Tibial and femoral articular cartilage exhibit opposite outcomes for T1ρ and T2* relaxation times in response to acute compressive loading in healthy knees.

Abnormal loading is thought to play a key role in the disease progression of cartilage, but our understanding of how cartilage compositional measurements respond to acute compressive loading in-vivo is limited. Ten healthy subjects were scanned at two timepoints (7 ± 3 days apart) with a 3 T magnetic resonance imaging (MRI) scanner. Scanning sessions included T1ρ and T2* acquisitions of each knee in two conditions: unloaded (traditional MRI setup) and loaded in compression at 40 % bodyweight as applied by an MRI-compatible loading device. T1ρ and T2* parameters were quantified for contacting cartilage (tibial and femoral) and non-contacting cartilage (posterior femoral condyle) regions. Significant effects of load were found in contacting regions for both T1ρ and T2*. The effect of load (loaded minus unloaded) in femoral contacting regions ranged from 4.1 to 6.9 ms for T1ρ, and 3.5 to 13.7 ms for T2*, whereas tibial contacting regions ranged from -5.6 to -1.7 ms for T1ρ, and -2.1 to 0.7 ms for T2*. Notably, the responses to load in the femoral and tibial cartilage revealed opposite effects. No significant differences were found in response to load between the two visits. This is the first study that analyzed the effects of acute loading on T1ρ and T2* measurements in human femoral and tibial cartilage separately. The results suggest the effect of acute compressive loading on T1ρ and T2* was: 1) opposite in the femoral and tibial cartilage; 2) larger in contacting regions than in non-contacting regions of the femoral cartilage; and 3) not different visit-to-visit.

Risk Factors Associated With a Noncontact Anterior Cruciate Ligament Injury to the Contralateral Knee After Unilateral Anterior Cruciate Ligament Injury in High School and College Female Athletes: A Prospective Study.

BACKGROUND: The incidence of contralateral anterior cruciate ligament (CACL) injuries after recovery from a first-time anterior cruciate ligament (ACL) disruption is high in women; however, little is known about the risk factors associated with this trauma. HYPOTHESIS: Patient characteristics, strength, anatomic alignment, and neuromuscular characteristics of the contralateral uninjured leg at the time of the first ACL trauma are associated with risk of subsequent CACL injury, and these risk factors are distinct from those for a first-time ACL injury. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Sixty-one women who suffered a first-time noncontact ACL injury while participating in high school or college sports and underwent measurement of potential risk factors on their contralateral limb soon after the initial ACL injury and before reconstruction were followed until either a CACL injury or an ACL graft injury occurred, or until the last date of contact. RESULTS: Follow-up information was available for 55 (90.0%) of the 61 athletes and 11 (20.0%) suffered a CACL injury. Younger age, decreased participation in sport before the first ACL disruption, decreased anterior stiffness of the contralateral knee, and increased hip anteversion were associated with increases in the risk of suffering a CACL injury. CONCLUSION: A portion of CACL injury risk factors were modifiable (time spent participating in sport and increasing anterior knee stiffness with bracing), while others were nonmodifiable (younger age and increased hip anteversion). The relationship between younger age at the time of an initial ACL injury and increased risk of subsequent CACL trauma may be explained by younger athletes having more years available to be exposed to at-risk activities compared with older athletes. A decrease of anterior stiffness of the knee is linked to decreased material properties and width of the ACL, and this may explain why some women are predisposed to bilateral ACL trauma while others only suffer the index injury. The risk factors for CACL injury are unique to women who suffer bilateral ACL trauma compared with those who suffer unilateral ACL trauma. This information is important for the identification of athletes who may benefit from risk reduction interventions.

Radiographic-based measurement of tibiofemoral joint space width and magnetic resonance imaging derived articular cartilage thickness are not related in subjects at risk for post traumatic arthritis of the knee.

