The Development, Validation, and Applications of a Three-Dimensional Dynamic Specimen-Specific Knee Model to Study Acl Strain

Rupture of the anterior cruciate ligament (ACL) is a common injury during sport activities, yet the mechanism of injury is not well understood. Previous investigations have primarily examined the effects of low-magnitude or quasi-static loads, while the injury itself is a very dynamic event. Simulation models provide a potentially valuable tool to isolate the factors that influence ACL strain under dynamic conditions.

The primary aims of this study were to develop, validate and apply a dynamic three-dimensional model of the knee to investigate the influence of various loading conditions on ACL strain, to improve the understanding of ACL injury mechanisms, as well as to extend the model to unanswered ACL-related clinical research questions. These studies have revealed that the risk of ACL injury by isolated quadriceps force is significantly reduced when a sizable deceleration force is present during landing motions. These studies also suggest that the presence of a valgus moment during landing increases the ACL strain. Moreover, physiological levels of combined valgus and tibial internal rotation moments were shown to significantly increase ACL strain enough to rupture the ACL; therefore, this combined valgus and internal rotation moment is most likely the predominant ACL injury mechanism.

Another specific goal of this work was to study the influence of anatomical variation in the extensor anatomy, especially the patellar ligament insertion angle (PLIA) on quadriceps usage following ACL injury. Using gait and MRI analysis, the large net reductions in external flexion moment during walking were shown to correlate with large PLIA only in ACL deficient knees, not in uninjured contralateral knees. The existence of this relationship only in ACL-deficient knees was supported by observations of high sensitivity of anterior tibial translation to quadriceps contraction in ACL-deficient knees, using a modified version of the simulated knee model.

In conclusion, the use of a three-dimensional dynamic specimen-specific knee model provides unique insight into the factors that affect ACL strain and ACL injury mechanisms. Applications of computational studies in this thesis provide a more theoretical understanding to complement findings in other in vivo and in vitro studies.

Year	Entry
1998	Andriacchi TP, Alexander EJ, Toney MK, Dyrby C, Sum J. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng. December 1998;120(6):743-749.
2001	Piazza SJ, Delp SL. Three-dimensional dynamic simulation of total knee replacement motion during a step-up task. J Biomech Eng. December 2001;123(6):599-606.
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.
2004	Olsen O-E, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. June 2004;32(4):1002-1012.
1992	Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS. Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech. May 1992;25(5):511-518.
1993	Mow VC, Ateshian GA, Spilker RL. Biomechanics of diarthrodial joints: a review of twenty years of progress. J Biomech Eng. November 1993;115(4B):460-467.
1991	Woo SL-Y, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217-225.
1991	Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ. Articular contact in a three-dimensional model of the knee. J Biomech. 1991;24(11):1019-1031.
1999	Li G, Gil J, Kanamori A, Woo SL-Y. A validated three-dimensional computational model of a human knee joint. J Biomech Eng. December 1999;121(6):657-662.
1996	Hewett TE, Stroupe AL, Nance TA, Noyes FR. Plyometric training in female athletes: decreased impact forces and increased hamstring torques. Am J Sports Med. November–December 1996;24(6):765-773.
2003	McLean SG, Su A, van den Bogert AJ. Development and validation of a 3-D model to predict knee joint loading during dynamic movement. J Biomech. December 2003;125(6):864-874.
2004	Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. March 2004;32(3):447-457.
1976	Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee: the contributions of the supporting structures: a quantitative in vitro study. J Bone Joint Surg. July 1976;58A(5):583-594.
1975	Girgis FG, Marshall JL, Al Monajem ARS. The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res. January–February 1975;106:216-231.
2002	Haut Donahue TL, Hull ML, Rashid MM, Jacobs CR. A finite element model of the human knee joint for the study of tibio-femoral contact. J Biomech Eng. June 2002;124(3):273-280.
1976	Crowninshield R, Pope MH, Johnson RJ. An analytical model of the knee. J Biomech. 1976;9(6):397-405.
1983	Andriacchi TP, Mikosz R., Hampton SJ, Galante JO. Model studies of the stiffness characteristics of the human knee joint. J Biomech. 1983;16(1):23-29.
1989	Essinger JR, Leyvraz PF, Heegard JH, Robertson DD. A mathematical model for the evaluation of the behaviour during flexion of condylar-type knee prostheses. J Biomech. 1989;22(11-12):1229-1241.
2005	Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer: a 13-year review. Am J Sports Med. April 2005;33(4):524-530.
1995	Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med. December 1995;23(6):694-701.
1995	Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GAM, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. November 1995;13(6):930-935.
2000	Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics. June 2000;23(6):573-578.
1999	Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. June 1999;34(2):86-92.
2004	Lohmander LS, Östenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. October 2004;50(10):3145-3152.
1994	Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. September–October 1994;22(5):632-644.
1984	Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg. March 1984;66A(3):344-352.
2004	McLean SG, Huang X, Su A, van den Bogert AJ. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech (Bristol, Avon). October 2004;19(8):828-838.
2005	Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. April 2005;33(4):492-501.
1988	Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech. 1988;21(9):705-720.
1986	van Eijden TMGJ, Kouwenhoven E, Verburg J, Weijs WA. A mathematical model of the patellofemoral joint. J Biomech. 1986;19(3):219-229.
1998	Beynnon BD, Fleming BC. Anterior cruciate ligament strain in-vivo: a review of previous work. J Biomech. June 1998;31(6):519-525.
2000	Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick R, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. ;8(3):141-150.
1980	Wismans J, Veldpaus F, Janssen J, Huson A, Struben P. A three-dimensional mathematical model of the knee-joint. J Biomech. 1980;13(8):677-685.
1990	Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng. 1990;37(8):757-767.
2004	von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. March 2004;63(3):269-273.

