Joint Contact Loads Research Articles

Knee joint contact load associated by balance control for stance leg during taekwondo front kick: A musculoskeletal modeling approach

Knee joint contact load associated by balance control for stance leg during taekwondo front kick: A musculoskeletal modeling approach

Combined musculoskeletal finite element modeling of femur stress during reactive balance training

The purpose of this study was to determine the material stresses experienced in the femoral neck during the stepping phase of recovery from a forward loss of balance achieved both using release from a static forward lean and rapid treadmill accelerations in 8 older adults. A scalable musculoskeletal model with 23 degrees of freedom and 92 force actuators was used to calculate joint reaction forces. A finite element model of the femur used joint reaction forces calculated by the musculoskeletal model to calculate the material stresses during stepping. Balance recovery from a static forward lean angle had a greater joint contact force and greater maximum tensile stress than a recovery from treadmill induced perturbations both before and after a training session. Hip joint contact loads were found to be large in magnitude, however, all stresses experienced by the bone are less than critical yield stresses for trabecular bone. We suggest that stepping balance recovery is safe for older adults with no obvious loss of bone density or strength and that analyses such as finite element analysis are necessary to understand stresses in the material at the joint level.

The Influence of Glenoid Bone Loss and Graft Positioning on Graft and Cartilage Contact Pressures After the Latarjet Procedure

Background: Glenohumeral joint contact loading before and after glenoid bone grafting for recurrent anterior instability remains poorly understood. Purpose: To develop a computational model to evaluate the influence of glenoid bone loss and graft positioning on graft and cartilage contact pressures after the Latarjet procedure. Study Design: Controlled laboratory study. Methods: A finite element model of the shoulder was developed using kinematics, muscle and glenohumeral joint loading of 6 male participants. Muscle and joint forces at 90° of abduction and external rotation were calculated and employed in simulations of the native shoulder, as well as the shoulder with a Bankart lesion, 10% and 25% glenoid bone loss, and after the Latarjet procedure. Results: A Bankart lesion as well as glenoid bone loss of 10% and 25% significantly increased glenoid and humeral cartilage contact pressures compared with the native shoulder (P < .05). The Latarjet procedure did not significantly increase glenoid cartilage contact pressure. With 25% glenoid bone loss, the Latarjet procedure with a graft flush with the glenoid and the humerus positioned at the glenoid half-width resulted in significantly increased humeral cartilage contact pressure compared with that preoperatively (P = .023). Under the same condition, medializing the graft by 1 mm resulted in humeral cartilage contact pressure comparable with that preoperatively (P = .097). Graft lateralization by 1 mm resulted in significantly increased humeral cartilage contact pressure in both glenoid bone loss conditions (P < .05). Conclusion: This modeling study showed that labral damage and greater glenoid bone loss significantly increased glenoid and humeral cartilage contact pressures in the shoulder. The Latarjet procedure may mitigate this to an extent, although glenoid and humeral contact loading was sensitive to graft placement. Clinical Relevance: The Latarjet procedure with a correctly positioned graft should not lead to increased glenohumeral joint contact loading. The present study suggests that lateral graft overhang should be avoided, and in the situation of large glenoid bone defects, slight medialization (ie, 1 mm) of the graft may help to mitigate glenohumeral joint contact overloading.

PREVENTING FALLS WITH PERTURBATION-BASED BALANCE TRAINING: HOW LARGE ARE THE HIP JOINT CONTACT LOADS, AND ARE THEY SAFE?

