ESB2015 - Abstract Book

ESB 2015
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5 8 JULY 2015
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21st CONGRESS
OF THE EUROPEAN SOCIETY
OF BIOMECHANICS
Clarion Congress Hotel Prague
Prague, Czech Republic
European Society
of Biomechanics
Book of Extended
Abstracts
Autor (editor):
Zdenk Hork, Matj Daniel, Karel Jeek
Nzev dla:
ESB 2015 Book of Extended Abstracts
Vydalo:
esk vysok uen technick v Praze
Zpracovala:
Fakulta strojn, stav mechaniky, biomechaniky a mechatroniky
Kontaktn adresa:
Technick 4, 166 07 Praha 6
Tel.:
+420 224 352 527
Tisk:
pouze on-line (pdf)
URL:
www.czech-in.org/ESB/ESB2015_Abstract_Book.pdf
Poet stran:
645
Poad vydn:
ISBN 978-80-01-05777-3
1.
Contents
Keynote Lectures
O 020 . . . . . 41
O 063 . . . . . 85
O 105 . . . . 132
O 147 . . . . 179
KL01 . . . . . . 1
O 021 . . . . . 42
O 064 . . . . . 87
O 106 . . . . 133
O 148 . . . . 180
KL02 . . . . . . 2
O 022 . . . . . 43
O 065 . . . . . 88
O 107 . . . . 134
O 149 . . . . 182
KL03 . . . . . . 3
O 023 . . . . . 44
O 066 . . . . . 89
O 108 . . . . 135
O 150 . . . . 183
O 024 . . . . . 45
O 067 . . . . . 90
O 109 . . . . 136
O 151 . . . . 184
Perspective Talks
O 025 . . . . . 46
O 068 . . . . . 91
O 110 . . . . 137
O 152 . . . . 185
PT 01 . . . . . 4
O 026 . . . . . 47
O 069 . . . . . 92
O 111 . . . . 138
O 153 . . . . 186
PT 02 . . . . . 5
O 027 . . . . . 48
O 070 . . . . . 93
O 112 . . . . 139
O 154 . . . . 187
PT 03 . . . . . 6
O 028 . . . . . 49
O 071 . . . . . 94
O 113 . . . . 141
O 155 . . . . 188
PT 04 . . . . 7
O 029 . . . . . 50
O 072 . . . . . 95
O 114 . . . . 142
O 157 . . . . 189
PT 05 . . . . . 8
O 030 . . . . . 51
O 073 . . . . . 96
O 115 . . . . 143
O 158 . . . . 190
PT 06 . . . . . 9
O 031 . . . . . 52
O 074 . . . . . 98
O 116 . . . . 144
O 159 . . . . 191
PT 07 . . . . . 11
O 032 . . . . . 53
O 075 . . . . 100
O 117 . . . . 145
O 160 . . . . 192
PT 08 . . . . . 12
O 033 . . . . . 54
O 076 . . . . 101
O 118 . . . . 146
O 161 . . . . 193
PT 09 . . . . . 13
O 034 . . . . . 55
O 077 . . . . 102
O 119 . . . . 147
O 162 . . . . 194
PT 10 . . . . . 14
O 035 . . . . . 56
O 078 . . . . 103
O 120 . . . . 148
O 163 . . . . 195
PT 11 . . . . . 15
O 036 . . . . . 57
O 079 . . . . 104
O 121 . . . . 149
O 164 . . . . 196
PT 12 . . . . . 16
O 037 . . . . . 58
O 080 . . . . 105
O 122 . . . . 150
O 165 . . . . 197
PT 13 . . . . . 17
O 038 . . . . . 59
O 081 . . . . 107
O 123 . . . . 151
O 166 . . . . 198
PT 14 . . . . . 18
O 039 . . . . . 60
O 082 . . . . 108
O 124 . . . . 152
O 167 . . . . 199
PT 15 . . . . . 19
O 040 . . . . . 61
O 083 . . . . 109
O 125 . . . . 153
O 168 . . . . 200
O 041 . . . . . 62
O 084 . . . . 110
O 126 . . . . 154
O 169 . . . . 201
Oral Presentations
O 042 . . . . . 63
O 085 . . . . 111
O 127 . . . . 156
O 170 . . . . 202
O 001 . . . . . 20
O 043 . . . . . 64
O 086 . . . . 112
O 128 . . . . 157
O 171 . . . . 204
O 002 . . . . . 21
O 044 . . . . . 65
O 087 . . . . 113
O 129 . . . . 158
O 172 . . . . 205
O 003 . . . . . 22
O 045 . . . . . 67
O 088 . . . . 115
O 130 . . . . 159
O 173 . . . . 206
O 004 . . . . . 24
O 046 . . . . . 68
O 089 . . . . 116
O 131 . . . . 160
O 174 . . . . 207
O 005 . . . . . 25
O 047 . . . . . 69
O 090 . . . . 117
O 132 . . . . 161
O 175 . . . . 208
O 006 . . . . . 26
O 048 . . . . . 70
O 091 . . . . 118
O 133 . . . . 162
O 176 . . . . 209
O 007 . . . . . 27
O 049 . . . . . 71
O 092 . . . . 119
O 134 . . . . 163
O 177 . . . . 210
O 008 . . . . . 28
O 050 . . . . . 72
O 093 . . . . 120
O 135 . . . . 164
O 178 . . . . 211
O 009 . . . . . 29
O 051 . . . . . 73
O 094 . . . . 121
O 136 . . . . 165
O 179 . . . . 213
O 010 . . . . . 30
O 052 . . . . . 74
O 095 . . . . 122
O 137 . . . . 166
O 180 . . . . 214
O 011 . . . . . 31
O 053 . . . . . 75
O 096 . . . . 123
O 138 . . . . 167
O 181 . . . . 215
O 012 . . . . . 32
O 055 . . . . . 76
O 097 . . . . 124
O 139 . . . . 169
O 182 . . . . 216
O 013 . . . . . 33
O 056 . . . . . 77
O 098 . . . . 125
O 140 . . . . 170
O 183 . . . . 217
O 014 . . . . . 34
O 057 . . . . . 78
O 099 . . . . 126
O 141 . . . . 171
O 184 . . . . 218
O 015 . . . . . 35
O 058 . . . . . 79
O 100 . . . . 127
O 142 . . . . 173
O 185 . . . . 220
O 016 . . . . . 36
O 059 . . . . . 80
O 101 . . . . 128
O 143 . . 1 7 4
O 186 . . . . 222
O 017 . . . . . 37
O 060 . . . . . 81
O 102 . . . . 129
O 144 . . . . 175
O 187 . . . . 223
O 018 . . . . . 38
O 061 . . . . . 83
O 103 . . . . 130
O 145 . . . . 176
O 188 . . . . 224
O 019 . . . . . 39
O 062 . . . . . 84
O 104 . . . . 131
O 146 . . . . 177
O 189 . . . . 225
O 190 . . . . 226
O 232 . . . . 269
O 274 . . . . 313
O 316 . . . . 355
P 038 . . . . 398
O 191 . . . . 227
O 233 . . . . 270
O 275 . . . . 314
O 317 . . . . 356
P 039 . . . . 399
O 192 . . . . 228
O 234 . . . . 271
O 276 . . . . 315
O 318 . . . . 357
P 040 . . . . 400
O 193 . . . . 229
O 235 . . . . 272
O 277 . . . . 316
O 194 . . . . 230
O 236 . . . . 273
O 2 7 8 . . . 317
Poster Presentations
P 042 . . . . 402
O 195 . . . . 231
O 237 . . . . 274
O 279 . . . . 318
P 001 . . . . 359
P 043 . . . . 403
O 196 . . . . 232
O 238 . . . . 275
O 280 . . . . 319
P 002 . . . . 360
P 044 . . . . 404
O 197 . . . . 233
O 239 . . . . 276
O 281 . . . . 320
P 003 . . . . 361
P 045 . . . . 405
O 198 . . . . 234
O 240 . . . . 277
O 282 . . . . 321
P 004 . . . . 362
P 046 . . . . 406
P 047 . . . . 407
P 041 . . . . 401
O 199 . . . . 235
O 241 . . . . 278
O 283 . . . . 322
P 005 . . . . 363
O 200 . . . . 236
O 242 . . . . 279
O 284 . . . . 323
P 006 . . . . 365
P 048 . . . . 409
O 201 . . . . 237
O 243 . . . . 280
O 285 . . . . 324
P 007 . . . . 366
P 049 . . . . 410
O 202 . . . . 238
O 244 . . . . 281
O 286 . . . . 325
P 008 . . . . 368
P 050 . . . . 411
O 203 . . . . 239
O 245 . . . 282
O 287 . . . . 326
P 009 . . . . 369
P 051 . . . . 412
O 204 . . . . 240
O 246 . . . . 283
O 288 . . . . 327
P 010 . . . . 370
P 052 . . . . 413
O 205 . . . . 241
O 247 . . . . 284
O 289 . . . . 328
P 011 . . . . 371
P 053 . . . . 414
O 206 . . . . 242
O 248 . . 2 8 5
O 290 . . . . 329
P 012 . . . . 372
P 054 . . . . 415
P 055 . . . . 416
O 207 . . . . 243
O 249 . . . . 286
O 291 . . . . 330
P 013 . . . . 373
O 208 . . . . 244
O 250 . . . . 287
O 292 . . . . 331
P 014 . . . . 374
P 056 . . . . 417
O 209 . . . . 246
O 251 . . . . 288
O 293 . . . . 332
P 015 . . . . 375
P 057 . . . . 418
O 210 . . . . 247
O 252 . . . . 289
O 294 . . . . 333
P 016 . . . . 376
P 058 . . . . 419
O 211 . . . . 248
O 253 . . . . 290
O 295 . . . . 334
P 017 . . . . 377
P 059 . . . . 420
O 212 . . . . 249
O 254 . . . . 291
O 296 . . . . 335
P 018 . . . . 378
P 060 . . . . 421
O 213 . . . . 250
O 255 . . . . 292
O 297 . . . . 336
P 019 . . . . 379
P 061 . . . . 422
O 214 . . . . 251
O 256 . . . . 293
O 298 . . . . 337
P 020 . . . . 380
P 062 . . . . 423
O 215 . . . . 252
O 257 . . . . 294
O 299 . . . . 338
P 021 . . . . 381
P 063 . . . . 424
P 064 . . . . 425
O 216 . . . . 253
O 258 . . . . 295
O 300 . . . . 339
P 022 . . . . 382
O 217 . . . . 254
O 259 . . . . 296
O 301 . . . . 340
P 023 . . . . 383
P 065 . . . . 426
O 218 . . . . 255
O 260 . . . . 298
O 302 . . . . 341
P 024 . . . . 384
P 066 . . . . 427
O 219 . . . . 256
O 261 . . . . 299
O 303 . . . . 342
P 025 . . . . 385
P 067 . . . . 428
O 220 . . . . 257
O 262 . . . . 300
O 304 . . . . 343
P 026 . . . . 386
P 068 . . . . 429
O 221 . . . . 258
O 263 . . . . 301
O 305 . . . . 344
P 027 . . . . 387
P 069 . . . . 430
O 222 . . . . 259
O 264 . . . . 302
O 306 . . . . 345
P 028 . . . . 388
P 070 . . . . 431
O 223 . . . . 260
O 265 . . . . 303
O 307 . . . . 346
P 029 . . . . 389
P 071 . . . . 432
P 072 . . . . 433
O 224 . . . . 261
O 266 . . . . 304
O 308 . . . . 347
P 030 . . . . 390
O 225 . . . . 262
O 267 . . . . 305
O 309 . . . . 348
P 031 . . . . 391
P 073 . . . . 434
O 226 . . . . 263
O 268 . . . . 306
O 310 . . . . 349
P 032 . . . . 392
P 074 . . . . 435
O 227 . . . . 264
O 269 . . . . 308
O 311 . . . . 350
P 033 . . . . 393
P 075 . . . . 436
O 228 . . . . 265
O 270 . . . . 309
O 312 . . . . 351
P 034 . . . . 394
P 076 . . . . 437
O 229 . . . . 266
O 271 . . . . 310
O 313 . . . . 352
P 035 . . . . 395
P 077 . . . . 438
O 230 . . . . 267
O 272 . . . . 311
O 314 . . . . 353
P 036 . . . . 396
P 078 . . . . 439
O 231 . . . . 268
O 273 . . . . 312
O 315 . . . . 354
P 037 . . . . 397
P 079 . . . . 440
ii
P 080 . . . . 441
P 119 . . . . 485
P 159 . . . . 526
P 198 . . . . 566
P 238 . . . . 608
P 081 . . . . 442
P 120 . . . . 486
P 160 . . . . 527
P 199 . . . . 567
P 239 . . . . 609
P 082 . . . . 443
P 121 . . . . 487
P 161 . . . . 528
P 200 . . . . 568
P 240 . . . . 610
P 083 . . . . 445
P 122 . . . . 489
P 162 . . . . 529
P 201 . . . . 569
P 241 . . . . 611
P 084 . . . . 446
P 123 . . . . 490
P 163 . . . . 530
P 202 . . . . 570
P 242 . . . . 612
P 085 . . . . 447
P 124 . . . . 492
P 164 . . . . 531
P 203 . . . . 572
P 243 . . . . 613
P 086 . . . . 448
P 125 . . . . 493
P 165 . . . . 532
P 204 . . . . 573
P 244 . . . . 614
P 087 . . . . 449
P 126 . . . . 494
P 166 . . . . 533
P 205 . . . . 574
P 245 . . . . 615
P 088 . . . . 450
P 127 . . . . 495
P 167 . . . . 534
P 206 . . . . 575
P 246 . . . . 616
P 089 . . . . 451
P 128 . . . . 496
P 168 . . . . 535
P 207 . . . . 576
P 247 . . . . 617
P 090 . . . . 452
P 129 . . . . 497
P 169 . . . . 536
P 208 . . . . 577
P 248 . . . . 618
P 091 . . . . 453
P 130 . . . . 498
P 170 . . . . 537
P 209 . . . . 578
P 249 . . . . 619
P 092 . . . . 454
P 131 . . . . 499
P 171 . . . . 538
P 210 . . . . 579
P 250 . . . . 620
P 093 . . . . 455
P 132 . . . . 500
P 172 . . . . 539
P 211 . . . . 580
P 251 . . . . 622
P 094 . . . . 456
P 133 . . . . 501
P 173 . . . . 540
P 212 . . . . 582
P 252 . . . . 624
P 095 . . . . 458
P 134 . . . . 502
P 174 . . . . 541
P 213 . . . . 583
P 253 . . . . 625
P 096 . . 4 5 9
P 135 . . . . 503
P 175 . . . . 542
P 214 . . . . 584
P 254 . . . . 626
P 097 . . . . 460
P 136 . . . . 504
P 176 . . . . 543
P 215 . . . . 585
P 255 . . . . 627
P 098 . . . . 461
P 137 . . . . 505
P 177 . . . . 544
P 216 . . . . 586
P 256 . . . . 628
P 099 . . . . 462
P 138 . . . . 506
P 178 . . . . 545
P 217 . . . . 587
P 257 . . . . 629
P 100 . . . . 463
P 139 . . . . 507
P 179 . . . . 546
P 218 . . . . 588
P 258 . . . . 630
P 101 . . . . 464
P 140 . . . . 508
P 180 . . . . 547
P 219 . . . . 589
P 259 . . . . 631
P 102 . . . . 465
P 141 . . . . 509
P 181 . . . . 548
P 220 . . . . 590
P 260 . . . . 632
P 103 . . . . 466
P 142 . . . . 510
P 182 . . . . 549
P 221 . . . . 591
P 261 . . . . 633
P 104 . . . . 467
P 143 . . . . 511
P 183 . . . . 550
P 222 . . . . 592
P 262 . . . . 634
P 105 . . . . 468
P 144 . . . . 512
P 184 . . . . 551
P 224 . . . . 593
P 263 . . . . 635
P 106 . . . . 469
P 145 . . . . 513
P 185 . . . . 552
P 225 . . . . 595
P 264 . . . . 636
P 107 . . . . 470
P 146 . . . . 514
P 186 . . . . 553
P 226 . . . . 596
P 265 . . . . 637
P 108 . . . . 471
P 147 . . . . 515
P 187 . . . . 554
P 227 . . . . 597
P 266 . . . . 639
P 109 . . . . 472
P 149 . . . . 516
P 188 . . . . 555
P 228 . . . . 598
P 267 . . . . 640
P 110 . . . . 473
P 150 . . . . 517
P 189 . . . . 556
P 229 . . . . 599
P 268 . . . . 641
P 111 . . . . 474
P 151 . . . . 518
P 190 . . . . 557
P 230 . . . . 600
P 269 . . . . 642
P 112 . . . . 475
P 152 . . . . 519
P 191 . . . . 558
P 231 . . . . 601
P 270 . . . . 643
P 113 . . . . 476
P 153 . . . . 520
P 192 . . . . 559
P 232 . . . . 602
P 271 . . . . 644
P 114 . . . . 478
P 154 . . . . 521
P 193 . . . . 561
P 233 . . . . 603
P 272 . . . . 645
P 115 . . . . 479
P 155 . . . . 522
P 194 . . . . 562
P 234 . . . . 604
P 116 . . . . 480
P 156 . . . . 523
P 195 . . . . 563
P 235 . . . . 605
P 117 . . . . 481
P 157 . . . . 524
P 196 . . . . 564
P 236 . . . . 606
P 118 . . . . 483
P 158 . . . . 525
P 197 . . . . 565
P 237 . . . . 607
iii
KL01
Joint lubrication: the molecular domain

J. Klein1
1
Weizmann Institute of Science, Department of Materials & Interfaces, Rehovot, Israel
Cartilage surfaces sliding past each other in

the major joints (such as hips and knees) exhibit
extremely low levels of friction under physiologically-high pressures, a lubricity which is essential for their
healthy performance. A detailed molecular-level
understanding of this could benefit treatments of
osteoarthritis (OA), as well as improved prosthetic
joint implants, where low friction may suppress
wear debris formation and the associated
periprosthetic osteolysis. Any insight must, first and
foremost, be able to account for the low friction
(coefficient of friction down to ca. 0.001) at the
high pressures (which can reach 100 atm or higher)
of the joints. Over the past decade, hydration
lubrication has emerged as a new paradigm for
extreme lubrication in aqueous systems1, which
may underlie also the very efficient boundary
lubrication of cartilage. According to this, the
hydration shells formed by dipolar water molecules
about charges in water (such as ions or zwitterions)
may be very tenaciously attached, so that they
resist being squeezed out even under large
pressures. At the same time, these same hydration
shells may behave very fluidly under shear. This
resistance to pressure together with low-friction
sliding makes them into excellent lubrication
elements. Very recently2, we discovered that
hyaluronan (HA) which is attached to a surface
to resemble its configuration at the outer cartilage
surface may complex with phosphatidylcholines
(PCs), lipids that are ubiquitous in synovial joints,

to form robust boundary layers. These layers act
synergistically to provide the very low friction
( 0.001) characteristic of cartilage, at the
highest physiological pressures, and contrast with
surface-attached HA on its own, which leads to
considerably higher friction. The very low friction
is ultimately due to the phosphocholine groups
exposed by the HA/PC surface complexes; these
groups are known to be strongly and highly-hydrated, and so they lubricate via the mechanism
described above. Our results thus point to a
scenario where HA, PCs and lubricin, each with a
very different role, act together synergistically to
reduce friction of cartilage in articulating joints.
Hyaluronan, anchored at the outer surface of
articular cartilage by lubricin molecules (which
are known to be present in the outer superficial
zone), complexes with joint phosphatidylcholines
to provide the extreme boundary lubrication
of synovial joints via the hydration-lubrication
mechanism.
1. Ma, L., Gaisinskaya, A., Kampf, N. and Klein, J.,
Origins of hydration lubrication, Nature Communications, | 6:6060 | DOI: 10.1038/ncomms7060 (2015)
2. Seror, J., Zhu, L., Goldberg, R., Day, A.J. and Klein
J., Supramolecular synergy in the boundary lubrication of synovial joints Nature Communications,
| 6:6497 | DOI: 10.1038/ncomms7497 (2015)
KL02
FEBio: Finite Elements for Biomechanics

J. A. Weiss1
1
University of Utah, Scientific Computing and Imaging Institute, Salt Lake City, Utah
The motility and proliferation of angiogenic

neovessels are modulated by the material
properties of the extracellular matrix (ECM).
Neovessels also modify the material properties of
the ECM as they migrate through and interact with
the ECM. This creates a dynamic feedback loop in
which angiogenesis is coupled with deformation
and remodeling of the ECM. In this talk, I will
discuss our experimental and computational
research to investigate the this phenomenon. The
experimental aspects of the research are based
on a 3D in vitro organ culture model of sprouting
angiogenesis. The computational approach
is based on coupling a validated model of
angiogenic growth with the FEBio finite element
software framework developed in our laboratory.
In these studies we demonstrate that angiogenic
neovessels extensively deform and remodel the
ECM through a combination of cellular traction

forces, proteolytic activity and generation of new
cell-matrix adhesions. Sensitivity analysis using our
computational model demonstrated that cellgenerated traction during growth is the most
important parameter controlling the deformation
of the matrix and therefore angiogenic growth,
remodeling and morphometry of the resulting
microvascular bed. Live, large-scale mulitphoton
imaging elu cidated several neovessel behaviors
during angiogenesis that are poorly understood
such as episodic growth/regression, neovessel
co-location, and anastomosis. The combined
approach has allowed us demonstrate that
angiogenic growth and the resulting topology of
a vascular network can be manipulated directly
by altering the mechanical interactions between
cells and the ECM.
KL03
Musculoskeletal function in human locomotion

M. Pandy1
1
University of Melbourne, mechanical Engineering, Melbourne, Australia
Gait-analysis techniques have been used for

more than a century to provide information
on thekinematics and kinetics of human
locomotion, yet the ability of this approach
to evaluatemusculoskeletal function is limited
as it cannot be used to discern the actions
of individual muscles. Computational modelling
is the only practical method available to
determine musculoskeletal functionnon-invasively.
Rapid increases in computing power combined
with recent advances in medicalimaging, more

accurate methods for measuring muscle-tendon
and joint motion dynamically, andmore efficient
algorithms for modelling the neuromusculo
skeletal system have enabled detailedanalyses
of musculoskeletal function. This presentation will
illustrate how computational modellinghas been
used in conjunction with gait analysis experiments
to evaluate lower-limb muscle and jointfunction
during human walking and running.
PT 01
KNEE BIOMECHANICAL ANALYSIS AND

3D MODELING: TO CLOSE THE GAP BETWEEN
SURGEONS AND ENGINEERS.
B. Innocenti1, S. Pianigiani2
1
2
Universit Libre de Bruxelles ULB, BEAMS Department, Bruxelles, Belgium
IRCCS Istituto Ortopedico Galeazzi, Istituto Ortopedico Galeazzi, Milano, Italy
Introduction
Knee kinematics is a complex three-dimensional roto-translation movement, which is strongly correlated
to the patient anatomy. In particular, the shape of
the femurs condyles, the tibia plateau, the patella
proximal surface and the morphological and
mechanical properties and location of the soft tissue
envelope are fundamental to discriminate such
movement. For these reasons, each human being has
a different knee kinetics and kinematics. Therefore,
the study and understanding of the patient-specific
knee joint anatomy and functionality, through
dedicated methodologies for kinematic and kinetic
analyses and soft tissue mechanical properties
determination, is the key factor for closing the gap
between surgeons and engineers.
Numerical studies, validated using experimental

techniques, demonstrated how a close to real
model of the knee joint is fundamental. In particular,
the soft tissue envelope, if neglected, completely
altered the tibio-femoral interaction [14, 21].
DIS C USSION
As knee kinematics and kinetics is a results of a
musculo-skeletal interaction, not only the bone
anatomy need to be integrated in this analysis but
also information on soft tissues need to be provided.
Moreover, especially in analyzing patients with
knee prosthesis, results of several studies highlight
how kinematics is not the only and also not the
most relevant parameter to predict or explain knee
function but knee kinetics should be integrated in
the clinical follow-up.
METHODS
In the last years, several knee biomechanics
study were performed using robotic simulator
[111] showing how this technique could be
beneficially used to investigate accurately knee
joint kinematics, in terms of both rotations and
translation in healthy and in knee with implant.
Moreover, parts of these study were dedicated
not only on tibio-femoral kinematics [1, 3, 711]
but also on the investigation of the patello-femoral
joint [2, 46], currently, and unexpectedly, not well
investigated nowadays, together with collateral
ligament strain [810] and knee alignment [8].
Dedicated patient-specific experimental and

numerical methodologies showed to be the
promising tool to fill this gap surgeon and engineer
and to guide patients from recover from their disease.
RE F EREN C ES
1 Victor et al, J Orthop Res, 2010;
2 Luyckx et al, JBJS Br, 2009;
3 Innocenti et al, IFMBE Proc, 2009a;
4 Innocenti et al, IFMBE Proc, 2009b;
5 Didden et al JBJS Br, 2010;
6 Vanbiervliet et al, JBJS Br, 2011;
7 Labey et al, J Biomech, 2012;
8 Delport et al, KSSTA, in press;
9 Heesterbeek et al, KSSTA, 2013
10) Delport et al, Clinical Biomec, 2013
11) Heyse et al, KSSTA, in press;
12) Innocenti et al, JOSR, 2009;
13) Catani et al, CORR, 2010;
14) Van Jombergen et al, JOSR, 2012;
15) Innocenti et al, J Biomech, 2011;
16) Pianigiani et al, J Biomech, 2012;
17) Innocenti et al, Lubricant, 2014;
18) Pianigiani et al, J Biomech, 2012;
19) Pianigiani et al, KSSTA, in press;
20) Soenen et al, JOA 2013;
21) Innocenti et al, JOA, 2014.
Furthermore, the coupling of numerical analysis

to experimental activity [1220] show a huge
improvement in the results, allowing sensitivity
analysis [15, 16, 18, 19] providing accurate
information on contact forces and pressures
[13], investigating bone stress [12, 14, 20, 21], or
integrating with additional outcomes as risk of
fracture or ligament strain distribution [17, 20, 21].
RESU L TS
Results showed that the kinematic and kinetic knee
joint activity is highly patient dependent, both in
healthy and in patient with prosthesis [15, 11, 12],
moreover, a wrong position of the implant or a bad
choice of the soft tissue position during modeling
could induce high alteration of the joint force
(up to 60%) even if the change in kinematics could
be quite small (less than 5% compared with the
theoretical position) [1519].
PT 02
UNRAVELING THE ROLE OF DIFFERENT MECHANOCHEMICAL CONDITIONS ON 3D CELL MIGRATION:

FROM MICROFLUIDICS TO NUMERICAL SIMULATION
J.M. Garcia Aznar1, O. Moreno-Artozena1, F. Ribeiro2, J. Escribano1,
M. Cndor1, I. Gonzalez1, C. del Amo1, C. Valero1, C. Borau1, T. Rberg3
1
2
University of Zaragoza, Mechanical Engineering, Zaragoza, Spain
Instituto Superior Tecnolgico, Mechanical Engineering, Lisbon, Portugal

3
University of Graz, Mechanical Engineering, Graz, Austria
Results
Preliminary results of fibroblast migration in 3D are
shown in Figure 1. Three different conditions have been
imposed on the left channel for the growth factors: no
growth factor (control), PDGF-BB and TGF-b1.
Introduction
Cell migration is crucial to all morphogenetic and
regenerative processes. It also contributes to the
development of numerous diseases, including
cancer. Research in cell migration has mainly
focused on 2D; however, 3D migration assays, in
which cells are embedded within a physiological
network of fibers, represent much better the
extracellular matrix. All the processes that cells
develop to update and guide their directional
movement are regulated by environmental signals
arising from the surrounding microenvironment.
Unraveling the intrinsic mechanisms that cells
use to define their migration is an essential
element for advancing the development of new
technologies in regenerative medicine. For this
aim, we propose to combine 3D cell cultures on
microfluidics platforms and numerical simulations
to advance towards a better understanding of the
cell migration phenomena.
Figure 1: D
irected cell migration in collagen gels under
control, PDGF-BB and TGF-1 conditions.1
Methods
We have developed microfluidic-based studies of
individual 3D fibroblast movement in biomimetic
microenvironments comprised by the matrix and
the biochemical factors that are moving through
the medium. In particular, we have analyzed
two physiologically relevant hydrogels (made
of collagen and fibrin) in combination with two
growth factors (PDGF-BB and TGF-b1).
These experimental results have been successfully

simulated predicting similar patterns. Additional
phenomena have been simulated in order to
understand how the effect of different local
properties of the microarchitecture can regulate
the migration of individual cells.
Discussion
In this work, we demonstrate that the local
microarchitecture of the hydrogels determines
the migratory properties of human fibroblasts
in response to controlled chemotactic and
haptotactic gradients. We are currently working
with this multidisciplinary approach to understand
3D migration of tumor cells.
At the same time, we are developing novel

numerical approaches to couple multiple
mechanisms
(protrusion,
contraction
and
adhesion) that regulate cell migration. These
numerical simulations will combine discrete and
continuous approaches that enable the design of
effective modeling strategies for each particular
event. Both approaches are combined together
with the experiments in order to improve the
understanding of 3D cell migration, based on a
continuous interactive methodology.
References
1 O. Moreno-Arotzena et al. Biomicrofluidics 8,
064122 (2014)
Ack n o wl e d g e m e n t s
This study was supported by the project
ERC-2012-StG 306751 and the Spanish Ministry
of Economy and Competitiveness
(DPI2012-38090-C03-01).
PT 03
IN SILICO CLINICAL TRIALS: REDUCE, REFINE AND

PARTIALLY REPLACE HUMAN EXPERIMENTATION.
M. Viceconti1
1
University of Sheffield, Insigneo institute for in silico medicine, Sheffield, United Kingdom
C o n cl u s i o n
With this perspective talk we hope to inspire new
research in an exciting and industrially relevant
direction.
Introduction
The Avicenna support action is roadmapping the
new research domain known as In silico Clinical
Trials, which refer to the use of individualised
computer simulation in the development or
regulatory evaluation of a medical intervention. In
this prospective talk we reflect on the difficulties
that the development of new medical devices
pose, and how in silico technologies may play an
important role in solving them.
References
A
vicenna web site: http://www.avicenna-isct.org
V
iceconti, M., 2014. Biomechanics-based in silico
medicine: The manifesto of a new science.
J Biomech Jan 21;48(2), 193194.
Coveney, P., Diaz, V., Hunter, P., Viceconti, M., Eds.,
2014. Computational Biomedicine. Oxford, Oxford
University Press.
Viceconti, M., 2011. Multiscale Modeling of the
Skeletal System. Cambridge University Press.
Exp e r i m e n t a l M e t h o d s
We will overview the current methods for the design
and assessment (both pre-clinical and clinical) of
new implantable medical devices, highlight the
main difficulties and shortcomings, and suggest
where in silico technologies could be used instead.
This work was partially supported by the Avicenna
CSA funded by the European Commission as part
of the 7th Framework Program (FP7).
Results and discussion

The analysis will make evident the current
methodological
and
technological
gaps,
suggesting possible directions for research and
development in this area.
PT 04
WHAT IS THE RELEVANCE OF BONE MATERIAL

PROPERTIES FOR OSTEOPOROTIC FRACTURES?
P. Thurner1, O.L. Katsamenis2, T. Jenkins2, L.V. Coutts2, O.G. Andriotis1,
V. Nedelkovski1, D.G. Dunlop3 , R.O.C. Oreffo4 , C. Cooper5, N.C. Harvey5
1
Faculty of Engineering and the Environment, University of Southampton,

Southampton, United Kingdom
University Hospital Southampton NHS Trust, University Hospital Southampton NHS Trust,
United Kingdom
4
Institute for Lightweight Design and Structural Biomechanics,

Vienna University of Technology, Vienna, Austria
Institute for Developmental Sciences, University of Southampton,

MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, United Kingdom
Age-related bone fragility is a severe and

increasing problem. Every third woman over 50 is
expected to suffer an osteoporotic fracture during
her lifetime. With increasing life expectancy the
problem to screen and treat patients at risk prior
to experiencing a fracture becomes increasingly
important. Historically bone quantity, i.e. bone
mineral density (BMD) and clinical risk factors, i.e. the
FRAX tool, have most widely been used. Yet, these
diagnostic measures suffer from low specificity for a
given sensitivity. For over a decade the importance
of bone quality, i.e. all intrinsic properties of bone
relating fracture risk that are not bone quantity,
has been investigated. Among the parameters
encompassed by this term are also the material
properties of bone tissue, which are strongly linked
to micro- and nanostructural arrangement and
composition. From a materials science perspective
an important question is whether and which
structural and compositional changes do occur as a
consequence of aging and/or osteoporosis disease
and what the potential implications for fracture risk
might be. This perspective paper summarises work
on bone material properties by ourselves and others
in the field over the past decade primarily focussed
on these questions.
enriched in NCPs appear to be reduced with aging

when investigating bone from the femoral midshaft
and so are fracture toughness measures. While the
impairment of material properties with ageing has
been reported in the past there are currently no data
points comparing osteoporotic to age-matched,
healthy bone. Our ongoing work suggests that at
least at the infero-medial portion of the femoral
neck (where fracture toughness samples can be
manufactured) there are no significant differences in
terms of fracture toughness. Whether this is also true
for the supero-lateral (where fracture initiates) side
cannot be answered, although micromechanical
investigations may elucidate putative changes in
material properties within this part of the femoral
neck. Nevertheless reference point indentation (RPI)
experiments are performed in vitro and in vivo can
measure differences between osteoporotic and
age matched healthy controls. But it is still unclear
what this technique actually measures and to which
component changes in structural and material
properties are influencing these measurements. While
RPI may offer a way to potentially improve fracture
risk assessment there are still a number of unresolved
questions: Is osteoporosis simply an effect of ageing
or are distinctive pathological changes occrring?
Are there underlying changes in bone composition
in terms of NCPs? Could this potentially offer novel
ways for complementary therapy? Further research
is required to provide answers to these questions
and with a fuller picture new diagnosis, treatments
and therapies appear feasible in the future for an
increasing aging population.
Imaging studies employing AFM and SEM revealed

that, at the nanoscale, bone failure surfaces are
predominantly located at the interface between
individual mineralised collagen fibrils [14]. Additional
studies showed that this interfibrilar space consists
of noncollagenous proteins (NCPs) [5], which can
form molecular meshworks that can repeatedly
dissipate large amounts of energy [6, 7] and can
furthermore also be covalently cross-linked [8]. This
suggests that the expression of NCPs during bone
formation may have a significant influence on
specifying bone material properties and indeed
this was shown in mouse models targeting only
osteoblastic protein expression [9]. The presence
of NCPs also suggest that diffuse microdamage,
which does not invoke a remodelling response [10]
may re-heal itself through molecular self-healing
processes [11]. Further the deletion of NCPs such
as osteopontin and osteocalcin results in significant
reduction of fracture toughness [12, 13], which
was linked only to the absence of diffuse damage
[13]. Further micromechanical modulation within
cortical bone due to interlamellar areas [14] that are
References
1 Fantner, NatMater 2005.;
2 Thurner, EngFracMech, 2007.;
3 Kindt, Nanotechnology, 2007.;
4 Braidotti, JBiomech, 1997.;
5 Thurner, JAdhesion, 2009.;
6 Fantner, NanoLett, 2007.;
7 Zappone, BiophysJ, 2008.;
8 McKee, CellsTissuesOrgans, 2005.;
9 Balooch, PNAS, 2005.;
10 Herman, Bone, 2010.;
11 Seref-Ferlengez, JBMR, 2014.;
12 Thurner., Bone, 2010.;
13 Poundarik, PNAS, 2012.;
14 Katsamenis, JMBBM, 2013.
7
PT 05
BIOMECHANICS OF CELL MEMBRANE NANOSTRUCTURES

A. Iglic1
1
University of Ljubljana, Faculty of Electrical Engineering, Ljibljana, Slovenia
Introduction
Membrane nanodomains are important functional
building blocks of biological membranes. As
an addition to the pure lipid bilayer, they can
significantly increase the complexity and alter
the physical properties of biological membranes.
Flexible membrane nanodomains (Figure 1) are
supposed to be small complexes composed of
proteins and lipids, where the proteins are often
chain-like biopolymers that cross the membrane
bilayer several times. Membrane raft elements
of biological membranes may also fall into this
category. Membrane nanodomains (inclusions)
may also be induced by a single rigid globular
membrane protein, which can be described in
the first approximation as a rigid object of a simple
geometrical shape. Some membrane-embedded
peptides may induce such nanodomains.
Results and Discussion

We present a possible mechanism that may explain
experimentally
observed
detergent-induced
tubular budding of the erythrocyte membrane. The
proposed mechanism is based on the energetically
favourable self-assembly of anisotropic membrane
nanodomains (raft elements) into larger membrane
domains
forming
nanotubular
membrane
protrusions. This mechanism of the growth and
stability of erythrocyte membrane tubular
membrane protrusions may also be relevant for
stabilization of tubular membrane protrusions
in other cellular systems and for the stability of
tunneling nanotubes that connect cells, and
could be important in intracellular and intercellular
transport and communication.
Methods
The single-nanodomain energy is derived in this
chapter. In this chapter, we present a theoretical
approach to the study of membrane nanodomains.
We derive the contribution to the free energy of
the membrane bilayer including nanodomains
which are in general flexible. For flexible
membrane nanodomains the phenomenological
interaction constants that appear in the free
energy expression depend on the physical and
geometrical. properties of the molecules that
constitute the membrane. Special consideration is
devoted to membrane nanodomains induced by
rigid membrane-embedded proteins. The cases
of constrained and unconstrained local shape
perturbations of the membrane around a rigid
membrane inclusion are discussed. The total free
energy of the membrane bilayer with membrane
nanodomains is derived.
PT 06
EVIDENCE THAT ATHEROSCLEROSIS IS TRIGGERED

BY MULTIDIRECTIONAL NEAR-WALL FLOW
P. Weinberg1
1
Imperial College London, Bioengineering, London, United Kingdom
Introduction
A striking feature of atherosclerosis is its
predilection for certain well-defined arterial sites.
Anitschkow [1933] first showed that lesions develop
downstream of branch ostia in the cholesterol-fed
rabbit, and that arterial wall uptake of plasma
proteins is elevated in the same locations, prior to
the development of disease. Fry [1969] proposed
that this is caused by elevated haemodynamic wall
shear stress (WSS) in these regions. However, Caro
et al [1971] found in post mortem human aortas that
areas downstream of branches had a particularly
low frequency of disease. They proposed that high
WSS is protective and that disease is triggered
instead by low WSS. Subsequently Ku et al [1985]
provided evidence that human atherosclerosis
occurs in regions where near-wall flow is not only
low but oscillatory. The theory that low, oscillatory
WSS triggers atherosclerosis underlies much
current research. However, it leaves a central
contradiction unresolved: human disease occurs in
arterial locations that, according to animal studies,
have the lowest uptake of plasma lipoproteins.
lesion prevalence in young and mature rabbits

[Mohamied, 2015]. No correlations supported the
low, oscillatory WSS theory.
Discussion
The data support the view that multidirectional
near-wall flow is highly atherogenic. A recent
observation [Wang, 2013] that flow has proinflammatory effects when acting perpendicularly
to the long axis of EC but anti-inflammatory effects
when acting parallel to it provides a plausible
cellular mechanism.
References
Anitschkow NN. In: Cowdry EV (ed). New York:
MacMillan, 1933.
Barnes et al, Exp Mol Pathol, 71:161k assessment
there are still a number of unresolved questions:
Is osteoporosis simply an effect of ageing or are
distinctive pathological change170, 2001.
Caro et al. Proc R Soc Lond B, 177:109k assessment
Fry, Circulation, 40:3857, 1969.
Ku et al, Arteriosclerosis, 5:293k assessment there
are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive
pathological change302, 1985.
Mohamied et al, Ann Biomed Eng, 43:16k assessment there are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or
are distinctive pathological change25, 2015.
Peiffer et al, Atheroscler, 223:114k assessment there
Peiffer et al, J Biomech Eng, 135:021023, 2013a.
Peiffer et al, Cardiovasc Res, 99:242k assessment
distinctive pathological change250, 2013b.
Peiffer et al, J Biomech, 46:2651k assessment there
pathological change2658, 2013c.
Sebkhi A et al, Arterioscler Thromb Vasc Biol,
1996;16:317k assessment there are still a number
of unresolved questions: Is osteoporosis simply an
effect of ageing or are distinctive pathological
change27.
Methods and Results

Our tracer studies showed that the pattern of uptake
by the wall changes with age [Sebkhi, 1996]. Hence
the apparent contradiction noted above could
have arisen because young animals were compared
with mature human subjects. Furthermore, we
showed that although cholesterol-induced lesions
occur downstream of aortic branch mouths in
young rabbits, this region is spared in older rabbits
[Barnes, 2001]. Furthermore, lipid deposition occurs
downstream of aortic branch mouths in immature
human aortas [Sinzinger, 1980]. When these changes
with age are taken into account, human lesion
location, rabbit lesion location and elevated uptake
of plasma macromolecules in rabbits all correlate.
Does the pattern of WSS also change with age,
or is there a change in the relation between WSS
and disease? Our CFD studies showed that the
pattern of WSS does change because tapering
of the aorta increases with age [Peiffer, 2012].
Despite this change, we were unable to show any
consistent spatial relation between low WSS and
lesion prevalence [Peiffer, 2013a]. Furthermore,
our systematic review [Peiffer, 2013b] found that
all five rigorous studies making a point-by-point
comparison between CFD-derived WSS and
lesion prevalence failed to support the theory.
We speculated instead that substantial changes
in the direction of WSS during the cardiac cycle
might be particularly atherogenic, and developed
a new metric, the transverse WSS (transWSS), to
capture multidirectionality [Peiffer, 2013c].TransWSS
correlated positively, strongly and significantly with
see the next page
S inzinger et al, Blood Vessels, 17:44k assessment

W
ang et al, Arterioscler Thromb Vasc Biol, 33:2130k
assessment there are still a number of unresolved
or are distinctive pathological change2136, 2013.
Weinberg, J Vasc Res, 2004;41:1k assessment there

pathological change17.
10
PT 07
PIANISTS HAND BIOMECHANICS:HERITAGE

AND NEW KNOWLEDGE
S.H. Lee1, A. Luciano2, S. Carey3
1
2
University of South Florida, School of Music, Tampa, USA
University of South Florida, Department of Pediatrics Division of Neonatology, Tampa, FL, USA
3
University of South Florida, Mechanical Engineering, Tampa, USA
Introduction
Classical piano discipline has inherited the
keyboard tradition that had evolved from the 17thcentury finger technique to 19th-century arm weight
technique, relaxation technique, and the modern
science of physiological mechanics. We now
know that these techniques are used together to
coordinate the skilled pianists biomechanics that
are displayed ultimately at the dexterous finger
touch control. We examined hand/finger shape,
size, arm/hand weights, and finger and intra-finger
motion in order to understand the efficient hand-piano key biomechanics (as well as ergonomics)
in skilled pianists playing. Advantages of the large
handed pianists versus injury risks of small-handed
pianists are still a topic of debate. However, history
reveals that the most eminent pianists over the
centuries came in varied hand sizes and shapes.
There were, however, no significant differences

between male and female in finger spans 1-5, 2-4, 3-5,
ulnar deviation, and hand-arm weight ratio. In Legato
playing, artists, graduate and injured pianists were
similar in articulation evenness (p=0.83, p=0.523) as
well as in tempo evenness (p=0.60, p=0.15), while
undergraduate pianists showed significant differences
in both temporal and articulation evenness control
(p=0.045, p=0.045). But, both injured (p=0.024) and
undergraduate pianists (p=0.042) showed significant
differences in tempo evenness in Staccato playing.
An injured and healthy pianists mocap data showed
significant differences in both MCP and PIP joints.
The aim of this study was to examine the relationships

between hand biometrics that include finger length,
span, arm and hand weight ratio, and wrist mobility
and the performance data as measured by MIDI
(Musical Instrument Digital Information) equipped
hybrid electro-acoustic piano. We also wanted to
pilot test and compare finger and between-finger
motion captures of a healthy and an injured pianist.
METHOD
We tested four groups of skilled pianists (N=31)
applying comprehensive hand measurements,
motion capture at 14 finger joints, and quantified
performance outcomes to examine systematically
relationships among hand biomechanics, music
performance outcomes, and motion capture.
Skilled pianists are classified into four categories: artists
(n=9), graduate pianists (n=8), undergraduate pianists
(n=5), and injured professional pianists (n=9). We
defined hand biomechanics per hand length and
width, composite finger lengths, composite finger
spans, hand and arm weights, weight ratio between
them, and ulnar deviation at the wrist. Performance
outcomes in playing seven tasks were measured by
temporal and dynamic evenness touch control on
the piano keys, quantified in MIDI data generated
from a hybrid acoustic-electronic piano. DataGlove
5DT was used to capture motion at 14 finger joints
to compare an injured and a healthy pianists joints
motions in playing a rapid scale.
Discussion
Our study demonstrates high correlations between
various components of hand biomechanics and piano
touch control. We have used the hand biomechanics
data and MIDI outcomes to rehabilitate pianists
pain and injury. We were able to demonstrate the
effective use of this novel knowledge in prevention
and rehabilitation of piano-related pain and injury.
Results
There were NO differences in hand biomechanics
among the four pianist groups. Significant differences
in hand size, shape and weight were observed
between male (n=16) and female (n=15) pianists.
11
PT 08
CHANGES OF MECHANICAL SIGNALS AND TISSUE

COMPOSITION IN HUMAN INTERVERTEBRAL DISC
DURING DEGENERATIVE PROGRESSION
W. Gu1, Q. Zhu2, X. Gao3
1
University of Miami, Mechanical and Aerospace Engineering,

Biomedical Engineering, Coral Gables, USA
University of Miami, Tissue Biomechanics Lab., Dept. of Biomedical Engineering, Florida, USA
3
University of Miami, Department of Mechanical and Aerospace Engineering, Florida, USA
Introduction
Intervertebral
disc
degeneration
involves
complicated changes in the biological, chemical,
electrical and mechanical events within the
tissue. Knowledge of these events is crucial for
understanding the mechanobiology in the disc
as well as for developing new diagnostic and
therapeutic methods for degenerated discs.
Therefore, the objective of this study was to
quantitatively investigate the temporal changes in
tissue composition and mechanical signals within
human lumbar discs during the degenerative
progression.
composition, and tissue deformation over time.

The knowledge of the variations of temporal and
spatial distributions of tissue composition and
mechanical signals can provide a new insight into
the progression of disc degeneration. It can also
help develop new strategies for diagnosis and
treatment of degenerated discs.
Figure
Methods
The disc is modelled as an inhomogeneous, porous,
mixture consisting of a charged solid phase [with
cells and proteoglycan fixed to the solid phase], a
fluid phase, and a solute phase with multiple species
(sodium ion, chloride ion, glucose, oxygen, and
lactate). The theoretical model was extended from
the cell-activity coupled mechano-electrochemical
model [Zhu et al., 2012]. A 3D numerical model was
developed based on the finite element method [Gu
et al., 2014]. The disc degeneration was simulated
by the reduction of the nutrition supply at the disc
boundaries [Zhu et al., 2014]. The configuration of the
disc at the healthy condition before degeneration
was chosen as the reference configuration. The
changes in stresses between current and reference
configuration were calculated.
Figure 1: ( A) Schematic of the rightupper quarter of the L2-3

disc (from a healthy male) [Jackson et al., 2011,
Zhu et al., 2012]. (B) 3D distribution of fluid pressure
at the healthy state. (C) Fluid pressure at 20 years of
degeneration. (D) Fluid pressure distributions in the
sagittal direction (averaged over the disc thickness).
(E) Fluid pressure distributions in the coronal direction (averaged over the disc thickness).
Only one upper-right quarter of the disc was

simulated due to symmetry (Figure 1A).
References
Gu et al., Spine, 39: E1411k assessment there are still
a number of unresolved questions: Is osteoporosis
simply an effect of ageing or are distinctive
Jackson et al, J Biomech Eng, 133: 091006k assessment there are still a number of unresolved questions: Is osteoporosis simply an effect of ageing or
are distinctive pathological change091013, 2011.
Zhu et al., J Biomech, 47: 3734k assessment
Zhu et al., J Biomech, 45: 2769k assessment
Results
With the progression of disc degeneration (over
50 years), the cell density, fixed charge density,
fluid pressure, and water content decreased
significantly in the nucleus pulposus (NP) and the
inner to middle annulus fibrosus (AF) regions of
the disc. The Von Mises stress (relative to that at
healthy state) increased within the disc, with a
larger increase occurring in the outer AF region.
Both the disc volume and height decreased with
the degenerative progression. Due to limited
space, only a small portion of the results (e.g., fluid
pressure) were presented (Figure 1B-E).
Discussion
This study provided detailed information on how
the nutrition deprivation affects the cell viability,
swelling pressure, mechanical stresses, tissue
12
PT 09
COMPARISON BETWEEN PREOPERATIVE DIGITAL

PLANNING AND POSTOPERATIVE OUTCOMES IN 197
HIP ENDOPROSTHESIS CASES USING SHORT STEM
PROSTHESES
P. Hhle1, S.M. Schrder2, J. Pfeil3
1
2
Klinikum Worms, Traumatology and Orthopaedics, Worms, Germany
GP Hospital Rsselsheim, Department of Trauma, Hand and Reconstructive Surgery,

Rsselsheim, Germany
3
St. Josefs Hospital, Department of Orthopaedics and Orthopaedic Surgery,

Wiesbaden, Germany
Introduction
Preservation of hip geometry is important for
treatment success in endoprosthesis implantation.
Digital planning can be used to estimate
postoperative hip geometry. This study examined
whether digital planning accurately predicts
surgical outcomes for two femoral neck resecting
short stem implants, Mayo (Zimmer) and Metha
(Aesculap).
Results
Implantation of the planned short stem prostheses
resulted in a mean femoro-acetabular leg
lengthening of 4.2 mm (SD 5.8 mm) and a mean
femoro-acetabular offset-reduction of 4.2 mm
(SD 5.9 mm) in comparison with preoperative
planning. Implantation of both stems resulted
in increased valgization compared to planning
(Metha , mean 5.4 [SD 3.7]; Mayo, mean k
questions: Is osteoporosis simply an effect of
ageing or are distinctive pathological change 3.2
[SD 3.4]).
Methods
Preoperative digital planning of the short stem and
acetabular cup was performed for 191 patients
(197 endoprostheses) with hip osteoarthritis. Digital
planning was done with mediCAD II (Hectec)
to evaluate types of prosthesis stems and sizes,
leg lengthening and offset, and angle of stem
inclination within the femur. The predicted values
for these parameters were compared to the
postoperative measurements. A double coordinate
system was developed to measure pelvic and
femoral distances separately. Individual scale
factors were applied to minimize measurement
bias.
Discussion
Differences between preoperative planning and
postoperative outcomes were greater for femoroacetabular than for cup-related leg length and
offset. On average, leg length was longer than
predicted and there was loss of femoro-acetabular
offset. Compared with the planning, valgization of
the implanted stems was frequently observed.
Reference:
This Research is being published in the Journal of Clinical Biomechanics in February 2015
K e yw o r d s
Short stem prosthesis, hip, valgization, leg lengthening, femoro-acetabular offset, digital planning
13
P T 10
MECHANICAL STIMULATION IN TISSUE ENGINEERING

D. Pioletti1
1
EPFL/STI/IBI/LBO, Lausanne, Switzerland
Introduction
Mechanical stimulation has been demonstrated
to be one of the strategies to optimize tissue
engineering construct. However, it is challenging
to rationally determine the optimal mechanical
stimulation to control the tissue differentiation in
construct. For instance, Li and colleagues have
shown that the parameters of frequency and
amplitude during dynamic compression modulate
chondrogenesis of human bone MSC seeded in
polymeric scaffolds 1. Particular frequency and
amplitude may be optimal for one type of scaffold
but may not be for another type, since the scaffolds
would differ in their mechanical properties and
in their microstructure, inducing then a different
stimulus to the cells. This leads to the need of
identifying an overarching variable to generally
take into account those parameters.Hence, the
aim of this study is to evaluate if dissipation could
be correlated to a tissue differentiation and then
be considered as a mechanobiology variable.
All the scaffolds were coated with fibronectin in

order to uniform the cell-scaffold interface between
the different types of scaffold. Scaffolds were then
seeded with epiphyseal chondro-progenitor cells 2
at 3 mio cells/scaffold. Cell-scaffold constructs of
the different groups were subject to mechanical
stimulation 3. Dynamic compression of 1Hz and
10% strain (with 10% pre-strain) was applied to
scaffolds 2 h/day during 4 consecutive days. After
the 4th day of testing, immediately after mechanical
stimulation, gene expressions of TGF-beta, Sox9,
Col2a and Aggrecan were analyzed for the loading
group and the free-swelling group used as control.
As a result, in general upregulation for all genes was
observed with dissipation close to the dissipation
of healthy cartilage, and downregulation was
observed for dissipation close to degenerated
cartilage. This study highlights then that there
is a sensitivity of chondrogenic expression to
dissipation. Dissipation could then be variable to
be considered in cartilage mechanobiology.
HEMA-based scaffolds have been developed
having different levels of dissipation when subject
to the same loading in terms of frequency
and amplitude of deformation. The levels of
dissipation where chosen to match the level of
dissipation of healthy and degenerated cartilage.
References
1 Li+, Tissue Eng Pt A, 2010
2 Darwiche+, Cell Medicine, 2012
3 Abdel-Sayed+, Biomaterials, 2014
14
P T 11
EXPLORING LUMBAR SPINE BIOMECHANICS AND

INTERVERTEBRAL DISC BIOPHYSICS THROUGH
MULTISCALE AND MULTIPHYSICS MODELLING
J. Noailly1,2
1
Universitat Pompeu Fabra UPF, Department of Information and Communication T

echnologies DTIC, Barcelona, Spain
2
Institute for Bioengineering of Catalonia, Biomechanics and Mechanobiology,

Barcelona, Spain
Introduction
Intervertebral disc (IVD) degeneration (DD) is an
intricate process. On one hand, disc cells respond
to mechanical, biochemical, and nutritional cues
that interact with pathway signalling. On the other
hand, the IVD is composed of different tissues that
interact mechanically and redistribute each cue
heterogeneously, depending on external load
transmissions. Still, numerical modelling allows
rational interpretations of complex interactions in
DD.

Under compressive loads representative of human
daily activity, reductions of diffusion distances
competed with tissue consolidation, in terms
of solute transport. For standard disc heights
(c.a. 10 mm), consolidation mostly hindered
glucose diffusion, but mechanical overload or
endplate sclerosis were necessary to induce cell
death. Nutrition seemed to control, however, the
proteoglycan loss characteristic of ageing.
Simulated
NP
dehydration
with
healthy
proteoglycan contents already caused drops
of glucose in the inner AF, suggesting that
nutrition-induced catabolic activities in the
AF could precede the commonly reported NP
degeneration. However, in (e.g. 14 mm) thick IVDs,
increased diffusion distances affected directly the
NP cell viability independently on tissue condition
[Malandrino, 2015].
Methods
3D porohyperelastic IVD finite element (FE)
models incorporated the annulus fibrosus (AF)
composite structure and the nucleus pulposus (NP)
osmotic pressure, in function of tissue composition
and/or condition. Focusing on nutrition as an
influent indirect mechano-transduction path,
poromechanical calculations were coupled to
metabolic transport models that predicted the
diffusion of oxygen, glucose and lactate, in function
of coupled solute reactions and glucose- and
pH-dependent cell viability [Malandrino, 2015].
This framework was used to explore the effect of:
1) mechanical cues on the nutrition-dependent cell
viability, 2) tissue alterations and disc geometries
on cell nutrition and viability, and 3) local cell
nutrition on the proteoglycan turnover.
While in human disc models nutrition-induced

local glucose deprivation was always most critical,
simulation of bovine disc organ cultures [Chan,
2013] revealed that compression-torsion loads might
induce primary cell death through local pH drops.
Use of the FE-based concentrations of lactate,
oxygen and glucose in the ABM led to catabolic
activity, partly compensated by the hydrostatic
pressure effect. These results qualitatively followed
the balance of mRNA expressions experimentally
determined for the simulated in vitro experiments.
Starting from the IVD scale, explorations were

expanded to the system scale through the
integration of the disc models into FE models of
the musculoskeletal lumbar spine. Interactions
between external loads and disc multiphysics were
studied, using a predictive muscle model coupled
to a geometrical description of the most relevant
local and global muscles [Toumanidou, 2014].
The maintenance of the IVD swelling capacity led

to muscle fascicle activation during simulated night
rest. On one hand, such activation made muscles
mechanically counterbalance the anterior body
mass in standing position [Toumanidou, 2014].
On the other hand, overnight disc strengthening
and AF integrity limited the need of muscle force
development during standing, and seemed to
mechanically protect the lumbosacral IVD.
The different cues transmitted through the IVD

were further explored against their capacity to
promote anabolic or catabolic cell activities.
In order to capture the complexity of these
processes, Agent-Based Models (ABM) were locally
coupled to the FE calculations, with special focus
on the effect of nutritional and mechanical cues
on mRNA expression and cytokine-mediated cell
communication.
All in all, the different mechanical and biophysical

interplays identified might explain the diversity of disc
degeneration phenotypes, in function of specific
patient spine morphology and muscle function.
My SPINE-269909
References
Toumanidou et al, VPH Conference, Paper #165,
2014; Malandrino et al, Frontiers in Bioeng Biotech
(in press); Chan et al, PLoS One, 8(8), 2013.
15
P T 12
BIOMECHANICAL ASPECTS OF SPINAL CORD INJURY

T. Oxland1, P. Cripton2
1
2
University of British Columbia, Orthopaedics, North Vancouver, Canada
University of British Columbia, Mechanical Engineering, Vancouver, Canada
clinically burst fracture and fracture-dislocation

result in different injury mechanisms to the spinal
cord and result in contrasting patterns of neural
injury in novel animal models. There remains much
to discover regarding the behavior of the spinal
column and spinal cord during the traumatic
event and how this affects the pathophysiological
degradation of the spinal cord.
Spinal cord injury (SCI) begins with mechanical

insult to the cord (i.e. primary injury), followed by
a myriad of biological events such as ischemia,
inflammation, etc. that further damage the
cord (i.e. secondary injury). The biomechanical
aspects of the spinal column injury (i.e. vertebrae,
disc, ligaments) and the subsequent insult to the
spinal cord may inform the development of novel
preventative and treatment strategies. Cadaveric
experimentation, animal model development and
computational simulations continue to provide
insight into the relation between spinal column
injury and spinal cord damage.
Learning Objectives
At the end of this presentation, you should be able to:
i) differentiate between injury to the spinal column
(i.e. vertebrae, disc, ligaments) and injury to the
spinal cord;
ii) describe how an understanding of spinal column
injury can help inform the design of devices to
prevent spinal injury;
iii) describe the pathological changes in the spinal
cord damage after the most common patterns
of spinal column injury (i.e. burst fracture,
fracture-dislocation) in novel animal models;
This presentation will highlight the research work

being done at our institution and elsewhere in these
three research areas to address the biomechanical
aspects of SCI. Our work in prevention uses new
and existing knowledge of spinal column damage
patterns to inform the development of a novel
helmet. Our SCI-focused efforts demonstrated that
two of the most common injury types observed
16
P T 13
UNRAVELING THE MYSTERIES OF RESPIRATORY

AIRFLOWS IN THE ACINAR AIRWAY DEPTHS
J. Sznitman1
1
Technion Israel Institute of Technology, Biomedical Engineering, Haifa, Israel
Introduction
Over the past 30 years, our understanding of
the fluid mechanics in the pulmonary acinus of
the lungs has been fundamentally revisited. In
this perspective talk, we will review our current
knowledge of convective acinar airflows and their
role in determining the fate of inhaled aerosols in
the distal regions of the lungs where sub-millimetre
airways are densely populated with pulmonary
alveoli [Sznitman 2013]. We will briefly review the
influential studies following the seminal experiments
of Heyder et al. (1988) who demonstrated in
inhalation studies in human subjects that fine
inhaled particles mix significantly with residual gas;
the deeper the inhaled bolus penetrates the lungs
the more dispersed it becomes upon exhalation,
suggesting that convective mixing occurs in the
acinar depths. This shift of paradigm began a
revolution in our understanding of the complex
nature of respiratory acinar flows.
To go beyond the state-of-the-art, we have

designed and microfabricated acinus-on-chip
platforms that mimic the physiological acinar
airway milieu at true scale. We have developed
the first ever prototypes of artificially-breathing
microfluidic in vitro acinar networks [Fishler et al.
2013] and obtained time-resolved quantitative
flow measurements, confirming for the first time
the broad range of alveolar airflow structures long
hypothesized to exist. Recently, we have begun
tracking time-resolved aerosol kinematics; to this
day, aerosol dynamics in the acinus had never
been experimentally demonstrated whether in
vitro, in situ or in vivo.
A n Ey e t o w a r d s t h e F u t u r e
Despite progress, including the integration of human
cellular airway barrier functions within our biomimetic
microfluidic devices [Tenenbaum-Katan et al. 2015],
we are still in the infancy of fully grasping the
complexity of transport phenomena at the acinar
scale. Crucially, we are unable to assess reliably the
outcomes of inhaling aerosols and predict ensuing
acinar deposition patterns. Our ongoing efforts are
paving the way to unravel quantitatively the fate
of inhaled aerosols in the acinus. Microfluidic in
vitro platforms of microscale alveolar cavities within
mesoscale respiratory acinar lung structures provide
for the first time the opportunity to interrogate in realtime and at true scale the underlying mechanisms
of respiratory phenomena under physiological
breathing conditions.
In silico Strategies
Using advanced computational fluid dynamics (CFD)
simulations [Hofemeier & Sznitman 2014, Hofemeier
et al. 2014], our group has delivered leading efforts in
developing some of the most physiologically-realistic
models emulating the pulmonary acinus, from the
microscale alveolar level, to more complex models,
from alveolated airways to multi-generation tree
networks [Sznitman et al. 2009].
Our in silico studies have helped shed light on the
range of complex oscillatory microflow topologies
that exist locally in alveolar cavities and describe the
ensuing convective mechanisms acknowledged to
generate kinematic irreversibility in the pulmonary
acinus, despite low-Reynolds-number airflows
(Re<1). These results, combined with dimensional
analysis, allow the physical interpretation of the
coupling that arises in the pulmonary acinus
between diffusive, convective and sedimentation
mechanisms for aerosol transport and deposition.
References
F ishler et al. J Biomech 46:2817k assessment there
H
eyder et al. J Appl Physiol 64:1273k assessment
distinctive pathological change1278. 1988.
H
ofemeier and Sznitman. J Biomech Eng
136:061007, 2014.
H
ofemeier et al. Fluid Dyn Res 46:041407, 2014.
M
a et al. J. Aerosol Sci. 40:403k assessment there
S znitman et al. J Biomech Eng 131:031010, 2009.
S znitman, J Biomech, 37:1k assessment there are still
simply an effect of ageing or are distinctive pathological change10, 2013.
T enenbaum-Katan et al. Biomicrofl in press, 2015.
In vitro Strategies
Traditionally, experimental approaches have
revolved around the use of scaled-up systems.
Yet, the fabrication of realistic models that
integrate features such as breathing motion in
multi-airway generations has proven delicate.
Moreover, scaled-up experiments are limited in
their applicability to investigate acinar aerosol
dynamics [Ma et al. 2009] due to the challenges
in matching both dimensionless flow (e.g. Re) and
particle numbers (e.g. Stokes number).
17
P T 14
ANTHROPOLOGICAL ASSESSMENT
OF BIOMECHANICALLY MEANINGFUL UNILATERAL
SHORTENING OF LEGS AND SOLUTION BY DRILLING
EPIPHYSIODESIS: LONG-TERM RESULTS
I. Marik1, D. Zemkova2, 3 , R. Myslivec4, 5, S. Petraskova1, J. Culik1
1
Ambulant Centre for Defects of Locomotor Apparatus l.l.c., orthopaedic,

University Hospital Motol, Prague, Czech Republic, Paediatrics, Prague 5, Czech Republic
3
4
Dept. of Paediatrics University Hospital Motol Prague Czech Republic
Orthopaedic and Traumatology Department, Hospital Pribram, Czech Republic

5
Faculty of Medical Studies, West Bohemia University Pilsen, Czech Republic
Introduction
Shortenings and deformities of legs at children are
symptoms of genetic skeletal disorders, congenital
limb defects, consequence of inflammation
and injury of growth plates and/or the result of
neurological diseases. Shortening 2 cm and more
causes a limping and implicates asymmetrical
overloading of the leg joints and spine, too. It is
known that this overloading causes premature
degenerative changes not only of big joints like
gonarthrosis and coxarthrosis but also spondylosis
and spondylarthrosis. We talk chain formation
of disorder underneath and biomechanically
meaningful shortentings represent so-called preosteoarthritis. Regulation of growth at the knee
region by drilling epiphyseodesis [Macnicol, 1992]
belongs to miniinvasive procedures in comparison
with corrective osteotomies and lengthening of
long bones. Epiphysiodesis carried out at the knee
region is a method of choice for the equalization
of shortenings 25 cm in growth period. Our
contribution summarizes our many years ongoing
experience with anthropological prediction of
remaining growth of the leg lengths discrepancies
and apropriate timing of the surgery.
RESU L TS
The final abbreviation ranged between 02.0 cm
(median 1 cm).
DIS C USSION
Drilling epiphyseodesis is an appropriate method
for the equalization of shortenings 25 cm. It is a
mini-invasive surgical procedure that is indicated
with the aim not only to prevent premature
degenerative changes of leg big joints and spine
but it improves the walking stereotype, posture
and visual aspect, too. Regular follow-up of
affected children from the beginning of puberty is
necessary for proper timing of surgery. We proved
that the remaining growth data by Anderson,
Green and Messner [1963] are enough precise for
our population.
RE F EREN C ES
A
nderson M et al, M. B. J Bone Joint Surg Am. 45:
1k assessment there are still a number of unresolved
or are distinctive pathological change14, 1963.
Macnicol M F et al, Seminars in Orthopaedics (the
Princess Margaret Rose Orthopaedic Hospital,
Edinburgh) 7 (3): 201k assessment there are still a
number of unresolved questions: Is osteoporosis simply an effect of ageing or are distinctive pathological change206, 1992.
M
oseley C F, J Bone and Joint Surg 70A(4):
520525, 1988.
S hapiro F J, Bone and Joint Surg 64-A (5):
63965, 1982.
T anner J M et al. Assessment of skeletal maturity
and prediction of adult height (TW3 method).
London: Saunders, 2001.
Methods
Prediction
method
combines
auxology,
anthropometry and radiology [Moseley, 1988,
Shapiro, 1982]. Bone age was evaluated before
surgery [Tanner, 2001] and remaining growth
was predicted according to Anderson, Green
and Messner [1963]. Resultant shortening was
compared with prediction and remaining growth
after epiphyseodesis. Total epiphyieodesis was
carried out by drilling of growth plate in the knee
region according to Macnicol technique. Total
permanent epiphysiodesis of distal femoral physis
and/or proximal tibia was carried out in a cohort of
49 children with predicted abbreviation 25,5 cm
in age 10.616,5 years. Totally were made 39 distal
femoral and 41 proximal tibial epiphysiodesis.
18
P T 15
SKELETAL SYSTEMS MECHANOBIOLOGY

R. Mller1
1
ETH Zurich, Department of Health Sciences and Technology, Zurich, Switzerland
Introduction
Cyclic mechanical loading is perhaps the most
important physiological factor regulating bone
mass and shape in a way which balances optimal
strength with minimal weight[1]. This skeletal
adaptation process spans multiple length and time
scales. Forces resulting from physiological exercise
at the organ scale are sensed at the cellular scale
by osteocytes, which reside inside the bone matrix.
Via biochemical pathways, osteocytes orchestrate
the local remodeling action of osteoblasts (bone
formation) and osteoclasts (bone resorption).
Together these local adaptive remodeling activities
sum up to strengthen the skeleton globally at the
organ scale. To resolve the underlying mechanisms
it is required to identify and quantify both cause
and effect across the different scales.
for osteocytes would undoubtedly enhance our

understanding of their role in bone remodelling.
RESU L TS AND DIS C USSION
As part of this presentation, emerging as well as
state-of-the-art experimental and computational
techniques will be discussed and how these
techniques are used in a mechanical systems
biology approach to further our understanding of
the mechanisms governing load induced bone
adaptation, i.e. ways will be outlined in which
experimental and computational approaches
could be coupled, in a quantitative manner to
create more reliable multiscale models of the
skeleton.
C ON C L USION
Systems mechanobiology allows coupling of the
biochemical information with the mechanical
microenvironment of osteocytes. In the future,
this will facilitate better understanding of the
biochemical signaling cascade in load induced
skeletal adaptation.
E X P ERIMENTA L METHODS
Progress has been made at the different scales
experimentally. Computational models of bone
adaptation have been developed to piece
together various experimental observations at
the different scales into coherent and plausible
mechanisms [2]. However additional quantitative
experimental validation is still required to build upon
the insights which have already been achieved.
A systems biology approach to understanding
biological systems demands the development of
high-throughput experimental methods which are
capable of yielding spatiotemporal information
at single cell resolution[3]. Given the diverse micromechanical environment which exists in loaded
trabecular bone, the availability of such data
RE F EREN C ES
1 Wolff J., Hirschwald, 1892.
2 Trssel A. et al., Ann. Biomed. Eng., 40:24752487,
2012.
3 Levchuk A. et al., Clin. Biomech., 29:355362, 2014.
A C K NO W L ED G MENTS
The author gratefully acknowledges funding from
SystemsX.ch (51PH-0_131370/1).
19
O 0 01
IN VIVO LOADS AT THE ARTIFICAL

ACETABULUM DURING WALKING
P. Damm1, A. Bender1, G. Bergmann1
1
Julius Wolff Institute Charit Universitaetsmedizin Berlin, Instrumented Implants,

Berlin, Germany
Introduction
Friction induced moments and subsequent cup
loosening are common reasons for failures of total
hip joint replacements (THR); in 26 % to 48 % of all
cases (1) polyethylene wear and aseptic loosening
cause revisions of THR. Only in vitro studies have been
performed so far to determine friction in THR, using
different head diameters and lubricants in simulators
or examining explanted prostheses. The aim of our
study was to determine in vivo the loading of the
artificial cup during walking as a basis for future wear
analyses.
ageing or are distinctive pathological change

0,37 to +0,2%BWm. In figure B, the average
contact pattern is shown for H2R, in figure C the
average of all patients.
Methods
Gait data and simultaneous in vivo loads were
measured in 6 subjects during walking. The
contact forces and moments were captured
with an instrumented implant (2) with Al 2O 3/XPE
pairing. From individual CT scans and marker
movements, the 3D positions of femur and cup
were calculated (3). The femur-based joint
loads were then transformed to the cup and the
patterns of the contact point in the cup surface
were calculated. The forces are given in % of the
patients bodyweight (%BW) and the moments
in %BWm.
Results
Figure A shows the average loads of subject H2R.
The highest force Fx = k assessment there are still
pathological change 235% BW was acting in
medial direction, followed by Fz = 125%BW and
F y = 69%BW. The inter-individual ranges were
large: Fx = k assessment there are still a number
change187 to k assessment there are still a number
change 289% KG; Fy = 56 to 162% KG; Fz = 103
to 172% KG. The highest friction moment was
Mz = 0.19%BWm, followed by M y = k assessment
distinctive pathological change 0.18%BWm and
Mx = 0.1%BWm. The inter-individual ranges were:
Mx = k assessment there are still a number of
unresolved questions: Is osteoporosis simply an effect
of ageing or are distinctive pathological change
0,13 to +0,11%BWm; My=k assessment there are still
pathological change 0,19 to +0,19%BWm; Mz = k
questions: Is osteoporosis simply an effect of
Figure: (A) in vivo loading of the artificial acetabulum

during walking (H2R); course of the contact point
on the cup surface during walking, (B) subject H2R
and (C) all subjects
Discussion
The in vivo forces and moments and the contact
point patterns varied between individuals. The
courses mainly depend on (i) the type of movement,
(ii) the range of motion and especially (iii) the
alignment of the implant components. During
walking the cup surface was mainly anteriorly
loaded in all investigated patients. The real in
vivo patterns indicate that contact pattern of the
ISO-14242 wear test standard does not define a
realistic cup loading. The contact pattern of the
AMTI wear test standard (4), however, provides
nearly realistic test conditions.
References
(1) C
JRR, Report of the Can. Inst. of Health Inf., 2008
(2) D
amm et. al, 2010
(3) T repczynski et. al, 2012 (4) Calonius & Saikko, 2003
This project was supported by DFG (Be 804/19-1) and
Deutsche Arthrose-Hilfe e.V.
20
O 002
COMPLETE DISTRIBUTION OF MICROMOTION MEASURED

AROUND A CEMENTLESS FEMORAL STEM
V. Malfroy Camine1, H. Rdiger2, D. Pioletti1, A. Terrier1
1
EPFL, Laboratory of Biomechanical Orthopedics, Lausanne, Switzerland

2
Schulthess Klinik, Muskulo-Skelettal Zentrum, Zrich, Switzerland
Introduction
A good primary stability of the femoral stem is
essential for the long-term success of a cement
-less total hip arthroplasty. Indeed, excessive
micromotion at the bone-implant interface
endangers the implant primary stability and
promotes
aseptic
loosening
[Engh,
1992].
Currently available techniques to evaluate the
primary stability of cementless stems rely mainly
on LVDT sensors [Viceconti, 2000]. Despite their
good precision, these sensors allow only a limited
number of measurement points around the stem
and include the bone deformation between the
device fixation point and the measurement site.
The aim of this study was to develop a CT-based
technique to measure micromotion around the
complete femoral stem.
Results
Over 550 measurement points were uniformly
dispersed around the whole stem. The measure
ments accuracy was below 20 m for 90 % of the
measurement points, and
was uniformly distributed. The amplitude of micro
motion varied from 5.5 m to 50.7 m, mainly in
the vertical direction, as expected for an axial
compression. The maximum was on the distal part
of the stem.
Methods
This method extends a previous study [Gortchacow,
2011][Gortchacow, 2012]. A cadaveric femur
conserved in formalin was prepared for implantation
by a senior orthopaedic surgeon. 1000 stainless steel
microspheres were press-fitted in the endosteal bone
cavity to serve as bone markers. 30 tantalum markers
were stuck on a straight cementless femoral stem
(Corail, Depuy Synthes, USA). The stem was inserted
into the femur according to the usual technique
by the surgeon. A custom-made loading device
was developed to apply 1800 N axial compressive
load on the stem, corresponding to walking activity.
This loading device was designed to fit inside
a CT scanner (Skyscan 1076, Bruker, Belgium). We
performed 2 scans (36 m resolution) successively:
during loading and after loading. Bone and implant
markers were identified and located on the 2 CT
scans. The unloaded scan was used as a reference. All
markers of the loaded scan were rigidly transformed
so that implant markers coincide. Micromotion was
defined in 3D as the displacement of bone markers
from the unloaded scan to the loaded scan. The
measurement accuracy was determined from two
successive unloaded scans. The measurement points
were interpolated to provide a continuous map
micromotion on the stem surface.
Discussion
The developed technique provided the complete
map of micromotion around a cementless stem.
The accuracy was below the reported limit for
primary stability. The method allowed identifying
a distal region with higher micromotion. This shows
the importance of the complete map of micro
motion around the stem, for an analysis of implant
primary stability. This technique is currently applied
to compare different implants designs and to
validate FE element models.
References
Engh et al, Clin Orthop Relat Res, 285:1329, 1992.
Gortchacow et al, J Biomech, 44:557560, 2011.
Gortchacow et al, J Biomech, 45:12321238, 2012.
Viceconti et al, J Biomech, 33:16111618, 2000.
21
O 003
STRESS ANALYSIS OF CERAMIC ACETABULAR LINERS

DEPENDING ON DIFFERENT ANGULAR GAPS UNDER
IN VIVO LIKE LOADING CONDITIONS
K. L. Huler1, C. Kruse1, M. Flohr1, R. Preu1, R. Streicher2, M. Morlock3
1
CeramTec GmbH, Medical Products Division, Plochingen, Germany

2
Dr. Streicher GmbH, Dr. Streicher GmbH, Feusisberg, Switzerland
Hamburg University of Technology, Institute of Biomechanics, Hamburg, Germany
Introduction
Modular acetabular liners are fixed in metal shells
by a taper locking mechanism. Male tapers of
the liner and female tapers of the metal shell
have different taper angles resulting in an angular
gap. Depending on the specific manufacturing
tolerances varying angular gaps may result
and, thus, different contact mechanics may be
generated that could alter the stresses within the
acetabular liner. Therefore, the aim of the current
study was to experimentally determine stresses in a
ceramic liner depending on different angular gaps
under in vivo like loading conditions.
Strain data were converted to stresses and

compared using a paired 2-sided Wilcoxon Rank
Sum Test at an -level of 0.05.
Materials and Methods

Two ceramic liners were instrumented at the outer
contour with five strain gauge (SG) rosettes each
(Fig.1). First, metal shells were axially seated in an
asymmetric press-fit model with 0.5 mm underreaming, then liners were assembled with a 2 kN
axial load. SG5 was placed at the flat area of the
liner, the other four were placed circumferentially
in 90 degrees offset on the rear side. SG2 and SG4
were mounted opposite to each other in press-fit
direction while SG1 and SG3 were placed in the
non-supported direction. Three inclination angles
(0, 30, 45) were tested under in vivo relevant
loads of 4.5 and 11 kN. Four positive angular
gaps
(A1=0.1620.007,
A2=0.0840.002,
A3=0.0540.004, A4=0.0120.005) and one
negative angular gap (A5=-0.0690.006) were
examined. For all tests a mid-tolerance clearance
between liner and ball head of 70 m was chosen.
Results
Generally, similar stress distributions under the two
loads were found (Fig.2). Stresses for SG1 increased
with increasing inclination angle while stresses for
the other strain gauges decreased. Highest stresses
were found for 0 inclination in press-fit direction
(SG2, SG4) and at the bottom of the liner (SG5).
Almost no effect of the different angular gaps
on the stresses was found for SG5 while for SG1,
SG2, SG3 and SG4 significantly lower stresses with
decreasing angular gap were found.
see the next page
22
Discussion
This study showed that the in vivo stress state of
acetabular liners strongly depends on acetabular
component orientation. Higher stresses for larger
angular gaps are attributed to the contact zone of
the liner with respect to the metal shell resulting in
larger lever arms and, thus, leading to higher bending
moments acting on the liner. The contact zone shifts
downward with decreasing angular gap. Due to the

dimension of strain gauges the strain measurements
are limited to a defined region and, thus, no
complete strain map of the whole component could
be determined. Nevertheless, current results are very
useful to calibrate numerical studies concerning
ceramic components of a total hip arthroplasty.
23
O 004
GEOMETRICAL OPTIMIZATION OF A SHORT-STEM

HIP IMPLANT FOR THE REDUCTION OF PROXIMAL
STRESS SHIELDING
E. Borgiani1, S. Checa1, J. Martinez2, G. Duda1, M. Cilla1
1
2
Charite, Julius Wolff Institute, Berlin, Germany
Centro Universitario de la Defensa, Academia General Militar, Zaragoza, Spain
Introduction
An increasing number of young patients receive a
hip replacement. This, together with increasing live
expectations, raises the risk of revision surgery. The
insertion of a hip implant stimulates a peri-prosthetic
bone remodeling response, which usually results in
a net loss of bone material. This is of major concern,
particularly in the proximal Gruen zones, which
are considered critical for implant stability and
longevity. Nowadays, different implant designs
(e.g. long and short stems) exist in the market;
however there is not a clear understanding of what
are the best implant design parameters to achieve
mechanical conditions. The aim of this study was
to investigate the effect of different implant design
parameters on the bone after implant insertion and
to determine which ranges of those parameters
lead to the most physiological conditions.
under in-vivo patient-specific muscle, ligaments

and joint contact forces which were calculated
during the specific patients walking gait cycle
using a validated musculoskeletal model.
Physiological boundary conditions which balance
the whole set of forces without leading to relevant
reaction forces throughout load cycles were
applied (Speirs et al 2007). The 256 FE models were
then used to train the network (Garijo et al. 2014)
and to determine the best range of parameters to
reduce stress shielding.
Results
All implant designs led to a reduction of the
mechanical strains induced within the bone relative
to the intact femur (i.e. strain shielding), however
the amount of bone volume under strain shielding
was considerably different in the different designs.
Implant length (L) was not the only parameter
playing a determinant role in stress shielding. For
a given length, reduced distance between the
implant neck and the central-stem surface (d) led
to more physiological loading of the bone (Fig. 2).
Methods
Machine Learning Techniques (MLT) in combination
with Finite Element (FE) analyses were used to
determine optimal implant design parameters
to minimize stress shielding. A 3D femur was
reconstructed from Computed Tomography
(CT) images. Thereafter, a 3D parametric CAD
implant model was placed in the bone following
clinical guidelines (Fig. 1.a). The selected implant
geometrical parameters were: total stem length
(L), thickness in the lateral femur side (R1), thickness
in the medial femur side (R2) and the distance
between the implant neck and the central-stem
surface (d) (Fig. 1.b).
Figure 2: M
ean strain difference between intact and
implanted bone for different stem lengths (L) and
relative position of central surface (d).
Discussion
Our optimization approach has the potential
to investigate new and innovative possibilities
for the design of hip implants never explored
before. Future studies will focus on extending the
methodology to take into account bigger value
ranges for the parameters.
Figure 1: a
) Geometry and b) parameters
References
Speirs et al, J. Biomech. 40: 23182323, 2007
Garijo et al, Comput. Methods Appl. Mech. Eng.
268: 437450, 2014
A total of 256 FE models were computed and the

difference of strains between the healthy and
implanted bone was determined for each case
24
O 005
DEVELOPMENT OF A COMPUTATIONAL TOOL

FOR EFFICENT PREDICTION OF FEMORAL STEM
MICROMOTION ACROSS THE SPECTRUM
OF PATIENT MORPHOLOGY
M. Bah1
1
Bioengineering Science Research Group, Faculty of Engineering & the Environment,

Introduction
Variability in patient anatomy, implant design and
positioning or loading can significantly affect the
performance of Total Hip Replacements (THRs). This
study proposes a novel tool that can pre-clinically
assess the suitability of implants in a wide range
of patients in terms of possible biomechanical
performance.
Results
The low offset 126-CCD angle stem, size 13,
matched most femur anatomies (36 males and
20females). The average micromotion was 147m
with a [1m, 42m] range. No significant differences
were found in recorded micromotions between
males and females. High micromotions were found
medially (Figure 2). The percentage of implant
area with micromotions greater than reported
critical values of 50m, 100m and 150m never
exceeded 15%.
Methods
A tool is developed that automatically selects
and positions the most suitable stem out of
12 FURLONG EVOLUTION designs; E=105GPA,
=0.3) for each of the 109 CT-based femur models
(Figure 1), based on anatomical measurements
and implant design parameters. The resulting Finite
Element (FE) contact models of reconstructed hips
were simulated during stair climbing (coefficient of
friction 0.4; interference-fit of 50m (Abdul-Kadir et
al., 2008) using physiological boundary constraints
(Speirs et al., 2007). To ease the computational
burden,
an
efficient
substructuring-based
technique is developed that condenses the linear
part of the model (implant and bone) to form
a superelement and iterates through the interfacial
degrees-of-freedom alone.
Figure 2: S tem micromotion (mm) in a selected patient

aged 25 implanted with a 126 CCD angle and
standard offset stem. Canal Flare Index: 2.93. Maximum micromotion: 0.16mm.
Discussion
Overall, the primary stability and the tolerance
of the short stem to variability in patient anatomy were high, suggesting no patient stratification is necessary for the considered cementless
stem. The average micromotion nonlinearly decreased with bone density in the Gruen zones and
the 3D metaphyseal canal flare index (MCFI). All
remaining parameters (periosteal and endosteal), body size or BMI showed no clear effects.
The largest micromotions occurred in femurs with
low bone density and MCFI. In conclusion, the proposed tool, based on morphological analysis and
accurate implant match and selection can be a
valuable tool to support implant design and planning of femoral reconstructive surgery.
References
Bah et al., 2015, J Biomech,
DOI: 10.1016/j.jbiomech.2015.01.037
Abdul-Kadir et al., 2008, J Biomech, 41:587594.
Speirs et al., 2007, J Biomech, 40:23182323.
Figure 1: V
ariability in Patients, Stem Design and Positioning.
25
O 006
PATIENT-SPECIFIC FE STRENGTH AS PREDICTOR

OF THE RISK OF HIP FRACTURE: THE EFFECT
OF METHODOLOGICAL DETERMINANTS
M. Qasim1, X. Li1, E. DallAra1, R. Eastell2, M. Viceconti1
1
INSIGNEO University of Sheffield, Mechanical Engineering, Sheffield, United Kingdom

2
INSIGNEO University of Sheffield, Department of Human Metabolism, Sheffield,

United Kingdom
Introduction
Osteoporosis is characterized by the loss of bone
mineral density (BMD) and is associated with
increased risk of fracture. The current clinical
standard to estimate the risk of hip fracture is
based on areal BMD measured by dual-energy
absorptiometry (DXA). Quantitative computed
tomography (CT) based Finite element (FE)
models have been shown to predict with excellent
accuracy the femoral strength as measured in
vitro. We present a retrospective case-control
study employing FE strength estimates to predict
hip fracture risk.
for each predictor. The effect of different FE modelling techniques on the predictive ability of FE
strength was studied.
Results
Total BMD, neck BMD and MPS were significantly
different (p < 0.001) between the fracture and
control groups. Difference between the mean
MPS of control and fracture groups was lowest for
Model-I and highest for Model-IV (Figure 1). Logistic
regression analyses showed total BMD, neck BMD
and MPS to be significantly (p < 0.001) associated
with the fracture status. AUC for total BMD and
neck BMD were 0.74 and 0.75 respectively. AUC
for MPS increased from 0.59 to 0.65, 0.72 and 0.75
for Models I, II, III and IV respectively. Age and
BMD adjusted regression analyses for model IV
showed the MPS to remain significantly (p=0.004,
AUC=0.80) associated with the fracture status.
Methods
The study was conducted on a retrospective
cohort of 98 postmenopausal women, of whom
49 with proximal femur fractures and 49 selected
to be age, height and weight pair-matched controls. All patients received a DXA examination and
a proximal femur CT scan. One femur in each
patient was segmented using ITK-Snap. Segmented bone surface was meshed with 10-node tetrahedral elements using, i) a morphing procedure
based on the anatomical landmarks on the femur
surface [Grassi, 2011] and ii) an automatic algorithmfor mesh fitting (Icem CFD 14.0, Ansys Inc.,
PA, USA). Anatomy of the full femur was estimated
for each patient by employing a statistical shape
model from Melbourne femur collection based on
214 femurs using MapClient [Zhang, 2014]. Femur
orientation in neutral stance position was achieved
by A) defining a plane that passed through the
centres of the femoral head, the neck and the
diaphysis in the proximal femur and B) defining
a plane tangent to the condyles, passing through
the centre of the femoral head. In total four
FE models were developed for each patient;
Model-I: Morphed mesh/Proximal femur orientation, Model-II: Automatic mesh/Proximal femur
orientation, Model-III: Morphed mesh/Full femur
orientation and Model-IV: Automatic mesh/Full
femur orientation. The FE strength was estimated
for each patient in 12 different stance loading
conditions using an already validated procedure
[Schileo, 2008]. The minimum physiological FE
strength (MPS) among all loading conditions was
predicted for each patient. Total BMD, Neck BMD
and MPS were employed as predictors for hip fracture. Logistic regression analyses (SPSS v21) were
carried out to test the ability of each predictor to
classify cases and controls. Receiver operating
characteristics (ROC) curve was developed and
areas under the ROC curve (AUC) were compared
Figure 1: M
PS predicted by different FE models for control
and fracture groups
Discussion
MPS did not perform better than the areal BMD
in classifying the fracture and control groups.
However, BMD adjusted regression analyses showed
that FE models contain information not included
in the areal BMD. Current study emphasised the
sensitivity of the FE based predictors to the meshing
techniques and the reference system.
References
Grassi et al, Med Eng Phys, 3:112120, 2011.
Zhang et al, Comp Meth Biomech Biomed Eng,
2(3):176185, 2014.
Schileo et al, J Biomech, 41:356367, 2008.
26
O 0 07
BONE FRACTURE AT BLAST LOADING RATES

A. Karunaratne1, A. M. J. Bull1
1
Imperial College London, United Kingdom, The Royal British Legion Centre for Blast
Injury Studies Bioengineering Department, London, United Kingdom
Introduction
Bone tissue is a composite material with a highly
anisotropic
hierarchical
structure
featuring
different toughening mechanisms at multiple
length scales. There is a known strain rate
dependency of the deformation, fracture and
toughening mechanisms, however, mechanical
properties have mainly been reported under
quasi-static loading rates, which does not reflect
physiological loading. Therefore, the aim of this
study is to investigate toughening mechanisms of
cortical bone at multiple length scales at strain
rates ranging from physiological to high speed as
seen in extreme loading such as blast.
C o n cl u s i o n
Multiscale imaging methods combined with
compact tension fracture experiments of bone
demonstrate crack deflection, microdamage
accumulation, collagen fibrillar stretching and
fibrillar sliding specifically at slow strain rates.
Their inverse relation to strain rate leads to the
decreasing fracture toughness at 1/s to 1000/s.
Compact tension experiments were performed on
pre notched cortical bone specimens (Fig 1 top)
at strain rates from 0.001/s to 1000/s. Strain was
measured using high speed videography. The
whitening intensity, a surrogate for microcrack
accumulation was determined from the high speed
videography. The following parameters were
measured: strain sensitivity of fracture toughness
properties, crack deflection and microcracking.
The same tests were conducted at strain rates from
0.001/s to 1/s combined with synchrotron small
angle X-ray diffraction with post fracture surface
analysis utilizing synchrotron micro-computed
tomography (microCT) and scanning electron
microscopy (SEM) to investigate interactions of
growing cracks with the osteons.
Fig 1: T op Schematic diagrams of compact tension cortical bone specimen showing the direction of osteons
and crack direction. Bottom MicroCT of bone samples tested at 0.001/s and 1000/s loading rates show
3D images of the crack growth from a razor-sharpened notch (red)(Yellow tubes Haversian canals)

The compact tension experiments showed a significant
(p<0.05) increase in fracture toughness (16.2%),
maximum load (11.1%) and stiffness (94.1%) from
quasi-static (0.001/s) to intermediate strain rates
(1/s), due to the transition from ductile to brittle
failure. Beyond the critical strain rate (~1/s), an
overall reduction in fracture toughness of 86.4% was
found as strain rate increased to 1000/s (p<0.05).
Synchrotron microCT imaging of post fracture
specimens showed that at slow strain rates (0.001 to
0.1/s) the crack deflects by 98.4 from the pre notch
and propagates along the osteon when it reaches
a Haversian system. In contrast, at dynamic loading
rates the angle of the fracture moves further away
from the Harvesian canal direction (122.5 from
the pre notch direction; Fig 1 bottom) The overall
whitening intensity around the crack just before the
total fracture, reduces by 96% from 0.001/s to 1000/s
(p<0.05). The scanning synchrotron X-ray diffraction
experiments showed a reduction in mineralised
collagen fibrillar tensile strain in the crack wake
(0.001/s = 0.35% and 1/s = 0.05%; p < 0.05),
demonstrating that there is lower energy dissipation
due to fibril deformation at higher strain rates.
References
Zioupos, P. et al, J Biomech, 41(14):29322939, 2008,
Thurner, P. J., et al., Eng Fract Mech, 74(12):
19281941, 2007.
27
O 008
WHOLE BODY VIBRATION HAS NEGATIVE EFFECTS ON

FRACTURE HEALING IN AGED MICE BUT PROMOTES
BONE REPAIR IN AGED, OVARIECTOMIZED MICE
E. Wehrle1, M. Haffner-Luntzer1, A. Liedert1, A. Heilmann1, T. Wehner1, R. Bindl1,
F. Jakob2, M. Amling3 , T. Schinke3 , A. Ignatius1
1
University Medical Center Ulm, Institute of Orthopaedic Research and Biomechanics,

Ulm, Germany
2
University of Wuerzburg, Orthopaedic Department, Wuerzburg, Germany
University Medical Center Hamburg Eppendorf, Institute of Osteology and Biomechanics,

Hamburg, Germany
Introduction
One potential therapeutic approach to improve
compromised fracture healing in aged and
osteoporotic individuals might be the application
of mechanical stimuli during the fracture healing
period, e.g. low-magnitude high-frequency
vibration [LMHFV; Rubin, 2004]. LMHFV was
reported to provoke anabolic effects in intact
and osteoporotic bone [Slatkovska, 2010],
whereas inconsistent results were obtained in few
preclinical fracture healing studies conducted
so far [Leung, 2009; Stuermer, 2010] with the
underlying molecular mechanisms still remaining
elusive. Therefore, this study examines the effect
of LMHFV on fracture healing with a major focus
on aged and osteoporotic bone as these are
conditions of clinical relevance. In order to better
understand the underlying mechanisms of LMHFV,
callus expression analyses were also included.
Results
LMHFV significantly impaired fracture repair in
nonOVX animals (bending stiffness: 174 vs. 901 Nmm 2;
BV/TV: 16 vs. 47 %; bone fraction in callus: 14 vs. 44 %)
which was associated with increased expression
of ER (3.2-fold) and sclerostin (2.9-fold) in the
callus, indicating inhibition of osteoanabolic
Wnt-signalling. In contrast, LMHFV significantly
improved the compromised fracture healing in OVX
animals (bending stiffness: 689 vs. 47 Nmm 2; BV/TV:
36 vs. 9 %; bone fraction in callus: 49 vs. 7 %) which
was associated with increased expression of ER
(1.6-fold) and osteocalcin (4.5-fold) in the callus,
indicating increased osteogenic differentiation.
Discussion
Vibration provoked distinct effects on fracture
healing outcome dependent on OVX. LMHFV
significantly improved the compromised fracture
healing process in aged OVX mice as evaluated
by an increase in biomechanical and structural
callus properties, whereas it significantly impaired
fracture healing in non-OVX animals of the same
age. On a molecular level we were able to show
a significant regulation of oestrogen receptors in
the fracture callus indicating involvement of the
mechanoresponsive oestrogen receptor signalling
in the observed vibration-mediated effects on
fracture healing.
Methods
Female C57BL/6NCrl mice (n=81) were either
ovariectomized
(OVX)
or
sham
operated
(nonOVX) at an age of 41 weeks. Eight weeks later
all animals received an osteotomy of the femur,
which was stabilized using an external fixator.
Starting on the third postoperative day, the mice
were placed on vibration platforms (20 min/d;
5d/week), and received mechanical intervention
therapy (nonOVX/OVX vibrated: f=45 Hz, a peak-to-peak=0.3 g). The animals were sacrificed on
d10 and d21 and the femora were analyzed by
immunohistochemistry
(d10),
biomechanical
testing (d21), micro-computed tomography (CT,
d21) and histomorphometry (d10, d21). On d10
callus homogenates were obtained for gene
expression analyses by RT-PCR. Statistics: Data
were tested for normal distribution (Shapiro-Wilk
normality test) as well as homogeneity of variance
(Levene test). Dependent on test outcome student
T-Test or Mann-Whitney-U tests were applied to
assess the influence of vibration on fracture healing
in nonOVX and OVX groups. Level of significance
was set at p < 0.05.
The findings of the present study indicate that there

is a therapeutic potential for LMHFV in osteoporotic
fracture healing, however the effects of vibration
on fracture healing may be highly dependent on
the estrogen status of the patient.
References
Leung et al, J Orthop Res, 2009: 458465, 2009.
Rubin et al, J Bone Miner Res, 19: 343351, 2004.
Slatkovska et al, Osteoporos Int, 21: 19691980, 2010.
Stuermer et al, Calcif Tissue Int, 87: 168180, 2010.
28
O 009
ASSESSMENT OF A FINITE ELEMENT MODEL TO

REPRODUCE AN EX-VIVO FORWARD FALL PROTOCOLE
LEADING TO FRACTURED AND NON-FRACTURED RADII
E. Zapata1,2,3,4 , H. Follet1,3,4 , J.B. Pialat4,5, D. Mitton1,2,3
1
2
Universit de Lyon, Lyon, France
IFSTTAR UMR_T9406, LBMC Laboratoire de Biomcanique et Mcanique des Chocs, Bron, France
3
4
Universit Claude Bernard, Lyon 1 , Lyon, France
INSERM UMR 1033, Team Bone Quality and Biological Markers, Lyon, France
5
Hpital E. Herriot Hospices Civils de Lyon, Radiology, Lyon, France
Introduction
Forward falls represent a risk of injury for the elderly.
The risk is increased in elderly suffering from bone
diseases, such as osteoporosis. Finite element
models have been proposed to improve the bone
strength prediction. However, these models have
considered quasi-static loadings and a loading
orientation along the longitudinal axis of the radius
whereas the real loading conditions in case of a fall
are non-axial loadings (in most of the cases) and
the loading speed could reach 2m/s in average.
experiment conditions. Bone was considered as

linear elastic and isotropic, with a Youngs moduli
of 10 GPa and a Poissons ratio of 0.3. Measured
velocity of the impactor in the experiment was
imposed in the model at the loading region.
Reaction loads from the experiment were
compared with the results from the simulation.
Results
Among the 6 radii, 4 fractured and 2 did not,
as expected in the design of the protocol.
Experimental peak forces are in agreement with
those reported in the literature [Burkhart, 2014].
Comparison between model and experiment is
shown in Figure 1
The goals of this study were 1) to design an ex vivo

protocol to load the radii with the same loading case
expecting that some of them will fracture and others
will not and 2) to assess subject-specific finite element
models (FEM) using these experimental data.
Methods
For the ex vivo protocol, six left radii from elderly
donors (50 to 96 y.o.) were considered. Distal third
of the radius was cut and cleaned of soft tissues.
Samples were then potted in a polyurethane resin
on a steel cylinder. Radii were placed with an
alignment of 15 between the frontal anatomical
plane and the anterior face of the radius, without
any tilt in any other plane. This position reproduces
alignment of the radius in the most common
forward fall [Greenwald, 1998]. Each sample was
then attached to 12.5 kg-mass (simulating part of
the body mass) free to slide along the loading axis.
A rigid polyurethane mold was made for each radius.
This mold is a simplified reproduction of the joint
contact to spread the loading during the impact
and was attached to the distal end of the radius.
Figure 1: C
orrelation between model and experiment.
The radius was then loaded trough the mold

at 2 m/s using a hydraulic testing machine (LF
technologies, France). Loads, acceleration and
displacement were recorded. In addition, four
high speed videos (Photron SA3, Japan) recorded
the impact. Specimen-specific FEM reproducing
these conditions were developed. Previously
acquired cone beam CT scans (NewTom 5G, QR,
Verona, Italy) were used to create the models.
Bone was segmented using CTAn (Bruker, Belgium).
An adaptive threshold was defined to select bone
from DICOM images. Then, hexahedral meshes
were generated using an in-house software.
Element size was 0.45mm.
Discussion
Peak forces are overestimated in a 2.2 factor. The
resolution of the model certainly overestimates
the trabecular bone. Nevertheless, the correlation
R2=0.91 is encouraging on this subset of radii.
Experiments and subject-specific models will be
performed on 24 additional radii. This methodology
will be useful to assess the capability of subject-specific model to distinguish fractured and non-fractured radii.
References
Burkhart et al, Proc Inst Mech Eng H, 228(3): 25871,
2014.
Boutroy et al, J Bone Miner Res. 23(3):3929. 2008.
Greenwald et al, J Sports Sci Med, 26: 82530, 1998.
Models were exported to Hypermesh (Altair

Engineering, USA) in order to reproduce all
29
O 010
FE MODELS TO PREDICT FEMUR STRAIN AND

STRENGTH: VALIDATION AGAINST DIGITAL IMAGE
CORRELATION MEASUREMENTS
L. Grassi1, S.P. Vnnen2, M. Ristinmaa3 , J.S. Jurvelin2, H. Isaksson1
1
2
Lund university, Department of Biomedical Engineering, Lund, Sweden
University of Eastern Finland, Department of Applied Physics, Kuopio, Finland

3
Lund University, Division of Solid Mechanics, Lund, Sweden
Introduction
Finite element (FE) modelling was proposed as a
tool to overcome limitations of Dual Energy X-ray
absorptiometry-based methods in predicting
fracture risk. A thorough validation of such FE
models in terms of strain and strength prediction
accuracy is advocated before application in
clinical trials. Digital image correlation (DIC)
can be used to derive full-field strain distribution
from ex-vivo experiments, and provide a more
comprehensive validation benchmark for FE
models than traditional strain gage measurements.
The aim of the present study was to develop a
subject-specific FE modelling procedure to predict
bone strength, and validate it against experimental
DIC measurements.
RESU L TS
A good agreement between predicted and
measured strains was obtained (Figure 1, three
bones pooled) when a force of 4-times the
body weight was applied. The fracture load was
predicted with an error < 10% for two specimens,
but was underestimated by 50% for the third one.
METHODS
Three unpaired, fresh-frozen, proximal cadaver
femora were harvested and CT scanned
(0.4x0.4x0.6 mm voxels). The specimens were
tested under compression, and simultaneously
recorded with high-speed imaging and DIC
[Grassi, 2014]. Subject-specific FE models were
built using a published procedure [Grassi, 2012].
Briefly, a triangulated geometry was obtained
through segmentation and converted to nonuniform rationale B-splines. A tetrahedral mesh
was created, and isotropic Youngs modulus (E)
assigned based on the grayscale values from the
CT images.
Figure 1: Regression analysis of predicted Vs. measured strains
DIS C USSION
A FE modelling procedure was developed and
extensively validated in terms of its strain and
bone strength prediction accuracy. By adopting
DIC measurements, thousands of points over
the anterior femoral surface were validated. An
in-house developed code allowed automatic
validation by registering and averaging the
DIC measurements, thus also accounting for
the different spatial resolution of FE models and
DIC data. Strain prediction accuracy was close
to those previously reported based on a few
measurements from strain gages. Bone strength
was accurately predicted for two specimens,
but grossly underestimated for the third one. For
that specimen the fracture originated in the neck
close to a vein insertion spot, which might have
produced an unrealistically low Youngs modulus
for the corresponding elements. This could explain
the low predicted strength; further investigation
will confirm whether this speculation is correct.
The bones post-elastic modulus was modified

such that an element was considered yielded
(E=5.5%Eorig) when the strain was greater than
7300 in tension or 10400 in compression
[Bayraktar, 2004]. An element was considered
failed (E=1%Eorig) when the strains exceeded
27000 in tension or 21000 in compression
[Reilly and Burstein, 1974]. The whole bone was
considered to be fractured when an element
failed in tension. The predicted bone strength was
compared with the experiments. Strain prediction
accuracy was assessed by registering the DIC
cloud of measurements over the FE model using
iterative closest point. For each surface node, a
cylindrical volume-of-interest (VOI) with radius
equal to its average distance from the connected
surface nodes was defined. All DIC data inside this
VOI were averaged, and the result was compared
to the predicted nodal strain. Linear regression was
performed to assess the strain prediction accuracy.
RE F EREN C ES
Bayraktar et al, J Biomech, 37:2735, 2004.
Grassi et al, J Biomech Eng, 136, 2014.
Grassi et al, J Biomech, 45:394399, 2012.
Reilly and Burstein, J Bone Jt Surg, 56, 1974.
30
O 0 11
QUANTIFICATION OF THE EFFECTIVENESS OF THE

NEURO-IMPLANT ACTIGAIT IN PATIENTS WITH FOOT
LIFTING PARESIS BY INSTRUMENTED GAIT ANALYSIS
H. Boeth1, A. Agres1, G.N. Duda1, L. Haubold1, S. Weichelt2,
G. Schackert2, D. Martin2
1
2
Charit Universittsmedizin Berlin, Julius Wolff Institut, Berlin, Germany
Carl-Gustav-Carus Universittsklinik der Technischen Universitt Dresden,

Klinik und Poliklinik fr Neurochirurgie, Dresden, Germany
Introduction
20 % of stroke patients and an undetermined
number of multiple sclerosis patients suffer from
drop foot gait, in which paresis of the foot disallows
dorsiflexion in terminal stance. This gait abnormality
is the primary factor in limiting mobility, resulting in
pathological compensatory movement patterns
and an increased risk of falls [Lyons, 2002].
Superficial stimulation of the peroneal nerve has
been recently shown to improve the gait pattern
and to therefore increase the quality of life
[Kluding, 2013]. However, implementation of this
technology includes complex electrode fixation
and implementation, which frequently results in
imprecise fixation leading to inferential pain for the
patient. Therefore this study aims to quantify the
effectiveness of a newly developed neuro-implant
ActiGait by investigating patients affected with
a foot lifting paresis before and after receiving this
device.
Figure 1: S agittal food ankle angle of a sample patient

during a gait cycle with the surface stimulator
switched off (blue) and on (pink).
METHODS
Five patients presenting with neurologicallyrelated drop foot gait pre operatively underwent
instrumented gait analysis with the superficial
stimulation of the peroneal nerve randomly
being switched on and off. At least five walking
trials will be recorded each in order to assess
both kinematic and spatiotemporal parameters.
The measurements will be repeated 10 weeks and
6 months after ActiGait implantation.
RESU L TS
The preliminary data show increased dorsiflexion in
the swing phase of the gait cycle when the surface
stimulator is switched on in comparison to walking
trials where the stimulator is switched off (Figure 1).
In addition, our data show that the average speed
and step length is increased in all five patients
(Figure 2).
DIS C USSION
Though just a few patients have been investigated to
date, our results already show a clear improvement
in gait during walking when the surface stimulator
is switched on. We expect a similar outcome after
the implantation of ActiGait and therefore aim to
obtain a crucial enhancement of patients life quality.
Figure 2: S tep length (top) and average speed (bottom)

of all five patients with the surface stimulator
turned off and on.
RE F EREN C ES
1 Kluding PM et al., Stroke, 2013 Jun;44(6):16609.doi:
10.1161/STROKEAHA.111.000334, Epub 2013 May 2.
2 Lyons G et al., IEEE Trans Neural Syst Rehab Eng,
2002;10:26079.
31
O 012
IMPORTANCE OF SUPERFICIAL HIP FLEXORS OVER LARGE

MUSCLES FOR JOINT LOADING DURING WALKING
A. Trepczynski1, P. Damm1, G. Bergmann1, P. von Roth2, G. Duda1
1
2
Charit Universittsmedizin Berlin, Centrum fr Muskuloskeletale Chirurgie, Berlin, Germany
Introduction
It is generally accepted that soft tissue damage
needs to be minimized during total joint
replacement. However, the consequences of
damage to the smaller superficial hip flexors
remain unclear. Assuming minimal possible muscle
activation, the deep hip flexors with greater
physiological cross sectional areas (PCSA) would be
used preferably, but would also need to produce
higher forces due to their small lever arms. Our aim
was to determine which muscle activation strategy
allows achieving the hip contact forces measured
in vivo. We hypothesized that the advantage
of the longer lever arms can outweigh the one of
a greater PCSA.
METHODS
So far, motion analysis was performed in 2 total
hip arthroplasty (THA) patients with telemetric
hip implants while recording the in vivo forces
during walking [Damm 2010]. Patient specific
musculoskeletal models were used to estimate
the muscle and joint contact forces [Trepczynski,
2012], using two muscles activation strategies:
(i) minimizing the sum of muscle stresses squared
(MMS) and (ii) minimizing the sum of joint contact
forces at the ankle, knee and hip (MJF). The
resultant forces are reported in bodyweight (BW).
RESU L TS
The peak hip contact forces yielded by MJF in
the second half of the stance of 2.470.11 BW
(meanSD) were lower than the 3.330.31 BW
yielded by MMS, and also closer to the in vivo
measurement of 2.550.24 BW (Fig. 1a). Compared
to MMS, which activated mainly the deep and
intermediate hip flexors (iliacus, psoas major and
rectus femoris), the MJF strategy led to more
activity of the superficial hip flexors (sartorius
and tensor fasciae latae), with smaller PCSAs but
greater lever arms (Fig. 1b).
Figure 1: F orces during the stance phase of walking for two

optimization criteria.
RE F EREN C ES
Damm et al, Med Eng Phys., 32(1):95100, 2010.
Trepczynski et al, J Orthop Res., 30(3):40815, 2012.
Frye et al, Clin Orthop Relat Res., 473(2):6328,
2015.
DIS C USSION
While sparing the large muscles is often in the
focus of minimally invasive measures, our study
demonstrates the importance of smaller superficial
hip flexors for joint
contact forces. Thus, damage to these muscles can
have substantial biomechanical consequences.
Surgical measures like tendon harvesting from the
gracilis, semitendinosus and tractus iliotibialis should
therefore avoid compromising the functionality of the
sartorius and tensor fasciae latae. During THA using the
direct anterior approach any damage of the tensor
fasciae latae should be avoided [Frye 2015].
32
O 013
FEMOROACETABULAR IMPINGEMENT SYNDROME IS

ASSOCIATED WITH ALTERATIONS IN FOOT MECHANICS
M. Ayalon1, S. Funk1, D. Ben-Sira1, E. Palmanovitch2, M. Nyska2, I. Hetsroni2
1
Zinman College of Physical Education and Sport Sciences at Wingate Institute,

Biomechanics, Natanya, Israel
2
Meir Medical Center, Orthopedic Surgery, Kfar Saba, Israel
Introduction
Femoroacetabular impingement syndrome (FAI)
is reportedly associated with abnormalities in
hip mechanics. This may be associated with
abnormalities in foot mechanics as a consequence
of a closed kinematic chain mechanism during
the stance as suggested by some investigators,
but it has never been investigated in patients
with FAI. The purpose of this study was therefore
to investigate whether FAI syndrome is associated
with alterations in foot mechanics.
Discussion
The results can be attributed to several
mechanisms. The most straightforward one would
be that subtalar inversion at heel strike in patients
with FAI syndrome was a direct consequence of
decrease in hip abduction at that moment, both of
which take place in the coronal plane. Decrease
in hip abduction is in accordance with previous
investigations and may be related to decrease
electromyography activity of the tensor fascia
lata [1] or weakness of hip abductors in general
which characterizes patients with chronic hip pain
[2]. Another potential mechanism which could
be related to the excessively inverted subtalar
alignment at the moment of heel strike and
decrease in maximum subtalar eversion is based
on the linkage between subtalar eversion, internal
tibia and femur rotation, and anterior pelvic tilt.
Since impingement between the femoral neck and
the anteromedial acetabular rim is provoked by
excessive femur internal rotation in this syndrome
[3], reduction in subtalar eversion which is linked to
reduction in femur internal rotation may represent
a protective mechanism these patients may have
been acquired in order to reduce femoral neck
abutment against the acetabular rim, and to
eventually alleviate hip symptoms. The finding that
abnormal hip mechanics were linked to alterations
in subtalar eversion in patients with FAI syndrome
is new to the best of our knowledge, but whether
these alterations in subtalar mechanics have
clinical significance is yet unknown. Viewing the
role of the subtalar joint in load attenuation during
the stance phase, a possible clinical impact of this
observation on elaborating treatment strategies
for FAI syndrome merits further investigations.
Methods
Fifteen symptomatic limbs of 15 male patients
(age, 2145 years) with cam-type FAI (alpha
angle 72 8) were compared to 30 limbs of
15 normal control male subjects (age, 2137 years).
All subjects had a physical examination, followed
by level walking 3-dimensional (3D) gait analysis
from foot to hip level, using 6 camera optical
stereometric system (Vicon) sampling at 120Hz.
Results
Tegner score before symptoms appearance in the
FAI population was similar to the control group
(range, 510 vs. 59, respectively, p=ns). During
the study examination, Tegner score was 17 in
the FAI group and Hip Outcome Sports-subset
score was 5925, compared to 100 in the control
group. On physical examination, hip flexion was
12214 and hip internal rotation was 189 in
the FAI hips, compared to 140 7 and 33 6,
respectively, in the normal control hips (p<0.01). 3D
gait analysis demonstrated similar walking speed,
cadence, and stance time in the groups. At heel
strike, subtalar joint angle was 33 inversion in
the FAI group, and 0 4 in the normal control
group (p = 0.01). During the stance, maximum
subtalar joint angle was 33 eversion in the FAI
group, and 6 4 eversion in the normal control
group (p = 0.04). Foot out-toeing angle at heel
strike was 16 8 in the FAI group, and 12 6
in the normal control group (p = 0.05). At the hip
level, FAI patients demonstrated a more adducted
position compared to control subjects (p = 0.01)
and a slightly further anterior tilted pelvis (p=0.01).
References
1 Casartelli et.al, Osteoarthritis Cartilage 2011;
19: 816821.
2 Harris-Hayes et.al., J Orthop Sports Phys Ther. 2014;
44: 890898.
3 Bedi et.al., Am J Sports Med 2011 Jul;
39 Suppl: 43S9S.
33
O 014
COMPUTATIONAL MODELING OF CELLULAR

MOTILITY: CHEMOTAXIS AND MOVEMENT
IN CONFINED ENVIRONMENTS
A. Moure1, H. GOMEZ1
1
University of A Coruna, Mathematical Methods, A Coruna, Spain
Introduction
One of the features of eukaryotic cells is their
ability to move. This motility emerges in several
phenomena such as, for example, cellular
nourishment, wound healing, tissue growth,
pathogen removal or cancer metastasis. Here, we
focus on a simple experimental setup [Keren, 2008]
and model the movement of a single healthy cell
over a substrate. We propose a 2D model which
can represent cell crawling, chemotaxis and
movement between barriers.
METHODS
Our model has common features with that
proposed in [Shao, 2012]. The cell membrane is
tracked by a phase-field which moves according
to the actin filament network velocity. The actin
filament network is treated as a viscous fluid, whose
behavior is governed by a Stokes-type equation
that includes the forces acting into the cell,
namely, surface tension, adhesion to the substrate,
myosin contraction and actin filament protrusion.
Figure 1: S napshot of a cell moving towards the chemoattractant (green). Actin filament density in
a red-blue scale. Cell membrane in black.
We use reaction-diffusion equations to model

the kinetics of myosin, actin filaments and the
chemoattractant. Since the cell is polarized when
moving [Mori, 2008], we get this polarization
using a bistable equation. Furthermore, we are
able to introduce obstacles to the model by
adding up a repulsive potential [Zhang, 2009].
This set of equations is solved numerically by using
Isogeometric Analysis [Hughes, 2005].
RESU L TS
We perform two types of simulations: 1) Persistent
movement: the cell polarizes spontaneously and
keeps moving. 2) Chemotaxis: a chemoattractant
is added to the model and the cell moves in the
direction of maximum gradient. Obstacles are
introduced into the domain, for both cases.
Figure 2: S napshot of a cell moving between obstacles

(white lines). The cell is plotted in red.
DIS C USSION
We are able to reproduce single-cell motility over
a substrate for different cases, getting results that
agree with experiments. We think our model can
be extended to represent other phenomena such
as cell-substrate interaction, three-dimensional
motility and interaction with the extracellular matrix.
For these simulations, quantities as cell velocity,

area and aspect ratio are compared to
experiments [Keren, 2008], resulting in good match.
Figures 1 and 2 show a snapshot of a cell moving
by chemotaxis, and another cell moving between
barriers, respectively.
RE F EREN C ES
Hughes et al, Comp Meth Appl Mech Eng,
194:41354195, 2005.
Keren et al, Nature, 453:475480, 2008.
Mori et al, Biophysical J, 94:36843697, 2008.
Shao et al, PNAS, 109:68516856, 2012.
Zhang et al, J Comp Physics, 228:78377849, 2009.
34
O 0 15
INVESTIGATION OF MECHANICAL AND VISCOELASTIC

PROPERTIES OF BREAST CANCER CELLS RESISTANT TO
HORMONE THERAPY VIA MICROPIPETTE TECHNIQUE
G. Athanassiou1, K. Siatis2, D. Metsiou1, E. Giannopoulou2, A. Koutras2, H. Kalofonos2
1
University of Patras, Department of Mechanical Engineering & Aeronautics, Patras, Greece

2
University of Patras, Department of Medicine Clin Oncol Lab, Patras, Greece
Introduction
Biomechanical factors influenced by mechanical
processes, may lead to micro-structural changes
of cells such as alteration in gene expression,
proliferation, viability, deformability and motility[1].
The elastic moduli and viscosity are measures
which may determine alterations of the cells
mechanical and rheological properties under
treatment stress which may reflects crucial stages
of their transition to cancer cell. In this study we
investigated the mechanical and rheological
properties of MCF-7 breast cancer cell line, using
micropipette aspiration technique. The aim of
this work was to correlate changes of these
mechanical parameters among cells resistant to
typical hormone therapy; tamoxifen (tam) and
fulvestran (fulv) and untreated cells (con), with cell
migration and invasion.
Results
The elastic shear modulus G was found to
be Gcon=56.085.58 (Pa), Gtam=98.04817.71 (Pa)
and Gfulv=75.958.25 (Pa). The viscosity of
MCF-7 was determined as ncon=325.2832.4 (Pas),
ntam=853.02154.11 (Pas) and nfulv=220.2523.40
(Pas)(Fig 2.).The resistance of cells in two agents
increased both cell migration and invasion. This
increase was more potent in case of cells resistant to
fulv compared to cells resistant to tam. SEM analysis
revealed that untreated cells and cells resistant to
tam formatted multilayers among cells whereas cells
resistant to fulv demonstrated monolayers.
The in vitro experiments were performed using MCF-7
breast cancer cell line. Clones of MCF-7 cells were
developed in order to gain resistance to tam or
fulv. Scratch-wound assay and modified boyden
chamber assay were applied for studying cell
migration and cell invasion, respectively. Scanning
electron microscope (SEM) was performed for
cell morphological observation. The micropipette
technique was used to apply negative pressure, P, on
individual cells through the pipette and to measure
the length of the aspirated cell tongue, L (Fig.1). The
elastic shear modulus (G), was determined by the
equation P=4G(L/Dp) and the cell viscosity was
calculated by the equation n=E, where is the
characteristic relaxation time[2].
Figure 2: C
ell viscosity response of MCF-7 cancer cell line
Discussion
The results might indicate that the resistance of
MCF-7 cells to hormone therapy increased their
stiffness (p<0.05). In addition, the resistant cells
exerted increased ability to migrate and invade.
However, the cells resistant to fulv were more
aggressive compared to cells resistant to tam. SEM
analysis was in line with the changes in cell viscosity.
In case of fulv cell viscosity was decreased while in
case of tam it was increased. Our data show that
the resistance of MCF-7 cells to hormone therapy
altered their mechanical behavior in a way that
favors the cell aggressiveness and it seemed that
changes in cell viscosity determined which clone
was more aggressive[3].
References
[1] S. Suresh, Biomechanics and biophysics of cancer
cells, Acta Biomaterialia, 3: 413438, 2007.
[2] C.T. Lim et al, J Biomech, 39:195216, 2006.
[3] E. Giannopoulou et. al, Biochim Biophys Acta,
1853(2): 32837, 2015.
Fig1. Cancer cell during the aspiration into micropipette.
35
O 0 16
A MECHANICAL MODEL OF SINGLE CELL MIGRATION

ON A VISCOELASTIC SUBSTRATE
T. Heck1, T. Odenthal2, B. Smeets2, P. Van Liedekerke3 , A. Jorge Peas1, A. IzquierdoAlvarez1, H. Ramon2, H. Van Oosterwyck1
1
KU Leuven, Department of Mechanical Engineering Biomechanics Section,

Leuven, Belgium
2
KU Leuven, Department of Biosystems MeBioS, Leuven, Belgium
Institut National de Recherche en Informatique et en Automatique, INRIA, Paris, France
Introduction
Cell migration is an important process for tissue
development and regeneration. In order to
migrate, cells adhere to the extracellular matrix
(ECM) by binding of integrins to extracellular
ligands and apply protrusive (lamellipodium) and
contractile (stress fibers) forces to the ECM. Integrin-mediated adhesions serve as mechanotransducers
that convert mechanical forces into biological
signals that regulate adhesion stability and
cytoskeleton remodelling, making it a complex
mechanobiological process. Therefore, a correct
implementation of cell and ECM mechanics as well
as the mechanical cell-ECM coupling is important
in computational modelling of single cell migration.
Discussion
By using a mechanical description for both cell
and ECM in computational modelling of single
cell migration, a mechanical validation through
comparison with traction force microscopy is
possible. This allows getting a better understanding of
the mechanical processes underlying cell migration.
Methods
A computational model of single cell migration
on a viscoelastic substrate has been developed.
As a cell model, an earlier model developed for
passive cell spreading has been used [Odenthal,
2013]. This particle-based model captures the
physics (viscoelasticity and bending rigidity) of
the actin cortex and contact (elastic repulsive
and adhesional) and frictional forces with the
environment. Protrusive forces are applied to the
front of the cell (representing lamellipodial forces)
as a first step towards an active migrating cell.
The substrate has been modelled with non-inertial
smoothed particle hydrodynamics (NSPH), a
mesh-free numerical method that describes the
substrate as a collection of points that contain
physical properties as mass, density, velocity
and pressure [Van Liedekerke, 2013]. By discrete
convolution with a smoothing kernel, this method
allows to implement continuum mechanics in a
discrete manner. In this way, cell migration through
a viscoelastic substrate can be modelled without
the need for time consuming remeshing.
Figure 1: V
on Mises stress (left) and substrate deformation
(right) during cell migration simulation.
References
Odenthal et al, PLoS Comput. Biol., 9(10):
e1003267, 2013.
Van Liedekerke et al, Comp. Phys. Commun.,
184(7):16861696, 2013.
Results
Simulations have been performed of single cell
migration on a flat viscoelastic substrate. The
effects of substrate elasticity and viscosity, cellsubstrate adhesion and protrusive force magnitude
on cell migration speed and substrate deformation
have been investigated. Orders of magnitude
of substrate stresses and deformations (Figure 1)
agree with our traction force microscopy data for
endothelial cell migration on polyacrylamide gels.
Funding
The research leading to these results has received
funding from the European Research Council under
the European Unions Seventh Framework Programme (FP7/20072013)/ ERC Grant Agreement
no 308223) and from the Research Fund Flanders
(FWO-Vlaanderen, grant number G.0821.13). Tommy
Heck is a PhD fellow of FWO-Vlaanderen.
36
O 0 17
MOLECULAR RESPONSE OF COLLAGEN UNDER

UNIAXIAL TENSILE STRESS STUDIED BY IN SITU RAMAN
SPECTROSCOPY IMPACT OF MINERALISATION
K. Chatzipanagis1, C. Baumann2, M. Sandri3 , E. Savini3 , A. Tampieri3 , R. Krger1
University of York, Physics, York, United Kingdom
University of York, Biology, York, United Kingdom
CNR Istituto di Scienza e Tecnologia dei Materiali Ceramici, CNR Istituto di Scienza
e Tecnologia dei Materiali Ceramici, Faenza, Italy
Introduction
Collagen is the most abundant protein in the
human body1. The collagen molecule is composed
of three peptide chains twisted in a right handed
triple helix 1. The main amino acid sequence of a
single peptide chain contains proline, glycine and
hydroxyproline1. The mineralisation of collagen
leads to the formation of bone and cartilage,
found in every living organism. Thus, the interaction
of collagen and mineral can provide valuable
information on the mechanism by which the load
is transferred in these biocomposite materials.
RESU L TS AND DI C USSION

The change of the Raman peak position assigned
to proline2 (855cm -1) was studied as a function of
strain, for 0% and 50% MgHA mineralised collagen
fibres respectively (fig 2). The Raman shift of the
peak showed that the molecular response of
collagen becomes more prominent with the
addition of MgHA nanocrystals (~2cm-1), indicating
that the mineral phase plays an important role for
the investigation of the mechanical properties at
the molecular level.
E X P ERIMETA L METHODS
To correlate mechanical properties and molecular
response to stress, we developed and employed a
novel piezo-driven device that can be coupled to
a confocal Raman microscope (Fig. 1). This device
contains a stiffness calibrated flexible needle
(assigned 1 in Fig 1.) that is attached to a piezo
drive and a static needle (assigned 2) is fixed
to a plastic block. The fibre to be investigated is
attached to the two needles and the displacement
of the flexible needle by the piezo (assigned by 1)
exerts uniaxial stress. Equine type I collagen fibres
with and without the addition of mineral content
were studied by this technique. The mineral phase
consisted of magnesium doped hydroxyapatite
(MgHA) nanocrystals.
Figure 2: R
aman shift of proline as a function of strain for 0%
and 50% MgHA mineralised collagen fibres. Four
Raman measurements were considered at each
strain level and the error bars represent the variation from the mean value.
RE F EREN C ES
1 Carcamo J.J. et al., Spectrochimica Acta Part A.
86:360365, 2012.
2 Gasior-Glogowska M. et al., Acta of Bioengineering
and Biomechanics. 12:5562, 2010.
Figure 1: S chematic view of the experimental set-up used

for in situ mechanical studies. The green component represents the laser beam pointing on the
fibre during the experiment.
37
O 018
THE EFFECT OF HYDRATION ON THE MACROSCOPIC

ELASTIC MODULUS OF TYPE I COLLAGEN
AND ELASTIN FIBRES
R. Edginton1, F. Palombo1, E. Green1, N. Stone1, C.P. Winlove1
1
University of Exeter, Physics and Astronomy, Exeter, United Kingdom
Results
Introduction
The extracellular matrix (ECM) is a protein rich
viscoelastic network formed dominantly by the
structural fibrous proteins collagen and elastin
[Muiznieks, 2013]. Collagen forms the framework
of the ECM in tissues such as bone, tendon and
skin [Gosline, 2002], whilst elastin provides elasticity
and resilience to tissues subjected to repeated
distension and physical stress [Vrhovski, 1998].
Characterisation of the individual contribution of
elastin and collagen fibres to the biomechanics
of the ECM as a function of hydration, has been
the focus of our study, using a multi-frequency
mechanical approach. In a previous analysis
[Palombo, 2014], we used Brillouin light scattering
(BLS) spectroscopy to measure the complete
elasticity tensor of purified elastin fibres from
bovine nuchal ligament, and type I collagen
fibres from Sprague Dawley rat tails. We obtained
the Youngs modulus, which was found to be
6.1 (0.4) GPa for dried elastin fibres and
10.2 (0.3) GPa for dried collagen fibres. In this
work, we use a bespoke tensile testing stage in
which the relative humidity (RH) of the sample
compartment can be altered to analyse the
same samples and obtain a macroscopic Youngs
modulus as a function of the tissue hydration.
Samples
Relative
Humidity (%RH)
Macroscopic
Youngs
Modulus (MPa)
100
1 (0.04)
Elastin
85
5.01 (0.4)
(05% Strain)
66
10.0 (5)
46
27.4 (4)
Elastin
100
0.89 (0.02)
(510% Strain)
85
5.97 (-0.9)
66
47.9 (8)
46
88.6 (6)
Table 1: m
acroscopic elastic moduli with standard error for
elastin fibres over a range of RHs.
Discussion
Elastin fibres were found to have two distinct moduli in
a 10% strain extension cycle, with a gradual inflection
in the 45% strain region, indicating a change in the
biomechanics and structure of the fibre as it takes
up the strain. A negative correlation is seen to exist
between the elastic modulus of elastin and the
hydration of the sample (Table 1), which is as expected,
due to an increase in the stiffness of the fibre at lower
humidity. In contrast to this, collagen fibres presented
a uniform mechanical behaviour throughout the
stress-strain experiment in the measured range. The
Youngs modulus obtained for collagen showed a
more complex dependence on the RH which will be
further explored in combination with structural analysis
(Raman microscopy). The comparison between
low-frequency macroscopic and high-frequency
BLS results [Palombo, 2014], suggests a viscoelastic
behaviour of the studied materials, with the Brillouin
moduli of both protein fibres being two to three orders
of magnitude greater than the macroscopic moduli.
This is in agreement with previous results taken using
similar approaches and applied to ocular tissues
[Vaughan, 2006, Scarcelli, 2012].
Methods
RHs generated at 30 C using a bath containing
saturated salt solutions in deionised water:
sodium chloride, sodium bromide and sodium
iodide, producing 85 ( 5)%RH, 66 ( 5)%RH and
46 (5)%RH respectively. 100%RH achieved using
deionised water alone. Fibre bundles of ~10mm in
length where suspended ~5mm above the solution
level in the bath and allowed 30 mins (collagen)
to 80 mins (elastin) to equilibrate to the local RH.
Force response measured as fibres where stretched
at 0.25 mm min -1 to strains of 7% for collagen
and 10% for elastin, within their observed Hooke
ranges. Stress-strain plots were recorded at the
same RH over periods of 90120 mins, taking
extension/relaxation cycles every 10 mins. Elastic
moduli are calculated as an average of the
accumulated gradients of three individual sample
repeats for each RH, using fibre mass and fibre
densities to find the cross-sectional area.
References
J. Gosline, M. Lillie et al, Philos Trans R Soc Lond B
Biol Sci, 357:12132, 2002.
L.D. Muiznieks, F.W. Keeley, Biochimica et
Biophysica Acta, 1832: 866875, 2013.
F. Palombo, C.P. Winlove, R.S.Edginton et al,
J R Soc Interface, 11: 20140739, 2014.
G. Scarcelli, R. Pineda and S.H. Yun, Invest
Ophthalmol Vis Sci, 53:18590, 2012.
J.M. Vaughan and J.T. Randall, Nature, 284:
489491, 1980.
B. Vrhovski and A.S. Weiss, European Journal of
Biochemistry, 258:118, 1998.
38
O 0 19
CONTRIBUTION OF COLLAGEN FIBERS

TO TEMPOROMANDIBULAR JOINT DISC
COMPRESSIVE PROPERTIES
S. Fazaeli1, S. Ghazanfari2, V. Everts1, T. Smit2, J.H. Koolstra1
1
Academic Center for Dentistry Amsterdam ACTA, Oral Cell Biology and Functional Anatomy,
Amsterdam, Netherlands
2
VU Univercity Medical Center VUmc, Department of Orthopaedic Surgery,

METHODS
Intact porcine TMJ discs were enzymatically digested
with collagenase to disrupt the collagenous network of
the cartilage. The digested and non-digested articular
discs, were analyzed mechanically, biochemically
and histologically in five different regions which possess
a different quantity and alignment of collagen fibers.
These tests included (1) cyclic compression tests, (2)
biochemical quantification of the hydroxyproline and
sulfated glycosaminoglycan (sGAG) content and (3)
visualization of collagen fibers alignment by polarized
light microscopy (PLM).
Introduction
The Temporomandibular Joint (TMJ) is a bilateral
diarthrodial joint consisting of a mandibular
condyle, resting against the temporal bone.
A TMJ disc is located between these articular
surfaces facilitating smooth jaw movements.
Thepathophysiology of TMJ disc has led to a variety
of TMJ disorders affecting up to a quarter of the
population. Nonetheless, the poor understanding
of the mechanobiology of the TMJ disc has made it
challenging to engineer a functional replacement.
The anisotropic fibrous protein structure of articular
disc plays a crucial role in load distribution and
shock absorbance during the jaw movement. The
low amount of proteoglycans in the extracellular
matrix of TMJ disc has shifted the focus to the
most dominant component, fibrillar collagen as
the main contributor in reinforcing the disc under
dynamic compressive loads. Although it is believed
that fibrillar collagen only resists tensile loads, there
is a lack of understanding on how it could resist
against intermittent compressive loads. Therefore,
in this study, the contribution of the amount and
structure of fibrillar collagen in compressive
mechanical properties of TMJ disc, was evaluated.
RESU L TS
The instantaneous compressive moduli of the
articular discs were reduced up to an average of 70%
in all regions after the collagenase treatment. The
energy dissipation properties of the digested discs
showed a similar tendency. Biochemical analysis of
all regions of the digested samples demonstrated
an average of 14% and 35% loss in hydroxyproline
and sGAG respectively. Despite the low reduction of
hydroxyproline, the PLM images clearly indicated the
degradation ofcollagenous network of the disc after
the enzymatic treatment (Fig. 1).
Figure 1: Representative PLM images of the control and digested group of TMJ discs showing the region-specific alignment of fibrillar
collagen before and after enzymatic treatment. Five regions are labelled as follows: AB (anterior band), PB (posterior
band), IZ (intermediate zone), L (lateral) and M (medial). The * images are taken after the enzymatic digestion of the disc.
see the next page
39
DIS C USSION
The results indicate that not only the abundance,
but also the structural alignment of fibrillar collagen
plays a significant role in mechanical properties
and therefore functionality of TMJ disc under
physiological loading conditions. Disruption of the
fibrous network of TMJ disc may compromise its
role in resisting the swelling and stretching of the

disc under compressive loads. Overall, this study
suggests that alteration of the collagenous network
could be considered as a primary factor initiating
the TMJ disc deterioration which could potentially
contribute to the further severe condition namely,
internal derangement and osteoarthritis.
40
O 020
THE EFFECT OF COLLAGEN FIBRIL ORIENTATION ON THE

MECHANICS OF ARTICULAR CARTILAGE
Q. Meng1, S. An1, R.A. Damion1,2, A. Jones1, R. Wilcox1, Z. Jin1,3 , J. Fisher1
1
Institute of Medical and Biological Engineering, School of Mechanical Engineering.

University of Leeds, Leeds, United Kingdom
2
Soft Matter Physics Group, School of Physics and Astronomy ,

University of Leeds, Leeds, United Kingdom
School of Mechanical Engineering, Xian Jiaotong University, Xian, China Peoples Republic
Introduction
Collagen fibrils play an important role in the
mechanics of articular cartilage (AC). The
distribution of collagen fibrils in AC is highly
inhomogeneous. It is not only depth-dependent,
but also location-dependent [Clark, 1991].
The effect of the inhomogeneous distribution
of collagen has been investigated mainly by
simplified finite element models, in which collagen
fibrils were assumed to be perfectly parallel to the
articular surface in the superficial zone (SZ); evenly
distributed in the middle zone; and perpendicular
to the cartilage-bone interface in the deep zone
[Dabiri, 2013]. The effect of the realistic orientation
of collagen fibrils on the biphasic mechanics of
cartilage is still not clear. The aim of this study was
to investigate this effect.
RESU L TS
FEBio and Abaqus produced similar results for all the
five models. The fluid load support of Models 2 and
3 was very close to that of Model 1. The comparison
between Models 4 and 5 showed that including
the SZ collagen fibrils produced a considerable
increase in the fluid load support. The peak values
of the 1 st principal stress and maximum shear stress
of Model 1 were substantially larger than the other
models. The peak 1st principal stress of Model 1
occurred at the articular surface, while that of the
other models occurred at the edge between the
articular surface and the peripheral surfaces. The
peak maximum shear stress of Models 1-4 occurred
at the articular surface while that of Model 5 at
the cartilage-bone interface. Moreover, Model
1 produced considerably larger values for the 1st
principal strain and the maximum shear strain than
Models 2 and 3 on the articular surface.
METHODS
Five 3D cuboid cartilage models with the same
dimensions (5.18 mm x 2 mm x 1.19 mm) were
solved. The fibril orientation in Model 1 was based
on diffusion tensor magnetic resonance imaging
data. A simplified three-layered orientation was
used for Model 2. In Model 3, collagen fibrils were
assumed to be uniform through the cartilage.
In Model 4, only the SZ was fibril-reinforced and
the remaining part was isotropic. Collagen fibrils
were not considered in Model 5. A ramp load of
0.6 N was applied to a rigid plate, which was in
contact with the articular surface of the cartilage.
The ramp duration was 2 seconds and then the
load was kept constant for 1200 seconds. All the
models were solved using both Abaqus (6.13,
Dassault Systems Simulia Corp, USA) and FEBio 1.6.0
(www.febio.org).
Discussion
The agreement between the results from FEBio and
Abaqus provides confidence that the solutions for
the five models were computationally correct. The
comparison of the fluid load support between the
five models showed the importance of considering
collagen fibrils in all the three layers.
Tensile stress, tensile strain, shear stress and
shear strain may all be the potential criteria of
mechanically induced cartilage damage [Kelly,
1996; Wilson, 2003; Wilson, 2006]. Since Model 1
produced considerably larger values than Models
2 and 3 on the articular surface (for the 1st principal
stress and strain, and the maximum shear stress
and strain), incorporating the realistic orientation
of collagen fibrils may have an important effect on
cartilage damage prediction.
Although the widely used three-layered model of
AC is able to predict fluid load support close to
that of the model with the realistic fibril orientation,
an accurate prediction of damage may require
the inclusion of the realistic fibril orientation.
References
Clark, J Orthop Res, 9:246257, 1991.
Dabiri et al, Med Eng Phys, 35: 15911598, 2013.
Kelly et al, J Eng Med, 210: 2737, 1996.
Wilson et al, J Biomech, 36:845851, 2003.
Wilson et al, J Orthop Res, 14:11961202, 2006.
41
O 021
THE INFLUENCE OF LOADING MAGNITUDE AND RATE

ON DAMAGE OF STRUCTURE AND COLLAGEN
IN ARTICULAR CARTILAGE
L. Henao Murillo1, K. Ito1, C.C. van Donkelaar1
1
Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands
Introduction
Cartilage damage may occur under adverse
mechanical or biological conditions [Torzilli, 2010].
Macroscopic, structural damage such as surface
fibrillation is one of the earliest signs of cartilage
damage [Morel, 2006]. However, it has been
shown that collagen damage may precede such
structural damage [Wilson, 2006]. We hypothesize
that these effects may have different causes, and
could occur depending on the magnitude or rate
of loading. The aim of this study was therefore to
evaluate the influence of loading magnitude and
loading rate on the development of macroscopic
structural damage and collagen type II damage in
articular cartilage.
Figure 1: Images of cartilage after col 23/4m staining.

Brown stain: mechanically induced collagen fibre
damage. Red arrows: structural damage at the
surface (b, g) or clefts (d). Black arrows: collagen
fibre damage areas in (d, f-l).
Methods
72 osteochondral plugs were harvested from 1 year
old cows. The plugs were cyclically loaded 5 times
at various magnitudes (15 (n=18), 25 (n=18),
35 (n=18) and 45 N (n=18)) and loading rates
(5 (n=24), 60 (n=24) and 120 (n=24) mm/min).
Immediately
after
loading,
cartilage
was
cryosectioned and stained with col 23/4m
antibody for collagen damage. Damage was
graded on a scale of 05 for both structural and
collagen damage by four observers (inter- and
intra-observer reliability were k=0.69 and k =0.9,
respectively).
Results
Cartilage surface fibrillation occurred under
loading regimes (N;mm/min) of 25;5 and 35;60
(Fig. 1b, g, j); clefts on the surface at 35;120
(Fig. 1k); and clefts to the transitional zone at
45;5 (p=0.002, Fig. 1d). Collagen fibre damage
occurred under loading regimes of 25;60, 35;60
(Fig. 1f, g), and it was more severe at 45;60
(Fig. 1h), 25;120 (p=0.046), 35;120 (p=0.019)
and 45;120 N (p=0.001) (Fig. 1j-l). The nominal
strain at each cycle increased with high loading
magnitudes and with low loading rates. Loading
magnitude and loading rate interacted with each
other to produce more damage (p=0.004, Fig. 2).
Figure 2: Degree of total damage based on validated scoring system of histological data (see Fig. 1). *p<0.05
Discussion
Interestingly, internal collagen damage depended
mainly on loading rate, while the development of
macroscopic surface damage depended more on
loading magnitude. This finding implies that considering superficial cartilage roughening is not sufficient to
evaluate the grade of osteoarthritis in a joint; internal
collagen damage may also contribute. Also, these
locations of damage may independently develop
following different mechanisms. Understanding such
mechanisms may be important for understanding
the aetiology of osteoarthritis.
References
Morel et al, J Biomech, 39:924930, 2006.
Torzilli et al, OA Cart, 18:97105, 2010.
Wilson et al, JOR, 24 (2): 220228, 2006.
42
O 022
THE INFLUENCE OF WALL MOTION ON COMPUTATIONAL

MODELLING OF AORTIC DISSECTION
M. Alimohammadi1, J. Sherwood2, M. Karimpour3 , O. Agu4 , S. Balabani5,
V. Daz-Zuccarini5
1
University College London, Mechanical Engineering, London, United Kingdom

2
Imperial College London, Mechanical Engineering, London, United Kingdom

4
University College Hospital, Vascular Unit, London, United Kingdom
Mechanical Engineering, University College London, London, United Kingdom
Introduction
Aortic dissection (AD) is a cardiovascular disease,
in which a tear in the aortic wall allows blood to
flow between the intimal and medial layers[1], forming a false lumen (FL) and a true lumen (TL). The
choice of interventional approach for AD retains
a degree of subjectivity[1] and CFD has the potential to provide information that is otherwise inaccessible to clinicians. A trade-off between model
complexity and efficiency is required. Although
commonly modelled as rigid[2], the vessel wall motion including the flap between the lumina adds
complexity and its influence on haemodynamics is
yet to be fully elucidated. In the present study, we
carried out a fluid-structure interaction (FSI) study
of a patient-specific AD, so as to establish whether
the additional computational expense required for
FSI is feasible and necessary.
Results
FSI and rigid wall simulations were carried out.
Fig1b shows the vessel wall motion at peak systole.
Wall displacements of up to 0.8 mm compare
favourably with imaging data [5]. Figs. 1c and d
show the time-averaged wall shear stress (TAWSS)
and oscillatory shear index (OSI). In the proximal
and distal FL, there is high OSI and low TAWSS,
which is indicative of a pathological environment
for endothelial cells[6]. Figure 2a compares the flow
through the distal FL for FSI and rigid wall models.
The rigid wall model shows no flow, compared to
the complex behaviour shown by the FSI model.
Streamlines in the distal FL are present in Figure 2b;
this highlights the interesting and complicated flow
patterns in this region.
The study was ethically approved and consent
obtained. A CT scan from a patient with AD was
used and the fluid domain (Fig. 1a) was generated
as described previously [2]. The solid domain (Fig. 1b)
was generated by extruding the fluid domain
such that the wall thickness was 2.5 mm, except
between the two lumina, where the gap was filled.
FSI simulations were carried out with ANSYS-CFX.
Blood was modelled as an incompressible fluid with
density 1056 kgm-3, dynamic viscosity described
by the Carreau-Yasuda model [3] and turbulence
approximated by the shear stress transport model.
An inlet flow wave from a previous study was
used. Outlet boundaries were modelled via 3D-0D
coupling to three-element Windkessel models,
with parameters tuned based on invasive pressure
measurements from the same patient [2]. The vessel
wall was modelled as hyperelastic [4] and motion
at the domain boundaries was restricted to the
horizontal plane.
Discussion
The FSI simulation took 14 times as long as the rigid
wall model, but the haemodynamics in the TL and
FL, which are potentially critical, were not captured
in the latter; meaning that despite the additional
complexity and expense, modelling the vessel wall
motion is essential in these simulations if intended
for use as a clinical interventional planning tool.
References
1 Capoccia L. et al., Vascular. 22(6): 439447, 2014.
2 Alimohammadi M et al., Med Eng Phys,
36:275284, 2014.
3 Gijsen F. et al., J. Biomech, 32:601608, 1999.
4 Raghavan ML. et al., J. Biomech, 33:475482, 2000.
5 Ganten M-K et al., Eur J. Radiol, 72:146153, 2009.
6 Meng H. et al., Am J. Neuroradiol,
35(7):12541262, 2014
43
O 023
LONGITUDINAL AND CIRCUMFERENTIAL MECHANICAL

BEHAVIOUR OF HUMAN CEREBRAL ARTERY
D. Ambard1, E. Omer2, L.F. Simon1, C. Vincent2, S. Mathieu1, J. Franck1
1
2
Universite Montpellier 2, LMGC, Montpellier, France
Hpital Gui de Chauliac CHRU Montpellier, Service de Neuroradiologie, montpellier, France
Introduction
The prevalence of unruptured intracranial
aneurysms in the general population, as reported
by a recent review [Wardlaw, 2000], ranges
between 3% and 6.6%. However, the incidence
of ruptured aneurysms is low, with approximately
0.5% per year, suggesting that very few aneurysms
rupture. Clearly, new patient-specific indexes
predicting aneurysm risk of rupture should be
proposed, in order to guide therapeutic decision
for unruptured aneurysm.
was carried out on the sample within the warmed

(40C) physiological liquid. This testing device was
composed of a Texture Analyzer with a 50 N load
cell and two digital video camera to compute a
DIC analysis (Fig.1).
To obtain the strain/stress relation, we proceed
to a mathematical matching to determine
the corresponding hyperelastic model and its
coefficients. In our cases, the best match was
obtained with a 2 parameters Yeoh model (eq. 1):
Previously, we showed that aneurismal pulsatility

might be a relevant patient-specific predictor
of aneurysm risk of rupture [Sanchez, 2013], as
the pulsability showed to provide information on
the degradation of the mechanical properties
of ruptured aneurism tissue. However, the
biomechanical properties of healthy arteries of
circle of Willis are poorly reported. In this study,
we attempted to identify the biomechanical
behaviour of healthy intracranial artery.
W(I1)= C1.(I1-3) + C 2(I 1-3)^2
(1)
Results
The mechanical behaviours in the longitudinal and
circumferential directions are significantly different
(Tab. 1) for healthy arteries, indicating a fibrous,
structured soft tissue. Indeed, the mechanical
behaviour is stiffer in the longitudinal direction than
in the circumferential direction, in agreement with
other studies [Hu, 2007].
Methods
Five circle of Willis were taken from 5 autopsied
subjects who died from an extra-cranial cause.
Their ages ranges from 30 to 80 years. This research
study protocol was approved by the local ethic
committee. From all circle of Willis, 16 segment of
artery was used in this study.
We also compared the mean stiffnesss of the

healthy arteries to the stiffnesss of the aneurysmal
tissue. We found a significant difference (p=0.01),
with a mean reduction factor of 2.8 on parameter
C2 between healthy artery and aneurysmal
tissue, suggesting a more linear behaviour in the
aneurysmal tissue.
Direction
C1[Mpa]
C2[Mpa]
Longitudinal
0.2 0.11
12.3 7.35
Circumferential
0.1 0.06
4.4 3.21
p value
0.1152
0.0365 *
Table 1: C
1 and C2 coefficients from human cerebral artery
with interval confidence (95%).
Discussion
Variations of the biomechanical properties was
found between aneuvrysmal tissue and healthy
artery tissue. First, a significant reduction of the
stiffness was found, in particular concerning the
C2 parameter in the Yeoh model used between
healhty and degradated tissue, suggesting that
the aneurysm has a more linear behaviour then
healthy tissue. Second, the mechanical behaviour
of degrated tissue is close to the mechanical
behaviour of circumferential direction of healthy
arteries.
Figure 1: G
reen Lagrange strain from DIC.
Under microscopy, the aneurysmal wall samples

were dissected in a longitudinal direction and
circumferential direction to obtain two regular
rectangular pieces (Fig.1). A uniaxial stretch test
References
Wardlaw et al, Brain, 123:205221, 2000
Sanchez et al, Ann. Biomed. Eng., 41:2840, 2013
Hu et al, J. Biomechanics, 40:25592563, 2007
44
O 024
A NOVEL APPROACH TO THE QUANTIFICATION OF

AORTIC ROOT IN VIVO STRUCTURAL MECHANICS
E. Votta1, M. Presicce1, A. Della Corte2, C. Bancone2, F. Sturla1, A. Redaelli1
1
Politecnico di Milano, Dept. of Electronics Information and Bioengineering, Milano, Italy

2
Seconda Universit di Napoli, Department of Cardiothoracic and Respiratory Sciences,

Napoli, Italy
Introduction
Understanding aortic root (AR) biomechanics is
pivotal in elucidating the mechanisms underlying
socially relevant and lethal pathologies, and in
designing surgical devices and procedures to
restore AR function. Computational models can
provide useful information, but, to yield reliable
results, should account for in vivo AR anatomical
features and tensions. To this goal, we set an imagebased framework for the structural analysis of the
AR, which allows for capturing patient-specific
anatomy, while accounting for tissue stresses acting
on the AR also in the initial configuration of the
numerical analysis. To the best of our knowledge,
only one study tackled both these issues, although
through a different approach [Labrosse, 2014].
Methods
The framework consists of five steps (Fig. 1):
i) acquisition of cine-cardiac magnetic resonance
(CMR) sequences, ii) manual tracing of AR structures
in the end-diastolic (ED) frame, iii) automated
reconstruction and dicretization of AR 3D anatomy,
iv) numerical computation of tissue stresses at
ED, assuming 80 mmHg ventricular and aortic
pressure, v) dynamic simulation of AR structural
mechanics throughout two cardiac cycles,
characterized by physiological time-dependent
aortic and ventricular pressures, starting from the
image-based ED geometry, pre-stressed based
on the results from step iv). AV leaflet tissue was
modelled as hyperelastic and transversely isotropic
[Lee, 2014], aortic wall tissue was assumed linear
elastic and isotropic. ABAQUS/Explicit 6.10 (SIMULIA,
Dassault Systmes) was used to run simulations.
Figure 1: M
odelling framework exemplified for a healthy AR.
A) CMR plane acquired at ED; manually traced
AR structures are highlighted. B) reconstructed
AR geometry. C) computation of ED stresses. D)
maximum principal stress computed at maximal
transvalvular pressure load in the final dynamic
simulation.
Discussion
Preliminary results are encouraging, and suggest
that the method might be suitable to analyze
pathologic AR conditions, in which patientspecific morphological details are a key factor.
In particular, the method will be soon applied to
the biomechanical analysis of a small cohort of
patients affected by bicuspid aortic valve disease,
i.e. different patterns of fusion of two out of the
three aortic leaflets.
Results
Preliminary results obtained on 4 healthy volunteers
highlighted that accounting for ED pre-stresses was
crucial to obtain consistency between computed
AR configuration and CMR ground truth data,
and to avoid unrealistic AR dilation and AV
insufficiency. Also, patient-specific morphological
features impacted on biomechanical variables.
This study was funded by the Italian Ministry of Health
Young Researchers 2009 program (Grant number:
GR-2009-1580434).
References
Labrosse et al, Med Image Anal, 2014, published
on line and in press.
Lee et al, J Biomech 47:20552063, 2014.
45
O 025
OF MICE AND MEN: IS ALLOMETRIC SCALING

APPLICABLE TO THE FLOW IN THE AORTA?
T. Schenkel1
1
Sheffield Hallam University, Department of Engineering and Mathematics, Sheffield,

United Kingdom
Introduction
Due to the long time-scales for the development
of the disease in humans, longitudinal studies on
arteriosclerosis are routinely performed on the
mouse model. This follows from the assumption
that allometric scaling laws[1] can be applied to
hemodynamics.
Previous studies have shown evidence that this
assumption is valid for mean Wall Shear Stress
(WSS) distributions and that scaling laws can be
derived for mean WSS in the aorta and following
branches[2].
Recently the usefulness of mean WSS as the
sole indicator of arteriosclerotic risk has been
questioned and unsteady indicators have been
proposed. Furthermore, hydrodynamic scaling
laws predict, that the complex flow in the aortic
arch cannot follow the simple allometric scaling.
Methods
Dimensional analysis is used to find dimensionless
numbers to describe aortic flow. A high resolution,
unsteady, three-dimensional numerical model of
a mouse aorta is scaled geometrically to the size of
a typical human aorta.
Figure 1: C
omparison of time-dependent WSS
C o n cl u s i o n
In the light of these results from a higher resolution
model, resolving the dynamics of the separation on
the inner curvature, many conclusions transferred
from the mouse model to humans are questionable.
While the mean and average WSS as well as the
local average WSS on the outer curvature follow
allometric scaling the time-dependent local
average WSS on the inner curvature shows a
distinctively different behaviour caused by higher
dynamics in the flow separation. As this is a key
region for arteriosclerosis the development of
lesions in humans may differ considerably from the
mouse model.

While the mean WSS and the time-dependent
overall average WSS agree well within the
assumptions of allometric scaling, scaling breaks
down for local evaluation of time-dependent WSS
and oscillatory shear stress index (OSI).
Figure 1 Compares WSS for mouse and human
aorta averaged over the whole aortic surface and
over ROI on inner and outer curvature.
While the overall average WSS and the WSS on
the outer curvature show a similar behaviour,
with higher WSS in the mouse as expected, the
influence of the larger geometry scale and resulting
dynamics on the WSS development is obvious on
the inner curvature.
References
1 West, G., Brown, J. & Enquist, B. A general model
for the origin of allometric scaling laws in biology.
Science (80-.). 276, 122126 (1997).
2 Greve, J. M. et al. Allometric scaling of wall shear
stress from mice to humans: quantification using
cine phase-contrast MRI and computational fluid
dynamics. Am. J. Physiol. Heart Circ. Physiol. 291,
H17008 (2006).
46
O 026
ANEURYSM FORMATION: THE ROLE OF SAMPLE

THICKNESS IN THE EXPERIMENTAL DATA COLLECTION
S. de Gelidi1, G. Tozzi1, A. Bucchi1
1
University of Portsmouth, School of Engineering, Portsmouth, United Kingdom
Introduction
In order to determine the stress achieved in the
stretched materials, measurement of sample
thickness represents a crucial step. Typically, the
thickness is measured for each specimen by laser
micrometer (Di Martino et al. 2006) or assumed
constant for all samples tested (Choudhury et al.
2009). This study aims at investigating the formation
of aneurysm, using uniaxial tensile tests performed
on healthy porcine descending aortas. The impact
of current practice in thickness estimation is
assessed by means of finite element predictions.
(Shi & Moita 1996) in Abaqus (Dassault Systmes

S.A., France). Four node shell elements with
reduced integration (S4R) were adopted to mesh
the tube. As boundary conditions, both ends were
fully constrained and an internal inflating pressure
of 1kPa was applied. Elastic instability, representing
aneurysm formation, was investigated by modified
Riks method (Wriggers 2010).
Results
No critical pressure was obtained for the Yeoh
strain-energy function, although this fits all the
experimental data. Critical pressure values for the
other two strain-energy functions are reported in
Table 1.
Methods
Dumb-bells shapes were cut out by means of a
custom made die, ISO 37:2005(E), type 4, from
porcine thoracic aortas. Thickness and initial length
were optically determined using a customised
Matlab script (Mathworks, Massachusetts, US) for
each sample. In both cases, Sobel edge detection
method is applied on the ROI, which was manually
selected (Figure 1).
Table 1: C
ritical pressure values [kPa] obtained for the
stiffest and softest stress-strain behaviour calculated
for three different thickness values: sample specific,
1.5mm and 3.5mm. When no critical pressure is
reached, no CP is reported.
Discussion
A novel method to estimate the sample specific
thickness is presented. Differently from other works,
the thickness value is computed as the average of
all points included in the ROI (Figure 1). Comparing
results related to the stiffest and the softest data
for each thickness, the minimum scatter (~1 kPa)
is obtained for the sample specific thickness.
Therefore, the most accurate prediction seems to
be related to a precise thickness determination
(Matlab script) as proposed in this work.
Extension of this work will include biaxial tensile
tests combined with FE simulations on a model
of descending aorta, as a refinement of the
presented tube.
Figure 1: S teps of Matlab script: ROI selection and application of Sobel edge detection method.
References
Di Martino et al., J. Vasc. Surg., vol. 43, no. 3, pp.
5706; discussion 576, 2006.
Choudhury et al., Cardiovasc. Pathol., vol. 18, no.
2, pp. 8391, 2009.
Shi & Moita, Comput. Methods Appl. Mech. Eng.,
vol. 7825, no. 96, pp. 265281, 1996.
Wriggers, Nonlinear Finite Element Methods. Berlin:
Springer-Verlag, 2010.
Pixel conversion in mm is based on the grip

dimensions, previously measured by an electronic
calliper. Six samples were pre-conditioned by 5 cycles
performed at 1.2 Hz. Uniaxial tensile tests were
carried out onto a BOSE Electroforce (Model, Bose
Corporation, USA) equipped with a 250N load cell.
Three values of thickness were considered for
the stress evaluation: sample specific (through
MatLab script), 1.5 mm and 3.5 mm constant. For
each of them, the stiffest and the softest stressstrain responses were selected. Filtered stressstrain data were fitted by 1 st order Ogden, NeoHookean and Yeoh strain-energy functions and
imported in a simplified artery, modelled as a tube
47
O 027
COMPARATIVE COMPUTER-BASED RANGE OF MOTION

ANALYSIS OF DIFFERENT HIP IMPLANT SYSTEMS USING
PREOPERATIVE MRI AND POSTOPERATIVE RADIOGRAPHS
A. Wolf1, E. Mick1, D. Kluess1, A. Hartmann2, J. Ltzner2, R. Bader1
1
University Medicine Rostock Department of Orthopaedics, Biomechanics and Implant

technolgy research laboratory FORBIOMIT, Rostock, Germany
Technical University of Dresden, Department of Orthopedic Surgery, Dresden, Germany
Introduction
In clinical practice surgical planning of total hip
arthroplasty (THA) is commonly based on planar
radiographs orientated in the frontal plane and the
surgical instructions given by the manufacturer. The
aim of the present study was to establish a systematic
procedure for a computer-based ROM analysis and
compare surgical planning against the postoperative
situation by analysing their maximum ROM.
Results
The evaluation of postoperative radiographs
revealed inclination angles from 31.1 to 50.3
(mean SD = 41.6 6.3) and anteversion angles
from 13.3 to 32.8 (mean SD = 22.3 5.2)
ROM for the flexion, internal rotation and external
rotation were 5.4%, 12.1% and 4.5% respectively
higher for the implant orientation following
postoperative radiographs than the surgical
instruction.
Methods
Using MRI 3D geometrical data of pelvis and femur
from 11 patients were obtained pre-operatively.
CAD-models of each patient were reconstructed
and used for computer-based ROM analysis.
Pre- and postoperative radiographs were used for
comparison of surgery planning and real implant
positioning (Figure 1). Therefore, the inclination
angle of the cup was read out directly from the
planar radiograph and the anteversion angle was
calculated according to [Liaw 2009] eliminating
the error caused by oblique projection.
Discussion
The systematic procedure for a computer-based
ROM analysis presented has proved to be a useful and reproducible approach to determine and
compare the range of motion of total hip implants.
The individual 3D-reconstruction of pelvis and
femur enabled the comparison between real postoperative implant position and a preoperatively
planned position.
As shown by [Liaw, 2009 and Widmer, 2004] the
cup anteversion angle derived from the planar
radiograph has to be corrected by a factor
depending on the cup inclination and on the
position of the central ray. Considering this factor
an error of up to 5 was observed in present study
which corresponds with findings of other groups
[Ackland, 1986; Liaw, 2009].
3D bone model was virtually equipped with the

clinically used hip system in two implant positions
following both, the postoperative radiograph and
the preoperative surgical planning. For the latter
inclination and anteversion angle were set to 45
and 15, respectively.
The implant systems used were Metha short stem and
BiCONTACT stem (Aesculap, Tuttlingen, Germany).
Positioning of the hip stem in accordance with

one planar radiograph may not be as accurate
as needed. Within surgical planning based on the
preoperative radiograph and surgical instruction
given by the manufacturer no information about
positioning the stem in other than the frontal plane
is provided. Hence, several landmarks and axes
of the 3D femur model were defined for a proper
position of the stems in all three spatial directions.
ROM analysis was performed according to [Kluess,

2008]. Three hip movements were investigated:
maximum flexion
maximum internal rotation at 90 flexion
maximum external rotation at 15 adduction and
10 extension.
In conclusion, we could demonstrate the necessity

of considering both, pre- and postoperative data
to perform comparative computer-based ROM
analysis of total hip replacements. Virtually derived
ROM is being higher for postoperative conditions
than for implant positions according to the
preoperative planning indicates the significance
of experienced orthopaedic surgeons judgement
during operation in situ.
References
Ackland et al., J Bone J Surg, 68B(3):409413, 1986
Kluess et al., Acta Orthop, 79(6):748754, 2008.
Liaw et al., J Arthro, 24(3):468474, 2009
Widmer et al., J Arthro, 19(3):387390, 2004
Figure 1: P
rocedure of computer-based ROM analysis
48
O 028
FIRST STEP FOR CLINICAL FALL RISK MONITORING:

ASSESSMENT OF SAMPLE FREQUENCY INFLUENCE
P. Tamburini1, R. Stagni1
1
University of Bologna, DEI Department of Electric Electronic and Information Engineering

Guglielmo Marconi, Bologna, Italy
Introduction
Falls represent a major community and public
health problem, with large clinical and economic
consequences. The understanding of locomotors
stability is a critical issue in clinical assessment
procedures. Clinicians use clinical rating scales for fall
risk assessment; but this approach highly relies on the
clinicians subjective judgment [Hamacher 2001].
Each index was calculated for the acquired signal

(at 128 Hz) and for other two signals obtained from
the original one by under-sampling at 64 and 32 Hz
and also for anterior-posterior (AP), medio-lateral
(ML) and vertical (V) acceleration directions.
Right heel strike instants were obtained from the
angular velocity measured by the sensor on the
ankle with wavelet analysis based method [Aminian
2001.] and stride time was calculated accordingly.
Several variability and stability indexes were

proposed in the literature for the subject specific
assessment of fall risk. Recent work [Riva 2014, Riva
2014] demonstrated that clustering appropriate
selected indexes can provide indication regarding
the specific subject alterations increasing fall risk.
The obtained indexes were testing with gaussianity

test (Kolmogorov-Smirnov test) in such way was
possible performed the right statistical analysis:
ANOVA test with a p-value of 5%.
The effective exploitation of this approach is

meant in its implementation on a portable device
for the continuous monitoring of subjects at risk,
either pathological (e.g. stroke subjects) or elderly.
The ideal device to maximize the exploitation, and
subject acceptance is a mobile phone. Although
the IMUs mounted on standard smart phones
have nothing to envy to other commercially
available devices, but sampling frequency at 100
or 200 Hz is not compatible with the computational
characteristics. The influence of reduced sampling
frequency on the assessment of variability and
stability indexes used for the monitoring must be
assessed, and this is the aim of the present work.
The statistical analysis compares the obtained

indexes by original signal (the reference) with the
indexes obtained by under-sampling from the
original one.
Results
CV, PSD2, HR, IH, lLE, maxFM, rr and MSE for the time
shifting 5 and 6 didnt show significantly differences
varying the sampling frequency.
SD, sLE, det, avg, max, div and MSE for time shifting
varying between 1 and 4 shown significantly
differences varying the sampling frequency.
NI, IV and PSD1 shown significantly differences only
for the sampling frequency at 32 Hz.
Methods
Ten healthy young subjects, 7 males and 3 females
(283 years, 17411 cm, 6713 kg), participated
to the study.
Discussion
The results show that the indexes calculated in
the frequency domain (HR and IH) and those that
describe the system as a whole (maxFM and lLE)
were not affected by the reduction of sampling
frequency, supporting the maintenance of the
performance of the method when implemented
on a portable device.
They performed a walking along a straight line at

self selected speed on 250 m long dead-end road
wearing 2 tri-axial accelerometers, one located
at the level of the fifth lumbar vertebra and one
on the right ankle. Acceleration and angular
velocity in vertical (V), medio-lateral (ML) and
antero-posterior (AP) were acquired with sample
frequency of 128 Hz.
MSE can be affected by reduction of sampling

frequency, depending on the amplitude of
selected time shift: the higher the time shift the least
the measure is sensitive to frequency changes.
Eleven gait variability and stability indexes were

calculated on stride time and trunk acceleration
data during gait.
References
Aminian et al., J. Biomech 35:689699, 2001.
Hamacher D et al., J R Soc Interface 8(65), 1682
1698, 2011.
Riva et al., conference proceeding SIAMOC-ESMAC 2014.
49
O 029
EXPLORING THE AETIOLOGY OF CONGENITAL

PSEUDARTHROSIS OF THE TIBIA WITH A LARGE
IN SILICO SENSITIVITY ANALYSIS
A. Carlier1, H. Brems2, J.M.A. Ashbourn3 , I. Nica4 , E. Legius2,
H. Van Oosterwyck1, L. Geris5
1
2
3
KU Leuven, Biomechanics Section, Leuven, Belgium
KU Leuven, Department of Human Genetics, Leuven, Belgium
University of Oxford, Department of Engineering Science, Oxford, United Kingdom

4
5
St Edmund Hall, St Edmund Hall, Oxford, United Kingdom
Universit de Lige, Biomechanics Research Unit, Lige, Belgium
Introduction
Congenital pseudarthrosis of the tibia (CPT) is a rare
disease which normally presents itself after birth by
anterolateral bowing of the tibia and spontaneous
tibial fractures [1]. Failure to maintain a bony union
is however frequent, resulting in multiple revision
surgeries and occasionally amputation. The exact
etiology of CPT is still highly debated. However, 4080%
of the CPT-patients are carriers of a mutation in the
Neurofibromatosis type 1 (NF1) gene potentially
resulting in an altered phenotype of the skeletal
cells and impaired bone healing. This study will use a
multiscale computational model of bone regeneration
to investigate the impaired healing in NF1 patients.
Exp e r i m e n t a l m e t h o d s
In order to examine the effect of the NF1 mutation on
bone fracture healing, the parameter values of the
factors describing the aberrant cellular behavior of
haploinsufficient cells were altered in a previously
established model of bone regeneration [2]
(Table 1). Next, a large sensitivity analysis using a
uniform design of 200 different parameter value
combinations was conducted to determine the
(relative) importance of the altered parameter
values on the callus tissue fractions. An additional
outcome CI (complication index) was defined
such that a high CI value corresponds to a high
degree of severity of CPT, i.e. the fracture healing
is severely impaired.
Factor
NF1 case
CI value
Fibroblast
invasion time
Fibroblastic
proliferation
Fibroblastic
differentiation
Osteogenic
differentiation
Endochondral
ossification
Cartilage
formation
Fibrous tissue
formation
Angiogenic
growth factor
production
Table 1: O
verview of the factors describing the aberrant
cellular behavior of NF1 haploinsufficient cells and
their influence on the predicted CI value.
C o n cl u s i o n
In summary, we can conclude that a slower
endochondral ossification process, an increased
invasion of fibroblastic cells and a reduced rate
of cartilage formation are key elements for the
development of a congenital pseudarthrosis in the
computational model. Experimental research is
necessary to verify this hypothesis.

A non-union resembling a CPT phenotype was
predicted by the computational model when the
parameter values were altered according to Table
1 (the NF1 case). From the sensitivity analysis the
following factors were found to be very influential
for the CI value: the rate of cartilage formation,
duration of fibroblast invasion and the rate of
endochondral ossification. Interestingly, many
combinations of altered parameter values resulted
in a similar CI value although the composition and
spatial distribution of the tissues within the fracture
callus was different. Moreover, the computational
model predicts a wide range (0.010.89) of CI
values, corresponding to different degrees of
severity by which the pseudarthrosis presents itself.
LG and AC acknowledge the European Research
Council under the European Unions Seventh Framework Program ERC grant agreement n279100. AC
and HB are post-doctoral fellows of the Research
Foundation Flanders (FWO-Vlaanderen). This work is
part of Prometheus, the Leuven R&D Division of
Skeletal Tissue Engineering of the KU Leuven.
References
1 Pannier S (2011) Congenital pseudarthrosis of the
tibia. Orthopaedics & Traumatology-Surgery &
Research 97: 750761.
2 Carlier A, Geris L, Gastel NV, Carmeliet G,
Oosterwyck HV (2014) Oxygen as a critical determinant of bone fracture healing-A multiscale model.
J Theor Biol 365C: 247264. S0022-5193(14)00601-8
[pii];10.1016/j.jtbi.2014.10.012 [doi].
50
O 030
BIOMECHANICAL EVALUATION OF TAPE

AUGMENTATION REPAIR VS. CONVENTIONAL REPAIR
TECHNIQUES FOR RECONSTRUCTION OF THE ANTERIOR
TALOFIBULAR LIGAMENT
E. Benca1, R. Schuh1, M. Willegger1, L. Hirtler2, S. Zandieh3 ,
J. Holinka1, W. Reinhard1
1
Medical University of Vienna, Department of Orthopaedic Surgery, Vienna, Austria
Medical University of Vienna, Department for Systematic Anatomy, Vienna, Austria

3
Hanusch Hospital, Radiology Department, Vienna, Austria
Introduction
Ankle sprain trauma is the most common sports
injury, whereas the rupture of the anterior talofibular
ligament (ATFL) is a common pathology. Anatomic
repair techniques show good results, however they
require a period of immobilization and protected
rehabilitation to avoid failure of the repair.
Recently, tape augmentation for the traditional
Brostrm repair has been introduced in order to
improve the primary stability of the reconstructed
ATFL and allow earlier mobilization.
InternalBrace: 45.8 14.6 and InternalBrace

without Brostrm group: 45.8 12.2. Statistical
analysis did not show significant differences
between the groups neither for torque nor the
angle at failure. Modes of failure show inferiority in
the suture-ligament interface.
Discussion
The ATFL with tape augmentation is at least as
strong as the native ATFL in a biomechanical
model simulating ankle sprain trauma conditions,
suggesting a possible early mobilization and/or
excessive stresses (in patients with long-standing
lateral ankle instability with attenuated native
tissue, in cavovarus patients and/or elite athletes).
The biomechanical stability of tape augmentation

suture anchor repair is not known yet.
Methods
Thirty fresh-frozen human ankle specimens were
randomly assigned to five different groups: native
ATFL, reconstruction using SutureTak (Arthrex Inc,
Naples, FL, USA) Suture Anchor, traditional Brostrm
repair, Brostrm repair with InternalBrace (Arthrex
Inc, Naples, FL, USA) tape augmentation (Figure
1) and InternalBrace tape augmentation without
Brostrm repair. In vivo loading conditions in ankle
sprain trauma were carried out in a quasi-static
manner. Resisting torque, as well as the rotary
displacement () of the ankle joint were recorded.
Intergroup differences for age, bone mineral
density (BMD), failure angle, and failure torque
were analyzed using repeated measurement
ANOVA.
References
Brown CA, Hurwit D, Behn A, et al. Biomechanical
comparison of an all-soft suture anchor with
a modified Brostrm-Gould suture repair for lateral
ligament reconstruction. Am J Sports Med, 2014,
42(2) p. 41722
Giza EE, Nathe RR, Nathe TT, et al. Strength of bone
tunnel versus suture anchor and push-lock
construct in Brostrm repair. Am J Sports Med, 2012,
40(6) p. 141923
Gould N, Seligson D, Gassman J. Early and late
repair of lateral ligament of the ankle. Foot Ankle,
1980, 1(2) p. 849
Karlsson J, Lundin O, Lind K, et al. Early mobilization
versus immobilization after ankle ligament
stabilization. Scand J Med Sci Sports, 1999,
9(5) p.299303
Waldrop NE, Wijdicks CA, Jansson KS, et al.
Anatomic suture anchor versus the Brostrm
technique for anterior talofibular ligament repair:
a biomechanical comparison. Am J Sports Med,
2012, 40(11) p.25906
Results
Torque at failure reached 8.3 3.1 Nm for the native,
8.4 2.9 Nm for the SutureTak, 5.7 1.9 Nm for the
Brostrm, 10.7 3.3 Nm for the InternalBrace and
11.3 6.0 Nm for InternalBrace without Brostrm
group. Angle at failure reached following values:
native: 33.5 6.7, SutureTak: 35.7 8.6, Brostrm:
24.1 5.8,
51
O 0 31
EFFECTS OF BODY WEIGHT UNLOADING ON KINEMATICS,

KINETICS, MUSCLE ACTIVITY, AND CENTER OF PRESSURE
DURING OVERGROUND GAIT
A. Fischer1, A. Wolf1
1
Technion Israel Institute of Technology, Mechanical Engineering, Haifa, Israel
Introduction
Body weight unloading (BWU) on treadmills is a
common method of gait rehabilitation which by
alleviating loads on lower joints allows patients with
neurological and musculoskeletal impairments
to undergo treatment at the onset or right after
surgery (Lee, 2008). However, the effects of BWU on
gait parameters are hard to assess as long as the
walking modality (treadmill vs. overground) and/or
subjects speed variability during overground
walking are not controlled (Threlkeld, 2003; Van
Hedel, 2006). In this research a novel mechanical
device was designed to pull the BWU system at
a constant speed allowing healthy subjects to
maintain a comfortable speed during overground
walking. In so doing, this study could examine the
unique effects of BWU on gait kinematics, kinetics,
elecromyographic (EMG) activity and center of
pressure (COP) under conditions that approximate
daily walking.
Methods
Fifteen healthy male subjects walked overground
under various levels of BWU with a Biodex system.
An electric winch pulled the system at a constant
speed of 4 km/h. The procedure included
overground walking under a control (No vest),
and three 0%, 15%, and 30% BWU experimental
conditions. The kinematic and kinetic measures of
the hip, knee and ankle joints were obtained using
an eight-camera infrared Vicon motion tracking
system. The EMG activity of the Tibialis Anterior
(TA), Lateral Gastrocnimius (Lat GC), and Vastus
Lateralis (VL) were recorded with an EMG ZeroWire
system and the COP of the foot was calculated
using the force plate and marker data.
Figure 1: ( a) EMG signal of the Lateral Gastrocnemius and

(b) Center of Pressure under three 0% 15% and 30%
BWU conditions.
Discussion
This study showed that healthy subjects during
overground gait with BWU exhibit very specific
kinetic and kinematic patterns which the treadmill
may obscure. The observed reduction in joint
moments, the shift in COP and reduction in EMG
activity resulting from BWU have wide implications
in gait rehabilitation suggesting that BWU may
safely be applied with clinical patients undergoing
rehabilitation in situ, i.e., under conditions that
replicate daily walking. As lower joints regain their
functional activity with respect to balance, range
of motion and locomotor patterns, patients body
weight may be gradually increased until they
resume normal daily walking without any BWU.
Results
Findings show that healthy subjects gait under BWU
showed small albeit significant modifications in
flexion and extension kinematic parameters of the
hip and knee joints. Further, the increase in BWU
resulted in a significant decrease of peak moments
and impulses in the sagittal and frontal planes.
A significant inverse relationship was also observed
between BWU levels and EMG measures (Fig. 1a).
As the BWU level increased, the impulse and peak
activity of the TA, Lat GC and VL decreased. In
contrast, the BWU level did not affect the EMG
signal trajectories. Increasing the BWU level
resulted in modifications of the foot COP, with
a lateral shift in the coronal plane of the COP
(Fig. 1b) during stance.
References
Lee et al, J Appl Physiol, 1043:747755, 2008.
Threlkeld et al, Gait Posture, 173:235245, 2003.
Van Hedel et al, Gait and Posture, 241:3545, 2006.
52
O 032
EFFECT OF TDCS ASSOCIATED WITH FES IN THE TIBIALIS

ANTERIOR, IN THE STATIC BALANCE IN SUBJECTS
WITH HEMIPARESIS POST STROKE
C. Fernanda1, A.M.A. Fruhauf1, G.C. Costa1, L.C. Grecco1,
S.M. Silva1, J.C. Correa1
1
Nove de Julho University UNINOVE, Rehabilitation Science Master and PhD Program,
Sao Paulo, Brazil
Introduction
The increase in cortical activity induced by
brain stimulation, associated or not with other
physiotherapy techniques, could increase the
effects therapeutic engines and functional in
individuals with cerebrovascular accident (CVA).
The objective are to checking the effects obtained
with the combination of the two techniques are
superior to those identified with the techniques
applied in isolation.
tDCS shunt Protocol + FES Active + Active

contraction do mm. tibialis observed decrease in
the COP with open eyes in ML (-9.862/-7.148mm)
and closed eyes in ML (-8.277/3.827mm).
However, the same not observed in AP, obtaining
the value of (1,814/-8.318mm) for open eyes and
closed eyes values (4.326/8.112mm). Anodal
tDCS Protocol + FES shunt + Active contraction
mm. tibialis noted decreased COP: open
eyes in AP (-9.666/-3.983mm), closed eyes in
ML (-71.823/-49.965mm) and closed eyes in
ML (-55.721/-45.701mm). However, the same
was not observed with closed eyes in AP
(-3.860/-6.175 mm). tDCS shunt Protocol +
+ FES shunt + Active contraction do mm.
tibialis noted an decreased COP: with closed
eyes in ML (-30.386/15.902mm) and open
eyes in AP (20.663/5.255 mm). However the
same not observed for COP with open eyes in
ML (-5.790/-38.180) and to the COP with closed
eyes in AP (6.460/10.639mm). The media data
submitted a pre and post intervention after
each patient.
Methods
Cross-sectional study, a randomized, double blind,
crossover, individuals with hemiparesis post stroke,
who met the inclusion criteria. Static balance
assessment by stabilometry, before and after four
intervention periods: (Anodal tDCS + FES active +
+ active contraction mm tibialis) (tDCS shunt + FES
active + active contraction mm tibialis) (anodal
tDCS + FES shunt + active contraction mm. tibialis)
and (tDCS shunt + FES shunt + active contraction mm.
tibial). The tDCS was applied to the primary motor
cortex and the FES on the tibialis anterior muscle. The
order of protocols was by randomization, with the
evaluator and blind patients.
Discussion
The partial results of the study, are promising and
favorable with tDCS technique applied in isolation
and with the association of FES for improving static
balance of patients post stroke. However, the
study is still in progress with more patients to better
conclusion.
Results
There Anodal tDCS Protocol + FES Active + Active
contraction mm. tibialis noted decreased
Center of Postural (COP): With open eyes and in
anteroposterior direction (AP) (-197/823 mm),
With open eyes and in medium-lateral direction
(ML) (-78.460/-54.247 mm) and closed eyes in
ML (-74.602/-53.617 mm), however; the same
not observed in closed eyes in AP (954/9.273 mm).
References
Bolognini et al, J Neuroeng Rehabil. 2009
Nitsche et al. BrainStimulation. 206223, 2008
53
O 033
SUGGESTION OF BALANCE TRAINING STRATEGY

OPTIMIZED FOR THE ELDERLY WITH BALANCE
DISTURBANCE: A PILOT STUDY
D. Lim1, H. Jung1
1
Sejong University, Dept. Mechanical Engineering, Seoul, Korea, Republic of Korea
Introduction
It has been reported that the elderly with balance
disturbance has a high potential risk of falling as one of
major public health problems [Ambrose,2013]. Diverse
strategies for balance training have been therefore
recently suggested to recover effectively the balance
ability of the elderly [Galvarsson, 2011]. Little information
is, however, still available about the optimized strategy
for the elderly with balance disturbance. The aim of
the current study is to identify the optimized strategy
for the elderly with balance disturbance.
the balance index of the participants. The balance

index was then determined via quantification of
a degree of deviation of COM from BOS (Base of
Support) derived from COP.
Statistical Analysis One-way ANOVA test with
Scheffe post hoc multiple comparisons were used
(p< 0.05).
Results
The alteration patterns of the joint angles were
significantly different for each dynamic motion
generally (p<0.05). Maximum deviation of COM was
shown in AP (60.315.5%) and ML (58.613.5%)
dynamic motions, compared to LD (35.59.9%)
and RD (14.96.0%) dynamic motions (p<0.05)
(Fig. 1B). It was, however, that no significant
differences were shown among the dynamic
motions in a deviation frequency point of view
(AP: 17.86.9%, ML: 15.74.6%, LD: 14.12.9%,
RD: 5.92.9%) (p>0.05).
MATERIA L S AND METHODS

Participants Following Institutional Review Board
approval, seven healthy participants with no sign
of musculoskeletal pathology (gender: 7 male,
25.51.7 years, height: 173.96.4 cm, weight:
71.36.5 kg) were tested.
Experimental Configuration Four dynamic motions
(Anterior-Posterior (AP), Medial-Lateral (ML), Left
Diagonal (LD), Right Diagonal (RD), rotations) were
considered by a customized balance training
system with controllable and unstable base plate
(Fig. 1A). The balance characteristics of the
participants responded to the dynamic motions
by the customized balance training system were
then measured using 3D motion analysis system
with eight infrared cameras (T-10s, VICON Motion
System Ltd., UK) and insole pressure mapping
system (Pedar X, Novel gmbh, Germany).
Discussion
It may be judged that AP or ML dynamic motion
should be dominantly considered in the balance
training for the elderly. Diagonal motions should
be, however, considered in the balance training
because we have to handle them shown
frequently in various activities of daily lives.
Optimized strategy for the balance training is not
concluded strongly in the current study because
all balance characteristics and clinical factors
are not considered fully. Those will be therefore
considered in our on-going study.
Data Analysis COM (Center of Body Mass) and COP

(Center of Pressure) were analysed dominantly to
identify the optimum dynamic motion based on
Figure.1 (A) Experimental configuration and (B) COM deviation from BOS in four dynamic motions
References
[1] Anne Felicia Ambrose, Maturitas 75 5161, 2013,
[2] Alexandra Halvarsson et al, Clinical Rehabilitation,
25(11) 10211031,2011
54
O 034
A LUMPED PARAMETER MODEL OF THE FLEXI-BAR:

TOWARDS INVESTIGATING THE EFFECT OF VIBRATION
TRAINING ON THE MUSCULOSKELETAL SYSTEM
K. Khalaf1, M. Abdollahi2, M. Parnianpour3 , M. Nikkhoo4 , M. Hoviattalab2,
M. Asghari2, S. Ashouri2, S. Nikpour2
1
Khalifa University of Science Technology and Research, Biomedical Engineering, Abu

Dhabi, United Arab Emirates
2
Sharif University of Technology, Mechanical Engineering, Tehran, Iran
University of Wisconsin, Industrial and Manufacturing engineeiring, Milwaukee, USA
Science and Research Branch Islamic Azad University, Department of Biomedical

Engineering, Tehran, Iran
Introduction
Vibration training is increasingly gaining popularity as
an effective warm-up/training modality for athletes
and as a therapeutic strategy in rehabilitation.
Several research studies have investigated the
effect of different exercises using flexible bars on
the musculoskeletal system [Gonalves et al, 2011].
Despite the abundance of studies on flexible poles,
such as FLEXI-BAR(FLEXI-SPORTS GmbH, DE), there
remains a gap in literature regarding the structural
modeling and simulation of the bars. The objectives
of this study are twofold: 1) to develop a lumped
parameter model of the FLEXI-BAR; and 2) to use the
model to simulate up-down exercises in AnyBody to
estimate the spinal loads at the L5/S1.
ration (C), while the 2 remaining tests (one free and

one forced vibration) were used for validation.
C. AnyBody Simulations
The robustness of the FLEXI-BAR developed
model was evaluated using simulations of the bar
implemented in AnyBody Modeling System (AMS)
(AnyBody Technology, Denmark). The optimized
model was coupled with the StandingModel in
the AnyBody Managed Model Repository (AMMR)
v.1.5. Up-down exercises were simulated such that
the system was moved up and down periodically
with specific amplitudes and frequencies.
The maximum compression and anterior shear
forces at the L5-S1 vertebral level were calculated
at five different frequencies, as depicted in Figure 2.
METHODS
The FLEXI-BAR has 3 parts: grip, flexible rod and
endpoint mass. A lumped parameter model was
developed for describing its mechanical behavior.
A. Lumped Parameter Model
The bar was divided into 3 segments. Two torsional
springs (stiffness K) and 2 torsional dashpots
(damping ratio C) were used to model the elastic
and damping behavior (Fig1).
Figure 1: L umped parameter model of the FLEXI-BAR
B. Experiments & Optimization Simulations

Two types of tests were conducted to evaluate
the dynamic behavior under different boundary
conditions. A digital camera was used in the first
test to observe the oscillation of the bar in a free
vibration setting, where the initial displacement was
fixed. The test was repeated 3 times using 3 different
initial displacements. The second test evaluated the
bar under forced vibration. The grip was vibrated
using a shaker. Two inertial sensors (Xsense, NL)
were placed on the grip and the endpoint of the
bar, respectively. The shaker induced vibrations
at five pre-specified frequencies: 2.86, 3.88, 4.25,
4.67, 7.33 Hz. In order to identify the mechanical
properties of the springs and dashpots, the two tests
were simulated in MATLAB (The Mathworks, MA)
using an optimal genetic algorithm that minimized
displacement. The outputs of 6 tests were then
used for optimizing the stiffness (K) and damping
Figure 2: M
ax. L5/S1 Compression/Shear posterior forces (N)
DIS C USSION
The
presented
model
provides
adequate
accuracy for large scale modeling using Anybody
or SIMM systems. The effect of higher vibration that
increases muscle/joint forces can guide exercise
and rehabilitation therapists regarding imposing
optimal stress levels on the musculoskeletal system
while avoiding pain and suffering that may affect
compliance. Ongoing and future work include
further validation and simulation of different types
of exercise.
References
Gonalves et al., Journal of Back and Musculoskeletal Rehabilitation 24.4: 209214, 2011.
55
O 035
FINITE ELEMENT INVESTIGATION OF THE EFFECTS

OF THE CUP ORIENTATION ON IMPLANT LOAD-BEARING
IN TOTAL HIP RESURFACING
A. Komeili1, B. Vafaeian1, S. Adeeb1, R. Gudena2, M. El-Rich1
1
2
University of Alberta, Civil Engineering, Edmonton, Canada
University of Calgary, Department of Surgery, Calgary, Canada
Introduction
An alternative to Total Hip Arthroplasty (THA) is the
Total Hip Resurfacing which has been reported as
a more effective and beneficial method especially
in younger patients [Sharp D.J., 1985]. Metal-On-Metal hip resurfacing technique is becoming widely
accepted as a viable alternative to other forms of
total hip replacements. The technique has many
proven benefits in terms of ease of the surgical
operation, operation outcome and subsequent
revisions. However, recent reports suggest that there
is an effect caused by the different femoral implant
and acetabular cup relative orientations on the
release of debris into the blood stream. These reports
suggest that an optimum orientation needs to be
sought. The search for an optimum position to
reduce wear of the metallic components has been
explored clinically and experimentally, however,
there are no reports to explain the mechanical
mechanisms behind an optimum position or lack
thereof. In this paper, a finite element analysis (FEA)
was conducted to investigate the effect of the
acetabular cup orientation on the implant behavior
under weight-bearing load.
inclination higher than 25 or 45 respectively

[Biedermann, 2005]. Metal ions concentration is a
clinical concern not only depends on mechanical
circumstances (wear mechanism and surface
lubrication) but also depends on biological
variables. It has been reported that the cup
inclination angle greater than 50 increases the
concentration of cobalt and chromium ions in
a MOM hip resurfacing [Hart A.J., 2008]. Overall,
combining our FEA results with those considerations
suggests that the optimum range for anteversion
and inclination angles are 10 to 25 and 35 to
45 respectively. The proposed region is in good
agreement with the recommended safe region
reported in available clinical studies in which the
ions concentration, wear rate, fracture of the bone
and bone remodeling were the focus of the study.
References
Biedermann R. et al., J Bone Joint Surgery Br.,
87(6):7629, 2005.
Hart A.J. et al, Hip International, 18(3): 212219,
2008.
Sharp D.J. et al, Clinical Orthopaedics and Related Research, 201:5156, 1985.
Methods
The geometry of the bony structures was extracted
from the CT-Scan image of anonymous hip
joint. The FEA model incorporates half of the
right pelvis, related femoral head and neck,
and all the components of the Birmingham Hip
Resurfacing implant as shown in Figure 1. The final
model consisted of 42126 linear shell elements for
cortical bone, and 416980 linear solid elements
for cancellous bone, implant components,
and cement. A wide range of anteversion and
inclination angles were investigated and the effect
of these orientations on the contact and von Mises
stresses in the implant for a one-legged stance
position was studied.
Results
The results of this study suggest that in the one legged
stance loading configuration the safe range of the
cup orientation, based on the minimum values
of the MCP and von Mises stress, is 0 to 25 of
anteversion and 30 to 45 of inclination(Figure 2).
Discussion
In addition to the FEA factors, the following
three other considerations on the cup optimum
orientation are apparent in literatures: the risk of
impingement, the possibility of dislocation, and the
metal ions concentration. Dislocation and instability
of the implant is associated with anteversion and
56
O 036
SURFACE DAMAGE CHARACTERISATION OF TAPER

JUNCTION IN HIP JOINT IMPLANTS
H. Farhoudi1, R. Oskouei1, C. Jones2, M. Taylor1, L. Solomon3
1
Flinders University, School of Computer Science Engineering and Mathematics,

Adelaide, Australia
University of Adelaide and SA Pathology, School of Medicine & School of Mechanical

Engineering and Adelaide Centre for Spinal Research, Adelaide, Australia
3
Royal Adelaide Hospital and University of Adelaide, Department of Orthopaedics

and Trauma, Adelaide, Australia
Introduction
By-products resulting from fretting wear and corrosion
within the taper junction of hip joint implants can
lead to aggressive biological reactions such as
pseudotumours and bone loss in some patients.
There is typically evidence of visible damage to
the head-neck junction and corrosion products
around the junction [Fricka et al., 2012]. Previous
retrieval studies were mainly limited to macroscopic
visual inspections [Dyrkacz et al., 2013, Higgs et al.,
2013] where the severity of fretting and corrosion
damage was graded on a numeric scale based on
these visual inspections. More detailed analyses of
the surface topography, roughness and chemical
elements present on the neck and head surfaces
appear to be necessary to better understand the
fretting corrosion behaviour at the taper junction.
regions compared to the undamaged regions. This

was consistent for the whole surface of the neck
(different paths). As shown in Figure 1b, roughness
increased from 0.39 m (undamaged) to 0.61 m
(damaged). EDS analyses of the damaged regions
(e.g. red rectangle shown in Figure 1c) revealed
the presence of chromium and oxygen in high
weight percentages indicating that corrosion
caused chromium to be released from the implant
alloy and form oxidised compounds in the corrosion
products on the surface.
Methods
Ethical approval was granted by the Southern
Adelaide Clinical Human Research Ethics Committee
(485.13). Two retrieved modular implants with metalon-polyethylene (MOP) articulations were studied.
Both implants had a 28 mm diameter CoCrMo head
connected to a 316L stainless steel stem. Implant #1
was retrieved after 94 months from an 83-year old
male patient of 77.5 kg. Implant #2 had a 99-month
service life in a 53-year old male patient of 107 kg.
Surface topography and roughness along 8 paths
parallel to the neck surface (with 45 spacing) was
characterised using an optical microscope and
a surface profilometer (WYKO NT9100, Veeco, USA).
Fretting and corrosion damage in the form of surface
depressions and deposited debris were examined
using scanning electron microscopy (SEM, Inspect
F50, FEI, USA). Energy-dispersive spectroscopy (EDS)
was used to determine the elemental composition
of points of interest.
Figure 1: ( a) Neck of Implant #1; (b) Surface topography;

(c) SEM image.
Discussion
Fretting corrosion damage increased the surface
roughness of the neck by approximately 50%.
Mismatch angles between the head and neck
seem to cause the distal contacting rim and
provide a crevice for corrosion attack. Damage
due to the mechanically assisted crevice corrosion
was more severe in the distal area compared to
the proximal area. More research is needed to
identify corrosion product phases.
Results
In both implants, surface damage to the neck
was more severe in the distal area, adjacent to
the rim of the head bore. Material removal and
deposited debris were observed increasingly on
the last 2 mm region of the contacting rim (Figure
1a). Most threaded regions in the proximal area
remained undamaged. Generally, roughness
value (R a)was found to be higher in the damaged
References
Dyrkacz et al, J Arthroplasty, 28: 103640, 2013.
Fricka et al, J Arthroplasty, 27: 2631e1, 2012.
Higgs et al, J Arthroplasty, 28: 26, 2013.
57
O 037
STRESSED VOLUME AS INDICATOR OF LONG-TERM

FATIGUE DAMAGE IN CEMENTED HIP REPLACEMENTS
C. McBrien1, N. Dunne1, A. Lennon1
1
Queens University Belfast, School of Mechanical and Aerospace Engineering, Belfast,

United Kingdom
Introduction
Survival rates of cemented hip replacements can
be improved by mechanically enhancing bone
cement. Experimental studies show that multiwalled carbon nanotube (MWCNT) reinforcement
improves cement properties [Ormsby et al., 2012].
Although unreinforced cement fatigue material
models have been successfully applied to estimating
revision risk [Lennon et al., 2007], fatigue of implants
supported with reinforced cement has not been
modelled to date. This study investigates effect of
MWCNT reinforcement on clinically relevant cement
fatigue by relating computational stress analysis with
measured damage accumulation from a cemented
femoral implant study [Ormsby et al., 2013].
Figure 1: P
redicted stress vs. damage.
Methods
Cemented implant computational models were
developed based on a previous experimental
model [Ormsby et al., 2013], with adapted
cement moduli to account for reinforcement. The
experimental model used a composite Sawbone
femur with an Exeter implant supported with
MWCNT reinforced bone cement. Femoral implant
and cement mantle positioning was reproduced
using bi-planar X-ray images. Cement voids were
incorporated, with implant-cement interfaces
modelled under both bonded and debonded
conditions. Maximum principal stress predictions
were compared to experimentally measured
damage, focusing on regional comparison of initial
stress and measured damage distributions.
Figure 2: V
olumes 10MPa vs. damage.
In conclusion, initial computational results qualitatively agree with the experimental data.
Future model development is required to improve
quantitative comparison with the fatigue damage
evolution. Ongoing companion studies, evaluating fatigue behaviour of reinforced cement and
developing a new fatigue model, will enable
more detailed analysis of the influence of MWCNT
addition on cement mantle fatigue.
Results
Debonded contact interface models better
represented experimentally measured damage
(Figure 1). Considering volumes of cement stressed
10MPa as critical [Murphy and Prendergast, 2000],
debonded models predicted lower stressed volumes
for MWCNT reinforced cement, except in the medial
distal region (Figure 2). Measured damage occurred
mainly in the distal region for all cases. Relative to
controls, the number of cracks in MWCNT reinforced
cement decreased approx. 3% in the medial middle
region, but increased in the lateral middle (3%) and
medial distal (approx. 9%) regions.
References
Lennon, A.B. et al., J Orth Res, 25, 2007.
Murphy, B.P. and Prendergast, P.J., Int.
J. Fat., 22(10), 2000.
Ormsby, R. et al., Acta Biomat, 8, 2012.
Ormsby, R. et al., 25th ESB, Madrid, Spain, 2013.
Discussion
Overall,
stressed
volume
did
correspond
qualitatively with crack location, apart from the
lateral middle and medial distal regions. Any lack
of corroboration could be due to comparison
of initial model predictions with the final fatigue
cracks; detailed simulation of the fatigue damage
accumulation is needed to determine if this is the
case. Other contributing factors include implant
and void positioning.
58
O 038
EXPERIMENTAL SETUP AND METHOD TO MEASURE

LOCALLY THE MICROMOTION BETWEEN
HIP IMPLANT AND FEMUR
L.C. Pastrav1, S. Leuridan2, J. Roosen3 , Q. Goossens1, M. Mulier3 , W. Desmet4 ,
K. Denis1, J. Vander Sloten2
1
KU Leuven Campus Group T, Health Engineering, Leuven, Belgium

2
KU Leuven, Biomechanics Section, Heverlee, Belgium
University Hospitals KU Leuven, Department of Orthopaedics, Pellenberg, Belgium

4
KU Leuven, PMA Section, Heverlee, Belgium
Introduction
Micromotions are cyclic implant-bone relative
displacements induced by physiological loads. This
phenomenon may trigger the loosening process
or at least contribute to it if the relative micromovements exceed 150 m [Viceconti 2000].
Therefore, measuring the micromotion is a method
to assess the stability of the implant-bone structure.
The existing measuring systems consider the implant
as a rigid body and determine up to six components
of motion [An 2000]. The experimental setup and
method presented in this paper allow to measure
locally the relative displacement between the
femoral implant and the bone taking into account
the deformations of both components.
Methods
For the preliminary tests a Wright Profemur implant
and an artificial composite femur were used. Figure
1 shows the experimental setup. A supporting
structure used to hold either guiding bushings or
linear variable displacement transducers (LVDT) is
attached to the implant.
Figure 1: E
xperimental setup
The micromotions are measured in proximal-distal,

medial-lateral or anterior-posterior directions at
four locations situated in two transverse planes.
At each location a pin is inserted in the implant
and a concentric bushing is inserted in the femur.
While the load is applied, four LVDTs are measuring
the displacements between the supporting plate
and the pin and, respectively, the bushing in two
perpendicular directions as indicated in Figure 2.
The whole system is installed on an Instron testing
machine. To simulate the hip abductors a cable
is used and its tension is measured with a force
cell. The cyclic load is similar to those used in other
experiments [Ostbyhaug 2010].
Figure 2: L VDTs positioning
Results
The
relative
bone-implant
micromotion
is
significantly bigger in the distal region than in the
proximal region.
Discussion
Preliminary tests generated significant and
promising results, proving the potential of the
proposed setup and method which could be used
to validate other stability assessing techniques (i.e.
vibration analysis). More experiments are needed
to evaluate the importance of the implant elastic
deformation.
References
An et al (editors), Mechanical testing of bone
and the bone-implant interface, 515526, 2000.
Ostbyhaug et al, Clin Biomech, 25:318324, 2010.
Viceconti et al, J Biomech, 33:16111618, 2000.
59
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MONITORING OF THE REAMER SEATING USING

ACOUSTIC INFORMATION
Q. Goossens1, S. Leuridan2, J. Roosen3 , L.C. Pastrav1, M. Mulier3 , W. Desmet4 ,
K. Denis1, J. Vander Sloten2
1
KU Leuven Campus Group T, Health Engineering, Leuven, Belgium

2
KU Leuven, Biomechanics Section, Leuven, Belgium
University Hospitals KU Leuven, Department of Orthopaedics, Pellenberg, Belgium

4
KU Leuven, PMA Section, Leuven, Belgium
Introduction
A large number of cementless total hip arthroplasties
(THA) are performed every year, during which
the hip joint is replaced by an artificial implant.
The primary fixation of the femoral component
of a cementless THA is obtained by press-fitting
the implant in the femur. At present, this primary
fixation is determined by the subjective auditive
and tactile experiences of the orthopaedic
surgeon. This initial fixation is one of the most
important determining factors to obtain a long
lifetime of the implant [Gheduzzi 2006]. A major,
underestimated complication during THA is an
intra-operative femoral fracture, which occurs
when the implant is excessively press-fitted. 5 % of
the primary cementless THA has to deal with an
intra-operative fracture [Lindahl 2007] and up to
30 % during revision cementless THA [Meek 2004].
observed; only a sudden change was observed in

the percentage power (figure 2). Also this could be
explained by the reamer making proximal contact
in the femur.
This study explores the feasibility of an acoustic

method to obtain additional information on the
reamer seating during primary cementless THA
preparation of the femur. The results of this study give
a first indication of the possibility to assess the implant
fixation/seating by means of an acoustic based
method. An in vitro cadaveric study is pursued.
Methods
14 cadaveric femurs where prepared for primary
cementless THA by an orthopaedic surgeon.
Different sizes of femur where used, resulting
in implant sizes from 1 to 8 (Wright). During the
preparation the hammering sound of the reaming
was recorded with two microphones (PCB
Electronics) at a distance of 1 m. LMS TestLab
(Siemens) was used for the recording of the
acoustic signals. The recorded time signals were
analyzed using Matlab software to extract sensitive
features. The data was filtered and normalized.
Discussion
These reaming results show the possibility of
acoustics to detect proximal contact when the
implant is inserted in the femur. This point is currently
hard to detect for surgeons and is a crucial step
to obtain a good initial fixation of the implant and
prevent intra-operative fractures.
Results
Significant trends were observed in several
features that were calculated out of the sound of
each reaming hit. The most sensitive feature was
the percentage of spectral power in the range
of 100 Hz 1000 Hz. Two different patterns were
recognized:
References
Gheduzzi S., Miles A., Proc Inst Mec Eng Part H, Vol
221, No 1, pp 3946. 2007.
Lindahl H., 2007. Int. J. Care Injured. 38, 651654.
Meek R.M., Garbuz D.S., Masri B.A., Greidanus
N.V., Duncan C.P., 2004. J. Bone Joint Surg. [Am]
86-A, 480485.
1. The power increased every succeeding hammer

hit until a certain hit to stagnate afterwards
(figure 1). This point of stagnation could explained by
the reamer making proximal contact in the femur.
2. When a specific size of reamer was repeated,
a different trend in percentage power was
60
O 040
REFERENCE POINT MICROINDENTATION SUPPLEMENTS

CLINICAL MEASURES TO DISCRIMINATE OSTEOPOROTIC
FROM NON-FRACTURED BONE
T. Jenkins1, L. Coutts1, D. Dunlop2, R. Oreffo3 , C. Cooper4 , N. Harvey4 , P. Thurner5,6
1
University of Southampton, Co-First Author Bioengineering Sciences,

2
University of Southampton, Institute for Developmental Sciences,

4
University Hospital Southampton, Trauma and Orthopaedics,

University of Southampton, MRC Lifecourse Epidemiology Unit,

Vienna University of Technology, Institute of Lightweight Design and Structural Biomechanics,

Vienna, Austria
6
University of Southampton, Bioengineering Sciences, Southampton, United Kingdom
Introduction
Current fracture risk assessment tools, primarily bone
mineral density (BMD) and clinical risk factors (FRAX),
hold a number of limitations and do not identify a
large proportion of individuals who subsequently
present with a hip fracture [Schuit, 2006].
the Curve, ROC AUC = 0.89, close to a perfect

identifier, 1.0) with a high sensitivity (85%) for a
given specificity (80%) and 115 m threshold.
BMD (sensitivity = 37%, specificity = 94% for a t-score of
-2.5) and FRAX (sensitivity = 54%, specificity = 75% for
the age-dependent threshold [Kanis, 2008]), identify
only a small proportion of individuals who fracture.
Reference Point Indentation (RPI) has an outer

reference probe to identify the surface bone and
a test probe that cyclically indents to assess the
total indentation depth (TID). RPI has been applied
clinically and is proposed to improve fracture risk
assessment by assessing a material property of the
bone [Diez-Perez, 2010]. To reach clinical potential,
RPI must be able to distinguish osteoporotic from
non-fractured, healthy tissue. Furthermore, the
technique should supplement whilst remaining
distinct from existing BMD and FRAX measures.
These clinical measures correlate with TID (BMD:

r = -0.32, p = 0.06 and FRAX: r = 0.31, p = 0.03),
but are not all encompassing and explain less than
50% of the RPI measure.
Therefore, combining RPI with clinical measures can
improve the discriminative ability of the techniques
(ROC AUC = 0.99, 100% sensitivity for an 80%
specificity with clinical thresholds and a TID of 115 m).
Methods
RPI was applied (Biodent Hfc , Active Life Scientific)
to the femoral neck, the site of most clinically severe
fracture. Bone resected from hip fracture patients
(OP, 46) and non-fractured cadaveric controls
(C, 16) were assessed using RPI. 13 indents (10 N, 2
Hz, 10 cycles) were made at 20 spacing excluding
the superolateral quadrant. For comparison with
clinical measures: BMD was measured clinically
(19 OP: Hologic Discovery A) and in the laboratory
(16 C: 225 kV X-TEK/Nikon Metrology
HMX ST) and FRAX (37 OP, 16 C) was calculated
through clinical factors (age, sex, previous fracture
etc. [Kanis, 2008]).
TID in OP and C (Left). BMD-TID correlation with

existing and potential thresholds (Right)
Discussion
RPI can differentiate osteoporotic from healthy
tissue by assessing properties distinct from
BMD and FRAX. As a result, combining RPI and
existing clinical measures increases discriminative
ability and, hence, offers potential for improving
fracture risk assessment.
This study was carried out under Southampton REC A

ethical approval (12/SC/0325).
Results
TID is significantly higher (p < 0.001, t-test) in the
OP (131.3 m) than the control (105.9 m) group.
This remains significant when adjusted for test
location, time stored and number of measurements
(p < 0.001, linear regression) and further adjusted
for age, sex, height and BMI (p = 0.051). Hence,
TID can discriminate clearly between the groups
(Receiver Operator Characteristic Area Under
References
Diez-Perez et al, JBMR, 25(8): 187785, 2010;
Kanis et al, Osteoporos Int, 19: 285397;
Schuit et al, Bone, 34(1): 195202, 2006;
61
O 0 41
HOW TO AUGMENT THE OSTEOPOROTIC PROXIMAL

FEMUR? ASK THE BONE!
P. Varga1, J. Schwiedrzik2, P. Zysset2, B. Gueorguiev1, M. Blauth3 , W. Markus1
1
2
AO Research Institute Davos, Biomedical Services, Davos, Switzerland
University of Bern, Institute of Surgical Technology and Biomechanics, Bern, Switzerland

3
Medical University Innsbruck, Department of Trauma Surgery, Innsbruck, Austria
Results
Experimental F fx of the intact proximal femora
could be well predicted (R 2=0.87). ATB-based
augmentation provided 8545% increase in
the predicted Ffx compared to the intact case
(p<0.001) and required cement volumes of
3040 ml.
Introduction
The incidence of a secondary (contralateral) hip
fracture following an initial one is 820% [Ryg, 2009]
and these injuries are associated with manifold
increase of mortality. Drug-based treatment is
often applied too late and the effectiveness of
external protection devices is limited mainly by
patient compliance. Previous studies suggest that
internal augmentation of osteoporotic femora by
means of surgical intervention has a high potential
to help to avoid injuries in case of a fall. However,
there is a significant variation in the mechanical
benefit of the different approaches proposed so
far. Instead of relying on intuition, we choose in this
study to ask the bone (ATB) a s internal structure
in sideways fall load case, which may indicate the
optimal augmentation strategy. We hypothesized
that the bone cement geometry identified by the
ATB concept would provide significant increase in
fracture load (Ffx) in a fall compared to the intact
case.
Discussion
In contrast with previous approaches aiming at
improving the bending resistance of the femoral
neck, the main outcome of the ATBbased
augmentation concept was the establishment of a
compression bridge spanning between the femoral
head and the greater trochanter, integrating
the superior neck cortex. The resulting increase
in F fx was higher compared to recent studies
[Beckmann, 2011] and is within the aimed range of
prophylactic strengthening. While the used amount
of cement may be high and its geometry idealized,
the identified guidelines can serve as the basis for
the development of clinically feasible solutions.
Numerical results of the augmented models
require experimental validation. Despite these
limitations, outcomes of this study suggest that
augmentation of the proximal femur using PMMA
cement alone may provide sufficient improvement
in fracture load in sideways fall. This method may
therefore help to decrease the risk of a secondary
hip fracture, reduce the associated morbidity and
mortality, and moderate the increasing burden
on the health care system. However, the path to
clinical applicability will require addressing further
issues like the risk/gain ratio and ethical justification
of prophylactic augmentation.
Methods
Thirteen intact proximal femora were scanned
with high resolution pQCT (XtremeCT, Scanco) and
tested experimentally in sideway fall configuration
by means of a drop-tower setup [Fliri, 2012]. CT
image-based finite element (FE) model of each
femur was generated and subjected to a simplified
set of loads acting in sideways fall. The numerical
bone remodeling algorithm of Huiskes et al. [Huiskes,
1987] was adapted and used in these simulations
to identify the optimal density distribution within
the trabecular compartment for these boundary
conditions. The resulting high density region was
the basis for defining the domain to be augmented
with polymethylmetacrylate (PMMA).
References
Beckmann et al, J Orthop Res, 29:17531758, 2011.
Huiskes et al, J Biomech, 20:11351150, 1987.
Fliri et al, J Biomater App, 28:136143, 2012.
Kinzl et al, J Biomech, 44:27322736, 2011.
Luisier et al, J Mech Behav Biomed,
32:287299, 2014.
R
yg et al, J Bone Miner Res, 24:12991307, 2009.
A fully automated numerical analysis framework

incorporating a validated nonlinear FE approach
[Luisier, 2014] was established and used to predict
Ffx in sideways fall for the intact and augmented
models. For the latter, the validated elasto-plastic
material properties of the bone-cement compound
were taken from previous studies investigating
vertebroplasty [Kinzl 2011].
62
O 042
FRACTURE TOUGHNESS OF CANCELLOUS BONE:

PREDICTIONS FROM MICRO-CT VALUES
G.J. Adams1, R.B. Cook2, C. Greenwood1, K.D. Rogers1, P. Zioupos1
1
2
Cranfield univeristy, Cranfield forensic institute, Swindon, United Kingdom
University of Southampton, National Centre for Advanced Tribology, Southampton,

United Kingdom
Introduction
Current protocol in determining if a patient is
osteoporotic and their fracture risk is based on
dual energy X-ray absorptiometry (DXA). DXA gives
an indication of their bone mineral density (BMD)
which is the product of both the porosity and
density of the mineralized bone tissue; this is usually
taken at the hip. The DXA results are assessed using
the fracture risk assessment tool as recommended
by the World Health Organization. While this
provides valuable data on a persons fracture risk
advancements in medical imagining technology
enables development of more robust and accurate
risk assessment tools. In order to develop such tools
in vitro analysis of bone is required to assess the
morphological properties of bone osteoporotic
bone tissue and how these pertain to the fracture
toughness (Kcmax) of the tissue.
Figure 1: B
V/TV vs Fracture toughness of human cancellous
bone

In a previous study the Kcmax was determined in vitro
and compared with in-vitro apparent density and
in vivo DXA measurements (Cook 2009). Sixty one
samples were taken from 37 osteoporotic patients
ranging from ages 5996 years. The samples were
taken from the centre of the femoral head and cut
into a disks conforming to ASTM standard E399-90
to be used in determining the plane-strain fracture
toughness. These samples have been imaged
using CT (XT H 225, X-Tek Systems Ltd) and from
the 3D images various morphological parameters
could be determined.
Results
As the results obtained from DXA are representative
of BMD which is a function of the material density
and porosity of bone these two morphological
parameters have been focused on. Here we will
use BV/TV instead of porosity. Figure 1 shows a
significant correlation between BV/TV and Kcmax
(R 2 = 0.56; p<0.001), where Figure 2 shows that
material density and Kc max are much less correlated
(R2=0.10; p=0.027). Knowledge of material density
must add extra information in predicting Kcmax, but
we suspect that Kcmax by in large depends mostly
on bone density at the macroscopic level.
Figure 2: M
aterial density vs Fracture toughness of human
cancellous bone
Discussion
The results have shown that measurement of BV/TV
and material density by micro-CT correlate
significantly with the fracture toughness of
excised samples in-vitro. Furthermore detailed
morphometric analysis of the samples promises to
reduce the noise in predicting Kcmax even further
and elucidate fully which structural features
bear more influence on fracture toughness, and
ultimately on bone fracture risk prediction.
References
Cook, R. B., & Zioupos, P. J Biomech, 42:
20542060, 2009
63
O 043
IMPROVING MUSCLE FORCE PREDICTION IN

MUSCULOSKELETAL SIMULATION USING STATISTICAL
SHAPE MODELLING
D. Nolte1, Z.Y. Ding1, C.K. Tsang1, K.Y. Zhang1, D. Rueckert2,
A.E. Kedgley1, A.M.J. Bull1
1
Imperal College London, Department of Bioengineering, London, United Kingdom

2
Imperal College London, Department of Computing, London, United Kingdom
Introduction
Musculoskeletal (MSK) simulation is an important
method to predict muscle forces. To achieve
realistic results, it is essential to use highly accurate
muscle geometries for origin, insertion and the line
of action. Creating subject specific geometries
manually by segmenting 3D scans is time consuming
and prone to errors. We propose a method to
create subject specific models by morphing bone
geometries using statistical shape modelling to
transform reference muscle geometries.
Methods
For statistical shape models (SSM) of tibia and
femur (Zhang et al. 2012) muscle geometries were
created by registration of manually segmented
geometries to the mean shapes of SSMs. Bone
surfaces were reconstructed using SSMs and nonrigid transformations were calculated (Schnabel
et al. 2001) by describing the deformation of the
mean shapes. The transformation was applied to
the reference muscle geometries to create subject-specific models. Muscle forces resulting from
three differently derived subject specific muscle
geometries are compared in a musculoskeletal
analysis of gait trials for 2 subjects: (1) muscle
geometries using SSM, (2) manual digitization
of points from MRI scans and (3) a linear scaling of
the Klein Horsman lower limb model (Cleather et
al. 2011).
Figure: C
omparison of muscle forces of m. vastus lateralis for
three differently derived subject specific models of
subject 1.
Discussion
The presented method shows a significant
improvement to reconstruct subject specific
muscle geometries. Reconstruction quality of
points decreases with increasing distance to the
bone. Good agreement of muscle forces between
the SSM reconstructed model and the manually
digitized model were obtained. With many different
technological advances being applied to MSK
models, this approach might be the final piece of
puzzle to now allow such models to be customised
in a rapid, clinically-applicable way.
Results
Point-to-point distances of muscle origin and
insertion points between models (2) and (3) are on
average 3 times higher than distances between
models (1) and (2) (Table).
References
Cleather et al, Ann of Biomed Eng, 2011.
Schnabel et al, Med Image Computing, 2001.
Zhang et al., WCB, 2014.
Calculated muscle forces for muscle groups

with origin and insertion on the femur and tibia,
respectively, show a better agreement between
muscle activations using manual digitisation and
SSM reconstructed (1) than the linear scaled model
(3), see Figure.
Tibia
(mm)
Subject 1
Subject 2
Femur
(mm)
SSM
4 15
8 41
linear
60 91
11 58
SSM
4 15
9 13
linear
62 100
13 63
Table: RMS distance (with range) of origin/insertion points to

manual digitisation.
64
O 044
STOCHASTIC MODELLING OF MUSCLE FORCES

DURING MOTION
S. Martelli1, D. Calvetti2, E. Somersalo2, M. Viceconti3
1
Flinders University, School of Computer Science Engineering and Mathematics,

Tonsley, Australia
Case Western Reserve University, Department of Mathematics Applied Mathematics

and Statistics, Cleveland, USA
University of Sheffield, Department of Mechanical Engineering and INSIGNEO Institute

for in silico Medicine, Sheffield, United Kingdom
Introduction
Our central nervous system (CNS) recruits muscles
by targeting multiple and competing goals and it
is task and healthy condition dependent [Loeb,
2012]. However, the spectrum of muscle forces
driving motion is commonly studied focusing on
a single representative muscle force pattern,
typically determined by assuming a known
CNSs optimal behaviour. Statistical methods
can provide information about the spectrum
of muscle forces by taking in input the motion
equations, electromyography measurements, and
muscle constraints [Heino, 2010]. We combined
musculoskeletal models, Bayesian statistics and
EMG-driven modelling for calculating the spectrum
of muscle forces driving motion. In this work, the
model is demonstrated by calculating the muscle
force spectrum for a single walking cycle. The
spectrum is then compared to a common static
optimization solution.
The solution that most closely represented the

EMG-driven force pattern was compared to the
static optimization solution.
Physiologically possible muscle forces, defined
as muscle forces within physiological constraints,
were calculated by constraining the muscle
forces between zero and the peak isometric force.
Physiologically plausible muscle forces, defined as
muscle forces likely to occur, were calculated by
constraining muscle forces within the EMG-driven
force range.
Results
The average distance over gait and muscles
between the spectrum of possible solutions
and the EMG-driven force and was on average
20 N. The average distance per muscle over gait
increased from 0 N to 120 N for one to 15 EMG-driven forces input to the model. The best-fit
solution better represented (R2=0.94, RMSE=19 N)
the EMG-driven force than the static optimization
solution (R2 = 0.38, RMSE = 61 N). Physiologically
possible muscle forces ranged, for most muscles,
between zero and the peak isometric force
causing joint contact forces of up to 11.3 BW at
the hip. The boundaries of physiologically plausible
muscle forces closely matched the boundary of
EMG-driven muscle forces (Figure 1).
Methods
The equilibrium equations at the joints while
walking, the muscle force constraints and the
muscle force pattern calculated by minimizing
the squared sum of muscle activation were taken
from an earlier model, which has been shown to
yield joint angles, joint moments, muscle lever
arms, muscle and joint forces in good agreement
with
published
patterns
of
corresponding
quantities [Martelli, 2014]. The fifteen-channel
electromyography (EMG) recorded from the
principal lower-limb muscles, for seven walking
cycles, was taken from the Living Human Digital
Library [Testi, 2010]. The EMG signal was bandpass filtered (8 th order, Butterworth filter, 10400 Hz)
to minimize noise due to motion artefacts and
the signal amplifier, rectified and low-pass filtered
(2 nd order, Butterworth filter, 6 Hz). Muscle activa
tion was obtained by normalizing the processed EMG
signal to the peak muscle activation calculated
using static optimization. EMG-driven muscle forces
were calculated following the guidelines proposed
by Zajac, 1989. A muscle force spectrum of 200,000
samples per walking frame (102), solution of the
muscle load sharing problem, was calculated
using Metaboloica [Heino, 2010], software that
combines Bayesian statistics and Markov Chain
Monte Carlo sampling method. The average
distance between the solution of the muscle load
sharing problem and the EMG-driven force and
was used as an indicator of the model consistency.
Discussion
The calculated force spectrum closely followed the
EMG-driven force pattern and variability, without
assuming an optimal CNS behaviour. The statistical
method is therefore well suited to study the muscle
force spectrum for every neuromotor condition.
Australian Research Council (DE140101530).
References
Heino et al, Comp Meth Bio 97:15167, 2010.
Loeb, Biol. Cybern. 106:75765, 2012.
Martelli et al, J Biomech. 47:178491, 2014.
Testi et al, Philos Trans A Math Phys Eng Sci
368:285361, 2010.
Zajac, Crit Rev Biomed Eng 17:359411, 1989
see the next page
65
Figure 1: The spectrum of muscle forces (shaded red) and the seven EMG repetitions.
66
O 045
CE OF MUSCLE ACTIVITY DETECTION

ON MUSCLE FORCE ESTIMATION
M.C. Bisi1, A. Botter2, R. Stagni1, T. Vieira2,3
1
University of Bologna, Department of Electrical, Electronic and Information

Engineering Guglielmo Marconi, Bologna, Italy
Politecnico di Torino, Laboratory for Engineering of the Neuromuscular System LISiN,

Department of Electronics and Telecommunications, Torino, Italy
3
Universidade Federal do Rio de Janeiro, Escola de Educao Fsica e Desportos,

Rio de Janeiro, Brazil
Introduction
Subject-specific muscle-skeletal models have
become widespread used in clinical diagnostic for
the possibility to estimate muscle force contributions
to joint moments. In EMG-driven muscle-skeletal
models, the estimation is driven by muscle activity
usually collected by Bipolar EMGs [Bisi, 2011].
Results
Figure 1 shows representative results of one
participant (a) and cross-correlation coefficients
for the group data (b).
Recent work [Vieira, 2011] indicates though that

Bipolar EMGs may not represent the entire muscle
activity and, in such case, lead to biased estimation
of muscle force. From EMGs collected with grids
of electrodes (HD EMGs), on the other hand, more
representative information on the whole muscle
activation dynamics may be obtained. The aim
of the present work was therefore to compare the
effect of the detection system, Bipolar EMGs and
HD EMGs, on muscle force estimation.
Methods
Eight subjects participated in the study (263y,
17211 cm, 6814 kg). A grid of 32 electrodes
(8x4; 1cm inter-electrode distance) was placed
on the participant right tibialis anterior (TA) muscle.
The right shoe was solidly attached to a Bertec
six-component load transducer. Surface EMGs and
ankle dorsi-flexion torque (W-EMG, Bitron s.p.a. and
LISiN-Politecnico di Torino, Italy) were collected
synchronously at 2441 Hz.
Participants performed dorsal flexion contractions
at their maximal effort (MVC) twice. Thereafter,
while provided with a visual-feedback of the
produced torque, they were asked to linearly
increase (5 s) and decrease (5 s) it up to 50% MVC
for five times.
Figure 1: a
) One participant representative results,
b) Group data (8 participants).
Discussion
The higher cross-correlation obtained with HD EMGs
was likely due to the larger muscle volume sampled
by the grid of electrodes when compared to the
traditional, bipolar derivation.
Muscle activation was assessed for EMGs

detected by two detection systems: HD EMGs and
bipolar EMGs. Bipolar EMGs were simulated by
considering HD EMGs detected at a skin region
typically considered in EMG-driven model studies
[Bisi, 2011]. Both HD EMGs and Bipolar EMGs were
rectified and low-pass filtered with the same
cut-off frequency considered to low-pass filter
ankle torque (8 Hz). Envelopes obtained for the
HD recordings were averaged across channels,
providing a representative TA signal.
The findings of these investigations will be useful

in order to define models and methods for
better evaluating the activity of a whole muscle
(e.g. methods for defying better electrodes position
and/or for defining muscle models).
References
Bisi et al, J Electromyogr Kinesiol, 21:107480, 2011.
Vieira et al, J Physiol, 589:43143, 2011
Cross-correlation coefficients were finally computed

between EMG envelopes and ankle torque, both
high-pass filtered at 1 Hz. Such cut-off frequency
ensures the cross-correlation estimates are mainly
associated with force fluctuation rather than with
the ramp profile.
67
O 046
THE EFFECT OF ARM MOTION ON THE REACTION

FORCES IN LUMBAR SPINE AND HIP JOINT
L. Angelini1, F. Di Puccio1, H. Schmidt2
1
University of Pisa, Department of Civil and Industrial Engineering, Pisa, Italy

2
Julius Wolff Institute, Charit Universittsmedizin Berlin, Berlin, Germany
Introduction
In computational models for gait inverse dynamic
(ID) problems, the arms and the trunk are often
considered as a single rigid body [Anderson et
al., 2001]. This simplification is assumed also when
their relative motion is not restricted during the
experimental trial. The aim of the present study
was to investigate the limit of such simplification
by comparing ID results obtained with two models,
including or not a normal arm motion (AM). In
particular, the attention was focused on the
estimates of the loads in the lumbar spine and hip joint.
Results
Figure 1a shows the mean value for all subjects of
the joint reaction force (JRF) in the lumbar spine
segment L4/L5 during walking with AM (dashed red
line) and without AM (solid red line). Differences in
load magnitude and in trend can be appreciated.
Without AM, the spinal loads are lower over the
entire stride and the maximum difference between
walking with and without AM is about 150 N.
However, during gait without AM, an increased
trunk musculature activation is required. Regarding
the hip JRFs (figure 1b), there is a good agreement
between the two models. At about 46% of the stride,
the mean value with AM is greater of about 200 N.
Methods
Five healthy males were included in this preliminary
study. A three-dimensional motion analysis was
performed using a 10 cameras motion capture
system (Vicon, Oxford, United Kingdom), setting the
frame rate at 150 Hz. Forty-seven reflective markers
were placed on specific anatomical landmarks
according to a custom full-body skin marker set.
Ground reaction forces (GRFs) were synchronously
measured using two AMTI force plates (AMTI, MA,
USA) at a rate of 900 Hz. For each subject, three
gait trials with normal AM were recorded. Marker
trajectories and GRFs were smoothed using a
second order, zero-phase, low-pass Butterworth
filter. The filter cut-off frequency was quantified for
each body segment by using the residual method
[Winter, 2005]. The filtered motion data were
imported into the Anybody Modeling System v. 6.
A musculoskeletal model was modified based on
the GaitFullBody model in the AnyBody Managed
Model Repository (AMMR) v.1.6.2. For each subject
and each gait trial, two kinds of simulations were
performed differing for the inclusion/exclusion of
AM. In both models, the segment lengths were
scaled according to the subject anthropometric
data. In addition, an optimization routine was
employed to improve both the segment scaling
and the marker position on the model in relation
to the experimental marker trajectories. Over the
entire gait trial, kinematic and inverse dynamics
analyses were carried out.
Discussion
A model with a single rigid arms-trunk segment
might be inaccurate for the investigation of
the spinal loads and trunk muscle forces. Even if
the influence of AM on hip joint forces is limited,
AM has a relevant impact on the spine. Thus, a
complete marker set of the upper extremities
appears not relevant when investigating loads in
lower extremity joints during normal gait.
Figure 1: M
ean value of JRFs in the lumbar spine segment
L4/L5 (a) and hip joint (b) during walking with AM
(dashed red line) and without AM (solid red line).
References
Anderson et al, J Biomech Eng, 123:381390, 2001.
Winter D., Biomechanics and Motor Control of
Human Movement 3rd Ed. Hoboken, NJ: Wiley.
68
O 047
INTRODUCING FREEBODY: A MATLAB APP

INCORPORATING A MUSCULOSKELETAL MODEL
OF THE LOWER LIMB
D. Cleather1, P. Price2, A. Bull3
1
St Marys University, School of Sport Health and Applied Science, Twickenham,

United Kingdom
St Marys University, School of Sport Health and Applied Sciences, Twickenham,

United Kingdom
3
Results
The model predictions showed a good agreement
with the reference values.
Introduction
The direct measurement of the forces experienced
by the muscles, joints and ligaments of the human
body is highly invasive. For this reason, there has
been interest in the development of musculoskeletal
models of the body that can provide an estimate
as to these internal forces based upon external
measurements of kinetics and kinematics.
Discussion
There are a number of musculoskeletal modelling

software packages that are commercially available however, these carry prohibitive licensing
fees. The number of open source solutions is limited
(a notable exception being the popular OpenSim
software). One barrier to the use of these packages
is the requirement for familiarity both with the software environment and the techniques of musculoskeletal modelling.
There is thus a need for open source models that
can bring musculoskeletal modelling technology
to a wider audience. This work describes a
musculoskeletal model of the lower limb that is
implemented as a user friendly MATLAB app.
Figure 1: V
isualisation of muscle forces
Methods
The lower limb model implemented in the MATLAB
app described here is based upon the model that
we have described in our previous work [Cleather
et al., 2011]. Optical motion capture and force
plate technology are used to measure the external
kinematics and kinetics of the movement of the
lower limb. A representation of the musculoskeletal
geometry of the lower limb is created by scaling
the data set of Klein Horsman et al. [2007] to
the subject in question. The external mechanics
are then related to the internal mechanics and
geometry using the equations of Dumas et al.
[2004]. The equations of motion are then solved
simultaneously using an optimization approach to
find the most physiologically realistic solution.
The model described here is implemented within

a GUI in the MATLAB software environment. The
user interface is thus readily accessible, and the
software is easy to download and run. It is easy
for a new user to employ the model with their
own data to gain predictions of muscle and joint
contact forces they simply need to format it into
a limited number of input files. These predictions
can then be visualised within the app (Figure 1). It
is our hope that this app will bring state of the art,
validated, musculoskeletal modelling technology
to a new population of users.
References
Cleather et al, Ann Biomed Eng,
39:19251934, 2011.
Dumas et al, Com Method Biomech Biomed Eng,
7:159166, 2004.
Klein Horsman et al, Clin Biomech,
22:239247, 2007.
The model predictions were validated by

comparison of predictions to both direct
measurements and values from the literature, in
activities of daily living and vertical jumping, using
a quantitative metric.
69
O 048
NANOMECHANICAL BEHAVIORS OF SS-CATENIN

REVEALED BY SINGLE-MOLECULE AFM
K. Maki1,2, S.W. Han1,2, T. Adachi1,2
1
Institute for Frontier Medical Sciences Kyoto University, Department of Biomechanics,

Kyoto, Japan
Graduate School of Engineering Kyoto University, Department of Micro Engineering,

Kyoto, Japan
Introduction
-Catenin, a component of adherens junction
(AJ), is known to transmit forces between cells and
stabilize their balance, resulting in contribution
to AJ maturation 1. In spite of its mechanical
importance in intercellular mechanotransduction
as a tension transmitter2, the mechanical behaviors
of -catenin remain unclear at molecular level. In
our study, we analyzed the mechanical behaviors
of -catenin by employing single-molecule atomic
force microscopy (AFM) .
behaves as a nonlinear elastic material under

tension, i.e., a mechanical component with low
stiffness under low tension and with high stiffness
under high tension. The nonlinear elastic behavior
exhibited in our experiment suggests a mechanical
function of -catenin to serve as a tension
transmitter at AJs: 1) preserving links between
AJmolecules under low tension and 2) transmitting
high tension with high mechanical stability.
Discussion
In the present study, we showed the mechanical
behaviors of -catenin as a tension transmitter at AJs,
employing the method of AFM nanomechanical
testing. This direct measurement of molecular
behavior can offer new insights into force-induced
dynamical mechanisms in multicellular systems. In
future work, we will try to achieve an overall picture
of molecular mechanotransduction mechanisms
at AJs by analyzing the mechanical behaviors of
other constituent molecules such as cadherin and
-catenin.
Methods
AFM nanomechanical testing is a method for
analyzing mechanical behaviors of single-biomolecules by direct loading. In our research,
we performed two types of experiments, in which a
part and a whole structure of -catenin were loaded
under tension. AFM tip modified with -catenin
molecules at their N-terminus was contacted to
the substrate in order to allow molecules to interact
with NTA-Ni2+/NHS-ester, which were modified on
glass surface. Finally, the tip was moved upward
at constant speed of 200[nm/s] so that -catenin
molecules were directly loaded.
References
1 Yonemura S. et al., Nat. Cell Biol. 12:533542, 2010
2 Huber H. A. et al., Cell 90:871882, 1997
3 Popa I. et al., J. Am. Chem. Soc. 135:1276212771,
2013
Results
As a result of nanomechanical testing, we
obtained force (F) versus extension (dL) curves
that represent the nanomechanical behaviors of
-catenin molecules. Force curves showing single-molecule behaviors of -catenin were identified
with the rupture force FR, which was the peak value
of force F in the force curves. In both of two types
experiments, force curves showed that -catenin
A C K NO W L ED G EMENTS
This work was partly supported by the Platform for Dynamic Approaches to Living System from the MEXT,
Japan. Koichiro Maki was supported by the JSPS
Research Fellowships for Young Scientists from the
Japan Society for the Promotion of Science.
70
O 049
INTERACTION OF VINCULIN WITH F-ACTIN REGULATES

LAMELLIPODIUM PROTRUSION VELOCITY
C. Borau1, J.M. Garca-Aznar1, I. Thievessen2, B. Fabry2
1
2
Friedich-Alexander-University of Erlangen-Nuremberg, Physics, Erlangen, Germany
Introduction
The dynamics of lamellipodium (LP), lamellum and
focal adhesion (FA) structures of migrating cells
have been extensively studied [1, 2]; However,
their exact interactions are still unclear. We have
previously reported that the FA protein vinculin
regulates F-actin retrograde flow dynamics by
coupling F-actin flow to FA [3]. Here, we extend
our previous work and investigate, how actin
cytoskeleton-ECM coupling through vinculin
affects the protrusion of the LP (Fig.1).
Primary vinculin deficient murine embryonic
fibroblasts (MEF) were generated by cre/loxPmediated vinculin gene disruption from parental
vinculin floxed control MEF [3]. F-actin flow dynamics
were recorded using spinning disk confocal (SDC)
microscopy with mApple-actin as fluorescent
marker. Incorporation of X-Rhodamine labeled
G-actin into LP F-actin network was performed
using a mild detergent, saponin, and followed
by glutaraldehyde-fixation and epi-fluorescence
microscopy.Leading
edge
dynamics
was
monitored using differential interference contrast
(DIC) or SDC microscopy using mApple-actin as
marker and quantified using manual kymograph
analyses and/or custom written MatLab software
for the simultaneous analysis of LP F-actin flow
velocity. A one dimensional continuum model of
LP dynamics was developed, incorporating known
key LP parameters, i.e. actin polymerization, F-actin
density, F-actin flow velocity and friction at FA,
plasmamembrane tension, and myosin mediated
cyclic contractions
Figure 1: Q
uantification of F-actin retrograde flow velocity
and leading edge protrusion dynamics on mApple-actin SDC time lapse image series.
C o n cl u s i o n
Our data demonstrate that vinculin, despite its role
in strengthening cytoskeleton-ECM coupling at FAs
to promote LP protrusion, effectively regulates LP
protrusion velocity. Our study suggests a regulatory
function of vinculin for leading edge protrusion in
migrating cells, through a mechanism involving the
direct interaction of vinculin with F-actin.
References
1 Giannone, G., et al.,Cell, 2007. 128(3): p. 56175.
2 Burnette, D.T., et al., Nat Cell Biol, 2011. 13(4):
p. 371U88.
3 Thievessen, I., et al., J Cell Biol, 2013. 202(1):
p. 16377
This work was funded by a European Project Starting
Grant (306571).

