Anterior cruciate ligament reconstruction with special reference to magnetic resonance imaging of the postoperative outcome

Anterior cruciate ligament (ACL) tear is a common sports injury of the knee. Arthroscopic reconstruction using autogenous graft material is widely used for patients with ACL instability. The grafts most commonly used are the patellar and the hamstring tendons, by various fixation techniques. Although clinical evaluation and conventional radiography are routinely used in follow-up after ACL surgery, magnetic resonance imaging (MRI) plays an important role in the diagnosis of complications after ACL surgery. The aim of this thesis was to study the clinical outcome of patellar and hamstring tendon ACL reconstruction techniques. In addition, the postoperative appearance of the ACL graft was evaluated using several MRI sequences. Of the 175 patients who underwent an arthroscopically assisted ACL reconstruction, 99 patients were randomized into patellar tendon (n=51) or hamstring tendon (n=48) groups. In addition, 62 patients with hamstring graft ACL reconstruction were randomized into either cross-pin (n=31) or interference screw (n=31) fixation groups. Follow-up evaluation determined knee laxity, isokinetic muscle performance and several knee scores. Lateral and anteroposterior view radiographs were obtained. Several MRI sequences were obtained with a 1.5-T imager. The appearance and enhancement pattern of the graft and periligamentous tissue, and the location of bone tunnels were evaluated. After MRI, arthroscopy was performed on 14 symptomatic knees. The results revealed no significant differences in the 2-year outcome between the groups. In the hamstring tendon group, the average femoral and tibial bone tunnel diameter increased during 2 years follow-up by 33% and 23%, respectively. In the asymptomatic knees, the graft showed homogeneous and low signal intensity with periligamentous streaks of intermediate signal intensity on T2-weighted MR images. In the symptomatic knees, arthroscopy revealed 12 abnormal grafts and two meniscal tears, each with an intact graft. Among 3 lax grafts visible on arthroscopy, MRI showed an intact graft and improper bone tunnel placement. For diagnosing graft failure, all MRI findings combined gave a specificity of 90% and a sensitivity of 81%. In conclusion, all techniques appeared to improve patients' performance, and were therefore considered as good choices for ACL reconstruction. In follow-up, MRI permits direct evaluation of the ACL graft, the bone tunnels, and additional disorders of the knee. Bone tunnel enlargement and periligamentous tissue showing contrast enhancement were non-specific MRI findings that did not signify ACL deficiency. With an intact graft and optimal femoral bone tunnel placement, graft deficiency is unlikely, and the MRI examination should be carefully scrutinized for possible other causes for the patients symptoms.

Magnetic resonance imaging and ultrasonography in brachial plexus birth injury

Brachial plexus birth injury (BPBI) is caused by stretching, tearing or avulsion of the C5-C8 or Th1 nerve roots during delivery. Foetal-maternal disproportion is the main reason for BPBI. The goal of this study was to find out the incidence of posterior subluxation of the humeral head during first year of life in BPBI and optimal timing of the ultrasonographic screening of the glenohumeral joint. The glenohumeral congruity and posterior subluxation of the humeral head associated to muscle atrophy were assessed and surgical treatment of the shoulder girdle as well as muscle changes in elbow flexion contracture were evaluated. The prospective, population based part of the study included all neonates born in Helsinki area during years 2003-2006. Patients with BPBI sent to the Hospital for Children and Adolescents because of decreased external rotation, internal rotation contracture or deformation of the glenohumeral joint as well as patients with elbow flexion contracture were also included in this prospective study. The incidence of BPBI was calculated to be 3.1/1000 newborns in Helsinki area. About 80% of the patients with BPBI recover totally during the follow-up within the first year of life. Permanent plexus injury at the age of one year was noted in 20% of the patients (0.64/1000 newborns). Muscle imbalance resulted in sonographically detected posterior subluxation in one third of the patients with permanent BPBI. If muscle imbalance and posterior subluxation are left untreated bony deformities will develop. All patients with internal rotation contracture of the glenohumeral joint presented muscle atrophy of the rotator cuff muscles. Especially subscapular and infraspinous muscles were affected. A correlation was found particularly between greatest thickness of subscapular muscle and subluxation of the humeral head, degree of glenoid retroversion, as well as amount of internal rotation contracture. Supinator muscle atrophy was evident among all the studied patients with elbow flexion contracture. Brachial muscle pathology seemed to be an important factor for elbow flexion contracture in BPBI. Residual dysfunction of the upper extremity may require operative treatment such as tendon lengthening, tendon transfers, relocation of the humeral head or osteotomy of the humerus. Relocation of the humeral head improved the glenohumeral congruency among patients under 5 years of age. Functional improvement without remodeling of the glenohumeral joint was achieved by other reconstructive procedures. In conclusion: Shoulder screening by US should be done to all patients with permanent BPBI at the age of 3 and 6 months. Especially atrophy of the subscapular muscle correlates with glenohumeral deformity and posterior subluxation of the humeral head, which has not been reported in previous studies. Permanent muscle changes are the main reason for diminished range of motion of the elbow and forearm. Relocation of the humeral head, when needed, should be performed under the age of 5 years.

