Research Papers

J Biomech Eng. 2018;140(6):061001-061001-9. doi:10.1115/1.4039173.

Evaluating risk of fatigue fractures in cardiovascular implants via nonclinical testing is essential to provide an indication of their durability. This is generally accomplished by experimental accelerated durability testing and often complemented with computational simulations to calculate fatigue safety factors (FSFs). While many methods exist to calculate FSFs, none have been validated against experimental data. The current study presents three methods for calculating FSFs and compares them to experimental fracture outcomes under axial fatigue loading, using cobalt-chromium test specimens designed to represent cardiovascular stents. FSFs were generated by calculating mean and alternating stresses using a simple scalar method, a tensor method which determines principal values based on averages and differences of the stress tensors, and a modified tensor method which accounts for stress rotations. The results indicate that the tensor method and the modified tensor method consistently predicted fracture or survival to 107 cycles for specimens subjected to experimental axial fatigue. In contrast, for one axial deformation condition, the scalar method incorrectly predicted survival even though fractures were observed in experiments. These results demonstrate limitations of the scalar method and potential inaccuracies. A separate computational analysis of torsional fatigue was also completed to illustrate differences between the tensor method and the modified tensor method. Because of its ability to account for changes in principal directions across the fatigue cycle, the modified tensor method offers a general computational method that can be applied for improved predictions for fatigue safety regardless of loading conditions.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061002-061002-9. doi:10.1115/1.4039307.

There is lack of investigation capturing the complex mechanical interaction of tissue-engineered intervertebral disk (IVD) constructs in physiologically relevant environmental conditions. In this study, mechanical characterization of anisotropic electrospinning (ES) substrates made of polycaprolactone (PCL) was carried out in wet and dry conditions and viability of human bone marrow derived mesenchymal stem cells (hMSCs) seeded within double layers of ES PCL were also studied. Cyclic compression of IVD-like constructs composed of an agarose core confined by ES PCL double layers was implemented using a bioreactor and the cellular response to the mechanical stimulation was evaluated. Tensile tests showed decrease of elastic modulus of ES PCL as the angle of stretching increased, and at 60 deg stretching angle in wet, the maximum ultimate tensile strength (UTS) was observed. Based on the configuration of IVD-like constructs, the calculated circumferential stress experienced by the ES PCL double layers was 40 times of the vertical compressive stress. Confined compression of IVD-like constructs at 5% and 10% displacement dramatically reduced cell viability, particularly at 10%, although cell presence in small and isolated area can still be observed after mechanical conditioning. Hence, material mechanical properties of tissue-engineered scaffolds, composed of fibril structure of polymer with low melting point, are affected by the testing condition. Circumferential stress induced by axial compressive stimulation, conveyed to the ES PCL double layer wrapped around an agarose core, can affect the viability of cells seeded at the interface, depending on the mechanical configuration and magnitude of the load.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061003-061003-11. doi:10.1115/1.4038431.

Inspiratory flow in a multigeneration pig lung airways was numerically studied at a steady inlet flow rate of 3.2 × 10−4 m3/s corresponding to a Reynolds number of 1150 in the trachea. The model was validated by comparing velocity distributions with previous measurements and simulations in simplified airway geometries. Simulation results provided detailed maps of the axial and secondary flow patterns at different cross sections of the airway tree. The vortex core regions in the airways were visualized using absolute helicity values and suggested the presence of secondary flow vortices where two counter-rotating vortices were observed at the main bifurcation and in many other bifurcations. Both laminar and turbulent flows were considered. Results showed that axial and secondary flows were comparable in the laminar and turbulent cases. Turbulent kinetic energy (TKE) vanished in the more distal airways, which indicates that the flow in these airways approaches laminar flow conditions. The simulation results suggested viscous pressure drop values comparable to earlier studies. The monopodial asymmetric nature of airway branching in pigs resulted in airflow patterns that are different from the less asymmetric human airways. The major daughters of the pig airways tended to have high airflow ratios, which may lead to different particle distribution and sound generation patterns. These differences need to be taken into consideration when interpreting the results of animal studies involving pigs before generalizing these results to humans.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061004-061004-12. doi:10.1115/1.4039284.

