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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.
Introduction: Previous studies of bone stresses in the human lumbar spine have relied on simplified models when modeling the spinal musculature, even though muscle forces are likely major contributors to the stresses in the vertebral bones. Detailed musculoskeletal spine models have recently become available and show good correlation with experimental findings. A combined inverse dynamics and finite element analysis study was conducted in the lumbar spine to investigate the effects of muscle forces on a detailed musculoskeletal finite element model of the 4th lumbar vertebral body. Materials and Methodology: The muscle forces were computed with a detailed and validated inverse dynamics musculoskeletal spine model in a lifting situation, and were then applied to an orthotropic finite element model of the 4th lumbar vertebra. The results were compared with those from a simplified load case without muscles. Results: In general the von Mises stress was larger by 30%, and even higher when looking at the von Mises stress distribution in the superio-anterior and central part of the vertebral body and in the pedicles. Conclusion: The application of spine muscles to a finite element model showed markedly larger von Mises stress responses in the central and anterior part of the vertebral body, which can be tolerated in the young and healthy spine, but it would increase the risk of compression fractures in the elderly, osteoporotic spine.
The musculoskeletal load scenario of computer-assisted Femur-First THR up to one year after surgery
(2015)
Navigated Femur First Total Hip Arthroplasty leads to improved Biomechanical Outcome after surgery
(2015)
Influence of minimally invasive total hip replacement on hip reaction forces and their orientations
(2014)
Minimally invasive surgery (MIS) is becoming increasingly popular. Supporters claim that the main advantages of MIS total hip replacement (THR) are less pain and a faster rehabilitation and recovery. Critics claim that safety and efficacy of MIS are yet to be determined. We focused on a biomechanical comparison between surgical standard and MIS approaches for THR during the early recovery of patients. A validated, parameterized musculoskeletal model was set to perform a squat of a 50th percentile healthy European male. A bilateral motion was chosen to investigate effects on the contralateral side. Surgical approaches were simulated by excluding the incised muscles from the computations. Resulting hip reaction forces and their symmetry and orientation were analyzed. MIS THR seemed less influential on the symmetry index of hip reaction forces between the operated and nonoperated leg when compared to the standard lateral approach. Hip reaction forces at peak loads of the standard transgluteal approach were 24% higher on the contralateral side when compared to MIS approaches. Our results suggest that MIS THR contributes to a greater symmetry of hip reaction forces in absolute value as well as force-orientation following THR.
We have developed a novel, computer-assisted operation method for minimal-invasive total hip replacement (THR) following the concept of “femur first/combined anteversion,” which incorporates various aspects of performing a functional optimization of the prosthetic stem and cup position (CAS FF). The purpose of this study is to assess whether the hip joint reaction forces and patient’s gait parameters are being improved by CAS FF in relation to conventional THR (CON). We enrolled 60 patients (28 CAS FF/32 CON) and invited them for gait analysis at three time points (preoperatively, postop six months, and postop 12 months). Data retrieved from gait analysis was processed using patient-specific musculoskeletal models. The target parameters were hip reaction force magnitude (hrf), symmetries, and orientation with respect to the cup. Hrf in the CAS FF group were closer to a young healthy normal. Phase-shift symmetry showed an increase in the CAS FF group. Hrf orientation in the CAS FF group was closer to optimum, though no edge or rim-loading occurred in the CON group as well. The CAS FF group showed an improved hrf orientation in an early stage and a trend to an improved long-term outcome.
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.
A prospective randomized controlled trial is presented that is used to compare gait performance between the computer assisted Femur First (CAS FF) operation method and conventional THR (CON). 60 patients underwent a 3D gait analysis of the lower extremity at pre-operative, 6 months post-operative and twelve months post-operative. Detailed verification experiments were facilitated to ensure the quality of data as well as to avoid over-interpreting of the data. The results confirm a similar data-quality as reported in the literature. Walking speed, range of motion and symmetry thereof improved over the follow-up period, without significant differences between the groups. While all parameters do significantly increase over the follow-up period for both groups, there were no significant differences between them at any given time-point. Patients undergoing CAS FF showed a trend to improved hip flexion angle indicating a possible long-term benefit.
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.
