Biomedical Engineering - Research Publications

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    Effects of Prophylactic Knee Bracing on Lower Limb Kinematics, Kinetics, and Energetics During Double-Leg Drop Landing at 2 Heights
    Ewing, KA ; Begg, RK ; Galea, MP ; Lee, PVS (SAGE PUBLICATIONS INC, 2016-07)
    BACKGROUND: Anterior cruciate ligament (ACL) injuries commonly occur during landing maneuvers. Prophylactic knee braces were introduced to reduce the risk of ACL injuries, but their effectiveness is debated. HYPOTHESES: We hypothesized that bracing would improve biomechanical factors previously related to the risk of ACL injuries, such as increased hip and knee flexion angles at initial contact and at peak vertical ground-reaction force (GRF), increased ankle plantar flexion angles at initial contact, decreased peak GRFs, and decreased peak knee extension moment. We also hypothesized that bracing would increase the negative power and work of the hip joint and would decrease the negative power and work of the knee and ankle joints. STUDY DESIGN: Controlled laboratory study. METHODS: Three-dimensional motion and force plate data were collected from 8 female and 7 male recreational athletes performing double-leg drop landings from 0.30 m and 0.60 m with and without a prophylactic knee brace. GRFs, joint angles, moments, power, and work were calculated for each athlete with and without a knee brace. RESULTS: Prophylactic knee bracing increased the hip flexion angle at peak GRF by 5.56° (P < .001), knee flexion angle at peak GRF by 4.75° (P = .001), and peak hip extension moment by 0.44 N·m/kg (P < .001). Bracing also increased the peak hip negative power by 4.89 W/kg (P = .002) and hip negative work by 0.14 J/kg (P = .001) but did not result in significant differences in the energetics of the knee and ankle. No differences in peak GRFs and peak knee extension moment were observed with bracing. CONCLUSION: The application of a prophylactic knee brace resulted in improvements in important biomechanical factors associated with the risk of ACL injuries. CLINICAL RELEVANCE: Prophylactic knee braces may help reduce the risk of noncontact knee injuries in recreational and professional athletes while playing sports. Further studies should investigate different types of prophylactic knee braces in conjunction with existing training interventions so that the sports medicine community can better assess the effectiveness of prophylactic knee bracing.
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    Prophylactic knee bracing alters lower-limb muscle forces during a double-leg drop landing
    Ewing, KA ; Fernandez, JW ; Begg, RK ; Galea, MP ; Lee, PVS (ELSEVIER SCI LTD, 2016-10-03)
    Anterior cruciate ligament (ACL) injury can be a painful, debilitating and costly consequence of participating in sporting activities. Prophylactic knee bracing aims to reduce the number and severity of ACL injury, which commonly occurs during landing maneuvers and is more prevalent in female athletes, but a consensus on the effectiveness of prophylactic knee braces has not been established. The lower-limb muscles are believed to play an important role in stabilizing the knee joint. The purpose of this study was to investigate the changes in lower-limb muscle function with prophylactic knee bracing in male and female athletes during landing. Fifteen recreational athletes performed double-leg drop landing tasks from 0.30m and 0.60m with and without a prophylactic knee brace. Motion analysis data were used to create subject-specific musculoskeletal models in OpenSim. Static optimization was performed to calculate the lower-limb muscle forces. A linear mixed model determined that the hamstrings and vasti muscles produced significantly greater flexion and extension torques, respectively, and greater peak muscle forces with bracing. No differences in the timings of peak muscle forces were observed. These findings suggest that prophylactic knee bracing may help to provide stability to the knee joint by increasing the active stiffness of the hamstrings and vasti muscles later in the landing phase rather than by altering the timing of muscle forces. Further studies are necessary to quantify whether prophylactic knee bracing can reduce the load placed on the ACL during intense dynamic movements.
