Emergency Department Visits From 2014 to 2018 for Head Injuries in Youth Non-Tackle Football Compared With Other Sports.

BACKGROUND: Non-tackle football (ie, flag, touch, 7v7) is purported to be a lower-risk alternative to tackle football, particularly in terms of head injuries. However, data on head injuries in non-tackle football are sparse, particularly among youth participants. PURPOSE: To describe the epidemiology of  emergency department visits for head injuries due to non-tackle football among youth players in the United States and compare the data with basketball, soccer, and tackle football. STUDY DESIGN: Descriptive epidemiology study. METHODS: Injury data from 2014 to 2018 were obtained from the National Electronic Injury Surveillance System database. Injury reports coded for patients aged 6 to 18 years and associated with basketball, football, or soccer were extracted. Data were filtered to include only injuries to the head region, specifically, the head, ear, eyeball, mouth, or face. Football injuries were manually assigned to "non-tackle" or "tackle" based on the injury narratives. Sports & Fitness Industry Association data were used to estimate annual sport participation and calculate annual injury rates per 100,000 participant-years. RESULTS: A total of 26,770 incident reports from 2014 to 2018 were analyzed. For head region injuries in non-tackle football, the head was the most commonly injured body part, followed by the face; the most common diagnosis was a laceration, followed by concussion and internal injury (defined as an unspecified head injury or internal head injury [eg, subdural hematoma or cerebral contusion]). The most common contacting object was another player. The projected national rate of head region injuries was lowest for non-tackle football across the 4 sports. In particular, the projected rate of injuries to the head for non-tackle football (78.0 per 100,000 participant-years) was less than one-fourth the rates for basketball (323.5 per 100,000 participant-years) and soccer (318.2 per 100,000 participant-years) and less than one-tenth the rate for tackle football (1478.6 per 100,000 participant-years). CONCLUSION: Among youth in the United States aged 6 to 18 years who were treated in the emergency department for injuries related to playing non-tackle football, the most common diagnosis for injuries to the head region was a laceration, followed by a concussion. Head region injuries associated with non-tackle football occurred at a notably lower rate than basketball, soccer, or tackle football.

Quantitative and qualitative analysis of head and body impacts in American 7v7 non-tackle football.

OBJECTIVES: Non-tackle American football is growing in popularity, and it has been proposed as a safer alternative for young athletes interested in American football. Little is known about the nature of head contact in the sport, which is necessary to inform the extent to which protective headgear is warranted. The objective of this study was to identify the location, types and frequency of head and body contacts in competitive 7v7 non-tackle American football. METHODS: Video analysis was used to document the type, frequency and mechanism of contacts across a series of under 12, under 14 and high school non-tackle tournament games. A subset of impacts was quantitatively analysed via 3-D model-based image matching to calculate the preimpact and postimpact speed of players' heads and the change in resultant translational and rotational velocities. RESULTS: The incidence rate of head contact was found to be low (3.5 contacts per 1000 athlete-plays). Seventy-five per cent of head contacts were caused by a head-to-ground impact. No head-to-head contacts were identified. Most contacts occurred to the rear upper (occiput) or side upper (temporal/parietal) regions. Head-to-ground impact was associated with a maximum preimpact velocity of 5.9±2.2 m/s and a change in velocity of 3.0±1.1 m/s. CONCLUSION: Non-tackle football appears to represent a lower contact alternative to tackle football. The distribution of head impact locations, mechanisms and energies found in the present study is different than what has been previously reported for tackle football. The existing tackle football standards are not appropriate to be applied to the sport of non-tackle football, and sport-specific head protection and headgear certification standards must be determined.

Years of running experience influences stride-to-stride fluctuations and adaptive response during step frequency perturbations in healthy distance runners.

