Design Innovation Papers

Combined in Vivo/in Vitro Method to Study Anteriomedial Bundle Strain in the Anterior Cruciate Ligament Using a Dynamic Knee Simulator

[+] Author and Article Information
Naveen Chandrashekar

e-mail: nchandra@uwaterloo.ca
Department of Mechanical and Mechatronics Engineering,
University of Waterloo,
Waterloo, ON, N2L 3G1, Canada

Contributed by the Bioengineering Division of ASME for publication in the Journal of Biomechanical Engineering. Manuscript received December 5, 2011; final manuscript received December 18, 2012; accepted manuscript posted January 29, 2013; published online February 11, 2013. Assoc. Editor: Richard Neptune.

J Biomech Eng 135(3), 035001 (Feb 11, 2013) (8 pages) Paper No: BIO-11-1508; doi: 10.1115/1.4023520 History: Received December 05, 2011; Revised December 18, 2012; Accepted January 29, 2013

The mechanism of noncontact anterior cruciate ligament (ACL) injury is not well understood. It is partly because previous studies have been unable to relate dynamic knee muscle forces during sports activities such as landing from a jump to the strain in the ACL. We present a combined in vivo/in vitro method to relate the muscle group forces to ACL strain during jump-landing using a newly developed dynamic knee simulator. A dynamic knee simulator system was designed and developed to study the sagittal plane biomechanics of the knee. The simulator is computer controlled and uses six powerful electromechanical actuators to move a cadaver knee in the sagittal plane and to apply dynamic muscle forces at the insertion sites of the quadriceps, hamstring, and gastrocnemius muscle groups and the net moment at the hip joint. In order to demonstrate the capability of the simulator to simulate dynamic sports activities on cadaver knees, motion capture of a live subject landing from a jump on a force plate was performed. The kinematics and ground reaction force data obtained from the motion capture were input into a computer based musculoskeletal lower extremity model. From the model, the force-time profile of each muscle group across the knee during the movement was extracted, along with the motion profiles of the hip and ankle joints. This data was then programmed into the dynamic knee simulator system. Jump-landing was simulated on a cadaver knee successfully. Resulting strain in the ACL was measured using a differential variable reluctance transducer (DVRT). Our results show that the simulator has the capability to accurately simulate the dynamic sagittal plane motion and the dynamic muscle forces during jump-landing. The simulator has high repeatability. The ACL strain values agreed with the values reported in the literature. This combined in vivo/in vitro approach using this dynamic knee simulator system can be effectively used to study the relationship between sagittal plane muscle forces and ACL strain during dynamic activities.

