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Journal of Orthopaedic Surgery and Research

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Open Access 01-12-2024 | Research article

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

Authors: Jason Koh, Nirav Mungalpara, Sunjung Kim, Asheesh Bedi, Mark Hutchinson, Farid Amirouche

Published in: Journal of Orthopaedic Surgery and Research | Issue 1/2024

Abstract

Introduction

The escalating incidence of anterior cruciate ligament (ACL) injuries, particularly among adolescents, is a pressing concern. The study of ACL biomechanics in this demographic presents challenges due to the scarcity of cadaveric specimens. This research endeavors to validate the adolescent porcine stifle joint as a fitting model for ACL studies.

Methods

We conducted experiments on 30 fresh porcine stifle knee joints. (Breed: Yorkshire, Weight: avg 90 lbs, Age Range: 2–4 months). They were stored at − 22 °C and a subsequent 24-h thaw at room temperature before being prepared for the experiment. These joints were randomly assigned to three groups. The first group served as a control and underwent only the load-to-failure test. The remaining two groups were subjected to 100 cycles, with forces of 300N and 520N, respectively. The load values of 300N and 520N correspond to three and five times the body weight (BW) of our juvenile porcine, respectively.

Result

The 520N force demonstrated a higher strain than the 300N, indicating a direct correlation between ACL strain and augmented loads. A significant difference in load-to-failure (p = 0.014) was observed between non-cyclically loaded ACLs and those subjected to 100 cycles at 520N. Three of the ten samples in the 520N group failed before completing 100 cycles. The ruptured ACLs from these tests closely resembled adolescent ACL injuries in detachment patterns. ACL stiffness was also measured post-cyclical loading by applying force and pulling the ACL at a rate of 1 mm per sec. Moreover, ACL stiffness measurements decreased from 152.46 N/mm in the control group to 129.42 N/mm after 100 cycles at 300N and a more significant drop to 86.90 N/mm after 100 cycles at 520N. A one-way analysis of variance (ANOVA) and t-test were chosen for statistical analysis.

Conclusions

The porcine stifle joint is an appropriate model for understanding ACL biomechanics in the skeletally immature demographic. The results emphasize the ligament’s susceptibility to injury under high-impact loads pertinent to sports activities. The study advocates for further research into different loading scenarios and the protective role of muscle co-activation in ACL injury prevention.

sports-and-exercise.pdf [Internet]. [cited 2023 Oct 1]. Available from: https://www.bls.gov/spotlight/2017/sports-and-exercise/pdf/sports-and-exercise.pdf.

Bates NA, McPherson AL, Rao MB, Myer GD, Hewett TE. Characteristics of inpatient anterior cruciate ligament reconstructions and concomitant injuries. Knee Surg Sports Traumatol Arthrosc. 2016;24(9):2778–86.PubMedCrossRef

Alghamdi W, Alzahrani A, Alsuwaydi A, Alzahrani A, Albaqqar O, Fatani M, et al. Prevalence of cruciate ligaments injury among physical education students of Umm Al-Qura university and the relation between the dominant body side and ligament injury side in non-contact injury type. Am J Med Med Sci. 2017;7(1):14–9.

Hewett TE, Lindenfeld TN, Riccobene JV, Noyes FR. The effect of neuromuscular training on the incidence of knee injury in female athletes. A prospective study. Am J Sports Med. 1999;27(6):699–706.PubMedCrossRef

Dodwell ER, Lamont LE, Green DW, Pan TJ, Marx RG, Lyman S. Twenty years of pediatric anterior cruciate ligament reconstruction in New York state. Am J Sports Med. 2014;42(3):675–80.PubMedCrossRef

Wojtys EM, Beaulieu ML, Ashton-Miller JA. New perspectives on ACL injury: on the role of repetitive sub-maximal knee loading in causing ACL fatigue failure. J Orthop Res. 2016;34(12):2059–68.PubMedPubMedCentralCrossRef