海洋平台张力腿非线性动力响应

采用非线性梁模型,充分考虑张力腿轴向与流向的耦合效应及平台运动对张力腿的作用,运用Galerkin法进行分析求解,研究不同的长径比(L/D)情况下,弯曲刚度和非线性耦合效应的影响,以期得到更适用于实际的张力腿简化模型.

线性张力腿模型与非线性模型的比较研究

平台运动对张力腿的非线性动力响应具有显著的影响.提出了新的更加符合实际的边界条件,分别采用线性的 Euler-Bernoulli梁和非线性梁模型,分析了在不同的张力腿长度和平台激励条件下,线性张力腿模型与非线性模型在预测其动力响应时所得结果的差异.为了保证数值计算的正确性和可靠性,运用了两种不同的计算方法;Galerkin法,有限差分法进行数值求解.结果表明:非线性模型所得的张力腿流向响应幅值要比线性模型的小,且随着张力腿长度以及平台纵荡幅值的增加,非线性模型与线性模型的预测结果之间的差异会变得越来越显著.

深水张力腿平台与系泊系统的耦合动力响应

把张力腿简化为非线性梁结构,运用Hamilton原理,推导出平面情况下平台本体与张力腿系泊系统的耦合运动方程及边界条件;分析了不同流场条件下,两种不同张力腿模型(非线性梁和无质量弹簧模型)对平台动力响应预测结果的影响;分析结果表明:随着流场条件的不同,采用不同的张力腿简化模型得到的平台动力响应预测结果具有明显的不同.阐明了两种模型所得结果产生差异的原因.

Efeitos do uso de antiinflamatório e do exercício aeróbico sobre a regeneração tecidual e perfil biomecânico do tendão calcâneo de ratos após ruptura completa

