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TECHNICAL PAPERS: Bone/Orthopedic

J Biomech Eng. 2004;126(4):393-401. doi:10.1115/1.1784473.

A tapered interference fit provides a mechanically reliable retention mechanism for the implant-abutment interface in a dental implant. Understanding the mechanical properties of the tapered interface with or without a screw at the bottom has been the subject of a considerable amount of studies involving experiments and finite element (FE) analysis. In this paper, approximate closed-form formulas are developed to analyze the mechanics of a tapered interference fit. In particular, the insertion force, the efficiency, defined as the ratio of the pull-out force to insertion force, and the critical insertion depth, which causes the onset of plastic deformation, are analyzed. It is shown that the insertion force is a function of the taper angle, the contact length, the inner and outer radii of the implant, the static and the kinetic coefficients of friction, and the elastic modulii of the implant/abutment materials. The efficiency of the tapered interference fit, which is defined as the ratio of the pull-out force to insertion force, is found to be greater than one, for taper angles that are less than 6 deg when the friction coefficient is 0.3. A safe range of insertion forces has been shown to exist. The lower end of this range depends on the maximum pull-out force that may occur due to occlusion in the multiple tooth restorations and the efficiency of the system; and the upper end of this range depends on the plastic deformation of the abutment and the implant due to interference fit. It has been shown that using a small taper angle and a long contact length widens the safe range of insertion forces.

Commentary by Dr. Valentin Fuster

TECHNICAL PAPERS: Cell

J Biomech Eng. 2004;126(4):402-409. doi:10.1115/1.1784474.

The perfusion microscope was developed for the study of the osmotic response of cells. In this microscope, the cells are immobilized in a transparent chamber mounted on the stage and exposed to a variety of milieus by perfusing the chamber with solutions of different concentrations. The concentration of the supplied solution is controlled using two variable-speed syringe pumps, which supply an isotonic solution and a hypertonic solution. Before using this system to characterize the osmotic response of cells, the change in the concentration of NaCl solution flowing through the chamber is examined quantitatively using a laser interferometer and an image processing technique. The NaCl concentration is increased from an isotonic condition to a hypertonic condition abruptly or gradually at a given constant rate, and decreased from a hypertonic condition to an isotonic condition. It is confirmed that the concentration is nearly uniform in the cross direction at the middle of the chamber, and the change in the NaCl concentration is reproducible. The average rate of increase or decrease in the measured concentration agrees fairly well with the given rate when the concentration is changed gradually at a constant rate. The rate of the abrupt change is also determined to be the highest limit achieved by the present method. As the first application of using the perfusion microscope for biological studies, the volume change of cells after exposure to a hypertonic solution is measured. Then, the hydraulic conductivity of the cell membrane is determined from the comparison of the volume change between the experiment and the theoretical estimation for the measured change in the NaCl concentration of the perfused solution.

Commentary by Dr. Valentin Fuster

TECHNICAL PAPERS: Fluids/Heat/Transport

J Biomech Eng. 2004;126(4):410-419. doi:10.1115/1.1784475.

Soluble surfactant and airway surface liquid transport are examined using a mathematical model of Marangoni flows which accounts for airway branching and for cyclic airway stretching. Both radial and longitudinal wall strains are considered. The model allows for variation of the amplitude and frequency of the motion, as may occur under a variety of ventilatory situations occurring during surfactant replacement therapy. The soluble surfactant dynamics of the thin fluid film are modeled by linear sorption. The delivery of surfactants into the lung is handled by setting the proximal boundary condition to a higher concentration compared to the distal boundary condition. Starting with a steady-state, nonuniform, surfactant distribution, we find that transport of surfactant into the lung is enhanced for increasing strain amplitudes. However, for fixed amplitude, increasing frequency has a smaller effect. At small strain amplitudes, increasing frequency enhances transport, but at large strain amplitudes, increasing cycling frequency has the opposite effect.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):420-429. doi:10.1115/1.1784476.

Flow visualization studies and supplementary numerical simulations are carried out on slow flow through a model alveolated duct. The results reveal that the type of flow that develops in the alveoli, or cavities, is controlled by the ratio of the depth to the width of the cavity and by the ratio of cavity volume to duct volume. While weak, the slowly rotating flow in the cavity is thought to be important to the convective transport of heat and mass transfer to, or from, the walls of the cavity. The relevance of these finding to particle transport and deposition deep in the lung is discussed.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):430-437. doi:10.1115/1.1784477.