Joint space width (JSW), measured as the distance between the femoral and tibial subchondral bone margins on two-dimensional weight-bearing radiographs, is the initial imaging modality used in clinical settings to diagnose and evaluate the progression of osteoarthritis (OA). While, JSW is the only structural outcome approved by the FDA for studying the treatment of this disease in phase III clinical trials, recent reports suggest that magnetic resonance imaging (MRI)-based measurements of OA changes are superior due to increased sensitivity and specificity to the structural changes associated with progression of this disease. In the current study, we examined the relationship between radiographic JSW and MRI-derived articular cartilage thickness in subjects 4 years post anterior cruciate ligament reconstruction (ACLR) who were at increased risk for the onset and early progression of post-traumatic OA, and in uninjured subjects with normal knees (Control). In both ACLR and Control groups, there were large measurement biases, wide limits of agreement, and poor correlation between the two measurement techniques. Clinical significance: The finding from this study suggest that the two methods of examining changes associated with the onset and early progression of PTOA either characterize different structures about the knee and should not be used interchangeably, or two-dimensional JSW measurements are not sensitive to small changes in articular cartilage thickness. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Combined anatomic factors predicting risk of anterior cruciate ligament injury for males and females.

BACKGROUND: Knee joint geometry has been associated with risk of suffering an anterior cruciate ligament (ACL) injury; however, few studies have utilized multivariate analysis to investigate how different aspects of knee joint geometry combine to influence ACL injury risk. HYPOTHESES: Combinations of knee geometry measurements are more highly associated with the risk of suffering a noncontact ACL injury than individual measurements, and the most predictive combinations of measurements are different for males and females. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: A total of 88 first-time, noncontact, grade III ACL-injured subjects and 88 uninjured matched-control subjects were recruited, and magnetic resonance imaging data were acquired. The geometry of the tibial plateau subchondral bone, articular cartilage, and meniscus; geometry of the tibial spines; and size of the femoral intercondylar notch and ACL were measured. Multivariate conditional logistic regression was used to develop risk models for ACL injury in females and males separately. RESULTS: For females, the best fitting model included width of the femoral notch at its anterior outlet and the posterior-inferior-directed slope of the lateral compartment articular cartilage surface, where a millimeter decrease in notch width and a degree increase in slope were independently associated with a 50% and 32% increase in risk of ACL injury, respectively. For males, a model that included ACL volume and the lateral compartment posterior meniscus to subchondral bone wedge angle was most highly associated with risk of ACL injury, where a 0.1 cm3 decrease in ACL volume (approximately 8% of the mean value) and a degree decrease in meniscus wedge angle were independently associated with a 43% and 23% increase in risk, correspondingly. CONCLUSION: Combinations of knee joint geometry measurements provided more information about the risk of noncontact ACL injury than individual measures, and the aspects of geometry that best explained the relationship between knee geometry and the risk of injury were different between males and females. Consequently, a female with both a decreased femoral notch width and an increased posterior-inferior-directed lateral compartment tibial articular cartilage slope combined or a male with a decreased ACL volume and decreased lateral compartment posterior meniscus angle were most at risk for sustaining an ACL injury.

Tibial articular cartilage and meniscus geometries combine to influence female risk of anterior cruciate ligament injury.

Tibial plateau subchondral bone geometry has been associated with the risk of sustaining a non-contact ACL injury; however, little is known regarding the influence of the meniscus and articular cartilage interface geometry on risk. We hypothesized that geometries of the tibial plateau articular cartilage surface and meniscus were individually associated with the risk of non-contact ACL injury. In addition, we hypothesized that the associations were independent of the underlying subchondral bone geometry. MRI scans were acquired on 88 subjects that suffered non-contact ACL injuries (27 males, 61 females) and 88 matched control subjects that were selected from the injured subject's teammates and were thus matched on sex, sport, level of play, and exposure to risk of injury. Multivariate analysis of the female data revealed that increased posterior-inferior directed slope of the middle articular cartilage region and decreased height of the posterior horn of the meniscus in the lateral compartment were associated with increased risk of sustaining a first time, non-contact ACL injury, independent of each other and of the slope of the tibial plateau subchondral bone. No measures were independently related to risk of non-contact ACL injury among males.