This study addresses the dynamic response to pulsatile physiological blood flow and pressure of a woven Dacron graft currently used in thoracic aortic surgery. The model of the prosthesis assumes a cylindrical orthotropic shell described by means of nonlinear Novozhilov shell theory. The blood flow is modeled as Newtonian pulsatile flow, and unsteady viscous effects are included. Coupled fluid–structure Lagrange equations for open systems with wave propagation subject to pulsatile flow are applied. Physiological waveforms of blood pressure and velocity are approximated with the first eight harmonics of the corresponding Fourier series. Time responses of the prosthetic wall radial displacement are considered for two physiological conditions: at rest (60 bpm) and at high heart rate (180 bpm). While the response at 60 bpm reproduces the behavior of the pulsatile pressure, higher harmonics frequency contributions are observed at 180 bpm altering the shape of the time response. Frequency-responses show resonance peaks for heart rates between 130 bpm and 200 bpm due to higher harmonics of the pulsatile flow excitation. These resonant peaks correspond to unwanted high-frequency radial oscillations of the vessel wall that can compromise the long-term functioning of the prosthesis in case of significant physical activity. Thanks to this study, the dynamic response of Dacron prostheses to pulsatile flow can be understood as well as some possible complications in case of significant physical activity.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061005-061005-7. doi:10.1115/1.4039174.

Percutaneous pedicle screw fixation (PPSF) is a well-known minimally invasive surgery (MIS) employed in the treatment of thoracolumbar burst fractures (TBF). However, hardware failure and loss of angular correction are common limitations caused by the poor support of the anterior column of the spine. Balloon kyphoplasty (KP) is another MIS that was successfully used in the treatment of compression fractures by augmenting the injured vertebral body with cement. To overcome the limitations of stand-alone PPSF, it was suggested to augment PPSF with KP as a surgical treatment of TBF. Yet, little is known about the biomechanical alteration occurred to the spine after performing such procedure. The objective of this study was to evaluate and compare the immediate post-operative biomechanical performance of stand-alone PPSF, stand-alone-KP, and KP-augmented PPSF procedures. Novel three-dimensional (3D) finite element (FE) models of the thoracolumbar junction that describes the fractured spine and the three investigated procedures were developed and tested under mechanical loading conditions. The spinal stiffness, stresses at the implanted hardware, and the intradiscal pressure at the upper and lower segments were measured and compared. The results showed no major differences in the measured parameters between stand-alone PPSF and KP-augmented PPSF procedures, and demonstrated that the stand-alone KP may restore the stiffness of the intact spine. Accordingly, there was no immediate post-operative biomechanical advantage in augmenting PPSF with KP when compared to stand-alone PPSF, and fatigue testing may be required to evaluate the long-term biomechanical performance of such procedures.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061006-061006-10. doi:10.1115/1.4039308.

Contractile stress generation by adherent cells is largely determined by the interplay of forces within their cytoskeleton. It is known that actin stress fibers, connected to focal adhesions, provide contractile stress generation, while microtubules and intermediate filaments provide cells compressive stiffness. Recent studies have shown the importance of the interplay between the stress fibers and the intermediate filament vimentin. Therefore, the effect of the interplay between the stress fibers and vimentin on stress generation was quantified in this study. We hypothesized that net stress generation comprises the stress fiber contraction combined with the vimentin resistance. We expected an increased net stress in vimentin knockout (VimKO) mouse embryonic fibroblasts (MEFs) compared to their wild-type (vimentin wild-type (VimWT)) counterparts, due to the decreased resistance against stress fiber contractility. To test this, the net stress generation by VimKO and VimWT MEFs was determined using the thin film method combined with sample-specific finite element modeling. Additionally, focal adhesion and stress fiber organization were examined via immunofluorescent staining. Net stress generation of VimKO MEFs was three-fold higher compared to VimWT MEFs. No differences in focal adhesion size or stress fiber organization and orientation were found between the two cell types. This suggests that the increased net stress generation in VimKO MEFs was caused by the absence of the resistance that vimentin provides against stress fiber contraction. Taken together, these data suggest that vimentin resists the stress fiber contractility, as hypothesized, thus indicating the importance of vimentin in regulating cellular stress generation by adherent cells.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061007-061007-9. doi:10.1115/1.4039375.

