Knee Tissue Strains and Effectiveness of a Novel Functional ACL Knee Brace During Dynamic in-Vitro Loading

Functional knee braces are commonly prescribed to help stabilize and protect the knee after an ACL injury or reconstruction. Newer brace designs employ a dynamic tensioning system to apply directional forces to the knee. The purpose of this thesis was to characterize meniscal loading under dynamic loading conditions and test the efficacy of a functional knee brace equipped with a dynamic tensioning system to reduce ACL and meniscal strain. A combined invivo/in-silico/in-vitro testing method was used to quantify tissue strains and the effect of the brace on cadaveric specimens. Tissue strains were quantified and validated before and after reconstruction, and the brace was found to lower tissue strains during most conditions. This work provides supportive evidence for the use of braces with a dynamic tensioning system for patients who are ACL deficient or following reconstruction.

Year	Entry
2007	Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. November 2007;54(11):1940-1950.
2003	Myklebust G, Engebretsen L, Brækken IH, Skjølberg A, Olsen O-E, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. March 2003;13(2):71-78.
1999	Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med. November–December 1999;27(6):699-706.
2006	Thelen DG, Anderson FC. Using computed muscle control to generate forward dynamic simulations of human walking from experimental data. J Biomech. 2006;39(6):1107-1115.
2005	Andriacchi TP, Dyrby CO. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech. February 2005;38(2):293-298.
2009	Winter DA. Biomechanics and Motor Control of Human Movement. 4th ed. Hoboken, NJ: Inc, John Wiley & Sons; 2009.
2004	Pflum MA, Shelburne KB, Torry MR, Decker MJ, Pandy MG. Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exer. November 2004;36(11):1949-1958.
2007	Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. October 2007;35(10):1756-1769.
1983	Ahmed AM, Burke DL. In-vitro of measurement of static pressure distribution in synovial joints, I: tibial surface of the knee. J Biomech Eng. August 1983;105(3):216-225.
2009	Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury: abnormalities in hip and ankle kinematics. Am J Sports Med. February 2009;37(2):252-259.
1998	Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. June 1998;31(6):519-525.
2010	Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. J Biomech. October 19, 2010;43(14):2709-2716.
1980	Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthrotic knee joints. Acta Orthop Scand. December 1980;51(5):871-879.
2008	Liu MQ, Anderson FC, Schwartz MH, Delp SL. Muscle contributions to support and progression over a range of walking speeds. J Biomech. November 14, 2008;41(15):3243-3252.
2012	Kristianslund E, Krosshaug T, van den Bogert AJ. Effect of low pass filtering on joint moments from inverse dynamics: implications for injury prevention. J Biomech. February 23, 2012;45(4):666-671.
1994	Delp SL, Ringwelski DA, Carroll NC. Transfer of the rectus femoris: effects of transfer site on moment arms about the knee and hip. J Biomech. October 1994;27(10):1201-1211.
2007	Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. March 2007;35(3):359-367.
2006	Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943-2950.
2015	Hicks JL, Uchida TK, Seth A, Rajagopal A, Delp SL. Is my model good enough? best practices for verification and validation of musculoskeletal models and simulations of movement. J Biomech Eng. February 2015;137(2):020905.

Year

Entry

2007

Delp SL, Anderson FC, Arnold AS, Loan P, Habib A, John CT, Guendelman E, Thelen DG. OpenSim: open-source software to create and analyze dynamic simulations of movement. IEEE Trans Biomed Eng. November 2007;54(11):1940-1950.

2003

Myklebust G, Engebretsen L, Brækken IH, Skjølberg A, Olsen O-E, Bahr R. Prevention of anterior cruciate ligament injuries in female team handball players: a prospective intervention study over three seasons. Clin J Sport Med. March 2003;13(2):71-78.

1999

Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes: a prospective study. Am J Sports Med. November–December 1999;27(6):699-706.

2006

Thelen DG, Anderson FC. Using computed muscle control to generate forward dynamic simulations of human walking from experimental data. J Biomech. 2006;39(6):1107-1115.

2005

Andriacchi TP, Dyrby CO. Interactions between kinematics and loading during walking for the normal and ACL deficient knee. J Biomech. February 2005;38(2):293-298.

2009

Winter DA. Biomechanics and Motor Control of Human Movement. 4th ed. Hoboken, NJ: Inc, John Wiley & Sons; 2009.

2004

Pflum MA, Shelburne KB, Torry MR, Decker MJ, Pandy MG. Model prediction of anterior cruciate ligament force during drop-landings. Med Sci Sports Exer. November 2004;36(11):1949-1958.

2007

Lohmander LS, Englund PM, Dahl LL, Roos EM. The long-term consequence of anterior cruciate ligament and meniscus injuries: osteoarthritis. Am J Sports Med. October 2007;35(10):1756-1769.

1983

Ahmed AM, Burke DL. In-vitro of measurement of static pressure distribution in synovial joints, I: tibial surface of the knee. J Biomech Eng. August 1983;105(3):216-225.

2009

Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury: abnormalities in hip and ankle kinematics. Am J Sports Med. February 2009;37(2):252-259.

1998

Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. June 1998;31(6):519-525.

2010

Hamner SR, Seth A, Delp SL. Muscle contributions to propulsion and support during running. J Biomech. October 19, 2010;43(14):2709-2716.

1980

Fukubayashi T, Kurosawa H. The contact area and pressure distribution pattern of the knee: a study of normal and osteoarthrotic knee joints. Acta Orthop Scand. December 1980;51(5):871-879.

2008

Liu MQ, Anderson FC, Schwartz MH, Delp SL. Muscle contributions to support and progression over a range of walking speeds. J Biomech. November 14, 2008;41(15):3243-3252.

2012

Kristianslund E, Krosshaug T, van den Bogert AJ. Effect of low pass filtering on joint moments from inverse dynamics: implications for injury prevention. J Biomech. February 23, 2012;45(4):666-671.

1994

Delp SL, Ringwelski DA, Carroll NC. Transfer of the rectus femoris: effects of transfer site on moment arms about the knee and hip. J Biomech. October 1994;27(10):1201-1211.

2007

Krosshaug T, Nakamae A, Boden BP, Engebretsen L, Smith G, Slauterbeck JR, Hewett TE, Bahr R. Mechanisms of anterior cruciate ligament injury in basketball: video analysis of 39 cases. Am J Sports Med. March 2007;35(3):359-367.

2006

Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943-2950.

2015

Hicks JL, Uchida TK, Seth A, Rajagopal A, Delp SL. Is my model good enough? best practices for verification and validation of musculoskeletal models and simulations of movement. J Biomech Eng. February 2015;137(2):020905.

Year	Entry
2023	Kalra M. An in-Vitro and Finite Element Investigation on the Efficacy of Unloader Knee Braces on Meniscus Strain and Tibiofemoral Pressure [PhD thesis]. University of Waterloo; 2023.

Year

Entry

2023

Kalra M. An in-Vitro and Finite Element Investigation on the Efficacy of Unloader Knee Braces on Meniscus Strain and Tibiofemoral Pressure [PhD thesis]. University of Waterloo; 2023.