Recurring Meeting of the Advisory Board
Date(s): November 20-21, 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.
Project Specific Aims
- To provide an open, freely available, and collaborative development, testing, simulation and dissemination platform for in silico exploration of the biomechanics of healthy and diseased knees.
- To develop in silico biomechanical models of healthy and diseased knee joints of different genders and ages, supported by specimen-specific joint and tissue level experimental mechanics.
Clinical. Jack Andrish, MD; Carl Winalski, MD; Morgan Jones, MD, MPH; Paul Saluan, MD (Cleveland Clinic)
Engineering. Yasin Dhaher, PhD (Northwestern University); Trent Guess, PhD (University of Missouri), Rami Korhonen, PhD (University of Eastern Finland)
- May 19, 2014 - November 20, 2014
Development Team during Progress Period
Cleveland Clinic Core Team. Craig Bennetts, Tara Bonner, Snehal Chokhandre, Robb Colbrunn, Ahmet Erdemir, Jason Halloran
Stanford University. Scott Delp, Joy Ku, Henry Kwong
University of Utah. Ben Ellis, Jeff Weiss, Steve Maas
Community. Shannon Donnola, Chris Flask, Katie Stemmer
See https://simtk.org/project/xml/team.xml?group_id=485 for full details on the project team.
Goals of Progress Period
- Enhance prototype of web based computation infrastructure (Stanford University)
- Implement additional features in simulation software (University of Utah)
- Complete experimentation for Specimen 001 (Cleveland Clinic)
- Complete experimentation for Specimen 002 (Cleveland Clinic)
- Launch model for Specimen 001 (Cleveland Clinic)
Complete development and review of modeling specifications (Cleveland Clinic & Community)
Complete development and review of simulations specifications (Cleveland Clinic & Community)
Start plans for 2015 summer internship program as part of community projects (reviews, internships, and collaborations) (Cleveland Clinic & Community)
- Publish previous work on Open Knee - Generation 1 (Cleveland Clinic)
Please also refer to previous meeting minutes of the Advisory Board at RecurringMeetings/2014-05-19. It should be noted that the timeline of activities has deviated from the original proposal, i.e., see the Roadmap and the proposed timeline of the proposal in GrantInformation/proposal.pdf.
Activities of Progress Period
- Cloud computing prototype
Cleveland Clinic and Stanford University teams continued to have monthly (and recently bi-monthly) conference calls to discuss web based computation interface. Please refer to meeting minutes in Cleveland Clinic - Stanford University section of RecurringMeetings.
SimTk.org site is currently under the process of migration to upgrade the infrastructure.
Web-based interfaces for submissions of simulations and for results retrieval were implemented and tested on a staging server. The team is waiting for SimTk.org upgrade to launch the cloud computing interface.
- Upcoming steps include development of a model administration interface, implementation of quota management features, and public release of the cloud computing infrastructure.
- Simulation software features
Cleveland Clinic and University of Utah teams continued to have monthly conference calls to discuss enhancements in FEBio, the simulation software used in Open Knee(s). Please refer to meeting minutes in Cleveland Clinic - University of Utah section of RecurringMeetings.
- In situ ligament strain feature was implemented in a generalized form. This work was presented by Steve Maas (University of Utah) at CMBBE 2014, 12th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering.
- Feature on set definitions (nodes, elements, surfaces) was implemented. Testing needs to be conducted to evaluate the use of these features, both for pre-processing (input files) and post-processing (of output files).
- Upcoming activities for simulation software enhancements include work on rigid body movement related features, e.g. kinematic joints, local coordinate systems.
- Experimentation scheduling changed significantly to accommodate routine testing of specimens and delivery of data for all specimens in an earlier fashion. The team decided to conduct joint imaging and joint mechanical testing (~3 full days of work for each knee) during the first week of each month until adequate number of specimens are tested. The tissue mechanical testing (~2 weeks of work for each knee) will be conducted in parallel. This scheduling helps the team to focus on experimentation and allow them to practice testing protocols in a regular fashion.
- Two new knee specimens were acquired:
- Joint imaging and joint mechanics testing were conducted on the following specimens:
- A few experimentation specifications, detailed description of protocols, were brought to a mature state (completely documented or close finalization):
Modeling & simulation
With the new focus on experimentation of all Open Knee(s) specimens (see above), the timing of modeling & simulation activities will be delayed.
