on joint kinematics and biomechanics has still not been studied. In this paper, a three-dimensional finite element model of an intact tibiofemoral joint was reconstructed. Three ACL constitutive models were compared under different joint loads (such as anterior tibial force, varus tibial torque, and valgus tibial torque) to investigate the effect of the change of the ACL constitutive model. The three constitutive models corresponded to an isotropic hyperelasticity model, a transversely isotropic hyperelasticity model with neo-Hookean ground substance description, and a transversely isotropic hyperelastic model with nonlinear ground substance description. Although the material properties of these constitutive equations were fitted on the same uniaxial tension stress-strain curve, the change of the ACL material constitutive model was found to induce altered joint kinematics and biomechanics. The effect of different ACL constitutive equations on joint kinematics depended on both deformation direction and load type. The variation in the ACL constitutive models would influence the joint kinematic results greatly in both the anterior and internal directions under anterior tibial force as well as some other deformations such as the anterior and medial tibial translations under valgus tibial torque, and the medial tibial translation and internal rotation under varus torque. It was revealed that the transversely isotropic hyperelastic model with nonlinear ground substance description (FE model III) was the best representation of the realistic ACL property by a linear regression between the simulated and the experiment deformation results. But the comparison of the predicted and experiment force of ligaments showed that all the three ACL constitutive models represented similar force results. The stress value and distribution of ACL were also altered by the change in the constitutive equation. In brief, although different ACL constitutive models have been fitted using the same uniaxial tension curve and have the similar longitudinal material property, the ACL constitutive equation should still be carefully chosen to investigate joint kinematics and biomechanics due to the different transverse material behavior.

A quantitative study of the relationship between the distribution of different types of collagen and the mechanical behavior of rabbit medial collateral ligaments.

The mechanical properties of ligaments are key contributors to the stability and function of musculoskeletal joints. Ligaments are generally composed of ground substance, collagen (mainly type I and III collagen), and minimal elastin fibers. However, no consensus has been reached about whether the distribution of different types of collagen correlates with the mechanical behaviors of ligaments. The main objective of this study was to determine whether the collagen type distribution is correlated with the mechanical properties of ligaments. Using axial tensile tests and picrosirius red staining-polarization observations, the mechanical behaviors and the ratios of the various types of collagen were investigated for twenty-four rabbit medial collateral ligaments from twenty-four rabbits of different ages, respectively. One-way analysis of variance was used in the comparison of the Youngs modulus in the linear region of the stress-strain curves and the ratios of type I and III collagen for the specimens (the mid-substance specimens of the ligaments) with different ages. A multiple linear regression was performed using the collagen contents (the ratios of type I and III collagen) and the Youngs modulus of the specimens. During the maturation of the ligaments, the type I collagen content increased, and the type III collagen content decreased. A significant and strong correlation () was identified by multiple linear regression between the collagen contents (i.e., the ratios of type I and type III collagen) and the mechanical properties of the specimens. The collagen content of ligaments might provide a new perspective for evaluating the linear modulus of global stress-strain curves for ligaments and open a new door for studying the mechanical behaviors and functions of connective tissues.

A review on research on development of ligament constitutive relations on macro, meso, and micro levels

Ligaments are densely connective soft tissues capable of maintaining stability and function of knee joint. As an important factor, the constitutive relation of ligament would affect its biomechanics and further play an essential role in the research on ligament injury, healing and treatment. The objective of this paper is to provide an overview of the current research on ligament constitutive relations on the macro, meso, and micro levels as well as the anatomy and histological structure of ligament. Some studies of biomechanical behaviors during ligament injury and healing periods have also been investigated. Based on the research on ligament constitutive relation in the past three decades, a discussion of some research perspectives is also presented, such as a validated accurate measuring method of in situ strain in ligament, a new constitutive relation involving the distribution of ultra-structural properties, and a rational estimation of ligament injury and healing process by the change of its ultra-structural or histological characteristics.

The effect of healing in the medial collateral ligament of human knee joint: A three-dimensional finite element analysis.