A decreased volume of the medial tibial spine is associated with an increased risk of suffering an anterior cruciate ligament injury for males but not females.

Measurements of tibial plateau subchondral bone and articular cartilage slope have been associated with the risk of suffering anterior cruciate ligament (ACL) injury. Such single-plane measures of the tibial plateau may not sufficiently characterize its complex, three-dimensional geometry and how it relates to knee injury. Further, the tibial spines have not been studied in association with the risk of suffering a non-contact ACL injury. We questioned whether the geometries of the tibial spines are associated with non-contact ACL injury risk, and if this relationship is different for males and females. Bilateral MRI scans were acquired on 88 ACL-injured subjects and 88 control subjects matched for sex, age and sports team. Medial and lateral tibial spine geometries were characterized with measurements of length, width, height, volume and anteroposterior location. Analyses of females revealed no associations between tibial spine geometry and risk of ACL injury. Analyses of males revealed that an increased medial tibial spine volume was associated with a decreased risk of ACL injury (OR = 0.667 per 100 mm(3) increase). Smaller medial spines could provide less resistance to internal rotation and medial translation of the tibia relative to the femur, subsequently increasing ACL strains and risk of ACL injury.

Abdominal muscle activation increases lumbar spinal stability: analysis of contributions of different muscle groups.

BACKGROUND: Antagonistic activation of abdominal muscles and increased intra-abdominal pressure are associated with both spinal unloading and spinal stabilization. Rehabilitation regimens have been proposed to improve spinal stability via selective recruitment of certain trunk muscle groups. This biomechanical analytical study addressed whether lumbar spinal stability is increased by such selective activation. METHODS: The biomechanical model included anatomically realistic three-layers of curved abdominal musculature, rectus abdominis and 77 symmetrical pairs of dorsal muscles. The muscle activations were calculated with the model loaded with either flexion, extension, lateral bending or axial rotation moments up to 60 Nm, along with intra-abdominal pressure up to 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight. After solving for muscle forces, a buckling analysis quantified spinal stability. Subsequently, different patterns of muscle activation were studied by forcing activation of selected abdominal muscles to at least 10% or 20% of maximum. FINDINGS: Spinal stability increased by an average factor of 1.8 with doubling of intra-abdominal pressure. Forcing at least 10% activation of obliques or transversus abdominis muscles increased stability slightly for efforts other than flexion, but forcing at least 20% activation generally did not produce further increase in stability. Forced activation of rectus abdominis did not increase stability. INTERPRETATION: Based on analytical predictions, the degree of stability was not substantially influenced by selective forcing of muscle activation. This casts doubt on the supposed mechanism of action of specific abdominal muscle exercise regimens that have been proposed for low back pain rehabilitation.

Refinement of elastic, poroelastic, and osmotic tissue properties of intervertebral disks to analyze behavior in compression.

Intervertebral disks support compressive forces because of their elastic stiffness as well as the fluid pressures resulting from poroelasticity and the osmotic (swelling) effects. Analytical methods can quantify the relative contributions, but only if correct material properties are used. To identify appropriate tissue properties, an experimental study and finite element analytical simulation of poroelastic and osmotic behavior of intervertebral disks were combined to refine published values of disk and endplate properties to optimize model fit to experimental data. Experimentally, nine human intervertebral disks with adjacent hemi-vertebrae were immersed sequentially in saline baths having concentrations of 0.015, 0.15, and 1.5 M and the loss of compressive force at constant height (force relaxation) was recorded over several hours after equilibration to a 300-N compressive force. Amplitude and time constant terms in exponential force-time curve-fits for experimental and finite element analytical simulations were compared. These experiments and finite element analyses provided data dependent on poroelastic and osmotic properties of the disk tissues. The sensitivities of the model to alterations in tissue material properties were used to obtain refined values of five key material parameters. The relaxation of the force in the three bath concentrations was exponential in form, expressed as mean compressive force loss of 48.7, 55.0, and 140 N, respectively, with time constants of 1.73, 2.78, and 3.40 h. This behavior was analytically well represented by a model having poroelastic and osmotic tissue properties with published tissue properties adjusted by multiplying factors between 0.55 and 2.6. Force relaxation and time constants from the analytical simulations were most sensitive to values of fixed charge density and endplate porosity.

