Human Medial Collateral Ligament Research Articles

Bioinspired multilayer braided structure with controllable nonlinear mechanical properties for artificial ligaments

Inspired by “crimped” collagen fiber, which induce a low-level load region within the hierarchical structures of ligaments and tendons, this study introduces a braiding technology aiming at characterizing nonlinear mechanical behavior. Samples of the developed artificial ligament with a multilayer braided structure were fabricated and tested. Alterations in the number of braiding layers, wales, and courses significantly affect the mechanical properties of the artificial ligaments. Specifically, the toe length exhibited an increase of up to 104.58 %, while the linear stiffness exhibited variations concomitant with changes in these parameters. Additionally, a mathematical model to describe the relationship between the toe length and linear stiffness was developed based on the braiding parameters and material properties of the fibers. Alternative fibers were employed and tested to demonstrate a consistency with the mathematical model. The correlation coefficients were calculated as 0.9644 for the toe length and 0.9203 for the linear stiffness. Lastly, this study mimics the mechanical behavior of the human medial collateral ligament (MCL) by integrating the artificial ligament into a bio-fidelity knee model with a joint stiffness of 1.77 Nm/deg, resulting in a high degree of similarity with human knee in valgus-varus, further affirming the utility and applicability of this study.

AN OPTIMIZATION FRAMEWORK TO ENABLE THE MEASUREMENT OF STRAIN IN LIGAMENTS USING ULTRASOUND

AbstractObjectivesUltrasound speckle tracking is a safe and non-invasive diagnostic tool to measure soft tissue deformation and strain. In orthopaedics, it could have broad application to measure how injury or surgery affects muscle, tendon or ligament biomechanics. However, its application requires custom tuning of the speckle-tracking algorithm then validation against gold-standard reference data. Implementing an experiment to acquire these data takes months and is expensive, and therefore prohibits use for new applications. Here, we present an alternative optimisation approach that automatically finds suitable machine and algorithmic settings without requiring gold-standard reference data.MethodsThe optimisation routine consisted of two steps. First, convergence of the displacement field was tested to exclude the settings that would not track the underlying tissue motion (e.g. frame rates that were too low). Second, repeatability was maximised through a surrogate optimisation scheme. All settings that could influence the strain calculation were included, ranging from acquisition settings to post-processing smoothing and filtering settings, totalling >1,000,000 combinations of settings. The optimisation criterion minimised the normalised standard deviation between strain maps of repeat measures. The optimisation approach was validated for the medial collateral ligament (MCL) with quasi-static testing on porcine joints (n=3), and dynamic testing on a cadaveric human knee (n=1, female, aged 49). Porcine joints were fully dissected except for the MCL and loaded in a material-testing machine (0 to 3% strain at 0.2 Hz), which was captured using both ultrasound (>14 repeats per specimen) and optical digital image correlation (DIC). For the human cadaveric knee (undissected), 3 repeat ultrasound acquisitions were taken at 18 different anterior/posterior positions over the MCL while the knee was extended/flexed between 0° and 90° in a knee extension rig. Simultaneous optical tracking recorded the position of the ultrasound transducer, knee kinematics and the MCL attachments (which were digitised under direct visualisation post testing). Half of the data collected was used for optimisation of the speckle tracking algorithms for the porcine and human MCLs separately, with the remaining unseen data used as a validation test set.ResultsFor the porcine MCLs, ultrasound strains closely matched DIC strains (R2 > 0.98, RMSE < 0.59%) (Figure 1A). For the human MCL (Figure 1B), ultrasound strains matched the strains estimated from the optically tracked displacements of the MCL attachments. Furthermore, strains developed during flexion were highly correlated with AP position (R = 0.94) with strains decreasing the further posterior the transducer was on the ligament. This is in line with previously reported length change values for the posterior, intermediate and anterior bundles of the MCL.ConclusionsUltrasound speckle tracking algorithms can be adapted for new applications without ground-truth data by using an optimisation approach that verifies displacement field convergence then minimises variance between repeat measurements. This optimisation routine was insensitive to anatomical variation and loading conditions, working for both porcine and human MCLs, and for quasi-static and dynamic loading. This will facilitate research into changes in musculoskeletal tissue motion due to abnormalities or pathologies.Declaration of Interest(a) fully declare any financial or other potential conflict of interest

Use of Biologics for Knee Collateral Ligament Injuries. Can We Heal Them Faster?