The medial collateral ligament (MCL) is one of the main ligaments that provide knee joint with major restraints against valgus, internal, and external torque loads. The MCL injury most frequently occurs near its femoral attachment but can be healed spontaneously. Hence, the usual clinical treatment for MCL injury is conservative therapy with early controlled rehabilitation motion. However, the effect of the variations in the healing conditions of the MCL portion (i.e. near the femoral insertion) is still unclear. In this study, finite element tibiofemoral joint models with three different MCL healing conditions were analyzed under six kinds of joint loads, such as 10 and 20u2009N·m valgus tibial torques, 5 and 10u2009N·m internal tibial torques, and 5 and 10u2009N·m external tibial torques. The three healing conditions corresponded to the early, medium, and final (i.e. healthy) stages of the healing period, respectively. It was found that different MCL healing conditions greatly affected the main joint kinematics under valgus tibial torques, but neither the reaction force nor stress results of the MCL. The peak strain values in the MCL healing portion changed greatly under all the six loads. Moreover, all the joint kinematics, strain results, and reaction force of the MCL at the medium stage were similar to those in the healthy joint, that is, at the final healing stage. These imply that the partially healed MCL might be enough for providing the restraints for knee joints and would not lead to some high strains occurring in the MCL.

An update on the constitutive relation of ligament tissues with the effects of collagen types

The musculoskeletal ligament is a kind of multiscale composite material with collagen fibers embedded in a ground matrix. As the major constituent in ligaments to bear external loads, collagens are composed mainly of two collagen contents with different mechanical properties, i.e., types I and III collagen. The constitutive relation of ligaments plays a critical role in the stability and normal function of human joints. However, collagen types have not been distinguished in the previous constitutive relations. In this paper a constitutive relation for ligament tissues was modified based on the previous constitutive relation by considering the effects of collagen types. Both the collagen contents and the mechanical properties of sixteen ligament specimens from four cadaveric human knee joints were measured for determining their material coefficients in the constitutive relation. The mechanical behaviors of ligaments were obtained from both the uniaxial tensile and simple shear tests. A linear regression between joint kinematic results from in vitro and in silico experiments was made to validate the accuracy of this constitutive relation. The high correlation coefficient (R(2)=0.93) and significance (P<0.0001) of the regression equation revealed that this modified constitutive relation of ligaments was accurate to be used in studying joint biomechanics. Another finite element analysis with collagen contents changing demonstrated that the effect of variations in collagen ratios on both joint kinematics and ligament biomechanics could be simulated by this constitutive relation.

A comparison of material characterizations in frequently used constitutive models of ligaments

Longitudinal tensile and simple shear stress-strain curves of human medial collateral ligaments (MCL) were fitted by six frequently used constitutive relations of ligaments using two different fitting methods for determining which was the best fitting method and the most preferable constitutive model for describing the ligament properties. According to the results of fitting goodness, two typical constitutive models were further analyzed by FEM to investigate the effect of the variation in MCL constitutive models under some physiological loads (i.e., 4.5u2009Nm external tibial and 10u2009Nm valgus tibial torques). It was found that different fitting methods induced great variations in describing the simple shear behavior whereas no obvious difference in the longitudinal tensile behavior. The most accurate description of both the longitudinal tensile and simple shear behaviors was obtained from the constitutive model with ground substance defined by an exponential function when the parameters were fitted by the two test data, respectively. Although the distributions of maximal principal stress were almost the same, the variation in MCL constitutive models affected the highest value of the stress greatly when MCL was under the complex physiological loads.

The effect of the material property change of anterior cruciate ligament by ageing on joint kinematics and biomechanics under tibial varus/valgus torques

It is known that the anterior cruciate ligament (ACL) plays a role in providing joint stabilities under tibial varus/valgus torques and the material behavior of the ACL has changed with ageing. However, the effect of this variation of the ACL material property on joint kinematics and biomechanics under tibial varus/valgus torques has still not been clarified.In this paper, three finite element (FE) models of an intact tibiofemoral joint were reconstructed with different ACL material properties, corresponding to the ACL on the younger, middle and older ages, respectively. The joint kinematics, the stress distribution and resultant force of the ACL were obtained under a tibial varus or valgus torque load. It was found that the variation in the ACL material property would result in great changes in some joint displacements (i.e., the tibial anterior translation and external rotation). The maximal stress value in the ACL had also altered while the stress distribution did not varied obviously. The great change in the tibial anterior translation illustrated that ACL played an important role against varus/valgus torques by controlling the coupled tibial anterior translation//external rotation rather than the corresponding varus/valgus rotation.

