Altered osmotic swelling behavior of proteoglycan-depleted bovine articular cartilage using high frequency ultrasound.

Swelling behavior is an electrochemical mechanical property of articular cartilage. It plays an important role in weight bearing and joint lubrication. In this study, the altered transient and inhomogeneous swelling behavior of the degenerated articular cartilage was observed and quantified in situ using ultrasound. Three groups of bovine patellar articular cartilage samples (n = 10 x 3) were obtained and digested by trypsin for 10, 20 and 30 min respectively to mimic different levels of degeneration. The osmotic-free shrinkage and swelling behavior induced by changing the concentration of the bathing saline solution from 0.15 M to 2 M and then back to 0.15 M were characterized using high-frequency ultrasound (central frequency = 35 MHz) before and after digestion. It was found that the degenerated cartilage specimens showed a weaker shrinkage-swelling behavior compared with the normal cartilage samples. However, no significant differences in the peak shrinkage or swelling strains were observed between different groups. The absolute values of the peak shrinkage strain significantly (p < 0.05) decreased by 45.4%, 42.1% and 50.6% respectively after the trypsin digestion for 10, 20 and 30 min, but such significance was not demonstrated for the peak swelling strains. Due to the potential alterations in the collagen-PG matrix during trypsin digestion, the correlation between the swelling strain and the shrinkage strain of the degenerated samples changed slightly in comparison with the normal samples. The proposed ultrasound method has been successfully used to measure the transient and inhomogeneous swelling behavior of the degenerated articular cartilage and has the potential for the characterization of osteoarthritis.

Morphology and adhesion of mesenchymal stem cells on PLLA, apatite and apatite/collagen surfaces.

Biomimetic apatite/collagen composite coating, previously reported particularly with regard to its fabrication, characterization and interaction with osteoblast-like cells, has been investigated in this study to understand the response of human mesenchymal stem cells (hMSC) to such surface. PLLA films and PLLA films with apatite coating were compared with PLLA films with apatite/collagen composite coating. The hMSC morphology in response to such conditions was first observed using fluorescence microscopy. To further understand such cell-material interactions at a molecular level, integrin expression, actin assembly and vinculin-positive focal adhesion plaques were examined. Our results demonstrated that spreading of stem cells on the apatite/collagen composite surface was determined best among the three types of surfaces, followed by the apatite surface and then the PLLA control. Integrin expression on the apatite/collagen surface was higher than those on the apatite surface and PLLA surface. Immunostaining for vinculin and actin suggested that the composite coating on PLLA enhanced the formation of focal adhesion.

Development and validation of a new approach for computer-aided long bone fracture reduction using unilateral external fixator.

An innovative computer-aided method to plan and execute long bone fracture reduction using Dynafix unilateral external fixator (EF) is presented and validated. A matrix equation, which represents a sequential transformation from proximal to distal ends, was derived and solved for the amount of rotation and translation required at each EF joint to correct for a displaced fracture using a non-linear least square optimization method. Six polyurethane-foam models of displaced fracture tibiae were used to validate the method. The reduction accuracy was quantified by calculating the residual translations (xr, yr, zr), the residual displacement (dr), and the residual angulations (alphar, betar, gammar) based on the X-Y-Z Euler angle convention. The experiment showed that the mean+/-S.D. of alphar, betar, gammar, xr, yr, zr and dr were 1.57+/-1.14 degrees, 1.33+/-0.90 degrees, 0.71+/-0.70 degrees, 0.98+/-1.85, 0.80+/-0.67, 0.30+/-0.27, and 0.50+/-0.77 mm, respectively, which demonstrated the accuracy and reliability of the method. Instead of adjusting the fixator joints in-situ, our method allows for off-site adjustment of the fixator joints and employs the adjusted EF as a template to guide the surgeons to manipulate the fracture fragments to complete the reduction process. Success of this method would allow surgeons to perform fracture reduction more objectively, efficiently and accurately yet reduce the radiation exposure to both the involved clinicians and patients and lessen the extent of periosteum and soft tissue disruption around the fracture site.

