A noninvasive MRI based approach to estimate the mechanical properties of human knee ligaments.

ABSTRACT

Characterization of the main tibiofemoral ligaments is an essential step in developing patient-specific computational models of the knee joint for personalized surgery pre-planning. Tensile tests are commonly performed in-vitro to characterize the mechanical stiffness and rupture force of the knee ligaments which makes the technique unsuitable for in-vivo application. The time required for the limited noninvasive approaches for properties estimation based on knee laxity remained the main obstacle in clinical implementation. Magnetic resonance imaging (MRI) technique can be a platform to noninvasively assess the knee ligaments. In this study the aim was to explore the potential role of quantitative MRI and dimensional properties, in characterizing the mechanical properties of the main tibiofemoral ligaments. After MR scanning of six cadaveric legs, all 24 main tibiofemoral bone-ligaments-bone specimens were tested in vitro. During the tensile test cross sectional area of the specimens was captured using ultrasound and force-displacement curve was extracted. Digital image correlation technique was implemented to check the strain behavior of the specimen and rupture region and to assure the fixation of ligament bony block during the test. The volume of the specimen was measured using manual segmentation data, and quantitative MR parameters as T2*, T1ρ, and T2 were calculated. Linear mixed statistical models for repeated measures were used to examine the association of MRI parameters and dimensional measurements with the mechanical properties (stiffness and rupture force). The results shows that while the mechanical properties were mostly correlated to the volume, inclusion of the MR parameters increased the correlation strength for stiffness (R2 ≈ 0.48) and partial rupture force (R2 = 0.53). Inclusion of ligament type in the statistical analysis enhanced the correlation of mechanical properties with MR parameters and volume as for stiffness (R2 = 0.60) and partial rupture (R2 = 0.57). In conclusion, this study revealed the potentials in using quantitative MR parameters, T1ρ, T2 and T2*, combined with specimen volume to estimate the essential mechanical properties of all main tibiofemoral ligaments required for subject-specific computational modeling of human knee joint.