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    Subject-specific musculoskeletal modeling in the evaluation of shoulder muscle and joint function
    Wu, W ; Lee, PVS ; Bryant, AL ; Galea, M ; Ackland, DC (ELSEVIER SCI LTD, 2016-11-07)
    Upper limb muscle force estimation using Hill-type muscle models depends on musculotendon parameter values, which cannot be readily measured non-invasively. Generic and scaled-generic parameters may be quickly and easily employed, but these approaches do not account for an individual subject's joint torque capacity. The objective of the present study was to develop a subject-specific experimental testing and modeling framework to evaluate shoulder muscle and joint function during activities of daily living, and to assess the capacity of generic and scaled-generic musculotendon parameters to predict muscle and joint function. Three-dimensional musculoskeletal models of the shoulders of 6 healthy subjects were developed to calculate muscle and glenohumeral joint loading during abduction, flexion, horizontal flexion, nose touching and reaching using subject-specific, scaled-generic and generic musculotendon parameters. Muscle and glenohumeral joint forces calculated using generic and scaled-generic models were significantly different to those of subject-specific models (p<0.05), and task dependent; however, scaled-generic model calculations of shoulder glenohumeral joint force demonstrated better agreement with those of subject-specific models during abduction and flexion. Muscles in generic musculoskeletal models operated further from the plateau of their force-length curves than those of scaled-generic and subject-specific models, while muscles in subject-specific models operated over a wider region of their force length curves than those of the generic or scaled-generic models, reflecting diversity of subject shoulder strength. The findings of this study suggest that generic and scaled-generic musculotendon parameters may not provide sufficient accuracy in prediction of shoulder muscle and joint loading when compared to models that employ subject-specific parameter-estimation approaches.
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    The use of laboratory gait analysis for understanding gait deterioration in people with multiple sclerosis
    Lizama, LEC ; Khan, F ; Lee, PVS ; Galea, MP (SAGE PUBLICATIONS LTD, 2016-12)
    Laboratory gait analysis or three-dimensional gait analysis (3DGA), which uses motion capture, force plates and electromyography (EMG), has allowed a better understanding of the underlying mechanisms of gait deterioration in patients with multiple sclerosis (PwMS). This review will summarize the current knowledge on multiple sclerosis (MS)-related changes in kinematics (angles), kinetics (forces) and electromyographic (muscle activation) patterns and how these measures can be used as markers of disease progression. We will also discuss the potential causes of slower walking in PwMS and the implications for 3DGA. Finally, we will describe new technologies and methods that will increase precision and clinical utilization of 3DGA in PwMS. Overall, 3DGA studies have shown that functionality of the ankle joint is the most affected during walking and that compensatory actions to maintain a functional speed may be insufficient in PwMS. However, altered gait patterns may be a strategy to increase stability as balance is also affected in PwMS.
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    Biomechanical testing of the calcified metacarpal articular surface and its association with subchondral bone microstructure in Thoroughbred racehorses
    Williamson, AJ ; Sims, NA ; Thomas, CDL ; Lee, PVS ; Stevenson, MA ; Whitton, RC (WILEY, 2018-03)
    BACKGROUND: Palmar/plantar osteochondral disease (POD) and third metacarpal/-tarsal condylar fractures are considered fatigue injuries of subchondral bone (SCB) and calcified cartilage due to repetitive high loads in racehorses. In combination with adaptive changes in SCB in response to race training, the accumulation of SCB fatigue is likely to result in changes of joint surface mechanical properties. OBJECTIVES: To determine the spatial relationship and correlation of calcified articular surface biomechanical properties with SCB microstructure and training history in the distal palmar metacarpal condyle of Thoroughbred racehorses. STUDY DESIGN: Cross-sectional study. METHODS: Third metacarpal condyles were examined from 31 Thoroughbred horses with micro-computed tomography (microCT). Hyaline cartilage was removed and reference point indentation (RPI) mechanical testing of the calcified articular surface was performed. Training histories were obtained from trainers. The association among indentation distance increase (IDI, an inverse RPI measure of toughness), and microCT and training variables was assessed using a mixed-effects generalised linear model. RESULTS: Untrained horses had higher IDI than horses that had commenced training (P<0.001). Death as a result of musculoskeletal bone fatigue injury (P = 0.044) and presence of POD (P = 0.05) were associated with higher IDI. The microCT variables connectivity density and trabecular pattern factor were positively (P = 0.002) and negatively (P<0.001) correlated with IDI respectively. MAIN LIMITATIONS: The application of RPI to the calcified articular surface is novel and there is a potential for measurement variability with surface unevenness. CONCLUSION: Commencement of race training is associated with altered material properties of the calcified articular surface in horses. Reduced articular surface material properties can also be detected in horses that have fatigue injuries of the distal metacarpus and at other sites in the skeleton. Measures of SCB connectivity and trabecular surface shape may be more important determinants of resistance to failure of the calcified articular surface than traditional measures such as SCB volume and density.
