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In the last few years, increasingly kicks to the head were observed as a criminal offense. This study examined the
influence of age, shoe type and kicking direction on the severity of head trauma.
Male test persons were divided into two groups “Old” and “Young”. Both groups were equipped with light
sneakers and combat boots. A standard laboratory crash dummy was used to simulate the victim’s body. First, the
dummy’s head, free floating above the ground, was kicked vertically. Second, the dummy’s head was kicked
horizontally. Established injury criteria were used to quantify the injury risk.
No influence concerning the type of foot wear and no difference between the groups “Old” and “Young” could be
found. For all analyses, kicking vertically generally lead to a higher risk for the subject compared to kicking
horizontally.
In this study, only the integral effect of the kicks could be analyzed. A detailed injury pattern cannot directly be
derived from the data. Nevertheless, the presented data show the massive potential of injuries associated with head
kicks.
Outputs of musculoskeletal models should be considered probabilistic rather than deterministic as they are affected by inaccuracies and estimations associated with the development of the model. One of these uncertainties being critical for modeling arises from the determination of the muscles' line of action and the physiological cross-sectional area. Therefore, the aim of this study was to evaluate the outcome sensitivity of model predictions from a musculoskeletal hand model in comparison to the uncertainty of these input parameters. For this purpose, the kinematics and muscle activities of different hand movements (abduction of the fingers, abduction of the thumb, and flexion of the thumb) were recorded. One thousand simulations were calculated for each movement using the Latin hypercube sampling method with a corresponding variation of the muscle origin/insertion points and the cross-sectional area. Comparing the standard hand to simulations incorporating uncertainties of input parameters shows no major deviations in on- and off-set time point of muscle activities. About 60% of simulations are located within a ± 30% interval around the standard model concerning joint reaction forces. The comparison with the variation of the input data leads to the conclusion that the standard hand model is able to provide not over-scattered outcomes and, therefore, can be considered relatively stable. These results are of practical importance to the personalization of a musculoskeletal model with subject-specific bone geometries and hence changed muscle line of action.
INTRODUCTION
Several clinical studies demonstrated long-term adjacent-level effects after implantation of spinal fusion devices[1]. These effects have been reported as adjacent joint degeneration and the development of new symptoms correlating with adjacent segment degeneration[2] and the trend has therefore gone to motion preservation devices; however, these effects have not been understood very well and have not been investigated thoroughly[3].
The aim of this study is to investigate the effect of varying the stiffness of spinal fusion devices on the adjacent vertebral levels. Disc forces, moments and facet joint forces were analyzed.
METHODS
The AnyBody Modeling System was used to compute the in-vivo muscle and joint reaction forces of a musculoskeletal model. The full body model used in this study consists of 188 muscle fascicles in the lumbar spine and more than 1000 individual muscle branches in total. The model has been proposed by de Zee et al.[3], validated by Rasmussen et al.[4] and by Galibarov et al.[5]. The new model[5] determines the individual motions between vertebrae based on the equilibrium between forces acting on the vertebrae from muscles and joints and the passive stiffness in disks and ligaments, figure 1a. An adult of 1.75 m and 75 kg with a spinal implant in L4L5 was modeled. This model was subjected to a flexion-extension motion using different elastic moduli to analyze and compare to a non-implanted scenario. The analyzed variables were vertebral motion, the disc reaction forces and moments, as well as facet joint forces in the treated and the adjacent levels: L2L3, L3L4, L4L5 and L5-Sacrum.
RESULTS
When introducing a spinal fusion device in the L4L5 joint the reaction forces and moments decreased in this joint with stiffer devices leading to lower joint loads. However, in the adjacent joints, L3L4 and L5Sacrum, an increase was observed when implanting stiffer devices. Similar trends could be found for the L2L3 joint. The loads in the facet joints showed the same trends. While introducing a spinal fusion device reduced the facet joint forces in the treated joint, the loads in the adjacent facet joints were increased according to the stiffness of the implanted device, figure 1b.