Fixation stiffness of Dynafix unilateral external fixator in neutral and non-neutral configurations.

A primary function of external fixator is to stabilize the fracture site after fracture reduction. Conventional fracture reduction method would result in fixator configurations deviated from its neutral configuration. How the non-neutral configurations would affect the biomechanical performance of unilateral external fixators is still not well-documented. We developed a finite element model to predict the fixation stiffness of the Dynafix unilateral external fixator at arbitrary configurations under compression, torsion, three-point, and four-point bending. Experimental testing was done to validate the model using six Dynafix unilateral external fixators in neutral and particular non-neutral configurations. Effects of loading directions on bending stiffness were also studied. It appeared that the model succeeded in revealing the relative stiffness of the neutral and non-neutral configuration in all the loading conditions. Our results also demonstrated that bending stiffness could vary substantially for different loading directions and the principle loading directions could be very different for different fixator configurations. Therefore, a more logical way to compare the bending stiffness is to identify the principle loading directions of each fixator configuration and used their maximum and minimum bending stiffness as comparison criteria. Given that fixator configurations could substantially change the stiffness properties of the bone-fixator system, computer simulation with finite element modeling of this kind will provide useful clinical information on the rigidity of certain configurations in stabilizing the fracture site for bone healing.

A cross-sectional study on the development of foot arch function of 2715 Chinese children.

A cross-sectional study was conducted to investigate the foot arch function of Chinese children. A total of 2715 children, 1246 girls, and 1369 boys, 4-18 years of age were recruited from kindergartens, primary, and secondary schools. The dynamic footprints of the children were collected using a portable pressure-sensing mat. The Contact Force Ratio (CFR, i.e. the ratio of the mid-foot loading to the total loading of the contacted foot, with the toes ignored) of each age group was calculated. In general, the CFR decreased from 4 to 10 years and plateaued at 10-12 years and then increased until 15-16 years. An abnormal low arch foot was defined as the foot that had a CFR value larger than the corresponding age mean plus one standard deviation. The cut-off CFR values of each age group were calculated. With the exception of the 17 years age group, which consisted of a relatively small number of subjects, the percentage of low arch subjects of all the other age groups ranged from 15 to 20%.

Vital sign monitoring for elderly at home: development of a compound sensor for pulse rate and motion.

This paper describes the development of a miniaturized wearable vital sign monitor which is aimed for use by elderly at home. The development of a compound sensor for pulse rate, motion, and skin temperature is reported. A pair of infrared sensor working in reflection mode was used to detect the pulse rate from various sites over the body including the wrist and finger. Meanwhile, a motion sensor was used to detect the motion of the body. In addition, the temperature on the skin surface was sensed by a semiconductor temperature sensor. A prototype has been built into a box with a dimension of 2 x 2.5 x 4 cm3. The device includes the sensors, microprocessor, circuits, battery, and a wireless transceiver for communicating data with a data terminal.

Nonlinear viscoelastic properties of articular cartilage in shear.

The strain dependence of the intrinsic viscoelastic properties of the cartilage matrix in shear was investigated. Stress relaxation experiments were performed on bovine articular cartilage at shear strains ranging from approximately 3% to 16%. The tissue was found to exhibit nonlinear strain-dependent viscoelastic behavior, with the nonlinearity occurring primarily in the short-time transient during stress relaxation. In addition, the equilibrium stress was found to fit a quadratic relation with strain. This relationship was noted to be nearly linear with strain from 3% to 16%. The instantaneous stress was seen to be highly nonlinear, and followed a cubic relationship with applied shear strain. Fung's quasilinear theory can be used to describe the stress relaxation response over the range of strains examined when a nonlinear regression is performed to determine an "average" normalized relaxation function. Alternately, strain dependence can be incorporated into the model to describe and predict more accurately the strain-dependent stress relaxation response.