There is a relative paucity in the orthopaedic literature regarding the use of biologics for collateral ligament injuries. A majority of the existing literature on this topic is preclinical, and only considers the use of biologics in medial collateral ligament injury, with only 2 clinical case reports (level V evidence) that describe the use of platelet rich plasma in human medial collateral ligament injuries. Further, at this time there are no studies, clinical or preclinical, that examine the effects of biologics on fibular collateral ligament injuries. Considering this relative paucity, further research is needed to investigate the utility of biologic agents with respect to collateral ligament injuries. Promising science should not be blindly implemented without clinical trials demonstrating successful, reproducible outcomes.

Mécanorécepteurs dans le ligament collatéral médial du coude

BackgroundThe human elbow maintains its stability mainly through its bony structure. Stability is enhanced by ligamentous structures. To allow the ligamento-muscular reflex, which protects against strain and stress, mechanoreceptors are embedded in the ligament. This report describes the existence and the distribution of the elbow medial collateral ligaments (MCLs) mechanoreceptors. Hypothesis1) the bony attachment site has the highest density of mechanoreceptors, and 2) the anterior part has the highest density of mechanoreceptors. Materials and methodsEight MCLs of elbow from fresh frozen cadavers were used. The MCLs were harvested deep to the periosteum from the medial epicondyle to the ulna. The fan-shaped ligaments were divided into six regions of interest (ROI) and stained with modified gold chloride stain. Specimens were evaluated under a light microscope. Golgi, Ruffini, and Pacinian corpuscles were found in every specimen. The number and the distribution of each mechanoreceptor in each ROI were recorded. The density of each mechanoreceptor was calculated in regards to its volume. ResultsGolgi, Ruffini, and Pacinian corpuscles were seen in the ligament with small nerve fibers. Ruffini corpuscles had the highest median density of all three corpuscles. The median corpuscle density was higher in the anterior than in the posterior part and higher in the bony attachment than in the mid-substance site except for Golgi corpuscle. ConclusionThe three typical types of mechanoreceptors were identified in human MCL with the anterior part and bony attachment as the dominant distribution site. Level of evidenceBasic Science Study.

Mechanoreceptors distribution in the human medial collateral ligament of the elbow.

The human elbow maintains its stability mainly through its bony structure. Stability is enhanced by ligamentous structures. To allow the ligamento-muscular reflex, which protects against strain and stress, mechanoreceptors are embedded in the ligament. This report describes the existence and the distribution of the elbow medial collateral ligaments (MCLs) mechanoreceptors. The bony attachment site has the highest density of mechanoreceptors, and the anterior part has the highest density of mechanoreceptors. Eight MCLs of elbow from fresh frozen cadavers were used. The MCLs were harvested deep to the periosteum from the medial epicondyle to the ulna. The fan-shaped ligaments were divided into six regions of interest (ROI) and stained with modified gold chloride stain. Specimens were evaluated under a light microscope. Golgi, Ruffini, and Pacinian corpuscles were found in every specimen. The number and the distribution of each mechanoreceptor in each ROI were recorded. The density of each mechanoreceptor was calculated in regards to its volume. Golgi, Ruffini, and Pacinian corpuscles were seen in the ligament with small nerve fibers. Ruffini corpuscles had the highest median density of all three corpuscles. The median corpuscle density was higher in the anterior than in the posterior part and higher in the bony attachment than in the mid-substance site except for Golgi corpuscle. The three typical types of mechanoreceptors were identified in human MCL with the anterior part and bony attachment as the dominant distribution site. Basic Science Study.