DISCUSSION
While the treated disc joint showed reduced motion and loads, the adjacent levels demonstrated a significant increase. In particular, the increased facet joint forces in the adjacent levels can lead to adjacent level facet pain or accelerated facet joint degeneration. Introducing a device resulted in preventing facet contact and therefore facet joint loads, even using the device with the lowest stiffness.
CONCLUSION
The presented model shows that clinical complications such as facet joint degeneration in adjacent levels after implantation of spinal fusion device are consistent with the change in the mechanical-stimulus distribution in the system.
Pelvic floor dysfunction is a common problem in women and has a negative impact ontheir quality of life. The aim of this review was to provide a general overview of the current state oftechnology used to assess pelvic floor functionality. It also provides literature research of the phys-iological and anatomical factors that correlate with pelvic floor health. The systematic review wasconducted according to the PRISMA guidelines. PubMed, ScienceDirect, Cochrane Library andIEEE databases were searched for publications on sensor technology for the assessment of pelvicfloor functionality. Anatomical and physiological parameters were identified through a manualsearch. In the systematic review 115 publications were included. 12 different sensor technologieswere identified. Information on the obtained parameters, sensor position, test activities and subjectcharacteristics were prepared in tabular form from each publication. 16 anatomical and physiologi- cal parameters influencing pelvic floor health were identified in 17 published studies and rankedfor their statistical significance. Taken together, this review could serve as a basis for the develop-ment of novel sensors which could allow for quantifiable prevention and diagnosis, as well as par-ticularized documentation of rehabilitation processes related to pelvic floor dysfunctions.
Pelvic floor dysfunction is a common problem in women and has a negative impact on their quality of life. The aim of this review was to provide a general overview of the current state of technology used to assess pelvic floor functionality. It also provides literature research of the physiological and anatomical factors that correlate with pelvic floor health. This systematic review was conducted according to the PRISMA guidelines. The PubMed, ScienceDirect, Cochrane Library, and IEEE databases were searched for publications on sensor technology for the assessment of pelvic floor functionality. Anatomical and physiological parameters were identified through a manual search. In the systematic review, 114 publications were included. Twelve different sensor technologies were identified. Information on the obtained parameters, sensor position, test activities, and subject characteristics was prepared in tabular form from each publication. A total of 16 anatomical and physiological parameters influencing pelvic floor health were identified in 17 published studies and ranked for their statistical significance. Taken together, this review could serve as a basis for the development of novel sensors which could allow for quantifiable prevention and diagnosis, as well as particularized documentation of rehabilitation processes related to pelvic floor dysfunctions.
Subject-specific Musculoskeletal Simulation of Hip Dislocation Risk in Activities of Daily Living
(2011)
Meniscal tears in the avascular zone have a poor self-healing potential, however partial meniscectomy predisposes the knee for early osteoarthritis. Tissue engineering with mesenchymal stem cells and a hyaluronan collagen based scaffold is a promising approach to repair meniscal tears in the avascular zone. 4 mm longitudinal meniscal tears in the avascular zone of lateral menisci of New Zealand White Rabbits were performed. The defect was left empty, sutured with a 5-0 suture or filled with a hyaluronan/collagen composite matrix without cells, with platelet rich plasma or with autologous mesenchymal stem cells. Matrices with stem cells were in part precultured in chondrogenic medium for 14 days prior to the implantation. Menisci were harvested at 6 and 12 weeks. The developed repair tissue was analyzed macroscopically, histologically and biomechanically. Untreated defects, defects treated with suture alone, with cell-free or with platelet rich plasma seeded implants showed a muted fibrous healing response. The implantation of stem cell-matrix constructs initiated fibrocartilage-like repair tissue, with better integration and biomechanical properties in the precultured stem cell-matrix group. A hyaluronan-collagen based composite scaffold seeded with mesenchymal stem cells is more effective in the repair avascular meniscal tear with stable meniscus-like tissue and to restore the native meniscus.