Ruptura do tendão calcâneo é uma das lesões tendíneas mais frequentes. Embora a maioria dos trabalhos sugira que o exercício seja benéfico na cicatrização tendínea, não há consenso sobre o efeito do antiinflamatório neste contexto. Trabalhos experimentais tentam reproduzir lesão aguda deste tendão, em diferentes espécies animais. Neste estudo, descrevemos uma técnica de tenotomia completa do tendão calcâneo direito em ratos e, em seguida, avaliamos os efeitos do uso do antiinflamatório e do exercício aeróbico, isoladamente e em combinação, sobre a proliferação celular e o perfil biomecânico do tendão calcâneo, durante o processo de cicatrização após tenotomia. Estudo experimental com 156 ratos machos adultos, da raça Wistar, com idade média de 3 meses e peso médio de 300g. Após anestesia com tiopental e com auxílio da microscopia de luz, foi realizada incisão longitudinal posterior de cinco milímetros, em direção proximal, a partir da tuberosidade posterior do calcâneo da pata direita do rato. Foi feito corte transversal do tendão calcâneo, a sete milímetros da tuberosidade do calcâneo, com preservação do tendão plantar. Utilizamos as técnicas de Hematoxilina e Eosina, Picrosirius-red e Resorcina-fucsina de Weigert para avaliação da cicatrização tendínea e das fibras dos sistemas colágeno e elástico. Após a tenotomia, metade dos animais receberam tenoxicam intramuscular por 7 dias e no 8o dia iniciou-se protocolo de exercício em esteira na metade de cada grupo. Os ratos foram divididos aleatoriamente em 4 grupos de tratamento: A sem antiinflamatório E sem exercício (controle); B com antiinflamatório E com exercício; C sem antiinflamatório E com exercício; D com antiinflamatório E sem exercício. Os animais foram eutanasiados com 1, 2, 4 e 8 semanas após a tenotomia, para avaliação histológica pelo PCNA, e biomecânica através do teste de resistência à tração e da medida do ciclo locomotor. Foram realizados análise de variância, teste de Kruskal-Wallis e o método de Bonferroni, no programa R Project, versão 2.11.1. O tempo cirúrgico médio foi de 1 minuto e 24 segundos, sem complicações observadas até a 8a semana pós-operatória. Observamos proliferação celular e fibrilogênese com duas semanas, e diminuição da celularidade e das fibras elásticas na 8a semana, além de mudanças na organização estrutural do sistema colágeno. Encontramos pico da imunomarcação com PCNA na 2a semana em todos os grupos, exceto no grupo A, cujo pico aconteceu com 1 semana da tenotomia. Evidenciamos resistência à tração significativamente maior (p=0,02) nos ratos submetidos ao exercício, 8 semanas após ruptura. Nos grupos com antiinflamatório, observamos um ciclo locomotor mais estável durante todo o tempo avaliado. Consideramos a técnica cirúrgica experimental de tenotomia completa do tendão calcâneo, realizada com auxílio da microscopia de luz e preservação do tendão plantar, simples, rápida, com sinais de cicatrização tendínea normal e de fácil reprodução em ratos. O exercício aeróbico, iniciado precocemente após tenotomia completa do tendão calcâneo, é significativamente benéfico na sua recuperação biomecânica e o uso combinado com antiinflamatório confere maior estabilidade na marcha, o que pode proteger contra rerruptura tendínea em ratos

Analysis of the Response Speed of Musculature of the Knee in Professional Male and Female Volleyball Players

The aim of this study was to evaluate the normalized response speed (Vrn) of the knee musculature (flexor and extensor) in high competitive level volleyball players using tensiomyography (TMG) and to analyze the muscular response of the vastus medialis (VM), rectus femoris (RF), vastus lateralis (VL), and biceps femoris (BF) in accordance with the specific position they play in their teams. One hundred and sixty-six players (83 women and 83 men) were evaluated. They belonged to eight teams in the Spanish women's superleague and eight in the Spanish men's superleague. The use of Vrn allows avoiding possible sample imbalances due to anatomical and functional differences and demands. We found differences between Vrn in each of the muscles responsible for extension (VM, RF, and VL) and flexion (BF) regardless of the sex. Normalized response speed differences seem to be larger in setters, liberos and outside players compared to middle blockers and larger in males when compared to females. These results of Vrn might respond to the differences in the physical and technical demands of each specific position, showing an improved balance response of the knee extensor and flexor musculature in male professional volleyball players.

