Recurring Meeting of the Advisory Board

Date(s): November 19, 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

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/2015-05-08. 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

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

Plans for Next Progress Period (November 20, 2015 - May 2016)

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:


  1. Ahmet Erdemir (Cleveland Clinic)
  2. Jack Andrish (Cleveland Clinic)
  3. Morgan Jones (Cleveland Clinic)
  4. Paul Saluan (Cleveland Clinic)
  5. Carl Winalski (Cleveland Clinic)
  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 emphasizing the dissemination, summer internship program, and upcoming activities. An update on experimentation and modeling work was provided along with the progress of collaborators at the University of Utah and Stanford University. Published, submitted, and planned manuscripts were discussed. Discussions included many other topics, which were summarized in here.
    • Two sets of conference calls were arranged. First one included Rami Korhonen, Carl Winalski, and Paul Saluan:
      • Carl and Rami had a chance to meet and introduce themselves to each other. They have common connections through the Oulu research group.
      • Carl identified an MRI scoring strategy, referred as MOKS. This scoring will help evaluate and report health status of Open Knee(s) specimens particularly from the perspective of osteoarthritis and it will be part of a data publication. Carl will send a relevant manuscript on MOKS to Ahmet. Carl also mentioned other scoring techniques that may be used. He will check with his colleagues for selection of the scoring method. He mentioned that given the number of knee specimens (7 to 12), it may be possible to utilize multiple methods and report. The team needs to provide Carl, the MRIs of Open Knee(s) specimens. Carl can download these from a website or the team can give him a copy in an external harddrive. Carl mentioned that he can upload these images to a research PACS system where they can be accessed easily within the Cleveland Clinic by radiologists.
      • Ahmet, Rami, and Carl discussed the segmentation process. The group agreed that a fully automated segmentation, particularly for cartilage, is not necessarily possible. A reasonable path appears to be a semi-automatic system where manual corrections are done in a facilitated manner, e.g. through interactive tools. This is essentially the anticipated strategy by the Open Knee(s) team. Currently, Craig Bennetts, Open Knee(s) engineer, utilizes grow cut for automation of a gross initial segmentation followed by slice by slice manual corrections to delineate the tissue boundary appropriately. The process takes about half a day for a tissue segment. Rami's group has similar experience. Carl also mentioned a commonly used strategy to quantify variability of segmentation process when there is a lack of gold standard, i.e., multiple people segmenting and each segmentation compared to average.
      • Ahmet mentioned Carl and Rami that about 15 research groups used Open Knee(s) or its data for modeling and simulation. He mentioned that it may be interesting to compile the results from these studies to see if they are similar.
      • Rami and Ahmet talked about his student's (Petri Tanska) visit to Cleveland Clinic next summer. Petri will be a post-doc at that moment. Ideally, he will work on a project relevant to Rami's currently funded research activity, which is also synergistic with Ahmet's multiscale cartilage mechanics work. Nonetheless, Petri may be able to do some work relevant to Open Knee(s). Ahmet will send some ideas to Rami and in return, Rami will think about combining these to Petri's project.
      • Ahmet and Rami also talked about experimentation and modeling and simulation of muscle's influence on knee mechanics.
    • The second conference call included Jack Andrish, Morgan Jones, and Trent Guess:
      • Ahmet noted that Open Knee(s) - Generation 1 model was published in a special issue of the Journal of Knee Surgery. The special issue was organized by Trent Guess. Per Ahmet's request, Trent described the special issue to Morgan and Jack. The issue brought together experimentation and modeling studies from prominent knee researchers. In general, the journal commonly focuses on publication of surgical techniques for management of knee problems and the audience is predominantly clinicians. Jack asked for the article information to be able to access it. Ahmet will e-mail him the article information.
      • Ahmet mentioned future plans for Open Knee(s) in relation to submissions grants for renewal, e.g. continued development of Open Knee(s) and other synergistic projects that utilize Open Knee(s) for scientific research and clinical translation. Ahmet asked Morgan and Jack how Open Knee(s) can be integrated to orthopaedic residents training or research, acknowledging that a lot needs to be done first to streamline the modeling & simulation workflow. Morgan mentioned that understanding how interventions work for different pathologies and for different knees is a key aspect. Jack emphasized that similar concerns had been raised in early modeling studies focusing on clinical translation. In this regard computational modeling may provide the capacity to understand robustness of the operation, i.e. to see if it will have very different results or not. Ahmet noted that one possibility is to change an existing model to simulation different patient populations. The other possibility is to build a set of specimen-specific models including both anatomical and mechanical properties from the same specimen. Open Knee(s) fit in the latter category and may serve as a virtual patient population

      • Morgan mentioned motivation for prospective modeling & simulation study, which may help understand appropriateness of X-ray imaging strategies to assess joint space. These studies may help increase the accuracy of diagnosis and prognosis of osteoarthritis and anterior cruciate ligament deficiency from X-ray imaging. Role of weight bearing and joint positioning may be explored systematically with the models.

      • Jack wondered how long it would take to validate the models such that clinicians can utilize them. Ahmet first talked about a stringent validation scheme based on specimen-specific models being able to predict specimen-specific response. This is possible with Open Knee(s) data, which provides comprehensive information including specimen-specific anatomical and tissue properties, and specimen-specific joint response. Nonetheless, he noted that this will likely require multiple modifications in the models to iteratively improve their capacity to represent measured response. He also noted that clinical translation may not necessarily require this stringent validation process as long as the model indicates the correct path for decision making. This was confirmed by Jack.
      • Trent emphasized the lack of data on properties of tissues that stabilize the menisci. Ahmet reminded him that the group dissects as much tissue as possible for prospective quantification of specimen-specific properties. He also noted the limited number of studies which actually collected mechanics data for characterization of tissue, e.g. anterior cruciate ligament.
    • Ahmet described his plans to both groups on publishing anatomical imaging and joint mechanics data by submitting manuscripts to Scientific Data, a journal specifically designed for publishing data collection strategies and to disseminate data. In response to Rami, Ahmet clarified the difference between Scientific Data and Scientific Reports, which are both journals of Nature Publishing Group. He also described the concept of data journals to Morgan Jones and others in the latter conference call. It may be possible to include the physicians in these publications, particularly to provide a clinical perspective for potential use of disseminated data.
  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.
    • Refer to notes above for the agenda item on progress update.

RecurringMeetings/2015-11-19 (last edited 2016-05-29 17:07:46 by aerdemir)