Simulation of anterior cruciate ligament injury and reconstruction using a 3D finite element knee joint model

A three dimensional computational knee joint model was utilized in simulating injury to the ACL and ACL reconstruction. The model was constructed and optimized using MR images and experimental data from the same knee. The model was validated by comparing its behavior to kinematic and kinetic data found in literature. The focus of the simulation was a parametric study of the effect variations in the stiffness of the ACL or graft material has on knee joint function The stiffness of the ACL was reduced by varying degrees to simulate partial ACL injury and complete ACL rupture. The behavior of the ACL deficient knee was analyzed under a simulated quadriceps load. Stiffness reduction of the ACL did have a considerable effect on knee joint function, although the results show that an injured ACL can still provide a majority of the stability provided by an intact ACL. ACL reconstruction was simulated using grafts with material properties similar to those of grafts most often used today. The results show that current reconstruction techniques, especially when high initial graft tensions are used, are likely to produce abnormal knee kinematics and kinetics. The graft fixation sites should be chosen such that the graft behavior matches that of the intact ACL. Thesis Supervisor: Guoan Li Title: Lecturer

[1]  R. Marder,et al.  Prospective evaluation of arthroscopically assisted anterior cruciate ligament reconstruction , 1991, The American journal of sports medicine.

[2]  S L Woo,et al.  Hamstrings—an anterior cruciate ligament protagonist , 1993, The American journal of sports medicine.

[3]  J. O'Connor,et al.  Can muscle co-contraction protect knee ligaments after injury or repair? , 1993, The Journal of bone and joint surgery. British volume.

[4]  S. Woo,et al.  The importance of quadriceps and hamstring muscle loading on knee kinematics and in-situ forces in the ACL. , 1999, Journal of biomechanics.

[5]  J L Lewis,et al.  Factors affecting graft force in surgical reconstruction of the anterior cruciate ligament , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[6]  J Wismans,et al.  A three-dimensional mathematical model of the knee-joint. , 1980, Journal of biomechanics.

[7]  K. Markolf,et al.  Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part II: Forces in the Graft Compared with Forces in the Intact Ligament* , 1996, The Journal of bone and joint surgery. American volume.

[8]  Freddie H. Fu,et al.  Determination of the in situ loads on the human anterior cruciate ligament , 1993, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[9]  K. Markolf,et al.  In vivo knee stability. A quantitative assessment using an instrumented clinical testing apparatus. , 1978, The Journal of bone and joint surgery. American volume.

[10]  K. Briggs,et al.  Reconstruction of the Anterior Cruciate Ligament in Patients Who Are at Least Forty Years Old: A Long-Term Follow-up and Outcome Study* , 1998, The Journal of bone and joint surgery. American volume.

[11]  F. Noyes,et al.  Intra-articular cruciate reconstruction. II: Replacement with vascularized patellar tendon. , 1983, Clinical orthopaedics and related research.

[12]  S. Woo,et al.  Use of patellar tendon autograft for anterior cruciate ligament reconstruction in the rabbit: A long‐term histologic and biomechanical study , 1989, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[13]  E. Chao,et al.  Prediction of antagonistic muscle forces using inverse dynamic optimization during flexion/extension of the knee. , 1999, Journal of biomechanical engineering.

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

[15]  P. Wood,et al.  An in vitro study of anterior cruciate ligament graft placement and isometry , 1988, The American journal of sports medicine.

[16]  K Kaneda,et al.  Effects of Initial Graft Tension on Clinical Outcome After Anterior Cruciate Ligament Reconstruction , 1997, The American journal of sports medicine.

[17]  T W Rudy,et al.  Effect of combined axial compressive and anterior tibial loads on in situ forces in the anterior cruciate ligament: A porcine study , 1998, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[18]  T. Andriacchi,et al.  Force displacement characteristics of the posterior cruciate ligament , 1992, The American journal of sports medicine.

[19]  B. Seedhom Reconstruction of the Anterior Cruciate Ligament , 1992, Proceedings of the Institution of Mechanical Engineers. Part H, Journal of engineering in medicine.

