Research Papers

J Biomech Eng. 2017;139(3):031001-031001-9. doi:10.1115/1.4035367.

A novel application of phase-space warping (PSW) method to detect fatigue in the musculoskeletal system is presented. Experimental kinematic, force, and physiological signals are used to produce a fatigue metric. The metric is produced using time-delay embedding and PSW methods. The results showed that by using force and kinematic signals, an overall estimate of the muscle group state can be achieved. Further, when using electromyography (EMG) signals the fatigue metric can be used as a tool to evaluate muscles activation and load sharing patterns for individual muscles. The presented method will allow for fatigue evolution measurement outside a laboratory environment, which open doors to applications such as tracking the physical state of players during competition, workers in a plant, and patients undergoing in-home rehabilitation.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031002-031002-12. doi:10.1115/1.4035261.

Abdominal aortic aneurysms (AAAs) represent permanent, localized dilations of the abdominal aorta that can be life-threatening if progressing to rupture. Evaluation of risk of rupture depends on understanding the mechanical behavior of patient AAA walls. In this project, a series of patient AAA wall tissue samples have been evaluated through a combined anamnestic, mechanical, and histopathologic approach. Mechanical properties of the samples have been characterized using a novel, strain-controlled, planar biaxial testing protocol emulating the in vivo deformation of the aorta. Histologically, the tissue ultrastructure was highly disrupted. All samples showed pronounced mechanical stiffening with stretch and were notably anisotropic, with greater stiffness in the circumferential than the axial direction. However, there were significant intrapatient variations in wall stiffness and stress. In biaxial tests in which the longitudinal stretch was held constant at 1.1 as the circumferential stretch was extended to 1.1, the maximum average circumferential stress was 330 ± 70 kPa, while the maximum average axial stress was 190 ± 30 kPa. A constitutive model considering the wall as anisotropic with two preferred directions fit the measured data well. No statistically significant differences in tissue mechanical properties were found based on patient gender, age, maximum bulge diameter, height, weight, body mass index, or smoking history. Although a larger patient cohort is merited to confirm these conclusions, the project provides new insight into the relationships between patient natural history, histopathology, and mechanical behavior that may be useful in the development of accurate methods for rupture risk evaluation.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031003-031003-6. doi:10.1115/1.4035406.

In this work, the biomechanical responses of the optic nerve head (ONH) to acute elevations in intracranial pressure (ICP) were systematically investigated through numerical modeling. An orthogonal experimental design was developed to quantify the influence of ten input factors that govern the anatomy and material properties of the ONH on the peak maximum principal strain (MPS) in the lamina cribrosa (LC) and postlaminar neural tissue (PLNT). Results showed that the sensitivity of ONH responses to various input factors was region-specific. In the LC, the peak MPS was most strongly dependent on the sclera thickness, LC modulus, and scleral canal size, whereas in the PLNT, the peak MPS was more sensitive to the scleral canal size, neural tissue modulus, and pia mater modulus. The enforcement of clinically relevant ICP in the retro-orbital subarachnoid space influenced the sensitivity analysis. It also induced much larger strains in the PLNT than in the LC. Moreover, acute elevation of ICP leads to dramatic strain distribution changes in the PLNT, but had minimal impact on the LC. This work could help to better understand patient-specific responses, to provide guidance on biomechanical factors resulting in optic nerve diseases, such as glaucoma, papilledema, and ischemic optic neuropathy, and to illuminate the possibilities for exploiting their potential to treat and prevent ONH diseases.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031004-031004-8. doi:10.1115/1.4034994.