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Griffin, L. Y., Albohm, M. J., Arendt, E. A., Bahr, R., Beynnon, B. D., Demaio, M., Dick, R. W., Engebretsen, L., Garrett, W. E., Jr., Hannafin, J. A., Hewett, T. E., Huston, L. J., Ireland, M. L., Johnson, R. J., Lephart, S., Mandelbaum, B. R., Mann, B. J., Marks, P. H., Marshall, S. W., Myklebust, G., Noyes, F. R., Powers, C., Shields, C., Jr., Shultz, S. J., Silvers, H., Slauterbeck, J., Taylor, D. C., Teitz, C. C., Wojtys, E. M., and Yu, B., 2006, “Understanding and Preventing Noncontact Anterior Cruciate Ligament Injuries: A Review of the Hunt Valley II Meeting, January 2005,” Am. J. Sports Med., 34(9), pp. 1512–1532. [CrossRef] [PubMed]
Hewett, T. E., Myer, G. D., and Ford, K. R., 2006, “Anterior Cruciate Ligament Injuries. Part I: Mechanisms and Risk Factors,” Am. J. Sports Med., 34(2), pp. 299–311. [CrossRef] [PubMed]
Hewett, T. E., Lindenfield, T. N., Riccobene, J. V., and Noyes, F. R., 1999, “The Effect of Neuromuscular Training on the Incidence of Knee Injury in Female Athletes: A Prospective Study,” Am. J. Sports Med., 27(6), pp. 699–706. [PubMed]
Freedman, K. B., Glasgow, M. T., Glasgow, S. G., and BernsteinJ., 1998, “Anterior Cruciate Ligament Injuries and Reconstruction Among University Students,” Clin. Orthop. Relat. Res., 356, pp. 208–212. [CrossRef] [PubMed]
Deacon, A., Bennell, K., Kiss, Z. S., Crossley, K., and Brukner, P., 1997, “Osteoarthritis of the Knee in Retired, Elite Australian Rules Footballers,” Med. J. Aust., 166(4), pp. 187–190. [PubMed]
Bahr, R., and Krosshaug, T., 2005, “Understanding Injury Mechanisms: A Key Component of Preventing Injuries in Sport,” Br. J. Sports Med., 39(6), pp. 324–329. [CrossRef] [PubMed]
Kirkendall, D. T., and Garrett, W. E., Jr., 2000, “The Anterior Cruciate Ligament Enigma. Injury Mechanisms and Prevention,” Clin. Orthop. Relat. Res., 372, pp. 64–68. [CrossRef] [PubMed]
Hewett, T. E., Myer, G. D., Ford, K. R., and Slauterbeck, J. R., 2007, “Dynamic Neuromuscular Analysis Training for Preventing Anterior Cruciate Ligament Injury in Female Athletes,” Instr. Course Lect., 56, pp. 397–406. [PubMed]
Aune, A. K., Cawley, P. W., and Ekeland, A., 1997, “Quadriceps Muscle Contraction Protects the Anterior Cruciate Ligament During Anterior Tibial Translation,” Am. J. Sports Med., 25(2), pp. 187–190. [CrossRef] [PubMed]
DeMorat, G., Weinhold, P., Blackburn, T., Chudik, S., and Garrett, W., 2004, “Aggressive Quadriceps Loading Can Induce Noncontact Anterior Cruciate Ligament Injury,” Am. J. Sports Med., 32(2), pp. 477–483. [CrossRef] [PubMed]
Shultz, S. J., Schmitz, R. J., Nguyen, A. D., Chaudhari, A. M., Padua, D. A., McLean, S. G., and Sigward, S. M., 2010, “ACL Research Retreat V: An Update on ACL Injury Risk and Prevention, March 25-27, 2010, Greensboro, NC.,” J. Athl. Train., 45(5), pp. 499–508. [CrossRef] [PubMed]
Myers, C. A., Torry, M. R., Shelburne, K. B., Giphart, J. E., LaPrade, R. F., Woo, S. L., and Steadman, J. R., 2012, “In Vivo Tibiofemoral Kinematics During 4 Functional Tasks Of Increasing Demand Using Biplane Fluoroscopy,” Am. J. Sports Med., 40(1), pp. 170–178. [CrossRef] [PubMed]
Torry, M. R., Shelburne, K. B., Peterson, D. S., Giphart, J. E., Krong, J. P., Myers, C., Steadman, J. R., and Woo, S. L., 2011, “Knee Kinematic Profiles During Drop Landings: A Biplane Fluoroscopy Study,” Med. Sci. Sports Exercise, 43(3), pp. 533–541. [CrossRef]
Taylor, K. A., Terry, M. E., Utturkar, G. M., Spritzer, C. E., Queen, R. M., Irribarra, L. A., Garrett, W. E., and DeFrate, L. E., 2011, “Measurement of In Vivo Anterior Cruciate Ligament Strain During Dynamic Jump Landing,” J. Biomech., 44(3), pp. 365–371. [CrossRef] [PubMed]