- Open Knee(s) - Generation 1 model was upgraded to work with FEBio version 2.0. The model is in the source code repository. Dissemination of this version should be completed in the upcoming months. This will also serve as a prototype problem for cloud computing interface.
Additional modeling & simulation specifications were outlined:
- The team has continued iterating various procedures to accomplish the target outcome of modeling specifications.
Katie Stemmer, an undergraduate student wrote down protocols for image segmentation, geometry generation, and meshing for her research project (see section on community projects). These will be incorporated into Open Knee(s) modeling & simulation specifications.
- The team discussed model assembly, compartmental modeling, and whole joint modeling, and started to identify the needs for processing of experimental data for finite element analysis of the knees.
As of November 19, 2014, Open Knee(s) provided 1 release package, Open Knee - Generation 1 version g1-s1-v22.214.171.124, which was downloaded 683 times (502 unique downloads), see Open Knee(s) download page.
As of November 19, 2014, Open Knee(s) provided 5 developer, 2 user documentation in release form, see Open Knee(s) documents page.
- With a few exceptions (as requested by a collaborating team), all of the project website; wiki site, e.g. specifications, meeting minutes; and source code repository are publicly accessible.
As of November 19, 2014, Open Knee(s) website received 149,146 page hits in the past 180 days with 30,678 unique visitors, see Open Knee(s) project activity.
As of November 19, 2014, Open Knee(s) enabled 8 studies by external research teams, see Open Knee(s) publications page.
- At this moment joint imaging and mechanical testing data are available for three knees, oks001, oks002, oks004. Dissemination of these data sets is pending, following organization of the information.
- Community projects
There were no feedback from the community on specifications disseminated through documents for developers in Open Knee(s) documents page. These specifications are still open for feedback through Open Knee(s) public forums and public write discussion pages at the wiki. Additional specifications disseminated through documents for developers in Open Knee(s) documents page are:
- Ahmet has been exploring the logistical details of implementing Community Internship Program. It seems like the initial implementation may require hosting intern at the Cleveland Clinic site during summer periods.
- Few synergistic short duration side projects that was started in previous progress report duration has been completed:
Cara Sullivan worked on a project through curation media and development of a promotional video. She developed a short movie script that can be used to create an Open Knee(s) video, see Revision as of November 20, 2014 or current version.
- Elvis Danso, a PhD student from Rami Korhonen's laboratory, along with Open Knee(s) Cleveland Clinic team, worked on testing tissue properties within the knee. The project informed fine-tuning of Open Knee(s) tissue testing protocols on the mechanical testing system acquired specifically for the project.
- A synergistic short duration side project was started and has been completed:
Katie Stemmer, an undergraduate student from Ohio State University, joined the laboratory during Summer 2014 as part of the NSF Research Experience for Undergraduates program. Katie worked on a project for development of a cruciate ligament complex model, see project site. She wrote specifications for segmentation, geometry generation, and meshing for her project. These information will be ported to Open Knee(s) wiki to populate modeling related specifications pages.
- Ahmet Erdemir had discussions with external investigators on philosophy of the Open Knee(s) and potential collaborations based on the Open Knee(s):
Peter Laz and Kevin Shelburne, Department of Mechanical & Materials Engineering, University of Denver, have significant expertise in knee joint modeling. Their insight can facilitate robust development of Open Knee(s) and its widespread adaptation. The team at the University of Denver also has significant knowledgebase and data on population related variations of knee anatomy and mechanics.
- Jason Halloran, Department of Mechanical Engineering, Cleveland State University, has recently accepted a position to launch his research program. Jason has been an active member of Open Knee(s) development team during his tenure at the Cleveland Clinic. There are opportunities to incorporate Open Knee(s) in his research program and the training he provides as part of the mechanical engineering curriculum.
- There were no progress on Open Knee - Generation 1 publication. At this moment, no estimate is available for a potential timeline to return back working on such a manuscript.
- There is an opportunity to publish an Open Knee(s) related article in Journal for Knee Surgery. Trent Guess is organizing a special issue and the Open Knee(s) team may submit a use case to illustrate the scientific and clinic utility of finite element analysis of the knee.