To test how vinculin affects LP dynamics, we
monitored LP protrusion/retraction of control and
vinculin deficient MEFs. In addition, we developed
a one-dimensional model to predict and analyze
how vinculin modulates LP F-actin flow and
protrusion. Combining experiments and model
predictions, we found that vinculin i) regulates
lamellipodium protrusion by restraining membrane
velocity specifically in the protrusion phase of
the LP protrusion/contraction cycle, ii) increases
lamellipodium F-actin density, but (iii) does not
affect the amount of G-actin incorporated into
lamellipodium F-actin over time, and (iv) limits LP
protrusion velocity through direct interaction with
F-actin.
71
O 050
MECHANICAL MODELLING OF FRACTIONAL-ORDER

HEREDITARINESS OF LIPID MEMBRANES
M. Zingales1, L. Deseri2
1
University of Palermo, Dipartimento di Ingegneria Civile, Ambientale, Aerospaziale,

dei Materiali, Palermo, Italy
University of Trento, Dipartimento di Ingegneria Civile, Ambientale, dei Materiali, Italy
Introduction
The evaluation of the mechanical stress across the
membrane bilayer is a very challenging features
since large strain/displacements field of the bilayer
are involved and configurational changes of the
membranes may sensibly affect the stress distribution. The impressive amount of research in terms
of elastic free energy as well as of the membrane
stress must be supplemented by the hereditariness
of lipid membranes that affects the membrane
configurations as well as the lipid phase change.
Fractional-order calculus will be used.to introduce hereditariness of lipid bilayers by means of
a small-on-large approach investigating the possibilities arising for non-homogenous equilibria. Such
portfolio of configurations essentially depends on
the value of the underlying (constant) large strain
upon which the lipid bilayer is perturbed.
the fractional-order lipid membrane hereditariness

will be presented. The free energy is necessary
to obtain, by means of variational derivatives,
the Euler-Lagrange equations of the hereditary
membrane.
It is shown that the onset of the loss of homogeneous
configuration is possible even in the purely elastic
case thanks to the interplay between the local and
the nonlocal part of the response. An evaluation
of the line tension at the very onset of the various
situations is given and a frequency analysis of
the lipid membrane behavior is discussed. This is
pursued considering lipid bilayers hereditariness in
terms of the Staverman Schwartzl free energy that
is the energy associated to power-law relaxation
[Deseri et al., 2014]. The results obtained show
under which conditions cases of necks, bulges or
rifts may be found in the cellular membrane.
Methods
The authors introduced the elastic behaviour of lipid
membranes in terms of the Helmoltz free energy
that accounts for the quasi-incompressibility as
well as for the flexural and gaussian curvatures of
the membrane during configurational changes.
The free energy function contains both local
and non-local terms of the control variables due
to the dimensionality reduction of the kinematic
fields. In this study an extension of the Heflrich
[Helfrich 1973] free energy for the lipid bilayer to
References
D
eseri L. and Zurlo G., Biomech. Mod. Mech., 6:
12331242, 2006.
D
eseri L., Di Paola M., Zingales M.: Int. J. Sol Str., 59:
31563167. 2014
D
i Paola M. and Zingales M., J. Rheol., 56:
9831004, 2012.
H
elfrich W., Z Nat., 28: 693703, 1973.
72
O 051
AUTOMATIZED PATIENT-SPECIFIC CORNEAL MODELING.

APPLICATION TO SIMULATION OF A GENERAL
NON-CONTACT TONOMETRY TEST
M.A. Ariza-Gracia1, D. Piero Llorens2, J. Zurita3 , B. Calvo Calzada1,
J.F. Rodrguez Matas1
1
Aragon Institute of Engineering Research I3A, Mechanical Engineering, Zaragoza, Spain

2
Medimar Internationl Hospital, Ophthalmology OFTALMAR, Alicante, Spain
University of Navarra, Mechanical Engineering Energetics and Materials, Pamplona, Spain
Introduction
The corneal shape is influenced by three main
factors: Intraocular Pressure (IOP), geometry
(Corneal Central ThicknessCCT and Curvature)
and corneal tissue [Roberts, 2014]. Despite former
average ocular models were suitable for developing
and understanding the main corneal behavior,
latest advances in imaging technology opened
new branches of personalized medicine allowing to
apply patient-specific models to finite element (FE)
analysis. However, an automatized methodology
amenable for implementation in commercial
devices has not been developed. This work proposes
a pipeline for building three-dimensional FE models
from patient-specific topographical data. The
methodology is demonstrated on the simulation of a
generic air-puff non-contact tonometry test (AP-NCT).
Biomarker
Healthy
KTC
LSK
Sample
CCT
[microns]
553.836.2
472.169.3
501.153.9
U [mm]
(no-ISC)
1.050.132
1.2130.191
1.1510.114
U [mm]
(ISC)
0.9330.110
1.0660.166
1.0330.097
CCT
[microns]
(Clinical)
52025
47538
52463
U [mm]
(Clinical)
1.040.10
1.130.12
1.080.14
Table 1: Statistics of the maximum apical displacement (U)

not accounting for the ISC (no-ISC), accounting for
it (ISC) and the reported results (Clinical)
MATERIA L AND METHODS

Point cloud anterior corneal surface and pachymetry
data obtained with a commercial topographer
(Pentacam,OCULUS) are used to model the anterior
and posterior surfaces of the patients cornea and,
afterwards, incorporated into a three-dimensional FE
eyeball model including the patient-specific cornea
and human average limbus and sclera. The cornea
is assumed as a hyper-elastic anisotropic material
with two families of collagen fibers [Lanchares, 2008;
Elsheikh, 2008]. Contrarily, one circumferential fibers
family is considered for the limbus, whereas sclera
is assumed to be isotropic. A pull-back algorithm to
account for the initial stress due to the IOP is also
incorporated into the modelling pipeline [Riveros,
2013] to take into account the influence of the IOP
on the initial geometry.
Figure 1: A
verage Percentage Error U during the AP-NCT
(blue) and its dispersion (red) when initial stress
configuration (no-ISC) is not accounted respect
accounting for it (ISC).
C o n cl u s i o n
The automatic methodology has been developed
and validated over a large number of patients with
numerical results ranging within the clinical results.
No considering the initial stress-free configuration
(ISC) could lead to errors in the calculated apical
displacement above 10%. However, this error
could be corrected by using a penalty factor for
the Healthy and LSK cases resulting on a substantial
computation time reduction.
The proposed methodology has been applied to the

simulation of a generic AP-NCT on 127 eyes (52 Healthy,
60 KeratoconusKTC, 15 Post-LasikLSK). Maximum
apical displacement (U) has been compared with
reported clinical results. In addition, the impact of
considering the initial stress configuration (ISC) in the
computations is also addressed.
References
Roberts CJ,Cataract Refract Surg,40:862869,2014.
Lanchares E et al.,J Biomech,41:797805,2008.
Elsheikh A et al.,Exp Eye Res,86:783790,2008.
Riveros F et al.,Ann Biomed Eng,41(4):694708,2013.
Valbon BF et al.,Arq Bras Oftalmol,76:22932,2013.
Hassan Z et al.,Cont Lens Anterior Eye,37(5):
33741,2014.

The displacements (U) were found to be within
the human range response when subjected to an
AP-NCT [Valbon, 2013; Hassan, 2014] (Table 1).
Regarding the influence of the ISC, the statistics
shows an average error of 15% in the calculated
U value (Figure 1), with a relative low dispersion
(c.o.v<2%) for Healthy and LSK eyes, whereas for
KTC eyes a larger dispersion was obtained.
73
O 052
A MECHANISTIC INSIGHT INTO THE MECHANICAL ROLE

OF THE STRATUM CORNEUM DURING STRETCHING
AND COMPRESSION OF THE SKIN
M. F Leyva-Mendidvil1, A. Page2, N.W. Bressloff3 , G. Limbert1
1
University of Southampton, National Centre of Advanced Tribology at Southampton nCATS

Bioengineering Research Group, Southampton, United Kingdom
2
University of Southampton, Biomedical Imaging Unit General Hospital.,

University of Southampton, Computational Engineering and Design Group,

Introduction
The skin is a complex hierarchical biological
structure featuring several layers with their own
distinct geometry and mechanical properties. Up
to now, no anatomically-based computational
models of the skin have simultaneously accounted
for these geometrical and material characteristics
to study and quantify their mechanical interactions
under particular macroscopic deformation modes.
The present study addresses these issues with
special emphasis of the role played by the stratum
corneum (SC).
Figure 1: R
atio of minimum principal strains in each skin layer
over a 20% macroscopic strain applied to the skin
composite model (expressed in %) for the compression case. A1, A2, B1 and B2 cases correspond to
different sets of mechanical properties.
Methods
A sample of fresh mid-back skin from a female
patient was prepared and sliced into histological
sections, under given consent. These sections
were imaged using optical microscopy and
processed for segmentation of the skin layers.
From the segmented structures a 2D finite element
mesh of the skin composite model was created
and geometrically non-linear plane-strain finite
element analyses were conducted to study the
sensitivity of the model to variations in mechanical
properties. Skin layers were modelled as isotropic
neo-Hookean materials and published data was
used [Lvque and Audoly, 2013; MagnenatThalmann et al. 2012]. The mechanical effect of
humidity/dryness on the SC was simulated as well as
variations in the properties of the viable epidermis
(VE) while the properties of the dermis (DE) were
kept constant. A series of eight finite element
analyses was conducted, simulating macroscopic
in-plane compression and extension of the skin.
Particular attention was paid to local principal
strains at particular topographical features of the
skin (furrows and crests).
Despite the small thickness of the SC, its Youngs

modulus has a significant effect not only on the
strain magnitude and directions within the SC layer
but also on those of the underlying layers. This
effect is reflected in the deformed shape of the skin
surface in simulated compression and extension
and is intrinsically linked to the rather complex
geometrical characteristics of each skin layer.
Discussion
The imaged-based computational study has
highlighted and quantified the critical role of the
structural and mechanical characteristics of the
skin layers over their mechanical response as well
as on the global response of the skin as a composite
structure. Given that the skin is the human bodys
interface to the external environment, these results
have implications for a variety of mechanical
or mechanobiological processes [Limbert and
Simms, 2013] across many domains of application
including skin tribology in general, consumer goods,
cosmetics, pressure sores and wound healing.
Results
Through a complex non-linear interplay, the
geometry and mechanical characteristics of the
skin layers (and their relative balance), play a
critical role in conditioning the skin mechanical
response to macroscopic in-plane compression
and extension. Topographical features of the skin
surface such as furrows were shown to act as an
efficient means to deflect, convert and redistribute
strainand so stresswithin the layers (Figure 1).
Strain reduction and amplification phenomena
were also observed and quantified.
References
Lvque and Audoly. Skin Res Technol 19:
4246, 2013.
Limbert and Simms. J Mech Behav Biomed Mater
28:395396, 2013.
Magnenat-Thalmann et al. IEEE Trans Inf Technol
Biomed 6:317323, 2002.
74
O 053
NUMERICAL ANALYSIS OF THE HUMAN INNER EAR

WITH FINITE ELEMENT METHOD
J.L. Flores Espejo1, A. Duran Escalante1, A.L. Garcia Gonzalez1
1
Universidad de Mlaga, Departamento Ingeniera Civil Materiales y Fabricacin,

Mlaga, Spain
Introduction
The knowledge of fluid-mechanical behaviour
of the cochlea is important to understand the
overall operation of the human auditory system.
The cochlea consists of several cavities filled with
liquid and separated by membranes. One of
them is the basilar membrane. In this membrane is
innervated the hair cells that perform the sensory
and motor tasks. All things considered make
the experimental observation inner ear is very
invasive and expensive. It all leads to unknown the
functioning of the Inner ear exactly. For this reason
the numerical simulation is inappropriate.
This work presents a numerical analysis of the
human ear with finite element method (FEM). The
main objective is to validate a previous model
of the inner ear [A Durn Escalante et al, 2014].
Therefore the result of this analysis is compared with
dates from the literature. [R. Aibara et al, 2001] [X.
Wang, et al, 2014]
Figure 1: M
odel inner ear
Methods
Numerical analysis have been performed in two
models; first, isolated inner ear model [A. Durn
Escalante et al, 2014] and; second, a full model of
the human auditory system.
In the first model ideal conditions of displacement
have been applied on the oval window, in order to
replace the effect produced by the external and
middle ear.
Figure 2: C
omplete model of the human auditory system.
C o n cl u s i o n
In conclusion, inner ear model has been validated
with numerical analysis.
The second model is made up of the external

auditory canal, the tympani and the middle ear
model [A.Garcia-Gonzalez et al, 2013]; and the
inner ear model [A. Durn Escalante et al, 2014].
The boundary condition has been applied to the
complete model, is 1Pa at the entrance of the
external auditory canal. Numerical simulations
with the FEM have been made through harmonic
analysis in the frequency range 0.210kHz with an
interval of 100Hz.
As a result new studies can be developed on

the inner ear model. For instance research is to
determine what amount of energy that enters
the oval window is reflected and how much is
absorbed by the basilar membrane, vestibule,
semicircular canals, round window and how much
is returned to the tympanic cavity.
The study of the phenomena of otoacoustic
emissions is another interesting research. Viewing
the integrity of the cochlea to determine the
correct functioning of the auditory system without
requiring cooperation of the patient
The study includes an analysis of the following

results: displacement of the basilar membrane;
pressures in the medium scale depending on the
length of the cochlea and the transfer functions of
middle ear.
References
R. Aibara et al, Hearing Research, 152: 12, 2001.
A. Durn Escalante et al., cnim2014, 2014
A. Garcia-Gonzalez et al. The Journal of the Acoustical Society of America, 2013
X. Wang, et al. Computer Methods in Biomechanics and Biomedical Engineering, 17:10, 2014.
75
O 055
MECHANICAL PROPERTIES OF CORNEOSCLERAL RIM

OF HUMAN EYE OBTAINED BY NANOINDENTATION
J. Nohava1, G. Schlunck2, P. Eberwein3
1
2
Anton Paar TriTec, Peseux, Switzerland
University Eye Hospital, Department of Opthalmology, Freiburg, Germany

3
University Eye Hospital, Klinik fr Augenheilkunde, Freiburg, Germany
RESU L TS & DIS C USSION

The Youngs modulus values of the central cornea
was in the range of 19 kPa, while in the scleral
region we found 17 kPa and the limbal rim region
10 kPa. These results differed significantly from
the O&P approach, which yielded much higher
numbers for E. Considerable creep relaxation
occurred during the hold period at maximum
load, which scaled with the elastic modulus
of the different structures. Moreover, the three
tissues showed very low to almost no recovery.
Histological sections of the corneoscleral
rim showed an alignment of collagen bands
consistent to previous publications. The obtained
results revealed unique biomechanical properties
of the corneoscleral rim with distinct mechanical
properties for the three anatomical regions. The
almost complete absence of recovery coupled
with substantial creep resulted in different values
for E depending on the approach used for the
calculation. This brings up the question whether
these formulas are applicable in highly poroelastic
tissues where measurements may depend on
the ability of the fluid to be pushed through the
intercellular space.
Introduction
The corneoscleral rim of the eye represents a
region with unique anatomical properties due
to its location between the cornea and sclera /
conjunctiva. It harbors the corneal epithelial stem
cells in the rim structure (limbus), which are essential
for the regeneration of the corneal epithelium
and preventing the conjunctival epithelium
from growing onto the corneal surface. As a
consequence, a dysfunction of the cells results in a
visual decline. Survival and self-renewal properties
of stem cells depend on specific biological
and biomechanical properties of the stem cell
niche. We therefore aimed to measure the local
mechanical properties of the human corneoscleral
rim using a novel nanoindentation device.
Methods
Nanoindentation experiments were performed
using a spherical indenter of 0.5 mm radius and
maximal load of 30 N. Loading rate was set to
60 N/min and a penetration depth was up to
60 m. The hold period at maximum load was
180 seconds. Youngs modulus (E) was calculated
using a Hertzian fit to the loading data but also
using Oliver&Pharr (O&P) approach.
76
O 056
IN-VIVO MECHANICAL PROPERTIES OF AORTIC TISSUES

G. Martufi1, A. Satriano2, N. Merchant3 , J.J. Appoo4 , E.S. Di Martino5,
F. Bellacosa Marotti1
1
2
3
University of Calgary, Diagnostic Imaging, Calgary, Canada

4
University of Calgary, Civil Engineering, Calgary, Canada
University of Calgary, Cardiac Sciences, Calgary, Canada

University of Calgary, Cardiac Surgery, Calgary, Canada
University of Calgary, Civil Engineering and Centre for Bioengineering Research

and Education, Calgary, Canada
Introduction
Thoracic aortic aneurysm (TAA) is a localized
dilatation of the thoracic aorta resulting from
progressive structural damage of the aortic wall
[Koullias, 2004]. Focal weakening of the wall
plays key role in the evolution of the aneurysmal
disease and is a concomitant factor that leads to
aortic rupture. Mechanical characterization of the
aneurysmal wall is critically important to locate
spots of altered mechanical properties, which may
highlight areas at high risk of rupture.
The constitutive parameter was then identified

through a statistical parameter estimation procedure.
Finally, we validated our approach to estimate
local material properties on a virtual aneurysmal
vessel wall applying a known non-homogenous
material properties distribution.
Results
We found excellent agreement between the
material properties estimated from our method
and those imposed on the virtual mesh (median
error of 2.4%). The mechanical properties obtained
for the patient specific model were distributed in
a complex pattern with large local variability. The
results showed a remarkable spatial variation with
the descending aorta exhibiting stiffer behavior
than the ascending aorta. This mirrors earlier
observations that indicated that the collagenrich descending aorta is stiffer than the collagenpoor ascending aorta [Langewouters, 1984]. The
aneurysmal arch showed areas of stiffer tissue
together with areas with low shear modulus, which
may suggest severe inflammation or discordant
remodeling mechanisms.
Tissue characterization usually involves an invasive

procedure requiring tissue harvesting and tensile
testing [Martufi, 2015]. This procedure is not
only invasive, but also not ideal to provide local
constitutive properties.
In this work we combine medical imaging with
continuum mechanics principles to non-invasively
determine local wall material properties from
dynamic computed tomography (CT) images. As
a proof of concept, we applied the methodology
to a case study of TAA.
Methods
A triangular mesh of a patient-specific TAA wall
was obtained from a stack of low-dose dynamic
10-phase CT images.
Discussion
Our results demonstrate that local material
properties for complex vascular pathologies
may be reasonably predicted by our approach.
Areas with decreased mechanical properties (low
shear modulus) as identified using our approach
may indicate local wall weakening, which could
become a surrogate marker of aortic rupture risk.
Most importantly, the tissue properties estimation
is non-invasive in nature. Therefore, in-vivo focal
weakening evaluation for any given patient is
clinically feasible and cost effective.
An iterative grey-scale feature-tracking approach

was used to estimate velocities at each node of
the aortic surface. Displacements were derived
from the nodal velocities, which in turn allowed
the calculation of the principal strains for each
element throughout the whole cardiac cycle
[Satriano, 2015].
An estimate of the stress throughout the cardiac
cycle was obtained using the Law of Laplace,
where the local mean curvature was evaluated by
an extended quadratic fitting approach.
References
K
oullias et al, Eur J Cardiothor Surg,
26:10981103, 2004.
M
artufi et al, Ann Biomed Eng, 2015, on-line.
S atriano et al, J Biomech, 2015, on-line.
L angewouters et al, J Biomech, 17:425435, 1984.
Once the strains and the stresses are known, the

planar biaxial problem was solved analytically
using an Ogden-like strain energy function with the
shear modulus being the only unknown quantity.
77
O 057
EVALUATION OF MINIMALLY INVASIVELY OBTAINED

MATERIAL PARAMETERS OF ARTERIAL TISSUE FOR
CONSTITUTIVE MODELS
M. Smoljkic1, L. Janssens1, P. Verbrugghe2, M. Larsson3 , E. Widman3 ,
A. Jorge-Penas1, H. Fehervary1, J. Dhooge4 , J. Vander Sloten1, N. Famaey1
1
KU Leuven, Department of Mechanical Engineering Biomechanics Section,

Leuven, Belgium
2
3
KU Leuven, Experimental Cardiac Surgery, Leuven, Belgium
KTH Royal Institute of Technology, Department of Medical Engineering,

School of Technology and Health, Stockholm, Sweden
KU Leuven, Department of Cardiovascular Sciences Cardiovascular Imaging

and Dynamics, Leuven, Belgium
Introduction
A common way to obtain material parameters
for constitutive models is by means of mechanical
testing, e.g. biaxial testing. These techniques require
a sample to be excised and as such cannot be
applied in clinical practice. The alternative is to obtain
parameters via minimally invasive (MI) measurement
techniques. However, these techniques have the
disadvantage of providing only a limited amount of
information, such that certain assumptions need to
be taken into account to allow a full characterization
of the anisotropic properties [Smoljkic, 2015].
lsqnonlin routine and the trust-region-reflective

optimization algorithm. The results were compared
with a Mann-Whitney U-test in Statistica.
Results
As can be seen in Table 1, only k2 was significantly
different (p = 0.049) when comparing both
approaches.
Min.
Invasive
In Smoljkic 2015, a MI material parameter evaluation

technique is evaluated in silico. The goal of this
study is to evaluate the same method in vivo, by
comparing the constitutive model parameters
obtained for sheep common carotid artery (CAA)
from MI measurements with the ones obtained
invasively.
Invasive
Material and Methods

Three one-year-old female Swifter sheep were used
in this study. Prior to the in vivo measurements, the
animals were sedated and anesthetized. A Millar
Mikro-Tip catheter was inserted into the left CCA
for pressure measurements. To measure diameters
and the wall thickness echography images were
obtained with the VIVID7 system. After extraction,
the samples were frozen in PBS solution at -80 C.
Biaxial testing was performed using a BioTester 5000
with a force-controlled protocol. The sample size was
8x8mm. 5 markers were attached on each sample
and in-house developed marker tracking software
(Matlab, MathWorks) was used to calculate 2D
strains.
Sheep 1
Sheep 2
Sheep 3
[MPa]
0.0505
0.2964
0.1245
k 1[MPa]
0.1010
0.1100
0.0000
k2[-]*
0.001
0.002
0.012
[]
47
90
90
[-]
0.00
0.14
0.00
R2
0.99
0.89
0.99
[MPa]
0.0406
0.0582
0.0314
k 1[MPa]
0.0011
0.0018
0.0000
k2[-]*
5.62
10.50
10.64
[]
90
90
[-]
0.00
0.03
0.19
R2
0.86
0.96
0.95
* p < 0.05
Table 1: P
arameters obtained from the minimally invasive
and invasive approach
Discussion
The difference in k2 could come from the fact that
only in vivo pressures can be used in MI approach.
Since k 2 is a parameter that expresses the stiffening
effect of the arterial tissue under high pressures, the
in vivo range might not be enough to characterize
it. Nevertheless, the lack of significant difference
for some parameters is an optimistic result which
indicates the possibility to obtain patient-specific
material properties in vivo. However, this conclusion
needs to be made with great caution. The intragroup variability can have a big influence on
statistical results and a bigger sample size would
be necessary to investigate this more thoroughly.
The constitutive material model used was

proposed in [Gasser, 2006]. The model contains
5 material parameters that are reported in Table 1.
The parameter identification approach consists of
a minimization of an objective function expressing
the difference between the measured and model
pressure (as a function of the arterial diameter) in
the MI approach. In the invasive approach, the
difference between the experimental and model
stresses (as a function of strain) is minimized. In the
MI case, extra terms were added to the objective
function as explained in [Smoljkic, 2015]. The
optimization was implemented in Matlab , using the
References
Smoljkic et al, accepted in J Biomech Mod
Mechanobiol, 2015.
Gasser et al, J R Soc Interface, 3, 1535, 2006.
78
O 058
PRACTICAL ASPECT OF BIAXIAL TESTING

OF VASCULAR TISSUE
V. Man1, P. Skacel1, S. Polzer1, V. Sevcik2, J. Bursa1
1
Brno University of Technology, Institute of Solid Mechanics Mechatronics

and Biomechanics, Brno, Czech Republic
Brno University of Technology, Institute of Automation and Computer Science,

Brno, Czech Republic
Introduction
In contrast to uniaxial testing, biaxial tests succumb
no standards, and their arrangement, specimen
shape and size or the way of load transmission on
the specimen (gripping) are fully chosen by the
staff or designer of the respective testing machine.
Because of this facts as well as some specific
features of soft living tissues there are many
problems with the realization of the tests and many
factors lowering the accuracy or even credibility
of results. Therefore sufficient experience with soft
tissue biaxial testing is decisive for its quality. At
our institute soft tissues have been tested for more
than 10 years. The aim of this paper is to present
the arrangement and capabilities of our in-house
biaxial testing rig and to summarize substantial
features of testing procedures influencing the
quality of the results.
Results
Application of clamps instead of hooks appears
to be more comfortable for operator and allows
him repeatable gripping of the specimen. Clamps
also generate less stress concentration compared
to hooks and eliminate risk of injury of operator
during manipulation with the specimen. Use of the
glass cover fully eliminates level waves and thus
improves the smoothness of obtained stress-strain
curves.
Methods
Square specimens (18 mm x 18 mm) are cut of
aorta or aneurysm wall so that the edges are
aligned with their circumferential and longitudinal
orientations. Then the specimen is placed into
the testing device. Contrary to most researchers
[Lally, 2004, Vande Geest, 2006] who use hooks
to fix a specimen, we use in-house made clamps
two per each side, see figure 1. Equibiaxial
preconditioning of the specimen is performed
using either displacement or force controlled
protocols until changes in response between two
consecutive cycles fall below a chosen tolerance.
Then the specimen is exempted from the rig and
the thickness is estimated as average of five
measurements in the central area using a specially
adjusted thickness gauge with only ca 1 kPa of
applied pressure. Finally, four markers are placed in
centre of the specimen and it is gripped again. An
additional glass is used then to eliminate waves and
other artefacts and thus improve the clarity of the
captured area. Then either displacement or force
ratio between axes is chosen, preconditioning is
performed again and the test is run. During the test
forces and corresponding images of the specimen
are stored at each time step. After testing the
results are analysed using in-house software Tibixus
to extract strains from the captured images and
thus to obtain experimental stress-strain curves.
Discussion
The proposed changes in biaxial experimental
device (clamps and glass coverage) are
inexpensive, decrease the overall time required
for performing large sets of tests (critical in testing
living tissues) and also increase confidence of the
obtained results.
Ack n o wl e d g e m e n t
This work was supported by Czech Science Foundation
project No.13-16304S.
References
Lally et al, Ann Biomed Eng, 32:13551364, 2004
Vande Geest et al, J BIOMECH, 39:13241334, 2006
79
O 059
A NONIVASIVE IN VIVO APPROACH FOR

THE IDENTIFICATION OF ELASTIC AAA WALL
PROPERTIES USING 3D ULTRASOUND DATA
A. Wittek1,2, W. Derwich3 , T. Schmitz-Rixen3 , C.P. Fritzen2, C. Blase1
1
Goethe University, Institute for Cell Biology and Neuroscience, Frankfurt/Main, Germany
2
University Siegen, Department of Mechanical Engineering, Siegen, Germany

3
Goethe University, Department of Vascular and Endovascular Surgery,

Frankfurt/Main, Germany
Results
The identified individual constitutive para-meters are:
= 0.2281 MPa, k1 = 4.7362 MPa, k2 = 1960.65 MPa,
= 0.207, = 4.6. The patient-individual model
shows a peak wall stress of 2.109 MPa, which is
close to the upper limit of the range of AAA wall
failure stresses (0.336 to 2.351 MPa) that is reported
in [Raghavan, 2006]. It exceeds the peak wall stress
of the population averaged model (0.912 MPa) by
more than 2 times.
Introduction
Computational biomechanical models of abdominal aortic aneurysms (AAA) aim at obtaining
patient-individual rupture risk predictors in addition
to the statistical diameter criterion. Despite the
great inter-individual variance of the parameters
determining the mechanical behavior of the AAA
wall, most of the approaches are patient-specific
only with regard to geometry and blood pressure.
In contrast, population averaged constitutive
equations are used in most cases [Humphrey,
2012]. In the present study we have determined
the individual nonlinear and orthotropic elastic
properties of the AAA wall noninvasively in vivo.
We have investigated the impact of the use of
patient-individual vs. population averaged constitutive behavior on the peak wall stress predicted
by a finite element analysis of the AAA wall.
Discussion
Both models predict increased peak wall stress for
an AAA that is not prone to rupture according to
the diameter criterion. The patient-individual model
indicates a much higher rupture risk according
to the peak wall stress criterion compared to the
population averaged model. Thus the presented in
vivo constitutive parameter identification method
is a promising step towards more patient-specific
computational models of AAA.
Methods
Three-dimensional volume data sets of a saccular
AAA with a maximum diameter of 32 mm were
acquired by use of a commercial real time
3D-echocardiography system (Artida, Toshiba
Medical Systems, Japan). A discrete field of 1080
material points on the aneurysm wall were obtained
for 19 geometrical configurations throughout the
pulse cycle by use of a customized commercial
speckle tracking algorithm (Advanced Cardiology
Package, Toshiba Medical Systems, Japan).
Diastolic and systolic blood pressure was measured
at the brachial artery.
In case of the model with the patient-individual
material properties (patient-individual model) the
constitutive parameters of a nonlinear orthotropic
strain-energy function (SEF) [Gasser, 2006] were
identified by use of an inverse finite element model
updating method that accounts for prestresses in
the imaged reference configuration [Wittek, 2013].
In case of the model with a population averaged
SEF (population averaged model) a 2 nd order
Yeoh constitutive equation with the parameters
c10 = 177 kPa and c20 = 1881 kPa was used [Polzer,
2013]. Finally, systolic wall stresses were calculated
for both models by applying hydrostatic transmural
pressure to the prestressed diastolic geometries.
Figure 1: V
on Mises wall stress distributions [MPa] predicted
by the FEA with patient-individual orthotropic
constitutive behavior.
References
Gasser et al, J Roy Soc Interface 3: 1535, 2006
Humphrey et al, J Biomech 5: 805814, 2012
Polzer et al, Med Eng Phy 35: 12829, 2013
Raghavan et al, J Biomech 39: 301016, 2006
Wittek et al, JMBBM 27: 16783, 2013
80
O 060
DETERMINATION OF LAYER-SPECIFIC MECHANICAL

PROPERTIES OF PORCINE AORTA. DEPENDENCE
ON ARTERIAL LOCATION.
M.A. Martinez Barca1, J.A. Pea2, E. Pea1
1
2
University of Zaragoza, Aragn Institute of Engineering Research, Zaragoza, Spain
University of Zaragoza, Manufacturing and Engineering Design Department, Zaragoza, Spain
Introduction
The goal of this study is to evaluate the hypothesis
that the layer-separated residual stresses and
mechanical properties of layer-separated thoracic
arteries differ depending on arterial location in
the aorta. To test this, we measured the axial prestretch and opening angle and performed uniaxial
and biaxial tests (Zeinali-Davarani, 2013) to study
the mechanical behavior of both intact and layer
separated porcine aortic tissue samples under
physiological loads taken from thoracic region.
Few studies provides layer-specific properties of
vascular tissue (Weisbecker, 2012).
In addition, for completeness, we also provided
constitutive parameters for each layer that can
be used by biomedical engineers for investigating
better treatment methods and developing arteryspecific devices (Garca, 2012).
Figure 1: R
epresentative image of the specimen mounted
in the biaxial tensile testing device. Several
randomized markers were placed in an on
the surface of the vessel.
Methods
Porcine aortas (n=10) were harvested postmorten
from approximately 3.5 months old female pigs,
sacrificed for other studies that did not interfere
with the aorta or the circulation system. Two arterial
rings and two longitudinal strips were cut from the
distal and proximal ends of the specimens. The
intimal layer of each ring and longitudinal strip pair
were separated very carefully with minimal force
using anatomical instruments, and then the media
was separated from the adventitia. Therefore four
samples (intact, intima, media and adventitia were
prepared for each test direction (circumferential
and axial) and arterial location (proximal and distal).
Results
We extracted a complete collection of layerspecific mechanical data from porcine aorta
artery also depending on axial location. This
information includes axial prestretch, opening
angle, uniaxial (Figure 2) and biaxial tensile tests.
Statistical significance was found for longitudinal
prestretch and opening angle between proximal
and distal location.
Discussion
Regional differences of layer-specific mechanical
properties of porcine aorta are measured and
compared. The relative location of the samples
highly affects the mechanical behavior of the
vessel, probably due to the transition of a pure
elastic vessel in the proximal zone to a more
muscular one in the distal position. A well-known
hyperelastic constitutive model (Holzapfel, 2000)
is fitted providing a good approximation to the
experimental data.
To measure the longitudinal in situ stretch,

separated 2 cm markers were fixed to the aorta
and axial lengths before and after harvesting
were determined by optical methods. Arterial rings
were cut from the distal and proximal ends of the
specimens for obtaining the layer-specific opening
angle (OA) measurements.
Simple tension tests of the circumferential and
axial aorta rectangular strips were performed in
a high precision drive Instron Microtester 5548
system adapted for biological specimens and
layer-specific stress-strain curves were extracted.
Square specimens were mounted in an Instron
BioPulsTM low-force planar-biaxial Testing System
via connecting four carriages by noddles clamps
and immersed into a bath filled with PBS and
maintained at 37C (Figure 1). Load controlled
tests were performed at peak tension ratios in
circumferential and longitudinal directions (Pc : Pl)
of 1:1, 2:1, 1:2, 2:2.
References
Garca et al, J Mech Behav Biomed 10,
166175, 2012.
Holzapfel et al, L Elasticity, 61:148, 2000.
Weisbecker et al, J Mech Behav Biomed,
12:93106, 2012.
Zeinali-Davarani et al, Ann Biomed Eng,
41:15281538, 2013.
81
Figure 2: E
quibiaxial tensile stress-stretch curves for (a) upper thoracic aorta and (b) lower thoracic aorta.
82
O 0 61
IS THE TRAJECTORY OF THE CENTRE OF MASS

A LEADING FACTOR FOR GAIT CONTROL DYNAMICS?
VERIFICATION ON CHILDREN GAIT.
M.C. Bisi1, R. Stagni1
1
University of Bologna, Department of Electrical Electronic and Information Engineering

Guglielmo Marconi, Bologna, Italy
Introduction
When performing a motor task, the redundancy
of the musculoskeletal system virtually allows an
infinite number of possible patterns, among which,
it is hypothesized, that the control system chooses
one by optimizing a certain cost function. It is still
debated, what optimization criteria is adopted
and whether a sub-optimal solution could be
rather selected in full respect of the physiological
constraints [Martelli, 2011]. A recent study [Bisi, 2015]
showed that newly walking toddlers manifested
characteristics of the pendulum mechanism
already after one month of walking experience,
even if showing strategies and patterns far from the
adult-like gait. These results suggest that the control
of centre of mass (CoM) trajectory could be one of
the driving factors allowing the control system to
choose among the infinite available solutions, even
when not choosing the optimal one. Verifying this
hypothesis on adults is difficult because their gait is
highly structured and repeatable, indicating that
an optimal choice has been found; on the other
hand, toddlers are still too variable, unstable [Bisi,
2015] and far from showing an adult like gait. The
aim of this work is to verify this hypothesis on 6-year
old children: their gait can be considered stable
from the motor control point of view [Perry, 2010]
but still shows high segmental kinematic variability
[Stern, 2012]. If CoM trajectory leads gait control
dynamics, the variability of CoM kinematic should
be lower than that of other kinematic variables.
trajectory and CoM acceleration were obtained.

The relative standard deviation (std%) of each
variable was calculated between the 5 walks of
each test and among the repetitions of the 5-walktest (intra-test and inter-test variability).
Results
Joint angles results showed higher variability in
children than in adults both for the intra-test and
the inter-test conditions: in particular children hip
flexion/extension and intra/extra rotation, and
ankle flexion/extension angles showed std% 6 times
(or more) greater than adults ones. CoM trajectory
in the inter-test condition showed similar std%
results for the two groups, while, in the intra-test,
mediolateral std% was higher in the children group
(5 times). In both intra-test and inter-test conditions,
children CoM acceleration showed std% similar to
adults for the antero-posterior and the vertical axis,
while higher on the mediolateral axis.
Discussion
The results of the present study support the
hypothesis that the trajectory of the CoM is a
leading factor of the gait control dynamics:
children showed lower variability in the CoM
kinematics (trajectory and acceleration) than in
joint angles. Based on present results, it could be
argued that, during gait, the control is focused on
the progression of the CoM and not on its lateral
stabilization: children variability on the mediolateral
axis was always higher than adults one.
Methods
4 children [5.70.5y, 1165cm, 213kg] and 7 adults
[221y, 1616 cm, 566 kg] participated in
the study. Each participant performed 15 walks,
divided in groups of 5 by a 7-minute pause. 3D
kinematic (SmartD, Bts, Italy) was collected using
Plug-in-Gait protocol. One triaxial inertial sensor
(Opal, Apdm, US) was positioned at approximately
CoM level. For each walking test, joint angles, CoM
References
Martelli S, et al, J Biomech, 44:171621, 2011.
Bisi MC, et al, Gait Posture 2015 in press
Perry J, et al, Gait Analysis, Slack Incorporated,
2010
Stern KA, et al, Pediatr Phys Ther, 24:28590, 2012.
83
O 062
BIOMECHANICAL AND OBSERVATIONAL GAIT

ANALYSIS REASONING TO MAKE RELIABLE INFERENCES
ON FUNCTIONAL AND WALKING PATTERNS
IN ARCHEAOLOGY
P. Benaglia1, M. Licata2, A. Ruspi1, G. Armocida2, D. Piscitelli3
1
2
3
University of Insubria, Physical Therapy, Varese, Italy
University of Insubria, Biotechnologies and Life Sciences, Varese, Italy
University of Milano-Bicocca, Department of Translational Medicine and Surgery,

Milano, Italy
Introduction
In archaeological research investigation of sociocultural implications about traumatic lesions in
ancient populations is of growing interest(1). We
used systematic biomechanical and Observational
Gait Analysis (OGA) reasoning (2,3) to find out
injury mechanism, therapeutic interventions and
gait outcomes of an ancient femur fracture.
has been laying supine onto a soft surface with

lateral splints for 46 months and after, as proved
by the ossification structure, resumed weight
bearing and then progressively recovered his
gait function. Main gait kinematic compensations
were: homolateral Duchenne sign and/or
homolateral vaulting, trunk forward bending in
weight acceptance with abolition of homolateral
first rocker, absence of homolateral push-off, knee
hyperextension during stance.
The fracture was analysed by means of autoptic
examination and CT scan, the OGA process was
performed to deduct pathological standing and
gait kinematics, finally we used motion capture
system to visualise the resulting pathological gait
patterns.
C o n cl u s i o n
Biomechanical and OGA reasoning allow to draw
reliable reconstructions of gait and functional
outcomes in archaeological research.
References
1 Lovell N.C. et al., Am J Phys Anthrop.
S25:139170, 1997.
2 Marchi D. at al., Am J Phys Anthrop.
4:447455, 2006.
3 Kirtley C., Clinical Gait Analysis: Theory and
Practice. Churchill Livingstone 2005.

Fracture was transverse, at proximal third of the
diaphysis due to a medial to lateral high energy
direct trauma. Fracture resulted in a large bone
callus, with shortening, posterior angulation and
external rotation of the distal fragment, without
misalignment on the frontal plane (fig 1). Subject
84
O 063
PREDICTION OF SPEED DEPENDENT GAIT KINEMATICS

USING LINEAR REGRESSION ANALYSES
S. Winiarski1, B. Pietraszewski1
1
University School of Physical Education in Wroclaw, Biomechanics Department,

Wroclaw, Poland
Introduction
Locomotive speed influences kinematic and
spatio-temporal parameters [1]. To account for
the effect of speed prediction methods based on
regression equations are provided [13]. However,
it has been shown that measurements on the
same population and environment provide better
prediction of gait kinematics and kinetics [1]. The
statistical relation between any speed-dependent
variable (y) and speed (v) may be expressed in
terms of linear relationship: y(v)=Av+B, where A
(the slope) and B (the intercept) are regression
coefficients. Therefore, reliable standardisation of
speed on gait data can be made with the single
linear regression approach.
BTS Smart-E motion analysis system equipped with 6

digital infrared cameras (1,1 mm) at 120Hz sampling
frequency, was used to record the variables of
kinematics and movement dynamics. 22 photoreflexive markers were placed on the subjects
body in accordance with the procedure for HayesDavis model. For each participant and gait variable
registration was carried out for three speeds: slow,
preferred and fast. The subject was to select the
speed individually and in random order. For each
parameter from the set of variables: (A) spatial, (B)
temporal and (C) angular kinematics, regression
analyses were conducted to evaluate potential
relationships between gait speed and each gait
variable. Angular joint motion was studied in all
three planes and reported in degrees. A linear
regression equation was fit to each parameter
and corresponding coefficient of determination
(R 2) derived.
The purpose of this study was to develop a set

of speed dependent regression equations for
kinematic parameters commonly used in the
analysis of human gait.
Method
Seventeen (17) healthy male university students
(22,01,0y, 77,859,03kg 1,790,13m) participated in this study. Detailed anthropometric
measurements of the lower limbs, necessary to
apply gait model, were conducted.
Results
The averaged speed for fast gait was
1,870,27m/s, preferred 1,360,17m/s and slow
1,160,17 m/s. The individual linear regression
coefficients for example angular gait parameters
are presented in Table 1.
Variable
Variable
Peak Pelvic
Tilt
3.409
3,611
0.89
Peak Hip
Flexion
15.678
24.092
0.71
Range of
Pelvic Tilt
0.644
0,712
0.83
Range of
Hip Flex/Ext
9.920
21.750
0,78
Peak Pelvic
Obliquity
3.145
2.598
0.79
Peak Hip
Abduction
0.568
1.355
0.78
Rang
of Pelvic
Obliquity
1.743
1.316
0.87
Range of
Hip Ab/Ad
5.304
4.937
0.68
Peak Pelvic
Rotation
4.508
1.171
0,98
Peak Hip
Rotation
1.018
1.410
0.51
Range
of Pelvic
Rotation
9.845
0.459
0.92
Range of Hip
Rotation
1.818
12.606
0.72
Peak Knee
Flexion
4.654
54.723
0.64
Peak Ankle
Dorsiflexion
-2.767
16.615
0.83
Range
of Knee
Fexion
6.323
48.947
0.79
Range
of Ankle
D/P-flex
0,982
25.829
0,72
Table 1: Example results of linear regression coefficients for angular gait parameters for n=17 males.
see the next page
85
References
[1] Schwartz MH, et al. 2008. J Biomech 41,
pp.163950.
[2] Stansfield BW, et al. 2006. Gait Posture 23,
pp.28894.
[3] Lelas JL, et al. 2003. Gait Posture 17(2):
pp.10612.
Discussion
In general, we found a good agreement of the
results with Lelas et al. [3]. The peak sagittal plane
kinematic parameters have stronger dependence
on gait speed (higher slope). Also the peak and
range of pelvic rotation is strongly influenced by
speed The speed-dependent relationships shown in
the table can be used as a reference for normal
gait parameter values. The speed-dependent
linear regression analyses allowed us to match
studied gait parameters to the data of predicted
reference group.
86
O 064
INFLUENCE OF KINEMATIC DATA ON THE ESTIMATION

OF GROUND REACTION FORCES DURING NORMAL GAIT
J. Ojeda1, J. Mayo1
1
University of Sevilla, Mechanical Engineering, Sevilla, Spain
Introduction
The
measurement
of
three-dimensional
lower body kinematics through the use of
stereophotogrammetry has been well tested and
validated over many years. Inverse gait analysis
now forms a major part of clinical decision making.
The challenge is developing a forward dynamics
algorithm which allows predicting the motion. The
use of predictive forward simulations is strongly
limited by the lack of a validated model that
describes the contact forces between the foot
and the ground. Several contact models as well as
procedures to adjust their parameters have been
discussed in the literature [Lugrs, 2013; PmiesVil, 2014]. The total contact force is divided into
the normal and tangential components. This work
analyzes the influence of the foot markers position
in the estimation of the contact forces.
Results
The local coordinates of the contact points were
defined by means of a trial and error optimization
procedure for one set of experimental data. Figure
1 shows the vertical coordinate of the contact
points which is the main kinematic variable to
define the normal force.
Figure 1: L eft: Vertical coordinates of the contact points.

Right: Location of the points.
Methods
Normal gait was measured in an adult male using
6 infrared Vicon cameras and a set of reflective
markers. Ground reaction forces were collected
with two AMTI force plates. An inverse dynamics
problem was solved. Ground reaction forces were
defined as a function of the contact laws and
the kinematics calculated from the markers data.
Data obtained from the force plates were used to
validate the ground reaction force estimated with
the models. The plantar surface was modelled as
5 contact points along the surface as shown in
Figure 1. Viscoelastic elements were defined on
each point to model the normal force [Wojtyra,
2003].
Figure 2 shows the normal contact force with

the ground of the right foot during a gait cycle
obtained with the optimized local coordinates of
the contact points and the two set of experimental
data.
Two set of data were recorded for the same

subject and the same technician in different days.
Plug-in-Gait protocol was applied to carry out the
body pose reconstruction.
Figure 2: V
ertical ground reaction force estimated with two
set of data compared with data from the force
plate (Exp).
Discussion
Results highlighted the significant influence of
minimal disturbance on the location of the markers
in the estimation of the contact forces. A detailed
study of the markers protocol should be carried out
to improve the procedure.
References
Lugrs et al, Multibody Syst Dyn, 30:247263, 2013.
Pmies-Vil et al, Mech Mach Theory, 75:
107116, 2014.
Wojtyra, Mech Based Des Struc, 31:357379, 2003.
87
O 065
CAN MODELLING OF MUSCULOSKELETAL SYSTEM HELP

IN DIAGNOSTICS OF PATHOLOGICAL GAIT?
J. Ogrodnik1, M. Syczewska2, S. Piszczatowski1
1
Bialystok University of Technology, Department of Materials and Biomedical Engineering,

Bialystok, Poland
2
The Childrens Memorial Health Institute, Dept. Neurology, Epileptology and Paediatric
Rehabilitation, Warsaw, Poland
Results
A special attention was paid to the possibility of
evaluation of muscle elongation during a gait
cycle on the basis of modelling results (Tab.1). A
great advantage consists also in the possibility of
analysing muscles situated in deep layer.
Introduction
The complexity of the systems responsible for
human locomotion (neural system, muscles, skeleton, etc.) as well as their mutual interactions makes
the diagnostics of pathological gait very difficult.
Nowadays, very sophisticated equipment is used in
gait laboratories to collect data necessary for the
human movement evaluation. However, there is
still an actual problem in the interpretation of information obtained this way. A final diagnosis should
give an answer to the question what is the primary
reason of gait pathology whilst the other symptoms
should be defined as secondary effects (compensation of primary pathology) [Novacheck, 2007].
The aim of presented study is to evaluate whether
the computer modelling of the musculoskeletal
system can deliver new information, important for
the diagnostics of patients with gait pathology due
to muscle spasticity.
Methods
The modelling of the musculoskeletal system was
performed using the AnyBody system (AnyBody
Technology A/S, Denmark) [Damsgaard, 2006].
Some earlier data collected during gait analyses
made for diagnostic purposes in The Childrens
Memorial Health Institute in Warsaw (Vicon system,
Kistler force platforms, sEMG) were transferred to
AnyBody using c3d files. For modelling, the MoCap
LowerBody Model, consisting of 55 muscles divided
into 159 branches for each leg with 7 joint degrees
of freedom (Fig.1) was used.
Table 1: A
nalysis of selected muscle elongation in
a gait cycle (girl, 12-years-old)
Discussion
The results of modelling allow finding an asymmetry
in the left/right side muscle branches elongation.
The differences in average muscle length make
it possible to evaluate muscle contractures. Such
data may help in a better interpretation of joint
angle and sEMG recordings and for this reason
the modelling should be more widely used in the
diagnostics of pathological gait.
References
Damsgaard M. et al, Simul Model Pract Th 14:
11001111, 2006
Novacheck T.F. et al, Childs Nerv Syst 23:
10151031, 2007.
Figure 1: V
isualization of the right hip region
in the musculoskeletal model
Results obtained from modelling were compared

with conclusions formulated after the gait analysis
to find out whether any new information could be
found as a result of the model analysis.
88
O 066
DESIGN AND 3D PRINTING OF A DYNAMIC WRIST SPLINT

IN THE DART THROW MOTION PLANE
S. Portnoy1, A. Sayapin2, Y. Kaufman-Cohen3 , Y. Levanon3
1
2
Tel Aviv University, Tel Aviv, Israel
Afeka College of Engineering, Medical Engineering department, Tel Aviv, Israel

3
Tel Aviv University, Occupational Therapy, Tel Aviv, Israel
Introduction
Rehabilitation following a wrist fracture often
includes exercising flexio n-extension movements
with a dynamic splint. Current studies show
that these sagittal wrist movements are not
representative of the natural daily wrist movements.
We actually perform most of our daily functions,
with our wrist moving on a Dart Throw Motion (DTM)
plane, also defined as the plane between radialextension and ulnar-flexion. Today, no dynamic
splint exists which facilitates wrist exercise in the
DTM plane.
(N=36) (Fig. 1a). The geometry of the splint was

designed to fit to a 3D scan of the wrist (Fig. 1b).
The splint was attached to the wrist using Velcro
as two wires attached to two pulleys, situated on
a joint axis, pull the hand to move in the desired
calculated plane.
Results
The printed splint fits the wrist of the subject, is easy
to don and doff and constricts movement to the
desired DTM plane. Hooks were inserted on each
part to allow the addition of rubber bands for
resistance training towards muscle strengthening.
Aim
To design and 3D print a subject-specific dynamic
wrist splint that facilitates wrist exercise in the DTM
plane.
Discussion
Exercising in the natural plane of the DTM may
reduce the time of rehabilitation. The evaluation
of the clinical benefits of this method, compared
to conventional rehabilitation methods following
wrist fracture, are a part of a PhD work, currently
conducted by an occupational therapist.
Method
First, the DTM plane was calculated using a wrist
electrogoniometer placed on the wrist of healthy
subjects, performing several activities of daily living
89
O 0 67
DOES HIGH-IMPACT FUNCTIONAL ACTIVITY INCREASE

LOWER LIMB MISALIGNMENT IN WOMEN WITH
PATELLOFEMORAL PAIN SYNDROME?
J.C.F. Correa1, A. Curcio dos Reis1, A.S. Bley2, N.D.D.A. Rabelo2,
T.Y. Fukuda3 , P.R.G. Lucareli2
Sao Paulo, Brazil
Sao Paulo, Brazil
Irmandade Santa Casa de Misericrdia, Department of Physical Therapy, Sao Paulo, Brazil
Introduction
Patellofemoral pain syndrome (PFPS) is commonly
associated with misalignment of the lower limb
during closed kinetic chain activities and has been
recorded in both low and high-impact activities. To
determine if high-impact activities cause greater
biomechanical abnormalities in the lower limb
than low-impact activities.
Discussion
The present study has some limitations, particularly
in relation to the fact that the assessment of the
landing phase of the jump was only conducted
during the transition from the first to the second
jumping the SLTHT. However, this decision was
made due to the kinetic and kinematic values
found during the pilot study. In addition, the fact
that the volunteers performed the jump barefoot
needs to be considered. Since it was difficult
to standardize the footwear of all participants,
we believe that it was the right decision for the
present study. Using different footwear could have
affected the results. The most significant clinical
implication of the present study is that, unlike the
expected results, the greatest biomechanical
abnormalities were associated with low-impact
phases of the SLTHT. This finding should be taken
into consideration when assessing, treating and
releasing PFPS patients. Most professionals are
concerned about only assessing biomechanical
behavior during the phase of the test with the
highest impact. However, despite the results of
the present study, it is impossible to infer that the
preparation phase is more harmful or dangerous
to women with PFPS. Consequently, further studies
should be undertaken to assess these two phases
and investigate more variables, including muscle
activity during each phase. Women with PFPS
exhibit different kinematic and kinetic behavior
during the preparation and landing phases of the
SLTHT. Thus, high-impact activities do not increase
misalignment when compared with low-impact
activities.
Methods
Twenty women with PFPS, aged between 18 and
35, were instructed to perform the single-leg triple
hop test (SLTHT). Kinetic and kinematic data were
collected during the preparation phase prior to
the jump and during the landing phase between
the first and the second hop.
Results
The women exhibited the following during
the landing phase: greater range of anterior
(36.14.8 vs 14.94.4) and ipsilateral trunk flexion
(9.52.5 vs 5.64.9); greater hip internal extensor
(2.70.5 vs 1.80.8) and abductor moments
(2.20.2 vs 1.60.4); as well as greater knee
extensor (1.90.3 vs 0.80.2); and invertor moment
(0.60.2 vs [-]0.60.2). The following variables
were greater during the preparation phase:
contralateral pelvic drop (14.82.9 vs 7.02.1);
hip flexion (80.875.19 vs 54.145.7), adduction
(19.953.7
vs
10.332.12)
and
medial
rotation (19.516.3 vs 12.973.2); knee flexion
(63.53.5
vs
48.022.7);
and
dorsiflexion
(35.34.7 vs 26.92.8); knee internal abduction
moment (2.60.5 vs 2.10.4).
References
B
arton et al, Gait Posture. 33(2):286291, 2011.
B
ley et al, PLoS One, 9(5):e97606, 2014.
F ukuda et al, JOSPT, 42(10):823830, 2012.
W
illson et al, Clin Biomech, 23(2):203211, 2008.
90
O 068
A SINGLE STEP ANALYSIS OF PLANTAR PRESSURE

DISTRIBUTION IN TENNIS SPECIFIC MOVEMENTS
P. Kornfeind1, A. Baca1
1
University of Vienna, Biomechanics/Kinesiology and Applied Computer Science,

Vienna, Austria
Introduction
An increasing number of sports facilities is equipped
with synthetic playing surfaces. Reasons, among
others, are their versatility, their durability and the
lower costs in maintenance [cf. Taylor et al., 2012].
Playing behaviour is affected by the surface layer.
Surface properties may thus increase injury rates.
regions defined by the forefoot and rear foot area.

Mean values and standard deviations were then
calculated for all variables on both surfaces for both
movements. A repeated measures 22 multivariate
analysis was performed with the surface and
the two regions as the repeated factors and mf,
pp and mp as the dependent variables. Paired
samples t-test was used to examine differences
in plantar loading parameters between surface
conditions for fore- and rear foot.
It is obvious that playing on different surfaces

results in different foot strike techniques, which,
as a consequence, requires wearing appropriate
footwear. Injuries mostly occur at deceleration
steps [Griffin et al., 2006], e.g. during a directional
change, which is typical during tennis play.
For plantar pressure distribution analyses in
tennis, different types of steps (acceleration/
deceleration) need therefore to be assessed for
obtaining revealing results.
Results
Significantly (p<0.05) higher loadings were
observed for the whole foot on clay for forefoot
strikes at forehand play. No significant differences
were found for baseline play. The multivariate
analysis revealed significant differences for both
repeated factors for ac as well as for dc steps
under both playing conditions. In the forefoot area
pp was significantly higher on clay for dc steps for
baseline play. This was also the case for mf, pp and
mp in ac steps during forehand play. In the rear
foot area significantly higher values on hard-court
for mf, pp and mp in dc steps during both types of
movement were found.
Methods
Eight right handed male tennis players with
an International Tennis Number of 6 or better
participated in the study. Players had to perform
two different tennis specific movements on the
two playing surfaces clay and hard-court: (1) eight
shuttle runs as described by [Girard et al., 2007] to
simulate baseline play and (2) a sequence of ten
forehand strokes.
Discussion
On hard court players have to absorbe a higher
impact when hitting the surface, while on clay the
foot has the ability to slide slightly. Using different
tread techniques might be useful when switching
surfaces, especially a controlled heel strike is
recommended on hard courts. The present study
also indicates that higher force values occur on
clay during acceleration. This would agree with the
assumption of an eventual need of higher force and
pressure to accelerate on the more slippery clay.
A Pedar-X insole measurement system (Novel

GmbH) was used for recording plantar pressure
distributions. The sensors were placed between the
foot and the plantar surface of the right shoe.
Steps were categorized either as forefoot strikes
(assuming acceleration) or heel strikes (assuming
deceleration). The respective classification was
based on the initial center of pressure (COP) during
impact (ac: COP at toes and forefoot; dc: COP at
heel). This was confirmed by the curve shape of
the vertical GRF and the path of the COP from the
impact until toe off event.
References
Girard et al, Br J Sports Med, 41: 733738, 2007.
Griffin et al, Am J Sports Med, 34 (9):
15121532, 2006.
Taylor et al, Phys Sportsmed, 40 (4): 6672, 2012.
Mean maximum force per step (mf), peak pressure

(pp) and mean peak pressure per step (mp)
were determined for the whole foot and for two
91
O 0 69
MUSCULOSKELETAL MODELLING FOR ERGONOMICS:

SHOULDER & LOWER BACK LOADING IN BRICKLAYING
S.H. Ismail1, A.E. Kedgley1, A.M.J. Bull1
1
Imperial College London, Bioengineering Department, London, United Kingdom
Introduction
Work-related musculoskeletal disorders (WMSDs)
have become an increasing problem, with a
significant socio-economic burden due to longterm disability. In 2011/2012 the total number
of WMSD cases was more than 40% of all workrelated illnesses across Britain [HSE, 2013]. WMSDs
are predominantly instigated by biomechanical
factors such as repetitive motion and loading,
as well as extreme loading and postures that
cause pain or functional loss [Michener et al.,
2003]. The building trade is one of trades that has
a high rate of WMSDs. WMSDs are multifactorial
conditions; they are produced by a complex web
of risk factors that cannot be unravelled by clinical
examination alone. Musculoskeletal modelling can
aid WMSD analysis [Lemieux et al., 2012]. The aim
of this study was to estimate shoulder muscle and
lower back loading during a bricklaying task under
occupational conditions.
Methods
A 10-camera optical motion tracking system
(Vicon, Oxford, UK) was used to measure the
kinematics of the trunk, scapula, humerus forearm
and pelvis. Two experienced and three trained
(inexperienced) bricklayers participated in the
experiment. An inverse dynamics musculoskeletal
model of the upper limb was used to quantify
muscle forces during bricklaying activities [Charlton
& Johnson, 2006]. The effects on muscle activation
and low back loading when lifting of two different
heights (ground level and 200 cm) were tested.
Additional code was custom-written in MATLAB
(The Mathworks, Natick, USA) to calculate the
inter-segmental forces and moments between the
pelvis and trunk.
Figure: Mean muscle activation for two shoulder muscles of

trained (TR) and experienced (EX) bricklayers over four trials
using 3kg brick.
Discussion
This measurement approach combined with
musculoskeletal modelling shows that experience
has an impact on shoulder and low back loading.
Changing the task by, for example, reducing task
mass and changing the lifting height, may reduce
low back loading. With further investigation,
this will lead to the quantification of parameters
associated with shoulder and low back pathology
produced in the workplace. This information can
be used to optimise the brick laying technique,
not only for performance, but also to reduce workrelated injuries through task design, equipment,
and/or training.
Results
In the case of placing bricks at ground level, higher
muscle activation was found in trained bricklayers
compared to experienced bricklayers (Figure). In
the case of placing bricks at 200cm, higher muscle
forces were found in experienced bricklayers
compared to trainees. For back loading, higher
moments were found when placing bricks at
ground level compared to placing the bricks at
200cm for both trained and experienced subjects.
References
Charlton & Johnson, Proc Inst Mech Eng H, 220:
80112, 2006.
HSE, http://www.hse.gov.uk/statistics/causdis/
musculoskeletal/msd.pdf, 2013.
Lemieux et al, Clin Biomech, 27:8016, 2012.
Michener et al, Clin Biomech,18:36979,2003.
92
O 070
POSTURAL DYNAMISM DURING COMPUTER MOUSE

AND KEYBOARD USE: A PILOT STUDY
Q.A. Louw1
1
Stellenbosch University, Physiotherapy, Cape Town, Republic of South Africa
Introduction
Postural dynamism (measured as the number of
postural changes in cervical and thoracic angles)
may vary between computer tasks (Van Dien et
al. 2001). Currently there is no knowledge about 3D
postural dynamism during different computer tasks.
The aim of this study was to measure 3D postural
dynamism during mouse use and keyboard typing.
D a t a a n a ly s i s
Descriptive statistics were used to describe the
postural dynamism (total number of cervical and
thoracic postural changes per minute). Graphs
were used to illustrate postural dynamism. A paired
t-test was performed to determine differences
(p >0.05) between the mouse clicking task and the
typing task.
METHODO L O G Y
Twelve freshman students participated. The
exclusion criteria included a history of spinal or
neurological pathology, a body mass index ratio
higher than 25 and/or a high waist-hip ratio less
than 0.8 in females and 0.9 in males.
Results
There were significant differences in 3D postural
dynamism (number of postural changes) between
the mouse and typing tasks for the cervical
(flexion/extension
(p=0.0003);
side
flexion
(p=0.0000); rotation (p=0.0002)) and thoracic
(flexion/extension
(p=0.0173);
side
flexion
(p=0.0163); rotation (p=0.0399)) spinal angles in
all three movement planes. Postural dynamism for
one participant is represented in Figure 2.
We determined that seven subjects were required

to detect a statistical difference between the two
computer tasks for an effect size of 1.66, using a
paired t-test (alpha level of 0.05).
The Vicon Motion Analysis system which consists
of eight (either wall-mounted or tripod-mounted)
T-10 MX cameras was used to film the participants.
Data was captured performing mouse clicking
and keyboard computer tasks. A custom-designed
computer program was used to give detailed
commands according to a specific time frame.
mov/min: Postural changes per minute
Postural dynamism was described as the total number

of postural changes that occurred during the data
capture period. A postural change is defined as the
difference in degrees between one turning point
(change in movement direction) and a successive
turning point in the data of a given angle (cervical
or thoracic angles) (Van Niekerk et al 2014; Figure 1).
As each angle is a continuous function, the derivative
of the data was used to calculate the turning points
concerned. The absolute difference between
successive turning points was calculated per subject.
Figure 2: E
xample Postural Dynamism of one subject
Discussion
We found that postural dynamism is less during
mouse use compared to keyboard typing. However
both of these input devices lead to monotonous
sitting posture, which is sustained for prolonged
periods. The use of computers is inevitable in
the occupational and academic environment.
Therefore, futuristic alternatives to traditional
computer input devices should be developed.
Computer users should also be advised to use a
range of different input devices to encourage
postural dynamism whilst sitting.
Figure 1: Illustration of postural turning points
93
O 071
DEVELOPMENT OF A SIMPLIFIED METHOD TO ESTIMATE

IMPLANT DESIGN PERFORMANCE UNDER DYNAMIC
LOADING CONDITIONS IN TOTAL KNEE REPLACEMENT
SYSTEMS
A. Maas1, I. Kutzner2, R. Larranzar-Garijo3 , T.M. Grupp1
1
2
3
Aesculap AG, Research and Development, Tuttlingen, Germany
Julius Wolff Institute, Charit Universittsmedizin Berlin, Berlin, Germany
Orthopaedic and Traumatology Department, Infanta Leonor University Hospital,

Madrid, Spain
Introduction
Dynamic finite-element (FE) models of the knee joint
are rarely used during the implant design process
because of their complexity. Using a new approach
this study introduces a simple and versatile method
of modelling total knee replacement implant
systems under dynamic loading conditions using
averaged high load cycles [Bergmann, 2014] to
determine the influence of alignment parameters,
excessive load, design and size combinations
on implant lifetime reducing factors such as
mechanical failure and wear.
To estimate the suitability of this method different

alignments as well as an additional level walk
load cycle were analyzed and compared to their
corresponding in vivo datasets.
Results
Although the analyzed and instrumented implant
designs are slightly different the resulting reaction
moments show similarities in curve characteristics
and magnitude of the occurring maxima which
also indicates comparable knee kinematics (Fig.2).
Methods
The example ascending stairs averaged in vivo
dataset was transposed to start at the lowest
knee flexion angle and a curve fitting procedure
delivered time dependent load functions for the
tibial load components FX(t), FY(t), FZ(t) and the
femoral knee flexion angle (t) with an average
R of 0,9988. A 3D model of an implant system
with ultracongruent gliding surface was aligned
according to the flexion angle delivered by
the (t) function for t = 0 and transferred into the
FE-software. Determined equations were applied
to the nonlinear 6-DOF FE-model as external loads
and the analysis duration was set according to the
validity range of the used functions. The location
and orientation of the femoral coordinate system
was determined by comparing the reaction
moments delivered by the in vivo datasets to the
results of the FE-model (Fig.1).
Figure 2: R
eaction moment over time of the original
HIGH100 stair climbing data (dotted lines) and
the results predicted by the FE-model (solid lines)
Discussion
This simplified approach may be an easy way
for implant designers to analyze their systems
in a variety of loading scenarios once the
corresponding load equations are determined or
published. The robustness of this technique allows
a fast estimation of implant performance under
scalable dynamic loading and different alignment
situations.
References
Bergmann G, Bender A, Graichen F, et al. Standardized Loads Acting in Knee Implants. Williams
BO, ed. PLoS ONE 2014;9(1):e86035. doi:10.1371/
journal.pone.0086035.
Figure 1: C
oordinate system alignment and boundary
conditions of the FE-model at initial state
94
O 072
BIOMECHANICAL ANALYSIS OF
J-CURVE VS SINGLE-RADIUS FEMORAL
DESIGNS DURING DAILY ACTIVITIES:
A NUMERICAL STUDY.
B. Innocenti1, H. Robledo Yage1, R. Alario Bernab1, W. Pascale2, S. Pianigiani2
1
2
Introduction
The lack of awareness of the exact number of
instantaneous centers of knee flexion/extension
rotation leads to the presence in the market
of Total Knee Arthroplasty (TKA) with different
femoral components designs. Following condylar
anatomy, J-curve (JC) was introduced [1] aiming
to replicate the physiological shape of the
femoral bone; however this design could lead
to potential issues on the extensor mechanism
and on the collateral ligaments. Therefore, to
provide a constant lever arm for the patella and
isometry of the collateral ligaments, Single-Radius
(SR) designs were introduced [2]. This design is
based on the isometry of the superficial medial
collateral ligament, and that is widely accepted
as a basis of soft tissue tensioning in TKA. Although
these theoretical advantages, few difference was
founded clinically and controversial results were
identify during kinematics analysis [35]. However,
no biomechanical analysis during daily activities is
present in the literature. For these reasons, the aim
of this study is to compare the two solutions for the
same posterior stabilized (PS) TKA design under daily
activities using dynamic 3D finite element analysis.
Both contact forces and kinematic outputs have
been analyzed and compared.
Results
The results show that the two solutions did not
present significant differences for any of the
analyzed outputs for the low demanding task daily
activity (up to 60). On the other hand, significant
differences in the behavior are highlighted during
the squatting motion especially after 80 of knee
flexion. From this point, the contact areas and
forces, especially for the post-cam interaction,
change and also the kinematics is altered
presenting an anomalous drop for the SR design
both in antero-posterior translation and internalexternal rotation. Moreover, the stress on the
polyethylene insert present higher values on the
posterior part of the insert (up to 50%).
Discussion
In this study the single radius and J-curved femoral
design were investigated during walking and
squatting. For the gait cycle, in which the flexion
angle is always lower than 60, results show similar
behavior in terms of kinematics and contact
forces, with difference lower than 1%. During
squatting, after 80 of flexion, the single radius
design determines slight higher tibio-femoral forces
(with a maximum change up to 3.7%) that induced
higher polyethylene tibial stress (up to 50%). These
different outputs can be critical for a possible
prediction of medium-long term patients follow-up.
Methods
Starting from a conventional J-Curved femoral
design, the correspondent Single-Radius design
was developed. For the two analyzed solutions,
the same tibial component has been used.
According to literature, a standard gait cycle and
the flexion phase of a squatting activity up to 120
were investigated for both designs [6, 7]. The tibiofemoral contact force and kinematics have been
investigated comparing the contact area between
components, the internal-external rotation, the
position and magnitude of the contact forces and
the Von Misses stresses on the polyethylene.
RE F EREN C ES
1 Gunston, J Bone Joint Surg Br, 1971;
2 Pinskerova et al, Orthopade, 2000;
3 Hall et al, J Arthrop, 2008;
4 Tamaki et al, J Arthrop, 2013;
5 Ah-Reum et al, J Arthrop, 2014;
6 International Standards Organization. Standard
number 14243-1;
7 Victor et al, J Orthop Res, 2010.
95
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STABILITY OF TIBIAL PLATEAUS UNDER DYNAMIC

COMPRESSION-SHEAR LOADING IN HUMAN
TIBIAE INFLUENCE OF KEEL LENGTH,
CEMENTATION AND TIBIAL STEM
T. Grupp1,2, K. J. Saleh3 , M. Holderied1, A. Pfaff1, C. Schilling1, C. Schrder4 ,
W.M. Mihalko5
1
Aesculap AG Tuttlingen, Research & Development, 78532 Tuttlingen, Germany

2
Ludwig Maximilians University Campus Grosshadern, Munich, Germany,

Clinic for Orthopaedic Surgery, Mnchen, Germany
3
Southern Illinois University School of Medicine Springfield, IL, USA,

Division of Orthopaedics, Springfield, USA
Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus Grosshadern,

Munich, Germany, Orthopaedic Surgery, Mnchen, Germany
5
Institute-University of Tennessee, TN, USA, Orthopaedic Reconstructive Research,

Tennessee, USA
Introduction
To assess the primary stability of tibial plateaus in
vitro, different approaches had been undergone:
cement penetration depth analysis [1, 2], static
tension [3, 4] or compression loading [5] until
interface failure. However, these test conditions
do not reflect the in vivo physiologic loading
modes, where the tibial plateau is predominantly
subjected to combined compression and shear
forces in a cyclic profile [69].
Results
In regard to the mean failure load there was no
significant difference (p > 0,22) between all tested
groups, whereas the failure load of Tibia&Stem
was highest and Tibia28 was lowest by trend
(Fig.2). A significant correlation between bone
mineral density and final failure load was solely
found for Tibia28 (p = 0.01).
The objective of the study was to evaluate the

impact of the tibial keel lenght, of a cemented
keel and of an additional stem on the primary
stability of a posterior stabilised tibial plateau under
dynamic compression-shear loading conditions in
human tibiae.
Methods
24 fresh-frozen human tibiae were divided into
four groups Tibia28, Tibia40, Tibia&Stem and
Tibia cemented keel based on the bone mineral
density of the tibial head. The implantations
were performed by experienced knee surgeons
(KJS,WMM) and after dissection the tibiae were
oriented on the test machine in a flexed position
to simulate peak joint loading during stair climbing
and loaded with a tibio-femoral load of 1800 N for
1000 cycles followed by a stepwise increase (steps
+300 N, 1000 cycles) until failure or termination
of the test at a demanding load level of 6000 N.
The motion of the implant relative to the tibia was
analysed by a 3D camera system (Pontos, GOM).
The cement layer and penetration into the bone
was assessed by CT-based segmentation (Fig. 1).
Figure 2: F ailure load of the test groups
Discussion
A method for evaluation of the implant-bone
interface stability of tibial plateaus in regards to
design parameters and cement fixation areas
was configured. The procedure enables to assess
surgical treatment options influencing the fixation
of implants in human donor tibiae.
References
1 Maistrelli,CORR312:2615,1995
2 Vanlommel,JOA 26:4926,2011
3 Schlegel,IntOrthop35:11659,2011
4 GebertdeUhlenbrock,ClinBiomech27:92935,2012
5 Clarius,Knee17:5760,2010
6 Kutzner,JBiomechanics43:216473,2010
7 Bergmann,PloSOne9:e86035,2014
8 Zhao,JOrthRes25:593602,2007
9 Grupp,ClinBiomech28:100613,2013
see the next page
96
Figure 1: E
xample of CT data analysis of bone cement layers superposition of two cement layers: Tibia&Stem (grey) and
Tibia cemented keel (blue).
97
O 0 74
ASSESSING THE PRIMARY STABILITY OF UNCEMENTED

FEMORAL KNEE IMPLANT USING DIGITAL IMAGE
CORRELATION
S. Berahmani1, D. Janssen1, W. David2, M. de Waal Malefijt3 , N. Verdonschot1,4
1
Radboud university medical center, Orthopaedic Research Laboratory,

Nijmegen, Netherlands
2
DePuy Synthes Joint Reconstruction, Leeds, United Kingdom
Radboud university medical center, Department of Orthopaedics, Nijmegen, Netherlands

4
University of Twente, Laboratory for Biomechanical Engineering, Enschede, Netherlands
Introduction
The primary stability of uncemented implants can
be evaluated in experimental set-ups by monitoring
bone-implant micromotions. Digital image correlation
(DIC) is a relatively novel tool, which previously has
been applied mainly to explore full-field displacements
and strain fields, but is also very useful to calculate the

relative displacements between bone and implant.
In the current study, we aimed to assess the primary
stability of an uncemented femoral knee implant
using DIC, under two different loading configurations.
Figure 1: A
) Gait set-up. ROIs at the posterior condyles are indicated. B) Speckle pattern and displacement distribution.

Six femora were prepared following the normal
surgical procedure. Calibrated CT-scans of
the bones were obtained to measure bone
mineral density (BMD). After implantation of the
appropriate size uncemented LCS femoral knee
component (DePuy Synthes, IN, USA), a blackand-white speckle pattern was applied to each
specimen (Fig.1). The micromotion measurement
was repeated three times in nine regions of interest
(ROIs): the medial and lateral condyles from the
posterior view; anterior, distal, and posterior regions
from the medial and lateral views; the proximal tip
of the anterior flange. The reconstructions were
subjected to a gait load (2223N, 16 of flexion,
3565% lateral-medial ratio, Fig.1A) and a fraction
of the peak force of a deep knee bend (DKB) to
prevent fracture of the proximal femur (either 40%
or 50% of 2156 N based on the implant size, 90
of flexion, 4555% lateral-medial ratio). The loads
were derived from the Orthoload database using
implant-specific inverse dynamics [Fitzpatrick et al.,

2012]. To compare micromotions under gait and
DKB loads, the micromotions under gait load were
determined under load levels that were equally
reduced to the DKB load fraction by capturing
videos from three ROIs.
Results
A wide range of micromotions was found
(2442 m) due to the variation in the BMD
[89200 mg/cm 3] and differences between ROIs.
A non-linear correlation was found between the
load and micromotion for the gait load, while a
linear relationship was found for the DKB load
(Fig.2A). Significantly higher micromotions on
either the medial or lateral sides were found for the
gait and DKB loading configurations, respectively
(Fig.2B). Only in the lateral side significantly higher
micromotions were found under DKB load in
comparison with the gait load.
see the next page
98
important to measure micromotions in multiple ROIs.

Depending on the loading configuration different
correlations between load and micromotion were
found, possibly due to the lower level of the DKB
load. We have also found that the higher medial
load during gait resulted in a higher range of
medial micromotions, while this was not the case
for the DKB load, which indicates the differences
as a result of loading configuration. In addition,
the significant effect of BMD on the micromotion
indicates the role of patient bone quality on the
implant primary stability. The regional micromotion
results as measured can serve as validation data for
micromotion simulations based on finite element
analysis.
Figure 2: A) The correlation between micro-motion and load

for one bone (anterior and medial-posterior views)
B) Regional micro-motions for the two loading
conditions.
Discussion
Preclinical assessment of the primary stability
of orthopaedic implants is essential. This study
has shown that DIC is a suitable technique to
investigate the stability. We have found that to
capture the complex behaviour of the implant, it is
This research was sponsored by DePuy Synthes Joint

Reconstruction, Leeds, UK.
References
Fitzpatrick et al, Comput Methods Biomech Biomed
Engin, p. 360, 2012.
99
O 075
THE INFLUENCE OF TOTAL KNEE ARTHROPLASTY

ON PRESSURE OF THE PATELLOFEMORAL JOINT
T. Hidenori1, T. Mitsunori2, O. Ryo1, H. Kengo3 , N. Yasuo3 , O. Kazunari1, N. Takeo4
1
Saitama City Hospital, Department of Orthopaedic Surgery, Saitama, Japan

2
3
4
National Institute of Advanced Industrial Science and Technology,

Digital Human Research Centre, Tokyo, Japan
Keio University School of Medicine, Department of Orthopaedic Surgery, Tokyo, Japan
Keio University School of Medicine, Department of Clinical Biomechanics, Tokyo, Japan
Introduction
Anterior knee pain is still an important complication
after total knee arthrplasty (TKA). It is assumed that
excessive postoperative retropatellar pressure
contributes to a great extent to postoperative
patella problems [Kulkarni SK, 2000]. It may be
possible to reduce the complication rate by
selecting TKA components that minimize patellar
load [Kainz H, 2012], however the retropatellar
pressure change in various TKA components
remains unclear. The aim of our study was to
evaluate the retropatellar pressure in the native
knee and with different types of TKA components.
Methods
Five fresh frozen knees were obtained from human
cadavers (age range between 82 and 94 years,
three females, two males). The experiment was
performed along with the guideline for clinical
education and research at Clinical Anatomy
Laboratory of our university. A customized patellar
component was made with a force sensor
(FlexiForce, Tekscan Inc., MA, USA). A standard
TKA surgery was performed using the Triathlon TKA
system (Stryker, MI, USA). After the patella was
resurfaced by the customized patellar component,
the knees were examined in the following order:
the native state, cruciate retaining type TKA
(CR-TKA), cruciate substitutin type TKA (CS-TKA),
and posterior stabilized type TKA (PS-TKA). An
optical three-demensional motion analysis system
(OptiTrack, NaturalPoint, OR, USA) was used to
measure the knee joint angle. Both kimematic data
and pressure data were corrected synchronously
in 120 Hz frequency. The retropatellar pressure
was calculated at knee flexion angles of every
10 degrees between 20 to 120 degrees. Statistical
comparisons were performed with SPSS Statistics
using one-way repeated measures ANOVA with
Bonferroni adjustment.
Figure 1: M
ean retropatellar pressure under the various
tested configurations.* indicates significant
differences compared to the native knee (P < 0.05).
Discussion
The results of this study showed that the retropatellar
pressure increases after TKA and the type of TKA
components affects the retropatellar pressure.
The increasing retropatellar pressure in the TKA
knees, which reaches double the pressure of the
native knee at maximum knee flexion, is supported
by a previous study [Steinbruck A, 2013]. This
increasing retropatellar pressure might lead to the
anterior knee pain in vivo [Fuchs S, 2005]. Although
significant difference was not observed in this
study, possibly due to small sample size, our study
suggests that evaluating the retropatellar pressure
in different types of components might be useful to
estimate patellofemoral complications after TKA.
References
Fuchs S et al, Knee, 12:912, 2005.
Kulkarni SK et al, J Arthroplasty, 15:424429, 2000.
Kainz H et al, Int Orthop, 36:7378, 2012.
Steinbruck A et al, BioMed Eng Online, 12:58, 2013.
Results
The retropatellar pressure increased as the
knee flexion angle increased from 20 degrees to
120 degrees (Fig.1). The retropatellar pressure of
the native knee was significantly smaller than the
retropatellar pressures of CR-TKA and CS-TKA at
knee flexion angle of 110 and 120 degrees. The
CS-TKA exhibited greater retropatellar pressure
compared with CR-TKA and PS-TKA however
significant difference was not observed.
100
O 0 76
MICRO-CT BASED FINITE ELEMENT MODELS PREDICT

ACCURATE DISPLACEMENT FIELD MEASURED WITH
DEFORMABLE IMAGE REGISTRATION
Y. Chen1, E. DallAra2, K. Manda3 , E. Sales3 , R. Wallace4 , P. Pankaj3 , M. Viceconti1
1
INSIGNEO Institute for in silico Medicine, Department of Mechanical Engineering,

University of Sheffield, Sheffield, United Kingdom
2
INSIGNEO Institute for in silico Medicine, Department of Human Metabolism,

University of Sheffield, Sheffield, United Kingdom
3
Institute for Bioengineering, School of Engineering, University of Edinburgh,

Edinburgh, United Kingdom
Institute for Bioengineering, Department of Orthopaedics, University of Edinburgh,

Introduction
Non-destructive 3D micro-computed tomography
(CT)-based finite element model (microFE)
has become a popular tool for studying bone
mechanical properties at tissue level [Donaldson et
al. 2011]. However, while we can easily validate its
predictions of apparent properties (e.g. stiffness),
nobody has reported so far a proper validation of its
local response (e.g. displacement field). The goal
of this study was to use a digital volume correlation
(DVC) approach [DallAra et al. 2014] to validate
the local microFE displacement predictions for
human trabecular bone.
Max.err=0.0338mm,
Max.err%=15.75v%;
Z
direction:
y=0.9928x0.0083,
R2=0.999,
RMSE=0.0108mm, RMSE%=2.45%, Max.err=0.0214mm,
Max.err%=4.86%; magnitude: y=1.0035x-0.0131,
R 2=0.998, RMSE=0.0122mm, RMSE%=2.45%,
Max.err=0.0294mm, Max.err%=5.89%).
Methods
A cylindrical trabecular bone sample (height
11.5 mm, diameter 10.6 mm) was cut from human
femoral head and scanned using CT (Skyscan
1172) at the voxel size of 17.22 m. The sample
was compressed up to 1% global strain and rescanned. Following the procedure described in
[DallAra et al. 2014], a deformable registration
algorithm was applied to the undeformed and
deformed subsampled images (Nodal Spacing
12, equivalent to ~413 m) in order to measure
the local displacement map. The reconstructed
image dataset was subsampled to the voxel size of
34.44m and the solid phase was converted directly
into homogeneous microFE model using eight-node
hexahedral elements. The material properties of the
bone tissue were assumed to be isotropic and linear
elastic, with a uniform Youngs modulus of 17GPa
and a Poissons ratio of 0.3. The microFE boundary
conditions (top and bottom plane) were assigned
based on the experimental displacement values
using element shape functions. Local displacements
(along X, Y, Z and their magnitude) of microFE model
were calculated at the same spatial locations of
the experiment. Comparisons were made only in
the nodes of the experimental grid that lay on the
bone elements of the model.
Figure 1: C
omparison between experimental and predicted
displacement magnitude
C o n cl u s i o n
There is a significant correlation between the
numerical predictions and the experiments.
It is concluded that, for the case considered,
homogeneous microFE model can predict
accurately the displacement field. Further analysis
will be performed on more samples and using
heterogeneous and nonlinear microFE models.
References
DallAra,E et al, J.Biomech., 47(12),
pp. 29562963,2014.
Donaldson FE et al, Proc IMechE, J Eng Med,
225(6), pp586596, 2011.
This study was partially supported by the FP7 European program MAMBO: PIEF-GA-2012-327357, the NC3R
funded project No. 113629 and the EPSRC funded
project MultiSim EP/K03877X/1; and by the EPSRC
funded project EP/K036939/1.

Results show significant correlation between
the numerical prediction and the experiments
(X direction: y=1.0383x0.0072, R 2=0.911,
RMSE=0.0055mm, RMSE%=3.96%, Max.err=0.0345mm,
Max.err%=24.8%; Y direction: y=1.0299x0.0096,
R 2=0.983, RMSE=0.0059mm, RMSE%=2.75%,
101
O 077
LINKING PROXIMAL TIBIA BONE MICROARCHITECTURE

TO IN VIVO DYNAMIC JOINT LOADS IN END-STAGE
OSTEOARTHRITIS: PRELIMINARY RESULTS
E. Perilli1, B.C. Roberts1, D. Thewlis2, L.B. Solomon3 , G. Mercer4 , K.J. Reynolds1
1
Flinders University, Medical Device Research Institute, School of Computer Science,

Engineering and Mathematics, Adelaide, South Australia, Australia
University of South Australia, School of Health Sciences, Adelaide, South Australia, Australia
3
Royal Adelaide Hospital, Department of Orthopaedics and Trauma, Adelaide,

South Australia, Australia
Repatriation General Hospital, Department of Orthopaedic Surgery, Adelaide,

South Australia, Australia
Introduction
In human knee osteoarthritis (OA), local changes in
areal bone mineral density in the tibia, as measured
by dual X-ray absorptiometry, are suggested to be
related to abnormal in vivo joint loading [Thorp,
2006]. The relationship between in vivo measures
of knee joint loading and changes in subchondral
bone 3D microarchitecture, however, has not yet
been explored. The subchondral bone, a shock
absorber, protects the overlying cartilage against
damage due to excessive joint loading.
Results
Statistically significant differences (p<0.05) in
subchondral bone microarchitecture were found
among subregions. The AM ROI exhibited highest
BV/TV (+45% to +82%), trabecular number
(+40% to +49%), and lowest SMI (61% to 68%)
compared to the AL, PM and PL regions. BV/TV
in the AM region was negatively correlated with
the peak ERM (r= 0.72, p<0.05) (Fig. 1a) and peak
IRM (r= 0.68, p<0.05), and positively correlated
with the peak JCF (r=0.70, p<0.05) and KAM
impulse (r=0.76, p<0.05) (Fig. 1b). A positive
trend was observed for BV/TV AM vs. peak KAM
(r=0.55, p=0.124).
The aim of this ongoing study is to examine, on

end-stage OA patients undergoing total knee
replacement (TKR), the relationships between
knee joint loads measured in vivo using gait
analysis prior to surgery, and variations in bone
microarchitecture of their excised knees quantified
with 3D micro-computed tomography (micro-CT).
Methods
Nine knee-OA patients scheduled for TKR surgery
(age 676 years) underwent pre-operative gait
analysis. The kinetic variables, collected with
12 Vicon cameras and four force platforms, and
analysed with Visual3D v5.0, included the peak
external moments at the knee: external (ERM) and
internal rotation moments (IRM), knee adduction
moment (KAM) and knee adduction moment
impulse, all normalized by bodyweight (BW). The
peak tibio-femoral joint contact force (JCF) was
calculated with a musculoskeletal model in Matlab
[Delp, 1990].
Figure 1: ( a) scatter plot with best fit line of BV/TV AM vs.

peak ERMand (b) of BV/TV AM vs. KAM impulse.
Discussion
Our results suggest that, during stance, lower peak
ERM and IRM and higher JCF and KAM impulse are
significantly associated with higher BV/TV in the
AM tibial plateau. These associations with bone
volume fraction found in the AM tibial region could
be linked to an adaptation of the bone due to
altered loading patterns that generate increased
stresses in this condyle [Adouni, 2014]. Further
analysis is required to elucidate these relationships.
Patient recruitment is ongoing.
After surgery, the tibial plateaus were retrieved

and scanned with micro-CT (17 m pixel size). The
following subchondral bone 3D microarchitectural
parameters were analysed in four cylindrical
subregions of interest (ROIs, 10 mm diameter, 4 mm
length), selected via software in the antero-medial
(AM), antero-lateral (AL), postero-medial (PM) and
postero-lateral (PL) condyle: bone volume fraction
(BV/TV), trabecular thickness, trabecular number,
structure model index (SMI).
References
Adouni, M, et al, J Orthop Res, 32:6978, 2014.
Delp, SL, et al, IEEE Trans Biomed Eng,
37:757767, 1990.
Thorp, LE, et al, Bone, 39:11161122, 2006.
Subregional differences in bone microarchitectural

parameters were tested by Kruskal Wallis followed
by Mann-Whitney U tests. Associations between
measurements from gait analysis and bone microarchitecture were investigated using Pearsons
correlations.
102
O 078
CONTRIBUTION OF THE POROELASTIC BEHAVIOUR

OF BONE ULTRASTRUCTURE TO THE STRAIN RATE
DEPENDENT BEHAVIOUR OF BONE TISSUE
S. Le Pense1, E. Sales2, K. Manda2, R. Wallace3 , P. Pankaj2, Y. Chen1
1
Heriot-Watt University, School of Engineering and Physical Sciences,

The University of Edinburgh, Institute for Bioengineering, School of Engineering,

The University of Edinburgh, Department of Orthopaedic Surgery, Edinburgh, United Kingdom
Introduction
Current research to improve osteoporotic fractures
predictions mainly focuses on the influence
of microstructure on bone tissue mechanical
properties. However, although fracture often
happens during a fall, loading rate dependency
is rarely taken into account. It has been shown
that bone stiffness and strength increase for higher
strain rates [Carter, 1977].
The study of bone at the microscale shows that
bone ultrastructure, making up cancellous bone
trabeculae as well as cortical bone, is a porous
material, where porosity is made from the lacunar-canalicular network. A poroelastic approach can
be used to model this material [Cowin, 1999].
A few recent studies have used poroelasticity
for bone modelling [Sandino, 2015]. However,
the poroelastic properties found in the literature
showed a great variability, and the poroelastic
behaviour is expected to be sensitive to in situ
loading and boundary conditions.
Figure 1: E
volution of the stress normalized by the stress
at low strain rate, as a function of strain rate,
for a confined compression test.
Results
Results are also shown to be sensitive to poroelastic
properties such as permeability and elasticity
parameters, for which accurate measurements
are challenging at this scale and considerable
variation can still be found from the literature. It is
also shown that poroelastic behaviour is strongly
affected, as expected, by bone microstructure.
The aim of this work is therefore to explore the

contribution of poroelasticity to the strain-rate
dependent behaviour of bone, while taking
into account the effect of material properties,
boundary conditions and microstructure.
Methods
In this study, we use bone tissue 3D images obtained
with X-ray microtomography, and assume the
solid part of this foam-like structure to be a porous
material filled with fluid. Bone microstructure is
segmented and meshed in ScanIP (Simpleware
Ltd, UK), and a poroelastic model, together with
a coupled pore fluid diffusion and stress analysis, is
used in Abaqus (Dassault Systmes, France).
Discussion
Results are very sensitive to boundary conditions,
which highlights the importance of carefully-chosen experimental settings used to study bone
mechanical properties. These should be as close
as possible to in vivo conditions, which are not yet
very well understood.
Several sets of parameters are applied, in order

to span the large range of values measured in
previous studies. Different fluid and solid boundary
conditions are utilised. The effect of bone
microstructure on poroelastic effects is also studied.
References
Carter and Hayes, J Bone Joint Surg,
59:954962, 1977.
Cowin, J Biomech, 32:217238, 1999.
Sandino et al, J Mech Behav Biomed, 44:19, 2015.
103
O 079
MASSIVE PARALLEL SIMULATIONS OF TRABECULAR BONE

F. Levrero Florencio1, L. Margetts2,3 , K. Manda1, P. Pankaj1
1
2
The University of Edinburgh, Institute for Bioengineering, Edinburgh, United Kingdom
University of Manchester, School of Earth Atmospheric and Environmental Sciences,

Manchester, United Kingdom
3
University of Oxford, Oxford e-Science Research Centre, Oxford, United Kingdom
Introduction
Bone is a hierarchical material, with complex
properties at each of its different working scales
[Schwiedrzik, 2013]. Within the bone microstructure,
the solid phase is generally assumed to be isotropic
elastoplastic [Niebur, 2000] while bone at the macroscale exhibits anisotropic elastoplasticity due to its
micro-architecture. Micro-FE (FE) simulations of
bone have been extensively used in the past to
evaluate its elastic properties [Donaldson, 2011]. In
these, the FE meshes are constructed from CT
images. Post-elastic behaviour is rarely simulated at
this scale. A non-linear problem with large RVE sizes
and high resolution meshes makes the simulations
computationally prohibitive even on large parallel
systems as iterations are required within each load
increment for implicit problems, and the meshes
may have more than tens of millions of degrees
of freedom (DOF). On parallel computing systems,
the time taken for solutions would ideally scale with
the number of cores used. In the context of FE, this
has been achieved with elastic problems but not
with those involving elastoplasticity. The aim of the
study was to develop an implicit FE solver within the
framework of the existing parallel solver ParaFEM
[Smith, 2014] to operate on parallel computing
systems and which is scalable with a large number
of cores for finite strain elastoplastic problems.
plasticity. Trilinear fully integrated hexahedra were

used. The scalability was tested using different
number of cores on an IBM BlueGene/Q.
Results
The time required to solve the two meshes with
different number of cores is given in Table 1.
DOF
Number
of cores
Time (s)
1,000,000
64
7,884
1,000,000
512
1,178
1,000,000
2,048
544
10,000,000
4,096
2,100
Table 1: R
unning times for the test problems
Discussion
The simulation was performed using implicit FE,
in 100 load increments. Geometrical nonlinearity
initiates with loading and localised yielding started
very early in the loading process, requiring several
Newton-Raphson iterations for some load steps.
Running times show that the driver program is able
to scale with large number of cores when dealing
with these nonlinear problems. With this code,
massive non-linear simulations can be performed
within a reasonable time and new constitutive
laws can be introduced in a very simple manner.
Our ongoing work involves incorporation of other
realistic and complex nonlinear constitutive models
to simulate the post-elastic micromechanical
behaviour of bone.
The authors would like to thank The Hartree Centre,
Science and Technology Facilities Council for access
to their IBM BlueGene/Q system through project
HCP010.
Ec t r o m y o g r K i n e s i o l , 2 1 : 1 0 7 4 8 0 , 2 0 1 1 .
Figure 1: 1
0 million trabecular bone FE mesh
Vieira et al, J es
Schwiedrzik J.J. et al, Biomech Model Mechanobiol,
12: 11551168, 2013.
Niebur G.L. et al, J Biomech, 33: 15751583, 2000.
Eterovic, A.L. et al, Int J Numer Meth Engng,
30: 10991114, 1990.
Smith I.M., et al, Programming the Finite Element
Method, Wiley, 2014.
Donaldson F.E. et al, Proc Inst Mech Eng H J Eng
Med, 225: 585596, 2011.
Methods
A return-mapping format based on logarithmic
strains is used [Eterovic, 1990]. It permits use of
material subroutines that are very similar to ABAQUS
(Simulia, Providence USA) user material subroutines
(UMAT). Two test problems were created from
CT scanned ovine trabecular bone samples
comprising of 1 million and 10 million DOF.
The simulations consisted in a 2% apparent
compression with kinematic boundary conditions,
using 100 load steps. The constitutive law is elastic
(linear relationship between the Kirchhoff stress
and the logarithmic strain) followed by von Mises
104
O 080
MICROMECHANICAL THREE-POINT-BENDING TEST

OF LAMELLAE IN CORTICAL BONE
V. Nedelkovski1, O.G. Andriotis1, P.J. Thurner1
1

Vienna, Austria
Introduction
Bone achieves its unique mechanical properties
due to a complex hierarchical architecture. To
understand bone mechanics, investigation of
deformation mechanisms at different length-scales
is required. At the macroscale, biomechanical
testing of bone has been performed for more than a
century, whereas investigating the microstructural
features, such as individual lamellae, remains
a challenge. Here we propose a method for
micromechanical testing of lamellar bone in the
form of a microbeam bending test.
Results
A beam with a total length of 80 m and a length
of 60.3 m between the supports, 11.9 m in width,
5.7 m in height was machined via FIB milling. SEM
images (Fig.1A) revealed an intact three-pointbending microstructure at the lamellar length scale.
Indentation modulus in transverse direction on the
supports was found to be 20.4 GPa (spherical tip)
and 26.8 GPa (Berkovich tip). Further the bending
modulus (elastic constant in the longitudinal
orientation of the beam/lamellae), was found to
be 20.67 GPa and the yield stress was found to be
0.36 GPa.
Methods
Transverse slices were initially cut from the distal
bovine femur with a diamond-coated band saw
(Exakt-300CP) and radial specimens were cut in
the anterior/posterior direction using a low-speed
saw (Buehler Isomet). To produce two smooth
and perpendicular surfaces with a sharp edge,
the superior cut was polished with a diamond
suspension and the anterior surface was ultramilled
with a diamond ultramiller (Leica-SP2600).
Subsequently, a 2 mm thick sample was prepared
with the low-speed saw. Finally, the sample was
mounted on a stage of a dual beam microscope
(FEI Quanta-200-3D-DBFIB) incorporating both
scanning electron microscopy (SEM) and focused
ion beam (FIB). FIB milling operated at 30 kV was
performed from two different sides of one of the
straight edges of the sample in several steps from
coarse to fine milling with ion beam currents ranging
20 nA to 1 nA, respectively. This way a three-pointbending geometry was produced consisting of 23
lamellae with the long axis of the beam parallel to
the long axis of the lamellae. Mechanical testing
was performed in air with a Nanoindenter (Hysitron
Triboindenter-TI900) using a diamond spherical
cone tip of 5 m tip radius and 65 cone angle to
minimize indentation depth. In addition to bending
of the beam, indentation measurements were
performed on both supports of the beam as well as
the surrounding bulk in the vicinity of the beam with
the same tip and with a conventional Berkovich
tip. Assuming that the bending measurement
consists of a pure bending and indentation part,
the displacement of the nanoindentation curve
was subtracted from the bending curve to obtain
a pure bending force vs. deflection curve (Fig. 1C).
A theoretical model of a beam clamped at both
ends was used to analyse the data. A straight line
was fitted to the linear portion shown in Figure 1C
to obtain a flexural stiffness value. Yield stress in
the longitudinal direction was computed at the
qualitatively estimated yield point of the bending
curve (data not shown). Nanoindentation data was
analysed according to the Oliver-Pharr Method.
Figure 1. ( A) SEM-image of cortical bone microbeam

after FIB-milling. (B) Schematic representation of
bending with spherical tip. (C) Force-displacement
curve from microbeam bending experiment
see the next page
105
Discussion
Values of the indentation modulus in transverse
direction, as well as of the bending modulus
and yield stress in longitudinal direction were
comparable to a recent study employing
micropillar compression [1]. Consequently, threepoint-bending testing at the microscopic level
of bone may provide similar, while offering fewer
experimental challenges. We envision that FIB
milling will further enable preparation of samples
for the direct mechanical characterisation of

individual lamellae, interlamellar areas and
cement lines in various loading modes. We expect
this to enhance our understanding of the origin of
bone quality at the nano- and microscale.
References
1 Schwiedrzik et al., 13, NatMater 2014
106
O 0 81
MUSCLE FORCES INFLUENCE THE TOPOLOGY

AND MAGNITUDE OF CONTACT JOINT FORCES
IN THE NATIVE AND PROSTHETIC ANKLCE
T. Natsakis1, J. Burg2, G. Dereymaeker1, J. Vander Sloten1, I. Jonkers2
1
KU Leuven, Mechanical engineering, Heverlee, Belgium

2
KU Leuven, Kinesiology deparment, Heverlee, Belgium
Introduction
Osteoarthritis (OA) is a common degenerative joint
disease in the ankle, with high economical and
societal impact. It is mainly of post-traumatic nature
[Valderrabano et al., 2009] and several reports link
it with aberrant loading. The loading conditions in
the joint are mainly affected by the gait kinematics
and kinetics; however, considerable loading is also
due to muscle forces. In this study, we investigated
the influence of individual muscle forces on the
load magnitude and distribution in the human
ankle. The investigation was performed before and
after performing a Total Ankle Arthroplasty (TAA).
Figure 1: C
hanges on the peak pressure with increasing
muscle force from the Peronei, Tibialis Anterior,
Tibialis Posterior and Triceps surae muscle groups
for the native (red) and TAA (blue) joint.
Methods
10 cadaveric foot specimens, amputated midtibially, were used to perform muscle perturbations
before and after the insertion of a Hintegra three
component TAA. The force delivered to the
tendons of six muscle groups was controlled by a
custom built cadaveric gait simulator [Peeters et
al., 2013]. Prior to the measurements, a calibrated
Tekscan #5033 pressure sensor was inserted in the
ankle joint and was fixated to the distal end of
the tibia. The magnitude of the peak pressure and
centre of pressure (CoP) location was quantified
at three static positions during the perturbations.
The three positions were representative of the
beginning, middle and end of stance phase.
To quantify the influence of muscle force on the
measured parameters, linear mixed effect models
were calculated for each position and muscle for
the two measured parameters.
Figure 2: C
hanges on the location of CoP with increasing
muscle force from the Peronei, Tibialis Anterior,
Tibialis Posterior and Triceps surae muscle groups
for the native (red) and TAA (blue) joint.
C o n cl u s i o n
We are able to quantify the influence of muscle
force on the loading conditions in the native and
TAA ankle joint. This information is useful when
designing muscle training strategies targeted at
relieving the articular surface areas that have
higher risk of OA. This is highly relevant as it has
been reported that the anterior and medial
regions of the talus have higher incidence of OA
[Koepp et al., 1999]. Furthermore, such information
is useful when designing TAA components, as the
compensations in muscle forces seen in patients
after surgery could affect the stability and wear of
the prosthetic components.
Results
For the native ankle joint in the beginning of stance,
a 100% increased force from triceps surae and
tibialis posterior muscles results in an increased peak
pressure in the joint by 17% and 18% respectively.
A decrease of 18% on peak pressure was measured
with increase of tibialis posterior. Similar influence
was measured for the TAA joint. Furthermore, the
location of the CoP was influenced with increase of
peroneal, tibialis posterior and triceps surae muscles,
shifting it towards the lateral and posterior direction.
References
Koepp et al., J Orthop Sci, 4:40712,1999
Peeters et al., P I Mech Eng H, 227:95567, 2013
Valderrabano et al., Clin Orthop Relat Res,
467:18006, 2009.
107
O 082
CONTACT PATTERNS IN THE TRAPEZIOMETACARPAL

JOINT DURING ISOMETRIC TASKS OBTAINED VIA
MATHEMATICAL MODELING
B. Dourthe1, P. DAgostino1, F. Stockmans2, E. Vereecke1
1
KU Leuven Kulak, Development and Regeneration, Kortrijk, Belgium

2
AZ Groeninge, Campus Loofstraat, Kortrijk, Belgium
Introduction
A clinically relevant way to investigate the
biomechanical behavior of the trapeziometacarpal
(TMC) joint is to evaluate its contact patterns
during isometric tasks. This will help us to obtain a
better understanding of the onset of osteoarthritis
(OA) and will eventually improve prevention and
treatment strategies of this highly disabling disease.
Methods
CT scans of the hand region of 20 female
volunteers (mean age: 60.8 years) were taken in
three different configurations: relaxed neutral,
lateral pinch and power grasp, using a radiolucent
jig with embedded load cell (Brown University,
USA). Four subjects showing radiological signs of
OA were excluded from the study. Scans were
segmented using Mimics (Materialise, Belgium)
and 3D models of the first metacarpal (MC1) and
the trapezium were created. The articular area
of each bone was quantified based on manual
measurements performed on the 3D bone models.
A custom-written Matlab code based on the
finite deformation biphasic theory 1 and cartilage
deformation properties 1, 2 was developed to
evaluate the contact area and stress distribution
of each bone. A quadrant division method 3 was
used to identify articular sub-regions subjected to
the highest stress.
Figure: Contact stress pattern of one subject during power

grasp: a) MC1; b) Trapezium (right hand)
Discussion
The findings suggest that a power grasp task
elicits higher contact stresses and might therefore
represent a more critical configuration for clinical
evaluation of the TMC joint. Lateral key pinch, on
the other hand, might create a higher joint instability
and is less reproducible. The mathematical model
presented in this paper offers the possibility to
predict contact patterns within the TMC joint
based on in vivo CT scans. Such a model can
provide relevant results which can help to achieve
a better understanding of joint functioning, and
is also particularly important in establishing new
prevention approaches.
Results
Measurements of the total articular area of the
MC1 and the trapezium presented no significant
difference (p > 0.1). A slightly smaller contact area
was calculated for the trapezium compared to the
MC1, however, this was only statistically significant
in the lateral pinch position (p < 0.05). Similar
amounts of stress were reported in the neutral and
lateral pinch configurations, while the power grasp
configuration displayed the highest stress levels.
Very consistent results for high stress location on
the volar/radial articular sub-region were found in
the neutral and power grasp configuration. More
variation was reported during lateral pinch.
References
[1] Kwan et al., J. Biomech, 23: 145155, 1990;
[2] Koff et al., J Hand Surg, 28A: 597604, 2003;
[3] Momose et al., J. Hand Surg, 24A: 491495, 1999
108
O 083
EXPLORING THE BIOMECHANICS OF FETAL MOVEMENT

S. Verbruggen1, J. Loo1, A. Phillips2, N. Nowlan1
1
2
Imperial College London, Civil and Environmental Engineering, London, United Kingdom
Introduction
Kicking and movement in the womb are a
natural part of fetal development. Recent studies
have shown that mechanical forces generated
by fetal movement are important for prenatal
musculoskeletal development [Nowlan, 2010],
particularly joint shape [Kahn, 2009]. Significantly,
abnormal joint shape leads to increased risk of
osteoarthritis in later life [Muller, 1953]. A relatively
common example of abnormal joint shape is
developmental dysplasia of the hip (DDH) [Leck,
2000]. Risk factors for DDH include fetal breech
position [Muller, 1953], low amniotic fluid volume
(oligohydramnios) [Hinderaker, 1994], and neuro
muscular disorders [Homer, 2000]. In each of these
cases, the movement of the fetus is restricted.
However, the biomechanics of fetal movements
remain poorly understood.
Discussion
This study provides a novel insight into the
biomechanical environment of the womb, through
the use of cine-MRI data of fetal movements.
With the development of custom-designed
tracking software and computational models, we
characterised the deflection of the womb wall and
the force generated by a fetal kick. This research
represents the first quantification of forces in the
skeleton due to fetal movements, and these results
will be applied in a second set of FE models of fetal
joints to investigate the local biomechanical stimuli.
This computational pipeline will enable us to
identify environments which increase the risk of
joint malformations, helping clinicians to consider
interventions pre-natally, to perform more intensive
screening on at-risk infants after birth, or to prescribe
suitable post-natal physiotherapy. This research
may therefore inform future preventative measures
for neonatal joint conditions such as DDH, thereby
potentially reducing the risk of osteoarthritis in later life.
Therefore, the objective of this research is to

employ computational techniques to quantify
the mechanical forces due to fetal movements
on prenatal skeletal development, with particular
emphasis on the hip.
References
B
uerzle et al, Biomech Model Mechanobiol,
12:4, 2011;
D
elp et al, IEEE Trans Biomed Eng, 2007;
H
inderaker et al, Acta Orthopaedia Scandinavia,
65:3, 1994;
H
omer et al, Paediat, 105, 2000;
H
ayat et al, Am J Neuroradiol, 32:2, 2011;
K
ahn et al, Developmental Cell, 16:5, 2009;
L eck, Lancet, 355:9199, 2000;
M
uller et al, J Bone Joint Surg, 35, 1953;
N
owlan et al, Bone, 46:5, 2010
Methods
Using novel cine-MRI techniques to capture fetal
movements in utero [Hayat, 2011], we developed a
method to automatically track joint displacements
during fetal kicking. It was thus possible to elucidate
the displacement of the womb wall caused
by kicking of a 21-week old fetus (Figure 1A).
A finite element (FE) model of the uterine wall was
generated, comprising a thin fetal membrane
and a thick uterine wall with material properties
obtained from literature [Buerzle, 2012]. Using this
model, the reaction force was calculated resulting
from the movement observed in the cine-MRI
(Figure 1B).
Access to fetal cine MRI scans courtesy of Profs
Rutherford & Hajnal (Kings College London);
assistance from A. Gopalakrishnan and A. Montanino
(Imperial College London) and funding from Arthritis
Research UK are gratefully acknowledged.
The data obtained from these two steps

were applied as boundary conditions for a
musculoskeletal model of the fetal leg in OpenSim
[Delp, 2007], scaled to the dimensions of the fetus
investigated (Figure 1C). Inverse dynamics and
static optimisation were performed, predicting
the intramuscular forces required to generate
observed motion.
Results
It was found that maximum displacement of the
uterine wall due to kicking was approximately
7.37 mm. This displacement, when applied in the
FE model, resulted in a maximum reaction force
of approximately 0.17 N. These conditions resulted
in predicted forces of 4.06 N, 6.06 N and 9.66 N
generated by the rectus femoris, gluteus medius
and biceps femoris muscles, respectively.
Figure 1: ( A) Tracking of fetal joint movements, (B) FE model

of effect of displacement on womb (stress shown)
and (C) musculoskeletal model of intramuscular
force
109
O 084
MUSCULAR ACTIVITY DURING ISOMETRIC INCISAL BITING

U. Santana-Mora1, A. Martnez-nsua1, U. Santana-Penn1, A. P. del Palomar2,
J. C. Banzo2, M.J. Mora1
1
2
University of Santiago de Compostela, Stomatology, Santiago de Compostela, Spain
Universidad de Zaragoza, Biomaterials Group, Aragon Institute of Engineering Research,

Zaragoza, Spain
Introduction
This study attempted to estimate TMJ loading
during incisal loading using a custom load-cell
device and surface electromyographic (sEMG)
recordings of the main jaw closers to assess the
outcome correlation.
Results
The mean (SD) submaximal incisal load recorded
was 498 (305.78) N, and the mean at 50% of the
submaximal load was 268.93 (147.37) N. Mean
(SD) sEMG activity during submaximal clenching
was 141.23 (87.76) V, with no significant differences
between the four muscles. During submaximal
voluntary
incisal
loading,
the
normalized
mean sEMG activity was 49.99 (34.54) mV %, and
27.17 (15.29) mV % during mean (50%) effort.
Methods
Study participants were 23 healthy volunteers. The
incisal loads having submaximal and mean intensity
were recorded using a calibrated electronic load-cell; simultaneously, surface electromyography
(sEMG) of the right and left masseter and
temporalis muscles was recorded. Readings of
the resting, clenching in maximal and submaximal
intercuspal positions and mean (50%) incisal loads
were recorded. Clenching sEMG activity was used
as a reference for normalization.
Discussion
The incisal load was generated mainly by the
masseter muscles, as these showed a positive
correlation during mean but not during submaximal
effort. In the edge-to-edge jaw position,the mean
incisal load effort seems to be physiological,
but excessive TMJ loads can be expected from
chronic or excessive incisal loading. In conclusion,
incisal loads require the activity of the masseter
muscles,which show a positive correlation between
sEMG activity and effective incisal loads during
mean,but not during submaximal, effort, and the
masseter muscles are dominant over the temporalis
muscles during submaximal incisal biting.
110
O 085
INFLUENCE OF HUMAN TMJ EMINENCE INCLINATION

ON THE MASTICATORY MUSCLES FORCES:
SENSITIVITY ANALYSIS
M. Markov1, L.M. Gallo1
1
University of Zrich, Center of Dental Medicine, Zrich, Switzerland
Results
With increasing eminence inclination, the muscle
forces on the working side increased considerably
for some muscles (anterior temporalis by 60%),
decreased for others (superficial masseter by 25 %),
or stayed at a similar level (anterior mylohyoid);
the muscle forces on the balancing side mostly
increased. With increasing eminence inclination,
the reaction force in the working TMJ increased
from 100 N for 30 to nearly 160 N for 70; in the
balancing TMJ the reaction force increased for
some inclinations and decreased for others.
Introduction
Inverse dynamic modeling is a valuable method
that helps calculating the activation of complex
muscle systems starting from kinematic and
anatomical data and is useful in several fields, such
as sports training, ergonomics, and even dentistry.
A major prerequisite for the use of a mathematical
model is that it is verified and validated (Anderson
et al., 2007; Hannam, 2011; Sargent, 2011).
Furthermore, sensitivity analysis should be held to
determine the relative significance of the various
input parameters and their influence on the
output (Hannam, 2011; Weiss et al., 2005). A large
set of musculoskeletal models of different parts
of the human body exists, but only few of these
models describe the temporomandibular joint
(TMJ) (Koolstra, 2002; Peck and Hannam, 2007).
Aim of this paper was to investigate the change in
masticatory muscle forces and temporomandibular
joint reaction forces when the steepness of the
anterior fossa slope was varied.
Discussion
With the change of eminence inclination from
30 to 70 the muscle forces during unilateral
clenching changed up to 166 % and the joint
forces up to 160 %. The eminence inclination in
mathematical models should be chosen consistently
with the CT/MRI-scan data used to create the
3D model and not only from literature data.
Methods
We used the model by Mark de Zee (de Zee et
al., 2007) created in AnyBody . The model was
equipped with 24 musculotendon actuators.
Mandibular movement was governed by the
trajectory of the incisor point during chewing. The
TMJ was modeled as a planar constraint canted
5 medially and the caudal inclination relative to
the occlusal plane was varied from 10 to 70
References
Anderson et al., 2007, Comput Method Biomec 10,
171184.
de Zee et al., 2007, J Biomech 40, 11921201.
Hannam, 2011, J Oral Rehabil 38, 217234.
Koolstra, 2002, Crit Rev Oral Biol M 13, 366376.
Peck and Hannam, 2007 Arch Oral Biol 52, 300304.
Sargent, 2011 In: Proceedings of the 2011 Winter
Simulation Conference, Phoenix, AZ, USA.
Weiss et al., 2005 Med Eng Phys 27, 845861.
111
O 086
WEAR MODE OF ARTIFICIALY AGED UHMWPE KNEE

BEARINGS EVALUATED BY THE SIMULATION OF DAILY
PATIENT ACTIVITIES
J. Schwiesau1, B. Fritz1, I. Kutzner2, G. Bergmann2, T.M. Grupp1,3
1
2
3
Aesculap AG, R&D, Tuttlingen, Germany
Charit-Universittsmedizin, Julius Wolff Institut, Berlin, Germany
Ludwig-Maximilians-University, Campus Grohadern, Orthopedic Department,

Munich, Germany
Results
Introduction
Abrasive wear and delamination are the
dominating wear phenomena observed in total
knee arthroplasty (TKA). The prevalence of the wear
mechanisms depends on the applied stress level
and the material properties of the bearing. With
increasing stress and reduced material properties
due to aging, delamination occurs more frequently.
To reduce the delamination risk of Ultra High
Molecular Weight Polyethylene (UHMWPE) knee
bearings, the aging resistance of the material should
be improved. Blending UHMWPE with Vitamin E is
one way to reduce oxidation, the dominant aging
process in the reduction of material properties of
knee bearings. To evaluate the influence of Vitamin
E blending on the wear behaviour, conditions
are simulated to induce clinically observed
delamination in the reference material.
Figure 1: A
verage wear of the bearing materials during
5million test cycles
Methods
Daily patient activities [1] are applied on three
artificially aged UHMWPE knee bearings with and
without 0.1% Vitamin E. Artificial aging is applied
according to ASTM F2003-2 for two weeks on
the bearings after sterilization by irradiation with
30 2 kGy. A cruciate retaining TKA design with
a CoCr femoral counterpart was used. Medio
lateral load distribution and soft tissue restrain
was simulated. The application of high flexion
activities was increased compared to normal
patient activity (40% stairs ascending, 40% stairs
descent, 10% level walking, 8% chair raising,
2% deep squatting).[2] An estimated time of
30 years is necessary to accumulate the same
number of high flexion activities in vivo for a patient
with an average activity level. Environmental
test conditions from ISO 14243-1 are applied.
The specimens were evaluated according to
ISO14243-2 for the gravimetric wear and optically
analyzed for their wear mode.
Figure 2: R
epresentative bearing contact area with the
femoral component after 5 million test cycles, left
UHMWPE + Vitamin E right UHMWPE (scaling 1mm)
References
[1] Bergmann G, Bender A, Graichen F, Dymke J,
Rohlmann A, et al. (2014) Standardized Loads
Acting in Knee Implants. PLoS ONE 9(1): e86035.
doi:10.1371/journal.pone.0086035
[2] Schwiesau J, Fritz B, Kutzner I, Bergmann G,
Grupp TM., CR TKA UHMWPE Wear Tested after
Artificial Aging of the Vitamin E Treated Gliding
Component by Simulating Daily Patient
Activities., Biomed Res Int. 2014;2014:567374. doi:
10.1155/2014/567374. Epub 2014 Nov 20.
Discussion
With the applied test protocol it is possible to
discriminate between the two bearing materials.
Delamination was not observed for the Vitamin E
blended material (Figure 2). Delamination began
after 2.0 million test cycles for the conventional
UHMWPE, indicated by the transition between
linear and exponential slope in Figure 1.
112
O 087
EFFECT OF SETUP AND INPUT CONDITIONS OF THE WEAR

OF A TOTAL KNEE REPLACEMENT: AN EXPERIMENTAL
AND COMPUTATIONAL STUDY
A. Abdelgaied1, C. Brockett1, T. Haythornthwaite1, C. Hardaker2,
J. Fisher1, L. Jennings1
1
University of Leeds, School of Mechanical Engineering, Leeds, United Kingdom

2
DePuy Synthes, Leeds, UK, DePuy Synthes, Leeds, United Kingdom
Introduction
Advancements in knee replacements design,
material and sterilisation properties have shown
improved clinical results. Further developments
are however on-going to address the needs of
the more demanding patient. The present study
investigated the effect of kinematics and femoral
centre of rotation setup on the wear performance
of a fixed bearing total knee replacement through
experimental and computational studies.
design, or according to the ISO specification

(ISO14243-3). Several test conditions were explored
through the study (Table 1). For the ISO setup, the
direction of the anterior-posterior displacement
was reversed with anterior translation of the
femoral component, preventing femoral roll back
and keeping the contact in the centre of the tibial
insert. The lubricant used was new-born calf serum,
diluted to 25%, and the wear was determined
gravimetrically. The computational framework
was adapted according to the experimental test
setup and was based on the contact area, sliding
distance and an independent experimentally
determined non-dimensional wear coefficient, a
function of cross-shear ratio (CS), to calculate the
volume wear loss. The computational framework is
described elsewhere [1].

Sigma fixed bearing cruciate retaining total
knee replacement (DePuy Synthes, Leeds, UK),
with GUR1020 UHMWPE inserts, was investigated
using a physiological six station Prosim knee wear
simulator. The femoral bearings were set up either
on the distal radius, as indicated by the device
Centre of Rotation
Distal Radius
Distal Radius
ISO
ISO
ISO
Kinematic Condition
High Kinematics
Intermediate
kinematics
Modified high
kinematics
Modified
intermediate
kinematics
ISO
Peak load/kN
2600
2600
2600
2600
2600
Anterior-posterior
displacement
0 to 10 mm
0 to 5 mm
0 to 10 mm
0 to 5 mm
0 to 5 mm
Internal-external
rotation
2 to +5.5
Flexion-extension
058
058
058
058
058
Table 1: Experimental test conditions:
Results
The wear rate measured on the distal centre of
rotation with high kinematics (9.2 2.9 mm 3/MC)
was found to be almost double the wear rate of the
ISO centre of rotation with modified high kinematics
(4.7 1.6mm3/MC; ANOVA, p<0.01). In addition,
increasing the kinematic level on distal centre of
rotation, from intermediate to high kinematics,
increased the measured wear rate, from 3.16 2
to 9.2 2.9 [mm 3/MC] respectively (ANOVA,
p>0.05). In contrary, increasing the kinematic
level on ISO centre of rotation, from intermediate

to high kinematics, decreased the measured wear
rate. There was a little difference between the high
and ISO kinematic conditions under ISO centre
of rotation setup (ANOVA p > 0.05), with a small
increase in wear rate observed under ISO input
kinematics (5.2 1.9mm3/MC) (Figure 1). Reversing
the intermediate kinematic inputs polarity under
the distal centre of rotation, in the computational
model, reduced the predicted wear rate from
6 to 4.8 [mm3/MC] respectively.
see the next page
113
D i s c u s s i o n a n d C o n cl u s i o n :
The current experimental and computational
studies have shown that the most important factor
influencing the wear of TKRs was the position of the
relative contact point at the femoral component
and tibial insert interface. The shift in the relative
contact position affected the contact area and
the resultant cross shear and therefore wear of
the polyethylene (Figure 1). Although the recently
revised version of ISO has reversed the kinematic
polarity (ISO 14243-3-2014), the results suggest a
need to revise the ISO centre of rotation setup
to match physiological setup and replicate the
wear rates found clinically. In addition, when
examining the wear performance of a total knee
replacement, it is critical to consider both the input
kinematics and the test setup conditions, and to
test a device under a combination of conditions
which yield the appropriate physiological relative
velocities and contact mechanics.
Figure 1: E
xperimental (mean 95% CI) and computational
wear rates and CS for fixed bearing total knee
replacement, with GVF bearing material, under
different setup and kinematic conditions.
References
[1] Abdelgaied et al. J Biomechanics, 44,
11081116, 2011.
114
O 088
WEAR PREDICTION OF THE TKP UHMWPE TIBIAL INSERT

V. Florescu1, C. Lucian2, V. Luige2
1
2
University of Civil Engineering, Material Technologies, Bucharest, Romania
Institute of Solid Mechanics of the Romanian Academy, Biotribology Department,

Bucharest, Romania
Introduction
Clinical studies on the massive wear of the tibial
polyethylene insert caused by improper contact
gear for the artificial knee joint, have shown that
this is the main cause for the correction of the
knee prosthesis. Knight et al. reports that in all of
the 18th worn prosthesis (out of 209 cases of primary
arthroplasty for knee joint) we can observe wear
pits on the surface of the tibial insert (specific
to the adhesive wear) as well as delaminating.
Prosthesis life was about 80 months, close to the
time reported in [1] that is 72 months. There were
also studies on the massive delaminating of the
polyethylene occurred earlier [2, 3].
new control functions. The hybrid position-force

control in Cartesian coordinates, conceived as
a control system in open architecture (OAH), is
realized by processing in real time the Jacobean
matrix obtained from kinematics through Danevit
Hartenberg method with the calculus of the
inverse Jacobean matrix for back loop control. The
studying method is produced a control system for
knee prosthesis simulator on 5 degree of freedom
which maintains a constant force of vertical
pressure on the tibial component.
The fatigue wear was identified as the main
phenomenon on responsible for the polyethylene
tibial insert failure. Clinical studies show that even
tibial parts that are retrieved for other reasons
(implant loosening, misalignment, etc.) presented
markers of fatigue wear (cracks in the subsurface,
wear pits, delamination, and loss of large pieces of
polyethylene). The cumulative nature of the wear
fatigue phenomenon requires a qualitative and
quantitative evaluation of the transfer of loadings
through the joint and a summation technique that
is relevant for the variety of the human activities.
The first part was assessed by a combination
of dynamic finite element analyses of the joint
contact mechanism. For the second part, we
assumed that normal walking, stair ascending and
stair descending were the regular activities with a
dominant impact on the phenomenon.
It was analyzed the contact mechanism of
femoral condyle tibial insert, based on the ball
on flat contact. Were you set parameters for
wear of UHMWPE tibial insert. Was developed a
knee prosthesis simulator (KPS) control system,
a new method developed for hybrid position
force control on five degrees of freedom (DOF)
in an open architecture with PC interfaced multiprocessor PLC system, in order to obtain new
control functions.
The first experiments carried out, using only FE and
APT movements, led to a very small wear rate. The
wear is manifested by the appearance of wear pits
on the side surfaces of the polyethylene tibial insert
due to its cyclic mechanical loading.
C o n cl u s i o n
Appreciating the wear of the tibial tray of total
knee prosthesis is very difficult. Measuring the wear
becomes more challenging due to polyehylenes
considerable yield.
The initial polishing of the polyethylenes contact
surface is a sign certifying the adhesive nature of
wear. The results obtained lead to the conclusion
that many clinically reported failures of the tibial
tray are caused by the mechanisms of adhesive
and fatigue wear.
Figure 1: T he wear of tibial insert using only FE and APT

movements (left) and the its severe wear using FE,
APT and IOR movements.
Aiming to improve the performance of knee

prosthesis simulator (KPS) control system, a new
method has been developed for hybrid positionforce control on five degrees of freedom (DOF)
in an open architecture with PC interfaced
multi-processor PLC system, in order to obtain
References
1 Heck D.A., et al., Orthopedics, 15: 2328, 1992.
2 Engh G.A., et al., J Bone Joint Surg, 917, 1992.
3 Jones S.M.G., et al., J Bone Joint Surg, 74B,
1822, 1992.
115
O 089
WEAR SIMULATOR STUDY OF TOTAL KNEE REPLACEMENT

WITH ADVANCED LOAD AND KINEMATIC TEST
CONDITIONS
C. Zietz1, H. Dempwolf1, R. Dammer1, A. Wolf1, R. Bader1, E. Mick1
1
University Medicine Rostock, Department of Orthopaedics, Rostock, Germany
Introduction
Wear analyses for new knee implant designs or
materials were usually performed using standard
test conditions according to ISO 14243. This
standard defines the forces and movements
during the wear test corresponding to continuous
walking. But the activity of patients supplied with
a total knee replacement (TKR) is a sequence
of different activities besides walking [Morlock,
2001], so that despite of preclinical standard
wear tests implants fail in vivo. Furthermore, from
instrumented TKR realistic forces and movements
are available for application to wear simulator
tests [Bergmann, 2014]. The aim of this study was
to compare the wear of the UHMWPE inserts of a
TKR under standard and advanced test conditions.
Discussion
Based on instrumented TKR systems realistic
kinematics loading can be determined for
biomechanical studies as wear simulator tests.
Compared to standard wear simulator tests, the
application of increased load and expanded
kinematics leads to a decrease in UHMWPE wear
during the first million load cycles. The difference
in kinematics between both test setups resulting in
enlarged contact areas could cause the decrease
of wear [Cottrell, 2006]. Further tests with increased
load cycles have to be carried out investigating
long-term UHMWPE wear.
References
B
ergmann et al, PLoS One, 9:e86035, 2014,
C
ottrell et al, J Biomed Mater Res B Appl Biomater,
78:1519, 2006,
M
orlock et al, J Biomech, 34:873881, 2001.
Methods
Wear testing was performed with a knee wear
simulator (EndoLab GmbH, Rosenheim, Germany),
using conventional UHMWPE tibial inserts combined
with a CoCr femoral component of the Multigen Plus
Knee System (Lima Corporate, San Daniele, Italy).
Loads and movements were applied according
to ISO standard 14243-1 for 5 million cycles (1) as
well as loads derived from data of instrumented
TKR by Bergmann et al. [Bergmann, 2014], in the
first instance for 1 million load cycles (2). Loads
and movements of the level walking are shown for
both test setups in Figure 1. Besides walking (94%)
the second wear test include ascending (2%) and
descending stairs (2%), sit down and stand up from
a chair (2%), simulating a body weight of 100 kg. The
maximum axial load during the standard wear test
was 2.60 kN. At the increased kinematic test setup
during walking 2.62 kN, for ascending 3.05 kN and
descending 3.36 kN, sit down and stand up from a
chair 2.83 kN were applied. The maximum flexion
angle was 58 for the standard test and maximum
83 under advanced test conditions respectively.
Amount of wear was determined gravimetrically.
Results
After 1 million load cycles wear of UHMWPE liner
amount to 10.1 1.4 mg and 2.4 1.6 mg at the
wear test according to standard ISO and under
advanced test conditions, respectively. The wear
regions on the inserts loaded with the expanded
kinematics and loading are extended in area and
on the medial condyle compared to the standard
test conditions.
116
O 090
THE IMPACT OF THE INITIAL POSITIONING

OF THE ENDO-PROSTHESIS TO WEAR ITS PARTS
J. Ronda1
1
Cape Peninsula Univesity of Technology, Cape Town, Republic of South Africa
In recent decades, the development of materials

science and biomedical still poses new challenges
to engineers both in terms of design, technology,
and also materials. In addition to the selection
and improvement of endoprosthesis materials, an
important issue is joint arthroplasty. Many years
of experience in operation of implants allowed
to select materials for biomedical applications,
meeting the basic requirements concerning, inter
alia, wear resistance, corrosion resistance, with
suitable mechanical properties and, above all
biocompatibility. However, joint arthroplasty is also
associated with failures resulting from the surgery
performed. The hip joint endoprosthesis durability
from 10 to 15 years is clearly insufficient, especially
for young active patients. This short endoprosthesis
lifetime is caused by excessive frictional wear of
the node elements. It is one of the main reasons.
The causes include excessive wear maladjustment
prostheses elements, poorly planned and carried
out surgery, lack of biocompatibility between
elements of the prosthesis and the human body,
improper design of the prosthesis or improperly
selected prosthesis surfacing. In summary, the
analysis of the causes of failure indicates the
need to further increase the reliability of implants
and prolong their life time. Currently, the aim is to
reduce the consumption of node elements through
the use of newer methods of ultra-high vacuum
surface engineering such as DB IBAD. The life of
the implant can be increased by improving the
surface of the prosthesis friction node by applying
a wear-resistant coatings, e.g., using a diamond
like carbon (DLC), i.e. carbon hybrids SP2 and SP3.
The article deals with the contact problem and

wear issues for the polyethylene cup and metal
femoral head. The focus is on the impact of the
prosthesis kinematics on wear of endoprosthesis
which is treated as the tribological node where
Archards model of wear is applied. The problem
is solved by using of a commercial finite element
method (FEM) software: ABACUS, with modified
open-for-user subroutine UMESHMOTION. The
specified boundary conditions, reflecting: the
node geometry, kinematics and dynamics of a hip
joint, were proposed to imitate the normal human
gait enriched by effects suitable to walking up
the stairs and down. The results of numerical
calculations show the calculated strain and wear
performance of the polyethylene acetabulum
(cup) depending on its presetting in the patient
pelvis after a hip replacement surgery and the
combination of the patient activity defined as a
combination of the normal gait plus walking up
the stairs and down. In addition, the results of FEM
calculations are verified by comparing them with
experimental results available in the literature.
Calculations has shown that:
w ear decreases with increasing inner diameter
of the cup,
annual average wear depth increases with
increasing angle of anteversion, and decreases
with increasing angle of abduction,
a local maximum wear depth increases with
increasing angle of abduction and angle of
anteversion,
t he contact surface moves towards the edge,
when the abduction angle increases. For smaller
angles of abduction and greater angles of
anteversion the contact surface moves in the
direction of the cup centre.
117
O 091
MINIMUM INDENTATION DEPTH FOR PROPER

QUANTIFICATION OF PLANTAR SOFT TISSUE STIFFNESS
T. Lee1, J.C. Teoh2
1
Dongguk University, Department of Medical Biotechnology, Seoul, Korea, Republic of Korea

2
National University of Singapore, Department of Biomedical Engineering, Singapore,

Singapore
Introduction
Several studies have been conducted to study the
mechanical properties of plantar soft tissues using
in vivo indentation system (Chao, Zheng et al. 2010,
Kwan, Zheng et al. 2010, Mickle, Munro et al. 2011).
These properties of plantar soft tissue is dependent
on the extent of tissue deformation (Chao, Zheng
et al. 2010) as well as the configuration of the
metatarsophalangeal joint (MTPJ) (Garcia, Hoffman
et al. 2008), specifically for the forefoot region.
Thus, selecting proper indentation parameters is
important to obtain meaningful outcome.
As the probe tip indents deeper into the plantar

soft tissue beyond a threshold depth (i.e. Xs), the
force gradient increases notably (Fig. 1B and 1C).
As shown in Table 1, the absolute value of Xs was
approximately 2.23 mm and 2.14 mm at the heel
and 2 nd sub-MTH respectively. Indentation depths
which were less than this threshold depth might not
be representative of the nature of plantar soft tissue
nor reflect the critical deformation it experiences
during physical activities that expose the tissue to
risk of ulceration.
However, many indentation techniques used are

limited by the inadequate indentation depth on
the tissue. The purpose of this study is to investigate
and
determine
the
minimum
indentation
depth required to effectively characterize the
biomechanical properties of plantar soft tissue
under weight-bearing conditions.
Methods
20 young subjects (2025 years) participated in this
study. The test was conducted with equal weight
borne on each of the participants feet to mimic the
static standing. During the experiment, the indenter
probed the 2nd sub-metatarsal head (MTH) and
heel pad tissue at a constant rate of 12.3mm/s. The
maximum tissue deformation induced was varied
from 1.2 mm to 6.0 mm, in steps of 1.2 mm. The tissue
stiffness obtained from the tissue response curves was
compared and fitted to the proposed viscoelastic
model (Garcia, Hoffman et al. 2008) as shown in Fig.1A.
2 nd
sub-MTH
Heel
p-value
Average Tissue
Thickness (mm)
13.801.76
18.042.42
< 0.01*
Stiffness
coefficient, K1
(N/% tissue
thickness )
0.230 0.122
0.4920.151
< 0.01*
Stiffness
coefficient, K2
(N/% tissue
thickness)
0.4770.168
1.0150.406
< 0.01*
Xs
(% tissue thickness)
16.1771.909
11.8451.284
< 0.01*
Damping coefficient,C
(N/% change
in tissue
thickness
per second)
0.7670.667
1.8030.651
0.03*
Table 1: P
lantar soft tissue properties of 2nd sub-MTH and
heel pad
C o n cl u s i o n
The results of this study demonstrate the existence
and significance of a minimum indentation
depth (Xs) required for investigating plantar soft
tissue properties. Adoption of an inappropriate
indentation parameter may result in erroneous
tissue stiffness measurements. Hence, a proper
quantifiable reference helps provide valuable
insights into plantar soft tissue behavior, which
can be used for computational modeling to
better understand complex foot mechanisms and
pathologies. Furthermore, the tissue properties
elicited provide valuable information and possible
indication of disease (Jahss, Michelson et al. 1992).
Hence, a rigorous description of plantar soft tissue
behavior is crucial and has good potential for
application in the diagnosis of foot abnormalities
related to diseases such as diabetes.

The viscoelastic model used in this is shown in Fig.
1A. K1 and K2 capture the elastic response of plantar
soft tissue at the initial and subsequent phases of
indentation.C characterizes the viscous behavior
of tissue which is only prominent at the latter stage
of indentation. Xs is the minimum indentation
depth beyond which the tissue exhibits nonlinear
viscoelastic behavior. The model suggests that
there is a need to indent the tissue beyond Xs in
order to assess both K1 and K2. This differs from the
paper by Garcia et. al. (2010), where there is no
mention of the reference value of Xs.
118
O 092
BIOMECHANICAL ANALYSIS OF THE PELVIC FLOOR

MUSCLES DURING THE INCREASE OF INTRA-ABDOMINAL
PRESSURE: THE STRESS MAPS
T. Da Roza1, S. Brando1, T. Mascarenhas2, R. Natal Jorge1
1
2
Faculty of Engineering, INEGI, Porto, Portugal
Faculty of Medicine / CHSJ-EPE, Department of Gynecology and Obstetrics ,

Centro Hospitalar de So Joo EPE, porto, Portugal
Introduction
Study the behaviour of the pelvic floor muscles
during increases of intra-abdominal pressure
(IAP) is relevant to understand the pelvic floor
dysfunction. It is recognized that during exercise
the increase in the IAP may result in stress urinary
incontinence if the pressure inside the abdomino-pelvic cavity is higher than the urethral closure
pressure [Haylen, 2010]. Since the pelvic floor
muscles are located inside the pelvis, it is difficult
to analyze the effects of the IAP. Accordingly, the
measures that are made by intra-vaginal devices
are indirect evaluations. The present study aims to
determine the stress maps on the insertion areas
of the pelvic floor muscles (coccyx, and in the
obturator fascia) according to different values of
IAP by using a computational model.
Methods
Five young nulliparous athletes were recruited. To
build the computational models, pelvic Magnetic
Resonance (MR) images were acquired at rest
(protocol: CES195/12). The images were used
to build 3D models of the pubovisceral muscle.
Boundary conditions were set in the nodes
corresponding the attachments in the coccyx and
also in the right and left sides of the obturator fascia
(Figure 1, orange points). The Abaqus software
was used to generate the finite element meshes.
Figure 1: C
omputational model of the pubovisceral muscle.
The pink arrows represent the intra-abdominal
pressure in the elements of the inner surface
of the muscle, and the orange points represent
the boundary conditions in the coccyx and
the obturator fascia attachments.
Discussion
This computational model enabled to represent
the increment in IAP. As expected, for higher
values of IAP, the stress on the nodes of the
boundary conditions also increase. The nodes of
the pubovisceral muscle in the region of anterior
attachment suffered higher values of stress for
superior values of IAP, which is in agreement with
the evidence of muscle disruption that is seen on
clinical ultrasound or MR images.
After that, numerical simulation of different

values of IAP 56.1, 98.7 and 153.9 cmH 2O was
performed in the inner surface of the pubovisceral
muscle (Figure 1, pink arrows), assuming them as
representative of walking at 5.6 km/h, running at
9 km/h and jumping, respectively [Shaw, 2014].
Stress maps were obtained, and the values of the
stress on the boundary conditions were plotted to
evaluate the effects of the different levels of IAP.
This is useful information to detect the attachment

areas which are more prone to develop muscle
defects.
Results
The stress maps evidenced superior values for the
stress maps for higher values of IAP. The highest
stress values were found in the left side of the
boundary conditions in the pubovisceral muscle
(290.6%), while the coccyx presented the lowest
values of stress (281.4%). During the increase in IAP
it was observed that the points of highest values
of stress moved anteriorly to the insertion of the
pubovisceral muscle in the symphysis pubis.
References
Haylen, et al., Neurourol Urodyn, 29. 420, 2010.
Shaw, et al., J Sport Sci, 32:11761185.
119
O 093
HUMIDITY CONTROLLED STATIC AND DYNAMIC

NANOINDENTATION OF THE SECONDARY WOOD CELL
WALLS IN PICEA ABIES
I. Zlotnikov1, L. Bertinetti1, U. Hangen2, M. Eder1, P. Leibner1, P. Fratzl1
1
Max Planck Institute of Colloids and Interfaces, Biomaterials, Potsdam, Germany

2
Hysitron, Hysitron, Aachen, Germany
Nanoindentation is the leading technique to study

local mechanical properties of a wide range of
materials on the one-micron scale including the
fields of organic and biological materials. The
properties of the latter are known to be critically
affected by the absorbed moisture content,
thus, on the humidity and temperature of their
surroundings. Therefore, a better understanding of
the structure to function relationship in biological
materials in respect to the environmental setting
of their habitat requires the nanoindentation
experiment to be performed in a strictly controlled
relative humidity (RH) and temperature. In
the present study, an approach for measuring
local mechanical properties of materials using
nanoindentation
technique
in
controlled
environment was developed. The approach
employs a commercially available stage for
relatively high temperature nanoindentation in

inert gas setting adapted to produce a local
atmosphere by fitting a humidity generator to
the inert gas infrastructure. Static and dynamic
nanoindentation study in different RHs performed
on wood cell walls of Spruce wood (Picea abies)
was used to demonstrate our ability of humidity
and temperature controlled local mechanical
characterization and its significance in biological
materials. For example, the hardness of the
secondary wood cell walls exhibited a systematic
decrease from an average hardness of approx.
0.6 GPa in RH of 6% down to approx. 0.2 GPa in RH
of 79%, thus, showing a total remarkable decrease
of 67 %. The details of the experimental set-up
and the results of the Spruce wood study will be
discussed in detail.
120
O 094
VISCOELASTIC CHARACTERISATION OF SOFT

BIOMATERIALS BY NANOINDENTATION:
THE NANO-EPSILON DOT METHOD
G. Mattei1, G. Gruca2, E.J. Breel2, N. Rijnveld2, A. Ahluwalia1
1
University of Pisa, Research Center E. Piaggio, Pisa, Italy

2
Optics11, Optics11, Amsterdam, Netherlands
Introduction
Nanoindentation is emerging as a popular
technique for the mechanical characterisation
of biological and biomimetic materials [Oyen,
2013]. Typically, a probe is brought into contact
with a surface, pushed into the material and then
retracted, recording load (P) and displacement
(h) over time (t). The P-h-t data are then analysed
with a range of models to derive material
mechanical properties. Although soft materials
are generally viscoelastic, most published works
focus on extracting elastic properties by analysing
the unloading portion of the indentation curve
with the Oliver-Pharr method [Oliver, 1992]. Here
we propose a method (the nano-epsilon dot
method, nano-M), to derive material viscoelastic
properties by indenting samples at different strain
rates considering data from the loading curve.
(0.025, 0.05, 0.1, 0.25 s -1) while being submerged

in water at room temperature. Generalized
Maxwell models with one (GM1) or two (GM2)
spring--dashpot series arms in parallel to a spring
were used to globally fit experimental -t LVR
series collected at different?, as described in
[Tirella, 2014].
Results
The LVR extended to up to 10% strain for both samples.
Table 1 shows instantaneous (kinst) and equilibrium
(keq) moduli and characteristic relaxation times
(1=1/E1, 2=2/E2) estimated with the nano-M.
The results are consistent with those reported in
[Tirella, 2014] and suggest that the GM1 model is
sufficient to describe the viscoelastic behaviour of
both samples, while GM2 over-fits the data.
Methods
The nano-M stems from the epsilon dot method
[Tirella, 2014], originally developed for bulk
viscoelastic characterisation with no sample
pre-stress. In this study it was implemented on
the Optics11 Piuma Nanoindenter, which allows
accurate detection of the surface contact,
identified as the point where the load crosses the
P-h abscissa after the snap-to-contact negative
region. This avoids sample pre-stress and hence
measures unbiased material viscoelastic constants
[Mattei, 2014]. The following definitions (Eq. 1) of
indentation stress () and strain (), based on the
Hertzs contact model, were adopted to obtain
-t series at constant strain rate (?) from the loading
portion of P-h-t data at constant displacement rate(?):
Parameter
Gelatin
GM1
Gelatin
GM2
PDMS
GM1
PDMS
GM2
kinst[kPa]
14.12
14.12
1.0210 3
1.0210 3
keq[kPa]
0.54
0.54
6.2810
6.2810 2
1[s]
7.31
7.30
0.70
0.70
2[s]
7.32
3.5510 11
Table 1: E
stimated viscoelastic parameters.
=P/(R(hR)) =4h/(3R*(1- 2 ))(1)
Discussion
The nano-M represents an easy-to-implement
and attractive method to characterise material
viscoelastic properties at cell length scales. The
use of - LVR data derived from the loading curve
(Eq. 1) has several advantages over the classical
Oliver-Pharr analysis which uses unloading P-h data
(see [Pathak, 2008]).
where R is the radius of the Piumas spherical

tip (70 m) and is the sample Poisson ratio
(assumed as 0.5). In this study, 5% w/v gelatin
(Gelatin Type A, G2500, Sigma Aldrich) and
PDMS (Sylgard 184, Dow Corning, 10:1 base to
catalyst w/w ratio) samples were tested at 4 different ?
References
Mattei et al, J Biomech 47:26416, 2014.
Oliver and Pharr, J Mat Res 7:156483, 1992.
Oyen et al, Exp. Tech. 37:7387, 2013.
Pathak et al, J Eur Cer Soc 28:221320,2008.
Tirella et al, JBMR Part A 102:332560, 2014.
121
O 095
FINITE ELEMENT BASED PARAMETRIC STUDY

OF INACCURACIES IN MECHANICAL TESTING
OF SOFT TISSUE
M. Slazansky1, S. Polzer1, J. Bursa1
1
Brno University of Technology, Institute of Solid Mechanic, Mechatronics and Biomechanics,

Introduction
Computational, especially finite element models
(FEM) represent a relevant approach in biomechanics of soft tissues nowadays and help us to
simulate mechanical behaviour of soft tissues.
Quality of the model depends primarily on the
quality of input data which are obtained from
experiments. Credibility of the experiment thus
defines the quality and plausibility of the computational model.
Methods
A 3D FEM model is used to perform sensitivity
analyses on various parameters of the test. Those
are the type of load transmission via clamps
or hooks, their number and size and specimen
characteristics its size and stiffness. Both
equibiaxial and proportional displacement-driven
loads were simulated. The quality of simulated
stress-strain data was quantified by Coefficient
of Determination R2 using two data sets: virtually
measured data from the FEM analysis and
the assigned specimen stress-strain curve. The
measured data were described as plausible when
the values coincided with the assigned stress-strain
curve of the specimen material.
Soft tissues are often tested via biaxial tension

testing device. Biaxial tests succumb no standards,
and their arrangement, specimen shape and size
or the way of load transmission on the specimen
(gripping) are fully chosen by the staff or designer
of the respective testing machine. It was shown that
the chosen features can be decisive for accuracy
of the results, may cause significant errors in some
cases and thus negatively influence outputs of the
computational models.
Results
Numbers and sizes of hooks or clamps have
significant influence on the quality of measured
data. It is possible to specify such binding methods
and range of their parameters (specimen size,
stiffness), which can guarantee plausible measured
data.
In both uniaxial and biaxial testing of soft tissues,

stresses are calculated by dividing the total force
by undeformed cross section area. Intrinsically the
assumption of uniform stress distribution throughout
the specimen cross section is introduced here.
Strains, however, are calculated on the basis of the
(optically recorded) undeformed and deformed
positions of markers (contrast points) in the central
part of the specimen called region of interest
(ROI) below. Consequently, the calculated values
represent an average throughout the ROI. This
difference may have significant consequences on
the accuracy of the stress-strain curves obtained
from these tests.
Discussion
The results of the analyses are consistent with
previous analyses [Jacobs 2013; Sun, 2005;
Waldmann, 2002]. In all the presented analyses
perfectly symmetric and accurate positions of
clamps and hooks were assumed. Naturally,
the accuracy of positioning of clamps or hooks
represents another important operator dependent
factor influencing the quality of results. However
investigation of this dependency is out of scope of
this paper.
The non-uniform load distribution along the

specimen edges is not far enough from the ROI
in the sense of Saint Venants principle, therefore
the load distribution along the specimen edge
influences the measured data.
This work was supported by Czech Science Foundation
project No.13-16304S.
References
Jacobs, Cortes, Vresilovic, Elliot, J Biomech Eng
135 (2), 2013.
Sun, Sacks, Scott, J Biomech Eng,
127(4) 70915, 2005.
Waldman, Sacks, Lee, J. of Materials Science
Letters 21 12151221, 2002
The goal of the FEM simulations is to assess the

inaccuracy of the measured data, to determine
main influences on the measured data and to
design the best setting of the biaxial testing device.
122
O 096
TRACTION FORCE MICROSCOPY OF THE IMATINIB

SENSITIVE KINEASES IN ENDOTHELIUM REVEALS
A BARRIER PROTECTIVE FORCE PHENOTYPE
E.T. Valent1, J. Aman1, R. Krishnan2, V.W.M. van Hinsbergh1,
G.P. van Nieuw Amerongen1
1
2
VU University Medical Center, Department of Physiology, Amsterdam, Netherlands
Beth Israel Deaconess Medical Center, Center for Vascular Biology Research, Boston, USA
Results
Stimulation with thrombin resulted in a normalized
traction force increase which was ablated in the
imatinib treated condition (t=15 min 2.6 vs 1.6,
t=30 3.4 vs 1.9, p<0.009). This was accompanied
by a significant reduction in the number and
size
of
thrombin-induced
inter-endothelial
gaps and cell apoptosis (0.6 vs 3.7, p=0.026) by
imatinib. Interestingly, pretreatment with Imatinib
significantly increase the baseline traction forces
(vehicle 112.7 26.6 Pa vs Imatinib 260.4 56.5Pa,
p=0.047) and stabilized the natural occurring
force fluctuations (vehicle 26.6 1.2 Pa vs imatinib
22.1 0.8 Pa, p=0.003). Moreover, with a siRNA
depletion of the two important imatinib-sensitive
kinases Arg and c-abl, we studied the kinases specific
contribution to the observed effect. This resulted
into opposite effects during thrombin stimulation
in which Arg knockdown showed force lowering
and barrier protection (t=15 1.2 vs 1.8 scramble,
t=30 1.4 vs 2.4 scramble), c-abl raised the
traction forces and caused disruptive phenotype
(t=15 2.1, t=30 2.8).
Introduction
The endothelium is a dynamic monolayer of cells
lining the most interior part of the entire vascular
bed. This monolayer is able to form a barrier
which prevents blood fluids from leaking into
the surrounding tissues. However, during many
inflammatory diseases the endothelium becomes
activated and hyper permeable, resulting in
vascular leakage. Currently specific therapies
of this significant pathogenic phenomenon are
lacking. Interestingly, a recent study from our
lab demonstrated that the anticancer drug
Imatinib both in vitro as well as in vivo reduced
the hyperpermeability of the endothelium
by
RhoA-independent
inhibition
of
MLC
phosphorylation and F-actin stress fiber formation1.
We hypothesize therefore that Imatinib protects
the endothelial barrier through local changes in
force distribution over the F-actin cytoskeleton
hampering cellular contractility and intercellular
gap formation upon stimulation with the vaso-active
agent thrombin. Moreover, we will focus on the
specific roles of two major tyrosine kinases inhibited
by imatinib, namely Arg and c-abl.
Discussion
This study shows a specific force-related mechanism
though which Imatinib lowers thrombin induced
contractile forces and increases baseline forces.
This could result from the previously observation
that imatinib causes an enforcement of endothelial
cell adhesion to the extracellular matrix.1 Finally,
our results indicate that the imatinib sensitive
kinases Arg and c-abl have opposite roles in the
thrombin induced contractile force enhancement.
Better understanding of their specific function
could provide an even greater potential to treat
endothelial barrier dysfunction in the future.
Methods
With the previously published traction force
we
studied
primary
microscopy
method2,
human umbilical vein endothelial cells on
4kPa polyacrylamide hydrogels. Fluorescent
microspheres, embedded within these gel
substrates, were traced and used to calculated
cell displacements. The conversion to traction
forces was achieved using a constrained Fourier
transformation. Before the start of the experiment
all cells were pretreated for 1 hour with 10 M
Imatinib or with a DMSO vehicle.
References
1 Aman et al. Circulation, 2012
2 Krishnan et al. Am J Physiol Cell Physiol, 2011
123
O 097
IN-VITRO WALL SHEAR STRESS WAVEFORMS DERIVED

FROM ARTERIOVENOUS FISTULA ELICIT ENDOTHELIAL
CELL ACTIVATION AND NEOINTIMAL HYPERPLASIA
RELATED MOLECULE PRODUCTION
M. Franzoni1, I. Cattaneo1, B. Ene-Iordache1, A. Remuzzi2
1
IRCCS Istituto di Ricerche Farmacologiche Mario Negri, Bioengineering, Bergamo, Italy

2
University of Bergamo, Industrial Engineering, Dalmine, Italy
Results
HUVEC exposed to PP waveform displayed an
elongated shape and a preferential orientation in
the flow direction. On the contrary, HUVEC exposed
to R1, R2, or kept in static conditions, maintained
polygonal shape with no preferential orientation
(n=10). PP-stimulation elicits a 5-fold increase in
KLF2 mRNA expression in HUVEC compared to those
maintained in static conditions (n=5, p<0.05).
This increase is absent in HUVEC stimulated with R1
or R2 waveforms. HUVEC after exposure to R1 and
R2 have a significantly higher production if IL-8 as
compared to PP and static condition (1.270.76
and 1.340.73 vs 0.760.44 and 0.510.13,
ng/hr/106cells, n=5, p<0.05). R2 pattern elicited
also a significant increase in MCP1 production
compared to PP and static condition (5.542.65
vs 2.591.21 and 2.310.52, ng/hr/10 6cells, n=5,
p<0.05).
Introduction
Native arteriovenous fistula (AVF) is recommended
as first choice to create a vascular access (VA)
in dialysis patients 1. AVF outcome however is
affected by ? 40% failure rate within 2 years 2.
First cause of AVF failure is vessel stenosis caused
by intimal hyperplasia (IH). Disease location is
strongly related to local hemodynamics 4. High
risk stenosis areas of AVF, as the venous side near
the anastomosis, are exposed to reciprocating
and disturbed WSS waveforms 5-6. The aim of the
present study was to investigate the in-vitro effect
of AVF-derived WSS waveforms on morphological
adaptations, gene and protein expression of EC,
related to development of IH.
Methods
Human umbilical endothelial cells (HUVEC)
between 4/5th passage, were used at confluence.
For flow exposure experiments, complete growth
medium was added with high molecular weight
dextran. We used a cone-and-plate device to
expose for 48 hrs HUVEC monolayers to three WSS
patterns, derived from CFD analysis of an idealized
AVF 7. The unidirectional, pulsatile pattern (PP)
calculated at AVF venous side downstream
anastomosis (range 23 to 12 dyn/cm 2, average
16 dyn/cm2) was compared to reciprocating
WSS, derived from the anastomosis floor
(R1, range 16 to 13dyn/cm 2, average ? 0dyn/cm2)
and from the venous side of anastomosis
(R2, range 26 to 11 dyn/cm 2, average ?
0 dyn/cm 2). HUVEC maintained in static conditions
were used as control. We performed RT-PCR
to quantify Krppel-like factor 2 (KLF2) gene
expression and ELISA to quantify interleukin
8 (Il-8) and monocyte chemo-attractant protein
1 (MCP1) release. We used one-way ANOVA and
the post-hoc Bonferroni multiple comparisons test
for statistical analysis. Data are presented as mean
value SD.
Discussion
Our results indicate that WSS patterns derived
from high risk stenosis areas induced in-vitro EC
activation and pro-inflammatory signaling. These
results suggest that WSS is an important player in
AVF stenosis due IH development and VA failure.
References
[1] NKF-DOQI. New York, National Kidney
Foundation, 1997.
[2] A. Caroli et al. Kidney Int., vol. 84(6),
pp 123745, 2013.
[3] T. C. Rothuizen et al. Neph. Dial. Trans., vol.28(5),
pp. 108592, 2013.
[4] M. C. Riella et al. Nat. Rev. Neph., vol. 9 pp.
34857, 2013.
[5] A. Remuzzi et al. CJASN, vol. 8(12),
pp. 218693, 2013.
[6] B. Ene-Iordache et al. Endothelium, vol. 10(2),
pp. 95102.
[7] B. Ene-Iordache et al. NDT, vol. 27,
pp. 35868, 2012.
124
O 098
FLUID-STRUCTURE INTERACTION ANALYSIS OF BICUSPID

AORTOPATHY: THE ROLE OF AORTIC SHAPE
AND VALVE PHENOTYPE
S. Pasta1, A. Rinaudo2, G. Gentile3 , G. Raffa4 , A. Luca3 , M. Pilato4 , C. Scardulla4
1
Fondazione RiMED, Tissue Engineering & Regenerative Medicini, Palermo, Italy

2
3
4
UniPA, DICGIM, palermo, Italy
ISMETT, Radiology, Palermo, Italy
ISMETT, Cardiothoracic, Palermo, Italy
Introduction
The mechanism underlying the development
of aortic dilatation in individuals with bicuspid
aortic valve (BAV) is an ongoing debate with
remarkable implication for surgical treatment [1].
The phenotypic presentation of BAV may include
an anterior-posterior cusp-fusion pattern (BAV-AP)
or a right-left cusp-fusion pattern (BAV-RL). In BAV,
the aorta can enlarge at either the isolated aortic
root (AR) or tubular ascending aorta (TA). This study
aims to quantify hemodynamic and structural
parameters portending aortic dilatation in BAV.
risk of aortic enlargement in these individuals. For

patients with TA dilatation, WSS and OSI dictated
by BAV-RL were found higher in the anterior wall of
the ascending aorta compared to those observed
in BAV-AP. Local maxima of wall stress and blood
pressure occurred in the distal ascending aorta
for BAV-RL and closer to sino-tubular junction in
BAV-AP. This suggests that the risk of complications
related to the development of aortic dilatation
differs among individuals with BAV.
C o n cl u s i o n
Hemodynamic and wall stress in BAV reflect the
heterogeneity of both bicuspid phenotype and
patterns of aortic dilatation. These differences may
have a prognostic implication in the progression of
bicuspid aortopathy and may be used to stratify
subgroups of patients with BAV at greater risk of
aortic dilatation.
Methods
Two-way
fluid-structure
interaction
analyses
were performed on n.17 patients with different
BAV phenotypes and degree of aortic dilatation
underwent CT angiography in our hospital institution
from 2011 to 2014. Segmentation included
reconstruction of the aorta and its valve, including
the spatial position of valve leaflets. Patientspecific flow conditions were imposed considering
trans-aortic flow measurements gathered by
echocardiography. The biomechanical behavior
of the aorta was modeled with a fibre-reinforced
constitutive model, considering material properties
and collagen fiber distribution determined in our
previous study [2]. Parallel coupling was performed
with FLUENT sending the fluid-induced wall forces
to ABAQUS, and ABAQUS sending the deformed
nodal coordinates to FLUENT.
RESU L T AND DIS C USSION
BAV-AP was observed in n.12 patients (70%) and
was associated to TA dilatation as compared
to AR dilatation (n.8 with TA and n.4 with AR).
Differently, BAV-RL occurred in n.5 individuals
(30%), with only one case of AR dilatation. For
both BAV phenotypes, the flow exhibited a nested
right-handed helical pattern with the jet directed
toward the right-anterior wall of the ascending
aorta (Figure). In BAV-RL, the flow jet impinged the
aorta in a more distal region compared to that
observed in BAV-AP. Wall shear stress (WSS) and
oscillatory shear index (OSI) were found higher
in patients with TA dilatation compared to those
with AR dilatation (Figure), suggesting a greater
Figure: ( A) Flow streamlines for a BAV-AP with AR dilatation;

(B) comparison of WSS and OSI between AR and
TA dilatations for different BAV phenotype
References
[1] Verma et al. Aortic Dilatation in Patients with
Bicuspid Aortic Valve. N Engl J Med, 370,
19209, 2014.
[2] Pasta et al. Difference in Hemodynamic and Wall
Stress of Ascending Thoracic Aortic Aneurysms
with Bicuspid and Tricuspid Aortic Valve.
J Biomech, 46, 172938, 2013.
125
O 099
THE INFLUENCE OF HANDGRIP SIDE POSITIONS

ON THE STANDING UP MOVEMENT
A. Saade1, F. Gabrielli1, P. Pudlo1, M. Lempereur2, O. Rmy-Nris2
1
Universit de Valenciennes et du Hainaut-Cambrsis, LAMIH, 59313, Valenciennes, France

2
Mdecine physique et radaptation, CHRU Brest, Hpital Morvan, 29609, Brest, France
Introduction
The sit-to-stand (STS) transition is particularly
complicated for hemiplegic subjects. Loading
the paretic limb 1 or the use of techniques
aiming at improving body weight distribution is
recommended 2. In the current study, a handgrip
was chosen to help people with hemiplegia to
stand up. It is known, for healthy subjects, that a
laterally placed grab-rail introduces asymmetries
into the dynamics 3. Thus, the aim of this study is to
investigate if, and how, lateral handgrip positions
influence the asymmetrical weight-bearing of right
hemiplegic individuals.
on the middle or left position (Dm>0; no significant

difference between the middle and the left
handgrip positions), and lean almost evenly
when the handgrip is on the right side (Dm~0;
p<0.01 comparing to the middle). Only one
hemiplegic wasnt able to stand up when the
handgrip was on the right side. Thus, the right
handgrip position seems to encourage the use
of the affected lower limb and tend to create a
centric-behaviour (Dm~0).</dm
Methods
18 healthy and 11 right hemiplegic (112 6 FIM-Functional independance Measure) subjects
performed STS movements using a handgrip for
three different positions of the handgrip: middle (in
front of the subjects neck), left (middle 15 cm)
and right (middle +15 cm). Two force plates under
the feet, were used to measure the external
contact loads. The magnitude of external loads is
normalized to body mass and averaged over time.
The difference (Dm) of external loads magnitude
between both legs is compared. A positive value
of Dm means that subjects lean on their left lower
limb more than the right one and vice-versa for a
negative value. Distributed values around 0, means
that subjects bear weight almost evenly on both
legs. Two statistical (Wilcoxon and Mann-Whitney)
tests were used to determine the significance of
the studied variable.
Discussion
Handgrip positions seem to influence the weight-bearing of people suffering hemiplegia, but in
a different way from healthy subjects. Healthy
subjects adapt their weight-bearing consequently
to handgrip positions, while the hemiplegic seem
to change their weight-bearing only when they
are compelled to do so. Bearing more weight on
the affected lower limb while standing up seems to
be closer to the way therapists teach the patients.
Therefore, the right handgrip position could be used
for rehabilitation. Future works will include more
hemiplegic subjects with a broader range of FIM.
Results
Dm values are shown in Figure 1 for the 3 handgrip
positions, for healthy and right hemiplegic
subjects. Comparing both sides of the lower limbs,
healthy subjects lean almost evenly on both limbs
when the handgrip is in the middle (1.5<dm0;
p<0.001 comparing to the middle), and more on
their right lower limb when the handgrip is on the
right (Dm<0; p<0.001 comparing to the middle).
This result is coherent with the literature3. The result is
different for the hemiplegic subjects. They lean on their
un-affected left lower limb when the handgrip is
RE F EREN C ES
1 HAS, Haute Autorit de Sant. 2012
2 Creutzfeldt et al., J G Int Med. 27:85360. 2012
3 OMeara et al., Hum mouv Sc. 25:257274. 2006
VHIPOD project (ANR -12-TECS-0001).
126
O 10 0
THE INFLUENCE OF MUSCLE ATROPHY ON CENTRE

OF MASS TRAJECTORY FOR HEMIPLEGIA:
A PRELIMINARY STUDY
A. Saade1, F. Gabrielli1, P. Pudlo1, M. Lempereur2, O. Rmy-Nris2
1
Universit de Valenciennes et du Hainaut-Cambrsis, LAMIH, 59313, Valenciennes, France

2
Mdecine Physique et Radaptation, CHRU Brest, Hpital Morvan, 29609, Brest, France
Introduction
Hemiplegia leads to asymmetrical muscle atrophy.
Literature 1,2 shows that, given the reduction in
lean mass and in muscles section and volume,
paretic limbs can be lighter then non-paretic limbs
by a coefficient up to 25% (C). Consequently, it
could change segments mass and global centre
of mass (CoM) position. Several authors have
highlighted this limitation, and tried to improve
the anthropometric tables 3 for example for
infants, obese population or pregnant women.
It is also known that any method relying on
anthropometric tables will introduce errors in the
estimation of the CoM position, which are likely not
to be negligible3. However, none of the reviewed
studies, tried to neither adapt anthropometric
tables to hemiplegia nor quantify the level of error
that could be produced. The present study is a first
approach to investigate the influence of adapted
anthropometric tables to hemiplegia on CoM
trajectory. The chosen example concerns the Sitto-Stand (STS) movement.
trajectory. Dl varies over time in a way the

kinematic of the movement is taken into account.
Figure 1 (b) represents the distribution of Dl for
6 hemiplegic subjects. It appears that Dl increases
with C (p=0.03) and mean Dl values were 0.36, 0.76
and 1.2 cm for 10%, 20% and 30% of percentage
asymmetrical atrophy respectively. Present results
have the same order of magnitude than those in
CoM based studies such as 23 mm of difference
between hemiplegic and healthy children during
gait5 or 6 mm in elderly balance6.
METHODS
6 right hemiplegic subjects (112 6 FIM-Functional
Independence Measure) performed one natural
STS. Motion analysis VICON was used to record the
kinematic of bodys segments during STS. De Levas
anthropometric table 4 was used to compute
segments mass and CoM positions with modified
mass coefficients that match asymmetrical
atrophy. The variable retained for this paper is
the average centre of mass error (Dl) between
the mean baseline trajectory and the mean
modified trajectory corresponding to the different
percentage of asymmetrical muscle atrophy. The
non parametric Wilcoxon test was used to show
significant differences.
Discussion
As expected, adapting mass distribution to
hemiplegia has an impact on CoM trajectory,
results will have to be taken with caution when
comparing hemiplegic to healthy subjects.
As a consequence, the absence of adapted
anthropometric tables for hemiplegia leads to
either using existent tables and quantifying the
order of magnitude of the produced error, or
adapting the tables to this pathology. Future works
will explore other approaches, investigate the most
reliable one, and include more subjects.
References
1 Ryan et al., APMR. 12: 17037. 2000
2 Mtoki et al., APMR. 82: 86265. 2003
3 Cotton et al., Bionics&Biomech. 00: 122. 2010
4 De Leva et al., J Biomech. 9: 122330. 1996
5 Hsue et al., Gait&Posture. 29: 465470. 2009
6 Lafond et al., J Biomech. 37: 142126. 2004
Results
Preliminary tests showed that CoM lateral trajectory
was the more influenced among the three
components of CoM trajectory by asymmetrical
muscle atrophy. Figure 1 (a) shows an example
for one subject of how C influences CoM lateral
VHIPOD project (ANR -12-TECS-0001).
127
O 101
AUTOMATIC CLASSIFICATION OF HEMIPLEGIA GAIT

PATTERN USING JOINT MOMENTS AND GREEDY METHOD
J. Pauk1, K. Minta-Bielecka1
1
Bialystok University of Technology, Automatics and Robotics, Bialystok, Poland
Introduction
The diversity of gait deviations observed in subjects
with lower limbs deformities has led to repeated
efforts to develop gait classification systems to
assist in diagnosis, clinical decision-making and
communication. To characterize gait pattern
some pattern recognitions and machine learning
techniques have been used to solve problem with
gait classification [Alaqtash, 2011]. The purpose
of the paper is to present the method, which can
be applied to analysis and to classify hemiplegia
gait patterns using joint moments data and greedy
algorithm. We suggest, that the proposed algorithms
will be applicable to provision of automated
guidance in support clinical decision-making.
Method
The study involved the gait patterns of 10 healthy,
and 43 hemiplegia subjects aged between
307.8 years. Clinical assessment of hemiplegia
patients was based on Barthel Index (BI).
Gait parameters were measured by using an
optoelectronic System ELITE 3D (BTS, Italy), and
2 KISTLER platforms. The measurement was
repeated to obtain a minimum of 4 valid walking
trials. 186 gait cycles of hemiplegia and 96 gait
cycles of typical subjects were captured. The
acquired joint moments data normalized to
body mass were represented as a matrix with
rows corresponding to patients and columns
corresponding to examination results. The goal was
to find subsets of rows and columns displaying high
similarity of their values and high row variance. In
the presented algorithm this was done iteratively
by first removing and then adding rows or columns
from and to the analyzed matrix until the defined
mean square residue score satisfied the supplied
threshold [Cheng, 2000].
Figure 1: 1
st bicluster discovered by algorithm (=108, =1.2)
contains samples which correspond to the
moments at ankle joint. The similarity is observed
in 13 cycles (2 trials from distinct hemiplegia and
11 trials from 3 typical subjects): N is sample size,
is a threshold that limits the value of mean
square residue score, is a threshold describing
when the multiple node deletion step is used.
Results
Out of many biclusters discovered by the proposed
algorithm two, corresponding to hemiplegia
patients with mild degree of dependency based
on BI, are shown in fig. 12.
Figure 2: 2
nd bicluster discovered by algorithm (=106, =1.2).
The similarity is observed at the ankle joint and in
the last phase of gait cycle in the knee joint.
The bicluster contains 36 cycles (7 trials from
5 hemiplegia and 29 trials from 7 typical subjects).
Discussion
We proposed the application of a new method,
biclustering, to gait data analysis. Proposed
solution is relevant to gait analysis because of the
complexity of the data. It can be used by clinicians
in diagnosis of human apparatus, supporting
decision making with respect to prescribing
orthotics, surgery, etc.
References
Alaqtash M. et al, Automatic classification of
pathological gait patterns using ground reaction
forces and machine learning algorithms,
Conf Proc IEEE Eng Med Biol Soc: 453457, 2011.
Cheng Y. et al, Biclustering of expression data,
American Association for Artificial Intelligence,
2000.
128
O 10 2
IMPACT OF BILATERAL, SEVERE KNEE OSTEOARTHRITIS

ON DYNAMIC BALANCING ABILITY
R. Kiss1, . Pethes2, G. Szab3
1
Budapest Univeristy of Technology and Economics, Mechatronics, Optics and Mechanical

Engineering Informatics, Budapest, Hungary
2
Szent Jnos Hospital, Department of Ortopeadics and Traumatology, Budapest, Hungary
Budapest Univerity of Technology and Economics, Mechatronics Optics and Mechanical

Engineering Informatics, Budapest, Hungary
Introduction
The gait parameters, the variability of gait, the
balancing ability are influenced by unilateral
knee osteoarthritis. Creaby et al 1 established
the gait parameters of patients with bilateral
knee osteoarthritis significantly differ from the
parameters of healthy, age-matched subjects,
however they are symmetrical. The aim of this
study is to analyze balancing ability after sudden
perturbation characterized Lehrs damping ratio
measured by provocation test stance on both
and on single limb at patient with bilateral knee
osteoarthritis.

The lateral dominance did not influence the Lehrs
damping ratio in male controls
(p both-dominant = 0.21;
pdominant-nondominant = 0.37;
pboth-nondominant = 0.09);
and in female controls
(pboth-dominant = 0.21;
pdominant-nondominant = 0.37;
pboth-nondominant = 0.09) (Table 2).
The gender did not influence significant the Lehrs
damping ratio
(pboth = 0.13;
p dominant = 0.17;
pnon-dominant = 0.09) (Table 2).
Balancing ability after sudden unidirectional
perturbation of 20 controls (10 males, 10 females,
68.46.22 years, 81.515.6 kg, 1.680.12 m),
20 patients with bilateral knee osteoarthritis
(9 males, 11 females, 67.210.1 years, 90.419.7kg,
1.710.13m) was examined by provocation tests
during double leg and single leg stance, using the
platform of the PosturoMed device. 2 Balancing
ability was characterized by the Lehrs damping
ratio.2
The Lehrs damping ratio significant smaller in both

gender compared to healthy subjects
(p both < 0.00007;
p dominant < 0.000004;
pnon-dominant < 0.00007)
C o n cl u s i o n
For patients with bilateral knee osteoarthritis the
dynamic balancing ability did not influenced by
gender and lateral dominance. The balancing
capacity while stance on single limb was
symmetrical. This finding was similar to findings from
results of gait analysis 1. The lower Lehrs damping
ratio of patients means the dynamic balancing
ability is decreased compared to controls. This
could be taken into account in the use of different
aids and in compiling the conservative protocol.
References
1 Creaby, M.W. et al., Archives of Physical Medicine
and Rehabilitation 93:822827, 2012.
2 Kiss RM, Medical Engineering and Physics,
33: 11601166, 2011.
A C K NO W L E G MENTS
This project is supported by the Hungarian Scientific
Fund K083650.
129
O 10 3
SIT-TO-STAND TRANSITION PERFORMED BY HEALTHY

YOUNG PARTICIPANTS
I. Campos Padilla1, A. Walmsley2, D. Jimenez Cruz2, T. Alonso Rasgado2
1
The University of Manchester, School of Mechanical, Aerospace and Civil Engineering,

2
The University of Manchester, School of Materials, Manchester, United Kingdom

Successful STS depends on the participant
generating sufficient linear momentum of the
Centre of Mass in the antero-posterior and vertical
axes, accounting for 59% and 32% respectively of
the total variance. Angular momentum variables
account for only 4% of the overall variance and so
are much less important than the linear momentum
variables.
Introduction
Sit-to-Stand (STS) transition analysis is a common
test of human motion used to estimate the level of
mobility of the participant. While the STS movement
has been studied extensively, the contribution of
the individual limb segments and the musculature
responsible for their movement has not been
extensively investigated. Hence, the objective of
this study, to estimate the contribution of the lower
limb segments during the STS, and determine the
most important momentum variables for each
segment.
C o n cl u s i o n
The head, arms, and trunk (HAT) and pelvis
segments are essentially passive loads driven by
the lower limb segments. Although all the lower
limb segments and joints have a role in performing
STS, the knee joint torques appear to be the most
important factor in creating the linear and angular
momentum necessary to leave the chair.
Ten healthy participants, mean age 282 years old
years old were studied during the performance of
the STS transition. Kinematics data were captured
using a six-camera high speed from a VICON motion
capture system. Kinetic variables were calculated
using custom software (SMAS, Ren, L. and et al. [1])
and PCA was used to reduce the dimensionality of
the data and clarify the momentum variables that
took up most of the variance in the kinetics.
References
1 Ren, L., R.K. Jones, and D. Howard, Whole body
inverse dynamics over a complete gait cycle
based only on measured kinematics. Journal
of Biomechanics, 2008. 41(12): p. 27502759.
130
O 10 4
POSTURAL RISK FACTORS IN MANUAL

MEAT CUTTING IN INDIA
P. Mukhopadhyay1
1
Indian Institute of Information Technology Design and Manufacturing Jabalpur, Design,

Jabalpur, India
Introduction
Employees in unorganized occupational sectors
are at high risk of postural risk factors. Manual meat
cutters in India belong to such a sector, as they
may be especially prone to awkward postures 1
over long periods of time. This study investigated
the nature and magnitude of posture related risk
factors2 among manual meat cutters in India. The
aim was to estimate the nature and quantum of
postural risk factors among adult male manual
meat cutters working in this sector.

Ovako working posture analysis indicated high
scores of 4 for the back in peeling, 6 for the arms
in cutting and 6 for the arms during mincing tasks.
REBA scores were extremely high at 10/10 for
deboning and mincing tasks, all associated with
awkward posture of the upper part of the body.
C o n cl u s i o n
The study indicates that majority of the
occupational tasks for meat cutters are in the highrisk category for occupation injury. Results suggest
that ergonomic intervention in the form of tool,
workstation and process design 3 would be useful
in reducing the number of injuries through postural
correction.
E X P ERIMENTA L METHOD :
Direct observation, activity analysis, questionnaires,
interviews, photography, and video to measure
the postural risk factors.
Acknowledgement is owed to all those who
volunteered for this project.
References
1 Kattel BP et al, Int Jr of Ind Erg. 18:423429, 1996.
2 Wiker FS et al, Erg. 32:211237, 1989.
3 Kumar S Erg. 44:1747, 2001.
131
O 10 5
EFFECTS OF PRELOAD, PERTURBATION LOAD, INITIAL

FLEXION AND ABDOMINAL PREACTIVATION ON SPINE
STABILITY IN SUDDEN PERTURBATIONS
A. Shahvarpour1, A. Shirazi-Adl1, C. Larivire2, B. Bazrgari3
1
Ecole Polytechnique, Mechanical Engineering, Montreal, Canada

2
3
IRSST, IRSST, Montreal, Canada
University of Kentucky, Mechanical Engineering, Lexington, USA
Introduction
Trunk stability margin in sudden perturbation
conditions is substantially improved by larger
agonist/antagonist exertions of paraspinal muscles
and greater spine passive stiffness associated with
larger flexion/compression. The objective here is to
quantify the role of passive, stationary active and
reflexive subsystems on the trunk stability in sudden
forward loads.

ANOVA P values
METHOD
Trunk displacement and perturbation load at the
T8 level and select surface EMG were recorded
in 12 asymptomatic volunteers. 1 Muscle forces
and spinal loads were estimated using a trunk
musculoskeletal FE model driven by measured
individual external load, kinematics and body
weight. 2 In stability analyses and at each time
step, each muscle has a stiffness K=q(F/L) with
F as the computed muscle force and L its length.
The critical stiffness coefficient, q cr taken the
same for all muscles, is subsequently sought as the
trunk smallest natural frequency approaches zero
(i.e., dynamic instability). The average q cr values
are evaluated over four separate time intervals;
1) Pre-q over 256 ms pre-perturbation, 2) Post-q1
over 60 ms post-perturbation set as the mean of
measured reflex latency 1, 3) Post-q2 during 60
to 240 ms post-perturbation in which the reflex
response translates into mechanical action 2, and
4) Post-q3 from 240 ms to 1 sec post-perturbation.
Smaller q cr indicates greater stability margin.
Variables
Pre-q
Post-q1
Post-q2
Post-q3
Preload (PL)
<0.001
0.634
0.393
0.348
Sudden load (SL)
0.314
0.082
0.004
<0.001
Preload _ Sudden
load
0.282
0.105
0.127
0.759
Initial flexion (IF)
<0.001
<0.001
<0.001
<0.001
Abdominal
Coactivation
<0.001
0.003
0.013
0.402
Higher preload markedly reduced the preperturbation qcr due to larger muscle exertion
and stiffness. Higher sudden load significantly
increased stability post-perturbation especially
after the back muscles reflex onset. With the
initial trunk flexion, trunk stability was substantially
improved. Abdominal preactivation increased the
trunk stiffness and stability (due to greater muscle
forces/stiffness) at all times except the final phase.
C ON C L USION
Results highlight the crucial role of the ligamentous
spine and muscles (passive/active) in augmenting
the trunk stiffness and hence stability at all phases,
a role much evident in the presence of initial trunk
flexion.
RE F EREN C ES
1 Shahvarpour, J Electro Kin, 24:394403, 2014. 2.
Shahvarpour, J Biomech, 48: 4452, 2015.
A C K NO W L E G MENT
Supported by NSERC-Canada and IRSST-Quebec
132
O 106
MECHANICAL PREDICTORS OF DISCOMFORT

DURING LOAD CARRIAGE
P.D. Wettenschwiler1, S. Lorenzetti2, R. Stmpfli1, R.M. Rossi1,
S.J. Ferguson2, S. Annaheim1
1
Empa- Swiss Federal Laboratories for Materials Science and Technology,

Laboratory for Protection and Physiology, St. Gallen, Switzerland
2
ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
Introduction
Discomfort during load carriage is a major issue
for activities using backpacks (e.g. infantry
manoeuvres, children carrying school supplies, or
outdoor sports). Nevertheless, the discomfort related
to the mechanical interaction between the body
and load carriage system is poorly understood. As
contact pressure is known to influence discomfort
at the shoulder and hip region [Stevenson, 1997],
hip belts may play a crucial role in load carriage
system design to relieve pressure in the shoulder
region. For its optimization, it is necessary to
know the parameters strongly associated with
discomfort. Therefore, we investigated how much
subjective discomfort can be explained by body
surface pressure, strap forces, and relative motion
between body and load carriage system.
by questionnaire, using visual analogue scales.