Particle image velocimetry (PIV) has been gaining acceptance as a routine tool to evaluate the flow fields associated with fluid mechanical devices. We have developed algorithms to investigate the wall shear-rates within the 50cc Penn State artificial heart using low magnification, conventional particle image velocimetry (PIV). Wall shear has been implicated in clot formation, a major post-implant problem with artificial hearts. To address the issues of wall scattering and incomplete measurement volumes, associated with near wall measurements, we have introduced a zero masking and a fluid centroid shifting technique. Simulations using different velocity fields were conducted with the techniques to assess their viability. Subsequently, the techniques were applied to the experimental data collected. The results indicate that the size of the interrogation region should be chosen to be as small as possible to maximize resolution while large enough to ensure an adequate number of particles per region. In the current study, a 16×16 interrogation window performed well with good spatial resolution and particle density for the estimation of wall shear rate. The techniques developed with PIV allow wall shear-rate estimates to be obtained from a large number of sites at one time. Because a planar image of a flow field can be determined relatively rapidly, PIV may prove useful in any preliminary design procedure.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):438-446. doi:10.1115/1.1784478.

As one important step in the investigation of the mechanical factors that lead to rupture of abdominal aortic aneurysms, flow fields and flow-induced wall stress distributions have been investigated in model aneurysms under pulsatile flow conditions simulating the in vivo aorta at rest. Vortex pattern emergence and evolution were evaluated, and conditions for flow stability were delineated. Systolic flow was found to be forward-directed throughout the bulge in all the models, regardless of size. Vortices appeared in the bulge initially during deceleration from systole, then expanded during the retrograde flow phase. The complexity of the vortex field depended strongly on bulge diameter. In every model, the maximum shear stress occurred at peak systole at the distal bulge end, with the greatest shear stress developing in a model corresponding to a 4.3 cm AAA in vivo. Although the smallest models exhibited stable flow throughout the cycle, flow in the larger models became increasingly unstable as bulge size increased, with strong amplification of instability in the distal half of the bulge. These data suggest that larger aneurysms in vivo may be subject to more frequent and intense turbulence than smaller aneurysms. Concomitantly, increased turbulence may contribute significantly to wall stress magnitude and thereby to risk of rupture.

Commentary by Dr. Valentin Fuster

TECHNICAL PAPERS: Joint/Whole Body

J Biomech Eng. 2004;126(4):447-457. doi:10.1115/1.1784479.

Background. Knowledge of the biodynamic response (BR) of the human hand-arm system is an important part of the foundation for the measurement and assessment of hand-transmitted vibration exposure. This study investigated the BR of human fingers in a power grip subjected to a random vibration. Method. Ten male subjects were used in the experiment. Each subject applied three coupling actions to a simulated tool handle at three different finger grip force levels. Results and Conclusions. The BR is practically independent of the hand coupling actions for frequencies at or above 100 Hz. Above 50 Hz, the BR is correlated to finger and hand sizes. Increasing the finger coupling force significantly increases the BR. Therefore, hand forces should be measured and used when assessing hand-transmitted vibration exposure. The results also show that under a constant-velocity vibration, the finger vibration power absorption at frequencies above 200 Hz is approximately twice that at frequencies below 100 Hz. This suggests that the frequency weighting specified in the current ISO 5349-1 (2001) may underestimate the high frequency effect on vibration-induced finger disorders.

Commentary by Dr. Valentin Fuster

TECHNICAL PAPERS: Soft Tissue

J Biomech Eng. 2004;126(4):458-465. doi:10.1115/1.1785803.