Beynnon, B., Howe, J. G., Pope, M. H., Johnson, R. J., and Fleming, B. C., 1992, “The Measurement of Anterior Cruciate Ligament Strain In Vivo,” Int. Orthop., 16(1), pp. 1–12. [CrossRef] [PubMed]
Cerulli, G., Benoit, D. L., Lamontagne, M., Caraffa, A., and Liti, A., 2003, “In Vivo Anterior Cruciate Ligament Strain Behaviour During a Rapid Deceleration Movement: Case Report,” Knee Surg. Sports Traumatol. Arthrosc., 11(5), pp. 307–311. [CrossRef] [PubMed]
Fleming, B. C., Beynnon, B. D., Renstrom, P. A., Johnson, R. J., Nichols, C. E., Peura, G. D., and Uh, B. S., 1999, “The Strain Behavior of the Anterior Cruciate Ligament During Stair Climbing: An In Vivo Study,” Arthroscopy: J. Relat. Surg., 15(2), pp. 185–191. [CrossRef]
Zhang, Y., Liu, G., and Xie, S. Q., 2011, “Biomechanical Simulation of Anterior Cruciate Ligament Strain for Sports Injury Prevention,” Comput. Biol. Med., 41(3), pp. 159–163. [CrossRef] [PubMed]
Laughlin, W. A., Weinhandl, J. T., Kernozek, T. W., Cobb, S. C., Keenan, K. G., and O'Connor, K. M., 2011, “The Effects of Single-Leg Landing Technique on ACL Loading,” J. Biomech., 44(10), pp. 1845–1851. [CrossRef] [PubMed]
Pflum, M. A., Shelburne, K. B., Torry, M. R., Decker, M. J., and Pandy, M. G., 2004, “Model Prediction of Anterior Cruciate Ligament Force During Drop-Landings,” Med. Sci. Sports Exercise, 36(11), pp. 1949–1958. [CrossRef]
Draganich, L. F., and Vahey, J. W., 1990, “An In Vitro Study of Anterior Cruciate Ligament Strain Induced by Quadriceps and Hamstrings Forces,” J. Orthop. Res., 8(1), pp. 57–63. [CrossRef] [PubMed]
Markolf, K. L., O'Neill, G., Jackson, S. R., and McAllister, D. R., 2004, “Effects Of Applied Quadriceps and Hamstrings Muscle Loads on Forces in the Anterior and Posterior Cruciate Ligaments,” Am. J. Sports Med., 32(5), pp. 1144–1149. [CrossRef] [PubMed]
Dürselen, L., Claes, L., and Kiefer, H., 1995, “The Influence of Muscle Forces and External Loads on Cruciate Ligament Strain,” Am. J. Sports Med., 23(1), pp. 129–136. [CrossRef] [PubMed]
Torzilli, P. A., Deng, X., and Warren, R. F., 1994, “The Effect of Joint-Compressive Load and Quadriceps Muscle Force on Knee Motion in the Intact and Anterior Cruciate Ligament-Sectioned Knee,” Am. J. Sports Med., 22(1), pp. 105–112. [CrossRef] [PubMed]
Wascher, D. C., Markolf, K. L., Shapiro, M. S., and Finerman, G. A., 1993, “Direct In Vitro Measurement of Forces in the Cruciate Ligaments. Part I: The Effect of Multiplane Loading in the Intact Knee” J. Bone Jt. Surg., Am. Vol., 75(3), pp. 377–386.
McLean, C. A., and Ahmed, A. M., 1993, “Design and Development of an Unconstrained Dynamic Knee Simulator,” J. Biomech. Eng., 115(2), pp. 144–148. [CrossRef] [PubMed]
Maletsky, L. P., and Hillberry, B. M., 2005, “Simulating Dynamic Activities Using a Five-Axis Knee Simulator,” J. Biomech. Eng., 127(1), pp. 123–133. [CrossRef] [PubMed]
Elias, J. J., Faust, A. F., Chu, Y. H., Chao, E. Y., and Cosgarea, A. J., 2003, “The Soleus Muscle Acts as an Agonist for the Anterior Cruciate Ligament. An In Vitro Experimental Study,” Am. J. Sports Med., 31(2), pp. 241–246. [PubMed]
Berns, G. S., Hull, M. L., and Patterson, H. A., 1992, “Strain in the Anteromedial Bundle of the Anterior Cruciate Ligament Under Combination Loading,” J. Orthop. Res., 10(2), pp. 167–176. [CrossRef] [PubMed]
MacWilliams, B. A., Wilson, D. R., DesJardins, J. D., Romero, J., and Chao, E. Y., 1999, “Hamstrings Cocontraction Reduces Internal Rotation, Anterior Translation, and Anterior Cruciate Ligament Load in Weight-Bearing Flexion,” J. Orthop. Res., 17(6), pp. 817–822. [CrossRef] [PubMed]
Yoo, J. D., Papannagari, R., Park, S. E., DeFrate, L. E., Gill, T. J., and Li, G., 2005, “The Effect of Anterior Cruciate Ligament Reconstruction on Knee Joint Kinematics Under Simulated Muscle Loads,” Am. J. Sports Med., 33(2), pp. 240–246. [CrossRef] [PubMed]
