Recurring Meeting of the Advisory Board

Date(s): May 8-21, 2015

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

• 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.

Project Infrastructure

• https://simtk.org/home/openknee (project website)

• http://wiki.simtk.org/openknee (project wiki)

Project Contact

• Ahmet Erdemir, PhD, erdemira@ccf.org, https://simtk.org/users/aerdemir

Advisory Board

• 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)

Progress Period

• November 20, 2014 - May 8, 2015

Development Team during Progress Period

• Cleveland Clinic Core Team. Craig Bennetts, Tara Bonner, Snehal Chokhandre, Robb Colbrunn, Ahmet Erdemir

• Stanford University. Scott Delp, Joy Ku, Henry Kwong

• University of Utah. Ben Ellis, Jeff Weiss, Steve Maas

• Community. Shannon Donnola, Chris Flask

See https://simtk.org/project/xml/team.xml?group_id=485 for full details on the project team.

Goals of Progress Period

• 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)

Please also refer to previous meeting minutes of the Advisory Board at RecurringMeetings/2014-11-20. 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 bi-monthly conference calls to discuss web based computation interface. Please refer to meeting minutes in Cleveland Clinic - Stanford University section of RecurringMeetings.

  • Detailed specifications on a prototype for web-based computing infrastructure can be found at the wiki page Revision as of May 6, 2015 or current version.

  • The team at the Stanford University mainly focused on the upgrade of the SimTk.org infrastructure. The launch of the updated site has been delayed.

  • In the previous progress report, it was noted that web-based interfaces for submissions of simulations and for results retrieval had been implemented and tested on a staging server. The team has been waiting for SimTk.org upgrade for the public release of the cloud computing interface. In following, usability testing of the infrastructure can be performed.

  • Following usability testing (anticipated to happen after the launch of updated SimTk.org site], the development of a model administration interface and the implementation of quota management features will be conducted.

  • The Cleveland Clinic team applied for a hardware grant from a commercial company with the intention to provide a dedicated high performance computing infrastructure for Open Knee(s). The application was not successful.
• 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.

  • Detailed specifications for desired features can be found at the wiki page Revision as of May 8, 2015 or current version.

  • Studies for implementing and testing in situ ligament strain feature advanced. A manuscript is under development.
  • Feature set definitions are ready for continued testing. To support model parametrization and scripting, a new feature to accommodate splitting and combining model files was implemented.
  • Rigid body movement related features, e.g. definition of cylindrical joints to represent anatomical joint coordinate systems and movement conventions, are primarily explored by Gerard Ateshian, co-lead of FEBio development team.
• Experimentation
  • In this progress period, the team focused on the acquisition of anatomical and mechanical data from a diverse group of knee specimens. Additional knee specimens were acquired and joint imaging and joint mechanics testing were conducted on the following specimens:

    • oks003, see Revision as of May 8, 2015,

    • oks006, see Revision as of May 8, 2015,

    • oks007, see Revision as of May 8, 2015,

  • oks005 was not tested due to questionable health history.

  • The team decided to test additional knees to increase diversity of Open Knee(s) (by adding specimens from mid-age donors) and augment data from young knees (by additional specimens).
  • Many experimentation specifications, detailed description of protocols, were at a mature state (completely documented or close finalization), which were previously mentioned in previous progress reports.

  • Tissue mechanical testing specifications has been under iterations to maximize acquired data and to accommodate the mechanical testing machine's capabilities, see Revision as of May 8, 2015 or current version. Based on previous discussions with the Advisory Board, the transverse ligament was added to the specifications as a primary tissue.

  • Many experimentation related as use cases has been started to describe, analyze, and publish some of the collected data:

    • Cases/JointImaging, Revision as of May 8, 2015 - to describe anatomical imaging of the knee joint in a scholarly form by curating data from multiple Open Knee(s) specimens.

    • Cases/TFJExperimentation, Revision as of May 8, 2015 - to describe tibiofemoral joint testing in a scholarly form by curating data from multiple Open Knee(s) specimens.

    • Cases/PFJExperimentation, Revision as of May 8, 2015 - to describe patellofemoral joint testing in a scholarly form by curating data from multiple Open Knee(s) specimens.

    • Cases/TissueCharacterization, Revision as of May 8, 2015 - to describe tissue mechanical testing in a scholarly form by curating data from multiple Open Knee(s) specimens.

• Modeling & simulation

  • Open Knee(s) - Generation 1 model, which was upgraded to work with FEBio version 2.0, was disseminated (see item on Dissemination below).
  • Many modeling and simulation studies as use cases has been started to illustrate the utility of knee joint models and to explore the capabilities of Open Knee(s) - Generation 1:

    • Cases/PivotShift, Revision as of May 8, 2015 - to explore the possibility to simulate pivot shift movement to assess anterior cruciate ligament function.

