Recurring Meeting of the Advisory Board

Date(s): May 19-30, 2014

Due to scheduling conflicts, the group meeting with the Advisory Board members were scheduled on an individual basis with each member. Please refer to Meeting Minutes for more details.

Progress Report

Project Specific Aims

Project Infrastructure

Project Contact

Advisory Board

Progress Period

Development Team during Progress Period

See for full details on the project team.

Goals of Progress Period

Please also refer to previous meeting minutes of the Advisory Board at RecurringMeetings/2013-10-28. For more details, see the Roadmap and the proposed timeline of the proposal in GrantInformation/proposal.pdf.

Activities of Progress Period

Details of activities can be found in past meeting minutes of various teams at RecurringMeetings. For a complete list of various tasks (finished or in progress), please refer to

Plans for Next Progress Period (May 19, 2014 - November 2014)

For more details, see the Roadmap and the proposed timeline of the proposal in GrantInformation/proposal.pdf.

Meeting Minutes

Date, Time, Means:


  1. Ahmet Erdemir (Cleveland Clinic)
  2. Jason Halloran (Cleveland Clinic)
  3. Morgan Jones (Cleveland Clinic)
  4. Paul Saluan (Cleveland Clinic)
  5. Yasin Dhaher (Northwestern University)
  6. Trent Guess (University of Missouri)
  7. Rami Korhonen (University of Eastern Finland)


  1. Progress update, see progress report at:
  2. Recap of previous meeting minutes, see meeting minutes at:
  3. Action items for following meeting.
  4. Other.

Immediate Action Items:

See notes for details.


  1. Due to scheduling conflicts, a series of meetings were conducted to inform the Advisory Board about Open Knee(s) activities and get feedback.
  2. Progress update.
    • Ahmet provided a summary of progress by using individual items in the progress report as reference (see above). The Advisory Board members found the progress appropriate. Clinicians noted the strength of the bottom-up approach to build reliable knee joint models and appreciated the detailed processes involved in establishing and executing specifications.
    • Ahmet emphasized the full specimen-specificity aimed for Open Knee(s) models and the difficulties in logistics of related data collection. This approach requires collecting tibiofemoral and patellofemoral joint kinematics-kinetics data (with contact pressure for the patellofemoral joint); anatomical imaging of the same joint, along with specimen preparation to accommodate accurate registration between imaging and mechanics data; and the acquisition and testing of tissue samples from the same joint.
    • For tissue modeling, Yasin raised a concern about the in situ strain in ligaments. The knee joint data will be purely specimen-specific, from joint geometry and kinematics-kinetics to tissue stress-strain response. There will not be any explicit measurement of in situ strain, as this is a rather difficult metric to measure. Nonetheless, joint kinematics-kinetics data, particularly under laxity loading, may provide opportunities to calibrate ligament in situ strains with material properties of the ligament determined from tissue testing in a specimen-specific manner.
    • Rami noted that 45 to 60 minutes relaxation time during tissue testing, particularly for ligaments and tensile cartilage and meniscus specimens may not be enough. Ahmet acknowledged this limitation and indicated that tests may be extended to accommodate long relaxation times. This may also depend on measurement and experimentation resolution.
    • For tissue testing, Morgan and Paul noted the importance of various tissues of the knee other than the primary ones planned for further testing. These included MPFL, ligaments of the posterior-lateral corner, ALL, various zones of articular cartilage, the IT band, quadriceps tendon and hamstring. While the former tissues were noted for their potential influence on joint response, the latter two are commonly used for reconstructions, e.g. of the ACL. Therefore the knowledge of their relative properties may be important for specimen-specific interventions. Ahmet noted that testing of all these tissue may not be possible due to logistical constrained. Nonetheless, he acknowledged that these tissues should be dissected and kept for future testing, when and if the opportunity arise. Snehal, who performs dissections, previously noted the difficulty to locate and appropriately dissect these tissues, a difficulty shared by Ahmet and Jason. Morgan and Paul were asked to help tissue dissection, in particular for isolation of these tissues. Ahmet will inform them about scheduling when the time comes.
    • In regard to joint testing, Morgan wondered how the alignment of the joint, based on hip and ankle location, would be determined. Relative location of anatomical landmarks can provide this information. Yet, Morgan raised the concern about the importance of joint positioning and loading, i.e., standing posture with some compressive loading, when comparing tibia and femur axes. While this may be difficult to attain during specimen preparation, such information can be reconstructed from robotics data, which will be registered with anatomical landmark locations and magnetic resonance images of the joint.
  3. Recap of previous meeting minutes.
    • A few discussions resurfaced from previous meeting minutes.
    • Trent reiterated that reproducibility of cartilage segmentation may be problematic. This issue was also discussed in the previous meeting and one way is to design a small study where different groups can work on the same knee to segment the cartilage and compare their results. At this moment, no resources are allocated within the Open Knee(s) team to conduct this. Nonetheless, the specifications on image segmentation will provide guidelines to minimize the subjectivity of segmentation.
  4. Action items for following meeting.
    • See Immediate Action Items above.
  5. Other.
    • Efforts to engage community were emphasized and the Advisory Board was asked to comment on the wiki about specifications. Ahmet also wondered if any of the board members had any ideas to engage the community. He summarized the plan for community internship program he had in his mind. Yasin proposed to reach out to individual laboratories and ask investigators if they have any student that can contribute during summer while they are hosted in their own institute. If a project that benefits both Open Knee(s) and the external investigators research program, this may be a good venue to pro-actively engage the community. Ahmet emphasized that these project should return something to the Open Knee(s) and if that is the case, the internship can be paid by the Open Knee(s). Ahmet also noted that there may be intern candidates who may not be associated with any laboratory or an established investigator but may still provide useful input and work for Open Knee(s). By having a mechanism to reach out such communities may be beneficial. Yasin also advised to have a virtual conference at the end of summer, where all the interns and their principal investigators may interact with each other. In another meeting, Paul mentioned the possibility to expose interns to clinical care of the knee joint. While this requires a physical visit to the Cleveland Clinic, it can be a unique opportunity allowing direct interactions with physicians, who are at Open Knee(s) Advisory Board.
    • Yasin wondered if Open Knee(s) data will provide cartilage thickness map in relation to anatomical landmarks. Such knowledge will be useful to morph cartilage geometries to different knees. While the project will not specifically provide this information, the image sets and registration approaches can facilitate generation of such processed data by others.
    • Morgan noted the possibility to build a specimen bank, using tissue dissected and stored during Open Knee(s) project. Previously, Paul kindly agreed to let the Open Knee(s) team utilize knee specimens used in his other studies, where various tissue types can be sampled and tested. All these tissue samples can be utilized to build a virtual tissue bank, providing their mechanical response. Nonetheless, if logistics allow, a physical tissue bank can be built and maintained.
    • Open Knee(s) specimens are hip-to-toe specimens. Paul asked about the possibility to use hips, ankles, and feet. Ahmet entertained this opportunity. Other investigators at the Cleveland Clinic may be interested in these, e.g. Jim Rosneck (hip), James Sferra (foot and ankle).

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