Musculoskeletal simulations of lumbar spine loading rely on a geometrical representation of the anatomy. However, this data has an inherent inaccuracy. This study evaluates the influence of defined geometrical parameters on lumbar spine loading utilising five parametrised musculoskeletal lumbar spine models for four different postures. The influence of the dimensions of vertebral body, disc, posterior parts of the vertebrae as well as the curvature of the lumbar spine was studied. Additionally, simulations with combinations of selected parameters were conducted. Changes in L4/L5 resultant joint force were used as outcome variable. Variations of the vertebral body height, disc height, transverse process width and the curvature of the lumbar spine were the most influential.
These parameters can be easily acquired from X-rays and should be used to morph a musculoskeletal lumbar spine model for subject-specific approaches with respect to bone geometry. Furthermore, the model was very sensitive to uncommon configurations and therefore, it is advised that stiffness properties of discs and ligaments should be individualised.
Für Mutter und Kind konnte das Risiko der Geburt durch die Weiterentwicklung der Medizin drastisch reduziert werden. Doch wie ist es um das Wohl derer bestellt, die die Gebärende unterstützen? Eine Studie der Ostbayerischen Technischen Hochschule Regensburg hat sich mit den muskuloskelettalen Beschwerden von Geburtshelfer:innen auseinandergesetzt
The number of spinal fusion surgeries is steadily increasing and biomechanical consequences are still in debate. The aim of this study is to provide biomechanical insights into the sagittal balance of the spine and to compare spinal load before and after spinal fusion.
METHOD:
The joint reaction forces of 52 patients were analyzed in proximo-distal and antero-posterior direction from the levels T12-L1 to L5-S1 using musculoskeletal simulations.
RESULTS:
In 104 simulations, pre-surgical forces were equal to post-surgical. The levels L4-L5 and T12-L1, however, showed increased spinal forces compression forces with higher sagittal displacement. Improved restauration of sagittal balance was accompanied by lower spinal load. AP shear stress, interestingly decreased with sagittal imbalance.
CONCLUSION:
Imbalanced spines have a risk of increased compression forces at Th12-L1. L4-L5 always has increased spinal loads. These slides can be retrieved under Electronic Supplementary Material.
Early motion therapy plays an important role for effective long-term healing of joint injuries. In many cases, conventional dynamic orthoses fail to address the intricate movement possibilities of the underlying joints, limited by their simplistic joint representations, often represented by revolute joints, enabling rotations by only one axis. In this paper, a two-dimensional compliant tensegrity joint for use in biomedical applications is investigated. It consists of two compressed members and five compliant tensioned members. Relative movement possibilities are realized by the intrinsic compliance of the structure. In the development of these systems, the first step is the determination of the static stable equilibrium. This analysis is conducted in this paper by considering the potential energy approach or by using the geometric nonlinear finite element method. The mechanical behavior of the structure is assessed with a specific emphasis on its mechanical compliance. The primary objective of this study is the investigation of the influence of structural parameters on the overall stiffness and movability of the structure. The results underscore the significant effect of member parameters on the stiffness and movability of the compliant tensegrity joint, particularly under varying load magnitudes. These findings provide insights for optimizing the joint’s performance, contributing to its potential application in advanced orthotic and exoskeleton devices.
On modelling spine curvature dependent on muscular and external forces in multibody dynamics system
(2011)
This paper presents a computational approach for investigating effect of muscular and external forces on curvature of the lumbar spine. Multibody dynamics system is used to compute the lumbar spine curvature using a force-dependent kinematics facility, e.g. this method allows releasing some degrees of freedom in order to be computed based on the current load configuration.