In situ microindentation for determining local subchondral bone compressive modulus.

Alterations to joint tissues, including subchondral bone, occur with osteoarthritis. A microindentation technique was developed to determine the local compressive modulus of subchondral bone. This test, in conjunction with a cartilage indentation test at the same location, could evaluate changes of these material properties in both tissues. The accuracy of the technique was determined by applying it to materials of known moduli. The technique was then applied to rat tibial plateaus to characterize the local moduli of the subchondral bone. An established nanoindentation method was adopted to determine the modulus of subchondral bone following penetration of the overlying articular cartilage. Three cycles of repeated loadings were applied (2.452 N, 30 s hold). The slope of the load-displacement response during the unloading portion of the third cycle was used to measure the stiffness. Indentation tests were performed on two polyurethane foams and polymethyl-methacrylate for validation (n=15). Regression analysis was used to compare the moduli with reference values. Subchondral bone moduli of tibial plateaus from Sprague-Dawley rats (n=5) were measured for central and posterior locations of medial and lateral compartments. An analysis of variance was used to analyze the effects of compartment and test location. The measured moduli of the validation materials correlated with the reference values (R(2)=0.993, p=0.05). In rat tibial plateaus, the modulus of the posterior location was significantly greater than the center location (4.03+/-1.00 GPa and 3.35+/-1.16 GPa respectively, p=0.03). The medial compartment was not different from the lateral compartment. This method for measuring the subchondral bone in the same location as articular cartilage allows studies of the changes in these material properties with the onset and progression of osteoarthritis.

Intra-abdominal pressure and abdominal wall muscular function: Spinal unloading mechanism.

BACKGROUND: The roles of antagonistic activation of abdominal muscles and of intra-abdominal pressurization remain enigmatic, but are thought to be associated with both spinal unloading and spinal stabilization in activities such as lifting. Biomechanical analyses are needed to understand the function of intra-abdominal pressurization because of the anatomical and physiological complexity, but prior analyses have been over-simplified. METHODS: To test whether increased intra-abdominal pressure was associated with reduced spinal compression forces for efforts that generated moments about each of the principal axis directions, a previously published biomechanical model of the spine and its musculature was modified by the addition of anatomically realistic three-layers of curved abdominal musculature connected by fascia to the spine. Published values of muscle cross-sectional areas and the active and passive stiffness properties were assigned. The muscle activations were calculated assuming minimized muscle stress and stretch for the model loaded with flexion, extension, lateral bending and axial rotation moments of up to 60 Nm, along with intra-abdominal pressurization of 5 or 10 kPa (37.5 or 75 mm Hg) and partial bodyweight (340 N). FINDINGS: The analysis predicted a reduction in spinal compressive force with increase in intra-abdominal pressurization from 5 to 10 kPa. This reduction at 60 Nm external effort was 21% for extension effort, 18% for flexion effort, 29% for lateral bending and 31% for axial rotation. INTERPRETATION: This analysis predicts that intra-abdominal pressure produces spinal unloading, and shows likely muscle activation patterns that achieve this.

Limitation of finite element analysis of poroelastic behavior of biological tissues undergoing rapid loading.