Atrial fibrillation (AF) currently affects millions of people in the U.S. alone. Focal therapy is an increasingly attractive treatment for AF that avoids the debilitating effects of drugs for disease control. Perhaps the most widely used focal therapy for AF is heat-based radiofrequency (heating), although cryotherapy (cryo) is rapidly replacing it due to a reduction in side effects and positive clinical outcomes. A third focal therapy, irreversible electroporation (IRE), is also being considered in some settings. This study was designed to help guide treatment thresholds and compare mechanism of action across heating, cryo, and IRE. Testing was undertaken on HL-1 cells, a well-established cardiomyocyte cell line, to assess injury thresholds for each treatment method. Cell viability, as assessed by Hoechst and propidium iodide (PI) staining, was found to be minimal after exposure to temperatures ≤−40 °C (cryo), ≥60 °C (heating), and when field strengths ≥1500 V/cm (IRE) were used. Viability was then correlated to protein denaturation fraction (PDF) as assessed by Fourier transform infrared (FTIR) spectroscopy, and protein loss fraction (PLF) as assessed by bicinchoninic acid (BCA) assay after the three treatments. These protein changes were assessed both in the supernatant and the pellet of cell suspensions post-treatment. We found that dramatic viability loss (≥50%) correlated strongly with ≥12% protein change (PLF, PDF or a combination of the two) in every focal treatment. These studies help in defining both cellular thresholds and protein-based mechanisms of action that can be used to improve focal therapy application for AF.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061008-061008-10. doi:10.1115/1.4039393.

Pelvic fractures are serious injuries resulting in high mortality and morbidity. The objective of this study is to develop and validate local pelvic anatomical, cross section-based injury risk metrics for a finite element (FE) model of the human body. Cross-sectional instrumentation was implemented in the pelvic region of the Global Human Body Models Consortium (GHBMC M50-O) 50th percentile detailed male FE model (v4.3). In total, 25 lateral impact FE simulations were performed using input data from cadaveric lateral impact tests performed by Bouquet et al. The experimental force-time data were scaled using five normalization techniques, which were evaluated using log rank, Wilcoxon rank sum, and correlation and analysis (CORA) testing. Survival analyses with Weibull distribution were performed on the experimental peak force (scaled and unscaled) and the simulation test data to generate injury risk curves (IRCs) for total pelvic injury. Additionally, IRCs were developed for regional injury using cross-sectional forces from the simulation results and injuries documented in the experimental autopsies. These regional IRCs were also evaluated using the receiver operator characteristic (ROC) curve analysis. Based on the results of all the evaluation methods, the equal stress equal velocity (ESEV) and ESEV using effective mass (ESEV-EM) scaling techniques performed best. The simulation IRC shows slight under prediction of injury in comparison to these scaled experimental data curves. However, this difference was determined not to be statistically significant. Additionally, the ROC curve analysis showed moderate predictive power for all regional IRCs.

Topics: Simulation , Wounds , Risk , Testing
Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061009-061009-8. doi:10.1115/1.4039576.

Biomechanical studies have indicated that the conventional nonanatomic reconstruction techniques for lateral ankle sprain (LAS) tend to restrict subtalar joint motion compared to intact ankle joints. Excessive restriction in subtalar motion may lead to chronic pain, functional difficulties, and development of osteoarthritis (OA). Therefore, various anatomic surgical techniques to reconstruct both the anterior talofibular and calcaneofibular ligaments (CaFL) have been introduced. In this study, ankle joint stability was evaluated using multibody computational ankle joint model to assess two new anatomic reconstruction and three popular nonanatomic reconstruction techniques. An LAS injury, three popular nonanatomic reconstruction models (Watson-Jones, Evans, and Chrisman–Snook) and two common types of anatomic reconstruction models were developed based on the intact ankle model. The stability of ankle in both talocrural and subtalar joint were evaluated under anterior drawer test (150 N anterior force), inversion test (3 N·m inversion moment), internal rotational test (3 N·m internal rotation moment), and the combined loading test (9 N·m inversion and internal moment as well as 1800 N compressive force). Our overall results show that the two anatomic reconstruction techniques were superior to the nonanatomic reconstruction techniques in stabilizing both talocrural and subtalar joints. Restricted subtalar joint motion, which is mainly observed in Watson-Jones and Chrisman–Snook techniques, was not shown in the anatomical reconstructions. Evans technique was beneficial for subtalar joint as it does not restrict subtalar motion, though Evans technique was insufficient for restoring talocrural joint inversion. The anatomical reconstruction techniques best recovered ankle stability.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061010-061010-10. doi:10.1115/1.4039577.