Boden BP, Torg JS, Knowles SB, Hewett TE. Video analysis of anterior cruciate ligament injury: abnormalities in hip and ankle kinematics. Am J Sports Med. 2009;37(2):252–9.PubMedCrossRef

Olsen OE, Myklebust G, Engebretsen L, Bahr R. Injury mechanisms for anterior cruciate ligament injuries in team handball: a systematic video analysis. Am J Sports Med. 2004;32(4):1002–12.PubMedCrossRef

Boden BP, Sheehan FT, Torg JS, Hewett TE. Noncontact anterior cruciate ligament injuries: mechanisms and risk factors. J Am Acad Orthop Surg. 2010;18(9):520–7.PubMedPubMedCentralCrossRef

10.

Bauer J, Efe T, Herdrich S, Gotzen L, El-Zayat BF, Schmitt J, Timmesfeld N, Schofer MD. Torsional stability of interference screws derived from bovine bone-a biomechanical study. BMC Musculoskelet Disord. 2010;11:1–8. https://doi.org/10.1186/1471-2474-11-82.CrossRef

11.

Burgio V, Casari S, Milizia M, Sanna F, Spezia G, Civera M, et al. Mechanical properties of animal ligaments: a review and comparative study for the identification of the most suitable human ligament surrogates. Biomech Model Mechanobiol. 2023;22(5):1645–83.PubMedPubMedCentralCrossRef

12.

Dargel J, Koebke J, Brüggemann GP, Pennig D, Schmidt-Wiethoff R. Tension degradation of anterior cruciate ligament grafts with dynamic flexion–extension loading: a biomechanical model in porcine knees. Arthroscopy. 2009;25(10):1115–25.PubMedCrossRef

13.

Li X, He J, Bian W, Li Z, Zhang W, Li D, et al. A novel silk-based artificial ligament and tricalcium phosphate/polyether ether ketone anchor for anterior cruciate ligament reconstruction—safety and efficacy in a porcine model. Acta Biomater. 2014;10(8):3696–704.PubMedCrossRef

14.

Cone SG, Lambeth EP, Ru H, Fordham LA, Piedrahita JA, Spang JT, et al. Biomechanical function and size of the anteromedial and posterolateral bundles of the ACL change differently with skeletal growth in the pig model. Clin Orthop Relat Res. 2019;477(9):2161–74.PubMedPubMedCentralCrossRef

15.

Woo SL, Orlando CA, Camp JF, Akeson WH. Effects of postmortem storage by freezing on ligament tensile behavior. J Biomech. 1986;19(5):399–404.PubMedCrossRef

16.

Hamon A, Aoustin Y, Caro S. Two walking gaits for a planar bipedal robot equipped with a four-bar mechanism for the knee joint. Multibody SysDyn. 2014;1:31.

17.

Marieswaran M, Jain I, Garg B, Sharma V, Kalyanasundaram D. A review on biomechanics of anterior cruciate ligament and materials for reconstruction. Appl Bionics Biomech. 2018;2018:e4657824.CrossRef

18.

Dye SF. An evolutionary perspective of the knee. J Bone Joint Surg Am. 1987;69(7):976–83.PubMedCrossRef

19.

Charles JP, Fu FH, Anderst WJ. Predictions of anterior cruciate ligament dynamics from subject-specific musculoskeletal models and dynamic biplane radiography. J Biomech Eng. 2021;143(3):031006. https://doi.org/10.1115/1.4048710.CrossRefPubMed

20.

Bergmann G, Bender A, Graichen F, Dymke J, Rohlmann A, Trepczynski A, et al. Standardized loads acting in knee implants. PLoS ONE. 2014;9(1):e86035. https://doi.org/10.1371/journal.pone.0086035.CrossRefPubMedPubMedCentral

21.

D’Lima DD, Fregly BJ, Patil S, Steklov N, Colwell CW. Knee joint forces: prediction, measurement, and significance. Proc Inst Mech Eng H. 2012;226(2):95–102.PubMedPubMedCentralCrossRef

22.

Shimokochi Y, Shultz SJ. Mechanisms of noncontact anterior cruciate ligament injury. J Athl Train. 2008;43(4):396–408.PubMedPubMedCentralCrossRef

23.