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    Microstructure Variations in the Soft-Hard Tissue Junction of the Human Anterior Cruciate Ligament
    Zhao, L ; Lee, PVS ; Ackland, DC ; Broom, ND ; Thambyah, A (WILEY, 2017-09)
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    The influence of rotator cuff tears on muscle and joint-contact loading after reverse total shoulder arthroplasty
    Ackland, DC ; Robinson, DL ; Wilkosz, A ; Wu, W ; Richardson, M ; Lee, P ; Tse, KM (WILEY, 2019-01)
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    Modelling apical columnar epithelium mechanics from circumferential contractile fibres
    Boyd, ARB ; Moore, S ; Sader, JE ; Lee, PVS (SPRINGER HEIDELBERG, 2017-10)
    Simple columnar epithelia are formed by individual epithelial cells connecting together to form single cell high sheets. They are a main component of many important body tissues and are heavily involved in both normal and cancerous cell activities. Prior experimental observations have identified a series of contractile fibres around the circumference of a cross section located in the upper (apical) region of each cell. While other potential mechanisms have been identified in both the experimental and theoretical literature, these circumferential fibres are considered to be the most likely mechanism controlling movement of this cross section. Here, we investigated the impact of circumferential contractile fibres on movement of the cross section by creating an alternate model where movement is driven from circumferential contractile fibres, without any other potential mechanisms. In this model, we utilised a circumferential contractile fibre representation based on investigations into the movement of contractile fibres as an individual system, treated circumferential fibres as a series of units, and matched our model simulation to experimental geometries. By testing against laser ablation datasets sourced from existing literature, we found that circumferential fibres can reproduce the majority of cross-sectional movements. We also investigated model predictions related to various aspects of cross-sectional movement, providing insights into epithelium mechanics and demonstrating the usefulness of our modelling approach.
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    Computational modeling of single-cell mechanics and cytoskeletal mechanobiology
    Rajagopal, V ; Holmes, WR ; Lee, PVS (WILEY, 2018-03)
    Cellular cytoskeletal mechanics plays a major role in many aspects of human health from organ development to wound healing, tissue homeostasis and cancer metastasis. We summarize the state-of-the-art techniques for mathematically modeling cellular stiffness and mechanics and the cytoskeletal components and factors that regulate them. We highlight key experiments that have assisted model parameterization and compare the advantages of different models that have been used to recapitulate these experiments. An overview of feed-forward mechanisms from signaling to cytoskeleton remodeling is provided, followed by a discussion of the rapidly growing niche of encapsulating feedback mechanisms from cytoskeletal and cell mechanics to signaling. We discuss broad areas of advancement that could accelerate research and understanding of cellular mechanobiology. A precise understanding of the molecular mechanisms that affect cell and tissue mechanics and function will underpin innovations in medical device technologies of the future. WIREs Syst Biol Med 2018, 10:e1407. doi: 10.1002/wsbm.1407 This article is categorized under: Models of Systems Properties and Processes > Mechanistic Models Physiology > Mammalian Physiology in Health and Disease Models of Systems Properties and Processes > Cellular Models.
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    The application of finite element modelling based on clinical pQCT for classification of fracture status
    Robinson, DL ; Jiang, H ; Song, Q ; Yates, C ; Lee, PVS ; Wark, JD (SPRINGER HEIDELBERG, 2019-02)
    Fracture risk assessment using dual-energy X-ray absorptiometry (DXA) frequently fails to diagnose osteoporosis amongst individuals who later experience fragility fractures. Hence, more reliable techniques that improve the prediction of fracture risk are needed. In this study, we evaluated a finite element (FE) modelling framework based on clinical peripheral quantitative computed tomography (pQCT) imaging of the tibial epiphysis and diaphysis to predict the stiffness at these locations in compression, shear, torsion and bending. The ability of these properties to identify a group of women who had recently sustained a low-trauma fracture from an age- and weight-matched control group was determined and compared to clinical pQCT and DXA properties and structural properties based on composite beam theory. The predicted stiffnesses derived from the FE models and composite beam theory were significantly different (p < 0.05) between the control and fracture groups, whereas no meaningful differences were observed using DXA and for the stress-strain indices (SSIs) derived using pQCT. The diagnostic performance of each property was assessed by the odds ratio (OR) and the area under the receiver operating curve (AUC), and both were greatest for the FE-predicted shear stiffness (OR 16.09, 95% CI 2.52-102.56, p = 0.003) (AUC: 0.80, 95% CI 0.67-0.93). The clinical pQCT variable total density (ρtot) and a number of structural and FE-predicted variables had a similar probability of correct classification between the control and fracture groups (i.e. ORs and AUCs with mean values greater than 5.00 and 0.80, respectively). In general, the diagnostic characteristics were lower for variables derived using DXA and for the SSIs (i.e. ORs and AUCs with mean values of 1.65-2.98 and 0.64-0.71, respectively). For all properties considered, the trabecular-dominant tibial epiphysis exhibited enhanced classification characteristics, as compared to the cortical-dominant tibial diaphysis. The results of this study demonstrate that bone properties may be derived using FE modelling that have the potential to enhance fracture risk assessment using conventional pQCT or DXA instruments in clinical settings.