The mean values of all subjects were used for
several multiple linear regressions in each region,
with discomfort as dependent variable and the
mechanical parameters as predictors. Entry
method was stepwise backwards with the exclusion
criterion p .05.
Results
The regression analysis with the mechanical
parameters that were measured directly on the
body (average and peak pressure, both static
and dynamic) revealed static peak pressure as
a significant predictor (p < .001) with R2 values
of 0.85 (shoulder) and 0.86 (hip).
The regression analysis with all mechanical
parameters (average pressure, peak pressure,
strap forces, and relative motion) revealed strap
tension for the static scenario (p < .001) and
strap tension and relative motion for the dynamic
scenario (p < .01) as significant predictors with
R2 values of 0.85 and above.
Methods
A commercially available backpack (Figure 1a)
was examined in 12 different configurations:
3 loads (15 kg, 20 kg, 25 kg) x 4 hip belt tensions
(30N, 60N, 90N, 120N).
Discussion
Static peak pressure is very well suited to predict
subjective discomfort and can be regarded as
an important mechanical parameter for future
optimization of load carriage system design. The
perception of static peak pressure on the body
does not depend on the type of load carriage
system; hence this finding can be applied to most
load carriage system types. Strap tension on the
other hand might well depend on the type of load
carriage system. Thus, applying strap tension as
a mechanical predictor of discomfort should be
limited to systems that are comparable to the one
used in this study, e.g. backpacks with hip belts.
Figure 1: B
ackpack applied in this study (a), and location of
the Tekscan sensors on a subject (b) as well as on
the dummy (c).
Pressure sensors (Tekscan type 9811E, Tekscan,

USA) were placed on the skin of the subjects
(n = 10) in the shoulder and hip region (Figure 1b).
Force sensors were applied at the shoulder strap
and the hip belt to assess the average strap forces.
Polhemus Liberty sensors (Polhemus, USA) were
used to measure the cumulative relative motion
between body and backpack in both regions.
3 repeats were conducted for both static (standing)
and dynamic (walking at 4.5 km/h) measurements.
Discomfort was assessed in randomized order
A comparison with measurements on a dummy

(Figure 1c) is currently running to investigate to
which extent future measurements of discomfort
during load carriage are possible without human
subject studies. The option of evaluating different
concepts and designs of load carriage systems on
a dummy reduces effort and costs in the future
development of load carriage systems.
References
Stevenson et al, Techn Rep, 2001081, 1997.
133
O 107
HIP ABDUCTORS ONSET ALTERATIONS DURING RUNNING

IN ILIOTIBIAL BAND SYNDROME SUBJECTS
V.H. Munoz-Martel1, E. Opazo2, C. Rozbaczylo2
1
2
Universidad SEK, Kinesiology, Santiago, Chile
Universidad de Chile, Kinesiology, Santaigo, Chile
Introduction
Running practice is highly associated with overuse
injuries. Among these injuries Ilio-tibial band
syndrome (ITBS) is the main cause for lateral
knee pain in distance runners. The etiology
for these condition has been associated with
multiple mechanical factors (Louw and Deary
2014). Augmented knee internal rotation and
hip abduction are strongly related with ITBS
etiology (Hamill et al. 2008; Ferber et al. 2010).
These kinematic alterations migth be related
with muscular weakness (Fredericson et al. 2000),
altough it is still controversial (Grau et al. 2011).
Since pain is expressed during contact (Rene,
1970) and considering that kinetic and kinematics
variables are an expression of neuromuscular
strategies this study proposes that ITBS migth be
related with muscular hip frontal control during
stance phase, wich migth cause lateomedial
overload at the knee. Therefore the aim of the
present study is to compare hip abductors onset
during running in ITBS and healty subjects.
Results
Wilcoxon test resut shows signifficative differences
for Gluteos Medium between groups where ITBS
shown late activation for GM (Z=2.295, p =0.22).
Methods
28 male volunteers (14 ITBS, 14 control) were tested
at Universidad de Chile`s Human Performance
Laboratory. After given written consent reflectives
markers were placed bilateraly in acromion,
anterior superior iliac spine, greater trochanter,
lateral femoral epicondyle, lateral malleolus and
the head of the fifth metatarsal. EMG sensors were
placed in Tensor Fascia Latae and Gluteus Medium
according to SENIAM recomendations. Subjects
were asked to run on a treadmill at 10 Km/h with 1%
inclination, after a 5 minutes warm up, IR kinematic
at 120 fps (BTS SMART, BTS Bioingeneering) and
emg at 1000 Hz (BTS FreeEMG, BTS Bioingeneering)
data were collected for 30 seconds, 3 trials per
subjects were performed. EMG signals were
trimmed from 100 ms prior to initial contact to the
next initial contact in order to abtain information
on the prepration for the cicle and the entire
cicle itself. Signals were averaged and onset was
obtained using double threshold method for each
muscle by a blind investigation. Onset times were
then separated is respectives groups and tested
for differences between grupos by Wilcoxon Test
with signifficance of 0.05.
References
F erber, R., Noehren, B., Hamill, J., & Davis, I. S.
(2010). Competitive female runners with a history of
iliotibial band syndrome demonstrate atypical hip
and knee kinematics. Journal of Orthopaedic
& Sports Physical Therapy, 40(2), 52e58.
F redericson, M., Cookingham, C. L., Chaudhari,
A. M., Dowdell, B. C., Oestreicher, N., & Sahrmann,
S. A. (2000). Hip abductor weakness in distance
runners with iliotibial band syndrome. Clinical
Journal of Sport Medicine, 10(3), 169e175.
Grau, S., Krauss, I., Maiwald, C., Best, R., & Horstmann, T. (2008). Hip abductor weakness is not the
cause for iliotibial band syndrome. International
Journal of Sports Medicine, 29(7), 579e583
Hamill, J., Miller, R., Noehren, B., & Davis, I. (2008).
A prospective study of iliotibial band strain in
runners. Clinical Biomechanics, 23(8), 1018e1025
Louw, M., & Deary, C., The biomechanical variables
involved in the aetiology of iliotibial band syndrome
in distance runners e A systematic review
of the literature, Physical Therapy in Sport (2013),
http://dx.doi.org/10.1016/j.ptsp.2013.07.002
Renne, J. W. (1975). Iliotibial band friction
syndrome. Journal of Bone and Joint
Surgery-American, 57(8), 1110e1111
Spearman`s correlation test shown a positive

correlation between delayed onset and ITBS
laterality (rho =0.570, Sig =0.002).
Discussion
The results of the present study suggest that there
is an alteration of neuromuscular control strategies
for hip frontal plane during stance phase, whereas
healty subjects show activation prior to initail
contact for all hip abductors, ITBS subject shows
a late activation where many activate GM
posterior to initial contact.
These result may copntribute to a neuromuscular
approach to overuse injuries, since it appear that
while healty subjects use a feedforward strategy to
control hip and knee mechanics during the ground
collision ITBS use a feedback strategy.
Considering the later.Key words

Running biomechanics, onset detection,
electromyography, knee pain, hipabductors.
134
O 10 8
COMPARISON OF DIFFERENT PROSTHETIC FEET AND

RUNNING STYLES IN A MACHINERY TEST SETUP FOR THE
MECHANICAL CHARACTERIZATION OF RUNNING SHOES
F. Starker1, A. Steck1, F. Blab1, F. Dennerlein1, U. Schneider1
1
Fraunhofer IPA, Biomechatronic Systems, Stuttgart, Germany
Introduction
Aim of this study was to investigate various
mechanical influences for the characterization of
running shoes with a prosthetic foot test machine
(ISO 22675) to mimic human running kinetics and
kinematics [Starker et al. 20141, 2014 2].
Methods
Human motion data of running was captured
from one subject (m, 27 y., 74 kg, UK 8.5) on
a 12 m runway in a motion lab. 3 different shoes
were worn (Vivo Barefoot Evo Pure, adidas
Gore-Tex XCR, Asics Gel DS Trainer). 10 consecutive
running trials were performed with each shoe.
Kinetic (AMTI AccuGait, 2400 Hz) and kinematic
data (Qualisys QTM, 9 cameras, 240 Hz) were
captured. One specific step of each shoe trial
was selected and processed to be feed into
the test machine software. The test machine
(Shore Western KS2-07, see Fig. 1) was equipped
with different prosthetic foot models (College
Park Soleus, Endolite Navigator, Otto Bock 1D10,
ssur Variflex Evo).
Figure 2: S implified Ishikawa diagram to break down

influences evaluated for cross comparison
for the simulation.
Results
Individual motion data could be applied
successfully to the machine. Captured data
needed to be filtered and fitted by a polynomial
(11 th order) aiming for a smooth automatic
adaptation of the force levels by the test machine.
The shoe models showed differences in resulting
moments by keeping input forces (Fzm) and
movement data similar. Hence anterior/posterior
forces are a result thereof. The prosthetic foot
model Navigator was modified at the metatarsal
region to reach a higher range of motion in toe
flexion. Thus, machine test results with Navigator
were most similar to human foot data during motion
lab running. Variances in shoe characteristics due
to their different mechanical designs could be
clearly shown in force, moment and calculated
supporting lever arm data.
The test machine was programmed with four

motion data sets. Each motion test was performed
with each shoe and each foot in overall 64 trials
(see Fig. 2). Forces and moments are acquired
with a 6 degrees of freedom load cell. Furthermore
machine sensor data (shank angle, axial height,
acceleration, force) is recorded for comparison.
The machine is displacement controlled and
consequently adapts after several steps to the
preferred force in axial piston direction (Fzm).
Other forces and moments are produced as results
of the test setup.
Discussion
This method can be used to characterize
mechanical properties of shoes based on individual
subject based biomechanical data. Endurance
tests up to 2 million movement cycle are possible.
Further research is needed to clarify the meaning
of acquired machine test data and its potential
effects to the human runner.
References
1 Starker, F. et al., Proc Eng 72, 405410, 2014
2 Starker, F., et al., Int. Calgary Running Symposium,
130131, 2014.
Figure 1: T est machine setup
135
O 109
ANALYSIS OF THE PLANTAR PRESSURE DISTRIBUTION

DURING RUNNING AFTER CYCLE SECTION OF SIMULATED
TRIATHLON RACE
D. Gerych1,2, A. Tvrznik2, K. Jelen1
1
Charles University in Prague, Faculty of Physical Education and Sport, Department of

Anatomy and Biomechanics, Prague, Czech Republic
Sports Research Institute of Czech Armed Forces, Department of Kinathropology, Prague,

Czech Republic
Results
A significant reduction of plantar pressure and
force under the toes 2.5. and significant reduction
of contact area under lateral forefoot were found
during running at the race intensity following the
cycling part of the competition simulated loading
in the observed group of triathletes. Furthermore,
there was a tendency for the peak pressure and
force to be higher under the medial and lateral
forefoot. However, these differences were not
statistically significant. No significant changes of
stride frequency and foot contact time were found
in the observed group of triathletes.
Purpose
The purpose of this study is to indicate the changes
in plantar pressure distribution, maximal force and
contact area during the stance phase of running
that may occur in triathletes during the run section
of a triathlon race as a consequence of altered
locomotion after previous cycling.
Methods
A group of 10 competitive triathletes (8 male
and 2 female) at age 2246 years participated
in this study. All subjects underwent competition
simulated
laboratory
test
which
included
10 minutes of running, 50 minutes of cycling and
10 minutes of running at intensities corresponding to
their race pace. Peak pressure, maximal force and
contact area during the stance phase of running
were detected at 7 regions of the foot (medial
heel, lateral heel, midfoot, medial forefoot, lateral
forefoot, big toe and other toes) during running
before and after cycling using Pedar-X Novel
tensometric system. All resulting values including
foot contact time and stride frequency were
obtained through an analysis of the 200 step period
selected from the record provided by the Novel
Pedar-X system during initial and final running.
C o n cl u s i o n
The results of this study indicate a shift of the
load from toes to the metatarsal area during
running after cycling segment of a triathlon race.
This change is supposed to result from altered
neuromuscular coordination and general, as well
as, local muscular fatigue after previous cycling.
136
O 11 0
RELIABILITY OF INERTIAL MEASUREMENT UNITS APPLIED

TO VIBRATION SIGNAL DURING RUNNING
T. Provot1, G. Vitry1, F. Bolaers2, X. Chiementin2
1
2
neXXtep Technologies, Reims, France
Universit de Reims Champagne Ardenne, GRESPI, Reims, France
Introduction
Sports domain present an interest about a
detailed description of human kinematic to assess
performance and injury risk. However today to
determine the athlete performance, kinematic
must be completed by vibration assessment
[Friesenbichler, 2011], [Giandolini, 2013]. The
outdoor measure of kinematic is usually carried
out using use inertial measurement units (IMU)
[Horvais, 2013], [Lee, 2010]. Moreover some of
these IMU present high sampling frequency. But
these sampling frequency are they enough to
make the IMU adapted to vibration assessment?
This study aimed to validate the use of an IMU
for vibration measurement during running using
two different sampling frequency. The validation
is done through a comparison with a calibrated
industrial accelerometer defined as gold standard.
Results
CV for both IMU were weak (2% and 3%) and similar
from references CV. For both IMU, the first range of
frequency were good correlated (p<0.001). Past
a threshold (90Hz for IMU1 and 30Hz for IMU2) the
correlation shows significant difference (Figure 1).
No differences were reported by changing speed
even if this parameter have impact on vibration
amplitude and spectrum staggering.
Methods
One male subject was recruited. He was equipped
on each leg with an IMU (Hikob, Fox system,
France) and a calibrated industrial sensor as gold
standard (Bruel&Kjaer, 4525B, Denmark, 2560Hz).
IMUs were securely placed on the body through
an elastic band, and references were attached
on the leg using double sided tape. Sensors were
placed on skin over the tibia near the center of
gravity of the leg. IMUs were sampled at 1344Hz
(IMU1) and 400Hz (IMU2) respectively for the right
and the left leg. Subject performs 15 randomized
measures on a treadmill divided in two studies.
A first study of reproducibility was composed
of 10 measures at 12 km/h. A second study of
speed influence was composed by 6 measures
at 81012141618 km/h (12 km/h was common
to both studies). Total acceleration was computed
for every sensors and presented as Root Mean
Square (RMS). Mean, standard deviation and
coefficient of variation (CV) were calculated on
the RMS to judge reproducibility of the 10 measures
at 12km/h. Correlation coefficient r was calculated
for a sliding windows of 10Hz between each
IMU and its reference on a range of 150Hz. Test of
Bravais-Pearson (p<0.05) was applied on r coefficient.
Figure 1: r coefficient for IMU1 for 16km/h (black line p=0.05).
Discussion
IMU Hikob Fox shows a good reproducibility in
running. The signal of IMU2 (sampled at 400Hz)
does not allows representing a complete running
spectrum, but the good correlation of the first
range of frequency can be used for movement
assessment. The signal of IMU1 (sampled at 1344Hz)
present a larger range of frequency and represent
an important part of a running spectrum. The IMU
present advantages for running assessment like
autonomy and lightness but it can be limited for
a complete representation of running spectrum.
The efficiency IMU is apparently not impacted by
change of speed, amplitude and frequency.
References
Friensenbichler et al, J Biomech, 44(1):11620, 2011.
Giandolini et al, Footwear Sci, 5(1):1415, 2013.
Horvais et al, Footwear Sci, 50(1):2627, 2013.
Lee et al, J Sci Med Sports, 13(5):55963, 2010.
137
O 111
SIMILAR EXPERIMENTAL CONDITIONS DECREASE

INTER-SUBJECT VARIABILITY OF RUNNING GAIT
D. Villeger1, A. Costes2, B. Watier3 , P. Moretto4
Universit de Toulouse, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9,
France, Toulouse, France
Universit de Toulouse, UPS, PRISSMH, 118 route de Narbonne, F-31062 Toulouse Cedex 9,
France, F2SMH, Toulouse, France
CNRS, LAAS, 7 avenue du colonel Roche, F-31400 Toulouse, France, GEPETO, Toulouse, France
4
CNRS, Centre de Recherche sur la Cognition Animale, 118 route de Narbonne, F-31062
Toulouse Cedex 9, France, Dynactom, Toulouse, France
Introduction
Originally used in the fluid mechanics field,
the concept of dynamic similarity enables two
different-sized systems to be considered as scaled
models by setting them in equivalent Experimental
Conditions (EC). This paper aims to use this concept
for comparing locomotion between subjects of
different sizes.
Human locomotion is commonly modelled by
a Spring Mass Model (SMM) which takes into
account an elastic component. By the pi theorem
[Buckingham, 1914], the SMM motion can be
reduced to 4 dimensionless variables. Two of them
are the Froude (Nfr = v2/ gl; with v the speed, g the
gravity and l the center of mass height) and the
Strouhal (Str = fl / v; with f the oscillation frequency)
dimensionless numbers.
The aim of this study is to induce dynamic similarity
among different-sized subjects with particular EC
dependent on Nfr and Str.
Figure 1: T he three experimental condition

(from top to bottom: ECSPEED, ECNFR and ECMOD).
METHODS
19 participants (height from 1.68 m to 1.94 m) ran
at six speed stages (1.67, 2.22, 2.78, 3.33, 3.89,
4.44 ms -1) in three different EC on a treadmill embed
to a forceplate sampled at 1 kHz (AMTI, Watertown,
MA, USA) surrounded by 12 optoelectronic
cameras sampled at 200 Hz (VICON, Oxfords
metrics, Oxford, UK).
RESU L TS
For all speed stages, the dynamic similarity was
met for 16 (mean r = 0.51), 32 (mean r = 0.49)
and 52 (mean r = 0.60) parameters out of 54 GRF
parameters in ECSPEED, ECNFR and EC MOD, respectively.
The variability of the dimensionless preceding
parameters and joint angles was significantly lower
in the third condition.
The three EC (figure 1) consisted of imposing

(i) EC SPEED: a constant speed, (ii) EC NFR: a fixed Froude
(similar speed) and (iii) EC MOD: a fixed combination
of Froude and Strouhal called Modela-r [Delattre,
2008] (similar speed and similar step frequency).
DIS C USSION
This study shows that the combination of Nfr and
Str (Modela-r) ensures dynamic similarity between
different-sized subjects. The relevance of using
similar experimental conditions (EC MOD) to compare
mechanical dimensionless parameters is also
proved and could highlight the study of running
techniques, or equipment, and could allow the
identification of abnormal and pathogenic running
patterns. On this basis, Modela-r have been
adapted for walking [Villeger, 2015] and may be
adapted to study other abilities requiring bounces
in human or animal locomotion or to conduct
investigations in comparative biomechanics.
For each speed stage the dynamic similarity was

evaluated from the comparison of theoretical
and measured scale factors [Villeger, 2014] for
9 Ground Reaction Forces (GRF) parameters (time,
force, impulse and loading rate). Moreover, the
effect of the EC on the inter-subject variability was
also tested for these dimensionless parameters
and for the ankle, the knee and the hip angles
throughout the running cycle.
RE F EREN C ES
Buckingham, E. Phys.Rev, 4: 345376, 1914.
Delattre et al. J. Biomech, 41: 28958, 2008.
Villeger et al. J. Biomech 47: 38627, 2014.
Villeger et al. Gait Posture 41: 2405, 2015.
138
O 11 2
TIBIAL STRAIN DISTRIBUTION FOLLOWING RTKR

SURGERY USING PRECISE COMPARTMENTAL
PHYSIOLOGICAL LOADING
S. Wright1, S. Gheduzzi1, A. Miles1
1
University of Bath, Centre for Orthopaedic Biomechanics Mechanical Engineering,

Bath, United Kingdom
Introduction
The implantation of stemmed tibial components
during revision total knee replacement (RTKR)
surgery is believed to alter the strain distribution
through the tibia and lead to proximal bone
resorption and patient reported pain at the stem
tip. Additionally, the in vivo use of instrumented
tibial components has demonstrated that the
compartmental load share across the tibial
condyles changes during daily living activities
[Mundermann, 2008]. Despite this, compartmental
load share is not directly measured or controlled
in experimental studies that assess load transfer
through the tibia.
The strain gauge results were processed to

calculate the principal strain values and averaged
across the five specimens. An example of the
results for a single gauge is presented in Figure 2.
The implantation of a tibial component produced
a significant reduction in strain in the three proximal
gauges and at the mid stem region (Within Subjects
ANOVA p<0.0125). There was also a significant
increase in strain at the stem tip with 0 flexion after
implant insertion.
Discussion
The significant reduction in strain in the proximal
tibia aligned with the proximal bone resorption
that has been reported post-RTKR. The increase
in strain around the stem tip correlates with the
pain that can be reported by patients after
surgery. These results should guide future implant
design to improve how load is transferred through
the tibia and advance clinical outcomes. The
specific design to adjust for physiological loading
also highlights the importance of incorporating
the compartmental load share into pre-clinical
assessment techniques.
The aim of this study was to assess the load

distribution through the tibia before and after
implantation of RTKR components, whilst monitoring
compartmental load distribution. An experimental
rig was developed that replicated physiological
loading through the knee, including a method
to measure and control the compartmental load
share across the tibial condyles. The investigation
employed force sensors to measure compartmental
load and strain gauges to provide the cortical
strains in a composite tibia as an indication of load
transfer through the bone. This investigation will
further understanding of the effect of stemmed
tibial components on the strain levels through the
tibia and guide future implant designs to improve
patient outcomes.
Methods
An experimental rig was developed to replicate
knee loading conditions and allow the adjustment
of the compartmental load share in the tibial
condyles (Figure 1). Five composite tibias (4 th
Generation Sawbones) were prepared with five
strain gauge rosettes (HBM) and tested under
physiological loading. The loading through the
medial and lateral compartments was measured
using two force sensors in the condyles (Tekscan)
and adjusted prior to each test. The cortical strains
were recorded under a 500 N load applied at 0
and 10 of flexion by a hydraulic test machine. The
five tibias were then implanted with Stryker Triathlon
components according to surgical protocol and
testing was repeated.
Figure 1: T he experimental rig capable of physiological

loading through the knee with a RTKR to measure
the strain distribution through the tibia.
Results
Preliminary test results verified the use of the force
sensors to measure the load share and illustrated
the relationship between compartmental loading
and strain distribution through the tibia.
see the next page
139
Figure 2: T his example shows the principal strain measured

at the mid stem gauge averaged across all five
specimens during four loading scenarios.
References
Mundermann, A., et al. J Orthop Res, 26(9):
116772, 2008
140
O 11 3
EFFECT OF VARUS-VALGUS MALALIGNMENT ON STRESS

DISTRIBUTION OF TIBIA USING FINITE ELEMENT ANALYSIS
C.H. Moon1, K.M. Kim1, O.S. You2, H.J. Chun1
1
2
Yonsei Univ., Mechanical Engineering, Seoul, Korea, Republic of Korea
CORENTEC Co.-Ltd, Central R&D center, Seoul, Korea, Republic of Korea
Introduction
Unicompartmental Knee Replacement (UKR) is
a great surgical option for knee reconstruction.
However, some patients felt postoperative
unexplained pain in their proximal tibia.
Unexplained pain is a controversial issue and is one
of the most critical causes of revision.[Pandit,2006]
Researchers suggest a high bone strain as a main
factor causing postoperative pain. It is believed
that bone strain would be affected by varusvalgus malalignment on tibia. Therefore, the effect
of varus-valgus malalignment on tibia bone strain
was investigated.
Methods
In this research, the influence of varus-valgus
malalignment on tibia using three-dimensional
validated finite element models was investigated.
The FE models representing generalized Asian
tibia and varus-valgus malalignment on tibia were
developed.[Dai,2013][Kwak,2007] The UKR design
were implanted and tibial inserts representing a
neutral alignment from 0 to 10 in 2.5 increments
varus and valgus alignments were modeled,
respectively and the transvers cut was made
with 3 posterior slope.[Cho, 2014] Each model
was simulated in flexion angles of 0, 45 and 60
respectively and compression loads of 1150N,
3200N and 2800N were applied to proximal tibia
in each flexion.[Villa,2004] In the 0 flexion model,
690N was applied to medial condyle and 460N to
lateral condyle.The 1920N and 1280N in flexion
45 were applied to medial condyle and lateral
condyle respectively. The 1680N and 1120N in
flexion 60 were also applied to medial condyle
and lateral condyle respectively.[Daley,1975]
Figure 1: P
osition of the region A
Figure 2: R
esults for principal strain of region A by tilt
of varus-valgus.
References
Cho et al, Springer-Verlag Berlin
Heidelberg 2014, 2014
Cobb et al, JBJS, 90:10321038, 2008
Dai et al, J Orthp. Res., 31:16431652, 2013
Daley et al, Unpub. Doc. Diss.,1975
Kwak et al, The Knee, 14:295300, 2007
Pandit et al, JBJS,88:5460
Villa et al, J of Biomech, 37:4553,2004
Results
The region A was observed because it is where
patients felt pain [Figure 1]. In neutral position, the
principal strains were 592, 1541 and 1336 in
flexion 0, 45 and 60 respectively. The maximum
strain was 1674 at varus 10 in flexion 45.
The minimum strain was 525 at valgus 10 in
flexion 0 [Figure 2]
Discussion
The changes of bone strains in tibia due to The
varus and valgus malalignments show opposite
tendency. Principal strain were reduced in valgus
malalignment. Therefore, varus malalignment of
prostheses could lead the negative effect on bone
strain, on the contrary to valgus malalignment.
However, valgus malalignment also has many
negative effects like increasing contact stress,
wear, early loosening and etc. on UKR. Both
malalignments of UKR should be avoided.
141
O 11 4
PATELLA IN PLACE GAP BALANCING MORE ACURATELY

RECREATES KNEE JOINT CENTER OF ROTATION
S. Lynch1, B. Fleischer1, M. Ettinger1, C. Hurschler1, T. Calliess1
1
Hannover Medical School, Orthopaedic Clinic, Hannover, Germany
Introduction
Total knee replacement involves removal of
damaged tissue and implantation of an artificial
surface. Conventional surgical technique is
measured resection (MR) defined through
anatomical
landmarks
(Victor,
2009).
The
conventional MR has proven to establish femoral
rotation however there is prevalence of joint gap
asymmetry that can be attributed to bone landmark
detection and repeatability (Dennis, 2010). Patella
in-place gap balancing (PIPB) establishes equal
ligament loads, thusly less dependent on anatomy
and is suggested to provide a more reproducible
flexion gap (Daines, 2014). The purpose of this
study is to investigate the ability of PIPB to return
natural knee function and its repeatability, whilst
additionally comparing PIPB to MR.
Discussion
This study presents that the COR for PIPB more closely
represents that of the native condition compared
to MR. Additionally, this paper supports the claims
of previous work (Daines, 2014) with a reduced
standard error and increased repeatability using
PIPB (Figure 1).
Methods
Freshly frozen cadaver specimens were randomly
assigned to MR or PIPB. Each group completed
six extensions, three prior and three post total
knee replacement. The specimen was fitted to a
specifically designed isokinetic in vitro knee flexionextension simulator. The femur was fixed in place
whilst the tibia was fitted to a force-feedback
lever arm that allows freedom of movement with
exception to flexion-extension under physiological
loading. The helical axis was referenced to the fixed
femoral bone and calculated using adaptations
from (Spoor, 1980) and (Metzger, 2010), per six
degrees of motion a centre of rotation (COR)
and axis of rotation was calculated. Results are
presented as the difference from the native COR.
Figure : A
nterior-Posterior (top) and superior-inferior
(bottom) shift of COR from native equivalent.
Results
Shift of native COR after MR was located
3.414.66 mm (MeanSE) and 5.7710.25 mm
posteriorly at 120 and 20, 13.091.47, 1.270.76,
12.236.59, 19.952.86 and 11.142.35 mm
anteriorly at 100, 80, 60, 40 and 5 respectively,
whilst PIPB was 3.481.37, 3.990.01, 3.760.03
and 11.898.08mm posteriorly at 120, 80, 60, and
20, and 3.780.31, 5.461.33 and 3.050.75
anteriorly at 100, 40 and 5 respectively (Figure
1). Furthermore the COR after MR was located
16.519.39, 2.231.39, 18.923.23, 31.6719.41,
17.267.97 and 29.164.26mm inferiorly at 120, 80,
60, 40, 20 and 5 respectively and 0.730.80 mm
superiorly at 100, whilst PIPB was 1.841.86,
17.587.44, 19.802.74 mm inferiorly at 80, 20
and 5 respectively and 2.232.20, 4.781.63,
6.280.21 and 10.730.16 mm superiorly at 120,
100, 60 and 40 respectively (Figure 1).
References
Daines, et al, Clin Orthop Surg, 6:18, 2014.
Dennis, et al, Clin Orthop Relat Res, 468:1027, 2010.
Metzger, et al, J Biomech, 43:28229, 2010.
Spoor, et al, J Biomech, 13:3913, 1980.
Victor, Orthop Traumatol Surg Res, 95:36572, 2009.
142
O 115
FEMORAL BONE STRAIN ASSESSMENT FOLLOWING

TOTAL KNEE REPLACEMENT USING DIGITAL
IMAGE CORRELATION
K. Rankin1, A. Dickinson1, M. Browne1
1
University of Southampton, Bioengineering Science Research Group,

Introduction
Periprosthetic bone remodelling after Total Knee
Replacement (TKR) [Abu Rajab, 2005] may be
attributed to local changes in the mechanical
strain field of the supporting bone due to the
implant-bone stiffness mismatch [Huiskes, 1987].
Experimental evaluation of the induced strain
field from different implant designs may indicate
stress shielding effects [Scott, 2013]. Digital
Image Correlation (DIC) is increasingly used
in biomechanics for full-field 3D surface strain
measurement. Test setup and selection of suitable
analysis parameters are essential for meaningful
results, but not always reported. The present study
aims to investigate the practicalities of applying
the technique to cadaveric bone for reliable
assessment of the effect of implant material on
femoral bone strain.
Figure 1: 2
nd Principal Bone Strain Maps
Methods
Two distally sectioned cadaveric femurs (2 donors)
were potted in resin at stance; a speckle pattern
was applied to the surfaces, after which they
were subjected to quasi-static loading. Images of
the speckle pattern were acquired using stereo
DIC in six repeated tests. Reference data were
obtained from the intact femora, before each
was implanted with a PEEK-OPTIMA (Invibio Ltd)
or CoCr TKR femoral component of the same size
and geometry, and the test repeated. DIC analysis
was performed using Vic-3D (Correlated Solutions
Inc.) with parameters (subset, step and filter size)
selected for maximum strain gradient sensitivity
vs noise on each model. The measurement bias
and resolution (mean+SD) were assessed under
nominally zero strain conditions and the principal
strains under load were recorded.
Discussion
For the cadaver model, using the same speckle
pattern for correlation before and after
implantation reduced intra-model uncertainty in
strain measurement, but the reduced repeatability
highlights the influence of other variables. The
strain distribution on cadaver bone compared to
the matched analogue models could be affected
by variability in test setup parameters due to
differences in femoral geometry, such as potting
angle, tibio-femoral contact, surgical cuts and
cement mantle thickness. In addition, the difference
in femur aspect ratio vs. implant size and bone
density can influence strain. Moisture formation
on the cadaveric bone must be eliminated to
prevent reflections that introduce measurement
uncertainty from pixel saturation. Correlation
criterion and lighting on the uneven cadaveric
surface are also important considerations. A large
population of cadaveric donors would be required
to determine the absolute effect of TKR implant
material on bone strain; however, paired bone
models would be a suitable way forward for a
comparative study.
Results
Using a subset, step and filter size of 31px, 7px and
15 data points, the lowest strain resolution was
71+56, and the highest measurement variability
(+3SD) was +137 for the cadaveric bone, almost
twice as high as that observed for a similar study
on artificial bone [Rankin, 2014]. Although the
qualitative strain distributions appear similar for both
the intact analogue and cadaver bone (Figure 1),
the change in strain magnitude for the implanted
case was greater in the cadaveric model.
References
Abu-Rajab et al, J Bone Joint Surg, 88, 2006
Huiskes et al, J Biomech, 20, 1987
Rankin et al, ICEM16, Cambridge, July 2014
Scott et al, Bone Joint J, 95, 2013
143
O 116
QUANTITATIVE PARAMETERS USED TO DESCRIBE

THE P-A STABILITY OF THE HUMAN KNEE:
A REVIEW OF IN VITRO DATA
A. Mor1, J. Becker1, C. Roesler1
1
Universidade Federal de Santa Catarina, Biomechanical Engineering Laboratory,

Florianpolis, Brazil
Introduction
Considering both the anatomical and the
functional design philosophy of total knee
prostheses, the knee stability can be see as
an important parameter during designing and
pre-clinical evaluation stages of total knee
prostheses. The ASTM International supplies
standards on the establishment of a database
of total knee replacement (TKR) motion
characteristics with the intent of developing
guidelines for the assignment of constraint of TKR
designs in an experimental in vitro environment.
The test methodology relies on apply a
compressive pre-load at the TKR and move them
in a pre-defined direction, like posterior-anterior
(P-A) displacement, and measure the range
of motion and the reaction force generated
for this direction. Its rationale attempts to the
fact that different individual have distinct soft
tissue capacities for knee stabilization resulting
that different prostheses designs will best fit
each patients needs. There is no acceptance
criterion against which the testing results may be
confronted. The aim of this paper is review and
group the literature data on the limiting values
measured for the P-A passive movement of the
knee on in vitro cadaveric testing. We believe
these data could serve as a preliminary indicative
for setting acceptance criteria when judging the
admissibility of new TKR designs.
after knee tranlation, (4) specify the applied force

as well as its direction and sense to have the range
of motion and (5) shows the degree of knee flexion
for each measure.
Results
Fig. (1) shows the tibial anterior translation values
for different knee angles. Each force value applied
and the corresponding author was represented by
a curve.
Figure 1: A
nterior tibial translation for different knee angles
and postero-anterior loading.
Discussion
The collected data allows a group view of the
AP passive knee stability behavior. These limiting
values can be used to judge the results from preclinical testing of the motion characteristics of TKR
designs.
Methods
The search of data was done at an online database
disponibilized by brazilian government, named
portal peridicos CAPES. The terms used in the
search were: biomechanical human knee laxity in
vitro. The result of the research was refined with
inclusion of articles containing the term: ACL,
in vitro, laxity, PCL, joint instability, knee,
biomechanics, knee joint, and exclusion of
articles with the following topics: patellofemoral
joint, pattela, injury, total knee artroplasty,
tissue engineering, cartilage, reconstruction,
osteoarthritis, tendons and knee injuries. The
articles found in the survey were submitted to
the following selection criteria: (1) is written in the
English language, (2) to analyze human knees in
vitro, (3) provide quantitative parameter before or
References
Anderson et al., Am J Sports Med. 38, 2010.
Kondo et al., Am J Sports Med. 38, 2010.
Piziali et al., J Biomechanics 13, 1980.
Schlepckow, Arch Orthop Trauma Surg. 111, 1992.
Suggs et al., The Journal of Arthroplasty. 19: 2, 2004.
Tsai et al., Am J Sports Med. 38, 2010.
Xu et al., Am J Sports Med. 39, 2011.
Zantop et al., Arch Orthop Trauma Surg. 127, 2007.
Zantop et al., Am J Sports Med. 36, 2008.
144
O 117
ANALYTICAL HOMOGENIZATION SCHEME REVEALING

THE NATURE OF BONE POROSITY PERMEABILITY
RELATIONS
C. Hellmich1, S. Scheiner1, T. Abdalrahman1
1
Vienna University of Technology TU Wien, Institute for Mechanics of Materials and Structures,
Vienna, Austria
Introduction
It is generally agreed on that trabecular bone
permeability,
a
physiologically
important
quantity, is governed by the material?s (vascular
or intertrabecular) porosity as well as by the
viscosity of the pore-filling fluids. Still, there is less
agreement on how these two key factors govern
bone permeability. In order to shed more light
onto this somewhat open issue, we here present
a random homogenization scheme for upscaling
Poiseuille flow in the vascular porosity, up to
Darcy-type permeability of the overall porous
medium trabecular bone [Abdalrahman, 2015].
Methods
The underlying representative volume element
of the macroscopic bone material contains
two types of phases: a spherical, impermeable
extravascular bone matrix phase interacts with
interpenetrating cylindrical pore channel phases
that are oriented in all different space directions.
This type of interaction is modeled by means of a
self-consistent homogenization scheme. While the
permeability of the bone matrix equals to zero, the
permeability of the pore phase is found through
expressing the classical HagenPoiseuille law for
laminar flow in the format of a micro-Darcy law.
The upscaling scheme contains pore size and
porosity as geometrical input variables; however,
they can be related to each other, based on
well-known relations between porosity and specific
bone surface [Martin, 1984].
Figure 1: E
xperimental model validation
Discussion
The new analytical model, a careful theoretical
extension of the famous Carmann-Kozeny relations
[Kozeny, 1927; Carman, 1937], which have often
been applied in the present context, is able to
explain key permeability features which were
assigned to scattering so far. This holds the promise
for soon arriving at more precise and reliable
ways to compute transport processes throughout
bony organs, in particular when combining the
new method with recent evaluation schemes for
computed tomographs [Blanchard, 2013].
Results
As two key results, validated through comprehensive
experimental data [Grimm, 1997; Baroud, 2004;
Naumann, 1999; Kohles, 2001], see Figure 1, it
appears (i) that the famous KozenyCarman
constant (which relates bone permeability to the
cube of the porosity, the square of the specific
surface, as well as to the bone fluid viscosity)
needs to be replaced by an again porosity-dependent rational function, and (ii) that the
overall bone permeability is strongly affected by
the pore fluid viscosity, which, in case of polarized
fluids, is strongly increased due to the presence of
electrically charged pore walls.
References
Abdalrahman et al., J Theor Biol 365, 433444, 2015.
Baroud et al, J Biomech. 2, 189196, 2004.
Blanchard et al, J Biomech 46, 27102721, 2013.
Carman, J Agric Sci.29, 262273, 1937.
Grimm et al, J Biomech. 30,743745, 1997.
Kohles et al, J Biomech. 34,11971202, 2001.
Kozeny, Sitzber Akad Wiss Wien, 136,271306, 1927.
Martin, Crit Rev Biomed Eng 10, 179222, 1984.
Naumann et al, Ann Biomed Eng 4,517524, 1999.
145
O 11 8
EFFECT OF MICRO-FE BOUNDARY CONDITIONS ON

QUADRIC YIELD CRITERIA OF HUMAN TRABECULAR BONE
J. Panyasantisuk1, D. Pahr2, P. Zysset1
1
2
University of Bern, Institute for Surgical Technology and Biomechanics, Bern, Switzerland

Vienna, Austria
Introduction
Hip fractures lead to high mortality and morbidity,
as well as high costs for our health care systems.
Finite element analysis of whole bones can deliver
improved fracture risk assessment but requires an
appropriate yield criterion for trabecular bone.
Identification of a full yield criterion is nearly
impossible in vitro but can be achieved in silico
by using micro-finite element (microFE) analysis
[Bayraktar, 2004] on cubical trabecular volume
elements.
Nevertheless, the influence of boundary conditions
on the obtained fitting parameters of a yield
criterion remains unknown.
Figure 1: L eft: a tri-axial tension on cubical bone region; upper right: the tri-axial tension on 1-3 plane applying
KUBCs; lower right: the tri-axial tension on 1-3 plane
applying PMUBCs.
Accordingly, the aim of this study is to compare

the fabric-based quadric yield criteria of human
femoral trabecular bone computed with classical
kinematic uniform boundary conditions (KUBCs)
and a new set of mixed uniform BCs, namely
periodicity-compatible mixed uniform boundary
conditions (PMUBCs).
Results
Yield surfaces for both BCs have an ellipsoidal
shape and their fitting parameters are shown in
Table 1. PMUBCs induce yield at substantially lower
stresses than KUBCs (Table 1), but the quadric
criteria [Schwiedrzik, 2013] can be well predicted
from volume fraction and fabric.
Methods
Sixteen trabecular cubic regions with a side length
of 5.3 mm were extracted from microCT images
with a resolution of 36 m of 3 human proximal
femora. Image voxels were converted directly
to finite elements with an approximated
Drucker-Prager plasticity model [Schwiedrzik, 2013].
Three uni-axial tensile, three uni-axial compressive,
three shear and eight multi-axial normal load
cases were applied on the trabecular cubes
using the non-linear ParFEAP program for both
KUBCs and PMUBCs (Fig. 1). The yield points of the
stress-strain curve were determined using a 0.2%
offset of the strain and stress norms. Subsequently,
quadric yield surfaces were fitted in stress space
using an optimization scheme in PYTHON.
KUBCs
PMUBCs*
PMUBCs
49.70
35.38
56.07
65.26
44.82
70.84
31.93
18.63
28.56
0.30
0.23
0.26
1.52
1.52*
1.81
0.71
0.71*
0.97
SEE
6.50%
11.49%
0.98
0.97
Table 1: F itting parameters for the volume fraction and fabric-based quadric yield criteria [Schwiedrzik, 2013].
In *, for comparison, the exponents of PMUBCs
were fixed to the same values as those of KUBCs.
Discussion
The obtained elliptic yield surfaces are in line with a
previous microFE study in the spine [Wolfram, 2012].
Additional samples will be necessary to consolidate
this preliminary analysis. The identification of these
yield parameters is expected to help improve
homogenized FE analysis of whole bones and the
assessment of hip fracture risk.
References
Bayraktar et al, JBME, 126(6):677684, 2004.
Schwiedrzik et al, BMMB, 12(6):11551168, 2013.
Wolfram et al, J Mech Behav Biomed Mater,
15:218228, 2012.
146
O 119
A COMBINED NONLINEAR VISCOELASTIC-VISCOPLASTIC

MODEL FOR TRABECULAR BONE
K. Manda1, R. Wallace2, S. Xie1, E. Sales1, F. Levrero Florencio1, P. Pankaj1
1
2
Introduction
As a material trabecular bone has been investigated extensively, but its time dependent creep
behaviour has not been well predicted. The
time-dependent behaviour of the trabecular
bone is extremely important to better understand
its response to dynamic loads such as those due
to fall. Yamamoto et al., (2006) reported that the
irrecoverable deformations arise from the time
dependent loading and remain there for very long
time after the unloading irrespective of load type
and levels. The aim of this study was to develop
a nonlinear viscoelastic-viscoplastic constitutive
model that can be used to simulate the dynamic
response of the bone using parameters derived
from creep-recovery experiments.
Results
The nonlinear stress dependent parameters from
Eq. (1) and parameters of viscoplasticity from
Eqs. (2)(5) were determined from the decoupled
experimental creep-recovery data. The predictions
from the developed constitutive model were in
good agreement with the experiments.
Methods
A recursive-iterative time integration algorithm [Kim
and Muliana, 2009, Huang, 2011] was developed
to model the nonlinear recoverable (viscoelastic)
and irrecoverable (viscoplastic) strain behaviour
of the trabecular bone, shown in Fig.1. Schaperys
integral model was used for viscoelastic response
while viscoplastic component follows Perzyna
model having an extended Drucker-Prager yield
criteria with non-associated flow and exponential
hardening function. Consistent tangent stiffness
matrix was formulated along with predictorcorrector iterative algorithm. The model was
used to analyse the nonlinear behaviour of the
trabecular bone at different loading conditions.
The recoverable strain of Schapery integral,
irrecoverable viscoplastic strain rate, yield
function, hardening function and rate-dependent
yield function are given by the following equations
(1)(5), respectively.
Figure 1: Integration algorithm for the nonlinear incremental

viscoelastic-viscoplastic constitutive model.
Discussion
The main objective of this study is to couple the
nonlinear viscoelasticity and Perzyna viscoplasticity
to model the time-dependent nonlinear behaviour
of the trabecular bone. A systematic methodology
was developed for identifying the parameters
associated with viscoelastic model and viscoplastic
model from creep-recovery experimental data.
Creep-recovery compressive tests were performed

on the cylindrical bovine trabecular bone samples
over a range of stress levels. The total strain
response from the creep-recovery curves was
decoupled into recoverable and irrecoverable
strain components.
References
Yamamoto et al, J Biomech 39:18121818, 2006
Kim and Muliana, Int J Numer Meth Eng,
79:550575, 2009
Huang et al, Int. J. Pavement Eng, 12:433447, 2011
147
O 12 0
COMPARISON OF PATELLAR BONE STRAIN

PREDICTIONS AFTER TKA: ISOTROPIC VS ANISOTROPIC
MATERIAL MODELS
A. Latypova1, G. Maquer2, P. Zysset2, D.P. Pioletti1, A. Terrier1
1
cole polytechnique fdrale de Lausanne, Laboratory of Biomechanical Orthopedics,

Lausanne, Switzerland
Introduction
Prediction of patellar strain after total knee
arthroplasty (TKA) in both resurfaced and nonresurfaced cases could help in understanding
postoperative complications such as anterior
knee pain (AKP) or patellar fracture. Numerical
modelling could be used to estimate strain within
patellar volume. However, literature is lacking
a model identified for the patellar bone, which
includes the anisotropy of the trabecular structure.
Moreover, the importance of the trabecular
structure in the estimation of patellar bone strain
has not been studied yet.
Two cases were tested for each patella: nonresurfacing (with cartilage) and resurfacing
(with polyethylene implant). We analysed and
compared bone octahedral shear strain at 70 of
knee flexion.
Results
The constitutive law identification was better for
anisotropy (R2 = 0.94) than isotropy (R 2 = 0.85). At 70
of knee flexion, the strain distributions of isotropic
and anisotropic laws were not significantly different
(K-S test). However, the isotropic law predicted
higher strain, especially for non-resurfaced patella
with low BV/TV (Fig.1).
Therefore, the first aim of this study was to identify

isotropic and anisotropic constitutive laws for
patellar trabecular bone. In a second step, bone
strain predictions of the whole patella after TKA
modelled with isotropic and anisotropic laws were
compared during a loaded knee flexion.
Methods
Twenty fresh-frozen cadaveric patellae were
scanned with a CT (Skyscan 1076, Belgium). We
extracted 10 cubes (5.3 mm side length) from each
patella and segmented bone with Medtool (www.
dr-pahr.at). These cubes were converted into microfinite element (FE) models with isotropic linear
elastic voxel elements for bone tissue (E = 12 GPa,
v = 0.3). Three compressions and three shear tests
were simulated with ParFE (parfe.sourceforge.
net). The elasticity tensor of each cube was
computed by means of stress and strain averages
of the FE results. In parallel, bone volume fraction
(BV/TV) and anisotropy (MIL fabric tensor) of each
cube were measured from the segmented CT
images. The elastic constants of the isotropic and
anisotropic constitutive laws were identified with
regression analyses [Zysset, 2003].
aDiscussion
This study confirmed that the prediction of apparent
elastic properties of patellar trabecular bone from
BV/TV is improved with the inclusion of fabric. The
isotropic model overestimates strain likely due to
a higher stiffness of the anisotropic model along
the physiological principal stress directions.
Modelling anisotropy is more critical for low
BV/TV patellae. Resurfaced patellae are less
sensitive to adding fabric information probably
due to the higher BV/TV of the remaining anterior
part of the bone. These preliminary conclusions
remain to be confirmed for the 20 patellae.
Two patellae (high/low BV/TV) were chosen

for the comparative study. Bone geometry
was extracted from CT. Homogenized finite
element (hFE) models of the entire patellae
were created in Abaqus (abaqus.com) with
tetrahedral elements. Material properties were
assigned with the two identified laws. BV/TV and
anisotropy were extracted from the CT images.
The patellar cortex was modelled with isotropic
shell elements (E = 12 GPa, v = 0.3, thickness =
= 0.5 mm). A TKA knee model was used to simulate
a loaded squat movement [Latypova, 2013].
References
Zysset P, J Biomech, 36(10):146985, 2003.
Latypova A et al, ORS 2013: 1709.
148
O 121
IMPLEMENTATION AND VALIDATION OF NONLINEAR

ANISOTROPIC VISCOELASTIC MODEL
FOR TRABECULAR BONE
K. Manda1, R. Wallace2, E. Sales1, F. Levrero Florencio1, P. Pankaj1
1
2
Introduction
Most musculoskeletal simulations assume that
the bone to be linear time-independent elastic
material though it has been previously recognized
that in reality its mechanical response is
time-dependent [Deligianni, 1994]. Predicting the
time-dependent behaviour of the trabecular bone
is a significant step towards better understanding
of the mechanical behaviour of the normal and
diseased bone including fracture. In the present
work we modelled the trabecular bone with
a nonlinear anisotropic viscoelastic material
model and developed a numerical recursive
iterative algorithm and thereby predicted the
time-dependent behaviour of the trabecular bone.
Results
The stress relaxation curves of trabecular bone
samples at different strain levels were obtained
from series of compressive relaxation experiments
and the viscoelastic parameters were determined
for each sample. The nonlinear parameters were
determined and expressed as a polynomial function
of effective stress, shown in Fig. 1(A). The predicted
relaxation response from the developed nonlinear
viscoelastic model was in good agreement with
the experimental data, Fig. 1(B).
Methods
An
implicit
recursive
iterative
numerical
algorithm was developed by extending nonlinear
Schapery integral to represent the anisotropic
time-dependent behaviour of the trabecular
bone based on [Haj-Ali,2004, Poon, 1999]. The
numerical algorithm was implemented as a user
defined material subroutine (UMAT) to be used
with ABAQUS (Simulia, RI, USA) interface. The
nonlinear stress dependent parameters were
expressed as polynomial function of effective
stress based on the experimental data, Fig. 1(A).
Human femoral heads were harvested and the
trabecular bone samples were cored-out to the
size of 10.64 mm diameter. The compression tests
were performed using a loading stage mounted in
a micro-CT Skyscan 1172 (SkyScan, Kontich,
Belgium)
and
simultaneously
scanned
at
intermittent stopping points. The observed stress
relaxation curves for one of the samples are shown
in Fig. 1(B) at two different strain levels equivalent
to 20% and 40% of yield strain respectively,
ensuring that it remains in the elastic regime. The
relaxation curve at 20% of yield strain was treated
as a master curve and the nonlinear parameters
were obtained by shifting this master curve to
match with other curves at higher strains using
nonlinear curve fitting procedures.
Figure 1: ( A) Nonlinear stress dependent parameters,

(B) Relaxation stress response of a cylindrical
trabecular bone sample (diameter = 10.64mm,
height = 12.27mm) at two different strain levels.
Discussion
The time-dependent behaviour of the trabecular
bone, observed from the experiments, was
significant and the linear viscoelastic models were
not sufficient to predict this behaviour. Hence, the
more general anisotropic nonlinear viscoelastic
material model was developed and was validated
with the experiments.
References
Deligianni et al, J Biomech. 27(12): 14691476, 1994
Haj-Ali et al, Int J Numer Meth Eng, 59(1): 2545, 2004
Poon et al, Int J Numer Meth Eng, 46(12):
20272041, 1999
149
O 12 2
STABILOMETRY AS A USEFUL TOOL IN ASSESSING

BALANCE CAPACITY.
C. Piqueras1
1
BAASYS, Clinical biomechanics, Barcelona, Spain
Introduction
Stabilometry, which measures the bodys center
of pressure (COP) movements, during relaxed
standing, has been used to distinguish individuals
with vestibular and neurologic dysfunctions from
normal subjects. It is a reliable and non-invasive
technique to evaluate equilibrium function and
is useful to quantify the vestibulospinal symptoms
such as dizziness, vertigo or truncal ataxia. Anlysis
of several parameters could asses in several
postural disorders and discriminate between
healthy and pathological subjects. Patients with
whiplash injury might exaggerate their symptoms
or be malingerers because of the potential gain
associated with insurance claims. We designed
a study to screen putative malingerers. We
compare ratio between two Romberg tests with
different difficulty in the performance, increasing
the ability. The purpose of this study was to
determine whether mathematical differences in
the magnitudes of the COP obtained from four
somatosensory testing conditions (Romberg tests)
could be used to discriminate between different
types of balance deficits, normal subjects and
feigned patients.
Feigned
156
69
189
Feigned
2.71
2.82
SR FCE-CE
3.67
5.39
2.79
SR FCE-OA
9.47
12.1
7.26
C o n cl u s i o n
The measures of anterior-posterior COP movements
provided the greatest discrimination. Malingering
must be diagnosed carefully and posturography could
be a helpful supplementary tool for differentiating
whiplash-associated vertigo from malingering, but
more investigation and development of the analysis
system is required to obtain more specific results.
References
Static stabilometry and repeated testing in
a normal population.Nordahl S. Space Environ
Med. 2000 Sep;71(9):88993.
Clinical stabilometry standardization: basic
definitionsacquisition intervalsampling frequency.
Scoppa F. Gait Posture. 2013 Feb;37(2):2902.
Vestibular and stabilometric findings in whiplashinjury
and minor head trauma. A. Nacci,.Acta Otorhinolaryngol Ital 2011;31:378389
Multivariate statistical analysis in stabilometry
in human upright standing-pattern recognition
of a stabilogram. Nihon Ji. 1989 Jun;92(6):90922.
Quantitative evaluation of disorders of upright
posture using stabilometry. Cesk Neurol Neurochir.
1991 Jan;54(1):1421.[ Saling M.F.
Static stabilometry and repeated testing in
a normal population. Aviat Space Environ Med.
2000 Sep;71(9):88993. Nordahl S.

According with database patients were classified in
order of their anterior-posterior and mediolateral COP
movement in normal, pathological and feigned.
Pathological
Pathologic
2.30
Statisitics Kruskal Wallis is P < 0.05. When comparing

the ratio average in different group in there was a
statiscally significant difference.Both the simulated
and pathological posturographic SR values differed
from normal under all test conditions. The average
in pathological group is greater than normal or
feigned. The differences are increasing at the same
time that increases complication in performance.
Static stabilometry is fundamental for assessing
postural deficits following a cervical proprioceptive
disorder. Analysis of the different parameters and
the indices referring to cervical interference not only
permits evaluation of altered postural performance,
but also detects and quantifies destabilisation activity
within the cervical proprioceptive component.
414 patients, 179 females (1865 years) y 235 males
(1869 years). Body Max Index females: 26.3 Body
Max Index males 28.4. Symptom at least during one
month. Quantitative evaluation of the stability of
posture was done under four conditions: with open
eyes (OE), with closed eyes(CE), and standing on
a 10 cm foam rubber mat with open (FOE) and
closed eyes (FCE), measurement of sways for
30s every condition. Using a computerized force
platform according to a standard protocol. The
stabilometry uses vertical force transducers to
determine instantaneous fluctuations in the center
of pressure. We use the parameter body sway area
of ellipse (BSE). It is the approximate area in which
subject balancing takes place. We tested twice
every condition and calculated the average.
Control
Control
SR CE-OE
Control Group criteria are test resulting in OE >95%,

CE>90%, FOE>90% and FCE >85%.
Stability Ratio (SR) is a body sway area of ellipse in mm2
coefficient between two tests with different ability in
the performance: SR CE-OE, SR FCE-CE, SR FCE-OA
150
O 12 3
HUMAN BALANCE CONTROL:

TIME DELAY AND INTERMITTENCY
T. Insperger1, J. Milton2, G. Stepan1
1
Budapest University of Technology and Economics, Department of Applied Mechanics,

Budapest, Hungary
2
The Claremont Colleges, Keck Science Department, Claremont, USA
Introduction
The observation that time-delayed feedback
can stabilize an inverted pendulum motivates the
formulation of models of human balance control in
terms of delay differential equations [Stepan, 2009].
Recently the intermittent, digital-like nature of the
neural feedback control of balance has become
evident [Loram, 2012]. In this work, we analyse
a simplified one dimensional model of human
balancing, which is a discrete time-counterpart of
the model used in [Eurich, 1996].
Methods
The model under analysis is a discrete map of the form
Figure 1: C
losed invariant set for the discrete map.
which models the following features of human

balance control: (1) an unstable upright position
in the absence of feedback; (2) stabilizing timedelayed feedback; (3) and a sensory dead zone.
Parameters a and b are related to the feedback
delay and time-constant of the system. Although
this system is a simplified model of the Newtonian
mechanics of inverted pendulum-like structures, it
still presents their main feature, namely, instability
occurs as an exponential fall (and not oscillatory).
Discussion
The prevention of falls in the elderly, and their
accompanying mortality and morbidity, are major
challenges faced by aging industrialized societies.
Surprisingly there is little mathematical insight into
why falls occur. Are falls simply the response to
external perturbations, such as slips and trips or can
falls occur as a result of the intrinsic dynamics of
balance control regulation? Although stochastic
explanations for falling have been proposed,
our observations demonstrate that escape from
a bounded time-dependent state can occur in
a deterministic model for balance control. The
possible association of balance control with issues
related to micro-chaos and transient micro-chaos
may motivate a re-evaluation of strategies based
on the control of chaos and stochastic resonance
to minimize the risk of falling in the elderly.
The conditions for permanent and temporary

bounded solutions associated with sustained and
transient micro-chaos are analysed [Haller, 1996,
Lai, 2010].
Results
Three types of different behaviours are distinguished,
each one is associated to a particular motion of
the continuous-time counterpart shown in [Eurich,
1996]. While the different motions in [Eurich, 1996]
are periodic, the discrete-time model analysed
here presents chaotic and transiently chaotic
motions for certain parameters combinations
(see, e.g., Figure 1).
References
C. W. Eurich and J. G. Milton, Phys Rev E,
54: 66816684, 1996.
G. Haller and G. Stepan, J Nonlin Sci,
6:415448, 1996.
Y-C. Lai and T. Tel, Springer, 2010.
I. D. Loram et al, J Roy Soc Interface,
9:20702084, 2012.
G. Stepan, Phil Trans R Soc A, 367: 11951212, 2009.
151
O 12 4
BIOMECHANICAL APPROACH TO TAI-CHI.

RELAXATION AND STABILITY
S. Tassani1, J.M. Font-Llagunes2, J. Noailly3
1
Institut de Bioenginyeria de Catalunya, Biomechanics and mechanobiology,

Barcelona, Spain
Biomedical Engineering Research Centre, Universitat Politcnica de Catalunya, Department

of Mechanical Engineering, Barcelona, Spain
3
Universitat Pompeu Fabra, Department of Information and Communication Technologies,

Barcelona, Spain
Introduction
Tai Chi is an ancient martial art based on stability
and elasticity and it is usually suggested as physical
activity for the wellbeing of elder people. The multiple
aspects of the discipline can suggest its applicability
to several forms of musculoskeletal or neurological
diseases. In the last few years several studies were
presented about the beneficial effect of Tai Chi.
Nonetheless, the variability of teaching methods
within this discipline creates difficulties in the univocal
evaluation of the discipline and its effects [Lauche,
2013]. Different styles teach different sequences for a
total of more than 100 different recognized forms.
Nonetheless, the study of the discipline reveals that
all styles and forms aim to teach 8 basic movements,
usually known as Ba Gua (Fig 1). All of them are
based on the concept of relaxation in order to teach
both stability and elasticity.
with particular attention to the gluteus, shoulders,

and deep diaphragmatic breathe. Four different
parameters were computed for each subject:
mean distance, RMS distance, mean velocity
and 95% confidence circle area. Non-parametric
Kruskal-Wallis test (significance 0.05) was applied
to the analysis of each parameter. For significant
results a Wilcoxon paired non-parametric test was
used to compare results of different condition.
Results and Discussions
The only parameter showing a difference of
variance was the mean velocity (p<0.001).
Figure 1: T he 8 trigrams around the Dao represent the 8

fundamental movements of Tai Chi.
Accordingly, the present study aims to measure the

effect of relaxation over the stability of the subjects.
Figure 2: B
ox-plot of the mean velocity related to the three
different conditions.
Methods
The statokinesigram of 10 subjects was acquired.
Foot-ground contact forces were recorded by using
a force plate (100Hz sampling). Subjects were asked
to stand over the force-plate for at least one minute
looking at a target painted on the wall approximately
at the height of the eyes. Each subject was analysed
three times to simulate different conditions: control,
tense and relaxed conditions. Control-condition
aimed to simulate standard daily situation. The
subject was asked to stand over the force-plate
without any additional information. Tense-condition
was simulated asking the subject to continuously
contract the body muscles with particular attention
to the contraction of the gluteus and shoulders (rising
of the shoulders). Additionally subjects were asked
to keep thoracic breathing. After tense analysis
subjects were guided through few exercises to relax
neck, shoulders, hips and ankles. Relaxed-condition
during the statokinesigram acquisition was then
simulated, asking the subject to relax the whole body
Velocity of both control and relaxed condition

were found significantly smaller than the tense one,
suggesting a reduced stability of the latter. This
preliminary results show not statistically difference
between control and relaxed condition. Nonetheless,
it is important to notice how the extremely common
task of standing can be influenced by the simulation
of a tense stance. Moreover, standing is a posture
that people is supposed to keep in a relaxed way,
but the closely significant result of the test (p=0.06)
suggests that more data could reveal the contrary.
This work was partially supported by the European
Community and the autonomous region of Catalonia
(acronym sMART-O, project number 2013-BP-B-00096).
References
Lauche R. et al. Complement Ther Med
2013;21:396406.
152
O 12 5
GAIT SPEED AND POSTURAL STABILITY DURING STAIR

NEGOTIATION: EFFECTS OF DUAL TASKS AND POSTURAL
TASK DIFFICULTY
F. Madehkhaksar1, A. Egges1
1
Utrecht University, Information and Computing Sciences Virtual worlds Research Group,
Utrecht, Netherlands
Introduction
Dual task interference occurs when the introduction
of a secondary task during a cognitive or motor
performance leads to a competition between
the attentional resources available, resulting in
a decreased performance in either task. The
attentional demands of a task and the interference
effects of concurrent tasks are influenced by
several factors, such as subjects age, skill
level, task difficulty and the nature of the tasks
involved (Woollacott, 2002). Two different types of
secondary tasks, a mental task and a manual task,
have been used in dual task studies (Woollacott,
2002; Asai, 2014). However, most postural control
studies only address dual-task interference with
and extra mental task. It is interesting to investigate
dual-task interference in the context of more
complex postural tasks, such as stair negotiation.
We study how secondary mental and manual tasks
interfere with stair negotiation and how attention
is allocated between tasks when a person
concurrently performs multiple tasks with different
levels of complexity.
Results
In mental and manual tasks, no significant main
effect of postural task was observed. In contrast,
results for gait speed and COM RoMs showed
a significant main effect of postural task and
secondary task (p<0.05). There also was a
significant effect of postural task by secondary
task interaction in gait speed (p<0.001). However,
no interaction effect was found in results for COM
RoMs. Overall, increasing difficulty of postural
tasks and secondary tasks lead to decreased gait
speed and increased AP-COM RoM. No systematic
change was observed in ML-COM RoM.
Discussion
Postural tasks did not have an effect on performance
of the secondary tasks. The secondary tasks did
however affect gait speed and postural stability:
more complex secondary tasks compromise the
postural stability and decrease the gait speed.
When there is competition between two motor tasks,
one of which is postural control, the maintenance
of stability has priority. Method and results of this
study can be used to evaluate postural stability
and gait in order to predict a possible fall. Also,
our results are useful for improving rehabilitation
and treatment procedures where the relationship
between attention demands and the control of
posture and gait is important.
Methods
Gait kinematic parameters and secondary task
performance were obtained from fifteen normal
subjects while ascending and descending a fourstep staircase at three inclinations (17.7, 29.4,
and 41.5) as well as level walking. They performed
a mental task, backward digit recall (Maylor,
1996), a manual task, holding a cup of water
and a combination of the two tasks concurrently.
Kinematic data was recorded by a 14-camera
three-dimensional motion capture system and
kinematic data of the lower extremities as well as
the body COM were collected by using the Plug-in
gait model. Gait performance was measured by
gait speed. Postural stability was assessed by CoM
RoMs in medial-lateral (ML-COM RoM) and anteriorposterior (AP-COM RoM) directions, separately.
Also, the performance of each secondary task
was measured. Two-way repeated measures of
ANOVA was performed for gait speed and CoM
RoMs as well as for secondary tasks performance.
This work is supported by the Dutch research project
COMMIT Virtual Worlds for Well-Being.
References
A
sai, et al., Gait & posture 39(1): 5459, 2014.
M
aylor, et al., J Gerontology Series B:
Psychological Sciences and Social Sciences 51(3):
P143P154, 1996.
W
oollacott, et al., Gait & posture 16(1): 114, 2002.
153
O 12 6
DYNAMICS ANALYSIS OF PATIENT-SPECIFIC RIGID

BODY MODELS DERIVED FROM MRI IMAGES
M. Sreenivasa1, C.J.G. Chamorro1, D.G. Alvarado1, S. Wolf2
1
University of Heidelberg, Optimization in Robotics & Biomechanics Interdisciplinary Center

for Scientific Computing, Heidelberg, Germany
Heidelberg University Hospital, Department of Orthopedics and Traumatology, Heidelberg,

Germany
Introduction
Patient-Specific Models (PSM) are interesting for
a range of biomechanical applications such as
quantifying pathological presentation and avoiding
the approximation errors typical in Generalized
Scaled Models (GSM). Current methods to generate
PSMs are time-consuming and their impact on the
final results unclear. Here, we present results from
an on-going project that automatically generates
kinematic and dynamic properties of PSMs from
imaging scans, and compares the differences
between using PSM, GSM, and the Vicon Plug-In-Gait
(VPIG) models, for gait analysis.
Estimating Limb Mass & Inertia: The segmented

data on bone, muscle and fat content were used
to compute accurate limb masses, Center of Mass
(CoM) and the inertial parameters, Fig. 1c.
Inverse Dynamics Computations: The kinematic
and dynamic information from the previous steps
were used to create the PSM. Inverse dynamics
analysis [Felis 2012] was then used to compute
the joint torques during a gait cycle, Fig. 2a. We
compare the PSM results to those computed
by using a GSM based on De Leva parameters
[deLeva 1996], as well as the VPIG model.
Results
We found several differences between the
kinematic and dynamic parameters of the PSM and
GSM models. For example; the femoral anteversion
of the PSM (estimated from bone landmarks on
the optimized mesh) was 4 more than that of the
default mesh; as well, the estimated mass of the
PSM left upper leg was 8% less than the GSM model,
with a CoM displacement of 4cm and additional
non-diagonal inertial terms. Consequently, we
found significant differences between the inverse
kinematics and dynamics results based on the
PSM, GSM and VPIG models, Fig. 2b.
Figure 1: P
atient-specific lower body model from MRI images using a) Affine mesh optimization b) Femoral
morphing c) 3D mass properties of bone, muscle
and fat
Methods
A PSM was developed from MRI scans of a 10-yr
old female diagnosed with Multiple Epiphyseal
Dysplasia.
Estimating Skeletal Kinematics: Figs. 1a & c show the
point clouds corresponding to the bone, muscle
and fat in each MRI slice. First, MRI segmentation
was performed using the Ilastik image processing
toolkit [Sommer 2011]. Second, the segmented
data were used to morph a generic skeletal mesh
[Arnold 2010] using custom built software and the
IsoMesh toolkit [Fang 2009], Fig. 1a. Additionally,
femoral characteristics were refined by allowing
for a larger morphing range, Fig. 1b.
Figure 2: a
) Sample gait trial with computation of b) sagittal
plane joint kinematics and dynamics
see the next page
154
Discussion
Our results show that development of patientspecific models from imaging data is achievable
and can have a significant impact on the results
of gait analysis. This has important consequences
for the planning of rehabilitation and orthopedic
interventions. Our current efforts are aimed at
improving the robustness of the segmentation
methods and making then available to the
biomechanics community as open-source tools.
References
Arnold et al, Annals Biomed Engg, 38:269279, 2010.
Sommer et al, IEEE ISBI:230233, 2011.
Fang et al, IEEE ISBI: 11421145, 2009.
Felis M, rbdl.bitbucket.org, 2012. de Leva P,
J Biomech, 29(9):122330, 1996.
155
O 12 7
EVALUATION OF 2-METHACRYLOYLOXYETHYL
PHOSPHORYLCHOLINE (MPC) NANOCOATINGS
FOR IMPROVED TRIBOLOGICAL FUNCTION
OF ORTHOPAEDIC DEVICES
M. Parkes1, P. Milner1, P. Cann2, J. Jeffers1
1
Orthopaedic Biomechanics, Mechanical Engineering Imperial College London,

London, United Kingdom
2
Tribology Group, Mechanical Engineering Imperial College London,

Introduction
2-methacryloyloxyethyl phosphorylcholine (MPC)
nanocoatings offer a promising solution to reduce
friction and improve wear-life of orthopaedic
devices by mimicking the mechanisms of biological
lubrication [Moro, 2004]. On model surfaces such
nanocoatings have reduced friction to levels
as low as those found in natural synovial joints
under reciprocating sliding tests [Chen, 2009].
These simple tests do not replicate the complex
loading patterns or kinematics experienced in
vivo and so the functional envelope of such
nanocoatings is yet to be determined. In this work
the tribological performance of MPC coatings on
UHMWPE substrates was systematically evaluated
for changes in contact pressure and sliding
kinematics, relevant to the human knee.
Results
MPC nanocoatings successfully reduced the sliding
friction coefficient in a proteinaceous lubricant
from 0.15 to 0.02. At high contact pressures, this
low friction coefficient was not maintained over
time and the underlying polymer demonstrated
significant wear. Low friction at the macroscale
was also found to be dependent on generation of
a homogenous coating at the nanoscale.
Discussion
The use of a custom tribometer allowed MPC
nanocoatings fabricated on a typical orthopaedic
material to be tested using a range of contact
pressures and physiological kinematics. From these
results a functional envelope has been defined in
which MPC is successful at reducing friction and
wear. This information can be used to determine
for which applications such nanocoatings can
be used to improve tribological performance of
orthopaedic materials in vivo.
Methods
MPC coatings were prepared on UHMWPE substrates
using
surface-initiated
photopolymerisation
[Kyomoto, 2007]. The macroscale friction coefficient
of both coated and uncoated samples sliding
against a glass counter surface was assessed using
a custom tribometer. Surfaces were lubricated
with solution of 25% Bovine Calf Serum in deionised
water at room temperature (20 C). Experiments
were conducted with translation only or translation
and rotation over a range of contact pressures
(216 MPa). Wear of both the sample and coating
was assessed using stylus profilometry, atomic
force microscopy and fluorescence microscopy.
References
C
hen at al, Science, 323:16981701,2009.
K
yomoto et al, J Biomed Mater Res A, 82:
107, 2007.
Moro et al, Nature Materials, 3:829 836, 2004.
156
O 12 8
SYNTHESIS OF ULTRA-LOW WEAR AND FRICTION

POLYMERIC SURFACES FOR ORTHOPAEDIC
APPLICATIONS
P.E. Milner1, R. Chapman2, M. Parkes1, P.M. Cann1, M.M. Stevens2, J. Jeffers1
1
2
Imperial College London, Department of Materials, Department of Bioengineering

and Institute for Biomedical Engineering, London, United Kingdom
Results
Post-polymerisation, all the substrates showed an
increased hydrophilicity, as measured by contact
angle goniometry, suggesting that pMPC had
successfully polymerised from the surface for
all materials. The reduction in contact angle of
the new materials was similar and in some cases
greater than that of the pMPC-UHMWPE. The
presence of pMPC on the surface of the polymers
was confirmed by ATR-FTIR, with the characteristic
phosphate and nitrate groups of pMPC clearly
identifiable. Fluorescence microscopy and AFM
indicated that there was not always homogeneous
growth of the pMPC across the substrates.
Introduction
Wear and the associated aseptic loosening are
primary failure modes of orthopaedic implants
[NJR, 2013]. Cartilage is able to reduce its own
wear through two mechanisms: interstitial fluid
pressurisation [Soltz, 2000] and boundary lubrication
[Hills, 1984]. By grafting lubricating polymers such
as poly(2-methacryloyloxyethyl phosphorylcholine)
(pMPC) from the surface of implants, orthopaedic
materials that mimic the boundary lubrication
of cartilage have become a possibility. Indeed,
pMPC has been successfully grown on UHMWPE
for applications in total joint replacement [Moro,
2014]. In this work we aim to extend the number of
materials functionalised with pMPC and compare
these to pMPC coated UHMWPE (pMPC-UHWMPE).
Discussion
We have found evidence that covalently
bound pMPC polymer chains have been grown
on the surface of various polymers that have
applications in orthopaedics. The inhomogeneity
in some samples detected by fluorescence and
AFM indicate the importance of optimising the
polymerisation variables for the different materials,
and this will be investigated in future work. Future
work will also investigate the tribological function
of these materials.
Methods
Substrates of several polymer materials with
potential applications in orthopaedics were
functionalised with pMPC in a custom built reaction
chamber and subsequently washed thoroughly
to remove any non-bonded pMPC. Specimens
were then investigated for pMPC coverage using
water contact angle, attenuated reflectance
Fourier transform infrared (ATR-FTIR) spectroscopy,
atomic force microscopy (AFM) and fluorescence
microscopy and compared to pMPC-UHMWPE.
References
H
ills, B. A. & Butler, B. D. (1984). Ann Rheum Dis,
43(4), 641648.
M
oro, T. et al. (2014). J Orthop Res, 32(3), 369376.
N
ational Joint Registry for England, Wales and
Northern Ireland (NJR). Annual report 2013.
S oltz, M. A. & Ateshian, G. A. (2000). Ann Biomed
Eng, 28(2), 150159.
157
O 12 9
IMPROVING THE LUBRICITY OF MUCINS

BY COMPLEXATION WITH POLYMERS
S. Lee1
1
Technical University of Denmark, Department of Mechanical Engineering, Kgs. Lyngby,

Denmark
Introduction
Mucins are a major macromolecular component
of mucus gels that are known to protect underlying
epithelial
surfaces
against
pathogen
and
mechanical insult. Mucins and mucus gels are
renowned for their unique lubricity, not only for
biological tissues, but also for various engineering
materials in aqueous environment. While previous
studies have mainly focused on elucidation of the
generic lubricating properties of mucins [S. Lee et
al 2005, G.E. Yakubov et al 2009, N. Nikogeorgos et
al 2014], we demonstrate that the lubricity of mucin
films can be further improved by complexation with
synthetic polymers, in particular mucoadhesive
polymers, in this study.
Methods
Porcine gastric mucin (PGM) and bovine
submaxillary mucin (BSM) were purchased from
Sigma Aldrich and dialyzed against water prior to
use. Chitosan, polyacrylic acid (PAA), and polyallyl
amine (PAAm), polyethylene imine (PEI) were used
as received. Various aqueous solutions of mucinpolymer mixture were prepared (0.1 to 1 mg/
mL in PBS with varying pH). Pin-on-disk tribometry
was employed to assess the lubricity of mucins,
polymers, and their mixtures. Silicone rubbers
(PDMS) employed as tribopair. Other analytical
techniques include dynamic light scattering (DLS),
zeta potential, and optical waguide lightmode
spectroscopy (OWLS).
Figure 1: C
oefficient of friction vs. speed plots for PGM,
chitosan, and their mixture (1:1), showing an
extensive synergetic lubricating effect between
PGM and chitosan.
Discussion
The synergetic lubricating effect between mucins
and mucoadhesive polymers can be explained
by the complexation of mucin with mucoadhesive
polymer
by
forming
physically
crosslinked
aggregates, resulting in higher cohesion and
lower interlayer chain interpenetration and
bridging. A simple electrostatic attraction, without
mucoadhesive interaction, was somewhat inferior
in synergetic lubricating effects. Meanwhile,
mucoadhesive complexation with electrostatic
repulsion, for example between PGM and PAA at
neutral pH, showed synergetic lubricating effect to
a certain extent.
Results
A synergetic lubricating effect between porcine
gastric mucin (PGM) and chitosan based on
their mucoadhesive interaction was observed [N.
Nikogeorgos et al 2015]. In acidic solution (pH 3.2)
and low concentrations (0.1 mg/mL), the interaction
of PGM with chitosan led to surface recharge and
size shrinkage of their aggregates. This resulted
in higher mass adsorption on the PDMS surface
with an increasing weight ratio of [chitosan]/
[PGM + chitosan] up to 0.50. While neither PGM
nor chitosan exhibited slippery characteristics, the
coefficient of friction being close to 1, their mixture
improved considerably the lubricating efficiency
(the coefficient of friction is 0.011 at an optimum
mixing ratio) and wear resistance of the adsorbed
layers. Other pairs between mucin and polymers
also showed similar, yet varying magnitude of
synergetic effect of lubrication. A representative
friction coefficient vs speed plot is shown in Figure 1.
References
G.E Yakubov et al, Langmuir, 25:23132321, 2009.
J.B. Madsen et al, Prep. Biochem. Biotech.,
45: 8499, 2015.
N. Nikogeorgos et al, Colloids and Surfaces B,
122:760766, 2014.
N. Nikogeorgos et al, Soft Matter, 11:489498, 2015.
S. Lee et al, Langmuir, 21:83448353, 2005.
158
O 13 0
OPTIMIZING THE THICKNESS OF CERAMIC COATINGS

TO PROTECT THE PLASTIC INSERT IN JOINT PROSTHESES:
A FINITE ELEMENT ANALYSIS
G. Marchiori1, N. Lopomo1,2, M. Bianchi1, M. Boi1, A. Visani2, A. Russo1,
M. Marcacci1,2, C. Signorelli2
1
2
Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie, Bologna, Italy
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica e Innovazione Tecnologica,

Bologna, Italy
Introduction
Wear of the plastic insert remains one of the
main causes of long-term joint implant failure.
Within this issue, permanent deformations greatly
affect mechanical properties and durability of
polymeric implant devices as well [Takahashi,
2015]. Innovative Pulsed Plasma Deposition (PPD)
technique has been proven to improve surface
properties by providing hard ceramic thin films
(i.e. zirconia) even onto polyethylene (UHMWPE)
components [Bianchi, 2013]. The main issues in
depositing a brittle film on a soft substrate are
related to prevent the cracking of the film and,
at the same time, the yielding of the bulk material
[Miranda, 2003]. The purpose of this study was to
use the Finite Element Analysis (FEA) to optimize
zirconia film thickness aiming both to protect the
UHMWPE under unusual local pressure phenomena
and to improve the local strength of the coating
itself.
Figure 1: M
ax Principal Stress in the coating subsurface.
Methods
Since third-body effect can be simulated via
nanoindentation [Sun, 2009], a corresponding Finite
Element Model (FEM) was implemented, exploiting
an axial-symmetric 2D geometry. The Berkovich
tip was modeled as a rigid cone, whereas the
sample was modeled as a 100x100 m square.
UHMWPE was implemented as visco-elasto-plastic
material, while the zirconia was considered linear
elastic. Several mechanical tests served both to
obtain the material constitutive parameters and,
changing the boundary conditions, to validate the
FEM. Once validated, the FEM was used to predict
the effect of different film thicknesses, 0.5123
45 m, simulated on the indented samples. Max
Principal Stress in the coating and creep behavior
(with 360 holding time) were used as assessment
parameters.
Figure 2: C
reep: indenter deeping at constant load
(holding time 360 s).
Discussion
A ceramic coating with thickness equal or above
4m shows a Max Principal Stress below the Zirconia
strength (supposed equal to 1.45 GPa [Miranda,
2003]). This thickness has been reported to be
commonly used in commercial joint replacements
[Liu, 2013] and can be easily achieved even with
PPD technique. Future work will assess and design
the implementation of multilayer films, aiming at
a better compliance of the coating to the loads
and, at the same time, favoring the use of lower
thicknesses, which are technologically less expensive
and, thence, more attractive for the industry.
Results
The FEA outputs chosen as critical showed an
exponential dependency on film thickness. In
particular the thickness increase reduced the
Max Principal Stress in the coating subsurface
(fig. 1), responsible of the radial crack formation,
preserved the film adhesion and limited the
indenter penetration, and so deformation, of the
substrate (fig. 2).
References
Bianchi et al, J Mater Chem B, 1: 310, 2013.
Liu et al, Mat Sci And Eng C 33, 27882794, 2013.
Miranda et al, Acta Mater 51, 43574365, 2003.
Sun et al, Wear, 267: 1845, 2009.
Takahashi et al, Acta Biomater 14, 595599, 2015.
159
O 131
FUNCTIONAL EVALUATION OF SYNTHETIC MESHES USED

IN REPAIR OF ABDOMINAL WALL
M. Kirilova-Doneva1,2, D. Pashkouleva3 , N. Gerassimov4 , S. Sopotensky5,
E. Moutafova6 , G. Petrova1, V. Kavardzhikov3
1
Medical University Sofia, Faculty of Pharmacy, Department of Social Pharmacy

and Pharmacoeconomics, Sofia, Bulgaria
2
3
Institute of Mechanics BAS, Department of Biomechanics, Sofia, Bulgaria
Institute of Mechanics BAS, Department of Solid Mechanics, Sofia, Bulgaria

4
Pharmacy Supernova, Dobrich, Dobrich, Bulgaria
UHATEM N.I.Pirogov, Urgent adoption and advisory department, Sofia, Bulgaria

6
MU Varna, Faculty of Public Health, Varna, Bulgaria
Introduction
The synthetic meshes have many applications
in a surgery. Because of the variety of mesh
brands available in the surgical practice, the
suitable choice of hernia meshes will lead to
better postoperative results, will decrease level
of complications and health care expenditures.
The relationships between the brand of implanted
meshes and outcomes of hernia therapy for
patients in Bulgaria have not properly investigated
yet. This has stimulated our interest on the problem.
The aim of this study is to compare mechanical
compatibility of the most applicable hernia
meshes in our country according to their elasticity
and orthotropy.
Results
The mechanical compatibility between fascia and
hernia meshes was accessed on the basis of their
orthotropy and elasticity. The elastic properties
of hernia meshes SP (E=4,36 1,04 MPa) and VP
(E=3,92 0,54 MPa) in L-direction approach the
elastic properties of the fascia from up to 65 years old
donors in the same direction (E=4,94 2,05MPa)
and the elastic properties of the fascia from
6580 years old donors in the transversal direction
(E=3,53 1,76 MPa) The elastic modulus of
SM in both directions (E L=7,06 1,09 MPa;
E T=7,46 1,34 MPa) is close to elastic
properties of the abdominal fascia of group B
(E=8,49 3,43 MPa) and C (E=8,1 3,86 MPa) in
L direction. The level of orthotropy of VP and PX
(LO=0,4) approaches the level of orthotropy of
the fascia samples in the group B (LO=0,42).
Materials and methods

A multi-centre study which included 88 surgeons
from different geographical regions was conducted
and reasons for the choice of implanted meshes
were investigated. The results showed that the
preferred brands of meshes nowadays in Bulgaria
are Surgimesh (SM), Surgipro (SP), VyproII (VP) and
Parietex (PX). Variations in elasticity and orthotropy
of SM, SP and VP meshes were revealed using
tensile experiments while data from PX were taken
from the literature [1]. Tensile tests were applied
to mesh specimens cut along the rows of loops
(T direction) and parallel to the column of loops
(L direction). From the stress stretch ratio curves
the secant modulus at 5% strain (E) and samples
level of orthotropy (LO) at 5%, 10% and 15% strain
were calculated. The results were compared
with the elasticity and orthotropy of the human
abdominal fascia samples, divided into three
age groups up to 64 years (group A), between
6580 years (group B) and between 8190 years
(group C) [2].
Discussion
Functional evaluation of synthetic meshes used
un repair of abdominal wall is important for
good postoperative results. The presented results
will help to assess the mesh ability to match
abdominal elasticity and orthotropy. The data for
the mechanical properties of hernia meshes will
be applied in mathematical model of implanted
meshes.
References
1 Saberski E., Orenstein S., Novitsky Y., Anisotropic
evaluation of synthetic surgical meshes. Hernia,
2011, 15:4752.
2 Kirilova, M., D. Pashkouleva, V. Kavardzhikov.
A long-term elastic behaviour of hernia meshes,
Series on Biomechanics, 2013, 28 (34), 2428.
160
O 13 2
FLUID-STRUCTURE INTERACTION AND

OPTIMIZATION-BASED APPROACH FOR
HOMOGENIZATION OF SOFT TISSUE VISCOELASTICITY
Y. Chen1, B. Esfandiar Jahromi1, J. Palacio-Torralba1, R.L. Reuben1
1
Heriot-Watt University, Institute of Mechanical Process and Energy Engineering,

Introduction
Biological soft tissue often presents highly nonlinear
mechanical behaviour, with certain anisotropy and
heterogeneity, and undergoes large deformation
when fulfilling its functionality or being tested
[Phipps, 2005b]. Physiopathological conditions of
soft tissue cause changes in the microstructure
and extracellular matrix (ECM). These influence
organs functionality and mechanical properties
[Gill & West, 2013]. Standard linear homogenization
has been widely used in evaluating the effective
properties of heterogeneous materials but may
become unsuitable for biological materials. In
this study we propose a method for multiscale
modelling of tissue to determine the influence
of different testing parameters on mechanical
properties of tissue.
Figure 1: Influence of strain rate in relaxation test.
Methods
In this study, we present an optimisation based
approach for homogenisation method that
integrates fluid-structure interaction (FSI) to
evaluate the viscoelastic nonlinear behaviour
of soft tissue. The microstructures of soft tissue
are treated as bi-phase materials, solid material
representing the cells and fluid phase for the
extracellular
fluid.
Homogenisation
method
is used here, together with an embedded
optimisation process taking into account different
boundary conditions that mimic the in vivo tissue
environment under various physiological and
pathological conditions. Variations in strain rate,
viscosity of extracellular fluid and different tissue
microstructures are assessed under the proposed
framework, where the viscoelastic behaviour
of the soft tissue is quantitatively linked to the
abovementioned factors. Such proposed method
would be beneficial for quantitative assessment
of mechanical properties of soft tissue, as well as
understanding the role of multiscale architectural
features of soft tissues in its biological functionality.
Figure 2: V
ariation in the time constant of the tissue for different viscosity and strain rates.
Discussion
The framework presented here allows the
homogenisation of nonlinear multi-phase soft
materials. This would allow determining the
dynamic mechanical properties of different
tissues in different physio-pathological conditions
therefore improving the methodologies for tissue
quality assessment. Results show that viscosity,
strain rate and tissue microstructure have a
significant influence on the viscoelastic behaviour
of soft tissue.
Results
Multi-phase modelling of soft tissue shows the
influence of strain rate in the apparent stiffness
of the tissue as shown in Fig.1. The viscoelastic
behaviour of the tissue is nonlinear with decreasing
time constants for increasing strain rates. Fluid
viscosity and microstructure of tissue has a
significant influence in the relaxation of the
material.
References
Phipps et al, Urology, 66:44750, (2005b).
Gill, B. J., & West, J. L. Journal of Biomechanics,
110.(2013).
161
O 13 3
TEMPERATURE INCREASE IN ARTICULAR CARTILAGE

INDUCED BY VISCOUS DISSIPATION
P. Abdel-Sayed1, M. Nassajian Moghadam1, R. Salomir2, D. Tchernin2, D. Pioletti1
1
Ecole Polytechnique Fdrale de Lausanne, Bioengineering, Lausanne, Switzerland

2
University Hospitals of Geneva, Radiology, Geneva, Switzerland
Introduction
Temperature measurement of the knee joint has a
long history in medical thermometry, attempting
to correlate articular disease with temperature
alteration. Temperature of a healthy knee joint is
33 C at rest 1. Given that articular knee cartilage
has viscoelastic properties, a local temperature
increase in the cartilage could be obtained due to
dissipation following a cyclic mechanical loading.
This is especially interesting for cartilage since it has
been shown that the rate of proteoglycan synthesis
and glycolysis chondrocytes are enhanced at
37C compC 2. The aim of this study was to assess
the temperature increase in articular cartilage
subsequent to mechanical loading of healthy and
degenerated cartilage, advocating a correlation
of the temperature alteration with the tissue
homeostasis.
In order to determine the temperature increase
in cartilage under mechanical loading due to its
intrinsic viscoelastic properties, a mathematical
model was developed. The model encompassed
three parameters determined experimentally
(Fig.1). The first parameter was the power of energy
dissipated subsequent to a mechanical loading,
which was quantified in vitro on human healthy
and degenerated cartilage samples. The second
parameter was the cartilage heat capacity, which
was measured in vitro on human cartilage samples
with Differential Scanning Calorimetry. Finally,
the third parameter was the time constant of
cartilage heat transfer, which was determined on
4 volunteers by Magnetic Resonance Thermometry.
For healthy cartilage samples, the model shows that
dissipation may be sufficient to raise the temperature
in articular cartilage from 33C to 36.7C after
a one hour walking. However, for degenerated
cartilage the temperature augmentation did
not exceed 1 C. Indeed, a significant (p < 0.01)
decrease in the energy dissipation can be
observed in degenerated samples, as it
drops from 12.82 1.18 to 2.82 0.97 mJ/g.
Thus this decrease in dissipation implied also a
reduced temperature increase during mechanical
loading
C o n cl u s i o n
The results of this study show that the thermal
aspect of cartilage mechanics may be related to
cartilage degeneration.
References
1 Becher+, BMC Musculoskelet Disord, 2008;
2 Brand+, Connect Tissue Res, 1991;
This project was supported by the Inter-Institutional
Center for Translational Biomechanics EPFL-CHUV-DAL.
Figure 1: F lowchart of the experiments.
162
O 13 4
IMPACT OF CANITIES ON VISCOELASTIC

PARAMETERS OF HUMAN HAIR
L. Simkova1, M. Skrontova2, J. Zeman3 , B. Chalupa3 , K. Jelen1
1
Faculty of Physical Education and Sports, Charles University in Prague,

Department of Anatomy and Biomechanics, Prague, Czech Republic
Faculty of Physical Education and Sports, Department of Anatomy and Biomechanics,

3
Faculty of Engineering, Czech University of Life Sciences, Department of Physics,

Methods
Hair diameter D had been ascertained optically
in 15 positions on each fibre. Young modulus
E, yield strength Yield, ultimate strength max
and maximum elongation max were determined
from the deformation curve. The strain went on
at 20 %/min speed.
Introduction
The text deals with comparison of viscoelastic
parameters of grey hair and hair of natural
colour, taken from the same persons heads. Most
works dealing with hair fibres, e.g. Robbins (2002)
describe the hair as an elastic material and work
with an analysis obtainable from the deformation
curve. Even in this case, no consensus is found in
the description parameters. While some authors
prefer establishing of the hair firmness and give
its diameter as an independent parameter, see
Hay (2011), most authors, much like Benzarti et al.
(2011), calculate strictly with the true stress and
evaluation of the Young modulus of elasticity.
Some authors plunge into a raw characterisation
of relaxation properties, using, however, a linear
model relying on two elasticities and one viscosity
at most. We use three viscous elements, keeping
the third one equal for all hairs.
Viscous characteristics, i.e. relaxation times 1 and

2 and their relevances F1 and F2 were determined
from the relaxation curve. Hair samples had been
cut from the occiput area just above the skin
surface.
All measurements have been carried out at
27 C 3 C temperature and 30 % 3 % relative
humidity.
Results
Summary of the results from 50 hairs can be seen
in the table.
VALUE
D [m]
E [GPa]
max[MPa]
max[%]
Yield[MPa]
color
79 19
4 0,8
323 76
48 5
100 19
41
gray
70 7
51
348 57
39 4
118 43
3,1 0,8
VALUE
F0 [%]
F1 [%]
F2 [%]
1 [s]
2 [s]
D [m]
color
42 6
94
10 2
91
101 38
57 2
gray
45 5
84
72
10 2
143 40
80 13
Discussion
Given the lack of homogeneity of the hair,
thinner hairs, containing higher percentage of
the more firm cortex, appear as hairs with higher
Young modulus. Furthermore, thickness increase
of 10 % on average as a result of canities can
be observed at most people. Comparison of
the results listed in the table leads us to a strong
belief that particular types of molecular bonds are
differently represented in particular hairs, resulting
in proportionally differently strong relaxation
effect. The most pronounced difference between
the original and the grey hair is always seen (w/o
exceptions!) at the 2 parameter, i.e. the long-term
relaxation. The parameter increases by 35 % on
average due to canities; grey hairs thus relax more
slowly. The long-term relaxation effect is however
smaller; generally it decreases from 10 % to 8 % of
the initial force, apparently due to a change in the
representation of particular tertiary bonds.
Yield[%]
This project was co-financed by the grant GAUK
884214.
References
B
enzarti, M., Tkaya, M. B., Mattei, C. P. & Zahouani,
H. (2011). Hair Mechanical Properties Depending
on Age and Origin. World Academy of Science,
Engineering and Technology 74, 471 477.
H
ay, J. & Wall, C. (2011). Mechanical Characterization of Brown and Grey Hair. Agilent Technologies,
Inc. 2011. 5990-8681EN.
R
obbins, R. C. (2002). Chemical and Physical
Behavior of Human Hair, 4th ed. ISBN 0-387-95094-X.
163
O 13 5
NONLINEAR COMPRESSION-RATE DEPENDENT

RESPONSE OF PORCINE KNEE JOINT
M. Rodriguez1, L. Li1
1
University of Calgary, Mechanical and Manufacturing Engineering, Calgary, Canada
Introduction
Cartilage response to load is extensively investigated
both computationally and experimentally using
relatively simple geometries, such as cartilage discs.
This relationship is characterized to be nonlinear
and viscoelastic by nature with a fluid load support
of 90% when a uniform compression is applied
rapidly [1, 2]. It is also known that cartilage response
is different when it is healthy or degenerated. In
the former, the reaction force can be up to 10
times greater than that of a slow compression
of the same magnitude [2, 3]. In the latter case
these differences related to compression-rates are
less significant. The objective of the present study
is to quantify the compression-rate dependent
mechanical response of a knee joint. We are
interested in the poromechanical response of the
human knee, but used porcine joints for lab tests
as a first step.
Our study will aid to understand the load share

between the fluid pressure and tissue matrices
within the healthy knee joint. We will use this
approach to further study how the load share
changes with compression rate for injured and
degenerated knees.
References
1 Atheshian GA, Hung CT, 2005, Clinical Orthopaedics & Related Research 81, 8190.
2 Li LP, Herzog W, 2005, Computer Methods Biomechanics Biomedical Engineering 8, 8391.
3 Li LP, Buschmann MD, Shirazi-Adl A, 2003, Journal of
Biomechanical Engineering 125, 161168.
4 Dabiri Y, Li LP, 2013, Medical Engineering & Physics
35, 15911598.
Methods
Compression tests of porcine knees were
performed on a Mini Bionix II (MTS, Minnesota).
Fresh porcine stifle joints with intact joint capsule
were obtained within 24h of slaughter. An 800-m
ramp compression was applied while the knee was
in its natural angle. Six compression rates, 10, 50,
100, 500, 1000 and 2000 m/s, respectively, were
used for the ramp compression followed by a 20
min relaxation period. Hydration was maintained
during testing. Fourteen joints have been tested so
far.
Results
Reaction force varied two times between the
smallest and fastest compression rates. The force
depends on compression rate but approaches to
the same value (~30 N) at long time (a complete
equilibrium was not reached). The fluid load support
was up to ~70% (Figure 1), because the equilibrium
load for the test shown here is approximately 30%
(~30/108) of the peak load (Figure 2).
Figure 1: L oad and compression relationship of the knee

joint.
Discussion
Reaction force highly depends on the rate of
compression for most healthy pig knee joints.
Conditions such as freezing and hydration were
found to affect the results significantly. The
difference between the peak and equilibrium load
is believed to contribute by the fluid pressure in
cartilage and menisci. In our case, the fluid pressure
can support 6070% of the total loading in most
pig knee joints, when the joint is subjected to a fast
compression. In the human knee joint computer
modeling, the equilibrium load was ~33% of the
peak load [4].
Figure 2: R
elaxation of the joint at different compression
rates.
164
O 13 6
CERVICAL REMODELLING DURING PREGNANCY:

MULTISCALE NUMERICAL SIMULATION
OF VISCOELASTICITY
L. Peralta1, G. Rus1, N. Bochud1, F.S. Molina2
1
2
University of Granada, Estructural Mechanics, Granada, Spain
San Cecilio University Hospital, Obstetrics and Gynecology, Granada, Spain
RESU L TS
Results show that the excitation frequency determines
which rheological model can be representative for
the tissue, and the simplest model that best describes
the simulated dispersion curves in cervical tissue is
the Maxwell law. Figure 1 shows the plausibility of the
proposed rheological model to describe cervical
tissue for an excitation frequency range.
Introduction
During the cervical ripening several changes occur
progressively in the structure of the tissue, such as
an increase in the hydration, decrease in elasticity
and disorganisation of the collagen network1. The
viscoelastic properties are recently being reported
to be particularly sensitive to the gestation process,
and to be intimately related to the microstructure
of the cervical tissue2. However, this link is not fully
understood yet
In this work, we explore the possibility of quantifying
both cervical elasticity and viscosity from shear
waves velocity. To this end, a numerical histomechanical model is proposed to link variations
in the microscopic histo-biomechanical processes
with shear waves propagation characteristics.
After determining the most convenient excitation
frequency and the best rheological law to describe
the micro-structure of the cervix, parametric
simulations are carried out for a broad range of
mechanical and geometrical parameters that
mimic gestational age.
Figure 1: P
lausibility of the proposed rheological models
for the excitation frequency range.
METHODS
We propose a model that quantitatively describes
the relationship between histological variables
and ultrasonic mechanical properties.
Results from the parametric study show a direct

relationship between the histological and morphological changes during pregnancy and the viscoelastic
behaviour of the tissue. An elasticity drop is shown for
all the morphological variables studied here, supporting that collagen fibres are mainly responsible for the
mechanical behavior of cervical tissue.
Shear waves propagation through cervical tissue

at the micro-scale is simulated by a heterogeneous
finite difference time-domain (FDTD) numerical
model. The cervical tissue is described by a
parameterized morphology model, which is able
to capture the collagen organization. Chemical
changes that happen during pregnancy are
incorporated to the cervical model by a mixture
theory-based model of mechanical properties.
DIS C USSION
This work highlights the role of collagen architecture in
soft tissue mechanics, and specifically, in the cervical
tissue. It has been demonstrated that firstly, the best
rheological model with less parameters to describe
cervical tissue is Maxwells law; secondly, results
suggest convergence at high frequency; and finally
it is worth pointing out that the elasticity offers a good
characterisation of the morphological changes in the
microstructure that occurs during gestation.
To finally connect with the macro-scale,

rheological properties are studied through the
dispersion curves by a phase difference algorithm
combined with a model-based inverse problem
(IP) to reconstruct the evolution of macroscopic
viscoelastic properties in the tissue. Three standard
rheological models (Voigt, Maxwell and Zener) are
evaluated regarding their ability to reproduce the
simulated dispersion curves, and their plausibility to
describe cervical tissue is ranked by a stochastic
model-class selection formulation 3. Finally, the
relationships between viscoelastic properties and
microstructure of the tissue are analysed by a
parametric study.
RE F EREN C ES
1 Mahendroo, Reproduction 143:429438, 2012.
2 Barone et al., ASME 2010 Summer Bioengineering
Conference 697698, 2010.
3 Bochud et al., IEEE T ULTRASON FERR, 59:
14431456, 2012.
Spanish Ministerio de Economa for project DPI2010-17065, Spanish Junta de Andaluca for projects
P11-CTS-8089 and GGI3000IDIB, and the European
Union for program Programa Operativo FEDER
de Andaluca 20072013.
165
O 137
REGION-SPECIFIC UNIXIAXIAL TENSILE PROPERTIES

OF SINGLE LAMELLAE IN THE INTERVERTEBRAL DISC
G. Marini1, E. van Haaften2, F. Passini1, S. Ferguson1
1
ETH Zrich, Health Sciences and Technology, Zrich, Switzerland
TU Eindhoven, Biomedical Engineering, Eindhoven, Netherlands
Introduction
Numerical studies [Marini, 2014] have shown that
the heterogeneous stiffness distribution of the outer
ring of intervertebral discs (annulus fibrosus, AF)
represent an optimum in order to reduce the local
stress, especially in compression. These studies
modelled the AF by assuming a direct correlation
between the mechanical properties and the local
biochemical composition of the tissue. However,
the link between these characteristics is still unclear,
in particular with respect to the local position in
the tissue. This information is relevant for designing
replacements that resemble natural tissue
[Mizuno, 2004] and could enhance substantially
the biofidelity of numerical analyses of the spine.
The aim of the current study was therefore to
characterize the uniaxial tensile response of single
lamellae with respect to their radial position within
the AF.
Figure 2: D
istribution of Elow (white), Emid (grey) and Ehigh
(black) vs the relative radial position in the AF (0
outer region, n=104)
Methods
Single lamellae were harvested from lumbar
bovine discs (n=13). The distance (x) from the
outer edges of the adjacent vertebrae was
noted. Before testing, the specimens were
immersed for 30 minutes in a physiological bath
(0.15 M NaCl). Afterwards, the lamellae were cut
into a rectangular shape and the size measured.
For the test, the specimens were sandwiched in
fabric and clamped in a testing machine (Instron
ElectroPuls). Microbeads were blown on the
surface to serve as reference points for subsequent
video strain analysis. After preconditioning
(0.1 N, 5 cycles at 0.05 Hz), the lamellae were
allowed to relax for 60s. The specimens were then
stretched at a constant speed (1 mm/min) to failure.
Slipping of the lamellae was assessed by post-test

analysis of the videos. The mechanical response
was characterized for regions between 0 MPa and
the yield stress (s g). The modulus was defined as the
maximum of the first derivative of the stress-strain
curve [Marini, 2012]. Three moduli were defined:
E low (00.1s g), E mid (0.1s g0.5s g) and E high (0.5s gs g)
(Figure 1).
Results
In general, outer lamellae were stiffer than lamellae
from the inner AF (Figure 2). This is reflected by
the radial changes of the tensile moduli and is in
agreement with previous studies [Skaggs, 1994].
The interpolation of each moduli distribution
with a linear function showed a high correlation,
R>0.53 (p<0.001).
Discussion
The present study investigated the tensile properties
of single lamellae with respect to their radial position
in the AF. The results suggest a corresponding
variation in biochemical composition, which will
be the focus in a future study.
References
Marini et al, Ann Bio Eng, 42:17601772, 2014
Marini et al, Int J Num Met Bio Eng, 28:8799, 2012
Mizuno et al, Spine, 29: 12901298, 2004
Skaggs et al, Spine, 19:13101319, 1994
Figure 1: S tress-strain curve of a single AF lamella
166
O 13 8
OUTER AND INNER ANTERIOR ANNULUS FIBROSUS

HAVE DIFFERENT STIFFNESS AND FAILURE STRENGTH
IN RADIAL TENSION
M. Mengoni1, A.C. Jones1, V.N. Wijayathinga1, R.K. Wilcox1
1
University of Leeds, institute of Medical and Biological Engineering, Leeds, United Kingdom
Introduction
The annulus fibrosus (AF) is the outer part of the
intervertebral disc. It comprises a series of lamellae,
composed of collagen fibres embedded in a ground
matrix. Secondary structures such as bridges across
the lamellae are also present [Schollum, 2008].
This complex composite architecture contributes
to the highly non-linear anisotropic behaviour
of the intervertebral disc. The aim of the present
study was to examine the damage occurrence
and failure strength of the anterior AF under radial
tension. This is a first step towards modelling failure
mechanisms to understand the effects of needle
puncture, for which there is evidence that it may
cause damage leading to degeneration.
Results
No significant differences between groups were
found for the strain level at which apparent
damage or failure occurred (Figure 1). As a result
of the difference in stiffness, the stress level at
occurrence of apparent damage was significantly
different between each group. No significant
difference was observed within each group
between the stress levels at the occurrence of first
failure and at macroscopic failure.
Methods
All discs used in this study were extracted from
frozen mature ovine thoracolumbar spines. Cuboid
AF specimens were divided into three groups:
outer annulus (N=6), inner annulus (N=8), and
specimens across the whole annulus thickness
(N=12). Tensile radial tests were performed at
1 mm/min and load was recorded. The linear
modulus was evaluated as the slope of the linear
fit of the stress between 0.5% and the strain value
for which the curvature of the stress/strain curve
deviates from zero. Occurrence of apparent
damage was defined as the stress and strain values
for which the residual of a linear fit is 15% higher
than the residual of the linear fit used to compute
the linear modulus. Initial local failure was defined
where the tangential modulus was negative for
at least 0.5% consecutive strain. Macroscopic
failure was defined as a drop of stress below 90%
its current value in less than 1% increase in strain.
The mechanical values were compared with
a Kruskal-Wallis test and Mann-Whitney tests.
Figure 1: M
echanical parameters (mean and std)
The optimization process converged to damage

values reproducing the sample secant stiffness
within 10% of the experimental value (Figure 2). At
a given strain level, the predicted damage of the
lamellae was higher than that of the inter-lamellar
space.
A 1D variable-stiffness spring model was designed

to represent the damage part of the experimental
data. Springs were assembled in series representing
either
the
lamellae
or
the
inter-lamellar
connections. Each spring was given an initial
stiffness value derived from an inverse FEA linear
model [Mengoni, 2014]. The damage variation
of the springs was derived for each group of
specimens with an optimization process to
minimize the difference between in-vitro and
in-silico secant stiffness.
Figure 2: S tiffness variation for the experimental data (,

mean and std) and the 1D model
see the next page
167
Discussion
The experimental data suggests that, in radial
loading, the annulus has an almost linear behaviour
up to about 20% strain followed by a modulus
decrease until the first instance of local failure.
Several local failures follow at similar stress levels
before macroscopic failure. The stress level at the
occurrence of damage and failure depends on
the radial location of the samples.
The in-silico results suggest the damage of the

lamellae is predominant in the damage mechanism
of the samples. This observation is supported by
microscopic imaging.
In conclusion, this study demonstrated that
damage can be adequately modelled using 1D
variable-stiffness springs, and this approach can
now be applied to models of the whole annulus to
examine clinical interventions.
References
M
engoni et al., WCB2014 Schollum et al. 2008 Spine
33(5) 2702-10
168
O 13 9
SECOND HARMONIC GENERATION IMAGING

AND NANOINDENTATION OF CARTILAGINOUS TISSUES
J. Sepitka1, Z. Burdikova2, E. Filova3 , J. Lukes1
1
Czech Technical University in Prague, Department of Mechanics Biomechanics

and Mechatronics, Prague, Czech Republic
Academy of Sciences of the Czech Republic, Department of Biomathematics,

3
Institute of Experimental Medicine, Department of Tissue Engineering,

Introduction
Interest on mechanical properties of a cartilaginous
endplate (CEP) seems to be more actual at present
spine biomechanics. Endplate is a transition zone
between intervertebral disc (IVD) and vertebral
body which plays undeniable role of a force
transmission. Poroelastic structure of CEP assures
nutrients delivery into and from the avascular
IVD. Knowledge of this amazing a few hundreds
micrometres thick indispensable cartilaginous slice
could explain basic steps of nature evolution. We
are not a first team who tried to study mechanical
properties of CEP. Surprisingly, we found alarming
anticoincidence in present papers. Mechanical
properties of the CEP are presented in literature
with large range of values. Elastic moduli are given
in the range from 5 MPa to 10 GPa. Which raises
the following questions: What causes this large
range of values? Is it an erroneously performed
experiment? Is it a poorly identified endplate?
Is it a non-sensitive macroscopic experiment to
inner microstructure of the endplate that causes
large range of measured values? We decided to
investigate mechanical properties depending on
inner microstructure of CEP and thereby detect
possible source of scattering of results. Second
Harmonic Generation imaging method (SHG) was
used to identify CEP area and its inner structure
in native state. Nanoscale Dynamic Mechanical
Analysis (nanoDMA) was used to investigate
structural dependent mechanical properties
afterwards. This work presents combination of a
nanoindentation technique and SHG imaging
to determine an influence of the cartilaginous
endplate microstructure on its local mechanical
properties.
Ready to move to SHG imaging and nanoindentation

afterwards. SHG signal was detected in two
ways: (1) the backward descanned mode when
the signal passed through the scanning head of
the confocal microscope and (2) the backward
non-descanned mode when the signal was
collected directly behind the objective. For
collagen detection the laser was tuned at the
wavelength of 860 nm, hence the SHG signal was
expected at 430 nm. In the descanned mode, the
SHG signal was detected in the range of 420 to
440 nm. In a nondescanned configuration, which
is supposed to improve the signal to noise ratio in
the acquired images, the external detector was
placed behind a 700-nm short-pass filter, which
attenuates IR light, followed by a 430-nm bandpass
filter with a bandwidth of 15 nm. Nanoscale
dynamic mechanical analysis (nanoDMA) was
performed with Hysitron TriboIndenter TI950
system with Diamond Fluid Cell Conical tip (angle
of tip 90, 10 m radius). Harmonic loading with
dynamic load amplitude P 0 = 1 N was specified
for the harmonic frequency range 5300 Hz. During
nanoDMA experiment was applied static load with
maximum force Pmax = 200 N. Specimen was glued
to the bottom of the Petri dish and surrounded
by physiological solution. The surface was under
physiological solution and ready to be indented
under a water level.
We identified two types of the cartilaginous
structures within the cartilaginous endplate
(unorganized and organized). Organized structure
has horizontal, vertical and cross oriented collagen
fibers. Mechanical properties represent by means
of storage modulus of cartilaginous endplate are
in the range from 2 to 35 MPa at frequency 5 Hz.
Values depend on a type of the structure and a
density of collagen fibers. Mechanical properties
of the native cartilaginous endplate depend on
loading rate.
Methods
A porcine cartilaginous endplate of lumbar spine
L3 was used in our study. The specimen of endplate
was cut from fresh porcine vertebra, dissected
from 1216 month animals. The lumbar spine
motion segments were immediately dissected and
five millimetre thick plates of vertebral body, end
plate and annulus fibrosus were cut and polished
under running water condition. Samples were
placed into the physiological solution right after.
References
Sepitka et al. Comput Method Biomech, 15:
335336, 2012.
169
O 14 0
A NEW STRAIN ENERGY FUNCTION

FOR THE HYPERELASTIC MODELLING
OF LIGAMENTS AND TENDONS
T. Shearer1
1
University of Manchester, School of Mathematics, Manchester, United Kingdom
Introduction
Ligaments and tendons are fundamental structures
in the musculoskeletal systems of vertebrates.
Ligaments connect bone to bone to provide stability
and allow joints to function correctly, whereas
tendons connect bone to muscle to facilitate the
transfer of the forces generated by muscles to
the skeleton. The distinct roles played by different
ligaments and tendons require differing mechanical
responses to forces, and their differing stress-strain
behaviours have been well documented.
Results
It will be shown that the new model gives a better
match to stress-strain data for human patellar
tendon [3] than the HGO model, with the average
relative error being 0.053 (compared with 0.57 for
the HGO model), and the average absolute error
being 0.12MPa (compared with 0.31MPa for the
HGO model).
Discussion
The majority of SEFs in the literature behave linearly
in the small-strain limit in order to be consistent with
linear elasticity. In this talk, however, I will show
that materials with the microstructure I will describe
should not be expected to behave linearly in that
limit. The SEF I derive is non-linear in the small-strain
limit, allowing it to match experimental data in the
toe-region of the stress-strain curve better than
those models which are linear under small strains.
Additionally, all of the parameters in the new SEF
can be directly measured via experiments, giving
it more predictive power than phenomenological
models.
Ligaments and tendons consist of collagenous

fibres organised in a hierarchical structure. Their
main subunit is the fascicle, which consists of fibrils
arranged in a crimped pattern. In this talk I will derive
a new strain energy function (SEF) for the hyperelastic
modelling of ligaments and tendons based on the
geometrical arrangement of their fibrils, and will
compare the ability of the new model to reproduce
experimental data with that of the commonly-used Holzapfel-Gasser-Ogden (HGO) model [1].
There are many models of the non-linear elastic
behaviour of ligaments and tendons; however, the
majority of these (including the HGO model) are
phenomenological. A microstructurally based model
will allow us to understand how the mechanical
response of ligaments and tendons arises from the
arrangement of their constituent subunits.
References
[1] Holzapfel, G.A. Gasser, T.C. Ogden, R.W., 2000.
A new constitutive framework for arterial wall
mechanics and a comparative study of material
models. Journal of Elasticity 61, 148.
[2] Kastelic, J. Paller, I. Baer, E., 1980. A structural
model for tendon crimping. Journal of Biomechanics 13, 887893.
[3] Johnson, G.A. Tramaglini, D.M. Levine, R.E.
Ohno, K. Choi N-Y. Woo, S.L-Y., 1994. Tensile and
viscoelastic properties of human patellar tendon.
Journal of Orthopaedic Research 12, 796803.
Methods
Kastelic et al. [2] derived the stress-strain response
of a fascicle under tension as a function of
the microstructural arrangement of its fibrils.
Unfortunately, however, an error in that paper
led to the derived stress-strain relationship being
incorrect. In this talk, I will correct the mistake in [2]
and use a new functional form for the radial crimp
angle distribution to derive an expression for the
stress-strain response of a single fascicle, which I
will use to derive the new SEF.
170
O 141
MECHANICAL CHARACTERIZATION OF ABDOMINAL

MUSCLE BY INVERSE ANALYSIS ON AN ANIMAL MODEL
R. Simn-Allu1, B. Calvo1, J.M.M. Montiel1, A. Oberai2
1
Aragn Institute of Engineering Research / University of Zaragoza, Mechanical Engineering,

Zaragoza, Spain
2
Scientific Research Computation Center SCOREC / Rensselaer Polytechnic Institute,

Department of Mechanical, Aerospace and Nuclear Engineering, Troy, NY, USA
Introduction
In this work we develop a methodology to
characterize in vivo the passive mechanical
behavior of abdominal muscle, using for that finite
element simulations combined with inverse analysis
and optimization algorithms.
p = D1 [exp (D 2 (I 1)) 1]
These parameters were obtained by inverse analysis,
posing the inverse problem as a minimization
problem and seeking the distribution of material
parameters that yields the displacement fields that
best match the experimental measures2.
The knowledge of the mechanical response of the

abdominal muscle is needed to determine the
features of the surgical mesh in cases of hernia
surgery.
Results (Fig. 2) showed that D 1 takes higher values

in the central zone of the surface, corresponding
to the muscle rectus abdominis. Same happened
with D 2. Maximum displacement values obtained in
the simulation were similar to experimental results.
Inflation test were performed on New Zealand rabbits,
increasing the inner pressure from 0 to 12 mmHg
(see Fig. 1 (a)). Experimental tests were recorded
using a stereo imaging system to obtain 3D
measurements of the abdominal surface along the
experiment.
C ON C L USIONS
Rectus seemed to be more rigid than the obliques.
The method worked properly to determine the
material parameters of the tissue.
RE F EREN C ES
1 Hernndez et al., J. Mech. Behav. Biomed. Mater.,
4(3):392404, 2011
2 Goenezen S. et al., Comput. Methods Appl. Mech.
Engrg., 200:14061420, 2011

The 3D measurements allowed us to reconstruct the
whole cavity for different pressures, which was lately
used for a finite element simulation (see Fig. 1 (b)).
For the FE analysis a quasi-incompressible isotropic
hyperelastic material model was proposed,
specifically Demirays model, dependent on two
material parameters (D1, D2) 1.
Spanish Ministry of Economy and Competitiveness,
through the grant BES-2012-053422 and the project
DPI2011-27939-C02-01.
Figure 1: a
) Experimental arrangement of the specimen at P=12 mmHg. b) Displacement field from a FEM simulation.
see the next page
171
Figure 2: a
) Distribution of D1 over the abdominal surface. b) Final deformed shape for the distribution of parameters chosen.
172
O 14 2
EXPERIMENTAL AND NUMERICAL ANALYSIS OF FIBERED

SOFT TISSUES CONSIDERING VISCOELASTICITY
AND MULLINS EFFECTS
E.A. Fancello1, O.T. Pinto1, C.R.M. Roesler1, J.M. Vassoler2
1
Federal University of Santa Catarina, Mechanical Engineering Department,

Federal University of Rio Grande do Sul, Mechanical Department, Porto Alegre, Brazil
Introduction
Soft biological fibered soft tissues like ligaments,
tendons or artery walls are mainly formed by
arrangements of collagen fibers and elastin
embedded in a ground substance. Their main
mechanical properties like anisotropy, high
nonlinear response, rate strain dependence
(viscosity), dependence on the maximum strain
attained (Mullins effect), are frequently related to
the mechanical adaptation to functional loadings.
The inclusion of some or all of these phenomena
in the numerical simulation of biomechanical
problems is important to achieve significant results.
To exemplify, the addition of the correct viscous
response of an arterial wall will produce a significant
influence on the pressure wave propagation
during a fluid-structure simulation. Despite several
models have been proposed to represent these
materials [12] the present work follows a unified
variational approach to represent isotropic and
fibered viscoelastic response coupled with the socalled Mullins effect and softening at excessive
strains [35]. In order to evaluate the capabilities
of the proposed model an experimental work using
pig tendons submitted to cyclic loadings was set
up and real stress-strain curves were obtained. The
model was finally used to find the best correlation
among simulated and experimental observations.
and decouple tissue relaxation (viscous effects)

from damaging effects. Local strains (axial and
transversal) were registered by digital image
correlation (DIC), allowing the construction of real
stress-strain loading curves.
Results
Figure 1 shows the loading history and the experimental versus numerical curves after parameter identification.
C o n cl u s i o n s
Experiments showed expected rate dependence
and softening effects depending on the maximum
strain achieved. The model on the other side was
successful enough to follow these phenomena
with excellent correlation values and turning it
candidate to reproduce similar behaviors in other
relevant soft tissues.
Method
The constitutive model is based on a variational
framework for inelastic materials proposed by Ortiz
and coworkers and specialized for viscoelasticity,
anisotropy and damaging phenomena in [46].
Within this framework a pseudo-potential energy
Incremental Potential is defined at each time
step in such a way the first Piola-Kichhoff can be
computed analogously to hyperelastic materials.
Anisotropy is modeled in the classical simplified
way of splitting the Incremental Potential in
isotropic and anisotropic contributions. The internal
variables updates including viscous flow and
damage are obtained by a minimization problem
within the time increment, providing the variational
character of the model.
References
[1] Pea E., Calvo B., Martinez M.A., Doblar M., On
finite-strain damage of viscoelastic-fibred materials.
Application to soft biological tissues. International
Journal for Numerical Methods in Engineering,
74:11981218, 2008.
[2] Maher E., Creane A., Lally C., and Kelly D. J.
Journal of the mechanical behavior of biomedical
materials, 12:919, 2012.
[3] Fancello, E.A., Ponthot, J.P., and Stainier, L.,A
variational formulation of constitutive models
and updates in non-linear finite viscoelasticity.
International Journal for Numerical Methods
in Engineering, 65:18311864, 2006.
[4] Vassoler, J.M., Reips, L., and Fancello, E.A.,
A variational framework for fiber-reinforced
viscoelastic soft tissues. International Journal for
Numerical Methods in Engineering,
89:16911706, 2012.
[5] Vassoler, J.M., Fancello, E.A., Stainier,
L. A variational framework for fiber-reinforced
viscoelastic soft tissues including damage.
Submitted.
The experimental work was performed using

pig flexor tendons submitted to displacementcontrolled cyclic increasing loadings. The
maximum strain value of each cycle was kept
constant during a short period in order to enhance
173
O 14 3
HOMOGENIZATION METHODS FOR THE MULTISCALE

CONSTITUTIVE DESCRIPTION OF SOFT
CONNECTIVE TISSUES
M. Marino1, P. Wriggers1
1
Leibniz Universitt Hannover, Institut fr Kontinuumsmechanik, Hannover, Germany
Introduction
Soft connective tissues share a peculiar histological structure, characterized by a hierarchical organization from the nanoscale (molecules) up to
the microscale (crimped collagen fibers). The mechanical behaviour of collagenous tissues affects
a number of both micro (e.g., mechano-regulated
tissue remodelling) and macro (e.g., mechanics of
joints or vessels) physiological systems. Moreover,
many physiopathological processes, which are
strictly related to experimentally observable histological or biochemical alterations, affect collagenous tissues mechanics and, therefore, the functional role of a number of anatomical structures
(e.g., joints or blood vessels). Accordingly, modeling the mechanical behaviour of collagenous
tissues is a challenging open problem [Holzapfel,
2007] and the choice of a multiscale approach
based on tissue structure enables to analyze macroscopic effects as a function of diseased histological features at different scales.
Results
The effects of collagen-related diseases, linking
histological evidences with mechanical alterations,
is analyzed. For instance, alterations in collagen
metabolism, in microscale crimp morphology and
in fiber arrangements are addressed. Moreover,
the physiological or pathological tuning of tissue
mechanics with collagen cross-linking enzymatic
activity is discussed. Furthermore, the effects of
remodeling mechanisms and/or pharmacological
treatments on the evolution of tissue mechanical
response is addressed.
Discussion
Proposed approach is effective and accurate for
different regular soft collagenous tissues (such as
tendons, periodontal ligament and aortic media)
as proved by the comparison between available
experimental data and computed results.
Moreover, the value of model parameters straight
follows histo-chemical evidences opening to the
analysis of the mechanics of diseased tissues or
organs. Finally, results highlight the key role of the
nanomechanics in tissue macroscale response.
Methods
In the present work, the mechanics of soft
connective tissues is modeled by employing
multiscale homogenization methods [Marino,
2013]. Crimped collagen fibers own a non-linear
mechanical behaviour due to their geometric
arrangement as well as to molecular kinks (i.e.,
labile domains) within molecular structure.
Analytical and computational approaches are
coupled in order to the obtain the macroscale
tissue response in function of both nanoscale
mechanisms [Uzel, 2011] and microscale nonlinearities [Maceri, 2010]. Parameters governing
polyconvex anisotropic strain energies are set on the
basis of computational models of curvilinear fiberlike structures and analytical entropic/energetic
molecular descriptions.
C o n cl u s i o n
Homogenization methods for the multiscale
constitutive description of soft collagenous
tissues is a powerful tool for characterizing the
mechanics of biological structures under physiopathological conditions. The coupling of analytical
and computational approaches allows to conduct
parametric analyses with low-cost computing efforts.
References
H
olzapfel et al, J Biomech Eng, 126:26475, 2004
M
aceri et al, J Biomech 43:355363, 2010
M
arino et al, Stud Mech Tis Eng Biomat,
14:73102, 2013
U
zel et al, J Mech Behav Biomed Mat,
4:4153161, 2011
174
O 14 4
FE-COMPATIBLE REFORMULATION OF A CONSTITUTIVE

MODEL OF THE ARTERIAL WALL EXPLICITLY ACCOUNTING
FOR COLLAGEN FIBER RECRUITMENT
G. Fernndez Collazo1, N. Debusschere2, F. Iannaccone2, M. De Beule2,
P. Segers2, T. Rodrguez3 , B. Verhegghe2
1
IbiTech-bioMMeda and Instituto Superior Politcnico Jos Antonio Echevarra Cujae,

Department of Electronics and Information Systems, Ghent University, Ghent, Belgium
2
IbiTech-bioMMeda, Department of Electronics and Information Systems,

Ghent University, Ghent, Belgium
Instituto Superior Politcnico Jos Antonio Echevarra, Cujae, Tecnologa de Construccin

de Maquinarias, La Habana, Cuba
RESU L TS AND DIS C USSON

Results show that the model can accurately
reproduce
the
non-linear
pressure-radius
relationship. Figure 1a displays how the analytical
description of the new material model can
excellently fit (chi-square=0.026) carotid pressuredistension data measured in a rat using a simple
(pre-stretched) cylindrical tube. Figure 1b shows
the response obtained from the numerical model
for the simulation of the pressure-distension
response of a simplified artery with diameter and
thickness taken for the rat carotid artery.
Introduction
Several constitutive models have been presented
in literature to describe the complex response of the
arterial wall to mechanical loading 1. One important
contribution to the description of the passive
response of blood vessels using a constituentsbased approach was proposed by Zulliger et
al. 2 However, this model presents a complex
formulation of the collagen fiber recruitment as the
load is applied (including a convolution integral),
which limits the implementation of the structural
model in finite element (FE) codes. In this study we
propose a modification of the above mentioned
model to account for a more implementationfriendly formulation for FE programs.
METHODS
We propose the following modification to the
mathematical description of the collagen
fiber recruitment presented in Zulliger et al. 2
The convolution of the individual fiber strain
energy function (SEF) with the fiber probabilistic
distribution function (PDF) (log-logistic) is replaced
by a simple multiplication of the individual fiber
SEF with the fiber cumulative distribution function
(CDF) (log-logistic). The modified constitutive
model contains the same parameters of the
original formulation. Validation of our strategy was
based upon fitting the material model parameters
to data obtained from ex-vivo rat carotid artery
measurements 3. We further verified that our new
SEF is a convex function of the stretch ratios, with
a global zero minimum when the material does
not experience deformation. We also checked
material incompressibility and the adequate
description of the experimental data. Then, the
novel constitutive model was implemented in a
user defined subroutine (UMAT) to be compatible
with the commercial FE solver Abaqus (Dassault
Systmes Simulia Corp., USA). Performances were
investigated by comparison of the numerical
results with the experimental data.
Figure 1: C
omparison of increase in radius measured experimentally (symbols) with the new mathematical
description of the collagen fiber recruitment (solid
line). Experimental mean curve fitted with the
analytical model (a) and Abaqus test to verify the
implementation (b).
C ON C L USION
We modified an existing arterial material model to
be applicable in FE analysis. This model explicitly
accounts for collagen fiber recruitment which
makes it more intuitive than traditionally used
strain energy based formulations. We were able
to extract material properties from experimental
data from rat carotid artery measurements
and successfully reproduced the experimental
outcome via FE simulation.
RE F EREN C ES
1 Holzapfel G. A. et al., Proc. R. Soc. A.
466:15511597, 2010
2 Zulliger M. A. et al., J. Biomech. 37:9891000, 2004
3 Fridez P. et al., J. Biomech. 36:671680, 2003
175
O 14 5
THE EFFECTS OF NITINOL STENT OVERSIZING

IN PATIENTS UNDERGOING FEMORO-POPLITEAL ARTERY
REVASCULARIZATION: A GEOMETRICALLY
PATIENT-SPECIFIC FINITE ELEMENT STUDY
C. Gokgol1, N. Diehm2, P. Buchler1
1
2
Kantonsspital Aarau, Interventional Angiology, Aarau, Switzerland
Introduction
Nitinol stent oversizing is commonly performed
during
endovascular
procedures;
however,
currently, stent sizing mostly relies on the expertise
of the clinicians and is not defined by objective
criteria. While oversizing a stent will undoubtedly
increase acute luminal gain, it can also create a
hostile chronic environment for the artery through
stent-to-arterial wall interactions, which may
ultimately lead to arterial damage, neointimal
hyperplasia and restenosis.
Previous clinical studies reported controversial
findings on the clinical outcome of stent oversizing.
Therefore, a better description of the biomechanical
implications of oversizing on arterial tissues may
help to understand the mechanisms responsible
for restenosis and help the clinicians select the
appropriate stent size during intervention. The aim
of the present study was to quantify the effects of
Nitinol stent oversizing using numerical models of
healthy and calcified femoro-popliteal (FP) arteries
obtained from patients undergoing endovascular
revascularization.
Figure 1: C
ut-views of a stent expansion in a healthy,
patient-specific artery (top) and a calcified artery
(bottom)
Results
For healthy arteries, adventitia was found to
be mechanically predominant, as well as the
most failure-prone arterial layer. For all cases,
the maximum circumferential stresses in this
layer increased non-linearly with respect to the
unconstrained stent diameters. Increasing the
oversizing ratio from 1.1 to 1.8 led to a 4.5% increase
of the lumen and a 66% increase of the wall
stresses. A gradual decrease in the safety factor
of the stent was found with increased oversizing
(5.28 0.1 to 1.18 0.11). Blood flow simulations
showed that localized areas affected by low WSS
increased with higher oversizing ratios and use of
the stiffer stent.
Methods
The anatomies of the FP arteries of five patients
were obtained via 3D rotational angiography.
Finite Element (FE) models of healthy and
calcified arteries were reconstructed around
arterial centerlines. The tissue was modelled as
hyperelastic with properties corresponding to
popliteal arteries [Gasser, 2006]. Damage models
for the calcification included plastic deformation
and stress softening.
Deployment simulations of two different Nitinol
stents, with diameters ranging from 5.5 to 9 mm,
were performed. For diseased arteries, the
simulations also included the clinical steps to
crack the calcification prior to stenting. Arterial
stresses, luminal gains and fatigue behavior of the
stents were analyzed. Furthermore, computational
fluid dynamics methods were used to simulate
the physiological blood flow inside the stented
healthy arteries to obtain wall shear stress (WSS)
parameters.
Discussion
Stent oversizing increases the risks of chronic irritation
of the structural and hemodynamic properties of
the popliteal arteries. The damage inflicted onto
the arterial walls and continuous degradation
caused by critical flow parameters may create
circumstances for restenosis. Our numerical model
indicates that a maximum oversizing ratio of 1.1
is recommended for the healthy FP arterial tract.
On the other hand, the predominant arterial layer
and the stress distribution in the arteries change
drastically with the inclusion of calcification. These
changes showcase the importance of modeling
the calcified layer, which can directly impact the
appropriate oversizing ratio.
References
Gasser et al, J R Soc Interface, 3:1535, 2006.
176
O 14 6
BIOMECHANICAL EVALUATION OF A PULMONARY

ARTERY AUTOGRAFT IN THE ROSS PROCEDURE
WITH AND WITHOUT A PEARS REINFORCEMENT
H. Fehervary1, J. Vastmans1, J. Vander Sloten1, T. Verbelen2,
P. Verbrugghe2, T. Treasure3 , F. Rega2, N. Famaey1
1
KU Leuven, Mechanical Engineering, Heverlee, Belgium

2
KU Leuven, Cardiovascular Sciences, Leuven, Belgium
University College Londen, Clinical Operational Research Unit, London, United Kingdom
Introduction
The Ross procedure is a treatment for young adults
and children suffering from aortic valve disease. In
this surgical procedure the aortic root is replaced
with a pulmonary root autograft. This entails that
the pulmonary arterial tissue is exposed to systemic
pressures, which results in late root dilatation when
entirely unsupported. Different reinforcements to
support the autograft are proposed, but still remain
subject of debate [Stelzer, 2011].
parameters of UP and a reinforced postoperative

situation (S3) in which a 15 mm section has the
parameters of RP and two adjacent 10mm sections
have the parameters of RA.
Results
The preliminary material parameters of the four
different tissue types (Table 1) and maximum
principal Cauchy stresses for each simulation
(Figure 1) are shown.
This abstract evaluates from a biomechanical point

of view the Ross procedure without reinforcement
and with a Personalized External Aortic Root
Support (PEARS) [Pepper, 2010].
Methods
A simplified version of the Ross procedure is
performed on 7 Lovenaar sheep: a section of the
thoracic aorta descendens was replaced by a
section of the truncus pulmonalis, which was then
reinforced with the PEARS textile. After 6 months, the
animals were sacrificed and the tissue harvested.
Four tissue types were collected for mechanical
testing: unreinforced pulmonary arterial tissue
(UP), reinforced pulmonary arterial tissue that was
placed in aortic position (RP), unreinforced aortic
tissue (UA) and reinforced aortic tissue (RA).
C10[MPa]
k 1[MPa]
k 2[-]
[]
[-]
UP
0.004
0.004
2.569
0.3
RP
0.006
0.019
2.115
60
0.0
UA
0.019
0.013
3.251
45
0.3
RA
0.006
0.019
2.115
60
0.0
Table 1: T he material parameters of the four tissue types

for the constitutive material model proposed in
[Gasser, 2006].
The BioTester (Cellscale) device was used to perform

planar biaxial tests on 7x7 mm samples using rakes.
The sample was immersed in physiological solution
of 37C. Forces were acquired with 23N load cell
(0.2 full scale accuracy) at 30 Hz and deformation
was tracked using markers and a CCD camera
(1280x960 pixels) also at 30Hz.
Figure 1: M
aximum principal Cauchy stresses in the aorta
loaded at systolic pressure for the preoperative
situation (S1), the unreinforced (S2) and the reinforced (S3) postoperative situation.
The constitutive model proposed in [Gasser, 2006]

was fitted to the data in a nonlinear optimization
process minimizing the model and experimental
stresses using Matlab 2013a.
Discussion
Figure 1 shows that pulmonary arterial tissue is stiffer
than aortic tissue when loaded to systemic pressures
and that no immediate dilatation is apparent.
However, these higher stresses in aortic position
compared to the physiological stresses in native
position, will trigger remodelling phenomena. On
the other hand, Figure 1 also shows a compliance
mismatch between the native aorta and the
section of reinforced pulmonary. The stresses are
A finite element simulation of an aorta under

systemic loading pressure and out-of-plane
boundary conditions at the edge was performed
using Abaqus Standard 6.12-2. The geometry was
a thick-walled aorta with dimensions realistic for
the sheep under study, meshed with 9000 C3D8RH
elements. The material model of [Gasser, 2006]
was assigned, using the parameters obtained from
the experimental data above. Three situations
are considered: the preoperative physiological
situation (S1) in which the whole tissue has
parameters of UA, the unreinforced postoperative
situation (S2) in which a 15 mm section has the
see the next page
177
References
reduced compared to the unreinforced pulmonary

section, but high stresses still occur at the border
between native and reinforced aortic tissue.
Further model refinement (e.g. calculation of
average material parameters and incorporation
of residual stresses) and first validation (e.g. visual
comparison with CT images) are required for a full
biomechanical evaluation of the Ross procedure
and the PEARS reinforcement.
P
. Stelzer et al, Semin. Thorac. Cardiovasc. Surg.,
23(2):115123, 2011.
J . Pepper et al, Interact. Cardiovasc. Thorac. Surg.,
10(3):360365, 2010.
T .C. Gasser et al, J. R. Soc. Interface.,
3(6):1535, 2006.
178
O 14 7
BIOMECHANICAL FINITE ELEMENT ASSESSMENT OF

NEOCHORDAL TECHNIQUES IN MITRAL PROLAPSE REPAIR
F. Sturla1, E. Votta1, F. Onorati2, O. Pappalardo2, G. Puppini2,
G. Faggian2, A. Redaelli1
1
Politecnico di Milano, Department of Electronics Information and Bioengineering,

Milano, Italy
2
Universit degli Studi di Verona, Division of Cardiovascular Surgery, Verona, Italy
Introduction
Neochordal implantation (NCI) is an established
technique for degenerative mitral valve (MV)
posterior prolapse (PP) repair [Adams, 2006],
although requiring a long-standing experience
to select the appropriate NCI configuration and
precisely assess neochordal length. At this aim
we have recently proposed patient-specific
finite element (FE) models, derived from cardiac
magnetic resonance (CMR), to assess the effects
of routine NCIs [Sturla, 2014] and the impact of
surgical precision in setting neochordal length, on
postoperative MV biomechanics.
Methods
Four patient-specific FE structural MV models
were derived through segmentation of cine
CMR long-axis planes, providing 3D end-diastolic
MV
configuration,
realistic
annular
and
papillary muscles (PMs) kinematic boundary
conditions, and accounting for anisotropic MV
mechanical properties [Stevanella, 2009] and
non-linear response of ePTFE neochordae. Using
ABAQUS/Explicit, we simulated for each MV the
preoperative systolic prolapsing condition, the
physiological condition with an intact chordal
apparatus (i.e. providing the physiological
distance between the insertion of the ruptured
chordae and the corresponding PM tip) and
post-operative outcomes of single, double and
standard loop NCIs (Fig.1). For each technique,
different suture lengths were simulated, replicating
a correct, a shorter and a longer NCI repair (2mm
with respect to the physiological length). Also, the
effect of a stabilizing rigid equal-sized annuloplasty
was assessed.
Figure 1: S tudy workflow and example of FE results

computed for standard loop technique.
On the contrary, overloading of shorter NCIs was

noticed, providing a sufficient CoA, but markedly
increasing mechanical leaflet stress and inducing
asymmetric load redistribution in multiple NCIs
(Fig.1). In case of longer sutures, relevant forces
continued to act on the prolapsing MV region
and on native neochordae. Ring reshaping,
though reducing annular area, improved CoA and
mechanical stress redistribution on MV leaflet.
Discussion
The FE analyses quantitatively assessed MV
biomechanics and the efficacy of neochordal
repair in each patient-specific PP-scenario. In
particular, subtle defects in tuning NC length may
result in significant biomechanical drawbacks,
potentially
elucidating
recurrence
of
MV
regurgitation due to leaflet tearing or dehiscence
as well as mechanisms of ePTFE early failures.
Results
PP-related dysfunctions well compared to CMRdata (Fig. 1). Tested NCIs effectively fixed MV
prolapse with satisfactory levels of coaptation
area (CoA); the outcomes of MV repair proved to
be technique-dependent with multiple NCIs better
transferring tensions, thus improving mechanical
stress distribution on the repaired MV leaflet.
References
Adams et al, Heart Fail Rev, 11:24157, 2006.
Stevanella et al, J Biomech Eng, 131(12), 2009.
Sturla et al, JTCVS, 148(3):102534, 2014.
179
O 14 8
IN VITRO TESTING OF THREE DIFFERENT

IVC FILTERS EFFICIENCY
M. Nicolas Chueca1, M. Malv2, E. Pea1, M.A. Martnez1, R.L. Leask3
1
2
Public Univeristy of Navarra, Mechanical Engineering, Pamplona, Spain

3
McGill University, Chemical Engineering, Montreal, Canada
Introduction
Pulmonary embolism (PE) is a serious, potentially
life-threatening condition. The cause is usually
a blood clot that dislodges from the deep veins
in the lower extremities and travels to the lungs 1.
Inferior vena cava (IVC) filters are used to prevent
PE by intercepting and trapping large clots while
allowing clot-free blood to pass freely towards the
heart.
manometer. Students t-test for independent

samples was used to evaluate differences between
filtration capacities of each filter.
Numerical validation
Some numerical simulations were carried out
to validate the pressure dop measurements.
Rhinoceros (Robert McNeel & Associates) was used
to create the 3D geometries, Ansys Icem (Ansys
Inc. Software, Canonsburg, PA, USA) was used to
obtain the numerical grids (see Figure 2) and the
fluid dynamics computations were carried out
using Ansys CFX (Ansys Inc. Software, Canonsburg,
PA, USA).
Newer filter designs have appeared in the market

in the last years so there is a necessity to test their
efficiency. The aim of this in-vitro study is to evaluate
the clot capture efficiency of the Gnther Tulip
and Celect filters, under different conditions and
to prove, if possible, the superiority of one of the
filters over the others.
Centered filter
In vitro set up
Filter
Small
clots
Large
clots
Small
Clots
Tilted filter
Large
clots
Modified
Gnther Tulip
5.5
21.2
NA
NA
Gnther Tulip
81.7 +
99.5 +
69.3*
99
Celect
78.5 +
98.8 +
57.8
99.3
Table 1: P
ercentage of clots captured. + P<0.001 using t-test
when centered filters compared with Modified
Gunther. * P<0.01 using t-test when tilted filters
compared with Celect
Empty filter
Figure 1: T op:Experimental set-up, bottom: FE mesh used for

the pressure drop simulations
Figure 1 shows a summary of the in-vitro set up

used. The fluid used to mimic the blood had a
density of 1.091 g/cm3 and a dynamic viscosity of
0.0036Pa.s. The fluid was Newtonian, laminar and
fully developed.
Filter with 6 clots
Filter
In-vitro
Numerical
In-vitro
Numerical
Gnther Tulip
0.6
0.63
4.1
4.3
Celect
0.6
0.62
4.2
4.2
Table 2: P
ressure drop in mmHg
Clot capture rates went from 5.5% to 99.5%. The

results show that the efficiency of the filters was
reduced as the size of the clots decreased and
as the position of the filter was tilted. The pressure
barely changed with the presence of the filter
alone, but higher pressures were recorded when
some clots were inserted. There was no significant
difference in the pressure drop recorded for
different filter models.
Testing procedures
Clot trapping capacity was assessed by placing
clots of various sizes into the flow system and
counting the number of clots passing through the
filter. The filters were tested at different positions
and with different clot volumes. The experiment
was repeated a total of 200 times, and a total
of 6000 clots were used. The pressure drop along
the system was also measured using a traceable
see the next page
180
References
1 Leask,R.L.,Johnston, K.W., Ojha,M. Hemodynamic
Effects of Clot Entrapment in the TrapEase Inferior
Vena Cava Filter. JVIR, 15(5), 485490
Figure 2: L eft: Celect filter in tilted position with some clots.

Right: centered Gnther Tulip with clots
The Modified Gunther Tulip filter has the lowest clot
capture efficiency, and cannot be used to prevent
PE. The most effective filter was the Gunther Tulip
The authors gratefully acknowledge research support
from the Spanish Ministry of Science and Technology
through the research project DPI2013-44391-P and
the grant BES-2011-043471. Finally, we want to thank
Dr. Leask for his help and collaboration in this project
181
O 14 9
AN IN-VITRO PHANTOM STUDY ON THE ROLE

OF BIRD-BEAK CONFIGURATION ON ENDOGRAFT
INFOLDING IN THE AORTIC ARCH
A. Rinaudo1, S. Pasta2, F. Scardulla1, G. Raffa3 , G. DAncona4 ,
M. Pilato3 , C. Scardulla3
1
2
3
4
Universita di Palermo, DICGIM, Palermo, Italy
Fondazione RiMED, Tissue Enginnering & Regenerative Medicine, Palermo, Italy

ISMETT, CardioThoracic Surgery, Palermo, Italy
Vivantes Klinikum im Friedrichschein und Am Urban, Cardiovascular Medicine Clinical

and Research Unit, Berlin, Germany
Introduction
Endograft collapse is a potentially devastating
complication reported for the Gore TAG device
that can occur after endovascular repair of
traumatic thoracic aortic injuries [1]. Excessive
device oversizing and proximal bird-beaking are
the principal factors leading to endograft infolding
and, ultimately, collapse [2]. In this study, the
infolding of oversized endografts was assessed to
evaluate the hemodynamic conditions that may
predispose a bird-beak configuration to infolding.
at high systemic pressure. No complete collapse of

endograft was observed under chronic perfusion
testing maintained for 30 days at pulse pressure
of 100 mmHg, suggesting that physiological flows
cannot engender hemodynamic loads on the
proximal bird-beaking sufficient enough to cause
TAG collapse.
C o n cl u s i o n
These findings suggest that endograft infolding
depends primarily on the amount of aortic
pulsatility, and that physiological flows cannot
engender hemodynamic loads on the proximal
bird-beaking sufficient enough to cause TAG
collapse. Hemodynamic variables such as the
systolic to diastolic pressure change may allow for
identification of patients at high risk of endograft
infolding, and help guide preventive intervention
to avert its occurrence.
Methods
In-vitro studies were done using a mock circulation
loop in a patient-specific compliant phantom
model (see Fig.1) reconstructed from a patient who
presented with collapse of a Gore TAG thoracic
endoprosthesis (WL Gore and Assoc, Flagstaff, Ariz)
[3]. Device infolding was measured under different
flow (Q=3, 5 and 7 L/min) and systemic pressure
conditions (185/150 mmHg and 70/20 mmHg) for
three protrusion extensions (PE=13 mm, 19 mm,
and 24 mm) of the bird-beak configuration resulting
from two TAG endografts with oversizing of 11%
and 45%, respectively. TAG device displacements
of the bird-beak apex and TAG device rotation
with respect to the graft fixation point were used to
characterize infolding. Linear regression was done
to correlate hemodynamic variables with infolding
parameters. Chronic hemodynamic condition was
also assessed by maintaining perfusion upon 30
days.
References
[1] Kasirajan et al. Incidence and outcomes after
infolding or collapse of thoracic stent grafts.
J Vasc Surg, 55,6528, 2013.
[2] Tadros et al. A multicenter experience of the
management of collapsed thoracic endografts.
J Vasc Surg, 53, 121722, 2011.
[3] Pasta et al. Computer modeling for the prediction
of thoracic aortic stent graft collapse. J Vasc
Surg, 57,135361, 2013.
RESU L T AND DIS C USSION

The bird-beak configuration with the greatest PE
exhibited the maximum TAG device displacement
(0.70 mm), while the lowest PE configuration led
to the minimum amount of both displacement
and rotation parameters (0.20 mm and 0.4 deg,
respectively). The larger device led to infolding
parameters comparable to the smaller device
when perfusion was maintained at the same
hemodynamic conditions. An inverse relationship
was observed between the infolding parameters
and the flow circulating in the aorta and left
subclavian artery. Interestingly, TAG device
displacement was positively correlated with
systemic pressure, with significant p<0.05 for all birdbeak configurations and device sizes. This suggests
that that endograft infolding depends primarily on
the amount of aortic pulsatility, with a greater risk
Figure 1: Photographs

of phantom model with particulars
of bird-beak configurations (PE)
182
O 15 0
THE EVALUATION OF MAMMALIAN THROMBI MODELS

FOR THE INVESTIGATION OF VASCULAR OCCLUSION
IN ACUTE ISCHEMIC STROKE: A PRELIMINARY STUDY
F. Malone1, P. Delassus1, J. Thornton2, E. McCarthy3 , P. Fahy1, L. Morris1
1
Galway Mayo Institute of Technology, Mechanical and Industrial Engineering,

Galway, Ireland
2
Beaumont Hospital, Neuroradiology Department, Dublin 9, Ireland
Galway Mayo Institute of Technology, Marine and Freshwater Research Centre,

Galway, Ireland
Introduction
Stroke remains the third most common cause of
death and the leading cause of acquired long-term
disability worldwide. A lack of blood supply to any
part of the brain tissue for an unknown period of time
will deprive the brain tissue of oxygen, which can
lead to stroke. Over 80% of all strokes are ischaemic
that result from an occlusion of a major cerebral
artery. This occlusion can be caused by emboli,
which are thrombi that have originated elsewhere
in the cardiovascular system but have travelled
lodged in the cerebral vasculature.The retrieval of
thrombi from humans for the investigation of stroke is
expensive and highly regulated. Therefore, embolus
analogues
manufactured
from
mammalian
blood play a unique role in understanding the
pathophysiology, morphology and mechanical
characteristics of thrombi [Chueh, 2011]. This
project concerns the histological and mechanical
examination and characterisation of thrombin
induced, erythrocyte rich mammalian thrombi. The
thrombi models were then used to experimentally
model and simulate ischemic stroke using an inhouse cerebral test facility.
Results
The presence of nuclei and erythrocytes correlated
significantly with stained human thrombi samples
[Chueh, 2011] (Figure 1A). The presence of fibrin and
collagen was determined in high concentrations of
thrombin induced mammalian thrombi (Figure 1B).
Tensile and compression tests were conducted at
varying strain displacements. Initial results indicate
a change in stiffness with increase in thrombin
concentration.
Figure 1: H
&E stain ovine thrombus(6NIH Units/ml blood) (A),
MSB stain bovine thrombus(9 NIH Units/ml blood) (B)
Discussion
The successful development of such thrombus
models and future clot flow studies may provide
a basis for the characterisation of post-operative
thrombi removed from humans. Knowledge about
the histological characteristics and lodgement
morphologies of thrombi may provide a means
for improving current endovascular therapies and
the development of new treatment strategies for
revascularisation in patients with acute ischemic
stroke. These findings could indicate that the
composition of thrombi is a potential key variable
regarding the selection of the appropriate
treatment options for ischemic stroke patients
and in predicting the performance of mechanical
thrombectomy devices and thrombolytics.
Methods
Mammalian blood of ovine and bovine origin
was harvested from a local abattoir and induced
immediately with bovine thrombin. To investigate
the effect of thrombin on thrombus composition,
the thrombin concentration was varied among the
samples (010 NIH units/ml blood). Haemotoxylin
and Eosin (H&E) and Martius, Scarlet and Blue (MSB)
stains were completed for compositional analysis.
Tensile (n=13) and compression tests (n=14)
were conducted on the corresponding thrombi
models and results were compared to literature
values [Krasokha, 2010]. 9 patient specific scans
of the aortic arch in DICOM format were imported
into Mimics Version 16.0 to generate 3D models
using segmentation techniques. Models were
geometrically characterised and differentiated
for flexible model production. These models
were incorporated into a cerebral test facility for
releasing the animal thrombi and tracking the
trajectory within the cerebral vasculature.
References
[1] Chueh, J.Y. et al, AJNR, 32:12371244, 2011.
[2] Krasokha N et al, Mat wiss u Werkstofftech,
41:10191024, 2010.
183
O 15 1
A TWO-LAYERED ARTERY WALL MODEL WITH COLLAGEN

DISPERSION FOR ARTERY BUCKLING ANALYSIS
H.C. Han1, M. Mottahedi2
1
2
University of Texas at San Antonio, Mechanical Eng, San Antonio, USA
University of Texas at San Antonio, Mechanical Engineering, San Antonio, USA
Results
Our results demonstrated that the critical buckling
pressure increased nonlinearly with increasing axial
stretch ratios. Compared to experimental critical
buckling pressures measured at axial stretch ratios
in the range of 1.01.7, both the single-layered
model and two-layered model demonstrated
similar level of accuracy (R 2 = 0.88 0.08 and
0.890.07, respectively). The measured and model
predicted critical buckling pressures obtained
from the one-layered and two-layered models at
the physiological axial stretch ratio (1.5 in vivo)
were 10.68 1.73 kPa, 9.93 3.56 kPa and
12.56 3.35 kPa, respectively. In the adventitia
layer, collagen fibers demonstrated two preferred
orientation, symmetrically aligned with respect
to circumferential direction (at 34.6 11.5);
however, in the media layer, only one preferred
fiber family, closely aligned with circumferential
direction (9.643.34), was present. Parametric
studies showed that with increasing fiber dispersion
parameter, the predicted critical buckling pressure
increases.
Introduction
Artery buckling has been proposed as a possible
mechanism of artery tortuosity which is associated
with aging, hypertension and atherosclerosis. Since
micro-structural of arterial wall remodels with aging
and diseases, it is necessary to understand how
artery buckling is linked to the micro-structural of
the arterial wall. The objective of this study was to
establish an artery buckling model based on a twolayered wall model with dispersed collagen matrix.
Methods
Five porcine carotid arteries were tested and
analyzed. Pressurized inflation test was performed
on intact arteries and separated intima-media layer
to determine the material constants. The critical
buckling pressures were measured for intact arteries
at series of axial stretch ratios in the range of 1.01.7.
Microstructural collagen distributions were obtained
through histological sections of adventitia and
media layers using an automated image processing
algorithm. The dispersion parameters quantifying
the collagen dispersion about the preferred
direction were determined by fitting a mixture of
modified von-Mises distributions. The arterial wall
was modeled as two layers with distinct material
properties for the intima-media and adventitia
layers. Buckling equations were developed using
two-fiber reinforced structural model that accounts
for collagen fiber dispersion to better represent the
anisotropic properties of the artery.
Discussion
We concluded that two-layered arterial wall
model with consideration of collagen dispersion in
each layer well described the buckling behavior of
arteries. This model improves our previous simplified
4-fiber model and sets a base for future studies to
examine the microstructural changes associated
with vascular diseases and its relationship to artery
tortuosity.
References
[1] A. Y. Lee, et al., Effects of elastin degradation
and surrounding matrix support on artery stability,
Am J Physiol Heart Circ Physiol,302 (4):
H873H884, 2012.
[2] Q. Liu, et al., Artery buckling analysis using
a four-fiber wall model, J Biomech, 47(11):
27902796, 2014.
[3] T. C. Gasser, et al., Hyperelastic modeling of
arterial layers with distributed collagen fiber
orientations, J R Soc Intf 3(6): 1535, 2006 3 (6):
1535, 2006.
184
O 15 2
ALGORITHM FOR INTRODUCING RESIDUAL STRESSES

INTO FINITE ELEMENT MODELS OF ANEURYSMS
J. Bursa1, S. Polzer1
1
Brno University of Technology, Institute of Solid Mechanics, Mechatronics and Biomechanics,

Introduction
It is generally accepted that computational
models cannot give realistic estimation of
stresses in arterial wall without taking residual
stresses into consideration. This has been usually
performed on the basis of manifestation of residual
strains quantified by opening angles of arterial
segments (Vaishnav & Vossoughi, 1983). This
approach, however, is not feasible for irregular
arterial structures like abdominal aortic aneurysm
(AAA) nor for patient-specific models in general.
Therefore other approaches to computational
modelling of residual stresses have been proposed.
The algorithm published by [Polzer et al., 2013] and
implemented in finite element (FE) model reduces
the stress gradients in aortic wall substantially.
It applies the uniform stress hypothesis [Fung,
1991] by splitting the deformation gradient tensor
into elastic and growth deformation gradients.
Its applicability was shown not only for simple
geometrical shapes (e.g. hollow cylinder as model
of artery) but for patient-specific geometries of
AAAs as well. However, the optimization criterion
applied here is stress difference between the
corresponding FE nodes on the inner and outer
surfaces. Although this difference is set close to
zero after iterative calculations, the volumetric
growth is set in surface nodes only. Consequently,
the calculated stresses are not uniform throughout
the wall thickness and a significant difference in
stresses remains between surface and inner nodes
of the FE mesh thus still violating the assumption of
uniform stress.
the FE node and average stress throughout the

wall thickness in the given location. In order to
make the stress distribution closer to uniform stress
hypothesis, the volumetric growth is prescribed in
more nodes throughout the wall.
Results
Results obtained with the above model show
that the new algorithm is capable to reduce
the stress differences throughout the wall even
more effectively than that by [Polzer et al., 2013].
Specifically, under 20 kPa inner pressure, extreme
stresses in the most concave location of the wall
were 82/53 kPa after 12 iterations with the original
algorithm and 78/60 kPa after 15 iterations with the
new one.
Discussion
The results presented in this study have been
obtained using regular hexahedron mesh but the
new algorithm is applicable for patient-specific
AAA models as well because also here we prefer
hexahedron mesh. Moreover, the algorithm shows
potential of even more efficient reduction of stress
gradients by prescribing volumetric growth by a
smoother function. Due to more iterations needed,
however, it is more time consuming which might
become significant for large models. This drawback
could be reduced by a more sophisticated
programming of the algorithm. For AAA models
with irregular mesh (combining tetra-, penta-, as
well as hexahedrons), however, the algorithm may
require further modifications and become even
slower.
Methods
The analysis is performed using a FEM model with a
simple 3D geometry showing convex and concave
parts. For the material we apply hyperelastic Yeoh
model fitted to our own mean population data
for AAAs. When loaded by inner pressure, local
bending of convex and concave parts of the
model increases the stress gradients throughout
the wall thickness; these should be reduced by
residual stresses. In contrast to [Polzer et al., 2013],
however, the volumetric growth is applied here
on the basis of difference between local stress in
This work was supported by Czech Science
Foundation project No.13-16304S.
References
Fung, Ann Biomed Eng 19, 237-249, 1991.
Polzer, Bursa, Gasser, Staffa, Vlachovsky, Ann
Biomed Eng 41 (7), 1516-1527, 2013.
Vaishnav, Vossoughi, Biomedical Engineering II,
Recent Developments, Pergamon Press, Oxford,
330333, 1983.
185
O 15 3
BIOMECHANICAL RUPTURE RISK ASSESSMENT

OF ABDOMINAL AORTIC ANEURYSMS BASED
ON NOVEL PROBABILISTIC RUPTURE REISK INDEX
S. Polzer1, T.C. Gasser2
1
Brno University of Technology, Institute of solid mechanics, mechatronics and biomechanics,

2
The Royal Institute of Technology, Department of Solid Mechanics, Stockholm, Sweden
Introduction
A rupture risk assessment is critical to the clinical
treatment of Abdominal Aortic Aneurysm (AAA)
patients. The biomechanical AAA rupture risk
assessment
quantitatively
integrates
many
known AAA rupture risk factors, such that it has
certain advantages over other risk assessment
methods. Despite encouraging results the
variability of risk predictions due to model input
uncertainties remains a challenging limitation of
the biomechanical AAA rupture risk assessment.
In contrast, calculated medians of PWWR were

0.568(SD0.149) and 0.774(SD0.453) for intact
and ruptured group respectively (p=0.128).
PRRI showed a high sensitivity and specificity
(discriminative power of 0.806) to discriminate
between ruptured and intact AAA cases.
Methods
The present study combined deterministic AAA
biomechanical modelling with probabilistic data
analysis in order to derive a Probabilistic Rupture
Risk Index (PRRI). Specifically, the uncertainties
in AAA wall thickness and wall strength were
considered [1], and wall stress was predicted with
a state-of-the-art deterministic biomechanical
model. The discriminative power of PRRI was tested
in a cohort of ruptured (n=6) and intact (n=6)
AAAs and compared to alternative risk assessment
method where software A4 clinics is used to
calculate deterministic criterion called peak wall
rupture risk (PWWR).
Discussion
Uncertainties in AAA wall stress predictions, the wide
range of reported wall strength and the stochastic
nature of failure motivate a probabilistic rupture
risk assessment. Advanced AAA biomechanical
modelling paired with a probabilistic rupture
index definition as known from engineering risk
assessment seem to have some advantages
over a purely deterministic approach as it shows
better discriminative power to distinguish between
ruptured and intact AAAs. Of course larger study is
needed for validation of proposed approach which
is however currently limited by long computational
times (approx. one week for one case).
Results
Prescribing a log-normal distribution of the AAA wall
thickness results in turn in a log-normal distribution
of the Peak Wall Stress predictions Medians of PRRI
were 1.86% (SD 6.82%) and 16.6% (SD 14.56%) for
intact and ruptured group respectively (p=0.045).
References
1R
eeps C. et al., Biomech. Model. Mechanobiol.
12, 717733. 2013
186
O 15 4
MECHANICAL CHARACTERISATION OF VALVULAR

TISSUES USING INVERSE ANALYSIS
C. Laville1, V. Acosta2, O. Trabelsi2, S. Avril2, Y. Tillier1
1
MINES ParisTech, Centre de Mise en Forme des matriaux CEMEF, Sophia Antipolis, France
2
Ecole Nationale Suprieure des Mines, CIS-EMSE, Saint-Etienne, France
Results
The HGO (Gasser et al., 2006) and Prot (Prot
et al., 2007) material models were successfully
implemented using linear tetrahedral elements
and validated against published data (fig.1).
Introduction
The use of numerical simulation to investigate heart
and valvular mechanics is becoming increasingly
popular. In particular, finite element analysis is
often used to support the operation planning
procedure as well as the design of artificial valves.
The mechanical response of the aortic valve
(AV) tissue strongly depends on the composition
and interaction of different constituents, such as
collagen fibres and elastin network. Accordingly,
constitutive equations including non-linearity
and anisotropy are necessary. Many constitutive
models have been developed to describe arterial
tissue, but just a few of them have been calibrated
specifically for the AV. An inverse analysis procedure
based on the finite element computation of biaxial
tensile tests is proposed to estimate material and
structural properties of aortic valves (AV).
The obtained material parameters will be later
used to model heart valve tissues.
Methods
Experimental data: Samples were collected from
several leaflets of fresh native porcine AV. They
were tested at room temperature using a biaxial
testing device. To characterize the mechanical
properties over a wide range of conditions, each
sample was subjected to different test protocols
with different stretch ratios. Force vs. displacement
curves were plotted and strain fields were
measured using digital image correlation (DIC).
Thanks to the DIC data acquired during the

biaxial tensile tests, the inverse analysis was
run to identify simultaneously relevant material
constant parameters and fibers local orientations
(structural parameters). This allowed us to perform
numerical simulations of whole heart valves under
physiological mechanical loads.
Numerical simulation: In order to model the

AV tissue behavior, two transversely isotropic
hyperelastic material models were implemented
in the finite element code FORGE (based on
an updated Lagrangian formulation). Biaxial
tensile tests were accurately modeled: specimen
geometries were obtained from photogrammetry
data and boundary conditions were defined as
close as possible to the gripping conditions used
experimentally (suture strands).
Discussion
In this study we considered as a first approximation
that
heart
valve
leaflets
are
monolayer
homogenous materials. Furthermore, only one fiber
direction was assigned to each element. Actual
collagen fiber orientations are currently being
characterized using multiphoton microscopy
images in order to address this limitation.
References
Gasser et al, Journal of the Royal Society Interface
3, 1535, 2006.
Prot et al, International Journal for Numerical
Methods in Engineering 71, 9871008, 2007.
Parameters identification: An inverse analysis

identification was carried out with MOOPI, an
optimization platform developed in our laboratory.
A metamodel-assisted evolutionary algorithm was
used to identify the set of material parameters.
187
O 15 5
COMPARAISON BETWEEN SHANKS MOUNTED

ACCELEROMETER AND GYROSCOPE
FOR TEMPORAL GAIT PARAMETERS
K. Ben Mansour1, N. Rezzoug1, P. Gorce1
1
HandiBio EA4322, Universit de Toulon, BP 20132, 83957 La Garde Cedex, France, UFR STAPS,
La Garde, France
Introduction
Measurement of temporal parameters with a
high accuracy level at all walking speed is a
prerequisite for the gait analysis [Lee, 2010].
Contrary to the motion analysis systems, force
plates and instrumented treadmill which are
limited to indoor assessment, wearable inertial
sensors (accelerometers or gyroscope) located at
the shank allow reliable foot contact detection in
unstructured environments [Selles, 2005]. Different
sensor types are used and the question arises
whether one type is the most suitable. Thus, the
purpose of this study is to test the accuracy of
gait temporal parameters assessed by a shank
mounted accelerometer and gyroscope.
which is set as a gold standard. The accuracy of

inertial sensors methods was computed based on
deviations away from the reference values. Table1
illustrates the mean and standard deviation of Root
Mean Square Error (RMSE) and the percentage of
error between temporal parameters quantified
from the treadmill and inertial methods. The
accelerometer and gyroscope gait parameters
deviation away from the gold standard follows the
same trend and decreases according to the gait
velocities. Overall, the gyroscope produced the
lowest RMSE value.
Methods
Treadmill walking was studied with 10 able-bodied
subjects (age: 29 (6) years, height: 1.79 (0.08) m
and weight: 79 (9) kg). Measurements were made
at the following speeds: 2.7, 4.5 and 6.3kmh-1. After
a 30s warm up on a treadmill with dual integrated
forceplates (ADAL3D-F TECHMACHINE, Andrezieux,
France, 200Hz), movement data are recorded for
a period of 30 s corresponding to a steady state
walking speed with one inertial sensor fixed at
the distal edge lateral surface of each shank. The
detection of gait events was made as follows:
Force treadmill method: The vertical component
of ground reaction force (GRF) was selected to
estimate gait events. The Initial foot Contact (IC)
and Terminal foot Contact (TC) were detected as
the first frame at which the vertical component
of GRF is greater and less than 20N, respectively
[Zeni, 2008].
Table 1: M
ean and Standard Deviation (SD) of RMSE
and percentage of error (%) between temporal
parameters quantified from the treadmill and
inertial methods
Shank accelerometer (MMA8453Q, Free scale Semi

conductor, Austin, Texas USA, 200Hz; 8g; 10bit):
The IC and TC were identified respectively from the
two main peaks of the acceleration norm pattern
[Lee, 2010].
Discussion
The obtained results from ANOVA showed that
shank gyroscope and shank accelerometer are
reliable tools to assess the temporal walking
parameters. Moreover, the RMSE and the percent
error revealed that shank gyroscope was more
accurate than shank accelerometer except for
stance, swing and double support at the highest
walking speed.
Shank Gyroscope (L3G4200D, STMicroelectronics,

Geneva, Switzerland, 200Hz; 250/s): Gait phases
were established based on the pattern of
mediolateral shank angular velocity. In fact,
per each step the TC and IC correspond to the
first and second negative peak respectively
[Salarian, 2004].
References
Lee et al, J Med Sys, 34:95966, 2010.
Selles et al, IEEE Trans Neural Syst Rehabil Eng;
13:818, 2005.
Zeni et al, Gait Posture, 27:7104, 2008.
Salarian et al, IEEE Trans Biomed Eng. 51:
14341443, 2004.
Results
For the set of treadmill walking speed, repeated
measures ANOVA showed no significant difference
between the basic temporal gait parameters (Stride,
step, stance, swing and double support duration)
computed from inertial sensors and treadmill
188
O 15 7
EXPOSURE OF FEMOROACETABULAR IMPINGEMENT

USING MULTI-BODY SIMULATION BASED
ON MOTION CAPTURE AND MRI
R. Cichon1, D. Raab1, S. Hewera2, A. Lazik3 , J. Theysohn3 ,
S. Landgraeber2, W. Kowalczyk1
1
Chair of Mechanics and Robotics, University of Duisburg-Essen, Duisburg, Germany

2
Department of Orthopaedics, University Hospital Essen, Essen, Germany
Institute for Diagnostic and Interventional Radiology and Neuroradiology, University Hospital
Essen, Essen, Germany
Introduction
In recent years, femoroacetabular impingement
(FAI) has become increasingly common. FAI is
caused by an abnormal contact between the
proximal femur and the acetabular rim, which
may lead to pain, limitation of movement, and
damage of the cartilage [1]. So far, FAI detection
and damage extension due to bone deformities
at the femoral head (cam deformity) and acetabular rim (pincer deformity) have been evaluated using physical and radiological examination.
A surgery is performed to correct the bone deformity, but this treatment is based exclusively on interpretations which is therefore a semi-quantitative
diagnosis. Computer-assisted techniques such as
multi-body simulations enable further evaluations,
thus allowing a more exact planning of the surgery.
Methods
In order to detect FAI, motion analysis is performed.
During the physical examination, the movement
of the lower body is recorded using a markerbased motion tracking, while pain is measured
with a chronological synchronism by using a
pressure-detecting device. Static and dynamic MRI
examinations are performed. The static MRI data
of the femur and the acetabulum are generated
with a comprehensive thin layer protocol and are
manually segmented using MIMICS (see Figure 1)
and a CAD model is generated. Finally, the CAD
model is synchronized with the gait labs motion data
and the motion and impact of the femur against
the acetabular rim is simulated using ANSYS (see
Figure 2). Afterwards the simulation is compared to
the dynamic MRI data. This allows a patient specific
pre-and post-operative FAI comparison.

With this method, it is possible to visualize the
movement of the patient and the contact
between the bones. This supports a repeatable FAI
evaluation before and after therapy. Additionally,
the simulation of the movement supports a more
exact resection of the bone. An automated
segmentation will be the next step to upgrade
the diagnosis and to create new standards.
Subsequently, an improved planning of the surgical
intervention will be pursued with the purpose of
optimizing the removal of the bone deformities.
In this context, a computer controlled navigation
may be used to assist and guarantee an exact
removal.
References
[1] O. Marin Pena: Femoroacetabular Impingement,
Auflage 1, Springer Verlag, 2012
189
O 15 8
FUNCTIONAL SUBJECTIVE SCORE AND OBJECTIVE

CENTRE OF ROTATION MIGRATION ESTIMATE ARE
NON CORRELATED IN PATIENTS WITH RECONSTRUCTED
ANTERIOR CRUCIATE LIGAMENT
F. Simini1, D. Santos2, F. Massa3
1
2
Universidad de la Repblica, Hospital de Clnicas, Montevideo, Uruguay
Universidad de la Repblica, Rehabilitation and Medical Physics, Hospital de Clnicas,

Montevideo, Uruguay
3
Universidad de la Repblica, Instituto de Estadstica, Montevideo, Uruguay
Introduction
The migration of the Centre of Rotation (COR) of the
knee with respect to the tibial plateau is altered by
the rupture of the Anterior Cruciate Ligament (ACL)
and again changed after reconstructive surgery.
The Tibialfemoral Contact Point technique yields
an estimation of the migration of the COR location
during sequences of fluoroscopic Rx knee images
during extension. On the other hand, subjective
satisfaction of knee function is measured using the
Lysholm-Tegner Score. The combined subjective/
objective estimation of parameters may be of
help for patient rehabilitation follow-up after
ACL surgery, but to a limited extent because the
subjective score was found to be not correlated to
objective COR estimations.
References
B
alzopoulos, V. (1995). A videofboroscopy method
for optical distortion correction and measurement
knee-joint kinematics. Clinical Biomechanics,
10(2), 8592.
Capozzo, A., Catani, F., Leardini, A., Benedetti, M. G.,
& Della Croce, D. (1996). Position and orientation in
space of bones during movement: experimental
artefacts. Clinical Biomechanics, 11(2), 90100.
M
arx, R., Jones, E., Allen, A., Altchek, D., O`Brien, S.,
& Rodeo, S. (2001). Reliability, Validity, and Responsiveness of Four Knee Outcome Scales For athletic
Patients. THE JOURNAL OF BONE & JOINT SURGERY,
83(10), 14591469.
P
anjabi, M. M., Goel, V. K., Walter, S. D., & Schick, S.
(1982). Errors in the center and angle of rotation
of a joint: an experimental study. Journal Of
Biomechanical Engineering, 104(3), 232237.
Santos, D., Francescoli, L., Loss, J., Arbo, F., & Simini, F.
(2013). A Tool to Assess Anterior Cruciate Ligament
Recostruction by Quantitative Localization of the
Knee Centre of Rotation. In 19th Congress of the
European Society of Biomechanics (ESB2013).
Patras; Greece.
Santos, D., Simini, F., Francescoli, L., Massa, F.,
Barquet, A., & Camarot, T. (2014). Beyond traditional
clinical evaluation of knee articulation movement
to physiological assesment of dynamic ACL funtion
during extension. In XIII International Symposium on
3D Analysis of Human Movement. cole Polytechnique Fdrale de Lausanne; Switzerland.
Lausanne Switzerland.
Simini, F., & Santos, D. (2014). Anterior Cruciate
Ligament Reconstruction Follow-up Instrumentation
based on Centre of Rotation Videofluoroscopy
Determination: Development of an original equipment, CINARTRO, and first clinical use. In Presented
at I2MTC Congress, Montevideo - Uruguay, May.
Tegner, Y., & Lysholm, J. (1985). Rating Systems in
the Evaluation of Knee Ligament Injuries. Clinical
Orthopaedics & Related Research, (196), 4349.
Method
To obtain the objective estimation we have
designed a new method and a subsequent new
equipment (CINARTRO) which operates with video
fluoroscopic images and creates clinical reports in
standard CDA format.
Results
For the first time in our region, the combination
of subjective score and clinical quantitative
assessment of the COR migration was assessed in
five patients, showing no correlation.
Discussion
The association of subjective and objective
measurements are complementary in clinical
practice and should both be considred when
designing new methods of evaluation.
190
O 15 9
VALIDATION OF THE MOTION ANALYSIS SOFTWARE

CVMOB FOR EVALUATION OF HUMAN GAIT.
A.P. Quixad1, K. S1, J.G.V. Miranda2
1
Bahia School of Medicine and Public Health, Physiotherapy, Salvador, Brazil

2
Federal University of Bahia, Nuclear Physics, Salvador, Brazil
Introduction
The evaluation systems of human movement has
been advancing exponentially in recent decades,
with exceptional software and hardware, as in the
example of three-dimensional systems. However,
the use of evaluation systems is not feasible for
clinical practice because it has a high cost and
scarcity of trained human resources to operate
them and interpret their results. For clinical
application, an ideal videogrammetry system
should be easy to use, low cost, with minimal
equipment and fast realization. Based on this
need, it was created the CvMob, a free tool for
dynamic evaluation of human movements that
express in figures, tables and graphs the results of
these measurements.
The image distortion caused by the camera lens

may have affected the plantarflexion range
of motion. The CvMob is a reliable tool for
two-dimensional evaluation of human gait in the
analysis of linear motion, lengths and angles.
References
A Williams G, Morris ME, Schache A, McCrory P.
Observational gait analysis in traumatic brain injury:
accuracy of clinical judgment. Gait Posture.
2009. 29(3):4549.
Ugbolue UC, Papi E, Kaliarntas KT, Kerr A, Earl L,
Pomeroy VM, et al. The evaluation of an inexpensive, 2D, video based gait assessment system for
clinical use. Gait Posture. 2013. 38(3):4839.
Bilney B, Morris M, Webster K. Concurrent related
validity of the GAITRite walkway system for quantification of the spatial and temporal parameters
of gait. Gait Posture 2003.17:6874.
Nielsen DB, Daugaard M. Comparison of angular
measurements by 2D and 3D gait analysis
[Internet]. Jnkping University; 2008.
Objective
To determine if CvMob is a reliable tool for the
evaluation of two-dimensional human gait.
Methods
An accuracy study with the sample of healthy
individuals who walked on a nine meters long
walkway, with anatomical points highlighted
by spheres adhered to the skin and were
simultaneously filmed by CvMob camera and
Vicon system, the studys gold standard. To
analyze the reliability between systems, trajectories
and angular measurements were compared, and
for the reproducibility, were related inter and
intra-rater findings. In order to test the reliability, it
was performed the Bland-Altman method and the
correlation of Spearman. The reproducibility inter
and intra-rater of the angles was tested by BlandAltman method and by the intraclass correlation
coefficient, and the one of the trajectories
was assessed by Spearman correlation. It was
considered an error margin of 5%.
Results
We found a high correlation ( = 0.988) of the
trajectories in both systems and in inter and
intra-rater analysis. According to the Bland-Altman
method, it had a good correlation, between the
systems, in the angle of flexion and full extension
(stance and swing) of the knee, dorsiflexion and
stride length.
Discussion
There are systems that analyze the spatial and
temporal parameters of gait, but their analysis are
limited to these variables and the CvMob system
is more complete, because it also gives the results
for angles and trajectories. The method chosen
for the evaluation of the hip angle may have
caused the lack of agreement between systems.
191
O 16 0
BIOMECHANICAL ASSESSMENT OF PITCHING

PERFORMANCE AND FATIGUE ON FOREARM MUSCLES
L.H. Wang1, K.C. Lo2, Y.S. Cheng3 , L.C. Kuo4 , I.M. Jou5, F.C. Su3
1
Cheng Kung university, Institute of Physical Education, Health & Leisure Studies, Tainan,
Taiwan Republic of China
2
Kun Shan University, Physical Education Office, Tainan, Taiwan Republic of China
3
Cheng Kung university, Department of Biomedical Engineering, Tainan,

Cheng Kung university, Institute of Occupational Therapy, Tainan, Taiwan Republic of China
5
Cheng Kung university, Department of Orthopaedics, National Cheng Kung University

Hospital, College of Medicine, Tainan, Taiwan Republic of China
Introduction
Fatigue leads to uncoordinated, sudden or
unnatural motion and thus the ball speed and
muscle force would decrease1,2, and it discharges
the strength loading on the joint and muscle to
prevent injury 3. This study intended to investigate
the kinematic differences in upper extremity
before and after fatigue occurred on forearm
muscles along with electromyography examining
the forearm muscle activities and ultrasonographic
examination to see any changes at the medial
elbow during fatigue.
For the muscle activity of the forearm, larger FCU

activity was found in pre-fatigue (p=.017). After
intense activity, possible tendon swelling was
found in a previous study 5. The ulnar nerve runs
through the two heads of the FCU tendons and
FCU tendon swelling might occur due to larger
muscle activity after fatigue protocol. Moreover,
during acceleration phase, the elbow joint would
move to a peak angle of around 94 and drop
rapidly to around 20 at ball release (pre-fatigue:
18.2215.17, post-fatigue: 22.1115.18 and
p=.242). Larger elbow flexion would lead the ulnar
nerve to be compressed and flattened against the
hard convex floor of the tip of the epicondyle and
the fascia of the flexor-pronator group, leading to
possible inflammation chronically 6. In other words,
the ulnar nerve would be repeatedly compressed
in a very high speed in a long pitching duration.
Therefore, these two factors combined might
explain the larger nerve flattening (diameter) and
swelling (cross-sectional area) in post-fatigue.
15 elite baseball pitchers were recruited for a
full ultrasonographic examination at the medial
elbow under 4 elbow positions (0, 45, 90 and
120), respectively. Manual muscle testing were
conducted on the 3 muscles (flexor carpi radialis,
flexor carpi ulnaris (FCU) and extensor carpi radialis)
to normalize the dynamic muscle activity during
pitching. eight-camera motion analysis system
surrounded to collect the throwing motion data
of upper extremity with a sampling frequency of
300 Hz. The statistic software SPSS14.0 was utilized
to analyze each parameter. Significance level was
defined as p <.05.
C o n cl u s i o n
There might be higher potential to develop nerve
flattening and swelling after long time of pitching,
and thus increased ulnar nerve diameter and
area were shown. Larger FCU activity was found
after fatigue and indicated larger varus torque
was produced as a contribution to protecting our
elbow joint from injury.

The prime analysis of this study was focused on the
acceleration phase which was considered the final
stage in which the energy bursts out to the upper
extremity to propel the ball. Pitching performance
was affected since the strike percentage showed
a significant difference after fatigue (pre-fatigue:
70.1117.79%, post-fatigue: 49.3317.24% and
p=.01). Larger long axis diameter and crosssectional area were found after fatigue at the
elbow flexion of 90 in the ultrasonographic
measurements. This phenomenon might display
larger ulnar nerve compression and possible
swelling 4. In both pre- and post-fatigue conditions,
the elbow joint angle would reach to a maximum
value of around 90. Since throwing over 90 or even
more than 100 pitches in a game is very common
for a starter in baseball, under such a longtime
circumstance of repetitive elbow motion to 90
during pitching might bring larger risk of negative
impact to the ulnar nerve.
References
[1] Blangsted K. et al., J Electromyogr Kinesiol. 15(2):
138-148, 2005.
[2] Kumar S., Ergonomics. 44(1): 17-47, 2001.
[3] Escamilla R.F. et al., Am J Sports Med. 35(1):
23-33, 2007.
[4] Shen P.C. et al., J Bone Joint Surg Br. 90(5):
657-661, 2008.
[5] van Drongelen S. et al., Arch Phys Med Rehabil.
88(3): 381-385, 2007.
[6] Tai T.W. et al., Ultrasound Med Biol. 40(1):
45-52, 2014.
The authors thank for the support by grant MOST
102-2410-H-006-110 from the Ministry of Science and
Technology.
192
O 161
NONTRADITIONAL MEANS OF THE HIGHLY

SKILLED SWIMMERS TRAINING
B. Dyshko1, A. Kochergin2
1
CEO of the scientific-practice firm Sport Technology member of the methodical Council
of the Centre of the Sports Training of the Russia Ministry of Sport, Centre of the Sport Training,
Moscow, Russia
2
Russian National Swimming team, Centre of the Sport Training of the Russian Ministry of Sport,
Moscow, Russia
Introduction
Comprehensive biomechanical training simulator
(hereinafter Simulator) is very intersted for
elite swimmers 1,2. The comprehensive effect
of the Simulator on the athletes functional
systems is stipulated by the simultaneous use
of physical, biomechanical and physiological
factors: regulated mechanical expiratory air
flow resistance, variable frequency vibration on
expiration, intensity of performed exercises.
The results of the experiment indicated that the

Simulator can be used for creating the artificial
controlled
hypoxic-hypercapnic
conditions
and faster, compared to standard conditions,
unwinding of the aerobic and anaerobic energy
support systems of athletes 1,3.
C o n cl u s i o n
The data showed in Table 1, 2 allow recommending
of the Simulator for training of skilled swimmers for
increasing of the aerobic and anaerobic energy
support systems in pool.
The research was aimed at studying of the influence
of the Simulator on features of the external
respiration with the work under the load with
constantly increasing power to failure for skilled
swimmers 9 men. The participants performed
exercise on the on bicycle ergo meter Monarch
using Simulator (Device) and without it (Br.mask).
References
1 Dyshko B.,et al.,Theory and practice of the physical
culture. Moscow, 122, 2012.
2 Dychko B., et al., Proceeding of XXVI International
Symposium on Biomechanics in Sport (ISBS):
343347, 2008.
3 Volkov N. Physical education and Sport. Moscow
162, 2000.

The dinamics of the experatory CO2 concentration
and the the oxygen utilization coefficient show in
Table 1, 2.
T, min
10
11
12
Device
5,04
5,24
5,66
5,70
5,86
5,84
5,80
5,89
6,54
6,52
6,60
6,49
Br.mask
4,50
4,38
4,40
4,36
4,29
4,02
3,92
3,70
3,67
3,61
3,65
3,59
Table 1. The dynamics of the oxygen utilization coefficient in test. T, min time of working in test.
T, min
10
11
12
Device
4,36
4,72
5,22
5,48
5,93
6,03
5,97
6,41
6,90
7,06
7,09
7,11
Br.mask
3,58
3,72
4,00
3,96
4,04
3,95
3,87
3,81
3,72
3,70
3,86
3,74
Table 2: The dynamics of the expiratory CO2 concentration in test.
193
O 16 2
RELATIONSHIPS BETWEEN LEG STIFFNESS

AND DROP JUMP HEIGHT
A. Struzik1, J. Zawadzki2, B. Pietraszewski2, A. Rokita1
1
University School of Physical Education, Department of Team Sport Games, Wroclaw, Poland
2
University School of Physical Education, Department of Biomechanics, Wroclaw, Poland
Introduction
Leg stiffness is a quantitative measure of elastic
properties of lower limbs. However, relationships
between leg stiffness and sport movement
performance remain unknown [Brughelli, 2008;
Serpell, 2012]. Therefore, the purpose of this study
was to determine whether there are relationships
between leg stiffness and drop jump height. If so,
what are their character?
Discussion
The results imply that maximum drop jump height
is achieved at a relatively low value of leg stiffness
in the amortization and take off phases. This allows
for performing a deeper countermovement during
the amortization phase.
Methods
The study was conducted among 11 rugby players.
Measurements employed a Kistler force plate and
a BTS SMART system for complex motion analysis.
Each participant performed two drop jumps from
platforms with height 15, 30, 45 and 60 cm. The
analysis was based on a higher jump of the two
jumps of each platform for each participant. Leg
stiffness was determined as a ratio of changes in
ground reaction forces to the respective changes
in the height of greater trochanter of the femur
(used as a conventional upper end of lower limbs),
separately for amortization and take-off phases
[Struzik, 2013]. The jump height was calculated
based on the time of the flight phase.
K a(kN/m)
K t(kN/m)
h(m)
DJ15
9.5 4.7
5.9 3.9
0.38 0.07
DJ30
7.8 2.4
5.8 1.8
0.39 0.05
DJ45
7.1 2.6
5.4 2.4
0.41 0.05
DJ60
7.2 4
5.3 2
0.4 0.07
Table 1: M
ean values (SD) of leg stiffness during the phases
of amortization (Ka) and take-off (Kt) and drop jump
height (h).
hDJ15
hDJ30
hDJ45
hDJ60
Ka
0.68*
0.64*
0.55**
0.49
Kt
0.72*
0.76*
0.57**
0.53**
Table 2: V
alues of correlation coefficients between leg stiffness during the phases of amortization (Ka)
and take-off (Kt) and drop jump height (h).
The differences in the values of leg stiffness during

the phases of amortization and take-off were
analysed using a t-test for the significance of the
differences for independent variables, with the
level of significance set at = 0.05. The r-Pearson
coefficient and t-Student test was used to examine
the relationships between the selected variables.
* statistically significant for p < 0.05,

** statistically significant for p < 0.1.
C o n cl u s i o n
Leg stiffness in the amortization and take-off phases
is characterized by a negative relationships with
drop jump height.
Results
Table 1 contains mean values (SD) of leg stiffness
and drop jump heights performed from each
platform. Leg stiffness during amortization phase
was statistically significantly greater than in the
take-off phase for drop jumps performed from
platforms with height of 15, 30, 45 and 60 cm
(p < 0.01). Statistically significant relationships were
found between leg stiffness and drop jump height
(see Table 2).
References
Brughelli M. et al, Scand J Med Sci Sports,
18:417426, 2008.
Serpell B.G. et al, J Sport Sci, 30:13471363, 2012.
Struzik A. et al, Acta Bioeng Biomech,
15:113118, 2013.
194
O 16 3
A 3D KINEMATIC ANALYSIS OF THE SADDLE HEIGHT

INFLUENCE DURING CYCLYNG
J. Ojeda1, V. Chaves1, J.R. Romero1, A. Martnez1
1
University of Sevilla, Mechanical Engineering, Sevilla, Spain
Introduction
Cycling is a very popular activity at both
professional and amateur level. The number
of studies of the human body kinematics and
dynamics during pedalling has increased during
the last few years [Kautz, 1993; Carpes, 2009; Bini,
2010]. These studies pursue a better understanding
of the movements and force transmissions while
pedalling to improve its efficiency and the
avoidance of injuries. However, most of the works
found in the literature are 2D studies, mainly in the
sagittal plane. The goal of this work is to present a
3D study of the cycling kinematics to analyse the
influence of the seat height.
One adult male subject, amateur cyclist, was

asked to pedal as his preferred cadence. The
velocity remained relatively stable during the test.
Three different heights of the saddle were tried. The
first (normal test, NT) was defined as the optimal
height using the dynamic goniometer technique.
The other two heights were 4 cm higher than NT
(HT) and 4 cm lower than NT (LT).
Results
Figure 2 shows the temporal evolution of the knee
angles during one crank revolution for the three
saddle heights.
Methods
Pedalling on a stationary bike has been monitored
at 100 Hz using a six-camera motion capture
system (Vicon). The body pose reconstruction of
the lower limb has been carried out by means
of the Plug-in-Gait protocol [Davis, 1991]. Some
extra markers were added to the bike to obtain
the plane defined by the pedal axle and the crank
arm along the time (see Figure 1).
Figure 2: T emporal evolution of knee angles during one

crank revolution at different saddle heights.
Discussion
Regarding the results, it can be noticed the
influence of the saddle height on kinematic data.
Results in the coronal and transverse planes are
especially relevant for clinicians to evaluate the
risk of injuries on the knee. On the other hand, a
proper definition of the parameters of the bike
is crucial to improve the efficiency of the cyclist
during the activity.
References
Bini et al, Sport Biomech, 9:223235, 2010.
Carpes et al, Sport Biomech, 8:275283, 2009.
Davis et al, Hum Mov Sci, 10:575587, 1991.
Kautz et al, J Biomech, 26:155165, 1993.
Figure 1: S et up of the test and protocol of markers used in
this work.
195
O 16 4
EFFECT OF ADJUSTABILITY ON THE SAFETY OF THE SEATED

BICEPS CURL RESISTANCE TRAINING EXERCISE
C.J. Kat1, K. Nolte2
1
University of Pretoria, Mechanical and Aeronautical Engineering, Pretoria,

Republic of South Africa
University of Pretoria, Department of Physiology Division: Biokinetics and Sport Sciences,

Pretoria, Republic of South Africa
Results
The exercise resistance (mean SD) at which the
participants were able to safely perform the exercise
on set-up 1 was 64% 9% of the predicted one
repetition maximum and 52.5% 5% on set-up 2.
Introduction
Resistance training is used in training programs
to prevent injury [Myer, 2005 and Fleck, 1986]
and to enhance athletic performance [Kraemer,
1998]. In order for resistance training to be
effective it should not result in injury of the user.
It is therefore essential that exercise equipment
is designed appropriately and evaluated to
ensure safety of the equipment with respect to
the exerciser. Design of exercise equipment is a
complicated task and warrants consideration
of a series of biomechanical and ergonomic
factors [Nolte, 2011]. This study investigates the
effect of the adjustability of the seated biceps
curl machine on the safety of the exercise.
Discussion
The exercise resistance at which the participants
were able to safely perform the exercise was lower
on set-up 2. However, participants performed
the exercise with a larger elbow range of motion
(ROM) on set-up 2 than on set-up 1 for the same
exercise resistance. The difference between the
exercise resistances and the elbow ROM of the
participants on the two set-ups seem to indicate
that the preacher curl platform off-set has an
influence on the safety/performance of the
exerciser. The change in this dimension between
the two set-ups caused the force between the
preacher curl platform and the participants chest
to be larger on set-up 2 than on set-up 1 at higher
exercise resistances. This may be a reason for the
participants performing the exercise at a lower
resistance on set-up 2 as they might have been
less comfortable. Fatigue cannot be excluded
as a possible contributor to the lower exercise
resistance on set-up 2 as participants performed
the exercise on set-up 2 after they performed
the exercise on set-up 1. This should be further
investigated by using a larger sample size and
have participants perform the exercise on the
two set-ups randomly. The sample should also be
extended to include other anthropometric cases
and male participants. The relationship between
the different dimensions of the machine and the
effects on the safety/performance of the exerciser
needs to be further investigated as well as the
existence of optimal dimensions of the machine.
This would aid designers in improving the safety
and performance of the machine.
Method
Measures
of
kinetics,
kinematics
and
electromyography were taken on five (n=5)
females in the 5 th percentile female group
during the performance of the seated biceps
curl resistance training exercise on two different
machine set-ups. The difference between the two
set-ups is in the preacher curl platform off-set with
it being 105.6 mm closer to the exerciser for setup 1. The dimensions of set-up 2 are based on a
commercially available machine. Participants
performed 10 warm-up repetitions after which
they performed repetitions at increasingly higher
exercise resistances. After the participant reached
her maximum exercise resistance she rested for
approximately 10 minutes while the machine setup was changed. The participant then repeated
the process excluding the warm-up repetitions. The
participants posture on both set-ups was visually
evaluated and if no obvious problems and/or risk
could be identified the assessment commenced.
References
Fleck, S.J. and Falkel, J.E., Sport Medicine, 3(1):
6168, 1986
Kraemer, W.J., Duncan, N.D. and Volek, J.S.,
J Orthopaedic and Sports Physical Therapy,
28(2):110119, 1998
Myer, G.D., Ford, K.R., Palumbo J.P. and Hewett
T.E., J Strength Cond Res, 19(1):5160, 2005
Nolte, K., Krger, P.E. and Els, P.S., Sports
biomechanics, 10(2):146160, 2011.
196
O 16 5
TIME ELAPSED MICRO-CT IMAGING

OF THE BONE-IMPLANT INTERFACE DURING SCREW
INSERTION IN HUMAN FEMORAL HEADS
M.K. Ryan1, E. Perilli1, M. Gravier1, K.J. Reynolds1
1
Flinders University, Medical Device Research Institute, Adelaide, Australia
Introduction
Stripping during screw insertion occurs with an
incidence as high as 45% (Stoesz et al. 2014). With an
increase in age and osteoporosis, overtightening is
more likely as surgeons try to achieve torques similar
to that observed in young healthy bone. Stripping
torque can be predicted based on the torque at
head contact (Reynolds et al. 2013). The question
remains however, how tight is tight enough? This
ongoing study uses a custom developed computercontrolled screw insertion device to perform timeelapsed micro-CT imaging of the bone-implant
interface. The aim is to visualize the deformation
of the trabecular bone at each rotation step with
increased tightening torque.
Figure 1:
Insertion torque vs. screw rotation. Screws were
inserted stepwise with micro-CT images taken
at 20% increments between head contact and
predicted Tmax.
Methods
Ten excised human femoral heads were used.
Cancellous lag screws (7.0 mm), commonly used
for fixation of intertrochanteric fractures, were
inserted to head contact. The torque measured at
head contact (THC) was used to predict stripping
torque (Tmax) (Reynolds, Cleek et al. 2013). Screws
were incrementally tightened using a novel testing
device within the micro-CT scanner (Ab-Lazid
et al. 2014). Micro-CT scans (isotropic pixel size
17m) were performed at 6 time points from head
contact to Tmax (Figure 1). 2D and 3D images were
reconstructed and visually inspected to identify
trabecular deformation around the screw threads.
Results
Ten tests were successfully completed in
conjunction with micro-CT image acquisition.
Preliminary visual image analysis demonstrated
that trabecular deformation was evident around
the top surface of the screw threads (Figure 2). The
majority of deformation appeared to occur after
the 80% step between head contact and Tmax.
Figure 2: 1
mm slices through the bone (white colour) and
screw (grey) at head contact (a) and post-failure
(b). The complete perforation through trabecular
spicules is evident at the screw threads (indicated
by the blue arrows).
References
Ab-Lazid, R. et al. J Biomech 47:347353, 2014.
Reynolds, K. J. et al. J Biomech 46:12071210, 2013.
Stoesz, M. J. et al. J Orthop Trauma 28:e17, 2014.
Discussion
The screw insertion device detailed above
has provided time-elapsed visualization of the
deformation of the peri-implant bone at the microstructural level, at increasing insertion torque
levels. The image data obtained can be used
for quantification of the micro-strains induced
in the peri-implant bone with increasing load by
use of digital volume correlation or finite element
analysis. This will allow a better understanding of
the coupling between insertion torque and microstructural failure mechanics.
This work was funded by an NHMRC Grant
(Grant ID 595933).
197
O 16 6
PARTIAL DATA RECONSTRUCTION USING

STATISTICAL SHAPE AND MATERIAL MODELLING
FOR DENTAL APPLICATIONS
C. Woods1, A. Taylor2, W. Pearson1, A. Dickinson1
1
2
University of Southampton, Bioengineering, Southampton, United Kingdom
Aurora Medical, Research and Development, Southampton, United Kingdom
Introduction
Understanding concealed dental geometry and
the position of teeth is essential for the effective
implementation of many dental/orthodontic
therapies. Statistical shape modelling (SSM) can
predict missing information using a database
of registered geometries [Buchaillard, 2007].
Methodologies exist for the virtual reconstruction
of geometry using SSM, but they do not distinguish
between crown and root anatomy. The aim of this
study was to predict missing crown data in teeth,
including a material identification parameter to
capture explicitly the cemento-enamel junction
(CEJ).
Results
Figure 2: P
redictive capability. a)Influence of modes(+outliers, []25th&75th percentile, median) b)Influence of training samples (error bars =1SD)
Discussion
Exhaustive modal analysis reconstructed each
tooth in the dataset using an increasing number
of modes (Fig.2a). It was seen that the median
shape error reduced with each additional mode
added. However, it was also seen that the range
increased with the number of modes, possibly
due to noise, which suggests that there may be
an optimum number of modes. Also, it should be
noted that additional modes incur time penalties.
The number of modes which gave the minimum
error range varied between reconstruction trials.
This set of 15 trials indicated that if the target shape
is not known, between 5 and 7 modes would give a
satisfactory reconstruction.
Methods
Figure1: M
ethodological procedure. a)SSM Compilation
b) bruxed tooth Introduction c)Optimisation
d)Optimisation quality check e)CEJ identification.
The Leave-One-Out (LOO) test reconstructed the

shape of a bruxed tooth that was excluded from
the training dataset. The size of the dataset was
increased until all teeth were included (Fig.2b).
From the LOO test it was seen that convergence
was achieved at approximately 12 training samples.
Convergence indicates that the dominant shape
characteristics have been captured.
A digital (.stl) database of 15 undamaged

mandibular canines was compiled from micro-CT.
A binary material operator was assigned to each
node. The data was registered to a baseline
model using elastic mesh-morphing, and principle
component analysis (PCA) was used to compile
the SSM. Each tooth was artificially bruxed to the
location of maximum distal crown width. A non-linear
sum of least squares algorithm was used to minimise a
non-rigid deformation objective function to predict
tooth geometry from partial data (E) (Eq.1&2),
where d and m are the target and the predicted
shapes respectively. is a vector containing the
weightings () for manipulating the eigenvectors
(e) with respect to the mean tooth (?) in rotation
(R) and translation (T). A smoothing algorithm
established the CEJ from a material probability
parameter (Fig.1).
The presented methodology was used to

reconstruct dental geometry and material location
from partial data. However, the optimisation
strategy, size of training set, number of modes and
computational resource must all be balanced
against reconstruction quality. This methodology
has the potential to improve prediction and
analysis within dentistry, bioengineering, forensic
medicine and osteo-archaeology, where dental
wear is scored qualitatively.
References
[1] S.I. Buchaillard, et al, Comp Biol Med,37:10,2007
198
O 16 7
A-MODE ULTRASOUND-BASED INTRAOPERATIVE

REGISTRATION ACCURACY ANALYSIS BASED
ON SIMULATION ENVIRONMENT
K. Niu1, J. Homminga2, N. Verdonschot3
1
2
University of Twente, Enschede, Netherlands
University of Twente, Department of Biomechanical Engineering, Enschede, Netherlands

3
Radboud University Medical Centre, Orthopaedic Research Laboratory, Nijmegen,

Netherlands
Introduction
In Computer-Aided Orthopedic Surgery (CAOS)
systems, A-Mode ultrasound has been proven
quite successful in experimental and clinical
environments, showing advantages, such as the
non-invasiveness and lower time requirements
[A.Mozes,
2010].
However
the
registration
accuracy and robustness still need to be improved
to provide reliable and stable registration results
[C.Amstutz, 2003]. A clearly defined registration
methodology/procedure is also important. The
number of detected points, the specific locations
that these points were obtained from, as well as the
amount of noise in the A-mode signal will influence
the accuracy of registration. To assess the effects
of these parameters and adjust them, a simulation
environment based on A-mode ultrasound
intraoperative registration procedure provides a
feasible way to repeat and to amend a certain
mode of ultrasound transducers palpation without
time-consuming in-vivo or in-vitro measurements
and validations. The quality of the resulting fit was
assessed by the error between the true location of
the bone and the registered results.
by randomly adding noise to the coordinates of

each point: no noise, 1 mm noise, or 2 mm noise.
Third, for every number of points in the sample point
set and for every level of noise, the simulation was
run 100 times over to capture the robustness of the
procedure. In total we thus ran 21 x 3 x 100 = 6300
simulations. After the full registration, the accuracy
of the registration was computed by determining
the root mean square error (RMSE) between the
registered points and the known true position of
those points.
Results
The addition of a pre-registration to the ICP
algorithm
improved
the
registration
quite
remarkably. After the registration procedure, the
average RMSE could be seen to improve with
increasing the number of sample points from
10 (RMSE: 1.23 mm) to 30 (RMSE: 0.11 mm). For
sample point sets of 27 points or more, the RMSE
reached zero in more than 75% of all cases. The
addition of noise to the positions of the points in
the sample point set, unsurprisingly, diminished the
accuracy of the registration. The RMSE for the case
of ten sample points, increased from 1.23 mm for
no noise, to 1.68 mm for 1 mm noise, to 2.39 mm for
2mm noise.
Methods
In this study, a surface mesh of a healthy subjects
femur was segmented based on CT scan[P.
Pellikaan, 2014] and to be used to generate a
number of various sample point sets to mimic the
actual detected points by A-mode ultrasound
in operating room. The sample point sets were
selected by following the proposed registration
methodology. The registration was implemented
by using a pre-registration (based on automatically
segmented anatomical landmarks on the bone
surface), followed by an accelerated Iterative
Closest Points (ICP) algorithm and Wobble
Optimizing algorithm. The procedures from point
selection to final registration was run several
times with different variations. First, the number of
points in the sample point set was varied between
10 and 30 to capture the needed number of sample
points for an accurate fit. Second, we simulated
the effect of uncertainty in the ultrasound position
Discussion
The registration accuracy will be improved with the
addition of sample points in proposed registration
methodology, which followed by restricting to
certain regions to ensure a good registration. The
influence of noise was assessed by simulation result
to provide the information to satisfy the certain
requirement of registration accuracy. The future
work will continue to test other bones.
References
A
. Mozes et al, Int J Med robotics Compit Assist
Surg, 6: 91101, 2010.
C
. Amstutz et al, Arch Otolaryngol Head Neck Surg,
129(12):13106, 2003.
P
. Pellikaan et al, Biomech, 47(5):11441150. 2014.
199
O 16 8
NUMERICAL ANALYSIS OF THE INTERACTION BETWEEN

TRACHEAL TISSUE AND DIFFERENT TYPES OF STENTS
J. Chaure1, C. Serrano2, R. Fernndez-Parra2,3 , E. Pea1, M.A. De Gregorio2,
M.A. Martnez1, M. Malv4
1
2
Universidad de Zaragoza, Department of Mechanical Engineering, Zaragoza, Spain
Universidad de Zaragoza, Departamento de Patologa Animal Grupo GITMI, Zaragoza, Spain

3
Ecole Vtrinaire de Maison Alfort, Department of Anaesthesia & Analgesia,

Maison Alfort, France
Universidad Pblica de Navarra, Department of Mechanical Engineering, Energetics and

Materials, Pamplona, Spain
Introduction
Stenting is a common treatment for atherosclerotic
arteries and tracheal stenosis. Metallic stents
for treating both diseases have advantages
but are associated with restenosis due to reepithelialization of the treated area. Although
many types of stents are commercially available,
silicone and metallic stents are the most frequently
used [Dumon, 1990]. Inflammation, migration
and obstruction of silicone stents are reported
as common post-operative complications [Sun,
2008]. In contrast, implantation of metallic stents
is an efficient method to reestablish patency in
stenotic tracheas [Hautmann, 2000].
Methods
We built a numerical rabbit trachea model and
analyzed it before and after device insertion. In
particular, two types of commercial stent were
evaluated: a ZilverFlex Stent and a WallStent.
The numerical simulations were carried out using
the software package Adina R&D Inc. (Watertown,
MA, USA) which allowed a fluid-structure interaction
analysis. The models were built starting from CTimages of treated rabbits. First, the stents were
deployed into a healthy trachea, then patient
specific boundary conditions were applied, in
order to simulate the breathing cycle. In parallel,
these two types of stent were implanted into 30
New Zealand White rabbits divided into two groups
of 10 animals corresponding to each stent type
and a third group composed of 10 animals without
a stent. Endoscopy, CT imaging and histology
assessed the tracheal wall response 90 days after
stent deployment. The animal model was used to
validate the numerical results.
Figure: C
omparison between numerical (maximum principal stress in [Pa]) and experimental findings (endoscopy and histology).
Discussion
Coupling histology and numerical simulations with CT
images allows the capture of highly correlated stimuli
between struts and the local biological response.
Further work is required to evaluate the consistency
of these correlations in restenosis models and whether
these effects are observed in a clinical context. The
outcomes from this study could be used to direct the
future design of prosthesis that consider the tissue
response at different levels of injury after implantation.
C o n cl u s i o n
The direct comparison of WSS and maximum principal stress with the biological response supports the hypothesis that these parameters may lead to a greater
tracheal epithelial response within the stented region.
This study may be helpful for improving stent design
and demonstrates the feasibility offered by the virtual
investigation of tracheal structural and fluid dynamics.
Results
Healthy tracheas were compared with stented
tracheas using the numerical analysis. Different
stress maps were found for the two stent types, due
to their dissimilar structures. Images from endoscopy
and histology associated with stent implantation
were compared with the numerical results. There
was a strong correlation between animal and
computational models (see Figure). Derived
numerical parameters such as wall shear stress
and maximum principal stress were correlated with
inflammation, re-epithalization and granuloma
formation assessed from the histomorphometric
analyses.
References
[1] F. Dumon, A Dedicated tracheobronchial stent,
Chest, 1990, 97:328332.
[2] F. Sun et al. Endotracheal stenting therapy in dogs
with tracheal collapse, The Veterinary Journal,
175:186193, 2008.
[3] H. Hautmann et al. Flexible bronchoscopy: a safe
method for metal stent implantation in bronchial disease, Annals of Thoracic Surgery, 69(2):398401, 2000.
200
O 16 9
ROBUST ENDOVASCULAR SURGERY SIMULATION:

TOWARDS CLINICAL VALIDATION
D. Perrin1, P. Badel1, L. Orgas2, C. Geindreau3 , J.N. Albertini4 , S. Avril1
1
Mines Saint-Etienne, Center for Biomedical and Healthcare Engineering,

Saint-Etienne, France
2
3
CNRS, 3SR Lab, Grenoble, France
Grenoble University, 3SR Lab, Grenoble, France
CHU Hoptial Nord Saint-Etienne, Cardiovascular Surgery Department, Saint-Etienne, France
Introduction
Endovascular
repair
of
abdominal
aortic
aneurysms (AAA) faces some adverse outcomes
which are difficult to predict and which restrain its
use although it is less invasive than open surgery.
Finite element simulations could make it become
prevalent by securing surgery planning, validating
patient eligibility and giving indications of possible
complications. The purpose of this work is therefore
to develop and validate in the clinical context a
numerical methodology predicting stent-graft (SG)
final shapes after surgery.
geometries, especially for proximal and distal stents

outside the aneurysm sac which are particularly
important for surgeons. Stent locations along the
vessel centerlines in the three simulations were
always within a few millimeters to actual stents
locations.
Methods
Three
patients,
whose
preoperative
and
postoperative scans were available, were included
in this study. Endosize software (Therenva, France)
was used to reconstruct the arterial geometries
that were then meshed with shell elements. The
mechanical behavior of the arterial wall was
considered as orthotropic linear elastic, linearized
from the data published in [Haskett, 2010].
Numerical geometries of SG main bodies and
limbs were provided by the manufacturer. Stents
and graft were meshed with linear beam and shell
elements respectively. The superelastic behavior
of Nitinol stents was implemented with parameters
provided by the manufacturer. Textile graft was
modeled as an orthotropic elastic material, with
parameters previously obtained by our group
[Demanget 2012].
Figure 1: E
xample of a simulation result, compared to the
real postoperative CT-scan.
Discussion
The present study details a novel methodology
to predict the deployment of SGs in real AAA
geometries of patients. This is the first time to
our knowledge that several marketed SG are
numerically deployed inside patient-specific
AAAs and that the results are validated against
postoperative scans. An asset of this method
is the very limited manual intervention on the
patient-specific
part,
thanks
to
morphing
techniques. Several features are not included or
neglected to keep it computationally effective, for
instance thrombus and calcifications are absent.
Yet, the observed errors are within clinically-acceptable ranges for surgeons, making this
predictive method very relevant for the practice.
Our methodology, although different from the

actual surgical procedure, has the potential to be
used for any SG model and any aneurysm model,
and aims at simulating only the postoperative
state. In practice, the device is positioned in a
virtual tubular shell which is kinematically morphed
into the preoperative geometry of the patients
AAA, thus deforming the SG by contact. Then, the
virtual shell is ascribed AAA mechanical properties
and its constraints are released to compute the
final equilibrium of the SG in the AAA.
Results
Postoperative scans following real EVAR procedures
were used to assess the results of simulation (Fig. 1).
The position and average diameter of each stent
were compared. We observed relevant matching
between simulated and actual deployed stent
References
Haskett et al, Biomech Model Mechanobiol, 9:
72536, 2010.
Demanget et al, J Mech Behav Biomed Mat, 5:
27282, 2012.
201
O 17 0
ISOGEOMETRIC-BASED TOOLS FOR THE EVALUATION

OF CAROTID ARTERY STENT PERFORMANCE
M. Ferraro1, F. Auricchio1, M. Conti1, S. Morganti2, A. Reali1, R.L. Taylor3
1
University of Pavia, Department of Civil Engineering and Architecture, Pavia, Italy
University of Pavia, Department of Electrical, Computer and Biomedical Engineering,

Pavia, Italy
University of California Berkeley, Department of Civil and Environmental Engineering,

Berkeley, California, USA
Introduction
Computer-based procedures based on finite
element analyses (FEA) are nowadays widely
adopted for biomechanical analyses. Within this
context, isogeometric analysis (IgA) is rapidly
emerging as a novel promising alternative in this field
[Morganti, 2015]. The main feature of the method
consists of using typical CAD basis functions for both
geometric description and variable approximation
[Hughes, 2005]. This implies the exact description of
the domain geometry and the ability to obtain a
more accurate solution with respect to FEA.
while the proximal one is clamped (see Figure 1).

We implement 8 h-refined FEA meshes, while for
IgA 4 k-refined IgA meshes.
Results
Convergence of the resulting reaction force
for both Model A and B, combined with shape
memory alloy constitutive law, are considered in
Figure 2. The force-displacement diagrams for
model B referring to FEA, IgA, and most refined IgA
and FEA are depicted in Figure 3.
This work is aimed at developing a novel

computational framework based on IgA to evaluate
the flexibility performance of commercially
available carotid artery stents.
Discussion
The results suggest that IgA is able not only to
accurately represent the computational domain,
but also to get a better approximation of the
solution with a widely reduced number of degrees of
freedom with respect to traditional FEA. Moreover,
when geometrical instability is present like when we
consider the model B, IgA shows the capability to
accurately reproduce nonlinear local effects, i.e.,
local buckling, even with coarse meshes.
Methods
Two different shape memory alloy carotid stent
designs are considered. They correspond to two
commercially available stents used in the clinical
practice. Model A is classified as open-cell design,
while model B is a fully closed-cell design. The
bending test is simulated through a displacement-based analysis under large deformation regime.
A displacement of 11 mm is imposed for all control
points referring to the distal extremity of the stent,
References
Hughes et al, CMAME, 194: 41354195, 2005.
Morganti et al, CMAME, 284: 508520, 2015.
see the next page
202
203
O 17 1
THE EFFECTS OF STENT INTERACTION ON PORCINE

URINARY BLADDER MATRIX EMPLOYED
AS STENT-GRAFT MATERIALS
A. Callanan1, N. Davis2, T. Mcgloughlin3 , M. Walsh2
1
University of Edinburgh, Institute for BioEngineering, School of Engineering,

University of Limerick, Department of Mechanical and Aeronautical Engineering,

Limerick, Ireland
Khalifa University of Science, Technology & Research, Department of Biomedical

Engineering, Abu Dhabi, United Arab Emirates
Introduction
One of the most common causes of death in
the western world is cardiovascular disease.
An alternative treatment for these conditions is
endovascular surgery using stent and stent graft
devices. However these devices have problems
such as restenois, migration and stent fracture.
Improved design and drug elution have been
utilized to enhance the performance, with limited
success. The application of tissue engineering
scaffolds to enhance device performance has had
limited studies. A Number of studies have looked
at Small Intestine Submucosa (SIS) in stenting
applications [Nakata 2003, Yamada 2001]. The
studies found that implanted ECM (SIS) stent-grafts
successfully treated simple and ruptured AAAs
and that SIS coated stent preformed better than
that of PTFE covered stent.
Results
The experimental results showed no significant
influence on failure strength after stent loading for
24h (figure 1). SEM analysis of samples showed no
damage to the architecture of the material. The
stresses developed in the FEA models due to stent
compression did not reach the failure strength of
the UBM material.
To further investigate the possible utilisation of

ECM tissue materials this current study examines
an alternative ECM material Urinary Bladder Matrix
(UBM) for the application in stenting procedures.
UBM is an Extracellular matrix material, mainly
collagen-based derived from a porcine urinary
bladder. The aim of this study was to investigate
the implication of stent loading interaction on
the ECM material using experimental and finite
element analysis [Callanan 2014].
Figure 1: UBM tissue failure strength under static and dynamic

loading conditions, compared to an unloaded
control.
Discussion
This study has indicated that cyclic loading over a
24h period has no effect on the mechanical integrity
of the UBM material [Callanan 2014]. Based on
these findings using UBM as a stent cover to improve
the performance and patency of implanted stent
devices is promising method. Additionally with the
remodeling capabilities of UBM-ECM materials, this
should ensure better integration and performance
of the devices [Nakata 2003, Yamada 2001]. The
influence of prolonged periods of loading will
require further study to examine if the mechanical
strength may alter. Also ECM degradation rate may
have influences on the long-term performance of
the material under stent loading.
Methods
The UBM material was constructed into 4-ply
flat sheet scaffolds. The scaffolds were cut into
dumbbell tensile test specimens. The specimens
were places on a agarose gel flat scaffold to
mimic arterial wall compliance. A simplified stent
strut configuration was applied to the surface.
Loading was applied statically and dynamically to
the ECM material. Each specimen was loaded for
24h. Samples were tensile tested with an MTS tensile
tester and the samples were loaded to failure.
Analysis of the results was based on failure strength
of the UBM material. Scanning electron microscopy
(SEM) was carried out on some samples after 24h,
examining the UBM Architecture. A finite element
model was constructed using similar geometrical
constrains. Loading was applied to the surface
using a movement boundary condition. Material
properties were developed from tensile test data.
References
Nakata M. et al., Cardiovasc Intervent Radiol,
26; 459467, 2003.
Yamada K. et al., Cardiovasc Intervent Radiol,
24; 99105, 2001.
Callanan A. et al., J. Biomech. 2:511, 2011
204
O 17 2
COMPUTER SIMULATION OF THE MECHANICAL

BEHAVIOUR OF IMPLANTED BIODEGRADABLE STENTS
IN A REMODELLING ARTERY
E. Boland1, J.A. Grogan1, P.E. McHugh1
1
National University of Ireland, Galway, Biomechanics Research Centre BMEC, Biomedical

Engineering, Galway, Ireland
Introduction
Coronary stents have revolutionised the treatment of
coronary artery disease. While coronary artery stenting
is now relatively mature, significant scientific and
technological challenges still remain. One of the most
fertile technological growth areas is biodegradable
stents; here there is the possibility to generate stents
that will break down in the body once the initial
necessary scaffolding period is past (612 months)
[Grogan, 2011] and when the artery has remodelled
(including the formation of neo-intima).
damager parameter and c is a constant which

relates the damage parameter to cell proliferation
rate. Elements in the ghost mesh become activated
(assigned tissue mechanical properties) when the
local cell concentration reaches a threshold level.
This model is combined with a simplified
implementation of stent degradation where
uniform degradation is represented through the
linear reduction in the elastic properties of the
material (Youngs modulus) over a defined period
of time.
Current finite element (FE) stent degradation

models (validated using in vitro experiments)
tend to estimate complete magnesium stent
degradation in a period of days [Grogan, 2011],
while in vivo data estimates complete degradation
in a period of months.These current FE models do
not include a representation for the active response
of the arterial tissue following stent implantation,
i.e. neo-intimal remodelling. This may explain the
discrepancies between current stent degradation
models and clinical data.
Results
The results of the arterial neo-intimal remodelling
simulations with a biodegradable stent show that
neo-intimal remodelling around the stent struts
has a significant effect on the stent mechanical
response and should not be ignored when
considering stent in-vivo loading performance.
Methods
Stent degradation in the context of a remodelling
artery is simulated to explore how neo-intimal
remodelling influences the mechanics of a
degrading stent. The representation of neo-intimal
remodelling is based on the work of Lally [Lally,
2004] and here it is implemented in Abaqus software
(DS-SIMULIA, USA) through a thermal analogy
formulation. The arterial lumen is meshed with a
ghost mesh, with negligible initial mechanical
properties (see Figure 1).
Discussion
As shown in Figure 2, as degradation proceeds
over time the stent deforms (stent strain increases)
and scaffolding support is lost. However once
neo-intimal remodelling initiates, this deformation
is noticeably retarded with the remodelled tissue
generating a certain level of mechanical support
for the stent.This result could contribute to the
explanation as to why biodegradable metals
stents degrade and lose scaffolding capability
more slowly in-vivo (where tissue remodelling is
occurring) in comparison to in-vitro.
Stress in the artery due to stent deployment is used

to generate a damage parameter D, which acts
like a source term that results in a diffusion of cells
into the ghost mesh. If the concentration of cells in
a small region or element is denoted n, the change
in the cell concentration, dn/dt is computed by;
dn/dt = k2n + cD
References
Grogan et al, Acta Biomater., 7: 35233533, 2011.
Lally et al, PhD Thesis TCD, 2004.
(1)
where k is the diffusion coefficient of cells into

arterial tissue, 2 is the Laplace operator, D is the
205
O 17 3
STRAIN RATE INFLUENCE ON THE TOUGHNESS

OF HUMAN CORTICAL BONE
D. Mitton1, H. Follet2, R. Gauthier1
1
Universit de Lyon IFSTTAR, Laboratoire de Biomcanique et Mcanique des Chocs,

Lyon, France
2
Universit de Lyon INSERM, UMR 1033, Lyon, France

The effect of strain rate on cortical toughness is
highlighted on Figure1 and Table 1.
Introduction
The number of fractures related to osteoporosis
is projected to increase by 30% by 2025 [Akesson
and Mitchell, 2012]. While most fracture-mechanics
investigations on bone have been performed at
low strain rates, in vivo strain rate can reach high
values during a fall [Fldhazy et al., 2005]. Only few
studies have been performed to assess the cortical
bone toughness at such strain rate [Zimmermann
et al., 2014]. Thus, the aim of the study is to observe
the effect of strain rate on human cortical bone
toughness.
Methods
Six human right distal tibias were obtained from
6 subjects (from 50 to 95 years old, 72.7 15.2).
25 mm-long rectangular specimens with a width
of 2 mm and a thickness of 1 mm were cut.
The samples were prepared in the transverse
orientation: the long side of the specimen was
parallel to the long axis of the bone. The samples
were then notched in there middle with an initial
crack length a~1.1mm. Two samples per bone were
obtained; one was tested at low strain rate (10-4s -1),
the other at high strain rate (10-1s -1) [Fldhazy
et al., 2005]. Fracture toughness measurements
were performed according to the standard ASTM
E-1820 [Zimmermann et al., 2014] for single-edge
notched bending specimens. We computed KIc
the critical linear-elastic stress intensity factor
that gives information on the elastic contribution
and K Jc including the nonlinear elastic J-integral
calculation to consider the plastic deformation
of the materials during the loading. Then, the KJc
term is related to this J-integral:
K Jc = (E*JIc)2
Figure 1: load-displacement curves of paired human cortical bone samples tested at high (blue) and low
(red, dotted) strain rate.
Strain rate (s1)
KIc(MPa.m1/2)
KJc(MPa.m1/2)
3.1 (0.5)
14.3 (1.7)
101
2.7 (0.5)
9.2 (1.1)
10
Table 1: T oughness values for human cortical bone samples

(n=6). The strain rate effect is significant for KJc,
p-value<0.05)
KIc values at the two strain rates are not statistically

different, meaning that the elastic behavior is not
affected by the strain rate. The strain rate has
a significant effect on the plastic contribution
quantified by K Jc. This result on the tibia confirms
those obtained on the femur of a single subject
[Zimmermann et al., 2014]. A larger number of
subjects and different anatomical sites should be
considered in future work.
(1)
References
Akesson, K., Mitchell, P. International Osteoporosis
Foundation, Switzerland, 2012
Fldhazy et al, J. Bone Joint Surg. Br. 87,
261266, 2005
Zimmermann et al, Biomaterials 35, 54725481, 2014
J Ic is an energy term that reports both elastic and

plastic contribution:
Where KIc is the critical linear-elastic stress intensity

factor that gives information on the elastic
contribution.
206
O 174
ANISOTROPIC PROPERTIES OF CHILDRENS CORTICAL

BONE MEASURED BY ULTRASONIC METHOD
E. Lefvre1, C. Payan2, C. Baron1, F. Launay3 , P. Lasaygues2, H. Follet4 , M. Pithioux1
1
2
Aix-Marseille Universit, CNRS ISM UMR 7287, Marseille, France
Laboratory of Mechanics and Acoustics, UPR CNRS 7051, Marseille, France

3
APHM, La Timone, Service de pdiatrie orthopdique, Marseille, France

4
Inserm UMR 1033, University of Lyon, Lyon, France
Introduction
Bone is a hierarchical and organized structure
with properties varying by successive stages from
juvenile to mature state. Numerous studies have
aimed to determine the mechanical properties of
cortical bone tissue collected from adult human
subjects, but few in growing bone. Few papers
study mechanicals properties of childrens bones
by different techniques. However, the notion
of anisotropy is poorly tackled. In this study, we
used ultrasonic wave velocities measured in the
three orthogonal bone axes (axial, radial and
circumferential) to evaluate elastic and shear
moduli (E ii and G ij). The aim of the study was to
bring new insights in growing bone and compare it
with adult bone.
Figure 1: C
omparison of the mean ( SD) elastic moduli with
age class.
Mean and SD are presented in Table 1. The elastic

coefficients for adult fibulae are similar to these
from the literature on femur [Hoffmeister, 2000].
Values from children, especially for femur, are
lower than these from adults.
Methods
15 fibula and 7 femur samples from 22 children
(118 y.o., mean age: 9.7 5.8 y.o.) were extracted
from the lower limb surgery. 16 fibula samples
from 16 elderly donors (5095 y.o., mean age:
76.2 13.5y.o.) were extracted from the same
location. Samples were cut with a water cooled
low-speed diamond saw into cubic parallelepiped
(dimensions: 2x2x2 mm3). The faces of the
specimen were oriented according to the radial
(axis 1), tangential (axis 2) and longitudinal (axis 3)
directions of bone. Elastic and shear moduli
were measured for each specimen in each of
the three orthogonal directions using ultrasonic
compressional and shear waves velocities
[Pithioux, 2002].
This study revealed a transverse isotropy in both

child and adult bone. Results showed that elastic
and shear moduli were highly correlated with age
in children (R>0.56, p<0.01) but less in adult. This
age-related increase in elastic and shear moduli
which could be explained by changes in structure
and material composition of load-bearing bones
[Bala, 2015].
References
Pithioux et al, J.Biomech, 35:9618, 2002.
Hoffmeister et al, Med. Biol. Eng. Comput,
38:3338, 2000.
Bala et al, Abstract ESB meeting, 2015.

E1
E2
E3
G23
G31
G12
12.9
(3.6)
16.4
(2.8)
15.9
(3.1)
23.9
(5.2)
4.2
(0.8)
4.0
(0.7)
3.1
(0.4)
76.2
(13.5)
17.7
(2.9)
17.7
(5.3)
28.0
(3.7)
4.8
(0.6)
4.6
(0.6)
3.6
(0.7)
12.2
(2.4)
12.9
(3.2)
19.0
(5.5)
3.6
(0.8)
3.3
(0.9)
2.8
(0.7)
Age
FIBULA
FEMUR
3.6
(5.3)
Table 1: Mean and SD of elastic (E) and shear (G) moduli,

per age class.
207
O 17 5
CORTICAL BONE ANISOTROPIC VISCOELASTICITYDENSITY RELATIONSHIPS ASSESSED FROM RESONANT

ULTRASOUND SPECTROSCOPY
S. Bernard1, J. Schneider2, P. Varga2, K. Raum2, P. Laugier1, Q. Grimal1
1
2
UPMC, CNRS 7371, INSERM 1146, LIB, Paris, France
Charit-Universittsmedizin, Berlin Brandenburg School for Regenerative Therapies,

Berlin, Germany
Introduction
Cortical bone tissue is an anisotropic material
characterized by typically five independent elastic
coefficients (for transverse isotropy) governing
shear and longitudinal deformations in the different
anatomical directions. It is well-established that the
Youngs modulus in the direction of the axis of long
bones has a strong relationship with mass density.
It is not clear, however, if relationships of similar
strength exist for the other elastic coefficients:
shear coefficients, poissons ratios, Youngs moduli
in the direction transverse to the bone axis. Elastic
coefficients other than the axial Youngs modulus
have been relatively little investigated. The results
of the few studies reporting on the variations
of anisotropic elasticity with mass density are
contradictory (Rho, Ultrasonics 34:777, 1996; Dong
and Guo, 37:1281, 2004).
RUS also measures the viscous part of the stiffness
tensor. An anisotropy ratio close to 2 was found for
damping coefficients and damping was found to
increase as the mass density decreased.
Methods
Resonant ultrasound spectroscopy (RUS) was used
to measure the transverse isotropic stiffness tensor
of 55 cortical bone cuboid tibia specimens from
19 donors.The anisotropic elastic coefficients (all
the terms of the stiffness tensor) were measured
with a precision varying from less than 3% (shear
coefficients and Youngs moduli) to 10% (poissons
ratios and non disagonal stiffness coefficient).
Discussion
The data suggests that a relatively accurate
estimation of all the mid-tibia elastic coefficients
can be derived from mass density. This is of
particular interest (1) to design organ scale bone
models in which anisotropic elastic coefficients
could be mapped according to Hounsfield
values from computed tomography scans as a
surrogate for mass density; (2) to model ultrasound
propagation at the midtibia, which is an important
site for the ultrasound assessment of bone status
with axial transmission techniques.
Results
Strong linear correlations were found between most
of the elastic coefficients (0.7 < R2 < 0.99). Strong
linear correlations were also found between these
coefficients and mass density (0.79 < R2 < 0.89).
The Table below presents the results of the linear
regression analysis. Comparison with previously
published data from femur specimens suggests
that the strong correlations evidenced in this study
may not only be valid for the mid-tibia.
208
O 176
BONE TISSUE ENGINEERING: THE NEED TO SEE INSIDE

S. Hofmann1,2, J. Vetsch2, J. Melke1, M. Ralph2, K. Ito1
1
Eindhoven University of Technology, Department of Biomedical Engineering,

Eindhoven, Netherlands
ETH Zrich, Department of Health Sciences and Technology, Zrich, Switzerland
Introduction
In bone tissue engineering, it is believed that cells
subjected to a certain load will either proliferate
or differentiate. However, studies about optimal
loading regimes are contradictory due to the
complexity of applied parameters [El Haj, 2010].
Most importantly, many studies do not take local
cellular conditions into account. When cells deposit
a matrix, they become embedded shielding
themselves from the applied load [Fig. 1]. Which
in turn means that if there is an optimal loading
condition for a certain cell type, loading regimes
on the tissue construct need to be adapted
taking into account the deposited matrix. In order
to do so, we need to be able to simultaneously
visualize scaffold morphology and the matrix that is
produced by the cells. We herewith describe such
an approach using micro-computed tomography
for bone tissue engineering.
Methods
Micro-computed
tomography
(CT)
was
investigated as a non-invasive tool to determine
both scaffold morphology as well as mineralized
matrix deposited by human mesenchymal stem
cells (hMSC) seeded on porous silk fibroin scaffolds.
Discussion
CT allows imaging of both the scaffold and newly
deposited mineralized matrix. However, this is
the first time that they have been simultaneously
visualised. In an in vitro culture, this will enable
us to set up a feedback mechanism to adapt
mechanical loading regimes, such as flow perfusion
through the scaffold pores, to maintain a local
mechanostimulatory environment. Only by applying
such non-destructive monitoring technology it will
be possible to identify and quantify parameters that
influence cell behaviour in vitro.
Results
Protein silk fibroin scaffolds take up water in a
physiological environment and are invisible to
CT. However, the incorporation of hydroxyapatite
powder enabled visualization of these scaffolds
(data not shown). Similarly, mineralized extracellular
matrix deposited by hMSC could be monitored
over time [Hagenmller, 2007] and enabled the
visualization of detailed structures at a resolution
of a few micrometers [Fig. 2].
References
El Haj et al, Proc Inst Mech Eng H, 224(12), 2010;
Hagenmller et al, Ann Biomed Eng, 35(10), 2007
Ack n o wl e d g m e n t s
The authors tehank Trudel Inc for providing silk and
funding from the European Unions 7th Framework
Programme (FP/20072013) / EU Project No. FP7NMP-2010-LARGE-4: 262948 and grant agreements
No. PCIG13-GA-2013-618603 and No. ERC-2013-StG:
336043.
209
O 17 7
FATIGUE-FRACTURE INTERACTION MECHANISMS

FOR LONGITUDINAL AND TRANSVERSE CRACK GROWTH
IN BOVINE CORTICAL BONE
L. Fletcher1, J. Codrington1, I. Parkinson2
1
2
The University of Adelaide, School of Mechanical Engineering, Adelaide, Australia
The University of Adelaide, Discipline of Anatomy and Pathology, Adelaide, Australia
Introduction
Fatigue microdamage accumulates in the skeletal
system due to everyday use (e.g. walking). This
accumulation of fatigue damage is thought to
contribute to the occurrence of fragility fractures in
the elderly [Burr, 1997]. However, the mechanisms
that are responsible for the interaction of fatigue
damage and the fracture resistance of bone are
not well understood. Therefore the aim of this study
is to analyse the effects of fatigue microdamage on
the longitudinal and transverse fracture resistance
of cortical bone.
Methods
Twenty longitudinal compact tension specimens
were machined from the cortical shaft of a
bovine femur. A further twenty transverse singled
edge notched bend specimens were machined
from another bovine femur. Ten specimens from
each femur were allocated as controls while the
remaining specimens underwent a cyclic loading
protocol to induce fatigue microdamage. Both
control and damaged specimens were imaged
using fluorescence microscopy to assess the fatigue
damage. All specimens were fracture resistance
tested to obtain the J-integral resistance curve
with further analysis undertaken on the elastic and
plastic components of the J-integral. After fracture
resistance testing the crack path toughening
mechanisms were assessed using fluorescence
microscopy. The method used for this study is
similar to our previous work, see [Fletcher, 2014] for
further detail.
Figure 1: F racture resistance curve confidence intervals for

the longitudinal (a) and damaged (b) groups
Discussion
For the longitudinal fracture group, fatigue
microdamage caused a decrease in both the
fracture initiation toughness and the rate of
toughening. This decrease was attributed to the
fatigue damage saturating weak interfaces of
the microstructure that would normally form new
damage during crack growth and absorb fracture
energy. For the transverse group, the effect of
fatigue microdamage was minimal with no observed
change in the fracture initiation toughness or rate of
toughening. The dominant toughening mechanism
for the transverse group was crack deflection. This
mechanism is controlled by the microstructure and
was unaffected by the fatigue damage.
The results of this study show that fatigue
microdamage is detrimental to the longitudinal
toughening behaviour of healthy bone. In aged
bone the crack deflection mechanism has been
shown to be suppressed for transverse cracking
[Koester, 2011]. Thus, the effects of fatigue
microdamage would become significant for crack
growth in this direction. Overall, it is therefore likely
that microdamage is detrimental to both the
longitudinal and transverse fracture behaviour of
aged bone.
Results
The 95% confidence intervals for the fracture
resistance curves of the longitudinal and
transverse groups are shown in Figure 1 (a) and (b)
respectively. The fracture initiation toughness J0
for the longitudinal control was 1.230.21 kJ/m2
and damaged 0.960.23 kJ/m 2. For the transverse
group the control fracture initiation toughness
was 2.320.44 kJ/m 2 and the damaged fracture
initiation toughness was 2.340.46 kJ/m2.
References
Burr et al, J Bone Miner Res,12:615, 1997
Fletcher et al, J Mater Sci: Mater Med, 25:
16611670, 2014
Koester et al, J Mech Behav Biomed Mater,
4:15041513, 2011
210
O 17 8
CREATING SUBJECT-SPECIFIC MUSCULOSKELETAL

MODELS FROM ANATOMICAL MRI SCANS
S. Menon1, K. Yan1, O. Khatib1
1
Stanford University, Computer Science, Stanford, USA
Introduction
Virtual simulations of musculoskeletal models are
a valuable tool for reconstructing dynamic human
motions and estimating neuromuscular control.
While the degree of biological plausibility required
depends on a studys specific goals, it is common
to use articulated body models with piece-wise
linear muscle kinematics. Such models are derived
from cadaver studies and are linearly scaled to
individual subject physiology. As a more precise
alternative, we present a tool-chain to recreate
exact subject-specific musculoskeletal kinematics
by building models based on segmented magnetic
resonance imaging (MRI) data. We used volumetric
bone data to create a subject-specific skeletal
articulated body system, and approximated
volumetric muscles with cylindrical segments that
represent fiber bundles. A comparison of our MRIbased model with a canonical cadaver model
from the OpenSim software system suggests that
subject-specific models can provide greater
kinematic accuracy. In addition, such models
also establish kinematic ground truth, which can
be used to estimate errors in further dynamics
reconstruction analyses.
canonical OpenSim (Delp, 2007) bone models. The

canonical muscle models kinematics were greatly
simplified, however, which prevented a direct
comparison with our exact MRI-based model.
We used a custom volume alignment method to
align bones since landmark based affine fitting
methods performed poorly. We first selected a
finite number of control points in each bone using
a volume filling algorithm. Each successive control
point was picked to maximize its distance from
the closest among the previously selected control
points. We then estimated point-correspondence
between the subject-specific and canonical models
using the Hungarian algorithm (Kuhn, 1955). Finally,
we fit an affine transformation to collectively warp
all the points in one bone to the other.
Results
We successfully created subject-specific full arm
musculoskeletal models from anatomical MRI scans
using our methods. The musculoskeletal volume
generation and articulation joint specification
presently requires some manual intervention.
Muscle fiber generation, however, is automated.
Methods
To extract musculoskeletal kinematics, we first
scanned subjects with MRI (T1, 0.8*0.8*0.8 mm
voxels, GE MR950 3T scanner) and extracted
volumetric data by manually segmenting the bones
and muscles (Fig. 1A). To capture each muscles
volume, we split it into slices, packed circles in
each slice, and connected corresponding circle
centroids and circumferences across slices. These
swept circles provided a decomposition analogous
to bundles of muscle fibers. Finally, muscle fiber
segments were attached to their corresponding
bones to obtain full musculoskeletal kinematics.
Discussion
Our MRI-based subject-specific musculoskeletal
models provide kinematic ground truth and are
potentially useful in analyses that are sensitive to
muscle structure and muscle-bone attachment
location. Our approach alleviates errors due
to mismatch between subject physiology and
canonical models, which affects existing marker
based human motion reconstruction methods.
References
Delp e.a., IEEE Tr. Biomed. Eng., 54:11, 2007
Demircan e.a., Springer Adv. Rob. Kinematics,
283292, 2010
Khatib e.a., J. Physiol, 103(3), 211219, 2009
Kuhn, Naval Res. Logistics Qtr., 2:8397, 1955
To
estimate
whether
our
subject-specific
models offer an advantage for human motion
reconstruction (Khatib, 2009, Menon 2015), we
performed a fit between the subject-specific and
see the next page
211
Figure 1: A
, Starting with segmented MRI scans, the pipeline creates bone (Stage 1) and muscle volumes (S2), then subdivides
muscles into fibers (S4), and finally creates a biomechanical model (S5,6). Colors in MRI scans (top) indicate different
bones. B, Subject-specific models avoid fitting errors in canonical model pipelines.
212
O 17 9
WORKING TOWARDS PATIENT-SPECIFIC LOCKING

PLATE SELECTION FOR BONE FRACTURE TREATMENT:
WHAT MATTERS?
A. MacLeod1, H. Simpson2, P. Pankaj1
1
2
The University of Edinburgh, School of Engineering, Edinburgh, United Kingdom
Introduction
Plating functions very differently depending upon
the type of screws used and the placement
of those screws (Gautier, 2009). Choosing a
patient-optimised plate and screw configuration
is not straightforward as there are many
interdependent variables relating to device
configuration. Moreover, every patient presents
a unique fracture pattern and has different
bone quality. Fracture healing is known to be
sensitive to interfragmentary movement (IFM)
produced by a device, and this is affected by
screw placement. Additionally, many modes of
plate failure such as screw loosening/cut-out
and plate breakage have been attributed to
inappropriate device configuration (Button 2004,
Gardner, 2009). Recent studies have shown that
there is wide variability in the screw configurations
used by different surgeons even when using similar
devices (Fitzpatrick, 2009) and when treating similar
fracture patterns (Button, 2004, Hoffman, 2013).
This highlights the demand for greater guidance.
Figure 1: T he different screw positioning variables examined

in the study and the regions of high strain around
screw holes.
Results
The study found that the main determinants of
IFM and plate stress were: the plate material and
geometry, and distance between the two screws
closest to the fracture (working length).
This study aimed to evaluate the influence of

different aspects of device configuration on IFM,
and the risk of screw loosening and plate breakage.
Additionally, the study aimed to evaluate that
effect that bone quality has on these variables.
The regions of high strain around screws were

influenced by additional variables including the
number of screws used and the spacing of the
screws. Interestingly, total plate span did not
influence predictions. Osteoporotic bone was
found to be more sensitive to the choice of screw
configuration and the use of different screw types.
Methods
Three-dimensional finite element models were
created and validated experimentally using
sawbones models. The analyses used nonlinear
screw-bone contact interfaces and included
nonlinear geometrical effects. The influence of screw
placement in osteoporotic bone was investigated
by including anisotropic and inhomogeneous
bone properties and the associated geometrical
changes. The IFM, plate stress and the level of
strain around screws was examined for a range of
screw positioning variables (Figure 1), plate types
and screw types.
Discussion
Based on this study, the approach to patientspecific locking plate configuration was derived
as follows:
(1) T he ideal IFM for the fracture pattern should be
determined.
(2) IFM and plate stress can then be optimised using
a combination of working length and choice of
plate material and geometry.
(3) F inally, loosening risk can be mitigated by the
placement of remaining screws. Bone quality
should be taken into account at this stage.
References
Gautier, AO Dialogue 2427. 2009.
Button et al, J Orth Trauma 18:565570. 2004.
Gardner et al, J Am Acad Orthop Surg 17:647657.
2009.
Fitzpatrick et al, OTC workshop on Trauma care,
Boston. 2009
Hoffmann et al. J Orthop Surg Res 8:843. 2013.
213
O 18 0
A TOTAL HIP REPLACEMENT TOOLBOX: FROM CT-SCAN

TO PATIENT-SPECIFIC FE ANALYSIS
D. Ferreira de Almeida1, R. B. Ruben2, J. Folgado1, P. R. Fernandes1,
M. De Beule3 , B. Verhegghe3
1
2
Instituto Superior Tcnico, IDMEC, Lisboa, Portugal
Instituto Politcnico de Leiria, CDRsp-ESTG, Leiria, Portugal

3
University of Gent, bioMMeda, Ghent, Belgium
Introduction
The hip joint has one of the most physically
demanding roles in the human body, carrying
up to 85% of the body weight in a single stance
and up to eight times the body weight when
running. The most common solution to the
numerous complications in the hip joint is its
replacement for a synthetic prosthesis Total Hip
Replacement (THR). In the scope of this paper a
pipeline for the femur segmentation, alignment
and prosthesis coupling was developed. Hence,
the orthopaedic surgeon will be provided with
quantitative information about the performance
of the different and prosthesis designs and
constituting materials in the patient-specific
femur prior to the surgical intervention and without
requiring extensive knowledge of the technique.
The femur volumes were then discretized in a

triangulated surface and oriented according to their
principal axis of inertia. Together with the orthopaedic
department at the UZ Gent, the automatic extraction
of key anatomical landmarks is also included in the
toolbox, in order to plan the femur neck osteotomy and
prosthesis insertion. The sizing and fitting optimization
was also addressed, developing methodologies that
optimize the alignment of the prosthesis axis in red
on Fig. 2. The segmentation of the medullar canal
green on Fig.2 will allow the physician to estimate
beforehand the optimal size of the stem.
Results
The methodologies developed avoid the trial-anderror stem size estimation and ultimately reduce the
amount of breaching at the time of the prosthesis
insertion, as shown in Fig. 2.
Methods
The first step of the pipeline is the segmentation of
the femur. For this purpose, an Active Shape Model
(ASM) [Cootes, 1994] was created from images
made available at the Universitair Ziekenhuis (UZ)
Gent, in Belgium. Briefly, the statistical shape model
is obtained by learning patterns of variability of a
training set of previously segmented femurs. The
ASM algorithm aims to deform the model to a new
scan Fig 1.
Figure 2: E
xample of a prosthesis optimal fitting to a patient-specific femur.
Discussion
A framework for planning a THR was successfully
developed. The computational procedure is
capable to automatically segment the patients
femur, orient it within a standardized coordinate
system, optimize the osteotomy based on
anatomical landmark extraction and surface
curvature and provide the tools for an optimal
prosthesis placement.
Figure 1: E
xample of the ASM segmentation results.
References
Cootes et al, J Computer Vision and Image
Understanding, 61:3859, 1994.
214
O 181
PERSONALIZED 3D FINITE ELEMENT MODELS OF THE HIP

FROM 2D RADIOGRAPHS BASED ON ANATOMICAL
MEASUREMENTS AND TEXTURE ANALYSIS
J. Thevenot1, J. Koivumki1, V. Kuhn2,3 , F. Eckstein3,4 , S. Saarakkala1,5, T. Jms1,5
1
University of Oulu, Department of Medical Technology, Oulu, Finland
Innsbruck Medical University, Department of Trauma Surgery and Sports Medicine,

Innsbruck, Austria
Paracelsus Medical University, Institute of Anatomy and Musculoskeletal Research,

Salzburg, Austria
Ludwig-Maximilians-University, Institute of Anatomy, Munich, Germany
Oulu University Hospital, Department of Radiology, Oulu, Finland
Introduction
Finite element (FE) modelling has often been
proposed as a tool for estimating fracture
risk. However, patient-specific FE models are
commonly based on computed tomography (CT)
and require high computing time to obtain both
geometry and material properties. It has been
suggested that radiographic texture analysis can
provide information on bone quality [Thevenot,
2013]. Thus, we present here a novel method to
automatically create a personalised 3D models
from standard 2D hip radiographs [Thevenot, 2014],
based on anatomical measurements to generate
the geometry and texture analysis to estimate the
material properties.
Discussion
This novel method for automatically constructing
a patient-specific 3D finite element model from
standard 2D radiographs shows encouraging
results in estimating patient-specific failure loads.
The compressive system in the neck area is the most
relevant location to estimate an overall distribution
of the material properties within the model, based
on texture analysis.
Methods
A set of geometrical parameters of the femur were
determined from seven a-p hip radiographs and
compared to the 3D femoral shape obtained from
CT as training material; the error in reconstructing
the 3D model from the 2D radiographs was
assessed. Using the geometry parameters as the
input, the 3D shape of another 21 femora was
built and meshed. Both trabecular and cortical
compartments were separated during the process.
Personalized material properties were derived from
the homogeneity index assessed by texture analysis
of the radiographs, with a focus on the principal
tensile and compressive trabecular systems, as
suggested previously [Thevenot, 2013]. In order
to estimate the material properties from texture
analysis, the homogeneity index was correlated to
CT scans-based elastic modulus from the training
set as reference. The ability of these patientspecific FE models to predict failure load was
determined by a comparison with an experimental
biomechanical test simulating a fall on the greater
trochanter.
Figure 1: C
ut of a generated model showing the typical
distribution of material properties based on texture
analysis of the radiograph.
References
Thevenot et al, J Biomech, 47:438444, 2014.
Thevenot et al, J Bone Miner Res, 28:
25842591, 2013.
Results
The average reconstruction error of the 3D models
was 1.77 mm (1.17 mm), with the error being
smallest in the femoral head and neck, and greatest
in the trochanter. Homogeneity index assessed in
the principal compressive system provided the best
information to affect material properties within the
generated FE model (Figure 1). The FE model was
able to predict the experimental failure load with
R2=64% accuracy.
215
O 18 2
SCALED-GENERIC MUSCULOSKELETAL MODELS

OVERESTIMATE THE KNEE MEDIAL CONTACT FORCE
Z.Y. Ding1, A.E. Kedgley1, C.K. Tsang1, A.M.J. Bull1
1
Imperial College London, Department of Bioengineering, London, United Kingdom
Introduction
Estimation of knee contact forces is important in
understanding the initiation and progression of
musculoskeletal conditions such as osteoarthritis.
Musculoskeletal modelling of the lower limb
provides a practicable approach to predict these
forces. However, the development and validation
of these models are challenging due to the knee
joint complexity and subject variability. The aim
of this study was to investigate the influence of
personalised anatomical parameters of lower limb
musculoskeletal models on the knee medial and
lateral contact force predictions.
Methods
Scaled-generic and MR-based musculoskeletal
models were developed for 2 male subjects. Scaled
models were achieved by scaling each segment
of the generic model (male, 1.74 m, 105 kg) [1]
to the subjects dimensions. Medial and lateral
contact points were located 20 mm medially
and laterally from the knee centre of rotation [2].
MR-based models were developed from MRI scans
of the subjects whole lower limbs. Subject-specific
medial/lateral contact locations were directly
measured from the MR images. Two models were
varied at bony landmarks, joint centres of rotation,
medial/lateral contact points, muscle geometry
and patella ligaments geometry. Kinematic and
ground reaction force data were collected for
each subject during gait. The contact forces
including the forces in the medial and lateral
compartments were predicted using a segment
based optimisation approach [3].
Figure 1: K
nee force predictions for two subjects.
Figure 2: M
edial and lateral contact forces
Results
The knee contact force predictions are shown
in the Figure 1. The total knee contact force
distribution patterns during the stance phase are
similar between cases; however, scaled-generic
models had greater estimates of knee contact
forces for the two subjects, by up to 1.07BW and
1.26BW, respectively. Moreover, the MR-based
models cause a decrease in the medial contact
force and an increase in the lateral contact force.
Discussion
This MR-based model predictions are in better
agreement with in-vivo measurements from the
literature ([4] Figure 2). Differences in lower limb
anatomical model were addressed for knee contact
force predictions. However, the sensitivity of these
knee contact forces to those subject-specific
anatomical parameters (e.g., the medial/lateral
contact locations, muscle and ligament geometry)
remains unknown. With more subject-specific
anatomical models available in our group, we are
now carrying out investigations to better quantify the
accuracy of the knee contact force estimations in
terms of different anatomical modelling techniques.
References
1 Klein Horsman MD. Et al., Clin Biomech,
22(2):239247, 2007
2 Cleather DJ. et al., Plos One, 9(12):e115670
3 Cleather D.J. et.al, Ann Biomed Eng, 39(1):
147169, 2011
4 Zachary FL. et al., J Biomech, (In Press)
216
O 18 3
3D-SCAFFOLD-FREE CARTILAGE TRANSPLANTATS (SFCT)

AS A NEW WAY IN CARTILAGE TISSUE ENGINEERING
I. Ponomarev1, T. Reuter2, C. Hauspurg3 , A. Kammel3 , D. Barnewitz1
1
2
fzmb GmbH, Veterinarian Clinic, Bad Langensalza, Germany
fzmb GmbH, Bioinstruments and Device Development, Bad Langensalza, Germany

3
TITK, Textile and Materials Research, Rudolstadt, Germany
Introduction
The limited self-repair capability of damaged
hyaline cartilage is the main cause of joint arthrosis.
Therefore, different tissue-engineering methods
have been developed to address this particular
problem. We focused on the development of a
new technology to produce a 3D-scaffold-free
cartilage trans-plantat (SFCT) by intermittent
mechanical stimulating chondrocytes of pellet
cultures.
Also, histochemical findings reveal clear proteoglycan and collagen staining. Even though immunohistological analyses indicate the presence
of collagen type I, collagen type II was the main
component of extracellular matrix in SFCTs. All
SFCTs exhibit a remarkable size (Figure 1).
Methods
For the production of SFCTs equine chondrocytes
of the stifle joint were used. After cultivation
and proliferation in monolayer cultures, cells
were
transferred
into
a
three-dimensional
structure without any artificial matrix, growth
or differentiation factors. In order to produce
scaffold-free transplants and extracellular matrix,
the samples were exposed to undifferentiated
mechanical pressure (manual) [1]. The SFCTs
were analysed after 46 weeks of cultivation.
Chondrogenesis in SFCTs was documented by
macroscopic, biochemical, immunohistological
and biomechanical analysis. For biomechanical
investigations, the E-modulus of samples was
determined using a material testing machine
INSTRON 4466 (100 N). The uniaxial compression of
the specimens was effected with a testing velocity
of v = 1 mm/s, with an initial load of F = 0.1 N and
with a strain of 30%. Native equine joint cartilage
was used as a control.
Figure 1: M
acroscopically presentation of Scaffold-free 3D
cartilage constructs (SFCTs).
Specimens
Collagen
E-modulus
SFCT
30,11,9 g
0,260,12 MPa
native
64,95,0 g
0,890,11 MPa
Table 1: C
haracterisation of native cartilage and SFCTs.
Discussion
The presented results allow the conclusion that tissue
engineered constructs created by scaffold-free
technology can be applied in the rehabilitation
of articular cartilage damages in veterinary and
human medicine.
Results
The biochemical results clearly demonstrate
that SFCTs have a high amount of proteoglycan
and collagen (20% and 45% of the native tissue,
respectively). The biomechanical results show
that the E-modulus of SFCTs was about 30% of the
native tissue E-modulus.
References
[1] Ponomarev I., Wilke I., Manufacturing process of
three dimensional tissue structures and structures
obtainable thereby, EP 1 550 716 B1, 2004.
217
O 18 4
MSC ALIGNMENT, PROLIFERATION AND ECM SYNTHESIS

IN 3D FIBRIN HYDROGELS IS REGULATED BY THE
MAGNITUDE AND FREQUENCY OF TENSILE STRAIN
S. Carroll1, D. Kelly1, C. Buckley1
1
Trinity College Dublin, Trinity Centre for Bioengineering, Dublin, Ireland
Introduction
Multipotent stromal cells (MSCs) can be isolated
from numerous different tissues and induced to
differentiate towards a chondrogenic lineage
[Vinardell (2012)], making them an attractive
alternative to autologous chondrocyte implantation
for articular cartilage repair strategies. However,
the in vivo phenotypic stability of cartilaginous
tissues engineered using such cells, irrespective
of their origin, is by no means assured. Previous
studies have demonstrated that joint specific
environmental cues, such as mechanical loading,
can significantly influence MSC differentiation
[Carroll (2014), Connelly (2010)]. A key challenge
when developing successful tissue engineering
strategies is to elucidate the influence of such
biophysical cues on stem cell fate. Here, we present
a novel bioreactor capable of controlling the
magnitude and frequency of tensile strain applied
to 3D cell laden hydrogels. This bioreactor is then
used to explore how cyclic tensile strain regulates
the alignment, proliferation and phenotype of
MSCs encapsulated into fibrin hydrogels.
Figure 1: A
novel tension bioreactor was developed to
apply uniaxial tensile strain to 3D hydrogels.
Methods
A novel bioreactor (Fig.1) was developed to
facilitate application of precise uniaxial tensile
strains to 3-dimensional hydrogels under controlled,
sterile conditions. Furthermore, this system was
able to control the local oxygen levels within the
bioreactor chamber via an aeration system which
introduced oxygen at a controlled partial pressure.
Expanded porcine bone marrow derived MSCs were
encapsulated at a final density of 10x10 6cells/mL in
fibrin hydrogels, which were moulded in recesses
in silicone strips and maintained in the tension
bioreactors in media containing factors known to
promote chondrogenic/myogenic differentiation.
Cyclic tensile strain was applied for 4 hours per
day for 16 days at various strain magnitudes and
frequencies.
Results
MSCs remained viable in all groups for the duration
of the study. MSCs within the hydrogels appeared to
align parallel to the direction of the applied tensile
strain, particularly for the 10% strain, 0.5Hz group
(Fig. 2a). A more developed actin-cytoskeleton
was observed with the application of this loading
regime. This group was also found to promote
cellular proliferation, as evident by a significant
increase in construct DNA content (Fig. 2b). An
increase in total extra-cellular matrix accumulation
was also observed in this group.
Figure 2: F -actin staining (a) and biochemical analysis

(b) of samples after 16 days culture in tensile
strain bioreactors. Direction of loading is left
to right in images.
Discussion
This study presents a novel bioreactor capable of
controlling the external mechanical environment
and oxygen tension of MSCs encapsulated in
3D hydrogels. The altered cytoskeletal structure
see the next page
218
References
Carroll, et al., J Biomech, 47: 211521 (2014).
Connelly, et al., Tissue Eng Part A, 16: 191323 (2010).
Vinardell, et al., Tissue Eng Part A, 18: 116170 (2012).
and cellular alignment in response to tensile

loading, coupled with increases in proliferation
and collagen matrix synthesis, suggest that the
MSCs are adopting a more myogenic phenotype
in response to this biophysical stimulation. We are
currently exploring how the application of such
cues regulates the specific matrix components
synthesised by MSCs in response to altered
magnitudes of cyclic tensile strain.
219
O 18 5
DAMAGE MECHANISMS OF FOCAL CARTILAGE DEFECTS:

NEW INSIGHTS USING FINITE ELEMENT MODELING
A. Heuijerjans1, W. Wilson1, K. Ito1, C.C. van Donkelaar1
1
Eindhoven University of Technology, Biomedical Engineering, Eindhoven, Netherlands
Introduction
Focal cartilage defects are common [Hjelle, 2002],
cause severe pain and disability [Heir, 2010; Solheim,
2014] and generally progress into osteoarthritis
[Hunziker, 2001]. This study investigated the underlying biomechanical mechanisms of damage
progression surrounding such defects using a finite
element model of a cartilage-cartilage contact
interface. We hypothesized that elevated collagen
strains would occur at the surface of tissue adjacent
to a defect, especially after sustained loading, as
a result of tissue deformation into the defect.
Figure 2: M
aximum principal strain after fast axial loading
(left) and creep loading (right) in intact and defect cartilage-cartilage contact.
Methods
A finite element geometry of cartilage-cartilage
contact was developed for an intact and defect
state. Due to symmetry, only half of the geometry
was simulated. The size of the defect was set to 8
mm, thickness of cartilage was 1.5 mm. The upper
cartilage-bone interface was fixed in all directions,
while the lower cartilage-bone interface was
only fixed in the horizontal direction. Fast loading
was performed on the lower cartilage-bone
interface by a load increase to 2 MPa in 1 ms and
prolonged loading was performed by a constant
load of 0.5 MPa for 900 s. Healthy cartilage tissue
was described using a validated fibril-reinforced
poroviscoelastic swelling model [Wilson, 2005].
Discussion
In accordance with the hypothesis, collagen strains
increased adjacent to a defect. Superficial fibers,
aligned parallel to the surface, were strained due
to horizontal stretch of the surfaces caused by the
defect. Similarly, vertical deformations of opposing
tissue caused increased collagen fiber strains
in the middle and deep zone where the fibers
were perpendicular to the surface (Fig 1). Sites of
elevated collagen strains in the surface adjacent
to a defect agree with previously reported sites of
high contact pressure [Manda, 2011] and might be
related to surface fibrillation.
Lateral deformations caused substantial increases
in maximum principal strains in the middle and
deep zone of tissue near the defect edge (Fig 2).
This site correlated with locations where cartilage
separation from underlying bone, also called
delamination, blistering or peel-off tearing, occurs
clinically [Beaul, 2003; Beck, 2005; Sekiya, 2009].
Results
Elevated fiber strains occurred opposing the
defect after fast loading and in superficial zones
adjacent to a defect after a sustained load (Fig 1).
Maximum principal strains increased at the edge of
the defect and the cartilage-bone interface after
fast loading (Fig 2). Prolonged loading caused
major increases in maximum principal strains close
to the defect edge, in the deep and middle zone.
These strains were mirrored in the opposing tissue.
Due to joint incongruence and motion in vivo, no

fluid entrapment in the defect was assumed. Future
3D modeling would allow studying effects of motion
and geometry. Whether the computed strains
induce damage is the subject of future study using
a damage progression model [Hosseini, 2014].
In conclusion, the present study demonstrated that
sites of high strains occur as a result of a cartilage
defect, at locations which concur with areas in
which damage is known to occur clinically. High
collagen strains close to the surface may be a
mechanism for surface fibrillation, whereas high
principal strains deep in the tissue may be a
mechanism for blistering.
Figure 1: M
aximum primary collagen fiber strains after fast
axial loading (left) and creep loading (right) in intact and defect cartilage-cartilage contact. In the
zoomed area the fibers are represented in black.
see the next page
220
References
Beaul et al., Can J Surg 46:4634. 2003;
Beck et al, JBJS Br 87:10128. 2005;
Heir et al, Am J Sports Med 38:231237, 2010
Hjelle et al, Arthroscopy 18(7):7304, 2002;
Hosseini et al OA Cart 22:95103, 2014;
Hunziker, OA Cart 10:43263, 2001;
Manda et al, J Biomech 44:794801, 2011;

Sekiya et al, Orthop 32, 2009;
Solheim et al, Knee Surg Sports Traumatol Arthrosc
2014 (Epub)
Wilson et al, J Biomech 38:1195204, 2005;
221
O 18 6
THE EFFECT OF DEHYDRATION ON THE MECHANICAL

PROPERTIES OF ARTICULAR CARTILAGE
A. Cederlund1, R. Aspden1
1
University of Aberdeen, Musculoskeletal Research Programme, Aberdeen, United Kingdom
Introduction
Articular cartilage is an anisotropic, non-linear
viscoelastic material that provides a low-friction
bearing surface while transmitting loads to the
underlying bone. It exhibits both stress relaxation
and creep behaviour when compressed. It has
a remarkably high water content, about 6080 %
of the tissue weight is water. This decreases with
ageing [Goodfellow, 1967] but increases with the
onset of osteoarthritis [Maroudas & Venn, 1977].
Viscoelasticity is often characterised by isochronal
stress-strain curves calculated from creep or stress
relaxation data, and stiffness or compliance
spectra [Ferry, 1970]. Creep and stress relaxation
are related if the viscoelasticity is linear [Ferry,
1970]. The role of water content in these spectra
has been little explored. In this study we investigate
the viscoelastic properties of articular cartilage in
relation to tissue water content.
(RH=100%) and 16.0 5.6 MPa (RH=96%) (Figure 1).