Singerman, R., Berilla, J., Archdeacon, M., and Peyser, A., 1999, “In Vitro Forces in the Normal and Cruciate-Deficient Knee During Simulated Squatting Motion,” J. Biomech. Eng., 121(2), pp. 234–242. [CrossRef] [PubMed]
Kanamori, A., Woo, S. L., Ma, C. B., Zeminski, J., Rudy, T. W., Li, G., and Livesay, G. A., 2000, “The Forces in the Anterior Cruciate Ligament and Knee Kinematics During a Simulated Pivot Shift Test: A Human Cadaveric Study Using Robotic Technology,” Arthroscopy: J. Relat. Surg., 16(6), pp. 633–639. [CrossRef]
Li, G., Rudy, T. W., Sakane, M., Kanamori, A., Ma, C. B., and Woo, S. L., 1999, “The Importance of Quadriceps and Hamstring Muscle Loading on Knee Kinematics and In-Situ Forces in the ACL,” J. Biomech., 32(4), pp. 395–400. [CrossRef] [PubMed]
Withrow, T. J., Huston, L. J., Wojtys, E. M., and Ashton-Miller, J. A., 2006, “The Effect of an Impulsive Knee Valgus Moment on In Vitro Relative ACL Strain During a Simulated Jump Landing,” Clin. Biomech. (Bristol, Avon), 21(9), pp. 977–983. [CrossRef] [PubMed]
Hashemi, J., Chandrashekar, N., Jang, T., Karpat, F., Oseto, M., and Ekwaro-Osire, S., 2007, “An Alternative Mechanism of Non-Contact Anterior Cruciate Ligament Injury During Jump-landing,” Exp. Mech., 47, pp. 347–354, [CrossRef]
Heijne, A., Fleming, B. C., Renstrom, P. A., Peura, G. D., Beynnon, B. D., and Werner, S., 2004, “Strain on the Anterior Cruciate Ligament During Closed Kinetic Chain Exercises,” Med. Sci. Sports Exercise, 36(6), pp. 935–941. [CrossRef]
Erdemir, A., McLean, S., Herzog, W., and van den Bogert, A. J., 2007, “Model-Based Estimation of Muscle Forces Exerted During Movements,” Clin. Biomech. (Bristol, Avon), 22(2), pp. 131–154. [CrossRef] [PubMed]
Damsgaard, M., Rasmussen, J., Christensen, S. T., Surma, E., and de Zee, M., 2006, “Analysis of Musculoskeletal Systems in the Anybody Modeling System,” Simul. Model. Pract. Theory, 14, pp. 1100–1111. [CrossRef]
Klein-Horsman, M. D., 2007, “The Twente Lower Extremity Model—Consistent Dynamic Simulation of the Human Locomotor Apparatus,” Ph.D. thesis, Universiteit Twente, Enschede, The Netherlands.
Delp, S. L., Ringwelski, D. A., and Carroll, N. C., 1994, “Transfer of the Rectus Femoris: Effects of Transfer Site on Moment Arms About the Knee And Hip,” J. Biomech., 27(10), pp. 1201–1211. [CrossRef] [PubMed]
Weinhold, P. S., Stewart, J. D., Liu, H. Y., Lin, C. F., Garrett, W. E., and Yu, B., 2007, “The Influence of Gender-Specific Loading Patterns of the Stop-Jump Task on Anterior Cruciate Ligament Strain,” Injury, 38(8), pp. 973–978. [CrossRef] [PubMed]
Hashemi, J., Breighner, R., Jang, T. H., Chandrashekar, N., Ekwaro-Osire, S., and Slauterbeck, J. R., 2010, “Increasing Pre-Activation of the Quadriceps Muscle Protects the Anterior Cruciate Ligament During the Landing Phase of a Jump: An In Vitro Simulation,” Knee, 17(3), pp. 235–241. [CrossRef] [PubMed]
Shin, C. S., Chaudhari, A. M., and Andriacchi, T. P., 2007, “The Influence of Deceleration Forces on ACL Strain During Single-Leg Landing: A Simulation Study,” J. Biomech., 40(5), pp. 1145–1152. [CrossRef] [PubMed]
Shimokochi, Y., Ambegaonkar, J. P., Meyer, E. G., Lee, S. Y., and Shultz, S. J., 2012, “Changing Sagittal Plane Body Position During Single-Leg Landings Influences the Risk of Non-Contact Anterior Cruciate Ligament Injury,” Knee Surg. Sports Traumatol. Arthrosc. (in press).
McLean, S. G., Oh, Y. K., Palmer, M. L., Lucey, S. M., Lucarelli, D. G., Ashton-Miller, J. A., and Wojtys, E. M., 2011, “The Relationship Between Anterior Tibial Acceleration, Tibial Slope, and ACL Strain During a Simulated Jump Landing Task,” J. Bone Jt. Surg., Am., 93(14), pp. 1310–1317. [CrossRef]