Efeito da estimulação transcraniana por corrente contínua sobre o desempenho físico: análise das respostas cerebrais, metabólicas e perceptivas durante e após exercícios aeróbio e de força

Estimulação transcraniana por corrente contínua (ETCC) sobre áreas corticais pré-selecionadas, tem aumentado o desempenho físico de diferentes populações. Porém, lacunas persistem no tocante aos mecanismos subjacentes à estes efeitos. Assim, a presente tese objetivou: a) investigar os efeitos da ETCC anódica (aETCC) e placebo (Sham) no córtex motor (CM) de indivíduos saudáveis sobre o desempenho de força máxima; b) comparar os efeitos da ETCC sobre a produção de força máxima e estabilidadade da força durante exercícios máximo e submáximo em sujeitos hemiparéticos e saudáveis; c) investigar o efeito da ETCC sobre a conectividade funcional inter-hemisférica (coerência eletroencefalográfica cEEG) do córtex pré-frontal (CPF), desempenho aeróbio e dispêndio energético (EE) durante e após exercício máximo e submáximo. No 1 estudo, 14 adultos saudáveis executaram 2 sessões de exercício máximo de força (EMF) dos músculos flexores e extensores do joelho dominante (3 séries de 10 rep máximas), precedidos por aETCC ou Sham (2mA; 20 mim). aETCC não foi capaz de aumentar o trabalho total e pico de torque (PT), resistência à fadiga ou atividade eletromiográfica durante o EMF. No 2 estudo, 10 hemiparéticos e 9 sujeitos saudáveis receberam aETCC e Sham no CM. O PT e a estabilidade da força (coeficiente de variação - CV) foram avaliados durante protocolo máximo e submáximo de extensão e flexão unilateral do joelho (1 série de 3 reps a 100% do PT e 2 séries de 10 reps a 50% do PT). Nenhuma diferença no PT foi observada nos dois grupos. Diminuições no CV foram obervadas durante a extensão (~25-35%, P<0.001) e flexão de joelho (~22-33%, P<0.001) após a aETCC comparada com Sham nos hemiparéticos, entretanto, somente o CV na extensão de joelhos diminuiu (~13-27%, P<0.001) nos saudáveis, o que sugere que aETCC pode melhorar o CV, mas não o PT em sujeitos hemiparéticos. No 3 estudo, 9 adultos saudáveis realizaram 2 testes incrementais máximos precedidos por aETCC ou Sham sobre o CPF com as respostas cardiorrespiratórias, percepção de esforço (PSE) e cEEG do CPF sendo monitoradas. O VO2 de pico (42.64.2 vs. 38.23.3 mL.kg.min-1; P=0,02), potência total (252.776.5 vs. 23773.3 W; P=0,05) e tempo de exaustão (531.1140 vs. 486.7115.3 seg; P=0,04) foram maiores após aETCC do que a Sham. Nenhuma diferença foi encontrada para FC e PSE em função da carga de trabalho (P>0,05). A cEEG do CPF aumentou após aETCC vs. repouso (0.700.40 vs. 0.380.05; P=0,001), mas não após Sham vs. repouso (0.360.49 vs. 0.330.50; P=0,06), sugerindo que a aETCC pode retardar a fadiga aumentando a conectividade funcional entre os hemisférios do CPF e desempenho aeróbio durante exercício exaustivo. No 4 estudo, o VO2 e EE foram avaliados em 11 adultos saudáveis antes, durante a aETCC ou Sham no CPF e 30 min após exercício aeróbio submáximo isocalórico (~200kcal). Diferenças não foram observadas no VO2 vs. repouso durante aETCC e Sham (P=0.95 e P=0.85). Porém, a associação entre exercício e aETCC aumentou em ~19% o EE após ao menos, 30 min de recuperação após exercício quando comparada a Sham (P<0,05).

Effects of solution exposure on the combined axial-shear behaviour of unidirectional CFRP rods

In fibre reinforced polymer (FRP) prestressed concrete applications, an FRP tendon must sustain high axial tensile stresses and, if cracks occur, additional dowel forces. The tendon may also be exposed to solutions and so the combined axial-shear stress performance after long-term environmental exposure is important. Experiments were conducted to investigate the combined axial-shear stress failure envelope for unidirectional carbon FRP tendons which had been exposed to either water, salt water or concrete pore solution at 60 °C for approximately 18 months. The underlying load resisting mechanisms were found to depend on the loading configuration, restraint effects and the initial stress state. When saturated, CFRP tendons are likely to exhibit a reduced shear stiffness. However, the ultimate limit state appeared to be fibre-dominated and was therefore less susceptible to reductions due to solution uptake effects. © 2012 Elsevier Ltd. All rights reserved.