Offset restoration in total hip arthroplasty (THA) is associated with postoperative range of motion (ROM) and gait kinematics. We aimed to research into the impact of high offset (HO) and standard stems on postoperative ROM. 121 patients received cementless THA through a minimally-invasive anterolateral approach. A 360° hip ROM analysis software calculated impingement-free hip movement based on postoperative 3D-CTs compared to ROM values necessary for activities of daily living (ADL). The same model was then run a second time after changing the stem geometry between standard and HO configuration with the implants in the same position. HO stems showed higher ROM for all directions between 4.6 and 8.9° (p < 0.001) compared with standard stems but with high interindividual variability. In the subgroup with HO stems for intraoperative offset restoration, the increase in ROM was even higher for all ROM directions with values between 6.1 and 14.4° (p < 0.001) compared to offset underrestoration with standard stems. Avoiding offset underrestoration resulted in a higher amount of patients of over 20% for each ROM direction that fulfilled the criteria for ADL (p < 0.001). In contrast, in patients with standard stems for offset restoration ROM did increase but not clinically relevant by offset overcorrection for all directions between 3.1 and 6.1° (p < 0.001). Offset overcorrection by replacing standard with HO stems improved ROM for ADL in a low number of patients below 10% (p > 0.03). Patient-individual restoration of offset is crucial for free ROM in THA. Both over and underrestoration of offset should be avoided.
Forschungsbericht 2017
(2017)
A key requirement in both native knee joints and total knee arthroplasty is a stable capsular ligament complex. However, knee stability is highly individual and ranges from clinically loose to tight. So far, hardly any in vivo data on the intrinsic mechanical of the knee are available. This study investigated if stiffness of the native ligament complex may be determined in vivo using a standard knee balancer. Measurements were obtained with a commercially available knee balancer, which was initially calibrated in vitro. 5 patients underwent reconstruction of the force-displacement curves of the ligament complex. Stiffness of the medial and lateral compartments were calculated to measure the stability of the capsular ligament complex. All force-displacement curves consisted of a non-linear section at the beginning and of a linear section from about 80 N onwards. The medial compartment showed values of 28.4 ± 1.2 N/mm for minimum stiffness and of 39.9 ± 1.1 N/mm for maximum stiffness; the respective values for the lateral compartment were 19.9 ± 0.9 N/mm and 46.6 ± 0.8 N/mm. A commercially available knee balancer may be calibrated for measuring stiffness of knee ligament complex in vivo, which may contribute to a better understanding of the intrinsic mechanical behaviour of knee joints.
Ergonomic workplaces lead to fewer work-related musculoskeletal disorders and thus fewer sick days. There are various guidelines to help avoid harmful situations. However, these recommendations are often rather crude and often neglect the complex interaction of biomechanical loading and psychological stress. This study investigates whether machine learning algorithms can be used to predict mechanical and stress-related muscle activity for a standardized motion. For this purpose, experimental data were collected for trunk movement with and without additional psychological stress. Two different algorithms (XGBoost and TensorFlow) were used to model the experimental data. XGBoost in particular predicted the results very well. By combining it with musculoskeletal models, the method shown here can be used for workplace analysis but also for the development of real-time feedback systems in real workplace environments.
Background
Iliac crest bone harvesting is a frequently performed surgical procedure widely used to treat bone defects. The objective of this study is to assess the biomechanical quantities related to risk for pelvic fracture after harvesting an autologous bone graft at the anterior iliac crest.
Methods
Finite element models with a simulated harvest site (sized 15 × 20 mm, 15 × 35 mm, 30 × 20 mm and 30 × 35 mm) in the iliac wing are created. The relevant loading case is when the ipsilateral leg is lifted off the ground. Musculoskeletal analysis is utilized to compute the muscle and joint forces involved in this motion. These forces are used as boundary conditions for the finite element analyses. Bone tissue stress is analyzed.
Results
Critical stress peaks are located between the anterior superior iliac spine (ASIS) and the anterior edge of the harvest site. Irrespective of the graft size, the iliac wing does not show any significant stress peaks with the harvest site being 20 to 25 mm posterior to the ASIS. The harvest area itself inhibits the distribution of the forces applied on the ASIS to extend to the posterior iliac wing. This leads to a lack of stress posterior to the harvest site. A balanced stress distribution with no stress peaks appears when the bone graft is taken below the iliac crest.
Conclusion
A harvest site located at least 20 to 25 mm posterior to the ASIS should be preferred to minimize the risk of iliac fatigue fracture.
Embodiment theories have proposed a reciprocal relationship between emotional state and bodily reactions. Besides large body postures, recent studies have found emotions to affect rather subtle bodily expressions, such as slumped or upright sitting posture. This study investigated back muscle activity as an indication of an effect of positive and negative emotions on the sitting position. The electromyography (EMG) activity of six back muscles was recorded in 31 healthy subjects during exposure to positive and negative affective pictures. A resting period was used as a control condition. Increased muscle activity patterns in the back were found during the exposure to negative emotional stimuli, which was mainly measured in the lumbar and thorax regions. The positive emotion condition caused no elevated activity. The findings show that negative emotions lead to increased differential muscle activity in the back and thus corroborate those of previous research that emotion affects subtle bodily expressions.