Grahic Jump Location
Fig. 4

The lower extremity model from AnyBody Modeling System

Grahic Jump Location
Fig. 3

A close-up view of the surrogate hip joint (a), muscle cable attachments on the cadaver knee (b), and the surrogate ankle joint (c) in the simulator

Grahic Jump Location
Fig. 2

The dynamic knee simulator system. The cadaver knee (K) is connected to the turnbuckles that are connected to surrogate hip (HI) and ankle (A) joints. The hip joint moves in the vertical direction (dark double head arrow) and the ankle moves in the horizontal direction (white double head arrow). The ankle joint also is unconstrained in the mediolateral direction (white double headed dotted arrow). Three muscle force actuators (Q, H, and G) are connected to the knee, and they apply dynamic quadriceps, hamstring, and gastrocnemius muscle forces (dark single head arrows). The hip moment actuator (HM) connected to the turnbuckle below the hip applies flexor-extensor moment. The load cells connected to the actuator rod ends are not seen in this view.

Grahic Jump Location
Fig. 1

A flow chart representing the inputs and outputs of in vivo, modeling, and in vitro parts of the experimental procedure

Grahic Jump Location
Fig. 6

The intended (dotted line) and actual (solid line) hip and ankle motion profiles and the corresponding knee flexion angle (solid) compared to in vivo data (dotted line). In the x axis, −100 ms represents 100 ms before landing and 0 represents ground contact. The gray vertical line across the graph shows the instance of ground contact.

Grahic Jump Location
Fig. 5

The applied muscle force profiles (solid line) of quadriceps (a) and hamstring (b) muscle groups and the applied hip extensor moment (c). The input to the actuators is shown as dotted gray lines. The resulting ACL strain (dotted line) and the corresponding GRF (solid line) is also shown (d). In the x axis, −100 ms represents 100 ms before landing and 0 represents landing. The gray vertical line across the graphs shows the instance of ground contact. The data is smoothed to remove electrical and mechanical noise.

Grahic Jump Location
Fig. 7

The comparison between the net knee extensor moments in the knee derived from inverse dynamics (gray dotted line) and the grouped muscle moments calculated by the AnyBody model (dark solid line). The gray vertical line across the graph shows the instance of ground contact. The GRF (solid gray curve) is also given for comparison purposes.



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