Insights into patellofemoral kinematics and cartilage stresses following paediatric anterior cruciate ligament reconstruction: An exploratory in silico study

IF 2.4 3区医学 Q3 BIOPHYSICS

Journal of biomechanics Pub Date : 2025-08-18 DOI:10.1016/j.jbiomech.2025.112924

Ayda Karimi Dastgerdi , Amir Esrafilian , Christopher P. Carty , Alireza Y. Bavil , Rami K. Korhonen , Ivan Astori , Wayne Hall , David John Saxby

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引用次数: 0

Abstract

Anterior cruciate ligament (ACL) injuries are prevalent among physically active paediatric and adolescent populations, often necessitating ACL-reconstruction (ACLR) to restore passive knee stability. Complications in the patellofemoral joint (PFJ), such as pain and early osteoarthritis, are common following ACLR. Despite these concerns, post-ACLR PFJ biomechanics remain insufficiently studied. This study aimed to explore the influence of ACLR surgical parameters and subject-specific factors (i.e., knee phenotype, neuromusculoskeletal function) on PFJ biomechanics using an in-silico neuromusculoskeletal (NMSK)-finite element (FE) modeling approach. Three subject-specific NMSK-FE models were used to simulate the effects of four surgical parameters (graft type, size, location, and pre-tension) on PFJ biomechanics (kinematics and cartilage stresses) during walking. Additionally, ACL-deficient (ACLD) models were included to compare PFJ biomechanics in the absence of ACLR. Each surgical combination and ACLD were compared to a corresponding intact knee. Normalized root-mean-square error (nRMSE) quantified deviations in PFJ biomechanics among ACLR, ACLD, and intact knees. PFJ biomechanics in ACLD knees consistently deviated more from intact knees than those in ACLR models, underscoring the restorative effect of reconstruction. Most ACLR surgical combinations restored PFJ kinematics and stress to near intact levels (nRMSE < 10 %) for two participants. In contrast, ∼80.2 % of combinations resulted in substantial deviations (nRMSE > 10 %) for one participant, potentially increasing the risk of cartilage degeneration. Subject-specific factors influenced PFJ outcomes but showed no consistent trends. These findings emphasize the importance of incorporating individualized geometry and loading in simulations to optimize ACLR for biomechanical outcomes. This study provides the first comprehensive evaluation of surgical parameter effects on paediatric PFJ biomechanics following ACLR.

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儿童前交叉韧带重建后髌股运动学和软骨应力的见解：一项探索性的计算机研究

前交叉韧带（ACL）损伤在体力活跃的儿童和青少年人群中很普遍，通常需要ACL重建（ACLR）来恢复被动膝关节稳定性。髌股关节（PFJ）的并发症，如疼痛和早期骨关节炎，是ACLR后常见的。尽管存在这些担忧，但aclr后PFJ的生物力学研究仍然不够充分。本研究旨在探讨ACLR手术参数和受试者特异性因素（即膝关节表型，神经肌肉骨骼功能）对PFJ生物力学的影响，采用计算机神经肌肉骨骼(NMSK)-有限元（FE）建模方法。使用三个受试者特异性NMSK-FE模型来模拟四种手术参数（移植物类型、大小、位置和预张力）对行走期间PFJ生物力学（运动学和软骨应力）的影响。此外，还包括acl缺陷（ACLD）模型，以比较无ACLR时PFJ的生物力学。将每个手术组合和ACLD与相应的完整膝关节进行比较。标准化均方根误差（nRMSE）量化了ACLR、ACLD和完整膝关节间PFJ生物力学的偏差。与ACLR模型相比，ACLD模型的膝关节PFJ生物力学与完整膝关节的偏差更大，强调了重建的修复作用。大多数ACLR手术组合将两名参与者的PFJ运动学和应力恢复到接近完整的水平（nRMSE < 10%）。相比之下，约80.2%的联合导致一名参与者出现严重偏差（nRMSE > 10%），潜在地增加了软骨退变的风险。受试者特异性因素影响PFJ的结果，但没有一致的趋势。这些发现强调了在模拟中结合个性化几何和载荷来优化ACLR生物力学结果的重要性。本研究首次全面评估了ACLR术后手术参数对小儿PFJ生物力学的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of biomechanics 生物-工程：生物医学

CiteScore

5.10

自引率

4.20%

发文量

345

审稿时长

1 months

期刊介绍： The Journal of Biomechanics publishes reports of original and substantial findings using the principles of mechanics to explore biological problems. Analytical, as well as experimental papers may be submitted, and the journal accepts original articles, surveys and perspective articles (usually by Editorial invitation only), book reviews and letters to the Editor. The criteria for acceptance of manuscripts include excellence, novelty, significance, clarity, conciseness and interest to the readership. Papers published in the journal may cover a wide range of topics in biomechanics, including, but not limited to: -Fundamental Topics - Biomechanics of the musculoskeletal, cardiovascular, and respiratory systems, mechanics of hard and soft tissues, biofluid mechanics, mechanics of prostheses and implant-tissue interfaces, mechanics of cells. -Cardiovascular and Respiratory Biomechanics - Mechanics of blood-flow, air-flow, mechanics of the soft tissues, flow-tissue or flow-prosthesis interactions. -Cell Biomechanics - Biomechanic analyses of cells, membranes and sub-cellular structures; the relationship of the mechanical environment to cell and tissue response. -Dental Biomechanics - Design and analysis of dental tissues and prostheses, mechanics of chewing. -Functional Tissue Engineering - The role of biomechanical factors in engineered tissue replacements and regenerative medicine. -Injury Biomechanics - Mechanics of impact and trauma, dynamics of man-machine interaction. -Molecular Biomechanics - Mechanical analyses of biomolecules. -Orthopedic Biomechanics - Mechanics of fracture and fracture fixation, mechanics of implants and implant fixation, mechanics of bones and joints, wear of natural and artificial joints. -Rehabilitation Biomechanics - Analyses of gait, mechanics of prosthetics and orthotics. -Sports Biomechanics - Mechanical analyses of sports performance.