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.
Biomechanical analysis of the right elevated glenohumeral joint in violinists during legato-playing
(2022)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS:
Elevating the right shoulder while playing the violin may pose a potential problem.
Biomechanical Analysis of the Right Elevated Glenohumeral Joint in Violinists during Legato-Playing
(2021)
BACKGROUND:
Many statistics reveal that violin players suffer most often from musculoskeletal disorders compared to musicians of other instrument groups. A common phenomenon, especially observed in violin beginners, is the tendency to elevate the right shoulder during playing the violin. This can probably lead to serious disorders in long-term practice with repetitive movements.
OBJECTIVE:
For this reason, this study investigated the relationship between the right shoulder elevation and the force in the right glenohumeral joint during violin playing. It was hypothesized that the forces in the right glenohumeral joint are higher during playing with the right shoulder raised compared to playing in normal posture.
METHODS:
Motion capture data from four experienced violinists was recorded and processed by means of musculoskeletal simulation to get the force and elevation angle while playing with raised shoulder and in normal position.
RESULTS:
The results indicate that the absolute values of the resulting force, as well as the forces in the mediolateral, inferosuperior, and anteroposterior directions, are higher in playing the violin with the shoulder raised than in a normal posture.
CONCLUSIONS: Elevating the right shoulder while playing the violin may pose a potential problem.
A 3-point skeletal anchorage with taping screws for distraction osteogenesis after a Le Fort III osteotomy was applied for the first time in a severely mentally impaired patient where intraoral devices had to be avoided. All 3-force application points included the center of resistance, which allowed an optimal control on the resulting moment. A novel device for skeletal long-term retention into the nasal dorsum prevented a relapse, whereas adjustment of the midface position was observed. Fusioned three-dimensional computed tomography analysis revealed real movements not accessible by a conventional cephalometry.
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.
Osteoporosis is a common disease of old age. However, in many cases, it can be very well prevented and counteracted with physical activity, especially high-impact exercises. Wearables have the potential to provide data that can help with continuous monitoring of patients during therapy phases or preventive exercise programs in everyday life. This study aimed to determine the accuracy and reliability of measured acceleration data at different body positions compared to accelerations at the pelvis during different jumping exercises. Accelerations at the hips have been investigated in previous studies with regard to osteoporosis prevention. Data were collected using an IMU-based motion capture system (Xsens) consisting of 17 sensors. Forty-nine subjects were included in this study. The analysis shows the correlation between impacts and the corresponding drop height, which are dependent on the respective exercise. Very high correlations (0.83–0.94) were found between accelerations at the pelvis and the other measured segments at the upper body. The foot sensors provided very weak correlations (0.20–0.27). Accelerations measured at the pelvis during jumping exercises can be tracked very well on the upper body and upper extremities, including locations where smart devices are typically worn, which gives possibilities for remote and continuous monitoring of programs.
Subject-specific Musculoskeletal Simulation of Hip Dislocation Risk in Activities of Daily Living
(2011)
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.
Background
There is a wide range of mechanical properties of spinal ligaments documented in literature. Due to the fact that ligaments contribute in stabilizing the spine by limiting excessive intersegmental motion, those properties are of particular interest for the implementation in musculoskeletal models. The aim of this study was to investigate the effect of varying ligament stiffness on the kinematic behaviour of the lumbar spine.
Methods
A musculoskeletal model with a detailed lumbar spine was modified according to fluoroscopic recordings and corresponding data files of three different subjects. For flexion, inverse dynamics analysis with a variation of the ligament stiffness matrix were conducted. The influence of several degrees of ligament stiffness on the lumbar spine model were investigated by tracking ligament forces, disc forces and resulting moments generated by the ligaments. Additionally, the kinematics of the motion segments were evaluated.
Results
An increase of ligament stiffness resulted in an increase of ligament and disc forces, whereas the relative change of disc force increased at a higher rate at the L4/L5 level (19 %) than at the L3/L4 (10 %) level in a fully flexed posture. The same behaviour applied to measured moments with 67 % and 45 %. As a consequence, the motion deflected to the lower levels of the lumbar spine and the lower discs had to resist an increase in loading.
Conclusions
Higher values of ligament stiffness over all lumbar levels could lead to a shift of the loading and the motion between segments to the lower lumbar levels. This could lead to an increased risk for the lower lumbar parts.
PURPOSE:
The purpose of this study was to find a suitable method of labelling cartilage samples for the measurement of distraction distances in biomechanical testing.