RESEARCH QUESTION: The current study investigated stride-to-stride fluctuations of step rate and contact time in response to enforced step frequency perturbations as well as adaptation and de-adaptation behavior. METHODS: Forty distance runners ran at a self-selected speed and were asked to match five different enforced step frequencies (150, 160, 170, 180, and 190 beats per min). The influence of experience was explored, because running is a skill that presumably gets better with practice, and increased years of running experience is protective against injury. Detrended fluctuation analysis was used to determine the strength of long-range correlations in gait fluctuations at baseline, during the perturbation, and post-perturbation. Adaptive response was measured by the ability to match, rate of matching, and aftereffect of step frequency perturbations. RESULTS: The structure of stride-to-stride fluctuations for step rate and contact time did not change during the perturbation or post-perturbation compared to baseline. However, fluctuations in step rate were affected by the level of perturbation. Runners with the most experience had a less persistent structural gait pattern for both step rate and contact time at baseline. Highly experienced runners also demonstrated the best adaptive response. They better matched the enforced step frequency, reached the enforced step frequency sooner, and returned to preferred step frequency more quickly following removal of the perturbation. SIGNIFICANCE: These findings indicate baseline locomotor flexibility may be beneficial to achieve task demands and return to a stable state once the task is complete. Increased locomotor flexibility may also be a contributing factor for reduced injury risk in experienced runners.

Quantification of Accelerometer Derived Impacts Associated With Competitive Games in National Collegiate Athletic Association Division I College Football Players.

Wellman, AD, Coad, SC, Goulet, GC, and McLellan, CP. Quantification of accelerometer derived impacts associated with competitive games in National Collegiate Athletic Association division I college football players. J Strength Cond Res 31(2): 330-338, 2017-The aims of the present study were to (a) examine positional impact profiles of National Collegiate Athletic Association (NCAA) division I college football players using global positioning system (GPS) and integrated accelerometry (IA) technology and (b) determine if positional differences in impact profiles during competition exist within offensive and defensive teams. Thirty-three NCAA division I Football Bowl Subdivision players were monitored using GPS and IA (GPSports) during 12 regular season games throughout the 2014 season. Individual player data sets (n = 294) were divided into offensive and defensive teams, and positional subgroups. The intensity, number, and distribution of impact forces experienced by players during competition were recorded. Positional differences were found for the distribution of impacts within offensive and defensive teams. Wide receivers sustained more very light and light to moderate (5-6.5 G force) impacts than other position groups, whereas the running backs were involved in more severe (>10 G force) impacts than all offensive position groups, with the exception of the quarterbacks (p ≤ 0.05). The defensive back and linebacker groups were subject to more very light (5.0-6.0 G force) impacts, and the defensive tackle group sustained more heavy and very heavy (7.1-10 G force) impacts than other defensive positions (p ≤ 0.05). Data from the present study provide novel quantification of positional impact profiles related to the physical demands of college football games and highlight the need for position-specific monitoring and training in the preparation for the impact loads experienced during NCAA division I football competition.

Long-term effects of adolescent concussion history on gait, across age.

The aim of this study was to examine the possible long-term effects of high school concussion history on gait performance across the lifespan. Individuals with and without a concussion history were grouped into 20-year-old (yo) (n=40), 40yo (n=19), and 60yo (n=18) age groups. Participants completed five trials of four walking conditions: a normal walk, a dual task walk, an obstructed walk, and an obstructed, dual task walk. Spatiotemporal gait parameters for gait analyses during single and dual task conditions. Gait velocity, step width, stride length, percent of time in double support, and obstacle toe clearance were the gait variables assessed along with number correct from dual task. Gait was analyzed via optical motion capture. Data were analyzed by two-factor, multivariate ANOVAs and significant interactions were explored using post hoc contrasts. A significant (F=2.62, p=0.03) interaction was observed for the obstructed walk condition. Further analyses yielded no significant concussion history and control group differences, within age. The data indicate that an adolescent concussion history has a non-observable effect on gait across the lifespan.

Predictors of Ulnar Collateral Ligament Reconstruction in Major League Baseball Pitchers.