The finite element method is used in biomechanics to provide numerical solutions to simulations of structures having complex geometry and spatially differing material properties. Time-varying load deformation behaviors can result from solid viscoelasticity as well as viscous fluid flow through porous materials. Finite element poroelastic analysis of rapidly loaded slow-draining materials may be ill-conditioned, but this problem is not widely known in the biomechanics field. It appears as instabilities in the calculation of interstitial fluid pressures, especially near boundaries and between different materials. Accurate solutions can require impractical compromises between mesh size and time steps. This article investigates the constraints imposed by this problem on tissues representative of the intervertebral disc, subjected to moderate physiological rates of deformation. Two test cylindrical structures were found to require over 10(4) linear displacement-constant pressure elements to avoid serious oscillations in calculated fluid pressure. Fewer Taylor-Hood (quadratic displacement-linear pressure elements) were required, but with complementary increases in computational costs. The Vermeer-Verruijt criterion for 1D mesh size provided guidelines for 3D mesh sizes for given time steps. Pressure instabilities may impose limitations on the use of the finite element method for simulating fluid transport behaviors of biological soft tissues at moderately rapid physiological loading rates.

Spatially resolved streaming potentials of human intervertebral disk motion segments under dynamic axial compression.

Intervertebral disk degeneration results in alterations in the mechanical, chemical, and electrical properties of the disk tissue. The purpose of this study is to record spatially resolved streaming potential measurements across intervertebral disks exposed to cyclic compressive loading. We hypothesize that the streaming potential profile across the disk will vary with radial position and frequency and is proportional to applied load amplitude, according to the presumed fluid-solid relative velocity and measured glycosaminoglycan content. Needle electrodes were fabricated using a linear array of AgAgCl micro-electrodes and inserted into human motion segments in the midline from anterior to posterior. They were connected to an amplifier to measure electrode potentials relative to the saline bath ground. Motion segments were loaded in axial compression under a preload of 500 N, sinusoidal amplitudes of +/-200 N and +/-400 N, and frequencies of 0.01 Hz, 0.1 Hz, and 1 Hz. Streaming potential data were normalized by applied force amplitude, and also compared with paired experimental measurements of glycosaminoglycans in each disk. Normalized streaming potentials varied significantly with sagittal position and there was a significant location difference at the different frequencies. Normalized streaming potential was largest in the central nucleus region at frequencies of 0.1 Hz and 1.0 Hz with values of approximately 3.5 microVN. Under 0.01 Hz loading, normalized streaming potential was largest in the outer annulus regions with a maximum value of 3.0 microVN. Correlations between streaming potential and glycosaminoglycan content were significant, with R(2) ranging from 0.5 to 0.8. Phasic relationships between applied force and electrical potential did not differ significantly by disk region or frequency, although the largest phase angles were observed at the outermost electrodes. Normalized streaming potentials were associated with glycosaminoglycan content, fluid, and ion transport. Results suggested that at higher frequencies the transport of water and ions in the central nucleus region may be larger, while at lower frequencies there is enhanced transport near the periphery of the annulus. This study provides data that will be helpful to validate multiphasic models of the disk.

Frequency-dependent behavior of the intervertebral disc in response to each of six degree of freedom dynamic loading: solid phase and fluid phase contributions.

STUDY DESIGN: Nondestructive displacement-controlled dynamic testing of cadaver material, with repeated measures design and randomized sequence of tests. OBJECTIVE: To determine whether the frequency-dependent changes in disc stiffness and phase angle between load and displacement differ between the 6 principal directions of displacement, and whether these differences are greater in deformation directions associated with greater intradiscal fluid flow. SUMMARY OF BACKGROUND DATA: Prior studies of time-dependent behavior of discs have focused on compression. Comparing different deformation directions allows effects of fluid flow to be distinguished from effects of the solid phase viscoelasticity. METHODS: Vertebra-disc-vertebra preparations (N = 9) from human lumbar spines were subjected to each of 3 displacements and 3 rotations (6 degree of freedom) at each of 4 frequencies (0.001, 0.01, 0.1, and 1 Hz) after equilibration overnight under a 0.4 MPa preload in a bath of phosphate buffered saline at 37 degrees C with protease inhibitors. The forces and torques were recorded along with the applied translation or rotation. The stiffness (force/displacement or torque/rotation) and the phase angle (between each force and displacement) were calculated for each degree of freedom from recorded data. RESULTS: Disc stiffness increased linearly with the log-frequency. The increases over the four decades of frequency were 35%, 33%, and 26% for AP shear, lateral shear, and torsion respectively, and were 45%, 29%, 51%, and 83% for compression, lateral bending, flexion, and extension. The phase angle (a measure of energy absorption) averaged 6.2, 5.1, and 5.1 degrees in AP shear, lateral shear, and torsion, respectively, and 7.0, 7.0, and 8.6 degrees for compression, lateral bending, and flexion-extension. There were no consistent variations of phase angle with frequency. CONCLUSION: The stiffness increase and phase angle decrease with frequency were greater for deformation modes in which fluid flow effects are thought to be greater.