Sopakayang R. Viscoelastic models for ligaments and tendons. 2010; Available from: https://vtechworks.lib.vt.edu/handle/10919/77298.

24.

Poh SY, Yew KSA, Wong PLK, Koh SBJ, Chia SL, Fook-Chong S, et al. Role of the anterior intermeniscal ligament in tibiofemoral contact mechanics during axial joint loading. Knee. 2012;19(2):135–9.PubMedCrossRef

25.

Mow VC, Ateshian GA, Spilker RL. Biomechanics of diarthrodial joints: a review of twenty years of progress. J Biomech Eng. 1993;115(4B):460–7. https://doi.org/10.1115/1.2895525.CrossRefPubMed

26.

Wang JHC, Guo Q, Li B. Tendon biomechanics and mechanobiology—a minireview of basic concepts and recent advancements. J Hand Ther. 2012;25(2):133–40.PubMedCrossRef

27.

Robi K, Jakob N, Matevz K, Matjaz V, Robi K, Jakob N, et al. The physiology of sports injuries and repair processes. Curr Issues Sports Exercise Med IntechOpen; 2013. Available from: https://www.intechopen.com/chapters/44614.

28.

Hewett TE, Myer GD, Ford KR. Anterior cruciate ligament injuries in female athletes: part 1, mechanisms and risk factors. Am J Sports Med. 2006;34(2):299–311. https://doi.org/10.1177/0363546505284183.CrossRefPubMed

29.

Bascuñán AL, Biedrzycki A, Banks SA, Lewis DD, Kim SE. Large animal models for anterior cruciate ligament research. Front Vet Sci. 2019;6:292.PubMedPubMedCentralCrossRef

30.

Proffen BL, McElfresh M, Fleming BC, Murray MM. A comparative anatomical study of the human knee and six animal species. Knee. 2012;19(4):493–9.PubMedCrossRef

31.

Takroni T, Laouar L, Adesida A, Elliott JA, Jomha NM. Anatomical study: comparing the human, sheep and pig knee meniscus. J Exp Orthop. 2016;3:1–3. https://doi.org/10.1186/s40634-016-0071-3.CrossRef

32.

Rodarte RRP, Guimarães JAM, Duarte BT, Kenedi PP, Pinho WR. Analysis of the mechanical behavior of the posterior cruciate ligament in a porcine model. Acta Ortop Bras. 2022;30(4):e236261.PubMedPubMedCentralCrossRef

33.

Zhou T, Grimshaw PN, Jones C. A biomechanical investigation of the anteromedial and posterolateral bands of the porcine anterior cruciate ligament. Proc Inst Mech Eng H. 2009;223(6):767–75.PubMedCrossRef

34.

Fleming BC, Spindler KP, Palmer MP, Magarian EM, Murray MM. Collagen-platelet composites improve the biomechanical properties of healing anterior cruciate ligament grafts in a porcine model. Am J Sports Med. 2009;37(8):1554–63.PubMedPubMedCentralCrossRef

35.

Lee CH, Huang GS, Chao KH, Wu SS, Chen Q. Differential pretensions of a flexor tendon graft for anterior cruciate ligament reconstruction: a biomechanical comparison in a porcine knee model. Arthroscopy. 2005;21(5):540–6.PubMedCrossRef

36.

Spindler KP, Murray MM, Devin C, Nanney LB, Davidson JM. The central ACL defect as a model for failure of intra-articular healing. J Orthop Res. 2006;24(3):401–6.PubMedCrossRef

37.

Kern SE. Challenges in conducting clinical trials in children: approaches for improving performance. Expert Rev Clin Pharmacol. 2009;2(6):609–17.PubMedPubMedCentralCrossRef

38.

Schmidt EC, Chin M, Aoyama JT, Ganley TJ, Shea KG, Hast MW. Mechanical and microstructural properties of pediatric anterior cruciate ligaments and autograft tendons used for reconstruction. Orthop J Sports Med. 2019;7(1):2325967118821667.PubMedPubMedCentralCrossRef

39.