Year

Entry

1998

Andriacchi TP, Alexander EJ, Toney MK, Dyrby C, Sum J. A point cluster method for in vivo motion analysis: applied to a study of knee kinematics. J Biomech Eng. December 1998;120(6):743-749.

2001

Piazza SJ, Delp SL. Three-dimensional dynamic simulation of total knee replacement motion during a step-up task. J Biomech Eng. December 2001;123(6):599-606.

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.

2004

Olsen O-E, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. June 2004;32(4):1002-1012.

1992

Butler DL, Guan Y, Kay MD, Cummings JF, Feder SM, Levy MS. Location-dependent variations in the material properties of the anterior cruciate ligament. J Biomech. May 1992;25(5):511-518.

1993

Mow VC, Ateshian GA, Spilker RL. Biomechanics of diarthrodial joints: a review of twenty years of progress. J Biomech Eng. November 1993;115(4B):460-467.

1991

Woo SL-Y, Hollis JM, Adams DJ, Lyon RM, Takai S. Tensile properties of the human femur-anterior cruciate ligament-tibia complex: the effects of specimen age and orientation. Am J Sports Med. 1991;19(3):217-225.

1991

Blankevoort L, Kuiper JH, Huiskes R, Grootenboer HJ. Articular contact in a three-dimensional model of the knee. J Biomech. 1991;24(11):1019-1031.

1999

Li G, Gil J, Kanamori A, Woo SL-Y. A validated three-dimensional computational model of a human knee joint. J Biomech Eng. December 1999;121(6):657-662.

1996

Hewett TE, Stroupe AL, Nance TA, Noyes FR. Plyometric training in female athletes: decreased impact forces and increased hamstring torques. Am J Sports Med. November–December 1996;24(6):765-773.

2003

McLean SG, Su A, van den Bogert AJ. Development and validation of a 3-D model to predict knee joint loading during dynamic movement. J Biomech. December 2003;125(6):864-874.

2004

Andriacchi TP, Mündermann A, Smith RL, Alexander EJ, Dyrby CO, Koo S. A framework for the in vivo pathomechanics of osteoarthritis at the knee. Ann Biomed Eng. March 2004;32(3):447-457.

1976

Markolf KL, Mensch JS, Amstutz HC. Stiffness and laxity of the knee: the contributions of the supporting structures: a quantitative in vitro study. J Bone Joint Surg. July 1976;58A(5):583-594.

1975

Girgis FG, Marshall JL, Al Monajem ARS. The cruciate ligaments of the knee joint: anatomical, functional and experimental analysis. Clin Orthop Relat Res. January–February 1975;106:216-231.

2002

Haut Donahue TL, Hull ML, Rashid MM, Jacobs CR. A finite element model of the human knee joint for the study of tibio-femoral contact. J Biomech Eng. June 2002;124(3):273-280.

1976

Crowninshield R, Pope MH, Johnson RJ. An analytical model of the knee. J Biomech. 1976;9(6):397-405.