[20]  Charles H. Brown,et al.  Hamstring tendon grafts for reconstruction of the anterior cruciate ligament: biomechanical evaluation of the use of multiple strands and tensioning techniques. , 1999, The Journal of bone and joint surgery. American volume.

[21]  J L Lewis,et al.  In vivo forces during remodeling of a two‐segment anterior cruciate ligament graft in a goat model , 1997, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[22]  J. Andrews,et al.  The role of arthroscopic surgery in the evaluation of acute traumatic hemarthrosis of the knee. , 1988, Clinical orthopaedics and related research.

[23]  M J Askew,et al.  The effects of graft tensioning on the laxity and kinematics of the anterior cruciate ligament reconstructed knee. , 1991, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[24]  R J Johnson,et al.  The Elongation Behavior of the Anterior Cruciate Ligament Graft in Vivo , 2001, The American journal of sports medicine.

[25]  F. Noyes,et al.  Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. , 1984, The Journal of bone and joint surgery. American volume.

[26]  H. Kohl,et al.  Cyclic Pull-Out Strength of Hamstring Tendon Graft Fixation with Soft Tissue Interference Screws , 1999, The American journal of sports medicine.

[27]  H. Grootenboer,et al.  Articular contact in a three-dimensional model of the knee. , 1991, Journal of Biomechanics.

[28]  D. E. Cooper,et al.  The strength of the central third patellar. tendon graft , 1993, The American journal of sports medicine.

[29]  B. Beynnon,et al.  The Relationship Between Anterior-Posterior Knee Laxity and the Structural Properties of the Patellar Tendon Graft , 1994, The American journal of sports medicine.

[30]  T. Mommersteeg,et al.  Characterization of the mechanical behavior of human knee ligaments: a numerical-experimental approach. , 1996, Journal of biomechanics.

[31]  M. Järvinen,et al.  The Incidence of Patellofemoral Osteoarthritis and Associated Findings 7 Years after Anterior Cruciate Ligament Reconstruction with a Bone-Patellar Tendon-Bone Autograft , 2001, The American journal of sports medicine.

[32]  R. Buzzi,et al.  Long-term study of anterior cruciate ligament reconstruction for chronic instability using the central one-third patellar tendon and a lateral extraarticular tenodesis , 1992, The American journal of sports medicine.

[33]  D L Butler,et al.  Location-dependent variations in the material properties of the anterior cruciate ligament. , 1992, Journal of biomechanics.

[34]  R. Burks,et al.  Determination of graft tension before fixation in anterior cruciate ligament reconstruction. , 1988, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[35]  Freddie H. Fu,et al.  Biomechanics of the ACL: Measurements of in situ force in the ACL and knee kinematics , 1998 .

[36]  D. B. O’Neill,et al.  Arthroscopically Assisted Reconstruction of the Anterior Cruciate Ligament: A Follow-up Report , 2001, The Journal of bone and joint surgery. American volume.

[37]  ACL INJURY CAUSES ROTATIONAL ABNORMALITIES AT THE KNEE DURING WALKING + , 2001 .

[38]  J O Galante,et al.  Model studies of the stiffness characteristics of the human knee joint. , 1983, Journal of biomechanics.

[39]  R J Johnson,et al.  The Effect of Anterior Cruciate Ligament Graft Elongation at the Time of Implantation on the Biomechanical Behavior of the Graft and Knee , 1996, The American journal of sports medicine.

[40]  Freddie H. Fu,et al.  The effect of anterior cruciate ligament graft fixation site at the tibia on knee stability: evaluation using a robotic testing system. , 1997, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[41]  L. Pinczewski,et al.  Long-term osteoarthritic changes in anterior cruciate ligament reconstructed knees. , 1999, Clinical orthopaedics and related research.

[42]  K. Markolf,et al.  Direct measurement of resultant forces in the anterior cruciate ligament. An in vitro study performed with a new experimental technique. , 1990, The Journal of bone and joint surgery. American volume.