A quantitative comparison of morphological and histological characteristics of collagen in the rabbit medial collateral ligament

Collagen fiber is one of the critical factors in determining mechanical properties of ligaments and both the morphological and histological characteristics of collagen have been widely studied. However, there was still no consensus about whether the morphological characteristics of collagen correlated with its histological characteristics in physiological ligaments. Rabbit medial collateral ligaments (MCLs) were measured under a transmission electron microscope and a polarized light microscope plus picrosirius red-staining to obtain the distributions of collagen fibril diameters and types at different anatomical sites of rabbit MCLs, respectively. The correlation between the fibril diameter and type was determined by a correlation analysis. The collagen fibril diameters at the different anatomical sites had different distributions (unimodal or bimodal) and mean fibril diameters were found to increase significantly from the anterior part to the posterior part (P=0.0482) as well as from the proximal to the distal sections (P=0.0208). Type I collagen in the core portion of MCLs was significantly less than at the other four peripheral areas (P<0.005) but no significant variation was found in each respective portion (P>0.05). The low coefficient in the correlation analysis (r=0.3759) demonstrated collagen fibril diameters had no correlation with collagen types. This may provide a new view of collagen types in studying the mechanical behavior of ligaments.

Do biodegradable magnesium alloy intramedullary interlocking nails prematurely lose fixation stability in the treatment of tibial fracture? A numerical simulation.

Intramedullary interlocking nailing is an effective technique used to treat long bone fractures. Recently, biodegradable metals have drawn increased attention as an intramedullary interlocking nailing material. In this study, numerical simulations were implemented to determine whether the degradation rate of magnesium alloy makes it a suitable material for manufacturing biodegradable intramedullary interlocking nails. Mechano-regulatory and bone-remodeling models were used to simulate the fracture healing process, and a surface corrosion model was used to simulate intramedullary rod degradation. The results showed that magnesium alloy intramedullary rods exhibited a satisfactory degradation rate; the fracture healed and callus enhancement was observed before complete dissolution of the intramedullary rod. Delayed magnesium degradation (using surface coating techniques) did not confer a significant advantage over the non-delayed degradation process; immediate degradation also achieved satisfactory healing outcomes. However, delayed degradation had no negative effect on callus enhancement, as it did not cause signs of stress shielding. To avoid risks of individual differences such as delayed union, delayed degradation is recommended. Although the magnesium intramedullary rod did not demonstrate rapid degradation, its ability to provide high fixation stiffness to achieve earlier load bearing was inferior to that of the conventional titanium alloy and stainless steel rods. Therefore, light physiological loads should be ensured during the early stages of healing to achieve bony healing; otherwise, with increased loading and degraded intramedullary rods, the fracture may ultimately fail to heal.

Finite element analysis of the effect of medullary contact on fracture healing and remodeling in the intramedullary interlocking nail-fixed tibia fracture.

Intramedullary interlocking nail is an effective treatment for tibial diaphyseal fracture. The contact between medullary rod and diaphyseal cortex is able to enhance fracture stability. However, how and to what degree the contact affects fracture healing and subsequent bone remodeling is still unclear. To investigate this, fracture healing and remodeling algorithms were combined, improved, and used to simulate the healing and remodeling processes in a transverse tibial diaphyseal fracture fixed with an intramedullary interlocking nail device. Two different diaphyseal fracture statuses, three different initial loading levels, and two nail materials were considered. The results showed that the medullary contact could significantly enhance the fixation stability; the strain reduction was up to 80% in the initial granulation callus. However, low initial loading level was found to be a more potential risk factor for the insufficient loading-induced nonunion other than medullary contact and stiffer nail material. Furthermore, the stabilizing effect of medullary contact diminished when stiff bone tissue formed in the callus; thus, the remodeling in the long-term was not affected by medullary contact. Copyright