The elastic modulus at 200 s increased from
0.7 0.8 MPa (fully hydrated) to 1.7 2.3 MPa
(RH=100%) and 5.2 4.6 MPa (RH=96%).
Stress relaxation (SR) tests were performed on 5 mm
diameter, full-thickness cores of bovine articular
cartilage (n=16). Each core was dehydrated in two
stages (equilibration 3 hours in relative humidities
(RH) of 100% and 96%). Total water content was
analysed by drying the cores at 110 C. Cores were
compressed to 5%, 10%, 15% and 20% at 60 mm
/ min and stress recorded for 240 seconds at a
rate of 0.02 s/signal. Creep tests were also done
and analysed for comparisons with SR. Isochronal
stress-strain curves were derived at selected
time points (10s, 200s) from SR curves and data
were Fourier transformed for dynamic analysis.
Differential Scanning Calorimetry (DSC) was used
to investigate the water behaviour in the tissue
during freezing and melting.
Figure 1: R
epresentative isochronals at two time points
(10 s and 200s) and three levels of hydration
(PBS, 100%, 96%).
No relationship could be found between creep

and SR data. The dynamic analysis indicates
that the tissue response is more viscous at higher
frequencies.
Discussion
Isochronal stress-strain relationships show the tissue
to be non-linear viscoelastic. A consequence is
that it becomes impossible to derive a relationship
between stiffness and creep compliance.
Decreasing water content increases the elastic
modulus of the tissue. These data indicate
that control of water content is crucial if tissue
engineered implants are to have the appropriate
mechanical properties.
Results
DSC showed that the water froze in one process
with a sharp onset at 14 C but melted in several
stages. The relative enthalpies depended on the
rate of warming. Dehydration reduced the water
content in the tissue from 78 3% (fully hydrated)
to 61 4% (RH=100%) and 45% 3% (RH=96).
The elastic modulus of the tissue at 10 s increased
from 9.6 6.8 MPa (fully hydrated) to 15.0 8.1 MPa
References
Ferry, D., Viscoelastic Properties of Polymers, 1970
Maroudas, A. & Venn, M. Ann Rheum Dis
36:399, 1977
Goodfellow, J. W., et al, J. Bone Joint Surg. Br,
49:175181, 1967
222
O 187
SITE-SPECIFIC CHANGES IN CELL BIOMECHANICS AND

CARTILAGE COMPOSITION IN MATURE RABBIT KNEE
JOINTS 3 DAYS AFTER A PARTIAL MENISCECTOMY
A. Ronkainen1, J. Fick1, A. Sawatsky2, W. Herzog2, R. Korhonen1
1
2
University of Calgary, Human Performance Laboratory, Faculty of Kinesiology,

Calgary, Canada
Introduction
Surgical operations that cause instabilities in the
knee joint, such as partial menisectomy (PM),
are commonly used in studying the progression
of osteoarthritis [Colombo, 1983]. It is not known
whether changes in chondrocyte biomechanics
and tissue composition occur 3 days after a PM in
the rabbit knee joint.
Methods
Fifteen New Zealand White rabbits (131 month)
were divided into surgery (n=10) and control
(n=5) groups. A PM of the meniscus in the
lateral compartment of the rabbit knee joint was
performed in a randomly chosen knee for each
surgery group rabbit, and these knee joint tissues
were harvested 3 days after surgery. All control
group rabbit knees were harvested. Harvested sites
included the patella, groove, femoral condyles
and tibial plateaus. Confocal laser scanning
microscopy (CLSM) with a custom-build indentation
system enabled capturing optical sections from
cartilages before and after indentation at steady
state (2 MPa for 20 minutes) using conjugated
Dextran as matrix stain. The chondrocytes were
cropped, reconstructed, and their volumes were
calculated [Han, 2009], and relative cell volume
changes due to compression were analyzed.
After CLSM, histological sections of all tissue sites
were prepared, and regions of indentation were
analyzed with digital densitometry [Kiviranta, 1985]
and polarized light microscopy [Rieppo, 2008] for
proteoglycan (PG) content and collagen fibril
orientation, respectively. Profiles were acquired
from the tissue surface to the bone. Profiles were
interpolated to 100 points and means from the first
20 points were calculated. Group comparisons
were performed with Students T-tests (p < 0.05).
Figure 1: A
) Relative cell volume changes due to indentation
from each site. B) Superficial PG content up to 20%
of tissue depth (from surface). A clear relationship
between PG loss and altered cell biomechanics is
observed. Black bars denote significant differences
between groups (p < 0.05)
C o n cl u s i o n
These results demonstrate that biomechanical
responses of chondrocytes are highly site-specific
and are affected as early as 3 days following a
PM. The results further suggest that the changes in
cell biomechanics reflect alterations occurring in
the PG content, whereas the collagen orientation
remains unaltered due to the surgery. The lateral
plateau was the only site where no changes were
observed. Without intervention, alterations in cell
biomechanics and PG loss may lead to more
severe degenerative changes in cartilage and the
development of osteoarthritis.
Results
Chondrocyte biomechanics were altered in a
highly site-dependent manner (figure 1A). Only in
the lateral plateau, cell volume change was not
affected by the surgery. The collagen orientation
remained unchanged at all sites (p > 0.05),
whereas the superficial PG content (up to 20 % of
tissue depth) was decreased in all but one location
of the knee joint, the lateral plateau (figure 1B).
References
Colombo et al, Arthritis Rheum, 26(7):87586, 1983.
Han et al, J R Soc Inter, 7(47):895903, 2009.
Kiviranta et al, Histochem, 82(3):24955, 1985.
Rieppo et al, Microsc Res Tech, 71(4):27987, 2008.
223
O 18 8
EFFECT OF DECELLULARISATION ON THE TENSILE

BIOMECHANICAL PROPERTIES OF PORCINE MENISCUS
A. Abdelgaied1, M. Stanley1, M. Galfe2, H. Berry2, E. Ingham1, J. Fisher1
1

2
Tissue Regenix Group Plc, York, Tissue Regenix, York, United Kingdom
Introduction
Partial meniscus replacement can maintain the
functional role of the meniscus and prevent early
degenerative joint disease. A potential solution to
the current lack of meniscal replacements is the
use of an acellular biological scaffold produced
from xenogeneic meniscus. This study investigated
the effects of decellularisation on the tensile
biomechanical properties of the porcine medial
meniscus.
scaffold showed lower initial elastic modulus

(9.41 1.38MPa) (ANOVA, p<0.05, n15).
The measured elastic modulus (133 11MPa),
ultimate strength (354.5MPa), transition stress
(1.660.23MPa), and transition strain (5.32 0.58)
for the decellularised porcine meniscus were,
however, not significantly different (ANOVA,
p>0.05, n15), compared to that of native
meniscus (Figure 1).

The animals used in the current study were typically
six months old and weighed between 90 to 105
kg. Native porcine meniscus was decellularised
by Tissue Regenix Group Plc, York, UK, according
to the developed decellularisation protocol by
Stapleton et al. [1]. The dumbbell-shaped tensile
test specimens were cut from the middle portion.
Five different native meniscal specimens were
tested to represent different meniscal regions (with
different structures) [2]. However, based on the
sensitivity study on native meniscus, decellularised
meniscal tensile specimens of 3x3 [mm] crosssectional area were used. Mechanical uniaxial
tensile tests were conducted at 20 C and strain
rate of 0.00167s -1, using an Instron uniaxial testing
instrument, to determine the tensile initial elastic
modulus (the slope of the linear curve fit up to
1% strain), elastic modulus (the slope of the linear
part of the curve), transition stress, transition strain
and ultimate tensile strength of each specimen. A
pre-load of 0.5N was applied and marker points
were added at the tissue grips edges to monitor
the tissue slippage. The meniscal specimens were
kept hydrated for the duration of the tests using
phosphate buffered saline (PBS) spray.
Figure 1: T ensile mechanical properties for native and decellularised menisci (3.0x3.0x10 [mm] specimens,
mean 95% CI, n 15) at a strain rate of 0.00167s-1.
D i s c u s s i o n a n d C o n cl u s i o n :
The dependence of the tensile biomechanical
properties on cross-sectional area and position
can be explained by the nature of the collagen
fibre arrangement in the structure of the
meniscus, with different regions having different
arrangements with varied fibre densities and
orientations. A decellularised scaffold derived
from the porcine medial meniscus maintained the
tensile biomechanical properties of the native
meniscus, but had a lower initial elastic modulus.
Moreover, the predicted biomechanical properties
of decellularised medial porcine meniscus were
within the reported range for the human meniscus.
The decellularised porcine meniscus therefore has
potential as a partial meniscus replacement device.
Results
The native meniscus results showed a dependence
of the tensile biomechanical properties on the
cross-sectional area of the tensile specimen. The
measured initial elastic modulus, elastic modulus,
ultimate tensile strength, and transition stress for
the native porcine meniscus were in the ranges
14 to 26, 113 to 142, 23 to 33, and 2 to 3.2 [MPa]
respectively. The corresponding transition strain
ranged between 4.6 and 6.4% strain, depending
on the cross-sectional area of the meniscal
samples. However, this dependence was found
not to be statistically significant in the majority of
the comparisons of the groups. The decellularised
References
[1] Stapleton et al. J Tissue Engineering Part A,
14, 505518, 2008.
[2] Fox et al. J Sports Health, 4, 340351, 2012.
[3] Proctor et al. J Orthopaedic Research,
7, 771782, 1989.
224
O 189
AN IN VITRO MODEL TO ASSESS THE BIOMECHANICAL

FUNCTION OF MENISCUS REPAIR METHODS
M. Stanley1, J. Fisher1, E. Ingham1, L. Jennings1
1
Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
Introduction
The menisci are integral parts of the knee joint,
distributing loads, providing shock absorbance and
providing stability. Due to their avascular nature,
damage to the meniscus often requires surgical
intervention, although the effectiveness of many
current methods is debatable [1]. As such there is much
interest in developing new devices and techniques
to assist in the repair. However, new devices are not
often assessed for their restorative biomechanical
function prior to animal or clinical trials.
Methods
An in vitro model using porcine knee joints is
proposed in order to allow new devices and/or
repair techniques to be functionally assessed to
establish their likely performance in vivo. Initial
investigations focussed on the porcine knee due
to its anatomical and geometrical similarity to that
of human knee. Specimens were mounted in a
custom rig and loaded with a uniaxial compression
tester (Instron 3365) (Fig. 1a) Pressure sensors
(Tekscan I-scan) were placed between the tibia
plateau and the inferior surfaces of the menisci.
The knee was loaded with 500N for 1000s and the
pressures transmitted to the tibal plateau were
recorded. The contact area was also recorded.
Figure 1: Images of the experimental setup (a) and typical

pressure (MPa) distribution maps (b).
Discussion
We have demonstrated that the in vitro porcine
model can distinguish between the three meniscus
conditions and while similar results have been
reported in human cadaveric knees [2], it has not
previously been shown that porcine knees produce
results comparable to human. We therefore
propose that this model can be useful in pre-clinically assessing the restorative biomechanical
function of meniscal repair devices. Additionally,
using porcine tissue has several advantages
including increased availability and reduced
variability when compared to human cadaveric
tissue, thus allowing easier testing of novel and
innovative repair devices.
The aim of this study was to obtain control

data to which repair devices and techniques
could be compared to assess their restorative
biomechanical function. Two control states were
identified, a negative control consisting of an
intact knee complete with cruciate and collateral
ligaments and both menisci, and a positive control
consisting of the intact knee with a total medial
meniscectomy. A third state of a partial medial
meniscectomy was also investigated.
References
[1] Sihvonen, R., et al., Arthroscopic Partial Meniscectomy versus Sham Surgery for a Degenerative
Meniscal Tear. New England Journal of Medicine,
2013. 369(26): p. 25152524.
[2] Fukubayashi, T. and H. Kurosawa, The Contact
Area and Pressure Distribution Pattern of the Knee
A Study of Normal and Osteoarthrotic Knee
Joints. Acta Orthopaedica Scandinavica, 1980.
51(6): p. 871879.
Results
Results demonstrated that transmitted pressures
were lowest and contact areas highest in the
intact knee, with highest contact pressures
and lowest contact areas found in the total
medial meniscectomy condition. The partial
meniscectomy condition showed values between
the two control conditions (Fig. 1b). Time dependant
studies demonstrated the biphasic nature of
both the cartilage and menisci with decreased
contact pressures and increased contact areas
for all conditions at 1000s when compared to their
respective conditions at 0s.
225
O 19 0
A NON-INVASIVE AND PATIENT-SPECIFIC METHOD

TO ASSESS SPINAL STIFFNESS IN ADOLESCENT
IDIOPATHIC SCOLIOSIS
S. Berger1, H. Carol2, D. Studer2, P. Bchler1
1
2
University of Bern, ISTB, Bern, Switzerland
Universitts-Kinderspital beider Basel, Orthopedy, Basel, Switzerland
Introduction
Adolescent Idiopathic Scoliosis (AIS) is a three
dimensional deformation of the spine which
develops during adolescence and is associated
with difficulties in carrying out physical activities
(lifting, running, standing and carrying), with
back pain problems and an affected self-image.
Spinal fusion surgery is generally indicated when
thoracic curve is expected to reach at least 50 by
skeletal maturity. To plan the surgery and predict
its outcome, spinal flexibility has to be evaluated
pre-operatively.
segment to represent the spinal flexibility along the

main anatomical directions: flexion, axial rotation
and bending. The vertebrae were considered as
rigid bodies. The boundary conditions correspond
to the experimental test: the lower vertebra has
been fixed while a vertical force was applied to
the most cranial vertebra. The Nealder-Mead
optimization algorithm was used to find the stiffness
parameters which best match our experimental
measurements.
Results
The Spinal Suspension Test has been applied on
5 AIS patients. For all these patients, a reduction of
the curve has been observed during the traction
test. In addition, the displacement of the vertebras
induced by the loading was in average 12 times
larger than the three-dimensional reconstruction
precision. The parameter identification showed
a prediction error on the vertebral position less
than 5[mm]. In addition, important variations of
the stiffness parameters were observed between
patients, while being comparable with previous
intra-operative measurements [Reutlinger, 2012]
Several techniques are used clinically to evaluate

spinal flexibility such as side bending or fulcrum
bending. All these methods use medical imagery
to compare the shape of the spine before and
after loading, but none report the amount of forces
used to provoke the observed motion. Therefore,
only reducibility (change of spine shape) can be
determined and not the flexibility of the spine,
which could explain the large variability in surgical
planning proposed by several experts for the same
patients [Robitaille, 2007].
Method
For these reasons, an alternative pre-operative
test has been developed, which combines an
axial suspension of the patient with inverse finite
element calculations [Bchler, 2014]. The Spinal
Suspension Test is based on the application of an
axial traction force on the patients spines using
a commercial head halter. The three-dimensional
displacement of the vertebras is assessed with
calibrated orthogonal radiographic images.
The spinal shape is measured before and after
application of a load corresponding to 30% of the
patients body weight. A numerical model of the
spine is proposed to quantify the patient-specific
mechanical properties. The model consists of
rotational springs to model the flexible components
of the spine. Three linear spring were used for each
Discussion
Since the spinal shape and mechanical properties
showed important variation across patients, this
quantitative information provided by the proposed
pre-operative test is critical for the development
of planning solutions that consider patient-specific
biomechanics. Such tools will become increasingly
important in the future due to the ever-increasing
complexity of the surgical instrumentation and
procedures and to provide a better understanding of
the complex biomechanical properties of the spine.
References
Bchler et al, Eur Spine J, 2014
Reutlinger et al, Eur Spine J, 21:8607, 2012
Robitaille et al, Eur Spine J, 16:160414, 2007
226
O 19 1
ANTERIOR OFFSET OF COMPRESSIVE LOAD

SIGNIFICANTLY AFFECTS INTERVERTEBRAL DISC
AND IMPLANT LOADS IN THE LUMBAR SPINE:
A FINITE ELEMENT ANALYSIS
L. Venancio P C Lima1, P. Rouch1, W. Skalli1
1
Arts et Metiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak,

Paris, France
Introduction
Although posterior pedicle screw implant systems are
widely used in the lumbar spine in order to achieve
fusion, clinical outcomes are variable, with possible
related drawbacks such as implant failures including
screw breakage, screw loosening or Adjacent
Segment Degeneration (ASD). Clinical studies often
report a relationship between postural disorders and
clinical outcomes, which may be due to an alteration
in the applied loads (Kumar et al., 2001).
different ligaments from the spine. Non linearities

related to large displacements, contacts and
material properties were taken into account.
Posterior implants consisted of 3 pairs of pedicle
screws inserted in L4, L5 and S1, linked by two
longitudinal rods. These were modeled by
beam elements. S1 was rigidly fixed and a 400N
compression load was applied to L1 with three
different anterior offsets values relative to the
center of the superior endplate\string: 0 mm
(no offset Case I), 57 mm (moderate offset Case II),
and 114 mm (large offset Case III). Screw and
intervertebral disc loadings were computed.
Erect posture represents a complex mechanical

structure: the lever arm of weight forces in relation
to the articular center of rotation creates a bending
moment at each vertebral segment. To keep both
static and dynamic balance, muscles apply passive
and active forces. Moreover, subject specific spinal
alignment as different upper spinal kyphosis may
influence spinal loads. Because of the large number
of related parameters, muscular modeling can be
complex however modeling the effect of a deviated
compression load can bring better understanding
between spinal loads and alignment. The aim of this
study is to investigate the effect of deviated loads
using a finite element model.
Results
The highest screw loads were found in S1. The magnitudes of these loads were correlated to the level
arm effect.
Table 1 presents screws bending moment and
maximum shear forces. Disc annular fiber forces
increased 4 times from Case I to Case II. For those forces,
further increases in loads from the Case II (57 mm)
to the Case III (114 mm) were between 2036%.
Max Moment de Flexion (Nm)
Offset
Case I (0 mm)
Case II (57 mm)
Case III (114

mm)
L4
1.2
3.2
3.9
L5
0.5
2.0
2.7
S1
0.6
7.0
8.7
Max Shear Force (N)

Offset
Case I (0 mm)
Case II (57 mm)
Case III (114

mm)
L4
88
255
294
L5
40
166
228
S1
90
701
876
Discussion
Sagittal load offset appears to be an important
factor affecting loads on screws and adjacent discs.
This could explain why restoring spinal alignment
seems important for good clinical outcome. Further
exploration using muscular models should yield
progress in understanding the relationship between
postural troubles and clinical outcome.
Methods
A FE model of a L1-S1 lumbar spine was used. This
model was validated against in-vitro data from L1 to
S1 levels. Hexahedral elements modeled vertebrae
and intervertebral discs. Two node tension-only link
elements were used to model annulus fibers and
References
Kumar et al., Eur Spine J, 2001
227
O 19 2
VERTEBRAL STRENGTH PREDICTION UNDER ANTERIOR

COMPRESSIVE FORCE USING A FINITE ELEMENT MODEL
J. Choisne1, J.M. Valiadis1, C. Travert1, P. Rouch1, W. Skalli1
1

Paris, France
Results
Experimental strength was 3145 N 1573 and
models strength was 3074 N 1423. Vertebral
strength determined by the FE model was strongly
correlated to the experimental vertebral strength
(R=0.95, p < 0.0001, Figure 1). Mean difference
in vertebral strength was 71 N 346 [min = 423;
max = 758] with a RMSE of 11% (347 N) and a SEE of
11.9% (374N). Experimental and models stiffness
were highly correlated (R=0.85, p<0.0001) as well
as experimental strength and stiffness (R=0.85,
p<0.0001). The FE models strength and stiffness
were strongly correlated (R=0.94, p<0.0001).
Introduction
Patient-specific finite element (FE) models derived
from quantitative computed tomography (QCT)
scans are used to predict failure strength of
vertebral bodies [Crawford, 2003; Buckley, 2007;
Imai, 2006]. Most of these models were validated
under axial compressive forces to the vertebral
body while vertebral fractures are more associated
with eccentric compression [Granhed, 1989]. The
purpose of this study is to validate a FE model
for vertebral strength prediction under anterior
compressive force with experimental data.
Methods
11 lumbar spines (5M and 6F aged: 82 yo 7) were
scanned on a QCT machine (Scanner ICT 256, Philips
Healthcare, Cleveland, OH, 120 Kv, 1489mA/s and
a slice thickness of 0.33 mm) along with the ESP
calibration phantom. The 28 vertebrae (L1L3)
were then cleaned from all soft tissue and the
posterior elements were transected. The vertebral
bodies were potted in PMMA for parallelism before
anterior compressive tests were conducted using a
spherical seating loading platen (Instron Ltd., High
Wycombe, UK) with the centre of rotation aligned
with the anterior third of the vertebral body.
Specimens were destructively tested in compression
at 1 mm/min. Vertebral strength was defined as
the ultimate load achieved and axial stiffness was
calculated as the slope of the force-displacement
curve. A FE model was built based on the QCT
images using a hexahedral mesh generated with
a custom-built algorithm (190306 nodes). Material
properties for each element were assigned using
density-modulus relationship [Kopperdahl, 2002].
PMMA was modelled (E = 2.5 GPa, ? = 0.3) with
the lower layer constrained and the upper layer
used to apply an anterior compressive force at the
anterior third of the vertebra. Vertebral strength
was defined when 1 mm 3 of elements reached
1.5% deformation [Sapin, 2012].
Discussion
With a strong correlation of 0.98, the FE model can
predict vertebral strength in anterior compressive
force. The next step would be to validate this
model in vivo.
References
Crawford et al, Bone, 33:744750, 2003.
Buckley et al, Bone, 40:767774, 2007.
Granhed et al, Acta Ortho., 60:10509, 1989
Imai et al, Spine, 31: 17891794, 2006
Kopperdahl et al., J. of Ortho. Res.,
20:801805, 2002
Sapin et al, Spine, 37:E156E162, 2012
Ack n o wl e d g e m e n t :
The authors are greatful to the Banque Public
dInvestissement for financial support through the
dexEOS project part of the FUI14 program
Figure 1: F E and experimental vertebral strength are strongly

correlated
228
O 19 3
STRAIN UNCERTAINTIES IN DIGITAL VOLUME

CORRELATION OF NATURAL
AND AUGMENTED VERTEBRAE
G. Tozzi1, V. Danesi2, M. Palanca2, R. Soffiatti3 , E. DallAra4 ,
M. Viceconti4 , L. Cristofolini2
1

2
University of Bologna, Industrial Engineering, Bologna, Italy

3
Tecres Spa, R&D, Verona, Italy
University of Sheffield, Mechanical Engineering, Sheffield, United Kingdom
Introduction
Digital
volume
correlation
(DVC)
recently
emerged as a powerful tool to investigate the
internal strain distribution in biological structures,
including vertebral bodies [Hussein et al., 2012].
However, the reliability of DVC strongly depends
on many factors such as computation strategy,
image quality, tissue microstructure (i.e. cortical vs
trabecular) and imaging settings [Palanca et al.,
submitted]. Furthermore, injectable biomaterials,
used in vertebral augmentation, could introduce
an additional source of strain uncertainties in the
DVC computation. The main aim of this study was to
evaluate the accuracy and precision errors when
computing strains in the trabecular/cortical bone
and in the injected cement for the augmented
vertebra.
Results
The preliminary accuracy and precision errors
calculated for the selected volumes of interest are
reported in Fig. 1.
Discussion
Preliminary results seem to indicate how in
absence of rigid registration and background
masking, the overall strain error produced is high
and unacceptable for many biomechanical
applications. In addition, most of the uncertainty
is localised in the trabecular-cortical transition.
Conversely, the fully augmented region had the
best accuracy and precision. Future work includes:
Optimization of the registration procedure by
including pre-elastic registration and masking of
the images between repeated scans.
Implementation of a different global DVC
approach (ShIRT) on the same images.
Evaluation of possible preferential direction in
the strain components.
Methods
Six single thoracic porcine vertebrae (T1, T2, T3 and T4)
were divided in two groups:
Prophylactic augmentation with Mendec (Tecres, IT)
was performed on 3 vertebrae.
T he remaining 3 specimens acted as untreated
control.
The authors would like to thank the European Society
of Biomechanics (ESB mobility award 2014) and the
Royal Society (RG130831).
For each specimen, repeated microCT imaging

was carried out (voxel size: 3339 micrometers)
in the unloaded state. Preliminary DVC analysis
(LaVision, UK) of one augmented vertebra was
performed on the two reconstructed volumes
obtained from the repeated scans, without
any rigid registration or masking of the images.
A central slice (887639481 voxels) was cropped
from the two scans. Moreover, to evaluate
the specific effect of materials and structures
on the strain uncertainty, four parallelepipeds
(150150310 voxels) containing regions with
only augmentation material (Cem), cement-bone
interface (Cem-Trab), only trabecular bone (Trab)
and trabecular-cortical combination (Trab-Cort),
were isolated from the slices. DVC computation
relied on iterative adjustment of the sub-volume
size: the final sub-volume size of 323232 voxels
overlapped by 75% was reached after successive
(predictor) passes using sub-volumes of 888888
voxels, 767676 voxels and 404040 voxels.
Strain accuracy and precision were evaluated
following [Liu & Morgan, 2007].
References
Hussein et al, Proc IUTAM 4: 11625.
Liu & Morgan, J Biomech 40: 351620.
Palanca et al, J Biomech Eng, submitted.
Figure 1: A
ccuracy and precision errors in the different
zones of the central slice isolated from
the augmented specimen.
229
O 19 4
COMPARISON OF THREE DIFFERENT DIGITAL VOLUME

CORRELATION APPROACHES ON BONE
M. Palanca1, G. Tozzi2, L. Cristofolini1, M. Viceconti3 , E. DallAra3
University of Bologna, School of Engineering and Architecture, Bologna, Italy
University of Sheffield, INSIGNEO institute for in silico medicine, Sheffield, United Kingdom
Introduction
An intrinsic difficulty in validating digital volume
correlation (DVC) is that no other experimental
technique allows measuring the internal strain
distribution. The aim of this study was to compare the
accuracy and precision of three DVC approaches.
Two local and one global algorithms were tested,
using trabecular and cortical specimens in a 3D
zero-strain condition.
C o n cl u s i o n
This work highlighted the importance of a quantitative and qualitative analysis of different DVC
approaches by using the same set of images.
The outputs demonstrated than the integration
between the DVC and a FE code provides the
lowest accurate and precise errors. However,
the local approaches, as a single software package, show reasonable results for large sub-volumes.

Two specimens (trabecular and cortical) were
extracted from a bovine femur. They were scanned
twice with a micro-CT (voxel size 9.96 micrometers)
[DallAra, 2014] in a zero-strain-condition, in which
small unknown displacement are present.
References
B
arber et al, Med Image Anal 11(6): 648662
D
allAra et al, J Biomech 47(12): 29562963
L iu et al, J Biomech 40(15): 35163520
P
alanca et al, J Biomech Eng In press
R
oberts et al, J Biomech 47(5): 923934.
Three DVC strategies were tested:

L ocal approach, based on Fast-Fourier-Transform
(DaVis-FFT, LaVision, Goettingen, Germany)
L ocal approach, based on Direct-Correlation
(DaVis-DC),
Global approach based on elastic registration
and
a
finite
element
solver
(ShIRT-FE,
home-written [Barber, 2007])
A range of different computation sub-volumes (or
element sizes), from 5 to 50 voxels, was tested. The
accuracy and precision errors for the strains were
computed as scalars [Liu, 2007], and for each
component of strain, in order to identify possible
preferential directions [Palanca, 2015]
Figure1: Trend of the accuracy of the DVC-computed

strain (expressed as a scalar average of the components)
for trabecular bone, as a function of the sub-volume size
Results
The accuracy and precision in computing strain was
consistently better for trabecular bone. For each
algorithm, the errors decreased asymptotically
for larger sub-volumes (Fig. 1). The accuracy error
obtained with ShIRT-FE was approximately half of
the DaVis-DC. In terms of precision, the errors shown
by DaVis-DC were closer to the ones computed by
ShIRT-FE. DaVis-FFT had the worst accuracy and
precision.
No systematic difference was observed between the
errors for the different strain components (Fig. 2).
Figure2: Accuracy of the six components of strain in the
cortical and trabecular bone, for the largest sub-volume
size considered.
230
O 19 5
NOVEL INSIGHTS INTO POROSITY BONE SPECIFIC

SURFACE RELATION IN HUMAN CORTICAL BONE
C. Lerebours1, D. Thomas2, J. Clement2, P. Buenzli1, P. Pivonka3
1
Monash University, School of Mathematical Sciences, Melbourne, Australia

2
University of Melbourne, Melbourne Dental School, Melbourne, Australia
University of Melbourne, Australian Institute of Musculoskeletal Science, Melbourne, Australia
Introduction
A characteristic relationship for bone between
bone volume fraction (BV/TV) and specific surface
(BS/TV) has previously been proposed based on 2D
histological measurements [Martin, 1984][Fyhrie et
al., 1995]. This relationship has been suggested to
be bone intrinsic, i.e., to not depend on bone type,
bone site and health state. In these studies, only
limited data comes from cortical bone. The aim
of this paper was to investigate the relationship
between BV/TV and BS/TV in human cortical bone
using high-resolution micro-CT imaging and the
correlations with subject-specific biometric data
such as height, weight, age and sex. Images from
femoral cortical bone samples of the Melbourne
Femur Collection were obtained using synchrotron
radiation micro-CT (SPring8, Japan). Sixteen bone
samples from thirteen individuals were analysed in
order to find bone volume fraction values ranging
from 0.20 to 1. Finally, morphological models of
the tissue microstructure were developed to help
explain the relationship between BV/TV and BS/TV
[Lerebours et al., 2015].
measured. Based on information on pore density,

sex, age at death, body height and body weight,
we studied the patient-specificity of the maximum
of the curve and the initial slope with respect of
these factors. Body height, body weight and age
at death were not correlated (p > 0.05). But pore
density and sex seem to be correlated with the
position of the curve. The upper curves in Fig.1(b)
come from males while the lower curves are from
females. The statistical correlation of this trend is
only such as: p = 0.041. Pore density was extracted
from the microCT images and put into relation
with the computed pore density. The correlation
between these values was p = 0.038.
Methods
The study samples consisted of 16 blocks of femoral
mid-shaft specimens from the right legs of 13
individuals ranging in age from 45 to 84 years old.
Individuals were considered healthy at the time of
their death, no pathology was revealed in blood
tests. This material came from the Melbourne Femur
Collection (MFC, acquired from the Victorian
Institute of Forensic Medicine with informed
consent of the next-of-kin of the donors). Blocks of
bone approximately 16 mm long axially were cut
from the anterior and posterior quadrants of each
specimen and were imaged using synchrotron
radiation micro-CT at beamline 20B2 of the SPring8
synchrotron, Hyogo Prefecture, Japan (Fig. 1(a)).
Figure 1: ( a) SR-microCT image of cortical bone specimen

and (b) BV/TV vs BS/TV relation.
Discussion
Our experimental findings indicate that the BV/TV
vs BS/TV relationship is subject specific. Sex and
pore density were statistically correlated with
the individual curves. However, no correlation
was found with body height, weight or age.
Experimental cortical data points deviate from
interpolating curves previously proposed in the
literature. However, these curves are largely based
on data points from trabecular bone samples. This
finding challenges the universality of the curve:
highly porous cortical bone is significantly different
to trabecular bone of the same porosity. Finally,
our morphological models suggest that changes in
BV/TV within the same sample can be explained by
an increase in pore area rather than in pore density.
This is consistent with the proposed mechanisms
of age-related endocortical bone loss.
Results
In Fig. 1(b), data points of different individuals have
been interpolated separately (using the same
interpolation function). The goodness of the fit is
r2 = 0.84, when interpolating the entire data set by
this root function. When interpolating data points
from each individual high coefficients of variations
are obtained (0.87 r 0.98) (Fig. 1(b)). The shape
of the interpolation function decreases rapidly
for high bone volume fractions, BV/TV > 0.85.
For lower bone volume fractions the bone
specific surface gradually increases while BV/TV
decreases. Only few experimental data points
below bone volume factions of 0.40 could be
References
Martin, Crit Rev Biomed Eng, 10:179222, 1984.
Fyhrie et al., Bone, 17:287291, 1995.
Lerebours et al., Bone, 72:109117, 2015.
231
O 19 6
FIRST 3D IMAGING OF OSTEOCYTES USING SERIAL

BLOCK-FACE SCANNING ELECTRON MICROSCOPY
P. Goggin1, K. Zygalakis2, R.O.C. Oreffo3 , P. Schneider1
1
University of Southampton, Bioengineering Science Research Group / Faculty of Engineering

and the Environment, Southampton, United Kingdom
University of Southampton, Mathematical Sciences / Faculty of Social and Human Sciences,

3
University of Southampton, Institute for Developmental Sciences / Faculty of Medicine,

Results
Figure 1 shows a single slice from an SBF SEM stack
and 3D ON&LCN reconstructions.
Introduction
Osteocytes, the most abundant bone cells, are embedded within hard bone matrix. By sensing and integrating local mechanical and chemical signals, they
play a key role for bone homeostasis by regulating
bone modeling and remodeling1. Abnormalities of the
osteocyte network and the encasing lacuno-canalicular network (ON&LCN) have been associated with
metabolic bone diseases such as osteoporosis2,3. However, there remains significant controversy as to how
mechanical loading is actually transferred to osteocytes. Thus, to characterise the ON&LCN in health and
disease and to better understand osteocyte function
through in silico modelling of bone mechanotransduction, high-resolution 3D imaging techniques for bone
at a cellular level and below are urgently needed.
However, high-resolution 3D examination of the
ON&LCN is still in its infancy4. Serial block-face scanning electron microscopy (SBF SEM) offers a promising 3D imaging approach on a sub-cellular level
since initial work in the neuroscience field a decade
ago 5. Using a remotely controlled ultramicrotome
within an SEM, nanoscopic layers are removed from
the tissue block, which is consecutively assessed by
a back-scattered electron detector to extract neuron morphologies from 3D SBF SEM stacks with resolutions comparable to transmission EM 6. SBFSEM can
cover large fields of view (~1 mm2) and in principle,
provides imaging contrast for soft and hard tissues at
the same time, such as the ON and the LCN, respectively. Therefore, this study was to adapt and extend
SBF SEM to assess the ON&LCN.
Figure 1: ( Left) A slice from a SBF SEM stack showing an osteocyte including nucleus, mitochondria and cell
processes, surrounded by pericellular space and
decalcified bone matrix (scale bar = 2m). The
Inset shows a cell process (yellow) and the pericellular space (green). (Right) Osteocyte derived
from 250 SBF SEM sections.
Discussion
We have demonstrated for the first time that SBF
SEM can produce high-resolution 3D images of the
osteocyte and the lacuno-canalicular network.
SBF SEM offers automation of sectioning and image
collection, while complex sample preparation
has to be noted, along with the destructive
nature of this emerging imaging method.
Importantly, SBF SEM allows for simultaneous
3D assessment of the ON (soft tissue) and the
LCN (hard tissue), not achieved with other
microscopy techniques to date. SBF SEM will
enable the assessment of hallmarks of healthy
and diseased bone in a quantitative fashion on
a cellular and sub-cellular level. ON&LCN models
based on experimental 3D data will allow more
realistic computational models in the field of
mechanobiology. These data will enhance the
knowledge of osteocyte involvement in bone
health, development and pathology, leading to
the identification of new targets for the diagnosis
and treatment of bone diseases.
Methods
A 2mm3 block from a tibia of a 10-week-old C57BL/6
mouse tibia was fixed, decalcified and prepared for
SBF SEM using a modified Ellisman protocol 7 which
permeates the tissue with heavy metals, providing
electrical conductivity and image contrast. The
tissue block was mounted on an aluminium pin
and a 500 m-thick section was cut and stained
with toluidine blue. An approximate area of
interest of 100 m 2 was chosen, which contained
several osteocytes. The block was retrimmed to
remove excess tissue and the surface sputtercoated with a layer of Au/Pd to further enhance
conductivity. The 3View system of Gatan Inc.
(Pleasanton, USA) within an FEI Quanta 250 FEG-SEM
was used to produce a stack of 600 images
at 2.5 kV, spot size 3, slice thickness 50nm and
vacuum 40Pa. A median filter was applied to
reduce noise and Reconstruct 8 was employed to
trace the surfaces of the ON&LCN by hand.
References
1 Schaffler et al., Calc Tiss Int 94(1):524,2014
2 Tatsumi et al, Cell Metab 5(6):46475,2007
3 Neve et al, Acta Physiologica 204(3):31730,2012
4 Webster et al, Bone 54(2):28595,2013
5 Denk et al, Nat Rev Neurosci13(5):3518,2012
6 Denk et al, PLoS Biol 2(11):e329,2004.
7 Deerinck et al., Microsc Microanal 16(S2):
11389,2010
8 Fiala JC, J Microsc 218(1):5261,2005
232
O 19 7
INCLUDING ANISOTROPIC INFORMATION OF

TRABECULAR BONE USING IMAGE REGISTRATION
E. Taghizadeh1, A. Latypova2, G. Maquer1, M. Reyes1, P. Bchler1
1
Institute for Surgical Technology and Biomechanics, University of Bern, Bern, Switzerland
2
Biomechanical Orthopedics Laboratory, cole polytechnique fdrale de Lausanne,

Introduction
Image-based modelling is a popular approach to
perform patient-specific biomechanical simulations.
Accurate modelling is critical for orthopaedic
application to evaluate implant design and
surgical planning. It has been shown that the bone
strength can be estimated from the Bone Mineral
Density (BMD) and the structure of the trabecular
bone. However, these findings cannot directly be
transferred to patient-specific modelling since only
BMD values can be derived from calibrated clinical
CT, but no information about the trabecular bone
structure is accessible by the clinician.
Results
We propose to test the method on two different
bone anatomies, patella and femur. CT and CT
of 10 patellae and 10 femurs from different donors
were acquired. From each database one bone
was chosen as a reference and the other bones
were defined as test samples.
The registration accuracy was high and the
morphed image provided a good approximation of
the trabecular bone structure in the patients bone
(Fig. 1). Our method predicted the displacement
and force values at failure with 2.7% and 3.8% error
respectively, while predictions obtained with an
isotropic material results in error of 7.4% and 6.5%.
The objective of this study is to propose a method

that predicts the structure of the patients
trabecular bone using a template CT image and
image registration.
Method
Our proposed approach consists of morphing the
bone architecture extracted from the CT of a
cadaveric patella to the patients clinical CT. As
CT scans can be very large, applying the nonrigid image registration is extremely demanding in
terms of computational resources and is practically
intractable. Instead of using the original CT images,
we down-sampled the CT of the template patella
and then registered the new image to the clinical
image. The registration was performed in three steps.
First, a coarse rigid registration was applied, then an
iterative affine registration with Normalized Mutual
Information metric, was performed and finally a
non-rigid registration using a Bspline registration
(elastix; Klein, 2010) was applied to the images. In
the next step, the resulting deformation fields were
applied to the original high-resolution CT image.
The anisotropic information was then extracted
from this high-resolution registered image.
Figure 1: T ypical result of the image registration. The ground

truth CT scan and the registered image are
overlapped.
Discussion
The results showed that our method improves the
bone strength calculated with FE compared to
an isotropic material model. It is possible to adapt
this method to use several bones as reference, for
instance using one reference for male and one for
female bone, which can improve the prediction
results. Exploring the impact of the selection of the
reference bone is part of our future research.
We evaluated the mechanical outcome of the

proposed method by comparing the finite element
(FE) strength calculated for bones, where the
material properties were assigned to the mesh i) using
anisotropic material from the original CT (groundtruth) ii) anisotropic properties from the registered
image and iii) using an isotropic material model.
Physiological loads were applied to these models.
Bone strength as well as failure were evaluated.
References
S. Klein, M. Staring, K. Murphy, M. Viergever, and
J. P. W. Pluim, Elastix: A toolbox for intensity-based
medical image registration, Medical Imaging,
IEEE Transactions on, 29:1, 2010.
233
O 19 8
IMPROVEMENT OF BITING FORCES WITH IMPLANTSUPPORTED OVERDENTURES FOR THE LOWER JAW:
NUMERICAL AND CLINICAL STUDIES
I. Hasan1, L. Keilig1, F. Heinemann2, H. Stark3 , C. Bourauel4
1
University of Bonn, Oral Technology Department of Prosthetic Dentistry, Preclinical

Education and Materials Science, Bonn, Germany
University of Greifswald, Department of Prosthodontics, Gerodontology and Biomaterials,

Greifswald, Germany
University of Bonn, Department of Prosthetic Dentistry, Preclinical Education and Materials

Science, Bonn, Germany
4
University of Bonn, Oral Technology, Bonn, Germany
Introduction
Treatment of edentulous patients with implant-supported removable dentures has the advantage
of improving the stability of dentures and the
adaptation of the patient to the new conditions in
the oral cavity. The improvement of biting forces is
obvious shortly after the treatment. However, the
difference in the improvement degree between the
different kinds of supporting implants is still unclear.
Hence, it was the aim of this study to analyse the
diversity in the improvement of the biting forces
for nine patients who received lower overdentures
supported by two to four conventional dental
implants ( 3.33.7 mm) and fourteen patients who
received four to five mini-implants ( 2.12.4 mm)
in the interforaminal region.
created by means of Finite Element Method (Marc

Mentat 2010, MSC.Software, Santa Ana, CA-USA)
based on Computed Tomography data. The
magnitudes of the measured biting forces were
applied in the numerical models vertically on the
denture. Denture displacements and stresses in the
bone bed around the implants were analysed and
compared for the different models.
RESU L TS
The total forces for patients who received two or
four conventional implants increased from 233 N
and 393 N to 611 N and 565, respectively. While
for patients who received four to five mini-implants
the increase ranged from 222 N and 269 N to 316 N
and 442, respectively. For all patients, the largest
part of the force prior to insertion of implants was
concentrated at the molar region and after the
insertion of implants the concentration of forces
was at the anterior region (interforaminal region).
METHODS
Biting forces were measured for 23 patients with
the existing complete denture prior to the insertion
of implants and after receiving the final implantsupported denture using special pressure sheets
(Two-sheet Low Type Prescale Measurement
Film, Fujifilm). The measuring time was 2 min. The
measured sheets were later on analysed using
FPD-8010E Software to record the forces and
pressures at the different biting regions. Numerical
individual models of three patients (model 1: two
conventional implants, model 2: four conventional
implants, and model 3: five mini-implants) were
DIS C USSION
The use of implant-supported overdentures instead
of complete dentures improves the biting ability
of the patients and reduces the risk of progressive
resorption of the residual ridge at the posterior
region. However, the improvement of biting forces
with conventional implants remains more obvious
than with mini-implants.
234
O 19 9
DEVELOPMENT OF ORAL IMPLANT SURGERY TRAINING

SIMULATOR WITH DRILLING FORCE SENSING CAPABILITY
M.A.A. bin Kamisan1, N. Takano2, Y. Yajima3 , A. Shinichi4
1
Keio University, Graduate School of Science and Technology, Yokohama, Japan

2
Keio University, Department of Mechanical Engineering, Yokohama, Japan

3
Tokyo Dental College, Department of Oral Implantology, Tokyo, Japan

4
Tokyo Dental College, Department of Anatomy, Tokyo, Japan
Introduction
To decrease the medical accidental cases in oral
implant surgery, which are increasing recently in
Japan, a new educational system focusing on
drilling mandibular trabecular bone has been
developed mainly for dental college students. It
consists of force sensing device and drilling force
database that is calculated by finite element
analysis. This paper presents the developed oral
implant surgery training simulator, numerical
method and the results of evaluation by clinicians
with comparison with the results of drilling polymeric
models.
Methods
The main feature of the developed system is that
the users can experience the force sense during
drilling jawbone using real handpiece as shown
in Fig. 1. The force sensing device consists of an
actuator and load cell, and the drilling speed
is controlled by the drilling force database
[N. Takano, 2014]. The drilling force was calculated
by micro-CT image-based 3D finite element
method using cadaver in order to consider
the bone quality of trabecular bone, and was
calibrated by measurement using fresh cadaver
[M. Nagahata et al, 2013].
Figure 1: O
verview of the developed oral implant surgery
training simulator.

8 clinicians at Tokyo Dental College tested the
developed system for 3 samples. All clinicians
could identify the differences among 3 samples,
and gave positive evaluation telling that the
system was realistic and close to real surgery. An
expert clinician could recognize the slight change
of required force clearly by 1N. By comparing
the impressions between young clinician and
expert one after testing the same sample, clear
difference was found. More quantitatively, the
relation between the drilling speed and input force
was obtained as shown in Fig. 2. The required force
shown is the force calculated and implemented
as the drilling force database. The input force of
8 clinicians ranged from 3N to 9N in the trabecular
bone region and the drilling speed ranged from 0.3
mm/s to 0.9 mm/s. By comparing this speed with
that measured for polymeric jawbone models, it
was found that the polymeric models were much
softer than real jawbone in the trabecular bone
region especially near the mandibular canal.
Figure 2: E
xample of measured input force and drilling
speed by an expert clinician for sample 1
References
M. Nagahata et al, Asia Pacific Cong on Comp
Mechanics (APCOM), 2013.
N. Takano, J Jpn Soc of Oral Implantology,
27:104, 2014.
235
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NUMERICAL ANALYSIS OF THE BIOMECHANICAL

PROPERTIES OF DIFFERENT PROSTHODONTIC
RESTORATIONS
L. Keilig1, S.M. Schneider1, I. Hasan1, C. Bourauel1
1
University of Bonn, Oral Technology, Bonn, Germany
Introduction
There is a large number of different anchorage
concepts available to connect a removable
partial dental denture to the remaining teeth. These
concepts differ in the required preparation of the
anchorage tooth as well as in the biomechanical
load transfer between the prosthesis and the
remaining teeth under functional load. It was the
aim of this study to characterise the biomechanical
characteristics of three different anchorage
concepts for removable partial dentures in the
lower jaw using the finite elements method (FEM).
stresses and strains were compared between the

different attachment systems. The simulations
were performed using the FE package MSC.Marc/
Mentat 2010.
RESU L TS
Depending on the simulated attachment concept,
the dentures showed clearly different loading
behaviour. Upon loading the denture near teh
anchoring canine, the movability of the denture
were clearly reduced for the extra-coronal
attachment (attachment: 0.31 mm, telescopic
crown; 0.39 mm, clasp: 0.4 mm), however this also
resulted in increased strains in the periodontal
ligament of the anchorage teeth as well as stresses
in the alveolar bone around the anchorage
teeth. Highest denture movements of 0.7 mm
were determined for the clasp-anchored denture.
This resulted in strains of up to 60% in the mucosa
underneath the prosthesis. In some simulations,
loading the posterior part of the prosthesis only on
one side resulted in a dislocation of the prosthesis
base on the contra-lateral side.
MATERIA L S AND METHODS

Based on a commercially available dataset of
an idealised dental arch in the lower jaw (teeth
with roots and gum, Viewpoint Data Labs [now
Digimation]), a three-dimensional model of the
following clinical situation was created: only the
anterior teeth from the left canine to the right first
premolar remained, and a marginal bone atrophy
was modelled in the posterior, now tooth-less
regions left and right. Periodontal ligament with
an assumed constant thickness of 0.2 mm was
modelled around the remaining teeth, and the
bone was covered with mucosa with a thickness of
1.0 to 2.4 mm [Schrder, 1992]. In the molar region
of this model, a denture with a sublingual arch was
modelled to replace the missing teeth. A perfect fit
between the base of the dentures and the mucosa
was assumed.
DIS C USSION
A distinct mechanical behaviour for each of the
investigated anchorage concepts was determined.
Generally, the movability of the dentures increased
from the attachment to the telescopic crown
and to the clasp. With this increased movability,
loading of the periodontal ligament and the bone
surrounding anchorage teeth decreased. This
might be of importance if the anchorage teeth
suffer from periodontal diseases or in case of a
misfit of the denture due to ongoing bone atrophy
in the mandibular bone below the prosthesis.
For each of the following anchorage systems

a separate FE model was generated: clasp,
telescopic crown, extra-coronal attachment
system. All anchorage systems were connected to
the canine on the left side and the first premolar
on the right side. Forces of up to 500 N were
applied on different parts of the dentures and on
the anchorage teeth. The resulting movements,
RE F EREN C ES
Schrder, Orale Strukturbiologie [in German]. 4th
revised edition. Thime Verlag Stuttgart 1992.
236
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NUMERICAL ANALYSIS OF DENTAL IMPLANT

FATIGUE LIFE FOR VARIOUS LOAD CASES
K. Szajek1, M. Wierszycki1
1
Poznan University of Technology, Civil and Environmental Engineering, Poznan, Poland
Introduction
Dental implant designing is complex process which
considers many limitations both nature biological
and mechanical. The complete procedure for
improvement of two-component dental implant
along with a few optimal designs for various
objectives was proposed by Szajek [Szajek, 2012].
This paper deals with design verification for fatigue
life maximization in context of representative load
case assumed in the optimization. The main goal
is to answer the question if the assumed load
scenario (solely horizontal occlusal load) leads to
the design which is also safe for oblique occlussal
loads regardless the angle from an implant axis.
5e6 cycles for 60N of solely horizontal load. The

implant failure within presented unsafe zone
is clearly the result of screw bending, yet, the
previously describe stabilization due compressive
loading make the allowed transverse load higher.
Assuming load which is less than 20 degrees off the
implant axis there is no unsafe zone within the
analyzed design space while for 30 degrees still a
high magnitude of 135,5N is allowed.
a)
Methods
Series of numerical analysis (Finite Element Method)
was used with simple design of experiment scheme
and full factorial pattern. Two parameters are
introduces, vertical and horizontal load component
magnitudes.
Fully
spatial
model
including
asymmetry geometry, elastic-plastic material and
contact condition is considered. All analysis were
carried out using Abaqus suite (v6.13). The fatigue
life estimation utilizes stress based approach with
linear Goodman theory.
Results
The maximal Mises stresses and normalized effective
stress amplitude (according to Goodman theory)
were registered for all load cases. The results were
visualized in form of contour plots presenting
cycles to fatigue failure in dependence to occlusal
load magnitude/angle (Figure 1). The limit of
5e6 cycles suggested by standard ISO 14801:2007
is indicated with thick isoline. The dashed trapeze
represents areas of physiologically justified loads
[Mericske-Stern et al., 2000, Morneburg et al., 2003].
b)
Discussion
Considering the screw in the initial design, a
safe value of transverse load can be estimated
at the level of 18N. Figure 1a presents an effect
of abutment stabilization when the vertical
load component is present. An allowed value of
transverse load exceeds 30N if it acts together with
a vertical load of 100N. The safe limit is almost
horizontal for higher value of vertical load. It is a
result of small stiffness of implant in axial direction
[Alkon et al., 2002] and, in turn, screw preload
reduction in response to compressive load. It is
important to note that the implant is entirely in
safe zone for the load which is in coincident with
an implant axis or is maximally 5 degrees off it. In
the optimal design the screw is able to withstand
Figure 1: C
ontour plot of cycles to fatigue for an abutment
screw in dependence to load angle/magnitude
for initial (a) and optimal (b) design.
References
Szajek, Optimization of a two-component implantology system using genetic algorithm, PhD, 2012
Mericske-Stern et al, J Prosthet Dent,
84:53547, 2000.
Morneburg et al, Int J Prosthodont, 16:48186, 2003.
Alkon et al, Int J Prosthet Dent, 15:3842, 2002.
237
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QUANTITATIVE ANALYSIS OF TOOTH MOBILITY FOR

ASSESSMENT OF ORTHODONTIC TREATMENTS
V. Colombo1, F. Chakroun1, M. zcan1, L.M. Gallo1
1
University of Zurich, Dental School, Zurich, Switzerland
Introduction
Fixed lingual retainers are appliances extensively
used in orthodontic treatment for the prevention
of relapses when the inter-canine width has to be
maintained for long time. These appliances can be
fabricated from multi-stranded stainless steel (SS) wires
or fibre-reinforced composites (FRC) and commonly
bonded to all the six teeth forming the lower anterior
arch. The multi-stranded wires provide the advantage
of mechanical retention of the luting composite
material onto the wire and they are claimed to
allow physiological tooth movement. The fibrereinforced composite (FRC) retainers are bonded to
all the teeth in the bonding range providing a more
rigid support compared to stainless steel wires. Their
advantage is their relative thinner profile. The limits of
the biomechanical performances of these materials
have never been examined [Sam Foek, 2013].
Figure 1: S chematic of the modelled teeth arch positioned

in the loading device for testing.
Results
Measured teeth movement was complex and
included a translational and a rotational motion
component. In this study only translations were
quantified and they were linearly related with the
force applied (0.06 0.01 mm for each 5N step).
In this preliminary study we investigate teeth

mobility by means of a tracking system combined
with force measurement.
Methods
The digital models of six extracted human teeth,
obtained by 3D reconstruction of Digital Volume
Tomography (DVT) images, were manufactured
with 3D printing method and positioned as an arch
with constant curvature into a base holder with
fitting compartments replicating the natural tooth
mobility (Fig. 1).
Discussion
The promising results obtained in the observation
of the mobility of the teeth models showed margins
of application of the system in the comparison of
lingual retainers of different type and material. The
model is standardized, because it uses replicas
of the same anatomy, therefore can be used to
perform several trials to test the different retainers.
Furthermore, given that all the data are digitally
available, it can be used also for application of
finite elements analysis of the forces occurring in
the roots of the teeth during their motion.
The models were positioned in a custom made

loading device, and pressed with forces ranging
from 5 to 30 N to the lingual surface of the
tooth by means of a metal tip while the tooth
displacement was measured by motion tracking
system. The digital models of the teeth were
then animated with their specific movement
by using software developed in the Laboratory.
References
Sam Foek et al, Korean J Orthod. 43:18692 2013.
238
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INJURY OF BONE AND SOFT TISSUE IN UPPER

LIGAMENTOUS CERVICAL SPINE DUE TO FRONTAL
IMPACT LOADING: FINITE ELEMENT ANALYSIS
T. Mustafy1, K. Moglo2, S. Adeeb1, M. El-Rich1
1
2
University of Alberta, Civil and Environmental Engineering, Edmonton, Canada
The Royal Military College of Canada, Mechanical Engineering, Kingston, Canada
Introduction
Cervical spine is the main location of serious
injuries due to Motor Vehicle Crashes (MVCs). Injury
mechanisms of the cervical spine during front/
rear automotive collisions have been thoroughly
investigated using numerical models. However,
most of these models considered the bone rigid
and limited the injury study to soft tissue (ligaments,
disc) [Fice et al. 2011]. Recently, we have reported
that rapid extension movement initiates fracture
in the cancellous bone of C2 and C3 vertebrae
in the facet joints region in addition to the high
stress developed in the capsular and interspinous
ligaments [Mustafy et al. 2014]. An accurate
prediction of ligamentous spine injury necessitates
implementation of strain rate dependent material
properties that can assess bone and soft tissue
failure [El-Rich et al. 2009]. The current study used
a detailed 3D nonlinear finite element (FE) model
of ligamentous (devoid of muscles) occipito-C3
cervical spine (Fig. 1) to investigate injury
mechanism due to different frontal impact loading
conditions.
Results
The failure instant and location as well as the
spinal components for which failure occurred are
reported in figure 2.
Methods
The model consists of the skull, C1 to C3 vertebrae,
C2C3 intervertebral disc, and surrounding 2D
ligaments. Viscoelastic and elastoplastic material
laws with failure properties were used to model
soft tissue and bone respectively. The model was
subjected to 5G and 10G frontal acceleration after
applying gravity load to the skull. In addition, 6mm
posterior shear displacements at rate of 6m/s was
applied in two cases with sagittal rotation allowed
or restrained. The bottom of C3 was fixed at for all
analyses.
Figure 2: Injured structures with Failure instants and locations.
Discussion
Frontal impacts increased stresses significantly
producing failure in most components for all
loading scenarios. The cancellous and cortical
bones, apical, Alar and CL ligaments are the most
vulnerable structures to frontal impact. Failure of
these components occurred at different instants
and spinal locations depending on the impact
direction and rate. Restraining the rotations
resulted from shear impact accelerated the failure
occurrence. Injury of the ligamentous occipito-C3
cervical spine occurred at early stage of front
impact loading.
Resulted stress in the spinal components and

contact forces in the facet joints were determined.
Failure occurrence and initiation instants were
investigated.
References
Fice JB, et al, Ann Biomed Eng., 39: 21522162,
2011.
Mustafy T et al., J. Biomech., 47:28912903, 2014.
El-Rich M, et al., J. Biomech., 42: 12521262, 2009.
Figure 1: O
ccipito-C3 Ligamentous Cervical Spine model
(skull is not to real scale)
239
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IN VIVO MEASUREMENT OF SPINAL CORD DEFORMATION

DURING TRAUMATIC SPINAL CORD INJURY
IN A RODENT MODEL
T. Bhatnagar1, J. Liu1, A. Yung1, P. Cripton1, P. Kozlowski1, W. Tetzlaff1, T. Oxland1
1
University of British Columbia, International Collaboration On Repair Discoveries,

Vancouver, Canada
Introduction
During traumatic spinal cord injury (TSCI), the spinal
cord is subject to deformation. The deformation of
the spinal cord results in mechanical injury to the
neural tissues and physiological dysfunction of
the spinal cord. Studies have shown that different
injury mechanisms (i.e. contusion, dislocation, etc.)
result in different manifestations of damage in the
spinal cord [Choo, 2007]. However, the complex
relationship between deformation of the spinal
cord, trauma induced in the neural tissue and the
ensuing cascade of pathophysiological processes
following TSCI, is currently not well understood.
This limitation is due to the inability of current
experimental TSCI models to facilitate observation
of the internal tissue behaviour of the spinal cord
where mechanical damage occurs. Therefore,
this study aimed to report novel quantified internal
spinal cord deformations due to contusion and
dislocation injury mechanisms of TSCI.
Figure 1: T ransverse-plane images and strain fields for contusion and dislocation injury mechanisms of TSCI.
compressive and medio-lateral tensile strain at

the injury epicenter, whereas the dislocation
injuries produced a laterally-oriented band of
dorso-ventral tensile strain (Figure 1). The gray
matter of the spinal cord appeared to retain its
cross-sectional morphological appearance after
injury more than the white matter in both injuries,
indicating that the gray matter may be less
susceptible to deformation than the white matter
in the transverse-plane. Furthermore, the lateral
and ventral white matter consistently experienced
transverse-plane compression during contusion
injuries.
Methods
A novel apparatus [Bhatnagar, 2014] was used to
create either a contusion or dislocation cervical
TSCI, which was sustained for 30 minutes, in an in
vivo rat model (n=24; twelve in each mechanism
group), inside of a magnetic resonance scanner
(7T Bruker Biospec, Germany). Three-dimensional
image sets were acquired of the spinal cord in
the normal state and in the deformed state during
the imposed TSCI. A validated image registration
approach was then used to quantify the threedimensional internal spinal cord morphological
change using displacement fields. Transverseplane displacement fields were reported as well as
strain fields of spinal cords undergoing TSCI.
Discussion
This work quantifies distinctly different internal
spinal cord deformations due to two clinically
relevant TSCI mechanisms, emphasizing the need
to consider mechanism of TSCI when predicting
the biological response of the cord. The methods
presented in this study will facilitate further study of
the relationship between mechanical deformation
of the spinal cord tissues during TSCI and the
ensuing tissue damage. Experimental in vivo TSCI
has never before been visualized internally, and
the capabilities shown in this study open up new
avenues for TSCI research.
Results
The contusion and dislocation injury mechanisms
produced different patterns of spinal cord
displacements and strains. Contusion injuries
produced a region of high-magnitude dorsoventral
References
Bhatnagar et al, J Biomech Eng, 136(9), 2014.
Choo et al, J Neurosurg Spine, 6(3): 255-66, 2007.
240
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AN IN VITRO INVESTIGATION OF LONG TERM

DEGENERATIVE EFFECTS OF MECHANICAL TRAUMA
ON CENTRAL NERVOUS SYSTEM NEURONS
A. Sendemir Urkmez1, O.M. Duman2, C. Celik3 , E. Turunc Bayraktar4 ,
G. Armagan4 , A. Yalcin4
1
Ege University, Bioengineering Department Faculty of Engineering, Izmir, Turkey

2
University of Fribourg, Department of Biology, Fribourg, Switzerland
Ege University, Bioengineering Department Graduate School of Natural and Applied

Sciences, Izmir, Turkey
4
Ege University, Dept. of Biochemistry Faculty of Pharmacy, Izmir, Turkey
Introduction
Central nervous system damage has become one
of the important health problems in developed
countries because of the increasing life expectancy.
Effects of mechanical loading on development
of central nervous system (CNS) cells and neurite
extension have been recognized recently [Chetta
J, 2010]. Effects of loading are complicated since
until a threshold strain plays a positive role while after
the threshold value, it is degenerative. The situation
gets more complicated since CNS is made up of
several different cell types that respond to different
loads diversely. There are some mechanical trauma
models in the literature, but they usually employ hard
and two dimensional culture substrates, which fail to
mimic the natural niche of the cells [Hengst U, 2009].
This work illustrates long-term degenerative effects of
mechanical strain in vitro on CNS cells.
levels
were
measured
Intracellular
Ca 2+
spectrophotometrically. Total RNA was isolated,
quantitative PCR were carried out and relative
expressions of proapoptotic and antiapoptotic
genes were quantified with 2-CT method.
Proapoptotic
and
antiapoptotic
protein
expressions were resolved by SDS-PAGE.
Results
There was no significant effect of 10% strain on
cell viability and proliferation, while cell death
was visible after 25 and 50% strains. Although 10%
strain did not cause any acute effect, molecular
investigations on protein and gene level revealed
that even 10% strain showed neurodegenerative
effects, and triggered apoptotic pathways.
Methods
Scaffold production and cell seeding:
12% polycaprolactone (wt/v) was dissolved
in 1:1 mixture of dichloromethane (DCM) and
dimethylformamide (DMF), and electrospun as
nanofibrous scaffolds.
B35 CNS cell line was seeded onto the scaffolds
(5x103 cells/cm2) and cultured in standard culture
conditions.
Scaffold Strain Device:
The device consisted of a moving upper part and
stable base part. Nanofibrous tissue scaffolds were
fastened to the bottom of the upper cylinder and
fixed with the grooves, so that a uniform bi-axial
strain was applied on attached cells in a reservoir
under sterile conditions. The strain values on fibrous
scaffolds under various strains were modelled using
finite element analysis with Ansys R15.
Figure 2: P
roapoptotic and antiapoptotic protein expressions
Discussion
A powerful system was built to simulate traumatic
brain injury due to falls, traffic accidents and
battlefield explosions, etc. Results showed that even
when there are no acute visible effects, it is possible
to observe late degenerative consequences in
CNS after trauma, which can decrease the quality
of life. There is an urgent need for novel diagnostic
techniques to detect possible CNS damage after TBI.
References
Chetta J, et al, Cytoskeleton; 67(10): 650665, 2010.
Hengst U et al, Nature Cell Biology Aug;11(8):
1024U1263, 2009
Figure 1: D
ifferent stress values after (A) 10%, (B) 25%, (C) 50
% train application
Characterisation of cells after strain:

Cell viability was measured by MTT assay. Cell
morphology was examined by scanning electron
microscopy (SEM).
241
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WHY CAUSE LARGE CRITICAL SHOULDER ANGLES

ROTATOR CUFF TEARS AND SMALL ONE OSTEOARTHRITIS?
AN EXPERIMENTAL EXPLANATION
R.P. Kuster1, B. Moor2, S. Bouaicha3 , D. Baumgartner1
1
ZHAW Zurich University of Applied Sciences, Biomechanical Engineering Institute

of Mechanical Systems School of Engineering, Winterthur, Switzerland
Bern University Hospital, Department of Orthopaedic Surgery and Traumatology,

Bern, Switzerland
3
University Hospital Zurich, Department of Trauma Surgery, Zurich, Switzerland
Introduction
The critical shoulder angle (CSA: angle between
the superior and inferior bony glenoid margins and
the most inferolateral point of the acromion [Moor,
2013]) is a new clinical instrument combining the
acromion index and glenoid inclination in a single,
simple to measure radiological index. It has a
high potential to discriminate between shoulders
associated to rotator cuff tears (RCT, if CSA>35)
and osteoarthritis (OA, if CSA<30) or being
asymptomatic for CSA in between [Moor, 2013].
However, the biomechanical background has not
yet been understood.
Figure 1: M
ean muscle and joint reaction force (JRF), and
instability ratio (with 95% confidence interval)
during thoracohumeral abduction from 15 to 90.
Identical acromion glenoid combination is highlighted in yellow.
Methods
A shoulder-simulator [Baumgartner, 2014] was
used to analyse independent influence of glenoid
inclination and acromion lateralisation during
abduction from 15 to 90. Instead of a metal
dummy [Gerber, 2014], two fresh-frozen human
humeri with a size-matched glenoid were used and
DC motors were fixed to the anatomical entheses
of the cadaver specimens via cables. A six-degree
of freedom force transducer (Transmetra) was
mounted directly behind the polyethylene glenoid
implant (Mathys Medical) to measure joint reaction
force (JRF) and calculate instability ratio (IR: ratio
shear to compressive JRF).
Discussion
A higher CSA due to glenoid inclination increases
risk for RCT as shear JRF rises, while a lower CSA
due to acromion position increases risk for OA
as compressive JRF rises. However, results need
to be verified with additional shoulders in the
discriminatory CSA range (2540) and by clinical
observations to confirm varying impact of glenoid
inclination and acromion lateralisation on muscle
and joint reaction force.

Results for one shoulder in one acromion position
with variable glenoid inclination and vice-versa
are exemplary shown in figure 1. Tilting the glenoid
to cranial (increasing CSA) increases shear JRF and
therefore IR, while shifting the acromion laterally
(increasing CSA) decreases muscle forces and
compressive JRF with inconsistent influence on IR.
Similar results were found for all acromion-glenoid
combinations of both shoulders.
References
Baumgartner et al, Med Biol Eng Comput, 52(3):
293299, 2014.
Gerber et al, J Orthop Res, 32(7): 952957, 2013.
Moor et al, Bone Joint J, 95-B(7): 935941, 2013.
242
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MUSCULOSKELETAL MODEL OF THE 6 DEGREES

OF FREEDOM SHOULDER JOINT
C. Quental1, J. Folgado1, J. Ambrsio1, J. Monteiro2
1
2
IDMEC, Instituto Superior Tcnico, Mechanical Engineering, Lisboa, Portugal
Faculty of Medicine, University of Lisbon, Orthopedic Department, Lisboa, Portugal
Introduction
Complex musculoskeletal models of the upper
limb have been developed to study the shoulder
joint. The synovial, ball-and-socket shoulder joint is
typically modelled as an ideal spherical joint, with
no translational degrees of freedom (d.o.f.). Even
though such assumption is considered legitimate in
the literature, the small translations that occur at the
shoulder joint are nonetheless a key factor in the study
of its stability mechanisms. The aim of this study is to
develop a large-scale musculo-skeletal model of the
upper limb that simulates the 6 d.o.f. of the shoulder
joint and propose an inverse dynamics procedure to
estimate not only the muscle and joint reaction forces,
but also the translations at the shoulder joint.
Results
For the abduction motion analysed, the shoulder
joint was estimated to translate superiorly and
posteriorly until, approximately, 40 of humeral
elevation, and inferiorly and anteriorly afterwards.
Figure 1 presents the superior-inferior translation of
the joint.
Methods
The musculoskeletal model of the upper limb is
composed of 7 rigid bodies, constrained by 6 anatomical joints, and is acted upon by 21 muscles,
modelled by 63 muscle bundles [Quental et al.,
2012, 2015]. The contact at the shoulder joint is described by a mathematical model of a spherical
joint with a clearance, and the elastic force developed in the contact is modelled by the well-known
Hertz contact law. The muscle contraction dynamics is described by a Hill-type muscle model.
Figure 1: S houlder joint translation. For comparison purposes,

the joint translation is described with respect to the
position of the joint at 15 of humeral elevation.
The muscle and joint reaction forces obtained are

similar to those estimated for an ideal spherical
shoulder joint.
The optimization problem of the inverse dynamics

procedure is formulated considering not only the
joint reaction forces and muscle activations as
design variables, but also 3 translational coordinates
responsible for positioning the shoulder joint in
proper contact. The inverse dynamic analyses
are formulated as the minimization of the muscle
energy consumption, subjected to the boundary
constraints of the activations, to the equilibrium of
the equations of motion, and to the stability of the
shoulder and scapulothoracic joints [Quental et
al., 2012]. During the optimization procedure, the
translational coordinates change the generalized
vector of positions, but the change in the velocity
and acceleration vectors is not taken into account.
Accordingly, an iterative procedure is adopted to
overcome such shortcoming, i.e., after analysing
all motion, new velocity and acceleration vectors
are computed and the optimization procedure is
repeated until convergence is achieved.
Discussion
Considering the shoulder joint a spherical joint
with a clearance, and its translational d.o.f. as
design variables, the inverse dynamic model
developed is able to estimate not only the muscle
and joint reaction forces, but also the shoulder
joint translations. The shoulder joint translations
estimated are consistent with those reported in the
literature, as shown in Fig. 1.
References
Favre et al, J Biomech, 45:22482255, 2012.
Kelkar et al, J Shoulder Elb Surg, 10:7384, 2001.
Quental et al, Multibody Syst Dyn, 28:83108, 2012.
Quental et al, Comput Method Biomec,
18:749759, 2015.
In this study, an unloaded abduction motion in the

frontal plane is analysed.
243
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ACTIVE STABILITY OF GLENOHUMERAL JOINT DIMINISHES

DURING THE END-RANGE MOTIONS
E. Sarshari1, D. Ingram2, C. Engelhardt3 , A. Farron4 , D. Pioletti3 ,
A. Terrier3 , P. Mllhaupt1
1
Institute of Mechanical Engineering, EPFL, Lausanne, Switzerland

2
3
4
Automatic Control Laboratory, EPFL, Lausanne, Switzerland
Biomechanical Orthopedics Laboratory, EPFL, Lausanne, Switzerland
Department of Orthopedics and Traumatology, CHUV, Lausanne, Switzerland
Introduction
The lack of congruence between the involved
articular surfaces causes the inherent instability of
the joint. This joint is therefore the most commonly
dislocated joint in the human body.1 Anterior
instability accounts for over 90% of the shoulder
dislocations. 2 The reason of this almost unidirectional
dislocation remains unknown. Few studies have
quantitatively discussed the joint stability utilizing
musculoskeletal models. The muscle contributions
toward stability of the joint are assessed in3 using a
biomechanical model. Other studies mainly utilized
either purely clinical4 or cadaveric5 approaches to
address the joint stability. The aim of this study is
to identify the key factors contributing to anterior
instability through a quantitative analysis of the
shoulders dynamic stabilizers.
The locus associated with the deltoid muscles

lie superoanteriorly during all the arm postures
indicating that their action as the main movers
coincides with destabilizing effects (Fig. 3). The
locus associated with the rotator cuff muscles move
anteriorly, expressing that their stabilizing function
becomes less effective in the end-range (Fig. 4).
However, during mid-range movements (6070 %
of elevation) they are well aligned to compensate
the destabilizing effects of the deltoid muscles.
Methods
The contributions of muscles as dynamic stabilizers
of the shoulder are assessed by a model of the
shoulder. The model includes all major muscles
spanning the glenohumeral joint. To dissociate
the stabilizing role of rotator cuff (RC) and deltoid
muscles the locus corresponding to the intersection
of their resultant forces and the glenoid fossa
are separately derived, (Fig. 1). We reproduced
abduction in the scapular plane (150) combined
with external rotation (35) to expose the joint
into the end-range posture where the anterior
dislocation is more likely to occur.
Results
The glenohumeral contact force predicted by
the model has been compared to in vivo 6,7 and
analytical8 results, partially assuring the validation.
The locus related to the muscles resultant force
shifts from central location anteriorly while arm is
approaching the end-range positions, indicating
gradual decline in the active stability (Fig. 2).
see the next page
244
Discussion
The destabilizing effect of the deltoid muscles,
as the prime movers of the arm, is compensated
by the rotator cuff muscles during mid-range
elevation. However, active stability diminishes in
the end-range, leading to anterior dislocation if the
capsuloligamentous structures are dysfunctional.
The results of this study can broaden our insight into
the contribution of different muscle groups toward
joint stability and can consequently help improve
physiotherapy procedures of anterior instability.
References
1 Veeger H E J. et al., J. Biomech. 40(10):211929, 2007.
2 Cutts S. et al, Royal Col. Surgeons Eng. 91(1):27,2009.
3 Yanagawa T. et al., J. Biomech. 130(2):021024, 2008.
4 VandenBerghe G. et al., S. Musc. Rad. 09:3443, 2005.
5 Labriola J. et al., J. Shoulder, 14(1SupS):32S38S, 2004.
6 Bergmann G., J. Biomech. 44(8):154352, 2011.
7 Poppen NK, et al., J. Clin Orthop, 135, 16570, 1978.
8.Terrier A. et al., J. Clin Biomech. 28(2), 146150, 2013.
This project was supported by the Swiss National
Science Foundation [K-32K1_122512].
245
O 209
TRACKING THE SCAPULA UNDER DYNAMIC CONDITIONS

AND THE SURROUNDED TISSUES EFFECT
E. Durazo1, T. Alonso-Rasgado2, A. Walmsley2, A. Watts3
1
The University of Manchester, School of Mechanical Aerospace and Civil Engineering,

2
Wrightington Hospital Wigan and Leigh NHS Foundation Trust, Orthopaedics,

Wigan, United Kingdom

The main rotation occurs about the ZG axis. A
linear behaviour (r2 > 0.99) with different tilts in
the slope for the three different scenarios were
obtained for this axis. The maximum amplitude
obtained considering the three scenarios tested
was 28 2.5 for humeral motion and 10 3
for the scapula. The predicted result using the
proposed polynomial gives a maximum error of
0.5. The agreement level between the predicted
and observed orientation gives a BIAS value close
to zero and a 95% confidence interval of 0.5.
This work demonstrates that is possible to track
the scapula in an easy way with non invasive
devices, with a high correlation and agreement
level. Also to understand how the different soft
tissues influence the real motion of the scapula.
The presented information can be used to analyse
shoulder instability over a whole range of motion
and to determine the influence of the dynamic
stabilizers of the shoulder.
Introduction
The assessment of the glenohumeral joint using
non invasive methods is challenging 1. Different
technologies and methodologies have been used
to track the scapula in order to determine the
influence of the surrounded soft tissues over the real
motion of the scapula, or to assess the dynamic
stabilisers of the shoulder. The aim of this work is
to develop a mathematical expression to track
the motion of the scapula dynamically by using a
correlation between the real and the measured
orientations of the scapula affected by soft tissues.
Methods
One healthy and juvenile pig 2 (3.5 months) intended
for human consumption was obtained from a local
butcher. A heading reset was applied over three
IMUs on a flat surface before the test begins. Two
IMUs were used to measure the angular velocity
of the scapula and the humerus while a third IMU
was fixed to the scapula by means of screws. The
dynamic test consisted of undertaking a series
91 continuous cycles without stopping, in three
different scenarios by placing the sensor directly
over: a) all the tissues, b) muscles and c) scapula
bone. Three local components of the angular
velocity were rotated to the global reference
frame (quaternion rotation). Each individual
repetition was split in cycles and integrated to
obtain the orientation of each axis.
References
1 Brochard S, Lempereur M, Rmy-Nris O. Accuracy
and reliability of three methods of recording scapular motion using reflective skin markers. Proceedings
of the Institution of Mechanical Engineers, Part H:
Journal of Engineering in Medicine 2011;225(1):
10005.
2 Sullivan TP, Eaglstein WH, Davis SC, Mertz P. The Pig
As A Model For Human Wound Healing. Wound
Repair and Regeneration 2001;9(2):6676.
3 Bland JM, Altman DG. Statistical methods for
assessing agreement between two methods of
clinical measurement. Lancet 1986;1(8476):30710.
The mean value of the scapular cycles were plot

against the mean value of the real bone motion,
where a mathematical model was proposed and
its r 2 value was calculated. Then the scapular
and humeral orientation were fitted to the screws
orientation using a best fit polynomial for the
averaged data. The best fit was used to predict
the scapular orientation, using the humerus
and the sensor placed directly over the scapula
(surrounded by all tissues). The agreement between
the measured and predicted orientation was
assessed using the Bland and Altman method3.
246
O 210
VALIDITY AND RELIABILITY OF 3D MARKER BASED

SCAPULAR MOTION ANALYSIS: A SYSTEMATIC REVIEW
M. Lempereur1, S. Brochard1, F. Leboeuf2, O. Rmy-Nris1
1
LaTIM Inserm U1101, LaTIM Inserm U1101, Brest, France

2
CHU de Nantes, CHU de Nantes, Nantes, France
Introduction
In 3D upper-limb motion analysis, the scapulo-thoracic (ST) and gleno-humeral (GH) are not
considered individually despite the fact that
scapular motion is a vital component of shoulder
function. The main obstacle to performing such a
detailed analysis is the difficulty to find a valid and
reliable method to estimate the scapular motion.
Among the various techniques for the measurement
of in vivo scapular kinematics, cutaneous
marker based methods (electromagnetic and
optoelectronic systems) have been the most
studied and used techniques. However, marker
based techniques are subject to inaccuracies due
to soft tissue artefacts (STA). This may question the
validity and reliability of the use of marker based
techniques for the recording of scapula motion.
Recently, in addition to the recommendations of
the International Society of Biomechanics (ISB),
many methods have been described such as the
acromion marker cluster (AMC) method or the
surface mapping. The marker placement and the
computation method (CAST, double and multiple
calibration, ) differ according to the methods
[Lempereur, 2012], [Brochard, 2011], [Bourne, 2011],
[Karduna 2001]. Despite existing literature on
scapular kinematic measurements, a systematic
review, reporting their metrological properties
(accuracy and reliability), is lacking in literature.
Results
The electronic database search identified a total
of 335 papers and 19 articles were included.
6 different methods (ISB, surface marker configuration, AMC with single or multiple calibrations, scapula tracker) were reported in the literature, each
based on different marker locations and post processing computation. The AMC method coupled
with a calibration of the scapula with the arm at
rest is the most studied method and is a reliable tool
to quantify scapular rotations in children and adults.
Below 90100 of humeral elevation, this method
is accurate to about 5 during arm flexion and
7 during arm abduction compared to the palpation. Good to excellent within-session reliability and
moderate to excellent between-session reliability
have been reported. The AMC method can be
improved using different or multiple calibrations.
Other methods using different marker locations or
more markers on the scapula are less accurate
than the AMC methods.
Discussion
Tracking ST joint kinematics based on cutaneous
markers remains a challenge. Combining static
imaging such as low-dose stereoradiographic
imaging (EOS) and motion analysis is certainly
a way to explore shoulder motion and to better
quantify STA. Based on the results of this review, we
recommend (1) the use of an AMC located at the
junction of the scapula spine and the acromion,
(2) use of a single calibration at rest if the task does
reach 90 of humeral elevation (3) use of a second
calibration at 90 or 120 of humeral elevation,
multiple calibrations or a scapula tracker for
movements above 90 of arm elevation.
Methods
A systematic search was performed in 5 electronic
databases. Keywords included (1) scapula, (2)
keywords relative to accuracy: accuracy,
validity, agreement, (3) keywords relative
to
reliability:
reliability,
reproductibility,
repeatability. The titles and abstracts of
articles retrieved from the search were assessed
independently by 2 reviewers. Papers were
included if they satisfied the following criteria: (1)
the study included human participants, (2) the
study evaluated a marker based method for the
estimation of 3D scapular motion, (3) concurrent
validity and/or reliability were evaluated, (4) full
scientific papers.
References
L empereur et al, J Biomech, 45:202834, 2012
B
rochard et al, J Biomech, 44:75154, 2011
B
rochard et al, Part. H, 225: 1005, 2011
B
ourne et al, Ann. Biomed. Eng., 39:77785, 2011
K
ardune et al, J Biomech Eng, 123:18490, 2001
247
O 2 11
K-PARTICLE IMAGE VELOCIMETRY AND

COMPUTATIONAL FLUID DYNAMICS STUDY OF CELL
SEEDING WITHIN A 3D POROUS SCAFFOLD
A.M. Campos Marin1, T. Grossi2, E. Bianchi2, G. Dubini2, D. Lacroix1
Insigneo Institute for in silico medicine, Department of Mechanical Engineering, University
of Sheffield, UK, Sheffield, United Kingdom 2Laboratory of Biological Structure Mechanics,
Department of Chemistry, Materials and Chemical Engineering, Politecnico di Milano,
Milano, Italy
Introduction
Cell seeding of 3D scaffolds is a critical step in
tissue engineering since it precedes all steps
in tissue formation. It is desirable to obtain
homogeneously distributed cells throughout the
entire structure and high cell seeding efficiency
since donor cells can be limited. The combination
of 3D interconnected porous structures with fluid
dynamic based bioreactors can enhance such cell
seeding outcomes [1]. So, it is important to optimise
key parameters involved in cell seeding in vitro
experiments such as perfusion flow rate in order to
obtain the most suitable mechanical environment
for cell adhesion. The goal of this study is to
develop a Computational Fluid Dynamics (CFD)
model able to predict cell seeding efficiency.
A new experimental approach using a micro
Particle Image Velocimetry (PIV) system is
presented in combination with CFD simulations to
explore and predict the local fluid dynamics and
cell motion inside a 3D scaffold.
Figure 1: a
) Velocity profiles results from CFD (left) and PIV
(right). b) Data extracted from CFD and PIV
profiles along the dark line that passes along
fibers center. c) Cells motion calculated with CFD.
d) Cells motion tracked with PIV.
Methods
A commercial PCL scaffold from 3D Biotek with
300 m pore size was trimmed and placed inside
a microfluidic PDMS chamber with square channel
profile (3x1x40 mm 3). The chamber was located
on the stage of an inverted microscope and 1 m
diameter red fluorescent polystyrene microspheres
diluted in distilled water were infused using a
syringe pump with a constant flow rate. The flow
media was illuminated using Nd:YAG 532 laser
and the emitted light from the tracer particles was
captured in double frame images. Images were
imported in Insight 3G and divided in sub-regions
where local velocity vectors were calculated
by statistical methods. To study cell motion,
MG63 cells were labelled with orange CMTMR
fluorescent dye (Life Technologies) and suspended
in culture media. Transient flow rate was applied
while single frame images were captured and
after that evaluated in ImageJ. CFD simulations
using Ansys Fluent were performed replicating
the experimental conditions. Incompressible
Newtonian fluid with viscosity of 1x10 -3 Pas and
no-slip condition were adopted. The fluid volume
was meshed around the CT-based scaffold
geometry with 10 million tetrahedral elements. To
calculate cell motion, cells were simulated as a
discrete phase of microsphere particles that move
along the fluid volume in a Lagrangian formulation.
Results
Although a limited number of spots have been fully
examined, PIV and CFD velocity profiles agree
well showing that fluid velocities are higher at the
center of the pores and decrease towards the
fibers. Values extracted from both profiles show
a difference less than 12% at the center of the
pore however near the fibers PIV values are much
higher. Cells both in CFD and PIV follow the fluid
streamlines, higher cell velocities and frequency of
cells passing are found at the center of the pores
(Figure 1).
Discussion
Despite the fact that cells reach all regions inside
the scaffold, they mainly follow streamlines without
intercepting the fibers. For this reason, low cell seeding
efficiency is expected as found in the cell seeding
CFD model. This suggests new configurations should
be developed to aid cells to collide with scaffold
substrate. This study shows an experimental approach
that permits to investigate cell seeding inside a 3D
scaffold and a computational model able to predict
local fluid dynamics and seeding efficiency.
References
1 Melchels FPW et al, Acta biomater, 6:420817, 2010.
Financial support from European Research Council
(258321) and the European Society of Biomechanics
Mobility Award.
248
O 212
DEVELOPMENT AND CHARACTERIZATION

OF A DECELLULARISED MITRAL VALVE SCAFFOLD
M. Granados1, L. Morticelli1, P. Iablonskii1, A. Hilfiker1, M. Harder2, B. Glasmacher3 ,
I. Tudorache1, S. Cebotari1, A. Haverich1, S. Korossis1
1
Hannover Medical School, Department of Cardiothoracic, Transplantation and Vascular

Surgery, Hannover, Germany
2
Corlife, Corlife, Hannover, Germany
Leibniz University of Hannover, Institute for Multiphase Processes/Biomedical Engineering,

Hannover, Germany
Introduction
Mitral valve regurgitation is the second most
common cause of surgery of the heart valves
[Chockalingam, 2004]. Current treatment options
are imperfect, requiring re-operations or lifelong
anticoagulation therapy. The aim of this work was
to develop and characterize a decellularised
mitral valve scaffold for mitral valve replacement.
the protocol is not damaging the collagen fibres.

Future work will focus on optimizing the protocol in
terms of more effectively removing the a-gal, as
well as on the biomechanical and hydrodynamic
characterisation of the decellularised MV scaffolds.
Methods
Whole mitral valves (MVs) from 6 month old pigs were
disinfected, placed in hypotonic buffer and treated
with 0.5% SDS and 0.5% sodium deoxycholate for
36hours, followed by extensive washes, nucleic acid
digestion, and sterilization in 0.1% peracetic acid.
Radial sections were analysed histologically by H&E,
DAPI, Massons trichrome, van Giesons elastin, and
Alcian Blue PAS staining; and immunohistochemically
by collagen IV and alpha-gal. DNA was quantified
from the annulus, leaflets, chordae and papillary
muscle, as well as the sulphated glycosaminoglycan
(GAG) content of both leaflets. Hydroxyproline
quantification was used to estimate the collagen
and denatured collagen content of the leaflets,
annulus and chordae tendinae.
Results
Following decellularisation, no cell nuclei were
observed. The histoarchitecture was conserved,
although GAGs and collagen IV were removed.
The treatment resulted in a decrease of a-gal. The
DNA content in the decellularised MVs was also
significantly reduced compared to the native tissue.
Biochemical quantification confirmed the loss of
GAGs, but the collagen content was unaffected.
There was no significant increase in denatured
collagen content after decellularisation (Fig. 1).
Discussion
A protocol that effectively removed cells and DNA,
whilst maintaining the native valve histoarchitecture
was developed. The use of peracetic acid has
been previously reported to remove collagen
IV, although whether this is important for cell
attachment remains unclear. Although some
a-gal was still detectable after decellularisation,
the reduction observed was encouraging. The
apparent increase in hydroxyproline content
in decellularised valves can be explained by
the loss of other components, such as cells and
GAGs. The lack of statistical significance in
denatured collagen content between native
and decellularised samples further suggests that
Figure 1: A
. Sulfated-GAG content in fresh and decellularised
leaflet samples. B. Hydroxyproline quantification
for collagen content estimation. C. Hydroxyproline
quantification for estimation of denatured collagen
content. Asterisks indicate statistical significance
(n=6; p<0.05).
References
Chockalingam et al, J Heart Valve Dis, 13: 1114, 2004
249
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FLUID-DYNAMICS IN POROUS SCAFFOLDS STIMULATED

BY CYCLIC SQUEEZE PRESSURE IN THE S2PR BIOREACTOR
M. Ferroni1, S. Giusti2, G. Spatafora1, F. Boschetti1, A. Ahluwalia2
1
Politecnico di Milano, Chemistry Materials and Chemical Engineering Department Giulio

Natta, Milano, Italy
2
University of Pisa, Research Center E. Piaggio, Pisa, Italy
Introduction
Studies concerning culture conditions demonstrated
the role of mechanical forces and fluid movement
on the organization of cardiomyocytes, improving
the nutrient transport [Shachar, 2012]. In this
work, we present a CFD multiscale model of the
Sensorized Squeeze Pressure (S2PR) bioreactor, used
to study the fluid-induced forces by hydrodynamic
stimuli on cardiomyocytes seeded in porous 3D
constructs and previously tested on different cell
cultures [De Maria, 2011].
follows a Michaelis-Menten kinetics and is referred

to cells with surface density of 3x104 cells/cm2. A
fluid-structure interaction (3D-FSI) 3D model was
also developed to study the tissue vitality, in terms
of shear stress values acting on cardiomyocytes at
the fluid-solid interface.
Results
2D models were used to analyse the flow conditions
around the scaffold at specific time-points,
comparing the results to the piston movement.
The O2 concentration field after 200s of simulation,
confirms that dynamic flow stimuli permit a better
transport in the external part of the scaffold,
whereas O 2 concentration remains the same at its
center, if compared to static conditions. Shear stress
values exported from 3D-FSI model demonstrate
that stimuli are able to develop an engineered
tissue without compromising cell vitality (0.1 Pa).
Methods
The S2PR is an innovative stimulation chamber,
provided with a force and position sensor, which
imposes a cyclic and contactless overpressure
on cell cultures, using a vertical piston movement
[De Maria, 2011]. Porous cryogels were fabricated
using the freeze-dry method from gelatin 5% w/v
chemically crosslinked with glutaradheyde 100mM.
Figure 2: D
ifferences in oxygen concentration between
3D-OCS (on the top) and 3D-OCD (on the bottom)
model.
Figure 1: a
) Block diagram of the architecture of the S2PR.
b) A detail of chamber and support base.
Discussion
Results from 2D models highlighted the importance
of characterizing the macro-properties of the
scaffold and time-dependent movement of the
piston. Static conditions are applied to 3D model
to confirm that the hydro-dynamical stimuli allow a
better oxygen transport at the external part of the
structure. The micro-scale models are developed
as a simplified geometry of the scaffold. Moreover,
the fluid-dynamic environment created in the 3D
scaffolds by the S 2PR improves O2 transport without
damaging the cells, only where the porous structure
is perfused by an adequate flow of medium.
Computational models were implemented using

Comsol Multiphysics. Fluid-dynamics of the entire
system is evaluated using the same conditions as
in [De Maria, 2011]. Time-dependent 2D models of
the transverse section of the bioreactor chamber
were implemented in order to evaluate the fluiddynamic stimuli acting on the external surfaces
of the scaffold, in terms of fluid pressure and
velocity fields. The Arbitrary Lagrangian-Eulerian
method was used to model the piston movement.
Then, 3D models were implemented to evaluate
O 2 consumption and shear stress values inside
the scaffold, using an idealized geometry and
the boundary conditions exported from the 2D
model. Static (3D-OCS), and dynamic (3D-OCD)
conditions were applied. Oxygen consumption
References
De Maria et al, Tissue Eng Part C Methods,
17(7):757764, 2011.
Shachar et al, Biotechnol Prog, 28(6):15519, 2012.
250
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MECHANICAL PROPERTIES AND MASS DIFFUSION

PROPERTIES IN FIBRIN HYDROGELS ARE
UNDER DISTINCT CONTROL
P. Bhattacharya1, K.A. Leonidakis1, D. Lambrechts2, M. Roeffaers3 ,
H. Van Oosterwyck1
1
KU Leuven University of Leuven, Mechanical Engineering, Leuven, Belgium

2
KU Leuven University of Leuven, Materials Engineering, Leuven, Belgium
KU Leuven University of Leuven, Surface Chemistry and Catalysis, Leuven, Belgium
Introduction
Cell fate is a function of mechanical and mass
transport properties of its milieu. For example cell
migration speed is influenced by substrate stiffness,
while mass transport of distinct molecular agents
in the cell-milieu controls distinct cell signalling
pathways. Thus, tissue engineering applications
find an obvious benefit in separate control of
mechanical and mass transport. In this study,
we demonstrate that mechanical response and
microstructure of fibrin hydrogels can be modified
separately from mass transport properties. It is
expected that separate control in fibrin hydrogels
will lead to them playing an important role in tissue
engineering [Drury, 2003].
causes a decrease in fiber radius (from 130 nm at

low concentrations of both enzymes to 117.5 nm
when thrombin is increased and 116.2 nm when
factor XIII is increased, at a density of 10 mg/ml)
and a rise in fiber length. The concentration of
the two enzymes positively affects the number
of fibers per unit of volume, especially for the
highest concentration of fibrinogen (from 23.1 at
low concentrations of the two enzymes, to 33.7
and 28.6 x10 7 fibers/mm 3, when thrombin and
factor XIII are increased, respectively). Finally,
diffusivity measurements showed that increasing
fibrinogen concentration leads to lower diffusivity
values (from 125.7 and 57.9 m/s at 5 mg/ml to
113.4 and 53.4 m/s at 20 mg/ml for 10 and 40 kDa
dextran, respectively), but the effects of thrombin
and factor XIII do not have a clear trend.
Methods
Fibrin hydrogels with concentrations of fibrinogen
(5, 10 and 20 mg/ml), thrombin (0.02 and 0.2 U/mg
fibrinogen) and factor XIII (0.02 and 2 U/mg
fibrinogen) were tested using shear rheology for
the estimation of storage shear modulus (G).
Separate samples were imaged by confocal
microscopy, and a fiber extraction algorithm [Stein,
2008] was used to analyse gel microstructure. FRAP
(Fluorescence Recovery after Photobleaching)
was used for measuring the diffusion coefficient
of 10 and 40 kDa dextran solutes through the
hydrogels.
Discussion
Based on the presented data it is evident that
variations in the composition of fibrin result in
moderate changes in terms of diffusivity, but in
significant changes in the fibrillar structure and
order of magnitude changes in mechanical
properties of the hydrogels. This selective control
makes fibrin hydrogels a promising candidate in
tissue engineering applications.
Results
Fibrinogen and factor XIII concentrations were
found to positively influence G, while thrombin has
a strong negative influence (table 1). These trends
were valid over a range of physiological frequen
cies (0.01100rad/s) and strains (0.01%10%).
Image analysis of the gel microstructure showed
that at low levels of thrombin and factor XIII, increase
in fibrinogen concentration leads to increase in
number of fibers per unit of volume (from 8.5 to
23.1 x10 7 fibers/mm 3 at 5 and 20 mg/ml fibrinogen
respectively). Increase in thrombin and factor XIII
Gel Composition
G [Pa]
F (5 mg/ml), T (0.02 U/mg), f13 (0.02 U/mg)
237
F (5 mg/ml), T (0.2 U/mg), f13 (2 U/mg)
67
F (20 mg/ml), T (0.02 U/mg), f13 (2 U/mg)
1570
F (20 mg/ml), T (0.2 U/mg), f13 (0.02 U/mg)
263
Table 1: S torage shear modulus (at 1% strain and 1 rad/s

frequency) is controlled strongly by fibrinogen (F),
thrombin (T) and factorXIII (f13) concentrations.
References
Drury et al, Biomaterials, 24:433751, 2003.
Steiner et al, J Microsc, 232:46375, 2008.
251
O 2 15
BIOMECHANICAL AND BIOCHEMICAL CHRATERISATION

OF 3D-SCAFFOLD-FREE CARTILAGE CONSTRUCTS
DURING LONG-TERM CULTIVATION
I. Ponomarev1, T. Reuter2
1
fzmb GmbH, Veterinarian Clinic, Bad Langensalza, Germany 2fzmb GmbH, Bioinstruments
and Device Development, Bad Langensalza, Germany
Results
Figure 1 depicts the constructs that were produced
employing SFCT-technology.
Introduction
3D-scaffold-free tissue constructs represent a
special kind of transplants in tissue engineering.
The fzmb developed a method (SFCT-technology)
to produce 3D-scaffold-free cartilage transplants
(SFCT). Cartilage constructs produced by SFCTtechnology provide promising opportunities to
restore cartilage defects. However, the in vitro
stability of these cartilage constructs has not
completely been investigated so far. Furthermore,
it is not known whether these potential timedependent changes are positive or negative.
Methods
Cartilage biopsies were harvested from equine
joints and enzymatically hydrolysed to isolate the
chondrocytes. After cultivation and propagation
in vitro, cells were transformed into a threedimensional state (SFCT) [1].
Figure 1: M
acroscopic morphology of SFCTs: a after 2.5
months; b after 6 months.
Table 1 provides the results of biochemical and

biomechanical analysis.
The cultivation of the tree-dimensional constructs

was performed in 6-well plates and medium was
changed daily. The cultivation and stimulation
time were accompanied by application of
cyclic, manual, mechanical loading. Different
cultivation periods were performed comprising 2.5
and 6 months. Subsequently, the constructs were
biomechanically tested for their compactness
(E-modulus)
and
fixated
for
biochemical
examinations.
To
determine
biomechanical
parameters, a dynamic mechanical analysis
(DMA) was performed at 25C room temperature
using the ElectroForce 3100 test instrument from
BOSE . A cyclically applied force F = 0.5 N and
f=1Hz was specified. The complex E-modulus E*
was estimated. For the biochemical investigations,
the constructs were dried and defatted (DDT) to
analyse the collagen and proteoglycan content
in g in relation to dried tissue in mg. Furthermore,
the collagen specific amino acid hydroxyproline
(Hypro) as well as the matrix shaping substance
glycosaminoglycan (GAG) were quantitatively
measured.
SFCTs
GAG
Hypro
E-modulus
E*
2.5 months
35 g
29 g
0,34 MPa
6 months
40 g
32 g
0,51 MPa
Table 1: C
haracterisation of SFCTs after 2.5 and 6 months.
The results indicate a positive trend in matrix building

compounds depending on the cultivation period
ranging from 2.5 and 6 months. The complexe
modulus of the SFCT (6-months cultivation) is
compared to SFCT (2.5-months cultivation) 34%
higher.
Discussion
The differences in biomechanical and biochemical
results can be explicated by the varying cultivation
durations accompanied by mechanical stimulation.
The used intermittent mechanical stimulation for
the SFCT has a positive effect on the synthesis
activity of the in vitro cultivated chondrocytes.
References
[1] Ponomarev I., Wilke I., Manufacturing process of
three dimensional tissue structures and structures
obtainable thereby, EP 1 550 716 B1, 2004.
252
O 2 16
CFD MODEL AND MICRO-PIV EXPERIMENTS

FOR SHEAR PROMOTED ENCAPSULATION
OF DRUGS IN ERYTHROCYTES
M. Piergiovanni1, G. Casagrande1, E. Bianchi1, M.L. Costantino1
1
Politecnico di Milano, Chemistry Materials and Chemical Engineering G. Natta,

Milano, Italy
Introduction
Chemical and physical forces are known to induce
temporary formation of pores on the membrane
of RBCs (Red Blood Cells) and thus allow for the
diffusion of molecules inside the erythrocyte
[Pierig, 2008] [Muzykantow, 2011]. Subsequent
haemolysis causes the release.
Results
The subhaemolytic flow conditions (according
to [Tillman, 1984]), suitable to promote Dextran
encapsulation were identified for different Ht
(Figure 2). The computational model also shows
that the distribution of particles in the channel is
homogeneous, without sedimentation, so that all
the flowing RBCs can be involved in the mechanism.
The efficiency of the process results higher in the
round crown region of the flow section, with radius
0.4R < r < 0.6R, where R is the hydraulic radius of
the channel.
The use of subhaemolytic shear forces arising within

a fluid in motion can directly induce the opening
of the pores. The aim of this preliminary study is to
find the most suitable flow condition promoting the
encapsulating process.
Methods
A computational model was developed using
COMSOL Multiphysics 4.2a, reproducing a
commercial micro channel (50x50 m cross-section, 58.8 mm length). The Mixture Model,
Laminar Flow was used to evaluate velocity,
volume fraction of dispersed phase and estimate
shear stress on RBCs (RBC) suspended in PBS. This
model accounts for rigid particles. The diffusion
dynamic of a probing molecule (Dextran) was
analytically modelled to evaluate the minimum
time (t min) required to guarantee the diffusion
of the molecule into the RBCs. Note that tmin has
always to be shorter than the transit time (ttran) of
the RBC cell into the channel. Finally, the effects of
the variations in flow rate and haematocrit (Ht) on
ttran and estimated RBC were evaluated.
Figure 2: P
airs of value RBC ttran from the computational
model at varying Ht and Q.
The experimental analysis showed that the real

shear stress is lower than the predicted one, but
still in the subhaemolytic portion of the Tillman
diagram.
Experimental activity was performed to take into

account the peculiar behaviour of the RBCs when
moving in micro channels (such as pinch effect).
Its impact on the velocity of the suspension (Figure 1)
was evaluated using micro Particle Image
Velocimetry (-PIV) analysis. Different flow rates
(Q) were investigated and the derived PIV were
compared to the RBC from the computational model.
Discussion
Coupling the results from the computational
model and -PIV analysis, it was possible to identify
suitable working conditions. The study provides the
preliminary understanding to control the process of
stress-promoted encapsulation of molecules in RBCs.
These results suggest the introduction of a previous
focusing step, so that most of the cells would follow
paths through maximum efficiency region.
References
Muzykantov V. et al., Expert Opin Drug Deliv,
7:403427, 2011;
Pierig F. et al., Advanced Drug Delivery Reviews,
60:286295, 2008;
Tillman W. et al, J. Biomech, 17:263289, 1984.
Figure 1: V
elocity field from -PIV analysis and CFD model
for Q = 15 l/min and Ht = 0.01.
253
O 2 17
WHAT IS THE EFFECT OF THE SHAPE OF A STENOSIS

ON THE AORTIC FLOW?
U. Gulan1, M. Holzner1
1
ETH Zurich, Environmental Fluid Mechanics, Zurich, Switzerland
Introduction
Aortic stenosis is a cardiovascular disease which
occurs as a consequence of calcification of the
valve leaflets. It may provoke disturbed flow as
elevated shear regions develop near the throat
of the stenosis which can activate atherosclerotic
platelets [Ku, 1997]. In clinical routine, derived
pressure gradients and effective orifice area
are used to evaluate the severity of a stenosis.
However, it is shown that the degree of stenosis
is not the sole parameter characterizing the flow
but also geometric and physiological features may
have considerable effects on the hemodynamics
[Berger, 2000]. Moreover, there is evidence that
the assumption of idealized velocity profiles as
inlet boundary conditions in numerical models can
lead to misleading representations of the aortic
hemodynamics [Morbiducci, 2014]. We aim at
better understanding the influence of the shape
of the stenosis on the aortic flow field and on the
onset of turbulent flow and energy loss in-vitro.
valve (Fig 1). Our analysis shows that more coherent

vortical patterns develop for the circular stenosis
which dampens the impact of turbulent flow. In
fact, spatially averaged TKE is around %15 higher
for the triangular stenosed valve. Furthermore, we
found that the budget of the TKE is also influenced
by the shape of stenosis which leads to a higher
energy dissipation downstream of the triangular
stenosis.
Figure 1: V
elocity contours at 1cm downstream of the stenosis for both stenosis shapes
Methods
Three-dimensional particle tracking velocimetry
(3D-PTV) is utilized to measure the mean and
fluctuating velocity fields and the budget of
turbulent kinetic energy (TKE) in an aortic cast.
It has been used for complex flow analysis
[Lthi, 2005; Holzner, 2008]. The measurements
have been performed in a realistic aortic phantom
with circular and triangular stenosed valves. The
stenosed valves were produced using 3D-printers.
The measurements were done under steady
state flow conditions. The temporal resolution
is 14 ms and the homogenous Eulerian voxel
size is 0.65 x 0.65 x 0.65 mm 3. The experimental
setup is described in detail in Glan et al.
[Glan et al, 2014].
Discussion
We found that the shape of the stenosis has a
distinct influence on the spatial evolution of the
MKE and TKE along the ascending aorta. The
investigation on the irreversible energy losses, i.e.
dissipation of the TKE, reveals that there is a strong
correlation between the geometry of the stenosis
and the energy loss and hence the cardiac
efficiency. We conclude that there is strong
dependence of aortic hemodynamics on stenosis
geometry. Therefore, the complex nature of the
aortic flow needs patient-specific approaches to
define criteria for a reliable diagnosis of stenosis
severity and risk evolution.
References
Berger et al, Annu Rev Fluid Mech, 32:347382,
2000.
Glan et al, Exp Fluids, 53:14691485, 2012.
Holzner et al, J Fluid Mech, 598:46575, 2008.
Lthi et al, J Fluid Mech, 528:87118, 2005.
Ku, Annu Rev Fluid Mech, 29:399434, 1997.
Morbiducci et al, J Biomech, 46:102109, 2013.
Results
We study the flow and turbulence characteristics
for both circular and triangular stenotic valves. The
results show that the spatial distribution of mean
velocity is similar in the vicinity of the valves, i.e.
a high speed region impinges on the outer aortic
254
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EXPERIMENTAL AND COMPUTATIONAL ANALYSIS

OF BLOOD AS A MULTIPHASE FLUID
J.M. Sherwood1, X. Li2, G.M. Karniadakis2, S. Balabani3
Brown University, Division of Applied Mathematics, Providence, USA
Introduction
Detailed knowledge of blood flow characteristics is
of fundamental importance in understanding a wide
range of physiological and pathological functions.
The multiphase nature of blood, being composed
of discrete cells suspended in a continuous medium,
drastically alters its flow characteristics from those
of a simple fluid such as water. The local RBC
concentration can be considered as a continuous
variable [1]. In this continuum approach, the
concentration of the suspending medium varies
in the opposite manner to the RBC concentration.
Furthermore, the velocities of RBCs and SM are
influenced by the RBC concentration [2]. In the
present study, we investigate microscale blood
flow in the paradigm of a two-phase fluid, with
spatially resolved measurements of velocity and
concentration of both the RBCs and the suspending
medium. Numerical modelling using the established
dissipative particle dynamics (DPD) methodology is
compared to the experimental results.
Methods
Details of the experimental setup and methodologies
used in the present study have been reported
previously [2]. Human blood was collected via
venepuncture and mixed with 1.8 mg/ml EDTA to
prevent coagulation, washed twice in PBS and
resuspended at a haematocrit of 0.25, with 0.1%
1.1 m fluorescent microparticles. Dextran 2000 at 5
mg/ml was added to induce RBC aggregation. The
blood was perfused through a polydimethylsiloxane
(PDMS)
microchannel
with
sequential
90
bifurcations a 5050m cross-section using a Fluigent
MFCS system. The microchannel was placed on an
inverted microscope and illuminated alternately
with laser and microstrobe illumination. Images
were acquired and processed using PIV algorithms
and image processing methodologies to extract
concentration distributions [2]. The DPD approach
is well established and has been described
elsewhere [3]. The cell membrane is modeled by a
2D triangulated network with vertices connected
by viscoelastic bonds to impose membrane
mechanics. Cell-cell aggregation interaction is
approximated using the Morse potential.
However, not only the RBC velocity is altered by

the RBC concentration distributions. As can be
seen in Figure 2, the suspending medium velocity
is notably higher than the RBC velocity in a branch
of the bifurcation, and both are skewed. These
variations in relative velocity are altered by flow
rate, flow ratio and RBC aggregation, and have
also been observed in the DPD simulations. Work is
underway to provide accurate comparison of the
relative velocity using the DPD technique.
Discussion
In addition to the necessity for better understanding
of haemodynamics on all length scales, and
particularly in the microvasculature, the present
work also has implications for experimental
measurement techniques such as PIV and clinical
imaging techniques that use the RBCs to measure
flows (e.g. ultrasound). Additionally, we hypothesise
that there may be a role for these complex
microscale haemodynamics in microvascular
diseases such as diabetes and malaria, through
altering shear stresses on the endothelium.
Results
Figure 1 compares the bluntness of the haematocrit
and velocity profiles. Definitions for the indices
have been described previously [2]. Comparing
the values of B*H (for which 1 would be a uniform
distribution of RBCs), it can be seen that although the
absolute bluntness predicted by the DPD simulations
is marginally lower than the experimental data, the
overall trends are well replicated.
References
[1] Sherwood, JM et al., PLOS One, 9(6): e100473, 2014
[2] Sherwood, JM et al., Biomech Mod Mechanobiol,
13(2): 259273, 2014.
[3] Li, X et al., Phys Biol, 9:026010, 2012.
255
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FREESTYLE, SQUAT AND STOOP LIFTING KINEMATICS

IN RELATION TO INTRINSIC LUMBAR SPINE CURVATURE
A. Pavlova1, K. Cooper2, J. Meakin3 , R. Barr1, R. Aspden1
1

2
Robert Gordon University, School of Health Sciences, Aberdeen, United Kingdom

3
University of Exeter, Biophysics Research Group, Exeter, United Kingdom
Introduction
It was recently shown that the lumbar spine has an
intrinsic shape; a characteristic of each individual,
which is partially maintained between trunk flexion
and extension and affects how spine shape
changes in response to static axial loads [Pavlova
2014, Meakin 2009]. Is spinal shape a risk factor for
injury and low back pain? Our aim in this study was
to determine the effects of lumbar spine shape on
lifting kinematics.
the type of trial. Thus individuals appeared to alter

their lifting style according to the instructions given
primarily by altering flexion at the knees while
retaining similar postures at the back.
Methods
We recruited 30 pain-free adults between 18 and
65 years of age. Mid-sagittal images of the lumbar
spine were taken while standing in an upright
magnetic resonance scanner (Fonar 0.6 T Upright).
Active shape modelling (ASM), a statistical method
involving principal components analysis, was used
to identify variations in spine shape. A 13 camera
Vicon motion capture system was used to analyse
lifting kinematics. Participants lifted a moderately
heavy box (615kg) from the floor using freestyle (no
instruction), squat and stoop techniques. The main
mode of variation (principal component) in spine
shape described overall lumbar curvature and
included a whole spectrum of spine shapes (Figure
1). Therefore, participants at the opposite ends of
this spectrum were grouped into curvy (N=3) and
straight (N = 5) spines by their deviation (> 1SD)
from the mean spine shape (Mean=0, Figure 1).
Figure 1: A
SM (a) and distribution of lumbar curvature
identified within the sample (b). Showing the average spine shape and when varied by 2SD about
the mean.
Results
In a sub-group analysis (total N=8) of FREESTYLE
lifting trials straight spines flexed more at the knees
(P<0.01), while curvy spines had more lumbar
flexion (P=0.02). Lifting kinematics did not differ
between curvy and straight spines in SQUAT or
STOOP trials.
Figure 2: D
ifferences in freestyle lifting between curvy and
straight spine sub-groups (N=8).
Discussion
The curvature of the lumbar spine was related
to whether individuals chose to stoop or squat.
Preferred movement characteristics persisted even
when altered instructions were given. Prescriptive
lifting guidelines may put at risk those who struggle
to perform that technique.
Considering the entire study sample (N=30), knee

flexion during FREESTYLE lifting correlated with the
degree of lumbar curvature (P=0.03). Peak flexion
angles correlated between FREESTYLE and SQUAT
trials (P0.03), but not others trials, indicating that
participants who naturally stooped struggled to
perform the SQUAT technique, instead retaining
their FREESTYLE kinematics. Controlling for peak
knee flexion, an analysis of covariance showed
that lumbar flexion was no longer associated with
References
Andersen et al, Arthritis Rheum, 56:13551364, 2007.
Hoogendoorn et al, Occup Environ Med, 59:
323328, 2002.
Meakin et al, J Anat, 215:206211, 2009.
Pavlova et al, Eur Spine J, 23:2623, 2014.
256
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A PILOT STUDY ON THE BIOMECHANICS

OF THE SYMPATHETIC TRUNK
L. Van Hauwermeiren1, L. Bekaert1, T. Van Hoof1
1
Gent University, Basic medical sciences, Gent, Belgium
Introduction
Several sources show a correlation between
altered peripheral nerve biomechanics and
disturbed nerve function. Some clinical studies
suggest that mechanical strain on the sympathetic
trunk (ST), a small autonomous nerve bundle in
front of the spine, could play a role in chronical
disorders like sympathetically maintained pain.
A clinical test, the sympathetic slump, consisting
of full spinal flexion combined with contralateral
lateral flexion and rotation in a long sitting position,
was proposed to maximally lengthen the ST and
thus evoke symptoms. However, biomechanical
data is lacking. Investigation of the ST is challenging
both through dissection and medical imaging due
to its position, size and numerous side branches.
Therefore, the aim of this study is to a develop
technique to visualize and quantify ST motion in
the sympathetic slump position.

Overall, marker movement and inter marker
movement were consistent. Only the lower lumbar
markers showed significant cranial movement in
both sympathetic slump positions (fig1.A), and
significant movement was noted around two
osteophytes during contralateral sympathetic
slump (fig1.B). The traditional slump showed no
significant movement of the ST.
C o n cl u s i o n
Despite the limitations in motion quantification
(strain could not be calculated since only markers
and not the entire nerve structure was visualized),
the results of this study suggest that the sympathetic
slump inflicts most ST movement in the lower
lumbar region and around structural pathological
changes like osteophytes. Larger datasets could
confirm these findings and further increase insight
into ST biomechanics.
The STs of a cadaver specimen were dissected
from an anterolateral angle, until there was
sufficient visualization for bilateral insertion of
30 metal markers without detaching the ST from
its environment. CT scans were performed in
supine position, neutral long sitting position, and
sympathetic slump position to the left and right.
A second supine CT scan was used to assess
possible marker migration. Markers and vertebrae
were segmented and 3D-rendered. Displacement
of markers from the neutral to each experimental
position were calculated and adjusted for
vertebral movement using custom Matlab code.
Furthermore, inter marker distances between
adjacent markers (along a mathematical spline
curve drawn between the markers to approximate
the course of the ST) were calculated for each
position to measure ST changes in length. Only
marker movements larger than the combined
errors of segmentation, registration and marker
migration were taken into account (4.22 mm for
long sitting position, 4.51 mm for slump positions
and 2.18mm for inter marker distances).
Figure 1: S T marker displacement from neutral to sympathetic

slump position
A. Anterior view of the low lumbar spine in neutral

position. Red dots = markers in neutral position and
yellow dots = markers in left sympathetic slump.
L4-5 = fourth-fifth lumbar vertebra. Note the cranial
movement of the bottom two markers in both STs.
B. Anterolateral view of the mid thoracic spine in
neutral position, showing ST movement during left
sympathetic slump (yellow dots) compared to
neutral ST position (red dots). The ST is tensed around
an osteophyte (O) on the fifth thoracic vertebra
and the sixth costovertebral joint. T4-6 = fourth-sixth
thoracic vertebra, R5-7 = fifth-seventh rib.
257
O 221
THORACIC SPINE KINEMATICS IN THE YOUNG

AND ELDERLY
D. Ignasiak1, A. Reger2, S.J. Ferguson1
1
2
ETH Zrich, Institute for Biomechanics, Zurich, Switzerland
Schulthess Klinik, Department of Physiotherapy, Zurich, Switzerland
Introduction
Vertebral fractures, the most common osteoporotic
fracture, lead to pain, immobility, loss of posture
and increased risk of future fractures [Ross, 1997].
These occur typically in the vertebrae around
the thoracic apex and thoraco-lumbar junction
[Delmas, 2005], often under the load of normal
daily living activities. To date little is known about
the thoracic spine kinematics, their change with
age and the possible impact on spinal segmental
loading and risk of fractures. Therefore, the aim of
this study was to provide a detailed description of
the whole thoraco-lumbar spine kinematics in a
sample of healthy young and elderly subjects.
Forty two healthy volunteers agreed to participate
in this study (Young: N=21, age 27.04.0; Elderly:
N=21, age 70.13.9). The volunteers performed
a forward flexion maneuver, while the whole body
kinematics was recorded using a motion-capture
system (Vicon) with 75 reflective skin markers. The
temporal change of the spine curvature, which
was approximated by a cubic function, was
analyzed. Based on observed characteristics of
the spinal motion, several classification systems
were established, and motion types were assigned
to every volunteer. Chi-square tests were used to
reveal age-group-dependent motion types.
Figure 1: The distinguished classifications of thoracic kinematics

that were found to be correlated with age groups
(based on Chi-square statistics).
Results
Flexion timing of the thoracic region of the spine,
as compared to the lumbar spine and hips, was
found to differ in the two age groups (p=0.009):
a delayed motion type was observed only in the
young, whereas a simultaneous motion mostly in
the elderly (Figure 1). Similarly, sequential flexion of
lower thoracic segments was found in most of the
young, whereas the majority of the elderly showed
simultaneous flexion (p=0.017). The amount of
flexion at the thoraco-lumbar junction was greater
than that of upper segments in most of the young;
the opposite was seen in most of the elderly
(p=0.008). T5T7 was more often in extension at
the end-of-range flexion in the young (p=0.06),
its time course differed from the elderly (p=0.09),
and the mean flexion velocity was lower (Figure 2).
Figure 2: T ime-averaged flexion velocities of thoracic spine

portions, normalized to average flexion velocity.
(ANOVA, *p0.05, ***p0.001)
Discussion
This study provides a novel detailed description of
thoraco-lumbar spine kinematics in healthy young
and elderly subjects. Significant differences were
found between the age groups in the motion
characteristics of lower and middle thoracic levels,
which are the most common sites of vertebral
fractures. Further investigation is needed to
explore the biomechanical consequences of these
age-related changes in spine kinematics.
References
[1] Ross, Am J Med 103(2), 1997.
[2] Delmas et al., JBMR 20(4), 2005.
258
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SAGITTAL PLANE ALIGNMENT AND CORRELATIONS

BETWEEN POSTURAL AND CLINICAL PARAMETERS IN
ANKYLOSING SPONDYLITIS PATIENTS EVALUATED BY
RASTERSTEREOGRAPHIC SYSTEM
M. Mangone1, T. Venditto1, L. Tognolo1, M. Paoloni1
1
Sapienza University, Rehabilitation, Rome, Italy
Introduction
A good understanding of sagittal plane alignment
and postural changes is essential to prevent
deformities of spine and achieve optimum outcomes
when treating Ankylosing spondylitis (AS) patients.
Rasterstereography is an optical measuring
system that allows tridimensional reconstruction
of spinal posture and pelvic position starting from
the back surface analysis.We hypothesized that
rasterstereography could be used to non invasively
assess the postural characteristics of AS patients.
The aim of our study was to evaluate differences of
sagittal plane alignment between AS patients and
healthy subjects by rasterstereographic system
and analyze the relationships between postural
and clinical parameters.
and a significant reduction of both lordosis

angle (p=0.045) and pelvic tilt (p=0.024) compared to healthy subjects. Signi?cant correlations
were observed between the following variables:
l, lordosis angle and BASMI (r=0.56, p=0.003),
kyphosis angle and BASMI (r=0.48, p=0.009), kyphosis angle and BASDAI (r=0.55 p=0.003), pelvic
tilt and BASMI (r=0.72, pv<0.001); pelvic tilt and
BASDAI (r=0.42, p=0.020); pelvic tilt and ASDAS-PCR
(r=0.58, p<0.001).
Discussion
Significant difference between AS patients and
healthy subjects according to kyphosis and lordosis
angles and pelvic tilt and positive correlation
between pelvic tilt and lumbar lordosis were found.
In our study we found a negative value of Sacral
Slope in two patients that could be related to the
presence of compensatory knee flexion.
Methods
AS patients of both sexes were recruited from the
rheumatologic out-patient clinic of our Hospital. All
patients met the modified New York criteria and
were successfully treated with anti-TNF-. Age
and sex matched healthy subjects were enrolled
from to form the control group. The metrology was
evaluated by using Bath Ankylosing Spondylitis
Metrology Index (BASMI). Disease status and
functional ability were assessed by Ankylosing
Spondylitis Disease Activity Scores-C reactive
protein (ASDAS-PCR), Bath Ankylosing Spondylitis
Disease Activity Index (BASDAI), Bath Ankylosing
Spondylitis Functional Index (BASFI). Spinal posture
was measured by rasterstereographic system
Formetric 4D that provides not invasively and
three-dimensional reconstruction of the spine.
References
1 Guidetti, L., et al., Intra- and interday reliability of
spine rasterstereography. Biomed Res Int, 2013.
2013: p. 745480.
2 Mohokum, M., et al., Reproducibility of rasterstereography for kyphotic and lordotic angles, trunk
length, and trunk inclination: a reliability study.
Spine (Phila Pa 1976), 2010. 35(14): p. 13538.
3 Schwab, F., et al., Adult spinal deformity-post
operative standing imbalance: how much can you
tolerate? An overview of key parameters in assessing
alignment and planning corrective surgery.
Spine (Phila Pa 1976), 2010. 35(25): p. 222431.
4 Zochling, J., Measures of symptoms and disease
status in ankylosing spondylitis: Ankylosing Spondylitis
Disease Activity Score (ASDAS), Ankylosing
Spondylitis Quality of Life Scale (ASQoL), Bath
Ankylosing Spondylitis Disease Activity Index (BASDAI),
Bath Ankylosing Spondylitis Functional Index (BASFI),
Bath Ankylosing Spondylitis Global Score (BAS-G),
Bath Ankylosing Spondylitis Metrology Index
(BASMI), Dougados Functional Index (DFI), and
Health Assessment Questionnaire for the Spondylarthropathies (HAQ-S). Arthritis Care Res (Hoboken),
2011. 63 Suppl 11: p. S4758.
Results
Forty-six healthy subjects and twenty-five AS
patients were enrolled in the study. According
to Pearsons correlation coefficient, statistical
signi?cant negative correlations were observed
between chest expansion and the following
variables: BASMI (0.652, p<0.001), BASDAI (0.612,
p<0.001), and ASDAS-PCR (0.64, p<0.001).
Rasterstereographic system revealed in AS subjects
a significant increment of both kyphosis angle
(p=0.012) and flche cervicale (p=0.006)
259
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HOW THE VARIATION IN LUMBAR SPINE GEOMETRY

AFFECTS ITS LOAD SHARING
S. Naserkhaki1, J. L. Jaremko2, S. Adeeb1, M. El-Rich1
1
University of Alberta, Radiology and Diagnostic Imaging, Edmonton, Canada
Introduction
The structural response of the lumbar spine to
mechanical loads depends mainly on its anatomy.
In addition to its material properties, sagittal
curvature of the spine known as lumbar lordosis
(LL) is the most important factor which affects its
load sharing (force in the discs, facet joints (FJF)
and ligaments). However, it is still unclear how the
other geometrical attributes such as sacral slope
(SS), pelvic incidence (PI) and orientation of facet
joints affect the spine response. This study aims to
investigate and compare the load sharing of three
lumbosacral spines with different geometrical
attributes using Finite Element (FE) modeling.
Methods
3D nonlinear FE models of three ligamentous spines
with personalized geometry were generated from
CT scans [Naserkhaki et al, 2014]. These spines
are hypo-lordotic (LL-15, SS-22, PI-30), normal-lordotic (LL-34, SS-43, PI-48), and hyper-lordotic
(LL-54, SS-53, PI-51). Compressive follower load
with varying magnitudes from L1 to S1 (average
491N) combined with 7.5Nm flexion/extension
was applied. The facet joints and ligament forces
at each level were determined. By performing
successive sections across the discs and satisfying
the equilibrium conditions at all levels, the internal
loads in the disc and the spinal load sharing
i.e. percentage of contribution of each spinal
component in carrying load were calculated.
Results
Extension produced contact at all levels of the
three spines while only the level L5-S1 experienced
contact under flexion.
The load sharing of the discs, facet joints and
ligaments are summarized in Table 1 for both
loading scenarios. As well, the internal forces and
moments developed in the disc are provided for
sake of comparison.
Table 1: Comparison of load sharing and disc force between

three spines
Discussion
The disc is the main load bearing component in
all spines for both flexion and extension followed
by the facet joints and ligaments in the extension
case. The facet joints slightly contributed to resist
flexion except in the lower level L5-S1. Spinal
load sharing is significantly affected by the spine
geometry particularly the contribution of the facet
joints under extension. It also affects the amount of
compression and shear experienced by the disc as
well as the shear sense anterior or posterior.
References
Naserkhaki et al, ASME 2014 International Mechanical
Engineering Congress and Exposition, Montreal,
Canada November, IMECE2014-40231:18, 2014
260
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A METHODOLOGY FOR KINEMATIC ANALYSIS OF HEAD

IMPACTS IN ELITE RUGBY UNION PLAYERS
G. Tierney1, T. Krosshaug2, C. Simms1
1
2
Trinity College Dublin, Bioengineering, Dublin 2, Ireland
Norwegian School of Sport Science, Sports Trauma, Oslo, Norway
Introduction
Rugby is intrinsically an impact sport which results
in concussions being a frequent injury within the
game with repeated concussion being linked to
early-onset dementia and depression. Therefore
a greater understanding of the dynamics of head
impacts in rugby and the mechanism of concussion
is required. Little detailed analysis of real head
impact cases has been performed.
Validation of the method is a current focus.

However, this initial study shows the MBIM approach
can work for rugby head impacts and the method
should be combined with head impact assessment
data and applied to a number of head impact
cases to establish thresholds for concussion injuries
in rugby.
Methods
For many sports injuries, traditional lab methods
cannot be used to obtain three-dimensional
kinematics. However reconstructions of motion
patterns from video sequences could improve the
understanding of injury mechanisms. Model-Based
Image-Matching (MBIM) can be used to measure
three-dimensional temporal joint angle histories,
velocities and accelerations from un-calibrated
video data where at least two camera views are
available. For a sample case freely available online,
the video resolution was 1080p with one camera
view recorded at 25 fps and another at 125 fps.
The MBIM was performed using 3-D animation
software Poser 4 and Poser Pro Pack (Curious Labs Inc,
Santa Cruz, California) using a method developed
by Krosshaug (2005). The surroundings are built
in the virtual environment based on the real
dimensions of the sport field. A skeleton model from
Zygote Media Group Inc (Provo, Utah) is then used
to fit the players anthropometry for each video
frame thus yielding the players kinematics. Using
a customised script in Matlab (MathWorks Inc,
Natick, Massachusetts), the joint angle time
histories are processed and plotted.
Figure 1: T he resultant head velocity throughout the video

sequence
Results
Figure 1 shows the time history of the head velocity
components. Figure 2 shows the corresponding
head angular velocity components.
Discussion
The peak linear and rotational accelerations from
this case were significantly less than reported for
head impact cases in American Football (81106g
and 50227951 rad/s 2 respectively) (McIntosh,
2014). This may be mostly due to the absence of
helmets in rugby but also the impact kinematics are
different for both sports. The change in linear and
rotational velocity values (6.6m/s and 33 rad/s) are
in the same range as previous rugby head impact
studies (McIntosh, 2000, Patton, 2012).
Figure 2: T he head angular velocity about the 3 axes of the

head.
References
McIntosh et al, BMJ Open, 4: e005078, 2014.
McIntosh et al, Med Sci Sports Exerc, 32:
19801984, 2000.
Patton et al, J Sports Eng Tech, 226: 177184, 2012.
Krosshaug et al, J Biomech, 38: 919929, 2005.
261
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DYNAMIC RESPONSE OF THE LOWER LIMBS

OF THE HUMAN BODY UNDER VIBRATION EXPOSURE
IN CYCLING
M. Munera1, W. Bertucci1, X. Chiementin1
1
Universit de Reims Champagne Ardenne, GRESPI Groupe de Recherche en Sciences pour

lingnieur, Reims, France
Introduction
Vibrations in cycling caused by road irregularities
could cause health problems and affect the cyclists
comfort and performance (Parkin and Sainte
Cluque 2014). Different studies have quantified the
effect of vibration in the human body while cycling
through dynamical and physiological responses,
but without including the influence of movement
(Arpinar-Avsar 2009). The dynamical response is
usually represented by measures of acceleration at
different parts of the human body and the bicycle
(Chiementin et al. 2011). The purpose of this work is
to analyse dynamic response of the human body
under different frequencies of vibration exposure
during the different phases of the cycling exercise,
using the measures of acceleration.
(Tjoint(f,ph)) is computed as the ratio between the

RMS values of each joint ajoint(f,ph) and of the input
(pedal) a input(f,ph) using equation 1. As example,
the obtained results for the ankle joint are provided
in figure 1.
Tjoint(f,ph)= a joint(f,ph)/ a input(f,ph)
Methods
Fifteen healthy male cyclist (age: 277.4 yrs; height:
1.770.04 m; mass: 69.25.7 kg, (meanSD))
with a regular training background participate
in this study and the experimental protocol was
approved by the universitys ethics review board.
The test bench includes a vibratory platform
(FITVIB 600, Germany), a road bike (carbon monoframe, Mavic Ksyrium Equipe wheels) and a power
control system (Tacx Power back, Holland). The
accelerometric data was acquired using tri-axial
accelerometers (Bruel & Kjaer deltatron 4524B,
Denmark). Those accelerometers were located
on the skin above the lateral malleolus of the tibia
(ankle), lateral tuberosity of the tibia (knee), the
anterior superior iliac spine (hip) and pedal. For
each vibration condition (six frequencies between
20 and 70 Hz), the subject performed 6 minutes
of cycling exercise with a constant pedalling
cadence (80 rpm) and an imposed power output
of 150 W follow by 4 minutes of recovery.
(1)
Figure 1: T ransmissibility pedal/ankle at the four phases

of the pedaling cycle. (*) Statistical significant
difference between phases (p<0.05)
The transmissibility found for the ankle, knee and hip

allows the identification of the frequencies where
these values are highest (40, 30 and 20 Hz respectively)
and lowest (50, 70 and 70 Hz respectively). The ankle
is the only studied joint that shows an amplification of
the input acceleration (T= 1.2).
Discussion
The protocol developed in this work shows the
influence of movement over the dynamic response
of the human body under vibration in different
phases of cycling. The frequencies where the
transmissibility peaks are found represent different
displacement speeds where the acceleration
received by the joint is higher. A high level of
acceleration could lead to joint damage, and thus
the identification of the transmissibility values can
be important to evaluate the physical risk.
Results
The root mean square (RMS) value of the high-frequency component of the acceleration is
calculated in stationary conditions for each
frequency (f) and each phase (ph) of the pedalling
cycle. The cut point of those different parts is
identified using the low-frequency component of
the acceleration at the pedal. This transmissibility
References
Arpinar-Avsar. 2009. Vibration transmission to
bicycle and rider: a field and a laboratory study.
Middle east technical university.
Chiementin et al, J. Vib. Control, 19(16):255160, 2012.
Parkin et al. UTSG 46th Conference: 68, 2014.
262
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ASYMMETRY OF ACHILLES TENDON MECHANICAL AND

MORPHOLOGICAL PROPERTIES BETWEEN BOTH LEGS
S. Bohm1, F. Mersmann1, R. Marzilger1, A. Schroll1, A. Arampatzis1
1
Humboldt-Universitt zu Berlin, Department of Training and Movement Sciences,

Berlin, Germany
Introduction
Although symmetry of Achilles tendon (AT)
properties between legs is commonly assumed in
research [e.g. Rosager, 2002] and clinical settings
[e.g. Silbernagel, 2006], different loading profiles of
both legs in daily life (i.e., foot dominance) may
affect the tendon properties in a side-depended
manner. Therefore, AT properties were examined
with regard to symmetry between legs.
Methods
Thirty-six male healthy adults (28 4 years),
who were physically active but not involved in
sports featuring dissimilar leg load participated.
Mechanical,
material
and
morphological
AT properties of the non-dominant and dominant
leg were measured by means of ultrasound,
magnetic resonance imaging and dynamometry.
A paired t-test was used to assess the differences
between AT properties of both legs and the
absolute asymmetry index (AAI) [Karamanidis,
2003] to analyse their symmetry:
AAI = |xD-x ND| / (xD+xND) 100%
Figure 1: A
bsolute asymmetry index for the investigated
parameters of the Achilles tendon (AT) and triceps
surae muscle of the non-dominant and dominant
leg (n = 36). Moment is referring to the maximum
plantar flexion moment, force is the maximum calculated tendon force, elongation is the maximum
elongation of the AT, lever arm is the AT lever arm,
stiffness is the AT stiffness, rest length is the distance
from the tuberositas calcanei to m. gastrocnemius
medialis-AT junction, strain is the maximum strain of
the AT, Emodulus is the Youngs modulus of the AT,
CSA is the average AT cross-sectional area, length
is the length of the free AT (m. soleus-AT junction
to initial attachment on the calcaneus bone) and
stress is the maximum AT stress.
(1)
x ND is the parameter from the non-dominant and xD

the corresponding parameter from the dominant
side. A value of close to 0% indicates that symmetry
is given.
Results
The AT of the dominant leg possessed a significant
higher Youngs modulus and length (P<0.05) but a
tendency toward lower maximum strain (P=0.068)
compared with the non-dominant leg. The
tendon cross-sectional area and stiffness were not
significantly different between sides. The absolute
asymmetry index of the investigated parameters
ranged from 3% to 31% indicating poor AT side
symmetry (fig. 1).
References
Karamanidis et al, Med Sci Sports Exerc,
35: 10091016, 2003.
Silbernagel et al, Knee Surg Sports Traumatol
Arthrosc, 14:12071217, 2006.
Rosager et al, Scand J Med Sci Sports,
12:9098, 2002.
Discussion
These findings provide evidence of distinct
differences of AT properties between both
legs in a population without any sport-specific
side-depended leg loading. The observed asymmetry
may be a result of different loading profiles of both
legs during daily activities (i.e., foot dominance) and
challenges the general assumption of symmetrical
AT properties between legs.
263
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LOADING OF THE KNEE AND HIP JOINT DURING

NORDIC WALKING
I. Kutzner1, P. Damm1, J. Dymke1, G. Bergmann1
1
Introduction
Nordic Walking (NW) is generally recommended
as low demanding activity which stimulates the
cardiovascular system. However, little is known
about the actual joint loading. Therefore, the aim
of this study was to measure hip and knee joint
loading during NW in vivo.
During NW Fres was often slightly increased

compared to normal walking (Table 1). Using the
double-poling technique smaller joint forces and
higher pole forces were observed compared to
the standard NW technique. Maximum pole forces
were applied during the early stance phase.
Methods
Instrumented implants were developed to measure
the joint contact forces in vivo [Heinlein 2007, Damm
2010]. Two male subjects (65/75 years, weight
(BW): 90/97 kg) with instrumented knee implants
and 2 male subjects (64/69 years, 80/86 kg) with
instrumented hip implants participated in this study.
The subjects were instructed by a NW coach and
performed 2 techniques, standard NW technique
and double-poling technique. Synchronous to the
resultant joint force (Fres) the contralateral axial
pole force (Fpole) was measured. Joint forces are
given in % of body weight (%BW).
Table 1: C
hanges of Fres during NW compared to normal
walking. Pole forces Fpole are given for the instants
of Fres1|Fres2.
Discussion
Contrary to popular assumptions a general
reduction of hip or knee joint loading by NW poles
was not observed. Often joint forces were even
higher than during normal walking. Slightly lower
joint loads are to be expected when using the
double pole technique compared to the standard
technique. The measurements have been carried
out with only 4 subjects and do not allow a general
statement yet.
Results
Within the stance phase of gait two peak values
(Fres1|Fres2) were observed in the resultant hip and
knee joint force (Figure 1). During normal walking
without poles peak forces of 275|288 (H2) and
284|238 (H6) %BW in the hip joint and 243|207 (K3)
and 214|240 (K5) %BW in the knee joint were
measured.
References
Damm et al, Med Eng Phys, 32:95100, 2010.
Heinlein et al, J Biomech, 40:S410, 2007.
This study was supported by the German Research
Foundation (DFG Be 804/18-1, Be 804/19-1) and
Deutsche Arthrose-Hilfe.
Figure 1: E
xemplary hip joint forces Fres and pole forces
Fpole during NW and normal walking
264
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STABILITY ANALYSIS OF GYMNASTIC LANDINGS

A. Siemienski1, P. Piestrak2, B. Pietraszewski1, A. Rutkowska-Kucharska1, R. Serafin2,
M. Sobera2, A. Struzik3
1
University School of Physical Education, Biomechanics, Wroclaw, Poland

2
University School of Physical Education, Gymnastics, Wroclaw, Poland

3
University School of Physical Education, Games, Wroclaw, Poland
Introduction
Stability of human posture is often associated
with the equilibrium condition that dates back to
Borelli [Pai and Patton, 1997]. It states that a body
will retain a stable upright position as long as the
vertical projection of its centre of mass remains
within its base of support.
Results
The results were expressed as positions of the
vertical projection of the whole body centre of
mass with respect to the position of the feet (base
of support) at the instant of impact, juxtaposed
with the horizontal and vertical velocities of the
centre of mass at the same moment.
There are situations, however, that are clearly

not accounted for by this simple and appealing
equilibrium condition, as when coming to a stop
while walking. An improved equilibrium condition
that can deal with such cases was formulated
by Hof et al. [2005] as the condition for dynamic
stability; it takes into account the position of the
centre of mass as well as its velocity.
They turned out incongruent with the dynamical

stability condition [Hof et al., 2005], resulting in
cases of false negative predictions: many landings
that the dynamical stability condition assessed to
end with a FLOB (forward loss of balance) were in
fact succesfull, perfectly stuck landings.
Discussion
The results suggest that the dynamical stability
condition cannot succesfully predict stability or loss
of balance in gymnastic landings. A modification
of the dynamical stability condition is therefore
needed.
While this dynamic stability condition works well for

walking, when velocity is predominantly horizontal,
it is not clear whether it can account for balance
maintenance when both velocity components,
horizontal and vertical, are substantial [Sheets and
Hubbard, 2007].
Not included here were violations of the original

Borelli stability condition due to the possibility of
movements at joints other than the ankle joint
[Curtze et al., 2010; Otten, 1999]; they may have
their counterparts within the context of this study,
and are therefore worth investigating.
To check this, we considered gymnastic landings

that occur after dismounts from equipment, often
as the final element of a routine, and are required
to be stuck, i.e. end in a still position; the vertical
movement component was important in all of
these landings.
C o n cl u s i o n
The horizontal and vertical components of a
gymnasts movement must not be seen separately
as balance factors; they should instead be
combined in such a way so as to base the stability
condition on angular momentum transfer.
Methods
Three female gymnasts and two male gymnasts
participated in the study. We asked them to
perform routines that ended with landings. The
landings were those occuring during dismount from
the balance beam in womens gymnastics and
those that conclude the vault over the vaulting
table in mens gymnastics.
References
C
urtze C. et al., Gait & Posture 32:627631, 2010.
H
of A.L. et al., J of Biomechanics, 38:18, 2005.
Otten E., Phil. Trans. R. Soc. Lond. B, 354:869875, 1999.
P
ai Y-C and Patton J., Journal of Biomechanics,
30(4):347354, 1997.
S heets A. and Hubbard M., Sports Engineering,
10:209220, 2007.
To analyse the landings we used the BTS SMART

(Italy) 3D movement analysis system to capture
the whole body kinematics. Four infrared cameras
were placed in such a way so as to cover the area
where the gymnasts were expected to land as well
as the area over which the final approach to the
landing took place. They were operated at 250 Hz.
The motion capture sessions took place in the gym
where the gymnasts normally practice and using
the equipment they were familiar with.
The position of the whole body centre of mass was
calculated based on the motion capture data,
and its velocity was then found by differentiation.
These quantities allowed for linear momentum
transfer during the landings, both vertical and
in the fore-aft direction, to be assessed. Angular
momentum transfer was estimated as well.
265
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MECHANICAL SIGNALS IMPARTED TO BONE MARROW

CELLS USING MULTISCALE MODELING
T.A. Metzger1,2, T.J. Vaughan1, L.M. McNamara1, G.L. Niebur2
1
National University of Ireland, Galway, Department of Biomedical Engineering,

Galway, Ireland
University of Notre Dame, Bioengineering Graduate Program, Notre Dame, USA
Introduction
Bone adapts to habitual loading through
mechanobiological signalling. Osteocytes are the
primary mechanical sensors in bone, upregulating
osteogenic
factors
and
downregulating
osteoinhibitors. However, most of the cell
populations of the bone marrow niche, which are
involved with bone remodelling as the source of
bone osteoblasts and osteoclast progenitors, are
also mechanosensitive. We hypothesized that the
deformation of trabecular bone would impart
mechanical stress within the entrapped bone
marrow consistent with mechanostimulation of the
constituent cells.
a median shear stress of 10.8 Pa, while the 20% BV/TV

sampled developed an 8.2 Pa median shear stress
(Fig. 1D). When the median stress was applied at
the cellular-level, the stresses were amplified by
a factor of 3 and more broadly distributed (Fig. 1D).
In this study, we developed a fluid-structure

interaction (FSI) model that characterizes the
mechanical environment of trabecular bone
marrow at the tissue and cellular levels to
understand the role of bone loss and marrow
adiposity on bone marrow mechanotransduction.
Methods
Two trabecular bone specimens, with bone volume
densities of 20 and 32%, were scanned by -CT (Fig.
1A). Computational models of the bone marrow
were formulated at two-length scales. At the
tissue-level, confined compression was applied
cyclically to the solid matrix to a maximum of 2000 or
3000 -strain at 1 or 2 Hz. A coupled CFD model was
used to calculate the resulting marrow mechanics.
The marrow was modeled as a Newtonian fluid
(0.4 or 85 Pas viscosity) (Bryant, 1989; Zhong, 2011)
or a power-law fluid (Metzger, 2014). At the cellular-level, marrow was modeled as a tri-phasic material
with constituents based on size and mechanical
properties: adipocytes, marrow cells, and blood
plasma (Bruder, 1998). Stress boundary conditions
were applied to the cell-level models based on
the median shear stress in the tissue-scale models
(Fig. 1A-B).
Discussion
The results demonstrate that compression of
trabecular bone during activities of daily living
can play a role in mechanical stimulation of the
cells in the bone marrow. Importantly, cell-level
shear stresses far exceeded levels that have
been found to cause osteogenic responses
from osteoprogenitors in vitro (typically ~1Pa).
The shear stress was lower in more porous bone,
suggesting that marrow mechanics could be
affected by bone diseases like osteoporosis that
cause a reduction in bone density. The overall
relationship is complex, as modulus decreases with
density, resulting in increased strain and osteocyte
stimulation. However, marrow mechanics depend
on strain rate, which may not scale with magnitude.
Results
At the tissue level, compression of trabecular
bone induced motion in the marrow within the
pore space. The velocity was lower than 0.1 mm/s,
averaging 0.016 mm/s. The mean shear stress and
mean pressure gradient followed a haversine with
peaks corresponding to the maximum deformation
rate of the bone. Both the mean shear stress and
pressure gradient increased linearly with viscosity
(Fig. 1C). When the power-law model was applied,
the mean shear stress reached 8 Pa with an
average pressure gradient of 0.46 kPa/mm at peak
strain rate. The 32% BV/TV sample developed
References
Bruder et al, J. Orthop.Res.,16: 155162, 1998.
Bryant et al, Proc Inst Mech Eng H, 1989.
Metzger et al, JMBBM, 40: 307313, 2014.
Zhong et al, Biorheology, 00: 19, 2011.
266
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SIMULATING PROTEOGLYCAN TURNOVER AND CELL

VIABILITY IN THE INTERVERTEBRAL DISC: A NUMERICAL
EXPLORATION OF NUTRITION-INDUCED CHANGES
ALONG DEGENERATION
C. Ruiz Wills1, A. Malandrino1, D. Lacroix2, J. Noailly1,3
1
Institute for Bioengineering of Catalonia, Biomechanics and mechanobiology,

Barcelona, Spain
INSIGNEO Institute for in silico medicine, Mechanical engineering, Sheffield, United Kingdom
Universitat Pompeu Fabra, Information and Communication Technologies, Barcelona, Spain
Introduction
Up to 85% of the population may suffer from low
back pain, often related to intervertebral disc (IVD)
degeneration (DD). Proteoglycan (PG) loss is a major
DD change, and affects disc osmotic pressure and
hydration, both relevant to nutrition. However, the
interaction between biochemical degradation and
nutrition during DD is still unclear. As such, this study
aims to explore the effect of PG loss on cell viability
via disc nutrition.
cF0 reduction alone had few effect on the calculated

solute concentrations. However when decreased
osmotic pressure was combined with a water loss
equivalent to the one reached in the fifth decade of
age, increased tissue consolidation made final glucose
concentration decrease by 30% (Fig. 2). Peaks of
pressure never affected the solute concentrations.
Cells remained alive in all simulation performed.
Methods
A L4-L5 IVD finite element model incorporated
composition-based tissue descriptions [Schroeder,
2010], and was coupled to a solute transport-cell
viability model [Malandrino, 2014]. PG fixed charge
density cF0, was a poromechanical parameter.
The transport model was modified and allowed cF0
updates, depending on the half-life, , and production
rate, kprod, of PG (Eq. 1). kprod switched between full rate
and 80% of the latter according to oxygen pressure
[Horner, 2001]. Full rate was calculated by assuming a
homeostatic state under ideal oxygen concentration.
c F0,t = c F0,t-1exp(-t)+k prodCell viabilityt
Figure 2: Simulation results for glucose content at the nucleus

centre, after 3 days
Discussion
In the non-homeostatic zone, the cF0 value of 0.17 mEq/mL
corresponds to a Pfirrmann grade III IVD, typical for
humans within the fifth decade of age [Steffen, 1996].
PG loss made the nucleus lose its swelling capability.
However, the need of additional water reduction
to reduce the nucleus glucose content suggests
that fibrosis or other PG-independent dehydration
processes are more relevant to nutrition issues.
(1)
Three cycles of daily load were simulated, each

consisting in 8 hours of rest and 16 hours of activity,
under 0.11 MPa and 0.54 MPa of compression,
respectively. Punctual increases of load were simulated
by distributing 9 peaks of 1.1 MPa during activity.
Fixed solute concentrations were applied at the outer
surfaces of the annulus and cartilage endplates.
pH and glucose levels did not reach the critical values

at which cells start to die, but whether the predicted
levels are low enough to trigger enzyme expressions
needs to be elucidated experimentally [NeidlingerWilke, 2012]. Specific disc geometries might involve
larger diffusion distances, which requires further
exploration.
Results
After the three days simulated, the nucleus
presented a large non-homeostatic zone in terms of
cF0 regulation, at the mid-height of the disc (Fig. 1).
This zone was surrounded by a quasi-homeostatic
zone. Using a time equivalent to about 45 years of
age for a patient, cF0 reached a value of 0.17 mEq/mL.
This study shows that disc cell nutrition might explain

the natural depletion of PG along degeneration. Yet,
it is important to unravel the origin of PG-independent
dehydration.
References
Schroeder, Y. et al, Biomech Model Mechanobiol,
9:641650, 2010.
Malandrino, A. et al, J Biomech, 47:15201525, 2014.
Horner, H.A. et al, Spine 26:25432549, 2001.
Steffen, A.J. et al, j Clin Invest 98(4):9961003, 1996.
Neidlinger-Wilke, C. et al, J Orthop Res, 30:
11221, 2012.
Figure 1: N
ucleus fixed charge density (cF0) distribution after
three simulated days
267
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MORPHOLOGICAL, MECHANICAL AND BONE TISSUE

PROPERTIES OF DMD AND TREATED MOUSE BONES
S.N. Mohamad1, J. Tong1, D. Gorecki2, M. Guille3 , P. Zioupos4
1
School of Engineering, University of Portsmouth UK, Mechanical Bahaviour of Materials,

Portsmouth, United Kingdom
University of Portsmouth UK, School of Pharmacy and Biomedical Sciences, Portsmouth,

United Kingdom
University of Portsmouth UK, School of Biological Sciences, Portsmouth, United Kingdom

4
Biomechanics labs, CFI, Cranfield University, DA of the UK, Shrivenham, UK
Introduction
Duchenne Muscular Dystrophy (DMD) is caused
by mutations in the dystrophin gene 1 and it has
been shown to affect bone tissue morphology 3.
To understand the mechanisms of DMD and to
develop novel treatment strategies, a receptor,
P2X7, was ablated in the mdx mouse model of DMD
and the effect assessed. In this study, we compare
the morphometric, the mechanical competence
and the bone matrix properties of the mouse
bones at 4 weeks of age between the treated, the
wild type and the mdx mice. The aim is to establish
the role of P2X7receptor in DMD at this early stage,
when muscle wasting has not yet fully developed.
at the early stage of the disease. Switching off

P2X7receptor generally appears to have improved
the overall morphometric, mechanical and bone
material properties of mdx, although not in all
parameters tested were the changes statistically
significant.
Genotypes studied were wild type (WT), mdx, P2X7-/knockout and mdx/P2X7-/- double knockout (n=6
for all groups). Four-week old mice tibias were
imaged using CT (XT H 225, X-Tek Systems Ltd) and
data acquisition was performed (V=5055kV,
I=95110A). The 3D reconstruction of the
samples was obtained using VG Studio MAX. The
morphometric parameters were taken at proximal
and midshaft levels (Fig. 1). A three-point-bending
arrangement was used to test the whole bone
samples at a rate of 0.155 mm/s until failure using
a Bose testing machine 2. Nano-indentations were
performed using a CSM-Nano Hardness Tester.
Students t-test was performed using PASW (ver. 18.0).
In mdx mice, significant bone loss is demonstrated
by evident morphometric parameters in both
proximal and midshaft regions as opposed to WT
(Table 1). In mdx/P2X7 -/- mice, most results show an
improvement over mdx, apart from the maximum
load at fracture and stiffness. Generally, the results
from P2X7-/- are close to those of WT. Results from
mechanical testing show significantly decreased
maximum load (by 38%), fracture energy (by 65%)
and stiffness (by 41 %) in mdx compared with
those in WT. In P2X7-/- mice, these parameters
are comparable to those of WT while mdx/P2X7-/values were not significantly different from mdx.
The cortical bone matrix properties of mdx/P2X7-/showed significant improvement in hardness and
elasticity compared to those of mdx (Fig 2).
There are significant differences between the
morphological, mechanical and bone tissue
properties between WT and mdx bones already
268
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SOST DEFICIENCY ALTERS RESORPTION CAVITY SHAPE

IN PHYSIOLOGICALLY AND ADDITIONALLY IN VIVO
LOADED MICE TIBIAE DETERMINED USING REGISTERED
LONGITUDINAL CT-IMAGES
A. Birkhold1, E. Thomson1, D. Pflanz1, T. Thiele1, M. Kneissel2, G. Duda1,
S. Checa1, B. Willie1
1
Charit Universittsmedizin Berlin, Julius Wolff Insitute, Berlin, Germany

2
Novartis Pharma, Novartis Pharma, Basel, Switzerland
C o n cl u s i o n
Our
combined
experimental-computational
approach reveals that adaptive formation as well
as resorption is regulated via a SOST-independent
pathway. In addition, SOST deficiency leads
to a change in resorption cavity shape: lower
surface and increased depth, which might alter
cortical porosity. However, this needs to be further
investigated.
Introduction
Sclerostin, encoded by the SOST gene, plays a
key role in bone homeostasis and may regulate
mechanotransduction 1. Morse et al. found that
SOST deficiency inhibits bone loss induced with
unloading and can augment increased bone
formation with loading 2. However, it is unclear if
these effects were solely due to reduced/increased
bone anabolism, or changes in resorption. We
aimed to determine the effect of SOST deficiency
on the kinetics of physiological and adaptive bone
formation and resorption.
Adult, 26 week old female (SOST-/-, littermate
C57Bl/6; n=7/genotype) mice underwent two
weeks of in vivo cyclic compressive loading
of the left tibia (216 cycles/day; f=4Hz;
max=900, right tibia control) 3. In vivo CT was
performed at day 0, 5, 10 and 15 at the tibial
mid-diaphysis. Images were rigidly registered and
segmented. Time-lapsed images were compared
(dayt=0 dayt=k) 4. Voxels were classified as
formed, resorbed or quiescent. 3D dynamic in
vivo morphometry was performed to quantify
sites of formation and resorption by volume
(MV/BV, RV/BV), surface area (MS/BS, RS/BS) and
thickness/depth (MTh, ED) (Fig.1a). For statistics,
repeated measures ANOVA and t-tests were used,
with values as mean SD, p<0.05.
Figure: (a) Methods. (b) Kinetics of mineralized and resorbed

bone volumes in loaded and control tibiae of WT
and SOST-/- mice. (c) Visualization of formation
and resorption at the endocortical and periosteal
mid-diaphysis. (d) Surface area and thickness/depth
of remodeling sites after 15 days.

Formation did not differ but, ES/BS was significantly
smaller and ED greater in SOST-/- compared
to WT mice. Loading led to a trend of elevated
formation in WT mice and significantly more
formation (MV/BS,MS/BS) in SOST-/-, whereas
resorption was significantly reduced in WT and
SOST-/- mice (Fig.1b,c,d).
References
1 Robling A et al., JBC 283(9):58665875, 2008
2 Morse A et al., JBMR 29(11):24562467, 2014
3 Willie B. et al., Bone 55(2):335346, 2013
4 Birkhold A. et al., Biomaterials 35:92909301, 2014
We thank S. Prohaska and H.-C. Hege for use of
ZIBAmira and the German Research Foundation
(WI 3761/1-1, WI 3761/4-1) for funding the study.
269
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INFLUENCE OF ESTROGEN RECEPTOR AND SS-CATENIN

SIGNALLING ACTIVATION ON MECHANICALLY INDUCED
BONE FORMATION IN OVARIECTOMIZED MICE
C. Nemitz1, M. Haffner-Luntzer1, F. Jakob2, A. Ignatius1, A. Liedert1
1
University, Institute of Orthopaedic Research and Biomechanics,

Center of Musculoskeletal Research, Ulm, Germany
University, Orthopaedic Center of Musculoskeletal Research, Wrzburg, Germany
Introduction
Dysfunctions of Wnt/-catenin and estrogen receptor signalling resulted in impaired mechanotransduction and bone loss as in osteoporosis [1,
2]. Previous studies demonstrated the interaction
of these pathways in mechanotransduction in
vitro and in vivo [3]. In this study, the influence of
the activation of estrogen receptor and -catenin
signalling on mechanically induced bone formation was investigated in ovariectomized mice.
and bone structure was analysed. Each treatment

group included 6 mice. Data were analysed for
significance (value p < 0.05) using the Mann-Whitney-U test. All experimental procedures were
approved by the National Ethics Committee.
Results
Loading induced bone formation. At the
endocortical surface, estrogen induced bone
formation and acted additively with loadin g.
At the periosteal surface, both estrogen and
SB415286 enhanced mechanically induced bone
formation in ovariectomized mice. When estrogen
and SB415286 were administered together, the
sensitizing effect on mechanically induced bone
formation of each activator alone was abolished
in these mice.
Methods
12-week-old mice were ovariectomized. 4 weeks
later, an estrogen pellet was implanted and the
right ulna was loaded for 2 weeks on 5 consecutive
days. For -catenin activation, the Gsk-3
inhibitor SB415286 was injected daily during the
loading period. Endocortical and periosteal bone
formation rates (EcBFR, PsBFR) was calculated
Control
Estrogen
SB415286
Estrogen +
SB415286
1.2 0.3*
1.2 0.5*
2.4 0.3*
OVX
EcBFR [m 3/m 2/d]
PsBFR [m 3/m 2/d]
1.1 0.4
1.6 0.3#
2.3 0.5*#
0.12 0.03
0.08 0.07
0.2 0.16
0.04 0.05*
2.2 0.8 #
5.6 1.4*#
6.6 1.8*#
2.2 0.6 #
*: p < 0.05, treatment vs. control group #: p < 0.05 loaded (L) vs. unloaded (C) ulna
Discussion
The interaction of estrogen receptor and
Wnt/-catenin signalling might be one mechanism
that is involved in regulating bone mass homeostasis
in response to different loading conditions.
References
[1] Rosen (2005), N Engl J Med 353, 595603
[2] Rawadi, Roman-Roman (2005), Expert Opin Ther
Targets 9, 106377
[3] Armstrong et al. (2007), J Biol Chem 282, 2071527
270
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MODELLING AND BIOMECHANICAL ANALYSIS

OF DISTAL HUMERUS FRACTURE STABILIZATION
A. Kruszewski1, J. Ogrodnik1, P. Piekarczyk2, K. Kwiatkowski2, S. Piszczatowski1
1
Bialystok University of Technology, Department of Materials and Biomedical Engineering,

Bialystok, Poland
2
Military Institute of Medicine, Department of Traumatology and Orthopaedics, Warsaw,

Poland
Introduction
The healing of multifragmental fractures of the
distal part of humerus still remains a difficult
problem in orthopaedics. The bone union requires
a stable fixation while in order to ensure a high
range movement in the elbow joint a very early
mobilization after the injury is required. A surgery
with the use of locking plates and screws is the
gold standard in such situation. Nowadays, two
configurations of the plate stabilizer (orthogonal
and parallel) are used, but it still remains
controversial which method is better. The global
stiffness of the bone stabiliser system was evaluated
in experimental research [Penzkofer, 2010; Zalavras,
2011]. However, reciprocal displacements between
particular bone fragments are more important for
the bone union.
A simplified inhomogeneous model of bone tissue

(cortical bone, two types of cancellous bone and
marrow cavity) was applied.
A joint reaction force in the elbow was taken for the
flexion [Kincaid, 2013] as well as for the pronationsupination of the forearm. To calculate the value
and the direction of joint reaction a model of
the upper extremity was analysed with the use
of the AnyBody software (AnyBody Technology).
Results
Displacement, strain and stress patterns were
obtained for bone stabilizer system. A global
stiffness were calculated on the basis of relation
between force and maximal displacements.
However, the most interesting was to evaluate
of the reciprocal displacement of articular bone
blocks (Fig. 2).
The aim of the present study was to elaborate

a numerical model of the distal humerus a stabiliser
system, and to evaluate the stability of articular
bone fragments for various loading conditions.
Methods
A geometrical model of the fractured humerus was
prepared on the basis of CT-data.
Two plating techniques: parallel (medial and lateral
plates) and orthogonal (medial and postero-lateral
plates) were considered (Fig.1.).
Figure 2: R
eciprocal displacements of medial and lateral
bone blocks calculated for points 1-3 (a) in
tangential direction to the fracture surface (b)
Discussion
The results of the analysis showed a similar global
stiffness of parallel and perpendicular plate
configurations. This is coincident with earlier
experimental studies. Differences between both
plate arrangements are visible in case of the
reciprocal bone fragment movement analysis.
Better results for the parallel configuration were
obtained. The simulations made for the elbow joint
reaction calculated for various activities showed
an insufficiency of stabilisation and could be
helpful to find an optimal rehabilitation plan.
References
Zalavras et al, J Shoulder Elbow Surg, 20:1220, 2011.
Penzkofer et al, Clin Biomech, 25:972978, 2010.
Kincaid et al, J Biomech; 46:23312341, 2013.
Figure 1: M
odel of the fractured distal humerus stabilizer
system. Plates in parallel (a) or orthogonal (b)
configuration
271
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ANTERO-LATERAL LOCKING PLATE IMPROVES GREATER

TROCHANTERIC FRACTURE FIXATION
Y. Petit1, L. Cloutier1, Y. Laflamme2
1
cole de technologie suprieure, Mechanical Engineering, Montral, Canada
Hopital du Sacr-Coeur de Montral, orthopaedic surgery, Montral, Canada
Results
The paired study showed that MIG of the GT
fragment significantly decreased in PA translation
(P=0.02) and rotation (P=0.01) with anterolateral plate as compared to a lateral plate. DISP
also decreased in PA (P=0.04) and LAT (P=0.03)
translation as well as for rotation around the
superior axis (P=0.04) with the AL implant.
Introduction
Greater trochanter (GT) fracture is a common
complication of primary or revision total hip
arthroplasty [Hendel, 2002]. This procedure is also
associated to a high rate of post-operative failures
and incomplete healing [Jarit, 2007]. Current
commercially available GT reduction plates fix
the fragment mainly in the lateral and superior
directions. However, recent clinical evidence
[Laflamme, 2012] suggests good clinical outcomes
on complex non-union of the GT using anterior and
lateral locking plates and screws.
Varying the GT fragment fixation from cable

cerclage only to locking screws showed a very
significant reduction in translational and rotational
MIG (all P<<0.01, exception rotation around
superior axis with P=0.66). The femoral shaft
fixation method significantly reduced superior MIG
translation when using screws were used (P<<0.01).
DISP was also significantly reduced by varying the
fixation from cerclage only to locking screw only for
superior translation and rotation around the PA axis
(P<<0.01), and to a lesser extent for rotation around
the lateral axis (P=0.01). The femoral shaft fixation
method showed no significant reduction of all DISP.
The objective of this study was to investigate on

the contribution of counteracting the anteroposterior in addition to cephalo-caudal forces and
of the use of locking screws on the primary stability
of GT fragment.
Methods
Two experimental protocols were performed on
a custom-made test-bench applying a load to
activate the abductors towards a PA direction
simulating a quasi-dynamic stair climbing. The
first protocol was a paired study performed on 20
cadaveric femurs to compare 2 types of fixation
plates (antero-lateral vs lateral plate). The second
protocol was a complete experimental design, with
2 repetitions for a total of 27 trials, performed on
synthetic specimens (Sawbones, 4th generation). The
latter compared locking screws, cable cerclage or
both fixations on the proximal (GT) and distal part
(femoral shaft) of an antero-lateral plate. Two main
responses were measured for both protocols: the
amplitude of movement between unloaded and
loaded states within a single cycle (DISP) and the
residual GT movement after cyclic stair climbing
compared to initial state (MIG).
Discussion
A novel quasi-dynamic stair climbing experimental
test bench was used to compare lateral versus
antero-lateral fixation of greater trochanteric
fractures, as well as to investigate on the optimal
fixation method of an antero-lateral plate
between locking screw and cable cerclage in
the proximal (GT) and distal (femoral shaft) parts.
The results show that an antero-lateral locking
plate represents an efficient surgical alternative
conteracting the multi-directional GT movements
occurring during hip-extension. It also suggests that
using cable cerclage is only recommended on the
femoral shaft when screw fixation is unachievable.
References
Hendel et al, Acta Orthop., 73:295297, 2002.
Jarit et al, J Am. Acad. Orthop. Surg., 15:614624, 2007.
Laflamme et al, J Arthroplasty, 27:638642.
272
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IN VITRO TESTING OF LOCKING PLATE FRACTURE

FIXATION WRONGLY PREDICTS THE PERFORMANCE
OF DIFFERENT IMPLANT MATERIALS
A. MacLeod1, H. Simpson2, P. Pankaj1
1
2
The University of Edinburgh, School of Engineering, Edinburgh, United Kingdom
Introduction
Locking plates are now routinely used for many
fracture patterns. It is known that the stiffness of
plates can be altered by different plate materials
and by positioning of the screws (Stoffel, 2003). More
flexible plates have been shown to better stimulate
healing (Lujan 2010), however, experimental
studies have shown that more rigid plates withstand
a greater number of loading cycles before fatigue
failure (Schmidt, 2013, Hoffmeier, 2011). These
findings infer that surgeons must compromise
on flexibility for plate durability. Throughout the
clinical literature, however, it is the generally more
rigid devices that experience plate breakage (Tan,
2009, Button, 2004, Hak, 2010). The study aimed to
explain this phenomenon by evaluating the plate
stress for in vitro tests compared with more realistic
modelling.
Results
The two different model types were found to
produce contradictory results regarding the effect
of plate material. In the in vitro style tests, case
(a), titanium plates produced larger stresses; in
the more realistic model, case (b), steel plates
produced larger stresses.
These differences were found to be a result of the
callus formation within the fracture gap, which
is absent in the in vitro case (a). This aspect was
investigated further and it was found that increasing
the callus stiffness alters the relative performance
of different rigidities of plate (Figure 2).
Methods
The study used three-dimensional finite element
models to evaluate the differences between
different types of modelling. Firstly, in vitro style
testing was examined using a gap defect model
(Figure 1a). Experimental models were used for
validation and to ensure each aspect of the
models was functioning correctly.
These models were then developed further to
incorporate the effect of fracture healing by
gradually increasing the Youngs modulus of the
callus surrounding the fracture (Figure 1b). More
realistic loading was also included using muscle
forces and joint reactions.
Figure 2: P
redicted plate stress under a given load for
increasing values of callus stiffness.
Discussion
The results provide an explanation as to why it is
generally the smaller bridging spans that result
in plate breakage. Rigid plates perform well in
the lab as they bend less reducing plate stress,
however, this study has shown that they produce
larger stresses later in the healing period.
In reality, even greater differences would be
observed as the speed of callus formation is thought
to be related to the plate flexibility (Lujan, 2010).
References
Stoffel et al, Injury, 34:1119. 2003.
Lujan et al, J Ortho Trauma, 24:15662. 2010
Schmidt et al, JoB, 42:19261934. 2013.
Hoffmeier et al, ClinBiomch, 26:405409. 2011
Tan et al, Inj-Int J Care Inj, 40:683691. 2009.
Button et al, J Orth Trauma, 18:56570. 2004.
Hak et al, Orthopedics, 33:752755. 2010.
Figure 1: ( a) in vitro style model with gap defect and

(b) model with muscles forces and callus
formation (purple region).
273
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VALIDATION OF A COMPUTATIONAL MODEL FOR

PREDICTION OF LOWER-LIMB INJURY
IN UNDER-VEHICLE EXPLOSIONS
N. Newell1, S. Masouros2
1
2
Imperial College London, London, United Kingdom
Introduction
The improvised explosive device (IED) has been
the single most prevalent threat to Coalition
Troops in recent conflicts 1. They are capable of
causing multiple severely injured casualties in a
single incident. Previous research has shown that
occupants lower extremities are particularly
susceptible to injury 2 and therefore various
mitigation systems have been developed to try
to reduce the severity of these injuries. Using
experimental techniques, these systems have
been shown to reduce the force transmitted
to the lower extremity 3, however, experimental
analysis is expensive and time consuming. The MILLx anthropometric test device was developed in
2009 to mimic to some extent the behaviour of the
human leg during an under-vehicle explosion and
presents the most biofidelic surrogate for undervehicle explosion research to date4.

The model of the combat boot was validated
against drop-tower tests5 and the MIL-Lx model was
validated against traces of upper tibia axial force
and compliant element compression obtained
through experiments conducted on a traumatic
injury simulator at a range of severities6.
In order to gain further confidence in the FE model,
boundary conditions and respective tibial axial
loads were obtained from five MIL-Lx experiments
conducted independently on University of
Virginias ODYSSEY rig 7. The difference in peak
axial force in lower and upper tibia load cells of
the MIL-Lx were 9% (range 117%) and 13% (range
919%), respectively.
C o n cl u s i o n
A validated numerical model of the MiL-Lx with
combat boot has been developed which can
now be used as a tool to examine the effect of
loading and protective systems on injury severity in
under-body blast without the need for expensive
experimentation.
The aim of this study was to develop a validated

finite element model of the MIL-Lx fitted with a
combat boot, which can be used as a tool to
assess current and design new mitigation systems
quickly and inexpensively.
References
1 Ramasamy A et al. J. Trauma 65:910914, 2008.
2 Ramasamy A et al. J. R. Soc. Interface 8:689698, 2011.
3 Quenneville CE and Dunning CE. J. Battlefield Tech.
14:14, 2011.
4 McKay BJ. PhD Thesis, Wayne State University,
Detroit, MI, USA, 2010.
5 Newell N et al. Inj. Prev. 18:109112, 2012.
6 Newell N et al. Proc. IRCOBI, 40:296303, 2012.
7 Bailey A et al. Proc. IRCOBI, 41:158170, 2013.
Axi-symmetric, finite element models of the MIL-Lx
and combat boot (Meindl Desert Fox Combat
Boot) were developed using MSC Marc
(MSC Software, USA) and validated separately
against experimental data.
Combat boot geometry was obtained through
analysis of the dimensions of the individual layers as
captured on microscopic computed tomography
(micro-CT) scans (HMX ST 225, Nikon Metrology Ltd,
Tring, UK) and the MIL-Lx geometry was reverse
engineered. The properties of the materials of
both combat boot and MIL-Lx were obtained
experimentally by harvesting material samples
which were then tested both quasi-statically and
dynamically in uniaxial compression tests.
Part of this work was conducted under the auspices of
The Royal British Legion Centre for Blast Injury Studies
at Imperial College London. Therefore the financial
support of the Royal British Legion is gratefully acknow
ledged. The financial support of the Royal Centre
for Defence Medicine (RCDM) for the acquisition
of equipment and consumables, of BBSRC for NN,
and of ABF The Soldiers Charity for SM are kindly
acknowledged. Finally, we thank the Defence
Science and Technology Laboratory (DSTL) for
lending us the MIL-Lx ATD.
274
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DESIGNING PASSIVE SAFETY SYSTEM PARAMETERS IN

AUTOMOBILES THROUGH INJURY
CRITERIA BASED OPTIMISATION
V. Esat1
1
Middle East Technical University Northern Cyprus Campus, Mechanical Engineering,

Mersin 10, Turkey
Introduction
Accidents are the fourth main reason of fatalities
after heart disease, cancer and stroke. Automobile
accidents constitute 49% of the overall accidents,
through which many people suffer various injuries
[Teng, 2008]. European Union addresses road
safety as a major societal issue. In 2011, more
than 30,000 people are reported to die on the
roads of the European Union [European Com.,
2012]. According to recent statistical data in the
United States, 72% of 33,800 people killed in road
vehicle accidents are occupants whereas drivers
alone comprise 52% of all fatalities [U.S. Census
B., 2012]. Crashworthiness and injury prevention in
automobile accidents warrant further research for
improved safety of the occupants.
2. Optimisation: Injury criteria predictions are

utilised in an optimisation algorithm to figure out
the best possible combinations for passive safety
system parameters as an attempt to mitigate the
injuries investigated altogether.
Results
Simulation predictions in the form of injury criteria
results for both female and male models at both
crash severities of 30 kph and 48 kph are collected.
An example is given in Figure 2. Then optimisation
of the collected data is carried out for the two
distinct sets of airbag deployment and steering
wheel column orientation cases.
Methods
This research embodies a novel methodology
to optimise the features of various passive safety
subsystems. The proposed methodology consists of
two consecutive steps:
1. Computational Modelling: Various computational
models comprising a typical automobile interior
with passive safety systems are constructed in a
specialised impact simulation software. Different
crash pulses are applied to the female and male
computational human body models simulating
full-frontal collisions. Selected passive safety system
parameters in the form of realistic airbag firing
times (AFT) and steering wheel orientations (SWCA)
are varied to investigate their effects. Predictions
including injury criteria for head, neck and upper
torso such as HIC, CTI, 3 ms max and maxVC are
analysed.
Figure 2: M
aximum viscous criterion (VC) vs steering wheel
column angle
Discussion
Analyses of predictions show for all injury criteria
that earlier the deployment, lower the injury value.
Airbag firing time should be chosen in the early
moments, roughly about within 525 ms, of the
onset of impact so that all injury related to head,
neck, and torso can be minimised. One of the final
optimised cases shows that an AFT of 9.143 ms and
a SWCA of 23.725 based on the 5 th female model
at 30 and 48 kph impacts provide some of the
lowest predicted injury criteria values.
References
European Commission, Directorate General for
Mobility and Transport, Statistics EU Road
Fatalities, 2012.
Teng T. L. et al, Technische Mechanik, 28 (34):
268278, 2008.
U.S. Census Bureau, Table 1105. Fatal Motor
Vehicle Accidents National Summary:
1990 2009, 2012.
Figure 1: C
onstructed vehicle computational model
including the 5th percentile female driver.
275
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BUS ACCIDENTS RECONSTRUCTION AND OCCUPANTS

INJURY ANALYSIS BASED ON COMPUTATIONAL
SIMULATION AND BIOMECHANICS INJURY CRITERIA
A.F. Vieira1, J. Dias2
1
Tcnico Lisboa, Institute of Mechanical Engineering, Lisboa, Portugal
Tcnico Lisboa, Institute of Mechanical Engineering, Lisbon, Portugal
Introduction
Bus accidents are uncommon, but in several
countries in Europe, the heavy passenger vehicle
(i.e. bus) accidents cause more than 20 deaths
during a single year (data from 2000 to 2012)
[CARE].
Discussion
Firstly, the severe injuries presented in unbelted
models supports others results previously reached
like in [Dias J. et al, 2010], [Albertsson P., et al (2006)].
Furthermore, to determine whether or not occupants
were using any retention system is interesting in
terms of legal processes and it could be used in
investigation of legal cases, in future, after improve
this analysis. So far, bus accident reconstruction,
namely the conditions under which it happened (bus
trajectory and retention systems used) could support
the methods and campaigns used to prevent and
minimise peoples injuries caused by road accidents.
Thus, the question is why are still so many people

dying? On the one hand some accidents are very
violent and nothing can be done, but on the other
hand, are the people using the required retention
system (common: seat belt)? Using biomechanics
models and bus accident simulations it is indented
to find out if the bus occupants behaviours and the
followed injuries are similar or not when they are
belted or unbelted.
References
Albertsson P., et al (2006): Case study: 128 injured
in rollover coach crashes in Swedeninjury outcome,
mechanisms and possible effects of seat
belts.Safety science 44.2 (2006): 87109.
Albertsson P. and Falkmer T., 2005: Is there a pattern
in European bus and coach incidents? A literature
analysis with special focus on injury causation and
injury mechanisms. Accident Analysis & Prevention
37.2 (2005): 225233.
CARE, 2013: Community database on accidents on
the roads in Europe, Mobility and transport, European Commission, Available at: http://ec.europa.eu/
transport/road_safety/pdf/statistics/historical_country_transport_mode.pdf
Datentechnik, S., 2013: PC-CRASH Operating and
Technical Manual Version 10.0. meaforensic.
Dias J. et al, 2010: In-depth Investigation and Reconstruction of Bus Accidents: Lessons from
a 17 Fatalities Accident, EVU Congress 2010,
1416 October 2010, Prague, Czech Republic
Hayes W. et al, 2007: Forensic Injury Biomechanics,
Annual Review Biomedical Engineering, 9 pp 5586
Kuppa S., 2004: Injury Criteria for Side Impact
Dummies; National Transportation Biomechanics
Research Center; National Highway Traffic Safety
Administration
Levine R., 2002: Injuries to the extremities, in
Accidental Injury Biomechanics and Prevention
(Eds. Nahum, Melvin), Springer Verlag, New York
Schmitt K-U., et al, 2007: Trauma Biomechanics
Accidental injury in traffic and sports, 2nd edition.
Springer-Verlag Berlin Heidelberg.
Transport Canada, 2002. Evaluation of occupant
protection in buses. Road Safety and Motor
Vehicle Regulation (ASFBE), Ottawa.
Vieira A., 2014: Computational Simulation of Buses
Accidents with Biomechanical Models, Injury
Analysis and Seat Belt Role. Master Thesis, Lisbon,
Instituto Superior Tcnico, Universidade de Lisboa.
Indeed, the large displacement between

occupants and vehicle structure causes huge
impact forces between these and high velocity of
ejection in case of this [Albertsson P. and Falkmer
T., 2005]. Moreover the rollover accidents are rare,
but the severity of the injuries is higher in this case
[Transport Canada, 2002] [Albertsson P., et al (2006)].
Methods
The methodology presented allows investigating
and performing the accident reconstruction
where a bus is involved, using the PC-Crash
software [Datentechnik, S., 2013]. The injury
analysis performed is based on injury criteria
(such as Abbreviated Injury Score (AIS) or Injury
Severity Scale (ISS)) [Schmitt K-U. et al, 2007]
[Kuppa S., 2004] [Levine R., 2002] [Hayes W. et al,
2007].
Results
Recently in Portugal, in two bus accidents,
28 people died, in total. From these five cases
study are studied and additional biomechanical
computational models are also used to analyse
the injuries.
It was verified that an unbelted passenger can be
subject to a wide range of motions during a rollover
bus accident is, which can be related to serious
injuries, cause of death or absence of injuries
in many body regions. And the most interesting
result is the proportional relation between
unbelted occupants and higher rates of fatality
[Vieira A., 2014].
276
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THE RISK OF A PEDESTRIANS FEMORAL BONE FRACTURE

DURING A CAR IMPACT
S. Pianigiani1, M. Bettoni2, W. Pascale1, F. Begani3 , B. Innocenti4
1
2
Universit Politecnica delle Marche, UnivPM, Ancona, Italy

3
IRCCS, Istituto Ortopedico Galeazzi, Milano, Italy

Universit degli Studi di Firenze, DIEF, Firenze, Italy
Universit Libre de Bruxelles, BEAMS Department, Bruxelles, Belgium
Results
The obtained results show that, among the several
considered parameters, the RF is mainly affected
by the impact force and the height of the
pedestrian. On the other hand, the bumper shape
and the inclination of the femur with respect to the
bumper, as well as the age of the pedestrian, are
more negligible factors.
Introduction
The declaration of false injuries in the context of
a car-pedestrian impacts is a common problem
with which the insurance companies have to face
constantly. To provide them a valid support tool,
this study aims to determine the risk of fracture (RF)
of the femur during a simulated car impact. The
conditions of the impact in a collision between
a car and a pedestrian were recreated through
a finite element model under several impact
situations.
Discussion
The results show that the features designs of a car
are not decisive for the RF, while the velocity of
the impact is more important to be correlated with
possible femur fractures. Moreover, the age of the
pedestrian, simulated as changes in the geometries
and material properties of the femur bone, is not
influencing the final outputs. On the other hand,
the height of the patient affects the RF as the
impact zone is then translated more proximally or
distally. This study presents several limitations, as the
complete embedment of the hip that, however,
amplifies the trend of the results. Even so, the final
aim of this study is not to provide a quantitative
value of the induced forces and stresses during a
car crash, but more to provide a tool to support
decisions of insurance companies after a suspect
car-pedestrian crash reimbursement request.
Methods
A physiological femoral bone model in contact
with different types of car bumper models has been
considered in this study. The femoral head has been
considered fully embedded while the distal part is
fully free to move. An impulsive 0.01s impact force
has been simulated for 40 and 100 km/h velocities,
for young and old, short and tall patients, for
different femur inclinations [1, 2]. Material properties
have been chosen accordingly [3].
The RF [4] has been evaluated for all these
conditions considering the maximum stress
achieved by the femur after the impact; an
example of the obtained configurations is shown
in Fig.1. Subsequently, the parameters that mostly
affect the RF of the femur are so identified.
References
[1] Croker et al., JCHB, 2009
[2] Abvabi et al., SS, 2010
[3] Crandall et al., BMJ, 2002
[4] Soenen et al. JoA, 2013
277
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ACL FORCE IN GAIT MARKEDLY INCREASES WITH

STEEPER TIBIAL POSTERIOR SLOPE
H. Marouane1, S. Shirazi-Adl1, M. Adouni2, J. Hashemi3
1
Ecole Polytechnique, Mechanical Engineering, Montreal, Canada

2
Northwestern University, Biomedical Engineering, Chicago, USA
Florida Atlantic University, Mechanical Engineering, Boca Raton, USA
Introduction
The anterior cruciate ligament (ACL) rupture is
common with higher prevalence in female athletes.
The posterior tibial slope (PTS) is a risk factor for
ACL rupture under large compression forces and in
females due to greater PTS.[1-3] Here we use a lower
extremity musculoskeletal model with a detailed
FE model of the knee joint[4] to compute the effect
of changes in medial and/or lateral PTSs by 5 on
the knee joint biomechanics and ACL force in gait.
Throughout the stance phase, tibial anterior

translation and ACL force significantly increased
with steeper PTS but decreased with reduced PTS.
Alterations in PTS separately in each plateau at
a time influenced ACL force when changing the
plateau with a larger compression force. Increases
in the anterior tibial translation and ACL force in
steeper PTS corroborate earlier in vitro and clinical
imaging [13] studies.
Methods
A validated FE model of the entire knee joint with
the articular cartilage, menisci, and ligaments is
employed.[4] It is introduced into a musculoskeletal
model of the lower extremity including hip and
ankle joints as well as uni- and bi-articular muscles.
Muscle forces are evaluated iteratively and applied
as additional external forces along with the ground
reaction forces and in vivo joint rotations/moments
to simulate the stance phase of gait under in vivo
kinematics/kinetics. [5] In each period, the medial
and/or lateral PTSs are altered by 5 while leaving
the ligaments and muscles footprints unchanged.
At all periods of gait stance, an increase in PTS

significantly increased the tibial anterior translation
and ACL force. Steeper PTS is hence a major risk
factor, especially in females and under activities
with large compression forces, in markedly
increasing ACL force and its vulnerability to injury.
References
1 Sonnery-Cottel et al, JBJS 93:14751478, 2011.
2 Todd et al, AJSM 38:6367, 2009.
3 Hashemi et al, AJSM 38:5462, 2009.
4 Adouni & Shirazi-Adl, JB 46:619624, 2013.
5 Astephen et al, JOR 26:332341, 2008.

Changes in PTS had relatively small effects on
muscle forces (<50 N) and contact forces/areas.
Supported by the NSERCCanada and MUTAN-Tunisia.
278
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PARAMETER ESTIMATION AND STRUCTURAL

IDENTIFIABIITY OF A MATHEMATICAL MODEL
OF THE ACHILLES TENDON
N. Chatzistefani1, N. Evans1, C. Hutchinson2, M. Chappell1
1
2
University of Warwick, Engineering, Coventry, United Kingdom
University Hospitals of Coventry and Warwickshire, Population Evidence & Technologies,

Coventry, United Kingdom
Introduction
In this paper our basic aim is to develop a
muscloskeletal model of the Achilles tendon by
using the methods of parameter estimation and
structural identifiability analysis. The Achilles tendon
forms the thickest and strongest tendon of the
most powerful muscle group of the body, the leg
group. It transmits tensile forces to the foot, permits
locomotion and enhances joint stability [Saxena,
2001, Wang, 2006]. It also has an energy-saving
mechanism for fast locomotion and is a spring and
shock absorber during gait. Hill-type muscle models
help in the simulation of muscles-tendon units as
a combination of mechanical components [Hill,
1938]. However, it is not feasible to measure the
dynamic properties of these components in vivo
[Yu, 2014]. Hence, we obtain parameter values
by using parameter estimation techniques, where
simulated data are fitted to measured data.
Newtons second and third laws were used to

derive the system equations. They describe the
ankle joint dynamics for all the movements tested
in the gait sessions. The mechanical characteristics
of the Achilles tendon and the gastrocnemius
muscle were represented by a modified Hill-type
muscle-tendon model.
Results
Laplace transform of the kinematic system
equations and the force output equation of the
Hill-type muscle model was conducted. Parameter
estimation was done on each subject in order
to acquire a set of fitted values for the damping
coefficient and the spring constants of the
model. Measured data of ankle angle trajectories
and Achilles tendon trajectories was attained
from the experiments while simulated data was
obtained from a simulation of a forward dynamic
model created from the system equations. The
acceptable parameter values for the model were
those that gave the minimum absolute error (MAE)
between measured and simulated data. The
Hill-type muscle model was found to be globally
identifiable and the overall musculoskeletal model
was identifiable
For the creation of the musculoskeletal model,
volunteers were requested to take part in gait
laboratory sessions. They were asked to stand still
on a force plate, to dorsiflex and plantar flex their
feet and to walk at their normal pace while having
reflective markers attached to them or while using
a Tekscan plantar pressure insole F-Scan device.
Ultrasound and Magnetic Resonance Imaging (MRI)
images obtained through the University Hospital of
Coventry and Warwickshire were used to design
the geometry of the tendon and to measure the
changes in length of the Achilles tendon and the
gastrocnemius muscle in dorsiflexion and plantar
flexion of the foot segment.
Discussion
Structural identifiability analysis on the modified
Hill-type muscle model which was incorporated
in this study, led to uniquely identifiable
parameters that can describe the movement of
the Achilles tendon. Parameter estimation of the
musculoskeletal model of the Achilles tendon led
to good results, where measured and simulated
data were in good agreement. This can lead to the
assumption that such a model and experimental
approach can be adapted to other joints, such as
the knee and hip joint, and other muscle groups
can be parameterized and studies in a similar way.
In order to develop the musculoskeletal model of

the Achilles tendon a two segment model of the
human foot and leg was created. The process by
which the reaction forces and muscle moments
were calculated is called link-segment modelling
[Winter, 1938]. To calculate joint reaction forces
and muscle moments a full kinematic description
of the movement, accurate anthropometric
measurements and the external forces applied
to the joints were needed. Using this model it
should be possible to predict any joint and tendon
reactions from inverse dynamics [Subhra, 2013].
References
H
ill, J Biolog Sciences, 126:136195, 1938.
S axena et al, J Foot & Ankle Surg, 40:132136, 2001.
S ubhra, J Rehabilit Robot, 1:9398,2013.
W
ang et al,J Biomech, 39:15631582, 2006
W
inter, Biomechanics & Motor Control of Human
Movement, NJ, 2005.
Y
u et al, J Comp Methods 7 Prog Biomed.
114:4659, 2014.
279
O 243
THE EFFECT OF EARLY VERSUS STANDARD

WEIGHTBEARING ON ANKLE FUNCTION AND ACHILLES
TENDON LENGTH 8 AND 12 WEEKS AFTER RUPTURE
A. Agres1, S. Manegold2, T. Gehlen2, A. Arampatzis3 , W. Taylor4 , G. Duda1
1
2
Charit Universittsmedizin Berlin, Julius Wolff Institute, Berlin, Germany
Charit Universittsmedizin Berlin, Center for Musculoskeletal Surgery, Berlin, Germany

3
Humboldt University of Berlin, Department of Training and Movement Science,

Berlin, Germany
4
Institute for Biomechanics, ETH Zrich, Zrich, Switzerland
Introduction
The incidence of Achilles tendon rupture (ATR) is
increasing, yet the ideal rehabilitation protocol
remains unclear [Chiodo, 2010]. Early weightbearing
(WB) has been suggested to yield better outcomes,
but functional assessments have been limited to
comparisons against immobilization [Brumann,
2014]. Post-ATR separation of tendon ends has been
reported in mid-term follow-ups [Silbernagel 2012],
but it is unknown if early WB could exacerbate
this problem. We hypothesize that compared to
standard WB, early WB patients will demonstrate
higher maximum moments on the injured limb and
more symmetric ankle function during gait analysis
but a longer Achilles tendon (AT) rest length at both
8 and 12 weeks after ATR repair.
Figure 1: T endon lengths (red & orange=injured, blue &

turquoise=non-injured).
Early WB
Methods
Fourteen patients were randomized to either early
(n=6) or standard (n=8) WB after surgical ATR
repair. Kinematic (f=120Hz) and kinetic (f=960Hz)
data were collected using 22 reflective markers on
the lower limbs and 10 infrared cameras (VICON,
Oxford, UK) for at least five barefoot walking trials
at a self-selected speed. ISB conventions were used
to determine ankle angles and inverse dynamics for
ankle moments. B-mode ultrasonography (f=25 Hz,
Esoate, Genoa, Italy) measured AT rest length,
with the knee outstretched and the ankle in 20
of plantarflexion. Maximum angles, moments,
and tendon lengths were compared both within
patients and between rehabilitation type at each
time point. Paired t-tests and one-way ANOVAs
were conducted in SPSS (IBM, Armonk, USA).
Late WB
INJ
CON
INJ
CON
Dorsi-flexion
11.5
2.6
13.7
3.8
9.0
3.6
11.3
4.4
Plantar-flexion
13.1
4.4
p = 0.122
8.7
3.3
p = 0.012*
p = 0.015*
16.9
3.3
12.1
2.4
p = 0.012*
Table 1: M
ean maximum ankle angles at 12 weeks.
Discussion
Surprisingly, compared to late WB, early WB
rehabilitation yielded similar moment production
on the injured side. Early deficits in moment
production were soon resolved, but ultimately led
to kinematic asymmetries at 12 weeks regardless
of rehabilitation. Early WB may postpone but
not hinder post-ATR tendon elongation. Further
biomechanical studies of the healed, post-ATR
tendon would allow for a better understanding of
AT elongation mechanisms.
Results
Comparison of early WB to standard WB yielded
no significant differences in ankle angle, ankle
moments, or AT rest length on the injured side for
both time points. AT rest length was significantly
longer for late WB patients at both 8 weeks and 12
weeks, and early WB had a tendency for a longer
tendon at 12 weeks (Fig.1). Late WB patients had
lower plantarflexion (p=0.002) and inversion
(p=0.005) moments on the injured side at 8 weeks,
which resolved at 12 weeks. All patients had
symmetric ankle angles at 8 weeks, but both groups
had higher plantarflexion at 12 weeks, and late WB
patients also had lower dorsiflexion (Table 1).
References
Brumann et al, Injury 45:178290, 2014.
Chiodo et al, J Bone Joint Surg Am 92:24668, 2010
280
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RELATIONSHIP BETWEEN PASSIVE ROTATIONAL LAXITY

AND ACTIVE ROTATION DURING WALKING
AFTER ACL INJURY
P. Moewis1, H. Boeth1, W.R. Taylor2, R. Ehrig3 , T. Jung4 , G.N. Duda5
1
Julius Wolff Institut, Charit Universittsmedizin Berlin, Belastung und Bewegung,

Berlin, Germany
2
3
Institut fr Biomechanik. ETH Zrich, Biomechanik, Zrich, Switzerland
Zuse Institute Berlin ZIB, Numerical Analysis and Modelling, Berlin, Germany
Centrum fr Muskuloskeletale Chirurgie, Charit Universittsmedizin Berlin, Berlin, Germany

5
Julius Wolff Institut, Charit Universittsmedizin Berlin, Julius Wolff Institut, CMSC,
Berlin, Germany
Introduction
The active overcompensation of AP translation
after anterior cruciate ligament (ACL) injuries has
been documented earlier [1]. Unclear however,
remained the relevance of rotational laxity
during active movements. Under application of
two techniques to determine passive and active
rotation of the knee joint, this study aimed to
elucidate the role of rotational joint laxity on active
tibio-femoral kinematics.
Methods
The passive and active tibio-femoral joint rotation
was examined in 13 patients with MRI confirmed
ACL rupture, and compared to their healthy
contralateral (CL) limbs.
Figure 1: left: Axial rotation during passive condition; right:

Axial rotation during walking
Passive rotational laxity was evaluated with a novel

rotometer device under manual application of
a 2.5 Nm axial torque at 30 of knee joint flexion while
synchronised fluoroscopic images were collected
at 3 Hz in a state of muscle relaxation. Specific 3D
bone geometry was then registered to the images to
calculate skeletal tibiofemoral rotation [2].
Discussion
Since no muscle activation was involved, the additional rotational laxity observed during passive conditions resulted from the absence or injury of soft
tissue structures such as the ACL. Obviously, these
structures act as secondary restraint of axial rotation.
However, in the preliminary results during walking, no
significant differences could be observed between
the ACL ruptured and the CL knees, possibly due to
the compensation of active stabilisers (muscles), with
the aim to obtain functional symmetry between both
limbs after injury. The rotation values observed in the
active conditions for the ACL ruptured and CL knees
could also have been influenced by other factors
such as patient weight, walking speed and external forces. Even though similar rotational kinematics
between ACL ruptured and CL knees can be
observed in the active condition, the muscular compensation not necessarily imply a sufficient stabilization after injury [4], and could also have a negative influence on knee joint stability in the long term.
Further analysis of stair down as well as pivot activities
where is known that the rotational component plays
a higher role should help elucidate these results.
Active rotation was determined using a Vicon motion

capture system merged with advanced techniques
for assessing skeletal kinematics throughout cycles
of walking, stairdown and pivot shift [3].
Results
Rotational laxity in the passive condition was
significantly increased in the ACL ruptured joints
compared to their healthy CL knees (Figure 1,
left, p=0.002). Preliminary results during walking,
showed however, no significant differences
between injured and CL knees. Also, similar values
as well as an increase of axial rotation can be
observed in the ACL ruptured and in the CL knee
joints respectively, for the active conditions when
compared to the values in the passive analysis
(Figure 1, right).
References
[1] Boeth et al., AJSM, 2013
[2] Moewis et al., Med Eng Phys, 2014
[3] Taylor et al., Gait & Posture, 2010
[4] Rudolph et al., KSSTA, 2000
BMBF Project: O1EC1408A
281
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THE EFFECT OF HAMSTRING TENDON GRAFT LENGTH

AND FIXATION TYPE ON ANTERIOR CRUCIATE LIGAMENT
RECONSTRUCTION: THREE-DIMENSION FINITE
ELEMENT MODEL
C. Wan1, Z. Hao2, S. Wen3 , J. Lin4 , Z. Li4
1
2
Tsinghua University, Department of Engineering Mechanics, Bejing, China Peoples Republic
Tsinghua University, Department of Mechanical engineering, Bejing, China Peoples Republic

3
Tsinghua University, State Key Laboratory of Tribology, Bejing, China Peoples Republic
4
Peking University Peoples Hospital, Arthritis Clinic & Research Center, Beijing,
China Peoples Republic
Introduction
Hamstring tendon (HT) graft has become more
and more popular in anterior cruciate ligament
(ACL) reconstruction. Compared to bone-patellar
tendon-bone graft, HT graft can be prepared
with various length values for the reconstruction.
The effective graft length is determined by where
it is fixed (i.e., the fixations in the femoral and
tibial tunnels). It was found that the graft length
affected both the structural properties of the graft
and the graft force in the reconstruction [Lewis,
1990; DeFrate, 2004]. However, the alteration of
the fixation was not considered in their papers.
The fixation type used for different graft length
was chose according to the fixation site. Different
fixation types have various strength and stiffness
[Kousa, 2003; Milano, 2006]. It was hypothesized
that both the kinematics and biomechanics
of the ACL reconstruction were affected by a
combination of graft length and fixation type,
rather than any single factor.
Figure 1: The schematic of the knee joint FE models with

different graft length (Section view). Short graft fixed
between point B&C, medium grafts between point
A&C and B&D, and long graft between point A&D.
Results
The intact joint model was validated by two linear
regressions between the kinematic results of some
previous experiments and our simulations (Eq.1)
and between the ligament force results (Eq.2).
Methods
Using magnetic resonance images of a 36-yearold female volunteer at full extension, a threedimension finite element (FE) model of normal knee
joint was reconstructed by software ABAQUS v6.10.
The FE model included bones, cartilages, menisci,
and main ligaments. Both the material properties
of the joint tissues and the boundary conditions
were defined by our previous papers [Wan, 2013].
The intact FE joint model was validated by the
published experiment measurements.
Y1 = 1.05 * X1 0.0745, R = 0.929
(1)
Y 2 = 0.885 * X2 + 2.57, R = 0.815
(2)
In all the double HT graft-reconstructed joint models,

both the anterior tibial translation and internal tibial
rotation were higher than those in the intact model
while other kinematic results were similar. The highest
graft force was found in the model FDTM (93.0~102 N).
The peak value of maximal principal strain in the
graft occurred at the femoral fixation in the model
FDTM (~0.129) while in the mid-substance in other
three models (~0.115).
Based on the intact joint FE model, four double

HT graft-reconstructed models were created with
three graft length, corresponding to the short graft
fixed on the femoral distal and tibial proximal sites
of bone tunnels (FDTP), the medium grafts fixed
on the femoral middle and tibial proximal sites of
bone tunnels (FMTP) and on the femoral distal and
tibial middle sites of bone tunnels (FDTM), and the
long graft fixed on the femoral and tibial middle
sites of bone tunnels (FMTM), respectively. The
initial tension of the double HT graft was 80 N. All
the joint kinematics, the graft force and maximal
principal strain were analyzed under 134 N anterior
tibial draw force in this study.
Discussion
The consideration of the fixation type affected the
joint kinematics as well as the strain distribution of the
graft in the FE models. It differed from the conclusion
in other FE simulations (with no fixation) that the joint
stability increased with decreasing graft length.
References
DeFrate et al, Am J Sports Med, 32: 993997, 2004.
Kousa et al, Am J Sports Med 31:182188, 2003.
Lewis et al, J Orthop Res, 8:514521, 1990.
Milano et al, Arthroscopy, 22: 660668, 2006.
Wan et al, J Biomech Eng, 135: 041002, 2013.
282
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A TISSUE ENGINEERED BONE MEMBRANE

FOR CLEFT PALATE REPAIR
G. Tetteh1, S. Puwanun1, I.U. Rehman1, G.C. Reilly1
1
University of Sheffield, Materials Science and Engineering, Sheffield, United Kingdom
Introduction
Birth defects remain an important public health
issue as a leading cause of lifelong disabilities, with
substantial impacts on health care costs. Cleft is
a birth defect that occurs when a babys lip or
palate does not form properly and is the most
common craniofacial birth defect in the world 1,2.
Current treatments involve many steps of surgical
procedures and cause donor site morbidity
associated with bone harvesting. It may be
possible to treat cleft palate defects with a tissue
engineered construct using osteoprogenitor cells
on a biodegradable electrospun scaffold to form
the hard palate3. Such a construct would need to
be strong and flexible to support bone formation in
the growing skull and degrade slowly. Hence, the
aim is to develop a biomimetic composite using
medical-grade polyurethane and hydroxyapatite
to repair the bone part of cleft defects.
Figure 1: E
xamples stress/strain curves of fabricated scaffolds
Methods
Polyurethane (PU) and Polyurethane-Hydroxyapa
tite (PU-HA) composite scaffolds were electrospun
at 1300 rpm to attain scaffolds with aligned fibres.
15%wt PU dissolved in 70/30 DMF/THF solvent were
doped with either micro or nano-sized HA particles in a ratio of 3 PU: 1 HA to create composite
scaffolds. Biocompatibility was assessed using MTT
cell viability and hES-MP Progenitor Cells over a
28-day culture period. Tensile mechanical testing,
histology and assays of calcium and collagen
deposition were also undertaken.
Figure 2: H&E staining on fabricated scaffolds on Day 14,21&28.

(Above):Transverse Orientation
(Below):Parallel Orientation
Results
Tensile mechanical testing in transverse and
parallel fibre orientations indicated Youngs
modulus in the fibre direction was 7 times the
moduli in the perpendicular direction and 3 times
higher than that of randomly orientated scaffolds4.
A similar trend was observed with the yield strength
values which were 6 times higher in fibre directions
but twice in random fibres. HA reinforced the
scaffolds and improved Youngs modulus by
two folds. SEM image analysis showed good cell
attachment and matrix production. FTIR and
Raman characterization confirmed the presence
of HA in all bioactive scaffolds. MTT assay showed
that hES-MP cells were viable on scaffolds across
all time points. Interestingly, highest cell viability
was on PU scaffolds that did not contain HA. Matrix
deposition and in-depth cell penetration across
the entire length of scaffolds was observed with
H&E, Alizarin Red and Sirius Red stains.
Discussion
Electrospun PU and PU-HA scaffolds supported the
attachment, proliferation and differentiation of
progenitor cells with very good matrix deposition,
as previously observed for polycaprolactone (PCL)
scaffolds. These scaffolds have aligned fibres
similar to the extracellular matrix of natural tissue,
and present with significantly higher mechanical
properties compared to PCL or PU with random
fibres 4 while still maintaining excellent flexibility and
failure properties. Furthermore, the inclusion of HA
reinforced the stiffness of composite scaffolds and
showed good cell penetration across all time points.
Such tissue engineered membranes mimic the protein
and mineral components of bone and is a promising
alternative construct for repairing cleft defects.
References
1 NHS UK(2014) Cleft lip and palate
2 Parker etal.(2010)Birth Defects Research PartA
3 Bye etal.(2013)Biomaterials Science,1(9),
4 Tetteh etal.(2014),JMBBM Vol.39C
283
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IN VIVO LOADING COMBINED WITH CELL THERAPY

AFFECTS THE BONE VOLUME DENSITY
IN A TISSUE-ENGINEERING SCAFFOLD
T. Hausherr1, L.A. Applegate2, D. Pioletti1,2
1
Ecole Polytechnique Fdrale de Lausanne, Institute of Bioengineering,

University Hospital of Lausanne, Department of Musculoskeletal Medicine,

Introduction
A main challenge in tissue engineering of bone
replacement is the combination between cell
seeding, growth factors and mechanical loading.
In this study, we examine the effect of an external
mechanical loading combined with cell therapy
on the bone growth inside a scaffold implanted in
femoral condyles of rats.
Each femoral condyle of 2 groups of female rats
(6 per group) was implanted with a PLA/5% -TCP
scaffold. The first group was implanted with cell-free
scaffolds while the second one was implanted with
scaffolds seeded with fetal bone progenitor cells 1.
One leg of each animal received a mechanical
loading (10 N at 4 Hz for 5 min, 5 times every
2 days, starting 2 days post-implantation) while the
contra-lateral leg was used as control. MicroCT
images at different time points were used to
evaluate the bone volume density (BV/TV) of
bone-scaffold construct.
Figure 1: B
one volume density (BV/TV) of cell-free scaffold
(w/o cells) and cell-seeded scaffold (w/ cells).
Statistical significant difference: *P < 0.05.
Nevertheless, the mechanical loading at the later

time point increased the BV/TV of 40.4% in the cell-seeded group.

The BV/TV of different scaffold-bone constructs,
cell-seeded or cell-free under no external loading
or under external mechanical loading, are
reported in Figure 1.
C o n cl u s i o n
The delivery of cells in the scaffold seemed to
impair the bone formation compared to cell-free
implanted materials. This result is in contrast to most
studies and could be explained by the observation
of a denser tissue surrounding the cell-seeded
scaffold. A positive effect on BV/TV was observed
anyway when external mechanical loading was
applied. Supplemental studies combining loading
and cell-seeded scaffolds are necessary to better
understand these observations.
Results show that generally BV/TV of the cell-seeded

groups with or without loading is significantly lower
compared to the cell-free group. In particular,
for the cell-seeded groups, after 12 weeks of
implantation, the BV/TV is 36% and 57.6% lower
for an external mechanical loading and for no
external loading respectively compared to the
cell-free scaffold. This drop of BV/TV could be
explained by cell migration out of the scaffold
towards more vascularized tissue. Through their
migration, the cells densify the surrounding tissue.
Therefore, reduced exchange (e.g. nutriments,
growth factors) slows down the bone growth inside
the scaffold.
References
1 Montjovent M.-O. et al., Bone 42:554564, 2008
284
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COMPARISON OF MECHANICAL PARAMETERS

OF TISSUE ENGINEERED AND NATIVE CARTILAGE:
A NUMERICAL STUDY
A. Completo1, C. Bandeiras1, A. Ramos1
1
University of Aveiro, Mechanical Engineering, Aveiro, Portugal
Introduction
One of the difficulties associated with tissue
engineered cartilage (TEC) is the inability to obtain
tissues with homogeneous mechanical properties
similar to the native cartilage (NC) ones 1. We will
simulate the effects of biphasic mechanical properties
obtained from simulation of free swelling culture
of tissue engineered cartilage on the mechanical
behaviour in comparison to homogeneous tissue
engineered cartilage and native cartilage with
homogeneous mechanical properties.
C o n cl u s i o n
The heterogeneous and inferior average values
of the mechanical properties are detrimental to
proper load distribution. Research on experimental
procedures and materials for a more optimal
reduction of permeability and heterogeneity of
mechanical properties is necessary to obtain new
tissue with similar properties to the native ones.
Axisymmetric 2D slices of TEC and NC (2x2.34mm)
were modelled in Abaqus v6.12.1 with a biphasic
model with neo-Hookean solid phase2,3. Mechanical properties of TEC were calculated by replicating the experimental conditions in 1 using the tool
in 2. Mechanical properties of the middle zone of
articular cartilage were taken from 4. Stress-strain
compressive mechanical tests until 20% were
simulated.
Figure 1: A
: Mechanical properties of TEC obtained from
simulation of the experimental conditions of1.
B: Average nominal stresses (squares) and pore
pressures (circles) for heterogeneous TEC (black),
homogeneous TEC (red) and NC (blue).