Mechanoreceptors distribution in the human medial collateral ligament of the elbow

Mechanoreceptors distribution in the human medial collateral ligament of the elbow

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., 4.5 Nm external tibial and 10 Nm 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.

A three-dimensional constitutive model for the stress relaxation of articular ligaments

A new nonlinear constitutive model for the three-dimensional stress relaxation of articular ligaments is proposed. The model accounts for finite strains, anisotropy, and strain-dependent stress relaxation behavior exhibited by these ligaments. The model parameters are identified using published uniaxial stress-stretch and stress relaxation data on human medial collateral ligaments (MCLs) subjected to tensile tests in the fiber and transverse to the fiber directions (Quapp and Weiss in J Biomech Eng Trans ASME 120:757-763, 1998; Bonifasi-Lista et al. in J Orthop Res 23(1):67-76, 2005). The constitutive equation is then used to predict the nonlinear elastic and stress relaxation response of ligaments subjected to shear deformations in the fiber direction and transverse to the fiber direction, and an equibiaxial extension. A direct comparison with stress relaxation data collected by subjecting human MCLs to shear deformation in the fiber direction is presented in order to demonstrate the predictive capabilities of the model.

A biomechanical assessment to evaluate breed differences in normal porcine medial collateral ligaments

Little information is available on the role of genetic factors and heredity in normal ligament behaviour and their ability to heal. Assessing these factors is challenging because of the lack of suitable animal models. Therefore, the purpose of this study was to develop a porcine model in order to evaluate and compare the biomechanical differences of normal medial collateral ligaments (MCLs) between Yorkshire (YK) and red Duroc (RD) breeds. It was hypothesized that biomechanical differences would not exist between normal YK and RD MCLs. Comparisons between porcine and human MCL were also made. A biomechanical testing apparatus and protocol specific to pig MCL were developed. Ligaments were subjected to cyclic and static creep tests and then elongated to failure. Pig MCL morphology, geometry, and low- and high-load mechanical behaviour were assessed. The custom-designed apparatus and protocol were sufficiently sensitive to detect mechanical property differences between breeds as well as inter-leg differences. The results reveal that porcine MCL is comparable in both shape and size to human MCL and exhibits similar structural and material failure properties, thus making it a feasible model. Comparisons between RD and YK breeds revealed that age-matched RD pigs weigh more, have larger MCL cross-sectional area, and have lower MCL failure stress than YK pigs. The effect of weight may have influenced MCL geometrical and biomechanical properties, and consequently, the differences observed may be due to breed type and/or animal weight. In conclusion, the pig serves as a suitable large animal model for genetic-related connective tissue studies.

Expression of MMPs and TIMPs Family in Human ACL and MCL Fibroblasts

The human ACL (anterior cruciate ligament) is susceptible to injury but has poor healing response, whereas an injured MCL (medial collateral ligament) can be repaired relatively well. Since MMPs (matrix metalloproteases) and TIMPs (tissue inhibitor of metalloproteases) are involved in this tissue remodeling process, investigation of different response of MMPs and TIMPs family in ACL and MCL fibroblasts might lead to understanding the differential matrix remodeling process as well as their different healing ability. The first step would be determination of whether these tissue remodeling effectors are present in ligaments. In this study, we designed primers for real-time RT-PCR and determined the expression of MMPs and TIMPs family in ACL and MCL fibroblasts with synovium as a positive control. Semiquantitative RT-PCR revealed that multiple MMPs and TIMPs expressed in human ACL and MCL fibroblasts except MMP-8, 10, 12, 13, 15, 16, 20, and 26. MMP-7 was present in MCL but not in ACL fibroblast. Quantitative real-time RT-PCR showed that mRNA levels of MMP-1, 2, 14, 17, 23A, and 23B and TIMP-4 are significantly higher in MCL than in ACL fibroblasts. However, MMP-3 is higher in ACL than in MCL fibroblasts. We conclude that numerous MMPs and TIMPs family members that are differentially expressed in ACL and MCL might be involved in the differential matrix remodeling process as well as the differential healing ability of ACL and MCL.