METHODS:
Samples of bovine cartilage were labelled using five different methods: hydroquinone and silver nitrate (AgNO3), potassium permanganate (KMnO4) with sodium thiosulphate (Na2S2O3), India ink, heat, and laser energy. After the labelling, we analysed the cartilage samples with regard to cytotoxity by histochemical staining with ethidiumbromide homodimer (EthD-1) and calcein AM. Furthermore, we tested cartilages labelled with India ink and heat in a T-peel test configuration to analyse possible changes in the mechanical behaviour between marked and unlabelled samples.
RESULTS:
Only the labelling methods with Indian ink or a heated needle showed acceptable results in the cytotoxity test with regard to labelling persistence, accuracy, and the influence on consistency and viability of the chondrocytes. In the biomechanical T-peel configuration, heat-labelled samples collapsed significantly earlier than unlabelled samples.
CONCLUSION:
Labelling bovine cartilage samples with Indian ink in biomechanical testing is a reliable, accurate, inexpensive, and easy-to-perform method. This labelling method influenced neither the biomechanical behaviour nor the viability of the tissue compared to untreated bovine cartilage.
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.
The success of surgical treatment for fractures hinges on various factors, notably accurate surgical indication. The process of developing and certifying a new osteosynthesis device is a lengthy and costly process that requires multiple cycles of review and validation. Current methods, however, often rely on predecessor standards rather than physiological loads in specific anatomical locations. This study aimed to determine actual loads experienced by an osteosynthesis plate, exemplified by a standard locking plate for the femoral shaft, utilizing finite elements analysis (FEA) and to obtain the bending moments for implant development standard tests. A protocol was developed, involving the creation and validation of a fractured femur model fixed with a locking plate, mechanical testing, and FEA. The model’s validation demonstrated exceptional accuracy in predicting deformations, and the FEA revealed peak stresses in the fracture bridging zone. Results of a parametric analysis indicate that larger fracture gaps significantly impact implant mechanical behavior, potentially compromising stability. This study underscores the critical need for realistic physiological conditions in implant evaluations, providing an innovative translational approach to identify internal loads and optimize implant designs. In conclusion, this research contributes to enhancing the understanding of implant performance under physiological conditions, promoting improved designs and evaluations in fracture treatments.
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.
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.
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.
Regarding the prevention of injuries and rehabilitation of the human hand, musculoskeletal simulations using an inverse dynamics approach allow for insights of the muscle recruitment and thus acting forces on the hand. Currently, several hand models from various research groups are in use, which are mainly validated by the comparison of numerical and anatomical moment arms. In contrast to this validation and model-building technique by cadaver studies, the aim of this study is to further validate a recently published hand model [1] by analyzing numerically calculated muscle activities in comparison to experimentally measured electromyographical signals of the muscles. Therefore, the electromyographical signals of 10 hand muscles of five test subjects performing seven different hand movements were measured. The kinematics of these tasks were used as input for the hand model, and the numerical muscle activities were computed. To analyze the relationship between simulated and measured activities, the time difference of the muscle on- and off-set points was calculated, which resulted in a mean on- and off-set time difference of 0.58 s between the experimental data and the model. The largest differences were detected for movements that mainly addressed the wrist. One major issue comparing simulated and measured muscle activities of the hand is cross-talk. Nevertheless, the results show that the hand model fits the experiment quite accurately despite some limitations and is a further step toward patient-specific modeling of the upper extremity.
The AnyBody™ Modeling System (AMS) [1], is an universally used musculoskeletal simulation software using inverse dynamics. Until now, no complete human hand model is known in the AMS. Also considering other musculoskeletal software platforms, just one detailed entire hand model is recently published [2] but is only based on one subject. The aim of this work is to implement a full detailed hand model for the AMS including all extrinsic and intrinsic muscles using data by the UWB gained through an anatomical study of ten cadaver hands.
Forschungsbericht 2016
(2016)
The mechanical complications of osteosyntheses after hip fractures are previously investigated by mostly static or dynamic uniaxial loading test systems. However, the physiologic loading of the hip joint during a normal gait is a multiplanar, dynamic movement. Therefore, we constructed a system to test osteosyntheses for hip fractures under physiologic multiplanar loading representative of normal gait. To evaluate the testing system, 12 femora pairs were tested under 25,000 cycles with two standard osteosyntheses (Proximal Femoral Nail Antirotation/Gamma3 Nail). For angular movement, the varus collapse to cut out (∝CO) (∝CO=4.8°±2.1° for blade and ∝CO=7.8°±3.8° for screw) was the dominant failure mode, and only slight rotational angle shifts (∝Rot) (∝Rot=1.7°±0.4° for blade and ∝Rot=2.4°±0.3° for screw) of the femoral head around the implant axis were observed. Angular displacements in varus direction and rotation were higher in specimens reinforced with screws. Hence, the cut out model and the migration directions showed a distinction between helical blade and hip screw. However, there were no significant differences between the different implants. The new setup is able to create clinical failures and allows to give evidence about the anchorage stability of different implant types under dynamic gait motion pattern.
