TableOfContents

Target Outcome

Prerequisites

Infrastructure

For more details see ["Infrastructure/ExperimentationMechanics"].

Previous Protocols

For more details see ["Specifications/Specimens"].

For more details see ["Specifications/ExperimentationAnatomicalImaging"]

For more details see ["Specifications/Registration"].

Protocols

Specimen Preparation

• Obtain specimens based on ["Specifications/Specimens"]
• Full leg should be procured (foot to femoral head)
• The specimen should be thawed for 12-18 hours prior to specimen preparation at room temperature
• Specimen demographics (e.g., age, height, weight, race etc) will be recorded.
• Remove all soft tissue on the femur side proximal to 5 inches from the epicondylar axis
• Remove all soft tissue on the tibia side distal to 4 inches from the epicondylar axis
• Three spherical markers should be rigidly mounted to the tibia and the femur as close to joint line as possible without damaging ligamentous structures (~50-60 mm)

attachment:knee_with_registration_markers.png

• Spherical markers are hollow plastic spheres (10 mm radius ) filled with water based gel and are attached to the bones using plastic screws for the tibia and femur.

attachment:spherical_marker.png

• The use of an optoelectronic camera system (Optotrak, Northern Digital Inc., Waterloo, Ontario, Canada) requires repeatable placement of the orthopedic research pin markers http://www.ndigital.com/lifesciences/spineresearchpins.php

• In order to ensure repeatable placement, brass (MRI compatible) fixtures were designed to be rigidly secured to the tibia and femur throughout experimentation.
• A threaded brass plug is attached to the bone through the use of three brass screws. Bone cement can be used to ensure purchase between the screws and bone.
• A second brass fixture can be securely screwed onto the plug through the used of two pins in a repeatable fashion.

attachment:optotrak_mounting_assembly.png

Tibiofemoral Joint Testing

Conditions

Measurements

Operating Procedure

• The joint testing is done in the 6 DOF motion control robot (Rotopod R­2000), which comes with an application program interface. The translation DOFs are X, Y and Z and rotational DOFs are called roll, pitch and yaw. It has a positioning accuracy of 50 μm.

• A geostationary MicroScribe G2L digitizer (Immerson Corp., San Jose ,CA ) is used to create a joint coordinate system specific to the specimen.

• A universal force sensor (UFS) is attached to the robot platform.
• A joint coordinate system is established : []
• The potted knee is placed in the fixture designed for whole knee testing which can flex the knee through a series of flexion angles upto 120°. fix the tibia to the UFS.
• A neutral loading position is established once the femur is fixed to a desired flexion angle by operating the robot in force control mode.
• By allowing the robot to rest in a position where the robot controller gains are not changing significantly, a consistent neutral position is established by biasing the knee joint using a small internal rotation moment of 0.001 Nm.
• The robot is operated in force control and loading trajectories are applied to determine 5 DOF kinematics of the joint.
• Once the initial set up is done, for every flexion angle ,laxity and combined loading test are performed.
• Run the laxity and combined loadings at 0°, 30°,60°,90° flexion angles.
• The specimen is preconditioned by applying the laxity loading protocols before data
• Once the kinematic data collection is over, a randomly selected laxity or combined loading protocol is repeated to ensure there was no injury or damage to any of the structures in the joint.
• Joint laxity is recorded in 3 isolated DOF:
  1. Internal­External laxity: Apply internal­external rotation moment from 0 to ±5 Nm in steps of 1 Nm at flexion angles from 0° to 90° in steps of 30°.
  2. Varus ­Valgus laxity : Apply varus – valgus rotation moment from 0 to ±10 Nm in steps of 2.5 Nm at flexion angles from 0° to 90° in steps of 30°.
  3. Anterior – Posterior laxity: Apply anterior­ posterior force of 0 to ±100 N in steps of 10 N at flexion angles from 0° to 90° in steps of 30°.
• Combined loading : The combined loading consists of permutations of I_E moment ranging from 0 to ±5 Nm and V­V moment ranging from 0 to ±10 Nm while under either anterior or posterior drawer force of 100 N.