Transversely isotropic distribution of sulfated glycosaminoglycans in human medial collateral ligament: A quantitative analysis

Decorin and its associated glycosaminoglycan (GAG) side chain, dermatan sulfate (DS), play diverse roles in soft tissue formation and potentially aid in the mechanical integrity of the tissue. Deeper understanding of the distribution and orientation of the GAGs on a microscopic level may help elucidate the structure/function relationship of these important molecules. The hypothesis of the present study was that sulfated GAGs are aligned with transversely isotropic material symmetry in human medial collateral ligament (MCL) with the collagen acting as the axis of symmetry. To test the hypothesis, sulfated GAGs were visualized using transmission electron microscopy (TEM). Three orthogonal anatomical planes were examined to evaluate GAG distributions against symmetry criteria. GAG populations were differentiated using targeted enzyme digestion. Results suggest that sulfated GAGs including DS, chondroitin sulfates A and C, as well as other sub-populations assume transversely isotropic distributions in human MCL. Sulfated GAGs in the plane normal to the collagen axis were found to be isotropic with no preferred orientation. GAGs in the two planes along the collagen axis did not statistically differ and exhibited apparent bimodal distributions, favoring orthogonal distributions with over half at other angles with respect to collagen. A previously developed model, GAGSim3D, was used to interpret potential TEM artifacts. The data collected herein provide refined inputs to micro-scale models of the structure/function relationship of sulfated GAGs in soft tissues.

Contribution of glycosaminoglycans to viscoelastic tensile behavior of human ligament

The viscoelastic properties of human ligament potentially guard against structural failure, yet the microstructural origins of these transient behaviors are unknown. Glycosaminoglycans (GAGs) are widely suspected to affect ligament viscoelasticity by forming molecular bridges between neighboring collagen fibrils. This study investigated whether GAGs directly affect viscoelastic material behavior in human medial collateral ligament (MCL) by using nondestructive tensile tests before and after degradation of GAGs with chondroitinase ABC (ChABC). Control and ChABC treatment (83% GAG removal) produced similar alterations to ligament viscoelasticity. This finding was consistent at different levels of collagen fiber stretch and tissue hydration. On average, stress relaxation increased after incubation by 2.2% (control) and 2.1% (ChABC), dynamic modulus increased after incubation by 3.6% (control) and 3.8% (ChABC), and phase shift increased after incubation by 8.5% (control) and 8.4% (ChABC). The changes in viscoelastic behavior after treatment were significantly more pronounced at lower clamp-to-clamp strain levels. A 10% difference in the water content of tested specimens had minor influence on ligament viscoelastic properties. The major finding of this study is that mechanical interactions between collagen fibrils and GAGs are unrelated to tissue-level viscoelastic mechanics in mature human MCL. These findings narrow the possible number of extracellular matrix molecules that have a direct contribution to ligament viscoelasticity.

On modelling nonlinear viscoelastic effects in ligaments

Experiments in human ligaments revealed that the rate of stress relaxation in such materials is strain dependent. This nonlinear behavior requires therefore a modified description of the standard quasilinear viscoelasticity theory commonly used in tissue biomechanics. The goal of this study is to characterize and demonstrate the importance of the nonlinear stress-relaxation behavior of ligaments undergoing finite deformation. The structural model presented herein is based on a local additive decomposition of the stress tensor into initial and non-equilibrium parts as resulted from the assumed structure of the free energy density function that generalizes Kelvin–Voigt nonlinear viscous models. We consider different viscoelastic behavior for the matrix and the fibers and the need of considering the strain dependency of this effect is clearly demonstrated. Model parameters were fit to experimental data obtained in specimens undergoing finite deformation in two directions: longitudinal and transversal with respect to the directions of the collagen fibers. The model was then tested against several multi-axial loading situations. The strain dependent relaxation and the strain rate dependent behavior of the human medial collateral ligament were accurately predicted.