An ultrasonic measurement for in vitro depth-dependent equilibrium strains of articular cartilage in compression.

The equilibrium depth-dependent biomechanical properties of articular cartilage were measured using an ultrasound-compression method. Ten cylindrical bovine patella cartilage-bone specimens were tested in compression followed by a period of force-relaxation. A 50 MHz focused ultrasound beam was transmitted into the cartilage specimen through a remaining bone layer and a small hole at the centre of a specimen platform. The ultrasound echoes reflected or scattered within the articularcartilage were collected using the same transducer. The displacements of the tissues at different depths of the articular cartilage were derived from the ultrasound echo signals recorded during the compression and the subsequent force-relaxation. For two steps of 0.1 mm compression, the average strain at the superficial 0.2 mm thick layer (0.35 +/- 0.09) was significantly (p < 0.05) larger than that at the subsequent 0.2 mm thick layer (0.05 +/- 0.07) and that at deeper layers (0.01 +/- 0.02). It was demonstrated that the compressive biomechanical properties of cartilage were highly depth-dependent. The results suggested that the ultrasound-compression method could be a useful tool for the study of the depth-dependent biomechanical properties of articular cartilage.

High resolution ultrasound elastomicroscopy imaging of soft tissues: system development and feasibility.

Research in elasticity imaging typically relies on 1-10 MHz ultrasound. Elasticity imaging at these frequencies can provide strain maps with a resolution in the order of millimetres, but this is not sufficient for applications to skin, articular cartilage or other fine structures. We developed a prototype high resolution elastomicroscopy system consisting of a 50 MHz ultrasound backscatter microscope system and a calibrated compression device using a load cell to measure the pressure applied to the specimen, which was installed between a rigidly fixed face-plate and a specimen platform. Radiofrequency data were acquired in a B-scan format (10 mm wide x 3 mm deep) in specimens of mouse skin and bovine patellar cartilage. The scanning resolution along the B-scan plane direction was 50 microm, and the ultrasound signals were digitized at 500 MHz to achieve a sensitivity better than 1 microm for the axial displacement measurement. Because of elevated attenuation of ultrasound at high frequencies, special consideration was necessary to design a face-plate permitting efficient ultrasound transmission into the specimen and relative uniformity of the compression. Best results were obtained using a thin plastic film to cover a specially shaped slit in the face-plate. Local tissue strain maps were constructed by applying a cross-correlation tracking method to signals obtained at the same site at different compression levels. The speed of sound in the tissue specimen (1589.8+/-7.8 m s(-1) for cartilage and 1532.4+/-4.4 m s(-1) for skin) was simultaneously measured during the compression test. Preliminary results demonstrated that this ultrasound elastomicroscopy technique was able to map deformations of the skin and articular cartilage specimens to high resolution, in the order of 50 microm. This system can also be potentially used for the assessment of other biological tissues, bioengineered tissues or biomaterials with fine structures.

Electromechanical potentials in cortical bone--I. A continuum approach.

An electrokinetic model to characterize the electromechanical effect in cortical bone has been developed using the basic principles of the biphasic theory of porous materials and a simple model for permeability and charge distribution for cortical bone. The model is developed analytically in Part I of this paper and is shown to account qualitatively for the principal experimental results reported to date. Part II of this paper concerns experimental analysis of this model, reporting results of low frequency testing of the dynamic characteristics of stress-generated potentials. Quantitative analysis of these results indicates that the microporosity of bone, made up of the channels around the hydroxyapatite encrusting the collagen matrix, is the compartment responsible for the electromechanical effects in fluid-saturated cortical bone. This microporous compartment would seem to be the obvious source of the electrokinetic effect, because it has the greatest surface area in bone and constitutes the rate limiting fluid flow compartment in deformation-induced fluid flow at low frequency.

Biphasic indentation of articular cartilage--I. Theoretical analysis.