The objective of this work was to develop a robotic device to perform biopsy and therapeutic interventions in the breast with real-time magnetic resonance imaging (MRI) guidance. The device was designed to allow for (i) stabilization of the breast by compression, (ii) definition of the interventional probe trajectory by setting the height and pitch of a probe insertion apparatus, and (iii) positioning of an interventional probe by setting the depth of insertion. The apparatus is fitted with five computer-controlled degrees of freedom for delivering an interventional procedure. The entire device is constructed of MR compatible materials, i.e. nonmagnetic and non-conductive, to eliminate artifacts and distortion of the MR images. The apparatus is remotely controlled by means of ultrasonic motors and a graphical user interface, providing real-time MR-guided planning and monitoring of the operation. Joint motion measurements found probe placement in less than 50 s and sub-millimeter repeatability of the probe tip for same-direction point-to-point movements. However, backlash in the rotation joint may incur probe tip positional errors of up to 5 mm at a distance of 40 mm from the rotation axis, which may occur for women with large breasts. The imprecision caused by this backlash becomes negligible as the probe tip nears the rotation axis. Real-time MR-guidance will allow the physician to correct this error. Compatibility of the device within the MR environment was successfully tested on a 4 Tesla MR human scanner.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):466-474. doi:10.1115/1.1785804.

In human voice production (phonation), linear small-amplitude vocal fold oscillation occurs only under restricted conditions. Physiologically, phonation more often involves large-amplitude oscillation associated with tissue stresses and strains beyond their linear viscoelastic limits, particularly in the lamina propria extracellular matrix (ECM). This study reports some preliminary measurements of tissue deformation and failure response of the vocal fold ECM under large-strain shear. The primary goal was to formulate and test a novel constitutive model for vocal fold tissue failure, based on a standard-linear cohesive-zone (SL-CZ) approach. Tissue specimens of the sheep vocal fold mucosa were subjected to torsional deformation in vitro, at constant strain rates corresponding to twist rates of 0.01, 0.1, and 1.0 rad/s. The vocal fold ECM demonstrated nonlinear stress-strain and rate-dependent failure response with a failure strain as low as 0.40 rad. A finite-element implementation of the SL-CZ model was capable of capturing the rate dependence in these preliminary data, demonstrating the model’s potential for describing tissue failure. Further studies with additional tissue specimens and model improvements are needed to better understand vocal fold tissue failure.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):475-484. doi:10.1115/1.1785805.

A tetrapolar method to measure electrical conductivity of cartilage and bone, and to estimate the thickness of articular cartilage attached to bone, was developed. We determined the electrical conductivity of humeral head bovine articular cartilage and subchondral bone from a 1- to 2-year-old steer to be 1.14±0.11 S/m(mean±sd,n=11) and 0.306±0.034 S/m,(mean±sd,n=3), respectively. For a 4-year-old cow, articular cartilage and subchondral bone electrical conductivity were 0.88±0.08 S/m(mean±sd,n=9) and 0.179±0.046 S/m(mean±sd,n=3), respectively. Measurements on slices of cartilage taken from different distances from the articular surface of the steer did not reveal significant depth-dependence of electrical conductivity. We were able to estimate the thickness of articular cartilage with reasonable precision (<20% error) by injecting current from multiple electrode pairs with different inter-electrode distances. Requirements for the precision of this method to measure cartilage thickness include the presence of a distinct layer of calcified cartilage or bone with a much lower electrical conductivity than that of uncalcified articular cartilage, and the use of inter-electrode distances of the current injecting electrodes that are on the order of the cartilage thickness. These or similar methods present an attractive approach to the non-destructive determination of cartilage thickness, a parameter that is required in order to estimate functional properties of cartilage attached to bone, and evaluate the need for therapeutic interventions in arthritis.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):485-491. doi:10.1115/1.1785806.

In the present study, a 1-D dynamic permeation of a monovalent electrolyte solution through a negatively charged-hydrated cartilaginous tissue is analyzed using the mechano-electrochemical theory developed by Lai et al. (1991) as the constitutive model for the tissue. The spatial distributions of stress, strain, fluid pressure, ion concentrations, electrical potential, ion and fluid fluxes within and across the tissue have been calculated. The dependencies of these mechanical, electrical and physicochemical responses on the tissue fixed charge density, with specified modulus, permeability, diffusion coefficients, and frequency and magnitude of pressure differential are determined. The results demonstrate that these mechanical, electrical and physicochemical fields within the tissue are intrinsically and nonlinearly coupled, and they all vary with time and depth within the tissue.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):492-497. doi:10.1115/1.1785807.