Shea KG, Cannamela PC, Dingel AB, Fabricant PD, Polousky JD, Anderson AF, et al. Anatomic dissection and CT imaging of the anterior cruciate and medial collateral ligament footprint anatomy in skeletally immature cadaver knees. J Pediatr Orthop. 2020;40(2):e109–14.PubMedCrossRef

40.

Salvato D, Green DW, Accadbled F, Tuca M. Tibial spine fractures: state of the art. J ISAKOS. 2023;S2059–7754(23):00518–27.

41.

Howe D, Cone SG, Piedrahita JA, Spang JT, Fisher MB. Age- and sex-specific joint biomechanics in response to partial and complete anterior cruciate ligament injury in the porcine model. J Athl Train. 2022;57(9–10):978–89.PubMedCrossRef

42.

Fleming BC, Proffen BL, Vavken P, Shalvoy MR, Machan JT, Murray MM. Increased platelet concentration does not improve functional graft healing in bio-enhanced ACL reconstruction. Knee Surg Sports Traumatol Arthrosc. 2015;23(4):1161–70.PubMedCrossRef

43.

Beveridge JE, Proffen BL, Karamchedu NP, Chin KE, Sieker JT, Badger GJ, et al. Cartilage damage is related to ACL stiffness in a porcine model of ACL repair. J Orthop Res. 2019;37(10):2249–57.PubMedPubMedCentralCrossRef

44.

Murray MM, Magarian EM, Harrison SL, Mastrangelo AN, Zurakowski D, Fleming BC. The effect of skeletal maturity on functional healing of the anterior cruciate ligament. J Bone Joint Surg Am. 2010;92(11):2039–49.PubMedPubMedCentralCrossRef

45.

Montalvo AM, Schneider DK, Webster KE, Yut L, Galloway MT, Heidt RS, et al. Anterior cruciate ligament injury risk in sport: a systematic review and meta-analysis of injury incidence by sex and sport classification. J Athl Train. 2019;54(5):472–82.PubMedPubMedCentralCrossRef

46.

Acevedo RJ, Rivera-Vega A, Miranda G, Micheo W. Anterior cruciate ligament injury: identification of risk factors and prevention strategies. Curr Sports Med Rep. 2014;13(3):186–91.PubMedCrossRef

47.

Donelon TA, dos Santos T, Pitchers G, Brown M, Jones PA. Biomechanical determinants of knee joint loads associated with increased anterior cruciate ligament loading during cutting a systematic review and technical framework. Sports Med Open. 2020;6(1):53.PubMedPubMedCentralCrossRef

48.

Cleather DJ, Goodwin JE, Bull AM. Hip and knee joint loading during vertical jumping and push jerking. Clin Biomech. 2013;28(1):98–103.CrossRef

49.

Killian ML, Cavinatto L, Galatz LM, Thomopoulos S. The role of mechanobiology in tendon healing. J Shoulder Elbow Surg. 2012;21(2):228–37.PubMedPubMedCentralCrossRef

50.

Chen X, Wang M, Zhang Y, Feng Y, Wu Z, Huang N. Detecting signals from data with noise: theory and applications. J Atmos Sci. 2013;1(70):1489–504.CrossRef

51.

Chandrashekar N, Mansouri H, Slauterbeck J, Hashemi J. Sex-based differences in the tensile properties of the human anterior cruciate ligament. J Biomech. 2006;39(16):2943–50.PubMedCrossRef

Title: Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints
Authors: Jason Koh
Nirav Mungalpara
Sunjung Kim
Asheesh Bedi
Mark Hutchinson
Farid Amirouche
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: Journal of Orthopaedic Surgery and Research / Issue 1/2024
Electronic ISSN: 1749-799X
DOI: https://doi.org/10.1186/s13018-024-04744-6

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Springer Medicine

Effects of various load magnitudes on ACL: an in vitro study using adolescent porcine stifle joints

Abstract

Introduction

Methods

Result

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Result

Conclusions

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