Abstract Perturbation-based training (PBT) is a balance training method presenting a high-challenge to balance which is extremely effective when compared to conventional training approaches. Common PBT methods use rapid treadmill belt translations with varying numbers of perturbations (20-1400 perturbations over 1-8wks). Importantly, the joint loads experienced during a stumble may be high enough to feasibly fracture bone (up to 12.7 Body Weights). However, the contact loads experienced during PBT are unknown. Because of increasing the prevalence of PBT it is necessary to specifically evaluate the range of joint loads experienced during PBT. Twelve participants completed a single PBT session of 24 perturbations. During both training and testing, participants movements were measured using a motion capture system which tracks body movements and records the forces under the feet. Hip joint contact loads were determined using Computational Musculoskeletal Modelling utilizing open-source software OpenSim. These techniques estimate the magnitude and pattern of force development of individual muscles and subsequently estimate the internal loads experienced by the hip joint.Hip joint contact loads were 4.90 ± 1.27 BW which is substantially lower that those previously reported by Graham et al. (2016) and Bergman et al. (2004) and is lower than the 5.5BW spontaneous fracture load boundary estimated by Schileo et al. (2014). Comparing the initial perturbation to the final perturbation revealed a 22% reduction in contact loads. We conclude that PBT performed using rapid translations on a treadmill are likely safe but suggest caution for individuals with poor bone mineral density or reduced neuromuscular function.

Functional knee apparatus for the evaluation of ligamentous tensions on contact loads

BackgroundSoft tissue balancing is integral in providing stability following total knee arthroplasty (TKA). Although intraoperative contact load sensors are providing insights into the effects of soft tissue balancing, there is still a lack of understanding of the relationship between the knee’s ligamentous tensions and joint surface contact loads. This study reports on the development of a multifunctional testing apparatus that can quantify the effects of ligamentous tension on joint contact loads in a controlled repeatable environment. MethodsThe functional knee apparatus was constructed to act as an anatomical substitute for the benchtop assessment of intraoperative soft tissue balancing. The system was calibrated through reproduction of results from a cadaveric study that employed intraoperative load sensors. Experimentation was then conducted to quantify the effects of tensile pretension variation on measured contact loads throughout the full range of flexion. ResultsA linear relationship between the ligamentous tensions and contact loads was observed, with ligaments contributing to 74–80% of the measured contact loads. Ligamentous tensions could be approximated from measured contact loads to within ± 23 N. ConclusionThe proposed apparatus can prove to be a valuable tool in the continued exploration of currently undocumented effects (e.g. surgical alteration) in soft tissue balancing. In addition to quantifying the relationship between ligamentous tensions and joint contact loads, soft tissue loading conditions where bicondylar contact was lost (i.e. known sign of kinematic instability) were identified. As a corollary, this system may be able to provide insights on soft tissue balancing standards predictive of patient outcomes.

An Electromyography-Based Constitutive Law for Force Generation in Skeletal Muscle-Part I: Model Development.

This paper proposes a new method for estimating skeletal muscle forces using a model derived from dimensional analysis. It incorporates electromyography signals and muscle force-length, force-velocity, and force-frequency relationships as inputs. The purpose of this model is to provide more accurate estimates of individualized muscle forces to better predict surrounding musculoskeletal tissue and joint contact loading. The derivation begins with dimensional analysis and a selection of critical parameters that define muscle force generation. The resulting constitutive equation gives way to a unique application of inverse-dynamics, one which avoids the issue of indeterminacy when reaction moments and ligament loading are minimized in a joint. The ankle joint is used as an example for developing the equations that culminate into a system of linear equations. A muscle force model capable of being calibrated and then used to predict joint contact and surrounding tissue loading is critical in advancing biomechanics research areas like injury prevention, performance optimization, and tissue engineering, among others. This model's foundation in dimensional analysis, along with its inclusion of electromyography signals, gives promise that it will be physiologically relevant and suitable for application-based studies. A following paper, Part II, will evaluate this premise in an experimental setting.