Mechanical damage is central to both initiation and progression of osteoarthritis (OA). However, specific causal links between mechanics and cartilage damage are incompletely understood, which results in an inability to predict failure. The lack of understanding is primarily due to the difficulty in simultaneously resolving the high rates and small length scales relevant to the problem and in correlating such measurements to the resulting fissures. This study leveraged microscopy and high-speed imaging to resolve mechanics on the previously unexamined time and length scales of interest in cartilage damage, and used those mechanics to develop predictive models. The specific objectives of this study were to: first, quantify bulk and local mechanics during impact-induced fissuring; second, develop predictive models of fissuring based on bulk mechanics and local strain; and third, evaluate the accuracy of these models in predicting fissures. To achieve these three objectives, bovine tibial cartilage was impacted using a custom spring-loaded device mounted on an inverted microscope. The occurrence of fissures was modulated by varying impact energy. For the first objective, during impact, deformation was captured at 10,000 frames per second and bulk and local mechanics were analyzed. For the second objective, data from samples impacted with a 1.2 mm diameter rod were fit to logistic regression functions, creating models of fissure probability based on bulk and local mechanics. Finally, for the third objective, data from samples impacted with a 0.8 mm diameter rod were used to test the accuracy of model predictions. This study provides a direct comparison between bulk and local mechanical thresholds for the prediction of fissures in cartilage samples, and demonstrates that local mechanics provide more accurate predictions of local failure than bulk mechanics provide. Bulk mechanics were accurate predictors of fissure for the entire sample cohort, but poor predictors of fissure for individual samples. Local strain fields were highly heterogeneous and significant differences were determined between fissured and intact samples, indicating the presence of damage thresholds. In particular, first principal strain rate and maximum shear strain were the best predictors of local failure, as determined by concordance statistics. These data provide an important step in establishing causal links between local mechanics and cartilage damage; ultimately, data such as these can be used to link macro- and micro-scale mechanics and thereby predict mechanically mediated disease on a subject-specific basis.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031005-031005-14. doi:10.1115/1.4035264.

The ascending thoracic aorta is poorly understood mechanically, especially its risk of dissection. To make better predictions of dissection risk, more information about the multidimensional failure behavior of the tissue is needed, and this information must be incorporated into an appropriate theoretical/computational model. Toward the creation of such a model, uniaxial, equibiaxial, peel, and shear lap tests were performed on healthy porcine ascending aorta samples. Uniaxial and equibiaxial tests showed anisotropy with greater stiffness and strength in the circumferential direction. Shear lap tests showed catastrophic failure at shear stresses (150–200 kPa) much lower than uniaxial tests (750–2500 kPa), consistent with the low peel tension (∼60 mN/mm). A novel multiscale computational model, including both prefailure and failure mechanics of the aorta, was developed. The microstructural part of the model included contributions from a collagen-reinforced elastin sheet and interlamellar connections representing fibrillin and smooth muscle. Components were represented as nonlinear fibers that failed at a critical stretch. Multiscale simulations of the different experiments were performed, and the model, appropriately specified, agreed well with all experimental data, representing a uniquely complete structure-based description of aorta mechanics. In addition, our experiments and model demonstrate the very low strength of the aorta in radial shear, suggesting an important possible mechanism for aortic dissection.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031006-031006-8. doi:10.1115/1.4035369.

The fixation of uncemented acetabular components largely depends on the amount of bone ingrowth, which is influenced by the design of the implant surface texture. The objective of this numerical study is to evaluate the effect of these implant texture design factors on bone ingrowth around an acetabular component. The novelty of this study lies in comparative finite element (FE) analysis of 3D microscale models of the implant-bone interface, considering patient-specific mechanical environment, host bone material property and implant-bone relative displacement, in combination with sequential mechanoregulatory algorithm and design of experiment (DOE) based statistical framework. Results indicated that the bone ingrowth process was inhibited due to an increase in interbead spacing from 200 μm to 600 μm and bead diameter from 1000 μm to 1500 μm and a reduction in bead height from 900 μm to 600 μm. Bead height, a main effect, was found to have a predominant influence on bone ingrowth. Among the interaction effects, the combination of bead height and bead diameter was found to have a pronounced influence on bone ingrowth process. A combination of low interbead spacing (P = 200 μm), low bead diameter (D = 1000 μm), and high bead height (H = 900 μm) facilitated peri-acetabular bone ingrowth and an increase in average Young's modulus of newly formed tissue layer. Hence, such a surface texture design seemed to provide improved fixation of the acetabular component.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031007-031007-16. doi:10.1115/1.4035535.