A mathematical solution has been obtained for the indentation creep and stress-relaxation behavior of articular cartilage where the tissue is modeled as a layer of linear KLM biphasic material of thickness h bonded to an impervious, rigid bony substrate. The circular (radius = a), plane-ended indenter is assumed to be rigid, porous, free-draining, and frictionless. Double Laplace and Hankel transform techniques were used to solve the partial differential equations. The transformed equations and boundary conditions yielded an integral equation of the Fredholm type which was analyzed asymptotically and solved numerically. Our asymptotic analyses showed that the linear KLM biphasic material behaves like an incompressible (v = 0.5) single-phase elastic solid at t = 0+; the instantaneous response of the material is governed by the shear modulus (mu s) of the solid matrix. The linear KLM biphasic material behaves like a compressible elastic solid with material properties defined by those of the solid matrix, i.e. (lambda s, mu s) or (mu s, v s) as t----infinity. The transient viscoelastic creep and stress-relaxation behavior, 0 less than t less than infinity, of this material is controlled by the frictional drag (which is inversely proportional to the permeability k) associated with the flow of the interstitial fluid through the porous-permeable solid matrix. For given values of the Poisson's ratio of the solid matrix v s and the aspect ratio a/h, where a is the radius of the indenter and h is the thickness of the layer, the creep behavior with respect to the dimensionless time H Akt/a2 is completely controlled by the load parameter P/2 mu sa2 and the stress relaxation behavior is completely controlled by the rate of compression parameter R0 = kH A/V0h where H A = lambda s + 2 mu s and the equilibrium strain u0/h. This mathematical solution may now be used to describe an indentation experiment on articular cartilage to determine the intrinsic material properties of the tissue, i.e. permeability k, and the elastic coefficients of the solid phase (lambda s, mu s) or (mu s, v s).

Deformation-induced hierarchical flows and drag forces in bone canaliculi and matrix microporosity.

Existing theories for interstitial flows in bone have only examined the contributions from different flow systems separately, such as the flows through the microporosity, the canaliculi, and the Haversian canals. An overall model encompassing the hierarchical microstructure is important to our understanding of the actual physics of flows in bone. The flow-induced drag forces and streaming electrical potentials could interact with the osteocytes to effect biological responses. A finite element model was developed to study the contributions from various hierarchical flow channels in bone. Cortical bone is modelled as a fully hydrated biphasic poroelastic material with a superposing network of one-dimensional channels radiating from the Haversian canals representing the canaliculi. Interfacial cross-flows between these one-dimensional channels and the neighbouring poroelastic matrix are driven by the pressure differences between the matrix and the channel. The model was subjected to stress fields simulating uniform compression and pure bending. The effects of the interfacial permeability and the solid content within the channels on the drag forces in the channels were assessed. Abrupt changes in these drag forces occurred as the channel solidity approached that of the microporosity. The results were quite sensitive to the interfacial permeability, i.e. the interconnectivity between the canalicular system and the matrix microporosity. This biomechanical model should be useful to the study of mechanotransduction in bone.

Reconstruction of shoulder function using a reflected long head biceps: a moment arm study.

A tendon transfer technique is proposed for the reconstruction of the paralyzed shoulders secondary to brachial plexus injury. This innovative technique does not require bone-to-bone or tendon to-bone fixation, and attempts to overcome other clinical limitations such as those due to insufficient length of donor muscle. The approach is referred to as the reflected long head biceps (RLHB) technique. The long head of biceps tendons is utilized as a bridging tendon graft. Two surgical alternatives, namely the through-deltoid (TD) pathway and the sub-deltoid (SD) pathway, were studied. The moment arms of the transferred tendons were assessed and reported. The TD technique yielded a larger moment than the SD technique. In the plane 30 degrees anterior to the scapular plane, the average moment arms were 3.8cm TD and 3.0cm SD at zero elevation. Such differences tended to further widen with increasing elevation. At 80 degrees elevation, the moment arms became 3.2cm TD and 1.2cm SD. The results supported the clinical feasibility of this RLHB tendon transfer approach.