- Open Knee(s) team presented work in various national and international conferences:
- Maas, S. A., Erdemir, A., Halloran, J. P. and Weiss, J. A. Computational framework for application of residual stress when the stress-free configuration is unknown, 12th International Symposium on Computer Methods in Biomechanics and Biomedical Engineering, October 13-15, 2014, Amsterdam, The Netherlands. (podium presentation by Steve Maas)
- Erdemir, A. Bringing finite element analysis of biological structures to the masses by extending simulation software with open access models, 7th World Congress of Biomechanics, July 6-11, 2014, Boston, MA. (podium presentation by Ahmet Erdemir)
- Bonner, T. F., Halloran, J. P., Erdemir, A. and Colbrunn, R. W. Pathway to quantify the effects of peripheral soft-tissue and capsule on knee joint response, 7th World Congress of Biomechanics, July 6-11, 2014, Boston, MA. (poster presentation by Tara Bonner)
- Ahmet Erdemir and Morgan Jones wrote a lay article about Open Knee(s) for Orthopaedic Insights, the newsletter of the Department of Orthopaedic Surgery, Cleveland Clinic. The article will appear in the Fall 2015 issue of the newsletter.
Wiki pages on case studies (Revision as of November 19, 2014 or current version) and on related knee projects (Revision as of November 19, 2014 or current version) were created. The former page is intended to list clinical and scientific uses of Open Knee(s). The latter is aimed towards collating a list of publicly available knee biomechanics data and models that may be of use for Open Knee(s) users and developers.
- Jason Halloran, an active member of the Open Knee(s) development team, has accepted a position in the Department of Mechanical Engineering, Cleveland State University. It is likely that the Open Knee(s) developers will continue collaborating with him and his research team.
Details of activities can be found in past meeting minutes of various teams at RecurringMeetings.
Plans for Next Progress Period (November 20, 2014 - May 2014)
- Launch and enhance web based computation infrastructure (Stanford University)
- Implement additional features in simulation software (University of Utah)
- Disseminate joint imaging and joint mechanics data for oks001, oks002, oks004 (Cleveland Clinic)
- Complete joint imaging and joint mechanics experimentation on oks003, oks005, oks006, oks007 (Cleveland Clinic)
- Complete tissue mechanics testing of oks001, oks002, oks004 (Cleveland Clinic)
Continue development and review of modeling & simulation specifications (Cleveland Clinic & Community)
- Start developing models for oks001, oks002, oks004 (Cleveland Clinic)
- Upgrade and disseminate Open Knee(s) - Generation 1 (Cleveland Clinic)
Implement 2015 summer internship program as part of community projects (Cleveland Clinic & Community)
- Publish previous work on Open Knee - Generation 1 (Cleveland Clinic)
Date, Time, Means:
- November 20, 2014, 9:00 AM EST, in person meeting (JA)
- November 20, 2014, 12:30 PM EST, in person meeting (PS)
- November 20, 2014, 3:00 PM EST, conference call (TG)
- November 21, 2014, 9:00 AM EST, conference call (RK)
- November 21, 2014, 12:00 PM EST, conference call (YD)
- Ahmet Erdemir (Cleveland Clinic)
- Jack Andrish (Cleveland Clinic)
- Paul Saluan (Cleveland Clinic)
- Yasin Dhaher (Northwestern University)
- Trent Guess (University of Missouri)
- Rami Korhonen (University of Eastern Finland)
- Progress update, see progress report at:
- Recap of previous meeting minutes, see meeting minutes at:
- Action items for following meeting.
Immediate Action Items:
See notes for details.
All Advisory Board Members
- Comment on current progress and planned activities in case some issues were overlooked during the discussions.
- Spread the word about Open Knee(s) to increase the project's visibility.
- Identify use cases where clinical utility of Open Knee(s) can be illustrated.
- Identify short projects to start a summer internship program.
- Explore the possibility to implement scoring and grading systems to classify the knees, to report overall and compartmental knee health, and to evaluate individual tissue state.
- Explore the feasibility of curating additional secondary tissues from Open Knee(s) specimens, in particular the transverse ligament.
- Start working on a use case to potentially publish in a special issue of the Journal of Knee Surgery as an invited article.
- Due to scheduling conflicts, a series of meetings were conducted to inform the Advisory Board about Open Knee(s) activities and get feedback.
- Progress update.
- Ahmet provided a summary of progress emphasizing the need for change of experimentation schedule and the resulting delay of modeling activities. The Advisory Board members found the justification appropriate and they seemed to be impressed with the group's tackling of logistically challenging experimentation.