This paper numerically investigates non-Newtonian blood flow with oxygen and carbon dioxide transport across and along an array of uniformly square and staggered arranged fibers at various porosity (ε) levels, focussing on a low Reynolds number regime (Re < 10). The objective is to establish suitable mass transfer correlations, expressed in the form of Sherwood number (Sh = f(ε, Re, Sc)), that identifies the link from local mass transfer investigations to full-device analyses. The development of a concentration field is initially investigated and expressions are established covering the range from a typical deoxygenated condition up to a full oxygenated condition. An important step is identified where a cut-off point in those expressions is required to avoid any under- or over-estimation on the Sherwood number. Geometrical features of a typical commercial blood oxygenator is adopted and results in general show that a balance in pressure drop, shear stress, and mass transfer is required to avoid potential blood trauma or clotting formation. Different definitions of mass transfer correlations are found for oxygen/carbon dioxide, parallel/transverse flow, and square/staggered configurations, respectively. From this set of correlations, it is found that transverse flow has better gas transfer than parallel flow which is consistent with reported literature. The mass transfer dependency on fiber configuration is observed to be pronounced at low porosity. This approach provides an initial platform when one is looking to improve the mass transfer performance in a blood oxygenator without the need to conduct any numerical simulations or experiments.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031008-031008-8. doi:10.1115/1.4035077.

Planus and cavus foot types have been associated with an increased risk of pain and disability. Improving our understanding of the geometric differences between bones in different foot types may provide insights into injury risk profiles and have implications for the design of musculoskeletal and finite-element models. In this study, we performed a geometric morphometric analysis on the geometry of metatarsal bones from 65 feet, segmented from computed tomography (CT) scans. These were categorized into four foot types: pes cavus, neutrally aligned, asymptomatic pes planus, and symptomatic pes planus. Generalized procrustes analysis (GPA) followed by permutation tests was used to determine significant shape differences associated with foot type and sex, and principal component analysis was used to find the modes of variation for each metatarsal. Significant shape differences were found between foot types for all the metatarsals (p < 0.01), most notably in the case of the second metatarsal which showed significant pairwise differences across all the foot types. Analysis of the principal components of variation showed pes cavus bones to have reduced cross-sectional areas in the sagittal and frontal planes. The first (p = 0.02) and fourth metatarsals (p = 0.003) were found to have significant sex-based differences, with first metatarsals from females shown to have reduced width, and fourth metatarsals from females shown to have reduced frontal and sagittal plane cross-sectional areas. Overall, these findings suggest that metatarsal bones have distinct morphological characteristics that are associated with foot type and sex, with implications for our understanding of anatomy and numerical modeling of the foot.

Topics: Bone , Shapes
Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031009-031009-8. doi:10.1115/1.4035472.

Musculoskeletal modeling and simulation techniques have been used to gain insights into movement disabilities for many populations, such as ambulatory children with cerebral palsy (CP). The individuals who can benefit from these techniques are often limited to those who can walk without assistive devices, due to challenges in accurately modeling these devices. Specifically, many children with CP require the use of ankle-foot orthoses (AFOs) to improve their walking ability, and modeling these devices is important to understand their role in walking mechanics. The purpose of this study was to quantify the effects of AFO mechanical property assumptions, including rotational stiffness, damping, and equilibrium angle of the ankle and subtalar joints, on the estimation of lower-limb muscle forces during stance for children with CP. We analyzed two walking gait cycles for two children with CP while they were wearing their own prescribed AFOs. We generated 1000-trial Monte Carlo simulations for each of the walking gait cycles, resulting in a total of 4000 walking simulations. We found that AFO mechanical property assumptions influenced the force estimates for all the muscles in the model, with the ankle muscles having the largest resulting variability. Muscle forces were most sensitive to assumptions of AFO ankle and subtalar stiffness, which should therefore be measured when possible. Muscle force estimates were less sensitive to estimates of damping and equilibrium angle. When stiffness measurements are not available, limitations on the accuracy of muscle force estimates for all the muscles in the model, especially the ankle muscles, should be acknowledged.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031010-031010-6. doi:10.1115/1.4035483.

