Simulated active control produces repeatable motion pathways of the elbow in an in vitro testing system

Dunning, Cynthia E.<sup>1,2</sup>; Duck, Teresa R.<sup>1,2</sup>; King, Graham J. W.<sup>1,2,3,4</sup>; Johnson, James A.<sup>1,2,3,4</sup>

Affiliations

¹Bioengineering Research Laboratory, Lawson Health Research Institute, Hand a Upper Limb Centre, St. Joseph’s Health Care London, London, Ontario, Canada

²Departments of Mechanical and Materials Engineering, The University of Western Ontario, London, Ontario, Canada

³Surgery, The University of Western Ontario, London, Ontario, Canada

⁴Medical Biophysics, The University of Western Ontario, London, Ontario, Canada

Abstract

The purpose of this study was to determine if the repeatability and pattern of elbow kinematics are affected by changing the relative magnitudes of loads applied to muscles around the elbow in vitro. In eight cadaveric upper extremities, passive and three methods of simulated active elbow flexion were tested with the forearm maintained in both pronation and supination. Passive flexion involved moving the elbow manually through a full arc of motion. Simulated active flexion used a custom designed loading system to generate elbow motion by applying loads to various tendons via pneumatic actuators. Three different simulated active loading protocols, with loading ratios based on muscle activity and physiologic cross-sectional area, were tested. Testing was performed initially on an intact elbow, and then an unstable elbow model created by transection of the lateral collateral ligament (i.e. the radial and lateral ulnar collateral ligaments). An electromagnetic tracking device was used to measure rotation of the ulna relative to the humerus. Varus–valgus angulation and internal–external rotation were less repeatable during passive flexion than simulated active flexion, regardless of the loading ratio used, in both the intact (p<0.05) and unstable (p<0.05) elbows. Throughout the arc of flexion, the motion pathways were similar for the three simulated active motion protocols employed in this study (p>0.05). The pathways followed during passive motion were different from those generated with simulated active motion, especially in the unstable elbow with the forearm supinated (p<0.001). These results suggest that using simulated active motion rather than manual passive motion can improve the repeatability of elbow kinematics generated in the laboratory, and that a wide range of muscle loading ratios may produce similar kinematic output.

Links

DOI: 10.1016/S0021-9290(01)00065-3

PubMed: 11448696

WoS: 000170018900008

History

Accepted: 2001-03-16

Cited Works (5)

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Cited By (10)

Year	Entry
2004	Beingessner DM, Dunning CE, Gordon KD, Johnson JA, King GJW. The effect of radial head excision and arthroplasty on elbow kinematics and stability. J Bone Joint Surg. August 2004;86A(8):1730-1739.
2003	Kuxhaus L. Development of a Feedback-Controlled Elbow Simulator: Design Validation and Clinical Application [PhD thesis]. University of Pittsburgh; 2003.
2003	Malone JR. A Comparison of Optoelectronic and Electromagnetic Motion Tracking Systems [Master's thesis]. Queen's University; October 2003.
2022	Anderson DA. In Vitro Investigation of Carpal Tunnel Volume and Morphology Changes With Non-Neutral Wrist Postures [PhD thesis]. University of Guelph; September 2022.
2001	Dunning CE. Development of a Motion-Controlled Testing Apparatus and Kinematic Techniques to Simulate and Describe Elbow Motion (development of Tools to Simulate and Describe Elbow Motion) [PhD thesis]. London, ON: University of Western Ontario; 2001.
2011	Ferreira LM. Development of an Active Elbow Motion Simulator and Coordinate Systems to Evaluate Kinematics in Multiple Positions [PhD thesis]. University of Western Ontario; 2011.
2012	Lalone EA. An Image-Based Tool to Examine Joint Congruency At the Elbow [PhD thesis]. University of Western Ontario; 2012.
2014	Giles JW. Development of an in-Vitro Passive and Active Motion Simulator for the Investigation of Shoulder Function and Kinematics [PhD thesis]. University of Western Ontario; 2014.
2016	Manocha RHK. Optimizing the Rehabilitation of Elbow Lateral Collateral Ligament Injuries [Master's thesis]. University of Western Ontario; 2016.
2018	Banayan SM. The Kinematic and Biomechanical Effects of Bracing on the Rehabilitation of the LCL Injured Elbow [Master's thesis]. University of Western Ontario; 2018.