BACKGROUND: Ulnar collateral ligament (UCL) reconstruction surgeries in Major League Baseball (MLB) have increased significantly in recent decades. Although several risk factors have been proposed, a scientific consensus is yet to be reached, providing challenges to those tasked with preventing UCL injuries. PURPOSE: To identify significant predictors of UCL reconstruction in MLB pitchers. STUDY DESIGN: Case control study; Level of evidence, 3. METHODS: Demographic and pitching performance data were sourced from public databases for 104 MLB pitchers who underwent UCL reconstruction surgery and 104 age- and position-matched controls. These variables were compared between groups and inserted into a binary logistic regression to identify significant predictors of UCL reconstruction. Two machine learning models (naïve Bayes and support vector machine) were also employed to predict UCL reconstruction in this cohort. RESULTS: The binary linear regression model was statistically significant (χ(2)(12) = 33.592; P = .001), explained 19.9% of the variance in UCL reconstruction surgery, and correctly classified 66.8% of cases. According to this model, (1) fewer days between consecutive games, (2) a smaller repertoire of pitches, (3) a less pronounced horizontal release location, (4) a smaller stature, (5) greater mean pitch speed, and (6) greater mean pitch counts per game were all significant predictors of UCL reconstruction. More specifically, an increase in mean days between consecutive games (odds ratio [OR], 0.685; 95% CI, 0.542-0.865) or number of unique pitch types thrown (OR, 0.672; 95% CI, 0.492-0.917) was associated with a significantly smaller likelihood of UCL reconstruction. In contrast, an increase in mean pitch speed (OR, 1.381; 95% CI, 1.103-1.729) or mean pitches per game (OR, 1.020; 95% CI, 1.007-1.033) was associated with significantly higher odds of UCL reconstruction surgery. The naïve Bayes classifier predicted UCL reconstruction with an accuracy of 72% and the support vector machine classifier with an accuracy of 75%. CONCLUSION: This study identified 6 key performance factors that may present significant risk factors for UCL reconstruction in MLB pitchers. These findings could help to enhance the prevention of UCL reconstruction surgery in MLB pitchers and shape the direction of future research in this domain.

In Vivo Hip Morphology and Kinematics in Elite Baseball Pitchers.

PURPOSE: To compare passive and real-time active hip range of motion (ROM) in asymptomatic collegiate pitchers, to investigate whether differences in hip morphology and ROM exist between lead and trail hips, and to relate active hip ROM during the pitch to hip morphology and femoroacetabular impingement. METHODS: Eleven collegiate baseball pitchers participated in kinematic testing that involved throwing 4 fastball pitches while wearing a full-body inertial-based motion-capture system. Passive flexion and rotation of each hip were measured using a goniometer. Nine pitchers also underwent a computed tomography (CT) pelvic scan, from which subject-specific computer models for each hip were created. Morphologic measurements were calculated from the models, and the models were tested for impingement during simulated pitching. RESULTS: Hip flexion was the only passive ROM measurement showing a significant difference between the lead and trail hips (mean difference [MD], 4°; P = .027). During the pitching motion, within-individual differences were discovered between the lead and trail hips for flexion (MD, 34°; P < .0001), extension (MD, 26°; P < .0001), abduction (MD, 8°; P = .026), adduction (MD, 6°; P = .008), external rotation (MD, 20°; P = .001), and total arc of rotation (MD, 13°; P = .001). There were no significant differences in morphologic measures between the lead and trail hips. Dynamic CT modeling did not lead to bony impingement in any subject. CONCLUSIONS: Asymptomatic collegiate pitchers approach their extremes of passive hip rotation when executing a fastball pitch. No differences were found in passive hip ROM or morphology other than a small difference in passive hip flexion. Dynamic CT modeling did not show femoroacetabular impingement during the pitching motion. CLINICAL RELEVANCE: Hip dysmorphology or poor pitching mechanics may lead to a high risk of bony impingement because pitchers have little reserve hip motion during the fastball pitch.