Although uniaxial tensile testing is commonly used to evaluate failure properties of vascular tissue, there is no established protocol for specimen shape or gripping method. Large percentages of specimens are reported to fail near the clamp and can potentially confound the studies, or, if discarded will result in sample waste. The objective of this study is to identify sample geometry and clamping conditions that can achieve consistent failure in the midregion of small arterial specimens, even for vessels from older individuals. Failure location was assessed in 17 dogbone specimens from human cerebral and sheep carotid arteries using soft inserts. For comparison with commonly used protocols, an additional 22 rectangular samples were tested using either sandpaper or foam tape inserts. Midsample failure was achieved in 94% of the dogbone specimens, while only 14% of the rectangular samples failed in the midregion, the other 86% failing close to the clamps. Additionally, we found midregion failure was more likely to be abrupt, caused by cracking or necking. In contrast, clamp failure was more likely to be gradual and included a delamination mode not seen in midregion failure. Hence, this work provides an approach that can be used to obtain consistent midspecimen failure, avoiding confounding clamp-related artifacts. Furthermore, with consistent midregion failure, studies can be designed to image the failure process in small vascular samples providing valuable quantitative information about changes to collagen and elastin structure during the failure process.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061011-061011-8. doi:10.1115/1.4039578.

Static frontal plane tibiofemoral alignment is an important factor in dynamic knee alignment and knee adduction moments (KAMs). However, little is known about the relationship between alignment and compartment contact forces or muscle control strategies. The purpose of this study was to estimate medial (MCF) and lateral (LCF) compartment knee joint contact forces and muscle forces during stair ascent using a musculoskeletal model implementing subject-specific knee alignments. Kinematic and kinetic data from 20 healthy individuals with radiographically confirmed varus or valgus knee alignments were simulated using alignment specific models to predict MCFs and LCFs. Muscle forces were determined using static optimization. Independent samples t-tests compared contact and muscle forces between groups during weight acceptance and during pushoff. The varus group exhibited increased weight acceptance peak MCFs, while the valgus group exhibited increased pushoff peak LCFs. The varus group utilized increased vasti muscle forces during weight acceptance and adductor forces during pushoff. The valgus group utilized increased abductor forces during pushoff. The alignment-dependent contact forces provide evidence of the significance of frontal plane knee alignment in healthy individuals, which may be important in considering future knee joint health. The differing muscle control strategies between alignments detail-specific neuromuscular responses to control frontal plane knee loads.

Commentary by Dr. Valentin Fuster
J Biomech Eng. 2018;140(6):061012-061012-7. doi:10.1115/1.4039674.

Much of our understanding of the role of elbow ligaments to overall joint biomechanics has been developed through in vitro cadaver studies using joint motion simulators. The principle of superposition can be used to indirectly compute the force contributions of ligaments during prescribed motions. Previous studies have analyzed the contribution of different soft tissue structures to the stability of human elbow joints, but have limitations in evaluating the loads sustained by those tissues. This paper introduces a unique, hybrid experimental-computational technique for measuring and simulating the biomechanical contributions of ligaments to elbow joint kinematics and stability. in vitro testing of cadaveric joints is enhanced by the incorporation of fully parametric virtual ligaments, which are used in place of the native joint stabilizers to characterize the contribution of elbow ligaments during simple flexion–extension (FE) motions using the principle of superposition. Our results support previously reported findings that the anterior medial collateral ligament (AMCL) and the radial collateral ligament (RCL) are the primary soft tissue stabilizers for the elbow joint. Tuned virtual ligaments employed in this study were able to restore the kinematics and laxity of elbows to within 2 deg of native joint behavior. The hybrid framework presented in this study demonstrates promising capabilities in measuring the biomechanical contribution of ligamentous structures to joint stability.

Commentary by Dr. Valentin Fuster

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