Biomechanical joint loading mechanism of Tai Chi gait in individuals with knee osteoarthritis: A pilot simulation study

ObjectivesTai Chi (TC) has shown beneficial effects on joint function in knee osteoarthritis (OA). Biomechanical mechanisms of knee joint contact load (JCL) and muscle activations during TC are less understood. The purpose of this biomechanical simulation study was to examine JCL of TC gait, the most common used TC from and its causal interactions with muscle activations in knee OA. DesignSix knee OA and five healthy participants were recruited. Their full body motion of TC gait was collected. The JCL and muscle forces were quantified using a musculoskeletal simulation approach based on collected kinematics and kinetics. The JCL and muscle activations were compared between knee OA and healthy control group. In addition, the muscle contributions to the JCL were determined and compared between the two groups. ResultsKnee OA subjects had lower peak anterior-posterior shear forces and higher lateral shear forces than healthy control subjects during TC gait. Knee OA subjects also showed higher activations of knee flexor muscles than control subjects. Both knee extensor and flexors of the knee OA group were contributing to JCL and in the control group mainly the knee extensors. ConclusionsOur simulation results showed the JCL, muscle forces profiles, and muscle contributions to the JCL during TC gait in knee OA. The findings of this study provided a direct scientific link between JCL and muscle forces during TC gait in knee OA. This would allow us to develop more effective TC interventions for knee OA in the future.

Biomechanical Study of a Tricompartmental Unloader Brace for Patellofemoral or Multicompartment Knee Osteoarthritis

Objective: Off-loader knee braces have traditionally focused on redistributing loads away from either the medial or lateral tibiofemoral (TF) compartments. In this article, we study the potential of a novel “tricompartment unloader” (TCU) knee brace intended to simultaneously unload both the patellofemoral (PF) and TF joints during knee flexion. Three different models of the TCU brace are evaluated for their potential to unload the knee joint.Methods: A sagittal plane model of the knee was used to compute PF and TF contact forces, patellar and quadriceps tendon forces, and forces in the anterior and posterior cruciate ligaments during a deep knee bend (DKB) test using motion analysis data from eight participants. Forces were computed for the observed (no brace) and simulated braced conditions. A sensitivity and validity analysis was conducted to determine the valid output range for the model, and Statistical Parameter Mapping was used to quantify the effectual region of the different TCU brace models.Results: PF and TF joint force calculations were valid between ~0 and 100 degrees of flexion. All three simulated brace models significantly (p < 0.001) reduced predicted knee joint loads (by 30–50%) across all structures, at knee flexion angles >~30 degrees during DKB.Conclusions: The TCU brace is predicted to reduce PF and TF knee joint contact loads during weight-bearing activity requiring knee flexion angles between 30 and 100 degrees; this effect may be clinically beneficial for pain reduction or rehabilitation from common knee injuries or joint disorders. Future work is needed to assess the range of possible clinical and prophylactic benefits of the TCU brace.

Hip Joint Contact Loading and Muscle Forces During Running With a Transtibial Amputation.

People with unilateral transtibial amputations (TTA) have greater risks of bilateral hip osteoarthritis, related to asymmetric biomechanics compared to people without TTA. Running is beneficial for physical health and is gaining popularity. However, people with TTA may not have access to running-specific prostheses (RSPs), which are designed for running, and may instead run using their daily-use prosthesis (DUP). Differences in joint loading may result from prosthesis choice; thus, it is important to characterize changes in peak and impulsive hip joint contact loading during running. Six people with and without TTA ran at 3.5 m/s while ground reaction forces, kinematics, and electromyography were collected. People with TTA ran using their own RSP and DUP. Musculoskeletal models incorporating prosthesis type of each individual were used to quantify individual muscle forces and hip joint contact forces (HJCFs) during running. People using RSPs had smaller bilateral peak hip joint contact forces compared to when wearing DUPs during stance and swing, and a smaller impulse over the entire gait cycle. Greater amputated leg peak hip joint contact forces for people wearing DUPs compared to RSPs occurred with greater forces from the ipsilateral gluteus maximus during stance. People with TTA also had greater bilateral peak hip joint contact forces during swing compared to people without TTA, which occurred with greater peak gluteus medius forces. Running with more compliant RSPs may be beneficial for long-term joint health by reducing peak and impulsive hip loading compared to DUPs.