Most soft tissues that are treated clinically via heating experience multiaxial states of stress and strain in vivo and are subject to complex constraints during treatment. Remarkably, however, there are no prior data on changes in the multiaxial mechanical behavior of a collagenous tissue subjected to isometric constraints during heating. This paper presents the first biaxial stress-stretch data on a collagenous membrane (epicardium) before and after heating while subjected to various biaxial isometric constraints. It was found that isometric heating does not allow the increase in stiffness at low strains that occurs following isotonic heating. Moreover, increasing the degree of stretch prior to heating increased the thermal stability of the tissue consistent with the concept that mechanical loading primarily affects the activation entropy, not the activation energy.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):498-505. doi:10.1115/1.1785808.

Indentation has historically been used by biomechanicians to extract the small strain elastic or viscoelastic properties of biological tissues. Because of the axisymmetry of indenters used in these studies however, analysis of the results requires the assumption of material isotropy and often yields an “effective” elastic modulus. Since most biological tissues such as bone and myocardium are known to be anisotropic, the use of conventional indentation techniques for estimating material properties is therefore limited. The feasibility of using an axially asymmetric indenter to determine material directions and in-plane material properties for anisotropic tissue is explored here using finite element analysis. The load versus displacement curves as would be measured by an indenter depend on the orientation of the indenter cross section relative to the in-plane material axes, thus suggesting a method for determining the underlying material directions. Additionally, the stiffness of the tissue response to indentation is sensitive to the values of the in-plane anisotropic material properties and prestretches, and thus test results can be used to back out relevant constitutive parameters.

Commentary by Dr. Valentin Fuster

TECHNICAL PAPERS: Other

J Biomech Eng. 2004;126(4):506-515. doi:10.1115/1.1786297.

During pulsed laser lithotripsy, the calculus is subject to a strong recoil momentum which moves the calculus away from laser delivery and prolongs the operation. This study was designed to quantify the recoil momentum during Ho:YAG laser lithotripsy. The correlation among crater shape, debris trajectory, laser-induced bubble and recoil momentum was investigated. Calculus phantoms made from plaster of Paris were ablated with free running Ho:YAG lasers. The dynamics of recoil action of a calculus phantom was monitored by a high-speed video camera and the laser ablation craters were examined with Optical Coherent Tomography (OCT). Higher radiant exposure resulted in larger ablation volume (mass) which increased the recoil momentum. Smaller fibers produced narrow craters with a steep contoured geometry and decreased recoil momentum compared to larger fibers. In the presence of water, recoil motion of the phantom deviated from that of phantom in air. Under certain conditions, we observed the phantom rocking towards the fiber after the laser pulse. The shape of the crater is one of the major contributing factors to the diminished recoil momentum of smaller fibers. The re-entrance flow of water induced by the bubble collapse is considered to be the cause of the rocking of the phantom.

Commentary by Dr. Valentin Fuster

TECHNICAL BRIEFS

J Biomech Eng. 2004;126(4):516-518. doi:10.1115/1.1785809.

Arterial branches are found to be a major site for formation of arterial plaque. In this study, we investigate the role of the bifurcation angle on the flow into a symmetric bifurcation. Specially, how the changes in the bifurcation angle influences the distribution of axial wall shear in the bifurcation model. The flow in a range of branch opening half-angle of π/25≤θ≤π/4 are numerically simulated. The flow in the above models is calculated for the inlet flow Reynolds numbers of 250, 500, 1000, and 2000. It is found that at higher values of the opening angle of the bifurcation, the possibility and severity of flow separation at the appropriate wall location increases.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):519-522. doi:10.1115/1.1785810.

Several studies on radiofrequency (RF) ablation are aimed at accurately predicting tissue temperature distributions by numerical solution of the bioheat equation. This paper describes the development of a solution that can serve as a benchmark for subsequent numerical solutions. The solution was obtained using integral transforms and evaluated using a C program. Temperature profiles were generated at various times and for different convection coefficients. In addition, a numerical model was developed using the same assumptions made in obtaining the benchmark solution. Comparison of surface and axial temperature profiles shows that the two solutions match very closely, cross validating the numerical methods used in evaluating both solutions.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):523-528. doi:10.1115/1.1785811.

