ACL Reconstruction Decision Support Through Personalized Simulation of the Lachm

The objective of the proposed approach is to develop a clinical decision support system (DSS) that will help clinicians optimally plan the ACL reconstruction procedure in a patient specific manner.Methods: A full body model is developed in this study with 23 degrees of freedom and 93 muscles. The knee ligaments are modeled as non-linear spring-damper systems and a tibiofemoral contact model was utilized. The parameters of the ligaments were calibrated based on an optimization criterion. Forward dynamics were utilized during simulation for predicting the model’s response to a given set of external forces, posture configuration and physiological parameters.Results: The proposed model is quantified using MRI scans and measurements of the well-known Lachman test, on several patients with a torn ACL. The clinical potential of the proposed framework is demonstrated in the context of flexion-extension, gait and jump actions. The clinician is able to modify and fine tune several parameters such as number of bundles, insertion position on the tibia or femur and the resting length that correspond to the choices of the surgical procedure and study their effect on the biomechanical behavior of the knee.Conclusion: Computational knee models can be used to predict the effect of surgical decisions and to give insight on how different parameters can affect the stability of the knee. Special focus has to be given in proper calibration and experimental validation.<a href="https://www.youtube.com/embed/zgcq0c5_w3c">https://www.youtube.com/embed/zgcq0c5_w3c</a> <br/><br/>This project includes the following software/data packages: <br/> <ul> <li> <a href="https://simtk.org/frs?group_id=1036#pack_1754">CustomLigamentPlugin </a> : Custom ligament plugin dll, lib files used in the model. Compatable with OpenSim 3.3 x64 </li> <li> <a href="https://simtk.org/frs?group_id=1036#pack_1755">Model </a> : An adjusted model (3DGaitModel2392) with unrestricted degrees of freedom in the knee joint (angle, adduction, rotation, anterior-posterior, inferior-superior, medial-lateral), 10 ligaments and a tibiofemoral contact. The swing model is used to simulate a swing action, while the Lachman model is used to simulate the Lachman test where a force is applied to the posterior of the tibia in the direction of anterior-posterior displacement (no contact model for Lachman model). </li> </ul>

本研究所提出的方法旨在开发一种临床决策支持系统（DSS），以帮助临床医生以患者个体化的方式优化ACL重建手术的规划。研究方法：本研究开发了一个具有23个自由度和93块肌肉的全身模型。将膝关节韧带模拟为非线性弹簧阻尼系统，并利用胫股关节接触模型。基于优化准则对韧带的参数进行了校准。在模拟过程中，采用前向动力学来预测模型对给定的一组外部力、姿势配置和生理参数的响应。结果：所提出的模型通过MRI扫描和著名Lachman测试的测量结果进行了量化，测试对象为几位ACL撕裂的患者。在屈伸、步态和跳跃动作的背景下，展示了所提出框架的临床潜力。临床医生能够修改和微调多个参数，如束带数量、胫骨或股骨上的插入位置以及静息长度，这些参数与手术方案的选择相对应，并研究其对膝关节生物力学行为的影响。结论：计算膝关节模型可用于预测手术决策的影响，并洞察不同参数如何影响膝关节的稳定性。必须特别关注正确的校准和实验验证。