Biomechanical Changes after Intertrochanteric Curved Varus Osteotomy for Femoral Head Necrosis: A Finite Element Simulation

The hip joint secondary to osteoarthritis due to high contact pressure by osteonecrosis of femoral head needs to be considered when performing a preservation hip surgery. In this study, the hip joint contact pressure and load transfer path of femoral head by giving an intertrochanteric curved varus osteotomy with several types of lesions were investigated using a finite element method. The contact pressure decreased and the load transfer path widened after this osteotomy. The intertrochanteric curved varus osteotomy could remove the lesion out of weight-bearing area as well as an effective way to decrease the joint contact pressure.

In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice?

Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.

Tibiofemoral joint contact pressure distributions differ between healthy controls, non-progressive osteoarthritis patients, and progressive osteoarthritis patients

Purpose: The aim of this study was to compare tibiofemoral joint (TFJ) contact loading pressure distributions between healthy control, progressive osteoarthritis (OA) and non-progressive OA groups to determine if TFJ contact pressure distribution differ between these populations. Specifically, the contact area, and contact magnitude will be assessed during walking gait using an existing published framework.

Ankle joint contact loads and displacement in syndesmosis injuries repaired with Tightropes compared to screw fixation in a static model

BackgroundThe effect of syndesmotic fixation on restoration of pressure mechanics in the setting of a syndesmotic injury is largely unknown. The purpose of this study is to examine the contact mechanics of the tibiotalar joint following syndesmosis fixation with screws versus a flexible fixation device for complete syndesmotic injury. MethodsSix matched pairs of cadaveric below knee specimens were dissected and motion capture trackers were fixed to the tibia, fibula, and talus and a pressure sensor was placed in the tibiotalar joint. Each specimen was first tested intact with axial compressive load followed by external rotation while maintaining axial compression. Next, syndesmotic ligaments were sectioned and randomly assigned to repair with either two TightRopes® or two 3.5 mm cortical screws and the protocol was repeated. Mean contact pressure, peak pressure, reduction in contact area, translation of the center of pressure, and relative talar and fibular motion were calculated. Specimens were then cyclically loaded in external rotation and surviving specimens were loaded in external rotation to failure. ResultsNo differences in pressure measurements were observed between the intact and instrumented states during axial load. Mean contact presure relative to intact testing was increased in the screw group at 5 Nm and 7.5 Nm torque. Likewise, peak pressure was increased in the TightRope group at 7.5 Nm torque. There was no change in center of pressure in the TightRope group at any threshold; however, at every threshold tested there was significant medial and anterior translation in the screw group relative to the intact state. ConclusionEither screws or TightRope fixation is adequate with AL alone. With lower amounts of torque, the TightRope group appears to have contact and pressure mechanics that more closely match native mechanics.

Joint Loading Estimation Method for Horse Forelimb High Jerk Locomotion: Jumping

Maximal local loads in animal joints are necessary to design bio-inspired mechanical joints. Many studies presented methods to determine joint reaction forces in humans and animals. However, many of these methods are invasive, and no work has been published yet about the joint reaction forces in the horse forelimb during jumping. Non-invasive methods to measure the kinematics and ground reaction force of a horse forelimb were used in this work. A musculoskeletal model of horse forelimb was built with mechanical methods for the estimation of joint reaction forces. The entire forelimb was reconstructed by scanning real bones geometry with a 3D optical scanner and modeling all the muscles on a Computer Assisted Design (CAD) software. The model dynamics were simulated with OpenSim in order to estimate the joint loading. This study allows knowing an order of magnitude of the loads at the joints at jumping in order to determine latter the maximal joint contact loading values that will be a key at designing bio-inspired joints for mechanical assemblies.

ESB Clinical Biomechanics Award 2018: Muscle atrophy-related increased joint loading after total hip arthroplasty and their postoperative change from 3 to 50 months

