Role of Ligaments in the Knee Joint Kinematic Behavior: Development and Validation of a Finite Element Model

The management of knee instability is a complex problem in orthopedic surgery. To comprehensively assess the biomechanical role of the knee joint and to investigate various aspects of knee mechanics, several Finite Element (FE) knee models have been developed. However, (i) the full validation of these models against tibio-femoral and tibio-patellar kinematic data and (ii) the high numerical costs associated with the computation of the biomechanical response of the knee joint are still main issues. Moreover, the contribution on knee mobility of the different ligaments is still unclear. The aim of this study was therefore to develop an FE model with both extensive validation and low computational for the investigation of the role of ligaments in the joint kinematic behavior. To this end, a 3D FE model, consisting of the distal and proximal part of the femur and tibia, respectively, the patella, the quadriceps tendon, the cartilage, and knee ligaments was developed in ANSYS. For the model evaluation, 23 fresh frozen knee joints were tested in flexion/extension using a validated device. The model-predicted response was within or at the limits of the experimental corridors for all translations and rotations of tibia and patella with regard to the femur. A sensitivity analysis was conducted to evaluate the impact of both the stiffness and initial strain of ligaments on the knee kinematic response. Our results showed the high sensitivity of the model to the mechanical parameters of the ligaments.

[1]  Ming Zhang,et al.  Redistribution of knee stress using laterally wedged insole intervention: Finite element analysis of knee-ankle-foot complex. , 2013, Clinical biomechanics.

[2]  S. Goldstein,et al.  The elastic moduli of human subchondral, trabecular, and cortical bone tissue and the size-dependency of cortical bone modulus. , 1990, Journal of biomechanics.

[3]  W. Skalli,et al.  Original articleEOS® orthopaedic imaging system to study patellofemoral kinematics: Assessment of uncertainty , 2010 .

[4]  James R. Robinson,et al.  Structural properties of the medial collateral ligament complex of the human knee. , 2005, Journal of biomechanics.

[5]  Clare K Fitzpatrick,et al.  Dynamic finite element knee simulation for evaluation of knee replacement mechanics. , 2012, Journal of biomechanics.

[6]  A. Amis,et al.  The mechanical properties of the two bundles of the human posterior cruciate ligament. , 1994, Journal of biomechanics.

[7]  James R. Robinson,et al.  Biomechanics of the PCL and related structures: posterolateral, posteromedial and meniscofemoral ligaments , 2003, Knee Surgery, Sports Traumatology, Arthroscopy.

[8]  Timothy E Hewett,et al.  Finite element model of the knee for investigation of injury mechanisms: development and validation. , 2014, Journal of biomechanical engineering.

[9]  L Blankevoort,et al.  Recruitment of knee joint ligaments. , 1991, Journal of biomechanical engineering.

[10]  W Skalli,et al.  EOS orthopaedic imaging system to study patellofemoral kinematics: assessment of uncertainty. , 2010, Orthopaedics & traumatology, surgery & research : OTSR.

[11]  King H. Yang,et al.  Patient-specific knee joint finite element model validation with high-accuracy kinematics from biplane dynamic Roentgen stereogrammetric analysis. , 2008, Journal of biomechanics.

[12]  A Cappello,et al.  Skin movement artefact assessment and compensation in the estimation of knee-joint kinematics. , 1998, Journal of biomechanics.

[13]  Clare K Fitzpatrick,et al.  A statistical finite element model of the knee accounting for shape and alignment variability. , 2013, Medical engineering & physics.

[14]  E. Abdel-Rahman,et al.  Three-dimensional dynamic behaviour of the human knee joint under impact loading. , 1998, Medical engineering & physics.

[15]  Bernard Moyen,et al.  In vitro analysis of patellar kinematics: validation of an opto-electronic cinematic analysis protocol , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[16]  Feng Xie,et al.  A study on construction three-dimensional nonlinear finite element model and stress distribution analysis of anterior cruciate ligament. , 2009, Journal of biomechanical engineering.

[17]  Yu Zhang,et al.  A Finite Element 3D Model of in Vivo Human Knee Joint Based on MRI for the Tibiofemoral Joint Contact Analysis , 2007, HCI.

[18]  Javad Hashemi,et al.  Sex-based differences in the tensile properties of the human anterior cruciate ligament. , 2006, Journal of biomechanics.

[19]  Michael Damsgaard,et al.  Do kinematic models reduce the effects of soft tissue artefacts in skin marker-based motion analysis? An in vivo study of knee kinematics. , 2010, Journal of biomechanics.

[20]  S. Majumdar,et al.  Analysis of three-dimensional in vivo knee kinematics using dynamic magnetic resonance imaging , 2005 .

[21]  Ming Zhang,et al.  Comparison of stress on knee cartilage during kneeling and standing using finite element models. , 2014, Medical engineering & physics.

[22]  K. Sugamoto,et al.  In vivo kinematic analysis of posterior-stabilized total knee arthroplasty for the valgus knee operated by the gap-balancing technique. , 2014, The Knee.

[23]  D L Butler,et al.  Comparison of material properties in fascicle-bone units from human patellar tendon and knee ligaments. , 1986, Journal of biomechanics.

[24]  R. Nagamine,et al.  Effect of medial displacement of the tibial tubercle on patellar position after rotational malposition of the femoral component in total knee arthroplasty. , 1996, The Journal of arthroplasty.

[25]  Andrew D. Pearle,et al.  Isometry of medial collateral ligament reconstruction , 2009, Knee Surgery, Sports Traumatology, Arthroscopy.

[26]  J. Middleton,et al.  Three-dimensional finite element modelling of the human ACL: simulation of passive knee flexion with a stressed and stress-free ACL. , 2004, Journal of biomechanics.

[27]  King H. Yang,et al.  A new method to investigate in vivo knee behavior using a finite element model of the lower limb. , 2004, Journal of biomechanics.

[28]  L. Mockros,et al.  Indentation tests of human articular cartilage. , 1976, Journal of biomechanics.

[29]  A Shirazi-Adl,et al.  Computational biodynamics of human knee joint in gait: from muscle forces to cartilage stresses. , 2012, Journal of biomechanics.

[30]  Markus Wünschel,et al.  The influence of asymmetric quadriceps loading on patellar tracking--an in vitro study. , 2012, The Knee.

[31]  D P Pioletti,et al.  Biomechanical evaluation of intra-articular and extra-articular procedures in anterior cruciate ligament reconstruction: a finite element analysis. , 2007, Clinical biomechanics.

[32]  A. Amis,et al.  Anatomic and Biomechanical Study of the Lateral Collateral and Popliteofibular Ligaments , 2001, The American journal of sports medicine.

[33]  J. O'Connor,et al.  The components of passive knee movement are coupled to flexion angle. , 2000, Journal of biomechanics.

[34]  Thore Zantop,et al.  Anterolateral rotational knee instability: role of posterolateral structures , 2007, Archives of Orthopaedic and Trauma Surgery.

[35]  Johnna S Temenoff,et al.  Techniques for biological characterization of tissue-engineered tendon and ligament. , 2007, Biomaterials.

[36]  Harry E Rubash,et al.  Kinematics of the knee at high flexion angles: An in vitro investigation , 2004, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[37]  A Shirazi-Adl,et al.  Biomechanics of the knee joint in flexion under various quadriceps forces. , 2005, The Knee.