Ball Speed and Release Consistency Predict Pitching Success in Major League Baseball.

Whiteside, D, Martini, DN, Zernicke, RF, and Goulet, GC. Ball speed and release consistency predict pitching success in Major League Baseball. J Strength Cond Res XX(X): 000-000, 2015-This study aimed to quantify how ball flight kinematics (i.e., ball speed and movement), release location, and variations therein relate to pitching success in Major League Baseball (MLB). One hundred ninety starting MLB pitchers met the inclusion criteria for this study. Ball trajectory information was collected for 76,000 pitches and inserted into a forward stepwise multiple regression model, which examined how (a) pitch selection, (b) ball speed, (c) ball movement (horizontal and lateral), (d) release location (horizontal and lateral), (e) variation in pitch speed, (f) variation in ball movement, and (g) variation in release location related to pitching success (as measured by fielding independent pitching-FIP). Pitch speed, release location variability, variation in pitch speed, and horizontal release location were significant predictors of FIP and, collectively, accounted for 24% of the variance in FIP. These findings suggest that (a) maximizing ball speed, (b) refining a consistent spatial release location, and (c) using varied pitch speeds should be primary foci for the pitching coach. However, between-pitcher variations underline how training interventions should be administered at the individual level, with consideration given to the pitcher's injury history. Finally, despite offering significant predictors of success, these three factors explained only 22% of the variance in FIP and should not be considered the only, or preeminent, indicators of a pitcher's effectiveness. Evidently, traditional pitching metrics only partly account for a pitcher's effectiveness, and future research is necessary to uncover the remaining contributors to success.

Grading the Functional Movement Screen: A Comparison of Manual (Real-Time) and Objective Methods.

Although intertester and intratester reliability have been common themes in Functional Movement Screen (FMS) research, the criterion validity of manual grading is yet to be comprehensively examined. This study compared the FMS scores assigned by a certified FMS tester to those measured by an objective inertial-based (IMU) motion capture system. Eleven female division I collegiate athletes performed 6 FMS exercises and were manually graded by a certified tester. Explicit kinematic thresholds were formulated to correspond to each of the grading criteria for each FMS exercise and then used to grade athletes objectively using the IMU data. The levels of agreement between the 2 grading methods were poor in all 6 FMS exercises and implies that manual grading of the FMS may be confounded by vague grading criteria. Evidently, more explicit grading guidelines are needed to improve the uniformity and accuracy of manual FMS grading and also facilitate the use of objective measurement systems in the grading process. Contrary to the approach that has been adopted in several previous studies, the potential for subjective and/or inaccurate FMS grading intimates that it may be inappropriate to assume that manual FMS grading provides a valid measurement tool. Consequently, the development and criterion validation of uniform grading procedures must precede research attempting to link FMS performance and injury rates. With manual grading methods seemingly susceptible to error, the FMS should be used cautiously to direct strength and/or conditioning programs.

Changes in a Starting Pitcher's Performance Characteristics Across the Duration of a Major League Baseball Game.

PURPOSE: With a view to informing in-game decision making as it relates to strategy and pitcher health, this study examined changes in pitching-performance characteristics across 9 innings of Major League Baseball (MLB) games. METHODS: 129 starting MLB pitchers met the inclusion criteria for this study. Pitch type, speed, ball movement, release location, and strike-zone data-collected using the MLB's ball-tracking system, PITCHf/x-were obtained for 1,514,304 pitches thrown from 2008 to 2014. RESULTS: Compared with the 1st inning, the proportion of hard pitches thrown decreased significantly until the 7th inning, while the proportions of breaking and off-speed pitches increased. Significant decreases in pitch speed, increases in vertical movement, and decreases in release height emerged no later than the 5th inning, and the largest differences in all variables were generally recorded between the 1st inning and the late innings (7-9). Pitchers were most effective during the 2nd inning and significantly worse in innings 4 and 6. CONCLUSION: These data revealed that several aspects of a starting pitcher's pitching characteristics exhibited changes from baseline as early as the 2nd or 3rd inning of an MLB game, but this pattern did not reflect the changes in his effectiveness. Therefore, these alterations do not appear to provide reasonable justification for relieving a starting pitcher, although future work must address their relevance to injury. From an offensive standpoint, batters in the MLB should anticipate significantly more hard pitches during the early innings but more breaking and off-speed pitches, with decreasing speed, as the game progresses.