Viscoelastic properties of proteoglycan subunits and aggregates in varying solution concentrations.

Using a cone-on-plate mechanical spectrometer, we have measured the linear and non-linear rheological properties of cartilage proteoglycan solutions at concentrations similar to those found in situ. Solutions of bovine nasal cartilage proteoglycan subunits (22S) and aggregates (79S) were studied at concentrations ranging from 10 to 50 mg ml-1. We determined: (1) the complex viscoelastic shear modulus G (omega) under small amplitude (0.02 radians) oscillatory excitation at frequencies (omega) ranging from 1.0 to 20.0 Hz, (2) the non-linear shear rate (gamma) dependent apparent viscosity napp (gamma) in continuous shear, and (3) the non-linear shear rate dependent primary normal stress difference sigma 1 (gamma) in continuous shear. Both the apparent viscosity and normal stress difference were measured over four decades of shear rates ranging from 0.25 to 250 s-1. Analysis of the experimental results were performed using a variety of materially objective non-linear viscoelastic constitutive laws. We found that the non-linear, four-coefficient Oldroyd rate-type model was most effective for describing the measured flow characteristics of proteoglycan subunit and aggregate solutions. Values of the relaxation time lambda 1, retardation time lambda 2, zero shear viscosity no, and nonlinear viscosity parameter muo were computed for the aggregate and subunit solutions at all of the solute concentrations used. The four independent material coefficients showed marked dependence on the two different molecular conformations, i.e. aggregate or subunit, of proteoglycans in solution.

Biomechanical assessment of plantar foot tissue in diabetic patients using an ultrasound indentation system.

The biomechanical properties of plantar tissues were investigated for four older neuropathic diabetic patients and four healthy younger subjects. Indentation tests were performed at four high-pressure areas with three postures in each subject. The tissue thickness and effective Young's modulus were measured by an ultrasound (US) indentation system. The system comprised a pen-size probe having a US transducer at the tip and a load cell connected in series with it. Results showed that the plantar soft tissues of the elderly diabetic patients were significantly stiffer and thinner when compared with the healthy young subjects. For the diabetic subjects tested, the Young's modulus at the 1st metatarsal head was significantly larger than those at the other three sites. This site-dependence was not observed in the healthy young subjects. The plantar tissue became significantly stiffer in the healthy young subjects as a result of posture changes. This posture-dependence of the Young's modulus was not established for the elderly diabetic group.

An ultrasound indentation system for biomechanical properties assessment of soft tissues in-vivo.

An ultrasound indentation system for biomechanical assessment of soft tissues in vivo was developed. The pen-size, hand-held probe was composed of an ultrasound transducer and a load cell. The ultrasound transducer was at the tip of the probe serving also as the indentor. The thickness and deformation of the soft tissue layer were determined from the ultrasound echo. A compressive load cell was connected in series with the ultrasound transducer to record the force response. A validation experiment was performed on porcine tissues. Force and deformation acquired with the present system was in good comparison with those obtained from a Housfield material testing machine. Material constants were obtained via a curve-fitting procedure by predicting the force transient response from the deformation-time data using a quasilinear viscoelastic model. In addition, deformation in the fat and in the muscle could be differentiated. The potential applications of this type of indentation probes are many. The specific application of this current development is for stump tissue assessment in the design of prosthetics.

Effects of knee bracing on the sensorimotor function of subjects with anterior cruciate ligament reconstruction.