The lack of nutrient supply to the cores of TEC
resulted in expressive spatial differences on the
mechanical properties (Fig 1A). Heterogeneous
TEC has nominal stresses and pore pressures 23 and
12% inferior to the homogeneous TEC and 57 and
51% inferior to the NC (Fig 1B), essentially due to
the high average permeability of TEC (Table 1).
Property
TEC
NC
E (kPa)
653.5
364
0.205
0.24
0.59
0.75
0.0967
0.0172
k (10 m .N-1.s )
-12
-1
This work is funded by COMPETE,
under the strategic project PEst-C/EME/UI0481/2013
and also in the scope of the following projects:
FCOMP-01-0124-FEDER-010248,
FCOMP-01-0124-FEDER-015143
and FCOMP-01-0124-FEDER-015191.
References
1 Bian L. et al, Osteoarth. Cartil. 17:677685, 2009.
2 Bandeiras C. & Completo A., Comput. Methods
Biomech. Biomed. Eng. 16:262263,2013.
3 Bandeiras C. & Completo A., Comput. Methods
Biomech. Biomed. Eng. 17:23,2014.
4 Boschetti F. et al, Biorheology. 41:159166, 2004.
Table 1: Average mechanical properties of TEC and NC.
285
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COMBINED COMPUTATIONAL STUDY OF A NOVEL

BIORESORBABLE CAGE DESIGN FOR TIBIAL TUBEROSITY
ADVANCEMENT APPLICATION
M. Castilho1, P. Fernandes1, J. Folgado1, E. Vorndran2, J. Rodrigues1
1
2
Instituto Superior Tecnico, Mechanical Engineering, Lisboa, Portugal
University of Wrzburg, Department for Functional Materials in Medicine and Dentistry,

Wrzburg, Germany
Introduction
Conventional treatment of cruciate ligament
rupture in dogs is given by tibial tuberosity
advancement (TTA), a method which includes the
implantation of a titanium cage as bone substitute
[Muir P, 2010]. Several alternative cages have been
investigated to overcome the disadvantages of
the titanium cage, but all are non-biodegradable
and fail in providing adequate implant-bone tissue
integration [Samoy Y, 2014]. This work aimed to
design and fabricate a new biodegradable cage,
which addresses the mechanical requirements
at local cage domain, and at same time present
sufficient permeability, to promote bone ingrowth.
Methods
3D finite element model (FEM) of the TTA system,
with conventional TTA implants, was developed,
based on a 3D scan of a real tibia. Different
loading conditions corresponding to different
stages of a dog walk, as well as, principal
ligaments and muscles acting at canine tibia were
considered. Stress, strain and strain energy density
(SED) distribution was analysed at different TTA
components. A topology optimization approach
[Dias, 2014], was then used for cage microstructure
design, considering the adverse mechanical
environment obtained at the cage domain. The
optimization problem was defined in order to
obtain the optimal cage topology that satisfied the
objectives of maximum permeability while assure
structural integrity, and fabrication requirements.
Optimized cage prototype was fabricated by 3D
powder printing of a tricalcium phosphate cement
followed by physical and chemical characterized
[Castilho, 2014].
Figure 1: a
) FEM of TTA system; b) Cage microstructure
design domain; c) Optimized microstructure with
respective void and material domain.
Discussion
Integrated 3D FEM with topology optimization
approach has demonstrated its potential for
designing a tailored cage for TTA. A optimized
cage prototype was successfully fabricated
with biodegradable material. Based on the FEM
developed and on the determined stress and strain
distribution of TTA system, important information for
designing new implants for dogs was provided,
which is data unavailable at this moment for
veterinary orthopaedic surgeons.
References
Muir P, ACVS Foundation and Wiley-Blackwell,
Iowa USA, 2010.
Samoy Y et al, Vet Surg, 10:1111, 2014.
Dias M et al, Med Eng Phys, 36:44857, 2014.
Castilho M et al, Biofabrication, 6:025005, 2014.
Results
Stress and SED distribution analysis evidenced
that the cage is more requested at the end of the
support phase (i.e 90% stage), in the distal region
of the cage domain. The average strain field ( ) in
the new cage region was determined for the 90%
stage, and then considered in the optimization
problem. Figure 1 presents the integrated topology
optimization strategy used, and the resulting
optimal cage microstructure. This microstructure
combines material distributed in all faces, primarily
aggregated along the diagonal directions, with
connected pores in all main directions (void
domain). A cage prototype resulting from the
periodic repetition of the optimized microstructure
was successfully fabricated.
286
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NANOINDENTATION OF 3D PRINTED POLYLACTIC

ACID BONE SCAFFOLD
J. Lukes1, J. Sepitka2, M. Berg3 , D. Kytyr4
1
Czech Technical University in Prague, Hysitron Nanomechanical Applicaitons Lab,

Czech Technical University in Prague, Mechanics Biomechanics and Mechatronics,

3
Hysitron Inc., Marketing & Sales, Minneapolis, USA
Academy of Sciences of the Czech Republic, Institute of Theoretical and Appliead

Mechanics, Prague, Czech Republic
Introduction
Artificial bone scaffolds represent an attractive
alternative to autografts and allografts used in
orthopedic repairs of bone defects. Bone and
bone microstructure adapted stiffness properties to
their load bearing function; hence effective elastic
properties of proposed bone scaffold should be
similar enough to provide bones primary function
of human body support.
is 200 C for the first layer and 185 C for all next
layers. Hysitron TI 950 TriboIndenter (Hysitron, USA)
nanomechanical test instrument was used for
instrumented nanoindentation with Berkovich
probe at different sites on samples. Local
mechanical testing were applied to reference
bulk material and printed open cube structure
withedge length 10 mm and wall thickness 1.5 mm.
Locations were mapped by three rows of indents
recording any mechanical gradient within layers.
As an alternative to widely used bone autografts

and allografts, artificial bone scaffolds have to
exhibit similar bone integration properties in terms
of tissue ingrowth, to allow nutrients to pass through
the bone marrow and also to preserve high rates of
bone regeneration.
Results
Nanoindentation testing at a corner of crosssectioned scaffold clearly showed mechanical
gradient of both indentation hardness HIT and
reduced modulus E r with increasing distance from
the outer layer. Both HIT and E r gradual decreased
(from HIT ~ 0.41 GPa to H IT ~ 0.35 GPa; from
E r ~ 6.07 GPa to E r~5.6 GPa) from sample surface.
This indicates that scanning strategy of the
printing head may have significant influence on
characteristics of produced objects.
3D printing of polylactic acid (PLA) can be

successfully used for production of porous 3D
structure that mimics bone tissue [Koudelka,
in press). However, final scaffold needs to be
inspected for potential impurities and mechanical
gradients due to hot rapid manufacturing process.
Nanoindentation can effectively serve as a quality
control tool at microscale.
C o n cl u s i o n
Nanoindentation of cross-section of 3D printed PLA
bone scaffolds indicated mechanical gradients at
micro level due to printing technological processes.
Methods
PLA (3dfactories, CZ) 3D scaffolds were printed
by 3D printer Profi3Dmaker (Aroja, CZ) at high
density printing mode with resolution 80 m and
nozzle diameter 200 m The printing material itself
is produced from corn or sugar cane in form of
a circular filament with diameter 1.75 0.05 mm.
During the printing process the print area is heated
to approx. 50 C and the device operates at
max. printing speed 40 mms -1. Nozzle temperature
References
Koudelka et al. Key Eng. Mater, (in press).
The research was supported by institutional support
RVO: 68378297.
287
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POLYHIPE SCAFFOLDS WITH TUNABLE MECHANICAL

PROPERTIES FOR BONE TISSUE ENGINEERING
R. Owen1, C. Sherborne2, F. Claeyssens3 , G. Reilly1
1
University of Sheffield, Insigneo Institute of in silico Medicine, Sheffield, United Kingdom

2
3
University of Sheffield, Kroto Research Institute, Sheffield, United Kingdom
University of Sheffield, Department of Materials Science and Engineering, Sheffield,

United Kingdom
Introduction
Solid free form fabrication techniques, such as
microstereolithography (SL), create porous
3D structures by depositing 2-D cross section.
The result is a porous structure with excellent
architectural control and pore interconnectivity,
distribution and morphology [Hutmacher, 2001].
Hierarchical porosity can be introduced to these
structures by using a photocurable High Internal
Phase Emulsion (HIPE). These emulsions are formed
from two immiscible liquids, when polymerised the
internal phase is removed, leaving a permeable,
highly interconnected porous polymer. When HIPEs
are structured using SL, micro- and macro-scale
pores are created. This study will assess the ability
of acrylate based PolyHIPE scaffolds to support
bone cells in vitro by seeding with immortalised
human embryonic stem cells. Compositions with
different stiffness will be used to evaluate effects
on differentiation
2.60 0.61% to 21.86 2.87%. 13 mm diameter

woodpile scaffolds were made from 0%, 50% and
100% EHA compositions at 80% porosity with a fibre
diameter of 350m and a spacing of 650m (Fig. 1).
All scaffolds supported cells, with an increase in
viability over time and no significant differences
between compositions. Composition also had
no significant effect on differentiation, with the
exception of the stiffest scaffold in combination
with an acrylic acid plasma treatment.
Methods
A range of PolyHIPEs were synthesised using
two monomers, EHA and IBOA, with proportions
varying from 100% of each at 25% intervals. The
former is an elastomer and the latter increases
brittleness. At each of the 5 proportions, HIPEs
at a nominal porosity of 75, 80, 85 & 90% were
synthesised, creating 20 compositions in total.
Three compositions with a range of stiffness
were selected for scaffold fabrication. Four layer
woodpile scaffolds were created using SL and
analysed using SEM. Scaffolds were plasma
treated to improve cell attachment and seeded
with hES-MP cells. Resazurin reduction assays were
used to assess viability and ALP and DNA assays for
osteogenic differentiation.
Figure 1: P
olyHIPE woodpile scaffold showing micro- and
macro-porosity
Discussion
PolyHIPEs can be used to create regular
porous structures by microsterolithography with
micropores. Mechanical properties can be fine
tuned by varying the monomer concentration to
provide a range of application specific stiffnesses
relevant for bone implants of bone tissue
engineering scaffolds.
References
Caldwell, S et al, Soft Matter, 8:1034410351, 2012.
Hutmacher, D et al, J Biomater Sci Polym Ed,
12:107124, 2001.
Results
Youngs Moduli of PolyHIPEs ranged from
63.019.13 to 0.36 0.04 MPa, UTS from 2.030.33
to 0.11 0.01 MPa and failure strain from
288
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BIOACTIVE GLASS CAN POTENTIALLY REINFORCE

LARGE BONE DEFECTS
N. van Gestel1, D. Hulsen2, C. Arts2, J. Geurts2, K. Ito1, B. van Rietbergen1
1
University of Technology Eindhoven, Department of Biomedical Engineering,

Eindhoven, Netherlands
Maastricht University Medical Centre, Department of Orthopeadic Surgery,

Maastricht, Netherlands
Introduction
Bio-Active Glass (BAG) is a promising bone graft
substitute for large bone defect reconstruction
because of its favourable osteoconductive,
antibacterial and angiogenic properties[1,2].
Potentially, it could also mechanically reinforce
the defect, thus making it suitable for load-bearing
defects. However, the mechanical properties of
the reconstructive layer consisting of BAG/bone
allograft mixtures are unknown. The goals of
this study therefore were, first, to measure the
mechanical properties of different BAG/bone
graft mixtures and, second, to investigate to what
extent such mixtures could reinforce distal tibial
defects using micro-FE analysis and high-resolution
CT scans.
Results
The confined compression tests showed a strong
dependence of the modulus of the BAG/bone
composite on the amount of BAG, ranging from
116.7 18.2 to 654.2 35.2 MPa. The micro-FE results
could well reproduce these measured moduli, when
using a stiffness of 25 MPa for the interface layer
(Fig. 2). The micro-FE analyses of the cortical defect
demonstrated that the stiffness of the tibial segment
would be reduced by 13 3 % with the defect.
Treatment with the BAG/bone composite could
restore the stiffness to 101 6 % of its original value.

Four different BAG/bone graft mixtures were
impacted in a cylindrical holder, mechanically
tested in confined compression and scanned with
micro-CT. From these images, bone graft material
and glass were segmented using two different
threshold values. The interface between bone and
BAG was modelled separately by dilating the glass
phase (Fig. 1). Micro-Finite-Element (FE) models
of the composites were made using a Youngs
modulus of 2.5 GPa for bone and 35 GPa for BAG.
The Youngs modulus for the interface region was
determined by fitting experimental and microFE results for the same specimens.For the second
goal, in-vivo high-resolution (82 m resolution)
CT scans of a 9 mm region of the distal tibia of
3subjects were used. Micro-FE models of this region
were made to determine its stiffness in the original
state, with a simulated cortical defect and after a
mixture of BAG/bone was modelled in the defect.
Figure 2: T he Youngs Modulus measured in the experiment

versus predicted by the model after fitting the
interface stiffness, for the different BAG contents.
Discussion
The experiments demonstrate that BAG/bone
mixtures have a composition-dependent stiffness,
in the range of that of trabecular bone, which
can be well estimated from micro-FE analyses.
Furthermore,
the
tibial
micro-FE
analyses
demonstrate that these mixtures potentially can
restore the stiffness of large bone defects at this
site. Future development of the model may predict
mechanical behaviour of BAG/bone mixtures
patient specifically.
Figure 1: C
ross-section of a micro-CT scan showing bone
grafts (white), BAG granules (red) and the
interface layer (yellow).
References
1 M.N. Rahaman et al (2014) Materials Science
and Engineering C (41): 224231
2 N.C. Lindfors et al (2010) Bone (47): 212218
289
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DESIGN AND CHARACTERISATION OF A NEW HYBRID

BONE-LIGAMENT-BONE SCAFFOLD
C. Laurent1, N. De Isla2, V. Fierro3 , A. Celzard3 , X. Wang2, R. Rahouadj1
1
CNRS Universit de Lorraine, LEMTA, Vandoeuvre-les-Nancy, France
CNRS. Universit de Lorraine, IMoPa, Vandoeuvre-les-Nancy, France

3
CNRS, Universit de Lorraine, IJL, Epinal, France
Introduction
The question of anchoring tissue-engineered
ligament within the joint is still unresolved, even
if it constitutes a real clinical challenge. Very
recently, novel methods are developed in order
to propose an anchorage strategy together with
an adapted ligament scaffold [Ma 2012, Li 2014],
and bone-ligament-bone units are characterized
instead of ligament scaffolds alone. Particularly,
solutions that would mimic the progressive
transition between ligament and bone are still to
be proposed. Recent work [Spalazzi 2008] confirms
that the formation of such a transition is possible,
and the design of a bone-ligament scaffold with a
progressive interface is a milestone in this strategy.
Based on the novel ligament scaffold developed
and characterized in our group [Laurent 2012],
in the present contribution we develop and
characterize a hybrid bone-ligament scaffold with
a progressive interface adapted to the formation
of a progressive bone-ligament transition.
Results
A global view of the hybrid bone-ligament scaffold
is shown Figure 1, together with a confocal image
of encouraging preliminary biological assessment.
The ultimate load is superior for the hybrid scaffold
than for the ligamentous part isolated, indicating
an adequate interface.
Methods
The ligamentous part of the bone-ligament scaffold
is made of copoly(lactic acid-co-(-caprolactone))
(PLCL) multilayer braid from 96 fibres of 200m.
Around 30 mm of this braid is conserved and the
fibres are voluntarily disposed in a disorganized
manner at its extremities, on a length of around
100mm. The two extremities are then compacted
into cylinders and slightly heated, in such a way
that fibres stuck each other and form rigid cylinders.
The porosity of these cylinders may be adjusted
by varying the compaction of the fibres, and
additive elements (such as hydroxyapatite) can
potentially be inserted prior to the compaction.
The mechanical properties of such units are tested
from tensile tests in aqueous medium using custom
devices, and the hybrid scaffolds are biologically
evaluated using a bioreactor designed for
ligament tissue engineering [Laurent 2014]. We are
moreover working on selective coatings of growth
factors on ligamentous and bony parts in order
to encourage differentiation into fibroblast and
osteoblasts respectively.
Figure 1: H
ybrid bone-ligament scaffold and preliminary
biological assessment (confocal imaging).
Discussion
The
present
technique
offers
promising
perspectives in the proposing of clinically relevant
bone-ligament-bone tissue-engineered substitutes.
It will moreover be used to intensively study the
formation of the progressive transition between
ligamentous and bony tissues.
References
Ma et al, Tissue Eng Part A 18, 103116, 2012
Laurent et al, J. Mechan. Behav. Biomed. Mater.,
12, 184196, 2012
Laurent et al, Processes 2, 167179, 2014
Li et al, Biofabrication 6, 015010, 2014
Spalazzi et al, J. Biomed. Mater. Res., 86A, 112, 2008
290
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MECHANICAL PROPERTIES OF EMBROIDERED SCAFFOLDS

FOR LIGAMENT TISSUE ENGINEERING
J. Hahner1, C. Hinber1,2, A. Breier1, G. Heinrich1,2
1
Leibniz Institute of Polymer Research Dresden, Institute of Polymer Materials,

Dresden, Germany
Technical University Dresden, Institute of Materials Science, Dresden, Germany
Introduction
The rupture of the anterior cruciate ligament (ACL)
is the most frequent injury of ligament tissue at the
knee joint. Due to the missing self-healing process
of the ACL there is the need to reconstruct it with
e.g. autologous tissue from patellar or hamstring
tendons. Restrictions like differing biomechanics,
donor site morbidity and limited availability, are
only a few mentioned arguments for continuing
research in the field of alternative reconstruction
strategies. Tissue engineering represents such a
potential. Biocompatible scaffolds with defined
biomechanical properties are required. Textile
manufacturing processes, especial embroidery
technology, offer the adaption of the mechanical
properties and the use of versatile material
combinations.
Results
The viscoelastic behaviour of embroidered
scaffolds was investigated and compared to lapin
ACL as potential animal model.
The intensity of relaxation decreased with previous
hysteresis loading for both scaffold types. The
relaxation behaviour was more pronounced for BICO
compared to MOCO. BICO showed an increased
hysteresis behaviour compared to MOCO.
The ultimate tensile properties showed no
significant differences for both scaffold types
whether the scaffolds were unloaded or preloaded
by relaxation and/or hysteresis.
Minor hysteresis and relaxation behaviour as
well as the greater ultimate tensile properties
demonstrated the improved suitability of the
MOCO scaffold.
Methods
Three dimensional (3D) scaffolds from absorbable
filaments of poly-L-lactic (PLA, multifilament,
155 dtex) and poly(lactic-co--caprolactone)
(PLA-CL, monofilament, 100 dtex) were fabricated
using
embroidery
technology.
Scaffolds
composed of three two dimensional (2D) layers,
stacked and locked together to build up a 3D
structure according to the dimensions of lapin
ACL (10 mm4 mm 2 mm). Each layer consisted
of one upper and one lower thread depositing on
a water soluble polyvinylalcohol (PVA) nonwoven.
After the locking procedure scaffolds were washed
in water to remove the PVA, so that a porous
structure remained.
Nevertheless it could be demonstrated that

the viscoelastic behaviour of both types of
embroidered scaffolds is comparable to lapin ACL
[Panjabi, 2001].
Discussion
The qualitative and quantitative characterisation of
the viscoelastic behaviour and the ultimate tensile
properties of two different types of embroidered
scaffolds were investigated to find an optimal
adjustment to native ligament tissue. Embroidered
scaffolds demonstrated the ability to adapt the
mechanical properties by configuring embroidery
pattern and material combination [Hahner,
2015]. In addition to the promising biomechanics,
Hoyer et al. investigated ACL cell adherence and
activity on embroidered scaffolds with collagen
hybridation and demonstrated the potential of this
strategy for ligament reconstruction [Hoyer, 2014].
Two types of embroidered structures were

manufactured, MOCO (mono-component, PLA
as upper and lower thread) as well as BICO (bicomponent, PLA-CL as upper and PLA as lower
thread).
The viscoelastic behaviour (relaxation, hysteresis
and retardation) and the ultimate tensile properties
of different test groups were evaluated with a
tensile testing machine. The relaxation behaviour
was analysed using a non-linear regression
[Obukhov, 1965] to allow the comparison between
different materials and scaffold combinations.
References
O
bukhov A., Mek P., 1:2529,1965
P
anjabi M. et al., Clin Biomech. 16:334340, 2001
H
ahner J. et al., Text Res J., DOI:
10.1177/0040517514566107, 2015
H
oyer M. et al., Mat Sci Eng C, 43:290299, 2014
291
O 255
MATERIAL PROPERTIES OF FOURTH-GENERATION

COMPOSITE SAWBONES DETERMINED THROUGH
MODAL ANALYSIS
S. Leuridan1, Q. Goossens2, L. Pastrav3 , K. Denis3 , S. Colen4 , J. Roosen4 , M. Mulier4 ,
W. Desmet5, J. Vander Sloten1
1
KU Leuven, Mechanical Engineering, Biomechanics Section, Heverlee, Belgium

2
KU Leuven, Campus Group T Health Engineering, Heverlee, Belgium

3
KU Leuven, Campus Group T Health Engineering, Leuven, Belgium
University Hospitals KU Leuven, Department of Orthopaedics, Pellenberg,

Pellenberg, Belgium
5
KU Leuven, Mechanical Engineering PMA, Heverlee, Belgium
Introduction
Sawbones fourth-generation composite bones
are used extensively for in vitro testing of boneimplant constructs. These composite bones have
been developed in order to closely mimic the
mechanical properties of human bone. The in
vitro tests are often complemented with FE models
in order to better understand the test results. It is
crucially important that the FE model is validated so
that is represents the physical models behaviour as
accurately as possible. Hence, besides the correct
geometry, the use of the right material properties in
the FE model is of paramount importance. Material
properties can be determined by destructive
testing [1] or by using the information obtained
from a non-destructive dynamic test such as modal
analysis. The material properties for three different
fourth-generation composite Sawbones models
obtained by updating a FE model using modal
analysis results are presented in this abstract.
Results
Table 1 shows the results for the different material
parameters before and after updating. The
average Modal Assurance Criterion (MAC) value,
a number that indicates the similarity between two
sets of mode shapes (FE extracted mode shapes
and the test mode shapes) was 0.80. The average
error on correlated frequencies before updating
of the models amounted to 4.5%. The average
correlated frequency error dropped to 1.13% after
updating.
Methods
Modal analysis was performed on three different
fourth-generation Sawbones composite (Medium
Femur, Medium Tibia & Cylinder). Three PCB
accelerometers (PCB 352A24, weight of 2g)
were attached using beeswax to the composite
bones. Every bone was excited at on average
40 locations using an instrumented impact hammer
(PCB 086C03). From these measurements the
modal parameters (resonance frequencies and
mode shapes) were extracted using the Polymax
algorithm available in Siemens Test Lab. CT scan
based FE models were built of the tested composite
bones. Cortical and cancellous bone regions were
assigned in the model based on grey values. The
cortical bone was modelled as transverse isotropic,
the cancellous bone was assumed to be isotropic.
The first 8 modes of the bones (range 200 2500 Hz)
obtained from the modal tests were used to update
the FE model. Starting values for the different
material parameters were obtained from the
Sawbones website. Testing and simulations were
performed under free-free boundary conditions.
Modulus
[MPa]
Femur
Cylinder
Tibia
E11
9830
9787
9880
E22
9830
9787
9880
E33
14200
14208
13810
G12
3968
3582
3760
G23
3950
3882
3990
G31
3950
3882
3990
Table 1: A
n overview of the different E and G moduli for the
different Sawbones models.
Discussion
The largest differences in material properties as
compared to the values on the Sawbones website
are noted for the transverse shear moduli (G23 and
G13) and the E33 modulus. This was apparent from
the large frequency error in the torsional modes of
the composite structures before updating.
C o n cl u s i o n
Updating the different material properties using
the first 8 resonance frequencies provides robust
estimates of these properties. Fourth-generation
Sawbones show a high degree of consistency
in their material properties independent of the
specific geometry.
References
Gardner et al. Ann Biomed Eng. 2010
Mar;38(3):61320
292
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A NOVEL META-MODEL ANALYSIS OF FINITE ELEMENT

SIMULATIONS TO OPTIMIZE THE DESIGN
OF CERVICAL CAGE
M. Nikkhoo1, A. Tahassory2, M. Haghpanahi3
1
Science and Research Branch, Islamic Azad University, Department of Biomedical

2
Attila Orthopaed Co., Managing Director, Tehran, Iran
Iran University of Science and Technology, School of Mechanical Engineering, Tehran, Iran
Introduct ion
Cervical interbody cages have been widely
used for the anterior reconstruction in treatment
of degenerative disc disease [Dagli et al., 2013].
Geometrical design of cervical cage is one of
the most critical parameters to provide a high
mechanical strength and rate of fusion. Hence, the
objective of this study was; first, to develop a novel
inverse FE model to estimate the optimal design of
the cervical cage; and second, to investigate its
biomechanical response in fusion surgery.
Figure 1: Independent geometric parameters of cervical cage.
Results
The optimal design of cervical cage showed
acceptable results according to ASTM F2077. When
compared with the intact model, the intersegmental
motions in lower levels decreased in fusion model
(Fig.2). The maximum increased stresses in vertebrae
and adjacent discs observed in flexion for C6 (20.3%)
and C6-C7 level (9.6%), respectively.
Methods
Development and validation of FE intact model.
A 3D FE cervical spine model (C2-C7) was
developed from the images of 15 healthy men
(age 324.5 years) using ANSYS Academic, v.13.
The elastic theory was used for cortical bones,
cancellous bones, endplates and anulus fibers
and the hyperelastic theory (i.e. Mooney-Rivlin)
was applied to model the intervertebral discs. The
ligaments were simulated as springs. To validate FE
model, pure moments of 1Nm in flexion, extension,
lateral bending and axial rotation were applied to
the model. The intersegmental motions of FE model
were well comparable with the results of in-vitro
cadaveric study [Panjabi et al., 2001].
Optimization. An optimization protocol, which
is basically a fitting algorithm consisted of FE
simulations and a quadratic response surface
(QRS) regression, was used to find the design
parameters. For this purpose, The full factorial
design of experiment was used. Three independent
geometric parameters (Fig.1) with three levels
were chosen as input data and the averaged
teeth deformations of the cervical cage subjected
to static and fatigue loading (according to ASTM
F2077) were chosen as output data. The result of
the 54 simulations in respect to the independent
geometric parameters was modeled as a QRS
model. After obtaining the QRS model, the
optimized geometric parameters were determined
by minimizing the root mean square error using a
direct search approach.
Figure 2: Intersegmental motions in different loadings.
Discussion
We developed a novel protocol using limited FE
simulations combined with the QRS model to find
the optimal design of cervical cage. The stress
values obtained in cervical cage were lower than
the strength of PEEK for both static and fatigue
loading. The biomechanical function of optimized
cervical cage in fusion model was within the range
of reported data in literature [Dagli et al., 2013]
and can be used in clinics.
Development of FE fusion model. After validation

of FE intact model, one-level fusion (C5-C6) was
created based on Smith-Robinson technique
using the optimized cervical PEEK cage. The
biomechanical responses of FE fusion model were
investigated under pure moment of 1Nm in flexion,
extension, lateral bending and axial rotation.
References
Dagli et al., Asian Spine J, 7 (1):.348, 2013.
Panjabi et al., Spine, 15 (26):22149, 2001.
293
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MEASUREMENTS OF IN VIVO INTERNAL LOADS

IN A SPINAL ROD INTRUMENTING AN ADULT PIG
M. Odet1, Y. Lafon1, S. Ronel1, M. Massenzio1
1
Universit Claude Bernard Lyon 1, Villeurbanne, France
Introduction
Progressive spinal deformities occurring before
the age of 5 years are called early-onset-scoliosis
(EOS). The standard corrective surgical techniques
based on growing rod systems (GR) induces the
immobilization of spinal column as well as an
overload of disks, causing disks degeneration
[Oetgen, 2012], [Cahill, 2010], [Roberts, 1993],
[Bibby, 2002].
Results
During awakening, absolute axial force was up to
400 N on average. Maximum moments to third of the
rod length were up to 6000 N.mm in frontal and up
to 4000 N.mm in sagittal. Due to a desynchronization
between the sagittal and frontal gauges signals,
deformations and forces are only relative for walking.
Relative axial force was 100 N in maximum.
Discussion
These values are consistent with those reported by
Hauerstock on sheep [Hauerstock, 2001]. However
measured efforts in the present study are not those
absorbed by the spine, but those transmitted to
the rod. No study to our knowledge has focused
on in vivo moments values.
Recent studies on new implants have concluded

that a more flexible instrumentation could improve
discs health [Newton, 2008], [Hunt, 2010], [Newton,
2011], [Upasani, 2011], [Demirkiran, 2013]. Another
way to preserve discs would be to connect a
suspension device in series with any existing GR
system. The purpose of this study is to present a
method to measure real-time in vivo loads applied
to a spinal rod, based on a large quadruped
animal model, to design such an implant.
Maximum axial force was in the order of magnitude

of the animal weight for both traction and
compression. Maximum moments went up to 6000
N.mm. To reproduce the physiological movements
of five disks of a 58 kg quadruped animal, the
suspension device stiffness should be in the range
of 50100N/mm.
Methods
The spine of one 6 months-old pig (58 kg) was
instrumented with a rod fixed to the spine by
using the standard surgical procedure, with two
vertebrae immobilized to support each extremal
anchor. Six vertebrae were localized between the
anchors. The rod was equipped with four strain
gauges, two in each anatomical plane (sagittal
and frontal). Cables were passed through the skin.
Deformation measurements were made during
post-surgery awakening as well as daily specific
activities (walking, sleeping ), during two days.
Axial force and moments were computing from
gauge measurements, based on the beam theory.
References
Bibby et al, Spine, 27:22202228, 2002.
Cahill et al, Spine, 35:E1199E1203, 2010.
Demirkiran et al, Spine, 34:18593, 2013.
Hauerstock et al, Transactions of the 47th Annual
Meeting of the Orthopaedic Research Society,
26:391, 2001.
Hunt et al, Spine, 35:371377, 2010.
Newton et al, Spine, 33:724733, 2008.
Newton et al, Spine, 36:109117, 2011.
Oetgen et al, Seminars in Spine Surgery,
24:155163, 2012.
Roberts et al, J Orthop Res, 11:747757, 1993.
Upasani et al, J Bone Joint Surg Am,
93:14081416, 2011.
294
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NEW EXPERIMENTAL PROTOCOL TO STUDY WEAR

IN FLEXIBLE SPINAL DEVICES
S. Le Cann1, J. Chaves-Jacob2, J.M. Rossi1, J.M. Linares2, P. Chabrand1
1
Institut des Sciences du Mouvement, GIBoc, Marseille, France

2
Institut des Sciences du Mouvement, CBI, Marseille, France
Introduction
Scoliosis is a 3D deformation of the spine, mostly
occurring during youth, and worsening during
growth spurt. The most common surgical treatment
is based on an arthrodesis [Cotrel and Dubousset,
1984] not suitable to preserve spine biomechanics
and growth. To overcome those limits new
fusionless implants are being developed
combining sliding screws and/or flexible rods
[McCarthy, 2009; Ouellet, 2011]. In action, those
devices undergo friction and are exposed to
wear. However, due to their recentness, adapted
standards do not yet exist to study their wear
behaviors.
With a non-contact 3D Measurement System

(Micromesure2) we measured the critic linear wear
profile of the rod near the 2nd sliding screw and
determined the maximum wear depth and the
sliding length. Wear volume was extrapolated from
this linear profile with a computer-aided design
software.
RESU L TS
Results of the lubricated tests are shown in Table
1. The sliding length is about 21 mm, and the
reference wear volume obtained is 0,43 mm3/
screw/million cycles.
We present here a new experimental protocol to

study wear of a flexible growing spinal system.
METHODS
The experimental set-up (Figure 1) is composed
of a synthetic spine made of polyethylene, representing 5 vertebrae of paediatric dimensions. On
this spine, a flexible device under development
is inserted. Through a 5-axis machining center
with rotation frequency equals to 2 Hz, we simulated a supra-physiological flexion of the spine
(10 between 2 vertebrae).
100000 cycles
1 million cycles
Maximum wear
depth (m)
7.5
15
Wear volume
(mm 3)
0.18
0.43
Table 1: R
esults of the lubricated tests, obtained for
the 2nd sliding screw.
Discussion
Spinal fusionless devices have been developed for
only 10 years. There is a need to study wear of such
sliding devices.
Tests were conducted in dry and wet (bovine serum) environment until 100 000 and 1 million cycles.
The experimental protocol presented here and

tested on a new device gave a wear volume similar
to the ones that could be found in intervertebral
disc arthoplasty [Xin, 2013] or in rigid spinal systems
[Singh, 2013].
Results were obtained here for an ideal
configuration (aligned screws); tests will be
continued to simulate misalignment. Moreover, a
numerical model is under development to obtain
contact information inside the screw head.
References
Cotrel and Dubousset, Rev Chir Orthop
Reparatrice Appar Mot 70, 489494, 1984.
McCarthy et al, Clin. Orthop. Relat. Res.
468, 705710, 2009.
Ouellet, Clin. Orthop. Relat. Res. 469,
13561367, 2011.
Singh et al, Spine 38, 15461553, 2013.
Xin et al, Wear 303, 473479, 2013.
Figure 1: E
xperimental set-up
295
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PERCENT CONTRIBUTION OF INTERVERTEBRAL JOINTS

TO LUMBAR ROTATIONAL MOTION DURING
A FUNCTIONAL LIFTING TASK: AN IN VIVO STUDY
A. Aiyangar1, L. Zheng2, W. Anderst2, X. Zhang3
1
EMPA Swiss Federal Laboratories forMaterials Science and Technology,

Mechanical Systems Engineering, Duebendorf, Switzerland
2
University of Pittsburgh, Orthopaedic Surgery, Pittsburgh, USA
University of Pittsburgh, Mechanical Engineering and Materials Science, Pittsburgh, USA
Introduction
The apportionment of lumbar rotation across its
individual segments is an important descriptor of
lumbar kinematics. While contributions from static
end-range-of-motion (eROM) images (Pearcy
1984) fail to capture potential variations occurring
throughout the motion, in vitro studies (Panjabi
1994) might not realistically represent in vivo
loading conditions. This paper aims to quantify
intervertebral segmental contributions to lumbar
flexion based on recently recorded continuous, in
vivo 3D data during a lifting task.
than progressively decreasing contribution from

L23 to L5S1 (Wong 2004), study results suggest
a more parabolic pattern (fig 2) with increased
contribution from the middle segments compared
to the outer segments.
Methods
11 healthy subjects (7 male, 4 female) lifted a known
weight (3 weights: 4.5, 9, 13.5 kg) from a trunk-flexed
position (~75 trunk flexion) to an upright position.
A unique biplane X-ray systemDynamic Stereo
X-ray (DSX)was used to record dynamic images
of subjects lumbar (L2-S1) motion in two directions
simultaneously (30frames/s, 2 seconds, radiation
pulse width 4ms/frame, 7080kV, 320630mA). 3D
models of the vertebrae were reconstructed from
subjects lumbar CT images to be used along with
custom, markerless model-based tracking software
to obtain highly accurate ( 0.26, 0.2 mm) 3D bone
kinematics. Segmental motion was expressed as
the motion of superior vertebra relative to the inferior one. Frame-wise total (L2-S1) extension of
each participant was first normalized as a percent
of their own upright posture (set as 100%) from
a static trial; starting position was defined as 0%.
Frame-wise segmental (L23, L34, L45, L5S1) extensions were plotted against the normalized L2-S1 extension. After interpolating to each % increment of
L2-S1 motion, fractional segmental contributions to
overall L2-S1 motion were then computed to show
the segmental apportionment of L2-S1 motion. As
a first analysis, data from the three lifting trials have
been aggregated.
Figure 1: C
ontinuous % segmental contribution
Figure 2: S egmental contribution, averaged over the entire

ROM for the lifting task.
Results
Overall, the inner segments (L34, L45) together
contributed a larger share (~60% combined)
compared to L23 and L5S1 (fig.1, 2. Shaded areas
and error bars are 95% confidence intervals).
Contribution from L34 and L45 remained largely
unchanged, on average. However, L23 contribution
increased while L5S1 contribution gradually
decreased in a somewhat complementary fashion
as motion progressed (fig. 2,3). In vitro and eROM
studies tend to underestimate L34/L45 contribution
while overestimating L23/L5S1 contributions. Rather
Figure 3: A
verage change in segmental contribution over
the ROM of the lifting task.
see the next page
296
Discussion
Motion across segments is not similar; rather there is
a modest difference between overall contributions
from
different
segments.
Some
segments
contributions vary more than others within the entire
motion. Continuous segmental rotation mapping
can potentially lead to improved biomechanical
markers of pathological conditions.
References
P
earcy et al. Spine, 9:294297, 1984;
P
anjabi et al., JBJS, 76:413424,1994;
W
ong et al., Spine, 29(19): 16361641, 2004.
A c k n o w l ed g e m e n t s
Marie Curie COFUND postdoctoral fellowship 201214;
CDC/NIOSH Grant (R21OH00996)
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TESTING OF HYBRID-INSTRUMENTATION IN LUMBAR SPINE

USING MAGNETIC TRACKING SYSTEM AND BIOREACTOR
A. Beckmann1
1
RWTH Technical University Aachen, Institute of General Mechanics, Aachen, Germany
One of the most common age-related changes

of the spinal column is degenerative lumbar
stenosis, where open decompression has become
the most popular surgical intervention. If required,
treatment may be combined with fusion of spinal
segments which may cause onset of adjacent
segment disease (ASD) [1]. Initial benefits after
posterior rigid stabilization might be outweighed
by ASD. Dynamic topping off devices
combine rigid fusion with an elastic rod system
to prevent hypermobility with axial intradiscal
overload, where the elastic component shows a
temperature-dependent stiffness.
for topping off, three different dynamic systems

are used (DTO ,Zimmer Co; BalanC, Medtronic
Co.; DSS, Paradigm Spine Co.). Each device is
tested in 10 specimens. To compare temperature
dependencies, a bioreactor is developed. With a
Cardan shaft setup pure moments are applied to
the spine to enable unrestricted deformation in six
spatial degrees of freedom (Fig. 2). Translational
and rotational vertebra motions are measured
using a magnetic tracking (MT) system. As for MT
no direct sight is mandatory, measurements can
be performed within a liquid-filled bioreactor,
with MT micro-receivers implanted in the bone.
Additionally, pressure transducers are implanted
into the nuclei of the discs. Range of motions,
nucleus pressures and shifts of rotational axes from
L2 to L5 are analyzed to investigate the risk of ASD.
To investigate the effect of topping off systems

on ASD, 30 human fresh frozen L2-L5 spines are
loaded quasi-statically with pure moments (Fig. 1).
Several tests are performed with each specimen
to investigate the combination of rigid (L4/L5) and
dynamic (L3/L4) stabilization and additionally the
influence of spinal decompression and facet joint
resection. For rigid fixation titanium devices and
1. Helgeson et al: Update on the evidence for adjacent segment degeneration and disease. The spine
journal 2013, 13(3):342351.
298
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HOW REPRODUCIBLE IS THE LOCALIZATION OF CRUCIATE

AND COLLATERAL LIGAMENTS INSERTION BY USING MRI?
B. Innocenti1, P. Salandra2, W. Pascale3 , S. Pianigiani3
1
2
Universit Politecnica delle Marche, Dipartimento di Ingegneria dellInformazione DII,

Ancona, Italy
3
Introduction
Nowadays, there is a need to improve the accuracy
in identifying the knee ligaments insertions, both
for clinical application and research. In fact, this
information is fundamental in order to develop
accurate patient-specific 3D models used for
surgical pre-planning, to design patient specific
instrumentation or implant and for biomechanical
analysis [12]. Despite their large use, up to now,
no study in the literature investigates on how
accurate and reproducible is the identification
of cruciate and collateral ligaments insertions by
using MRI. This work aims to define a method for this
purpose and to validate it testing for both the tibia
and the femur bones.
Results
Collecting all the outputs together for the lowest
quality images in identifying the borders of the
cruciate ligaments insertions on the tibia, a
maximal variability of 3.2 mm and 4.4 mm has
been reported in identifying the ACL and the PCL
respectively.
When the quality of the image improves, the ACL
confirms its accuracy, while the identification of
the PCL is improved.
For the highest image-quality, both intra and inter
ICC indexes results bigger than 0.87 with exception
for the medial collateral ligament for both femur
and tibia and the lateral collateral ligament for the
tibia localization. All the indexes increases after the
operators viewed the tutorial video (up to 127%).
In general, the quality of the image improves the
reproducibility in localization up to 80%.
Methods
The new proposed procedure requires to identify
the insertion areas of the two cruciate and the two
collateral ligaments directly in the MRIs. In details,
two points are needed for the cruciate ligaments
(the anterior and the posterior extremities of the
insertion area) and one point for the collateral
ligaments (considered as the mid-point of the
insertion area) [3, 4].
Discussions
The aim of this study was to develop and prove the
efficacy of a new procedure to identify insertions
of knee ligaments from MRI images. The obtained
results of the intra and inter ICC analysis evidence
that the proposed procedure can be considered
highly suitable. In particular, the cruciate ligaments
insertions could be defined independently from
the quality of the medical image and the operator.
More attention should be taken into account for the
distal insertion of the medial collateral ligament.
A detailed description of the procedure to be used

to identify these points has been made together
with an illustrative tutorial video.
The validity, the reproducibility and the repeatability
of the new technique were determined. In
particular, the INTRA and INTER-Class Correlation
(ICC) analysis has been performed on 10 legs, by
three different operators. The operators were asked
to apply the procedure in two ways: only after
reading the description and also after viewing the
tutorial video.
RE F EREN C E
1 Thienpont et al, The Knee, 2013;
2 Renson et al, The Knee, 2014;
3 Victor et al, The Knee, 2009;
4 Grood and Suntay, J Biomech Eng, 1983.
Moreover, the procedure has been applied on two

different image-qualities (MRI with magnetization
at 0.4T and at 1.5T) to check if the proposed method
could be considered image-quality independent.
The data describing the insertion point localizations
from the different operators have been collected
and normalized before comparison.
299
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INTERACTIVE EXPLORATION OF LOCAL STRAIN

ON ULTRASOUND IMAGES A STEP CLOSER TOWARDS
CLINICAL IMPLEMENTATION
C. Carvalho1,2, P. Slagmolen1,2, J. Dhooge3 , L. Scheys4 , K. Peers5,
S. Bogaerts5, P. Suetens1,2
1
KU Leuven, Department of Electrical Engineering, ESAT/PSI, Medical Image Computing

and UZ Leuven Medical Imaging Research Center, Leuven, Belgium
2
3
4
5
iMinds, Medical IT Department, Leuven, Belgium
KU Leuven and UZ Leuven, Department of Cardiovascular Sciences, Leuven, Belgium

KU Leuven and UZ Leuven, Department of Orthopedics, Leuven, Belgium
KU Leuven and UZ Leuven, Department of Development and Regeneration, Leuven, Belgium
Introduction
In competitive sports, tendinopathies are among
the most common injuries, mostly caused by
tendon overuse.
Nowadays, the diagnosis of these tendon related
diseases is commonly performed using 2D ultrasound
through visual evaluation. This adds no further
information leading to therapeutic differentiation
or optimisation and makes it difficult to detect
the disease in earlier stages. However, physicians
believe that this extra diagnostic information can
be obtained via a biomechanical approach where
strain is evaluated. Typically, strain is estimated in a
global manner by tracking both the insertion and
origin of the tendon while this is being stretched.
In our approach we estimate strain locally adding
valuable diagnostic information regarding the
tendon biomechanics.
Figure 1: S election of region of interest within 2D ultrasound

image of sheep tendon at 5% strain superimposed
with a color map representing the tissue displacement at this strain.
Results
The accurate evaluation local strain estimations
is challenging due to the unknown ground-truth.
Therefore, we use a global average of the local
strain within a subdivision of the region of interest,
selected using the interactive interface (Figure 1),
as a surrogate and validate this with extensometers
on the ex-vivo acquisition. We can see a very strong
correlation (98%) between the imposed strain and the
strain measured by the extensometers. The absolute
strain values are 6.83%, 2.5% and 1.8% in the three
tendons, respectively, and are reproducible up to
0.15% in the repeated tests. These absolute values
are different from the imposed strain and from the
extensometer values. This can be justified by local
variations of strain within the tendon or because the
imaged region does not correspond to the maximum
strain region or to the extensometer region.
Methods
In order to estimate strain, 2D+t dynamic ultrasound
images with high spatial (0.02x0.04 mm) and
high temporal (100 fps) resolution were acquired
using the ultrasound system Vevo2100 (FUJIFILM
VisualSonics) with a MS250 linear transducer at a
central frequency of 20MHz. Three ex-vivo sheep
tendons were stretched between 0 and 5% of
strain using a material-testing machine and used
to evaluate the performance of this work. Each
specimen was stretched twice simultaneous with
the acquisition of ultrasound images.
Afterwards, a pre-processing step, based on
deformable image registration using Elastix [1, 2]
was applied between consecutive pairs of 2D
images. The applied method used a B-spline
transformation model in a multi-resolution scheme.
The similarity measure for the registration was
sum-of-squares difference and a quasi-newton
optimizer was used. The output of this registration
yielded a displacement field for all voxels of the
image. These local displacement maps were
composed together and resulted in a cumulative
displacement map.
This work shows promising results that bring
the application of ultrasound based strain
measurements in clinical scenarios closer to
reality. However, further validation should confirm
our preliminary conclusions and its benefit should
be assessed in-vivo in pathological cases. In the
long run, this work can support physicians to
evaluate abnormal deformations of tendons,
guide rehabilitation and prevent major injuries in a
straightforward manner.
References
S. Klein et al, T-MI,29(1):196205,2010.
D.P. Shamonin et al, Front.Neuroinform,
7(50): 115, 2014.
300
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THREE-DIMENSIONAL MAPPING VENTRICULAR

ENDOCARDIAL CURVEDNESS USING CMR IMAGE
IN MORPHOLOGICAL SUBTYPES OF HYPERTROPHIC
CARDIOMYOPATHY
L. Zhong1, S.K. Teo2, X.D. Zhao1, Y. Su2, H.C. Tang3 , R.S. Tan3
1
National Heart Centre Singapore, National Heart Research Institute of Singapore,

Singapore, Singapore
2
ASTAR, Institute of High Performance Computing, Singapore, Singapore

3
National Heart Centre Singapore, Cardiology, Singapore, Singapore
Introduction
Hypertrophic
cardiomyopathy
(HCM)
is
a
relatively common genetic cardiac disorder in
which a portion of the myocardium becomes
hypertrophied. The pattern of hypertrophy is
variable and can be classified into the following
subtypes:
reverse
curvature,
sigmoid
and
neutral, apical HCM and mid-ventricular HCM.
Appropriate identification of these morphological
subtypes may be helpful because they appear
to be closely related to the presence or absence
of a HCM-related genetic abnormality. In this
study, we aimed to develop a method to map
three-dimensional ventricular curvedness from
cardiac magnetic resonance imaging (MRI) and
assessed the difference of area strain in subtypes
of patients with hypertrophic cardiomyopathy.
exhibited significant decreases in curvedness

variation in both ED and ES (ED: 22% vs 35 %;
ES: 37 % vs 49 %, both P < 0.001). Area strain was
73%20% in normal control, 71%20% in sigmoid
subtype, reduced 53% 14% in reserve curvature
subtype (P<0.05) and 75%20% in neutral subtype
(ANOVO P<0.05). Curvedness variation positively
correlated with area strain (r=0.72, P<0.05).
D i s c u s s i o n A n d C o n cl u s i o n
A method of three-dimensional curvedness
mapping is proposed by using cine MRI. The
curvedness mapping for each subtype of HCM
is successfully demonstrated. Reserve curvature
subtype has demonstrated a significant impaired
area strain, which may be associated with extent
of myocardial fibrosis.
METHOD
The proposed method was experimented on
18HCM patients (male/female=12/8) and 9 age-matched normal control (male/female=8/1).
The MR images were acquired on a 1.5T Siemens
scanner with conventional ECG gating. The pixel
spacing is 1.67 mm. The TR/TE/flip angle is typically
63.84/1:13/70. Short-axis and long-axis MRI
were used to reconstruct end-diastolic (ED) and
end-systolic (ES) LV three-dimensional geometry.
The principal maximum and minimum curvatures
on the endocardial surface were determined by
using our custom software and the local surface
curvedness (C) was calculated as the root mean
square of these principal curvatures [12]. The
area strain was calculated as the surface area
change from ED to ES phases [3]. The curvedness
and area strain values were averaged in standard
16-element model, according to American Heart
Association.
References
1 Zhong, L., et al. Am J Physiol Heart Circ Physiol 2009,
296:H573H584.
2 Zhong L, et al. Am J Physiol Heart Circ Physiol 2011,
300:H1653H1660.
3 Zhong L, et al. Am J Physiol Heart Circ Physiol 2012,
302:H1306H1316.
Results
Cardiac magnetic resonance imaging examples
of each HCM morphologic subtypes and the
corresponding
three-dimensional
curvedness
mapping are shown in Figure 1. There were
6 sigmoid, 7 reserve curvature and 5 neutral HCM.
Comparing to normal control, HCM patients
Figure 1: S ubtypes of hypertrophic cardiomyopathy

(A) sigmoid, (B) reverse curvature (C) neutral HCM
from cardiac MRI (top row) and curvedness mapping (bottom row).
301
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REGIONAL ASSESSMENT OF CARTILAGE THICKNESS

AND SUBCHONDRAL BONE DENSITY USING
CT-ARTHROGRAPHY
J. Favre1, P. Chakravarty1, A. Cavinato1, V. Meyer1, B. Jolles-Haeberli1, P. Omoumi2
1
Centre Hospitalier Universitaire Vaudois and University of Lausanne, Swiss BioMotion Lab,
2
Centre Hospitalier Universitaire Vaudois and University of Lausanne,

Department of Radiology, Lausanne, Switzerland
Introduction
Knee osteoarthritis (OA) is a leading disease
worldwide for which no cure exists. To improve
fundamental understanding and treatment, there is
a need for more sensitive methods to assess tissue
degenerations. Recently, MRI-based methods were
proposed to measure cartilage thickness in various
regions of interest (ROI) and greatly improved the
quantification of morphological changes with disease
development [Pelletier, 2007]. Since OA also affects
bone structures [Baker, 2012], a method including
the characterization of regional subchondral bone
mineral density (BMD) would be highly beneficial.
Results
There were significant differences between
properties of non-OA and OA knees (Table 1).
This study aimed to design a method for

simultaneous assessment of regional cartilage
thickness and BMD using CT-arthrography (CTA).
Table 1: A
verage values per ROI. Bolded results were significantly different between groups (t-test p-value < 0.05).
Method
The proposed method works with any standard
CTA procedures. Once the knee has been
scanned, bones and cartilages are segmented in
the CTA images and 3D models of the tissue are
reconstructed using custom software. Then, each
point on the bone surface covered with cartilage
is given a cartilage thickness and BMD values.
Cartilage thickness is calculated as the distance
between bone and cartilage model surfaces. BMD
is calculated as the average signal intensity over
the CTA bone voxels within a distance of 3 mm
from the point of measurement. The 3D properties
maps are then reduced by calculating average
values for specific ROI (see Fig. 1).
Discussion
This study introduced a novel method for
simultaneous assessment of cartilage morphology
and bone composition. When used to compare
healthy and OA knees, the method was able to
detect significant differences. The differences
observed in cartilage thickness well agreed
with prior studies. On the other hand, literature
is very scarce on subchondral BMD. Thus, this
study brought new insight by showing that BMD
just below the cartilage is lower in OA knees and
that the differences differ among regions. While
the clinical interpretation of the results is limited
due to the small population, the results already
demonstrated the potential of this new method.
This study focussed on the condyles, but the
method can be used without modification to
characterize any joint surface. A point to consider
is that CTA is more invasive than MRI. Nevertheless,
CTA allows measuring BMD in addition to cartilage
morphology and it is a standard imaging modality
in numerous countries. Tissue segmentation is also
easier with CTA, thus increasing the chance for the
method to translate to routine evaluations.
The method was assessed by comparing the

femur of four end-stage medial OA knees with four
knees without imaging signs of OA. This study was
approved by our Ethical Comity and knees were
matched for age and bone size.
References
Jean-Pierre Pelletier, Arthritis Research & Therapy,
9:R74, 2007.
Julie C. Baker-LePain, Bone 51:197200, 2012.
Figure 1: Example of 3D cartilage thickness map and definition
of the ROI according to [Pelletier, 2007]. M: Medial,
L: Lateral, A: Anterior, C: Central, P: Posterior.
302
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IN-VIVO ASSESSMENT OF THE PREGNANT CERVIX USING

TRANSIENT ELASTOGRAPHY
L. Peralta1, F.S. Molina2, J. Melchor1, L.F. Gmez2, J. Florido3 , P. Mass3 , G. Rus1
1
2
San Cecilio University Hospital, Obstetrics and Gynecology, Granada, Spain

3
University of Granada, Obstetrics and Gynecology, Granada, Spain
Introduction
In the last years, quasi-static elastography has been
proposed by many authors to evaluate cervical
stiffness/softness. Nevertheless, all of them showed
inconsistent results in terms of reproducibility and
correlation between softness and gestational
age 1,2. The resulting colour map represents
only a qualitative description of the relative
strain distribution, far away from a quantitative
description of the real stiffness of the tissue, and
measurements are dependent on transducer
pressure applied by the operator. Hence, absolute
values of cervical stiffness are necessary for an
objective assessment of the cervical ripening3.
Results
There were significant correlations between
cervical stiffness measured in the four regions
with gestational age and the remaining time for
delivery (see Table 1). Results confirm stiffness
variability within the cervix. No significant
association was found between cervical length
and stiffness in the four ROIs. The external part of
the cervix was significantly softer than the internal
one, and these stiffness values significantly vary
in the anterior compared to the posterior cervix.
The measurements taken by the same and by two
different observers for different regions in the cervix
were reliable and reproducible.
Dynamic elastography techniques, which rely

on shear waves propagation, may produce
quantitative and higher resolution of cervical
stiffness compared to quasi-static methods 4.
This study is aimed to evaluate the feasibility
of providing quantitative information on the
evolution of the cervical stiffness of shear waves
elastography along pregnancy.
Stiffness
CL
GA
TD
A1
0.259
0.672**
0.670**
A2
0.413*
0.796**
0.803**
A3
0.331*
0.786**
0.790**
A4
0.057
0.567**
0.573**
Table 1: P
earson correlation coefficient between cervical
stiffness, cervical length (CL), gestational age (GA)
and interval time from elastography examination
to delivery (TD). *p<0.05, **p<0.0005.
Methods
Transient elastography was used to quantify the cervical stiffness in four anatomical regions. Forty-two women aged between 17 and 43 years, at 641 weeks of
gestation were studied. The stiffness was related to
gestational age at time of examination (GA), interval
from ultrasound examination to delivery (TD) and cervical length (CL), to evaluate the potential of transient
elastography to assess cervical ripening. In addition,
a sensitivity analysis based on Cronbachs alpha coefficient was carried out to assess the concordance
between inter/intra-operator measurements.
Discussion
It is feasible to objectively quantify the decrease
of cervical stiffness correlated to gestational age.
Transient elastography is a valuable promising tool
to provide additional information on the process of
cervical effacement to that obtained from digital
examination and conventional ultrasound.
References
1 Fruscalzo et al, Ultraschall in der Medizin,
33(07):E101E107, 2012.
2 Molina et al, Ultrasound in Obstetrics & Gynecology,
39(6):685689, 2012.
3 Feltovich et al, Ultrasound in Obstetrics & Gynecology,
41(2):121128, 2013.
4 Gennisson et al, Diagnostic and interventional
imaging, 94(5):487495, 2013.
Spanish Ministerio de Economa for project
DPI2010-17065, Spanish Junta de Andaluca for
projects P11-CTS-8089 and GGI3000IDIB, and the
European Union for program Programa Operativo
FEDER de Andaluca 20072013.
Figure 1: Elastographic and B-mode images of the cervix.

Circles correspond to the ROIs to assess the stiffness.
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EFFECTS OF NORMAL AND ABNORMAL LOADING

CONDITIONS ON PRENATAL HIP JOINT DEVELOPMENT
M. Giorgi1, A. Carriero2, S.J. Shefelbine3 , N. Nowlan1
1
2
3
Florida Institute of Technology, Biomedical Engineering, Melbourne, USA
Northeastern University, Mechanical and Industrial Engineering, Boston, USA
Introduction
At gestational week 11 of human hip joint development, a globular femoral head is almost completely enclosed by a deep-set acetabulum. From
that time until birth, the acetabulum becomes
shallower and the femoral head loses substantial
sphericity (Rli and McKibbin, 1973). The coverage of the femoral head is at its lowest at birth
(Rli and McKibbin, 1973), and this may influence
the emergence of developmental dysplasia of the
hip (DDH) in which the hip is unstable or dislocated. In this study, we develop a mechanobiological
simulation of prenatal hip joint morphogenesis in
order to provide new insights into the normal physiology of joint morphogenesis and into the etiology
of DDH. We hypothesize that reduced or asymmetric fetal movements may negatively influence hip
joint shape at birth.
2-D), suggesting that increased movements in the

case of mal-positioning or joint laxity in utero may
actually increase the risk of DDH.
Figure 1: A
) Initial shape; B) Acetabular and femoral head
ratios; C) Acetabular and femoral head skew factors.
Methods
An idealised 2D geometry of a simplified hip joint was
created. The joint consisted of two opposing cartilage
rudiments: the proximal femur and the pelvis, which
included a concave acetabular region (Figure 1-A).
All material properties were assumed to be linear
elastic, isotropic and homogeneous. Three phases
of development were modelled; early, middle and
late, where growth rates and the range of movement
decreased step-wise over the three developmental
phases. Symmetrical movements from 40 in the
early stage, 30 in the middle stage, and 5 in the
late stage were used to simulate the physiological
range of hip motion. We also explored the effects of
reduced movements at each of the three stages of
development. Asymmetric movements and reduced
asymmetric movements were also simulated. The
changes in shape were assessed by looking at two
parameters, the acetabular ratio and the femoral
head ratio and, as a measure of asymmetry we
calculated the acetabular and femoral head skew
factors (Figure 1-B, C).
Figure 2: A
) predicted shape with symmetric movements;
B) predicted shape with asymmetric movements;
C) Effects of symmetric reduced movements;
D) Effects of asymmetric reduced movements.
Discussion
This study demonstrates that normal fetal movements
are important for the emergence of hip joint shape
and coverage. Symmetric movements help to
maintain some of the acetabular depth and femoral
head sphericity while reduced symmetric movements
lead to decreased sphericity and acetabular
coverage of the femoral head. Asymmetric
movements lead to an abnormal hip joint shape with
characteristics of DDH such as a malformed femoral
head and an asymmetric shallower acetabulum. This
research provides evidence for the importance of
fetal movements in promoting normal and abnormal
hip joint morphogenesis.
Results
Our physiological predictions replicated the
trends of human hip joint development, with
the acetabulum progressively opening and the
femoral head showing the onset of a flatter
surface at its proximal end over development
(Figure 2-A). When reduced symmetric movements
were simulated, the results suggest that fetal
movements tend to minimise the natural trend
of decreasing stability (Figure 2-B). When an
asymmetric movement pattern was simulated, the
predicted joint shape was abnormal (Figure 2-C).
Acetabular depth and skew were exacerbated
with greater asymmetric movement ranges (Figure
References
Rli, Z., McKibbin, B., 1973. Changes in shape of
the human hip joint during its development and
their relation to its stability. Journal of Bone & Joint
Surgery, British Volume 55, 780785.
304
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CORRELATING LOCAL STRAIN MODALITIES WITH LOCAL

GENE EXPRESSION IN VIVO IN BONE TISSUE
E. Goff1, A. Levchuk1, A.J. Trssel1, P. Christen1, R. Mller1
1
ETHZ, Institute for Biomechanics, Zurich, Switzerland
Introduction
Animal studies have investigated and related
bones remodeling response to external loading
applied in vivo [Schulte, 2013]. At the gene-level,
previous in vitro experiments have applied loading
to bone cells and identified specific genes, such
as Sfrp1, RANKL, and Wnt10b, to be involved in the
mechanical signaling processes [Robinson, 2006;
You, 2008]. Yet, while it has been demonstrated that
gene expression is linked to loading, it remains to
be determined how gene expression is associated
with loading at the local level in vivo. Based on
previous in vitro studies, we hypothesized that the
expression of Sfrp1, RANKL, and Wnt10b genes,
are correlated locally with mechanical loading.
To test this hypothesis we combined laser cutting
PCR methodologies with micro-finite element
(FE) analyses based on time-lapsed in vivo microcomputed tomography (CT) [Trssel, 2013]. The
local strain characteristic at the gene level is still
unclear. We thus tested different strain modalities
such as the mean, median, mode, and standard
deviation. E.g., the mode is relevant as it represents
the strain level occurring most frequently in the
region examined and could reflect the behavior
of present osteocytes. Representing the inverse of
the mode, the standard deviation could provide
insight into how some genes respond to the outer
bounds of experienced strain levels.
SED parameters between week 0 and week 2.

The quantitative relationship between these local
strain parameters and local gene expression was
then evaluated in time-specific linear regression
models created in R 3.1.2.
Results
In each regression model, between 1 and
4 time-specific local SED parameters emerged
as significant. Among the genes tested, Sfrp1
demonstrated the strongest correlation to the
included SED variables with respect to each of the
discrete time-point models.
Gene
Most Significant
SED Variable
Correlation
Coefficient R
Sfrp1
Mode (p<0.001)
0.7150
RANKL
Stdev (p<0.01)
0.4378
Wnt10b
Mean (p<0.01)
0.4136
Table 1: S elected significant parameters from linear regression models that describe the genes correlation
to SED changes from week 0 to week 2.
Discussion
Here we have shown, for the first time, that certain
gene expression is indeed correlated locally with
mechanical loading in vivo. This supports our
hypothesis and previous in vitro studies. When
including only a single strain parameter in each
model, the level of correlation drops drastically.
Thus, we still need to further elucidate the effects
of strain modalities. Based on the correlations
established in our model, we conclude that the
investigated genes are sensitive to mechanical
loading with varying degrees. The presented
approach provides the framework to further
investigate these complex genetic regulations of
mechanical bone adaptation.
Methods
The sixth caudal vertebrae of nine C57BL/6 mice
were imaged in vivo using CT at week 0, 1, and 2
in a healthy aging experiment. These scans were
then transformed into a FE model and then solved
using a previously in-house developed FE solver
(ParFE) to create a high resolution strain energy
density (SED) map of the bone on the order of
10 m. The mice were sacrificed at week 2 and
laser-extraction PCR methods were implemented
to quantitatively measure local gene expression in
identified osteocyte dense (groups of 5 to 15 cells)
trabecular regions of each animals vertebra.
The location of each extracted section was
matched spatially with the corresponding region
in the CT based SED map to calculate local SED
parameters at each time point of the experiment.
Also calculated was the change in each of these
References
Robinson et al, J. Biol. Chem. 281: 3172031728, 2006.
Schulte et al, PLOS ONE 8: 112, 2013
Trssel et al, Proc. ICCB 146, 2013
Wolff J (1892) Das Gesetz der Transformation der
Knochen. A Hirschwald, Berlin.
You et al, Bone 42: 172179, 2008
305
O 268
COMPUTATIONAL MODEL OF THE FORMATION OF FLAT

BONES, FONTANELLES AND SUTURES IN THE HUMAN
CRANIAL VAULT
F. Burgos1, D.A. Garzn Alvarado1
1
Universidad Nacional de Colombia, Departamento de ingeniera mecnica y mecatrnica,

Bogota, Columbia
Introduction
The growth rate of the flat bones and the formation
of fontanels and sutures in the human cranial vault
are determined by a complex interaction between
biochemical and mechanical factors that regulate
bone formation throughout prenatal and postnatal
development. Alterations in these processes may
cause premature fusion of cranial sutures during
or after embryonic development, condition known
as craniosynostosis (CS) [Enlow, 1986]. CS patients
have an altered cranial morphology, intracranial
hypertension and delayed cognitive development
[Lekovic, 2004]. Here we propose a computational
model that simulates the formation of the flat
bones, fontanels and sutures of human cranial
vault during prenatal and postnatal development,
thus providing alternatives in the study of CS.
Results
Figure 1 shows the results of concentrations of DLX5
and TGFB-3 for the parietal bones and sutures.
Figure 1: ( a) TGFB-3 concentration on suture sites (ng/ml).

(b) and (c) DLX5 concentration for each parietal
bone (ng/ml). (d) Bone formation and suture
patterning on the cranial vault (bone in green-suture
in blue).
Sites where concentrations of TGFB-3 are higher

than 0.4 ng/ml maintain suture patterning, whereas
locations with concentrations bellow 0.1 ng/ml exhibit
sagittal suture obliteration, as shown in figure 2.
Methods
This article assumes that the formation of flat
bones, fontanels and sutures is controlled by two
different stages: Growth of the flat bones from
ossification centers. The flat bones of the skull (two
parietal, two frontal and two occipital) grow from
ossification centers through the action of DLX5, a
molecule that is expressed on the ossification fronts
of each bone and stimulates the differentiation
of mesenchymal cells to osteoblast at this sites
[Holleville, 2003]. Once the opposing bone fronts
are relatively close to each other, the formation of
sutures and fontanels begins. Sutural mesenchymal
cells express transforming growth factor beta 3
(TGFB-3), a molecule which is thought to inhibit the
differentiation of mesenchymal cells to osteoblast
at the bones fronts [Opperman, 2002]. In this way,
bone formation at the ossification fronts is regulated
by the concentrations of these molecules.
Figure 2. ( a) TGFB-3 concentration for each flat bone.

(b) Bone formation and premature suture fusion of
the sagittal suture (Bone in green, suture in blue).
Discussion
The results suggest the existence of a regulatory
loop between TGFB-3 and DLX5, where low
concentrations of TGFB-3 (lower than 0.1 ng/ml)
induced premature suture fusion of the sagittal
suture, while high concentrations maintained
suture patterning. Also, when changes in DLX5
concentrations at bone ossification fronts were
computationally set, suture interdigitation was
induced. This could be explained by variations
in compressive and tensile stress on the suture
sites during prenatal and postnatal brain growth
[Opperman, 2006], which may modify molecule
synthesis trough a mechanotransduction pathway
[Huang, 2010].
To simulate our hypothesis, a computational

model was implemented using the finite element
method by means of a system of reaction diffusion
equations between these two molecules, DLX5 and
TGFB-3, whose concentration gradients regulate
the rate of differentiation of mesenchymal cells
to osteoblasts at the ossification fronts of each flat
bone.
see the next page
306
References
Enlow, D, Normal craniofacial growth, Craniosynostosis: diagnosis, evaluation, and management,
p. 131156, 1986.
H
olleville, N et al, Developmental Biology, 257(1):
177189, 2003.
H
uang, C et al, The journal of the Federation of
American Societies for Experimental Biology,
10: 36253632, 2010.
Lekovic, GP et al, Seminars in Pediatric Neurology,

11(4):305310, 2004.
Opperman, L et al, The Anatomical Record, 267(2):
12030, 2002.
Opperman, L, Orthodontics & Craniofacial
Research, 9(3): 11122, 2006.
307
O 2 69
COMPARATIVE STUDY ON VARIOUS FIXATIONS

OF SACRAL BONE INJURIES
L. Lobovsky1, M. Salasek2, M. Jansova1, J. Hartlova1, J. Krystek1, J. Kren1
1
University of West Bohemia Faculty of Applied Sciences, NTIS New Technologies for
Information Society, Plzen, Czech Republic
University Hospital Plzen, Clinic for Orthopaedics and Traumatology of Locomotive Organs,
Plzen, Czech Republic
Introduction
The study is focused on experimental as well as
computational analysis of several techniques that
are used in surgical treatment of human pelvis
injuries. A special attention is paid to fixation of the
relative position of parts of fractured sacral bone.
The two fractured parts of sacral bone may be
attached together directly using iliosacral screws
[Girldez-Snchez, 2014] or the relative position
of these bone parts may be constrained using
the transiliac plate or the transiliac fixator etc.
[Dienstknecht, 2011], [Suzuki, 2009]. The study aims
at rigorous description of mechanical response of
fractured sacrumwith various types of fixations to
physiological loading.
findings were validated. All results were corelated

with the data recorded by the extensometer and
the load cell of the testing device applying the
mechanical load on pelvic bones.
Results
The DIC analysis enabled a reconstruction of the
three-dimensional surface of pelvic bones and
its deformation based on correlation of images
recorded by multiple cameras (i.e. two and
more) at the same instant, see Figure 1. Based on
the experimental data as well as computational
simulations, the relative motion of the two parts
of fractured sacrum was minimised using iliosacral
screws. Application of two iliosacral screws was
identified superior to a single iliosacral screw
treatment as they provided better support to the
fractured sacral bone while minimised the loads on
the surrounding bone tissue.
Methods
The orthopaedic model of intact male pelvis
was subjected to well defined mechanical
loading and its deformations were analysed using
photogrammetric approaches and techniques of
digital image correlation (DIC). The model was
mounted on a dedicated metal stand that was
designed and manufactured in order to provide
a rigid support to pelvis in acetabula such that
the position of pelvis was fixed in space and its
rotations in the sagittal plane were prevented.
The prescribed mechanical loading was applied
by the mechanical testing device at the base of
the sacrum and the deformation of pelvic bones,
the displacement of selected points on their
surface respectivelly, was studied by means of
DIC for various loads. Furthermore, a dedicated
computational model was developed using the
finite element method (FEM) and the experimental
Discussion
The experimental data served as a reference for
validation of the computational model while the
computational analysis enabled a deeper insight
into material response of the orthopaedic model
of pelvic ring. The study is considered as a starting
point for future computational analysis which
aims at addressing real physiological conditions
in human pelvis, incorporating the real material
properties of pelvic bones and implementation of
models for cartilage and ligamentous tissues.
References
D
ienstknecht T. et al., Int. Orthopaedics 35:
18631868, 2011.
Suzuki T. et al., Int. J. Care Injured 40:405409, 2009.
Girldez-Snchez M.A. et al., Int. J. Care Injured,
in press, 2014.
308
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CT-BASED FINITE ELEMENT MODELS OF LOCKING PLATE

FRACTURE FIXATIONS FOR THE PREDICTION OF STIFFNESS
AND SCREW LOADS
A. Synek1, S. Baumbach2, D. Pahr1
1

Vienna, Austria
2
Ludwig Maximilians University Munich, Trauma Surgery, Munich, Germany
Introduction
Internal fixation of unstable bone fractures with
locking plates is a common surgery procedure.
Finite element (FE) analysis can help to compare
and improve the various available fixation devices.
However, published FE modelling procedures differ
considerably. In this study, we present a method
for generating FE models of the bone-implant
system based on computed tomography (CT) data
of intact bone which allows the semi-automatic
evaluation of the overall stiffness and screw loads.
For the first time, three bone material modelling
strategies were compared. This general method is
exemplified on volar locking plate osteosynthesis
of distal radius fractures (DRF).
Results
The overall stiffness of type (b) models correlated
highly (R 2 = 0.998) with type (a) (Fig. 2, left), i.e.
orthotropy made no difference. R2 was considerably
lower for model type (c) (R 2 = 0.738), i.e. local
density counted. No significant differences were
found for the screw loads between models of type
(a) and (b) (not shown), but individual screw loads
differed significantly from those in models of type
(c) (Fig. 2, right).
METHODS
The FE model generation was done in medtool
(Dr. Pahr Ingenieurs e.U.) and based on two data
sources an HR-pQCT scan of intact bone and
template geometries of the fracture, implant,
and embedding material (Fig. 1, left). The whole
procedure was conducted in 25 intact, human
cadaveric radii. The template geometries were
positioned with respect to the bone surface
extracted from the CT image and combined
with the CT image (Fig. 1, middle) which shows
separated
cortical
and
trabecular
bone.
The combined 3D image was meshed with
tetrahedrons (Fig. 1, right). Connector elements
were inserted between implant plate and screws
to evaluate the section forces and moments. Bone
material properties were assigned using three
different material mapping strategies [Pahr, 2009]:
(a) Isotropic cortical and orthotropic cancellous
bone,
both
inhomogeneous
(b)
Isotropic
cortical and isotropic cancellous bone, both
inhomogeneous (c) Isotropic cortical and isotropic
cancellous bone, both homogeneous
Figure 2: O
verall stiffness (left) and normalized screw loads
(right). * indicates p<0.05
DIS C USSION
The presented method for generating FE models
of locking plate implants allowed the estimation of
stiffness and screw loads with template geometry
positioning being the only manual step. The shown
data revealed that homogeneous models should
be avoided. Bone inhomogeneity (local density
dependence) essentially influenced the results,
whereas local bone orthotropy (local degree of
anisotropy) had a minor effect.
RE F EREN C ES
Pahr & Zysset, J. Biomech, 42, 2009
Figure 1: O
utline of the FE model generation.
309
O 271
TIME COURSE OF BONE SCREW FIXATION FOLLOWING

A LOCAL DELIVERY OF ZOLEDRONATE
IN A RAT FEMORAL MODEL
U. Kettenberger1, A. Latypova1, A. Terrier1, D. Pioletti1
1
Ecole Polytechnique Fdrale de Lausanne, Laboratory of Biomechanical Orthopedics,

Introduction
A good anchorage of orthopedic implants requires
strong peri-implant bone [1]. One approach to
augment the bone structure is a local delivery of
bisphosphonates, which has been shown to locally
enhance bone density and increase mechanical
stability of implants [2, 3]. In this study, microFE
analysis was used to investigate the temporal
effect of locally delivered Zoledronate on screw
anchorage in a rat model of osteoporosis.
a total increase in predicted force at yield of 50%

was found between day 3 and 31. Statistically
significant differences between the groups were
detected from day 31 after surgery. A similar
time course was found for the force at pullout
(Fig. 1 right) and stiffness (data not shown). Good
correlations between the results of the present
study and published experimental and numerical
data were found.
Eight ovariectomized rats were implanted with
one screw in each femoral condyle. For 4 animals
(Zol-Gel-group), the pre-drilled screw holes were
filled with a Zoledronate-containing hyaluronic
acid hydrogel, the second group (Controlgroup) received only screws. Following screw
implantation, the animals were scanned with an
in vivo microCT first weekly and later biweekly.
After image processing, microFE models for all
scans were created with direct voxel-to-element
conversion [4] before doing numerical pullout tests.
Another experimental study with rat cadavers was
performed to validate the numerical study and
define the failure criteria.
C o n cl u s i o n
We were able to show with a combination of in
vivo microCT and microFE analysis that locally
delivered Zoledronate can significantly increase
implant anchorage in a rat model early and for a
prolonged time.
Figure 1: T ime course of predicted force at yield (left) and

force at pullout (right) for the two experimental
groups.

The predicted force at yield rose in the control
group between day 3 and 10 after surgery by 9%
and then did not change significantly until the
end of the study (Fig. 1 left). For the Zol-Gel-group,
References
[1] Schiuma et al, Med Eng Phys. 2013.
[2] Peter et al, J Biomed Mater Res A. 2006.
[3] Andersson et al, J Mater Sci Mater Med. 2010.
[4] Muller et al, Med Eng Phys. 1995.
310
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STOCHASTIC RELIABILITY ASSESSMENT OF FEMORAL

SCREWS INTENDED FOR COLLUM FEMORIS FRACTURES
K. Frydrysek1, M. Sir2, L. Pleva2
1
VSB Technical University of Ostrava, Faculty of Mechanical Engineering, Department of

Mechanics of Materials 339, Ostrava, Czech Republic
2
Faculty of Medicine University of Ostrava, Institute of Emergency Medicine,

Ostrava, Czech Republic
Introduction
Proximal femoral neck fractures, see Fig. 1, remain
a vexing clinical problem in traumatology. One
possible treatment method for femoral neck
fractures, is the application of femoral screws
made up from stainless steel or Ti6Al4V material.
Our own model for strength analyses of femoral
screws is based on the theory of beams on an
elastic foundation, where the bone interaction is
approximated by the elastic foundation.
Figure 2: L oading and its histogram, bending moment

distribution for cannulated femoral screw (result
of 1 Monte Carlo simulation) and 2D histogram
of parameter RF.
Probabilistic reliability assessment can be carried

out via the Simulation-Based Reliability Assessment
(SBRA) Method by means of the reliability function
RF = Re-abs(s MAX) /MPa/ (extreme stress values
compared to yield limit).
Figure 1: F emoral neck fracture and its treatment via three

femoral screws.
Methods
Three screws of length L = 90 mm are applied in
femur, see Fig. 1. The force F=Fm/n/N311/ acting
in one beam (screw) can be defined via total
loading force Fm/N/ which including the mass of
a patient and dynamical effects, see Fig. 2. The
parameter n /1/ is the coefficient of inequality
in the division of force Fm into three screws and
a /deg/ is femoral screw angle (defined by the
limiting angles of adduction and abduction, see
Fig. 1). All these variables, together with material
properties (yield stress Re /MPa/), are defined
via truncated histograms (stochastic approach,
Monte Carlo Method), see Fig. 2 for examples.
Three linear differential equations for the intervals
x1,2,3 /m/ can be written as E*J*v+F2*v+k*v=0
together with 12 boundary conditions. Parameters
E*J/Nm2/ is flexural stiffness, v /m/ is displacement k
/Pa/ is elastic foundation stiffness. Hence, bending
moments M oi/Nm/, maximum stresses s MAX /MPa/,
vi, stochastic reliability assessment etc., see e.g.
Fig. 2, can be calculated.
Results
The probability that plastic deformation will occur
in the screw is P(RF<0)= 2.51E-5 = 0.00251%.
Hence, the femoral screws are safe and suitable
for patient treatment. The presented stochastic
beam model was compared with 3D FE model with
adequate results too. For more information see
references. The authors gratefully acknowledge
the funding from the Czech projects TA03010804
and SP2015/180.
References
Frydrek. K., Strength Analyses of Full and Cannulated Femoral Screws Made up from Stainless Steel
and Ti6Al4V, Calculation report, VB Technical
University of Ostrava, Czech Republic,
2014, pp. 143.
Frydrek K., Tvrd K., Janco R. et al, Handbook
of Structures on Elastic Foundation, VB Technical
University of Ostrava, Czech Republic,
2013, pp. 11691.
Marek P., Brozetti J., Gutar M., Tikalsky P. et al,
Probabilistic Assessment of Structures Using Monte
Carlo Simulation, 2nd edition, Institute of Theoretical
and Applied Mechanics, Academy of Sciences of
the Czech Republic, Czech Republic,
2003, pp. 1471.
311
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HOW TO REPLICATE THE MECHANICAL BEHAVIOR

OF BONE-IMPLANT SYSTEMS USING MICRO-CT BASED
FINITE ELEMENT ANALYSES
J.A. Steiner1, S.J. Ferguson1, G.H. van Lenthe2
1
2
ETH Zurich, Institute for Biomechanics, Health Science and Technology, Zurich, Switzerland
KU Leuven, Biomechanics Section, Department of Mechanical Engineering, Leuven, Belgium
Introduction
Experimental mechanical tests to quantify the
primary stability of trabecular bone screws
typically require large sample sizes because of
wide specimen-specific variation in bone quality.
High-resolution computational analyses (microFE)
are capable of capturing the microstructural
variation in trabecular bone based on microCT imaging and could therefore be a potential
complementary
method
to
experimental
mechanical testing. Indeed, we have shown
that force-displacement curves, as measured
experimentally, can be replicated using microFE.
We have also shown that this requires the inclusion
of a bone-screw interface (BSI) region with
reduced mechanical properties [1]. At present, it is
unclear how the specimen-specific tissue modulus
of the BSI (E_BSI) can be quantified a priori. For the
present study, we hypothesized that E_BSI is related
to morphometric and mechanical parameters of
bone at the implant site.
Results
The best multi-linear predictive model for E_BSI was
obtained for the VOI that included all bone within
3mm distance to the implant. Input variables for this
model were Stiff, Emod, BS/BV, SMI and Tb.Th; rootmean-square error (RMSE) for the predicted E_BSI
was 0.063 GPa. When plugged into the microFE
bone-screw models, the measured stiffness was
accurately estimated with RMSE = 152 N/mm (3.5%),
R 2=0.89, and a slope close to 1 (Fig. 1).
Methods
Ten trabecular bone specimens were core-drilled
(16 mm in height and diameter) from fresh-frozen
human femoral heads and scanned in a CT
scanner at 20 m resolution. After insertion of a
bone screw, all specimens were scanned again
right before uniaxial quasi-static compression
testing to failure. For the microFE analyses, tissue
moduli of 120 GPa and 18 GPa were defined
for the implant and bone, respectively. The
tissue modulus of the BSI (E_BSI) was determined
such that the computed implant/bone system
stiffness, using the parallel FE solver ParoSol [2],
matched the experimentally measured stiffness.
Subsequently, morphometric and mechanical
properties of virtual bone biopsies were quantified
for each specimen. Different cylindrically-shaped
volumes of interest (VOIs) were defined in the
peri-implant bone, with radii 0 mm to 4 mm from
the implant surface. Morphometric parameters
measured were bone volume fraction (BV/TV),
specific bone surface (BS/BV), trabecular number
(Tb.N.), trabecular thickness (Tb.Th.), trabecular
spacing (Tb.Sp.) and structural model index (SMI).
Mechanical parameters determined for the periimplant bone of each biopsy were stiffness (Stiff)
and apparent modulus (E_app). A multi-linear
regression analysis (Matlab 2014a) was conducted
to determine which of these parameters (maximum
5) would yield the best estimate for E_BSI. The
predicted E_BSI was then used in the screw-bone
model to quantify the predictive power for in vitro
bone-implant stiffness.
Discussion
A multi-linear regression model has been
established that relates morphometric and
mechanical parameters of bone biopsies at the
implant site to the reduced tissue modulus of the
bone-screw interface region. With this relationship
in place, micro-CT based FE models can accurately
replicate the measured apparent stiffness of bonescrew constructs.
The authors acknowledge funding from the Swiss
Commission for Technology and Innovation
(CTI 14067.1 PFLS-LS) with Synthes as an industrial
partner. Computing time was provided by the Swiss
National Supercomputing Centre (CSCS).
References
[1] J. Steiner (2015), Orthopedic Research Society
Conference (accepted poster), Las Vegas, How
Much Trabecular Bone Damage Is Induced By
Screw Insertion?
[2] C. Flaig (2012), PhD Thesis ETH Zurich, A Highly
Scalable Memory Efficient Multigrid Solver for
-Finite Element Analyses.
312
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NUMERICAL METHODOLOGY TO EVALUATE THE EFFECTS

OF BONE DENSITY AND CEMENT AUGMENTATION ON
THE FIXATION STIFFNESS OF BONE ANCHORING DEVICES
Y. Chevalier1
1
University Hospital of Munich LMU Campus Grosshadern, Department of Orthopedic Surgery,

Physical Medicine and Rehabilitation, Munich, Germany
Introduction
Bone quality was suggested to influence the
success of bone anchoring for arthroscopic repairs
of torn rotator cuffs or Bankart lesions at the
shoulder [Cummins, 2003]. In this work, a numerical
method is proposed to study how bone quality and
cement augmentation affect the fixation stiffness
of bone anchors in various loading schemes.
Results
hFE-based axial pull-out stiffnesses correlated
excellently with the FE gold standard (R2=0.98).
Good correlations were obtained between the hFE
main stiffness components and apparent density
(R 2=0.67 to 0.99). Axial pull-out stiffness also
correlated strongly with main stiffness components
but weakly with coupling terms (Fig 2). Cementing
with increasing thickness progressively stiffened
the fixation, decreased bone stresses, and altered
these relations in dependence with apparent
density.
Methods
Bone biopsies were scanned with a microCT
at 26m and the images processed for virtual
implantation of a typical design of bone anchor.
These were converted to micro finite element (FE)
models similar to recent studies [Wirth, 2011] and
homogenized FE models (hFE) with 1-mm-sided
tetrahedrons using custom codes. FE and hFE
analyses were performed to mimic pulling on the
anchor using a parallel solver (parFE, ETH Zurich)
and commercial software (ABAQUS 6.13, Dassault
Systmes, France), and predictions of axial pull-out
stiffness compared, considering FE as structural
gold standard. Bone stresses and stiffness in all
orthogonal load cases with and without cement
augmentation of various thickness were then
computed with the hFE models and related to
apparent bone volume fraction (BV/TV) (Fig. 1).
Figure 2: C
orrelation R2 of some components of the stiffness
matrix S with BV/TV (a) and axial pull-out stiffness
(b) with and without different cement thicknesses
(f=force; m=moment;1,2,3 are the orthogonal
directions shown in Fig 1).
Discussion
The results suggest that bone anchoring stiffness
varies with loading direction and bone quality,
with revealed relations between the axial pull-out
and main orthogonal directions. Cementing
expectedly stiffened the fixation but also modified
these correlations. These insights will be refined with
further inclusion of implantation effects, nonlinear
material behaviour and experimental validation in
variety of load schemes. Applied to larger bone
structures, such method will help optimize ongoing
research on fixation characteristics of anchoring
systems used in orthopedics.
References
Cummins et al. J Shoulder Elbow Surg,12:128133,
2003. Wirth et al. Bone, 49:437478, 2011.
Figure 1: C
reation of FE and hFE models of implanted bone
anchors to predict fixation stiffness in various loading
and surgical conditions.
313
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MICRO FINITE ELEMENT ANALYSIS OF PERIPROSTHETIC

BONE TISSUE AND CEMENT STRESSES FOR TWO DESIGNS
OF ANATOMICAL GLENOID REPLACEMENT
Y. Chevalier1, I. Santos1, P.E. Mller1, M. Pietschmann1
1
University Hospital of Munich LMU, Campus Grosshadern, Department of Orthopedic Surgery,

Physical Medicine and Rehabilitation, Munich, Germany
Introduction
Glenoid loosening, still a main complication for
shoulder arthroplasty, was suggested to be related
not only to glenohumeral conformity, cementing
techniques, orientation, or design of the implant,
but also to patient-specific factors such as bone
quality [Zhang, 2013][Stroud, 2013]. So far no study
used refined finite element models with realistic
bone microstructure to quantify potential effects
of glenoid replacement design and bone quality
on internal bone tissue and cement stresses under
physiological loads.
Methods
The 82m high resolution peripheral quantitative
computer tomography (HRpQCT) images of
isolated cadaveric human scapulae were
processed to allow virtual implantation of two types
of anatomical glenoid replacements (UHMWPE
keeled and pegged fixations, Exactech). The
resulting images were converted to FE models
consisting of nearly 43 million hexahedral elements
with bone tissue, cement layer and implant regions
assigned isotropic elastic properties based on
literature. Models were subjected to central and
superiorly shifted loads at the articular surface
mimicking healthy and torn rotator cuff conditions.
The models were solved for internal stresses within
the structures with a parallel solver (parFE, ETH Zurich)
on a Linux Cluster (Fig. 1).
Figure 2: a
) Trabecular-to-cortical stress ratio for both designs
for central and shifted load; b) change in stresses
for keeled and pegged following a superior load
shift; c) effects of glenoid bone density on trabecular-to-cortical load stress ratio.
Results
A larger trabecular load share was predicted with
the pegged design compared to the keeled design
(Fig. 2a). Superior load shift reduced this ratio but
resulted in slight stress increase in the cement layer
and implant, with the keeled design less sensitive
to this shift (Fig. 2b). These effects were observed
to be more pronounced with decreased overall
bone density of the glenoid region (Fig. 2c).
Discussion
Our FE analyses suggest that implant fixation
design affects the sensitivity of internal stresses to
glenohumeral load shifts, in particular within the
cement region and through alterations in load
sharing in the periprosthetic bone. Future steps
including reverse replacements, glenohumeral
curvature mismatch and more physiologically
accurate loading conditions will provide improved
insights into the clinical incidences of glenoid
loosening.
Figure 1: T ypical FE stress predictions (frontal cut view) for

(a) keeled and (b) pegged glenoid replacements
under simulated glenohumeral contact load.
References
Stroud et al. J Shoulder Elbow Surg, 22:15731579,
2013. Zhang et al. J Shoulder Elbow Surg,
22:350356, 2013.
314
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THE EFFECT OF MISALIGNMENT ON CEMENTLESS

GLENOID PROSTHESIS FIXATION
C. Sukjamsri1, U. Hansen1
1
This study investigated the effect of misalignment

on cementless glenoid fixation; specifically,
the effect of version on glenoid component
micromotion. A novel in-vitro method for measuring
micromotion using digital volume correlation and
micro-CT scans (DVC-mCT) was validated and in
combination with FE analyses used to investigate
the effect of version on micromotion. A glenoid
prosthesis was implanted into 7 porcine specimens
at different degrees of version: 15, 10 and 5 of
retroversion and anteversion, respectively, and
one in neutral version (0).
The results showed consistent assessments between

the DVC-mCT and FE method providing confidence in
both methodologies.The results indicated that version
did affect both the distribution and magnitude of
micromotion. However, in all cases a gap (imperfect
implant seating) was present at the implant-bone
interface and had to be isolated to evaluate the
effect of version from the clearly strong effect of the
interface gap. The higher level of micromotion was
such that more retroverted glenoids were shown
to be at risk of not osseointegrating and indicates
a need for developing tools to aid the surgeon to
better align the prosthesis or for implant designs
that are more tolerant of misalignment.
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A FEA ANALYSIS COMPARING KINEMATICS OF THREE

DIFFERENT REVERSE SHOULDER ARTHROPLASTY DESIGNS
D. Lombardo1, W. Liou2, Z. Steffes1, Y. Yang2, V. Sabesan1
1
Wayne State University School of Medicine, Orthopaedic Surgery, Dearborn, USA

2
Western Michigan University, Department of Engineering, Kalamazoo, USA
Introduction
Reverse Shoulder Arthroplasty (RSA) successfully
improves the mechanical characteristics of arthritic
shoulders; however, scapular notching and limited
range of motion remain common complications
(Bohsali 2006). Recent design advancements to
optimize RSA performance and minimize failures
have included lateralizing components. These
advancements are not without trade off and
can also have negatively biomechanical effect,
such as increased shear forces along the glenoid
bone interface (Hoenecke 2014). The objective
of this study is to develop a comprehensive finite
element analysis model to evaluate the effects
of RSA implant parameters on muscle forces and
joint reactive force. We believe these findings will
provide valuable insight into possible improvements
in RSA design.
Results
The HLD reached the highest peak force on both
the medial and anterior bundles of deltoid muscle,
while the GLD reached the highest peak force on
the posterior deltoid and demonstrated a time
delay in force generation compared to two other
prostheses. In regards to the external rotators,
the GLD reached the highest peak force on the
infraspinatous, while the HLD displayed no force
generation through the infraspinatous. The highest
peak force generation through the subscapularis
occurred with the GLD. The joint reaction forces
were greatest in the GLD and the lowest in HLD.
The vertical shear force change in direction was
unique to the GLD, while the MGD displayed the
greatest vertical peak shear force.
C o n cl u s i o n
These findings demonstrate that the design
characteristics implicit in these different prostheses
results in kinematic differences in the muscle forces
and joint reactive forces following RSA. These
differences could in turn play a significant role in
the clinical success or failure of RSA for patients to
achieve specific treatment goals, such as range of
motion, strength and stability.
Methods
A 3-D computer model of a normal shoulder
joint was adapted and used to simulate shoulder
abduction. Motion at the joint with appropriate
external loading was used for the inverse dynamics
simulation. Static optimizations then allowed for
calculation of the net joint moments to the individual
muscle forces. The muscle forces were then found
via static optimization of the joint assembly. Outputs
of the simulations included joint contact forces,
muscle length and forces, and moment arms.
Accurate 3-D computer models comparing three
conceptually different reverse shoulder arthroplasty
implant designs (Humeral Lateralized design
(HLD)= Equinoxe, Exactech, Glenoid Lateralized
Design (GLD)= Encore, DJO Surgical, Medialized
Grammont design(MGD)= Aquelis, Tornier) were
also developed and parametric studies were
performed based on the numerical simulation
platform produced above for the pilot shoulder.
Bohsali, K. I., et al. J Bone Joint Surg Am 88(10):

22792292. (2006).
Hoenecke, H. R., Jr., et al. J Shoulder Elbow Surg
23(8): 11281135. (2014).
Figure: G
lenoid Lateralized Design (GLD)= Encore,
DJO Surgical,Humeral Lateralized design
(HLD)= Equinoxe, Exactech,
Medialized Grammont design(MGD)= Aquelis, Tornier
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ASSISTIVE SYSTEM OF THE SHOULDER JOINT

IMPLEMENTED AS LIGHTWEIGHT EXOSKELETON
E. Scheuner1, R.P. Kuster1, D. Textor1, B. Heinlein1
1
ZHAW Zurich University of Applied Sciences, Institute of Mechanical Systems,

Winterthur, Switzerland
third are aligned with the glenohumeral joint. Each

joint is driven by a DC motor and Bowden cables
are used for force transmission. The exoskeleton is
mounted on the upper back and the arm of the
user is strapped to a brace. The system supports
120 abduction, 120 flexion and 50 extension
and can be controlled intuitively using surface
electromyography (EMG) signals or alternatively
with voice control. In EMG mode, the device
detects the muscle activity and adjusts the level of
assistance accordingly.
The mobility of the upper extremity is crucial

for activities of daily living and independent
housekeeping. More than 20% of the elderly
are affected by shoulder disorders mainly due
to rotator cuff diseases resulting in pain, lack of
flexibility or loss of strength [Lin, 2008]. An assistive
system can be helpful for people with an impaired
shoulder joint to compensate for reduced muscle
forces and limited range of motion. Post-operative
rehabilitation (e.g. after shoulder arthroplasty) and
neurorehabilitation of stroke patients are further
fields of application.
A first prototype (Fig. 1) served as concept
verification and was presented at the World
Congress of Biomechanics 2014 [Scheuner, 2014].
However, the device is bulky and not very userfriendly. Therefore, the assistive system was
optimized in terms of weight reduction and
distribution, wearing comfort and usability. The
revised prototype will be presented at the ESB
congress.
Figure 2: R
evised prototype
Initial user studies on acceptance, satisfaction and

suitability for everyday life will be performed with
the revised prototype. The weight of the system
has been substantially reduced compared to the
first prototype: The studies need to prove that the
stability is still sufficient. Changing the system from
right- to left-arm usage and vice-versa is simplified
in the new prototype. Dividing the back fixation
into an upper and lower part offers more flexibility
to the lumbar spine region. Additionally, moving
two motors and the battery sidewards above the
hip enables a more comfortable sitting position. In
the future, a docking station will help the user to
don and doff the assistive system.
Figure 1: F irst prototype for concept verification
The revised assistive system (Fig. 2) can be used

for the right or left shoulder. Additional load in the
shoulder joint is prevented as rigid links bear the
occurring forces. To enable a physiological motion,
the scapulohumeral rhythm in the frontal plane is
implemented. As a result the exoskeleton consists
of three serial joints: the first replicating the rotation
of the scapula, so that the axes of the second and
Lin et al., J Am Med Dir Assoc, 9:626632, 2008.

Scheuner et al., World Congress of Biomechanics,
2014.
317
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ASSESSMENT OF DENTAL RESORPTION ASSOCIATED

WITH IMPACTED WISDOM TEETH USING FINITE
ELEMENT ANALYSIS
A.C. Oenning1, F.B. Prado2, P.H.F. Caria2, L. Correr-Sobrinho3 ,
A.R. Freire2, F. Haiter-Neto4
1
University of Campinas UNICAMP, Oral Diagnosis, Piracicaba, Brazil

2
University of Campinas UNICAMP, Morphology, Piracicaba, Brazil
University of Campinas UNICAMP, Restorative Dentistry, Piracicaba, Brazil

4
University of Campinas UNICAMP, Oral Diagnosis, Piracicaba, Brazil
Introduction
An impacted tooth is one that does not erupt
correctly due to a physical impaction located
on the eruption pathway. These teeth can lead
to several symptoms and pathologic conditions
such as root resorption of the adjacent tooth
(Oenning et al., 2014). Studies suggest that the
dental resorption caused by unerupted teeth may
be related to the pressure exerted by them during
the eruption process (Nitzan et al., 1981; Yamaoka
et al., 1999). According to a finite element
analysis study, this eruption movement is under
the influence of functional bite forces (Sarrafpour
et al., 2013). Therefore, the aim of this study was
to evaluate the mechanic pressure theory of the
resorption in second molars adjacent to impacted
third molars using finite element analysis.
Results
The VM stress showed high concentration on the
distal root of the second molar at cervical level
(Figure 1); the MP stress exhibited compression
areas at the same site.
Methods
A Cone Beam Computed Tomography exam
presenting an impacted mandibular third molar in
mesioangular position was selected from a database
(Ethics Committee in Research approval: 077/2011).
This position was chosen based on previous studies
that associated mesioangular third molars with a
high prevalence of resorption in second molars
(Oenning et al., 2014). The segmentation was
performed based on the variation of HU (Hounsfield
Units) values in the software InVesalius 3.0b. STL
models (stereolithography) were obtained from
the following structures: cortical bone, cancellous
bone, mandibular condyle, enamel, dentin, pulp,
periodontal ligament and soft tissue dental follicle.
The Bio-CAD modeling was performed by reverse
engineering using the software Rhinoceros 3D
4.0, and, after that, the mesh was generated for
loading simulation related to eruptive forces (Ansys
v14.0. software). The equivalent von Mises (VM)
stress and the minimum principal stress (MP) were
evaluated.
Figure 1: M
odels presenting third molar impaction
(upper model) and the high von Mises stress area
at the point of contact (lower model with removal
of the enamel model).
Discussion
According to the proposed theory and the
biomechanics results, the site of high stress
associated with compression areas was due to
the impacted third molar position. Therefore, we
can suggest a correlation of these forces with the
triggering of resorptive lesions in teeth adjacent to
dental impaction areas.
This research was sponsored by So Paulo Research
Foundation (FAPESP Brazil).
References
Nitzan et al., Oral Surg Oral Med Oral Pathol,
51: 221224, 1981.
Oenning et al., J Oral Maxillofac Surg,
72:1444 55, 2014.
Sarrafpour et al., PLoS One, 8: e58803, 2013.
Yamaoka et al., Aust Dent J, 44: 112116, 1999.
318
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ORTHOTROPIC 3D MODEL OF ALVEOLAR BONE: STRESS

DISTRIBUTION FROM MOLAR OCCLUSION A FINITE
ELEMENT ANALYSIS
A.C. Rossi1, A.R. Freire1, F.B. Prado1
1
Piracicaba Dental School State University of Campinas UNICAMP, Morphology,

Piracicaba, Brazil
Introduction
Inadequate information on material properties
complicates the interpretation of mandibular
finite element models (Korioth et al., 1992). The
orthotropic is the property that characterizes
structures having different physical characteristics
with respect to the spatial orientation (Schwartz-Dabney & Dechow, 2003). This property have
been applied in biomechanical bone tissue with
the finite element method and which allows the
construction of three-dimensional models of bone
(Apicella et al., 2009). Thus, the aim of this study
was evaluate the stress distribution from molar
occlusion simulated by finite element analysis using
a orthotropic 3D model of alveolar bone.
bone was assigned as orthotropic. The load was

applied simulating bite action on the occlusal
face of the tooth with a magnitude of 15.49 N. The
total displacement (in mm) from deformation was
evaluated.
Results
In orthotropic 3D model the point of maximum
displacement occurred in the interradicular septum
(ranged from 0 to 0.000395 mm). The orthotropic
model showed large and homogeneous distribution
of the deformation.
Discussion
Accurate modelling of biological tissues, such as
bone related organs, is a very difficult task because
of their inherent in homogeneous and anisotropic
characteristics (Apicella et al., 2009). Considering
the limitations in reproducing the anisotropy models
for finite element analyses, we suggested that the
orthotropic model is recommended to analyses
applied to the mandibular cortical bone, because
its structure is more sensitive to mechanical forces
and provides greater distribution of deformation.
Methods
The CT (GE HiSpeed NX / i CT scanner General
Electric, Denver, CO, USA) was performed at the
adult and macerate jaw. To increase the accuracy
in the geometry, the CT slices had 0.25 mm of
thickness.3D geometry of alveolar segment at
molar region from human mandible were used. The
geometry were formed by: socket, molar tooth and
the periodontal ligament, which were constructed
by BioCAD reverse engineering using Rhinoceros
3D 5.0 (McNeel & Assoc., USA) software. From the
3D model was generated a finite element mesh
using ANSYS v14 (Ansys, Inc., USA) software. The
molar tooth, trabecular bone and periodontal
ligament were assigned as isotropic. The cortical
References
Apicella D, et al, J Biomed Mater Res B Appl
Biomater, 93(1):150163, 2010.
Korioth TWP, et al, Am J Phys Ant, 88: 6996, 1992.
Schwartz-Dabney CL, et al, Am J Phys Anthropol,
120: 252277, 2003.
319
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COMPARATIVE ESTIMATION OF ALVEORAL BONE

REMODELLING IN ORTHODONTIC PROCEDURES
G. Milewski1
1
Institute of Applied Mechanics/Cracow University of Technology, Cracow, Poland
Introduction
Orthodontic extrusion is considered as a
supplementary method which aim is the proper
teeth preparation for further prosthetic treatment.
Application of an additional tensile force coming
from special elastic tractions, mobile or permanent
devices produces eruptive tooth movement in
occlusion plane, stimulates periodontal ligament
and surrounding bone tissues and finally leads to
the bone remodeling of both alveolar process
and bone area close to the root apex. The
main advantage of the method is to maintain
the own tooth root together with periodontal
ligament and adjacent bone tissue. Orthodontic
extrusion enables to avoid tooth extraction as
well as following bone resorption and dental arch
disorders [1].
Results
The series of the numerical calculations were done
for the various extrusion force values, respectively
20, 25, 30, 35, 40, 45 and 50 [cN]. The analysis was
done with the regards to the both strain intensity in
the bone tissues adjacent to the incisor root as well
as von Mises reduced stress [MPa] in the periodontal
ligament consisting of the set of collagen fibres.
The range of strain values which stands for the
physiological equilibrium of bone tissue and the
beginnings of the mineral phase increase was
taken as (2 40) x 10 4 [2]. Discussion The series of
the numerical simulations show that the value of
the extrusion force which stands for the positive
remodelling phenomena in the adjacent area of
bone close to the alveolar process and tooth root
apex starts from 40 [cN]. On the other hand the
maximal effort of the periodontal ligament do not
exceed 0.55 MPa. As the periodontal ligament
of 20 49 years old man is able to carry maximal
stresses 1,6 1,7 MPa [4] it seems to be the safe
stress level for collagen fibres.
The aim of the paper was to analyze and estimate

extrusion forces values which result in positive
remodelling bone phenomena in the area close
to the alveolar process and tooth root apex. Local
strain distribution changes were considered as the
most important factor stimulating adaptive bone
material response.
References
[1] Bach N., et al, J. Can Dental Assoc, 70(11):
775780, 2004.
[2] Milewski G., Cracow Univ. Tech Publish. s. Mech.,
no 89, Cracow 2002, DSc thesis.
[3] Yoshida N., et al, Med Eng & Physics, 23(8):
567572, 2001.
[4] Komatsu K., J of Dent Biomech.: 2010, ID502318.
Methods
The upper mesial incisor was the subject of the
numerical simulations. The model consisted of
enamel, dentine, pulp as well as periodontal
ligament and surrounding alveolar bone structures.
Periodontal ligament (PDL) was modelled
alternatively as a continuous membrane and as
a set of 3600 longitudinal and tangential collagen
fibres. All structures were taken as elastic and
isotropic [2, 3].
320
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MECHANICAL DAMAGE ANALYSIS OF DENTAL

TRILAYER STRUCTURES USING XFEM
E. Homaei1, K. Farhangdoost1, J.K.H. Tsoi2, J.P. Matinlinna2, X. Jin2, A. Homaee3
1
2
Ferdowsi University of Mashhad, Mechanical Engineering, Mashhad, Iran
The University of Hong Kong, Department of Dental Materials Science, Faculty of Dentistry,
Hong Kong, China Peoples Republic
3
Khavaran Institute of higher education, Civil Engineering, mashhad, Iran
Introduction
Multilayer structures are used in dental restorations,
where a porcelain veneer is fused to a stiff metal
core to form an integral crown, which is then
cemented onto a compliant dentin tooth base
[Qasim, 2006]. Extended finite element method
(XFEM) has been performed to the experiments
done by Zhao et al [Zhao, 2002]. XFEM not only
has the ability to simulate crack initiation points,
but also can estimate crack propagation process
[Lawn, 2013]. The overall intention is to find the
optimum combination of materials and thicknesses
to provide a durable restoration.
Discussion
Whenever the top surface of metal faces the
plastic deformation and hence large strain values
along the indenter axis, it facilitates flexure of
porcelain layer. Therefore, as a result of creation of
high tensile stresses at the porcelain undersurface,
radial cracks initiate. In this way, P R diagrams are
higher than PY for all three dental metals.
In General, the minimum thickness of porcelain
layer is recommended to be 0.5 mm, avoiding
the structure from large deflection of metal top
surface and following radial cracks. Furthermore,
the metal layer shouldnt be too thin to be able to
protect dentin and inhibit radial cracking. Finally,
the models with stiffer metal cores meet higher
resistance to radial cracking in all thickness ranges.
Methods
Abaqus
6.12
(Dassault
Systmes
Simulia,
Providence, RI, USA) was applied for validation
of XFEM to compare the numerical results with
experimental data.
For more realistic structure, dental metals (Au-, Pd-,
and Co-alloy) were used as core layer, porcelain as
veneer, and dentin as substrate. To simulate what
happens in practical limitations imposed on dental
crowns, total thickness of metal and porcelain is
constrained to be 1.5 mm.
When the first stress component of porcelain
reaches its yield strength, it is assumed that crack
initiates and the load leading to this point is
recorded as critical load for radial crack (PR). For
crack propagation, fracture mechanics approach
was applied. The typical value of fracture
toughness for porcelain is approximately 1 MPam
[Sakaguchi, 2012]. When the stress intensity factor
(K I) of each element meets porcelain fracture
toughness (KIC), the crack would grow through it.
The critical load for plastic deformation on top of
the metal core (PY) was measured when Von Mises
stress reaches metal yield strength.
Results
Figure 1 demonstrates critical loads of dental
trilayers in various porcelain thicknesses. It is obvious
that porcelain thickness ranges between 0.75 and
1.25 mm is the most desirable design, avoiding the
structure from radial cracks. Declining PR and PY
for porcelain thicknesses higher than 1 mm can be
relevant to the fact that in these models, porcelain
undersurface is so close to adhesive layer between
metal and dentin. Therefore, it would impose more
bending and PR reduces.
References
Lawn et al, J Biomech, 46:15611567, 2013.
Qasim et al, J Mat&Eng:A, 419: 189195, 2006.
Sakaguchi et al, Craigs restorative dental
materials, 2012.
Zhao et al, J Mat Res, 17:11021111, 2002.
Figure 2 shows the crack initiation point and also

crack growth path.
321
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NANOMECHANICAL AND RAMAN MAPPING OF TEETH

J. Lukes1, D. Carlson2, J. Sepitka3
1
Czech Technical University in Prague, Hysitron Nanomechanical Applications Lab, Prague,

Czech Republic
2
Hysitron Inc., Sales & Marketing, Eden Prairie, USA
Czech Technical University in Prague, Mechanics Biomechanics and Mechatronics, Prague,

Czech Republic
Introduction
Instrumented
indentation
techniques
have
become an important set of research tools
in the biomechanics community; however,
local mechanical properties should be always
published along with microstructural information
for proper validation of the quantitative results.
Nanoindentation benefits from the ability to target
specific local regions of interest, which can be also
defined by one of spectroscopy techniques.
indenter probe was calibrated; thus, information on

chemical composition and mechanical properties
can be acquired in situ.
Samples of rat and human teeth were embedded
in epoxy, cross-sectioned and polished down to
average roughness of several nanometers only.
Enamel and dentin parts of a tooth were clearly
identified by bright field microscopy.
Raman spectroscopy is highly selective, allowing
researchers to identify and target specific
molecules and chemical structures. Intensity of
internal vibration mode of PO4 is associated with a
volume of hydroxylapatite (Ca5(PO4)(OH)) crystal
which makes mineralized tissue stiffer. The higher
is the intensity of v1(PO4) peak the higher is the
content of mineral and elasticity should increase.
This was consistent with resulting overlay of Raman
and modulus maps from the same region. Enamel,
which is hard top layer of teeth, showed significantly
higher content of mineral and higher modulus than
dentin tissue. Moreover, mechanical and chemical
mapping indicated mineralization gradient and
stiffening towards outer layer of tooth.
A nanomechanical test instrument equipped

with Raman spectroscopy is a powerful tool
for
comprehensive
nanoscale
materials
characterization. This combination provides the
capability for full mechanical characterization
of the material at the nanoscale and its direct
correlation to the localized chemical composition.
Methods
Raman adapter was directly integrated into
fluorescence microscopy column of Hysitron TI950
TriboIndenter. An optical fibre was used for bringing
the 785nm laser beam onto a sample surface as
well as transferring the reflected light back to a
spectrometer. XY distance between laser spot and
322
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FINITE ELEMENT ANALYSIS AND CHARACTERIZATION

OF A NEW LOW MODULUS TITANIUM ALLOY USED
IN TWO THA DESIGNS
M. Fischer1, P. Mille2, J. Krier3 , H. Pelletier3 , P. Laheurte1
1
LEM3: Laboratoire dtude des microstructures et de mcanique des matriaux UMR CNRS
7239, SMART: Multi-phased systems, rheology, fatigue and applications, METZ, France
2
3
LGeCo: Laboratoire du Gnie de la Conception, LGeCo, Strasbourg, France
ICS: Institut Charles Sadron, CNRS-UPR22, Physics-Mechanics and Tribology of Polymers,

Strasbourg, France
Introduction
Replacement arthroplasty is used to replace a
damaged joint. The problem of current prostheses
is the behaviour of the treated bone over time.
Indeed, bone remodelling is related to the stresses
in the bone. After a joint replacement using an
implant made of material with high Youngs modulus
a significant part of the load is carried by the
stem. Because of this stress-shielding phenomenon
directly resulting from Youngs modulus mismatch
between the stem and the cortical bone, the bone
is subjected to reduced stresses 1. In accordance
with Wolffs law, it will result in bone resorption and
could lead to loosening of the implant.
the use of a low modulus alloy as a layer around a

solid core leads to a lesser stress jump at the stembone interface but does not significantly increase
the stress values in the cortical bone. Hence, in a
second part is investigated the idea of a porous
TA6V stem core with a properties gradient, built
by selective laser melting and also covered with a
TiNb CLAD layer. An ideal configuration that brings
the stress gradient closer to that of the healthy
bone is selected.
Discussion
We demonstrated that the use of porous material
in the core of the stem would be more efficient, in
terms of reducing stress-shielding, than the use of
only a low modulus material on the surface. Indeed,
even if the first design led to the reduction of the
discontinuity at the stem-bone interface (which
constitutes a significant improvement compared
to the full TA6V stem), it did not significantly
increase the intensity of stress in the bone. On the
other hand, the second lever, favouring the use of
a lattice structure to improve the biomimetism of
elastic properties, has the advantage of generating
both low stresses in the stem and stresses close to
physiological values in the bone.
A new biocompatible metastable beta titanium

alloy with low elastic modulus (60GPa) has recently
been developed along with a nanostructuration
treatment that results in an ultra low modulus
(35GPa) 25. The aim of the study was to design hip
prostheses (THA), with biomimetic shapes, partly
made of this Ti-26Nb alloy, in the form of material
layers built by CLAD process.
Methods
Finite element models of the proximal femur and
of different implants have been created using
MSC Patran and analysed using Marc Mentat. The
stress distribution in the bone and stem have been
studied for one loadcase corresponding to single
leg stance, the goal being the maximisation of the
stresses in the bone and the reduction of the stress
jump between the stem and the bone. All results
were compared to the physiological condition
and to a classical TA6V implant. Moreover,
Ti-26Nb deposits on TA6V were analyzed by X-ray
microtomography, SEM, and with nanoindentation.
References
1 R. Huiskes et al., Stress Shielding and Bone Resorption
Number 274, January 1992
2 F. Sun et al., Scripta Materialia 63 (2010) 10531056
3 P. Laheurte et al., Journal of the Mechanical Behavior of Biomedical Materials 3 (2010) 565573
4 F . Sun et al., Journal of the Mechanical Behavior
of Biomedical Materials 4 (2011) 18641872
5 W. Elmay et al., Computer Methods in Biomech.
and Biomed. Eng. Vol. 14, No. 1, August 2011,
p119120.
Results
The first implants were constructed from a solid
forged TA6V core covered with a layer of Ti-26Nb
built by CLAD process. This study showed that
Research funded by the French National Research
Agency, Grant N ANR-12-EMMA-0003-02
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CONSTITUTIVE MODELLING OF CURING PHENOMENA

IN ACRYLIC BONE CEMENTS
R. Landgraf1, J. Ihlemann1, S. Kolmeder2, A. Lion2
1
Technische Universitt Chemnitz, Faculty of Mechanical Engineering,

Professorship of Solid Mechanics, Chemnitz, Germany
University of the Federal Armed Forces of Germany, Faculty of Aerospace Engineering,

Institute of Mechanics, Neubiberg, Germany
Introduction
Acrylic bone cements are widely used in
orthopaedic surgery. Examples are the fixation of
prostheses or the minimal invasive procedures of
vertebroplasty and kyphoplasty. Thereby, paste like
bone cement gets injected into the human body
and therein cures to a viscoelastic solid. During the
curing stage, different physical processes can be
observed. First of all, the materials stiffness rises,
i.e. the material undergoes a phase change from
a liquid to a solid. Moreover, due to an underlying
polymerisation process, which is an exothermic
chemical reaction, heat gets dissipated and leads
to a temporally rising temperature. Moreover,
changes in bone cements volume resulting from
heat expansion and chemical shrinkage processes
are observed. Finally, all physical processes exhibit
distinct temperature dependencies.
The structure is based on the viscoelastic model

provided by [Lion, 2007]. However, different
modifications and extensions were applied to
simulate the specific material behaviour of the
acrylic bone cement used in this study. As one
example, this includes an additional application
of a process dependent elastic formulation (see
[Landgraf, 2014]). Moreover, specific material
functions were defined for the different parts of the
model and the material parameters were identified
using the experimental data. Finally, the coupled
model was implemented into the commercial finite
element software MSC.MARC.
Results
First, the material model is able to simulate the
mechanical, thermal and chemical processes
of the acrylic bone cement very well. Moreover,
the curing process of bone cement inside the
trabecular structure of human cancellous bone was
calculated by finite element simulations. Thereby,
investigations on temperature evolution as well
as deformations and stresses due to chemical
shrinkage were conducted. The simulation results
are in accordance with phenomena reported in
the literature (cf. [Landgraf, 2015].
To simulate the phenomenological behaviour

of acrylic bone cements, a thermochemical-mechanically coupled material model has been
developed. Within this contribution, the model
structure, specific material functions and the
identified material parameters are presented.
Moreover, the application within the finite element
method is exemplified.
Methods
To study the phenomenological behaviour of acrylic
bone cements, different methods of experimental
characterisation were applied to one specific
material (see [Kolmeder, 2010] and [Kolmeder,
2011]). This includes relaxation and dynamic
loading tests to analyse the viscoelastic behaviour
of the cured material. Moreover, oscillatory
rheometer experiments on cylindrical specimens
were used to characterise the mechanical
behaviour during the curing process. The chemical
reaction and the related heat production were
examined using dynamic scanning calorimetry
experiments. Finally, changes in volume and
density were investigated using an experimental
setup based on Archimedes principle.
Discussion
The material model enables the coupled simulation
of thermal, chemical and mechanical processes
of acrylic bone cements during the curing process
and in fully cured state. Moreover, by the help of its
finite element implementation, different numerical
investigations in the field of orthopaedic surgery
are facilitated.
References
Kolmeder et al, Technische Mechanik,
30:195202, 2010.
Kolmeder et al, J. Therm Anal Calorim
105:705718, 2011.
Landgraf et al, Comput Mech 54:547565, 2014.
Landgraf et al, ZAMM, DOI:10.1002/
zamm.201400064, 2015
Lion et al, Arch Mech, 59:5989, 2007.
Next, a constitutive model was formulated within

the framework of nonlinear continuum mechanics.
324
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ANALYTICAL AND NUMERICAL INVESTIGATION

OF MECHANICAL PROPERTIES OF TRUNCATED CUBE
POROUS OPEN-CELL STRUCTURES
R. Hedayati1, S. Mojtaba1, M.A. Mohammad1
1
Amirkabir University of Technology, Mechanical Engineering, Tehran, Iran
Highly porous titanium biomaterials are recently

used in implantology due to their excellent
mechanical and in-vitro properties, such as bonelike stiffness, corrosion-resistance, bio-compatibility,
and bio-inert. In this paper a novel morphology,
truncated cube, is proposed for the being used
inside implants. The mechanical properties
of truncated cube lattice structure, including
elastic modulus, Poissons ratio, and yield stress
was obtained numerically and analytically. The
obtained analytical relationships are very useful
for obtaining fast and exact elastic mechanical
properties of these structures which are useful for
understanding the influence micro-geometrical
properties of the lattice structure. For the analytical
solution, Euler-Bernoulli beam theory was used to

obtain the stiffness matrix of a unit cell from which
the elastic properties were extracted. On the other
hand, for the numerical simulation Timoshenko
beam theory was used in ANSYS Finite Element
code for static non-linear solution. Comparison
of numerical and analytical results showed their
excellent agreement for elastic modulus and yield
stress and acceptable agreement for Poissons
ratio. The length of inclined and vertical struts in
a truncated cube is not necessarily equal and
variation of the ratio of these two lengths can
alter the mechanical properties of this structure
significantly. The presented analytical solution
were all expressed as functions of this ratio,
325
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LOCAL STIFFNESS MEASUREMENTS OF APATITE

AND BRUSHITE CEMENTS
I. Ajaxon1, G. Lionello2, M.P. Ginebra3 , C. hman1, M. Baleani2, C. Persson1
1
2
3
Uppsala University, Department of Engineering Sciences, Uppsala, Sweden
Istituto Ortopedico Rizzoli, Laboratorio di Tecnologia Medica, Bologna, Italy
Technical University of Catalonia, Biomaterials, Biomechanics and Tissue Engineering Group,

Department of Materials Science and Metallurgy, Barcelona, Spain
Results
HA cements were found to be significantly less stiff
(p<0.001) and of a lower strength (p<0.001) than
the brushite cements, see Table 1. DIC was also
found to give consistently higher values compared
to platens (p<0.001).
Introduction
Ideally, injectable bone cements should have
mechanical properties matching those of the
bone tissue the material is used to replace or repair
[Tamimi, 2012]. An accurate knowledge of material
parameters is also crucial in computational models
of the cements. Literature values of the Youngs
modulus (E) of calcium phosphate cements (CPCs)
are scarce and usually calculated from platen
displacement measurements [Unosson, 2014,
Lacroix, 2006]. This method is simple but it may
suffer from low accuracy, especially for small
deformations. Digital image correlation (DIC)
is a technique that can measure accurate
displacements directly on the specimen surface,
hence avoiding end artefacts. The aim with this
study was to determine the compressive behaviour
of injectable CPCs using the DIC technique.
CPC
E - Platens
E - DIC
[GPa]
[MPa]
HA
6.6 1.4
14.8 5.6
39.1 8.6
Brushite
9.4 1.1
26.5 4.9
56.4 12.0
[GPa]
CS
Table 1: E
and CS for HA and brushite CPCs.
Discussion
The brushite cements gave a higher E and CS than
the HA cements. The differences in mechanical
properties found between the two investigated
CPCs are likely due to differences in porosity and
microstructure between them. In fact, it has been
reported that HA cements have a higher porosity
than the brushite cements [Unosson 2014, Espanol
2009]. Additionally, the collected data confirm
that the platen displacements may substantially
underestimate the Youngs modulus in agree
ment with a recent publication on a calcium
sulphate cement [Koh, 2014]. The DIC technique
can accurately measure local deformations, and
may thus give more realistic values of the stiffness
of CPCs.
Methods
Two different types of CPCs were used in this study:
hydroxyapatite (HA) and brushite. For HA cements,
-TCP and 2 wt% precipitated HA was mixed with
2.5 wt% Na2HPO 4-solution, at a liquid to powder
(L/P) ratio of 0.35 ml/g. For brushite cements,
45:55 mol% MCPM:-TCP was mixed with 0.5 M citric
acid (L/P = 0.22 ml/g). The specimen dimension
was chosen according to ASTM F451 standard
[ASTM, 2008] and the specimens were kept wet
until testing. The compression strength (CS) and
E of specimens were obtained using a materials
testing machine, equipped with a DIC system,
see Figure 1.
References
Tamimi F et al, Acta Biomater, 8:47487, 2012.
Unosson J, Engqvist H, Bioceram Dev Appl.
4:1, 2014.
Lacroix D et al, Biomaterials, 27:532634, 2006.
ASTM F 451-08. Espanol M et al, Acta Biomater,
5:27522762, 2009.
Koh I et al, J Mech Behav Biomed, 34:
187198, 2014.
Figure 1: E
xperimental set-up.
E was also calculated from platen displacement.

A general linear model analysis was performed on
the stiffness results, with method (platens or DIC)
as within-specimen factor, and material (HA or
brushite) as between-specimen factor. Students
t-test was used to evaluate differences in strength
between the two materials.
326
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NOVEL CALCIUM PHOSPHATE CEMENTS BASED

ON BIOACTIVE GLASSES
R. Hill1, N. Kent2, N. Karpukhina2, G. Blunn3
1
Queen Mary University of London, Dentistry, London, United Kingdom

2
QMUL, Dentistry, London, United Kingdom
Univiversity College London, Bioengineering, London, United Kingdom
Introduction
Existing calcium phosphate cements, CPCs
are formed from reacting mixtures of calcium
phosphate salts with water. They set hard to form
either brushite or calcium deficient apatites. They
have relatively poor strength, are prone to washout
and are not very resorb able. Bioactive glasses
stimulate bone growth and are much more resorb
able than CPCs, however unlike CPCs they are not
very injectable, are not mouldable and do not
set solid in vivo. In this paper we investigate novel
CPCs using high phosphate content Bioactive
glasses as an alternative to calcium phosphate
salts. The objective being to design and develop
CPCs that combine the resorb ability of Bioactive
glasses with the inject ability and in situ setting
properties of existing CPCs. A great advantage of
using Bioactive glasses as opposed to crystalline
calcium phosphate salts is that the properties and
composition of Bioactive glasses can be altered
over a wide composition range and they are not
restricted by the stoichiometric nature of crystals.
the mould then immersed in water. The cements

were characterised by FTIR, XRD and 31P and 19F
MAS-NMR. Selected cements were evaluated in an
ovine model for three months.
Results
The cements formed Brushite, Octacalcium
phosphate
calcium
deficient
apatite,
hydroxyapatite or fluorapatite depending on the
glass composition used. The setting times were
between 5 and 100 minutes. Compressive strengths
varied from 2 to 20MPa. Low Na2O content glasses
formed slow setting brushite cements, whilst
higher sodium contents favoured OCP formation
and apatite formation. OCP transformed with
time towards apatite. The introduction of fluoride
even at very low concentrationsinto the glass
eliminated OCP formation and favoured the
direct formation of apatite and the apatite was
a fluoridated apatite. The presence of fluoride in
the glass changed the microstructure of the set
cement from a plate like morphology to a needle
like structure. The implant studies showed between
90 and 100% osseointegration and the cements
were osteoconductive.Bone grew into any cracks
or pores in the cement surface.
Methods
A range of bioactive glasses were synthesised
by a melt quench route. The synthesis conditions
are similar to those used by Mneimne et al.[1].
The glasses consisted of three series based on
varying P2O5 content, varying CaF2 content and
varying Na2O content. The glasses were fritted into
water and ground and sieved to give a powder
<38 microns. This powder was then mixed with
CaHPO4 to give a Ca:P close to 1.6. These powder
mixtures were then mixed with water. Working
and setting times of the resulting cement pastes
were determined using a Gilmore needle. The
cement pastes were packed in 6mm high x4mm
diameter moulds allowed to set for one hour in
New CPC cements have been developed based on
bioactive glasses. The cement phases formed and
the cement microstructure are highly dependant
on the Bioactive glass composition used. These
new cements show excellent osseointegration and
osseoconduction in vivo.
Reference
1 M.A Mneimne, RG Hill, AJ Bushby and DS brauer.
Acta Biomaterialia 7 (2011) 3476.
327
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THE UNIQUE FRUITS OF DEVILS CLAWS:

A MATERIALS PERSPECTIVE
C. Neinhuis1, M. Horbens2
1
2
TU Dresden, Biology, Dresden, Germany
Institut for Botany, Biology, Dresden, Germany
Introduction
Martyniaceae are characterized by capsules with
two upwardly curved, horn-shaped extensions
representing
morphologically
specialized
epizoochorous fruits. Because the capsules
are assumed to cling to hooves and ankles of
large mammals, fiber arrangement and tissue
combinations within the endocarp ensuring
proper attachment to the vectors feet during
transport are of particular interest. In this first
detailed anatomical investigation, the functional
adaptation of the fruits and their implications for
the specific dispersal mode are provided. The
peculiar fibre arrangement may also be of interest
for future biomimetic composite materials.
circularly reinforce and protect the loculus. This

fibrous pericarp tissue develops within few days
by localized cell divisions and intrusive growth of
primarily isodiametric parenchyma cells in the
pistil. By means of a detailed mechanical and
compositional characterisation of the curved fruit
extensions we demonstrate that (1) the flexibility
upon tensile and bending loads, (2) the high
strength of fruit extensions, and (3) their benign
failure are attributed to both the chemical
composition and specific structural arrangement.
Discussion
Our studies provide fascinating insights into the
intriguing, functionally adapted epizoochorous
fruits of the plant family Martyniaceae comprising
morphological and microstructural adaptations.
The results reveal a unique and complex example of
functionally driven cell growth and tissue formation.
The long-horned fruits of Proboscidea and Ibicella
obviously are highly specialized to epizoochorous
dispersal, pointing to primary vector-related seed
dispersal. The highly ordered arrangement of fibres
results in a great mechanical firmness able to cope
with mechanical stresses such as tension, bending
and torsion.
Methods
Endocarp anatomy and details of tissue
differentiation were examined in fruits of Ibicella
lutea and Proboscidea louisianica subsp. fragrans
combining light microscopy, SEM, and x-ray
microtomogra-phy analysis. Various mechanical
tests were conducted applying tension, three point
bending, as well as torsional approaches.
Results
While longitudinally oriented fibres predominantly
reinforce tips of the extensions, in the middle
segment these fibres are densely packed in
individual bundles entwined and separated by
transversely elongated cells. Within the capsule
wall, the fibre bundles are embedded in a
dense mesh of transversely oriented fibres that
References
H
orbens, M., Gao, J. & Neinhuis, C. (2014) Cell
differentiation and tissue formation in the unique
fruits of devils claws (Martyniaceae). American
Journal of Botany 101(6): 914924.
328
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STRESS-INDUCED CHANGES IN MECHANICAL

PROPERTIES OF TOBACCO LEAVES
M. Sahaf1, E. Sharon1
1
The Hebrew University of Jerusalem, Racah Institute of Physics, Jerusalem, Israel
Introduction
Cell expansion, driven by turgor pressure, is the
process through which the leaf grows in area by
many orders of magnitude, after cell division had
stopped. For a leaf to reach its normal shape
there should either be no spatial fluctuations in the
growth rate, or any such fluctuations should be
counteracted before the leaf has been irreversibly
deformed. It would make sense to assume,
therefore, that stress build-up would serve to
trigger a correcting response, which will manifest
as a change in growth rate. That can happen if
the mechanical properties of the leaf, which is a
complex viscoelastic tissue, change as a result of
mechanical stress or strain.
Figure 1: S tress-strain alignment in a leaf held under

constant mechanical stress, over 10 hours.
When examining the visco-elastic properties of

the leaf using oscillatory stress, we can observe
the natural changes of its properties over time,
and compare them to stress-induced changes.
Fig 2(a) shows measurements of Youngs modulus
of the leaf taken 24 hours apart, during which the
leaf was held under constant stress. An increase is
evident. Fig 2(b) shows Youngs modulus measured
24 hours apart with no stress applied between the
measurements, and in this case a slight decrease
naturally-occurring can be seen.
Methods
Most of the study of plant viscoelasticity was
performed on dead tissue material [Kutschera
1996, Ryden 2003]. More recent studies such as
[Hayot 2012] use nanoindentation to measure the
properties of single cell walls in a living tissue. This
study focuses on measurements of whole living
leaves, using protocols of dynamic mechanical
analysis (DMA) to measure the viscoelastic
properties of the leaf.
We study the growth of young leaves of Nicotiana
Tabacum under controlled stretching using a
setup consisting of a stress-control system, and
two cameras which collect 3D data for growth
analysis. The images are then processed using
PIV (particle imaging velocimetry) technique to
measure the growth (strain tensor) with temporal
resolution on the order of minutes, and spatial
resolution on the order of tens of microns. Two
types of measurements are performed: growth
under constant, almost uniaxial stress, which allows
for measurements of changes in growth patterns
as a response to stress; and short-time periodical
stress-strain measurements (DMA), which allows to
obtain the viscoelastic properties of the leaf while
causing minimal changes.
Figure 2: ( a) Youngs modulus of the leaf measured 24 hours

apart, during which the leaf was held under constant
stress. (b) Youngs modulus of the leaf measured 24
hours apart, with no stress applied in between.
Discussion
We observe a process in which the effect of
mechanical stress on growth decreases over time.
This is accompanied by changes in the mechanical
properties of the tissue, which make it more resilient
to strain. This can indicate a mechanism through
which leaves can maintain their shape and resist
deformation due to mechanical stress.
Results
We define an angle between the principal
direction of the local growth tensor and the
principal direction of the local applied stress
tensor. On times <1 hour we see a good alignment
between the two, i.e., tan() 1. However, over
several hours, we observe a decrease in this
alignment, as can be seen in fig. 1, although the
leaf is held under constant force.
References
Hayot, C.M., et al., J. Exp. Bot. 63(7):
p. 25252540 2012.
Kutschera, U J., Exp. Bot. 47(302): p. 13871394, 1996.
Ryden, P., et al., Plant Physiology. 132(2):
p. 10331040, 2003
329
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THE MECHANISM OF SESAME CAPSULE

OPENING A GRADATED BILAYER
I. Shtein1, B. Bar-On2, R. Elbaum1
1
2
The Hebrew University, The Faculty of Agriculture, Rehovot, Israel
Ben Gurion University of The Negev, Department of Mechanical Engineering, Beer Sheba,
Israel
Introduction
Hygroscopic movements occur in desiccating dead
plant organs, promoting seed dispersal (Elbaum
and Abraham, 2014). The movement is governed
by the arrangement of cellulose microfibrils within
cell walls and the distribution of the cells within the
tissue. Hygroscopic movement is well studies in long
and narrow plant awns 1D constructs (Elbaum et
al., 2007) and flat pods 2D constructs (Armon et
al., 2011). However, similar movements in capsules
(3D constructs) are not studied. Sesame (Sesamum
indicum L.) capsules consist of 4 locules with a
simple exocarp, a parenchymatous, multi-layered
mesocarp, and a multi-layered fibrous endocarp
(Fig.1A). Dry capsules shatter at the false septum
region and disperse the seeds. When opening, the
capsule walls curve away from the false septum.
We suggest that this hygroscopic movement is
actuated by the fibrous endocarp the only
pericarp tissue that exhibits lignified cell walls.
Discussion
Upon drying, the fibres shrink transversely and
pull the false septum apart. We suggest that the
endocarp contains residual stress because of the
perpendicular direction of the fibre layers in the
bilayer. The combination of humidity gradient
caused by the pectin and changing proportions
of longitudinal/radial fibres around the locule
is suggested to cause the observed complex
movement. Hygroscopic movements in capsules of
other plant species and families may follow similar
mechanistic model.
Figures
Methods
The capsules were embedded in paraplast and
sectioned at 12 m thickness to investigate
microscopic structure and birefringence. Sample
birefringence was investigated using a LC-PolScope
image processing system and the image analysis
was done using Abrio 2.2 software. Directional cuts
through rehydrated capsules were made to study
stress forces within the capsule during drying.
Figure 1: S esame capsule in cross-section (A) and a schematic representation of the bilayer structure (B).
Ep epicarp, M mesocarp, En endocarp,
FS false septum, CS carpel septum, L locule.
Results
Microscopic observation showed that the endocarp
was built of a bilayer of radial and longitudinal
fibre cells with the layers positioned in a semi-circle
one inside the other (Fig1B). Near the false septum
the bilayer consisted only of longitudinal cells,
while towards the carpel septum it was gradually
reduced to a layer of radial cells. Endocarp
sections examined by polarised-light microscopy
showed that the cellulose microfibrils lie almost
parallel to the fibre long axis (Fig.2). Upon drying,
the fibres change their width, allowing bending
parallel to fibre axis. Further complexity was added
by pectin-rich cells, surrounding the endocarp
fibres, which probably slow down the desiccation
of the active tissue. Residual stresses within the
capsule supported a bilayer twisting mechanism.
Figure 2: L C-PolScope image of microfibril orientation

in the fibre bilayer. A visible light image,
B orientation image. En endocarp, L locule,
EnE inner epidermis of the endocarp,
C seed coat crystals.
References
Armon et al., Science, 333:17261730.
Elbaum and Abraham, Plant Sci, 223:124133, 2014.
Elbaum et al., Science, 316:884886, 2007.
330
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A NON-DESTRUCTIVE METHOD OF PREDICTING

CORN STALK FAILURE
D. Robertson1, D. Cook2
1
2
New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
New York Univserity Abu Dhabi, Engineering, Abu Dhabi, United Arab Emirates
Introduction
Over 2 trillion pounds of corn are produced
annually. However, 1020% of the corn harvest
is lost each year due to structural failure of the
stalk (also known as stalk lodging). Many methods
have been developed to predict susceptibility to
lodging. However, these methods generally require
physically breaking the plant thus preventing
analysis of temporal data. All non-destructive
predictors of plant strength presented thus far are
not strong predictors of lodging. The purpose of this
study was test the hypothesis that flexural rigidity of
corn stalk can be measured non-destructively and
that is a more accurate method of assessing stalk
strength than rind puncture resistance (one of the
most commonly used non-destructive methods of
strength assessment in field).
measurements. A device to measure flexural rigidity

of corn stalk in the field is under development
with the help from our industrial collaborators at
Monsanto, Inc.
References
Robertson, D. J., Crop Science, 54: 20382044, 2014.
Figures
Methods
Five commercial varieties of fully matured
corn stalks sowed at 5 planting densities were
investigated in this study. A modified 3-point
bending test was used to determine the bending
strength (failure moment) of all stalks [Robertson,
2014]. The bending stiffness of each stalk (i.e.
flexural rigidity) was calculated by deflecting the
stalk by 5 mm and solving for flexural rigidity from
the appropriate engineering beam equations.
The bending strength was then correlated to both
flexural rigidity and rind puncture resistance.
Figure 1: B
ending strength was found to be moderately
correlated to rind puncture measurements (top)
and strongly correlated to flexural rigidity (bottom).
Results
Flexural rigidity was a much better predictor of
bending strength than rind puncture resistance.
The coefficient of determination R2 for flexural
rigidity (0.79) was substantially higher than the
coefficient for rind puncture measurements (0.21)
(Figure 1). In addition the slope of the regression
line for flexural rigidity was largely independent of
hybrid and planting density, demonstrating that the
same flexural rigidity model can be used to predict
lodging in a wide range of corn stalk varieties.
Flexural rigidity decreased with increasing planting
density and was able to statistically distinguish
between the strength of the different corn stalk
varieties (Figure 2). Results for rind puncture
were less clear and it frequently made incorrect
predictions regarding the relative strength of the
five stalk varieties investigated in this study.
Discussion
Results demonstrate that flexural rigidity is a
much stronger predictor of stalk lodging than rind
puncture. Not only can it statistically distinguish
between different hybrids and planting densities
but it is also less invasive than rind puncture
Figure 2: F lexural rigidity of corn stalk varieties sowed at

5planting densities. Boxes indicate 25th and 75th
percentiles. Notches indicate interquartile range.
331
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FUNCTIONAL ANATOMY, BIOMECHANICS AND

DEVELOPMENT OF CACTUS RAMIFICATIONS
H. Schwager1, C. Neinhuis1
1
Technische Universitt Dresden, Institute for Botany, Dresden, Germany
Introduction
Columnar cacti from the subfamily (Cactoideae)
represent a group of highly modified dicot plants.
Due to their succulent pith and cortex the branches
have to be attached to the outer shell of the
parental stele, instead of being anchored within
a comapct body of wood like in broad leaf trees.
This anatomic characteristic has some impact on
the load adaptation strategy of the stem branch
attachment by secondary growth of the lignified
vascular tissue.
In H. undatus, two kind of ramifications of vegetative

and floral side shoots are present. Both derive from
the same initials, the leaf and bud traces, but due
to the formation (branch) or absence (flower) of
an interfascicular cambium between the traces,
the branch base develops a cylindrical shape
while the flower support remains reticular.
Discussion
The succulent cortex restricts the space for
secondary growth, no homogeneous stress
distribution with minimized mechanical stress as
described for dicot trees is possible. In columnar
cacti the outer shape and inner structure of the
woody branch base help to realize a stress state
matching the preordained fiber orientations from
stem to branch. The closed cambium ring that is
needed for this continuous secondary growth of
the branch base is not present initially. It only forms
by remeristematisation of cortex parenchyma cells
between the fascilcular cambia of the leaf and
bud traces.
Methods
Macroscopic and light-microscopic investigations
were carried out on specimens of two representative
model species: Piloscereus catingicola and
Hylocereus undatus. The results served to generate
simplified finite element models with the preprocessing software Patran 2012. Their analysis with
Abaqus 6.6.1 allowed to determine the mechanical
influence of the specific anatomic characteristics.
It is likely that phytohormons from the axillary bud

meristem regulate the cambial acticity. After
conversion to a floral meristem this effect stays
out. Further research in this direction may help
to understand the development and the load
adaptive growth in plant ramifications, not only in
cacti, but also in other dicot plant.
Figure: fl ower support leaf and bud traces branch base
finite elemement model
Results
In P. catingicola, the branch base is compact and
not tubular like in the shoots out of the ramification.
The longitudinal fibers of the parental shoot lateral
to this socket exhibit a higher degree of crosslinkage with interconnections running towards the
branch base. On the top and bottom side of the
branch socket, distinct indentation are present. The
results of the finite element analysis shows that these
indendations help to adjust the stress distribution in
a way that stress maxima occur only in regions with
fiber orientations matching the stress directions.
References
[1] Schwager H, Masselter T, Speck T & Neinhuis C
2013 Functional morphology and biomechanics
of branchstem junctions in columnar cacti. Proc
R Soc B 280: 20132244.
[2] Schwager H, Neinhuis C & Mauseth JD 2015
Secondary growth of the leaf and bud traces
in Hylocereus undatus (Cactaceae) during the
formation of branches or flowers. Int J Plant Sci
(submitted 20141114)
332
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THE EFFECT OF MASTICATORY LOADING ON THE

CERVICAL LOOP REGION OF THE INCISOR IN RODENTS
T. Mitsiadis1, A. Tsouknidas2, S. Savvakis3 , E. Karatsis3 , N. Michailidis2
1
2
University of Zurich, Institute of Oral Biology, Zurich, Switzerland
Aristotle University of Thessaloniki, Department of Mechanical Engineering,

Thessaloniki, Greece
3
BETA CAE Systems S.A., Biomechanics, Thessaloniki, Greece
Introduction
Rodents are arguably the dominant model
organism for studies investigating the effect of
genetic traits on the pathways to mammalian skull
development, thus being integral in exploring their
craniofacial evolution. Mice mandibles exhibit
unique characteristics associated, among others,
to the cervical loop region of their incisor hosting a
high concentration of epithelial stem cells. As these
cells are highly mechanosensitive [Gurkan, 2008],
it stands to reason that their differentiation could
considerably affect the postnatal mandibular
growth. Surprisingly there is no literature available on
the influence of masticatory loads on the cervical
loop area of the incisor, which could well be a
decisive factor for the endemic stem cell fate. To
analyse the functional significance of masticatory
loads on the mouse mandible and identify critical
stress accumulations that could trigger phenotypic
differentiations in their skull morphology.
Figure 1: C
onsidered muscle architecture.
Results
Chewing and gnawing resulted in varying loading
patterns of the mouses mandible, Biting type
(incisal or molar) had a dominant effect on the
stress variations experienced by the mandible,
with biting intensity resulting in an almost linear
stress increase. Gnawing led to loading patterns
which were more pronounced in the superior
mesenchyme (dental follicle), whereas chewing
had a similar effect on the stress fields in the apical
dental papilla region of the incisor, while provoking
a slight anterioposterior swift of the observed stress
concentrations.
Methods
High resolution Computed Tomography was used
to reconstruct a 3D model of a rodents skull.
Upon segmenting the main components of the
models mandible (e.g. incisor, molars, alveolar
bone, mesenchyme, cervical loop etc.), material
properties were assigned according to table 1.
E [GPa]
Poisson ratio
Cortical bone
19.92
0.3
Alveolar Bone
0.345
0.38
Enamel
84.1
0.33
Dentine
18.6
0.31
Pulp
0.002
0.45
Cervical loop
0.1
0.37
Mesenchyme
0.1
0.37
Periodontal lig.
0.05
0.45
C o n cl u s i o n
The simulation provided refined insight on the
mechanobiology of the cervical loop of the
incisor in mice, indicating that food consistency
could exert a dominant role on the endemic stem
cell proliferation and differentiation. The results
suggest that extracellular forces developing during
mastication can influence micro evolutionary
divergence patterns in the mouse mandible.
Part of this work was funded in the frame of the COST
Action MP1005 (NAMABIO).
Table 1: Material properties of the mandible.
References
Gurkan UA. et al, Ann. Biomed. Eng. 36, 19781991,
2008.
Hautier L.et al, J Anat. 215(4): 401410, 2009.
Two masticatory scenarios were identified, incisal

biting (gnawing) and chewing at the molars and
both of them examined at two load intensities
(corresponding to soft and hard pellets). The biting
force was countered by a muscle architecture
according to [Hautier, 2009] while also considering
the effect of the temporomandibular joint, as
shown in figure 1.
333
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INDENTATION MAPPING OF ARTICULAR CARTILAGE

MECHANICAL PROPERTIES IN NORMAL AND
OSTEOARTHRITIC MICE
J.F. Lavoie1, 2, 3 , S. Sim1, 3 , E. Quenneville3 , M. Garon3 , A. Moreau2, 4 ,
M.D. Buschmann1, C.E. Aubin1, 2
1
Polytechnique Montreal, Institute Biomedical Engineering, Montreal, Canada
Sainte-Justine University Hospital Center, Research Center, Montreal, Canada

3
Biomomentum, R&D, Laval, Canada
University of Montreal, Dept. of Biochemistry and Dept. of Stomatology, Montreal, Canada
Mechanical assessment of articular cartilage can

identify early cartilage degradation (Armstrong
1982). Murine models are often used to study
osteoarthritis (OA) and to assess the efficacy of
therapeutics. Due to their size, mouse models
pose significant challenges to map mechanical
properties over their knee articular surfaces
(~5 mm2). This study aims to determine if an
automated indentation technique could be used
to map the mechanical properties of murine knee
articular surfaces; in order to assess early OA lesions
in the mouse strain (STR/ort) that spontaneously
develops osteoarthritis (OA) on the medial side of
their knees (Walton 1977).
Methods
Mechanical measurements were performed ex
vivo, on left femoral condyles and tibial plateaus
of five healthy Balb/c males (1215 weeks old)
and five age- and sex-matched STR/ort mice,
using a 3-axis mechanical tester (Mach-1 v500css)
equipped with a multiple-axis load cell. Indentation
measurements (3042/surfaces) were performed
using a 0.35 mm diameter spherical indenter.
Data are reported as the structural stiffness at
an indentation depth of 10 m. To compare the
stiffness between healthy and OA-developing
animals, each articular surface was divided in
4 zones corresponding to the exterior and inner
halves of each surface. Data is reported as the
mean SE (n=5 animals). Statistical analysis was
performed with ANOVA.
Figure 1: M
apping and quantification of structural stiffness
at 10 m indentation on healthy and OA mice
(* = p<0.05).
Discussion
This study shows that this automated indentation
technique can map the mechanical properties
of murine knee joints. The stiffness mapping of
healthy mice shows similar distribution patterns
to those previously observed for larger species
(horse, sheep and rat) (Sim 2013a,b). In OA mice,
regions identified with lower structural stiffness
were at sites reported to develop OA in the
STR/ort strain (Walton 1977). This will be corroborated
by ongoing studies, using histology. These results
suggest that indentation mapping can be used
in mice to identify or characterize OA affected
articular surfaces and potentially test the efficacy
of drugs aiming to inhibit cartilage degradation or
promote healing in OA.
Results
In healthy animals, mapping of the structural
stiffness showed that regions with higher value of
stiffness are mostly located at the exterior halves of
each cartilage surface. In OA animals, the stiffness
appeared reduced on the medial condyle and
the tibial plateaux showed a larger area of lower
stiffness in the load bearing region. Comparison
with healthy mice of zone averages shows a lower
stiffness in the external half of the medial condyle
of OA mice (Fig.1, zone I), the external half of
the medial and the inner half of the lateral tibial
plateaux (Fig.1, zones I & III).
References
Armstrong et al, JBJS. 64: 8894, 1982.
Sim et al, ICRS2013: session 11.2.9, 2013a.
Sim et al. ORS2014: poster 2015, 2013b
Walton et al, J. Pathol. 123:10922, 1977.
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A RABBIT MODEL FOR MIMICKING THE INTERVERTEBRAL

DISC DEGENERATION: AN EXPERIMENTAL AND
COMPUTATIONAL STUDY
A. Calvo-Echenique1, J. Cegoino1, L. Correa-Martn2, L. Bances3 ,
A. Prez-del Palomar1
1
Aragn Institute of Engineering Research I3A, University of Zaragoza,

Group of biomaterials, Zaragoza, Spain
2
Minimally Invasive Surgery Center: Jess Usn, Cceres, Spain
Hospital Clnico Universitario Lozano Blesa de Zaragoza, Department of Neurosurgery,

Zaragoza, Spain
Introduction
Animal models are a useful tool for the study of
degenerative diseases and for evaluating new
therapies1. Lumbar intervertebral disc degeneration
(IDD) has been studied in previous works in sheeps 2
or rabbits 3,4, but in most cases one of the spine
discs was used as control and the disease progress
was followed by MRI and histology. The main
novelties of this research were: 1) the study of the
spine as a whole using an animal control group.
2) a finite element model (FEM) development for
simulating the different stages. The aim of this work
is to establish a new rabbit model for mimicking the
IDD and draw the pathway of the degeneration
progress finding cause-and-effect relationships
between computational and experimental data.
stresses in the disc increased markedly, varying the

proteoglycan and water content which led to an
increase in stiffness and therefore a new increment
in disc stresses. This increment caused a repetitive
cycle as seen in Figure 1.
Experimental design
Twenty New Zealand White rabbits were randomly
distributed into three groups. Group 1 (n=8) was
received a percutaneous puncture in three discs
(D34, D45 and D56), group 2 (n=8) was received a
single percutaneous puncture in D45. The control
group (n=4) remained unaltered.
Follow-up period
Damaged discs and the adjacent ones were
followed-up with MRI and mechanical testing 3
and 6 months after the surgery. The nucleus area,
nucleus mean signal intensity and disc height were
measured and statistically compared with T-test.
The viscoelastic parameters were measured in half
of the animals at each time point with a frequency
domain compression test.
Figure 1: IDD pathway established with the experimental

and computational results.
C o n cl u s i o n
A progressive degeneration model was found
in case of a percutaneous puncture in one disc,
this progress could be followed with MRI and
computational model and showed the same
cascade events as the human disease, so it is a
reliable method to evaluate new treatments in
future researches.
Computational model
At the end of the experiment, a FEM was built and
used for simulating the following four stages in each
group: 1) healthy 2) immediately after the surgery
(punctured geometry + healthy properties), 3) three
and 4) six months after the surgery varying the
mechanical parameters.
References
1 Vo N. et al, J. Orthop. Res. 31:831837,2013
2 Kim KS. et al, Spine 30:3337, 2005
3 Osti OL. et al, Spine 15:762767, 1990
2 Zhou R. et al, J. Surg. Res 181:e65e74, 2013

No progressive degeneration was found for the
group with 3 punctured discs. But successful results
were found in the group with one damaged
disc. A high correlation was found between MRI
measurements and mechanical data, also a
relationship with the stress-strain patterns calculated
computationally was seen. After the puncture the
The authors want to express their gratitude to the
Spanish Ministry of Economy and Competitiveness for
their financial support of the project DPI2011-23148.
335
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BIOMECHANICAL SIMULATIONS OF BROILER CHICKEN

GAIT: MUSCLE CONTRIBUTIONS TO SUPPORT
AND MOVEMENT ACROSS ONTOGENY
H. Paxton1, J.W. Rankin1, J.R. Hutchinson1
1
Royal Veterinary College, Comparative Biomedical Sciences, Hatfield, United Kingdom
Introduction
Over nine billion broiler chickens are produced
per year and it is estimated that approximately
28% of the population are affected by lameness
or poor walking ability [Knowles et al. 2008]. Their
unique anatomy (e.g. their large pectoral muscle
mass accounting for ~16% of body mass), gait
mechanics, muscle physiology and other factors
that are part of their musculoskeletal function
likely relate to this leg weakness in ways that are
extremely complex. For the first time, we are able
to combine data on anatomy and locomotor
behaviour into 3D computer simulations to show
how their muscles, tendons and joints produce
forces necessary to support and move these
chickens. Extreme anatomical differences are
noted in broiler chickens between 2, 4 and 6 weeks
of age [Tickle et al., 2014] and we determine how
these have affected the contribution of individual
muscles to the stance phase of locomotion. An
estimation of individual muscle forces can provide
an insight into the joint loads incurred during walk
and thus elucidate how these directly correlate with
1) the incidence of joint-related pathologies (higher
loads should incur greater risks of pathologies), and
2) the level of activity/ fatigue in broilers (animals
with higher joint loads might walk less).
Discussion
This comprehensive outlook on how their
anatomical features affect broiler gait will allow
us to make informed decisions on selecting for/
against measurable, anatomical traits. This, then,
is fertile ground for applying the insights from this
technology to industry.
Methods
3D musculoskeletal models (subject-specific; see
Table 1 for subject data) were used to calculate
muscle forces, activations and specific tension
(maximum muscle force normalised with respect
to physiological cross sectional area) through the
stance phase of locomotion. A combination of SIMM
(Musculographics Inc.) and OpenSim software are
used. Model inputs included the kinematic and kinetic
data (six trials per bird per age group) and measured
anatomical data (muscle-tendon unit lengths and
architectural measurements) for each bird. CT
data were also used to estimate muscle pathways.
Figure 1: S imm model of a six week broiler chicken showing

all 32 muscles of the limb.
Age
Mass
Breast Muscle Mass
14
0.53
13
28
1.20
15
42
2.68
16
(days)
(kg)
(% body mass)
Table 1: S ubject Data
Results
It is predominantly the hip extensors and flexors,
as well as the M. gastrocnemius (acting as a
knee flexor and ankle extensor) active through
the stance phase of locomotion. The hip medial
rotators (M. ilitrochantericus) are also active.
Muscle forces are highest in the M. gastrocnemius
and M. femorotibialis (~ 60N). Muscle forces are
typically less than 30N in the remaining muscles
of the hindlimb. Specific muscle tension values of
approximately 100 300 kPa were recorded. There is
a relative increase in muscle force across ontogeny.
References
Knowles et al, PLoS one, 3.2:e1545, 2008.
Tickle et al, PeerJ, 2:e432, 2014.
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BIOMECHANICAL AND NUMERICAL INVESTIGATION

ON THE APPLICABILITY OF A PIN-SLEEVE SYSTEM FOR
EXTERNAL FIXATION OF EQUINE DISTAL LIMB FRACTURES
U. Eberli1, D. Widmer1, P. Varga1, R. Schwyn1, S. Brianza1, B. Gueorguiev1,
S. Zeiter2, A. Frst3
1
AO Research Institute, Biomedical Services, Davos, Switzerland
2
3
AO Research Institute, Preclinical Services, Davos, Switzerland
Vetsuisse Faculty of the University of Zrich, Equine Hospital, Zurich, Switzerland
Introduction
The transfixation pin cast (TCP) is the preferred
method to treat equine distal limb fractures
which are contaminated, severely comminuted
or associated with extensive soft-tissue trauma.
However, using the TCP can lead to complications
at the bone implant interface. Previously, a pinsleeve cast system was developed to overcome
the most important issue of pin-loosening [Brianza,
2010, 2011]. Although peak strains could be
reduced and more evenly distributed in the bone
around the pins when using the pin-sleeve cast
system, its dimensions were judged by experienced
equine orthopaedic surgeons to be too large to
be usable in practice. Thus the aim was to reduce
the pin-sleeve cast system dimensions to meet the
surgeons requirements while still providing the
necessary system stiffness and stability.
Results
In biomechanical testing of the cadaveric
specimen instrumented with two and three PSC
systems, pin-sleeve contact occurred at 2088
N and 3834 N and pin breakage at 3286 N and
4386 N, respectively. In the simplified FEA the
critical load was determined as 2300 N/3050 N
(two/three PSC systems) whereas by adding the
optimal pin pretension force of 2 kN the critical
load could be increased up to 5200 N/6850 N
(two/three PSC systems).
Discussion
The FEA revealed a reasonable magnitude of
the critical force as obtained experimentally.
Although FEA showed that the critical force can
be increased to 6800 N by using pin pretension,
the system provides just enough mechanical
stability considering the peak ground reaction
forces acting in horses (6 kN/10 kN per leg at
walk/trot) [Weishaupt, 2002], but an inadequate
safety factor. Keeping in mind the rather ideal
assumptions and simplifications of the FE model,
the real critical forces may be even lower than the
ones obtained numerically. Summarized, the PSC
system appears not to provide sufficient stability to
justify its application in adult horses.
Methods
A modified pin-sleeve cast system (PSC) consisting
of two separate sleeves and having a reduced
outer diameter was tested biomechanically and
by means of finite element analysis (FEA). Two
cadaveric distal horse limbs were instrumented
with two or three PSC systems, respectively and
biomechanically tested under cyclic axial loading
until failure. An FE model of this setup was built,
analysed and validated by biomechanical
testing. Furthermore, the gain in system stiffness
by adding pin pretension was evaluated by FEA
after determining the optimal pin pretension
numerically. While in biomechanical testing
parameters of interest were the occurrence of
pin-sleeve contact as well as pin failure, in FEA the
critical load was defined as the minimum of those
causing pin-sleeve contact and pin yielding.
References
B
rianza et al, Vet Surg, 39(5):601608; 2010
B
rianza et al, Vet J, 190(2):260267; 2011.
W
eishaupt et al, Am J Vet Res, 63(4):520527; 2002
337
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BIOMECHANICS OF COLLAGEN REMODELING DURING

VOCAL FOLD WOUND HEALING
L. Mongeau1, H.K. Heris1, A.K. Miri2, N.R. Ghattamaneni3 , N.Y. Li4 ,
S. Thibeault5, P.W. Wiseman3
1
McGill University, Mechanical engineering, Montreal, Canada

2
4
5
McGill University, Material science, Montreal, Canada
McGill University, Physics and Chemistry Departments, Montreal, Canada

McGill University, communication science disorders, Montreal, Canada
University of Wisconsin, Division of Otolaryngology Head and Neck Surgery, Department of

Surgery, Madison, USA
Introduction
Vocal fold scars can result from the surgical
removal of benign or malignant vocal fold lesions,
phonotrauma [Hansen 2006]. During wound
remodeling, the last phase of the healing process,
the extracellular matrix (ECM) of the granulation
tissue is reorganized dynamically over months to
develop into a mature scar. The remodeling phase
in rat vocal fold undergoes an active remodeling
phase between weeks 2 and 4, and reaches a stable
remodeling phase at week 8 [Tateya 2005]. The
goal of this study was to characterize the structure
of the extracellular matrix and the elasticity of
scarred vocal folds using nonlinear laser scanning
microscopy (NLSM) and atomic force microscopy
(AFM)-based indentation, respectively [Heris 2015].
was greater than uninjured controls (p = 0.18).

The SHG images indicated that the collagen area
fractions were statistically greater (p<0.05) in
one-month (35.4 2.4%) and two-month scarring
(36.9 4.5%) than uninjured tissue (28.7 6.6%
and 29.6 2.6%). Interestingly, both the amplitude
and the periodicity of collagen fibrils qualitatively
increased during the remodelling phase [Heris 2015].
Discussion
The formulation for the indentation elastic modulus
is based on linear elasticity. The adhesion force
between the tissue and probe was negligible
justifying the use of Hertzian contact theory.
However, the roughness of the biopsy samples
caused significant measurement errors. Since
there is no explicit solution for Hertzian contact on
anisotropic materials, tissue samples were assumed
to be isotropic. The indentation elastic modulus
of the uninjured rat LP is much greater than the
indentation elastic modulus of the human LP (~4 kPa)
[Chhetri 2011]. The differences of indentation moduli
between uninjured and scarred rat vocal fold
samples were statistically insignificant in this study.
Methods
Vocal fold injuries were created in fourteen
Sprague-Dawley adult male rats. Animals were
euthanized for laryngeal harvest at one and two
months after surgery. For each larynx, vocal fold
mucosa was dissected from the thyroarytenoid
muscle. Indentation tests were performed using
an AFM. Colloidal probes with a nominal stiffness
of 7.5 N/m and a probe diameter of 25 um were
used. A custom built multi-modal NLSM was used
to perform optical section laser-scanning imaging
of the control and scar samples. ImageJ (NIH,
Bethesda, MD, USA) was used for image analysis.
For comparison of groups, we used two-way
ANOVA with repeated measures with the two
factors being time and treatment.
Several challenges were associated with NLSM

imaging. First, because of the substantial variations
in the thickness of the biopsy samples, the laser
powers had to be adjusted for each sample before
image acquisition. Excessive laser power may
damage the tissue through ablation. On the other
hand, insufficient power reduces the collected SHG
signal and consequently the quality of the images.
Results
The elastic moduli of both uninjured control
samples (one-month control: 250 140 kPa;
two-month control: 240 130 kPa) were similar
(p = 0.42). The average elastic moduli at onemonth scarring (160 60 kPa) was smaller than those
at two-month scarring (380 160 kPa) and uninjured
controls (p = 0.09 and p = 0.34, respectively). The
average elastic moduli at two-month scarring
References
Chhetri DK et al, Journal of Voice, 25:17, 2011.
Hansen JK and Thibeault SL, J Voice, 20:
11020, 2006.
Heris HK et al, 10.1016/ j.jbiomech.2015.01.014.
Tateya T et al. Ann Otol Rhinol Laryngol, 114:
18391, 2005.
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MECHANISTIC MICRO-STRUCTURAL THEORY OF SOFT

TISSUES GROWTH AND REMODELING
Y. Lanir1
1
Technion I.I.T., Biomedical Engineering, Haifa, Israel
Introduction
Biological tissues adapt to altered mechanical
environment by changing their size, structure
and mechanical properties. Tissue growth and
remodelling (G&R) occurs since in order to survive
and proliferate, tissue cells need to maintain a
homeostatic mechanical environment (Grinnell,
1994) by adapting their extracellular matrix (ECM)
via production and removal of ECM constituents.
Modelling G&R can be of great value in unifying
a collection of seemingly un-related facts into a
general scientific framework, thus providing insight
into the processes involved. In practice, models
serve for quantitative prediction and design
(e.g., tissue engineering) where mechanical
conditioning stimulates matrix production and
plays a key role in the evolution of the constructs
toward targeted micro-structure and mechanical
properties (Jockenhoevel et al., 2002; Nerem and
Seliktar, 2001).
Figure 1: E
volution of the fibers recruitment stretch density
distribution from a uniform birth stretch.
Methods
A new mechanistic micro-structural theory was
developed for soft tissues growth and remodeling
(G&R). In deviance from previous ad hoc
phenomenological G&R modelling, the new
theory is based on fundamental processes of
the loading-dependent local turnover events of
each constituent and on the resulting evolution of
the tissue micro-structure and its dimensions and
mechanical properties. The theory incorporates
the specific mechanical properties and turnover
kinetics of each constituent thereby establishing a
general platform which can serve for integration
of additional mechanisms involved in G&R. The
theory considers tissues with unidirectional fibers.
Its feasibility was examined by considering a
specific realization of tissues with one constituent
(collagen fibers) assuming specific loadingdependent first order turnover fibers kinetics and
deposition characteristics. The tissue was subjected
to a continuous constant-rate growth. Model
parameters were adopted from available data.
Figure 2: E
volution of the tissue mechanical properties.
Discussion
These results show that mechanistic micro-structural
modeling of soft tissue G&R based on first principles
can successfully predict the observed evolution of
the tissue structure and size, and of its associated
mechanical properties.
References
Grinnell F, The Journal of Cell Biology 124 (4):
401404, 1994.
Jockenhoevel S et al, Asaio J. 48 (1):811, 2002.
Nerem RM and Seliktar D, Annual Review of
Biomedical Engineering 3:225243, 2001.
Results
The
resulting
predictions
show
qualitative
agreement with a number of well-known features
of tissues including the evolutions of fibers nonuniform recruitment density distribution (Figure 1),
and of the associate tissue convex non-linear
stress-stretch relationship (Figure 2), as well as the
development of tissue pre-stretch and pre-stress.
339
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AN EFFICIENT APPROACH FOR THE STABILITY

OF BONE REMODELING MODELS
N. Garijo1, M.A. Prez1, J.M. Garca-Aznar1
1
Aragn Institute of Engineering Research I3A University of Zaragoza, Multiscale

in Mechanical and Biological Engineering M2BE, Zaragoza, Spain
Introduction
Bone remodeling is the mechanism that regulates
the relationship between bone morphology and its
internal mechanical loads, and it is based on the
fact that the bone has the ability to adapt itself to
the mechanical conditions to which it is exposed.
The first phenomenological law that qualitatively
described this mechanism is generally known as
Wolffs Law. During recent decades, a great number
of numerically implemented mathematical laws
have been proposed, but most of them have not
presented a full analysis of stability, convergence
and dependence of the initial conditions.
Following Garijo et al.[2014], a novel assumption
is presented in this work: it is considered that the
reference equilibrium stimulus is changing but
at the same time it is locally dependent on the
loading history that each local point is effectively
supporting.
Methods
We use Stanfords bone remodeling theory [Jacobs,
1995]. This approach is based on the principle
that bone remodelling is induced by a local
mechanical signal which activates the regulating
cells (osteoblasts and osteoclasts) forming or
removing bone, respectively. In fact, the apparent
density is used as an internal variable to quantify
the adaptive evolution of the microstructure that
defines the bone mechanical behavior. Hence, this
model assumes that a certain level of mechanical
stimulus is required to maintain bone homeostasis
and to regulate bone mass evolution.
Figure 1: The density distribution resulting from a bone

remodeling simulation carried out using the
Stanfords remodeling model [Jacobs, 1995] for
(a) 300 days, (b) 1000 days, and (c) 4000 days;
and the modified model for (d) 300 days,
(e) 1000 days and (f) 4000days.
Discussion
This modification improves the convergence of the
solution, clearly leading to its numerical stability
in the long-term. Most of the bone remodeling
algorithms are based on the mechanostat theory,
defining a reference equilibrium stimulus and
a dead zone. Therefore the updated law here
proposed for the reference equilibrium stimulus
could be applied to all of them improving the
prediction in the long-term.
This approximation is introduced by using the finite

element method and the explicit Euler scheme.
Numerical results are presented to demonstrate
the behavior of the solution.
Results
A qualitatively comparison has been done with
our modification against the classical Stanfords
model. As outlined by Jacobs [1995] the number
of load cases applied affects significantly to the
computational results. Stanfords model obtains
the best results in a certain number of days (300)
(Figure 1a). As time goes on, the results become
less accurate (Figure 1b and c). There is no
numerical stability of the model. The modification
proposed in this work shows a stabilized bone
density distribution (Figure 1d, 1e and 1f). These
results clearly display a great improvement in the
stability solution with the modification proposed for
the Stanfords model.
This project has received funding from the European
Unions Seventh Framework Programme for research,
technological development and demonstration
under grant agreement n286179 and the Spanish
Ministry of Economy and Competitiveness through
research project DPI2011-22413.
References
Garijo et al., Comput Method Appl M,
271:253268, 2014.
Jacobs et al, J Biomech, 28(4):449459, 1995.
340
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A COUPLED POROMICROMECHANICAL/SYSTEMS
BIOLOGY APPROACH FOR SIMULATING
THE BIOCHEMICAL AND MECHANICAL
CUES OF BONE REMODELING
S. Scheiner1, P. Pivonka2, M. Pastrama1, C. Hellmich1
1
Vienna University of Technology, Institute for Mechanics of Materials and Structures,

Vienna, Austria
2
The University of Melbourne, Australian Institute for Musculoskeletal Science,

Melbourne, Australia
Introduction
Bone is able to accommodate, in terms of its structure
and composition, to a long-term changing mechanical
loading environment. Bone remodeling is the term
summarizing the underlying cellular activities, leading
to removal of mature bone tissue and subsequent
formation of new bone tissue, driven by complex
interrelations between the involved biological cells.
Importantly, these interrelations are dynamically
governed by a multitude of biochemical factors,
and the mechanical loading [Jacobs et al, 2010].
Experimental results suggest that the hydrostatic
pressure acting onto osteocytes in the lacunar pore
space, related to the macroscopically applied
physiological loading, is a potential stimulus for
modulating mechanobiological regulation of
bone remodelling [Gardinier et al, 2010]. Here
we pick up on these findings, and present a
poromicromechanics model for quantifying the
lacunar pore pressure, which can be integrated
in a coupled micromechanics/systems biology
approach for simulation of bone remodeling.
Methods
The presented poromicromechanics model takes into
account the composition of bone on the considered
length scales, the interactions of the lacunar
and vascular pore spaces with the respectively
surrounding extracellular and extravascular bone
matrices, and the interactions between the pore
spaces across several orders of magnitude of length
scale [Scheiner et al, 2015]. The computed lacunar
pore pressure can be straightforwardly coupled to
a systems biology approach to bone remodeling
[Scheiner et al, 2013], based on a bone cell
population model, which considers the dynamically
developing densities of osteoclasts and osteoblasts
within a representative volume element of bone,
driven by biochemical factors, and changes of the
prevailing mechanical loading, see Figure 1.
Figure 1:
Schematic sketch of the modelling approach
for prediction of biochemically and mechanically
regulated bone remodeling
Discussion
These numerical results confirm that the proposed
model strategy soundly considers the key features
of biochemically and mechanically regulated
bone remodeling. This gives rise to the hope that the
presented approach holds the promise to evolve
into a clinically deployable instrument providing
well-founded interpretation of clinical data and
predictions regarding the expected development
of bone remodeling-related processes over time.
References
Jacobs et al, Annu Rev Biomed Eng, 12:369400, 2010.
Scheiner et al, Comput Methods Appl Mech Eng,
254:181196, 2013.
Scheiner et al, Int J Numer Meth Biomed Engng,
30:127, 2014.
Scheiner et al, Biomech Model Mechanobiol,
Submitted, 2015.
Results
After validation of the poromicromechanics
model, a microgravity (i.e. spaceflight) scenario is
simulated, with the results being in good agreement
with related experimental data [Scheiner et al,
2013]. Secondly, postmenopausal osteoporosis is
simulated, optionally taking into account treatment
by means of the anti-catabolic drug denosumab
[Scheiner et al, 2014]. The predicted bone volume
development agrees well with clinical studies.
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PATIENT SPECIFIC REMODELING TO PREDICT CHANGES

IN TISSUE COMPOSITION AFTER LUMBAR FUSION
M. van Rijsbergen1, W. Wilson1, B. van Rietbergen1, K. Ito1
1
Eindhoven University of Technology, Orthopaedic Biomechanics Department of Biomedical

Engineering, Eindhoven, Netherlands
Results
As a result of the fusion, modest changes in
bone density and IVD tissue composition were
predicted. These changes reflected changes in
tissue loading and matched the clinical followup data reasonably well (Fig. 1). For bone density
change, reasonable to good agreement was
found between predicted and observed (R2 from
0.41 to 0.95). In three cases, no change in IVD
degeneration grade was predicted agreeing
with clinical evaluations. In one case, a change
in degeneration grade was predicted while not
clinically observed.
Introduction
Low back pain resulting from intervertebral disc
(IVD) degeneration is a common problem. If
conservative treatment fails, spinal fusion is the
most common surgical intervention. With this
intervention, loading conditions on the adjacent
discs and vertebrae change, which may lead to
degenerative tissue adaptation. Recently, we
combined a multiscale bone remodeling model
with a mechanoregulated composition-based
IVD FE model to predict changes in bone density
and IVD tissue composition. The individual tissue
adapation models were previously validated and
described [van Rijsbergen 2014, van Rijsbergen
2014]. The goal of the current study was to
determine its ability to predict patient-specific
tissue changes post-fusion at the adjacent level
by comparing the model outcome against clinical
2-year follow-up data.
Methods
For four patients (L3-L4: n=1; L4-L5: n=3), a patientspecific FE model of the vertebrae and IVD adjacent
to the fusion was made. Using a CT scan, the bone
density per element was determined. IVD matrix
composition, spatial distribution and corresponding
constitutive material parameters were mapped to
a healthy IVD (Pfirrmann grade II). To investigate
the effect of fusion on the adjacent tissue, the
expected surgery-induced changes in boundary
conditions were applied to the model (calculated
by a patient-specific lumbar model). This led
to changes in strain energy density distribution
(for bone tissue) and mechanoregulation signal
(for disc tissue), inducing bone remodeling with
corresponding bone density and disc tissue matrix
changes. The changes in matrix components were
mapped back to changes in degeneration grade.
To validate the predicted changes in bone density
and degeneration grade, the outcome was
compared to patient 2 year follow-up data. For
the bone density, a correlation coefficient (R2) was
calculated between the clinical follow-up data
and predicted density (per finite element); IVD
degeneration grade was compared to the clinically
scored degeneration grade. For bone density,
only the upper vertebra was used for comparison.
Figure 1: C
hanges in bone density and disc composition at
baseline and as predicted/ measured after fusion.
(Note: For disc tissue, no algorithm was available
to quantify water content from actual MRI values)
Fusion was performed at the lower (L4-L5) level.
For the bone only results for the L3 level were
compared since screws were present in L4.
Discussion
A possible explanation for the one case where disc
degeneration prediction did not match the clinical
case, could be that the absolute change in tissue
content indicated a grade change while this
change was not visible by MRI yet. In conclusion,
the possibility to simulate patient-specific bone
remodeling and to account for patient-specific
disc degeneration status can yield realistic
predictions of the effect of surgical interventions.
References
[1] van Rijsbergen et al, 2014, WCB 2014
[2] van Rijsbergen et al, 2014, CMBBE 2014
342
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A COMBINED MULTISCALE NUMERICAL AND

EXPERIMENTAL APPROACH FOR THE DESIGN
OPTIMIZATION OF HOLLOW-FIBER BASED
MEDICAL DEVICES
F. Consolo1, A. Dimasi1, R. Testa1, S. Speranza1, S. Reggiani2, G.B. Fiore1, A. Redaelli1
1
Politecnico di Milano, DEIB - Dipartimento di Elettronica Informazione e Bioingegneria Bioengineering Division - Biomechanics Group, Milano, Italy
2
Sorin Group Italia, Research and Development, Mirandola MO, Italy
Introduction
With the introduction of hollow-fiber based blood
oxygenators (OXY) and heat exchangers (HE)
for extracorporeal circulation (ECC), finding
an optimal trade-off between different design
specifications has become a refined challenge
that benefits from the use of advanced numerical
modelling techniques combined with innovative
experimental methods. In collaboration with Sorin
Group Italia (SGI), we have designed a new strategy
based on multiscale computational fluid dynamics
(CFD) that couples macro- and microscale flow
effects to optimize the performance of integrated
ECC devices, including analysis of platelet
activation to characterize the device thrombotic
impact.
Figure 1: T he multiscale modeling approach combined with

in vitro PAS analysis.
The microscale analysis highlighted the presence

of non-negligible hemodynamic forces in the fiber
bundle regions of the HE and the OXY, in particular
due to the significant residence time of the
platelets within the bundles, potentially eliciting
platelet activation. In vitro PAS analysis with the
HSD is ongoing, to quantify the actual thrombotic
potential of the device.

A multiphysic analysis at the macroscale allowed
the extraction of quantitative geometrical-dependent parameters, not derivable from
empirical methods, to optimize the hemo- and
thermo-dynamics performance of the HE module
of an integrated hollow-fiber OXY. Afterwards,
the inner core micrometric fiber bundles were
modeled to capture the local flow phenomena
at the fiber level. Multiscale simulations were
integrated with a transient Lagrangian analysis
of the mechanical load experienced by
platelet-like particles, to gather data concerning
the
stress
history
experienced
by
cells
recirculating within the device (Pelosi et al., 2013).
Representative shear stress loading waveforms
were selected to be reproduced in vitro into the
Hemodynamic Shearing Device (HSD, Fig. 1), in
order to quantify the platelet activation state (PAS)
(Bluestein et al., 2013).
Discussion
The proposed composite numerical-experimental
methodology allows for the identification of
suitable working conditions of blood handling
medical devices, including the minimization of
stress-mediated blood cells sensitization and
thrombus susceptibility.
References
Pelosi A. et al., BMMB, 2013
Bluestein D et al., J Biomech 2013.
This work was financially supported by Fondazione
Cariplo, Grant no. 22412011.
Results
A convenient design configuration of the HE
was identified, characterized by i) uniform blood
flow pattern within the fiber bundle, preventing
blood flow shunting and the onset of stagnation/
recirculation areas and/or high velocity pathways,
inducing hemolysis and platelet activation;
ii) enhanced blood heating efficiency; and
iii) reduced blood pressure drop and priming
volume.
343
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NON-INVASIVE METHOD FOR DIAGNOSIS AND

CORRECTION THE DEFORMITIES OF INFANTS HEAD
W. Wolanski1, D. Larysz2, M. Gzik1, E. Stachowiak1
1
Faculty of Biomedical Engineering, Silesian University of Technology, Biomechatronics

Department, Zabrze, Poland
Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Radiotherapy

Department, Gliwice, Poland
Introduction
Recently development of technology and
integration between medical and community of
engineers lead to increase the quality of medical
services. The latest technical achievements make
it possible to create a system, which supports
medical treatment and diagnosis of head shape
deformities in infants1. This system enables complex
diagnosing of deformity, monitoring of skull growth.
Also creation of orthesis for correction of head shape
is possible based on data from 3Dscanner. Results
of conducted studies can support surgeons and
neurologists in decisions which method of treating
should be chosen. Performed researches make it
possible to analyze infants head development in
cases of children with positional plagiocephaly,
craniosynostosis and in case of helmet treatment.
Figure 1: 3
D model of correction helmet
Nowadays it shall be directed to non-invasive
health assessment and reduction of harmful agents,
like X-ray. Application of non-invasive techniques
of medical imaging is an innovative problem. With
these methods you may treat a particular disease
by defining the numerical parameters, which give
objective, quantitative information. According
to the above information, non-invasive method
of diagnosing childrens heads was prepared.
It is based on an application of 3D scanner
MEGACAPTUROR II TM. This kind of scanners is used
for digitalization of human body and creating 3D
modes of whole body. Performed 3D models are
used for collection of anthropometrical data, and
design of custom-design orthosis.
C o n cl u s i o n
In this study complex process of individual design
of helmet and evaluation of head growth was
performed. Developed method of head shape
correction is the answer to the request of the
society, signalized by surgeons. Due to a big variety
of head deformations, it is impossible to create
reliable statistics for examined number of patients.
However, it can be concluded that described
process can be a useful procedure as a tool to
decide which method of treatment and evaluation
of its effectiveness should be chosen. It is also
certain that it is a good method to perform studies
on head development in positional plagiocephaly.
References
1 Wolanski W., Larysz D., Gzik M., Kawlewska E.:
Modeling and biomechanical analysis of craniosynostosis correction with the use of finite element
method. International Journal for Numerical
Methods in Biomedical Engineering 2013,
Vol.29, No.9, pp. 916925.

3D scanning of head shape is performed to monitor
and analyze the growth of head, or to design
personalized orthosis. Depending on deformity
and age of child, the examination is made every
15 month. So far 27 (9female, 18 male) patients
have been delaminated. Age of patients was
between 325 month. After each study a 3D model
of head shape was created and compared with
the previous model analyzed by craniometrical
indexes. The virtual model of head also is needed
to design the orthosis to correction of deformation
the infants head. From biomechanical point of
view the knowledge of the shape head is necessary
to select optimal parameters of the orthosis. An
example of the shape of the helmet designed for
positional plagiocephaly correction shows figure 1
344
O 306
ANTEROLATERAL PLATES FOR TREATMENT OF DISTAL TIBIA

FRACTURES NUMERICAL SOLUTION
G. Theisz1, K. Frydrek1, L. ilka2, L. Pleva3
1
VSB Technical University Of Ostrava, Department of Applied Mechanics,

2
3
Medin a.s, Unspecified, Nove Mesto na Morave, Czech Republic
University Hospital in Ostrava, Trauma Centre, Ostrava, Czech Republic
Introduction
This paper analyzes anterolateral plates for
osteosynthesis via FEM; see Fig. 1 (producer: Medin,
a.s.). The plate is used for the internal fixation of
distal tibia fractures.
of the metaphysis and joint surface defined

according to the AO classification 43-C1.1; see
Fig. 1. Coulomb friction between the non-fused
bone fragments is defined with friction coefficient
0.4. It is very difficult to determine the force acting
upon the tibia during walking. For this reason the
force F was selected, corresponding with the
entire weight of the patient mp = 100 kg, taking
into account the dynamic loading of the bone.
The contact between the tibia and the talus is
replaced by the boundary condition of elastic
support; this boundary condition is a suitable
replacement for the cartilage and mechanical
contact with the talus. Variant calculations were
carried out for fused bone (successful treatment)
and non-fused bone (unsuccessful treatment); see
Tab. 1. With regard to the minimum yield strength
of the material, the safety factor is calculated
using the equation: ksy=s redMAX/s y, where sredMAX/ isthe
maximum reduced stress according to von Mises
theory and sy is the minimum yield strength of the
given material.
Figure 1: A
nterolateral plates and their application, material
properties in tibia and stress analysis.
Results
The situation of maximum loading on non-fused
bone is an extreme state in which the fracture fails
to heal and the patient places excessive stress
on the limb (with loading even exceeding yield
strength causing plastic deformation). In cases of
successful treatment the safety factor ky>10. From
this perspective the analyzed anterolateral plate
can be considered safe. In cases of unsuccessful
treatment, the safety factor may be k y<1. In such
cases the plate is unsafe and the fracture must be
re-operated. The authors gratefully acknowledge
the funding from the Czech projects TA03010804
and SP2015/180.
Methods
In order to provide an adequate description of
reality, the bone model was divided into cortical
and spongy (cancellous) tissues. These individual
parts were each divided into 4 areas (giving
a total of 8 areas displaying different material
properties); see Fig. 1. The analysis was performed
on a selected simple intra-articular fracture
References
F rydrek K., Jorenek J., Ucen O., Kubn T., ilka L.,
Pleva, L., Design of External Fixators Used in Traumatology and Orthopaedics Treatment of Fractures
of Pelvis and its Acetabulum, Procedia Engineering,
vol. 48, 2012, pp. 164173.
C
owin C. S., Bone Mechanics Handbook, CRC
Press, Florida, USA, 2001.
345
O 307
CT-BASED FINITE ELEMENT MODELLING OF PLATED DISTAL

RADIUS FRACTURE OSTEOSYNTHESIS: EVALUATION
AGAINST EXPERIMENTAL MEASUREMENTS
A. Synek1, S. Baumbach2, D. Pahr1
1

Vienna, Austria
2
Ludwig Maximilians University Munich, Trauma Surgery, Munich, Germany
Introduction
Various surgical procedures exist to treat distal
radius fractures (DRF), which are among the
most common fractures. The variety of treatment
approaches could be compared and improved
using finite element (FE) analysis. However,
previously presented FE models [Lin, 2011]
[Mair, 2011] lack thorough experimental validation.
The goal of this study was to compare the FE
predictions of overall stiffness and screw loads of
DRF osteosynthesis with the results of biomechanical
experiments on a large sample size.
Results
FE and experimental stiffness were highly correlated
(R 2=0.82) but a 1:1 relation was not achieved
(Fig. 2, left). FE models overestimated the
experimental stiffness by a factor of 2. Experimental
failures were observed particularly at the screw-plate
interface. Screws number 5and 8 failed most
often (#5: 5x; #8: 6x), which is in agreement
with the largest averaged normal forces at the
screw-plate interface (Fig. 2, right).
Methods
Biomechanical experiments (Fig. 1, left) and FE
analysis (Fig. 1, right) were conducted in 25 fresh
frozen cadaveric radii with DRFs treated by volar
locking plate osteosynthesis. HR-pQCT scans
(82 micron) were used to separate cortex from
cancellous bone and map local density-based
material cards to each element [Pahr, 2009].
Clinical quantitative CT (QCT) scans of the prepared
samples were used to place the implant system
in accordance to the experiments. The models
were generated with medtool (Dr. Pahr Ingenieurs
e.U.) and the implant was placed with Blender
(Blender Foundation). The overall axial stiffness
of the FE models was computed and compared
to the experimental results using linear regression
analysis. Screw loads were evaluated as section
forces and moments at the screw-plate interface
and compared to experimental observations of
screw-plate interface failures.
Figure 2: E
XP and FE overall Stiffness (left) and averaged,
normalized axial screw loads (right)
Discussion
A high correlation was found between experimental and FE simulated overall axial stiffness of
DRF osteosynthesis. Remaining deviations of the
absolute stiffness values might be explained by the
fully bonded screw-bone and screw-plate interface used in the presented models. Future studies
should investigate the mechanical behaviour of
the screw-plate and screw-bone interfaces in more
detail to improve the predictions of DRF osteosynthesis FE models. A good agreement was found
between the screw loadings and failed screws in
the experiment.
References
Lin et al. JMBE 2012
Mair et al. Der Unfallchirurg 2013
Pahr & Zysset. J. Biomech 2009
Figure 1: E
xperimental test-setup (left) and FE model (right)
346
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FINITE ELEMENT ANALYSIS OF A CLOSED FIXATION

FOR VERTICAL NECK FRACTURES IN YOUNG ADULTS
C. Roesler1, J. Guimares2, M. Duarte2, J. Martins3 , E. Fancello3
1

Instituto Nacional de Traumatologia e Ortopedia, Orthopedic Trauma, Rio de Janeiro, Brazil

3
Universidade Federal de Santa Catarina, Mechanical Engineering, Florianpolis, Brazil
Introduction
Vertical femoral neck fractures in young adults
generally results from trauma involving greater
shearing forces at femoral head and shaft union.
Their treatment is challenging and should include
precise reduction and rigid internal fixation [Szita,
2002]. The most used devices for fixation of vertical
femoral neck fractures are multiple parallel screws
or a sliding hip screw [Bonnaire, 2002]. However,
shortening of the femoral neck are reported
[Zlowodzki, 2008]. We studied a fixation strategy
using two parallel 7.0 mm lag cancellous screws
inserted towards the neck at a 125 angle from the
femoral shaft and a third transverse screw, inserted
perpendicularly to the fracture line between
the first two others screws. The main goal of this
construct was to achieve a stable fracture fixation
to promote bony union and avoid telescoping of
fragments and consequently, femur shortening.
The finite element (FE) method was used to provide
a measure of mechanical stability at the fracture
site.
Figure 1: T he model of femur with screws and the finite

element mesh
Results
The relative tangential micro-movements measured are presented in Table 1.
Methods
The current investigation was performed by using
3-D finite-element model of a human femur. The
simplified load conditions were applied through a
joint reaction force of 730 N in the femoral head
according directions in Simes [2000].
Control point
Tangential micro-movement[m]
67.99
16.24
36.16
25.31
Table 1: M
easured tangential micro-movement
Discussion
These preliminary results obtained in finite element
simulations indicated maximum relative tangential
displacement of 68 m, below the threshold value
of 150 m (Perren, 1979), suggesting a beneficial
stability for bone healing. These results contribute
to understand good clinical outcomes seen using
this fixation strategy.
The analysis was performed using linear isotropic

elasticity. Although this is a rough approximation,
it is acceptable as a first analysis. The value of the
Young and Poisson modulus of the materials are
E = 187 GPa and n = 0.33 for the Stainless steel
ASTM F138,E = 4 GPa and n = 0.3 for trabecular and
E = 16 GPa and n = 0.3 for the cortical bone. The
fracture was modeled by means of a separation
plan in the femoral neck region. A frictionless
contact condition was adopted in the fracture
plane. The screws were positioned according
surgical protocol and a bonded contact condition
was used at screw thread and trabecular bone
interface. Geometry was discretized using shell
elements from ANSYS Workbench. Figure 1 depicts
the frontal view of the treated femur, the four
points where the relative tangential displacement
was measured, and the whole finite-element mesh.
References
Bonnaire et al., Injury,33Suppl 3:C2432, 2002.
Perren, Clin. Orthop., 138: 175, 1979.
Simes, Medical Engineering & Physics 22,
453459, 2000.
Szita et al., Injury, 33 Suppl 3:C4146, 2002.
Zlowodzki et al., J Bone Joint Surg Br. 90:
14871494, 2008.
347
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MULTISCALE COMPUTATIONAL MODELLING OF NORMAL

AND CANCER CELL BIOMECHANICS AND BEHAVIOUR
A.S. Ferreira1, D. Lacroix1, D. Walker2
1
Insigneo Institute, Mechanical Engineering, Sheffield, United Kingdom

2
Insigneo Institute, Computer Science, Sheffield, United Kingdom
Introduction
A number of diseases, including cancer, are
known to be associated with changes in the
mechanical properties of cells and tissues.
Therefore, understanding how the latter relates to
cell behavior is important. The aim of the present
work is to investigate the mechanics of collective
migration and cell interaction within a population.
A multiscale computational model is proposed
in which a middle-out approach is considered.
Single-cell mechanics is studied using a singlecell finite element model (FEM) [1], while its role
in the emergence of collective behaviour is
explored using an agent-based model (ABM). This
framework can be useful to explore the mechanics
of several diseases such as cancer progression
through metastasis.
Results
Figure 1 shows the multiscale approach considered.
The FEM is used to determine the net reaction
force on the bottom of each cell resultant from
the intercellular forces defined in the ABM. This
reaction force is subsequently translated into an
active traction that contributes to cell motion.
Methods
Single-cell mechanics is investigated by means
of a hybrid FEM developed using the software
ABAQUS. This model is a modified version of
the one described by Barreto et al [1]. Instead
of representing the mechanical response of
an adherent cell to atomic force microscopy
indentation, it represents the mechanical response
of an adherent cell to the multicellular interactions
emergent within a population. Cellular migration
and multicellular interactions are included through
the combination with an ABM.
Figure 1: M
ultiscale approach proposed: a) cell population
scale ABM and b) single-cell scale FEM. Multicellular
forces defined by the ABM are an input to the FEM.
Thereby, the net reaction force is computed and
fed back to the ABM, where a net traction force
is obtained and its contribution to cell motion
determined.
Discussion
The inclusion of a stress driven remodelling
mechanism for the cells cytoskeleton will give
new insights into the mechanics of cell motion and
multicellular interactions.
In the finite element representation of the cell,

the cytoplasm, nucleus and cortex are modelled
as elastic isotropic continuum materials; while the
cytoskeleton is considered as an elastic discrete
network of microtubules and prestressed actin
filaments. Regarding the ABM, cell interactions
are modelled using the Johnson-Kendall-Roberts
(JKR) model of elastic contact [2]. The hypothesis
behind this work is that, when imbalanced, these
interactions contribute to the generation of active
traction forces within the cell cluster, contributing
to cell motion.
This multiscale framework has the potential to

provide a mechanistic answer to the collective
behavior observed in cellular populations.
References
[1] Barreto et al, Biomaterials, 34(26):61196126, 2013.
[2] Pathmanathan et al, Phys. Biol., 6(3):036001, 2009.
EPSRC Frontier Engineering Award (EP/K03877X/1);
FP7 EC http://chic-vph.eu/; European Research
Council (258321).
348
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PATIENT SPECIFIC MODELLING AND QUANTITATIVE

TISSUE QUALITY ASSESSMENT FOR PROSTATE
CANCER DIAGNOSIS
J. Palacio-Torralba1, E. Jimnez Aguilar2, B. Esfandiar Jahromi1, S.A. McNeill3 ,
G.D. Stewart3 , R.L. Reuben1, Y. Chen1
1
Institute of Mechanical Process and Energy Engineering. School of Engineering and Physical
Sciences, Heriot-Watt University, Mechanical Engineering, Edinburgh, United Kingdom
2
Servicio de Oncologa Mdica, Hospital 12 de Octubre, Madrid, Spain
Edinburgh Urological Cancer Group, Division of Pathology Laboratories, Institute of Genetics

and Molecular Medicine, University of Edinburgh, Western General Hospital,
Department of Urology, Edinburgh, United Kingdom
Introduction
Palpation has proved an efficient diagnostic
technique for centuries and is still being used for
early detection of diseases such as cancer [Phipps,
2005b].The technique consists on exploring by
touching the tissues looking for abnormalities
produced by the changes in the mechanical
properties that diseases cause. However, this
method remains a qualitative technique subject
to inter-clinician variations. Several methodologies
have been proposed to use instrumented palpation
to enhance the outcome of the procedure [Ahn,
2012]. These techniques often investigate changes
in the stiffness of the tissue and relate them
to the tissue quality [Phipps, 2005a]. However,
these frameworks do not often consider patient
specific features such as structural differences,
consequences of surgical treatments etc. Therefore
elasticity measurements can be uncertain and may
lead to innacurate diagnosis. More importantly, it
has been shown that the viscoelastic properties of
soft tissues are also related to tissue quality [Phipps,
2005b]. These could enhance the diagnosis
quantitatively and therefore improve clinical
decisions for further treatment.
as seen in Fig. 1. In contrast, TQI shows a better

sensitivity to assess tissue quality as shown in Fig. 2.
Figure 1: IDRE force feedback for healthy and cancerous

prostate under low (LIBP) and high(HIBP)
intrabladder pressures.
Methods
The pelvic cavity of three diffferent patients
with various physiopathological conditions is
reconstructed from MRI images using ITK-SNAP
[Yushkevich, 2006]. Using finite element analysis
instrumented digital rectal examinaion (IDRE) is
modelled under different intrabladder pressure
conditions to determine the pre-examination
conditions that will lead to the best sensitivity and
reliability of the procedure. Furthermore this analysis
would help to understand how structural differences
influence the outcome of the procedure and how
to take advantage of them. For the purpose of
quantitative tissue diagnostic the tissue quality index
(TQI) is defined. It relates the viscoelastic behaviour
of the palpated sample with a numerically simulated
healthy prostate model.
Figure 2: Q
uantitative tissue quality assessment of prostatic
tissue using TQI.
Discussion
Subject
specific
structural
features
and
physiological conditions influence the observed
stiffness during IDRE. The use of apparent
viscoelasticity (TQI) has significant advantages
over using just stiffness measurements for tissue
quality assessment and therefore could become
useful tool in clinical practice.

Patient specifc models show that the relative
position of the bladder and the prostate significantly
influence the effects of intrabladder pressure on
the outcome of IDRE. Furthermore, the measured
stiffness significantly varies from patient to patient
References
Ahn et al, Med Biol Eng Comput, 50:96171, 2005.
Phipps et al, Urology, 65:10248, 2005a.
Phipps et al, Urology, 66:44750, 2005b.
Yushkevich et al, NeuroImage, 31:11628, 2006.
349
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SOLID STRESS-INDUCED COLLAGEN FIBRE REMODELLING

AND ENCAPSULATION DURING TUMOUR PROGRESSION
A. Pirentis1, C. Polydorou1, P. Papageorgis1,2, C. Voutouri1,
F. Mpekris1, T. Stylianopoulos1
1
2
University of Cyprus, Cancer Biophysics Laboratory, Nicosia, Cyprus
European University Cyprus, Program in Biological Sciences, Nicosia, Cyprus
Results
The model predicts that intratumoural solid stress
is compressive, whereas peritumoural stress is
compressive in the radial direction and tensile in the
periphery. Furthermore, collagen fibres engaged
in stress generation only in the peritumoural region,
and not in the interior where they were slackened
due to the compressive stress state. Peritumoural
fibres were driven away from the radial direction,
tended to realign tangent to the tumour-host
interface (Fig. 1), and were also significantly
stretched by tensile circumferential stresses.
Introduction
Solid stresses emerging as an expanding tumour
deforms the surrounding normal tissue, and also
due to intratumoural component interplay, induce
extensive extracellular matrix reorganization.
In this study, we developed a computational
model of tumour growth that distinguishes the contribution to stress generation by collagenous and
non-collagenous tumour structural components,
and also investigates collagen fibre remodelling
exclusively due to solid stress.
Methods
We used an orthotopic breast cancer mouse model
to monitor primary tumour growth and derive
its mechanical properties. We also performed
immunohistochemical analysis to observe collagen
expression localization.
In the finite element model, a spherical tumour
was developed at the centre of a much larger
normal tissue domain. To describe kinematics,
the decomposition of the total deformation
gradient F = Fe F g was used [Rodriguez, 1994],
where Fe describes elastic interactions between
normal tissue and tumour, and F g = g I, with g a
Gompertzian growth stretch ratio [Stylianopoulos,
2013], accounts for cancer cell proliferation
and growth. In both domains, collagen fibres
were assumed to be embedded in an isotropic,
compressible, neo-Hookean matrix representing
the mechanical behaviour of all non-collagenous
material. We also assumed that fibres were
hyperleastic and isotropically distributed. Finally,
the models mechanical and growth parameters
were specified by comparison with experiments.
Figure 1: S patial distribution of distinct fibre angular distance from the radial direction ( = 0). Vertical
dashed line denotes the tumour-host interface.
Moreover, our histologic analysis revealed a

distinct band of collagen delineating the tumour
periphery.
Discussion
By means of this remodelling process, the model
predicts that the tumour is enveloped by a
progressively thickening capsule of collagen fibres.
This prediction is consistent with long-standing
observations of tumour encapsulation and the
histologic sections we performed, and it further
corroborates the expansive growth hypothesis for
the formation of the capsule [Byrne, 2006].
To monitor collagen fibre remodelling, the fibre

distribution was approximated with a custom set
of vectors n^ i, the spatiotemporal evolution of
which, n i F e n^ i, was documented in terms of their
change in length and change in angular distance
(dot product angle) i from the radial direction.
References
Byrne et al, Phil Trans R Soc A, 364:156378, 2006.
Rodriguez et al, J Biomech, 27:45567, 1994.
Stylianopoulos et al, Cancer Res, 73:338341, 2013.
350
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MECHANICAL PROFILING OF BIOPSIES BY PARALLEL AFM

FOR RAPID SENSING OF CANCER
G. Weder1, J. Cottet1, R. Ischer1, L. Le Reste1, M. Favre1, C. Martin Olmos1,
H. Heinzelmann1, M. Liley1
1
CSEM SA, Micro & Nano Systems, Neuchtel, Switzerland
Introduction
The mechanics of biological cells, in particular
their stiffness and elasticity, is an important factor
that changes during the development of cancer
[Plodinec, 2012]. Molecular and structural changes
in the extracellular matrix and cytoskeleton
occur during cancer initiation, progression and
metastasis. Typical mechanical profiles have
been correlated to pathohistological analysis
of normal, benign and malignant human breast
tissue. These distinct nanomechanical signatures
of breast cancer can be used as diagnostic tool.
Atomic force microscopy (AFM) is the ideal tool
to investigate the mechanical properties of cells
in biopsy samples in a reliable way (Figure 1).
It is, however, slow. This is a significant limitation
since a large number of force-distance curves on
the biopsy sample are required for a statistically
meaningful set of data. Currently, one of the major
obstacles for a routine use of AFM is the turnaround
time of several hours.
Results
The strategy consists in reading a cantilever
array with a VCSEL array (Vertical Cavity Surface
Emitting Laser). Each laser beam is focused at
the end of one cantilever of the array, and the
reflected light is detected using a photodetector
(Figure 2). The development of the demonstrator
is focussed on reproducible laser alignment and,
fast and parallel read-out. The VCSELs are actually
driven at 25 kHz. The demonstrator includes
positioning stages for laser alignment and scanners
for living tissue indentation. It will then be improved
towards a prototype that will be equipped with a
temperature-controlled fluid chamber. Throughout
the development, highly compact probe arrays
are used to be suitable with the rough biopsy
samples.
Figure 1: N
anometer-scale palpation of breast tissue (left)
and typical mechanical profiles of healthy and
cancerous tissues (right).
Figure 2: S chematic of parallelized AFM cantilevers to investigate breast samples rapidly (left) and picture of a
cantilever array (right).
Methods
To reduce this analysis time, CSEM is working
on parallelizing several mechanical sensors. In
combination with a commercial AFM-based
diagnostic tool called ARTIDIS (Automated and
Reliable Tissue DIagnosticS) that performs highly
automated but serial measurements, this will
reduce data acquisition time from hours to minutes.
The standard procedure starts with removal of a
breast biopsy from the suspicious lesion. Multiple
elasticity maps are then acquired across the entire
biopsy using an AFM cantilever. The replacement
of this single cantilever by a cantilever array
8 cantilevers operating in parallel involves
an innovative parallel read-out of the probes.
Compared to the current state of art, where only
one probe is used to acquire about 20000 forcedistance curves per biopsy, these arrays will reduce
the data acquisition time by a factor of eight.
Discussion
The major innovation of this development is to
reduce the analysis time of the tissue mechanical
profile from hours to minutes for clinical breast
cancer diagnosis. It may also contribute to a better
understanding of the physical mechanisms of
cancer metastasis and the development of novel
strategies for cancer prevention. Parallelized AFM
measurements in combination with the existing
ARTIDIS tool should open new perspectives for
clinical application.
References
Plodinec et al, Nature Nanotechnology, 7:757765,
2012. This work is partially funded by the Swiss research program Nano-Tera.
351
O 313
CONTRIBUTION OF GLYCOSAMINOGLYCANS
TO THE MECHANICS OF A GROWING TUMOR
C. Voutouri1, T. Stylianopoulos1
1
University of Cyprus, Cancer Biophysics Laboratory, Mechanical and Manufacturing

Engineering, Nicosia, Cyprus
Results
Simulations were performed for GAG concentrations
for sarcomas, melanomas, breast and colon
cancers and showed that the amount of GAG was
increased linearly from zero to 0.4 mg/g wet wt, in
a period of 8 days. Moreover, the concentration
of fixed charges c f, and the sum of free ions ck,
increase with time as the GAG content increases.
The resulting osmotic pressure is negative and
negligible compared with IFP (Fig. 1).
Introduction
The mechanical microenvironment of solid tumors
includes both fluid and solid stresses. These stresses
play a crucial role in cancer progression and
treatment and have been analyzed rigorously
both mathematically and experimentally. The
magnitude and spatial distribution of osmotic
pressures in tumors, however, cannot be measured
experimentally and to our knowledge there is no
mathematical model to calculate osmotic pressures
in the tumor interstitial space. In this study, we
extended a previous model [Stylianopoulos, 2013]
and we developed a triphasic biomechanical
model of tumor growth taking into account not only
the solid and fluid phase of a tumor, but also the
transport of ions, as well as the fixed charges at the
surface of the glycosaminoglycan (GAG) chains.
Our model suggests that for physiologically relevant
GAG concentrations for tumors, osmotic pressures
are relatively low and should not contribute to the
compression of intratumoral blood vessels.
Figure 1: Interstitial fluid pressure (a) and osmotic pressure

(b) in the tumor and surrounding normal tissue.
Methods
Tumor growth was modeled using the multiplicative
decomposition of the deformation gradient tensor
F [Rodriguez, 1994]. The tensor F is decomposed
to three independent motions: the growth of the
tumor, F g, the generation of residual stresses Fr, and
the elastic mechanical interactions F e. Therefore
[Sun, 1999],
F = Fe Fg Fr.
Discussion
According to our calculations the magnitude of
the osmotic pressure is considerably lower than the
magnitude of IFP. Therefore, our results suggest that
it is the solid stress that compresses intratumoral
blood vessels and the osmotic pressure should
have no effects on vessel compression.
(1)
References
Mattern et al, Biophys. J. 95, 648656, 2008.
Rodriguez et al, J. Biomech. 27, 455467, 1994.
Stylianopoulos et al, Cancer Res. 73,
38333841, 2013.
Sun et al, Int. J. Numer Methods Eng. 45,
13751402, 1999
The momentum balance equations for a triphasic

medium are:
div( s pI)=0,
(2)
k div(gradp) + divvs = Q + Ss + k [Fc cf div(grad) +

+ Fc gradcf grad R T ( 1) div(gradck)],
(3)
where is the solid stress, p is the interstitial fluid
pressure (IFP), k is the hydraulic conductivity of
the interstitial space, F c is Faradays constant,
is the electric potential, cf is the concentration
of the fixed ions, ck is the sum of the free anions
and cations within the tissue, and is the osmotic
coefficient. The ion transport equations for the
cations, and anions, are [Mattern, 2008]:
(wc)/t + gradc wv w div{wD [gradc
(Fc c grad / RT)]} = 0,
(4)
where D are the diffusion coefficients of the
cations and anions, respectively, and is the
electric potential.
352
O 314
Biomechanics of traumatic brain injury

M. Ratajczak1, R. Bdziski1
1
University of Zielona Gra, Faculty of Mechanical Engineering, Zielona Gra, Poland
Results
As the result of the conducted numerical analysis,
critical values of strain, stress, strain energy density,
in both local and global models have been
obtained. The following analysis showed high
diversity in the properties of the different regions
of the head.
Introduction
Traumatic brain injury (TBI) resulting from vehicular
collisions, contact sports, or battlefield operations
can have devastating consequences. Traumatic
head impact injuries occur when the human skull
and brain are rapidly subjected to intolerable levels
of energy. Computational simulations, especially
the finite element method (FEM) are essential in
understanding the mechanics of the head trauma
[1, 2]. In the present research work, FE models of
brain tissue fragments were designed and various
numerical studies were performed taking into
account the boundary conditions arising from
violent overloads due to combat operations.
Discussion
The head model was developed for analyzing and
characterizing the mechanical response of the
brain tissue under small and large deformation
under impact loading. In the numerical analysis,
the boundary values of the protective structures,
such as the skin, skull, and meninges, have been
exceeded. The described models explain the
mechanism of trauma dealt to the different layers
of the head and allow for the estimation of the
degree of tissue destruction under a given impact
load. The conducted numerical analysis, combined
with widespread experimental studies can be of
utmost significance in the assessment of stroke and
impact loading effects among soldiers taking part
in combat operations or in traffic accidents.
Methods
The finite element model used in this study was
developed of the previous model by Ratajczak M.
and Bdziski R. [2] using the LS-DYNA software.
The anatomically detailed human head model
developed from the DICOM images derived
from computed tomography (CT) with a very
highly thickened mesh sampling. Mechanical
properties of brain structures were obtained from
experimental studies [3, 4]. The selected fragments
of the FE model are shown in Fig. 1
References
[1] Kleiven, S.: Predictors for traumatic brain injuries
evaluated through accident reconstructions.
Stapp Car Crash Journal. 51, 81114, 2007.
[2] Ratajczak M., Bdziski R., An investigation of
brain structure deformations under impact loading, International Conference of the Polish Society
of Biomechanics BIOMECHANICS 2014, d,
Polska, pp. 183184, 2014.
[3] Xin J., Feng Z., Haojie M., Ming S., King H. Y.:
A comprehensive experimental study on material
properties of human brain tissue. Journal of
Biomechanics. 46(16,15), 27952801, 2013.
[4] Fallenstein G.T, Hulce V.D.: Dynamic mechanical
properties of human brain tissue. Journal of
Biomechanics. 2 (3), 217226. 1969.
Figure 1:The numerical head models: skull, brain with the

venous system, falx cerebri, tentorium cerebelli.
The boundary conditions were obtained from the

real combat conditions in Afghanistan and battle
range studies of explosive charge explosions of
various sizes detonated from under the hull of
vehicles. This model has been experimentally and
numerical validated on the basis of anthropometric
Hybrid III dummy.
353
O 3 15
VALIDATION OF A SHAPE-BASED VOLUME PREDICTION

METHOD IN THIGH MUSCLES
F. Mersmann1, S. Bohm1, A. Schroll1, H. Boeth2, G. Duda2, A. Arampatzis1
1
Humboldt-Universitt zu Berlin, Training and Movement Sciences, Berlin, Germany

2
Introduction
Magnetic resonance image (MRI) based wholemuscle reconstruction for muscle volume (V)
assessment is a time-consuming procedure. A
promising approach of volume prediction, using
only the muscle length (L), the maximal anatomical
cross-sectional area (ACSAmax) and a muscle
specific shape factor, was proposed by Albracht
et al. [2008] for the triceps surae. The present study
aims to validate the applicability of this method
on the quadrieceps femoris vastii (QFv) and
investigate the effect of sex and muscle growth on
the consistency of muscle shape.
no significant effect on muscle shape and was

also detected with the prediction method. The
between-method RMS differences of the pre-post
changes were in the order of 3 to 4%.
Methods
L, ACSAmax and muscle volume and were calculated
from MRI-based muscle reconstructions of the vastus
intermedius (VI), lateralis (VL) and medialis (VM)
of a population featuring a wide range of muscle
dimensions and physical activity (n=37), including both
sexes. The average shape factors (S) were calculated
as S = V/ACSAmax*L (1) and used to predict
muscle volumes (Vp) in a group of independent
adolescent athletes (n=18) before and after two
years of athletic training using only the measured
ACSAmax and L. Vp values were then compared to
the values from muscle reconstruction. A repeated
measures analysis of variance was applied as test
statistics with an alpha level of 0.05.
Figure 1: M
easured and predicted muscle volumes and
coefficients of detemination (R2) before (pre) and
after (post) two years in adolescent athletes and
coefficients of determination (R2) of the prediction
method for the vastii muscles (combined pre and
post values).
Discussion
Our results provide evidence that the muscle shape
of the investigated leg muscles is independent of
muscle dimensions and sex. Predicting the muscle
volumes using averaged shape factors is sensitive
enough to detect between-group differences
of 5 to 7% and even more subtle changes in
longitudinal designs. Thus, the proposed method is
applicable to investigate muscle volume changes
in the context of degeneration [Suetta, 2005],
atrophy [Alkner, 2004] or hypertrophy [Aagaard,
2001] and greatly reduces the time needed for
segmentation.
Results
Though there were significant differences in the
muscle dimensions between male and female
participants regarding the quadriceps femoris
vastii (QFv), S was similar across groups and in
average 0.582, 0.658, 0.543 for the VI, VL and VM,
respectively. The position of ACSAmax showed low
variability and was located at 57, 60 and 81% of
the thigh length for VI, VL and VM, respectively.
When S was applied to the adolescent athletes,
there were no significant differences between the
measured and predicted QFv volumes with root
mean square differences (RMS) of 5 to 6% and
a high determination of the volume prediction
(Fig.1). The moderate but significant muscle growth
(5 to 7% volume increase) over two years had
References
Aagaard et al, J Physiol (Lond), 534:613623, 2001.
Albracht et al, J Biomech, 41:22112218, 2008.
Alkner et al, Eur J Appl Physiol, 93:294305, 2004.
Suetta et al, J Appl Physiol, 107:11721180, 2005.
354
O 3 16
RESPIRATORY FLOWS DURING EARLY CHILDHOOD:

IN-SILICO AND IN-VITRO BIOMIMETIC MODELS OF
INHALATION THERAPY IN THE DEVELOPING AIRWAYS
J. Tenenbaum-Katan1, P. Hofemeier1, R. Fishler1, B. Rothen-Rutishauser2, J. Sznitman1
1
Technion Israel institute of technology, Biomedical engineering, Haifa, Israel

2
Universit de Fribourg, Adolphe Merkle Institute, Fribourg, Switzerland
Introduction
Inhalation therapy is the cornerstone of earlychildhood treatments of asthma, as well as a
potent strategy for systemic drug delivery and
vaccination [Kwok & Chan 2014]. A detailed
understanding of respiratory flow phenomena is
indispensable to characterize particle transport
in the deep regions of childrens lungs and a
necessary step for efficient targeting in inhalation
therapy. However, children are not miniaturized
adults whereas fundamental research is still
overwhelmingly focused on fully-developed
adult lungs [Kleinstreuer et al. 2008]. Dysanaptic
lung growth [Bisgaard et al, 2001] accompanied
with varying breathing patterns are anticipated to
influence deposition patterns of inhaled particles
in young and developing airways [SemmlerBehnke et al 2012]. Utilizing both in silico and in
vitro microfluidic approaches, we examine the
developing lungs and how the coupling between
morphological changes and ventilation patterns
affect aerosol transport and deposition during the
first years of life.
acinar tree. Such platform can be potentially

utilized to examine microscale outcomes at
the cellular level of varying deposition patterns
occurring with aerosol inhalation.
Discussion
Our coupled in silico-in vitro methods offer a fresh
approach to fundamental research on paediatric
respiratory flows and aerosol transport. These new
findings underscore the potential to contribute to
practical guidelines in inhalation therapy protocols
and their modification with age.
Methods
Based on cast measurements [Menache et al, 2008],
we have developed an anatomically-inspired model
of a multi-generational tree, representing pulmonary
acinar regions at several ages during a childs
development. Using numerical simulations, we have
examined respiratory flows and particle deposition
maps within our acinar model, accounting for
age-dependant ventilation patterns; in parallel,
biomimetic microfluidic designs of our model were
integrated with pulmonary epithelium (A549 cell
line) to recreate in-vivo environments and examine
particle deposition effects on surfactant-secreting
cellular linings.
Figure 1: ( a) Anatomically-inspired microfluidic design of

acinar airways at early childhood. Inset: confluent
epithelium (A549) across our multi-generational
design. (b) Surfactant secreting alveolar epithelial
cells (A549). (c) Intact monolayers of A549, including
confluent actin filaments and tight junctions.
Results
Numerical simulations of respiratory flows within
our acinar model suggest diversity of respiratory
patterns as the pulmonary tree gradually develops.
Accordingly, deposition maps of aerosols within the
deep airways alter with growth; our findings may
suggest that medication protocols of inhalation
therapy in young children should be reconsidered
in accordance with the childs development.
References
Bisgaard et al, CRC Press, 2001
Kleinstreuer et al, Annu. Rev. Biomed. Eng.,
10:195220, 2008.
Kwok and Chan, Adv. Drug. Deliv. Rev.,
73:838, 2014.
Menache et al, Inhal. Toxicol., 20:101126, 2008.
Semmler-Behnke et al, Prov. Natl. Acad. Sci. U.S.A.,
109:50927, 2012.
In parallel, our biomimetic devices recreate

biological aspects of acinar airways (Fig. 1a),
modelling several stages during early childhood,
including epithelial monolayers (Fig 1c) that secrete
surfactant (Fig 1b) across a multi-generational
355
O 3 17
FIRST STUDY ON ULTRASTRUCTURE ARRANGEMENT OF

HUMAN TRABECULAE USING 3D SCANNING SAXS
M. Georgiadis1, M. Guizar-Sicairos2, A.J. Trssel1, P. Hangartner1,
O. Bunk2, R. Mller1, P. Schneider3
1
2
3
ETH Zurich, Institute for Biomechanics, Zurich, Switzerland
Paul Scherrer Institut, Swiss Light Source, Villigen PSI, Switzerland
University of Southampton, Engineering and the Environment, Southampton, Switzerland
Introduction
It is recognized that the orientation of mineralized
collagen fibrils bones ultrastructural units plays a
major role in determining local mechanical properties
in bone [Granke 2013]. However, till now the 3D
ultrastructure arrangement in trabecular bone has only
been studied in micrometer scale volumes [Reznikov,
2015]. 3D scanning small-angle X-ray scattering (3D
sSAXS) enables derivation of the 3D orientation of bone
ultrastructure for whole trabeculae at micrometer
resolution [Georgiadis, 2015]. Here, we have derived
for the first time the ultrastructure arrangement for
various trabeculae of different subjects. We further
intend to study ultrastructure arrangement patterns
and differences related to trabecula type (plate-rod),
orientation and subject age.
orientation is organized in domains of tens of

micrometers in size. Higher DO regions are typically
closer to the surface and have low mineralization
levels.
Transition
zones
between
different
ultrastructure orientation domains are characterized
by low DO and higher mineralization levels. We
are currently analyzing patterns of ultrastructure
arrangement as well as differences for trabeculae
of different type, orientation and age. Furthermore,
we have integrated the orientation and DO results
into finite element models (FEM) and intend to
examine the effects of the arrangement of bone
ultrastructure on bone mechanics (Fig. 1D-F).
Methods
Sample preparation and 3D sSAXS experiments were
conducted according to [Georgiadis, 2015]. In brief,
4 trabecular bone specimens were extracted from
human vertebral bodies, imaged with CT at 12.4m
voxel size and embedded into PMMA. For each of
them, consecutive 20 m-thick sections were cut
and in total 74 sections containing 21 trabeculae
were chosen for further analysis (Table 1). Sections
were raster-scanned using sSAXS for different rotation
angles with a 20 m X-ray beam spot and step size,
and the 3D ultrastructure orientation was derived
for every 202020-m3-volume of the bone tissue.
Next, the sections were registered to the CT-derived
trabecular structure [Trssel, 2012] so that the
21 trabeculae assessed by 3D sSAXS could be
mapped on the CT scans and their 3D ultrastructural
arrangement could be reconstructed and analyzed.
Specimen
Subject
gender
Subject age
50
27
52
77
Vertebra
T12
T12
T10/11*
T10/11*
BV/TV (%)
12.8
21.8
10.3
4.8
Sections
44
10
10
10
Trabeculae
11
Figure 1: A
-C) Trabecular network from specimen 1 (A) in
which 5 trabeculae which were scanned with 3D
sSAXS are identified (A-B) and their 3D orientation
maps derived (C). D-F) Ultrastructure arrangement
(F) is mapped on trabecular structure (D) to
provide FEM with ultrastructure arrangement
information (E)
Discussion
Using 3D sSAXS, we analyzed and compared for
the first time the 3D ultrastructure arrangement
for 21 trabeculae of different type, orientation
and subject age. Observations have enabled
identifying preliminary patterns; however, we
are further investigating correlations of the
ultrastructure arrangement with the microstructure,
and differences between trabeculae of different
type, orientation and age. Finally, integration of
ultrastructure arrangement in FEM can help to
examine the effects on bone mechanics.
Table 1: Trabecular bone specimens. BV/TV: bone volume

fraction, *: exact thoracic number unknown
Results
The 3D ultrastructure orientation and degree of
orientation (DO) could be successfully derived
for all 74 sections and the information could be
mapped to the examined trabeculae (Fig. 1A-C).
For all trabeculae, we observe that ultrastructure
References
Georgiadis et al., Bone, 71:4252, 2015.
Granke et al., Plos One, 8:e58043, 2013.
Reznikov et al., Bone, 71:189195, 2015.
Trssel et al., J Biomech, 45:S108, 2012.
356
O 318
DIFFERENTIAL PROLIFERATIVE RESPONSES OF HUMAN

CARDIAC FIBROBLASTS TO CYCLIC STRAIN
IN A MICRODEVICE
G.S. Ugolini1, M. Rasponi1, A. Pavesi2, R. Kamm3 , G.B. Fiore1, M. Pesce4 , M. Soncini1
1
2
Politecnico di Milano, Dept. of Electronics Information and Bioengineering, Milan, Italy
Singapore-MIT Alliance for Research and Technology, Singapore-MIT Alliance for Research
and Technology, Singapore, Singapore
3
Massachusetts Institute of Tehcnology, Dept. of Biological Engineering, Cambridge, USA

4
Centro Cardiologico Monzino, Laboratorio di Ingegneria Tissutale Cardiovascolare,

Milan, Italy
Introduction
Cyclic mechanical strain is one of the most relevant
biomechanical stimuli in the human heart. Several
studies have been carried out to elucidate the
effects of cyclic strain on cardiac cells behavior
and the modulation of proliferation seems a
controversial point with studies showing both
up- and down-regulated proliferation under
different strain intensities and for different cell
types [Shyu, 2009]. In this study we developed
a microdevice, inspired to the lung-on-a-chip
[Huh, et al., 2010], that applies controlled uniaxial
cyclic strain. We extracted human primary cardiac
fibroblasts from human tissues and evaluated
progression through the cell cycle, morphological
changes and mechano-transduction responses
to different intensities of strain (2% and 8%).
8% cyclic strain. Cells were then fixed and stained

for Phalloidin (actin fibers, morphology), Ki67
(entire cell-cycle), Phospho-Histone-H3 (mitotic
phase) and YAP (mechano-sensing dependent
transcription factor).
Results
Methods
Device design and fabrication: The devices are
made of polydimethylsiloxane (PDMS) and are the
assembly of a thin deformable membrane included
between two fluidic layers fabricated through
standard microfabrication techniques. The design
of the layers features two side chambers that, upon
application of controlled negative pressure, stretch
the central thin membrane. We included four
separate chambers per device in order to increase
the throughput. Devices were characterized by
tracking displacements of graphite dots on the
culture membrane with Digital Image Correlation
algorithms applied to images taken at different
negative pressures.
Figure 2: R
epresentative images of cell orientation (first row),
PHH3 (second row) and YAP (third row) stainings
after 72h. Bar graphs (bottom) show fraction of
cells positive to PHH3 (cell mitosis), Ki67 (whole
cell cycle), YAP (mechano-sensing protein) and
fraction of cells with nuclei aligned on the horizontal (015). In all bar graphs: grey=control,
orange=2% strain, red=8% strain.
Discussion
We report a morphological response of cell
alignment on the direction orthogonal to the strain
field only after 72h of 8% strain (Fig.2).
We found an evident up-regulation of the mitotic
marker PHH3 in cells strained for 24 h and 72 h at
2 %, whereas 8 % strained cells experienced the
same up-regulation however only for 24 h. No
significant change was found in Ki67 expression
(Fig. 2). We propose 2% strain as a proliferative
Figure 1: A
fabricated device (A), strain-to-pressure dependency (B) and strain field maps on xx and yy directions (C). Strain field results linear with the negative
pressure applied, and highly uniform and uniaxial
on the culture membrane.
Cell Culture: primary human cardiac fibroblasts

were extracted according to a standard method
[Neuss, et al., 1996], seeded on fibronectin-coated
devices, and exposed to 24 h or 72 h of 2 % and
see the next page
357
By applying uniaxial cyclic strain to human cardiac
fibroblasts, we found differential proliferative,
morphological
and
mechano-transduction
responses according to strain intensity and time.
biomechanical stimulus and 8 % strain as a timedependent stimulus that is first (24h) characterized
by a proliferative response and later (72h) sensed
as cellular stress inducing cell alignment and
control-like mitotic levels. We also report that YAP
translocates into the nuclei of cyclically strained
cells (Fig. 2), confirming its involvement into
mechano-sensing pathways.
Shyu, Clinical Science, 116(5):37789, 2009.