Quantification of Competitive Game Demands of NCAA Division I College Football Players Using Global Positioning Systems.

The aim of the present study was to examine the competitive physiological movement demands of National Collegiate Athletic Association (NCAA) Division I college football players using portable global positioning system (GPS) technology during games and to examine positional groups within offensive and defensive teams, to determine if a player's physiological requirements during games are influenced by playing position. Thirty-three NCAA Division I Football Bowl Subdivision football players were monitored using GPS receivers with integrated accelerometers (GPSports) during 12 regular season games throughout the 2014 season. Individual data sets (n = 295) from players were divided into offensive and defensive teams and subsequent position groups. Movement profile characteristics, including total, low-intensity, moderate-intensity, high-intensity, and sprint running distances (m), sprint counts, and acceleration and deceleration efforts, were assessed during games. A one-way ANOVA and post-hoc Bonferroni statistical analysis were used to determine differences in movement profiles between each position group within offensive and defensive teams. For both offensive and defensive teams, significant (p ≤ 0.05) differences exist between positional groups for game physical performance requirements. The results of the present study identified that wide receivers and defensive backs completed significantly (p ≤ 0.05) greater total distance, high-intensity running, sprint distance, and high-intensity acceleration and deceleration efforts than their respective offensive and defensive positional groups. Data from the present study provide novel quantification of position-specific physical demands of college football games and support the use of position-specific training in the preparation of NCAA Division I college football players for competition.

On-Ice Functional Assessment of an Elite Ice Hockey Goaltender After Treatment for Femoroacetabular Impingement.

BACKGROUND: Femoroacetabular impingement (FAI) is a major cause of performance inhibition in elite-level athletes. The condition is characterized by pain, osseous abnormalities such as an increased alpha angle, and decreased range of motion at the affected hip joint. Arthroscopic surgical decompression is useful in reshaping the joint to alleviate symptoms. Functional kinematic outcomes of sport-specific movements after surgery, however, are presently unknown. HYPOTHESIS: The ability of an ice hockey goaltender to execute sport-specific movements would improve after arthroscopic surgery. STUDY DESIGN: Clinical research. LEVEL OF EVIDENCE: Level 5. METHODS: An ice hockey goaltender was evaluated after arthroscopic correction of FAI on the symptomatic hip. Passive range of motion and radiographic parameters were assessed from a computed tomography-derived 3-dimensional model. An on-ice motion capture system was also used to determine peak femoral shock and concurrent hip joint postures during the butterfly and braking movements. RESULTS: Maximum alpha angles were 47° in the surgical and 61° in the nonsurgical hip. Internal rotation range of motion was, on average, 23° greater in the surgically corrected hip compared with contralateral. Peak shock was lower in the surgical hip by 1.39 g and 0.86 g during butterfly and braking, respectively. At peak shock, the surgical hip demonstrated increased flexion, adduction, and internal rotation for both tasks (butterfly, 6.1°, 12.3°, and 30.8°; braking, 14.8°, 19.2°, and 41.4°). CONCLUSION: On-ice motion capture revealed performance differences between hips after arthroscopic surgery in a hockey goaltender. Range of motion and the patient's subjective assessment of hip function were improved in the surgical hip. While presenting as asymptomatic, it was discovered that the contralateral hip displayed measurements consistent with FAI. Therefore, consideration of preemptive treatment in a presently painless hip may be deemed beneficial for young athletes seeking a long career in sport, and future work is needed to determine the costs and benefits of such an approach. CLINICAL RELEVANCE: Surgical treatment of symptomatic FAI can achieve pain relief and improved kinematics of the hip joint with athletic activities. Additional studies are necessary to determine whether improved kinematics enhance the longevity of the native hip and alter the progression of osteoarthritic changes in those with asymptomatic FAI deformity.