Noninvasive Determination of Ligament Strain with Deformable Image Registration

Ligament function and propensity for injury are directly related to regional stresses and strains. However, noninvasive techniques for measurement of strain are currently limited. This study validated the use of Hyperelastic Warping, a deformable image registration technique, for noninvasive strain measurement in the human medial collateral ligament using direct comparisons with optical measurements. Hyperelastic Warping determines the deformation map that aligns consecutive images of a deforming material, allowing calculation of strain. Diffeomorphic deformations are ensured by representing the deformable image as a hyperelastic material. Ten cadaveric knees were subjected to six loading scenarios each. Tissue deformation was documented with magnetic resonance imaging (MRI) and video-based experimental measurements. MRI datasets were analyzed using Hyperelastic Warping, representing the medial collateral ligament (MCL) with a hexahedral finite element (FE) model projected to a manually segmented ligament surface. The material behavior was transversely isotropic hyperelastic. Warping predictions of fiber stretch were strongly correlated with experimentally measured strains (R (2) = 0.81). Both sets of measurements were in agreement with previous ex vivo studies. Warping predictions of fiber stretch were insensitive to bulk:shear modulus ratio, fiber stiffness, and shear modulus in the range of +2.5SD to -1.0SD. Correlations degraded when the shear modulus was decreased to 2.5SD below the mean (R (2) = 0.56), and when an isotropic constitutive model was substituted for the transversely isotropic model (R (2) = 0.65). MCL strains in the transitional region near the joint line, where the material behavior and material symmetry are more complex, showed the most sensitivity to changes in shear modulus. These results demonstrate that Hyperelastic Warping requires the use of a constitutive model that reflects the material symmetry, but not subject-specific material properties for accurate strain predictions for this application. Hyperelastic Warping represents a powerful technique for noninvasive strain measurement of musculoskeletal tissues and has many advantages over other image-based strain measurement techniques.

Effect of dermatan sulfate glycosaminoglycans on the quasi‐static material properties of the human medial collateral ligament

The glycosaminoglycan of decorin, dermatan sulfate (DS), has been suggested to contribute to the mechanical properties of soft connective tissues such as ligaments and tendons. This study investigated the mechanical function of DS in human medial collateral ligaments (MCL) using nondestructive shear and tensile material tests performed before and after targeted removal of DS with chondroitinase B (ChB). The quasi-static elastic material properties of human MCL were unchanged after DS removal. At peak deformation, tensile and shear stresses in ChB treated tissue were within 0.5% (p>0.70) and 2.0% (p>0.30) of pre-treatment values, respectively. From pre- to post-ChB treatment under tensile loading, the tensile tangent modulus went from 242+/-64 to 233+/-57 MPa (p=0.44), and tissue strain at peak deformation went from 4.3+/-0.3% to 4.4+/-0.3% (p=0.54). Tissue hysteresis was unaffected by DS removal for both tensile and shear loading. Biochemical analysis confirmed that 90% of DS was removed by ChB treatment when compared to control samples, and transmission electron microscopy (TEM) imaging further verified the degradation of DS by showing an 88% reduction (p<.001) of sulfated glycosaminoglycans in ChB treated tissue. These results demonstrate that DS in mature knee MCL tissue does not resist tensile or shear deformation under quasi-static loading conditions, challenging the theory that decorin proteoglycans contribute to the elastic material behavior of ligament.