Effect of the fractured calcaneus's peripheral fragment displacement on the triceps surae function
(2015)
In the structure of musculoskeletal injuries, calcaneal fractures account for up to 4 % of all skeletal fractures and up to 60 % of hindfoot fractures. The effect of the displacement of the peripheral fragment of the calcaneus on the calf muscles’s reaction forces at the time of the adoption of the simplified squatting position was investigated by modeling in AnyBody Modeling System 6.0 software. M.gastrocnemius (lateralis et medialis) in the initial phase of motion in all variants of the peripheral fragment displacement did not develop sufficient muscular effort in comparison to the intact calcaneus. M.soleus medialis et lateralis showed significant increase in muscle activity rates in the initial phase of motion (41.87 ± 1.90 H and 52.07 ± 2.10 H) before reaching its maximum values, as compared with those of the intact calcaneus. In the final phase of the movement, upon muscle reaches its maximum length, muscular strength indicators of the m.soleus returned to their original values or were significantly below them. The decline in muscle strength was due to shortening of the moment arm or muscle excursion in case of convergence of muscle attachment points. When the peripheral fragment is displaced, due to putting down the heel to the surface of the support in terms of anatomical muscle lengthening, it takes extra effort to achieve rest length and its maximum power. In all types of the displacement of the peripheral fragment, the function of three-headed calf muscle is disturbed with involvement of additional muscular effort and energy expenditure. This fact should motivate the surgeon on the need for accurate repositioning of bone fragments in calcaneal fractures with the displacement of the peripheral fragment.
Forschungsbericht 2012
(2012)
Common Schanz screw systems can be used to stabilize pelvic ring fractures. In order to accommodate for different patient’s requirements, implants can be placed in cranio-caudal direction into the os ilium (T1), or into the supraacetabular bone canal, and thus, in dorso-ventral direction (T2). Whereas both techniques are currently used, no data of the biomechanical behavior is available up to this date. The aim of this study is to analyze, whether T2 shows biomechanical advantages with respect to tissue and implant stresses due to the enlarged bone-implant interface. Forces acting on the pelvis were analyzed using motion capture data of a gait cycle obtained by the utilization of a musculoskeletal simulation program. A three dimensional finite element (FE) model of the pelvis with grayscale-based material properties was generated. The muscle and joint reaction forces at toe-off were applied to the FE model and instable pelvis fractures were implemented. The osteosynthesis systems were positioned within the model in order to enable the comparison between the two different surgical techniques. Stresses and displacements were analyzed for bone tissue, fracture zone and implant.
T2 lead to approx. 30% larger displacements in the fracture zone. Von-Mises stresses were larger for T2 in the implant (80 MPa vs. 227 MPa), whereas T1 leads to larger stresses in the bone tissue (200 MPa vs. 140 MPa).
Both implantation techniques showed a good biomechanical behavior. Differences could be found with respect to tissue strains and deformations in the fracture zone. If bone quality or fracture healing are of concern, T2 or T1 should be used, respectively. However, both techniques seem to be applicable for cases with no special requirements. Further analyses aim to investigate the behavior under cyclic loading.
BACKGROUND: Validation and verification of multibody musculoskeletal models sEMG is a difficult process because of the reliability of sEMG data and the complex relationship of muscle force and sEMG. OBJECTIVE: This work aims at comparing experimentally recorded and simulated muscle activities considering a numerical model for crosstalk. METHODS: For providing an experimentally derived reference data set, subjects were performing elevations of the arm, where the activities of the contemplated muscle groups were measured by sEMG sensors. Computed muscle activities were further processed and transformed into an artificial electromyographical signal, which includes a numerical crosstalk model. In order to determine whether the crosstalk model provides a better agreement with the measured muscle activities, the Pearson correlation coefficient has been computed as a qualitative way of assessing the curve progression of the data sets. RESULTS: The results show an improvement in the correlation coefficient between the experimental data and the simulated muscle activities when taking crosstalk into account. CONCLUSIONS: Although the correlation coefficient increased when the crosstalk model was utilized, it is questionable if the discretization of both, the crosstalk and the musculoskeletal model, is accurate enough.