Femoroacetabular Impingement in Elite Ice Hockey Goaltenders: Etiological Implications of On-Ice Hip Mechanics.

BACKGROUND: Femoroacetabular impingement (FAI) is particularly prevalent in ice hockey. The butterfly goalie technique is thought to involve extreme ranges of hip motion that may predispose goaltenders to FAI. PURPOSE: To quantify hip mechanics during 3 common goaltender movements and interpret their relevance to the development of FAI. STUDY DESIGN: Descriptive laboratory study. METHODS: Fourteen collegiate and professional goaltenders performed skating, butterfly save, and recovery movements on the ice. Hip mechanics were compared across the 3 movements. RESULTS: The butterfly did not exhibit the greatest range of hip motion in any of the 3 planes. Internal rotation was the only hip motion that appeared close to terminal in this study. When subjects decelerated during skating­shaving the blade of their skate across the surface of the ice­the magnitude of peak hip internal rotation was 54% greater than in the butterfly and 265% greater than in the recovery. No movement involved levels of concomitant flexion, adduction, and internal rotation that resembled the traditional impingement (FADIR) test. CONCLUSION: The magnitude of internal rotation was the most extreme planar hip motion (relative to end-range) recorded in this study (namely during decelerating) and appeared to differentiate this cohort from other athletic populations. Consequently, repetitive end-range hip internal rotation may be the primary precursor to symptomatic FAI in hockey goaltenders and provides the most plausible account for the high incidence of FAI in these athletes. Resection techniques should, therefore, focus on enhancing internal rotation in goaltenders, compared with flexion and adduction. While the butterfly posture can require significant levels of hip motion, recovering from a save and, in particular, decelerating during skating are also demanding on goaltenders' hip joints. Therefore, it appears critical to consider and accommodate a variety of sport-specific hip postures to comprehensively diagnose, treat, and rehabilitate FAI.

Accuracy of Femur Angles Estimated by IMUs During Clinical Procedures Used to Diagnose Femoroacetabular Impingement.

We present a novel method for quantifying femoral orientation angles using a thigh-mounted inertial measurement unit (IMU). The IMU-derived femoral orientation angles reproduce gold-standard motion capture angles to within mean (standard deviation) differences of 0.1 (1.1) degrees on cadaveric specimens during clinical procedures used for the diagnosis of Femoroacetabular Impingement (FAI). The method, which assumes a stationary pelvis, is easy to use, inexpensive, and provides femur motion trajectory data in addition to range of motion measures. These advantages may accelerate the adoption of this technology to inform FAI diagnoses and assess treatment efficacy. To this end, we further investigate the accuracy of hip joint angles calculated using this methodology and assess the sensitivity of our estimates to skin motion artifact during these tasks.

Position-Specific Hip and Knee Kinematics in NCAA Football Athletes.