Two-dimensional (2-D) strain fields were estimated non-invasively in two simple experimental models of closed-head brain injury. In the first experimental model, shear deformation of a gel was induced by angular acceleration of its spherical container. In the second model the brain of a euthanized rat pup was deformed by indentation of its skull. Tagged magnetic resonance images (MRI) were obtained by gated image acquisition during repeated motion. Harmonic phase (HARP) images corresponding to the spectral peaks of the original tagged MRI were obtained, following procedures proposed by Osman, McVeigh and Prince [1]. Two methods of HARP strain analysis were applied, one based on the displacement of tag line intersections, and the other based on the gradient of harmonic phase. Strain analysis procedures were also validated on simulated images of deformed grids. Results show that it is possible to visualize deformation and to quantify strain efficiently in animal models of closed head injury.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):529-535. doi:10.1115/1.1785812.

In this work, we propose a simple method to simultaneously match the refractive index and kinematic viscosity of a circulating blood analog in hydraulic models for optical flow measurement techniques (PIV, PMFV, LDA, and LIF). The method is based on the determination of the volumetric proportions and temperature at which two transparent miscible liquids should be mixed to reproduce the targeted fluid characteristics. The temperature dependence models are a linear relation for the refractive index and an Arrhenius relation for the dynamic viscosity of each liquid. Then the dynamic viscosity of the mixture is represented with a Grunberg-Nissan model of type 1. Experimental tests for acrylic and blood viscosity were found to be in very good agreement with the targeted values (measured refractive index of 1.486 and kinematic viscosity of 3.454 milli-m2 /s with targeted values of 1.47 and 3.300 milli-m2 /s).

Commentary by Dr. Valentin Fuster

DISCUSSIONS

J Biomech Eng. 2004;126(4):536. doi:10.1115/1.1785814.
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Walker,  P. S., Dowson,  D., Longfield,  M. D., and Wright,  V., 1968, “ ‘Boosted Lubrication’ in Synovial Joints by Fluid Entrapment and Enrichment,” Ann. Rheum. Dis., ARDIAO27, pp. 512–560.andARDIAO0003-4967McCutchen, C. W., 1980, “Joint Lubrication,” In: Biology of Articular Cartilage in Health and Disease, Proceedings of the Second Munich Symposium of Biology of Connective Tissue, July 23–24, 1979.McCutchen,  C. W., 1962, “ The Frictional Properties of Animal Joints,” Wear, WEARCJ5, 1–17.weaWEARCJ0043-1648