Navigated Femur First Total Hip Arthroplasty leads to improved Biomechanical Outcome after surgery
(2015)
Elbow stability is derived from a combination of muscular, ligamentous, and bony structures. After an elbow trauma the stability of the joint is an important decision criterion for the subsequent treatment. The decision regarding non-operative/operative care depends mostly on subjective assessments of medical experts. Therefore, the aim of this study is to use musculoskeletal simulations as an objective assessment tool to investigate the extent to which failure of different stabilizers affects the elbow stability and how these observations correspond to the assessment from clinical practice. A musculoskeletal elbow simulation model was developed for this aim. To investigate the stability of the elbow, varus/valgus moments were applied under 0°, 45°and 90° flexion while the respective cubital angle was analyzed. This was performed for nine different injury scenarios, which were also evaluated for stability by clinical experts. With the results, it can be determined by which injury pattern and under which flexion angle the elbow stability is impaired regarding varus/valgus moments. The scenario with a complete failure of the medial and lateral ligaments and a fracture of the radial head was identified as having the greatest instability. The study presented a numerical determination of elbow stability against varus/valgus moments regarding clinical injury patterns, as well as a comparison of the numerical outcome with experience gained in clinical practice. The numerical predictions agree well with the assessments of the clinical specialists. Thus, the results from musculoskeletal simulation can make an important contribution to a more objective assessment of the elbow stability.
Musculoskeletal modelling of the shoulder – effects on muscle recruitment and joint reaction force
(2019)
With the progress in modern medicine, it was possible to significantly reduce the risks of birth for mother and child. One aspect that has received less attention so far is the risk of injury to the accoucheurs (obstetricians and midwives) during the birth process. Indeed, studies indicate that 92% of midwives suffer from musculoskeletal disorders, with the lower back being the main cause of complaints (72%). The aim of this study was to investigate two commonly used postural techniques used by accoucheurs during childbirth and to analyze the resulting load on the lower back using the AnyBodyTM musculoskeletal simulation software.
Musculoskeletal lower back load of accoucheurs during childbirth – A pilot and feasibility study
(2021)
Introduction: Back problems represent one of the leading causes of accouchers' work-related musculoskeletal morbidities. The correct execution of birth-related maneuvers including manual perineal protection is crucial not only for the mother and child but also for obstetricians and midwives to reduce any strain on their musculoskeletal system. Therefore, the overall aim of this study was to test the feasibility of determining the effect of different accouchers' postures (standing and kneeling) on their musculoskeletal system.
Methods: The biomechanical analysis is based on musculoskeletal simulations that included motion recordings of real deliveries as well as deliveries conducted on a birthing simulator. These simulations were then used to determine individual joints' loads.
Results: In the kneeling posture, both a low intra-operator variability and a lower average maximum load of the lower back was observed. For the standing position the spine load was reduced by pivoting the elbow on the accouchers' thigh, which in turn was associated with a significantly greater load on the shoulder joint.
Conclusion: The study demonstrated the feasibility of our technique to assess joints loads. It also provided initial data indicating that a posture that reduces spinal flexion and tilt, achieved in this study by the kneeling, can significantly reduce the strain on the practitioner's musculoskeletal system.
Mental stress reduces performance and changes musculoskeletal loading in football-related movements
(2020)
Purpose:
Football players have a high risk of leg muscle injuries, especially when exposed to mental stress. Hence, this study investigated the musculoskeletal response of elite youth football players during highly dynamic movements under stress. The hypothesis is that mental stress reduces performance and changes the muscular forces exerted.
Materials & methods:
Twelve elite youth football players were subjected to mental stress while performing sports-specific change-of-direction movements. A modified version of the d2 attention test was used as stressor. The kinetics are computed using inverse dynamics. Running times and exerted forces of injury-prone muscles were analysed.
Results:
The stressor runs were rated more mentally demanding by the players (p = 0.006, rs = 0.37) with unchanged physical demand (p = 0.777, rs = 0.45). This resulted in 10% longer running times under stress (p < 0.001, d = −1.62). The musculoskeletal analysis revealed higher peak muscle forces under mental stress for some players but not for others.