Spatial distribution and orientation of dermatan sulfate in human medial collateral ligament

The proteoglycan decorin and its associated glycosaminoglycan (GAG), dermatan sulfate (DS), regulate collagen fibril formation, control fibril diameter, and have been suggested to contribute to the mechanical stability and material properties of connective tissues. The spatial distribution and orientation of DS within the tissue are relevant to these mechanical roles, but measurements of length and orientation from 2D transmission electron microscopy (TEM) are prone to errors from projection. The objectives of this study were to construct a 3D geometric model of DS GAGs and collagen fibrils, and to use the model to interpret TEM measurements of the spatial orientation and length of DS GAGs in the medial collateral ligament of the human knee. DS was distinguished from other sulfated GAGs by treating tissue with chondroitinase B, an enzyme that selectively degrades DS. An image processing pipeline was developed to analyze the TEM micrographs. The 3D model of collagen and GAGs quantified the projection error in the 2D TEM measurements. Model predictions of 3D GAG orientation were highly sensitive to the assumed GAG length distribution, with the baseline input distribution of 69 ± 23 nm providing the best predictions of the angle measurements from TEM micrographs. The corresponding orientation distribution for DS GAGs was maximal at orientations orthogonal to the collagen fibrils, tapering to near zero with axial alignment. Sulfated GAGs that remained after chondroitinase B treatment were preferentially aligned along the collagen fibril. DS therefore appears more likely to bridge the interfibrillar gap than non-DS GAGs. In addition to providing quantitative data for DS GAG length and orientation in the human MCL, this study demonstrates how a 3D geometric model can be used to provide a priori information for interpretation of geometric measurements from 2D micrographs.

An uncoupled directional damage model for fibred biological soft tissues. Formulation and computational aspects

AbstractIn this paper we present a fully three‐dimensional finite‐strain damage model for fibrous soft tissue. Continuum damage mechanics is used to describe the softening behaviour of soft tissues under large deformation. The structural model is formulated using the concept of internal variables that provides a very general description of materials involving irreversible effects. We considered the internal variables associated to damage to correspond to separated contributions of the matrix and fibres. In order to show clearly the performance of the constitutive model, we present 3D simulations of the behaviour of the human medial collateral ligament and of a coronary artery. Results show that the model is able to capture the typical stress–strain behaviour observed in fibrous soft tissues and seems to confirm the soundness of the proposed formulation. Copyright © 2006 John Wiley &amp; Sons, Ltd.

Differential MMP-2 activity of ligament cells under mechanical stretch injury: An in vitro study on human ACL and MCL fibroblasts

Recent studies have revealed that following injuries, ligament tissues such as anterior cruciate ligaments (ACL), release large amounts of matrix metalloproteinases (MMPs). These enzymes have a devastating effect on the healing process of the injured ligaments. Although these enzymes are produced following ligament injuries, because of different healing capacities seen between the medial collateral ligament (MCL) and ACL, we were curious to find if the MMP activity was expressed and modulated differently in these tissues. For this purpose ACL and MCL fibroblasts were seeded on equi-biaxial stretch chambers and were stretched in different levels. The stretched cells were assayed using Zymography, Western Blot and global MMP activity assays. The results showed that within 72 h after injurious stretch, production of 72 kD pro-MMP-2 increased in both ACL and MCL. However, the ACL fibroblasts generated significantly more pro-MMP-2 than the MCL fibroblasts. Furthermore we found in ACL pro-MMP-2 was converted more into active form. With 4-aminophenyl mercuric acetate (APMA) treatment, large amounts of pro-MMP-2 were converted into active form in both. This indicates that there is no significant difference between ACL and MCL fibroblasts in post-translational modification of MMP-2. The fluorescent MMP activity assays revealed that the MMP family activities were higher in the injured ACL fibroblasts than the MCL. Since the MMPs are critically involved in extracellular matrix (ECM) turnover, these findings may explain one of the reasons why the injured ACL hardly repairs. The higher levels of active MMP-2 seen in the ACL injuries may disrupt the delicate balance of ECM remodeling process. These results suggest that the generation and modulation of MMP-2 may be directly involved in the different responses seen in ACL and MCL injuries.