Thoracolumbar spine model with articulated ribcage for the prediction of dynamic spinal loading
(2016)
Musculoskeletal modeling offers an invaluable insight into the spine biomechanics. A better understanding of thoracic spine kinetics is essential for understanding disease processes and developing new prevention and treatment methods. Current models of the thoracic region are not designed for segmental load estimation, or do not include the complex construct of the ribcage, despite its potentially important role in load transmission. In this paper, we describe a numerical musculoskeletal model of the thoracolumbar spine with articulated ribcage, modeled as a system of individual vertebral segments, elastic elements and thoracic muscles, based on a previously established lumbar spine model and data from the literature. The inverse dynamics simulations of the model allow the prediction of spinal loading as well as costal joints kinetics and kinematics. The intradiscal pressure predicted by the model correlated well (R2=0.89) with reported intradiscal pressure measurements, providing a first validation of the model. The inclusion of the ribcage did not affect segmental force predictions when the thoracic spine did not perform motion. During thoracic motion tasks, the ribcage had an important influence on the predicted compressive forces and muscle activation patterns. The compressive forces were reduced by up to 32%, or distributed more evenly between thoracic vertebrae, when compared to the predictions of the model without ribcage, for mild thoracic flexion and hyperextension tasks, respectively. The presented musculoskeletal model provides a tool for investigating thoracic spine loading and load sharing between vertebral column and ribcage during dynamic activities. Further validation for specific applications is still necessary.
Thoracolumbar spine model with articulated rigcage for the prediction of dynamic spinal loading
(2015)
One of the main goals in reconstructing rotator cuff tears is the restoration of glenohumeral joint stability, which is subsequently of utmost importance in order to prevent degenerative damage such as superior labral anterior posterior (SLAP) lesion, arthrosis, and malfunction. The goal of the current study was to facilitate musculoskeletal models in order to estimate glenohumeral instability introduced by muscle weakness due to cuff lesions. Inverse dynamics simulations were used to compute joint reaction forces for several static abduction tasks with different muscle weakness. Results were compared with the existing literature in order to ensure the model validity. Further arm positions taken from activities of daily living, requiring the rotator cuff muscles were modeled and their contribution to joint kinetics computed. Weakness of the superior rotator cuff muscles (supraspinatus; infraspinatus) leads to a deviation of the joint reaction force to the cranial dorsal rim of the glenoid. Massive rotator cuff defects showed higher potential for glenohumeral instability in contrast to single muscle ruptures. The teres minor muscle seems to substitute lost joint torque during several simulated muscle tears to maintain joint stability. Joint instability increases with cuff tear size. Weakness of the upper part of the rotator cuff leads to a joint reaction force closer to the upper glenoid rim. This indicates the comorbidity of cuff tears with SLAP lesions. The teres minor is crucial for maintaining joint stability in case of massive cuff defects and should be uprated in clinical decision-making.
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.
Subject Specific Scaling Of Muscle Strengths In The Lower Extremity For Musculoskeletal Models
(2024)
In recent years, musculoskeletal computation has become a widely used tool to investigate joint and muscle forces within the human body. However, the issue of muscle fatigue is not considered adequately in most models and is a challenging task. One aspect that needs to be examined is the interaction of muscles during an exhausting task. Therefore, an experimental study was designed to analyze the changes of back muscle recruitment pattern during such exercises.
In this study 38 subjects (27 male, 11 female, height = 177±8.5 cm, weight = 74.0±13.6 kg) participated. Each subject had to perform three static and three dynamic exhausting exercises where the back muscles were loaded with subject specific forces using a dynamometer adapter especially designed for the trunk muscles. To collect the muscle activity, twelve surface electromyography sensors were applied on the back, and four on the abdominal muscles. Muscle activity and fatigue were analyzed by calculating the maximum voluntary contraction normalized signal and the median frequency. At first the fatigue of m. erector spinae and m. multifidi was analyzed, since these muscles carry the main load during the exercises. Subsequently the activity of the m. trapezius, m. rectus abdominis and m. obliquus externus were investigated to determine recruitment patterns. To gain more detailed information of these patterns a numerical model was built using the AnyBody Modeling System™. Analyzing the measurements, we can observe an increasing muscle activity during isokinetic exercises while the force is constant. Since the activity in the simulation is defined as the current force output divided by the strength of the muscle, the strength parameter was scaled down based on the measured data, assuming a linear force – activity correlation, and using a numerical algorithm considering the influence of cross talk.
The results show, that changes in recruitment pattern can be divided into three major subgroups. Prior to total exhaustion, some of the subjects show additional activation of muscles in the trapezius region, while other subjects show an additional activation of abdominal muscles, increasing the intra-abdominal pressure which supports the spine. In the third group an activation in both regions can be observed.