Knowledge of spinal loads in neighboring disks after interbody fusion plays an important role in the clinical decision of this treatment as well as in the elucidation of its effect. However, controversial findings are still noted in the literature. Moreover, there are no existing models for efficient prediction of intervertebral disk stresses within annulus fibrosus (AF) and nucleus pulposus (NP) regions. In this present study, a new hybrid rigid-deformable modeling workflow was established to quantify the mechanical stress behaviors within AF and NP regions of the L1–2, L2–3, and L4–5 disks after interbody fusion at L3–4 level. The changes in spinal loads were compared with results of the intact model without interbody fusion. The fusion outcomes revealed maximal stress changes (10%) in AF region of L1–2 disk and in NP region of L2–3 disk. The minimal stress change (1%) is noted at the NP region of the L1–2 disk. The validation of simulation outcomes of fused and intact lumbar spine models against those of other computational models and in vivo measurements showed good agreements. Thus, this present study may be used as a novel design guideline for a specific implant and surgical scenario of the lumbar spine disorders.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031011-031011-7. doi:10.1115/1.4035368.

Three-dimensional (3D) finite element (FE) models are commonly used to analyze the mechanical behavior of the bone under different conditions (i.e., before and after arthroplasty). They can provide detailed information but they are numerically expensive and this limits their use in cases where large or numerous simulations are required. On the other hand, 2D models show less computational cost, but the precision of results depends on the approach used for the simplification. Two main questions arise: Are the 3D results adequately represented by a 2D section of the model? Which approach should be used to build a 2D model that provides reliable results compared to the 3D model? In this paper, we first evaluate if the stem symmetry plane used for generating the 2D models of bone-implant systems adequately represents the results of the full 3D model for stair climbing activity. Then, we explore three different approaches that have been used in the past for creating 2D models: (1) without side-plate (WOSP), (2) with variable thickness side-plate and constant cortical thickness (SPCT), and (3) with variable thickness side-plate and variable cortical thickness (SPVT). From the different approaches investigated, a 2D model including a side-plate best represents the results obtained with the full 3D model with much less computational cost. The side-plate needs to have variable thickness, while the cortical bone thickness can be kept constant.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031012-031012-8. doi:10.1115/1.4035585.

The role of trabeculae carneae in modulating left ventricular (LV) diastolic compliance remains unclear. The objective of this study was to determine the contribution of trabeculae carneae to the LV diastolic compliance. LV pressure–volume compliance curves were measured in six human heart explants from patients with LV hypertrophy at baseline and following trabecular cutting. The effect of trabecular cutting was also analyzed with finite-element model (FEM) simulations. Our results demonstrated that LV compliance improved after trabecular cutting (p < 0.001). Finite-element simulations further demonstrated that stiffer trabeculae reduce LV compliance further, and that the presence of trabeculae reduced the wall stress in the apex. In conclusion, we demonstrate that integrity of the LV and trabeculae is important to maintain LV stiffness and loss in trabeculae leads to more LV compliance.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):031013-031013-8. doi:10.1115/1.4035481.