    • Cases/CruciateComplexCompartmentalModel, Revision as of May 8, 2015 - to investigate development of a compartmental model, which will be driven by experimentally measured joint movements to quantify anterior and posterior cruciate ligament mechanics.

    • Cases/ConvergenceOptimization, Revision as of May 8, 2015 - to understand convergence characteristics of Open Knee(s) - Generation 1 model to conduct simulations in an efficient and effective manner.

  • The work to expand upon the outlines of various modeling & simulation specifications was postponed, awaiting for summer interns (described in the item below on Community Projects).

• Dissemination

  • As of April 8, 2015, Open Knee(s) provided 2 release packages, Open Knee - Generation 1 versions g1-s1-v1.1.0.391 & g1-s1-v1.0.1.202. The new release, g1-s1-v1.1.0.391, is an updated model compatible with FEBio v2.1.2.6432 and above. Total downloads for all Open Knee – Generation 1 versions is 806 (582 unique downloads) as of April 8, 2015, see Open Knee(s) download page.

  • As of May 8, 2015, Open Knee(s) provided 5 developer, 3 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 June 7, 2015, Open Knee(s) website received 130,067 page hits in the past 180 days with 24,348 unique visitors, see Open Knee(s) project activity.

  • As of May 8, 2015, Open Knee(s) enabled 12 studies by external research teams, see Open Knee(s) publications page.

  • At this moment joint imaging and mechanical testing data are available for six knees, oks001, oks002, oks003, oks004, oks006, oks007. Joint imaging data were disseminated (see Open Knee(s) download page), dissemination of mechanical testing 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.

  • A summer internship program was implemented and recruited the first round of students.
    • Omar Gad, from University of Toledo, to work on pre-processing of tibiofemoral joint kinematics and kinetics data. Omar will be supported by NSF Research Experience for Undergraduates program at the Department of Biomedical Engineering, Cleveland Clinic.
    • Connour Lough, from Saint Louis University, to conduct registration of joint mechanical testing coordinate systems and imaging coordinate systems.
    • Diana Suciu, from Case Western Reserve University, to work on pre-processing and analysis of patellofemoral joint contact pressure data.
    • Raghav Malik, from Mentor High School, to work on camera-based tissue thickness measurement system. Raghav will be volunteering during the summer.
  • Ahmet Erdemir interacted with Leonardo Ruggiero, who expressed interest in contributing to the development of next generation knee models. Leonardo previously worked with Open Knee(s) - Generation 1 model and was in the process of applying for a post-doctoral fellowship in Belgium. He incorporated Open Knee(s) work as part of his application.
• Publications
  • A manuscript on Open Knee - Generation 1 was submitted to a special issue of Journal for Knee Surgery organized by Trent Guess and Jimi Cook.
  • Various abstracts were submitted to conferences for upcoming presentations in the next progress period:
    • Overview of the whole experimentation workflow with some example data was submitted to 2015 BMES/FDA Frontiers in Medical Devices Conference: Innovations in Modeling and Simulation, May 18-20, 2015, Washington DC.
    • Anatomical imaging and tibiofemoral joint testing studies were submitted to Summer Biomechanics, Bioengineering, and Biotransport Conference, June 17-20, 2015, Snowbird, UT as two different studies.
    • Patellofemoral joint testing study was submitted to 39th Annual Meeting of the American Society of Biomechanics, August 5-8, 2015, Columbus, OH.
• Other
  • An editorial type of an article about Open Knee(s) was published in Orthopaedic Insights, the newsletter of the Department of Orthopaedic Surgery, Cleveland Clinic:
  • Erdemir, A. And Jones, M. (2015) Open Knee(s) project: using crowdsourcing to harness community insight and clinical expertise to revolutionize knee modeling, Orthopaedic Insights (Winter 2014-2015), A Physician Newsletter from the Department of Orthopaedic Surgery, Cleveland Clinic.

  • Using crowdsourcing to revolutionize knee modeling

  • Dissemination of image sets for Open Knee(s) - Generation 2 was promoted in Biomch-L forums:

  • http://biomch-l.isbweb.org/threads/27781-Imaging-data-for-Open-Knee%28s%29-Generation-2-specimens

  • Ahmet presented Open Knee(s) project at the University of Missouri, Columbia, MO.
  • Erdemir, A., Open Knee(s): a path towards open source virtual musculoskeletal joints, March 18, 2015, Departments of Bioengineering and Mechanical Engineering, University of Missouri, Columbia, MO.

  • https://simtk.org/svn/openknee/doc/mizzou_2015.pdf

Details of activities can be found in past meeting minutes of various teams at RecurringMeetings.