The numerical simulations show an increasing activity of abdominal muscles as well as muscles in the upper back. Especially the m. latissimus dorsi shows a significantly higher activity.
The results lead to the conclusion that prior to total exhaustion, additional muscles are recruited to support the main muscles. It was shown that abdominal muscles are activated to support back muscles by pressurizing the trunk cavity to delay total exhaustion as long as possible. In conclusion, the results show that changes in muscle recruitment pattern need to be considered when introducing muscle fatigue to musculoskeletal models.
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.
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.
To avoid dislocation of the shoulder joint after reverse total shoulder arthroplasty, it is important to achieve sufficient shoulder stability when placing the implant components during surgery. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this research was to develop a temporary reverse shoulder implant prototype that would allow intraoperative measurement of shoulder stiffness while varying the position of the implant components. Joint angle and torque measurement techniques were developed to determine shoulder stiffness. Hall sensors were used to measure the joint angles by converting the magnetic flux densities into angles. The accuracy of the joint angle measurements was tested using a test bench. Torques were determined by using thin-film pressure sensors. Various mechanical mechanisms for variable positioning of the implant components were integrated into the prototype. The results of the joint angle measurements showed measurement errors of less than 5° in a deflection range of ±15° adduction/abduction combined with ±45° flexion/extension. The proposed design provides a first approach for intra-operative assessment of shoulder stiffness. The findings can be used as a technological basis for further developments.
Introduction
Dislocation of the shoulder joint is one of the more common complications after reverse total shoulder arthroplasty [1], which is often associated with malposition of the prosthetic components [2]. Therefore, achieving sufficient shoulder stability should not be neglected when positioning the implant components. One parameter for assessing shoulder stability can be shoulder stiffness. The aim of this work is to develop a reverse shoulder implant prototype that allows intraoperative measurement of shoulder stiffness while varying the position of the implant components. The measured stiffness could provide a quantitative statement regarding the optimal positioning of the implant components, which can be adjusted accordingly in the final reverse shoulder prosthesis.
Methods
To measure the stiffness of the shoulder joint, it is necessary to record the joint angles and the torques generated during movement. The changes in the rotation angles were measured using 3D hall sensors and magnets. The magnets were placed under the humerosocket, and the hall sensors were integrated into the glenosphere. The strength of the magnetic field was used to determine the position of the humerosocket in relation to the glenosphere. The accuracies of the angle measurements were tested using a test bench.
Three thin film pressure sensors were used to record forces at different points under the humerosocket. To obtain a force value from the sensor signal, the sensors were calibrated using a load cell. The variation of the implant components positions was integrated into the prototype implant through different constructive mechanisms to adjust the stiffness of the shoulder joint.
Results
In the range of ±45° flexion/extension combined with ±15° adduction/abduction, the joint position could be determined with sufficient accuracy (error e ≤ 5°). The areas near the combined maximum deflections of ±45° flexion/extension and ±45° adduction/abduction indicate the greatest deviation from the target angle. The force values of the thin film sensors enable the calculation of moments around two axes. As variable component position parameters, the tray offset, the neck-shaft angle and the humerus version were integrated into the implant prototype.
Discussion
Ideally, the accuracy of the angle measurements should only depend on the amount of deflection and not on the direction of deflection. The asymmetric behavior indicates a deviation from the correct positioning of the hall sensors. The application of a calibration matrix could compensate for the measurement errors and could demonstrate the potential of the new method for joint angle measurements. The accuracy of the torque measurements and the functionality of the mechanical arresting mechanisms must be investigated in further studies. Overall, the developed measurement method can help to avoid malpositioning of the implant components in reverse total shoulder arthroplasty.
References
1. Clark et al, J Shoulder and elbow surgery, 21:36-41 2012.
2. Randelli et al, J Musculoskeletal surgery, 98:15-18, 2014.
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.
Workflow for the development of a non-invasive feedback device to assess pelvic floor contractions
(2024)
Introduction
Pelvic floor disorders affect about 40% of women worldwide [1]. Pelvic floor muscle (PFM) training is both a preventive and a therapeutic intervention. Current PFM training devices are invasive and have little scientific evidence. The idea is to develop a noninvasive feedback device to assess adequate PFM contraction. Therefore, evidence-based female musculoskeletal models, non-invasive data acquisition, sensor technology and artificial intelligence (AI) will be combined. This work presents the workflow to achieve such a feedback device and describes the interaction of the technologies used.
Methods
Exercises that induce PFM contractions have been evaluated and defined. Motion capture of these exercises will provide input for female musculoskeletal models. A combination of biomechanical rigid body and FEM simulations will be used to estimate PFM contractions. In addition, a non-invasive sensor will measure pelvic floor activity. The simulated and measured data will be used to develop an AI model that provides feedback on PFM contractions based on non-invasive data collection.