Discussion:
The study shows that motion capture combined with musculoskeletal computation is suitable to analyse the effects of stress on athletes in highly dynamic movements. For the first time in football medicine, our data quantifies an association between mental stress with reduced football players’ performance and changes in muscle force.
Objectives: The mechanical properties and seeding with endothelial cells were investigated in fresh and cryopreserved human umbilical vein.
Methods: Human umbilical veins (HUV) were frozen in Euro-Collins/1M DMSO at –1°C/min and stored in liquid nitrogen. Stress-strain relationships of fresh and thawed veins were determined in an uniaxial tension-testing rig. HUV endothelial cells (HUVEC) were seeded onto denuded HUV under static conditions and grown for 3d. Luminal surfaces were analyzed by scanning electron microscopy. Calcein-stained cells were seeded hyperconfluently to determine the cell retention capacity of fresh and cryopreserved veins.
Results: The stress-strain relationships of HUV followed a biphasic pattern typical for natural vessels. Neither the failure stress (2.71±0.36 vs. 3.25±0.97 N, n=3) nor the displacement required to achieve failure (9.73±0.9 vs. 7.43±2.07mm, n=3) were altered by cryopreservation. The burst pressure was estimated as approx. 1000mm Hg within the limitations of the uniaxial model. HUVEC seeded onto denuded HUV formed patches (at 9E3 cells per cm2) or an almost confluent endothelium (at 3E4 cells per cm2) within three days. The capacity to retain seeded HUVEC of denuded HUV was not altered by cryopreservation (1.15±0.08E5 vs. 1.26±0.14E5 cells per cm2, n=6).
Conclusions: The burst pressure of HUV seems to be sufficiently high for the human arterial circulation and is not altered by cryopreservation. HUVEC can establish a confluent endothelium on denuded HUV. Therefore HUV appears to be a suitable storable scaffold for vascular tissue engineering.
Measuring functional outcome after total hip replacement with subject-specific hip joint loading
(2012)
Total hip replacement is an often-performed orthopedic surgical procedure; the amount of procedures undertaken will increase since our life expectancy is growing. In order to optimize function, hip biomechanics should be restored to as near normal as possible. The goal of this pilot study was to determine whether or not it is feasible to compute the vectorial hip reaction force pathways on the head of the prosthesis and the force angles relative to the cup of the prosthesis that occur during gait in total hip replacement patients, serving as an objective measurement of the functional outcome following hip replacement. A three-dimensional gait analysis, measuring ground reaction forces and kinematics, was performed. The data retrieved from the gait analysis was used as the input for the musculoskeletal model to compute vectorial joint reaction forces for data processing. To evaluate the position and orientation of the joint reaction forces, the force path, as well as the force angles for the operated and non-operated joint, has been calculated during the stance phase of the specific leg. The force path for subject 2 on the non-operated side is only located in the posterior-lateral quarter, as is the force path for subject 1. In contrast to this subject, the force path for subject 2 at the operated hip joint can be found only within the anterior quarter of the head of the implant, where it is nearly equally distributed in the medio-lateral half of the prosthesis head. The force-inclination angles on the cup of subject 1, with respect to the plane of the socket face, indicates that the force vector is mainly positioned in the same quadrant when compared with subject 2 (in a cup-fixed coordinate system). The force-anteversion angle behaves similarly to the force-inclination angle, even when the effects are not as pronounced. The proposed methods in this article are aiming to define two functional outcomes of total hip replacement that are related to wear and rim loading. It is accepted that wear is not only a function of time, but a function of use. Owing to the methods listed in this article, we are able to determine a) the applied force and b) the sliding distance (force pathway) in a subject-specific manner. The computed hip-reaction force angles and the distance to the rim cup are a measurement for cup or rim loading, and occurs in the so-called safe-zones. This method may well give us insight into the biomechanical situation during gait, after receiving total hip replacement, that we need to fully understand the mechanisms acting on a hip joint and to prove a possible increase of functional outcome after receiving total hip replacement.