[43]  G. Li,et al.  Variability of a three-dimensional finite element model constructed using magnetic resonance images of a knee for joint contact stress analysis. , 2001, Journal of biomechanical engineering.

[44]  F. Noyes,et al.  The symptomatic anterior cruciate-deficient knee. Part I: the long-term functional disability in athletically active individuals. , 1983, The Journal of bone and joint surgery. American volume.

[45]  B. Hillen,et al.  Intra-articular reconstruction of the anterior cruciate ligament. An experimental study of length changes in different ligament reconstructions. , 1984, Clinical orthopaedics and related research.

[46]  M. Freeman,et al.  Anteroposterior and rotational movement of femur during knee flexion. , 1999, Clinical orthopaedics and related research.

[47]  C B Frank,et al.  The science of reconstruction of the anterior cruciate ligament. , 1997, The Journal of bone and joint surgery. American volume.

[48]  T. Wredmark,et al.  A comparison of quadruple semitendinosus and patellar tendon grafts in reconstruction of the anterior cruciate ligament. , 2001, The Journal of bone and joint surgery. British volume.

[49]  R. Barrack,et al.  The natural history of conservatively treated partial anterior cruciate ligament tears , 1989, The American journal of sports medicine.

[50]  B. Beynnon,et al.  Anterior cruciate ligament strain in-vivo: a review of previous work. , 1998, Journal of biomechanics.

[51]  K. Markolf,et al.  Biomechanical Consequences of Replacement of the Anterior Cruciate Ligament with a Patellar Ligament Allograft. Part I: Insertion of the Graft and Anterior-Posterior Testing* , 1996, The Journal of bone and joint surgery. American volume.

[52]  S L Woo,et al.  A validated three-dimensional computational model of a human knee joint. , 1999, Journal of biomechanical engineering.

[53]  K. Markolf,et al.  Measurement of knee stiffness and laxity in patients with documented absence of the anterior cruciate ligament. , 1984, The Journal of bone and joint surgery. American volume.

[54]  G. Schwab,et al.  Performance of an athlete with straight posterior knee instability , 1981, The American journal of sports medicine.

[55]  J. Feagin,et al.  Consideration of the anterior cruciate ligament injury in skiing. , 1987, Clinical orthopaedics and related research.

[56]  S. Woo,et al.  The forces in the anterior cruciate ligament and knee kinematics during a simulated pivot shift test: A human cadaveric study using robotic technology. , 2000, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[57]  J B Morrison,et al.  The mechanics of the knee joint in relation to normal walking. , 1970, Journal of biomechanics.

[58]  Freddie H. Fu,et al.  Biomechanical function of the human anterior cruciate ligament. , 1994, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[59]  S. Woo,et al.  Tensile properties of the human femur-anterior cruciate ligament-tibia complex , 1991, The American journal of sports medicine.

[60]  B. Beynnon,et al.  Evaluation of Knee Joint Laxity and the Structural Properties of the Anterior Cruciate Ligament Graft in the Human , 1997, The American journal of sports medicine.

[61]  G. Losse,et al.  Instrumented measurement of anterior laxity of the knee. , 1985, The Journal of bone and joint surgery. American volume.

[62]  K. Shelbourne,et al.  Results of Anterior Cruciate Ligament Reconstruction Based on Meniscus and Articular Cartilage Status at the Time of Surgery , 2000, The American journal of sports medicine.

[63]  R. Warren,et al.  An in vitro biomechanical evaluation of anterior-posterior motion of the knee. Tibial displacement, rotation, and torque. , 1982, The Journal of bone and joint surgery. American volume.

[64]  T. Muneta,et al.  Relationship between changes in length and force in in vitro reconstructed anterior cruciate ligament , 1993, The American journal of sports medicine.