BACKGROUND: Femoroacetabular impingement is a debilitating hip condition commonly affecting athletes playing American football. The condition is associated with reduced hip range of motion; however, little is known about the range-of-motion demands of football athletes. This knowledge is critical to effective management of this condition. PURPOSE: To (1) develop a normative database of game-like hip and knee kinematics used by football athletes and (2) analyze kinematic data by playing position. The hypothesis was that kinematics would be similar between running backs and defensive backs and between wide receivers and quarterbacks, and that linemen would perform the activities with the most erect lower limb posture. STUDY DESIGN: Descriptive laboratory study. METHODS: Forty National Collegiate Athletic Association (NCAA) football athletes, representing 5 playing positions (quarterback, defensive back, running back, wide receiver, offensive lineman), executed game-like maneuvers while lower body kinematics were recorded via optical motion capture. Passive hip range of motion at 90° of hip flexion was assessed using a goniometer. Passive range of motion, athlete physical dimensions, hip function, and hip and knee rotations were submitted to 1-way analysis of variance to test for differences between playing positions. Correlations between maximal hip and knee kinematics and maximal hip kinematics and passive range of motion were also computed. RESULTS: Hip and knee kinematics were similar across positions. Significant differences arose with linemen, who used lower maximal knee flexion (mean ± SD, 45.04° ± 7.27°) compared with running backs (61.20° ± 6.07°; P < .001) and wide receivers (54.67° ± 6.97°; P = .048) during the cut. No significant differences were found among positions for hip passive range of motion (overall means: 102° ± 15° [flexion]; 25° ± 9° [internal rotation]; 25° ± 8° [external rotation]). Several maximal hip measures were found to negatively correlate with maximal knee kinematics. CONCLUSION: A normative database of hip and knee kinematics utilized by football athletes was developed. Position-specific analyses revealed that linemen use smaller joint motions when executing dynamic tasks but do not demonstrate passive range of motion deficits compared with other positions. CLINICAL RELEVANCE: Knowledge of requisite game-like hip and knee ranges of motion is critical for developing goals for nonoperative or surgical recovery of hip and knee range of motion in the symptomatic athlete. These data help to identify playing positions that require remedial hip-related strength and conditioning protocols. Negative correlations between hip and knee kinematics indicated that constrained hip motion, as seen in linemen, could promote injurious motions at the knee.

Poroelastic evaluation of fluid movement through the lacunocanalicular system.

A poroelastic lacunocanalicular model was developed for the quantification of physiologically relevant parameters related to bone fluid flow. The canalicular and lacunar microstructures were explicitly represented by a dual-continuum poroelastic model. Effective material properties were calculated using the theory of composite materials. Porosity and permeability values were determined using capillaric and spherical-shell models for the canalicular and lacunar microstructures, respectively. Pore fluid pressure and fluid shear stress were calculated in response to simulated mechanical loading applied over a range of frequencies. Species transport was simulated with convective and diffusive flow, and osteocyte consumption of nutrients was incorporated. With the calculated parameter values, realistic pore fluid pressure and fluid shear stress responses were predicted and shown to be consistent with previous experimental and theoretical studies. Stress-induced fluid flow was highlighted as a potent means of species transport, and the importance of high-magnitude low-frequency loading on osteocyte nutrition was demonstrated. This new model can serve as the foundation for future hierarchical modeling efforts that may provide insight into the underlying mechanisms of mechanotransduction and functional adaptation of bone.

Influence of vascular porosity on fluid flow and nutrient transport in loaded cortical bone.

Load-induced fluid flow is a key factor in triggering bone modeling and remodeling processes that maintain bone mass and architecture. To provide an enhanced understanding of fluid flow in bone, unique computational models of a tibial section were developed. The purpose of the study was to examine the effects of incorporating vascular porosity on pore fluid pressure and resulting lacunocanalicular flow and to determine the role of load-induced fluid flow in tracer transport. Simulations revealed large local pressure gradients surrounding the vascular canals that were dependent on the magnitude and state (i.e., compressive or tensile) of the stress. Fluid velocity magnitudes were increased by over an order of magnitude in the dual-porosity model, relative to the single-porosity model. Fluid flow had a marked effect on tracer perfusion within the cortex. After 10 loading cycles, a 9-fold increase in tracer concentration, relative to diffusion alone, was observed in the compressive region where fluid exchange was greatest between the lacunocanalicular porosity and the vascular canals. Agreement was achieved between computational results and experimental investigations of electrokinetic phenomenon, tracer transport, cellular stimulation, and functional adaptation. The models produced substantial improvements in bone fluid flow simulation and underscored the significance of incorporating vascular porosity in models designed to quantify fluid pressure and flow characteristics within mechanically loaded cortical bone.