- Ahmet went over current properties of the tested knees. He informed the Advisory Board about the difficulty to acquire healthy knee specimens from elderly donors particularly based solely on X-rays. Jack Andrish acknowledged the potential difficulty of pre-screening of specimens before purchase. He advised to score all the knees to come up with compartmental and overall grading for osteoarthritis level of each knee. He noted that this can be accomplished by using the readily collected MRI. Carl Winalski will be able to provide more insight in this regard. This approach may result in an update in the specifications for specimen characteristics.
- Ahmet emphasized the need for surgeons' assistance during specimen dissection, particularly to curate secondary tissues. Jack Andrish is usually available in Wednesdays. Paul Saluan is not necessarily available but he may be able to get residents and/or fellows to help the Open Knee(s) team.
- Primary and secondary tissues for prospective testing were discussed along with tissue testing protocols that have been implemented. Advisory Board members considers the development of a physical tissue bank from primary and secondary tissue structures of the knees a good idea.
- Trent Guess asked about the possibility to test the transverse ligament, which connects anterior segments of the menisci. He noted the lack of information in literature on the material properties of this tissue. Open Knee(s) testing team will try to curate transverse ligament samples from upcoming knee specimens to keep in freezer as part of secondary tissue bank.
- Rami Korhonen provided his experience with meniscus testing. In particular, his group found meniscus to be very soft under compression. Their indentation tests also revealed the lateral meniscus to be homogeneous whereas the medial to be stiffer on the anterior side. Rami also advised grading of the meniscus during dissection. Their team has noticed that there may not be a correlation between MRI based scoring of meniscal health and its biomechanical properties, i.e., any damage may not be visible in the MRI.
- Rami Korhonen also noted the role of subchondral bone on cartilage mechanics. They have been collecting CT images and data to characterize subchondral bone properties. The testing team stores bone samples from Open Knee(s) specimens, which can later be used to obtain mechanical properties of subchondral bone.
- Ahmet described the possibility to establish a traditional summer internship program for Open Knee(s) for convenience. Trent Guess and some of his colleagues may be interested in sending students to such a program.
- Jack Andrish wondered if the open development approach of Open Knee(s) may inhibit scholarly publishing and prospective funding renewals. Ahmet does not see this as an issue as model development procedures, novel types of data, and use cases may result in new knowledge that can lead into publications. In addition, Ahmet noted that NIH has started to acknowledge products other than publications as part of progress. Open Knee(s) results in specifications for various procedures, data, and models, which are all part of the outcome of the activity.
- Trent Guess and Ahmet discussed an Open Knee(s) publication in a special issue of the Journal of Knee Surgery. Trent is a co-editor. A use case exploring clinical utility of Open Knee(s) is a possibility.
- Yasin Dhaher asked for the possibility to incorporate cloud computing for other simulation software, e.g., Abaqus. Ahmet noted the limitations associated with licensing of such software. Yasin recommended to reach out to software companies to provide such capabilities.
- Recap of previous meeting minutes.
- The discussions mainly focused on progress and change of experimentation and modeling schedule (see item above).
- Action items for following meeting.
- See Immediate Action Items above.
- Ahmet described potential development of use cases to promote Open Knee(s) for explorations of healthy and diseased knee biomechanics. Laxity simulations, pivot shift, patellofemoral joint loading, all are possible scenarios for evaluating Open Knee(s). Paul Saluan and Jack Andrish have an interest in such simulation scenarios as part of their clinical program.
- Ahmet encouraged Advisory Board members to promote Open Knee(s), therefore increase its visibility. This will help bring the community together and allow additional funding to prioritize development of additional knee models with different specifications. Paul Saluan is willing to spread the word in that regard.
- Jack Andrish notices the potential utility of Open Knee(s) by its incorporation to clinical training and practice where physicians can manipulate the joint virtually and evaluate its biomechanical response. Ahmet noted that this is indeed an ultimate goal for Open Knee(s) clinical translation. Nonetheless, Ahmet also acknowledged that this will take significant time and effort as models should be at a level of robustness and credibility sufficient for clinical decision making.
- Yasin Dhaher is interested in the classification of the knees based on their shape. This way, exploration of differences in morphologies, particularly that of the cartilage, may be possible, including morphing of existing cartilage anatomies to patient-specific characteristics. Ahmet and Yasin briefly talked about the opportunity to spin-off a synergistic study, possibly relying on Osteoarthritis Initiative data and funding programs.
- Rami Korhonen recently submitted a project on knee and cartilage mechanics to a funding program in Finland. The program emphasized open access. If funded, Open Knee(s) experience may be beneficial.