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):537. doi:10.1115/1.1785816.
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McCutchen,  C. W., 1959, “ Sponge-Hydrostatic and Weeping Bearings,” Nature, NATUAS184, p. 1284.natNATUAS0028-0836McCutchen,  C. W., 1962, “ The Frictional Properties of Animal Joints,” Wear, WEARCJ5, pp. 1–17.weaWEARCJ0043-1648Ateshian,  G. A., Wang,  H., and Lai,  W. M., 1998, “ The Role of Interstitial Fluid Pressurization and Surface Porosities on the Boundary Friction of Articular Cartilage,” J. Tribol., JOTRE9120, pp. 241–251.jtqJOTRE90742-4787Ateshian,  G. A., Soltz,  M. A., Mauck,  R. L., Basalo,  I. M., Hung,  C. T., and Lai,  W. M., 2003, “ The Role of Osmotic Pressure and Tension-Compression Nonlinearity in the Frictional Response of Articular Cartilage,” Transp. Porous Media, TPMEEI50, pp. 5–33.tpmTPMEEI0169-3913Mow,  V. C., Kuei,  S. C., Lai,  W. M., and Armstrong,  C. G., 1980, “ Biphasic Creep and Stress Relaxation of Articular Cartilage in Compression? Theory and Experiments,” J. Biomech. Eng., JBENDY102, pp. 73–84.jbyJBENDY0148-0731Lai,  W. M., Hou,  J. S., and Mow,  V. C., 1991, “ A Triphasic Theory for the Swelling and Deformation Behaviors of Articular Cartilage,” J. Biomech. Eng., JBENDY113, pp. 245–258.jbyJBENDY0148-0731Krishnan, R., Kopacz, M., and Ateshian, G. A., “Experimental Verification of the Role of Interstitial Fluid Pressurization in Cartilage Lubrication,” J Orthop Res, In Press.Park,  S., Krishnan,  R., Nicoll,  S. B., and Ateshian,  G. A., 2003, “ Cartilage Interstitial Fluid Load Support in Unconfined Compression,” J. Biomech., JBMCB536, pp. 1785–1796.jbiJBMCB50021-9290Lipshitz,  H., Etheredge,  R., and Glimcher,  M. J., 1976, “ Changes in the Hexosamine Content and Swelling Ratio of Articular Cartilage as Functions of Depth From the Surface,” J Bone Joint Surg Am, JBJSA358, pp. 1149–1153.jsaJBJSA30021-9355Torzilli, P. A., Askari, E., and Jenkins, J. T., 1990, “Water Content and Solute Diffusion Properties in Articular Cartilage,” Biomechanics of Diarthrodial Joints, V. C. Mow et al., eds., Springer-Verlag, New York, pp. 363–390.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):538. doi:10.1115/1.1785813.
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Mann,  R. W., 1998, “ Discussion,” J. Tribology, JOTRE9120, pp. 249–251.jtqJOTRE90742-4787Walker,  P. S., Dowson,  D., Longfield,  M. D., and Wright,  V., 1968, “ Boosted Lubrication in Synovial Joints by Fluid Entrapment and Enrichment,” Ann. Rheum. Dis., ZZZZZZ27, pp. 512–560.andARDIAO0003-4967McCutchen,  C. W., 1959, “ Mechanism of Animal Joints: Sponge-Hydrostatic and Weeping Bearings,” Nature (London), NATUAS184, pp. 1284–1285.natNATUAS0028-0836Macirowski,  T., Tepic,  S., and Mann,  R. W., 1994, “ Cartilage Stresses in the Human Hip Joint,” J. Biomech. Eng., JBENDY16, pp. 10–18.jbyJBENDY0148-0731Rushfeldt,  P. D., Mann,  R. W., and Harris,  W. H., 1981, “ Improved Techniques for Measuring In Vitro the Geometry and Pressure Distribution in the Human Acetabulum—I. Ultrasonic Measurement of Acetabular Surfaces, Sphericity and Cartilage Thickness,” J. Biomech., JBMCB514, pp. 253–260.jbiJBMCB50021-9290Tepic,  S., Macirowski,  T., and Mann,  R. W., 1983, “ Articular Cartilage Mechanical Properties Elucidated by Osmotic Loading and Ultrasound,” Proc. Natl. Acad. Sci. U.S.A., PNASA680, pp. 3331–3333.pnaPNASA60027-8424Rushfeldt, P. D., Mann, R. W., and Harris, W. H., “Improved Techniques for Measuring In Vitro the Geometry and Pressure Distribution in the Human Acetabulum—II Instrumented Endoprosthesis Measurement of Articular Cartilage Surface Pressure Distribution,” J. Biomech., 19, pp. 315–323.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2004;126(4):539. doi:10.1115/1.1785815.
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Macirowski,  T., Tepic,  S., and Mann,  R. W., 1994, “ Cartilage Stresses in the Human Hip Joint,” J. Biomech. Eng., JBENDY116, pp. 10–18.jbyJBENDY0148-0731Hou,  J. S., Mow,  V. C., Lai,  W. M., and Holmes,  M. H., 1992, “ An Analysis of the Squeeze-Film Lubrication Mechanism for Articular Cartilage,” J. Biomech., JBMCB525, pp. 247–259.jbiJBMCB50021-9290Hlavacek,  M., 2000, “ Squeeze-Film Lubrication of the Human Ankle Joint With Synovial Fluid Filtrated by Articular Cartilage With the Superficial Zone Worn Out,” J. Biomech., JBMCB533, pp. 1415–1422.jbiJBMCB50021-9290Hlavacek,  M., 1993, “ The Role of Synovial Fluid Filtration by Cartilage in Lubrication of Synovial Joints-H. Squeeze-Film Lubrication: Homogeneous Filtration,” J. Biomech., JBMCB526, pp. 1151–1160.jbiJBMCB50021-9290

Commentary by Dr. Valentin Fuster

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