Permeability of human medial collateral ligament in compression transverse to the collagen fiber direction

This study quantified the apparent and intrinsic hydraulic permeability of human medial collateral ligament (MCL) under direct permeation transverse to the collagen fiber direction. A custom permeation device was built to apply flow across cylindrical samples of ligament while monitoring the resulting pressure gradient. MCLs from 5 unpaired human knees were used (donor age 55 ± 16 yr , 4 males, 1 female). Permeability measurements were performed at 3 levels of compressive pre-strain (10%, 20% and 30%) and 5 pressures (0.17, 0.34, 1.03, 1.72 and 2.76 MPa). Apparent permeability was determined from Darcy's law, while intrinsic permeability was determined from the zero-pressure crossing of the pressure–permeability curves at each compressive pre-strain. Resulting data were fit to a finite deformation constitutive law [Journal of Biomechanics 23 (1990) 1145–1156]. The apparent permeability of human MCL ranged from 0.40 ± 0.05 to 8.60 ± 0.77 × 1 0 - 16 m 4 / N s depending on pre-strain and pressure gradient. There was a significant decrease in apparent permeability with increasing compressive pre-strain ( p = 0.024 ) and pressure gradient ( p < 0.001 ) , and there was a significant interaction between the effects of compressive pre-strain and pressure ( p < 0.001 ) . Intrinsic permeability was 14.14 ± 0.74 , 6.30 ± 2.13 and 4.29 ± 1.71 × 1 0 - 16 m 4 / N s for compressive pre-strains of 10%, 20% and 30%, respectively. The intrinsic permeability showed a faster decrease with increasing compressive pre-strain than that of bovine articular cartilage. These data provide a baseline for investigating the effects of disease and chemical modification on the permeability of ligament and the data should also be useful for modeling the poroelastic material behavior of ligaments.

Viscoelastic properties of the human medial collateral ligament under longitudinal, transverse and shear loading

Ligament viscoelasticity controls viscous dissipation of energy and thus the potential for injury or catastrophic failure. Viscoelasticity under different loading conditions is likely related to the organization and anisotropy of the tissue. The objective of this study was to quantify the strain- and frequency-dependent viscoelastic behavior of the human medial collateral ligament (MCL) in tension along its longitudinal and transverse directions, and under shear along the fiber direction. The overall hypothesis was that human MCL would exhibit direction-dependent viscoelastic behavior, reflecting the composite structural organization of the tissue. Incremental stress relaxation testing was performed, followed by the application of small sinusoidal strain oscillations at three different equilibrium strain levels. The peak and equilibrium stress–strain curves for the longitudinal, transverse and shear tests demonstrate that the instantaneous and long-time stress–strain response of the tissue differs significantly between loading conditions of along-fiber stretch, cross-fiber stretch and along-fiber shear. The reduced relaxation curves demonstrated at least two relaxation times for all three test modes. Relaxation resulted in stresses that were 60–80% of the initial stress after 1000 s. Incremental stress relaxation proceeded faster at the lowest strain level for all three test configurations. Dynamic stiffness varied greatly with test mode and equilibrium strain level, and showed a modest but significant increase with frequency of applied strain oscillations for longitudinal and shear tests. Phase angle was unaffected by strain level (with exception of lowest strain level for longitudinal samples) but showed a significant increase with increasing strain oscillation frequency. There was no effect of test type on the phase angle. The increase in phase and thus energy dissipation at higher frequencies may protect the tissue from injury at faster loading rates. Results suggest that the long-time relaxation behavior and the short-time dynamic energy dissipation of ligament may be governed by different viscoelastic mechanisms, yet these mechanisms may affect tissue viscoelasticity similarly under different loading configurations.