Plans for Next Progress Period (May 8, 2015 - November 2015)

• Launch and test usability of web based computation infrastructure (Stanford University)
• Publish in situ strain feature and implement additional features in simulation software (University of Utah)
• Disseminate joint mechanics data for oks001, oks002, oks003, oks004, oks006, oks007 (Cleveland Clinic)
• Complete joint imaging and joint mechanics experimentation on oks008, oks009, oks010, oks011 (Cleveland Clinic)
• Start tissue mechanics testing of all specimens (Cleveland Clinic)

• Continue development and review of modeling & simulation specifications (Cleveland Clinic & Community)

• Start developing models for all specimens (Cleveland Clinic)
• Follow up publication of previous work on Open Knee - Generation 1 (Cleveland Clinic)

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.

Meeting Minutes

Date, Time, Means:

• May 8, 2015, 11:00 AM EST, in person meeting (AE,CB,SC,JA,MJ,YD)
• May 8, 2015, 4:00 PM EST, conference call (TG)
• May 21, 2015, 9:00 AM EST, conference call (RK)
• May 21, 2015, 12:00 PM EST, in person meeting (PS)

Attendees:

1. Ahmet Erdemir (Cleveland Clinic)
2. Craig Bennetts (Cleveland Clinic)
3. Snehal Chokhandre (Cleveland Clinic)
4. Jack Andrish (Cleveland Clinic)
5. Morgan Jones (Cleveland Clinic)
6. Paul Saluan (Cleveland Clinic)
7. Yasin Dhaher (Northwestern University)
8. Trent Guess (University of Missouri)
9. Rami Korhonen (University of Eastern Finland)

Agenda:

1. Progress update, see progress report at:

   • http://wiki.simtk.org/openknee/RecurringMeetings/2015-05-08

2. Recap of previous meeting minutes, see meeting minutes at:

   • http://wiki.simtk.org/openknee/RecurringMeetings/2014-11-20

3. Action items for following meeting.
4. Other.

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.

• Ahmet Erdemir

  • 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.

Notes:

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 emphasizing the experimental work, the collected data sets, planned use cases, and submitted conference abstracts and Open Knee(s) - Generation 1 publication. The Advisory Board members found the progress appropriate. Ahmet informed the Advisory Board members about addition of new knee specimens and the summer internships.
   • It was possible to arrange a face-to-face meeting among Jack Andrish, Morgan Jones, Yasin Dhaher and some members of the Open Knee(s) development team. Ahmet summarized the progress by going over the slides prepared for a recent presentation he delivered at the University of Missouri at Columbia. Craig and Snehal were able to join the discussions and describe their work to the Advisory Board members. The attending Advisory Board members found Open Knee(s) project on track. The experimentation workflow and the collected data were appreciated. Exciting discussions on knee biomechanics and the joint's clinical care emerged with the possibility of bringing engineers and physicians together. Physicians noted the role of transverse ligament and why they try to keep it in meniscal surgeries. Morgan described some of his upcoming work on meniscus function. Yasin asked about the potential role of menstrual cycle on the mechanics of the joint and the connective tissues. Yasin brought up the issue of reproducible segmentation of knee structures. Ahmet noted that summer students will be tasked with segmentation of the same knee joint as a side project, with the goal to evaluate uncertainties associated with geometry generation.
   • Ahmet had separate conference calls with Trent Guess and Rami Korhonen. The discussions mostly focused on Open Knee(s) progress and upcoming testing, which were found adequate.
   • Ahmet and Paul Saluan met to meet Open Knee(s) progress. Ahmet informed Paul Saluan about the progress of the pivot simulation study, which he has been involved. Convergence issues of Open Knee(s) - Generation 1 have been explored before enabling such simulations. Ahmet also asked Paul Saluan his help to seek for philanthropic support for Open Knee(s). Ahmet will forward documents to Paul Saluan to pass to interested parties. They also discussed how Open Knee(s) may fit in innovations and different business models, i.e using Open Knee(s) for device design, simulation as service, etc. Paul Saluan emphasized his interest to join face-to-face group meetings; he will need to be informed four weeks in advance for scheduling.
3. Recap of previous meeting minutes.
   • The discussions mainly focused on progress (see item above).
4. Action items for following meeting.
   • See Immediate Action Items above.
5. Other.
   • Yasin Dhaher visited Cleveland Clinic on May 11, 2015. Ahmet provided a tour of the laboratories and the Cleveland Clinic. They discussed various projects, not only limited to knee biomechanics but also including neuromechanics of other musculoskeletal joints. Yasin was able to join to a face-to-face meeting with other members of the Advisory Board and the Open Knee(s) development team (see above).
   • Rami Korhonen received funding to investigate multiscale mechanics of cartilage and the knee. It is likely that some synergy will be established between his proposed project and the Open Knee(s).
   • Ahmet has been trying to set up a meeting with Carl Winalski to devise a plan for evaluation of the knees from MRI.
   • Ahmet re-emphasized the need for surgeons' assistance during specimen dissection, particularly to curate secondary tissues. The team will reach out the physicians for potential scheduling.