Note: The protocol is adapted from the doctoral work of Bhushan Borotikar PhD.

Borotikar, Bhushan S. Subject Specific Computational Models of the Knee to Predict Anterior Cruciate Ligament Injury. Cleveland State University

Patellofemoral Joint Testing

A separate test is outlined to quantify patellofemoral response. Details are as follows.

Conditions

Quasi-static patellofemoral testing protocol

• Patellofemoral loading will be performed at tibiofemoral flexion angles of: 0°, 15°, 30°, 45°, and 60°.
  • expected tibiofemoral flexion angles during gait and other ADL
• Tibiofemoral joint configurations will be achieved through passive flexion
  • joint loading will be minimized during passive flexion
  • the tibiofemoral joint will be locked at each flexion angle where quadriceps loading will be prescribed
• Quandriceps loading consists of:
  • nominal (~20 N) followed by 100 N up to 600 N, in 100 N increments
• Quadriceps tendon forces will be applied through a linear actuator attached to the tendon using a freeze clamp (link to tools and equipment).
  • the orientation and line of action of the actuator line of action will be quantified during robot initialization (link to protocol)
• At each increment of loading, relative bone positions and patellofemoral contact pressures will be recorded (link to "Measurements").

-- ["hallorj"] DateTime(2013-10-10T14:14:18Z) Should we consider perturbing tibiofemoral IE at some/all of the fixed flexion angles? Both in vivo and in silico based studies suggest patellofemoral mechanics are sensitive to this degree of freedom.

Measurements

Pressure measurements:

• Accomplished using a pressure sensor (K-Scan sensor 5051, Tekscan Inc., MA) placed between the cartilage surfaces of the patella and femur
  • the current sensor number might be 5101
  • Measures contact pressure distribution, area, and total force
  • equivalencing and calibration will need to be performed before the testing begins, refer to ["Specifications/PressureCalibration"]

Joint kinematics:

• Measured using Optotrak (NDI Corp., Ontario, Canada) infrared emitting diode (IRED) markers
  • triad marker clusters will be attached to each bone using the previously developed fixation protocol/approach (link to tools and equipment and protocol)
• Kinematics will be described using a standard joint coordinate system, much like the tibiofemoral joint (link to post-processing specifications and/or joint coordinate system page???)

-- ["hallorj"] DateTime(2013-10-10T14:14:18Z) I will verify the pressure sensor number.

Operating Procedure

To accommodate the necessity for manual acquisition of patellofemoral pressure maps, loading states will be manually controlled. A flexion angle along with a quadriceps load will be specified using the Labview GUI developed by the BioRobotics Core for control of the joint level loading in the UMS robot (link to robot specifications). For convenience, testing will start at 0° knee flexion where the quadriceps load will be ramped from 100 N up to 600 N and held at each increment of 100 N. Passive flexion (minimizing out of plane loads) will be specified between each flexion angle and snapshots of data (joint kinematics, pressure) will be recorded at each loading state.

For both pressure and kinematic measurements, consistent file names will be utilized to facilitate post-processing of the data.

Tekscan pressure measurements output in the proprietary .fsx format. Pressure measurement file names will be specified as Specimen#_surgicalState_flexionAngle_quadLoad_Trial#.fsx.

A description of each part of the file naming convention:

• Specimen# = specimen identifying number as provided by the cadaveric supplier. Specimen demographics will be provided for each specimen.
• surgicalState = This is the overall sate of the joint. This testing includes a cleaned yet structurally intact joint. As such, it will be described as "cleaned." Details related to specimen preparation can be found in ["Specifications/SpecimenPreparation"]
• flexionAngle = tibiofemoral flexion angle
• quadLoad = specified quadriceps loading value
• Trial = trial number. This should correspond to the trial number in the kinematics file as well.

References

Testing protocol

1. Specimen initialization
2. Laxity loadings, combined loadings, quasi-static patellofemoral joint loadings
3. Data acquisition details, coordinate system details