Surgical parameters influence paediatric knee kinematics and cartilage stresses in anterior cruciate ligament reconstruction: Navigating subject‐specific variability using neuromusculoskeletal‐finite element modelling analysis

Purpose Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the pat...

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Veröffentlicht in:	Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA Jg. 33; H. 3; S. 817 - 827
Hauptverfasser:	Dastgerdi, Ayda Karimi, Esrafilian, Amir, Carty, Christopher P., Nasseri, Azadeh, Barzan, Martina, Korhonen, Rami K., Astori, Ivan, Hall, Wayne, Saxby, David John
Format:	Journal Article
Sprache:	Englisch
Veröffentlicht:	Germany John Wiley and Sons Inc 01.03.2025
Schlagworte:	Adolescent Anterior Cruciate Ligament Injuries - physiopathology Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Biomechanical Phenomena biomechanics cartilage Cartilage, Articular - physiology Cartilage, Articular - physiopathology Child computational modelling Female Finite Element Analysis gait Humans in silico Knee Knee Joint - physiology Knee Joint - physiopathology Knee Joint - surgery Male precision medicine Stress, Mechanical surgical planning knee gait cartilage computational modelling precision medicine surgical planning biomechanics in silico
ISSN:	0942-2056, 1433-7347, 1433-7347
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Abstract	Purpose Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early‐onset knee osteoarthritis. Methods This study employed a linked neuromusculoskeletal (NMSK)‐finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre‐tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%. Results Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large‐ and medium‐sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject‐specific nature of the knee and neuromuscular system. Conclusion Study findings underscore subject‐specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject‐specific factors to advance personalized surgical planning. Level of Evidence Level III.
AbstractList	Purpose Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early‐onset knee osteoarthritis. Methods This study employed a linked neuromusculoskeletal (NMSK)‐finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre‐tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%. Results Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large‐ and medium‐sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject‐specific nature of the knee and neuromuscular system. Conclusion Study findings underscore subject‐specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject‐specific factors to advance personalized surgical planning. Level of Evidence Level III. Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early-onset knee osteoarthritis. This study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%. Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system. Study findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning. Level III. Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early-onset knee osteoarthritis.PURPOSEAnterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction (ACLR) to restore knee stability. However, ACLR substantially alters knee biomechanics (e.g., motion and tissue mechanics) placing the patient at elevated risk of early-onset knee osteoarthritis.This study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%.METHODSThis study employed a linked neuromusculoskeletal (NMSK)-finite element (FE) model to determine effects of four critical ACLR surgical parameters (graft type, size, location and pre-tension) on tibial articular cartilage stresses in three paediatric knees of different sizes during walking. Optimal surgical combinations were defined by minimal kinematic and tibial cartilage stress deviations in comparison to a corresponding intact healthy knee, with substantial deviations defined by normalized root mean square error (nRMSE) > 10%.Results showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system.RESULTSResults showed unique trends of principal stress deviations across knee sizes with small knee showing least deviation from intact knee, followed by large- and medium-sized knees. The nRMSE values for cartilage stresses displayed notable variability across different knees. Surgical combination yielding the highest nRMSE in comparison to the one with lowest nRMSE resulted in an increase of maximum principal stress on the medial tibial cartilage by 18.0%, 6.0% and 1.2% for small, medium and large knees, respectively. Similarly, there was an increase of maximum principal stress on lateral tibial cartilage by 11.2%, 4.1% and 12.7% for small, medium and large knees, respectively. Knee phenotype and NMSK factors contributed to deviations in knee kinematics and tibial cartilage stresses. Although optimal surgical configurations were found for each knee size, no generalizable trends emerged emphasizing the subject-specific nature of the knee and neuromuscular system.Study findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning.CONCLUSIONStudy findings underscore subject-specific complexities in ACLR biomechanics, necessitating personalized surgical planning for effective restoration of native motion and tissue mechanics. Future research should expand investigations to include a broader spectrum of subject-specific factors to advance personalized surgical planning.Level III.LEVEL OF EVIDENCELevel III.
Author	Barzan, Martina Hall, Wayne Carty, Christopher P. Nasseri, Azadeh Saxby, David John Esrafilian, Amir Astori, Ivan Korhonen, Rami K. Dastgerdi, Ayda Karimi
AuthorAffiliation	4 School of Engineering and Built Environment, Mechanical Engineering and Industrial Design Griffith University Gold Coast Queensland Australia 1 Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) Griffith University Gold Coast Queensland Australia 2 Department of Technical Physics University of Eastern Finland Kuopio Finland 3 Department of Orthopedics Children's Health Queensland Hospital and Health Service Brisbane Queensland Australia
AuthorAffiliation_xml	– name: 3 Department of Orthopedics Children's Health Queensland Hospital and Health Service Brisbane Queensland Australia – name: 2 Department of Technical Physics University of Eastern Finland Kuopio Finland – name: 4 School of Engineering and Built Environment, Mechanical Engineering and Industrial Design Griffith University Gold Coast Queensland Australia – name: 1 Griffith Centre of Biomedical and Rehabilitation Engineering (GCORE) Griffith University Gold Coast Queensland Australia
Author_xml	– sequence: 1 givenname: Ayda Karimi orcidid: 0009-0001-2150-9557 surname: Dastgerdi fullname: Dastgerdi, Ayda Karimi email: ayda.karimidastgerdi@griffithuni.edu.au organization: Griffith University – sequence: 2 givenname: Amir orcidid: 0000-0002-8321-8528 surname: Esrafilian fullname: Esrafilian, Amir organization: University of Eastern Finland – sequence: 3 givenname: Christopher P. surname: Carty fullname: Carty, Christopher P. organization: Children's Health Queensland Hospital and Health Service – sequence: 4 givenname: Azadeh surname: Nasseri fullname: Nasseri, Azadeh organization: Griffith University – sequence: 5 givenname: Martina surname: Barzan fullname: Barzan, Martina organization: Griffith University – sequence: 6 givenname: Rami K. surname: Korhonen fullname: Korhonen, Rami K. organization: University of Eastern Finland – sequence: 7 givenname: Ivan surname: Astori fullname: Astori, Ivan organization: Children's Health Queensland Hospital and Health Service – sequence: 8 givenname: Wayne surname: Hall fullname: Hall, Wayne organization: Griffith University – sequence: 9 givenname: David John surname: Saxby fullname: Saxby, David John organization: Griffith University
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Snippet	Purpose Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL... Anterior cruciate ligament (ACL) rupture is increasingly common in paediatric and adolescent populations, typically requiring surgical ACL reconstruction...
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SubjectTerms	Adolescent Anterior Cruciate Ligament Injuries - physiopathology Anterior Cruciate Ligament Injuries - surgery Anterior Cruciate Ligament Reconstruction - methods Biomechanical Phenomena biomechanics cartilage Cartilage, Articular - physiology Cartilage, Articular - physiopathology Child computational modelling Female Finite Element Analysis gait Humans in silico Knee Knee Joint - physiology Knee Joint - physiopathology Knee Joint - surgery Male precision medicine Stress, Mechanical surgical planning
Title	Surgical parameters influence paediatric knee kinematics and cartilage stresses in anterior cruciate ligament reconstruction: Navigating subject‐specific variability using neuromusculoskeletal‐finite element modelling analysis
URI	https://onlinelibrary.wiley.com/doi/abs/10.1002%2Fksa.12413 https://www.ncbi.nlm.nih.gov/pubmed/39105430 https://www.proquest.com/docview/3089515028 https://pubmed.ncbi.nlm.nih.gov/PMC11848988
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