[65]  A L Otero,et al.  A comparison of the doubled semitendinosus/gracilis and central third of the patellar tendon autografts in arthroscopic anterior cruciate ligament reconstruction. , 1993, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[66]  Freddie H. Fu,et al.  The Position of the Tibia during Graft Fixation Affects Knee Kinematics and Graft Forces for Anterior Cruciate Ligament Reconstruction * , 2001, The American journal of sports medicine.

[67]  Ephrat Most,et al.  Development of a 6-DOF robotic test system for studying the biomechanics of total knee replacement , 2000 .

[68]  M. Cross,et al.  Long-term followup of posterior cruciate ligament rupture: A study of 116 cases , 1984, The American journal of sports medicine.

[69]  A. Ferretti,et al.  Osteoarthritis of the knee after ACL reconstruction , 2004, International Orthopaedics.

[70]  R J Johnson,et al.  An analytical model of the knee. , 1976, Journal of biomechanics.

[71]  B. Beynnon,et al.  Isometric versus tension measurements. A comparison for the reconstruction of the anterior cruciate ligament. , 1993, The American journal of sports medicine.

[72]  L. Engebretsen,et al.  A Prospective, Randomized Study of Three Operations for Acute Rupture of the Anterior Cruciate Ligament. Five-Year Follow-up of One Hundred and Thirty-one Patients* , 1996, The Journal of bone and joint surgery. American volume.

[73]  K. Kaufman,et al.  Fate of the ACL-injured Patient , 1994, The American journal of sports medicine.

[74]  P. Walker,et al.  Ligament length patterns, strength, and rotational axes of the knee joint. , 1976, Clinical orthopaedics and related research.

[75]  Russell F. Warren,et al.  The Effects of Time Course after Anterior Cruciate Ligament Injury in Correlation with Meniscal and Cartilage Loss , 2001, The American journal of sports medicine.

[76]  L. Blankevoort,et al.  Validation of a three-dimensional model of the knee. , 1996, Journal of biomechanics.

[77]  M. S. Hefzy,et al.  Anterior cruciate ligament replacements: A mechanical study of femoral attachment location, flexion angle at tensioning, and initial tension , 1990, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[78]  P. Belmont,et al.  Incidence and outcomes of anterior cruciate ligament reconstruction among U.S. Army aviators. , 1999, Aviation, space, and environmental medicine.

[79]  Jeremy Suggs,et al.  The effect of graft stiffness on knee joint biomechanics after ACL reconstruction--a 3D computational simulation. , 2003, Clinical biomechanics.

[80]  Paolo Aglietti,et al.  Patellar Tendon Versus Doubled Semitendinosus and Gracilis Tendons for Anterior Cruciate Ligament Reconstruction , 1994, The American journal of sports medicine.

[81]  J R Essinger,et al.  A mathematical model for the evaluation of the behaviour during flexion of condylar-type knee prostheses. , 1989, Journal of biomechanics.

[82]  Tomoyuki Sasaki,et al.  Graft Incorporation within the Tibial Bone Tunnel after Anterior Cruciate Ligament Reconstruction with Bone-Patellar Tendon-Bone Autograft * , 2001, American Journal of Sports Medicine.

[83]  Freddie H Fu,et al.  The effect of axial tibial torque on the function of the anterior cruciate ligament: a biomechanical study of a simulated pivot shift test. , 2002, Arthroscopy : the journal of arthroscopic & related surgery : official publication of the Arthroscopy Association of North America and the International Arthroscopy Association.

[84]  R. Hawkins,et al.  Followup of the acute nonoperated isolated anterior cruciate ligament tear , 1986, The American journal of sports medicine.

[85]  B. Reider,et al.  Anterior cruciate ligament reconstruction using one-third of the patellar ligament, augmented by extra-articular tendon transfers. , 1982, The Journal of bone and joint surgery. American volume.

[86]  M Pope,et al.  Effect of tension and placement of a prosthetic anterior cruciate ligament on the anteroposterior laxity of the knee , 1992, Journal of orthopaedic research : official publication of the Orthopaedic Research Society.

[87]  J. Buckwalter,et al.  Athletics and Osteoarthritis , 1997, The American journal of sports medicine.