Award Winner in the Young Investigator Category, 2014 Society for Biomaterials Annual Meeting and Exposition, Denver, Colorado, April 16-19, 2014: Periodically perforated core-shell collagen biomaterials balance cell infiltration, bioactivity, and mechanical properties.

Orthopedic tissue engineering requires biomaterials with robust mechanics as well as adequate porosity and permeability to support cell motility, proliferation, and new extracellular matrix (ECM) synthesis. While collagen-glycosaminoglycan (CG) scaffolds have been developed for a range of tissue engineering applications, they exhibit poor mechanical properties. Building on previous work in our lab that described composite CG biomaterials containing a porous scaffold core and nonporous CG membrane shell inspired by mechanically efficient core-shell composites in nature, this study explores an approach to improve cellular infiltration and metabolic health within these core-shell composites. We use indentation analyses to demonstrate that CG membranes, while less permeable than porous CG scaffolds, show similar permeability to dense materials such as small intestine submucosa (SIS). We also describe a simple method to fabricate CG membranes with organized arrays of microscale perforations. We demonstrate that perforated membranes support improved tenocyte migration into CG scaffolds, and that migration is enhanced by platelet-derived growth factor BB-mediated chemotaxis. CG core-shell composites fabricated with perforated membranes display scaffold-membrane integration with significantly improved tensile properties compared to scaffolds without membrane shells. Finally, we show that perforated membrane-scaffold composites support sustained tenocyte metabolic activity as well as improved cell infiltration and reduced expression of hypoxia-inducible factor 1α compared to composites with nonperforated membranes. These results will guide the design of improved biomaterials for tendon repair that are mechanically competent while also supporting infiltration of exogenous cells and other extrinsic mediators of wound healing.

Bipedal walking and running with spring-like biarticular muscles.

Compliant elements in the leg musculoskeletal system appear to be important not only for running but also for walking in human locomotion as shown in the energetics and kinematics studies of spring-mass model. While the spring-mass model assumes a whole leg as a linear spring, it is still not clear how the compliant elements of muscle-tendon systems behave in a human-like segmented leg structure. This study presents a minimalistic model of compliant leg structure that exploits dynamics of biarticular tension springs. In the proposed bipedal model, each leg consists of three leg segments with passive knee and ankle joints that are constrained by four linear tension springs. We found that biarticular arrangements of the springs that correspond to rectus femoris, biceps femoris and gastrocnemius in human legs provide self-stabilizing characteristics for both walking and running gaits. Through the experiments in simulation and a real-world robotic platform, we show how behavioral characteristics of the proposed model agree with basic patterns of human locomotion including joint kinematics and ground reaction force, which could not be explained in the previous models.

Learning legged locomotion

Legged locomotion of biological systems can be viewed as a self-organizing process of highly complex system-environment interactions. Walking behavior is, for example, generated from the interactions between many mechanical components (e.g., physical interactions between feet and ground, skeletons and muscle-tendon systems), and distributed informational processes (e.g., sensory information processing, sensory-motor control in central nervous system, and reflexes) [21]. An interesting aspect of legged locomotion study lies in the fact that there are multiple levels of self-organization processes (at the levels of mechanical dynamics, sensory-motor control, and learning). Previously, the self-organization of mechanical dynamics was nicely demonstrated by the so-called Passive Dynamic Walkers (PDWs; [18]). The PDW is a purely mechanical structure consisting of body, thigh, and shank limbs that are connected by passive joints. When placed on a shallow slope, it exhibits natural bipedal walking dynamics by converting potential to kinetic energy without any actuation. An important contribution of these case studies is that, if designed properly, mechanical dynamics can generate a relatively complex locomotion dynamics, on the one hand, and the mechanical dynamics induces self-stability against small disturbances without any explicit control of motors, on the other. The basic principle of the mechanical self-stability appears to be fairly general that there are several different physics models that exhibit similar characteristics in different kinds of behaviors (e.g., hopping, running, and swimming; [2, 4, 9, 16, 19]), and a number of robotic platforms have been developed based on them [1, 8, 13, 22]. © 2009 Springer London.