The sensorimotor performance of the knee joint in 31 subjects who had undergone unilateral anterior cruciate ligament reconstruction at least 5 months previously was tested under three bracing conditions, 1) the DonJoy Legend brace, 2) a mechanical placebo brace, and 3) no brace, in random order. The accuracy of the subjects' ability to reproduce specified knee joint angles was tested as well as the isokinetic performance of their knee muscles at 60 and 180 deg/sec. The results showed that subjects with the brace or placebo brace performed similarly in reproducing the knee joint positions, but both groups performed better than the subjects without a brace. Isokinetic tests revealed no difference among the three groups in extensor and flexor peak torque production at 60 deg/sec or total work done by the extensors and flexors at 60 and 180 deg/sec. These results suggest that knee bracing can improve the static proprioception of the knee joint, but not the muscle contractile function, in subjects with anterior cruciate ligament reconstruction under isokinetic testing conditions. The finding of similar performances for joint angle reproduction in the brace and placebo brace groups suggests that the apparent improvement in proprioception with knee bracing was not due to the mechanical restraining action of the brace.

Development of computer-based environment for simulating the voluntary upper-limb movements of persons with disability.

Upper-limb orthotic systems have been designed for restoring the upper-limb functions of individuals with disabilities resulting from spinal cord injury (SCI), stroke and muscular dystrophy. These systems employ either functional electrical stimulation or external power. It is proposed that, instead of time-consuming and complicated monitoring using sensors and motion analysis, a software simulator with both angular displacement and acceleration parameters can facilitate the design of a control strategy for an orthosis. Reaching movements of three cervical SCI subjects are used to verify the simulator. A motion analysis system is used to measure the range of motion and joint angles during hand reaching. Results indicate that quaternion and spline curve techniques are suitable for interpolation of the hand reaching movements. The information needed for good simulation only compress the shoulder and elbow joint angles in a few key postures. Stimulated acceleration signals on the upper-arm segment have a high correlation coefficient (> 0.9) and a small root mean squared error (< 0.11 g) with a real bi-axial accelerometer.

Command control for functional electrical stimulation hand grasp systems using miniature accelerometers and gyroscopes.

Recent commercially available miniature sensors have the potential to improve the functions of functional electrical stimulation (FES) systems in terms of control, reliability and robustness. A new control approach using a miniature gyroscope and an accelerometer was studied. These sensors were used to detect the linear acceleration and angular velocity of residual voluntary movements on upper limbs and were small and easy to put on. Five healthy subjects and three cervical spinal cord injured subjects were recruited to evaluate this controller. Sensors were placed on four locations: the shoulder, upper arm, wrist and hand. A quick forward-and-backward movement was employed to produce a distinctive waveform that was different from general movements. A detection algorithm was developed to generate a command signal by identifying this distinctive waveform through the detection of peaks and valleys in the sensor's signals. This command signal was used to control different FES hand grasp patterns. With a specificity of 0.9, the sensors had a success rate of 85-100% on healthy subjects and 82-97% on spinal cord injured subjects. In terms of sensor placement, the gyroscope was better as a control source than the accelerometer for wrist and hand positions, but the reverse was true for the shoulder.

Assessment of neck tissue fibrosis using an ultrasound palpation system: a feasibility study.

Fibrotic change in the soft tissue of the neck is a common side-effect after radiotherapy treatment for cancers of the head and neck region. The development of a quantitative approach for the assessment of neck tissue stiffness using an ultrasound palpation system (UPS) is reported. A testing protocol was established with the participation of eight normal subjects and four patients who had neck fibrosis after previous radiotherapy to the neck. Six reference sites were assessed on each side of the neck in each subject. Site-dependence, inter-observer variability, and intra-observer variability were further evaluated by measurement of sites 1 cm anterior, posterior, superior and inferior to two of the reference sites on each side of the neck, and by repeating measurements using a second observer on the same occasion and using the same observer one week afterwards. The mean tissue Young's modulus for normal subjects was 12.8 +/- 3.9 kPa, and that of the radiotherapy-treated patients ranged from 46.4 to 108.3 kPa. The modulus shows limited variation among anatomical sub-sites within the neck. For a confidence level of 95%, there was a variation of +/- 14.2% for site-dependence, +/- 15.2% for inter-observer, and +/- 7.2% for intra-observer tests for the group of normal subjects. The variation in the patients was +/- 13.6% for site-dependence, and +/- 13.1% for the inter-observer test.