We aimed to investigate the relationship between postoperative leg length/offset (LL/OS) reconstruction and gait performance after total hip arthroplasty (THA). In the course of a prospective randomized controlled trial, 60 patients with unilateral hip arthrosis received cementless THA through a minimally-invasive anterolateral surgical approach. One year post-operatively, LL and global OS restoration were analyzed and compared to the contralateral hip on AP pelvic radiographs. The combined postoperative limb length/OS reconstruction of the operated hip was categorized as restored (within 5 mm) or non-restored (more than 5 mm reduction or more than 5 mm increment). The acetabular component inclination, anteversion and femoral component anteversion were evaluated using CT scans of the pelvis and the femur. 3D gait analysis of the lower extremity and patient related outcome measures (HHS, HOOS, EQ-5D) were obtained pre-operatively, six months and twelve months post-operatively by an observer blinded to radiographic results. Component position of cup and stem was comparable between the restored and non-restored group. Combined LL and OS restoration within 5 mm resulted in higher Froude number (p < 0.001), normalized walking speed (p < 0.001) and hip range-of-motion (ROM) (p = 0.004) during gait twelve months postoperatively, whereas gait symmetry was comparable regardless of LL and OS reconstruction at both examinations. Clinical scores did not show any relevant association between the accuracy of LL or OS reconstruction and gait six/twelve months after THA. In summary, postoperative LL/OS discrepancies larger than 5 mm relate to unphysiological gait kinematics within the first year after THA. DRKS00000739, German Clinical Trials Register.
Für Fußballer:innen stellen muskuläre Verletzungen der unteren Extremitäten ein großes Problem dar. Ein Beispiel hierfür liefert die Nationalmannschaftsstürmerin Alexandra Popp, die aufgrund muskulärer Probleme das EM-Finale 2022 in Wembley kurzfristig verpasste. Oftmals stehen gerade hohe Anspannungssituationen in zeitlichem Zusammenhang mit Verletzungen, der Einfluss der psychischen Beanspruchung auf die biomechanischen Belastungen wird jedoch meist nur wenig beachtet.
Static pelvic tilt impacts functional cup position in total hip arthroplasty (THA). In the current study we investigated the effect of kinematic pelvic changes on cup position. In the course of a prospective controlled trial postoperative 3D-computed tomography (CT) and gait analysis before and 6 and 12 months after THA were obtained in 60 patients. Kinematic pelvic motion during gait was measured using Anybody Modeling System. By fusion with 3D-CT, the impact of kinematic pelvic tilt alterations on cup anteversion and inclination was calculated. Furthermore, risk factors correlating with high pelvic mobility were evaluated. During gait a high pelvic range of motion up to 15.6° exceeding 5° in 61.7% (37/60) of patients before THA was found. After surgery, the pelvis tilted posteriorly by a mean of 4.0 ± 6.6° (p < .001). The pelvic anteflexion led to a mean decrease of −1.9 ± 2.2° (p < .001) for cup inclination and −15.1 ± 6.1° (p < .001) for anteversion in relation to the anterior pelvic plane (APP). Kinematic pelvic changes resulted in a further change up to 2.3° for inclination and up to 12.3° for anteversion. In relation to the preoperative situation differences in postoperative cup position ranged from −4.4 to 4.6° for inclination and from −7.8 to 17.9° for anteversion, respectively. Female sex (p < .001) and normal body weight (p < .001) correlated with high alterations in pelvic tilt. Kinematic pelvic changes highly impact cup anteversion in THA. Surgeons using the APP as reference should aim for a higher anteversion of about 15° due to the functional anteflexion of the pelvis during gait.