Huh, et al, Science, 328:16628, 2010.
Neuss, et al., Cell Tissue Res, 286:14553, 1996.
358
P 0 01
CELL MEMBRANE STIFFNESS AND ADHESION MEASURED

BY INSTRUMENTED NANOINDENTATION
J. Lukes1, J. Sepitka2
1
Czech Technical University in Prague, Hysitron Nanomechanical Applications Lab,

Czech Technical University in Prague, Mechanics Biomechanics and Mechatronics,

Introduction
Cell adhesion on different substrates as well as
mechanical properties of cell membrane itself
is one of the main topics in tissue engineering.
Fluorescence microscope option for state of the
art nanomechanical test instruments enables clear
visualization of Green Fluorescent Protein (GFP)
transfected cells kept in a nutrient medium solution.
However, identification of initial contact between
an indenter probe and a very soft cell membrane
can be very challenging. Contact forces are very
low even compared to PBS meniscus forces and
membrane adhesive forces acting on the probe.
It has been recently shown that monitoring phase
shift during oscillatory approach clearly identifies
the contact point [Sepitka, 2014].
positioning of indenter probe. The compression

test was performed by force controlled nanoDMA
indentation starting out of contact.
Results
Since we were able to determine both the
beginning and the end of the cell compression
test via phase shift signal, total deformation was
calculated to be approximately ~1800 nm in
average. Maximum force measured either at
bursting point of a cell or total displacement varied
from ~5N to ~10N only. Bursting of a cell can
be traced by a force drop in load/displacement
data. Average measured stiffness of cell membrane
was ~5nN/nm.
Methods
A Hysitron TI 950 TriboIndenter nanomechanical
test instrument was used to perform compression
tests and scratch tests on a single cell with a
diamond fluid cell 100 m flat end 90 conical
probe. Cells were treated in a nutrient medium to
maintain natural testing conditions. The transducer
dynamic characteristics were calibrated for
the whole displacement range while in contact
with the PBS solution. Single cells were identified
using an integrated fluorescence microscope.
TriboIndenters microscope also enabled precise
Discussion
Infection and disease frequently result in
variations in the mechanical properties of living
cells. Quantitative nanomechanical tests of cell
membrane stiffness can help identify if and how a
single cell was affected.
References
Sepitka et al. Comput Method Biomec, 2014.
This research was supported by Grant Agency
of the Czech Technical University in Prague,
grant No. SGS13/176/OHK2/3T/12.
359
P 002
OSMOTIC STRESS IS A MAJOR CONTRIBUTOR

TO THE FUNCTION OF COLLAGEN FIBRIL
O. Andriotis1, S. Desissaire1, P. Thurner1,2
1
Vienna University of Technology Institute of Materials Science and Technology,

Institute of Lightweight Design and Structural Biomechanics, Vienna, Austria
University of Southampton, Bioengineering Science Research Group, Southampton,

United Kingdom
Introduction
Collagen is the major structural and mechanical
constituent in the human body. In biological tissues,
collagen fibrils co-exist with the highly negatively
charged proteoglycans, located in their vicinity.
The high negative charge creates osmotic stress
on collagen fibrils by retracting intermolecular ions
from collagen. This results in change of collagen
fibril hydration and consequently also mechanical
function. In this study we investigate the effect of
osmotic stress on fibril diameter and transverse
indentation modulus via direct measurements
using atomic force microscopy (AFM).
In addition, the indentation modulus increased

about 6-fold in the presence of PEG (in PBS:
EPBS=19.1 4.7 MPa and in PEG: EPEG=115.6 58.2 MPa).
Discussion
The results clearly show that osmotic stress serves as
an important determinant of collagen fibril stiffness,
via steering of effective fibril hydration. Hence, the
reduction in fibril diameter can be explained by
the osmotic stress exerted from PEG as a result of
the concentration gradient of ions between the
intra- and extrafibrillar space. While the influence
on the diameter is reasonably limited (10% change)
the increase of the elastic modulus due to the
presence of PEG is large as the fibrils increase their
stiffness by an order of magnitude. Importantly, this
study shows that osmotic stress influences collagen
fibril stiffness to a large extent. Therefore it seems
important to control this parameter for mechanical
tests and adjust osmotic stress to levels experienced
in the body to obtain meaningful results and derive
mechanical properties of biological tissues.
Methods
Collagen fibrils were obtained from a mouse tail
tendon of unknown age. As presented previously,
collagen fibrils where deposited on poly l-lysine
coated microscope glass slides (Thermo Scientific),
washed with distilled water and air dried in room
temperature (~22 C) (1). AFM imaging was
performed in contact mode in air and Quantitative
Imaging mode (QI mode, JPK Instruments) in
phosphate buffered saline (PBS) solution and
polyethylene glycol (PEG, Sigma Aldrich, molecular
weight 200 kDa) diluted in PBS on a NanoWizard
ULTRA Speed A AFM instrument (JPK Instruments,
AG, Berlin, Germany) with a commercial
rectangular AFM cantilever (PNP-DB of ~0.48 N/m
spring constant and ~10 nm tip radius). To avoid
artefacts related to the envelope effect, the fibril
height was measured for diameter estimations from
the height retrace topography AFM images. Three
collagen fibrils were imaged in air (dried state but
bound water is present) and then in PBS pH7.3.
Finally, the collagen fibrils were imaged in 70%
PEG (or 13M PEG). Quantitative Imaging generates
force-displacement curves which were analysed
by a simple Hertzian model, (2), with a quadratic
contact area (approaching the 4-sided pyramidal
tip of the PNP-DB cantilevers).
Results
The fibril diameter increased by 1.43 times (1.43 0.07)
when the collagen fibrils were imaged in PBS
(fully hydrated state) from the air-dried state.
Subsequently, the fibril diameter was decreased by
an average of 0.9 times (0.90 0.01) when collagen
fibrils were imaged in 70% PEG from the fully
hydrated state (PBS). Panel A of figure 1 shows the
AFM height retrace images of the three collagen
fibrils imaged in air (blue), PBS (red) and 70%
PEG (green). Panel B shows box plots of the fibril
diameter of each collagen fibril imaged under the
three different conditions (air, PBS and 70% PEG).
Figure 1: P
anel A shows atomic force microscope height
images of 2.5 m x 2.5 m scan region of three
collagen fibrils imaged in Air (blue), PBS (red) and
70% PEG (green). Panel B shows box plots of the
fibril diameter, for each collagen fibril, in Air (blue),
PBS (red) and 70% PEG (green).
References
1 Andriotis, O.G. et al, J Mech Behav Biomed Mater
39: 926, 2014.
2 Grant, C.A. et al, Appl Phys Lett 92: 233902, 2008.
360
P 003
ANTAGONIZING MIDKINE INCREASED THE

MECHANOTRANSDUCTION IN OSTEOGENIC CELLS
M. Haffner-Luntzer1, T. Schinke2, M. Amling2, A. Ignatius1, A. Liedert1
1
University Medical Center Ulm, Institute for Orthopaedic Research and Biomechanics,
Ulm, Germany
University Medical Center Hamburg-Eppendorf, Institute of Osteology and Biomechanics,

Hamburg, Germany
Introduction
Experimental studies showed a regulatory function
of the growth- and differentiation factor Midkine
(Mdk) during bone remodeling [1, 2]. It was shown
that Mdk-deficiency increased the mechanically
induced bone formation in mice. In vitro
experiments demonstrated that recombinant Mdk
inhibited the mechanotransduction in ostegenic
cells. Therefore, the aim of this study was to
evaluate possible positive effects of antagonizing
Mdk on the mechanotransduction in osteogenic
cells. Additionally, proteins interacting with Mdk
during this process and possible signaling pathways
should be identified to clarify the exact role of Mdk
during mechanoregulation of the bone.
Results
The immunoprecipitation experiments showed that
Mdk interacted with the cell membrane receptor
LRP-6 in osteogenic cells. Recombinant Mdk
decreased the gene and protein expression of
cFos in mechanically stimulated cells. Additionally,
phosphorylation of LRP-6 was decreased as well as
activation of beta-catenin. Addition of the MdkAb was able to attenuate those negative effects
of Mdk on the mechanotransduction of the cells.
Discussion
It has been shown previously that LRP-6 plays an
important role in activation of the beta-catenin
signaling pathway [3] and that this pathway
is essential for the mechanotransduction in
osteoblasts [4]. Our results suggest that Mdk binds
to LRP-6 on the cell membrane of osteogenic cells,
decreasing the phosphorylation and therefore
activation of LRP-6 which affects beta-catenin
signaling and therefore mechanotransduction.
Antagonizing Mdk with a Mdk-Ab was able
to block the negative effects of Mdk on the
mechanotransduction. Therefore antagonizing
Mdk could be a promising new therapeutic
approach to treat patients with dysfunction of the
mechanoregulation in the bone.
Methods
Preosteogenic MC3T3-E1 cells were differentiated
in osteogenic medium for 14 days and stimulated
mechanically with 2% cyclic stretching (1 Hz, 30 min).
Parts of the cells were treated with recombinant
Mdk with or without an antagonizing Mdk-antibody
(Mdk-Ab) during stimulation. Afterwards, the gene
and protein expression of the mechanoresponsive
protein cFos were detected by qPCR and western
blotting. Additionally, the protein expression
and phosphorylation status of beta-catenin and
LRP-6 was measured. To detect Mdk interaction
partners, immunoprecipitation experiments were
conducted after stimulation of MC3T3-E1 cells with
recombinant Mdk for 1 h.
References
[1] Neunaber et al., JBMR (2010)
[2] Liedert et al., Bone (2011)
[3] Niehrs et al., Cell Mol Life Sci (2010)
[4] Tu et al., Bone (2012)
361
P 004
GAIT FEATURES IN THE TRASTIBIAL AMPUTEES WEARING

ADAPTIVE ANKLE FEET AND ENERGY STORING AND
RETURNING FOOT DURING LEVEL WALKING
C.Y. Ko1, J. Park1, S.B. Kim1, J.K. Kim1, Y. Chang1, J. Ryu1, S. Kim1, M. Mun1
1
KOREC, research team, Incheon, Korea. Republic of Korea
Introduction
To overcome lack of dorsiflexion and plantarflexion
of conventional prosthetic feet, several adaptive
ankle feet (AAFs) with different ankle mechanisms,
a microprocessor-controlled motor (Proprio-Foot
TM, ssur, IcEland) 1,2, a powerful microprocessorcontrolled hydraulic actuator (lan) and passive
hydraulic control (Echelon) by Endolite (USA). There
was few comparison of the kinematics and kinetics
of lower limb among AAFS and energy storing
and returning foot (ESRF) during level walking. The
aim of this study is to evaluate the biomechanical
features of AAFs and ESRF during level walking.
the knee and hip. Lower dorsiflexion moment in the

ankle and extension moment in the knee were shown
in AAFs than ESRF. Additionally, higher extension
moment the knee in was shown in Proprio Foot than
lan, and Echelon. In prosthetic limb, less dorsiflexion
in the ankle and flexion in the knee and hip were
shown in AAFs than ESRF. Lower dorsiflexion moment in
the ankle and only extension moment at late stance
phage were shown in AAFs. Additionally, higher
dorsiflexion in the ankle was shown in Proprio Foot
than lan, and Echelon. These results indicated that
AAFs affected the kinematics and kinetics in sound
limb as well as prosthetic limb. Moreover, there were
similar effects between hydraulic control systems.
Three health male transtibial amputees were
participated in this study. They wore ESRF,
Proprio-Foot, lan, and Echelon and walked the
level ground. The kinematics and kinetics were
evaluated by using 3D motion analysis system
(Motion Analysis, Motion Analysis Cor., USA) and
force plates (Kistler Corp., USA).
C o n cl u s i o n
This study is to evaluate and compare the
biomechanical features of AAFs and ESRF during
level walking. AAFs affected kinematics and
kinetics in sound limb as well as prosthetic limb.
Furthermore, there were differences between
hydraulic and motor control systems.

In sound limb, less dorsiflexion and more
plantarflexion in the ankle in AAFs were shown
than those in ESRF and no changes in angle of
References
1 Alimusaj et al., Gait & Posture, 30; 356363, 2009
2 Fradet et al., Gait & Posture, 32; 191198, 2010
362
P 005
STRENGTH TRAINING EFFECT WITH AND WITHOUT LOAD

AND LACTATE LEVELS ON BICEPS AND TRICEPS MUSCLES
L. Yi1, G. Santos1, M. Curtolo1, P. Azevedo1, A.P. Ribeiro2
1
2
Federal University of So Paulo, Human Movement, Santos, Brazil
University of Santo Amaro School of Medicine, Physical Therapy, So Paulo, Brazil
Introduction
Acute phase injuries or post-surgical need to
get good muscle activation for potential gain
strength, in order to restored functional activities.
However, to start the rehabilitation process, should
be cautious in the progression of load intensity
imposed on muscle strength, mainly to prevent
injuries and worsening of pain symptoms. It is not
yet clear in the literature the effect of muscle
strength training, without external load to maintain
or gain strength in the early stages of injuries on
upper limbs. Currently, this evidence also is not
yet clear in individuals without injury. Thus, the
objective of this study was to analyze the effect of
strength training with and without external load on
the dynamic muscle activation of the biceps and
triceps.
the groups (inter-groups), only after the intervention,

there was no difference (Table 2). Thus, it can be
argued that at an early rehabilitation, strength
training biceps and triceps muscles without load
can maintain the existing strength, not requiring,
the short term, to impose external load intensity
that leads to worsening of pain.
Twenty four young males adults without injuries
were recruited and divided into two groups:
load group (LG) (21.12.3 years; 24.91.8 BMI)
and without load group (WLG) (20.22,00 years;
24.61.4 BMI). Both groups underwent muscle
strength training for 8 weeks consecutive during 40
minutes, twice a week (Figure 1). At baseline and
after intervention, were measured the maximum
isometric muscle strength, of biceps and triceps,
using handheld dynamometry and blood lactate.
For LG, the load during training was standardized to
40% of the 1 maximum repetition of muscle strength
until concentric failure or postural compensations.
Were established two sets of training and full cycle
of movement was of 4 seconds.
The muscle strength and blood lactate showed
increased, with significant differences in comparing
intra-groups (LG and WLG) between baseline and
after intervention for biceps and triceps muscles
of both side (Table 1). However, when comparing
the muscle strength of these muscles between
C o n cl u s i o n
The strength training without external load
promotes dynamic muscle activation increase,
similar to training with external load imposed.
see the next page
363
364
P 006
THE VERSATILE INTELLIGENT PORTABLE ROBOT

PLATFORM FOR THE SIMULATION AND TESTING
OF THE PROSTHESES HIP IMPLANTS
L. Vladareanu1, L. Capitanu2
1
Institute of Solid Mechanics of the Romanian Academy, Robotics and Mechatronics

Department, Bucharest, Romania
2
Institute of Solid Mechanics of the Romanian Academy, Tribology Department,

Bucharest, Romania
Introduction
The simulation and testing of the prostheses hip
implants, vary in their level of sophistication,
playing important role in preclinical validation of
biomaterials used for orthopedic implants. The
goals of the simulations are necessary to perform
wear tests on biomaterials, prior the implantation
in the human body, in order to acquire further
knowledge as to the tribological processes that
involve joint prostheses [1, 2]. The paper presents
a versatile, intelligent and portable platform
VIPRO for prosthetic hip implants by an original
virtual projection method known as VladareanuMunteanu method, which involves implementation
of the total knee prosthesis simulator (TKP) in a
3D virtual environment using a strong prosthesis
simulator, an open architecture system and
adaptive networks over the classical control
system, and developing of the intelligent control
interfaces through advanced control technologies
adapted to the prosthesis hip implant environment,
such as Extenics and Neutrosophic control, human
adaptive mechatronic [35].
Figure 1: T he TKP simulator using VIPRO Platform
RESU L TS AND C ON C L USIONS

The novelty VIPRo platform will be able to be sold
in competition with other similar virtual simulation
platforms, called virtual instrumentation: CDA, CAM,
CAE, Solid Works, very reliable platforms in powerful
modeling but only in a virtual environment, or MatLab,
Simulink, Lab View simulation platforms allow extensions
for real time data acquisition and signal processing,
and none of which allow the design, testing and experiment of intelligent control methods on a real TKP control system. The VIPRO platform used to the simulation
and testing of the prosthetic hip implants is expected
to be applied in developing human aid mechatronics
in various fields such as rehabilitation support and physical training support in medical field, ADL support for
disabled people, rescue support at disaster sites.
The
VIPRO
dynamic
versatile
intelligent
portable robot platform is developed through
a multi-disciplinary concept using the 3D virtual
representation with high graphic processing power
and advanced programming languages through
the mechanical structure modeling, an open
architecture system keeping the TKP classic control
system and of the intelligent control interfaces
(fuzzy control, multi-agent control, dynamics
and adaptive control, robust and iterative
learning control, etc.) implemented through IT&C
techniques on fast and high data processing.
References
[1] Vladareanu L., Capitanu L., Hybrid Force-Position
Systems with Vibration Control for Improvment of
Hip Implant Stability J. of Biomechanics, vol. 45,
Elsevier, 2012, ISSN 00219290
[2] Taylor, S., Walker, P., Forces and moments telemetered from two distal femoral replacements
during various activities, Journal of Biomechanics,
34, pp. 839848, 2001.
[3] V
ladareanu Victor, G. Tont, L. Vladareanu, F.
Smarandache, The navigation of mobile robots in
non-stationary and non-structured environments,
Int. J. Adv. Mechatronic Systems, IJAMechS, Vol. 5,
No. 4, 2013, pg.232243, ISSN 1756-8412.
[4] Smarandache F., Vladareanu L., Applications
of Neutrosophic Logic to Robotics, The Int. Conf.
on Granular Computing Kaohsiung, 2011, pg.
607612, ISBN 978-1-4577-0370-6, CFP11GRC-PRT
[5] Vladareanu V., Schiopu P., Vladareanu L., Theory
and Application of Extension Hybrid Force-Position
Control in Robotics, U.P.B. Sci. Bull., Series A,
Vol. 76, Iss.3,, pg. 4354, ISSN 1223-702, 2014.
The improvement of the VIPRO platform

performances is developed through optimization
of certain intelligent control methods: Robot
Neutrosophic Control (RNC) known as VladareanuSmarandache method [4], Human Adaptive
Mechatronics method that able adapt themselves
to the humans skill in various environments [5],
Petri Net and Markov Chains Approach (PNMCA)
for motion dynamic control in a more efficient
concurrency control [3]. The VIPRO real time
control system with Open Architecture (OAH)
ensures flexibility, short time execution with
precision targeting and repeatability of the motion
and developments to increase the performances.
365
P 0 07
BIOMECHANICAL ANALYSIS OF THUMB MOVEMENTS

WITH TWO SMARTPHONE HOLDING TECHNIQUES
W.S. Chae1, J.H. Jung1, D.S. Kim1, H.S. Lee1
1
Kyungpook National University, Physical Education, Daegu, Korea, Republic of Korea
Introduction
A smartphone has became popular and it
makes users lives more convenient. However, the
excessive use of scroll wheel and frequent textmessaging associated with the smartphone can
cause extreme stress with wrist and fingers. Berolo
et al.(2011) reported that smartphone users spend
time for texting, E-mailing, internet search an
average of about 3.5 hours, to be the cause of
pain in the thumb for long hours. Until now, very
few scientific studies have been conducted to
investigate the biomechanical effects of holding
smartphone.
electrodes
with
on-site
preamplification
circuitry(Delsys Trigno Wireless System, Delsys Inc.)
were attached to the extensor digitorum(ED),
first dorsal interosseous(FDI), abductor pollicis
longus(APL), and abductor pollicis brevis(APB).
Each subject was instructed on how to tap the
smartphone screen with one hand(OH) and two
hands(TH: putting one hand over another). Both
kinematic and EMG data were collected while
the participants was asked to follow the computer
on-screen direction to tap random numbers for
10 mins. For each dependent variable, paired
t-test was used to determine whether there were
significant differencesbetween OH and TH(p<.05).
The purpose of this study was to determine whether

there are significant differences in kinematic
variables and muscle activities of the thumb
between two smartphone holding techniques.
Results
This study found that flexion angle of the IP joint and
all angles except adduction of the MCP joint in TH
were slightly greater than corresponding values of
the TH(Table1). However, flexion, adduction, and in/
external rotation angles in OH were slightly smaller
than those values found in TH. The resultsalso showed
that an increase in the angular velocity of all joints
in TH when compared to OH(Table 2). The statistical
analysis revealed that the main effect of the smartphone holding conditions was significant in the peak
normalized muscular activities of FDI and APL(Table3).
Methods
Twelve university students(25.43.9 yrs.,176.25.1 cm,
75.811.4 kg) were recruited as the subjects.
Kinematic data were acquired by using two
high speed cameras(Motion Master100, Visol
Inc., 200 frames/s). The landmarks of interest
were the right carpometacarpaljoint(CMC),
metacarpophalangeal joint(MCP), interphalangeal
joint(IP), and tip of the thumb(TT). Four surface
IP
MCP
CMC
OH
TH
OH
TH
OH
TH
Flex
69.0(18.0)
72.9(18.2)
45.4 (9.6)
47.7 (20.0)
3.4 (2.1)
2.5(2.0)
Ext
4.3 (1.8)
5.8 (1.9)
29.4 (6.6)
30.4(8.0)
Abd
15.8 (1.0)
15.5 (1.3)
10.3 (3.6)
7.1(4.4)
Add
14.2 (8.4)
20.8(13.2)
48.7 (14.2)
51.3(16.5)
Int
17.8 (9.0)
24.2 (7.3)
4.7 (3.3)
3.4(3.0)
Ext
16.8 (8.2)
24.8(7.0)
42.1 (19.8)
40.4(16.1)
Table 1: Maximum joint angle of the thumb(deg).
Average
OH
Maximum
TH
OH
TH
IP
Flex/Ext
58.4(16.3)
60.1(13.4)
148.9(55.1)
158.6(38.3)
MCP
Flex/Ext
36.5(9.7)
37.3(11.4)
88.7(30.4)
96.2(29.5)
Abd/Add
31.9(10.5)
35.7(4.9)
88.8(30.7)
93.8(11.8)
Int/Ext
46.6(19.3)
49.6(11.9)
117.8(49.4)
123.6(32.8)
CMC
Flex/Ext
27.3(10.5)
28.5(11.9)
63.8(29.4)
Abd/Add
18.5(5.7)
19.5(5.7)
46.6(15.5)
53.5(16.1)
Int/Ext
38.1(14.6)
40.4(15.6)
92.6(37.4)
103.5(37.5)
Table 2: Angular velocity of the thumb(?/s).
69.8(29.6)
see the next page
366
ED
FDI
APB
APL
5.4(2.0)
Avg.
OH
3.0(1.5)
4.4(2.1)
8.0(3.8)
TH
3.2(1.5)
3.9(1.8)
11.3(5.7)
4.1(2.7)
Peak
OH
8.6(3.4)
17.3(9.5)*
48.3(22.7)
TH
9.9(3.7)
12.9(4.5)*
48.8(26.9)
21.6(10.8)*
33.9(15.0)*
Table 3: Average and peak normalized EMG(%MVIC).
Discussion
Although smartphone holding technique doesnt
affect on mobility and movement of the thumb
significantly, it may affect on active degree of
the thumb and the upper extremity in directly and
indirectly. Gustafsson et al.(2010) reported that
the posture of participant affects the movement
of the thumb when text messaging, and support
of forearm increases the joint angle and angular
velocity of the wrist and fingers. This study found
that a consistent increase in the angular velocity
of each joint as the peak normalized muscular

activities of FDI and APL decreased was observed
for TH when compared to OH. This result indicated
that using both hands is more effective and stable
when tapping numbers on the smartphone.
References
B
eroloet al., Appl Ergon, 42(2):371387, 2011.
G
ustafssonet al., J Electromyogr Kinesiol,
20(1):127135, 2010.
367
P 008
FREQUENCY LIMITATION OF THE SPINE ACTIVE

DAMPENING EFFECT
J. Reznickova1, K. Rasova1, J. Zeman2, B. Chalupa2
1
2
Charles University, Third faculty of medicine, Praha, Czech Republic
Czech University of Life Science, Faculty of Engineering, Praha, Czech Republic
Introduction
Several neuromuscular chains exist that can stabilize
parts of the body. The fastest of them is the purely
reflexive spinal (chordal?) loop. Considering that
possible reaction time depends also on the nerves
length from the tactile sensor to the spine and from the
spine to the motoric muscle unit, it can be envisaged
that fastest active neuromuscular damping will
be found at the damping of spine vibrations.
end of the spine than at the other. The damping

had been determined for the resonance frequency
35 Hz of the Th5Th11 section. As the signal
changes gradually from the lowest frequencies
to the highest ones and then back with a threeminute period, and this cycle repeats three times,
the runs for increasing and decreasing frequencies
are plotted separately in the chart.
Methods
TVS (Transfer Vibration through Spine) method
was used for meaurement, where a vibrator
with sweeping frequency 5170 Hz is applied
to a vertebra, most frequently C7 or L5, and the
transferred acceleration is sensed on spinal thorns
C7 to S1. Measurements were carried out on five
healthy people 2328 years of age, in horizontal
position, in most relaxed state.
Discussion
In the right half of the chart, at the 70170 Hz
frequencies, we can see damping growth caused
purely physically by material viscosity. In this region,
no active damping caused by neuromuscular
chain asserts any more, as its reaction time is
longer than the vibration period. In the left part
of the chart, in the up to 50 Hz range, on the
other hand, the neuromuscular chain is still has
an effect on the damping that rises in the lower
frequencies direction. The lowest spine damping
can be observed in the range about 35 Hz, where
the neuromuscular chain practically cant follow
already and the material damping is still low.
Results
Averaged damping results of the spine as a whole
can be seen in Fig. 1. The data with the c index
denote how many times the signal is weaker at one
368
P 009
FORCE SHARING FOR DIFFERENT GRASP TYPES WHEN

TRANSPORTING A CYLINDER
A. Prez-Gonzlez1, J. Cepri1, F.J. Andres1, J.L. Sancho-Bru1
1
Universitat Jaume I, Ingeniera Mecnica y Construccin, Castellon de la Plana, Spain
Introduction
When grasping an object, humans adapt the hand
posture to the object and the task, using different
grasp types [Ansuini, 2008]. Depending on the grasp
type and the task, the force is shared differently
among the hand areas to provide stability and
dynamical equilibrium. The study of force sharing
when grasping is interesting in fields as prosthetics
design and robotic grasping.
This work focuses on comparing force sharing
during transport of a cylindrical object for grasp
types involving different number of digits and
hand areas: 2 digits grasp (2D), 3 digits grasp (3D),
5 digits grasp (5D) and cylindrical grasp (C).
Figure 1: E
xamples of pressure maps: 5D (left) and C (right)
grasps.
Methods
A rigid cylinder (diameter 50 mm, height 210 mm,
weight 1117 g) was wrapped with a thin square
pressure sensor (dimension 167x167 mm, Tekscan
Inc, model 3200). The sensor was calibrated and
equilibrated using the recommendations of the
manufacturer. A subject (hand length 180 mm
from wrist crease to the tip of third digit), seated
at a table, was instructed to reach and grasp this
cylinder from the table and transport it to a new
position 15 mm further in distal direction, using
each of four different grasp types (2D, 3D, 5D, C).
Three repetitions of the task were done for each
grasp type after three non-registered training
trials. Pressure maps registered by the sensor
where interpolated and segmented in Matlab,
and force sharing was computed for the instant
of maximum grip force for each grasp type and
repetition. Averaged results for each grasp type
were obtained.
Results
Figure 1
pressure
Figure 2
different
Figure 2: M
ean (SD) force share for each grasp type
(D-distal, MP-medial & proximal).
Discussion
2D, 3D and 5D grasps can be considered precision
grasps, as only the fingertips are used. Grasps with
more than two digits (3D, 5D) show a progressive
decrease in force sharing from index to little finger.
C grasp seems to be less repeatable than precision
grasps. Additionally, the index has a smaller
contribution to the grip force than the other fingers
in C grasp, the force on the thenar eminence of the
palm being opposed to the middle, ring and little
finger forces. This result differs from that obtained by
[Pataky, 2012] for a 60 mm diameter cylinder during
a lifting task. Although the ring and little fingers are
of less significance in precision grasp, our results
suggest that they have a major role for C grasp.
shows two representative examples of

maps for 5D (left) and C (right) grasps.
shows the mean force sharing for the
grasp types (SD shown in error bars).
A good repeatability is observed among

repetitions, especially in 2D, 3D and 5D grasps.
Only distal phalanges are involved in 2D, 3D, 5D.
The thenar eminence of the palm and medial and
non-distal phalanges of the thumb and index are
also recruited in C grasp.
References
Ansuini et al, Exp Brain Res, 185:111119, 2008. Pataky et al, J Biomech, 45:218224, 2012.
369
P 010
RELATION BETWEEN CRUTCH LOADING AND UPPER

LIMBS MUSCLES ACTIVITY OF IN SWING-THROUGH GAIT
A. Rzepnicka1, L. Dworak2, M. Murawa1, J. Kabacinski1
1
Poznan University of Physical Education, Biomechanics, Poznan, Poland

2
University of Arts, Bionics, Poznan, Poland
Introduction
Swing through gait is the most common and is
said to be the fastest of all crutch gait patterns.
Notwithstanding it demands shoulder girdle
muscles strength and endurance together with
good sense of balance [Shoup, 1974]. The aim of
the study was to check if both crutches are loaded
symmetrically and how muscle activation pattern
depends on that.
Methods
Group of 18 young males with unilateral lower limb
injury participated in the study. In order to record the
technique of movement and kinematic quantities
of swing-through crutch gait 6-cameras BTS Smart
D system was used simultaneously with 2 AMTI force
platforms to measure GRF for weight bearing foot
and crutches and 16-channell NORAXON System
to record sEMG activity of 12 selected muscles of
shoulder girdle and upper limbs.
Figure 1: M
uscles activity in swing-through gait.
Discussion
Values of vertical loads on crutches were
opposite to Sallards research results [Stallard,
1998] presumably the reason was that their
subjects were healthy and only simulated the
crutch gait. The questionnaire conducted among
examined patients shows the lack of instructing
procedure about optimal locomotion pattern
after injury. Patients are not aware of overloads
and asymmetries connected with swig-through
crutch gait. Further investigation is needed to find
the exact relationship between muscles activation
and crutch loading.
Results
Average maximum loads (VGRF) on the crutches
were 0.55 BW on injured leg side and 0.52 BW
on no-injured side. According to on-set and offset analysis the examined muscles were divided
into two groups: those activated during stance
phase on crutches (ST) and those working in
swing phase of crutches (SW). Pectoralis major,
latissimus dorsi and triceps brachii (caput lateralis)
are the muscles that carry the body weight during
crutch ST, while trapesius (pars descending),
deltoideus (pars acromialis) and. biceps brachii
(caput longum) play their role in advancing
the crutches (Fig.1). EMG signals amplitude was
normalized to MVC values [Kuhtz-Buschbeck,
2012]. For lattisimus dorsi the asymmetry was
transparent the activation was higher on the
more loaded crutch side. For pectoralis major and
triceps brachii there was tendency observed of
higher activation of muscles on non-injured side
but was not clear among examined patients.
References
Shoup et al, Biomechanics of crutch locomotion.
Journal of Biomechanics; 7: 1119, 1974.
Stallard et al, One leg swing-through gait using
two crutches. Acta Orthopedica, 51: 7177, 1998.
Dworak et al, Swing-through gait from the perspective of biomechanics and kinesiology. Critical
analysis of the current state of knowledge and
the idea behind the research. Chirurgia Narzadw
Ruchu i Ortopedia Polska; 75(6), 392398, 2010.
Kuhtz-Buschbeck et al, Activity of upper limb
muscles during human walking. Journal of Electromyography and Kinesiology; 22:199206, 2012.
370
P 0 11
FREQUENCY OF POSTURAL CHANGES DURING SITTING

WHILST USING A DESKTOP COMPUTER EXPLORING
AN ANALYTICAL METHODOLOGY.
S.M. Van Niekerk1, Q. Louw1, K. Grimmer1,2
1
2
Stellenbosch University, Physiotherapy, Cape Town, Republic of South Africa
University of South Australia, International Centre for Allied Health Evidence, Adelaide,
Australia
Introduction
Dynamic movement whilst sitting is advocated as
a way to reduce musculoskeletal symptoms from
seated activities. 1 Conventionally, in ergonomics
research, only a snapshot of static sitting posture
is captured, which does not provide information on
the number or type of movements over a period of
time. A novel approach to analyse the number of
postural changes whist sitting was employed in order
to describe the sitting behaviour of adolescents
whilst undertaking computing activities.
Figure 1: llustration of descriptive analysis method
Methods
A Pilot repeated-measures observational study
was conducted. Twelve high school students were
randomly selected from a conveniently selected
school. Fifteen minutes of 3D posture data was
recorded to determine the number of postural
changes whilst using computers.
To summarise the data descriptively, the median
and IQR for the neck, thorax and pelvic angles
were determined as measures of central tendency
and variability for the total capture duration. The
difference between the smallest (min) median
value and the largest (max.) median value was
calculated for each subject. The median could
therefore be found anywhere within the range
presented. Figure 1 illustrates how this statistical
procedure was accomplished. The next step taken
was to illustrate the median angles and IQR for the
neck, thorax and pelvic angles for each minute
of the capture duration, as an indication of the
variability in the median angle and the IQR per
minute. Box plots illustrated the data. A postural
change was defined as the difference in degrees
between one turning point (change in movement
direction) and a successive turning point in the
data of a given angle (Figure 2). Within-subject
variability in the pelvic, thoracic and head angles
adopted when sitting was analysed, by comparing
the overall median per subject, the minimum and
maximum median (from the per-minute analysis)
and the IQR of the head, thoracic and pelvis
angles, for the entire duration of the capture, as
part of the descriptive analysis of adolescent sitting
posture over time.
Figure 2: T he way in which turning points were calculated
Results
Data of 11 students were analysed. Large intra-subject
variation of the median and IQR was observed,
indicating frequent postural changes whilst sitting.
Discussion
To date, the manner of describing sitting posture
entails calculating a mean and SD of angles over
a short period of time during the sitting capture
period. This method assumes that sitting posture
rarely varies over time. Our investigation into sitting
posture data generated over a longer period of
time suggests that sitting posture is dynamic and not
readily predictable from short periods of capture.
Further research is now required to better
understand the effect of frequent postural changes
over a period of time, and optimum number and
amplitude of the postural changes. The associations
between postural dynamics and musculoskeletal
dysfunction associated with sitting-based tasks also
need to be determined. This might unlock valuable
information about the association between sitting
posture and musculoskeletal symptoms.
References
1 Cook, C., and R. Burgess-Limerick. 2003. Guidelines
for Computer Workstations. Ergonomics Australia
17: 1937.
371
P 012
DOES THE PROTOTYPE EXPERIMENTAL CHAIR

FACILITATE MORE POSTURAL CHANGES IN COMPUTING
ADOLESCENTS COMPARED TO A NORMAL
SCHOOL CHAIR?
S.M. Van Niekerk1, Q. Louw1, K. Grimmer1,2
1
Stellenbosch University, Physiotherapy, Parow, Cape Town, Republic of South Africa

2
University of South Australia, International Centre for Allied Health Evidence,

Adelaide, Australia
Introduction
Prolonged sitting, such as when computing, has
been linked to adolescent spinal pain [1, 2, 3]. A
chair should fit the users body dimensions and
aid the user in frequently changing sitting posture,
rather than support one ideal posture, such a chair
is not currently available to high school learners.
Results
Data of eleven learners were analysed. Pelvic
rotation illustrated a substantially higher ratio
(10.0) of postural changes, as well as a higher
thorax rotation ratio (2.0) in the prototype chair,
compared to the school chair.
Methods
A development and validation study was
conducted. Twelve high school students were
randomly selected from a conveniently selected
school. Fifteen minutes of 3D posture measurements
were collected in both the prototype (Figure 1)
and school computer chair (Figure 2). The analysis
focused on the frequency of postural movement.
Discusion
The experimental chair provided more postural
movements when compared to the school
computer chair. Future studies should use this
experimental chair to determine the effect of
increased postural movement, of especially
the pelvis, on the prevalence and intensity of
musculoskeletal symptoms of high school learners
in our specific demographic.
Figure 1: P
rototype chair set-up
Figure 2: S chool computer chair set-up
References
1 Kovacs FM, Gestoso M, Gil del Real MT, Lpez J,
Mufraggi N et al. (2003). Risk factors for non-specific
low back pain in schoolchildren and their parents:
A population based study. Pain, 103(3):259268.
2 Watson KD, Papageorgiou AC, Jones GT, Taylor
S, Symmons DPM, et al. (2002). Low back pain in
schoolchildren: Occurrence and characteristics.
Pain, 97(1):8792.
3 Wedderkopp N, Leboeuf-Yde C, Andersen LB,
Froberg K, Hansen HS (2001) Back pain reporting
pattern in a Danish population-based sample of
children and adolescents. Spine, 26(17):1879.
372
P 013
QUANTIFYING MUSCLE FATIGUE OF THE TRUNK DURING

REPITITIVE LOAD LIFTING USING LYAPUNOV ANALYSIS
E. Spyropoulos1, A. Kyvelidou2, N. Stergiou2, G. Athanassiou1
1
University of Patras, Department of Mechanical Engineering & Aeronautics,

Rion Patras, Greece
University of Nebraska at Omaha, Department of Health, Physical Education and Recreation,

Omaha, USA
Introduction
Occupational low back disorders caused by
ergonomically unfavorable working postures have
been hypothesized to occur when trunk equilibrium
is disturbed [1]. Trunk dynamic stability can be
estimated using the maximum finite-time Lyapunov
exponent (max), where a higher max reflects
lower spinal stability [2]. Thus the objectives of this
study were to (1) assess the max of the trunk as a
function of repetitions and (2) determination of the
time of transmission to the substantial fatigue phase
(TSFO) during the repetitive light weight load lifting.
the results was conducted using SPSS Student t-Test

(p<0.05).
l = 1/(t M t0) * k=1-M*log2(L?(tk)/L(t k-1))(1)
Where L=divergence of infinitesimally close trajectories, k=number of markers and t=time moment of
markers position.
Results
Figure 2 shows a characteristic diagram of the
Lyapunov exponent max results of markers L5/S1.
High change of the Lyapunov exponent, max,
values was observed between the first 14 cycles of
the lifting task and the last 14 cycles of the lifting
task (figure 2).
Methods
The protocol consisted of 2-D video recording
during the repetitive load lifting from the ground
to a 70 cm workbench. Seven (7) male volunteers
with a mean age of 242,4 years participated in
this study. Ten (10) markers were placed on certain
vertebrae (S1, L5, L4, L3, L1, T9, T6, T4, T2 C7) in
order to record the patterns of the spine during the
task (figure 1).
Figure 2: L yapunov exponent max values compared to the

lifting cycles, markers L5/S1.
Discussion
The rapid increase of the Lyapunov exponent max
values (from =0.25 to =0.58) is observed after
the first 14 cycles of the working task implying
crucial spine instability and probably signifies a
large increase of muscle fatigue accumulation.
The assessment of the fatigue perception by
the volunteers using the results of Borgs scale
indicated that the TSFO was found to be between
Borgs values 7 and 8, which corresponded to the
29 th and 30 th lifting cycles. These findings indicated
that although high spine instability occurred
the volunteers continued to execute the task as
they didnt percept the fatigue accumulation. In
practice these findings help for an ergonomic design
of the work/rest ratio to prevent spine damage.
Figure 1: M
arkers on the spine
Maximum voluntary contraction (MVC) measure

ments were conducted to each participant and
the lifting weight was set to 15%*MVC, kg, for each
participant correspondingly. After the execution
of each lifting cycle the volunteers evaluated their
fatigue level as Perceptible Fatigue (PF) based on
Borgs scale [3]. The coordinates of each marker
were analyzed for each time moment using
nonlinear Lyapunov analysis in order to calculate
the values of max (equation 1) [4]. The analysis of
the markers movement was conducted using the
Biokin 2-D software and the statistical analysis of
References
1 Dingwell JB. Journal of biomechanical engineering
129:586, 2006
2 Granata KP. Ergonomics 51:125871, 2008
3 Borg, 1970. Scand J Rehabil Med 2:2534.
4 Wolf et al., Physica D 16:285317, 198.
373
P 014
SIMULATION OF THE MANEUVERS PERFORMED

IN VESTIBULAR REHABILITATION
C. Santos1, F. Gentil2, M. Parente3 , R. Natal Jorge3
1
2
INEGI, Porto, Portugal
Escola Superior de Tecnologia da Sade do Porto, Porto, Portugal

3
INEGI, Mechanical, Porto, Portugal
Introduction
The vestibular system is located in the posterior
portion of the inner ear and is a key to our sense
of balance and movement. Any changes in this
system can cause symptoms such as dizziness,
blurred vision, imbalance and nausea, which are
vertiginous syndrome indicators. Vertigo is reported
as one of the most common symptoms in the world.
It is considered the third most frequent complaint
in medicine, transmitting a sense of inadequacy
and insecurity [J.M. Wolfe et. Al, 2009].
The method used to accurately reproduce the

maneuvers made by the audiologist expert
was based in the use of an accelerometer. The
acceleration along time obtained in the three axis
was applied to the vestibular system model.
The boundary conditions imposed in that model is
the general contact between the membrane and
the fluid, the gravitational force, the node fixed
and the angular movement.
Results
The movement presented in the Fig. 2 not represent
a movement of the rehabilitation. It is a random
movement, used as the first step of the work, to
verify if the particles flow is right and goes with the
canal movement according to the predictable.
It is possible to observe that in the four frames
obtained there are a continuous movement that
represent the one acquired with the accelerometer
data.
Figure 1: V
estibular system.
The aim of this work is to contribute to a better

understanding on how the vestibular system works.
This knowledge will help in the development of
new techniques that will facilitate a more efficient
rehabilitation. Vestibular rehabilitation consists
in a set of exercises, known as maneuvers, which
can reduce and even eliminate the symptoms
of dizziness and imbalance associated with a
vestibular disorder [Williams, L et al, 2010].
Figure 2: M
odel built in finite element method.
The displacement of the particles inside the shell ring

that represent one SCC is similar to the expected
and follows the ring moves. So this method seems
appropriated to simulate the rehabilitation
maneuvers.
Methods
In order to understand biomechanical behaviour
of the vestibular system is important to simulate
its components and its activity. One of the most
important components of that system is the fluid
inside the labyrinth (composed by three semi-circular
channels placed orthogonally and two otolith
organs Figure 1), and simulation of this fluid is a
challenge.
Discussion
The results obtained with the accelerometer will
be the best way to simulate the real movements
performed during vestibular rehabilitation.
The next step with that circular model is to
introduce a cilium fixed inside the ring to observe
its interaction and movement with the fluid flow.
The 3D model was developed with finite element

method and it was composed of two main parts;
a small shell ring that represents one semicircular
channel (SCC) and particles that represent the
fluid inside. The model represents the vestibular
membrane of the SCC and it is define as rigid
body. The kind of elements used in that part are
linear 4-node shell (S4R) element.
References
J.M. Wolfe et. al. (2009). Sensation & Perception.
2nd ed. Sunderland: Sinauer Associated Inc;
Williams, L.; Wilkins. New Vestibular Rehabilitation
Techniques Can Help Patients with Dizziness, Journal of Neurologic Physical Therapy, 2010.
374
P 0 15
MOTION ANALYSIS OF THE SEATED POSTURE

ON AUTOMOTIVE PROTOTYPE SEAT
R. Toubiana Meyer1, S. Baudu2, B. Sandoz1, S. Laporte1
1
Arts et Metiers ParisTech, LBM/Institut de Biomcanique Humaine Georges Charpak,

Paris, France
Faurecia Siges dAutomobile, R&D Confort Ergonomie et Acoustique, Etampes, France
Introduction
In automotive industry, by the past, postural
comfort was generally predicted through pressure
distribution [Mergl, 2005; Zenk, 2007]. Measuring
the joint angles, for the automotive sitting comfort,
becomes a new investigation field [Schmidt,
2014]. The aim of this study is to evaluate the
reproducibility of sitting movement.
reproducible between the 2 first phases. And

2 volunteers are not reproducible. For the pelvis,
only 2 volunteers are reproducible between
2 phases: phase 1 and phase 3 or phase 2 and
phase 3. The others are not reproducible.
Methods
Six asymptomatic volunteers (mean: 26yo, 1.74m,
69kg), without back pain, participated in this study.
The volunteers sat on a normative prototype seat
as Robbins et al (1983). The footrest was placed
in order to have a thigh angle of 15. Participants
were asked to successively sit 20 times during 3
phases (for a total of 60). The 2 first phases took
place in the same day (morning and afternoon)
and the third phase took place in the coming
month. Motion capture was made with an optoelectronic system Vicon at 100 Hz. The whole body
was equipped with 29 retroreflective markers
placed on specific anatomical landmarks and
technical plates. Anatomical frames, segmental
and articular kinematics of the lower limbs (hip), the
pelvis and the trunk were computed according to
Pillet et al (2010).Flexion/extension, lateral bending
and axial rotation were calculated for trunk and
pelvis. Lateral bending and axial rotation were
used to confirm that the movement was plane.
For the flexion-extension, the variation between
the beginning and the end of the movement was
measured. The reproducibility was evaluated by
Mann-Whitney test.
Figure 1: F lexion/extension of the pelvis for a volunteer

during a phase
Discussion
According to the variation of axial rotation and
lateral bending, the movement is considered to
be plane. As expected, the pelvic anteversion
is observed during the movement. For the
reproducibility study, the results show that
volunteers do not sit in the same way for the
3 phases. These preliminary results quantified the
movement during sitting. More volunteers currently
increase the number of experimentations.
Results
Axial rotation and lateral bending can be
considered as negligible. Indeed, the standard
deviation (SD) is less than 2.5. For the flexion/
extension, the volunteers are repeatable during
a phase (Figure 1). For the trunk, 3 volunteers are
reproducible for the 3 phases. One volunteer is
References
Mergl et al, SAE, 2005.
Pillet et al, Gait & Posture, 31:147152, 2010.
Robbins et al, SAE, 1983.
Schmidt et al, Appl. Ergon., 45:247260, 2014.
Zenk et al, SAE, 2007.
375
P 0 16
BREATHING AND ITS PARAMETERS IN INCREASED

POSTURAL TASKS
M. Stredova1, M. Sorfova1, P. Kubovy1
1
Charles University in Prague Faculty of Physical Eduation and Sport, Anatomy and
Biomechanics, Prague, Czech Republic
Introduction
Disorders of postural stability represent a globally
significant increase expenses in health care.
Postural and respiratory systems have much in
common, and often their functions are connected
very closely. Physiotherapists deal every day with
patients with poor breathing stereotype and
deviations from correct posture. Also they use
balance platforms for postural stability training.
It is known that breathing movements directly affect
posture and postural stability and according to
Vle and Strnad [2014] breathing can be adjusted
according to postural tasks.
distance during the measurements on the unstable

platform. It is supporting the theory of inverted
pendulum and also shows that COP is most stable
part of our body. The influence of internal disturbing
deviations to stabilization process was obvious.
When breath was increased the travelled distance
was extended.
Discussion
Autors suggest that with increasing demands
for maintaining postures increases ventilation.
According Pierson [1976] this happens because of
higher muscle work, which is needed as the body
is retained in the desired position against gravity.
On the other hand, Cresswell [1994], Safarova and
Kolar [2011] indicate that the increased demands
on the stabilization of the body can cause the short
term conflict between the mechanics of breathing
and the diaphragm and spine stabilization system.
The subject of our research is to define the

compromise between ventilation and postural
stability affecting the respiratory parameters.
Methods
We measured respiratory parameters using
laboratory lung spirometer and motion capture
system in 3D space using Qualisys software. We
recorded passive markers in the proc. malleolus
lateralis, processus spinosus vertebrae C7 and L5.
Kantors [2001] research showed that pelvis

movement are in phase with chest movement. It
indicates that the area of lumbar spine is the local
point for managing the fluctuations. From our
perspective, we compared the lumbar area as the
most stabile component due to neck and ancles.
We measured quiet breathing and set pace

of deep breathing (f= 0,5 Hz) while standing
on the ground or when standing on a unstable
platform. Total of 4 measurements were carried
out after 20 seconds. The study was participated
by 14 probands (age 2231 years, 10 women and
4 men, average age 24.5 years, mean height was
172.5 cm and mean weight 68.6 kg). All of them
were healthy non-smokers with no respiratory or
CNS disease.
References
Cresswell, A., Oddson, L.,Thostensson, A. The influence
of sudden perturbations on trunk muscle activity
and intra-abdominal pressure while standing.
Exp. Brain Res. 1994, roc. 98, c. 2, s. 33641.
Kantor, E., Poupard, L., Bozec, S., Bouisset, S. Does
body stability depend on postural chain mobility
or stability area? Neuroscience Letters. 2001,
roc. 308, c. 2, s. 128132.
Pierson, D. J., Dick, N. P., Petty, T. L. A comparison
of spirometric values with subjects in standing and
sitting positions. Chest journal. 1976, roc. 70,
c. 1, s. 1720.
afrov, Marcela, KOLR, Pavel. Posturln stabilizace a sportovn zte*. Mcek, Milo, Radvansk,
Jir. Fyziologie a klinick aspekty pohybov aktivity.
Praha: Galn, 2011, 177188.
ISBN 978-80-7262-695-3.
Vle, Frantiek, Strnad, Pavel. Oral communication.
Prevence a terapie vertebrogennch poruch
PFYZ140. Prague: FTVS UK, 2014.
Results
The sum of tidal volumes and the minimal level of
expiratory volume were higher while standing on
the balanced platform. Tidal volumes did not show
significantly greater differences between stands
on the floor and on the unstable platform.
Markers which were situated higher reached
longer distance than markers situated below while
standing on the ground. While the standing on the
unstable platform the lower limbs can absorb small
disturbances due to a greater number of points
of loose therefore the L5 marker had the shortest
376
P 0 17
ANALYSIS OF DRIVER SAFETY WITH SYSTEM HANS

DURING CAR ACCIDENT.
K. Joszko1, M. Gzik1, W. Wolanski1, M. Burkacki1, S. Suchon1,
A. Muszynski2, K. Zielonka2
1
Silesian University of Technology, Faculty of Biomedical Engineering, Zabrze, Poland

2
Automotive Industry Institute, Vehicle Safety Laboratory, Warsaw, Poland
Introduction
Rally car much different from the passenger vehicle
in terms of safety systems applied. This is mainly
due to the increased probability of an accident
during a race at high speed. One of the innovative
safety systems in recent years for use in rally cars
is the HANS system supporting the head and
cervical spine of driver. The purposes of analyzing
the above mentioned. system in terms of reducing
injury rates in a car accident experimental research
was conducted in the Automotive Industry Institute
and modeling studies using the software Madymo.
the model as a tool to assess the effectiveness of

the HANS system in the event of an accident.
Results
As part of numerical simulations was designated
waveforms recorded acceleration values for the
head, chest and pelvis. In addition, designated the
criteria traumas of head, neck, chest and lower limbs.
The results were used to determine the effectiveness
of the Hans.
Discussion
Analysis of the safety of the driver using the HANS
system in a car accident was based on modeling
Madymo software. The models were formulated
using multibody method which is often used for
the analysis of active and passive safety systems
used in the automotive industry, etc. [Joszko,
2012] [Gzik, 2007] [Burkacki, 2013]. This method
significantly reduces the computation time, due
to the extensive library of dummies used in crash
tests. It must be remembered that each numerical
model should be verified based on experimental
studies to confirm the authenticity of the results.
The conclusions derived from studies carried out
on sports safety systems will be used to modify the
security systems used in the series production cars.
Methods
In the Madymo software was developed simplified
model that reflects the conditions in the passenger
car. It consists of a 50-percentile the Hybrid III
dummy positioned in bucket seat, Hans system with
a five-point safety belt system. In the next stage
the model was verified based on experimental
studies conducted in the laboratory of the Institute
of Automotive Industrial PIMOT in Warsaw. On the
basis of qualitative and quantitative conformity of
the characteristics obtained from the simulation
model and experimental studies assumed that
developed in the Madymo model has been
well-formed. Positive verification allows the use of
377
P 018
FORCE RELAXATION IN DISTRACTION CALLUS DURING

BONE TRANSPORT
J. Mora-Macas1, E. Reina-Romo1, M. Lpez-Pliego2, M.A. Girldez-Snchez2,
J. Morgaz3 , J. Domnguez1
1
2
University of Seville, Mechanical Engineering and Manufacturing, Seville, Spain
Hospital Virgen del Roco de Sevilla, Orthopaedics and traumatology, Seville, Spain
3
University of Cordoba, Animal Medicine and Surgery, Crdoba, Spain
Introduction
Distraction osteogenesis (DO) is a technique
to generate new bone tissue by the gradual
separation of two bone fragments from an
osteotomy. One of the applications of DO is bone
transport (BT).
There are some experimental studies about
force relaxation in leg lengthening by means
of DO [Aronson and Harp 1994; Aarnes, 2002]
and BT [Brunner, 1994; Hyodo 1996]. However,
none of those works provide a continuous force
measurement and, therefore, the viscoelastic
parameters of the callus tissue from the fit of the
relaxation curve.
Figure 1: E
xperimental values of the distraction force at
peak, after 8 minutes and 45 minutes relaxation.
Therefore, the aim of this study is to provide an

experimental model of the viscoelastic behaviour
of the callus tissue.
Methods
Seven adult merino sheep aged 42 years were
used. For each animal the same bone transport
protocol was applied. After a latency period,
distraction phase was carried out, moving the
bone transportable segment 1 mm once a day
during 15 days. The distraction force through the
bone transportable segment was monitored from
moments before the displacement to a minimum
of 10 minutes later.
Figure 2: D
istraction force through bone transportable segment during the distraction.
Discussion
This work provides two models of the viscoelastic
behaviour of the callus tissue from experimental
continuous monitoring of the distraction force
relaxation curve. These models could represent the
bounds of the real behaviour of the callus tissue. In
fact, the values of residual force obtained by Brunner
et al. in similar experiments are within these limits.
Results
Daily experimental relaxation curves were
measured and fits were performed for all sheep.
Experimental values of the distraction force at
peak, and after 8 minutes and 45 minutes relaxation
are shown in figure 1.
According to experimental values, two different
models of the viscoelastic behaviour of the callus
tissue were obtained (figure 2). The former, (red)
assumed total tissue relaxation after each day of
distraction, and the latter, (green) a daily residual
stress proportional to the force peak.
According to our results, residual forces after

each day of distraction are between 0 and
71.6 N maximum. This contrasts with the residual
force values of ?? 200300 N detected in bone
lengthening in sheep after 15 days of distraction
at 1 mm/day [Wee, 2011]. This shows that in DO
residual forces may be due to the elongation of
the surroundings soft tissues and not to the callus
tissue elongation.
Some long experimental relaxation curves (34 hours)

showed that the value of force after 24 hours of
the green curve represent an upper bound of real
values of daily residual forces.
References
Aarnes et al, J Orthop Res, 20(1):13741, 2002.
Aronson and Harp, Clin Orthop Relat Res, 301:739,
1994.
B
runner et al, Clin Orthop Relat Res, 301:14755, 1994.
Hyodo et al, Clin Orthop Relat Res, 325: 25668, 1996.
Wee et al, Med Eng Phys, 33(8): 10017, 2011.
378
P 0 19
MECHANICAL PARAMETERS ANALYZED IN ZYGOMATIC

ROOT OF CAPUCHIN MONKEYS
F.B. Prado1, A.R. Freire1, A.C. Rossi1
1
Piracicaba Dental School State University of Campinas UNICAMP, Morphology,

Piracicaba, Brazil
Introduction
The trabecular bone can be one mechanically
important parameter to study the stress distribution
in order to understand its functional relationship
with masticatory forces. The application of highefficiency micro-computed tomography (microCT) for tridimensional analysis of the bone is needed
to clarify the importance of zygomatic root in
mastication in capuchin monkeys, especially in
Cebus paella (Strait et al., 2008). The aim of this
study was to evaluate the mechanical parameters
of bone structure of zygomatic root of Cebus
apella monkeys using 3-dimensional micro-CT.
These parameters were calculated using the

morphometric analysis of CT-Analyser (SkyScan,
Leuven, Belgium) software in 3D based on a volume
model. Shapiro-Wilk test was used to determine if
the measurements were conformed to a normal
distribution. Comparisons of sex were analyzed
with an unpaired t test. This test was performed
to verify the significance different of means. In all
cases, the significance level was set at p<0.05.
Results
There were no differences in all the bone trabecular
parameters between male and female zygomatic
root of Cebus apella, except to trabecular
thickness. In this parameter the males had higher
Tb.Th values than females (P = 0.0478).
Methods
Micro-CT of 6 (3 female and 3 male) skulls of adult
Capuchin Monkeys (Order: Primate; Genus: Cebus;
Family: Cebidae; Specie: Cebus apella), were used
in this study. The monkeys were obtained from the
Center of Tufted Capuchin Monkey Procreation
of the Araatuba Dental School, Paulista State
University (UNESP) in Araatuba, SP, Brazil were
used. The skulls were scanned in SkyScan 1174
(SkyScan, Belgium) microtomography with 50 Kv
and 800 mA. The images obtained were configured
with high resolution (1024 x 1024 pixels) and 30-m
pixel size. In each micro-CT obtained we quantify
the volumes of interest (VOI) of three-dimensional
structure of trabecular bone in the zygomatic
root. The VOI were extracted from each dataset in
CT-Analyser (SkyScan, Leuven, Belgium) software.
Mechanical structural morphometric parameters
analyzed were: Trabecular Thickness (Tb.Th);
Trabecular Number (Tb.N); Trabecular Separation
(Tb.Sp) and Structure Model Index (SMI).
Discussion
In our study, higher Tb.Th in male Cebus apella
suggested that the trabecular bone of zygomatic
root becomes more robust in male than female
Cebus paella (Wright, 2005). Although not
significant, the trabecular bone number was
higher in female than in male, indicating that
female presented greater number of trabeculae,
but thinner than male. In addition, our results have
potential relevance for understanding sex-related
bone loss in other primates.
References
S trait DS et al, In: C. Vinyard et al. (eds.). Primate
Craniofacial Function and Biology Series: Developments in Primatology: Progress and Prospects. Ed.
Springer. 173198, 2008.
Wright BW, Cebus. J Hum Evol. 48(5):473492, 2005.
379
P 020
MODELING AND SIMULATION OF SPATIOTEMPORAL

DYNAMICS OF TRABECULAR AND OSTEONAL
BONE REMODELING
T. Adachi1, K. Imai1, K. Takenaka1, Y. Inoue1
1
Institute for Frontier Medical Sciences, Kyoto University, Department of Biomechanics,

Kyoto, Japan

We conducted computer simulations for a single
trabecula and a single osteon under uniaxial
compressive loading, using voxel finite element
models 3. Roles of mechanical loading on the
trabecular and osteonal orientations were
discussed, and the effects of the RANKL expression
level on the remodeling turnover rate were
investigated. Computer simulation demonstrated
that the distribution of mechanical stimulus in both
trabecular and osteonal surfaces was regulated
to become uniform with morphological changes
to align along mechanical loading direction,
suggesting that modeling and simulation of bone
signaling and their interactions will be a framework
to investigate the spatiotemporal regulation in
complex bone adaptation by remodeling. As future
studies, the proposed framework could be applied
to assess the effect of drugs on bone metabolism
and to predict changes in bone microstructure
that can be quantitatively compared with in vivo
experiments.
Introduction
Through trabecular and osteonal remodeling,
cancellous bone and cortical bone remodel
their internal microstructure to functionally adapt
to their changing mechanical environment 1, in
which coordinated cycles of osteoclastic bone
resorption and osteoblastic bone formation are
spatiotemporally regulated by mechanochemical
couplings at cellular level. Recently, osteocytes
embedded in mineralized bone matrix have been
recognized as mechanosensor cells controlling this
complex regulation process through intercellular
communication among bone cells. However,
fundamental mechanisms, by which cellular level
remodelling event results in tissue level functional
adaptation, have not been clearly understood.
In this study, we proposed a mathematical model
of trabecular and osteonal bone remodeling
with mechanosensing and communication by
osteocytes as well as biochemical signalings, and
conducted computational simulation.
Methods
As one of the important signaling systems in bone
metabolism, RANKL/RANK/OPG system 2 that
regulates osteoclast differentiation, was introduced
in the mechanoregulation model 35 of trabecular
and ostemal remodeling. RANKL activates
osteoclastogenesis and OPG prevents RANKL
from binding to its receptor, RANK, both of which
are known to be produced by osteoblasts and/or
osteocytes. Therefore, the RANKL/RANK/OPG
system provides positive and negative regulations
of osteoclast differentiation that make the bone
remodeling cycles more complicated.
A C K NO W L ED G EMENT
This work was partly supported by the Platform for
Dynamic Approaches to Living System from the MEXT,
Japan.
References
[1] A. M. Parfitt, J. Cell Biochem., 55, 273 (1994).
[2] T. Suda, et al., Endocrine Rev., 20, 345 (1999).
[3] K. Tsubota, et al., J Biomech., 29, 1088 (2009).
[4] Y. Kameo, et al., Biomech & Model Mechanobiol.,
13, 851 (2014).
[5] Y. Kameo, et al., Acta Mech., 225, 2833 (2014).
380
P 021
BONE ANISOTROPY MEASURED WITH DEPTH

SENSING MICRO-INDENTATION AND REFERENCE
POINT INDENTATION
E. DallAra1, P. Grabowski2, P. Zioupos3 , M. Viceconti1
1
University of Sheffield, Department of Mechanical Engineering and INSIGNEO Institute

for in silico medicine, Sheffield, United Kingdom
University of Sheffield, Department of Human Metabolism, University of Sheffield, Sheffield,

UK, Sheffield, United Kingdom
3
Cranfield University, Cranfield forensic Institute, Shrivenham, United Kingdom
Results
All DSM measurements were dependent on the
parameter Direction (p<0.001) apart from
Wel (p=0.436). In particular, the local indentation
modulus Ei was found to be highest for the axial
direction (24.3 2.5 GPa) compared to the one
from circumferential indentations (19%) and
from the radial direction (30%). Also all RPI
measurements but IDI (p=0.173) were found to be
dependent on direction (p<0.001). In particular,
the US1 was found to be highest in case of axial
indentations (0.47 0.03 N/m) compared to the
circumferential (11%) and radial ones (17%).
Introduction
Bone is a heterogeneous, anisotropic hierarchical
material. The goal of this study was to compare
the mechanical properties of bovine plexiform
bone tissue measured along different anatomical
directions with Reference Point Indentation (RPI) 1
and Depth Sensing Microindentation (DSM)2.
Methods
One bovine femur was obtained of an 18 month
old animal from the local abattoir. Fifteen prismatic
samples were extracted and indented along the
axial, circumferential or radial direction. One half
of each sample was indented 24 times with DSM
in load control, up to 2.5 m and with constant
loading and unloading rate (120 mN/min).
The indentation modulus (Ei), hardness (HV),
elastic work (Wel) and dissipated work (Wpl) were
computed for each indentation. The other half of
the sample was indented with RPI. We carried out
ten cycles in load control until a maximal force
of 6N and with a frequency of 2 Hz. For each
indentation the unloading slope of the first cycle
(US1), average unloading slope (USAvg), average
dissipated work (EnDisAvg), total indentation
distance (TID), average creep distance (CDAvg)
and indentation distance increase (IDI) were
computed. Non parametric Kruskas-Wallis (KW)
tests were performed in order to reveal any
dependency of the measured properties to the
loading direction.
Discussion
This study shows that, in optimal testing conditions,
most of the RPI measurements can discriminate
plexiform bone anisotropy. However, the IDI
measurement, most used parameter for preclinical
and clinical investigations, is a poor indicator of
anisotropy. It remains to be seen whether these
results remain valid in more complex in vivo testing
conditions.
References
1 Hansma, RevSciInstrum,79(6):064303,2008
2 Oliver&Pharr, JMaterRes,7:156483,1992
The authors would like to thank FP7 European program (MAMBO: PIEF-GA-2012-327357) for partially
funding this study.
Micro-indentation
Axial
Circumferential
Radial
KW
Eind [GPa]
24.3 2.5
19.6 3.1
16.9 1.4
p<0.001
HV [.]
70.6 7.2
61.6 7.3
55.6 6.2
p<0.001
Wel [J]
0.027 0.005
0.027 0.003
0.027 0.004
p=0.436
Wpl [J]
0.084 0.011
0.067 0.010
0.061 0.006
p<0.001
Wtot [J]
0.110 0.015
0.095 0.011
0.088 0.008
p<0.001
US1 [N/m]
0.47 0.03
0.42 0.03
0.39 0.03
p<0.001
USAvg [N/m]
0.48 0.03
0.43 0.03
0.40 0.03
p<0.001
IDI [m]
4.56 0.34
4.79 0.54
4.76 0.54
p=0.173
EnDisAvg [J]
12.02 1.63
14.15 1.72
14.86 1.50
p<0.001
TID [m]
49.8 2.5
51.0 2.0
51.8 1.7
p<0.001
CIDAvg [m]
0.95 0.08
1.05 0.12
1.12 0.11
p<0.001
381
P 022
CONTINUUM DAMAGE INTERACTIONS BETWEEN TENSION

AND COMPRESSION AND OSTEONAL BONE
M. Mirzaali1, A. Brki1, J. Schwiedrzik1, P. Zysset1, U. Wolfram1
1
Introduction
Skeletal diseases such as osteoporosis impose
a severe socio-economic burden to ageing
societies. Decreasing mechanical competence
causes a rise in bone fracture incidence and
mortality especially after the age of 65 years. At
the hip, 90 % of all fractures are related to falls and
a third of all people over 65 years fall annually.
Every hip fracture starts in the vicinity of or induces
bone damage and the load direction during a fall
is distinct from the loading of daily activities. The
mechanisms of how bone damage is accumulated
under different loading modes and its impact on
bone strength are unclear. We hypothesise that
damage accumulated in one loading mode
increases the fracture risk in another.
Figure 1: W
e compare the impact of an overloading in
either uniaxial tension (UT, red) or uniaxial compression (UC, blue) on the other loading mode. The
moduli are normalised with respect to the initial
elasticity of load step 0 so that (1 D) is shown on
a log-scale.
Methods
This study aimed at identifying damage interactions
between tensile and compressive loading modes.
We propose and identify the material constants of
a novel piecewise 1D constitutive model capable
of describing the mechanical response of bone
in combined tensile and compressive loading
histories. We performed several sets of quasi-static
loading reloading experiments at 0.0003 s? on
93 dumbbell shaped specimens to record stiffness,
plastic strains, and stress-strain curves.
Plastic strain at ultimate stress was the same in

tension and compression. Compression showed
softening and tension exponential hardening in
the post-yield regime. The hardening behaviour in
compression is unaffected by a previous overload
in tension but the hardening behaviour in tension is
affected by a previous overload in compression as
tensile reloading strength is significantly reduced.
C o n cl u s i o n
This
paper
demonstrates
how
damage
accumulated under one loading mode affects
the mechanical behaviour in another loading
mode. An overloading in compression strongly
affects the tensile reloading properties while an
initial tensile overloading has only minor effect on
the compressive reloading properties. The results
improve our understanding of hip fractures.
Results
For tensile overloading, an apparent stiffness
reduction (damage) of 60% at 0.65% accumulated
plastic strain was detectable as stiffness reduction
of 20% under compression. For compressive
overloading, 60 % damage at 0.75% plastic strain
was detectable as a stiffness reduction of 50% in
tension (Fig. 1).
The authors would like to thank the AO Foundation
for financial support (S-12-13W).
382
P 023
EVALUATION OF THE MECHANICAL PARAMETERS

OF CU-DEFICIENT BONE TISSUE
L. Harislamova1, E. Kirillova2, N. Shamsutdinova2, O. Sachenkov3 , Y. Konoplev3
1
Kazan Scientific Center, Russian Academy of Sciences, Kazan, Kazan Scientific Center,
Kazan, Russia
2
3
Kazan State Medical University, Department of Hospital Therapy, Kazan, Russia
Kazan Federal University, Institute of Mathematics and Mechanics, Kazan, Russia
Introduction
At present people with copper deficiency are
proven to suffer from osteoporosis. Osteoporosis
is a metabolic bone disease characterized by
low bone mineral density and increased risk of
low-energy fractures. In this study the results of
defining bone tissue mechanical characteristics
according to copper deficiency and its various
timing recovery in the body are shown.
term increase the bone tissue stiffness increases

sharply compared to that of the control group, the
value of the limiting shear stresses also increases
compared to the value of the limiting shear stresses
in the control group, at a maximum recovery term
it increases by 30%. The value of the ultimate
normal stress decreases sharply with increasing
Cu recovery term, up to 40%.
METHODS
The experimental research was performed to
define mechanical properties of bone tissue
rats that were exposed to the diet, causing
Cu-deficiency (diet I), a recovery diet (diet II) and
the control group. To make analysis convenient
the objects under research were divided into
three groups: 1 group was subjected only to diet I;
2 group was subjected during 5 weeks to diet I,
followed by the recovery diet II; 3 group was
subjected during 8 weeks to diet I, followed by the
recovery diet II. In the experimental study femoral
bones of rats were taken, weighed, their density
estimated, geometrical parameters measured,
that followed by a bending test. For the tests in
bending experimental equipment was designed
and assembled. The task of research was to
determine the Youngs modulus, admitted normal
stresses and admitted tangential stresses.
DIS C USSION
The purpose of adjustment is to obtain an optimal
bone microstructure in which all elements
would be equally loaded. The Haversian system
formation time is 4 to 5 weeks. In this case, the
results can be interpreted as follows: at the value
of Cu deficiency up to 5 weeks the formation of
the Haversian system is not complete and at the
rehabilitation diet the restructuring of bone tissue
returns to normal state (control group), with an
increase in the term of Cu deficiency bone tissue is
fundamentally restructured.
RE F EREN C ES
1 Akulich Yu.V., Akulich A.Yu., Denisov A.S.,
Opredeleniye parametrov struktury gubchatoy
kosti proksimalnogo otdela bedra cheloveka po
opticheskoy plotnosti rentgenologicheskogo izobrazheniya, Izvestiya vysshikh uchebnykh
zavedeniy. Povolzhskiy region. Meditsinskiye nauki.,
2007, Vol. 1, 311.
2 Akulich A.Yu., Akulich Yu.V., Denisov A.S.,
Eksperimentalnoye opredeleniye razrushayushchikh
kasatelnykh napryazheniy trabekulyarnoy kostnoy
tkani golovki bedra cheloveka, Rossiyskiy zhurnal
biomekhaniki, 2010, Vol. 14, No. 4 (50), 716.
3 Akulich Yu.V., Akulich A.Yu., Denisov A.S.,
Shaymanov P.S., Shulyatyev A.F., Utochneniye
individualnoy zavisimosti modulya uprugosti
trabekulyarnoy kostnoy tkani ot obyemnogo
soderzhaniya matriksa, Rossiyskiy zhurnal
biomekhaniki, 2014, Vol. 18, No. 2, 158167.
RESU L TS
Group 1: with the Cu deficiency term increase in
bone tissue the stiffness decreases, the ultimate
values of the normal and tangential stresses are
also reduced with increasing Cu deficiency term.
Group 2: with increasing recovery period bone
tissue stiffness tends to the average stiffness of the
control group, the ultimate value of the tangential
stresses is also in the range of shear stresses of the
control group, at the maximum term of recovery
increases to 10%. The value of the ultimate normal
stresses increases with the growth of Cu recovery
period up to 20%. Group 3: with the recovery
383
P 024
PATIENT-SPECIFIC PREDICTIONS OF FRACTURE RISK

THROUGH THE DEVELOPMENT OF A 3D PARAMETRIC
MODEL FO THE PROXIMAL FEMUR
M.A. Perez Anson1, M. Remacha Andres2
1
2
EUPLA University of Zaragoza, Mechanical Engineering, Zaragoza, Spain
Introduction
The vast majority of orthopaedic computational
studies use a single or limited number of bone
models. The derived results are then extrapolated
to try to draw conclusions for the population as
a whole. This sacrifices quantitative accuracy by
ignoring natural inter-patient variability. Current
applications of the finite element (FE) models
are limited by the need of creating a new model
from scratch in each new patient; furthermore,
only small gains in efficiency are obtained by this
approach. There is also an important heterogeneity
of modelling approaches [1]. Therefore, the
main goal of this study is the development of a
parametric model of the proximal human femur
incorporating geometric and material properties.
The use of parametric modelling methods would
greatly reduce time required to construct a model
of an individuals femur and, by preserving model
fidelity, would not negatively impact the predictive
accuracy of the model.
(R2=0.98) (Figure 1). Similar results were obtained

when computing the fracture load under an
oblique fall (results not shown). A correlation of
R2=0.95) was obtained in that case.
Figure 1: R
eal vs. parametric stiffness of the proximal femur
under a vertical load applied over the femoral head.
DIS C USSION
In conclusion, this study illustrates a methodology with
the potential to generate patient-specific proximal
femur models. The results demonstrate that the
presented method is an advance stage, and can be
used in clinical studies of femoral neck fracture risk
prediction. The use of parametric modelling methods
would greatly reduce time required to construct a
model of an individuals femur and, by preserving
model fidelity, would not negatively impact the
predictive accuracy of the model.
METHODS
The parametric model has been created using
Abaqus Cae version 6.11. The model is able to
generate a personalized 3D model using only
9 geometrical parameters that completely
characterized the proximal femur geometry. The
bone density distribution and its corresponding
mechanical properties (young modulus and
poisson ratio) also depend on the proximal femur
geometry. Ten real left femurs (male and female)
were used to validate the parametric model. The
femurs were scanned (CT scan), segmented and
meshed using MIMICS and 3-MATIC. And their
materials properties obtained from the Hounsfield
Units (CT data) provided by MIMICS were estimated.
Femur stiffness was computed for both real and
parametric models and compared. But also, the
fracture risk under the impact of an oblique fall to
the side was analyzed for both models.
RE F EREN C ES
[1] E. Schileo, L. Balistreri, L. Grassi, L. Cristofolini,
F. Taddei. To what extent can linear finite element
models of human femora predict failure under
stance and fall loading configurations? J Biomech
47 (2014) 3531-3538.
funding from the (European Commission) Seventh
Framework Programme (FP7/20072013) under grant
agreement n286179 and the Spanish Ministry of
Economy and Competitiveness through research
project DPI 201122413.
RESU L TS
The real vs. parametric stiffness of the proximal
femur under a vertical load applied at the femoral
head was computed and represented in Figure1.
The overall predictions correlated very well
384
P 025
BONE REMODELING PREDICTIONS: THE CHALLENGE

OF PERFORMING REAL-TIME SIMULATIONS
M.A. Perez Anson1, J.M. Garcia-Aznar1
1
Introduction
The process of strain-adaptive bone remodeling
can be described mathematically and simulated
in a computer model, integrated with the finite
element method (FEM). A bone remodeling model
implemented in a FE code can determine the longterm behavior of bone and the impact on bone
biomechanics produced by the incorporation of
prostheses. Bone remodeling simulation normally
starts assuming a uniform bone density distribution.
As a consequence of the sequentially loads
application, bone material properties changed,
till a stable bone density distribution is predicted.
As a consequence, we should run the FE solver
for a large number of time increments to find out
the final density distribution. Therefore, the aim of
this work is to combine FE analyses with numerical
extrapolation
techniques
to
run
real-time
simulations of bone remodeling predictions [1].
Figure 1: B
one density distribution predicted with the RRE
technique and the error between the extrapolation and the real solution.
DIS C USSION
In this work, we have demonstrated that realtime bone remodeling predictions can be
computed using two different vector extrapolation
techniques, reduced rank extrapolation (RRE) and
minimal polynomial extrapolation (MPE) [1]. RRE
and MPE are very cheap to implement in terms of
the computational cost and storage savings. Both
methods are based on basic vector multiplications
in linear algebra, so they are able to calculate
the extrapolation vector much faster than the FE
simulation combined with the bone remodeling
algorithm. The most important advantage of the
proposed methodology is its compatibility with any
bone remodeling theory and the reduction in the
computing time will be very useful in the clinical
practice.
METHODS
Two vector extrapolation methods, reduce ranked
extrapolation (RRE) and minimal polynomial
extrapolation (MPE), are used to reduce
the simulation time. The minimal polynomial
extrapolation (MPE) and the reduced rank
extrapolation (RRE) are two methods used in
accelerating the convergence of a large class
of vector sequences [1]. In particular, they are
employed for acceleration the convergence
of fixed-point iterative techniques for linear or
nonlinear systems of equations, such as those that
arise in the discrete solution of continuum problems.
RESU L TS
These extrapolation techniques have been applied
to predict the bone density distribution of several
3D FE models (femur, femur with a hip prosthesis
and mandible). Figure 1 shows the bone density
distribution predicted with the RRE technique
and the error between the extrapolation and the
real solution. The procedure is extremely fast and
substantially reduces the computational cost. For
example, the simulation time of a 3D femur model
in order to obtain its bone density distribution has
been reduced by a factor of 10; and the mandible
has been reduced by a factor of 7.5.
RE F EREN C ES
[1] K
. Mohaghegh, M. A. Prez, J. M. Garca-Aznar.
Accelerating numerical simulations of
strain-adaptive bone remodeling predictions.
Computer Methods in Applied Mechanics and
Engineering. 273: 255272
funding from the (European Commission) Seventh
Framework Programme (FP7/20072013) under grant
agreement n286179 and the Spanish Ministry of
Economy and Competitiveness through research
project DPI 201122413.
385
P 026
FINITE ELEMENT ANALYSIS OF THE VARIATION

OF THE POSITION OF THE ACETABULAR FRAGMENT
IN A VIRTUAL GANZ PERIACETABULAR OSTEOTOMY
A. Chavez-Arreola1, Z. Zou1, T. Board2, T. Alonso-Rasgado3
1

2
Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Orthopaedics,

Results
The variation of the CE angle not only modifies
the lateral acetabular coverage, it also modifies
the anterior acetabular coverage. In the same
way the variation of AAC angle not only modifies
the anterior acetabular coverage, it also modifies
the lateral acetabular coverage. The contact
area, average contact pressure and average Von
Mises stress vary according to the position of the
acetabular fragment. The optimal position of the
acetabular fragment is patient-dependant.
Introduction
Developmental dysplasia of the hip (DDH) is a
disease related to abnormal development of the hip
bones. The patients suffering DDH have a deficient
acetabular coverage of the femoral head [Casey,
2005, McCarthy, 2005]. Ganz periacetabular
osteotomy (PAO) is a reconstructive pelvic
osteotomy used to correct the DDH. Ganz PAO
relocates the acetabulum in order to improve the
acetabular coverage. However this is a technically
challenging procedure and the success depends
on surgeons experience [Clohisy, 2009, Ganz,
1988, Pogliacomi, 2005]. The aim of this research is
to optimize the position of the acetabular fragment
before a Ganz PAO using Finite Element Analysis.
Discussion
This research shows that it is possible to predict the
optimal position of the acetabular fragment before
a Ganz PAO. It is very important that the optimal
position of the acetabular fragment does not
exceed the normal range, since an overcorrection
may cause problems such as impingement. The
optimal position is defined as the one which
improves the acetabular coverage of the femoral
head to the normal range and maximise the
contact area and minimise the average contact
pressure and the average Von Mises stress.
Methods
A virtual Ganz PAO was performed on four hip
models. The models were constructed based
on computed tomography (CT) scan from three
patients, all females between 27 and 34 years
old. The models were constructed using ScanIP
which is an image based modelling software.
During the virtual surgery the acetabular fragment
was rotated increasing the centre edge (CE)
angle and the anterior acetabular coverage
(AAC) angle, in order to improve the lateral and
anterior acetabular coverage. The virtual PAO
was performed using the software Abaqus/CAE.
Finite element analysis was carried on the models
considering the patients standing in one leg.
References
Casey et al, Curr Opin Orthop 16: 472477, 2005.
Clohisy et al, Clin Orthop Relat Res 467(8):
20412052, 2009.
Ganz et al, Clin Orthop Relat Res (232): 2636, 1988.
McCarthy et al, Curr Orthopaed 19: 223230, 2005.
Pogliacomi et al, Acta Orthop 76(1): 6774, 2005.
386
P 027
SIMPLE MEASURES OF BONE MASS, BODY WEIGHT

AND GEOMETRY ARE PREDICTORS OF FEMORAL
NECK STRAINS
M. Taylor1, E. Perilli1, S. Martelli1
1
Flinders University, Medical Device Research Institute, Adelaide, Australia
Results
The MLR and ANN surrogate models were both
able to reliably predict the mean (Fig. 1) and 90 th
percentile equivalent and min. prin. strains using
just 4 inputs (FNBM, BW, FNCBV and either FNL
(level gait) or FNA (fall load case)) for both load
cases (R 2ranging from 0.840.94). However, the
predictive ability of the surrogate models for the
max. prin. strains was lower the level gait load
case. Although the ANN surrogate models required
more training (500 models vs 200), they consistently
out-performed MLR based surrogate models.
Introduction
Areal Bone Mineral Density (aBMD) measurements
from Dual Energy X-ray Absorptiometry (DEXA)
are the standard tool for clinical assessment of
patients at risk of femoral fractures, but they are
poor predictors either in terms of sensitivity and
specificity Including 3D geometrical and BMD
information from patients computed-tomography
examinations, finite-element (FE) predictions of
femoral strain have been shown to improve ability
of the DEXA-based assessment of the patients
fracture risk from 65% to 82% [1]. However,
FE modelling cannot be implemented in routine
clinical practice because of the invasive nature
of CT scans and generating FE models is time
consuming, making it financial unviable. Surrogate
models can bridge the gap between FE models
and clinical application, as they are well suited for
exploring the relationships between FE-based bone
strains vs 2D/3D geometrical and BMD parameters
collectable in the clinic. This study develops and
compares two surrogate modelling approaches
to predict femoral neck strains, using previously
generated population-based FE models.
Methods
Training sets from 50 to 1000 femurs were generated
by sampling of the first 30 modes of a previously
developed active appearance model of the
femur [2]. A further 100 femurs were generated,
to later test the surrogate models. For each
femur, ten structural and geometric features were
automatically measured including: femoral neck
diameter (FND), femoral neck angle (FNA) angle,
femoral neck length (FNL), neck volume (NV), and
body weight (BW). Each femur was subjected to the
peak forces associated with the stance phase of
level gait, using a reduced muscle force set [3] and
a fall load case. A region of interest was defined in
the femoral neck, where the minimum, maximum
and equivalent strain distributions were predicted.
Statistics: Two surrogate modelling approaches
were used, multivariate linear regression (MLR)
and adaptive neural networks (ANN), to estimate
the femoral neck strain based on the geometric
information, bone volume, bone mass and body
weight. These were used to generate surrogate
models for the mean and the 90th percentile strain
values. The surrogate models were tested against
FE predictions of the 100 unseen femurs.
Figure 1: L inear regression analysis of the mean equivalent

neck strain for 100 unseen femurs for the level gait
case as predicted by finite element (FE) analysis
and the ANN surrogate model (ANN SM).
Discussion
Simple surrogate models can reliably predict the
magnitude of femoral neck strains for level gait and
fall load cases. The main predictive variables were
femoral neck bone mass and body weight and
two out of the three other variables (FNL and FNA)
can easily be derived from planar DEXA images.
The results are encouraging for development
of a simple clinical tool capable of estimating
femoral neck strains as part of routine fracture risk
assessment.
References
[1] Testi et al., Ann. Biomed. Eng., 2002, 30, 801807.
[2] Bryan et al., J. Biomech., 2009, 42, 21712176.
[3] Heller et al., J. Biomech., 2005, 38, 11551163.
387
P 028
HIGH SPEED IMPACT LOADING OF BOVINE TRABECULAR

BONE WITHIN A DROP TOWER EXPERIMENT
W. Enns-Bray1, A. Rmmeler1, R. Seung Hyun1, S. Ferguson1, B. Helgason1
1
ETH Zrich, Institute for Biomechanics, Zrich, Switzerland
Introduction
CT-based finite element models typically neglect
the viscoelasticity in bone tissue based on previously
reported weak dependencies of stiffness and
strength [1]. However, these experiments stopped
short of the physiologically relevant loading rates
that would occur during a sideways fall injury to
the hip. Biofidelic impact experiments on cadaver
femurs tested at sideways fall speeds showed that
higher strain rates can lower maximum force by
24% and increase stiffness by 160% [2]. Our aim
was to better quantify the strain rate dependencies
of trabecular bone tissue by loading specimens at
physiologically relevant sideways fall speeds.

Multivariable exponential regression was used to
predict the dependence of stiffness and ultimate
strength from rhoapp, DA, and epsilon_dot for the
pooled QS and impact data (Figure 2). Strain rate
had little effect on stiffness, while ultimate strength
showed higher strain dependency. Stiffness,
ultimate stress, and strain energy at failure were
slightly higher on average under impact than QS
loading, which is potentially due to the presence of
bone marrow, which has been shown to increase
stiffness at high strain rates [1]. The resulting stiffness
regression model is less dependent on rhoapp
than published in previous studies, however, this
finding only applies to the low density range of the
specimens used in this study.
Cylindrical cores of trabecular bone with marrow
included were machined from bovine tibia
(D=8 mm, L=26 mm), scanned with micro CT
at 20m resolution (Scanco Medical, Brttisellen,
Switzerland), and glued within 6 mm deep
aluminum end caps. 22 Specimens were tested in a
mini drop tower apparatus in uniaxial, unconfined
compression during impact with 1J input energy
(Figure 1). Force and displacement were measured
with a piezoelectric load cell (sampling at 250kHz)
and high speed video (50 kHz frame rate),
respectively. A control group (n=27) was tested
quasi-statically (QS) in an Instron testing machine.
Specimen apparent density (rhoapp), degree of
anisotropy (DA), and strain rate (epsilon_dot)
were measured, and used to predict experimental
stiffness and ultimate strength.
C o n cl u s i o n
We confirmed the presence of strain dependence
in trabecular bone strength after loading at higher
strain rates than previous studies [1]. This could
suggest that organ-level finite element models of
impact loading may also need to include strain
rate dependency within the material mapping
strategy. Future studies should also test the effect
of different input energies during impact on the
resulting mechanical properties and strain rate
dependencies.
References
[1] Carter D. and Hayes W., J Bone Joint Surg,
1977, 59:95492.
[2] Gilchrist S. et al., J Biomech, 2014, 47:37443749.
Swiss National Science Foundation and ThinkSwiss
Scholarships.
388
P 029
TWO-STEP DIAGNOSTICS OF OSTEOPOROSIS

AND PREDICTION OF FRACTURE RISK
J.S. Jurvelin1, S. Vnnen1, M. Malo1, L. Grassi2, J. Karjalainen1,
O. Riekkinen1, J. Tyrs1, H. Isaksson2, H. Krger3
1

2
Lund university, Department of Biomedical Engineering, Lund, Sweden
Kuopio University Hospital, Department of Orthopaedics, Traumatology and Hand Surgery,

Kuopio, Finland
Introduction
Early osteoporosis (OP) should be diagnosed for
most subjects at primary healthcare and conducted
at special healthcare only if truly needed. We
propose a two-step diagnostic procedure to
improve OP diagnostics and assessment of fracture
risk while minimizing healthcare costs (Fig. 1).
neck BMD. After US measurements 28.7% of subjects

needed verification using DXA (at 90% sensitivity/
specificity) (Karjalainen et al., submitted).
DXA+FEA. We built a statistical appearance
model (SAM) from a common set of CT images of
proximal femur and pelvis [Vnnen et al. 2012].
Then, we created a realistic 3D model based on
the SAM and 2D DXA images [Vnnen 2014],
including geometry and spatial volumetric BMD
information. Automatic algorithm registering the
3D SAM to 2D DXA image of hip made possible
the development of patient specific FE models.
A procedure to validate FE models against fullfield strain measurements [Vnnen et al., 2013]
was evaluated on composite femurs [Grassi et
al. 2013]. Next, we collected experimental data
about the mechanical strength of cadaver femurs
[Grassi et al. 2014], which will be used to validate
our FE model
Discussion
When successfully verified, the two-step procedure
may be implemented for general use in order to
manage the OP challenge more effectively.
In most patients the OP treatments could be
initiated after US diagnostics at the primary health
care. Thereafter, only patients with true need
(<30% of all) could be guided to DXA diagnostics,
and potentially supplemented by FEA, at the special
health care. By inclusion of risk factors (Fig. 1)
we wish to further improve accuracy of fracture
predictions. If our two-step procedure (US+DXA)
were included in the Finnish care pathway, the
healthcare costs related to OP diagnostics could
be significantly decreased [Asseburg et al. 2013].
Figure 1: T wo-step diagnostic strategy
Methods
For primary health care, we develop novel
ultrasound (US) methodology that characterizes
bone status of peripheral and axial skeleton
[Karjalainen et al. 2008,2012], as well as the dual
frequency US method [Riekkinen et al. 2008] that
minimizes the error arising from soft tissues overlying
the bone on the US parameters. By combining US
data on cortical thickness with subject-specific
clinical information (Density index, DI) we predict
bone mineral density (BMD) at the femoral neck of
448 female subjects.
References
Asseburg C et al. Value Health 16:A5645, 2013;
Grassi L et al. J Mech Behav Biomed Mater
21:8694, 2013;
Grassi L et al. J Biomech Eng 134:090202, 2014;
Karjalainen JP et al. IEEE Trans Ultrason Ferroelectr
Freq Control 55:21917, 2008;
Karjalainen JP et al. Osteoporos Int 23:
128795, 2012;
Riekkinen O et al. Ultrasound Med Biol 34:
17038, 2008;
Vnnen SP Ph.D Thesis, University of Eastern
Finland 2014;
Vnnen SP et al. J Biomech 45:227983, 2012;
Vnnen SP et al. J Biomech 46:192832, 2013
For special health care, we calculate the strength

of the proximal femur by combining DXA images
with FEA (Finite element analysis) [Vnnen 2014].
The 3D shape and BMD distribution of the patients
femur are constructed from the DXA information,
and a FE model is built utilizing the reconstructed
femur with realistic loading conditions.
Results
Ultrasound. In 448 female subjects, DI correlated
significantly with the proximal femur BMD. When
implemented into Finnish care pathway with FRAX
(http://www.shef.ac.uk/FRAX/), DI provided highly
similar treatment suggestions as FRAX with femoral
389
P 030
MATERIAL AND STRUCTURAL PROPERTIES INFLUENCE

REFERENCE POINT MICROINDENTATION
T. Jenkins1, O. Andriotis2, O. Katsamenis3 , L. Coutts1, D. Dunlop4 , R. Oreffo5,
C. Cooper6 , N. Harvey6 , P. Thurner1,2
1
University of Southampton, Bioengineering Sciences, Southampton, United Kingdom

2
3
4
Vienna University of Technology, Institute for Lightweight Design and Structural

Biomechanics, Vienna, Austria
University of Southampton, muVIS X-ray Imaging Centre, Southampton, United Kingdom
University Hospital Southampton, Trauma and Orthopaedics, Southampton, United Kingdom

5
University of Southampton, Institute for Developmental Sciences,

University of Southampton, MRC Lifecourse Epidemiology Unit, Southampton, United Kingdom
Introduction
Reference Point Indentation (RPI) is a new
technique aiming to overcome limitations as well
as complement current fracture risk assessment
(i.e. bone mineral density and clinical factors)
tools by assessing bone quality measures such
as structural or material properties. RPI involves
a reference probe to identify the bones surface
and a test probe measuring parameters including
Indentation Distance Increase (IDI). RPI initiates
cracking [Diez-Perez, 2010], measuring a fracture
resistance property but this correlation is still unclear
[Granke, 2015 and Carriero, 2014]. Furthermore,
elastoplastic properties may be assessed [Gallant,
2013]. To clarify what property RPI assesses and aid
interpretation of the results this study applies: indent
imaging and correlation with material properties.
for OP donors, else p > 0.1 for the cadaveric group).

A correlation with imaged indent depth (r = 0.78,
p < 0.01) translates to a minimal relationship with
elastic modulus (r = 0.64, p = 0.02 for OP donors
only) and the previously reported strength and
toughness relationships [Gallant, 2013]. Structural
features; porosity (r = 0.93, p < 0.01), proximity to
the closest pore (r = 0.55, p = 0.03) and thickness
[Coutts, under review] also correlate with IDI.
Methods
The whitening front tracking method [Katsamenis,
2013] was applied to derive the fracture toughness
and elastic modulus of the inferomedial femoral
neck, the site of most clinically severe fracture.
35osteoporotic (OP resected following fracture)
and 32 cadaveric (C no fracture history) samples
were machined from 14 OP and 10 C donors. RPI
(Biodent Hfc , Active Life Scientific) was then
applied to these samples (5 measurements, 10 N,
2 Hz, 10 cycles). For comparison with material and
structural properties, individual indents were imaged
(3 OP, 4 C) using micro-computed tomography
(CT, Xradia Versa 510, Zeiss) and basic fuchsin
staining (10 OP, 6 C) followed by serial sectioning
(SM250, Leica Microsystems) and fluorescence
microscopy (FL, Axio Imager.Z1 m, Zeiss).
CT (left) and FL (right) indent visualisation
Discussion
RPI correlates with fracture, elastoplastic and
structural properties but is not indicative of any
individual measure. Correlation with elastic and
fracture properties in the osteoporotic but not
in non-fractured bone also further implies other
properties (e.g. structure and plasticity) influence
RPI. This technique thus has the potential to
measure multiple aspects of bone quality that
cannot currently be assessed clinically but requires
further development to aid interpretation and
subsequent application.
This study was carried out under Southampton REC

A ethical approval (12/SC/0325).
References
Carriero et al, Bone, 69C: 174179, 2014
Coutts et al, JMBBM, under review
Diez-Perez et al, JBMR, 25(8): 187785, 2010
Gallant et al, Bone, 53(1): 301305, 2013
Granke et al, J Bone Miner Res, in press
Katsamenis et al, Plos One, 8(2): e55641, 2015
Results
RPI has associated microdamage as visualised
with CT and FL, the length of which correlates
with IDI (r = 0.54, p = 0.03) and translates to a minimal
relationship with fracture toughness (r = 0.48, p = 0.09
390
P 0 31
DISCRETIZATION OF THE GAIT CYCLE TO ESTIMATE BONE

DENSITY IN A FEMUR WITH BONE REMODELING MODELS
J. Martnez-Reina1, M. Juana1, J. Ojeda1
1
Universidad de Sevilla, Mechanical Engineering, Sevilla, Spain
Introduction
Bone remodelling models (BRMs) have been widely
used to estimate the density distribution in bones
from the daily activity. Most of the BRMs found in
the literature study cyclic loads in a very simplistic
way. For example, in the gait cycle they consider
only one instant as representative of the whole
cycle. The objective of this work is to study the
effect of considering the variation of mechanical
stimulus through the gait cycle in the estimation of
the bone density.
Case
Instants considered
Mass (g)
340
1+2
236
1+2+3
211
Table 1: M
ass of the femur when the convergence was
achieved in the three cases.
Methods
A FE model of the proximal half of a right human
femur was built from CT data and analysed with
Abaqus FEA. The gait loads were taken from
Behrens, (2009) and consist in muscle and hip
reaction forces. The model was fixed in its distal
end.
The variation of the mechanical stimulus along
the gait cycle was considered by discretizing
the cycle (Vaughan, 1999). Three instants of the
support phase of the right leg were considered,
corresponding to 25, 45 and 65% of the gait cycle
(Behrens, 2009) (instants 1, 2 and 3, respectively).
Figure 1: Instant of the cycle when the peak of stimulus is

reached for each point (left: case 2; middle: case
3). Density distribution in case 3 (right). A section of
the femur is shown in all cases.
A previous anisotropic BRM (Doblar, 2006) was

modified to consider the variation of the stimulus
during cyclic loads. The evolution of the stimulus
was discretized (in the 3 instants) at each point
of the femur to calculate the maximum. The
remodelling response was based on the value of
that peak of stimulus.
Discussion
Results highlighted the importance of considering
the variation of mechanical stimulus during the
gait cycle. As the number of instants considered
increases, the peak of stimulus was better captured
for each point.
Three simulations were compared depending on

the instants considered to discretize the cycle (see
table 1). Case 1 is similar to old approaches, with
no discretization. In cases 2 and 3 more instants are
considered each time.
The density distribution was more realistic in case 3

(though cases 1 and 2 are not shown). Interestingly,
the mass of the femur decreases as the number
of instants increases and the difference between
successive cases is decreasing (converging).
Such decrease of mass reflects that bone is
more efficiently distributed in case 3. So, bone
is deposited where it contributes to increase the
global stiffness in an optimal way, with less weight.
Results
Table 1 shows the mass of the femur after the
convergence of bone density (variation of mass
lower than 0.2% between successive steps). Figure
1 shows the phase of the gait cycle where the
peak of the stimulus was reached in each point for
the cases 2 and 3. It also shows the final distribution
of density in case 3.
References
Behrens et al, (2009) Biomed Eng Onlin,8:19.
Doblar et al, (2006) J Biomech, 35:117.
Ojeda, (2012) PhD Thesis, Univ. de Sevilla.
Vaughan et al, (1999) Dynamics of Human Gait,
Kiboho Publishers.
391
P 032
MODELLING CYCLIC WALKING IN FEMURS WITH

METASTATIC LESIONS: FEMUR-SPECIFIC
ACCUMULATION OF PLASTICITY
L. Derikx1,2, D. Janssen1, J. Schepers3 , M. Wesseling2, N. Verdonschot1,4 ,
I. Jonkers2, E. Tanck1
1
Radboud university medical center, Orthopaedic Research Laboratory,

KU Leuven, Human Movement Biomechanics Research Group, Leuven, Belgium

3
Materialise N.V., Leuven, Belgium
University of Twente, Laboratory of Biomechanical Engineering, Enschede, Netherlands
Introduction
Clinical fracture risk assessment in metastatic bone
disease is extremely difficult, but subject-specific
finite element (FE) modelling may improve these
assessments in the future [Derikx, 2015]. By coupling
to musculoskeletal modelling, realistic loading
conditions can be implemented in FE analysis.
However, it is unknown whether such analyses
require complex elastic-plastic material models,
or whether a linear elastic calculation already
provides a reasonable prediction of fracture.
Moreover, plastic deformation may accumulate
over time, which is ignored by linear elastic
calculations. In this study we compared linear
and non-linear fracture predictions under realistic
loading conditions in two patients with metastatic
bone disease.
and eventually resembled the volume of elements

with SF<1 in the linear analysis.
Methods
Two patients (P1, P2) with lytic lesions were
included. Patient-specific femoral geometry and
bone density were retrieved from quantitative
CT-scans; the latter was used for implementing
element-specific material behaviour [Keyak, 2005].
Muscle forces and hip contact forces acting on
the femur during walking were calculated using
musculoskeletal modelling (one typical case,
adapted from [Wesseling, 2014]), and subsequently
normalized to the patients body weight. Muscle
forces were applied to attachment points that
were morphed onto the patient femurs. Hip
contact forces were applied to a cup mimicking
the acetabulum, via a control node in the hip joint
centre. Two simulations were run for each patient: a
linear elastic analysis simulating a single walk cycle
and a non-linear elastic-plastic analysis simulating
10 subsequent walk cycles. The safety factor (SF;
yield stress/Von Mises stress) and plasticity were
studied as measures of femoral failure in the linear
and non-linear simulations, respectively, and
compared between patients.
Figure 1: A
) Relative volume of elements with SF<1 in linear
elastic simulations. B) Relative volume of plastic
deformation in non-linear elastic-plastic simulations
(solid) and peak SF (dashed) for P1 and P2.
Discussion
These preliminary results suggest that accumulation
of plasticity under cyclic loading is femur-specific.
Due to the variable and local weakening of the
bone strength by metastatic lesions, relatively
small changes in magnitude or direction of loading
may initiate local failure and catalyze progressive
failure in subsequent loading cycles. Hence, in
some cases a linear analysis is sufficient, while in
others it is not. Non-linear material behaviour and
cyclic loading conditions are therefore required to
capture these phenomena.
Results
The volume of elements with SF<1 (Figure 1A) as
well as the volume of elements that underwent
plastic deformation (Figure 1B) was highest in the
femur of P1. In P1 the volume of plastic deformation
increased over the loading cycles and eventually
exceeded the peak volume of elements with SF<1
in the linear analysis. In P2, the volume of plasticity
more or less stabilized after two loading cycles,
References
Derikx et al, J Biomech, 2015. (in press)
Keyak et al, CORR, 437:21928, 2005.
Wesseling et al, JOR, 2014. DOI:10.1002/jor.22769.
This study was funded by the Dutch Cancer Foundation (KUN2012-5591) and NutsOhra (1102-071).
392
P 033
MULTISCALE GROWTH-RELATED CHANGES

IN STRUCTURE AND MATERIAL COMPOSITION
OF LOAD-BEARING BONES
Y. Bala1, E. Lefevre2, M. Pithioux2, H. Follet3 , V. Kaftandjian1
1
2
3
INSA Lyon, Laboratoire Vibrations Acoustique, Lyon, France
CNRS UMR 7287 Institut des Sciences du Mouvement, Equipe GIBoc, Marseille, France
INSERM UMR 1033, Pathophysiology, Diagnosis and Treatments of Bone Diseases, Lyon, France
Results
In our population of growing children, increasing
age was significantly associated with a lower
cortical porosity (r=0.86, p<0.001) originating
from a higher pore number (r=0.77, p<0.001) but
a decrease in their diameter (r=0.50, p=0.05).
At bone tissue level, increasing age correlated
with higher TMD (r=0.83, p=0.002) and lower
HI (r=0.50, p=0.04). Decomposing the cortex in
its osteonal and primary components, primary bone
had higher mineral and collagen maturities, higher
index of mineralization and higher crystallinity than
that assessed in osteonal bone (all p<0.02). These
differences resulted in primary bone having higher
Hv than osteonal bone (p<0.001). In osteonal
bone, neither the material composition nor the
mechanical properties of osteonal bone were
age-dependent. Confined to the primary bone,
the mineralization index (r=0.64, p=0.02), the
collagen maturity (r=0.58, p=0.03) and the Hv
(r=0.5, p=0.05) were positively correlated with
increasing age.
Introduction
In addition to bone mass and architecture,
material composition is a critical determinant
of bone strength. During growth, human bone
is a metabolically active tissue that is not only
modeled (i.e., addition of new bone without prior
resorption) to acquire its size and geometry but
also remodeled. During remodeling, primary bone
is resorbed and replaced by new bone matrix.
Modeling and remodeling are regionally regulated
by the complex strain environment allowing bone
to adapt to its mechanical function. However,
growth-related changes in material composition in
load-bearing bones are not known. In order to bring
new insights in understanding skeletal adaptation
during growth, we proposed to characterize
cortical bone structure and material composition
in bone sample taken from growing children.
Methods
Fibula bone samples from 12 children (416 y.o.,
mean age: 9.5 3.4 y.o) were extracted during
lower limb surgery. Samples were included in resin
and sectioned in 100-m and 2-m-thick slices.
Microradiography of the 100-m thick sections
allowed at the tissue level the assessment of
cortical microstructure (porosity, pore number
and pore size) and tissue mineral density (TMD in
g/cm3) as well as its heterogeneity (HI in g/cm 3).
Two-m-thick sections were used to assess material
characteristics as mineral and organic maturities,
the index of mineralization as well as crystallinity
(Size/perfection of mineral particles) using Fourier
Transform Infra Red Micro spectroscopy (FTIRM)
[Bala, 2012]. The remaining part of the sample
was used for indentation testing to assess hardness
(Hv, Kg/mm 2, 25g load applied during 10s). Hv and
FTIRM assessments were performed in 10 osteons
(i.e., the bone tissue unit resulting from remodelling
cycle) and 10 area of primary bone (i.e., primary
bone deposited during modelling).
Discussion
Within the limitations of a cross-sectional study and
a small sample size, we reported that load-bearing
long bone growth is associated with modeling
and remodeling-mediated multiscales changes
in cortical structure and material composition.
Remodeling activity fashions a microstructure with
more but smaller pores decreasing the overall
porosity while maturation of primary bone drive
the accumulation of more mature and more
mineralized matrix having higher hardness. We
propose that these changes are likely to explain
the age-related increase in elastic and shear
moduli observed in the same children [Lefvre et
al, 2015].
References
Bala et al, J Bone Miner Res, 27:110, 20012.
Lefvre et al, Abstract ESB Meeting 2015.
393
P 034
MICRO-CT VALUES VERSUS MATERIAL PROPERTIES

OF BONE OVER A VERY BROAD RANGE
OF MINERALISATION LEVELS
G. Adams1, R. Cook2, J. Hutchinson3 , P. Zioupos1
1
Cranfield Univeristy, Cranfield Forensic Institute, Swindon, United Kingdom

2
University of Southampton, National Centre for Advanced Tribology,

RVC University of London, Comparative Biomedical Sciences, Hatfield, United Kingdom
Introduction
When investigating bone diseases, fractures and
treatments, determination of the mechanical
properties of bone is of great clinical and biological
importance. With advancements in state of the art
medical imaging and Finite Element (FE) modelling
we are approaching patient specific FE based
fracture risk analysis. Before this can be achieved
fundamental relationships between voxel based
imaging, computed tomography (CT), and
materials properties of bone must be established.
Assessment of the materials properties of bone
by nano indentation and CT to be used in FE
simulations has previously been performed using
the average material modulus (Chevalier, 2007).
This can be taken a step further by determining the
material properties of each voxel based in relation
to its density.
a QRM-MicroCT-HA calibration phantom. Hounsfield

units were also derived from the image data
(Mah, 2010).
Results
The preliminary data shows that there are large
variations in the density and hardness between
the samples, which cover most naturally occurring
physiological ranges of bone density. They also
show that there is a large intra-sample variability
suggesting voxel-hardness measurements will
provide a more accurate correlation between
density and hardness.
Discussion
Analysis of a voxel by voxel hardness rather than
average sample hardness could prove to be
useful in development of FE models. Development
of such FE models could lead to use of patient
specific analysis more often and yield more
accurate fracture risk prediction. Although human
tissue was not part of this analysis, human bone
sits nicely in the middle of this very broad range
of mineralisation states and therefore it is also
covered by this approach
Methods
Six samples were taken from six different animals
covering a range of mineral contents: Mesoplodon
densirostris rostrum, tympanic bulla of a whale,
bovine femur, elephant tusk dentine, deer
antler and nacre (mother of pearl). A slice on
each sample was ashed at 600 C for 6 hours to
determine mineral content. The remaining samples
were mounted in epoxy resin and imaged using CT
(XT H 225, X-Tek Systems Ltd). Nano-indentations
were performed using a CSM-Nano Hardness Tester.
The density of the samples was determined using
Sample
Mean
(g/cm 3)
References
Chevalier, Y et al, J Biomech 40:33333340, 2007.
Mah, P, et al, Dento Maxillo Facial Radiology 39:
323335, 2010
Min content
w/w(%)
Hardness
Vickers
Modulus
(GPa)
Hounsfield
Nacre RC
2.8 1.2
[9899]
[264272]
[6466]
15621 405
Rostrum RC
2.7 1.2
[9294]
[235265]
[6070]
14258 463
Bulla RC
2.3 1.2
[8284]
[100200]
[3045]
10503 131
Bovine RC
2.2 1.1
[6567]
[6090]
[2628]
9566 255
Tusk RC
1.9 1.1
[4648]
[4246]
[1618]
7016 103
Antler RC
1.9 1.2
[4044]
[3750]
[1017]
6171 290
Table 1: Preliminary data on the material and structural properties of a wide range of bone samples
394
P 035
THE CHANGING MICROARCHITECTURE OF TRABECULAR

BONE WITH HIGH STRAIN COMPRESSION
R. Wallace1, K. Manda2, E. Sales2, P. Pankaj2, H. Simpson1
1
2
University of Edinburgh, Orthopaedics, Edinburgh, United Kingdom
University of Edinburgh, Institute of Bioengineering, Edinburgh, United Kingdom
Introduction
Trabecular bone is a load bearing and shock
absorbing material found at the ends of long
bones, vertebrae and flat bones. Its complex
micro-architecture
and
biphasic
individual
constituents hugely affect the macro mechanical
behaviour of the. Although trabecular bone
yields at small strains, large deformation analysis is
necessary to understand the failure mechanisms.
In this study we performed large compressive tests
on trabecular bone samples from human femoral
heads and assessed the microstructural indices.
The specific aim of this study was to determine if
there are any changes in the alignment or structure
of the trabeculae during loading. Changes in the
morphometry will elucidate how strain is distributed
through the structure.
statistically significant difference (SSD). The results

of this analysis are shown in table 1. Properties that
do not share a letter are said to be SSD.
On all 6 samples, a paired t-test compared the
values (not normalised) pre and post compression.
SSD in BV/TV (p = 0.049) was found, implying that
the bone does not return to the pre deformation
structure. No other property displayed a SSD when
comparing preload with post-load.
BV/TV
Methods
6 cores with a diameter 10.64 mm and a mean
length of 12.15 (0.65) mm were extracted from
3 human femoral heads (mean age 68 6). These
were inserted into a compression stage mounted
in a Skyscan 1172 microCT (SkyScan, Kontich,
Belgium) and scanned with a preload of 5N. Load
was applied at a rate of 0.01 mm/s. In 3 cases,
scans were conducted pre and post loading only
(2 anterior, 1 posterior). In the remaining samples
(2 central and 1 posterior) the samples were held
and scanned at displacements equivalent to 2%,
4%, 6%, 8% and 10% strain. After full unloading,
another scan was taken for all samples. A voxel
resolution of 17.22m was used throughout.
SMI
Tb.Sp
DaA
Mean
Sig
Mean
Sig
Mean
Sig
Mean
Sig
pre
100%
AB
100%
AB
100%
100%
2%
100%
100%
AB
100%
106%
4%
99%
97%
BC
101%
108%
6%
101%
AB
95%
BC
98%
107%
8%
103%
AB
94%
BC
95%
107%
10%
104%
91%
93%
109%
post
103%
AB
106%
93%
101%
Table 1: N
ormalised results and statistical significance
(found where values do not share a letter)
Discussion
During loading, the alignment of trabeculae was
altered with respect to its original state, resulting
in a change in the degree of anisotropy. The
qualitative movement of trabeculae between
unloaded and 10% strain is shown in Figure 1.
Frequently, implants under load in the body
are considered for finite element analysis. The
morphometry/bone architecture for this analysis is
assessed in unloaded situations. Our data indicates
significant changes in architecture under load. If
trabeculae are modelled as a continuum (as in
most large scale models) the changing architecture
would result in different properties under load than
would be derived from the unloaded scan data.
This may affect how the load around an implant
is distributed. This problem is magnified when we
look at the bone architecture peripheral to the
principal loading axis of the femoral head.
A region of interest of 570 pixels (equivalent to a

9.8 mm circular shape) was used to determine;
Percent bone volume (BV/TV, %), Structural model
index (SMI), Trabecular separation (Tb.Sp, mm)
and Anisotropy (DM) using CTan (SkyScan, Kontich,
Belgium).
Results
In order to facilitate comparison the data for
each specimen was normalised with respect
to the preload. The data was analysed using an
ANOVA (Tukey) with a p value < 0.05 indicating a
395
P 036
MAPPING ANISOTROPY OF THE PROXIMAL FEMUR FOR

ENHANCED IMAGE BASED FINITE ELEMENT ANALYSIS
W. Enns-Bray1, J. Owoc1, K. Nishiyama1, S. Boyd2
1
2
University of Calgary, Biomedical Engineering, Calgary, Canada
University of Calgary, Department of Radiology, Calgary, Canada
with directionality interpolated from the map of

anisotropy. Models were loaded in a sideways
fall configuration and the resulting whole bone
stiffness was compared to experimental stiffness
and ultimate strength. Anisotropic models were
consistently less stiff, but no statistically significant
differences in correlation were observed between
material models against experimental data. The
mean difference in whole bone stiffness between
model types was approximately 26%, suggesting
that anisotropy can still effect considerable
change in the mechanics of proximal femur models.
The under prediction of whole bone stiffness in
anisotropic models suggests that the orthotropic
elastic constants require further investigation. The
ability to map mechanical anisotropy from highresolution images and interpolate information into
clinical-resolution models will allow testing of new
anisotropic material mapping strategies. [1]
The following abstract is an excerpt from the

study of the same title, published in the Journal of
Biomechanics in 2014:
Finite element (FE) models of bone derived from
quantitative computed tomography (QCT) rely on
realistic material properties to accurately predict
bone strength. QCT cannot resolve bone microarchitecture, therefore QCT-based FE models lack
the anisotropy apparent within the underlying
bone tissue. This study proposes a method for
mapping femoral anisotropy using high-resolution
peripheral quantitative computed tomography
(HR-pQCT) scans of human cadaver specimens.
Femur HR-pQCT images were sub-divided into
numerous overlapping cubic sub-volumes and the
local anisotropy was quantified using a directmechanics method. The resulting directionality
reflected all the major stress lines visible within
the trabecular lattice, and provided a realistic
estimate of the alignment of Harvesian systems
within the cortical compartment. QCT-based FE
models of the proximal femur were constructed
with isotropic and anisotropic material properties,
References
[1] Enns-Bray W., et al., J Biomech, 2014, 47:
32723278.
396
P 037
FINITE ELEMENT ESTIMATES OF BONE STRENGTH FROM CT:

PERSPECTIVE, OR JUST RETROSPECTIVE?
F. Taddei1, E. Schileo2
1
2
Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy
Introduction
Finite Element (FE) estimates of bone strength
from Computed Tomography (CT) data have
been developed for almost 30 years now. They
have been extensively validated against in vitro
experiments, and ultimately applied to clinical
studies.
How can we think of improving CT-based FE

models?
working on image processing to reduce CT
deblurring [Pakdel, 2014] and/or accurately model
cortical bone [Treece, 2015]. If not revolutionary,
this is a very promising field, and the first
applications are already underway. Vertebral and
femoral application may equally benefit from it.
When comparing FE strength estimates to DXA-derived bone mineral density in bone fracture
studies, only few studies reported a clear advantage
in classifying cases from controls [Falcinelli, 2014].
Consequently it is debated if the (moderate)
advantage FE models bring [Kopperdahl, 2014] is
worth the higher dose and effort they imply.
improving bone failure models, with special

regard to fracture mechanics approaches. Some
work has already been performed in this sense [Ali,
2014]. However, the biggest step required in this
perspective would be to find the way to personalise
information on bone toughness, possibly leveraging
on basic bone research.
A key finding from the literature is that validation

studies from different groups, using different,
sometimes radically different models, have
reached an impressively similar, and yet not
optimal, level of accuracy [Schileo, 2014]. This may
be interpreted as an implicit demonstration that
a ceiling-effect in results has been reached, i.e.
most of bone-related information in CT has already
been fully exploited.
clever coupling with (i) muscoloskeletal (MS)

and (ii) remodelling models. The link between
muscle&bone
is
becoming
manifest
from
biochemistry to exercise studies. We have already
demonstrated at a population level the potential
of coupling FE and MS models [Taddei, 2014], now
we would need to integrate it in a personalised
approach. As to remodelling models, it could be
time to use some of the few available that do not
require full micro-scale information [Colloca, 2014],
to verify if they can yield consistent predictions in
clinical longitudinal studies.
So while we are moving to micro-modelling in

vivo, which however will likely take some years
to be applicable to the axial skeleton, the
question is: should we look at CT-based FE models
prospectively, or just retrospectively?
R e s e a r c h h yp o t h e s i s
Our research hypothesis for the coming years is that
we are far from the full exploitation of CT-based FE
models. This hypothesis comes with some ideas on
how to proceed, and together with a proposal to
rethink the role of these models.
C o n cl u d i n g r e m a r k s
In summary, we would like to stress the many open
opportunities to improve the field of CT-based FE
models of bone strength. But what should these
models be used for? Despite what was often
suggested, we believe they cannot be, at least
with the current technologies, a screening tool for
the risk of bone fracture in osteoporosis, even if they
may be used as second level diagnostic (e.g. risk
of second fracture). Conversely, we are convinced
that they can be of great help in research studies
trying to link bone strength and bone metabolism,
and understanding bone involvement in different
pathologies.
References
A
li et al, J Biomech, 47:53643, 2014
C
olloca et al, Bone 64:30313, 2014
F alcinelli et al, Bone, 67:7180, 2014
K
opperdahl et al, JBMR 29:57080, 2014
P
akdel et al, Med Phys 41:011906, 2014
S chileo et al, J Biomech, 47:35318,2014
T addei et al, J Biomech, 47:343340, 2014
T reece et al, Med Image Anal 20:24964, 2015
397
P 038
DIGITAL IMAGE CORRELATION CAN ACCURATELY

MEASURE SURFACE DISPLACEMENTS
ON TRABECULAR BONE
L. Falco1, G. Lionello1, M. Baleani1
1
Introduction
An accurate measurement of displacements
occurring in trabecular microstructure undergoing
loading conditions is crucial for determining the
mechanical properties of bone tissue. Time-elapsed
three-dimensional displacement field of the
microstructure can be obtained through microCT.
Time-elapsed microCT however forces to adopt
incremental loading, and thus neglects the stressrelaxation actually occurring in the trabecular
microstructure. Alternatively, the displacement
field can be measured using digital image
correlation (DIC). This method allows dynamic
imaging of the three-dimensional displacement
field, although only on the visible surface. This
study investigated the feasibility and the accuracy
of DIC in determining surface displacements of
human trabecular bone microstructure.
of the specimen previously monitored by DIC.

Therefore four load-displacement curves were
obtained for each side.
Relative DIC displacements, between the exact
locations (height levels, circumferential position)
of the extensometer arms attachment, were
computed for each displacement map. When the
difference between the two displacement values,
calculated for the same specimen side, exceeded
4m, the data were excluded. The reference value
of the relative displacement was the average of the
four measurements collected by the extensometer
at the same load levels of DIC acquisitions. The four
values were also used to estimate the precision of
the extensometer technique.
Results
During the experimental sessions, technical errors
occurred in testing 3 specimens. DIC data collected
on 4 out of the 34 remaining specimen sides were
excluded for the criterion about DIC measurement
precision. In these cases, DIC showed a high
gradient in the displacement values at local level.
Methods
The accuracy of DIC was determined comparing
DIC-calculated displacements with those measured
with the current gold-standard procedure, i.e.
an extensometer directly attached to the tissue
[Keaveny, 1997].
In 17 out of the 30 remaining cases, the differences

between DIC and extensometer were within 3 m,
i.e. comparable with the precision of the current
gold-standard. The maximum difference was 8 m
(2 cases).
Twenty trabecular specimens (diameter: 10 mm;

height: 26 mm) were extracted from the distal
femora of five subjects. Before testing, the
specimen ends were embedded in acrylic resin
(end-cap technique) leaving a free length of
20mm [hman 2007]. A highly-contrasted speckle
pattern was created on the sample surface using
a water based white paint (background) and an
acrylic black paint (pattern).
Discussion
This study demonstrated the feasibility and
accuracy of the DIC in measuring surface
displacements of trabecular bone microstructure.
In fact, this technique has been recently used to
obtain experimental displacement map useful
to evaluate finite element model predictions
[Cyganik 2014]. However, attention must be paid to
the precision of DIC map in highly heterogeneous
specimens.
Monotonic axial compression tests were performed

under displacement control. Since simultaneous
measurements with the two techniques are not
possible, each specimen underwent two series of
test. Each series consisted of four cycles up to 0.5%
strain. In the first series, DIC was used to obtain the
surface displacement field of the opposite sides of
the specimen. DIC monitored the first side during
the first two cycles and then the opposite side in
the last two cycles obtaining two repetitions per
side. In the second series, two extensometers were
simultaneously mounted on the two opposite sides
References
Cyganik et al, J Mech Behav Biomed Mater,
36:120134, 2014.
Keaveny et al, J Orthop Res, 15:101110, 1997.
hman et al, J Biomech, 40:24262433, 2007.
398
P 039
A NOVEL BEAM PROJECTION MODEL FOR EFFICIENT

EXTRACTION OF BONE STRUCTURAL PROPERTIES
C. Collins1, K. Suresh1, H.L. Ploeg1
1
University of Wisconsin-Madison, Mechanical Engineering, Madison, USA
Introduction
Destructive mechanical testing is commonly used
to characterize bone mechanical and structural
properties, since it reliably measures bone stiffness
and strength. However, the accuracy of derived
bone mechanical properties is limited by assumed
simplified and uniform cross-sectional geometries
along the bone. Medical image-based structural
analysis methods, in contrast, provide accurate
section geometry along the length of the bone.
Further, medical image-based finite element
analysis (FEA) predicts the three-dimensional (3D)
mechanical behaviour of bone. Although 3D FEA
is arguably the most accurate and informative of
these methods, it is also the most costly in time and
resources. Therefore, the purpose of this research
was to present a beam projection approach to
efficiently determine bone structural properties
directly from medical image data.
(84 mm outer, 44 mm inner diameter) were analysed.

To test the sensitivity of the analytical beam model
to non-uniform cross-sectional geometry (HCN) a
central 500 mm long section was removed from
the HC. The results of the medical image-based
bending analyses were compared to those of
EB beam theory of a HC in cantilever bending and
3D FEAs.
Results
The calculated deflections from the 1D beam
model were 2% less and 24% greater than EB theory
for the HC and HCN, respectively. In comparison,
the 3D FEAs converged on tip deflections with less
than a 0.5% and 20% difference from EB beam
theory (Figure 2).
Methods
In the proposed method (Figure 1) the bone
geometry is directly captured from medical image
data using a 3D voxel mesh and a user-defined
image-density threshold. The beam bending
stiffness matrix is determined by an algebraic
reduction method (Jorabchi, 2010) from the
voxel coordinates and density data. This stiffness
matrix is projected onto 1D virtual beam elements,
governed by 1D Euler-Bernoulli (EB) beam theory,
under cantilever bending using a custom-made
algebraic reduction algorithm in MATLAB.
Figure 2: P
ercent difference in deflection between the 1D
beam models and 3D FEAs and EB beam
theory vs DOF for the HC and HCN.
Discussion
The 1D beam model required significantly less DOFs
to converge than the 3D FEAs; and, the 1D beam
model converged on a tip deflection for the HCN
only 4% less than the 3D FEAs. The 2% difference
in deflection of the 1D HC beam compared to EB
is due to voxelization. In conclusion, the results of
this study show that the proposed beam projection
model can be used to efficiently and accurately
determine mechanical behaviour directly from
medical image data.
Figure 1: S chematic of proposed approach demonstrated

on a mouse femur in bending.
To evaluate the proposed combination of beam

bending theory and medical image data, Digital
Imaging and Communications in Medicine
(DICOM) images (1 mm 3 voxels) of a hollow,
homogeneous, 1000 mm long cylinder (HC)
References
Jorabchi et al., Computer-Aided Design,
42(9):808816, 2010.
399
P 040
HIGH RESOLUTION ANALYSIS OF MINERAL DENSITY

AND GEOMETRY IN HEALTHY AND FRACTURED HUMAN
FEMORAL NECK CORTICAL BONE
L. Coutts1, T. Jenkins1, D. Dunlop2, R. Oreffo3 , C. Cooper4 , N. Harvey4 , P. Thurner5
1
2
3
4
University of Southampton, Faculty of Engineering and the Environment,

University Hospital Southampton NHS Trust, Southampton, United Kingdom
University of Southampton, Faculty of Medicine, Southampton, United Kingdom
University of Southampton, MRC Lifecourse Epidemiology Unit, Southampton, United Kingdom

5
Vienna University of Technology, Institute for Lightweight Design and Structural

Biomechanics, Vienna, Austria
Introduction
Evaluation of patient susceptibility to bone
fracture and assessment of treatment response
is currently limited to bone densitometry and
imaging techniques such as dual energy x-ray
absorptiometry (DXA). This study aimed to
investigate whether densitometry, if performed to
greater detail than currently used for diagnosis,
may have potential to inexpensively improve
fracture risk assessment.
the infero-medial section, to thinnest at the

supero-lateral region (mean for controls 4.3 mm
and 1.7mm respectively). Cortical BMD followed a
similar trend, but to a lesser extent for fracture than
controls, between the thicker infero-medial and
the thinner supero-lateral regions. This behaviour is
illustrated in Figure 1, where average femoral neck
BMD, when normalised to the maximum BMD found
in the infero-medial section, is higher (p < 0.001,
t-test) in those with a history of fracture, i.e. BMD
appears to vary less within fractured femoral necks
than controls. Data is shown against standard
clinical femoral neck BMD on the horizontal axis,
showing how such novel regional analyses may
be combined with current clinical methods as a
potential method for improving diagnosis.
Methods
Sixteen cadaveric whole femur samples (age range
57 to 92, free from bone disease) and 7 femoral
neck samples from hip fracture surgery following
trauma (age range 70 to 89) were acquired from
both male and female subjects (ethical approval
12/SC/0325). Whole proximal cadaveric femurs were
imaged (225 kV X-TEK/Nikon Metrology HMX ST) at
dual energies (100 & 140 keV), to replicate a clinical
DXA bone mineral density (BMD) measurement
of the femoral neck. For all samples, 7 mm thick
femoral neck slices were cut (mean slice thickness
standard deviation within slices was 0.53 mm)
and imaged at dual energies (100 & 140 keV),
to produce high resolution density images of
neck slices, allowing regional cortical BMD and
thickness around the femoral neck circumference
to be analysed. Of the seven hip fracture surgery
subjects providing neck samples, three later
returned for clinical DXA scans of the contralateral
femoral neck, acquired using a Hologic Discovery
A (MA, US). Further clinical DXA femoral neck scan
data were also acquired from a separate group
of 15 subjects, recently also undergoing surgery for
femoral neck fracture, age range 59 to 90.
Figure 1: F emoral neck BMD normalised to infero-medial

BMD, for both (left) fractured (mean 0.930.11)
and control (0.630.14) in vitro neck slice samples
and (right) in vivo fracture subjects contralateral
whole femoral neck (0.410.05), and in vitro control whole femoral neck (0.280.10) (as per
clinical technique).
Discussion
Substantial spatial variation was observed in
cortical BMD and thickness around the femoral
neck. More localised analysis of density through
the femoral neck offers potential to improve the
accuracy of predicting likelihood of hip fracture.
Results
Cortical thickness varied around the femoral neck
circumference for both control and fractured
samples, reducing from the thickest region within
400
P 0 41
CT BASED HIP CARTILAGES HEXAHEDRAL MESH TO USE

ON COMPRESSION FINITE ELEMENTS MODELS
I. Mariaka1, J.F. Ramrez2
1
2
Master Student, Mechanical Engineering, Medelln, Colombia
Universidad Nacional de Colombia, Mechanical Engineering, Medelln, Colombia
Introduction
One of the requirements for finite element analysis
is the use of a geometry as close as possible to the
real one. 3D reconstruction from CT can achieve
this objective; however, it is not the best option
when cartilage is involved.
needed in height and length for every pair of

surfaces, the thickness was always stablished in four
elements that corresponded to 1mm [Shepherd et
al., 1999] and [Naish et al., 2006].
Results
Figure 2 shows the hexahedral mesh obtained for
the acetabular cartilage. The same procedure
was made for the femoral cartilage; the round
ligament hole was created by the elimination of
some elements, Figure 2.
Hip cartilages were constructed from their

respective articular surfaces, hip for the acetabular
cartilage and femur for the femoral cartilage;
previously obtain by simple CT.
Method
Over the hip, a curve was draw to demarcate
the acetabular surface; taking into account, the
specific shapes [Matej et al., 2005]. On the femur
a three point plane was used to differentiate the
femoral zone on the head, obtaining a surface
with the same geometry as the bone [Anderson et
al., 2010], Figure 1.
Figure 2: A
cetabular cartilage hexahedral mesh and construction of the round ligament hole.
Discussion
Although the meshes created have constant
thickness, which it is not accurate for hip cartilages;
this geometries have worked appropriately in finite
element analysis to determine cartilage stress
[Snchez Egea et al., 2014]. Therefore, this method
could be considered successful to obtain hip
cartilage geometry.
Figure 1: C
artilages demarcation.
Acetabular surface (S1) was divided in quadrilaterals and an equidistant surface (S2) was created by
using SalomeMeca software. Every square on S1
was joint with the respective pair in S2, until all the
squares were paired. Finally, the union of S1 and S2
creates the solid form of the acetabular cartilage.
References
Anderson et al, Journal of Biomechanics 43: 135157.
Matej et al, Journal of Anatomy 207: 8591.
Naish et al, Osteoarthritis and Cartilage 14: 96773.
Snchez Egea et al, Clinical Biomechanics.
29:444450.
Shepherd et al, Annals of the Rheumatic Diseases
58: 2734.
For the generation of a hexahedral mesh, the

program calculated the number of elements
401
P 042
DIC-BASED NUMERICAL ASSESSMENT OF ELASTIC

PROPERTIES OF TRABECULAR BONE
M. Pani1, C. Lavecchia1, F. Luigi1, I. Gianluca1, S. Enrico1, B. Fabio1,
B. Massimiliano1, T. Fulvia1
1
Introduction
When coupled with uniaxial compression tests,
linear Finite Element (FE) models based on MicroCT-based can assess elastic modulus of the trabecular
bone tissue [Van Rietberghen, 1995]. Values at tissue
level (Et) are derived by matching experimentally
derived and numerically calculated elastic moduli
at apparent levels (Eapp). Axial strains are usually
obtained by an extensometer [Keaveny, 1997].
The highly irregular micro-structure and the porous
surface might produce artifacts in these few pointwise measurements. Recently, we managed to
apply Digital Image Correlation (DIC) to accurately
measure trabecular bone displacements, making
it possible to monitor micro-scale displacements
over a whole aspect of a specimen. Aim of this
work is to present a method to assess Et by tuning
linear microFE models with extended displacement
measurements based on DIC.
to microCT scanning. DIC displacements were

filtered to eliminate out-of-surface DIC artifacts
and correlated with microFE displacements at
the corresponding location. The FE results were
then scaled so that the slope of the DIC-FEM
regression line was unitary. Et was finally obtained
by matching the experimentally applied load
with the scaled nodal reaction of the FEM model
(linearly dependent on the elastic modulus set for
the tissue). Corresponding Et values were obtained
considering the average axial strains assessed by
extensometers.
Results
An high correlation was obtained between
MicroFE-derived and experimentally measured
displacements (average R2=0.86, CoV=7.3 %). The
mean Et found using extensometers and DIC was
similar, but Et from extensometers showed a far
larger variability (Table1).
Methods
Nineteen cylindrical samples (20 mm free length,
10 mm diameter) severed from the distal human
femur of four donors (BV/TV range: 12.9430.68%)
were microCT scanned (19.5 micron resolution).
mean
Non-destructive
uni-axial
compressive
tests
were performed with gold-standard procedures
(bone cement end-caps, four test repetitions).
Axial strains were measured by extensometers
symmetrically placed on opposite aspects. At a
90 shifted aspect, full-field displacements were
detected with DIC.
Et_Ext [GPa]
Et_DIC [GPa]
17.0
18.1
min
3.0
14.2
max
49.6
27.3
SD
13.2
3.5
Table 1: F E-derived Et values obtained by point-wise

measurements of extensometers (Et_Ext) and by
displacements fields detected using DIC (Et_DIC)
Discussion
The average Et found was realistic and non dissimilar
between the two techniques. The huge variability
and the peak values observed in Et_Ext are instead
likely related to measurement artefacts. On the
contrary, high FEM-DIC correlations corroborate
Et_DIC estimates, suggesting that it could
constitute a reliable technique to assess inter and
intra-subject variability of Et.
Isotropic hexahedral microFE models (39 micron)

were directly derived from binarized subsampled
microCT images. Nodes beyond the free length
were constrained, applying null displacements
on the lower end-cup and constant axial
displacements on the upper one.
The displacement field obtained by DIC constituted
a cloud of points (range 50009000) distributed
over a regular lattice on the visible surface of
each specimen. Each cloud was approximated
(least squares) with a cylindrical surface that was
then registered over microFE models through a
set of spheres glued on specimen end-caps prior
References
Van Rietbergen et al., J. Biomech. 28, 1995
Keaveny et al. J Orthop Res. Jan 15(1), 1997
Arbenz et al., Int. J.Num. Meth. in Eng., 73 (7), 2008
Cyganik et al., Mech Behav Biomed Mater. 36, 201
402
P 043
LOCAL OSTEOPOROSIS AND ITS EFFECTS

ON ANTI-RESORPTIVE DRUG TREATMENT: A 3-YEAR
FOLLOW-UP FINITE-ELEMENT STUDY
IN RISEDRONATE-TREATED WOMEN
T. Lee1, A. D.2
1

2
National University of Singapore, Department of Biomedical Engineering,

Singapore, Singapore
Introduction
Osteoporosis remains a prevalent problem
amongst the elderly. Its prevalence is known to vary
from 1020% in patients aged 50 years and older,
depending on race and assessment methods.
Currently, bone mineral density (BMD) obtained
from dual X-ray absorptiometry (DXA) is the golden
standard in diagnosing osteopenia (1.0 < t < 2.5)
and osteoporosis (t > 2.5). However, following
osteoporosis therapy, increases in BMD can be
deceptive. Although hip fracture risk can be
reduced with the aid of drugs, treated patients still
face considerable risk as most people who sustain
hip fracture do not have generalised osteoporosis
[1]. This necessitates a study of the local distribution
of bone mass which contributes to the geometry
and consequently the bone strength.
Figure 2: A
typical femoral neck cross-section of a subject
Results and Discussion This is further validated by
finite element analysis where critical strain regions
were predicted at similar zones and this is coherent
with the fact that reduced thickness of the cortical bone has been related to increased risk of
fracture initiation [2]. Hence, from individual radar
plots, we can determine if the effect of drugs had
outweighed the effect of aging and thus propose
a course of treatment drug better suited for the
patient in the clinical scenario.
Methods
By identifying the respective regions in the femoral
neck as illustrated in Figure 1, the geometric
changes were localized and differed between
each patient, leading to the conclusion that drug
treatment elicits local changes in Rmean and CTmean
(Fig. 2).
Discussion
Clinically, little conclusion can be drawn from just
the BMD in osteopenic/ osteoporotic patients.
This emphasizes the necessity of using geometry
and structure to predict fracture risk. Thus, we
believe that focusing on a patient specific analysis
for clinical diagnosis will improve diagnosis of
osteoporosis and ultimately fracture prediction.
References
K. E. S. Poole, G. M. Treece, P. M. Mayhew,
J. Vaculik, P. Dungl, M. Horak, J. J. Stepan,
and A. H. Gee, PLoS One, 7, e38466 (2012).
C. C. Gler, S. R. Cummings, A. Pressman, J. Li,
K. Gler, K. G. Faulkner, S. Grampp, and
H.K. Genant, J Bone Miner Res, 9, 671677 (1994).
Figure 1: S chematic representation of the cross-section of

femoral neck showing the four regions
403
P 044
INVESTIGATION OF THE LOWER LIMB MORPHOLOGY

AND DENSITY IN CHINESE AND UK POPULATIONS
J. Shi1, M. Heller1, D. Barrett2, B. Ji3 , Q. Yang4 , D. Dunlop2, L. King5, M. Browne1
1

2
Southampton University Hospital, Department of Orthopaedics,

Shandong University, School of Control Science and Engineering, Shandong,

Shandong Provincial Hospital Affiliated to Shandong University, Galactophore and Thyroid

Surgery Ward, Shandong, China Peoples Republic
Southampton University Hospital, Oncology Imaging Suite, Southampton, United Kingdom
Introduction
A number of factors affect the performance of hip
and knee arthroplasty, including bone material
properties and geometry, patient activity, implant
size and surgical procedure. The lower limb
morphology in particular will dictate the choice of
implant. In the present study, cohorts of Chinese
and UK patients are assessed for differences in
lower limb geometry and density.
the UK cohort (blue line Figure 1a), however,

there was no significant difference for the tibial
aspect ratio. Figures 1b and 1c indicate that there
is interdependency between varus angle and M/L
density ratio for the Chinese population. This effect
is more pronounced when the tibial plateau is used
as a reference rather than the leg varus angle.
Methods
CT scans of 30 Chinese patients (21 male, age
4480yrs; 9 female, age 2476yrs) and 80 UK
patients (56 male, age 1798yrs; 24 female,
age 35106yrs) were segmented using ScanIP
software and 3D geometries of the lower limb were
reconstructed. The bones (femur, tibia, patella and
fibula) were aligned to the full extension position
with the tibia positioned to maintain an equal
gap between the tibia and femur on medial and
lateral side. The patella was positioned to maintain
a constant patella tendon length. Customized
Matlab scripts were used to measure lower limb
morphological parameters. Density data was
also acquired for all bones. Table 1 compares the
femoral and tibial dimensions of the two cohorts.
Table 1 shows that the average femoral and tibial
dimensions of the Chinese cohort are smaller than
those of the UK cohort. The Chinese population
(red line) had a higher femoral aspect ratio than
Chinese
UK
Femoral length (mm)
434.622.6
464.231.3
Distal femur width (mm)
80.94.7
84.27.0
Distal femur depth (mm)
63.23.7
66.95.6
Tibial length (mm)
358.917.3
383.431.6
Tibial medial
posterior slope()
4.61.8
3.31.9
Tibial plateau width (mm)
76.14.1
78.26.3
Tibial plateau depth (mm)
55.64.0
57.14.6
Leg varus(+)/valgus(-) angle()
-2.80.7
-3.50.9
Tibial plateau
varus(+)/valgus(-) angle
1.11.8
1.52.0
Table 1: C
omparison of femoral and tibial dimensions of
Chinese and UK populations
Figure 1: C
omparison of morphological and density parameters of Chinese (red) and UK (blue) populations
404
P 045
ARTICULATED STATISTICAL SHAPE MODELS OF THE LOWER

LIMBS OF CHINESE AND BRITISH POPULATIONS
J. Shi1, M. Browne1, D. Barrett2, B. Ji3 , Q. Yang4 , D. Dunlop2, L. King5, M. Heller1
1

2
Southampton University Hospital, Department of Orthopaedics,

Shandong University, School of Control Science and Engineering, Jinan,

Shandong Provincial Hospital Affiliated to Shandong University, Galactophore and Thyroid

Surgery Ward, Jinan, China Peoples Republic
Southampton University Hospital, Oncology Imaging Suite, Southampton, United Kingdom
Introduction
The shape of the skeleton is influenced by its
mechanical loading conditions and disease but is
largely genetically determined. Local features of
lower limb anatomy appear to be highly correlated
and consideration of such interrelationships in the
analysis of lower limb mechanics is therefore critical.
Articulated statistical shape modelling (ASSM) is
a powerful tool providing a holistic approach to
capture anatomical relationships that exist across
the entire lower limb and could offer further insight
into the role of ethnicity on skeletal shape and
mechanics. This study used ASSM to investigate
differences in lower limb anatomy of Chinese and
British populations.
less than 0.1 mm when at least 24 shape modes

were considered. However, the error when
using the B-ASSM to reconstruct the original
Chinese lower limbs was 2.07 mm on average
using 30 shape modes, and remained largely
unchanged (1.59 mm) even if all 80 modes were
used for reconstruction
Figure 1
Methods
This study approved by the local ethics committee
is based on CT data of 30 Chinese (21 male,
9 female) and 80 British subjects (56 male). The
CT scans of the lower limbs were segmented
(ScanIP, Simpleware Ltd., UK) to reconstruct the 3D
surfaces of femur, tibia, patella and fibula. These
surfaces were used to initially create a SSM of each
bone individually. The SSM registered bones were
then combined and aligned to create the ASSM
where all limbs were aligned to a fully extended
reference pose. This process was performed for
each group resulting in an ASSM for Chinese and
British subjects. To document how well the ASSMs
captured the anatomy of the respective groups,
a reference reconstruction error was computed.
Here, 30 shape modes of the Chinese ASSM
(C-ASSM) were used to reconstruct the bones on
which the model was based while recording the
mean distances between the surface of the fitted
ASSM instance and the surfaces of the 30 original
lower limbs. In a second step, the B-ASSM based on
either 30 or 80 shape modes was used to reconstruct
the 30 original Chines lower limbs. These errors are
indicative of fundamental differences in lower limb
shape between both groups.
Figure 1: E
rror using the B-ASSM to reconstruct Chinese lower
limbs.
Discussion
This study compared differences in lower limb
anatomy of Chinese and British populations in a
holistic manner using ASSM. While variation in lower
limb anatomy in each group were well captured in
the ASSMs, the larger error when using the B-ASSM
for recovering the Chinese lower limbs is indicative
of important anatomical differences between
these groups that act across all of the lower limb
bones. ASSMs capturing anatomical differences
linked to ethnicity now allow to systematically
investigating their mechanical consequences.
Such tools enable devising rehabilitation programs
and developing implant designs specifically
targeted at the needs of individual ethnic groups.
Results
The average reference reconstruction error of
Chinese limbs from their respective ASSM was
405
P 046
3D MODELING OF THE HUMAN INNER EAR

WITH FINITE ELEMENT METHOD
A. Durn Escalante1, J.L. Flores Espejo1, A.L. Garcia Gonzalez1
1
Universidad de Malaga, Ingenieria Civil, Materiales y Fabricacion, Mlaga, Spain
Introduction
Many daily routine are based on the use of the
auditory system. Many diseases and hearing
disabilities affect millions of people each year.
The success of their treatments may be higher if
the performance of the auditory system is known.
A numerical model with vital functions of auditory
system of a patient could help pinpoint the clinical
problem. Further, a numerical model offers the
possibility of making an artificial model using
3D printing that could help surgeons to create
an intervention plan or investigate new surgical
techniques [Poznyakovskiy, 2008]. In general, the
proposed models in the literature can be sort in
two types: geometric and numerical. This study
is focused to create a numerical Finite Elements
model of human inner ear (Figure 1). Any system
can be reconstructed if its cloud of relevant points
is obtained. Therefore, the first aim to get the
point cloud describing an inner ear and import it
into Ansys. The second aim to create a numerical
model from the point cloud. Particularly, the model
consists of three systems: coiled cochlea, vestibule
and semicircular canals. Nowadays, there is not
model that contains the semiautomatic modeling
of geometry with subsequent numerical model with
Finite Element Method (FEM). The main contribution
of this work is a comprehensive method based
on the combination of a new semiautomatic
algorithm to obtain the inner ear geometric from
a stack of parallel 2D histological sections images,
and subsequent post processing to create the
numerical model.
Figure 1: F inite elements numerical model of inner ear.
Results
The result is a complete numerical model of the inner
ear composed of a coiled-shaped cochlea whole
meshed with hexahedral finite elements with the three
chambers fluid divided by the basilar membrane and
Reissners membrane (Figure 2), and attached to a
model of the vestibule and the semicircular canals.
This numerical model could serve as a support for
a more complete model with which to perform
numerical tests with the Finite Element Method.
METHOD
The proposed method to generate the numerical
model of the human inner ear consists of two
phases. First, a semiautomatic algorithm of image
processing has been developed to obtain the
cloud of characteristic points which define the
cochlea cross sections, the vestibule contours and
the curvilinear path of the semicircular canals.
Second, the points cloud has been imported in
Ansys to create the numerical model with FEM.
The points cloud of the three systems has been
extracted by processing 36 selected in the axial
plane histological sections of 0.4 mm thickness
from freeware 3D Surface Viewer of [Wang, 2006].
Figure 2: Hexahedral Finite Elements of cochlea cross section.
Discussion
The results of the geometrical modeling of the
cochlea provide a substrate for the understanding
mechanical processes of hearing. Images of
histological sections can be used to 3D reconstruct
the inner ear. Further, the more high resolutions
images more faithful model is obtained applying
our algorithm. In summary, a method has been
created to develop a comprehensive 3D FEM
model of the inner ear, with attention to coiledshaped cochlea with three chambers fluid.
References
A. Poznyakovskiy et al, Hearing Research,
282:2534, 2008.
Wang et al. Otology & Neurotology, 27:
452457, 2006.
406
P 047
COMPARISON BETWEEN ACTIVE AND PASSIVE KNEE

KINEMATICS DURING NAVIGATED TKA PROCEDURE
F. Colle1,2, N. Lopomo1,2, D. Bruni1, F. Iacono1, M. Capozzi3 , S. Zaffagnini1,
M. Marcacci1, C. Signorelli1
1
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica ed Innovazione Tecnologica,
Bologna, Italy 2 Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie NaBi, Bologna,
Italy 3 Casa di Cura Santa Maria, Casa di Cura Santa Maria, Bari, Italy
Introduction
Navigation systems provide the possibility to intraoperatively assess the achievement of a correct
joint kinematics also during total knee arthroplasty
(TKA) [Siston 2006, Stiehl 2009]. Usually, one of the
major issue related to the navigation concerns
the capacity of evaluating the only passive
kinematics, thence without a proper muscular
control performed by the subject. Assuming that

even passive kinematics may properly describe
the biomechanical behaviour of the knee, the
main goal of this work was to intra-operatively
acquire and compare a flexion movement actively
performed by the patient with respect to a passive
one, manually performed by the surgeon (Figure 1).
Figure 1: A
ctive and passive flexion movements acquired during navigated TKA.
Methods
The acquisitions were performed on 31 patients,
who underwent navigated TKA (BLU-IGS, Orthokey,
USA). All the surgeries were performed under
local anaesthesia (combined spinal and epidural
anaesthesia CSE technique), which allowed to
perform 3 active and 3 passive flexion movements.
Both in pre- and post-implant conditions, internalexternal (IE) rotations and anterior-posterior (AP)
translations were estimated.
Results
No statistical difference (n.s.) were found about
IE rotation angles for all the analysed conditions.
Likewise, AP translations did not show any statistical
difference (n.s.) both between active and passive
flexion movement, and between pre- and postimplant conditions (n.s.).
see the next page
407
Discussion
The use of a navigation system in TKA has been
proven to be extremely useful to perform a reliable
intra-operative assessment of joint kinematics.
The comparison between active and passive
movements seemed to demonstrate that the
absence of active muscular control does not
heavily affect the kinematic analysis. Therefore,
navigation could be considered as reliable as other

comparable techniques, which include muscular
control in active tasks.
References
Siston et al. J OrthopRes, 24:16071614, 2006.
Stiehl et al. IntOrthop, 33:679685, 2009.
408
P 048
COMPARATIVE BIOMECHANICAL ANALYSIS

OF OPEN AND PERCUTANEOUS SURGICAL
SPINAL FUSION TECHNIQUES
H. Stark1, A. Gussew2, B. Ullrich3 , P. Schenk3,4 , H.C. Scholle4
1
Institute of Systematic Zoology and Evolutionary Biology, Friedrich Schiller University,

Jena, Germany
2
Medical Physics Group, Institute for Diagnostic and Interventional Radiology I,

Jena University Hospital, Jena, Germany
3
Clinic for Trauma Surgery, BG Clinics Bergmannstrost, Halle, Germany
Clinic for Trauma, Hand and Reconstructive Surgery Division of Motor Research,
Pathophysiology and Biomechanics, Jena University Hospital, Jena, Germany
Motor Research. Based on the latter, the simulation

was subsequently optimized and evaluated.
Additionally obtained tissue samples initially served
to supplement the EMG findings and to optimize
the simulations in addition with respect to muscle
fibre types.
After trauma of the spine, especially following

spinal stabilization by spinal fusion of one or more
segments, a subset of patients develops chronic
pain syndromes caused by emerging instabilities
in adjacent segments. These pain syndromes
cause high costs. The rate of complications after
spinal fusion increases with the number of fused
segments, but also depends on the location
of the fusion, the applied surgical technique
and postsurgical treatment. To explore these
relationships, the collaborative project vertebral
stabilization was initiated, and aims at clarifying
whether these complications are caused by the
surgical intervention, the injury itself or by changes
in the central-nervous system.
Using these models, it is possible to evaluate

various simulations for stabilization procedures. The
simulations were compared to existing surface
EMG and MRI (magnetic resonance imaging)
parameters (e.g., pre-/postoperative). One finding
was the heterogeneity of stress distribution of
adjacent regions on specific spinal levels. The
combination of EMG, imaging studies and modelled
data in this project contributes significantly to a
better understanding of pathological mechanisms
and the optimization of rehabilitation.
For this study, several Finite-Elemente-Method-models were used, which emerged from a
collaboration between the Department of
Anatomy I of the Friedrich-Schiller-University Jena,
the Clinic for Trauma Surgery, and the Medical
Physics Group/IDIR I. The accuracy for all models
was 2x2x2 mm and considers the anisotropic
behaviour of tendon and muscle tissues. The
control and patient situations could be simulated
for the different spinal fusion techniques and
muscle traumata. For the simulations, we used FEBio
from the Musculoskeletal Research Laboratories
(University of Utah, USA). To this end, the calculated
stress data could be directly compared with the
electromyographic (EMG) data from the Division of
We thank all additional project members
(C. Anders, M.S. Fischer, P. Hiepe, G. Hofmann,
J.R. Reichenbach, R. Rzanny, N. Schilling, K. Wohlfahrt
and J. Wollmann) of vertebral stabilization
FF-FR0194 for very stimulating discussions and their
support. Additionally, we thank I. Wei and B. Hesse
for their support and discussion regarding muscle
fibre typing. This study was supported with research
funds by the German Statutory Accident Insurance
(DGUV). The authors are responsible for the content
of this publication.
409
P 049
GEOMETRIC PARAMETERS AFFECTING FINITE

ELEMENT ANALYSIS OF BONE LOADING CAUSED
BY NON-PASSIVELY FITTING IMPLANT-SUPPORTED
DENTAL RESTORATIONS
1, W. Winter2
1
University of Erlangen-Nuremberg, Department of Prosthodontics, Erlangen, Germany
2
University of Erlangen-Nuremberg, Department of Mechanical Engineering, Erlangen,

Germany
Introduction
Finite element analysis (FEA) has been frequently
applied for studying the loading situation of dental
implants and bone as resulting from the fixation of
non-passively fitting restorations. The goal of the
present investigation is to demonstrate the effect
of geometric model parameters and mesh size on
FEA results.
of the bone around the implants was recorded as

von Mises equivalent stress.
Maximum stress magnitudes ranging from 13.1 MPa to
24.9 MPa occurred in the cortical part of the implant
site where the neck of the implant penetrates bone.
In trabecular bone, loading magnitudes were lower
by a factor of 20. Modelling implant threads did have
a remarkable effect on the stress situation as well as
different span lengths of the restorations modelled.
All other parameters only led to small variations in
maximum loading magnitudes.
Five three-dimensional FE models representing a
three-unit fixed dental prosthesis (FDP) supported
by two terminal implants were constructed. The
models differed in terms of mesh size, geometry of
bone, implants and restoration which were either
created by joining virtual free-form objects or by
utilizing optical scans of existing components.
Applying thermal changes in volume of specific
elements in the area of the FDP pontic, a horizontal
misfit of 10m between implants and restoration
was introduced and the resulting loading situation
C o n cl u s i o n
Simplistic FEA models based on virtual free-form
objects with limited level of mesh refinement seem
to allow for a basic evaluation of peri-implant
bone loading resulting from the fixation of misfitting
superstructures.
410
P 050
A PRELIMINARY STUDY OF THE KINEMATICS OF MEDIAL

PIVOT KNEE ARTHROPLASTY IN HIGH-FLEXION
1, A.H. Kadarman2, A. Ahmed Shokri3 , M.E. Aziz4 , S. Shuib5
1
Universiti Sains Malaysia, Mechanical Engineering, Pulau Pinang, Malaysia

2
Universiti Sains Malaysia, Aerospace Engineering, Penang, Malaysia

3
Universiti Sains Malaysia, Orthopedics, Kelantan, Malaysia

4
Universiti Sains Malaysia, Radiology, Kelantan, Malaysia
Universiti Teknologi Mara, Mechanical Engineering, Selangor, Malaysia
Introduction
Medial pivot knee arthroplasty is known as
prosthesis that has ball-contact joint on the medial
side. Reduction number of radius from two to one
on the femoral component might change the
kinematics implant. Numerous studies have done
it in low-flexion and for high-flexion is still deficient.
Two objectives upon this study: (1) how is the
kinematics of medial pivot knee arthroplasty in
high-flexion? (2) Does pivoting mechanism last until
full flexion?
interval 10. Secondly in-vivo study, nine subjects

(3 male: 4 female) were selected to participate
(25 months postoperative) and were asked to
lay-on-side on the interested leg for x-ray procedure.
R e s u l t & C o n cl u s i o n
Empirical study finding shows the jig that holds
the artificial bone influenced the kinematics of
implant. Differently for in-vivo study, finding shows
that the femoral component translated posteriorly
on lateral side for about 15 mm from position
100 flexion. The pivoting mechanism on medial
side was activated at 120 flexion and beyond. The
kinematics of medial pivot knee arhtroplasty shows
a positive mimicry knee motion. Further study is
needed for weight-bearing position.
Method
Harnessing a 2/3 registration technique, two
experiments had been conducted. Firstly empirical
study, artificial bones and x-ray machine were used
to capture five flexions ranged 100 to 140 with
411
P 051
A NEW MINI EXTERNAL FIXATOR FOR SEVERE HALLUX

VALGUS TREATMENT; A BIOMECHANICAL STUDY
M. Erdil1, H. Ceylan2, G. Polat3 , D. Kara4 , E. Bozdag5, E. Sunbuloglu5
1
Medipol University, Orthopaedics and Traumatology, Istanbul, Turkey

2
3
4
LNB Hospital, Orthopaedics and Traumatology, Istanbul, Turkey
Istanbul University, Orthopaedics and Traumatology, Istanbul, Turkey
Bezmialem Vakif University, Orthopaedics and Traumatology, Istanbul, Turkey

5
Istanbul Technical University, Mechanical Engineering, Istanbul, Turkey
Introduction
Proximal and shaft osteotomies are biomechanically
more unstable in comparison to distal osteotomies.
Conventional screw fixation in proximal osteotomy
is not sufficient for early weight bearing due to
biomechanical insufficiency. The purpose of this
study is to compare the stability of conventional
screw fixation and our new design mini external
fixator.
calculated on the 1st, 10 th, 50 th, 100 th, 200 th, 300 th
and 1000 th load cycles. Dorsal angulation of 10
and displacement of 10 mm were defined as
failure threshold value for bone model constructs.
The mean failure cycles of group A was 556 (456823)
and mean failure cycles of group B was 997
(6211204). Statistical significance was defined at
the 5% (p .05). Paired, Mann-Whitney tests were
used to determine the significance of differences
in the number load cycles before failure with
dorsal angulation > 10 degrees at each cyclic
load interval. Construct stiffness of group B was
statistically better than group A at 10 th (p:0.05),
400 th (p:0.003), 500 th (p:0.014), 700 th (p:0.05),
800 th (p:0.001), 900 th (p:0.004), and 1000 th (p:0.011)
cycles. To our knowledge this is the first technical
report that compares the external fixator and
screw fixation in the treatment of hallux valgus.
Exp e r i m a n t a l M e t h o d s
18 metatarsal sawbones had prepared for
biomechanical
study.
First
all
specimens
osteotomized proximally with a saw blade and
divided into two groups. 9 of these metatarsals
fixed with a Headless Compression Screw
(Acutrac, Acumed, Beaverton, OR) and remaining
metatarsals had fixed with our new mini external
fixator. All the specimens tested with an MTS 858
Mini Bionix 2 universal dynamic test system and
axial compression, distraction, torsion and bending
tests had applied. The measurements of these tests
recorded and controlled by a MTS Multipurpose
Testware software. Displacement of the osteotomy
site was measured by a static optical camera and
3D correlation system. Dynamic, axial and torsional
loading capacity of the system was 100Hz, 25 kN
and 200Nm, respectively. Construct stiffness and
the amount of interfragment angulation were
C o n cl u s i o n
This study demonstrated that mini external fixator
provided superior osteotomy stability in comparison
to the conventional screw fixation.
We thank toScientific Research Projects Fund of our
institute.
412
P 052
POSTOPERATIVELY CHANGE OF THE IN VIVO

MEASURED FRICTION IN TOTAL HIP JOINT REPLACEMENT
DURING WALKING
P. Damm1, A. Bender1, G. Bergmann1
1
Julius Wolff Institute Charit Universitaetsmedizin Berlin, Instrumented Implants,

Berlin, Germany
Introduction
Friction induced moments and cup loosening is a
common reason for failure of total hip replacements
(THR). To determine friction in THR different in vitro
studies were published. Aim of the study was to
determine realistic in vivo data of friction acting in
the hip joint.
Methods
To measure joint loads in vivo, an instrumented
THR (Al2O 3/XPE) was developed (1). It is powered
inductively; measured 3D loads are transmitted
wireless and reported in %BW (%bodyweight) and
%BWm. Measurements were taken in 9 subjects
during walking; 3 to 12 months pOP. Load patterns
were averaged inter- and intra-individually (2).
Resultant force vector (Fres) and vector of the
friction moment (Mres) were used to calculate the
coefficient of friction (). During walking the joint
rotates about 3 axes, consequently a 3D approach
was chosen for .
Discussion
This study reporting joint friction under in vivo
conditions. The increase of during stance phase
revealed lubrication is not constant. In the literature
its reported that increases when slide conditions
change from lubricated to dry (3). A explanation
are that synovia is squeezed out at phases of high
loading and transported back when load is low.
The sudden increase of at the end of the stance
phase may be caused by dry friction, but also by
speed dependent change of synovia viscosity.
Decrease of Mres and during the first year pOP
indicate changed lubricating properties, but also
running-in effects.
Results
Between ipsilateral heel strike (HS) and toe off (TO),
Fres had 2 maxima at contralateral toe off (CTO)
and heel strike (CHS) (Figure). Mres increased from
HS until reaching its maximum around CHS; then it
had an minimum shortly before TO. continuously
increased between HS and CTO, then rose sharply
until reaching its maximum at around TO. Between
3 and 12 months pOP, the peaks of Fres changed by
1% (CTO) and +4% (CHS). M res was decreased by
48% (CTO) and 30% (maximum). The coefficient
of friction was decreased by 48% (CTO),
36% (CHS) and 13% (maximum).
This project was supported by DFG and Deutsche
Arthrose-Hilfe e.V.
References
(1) D
amm et al., 2010.
(2) B
ender and Bergmann, 2011.
(3) U
nsworth, 1978
413
P 053
MODELING OF ACETABULAR DISLOCATION

IN ACETABULAR DYSPLASIA
O. Sachenkov1, A. Mazurenko2, R. Tihilov3 , Y. Konoplev1
1
2
Federal Center of Traumatology, Orthopedics and Prosthetics, Trauma and orthopedic

department ?3, Cheboksary, Russia
3
Russian Scientific Research Institute of Traumatology and Orthopedics. RR Vredena,

Therapeutic and diagnostic unit, St. Petersburg, Russia
Introduction
Hip arthroplasty remains to be the main
treatment for patients with dysplastic coxarthrosis.
Reconstructive surgical interventions are effective
only in early stages of the disease and provide only
510 years remission period. Until now the problem
of hip replacement in dysplastic coxarthrosis
is not solved completely. Unsuccessful surgery
risk in dysplastic arthrosis is 1.5 times higher, and
in dysplastic arthrosis with the dislocation 2
times higher than in standard hip replacement.
With that in mind experimental studies of the
acetabular component instability in the hip joint
with acetabular dysplasia total arthroplasty were
carried out.
for a comfortable, practical terms, diagrams were

obtained by regression function for the calculated
data, the band described by these curves in the
axes weight-percentage of undercoverage.
DIS C USSION
Overall, our results are consistent with clinical data
that critical undercoverage value is about 30% of
the surface area. Of course, that the results are not
absolutely certain, because the actual conditions
during surgery may differ significantly from inherent
in the mathematical model, but studies can form
an idea of the effect of the deficiency of the
coating and allows the surgeon to navigate in the
selection of additional methods of stabilization.
The results of studies to be more free to choose the
surgical tactics at implantation of the acetabular
component and more accurately judge the
degree nedopokrytiya acetabular component
as one of the factors affecting the mechanical
stability of the implant.
METHODS
For numerical studies was built three-dimensional
model of the hip joint and the acetabular
component. As part of the settlement was taken
into account in the interference fit acetabular
component in bone contact and interaction
between them, taking into account the friction. The
acetabular component was modeled as a twocomponent object: titanium outer cup, the inner
cup ceramic. Take into account the friction between
the bone and the implant. The diameter of the cup
was taken to 4 mm larger than the diameter of the
acetabulum. By the cup was applied force directed
along the normal, calculations were carried out by
different forces. Wherein the implant has moved
inside the cup, i.e. the ability of the carrier lost. The
results obtained coincide with experimental and
clinical research in this area.
RE F EREN C ES
1 Konoplev YU.G., Mazurenko A.V., Mitryaykin V.I.,
Sachenkov O.A., Tikhilov R.M. Eksperimentalnoye
issledovaniye vliyaniya stepeni nedopokrytiya
vertluzhnogo komponenta na nesushchuyu
sposobnost endoproteza // Rossiyskiy zhurnal
biomekhaniki. 2014. T. 18, ? 3. S.333344.
2 Tikhilov R.M., Shubnyakov I.I., Mazurenko A.V.,
Mitryaykin V.I., Sachenkov O.A., Kuzin A.K.,
Denisov A.O., Pliyev D.G., Boyarov A.A.,
Kovalenko A.N. Eksperimentalnoye obosnovaniye
ustanovki atsetabulyarnogo komponenta s nedo
pokrytiyem pri endoprotezirovanii patsiyentov
s tyazheloy stepenyu displazii // Travmatalogiya
i ortopediya Rossii ?4(70) 2013 S.4251.
3 Sachenkov O.A., Mitryaikin V.I., Zaitseva T.A.,
Konoplev Yu.G. Implementation of Contact Interaction in a Finite-Element Formulation // Applied
Mathematical Sciences, Vol. 8, 2014, no. 159,
78897897.
RESU L TS
Were calculated for cups of different diameters:
52, 54, 56 mm. When undercoverage under 18%
a force of 4000 N to loss of carrying capacity
of the acetabular component is not observed,
undercoverage ranging from 18% to 30% greater
than the critical force value of 2000 N in a range from
30% to 40% greater than the critical force of 1000
N, with further increase in the percentage of the
value of the critical force undercoverage dropped
down to 500 N. The obtained dependences are well
described by an exponential regression equations,
A C K NO W L ED G MENT
This work has been partially supported by the Russian
Foundation for Basic Research (grant 14-01-31291)
414
P 054
MODELING OF THE PROXIMAL FEMUR

ROTATION OSTEOTOMY
O. Sachenkov1, R. Hasanov2, L. Sultanov1, P. Andreev2, Y. Konoplev1
1
2
Republican Clinical Hospital, Trauma and orthopedic department baby, Kazan, Russia
Introduction
Legg-Calve-Pertes disease - a serious and
prolonged femoral disease of childhood period
associated with femoral head blood supply
circulatory nutrition deficiency with subsequent
necrosis. It belongs to the osteochondropathy
group of diseases. Clinical practice shows that
functional and orthopedic clinical diagnosis
of Pertes disease and slipped capital femoral
epiphysis, treatment programs, surgical tactics
justification and the whole patients rehabilitation
complex effectiveness evolution methods adopted
by our domestic clinics are largely subjective.
A decision was made to investigate the proposed
surgical treatment method.
acetabular osteotomy must change tactics the

partial reversal of the proximal femur, with the
gradual correction after surgery.
METHODS
Proposed method includes osteotomy along the
lower contour of the femoral neck, thereby dividing
the bone in two parts and subsequent rotation of the
proximal portion to a certain angle, thus removing
the strain from the affected area. The study was
conducted based on the previously constructed
kinematic model of the hip joint. The model was
supplemented by elastic elements (muscles),
muscle attachment sites were determined using
human anatomy textbooks with mechanical
characteristics taken from the literature. FEM model
was built with the visco-elastic elements (muscles).
The model took into account the following muscles:
mm. piriformis, rectus femoris, iliopsoas, obturator
internus, gluteus minimus, medius et maximus. Elastic
characteristics of the mechanical models of muscle
were taken according to studies. For modeling the
mechanical behavior of muscle Hills model was
used. Muscle attachment zone were determined
on the basis of anatomical studies. Joint boundary
conditions for the bones was bearing on the sacrum,
between the femoral head and the acetabulum to
contact interaction was set. Osteotomy simulated
parabolic cut femur along the arc Adams.
Kinematic boundary conditions of the free surface
of the proximal portion of the bone was set.
References
1 Skvortsov A.P., Andreyev P.S., Yashina I.V., Khasanov R.F. Biomekhanicheskiye aspekty primeneniya
monolateralnykh apparatov vneshney fiksatsii dlya
lecheniya ukorocheniy i povrezhdeniy bedrennoy
kosti u detey // Sovremennoye iskusstvo meditsiny
2012. ? 6 (8) S. 6269.
2 Khasanov R.F., Andreyev P.S., Skvortsov A.P., Akhtyamov I.F., Yashina I.V. Varianty khirurgicheskogo
lecheniya bolezni Legga-Kalve-Pertesa // Sovremennoye iskusstvo meditsiny 2013. ? 4 (12) S. 59.
3 Zakirov R.KH., Konoplev YU.G., Mitryaykin V.I.,
Sachenkov O.A. Matematicheskoye modelirovaniye biomekhaniki sustava // Nauchno-tekhnicheskiy
vestnik Povolzhya. Kazan: Nauchno-tekhnicheskiy
vestnik Povolzhya 2012. ?1 S.3137.
4 Golovanov A.I., Konoplev YU.G., Sultanov L.U.
Chislennoye issledovaniye konechnykh deformatsiy
giperuprugikh tel. IV. Konechnoelementnaya
realizatsiya. Primery resheniya zadach //
Uchenye zapiski Kazanskogo universiteta. Seriya:
Fiziko-matematicheskie nauki. 2010. T. 152,
? 4. S. 115126.
Results
Calculations analysis has shown that during the
internal rotation muscles behavior is more stable
with anatomical parameters alteration, while during
the external rotation a number of muscles begin
to contract, depending on the antetorsion angle.
Based on acquired data we are now studying the
stability of muscles behavior in relation to the bone
attachment sites and comparing obtained results
with clinical trials as well as analyzing the proximal
portion of the bone strain condition after rotation.
DISCUSSION To restore normal biomechanical
condition of the joint, reduce muscle tension and
A C K NO W L ED G EMENT
This work has been partially supported by the Russian
Foundation for Basic Research (grant 14-01-31291)
415
P 055
IMPROVEMENT OF IMPLANT ANCHORAGE

IN TRABECULAR BONE BY IN SITU AUGMENTATION
W. Schmoelz1
1
Medical University Innsbruck, Trauma Surgery, Innsbruck, Austria
Introduction
In geriatric patients with reduced bone quality
screw anchorage of fracture stabilising implants
generally poses a problem to the surgeon. In
particular fractures locations in which the main
anchorage of the implants is in trabecular
bone show high implant related complication
rates in clinical practice. One feasible and
clinical applicable option to improve implant
anchorage in trabecular bone is augmentation
of the trabecular structure with bone cement.
For conventional implants the augmentation
must take place prior to screw insertion and
changes the surgical procedure. In order to keep
the surgical procedure similar and to give the
surgeon the option to decide intraoperatively
if implant anchorage is insufficient cannulated
and perforated screws were developed. Such
screws allow an in situ augmentation through the
cannulation with cement. In the past years several
studies were carried out to investigate the effect
of in situ augmentation on implant anchorage as
well as the feasibility of implant removal in case of
infection or hardware failure.
Figure 1: P
roximal humerus with three part fracture fixed with
an angular stable plate. Control group with standard
treatment (A) and treatment group (B) with four in
situ augmented screws (0.5ml PMMA cement).
Results
In situ augmentation significantly increased the
implant anchorage in all investigated locations.
Revision and removal of in situ augmented
implants was feasible in all locations without
additional damage to the bone. Interface failure
during implant removal occurred in the screw
cement interface while the cement bone interface
remained intact.
Methods
In vitro studies with human specimens were carried
out for proximal femur [Erhart, 2011], proximal
humerus [Unger, 2012; Rderer, 2013] and spinal
implants [Bostelmann, 2015]. To have a baseline
and control group with comparable bone stock
a pairwise comparison (left/right) was used to
quantify the effect of the augmentation on implant
anchorage (Fig. 1). Instrumented specimens
were cyclically loaded until implant loosening or
construct failure.
Discussion
In clinical practice in situ augmentation to
improve implant anchorage in geriatric patients is
starting to become an accepted and reimbured
treatment in some countries while others do not
cover the additional cost of augmentation. In situ
augmentation of pedicle screws is widely spread
and accepted. For proximal femur fractures
clinical studies have investigated the safety and
effectiveness of in situ augmentation. For proximal
humerus fractures a multicentre study to investigate
its effectiveness is currently ongoing.
Increasing load protocols were used for cyclic

testing in order to compensate for different
overall construct stiffness of augmented and
non-augmented specimens and to ensure
implant loosening in a reasonable timeframe As
augmentation material PMMA cement was used.
References
Bostelmann et al, ESJ, in press
Bullmann et al, Spine, 35(19) E9329, 2010
Erhart et al, Injury, 42(11) 13227, 2011
Erhart et al, AOTS, 132(11) 157781, 2012
Goetzen et al, ClinBiomech, 29(9) 10239, 2014
Rderer et al, Injury, 44(10) 132732, 2013
Unger et al, Injury, 43(10) 175963, 2012
Implant removal and revision strategies were also

investigated for spinal pedicle screws [Bullmann,
2010], proximal femur [Erhart, 2012] and proximal
humerus implants [Goetzen, 2014].
416
P 056
PREPARATION OF FEM MODEL FOR DENTAL RETAINERS

T. Goldmann1, Z. Horak1, M. Vilimek1, J. Kucera2
1
CTU in Prague, Facoulty of Mechanical Engineering, Dept. Of Mechanics, Biomechanics

and Mechatronics, Praha 6, Czech Republic
2
Charles University, 1st Medical Facoulty, Dept. of Orthodontics, Prague, Czech Republic
Introduction
The aim of this study was to create a finite element
model of the human mandible with physiological
loading of the muscles and individual bone
material model. We simulated maximal bite on
the first right molar and evaluate stress and strains
distribution in bone tissue region close to teeth.
on the left mandibular. The movement of model

was physiologically realistic. We assumed that the
physiological load of the muscles was estimated
correctly. The maximal stress was registered on the
insertion of the temporal muscle which had the
biggest influence on the unilateral bite.
C o n cl u s i o n
The aim of this study was to create a finite element
model of the human mandible from CT scans and
to simulate a maximal unilateral bite on the first
right molar. We used elastic-plastic mechanical
properties of the bone, linear isotropic properties of
the teeth and the PDL. The mandible was modeled
as inhomogeneous. It was loaded physiologically.
This model will be used to simulate the reaction of
the jaw bone to inserted retainers.

The model of the human mandible was created
from CT scans of a young healthy woman. She
was 17 years old at the time of study and she had
not had any clinical problems. The CT scans were
used in DICOM format. The model of the mandible
consisted of 3 parts the bone, 16 teeth and the
periodontal ligament (PDL) of each tooth. The finite
element mesh was created in Abaqus software
(Simulia, USA). We used 3D tetrahedral elements
for bone tissue and teeth. The PDL was modeled
as a membrane which was created from a 3D CT
model of PDL by membrane elements.
The material model of the teeth consisted of the

same mechanical properties as dentin. It was
a sufficient condition for our model. The PDL
was modeled as an isotropic membrane. The
mechanical properties of the PDL are generally
nonlinear and viscoelastic. The viscoelastic material
model is not necessary for the static analysis, but we
must assume that a bilinear material model of the
PDL can define general behaviour well (Vollmer et
al., 1999). This will be used in the second phase. We
used the inhomogeneous material model for the
bone. It is a very good description for the structures
of the bones. The elastic material constants were
obtained from the mechanical testing of real
human mandibles. The plastic properties were
derived from the mechanical testing of human
femurs. We used this data because plastic
properties of the mandibles could not be found in
available literature.
The mechanical properties of the bone were

obtained from CT scans. We determined the
relationship between apparent bone density
and Hounsfields units (HU) with linear regression
(Mish et al., 1999; Schwartz-Dabney,2002).
Our model was loaded physiologically. We modeled
all masticatory muscles. The data of muscles force
value was obtained from measurement performed
in our laboratory (Vilimek,2002).
We simulated the maximal unilateral bite on the
first right molar.
Figure 1: E
xample of mosdel results and possible retainer
placement
This research was supported by the Ministry of Health
in the Czech Republic, project: NT14189 Unexpected
Complications of Fixed Orthodontic Retainers.
Results and discusion

The model of the human mandible contained
1.443.266 elements. We used dense mesh between
the bone and the teeth. The maximal von Mises
stress of the bone was registered on the coronoid
processes, where the insertion of the temporal
muscle was made. The maximal displacement was
References
S chwartz-Dabney et al J Dent Res 81.9:
613617, 2002.
Vilimek M et al Comput Method Biomec
Van Der Bilt et al. Eur J Oral Sci 116.3: 217222,2008.
Someone et al, J Biomech Eng, 20:100107, 2005.
Volmer D et al Eur J of Orthod. 21.6: 633648, 1999
417
P 057
RADIATION EXPOSURE IN INTRAMEDULLARY NAILING:

A COMPARISON BETWEEN FREE-HAND TECHNIQUE
AND ELECTROMAGNETIC ASSISTED TECHNIQUE
H. Kobayashi1, H. Tanikawa1, R. Ogawa1, K. Hartato2, Y. Niki2, T. Nagura3 , K. Okuma1
1
2
3
Saitama City Hospital, Orthopaedic, Saitama-shi, Japan
Keio University School of Medicine, Orthopaedic, Tokyo, Japan
Keio University School of Medicine, Clinical Biomechanics, Tokyo, Japan
Introduction
Positioning of the distal locking screws of an
intramedullary nail is often challenging and exposes
the patient and surgeon. The SURESHOT Distal
Targeting System (Smith & Nephew, Inc., Memphis,
TN, USA) is a commercially available radiation-free
system that utilizes electromagnetic field tracking
technology to specify the position of the distal
locking holes. In this study, we compared intraoperative site-specific radiation exposure during
intramedullary nailing between the conventional
free-hand (FH) technique and the electromagnetic
(EM) assisted technique.
Discussion
The EM assisted technique decreases the intraoperative radiation exposure of the patient and
surgeon during intramedullary nailing, especially in
the surgical field by 74 % and surgeons hands by
80 %. The results are consistent to the past reports
that documented the EM field-generating device
significantly reduces the duration of exposure to
radiation [Moreschini O, 2014]. The EM assisted
technique also decreases the fluoroscopy time
required for fixation of the distal screw, whereas
no significant difference in the surgical time for the
fixation of distal screw between EM group and FH
group, possibly because of the operative procedure
that we used the fluoroscopy for a short time in EM
group to confirm correct passage of the screws
through the nail holes. Recent studies revealed an
increased risk of cancer, potentially attributable to
radiation exposure, among orthopaedic surgeons
[Mastrangelo G, 2005]. This study suggests that the
EM assisted technique is effective for reducing
the amount of radiation exposure of orthopaedic
surgeons during intramedullary nailing and may
decrease the risk of cancer.
Methods
Subjects were nine patients with femoral or tibial
fracture that requires intramedullary nailing. The
surgeries were performed using FH technique
(n = 5) or EM assisted technique (n = 6). A group of
ten nanoDotTM (Landauer, Inc., Glenwood, IL, USA)
dosimeters attached on the patients and surgeons
body were used to measure the intra-operative
radiation exposure. One dosimeter was used as a
control and kept out of the operation room. The
variables, including site-specific radiation exposure
(patients eyes, patients genital region, surgical
field, surgeons eyes, surgeons genital region,
surgeons hands), surgical time and fluoroscopy
time required for fixation of the distal transverse
screws, were statistically compared between the
EM group and the FH group. Two-tailed Students
t-tests were used to compare variables between
the two groups, with an alpha level set at 0.05.
References
C
han DS et al. J Orthop Trauma. 27:363366, 2013.
M
astrangelo G et al. Occup Med 55:498500, 2005.
M
oreschini O et al. Injury. 45:405407, 2014.
Results
Average radiation exposure of the surgical
field was significantly lower on the EM group
(3.00 1.23 mSv) than the FH group (11.5 6.00 mSv).
Average radiation exposure of surgeons hands
was significantly lower on the EM group
(0.12 0.09 mSv) than the FH group (1.89 2.85 mSv).
There were no significant difference between the
two groups in the other regions (Fig. 1). Fluoroscopy
time required for fixation of the distal screw
was significantly shorter on the EM group
(0.43 0.21 min) than FH group (2.19 1.20 min),
while there was no significant difference in the
surgical time for the fixation between the two groups.
Figure 1: M
ean radiation doses measured at different areas
during the intramedullary nailing.
418
P 058
INVESTIGATION INTO THE EFFECT OF REVISION I

MPLANTS ON FEMORAL STRESS IN REVISION TOTAL
HIP ARTHROPLASTY
M. Moya Bencomo1, T. Alonso Rasgado1, C. Bailey2, T. Board3
1
2
3
The University of Manchester, The University of Manchester, Manchester, United Kingdom
Wrightington Hospital, Wigan and Leigh NHS Foundation Trust, Orthopaedics, Manchester,
United Kingdom
Introduction
Total Hip Arthroplasty (THA) is an orthopaedic
procedure performed on certain hip pathologies.
This procedure can be affected by biological or
mechanical causes producing the primary implant
to fail. When this happens a second surgery is
necessary to replace the implant, this surgery is
known as Revision Total Hip Arthroplasty (RTHA).
However, the stress distribution may suffer a
modification because the revision implant tend to
be larger, and a considerable portion of the bone is
removed. The aim of the research is the evaluation
of the mechanical effects that the revision implants
produce on the femoral component of the joint.
The deflection of the three models doesnt trespass

the maximum deflection that the bone can resist
before fracture. The standard and revision implant
showed the same stress shielding pattern on the
proximal part of the bone. However, on the distal
part the stress shielding from the revision implant
continues until the tip of the stem.
C o n cl u s i o n
The use of FE supports the prediction of where the
stress shielding will be produced with the different
implants. This will help to indicate the mechanical
problems that a revision implant may produce.

A three dimensional Finite Element (FE) model
of the femoral component was created from
the segmentation of a CT Scan. The Femur was
integrated by Cortical and Trabecular tissue. The
load conditions used on the model were based
on the instrumented hip studies performed by
Bergmann (1993) and the muscle forces were
estimated by constraining the muscle attachments
in the bone. Three different models were created
for analysis: an intact femoral component (a) an
integrated standard implant (b) and an integrated
revision implant (c). To validate the model an
experimental test using artificial bones was made.
The femur was placed in a mechanical testing
machine and was loaded simulating the same
load conditions. The surface strain of the bone was
measured by using optical strain instruments.
References
Bergmann, G., Graichen,. F., Rohlmann, A., 1993.
Hip joint loading during walking and running,
measured in two patients. Journal of Biomechanics
26, 969990.
Akay, M., Aslan, N., 1996. Numerical and experimental stress analysis of a polymeric composite
hip joint prosthesis. Journal of Biomedical Materials
Research 31, 167182.
Martens, M., Van Audekercke, R., Meester, P.,
Muller, J.C.,1986. Mechanical Behaviour of femoral
bones in bending loading. Journal of Biomechanics
19, 443454.
McLaughlin, J., Lee, K., 2011. Total hip arthroplasty
with an uncemented tapered femoral component
in patients younger than 50 years. Journal of
Arthroplasty 26, 1, 915.
Taylor, J., Rorabeck, C., 1999. Femoral Revision
Hip Revision Arthroplasty Approach to the Femoral
Side. Clinical Orthopaedics and Related Research
369, 208222.

The deflection and the stress distribution of the
bone were plotted to observe the differences.
419
P 059
ANALISYS IF THE EFFECT OF DIFFERENT CONSTRAINED

DESIGN IN POSTERIOR STABILIZED TKA BEHAVIOUR
S. Pianigiani1, R. Alario Bernab2, H. Robledo Yage2, W. Pascale1, B. Innocenti2
1
2
Universite Libre de Bruxelles, BEAMS Department, Bruxelles, Belgium
Introduction
Posterior-Stabilized (PS) total knee arthroplasties
(TKA) (PS) have been widely used during the last
three decades reporting generally excellent
results in long-term studies [1]. But, when the
patient has non-enough stable knee envelope,
he may require larger degree of constrain as the
Semi-Constrained design in which the post have
larger dimension. However, there is a lack of
confidence from surgeons to this design because
they fear that its larger post could lead to a
premature failure of the post-cam mechanism of
the prosthesis [2]. However, up to now, no direct
biomechanical analysis has never be performed.
For this reasons, a conventional PS TKA design and
a semi-constrained one have been kinematically
and kinetically compared, replicating walking and
squatting activities by means of a finite element
analysis (FEA).
Generally, due to the increased cross-section of the

semi-constrained tibial insert, larger contact forces
and pressures are experienced by lateral and medial
sides of the post in the semi-constrained version
compared to those in the conventional one, where
no contact forces can be observed. This effect is more
pronounced for the squat that for the walking task.
Discussion
By means of this study it has been shown that the
modification of the geometry of the post induce
a change in the contact between the femoral
component and the tibial insert of a PS TKA.
The main difference is observed in the post,
which establishes larger contact with the femoral
component especially on its medial and lateral
sides for the semi-constrained solution.
Methods
For the two analyzed solutions, the same femoral
component has been used [3]. A standard
gait cycle and a squatting activity up to 120
were simulated for both TKA situations [4]. The
tibiofemoral kinetics and kinematics have been
investigated comparing the contact area between
components, the internal-external rotation, the
position and the magnitude of the contact forces
and the Von Misses stresses on the polyethylene.
Special attention to the post-cam engagement
mechanism behaviour has been paid.
Consequently, the rotation of the knee becomes

also limited, which leads to a change on the position
of the contact force on the tibial compartments.
Thus, the kinematics of the knee prosthesis are
modified, limiting the internal-external rotation
and increasing the anterior-posterior translation.
Resulting from that, it takes place an increase
of the bending movement exerted on the semiconstrained post. Less demanding motor tasks,
such as gait, have shown limited differences in
the outputs. The reported alterations could induce
earlier wear of the revision design compared to
the conventional one.
Results
The obtained results have shown a change on
the kinematics especially along anterior-posterior
direction as well as an increase of contact forces
on the post of the semi-constrained design.
References
1 Orozco, 2012
2 King et al., Knee, 2014
3 Sang et al., KSRR, 2012
4 Innocenti et al., JoB, 2011
420
P 060
BIOMECHANICAL EVALUATION OF A POSTERIOR

DYNAMIC DEVICE USING ACCURATE FINITE ELEMENT
MODEL OF THE LUMBAR SPINE
C. Hassan1, I. Zafarparandeh1, D. Erbulut1,2, I. Lazoglu1, A. Ozer2
1
Koc University, Mechanical Engineering, Istanbul, Turkey

2
Koc University, Neurosurgery, Istanbul, Turkey
Introduction
Several studies have evaluated the biomechanical
effects of rigid fusion rods and PDS devices on
lumbar spine. However, most of these analyses
were done using symmetrical or simplified lumbar
FE models. The aim of present study is to propose
an accurate geometry FE model of complete
lumbosacral spine. The model was used for
evaluation of the biomechanical parameters, such
as range of motion (ROM), facet loads (FL) and
intradiscal pressure (IDP), after instrumentation
with rigid rod and spring rod.
and found that Nitinol spring rod is effective at

restoring highest amount of motion in all planes.
However, the restored motion is still less than 30%.
It was found that both Titanium and Nitinol spring
rods have same effect at adjacent levels, causing
no significant excessive motion, or disc pressure.
Despite this, spring rods of both types were not able
to eliminate the adjacent level effects completely,
especially high facet loads in adjacent segments
in extension-flexion plane.
Methods
A three-dimensional FE model of the lumbosacral
spine (L1-S1) was developed, as described in our
previous studies [1, 2]. The model was validated
by load-control method against published in vitro
studies in all three motion planes under 10Nm pure
moment and 400N compressive follower load [35].
Three implant cases at L4-L5 lumbar segment
were considered: rigid rod posterior fusion (RRF),
Titanium spring rod (SR-Ti), and Nitinol spring rod
(SR-Ni). ROM, FL and IDP were investigated at the
index and adjacent levels for intact and implanted
models.
Results
ROM of the FE model for flexion was found stiffer
than cadaver studies while extension was within
standard deviation. Lateral bending and axial
rotation in the FE model were in range of or more
flexible than the cadaver studies. For intact case
at index level, ROM was predicted as 3.2 in
extension which decreased by 95%, 98% and
84% after instrumentation with RRF, SR-Ti and
SR-Ni, respectively. ROM in extension and flexion
at adjacent levels changed less than 0.1 after
instrumentation in all three cases. The predicted
IDP and FL are shown in Figure 1 and Figure 2,
respectively, for intact and instrumented models
at index and adjacent levels.
References
[1] Erbulut, D. et al., 2014. Med Eng Phys. 36, 915921.
[2] Erbulut, D.U., 2013. Turk Neurosurg. 24, 923928.
[3] Niosi, C.A. et al., 2006. Eur Spine J. 15, 913922.
[4] Schmoelz, W. et al., 2003. J Spinal Disord Tech.
16, 418423.
[5] Yamamoto, I. et al., 1989. Spine. 14, 12561260.
[6] Ozer, A.F. et al., 2010. Open J Orthop. 4, 137.
[7] Ghiselli, G. et al., 2004. J Bone Joint Surg. 86,
14971503.
Discussion
Rigid rod fusion has been a standard clinical
procedure for decades to treat chronic low
back pain [6]. However, rigid fusion is identified
as a cause of adjacent level effects, causing
degeneration between 1535% for 510 years
after fusion [7]. Several alternative PDS devices
have been proposed including spring rod. In this
study, we compared spring rod with rigid rod fusion
421
P 0 61
GEOMETRIC AND MECHANICAL BEHAVIOUR

ANALYSIS OF THE TALUS FOR THE ESTABLISHMENT
OF A COMPATIBLE TALUS PROSTHETIC
A. Trovato1, M. El-Rich1, S. Adeeb1, T. Bornes2, S. Dhillon3 , N. Jomha2
1
2
University of Alberta, Orthopaedic Surgery Department of Surgery, Edmonton, Canada

3
University of Alberta, Radiology and Diagnostic Imaging, Edmonton, Canada
Introduction
Trauma to the talus can result in fracture, avascular
necrosis (AVN) and structural collapse of the talus.
Until recently, treatment for complications of this
injury has been limited to surgical fusion which
causes loss of motion and function [Barton et al.
2011; Haddad et al. 2007, Hendrickx et al. 2011].
More recently, total ankle arthroplasty has been
implemented with growing success. However,
these procedures may not be an appropriate
treatment for avascular necrosis (AVN). There
have been cases of custom-made implants to deal
with issues associated with fusion and arthroplasty
but these have time and monetary restraints. To
mitigate the issues associated with a custom-made
talar implant, a generic talar prosthesis available
in various sizes may serve as a suitable alternative.
The overall objective of this study is to create
a generic prosthesis in multiple sizes that can
maintain the function and geometric compatibility
of a biological talus.
the biological talus when the surrounding bones

from each scan were aligned with each other.
Results
The average average deviation (D_av) between
tali after volume scaling was 1.07 mm between
male tali and 0.87 mm between female tali. The
male and female implants had D_av values in
comparison to remaining tali of its sex equal to
0.890.14 mm and 0.750.11 mm respectively.
The female and male implants were considered to
be the same (with an average deviation between
the two of 0.60mm) and a unisex implant template
was created. The overall D_av between each talus
and its respective size was found to be 0.88 mm
with deviations on the talar dome under 1 mm. A
preliminary analysis of the scans from the cadaver
study has been completed with promising results
(deviations less than 1mm on articulating surfaces).
Discussion
Thus far, the outcomes of the study are promising.
A unisex implant in 10 different sizes was created
and a cadaveric assessment is well underway. We
are optimistic that it is possible to create a generic
talar implant in multiple sizes.
Methods
CT scans of 91 tali were obtained and 3D modelled
to determine the geometric variation between
individual tali. Comparisons between models were
carried out to determine shape variation and
from these the best shape was determined for the
female and male template. The templates scaled
to the same size and compared to determine if a
unisex implant would be possible. A template for
a talar implant in multiple sizes was then created
and validated by comparing the template to the
models. The joint compatibility of the talar implants
is currently being verified in a human cadavers
study. The sizes of the implant for the right ankles
were 3D printed using the volume of the left talus.
The right ankles were scanned with the biological
talus and implant in the ankle. The scans were 3D
modelled and the location of the implant within
the ankle joint was compared to the location of
References
T . Barton et al. Biomechanical changes associated
with the osteoarthritic, arthrodesed, and prosthetic
ankle joint, Foot Ankle Surg, vol. 17, no. 2, pp. 527,
June 2011.
S . Haddad et al. Intermediate and long-term
outcomes of total ankle arthroplasty and ankle
arthrodesis. A systematic review of the literature,
J Bone Joint Surg Am, vol. 89, no. 9, pp. 1899905,
September 2007.
R
. Hendrickx et al. Medium- to long-term outcome
of ankle arthrodesis, Foot Ankle Int, vol. 32, no. 10,
pp. 9407, October 2011
422
P 062
BONE STIFFNESS DETERMINED FROM ACETABULAR

SHELL DEFORMATION
T. Pandorf1, P. Dold1, M. Flohr1, R. Preuss1, D. Deehan2, J. Holland2, M. Bone3
1
2
CeramTec GmbH, Medical Division, Plochingen, Germany
Freeman Hospital, Newcastle Surgical Training Centre, Newcastle upon Tyne, United Kingdom
3
Newcastle University, School of Mechanical Engineering, Newcastle upon Tyne,

United Kingdom
Introduction
Deformation of modular acetabular press-fit
shells is a topic of high interest for surgeons and
manufacturers. Initial fixation is achieved through
press-fit between shell and acetabulum with the
shell mechanically deforming upon insertion. Shell
deformation may disrupt the assembly process
of modular systems and may adversely affect
integrity and durability of the components and
tribology of the bearing.Clinically relevant data to
quantify and understand such shell deformation
can be achieved by cadaver measurements. ATOS
Triple Scan III (ATOS) optical system was identified
and validated as a suitable measurement system
to perform those measurements [Dold, 2014]. The
aim of the study presented here was to calculate
the bone stiffness from both the measured shell
deformation data and the shell stiffness.
Results
Radial stiffness for shells with 3 mm wall thickness
ranged between 2920 N/mm and 6257 N/mm.
Shells with wall thickness of 4 mm ranged between
6875 N/mm and 14341 N/mm. The radial shell
deformation ranged between 3 m and 187 m. To
account for possible measurement errors, the mean
deformation value for approx. 1 around the point
of maximum deformation has been calculated.
The resulting maximum radial forces acting on the
shells ranged between 26 N and 916N. From these
values, a bone stiffness [N/mm] at the point of
the maximum deformation has been calculated.
Adding the bone stiffness and the shell stiffness
using the equation for serial springs, one obtains
a positive correlation between total stiffness and
maximum deformation.
Discussion
The measured deformation values are within the
same order of magnitude previously published [Lin
2006, Squire 2006]. The large variations of resulting
maximum forces exhibit the need to further
investigate shell deformation using commercial
shell systems. The calculated bone stiffness at the
point of the maximum deformation seems to be
a valid predictor for expected shell deformation,
but this also needs more data. A future goal is
to determine expected shell deformation from
bone data as a design rational to determine the
necessary clearance for thin shells. This study also
supports that the ATOS system fulfils the necessary
requirements
to
accurately
measure
shell
deformation in cadavers.
Methods
The stiffness of the generic shells was determined
using a uniaxial/ two -point loading frame to apply
different loads, and the change in dimension was
measured by a coordinate measurement machine
(CMM). Cadaver lab deformation measurements
were done before and after insertion for 32 shells
with 2 wall thicknesses and 10 shell sizes. Multiple
deformation measurements per cadaver were
performed by using both hip sides and stepwise
increasing the reamed acetabulum by at least
1 mm, depending on sufficient residual bone stock.
The underreaming was varied between 0 mm and
1 mm, respectively. Bone stiffness was calculated
using the maximum deformation and assuming
force equilibrium as well as linear-elastic material
behaviour in each point at the rim of the shell.
References
D
old et al, P I Mech Eng H. pii: 0954411914546562
Epub ahead of print, 2014.
L in et al, Proc Inst Mech Eng H, 220: 299309, 2006.
S quire et al, J Arthroplasty, 21: 7277, 2006.
423
P 063
FINITE ELEMENT ANALYSIS OF FEMORAL NECK

FRACTURE TREATED WITH HANSSON PIN UNDER
DYNAMIC GAIT LOADING
Y. Nakamura1, K. Naoi1, K. Adachi1, M. Noda2, M. Matsuda1
1
Kobe University, Department of Mechanical Engineering, Kobe, Japan

2
Konan Hospital, Department of Orthopaedics, Kobe, Japan
Introduction
Osteosynthesis with Hansson pin (HP, Stryker)
is widely used for proximal femoral fractures,
however complications such as bone refracture
around the insertion holes may occur during
postoperative physical rehabilitation with weight
bearing. The purpose of this study is to evaluate
the time dependent stress distribution of proximal
femur with HP subject to gait loading by using finite
element analysis.
Experimental Method: A novel three-dimensional
hip joint model, acetabular and proximal femur
with femoral neck Pauwels type III fracture, was
reconstructed from CT images and discretized into
3-noded tetrahedral elements. Moving boundary
condition was set to the proximal femur for
simulating a gait motion. Both joint reaction and
abduction forces were considered as dynamic
loading conditions during a gait cycle. The
abduction at greater trochanter was the tensile
force with single peak and the hip joint reaction
was the compressive force with the double peak
during a gait cycle. The hip joint reaction was
obtained by the inverse dynamic analysis of human
gait using in-house two-leg musculoskeletal model.
We numerically evaluated the time varying von
Mises stress distribution by dynamic explicit method
using ABAQUS 6.13-5 (SIMULIA).
Figure 1 summarized the finite element analysis.
Figure 2 shows the time varying stress of proximal
femur during a gait cycle. In case of normal
control, maximum von Mises stresses were 15.5MPa
around the proximal insertion hole and 16.6MPa
around the fracture surface. However, in case of
HP treatment, these were 99.8MPa and 18.9MPa
at the same regions. This result shows the significant
stress concentration around the proximal insertion
hole of HP under gait loading.
C o n cl u s i o n
We concluded that von Mises stress in the proximal
insertion hole is affected by the hip joint reaction
due to gait motion. This suggested the explanations
for the bone refracture around the insertion holes
during postoperative physical rehabilitation with
weight bearing.
424
P 064
CYCLIC TEST OF MATERIAL USED IN HERNIA REPAIR

A. Ambroziak1, K. Szepietowska1, I. Lubowiecka1
1
Gdansk University of Technology, Department of Structural Mechanics, Gdansk, Poland
Introduction
Hernia is common medical problem. Nowadays,
gold standard in its treatment is to reinforce
abdominal wall by surgical mesh. However, due
to high cost of such treatment in underdeveloped
countries surgeons needed to find cheaper
solution and started to use sterilised textile usually
used for the manufacturing of mosquito nets as
an alternative to expensive commercial surgical
meshes [Sanders, 2013]. Studies conducted
by Sanders et al. including mechanical tests
led to positive conclusions about usefulness of
mosquito nets in hernia repair and its similarity
to commercial meshes. Next, [Ambroziak, 2015]
identified parameters of material law for chosen
mosquito nets fabrics. The results were compared
with behaviour of commercial implants and also
with properties of fascia, which is a key role tissue
in the context of hernia, due to desired mechanical
compatibility.
RESU L TS
The mechanical behaviour of tested material
under uniaxial tensile stress is shown on an example
of stress-strain curves, see Figure 1. This is a curve
registered for one direction and one material type.
Preconditioning was observed and studied

in biological tissues [Fung, 1993] and also in
commercial implants used in hernia repair
e.g. [Maurer, 2014]. Due to importance of this
phenomenon to behaviour of implanted material
we are presenting outcomes of cycling tests
conducted on mosquito nets materials as a next
step in the research of their usefulness in hernia
repair.
Figure 1: E
xample of stress-strain curve for one of mosquito
nets under uni-axial cyclic load
Discussion
As in the case of commercial implant e.g. [Li, 2014]
hysteresis was observed for both directions and all
types of tested meshes. It should be noted that their
stiffness increased after second cycle and stayed
at similar level in next cycles. Preconditioning ratio
is similar for mosquito nets with similar structure and
differs for the mesh with another structure. The ratio
is lower for samples which were cut in the direction
characterised by higher stiffness.
METHODS
Cyclic uni-axial tensile test was performed on
Zwick type, computer operated strength-testing
machine. The samples (with 50 mm width and
200 mm grip separation) of textile material were
cut in two perpendicular directions. 5 cycles
were conducted on each level of stress (5 levels
at different values according to their uniaxial
behaviour). 4 brands of materials were studied.
3 of them have similar textile structure, the forth
one has different structure. Linear or piecewise
linear constitutive model was identified for
each cycle. For comparison of their mechanics
a parameter reflecting cyclic behaviour was
calculated according to definition proposed by
[Maurer, 2014]. This is a ratio of residual strain for
last cycle to maximum strain reached at first cycle.
To sum up mosquito nets fabrics behave similarly

to commercial implants used for hernia repair
when exposed to cyclic load.
References
Ambroziak et al, accepted to Comput. Methods
Biomech Biomed Engin, 2015
Fung, Springer, 1993
Li et al, J Mech Behav Biomed Mater, 37, 4855, 2014
Maurer et al. J Mech Behav Biomed Mater, 40,
4258, 2014
Sanders et al, World J. Surg. 37, 73745, 2013
425
P 065
A NOVEL NON-INVASIVELY ADJUSTABLE GLAUCOMA

DRAINAGE DEVICE
N. Stergiopulos1, A. Villamarin1, S. Roy1, A. Mermoud3
1
2
IBI, EPFL, Lausanne, Switzerland
Clinique de Montchoisi, Centre dOphtalmologie, Lausanne, Switzerland
Introduction
This work reports on the in vivo testing of a novel
non-invasively adjustable glaucoma drainage
device (AGDD). The AGDD features an adjustable
outflow resistance, thereby allowing the physician
to regulate the intraocular pressure (IOP) on a per
patient basis.
operated eyes was no longer significant (p = 0.12).