Results
The AMMR (AnyBody Managed Model Repository) of the AnyBody modelling system (AMS, Aalborg, Denmark) serves as the initial model for performing inverse dynamic simulations of the exercises. To calculate the PFM forces, the full-body model must be supplemented with the relevant pelvic floor structures and a mass model of the internal organs. A modified abdominal pressure model must also be incorporated. The AMS calculates the PFM activities caused by the internal organ loads and the generated abdominal pressure during the exercises. The muscle activities are transferred to a FEM model of the female pelvic floor (SfePy, simple finite elements in Python). The identical pelvic floor structures were integrated into the FEM model as in the AMS. Active PFM contractions can be simulated using the FEM model. Movement of the coccyx due to PFM contractions has been reported in the literature [2,3]. Therefore, a noninvasive coccyx motion sensor will be developed to provide additional information on PFM contractions. The measured data (coccyx motion sensor, motion capture) and the simulation results of the models will be combined to create an AI feedback model using Python. The final feedback device will consist of the AI model and the developed coccyx motion sensor, which can reproduce the resulting PFM contractions based on the sensor data and simplified motion tracking.
Discussion
The creation of the AMS and the FEM model is a prerequisite for the development of the feedback device. The relevant structures in the models are located inside the body. This limits the ability to observe the structures during the exercises, which can lead to difficulties in model validation. The development of a user-friendly sensor with sufficient measuring accuracy of the coccyx motion is another challenge. Nevertheless, the workflow represents a promising approach to develop a noninvasive feedback system to assess PFM contraction.
References
1. Wang et al, Front Public Health, 10:975829, 2022.
2. Bø et al, Neurourol Urodyn, 20:167–174, 2001.
3. Fujisaki et al, J Phys Ther Sci, 30:544–548, 2018.
Acknowledgements
This work was supported by the project no. BYCZ01-014 of the Program INTERREG Bavaria – Czechia 2021–2027.
Fragestellung
Es soll in dieser Computersimulationsstudie untersucht werden, wie der Osteosyntheseverbund Platte mit Schrauben im Verbund mit einer im mittleren Drittel gebrochenen Clavicula durch das Bewegungsausmaß
in vivo belastet ist. Was sind die grundlegenden Kräfte die auf Clavicula und Implantat wirken und welchen Einfl uss hat die Bruchform.
Methodik
Die Muskel- und Gelenkkräfte sowie die Belastung des Implantatverbundes wurden mit einer muskuloskelletalen
Simulationssoftware (AnyBody Technology, V.4) berechnet. Hierfür wurden mit einem komplexen Model des menschlichen Körpers folgende Bewegungen analysiert: eine Flexion von 160° und Abduktion 160° mit
einem Gewicht von 2 kg in der Hand. Aus CT-Patientendaten wurden zwei dreidimensionale Modelle des Clavicula-Implantat Verbundes gebildet, die sich in der Frakturform unterscheiden (Querfraktur und vertikale
Fraktur). In beiden Modellen wurde eine Claviculaosteosynthese in superiorer Position mit einer 6 Loch LCP mit 2 Schrauben pro Hauptfragment verwendet. Die Materialeigenschaften wurden aus der Dichte des Materials sowie aus Literaturdaten verwendet. Die Muskel- und Gelenkkräfte aus der muskuloskelletalen Berechnung wurden auf das Finite Elemente Modell übertragen und die Spannungen und Dehnungen des Implantat-Knochenverbundes
wurden berechnet.
Ergebnisse
Es zeigte sich, dass die simulierte in vivo Belastung stark abhängig vom Flexionswinkel ist. Das Implantat ist in der superioren Lage auf Biegung belastet, welche maximale Werte im Überschulterniveau erreicht. Die Bruchform mit anatomischer Reposition und Kontakt der Hauptfragmente zueinander führt zu einer deutlichen Entlastung des Osteosyntheseverbundes im Vergleich zu einer Bruchform mit vertikaler Fraktur.
Schlussfolgerung
Aus den Analysen ist eine Positionierung der Plattenosteosynthese für die im mittleren Drittel frakturierte Clavicula in anterior-superiorer Lage wünschenswert. Die anatomische Reposition entlastet den Osteosyntheseverbund und sollte möglichst erreicht werden. Die Nachbehandlung sollte ein Bewegungsausmaß für den Arm für 4 Wochen für einfache Bruchformen auf 70° Flexion und Abduktion limitieren und für komplexe Bruchformen diese Limitierung ausgedehnt werden.