Structural behavior of human lumbar spinal motion segments.

The objectives of this study were to obtain linearized stiffness matrices, and assess the linearity and hysteresis of the motion segments of the human lumbar spine under physiological conditions of axial preload and fluid environment. Also, the stiffness matrices were expressed in the form of an 'equivalent' structure that would give insights into the structural behavior of the spine. Mechanical properties of human cadaveric lumbar L2-3 and L4-5 spinal motion segments were measured in six degrees of freedom by recording forces when each of six principal displacements was applied. Each specimen was tested with axial compressive preloads of 0, 250 and 500 N. The displacements were four slow cycles of +/-0.5mm in anterior-posterior and lateral displacements, +/-0.35 mm axial displacement, +/-1.5 degrees lateral rotation and +/-1 degrees flexion-extension and torsional rotations. There were significant increases with magnitude of preload in the stiffness, hysteresis area (but not loss coefficient) and the linearity of the load-displacement relationship. The mean values of the diagonal and primary off-diagonal stiffness terms for intact motion segments increased significantly relative to values with no preload by an average factor of 1.71 and 2.11 with 250 and 500 N preload, respectively (all eight tests p<0.01). Half of the stiffness terms were greater at L4-5 than L2-3 at higher preloads. The linearized stiffness matrices at each preload magnitude were expressed as an equivalent structure consisting of a truss and a beam with a rigid posterior offset, whose geometrical properties varied with preload. These stiffness properties can be used in structural analyses of the lumbar spine.

Physiological axial compressive preloads increase motion segment stiffness, linearity and hysteresis in all six degrees of freedom for small displacements about the neutral posture.

The stiffness of motion segments, together with muscle actions, stabilizes the spinal column. The objective of this study was to compare the experimentally measured load-displacement behavior of porcine lumbar motion segments in vitro with physiological axial compressive preloads of 0, 200 and 400 N equilibrated in a physiological fluid environment, for small displacements about the neutral posture. These preloads are hypothesized to increase stiffness, hysteresis and linearity of the load-displacement behavior. At each preload, displacements in each of six degrees of freedom (+/-0.3 mm AP and lateral translations, +/-0.2 mm axial translation, +/-1 degrees lateral bending and +/-0.8 degrees flexion/extension and torsional rotations) were imposed. The resulting forces and moments were recorded. Tests were repeated after removal of posterior elements. Using least squares, the forces at the vertebral body center were related to the displacements by a symmetric 6 x 6 stiffness matrix. Six diagonal and two off-diagonal load-displacement relationships were examined for differences in stiffness, linearity and hysteresis in each testing condition. Mean values of the diagonal terms of the stiffness matrix for intact porcine motion segments increased significantly by an average factor of 2.2 and 2.9 with 200 and 400 N axial compression respectively (p<0.001). Increases for isolated disc specimens averaged 4.6 and 6.9 times with 200 and 400 N preload (p<0.001). Changes in hysteresis correlated with the changes in stiffness. The load-displacement relationships were progressively more linear with increasing preload (R(2)=0.82, 0.97 and 0.98 at 0, 200 and 400 N axial compression respectively). Motion segment and disc load-displacement behaviors were stiffer, more linear and had greater hysteresis with axial compressive preloads.