In the 3 rabbits from group 2 a difference in IOP in
the early postoperative period between the AGDD
(closed position) and the Ex-PRESS was present but
did not reached a statistical significance (p = 0.1).
Hypotony was present for a longer period in the
eyes implanted the Ex-PRESS as compared to eyes
with AGDD (6 days vs. 3 days). For both groups the
IOP dropped significantly from 11.2 2.9 mmHg
down to 4.8 0.9 mmHg (p < 0.05) when the AGDD
was opened from its fully closed (maximum outflow
resistance) to fully opened (minimum outflow
resistance) position.
Methods
The in vivo study was carried on 10 white New-Zealand
rabbits for duration of 6 months. The AGDD was
implanted in a way analogous to the Ex-PRESS
device. A scleral flap was dissected and the
nozzle was inserted in the anterior chamber.
The AGDD was implanted in an operationally
closed position and left in that position during
the initial postoperative period. During the first
postoperative week, IOP was measured daily on
both the operated and the control eyes using a
rebound tonometer. In the following weeks, such
measurement was performed once a week. Once
a week the AGDD was adjusted non-invasively
from its fully closed to its fully open position and
the pressure drop was measured. Hypotony was
defined as IOP equal or lower than 6 mmHg. In
7 out of 10 rabbits the contralateral eye was not
operated and served as control (group 1). In 3 of
the 10 rabbits, an Ex-PRESS P-50 was implanted in
the contralateral eye (group 2). In this group IOP
measurements were performed on both eyes.
Discussion
Critical aspects such as safety and efficiency
of the AGDD were assessed in this first in vivo
study. The rate of aqueous humor outflow was
easily adjustable during the entire postoperative
period. Technically the surgical procedure to insert
the AGDD does not differ significantly from the
implantation,
demonstrating
the
Ex-PRESS
simplicity and relative easy use of the implant.
These first in vivo results provided encouraging
data on the safety and performance of the device.
A human clinical trial will follow to demonstrate
all aspects of safety, performance and efficacy
of the AGDD. This will provide an effective means
of controlling IOP during both the early and late
post-op period on a per patient basis, in the aim
of possibly minimizing the risk of hypotony in the
early postoperative stages, particularly when the
AGDD is being used in conjunction with a seton
tube. Furthermore the very small diameter and
anatomical localization of the nozzle could help
avoiding one of the most feared complications
encountered when using seton tubes, in preventing
a corneal failure resulting from endothelial cell loss.
Results
The mean preoperative IOP was 11.1 2.4 mmHg.
In the 7 rabbits from group 1 hypotony was present
in the operated eyes during the first 3 days after
implantation (mean IOP was 6 1.4 mmHg) and
the difference with the control (non-operated)
eyes was significant (p < 0.05). Eight days after
surgery the difference in IOP between control and
426
P 066
ENGINEERING ASSISTANCE IN SELECTING

A PERSONALIZED ORTHOSIS
J. Jurkojc1, K. Jochymczyk-Wozniak1, R. Michnik1, I. Chuchnowska1,
K. Nowakowska1, M. Gzik1
1
Silesian University of Technology, Biomechatronics Department, Zabrze, Poland
Introduction
Data shown by the International Society for Prosthetics and Orthotics and by the World Health
Organization (WHO) indicate that a round 0,5% of
the population of developing countries is in need
of orthopedic supplies in the form of prosthetics/
/orthoses or other orthopedic equipment. The
main goal is to develop a method to choose AFO
(Ankle Foot Orthosis) or DAFO (Dynamic Ankle Foot
Orthosis) orthoses that uses the computing power
of IT systems and the innovative measuring methods. The shown methodology enables choosing an
optimal construction features of AFO/DAFO orthoses to meet their treatment function and patients
anthropomorphic structure. This study concentrates on the verification whether the given orthosis was correctly chosen through examining gait
kinematics.
without footwear and second using orthoses and

fitted footwear. For both patients the orthosis
manufacturing process was performed using
standard procedures.
To facilitate the patients functional gait analysis
indicator gait evaluation methods were used [Suchtte,
2000; Schwartz, 2008]. The evaluation of treatment
progress was performed using GGI, GDI and the
16 analyzed marker values obtained from both tests
and comparing them to a control group results
healthy children [Jochymczyk-Wozniak, 2011].
It has to be stressed out that the motor function
handicap (test w/o orthoses) was on a similar level
for both patient, which is proven by the results
in Table 1. The evaluation using GGI and GDI
coefficients is coherent (Table 1).
Table 1: G
GI and GDI coefficient values for two patients
during the test without footwear (study 1) and using
orthoses and footwear (study 2).
The measurements taken show, that for patient P2

the orthoses used were fulfilling their task correctly,
whereas for patient P1 using the orthoses reduces
the motor functions by a large degree. The obtained
results show clearly the need of developing a
methodology for selecting orthoses with the use of
modern measuring and computation tools and not
only on a subjective medical evaluation.
Figure 1: A
general schematic of choosing an optimal construction form of an AFO/DAFO orthosis
Methods
The study was performed using the gait analysis
system BTS Smart.
References
Jochymczyk-Wozniak, Doctoral thesis, 2011.
Schutte L.M et al Gait & Posture, 2000, 11, 2531.
Schwartz M.H. et al Gait & Posture, 2008, 28,
351357.
The study group consisted of children suffering

from various forms and grades of CP. In this study
results from two patients with right-side hemiparesis
were shown. Each patient was tested twice, first
427
P 0 67
IMPLANT DESIGN AND POSITIONING AFFECT

THE INTERFACE MICROMOTION AND BONE STRAINS
IN TOTAL ANKLE REPLACEMENT
R.S. Sopher1, J. Calder2, A.A. Amis1, J.R.T. Jeffers1
1
Imperial College London, Department of Mechanical Engineering, London, United Kingdom
2
Chelsea & Westminster Hospital, London, UK, Fortius Clinic, London, UK, Imperial College
London, UK, Chelsea & Westminster Hospital, Fortius Clinic, Imperial College London, London,
United Kingdom
Introduction
Survival rates of recent total ankle replacement (TAR)
designs are lower than those of other arthroplasty
prostheses. Loosening is the primary indication for TAR
revisions [NJR, 2014], leading to a complex arthrodesis
often involving both the talocrural and subtalar
joints. Loosening is often attributed to early implant
micromotion, which impedes osseointegration at
the bone-implant interface, thereby hampering
fixation [Soballe, 1993]. Migration or micromotion of
TAR prostheses have been assessed to evaluate the
stability of the bone-implant interface by means of
radiostreometric analysis (e.g. Dunbar et al., 2012)
and biomechanical testing [McInnes et al., 2014].
The aim of this study was to utilise computational
modelling to complement the existing data by
providing a detailed model of micromotion at
the bone-implant interface for a range of popular
implant designs, and investigate the effects of
implant misalignment during surgery.
Figure 1: M
icromotion plots for all tibial component designs
and 5 intervals of the GC.
Methods
The geometry of the tibial and talar components
of three TAR designs widely used in Europe (BOX,
Mobility and SALTO; NJR, 2014) was reverse-engineered, and models of the tibia and talus were
generated from CT data. Virtual implantations were
performed and verified by a surgeon specialised in
ankle surgery (JC). In addition to the aligned case,
misalignment was simulated by positioning the
tibial components in 5 and 10 varus/valgus and
5 and 10 dorsiflexion; dorsiflexed misalignement
was combined with 5 posterior gap to simulate the
clinical scenario of this misalignment case. Finite
element models were then developed to explore
bone-implant micromotion and loads occurring in
the bone in the implant vicinity.
Figure 2: M
icromotion plots for all tibial component designs
at 55%GC (last BOX column is missing due to
meshing difficulties).
Discussion
The Mobility had greater implant micromotion
than the SALTO and BOX, and this agrees with
higher revision rates reported in registry data
(e.g. NZJR, 2014). The increased micromotion
assoc ia t ed w it h do siflex io n misa lign ment
hi ghl i ghts the importance of aligning the tibial
component correctly. Implant design and alignment are therefore important factors that affect
the performance of the reconstructed joint.
Results
BOX and SALTO demonstrated the lowest tibial
micromotion, with under 30% of bone-implant
interface area subjected to micromotion larger
than 100m (as opposed to > 55% for Mobility;
Fig. 1). No talar components demonstarted
micromotion larger than 100m. Bone strains
in the tibia were elevated in all implanted
cases compared with the non-implanted case.
Dorsiflexed implantation of all tibial components
increased micromotion and bone strains compared
to the reference case (Fig. 2). The posterior gap
between the tibia and implant further increased
bone strains. Varus/valgus tibial implantation
did not affect micromotion to a great extent.
References
Dunbar et al., Acta Orthop 83: 394400, 2012.
McInnes et al., J Bone Joint Surg Am 96: e147, 2014.
National Joint Registry for England, Wales and N.
Ireland, 11th Annual Reports, 2014.
New Zealand Joint Registry, 15th Year Report, 2014.
Soballe, Acta Orthop Scand Suppl 255: 158, 1993.
428
P 068
MODELLING OF KNITTED SYNTHETIC MESH FOR VENTRAL

HERNIA WITH RESPECT TO STIFFENING EFFECT
A. Tomaszewska1, I. Lubowiecka1, C. Szymczak2
1
Gdansk University of Technology, Faculty of Civil and Environmental Engineering,

Structural Mechanics, Gdansk, Poland
Gdansk University of Technology, Faculty of Ocean Engineering and Ship Technology,

Theory and Ship Design, Gdansk, Poland
Introduction
There is a variety of knitted synthetic meshes for
ventral hernia treatment in the medical market.
Although medical and mechanical analyses are
conducted for dozens of years, still the question
concerning efficient hernia operation is open,
because recurrences and chronic post-operative
pain occur. Many constitutive models of surgical
meshes are reported in literature, however they
do not refer to the mesh stiffening effect, although
the effect is known since some time, see e.g.
[Velayudhan et al., 2009]. The issues of stiffening
effect, constitutive modelling and FEM modelling
of knitted mesh are discussed in this contribution
on the example of DynaMesh-IPOM. There are the
following aims of the study: to quantitatively assess
the mesh stiffness increase under load history
and to assess its influence on the mesh-fastenerabdominal tissue system behaviour.
cough of a patient, see e.g. [Tomaszewska et al.,

2013]. The physical model was built of a porcine
meat, the discussed mesh and metal tacks.
Results
The analysis of experimental results shows a double
increase of the material stiffness when its state
changes from the initial to the preconditioned
one. That relation is valid for the two considered
directions of the mesh in whole stretch ranges
covered by the analysis. This stiffness increases results
in the mesh deflection reduction in the numerical
model. For example, for the impulse load of 35kPa
(cough pressure) the mesh maximal deflection is
calculated for its initial and preconditioned state
when nonlinear stiffness functions are considered.
The difference between maximum deflections of
the membrane in both states is about 10%. Similar
results have been obtained in experiments on
physical model for the same load level.
Methods
Rectangular samples, cut in two orthogonal
directions out of the implant, have been subjected
to simple tensile tests and cyclic loading and
unloading tests in physiological range of stretches.
The former tests served for constitutive model
determination for the mesh in the initial state,
while the cyclic tests were used to identify stiffness
function for the preconditioned state of the mesh.
The stiffness functions are formulated according
to Ogden model [Ogden, 1997] for both states
of the materials. Also simpler, bilinear constitutive
models are considered for the two material states.
The constitutive models are applied to dense net
material model introduced in membrane model
of the mesh, built using finite elements method
(FEM). Commercial program MSC.Mark with our
own subroutines for dense net model is used
[Lubowiecka, 2013]. The FEM model reflects circular
mesh covering abdominal tissue with hernia of
5cm diameter. The mesh is fastened in the tissue in
10points, regularly distributed on the mesh edge. The
model is calibrated to obtain the mesh deflection
similar to the deflection measured for the physical
model of the considered structure under simulated
Discussion
The presented analysis shows an influence of the
stiffening effect, which occurs in knitted mesh,
on the operated hernia system behaviour. This is
a preliminary study, in which numerical models
of the mesh being in two states, initial and
preconditioned, are formulated. The calculated
deflections of the mesh in the two states are
similar that physically measured. The presented
analysis may be a subsequent step towards better
understanding of the operated hernia system
physics as well as towards improved planning of a
given mesh fixation in the abdominal wall in order
to reduce hernia recurrence rate.
References
Lubowiecka, Comp Meth Biomech Biomed Mat,
3741, 2013.
Ogden, Non-Linear Elastic Deformations, Dover
Publications, Inc., 1997.
Tomaszewska et al, Clin Biomech, 28, 743751, 2013.
Velayudhan et al, J Biomed Mat Res Part B: Appl
Biomat, 287296, 2009.
429
P 0 69
EFFECT OF TRUNNION CHARACTERISTICS AND ASSEMBLY

FORCE ON THE HEAD-NECK TAPER STRENGTH
OF A MODULAR HIP IMPLANT
S.Y. Jauch1, A.W. Miles1, H.S. Gill1
1
University of Bath, Centre for Orthopaedic Biomechanics, Bath, United Kingdom
Introduction
Modular hip prostheses are commonly used in total
hip replacement operations. The taper connections
of modular hip implants bear the risk of fretting, wear
and corrosion resulting in a limited implant survival
as observed clinically [Collier, 1992]. Currently,
explicit instruction guidelines to assemble modular
components are rarely available. Clinical data
showed a higher incidence of this failure mode for
some implants.
Results
Consecutive testing of the implant components
did not influence the pull-off forces (p 0.216). For
all test groups, the pull-off forces increased with
rising peak assembly force (p < 0.001, Figure 2).
For assembly forces of 4 kN or less, smooth standard
tapers offered significantly higher pull-off forces
compared to grooved standard tapers (p < 0.038,
Figure 2). An assembly force of 2 kN caused a higher
taper strength for mini tapers than for standard
tapers (both grooved surface, p = 0.037). Following
a 6 kN impaction, no influence of the surface finish
(p = 0.426) and taper length (p = 0.266) on the
pull-off force was detected.
Therefore, this study investigated the effect of

trunnion characteristics on the head-neck taper
strength of a modular implant under typical
intraoperative assembly forces.
Methods
For mechanical testing three groups of trunnions
(Corin Group PLC, Cirencester, UK, n = 5 each)
with different taper lengths and surface finishes
were tested: smooth, standard tapers vs. grooved,
standard tapers vs. grooved, mini tapers. Titanium
trunnions were assembled with 28 mm cobalt-chromium ball heads (size L) by an impaction
using a custom-made drop-rig with peak forces
ranging from 2 kN to 6 kN (F1= 2 kN, F2= 2 kN, F3= 4 kN,
F4= 2 kN, F5= 6 kN, F6= 2 kN). After each assembly
process the heads were disassembled with a
materials testing machine (Series 3300, Instron,
Norwood, MA, USA, v = 0.008 mm/s, ISO 7206-10:
2003, Figure 1) to detect the pull-off force as a
measure for the taper strength. For statistical
analyses parametricand non-parametric tests were
performed ( = 0.05, SPSS Statistics 20, Munich,
Germany).
Figure 2: P
ull-off force for the three groups tested.
Discussion
The
results
imply,
that
trunnion-specific
parameters have a significant impact on the
taper strength especially in the most common
range of intraoperative assembly forces (90% <
6 kN, [Nassutt, 2006]). Based on these results, an
assembly force of at least 4 kN is recommended
to minimize the influence of trunnion-specific
effects on the taper strength and to reduce the
risk of fretting-induced complications. However, it
should also be considered that an extremely strong
hammer blow (F > 8 kN) may provoke damage to
the bony structure and/or the surrounding tissue or
cause plastic deformation of the implant.
References
Collier et al., J Bone Joint Surg Br. 74: 511517, 1992
Nassutt et al., Biomed Tech. 51: 103109, 2006
The authors gratefully acknowledge the cooperation
and support of Corin Group PLC.
Figure 1: Set-up in the materials testing machine to determine

the pull-off force.
430
P 070
COMPUTATIONAL EVALUATION OF POLYMER CHAINS

ORIENTATION IN STYRENE BLOCK COPOLYMERS TREATED
BY INJECTION MOULDING TECHNIQUE
F. De Gaetano1, M. Serrani2, J. Brubert2, J. Stasiak2, G. Moggridge2, M.L. Costantino1
1
Politecnico di Milano, Chemistry, Material and Chemical Engineering Department

Giulio Natta, Milano, Italy
University of Cambridge, Department of Chemical Engineering & Biotechnology,

Cambridge, United Kingdom
Introduction
Currently, mechanical heart valve prostheses
guarantee durable performances but need
permanent anticoagulation therapy whereas
biological prostheses display optimal fluid dynamics
but show limited durability due to rapid calcification.
Polymeric Heart Valve (PHV) prostheses aim at
combining the hemodynamic advantages of
biological valves with the durability of mechanical
valves. Styrene Block Polymers (SBPs) appear as
the best materials to this purpose, because of their
excellent biocompatibility, chemical stability and
fatigue resistance. In addition, these materials can
be processed by injection moulding, a technique
that allows controlling the alignment of the
polystyrene micro chains [Stasiak, 2014]. The aim of
this work is the investigation of the micro domains
orientation within the PHV leaflets produced by
injection moulding technique in order to optimise
the PHVs manufacturing.
optimize also the entire mould, configurations with

different injection points location can be selected
without affecting the micro domain alignment in
the PHV leaflets. Numerical results confirm that
these changes allow us to reach this goal without
significantly altering the chains orientation along
the leaflet (Figure 1). Different mass flow rates
were considered to highlight the effects on the
orientation of the polymer chains along the leaflet.
The effect of different flow rate resulted negligible.
Discussion
In conclusion, the comparison of the different
location of the injection points on the leaflet
showed the same alignment of the polymer chains
of the SBP; in particular, the micro domains are
mainly oriented along the flow direction, with
only negligible differences among the different
configurations as well as the effects of different
flow rates. Both these results allow the optimisation
of the moulding process in terms of minimisation of
the manufacturing time duration.
Methods
Numerical models of the injection moulding of
the valve were developed using ANSYS fluent;
different injection points, polymer outlets and flow
rate were simulated to study the influence of all
these parameters on the material microstructure.
The rheology of poly-(Styrene-Isoprene-ButadieneStyrene) with 19% styrene (SI/BS19) was described
by the Carreau Model. Spatial coordinates and
velocity data obtained by the computational
analyses were processed with Matlab to calculate
from the deformation tensor Da stretch rate
and the shear rate . These vectors describe the
directions along which the extensional flow and
the shear flow align the polymer chains. When the
stretch and the shear vectors were not aligned the
dominant vector for the micro domains orientation
was determined by comparing the ratio v=||/
||with a threshold value vc. This threshold has
been determined by comparing the polymeric
chain orientation in a thin injection moulded
membrane measured by Small Angle X-ray
Scattering Analysis and the output of a simplified
numerical model.
References
Stasiak J. et al, Soft Matter, 10: 6077-6086, 2014.
Results
Modelling predictions of the SI/BS19 microstructure
show a micro domains orientation mainly in the
direction of the flow (Figure 1b). Different injection
inlet/outlet configurations were simulated. No
significant effects on the polymer chains orientation
along the leaflet were obtained. In order to
Figure 1: a
) Streamlines in a mould characterized by 3 Inlets
and 3 Outlets. The colour scale ranges from 0.02 mm/s
to 2 mm/s. b) Orientation vectors of the polymer
chains predicted by the computational model for
the configuration displayed (given the symmetry of
the system, is shown only one half of the leaflet).
431
P 071
FROM MUSCULOSKELETAL TO ORTHOPAEDIC

BIOMECHANICS MODELLING PATHWAY
S. Piszczatowski1, J. Ogrodnik1, A. Kruszewski1
1
Bialystok Univeristy of Technology, Department of Materials and Biomedical Engineering,

Bialystok, Poland
Introduction
Modelling and numerical simulation are common
methods used in the modern biomechanics. A
wide range of available tools facilitates strength
analysis, designing of custom-fitted implants
or other orthopaedic devices, kinematic and
dynamic analyses of musculoskeletal system etc.
Results
The ANSYS (Ansys Inc.) software is a good candidate
to occupy the centre-stage of the whole modelling
system oriented at the orthopaedic biomechanics
due to the APDL availability and a good integration
with other parts of the system. Based on the
queries of Medline, ANSYS is the most popular FEA
system, the Elsevier database gives similar results
for ANSYS and ABAQUS (Dassault Systmes Simulia
Corp.). MIMICS (Materialise) is probably the most
frequently used software for tomographic data
processing. However, the authors experience
indicates the ScanIP (Simplewere) usefulness.
In the authors system, the AnyBody software
(AnyBody Technology A/S) was chosen for the
musculoskeletal simulation, primary due to an
easy integration with ANSYS and a wide range of
available models.
Nowadays, crucial is an optimal configuration of

laboratory (software and hardware) as well as
recruiting and educating professional staff to get
the most of potentially available possibilities of
modern tools.
The aim of the paper is to animate discussion about
the optimal pathway of the modelling process,
useful especially for orthopaedic biomechanics.
Methods
The finite element analysis (FEA) is probably the most
commonly used modelling method in orthopaedic
biomechanics. However, the process of model
preparation for FEA requires a few elements:
the geometry of the analysed structure,
the material properties of the inhomogeneous
tissues,
the loading conditions.
Tools facilitating the reconstruction of geometrical
data of inner structures of the body, based on the
tomographic data (X-ray CT, MRI) are of great
significance. Such systems are necessary in the
process of geometrical modelling of anatomical
structures. Additionally, important information
about mechanical properties of living tissues
can be received this way. The data that can be
obtained from optical scanners (anthropometric
data, surface modelling of the body) is of second
ary importance.
Figure 1: Scheme of the modelling system used in the analysis

of child hip joint pathological deformation during
growth
Discussion
The system presented above was collected on
the basis of nearly 20 years of the authors own
experience. Another configuration may obviously
be considered, and it would be interesting to
discuss pros and cons of particular solutions.
The complexity of the musculoskeletal system

leads to difficulties in defining the realistic loadings
acting in biomechanical models. Very promising is
the use of software packages facilitating static and
dynamic analyses of the musculoskeletal system.
It could be used to find loadings encompassing
various situations. The problem of muscle force
distribution has to be solved, however, with the use
of an optimisation method.
The presented methodology is of great significance in case of the patient-oriented analysis. A

numerical model made on the basis of individually
reconstructed geometry and material structure
with personally calculated loadings gives a chance
to design really custom-fitted products (endoprostheses, orthoses etc.). However, the data
collected for individual cases could be used also
for parametrical modelling, made for more general
purposes.
432
P 072
IN-VITRO TESTS FOR PERIPHERAL NITINOL STENT

CHARACTERIZATION: A FOCUS ON THE TRASMITTED
AXIAL DEFORMATION
D. Allegretti1, G. Pennati1, L. Petrini2, F. Migliavacca1, G. Dubini1
1
Politecnico di Milano, Dept. of Chemistry, Materials and Chemical Engineering Giulio Natta,
Milan, Italy
2
Politecnico di Milano, Department of Civil and Environmental Engineering, Milan, Italy
Introduction
Use of Nitinol medical devices is still undermined
by complications related to fatigue failure,
despite the encouraging results achieved so far.
Concerning peripheral stents implanted in the
lower extremities, hip and knee daily movements
expose the femoral arteries to large and cyclic
deformations that might cause long-term failure of
the device.
been modeled as a friction contact. The model

takes into account the elastic modulus of both the
tube and the stent (as measured in static tests),
and the initial stretch, imposed to the tube before
the stent deployment.
To mimic the in-vivo behavior and study the

fatigue failure of Nitinol stents, Nikanorov et al.
[1] proposed a set-up in which the devices are
subjected to cyclic loads after their deployment in
silicone tubes. The tests were carried out assuming
that the axial deformation imposed on the tube
prior the stent deployment results on the same axial
compression of the stent once the tube is released.
Figure 2: L umped parameter model of a stent implanted in

a tube.
The friction force has been tuned by comparing

the analytical data with the in-vitro tests.
This work is aimed to verify experimentally and

analytically the correct load to apply to the stent
that reproduces the in-vivo environment.
The LPM allows calculating the stent shortening

of every system unit after the tube elongation is
released and equilibrium is achieved.
Methods
Experimental observations:
An in-vitro set-up has been designed to reproduce
the stent release into a silicone tube. A few different
types of stents and tubes have been tested to
study the interaction between the devices and the
tube. Three levels of tube elongations (10, 15 and
20%) have been used to apply axial shortening to
the stent.
Results
In each experimental test, the stent shortening is
lower than the initial tube elongation. Moreover,
the stent shortening is strongly influenced by both
the stent and tube types and by their interaction.
The LPM results show a good matching between the
analytical and the experimental data. The model
confirms the high influence of friction between
the stent and the tube on the final shortening
transmitted to the stent.
Discussion
In fatigue tests of Nitinol stents the device behavior is
strongly related to the effective stent deformation.
A reliable estimation of the real axial deformation
transmitted to the devices is advisable to allow a
correct comparison of different peripheral devices
during in-vitro test.
References
[1] Nikanorov et al, J Vasc Surg., 48:435440, 2008.
Figure 1: S tent implanted in the tube before (a) and after

(b) the axial release of the tube (i.e. Faxial=0).
This work has been carried out within the project

RT3S Real Time Simulation for Safer vascular Stenting partially funded by the European Commission
under the 7th Framework Programme, GA FP7-2009ICT-4-248801
Interpretative model:
The experimental results have been interpreted by
means of a lumped parameter model (LPM). The
stent-tube system has been described with a finite
number of units composed of parallel springs. The
interaction between the stent and the tube has
433
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STRESS EVALUATION FROM CHANGES IN GEOMETRICAL

BONE DENSITY AND DENTAL IMPLANT CONNECTORS
BY FINITE ELEMENT ANALYSIS
A.R. Freire1, A.C. Rossi1, F.B. Prado1
1
Piracicaba Dental School-State University of Campinas, Morphology, Piracicaba, Brazil
Introduction
Bone density provides the mechanical stabilization
of the implant during healing and also enables
the distribution and transmission of stresses (after
healing) from prosthesis to the bone / implant
interface. Mechanical stress distribution occurs
mainly in the bone contact with the implant.
Factors such as the amount of contact with the
bone, the elastic modulus and the axial stress
distribution around the implant are all affected
by bone density (Gargallo et al., 2008). The aim
of this study was to evaluate the stress distribution
transmitted from implants with different connectors
to bone structure with different geometrical bone
density using finite element analysis.
Results
Regarding the geometry differences of connector,
the MT type showed minor stress intensity
compared to EH implant. Regarding the geometric
bone density, changes occurred in the distribution
and intensity of the stresses, with the tendency to
increase according to the decrease of compact
bone thickness bone associated with increased
trabecular bone.
Discussion
The present study showed EH implant disadvantage
compared to CM, as presented major stress intensity
in all types of bone density, whose condition
may be related to changes in bone remodeling
(Tonella et al., 2011). Thus, the CM allows better
distribution of forces and better adaptation to the
bone structure. This condition has been linked to
the platform positioning in contact with compact
bone, which responds with major force absorption
due its rigidity (Roberts et al., 2000). Thus, in this
study were observed a similar distribution of stress
between the two types of implants in D4 bone
density, in which cortical bone is thinner and,
therefore, presents more load sensibility. Within
the limitations of the finite element analysis and
considering the conditions in this study, it can be
concluded that the variations of the geometric
bone density and implant connectors influenced
the distribution of stresses.
Methods
Geometries of the bone structure and implants
were constructed, respecting the geometrical
characteristics of bone density: D1, D2, D3 and
D4 (Misch, 1990) and connector geometry:
external hexagon (EH) and Morse taper (MT), using
Rhinoceros 3D 5.0 program (McNeel & Associates).
Finite element analysis was performed using ANSYS
v14 (Ansys Inc.), which was simulated masticatory
load with 200N magnitude in the axial direction on
the implants. Finite element mesh tetrahedron was
used and linear elastic material corresponding to
the bone structure and material of implant were
assigned. Equivalent von Mises stress was evaluated
to assess the transfer of energy converted into
stress from implant to bone tissue. The regions of
interest were the bone structure of platform level
and in the cervical third of the implant threads.
References
G
argallo AJ et al, Med Oral Patol Oral Cir Bucal,
13:124128, 2008.
M
isch CE, Int J Oral Implantol, 7:917, 1990.
Tonella BP et al, J Craniofac Surg, 22:20602063, 2011.
R
oberts WE et al, In: McNeill C. Science and
practice of occlusion, p81, 2000.
434
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FE ANALYSES OF EDGE LOADING

IN CERAMIC-ON-CERAMIC HIP REPLACEMENTS
WITH DIFFERENT RIM DESIGN
F. Di Puccio1, L. Mattei1, N. Punzi1
1
University of Pisa, Department of Civil and Industrial Engineering, Pisa, Italy
Introduction
Ceramic-on-ceramic (CoC) hip replacements
(HRs) are becoming more and more attractive,
particularly for young and active patients, thanks to
their bio-inertness and high wear resistance [Ciulli,
2014]. However, their use is still limited because of
several factors among which the edge-loading,
i.e. a severe contact between the cup rim and
head causing stripe wear and squeaking. Although
its origin is still a debated issue, two main causes
are recognized in rotational and translational
implant malpositioning, the latter well known as
microseparation. Very recently, a few numerical
studies have addressed the simulations of such
conditions, showing the high sensitivity of contact
pressure to implant orientation [Sariali, 2012] and
rim design [Mak, 2011]. However, to the best of
our knowledge, the combined effect of such
factors has never been discussed in the literature.
This study presents a comprehensive numerical
investigation on contact mechanics of CoC HRs
under edge-loading condition. In particular, the
combined effect of implant positioning and design
on the contact pressure is analysed for different
load levels. The final aim is to identify design/
configuration solutions which minimize the risks
associated to edge-loading.
Figure 1: F E models of CoC hip implants (a) developed with

different rim designs (b). Boundary conditions applied
for simulating two different cases of edge-loading (c).
Results
Simulations provided contact pressure profiles (Fig.2)
used to compare different configurations and
designs. Preliminary results pointed out: i) the validity
of the Hertzian theory for centered contact (<70);
ii) the fundamental role of implant geometry in
edge-loading, with more conformal couplings and
fillet rims assuring lower contact pressure. The influence
of rim design parameters (i.e. ,? and r of Fig.1-b)
was also discussed. Moreover, it was shown that
the effect of the edge loading on contact pressure
appears for values of and dm which depends both on
implant/rim design and load levels.
Methods
Several finite element models of CoC HRs were
developed in Ansys both for centered and edge
contact. All models have some common features
(Fig.1): they consist of a ceramic head and cup,
the latter glued to a metal backing having the
outer surface fully constrained; only one half of the
real geometry is considered, taking advantage
of the plane of symmetry for the problem. The
models differ for implant geometry and rim design.
In particular, they were considered 3 values of
head size (28, 32 and 36 mm) combined with 3 of
diametrical clearance (60, 80 and100 m), and
3 rim geometries (i.e. sharp, tapered and fillet
rims) (Fig.1-b). Simulations were carried out for
two cases (Fig.1-c): 1) rotational malpositioning,
modelled by cup/backing rotation (=085);
2) microseparation, obtained by means of head
lateralization 750 m). In both cases a vertical load
was applied to the head (0.33 kN).
Figure 2: P
reliminary results: contact pressure for different
cup inclinations.
Discussion
The present study underlined the role of the rim
geometric features in the critical conditions for
CoC implants. As expected a fillet should be
preferred but also the value of its radius plays a
major role.
References
Ciulli E. et al, Adv Sci Tech 89:1020, 2014.
Mak M. et al, J Arthroplasty, 26:131136, 2011.
Sariali E. et al, J Biomech, 45:390393, 2012.
435
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FIXATION OF ACUTE SCAPHOID FRACTURES:

BIOMECHANICS AND CLINICAL RESULTS
OF THE TRANSTRAPEZIAL APPROACH
G. Meermans1, F. Verstreken2
1
Lievensberg Hospital, Orthopaedics, Bergen op Zoom, Netherlands 2Monica Hospital,

Orthopaedics, Deurne, Belgium
Introduction
Of all wrist injuries, the incidence of scaphoid
fractures is second only to fractures of the
distal radius. Surgical treatment results in faster
recovery 1,2 but is technically demanding. When
using a standard volar percutaneous technique,
central screw placement at the distal pole is
hindered by the trapezium. This report focuses
on the transtrapezial approach for the fixation of
nondisplaced scaphoid waist fractures. The goals
of this report are to (1) review the biomechanics of
scaphoid fracture fixation, (2) present the rationale
behind a transtrapezial approach, and (3) report
on the outcome of this technique.
Clinically, there was a 100% union rate with an

average time to union of 6,4 weeks. According to
the modified Mayo wrist score there were 4 good
and 37 excellent results. Radiographs showed
central placement of the screw in all patients.6
Discussion
Placement of a screw along the central axis of the
scaphoid has been shown to be biomechanically
superior to a more eccentric position of the screw
at the distal pole. This can be reliably achieved with
the use of a transtrapezial approach with excellent
clinical results. At present, histomorphometric
studies of the scaphoid using micro CT are done
to look at regional variations and differences in
the scaphoid to further optimize scaphoid fracture
fixation biomechanics for different fracture
patterns.
Methods
Biomechanical testing was done on 14 matched
pairs of cadaveric wrists. 3 Methods to optimize
central screw placement were compared on
3D reconstructions of CT scans of 40 unfractured
scaphoids and trapeziums. 4,5 In 41 patients
with undisplaced scaphoid waist fractures the
transtrapezial approach was used for screw
placement.6
References
1 Buijze GA, Doornberg JN, Ham JS, Ring D, Bhandari
M, Poolman RW. Surgical compared with conservative treatment for acute nondisplaced or minimally
displaced scaphoid fractures: a systematic review
and meta-analysis of randomized controlled trials.
J Bone Joint Surg Am. 2010;92:153444.
2 Ibrahim T, Qureshi A, Sutton AJ, Dias JJ. Surgical
versus nonsurgical treatment of acute minimally
displaced and undisplaced scaphoid waist fractures:
pairwise and network meta-analyses of randomized
controlled trials. J Hand Surg Am. 2011;36:17591768.
3 Meermans G, Van Glabbeek F, Braem MJ, van Riet
RP, Hubens G, Verstreken F. Comparison of two
percutaneous volar approaches for screw fixation
of scaphoid waist fractures: radiographic and
biomechanical study of an osteotomy-simulated
model. J Bone Joint Surg Am. 2014;96:136976.
4 Meermans G, Verstreken F. Influence of screw
design, sex, and approach in scaphoid fracture
fixation. Clin Orthop Relat Res, 2012;470:167381.
5 Meermans G, Verstreken F. A comparison of 2
methods for scaphoid central screw placement
from a volar approach. J Hand Surg Am. 2011;
36:166974.
6 Meermans G, Verstreken F. Percutaneous transtrapezial fixation of acute scaphoid fractures. J Hand
Surg Eur Vol. 2008;33:7916.
Results
The load at 2 mm of displacement and load at
failure were 324.4 N (SEM 73.49) and 386.4 N (SEM
65.58) for screws central at the proximal and distal
pole compared with 125.7 N (SEM 22.61) (p=0.002)
and 191.4 N (SEM 36.30) (p=0.005) for screws
central only at the proximal pole respectively.3
Regardless of screw design, the mean maximum
screw length was higher (p < 0.0001) when using
a volar approach (23.72 SEM 0.19 mm) than when
using a dorsal approach (23.31 SEM 0.19 mm).
Screws with a leading thread diameter of greater
than 3.0 mm and a trailing thread diameter of
greater than 3.9 mm were shorter (p < 0.0001).
Screws with increments of 2 or 2.5 mm were
significantly shorter (p < 0.01 and p < 0.0001,
respectively) compared with screws with 1-mm
increments.4
Irrespective of wrist position, all central guidewires
passed through the trapezium.5 All screws placed
using the transtrapezial approach were inside
and all screws placed using the standard volar
approach were outside the central one-third of
the distal pole (Fig 4). 3,5
436
P 0 76
NEW DIAGNOSTIC TOOL DEMONSTRATES

INTRA-OPERATIVE PELVIC ORIENTATION IS NOT NEUTRAL
IN TOTAL HIP REPLACEMENT
M. Rutherford1, A. Lennon1, D. Beverland2, J. Hill2, J. OConnor1, N. Dunne1
1
Queens University, School of Mechanical and Aerospace Engineering,

Belfast, United Kingdom
2
Musgrave Park Hospital, Primary Joint Unit, Belfast, United Kingdom
Results
Average PO version of 25.6 (Table 1) exceeded
Lewinneks recommend safe zone of 155
[Lewinnek,1978]. This was to be expected given
that z, which is co-planar with version, was the
greatest rotation, Table 1. The values predicted
by this model fall within range of those measured
by Grammatopoulos et al [2014], who reported
a mean pelvic orientation of x = 8, y = 4, and
z=8, at set up, with mean angular movement of
the pelvis equivalent to 9 during surgery (n=67).
Introduction
Pelvic orientation during total hip replacement
may affect the positioning of the acetabular
cup. Mal-positioned cups can incur negative side
effects such as dislocation [Wan, 2008]. Computer
Assisted Surgery may be used to monitor pelvic
position, but is used in less than 1% of surgeries
within the UK [NJR, 2013].
To reduce negative outcomes and the need for
revision surgeries in the UK (n=10,040 [NJR, 2013]),
new affordable techniques to monitor and control
pelvic orientation are needed. The aim of this study
is to develop a tool that can quantify the extent of
pelvic movement during surgery.
Methods
A pilot study was undertaken using data from
10 patients. A freehand surgical approach was
utilised to control cup position. Intra-operative (IO)
cup version and inclination, Figure 1, was obtained
using stereo-photogrammetry.
Discussion
A feature of the composite rotation problem is
that it contains multiple mathematical solutions,
which will need to be refined by limiting the search
boundaries of the PSO solver. This will be achieved
by undergoing clinical studies to monitor the
extent of pelvic movement. Regardless, it shows
that the pelvis was not in the presumed neutral
orientation and that the tool may be utilised as a
post-operative diagnostic tool to identify trends in
pelvic orientation.
Figure 1: A
) Front view B) Side view
Post-operative (PO) cup orientation was measured

using Imatri. A mathematical model was developed
to solve for the unknown pelvic orientation (x, y, z)
that accounted for the difference in IO and PO
cup orientation. Cup orientation was treated as
a unit vector, coincident with the handle of the
introducer. The transformation between IO and
PO orientation was represented using rotation
matrices, Equation 1.
References
Grammatopoulos et al, JBJS, 96 (7):876883, 2014.
Kennedy et al, Proc. IEEE Int Conf. Neural Networks,
pp1942 1948,1995.
Lewinnek et al, JBJS, 60(2):217220,1978.
NJR 10th Annual Report 2013.
Wan et al, J Arthroplasty, 23(1):5156,2008.
[x PO,yPO,zPO] T=(-R y) (-R z) (-R x) [x IO,yIO,zIO] T(1)

A Particle Swarm Optimiser (PSO) [Kennedy, 1995]
was developed using Matlab to solve for the
unknown pelvic orientations.
437
P 077
DOES DELTOID LENGTHENING IMPROVE PATIENT

SATISFACTION AND RANGE OF MOTION IN REVERSE
SHOULDER ARTHROPLASTY
V. Sabesan1, D. Lombardo1, D. Josserand2, J.M. Wiater3
Wayne State University, Orthopaedic Surgery, Dearborn, USA
Botsford Hospital, Orthopaedic Surgery, Farmington Hills, USA
Oakland University William Beaumont School of Medicine, Orthopaedic Surgery,

Royal Oak, USA
B a ckg r o u n d
Reverse shoulder arthroplasty (RSA) is based on
the biomechanical advantages of lengthening
the deltoid while medializing its center of rotation
(COR)(Boileau 2005). However, little evidence
exists describing the clinical benefits of these
reported biomechanical advantages. The purpose
of this study was to assess the relationship between
deltoid lengthening and medialization of the
center of rotation with functional outcomes for
patients treated with a RSA.
C o n cl u s i o n
Our results suggest that lengthening of the deltoid does
not correlate with improvements in active forward
flexion or external rotation after RSA for rotator cuff tear.
These findings could indicate that change in deltoid
length is of less importance than previously thought
with regards to the functional outcomes following RSA.
Based on this, it is clear further studies are needed to
better assess the role of deltoid length as well as other
factors that may impact outcomes following RSA.
Boileau, P., et al. J Shoulder Elbow Surg 14(1 Suppl S):
147s161s. (2005).
De Wilde, L., et al. Clin Biomech (Bristol, Avon) 17(7):
499505. (2002).
Hoenecke, H. R., Jr., et al. J Shoulder Elbow Surg
23(8): 11281135. (2014).
Methods
We conducted a retrospective review consisting of
95 patients treated with primary RSA. Radiographic
measurements of deltoid length (DL), Acromial
Greater Tuberosity distance (AGT) and center of
rotation (COR) and clinical assessments of forward
elevation (FE) and external rotation (ER) as well as
functional outcome scores were obtained pre and
postoperatively for the cohort. Linear regression
analyses were performed to assess the relationship
between these radiographic measurements and
changes in shoulder functionality as well as patient
outcome scores.
Results
All patients had significant improvements in
function and expected increases in deltoid length
and medialization of the COR. Post-operative COR
correlated weakly with post-operative forward
elevation (R=0.237 p=0.019). There was a weakly
negative correlation between increase in AGT
and post-operative forward elevation (R=0.269
p=.045); and between deltoid lengthening and
FE improvement elevation (R=0.47, p=0.031).
Otherwise, there were no significant correlations
between any of the radiographic measurements
and range of motion or outcome scores.
Figure 1: P
re and postoperative radiographic measurements of deltoid length (DL), acromion greater
tuberosity distance (AGT), and center of rotation
(COR).
438
P 078
PRESSURE MEASUREMENTS IN TRANSTIBIAL SOCKETS

WITH YIELDING STRUCTURES PRELIMINARY RESULTS
USING ROBOTIC GAIT SIMULATOR
T. Saey1, E. De Raeve1, L. Muraru1, L. Peeraer1,2
1
2
Thomas More University College, MOBILAB, geel, Belgium
KU Leuven, Faculty of Kinesiology and Rehabilitation Sciences, Leuven, Belgium
Introduction
Selective Laser Sintering (SLS) is an additive
manufacturing technique that proved its feasibility
for manufacturing of prosthetic sockets [Faustini,
2006] and other customised orthotic and prosthetic
devices. Lab measurements at the stump prosthetic
socket interface reveal regions of high pressure
corresponding to pain complaints. The integration of
yielding structures in SLS printed sockets can locally
relieve contact pressure [Faustini, 2005]. The efficiency
of such constructions can be validated prior to clinical
trials, in a bench test set-up, unbiased by patient
condition. The objective of this study was to establish a
framework to quantify interface pressure in transtibial
sockets (at the level of specially designed compliant
structures) by testing in a robotic gait simulator.

The interface pressure measured for the socket
with the yielding structure was considerably lower
than the pressure measured for the socket with
the unaltered rigid wall (Fig. 2 left) while vertical
ground reaction forces were the same (Fig. 2 right).
Although preliminary, the results presented in this
abstract demonstrate the efficacy of introducing
flexible structures to relieve interface pressure.
Also, these first measurements demonstrate the
feasibility of our protocol for quantifying in-socket
pressure in a gait simulator.
References
Faustini et al. J Biomech Eng 2005
Faustini et al. IEEE 2006
Rogers et al. Prosthet Orthot Int 2007
Methods
One prosthetic socket with an integrated yielding
structure (Fig. 1) was compared to a normal socket
on a robotic gait simulator. The socket was designed
based on a 3D scan of a transtibial amputee stump
according to Rogers et al. [Rogers, 2007]. The same
scan was used to design an artificial stump (consisting
of a scaled 3D printed model of an amputated tibia
and fibula covered with a soft silicone material to
mimic human soft tissue). The gait simulator, based
on a Kuka KR210 industrial robot, is able to simulate
lower limb gait kinematics. The combination of the
simulator and the artificial stump allows measuring
interface pressure between socket and stump during
a realistic unroll of the foot.
Ack n o wl e d g e m e n t s :
Part of this research was performed in the framework
of TICOON and of EFFORTH project, both funded
by IWT Belgium (Flanders Agency for Innovation by
Science and Technology).
Interface pressure and ground reaction force were

recorded simultaneously in both cases. 4 pressure
sensors were placed between the yielding area
and the socket.
Figure 2: A
in-socket pressure over yielding area
(black-rigid socket wall, grey-pressure relieving
structure); B vertical ground reaction forces
Figure 1: S LS socket with flexible feature.
439
P 079
TEXTILE BASED IMPLANT CHARACTERIZATION BY SHEAR

FORCE ASSESSMENT AT FIXATION POINTS: APPLICATION
TO ABDOMINAL HERNIA REPAIR
T. Belzacq1, C. Ordrenneau1, F. Turqier1
1
Medtronic, Biomechanics, Trvoux, France
Introduction
Abdominal wall hernia repairs with textile based
implants (mesh) fixed by punctual fixation means
such as tacks or transfacial sutures have been
recognized as successful treatment. However
high intra-abdominal pressure could lead to
high shear forces at fixation points resulting in
potentially fixation pull out or/and mesh tears
and consequently in recurrences and pain [1].
An experimental method has been developed
to assess the distribution of the shear forces at
fixations points, when the defect is non-closed, at
high intra-abdominal pressure.
Table 1: S hear forces distribution vectors and profile.

An axisymmetric set-up is considered to characterize
a mesh free of geometrical non-linearity. The defect
is a circle of diameter 100 m and a circle single
crown of diameter 230mm is considered as fixation
distribution. The single crown is 1cm away from the
mesh edge and the fixation points are 2 cm apart
from each other. For Parietex Light Weight, the results
are reported in Tab 1 for a contact field load of 147N
corresponding to a high intra-abdominal pressure.
The profile highlights the isotropy of the textile then
no high shear forces concentrations are located.
E X P ERIMENTA L METHOD
The mesh is fixed to perpendicular rods accordingly
to a fixation distribution and is engaged through
the defect by a contact field load applied by a
plunger which mimics an intra-abdominal pressure
(Fig. 1). The load is transferred by the mesh to the
fixation points resulting in the rods bending. Using
a system composed of 2 cameras and a 3D digital
image correlation software, the position and
the displacement vectors of markers located at
fixation points are calculated. Function of the load,
the shear force vector at each fixation point where
markers exist is calculated using the displacement
vector of the markers and the rods continuum
mechanics theory.
C o n cl u s i o n
This experimental method constitutes a promising
way to characterize the meshes by a critical
criterion which is related to the safety and the
efficacy of an abdominal wall repair. Parametric
studies could be conducted by varying the defect
geometry and the fixation distribution. Such studies
could serve to validate mesh modeling [2].
References
1 Vidovic D. et al., Factors affecting recurrence after
incisional hernia repair. Hernia 10(4):322325, 2006
2 Guerin G. et al., Impact of the defect size, the
mesh overlap and the fixation depth on ventral
hernia repairs: a combined experimental and
numerical approach. Hernia 17(5):647655, 2013
The authors would like to thank the Plateforme
Biomecanique Experimentale of LBMC (Laboratoire
de Biomecanique des Chocs IFSTTAR, UCBL 1)
for the access to their testing facilities and to
acknowledge the critical contribution of Stphane
Ardizzone (IFSTTAR)., 2013
Figure 1: S cheme of the experimental set-up.
440
P 080
QUANTITATIVE PARAMETERS USED TO DESCRIBE

THE P-A STABILITY OF THE HUMAN KNEE:
A REVIEW OF IN VITRO DATA
A. Mor1, J. Becker1, C. Roesler1
1

Introduction
Considering both the anatomical and the functional
design philosophy of total knee prostheses, the knee
stability can be see as an important parameter during
designing and pre-clinical evaluation stages of total
knee prostheses. The ASTM International supplies
standards on the establishment of a database of total
knee replacement (TKR) motion characteristics with
the intent of developing guidelines for the assignment
of constraint of TKR designs in an experimental in vitro
environment. The test methodology relies on apply
a compressive pre-load at the TKR and move them
in a pre-defined direction, like posterior-anterior
(P-A) displacement, and measure the range of
motion and the reaction force generated for this
direction. Its rationale attempts to the fact that
different individual have distinct soft tissue capacities
for knee stabilization resulting that different prostheses
designs will best fit each patients needs. There is
no acceptance criterion against which the testing
results may be confronted. The aim of this paper is
review and group the literature data on the limiting
values measured for the P-A passive movement of
the knee on in vitro cadaveric testing. We believe
these data could serve as a preliminary indicative
for setting acceptance criteria when judging the
admissibility of new TKR designs.
vitro, (3) provide quantitative parameter before or

after knee tranlation, (4) specify the applied force
as well as its direction and sense to have the range
of motion and (5) shows the degree of knee flexion
for each measure.
Results
Fig. (1) shows the tibial anterior translation values
for different knee angles. Each force value applied
and the corresponding author was represented by
a curve.
Figure 1: A
nterior tibial translation for different knee angles
and postero-anterior loading.
Discussion
The collected data allows a group view of the
AP passive knee stability behavior. These limiting
values can be used to judge the results from preclinical testing of the motion characteristics of TKR
designs.
Methods
The search of data was done at an online database
disponibilized by brazilian government, named
portal peridicos CAPES. The terms used in the
search were: biomechanical human knee laxity in
vitro. The result of the research was refined with
inclusion of articles containing the term: ACL,
in vitro, laxity, PCL, joint instability, knee,
biomechanics, knee joint, and exclusion of
articles with the following topics: patellofemoral
joint, pattela, injury, total knee artroplasty,
tissue engineering, cartilage, reconstruction,
osteoarthritis, tendons and knee injuries. The
articles found in the survey were submitted to
the following selection criteria: (1) is written in the
English language, (2) to analyze human knees in
References
Anderson et al., Am J Sports Med. 38, 2010.
Kondo et al., Am J Sports Med. 38, 2010.
Piziali et al., J Biomechanics 13, 1980.
Schlepckow, Arch Orthop Trauma Surg. 111, 1992.
Suggs et al., The Journal of Arthroplasty. 19: 2, 2004.
Tsai et al., Am J Sports Med. 38, 2010.
Xu et al., Am J Sports Med. 39, 2011.
Zantop et al., Arch Orthop Trauma Surg. 127, 2007.
Zantop et al., Am J Sports Med. 36, 2008.
441
P 0 81
VALIDATION OF PARAMETERS FOR THE NEW TYPE

OF CHILDRENS ORTHOTIC USING METHOD OF IN-SHOE
FOOT PLANTAR MEASUREMENT SYSTEM
M. Borsky1, N. Murphy2, M. Souckova3
1
Proteching B, Biomechanics pressure mapping analysis, Zlin, Czech Republic

2
3
Tekscan Inc., Medical Division, South Boston, USA
MUDr. Marie Souckova, Medical Orthopedic Centre, Prag, Czech Republic
Introduction
Support of the foot using orthotics is common practice
to improve the biomechanical function of pathological
feet. Plantar foot pressure measurement systems
are often used as a tool to assess pathomechanical
function of the feet. Specifically, the In-Shoe plantar
force and pressure measurement system is also
commonly used to compare the effect of different
types of plantar orthotics on foot biomechanics. In this
study, we investigated the effect of a new childrens
OTC (over the counter) orthotics relative to the effect
of a custom-made orthotic.
Results
Analysis of the data reveals that the OTC orthotic
improved desired support of the plantar feet,
the rearfoot (subtalar joint), the biomechanical
function of the feet, especially in the diagonal
(progression) line. This is refleected in the following:
reduced pressure on the medial side of the heel
enhanced position of the rearfoot (subtalar joint)
reduced flattening of the medial (longitudinal)
arch
reduced pressure in the metatarsal region
increased the pressure under the hallux
(engagement of the 1st metatarsal joint big toe
joint)
improvement in trajectory for the Centre of Force
(desired trajectory)
DIS C USION
The OTC orthotic, which has a higher stability
effect on the foot, improved the biomechanical
function of the foot. The OTC orthotic was found
reliable and comparable to the custom-made
orthotic in its desired function to improve the
pathomechanics associated with common foot
problems such as flat and valgus feet.
Methods
A 7-year old boy diagnosed with pedes planovalgi (pes
planus, flat feet) was instrumented with the F-Scan
In-Shoe Pressure Measurement system (Tekscan, USA).
The reliability of the F-Scan In-Shoe system has been
previously documented (1,2). Measurements while
the boy was walking were recorded wearing the OTC
orthotics inserted in his shoes, and when the custom-made orthotics were inserted in his shoes. F-Scan
Clinical 7.0 software was used to record and display
the data for subsequent analysis. Plantar pressure
profiles and the 3-Box data display and analysis
protocol were used for analysis. The 3-Box protocol
subdivides the foot into regions; heel, midfoot,
metatarsal and toes. Force-Time graphs for the whole
foot, heel and metatarsal regions are automatically
generated for the regions (sample illustrated below).
The measured parameters were compared between
the OTC and the custom-made orthotics.
The new 3-Box protocol in the up-dated Software

7.0 was found reliable for segmenting the foot
into regions and for data analysis related to foot
biomechanics.
References
1 Ahroni J, Bovko E, Forsberg R: Reliability of F-Scan
In-Shoe Measurements of Plantar Pressure. American Orthopaedic Foot & Ankle Society 1998,
88 (4) 166175
2 Luo Z, Berglund L, An K: Validation of Tekscan
pressure sensor system: A technical note. Journal
of Rehabilitation Research and Development 1998,
35: 186191.
3 Collins N, Bisset L, McPoil T, Vicenzino B: Foot orthoses in lower limb overuse conditions: a systematic
review and meta-analysis. Foot Ankle Int. 2007,
28(3): 396412.
4 Najafi B. and all: Mechanism of orthotic therapy
for the painful cavus foot deformity. Journal of Foot
and Ankle Research 2014 7:2 (23 January), 19.
442
P 082
FINITE ELEMENT ANALYSIS OF PRESS-FIT

ACETABULAR CUP INSERTION
D. ORourke1, M. Bottema1, M. Taylor1
1
Flinders University, Computer Science Engineering and Mathematics, Adelaide, Australia
Introduction
Stability of press-fit acetabular components relies
on an interference fit with the reamed acetabular
cavity. During surgery, a component, which is oversized with respect to the cavity, is impacted with
repeated mallet blows. As a result of the impaction,
elastic spring back of the cup occurs to create
a gap between the surfaces. It also generates
residual stresses in the bone which contribute to
the primary stability [Mathieu, 2013].
Results
Previously, FE studies have simulated press-fitting

by perfectly positioning the cup and pushing apart
the contact surfaces to the required interference
[Udofia, 2007]. Implantation has been represented
in studies through displacement [Clarke, 2012],
force [Spears, 2001] and velocity [Hothi, 2011]
driven approaches. These studies have, however,
neglected to report the strain field in the
acetabulum after cup insertion [Clarke, 2012]
[Ong, 2008].
The aim of this study was to conduct an explicit
finite element analysis to assess the peri-acetabular
strain field after cup insertion.
Methods
An explicit FE analysis (ABAQUS, Providence, RI, USA)
was conducted on 14 subjects. For each subject,
the geometry of the hemipelvis was segmented
from a CT scan. We reamed a hemispherical
cavity to the level of the acetabular notch. A
volumetric mesh, consisting of linear 4-node
tetrahedral elements, was then generated. Shell
elements, 1.5 mm thick, were used to represent
the cortex. There was no cortical bone present in
the acetabular region that was reamed. The mean
number of elements in the subjects was 270,000.
The material properties of cancellous bone were
inhomogeneous and assigned based on the CT
greyscale values. The cortical bone was assigned
an elastic modulus of 17GPa and a Poissons ratio
of 0.3. All materials in the model were assumed to
be isotropic and linear-elastic. The coefficient of
friction between the cup and the bone was 0.5.
Figure 1: T he implanted hip joint at equilibrium. Areas of red

indicate yielding of the bone
For each subject, the volume of bone in the

acetabular
region
of
interest
exceeding
7000strain [Morgan, 2001] was calculated and
expresses as a percentage.
In each subject, the cup rebounded during
unloading and created a gap at the cup dome at
equilibrium. The range of bone in the acetabular
volume of interest exceeding the yield criterion
was 23.581.5% at equilibrium. The mean volume
of bone yielding was 63.8%.
In each subject, a 1mm over-sized cup was pressfitted into the acetabulum, by displacement
control, until the cup surface was in full contact
with the acetabular floor. The cup was then
unloaded by applying viscous damping until the
cup reached its equilibrium position.
This was predominantly located at the periphery of

the acetabulum in each subject.
see the next page
443
Discussion
There was extensive yielding of bone in the
acetabular region of each subject. There are two
reasons this amount of yielding was observed in the
analysis. The linear-elastic assumption made in this,
and other studies examining press-fit insertion, may
have been unsuitable. Furthermore, it is possible
that an exact interference of 1 mm may not be
valid and including variation in the dimensions of
the reamed cavity may be required [Spears, 1999].
References
A
mirouche et al, Med Eng Phys 35: 117785, 2014
C
larke et al, J Biomech 45:16981704, 2012
M
athieu et al, Med Eng Phys 35: 155863, 2013
M
organ et al, J Biomech, 34: 56977, 2001
O
ng et al, J Biomech Eng, 130:111, 2008
S pears et al, J Biomech, 32: 11831189, 1999
S pears et al, J Biomech, 34: 113120, 2001
U
dofia et al, J Bone Joint Surg 89-B:54956, 2007
Any subsequent analysis of the micromotion, stress

or strain fields, as a result of these assumptions in FE
models, may not be conducted in a representative
mechanical environment.
444
P 083
STRESS EVOLUTION IN NITI STENT DURING

SYSTOLIC/DIASTOLIC PRESSURE PULSE
M. Ackermann1, L. Capek1
1
Technical University of Liberec, Applied Mechanics, Liberec, Czech Republic
Introduction
NiTiNOL as a member of Shape memory alloys
(SMA) group is distinguished from conventionally
used materials by the unique behaviour such
as pseudoelasticity and shape memory effect
[Lagoudas, 2008]. Moreover, the excellent
biocompatibility predestines its use in medical
applications [Duerig, 1999].
according to actual simulation time. Thanks to the

contact which was defined between the surface
and the stent, it was possible to squeeze the stent
into aorta. Last loadcase applies pressure pulse
with peak value of 120 mmHg. Duration of the
loadcase was set to 0.85 s.
Results
In Figure 2, results of last loadcase are shown.
Evolution of Equivalent Von Mises Stress in most
loaded node with display of actual value of
aortic pressure can be seen. Little fluctuations of
stress which are present in the characteristics can
be attributed to issues related with stent/aorta
contact.
Presented work deals with evaluation of stress

evolution in a NiTi stent which is implanted into
an artery and subjected to systolic pressure pulse.
Such a data are meant to be used for further work
which main goal is durability analysis of the stent.
Methods
The problem was solved using MSC.Marc software.
FEM model itself is composed of three bodies.
Stent is characterized by eight-node hexagonal
elements with amount of 35,856. Cylindrical body,
17 mm in diameter with 1,440 shell elements of
constant thickness t = 1.5 mm, represents aorta.
Last feature is a rigid cylindrical surface which is
used to drive stents diameter (Figure 1).
Discussion
With respect to the data, final stress range of the
cycle is about 4 MPa with mean value of 133 MPa.
Together with known fatigue curve of the material,
these results are crucial for performance of desired
durability analysis. Thus, further work will deal with
estimation of stents fatigue life.
References
Duerig et al, Mat Sc & Eng, 273275:149160, 1999.
Lagoudas et al, Shape memory alloys: Modeling
and Engineering Applications
Raghavan et al, J Biomech Eng, 33:475482, 2000.
Concerning material data, a thermomechanical

SMA model implemented in MSC.Marc was used
for stent. In the case of aorta, widely recognized
Raghavan et al. model was employed [Raghavan,
1999].
This work was supported by national financial
resources of Ministry of Education of Czech
Republic for specific university research.
In the first loadcase, a diastolic pressure of

75 mmHg was applied to aortic wall. Then, the
rigid surface was gradually decreased in diameter
445
P 084
COMPARISON OF AN INTRAMEDULLARY NAIL

WITH AN ANGULAR STABLE PLATE FOR PROXIMAL
HUMERUS FRACTURES
S. Kathrein1, F. Kralinger1, M. Blauth1, W. Schmoelz1
1
Medical University Innsbruck, Trauma Surgery, Innsbruck, Austria
Introduction
The proximal humeral fracture counts beside the
distal radius, the vertebral body and proximal femur,
to the common osteoporotic fractures. Although
there are a number of treatment options available,
the clinical outcomes in geriatric patients are still
unsatisfactory. Several operative treatments have
been described like k-wires, intramedullary nails
and plate fixation. The choice for the optimum
treatment is still challenging for the trauma surgeon
as there is still no consensus for standard care. The
aim of the study was to compare an angular stable
plate to an intramedullary nail with an angular
stable locking system (ASLS) in a humerus test
bench with active muscle forces.
(Range [0.55][2.23]) for the plate group and the

nail group, respectively (p > 0.05). The median tilt per
cycle motion at the 500th cycle was 0.22 (Range
0.07 1.50) for the plate group and 0.1 (Range
0.05 0.12) for the nail group. The tilt per cycle
motion in the nail group was significant lower compared
to the plate group after 500 cycles (p< 0.05).
Discussion
The nail group with the ASLS showed a significant
higher angular stability compared to the plate in an
unstable two part fracture model. The presented
results provide a biomechanical support that ASLS
in combination with nails could be an alternative
to plates. Especially older patients, who often
suffer from other co-morbidities, could benefit from
a minimal invasive operative treatment with nails.
Methods
12 fresh frozen humeri were used for biomechanical
testing in a test bench simulating ab- and adduction
between 15 and 45 for 500 cycles. Abduction
and adduction were carried out with active forces
applied by pneumatic muscles mimicking the
supraspinatus and deltoideus for abduction and the
teres major and the pectoralis major for adduction
(Fig.1). Two different two part fracture models,
simulating a stable and an unstable fracture, were
used to compare an angular stable plate and an
intramedullary nail with an angular stable locking
system (ASLS, Synthes Austria). For measurement of
the fracture gap movement a motion analysis system
was used. Two parameters (per cycle and plastic
deformation) in two axes (y and z) were evaluated
for statistical analysis (Fig. 2). The per cycle motion
range of motion (ROM) of the humeral head relative
to the implant during abduction and adduction was
evaluated to assess implant loosening. The varus
impaction (rotation along the y-axis) and tilt (rotation
along the z-axis) were defined as the change at the
unloaded state (15 abduction) in the course of cyclic
loading which equates to the plastic deformation of
the humeral head relative to the shaft.
Figure 1: S et up of the test bench. Uniaxial load cells,

6-component load cell and angle measurement
are labelled in orange, linear bearing and circular
arc guidance are labelled in blue, active muscles
are labelled in red Supra (supraspinatus) Del (deltoideus) TM (teres major) PM (pectoralis major), the
glenoid cavity replica is marked in green.
Results
For the stable fracture no significant difference
p > 0.05 was detected. In the unstable state
the median varus impaction was 0.96 (Range
[0.55][4.26]) for the plate group and 0.5
(Range [3.06][0.98]) for the nail group
after 500 cycles. The median per cycle varus
impaction after 500 cycles was 0.62 (Range
0.38 2.31) and 0.14 (Range 0.05 0.17)
for the plate group and for the nail group,
respectively. In the course of cyclic loading the
nail group showed a significant lower per cycle
and plastic varus impaction. The median tilt
was 0.54 (Range [3.51][0.82]) and 1.27
Figure 2: C
oordinate system used for measuring the fracture
gap motion
446
P 085
PARAMETRIC ANALYSIS OF GLENOID IMPLANT DESIGN

D.M. Geraldes1, U. Hansen1, A.A. Amis1
1
Imperial College London, Biomechanics Group, Mechanical Engineering,

Introduction
Common post-operative problems in shoulder
arthroplasty can be reduced by improvements
in glenoid design, shape, material choice and
fixation method [1]. An automated framework
for parametric analysis of different implant
configurations was developed in order to efficiently
sift through potential implant designs.
the centre. Thicker glenoids were shown to be less

stable under edge loading (Figure 1, bottom), due
to an increase of stiffness of the whole implant,
transmitting more of the displacements to the
opposite end.
Methods
4 different reference geometries representing the
current gold standard implant fixation types were
generated in SolidWorks. Parametric variations
(10 per geometry type, approximately) were
automatically generated in order to assess the
influence peg/keel size and position, base plate
thickness or material in implant stress performance
and fixation and implanted with repeatability using
Rhino. The glenoid-bone models were meshed in
Abaqus, and boundary conditions and loading
applied via a custom-made Python script. Finally,
another MATLAB script integrated and automated
the different steps and sifted the results. This study
compared the influence of fixation type (keel vs.
2-pegged vs. 3-pegged vs. 3-pegged with central
anchor peg) on glenoid components with bearing
surface thickness of 3, 4, 5 or 6 mm and varying fixation
feature dimensions. A total of 40 different glenoid
geometries were assigned UHMWPE (E = 1 GPa,
? = 0.46) or VITA E PE (E = 800 MPa, ? = 0.43)
material properties and the bone-implant surface
was tied. Fixed boundary conditions were applied
at the distal surface of the cube and a 1000 N force
applied as a distributed load. Four different loading
scenarios were considered: a physiologically
common central loading distribution and three
edge-loading conditions (posterior, superior and
inferior), simulating the most common mechanism
of fixation failure in glenoid implants [2]. Two
different bone qualities were modelled: healthy
trabecular (E = 300 MPa, ? = 0.3) and rheumatoid
bone (E = 30 MPa, ? = 0.3).
C o n cl u s i o n
The developed method allows for simple, direct,
rapid and repeatable comparison of different
design features, material choices or fixation
methods by analysing how they influence the
mechanical environment of the bone surrounding
the implant, providing invaluable insight in implant
design optimisation by screening through multiple
potential design modifications at an early design
evaluation stage.
Results
A total of 640 models were analysed and compared
over 24 hours. The data produced was filtered in
order to assess the influence of design parameters
in the implants mechanical environment. In
this particular example, the normalised implant
deformation under central loading (Figure 1,
top) and the fixation instability (Figure 1, bottom)
could be evaluated for all the different geometries
simultaneously. 2-pegged geometries (2Peg)
consistently produced higher deformations under
central loading than the other configurations
(Figure 1, top) due to lack of bone support at
References
[1] Fox, T.J., et al., Survival of the glenoid component
in shoulder arthroplasty. J Shoulder Elbow Surg,
2009. 18(6): p. 85963.
[2] Anglin, C., U.P. Wyss, and D.R. Pichora,
Mechanical testing of shoulder prostheses and
recommendations for glenoid design. J Shoulder
Elbow Surg, 2000. 9(4): p. 32331.
447
P 086
FRACTURE RESISTANCE OF TEETH RESTORED WITH FIBER

POSTS AND CERAMIC CROWNS
P.J. Rodrguez-Cervantes1, C. Gonzlez-Lluch1, M. Lopez-Galindo2,
A. Prez-Gonzlez1
1
University Jaume I, Department of Mechanical Engineering and Construction,

Castelln de la Plana, Spain
European University of Valencia, Department of Odontology, Valencia, Spain
Introduction
The purpose of the present study is to evaluate
the fracture resistance of endodontically treated
maxillary incisors and to compare it with that of
sound teeth. There are studies that have compared
fracture resistance of endodontically treated
teeth on canines [Barcellos RR, 2013], premolars
[Soares CJ, 2008] and molars [Santana FR, 2011]
using sound teeth as a control group, but there are
no studies dealing with maxillary central incisors.
To avoid root fractures, a post with a modulus
of elasticity similar to that of dentin helps to
distribute the stress resulting from occlusal loads in
a uniform pattern [Rodrguez-Cervantes PJ, 2007].
The hypothesis tested was that the restoration of
endodontically treated teeth, with a fiberglass
post system, influences the fracture resistance and
the failure mode of maxillary central incisors.
Figure 2: M
ode of failure of a restored specimen.
Discussion
The hypothesis was supported by the results:
restoration with a fiberglass post system had an
influence on the fracture resistance and failure
mode of maxillary central incisors.
Methods
Ten human maxillary central incisors were treated
endodontically and restored with a fiberglass post and
with an all-ceramic crown. Another group of intact
teeth (n=10) was used as a control group. Specimens
were tested, under a flexural-compressive load,
using a universal testing machine. Specimens were
mounted on a bronze mold that was inclined so that
the tooth is loaded, on the palatal side, at 50-degrees
to the radicular axis, in the vestibular direction, thus
simulating the real direction of loads during type
I occlusion. The failure loads were recorded and
analyzed using a one-way ANOVA (P<.05)
Though dealing with other types of teeth, these

results are consistent with others published in the
literature. The fracture resistance values found, in all
groups tested in the present study, were considerably
higher than the maximum physiological forces that
act on anterior teeth in the oral cavity. Despite
the good results obtained with fiberglass posts as
intraradicular retainers, additional clinical studies
are necessary to determine the best techniques and
materials to improve the resistance of structurally
compromised teeth.
Results
The fracture loads were higher in the control
group (P=.012). The mode of failure for the
control group was mostly reparable (above the
level of the simulated bone), whilst 40% of the
restored teeth suffered non-reparable fractures.
In Figure 1, a box-and-whisker plot shows the spread
of data groups around their medians: for restored
teeth (left) and for sound intact teeth (right). Figure
2 shows the mode of failure of a restored specimen.
This research is supported by University Jaume I
through Project P11B2012-10.
References
Barcellos RR et al, J Biomech, 46:25722577, 2013.
Rodrguez-Cervantes PJ et al, J Oral Rehabil,
34:141152, 2007.
Santana FR et al, Int Endod J, 44:386394, 2011.
Soares CJ et al, J Endod, 34:10151019, 2008.
Figure 1: B
ox-and-whisker plot of failure loads.
448
P 087
ASSESSMENT OF LOCOMOTIVE FUNCTIONS AS WELL AS

LOADS OF SKELETAL AND MUSCULAR SYSTEM
OF THE PATIENTS WITH CEREBRAL PALSY
R. Michnik1, K. Nowakowska1, J.W. Katarzyna1, J. Jurkojc1, M. Mandera2, I. Kopyta2
1
Silesian University of Technology, Biomechatronics Department, Zabrze, Poland

2
Medical University of Silesia, Katowice, Poland
Introduction
In pursuit of objectivization of the diagnostics of
the movement apparatus it is becoming more and
more frequent to analyse kinematic and dynamic
parameters of the body movement.
The
paper
presents
possibilities
of
using
biomechanical tests of gait to support the
diagnostics of patients with infantile cerebral
palsy (CP). The research is conducted jointly by
physicians at the Uppersilesian Childrens Health
Care Institute in Katowice and engineers at the
Silesian University of Technology.
Figure 1: M
odel of lower limbs and courses of selected
muscle forces in gait of one of the tested patients.
Methods
The assessment of the locomotive functions of the
examined patients was carried out on the basis of
the test results of gait kinematics (with the use of
BTS Smart) as well as on the basis of the set loads
of the skeletal and muscular system, i.e.: lower limb
muscle forces and joints reaction (determined with
the use of Anybody Modeling System in which the
movement system was modelled on the grounds of
a modified model of Gait Full Body. The research
encompassed a group of 17 patients treated with
a botulinum toxin. The tests were performed before
the application of the botulinum toxin (B1) and
6 months after the application (B6m).
Discussion
On the basis of the results obtained in the research,
it was observed that patients with CP have much
bigger values of muscle forces and reaction in
joints in relation to healthy children. The research
showed dependence between malfunctioning
of the muscle apparatus and disorders of the
gait kinematics. It also proved that 75% of the
patients treated with BTX-A showed improvement
of the locomotive functions (it was observed what
follows: the decrease of GGI indicator and joints
reaction as well as improvement of the functioning
of muscles).
Results
The analysis of the degree of irregularity of the
movement apparatus functioning was conducted
on the basis of the analysis of the courses of
kinematic and dynamic values (comparing them
to standard courses). It used also the determined
GDI and GGI indicators.
C o n cl u s i o n
Combining the analysis of movement kinematics
with dynamic loads provides a fuller picture of
dysfunctions of the movement apparatus. The
presented algorithm of procedure is beginning to
be applied by physicians during treatment with the
use of BTX-A as well as during rehabilitation.
The patients with MPD showed the values of GGI

indicator within the following range: 28.871623.9
(average value 297.74), and the values of
GDI indicator between 52.97 and 101.72
(on average 77.35).
The study was supported by the research grant no.

DEC-2011/01/B/NZ7/02695 of the National Science
Centre.
References
Schutte L. M.at al., Gait & Posture 11 (2000), 2531
Filho M.C. at al., Gait & Posture 28 (2008), 316322
van der Krogt MM at. al., Gait & Posture 36(2012),
113119
449
P 088
DYNAMICS OF HEAT GENERATION DURING

MUSCLE CONTRACTION
J. Reznickova1, K. Rasova1, J. Zeman2, B. Chalupa2
1
2
Charles University, Third Faculty of Medicine, Praha, Czech Republic
Czech University of Life Science, Faculty of Engineering, Prag, Czech Republic
Introduction
During muscle contraction, 80 % of ATP energy is
converted into heat. This heat warms up the muscle
that has generated it; then it is conducted to the
hypodermis and the skin, whose temperature can
be measured by a thermographic camera. Our
analysis has been carried out during a periodic
muscle contraction with a 5 s period. Actuating
of the muscle activity was monitored by surface
platinum electrodes, the muscle contraction itself
by light absorption change by the muscle in the VIS
and near-IR domains. Furthermore, effects of muscle
activity had been monitored in the thermal range,
i.e. LWIR by a sensitive thermographic camera at
25 fps. Surface temperature changes had been
studied i.e. by Chapperon and Seuront; however
he followed longer-range thermal exhibitions, and
not changes in the fractions of a second range.
between the driving signal and maximum of the

contraction and the incurred thermal wave.
Results
Surface temperature of the muscle was lower than
the ambient temperature during measurement,
even in the regions heated up by the movement.
It turned out that muscle contraction runs slower
than the relaxation phase. It can be seen both on
the form of the VIS and IR signals, and on the shape
of the surface thermal wave. Measured amplitude
of the surface thermal wave was 0.12 C.
Discussion
Its interesting that the surface wave is in phase
opposition to the muscle activity by this kind of
periodic movement. That can have interesting
effect on the contraction process chemism.
Methods
Measurements passed on the foot of Achatina
immaculata.
During
measurement,
typical
periodic movement with 8 mm wavelength and a
period of 5 s was running on the foot. Visual, IR and
thermographic measurements were done through
a 3 m thick plate. The pressure between the plate
and the foot was about 150 Pa. VIS absorption
was determined at 750 nm and IR at 1020 nm; the
thermography at 814 m, always at 25 fps. EMG
was read through five platinum electrodes on the
surface, with 0.05 mm diameter and 1 mm distances.
Resolution of the thermograms was 0.02 C; that
allowed interpolating a line segment through the
thermogram that was perpendicular to the muscle
contraction lines, and carry out an analysis of the
travelling wave, see Fig. 1. IR absorption signal
of the contracting muscle differed from the IR
one; thus it was possible to determine the delay
References
Chapperon, C.; Seuront, L.: Spacetime variability in
environmental thermal properties and snail thermoregulatory behaviour, Functional Ecology, October
2011, 25/5, p 10401050.
Figure 1: A
sliding wave, caused by a progressive muscle
contraction, can be seen at the foot perimeter in
the thermogram.
450
P 089
IMPACT OF CRITICAL SHOULDER ANGLE ON SHOULDER

MUSCLE FORCES, JOINT AND CARTILAGE LOAD DURING
SIMULATED ABDUCTION
C. Engelhardt1, D. Ingram2, P. Muellhaupt2, A. Farron3 , F. Becce4 ,
D. Pioletti1, A. Terrier1
1
Laboratory of Biomechanical Orthopaedics, EPFL-STI-CBT-LBO, Lausanne, Switzerland

2
Automatic Control Laboratory, EPFL-STI-IGM-LA, Lausanne, Switzerland
Orthopaedic and Traumatology Service, CHUV, Lausanne, Switzerland
Department of Diagnostic and Interventional Radiology, CHUV, Lausanne, Switzerland
Introduction
Clinical studies suggest a link between the
critical shoulder angle (CSA) and glenohumeral
osteoarthritis (Moor 2012). The objective of this
study is to evaluate the biomechanical rational of
this observation. We answered this question with a
patient-specific numerical model.
the medio-lateral position of the acromion (middle

deltoid origin).
Compared to the normal CSA, a small (large) CSA
decreased (increased) rotator cuff muscle force
20% (+15%), and increased (decreased) middle
deltoid force +11% (8%), joint force +7% (6%),
and contact pressure +5% (3%). This effect was
more important below 60 of elevation than above.
Methods
A musculoskeletal shoulder model was developed
based on in vivo MRI images of a healthy 28 years-old
male volunteer. The model included the 4 joints
and 16 muscles of the shoulder girdle. The undetermined problem of muscle force distribution
was solved using inverse dynamics and null space
optimization (Ingram 2012). The cost function was
the sum of squared muscle stresses. Muscle and
joint forces were calculated during abduction in
the scapular plane.
The MRI images provided anatomic data with a

normal CSA. The numerical model was used to
predict tendencies for large and small CSA. Muscle
force calculation and humeral head translation
were decoupled. We only simulated a quasi static
abduction movement. Simulating movements
of daily living and taking into account dynamic
effect might give further insight on the impact of
unphysiological CSA.
A finite element model of the glenohumeral joint

was implemented based on the same in vivo
MRI images. The joint force calculated in the
musculoskeletal model was applied. The cartilage
layers were modeled as hyperelastic materials.
The contact was assumed frictionless. The humeral
head was free to translate within the glenoid
cavity.
C o n cl u s i o n
This numerical study supports the clinical hypothesis
that small CSA promotes the development of
osteoarthritis, while large CSA increases the risk of
rotator cuff tears.
References
M
oor et al, Bone Joint 7, 935941, 2013.
Ingram, D. et al, BioRob 2012 4th IEEE RAS & EMBS
International Conference, 407412.
We compared 3 typical CSA: normal (33), small

(28), large (38). The CSA was changed by moving
451
P 090
MECHANICAL BEHAVIOURS OF NINE THIGH MUSCLES

USING MAGNETIC RESONANCE ELASTOGRAPHY
M. Chakouch1, F. Charleux2, S. Bensamoun1
1
Universit de Technologie de Compigne, Biomechanics and Bioengineery Laboratory,

Compiegne, France
2
ACRIM Polyclinique Saint Cme, Medical Imaging Center, Compiegne, France
Introduction
In case of muscle pathology or injury, it appeared
that all muscles did not have the same changes.
To adapt the treatment, as a function of the
muscle damage, the elastic properties of single
muscles must be characterized. Previous studies
have used MR elastography (MRE) technique to
analyze the mechanical behavior of healthy1 and
pathological 2 muscle. The purpose of this study
was to develop specific MRE protocols to provide
the passive elastic properties of nine thigh muscles.
( _Gr = 6.15 0.45 kPa, _ Sr = 5.15 0.19 kPa,

_ ST = 5.32 0.10 kPa) compared to the other tissues
(from _ RF = 3.91 0.16 kPa to _VI = 4.23 0.25 kPa)
(figure 1). The subcutaneous adipose tissue had
the lowest stiffness (3.04 0.12 kPa).
Methods
Twenty nine healthy volunteers (mean age =
= 26 3.41 years) with no muscle abnormality
or disease had a MRE tests 2 (1.5T MRI). New MRI
protocols were developed to quantify the passive
stiffnesses of nine thigh muscles (rectus femoris
(RF), vastus medialis (VM), vastus intermedius (VI),
vastus lateralis (VL), sartorius (Sr), gracilis (Gr),
semimembranosus (SM), semitendinosus (ST) and
biceps (BC)) and subcutaneous adipose tissue.
Shear waves were generated at 90Hz within the
thigh and a quantification of the wavelength ()
within each muscle was realized.
Discussion
In passive condition, healthy muscles did not have
the same functional behaviors. These stiffness data
could be used to identify pathological muscles,
to follow the effects of treatment, as well as for
modeling purposes.
Results
The developed protocols revealed a clear
propagation of the wave within each muscle.
Gracilis, sartorius and semitendinosus muscles
showed a significant higher shear modulus
References
1D
ebernard L, et al.,Journal of Biomechanics 44:
397401,2011
2B
ensamoun S. F.et al.,Innovation and Research in
BioMedical engineering (IRBM),2015.In press
452
P 091
HEAT TRANSFER IN BONE DRILLING: MODELING

AND EXPERIMENTAL IDENTIFICATION
J.E. Lee1, P. Zysset1, O.B. Ozdoganlar2, Y. Rabin2
1
2
Carnegie Mellon University, Department of Mechanical Engineering, Pittsburgh, USA
Introduction
During drilling, generation of heat can cause
significant thermal damage to the bone tissue.
Hence, prediction of the developing temperature
field as a function of the drilling parameters is of
high clinical value [Bachus et al., 2006]. However,
no experimentally validated model has been
reported yet. The current study aims at developing
a realistic and practical thermal model and
identifying it experimentally for temperature rise
during drilling.
experiment and simulation. Unlike previous studies

this study used a thermocouple located as close as
0.15 mm from the drilled hole periphery.
Results
As displayed in Fig. 2, the result from the model was
compared with the result from the experiments.
With appropriate material constants, the prediction
matched the experimental results for both the
maximum temperature and its evolution in time.
MATHEMATI C A L MODE L
Figure 2: T emperature profiles obtained from the model and

experiments
Based on the previous results in Lee et al.,
2012, a dramatic discrepancy of the maximum
temperatures measured at the radii locations
between 0.15 mm and 0.5 mm was observed,
showing a difference of 65 C as shown in Fig.2.
Figure 1: S cheme of the thermal model of the drill bit-chip

and bone system: a. drill bit outside of the bone,
and b. drill bit-chip system inside the bone.
The mathematical model of the bone moving

with respect to the drill bit-chip system shown in
Fig. 1 requires the resolution of two coupled sets
of equations. The drill-bit chip stream 1D system is
assumed as a thermally lumped capacity system
in the radial direction, and a distributed system in
the axial direction. The 2D bone system is assumed
semi-infinite in the radial direction, representing
a much larger domain than the drill-bit diameter.
The model is solved numerically, using a finitedifference scheme.
Furthermore, for the selected drilling parameters,

the bone near the drilled hole would have
experienced thermal necrosis based on the criteria
by Eriksson et al., 1984.
In conclusion, the model proposed in this study
predicted correctly the temperature profile
measured in the bone. It could be observed that
the thermal history significantly changes at the
vicinity of the drilled hole region. Ultimately, this
study may contribute to optimize bone drilling
parameters.
A set of experiments was conducted on bovine
cortical bone, following the new procedures
suggested in Lee et al., 2012 in order to ensure a
high degree of accuracy and repeatability.
This work was supported by Excellence Swiss Government Scholarship and Dowd-ICES fellowship in
Carnegie Mellon University.
Drilling tests were conducted on a CNC machine

using twist drill bits with 2.5 mm diameter. A spindle
speed of 3800 rpm, a feed rate of 1.5 mm/s, and
a drilling depth of 7 mm were selected for both
References
Bachus K.N. et al., Med. Eng. Phys. 22:685691, 2000.
Lee J.E. et al., Med. Eng. Phys. 45:10761083, 2012.
Eriksson et al., Acta Orthop Scand. 55: 629631, 1984.
453
P 092
DECREASED FRACTAL DIMENSION OF POSTURAL SWAY

UNIQUELY CORRELATES WITH MILD NECK PAIN-RELATED
DISABILITY IN YOUNG ADULTS.
J. Kendall1, F. Fuss2, M. Azari1
1
RMIT University, Discipline of Chiropractic, School of Health Sciences, Melbourne, Australia

2
RMIT University, School of Aerospace Mechanical and Manufacturing Engineering,

Melbourne, Australia
A sensitive and objective method for quantification

of neck pain is currently not available. Such a
method would be indispensable in determining
the severity of neck pain, and the effectiveness
of treatment to alleviate such pain. It would also
have applications in the medico-legal setting to
document neck pain following injury. Here we
define the use of the fractal (Hausdorff) dimension
of changes of the centre of pressure (COP) as a
sensitive method to detect mild neck pain-related
disability in young adults. 25 young volunteers of
both genders (17 female and 8 male) between
the ages of 18 and 28 were the subjects of this
study. 12 of these subjects had no neck pain (Neck
Disability Index [NDI]=0%), whereas 13 have mild
neck pain (NDI=1630%). Unlike other analyses

of COP changes including distance velocity and
area of sway, the fractal dimension was capable
of detecting those with mild neck pain (p<0.0001
using t-test). This was the case with different
positions including eyes open and eyes closed with
and without the application of vibration to the midcervical spine. Linear regression also demonstrated
a significant negative correlation between NDI
scores and COP fractal values (p<0.05 and r
squared = 0.1589 for the antero-posterior axis).
While this method needs to be further validated,
it potentially represents a sensitive and objective
measure of neck pain-related disability at least in
the young adult population.
454
P 093
RESOLVING JAW JOINT OPEN LOCKS

J.H. Koolstra1, M. Tuijt1, F. Lobbezoo2, M. Naeije2
1
Academic Centre for Dentistry Amsterdam ACTA, Oral Cell Biology and Functional Anatomy,
Academic Centre for Dentistry Amsterdam ACTA, Oral Kinesiology, Amsterdam, Netherlands
Introduction
Patients with symptomatic hypermobility of their
jaw joint (temporomandibular joint = TMJ) may
have problems with the closing movement of
their jaw. Some are even unable to close their
mouth after being opened wide. This is indicated
as an open lock. It has been demonstrated
biomechanically [Tuijt, 2012] that unfavorable
combinations of joint geometry and orientation of
the jaw closing muscles can make the masticatory
system vulnerable for this adverse situation.
activation of the muscles that would move the lower

incisors to the right. Thereafter, all muscles were
activated like a normal jaw closing attempt. This
resulted in the retrieval of the mandibular condyles
one by one to their respective glenoid fossae.
Thereafter the jaw could be closed normally. The
laterotrusion strategy remained effective for some
of the configurations where the relaxation strategy
was not effective anymore.
Clinical experience suggests that relaxing the jaw

muscles or performing a jaw movement to one
side (laterotrusion) might be helpful for patients
suffering from a locked open jaw every now
and then. The aim of our study was to assess the
biomechanical potential of these strategies for
resolving an open lock. Since laterotrusion is often
observed in patients with difficulty to close their
jaw normally it was hypothesized that this strategy
has a more potential to overcome an open lock
than the relaxation strategy.
Methods
A 3D biomechanical model of the masticatory
system with a joint shape and muscle orientation
that predispose for an open lock was applied
in a forward dynamics approach. The effect of
relaxation and laterotrusion strategies on jaw
closure after being opened wide was predicted.
The interplay of muscle forces, joint reaction forces
and their moments was assessed for analysis of the
biomechanical consequences.
Figure 1: B
alance of forces and torques during an open
lock. Cross-hairs: centre of gravity of the lower jaw.
Discussion
The magnitudes of the posterior force component
and the closing torque were larger for the
laterotrusion strategy than for relaxation strategy,
which explains its larger capacity for resolving
open locks. The simulations showed that a net jaw
closing torque as suggested bij Tuijt [2012] is not
enough to grant proper jaw closing. If this moment
is combined with insufficient posteriorly directed
forces, the condyles will fail to return to their
respective fossae and jaw closing ends with a half
open mouth in a protruded position.
Results
The relaxation strategy included a short phase
of inactivation of all muscles after the jaw had
been opened wide. Therefore, these muscles
only produced passive forces at the start of a
jaw closing attempt. These resulted in a net force
and moment successfully resolved an open lock.
The laterotrusion strategy included a selective
References
Tuijt et al, Clin Biomech, 27:749753, 2012.
455
P 094
HIP EXTENSOR MUSCLES INCREASE FEMORAL NECK

BONE STRENGTH: A CASE STUDY
S. Martelli1, P. Pivonka2, P. Ebeling3
1
2
Flinders University, Tonsley, Australia
The University of Melbourne, North West Academic Centre, St Albans, Australia

3
Monash University, Department of Medicine, Clayton, Australia
Introduction
Physical activity is used to mitigate age-related
bone loss and the associated increased risk of hip
fracture. However, different exercise regimens yield
variable bone responses, ranging from no response
to significant increases in areal Bone Mineral
Density (aBMD) [Guadalupe-Grau, 2009]. Lang et
al. (2014) suggested these variable responses to
different exercise regimens in the femoral neck are
attributable to the complex interaction between
skeletal loads, muscle activity and exercise type.
Therefore, understanding the effect of isolated
muscle groups in the proximal femur may help
design targeted exercise interventions to increase
hip strength. In this study, we examined bone
changes and loads in the proximal femur caused by
isolated contractions of the hip extensor muscles,
combining a longitudinal exercise intervention with
computational models.
V, was calculated as
ms= (VbsdV int)/DaBMD
where DaBMD is the measured aBMD change in
the inter-trochanteric region. Volumetric BMD
(vBMD) changes in the trochanteric and femoral
neck region were calculated as
DvBMD=ms VbsdV
Finally, the calculated vBMD and measured aBMD
changes were compared.
Results
A single 40 year-old participant met the criteria
for analysis. Exercise compliance was 97% and
the resistance weight increased over the course
of training from 10 kg to 90 kg. Adjusted aBMD
changes were 0.7%, 4.1% and 0.1% in the
femoral neck, trochanteric and inter-trochanteric
regions, respectively. The biomechanical stimulus
bs was spatially highly heterogeneous (Fig. 1),
showing a high stimulus for bone apposition in the
most proximal femoral neck region and a bone
resorption stimulus in the trochanteric region.
Calculated vBMD changes were 0.8% and 0.5%
in the trochanteric and inter-trochanteric regions,
respectively, showing a similar direction to those in
aBMD.
Methods
Healthy pre-menopausal women able to sustain
intense physical activity were recruited. Training
was a six-month unilateral leg-press exercise
targeting the hip extensor muscles, including
fifty exercises per session, four sessions per week.
The resistance weight was set to 80% of the One
Repetition Maximum (1-RM) and regularly updated
over the course of training. Participants showing
compliance above 90% and a 40% 1-RM increase,
or above, were selected for analysis. aBMD was
measured at both hips, using dual energy X-ray
absorptiometry (DXA), at commencement and
completion of training. Changes in aBMD at
the trochanteric, intertrochanteric and femoral
neck regions of the hip of the exercise leg were
calculated and adjusted for changes in the
control leg. Computational models comprised a
lower-limb musculoskeletal model and a femur
finite-element model; both models were previously
developed and validated [Martelli, 2014]. Strain
energy density (SED) in the proximal femur was
calculated mimicking isometric contractions of the
hip extensor muscles for fifteen hip flexion angles
uniformly distributed between 110 and 20. The
average SED during the walking stance phase,
taken from our previous work [Martelli, 2014],
was assumed to be the homeostatic value bone
tended to maintain. The biomechanical stimulus
(bs) for bone adaption was then the percentage
difference between the average SED during
hip extensor contractions and the homeostatic
value. The trochanteric, intertrochanteric and
femoral neck regions were identified in the model
of the femur. The bone mechano-sensitivity (ms),
assumed constant over the proximal femur volume
Figure 1: T he biomechanical stimulus (bs) for bone adaption

in the proximal femur.
Discussion
Hip
extensor
muscles
induce
a
spatially
heterogeneous biomechanical stimulus for bone
adaptation, causing a BMD increase in the proximal
femoral neck, but not in the trochanteric and
inter-trochanteric regions. Therefore, hip extensor
see the next page
456
contractions may prove effective in the design of

exercise interventions to promote femoral neck
strength. Different imaging modalities, such as
quantitative computerised-tomography (QCT),
may further delineate the distribution of bone
adaptation within each femoral subregion.
References
Guadalupe-Grau et al, Sports Med. 39:43968, 2009.
Lang et al, J. Bone Miner. Res. 29:133745 2014.
457
P 095
KINEMATIC AND DYNAMIC MOVEMENT PATTERN

DURING ACTIVITY OF DAILY LIVING
A. Guzik-Kopyto1, P. Wodarski1, R. Michnik1, J. Jurkojc1, M. Piecko1
1
Faculty of Biomedical Engineering, Silesian University of Technology, Poland,

Biomechatronics Department, Zabrze, Poland
Introduction
Quantitative and qualitative evaluation of the
kinematics and dynamics of the upper limbs motion
is extremely difficult because of complex structure
of the upper limb and the variety of performing
movements [Quental 2015; Guzik 2006]. Moreover,
because of much lower limit range of motion of
joints of upper limb in relation to lower limb we
can observe much more flexibility in performing
movements than in the case of gait [Carolien J.
van Andel, 2008; Sheikhzadeh 2008]. Assesment of
kinematics and loads of musculoskeletal system of
the upper limb can be used for its the diagnosis.
The aim of this study was to determine develop a
kinematic and dynamic movements movement
pattern during selected activity of daily living.
Figure 1: a
) model of human upper limb in AnyBody, b)
dynamic pattern of averaged joint reaction force
in glenohumeral joint.
Methods
Research methodology was based on the
measurement of kinematic quantities in joints of
the limb with the use of Xsens MVN Biomech system
while performing drinking from a cup. Obtained
results were used as input data for modeling of
loads of the upper limb musculoskeletal system
in the program Anybody. In the calculations a
modified Moving Free Posture Model was used.
The model includes 48 muscles of the upper limb.
The participants (18 men) had no upper extremity
symptoms. The age of participants was ranged
1929. All participants had a dominant right arm.
The measurements were carried out for both the
dominant and non-dominant limb.
Discussion
Elaborated patterns can be used for qualitative
and quantitative assessment of performed activity
of daily living by the comparison with the courses of
stroke patients obtained before the rehabilitation
and the verification of their progress during and
after rehabilitation. Kinematics movement patterns
show that the greatest activity from all three major
joints of the upper limb during performed activity
has an elbow, in the range up to approx. 45
(80125). Dynamic patterns show that the largest
reaction is in glenohumeral joint 44.8% (relate to
body weight) (fig.1) and the lowest value was
noticed for wrist joint 3.26% (relate to body weight).
References
Quental C. et al, Computer Methods in Biomechanics and Biomedical Engineering,
18:749759, 2015
Sheikhzadeh et al, J Shoulder Elbow Surg
November/December, 936942, 2008
Carolien J. van Andel et al, Gait & Posture,
27: 120127, 2008
Guzik A., et al, Acta of Bioengineering and
Biomechanics, 8(2), p.7987, 200
Results
Kinematics movement patterns, as well as
patterns of forces generated by muscles and
patterns of joint reactions forces were elaborated
using obtained results. In the case of dynamic
pattern, the determined courses of reaction
forces in the joints and muscles for each of the
subjects were related to the body weight of
subjects. Kinematic and dynamic courses were
normalized with respect to time. The duration
of the whole operation was expressed as a
percentage (0% start and 100% end of activity.
458
P 0 96
ATYPICAL FEMORAL FRACTURES ARE ASSOCIATED

WITH HIGH TENSILE STRAIN PATTERNS WHILE WALKING
S. Martelli1, P. Pivonka2, P. Ebeling3
1
Flinders University, School of Computer Science, Engineering and Mathematics,

Tonsley, Australia
The University of Melbourne, North West Academic Centre, St Albans, Australia

3
Monash University, Department of Medicine, Clayton, Australia
Introduction
Atypical femoral fractures (AFFs) are rare lowenergy stress fractures progressing from the
lateral femoral shaft to complete, predominantly
transverse, fractures. Anti-resorptive therapy,
commonly used to contrast the age-related bone
loss in the elderly population, have been associated
with an increased risk for AFFs [Shane, 2010].
However, the systemic effect of anti-resorptive
therapy in the femoral bone doesnt explain
the typical location of AFFs onset in the lateral
femoral shaft. We hypothesised that the typical
AFF onset location is associated with the femoral
strain pattern during daily activities. To this aim,
we analysed earlier calculations [Martelli, 2014] of
femoral strain while walking, stair ascending, stair
descending, squatting, rising from and sitting on a
chair by focusing on the femoral shaft.
measurements were obtained by averaging the

nodal strain results within 4 mm and averaged over
the stance phase of each activity.
Results
The lateral aspect of the femur was subjected to
tensile strains during all the investigated activities,
with walking showing the highest average tensile
strains in correspondence with the location of onset
of commonly observed AFFs (Fig. 1). The average
tensile strain in the lateral shaft varied from 327
(squatting) to 2004 (walking). The medial shaft
was mainly compressed. The principal compressive
strain ranged from 369 (stair ascent) to 1942
(walking).
Methods
Motion data included the skin-marker trajectories
and the ground reaction force at both the right
and left foot while walking, stair ascending, stair
descending, squatting, rising from and sitting on a
chair obtained from a healthy volunteer (female,
25 yr, 57 kg, 165 cm). Data were downloaded
from the Living Human Digital Library (LHDL)
[Testi, 2010]. The model was generated and
validated earlier [Martelli, 2014] by integrating
a lower-limb musculoskeletal model with the
finite-element model of the right femur. Anatomical
and physiological data were taken from a healthy
donor (female, 81 yr, 63 kg, 167 cm) and are
publicly available from the LHDL repository [Testi,
2010]. The model of the musculoskeletal apparatus
was based on computed-tomography (CT)
images. OpenSim (www.simtk.org) was used to
calculate the joint angles, muscle and joint forces.
The FE model was generated from CT images
following an established procedure [Schileo,
2007]. Muscle and joint forces were applied to the
finite-element model using a custom-made Matlab
(The Mathworks, Natick, USA) routine. Femoral
strains were calculated using the direct solver
implemented in ABAQUS (Dassault Systmes Inc.,
USA). The model yielded joint moments, muscle
and joint forces in agreement with published
patterns, while calculated and measured femoral
strain were linearly correlated (R2 = 0.95, Root
Mean Square Error = 84 microstrains). The different
activities were compared by calculating the
principal tensile and compressive strains along the
frontal, posterior, medial, and lateral femoral shaft
at ten uniformly distributed locations between the
sub-capital region and the distal epiphysis. Strain
Figure 1: Tensile strain pattern during walking (left) and typical

AFFs onset locations (courtesy of Saleh et al, (2012)).
Discussion
The lateral femoral shaft is subjected to tensile strains
during a variety of physical activities and walking
induces the highest tensile strain levels. Therefore,
the combination of tensile loads, to which bone
is most susceptible, and the bone fragility caused
by long-term anti-resorptive therapy are important
co-factors in creating a favourable environment
for AFFs. A reduced walking speed could help
mitigating the risk for AFFs is patients showing early
radiographic evidence of AFF onset.
References
Shane et al, J. Bone Miner. Res. 25, 226794, 2010.
Testi et al, Philos Trans A Math Phys Eng Sci
368:285361, 2010.
Schileo et al, J Biomech. 40:29829, 2007.
Saleh et al, HSS J. 8:103110, 2012.
459
P 097
COMPUTATIONAL MODEL POPULATIONS TO DETERMINE

MECHANICAL SKELETAL MUSCLE PROPERTIES
J. Grasa1, M. Sierra1, M.J. Muoz2, F.J. Miana-Mena3 , B. Calvo1, J.F. Rodrguez1
1
Instituto de Investigacin en Ingeniera de Aragn I3A Universidad de Zaragoza,

Applied Mechanics and Bioengineering AMB, Zaragoza, Spain
Instituto de Investigacin en Ingeniera de Aragn I3A Universidad de Zaragoza, Laboratorio

de gentica bioqumica de la Universidad de Zaragoza LAGENBIO, Zaragoza, Spain
3
Universidad de Zaragoza, Applied Mechanics and Bioengineering AMB, Zaragoza, Spain
Introduction
The finite element method is a powerful tool to
simulate and understand, from a mechanical point
of view, biological systems. However, differences
between individuals related to tissue properties
may limit the predictive utility of these models.
When simulations of muscle tissue are concerned,
stress/strain relations for both passive and active
behaviour are required. Passive [Calvo, 2010] and
active response [Grasa, 2014] has been studied
experimentally and the response of the different
tissues shows a characteristic dispersion.
The proposed material model was implemented

in a UMAT subroutine in the commercial finite
element software ABAQUS. In Figure 1 the finite
element mesh of the rat TA muscle and the
fibre orientations are presented. A Monte Carlo
simulation with 1000 samples was conducted. In
this simulation the characteristic active parameters
of the model were uniformly distributed to simulate
the muscle concentric contraction. A subset of
the initial population of models was then selected
considering the experimental results.
A numerical methodology is proposed to identify

model parameters for a three-dimensional
simulation of muscle concentric contraction. A
family of model parameters that predict the tissue
response within the variability of experimental
observations is identified using Monte Carlo
simulations.
Methods
The passive and active finite strain response of
the muscle was simulated using a strain energy
function (SEF) decoupled into volume-changing
and volume-preserving parts as:
=vol+p(I 1,I2,I4)+f fVftraina(J 4)(1)
Figure 2: E
volution of total muscle stretch during contraction.
The SEF is a function of the strain invariant

deformation tensor of the modified CauchyGreen tensor for the passive part. Three functions
characterize the active behaviour related to
the muscle stretch and to the amplitude and
frequency of the electrical stimulus [HernndezGascn, 2013].
Results
Figure 2 shows in black the 1000 curves obtained for
the evolution of muscle stretch when a simulated
weight of 2 N was lifted. The experimental curves
are represented in red. The subpopulation of
models results within the range of the experimental
curves are plotted in blue.
Discussion
This study shows the Monte Carlo method as a
valid alternative for identifying muscle material
model parameters considering the variability in the
experiments. The 3D computational results showed
important aspects regarding the mechanics of muscle
contraction. Higher tension regions are located in the
musculotendinous junctions where the cross-sectional
area diminishes. These maximum values increase
when the weight lifted by the muscle also increases.
References
Calvo, B. et al, J Biomech 43(2): 318325, 2010.
Hernndez-Gascn, B. et al, J Theor Biol, 335:
108118, 2013.
Grasa, J. et al, Biomech Model Mechanobiol,
13(6): 13731385, 2014.
Figure 1: F inite element model of the Tibialis Anterior rat

muscle and muscle fibres distribution.
460
P 098
FORCE POTENTIATION INDUCED

BY STRETCH-SHORTENING CYCLE DEPENDS
ON THE JOINT ANGULAR VELOCITY
A. Fukutani1, T. Kurihara2, T. Isaka2
1
Ritsumeikan University, Research Organization of Science and Technology, Kusatsu, Japan

2
Ritsumeikan University, Faculty of Sport and Health Science, Kusatsu, Japan
Introduction
It is widely known that muscle force attained
during concentric contractions is potentiated
by conducting eccentric contractions before
the concentric contractions. This phenomenon is
called stretch-shortening cycle (SSC)1. The purpose
of this study was to examine the influence of joint
angular velocity on the force potentiation induced
by SSC (SSC effect).
Discussion
Our result clearly showed that the magnitude
of SSC effect was affected by the joint angular
velocity, which was larger in the higher joint angular
velocity. This phenomenon would be related to the
preactivation which is one of the factor for SSC
effect. The influence of preactivation on the joint
torque is large when activation level is submaximal
due to insufficient contraction duration for
increasing activation level 2. Considring the fact
that contraction duration for increasing activation
level is shorter in the larger joint angular velocity
condition, the influence of preactivation should
be larger in the higher joint angular velocity. This
idea is supported by the data that SSC effect was
prominent in the first phase (i.e., shorter contraction
duration) compared to the later phase (longer
contraction duration) of concentric contraction.
Methods
Twelve men (24.2 3.2 years; height, 1.73 0.05m;
body mass, 68.1 11.0 kg) participated in this
study. Slow and fast conditions were adopted in
this study. Ankle joint angle was passively moved
by a dynamometer, with a range of motion from
dorsiflexion (DF) 15 to plantar flexion (PF) 15.
Muscle contractions were evoked by electrical
stimulation. Joint angular velocities of concentric
contractions were 30/s (slow) and 150/s (fast),
respectively whereas that of eccentric contraction
was identical (60/s) between slow and fast
conditions. Joint torques were recorded at
following three joint angles; DF5, PF0, and PF5.
For calculating SSC effect in the two velocity
conditions, SSC trial (concentric contraction with
preceding eccentric contraction) and control
trial (concentric contraction without preceding
eccentric contraction) were done in the two
velocity conditions. The magnitude of SSC effect
was calculated at the three joint angles by the
following formula;
References
1 Cavagna GA, et al., J. Appl. Physiol. 24:2132, 1968
2 Jensen RC, et al., Med. Sci. Sports. Exerc.
23:1014, 1991
SSC effect (%) = torque obtained in SSC trial/torque

obtained in control trial 100
Two-way analysis of variance with repeated
measure was adopted to examine the interaction
(velocity joint angle) and main effect for SSC
effect followed by post-hoc test (Bonferronis
correction).
Figure: S SC effect between 30/s (filled circle) and 150/s

(open circle) conditions recorded at each joint
angle. # indicates the significant difference among
joint angles. * indicates the significant difference
between velocities.
Results
The magnitude of SSC effect was significantly
larger in 150/s condition than in 30/s condition.
Moreover, in both velocities conditions, SSC effect
was significantly larger in DF5 than in PF0 and in
PF5.
461
P 099
A KINEMATIC AND ELECTROMYOGRAPHIC

STUDY ASSESSING THE EFFECT OF BLOCKING
THE ANCONEUS MUSCLE
I. Miguel Andres1, T. Alonso Rasgado2, A. Walmsley2, A. Watts3
1

2

3

Introduction
The anconeus, a small triangular muscle located
in the posterolateral part of the elbow, has been
the subject of debate concerning the role it plays
in human elbow kinematics. In 1867, Duchenne
mentioned that the muscle was involved in
extension of the forearm and abduction of
the ulna 1. Since then, there has been little
agreement among researchers to define the
specific function of anconeus24. This investigation
aimed to study the relative contribution that the
anconeus defunctioning might have on elbow
kinematics when the muscle is blocked with a local
anaesthetic.
angular velocity. The electrical activity of anconeus

in horizontal flexion-extension movements before
the anconeus defunctioning, clarifies without
doubt that the anconeus activity is higher during
extension as some researchers had observed 24.
This outcome implies that anconeus behaves as
an elbow extensor muscle. However, although
the relative electrical activity of anconeus was
higher in extension, the linear relationship between
the relative angular velocity before and after the
anconeus defunctioning suggests that the anconeus
contribution on elbow kinematics is non-significant.
C o n cl u s i o n
In conclusion, the results of the myoelectric activity
in combination with the elbow kinematics before
and after the blocking provide evidence that
indicates anconeus is a weak elbow extensor
muscle.
Ten healthy volunteers aged 29.30 2.21 years
and mass 66.80 9.56 kg, performed elbow
flexion-extension movements in the horizontal
plane. Surface electromyography was employed
to collect the myoelectric activity of anconeus,
biceps and triceps brachii and 3D inertial motion
sensors were used to obtain the elbow kinematics of
the right hand. The protocol was approved by the
ethics committee of The University of Manchester.
RE F EREN C ES
1 Duchenne GBA. Physiology of motion demonstrated by means of electrical stimulation and clinical
observation and applied to the study of paralysis
and deformities. Philadelphia: J. B. Lippincott
Company. 1867.
2 Basmajian JV, Griffin Jr WR. Function of anconeus
muscle. An electromyographic study. J Bone Joint
Surg Am. 54: 17121714, 1972
3 Le Bozec S, Maton B, Cnockaert JC. The synergy
of elbow extensor muscles during dynamic work
in man. I. Elbow extension. Eur J Appl Physiol. 44:
255269, 1980.
4 Bergin MJG, Vicenzino B, Hodges PW. Functional
differences between anatomical regions of the anconeus muscle in humans. J Electromyogr Kinesiol.
23: 13911397, 2013.

In horizontal flexion-extension movements before
blocking,
anconeus
activity
increased
from
9.4 3.5% MVC to 33 7.5% MVC in early extension,
between 50% and 78% of the flexion-extension cycle.
The anconeus activity after the blocking was 2% MVC,
indicating that anconeus was effectively blocked.
The relationship between the elbow angular
velocity before and after the anconeus
defunctioning showed a linear trend with slope of
0.977 and a Pearsons correlation coefficient (r) of
0.995, indicating no apparent difference in elbow
462
P 10 0
KINEMATIC MODELLING OF INDEX MCP

N.J. Jarque-Bou1, J.L. Sancho-Bru1, A. Prez-Gonzlez1, M. Vergara1
1
Universitat Jaume I, Departament dEnginyeria Mecnica i Construcci, Castelln, Spain
Introduction
Hand biomechanical models are valuable tools to
simulate surgeries, plan rehabilitation, or to design
prostheses. But to be useful, they should rely on
appropriate kinematic models.
and were used within an evolutionary optimization

approach [Hansen, 2004] to determine the model
parameters and joint angles, by minimizing the
norm of the sum of differences between the
40 pairs of model-experimental transformation
matrices (translations in cm), inspired by [Cerveri,
2001]. Joint angles for all motion frames and for
5 additional static postures (grasping a cone, and
the American Sign Language letters A, O, V, & R)
were measured using the NINO model and the UJ
one described in [Sancho-Bru, 2014].
We evaluate a model for the index metacarpophalangeal (MCP) joint with 2 non-intersecting
and non-orthogonal rotation axes (NINO model),
and we compare it with a classic universal joint
(UJ) model.
Methods
The NINO model considers a flexion-extension
(FE) axis attached to the metacarpal, and an
abduction-adduction (AA) axis attached to the
proximal phalanx.
Results
The optimization took about 79.7 hours to converge
in Matlab, providing the following axes with a
function error of 3.5106:
A Vicon system was used to track 12 markers

(Fig.1). Landmarks defined the coordinate systems
(CS), with origin on MCP2 and Y-axes aligned with
the segments, pointing distally. YZ-plane is set by
CMC2, MCP2 & MCP3 for the metacarpal, and by
PIP 2, MCP2 & MCP3 for the phalanx. Z-axes point
radially.
v FE = [(9.0, 3.4, 0.5) mm, (30.0, 24.7)]

v AA = [(13.6, 2.4, 1.3) mm, (99.6, 118.2)]
Joint angles obtained for the 5 static postures are
shown in Table 1. The rms difference between
NINO and UJ models for FE and AA angles, for the
40 frames used in the axes search, were 15.7 and
10.6 deg, respectively.
Axis
Model
Cone
FE
NINO
75.7
65.0
104.0
4.7
1.1
FE
UJ
62.1
49.9
74.2
10.5
-0.6
AA
NINO
21.8
25.4
37.6
13.5
10.3
AA
UJ
12.3
7.9
0.1
13.4
15.3
Table 1: J oint angles () of static postures
Discussion
The NINO model reproduces the kinematics of the
index MCP joint with a very low error. The orientation
of the axes generates noticeable differences in
the measurement of MCP angles between the
NINO and UJ models. Implications of incorporating
this model into finger musculoskeletal models
commonly used in literature should be analyzed.
Figure 1: 4
landmarks and 8 tracking markers
FE axis is described by a vector v FE containing the

3 translations (Tx, Ty & Tz) and 2 rotations (Rz & R x)
of the metacarpal CS that transform the Z-axis into
the FE axis. AA axis is described analogously by
vector vAA, with respect the phalanx CS.
To obtain the 10 model parameters, 3 dynamic trials
(MCP FE, AA and circumduction) and a reference
posture (flat hand with phalanxes and metacarpals
aligned) were acquired to 1 male subject
who provided written consent. 10 frames were
considered for each FE and AA cycles, and 20 for a
circumduction cycle. The segment transformation
matrices were obtained from the tracking markers,
using the method proposed by [Sderkvist, 1993],
We thank the Universitat Jaume I for financial support

through project P11B201333
References
Cerveri et al, IEEE Trans Evol Comput, 5:271,
282, 2001.
Hansen et al, Proc PPSN VIII, 282291, 2004.
Sancho-Bru et al, P I Mech Eng H, 228:1829, 2014.
Sderkvist et al, J Biomech, 26:14737, 1993.
463
P 101
SOFT TISSUE DRIVEN SIMULATION AND OPTIMIZATION

OF ORTHODONTIC TOOTH MOVEMENT
Z. Liao1, J. Chen1, W. Li1, A.M. Darendeliler2, M. Swain2, Q. Li1
1
The University of Sydney, School of Aerospace, Mechanical and Mechatronic Engineering,

Sydney, Australia
2
The University of Sydney, Faculty of Dentistry, Sydney, Australia
Introduction
Despite the challenges of accurate modeling and
definition of material properties of dental structures,
finite element (FE) methods have been extensively
employed in the field of orthodontic research.
We aim to improve the current computational
methodology and advance the comprehension
of the biomechanics of orthodontics, thereby
providing an innovative insight into understanding
and optimizing orthodontic practices.
DIS C USSION
The global hydrostatic stress should be adopted as a
stimulus to drive OTM, evidenced by the agreement
with past clinical studies seeking optimal orthodontic
force, through which the remodeling parameters
were derived (Figure 2). The addition of dynamic
loads enlarging the soft tissue response preliminarily
suggested the possible competence of vibration, as
an integrated part of existing orthodontic regime in
OTM acceleration, which contributed a solid piece
of theoretical evidence to clinical studies. The
instantaneous and time-dependent studies herein,
with and without dynamic analyses, formulated a
computational means of analysing and predicting
possible OTM outcomes.
Three correlated topics are presented in this paper.

First, the optimal ranges for orthodontic forces were
investigated based on the hypothesis involving
the periodontal ligament (PDL) and hydrostatic
stress. Second, a PDL driven and time-dependent
orthodontic tooth movement (OTM) remodelling
algorithm was showcased. Third, a dynamic analysis
was conducted to evaluate vibratory characteristics
of dental structures and potential for accelerating
orthodontic treatment induced by vibration.
METHODS
A patient-specific maxilla model featuring heterogeneous bony tissues, hyperelastic PDLs and damping properties was developed based on CT images
(Figure 1). A spectrum of orthodontic forces ranging
from 7.5g to 300g was applied to simulate tipping and
translation of teeth, following the calculation of the
center of resistance (CRe) of each maxillary tooth.
Resultant localized and volume-averaged hydrostatic stresses (VAHS) within the PDLs were compared
with the OTM-effective zone thresholds. A power
law-based remodeling procedure was subsequently
introduced to further examine the time-dependency
of the orthodontic forces and correlate with clinical
data collected. In couple with the static orthodontic
loading system, vibratory forces of various frequencies were added, as the ensuing protocol, to explore
the effects of vibration on OTM by using steady-state
dynamic analysis that was grounded on eigen-frequencies and eigen-modes predetermined.
Figure 1: ( a) DICOM images; (b) Image segmentation; (c)

NURBS surfaces; (d) Heterogeneous tissue mapping
in Abaqus
RESU L TS
The results indicated that the proposed hydrostatic
stress-based OTM thresholds and remodeling
algorithm can effectively simulate the sophisticated
course of OTM from a biomechanical perspective.
It was found that optimal orthodontic force ranges
can be defined by local and global hydrostatic
stresses in PDLs, e.g. 76g 266g, defined by VAHS, as
the optimal range for canine translation. Simulated
movement profiles were also found to match the
impression molds at different time measurement
points. With accompanying light dynamic loads,
the PDL response was visibly amplified.
Figure 2: V
AHS vs. orthodontic forces
References
Chen, J., Li, W., Swain, M. V., Ali Darendeliler, M., &
Li, Q. (2014). A periodontal ligament driven remo
deling algorithm for orthodontic tooth movement.
Journal of biomechanics, 47(7), 16891695.
464
P 10 2
ANALYSING THUMB KINEMATICS USING DYNAMIC CT:

THE NATIVE AND PATHOLOGICAL JOINT
F. Kerkhof1, E. Brugman2, F. Stockmans1,3 , I. Jonkers4 , E. Vereeck1, B. Dourthe1
1
KU Leuven Kulak, Department of Development and Regeneration @ Kulak, Kortrijk, Belgium

2
AZ Groeninge, Medical Imaging, Kortrijk, Belgium

3
AZ Groeninge, Hand Surgery, Kortrijk, Belgium
KU Leuven, Department of Kinesiology, Leuven, Belgium
Introduction
Previous research has shown that dynamic CT can
be used to directly quantify movements of individual
(meta)carpal bones [Kerkhof 2013, Goto 2013].
This technique enables accurate investigation of
3D kinematics in non-cyclical tasks, making it a
promising method to explore joint (dys)function.
The aim of the current study is to further validate
the use of dynamic CT for the quantification of
bone kinematics and to demonstrate the potential
of dynamic CT in the investigation of pathological
joint functioning.
of the thumb using a radiolucent jig. Image acquisition, segmentation and kinematic analysis were
done as in the cadaveric study. In addition, we
mapped changes in the contact patterns between
the articular facets during the entire motion cycle.
Results
During passive thumb opposition, there is
motion at both the trapeziometacarpal and
trapezioscaphoid joints. However, the location
and orientation of the helical axes differ between
specimens. Inter-centroid distances of the
calibration beads deviated on average 0.23 mm
( 0.02 mm) from the known machined distances;
differences between frames were < 0.2 mm. In
the clinical case, dorsal luxation of MC1 could
clearly be seen and quantified using helical axis
and their intersection angle with an anatomical
plane during the full range of motion. Furthermore,
we were able to quantify the change in articular
contact area over time for each active motion.
Methods
Six fresh frozen cadaveric human forearms were
placed in a motion simulator controlling thumb
opposition. A dynamic CT scan was acquired
during full thumb opposition using a 64 slice CT
scanner. For validation purposes, a calibration
cube with eight silicon-nitride beads was placed
on the lateral side of the first metacarpal (MC1)
during each acquisition. In one specimen, siliconnitride beads were inserted inside the MC1 base
to test the use of rigid body dynamics to calculate
arthrokinematics. Distances between pairs of
beads were compared between frames, as well
as to the known machined distances. Image
segmentation was semi-automated using an
algorithm developed by Materialise . Scaphoid,
trapezium and MC1 motion were quantified using
helical axes and their inclination angles with an
anatomically defined plane using Matlab.
Discussion
Dynamic
CT
allows
to
quantify
thumb
arthrokinematics with submillimeter accuracy
making it a valuable tool for in vivo analysis and
quantification of native and pathological joint
function. Using a larger sample size, including both
healthy volunteers and symptomatic patients, will
improve our understanding of joint (dys)functioning
and eventually lead to better prevention and
treatment strategies for osteoarthritis of the thumb.
To demonstrate the possibilities of dynamic CT in

the study of pathological joint function, dynamic CT
scans of a 41-year-old male with pain at the basal
thumb joint were made during active abduction-adduction, flexion-extension and opposition-reposition
References
Goto et al, Clin Orthop Relat Res, 2014
Kerkhof et al, ISB 2013 Brazil, 2013.
465
P 10 3
INSIGHT INTO THE 3D-TRABECULAR ARCHITECTURE

OF THE HUMAN PATELLA
S. Hoechel1, S. Georg2, M. Mller-Gerbl1
1
University of Basel, Department of Biomedicine, Basel, Switzerland
University of Basel, Biomaterials Science Center, Basel, Switzerland
Introduction
The subchondral bone plate (SBP) is a dynamic
component that shows functional adaptation to
its long-term loading history as it can be seen in
its density distribution that can be visualized with
the help of CT-osteoabsorptiometry (CT-OAM)
[Mueller-Gerbl, 1989]. Since the impact force gets
transmitted through the SBP into the trabecular
system, we expect the trabecular to show
function-dependent topographical differences in
accordance to the long-term load distribution as well.
increased. The distribution pattern persisted down

to the 5th mm. The differences between maximum
and minimum values decreased gradually (Fig. 2).
(III) The correlation of the density distribution of the
SBP and the first mm analysed beneath the SBP are
as follows: BV/TV (r2 = 0.81); Tb.N (r2 = 0.88); Tb.Th
(r2 = 0.79); Tb.Sp (r2 = -0.76); and SMI (r2 = -0.75).
All data showed to be significant (p < 0.01). With
increasing depth down to the 5th layer analysed, the
coefficients of correlation decreased for all values.
Methods
All patellae (10 x Outerbridge 0) were scanned via
a conventional CT-scanner (Siemens Somatom)
for CT-OAM and micro-CT (phoenix nanotom
m) for trabecular analysis. CT-OAM was used for
visualization of density distribution and acquisition
of density values of the SBP (HU). VGStudio Max
and CT-analyser for structural analysis of the
trabecular bone. The patellae were virtually
divided into 24 measuring cubes and analysed
in 1 mm layers down to a depth of 5 mm (Fig. 1).
Obtained parameters for analysis: density values of
the SBP (HU) and: Bone volume fraction (BV/TV);
trabecular number (Tb.N); trabecular thickness (Tb.
Th); trabecular separation (Tb.Sp); and structure
model index (SMI).
Figure 2: A
bstract of parameter distribution of one sample.
A) Density B) BV/TV C) SMI.
Discussion
The trabecular network, in its function to support
the SBP, adapts to its needs and is therefore not
homogenous in its architecture. In high correlation
to the long term-load intake of the SBP, the strain
energy density (SED) within the trabecular network
seems to administer a delicate differentiation of the
network. Defined as the summation of single load
intake moments added up to the loading history
over a period of time, differences in SED distribution
across the articular surface model the trabecular
network for an optimal mechanical support of the
SBP. This distinctive adaptation changes from a high
degree of differentiation just beneath the SBP to a
more equal distribution within the lower analysed
layers as a state of homeostasis between structural
arrangement and a more equally distributed SED
is created. Therefore, the SBP and the trabecular
network must be seen as functional unit of a joint.
Figure 1: A
) Patella, dorsal view, 24 measurement cubes
marked B) Density distribution by CT-OAM C) Measurement cube incl. 5x1 mm measuring layers for
trabecular data.
Results
(I) The parameters varied throughout the
trabecular system beneath the articular surface
of each specimen. Consistently, maxima of BV/TV,
Tb.N, and Tb.Th were found beneath the lateral
facet, decreasing into the periphery. Tb.Sp and
SMI showed constant minima below the lateral
facet. (II) The absolute values for BV/TV, Tb.N,
and Tb.Th decreased with depth, Tb.Sp and SMI
References
Muller-Gerbl, Advances in anatomy, embryology,
and cell biology, 141:1134, 1998.
466
P 10 4
SIMULATION OF IN VIVO DYNAMICS DURING ROBOT

ASSISTED JOINT MOVEMENT
E. Bobrowitsch1, A. Lorenz1, N. Wlker1, C. Walter1
1
University Hospital Tbingen, Orthopaedic Surgery, Tbingen, Germany
Introduction
Robots are very useful tools in orthopedic research.
In a previous study 1, the measurement of the
dissipated energy was carried out while the robot
moved an ovine knee with constant axial load
and flexion velocity. But under real conditions, the
axial force and the flexion velocity altered during
a gait cycle. The aim of this study was to develop
and evaluate an algorithm for a robot in order to
reproduce the complex in vivo joint dynamics 2 in
ovine knee specimens.
or hamstring tendons could not contribute to the

P-A force. Therefore, in our experimental set-up,
the measured P-A force differed from in vivo values
(Figure 1).
C o n cl u s i o n
We developed and evaluated an algorithm for
the robotic simulation of complex in vivo joint
dynamics using a joint specimen. This should be a
new biomechanical testing tool for analyzing joint
properties after different treatments.
The algorithm was tested on four ovine knee
specimens. Approximate body weights (BW) of
the four sheep were 30 kg, 30 kg, 30 kg and 35 kg.
Discretization of passive knee flexion 1 was used to
construct a complex flexion movement by a robot
and apply altering axial load in a superimposed
force torque control mode. Posterior-anterior (P-A)
and medio-lateral (M-L) forces were detected by
the robot as a backlash of joint structures. Flexion
velocity profiles were calculated from the in vivo
knee flexion data2 by means of differentiation and
normalization. The in vivo loads were simulated for
200 gait cycles on each of the four knee specimens.
References
1 Lorenz A, et al., JBiomech, 46(8):14271432, 2013
2 Taylor WR, et al., JBiomech, 39(5):791798, 2006
We gratefully acknowledge the financial support of
Aesculap AG, Tuttlingen, Germany.

The experiments on all knee specimens were
successfully completed. Visual examinations of the
specimens before, during and after joint dissection
revealed that the joint structures were intact. The
robot applied an in vivo like axial force profile with
high reproducibility during the corresponding knee
flexion (total STD of 0.025 BW). A total residual error
between the in vivo and simulated axial force was
0.16 BW. The curve forms of P-A and M-L forces
were similar to curve forms of corresponding in vivo
measured forces, but in contrast to the axial force,
they showed higher total STD of 0.118 and 0.203 BW
and higher total residual error of 0.79 and 0.21 BW
for P-A and M-L forces respectively. We assume
that in the absence of active muscles, the patellar
Figure 1: C
omparison of simulated forces to in vivo forces. (A) Curves of averaged contact forces (the
shaded areas along the curves denote one STD).
(B) The residual error curves represent the error between corresponding in vivo and simulated forces.
467
P 10 5
RELIABILITY OF HEAD, NECK AND TRUNK

ANTHROPOMETRIC MEASUREMENTS USED
FOR PREDICTING SEGMENT TISSUE MASSES
IN LIVING HUMANS
N. George1, C. Kahelin1, T. Burkhart2, D. Andrews1
1
2
University of Windsor, Kinesiology, Windsor, Canada
Western University, Mechanical and Material Engineering, London, Canada
Introduction
Wobbling mass biomechanical models require
accurate estimates of segment soft and rigid tissue
masses of living humans. Tissue mass prediction
equations for the upper [Arthurs & Andrews, 2009]
and lower [Holmes, Andrews, Durkin & Dowling,
2005] extremities have been developed from
surface anthropometric measurements. However,
corresponding prediction equations for the head,
neck and trunk [Bazgari, Nussbaum, Madigan
& Shirazi-Adl, 2011] are currently not available.
Previous work [Burkhart, Arthurs & Andrews, 2008]
has shown that the reliability of the upper and
lower extremity anthropometric measurements
was good to excellent (ICC 0.75), but the
reliability of head, neck and trunk measurements
has yet to be determined. Therefore, the purpose
of this study was to quantify the between- and
within-measurer reliability of 34 head, neck and
trunk anthropometric measurements, which can
be used to predict segment soft and rigid tissue
masses in living humans.
Results
Measurement differences between- and withinmeasurers were small overall, with 74% and 88% of
the differences being less than 1 cm in magnitude,
respectively. The trunk segment had the greatest mean
measurement differences across all measurement
types (0.91) compared to the head (0.24 cm) and
neck (0.61 cm) segments (Table 1). Good to excellent
reliability was demonstrated for all measurement types.
Mean ICCs ranged between 0.90 and 0.99, and 0.86
and 0.98 for lengths and circumferences betweenmeasurer, and within-measurer, respectively.
Discussion
Creating tissue mass prediction equations for the
head, neck and trunk from surface anthropometric
measures
would
help
researchers
develop
biomechanical models of living humans which more
accurately account for the attenuating effects of
soft tissues (muscle, fat, skin) following impact. The
reliability of the anthropometric measures studied here
was found to be good to excellent, which is consistent
with previous work for the extremities [Burkhart et al.,
2008]. Measurement differences between- and withinmeasurer resulted from inaccuracies in landmark
identification, due to factors such as landmark size
and amount of subcutaneous fat. These factors may
have an increased effect on measurement reliability in
other populations such as middle-aged adults, given
the changes in body composition that are associated
with aging. The impact that these measurements
have on tissue mass prediction equations of the head,
neck and trunk has yet to be determined, but is the
focus of an ongoing study.
Methods
Surface anthropometric measurements of the
head, neck and trunk segments were taken
twice, separately, from 50 healthy, young
(mean age, height and body mass: 20.2 years,
170.4 cm, and 69.3 kg) participants (25 M, 25
F) by two trained investigators using flexible
measuring tapes, anthropometers and skinfold
callipers. Measurement types included segment
lengths (11 measurements), circumferences (7
measurements), breadths (11 measurements),
and skinfold thicknesses (5 measurements), which
were standardized with respect to prominent and
accessible anatomical landmarks. Between- and
within-measurer reliability was quantified using
intra-class correlation coefficients (ICCs 0.75).
Measurement
Types
Lengths
Measurement
Difference
Head
(cm)
Measurement
Difference
Neck
(cm)
References
A
rthurs et al, J Biomech, 42:389394, 2009.
B
azgari et al, J Biomech, 44:547551, 2011.
B
urkhart et al, J Biomech, 41:16041610, 2008.
H
olmes et al, J Biomech, 21:371382, 2005.
Measurement
Difference
Trunk
(cm)
0.91
ICC
Between
ICC
Within
0.90
0.86
0.20
0.73
Circumferences
0.38
0.49
0.94
0.99
0.98
Breadths
0.16
0.62
0.96
0.94
Skinfolds
1.19
0.97
0.95
Table 1: Mean measurement differences for the head, neck and trunk segments and intra-class correlation coefficients (ICC)
across all measurement types.
468
P 106
THE EFFECT OF BOUNDARY CONSTRAINTS ON FINITE

ELEMENT MODELING OF THE PELVIS
A. Dostanpor1, P. Watson1, C. Dobson1, M. Fagan1
1
University of Hull, Medical and biological engineering research group, School of engineering,
Hull, United Kingdom
Introduction
Biomechanical analyses of hip joint prostheses
often utilise finite element analysis (FEA) to predict
stress/strain distributions in implant designs, and
the pelvic bone post-operatively (Zhou et al,
2013). However, the methods used to model pelvic
biomechanics through FEA varies between studies.
Some analyses model the full pelvic girdle (with or
without sacrum), whereas others take advantage
of anatomical symmetry and model only the hemipelvis. Consequently, methods of replicating the
complex sacro-iliac joint (SIJ) and pubic symphysis
(PS) vary from allowing movement in all 6 degrees
of freedom (DOF), to fully constrained joints.
Studies also differ in the definition of cartilaginous
material, using either linear or non-linear properties.
The influence of simplifying the biomechanics of
the pelvic joints, upon predicted stresses/strains, is
not fully known. This study investigates the effect of
modelling the SIJ and PS with differing DOF upon
the results of FEA modelling. It also analyses the
effect of modelling the pelvic girdle as opposed to
only the hemi-pelvis.

Preliminary results (shown in Figure1) have
suggested that that modelling the hemi-pelvis leads
to over-constraint of the joints, which generates
high stress/strain distributions, which would not
be experienced physiologically. Sequentially
enabling more DOF is shown to allow greater force
dissipation and lower stresses/strains. Further results
are predicted to suggest that modelling the pelvic
girdle physiologically replicates the complex joints
and leads to more accurate results.The results
will demonstrate the most accurate method
of replicating the pelvic joints in finite element
models. This will also determine the level at which
the pelvic anatomy can be simplified without
affecting predicted stress/strain distributions. This
has a large implication for improving the accuracy
in FEA of the pelvis for orthopaedic purposes.
References
Z hou et al, J Orthop, 37:653658, 2013.
Methods
A digitised three-dimensional model of the male
pelvic girdle (including separate bone constituents
and soft tissues) was created within AVIZO image
visualization software (Visualization Sciences
Group, AVIZO Inc. USA) using data from the visible
human CT dataset. This digital model was used to
create 5 separate FEA models in ANSYS (ANSYS
Inc, Canonsburg PA, United States). Each model
was loaded in an identical manner, with the
muscle and hip joint force associated with the 48%
phase of the gait cycle. These forces were taken
from a subject-specific musculoskeletal model in
AnyBody Modelling System (AnyBody Technology,
Alborg, Denmark). The complexity of modelling
the pelvic joints was sequentially increased across
the models, initiating with a hemi-pelvis that was
fully constrained; progressing to a pelvic girdle
whereby the SIJ and PS could move in all DOF.
Table 1 details how each model was constrained.
Figure 1 illustrates the models differing levels of
complexity.
SIJ
PS
Model
1
Hemi-pelvis
Fully
constrained
Fully
constrained
Model
2
Hemi-pelvis
Fully
constrained
1 DOF
(medio-lateral)
Model
3
Pelvic girdle
(excluding
sacrum)
Fully
constrained
6 DOF
Model
4
Pelvic girdle
(excluding
sacrum)
3 DOF
(allowing
rotation)
6 DOF
Model
5
Pelvic girdle
6 DOF
6 DOF
Table 1: M
odels constraint method
Figure 1: F EA modelling of pelvis showing: (a) Model 1;

(b) Model 5; (c) large stress in Model 1; and
(d) stress relief in Model 5.
469
P 107
ROBOT-AIDED MEASUREMENT OF PATELLAR

STABILITY AN IN-VITRO STUDY ON THE EFFECT
OF MUSCLE LOADING
A. Lorenz1, E. Bobrowitsch1, C. Walter1, N. Wlker1, U.G. Leichtle1
1
University Hospital Tbingen, Department of Orthopaedic Surgery, Tbingen, Germany
Introduction
Anterior knee pain is often associated with patellar
maltracking and instability [Powers, 1998; Werner,
2014]. However, objective measurement of
patellar stability under clinical and experimental
conditions is difficult and muscular activity is
additionally influencing the results. Therefore, the
aim of the current study was to establish a new
biomechanical testing device for the objective
in-vitro measurement of patellar stability and
to analyze the influence of muscle forces and
asymmetric muscle force distributions.
Methods
For the measurement of patellar stability, two
established methods were combined an upright
knee simulator for the positioning and loading
of the knee specimens [Leichtle, 2014], and a
KUKA industry robot for the mediolateral patellar
displacement [Lorenz, 2013]. A minimally invasive
coupling and force control mechanism enabled
an unconstrained motion of the patella as well
as the measurement of patellar motion in all six
degrees of freedom via an external ultrasonic
motion tracking system (Zebris). Lateral and medial
patellar displacement were measured on seven
fresh frozen human knee specimens in 6 different
flexion angles with varying muscle force levels
(30N, 150N, 300N) and distributions (central, lateral,
medial).
Results
Patellar lateral and medial shift were slightly
decreasing with increasing flexion angle. Higher
muscle forces led to smaller displacement and
larger decrease, especially in medial direction
(Fig. 1). The additional measurement of patellar tilt
provided interesting insight into the displacement
mechanisms in lateral and medial direction.
While for lateral displacement, the patellar
mostly tilted in the same (lateral) direction, it
tilted contrariwise (again laterally) for medial
displacement. Considering asymmetric muscle
force distributions, a distinct influence was found
for lateral displacement, while no effect was visible
in medial direction.
Figure 1: P
atellar shift and tilt for lateral and medial
displacement and different muscle loadings
Discussion
For medial and lateral patellar displacement,
different
mechanisms
and
sensitivities
to
muscle forces were shown. Furthermore, a new
experimental technique was established, which
delivered reproducible results and was found to
be an excellent in-vitro testing method for the
analysis of patellar stability and future investigation
of surgical techniques for patellar stabilization and
total knee arthroplasty.
References
Leichtle et al, Knee.Surg.Sports Traumatol.
Arthrosc, 22:500508, 2014.
Lorenz et al, J.Biomech, 46:14271432, 2013.
Powers, J.Orthop.Sports Phys.Ther. 28:345354, 1998.
Werner, Knee.Surg.Sports Traumatol.Arthrosc,
22:22862294, 2014.
470
P 10 8
A COMPARATIVE STUDY OF COMPUTATIONAL

TECHNIQUES TO ASCERTAIN FIBRE ORIENTATION AND
FINITE ELEMENT ANALYSIS IN SKELETAL MUSCLE
C. Gondwe1, Y. Lu1, C. Mazz1, X. Li1, M. Viceconti1
1
Insigneo University of Sheffield, Department of Mechanical Engineering,

Sheffield, United Kingdom
Introduction
Skeletal muscles are one of the main actuators
of motion in the human body, however their
mechanical behaviour is not yet fully understood.
The macroscopic arrangement of skeletal muscle
fibres highly governs its mechanical response
[Burkholder, 1994] [Lieber, 1992]. Therefore, it
is imperative to consider fibre orientations and
muscle architecture during skeletal muscle
simulations. As such, various skeletal muscle models
include an arbitrary fibre arrangement rather than
considering the true fibre arrangement [Lu, 2011]
[Blemker, 2005] [Tang, 2009]. The aim of this study
is to investigate the efficiency and accuracy
of different computational techniques used to
ascertain fibre orientations within the right bicep
femoris long head (Bflh), using a finite element
approach based on Hills muscle model [Hill, 1938].
Their proximity to previously validated models and
true fibre orientations will be analysed to ascertain
the models accuracy.
Results
The idealised fibre arrangement was less
computationally expensive. However, it oversimplified the model in respect to the muscle
architecture. In contrast, the FEM-NURBs algorithm
provided a more comprehensive fibre orientation,
but had limitations in handling complex muscle
geometries, branched muscle arrangements and
irregular fibre orientations.
Discussion
Although each technique has demonstrated
limitations to which muscle it can accurately
represent; the FEM-NURBs method promised
considerations of complex fibre orientations
and geometries. The simplified model also
promises applications in dynamic modelling as
was explicated by Blemker et al (2005), where
the FEM-NURBs algorithm considers applications
within quasi-static simulations. Therefore each
of these methods can be used accurately within
the right simulation context. Further limitations of
the FEM-NURBS algorithm conveyed limitations
in representing muscles with multiple branchi.
Future work proposes the inclusion of activation
mechanisms in the constitutive equations used to
run these FE simulations. As such, these activation
parameters will be reduced and a sensitivity
analysis can be carried out a priori of EMG data
acquisition.
M e t h o d o l o gy
The geometry of the right Bflh was developed from
the MR images of a 9 year old female subject.
The MR images were segmented and rendered
into a 3D object using the 3D slicer segmentation
tool. The scanning sequence for all the MR images
followed the e-Thrive_1, Philips M systems, TR4.4215.
TE 2.158. The segmented geometry was confirmed
by an experienced radiologist and a finite element
mesh was then created based on the segmented
geometry. The muscle was modelled as a quasiincompressible hyperelastic material and two
types of fibre orientations were implemented: one
with the idealised fibre arrangement, i.e. parallel
single-direction fibres going from the muscle origin
to insertion sites as demonstrated by [Blemker,
2005], and the other with curved fibre arrangement
which follows the muscle shape. The second fibre
arrangement was implemented through the finite
element method non-uniform rational B-spline
(FEM-NURBs) technique by means of user material
(UserMAT) subroutines in ANSYS. The second fibre
orientation was also implemented from previous
methodological techniques, which have been
validated [Blemker, 2005] and qualitatively
compared to the FEM-NURBs algorithm, as
developed by Lu et al, 2011.
The authors would like to thank Dr. Rachel Musson
for assisting in the anatomical accuracy the muscle
model, ANSYS(R) UK and the EPSRC for the provision
of funding and technical support, and the MultiSim
project (EP/K03877X/1) for its support.
References
B
urkholder, et al, (1994) J. of Morphology.,177190.
B
lemker SS, et al (2005) Annals of Biomed. Eng. 38:
661673.
C
.Y. Tang et al (2009) Journal of Biomechanics 42:
865872
H
ill, A. (1938). R. Soc. London. B Biol. Sci., 136195.
L ieber et al, (1992). J. Phys. Therapy., 844856.
L u, YT (2011) et al Computer Methd.in Biomech.
and Biomed. Eng. 14:12, 10791088
471
P 109
FRACTURE MECHANISM AFTER OSTEOCHONDROPLASTY

FOR HIP IMPINGEMENT ON OSTEOPOROTIC AND
NON-OSTEOPOROTIC BONES UNDER NORMAL
AND HIGH LOADING: FINITE ELEMENT STUDY.
D. Jimenez Cruz1, T. Alonso Rasgado1, C. Bailey2, T. Board3
1
2

3

Introduction
Femoral osteochondroplasty is frequently performed as the surgical treatment for cam-type
femoroacetabular impingement [13]. Post-operative femoral neck fracture is one of the recognized
complications of this surgery and increases further
when the bone is osteoporotic. The effect of osteoporosis on the risk of postoperative fracture is
unknown. Even though this procedure is uncommon
in older patients, it is sometimes appropriate, and,
in addition, osteoporosis is found increasingly in
younger people.An experimental cadaveric study
[3] reported that at resection depths of 30% of
the diameter of the femoral neck and greater,
the energy required to produce fracture reduced
significantly, causing a modification to the failure
pattern. The results from a recent finite element
study [4] suggested that resection depth should be
kept to less than 1/3 of the diameter of the neck in
order to ensure integrity of the femoral head and
neck.
Results
The numerical models show that fracture in healthy
bones appears only in the critical resection case
(12 mm), initiating in the femoral neck at the
resection site. However, the osteoporotic models
show that fracture appears in the same location as
for the healthy bones but at the lowest resection
depth (6 mm) and that the volume of bone
fractured increases with resection depth and load.
The finite element model predicts a substantial
increase in the risk of fracture in osteoporotic
patients after osteochondroplasty for cam-type
impingement. In addition, the risk of fracture
increases when they are subjected to high load
conditions, even in non-osteoporotic patients.
These conclusions highlight the importance of
assistance for weight-bearing in osteoporotic
patients in the postoperative phase.
References
1 Ganz R, Parvizi J, Beck M, Leunig M, Ntzli H, Siebenrock KA. Femoroacetabular impingement.
A cause for osteoarthritis of the hip. Clin Orthop
Relat Res 2003; 417: 112120.
2 Leunig M, Beaul PE, Ganz R. The concept of
femoroacetabular impingement: current status
and future perspectives. Clin Orthop Relat Res
2009;467(3): 616622.
3 Mardones RM, Gonzalez C, Chen Q, Zobitz M,
Kaufman KR, Trousdale RT. Surgical treatment of
femoroacetabular impingement: evaluation of
the effect of the size of the resection. J Bone Joint
Surg Am 2005; 87(2): 2739.
4 Alonso-Rasgado T, Jimenez-Cruz D, Bailey CG,
Mandal P, Board T. Changes in the stress in the
femoral head neck junction after osteochondroplasty for hip impingement: a finite element study.
J Orthop Res 2012;30(12): 19992006.
Methods
By obtaining the geometry of a hip with camtype impingement from CT scan data, a 3D
finite element model was constructed. Femoral
ostechondroplasty was performed virtually for
two different resection depths (6mm and 12mm)
following the area defined by a surgeon. Cortical
and trabecular bone and their corresponding
material properties were modelled for both healthy
and osteoporotic cases. The forces acting on the
femoral head corresponding to the activity of
walking downstairs were included in the models.
472
P 11 0
BIOMECHANICAL EVALUATION OF FEMORAL NECK

FRACTURE FIXATION WITH THE NEW FEMORAL NECK
SYSTEM COMPARED TO DIVERSE STANDARD
IMPLANTS FOR OSTEOSYNTHESIS
K. Stoffel1, I. Zderic2, C. Sommer3 , U. Eberli2, D. Mueller4 , M. Oswald5, B. Gueorguiev2
1
Cantonal Hospital Baselland and University Basel, Clinic for Orthopaedics and Traumatology,
Liestal, Switzerland
2
AO Research Institute Davos, Biomedical Services, Davos, Switzerland

3
4
5
Cantonal Hospital Graubuenden, Trauma Surgery, Chur, Switzerland
DePuy Synthes, Trauma Product Development Asia Pacific, Zuchwil, Switzerland
DePuy Synthes, Trauma Product Development AsiaPacific, Suzhou, China Peoples Republic
Introduction
Three Cannulated Screws (3CS), a Dynamic Hip
Screw (DHS) with antirotation screw (DHS-Screw) or
with a Blade (DHS-Blade) are the gold standards
for fixation of unstable femoral neck fractures.
Compared to 3CS, both DHS systems require a
larger skin incision with a more extensive soft tissue
dissection while providing the benefit of superior
stability [Krastman, 2006, Madsen, 2010, YihShiunn,
2007]. A newly designed Femoral Neck System (FNS)
combines the advantages of angular stability with a
less invasive surgical technique. The aim of this study
is to evaluate the biomechanical performance of
FNS in comparison to established methods for fixation
of the femoral neck in a cadaveric model.
Results
Highest axial stiffness was observed for FNS
(748.966.8 N/mm), followed by DHS-Screw
(688.844.2 N/mm), DHS-Blade (629.131.4 N/mm)
and 3CS (584.147.2 N/mm) with no statistical
significances. Cycles until 15 mm leg shortening
were comparable for DHS-Screw (205422488),
DHS-Blade (191611264) and FNS (17372947),
and significantly higher than for 3CS (7293850),
p<0.001. Similarly, cycles until 15 mm femoral neck
shortening were comparable between DHS-Screw
(208462446), DHS-Blade (189741344) and FNS
(18171818) and significantly higher than 3CS
(8039838), p<0.001.
C o n cl u s i o n
From a biomechanical point of view, the Femoral
Neck System (FNS) is a valid alternative to treat
unstable femoral neck fractures, representing the
advantages of a minimal invasive implant with
comparable stability to the two DHS systems and
superior to Three Cannulated Screws.
Methods
Twenty pairs of fresh-frozen human cadaveric
femora were instrumented with either DHS-Screw,
DHS-Blade, 3CS or FNS. A reduced unstable
femoral neck fracture 70 Pauwels III, AO/OTA 31
B2.3 was simulated with 30 distal and 15 posterior
wedges. Cyclic axial loading was applied with 16
adduction, starting at 500 N and with progressive
peak force increase at 0.1 N/cycle until construct
failure (Figure 1). Relative interfragmentary
movements were evaluated with optical motion
tracking. Statistical analysis was performed at a
level of significance set to 0.05.
References
Krastman et al, Arch Orthop Trauma Surg,
126:297303, 2006.
Madsen, BMJ, 340: c2810, 2010.
YihShiunn et al, Int Orthop, 31:677682, 2007.
Figure 1: S etup for biomechanical testing.
473
P 111
PARAMETERISED COMPUTATIONAL MODELLING OF THE

NATURAL HIP TO INVESTIGATE ITS CONTACT MECHANCIS
X. Hua1, R. Wilcox1, J. Fisher1, A. Jones1
1
Institute of Medical and Biological Engineering, University of Leeds, Leeds, United Kingdom
Introduction
The inherently complex structure of both the pelvis
and cartilage create difficulties in systematically
characterising the geometric features and
analysing their effects on the contact mechanics
of the natural hip in current subject-specific
computational modelling [Harris, 2012]. The aim
of this study was to develop and evaluate a
parameterised computational model for the natural
hip which allows these features to be characterised
systematically and tested quantitatively.
Results
The results predicted by the parameterised models
and the image-based models matched well for
both hip specimens, with maximum differences of
10.1% across seven activities simulated (Figure 2).
In addition, the parameterised models were able
to replicate features of the contact pressure/area
fluctuations over the loading cycle that differed
between the two specimens (Figure 2a).
Methods
Three-dimensional images of the pelvises of two
subjects were used. Image-based finite element
models were first generated using standard
segmentation, solid model generation and meshing
processes [Li, 2014]. In addition, parameterised
models of each pelvis were created. Following
sensitivity studies, the pelvis was represented by
a block. The geometric features of acetabulum
and cartilage were described and reconstructed
using five parameters: the acetabular depth d,
the centre and radius of the anterior edge cut
o1 and r1, the centre and radius of the cartilage
fossa o 2 and r2 (Figure 1a). These parameters were
extracted from the image-based models using a
best-fit technique.
All the solid models were meshed using triangular
shell elements, tetrahedral and hexahedral
elements. The material properties were based
on the literature [Russell, 2006]. The boundary
conditions for the models are shown in Figure 1.
Loading was applied to all the models to represent
seven physiological activities. In order to examine
the validity of the parameterised models, each
model prediction was compared between the
parameterised and equivalent image-based
model.
Figure 2: T he comparison of predictions between the two

models for descending stairs (DS) (a) and the maximum differences of predictions between the two
models across other difference activities (b).
Discussion
The present study developed an initial methodology
for generating parameterised computational
models of the human hip based on measurements
from three-dimensional images. By comparing the
predictions between the parameterised model
and equivalent image-based model, the results
demonstrated that the parameterised approach
could be used to generate representative finite
element models of the human hip for contact
analysis. Such a method has the potential to
be used to systematically evaluate geometric
features that can be captured from simple
clinical measurements and provide a cost and
time effective approach for stratification of the
acetabular geometries in the patient population.
Figure 1: T he variables used in the parameterised models

(a). The boundary conditions in the parameterised
(b) and image-based (c) models.
References
Harris et al, J Orthop Res, 30: 11331139, 2012.
Li et al, Proc Inst Mech Eng H, 228: 547555, 2014.
Russell et al, J Orthop Res, 3: 16, 2006.
474
P 11 2
IN VIVO HUMAN TIBIA DEFORMATIONS DURING

DIFFERENT LOCOMOTOR ACTIVITIES
P.F. Yang1, M. Sanno2, B. Ganse3 , T. Koy4 , P. Shang1, G.P. Brggemann2,
L.P. Mller4 , J. Rittweger3
1
Northwestern Polytechnical University, School of Life Sciences, Key Laboratory for Space
Bioscience and Biotechnology, Xian, China Peoples Republic
2
German Sport University Cologne, Institute of Biomechanics and Orthopaedics,

Cologne, Germany
German Aerospace Center, Institute of Aerospace Medicine, Division of Space Physiology,

Cologne, Germany
University of Cologne, Department of Orthopaedic and Trauma Surgery, Cologne, Germany
Introduction
Bone deformation plays a decisive role in bone
adaptation to the environment. Insufficient
mechanical loading on bone can lead to
osteopenia. However, to date, our understanding
of the in vivo human bone loading regimes and
deformation amplitude are still limited due to
technical difficulties [Burr, 1996]. It remains unclear
that how different locomotor activities affect the
mechanical loading on bone in vivo. Utilizing a
novel established optical approach, the purpose
of the present study was to comprehensively
understand the in vivo human tibia loading
regimes and segment deformation amplitude
during different locomotor activities.
(0.52 0.07) during maximum isometric plantar

flexion. When compared to anterio-posterior and
torsional deformation, the medio-lateral bending
angle remained at a rather low level.
Discussion
Bending and torsion predominated the tibia
deformation regimes during the investigated
activities. Unexpected large torsional deformation
might be another candidate to drive the long
bone adaption. The presented results suggest that
forefoot running might be one of the most effective
exercises to build the most resistant bones, despite
the fact that the importance of different bone
deformation regimens on bone adaptation
still remains largely unexplored. These findings
therefore are relevant to the development the
training protocol as the potential countermeasures
against osteopenia.
Methods
Tibia deformation was recorded in five subjects
utilizing an optical segment tracking (OST)
approach established previously [Yang, 2014].
Two marker clusters with three non-collinear retroreflective markers on each cluster were affixed
into the proximal and distal anterio-medial aspect
of tibial cortex by bone screws. The markers
trajectories were captured at 300 Hz with an
optical system during different activities, including
gait at 5.5 km/h, running with forefoot and rear foot
strike at 5.5 and 9 km/h, stair ascent with forefoot
and rear foot strike, and isometric maximum
volunteer plantar flexion. Tibia loading regimes
and deformation amplitude, namely peak-to-peak
(p2p) bending and torsion angles, were computed
from the relative movement of the proximal cluster
with respect to the distal cluster.
References
Burr, DB et al, Bone, 18:405410, 1996.
Yang, PF et al, Med Eng Phys, 36:10411046, 2014.
Yang, PF et al, PLoS ONE, 9:e94525, 2014.
Results
The proximal tibia primarily bent to the posterior
aspect (bending angle: 0.861.85) and twisted to
the external aspect (torsion angle: 0.650.90) for
all test subjects during walking at 5.5 km/h (Figure 1).
Running, in particular with forefoot strike, had the
potential to induce largest torsion and anterioposterior bending deformation. The anterioposterior bending angles for two involved test
subjects were 1.67 0.15 and 1.80 0.18 during
forefoot running at 9 km/h. Comparatively, the
torsional angle ranged between 1.72 0.08 and
2.25 0.21. The p2p torsional angle was larger
with forefoot than rear foot stair ascent and running.
The tibia deformation regimes were characterized
by torsion (1.35 0.07) rather than bending
Figure 1: T ibia bending and torsional angle during locomotor activities. G (5.5): gait at 5.5 km/h. FR(5.5) and
RR (5.5): forefoot and rear foot running at 5.5 km/h.
FR (9) and RR (9): forefoot and rear foot running
at 9 km/h. ForeS and RearS: forefoot and rear foot
stair ascent. PF: maximum volunteer plantar flexion.
475
P 11 3
AUTOMATIC PARAMETERIZATION OF OPENSIM MODELS

AND BIOMECHANICAL DATA INTEGRATION IN OPEN
SOURCE VISUALIZATION PLATFORM VISNOW.
N. Kapinski1, B. Borucki1, K. Nowinski1
1
University of Warsaw, Interdisciplinary Centre for Mathematical and Computational

Modelling, Warsaw, Poland
Introduction
High-end commercial softwares for biomechanical
analysis like SIMM, Visual 3-D, Anybody provide
individual, generic biomechanical models which
can be personalized with the use of platform-specific
tools. Furthermore, noncommercial products such
us OpenSim provide an open environment for
biomechanical simulations, allowing researchers
to perform patient-specific modelling. It is however
known that tools for parametrization of a generic
OpenSim model within the software have limited
functionality, allowing to scale generic solutions
based on manually defined constraints. Additional
parameterization features (e.g. bone and joint
deformations, muscle attachment placement)
can be obtained by use of NMSbuilder, SIMM tools
or scripting in Matlab, however this approaches
are cost- or/and time-consuming. Within this work
we present a fast, automatic method for scaling
and pose estimation of OpenSim models, based
on automated analysis of motion capture data.
Additionally we discuss advantages of integrating
patient-specific data within VisNow (www.visnow.
icm.edu.pl) open source visualization platform.
Discussion
Maximal optimized value f was 8.8e2 (given the
average euclidean distance between markers of
2.24 mm), minimal optimized value f is 4.5e2 (given
the average euclidean distance of 1.58 mm).
The parametrization was performed directly from
the movie data which allows to use commercial
motion capture systems, other than Vicon or BTS,
that have no implemented tools for model export
to OpenSim (e.g. Simi Aktisys). Low-cost solutions
broadly used in students studies, based on kinect,
sony eye cameras etc. can also be supported.
Furthermore, with use of tools implemented in
VisNow (Windows, Linux, Mac OS compatible
platform), it is possible to read DICOM files (e.g. CT,
MRI, ultrasonography), podoscopy (e.g. ZEBRIS) or
other measurement data and perform integration
and complex image processing or visualization [3,
4]. E.g. bone feature detection in CT, MRI or DEXA
for muscle attachment localization. An exemplary
data integration in VisNow is presented on Fig. 1.
Methods
8 sets of motion capture movies were gathered.
Each of the set represents different patient
recorded from 6 views, with 18 optical activemarkers on. To calibrate the scene and reconstruct
marker positions an algorithm presented in the
work [1] was used. Generic OpenSim model [2] was
scaled and automatically fitted to the data with
optimization of 59 DOF (23 inner coordinates of the
model and 36 scale parameters i.e 3 for each of
12 body segments). The optimization problem was
solved using Powells method with energy function
defined as mean weighted square error:
where n is the markers number, w is the weight,

xexp is the experimental marker position and
xvirt(q) is the positions of the corresponding marker
on the model depending on 59 q values.
Figure 1. Integration of multimodal biomechanical data in

VisNow.
Results
Table 1 presents the values of functions (1) obtained
for 8 sets.
1
0.058
0.046
0.063
0.034
0.052
0.088
0.044
0.046
see the next page
476
References
[1] N.Kapinski, B.Borucki, K.S.Nowinski, Error assessment and minimization in 4D motion tracking for
functional orthopaedics diagnostics, Int. J. of
Computer Assisted Radiology and Surgery, Vol.8,
Supp.1, June 2013, pp 157159.
[2] Delp, S.L., Loan, J.P., Hoy, M.G., Zajac, F.E., Topp
E.L., Rosen, J.M.: An interactive graphics-based
model of the lower extremity to study orthopaedic surgical procedures, IEEE Transactions on Biomedical Engineering, vol. 37, pp. 757767, 1990.
[3] K.S.Nowinski, B.Borucki, VisNow ? a Modular,

Extensible Visual Analysis Platform, Proc. of 22nd
Int. Conf. in Central Europe on Computer
Graphics, Visualization and Computer Vision
WSCG2014, pp 7376
[4] B.Borucki, K.S.Nowinski, M.Chlebiej, A.Rutkowski,
P.Adamczyk, J.M.Laskowski, Automated
geometric features evaluation method for
normal foot skeleton model, Annales UMCS
Informatica, Vol.4, 2011, pp 6175
477
P 11 4
PREDICTION OF THE RIB CAGE VOLUME AND THORAX

DENSITY FROM ANTHROPOMETRIC DATA.
C. Amabile1,2, J. Choisne1, A. Nrot1,3 , H. Pillet4 , W. Skalli1
1
Arts et Mtiers ParisTech, Institut de Biomcanique Humaine Georges Charpak/LBM,

Paris, France
NYU Hospital for Joint Diseases, Department of Orthopedic Surgery, New York City, USA
3
IFSTTAR, UMR_T9406, LBMC Laboratoire de Biomcanique et Mcanique des Chocs,

Bron, France
Arts et Mtiers ParisTech, Institut de Biomecanique Humaine Georges Charpak/LBM,

Paris, France
Introduction
Rib cage volume and thorax density are useful both
for clinical issues (Sverzellati et al. 2013) and for
multi-segmental body modeling. In the latter case
mean density is generally assumed, using data from
Dempster et al (Dempster 1955), which could be
over-evaluated due to the lack of consideration of
lung density. Bi-planar X-Ray system (Dubousset et
al. 2010) combined with 3D reconstruction allows
to get both the rib cage and the external body
shape. The aim of this study is to estimate the rib
cage volume compared to the thorax volume and
to propose a refined thorax density estimation.
Prediction of the RCV was significant with p < 0.05

and R =0.88. SEE and LOOE were respectively 7.3 %
and 7.8% of the mean RCV. Mean density was
0.80 g/cm 3 (SD 0.007).
Discussion
This study brings a new evaluation of the rib cage
volume from anthropometric parameters. This
could serve as a reference when studying rib cage
variability for pathological population.
It also allows providing a refined value of global
thorax density, which is lower than the one
proposed by Dempster et al. (0.92 g/cm 3), and
could be more relevant for multibody human
models.
Methods
55 asymptomatic volunteers were considered (35
males, 20 females); mean age: 38.3 y.o. [2085]
and mean body mass index (BMI): 22.9 kg/m
[15.429.5]. Head to feet low dose bi-planar
X-Rays were acquired using the EOS system
(EOS Imaging, Paris, France) followed by performing
the 3D reconstructions of the spine, rib cage and
external body shape (Humbert et al. 2009; Aubert
et al. 2014; Nrot et al. 2015) (Figure1). Bone, Rib
cage and thorax volumes (TV) were computed
(from T1 to T12 levels). Lung volume was estimated
as the inner rib cage volume (RCV) minus the heart
volume computed from the literature (Badouna et
al. 2012). Multi-linear regression was considered to
search for correlation between RCV and regressors
such as TV, BMI, Age and Gender. Gender was set to
1 for Male subject and 0 for Female subject. Criteria
to determine the ideal number of regressors were:
the leave-one-out-error (LOOE), the R-squared
statistics (R), the p-value (pval) and the standard
error of estimate (SEE). Moreover, global thorax
density was calculated using literature reported
densities of each component (bone, lung, heart
and soft tissues), and their respective calculated
volumes.
References
Aubert, B. et al, Comput Methods Biomech
Biomed Eng Imaging Vis, (May),115, 2014.
Badouna, A.N.I. et al. Phys Med Biol, 57(2):
47384, 2012.
Dempster, W.T. Space Requirements of the
seated operator, 1955.
Dubousset, J. et al, JMR, 13: 112, 2010.
Humbert, L. et al. CMBBE, 12(S1): 151163, 2009.
Nrot, A. et al, Submitted to the ISB 2015
Congress, 2015.
Sverzellati, N. et al, PloS one, 8: e68546, 2013.
Results
Mean RCV was 7793 cm 3 (SD: 1675) and mean
reconstructed TV was 18020 cm3 (SD: 4528).
The most relevant predictive equation was:
RCV (cm3) = 0.336 * TV (cm3) + 151.4 * Gender + 1609.2.
Figure 1: a
) & b) Bi-planar radiographies with reconstructed
spine and rib cage. c) 3D reconstruction of the
spine and rib cage.
478
P 115
PREDICTION OF BIOMECHANICAL MODIFICATION

INDUCED BY A THERAPEUTIC ACTION: APPLICATION
TO A TOTAL KNEE JOINT REPLACEMENT
B. Dousteyssier1, J. Molimard1, C. Hamitouche2, W.S. Han1, E. Stindel3
1
Ecole Nationale Suprieure des Mines de Saint Etienne, Ingnierie des Surfaces et des Tissus
Biologiques, Saint Etienne, France
2
3
Telecom Bretagne, Image et Traitement Information, Brest, France
Centre Hospitalier Universitaire de Brest, Laboratoire de Traitement de lInformation

Mdicale, Brest, France
Introduction
The knee is the joint that support the most stress
in the human body. It is not uncommon to see
osteoarthritis develop in this joint. A survey lead
in 18 different countries showed that 175 out of
100 000 persons needed a total knee arthroplasty
[Kurtz, 2011], which became a common procedure
against the knee osteoarthritis. But with a bad
position, the prosthesis ages faster and has to be
replaced [Liau, 2002]. Any new intervention is a
hard task; it is very painful for the patient, he will
lose mobility with the new joint replacement, and
this intervention is very expensive. To avoid that, it
is important that the position of the knee prosthesis
is correct at the first intervention.
conditions of a standing position and computes

correctly.
Results
To validate this model, its bony structure was
confronted with the EOS images with two methods.
First, a statistical bone shape model of the knee was
fitted on the EOS images, and the external surfaces
of this statistical model were compared with the
ones of the FE model. Second, the projected
images of the bones were segmented on the EOS
images, and then compared with FEA outputs.
The comparison between the model and the EOS
images is satisfying. The specific-patient geometry
was not lost in the process.
This study aims to build a Finite Element model of

the knee specific-patient allowing us to predict
the biomechanical effects of the surgery and to
propose an optimal position for the knee implant.
Discussion
The FE model now has to be tested with more
complex boundary conditions. It is the first step
in the study of the optimal position for the knee
implant.
Method
One healthy 24 year old male volunteer underwent
a MRI and an EOS imaging of the right knee. EOS
imaging is a low dose X-ray system dedicated to
orthopedic imaging [Wybier, 2013]. Several MRI
stacks were taken in order to reconstruct the
different parts of the knee.
In this case a FE model has been built from MRI and

validated with EOS images. But the comparison
between the FE model and the EOS images is
promising: the EOS imaging is quick (around 10
seconds for the acquisitions) and easy to process,
a generic biomechanical model can be fitted on
the EOS images of a patient for a specific response.
A 3D geometrical model was segmented from

the MRI stacks using the software Aviso. This
model is rather complete and includes the bones,
the cartilages and the soft tissues of the knee
(ligaments, tendons, and meniscus). This model
was then meshed and smoothed using a Low Pass
filter [Taubin, 2000] for Finite Element Analysis (FEA).
References
Liau et al, Clinical Biomechanics 17.2: 140146, 2002.
Kurtz et al, Int. Orthop. 35:17831789, 2011.
Taubin et al, Eurographics State of the Art Reports
4.3, 2000
Wybier, et al, Joint Bone Spine 80.3: 238243, 2013.
The model obtained has 150 000 elements, mostly

hexahedral. It has been tested with the boundary
479
P 116
EVALUATION OF LOWER LIMB MUSCLE

ACTIVATION PATTERNS BEFORE AND AFTER TOTAL
KNEE ARTHROPLASTY (TKA) USING A GENERIC
MUSCULOSKELETAL (MSK) MODEL
K.E. Tecante Gutierrez1, M. Schwarze1, C. Hurschler1
1
Medical School of Hannover, Orthopaedic Clinic, Hannover, Germany
Introduction
TKA is a well-known practice used in patients with
OA and it has increased over the years. A good
number of studies have focused on development
and improvement of MSK models to better predict
knee contact forces [1]. However, less attention
has been given on validating muscle activation
patterns despite its known impact on knee
compressive forces. Good agreement has been
shown between measured EMG and predicted
muscle activity in a healthy group [2]. However, to
the authors knowledge, it has not been shown if
such good agreement remains when evaluating a
population with a MSK impairment. Therefore, the
goal of this study was to validate predicted muscle
activation patterns against measured EMG in a pre
and post TKA group.
METHODO L O G Y
Four individuals (age 60.08.0, height 1.700.01,
and weight 91.212.0) were recruited for the study.
Kinematic and kinetic data were acquired during
walking before, 3 and 6 months after TKA. EMG from
rectus femoris (RF), vastus medialis (VM), vastus
lateralis (VL), biceps femoris (BF), semitendinosus
(ST), tibialis anterior (TA), gastronemius medialis
(GM) and gastronemius lateralis (GL) were
recorded. The EMG signals were smoothed using
a moving RMS filter with a 25 ms window. GLEM
from AnyBody (AnyBody Technology, Denmark)
was anthropometrically scaled and used to model
the lower limb. Average profiles over three trials
were generated and time was normalized to
percentage of gait cycle. Paired t-test (=0.05)
determined significant differences between pre
and post TKA. Dynamic time warping (DTW) was
used as a measure of similarity between measured
EMG and predicted muscle patterns.
Figure 1: P
redicted (top) and measured (bottom) muscle
activity before and after TKA (one representative
subject trial).
Discussion
MSK models are of great assistance to predict
muscle activity profiles. Furthermore, research
has observed a greater accuracy in muscle
moment arm computation in subject-specific MSK
models in comparison to generic MSK models [3].
Nevertheless, implementing a subject-specific
model is extremely time consuming and thus,
rather difficult to implement on a daily basis in the
clinical area. Generic MSK models are available
through specialized simulation software and offer
less implementation time. Hence, it is important to
validate such models not only in healthy groups
but also on specific clinical applications. This study
not only showed that generic-scaled MSK models
are capable of discerning differences pre and
post TKA but also that similarity between measured
and predicted muscle activity is consistent with the
one observed in healthy groups [2].
Results
For all subjects, kinematic and kinetic results as
well as measured EMG activity were consistent
with those observed in individuals with TKA.
However, differences were more significant after a
6 months period. Predicted muscle activity showed
significant differences before, 3 and 6 months
after TKA except for the VM and VL, where
significant differences were observed at 6 months.
Comparisons between measured and predicted
muscle patterns showed that RF and BF have less
similarity.
References
[1] Fregly et al, J Orthop Res, 30(4): 503513, 2012
[2] Heintz et al, Gait Posture, 26(2): 279288, 2007
[3] Correa et al, J Biomech, 44: 20962105, 2011
480
P 117
MODELLING PATIENT VARIATION FOR IMPLANT

DESIGN USING A PRINCIPAL COMPONENT ANALYSIS
BASED APPROACH
S. Sikora1, S. Rehman1, A. Jones1, R. Wilcox1
1
Institute of Medical and Biological Engineering, Mechanical Engineering,

The University of Leeds, Leeds, United Kingdom
Results
Introduction
The great variability in outcome of spinal
therapies such as Vertebroplasty indicates that
patient variation is an important determinant of
the success of a given therapy or device. When
developing a novel therapy, stratification of the
patient population according to this variability
at the pre-clinical testing stage could enable
the development of solutions tailored to each
sub-group. However, identifying the parameters
that exhibit significant variation over the patient
population and usefully reproducing this variation
is restricted by the limited pool of test specimens
available for study. In this work we 1: Evaluate the
ability of a computational Principal Component
Analysis (PCA) based tool to identify the most
significant sources of variation across a population
of elderly human vertebral specimens and identify
the ranges over which these parameters vary,
2: Generate new specimen instances exhibiting
chosen values of these parameters within these
ranges and 3: Compare the new instances with
those used as input to the PCA tool.
Figure 1: C
omparison between Input and Spawned specimens across a wide range of geometric measurements
Methods
A series of CT scans of elderly human lumbar
and thoracic vertebrae (n=30) taken from the
iMBE specimen library were down-sampled and
used to generate finite element (FE) models using
a previously validated approach 1 and solved to
determine their FE-predicted compressive stiffness.
A custom software tool developed by Simpleware
Ltd (Exeter, UK) was then used to conduct PCA of
the down-sampled CT scans to determine the
five most significant modes of parameter variation
(components) across the input dataset, their
relative significance and the ranges across which
these components vary. The PCA tool was then
used to generate new spawned down-sampled
vertebral specimen CT scans across the range of
the first principal component (PC-1), from 3 to +3
standard deviations around the mean value. From
these spawned scans, FE models were generated
and solved to determine their FE-predicted
compressive stiffness in the same manner as
for those scans used as inputs to the PCA tool.
Finally, comparisons were drawn between input
and spawned specimens with regard to their
geometric and greyscale properties and their
FE-predicted compressive stiffness.
Figure 2: Mean trabecular greyscale (density) vs FE-predicted

compressive stiffness for Input and Spawned
specimens
Good agreement was found between the

input and spawned specimens with respect
to their geometric (Figure 1) and greyscale
(density) properties, both in terms of the mean
measurements in each case and the overall
range. Good agreement was also found between
the input and spawned specimens with respect
to their relationships between mean trabecular
greyscale (density) and FE-predicted compressive
stiffness (Figure 2).
see the next page
481
Discussion
The good agreement between the FE-predicted
compressive stiffness mean, range and mean
trabecular density compressive stiffness relationships
for both input and spawned specimens suggests
that the spawned specimens not only look like
but also behave like vertebrae under the boundary
conditions studied. Further to this, as shown in Figure
1 it is clear that PC-1 accounts for the majority of the
geometric and greyscale (density) variation seen
within the input population. This has the potential
to greatly simplify the generation of stratified
pre-clinical simulated vertebral test specimens,

restricting the range of variation parameters that must
be considered. Ongoing work aims to determine the
significance of the remaining principal components.
References
1 Wijayathunga V.N., Jones A.C., Oakland R.J., Furtado N.R., Hall R.M., Wilcox R.K. Development of
specimen-specific finite-element models of human
vertebrae for the analysis of vertebroplasty. Proc.
Inst. Mech. Eng. H. 2008;222(H2):221228.
482
P 11 8
A MULTI-SCALE STUDY OF THE HIP JOINT MECHANICS:

INFLUENCE OF INERTIAL FORCES
S. Tassani1, A. Peiret2, E. Bosh2, G. Serrancol3 , J. Noailly4 , J.M. Font-Llagunes3
1
Institut de Bioenginyeria de Catalunya, Mechanics and mechanobiology, Barcelona, Spain

2
Institut de Bioenginyeria de Catalunya, Universitat Politcnica de Catalunya,

Mechanics and mechanobiology, Barcelona, Spain
Biomedical Engineering Research Centre, Universitat Politcnica de Catalunya,

Department of Mechanical Engineering, Barcelona, Spain
Universitat Pompeu Fabra, Department of Information and Communication Technologies,

Barcelona, Spain
Introduction
Development of multi-scale model of human gait
must face the double proposition to integrate
communication between the different scales of
analysis and to translate a dynamic reality into
a history of static loads. The idea to translate
forces from body movement analysis into tissue
model loads was already presented [Adouni,
2014]. However, the representation of inertial
loads into static loads at a specific time point is
poorly addressed. Hence, the goal of this study
was to evaluate the influence of inertial forces on
cartilage load calculations in a deformable hip
joint model.

Preliminary results of the study are reported. The
model of the right swing successfully converged,
while it was only possible to analyze the right stance
up to about 20% of the global load. Minimum
principal strain distributions at the femoral cartilage
in the four cases are displayed in Figure 1.
Methods
A multi-scale approach combined a musculoskeletal rigid body (RB) model of the entire human body
with a deformable Finite Element (FE) model of the
hip joint. The RB model consisted in 12 segments
animated through the trajectories of 21 markers
during a volunteer gait (67kg body-weight). Footground contact forces were recorded. An inverse
dynamic problem was solved, and forces developed in coupled muscle actuators were estimated.
At the organ-tissue scales, a hip joint FE model was
used [Snchez, 2014]. The model included the joint
ligaments, the acetabular and femoral cartilages,
and the labrum. Bones were linear elastic, and
cartilage tissues were considered as hyperelastic
Neo-Hookean materials, with material parameter
values taken from [Anderson, 2008]. The boundary
loads on the FE model were automatically
extracted from subject motion analysis through the
RB model.
Figure 1: D
istributions of minimum principal strains on the
femoral head are displayed. a) right swing without
Inertia, b) right swing with Inertia, c) right stand
without Inertia, d) right stand with Inertia.
During the swing phase, the overall relieve

of cartilage loads with the inertial forces was
more realistic than the load predicted without
these forces. Preliminary results in the stance
phase already show load distributions similar
to experimentally measured contact stress
distributions [Henak, 2013]. While inertial forces did
not affect this distribution, they globally increased
the loads transferred to key tissues such as the
labrum (Fig 2).
In order to convert the RB dynamics into an

equivalent static problem for the FE simulations, the
pelvis was fixed, and a distribution of dAlembert
inertial forces was applied to the femur elements
as body forces.
Two time-points of the gait were selected: swing
phase with no reaction forces on the ground and
monopodalic right stance position. The influence of
inertial forces on the FE calculations was studied, in
addition to that of body weight and muscle forces,
leading to four simulation cases.
see the next page
483
suggest that the analysis of cyclic cartilage loads

during gait requires full multiscale coupling,
including inertial loads.
This work was partially supported by the European
Community and the autonomous region of
Catalonia (acronym sMART-O, project number
2013-BP-B-00096)
References
Anderson et al., J Biomech Eng, 2008;
Adouni et al., J Orthop Res. 2014;
Henak, C. R. et al., J. Biomech. Eng. 2013;
Snchez Egea et al., Clin Biomech, 2014;
Figure 2: P
ercentage of elements per strain range in the
labrum, with (a), and without (b) inertial forces
Body dynamics were successfully translated into

a history of static loads for FE calculations. Results
484
P 119
INTER-SEGMENT COORDINATION USING CONTINUOUS

RELATIVE PHASE AN ELABORATIVE PERSPECTIVE
TO STUDY KINEMATICS IN ANKLE JOINT
S. Chopra1, J. Favre1, X. Crevoisier1
1
Centre Hospitalier Universitaire Vaudois CHUV, Department of Orthopaedic Surgery and

Traumatology, Lausanne, Switzerland
Results
Max peak indicates that the distal segment is
rotating faster than the proximal segment and min
peak indicates vice versa (Figure 1).
Introduction
Joint kinematic provides information about the
mobility in foot and ankle. So far, it has been
commonly assessed by measuring amplitude of joint
rotation, using cameras or sensors[1]. This method
describes the degree of movement occurring at
a joint however it does not explain, how the two
segments coordinate to perform the movement.
This information of foot segment coordination
is significant to understand the compensatory
movement patterns. The phase space relation
between two segments gives information regarding
the coordination between the two segments to
perform the defined movement. This study aims
to see if inter-segment coordination analysis can
add more clinical information in comparison to
only joint angulation assessment in foot and ankle
research.
C
ontrols: ff-hf and ff-sh segments showed two
max peaks during stance and a min peak at initial
swing (IS). While at hf-sh a min and max peak at
stance and a min peak at IS was reported.
TAR: The patterns for all three segments were
similar to controls, but at hf-sh, during IS, max peak
was reported. All the peaks were significantly
smaller.
AA: The pattern was modified with ff performing
majority of rotation in ff-hf and ff-sh. While in hf-sh
the max peaks at stance and at IS the min peak,
same as TAR, was reported, both peaks were
significantly smaller.
CMC for CRP curve between the three groups
were as follows: ff-hf CRP=0.95, hf-sh CRP=0.80
and ff-sh CRP=0.98.
METHOD
Gait data were collected from 17 controls, 10 total
ankle replacement (TAR) and 10 ankle arthrodesis
(AA) patients using 3 D inertial sensors (Physilog ).
The participants walked along a 50m long corridor
twice and the movement along each segment
was calculated over 100% of gait cycle. The foot
was divided into 3 segments: forefoot (ff), hindfoot
(hf) and shank (sh). Sagittal angles and angular
velocities of each segment were measured and
their phase angles (?) calculated. Continuous
relative phase (CRP) were also obtained; ? ff-hf, ?
hf-sh and ? ff-sh. The CRP outcome of each group
was assessed over 100% gait cycle and each cycle
was divided into 7 phases in which positive (max)
and negative (min) peaks were calculated for
each phase and compared, coefficient of multiple
correlation (CMC) was assessed between the three
groups (p<0.05).
C o n cl u s i o n
Based on our results inter-segment coordination
adds information which is masked by the existing
kinematic assessment method. Combination of
the two methods, amplitude of joint rotation and
inter-segment coordination, would be useful in
understanding the role of individual segment in
attaining the defined joint rotation in ankle.
References
1 H. Rouhani, J. Favre, K. Aminian, X. Crevoisier.
Multi-segment foot kinematics after total ankle
replacement and ankle arthrodesis during relatively
long-distance gait. Gait Posture. 2012 Jul;36(3):
5616. doi: 10.1016.
485
P 12 0
ANALYZING THE PATTERNS OF ANTERIOR KNEE

LAXITY DURING FLEXION
A. Imran1
1
Ajman University of Science & Technology, Biomedical Engineering,

Ajman, United Arab Emirates
Introduction
Cruciate ligaments of the knee are considered
as the main stabilizers of the joint in the sagittal
plane. Integrity of these ligaments of is tested using
anterior-posterior laxity tests. Increased laxity,
normally compared to the contralateral knee,
may indicate injury to the ligaments. The ligaments
consist of fibers which change their geometry and
may stretch or slacken during motion. This could
have an effect on the knee laxity.
those of experimental tests on cadaver knees

reported in the literature [Lo, 2011]. Only qualitative
results are discussed here as follows.
The anterior laxity first increased non-linearly from
0 to about 45 degree flexion and then decreased,
again non-linearly, in higher flexion. At each flexion
angle, the knee laxity increased in proportion to
a corresponding increase in the external load.
However, the pattern of variation over flexion
remained unchanged.
In the present study, the patterns of anterior laxity

of the knee during flexion are analyzed in terms of
changing lengths of the anterior cruciate ligament
(ACL) in the sagittal plane.
To understand this pattern of laxity variation over

flexion, the geometry of the ACL fibers was also
analyzed in terms of anterior, intermediate and
posterior fibers. For all applied loads during the
simulated tests, the anterior fiber was stretched
at all flexion positions, while the posterior fiber first
stretched at 0 degree flexion and then slackened
significantly till about 60 degrees to start stretching
again in higher flexion. The intermediate fiber was
stretched at 0 degree and then slackened till 90
degrees to start stretching again with further flexion.
Methods
A mathematical model of the knee was used with
the cruciate ligaments represented as non-linear
elastic fibers in the sagittal plane. Flexion motion of
the knee was defined during 0120 degree without
any muscle force or external load. An anterior
laxity test was simulated at several flexion positions
of the joint by applying a known anterior force on
the tibia. The force translated the tibia anterior to
the femur and stretched the ACL. The translation
gave the anterior laxity. Anatomical parameters
and material properties of the ligaments were
taken from the literature.
Laxity of the knee is considered as an important
clinical indicator of ligament integrity. The laxity
varies with applied external loads and flexion
position of the joint. The model calculations
showed variations similar to in vitro experimental
observations. Further, the model simulation helped
in gaining insight into the patterns of laxity variation
in terms of individual fiber behavior of the ACL.
R e s u l t s a n d A n a ly s i s
During flexion in the absence of muscle forces
or external loads, selected fibers of the cruciate
ligaments maintained their lengths within 1 %
[Imran, 2012]. This agrees with other anatomical
and theoretical studies suggesting that selected
ligament fibers maintain their lengths during flexion
in the unloaded state of the knee. The model
calculations for anterior laxity compared well with
References
Imran A, Proc. World Congress Engineering, UK,
Vol. III: 19851988, 2012.
L o JH et al, The Knee 18(6):491495, 2011.
486
P 121
LATTICE FINITE ELEMENT INVESTIGATION OF THE

INFLUENCE OF AGING ON THE MECHANICAL
CHARACTERISTICS OF HUMAN CERVICAL VERTEBRA
Z. Kamal1, A. Komeili2, A.A. Pashazanoosi3 , M. El-Rich4
1
Amirkabir University of Technology, Biomedical engineering, Tehran, Iran

2
3
University of Alberta, Civil Engineering, Edmonton, Canada
Qazvin Azad Islamic University, Mechanical Engineering, Qazvin, Iran

4
Univerisity of Alberta, Civil Engineering, Edmonton, Canada
Introduction
Osteoporosis in spinal vertebra is a major concern
in ageing societies. Osteoporosis is a disease
characterized by low bone mass and microarchitectural deterioration of bone tissue, with
a consequent decrease in bone strength and
stiffness as well as increase in fracture risk [Anon,
1993]. Several methods were developed to
predict the failure probability in vertebrae [Polikeit
A, 2004]. However, less attention was paid to
the biomechanics of the transverse structural
elements. This study developed a multi-scale finite
element (FE) model of C5 vertebra in three levels
of aging, to investigate the mechanical influence
of osteoporosis in trabecular bone on vertebral
stiffness and strength in the spine.
the linear part of the force displacement curve, and

the ultimate force was defined as the intersection
point between the region of linear elasticity and the
region of constant strain hardening.
Results
The compressive displacements were similar for
both male and female while compressive load was
below 15 kg (Fig. 2). With increasing compression,
larger displacements were observed in female cases
rather than male models. The ultimate strength for
cases aged over 75yrs exhibited a plastic behavior
for weights >13Kg in which the female models
showed more flexibility in compare to male cases.
Discussion
In summary, this work showed the potential of
developed osteoporotic vertebral multi-scale FE
model to investigate the vertebral compressive
fracture. Overall, the curves showed similar trend
to those in literature [Mosekilde L., 1989]. The older
the cases, the more flexible the tissues have been
observed in the results. Accompany of decreasing
the ability of weight bearing with descending the
weight of tissues in process of aging supports the
smartness of body. In fact, tissues, including bones,
will adapt with new situation and their density will
decreased gradually with aging. This model can
be used in future studies to investigate the micromechanisms of vertebral compression fracture
which occur in osteoporosis.
Methods
A perturbed tetragonal lattice model was chosen
to represent the trabecular microstructure. The
lattice was generated using Matlab (R2012a)
which specified the vertices of the lattice, and then
generated FEs between the vertex points. Based on
clinical evidence, the lattice FE model of trabecular
bone microstructure was comprised of longitudinal
and transverse beams of thickness and spacing as
literature [Mosekilde L., 1989], in which characterized
trabecular bone microstructure for three age groups
(age <50 yr, age 5075 yr, age >75 yr), both male
and female. The material properties of bone were
defined as homogeneous and transversely isotropic
for transverse and cortical bone, respectively. Both
were modelled as an elasto-plastic material. Figure
1 showed the sequences of construction of lattice
model of C5. The analyses were performed using
ABAQUS6.13 (Simulia, RI, USA). To find the failure point
on the curves, compressive pressure is gradually
increased, and the maximum displacement was
recorded. Stiffness was defined as the slope of
References
A
non, American J. of Medicine, 94:64650, 1993.
P
olikeit A, J Biomechanics, 37(7):10619, 2004.
M
osekilde L., Bone, 10(6):425432, 1989.
see the next page
487
488
P 12 2
EVALUATION OF LAXITY TESTS WITH A MUSCULOSKELETAL

MODEL OF TOTAL KNEE ARTHROPLASTY
M. Marra1, M. Strzelczak1, S. van de Groes2, P. Heesterbeek3 ,
A. Wymenga4 , B. Koopman5, N. Verdonschot1, D. Janssen1
1
Radboud University Medical Centre, Orthopaedic Research Laboratory,

Radboud University Medical Centre, Orthopaedic Department, Nijmegen, Netherlands

3
4
Sint Maartenskliniek, Research Department, Nijmegen, Netherlands
Sint Maartenskliniek, Department of Orthopaedics, Nijmegen, Netherlands
University of Twente, Department of Biomechanical Engineering, Enschede, Netherlands
Introduction
Musculoskeletal models are emerging as potential
tools for the use in many clinical applications. One
important example is aid to the clinical decision
in the orthopaedic field. Recently, a patientspecific model of Cruciate-Retaining Total Knee
Arthroplasty (CR-TKA) was presented and validated
with respect to knee joint forces and kinematics
[Marra, 2015]. However, the ligament restraints
were not calibrated and inaccuracies in knee
kinematic predictions were present. The objective
of this study was to evaluate the effect of ligament
calibration on the performance of simulated laxity
tests.
and reference strain were made iteratively in order

to obtain laxity envelopes close to those reported
in the literature for cadaveric tests on a CR-TKA
[Saeki, 2001]. All the laxity tests were eventually
simulated with the same ligament configuration.
Results
The results for all simulated laxity tests and the
reference values from the literature are summarized
in Table 1.
Methods
A musculoskeletal model of CR-TKA was previously
described [Marra, 2015]. The model comprised the
musculoskeletal architecture of a TKA patient and
a force-dependent model of the prosthetic knee
and patellofemoral joint. Ligament restraints were
modelled using non-linear springs and contact
was solved using a rigid formulation. To calibrate
the ligament parameters we simulated anterior/
/posterior, valgus/varus and endo-/exorotation
laxity tests. Each test was performed at four
different knee flexion angles (0, 30, 60, 90 deg).
The anterior (respectively posterior) laxity load
consisted of a 35 N force applied on the tibia
at a distance of approximately 15 cm from the
surface of the tibial component, pointing anteriorly
(respectively posteriorly). Valgus (respectively
varus) test was simulated by applying a force on
the tibia at a distance of approximately 15 cm
from the ankle joint, pointing laterally (respectively
medially) so that the resulting moment was equal
to 10 Nm. For the endo- (respectively exo-) rotation
a 1.5 Nm torque was applied to the longitudinal
axis of the tibia. Laxity envelopes for each test were
calculated as the difference between the values
obtained in the two opposite directions of the test.
Manual changes to ligament insertion site, stiffness,
30
60
90
AP (M)
3.5mm
4.2mm
1.0mm
1.0mm
AP (L)
1.5mm
5mm
4mm
4.5mm
VV (M)
0.9
4.3
2.6
1.5
VV (L)
3.0
6.0
7.0
7.0
EE (M)
7.0
16.5
4.0
5.5
EE (L)
6.5
22.0
21.0
23.0
Table 1: A
P: Anterior/Posterior, VV: Valgus/Varus,
EE: Endo-/Exorotation, M: Model prediction,
L: Literature value
Discussion
The laxity envelopes predicted by the model were
in partial agreement with those reported in the
literature. The largest differences were noted for
6090 degrees of knee flexion for all laxity tests,
where the model showed considerably less laxity.
These deviations may be attributable to actual
differences between the implant design and
subject geometry currently simulated and those
used in the cadaveric tests. In future studies we
aim to simulate surgical variations such as implant
size and positioning, joint line elevation and
ligament restraint. This musculoskeletal model of
TKA has potential as a pre-operative planning tool
for orthopaedic interventions.
References
Marra et al, J Biomech Eng, 137, 2015
Saeki et al, Clin Orthop Relat Res, 392:184189, 2001
489
P 12 3
COUPLING MUSCOLOSKELETAL AND FINITE ELEMENT

MODELS TO STUDY THE LONG-TERM BIOMECHANICAL
ADAPTATION IN A BIOLOGICALLY-RECONSTRUCTED
FEMUR AFTER EWING SARCOMA
G. Valente1, L. Pitto1, S. Piroddi1, E. Schileo2, A. Roncari1,
A. Leardini3 , M. Manfrini4 , F. Taddei1
1
2
Istituto Ortopedico Rizzoli, Laboratorio di Bioingegneria Computazionale, Bologna, Italy

3
Istituto Ortopedico Rizzoli, Laboratorio di Analisi del Movimento, Bologna, Italy

4
Istituto Ortopedico Rizzoli, Muscoloskeletal Oncology, Bologna, Italy
Introduction
A promising technique for limb-salvage surgery after
primary bone tumours is biological reconstructions
comprising
massive
bone
allograft
(MBA)
vascularised fibula autografts (VFA) [Manfrini,
2004]. However there is limited knowledge about
functional outcomes after surgery based on
quantitative data.Our aim is to study the long-term
biomechanical adaptation in a paediatric case by
analyzing: (i) musculoskeletal forces and muscle
compensation strategies in different motor tasks
through musculoskeletal modeling; (ii) mechanical
stress in the reconstruction during the motor tasks
through finite element analysis, also including
potential revision surgery scenarios.
chair rise/sit, stair ascent/descent, squat) and CT

scanning after being instrumented with the same
reflective marker setup [Leardini, 2007]. A 9-body
segment, 12 degree-of-freedom articulated 3D
linkage actuated by 85 musculotendon actuators
was created from these images (Figure) using a
previously developed framework [Valente, 2014], and
a typical inverse dynamics and static optimization
approach was then applied to calculate muscle
and joint contact forces during each motor task.
Subject-specific finite element models of both femurs
were built using a validated procedure [Schileo,
2014]. The muscles and joint contact forces were
applied as loading conditions, and physiologically-oriented constraints were used [Speirs, 2007]. Plate
and screws safety was tested in terms of von Mises
stresses against fatigue limit. Bone principal strains
and strain energy density were computed to assess
risk of fracture [Schileo, 2014] and remodeling
stimulus [Huiskes, 1992]. In the operated femur, the
finite element analyses were repeated simulating
different screw-removal configurations to reduce the
expected stress-shielding.
Methods
The patient (male, 8 yrs) underwent a biological
reconstruction of the proximal right femur, and was
then continuously disease free. Lower limbs CT were
acquired during follow-ups at every 6 months for
routine controls. The evolution of bone morphology
and density was quantitatively evaluated. After
7years, the patient underwent gait analysis (walking,
see the next page
490
RESU L TS a n d DIS C USSION

Overall, joint contact forces were larger in the
contralateral limb during all motor tasks, except
for walking. Knee and ankle loads were markedly
higher (up to 3 body-weight difference), particularly
in double-support tasks (chair rise/sit and squat).
Muscle compensation strategies showed large
forces of the vasti and gastrocnemius muscles of
the contralateral limb, while gluteii and biarticular
hip muscle forces of the operated leg were
marked. Plate and screws stresses were below
critical values in all motor tasks. Maximum strains
were not critical in both femurs (safety factor >= 3)
and the average strains in the operated femur
were lower than in the intact contralateral. A
marked regional variation in strains and strain
energy density was observed within the allograft:
normal levels in medial compartment, extremely

low values in anterior and posterior compartments.
This mechanical condition appears compatible
with a further bone resorption. We found that a
complete removal of the proximal screws would
be needed to restore a more physiological bone
strain configuration.In summary the results allow
interpretation of the complex bone remodeling
mechanism, raise some concern on possible
negative remodeling in the long term.
Manfrini et al., AJR182:96370,2004. Leardini et al.,
Gait Posture, 26: 560571, 2007. Valente et al., PLoS
ONE, 9: e112625, 2014. Schileo et al., J Biomech, 47:
35318, 2014. Speirs et al., J Biomech, 40: 231823,
2007. Huiskes et al., CORR, 274: 12434, 1992.
491
P 12 4
THE TORUS OBSTACLE-SET ALGORITHM USED

FOR MUSCLE PATHS MODELING
L. Havelkov1, L. Hynck1
1
University of West Bohemia, New Technologies Research Centre, Plzen, Czech Republic
Introduction
The musculoskeletal computer models have
wide range of applications. They help in clinical
practice to prevent injuries and diseases, to
optimize rehabilitation, to improve diagnoses, etc.
Nevertheless, existing models are still insufficient
especially because of muscle models (such as their
unreal shape and path, oversimplified physiological
properties, excessive sliding over joints).
The Hill-type model is used to simulate the real

muscle behaviour. The muscle forces and moment
arms generated for given movement of shoulder
are computed using the inverse dynamics and
optimization method. The final model is constructed
in MATLAB software.
Results
Presented model was precisely validated. The
muscle length and muscle moment arm were
calculated for four different movements of shoulder
joint (abduction till 90 degrees, forward flexion till
90 degrees, neutral position, backward extension
till 45 degrees). Calculated values were compared
with the literature [Lu, 1997].
Therefore, the main goal of this study is to find a

new method for muscle path definition based
on [Garner, 2000]. In addition, the shoulder is the
most complicated joint having a huge range of
motion. And thus, the method is firstly developed
for deltoid muscle.
Methods
The 3D model consists of the scapula, the humerus
and the deltoid muscle. Bones are modelled by
rigid bodies connected by real joints, equations of
motion based on [Shabana, 2011].
The MR images of shoulder in same four positions

were recorded. The positions were reconstructed
using the model and obtained muscle shapes were
compared. The validations were satisfying.
Discussion
The new muscle wrapping method was used to
model the deltoid muscle. The muscle forces and
moment arms were computed for few different
shoulder movements. The method limits the lacks
of existing models such as excessive sliding and
unreal muscle shapes. This method is useful for all
arbitrary movements.
The muscle is represented by frictionless elastic

bands moving freely over neighbouring structures
such as bones, joints and other muscles. The
anatomical constraints, referred to as obstacles,
are replaced by set of torus. The muscle line of
action is then composed of the straight-line going
tangentially from origin to the torus, the curved-line
wrapping over the obstacle and another straight-line
going tangentially from torus to insertion.
References
G
arner et al, Com Method in Biomech and
Biomed Eng, 3: 130, 2000.
L iu et al, Clin Biomech, 12(1): 3238, 1997.
S habana, Computational Dynamics, Willey,
Chicago, 2011.
The model geometry is obtained from MRI of the

healthy man. The muscle lines origins and insertions
as well as positions of torus are computed using
the k-means algorithm, all located in the local
coordinate system of corresponding segment.
492
P 12 5
GROUND REACTION FORCE DURING WALKING IN

PATIENTS AFTER TOTAL HIP ARTHROPLASTY REVISION
E. Kubonova1, Z. Svoboda1, J. Gallo2, S. Duskova3 , M. Janura1
1
Palacky University, Faculty of Physical Culture, Department of Natural Sciences

in Kinanthropology, Olomouc, Czech Republic
2
University Hospital, Olomouc, Department of Orthopaedic Surgery,

Olomouc, Czech Republic
University of Ostrava, Faculty of Medicine, Department od Rehabilitation,

Introduction
Gait analysis of patients after total hip arthroplasty
(THA) is necessary for an objective assessment of
the THA effectiveness [Lamontagne, 2009; Slaven,
2012]. There are several studies that indicate the
necessity to deal with post-operative condition
THA issue [Beaulieu, 2010; McCrory, 2001; Palieiri,
2011]. Nevertheless no study has been found to
assess post-operative condition after total hip
arthroplasty revision. The aim of this study was to
determine ground reaction force (GRF) differences
between operated and non-operated lower limb
during gait in patients after total hip arthroplasty
revision.
(p = 0.01) and total vertical force impulse (p = 0.02)

were found for the non-operated limb. The first part
of the stance phase as well as the time of load
increasing (from heel strike to 75 % loading) was
longer on operated limb (p = 0.02).
Discussion
Significant higher loading (force and impulse)
on non-operated limb indicates more dynamic
movement performance, but on the other side
shows on operated limb uncertainty during gait even
a few years after revision surgery. A shorter time of
the loading transfer on operated limb in the first part
of the stance phase as well as worse muscle timing
during heel strike may related to inability to create
reliable shock absorber. These results are supported
by other research of primary THA patients [Bhargava,
2007; McCrory, 2001]. This could be warning because
the permanently increased loading on the nonoperated limb can lead to overloading of the
healthy contralateral joints.
Methods
An experimental group consists of 24 patients
(12 men and 12 women) after total hip unilateral
arthroplasty revision (average age 59.87.5 years,
height 167.4 10.1 cm, weight 78.3 17 kg, time
after surgery 7.44.3 years). For measuring ground
reaction force during gait were used two force
plates Kistler 9286AA (Kistler Instrumente AG,
Winterthur, Switzerland). Five gait trials of each
subject were evaluated. Comparison of force
variables on operated and non-operated limbs was
performed by ANOVA and effect size (Cohens d).
References
Beaulieu, M. L. et al., Gait Posture, 32:269273, 2010.
Bhargava, P. et al., Indian J Orthop, 41:158162, 2007.
McCrory, J. L. et al., Gait Posture, 14:104109, 2001.
Lamontagne, M. et al., Orthop Clin North Am,
40:397+, 2009.
Palieri, G. et al., Eur J Phys Rehab Med, 47:917, 2011.
Slaven, E. J., Phys Ther, 92:13861394, 2012.
Results
Differences between operated and non-operated
lower limb were found on vertical component of
the GRF. Higher values of the first vertical peak
493
P 12 6
ECCENTRIC CONTRACTION MODELED BY THREE

FILAMENT CROSS-BRIDGE MODEL
V. Cibera1
1
Simulation and Results

The main subject of the simulation was to simulate
the stretch of sarcomere for the three cases. In
all cases, the velocities of the stretches remained
the same, but the stretches were considered for
different magnitudes.
Introduction
The purpose of this study was to theoretically
model and consequently simulate the contraction
of skeletal muscles on a single sarcomere level. The
study was predominantly focused on muscles during
and after stretching, i.e. on eccentric contraction.
Till nowadays, this topic is still insufficiently explained
namely with regard on the increase in force (force
enhancement) in comparison to the force which
is generated during isometric contraction with
corresponding sarcomeres length.
The results in fig. 1 show characteristic property

of force enhancement. Specifically it shows the
dependence of magnitude of force enhancement
on the magnitude of stretch, which is in concor
dance with measured data as for instance in
[Herzog, 2002]. The other results of simulated
mechanical properties can be well compared as
well as for isometric and eccentric contraction.
But the main result is before all that the force
enhancement can be explained on single (half)
sarcomere level if the modified properties of titin
are considered. For the future work, the proposed
model needs to be compared with results of
energetics measurements.
The force enhancement following after stretch is

hard to explain on account of interaction among
two main contractile proteins actin and myosin.
The explanation of the problem may lay in the
special and recently discovered properties of the
third most abundant sarcomeres protein titin.
Titin is traditionally considered as source of passive
(elastic) force in sarcomere. But according to the
recent proposals in [Herzog, 2012] and measured
data in [DuVall, 2013], titin can actively interact
with actin through its specific parts and change
its mechanical properties when introduced to
calcium. Therefore, the main aim of this study
was to take into account these special properties
of titin and incorporate them into classical crossbridge theory of muscle contraction.
Figure 1: S imulation of the three eccentric contractions

with same speed but various values of magnitudes
of stretches.
Methods
The new mathematical model was proposed on
account of the fact noted above. The mathematical
model is comprised of two parts. The first part is
based on classical but considerably modified two
state Huxleys cross-bridge model [Huxley, 1957]. This
part captures the force FCB, which is the sarcomere
able to actively develop due to interaction among
actin and myosin proteins.
The work was supported by grant SGS-2017-026.

References
DuVall, M. et al, Eur Biophys J, 42:301307, 2013
Herzog, W. et al, Mol Cell Biomech, 9(3):175191,
2012
Herzog, W. & Leonard, T. R., J Exp Biol, 205:1275
1283, 2002
Huxley, A. F., Prog Biophys Biophys Chem, 7:255
318, 1957
The second component of the model expresses the

force FT produced by titin. The titin properties were
integrated into the model as proposed in [Herzog,
2012]. The resulting force F is then simply:
F = FCB + FT.
(1)
494
P 12 7
PREDICTIVE MATHEMATICAL MODELING OF KNEE

STATIC LAXITY AFTER ACL RECONSTRUCTION
C. Signorelli1, T. Bonanzinga1,2, A. Grassi1,2, N. Lopomo1,3 ,
S. Zaffagnini1,2, M. Marcacci1,2
1

Bologna, Italy
2
Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy
Istituto Ortopedico Rizzoli, Laboratorio di NanoBiotecnologie NaBi, Bologna, Italy
Introduction
Different studies have tried to determine the effect
of specific surgical variables on postoperative
surgery outcome (Bedi 2012, Zaffagnini 2004,
Amis and Jackob 1998). Concerning the surgery
outcome quantification, computer navigation
systems have been shown to represent a valid
method for increasing the accuracy of different
surgical variables compared to the traditional
arthroscopy
(Ohkawa,
2012,
Schep
2005)
.Unfortunately, previous studies did not take into
consideration all the different aspects of the
performed Anterior Cruciate Ligament (ACL)
reconstructive surgery and the interaction among
them in the definition of postoperative outcome.
Thus, multivariate analysis will be conducted to
quantify the correlation between post-operative
static laxity parameters and specific technical
variables of the surgical procedure acquired in an
in-vivo setting by a computer navigation system.
MODEL
AP30estimate
0.987
0.014
AP90 estimate
0.968
0.054
IE30 estimate
0.995
0.005
IE90 estimate
0.568
0.010
VV0 estimate
0.932
0.003
VV30 estimate
0.175
0.012
Table 1: C
orrelation ratio (2) and corresponding P-value
(P) for the analyzed multivariate models.
As an example of the defined models, Formula 1

shows the IE90 estimate:
IE90estimate = 427.447 + 0.211* FTRA + 2.805* TSAG +
+ 3.902* TCOR + 4.993* TTRA(1)
Methods
Seventeen patients who underwent navigated
Single Bundle plus Lateral Plasty ACL reconstruction
were enrolled in the study. Static laxity has been
evaluated as the value of anterior/posterior
displacement at 30 and at 90 of flexion, internal/
/external rotation at 30 and 90 of knee flexion,
varus/valgus test at 0 and 30 of flexion. The
evaluated surgical variables were analyzed
through a multivariate analysis defining the
following models: AP30estimate, AP90estimate, IE30 estimate,
IE90 estimate, VV0 estimate,VV30 estimate. Surgical variables
has been defined as the angles between
the tibial tunnel and the three anatomical planes,
the lengths of the tunnel and the relationship
between native footprints and tunnels. An
analogous characterization was performed for
the femoral side. Performance and significativity
of the defined models have been quantified by
the correlation ratio (2) and the corresponding
P-value (* P<0.050).
Where: TTRA orientation of tibial tunnel respects to

transverse plane, TCOR orientation of tibial tunnel
respects to coronal plane, TSAG orientation of tibial
tunnel respects to sagital plane, FTRA orientation of
femoral bundle respects to transverse plane.
Results
The analyzed models resulted to be statistically
significant (P<0.05) for prediction of postoperative
static laxity values. The only exception was the
AP90 estimate model. The 2 values and their P-value
have been reported (Tab.1) for all the defined
models. The orientation of the tibial tunnel resulted
to be the most important surgical variable for the
static laxity estimation.
References
Amis et al, 1998. KSSTA6 (1), S2S12, 1998
Bedi et al, Am J Sports Med 39(2):36673, 2011.
Ohkawa et al, KSSTA; 20:77884, 2012.
Schep et al, Arthroscopy 21:9427, 2005
Zaffagnini et al, Comput Biol Med 34(2):15363, 2004
Discussion
Mathematical models for postoperative knee laxity
is a useful tool to evaluate the effects of different
surgical variables on the postoperative outcome.
They can also be implemented in navigation
system for intraoperative assessment. The models
parameters have been determined on the basis of
a multivariate analysis. The usefulness of the model
is the greatest while planning custom-made ACL
reconstructive surgery, yet it can be implemented
for different kinds of surgical techniques. Future
research should focus on the introduction in the
multivariate models of different anatomic variables
as well as dynamic laxity parameters for the surgery
outcome assessment.
495
P 12 8
3D JOINT KINEMATICS OF LOWER EXTREMITIES

IN THE FEMALE ELDERLY DURING AMBULATION
CONSIDERING BERG BALANCE SCALE
C.Y. Ko1, H.J. Choi2, S. Kang2, J. Ryu2, M. Mun2
1
Korea Orthopedics & Rehabilitation Engineering Center, Incheon, Korea, Republic of Korea
2
Korea Orthopedics & Rehabilitation Engineering Center, research team, Incheon, Korea,
Republic of Korea
Introduction
Gait and balance function in the elderly declines.
Berg balance scale (BBS) is clinically reliable index
for evaluation of balance function. Although
balance function is strongly related to gait
function, few studies on correlation between
BBS and 3D joint kinematics of lower limb in the
elderly have conducted. The aim of this study was
to evaluate gait biomechanical features in the
elderly considering BBS. Additionally, kinematics of
mediolateral center of mass (COM), which is one
of the main determinants to adapt gait pattern in
the elderly1, was assessed.
shown than in the GB. In the ankle, more dorsiflexion

and toe-out, and less supination at early stance
phase and pronation at pre- and swing phase
were shown in the PB than GB. In the knee, less
flexion and more varus were shown in the PB than
GB. In the hip, more internal rotation at stance
phase and less external rotation at swing phase,
less adduction at stance phase and less abduction
at swing phase were shown in the PB than GB,
whereas there were no differences on sagittal
plane. As a result, differences in balance might
be less effect on gait spatio-temporal features in
the elderly, whereas COM and kinematics of lower
limb were changed according to balance.
Twenty health female elderly were involved. They
were evenly allocated to 2 groups according to
BBS; good balance (GB) vs. poor balance (PB)
group. Then they walked a gait way at 10 min and
gait analysis was performed by using 3D motion
analysis system (Motion Analysis, Motion Analysis
Corporation, Santa Rosa, CA).
C o n cl u s i o n
The elderly with poor balance seem to have a
malfunction of regulating mediolateral COM,
leading changes in kinematics of lower extremities.
References
1 Hernndez et al., Gait Posture, 30: 217222, 2009

There were no differences in spatio-temporal
parameters between GB and PB (p > 0.05). More
mediolateral fluctuation of COM in the PB was
This research project was supported by the Sports
Promotion Fund of Seoul Olympic Sports Promotion
Foundation from Ministry of Culture, Sports and Tourism.
496
P 12 9
ENHANCING GAIT AND KNEE FLEXION CONTRACTURE

IN A TRANSTIBIAL AMPUTEE BY AN ELECTRIC INJURY
VIA A PROSTHETIC TRAINING PROGRAM
C.Y. Ko1, J. Park1, S.B. Kim1, J. Son1, S. Kang1, J. Ryu1, M. Mun1
1
KOREC, research team, Incheon, Korea, Republic of Korea
Introduction
Knee flexion contracture (KFC) is one of the most
prevalence in the electric shock accident patients.
A prosthetic socket in most of the transtibial
amputee with KFC is practically fabricated to
accommodate for the contracture. Therefore,
there are drawbacks, i.e. the limited range of
motion (ROM) of knee flexion, less gait abilities
and mechanical overload on the joints 1. The
aim of this study is to evaluate the effectiveness
of a prosthetic training program, which is
executed by an interdisciplinary team consists of
biomedical/biomechanical engineers, prosthetists,
physiotherapists, etc., for improvement of gait and
ROM of knee flexion in a transtibial amputee with
KFC.
the gait abilities was evaluated by using 3D motion

analysis system (Motion Analysis, Motion Analysis
Corporation, Santa Rosa, CA) every month.
ROM of the knee increased from 136 to 166.
Gait cadence (increase of 35%), speed (increase
of 44%), and stride length (increase of 36%)
improved after 4 months of training compared to
before the training. Additionally the stance phase
of the sound limb decreased, whereas the swing
phase increased. The initial double limb support
capacity of the lower limbs decreased. These results
indicated a prosthetic training could release KFC
and improve gait in a transtibial amputee with KFC.
A male unilateral transtibial amputee with KFC was
participated. Then he wore a hydraulic control-type
prosthetic foot (Echelon, Endolite, UK) and a
patellar tendon bearing socket. The training was
conducted five times a week, 1 hour each session,
for 4 months, and the ankle of prosthetic foot
and socket alignment was adjusted by a skilled
prosthetist. During the training, the ROM of the
knee was measured by using a goniometer (digital
display goniometer SP-II, Jiangmen, China), and
C o n cl u s i o n
After 4 months of a prosthetic training, ROM of the
contractured knee was released and gait fuction
was enhanced. Consequently, a prosthetic training,
which is executed by an interdisciplinary team, is
effective for improvement of gait in a transtibial
amputee with KFC associated with release of KFC
without surgery and drug treatments.
References
1 Harato K. et al., The knee. 15; 467472, 2008
497
P 13 0
EFFECTS OF VARYING FOOT ALIGNMENTS ON CHANGES

IN FRONTAL PLANE BIOMECHANICS IN SUBJECTS
WEARING LATERAL WEDGE INSOLES
T. Sawada1, K. Tokuda1, K. Tanimoto1, Y. Iwamoto1, Y. Ogata1, T. Takeda1, M. Anan2,
M. Takahashi2, N. Kito3 , K. Shinkoda2
1
Hiroshima University, Graduate School of Biomedical & Health Sciences, Hiroshima, Japan
2
Hiroshima University, Institute of Biomedical & Health Sciences, Hiroshima, Japan
Hiroshima International University, Department of Rehabilitation, Higashi-Hiroshima, Japan
Introduction
Knee
osteoarthritis
(OA)
is
a
common
musculoskeletal disorder worldwide and a leading
cause of knee pain and disability in the elderly.
A high knee adduction moment (KAM) is widely
regarded as a surrogate measure of medial knee
compression. Although lateral wedge insoles
(LWIs) reduce the peak KAM, some patients
demonstrate adverse biomechanical effects
with insole treatments, possibly due to varying
foot alignments. The purpose of this study was to
evaluate the immediate effects of LWIs during gait.
(IBM Japan) statistical software and significance

was set at P < 0.05.
There was no significant difference in the 1st or
2 nd peak KAM between the conditions in all feet
(n = 30). In contrast, the 1st peak KAM was reduced
by LWIs in normal feet (n = 17) compared with that
in BF (0.54 0.14 N?m/kg and 0.56 0.14 N?m/kg,
respectively, P < 0.01). Reductions in 1st peak
KAM were correlated with a more lateral center
of pressure (r = 0.49, P < 0.05) and reduced kneeground reaction force lever arm (r = 0.54, P < 0.05).
In addition, the reduced knee-ground reaction
force lever arm was correlated with less hip
adduction (r = 0.55, P < 0.05).
Fifteen healthy young adults participated in
this study (age, 22.4 1.5 years). Their feet were
categorized as normal, pronated, and supinated
using the foot posture index. All subjects were
subsequently requested to perform a normal gait
under two conditions: barefoot (BF) and with LWIs.
Frontal plane parameters at the heel, knee, and hip
were evaluated, including KAM (1st and 2 nd peak),
center of pressure displacement, and kneeground reaction force lever arm. These variables
were measured using a three-dimensional motion
capture system (Vicon) and force platforms (Tec
Gihan). All data were analyzed with SPSS ver. 22.0
C o n cl u s i o n
LWIs significantly reduce 1 st peak KAM in normal
feet. Our results suggest that assessment of foot
alignment may provide insights on how to offer
adequate insole treatments for knee OA patients.
The authors would like to thank all the volunteers for
their cooperation.
498
P 131
TRUNK MUSCLES ACTIVITY DURING TWO DIFFERENT

EXERCISES WITH OSCILLATING FLEXIBLE POLE IN FEMALE
SUBJECTS WITH AND WITHOUT LOW BACK PAIN
S. Kahrizi1, M. Herasi1, M. Hoviattalab2
1
2
Tarbiat Modares University, Physical Therapy, Tehran, Iran
Sharif University of Technology, Biomechanics Department, Tehran, Iran
Introduction
Background and Purpose: Nonspecific low back
pain is a significant problem in industrialized
societies due to limitation on the effectiveness of
intervention. Several studies have indicated that
the activation of trunk muscles of subjects with low
back pain are different from subjects without low
back pain due to motor control impairment [1].
Exercise with Hand-held flexible poles, which are
brought into oscillation are advocated as training
devices that could increase levels of stabilizing
trunk muscle activity in healthy subjects [2]. So
The objective of this study was to compare the
activation of trunk muscle pattern in subjects with
and without non-specific low back pain when
using the oscillating flexible pole.
Figure 2: T runk muscles activity during symmetric exercise
Discussion
This study provides one step forward in the
knowledge concerning the efficacy of exercise
program to activating the stabilizing muscles and
could provide an application to aid rehabilitation
of LBP individuals. The Different pattern of activation
of back muscles in the people with a history of low
back pain than healthy subjects, during the cyclic
forces could be important from a clinical point of
view. Probably there is more impairment of motor
control in back muscles than abdominal muscles
due to pain.
Methods
Twelve subject 2533 years old with a history of low
back pain, and twelve age- and weight-matched
Subjects without a history of low back pain
performed two different exercises with flexible poles.
Fifteen second EMG activity were collected from
Rectus Abdominis(RA),Oblicus Internus(TrA/IO),
Oblicus Externals(EO) and Erector Spine(ES)
continuously measured during two hand-held
flexible poles which are brought into oscillation in
sagital and horizontal plane. The EMG signals were
analyzed through the calculation of Root Mean
Square(RMS) and then normalized by the maximum
RMS obtained for each muscle. Statistical analysis
was performed with MANOVA.
This material was based on work supported Medial
Science Faculty of Tarbiat Modares University,
Tehran IRAN.
Results
There were no significant differences in the activation of trunk muscles between two groups, but
ES muscle showed the reverse pattern of activity
in subjects with low back pain in comparison of
healthy subjects. There were significant difference
between two exercises on activity of two abdominal muscles IO and EO (p<0.05).
References
1 Hodges, P. W.; Richardson, C. A., Inefficient muscular
stabilization of the lumbar spine associated with
low back pain. A motor control evaluation of
transversus abdominis. Spine 1996, 21 (22), 264050.
2 (a) Goncalves, M.; Marques, N. R.; Hallal, C. Z.;
van Dieen, J. H., Electromyography activity of trunk
muscles during exercises with flexible and non-flexible
poles. Journal of back and musculoskeletal
rehabilitation 2011, 24 (4), 20914.
Figure 1: T runk muscles activity during asymmetric exercise
499
P 13 2
VALIDATION OF A POSTURAL-FUNCTIONAL
REGISTRATION PROTOCOL FOR LOW-COST MOTION
CAPTURE SYSTEM
F. Colle1,2, N. Lopomo1,2, A. Visani1, S. Zaffagnini1, M. Marcacci1, C. Signorelli1
1
Istituto Ortopedico Rizzoli, Laboratorio di Biomeccanica ed Innovazione Tecnologica,

Bologna, Italy
2
Introduction
Recently, the importance of several markerless
motion capture systems have been rapidly
increasing, thanks to their low costs and to the
possibility to track human motions in real-time.
The main goal of this work was to investigate the
possibility of application of the Microsoft Kinect
Sensor (Microsoft Corp., Redmond, WA, USA) to the
kinematic analysis of the knee joint. In particular,
a dedicated postural-functional registration
protocol was designed and preliminary validated
on healthy subjects with respect to a standard
optoelectronic marker-based system.
Results
The reliability of the registration is reported in
Figure 2A. The Root Men Square Distance(RMSD)
between the marker-based outcome and the
proposed approach in terms of kneejoint angle
(FE, VV and IE) is reported in Figure 2B.
Methods
The postural-functional registration protocol
was tested on 6 volunteers, which underwent:
(1) a standing phase, to identify the hierarchical
structure of bone segments; (2) a set of
circumduction movements of the hip joint to
identify the hip joint center (HJC) [Siston&Delp
2006]; (3) a set of knee flexion-extension (ML)
movements to identify the knee flexion-extension
axis [Ehrig et al. 2007] and the corresponding knee
joint center (KJC). The anatomical references
systems were then defined as reported in Figure 1.
Figure 2: ( A)Variability in functional estimation of HJC,KJC

and flex-ext axisorientation. (B) RMSDof the knee
joint angles estimated with marker-based and
markerless technique.
Discussion
The proposed postural-functional registration phase
combinedwith an inverse kinematic approach
seemed to improve the reliability of thelow-cost
motion capture system, showing also a fair
agreementwith the marker-based methodology.
Therefore, these preliminary results suggestedthe
possibility of using the Kinect sensor to obtain a
reliable kinematic modellingof the lower limb.
References
Siston and Delp. J Biomech, 39(1):125130, 2006.
Ehrig et al. J Biomech, 40(10):21502157, 2007.
An inverse kinematic approach was then performed

to obtain knee joint kinematics by means of an
evolution strategy optimization approach. As
indication of the reliability of the registration phase
the variability in HJC and KJC estimation, and in
ML axis orientation were analysed. The reliability
of the knee joint angles during a squat was also
estimated and compared to the marker-based
method.
500
P 13 3
LOCOMOLYZER: A COMPREHENSIVE TOOL

FOR ANIMAL LOCOMOTION ANALYSIS
M. Abdelhack1, I. Maruyama1
1
Okinawa Institute of Science and Technology Graduate School, Biology Information

Processing Unit, Onna-son, Japan
Introduction
Behavioral and biomechanical animal studies
constantly need tools for tracking and posture
analysis. In many studies, recording animals
behavior by video is a standard technique;
however there is shortage of reliable, easy-touse and comprehensive quantitative tools for
tracking and posture analysis. We present an
open-source analysis tool for tracking and posture
analysis of single animals. The tool was designed
originally for tracking the Caenorhabditis elegans
nematode but it can also be used for several kinds
of animals especially those that employ undulatory
locomotion.
recordings were very clean with relatively little

artifacts. It also achieved high accuracy (>90%
correct) with highly noisy images. It was able to
generate a correct spline even in the presence of
large artefacts like the worm picker even when the
picker crossed the worms body in the image.
Discussion
During the tool design process, there were several
aspects that were taken into account. Processing
speed was taken into account as the software can
process thousands of frames in a few minutes. It is
also very easy to use as all the needed options are
on the same window. It works on offline videos as
it is not aimed to be used with specific hardware.
The software is aimed in the near future to be
able to track movement of the plate only by using
image processing techniques in order to be usable
for data that involve plate movement without
automatic tracker (e.g. by hand). Another future
plan is adding the possibility to track and extract
fluorescence signals to enable simultaneous
measurement of calcium signals in excitable cells.
We anticipate this tool to be useful for the entire
community of behavioral and biomechanical
researchers as they need to simply plug in their
imaging data regardless of imaging conditions or
hardware.
Methods
The software receives input from the user to specify
the midline spline of the first frame and uses this
data to find the next splines end points and to
constrain the search area in order to boost the
code speed. The spline extraction algorithm starts
with finding local minima and thresholding of the
image, then thinning the thresholded image, then
head and tail detection, then removal of artefacts,
and finally generating the spline.
Results
Upon testing the tool, it managed to achieve
perfect detection accuracy when the input
501
P 13 4
ON THE MECHANICAL CHARACTERIZATION OF PORCINE

CORNEAL TISSUE BY AN INDENTATION TEST
M.A. Ariza-Gracia1, . Ortills Gonzalo2, A. Agudo Martnez3 ,
J.F. Rodrguez Matas1, B. Calvo Calzada1
1
Aragon Institute of Engineering Research I3A, Mechanical Engineering, Zaragoza, Spain

2
Aragon Institute of Engineering Research I3A, Animal Pathology, Zaragoza, Spain
Aragon Institute of Engineering Research I3A, Mechanical Engineering and Computer Vision,
Zaragoza, Spain
Introduction
The eyes behaviour is considered to depend on the
Intraocular Pressure (IOP), the corneal geometry that
involves both the Corneal Central Thickness (CCT)
and the curvature, and the mechanical properties of
the corneal tissue [Roberts, 2014]. Currently, corneal
characterization is performed by means of noncontact tonometry tests (NCT). However, this test is
not able to discriminate the corneal material response
since it is affected by the coupled effect of the IOP,
the geometry and the material behaviour. The main
objective of this work is to propose a methodology to
characterize the mechanical properties of a porcine
cornea from an indentation test using an inverse finite
element (FE) minimization algorithm.
Inverse FE Methodology
An inverse FE iterative methodology, which accounts
of the initial stress of the eye during the test due to the
IOP [Riveros, 2013], to identify the material parameters
of the cornea (D1 and D2) has been developed.
The algorithm minimizes the mean-squared error
between the FD-EC and the numerically estimated
Force-Displacement curve (FD-NC).
Results
Uniaxial tests were fitted to the strain energy
(Eq.1), and the obtained material parameters
were compared with the material parameters
identified from the indentation tests by means of
the inverse finite element algorithm. The difference
between the identified material parameters was
less than 10%. Figure 2 shows the simulation of the
indentation test using the material parameters
from the uniaxial test fitting, and those identified
with the inverse finite element method.
Methods
Experimental Laboratory Tests
Six porcine eyes 1-hour post-mortem obtained at
the local slaughter were considered. Geometrical
characteristic and the IOP measured with an
applanation tonometer (TonoPen XL) were
collected in the lab. A displacement-controlled
indentation test protocol [Ko, 2014] at two IOP levels
(Figure 1.A) was performed on each eye to obtain the
ForceDisplacement experimental curve (FD-EC).
In addition, SuperiorInferior corneal strips cut with
a double-blade scalpel were subjected to uniaxial
traction test, keeping part of the scleral ring in
order to facilitate clamping of the specimen.
Figure 2: A
verage FD-EC at 2 IOP levels (25 and 35 mmHg)
and FD-NC obtained with Uniaxial fitted constants
(solid line) and with the inverse FE methodology
(dashed line).
Figure 1: Indentation test. A) Experimental setup.
B) Numerical model.
Discussion
This work proposes a novel and improved
methodology to identify the mechanical properties
of porcine corneas from indentation tests. The
methodology is amenable for humans application
where corneal response is characterized by NCT.
Despite the considerable computational costs,
due to its iterative nature, the methodology shows
a good accuracy using traditional cost functions.
3D FE Initial Model
An average porcine eyeball model (Figure 1.B) has
been built in order to simulate the indentation test.
The cornea is assumed to be hyperelastic with a
strain energy function,
W=D 1(e D2(I1-3)-1)+k(J-1) (Eq.1)
where D 1 and D 2 are material parameters, k is a
volumetric constant associated with the material
incompressibility, I 1 is the first invariant of the
modified right Cauchy-Green deformation tensor,
and J is the local material volume change.
References
Roberts CJ, Cataract Refract Surg, 40:862869, 2014
Ko MW et al., Med Eng Phys, 36(9):111521, 2014
Riveros F et al., Ann Biomed Eng, 41(4):694708, 2013
502
P 13 5
VISCOELASTIC PARAMETERS OF MAMMALIAN HAIR

M. Skrontova1, L. Simkova1, J. Zeman2, B. Chalupa2, K. Jelen1
1
Faculty of Physical Education and Sports, Charles University, Department of Anatomy

and Biomechanics, Prague, Czech Republic
2
Faculty of Engineering, Czech University of Life Sciences, Department of Physics,

Introduction
The article deals with comparison of mechanical
and viscoelastic parameters of various mammalian
hair. Authors studying various elastic properties of
hair include Robbins (2002). Our team investigates
viscous parameters in addition to those above.
their relevances F1 and F2 were determined from

relaxation curve. Hair samples were cut from
withers close to the skin. All measurements were
taken at temperature 27 C and 30 % humidity.
Discussion
These results suggest that various types of molecular
bonds are represented differently in different
species, resulting in different strength of relaxation
effect. We can see in the table that the share of
long-term relaxation in rabbit and feret are very
small. The highest share of long-term relaxation is
exhibited by domestic pig. It is interesting to note
that humans and cats relax the most from all the
species of mamals listed above.
Methods
Hair diameter D was measured optically with 15
repetitions along each fibre. Youngs module
E, yield strength Yield, ultimate strength max,
maximum elongation max and elasticity limit
Yield were determined from deformation curve.
Transformation took place at 20 %/min. Viscous
properties i.e. relaxation times 1 and 2 and
Results
VALUE
D [m]
Yield[%]
Yield[MPa]
max[%]
max[MPa]
E [GPa]
human
88 15
74
69 29
97 19
224 39
12 2
cat
63 3
4,6 0,2
76 9
23 14
113 22
19 3
dog
88 27
60
102 22
75 11
256 66
18 4
guinea pig
74 18
31
57 31
29 12
138 79
31
rabbit
44 8
1,2 0,9
14 12
14 3
41 19
12 2
sheep
75 6
5,9 0,4
95 14
59 9
228 33
19 3
goat
180 26
71
83 24
55 29
206 37
14 2
cow
84 4
61
104 14
64 17
221 6
19 5
ferret
86 8
2,9 0,3
28 9
25 1
64 17
10 3
pig
290 32
1,55 0,02
94 27
83
125 55
65 17
zebra
39 4
2,9 0,2
1627 165
29 3
3157 453
608 84
lemur
47 2
1,7 0,5
88 16
12 8
155 53
57 4
dromedary
63 4
42
38 9
53 7
80 15
1,1 0,1
VALUE
D [m]
F0[%]
F1 [%]
F2 [%]
1[s]
2[s]
human
89 15
53,21
5,92
7,08
13,22
135,97
cat
64 3
73,15
11,95
11,58
7,02
104,51
dog
88 27
82,97
7,18
11,96
9,39
107,50
guinea pig
74 18
73,62
13,47
10,95
14,20
247,25
rabbit
44 8
88,45
9,36
2,50
127,29
sheep
75 6
83,67
6,84
8,04
10,82
99,00
goat
180 26
83,90
8,10
16,51
10,65
158,19
cow
84 4
78,74
6,60
15,92
14,78
338,14
ferret
86 8
82,94
12,47
1,64
18,79
317,49
pig
290 32
78,38
2,60
12,23
28,89
423,22
zebra
39 4
74,81
6,19
10,75
14,32
176,63
This project was co-financed by the grant GAUK
884214.
References
R
obbins, R. C. (2002). Chemical and Physical Behavior of Human Hair, 4th ed. ISBN 0-387-95094-X.
503
P 13 6
MODELING OF HOT CALORIC TEST AND CUPULA

DEFORMATION IN THE SEMICIRCULAR CANAL
N. Filipovic1, I. Saveljic1
1
BioIRC Kragujevac, Kragujevac, Serbia
Introduction
Benign paroxysmal positional vertigo (BPPV) is
the most commonly diagnosed vertigo syndrome
[Brandt, 1991].
For fluid-structure interaction problem we use

loose coupling methodology. The tissue of SSC has
nonlinear constitutive laws, leading to materially-nonlinear finite element formulation.
BPPV is caused by a mechanical dysfunction of the

vestibular system in the inner ear, whose fluid-filled
semicircular canals normally act to detect rotation
via deflections of the sensory membraneous
cupula [Semont et al., 1998].
Results
Dynamics response of the SSC caloric test in
combination with cupula deformation is presented.
The natural convection moves the endolymph
in HC duct. The velocity in the two vertical SSC is
also generated. The flow induces the HC cupula
deformation due to fluid forces which act on the
cupula wall.
The caloric response is connected with the central

nervous system, which is important in differentiating
between central and peripheral vestibular
diseases.
Caloric stimulation may be done with water or air;
it generates an endolymphatic current within the
stimulated lateral canal, analogous to a 0.003 Hz
angular movement [Zajonk and Roland 2005].
Velocity distribution after 300s for the caloric

response is presented in Fig 1.
Methods
The governing equations for simulation of
endolymph flow include the Navier-Stokes
equations of balance of linear momentum and
the continuity equation with application of ALE
formulation as [Filipovic et al, 2006].
Where v and vim are the velocity components of a
fluid and of the point on the moving mesh occupied
by the fluid particle, respectively; ro is fluid density,
p is fluid pressure, mi is dynamic viscosity, and F are
the body force components (gravity).
Figure 1: Velocity distribution after 300 s for the caloric response
Thermodynamics equations are:
We presented in this study finite element model of
hot caloric test response in 3D semicircular canals
and the cupular deformation which is associated
with eye response (nystagmus).
References
Brandt, T., Springer, London, 1991.
Filipovic et al, Comp. Meth. Appl. Mech. Eng.
195:63476361, 2006.
Semont et al, Advances in Otorhinolaryngology
42: 290293, 1998.
Zajonk and Roland, Ear Nose Throat J
84(9):5814. 2005.
where r0 is initial density, b T is thermal expansion

coefficient, c is heat capacity and k is thermal
conductivity of fluid.
504
P 137
ANALYSIS OF THE STENOSIS EFFECTS ON THE BLOOD

FLOW IN THE COMMON CAROTID ARTERY BIFURCATION
N. Antonova1, D. Xu2, I. Velcheva3 , E. Kaliviotis4 , P. Tosheva1
1
Institute of Mechanics to the Bulgarian Academy of Sciences, Department of Biomechanics,

Sofia, Bulgaria
2
Tianjin University, School of Civil Engineering, Tianjin, China Peoples Republic
University Hospital of Neurology and Psychiatry St. Naum Medical University, Department
of Neurology, Sofia, Bulgaria
4
Faculty of Engineering and Technology, Department of Mechanical Engineering and

Materials Science and Engineering, Limassol, Cyprus
The study aimed to investigate the influence of

stenoses on the blood flow in the common carotid
artery bifurcation. Blood flow in the common
carotid artery bifurcation is studied on the basis
of Navier-Stokes equations performing numerical
simulations by a finite volume method and
considering one wave period. Based on geometry
reconstruction a mesh generation is done. Four
different cases of the common carotid bifurcation
are examined: without stenoses, with one, two
and three stenoses. The case studies were based
on different anatomies presented by the one, two
or three stenoses of the common carotid artery
bifurcation. The physiological geometry can be
imported into a CFD solver.
The numerical results of the blood flow in the

common carotid artery bifurcation give detailed
picture of the axial velocity and WSS distribution,
velocity and vorticity magnitudes. Visualization of
transitional flow pattern in stenosed carotid artery
bifurcation is done and the flow characteristics
inside the stenosed carotid bifurcation are
illustrated. For the case of carotid bifurcation
without stenoses results for the axial velocity
distribution are presented in six characteristic
time points of the pulse wave: T=0 s, 0.1s, 0.2s,
0.3s, 0.4s, 0.5s. The recirculation zone behind the
stenosis is the area of low WSS. Thus this area is the
most probable one for monocytes and platelet
aggregation and thrombosis formation.
505
P 13 8
BLOOD RHEOLOGICAL PROPERTIES AND PROTEOMIC

ANALYSIS OF BLOOD PLASMA IN PATIENTS WITH TYPE 2
DIABETES MELLITUS
V. Kostova1, N. Antonova1, V. Lantsova2, V. Ionova2, N. Firsov3
1
2
Institute of Mechanics, Biomechanics, Sofia, Bulgaria
Research center of Neurology RAMS, Laboratory of Haemorheology and Neuroimmunology

with clinical laboratory diagnostics, Moscow, Russia
3
Russian State Medical University, Medico-Biological Department, Moscow, Russia
Introduction
Type 2 diabetes accounts for 8590% of all diabetes
and can be affected by lifestyle choices. It usually
occurs in adults but younger people and even
children are now developing the condition.
sulphate-polyacrylamide gel (SDS-PAGE) electro

phoresis according to Laemmli and Two-Dimensional (2D) SDS-PAGE with the same group of
patients suffering from type 2 diabetes.
The work aimed to evaluate RBC aggregation and

deformation in parallel with proteomic analysis
of blood plasma in patients with type 2 diabetes
mellitus.
Results
It was observed that the aggregation parameter
T1 (the time for the formation of linear aggregates)
is considerably reduced and (hydrodynamic
strength of aggregates) is larger in comparison with
the control group of healthy individuals [1]. The
results obtained from the electrophoresis reflected
changes in the protein spectrum of blood plasma
in patients with complications (angiopathy,
neuropathy) and without complications. These
proteins were identified and analyzed and could
be potential prognostic indicators (markers) in the
development of complications in patients with
type 2 diabetes [2].
Methods
The study provided identification on plasma
proteome and analysis of the kinetics of red blood
cell (RBC) aggregation-desaggregation and
deformation process. A group of 12 patients (aged
from 38 to 74 years, mean age 58, 58 11, 42)
with type 2 diabetes mellitus with various types
of therapy (insulin or tablets) were investigated.
Rheological studies were conducted using a laser
aggregometer deformometer of erythrocytes
(LADE, modified by N. Firsov, Moscow, Russia). The
following parameters characterizing kinetics of RBC
aggregation/disaggregation and deformation
were determined: characteristic time T1 (s) for
linear aggregates formation and characteristic
time T2 (s) for 3-D aggregates formation,
(s 1) hydrodynamic strength of aggregates, the
coefficient of deformability of erythrocytes (D) and
parameter I2.5 which characterizes the percentage
of aggregates that are destroyed at shear
rate = 2.5 s -1. Proteomic analysis of blood plasma
samples was carried out by Sodium dodecyl
Discussion
The study allowed detailed analysis and
differentiation between the control group and the
group suffering from type 2 diabetes mellitus.
References
[1] Firsov N. N. et al., Clinical application of the measurement of spontaneous erythrocyte aggregation
and disaggregation. A pilot study, Clinical Hemorheology and Microcirculation, 18, 1998, 8797
[2] XXVII, 8-13.09. 2014, 110112
506
P 13 9
STENOSIS ECCENTRICITY HAS A SIGNIFICANT EFFECT ON

CORONARY BIFURCATION LESION FUNCTIONALITY
C. Pagiatakis1,2, J.C. Tardif2,3 , P. L. LAllier2,3 , R. Mongrain1,2
1
McGill University, Mechanical Engineering, Montreal, Canada

2
Montreal Heart Institute, Montreal, Quebec, Canada
University of Montreal, Faculty of Medicine, Montreal, Canada
Introduction
The treatment of coronary bifurcation lesions
(CBLs) is high risk; the factors that influence their
functionality are not understood. Stenoses near
coronary bifurcations tend to be eccentric
(Oviedo, 2010). While studies have shown that
stenosis eccentricity affects the distal recirculation
zone (Javadzadegan, 2012), its effect on CBL
functionality is unknown. Thus, the objective was
to compare the functionality between eccentric
and concentric stenoses within different CBL
configurations.
Results
Figure 2 shows that FFR values are generally
lower for configurations with eccentric stenoses.
Significant differences are observed between the
eccentric and concentric cases for configurations
with a diseased LMCA.
Methods
Thirty-two CBL geometries (4 configurations,
4 diameter reductions, eccentric and concentric
stenoses) were considered (Figure1).
Figure 2: F FR in the (a) LAD and (b) LCX for eccentric (E)
and concentric (C) stenoses
Moreover, configurations with two eccentric

stenoses result in lower FFR values than the threelesion case with concentric stenoses.
Discussion
The results indicate that stenosis eccentricity is
a factor that affects CBL functionality such that
the likelihood of clinical significance increases
with increasing eccentricity. In particular, the
eccentricity of the supplying vessel appears to
play a central role in the functionality. Clinically,
these results are significant because they imply
that in diagnosis, the location of the stenoses and
the corresponding degree of lesion eccentricity
should be regarded to be more important than
the total number of stenoses in the configuration.
Thus, configurations with two lesions should be
considered just as, if not more significant than
those with three lesions.
Figure 1: E
xamples of CBL configurations (eccentric lesions)
and stenosis severities
An iterative partitioned approach (Quarteroni,

2001) was used to numerically couple each 3D
configuration to a 0D model of the heart and the
systemic, pulmonary and coronary circulations
(Pagiatakis, 2014; details found therein). The
commercial software package ANSYS Fluent
(Canonsburg, PA, USA) was used to solve the
transient, incompressible and Newtonian Navier
Stokes equations (NSE) modelling the 3D CBL
domain. At each timestep, the solution of the
0D model was coupled to the NSE through average
uniform pressure boundary conditions, using a fullyautomated in-house subroutine. The fractional flow
reserve (FFR), defined as the ratio of the diseased
to normal flow in a given artery, was calculated
using the computed 3D flows. The FFR is the goldstandard clinical diagnostic index; values below
0.8 are clinically regarded as being critical.
References
Javadzadegan A. et al., Am J Physiol Heart Circ
Physiol. 304: H559H566, 2012.
Oviedo C. et al., Circ Cardiovasc Interv.
3:105112, 2010.
Pagiatakis, C. et al., WCCM XI ECCM V ECFD VI,
ID:1852, 2014.
Quarteroni, A. et al., Comput Visual Sci,
4:111124, 2001.
507
P 14 0
A BIOMECHANICAL EVALUATION OF FAT AND

BIOBURDEN REDUCTION BIOPROCESSES
IN THE DECELLULARISATION OF PORCINE
SUPER FLEXOR TENDONS
A. Herbert1, G. Jones2, E. Ingham2, J. Fisher1
1

2
University of Leeds, Faculty of Biological Sciences, Leeds, United Kingdom
Introduction
The use of acellular biological scaffolds in the
substitution of damaged biological tissues such
as the anterior cruciate ligament (ACL) offers a
promising alternative to conventional autograft
or allograft treatments. However, optimisation of
the decellularisation process is key in producing
a biocompatible and biomechanically adept
product, capable of cell in-growth and remodelling.
Recently, our groups decellularisation protocol for
the porcine super flexor tendon (pSFT) has been
extended to include fat-reduction and bioburden
reduction bioprocesses [Herbert et al., 2015]. Here,
we investigated the biomechanical consequences
of using different agents to perform these steps.
strength testing data. Statistical significance

between groups was examined using 1-way
ANOVA with Tukey post-hoc analysis.
Results
In both studies, no statistical differences were found
for material properties such as tensile strength
and Youngs modulus between the majority of
decellularised groups and native control. Significant
differences were evident for many of the viscoelastic
parameters, but also for the tangent modulus in the
toe-region indicating a change in performance at
low strains. The greatest deviation from the native
tangent modulus was found to occur in Study 2 when
PAA was used as a bioburden reduction step.
Methods
pSFTs were decellularised using an adaptation of a
previously developed protocol for porcine patellar
tendon [Ingram et al., 2007], following which two
studies were performed (figure 1). Study 1 investigated
the introduction of fat reduction agents (acetone and
chloroform methanol). The most effective of these was
then carried forward into study 2, which investigated
the introduction of peracetic acid or antibiotics as a
bioburden reduction agent, with/without the use of
peractic acid as a terminal sterilant.
Discussion
Changes in elasticity can be attributed to collagen
crimp alteration, whereas changes in viscoelasticity
are also due to increased fluid flow due to cell
removal. Due to their superior performance,
acetone was preferred as a fat reduction step
whereas, antibiotics were chosen over PAA as
a bioburden reduction step. Although some
biomechanical changes were found to between
native and decellularised pSFT, these are unlikely
to cause adverse effects at a structural level when
the product is used as an ACL replacement graft.
For each test group investigated (n=6), pSFT

specimens were subjected to uniaxial tensile
testing. A MaxwellWiechert viscoelastic model
was used to analyse stress relaxation data, while
traditional material properties and the tangent
modulus of the toe-region were determined from
References
Herbert et al, J Biomech, 48:2229, 2015.
Ingram et al, Tissue Eng, 13(7):15611572, 2007.
Figure 1: T he decellularisation processes and additional steps investigated for studies 1 & 2 [Herbert et al., 2015].
508
P 141
MECHANICAL BEHAVIOUR OF DERMIS SUBJECTED

TO DIFFERENT CELL REMOVAL TREATMENTS
M. Terzini1, C. Bignardi1, C. Castagnoli2, I. Cambieri2, E. Zanetti3 , A. Audenino1
1
2
3
Politecnico di Torino, DIMEAS, Torino, Italy
AOU Citt della Salute e della Scienza, Skin Bank, Torino, Italy
University of Perugia, Department of Engineering, Perugia, Italy
Introduction
Skin allografts are the most suitable replacement
integumentary for reconstructive surgery [Wong
et al., 2009] since they maintain the peculiar
architectural structure of the dermis while remaining
a not immunogenic product when transplanted in
the patient. Different cell removal treatments result
in different mechanical behaviour of the human
acellularized dermal matrix [Reing et al., 2010]:
mechanical properties have been here compared
and measured, both from engineering curves and
true curves [Khanafer et al., 2011].
not significantly different from untreated ones. On

the contrary, all specimens cut along craniocaudal
direction, for whatever treatment duration, were
significantly different from the reference native
group. Also true curves were considered since the
dermis has exhibited large deformations during
tests. UTS and E values measured on these curves
have resulted to be considerably higher: 34 times
and up to 7 times respectively for UTS and E (Fig. 1).
Methods
Specimens of dermal tissue have been collected
from a human donor; they were dissected along
craniocaudal (CC) or mediolateral (ML) directions
and decellularized in NaOH culture. They were
either non-chemically treated or incubated from
1 to 7 weeks. The specimens were subjected
to uniaxial tests (Bose Electroforce 3200 ) in
displacement control at a strain rate of 0.032 s 1.
Results of failure tests have been reported following
two
different
representations:
Engineering
stress/strain curves [N. Annaidh et al, 2012] and
True stress/strain curves [Yoder et al, 2010] with
specimen cross section and length measured
in real time. Descriptive parameters have been
identified in both curves: ultimate tensile strength
and strain and the elastic modulus.
Figure 1: M
aximum Youngs modulus (E) values obtained
for engineering (white) and true curves (grey) in
function of treatment Tn (n represents the number
of treatment weeks).
Human excised dermal matrix tissue, when
decellularized under incubation culture in NaOH for
56 weeks, exhibits mechanical properties, which
are comparable to the native ones. Besides, the
mechanical properties of specimens cut along the
mediolateral direction were systematically higher
than those obtained for specimens cut along the
craniocaudal direction. From a quantitative point
of view, the values of ultimate tensile strength
and Youngs modulus estimated from engineering
stress/strain curve can be greatly underestimated
for this tissue since it undergoes large deformations,
neverthless they can still allow to perform reliable
comparative analyses.
Results
The mechanical behaviour of the dermis is nonlinear
and anisotropic. The decellularization treatment
has proven to reduce dermal mechanical
properties, considering all incubation times. An
incubation period between 5 and 6 weeks makes
an exception since, in this case, the mechanical
properties are partially recovered. A statistical
analysis demonstrated how both specimen
cut orientation and treatment duration have
significant influence, while multiple comparisons
demonstrated how specimens cut along ML
direction and decellularized for 5 and 6 weeks were
References
N.Annaidh et al, JMBBM, 5:139148, 2012.
Pereira et al., JBiomech, 30:9194, 1997.
Wong et al, StemBook, 2009.
Yoder et al, ClinBiomech, 25:378382, 2010.
Reing et al., Biomaterials.31: 862633, 2010.
Khanafet&al., EurJVascEndovSurg, 45:3329.
509
P 14 2
BIOABSORBABLE PCL/IBUPROFEN SCAFFOLDS

PREPARED BY SELECTIVE LASER SINTERING
G.V. Salmoria1, M.R.C. Cardenuto1, L.A. Kanis2, C.R. Roesler1
1
2
UFSC, EMC, Florianopolis, Brazil
UNISUL, Bioquimica, Tubarao, Brazil
Introduction
Selective Laser Sintering can fabricate scaffolds
with porosity from 45 to 75% and interconnected
pores of 50 to 600um, what can aid cells and
tissues growth, nutrient transport and metabolism.
Manufacturing of drug delivery systems by SLS
have been developed for progesterone hormone
release using this layer manufacturing technique
[1]. In tissue regeneration, scaffolds that release
anti-inflammatory drug can be advantageous.
Ibuprofen is an anti-inflammatory, which belongs
to the group of non-steroidal. It combines features
of combat acute and chronic inflammation,
with few occurrences of adverse reactions. This
study evaluates the structure and properties of
polycaprolactone/ibuprofen scaffolds produced
by SLS and its possibility of application tissue
regeneration.
Results
The structure and properties of the scaffolds
fabricated at different process condition were
characterized by FTIR spectroscopy, X ray
diffraction, SEM, flexural tests and drug release test.
ibuprofen at higher laser power densities (PI2 and

PI3) showed a lower degree of crystallinity (larger
amorphous phase) that the specimens without the
drug (P2 and P3), which can be attributed to a
higher cooling rate caused by the greater heating
the mixture PCL / ibuprofen generated by the
absorption of laser energy by the drug. The bending
test to obtain the stress-strain curves showed values
??of flexural modulus greater for the specimens
sintered with higher degree of sintering, an increase
in stiffness values ??was also observed by comparing
the samples with and without ibuprofen, getting
higher values ??in the specimens with the drug
due to the increase of the degree of sintering. The
presence of ibuprofen did not show significant
changes in Tg values ??for the samples, suggesting
that no occurrence of solubilization and formation
of significant secondary chemical interactions
between the drug and the matrix PCL. The analysis
of the mechanism of release of ibuprofen in
polycaprolactone indicate that release kinetics
for ibuprofen in PCL is Fickian one, and occurs by
diffusion. However there can be a combination of
diffusion and erosion mechanisms affecting this
behavior. The development of PLC devices with
release of ibuprofen by SLS proved to be possible.
The release profile of ibuprofen from the PCL matrix
prepared by selective laser sintering porous suggests
that this device may be usable in applications
where bone regeneration is needed to control the
inflammatory process early after implantation, since
the drug is released relatively quickly.
Discussion
In the micrographs can be seen that the samples
were homogeneous structural interconnected
pores distributed structures and different degrees
of sintering between the specimens. The x-ray
diffraction performed on specimens sintered with
References
[1] Salmoria G.V., et al The effects of laser energy
density and particle size in the selective laser sintering of polycaprolactone/progesterone specimens. International Journal of Advanced Manufacturing Technology, 2013, 66,, pp 1113-1118
E X P ERIMENTA L
The polymeric powder used in this study was
commercial PCL from Sigma Aldrich Company. The
particle sizes were from 125 to 212 m. Ibuprofen
was obtained from Equilibrium LTDA. The specimens
(dimensions of 3551.4 mm) using a CO2 laser
with beam diameter of 250 m at 45 C. The laser
scanning speed was maintained at 50 mm/s.
510
P 14 3
DEVELOPMENT OF A VAGINAL DELIVERY POLYMERIC

FILM CONTAINING ANTIRETROVIRAL-LOADED
NANOPARTICLES FOR PREVENTING HIV TRANSMISSION
C. Cunha Reis1, M. Alexandra2,3 , B. Sarmento1,2,3
1
CESPU Cooperativa de Ensino Superior Politcnico Universitrio, Instituto de Investigao e

Formao Avanada em Cincias e Tecnologias da Sade, Gandra, Portugal
2
Universidade do Porto, Instituto de Investigao e Inovao em Sade, Porto, Portugal

3
Universidade do Porto, INEB Instituto de Engenharia Biomdica, Porto, Portugal
Introduction
The use of vaginal products containing antiinfective agents, termed microbicides, has shown
to be a promising strategy in the combat of HIV/
AIDS epidemic. The use of drug nanocarriers
can contribute to the development of improved
microbicides, since these systems enable specific
drug-targeting, increased drug residence, lower
toxicity, or intracellular delivery [das Neves, 2014].
Vaginal films are amongst the most acceptable
vaginal dosage forms and present advantageous
technological features such as good physicalchemical stability, ease of manufacture, and
reduced price [Zhang, 2014]. In this study, we
report the development and characterization of
polyvinyl alcohol (PVA) films containing poly(lacticco-glycolic acid) (PLGA) nanoparticles produced
for the incorporation of tenovovir, a nucleoside
reverse transcriptase inhibitor.
Results
The average thickness of the films was 76 m. The
moisture content of blank films was 10.8% 1.9,
whereas in the NPs loaded films it was 12.8% 0.23.
The mechanical tests indicated that the
incorporation of PLGA nanoparticles increased the
elasticity of the films, as shown in table 1. These
findings may be ascribed to crystallinity differences.
Mucoadhesion tests using a cow vaginal mucosa
model indicate that the films possess a suitable
mucoadhesive potential. In vitro cytotoxicity of
blank and NPs loaded films is under evaluation.
However, based on the results obtained with the
free NPs, no differences are expected.
Methods
Films were produced by solvent casting. Briefly, a
1% w/w aqueous solution was prepared by adding
the excipients in the following proportions: 90%
PVA and 10% glycerin. The solution was placed
in polystyrene moulds and dried at 35 C. For the
films containing PLGA 50:50 nanoparticles (NPs), the
procedure was identical, but 10 ml of an 80 mg/ml
suspension prepared by a double emulsion/solvent
evaporation method were added to the PVA solution
at room temperature. Film thickness was measured
using an electronic digital micrometer. Tensile
strength, puncture strength and mucoadhesion
were assessed using a texture analyzer.Youngs
Modulus was determined from the slope of the
initial linear portion of the stress-strain plots. Moisture
content was determined using an infrared balance.
Cytotoxicity of NPs was determined using the
lactate dehydrogenase (LDH) release assay and
the methyl thiazol tetrazolium (MTT) assay.
Youngs
Modulus
(g/mm 2)
Tensile
Strength
(g/mm 2)
Puncture
Strength
(g/mm2)
PVA
81.58 24.9
893.9 106.2
129.2 45.8
PVA + NPs
20.3 0.0
384.1 117.8
33.1 9.1
Table 1: M
echanical characterization of blank vs nanoparticles containing polymeric films
Discussion
The nanoparticle loaded films exhibited good
aesthetic and mechanical properties, were
soft, flexible and presented no sharp edges.
Furthermore, they suggest no evidence of
cytotoxic effects, indicating that this carrier system
may have a promising role on the development of
vaginal microbicides.
References
Das Neves et al, Pharm Res, 31:18341845, 2014.
Zhang et al, International Journal of Pharmaceutics,
461:203 213, 2014.
511
P 14 4
COMPARISON OF ELASTIC PROPERTIES

OF OPEN-CELL STRUCTURES
R. Hedayati1, S. Mojtaba1, M. Mohammadi-Aghdam1
1
Amirkabir University of Technology, Mechanical Engineering, Tehran, Iran
morphology, cross-section type, strut length, and

apparent density on the elastic modulus of opencell tessellated cellular structures was investigated
numerically to find the appropriate configuration
for applications with low-stiffness or high-stiffness
requirements. The obtained results showed that
considering exact density instead of approximate
density leads to higher values of calculated elastic
modulus and yield stress, while it leads to lower
values of Poissons ratio. The results obtained
from the models with exact density were in good
accordance with experimental results. It was also
demonstrated that the elastic moduli obtained
from structures having different morphologies and
apparent densities lie in the corresponding range
of different body bones. Using the obtained elastic
modulus pattern for different configurations here,
an implant can be custom-designed in terms of
its morphology and apparent density resulting in
different elastic moduli in its different locations
mimicking the elastic modulus distribution in a
natural bone.
Nowadays, low-density open cell porous structures

made of titanium alloys are widely used due
to their mechanical properties close to natural
bone, their open-cell interconnected structure
which allows ingrowth of new bone tissues, and
their great corrosion resistance. Investigations
have shown that the mechanical properties of
a porous lattice structure are heavily dominated
by its apparent density. Surveying the literature
revealed that in the previous published numerical
and analytical studies, there are inaccuracies in
calculating the apparent density. In this study,
the effect of considering exact apparent density
on the values of elastic modulus, yield stress, and
Poissons ratio is investigated. The accuracy of
the created model is studied by comparing its
mechanical properties to those of experimental
tests.
Five
different
morphologies,
namely
cube, rhombic dodecahedron, Kelvin, WeairePhelan, and diamond and three different crosssection geometries namely circle, square, and
triangle were considered. The effect of structure
512
P 14 5
VACUUM-SINTERED POROUS BODY OF A NOVEL APATITE

FOR USE AS REGENERATIVE ARTIFICIAL BONE
K. Tamura1, R. Sasaki1, T. Uchino1
1
Nihon University, College of Engineering, Koriyama, Japan
Introduction
Regenerative artificial bone materials were
fabricated
using
vacuum-sintered
bodies
of
a
titanium
medical
apatite
(TMA,
[Ca 10(PO 4) 6]TiO 3nH2O)
that
is
formed
by
chemically connecting Ti oxide molecules to the
reactive [Ca 10(PO 4) 6] group of HAp. At sintering
temperatures 1300 C, TMA vacuum-sintered
bodies caused to recrystallize and form a varying
mix of -TCP, -TCP and Perovskite-CaTiO3 phases.
This TMA bodies became the Vickers hardness
is 400 HV, the compressive strength is 270 MPa
and the bending strength is 43 MPa. Furthermore
the biomaterial parts were cut from the TMA
bodies using 3D modelling machine are shown in
Figure 1 1,2. On the hand, TMA vacuum-sintered
bodies were confirmed to be non-toxic conducted
by insertion into jaw bone of rabbits. After one
month, rejection due to biocompatibility reactions
was not found at the surrounding structure of the
sintered bodies.