Analysis of structural health monitoring data from hammersmith flyover

There has recently been considerable research published on the applicability of monitoring systems for improving civil infrastructure management decisions. Less research has been published on the challenges in interpreting the collected data to provide useful information for engineering decision makers. This paper describes some installed monitoring systems on the Hammersmith Flyover, a major bridge located in central London (United Kingdom). The original goals of the deployments were to evaluate the performance of systems for monitoring prestressing tendon wire breaks and to assess the performance of the bearings supporting the bridge piers because visual inspections had indicated evidence of deterioration in both. This paper aims to show that value can be derived from detailed analysis of measurements from a number of different sensors, including acoustic emission monitors, strain, temperature and displacement gauges. Two structural monitoring systems are described, a wired system installed by a commercial contractor on behalf of the client and a research wireless deployment installed by the University of Cambridge. Careful interpretation of the displacement and temperature gauge data enabled bearings that were not functioning as designed to be identified. The acoustic emission monitoring indicated locations at which rapid deterioration was likely to be occurring; however, it was not possible to verify these results using any of the other sensors installed and hence the only method for confirming these results was by visual inspection. Recommendations for future bridge monitoring projects are made in light of the lessons learned from this monitoring case study. © 2014 This work is made available under the terms of the Creative Commons Attribution 4.0 International license,.

Dexterous Robotic Hands: Kinematics and Control

This report presents issues relating to the kinematics and control of dexterous robotic hands using the Utah-MIT hand as an illustrative example. The emphasis throughout is on the actual implementation and testing of the theoretical concepts presented. The kinematics of such hands is interesting and complicated owing to the large number of degrees of freedom involved. The implementation of position and force control algorithms on such tendon driven hands has previously suffered from inefficient formulations and a lack of sophisticated computer hardware. Both these problems are addressed in this report. A multiprocessor architecture has been built with high performance microcomputers on which real-time algorithms can be efficiently implemented. A large software library has also been built to facilitate flexible software development on this architecture. The position and force control algorithms described herein have been implemented and tested on this hardware.

Contact Sensors for Dexterous Robotic Hands

This thesis examines a tactile sensor and a thermal sensor for use with the Utah-MIT dexterous four fingered hand. Sensory feedback is critical or full utilization of its advanced manipulatory capabilities. The hand itself provides tendon tensions and joint angles information. However, planned control algorithms require more information than these sources can provide. The tactile sensor utilizes capacitive transduction with a novel design based entirely on silicone elastomers. It provides an 8 x 8 array of force cells with 1.9 mm center-to-center spacing. A pressure resolution of 8 significant bits is available over a 0 to 200 grams per square mm range. The thermal sensor measures a material's heat conductivity by radiating heat into an object and measuring the resulting temperature variations. This sensor has a 4 x 4 array of temperature cells with 3.5 mm center-to-center spacing. Experiments show that the thermal sensor can discriminate among material by detecting differences in their thermal conduction properties. Both sensors meet the stringent mounting requirements posed by the Utah-MIT hand. Combining them together to form a sensor with both tactile and thermal capabilities will ultimately be possible. The computational requirements for controlling a sensor equipped dexterous hand are severe. Conventional single processor computers do not provide adequate performance. To overcome these difficulties, a computational architecture based on interconnecting high performance microcomputers and a set of software primitives tailored for sensor driven control has been proposed. The system has been implemented and tested on the Utah-MIT hand. The hand, equipped with tactile and thermal sensors and controlled by its computational architecture, is one of the most advanced robotic manipulatory devices available worldwide. Other ongoing projects will exploit these tools and allow the hand to perform tasks that exceed the capabilities of current generation robots.