BackgroundHip joint loading is dominated by muscular activity. Thus, contact forces exceeding many times one's body weight are a consequence of imbalanced muscular activity. The objective was to analyze the influence of muscle atrophy after total hip arthroplasty on in vivo hip joint contact loading initially and long term. We hypothesized that an impaired periarticular muscle will lead to increase in vivo joint load, specifically in the long term. MethodsUsing a group of nine patients with instrumented hip implants, contact forces and muscle status were analyzed one day prior to 3 and 50 months after joint arthroplasty. In vivo load measurements were performed for different activities of daily living (ADL). Pre- and postoperative pelvic CT scans were analyzed to assess the periarticular muscle status. Finally, the muscle morphologies and in vivo contact forces were compared. ResultsAt 3 months after total hip arthroplasty we found a significant correlation of lower lean gluteus minimus muscle (GMin) volume with higher loads during all tested activities of daily living. 50 months postoperatively statistical analysis revealed lower lean volume of the gluteus maximus to be correlated with higher joint loads in walking. ConclusionOur data generally show a good comparability between muscle status and joint contact forces and thus support our hypothesis that an impairment of periarticular musculature contributes to an increase of the in vivo joint loads after total hip arthroplasty. Effects were most pronounced during stair climbing and sit-down/stand-up from a chair at 3 months and during level walking at 50 months.

Biomechanical factors related to clinical vs. structural progression of knee OA

Purpose: The purpose of this presentation is to provide an overview of the in vivo human gait studies investigating biomechanical factors related to clinical (i.e. evidence of structural damage and symptoms) versus structural severity/progression in knee osteoarthritis (OA). Background: Biochemical responses, commonly triggered by biomechanical factors, are related to changes in the homeostatic balance of articular cartilage synthesis and degradation associated with OA. Historically, cartilage degradation has been the hallmark for OA; however, its effects on other structures such as muscles, ligaments, synovium and nerves are gaining recognition. The presence of symptoms is also fundamental in diagnosing OA (e.g. pain, stiffness, swelling, etc.), with pain as the most common symptom for seeking clinical care. Importantly, the level of pain and degree of structural damage are not well correlated in individuals with knee OA and suggest that each component may progress using different pathways. Much of our existing knowledge about OA mechanisms comes from fundamental in vitro or animal model studies that link biomechanical loading to biochemical responses related to OA processes (i.e. cartilage damage, inflammation and pain). In human models, gait (i.e. walking) studies have been the primary source of information for understanding knee joint-level loading in knee OA, and much of the work to date has examined joint moments from biomechanical models. Over the past 10 years an increasing number of studies have examined muscle activation patterns, including the contribution of muscles when modelling joint contact loads associated with OA processes. Summary: Differences in joint moment and muscle activation patterns have been associated with the level of structural severity, and evidence exists that associates specific pattern features with increased risk of structural progression defined using radiography and magnetic resonance imaging. Although fewer studies have focused on biomechanical and muscle activation patterns associated with clinical severity and risk of clinical progression, interesting trends are emerging and differ from features observed for structural outcomes. These gait studies provide information related to the magnitude, distribution, pattern and duration of joint loading. Features associated with the magnitude of joint moments are related to structural processes, whereas muscle function features and patterns of loading are linked with clinical outcomes such as joint replacement surgery. A critical evidence gap exists among these human studies related to the effect of loading frequency on OA progression. Aerobic exercise, particularly increasing walking frequency, is recommended across international non-surgical, non-pharmacological knee OA management guidelines based on pain relief, improved general health (i.e. cardiovascular outcomes), and the response of healthy cartilage to physical activity and exercise, but less on the effects on damaged tissue. The few human studies that link joint loading features during locomotion to biomarkers related to cartilage damage and pain processes in individuals with knee OA provide early evidence of a causal effect. Conclusions: Collectively, the work to date suggests that different biomechanical targets exist for structural versus clinical OA processes and should be considered when tailoring person-specific interventions.