1983

Andriacchi TP, Mikosz R., Hampton SJ, Galante JO. Model studies of the stiffness characteristics of the human knee joint. J Biomech. 1983;16(1):23-29.

1989

Essinger JR, Leyvraz PF, Heegard JH, Robertson DD. A mathematical model for the evaluation of the behaviour during flexion of condylar-type knee prostheses. J Biomech. 1989;22(11-12):1229-1241.

2005

Agel J, Arendt EA, Bershadsky B. Anterior cruciate ligament injury in National Collegiate Athletic Association basketball and soccer: a 13-year review. Am J Sports Med. April 2005;33(4):524-530.

1995

Arendt E, Dick R. Knee injury patterns among men and women in collegiate basketball and soccer: NCAA data and review of literature. Am J Sports Med. December 1995;23(6):694-701.

1995

Markolf KL, Burchfield DM, Shapiro MM, Shepard MF, Finerman GAM, Slauterbeck JL. Combined knee loading states that generate high anterior cruciate ligament forces. J Orthop Res. November 1995;13(6):930-935.

2000

Boden BP, Dean GS, Feagin JA Jr, Garrett WE Jr. Mechanisms of anterior cruciate ligament injury. Orthopedics. June 2000;23(6):573-578.

1999

Arendt EA, Agel J, Dick R. Anterior cruciate ligament injury patterns among collegiate men and women. J Athl Train. June 1999;34(2):86-92.

2004

Lohmander LS, Östenberg A, Englund M, Roos H. High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis Rheum. October 2004;50(10):3145-3152.

1994

Daniel DM, Stone ML, Dobson BE, Fithian DC, Rossman DJ, Kaufman KR. Fate of the ACL-injured patient: a prospective outcome study. Am J Sports Med. September–October 1994;22(5):632-644.

1984

Noyes FR, Butler DL, Grood ES, Zernicke RF, Hefzy MS. Biomechanical analysis of human ligament grafts used in knee-ligament repairs and reconstructions. J Bone Joint Surg. March 1984;66A(3):344-352.

2004

McLean SG, Huang X, Su A, van den Bogert AJ. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting. Clin Biomech (Bristol, Avon). October 2004;19(8):828-838.

2005

Hewett TE, Myer GD, Ford KR, Heidt RS Jr, Colosimo AJ, McLean SG, van den Bogert AJ, Paterno MV, Succop P. Biomechanical measures of neuromuscular control and valgus loading of the knee predict anterior cruciate ligament injury risk in female athletes: a prospective study. Am J Sports Med. April 2005;33(4):492-501.

1988

Blankevoort L, Huiskes R, de Lange A. The envelope of passive knee joint motion. J Biomech. 1988;21(9):705-720.

1986

van Eijden TMGJ, Kouwenhoven E, Verburg J, Weijs WA. A mathematical model of the patellofemoral joint. J Biomech. 1986;19(3):219-229.

1998

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

2000

Griffin LY, Agel J, Albohm MJ, Arendt EA, Dick R, Garrett WE, Garrick JG, Hewett TE, Huston L, Ireland ML, Johnson RJ, Kibler WB, Lephart S, Lewis JL, Lindenfeld TN, Mandelbaum BR, Marchak P, Teitz CC, Wojtys EM. Noncontact anterior cruciate ligament injuries: risk factors and prevention strategies. J Am Acad Orthop Surg. ;8(3):141-150.

1980

Wismans J, Veldpaus F, Janssen J, Huson A, Struben P. A three-dimensional mathematical model of the knee-joint. J Biomech. 1980;13(8):677-685.

1990

Delp SL, Loan JP, Hoy MG, Zajac FE, Topp EL, Rosen JM. An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures. IEEE Trans Biomed Eng. 1990;37(8):757-767.

2004

von Porat A, Roos EM, Roos H. High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: a study of radiographic and patient relevant outcomes. Ann Rheum Dis. March 2004;63(3):269-273.

Year	Entry
2009	Shin CS, Chaudhari AM, Andriacchi TP. The effect of isolated valgus moments on ACL strain during single-leg landing: a simulation study. J Biomech. February 9, 2009;42(3):280-285.

Year

Entry

2009

Shin CS, Chaudhari AM, Andriacchi TP. The effect of isolated valgus moments on ACL strain during single-leg landing: a simulation study. J Biomech. February 9, 2009;42(3):280-285.