We present a new approach to designing three-dimensional, physically realizable porous femoral implants with spatially varying microstructures and effective material properties. We optimize over a simplified design domain to reduce shear stress at the bone-prosthetic interface with a constraint on the bone resorption measured using strain energy. This combination of objective and constraint aims to reduce implant failure and allows a detailed study of the implant designs obtained with a range of microstructure sets and parameters. The microstructure sets are either specified directly or constructed using shape interpolation between a finite number of microstructures optimized for multifunctional characteristics. We demonstrate that designs using varying microstructures outperform designs with a homogeneous microstructure for this femoral implant problem. Further, the choice of microstructure set has an impact on the objective values achieved and on the optimized implant designs. A proof-of-concept metal prototype fabricated via selective laser melting (SLM) demonstrates the manufacturability of designs obtained with our approach.

Commentary by Dr. Valentin Fuster

Technical Brief

J Biomech Eng. 2017;139(3):034501-034501-5. doi:10.1115/1.4035260.

Abnormalities of blood cholesterol concentration are associated with increased risks for vascular disease, especially heart attacks and strokes. As one of the main lipid components of plasma membrane in all mammalian cells, cholesterol has a major impact on the mechanical properties of the membrane of endothelial cells. Although the effect of cholesterol depletion on cell mechanical properties has been studied, no results yet have been reported on quantitative investigation of cholesterol repletion effect. In this study, the cholesterol repletion effect on the nanomechanical properties of human umbilical vein endothelial cell (EA.hy926) was studied using a control-based atomic force microscope (AFM) nanomechanical measurement protocol. The viscoelasticity of EA.hy926 cells were measured over a large frequency range (0.1–100 Hz) using both constant-rate excitation force with different loading rates and a broadband excitation force. The viscoelasticity oscillation of the cell membranes under the cholesterol effect was also monitored in real-time. The experiment results showed that under the effect of cholesterol repletion, both the Young's modulus and the complex modulus of EA.hy926 cell were increased over 30%, respectively, and moreover, the amplitudes of both the elasticity oscillation and the viscosity oscillation at a period of around 200 s were increased over 70%, respectively. Therefore, this work is among the first to investigate the mechanical properties, particularly, the broadband viscoelasticity variations of EA.hy926 cells under cholesterol repletion treatment. The results revealed that cholesterol repletion may reinforce the coupling of F-actin to plasma membrane by increasing actin stability, and the cholesterol might have modified the submembrane cytoskeletal organization of EA.hy926 cell by causing the involvement of the motor protein nonmuscle myosin II.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2017;139(3):034502-034502-6. doi:10.1115/1.4035537.

A nearly avascular tissue, the knee meniscus relies on diffusive transport for nutritional supply to cells. Nutrient transport depends on solute partitioning in the tissue, which governs the amount of nutrients that can enter a tissue. The purpose of the present study was to investigate the effects of mechanical strain, tissue region, and tissue composition on the partition coefficient of glucose in meniscus fibrocartilage. A simple partitioning experiment was employed to measure glucose partitioning in porcine meniscus tissues from two regions (horn and central), from both meniscal components (medial and lateral), and at three levels of compression (0%, 10%, and 20%). Partition coefficient values were correlated to strain level, water volume fraction, and glycosaminoglycan (GAG) content of tissue specimens. Partition coefficient values ranged from 0.47 to 0.91 (n = 48). Results show that glucose partition coefficient is significantly (p < 0.001) affected by compression, decreasing with increasing strain. Furthermore, we did not find a statistically significant effect of tissue when comparing medial versus lateral (p = 0.181) or when comparing central and horn regions (p = 0.837). There were significant positive correlations between tissue water volume fraction and glucose partitioning for all groups. However, the correlation between GAG content and partitioning was only significant in the lateral horn group. Determining how glucose partitioning is affected by tissue composition and loading is necessary for understanding nutrient availability and related tissue health and/or degeneration. Therefore, this study is important for better understanding the transport and nutrition-related mechanisms of meniscal degeneration.

Commentary by Dr. Valentin Fuster

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