Tribological performances of total knee prostheses: Roughness measurements on medial and lateral compartments of retrieved femoral components

BackgroundTotal replacement of the knee joint is a well-established surgical procedure performed to relieve pain and to restore the functionality of a compromised knee. Nevertheless, wear is still one of the main issues affecting joint prostheses, causing loosening and, eventually, implants failure. Surface roughness of the implant has been found to influence the mechanisms for premature wear, having relevant influence on the tribological performance. QuestionJoint load distribution have provided valuable insight into the knee loading patterns, showing that joint contact loads differ in medial and lateral condyles. We wondered if it is possible to find any alteration between surface roughness of medial and lateral sides and if the body mass index is in any way related to the in vivo roughening of the elements. MethodsFor this purpose, 11 explants of total knee replacement (mean follow up of 3.2 years), with identical design, were analysed acquiring the roughness on the femoral components. ResultsMacroscopic inspections show that lateral condyles underwent more surface damage than the medial ones. However, surface roughness was not significantly different comparing medial and lateral sides. Statistical tests outlined a significant difference in surface roughness when distinct sizes of implants, namely 3 and 4, are considered.

Correction to: Predictive Simulations of Neuromuscular Coordination and Joint-Contact Loading in Human Gait.

In the "Materials and Methods" section, the link provided at the bottom of the second paragraph should be https://simtk.org/home/dcwithjtcontact/ .

Design and clinical outcome of a novel 3D-printed prosthetic joint replacement for the human temporomandibular joint

BackgroundStock prosthetic temporomandibular joint replacements come in limited sizes, and do not always encompass the joint anatomy that presents clinically. The aims of this study were twofold. Firstly, to design a personalized prosthetic total joint replacement for the treatment of a patient's end-stage temporomandibular joint osteoarthritis, to implant the prosthesis into the patient, and assess clinical outcome 12-months post-operatively; and secondly, to evaluate the influence of changes in prosthetic condyle geometry on implant load response during mastication. MethodsA 48-year-old female patient with Grade-5 osteoarthritis to the left temporomandibular joint was recruited, and a prosthesis developed to match the native temporomandibular joint anatomy. The prosthesis was 3D printed, sterilized and implanted into the patient, and pain and function measured 12-months post-operatively. The prosthesis load response during a chewing-bite and maximum-force bite was evaluated using a personalized multi-body musculoskeletal model. Simulations were performed after perturbing condyle thickness, neck length and head sphericity. FindingsIncreases in prosthetic condyle neck length malaligned the mandible and perturbed temporomandibular joint force. Changes in condylar component thickness greatly influenced fixation screw stress response, while a more eccentric condylar head increased prosthetic joint-contact loading. Post-operatively, the prosthetic temporomandibular joint surgery reduced patient pain from 7/10 to 1/10 on a visual analog scale, and increased intercisal opening distance from 22 mm to 38 mm. InterpretationThis study demonstrates effectiveness of a personalized prosthesis that may ultimately be adapted to treat a wide-range of end-stage temporomandibular joint conditions, and highlights sensitivity of prosthesis load response to changes in condylar geometry.

Shoe cushioning affects lower extremity joint contact forces during running

This study evaluated the effect of running shoes with differing midsole cushioning on ankle, knee and hip contact forces during running. Joint contact forces were estimated in 40 recreational runners (28 female, 12 male) while running over ground in three shoe conditions. Shoes differed only in midsole cushioning (45, 57 and 70 Asker C). Three-dimensional kinetics and kinematics were collected during running and input to a musculoskeletal model to estimate internal axial forces at the ankle, knee and hip. Multivariate ANOVA suggested that more cushioned shoes, relative to less cushioned shoes, reduced peak joint contact forces (p < 0.01) and load rates (p < 0.01). Ankle joint contact force and load rate were reduced with increased cushioning (p < 0.01) with moderate to large effects observed between pairwise comparisons (p ≤ 0.01–0.05, dz=0.41–1.35). Cushioning effects were also observed for knee joint contact force (p = 0.03) and loading rate (p < 0.01) with load reduction only seen when comparing the soft and hard shoes (p ≤ 0.05, dz=0.41–0.44). Midsole cushioning had less of an effect on hip contact force (p = 0.31) although hip contact force loading rate was influenced by midsole cushioning (p < 0.01) with lower rates observed for soft versus medium and hard shoe comparisons (p ≤ 0.01, dz=0.41–0.62). These results suggest that increasing shoe cushioning properties ∼10–20% may benefit individuals susceptible to high loads at the ankle, and to a lesser extent knee and hip, during running.