Literature Review

Saikat, Pal, 2008, Explicit Finite Element Modelling of Joint Mechanics

Provided by Dr Pankaj, it gave us a good overview of the knee joint and how it is analysed computationally. It gave examples of how muscles are attached in a computational method while also providing some general information as a starting point for our knee. As our thesis progresses it can then be used as a reference for our computational model.

Klein Horsman, M.D., Koopman,H.F.J.M., van der Helm,F.C.T., Poliacu Prose, L., Veeger, H.E.J., 2007, Morphological muscle and joint parameters for musculoskeletal modelling of the lower extremity, Elsevier Science Ltd

This document dissected a male leg and analysed all the muscles. It referenced all the muscles, their origin and insertion points and also the muscle properties. It provided a table of all the muscles in the leg with the muscle co-ordinates along with how they how they attach. This information could be used to build up our computational model of the femur as we have a co-ordinate system for the muscles.

Phillips, AT, 2009, The femur as a musculo-skeletal construct: a free boundary condition modelling approach., Med Eng Phys.

This paper is by an former Phd student of Edinburgh University. It follows a similar idea as our thesis as it looks at attaching muscles in a computational model of the femur. This details the mathematical representation of muscles along with the properties of bones and ligaments. This could prove to be a very useful paper that could provide a basis of our model also. Differences are that he was more concerned with the superior side of the femur, which relates to the hip joint. Our model will be concentrating on the knee joint and therefore concentrating on the inferior side of the femur.

Hull, M.L, Berns, G.S, Varma, H, Patterson, H.A. Strain in the medial collateral ligament of the human knee under single and combined loads. Biomechanics, Volume 29 (1996): 199-206 

This is a study of 13 knee specimens to determine loads that are most likely to cause injury. The fexion angle of the knee was fixed and loads were applied that still allowed 6 degrees of freedom. The external axial moment applied was found to be the most damaging. The posterior superior site experienced the greatest strain at 0 degrees while on the anterior superior side it occurred at 30 degrees.

Mesfar, W, Shirazi-Adl, A. Biomechanics of the knee joint in flexion under various quadriceps forces. The Knee 12 (2005) 424-434

Tested knee at different flexion angles between 0 and 90 degrees and applying different quadriceps forces of 3, 137 and 411N. Investigated the effects of changing the location and magnitude of the restraining force on a model consisting of 3 bony structures. It also had the articular cartilage layers, menisci, the principal ligaments the quadricep muscle and the patellar tendon. The quadriceps forces significantly increased the anterior cruciate ligament, patellar tendon and contact forces/areas as well as the joint restraining moments. By increasing the flexion angle, however, all were diminished with the exception of the patella femoral contact force/area which increased in flexion. 
It was found that almost the entire applied quadriceps force was supported by the patellar tendon. The forces in the anterior cruciate ligament and patellar tendon decreased with increasing flexion where as the posterior cruciate ligament only initiates its mechanical role at larger angles of flexion. 
The forces in the collateral ligaments remained small at all the tested angles and quadriceps forces. 
This is all useful information when understanding the working of the knee and how the loading within the joint varies with different activities.

Nagura, T, Dyrby, C.O, Alexander, E.J, Andriacchi, T.P. Mechanical loads at the knee joint during deep flexion. Journal of Orthopaedic Research 20 (2002) 881-886

Surgical techniques and prosthesis design have been greatly developed meaning that the range of motions, after a total knee anthroplasty, that a patient is able to manage has improved. This study compared the mechanical loads during activities requiring deep flexion to those during walking and stair climbing. It was found that net quadricep momets and net posterior forces were larger during deep flexion, than during routine activities. These peaked between 90 and 150 degrees. These large forces and moments will result in high stresses at high angles of flexion and can influence pathological changes to the joint. These are important considerations for reconstructive procedures on the knee. It is also the mechanics of the knee in deep flexion that are likely to be a causing factor of posterior instability in total knee anthroplasty surgery. 

Moore, K.L and Dalley, A.F. Clinically Oriented Anatomy. 4th Edition (Maryland:Lippincott Williams & Wilkins, 1999)

This reference was used to aid in the determination of muscle attachment points when creating our model. It also gives full details of the anatomy of the knee and the purpose of each muscle and ligament.

Opensim Tutorials,

These tutorials gave us an understanding of how Opensim operates and what information it can produce. These tutorials also gave example models that could be used for comparison of muscle forces against our model femur. Opensim also has muscle geometry which could allow us to match the geometry in our FE analysis.

This Website provides the information on every muscle in the lower leg. It details the origin, insertion and action of each muscle. This website was used to identify all the relevant muscles to our thesis. It then aided us in producing our 3D model of the knee bone.
Website References

  8. From Noel Conlisk, Phd student, Edinburgh University

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