Figure 2 shows the relationships between the
compressive strength and the -TCP contents
ratio C in TMA vacuum-sintered bodies. The at
the T=1300C and 1200C became the value of
compact bone. The at the T=1100C became
the value of cancellous bone. However, the porosity
P of the mixed TMA with -TCP bodies became
35%55%, which were smaller than the present
artificial bone grafts (P=60%85%).
The vacuum-sintered porous bodies of the mixed
TMA with -TCP became the compressive strength
of human bone, be able to cutting. Therefore, I is
considered that the rehabilitation of the patients
can begin at an earlier period than it is now.
References
1 K. Tamura, T. Fujita and Y. Morisaki, Central
European Journal of Engineering, 3, 700706, 2013.
2 K. Tamura, Journal of Biomaterials and
Nanobiotechnology, 6, 4552, 2015.
This paper described the vacuum-sintered porous

bodies of the mixed TMA with -TCP for artificial
bone are examined the compressive strength and
the porosity.
Mixed TMA powders with -TCP powders were
kneaded with water to form solid cylinders (16 mm
in diameter 20 mm in length), which were then
compacted by compression molding at 10 MPa.
The resulting compacts were dried at 110 C for
12 hours, and then sintered under vacuum (about
8 mPa) using a resistance heating furnace. The
sintering temperature T was 1100C, 1200C and
1300 C, holding time was 30 minutes, and the
compression less. Compression tests were carried
out at a load speed of 98 N/s using a SUVT-type
material testing machine.
Figure 1: S amples of the biomaterial parts were cut from

the TMA vacuum-sintered bodies using
3D modelling machine.
Figure 2: R
elationships between compressive strength
and -TCP contents ratio in TMA vacuum-sintered
bodies.
513
P 14 6
MECHANICAL PROPERTIES OF Ti6Al4V GYROID LATTICE

STRUCTURE FABRICATED BY ELECTRON BEAM MELTING.
A CHALLENGE TO AVOID STRESS SHIELDING
A. Ynez1, A. Herrera1, O. Martel1, H. Afonso2, D. Monopoli2
1
University of Las Palmas de Gran Canaria, Mechanical Engineering,

Las Palmas de Gran Canaria, Spain
2
Instituto Tecnolgico de Canarias, Mechanical Engineering,

Las Palmas de Gran Canaria, Spain
Introduction
Recently developed additive manufacturing
techniques allow the production of porous
titanium biomaterials. One of these techniques
is the Electron Beam Melting (EBM), developed
by Arcam AB (Kroksltts Fabriker 27A, SE43137
Mlndal, Sweden).The main advantage of these
techniques, as compared to others, is their ability to
manufacture interconnected porous biomaterials
with predictable and pre-determined unit cells.
This means that the possibility to combine designs
of unit cells will open up a broad field with many
opportunities for optimal design of orthopedic
implants [Campoli, 2013].
In addition to the variation of the fabrication angle,

the properties of the specimens in two fabrication
directions were studied.
In many cases, the aim is, on one hand, to

fabricate
three-dimensional
structures
with
an interconnected porosity suitable for tissue
ingrowth and vascularization, and, on the other
hand, to search for mechanical properties, such
as compressive strength and elastic modulus (E),
that are similar to those of human bone. Thus,
stress shielding effects after implantation might
be avoided [Heinz, 2008]. The current trend is to
fabricate patient-tailored implants for which some
researchers have proposed different types of
non-stochastic lattice structures.
Figure 1: T wo gyroid lattice structures: one to 19 degrees

and the other to 45 degrees.

In this study, gyroid lattice structures were designed
with the aim of applying the orientation of loads
according to Wolffs law. The elastic moduli
obtained varied between 55.34 and 630.24 MPa.
Some of the values are within the E range for human
cancellous bone (100 1500 MPa) [Reilly, 1974].
Compressive strength values ranged between 2.9
and 14.54 MPa.
To obtain structures with greater strength capacity

in the direction of loading, as according to Wolffs
law and achieve an elastic modulus similar to that
of cancellous bone, gyroid lattice structures were
designed [Mager, 2013]. This study evaluates the
mechanical properties of this kind of structures
fabricated by EBM.
The values of the mechanical properties clearly

show an increase in the mechanical characteristics
in proportion as the structure is favorably oriented
to the load. On the other hand, the study in the two
possible directions reveals the anisotropy of these
types of specimens, being this behavior reduced
as the inclination reaches 45 degrees. Logically,
the isotropy of the sample would be obtained with
such inclination.
Methods
A total of twenty five gyroid lattice structures were
submitted to compression tests. The variables that
were incorporated in the geometry in order to
find some similarity with the mechanical behavior
of cancellous bone were: the angle formed on
the surfaces of the gyroids with respect to the
longitudinal axis of the structure, the built strut
surface and the percentage of porosity. Thus,
structures with angles of between 19 and 45 degrees,
with respect to the loading direction, are shown.
References
Campoli, G. et al, Materials and Design,
49:957965, 2013.
Heinz, P. et al, Acta Biomaterialia,
4:15361544, 2008.
Mager, V. et al, Applied Mechanics and Materials,
371:280284, 2013.
Reilly, D. T. et al, J. Biomechanics 7:271275, 1974.
514
P 14 7
CARBON/PEEK COMPOSITE MATERIALS

AS AN ALTERNATIVE FOR STAINLESS STEEL/TITANIUM
HIP PROSTHESIS: A FINITE ELEMENT STUDY
K. Hassani1, F. Rezaei2
1
Science and Research Branch Islamic Azad University, Biomechanics, Tehran, Iran
2
Najafabad Branch Islamic Azad University, Mechanical, Isfahan, Iran

The Von Mises stresses and strain contours were
obtained for metallic and carbon/PEEK composites.
Thecarbon/PEEK implants experience less stress
than metallic ones andconfiguration III composite
shows theleast induced stress along the prostheses
length. Howeverour results regarding Von Mises
stress conform to Boudea et al [2] findingsthat
metallic stems transfer higher stress than
carbon/PEEK composite implants.
Introduction
In order to prevent the implant loosening, it is
very important to use the materials with close
mechanical properties to the bones [1]. In this
regard, the composite materials like carbon/PEEK
were proposed for medical implant devices, we
have introduced six FE model of different prostheses
from TI, SS, and carbon/PEEK composites (three
configurations) to analyze the load transferring
in the system including prostheses and the bone
under statics loads. The numerical predicts were
compared with some existing literature.
C o n cl u s i o n
The results of this study showed that carbon/
PEEKcomposites experience low interface stress
and strain comparing to metallicones. Therefore,
these composites, with +45/45 degree fiber
orientation, configuration III, could be a new
design for femoral prostheses which can transform
the loadsbetter to the proximal portion of the bone
and rate of deformation andloosening is less than
other types.
METHODS
Mechanical properties of carbon/PEEK composites
have been considered based on three different
configurations. The distal end of the bone has
been fixed then 3000N and 1250N were applied
on the head of prostheses and lateral side of the
femur at angle of 20. The three dimensional (3D)
triangular elements was chosen for SS/Ti prostheses
and 3D cubic elements for composite prostheses.
The 3D triangular wedge elements were also used
for bone geometry. The finite element package of
ABAQUS was used for analysis of the models. The
sweep meshing was performed for carbon/PEEK
composite implants.
References
[1] Manivasagam G, Dhinasekaran D, Rajamanickam A, BiomedicalImplants: Corrosion and its
Prevention A Review, RecentPatents on
Corrosion Science 2: 4054, 2010.
[2] BoudeauN, Liksonov D, Barriere T, Maslov L, GelinJC,
Composite based on polyetheretherketone
reinforced with carbon fibres analternative to
conventional materials for femoral implant:
ManufacturingProcess and resulting structural
behaviour, Materials and Design 40: 148156, 2012.
515
P 14 9
THE QUANTITATIVE FLOW VISUALIZATION STUDY ON THE

FLOW CHARACTERISTICS THROUGH TUBE WITH STENOSIS
ACCORDING TO THE FLOW RATE CHANGE
H.S. Ji1, S. Huang2, M.J. Kang3
1
Pusan National University, MEMS Technology Center, Busan, Korea, Republic of Korea
2
Pusan National University, Department of Mechanical Engineering, Busan, Korea,

Republic of Korea
3
Kibo Technology Fund, Kibo Technology Fund, Seoul, Korea, Republic of Korea
Introduction
In this study, the flow characteristics for the
tube with stenosis based on angiogram were
investigated using quantitative flow visualization
technique. The tube core model with stenosis
was fabricated using 3-D printing system. And
finally tube model was fabricated with PDMS and
3-D printing core model. To prevent the optical
distortion, mixture with glycerin and DI water as flow
media was substituted for plasma of blood. For PIV
experiments, appropriated fluorescent particles
concentration was controlled through pre-test.
The diameter of fluorescent particles employed
in this study was 10 micro meter similar with Red
Blood Cells. The flow rates were controlled using
the circulating pump system and silicon tubes.
The flow characteristics through tube with stenosis
replaced on blood vessel with stenotic lesion were
investigated successfully with respect to the flow
rate changes.
The tracing particles images withoud optical

distorsion were acquired for instantanesou flow
fields obervation. The Reynolds numbers based on
tube diameter controlled in this study were 10, 50
and 90, respectively. Ensembel averaged velocity
fields were calculated from intantaneous flow
fields passing through the stenosis using Foulier Fast
Transform.
Discussion
S The flow characteristics through the tube with
stenosis were successfully investigated using
quantitative flow visualization technique. The flow
features from this study seem to be helpful for
fundamental hemodynamic feature comparison
study.
This work was supported by the Korea Research
Foundation (National Research Foundation of
Korea) Grant funded by the Korean Government
(2013R1A1A2012160)
Methods
To calculate instantaneous velocity vectors from
two consecutive flow images, the FFT based crosscorrelation algorithm was applied. The size of
the interrogation window was 16 16 pixels, with
50% overlap. A total of 1,000 flow images were
captured for each experiment. The instantaneous
velocity fields were ensemble-averaged to obtain
the spatial distributions of mean velocity. The
frequency characteristics of the arterial blood
flow and the variation of velocity waveform were
assessed by FFT analysis of the temporally resolved
instantaneous velocity field data
References
[1] Lee JY., Ji HS., and Lee SJ., Micro-PIV measurement of blood flow in extraembryonic blood
vessels of chicken embryos, Physiological
Measurement, Vol. 28, pp. 11491162, 2007
[2] Taylor CA. and Draney MT., Experimental and
Computational Methods in Cardiovascular Fluid
Mechanics, Annual Review of Fluid Mechanics,
Vol. 36, 197231, 2004
[3] Ji HS. Lee JY., and Lee SJ., In-vitro study on the
hemorheological characteristics of chicken blood
in microcirculation, Korea-Australia Rheology
Journal, Vol. 19, pp. 8995, 2007
[4] Kiousis DE., Gasser TC. and Holzapfel GA., A Numerical Model to Study the Interaction of Vascular
Stents with Human Atherosclerotic Lesions, Annals
of Biomedical Engineering, Vol. 35, 18571869, 2007
[5] Bruce F., and Barbara CF., 2008, Mechanism of
Thrombosis Formation, New England Journal of
Medicine, Vol. 359, 938949
Results
The mixed flow media with glycerin and DI water
replaced with blood plasma was employed in this
study. The viscosity of flow media was controlled
similar with blood plasma. The glass sphere with
10 micro meter as a diameter was employed as
tracing particles for semi-hemodynamic feature
investigation through sinusoidal tube with stenosis.
516
P 15 0
WHY IS AXIAL PRESTRETCHING OF ELASTIC

ARTERIES A SMART DESIGN
L. Horny1, M. Netusil2
1
Faculty of Mechanical Engineering, Czech Technical University in Prague, Department

of Mechanics, Biomechanics and Mechatronics, Prague, Czech Republic
Faculty of Mathematics and Physics, Charles University in Prague, Mathematical Institute,

Introduction
Elastic arteries in situ are significantly prestretched
in the axial direction. This property minimises an
axial deformation during a pressure cycle. Ageinginduced changes in the arterial biomechanics,
among others, are manifested via a marked
decrease in the prestretch. Although this fact is well
known, only a little attention has been paid to the
effect of the decreased prestretch on mechanical
response.
Figure 2: Inflation-extension response of human aorta with

applied high (red dashed curve), mean (blue solid), and weak axial prestretch (black dotted).
Discussion
Results suggest that the axial prestretch could play
a more important role than merely a way how to
endow abdominal aorta with a property of almost
constant axial length during the pressure cycle.
Additional simulations were performed suggesting
that this property is not a feature of the anisotropy
or a specific model but rather a property of the
geometry and non-linear mechanics.
Figure 1: A
geing and changes of the prestretch.
Methods
Our study presents results of a simulation of the
inflation-extension behaviour. The constitutive
parameters and geometries for 17 aortas
adopted from the literature [Labrosse, 2013] were
supplemented with initial axial stretches predicted
from the statistics of 365 autopsy measurements
[Horny, 2014a]. The aorta was modeled as an
anisotropic hyperelastic material.
This research has been supported by Czech Ministry
of Health in project NT13302
References
Horny et al, J Mech Behav Biomed Mater,
33:9398, 2014a.
Horny et al, Biomech Model Mechanobiol,
13:783799, 2014b.
Labrosse et al, J Mech Behav Biomed Mater,
17:4455,2013.
Results
We have shown that a higher axial prestretch
results in a higher circumferential distensibility
[Horny, 2014b]. We have also confirmed that the
prestretch helps to reduce the variation in the axial
stress between systole and diastole.
517
P 15 1
ITERATIVE METHOD FOR RECONSTRUCTING THE

CONTINUOUS CURVILINEAR AXIS OF AXISYMMETRIC
TORNADO-LIKE FLOW EVOLUTION IN THE CAVITY
OF THE LEFT VENTRICLE
A. Gorodkov1, E. Talyguin1, S. Zhorzholiany1, N. Zazybo1, I. Krestinich1, A. Mironov1,
G. Kiknadze1, L. Bockeria2
1
Bakulev Research center for Cardiovascular Surgery, Experimental, Moscow, Russia

2
Bakulev Research center for Cardiovascular Surgery, Bakulev Research center

for Cardiovascular Surgery, Moscow, Russia
Introduction
In the previous studies it has been shown that the
geometrical characteristics of the left heart flow
channel precisely correspond to the directions
of the current lines of self-organizing tornado-like
viscous flows, described by the exact solution of
unsteady-state hydrodynamic equations for this
class of flows [1]. The structure of the flow was
characterized using the spatial configuration of
the LV cavity and the orientation and temporal
expression of trabecular profile and papillary
muscle, visualized by MSCT in the appropriate
phase of the cardiac cycle [2].
Results
For the axis reconstruction the algorithm was worked
out based on the analysis of dynamic architectonics
of trabeculae and papillary muscles in the beating
LV cavity. The algorithm consists of several stages:
1. Modeling of the spatial arrangement of the
points clouds containing the desired axis with
100% probability using measured topology at a
given time.
2. Selecting a straight axis in the center of the
resulting clouds
3. The resulting axis is divided into a finite number
of small equal intervals.
To restore the flow structure and the calculation

of its parameters it was necessary to determine
the axis position, satisfying the basic conditions
of tornado-like jet. At the previous stages of the
work two straight axes were chosen referred to
the inflow and outflow tracts of the left ventricle.
Herewith a continual evolution of tornado-like
flow through the left ventricular cavity was proved
conserving the tornado-like jet structure throughout
the cardiac cycle. This method was used for the
analysis of the intraventricular flow structure in the
patients without severe geometrical alterations of
the LV cavity and in the patients with hypertrophic
cardiomyopathy [3].
4. By iteration of each segment the distance is

measure to the nearest trabeculae
5. Fitting such distances and angles of the tangent
to the trabeculae satisfying the conditions of
axial symmetry and the convergence of the
trabeculae and papillary muscles in every
moment of the cardiac cycle.
6. Successive approximation set of small segments
provides a curved axis, satisfying the conditions
of axial symmetry and the convergence along
the path of the flow evolution.
Conlusion.
Performing such iteration for inlet and the outlet parts
of the left ventricle reduces the magnitude of the gap
between the ends of axes corresponding to the phases
of filling and ejection. Thus, the geometric position
of the axis in the isometric phases become more
defined, to get closer to the complete reconstruction
of the evolution path of an intracardiac blood flow
throughout the cardiac cycle.
It is evident that in reality, axisymmetric tornadolike blood flow evolves in the LV cavity along a
continuous curvilinear axis changing its orientation
within the LV cavity during the cardiac cycle in a
defined manner repeated cyclically. Determining
of the axis position will clarify the details of the
evolution of tornado-like blood flow throughout
the cardiac cycle, including isometric phases.
References
1 Kiknadze G.I., Krasnov Yu.K. Evolution of a
spout-like flow of a viscous fluid.Sov Phys Dokl
1986;31:799801.
2 Bockeria L.A., Kiknadze G.I., Gachechiladze I.A.,
Gabidullina R.F., Makarenko V.N., Gorodkov A.Yu.
Analysis of structure of intraventricular blood flow
based on studies of architectonics of trabecular
layer in left ventricle. Open access journal CARDIOMETRY, No3 November, 2013, pp. 530.
3 Bockeria L., Kiknadze G., Gorodkov A. Tornado-like
blood flow concept New quantitative dependences in the heart reflect the intracardiac
hydrodynamics and the heart remodeling.
WCB 2014, Proceedings.
518
P 15 2
CAN VALIDATED NUMERICAL MODELS INFER ARTERIAL

WALL PROPERTIES DURING CARDIAC INTERVENTIONS?
G.M. Bosi1, B. Biffi2, G. Biglino1, V. Lintas3 , C. Capelli1, S. Tzamtzis4 ,
G. Burriesci4 , F. Migliavacca3 , A.M. Taylor1, S. Schievano1
1
2
University College London, Institute of Cardiovascular Science, London, United Kingdom
University College London, Dept of Med Phys & Biomedical Eng, London, United Kingdom
3
Politecnico di Milano, Laboratory of Biological Structure Mechanics LaBS Chemistry,

Materials and Chemical Engineering Department Giulio Natta, Milano, Italy
University College London, Dept of Mechanical Engineering, London, United Kingdom
Results
NuMED and Edwards balloons showed distensibility
values of 55x10 5 1/mmHg and 43x10 5 1/mmHg,
respectively. During the experiments, NuMED
reached a maximum pressure of 0.4atm, while
Edwards of 6.3atm. The RP cylinder samples for
the mock aortic and pulmonary material exhibited
distensibility of 2x10 3 and 7.5x10 3 1/mmHg,
respectively. Good agreement was found between
balloons/cylinders interaction simulations and
the experimental data (error <3%), while in the
more complex balloons/mock arteries interactions
(Figure 1) the error was higher (<10%). Using
the
simulation
results,
material
properties
were correctly inferred for PPVI candidate
(Youngs Modulus = 0.65 MPa vs. 0.67 MPa
experimental) while for the TAVI patient too broad
a range of Young Modulus was predicted.
Introduction
Computational patient-specific models can
provide valuable information for planning complex
cardiovascular interventions [Schievano, 2010].
However, there is still a knowledge gap regarding
implantation site response to overload during
device procedures. We propose a method to
derive this response through patient-specific
simulations of balloon sizing and valvuloplasty
procedures, by coupling balloon pressure, with
volume and diameter changes. Particularly, finite
elements (FE) models of two types of balloons
are created, and validated against in-vitro
experiments, reproducing balloon inflation in
simplified cylindrical implantation sites as well as in
patient-specific mock arteries.
Methods
A 40mm diameter compliant sizing balloon (NuMED)
and a 23mm diameter non-compliant balloon used
for aortic valve dilatation (Edwards) were analysed.
An ad-hoc pump system was adopted to inflate
the balloons, allowing for simultaneous volume and
pressure recordings. The corresponding balloon
diameters were obtained after post-processing
of biplane fluoroscopy images acquired in the
catheterisation laboratory where the experiments
were performed, allowing for estimation of balloon
distensibility. Data were also used to build and
validate a FE model of the balloons during inflation,
using fluid cavity interaction simulations (Abaqus/
/Explicit). A combination of RP materials
(i.e. compliant 930TangoPlus [Biglino, 2012] and stiff
830VeroWhite FullCure) was chosen to manufacture
implantation sites with realistic distensibility. The latter
was measured experimentally in cylindrical samples.
The pressure-volume relationship of each cylindrical
sample was reproduced computationally. Balloons
were then tested inside simplified RP anatomies
(i.e. cylinders) as well as in an aortic root with
calcified aortic valve (including leaflets and
calcifications) from a transcatheter aortic valve
implantation (TAVI) patient and a pulmonary artery
from a percutaneous pulmonary valve implantation
(PPVI) candidate. The 3D anatomies were derived
segmenting medical images. According to their
applications and dimensions, NuMED was tested
in the PPVI candidate and Edwards in the TAVI
patient. Pressure-diameter and pressure-volume
relationships were gathered in-vitro and balloon
inflation inside cylinders and patient-specific
FE models was virtually simulated adopting a
contact algorithm.
Discussion
Computational models of balloon sizing and
valvuloplasty procedures were validated against
in-vitro tests. Pressure, volume and diameter changes
recorded during sizing balloon inflations could be
used to derive patient-specific implantation site
response to overload; including this information
may increase the reliability of computational
simulations of minimally invasive pulmonary device
implantation. Results also highlighted how the
high stiffness of the valvuloplasty balloon affects
simulation results for this kind of prediction on the
aortic side.
References
Biglino et al, JCMR, 15:2, 2013.
Schievano et al, EuroIntervention, 5:745750, 2010.
519
P 15 3
NON INVASIVE IMAGE BASED MODELS FOR THE

DIAGNOSIS OF PULMONARY HYPERTENSION
A. Lungu1, J. Wild1,2, D. Capener1, D. Kiely3,4 , A. Swift1,2, R. Hose1,2
1
University of Sheffield, Cardiovascular Science, Sheffield, United Kingdom

2
3
4
INSIGNEO, Cardiovascular Science, Sheffield, United Kingdom
University of Sheffield, Infection and Immunity, Sheffield, United Kingdom
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield Pulmonary Vascular Disease Unit,
Sheffield, United Kingdom
Results
The 1D model showed that on average, the
backward wave contribution to the total wave it
was significantly higher (p<0.001) in the severe
diseased group (40%0.1%) than in the healthy
volunteers (10%0.036%) and NoPH group
(24%0.067%). W pb/Wptotal was also found to differ
significantly between the 2 PH subgroups. The
results of the 0D model showed decreased vascular
compliance (C) and increased distal resistance (R d)
in PH. R d showed statistical significance between
the NoPH and mild PH group, this being the only
pair of groups where the Wpb/Wptotal metric did not
show statistical significance.
Introduction
Pulmonary hypertension (PH) is a severe condition,
characterised by elevated mean pulmonary
arterial pressure (mPAP25 mmHg) caused by
increased ventricular load (increased pulmonary
vascular resistance PVR, decreased vascular
compliance). Right heart catheterisation (RHC), an
invasive procedure, is currently the gold standard
for PH assessment [Kiely et.al,2013]. Albeit argued
[Hoeper et.al, 2006] that performed in specialised
centres,
the
complications
following
RHC
intervention are reduced, they are yet important
and non-invasive methods are highly desirable.
We had proposed [Lungu et. al, 2014] a totally
non-invasive method, that combines simple
mathematical models, based on electrical analogy
(RCR Windkessel model) and wave transmission
theory (1D model of a straight elastic tube) with
MR based measurements (flow and anatomy) of
main pulmonary artery (MPA) to infer the status of
pulmonary circulation in health and disease.
Methods
35 subjects, 8 healthy volunteers and 27 clinical
patients were part of the pilot study. The clinical
patients underwent RHC at Sheffield Pulmonary
Vascular Disease Unit and upon the investigations
were classified in 3 sub-groups according to the
presence/absence and severity of the disease:
NoPH (n=4), PVR<4 WU (n=9) and PVR 4WU
(n=14).
Figure 1: L eft: measured and fitted pressure wave returned

by the 0D model. Right: pressure wave decomposition for a PH patient. The backward wave
contributes to the total pressure wave in a similar
proportion to the forward wave (1D).
Discussions
The published results [Lungu et. al, 2014], indicated
that the proposed metrics derived from simple
mathematical models and MRI measurements of
MPA could be used to non-invasively differentiate
healthy from diseased PH patients consistent with
the clinical stratification. Work it is carried out to
evaluate the metrics on an extended cohort.
Each subject underwent flow (phase contrastPC) and anatomical cine imaging (bSSFP) of
the MPA on a GE HDx1.5T scanner. Images were
post-processed to provide simultaneous flow, Q(t)
and pressure, p(t) (radius used as a surrogate)
measurements at single anatomical location,
during the entire cardiac cycle. The Windkessel
model parameters were tuned by minimising a
mixed cost function between the measured and
models output pressure (fig. 1, left). Using a 1D
wave transmission model, the pressure waves were
decomposed into their forward and backward
components (fig. 1, right). The energy, expressed
as wave power, contained in the reflected wave
was quantified as a proportion from energy of
the total wave. The derived electrical parameters
(R d, C and Rc) and the backward-to-total wave
power ratio (Wpb/Wptotal) were proposed as
diagnosis indices for PH.
References
Hoeper, et al, J Am Coll Cardiol, 48:25462552, 2006.
Kiely, et. al, BMJ 346, 2013
Lungu et. al, J Biomech 47: 29412947, 2014
520
P 15 4
PATIENT-SPECIFIC COMPUTATIONAL
MODELLING OF THE MITRAL VALVE
P. Kalozoumis1, L. Morticelli1, I. Tudorache1, S. Cebotari1,
A. Haverich1, S. Korossis1, M. Granados1
1
Hannover Medical School, Department of Cardiothoracic, Transplantation and Vascular

Surgery, Hannover, Germany
Introduction
Current approaches to valve repair and
replacement are based to one-size-fits-all. As such
there is a big drive towards more personalised
surgical interventions. The mitral valve (MV) is
a complex anatomical structure and its proper
function depends on the delicate force distribution
and synchronised function of all of its components
[Sacks, 2002]. The aim of this project was to develop
a novel prognostic/forecasting computational
simulation tool that will provide patient-specific preoperative optimisation of mitral valve replacement
or repair.
Methods
MicroCT images of the intact porcine MV were
segmented in Simpleware and the whole MV
apparatus was reconstructed. In preliminary
computational models, the atrial surfaces of the
leaflets were simplified as membranes and the
chordae as tension strings. Anterior and posterior
leaflet samples were tested under biaxial tension
to obtain the regional biomechanics of the MV.
Additionally, samples from the two main chordae
tendineae types (strut & commissural) were tested
uniaxially. The stress-strain data obtained was
imported in the computational model to specify
the regional material properties of the MV. Initially
an orthotropic material model was used for
the leaflets and a linear elastic material for the
chordae tendineae. The model was imported into
LS-DYNA, where a Fluid-Structure Interaction (FSI)
simulation of the MV closure was simulated for one
cardiac cycle. The differential pressure between
the ventricle and the atrium was given as an inlet
boundary condition.
Figure 1: M
aximum effective surface stresses (Pa) of the
mitral valve closure at early systole (A) and
mid-systole (B).
Discussion
This study has indicated that different components
of the MV experience different levels of stress and
strain, which has an implication in the selection of
appropriate repair materials for MV reconstruction.
Future work will focus on adapting several material
models able to describe as close as possible the
viscoelastic behaviour of the tissues. Future work
will also include development of blood-structure
interaction models of the native 3D geometry of
the MV that incorporates the left ventricle, aortic
valve and aortic arch anatomy from clinical scans.
Results
The MV apparatus demonstrated significant
regional and directional mechanical anisotropy.
The anterior leaflet demonstrated significant
directional anisotropy, whereas the posterior
leaflet showed a rather isotropic behaviour.
Significant differences in the mechanical properties
were also found between the different types of
chordae tested. The computational simulations
predicted regions of both leaflets with elevated
stress concentration during the cardiac cycle
(Figure 1), in accord with failure regions observed
clinically [Dominik, 2010]. Moreover, the simulations
indicated variable loading of the different chordae
during the cardiac cycle.
References
Dominik et al, Heart Valve Surgery: An Illustrated
Guide, 213307, 2010
Sacks et al, Ann Biomed Eng, 30:128111290, 2002.
521
P 15 5
FSI-BASED APPROACH FOR HEART VALVES PROSTHESIS

OPTIMIZATION: A POLYMERIC PROTOTYPE CASE-STUDY
F. Piatti1, F. Sturla1, T.E. Claiborne2, G. Marom2, J. Sheriff2, D. Bluestein2, A. Redaelli1
1
Politecnico di Milano, Eletronics, Information and Bioengineering, Milano, Italy

2
Stony Brook University, Biomedical Engineering, Stony Brook, USA
Introduction
Mechanical and bio-prosthetic heart valves provide
life-saving solutions, but critical comorbidities (e.g.
thrombogenic failures, premature degradation)
still occur. These major issues suggested the
concept of next-generation devices, such as
polymeric heart valves (PHV) [Bezuidenhout,
2014]. Preliminary in-vitro tests showed promising
results, but a complete methodology that provides
an overview of their performances still lacks.
At this aim, we developed a full fluid-structure
interaction (FSI) method that mimics the operative
conditions of an experimental testing set-up so as
to deeply investigate the fluid dynamic, kinematic
and thrombogenic performances of the x-SIBS
Polynova polymeric prototype valve [Claiborne,
2013], aiming at its optimization.
regular profile, related to a symmetric open position

of the leaflets (Figure 1). Commissural trajectories
exhibited higher level of PAS than central-jet
ones, respectively, 5% and 2% with respect to the
maximum possible platelet activation.
FSI
Experimental
Qpeak (ml/s)
447.71
454
Vmax
3.37
3.42
?Pmean (mmHg)
18.60
20.91
EOA (cm^2)
1.54
1.47
Table 1: V
erification of the numerical model

The geometry of the FSI model was derived from
technical drawings of the Polynova valve and
the ViVitro Pulse Duplicator (ViVitro Labs Inc.,
Victoria, BC, Canada). Numerical simulations were
performed with the explicit solver LS-DYNA (LSTC,
Livermore CA, USA). Ventricular (Pv) and aortic
(Pao) pressure waveforms were extracted from
experimental testing [Claiborne, 2013] and used
as boundary conditions at the Inlet and Outlet
reservoirs of the fluid domain. As regards the
thrombogenicity analysis of the device, numerical
particles (i.e. ideal human platelets) were
injected in ventricular position and an in-house
post-processing tool was used to calculate their
stress-time ((t)) histories and to condense them
into a thrombogenic footprint. Commissural hotspots and central-jet trajectories were selected and
programmed into a hemodynamic shearing device.
The mechanically-induced platelet activation state
(PAS) was quantified by means of an innovative
experimental protocol [Bluestein, 2013].
Figure 1: O
verall characterization of the Polynova polymeric
prototype valve
Discussion
The experimental verification of the FSI model
showed reliable results and the thrombogenic
analysis identified critical geometrical hot-spots
commissural zones which mostly activates
platelets and may represent the key-feature that
governs the thrombogenic impact of trileaflet
prosthesis. We confidently suggest that our analysis
can provide a step-forward into the optimization
process of valvular prosthesis.
Results
As a first step, characterizing parameters (i.e.,
Qpeak, Vmax, ?Pmean, EOA) were compared
between the numerical solution and experimental
data to assess the reliability of the proposed FSI
method (Table 1). At the peak systolic phase, the
blood flow was characterized by a centred and
References
Bezuidenhout et al., Biomat. 36:625, 2015
Claiborne et al., J Biomech Eng, 135(2), 2013
Bluestein et al., J Biomech, 46(2):33844
522
P 15 6
MICROFLUIDIC EMULATORS OF VENTRICULAR ASSIST

DEVICE SHEAR STRESS PATTERNS: LAB-ON-A-CHIP TEST
BENCHES FOR PLATELET ACTIVATION UNDER DYNAMIC
DEVICE-LIKE SHEAR FLOW
A. Dimasi1, M. Rasponi1, F. Consolo1, L. Valerio1, G.B. Fiore1,
D. Bluestein2, M. Slepian3 , A. Redaelli1
1
Politecnico di Milano, Department of Electronics, Information and Bioengineering,

Milano, Italy
2
Stony Brook University, Department of Biomedical Engineering, Stony Brook, USA
University of Arizona, Department of Medicine and Biomedical Engineering, Tucson, USA
Introduction
Ventricular assist devices (VADs) are used to
provide restoration of hemodynamics in patients
with heart failure. However, VADs have been
frequently affected by thrombosis, mainly due
to the altered shear stress conditions they expose
platelets to [1, 2]. Although patients are treated
with anti-thrombotic drugs, these therapies often
turn out to be ineffective. Much research has been
conducted on this issue, which highlighted the
need for frequently monitoring the thrombotic risk of
patient blood under dynamic shear flow conditions
and under the effect of different drugs, with the aim
of allowing personalization of anti-platelet therapies
and enhancing device performances. In this
context, we designed and realized a microfluidic
platform prototype able to replicate shear stress
patterns of medical devices, with the ultimate aim
of developing a Lab-on-a-Chip device that can be
used as a test bench for platelet activation studies
under VAD-like dynamic flow conditions.
shear stress waveforms of the HMII microfluidic

and the HMII VAD are compared. Results of the
PAS assay are reported in Fig. 1d at different time
points. A sigmoid-like behaviour was observed,
characterized by a rather linear trend at low
activation levels, followed by a plateau at the
highest level of PAS of the sample.
Methods
As a test case, we considered the HeartMateII
VAD (HMII, Thoratec Corportation, Pleasanton,
CA, USA), whose significant dynamic shear stress
waveforms along platelet trajectories were
extracted through computational fluid dynamic
(CFD) analyses in a previous work [3]. CFD analyses
were also used to design a microfluidic channel unit
able to replicate those waveforms when perfused
at a constant flow rate. Prototypes of microfluidic
platforms were realized on polydimethylsiloxane
(PDMS) through standard soft lithography, starting
from the designed channel unit. Preliminary in vitro
tests were performed to characterize the PDMS
devices: the platforms were perfused in a closed
loop configuration with ovine gel-filtered platelet
(GFP) using a peristaltic pump system. Platelet
activation at different time points was tested using
the platelet activity state (PAS) assay [4].
Discussion
We demonstrated the feasibility of using microfluidic
technologies to design microfluidic platforms able
to replicate the dynamic shear stress patterns of
VADs. We performed preliminary characterization
tests of the microfluidic devices. The approach
seems promising to develop a novel technology
which could possibly evolve towards Point-of-Care
devices for monitoring patient thrombotic risk under
realistic shear flow conditions. To this ultimate aim,
current studies are focused on developing and
testing an on-chip platelet activation assay, with
the aim of downscaling and integrating readout
capabilities directly on the microfluidic platform.
This work was financially supported by Fondazione Cariplo grant no. 2241-2011 and NIH/NIBIB
5U01EB012487
Results
The design of the microfluidic channel unit (HMII
microfluidic) is shown in Fig. 1a, together with
a top view picture of the layout of a device
embedding 4 repeating units (Fig. 1b). The channel
is characterized by a constant height (50 m),
while its width was modulated to generate the
desired shear stress pattern. In Fig. 1c, significant
References
[1] Mehra, MR et al. J Heart Lung Transplant,
33(1):111, 2014.
[2] Starling, RC et al., N Engl J Med, 370(1):3340, 2014.
[3] Chiu, W et al., J Biomech Eng, 136:021014, 2014.
[4] Jesty, J and Bluestein, D, Anal Biochem,
272(1):6470, 1999.
523
P 15 7
MITRAL VALVE REAPAIR TECNIQUES: MASS SPRING

APPROACH FOR SURGICAL PLANNING
O. Pappalardo1, F. Onorati1, F. Sturla2, E. Votta2, P. Giovanni1,
A. Redaelli2, G. Faggian1
1
Universit degli studi di Verona, Cardiovascular Surgery, Verona, Italy

2
Politecnico di Milano, DEIB, Milano, Italy
Introduction
Surgical repair of mitral valve (MV) is technically
demanding and strongly relies on surgeons
expertise[Adams,2006]. In order to support clinical
decision making, pre-operative and post-operative
conditions can be modelled by finite element
models (FEM), which provide high level of accuracy
but require high computational cost [Sturla, 2014].
Mass-Spring Models (MSMs) represent a more
approximate but still reliable approach that allows
for almost real-time simulations [Hammer,2011].
In this study, we presented a novel mass spring
model (MSM) approach based on CMR-imaging
for almost real-time simulations of MV.
Simulations were performed with an explicit

integration algorithm. A contact algorithm was
implemented to identify interacting regions.
As validating benchmark FEM simulations were
performed using ABAQUS [Sturla, 2014].
Results
Figure 2 shows the pre and post-operative
configurations of one patient. In pre-operative
(Figure 2-A) prolapsing MVs the extent and
location of the prolapsing region were very similar
in both type of models. Similarly, in repaired MVs
the effects of surgical procedures obtained by the
MSM well reproduce the configuration yielded by
FEM (Figure 2-B).
Methods
Cardiac Magnetic Resonance (CMR) was
performed on 4 patients with MV prolapse. The
entire framework of MSMs was developed with
a dedicated software in Matlab (Mathworks).
Annulus, leaflets free-edge and papillary muscles
(PMs) were manually identified reproducing
MV configuration and the annular and PMs
kinematic
boundary
conditions.
Chordae
tendineae were defined according to ex vivo
findings. Tissues were assumed non-linear and
elastic. Anisotropic mechanical properties of
MV leaflets were considered. Systolic closure
was simulated applying a physiological pressure
load to the leaflets. MV repair was performed
testing different techniques: annuloplasty, leaflet
resection and neochordoplasty (Figure 1).
Figure 2: C
omparison between configurations of MV
obtained with FEM and MSM before and
after a neochordoplasty.
The computational time required by MSM simulation

on one single CPU with a not yet optimized code
is less than 2 hours, i.e. at least one order of
magnitude faster than FEM.
Discussion
According to our preliminary results MSM can be
used for building customized software to help the
surgeon in the surgical planning with a reasonable
accuracy trade-off with respect to FEM analysis.
Figure 1: R
epair technique of MV.
References
Adams et al, Heart Fail Rev 11:241257,2006.
Sturla et al, J Thorac Cardiovasc Surg,
148:102534, 2014.
Hammer et al, LNCS 6666:233240.
524
P 15 8
MODELLING RESIDUAL STRESS STATE OF A TWO-LAYERED

PATIENT-SPECIFIC ARTERIAL SEGMENT BY USING
A THERMOMECHANICAL ANALOGY
J. Urevc1, V. Flis2, M. Brumen3 , B. Tok1
1
Faculty of Mechanical Engineering, University of Ljubljana, Laboratory for Numerical

Modelling and Simulations, Ljubljana, Slovenia
University Clinical Centre Maribor, Department of Vascular Surgery, Maribor, Slovenia

3
Faculty of Medicine University of Maribor, Chair of Biophysics, Maribor, Slovenia
Introduction
The prediction of a patient-specific arterial
mechanical response is, due to the assessment of the
arterial residual stress state, an open problem in the
field of bioengineering. One of the reasons for that is
that the arterial initial zero-stress configuration cannot
be obtained experimentally. The configuration,
however, in general represents the starting point
of any numerical analysis. Additional complexity
of the problem represents the arterial behaviour,
which is multi-layered, with each layer having
different amount of residual stresses, and anisotropic
[Holzapfel, 2010]. Recently, a new methodology has
been proposed by the authors which predicts the
patient-specific arterial response without knowing
the arterial initial zero-stress state [Urevc, 2015].
The aim of this paper is to apply the methodology
presented in [Urevc, 2015] to model a two-layered
patient-specific arterial segment.
arterial two-layered segment (slice) was treated as

presented in [Stlhand, 2009]. Based on its residual
stress state, an idealised thermomechancial model is
characterized from where the two-layered patientspecific thermomechanical model is constructed.
From the latter, the response of the two-layered
patient-specific arterial segment is obtained.
Results
The predicted in vivo stress state of the twolayered patient-specific arterial segment agrees
nicely with the data provided from literature. The
appropriateness of the methodology is also shown
by predicting the opened zero-stress state of the
arterial segment. We also demonstrated for the
validation of the methodology that the thermal
stresses of the circular two-layered fictitious model
are equivalent to the bending stresses of an open
two-layered circular arterial section.
Methods
We tackle the problem of modelling the patientspecific arterial response by means of an analogical
approach, which we apply in the assessment
of the arterial residual (bending) stresses. The
arterial bending stresses are predicted by solving
a thermomechanical problem of a fictitious closed
tube [Urevc, 2015]. Therein, the approach is
applied to a single-layered artery and is extended
in this work to account for multi-layered arterial
structure. The geometry of the thermomechanical
model, which also consists of two different layers,
is defined based on the in vivo arterial geometry.
We assumed the artery to be composed of
intima-media and adventitia. To characterize the
properties of the fictitious arterial model, idealised
Discussion
In this work, the capability of the thermomechancial
methodology to model multi-layered patient-specific
arterial response is demonstrated. In this work,
however, the arterial response was assumed isotropic.
The implementation of the anisotropic arterial
behaviour in the methodology is an ongoing project.
References
Holzapfel, G.A., et al, J R Soc Interface,
7: 787799, 2010.
Stlhand J., Biomech Model Mechanobiol,
8(6): 431446, 2009.
Urevc, J. et al, Strojniki Vestnik Journal of
Mechanical Engineering, 61: 523, 2015.
525
P 15 9
CENTERING FORCES OF TRANSAORTIC VAD-CANNULAS

IN A STATIC AND PULSATILE SETUP
P. Aigner1, M. Stoiber1, M. Granegger1, F. Moscato1, H. Schima2
1
Medical University of Vienna, Ludwig Boltzmann Cluster for Cardiovascular Research, Center
for Medical Physics and Biomedical Engineering, Vienna, Austria
Medical University of Vienna, Ludwig Boltzmann Cluster for Cardiovascular Research, Center
for Medical Physics and Biomedical Engineering, Department for Cardiac Surgery,
Vienna, Austria
Introduction
Ventricular Assist Devices (VAD) became an
established therapeutic option for patients suffering
from end stage heart failure. The steady development
of these pumps lead to an improved and excellent
survival
[Pirbodaghi,
2013].
With
increasing
miniaturization it is now possible to implant VADs via
the apex of the heart and place the pump inside
the left ventricle [Tamez, 2014]. In this configuration
the outflow cannula is positioned across the aortic
valve. In an isolated heart experiment and a
transaortic VAD cannula configuration [Granegger,
2013] a centering of the cannula depending on the
transvalvular pressure was observed (see Figure 1).
A certain centering force seems to be applied to
the cannula when the aortic valve is closed and this
seems to be necessary to center the valve.
In this work the radial forces on a transaortic cannula
are investigated in a static and pulsatile in-vitro model.
The influences of pressure and cannula diameter at
different cannula displacements were investigated.
Figure 2: P
ulsatile setup for measuring centering forces
Results
An increase of transvalvular pressure resulted in
higher centering forces (+214% per 20 mmHg)
with linear behavior in the static and pulsatile setup.
Highest centering forces up to 1.12 N were found
when the cannula was close to the aortic wall.
Minimal forces were observed not only in a single
point, but an area of low force was measured. In
the static measurements slightly differing centering
force patterns along the commisures and leaflets
were observed, although single leaflets were not
represented by the force distribution. Also the size of
the cusp was not associated with the centering force.
The diameter of the cannula had minor influence on
the force and comparable force distributions were
seen between all three cannula sizes.
Figure 1: V
AD-cannula centered in the aortic valve
Discussion
Static and dynamic behavior of cannulas
positioned across the aortic valve was investigated
in an in-vitro setup. A certain pressure related force
seems to be necessary to center cannulas in the
coaptation point of the leaflets.
Methods
Three aortic valves were harvested from porcine
hearts taken from the abattoir and mounted
[Schlglhofer, 2013] in a test rig (see Figure 2).
Cannula dummies (diameter: 4 mm, 6 mm and 8 mm)
were mounted on a linear motor (Bose LM1)
equipped with a 10N force transducer. The
cannula was deflected from the central position
by the linear motor in 1 mm steps and the valve
rotated in 30 steps. In a static and a pulsatile mode
(transvalvular pressures of 60 mmHg, 80 mmHg and
100 mmHg) the centering forces exerted on the
cannula were measured in all possible positions.
References
Pirbodaghi et al, Eur J Cardiothorac Surg,
43:3838, 2013
Tamez et al, ASAIO J, 60(2):170177, 2014
Granegger et al, Int J Artif Organs,
36(12):878886, 2013
Schlglhofer et al, Int J Artif Organs,
36(10):738741, 2013
526
P 16 0
BLOOD RHEOLOGICAL PROPERTIES AND CHANGES OF

OSCILLATIONS IN SKIN TEMPERATURE AFTER COLD TEST
IN PATIENTS WITH TYPE 2 DIABETES
N. Antonova1, I. Velcheva2, S. Podtaev3 , V. Kostova1, N. Chaushev2, K. Tsiberkin4
1
3
4
Institute of Mechanics to the Bulgarian Academy of Sciences,

Department of Biomechanics, Sofia, Bulgaria
University Hospital of Neurology and Psychiatry St. Naum, Medical University,

Department of Neurology, Sofia, Bulgaria
Research Center FM Diagnostics, Research Center FM Diagnostics, Perm, Russia
Perm State University, Physical Faculty, Theoretical physics department, Perm, Russia
average amplitudes in the three frequency ranges

were estimated by a box plot diagram.
The aim of the study was to evaluate the

relationship between rheological properties of
the blood and the dynamics of changes of the
temperature oscillations corresponding to the
myogenic, neurogenic and endothelial regulation
of the skin vascular tone during indirect cold test
in 10 patients with type 2 diabetes and 10 healthy
age and sex matched controls.
A rotational viscometer Contraves Low Shear 30

(Switzerland) was used to measure whole blood
viscosity at shear rates of 0, 0237s 1 to 128,5s 1
in both groups. The basic hemorheological
constituents: hematocrit (HT), whole blood (WBV)
and plasma viscosity (PV) were also investigated.
The increased blood viscosity in patients versus
controls was correlated with the decreased skin
blood flow. An attempt was made to approximate
the viscosity versus shear rate of a power function
as standard hydrodynamic model pseudoplastic
fluid:, where n <1. Since viscosity variation was
large, it was only determined to n. The results
were compared with those of thermometry using
Spearman correlations. It should be noted that no
significant correlations could be reached for any of
the examined groups. However, when calculating
the correlations between the absolute values of
the viscosity and temperature fluctuations of the
amplitudes obtained, positive correlations in the
control group predominated, while in the patients`
group the correlations were negative.
The skin temperature was measured on the palm

surface of the distal phalanx of the second (index)
finger with two closely-spaced sensors. It was
continuously registered under basal conditions
(10 min), during contralateral hand immersion
in cold water (3 min) and thereafter (10 min) by
Microtest device.
Wavelet transformation analysis was used to estimate
the localized variations of the low amplitude
oscillations of skin temperature in accordance
with the myogenic (0.050.14 Hz), neurogenic
(0.020.05 Hz) and endothelial (0.00950.02 Hz)
control mechanisms. The dynamics of changes of the
skin temperature oscillations in the different frequency
ranges was evaluated through the root mean square
values of the spectral amplitudes. The measured
527
P 161
MINIMALLY INVASIVE, PNEUMATICALLY OPERATED

LEFT VENTRICULAR ASSIST DEVICE DESIGN
AND FIRST IN-VITRO RESULTS
C. Janeczek1, M. Hinteregger2, A. Karabegovic2, R. Willinger3 ,
W. Mohl4 , V. Soragnese4 , M. Gfhler2
Vienna Univeristy of Technologie, Institute for Engineering Design

and Logistics Engineering, Vienna, Austria
Vienna University of Technologie, Institute for Engineering Design

and Logistics Engineering, Vienna, Austria
Vienna Univeristy of Technologie, Institute for Energy Systems and Thermodynamics,

Vienna, Austria
4
Medical Univeristy of Vienna, Heart Surgery, Vienna, Austria
Introduction
After a myocardial infarction and certain
cardiomyopathies critically ill patients need
temporary circulatory assistance. Intra-aortic
counter-pulsation (IABP) and electrically driven
left ventricular assist devices (LVADs) are clinically
used to increase cardiac output and support the
failing heart during recovery [D. Mansini, 2005].
Results
For operating as an efficient driving unit the
performance of the turbine was optimized in order
to produce an estimated power output of 5 W at
160000 rpm along with a mean rotor diameter of
4.3 mm.
The design point of the pumping unit was defined
at a flow rate of 2.5 L/min against the pressure
difference of 100 mmHg by a speed of 39600 rpm
with an outer rotor diameter of 5.1 mm. First invitro tests of the pump showed promising results.
An offset of 25 mmHg from the design point to
the working point was measured. Considering the
characteristic curve of the pump at 39600 rpm, flow
rates from 2.9 to 1.3 L/min against 20 to 140mmHg
can be achieved, respectively Furthermore,
hemolysis of the first pumps prototype with the
above described properties was determined in a
static mock circulation with 72h old animal blood.
The mean value at a stationary run of modified
index of hemolysis [A. Arvand, 2005] MIH=12.5
with a minimum of MIH = 1.1 was measured.
In order to provide more effective heart assistance

we have developed a tiny pneumatically driven
heart pump to use in combination with the IABP.
This combined system can simultaneously assist the
heart in unloading the left ventricle and increase
coronary perfusion. Besides from the technical
aspects of the LVAD, medical requirements
also have to be fulfilled, such as minimizing the
hemolysis produced by the pump.
Methods
For minimally invasive placement through the
femoral artery into the left ventricle, the system is
designed as catheter pump. The complete device
is limited to 6 mm in diameter and 45 mm in rigid
length. The working medium of the driving unit is
Helium which is also used for inflating the IABP. The
technical development of the LVAD was done using
3D computational design and a computational
fluid dynamics (CFD) simulation. The driving unit was
designed as a single stage reaction turbine with
partial admission. Transmission of torque from the
driving unit to the axial pump is achieved using a
novel and patent pending magnetic coupling that
enables a hermetic separation between the two.
Discussion
The offset from design point to the working point
occurred due to certain simplifications in the
design process of the pump (e.g. empirically
determined efficiency) and slight imperfections
in the manufacturing process. The progression of
hemolysis during the test run with animal blood
has shown significantly higher values during the
beginning stage of the experiment. This indicates
a major influence of the accelerating phase of the
pump on the blood damage.
The pumps rotational speed is modified by

regulating the mass flow through the turbine.
References
A. Arvand et al, Artificial Organs, 29(7):531540, 2005
D. Mansini et al, Circulation, 112:438448, 2005
Figure 1: M
inimally Invasive, Pneumatically Operated Left
Ventricular Assist Device
528
P 16 2
A PARAMETRIC FINITE ELEMENT MODEL

ENVIRONMENT FOR DAMAGE ASSESSMENT
IN CAROTID ARTERY STENTING
F. Iannaccone1, N. Debusschere1, M. De Beule1, F. Vermassen2,
P. Segers1, B. Verhegghe1
1
Ghent University, IbiTech-bioMMeda, Department of Electronics and Information Systems,

Ghent, Belgium
Ghent University Hospital, Department of Thoracic and Vascular Surgery, Ghent, Belgium
Introduction
Carotid artery stenosis is a major cause of
ischemic stroke worldwide [Mathers, 2009].
Traditionally treated by surgical removal of the
plaque, endovascular procedures, i.e. carotid
artery stenting (CAS), has become a valid
alternative for of severe carotid stenosis thanks
to its he minimally invasive nature and short
hospitalization. Nevertheless both short- and
long-term efficacy of CAS is debated and the
underlying causes which lead to procedural
failure are yet not completely understood. Clinical
evidence has shown that plaque composition is
a determinant for plaque vulnerability and periprocedural embolism [Hellings, 2006], although
current clinical guidelines are based exclusively
on the degree of luminal stenosis and plaque
severity. In order to gain further insights into the
endovascular intervention, a structural finite
element model (FEM) framework was built to
simulate the CAS procedure. We used an Acculink
stent (Abbott Vascular, Boston, IL) and parametric
diseased carotid geometries to investigate the
influence of different pathological scenarios.
Figure 1: S tent deployment in all the vascular anatomies.

Cauchy stresses (kPa) are depicted for the
fibrous cap.

Our findings demonstrated that an elliptic lumen
shape and a thinner fibrous cap with an underlying
lipid pool result in higher stenosis reduction confirming
previous clinical studies. On the other hand large
calcifications and fibrotic tissue are prone to recoil.
A thicker fibrous cap helps to shield the lipid pool by
reducing local compressive stresses, thus preventing
risk of debris leakage. Soft plaque seemed to reduce
the damage in the healthy vascular structures.
Stenting of hard plaques led to high stresses in
the healthy intima-media layer, but induced less
damage volume in the fibrous cap. As restenosis is
considered a response to vascular injury, this may
suggest that stenting of hard plaque may promote
tissue growth that might re-occlude the vessel.
Methods
Five lesions (Figure 1) with a 85% stenosis degree,
were simulated by changing both material
properties (vulnerable -lipid- versus stable
-calcified and fibrous- plaques) and vascular
geometrical features (circular or elliptic lumen).
The constitutive arterial model included damage
[Balzani, 2006] to quantify the injury of the vessel.
Different fibrous cap thicknesses (from 0.25 to
0.5 mm) were also included to understand the
effect on plaque vulnerability. The results were
analysed with respect to lumen gain and wall
stresses, potential factors leading to adverse
clinical outcome. All simulations were carried out
using the FEM solver Abaqus/Explicit (Dassault
Systmes Simulia Corp.,USA).
In this work we studied the effects of different
plaque constitution and lumen shape on CAS. Our
approach has shown the capability to investigate
comparative scenarios that are impossible to
reproduce in vitro or in vivo. Findings are in line with
observations in clinical studies. While this does not
strictly validate the model, it supports the role of
FEM simulations as a framework for pre-operative
of different pathological scenarios.
The authors gratefully acknowledge the Research
Foundation Flanders (grant 3G065910) for financial
support.
References
Mathers et al, British Medical Bulletin 7:3292, 2009
Hellings et al., J Card Surg, 115:12647, 2006
Balzani et al, Acta Biomat. 609:6182, 2006
529
P 16 3
ASSESSMENT AND RELEVANCE OF VENTRICULAR

WALL STRESS IN CARDIOLOGY
L. Zhong1, D. Ghista2, R.S. Tan3
1
2
3
National Heart Centre Singapore, Singapore, Singapore
University 2020 Foundation, University 2020 Foundation, MA, USA
National Heart Centre Singapore, Cardiology, Singapore, Singapore
Left ventricular (LV) wall stress has intrigued scientists

and cardiologists since the time of Lame and
Laplace in 1800s. The left ventricle is an intriguing
organ structure, whose intrinsic design enables it to
fill and contract. The development of wall stress is
intriguing to cardiologists and biomedical engineers.
The role of left ventricle wall stress in cardiac
perfusion and pumping, energy metabolism, gene
expression as well as in cardiac pathophysiology
is a relatively unexplored phenomenon. In clinical
practice, when does elevated myocardial wall stress
activate cardiomyocyte death pathways, which
may be the critical factor underlying the distinction
between adaptive and maladaptive hypertrophy is
also unknown.
of left ventricle wall stress models, their mechanics,

stress computation and clinical relevance. We have
provided herein a compendium of major type of
wall stress models: thin-wall models based on the
Laplace law, thick-wall shell models, elasticity theory
model, thick-wall large deformation models and finite
element models. We have compared the mean stress
values of these models as well as the variation of
stress across the wall. All of the thin-wall and thick-wall
shell models are based on idealised ellipsoidal and
spherical geometries. However, the elasticity models
shape can vary through the cycle, to simulate the
more ellipsoidal shape of the left ventricle in the
systolic phase. The finite element models have
more representative geometries, but are generally
based on animal data, which limits their medical
relevance. This paper can enable readers to obtain
a comprehensive perspective of left ventricular wall
stress models, of how to employ them to determine
wall stresses, and be cognizant of the assumptions
involved in the use of specific models in cardiology.
Myocardial stress cannot be measured directly.

Therefore, a mathematical framework is needed to
indirectly obtain stress-estimations from measured
anatomy and cavity pressure. In this paper, we are
responding to the need for a comprehensive review
530
P 16 4
TOWARDS A FULL UNDERSTANDING OF THE LINK

BETWEEN OESOPHAGEAL STENT DESIGN
AND ITS CLINICAL OUTCOME
M. Peirlinck1, B. Verhegghe1, P. Segers1, M. De Beule1
1
Ghent University, Electronics and Information Systems, Gent, Belgium
Introduction
Endoscopic placement of a self-expanding stent
is an established treatment for both malignant
and benign oesophageal strictures. Despite the
constant technological innovations in oesophageal
stent designs, it still remain unclear how the designintrinsic mechanical behaviour of the stent relates
to its clinical outcome for the patient. Previous
research focused on in-vitro measurements of
device characteristics such as radial force and
flexibility in an attempt to relate these factors to
clinical outcome [Hirdes M. et al, 2013]. As more
factors are involved in in-patient stent behaviour,
we developed a numerical framework in which a
(biodegradable) polymeric braided wire stent gets
virtually implanted in an oesophageal anatomy.
Figure 1: V
irtual stent implantation procedure and pressure
exerted by the stent on the oesophageal wall
(blue-red: 040mmHg)
Discussion
This biomechanical analysis is the first study on the
mechanical behaviour of oesophageal stents in
an in vivo setting. The stents radial and axial force
data alone are insufficient to study the association
between stent design and size on the one hand
and clinical outcome on the other. Factors such
as the used material, the wire diameter, the cell
size and the braiding angle further affect the
stents in vivo behaviour. As the stress distribution
within the oesophageal wall also depends on the
oesophageal geometry, we are currently refining
this framework by implementing patient-specific
oesophagus models (see Figure 2) into the
framework.
Methods
We generated finite element models (FEM) of
both an oesophageal stent and an oesophagus
in order to perform a virtual stent implantation
procedure. Regarding the stent, we chose for the
first biodegradable oesophageal stent introduced
in Europe, the Ella-BD stent. To calibrate the
developed FEM of this polymeric braided wire stent,
we performed in-vitro compression and tensile
tests. The stent model was validated in an-vitro
degradation study, in which the stent was conserved
in a phosphate buffer solution for 10 weeks.
The models predicted evolution of radial strength
throughout time and the degradation studys results
corresponded. The oesophagus was modelled as a
simplified two-layered tube with both the mucosal
and muscular layer having their own specific
material behaviour. A stricture was preliminarily
modelled as a local thickening of both layers. The
virtual implantation procedure itself combined
the two aforementioned FEMs by crimping the
stent onto a catheter and slowly pulling back
the crimping sheath allowing the stent to expand
within the oesophagus FEM (see Figure 1).
RESU L TS
The developed numerical framework gave us
specific insights in the chosen stents mechanical
behaviour on the oesophageal wall. The stresses
and strains throughout the oesophageal wall,
which play a role for functions of mechanosensitive
receptors in the wall related to remodelling and
mechano-
sensory function [Liao D. et al,
2004], have been obtained (e.g. see Figure 1).
Figure 2: P
atient-specific oesophagus model
References
Hirdes M. et al, Endoscopy, 45(12): 9971005, 2013
Liao D. et al, Med Eng Phys, 26(7): 535543, 2004
531
P 16 5
NON-INVASIVE ULTRASONIC METHOD TO ASSESS TOTAL

AXIAL STRESS OF THE COMMON CAROTID ARTERY WALL
M. Mokhtari-Dizaji1, E. Soleimani1
1
Tarbiat Modares University, Med Phys, Tehran, Iran
R e s u l t s a n d C o n cl u s i o n
Statistical analysis results showed that with stenosis
initiation and its progression, axial acceleration
and stress increase significantly. According to the
results of the present study, maximum axial stress of
the arterial wall is 1.7130.546, 1.9930.731 and
2.6100.603 (kPa) in normal, with less and more
than 50% stenosis in carotid artery respectively.
Whereas minimum axial stress is 1.7140.676,
1.9820.663 and 2.5930.661 (kPa) in normal,
with less and more than 50% stenosis in carotid
artery respectively. Moreover, internal diameter
and intima-media thickness of the artery also
increase significantly with stenosis initiation and its
progression. In this study, the feasibility of axial wall
stress computation for human common carotid
arteries based on non-invasive in vivo clinical data
is concluded.
Introduction
Mathematical description of mechanical behavior
of human arteries is an essential prerequisite
for vascular mechanics to realize its various
perspectives regarding the investigation of clinical
issues. In the present study, developing a new non
invasive method independent from blood flow,
we estimated and compared the total axial stress
of the common carotid artery wall in healthy and
atherosclerotic subjects over three cardiac cycles.
Consecutive ultrasonic images (30 frames per
second) of the common carotid artery of 48male
subjects including 16 healthy subjects, 16 subjects
with less and 16 subjects with more than 50 %
stenosis in carotid artery were recorded and
transferred to a personal computer. Longitudinal
displacement and acceleration was extracted
from ultrasonic image processing using a block
matching algorithm. Furthermore, images were
examined using a maximum gradient algorithm
and time rate changes of the internal diameter
and intima-media thickness were extracted. Finally,
axial stress was estimated using an appropriate
constitutive equation. Extremum and mean values
of all parameters were analyzed with statistical
analysis of ANOVA.
We found a strong and graded association

between axial stress and severity of carotid stenosis,
which might be used to discriminate healthy from
atherosclerotic arteries.
532
P 16 6
THE STRUCTURAL FAILURE OF IMMATURE BONE

IN FOUR-POINT BENDING AND TORSION
V.S. Cheong1, A.M.J. Bull1
1
Introduction
Radiological features alone do not allow the
discrimination between accidental paediatric
long bone fractures or those sustained by child
abuse. Moreover, most existing work on bone
fractures have focussed on the geriatric population
(Forman et al., 2012), or for automotive injury
prevention (Kress et al., 1995; Ouyang et al.,
2003). Only three studies have investigated the
fracture tolerance of the immature population,
but inconsistent fracture patterns were obtained
(Forman et al., 2012; Ouyang et al. 2003; Pierce
et al. 2000). Moreover, no four-point bending
or torsional loading test has been conducted
across strain rates or at para-physiological loading
conditions where household injuries are likely to
occur. There is thus a clinical need to characterise
the mechanical behaviour and fracture patterns
of immature bone across strain rates to the point
of failure.
Figure 1: H
igh-speed video recordings of (A) oblique, (B)
transverse and (C) spiral fracture pattern.
Discussion
No previous study has conducted four-point
bending of immature bone to failure and this work
represents the first attempt to do so. No oblique
fracture was generated below the strain rate of
0.08s 1, which indicates a clear shift of fracture
pattern generated from transverse to oblique as
the strain rate increases. In torsional loading, no
prior work managed to generate spiral fractures
consistently in immature bones. The fracture
pattern produced is invariant of strain rates, but
the appearance of comminution or multiple
fractures may be a function of the fracture force.
Therefore, the results from this study show that there
is a differentiation of fracture patterns, and the
results from this study would be useful in building
computational models to forensically analyse the
loading required to produce an observed fracture
pattern.
Methods
Four-point bending and torsional tests to failure
were conducted on custom-designed testing rigs
to characterise the structural behaviour of ovine
immature bones (Table 1). A novel subject-specific
reference system, based on the bones geometrical
properties, was used during testing for alignment
purposes to enable the bone to approximate a
state of pure bending and torsion.
Type of test
Strain rate
Four-point bending
(posterior side in tension)
0.003-0.004s -1, 0.08-0.1s -1

and 0.1-0.4s -1
Torsional loading
(extra-rotation)
0.006-0.02s -1
and 0.07-0.2s -1
Table 1: Details on the four-point bending and torsional

loading tests conducted.
Results
Transverse, oblique, and spiral fracture patterns
were consistently reproduced (Figure 1). High-speed
video recordings showed that all crack initiation
took place in less than 0.1 ms. Moreover, the
immature ovine tibiae behave linearly up to failure
for quasi-static and para-physiological strain rates
and a significant increase in bending stiffness was
found when the strain rate was increased from
0.0030.004s 1 to 0.080.4s 1.
References
F orman et al, IRCOBI, 40:524539, 2012.
K
ress et al, IRCOBI, 23: 155169, 1995.
Ouyang et al, Chinese J of Clin Ant, 21:620623, 2003.
P
ierce et al, J Orthop Trauma, 14:571576, 2000.
533
P 16 7
AUTOMATION OF HUMAN IDENTIFICATION

PROCESS FROM GAIT PARAMETERS
D. imk1, A. Galajdov1, V. Porada2
1
2
Technical University, Automation, Control and HMI, Koice, Slovak Republic
VSKV Karlovy Vary, Katedra trestnho prva, kriminalistiky a forenznch discipln, Karlovy Vary,
Czech Republic
Results
Proposed method was tested only on small
database. Within this database we were able
to identify object and assign its identity within a
database of persons with 95.92 % success rate.
Introduction
The aim of this work is to form a motion formula
for mathematical and statistical analysis of gait
parameters, through which we are able to identify
the studied object and assign the uniqueness of
the person gait to existing entity.
Discussion
Next work will continue with bigger database of
gait measurement, to support results of this work.
Methods
We worked with database of gait measurements
from ten persons. Angle trajectories in 25 points for
each subject were measured during normal speed
gait of persons. These trajectories were evaluated
with aim to reduce their number and to choose
the most important parameters for classification
with acceptable accuracy within ten persons
group by multi-criteria analysis. The selected group
of features is a specific model of gait formula
that enables us successfully distinguish persons at
comparison within a group. With this formula, we
are able to assign the identity of person, which has
the most significant compliance of joint motion
features with a particular entity
References
B
oyd, J.E., Little, J.J.: Biometric Gait Recognition.
[online].University of Calgary, University of British
Columbia.
H
ossain, S.M.E., Chetty, G.: Next Generation
Identity Verification Based on Face-Gait Biometrics.
[online]. Australia, University of Canberra,
2011 [s.a.]. [cit. 2014 143
Jain, A. K., Flynn P., Ross, A. A.: Handbook
of Biometrics. New York: Springer: 2008, 550 s.
ISBN-13: 978-0-387-71040-2
P
orada, V., imk, D., et. al.: Identifikace osob
podle dynamickho stereotypu chuze. Praha:
Druckvo, Vysok kola Karlovy Vary, 2010.
311 s. ISBN 978-80-87236-01-7
S harma, S., Tiwari, R.,Shukla, A.,Singh, V.: Identification of People Using Gait Biometrics. [online].
International Journal of Machine Learning and
Computing, Vol. 1, No. 4, 2011
534
P 16 8
BIOMECHANICAL INJURY CRITERIAS

FOR THE INVESTIGATION OF ROAD ACCIDENTS
WITH TWO WHEELERS
J. Dias1, S. Carvalho2, P. Francisco2, F. Vieira2
1
2
University of Lisbon, Instituto Superior Tcnico, Lisbon, Portugal
University of Lisbon, LAETA, IDMEC, Instituto Superior Tcnico, Lisbon, Portugal
Introduction
Two wheelers accidents (bicycles, mopeds,
scooters, and motorcycles) represent a major
concern in Europe especially due to the
vulnerability of their occupants.
Results
Several case studies are analysed and in each
one a simulation is validated using multibody
biomechanical models. In order to provide a
complete explanation of the methods and results,
a detailed case is presented.
In order to analyse the legal responsibilities of

an accident and how and why it happens it is
necessary to perform an accident reconstruction.
A detailed analysis of injuries and its correlation
with computational methods is crucial for a
detailed in-depth investigation of accidents
involving vulnerable road users (Carvalho 2013).
To accomplish this, a methodology to evaluate
and validate biomechanical injury criterions from
the results of accident simulation softwares such
as Pc-Crash is presented. The validation of the
criteria is achieved by comparing the obtained
results from accident reconstructions with clinical
and/or medico-legal autopsy reports. This
methodology establishes injury criteria for each
body part. Following a similar structure as it may
be found in the literature, the considered regions
include the head, neck, thorax, abdomen, pelvis,
lower and upper extremities.
Using the data available from medical and/or

forensic reports, the results from simulations are
compared as global, i.e, the fatality probability,
using the ISS (Injury Severity Score), and the AIS for
each body region. The methodology used does
not only reveal itself to be adequate to predict the
life risk of the TW accident victims but also to be
used in each body region to predict the severity
of localized injuries. Moreover, two examples
are included to demonstrate that this method is
suitable to be used in the reverse approach, i.e,
to use the victims injuries severity data to optimize
the accident reconstruction simulation using the
same methodology.
Discussion
The validation of the injury criteria for 2-wheeler
occupants, is obtained with biomechanical models
applied to road traffic accident reconstruction.
Methods
Accident reconstruction computational techniques
using two wheeled vehicles riders biomechanical
models are used to evaluate the conditions of the
accidents that lead to the injuries, as the speed
and the impact location. For that biomechanical
injury criterias as the AIS (Abbreviated Injury Scale),
the HIC (Head Injury Criterion) and other injury
criterions based on the resulting accelerations in
the pedestrians body (Schmitt 2007) are used.
The methodology presented in this work enables

the application of an inverse procedure, i.e., to
optimization of the accident simulations based on
the victims clinical and/or medico-legal autopsy
reports, by changing the simulation parameters
in order to achieve a better adjustment between
the observed injuries severity score, and the score
predicted by the simulations results using a specific
model.
References
S chmitt, et al, Springer-Verlag, 2007.
C
arvalho, S., Ms. C Thesis, 2013.
Y
oganandan, et al, Accid Anal Prev, 42(9):
11771192, 2009.
The injuries for each body part are obtained in an

AIS (Abbreviated Injury Score) evaluation, except
for the upper extremities, where only fractures
occurrence are used, based on risk factor
(Yoganandan 2009).
535
P 16 9
COMPARISON OF MULTI-SEGMENTAL KINEMATIC

BETWEEN NORMAL AND FLAT FOOT DURING SQUAT
PHASE OF ANTERIOR AND LATERAL STEP DOWN TEST
L. Yi1, C. Ferreira1, P. Lucareli2
1
Federal University of So Paulo, Human Movement Science, Santos, Brazil

2
Nove de Julho University, Rehabilitation Science, So Paulo, Brazil
Introduction
The three-dimensional kinematic analysis has been
allowed to understand the behavior of normal and
flat feet that are more prevalent in asymptomatic
adult during gait. However, little is known how they
behave in closed kinetic chain functional tasks.
The aim of this study was to compare the multisegmental kinematic behavior between normal foot
and flatfoot during squat phase of the Anterior and
Lateral Step Down (ASD and LSD) functional tests.
According to Foot Posture Index, feet were classified

in the following types: normal foot (n=18) and flatfoot
(n=24). Nine trials of squatting of each test (ASD
ad SDL) were collected bilaterally using the Oxford
Foot Model and three-dimensional motion capture
system. The range of motion (ROM) was analyzed in
the three planes of motion for the segments: hindfoot
relative to the floor (HFTFL); hindfoot relative to the
tibia (HFTBA); forefoot relative to the tibia (FFTBA);
forefoot relative to the hindfoot (FFHFA). For statistical
analysis the MANOVA test was used, adopting an
alpha error of 5% (p0.05).
Twenty volunteers (40 feet) were evaluated.
Table 1: Comparison of the mean and standard deviation of the ROM and effect size between normal foot and flatfoot.

Differences were found between the groups in the
sagittal plane for the following segments: HFTFL e
FFHFA in both tests and for HFTBA during the SDL.
In the frontal plane the groups showed differences
only for the FFHFA in ASD. The flatfoot performed
lower ROM for all segments, except for the HFTBA.
The weakness of the intrinsic muscles, usually
found in the flatfoot, may have affected the load
absorption mechanisms and their suitability to
the supporting surface. The high dorsiflexion ROM
of HFTBA for the flatfoot could be considered a

strategy for the implementation of squat, due the
lower mobility of other segments of the foot.
C o n cl u s i o n
During squat phase of the ASD and LSD, the flatfoot
performed lower ROM for all segments, except for
the HFTBA in the sagittal plane. The high dorsiflexion
indicate a strategy for the implementation of the
squat to compensate the lower mobility of other
segments of the foot.
536
P 17 0
TORSIONAL JOINT STIFFNESS OF LOWER EXTREMITIES

IN THE TRANSTIBIAL AMPUTEE WEARING PROSTHETIC
ADAPTIVE ANKLE FEET DURING LEVEL WALKING
C.Y. Ko1, J. Ryu1, S.B. Kim1, J.K. Kim1, Y. Chang1, S. Kim1, M. Mun1
1
Korea Orthopedics & Rehabilitation Engineering Center, Research Team,

Incheon, Korea, Republic of Korea
Introduction
Torsional joint stiffness (TJS) has been widely
evaluated for further understanding the lower
extremities` mechanics and considered to develop
new prosthesis or rehabilitation systems. Previous
study showed that ankle`s TJS affected adaptation
of other joints` TJS1. This study aimed to evaluate
TJS in the transtibial amputee with and without
PAAFs during level walking.
of TJS between ESRF and AAFs was the highest in

the ankle and was the smallest in the hip. For the
amputation leg, the tendency of differences of TJS
between ESRF and PAAFs in the knee and hip was
analogous to sound leg.
As a result, prosthetic feet caused asymmetry of
TJS in the knee and hip between the sound and
amputation legs, particularly higher asymmetry in
the knee. Furthermore, PAAFs reduced TJS in the
ankle, knee and hip in sound leg and the knee and
hip in amputation leg as compared to ESRF.
In this study, 3 male transtibial amputees were
involved. They wore ESRF, Proprio-Foot (ssur,
IcEland), lan and Echelon (Endolite, USA) and
walked the level ground. TJS were calculated
as the slope the moment-angle curve, which
acquired from motion analyses by Motion Analysis)
Motion Analysis Corp., USA) and force plates
(Kistler Corp., USA).
C o n cl u s i o n
Prosthetic feet affected TJS of the lower extremities
in both legs. AAFs affected TJS in both legs as
compared to ESRF, particularly more effects
in the knee.
References
1 Versluys et al., Prosthet Orthot Int, 33: 368377, 2009

In the sound leg, higher TJS was shown in the knee
than the hip. In contrast, the knee was less stiff in
the amputation leg than the hip. For the sound leg,
higher TJS in the ankle, knee and hip were shown
in ESRF than PAAFs. In particularly, the difference
This research project was supported by the Sports Promotion Fund of Seoul Olympic Sports Promotion Foundation from Ministry of Culture, Sports and Tourism.
537
P 17 1
IMPACT OF VISUAL DISORDERS ON THE ABILITY OF

MAINTAINING OF BALANCE IN A VR ENVIRONMENT
P. Wodarski1, J. Jurkojc1, R. Michnik1, A. Bieniek1, M. Gzik1
1
Silesian University of Technology, Faculty of Biomedical Engineering, Gliwice, Poland
Introduction
The ability to keep the balance is one of the crucial
element enabling normal human activity. It mainly
depends on the effective cooperation of the
senses of sight, feeling (including proprioception)
and balance. Imbalance diagnosis, treatment and
rehabilitation should be based on the examination
of all these senses. The tool which can ensure such
approach is a Virtual Reality Technology [1, 2, 3].
The aim of the study is to assess the impact of
separated visual stimuli on the ability to keep the
balance.
Results
Examples of the results of the FFT and the STFT for
study with small amplitude in closed scenery is
shown in Fig. 2.
Methods
A group of 78 healthy subjects took part in the
research (age: 2028). Studies were carried out
with the use of a system to spatial visualization of
sceneries (Cave system based on Virtual Reality
Technology) and Zebris FDM-S platform which
enabled measurements of Center of Foot Pressure
(COP) on the ground.
Figure 2: C
harts of FFT and STFT of the COP for study
with small amplitude in closed scenery is in
the sagittal plane
Discusion
On the basis of obtained results it can be noticed that:
p eaks obtained in FFT and STFT analysis shows
the influence of external, visual disturbances on
ability to keep the balance
there is decrease of the amplitude of the dominant
component in time. This is the result of getting
used to disturbances. Change of the disturbance
frequency cancels the effect of habit
greater values of COP amplitude were measured
for the closed scenery
t he frequency 0.7 Hz had the greater impact on
tested persons than 1.4 Hz
t he effect of getting used to disturbances is
slightly bigger for the closed scenery
c omparison of two types of tests (increasing
and decreasing of the disturbances frequency)
shows that there are no significant differences
in terms of the effect of getting used to visual
disturbances.
Two sceneries were developed: closed (simulating

a closed room) and open (a meadow with trees
and a horizon in the distance) (fig.1). Sceneries
were used to implement visual disturbances based
on translational and rotational movements of the
surrounding space.
References
[1] Michnik R. et al, Arch Budo, 10 p.133140, 2014
[2] Kasse A.C. et al, Braz J Otorhinolaryngol. 76(5),
p. 6239, 2010
[3] McAndrew P. et al, Journal of Biomechanics 43,
p. 14701475, 2010
The following tests were conducted: referential

test (standing for 30 seconds) and tests with various
amplitudes and frequencies of sceneries motion.
Changes of COP position for each test were measured.
The analyses of COP displacements were carried
out by means of a Fast Fourier Transform FFT and
short-term Fourier transform STFT
538
P 17 2
EFFECTS OF PHYSICAL FATIGUE CAUSED BY RUNNING

AS WELL AS SQUATTING EXERCISE ON VARIABILITY
DURING WALKING
S. Niederer1, W.R. Taylor1, P. Koopmans1, N. Knig1, N. Singh1
1
ETH Zrich, Institute for Biomechanics, Zrich, Switzerland
Introduction
Walking is one of the most common activities
of daily living. During repetitions of walking
intercycle variations are observed and these
have been associated with functioning of the
human sensorimotor system and its interaction
with the environment [1]. It is therefore likely
that an assessment of gait variability will allow
characterization of neuromotor modifications.
the skin and tracked at 100 Hz using a 20 camera

motion capture system (Vicon, UK). Participants will
be requested to walk barefoot along the so-called
8-walk [3]. Variability will be represented as CV of stride
length, time and the MeanSD from trunk markers.
Results
An overall decrease in gait variability for CV of
stride time was observed post-fatigue, which
progressively increased to pre-fatigue values after
approx. 28 strides (Table 1). Furthermore, there was
a 15% increase in MeanSD in the vertical direction
of the pelvic marker post-fatigue. The running
fatigue protocol showed an increase in the CV of
stride length and time post-fatigue (Table 1).
Physical fatigue, a task related perturbation,

known to occur during sustained activity leads to
neuromotor modifications such as incapability to
produce a certain force [2]. A direct comparison
of different types of sustained activity protocols
holds the key towards comprehensive assessment
of the neuromotor modifications and subsequent
effects on task performance. Therefore, this
preliminary investigation compares the neuromotor
modifications resulting from two different kinds of
exercise protocols on gait variability.
Discussion
Our preliminary results suggest differences in the
fatigue-related change in the amount of gait
variability among the two fatiguing protocols.
This would indicate that different neuromotor
modifications occur due to exercise duration,
intensity and task. Results from the squatting
exercise suggest a trend towards lower variability
in stride time during walking. This might indicate
increased rigidity during task performance [4].
In conclusion, different types of physical fatigue
might lead to specific neuromotor modification
resulting in differing effects on task performance.
Methods
We will recruit up to 10 healthy young subjects.
Participants will be performing all-out squatting
and running activities conducted on separate
days. Each activity session will be separated in
pre- and post-activity series. The pre-activity series
will include measurements of maximum voluntary
isometric contraction (MVIC) from knee extensors
upon warming up, followed by continuous walking
task conducted at self-selected walking speed [3].
Post-activity series will be similar to the pre-activity
series, performed after a reduction of 15% MVIC.
References
[1] Hamacher D, Interface, 2011.
[2] Singh NB, Plos One, 2012.
[3] Konig N, Gait Posture, 2014.
[4] Stergiou N, J Neurol Phys Ther, 2013.
The 3D kinematics of the feet and trunk will be

monitored using a set of 33 markers attached to
CV (11th stride)
CV (28th stride)
Pre-fatigue
Post-fatigue
Pre-fatigue
Post-fatigue
Stride time
0.018 0.006
0.014 0.005
0.017 0.003
0.017 0.002
Stride length
0.019 0.005
0.016 0.004
0.018 0.003
0.02 0.003
Stride time
0.016 0.002
0.019 0.002
0.018 0.004
0.024 0.004
Stride length
0.03 0.001
0.031 0.001
0.026 0.01
0.039 0.01
Squatting (N = 5)
Running (N = 2)
539
P 17 3
EFFECT OF RECOIL DESTABILIZATION ON SOLDIER

PERFORMANCE: PRELIMINARY RESULTS OF THE STUDY
OF SWAY PATH EVOLUTION WITH TIME
S. Scataglini1, E. Truyen1, J. Gallant1, D. Van Tiggelen2
1
2
Royal Military Academy, Weapon Systems and Ballistics, Bruxelles, Belgium
Queen Astrid Hospital, Center for Musculoskeletal Medicine & Rehabilitation,

Bruxelles, Belgium
Introduction
Cost cuts in the Belgian Defence reduce the number
of training days that soldiers spend in the field or at
the shooting range. Question rises to what extend
training and experience influence the performance
level of our soldiers. Physical loading conditions
can be very intense and diverse. In shooting, recoil
energy provokes a perturbation on postural control
that can induce the COP to exit the base of support
with the risk of fall. [Mononen, 2008] found also that
postural balance is related to the shooting accuracy
both directly and indirectly through rifle stability.
Indeed it was shown that postural balance is a vital
component of a successful shooting performance.
[Era, 1996] investigated the postural stability and
skilled performance on top level and naive rifle
shooters. They showed a better control of the posture
in trained athletes, who were also able to improve
their stability in the last seconds preceding the shots.
However no many studies have been published of
recoil destabilization in time on soldier performance.
Fig 1: E
volution of COP during firing one shot (left)
and second burst of 10 shots (right).
In the second burst the soldier processes the

information of the outcome of the recoil.The
soldier used augmented feedback part of motor
learning process which is called Knowledge of
performance [Schmidt, 2013]. To evaluate the
effect of the destabilization in time we analyzed the
stability in standing at one minute and 5 minutes
after second burst of ten shots. We realized a
decrease of COP trajectory, as shown on figure
two.This means the soldiers was more stable.
Methods
The effect of recoil on soldier performance was
analysed with use of a pressure plate (1 meter)
synchronized with a 2D high speed camera (Photron)
and a 3D motion capture (Krypton). To evaluate the
effect of recoil in posture control we analysed the
soldier in standing. Then, we disturbed the motor
control system by firing shots three times: only one
shot, then a burst of ten automatic shots and to
conclude a second burst of ten automatic shots.
The firing rate of the burst is 10 shots per second.
During this acquisition we evaluate the effect of the
destabilization after 1 minute and 5 minutes.
Figure 1 shows the COP trajectory for two cases:
one shot (figure on the left) and a second burst of
ten shots (figure on the right).We observe a longer
trajectory than in the first case. In our case we
compare the sway path during the first burst of ten
shots and during the second ten shots. It emerged
that in the first ten shots the COP moves out of the
base of support and the soldier had to step out
to the platform. Therefore no measurement of the
COP movement during the first burst of ten shots
is available. During the second burst the shooter
anticipated and controlled his stability much
better, as can been seen in figure 1 on the right.
Fig 2: C
OP trajectory after 1 minute and 5 minutes after
the second burst of ten shots.
C o n cl u s i o n
Recoil destabilization affects soldier performance.
Motor learning plays an important role and
therefore training and experience can influence
the soldier performance significantly.
References
K. Mononen et al, Relation between postural balance,
rifle stability and shooting accuracy among novice rifle
shooters. Scand J. Med Sci Sports 2007; 17:180185.
P. Era et al, Stability and skilled performanceA
study on top-level and naive rifle shooters.
J. Biomech. 1996 Mar; 29(3):3016.
R. Schmidt et al, Motor Learning and Performance,
5E-2013.
540
P 174
BIOMECHANIC ASSESSMENT OF GAIT

PATTERN IN MULTIPLE SCLEROSIS
L. Rusu1, M. Mihnea2, D. Mihai1
1
University of Craiova, Sports Medicine and Kinesiology, Craiova, Romania

2
University of Craiova, Applied Mechanics, Craiova, Romania
Introduction
Multiple sclerosis (MS) is a diseases of the central
nervous system. Studies have tried to present
aspects of postural control, foot control and gait
pattern in MS. The aim of this study is to present
the biomechanic assessment of gait in MS without
clinical gait disorders for predict the evolution of
gait[Pozzilli, 2002].
Discussion
Local asymmetry is a significant statistic for gait
and for comparison between right and left foot.
The biomechanic evaluation can be use for a
rehabilitation programme, regarding load of
foot-ankle, motor control and the coordination
of movement. Also the functional deficit of ankle
joint, which involves the changes of physiological
direction of force from shank to foot, meaning
a decomposition on the vertical and horizontal
planes. Loading is related to the muscle force
helps to understand proprioceptive stimulation
and motor control. It is a large zone for minimum
and maximum values for loading at heel region.
Foot balance is a feature of the foot influences the
heel contact in the next gait phase and related
to heel exorotation. Foot balance disorders are
present without clinical disorders and associated
with lack of a neutral foot position [Kelleher,2010].
Method
48 MS patients(46.04 10.99 years), included
in
primary
progressive
multiple
sclerosis.
Biomechanical foot evaluation was performed
using a force plate RSscan International. Recording
during 2 gait cycles, the distance for gait analyses
was 2.50 meters. The parameters: Loading rate
measured in the region load rate-LR (N/cm.s)
which is the upload speed in the assessed region;
Subtalar angle between talus and calcaneus,
constant walking-speed.
Biomechanic assessment helps to predict the
functional evolution of MS patients gait pattern,
helps the development of strategies for rehabilitation
that prevent the wrong position of the ankle foot,
produced by the lack of motor control. Clinicians have
the possibility to monitor the ankle foot function during
static and dynamic balance, and gait and to enable
proprioceptive training to enhance the afferents
(inputs) to nervous central system and develop some
way to increase motor control of the foot.
Results
Loading means the load of plantar region is made
and how proprioceptive stimulation occurs
(average value for left side is 0.116.13N/cms
and for right side is 0.172.80 N/cms). Subtalar
angle: It is important for ankle foot stability and
it has minimum average value of 1.18 for the
right foot and 4.27 for the left foot, and for a
maximum average value of 6.27 for right foot and
5.03o for left foot. Foot balance: without clinical
aspect of gait disorder, the foot is oriented on
exorotation and supination average values 59
and 10, negative values meaning exorotation
and supination.
References
1 Pozzilli C.et.al: J Neurol., 249:5056,2002
2 Kelleher, K.J. et.al: Disability and Rehabilitation,
32(15): 124250, 2010
541
P 17 5
ACCURACY OF THE NEW KINECT FOR XBOX ONE

IN PHYSIOTHERAPEUTIC EXERCISES OF THE LOWER BODY
R.P. Kuster1, C.M. Bauer2, B. Heinlein1, E. Graf2
1
ZHAW Zurich University of Applied Sciences, Biomechanical Engineering Institute

of Mechanical Systems School of Engineering, Winterthur, Switzerland
ZHAW Zurich University of Applied Sciences, Institute of Physiotherapy School of Health

Profession, Winterthur, Switzerland
Results
Kinect generally underestimated ROM, except for
thigh in HF (table 1). Thighs showed lower BAMD
and higher ICC and CMC as the pelvis. Highest
relative differences (BAMD70%) were found for
the pelvis in PT and HAS, while ICC was lowest for
pelvis in OLJ and HF (<.50). CMC of the pelvis was
in all exercises below 0.6.
Introduction
The quantitative description of human motion
is becoming increasingly important in clinical
settings. Typically, marker-based-systems (MBS)
or goniometers are used to measure range of
motion (ROM). MBS require high financial and
temporal effort and advanced technical expertise
[Mndermann 2006], while the use of goniometers
has only limited accuracy of around 5 to 10%
[Oesch, 2007]. In contrast, marker-less-systems
(MLS) are more affordable and easy to set up,
but current systems also have limited accuracy
[Pfister 2014]. Microsoft recently launched a new
generation of their MLS (Kinect for Xbox one).
However, no literature is available about the
accuracy of the new sensor with respect to the
clinical setting. Therefore, the aim of this study
was to analyse the accuracy of the new Kinect by
comparing it to Vicon (gold standard).
Table 1: R
ange of motion for Kinect and Vicon
(meanstandard deviation (SD)) with Bland-Altman mean difference (BAMD) in % of mean of both
systems, intra-class-correlation coefficient (ICC)
with 95% confidence interval, and meanSD for
coefficient of multiple correlations (CMC).
Methods
17 healthy subjects (33.29.4yrs, 1.73.07 m,
65.910.6 kg) provided written consent and
performed four physiotherapeutic exercises for the
lower body: pelvic tilt (PT), one leg jump (OLJ), hip
flexion (HF) (all standing), and hip abduction in
sitting (HAS). Data were simultaneously gathered
with Kinect (custom software based on Kinect
for Windows SDK 2.0) and a seven camera Vicon
MX system (Vicon Nexus 1.8.5 with Plug in Gait
marker model) and filtered (Butterworth 2nd order,
low-pass, cutoff-frequency: 2Hz resp. 7.5Hz for OLJ
due to higher moving speed). Body segments were
defined by each 2 adjacent joint centres: hip right
to hip left for pelvis, hip to knee for thigh. Pelvis
orientation in frontal (PT, OLJ, HF) and horizontal
plane (HAS) and thigh orientation in sagittal (HF)
and horizontal plane (HAS) was analysed. Systems
were compared using relative Bland-Altman
mean difference (BAMD) [Bland, 1986] and intraclass-correlation coefficient (ICC). Temporal
characteristics were analysed using Coefficient of
Multiple Correlation (CMC) [Ferrari, 2010].
Discussion
The new Kinect for Xbox one has a lower
accuracy than literature reports for the use of
goniometers by trained experts [Oesch, 2007].
Therefore, Kinect is deemed inadequate for the
motion analysis of the lower trunk in clinical settings;
the factory-software (and hardware) needs to be
revised in order to increase validity of the new
sensor. However, the analysis of the thighs showed
only minor differences in the ROM, indicating
better accuracy for extremities than trunk. Faster
movements showed no major differences as slower
(OLJ vs. PT).
References
Mndermann et al, J Neuroeng Rehabil,
3:111, 2006.
Pfister et al, J Med Eng Technol, 38:274280, 2014.
Bland et al, Lancet, 1(8476):307310, 1986. Ferrari et
al, Gait Posture, 31:540542, 2010.
Oesch et al, in: Assessments in der muskulo-skeletalen Rehabilitation, Verlag Hans Huber, 2007
542
P 176
EXTRINSIC RELIABILITY OF ANTHROPOMETRIC

MEASUREMENTS IN CLINICAL GAIT ANALYSIS
D. Krumm1, J. Cockroft2, F. Zaumseil3 , S. Odenwald1, T.L. Milani3 , Q. Louw2
1
Technische Universitt Chemnitz, Sports Equipment and Technology, Chemnitz, Germany

2
Stellenbosch University, Division of Physiotherapy, Stellenbosch, Republic of South Africa

3
Technische Universitt Chemnitz, Human Locomotion, Chemnitz, Germany
Introduction
Reliability of gait analysis systems is important for
clinical decision making [McGinley, 2009]. The
reliability of gait analysis is influenced by intrinsic
factors, i.e. individual variability, and extrinsic factors,
i.e. experimental procedures [McGinley, 2009].
examiner
leg
length
Extrinsic reliability in gait analysis is influenced by

several sources [Chiari, 2005]. One key source
of errors are anthropometric measurements
that depend on precise identification of bony
landmarks. Hence, the purpose of this study was
to evaluate inter-examiner (IE), inter-session (IS)
and inter-day (ID) reliability of anthropometric
measurements.
[mm]
[%]
IE
A&B
1.5
0.2
IS
3.6
0.4
1.3
0.1
3.4
0.4
2.2
0.2
IE
A&B
0.6
0.6
IS
0.7
0.7
1.1
1.0
ID
0.9
0.9
0.8
0.8
IE
A&B
0.4
0.5
IS
0.7
1.0
0.6
0.8
1.0
1.3
0.6
0.8
ID
knee
width
Methods
Six subjects (age: 38 10y) volunteered to
participate. The subjects anthropometric data,
i.e. leg length, knee width and ankle width,
were assessed with a measuring tape and an
anthropometer by two experienced examiners
(experience: 47y). For the evaluation of IE, IS and
ID reliability a total of 43 blinded measurement
sessions were performed. The extrinsic reliability
of subjects anthropometrics were estimated
using absolute (u abs) and relative measurement
uncertainties (urel) [DIN 1319-2, 1996].
ankle
width
mean Uabs mean U re
ID
Table 1: M
ean absolute (Uabs) and relative measurement
uncertainties (Urel) of subjects anthropometric data.
Discussion
Although not explicitly reported from the results
of Benedetti et al. [2013], relative measurement
uncertainties of 0.7 % for leg length, 1.2 % for knee
width and 3.1 % for ankle width can be inferred.
Hence, our study yielded extrinsic IE reliabilities
that were inferior to those. Reliable anthropometric
measurements in clinical gait analysis are required
since they directly influence the calculation of
joint kinematics. For instance, an overestimated
knee width estimates the knee too medial which
affects hip, knee and ankle frontal plane data.
Hence, in a prospective study the influence of
anthropometric measurements on joint kinematics
will be evaluated.
Results
The highest mean absolute measurement
uncertainty of subjects measured anthropometrics
was 3.6 mm and occurred for leg length
measurements performed by examiner A (Table
1). The highest mean absolute measurement
uncertainties for knee width and ankle width
amounted 1.1 mm and 1.0 mm, respectively.
Reliability of leg length, whose mean relative
measurement uncertainty amounted 0.3%, was
higher compared to reliability of knee width and
ankle width, whose mean relative measurement
uncertainties
amounted
0.8%
and
0.9%,
respectively. On average, examiner B had lower
measurement uncertainties and hence higher
reliability compared to examiner A. IE reliability of
anthropometric measurements was on average
marginally higher than IS reliability, which in turn
was on average marginally higher than ID reliability.
References
Benedetti et al, Gait Posture, 38(4):9349, 2013.
Chiari et al, Gait Posture, 21(2):197211, 2005.
DIN 1319-3: 1996-05.
McGinley et al, Gait Posture, 29(3):3609, 2009.
543
P 17 7
GAIT KINEMATIC RELATION BETWEEN GAIT PROFILE

SCORE (GPS) AND GAIT DEVIATION INDEX (GDI)
ON LOWER LIMBS
R. Cardenas1
1
Universidad del Rosario, Escuela de Medicina y Ciencias de la Salud, Bogota, Colombia
In Colombia the biomechanics values of gait

should be normalized to assessment the clinical
biomechanics gait on different pathologies
for example Parkinsons disease, hip and
knee replacement, osteoarthritis and another
orthopedic and neurological disorders. Currently,
clinical rehabilitation uses kinematic rates to
analyze the normal and pathological gait. The
main of this study is to compare the kinematic
relation between gait profile score (GPS) and gait
deviation index (GDI) on lower limbs of young
adults undergraduate students. The biomechanics
gait of the sample was evaluated using motion
analysis technology using BTS Smart-DX system with
four infrared digital cameras and two platform
forces. The protocol Davis was applied. The BTS
Smart-Clinic software was used to obtain the GPS
and GDI rates. The results were analyzed using
Wilcoxon matched pairs signed rank test. There
were not significantly differences on GPS and
GDI (p<0.05) between right and left lower limbs.
According literature, the GPS and GDI mean values
of low limbs suggest abnormal gait. In conclusion
this study might contribute to the development
of future researches with more sample size to
normalize results on the Colombian Population.
544
P 17 8
QUANTITATIVE ANALYSIS OF TEMPOROMANDIBULAR

JOINT FUNCTIONAL ANATOMY
V. Colombo1, I. Hugentobler1, L.M. Gallo1
1
University of Zurich, Dental school, Zurich, Switzerland
Introduction
Functional anatomy is defined as the study of
anatomy in its relation to function. Very often,
functional anatomy of joints investigates interactions
between morphology and kinematics in order to
understand their behaviour during function and
dysfunction. As a matter of fact, joint diseases
such as osteoarthritis can radically change the
relationship between joint shape and function.
were recorded by means of magnetic resonance

imaging at 1.5 T and jaw tracking. All TMJs were
then software modelled and animated with the
recorded kinematics. For every joint, the main
condylar axis (MCA), its length (LMCA) and its
angulation (MCA) in 3D were determined. Traces
and velocities of two specific condylar points,
i.e. medial pole (MP) and lateral pole (LP) were
calculated and statistically analysed.
To date, information about functional anatomy of

the temporomandibular joint (TMJ) in healthy and
pathologic subjects is still poor. Mostly, it relies on twodimensional anatomical images as well as on the
analysis of specific anatomical points, not allowing
for a whole insight into the joint [Palla, 2003].
Results
The anatomical parameters showed no significant
differences of the condyle length or angulation
among the three groups (LMCA = 20.50 1.85 mm,
19.172.08mm, 19.971.40mm; MCA=139.6813.75,
137.6910.31, 133.089.95 for GI, GII and GIII
respectively). However, condylar length was gender
dependent (p=0.02). The kinematic analysis
showed that, overall, the maximum velocity of
condylar points MP and LP were larger at closing
than at opening and LP was faster than MP:
Quantitative
analyses
of
the
mechanical
environment of the TMJ can be performed by
means of dynamic stereometry, a technique
that combines 3D software models of real joint
anatomy with corresponding 6 d-o-f jaw tracking. It
provides direct kinematic information and indirect
assessment of loading areas of joint soft tissues
[Gallo, 2005].
MP: Vopen = 58.5 21.6 mm/s Vclose = 88.3 44.2 mm/s,

LP: Vopen = 65.2 24.0 mm/s Vclose = 97.7 49.6 mm/s,
p=0.0001.
Aim of this study is the quantitative analysis of

anatomical and kinematic features of subjectspecific
TMJ
anatomies
three-dimensionally
reconstructed by means of dynamic stereometry.
Discussion
Although no statistical differences were found,
LMCA and MCA show a trend that could
appear clearer with increased sample size. Power
analysis run on the anatomical data showed
that at least 150 subjects should be tested to
determine statistically significant differences on
the anatomical data.
Methods
In this pilot study, 26 subjects (12 male, 14 female;
aged 22 to 64) were divided into three groups:
GI: asymptomatic (n=16), GII: subjects presenting
articular disc displacement without pain (n=5), and
GIII: subjects presenting articular disc displacement
with pain (n=5). Bilateral TMJ anatomy and jaw
opening/closing movements of each subject
References
Palla et al, Orthod Craniofac Res 6:3747, 2003.
Gallo, Cells Tissues Organs, 180:5468, 2005.
545
P 17 9
THREE-DIMENSIONAL HUMAN GAIT PATTERN:

REFERENCE DATA FOR NORMAL WOMEN
B. Pietraszewski1, S. Winiarski1
1
University School of Physical Education in Wroclaw, Biomechanics Department,

Wroclaw, Poland
Introduction
The aim of the investigation was to establish a
kinematic pattern of adult gait for motion analysis
system BTS Smart-E used in the research conducted
in the Laboratory of Biomechanical Analysis in
University School of Physical Education, Wroclaw.
Subjects sex, age and speed of gait is to be
considered in the kinematic normal gait pattern.
BTS Smart-E (BTS Bioengineering, Milan, Italy)

motion analysis system was used to record the
kinematics and dynamics of movement. The system
contained: 6 digital infrared cameras (1,1 mm) at
120Hz sampling frequency, two NetworkCam AXIS
210A visible range cameras at 20Hz frequency,
two tensometric Kistler forceplates type 9286A
and two Kistler amplifiers type 9865. The control
group gait was recorded once for each speed
(high, preferred, and low) in set of 8 repetitions
each containing 3 gait cycles (depending on gait
speed). All measurements were carried out in the
certified Laboratory of Biomechanical Analysis.
In addition to data published before [1], this report

aims at presenting gait pattern for an adult female
group for three speed levels: high (1), preferred (2)
and low (3).
Method
Twenty (20) healthy female university students
(22,01,0 y, 66.238,3kg and 1,710,07m)
participated in the research. The subjects ware
asked to walk the distance of circ. 6 meters with
three different speeds: high, preferred and low.
The subjects ware to select the speed themselves.
Results
The averaged speed for fast high speed was
1,870,27 m/s, preferred 1,360,17 m/s and low
speed 1,160,17 m/s. Figure 1 shows an example
angular course of movement variability in hip, knee
and ankle joints for the right limb in sagittal plane
for n=20 female subjects.
Discussion and results

Differences between the high, preferred and low
gait speed were noticeable. The increase in gait
speed was related to the change in the angular
range of motion in the hip joint sagittal plane.
The range of motion for this joint was 42, 45.8 and
53.3 deg (Figure 1) for low, preferable and high
speed of gait, respectively. Similar correlations
were observed in the knee joint area. The range
of motion in joints increased with the subjects
speed (60.7 high, 57.8 preferred and 56.1
low speed). No significant differences between
the range of motion and speed were observed in
the ankle joint (27.6 high, 27.4 preferred and

26.8 low speed).
Many measurement data can be found in the
literature, however many researchers claim [2] that
each laboratory, due to its specificity, should have
norms adjusted to its measurement conditions.
References
[1] Pietraszewski B., Winiarski S., Jaroszczuk S. 2012.
Acta Bioeng Biomech 14(3), pp.916.
[2] Whittle M.W., 2002. Gait analysis: An introduction
(4th Edition). Butterworth-Heinemann, Oxford.
546
P 18 0
HUMAN WALKING: MOTOR CONTROL

AND OPTIMISATION
D. Despotova1, P. Kiriazov2
1
Institute of Mechanics, Bulgarian Academy of Sciences, Biomechanics, Sofia, Bulgaria

2
Institute of Mechanics, Biomechanics, Sofia, Bulgaria
Introduction
Human body (HB) has many joints and complex
multibody and muscle dynamics. Control functions
(neural signals to muscles) have to achieve
optimal trade-off between, at least, three
important but contradicting performance indices:
locomotion speed, accuracy of steps, and energy
consumption.
Results
Our control concepts have been successfully
verified in numerous computer simulations. We
have considered 2D walking for a biped model
with six controlled joints. Satisfactory motion
performance has been achieved:
Performing a step in dynamic biped locomotion

is characterized by three phases: taking-off,
flying, and landing. The bipedal motion can
be considered as a composition of several
goal-directed movements with different dynamics
structures, which implies different control structures
for the corresponding phases.
For dynamic goal-directed movements, we can
apply an efficient control learning (CL) scheme,
[Kiriazov, 2005], [Kiryazov, 2010].
Figure 1: O
n steps performing in 2D.
Methods
We have been developing, [Kiryazov, 2010], a
generic design approach for controlled multibody
systems that perform goal-directed and/or
posture-stabilization motion tasks. Correspondingly,
the controllers are open loop and closed-loop
with bounded control functions. Correspondingly,
we apply the CL scheme and optimal robust
controllers. Our principal guideline in the control
structure design is, for any task, to have a fully
controllable system.
We have found that that our approach is very

promising and could be efficiently applied to more
complex human models. We think that in order to
achieve human-like locomotion, the human model
has to have at least eight links: trunk, pelvis, two
thighs, two shanks, and two feet.
Discussion
Our current research intention is to extend the
proposed approach to meet the next challenge:
optimal control synthesis of 3D humanoid
locomotion to produce efficient and naturally
looking walking. As the above proposed control
concepts are biologically plausible, they could
also be very useful in designing and controlling
leg prostheses as well as in neuro-muscular
rehabilitation of disabled people.
Of primary importance is to define a set of

variables that best characterize the dynamic
performance of the HB in the required motion task.
Then, to enable the HB to fulfill the task, driving
forces/torques are to be properly assigned.
Our approach is based on the real robot/human
dynamics and its control concepts are biologically
plausible. Moreover, the proposed CL approach
has the necessary mathematical guarantees for its
feasibility and fast convergence.
References
Kiriazov, P., (2005) Efficient Learning Control and
Adaptation in Dynamic Locomotion, In: Proc.
3rd Int. Symp. on Adaptive Motion in Animals and
Machines, Ilmenau, Germany, pp.18.
Kiryazov K. and P. Kiriazov, (2010) Efficient learning
approach for optimal control of human and robot
motion, in: Emerging Trends in Mobile Robotics,
Eds: H. Fujimoto et al 2010, 121927.
547
P 181
DIFFERENCES BETWEEN OVERGROUND AND TREADMILL

WALKING IN DYNAMIC STABILITY ASSESSMENT USING
FREQUENCY AND NONLINEAR ANALYSIS PILOT STUDY
L. Bizovsk1, Z. Svoboda1, M. Janura1, Z. Hirjakov2
1
Palacky University in Olomouc, Faculty of Physical Culture, Department of Natural Sciences in

Kinanthropology, Olomouc, Czech Republic
2
Slovak Academy of Sciences, Institute of Normal and Pathological Physiology,

Bratislava, Slovak Republic
and characteristics of accelerations within

stride mean, standard deviation, root mean
square and peak acceleration. Statistical analysis
was performed using one-way ANOVA and
Bonferroni post-hoc test, p-level was set as 0.05.
Majority of falls occur during dynamic conditions,

thus dynamic stability assessment is widely
discussed issue in literature. For stability assessment
during locomotion, many different approaches
have been used spatial-temporal and kinematic
characteristics [Beurskens, 2014; Konig, 2014;
Chang, 2010], nonlinear analyses [Bruijn, 2014;
Kang, 2008], frequency analyses [Riva, 2013] and
others. These variables can be computed from
signals recorded during overground or treadmill
walking trials. Scientific studies showed that gait
patterns in overground and treadmill conditions
seem to be different [Rosenblatt, 2010], thus the
aim of this study was to verify whether dynamic
stability variables computed by frequency and
nonlinear analyses are different in overground and
treadmill conditions.
The results showed that both short-term LE were

significantly lower during TW for all three axes.
Opposite situation was found in long term LE which
were significantly higher during TW. HR from vertical
and lateral accelerations were significantly lower
during OGW. HR computed from anterior-posterior
acceleration was significantly higher during OGW.
No significant differences were found for other
computed variables.
The results of this study showed that there are
significant differences between overground and
treadmill walking in nonlinear and frequency
variables describing dynamic stability. Lower
short-term LE during TW indicates increased gait
stability in comparison with OGW. On the other
hand, long-term LE increased during TW which
indicates decreased long-term stability during
TW. Higher value of HR from lateral acceleration
during TW indicates smoother and more stable
gait pattern in lateral direction, but lower value
of HR computed from anterior-posterior direction
during TW indicates instability. Several studies
aimed to research similar issues considering gait
characteristics during walking on the different
surfaces [Dingwell, 2001]. Since the aim of most
researchers is to analyze natural gait patterns, and
walking on the treadmill seems to change them, in
future, overground walking should be considered
when assessing dynamic stability during gait.
Ten healthy young adults participated in this

study 6 males, mean age 22.4years, height 1.78 m,
weight 71.2 kg. Walking protocol included two
walking trials, firstly 5 min walking overground
and then 3 minutes walking on the treadmill
(LODE Valiant, Lode, B. V. Medical Technology,
Groningen, Netherlands). Signal form a 3D accelero
meter (sampling rate 296.3 Hz, Trigno wireless
system, Delsys Inc., Natick, MA, USA) placed on
the L5 vertebrae was used for further analysis.
Participants walked overground (OGW) in a
25 walkway with their preferred walking speed
wearing comfortable sport shoes. The walking
speed was determined using two photocell
gates (Fitronic, Bratislava, Slovakia) placed in
the middle of the walkway with inner distance of
1.5 m. Since the participants walked through the
walkway 1420 times depending on the walking
speed, average speed was then computed from
all the intervals. This speed was set on the treadmill
afterward. The treadmill walking trial (TW) consisted
of 27 minutes of familiarisation, accelerometric
signal was then recorded during 3 minutes.
Accelerations were filtered using 2 nd order lowpass Butterworth filter with cut-off frequency 50 Hz
prior to further analysis. From each measurement,
140 strides were extracted. Dynamic stability
was assessed for all three axes using short-term
(through one step and one stride) and long-term
Lyapunov exponents (LE), harmonic ratio (HR)
References
Beurskens et al. J Biomech, 47:16751681, 2014.
Bruijn et al. Front Aging Neurosci, 6:104, 2014.
Chang et al. Hum Movement Sci, 29:977986, 2010.
Dingwell et al. J Biomech Eng, 127:2732, 2001.
Kang and Dingwell. J Biomech, 41:28992905, 2008.
Konig et al. J R Soc Interface 11(97), 2014.
Riva et al. Gait Posture, 38:170174, 2013.
Rosenblatt and Grabiner. Gait Posture,
31:380384, 2010.
548
P 18 2
FOOT KINEMATICS ANALYSIS IN EXTREME LOAD

B. Pankova1, P. Kubovy1, D. Ravnik2, K. Jelen1
1
Charles University in Prague Faculty of Physical Education and Sport, Dep. of Anatomy and
Biomechanics, Praha 6, Czech Republic
2
University of Primorska, Faculty of Health Sciences, Izola-Isola dIstria, Slovenia
Introduction
With the present lifestyle, the loss of natural
functions of the foot occurs with decreasing of the
mobility and activity of the foot in daily movements.
Although research on foot biomechanics is
widespread, questions about individual strategies
of movement of the foot are still arising, not only
during walking, but also in more extreme loading
situations. The foot kinematics changes during
locomotion in accordance with the motion
character. In the case of the vertical jump first
comes the subtalar joint pronation to absorb the
shock after the impact, when the maximum of the
arch flexibility is used. After that the foot supinates
to stabilize the medial arch to prepare for take off
[1], load transfers to the first metatarsal head and
the hallux [2]. The aim of this study was to describe
individual strategies of foot kinematics in extreme
loading during vertical jump on one foot and to
compare this parameter to the active function
and mobility of the foot.
the force process during the jump. The kinematic

parameters of 20 feet were compared with the
static parameters in the quasi-static stand. To
determine the active function and mobility of the
foot the routinely used clinical examination was
done, including the exercice small foot.
Results
Interindividual differences between the course of
the longitudinal arch angle and forefoot width
changes were found. Also the variability between
single perform jumps differed in each subject.
However, some statistical significant correlations
were registered between higher force impulse
(higher body weight) and lower medial arch
mobility; the lower medial arch mobility correlated
with lower medial arch. Lower medial arch also
correlated with higher forefoot width mobility. Also
different individual strategies of the take-off were
found some subjects used toe and some used
metatarsals to land. The force impulse when using
the toe to land was higher than when landing from
metatarsals, also higher mobility of medial arch in
active foot was found.
Methods
10 healthy people 237 years old, 7511 kg
were asked to do perform jumps on one foot to
maximal height, for 30 seconds. The 6 cameras
motion capture system Qualisys was used, markers
were applied according the Oxford model [3]
to anatomic points of the foot (Fig.1). D1MT=first
metatarsal head, NAV=os naviculare, MCAL=medial
calcaneus, D5MT=fifth metatarsal head. The
longitudinal
arch
angle
(D1MT-NAV-MCAL)
was captured as used in the study of Ferber et
al. [4], the next parameter to capture was the
forefoot width (D1MT-D5MT). Each parameter was
registered in maximal loaded and unloaded foot.
The tensometric plate Kistler was used to capture
Discussion
The foot kinematics in extreme load is probably
dependent on the active mobility of the foot. These
results can lead to improvement of understanding
the foot kinematics, to accomplish the sport
performance, physiotherapy or footwear.
References
[1] Glasoe et al., Clin Biomech, 79: 854859, 1999.
[2] Jacob, Clin Biomech, 16: 783792, 2001.
[3] Stebbins et al., Gait Posture, 23: 401410, 2006.
[4] Ferber et al., J Foot Ankle Res, 4, 2004.
549
P 18 3
ANALYSIS OF STATIC AND DYNAMIC IMAGING

DATASETS BASED ON COMPUTATIONAL METHODS
OF IMAGE REGISTRATION: A PERSPECTIVE OVERVIEW
J. Tavares1
1
Faculdade de Engenharia da Universidade do Porto, Departamento de Engenharia

Mecnica, Porto, Portugal
Introduction
Image registration is the process of transforming
an imaging dataset so that the features in it are
properly adjusted to the homologous features
in a second dataset. Computational methods of
image registration are frequently applied to static
and dynamic datasets.
terms of space combined with a linear temporal

transformation to cope with the time. Finally, the
registration is improved by iteratively optimizing a
similarity measure both in space and time.
Our registration methods have been used in several
applications, including in the analysis of plantar
pressure datasets, which is especially important in
biomechanical studies related to gait and posture;
in the diagnosis of Parkinsons disease based on
brain imaging; and in the building of enhanced
3D biomechanical models of organs and tissues,
including the bladder, the pelvic floor, the vagina
and the ear.
One of the registration methods that we have
developed starts by matching the features
segmented
in
each
dataset.
Then,
the
transformation is computed and applied to one of
the datasets.
Besides the feature-based method, we have
developed two methods based on the intensity
of all pixels (or voxels) in the datasets. One starts
by transforming the datasets from the Cartesian
space into the Fourier space. Then, the translation,
rotation and scaling are found and applied to one
of the datasets. To cope with local deformations,
a second method changes one of the datasets
locally in order to maximize a similarity measure.
C o n cl u s i o n
The feature-based methods are faster and more
robust to large deformations than the intensitybased methods. However, superior registration
results can be obtained if a local minimization
process is carried out. Also, the feature-based
methods can be more morphologically oriented,
which is an advantage in cases with datasets
acquired using different imaging modalities.
A method to register dynamic datasets in space

and in time simultaneously was also developed.
It starts by building a representative image for
each dataset. Then, the representative images
are registered in space, and the transformation
found is used to initially register the datasets in
This work has been partially developed
in the scope of the project with reference
PTDC/BBB-BMD/3088/2012,
financially supported by FCT.
550
P 18 4
MMP-13 ACTIVATABLE ALL GOLD FRET SUBSTRATE

PROBES FOR INFLAMMATORY ARTHRITIS
C.K. Wang1, C.Y. Lee1, C.H. Chen2, W.C. Hung1, M.L. Ho3
1
Kaohsiung Medical University, Department of Medicinal and Applied
Chemistry / Orthopaedic Research Center, Kaohsiung, Taiwan Republic of China
2
Kaohsiung Medical University, Department of Orthopaedics / Orthopaedic Research Center,

Kaohsiung, Taiwan Republic of China
Kaohsiung Medical University, Department of Physiology and Orthopaedic Research Center,

Kaohsiung, Taiwan Republic of China
Introduction
The main attraction of Forster resonance energy
transfer (FRET) is its sensitivity to very small
spatial changes (10100). [Wu, 1994] The gold
nanoclusters (GNCs) are good photostability, low
toxicity and exhibit bright fluorescence ranging
from the visible to the infrared. [Huang, 2009] Gold
nanorods (GNRs) have a phenomenon known
as the surface plasmon resonance (SPR) effect.
[Moskovits, 1985] Immuno-histological analysis
of osteoarthritis (OA) cartilage show increased
expression of matrix metalloproteinase-13 (MMP-13).
[Reiner, 2000] Here, we study the efficacy of all
gold FRET between the GQDs (Donor) and GNRs
(Acceptor), linked through specific peptide
sequences (PSs) for MMP-13 cleavage. Preliminary
results may offer inflammatory arthritis therapy as
an efficient and cheaper instrument in clinical
diagnosis potency.
at 37 C with various concentrations. It can be

observed a near proportional relationship between
MMP-13 quantity and fluorescence recovery,
shown in Fig. 2 (A). This would be represented
mathematically as y = 2.8752x + 35.34.
Methods
We synthesized GNRs with different aspect ratios
using a variety of different gold seeds by adjusting
Murphys technique. [Gole, 2004] However,
GNRss surface was modified by cysteamine and
coupled to the peptide containing the MMP-13
protease-specific
cleavage
site
(Glycine
(G)-Valine (V) bond) linked with GNCs. Lipoic
acid-protected GNCs were modified and synthesized
by a reductant strategy as previously reported.
[Shang, 2011] A GNCs colloid solution was added
to peptide-GNR solution at 25 C with stirring. The
unbound GNCs were separated by centrifugation.
The settlement was washed with deionized water.
To evaluate the quantity of fluorescence recovery,
100 ml solutions of various concentrations of
MMP-13 (Enzo Biochem, Inc, US) were incubated
with all gold FRET probes in reaction phosphate
buffered saline at 37 C for 2 day. Fluorescence
data were recorded using a fluorescence
spectrophotometer.
Figure 1: F luorescence spectra of GNCs colloid at initial

reaction concentration and the supernatant of
as-synthesized GNCs-peptide-GNR probe solution.
Figure 2: F luorescence spectra of MMP-13 activity were

detected after adding variable volumes of MMP-13.

Once the GNCs were successfully conjugated
to the peptide-GNRs, most of the fluorescence
signal (> 95 %) can be quenched compared
with the strong fluorescence signal of the initial
reaction GNCs amount (Fig. 1). The settlement
of the all gold FRET probes after centrifugation
showed almost no fluorescent signal in reaction
buffer due to the quenching capacity of the GNRs
on the emitting GNCs fluorophores. This all gold
FRET probes were incubated with MMP-13 buffer
References
Gole A. et al, Chem Mater, 16:36333640, 2004.
Huang C. et al, J Mater Chem, 19:755759, 2009.
Moskovits M. et al, Rev Mod Phys, 57:783826, 1985.
Reiner A. et al, Arthritis Rheum, 43:673682, 2000.
Shang L. et al, Small, 7:26142620, 2011.
Wu P.G. et al, Anal Biochem, 218:113, 1994.
551
P 18 5
AN INTRAVASCULAR ELASTIC MODULUS IMAGING

TECHNIQUE FOR LIMITED DEPTH PENETRATION
ULTRASOUND SIGNALS
A. Tacheau1, F. Deleaval1, S. Le Floch2, G. Finet3 , S.K. Yazdani4 ,
R.I. Pettigrew5, G. Cloutier6 , J. Ohayon7
1
2
Laboratory TIMC-IMAG-UJF-CNRS UMR 5525, DyCTiM Group, Grenoble, France
University of Montpellier, Laboratory LMGC- CNRS UMR 5508, Montpellier, France

3
Hospices Civils de Lyon, INSERM Unit 886, Lyon, France
University of South Alabama, Department of Mechanical Engineering, Mobile, AL, USA

5
6
7
National Institutes of Health, NIBIB, Bethesda, MD, USA
University of Montreal Hospital, LBUM, Montreal, Quebec, Canada
Laboratory TIMC-IMAG-UJF-CNRS UMR 5525 and University of Savoie, DyCTiM Group,

Grenoble, France
Introduction
Although past studies have identified fibrous cap
thickness (Cap thick) as the primary predictor of
coronary vulnerable plaque (VP) rupture, several
biomechanical studies have recognized peak
cap stress (PCS) as an additional key predictor
of VP disruption [Finet, 2004; Ohayon, 2013].
Quantification of PCS amplitude requires not only
an accurate description of VP morphology but also
a precise knowledge of the mechanical properties
of plaque components. A recent approach
(named iMOD for imaging modulography) has
been conducted by our group to reconstruct
the Youngs modulus map (i.e. modulogram)
from intravascular ultrasound (IVUS) strainelastogram [Le Floch, 2012]. However, one
major limitation of such a method is the need to
accurately estimate the strain field in the entire
cross-sectional wall, which may be often difficult
when using intravascular imaging techniques with
limited (or strongly attenuated) depth penetration
signals. Therefore, an extended iMOD approach
(E-iMOD), based on the continuum mechanics
theory prescribing the strain field in the limited
atherosclerotic endoluminal region, was designed
and successfully applied to coronary lesions of
patients imaged in vivo with IVUS.
distributions were obtained by performing static FE

computations on the entire VP geometries under
the assumption of plane strain. Inverse problem: The
E-iMOD algorithm first consisted in extracting, in the
endoluminal domain of interest, the intraplaque
heterogeneity contours using a strain dependent
criterion very sensitive to the spatial derivative of
the Youngs modulus [Le Floch, 2009]. Second,
based on the resulting pre-conditioning regions
and knowing the displacement field in the outer
boundary of the endoluminal region of interest, an
optimization procedure which minimized the root
mean squared (RMS) error between the computed
and the measured radial strain fields, was
conducted to obtain the elasticity map.
R e s u l t s a n d C o n cl u s i o n
The proposed E-iMOD method appeared to be
efficient and robust for the detection of sites of
heterogeneity as well as for the identification of
the Youngs moduli of the necrotic core and fibrous
region (mean values found 12.0 3.0 kPa and
798.8 69.7 kPa instead of expected values of 5 kPa
and 800 kPa, respectively). This study demonstrates
the potential of the new IVUS E-iMOD modulography
approach to detect and accurately characterize
the mechanical properties of coronary VPs in spite
of the use of intravascular imaging techniques with
limited depth penetration signals.
Methods
Five patients underwent coronary intravascular
ultrasound, and the extracted plaque geometries
were used to simulate strain fields from which
the performance of the E-iMOD approach was
tested. The IVUS echogenecity aspects were used
to characterize atherosclerotic VP components.
Forward problem: The mechanical properties of
the fibrous regions, calcified inclusions and soft
necrotic cores were modelled as isotropic and
quasi-incompressible media (Poisson ratio =
0.49) with Youngs moduli E fibrosis = 800 kPa, E calcified =
5000 kPa and E core = 5 kPa, respectively. A realistic
pressure gradient P of 1 kPa (or 7.5 mmHg)
occurring between two successive IVUS images of a
recorded IVUS sequence was assumed. Simulated
measured displacement and radial strain
Research supported by the ANR (MELANII project
# 09-BLANC-0423) and NSERC strategic grant #STPGP-381136-09. F. Deleaval and A. Tacheau held
a doctoral fellowship from la Rgion Rhne-AlpesFrance (201013) and University Joseph Fourier AGIRFrance (201417), respectively.
References
Finet et al, Coronary Artery Disease 15:1320, 2004.
Le Floch et al, Ultrasound Med Biol, 38:208497, 2012
Le Floch et al, IEEE Trans Med Imag, 55:570121, 2009
Ohayon et al, Ann Biomed Eng, 42:26979, 2013
552
P 18 6
POSSIBILITY OF DUAL-ENERGY CT
IN DIAGNOSING PSEUDOGOUT
R. Ogawa1, H. Tanikawa1, K. Namiki2, H. Watanabe2, S. Tominaga2,
K. Harato3 , K. Okuma1
1
Saitama Municipal Hospital, Department of Orthopedics, Saitama, Japan

2
Saitama Municipal Hospital, Department of Radiology, Saitama, Japan
School of Medicine, Keio University, Department of Orthopaedic Surgery, Tokyo, Japan
Introduction
Dual-Energy CT (DECT) has been shown to detect uric
acid with high specificity, and is being implemented
in the diagnosis of gout [Nicolau, 2012]. Pseudogout
is caused by deposition of calcium pyrophosphate
dehydrate (CPPD) crystals and occurs in various
joints. We report on the possibility of using DECT
to detect CPPD crystals, which could lead to a
noninvasive method of diagnosing pseudogout;
especially when arthocentesis is risky, such as in
crowned dens syndrome.
Methods
CT images at 80 kV and 140 kV of the effected
joint of four patients suspected for crystal-induced
arthritis were obtained using a DECT system
(SOMATOM
Definition,
Siemens
Healthcare,
Forchheim, Germany). Areas of crystallization
were identified, and CT values at 80kV and 140kV
were determined using an image-processing
software (ImageJ, U.S. National Institutes of Health,
Maryland, USA). CT values at 80kV were plotted on
the x-axis, CT values at 140kV were plotted on the
y-axis, and linear approximation was determined.
Figure 1: C
T values of crystals in joints at 80kV and 140kV.
Discussion
Plots of CT values for base materials results in a
straight line due to the material-specific differences
in attenuation between the high and low tube
voltage acquisitions [Nicolau, 2010]. In this study,
the linear approximations are similar for the four
patients. Since CPPD crystals are proven in three of
the four patients, this linear approximation may be
specific to CPPD crystals. The dispersion of the plot
of patient 4 may be due to the small crystal size,
and to artifacts from dental implants. DECT carries
the demerits of high cost and radiation exposure,
however it may provide a noninvasive method
of diagnosing pesudogout. This is a preliminary
report, and further studies are needed to develop
a protocol to detect CPPD crystals with high
sensitivity and specificity using DECT.
Results
The linear approximation was y=0.49x+67,
y=0.58x+39, y=0.52x+49, y=0.52+54 for patients
1 to 4, respectively (Fig. 1). Patient 1 and 3 were
later diagnosed as pseudogout by arthrocentesis
and detection of CPPD crystals in the joint fluid by
polarizing microscope. Patient 2 later underwent
total knee arthroplasty, and histology of the
resected meniscus revealed CPPD crystals. Patient
4 received oral acetaminophen, and his neck pain
and fever resolved within a few days, and was
clinically diagnosed as crowned dens syndrome.
References
Nicolaou et al, AJR Am J Roentgenol,
194:10728. 2010.
Nicolaou et al, AJR Am J Roentgenol,
199:S7886. 2012.
553
P 187
THE EFFECT OF CRYOTHERAPY ON THE VASCULAR

REGENERATION IN SKELETAL MUSCLE FOLLOWING
CLOSED SOFT TISSUE TRAUMA
Z. Barani Lonbani1, D. Singh1, J. Peake1, M.A. Woodruff1, T. Parker1,
M. Schuetz1,2, R. Steck3
1
Queensland University of Technology, Institute of Health and Biomedical Innovation,

Brisbane, Australia
2
Princess Alexandra Hospital, Trauma Service, Brisbane, Australia
Queensland University of Technology, Medical Engineering Research Facility, Brisbane,

Australia
Introduction
Icing (cryotherapy) is commonly used for the
treatment of closed soft tissue trauma (CSTT). It
is believed that it induces vasoconstriction and
thereby reduces inflammation [Smith, 1994].
However, the impact of this treatment on the
healing of impaired vasculature and muscle tissue
remains controversial [Takagi, 2011]. Consequently,
we aimed to investigate the effect of cryotherapy
on the vascular morphology following CSTT by
using contrast-enhanced micro-CT imaging in a
rat model.
in the sham and control groups at days 1, 3 and 7,

post injury. While the injured legs of the sham group
exhibited a decrease in VN and VConn 28 days post
trauma, indicating a return to the original values prior
to trauma, these parameters had increased in the
icing group (Figure 1). Also, at day 1 post injury, VV
and VD of the injured legs were significantly higher in
the sham group compared to the icing group, which
may be attributed to the effect of vasoconstriction
induced by icing. Further histological evaluation
of day 1 post injury, indicated that although
cryotherapy significantly reduced the injury size and
influx of inflammatory cells, a delay in vascular and
muscle fibre regeneration was found at later time
points, confirming other reports from the literature
[Takagi, 2011]. These findings may be useful for the
development of future clinical monitoring, diagnosis
and treatment methods for CSTT.
Methods
54 rats were divided into three groups: control (no
injury, n=6), icing (CSTT, treated with one session of
ice block massaged on the injured muscle for 20
minutes) and sham (CSTT but no icing). The CSTT
was induced using an impact device to the left
thigh of anaesthetised male Wistar rats to create a
standardized and reproducible muscle injury [Claes,
2006]. Following trauma, animals were euthanized
after 1, 3, 7, and 28 days healing time (n=6 per
treatment and time point). For a three-dimensional
vascular morphological assessment, the blood
vessels of euthanised rats were perfused with a
radio-opaque contrast agent (Microfil, MV 122,
Flowtech, USA) using an infusion pump. Both hindlimbs were dissected, and 8mm diameter biopsies
from the region of the injured muscle imaged using
a micro-CT scanner (CT 40, Scanco Medical,
Switzerland) at 6 m resolution. The following
morphological parameters were determined:
vessel volume (VV), diameter (VD), spacing
(VSp), number (VN) and connectivity (VConn).
The biopsies were then analysed histologically to
confirm the results derived from micro-CT imaging.
Figure 1: T he average number of vessels per volume of the

biopsies from the injured legs normalized to the
contralateral non-injured legs (MeanSD), indicating higher values for the sham group at early time
points, and higher values for the icing group at the
latest time point.

The biopsies from the injured legs of the icing group
showed a significant reduction in VV, VN, VD,
VConn and an increase in VSp compared to those
References
Claes, L., et al, J. Orthop. Res., 11781185, 2006.
Smith, et al., Pathophysiol., 1(4): 229233, 1994.
Takagi et al., J Appl Physiol., 110: 3828, 2011.
554
P 18 8
AUTOMATED ALGORITHM EVALUATING

ORIENTATION OF STRUCTURES FROM POLARIZED
LIGHT MICROSCOPY IMAGES
S. Polzer1, K. Novak1
1
Brno University of Technology, Institute of Solid Mechanics, Mechatronics and Biomechanics,

Introduction
Polarized light microscopy (PLM) is generally
considered as a powerful method for detecting
and describing anisotropy of any specimens (from
crystals to soft connective tissues [Canham et al.,
1989]) which have the feature to turn the plane of
polarized light (PL), i.e. natural birefringence. This
method is inexpensive in comparison with other
methods like confocal microscopy or scanning
electron microscopy. On the other hand, this
method has three major drawbacks. Manual
measurements are time consuming and may
give operator-dependent results. Moreover, in its
basic setup (without quarter wave plate) it suffers
from the 90 uncertainty arising from PL principle
itself, i.e. it cannot distinguish between mutually
perpendicular structures. In this study we propose a
new optical setup and new automated algorithm
removing these drawbacks.
Figure 1: B
rightfield images and histograms of PL images.
Histograms confirm detection of angles above 100
in accordance with the micrographs. Angles are
measured from horizontal axis counter clockwise.
Methods
In order to distinguish between perpendicular
structures we have captured 8 mutually rotated
images of the investigated area under PL. Unlike
other investigators, we did not use mutually
perpendicular alignment of polarizing filters
(polarizer and analyser). Instead we set the
analyser to form an 80 angle with the polarizer.
This setup changes the periodicity of certain wave
lengths and allows us to determine the correct
angle within the full range of 180. The red and
green components of the passed light are used
to find the angle of their extinction on the basis of
phase correlation algorithm [Pratt, 2007] while the
blue component serves as a criterion which of the
two possible angles represents the true orientation
of the investigated structure. The algorithm was
verified on Achilles tendon tissue.
Discussion
We used previously proposed phase-correlation
algorithm [Novak et al., 2014]. The automated
algorithm was modified to trace all three
component of light spectrum, especially blue
colour having periodicity of 180 under the specific
orientation of PLM equipment. Results confirm
capability of the proposed algorithm to correctly
estimate the local orientations of birefringent
structures in whole 180 range without necessity of
incorporation of quarter wave plate.
This work was supported by Czech Science
Foundation project No.13-16304S.
References
Novak et al., WCCM XI Congress, Barcelona, 2014
Canham et al., Cardiovasc Res, 23: 973982, 1989.
Pratt, Digital image processing, 4th Edition, A John
Wiley & Sons, 2007
Results
Capturing and analysis of one sample took about
1.5hours and provides some 100k individual angle
values. Comparison of investigated tissue samples
with the obtained histograms shows clearly that
orientations are estimated within 180 range and
not just 90 range as shown in Figure 1.
555
P 189
INVESTIGATION OF THE NON-LINEAR

BEHAVIOUR OF TRABECULAR BONE USING
DIGITAL VOLUME CORRELATION
F. Gillard1, F. Pierron2, M. Browne1
1
University of Southampton, Bioengineering Science Research Group, Faculty of Engineering

& the Environment, Southampton, United Kingdom
University of Southampton, Engineering Materials, Faculty of Engineering & the Environment,

Introduction
The advent and increased uptake of laboratory
based high resolution computed tomography
(CT) scanning equipment now enables hitherto
unobtainable data rich quantification of internal
structures. Digital Volume Correlation (DVC) has
emerged recently as an innovative approach for
full-field displacement and strain measurements in
materials, particularly in conjunction with CT. The
present research utilises CT and DVC to ascertain
strain development in cancellous bone using fullfield displacement measurements. In addition, a
novel inverse method, the virtual fields method
(VFM) is applied to investigate the variation in
Poissons ratio and Youngs modulus of trabecular
bone during compression.
Methods
CT measurements were carried out using a
225kV/450kV Nikon/Metris HMX ST scanner (Nikon
Metrology) on a cubic specimen (15 mm 3) of
femoral cancellous bone. The specimen was
axially compressed at 0.4 mm increments using
a customised in-situ CT 5 kN tensile/compression
loading rig (Deben UK Ltd, UK). An incremental DVC
analysis (stepwise volume pairs) was performed
to generate full-field displacement and strain
measurements. A virtual field was defined away
from bone yielding and relationships between
strain, displacement and the constitutive equations
enabled the Poissons ratio and Youngs Modulus
to be calculated.
Figure 1: E
volution of incremental Youngs Modulus for bovine bone during compression.
Once failure initiated, Youngs Modulus and

Poissons ratio remained relatively stable as did the
load due to the formation of a crushed layer.
Discussion
This study has characterised the strain resolution
of DVC applied to CT volume images of bovine
trabecular bone under compressive loading. The
results demonstrated that the strain resolution
allowed significant strains to be measured prior to
and after the onset of bone failure. Coupling DVC
and VFM highlighted a decreasing trend in Poissons
ratio and Youngs modulus prior to the onset of
bone crushing. The intrinsic material behaviour
and structural composition play a fundamental
role in trabecular failure mechanisms [Morgan,
2001]; it is important that accurate modulus and
Poissons ratio data is available, especially for the
development of micro-CT based finite element
analyses, as errors in these will directly affect the
conclusions of the studies [Keaveny, 1997].
Results
From the noise study a strain resolution of 400
was determined for an optimum sub-volume
size of 64 voxels with a 50% overlap. The onset
of bone crushing occurred at ~1 % strain under
a compressive stress of 3.38 MPa. The Youngs
Modulus significantly decreased up to failure
(Fig 1.). Poissons ratio also decreased from 0.37 to
0.25. These decreases are thought to be caused
by the non-linear behaviour of bone as a result of
damage accumulation.
References
Keaveny TM et al, J Orthopaed Res.
15(1):10110, 1997
Morgan EF et al, J Biomech. 34(5):56977, 2001
556
P 19 0
CAN CT IMAGE DEBLURRING IMPROVE STRAIN

PREDICTION AT THE PROXIMAL FEMUR?
C. Falcinelli1, E. Schileo1, A. Pakdel2, C. Whyne2, F. Taddei1
1
2
Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Canada
Introduction
FE bone strength, derived from FE procedures
validated in-vitro, has been proposed to classify
osteoporotic fractures in-vivo. Our subject-specific
FE modelling procedure allowed us to obtain good
results not only in-vitro [Schileo, 2007] [Schileo,
2014] but also in-vivo [Falcinelli, 2014]. However,
some limitations in our FE results remain: i) high
peak errors in FE-predicted vs. experimental strain
values, particularly where the cortical bone is
very thin (i.e. femoral neck); ii) differences of up
to 37% between experimental and FE-predicted
failure loads despite high correlation between
experimental and FE-predicted values (R 2=0.89).
These discrepancies may be at least partly
explained by the presence of CT artefacts, e.g.
partial volume effect (PVE), which can lead to
errors in both bone surface geometry and intensity.
Recently, a CT image deblurring algorithm [Pakdel,
2012], designed to restore geometry and intensity
of thin bone structure, has been developed
in the Orthopaedic Biomechanics Laboratory
(Sunnybrook Research Institute, Toronto). The aim
of the present study was to verify if the inclusion
of this deblurring algorithm in the FE workflow can
improve the strain prediction accuracy at the
proximal femur.
strains derived from the deblurred data and

experimental strains were found, with slight
improvements over the FE models derived from
original CT. Comparing the accuracy indicators
obtained in the present study and those obtained
using FE models derived from original images, it
was found that: i) the correlation slightly improved;
ii) the slope was closer to 1, particularly for fall;
iii) RMSE and peak errors were also slightly reduced.
Methods
Eleven fresh-frozen cadaver femora were CT
scanned, and tested in fall and stance loading
configurations following experimentally published
procedures [Taddei, 2006]. Twelve strains gauges
located on the proximal femur were used to
measure strains experimentally. To employ the
deblurring algorithm, first an estimate of the 3D
Point Spread Function (PSF) was made for all the
cadaveric femoral CT images. The PSF was then
used within a deconvolution solver to minimize
blurring in the digital images and restore the
geometry and intensity values in the CT image
stacks. Using the deblurred CT images, FE models
of proximal femur were generated as reported in
[Schileo, 2007]. The deblurred FE-predicted strains
were compared with experimental measurements
and FE predicted strains derived from the original
CT datasets.
Fall
Deblurred
model
Reference
model
R2
0.92
0.91
Slope
1.07
1.17
Intercept (me)
RMSE (me)
199
241
RMSE %
9.0
10.9
Max. err. (me)
1136
1209
Max. err. %
51.6
54.9
Stance
Deblurred
model
Reference
model
R2
0.92
0.90
Slope
1.11
1.12
Intercept (me)
RMSE (me)
128
144
RMSE %
9.2
10.3
Max. err. (me)
598
715
Max. err. %
42.8
51.2
Table 1: A
ccuracy indicators on pooled data for FE models
tested in fall (above) and stance (below) configurations
Discussion
Starting from deblurred CT images in which thin
cortical features are better captured leads to an
improvement in the strain prediction accuracy
of CT based FE modelling. Incorporating PVE
reduction methods may extend further the benefits
realized by image deblurring. The extension to
bone failure modelling is planned next.
References
Falcinelli et al, Bone, 67:7180, 2014
Pakdel et al, Phys Med Biol, 57:80998116, 2012
Schileo et al, J Biomech, 40:29822989, 2007
Schileo et al, J Biomech, 47:35313538, 2014
Taddei et al, J Biomech, 39: 24572467, 2006
Results
Preliminary results from 4 femurs (pooled data) analysed both in fall and stance are reported in Table 1.
Strong agreement between the FE-predicted
557
P 19 1
USING AN INFRARED LASER IN OUTER BODY

MEASUREMENT: FEASIBILITY STUDY
G. Horst1, M. Fritzsche2, D. Rixen1
1
Institute of Applied Mechanics, Department of Mechatronics, Garching, Germany

2
Polytec GmbH, Waldbronn, Germany
Introduction
The most common form of aneurysms, a dilation of
the aorta, is the abdominal aortic aneurysm (AAA).
As the mortality of aortic rupture is very high but the
prediction of the pressure on the aneurism wall is
still impossible with common techniques (computer
tomography or ultrasound), this work deals with the
approach of Laser Doppler Vibrometry (LDV) to
analyse skin vibration in the abdominal area. The
feasibility of this method was shown by Schuurman
[Schuurman, 2013] using a commercial LDV
system with a laser wavelength of 633nm. As the
reflectivity on bare skin for this wavelength is quite
low, reflective stickers were glued on the patient.
Apart from this time consuming procedure, there
are further disadvantages discussed by Scalise
[Scalise, 2006]. With infrared LDV scanning
technique becoming commercially available, the
aim of this work is to show a better repeatability
even without the use of markers and therefore get
a less time consuming and more precise procedure
to measure skin vibration on AAA-patients.
period of one heartbeat (1.21.6s). As skin velocity

is not only caused by blood pressure pulsation but
also gastrointestinal or respirational motion at lower
frequencies (0.10.2Hz [Tang, 2004]), in the second
measurement less grid points were measured for a
period of 10s. Breathing was adapted to heart rate.
The data was high-pass filtered.
Results
Despite chest hair, the measured signals show almost
no speckle noise. The coherence obtained for the
reference LDV was good (>0.8) for frequencies of
interest, i.e. below 50Hz. In Fig. 2, skin velocity for
0.8 seconds after the heart beat is shown for grid
points along the red path in Fig. 1. All measurements
could be performed within 57 minutes.
Figure 2: v
elocity along marked path
Discussion
Without the need of averaging, the measured
data show a good repeatability. Compared to the
former study, the test setup was both less invasive
and less time consuming and even revealed
better results. With the suggested approach the
pulse wave speed in the aorta and the aortic wall
pressure could be determined.
Figure 1: s canned gridpoints
Methods
In contrary to the mentioned study, the measurements
were performed using two Polytec RSV-150 LDVs
with a laser wavelength of 1550 nm (infrared). One
LDV was focused on a reflective sticker placed on
the chest, the other one was used with a scanning
device to measure a grid of points on the bare
abdomen. The electro cardiac signal was used to
trigger the measurements. Up to 195 grid points were
measured consecutively, as there is no possibility for
a simultaneous measurement yet (Fig. 1). As the first
LDV was used as a reference, no blood pressure was
measured. The six subjects were all male, 2531 years
old. Two types of measurements were performed: In
the first one, the grid points were measured for the
References
Scalise, L., Morbiducci, U., Melis, M.D., A laser Doppler
approach to cardiac motion monitoring: effects of
surface and measurement position. In: Proceedings
of the Seventh International Conference on Laser
Vibrometry, Ancona, vol. 6345, C0C9, SPIE, 2006.
Schuurman et al, Feasibility of Laser Doppler
Vibrometry as potential diagnostic tool for patients
with abdominal aortic aneurysms. In: J Biomech,
46:11131120, 2013.
Tang, J., Dieterich, S., Cleary, K., 2004. Respiratory
motion tracking of skin and liver in swine for
cyberknife motion compensation. In: SPIE Medical
Imaging 2004 Proceedings.
558
P 19 2
ARE MRI IMAGES NEEDED FOR MODELING

PATIENT-SPECIFIC KNEE SOFT TISSUES?
S. Pianigiani1, D. Croce2, M. DAiuto2, T. Villa2, W. Pascale1, B. Innocenti3
1
2
Politecnico di Milano, Department of Chemistry, Materials

and Chemical Engineering, Milano, Italy
Introduction
Usually, to develop patient-specific native knee
model geometries, CTs and MRIs are used.
Unfortunately, while the generation of bone
geometries by using CTs is quite consistent, MRIs
are hardly readable, due to the usual lower
resolution, and consequently the obtained softtissues geometries are not detailed. In particular,
cartilages and menisci get noised shape and their
surfaces need to be highly smoothed before being
efficiently used in finite element analysis (FEA).
Such smoothing procedures are usually manual
and not standardized, and they could generate
final geometries that could be quite dissimilar to
the originals. Moreover, the registration between
CTs and MRIs results in geometries that could
present bad interfaces leading to failure of the
knee model simulation.
The obtained geometries, by CAD method and

from traditional MRIs reconstructions, have been so
compared after calculating the volume. Also an
evaluation of the operating time among the two
procedures has been considered.
Results
Figure 1 shows the graphical overlapping between
the CAD obtained geometries (in yellow color) and
the MRI reconstructed ones (in green color). The
reconstructed volumes differ from 2% to 14% from
the MRIs obtained ones. Comparing the obtained
cartilages thicknesses, percentage relative errors
of 4%, 2% and 7% were calculated for the femoral,
tibial and patellar cartilages, respectively.
In comparing the obtained menisci volumes, a
similar maximum error of 15% is achieved for both
the medial and the lateral.
Then, this study aims to prove the efficacy of

alternative methods to generate 3D cartilages
and menisci geometries, based on patients data,
avoiding the use of MRI scans.
By using both methods, geometries are obtained

with 75% less time consuming.
DI C USSION
This study shows alternative methods to faster
generate patient-specific knee cartilages and
menisci geometries, without using MRIs, aiming of
using them for FEA, showing a maximum difference
among the volume of 15%.
Methods
In this study, knee cartilages and menisci have
been traditionally reconstructed from 3 MRIs of
different healthy knee specimens. For the same
specimens, CTs were used in order to obtain the
knee bone geometries. Both reconstructions have
been performed by experts in the biomedical field.
Even if there are some limitations in these proposed

procedures, as only one constant section area is
used for the menisci generation or the use of only
healthy knees, this preliminary study presents good
and promising results for the development of these
geometries. The main advantage are the reduced
operating time, the shape of the final geometries
that do not need any further optimization, being
more regular, and also the associated mesh will be
more regular, and eventually automatized, earning
further time and accuracy for the simulation. No
interference among the knee parts are so verified
in the registrations with CTs.
The procedure to generate the cartilage consists

on creating an offset from the bone geometries,
while menisci are generate by an extrusion based
on tibia borders.
Basing on the literature, manually marked cartilages
areas have been detected on the knee bones and
these have been used to create and offset and so
generate the cartilage layer by means of a CAD
software. In particular, 2.5 mm thickness has been
used for the femoral and the tibial cartilages, while
for the patella 3 mm. [13]
Then, by means of a CAD software, the proximal
surface of the tibia, already including the cartilage
thickness, has been used to extract the external
profile of the two menisci. The cross section area
of the two menisci has been recognized as a
right-angled triangle with rounded corners and
measured on MRIs. The geometry of the meniscus
has been achieved by the extrusion of the triangle
along the tibial external edge.
References
[1] Okafor et al., 2014
[2] Adamr et al., 1998
[3] Buck et al., 2013
see the next page
559
560
P 19 3
IN-HOUSE VIRTUAL BIOMECHANICAL HUMAN BODY

MODEL FOR FAST IMPACT CALCULATIONS
J. pika1
1
Introduction
The purpose of this paper is to build an in-house
model for a fast spatial simulation of a human
body motion in various scenarios characterized by
contacts.
Methods
The presented software lays on the multibody
approach, where external shape of humanoid is
modelled within open kinematic tree structure. The
system of articulated rigid bodies, which represent
a human body, is linked by spherical joints to
approximate external shape of the humanoid. The
model contains 17 rigid bodies and 16 spherical
joints, see Figure 1. Equation of motion is derived
based on [Shabana, 2001 and Brt, 1981]. Author
uses generalized coordinates for description of
motion of each body and the global equation of
motion for the i-th body can be expressed as Eq. (1)
Results
Human model is fixed in the space by the head
and is loaded only by gravity. Simulation of 3, 5
and 10 seconds respectively were performed and
the CPU duration time is shown in the Table 1.
where Mi is the mass matrix of i-th body, qi is the

vector of three translational and three rotational
coordinates of this body and and are vectors of
generalized force associated with generalized
translations and orientations, respectively. Introducing of constraint equation the final equation
of motion of the system can be written as Eq.(2)
Duration [s]
CPU time[s]
2.03
3.68
10
7.57
Table 1: C
PU calculation time
Discussion
Presented model shows a good behaviour in real
time calculations. However it suffers from instability
for some initial configurations. The stability of
numerical simulation is being currently improved.
where M is the total mass matrix, is the constraint

Jacobian matrix, is the vector of Lagranges
multipliers, and are vectors of applied and inertia
forces, respectively and is vector that quadratic
terms in the velocities. Mutual contact between
2 bodies or between body and any external
subject is implemented by the continuous contact
force model as Eq. (3)
References
Alves et al, Contact Analysis for Different Viscoelastic Contact Force Models, Eccomas 2013.
Brt, Maticov metody v analze a syntze
prostorovch vzanch mechanickch systmu,
Akademia Praha, 1981
Haj*man et al, Application of stabilization techniques in the dynamic analysis of multibody systems, ACM 1: 479-488, 2007.
Shabana, Computational Dynamics, Second
Edition, 2001.
picka, Double pendulum contact problem,
Master thesis, 2013.
where F is the contact force vector, is the

penetration between bodies and is the penetration
velocity. Several contact force models were
discussed [picka, 2013 and Alves, 2013].
Baumgartes stabilization method is utilized in order
to stabilize the numerical integration for wide set
of loading scenarios. Numerical integration of Eq.2
with respect to contact scenario was performed in
MATLAB software.
561
P 19 4
BIOMECHANICAL ANALYSIS OF DYNAMICAL LOADS

INFLUENCING ON SOLDIERS BODY DURING IED BLAST
M. Gzik1, W. Wolanski1, K. Joszko1, M. Burkacki1, S. Suchon1
1
Faculty of Biomedical Engineering, Silesian University of Technology,

Department of Biomechatronics, Zabrze, Poland
Introduction
Improvised explosive device IED attack becomes
main reason of casualties among polish soldiers
during military missions in Afghanistan and Iraq.
It is important to investigate mechanism of injury
on soldiers body to counteract negative effect
of explosion [Gzik, 2014]. There is need to develop
new and improved currently applied personal
safety systems. To do so, blast examinations are
need to be performed but they have limitations
according to safety issues and expenses. Response
to the represented problem is application of
numerical modelling. Modelling studies have many
advantages: they are cheaper compounding to
real object experimental examination, results of
this studies are repeatable, parameters of model
are easy to manipulate, input data is easy to
change, factors which in reality occurs inseparably
or unmeasurable can be obtained individually
[Gzik, 2000].
Results
The simulation results were used to assess the safety
of soldiers and proposed safety solutions such as
seat with footrest and different types of seatbelts.
The main part of this study involved the analysis
of the model kinematics, as well as the dynamic
load of the head, neck, thorax and lower limbs.
Injury criterions were determined with STANAG
HFM-148 document. Obtained results will be used
to improve safety systems of vehicles crew and
minimize injuries caused by IED explosion.
Discussion
Modelling with MADYMO software is suitable
for biomechanic analysis of rapid acceleration
originating from explosion on soldiers body. This
method allows to reduce costs and effort during
safety system development. Possibility of analyzing
individual factors enables detailed recognition of
injury mechanism. However numerical simulation
are not substitute for physical studies and require
verification to be consider trustworthy.
Methods
In this study authors numerical models of armoured
wheeled vehicle and equipped soldiers model
based on Hybrid III mannequin were developed in
MADYMO software. The program allows to analyse
the biomechanical effects of the explosion,
traffic accidents and etc. [Gzik, 2007][Burkacki,
2013]. The model studies considered influences of
the following factors on the dummy load: initial
arrangement of crew seats, type of seat belts, seat
characteristics (geometry of the seat, its flexibility),
attachment position and the distance between
the seats.
References
G
zik M. et al, Acta of Bioengineering and
Biomechanics, 2:3340, 2000.
Gzik M. et al, Modelowanie Inzynierskie,
34:.2936, 2007.
Burkacki M. et al, Aktualne Problemy Biomechaniki,
7:.1822, 2013.
Gzik M. et al, Modelowanie zolnierza na potrzeby
analizy biomechanicznej wplywu obciazenia
pochodzacego od fali uderzeniowe, [in] Bezpieczenstwo Wojsk W Aspekcie Zagrozen Wynikajacych
Z Uzycia Improwizowanych Urzadzen Wybuchowych
(IED), 7932, 2014.
562
P 19 5
PREDICTION OF THE FOREARM RANGE OF MOTION

REDUCTION DUE TO DISTAL RADIUS DORSAL MALUNION
I. Sanchez Arce1, A. Watts2, A. Walmsley3 , C. Bailey4 , T. Alonso Rasgado3
1

2
3
4


From our numerical simulations, a reduction in
the active range of motion because of a dorsal
malunion is predicted. For dorsal malunion degrees
up to 10 de reduction in the total range of
motion is minimal (0.8%). However, beyond 10
the reduction can go up to 30% for 30 of dorsal
malunion. Which complies with data already
published for cadaveric studies 1.
Introduction
Malunion of distal radius fractures may lead to the
development of pathologies, such as pain, range
of motion reduction, soft tissue damage, amongst
others. Malunion effects have been studied in both
cadaveric and in vivo studies 1, 2. Finite element
has proven to be an excellent tool for biomedical
research and orthopaedics; it has been broadly
used for hip research 3,4, wrist 5, etc. This research
aims to investigate the relationship between the
dorsal degree of malunion and the reduction in
the range of motion.
C o n cl u s i o n
The forearm range of motion may have a
considerable reduction for dorsal malunion
degrees above 10. The supination motion of the
forearm is more affected by the dorsal malunion
alone in comparison with pronation. The maximum
and minimum muscle lengths are important for
constraining the range of motion.
A computational model of a left forearm has
been created from a set of CT scans4,5. The model
was then imported into a finite element software
where muscles and stabilising soft tissue were
taken in account 6,7. A resection was performed
in the distal forearm using similar measurements
to those provided by Fraser 1 in order to produce
and adjustable model, like has been reported in
cadaveric tests. The model was solved for several
degrees of malunion (none, 10, 15, 20, 25, 30)
from neutral position to maximum pronation and
maximum supination. Therefore, the total range
of motion was calculated from the coordinates of
ulnar fovea and the mid sigmoid notch throughout
the simulations with a Matlab script.
References
1 F raser GS, et al. The Journal of Hand Surgery;
34(5):838-48,2009
2C
risco JJ, et al. Journal of Orthopaedic Research;
25(4):54755,2007
3A
nderson AE, et al. J Biomech Eng;
130(5):051008,2008
4 Z ou Z, et al. Journal of Orthopaedic Research;
31(3):47279,2013
5G
slason MK, et al. Medical Engineering &
Physics;32(5):52331,2010
6N
oda K, et al. Journal of Hand Surgery; 34(3):415
22,2009
7 S himawaki S, et al. Journal of Biomedical Science
and Engineering;8(3):15,2013
563
P 19 6
MODELLING PAEDIATRIC BONES: USING CT

TO INVESTIGATE FRACTURE MECHANISMS
G. Williams1,2, M. Viceconti1,2, X. Li1,2, A. Offiah1,3,4
1
INSIGNEO Institute for in silico Medicine, The University of Sheffield, Sheffield, United Kingdom
2
Department of Mechanical Engineering, University of Sheffield, sheffield, United Kingdom

3
Academic Unit of Child Health, University of Sheffield, sheffield, United Kingdom

4
Department of Radiology, Sheffield Childrens NHS Foundation Trust, sheffield,

United Kingdom
Introduction
Forty million children worldwide are subjected
to child abuse each year 1. Those who cant
communicate, mainly children under the age of
three, being at the highest rate of experiencing
inflicted injuries. However there are currently no
reliable tests to distinguish accidental from inflicted
injuries; paediatricians judgment and adults
narration of the events are heavily relied upon. This
study applies a well-validated finite element model
(FEM) approach2, originally developed for adults, to
children. By creating individualised biomechanical
models, it is hoped that a more accurate diagnosis
can be made, as it will be possible to quantitatively
analyse the force required to fracture these bones.

We will look at the strain distribution of torsion
and bending in the paediatric bone in order to
ascertain the mechanical behaviour under various
loading conditions. We will compare these results
across numerous Individuals and look at difference
in age, gender and injury mechanism.
C o n cl u s i o n
Finite element analysis has the potential to provide
quantitative evidence to assist diagnosis with
regards to accidental injury and physical abuse.
References
1 Abuse and Neglect Information Bulletins.,2015.
Abuse and Neglect Information. Bulletins. [ONLINE]
Available at: http://www.internationalcap.org/
abuse_statistics.html. [Accessed 19 January 2015].
2 Zannoni, C., Mantovani, R. and Viceconti, M., 1998.
Material properties assignment to finite element
models of bone structures: a new method.
Medical Engineering & Physics, 20, 735740.
Exp e r i m e n t a l M e t h o d s / METHODO L G Y
Data from 32 post mortem CT scans of children
03 years old was used to create finite element
meshes of femur and tibiae. Different loading
conditions such as bending and torsion were
applied to the model using Ansys. Some of these
will be informed by the injury data collected
from Sheffield Childrens Hospitals Emergency
Department. These results will be explored to see
if the predicted results relate to the actual results.
The authors would like to thank ANSYS and ESPRC for
providing financial support to this project. They would
also like to acknowledge the MultiSim project
(EP/K03877X/1) for its support.
564
P 19 7
IDENTIFYING RELATIVE MOTION USING HIGH-SPEED

X-RAY IMAGING IN A RODENT DISLOCATION SPINAL
CORD INJURY MODEL
S. Mattucci1, J. Liu1, P. Fijal1, X. Wu1, W. Tetzlaff1, T. Oxland1
1
University of British Columbia, Orthopaedics, Vancouver, Canada
Introduction
During a spinal cord injury (SCI), various
combinations of forces result in different primary
injury mechanisms. The most common, and most
severe mechanism is fracture-dislocation, and
occurs in roughly 45% of SCI cases [Sekhon 2001],
where injury occurs as one vertebra slides over the
other, pinching the cord.
included C5 translating ventrally w.r.t. caudal

clamp (4 instances), C4 translating dorsally w.r.t.
rostral clamp, C5 rotating w.r.t. caudal clamp,
C4 rotating w.r.t. rostral clamp (8 instances each),
and the canal remained relatively open (combined
C4 and C5 rotation, 6 instances), and relative motion
was often present at more than one interface.
Further, when the spinal cords were sectioned and
stained for hemorrhaging, the cords that had more
relative motion had noticeably less hemorrhaging
from those that remained most rigid, suggesting the
slipping instances resulted in less neurological injury.
Our group can produce distinct types of clinically

relevant SCI including dislocation in a rat model,
where findings mimic clinical observations that
dislocation is a more severe injury than contusion.
Additionally, different patterns of tissue damage
[Choo 2007] could narrow the therapeutic timewindow for surgical intervention. Despite the high
precision in injury parameters; previous results
demonstrate variable injury outcomes in both tissue
damage and behaviour [Chen 2015, unpublished].
Discussion
This study demonstrates the importance of
measuring the high-speed kinematics of preclinical models for SCI and emphasizes the need
for precision vertebral clamps to prevent slippage
at the vertebra-clamp interface.
The research objectives were to i) precisely

measure intervertebral kinematics during a high-speed dislocation injury in an in vivo rat model;
and ii) to determine whether there is slippage
(i.e. relative motion) at the vertebral-clamp
interface.
References
Sekhon, Fehlings, (2001). Epidemiology, demographics, and pathophysiology of acute spinal cord
injury. Spine, 26(24 Suppl), S212.
Choo, Liu, Lam, Dvorak, Tetzlaff, Oxland, (2007).
Contusion, dislocation, and distraction: primary
hemorrhage and membrane permeability in
distinct mechanisms of spinal cord injury. Journal
of Neurosurgery: Spine, 6(3), 25566.
Methods
Rats were tested in vivo (n=17) and sacrificed
immediately post-injury. A high-speed camera
x-ray device captured the motion during injury,
by tracking 0.4mm tantalum beads affixed to the
vertebrae and clamps. The rostral clamps held C3
and C4 in place, while the caudal clamps held
and dislocated C5 and C6 dorsally.
Kinematics were compared between vertebrae
and clamps for dorsal/ventral and rostral/caudal
translation, and rotation. Vertebral motion that
exceeded two standard deviations of the average
clamp motion was identified as slipping. The most
important metrics to assess slippage included
C4 or C5 with respect to (w.r.t.) their respective
clamps in dorsal translation and rotation. C5 w.r.t.
C4 compared to caudal clamp w.r.t. rostral clamp
determined if the vertebral dislocation distance
was equivalent to actuator distance as slipping
could occur at both clamps. The sum of C4 and
C5 rotation was observed as the overall integrity of
the spinal canal a large combined rotation value
would indicate the canal remaining open, and not
imparting a shear force on the cord.
Results
The results demonstrated that the C4-C5 translation
was slightly less than the 2.3 mm prescribed
by the testing machine (see Table at right).
Slippage was observed in some animals that
565
P 19 8
THE CHANGE IN ENERGY ABSORBED POST REMOVAL

OF METALWORK IN A SIMULATED PAEDIATRIC
LONG BONE FRACTURE
A. Howieson1, M. Jones2, P. Theobald2
1
2
NHS Forth Valley, Larbert, United Kingdom
Cardiff University, Engineering, Cardiff, United Kingdom
Results
Absorbed energy was reduced by 47 % in the ORIF
group compared to both the control (p = 0.011)
and ESIN (p = 0.018) groups. The peak shear stress
and torque were also significantly different. All
ORIF bones failed through drill holes, suggesting
stress localisation around the defects.
Introduction
The surgical treatment of paediatric fractures is
increasing. Open reduction and internal fixation (ORIF)
with plates and screws is long established, whilst the
use of elastic stable intramedullary nailing (ESIN) has
become increasingly popular. This study quantifies, in
terms of the energy required to produce a fracture,
the biomechanical sequelae of both techniques
post removal of metalwork, to provide clinicians with
evidence to guide post-operative advice.
DIS C USSION AND RE F EREN C ES

This study suggests that there is a significantly
higher re-fracture risk following the removal of
ORIF plates when compared to both ESIN and
the control environment. Whilst this may reflect the
intuitive view of many clinicians, this study provides
a quantitative value of the reduction in strength
and should help clinicians to appropriately caution
patients and parents prior to surgery.
Methods
An immature bovine model was adopted to ascertain
whether these techniques exposed the bone to
a greater re-fracture risk following removal of the
device. Bones were prepared to reflect ORIF or ESIN
techniques, or prepared intact for the acquisition of
control data. Each bone was tested to failure at 90
/s, with the absorbed energy then being calculated
to determine the relative difference between each
technique and versus control data. Data describing
peak shear stress and torque were recorded.
References
(References number 29 in total and are too many to
list in the abstract).
566
P 19 9
RELATING MECHANICAL STRAIN TO TISSUE DAMAGE

IN EXPERIMENTAL TRAUMATIC SPINAL CORD INJURY
T. Bhatnagar1, J. Liu1, A. Yung1, P. Cripton1, P. Kozlowski1, W. Tetzlaff1, T. Oxland1
1
University of British Columbia, International Collaboration On Repair Discoveries,

Vancouver, Canada
Introduction
The relationship between mechanical deformation
of the spinal cord during traumatic spinal cord injury
(TSCI) and the ensuing biological and functional
damage is not well-understood. Studies have
shown that generally, a greater deformation of the
spinal cord results in more severe tissue damage
and neurologic deficit. Furthermore, it has been
shown that different mechanisms of TSCI produce
distinctly different patterns of tissue damage,
indicating that the pattern of deformation that the
spinal cord undergoes is of key importance [Choo,
2007]. However, there is currently no recognized
quantitative relationship between mechanical
deformation of tissue and the biological response
during TSCI. This study aimed to determine if such
a relationship can be observed in an in vivo rat
model of cervical contusion TSCI.
Figure 1: Correlative relationship between minimum principal

strain and neuronal viability in the ventral horn of
the gray matter.
Methods
A novel apparatus [Bhatnagar, 2014] was used to
create sustained cervical contusion TSCI at various
severities, which were sustained for 30 minutes, in
an in vivo rat model (n=12), inside of a magnetic
resonance (MR) scanner (7T Bruker Biospec,
Germany). Three-dimensional images of the spinal
cord in the normal state and in the deformed
state, during the imposed TSCI, were input to a
validated image registration approach to quantify
the internal spinal cord morphological change
during injury. The transverse-plane mechanical
strains observed in the spinal cord throughout a
cranio-caudal region of interest around the injury
epicenter were then compared to a measure of
gray matter neuron survival in the ventral horns.
Regression analyses were performed to determine
the type of mechanical strain that best explained
the observed tissue damage.
(Figure 1). The observed spinal cord strain

patterns were similar to predictions reported
from computational simulations of TSCI. Although
there were consistent trends between strain and
tissue damage, the results suggest that there
are additional parameters of injury that should
be considered when predicting tissue damage
following TSCI.
Discussion This work comprises the first study of
experimental TSCI that provides both quantified
mechanical deformations of the in vivo spinal
cord and a measure of ensuing tissue damage.
Previously,
relationships
between
tissue
deformation and damage were inferred, but never
directly evaluated. Further development of the
presented methods will enable characterization of
the effects of mechanical parameters of injury on
tissue damage. The link that this study established
between mechanical deformation and tissue
damage during TSCI will provide greater insight
into tissue damage tolerances. This information
will contribute to the ability to use computational
simulations of TSCI as a clinical tool to predict
patterns of tissue damage that will ensue from
spinal cord deformation.
Results
This study showed that the average transverseplane minimum principal strain in the ventral horns
of the gray matter during contusion TSCI was
significantly correlated (R2 = 0.19, p=0.000) to a
loss of neuron viability
References
Bhatnagar et al, J Biomech Eng, 136(9), 2014.
Choo et al, J Neurosurg Spine, 6(3): 255-66, 2007.
567
P 200
QUANTITATIVE EVALUATION OF THE SEAL FUNCTION

OF THE ACETABULAR LABRUM: BIOMECHANICAL STUDY
C. Signorelli1, N. Lopomo1,2, T. Bonanzinga1,3 , S. Zaffagnini1,3 ,
S. Marc4 , M. Marcacci1,3
1

Bologna, Italy
2
Istituto Ortopedico Rizzoli, Clinica Ortopedica e Traumatologica II, Bologna, Italy

4
Stanford University, Department of Orthopaedic Surgery, Redwood City, USA
Introduction
An intact acetabular labrum is able to create
a seal between the peripheral and central
compartment of the hip joint, thus increasing joint
stability. It also provides proper joint lubrication
and correct distribution of the pressure in the joint
tissues and fluids (Freehill 2011, Ferguson 2000,
Ferguson 2003) There are different factors that can
lead to a hip labral tear such as femoroacetabular
impingement (FAI), hip dysplasia, instability, psoas
impingement, and degenerative arthritis (Freehill,
2011). Recently, different arthroscopic surgical
treatments have been proposed for labral tears
(Ayeni, 2014). There is a lack of scientific evidence
supporting any particular technique (Freehill,
2011). The goal of the study was to determine the
efficacy of the labral seal function, by comparing
different surgical techniques with the native intact
structure and the torn one.
The trend of HJC displacement as the applied load

increases has been graphically reported (Fig. 1).
Figure 1: H
JC displacement [mm] versus applied force [N]
for all the evaluated labral condition (INTACT,
LAB CH= labral-chondral separation,
CERC=cerclage repair, VERT=vertical mattress
repair, LABRE=labrectomy). The displacement values
are a percentage of the intact condition values.
Methods
Eight fresh-frozen cadaveric hips were tested.
A system for intra-operative kinematic assessment
(Orthokey Ltd, DE, US) was used to acquire
kinematics data. To measure the applied force
when performing the test a 6-axis load cell (AMTI,
Virginia, US) was fixed into the canal of each
distal cut femur. A load was manually applied
by the tester. Pivoting movement of the hip
and distraction test were performed. The HJC
displacement occurred during the distraction
test has been evaluated in correspondence of
7 different values of the applied force (L0-L6) 18N,
36N, 54N, 89N, 134N, 190N, 224N. During the
pivoting motion it has been evaluated the
maximum value of HJC displacement [mm]
reached in medial/lateral (M/L), anterior/posterior
(A/P) and proximal/distal (P/D) direction as well
as the 3D absolute value. Five different conditions
were tested for each specimens: Intact, LabralChondral, Vertical Mattress repair, Cerclage
reconstruction, Partial Labrectomy.
During pivoting motion has been found a statistically

significant greater displacement after labrectomy
respect to cerclage repair (p=0.03) and vertical
mattress repair (p<0.01) in M/L direction. Along
P/D direction has been found a significant lower
displacement after labrectomy compared to the
cerclage repair status (p=0.03). Performing the
pivoting motion at the extreme range of motion
underlined a higher value of HJC displacement after
labrectomy versus all the previous tested conditions.
Discussion
Labrectomy significantly affects the biomechanical
measurements increasing the HJC displacement
compared to the intact, labral chondral separation
and repaired labrum condition. Even the analysis
of HJC displacement during pivoting motion,
especially reaching the extreme of hip ROM, seems
to confirm the superiority of labral repair respect to
the labrectomy.
Results
Concerning the HJC displacement evaluated at
fixed value of applied force, paired sample t-test
underlined statistically significant differences
(p<<0.05) for all the five tested condition among
themselves except for intact-labral chondral
separation comparison.
References
Ayeni OR et al, KSSTA; 22(4):73743, 2014.
Ferguson SJ et al, Clin Biomech 15:463468, 2000.
Ferguson SJ et al, J Biomech;36: 171178, 2003.
Freehill M et al, Clin Sports Med; 30: 293315, 2011.
568
P 2 01
EFFECT OF PARTIAL RESECTION OF MANDIBLE BODY

ON DISPLACEMENTS AND STRAINS
A. Szust1, P. Strzyk1
1
Wroclaw University of Technology, Faculty of Mechanical Engineering, Wroclaw, Poland
Introduction
Although cancerous changes within the mandible
bone are not among the most prevalent disease
cases, because of the place where they occur
and the character of the operation they have
an adverse effect on the patients life comfort,
affecting, among other things, the face morphology,
the vocal organs, the respiratory system and the
alimentary system as well as the deformability,
stiffness and strength of the mandible. In the
case of mandible resection it is usually necessary
to reconstruct the latter for both functional and
aesthetic reasons. Because of the complexity of
the problem the authors limited the study to the
partial resection of the mandible body. The aim of
the research was a comparative analysis based
on three models, i.e. a model without resection
(M1), a post-resection model without a plate (M2),
a post-resection model with a plate (M3). The
compared parameters were displacements and
equivalent strains. Computations were performed
for loading corresponding to the biting off and
unilateral crushing of a food bite.
Figure 1: C
hange in component Y along mandible base
depending on model and load: a) P1 =135N,
b) P2=325N.
Methods
The authors own numerical models derived from
a polyurethane model of the human mandible
(Synbone) were used in the computations. The
implant model was based on the commonly used
plate implants (including the screws). The physical
properties of both the mandible and the implant
were adopted on the basis of [Kimura, 2006,
www]. An original load configuration, in which the
forces generated by the muscles (m. levatores
mandibulaes) amounted to 50 % of the maximum
load [Chladek, 2000, Knoll, 2006], i.e. P 1=135N for
biting off and P2=325N for crushing, was adopted.
The models were mounted on the mandible heads,
the incisors and the molar. The computations were
carried out using the ANSYS (ver. 11) package.
Table 1: S trains eeq determined in place of partial resection

depending on model and load.
Discussion
The analysis of the displacements and the strains
has shown that fixing the implant to the outer side
of the mandible body not only does not restore the
mandibles original stiffness, but even increases it
in comparison with the mandible without the plate.
References
[1] Chladek W., Silesian University of Technology,
Poland, (Polish language), 2000.
[2] Kimura A., et.al., J Oral Maxillofac Surg.
34: 193200, 2006.
[3] Knoll W. D., et. al., J Oral Maxillofac Surg.
34: 201209, 2006
[4] www. matweb.com (www. asm.matweb.com)
Results
The displacements and strains for 13 points lying
along the mandible base, i.e. points 16 on the
right side, points 813 on the left side and point 7 in
the agnation, were determined. Figure 1 shows the
displacements of component Y (parallel to planum
medianum) while the values of equivalent strains
eeq are given in table 1.
569
P 202
TOWARDS AN IMPROVED INTERPRETATION

OF BONE ADAPTATIONS: CONSIDERING THE IN VIVO
MICRO-COMPUTED TOMOGRAPHY
MEASUREMENT ERROR
Y. Lu1, M. Boudiffa2, E. DallAra1, I. Bellantuono2, M. Viceconti1
1
The University of Sheffield, Department of Mechanical Engineering, Sheffield, United Kingdom

2
The University of Sheffield, Department of Human Metabolism, Sheffield, United Kingdom
Introduction
Several musculoskeletal pathologies (e.g. Osteo
porosis) affect the morphology and density of
the bone over time, impairing the length and
quality of the life of the ageing populations.
A number of subject specific modelling
approaches have been developed to study
the effect of pathologies and drug treatments
on the mechanical properties of bone structure
[Christen, 2010; Keaveny, 2008]. However, the
validation of such models is not trivial as the
adaptations of the bone density and morphology
should be quantified over time experimentally
[Levchuk,
2014].
In
vivo
micro-computed
tomography (CT) scanning is an important tool
for longitudinally monitoring the bone adaptations
in animal models. However, the error associated
with the usage of in vivo CT measurements for
the evaluation of the bone adaptations in animal
studies is still unclear. The aim of this study was to
evaluate this measurement error using the bone
surface distance approach.
Figure 1: T he 25th, 50th, 75th and 95th percentile bone surface

distances between the three repeated scan datasets and the baseline scan dataset for the eight
mouse tibias.
Discussion
The measurements of bone adaptations in the
same animal by the in vivo CT scanning is
affected by errors coming from the hardware used,
the scanning protocol, the partial volume effect,
the image processing steps such as segmentation,
interpolation, etc. While the assessment of the
measurement error should be performed every
time when the image quality is changed, this study
proposed a methodology to estimate it.
Methods
The right tibias of eight 14-week-old C57BL/6J
female mice were consecutively scanned four
times in an in vivo CT scanner with reposition
between each scan. The repeated scan image
datasets were aligned to the corresponding
baseline scan image dataset using the rigid
registration and a region of interest was selected in
the proximal tibia metaphysis for analysis. The bone
surface distances between the repeated and the
baseline scan datasets were evaluated.
Knowing the error in the in vivo CT measurement

of bone microarchitecture is a prerequisite for
an accurate interpretation of the superimposed
longitudinal image datasets. After superimposing
the longitudinal image datasets and the
application of Boolean operations, four regions
should be defined: an uncertain region, the size
of which is determined by the measurement error;
a bone formation region, formed by the newly
appeared bone voxels; a bone resorption region,
formed by the disappeared bone voxels; and a
quiescent bone region, formed by the bone voxels
present at both time points (Figure.2).
Results
The mean (standard deviation) median and
95 th percentile bone surface distances were
3.10 (0.76) m and 9.58 (1.70) m, respectively
(Figure 1). In all the groups, 95.74% (3.08%)
of the distances was shorter than 10 m and
0.31% (0.25%) of the distances was longer than
20 m. The mean maximum distance in all the
groups was 171.63 (61.84) m.
see the next page
570
References
Christen et al, Philos Trans A Math Phys Eng Sci,
368:265368, 2010.
Keaveny et al, J Bone Miner Res, 23: 197482, 2008.
Levchuk et al, Clin Biomech, 29:35562, 2014.
Figure 2: A
representative illustration of interpreting the
longitudinal scan images by taking into account
the measurement error
571
P 203
MECHANOBIOLOGY MODEL OF THE ATHEROMA PLAQUE

FORMATION AND DEVELOPMENT TO STUDY THE EFFECT
OF TRANSMURAL TRANSPORT PROPERTIES
E. Pea1, M. Cilla2, M.A. Martinez1
1
Univerity of Zaragoza, Aragn Institute of Engineering Research., Zaragoza, Spain

2
Julius Wolff Institut. Charit Universittsmedizin Berlin, Julius Wolff Institut.

Charit Universittsmedizin Berlin, Berlin, Germany
Introduction
The fundamental cause of plaque development
is believed to be the abnormal enlargement of
the intima by the infiltration and accumulation
of macromolecules such as lipoproteins and the
associated cellular and synthetic reactions. This
suggests that the macromolecular transport in
the arterial wall must have some impact on the
initiation and development of atherosclerosis
[3]. Therefore, zones of elevated LDL tend to
correspond to areas of atherosclerotic lesion
development and intimal thickening, and such
zones also tend to have abnormal WSS patterns.
In a previous work, a computational modeling
based on reaction-convention-diffusion equations
coupled with blood-wall mass transport of the main
biological species which lead to atheroma plaque
development was presented.
Decreasing the diffusion coefficients ratio means

a higher concentration of the foam cells close to
the intima.
Methods
We used a mathematical model of atheroma
plaque initiation and early development in coronary
arteries using anisotropic transmural diffusion
properties [1]. The phenomena modeled using
diffusion-convection-reaction equations of the
main species and substances which play a role in
early atherosclerosis development, i.e. LDL, oxidized
LDL, monocytes, macrophages, foam cells, smooth
muscle cells, cytokines and collagen. Our current
approach is on the process on plaque initiation
and intimal thickening rather than in severe plaque
progression and rupture phenomena. The effect
of transport properties, in particular the anisotropy
of diffusion properties of the artery, on plaque
formation and development is investigated using
the proposed mathematical model.
Figure: S patial concentration distribution of the cells and

substances
Discussion
Due to the fact that foam cells concentration is
associated to the necrotic core formation, the
final distribution of foam cells is critical to evolve
into a vulnerable or fibrotic plaque. Therefore, the
transmural properties could be an important factor
for the development of fatty or fibrotic plaques.
However, this is an hypothesis that should be
validated.
References
[1] M. Cilla, E. Pea, and M. A. Martnez. Mathematical
modelling of atheroma plaque formation and
development in coronary arteries. J R Soc
Interface, 11:20130866 116, 2014.
[2] U. Olgac, V. Kurtcuoglu, and D. Poulikakos. Computational modeling of coupled blood-wall mass
transport of LDL: Effects of local wall shear stress.
Am J Physiol Heart Circ Physiol, 294(2):909919,
2008.
[3] J. M. Tarbell. Mass transport in arteries and the
localization of atherosclerosis. Annu Rev Biomed
Eng, 5:79118, 2003.
Results
There is not a strong influence of the anisotropic
transmural properties on LDL, SMCs and collagen
distribution and concentrations along the
artery. On the contrary, foam cells distribution
strongly depends on the value of the radial
diffusion coefficient of the substances and the
ratio between radial and longitudinal diffusion.
572
P 204
MECHANICAL STIMULATION OF POLYCYSTIN-1

IN HUMAN OSTEOBLASTIC CELLS POTENTIATES
THE JAK/STAT SIGNALING AXIS
G. Dalagiorgou1, C. Adamopoulos1, C. Piperi1, U. Georgopoulou2,
K.A. Papavassiliou1, A. Spyropoulou1, A.G. Papavassiliou1, E.K. Basdra1
1
University of Athens Medical School, Department of Biological Chemistry, Cellular

and Molecular Biomechanics Unit, Athens, Greece
2
Hellenic Pasteur Institute, Department of Virology, Athens, Greece
Introduction
Mechanical forces trigger biological responses in
bone cells that ultimately control osteoblastogenesis
and
bone
remodeling.
Although
several
mechanosensors have been postulated, the precise
mechanotransduction pathway remains obscure as
the initial mechanosensing event has not yet been
identified. Studies in kidney cells have shown that
polycystin-1 (PC1), via its extracellular N-terminal
part, may function as an antenna-like protein
providing a linkage between environmental cues
and their conversion into biochemical responses that
regulate various cellular processes [Dalagiorgou et
al, 2010]. PC1 has been implicated in the regulation
of multiple signaling pathways including the
JAK/STAT pathway. In renal epithelial cells it has been
shown that membrane-anchored PC1 activates
STAT3 in a JAK2-dependent manner, leading
to STAT3 Tyr phosphorylation and concomitant
transcriptional activity.
and returned to normal at 6 h. In accordance with

the activation mechanism of STAT3, stretching of
cultured cells pre-treated with STAT3 Inhibitor VII
(a cell-permeable dihydroquinoline compound
that potently and specifically inhibits JAK1/JAK2/
/TYK2/STAT3 activation) abrogated the observed
decrease in the abundance of the cytoplasmic STAT3
(unphosphorylated/DNA
binding-incompetent)
species. Importantly, stretching of osteoblastic
cells pre-treated with an antibody against
the mechanosensing N-terminal part of PC1
also abrogated the observed reduction in the
cytoplasmic levels of the inactive STAT3 species.
Discussion
In as much as STAT3 together with other
transcription factors [Dalagiorgou, 2012] regulates
the expression of key osteoblastic genes (runx2,
osteocalcin) our data pose that PC1 acts as
chief mechanosensing molecule that modulates
osteoblastic gene transcription and hence bone-cell differentiation via the JAK/STAT signaling axis.
Methods
Cell culture: Human PDL (hPDL; osteoblast-like)
cells were obtained from explants cultures of PDL
tissues dissected from the roots of healthy teeth
extracted for orthodontic treatment purposes,
and passages P3-P5 were used for experiments
[Dalagiorgou, 2012]. hPDL cells were cultured on
Lumox 50-mm petri dishes whose bottom surface
has a flexible, hydrophilic growth membrane
which can be uniformly stretched. Cells were
cultured and stretched for specific time periods.
FACS: A total of 10,000 events were analyzed per
sample. Flow cytometry analyses were performed in
a FACSCalibur flow cytometer (BD Biosciences, USA).
TransAM: Five micrograms of nuclear extracts were
tested for phosphorylated(p)STAT3 DNA-binding
activity using TransAM kit that employed a
wild-type STAT3 recognition sequence and a specific
pSTAT3 antibody, according to the manufacturers instructions (Active Motif, USA). The results
(O.D. measured at 450 nm) were expressed as
percentage increase over basal (untreated cells).
Figure 1: P
C1 may function as a mechanosensing molecule
that potentiates the JAK/STAT signalling cascade
in mechanostimulated human osteoblastic cells.
Results
Our study explored the involvement of PC1 in igniting
the JAK/STAT signaling cascade in mechanical
load (stretch)-induced hPDL (osteoblast-like)
cells. FACS and TransAM Transcription Factor
ELISA analyses employing extracts from hPDL
PC1-expressing cells subjected to mechanical
stretching (06 h) revealed that pSTAT3 (DNA
binding-competent species) increased at 0.51 h
References
Dalagiorgou G, et al Cell. Mol. Life Sci. 70:
167180, 2012.
Dalagiorgou G, et al Int. J. Biochem. Cell Biol.
42:16103, 2010.
573
P 205
SKELETAL MATURATION LEADS TO A DIMINISHED

MECHANORESPONSIVENESS IN SOST DEFICIENT MICE
L. Albiol1, A.I. Birkhold1, D. Pflanz1, T. Thiele1, M. Kneissel2, G.N. Duda1,
S. Checa1, B.M. Willie1
1
2
Novartis Institutes for BioMedical Research, Musculoskeletal Disease Area, Basel, Switzerland
Introduction
Mechanical loading is known to reduce osteocyte
expression of SOST/sclerostin1. A recent study using
SOST deficient mice 2 has shown that sclerostin
independent pathways are involved in the bone
formation response to mechanical loading. It
remains to be determined whether this response is
altered with age. We hypothesized that maturation
would lead to a reduced mechanoresponsivess in
SOST deficient mice, as seen previously in wild-type
mice3.
resorptive response was unaffected, the formation

response to additional loading was significantly
decreased with skeletal maturation in SOST deficient
mice (MV/BV, p<0.001; MS/BS, p=0.010; MTh,
p=0.038).
Female 10 and 26 week old SOST deficient
mice underwent two weeks of in vivo cyclic
compressive loading of the left tibia (n = 7/age,
right tibiae=internal control, 216 cycles/day,
f = 4 Hz, max = 900). A pilot study showed higher
loads (engendering 1200) led to mice limping.
In vivo microCT of the midshaft was performed at
day 0 and 15. Images were registered and voxels
were labelled as newly formed, quiescent or
resorbed bone3. 3D dynamic in vivo morphometry
was performed to quantify normalized formed
and eroded volume (MV/BV, EV/BV), normalized
surface area (MS/BS, ES/BS) and thickness/depth
(MTh, ED) (Fig.1a). An ANOVA was used to assess
within-subject and between-subject effects, and
interactions.
Fig 1: ( a) Methods. (b) Formation parameters. (c) Resorption

parameters; MeanSD, loading effect, *age effect,
#
loading and age interaction effects; p<0.05.
Our results reveal that sclerostin-independent
pathway(s) contribute to diminished mechanore
sponsiveness and enhanced bone resorption with
skeletal maturation as well as to loading-related
changes in surface area of mineralizing and
eroding bone. These data suggest that the anabolic
benefits of mechanical loading in combination with
sclerostin inhibition are age-specific. Further studies
are required to confirm this in humans as well as
identify other signaling pathways contributing to
the reduced mechanoresponsiveness with aging.
Results
Maturation decreased formation (MV/BV and MS/BS,
p < 0.001) and increased resorption (EV/BV,
ES/BS, and ED, p< 0.001) in SOST deficient
mice. Additional loading increased MV/BV and
MS/BS (p<0.001) in SOST deficient mice compared
to the control limb (Fig.1b). ES/BS was reduced by
additional loading (p=0.023; Fig.1c). Although the
References
1 Robling et al., JBC 283(9):58665875, 2008.
2 Morse et al., JBMR 29(11):24562467, 2014.
3 Birkhold et al., Bone: 66:1525, 2014.
574
P 206
HOW DO CELLS ORIENTATE UNDER

A COMPLEX MECHANICAL LOADING?
C. Laurent1, J.F. Ganghoffer1, R. Rahouadj1
1
CNRS, Universit de Lorraine, LEMTA, Vandoeuvre-les-Nancy, France
Introduction
One milestone in the challenge of regenerating
complex tissues is to understand the behaviour
of isolated stem cells. It has been observed that
the cells orientation depends on the mechanical
loading prescribed to their substrate [Tondon 2014].
Our group has performed 2D cultures of stem cells
on membranes subject to cyclical mechanical
loading [Zhang 2008], and have observed the
alignment of cells along particular angles with
respect to the stretching direction. Based on these
observations, in the present contribution we test
and implement the hypothesis that, under a given
3D mechanical loading, the cells preferential
orientation is guided by the direction of unitary
stretch calculated from the right Cauchy-Green
tensor.
Simulations of different 2D and 3D loadings were
performed using the finite element code FEBio,
and were used to calculate the direction of
unitary stretch at each point. These simulations
firstly aimed at evaluating our hypothesis with
respect to our experimental data [Zhang 2008],
and were then used to predict cellular preferential
orientation under more complex loading easily
achievable experimentally such as the stretching
of a perforated silicone membrane (Figure 1) or the
compression of an alginate gel (Figure 2). Finally,
cellular preferential directions are computed in
more complex structures such as a porous scaffold
for bone tissue engineering or a multilayer braid for
ligament tissue engineering [Laurent 2014].
Figure 1: C
omputed cellular preferential orientation
(black lines) on a perforated membrane. Color
code corresponds to equivalent Lagrange strain.
Figure 2: C
omputed cellular preferential orientations
(black lines) in 3D during the compression of
an alginate gel.
Results
Experimentally, the cells aligned along two
directions forming angles of 6070 and
110120 with respect to the stretching direction
[Zhang 2008] for a silicone membrane subject to
10% cyclical strain. Numerically, angles of 62 and
118 were computed. The hypothesis was then
numerically implemented in more complicate
cases such as the perforated silicone membrane
showed below (Figure 1).
Discussion
Our first results validate the formulated hypothesis,
and the developed numerical procedure enables to
compute the cellular preferential orientation under
any complex mechanical loading. A series of simple
2D and 3D upcoming experiments are proposed in
order to further validate the formulated hypothesis.
The present contribution thus presents a simple and
unified solution to interpret biological observations
concerning the cellular direction under a given
mechanical loading, which may play a crucial
role in the forming of the most efficient functional
collagen network during tissue development.
References
Laurent et al, J. Mech. Behav. Biomed. Mater.
40, 222, 2014.
Tondon et al, PLoS ONE 9, e89592, 2014.
Zhang et al, Cell Biol. Int. 32, 344, 2008.
575
P 207
IDENTIFICATION OF THE MECHANOTRANSDUCTIVE

MECHANISMS THAT ACCELERATE BONE FORMATION TO
PROMOTE BONE REPAIR IN CHILDREN AND ADULTS
S. Barreto1, 2, 3 , A.R. Cameron1, 2, 3 , D. Murray4 , F.J. OBrien1, 2, 3
1
Tissue Engineering Research Group, Royal College of Surgeons in Ireland, Dublin, Ireland
2
Advanced Materials and Bio-Engineering Research Centre, AMBER, Dublin, Ireland

3
Trinity Centre for Bioengineering, Trinity College Dublin, Dublin, Ireland
National Paediatric Craniofacial Center, Childrens University Hospital, Temple Street,

Dublin, Ireland
Introduction
Children have a remarkable capacity for bone
healing compared to adults. However, normal
bone formation can sometimes be altered in
developmental diseases, such as craniosynostosis
(CS), where an acceleration of ossification within
patent sutures of the skull can prematurely form
fused sutures. Since bone generation is mediated by
signalling mechanisms that include stimuli from the
surrounding environment [Engler, 2006], pathological
changes in the physiology of the sutures of CS children
may be associated with changes in both the stimuli
provided by the extracellular environment, as well as
the functional capacity of cells within the sutures to
sense and respond to the stimuli.
those cultured on 10 kPa gels, in both GM and OM.

PCs cultured on 10 kPa PA gels had a lower calcium
production compared to FCs and NCs (3.7- and
4.7-fold decreases respectively) in OM (Fig.1). In contrast,
there was an 8.7-fold increase in calcium production
by PCs on 300 kPa compared to 10 kPa gels, with levels
similar to FCs and NCs on these stiff substrates (Fig.1).
The goal of this study is to use 2D polyacrylamide (PA)

gels with a range of stiffness to understand the specific
mechanotransductive processes that underpin the
responses of cells isolated from patent and fused
sutures (PCs and FCs respectively) of CS patients.
Figure 1: C
alcium activity of PCs, FCs and NCs in OM after
14 days in culture on 10 and 300 kPa PA gels.
Discussion
The characterisation study of cells from CS patients
suggests a more progressed bone formation in
fused versus patent sutures, similar to the phenotype
of cells of the mature bone located in normal
calvarial tissue, as previous histomorphological
studies have shown [Milovanovic, 2012].
Methods
PCs, FCs, cells derived from normal calvarial tissue
of CS patients (NCs) and adult mesenchymal
stem cells (MSCs) were characterised in terms
of their phenotype and potential for osteogenic
differentiation by measuring alkaline phosphatase
(ALP) and calcium activity, in both growth medium
(GM) and osteogenic medium (OM). In order to
analyse the changes in the mechanosensitivity
of cells from CS patients, PA gels of different
stiffness were coated with collagen type I before
seeding with PCs, FCs and NCs at a 3000 cells/cm2.
The effect of stiffness on osteogenic differentiation
of cells from CS patients was analysed using a
calcium mineralisation assay after 14 days in culture.
Similar to the ability of CS cells to respond to biochemical osteogenic cues, we also showed that these cells
respond to biophysical cues, with all three groups of
CS cells increasing calcium expression with increasing
substrate stiffness in GM and OM. When cultured in
OM, cells derived from patent sutures had the greatest increase in osteogenic differentiation with increasing substrate stiffness. Also, the fact that levels of
osteogenesis were equivalent between the different
cell types on the stiff substrates suggests that mechanotransductive processes may affect CS pathology.
This is in line with a previous study that found cyclical
load also resulted in histological evidence of premature fusion in murine sutures [Oppenheimer, 2009].
Results
Initial characterisation studies revealed that calcium
expression in the CS cells cultured in GM was similar to
adult MSCs and an enhanced osteogenic potential
of CS cells was observed when cultured in OM. This
indicates that CS cells are not mature osteoblasts
but rather a population of osteo-progenitor cells
with a greater capacity for differentiation than adult
MSCs. However, there were differences in the level
of maturation between the different CS groups, with
greater expression of osteogenic markers in FCs and
NCs compared to PCs.
Taken together, these findings highlight a role

for mechanotransduction in accelerating bone
formation in CS cells.
References
Engler et al, Cell,126(4):67789, 2006
Milovanovic et al, Eur Cell Mater,24:441458, 2012
Oppenheimer et al, Plast Reconstr Surg,124(6):
18401848, 2009
Calcium production within all CS cells was higher

when cultured on 300 kPa PA gels compared to
576
P 208
THE EFFECT OF PERIODONTAL LIGAMENT ON

ULTRASONIC PRESSURE DISTRIBUTED ON TOOTH ROOT
SURFACE: A FINITE ELEMENT STUDY
B. Vafaeian1, M. Kim2, S. Al-Daghreer3 , M. El-Rich1, T. El-Bialy4 , S. Adeeb1
1
University of Alberta, Civil and environmental engineering, Edmonton, Canada

2
3
University of Alberta, Mechanical Engineering, Edmonton, Canada
King Abdulaziz University, Department of Orthodontics, Jeddah, Saudi Arabia

4
University of Alberta, Faculty of Medicine and Dentistry, Edmonton, Canada
Introduction
The stimulatory effect of low intensity pulsed
ultrasound (LIPUS) on regeneration of new tooth root
cementum (outer layer of root surface) has been
demonstrated before [1]. It is hypothesized that the
stimulatory effect is originated from the induced
mechanical stresses by the ultrasound. Our previous
study, through a three-dimensional finite element (FE)
model of a tooth/bone structure [2], supported the
hypothesis by demonstrating a positive qualitative
relation between ultrasonic pressure and cementum
regeneration. One of the parameters affecting
the ultrasonic pressure on the root surface is the
periodontal ligament (PDL). Since a wide range of
values for the mechanical properties of PDL has
been reported, we found it necessary to investigate
the effect of PDL on ultrasonic pressure on the root.
Figure 1. ( a) FE models of a section of tooth/bone structure.

(b) and (c) pressure amplitudes on the root surface.
Discussion
Due to high impedance difference between PDL
and bone, the existence of PDL was expected
to decrease the pressure on the root surface.
However, the model with PDL demonstrated
higher pressure, specially for the single-sided
ultrasound. We can infer that the geometry of
the PDL may act as an acoustic lens focusing the
ultrasound on some parts of the root. Even in the
case of double-sided ultrasound, excluding the
PDL merely increases pressure by 20% in average.
This indicates that the geometry of the PDL may
compensate the impedance difference by acting
as an acoustic lens. In conclusion, the effect of PDL
material (from being part of the bone to be a soft
tissue modeled as fluid) and its geometry on the
ultrasonic pressure can be significant. Therefore,
the effect of PDL material properties should be
reckoned for true ultrasonic simulations.
Methods
To investigate the effect of PDL on ultrasonic
pressure, horizontal section of the tooth/bone
structure model used in our previous FE study
[2] was selected. Two dimensional FE analyses
of ultrasound propagating in the section with
and without PDL (PDL as part of the bone) were
performed. The PDL was assumed as a non-viscous
fluid associated with the soft tissue. The ultrasound
was once applied on the buccal side (from
outside), and once simultaneously on the buccal
and lingual (from inside) sides (Fig. 1a).
References
[1] T. El-Bialy, I. El-Shamy, T.M. Graber, Repair of
orthodontically induced root resorption by
ultrasound in humans, Am. J. Orthod. Dentofac.
Orthop. 126 (2004) 186193.
[2] B. Vafaeian, M. Kim, S. Adeeb, M. El-Rich,
S. Al-Daghreer, T.H. El-Bialy, Finite Element
Simulation of LIPUS-Induced Mechanical Stresses
in Dentoalveolar Structure, The AADR Annual
Meeting & Exhibition, 2014.
Results
The simulated results in the case of single-sided
ultrasound indicate significantly higher pressure
amplitudes (60% on average) on the root surface in
the model with PDL (Fig. 1b). In the case of doublesided ultrasound, however, almost higher pressure
amplitudes (20% on average) were observed in the
model without PDL (Fig. 1c). Comparing the results
of single- and double-sided ultrasound indicates
predominately higher pressure when double-sided
ultrasound was applied.
577
P 209
DYNAMIC COMPRESSION HAS A MAGNITUDE

DEPENDENT EFFECT ON CHONDROGENESIS OF MSCS
A. Irvine1, D. Kelly1, 2
1
Trinity Centre for Bioengineering, Trinity Biomedical Sciences Institute, Trinity College Dublin,
Dublin, Ireland., Mechanical and Manufacturing, Dublin, Ireland
Advanced Materials and Bioengineering Research Centre AMBER, Royal College of Surgeons
in Ireland and Trinity College Dublin, Dublin, Ireland., Bioengineering, Dublin, Ireland
Introduction
Mesenchymal stem cells (MSCs) are a promising
cell source for cartilage tissue engineering due to
their strong chondrogenic potential as well as their
capacity to proliferate and self-renew. Limitations
associated with MSC based cartilage tissue
engineering strategies include inferior mechanical
properties compared to chondrocyte laden grafts
and the tendency for chondrogenically primed
MSCs to progress along the endochondral pathway
and form bone.1,2 Dynamic compression has been
however little is known about how the magnitude
of such stimuli regulate the development of
engineered cartilage grafts and their tendency to
progress along the endochondral pathway. The
hypothesis of this study is that dynamic compression
will regulate chondrogenesis and hypertrophy of
MSCs in a magnitude dependent manner.
compression (20%), however, acted to suppress the

increase seen in calcium deposition stimulated by
the lower magnitudes (data not shown). Increases
in construct mechanical properties were found to
correlate with increased calcium deposition within
the engineered tissues.
Figure 1: E
ffect of intermediate magnitude dynamic compression (10% strain) on (A) construct DNA content
(B) GAG content, (C) Calcium deposition,
(D) equilibrium modulus and (E) representative
images of type II collagen, GAG (Alcian Blue) and
calcium (Alizarin Red) deposition.
Methods
2% agarose containing 20 million porcine MSCs/ml
final cell suspension was cast in a stainless steel
mold to produce cylindrical constructs. Constructs
were maintained separately in 12well plates in free
swelling (FS) conditions with 2 mL chondrogenic
medium for 24 days prior to the application of
loading. Medium was exchanged twice weekly.
The dynamic compression protocol cons isted
of either 5%, 10% and 20% strain amplitude
superimposed on a maximum 1% strain preload,
at a frequency of 1Hz employed for a period of
2h/day, 4days/week. Unloaded controls were
placed in the bioreactor and the loading platen
was displaced to agitate the media but not deform
the MSC laden hydrogels.
Discussion
Low magnitudes of dynamic compression were
found to enhance chondrogenesis and the
mechanical functionality of cartilaginous grafts
engineered using bone marrow derived MSCs.
Interestingly, such levels of compression also
appeared to enhance continued progression along
the endochondral pathway. Only by applying high
levels of compressive strain was hypertrophy and
mineral deposition supressed within the MSC laden
grafts, suggesting that such mechanical cues play
an important role in promoting the development of
a stable articular cartilage phenotype. These results
have important implications for articular cartilage
and endochondral bone tissue engineering.
Results
The application of an intermediate magnitude
of dynamic compression (10%) was found to
enhance the differentiation of MSCs along
the chondrogenic pathway, as evidenced by
enhanced type II collagen deposition, increased
calcium deposition (a marker of chondrocyte
differentiation along the endochondral pathway)
and improved construct mechanical properties
(figure 1E,C,D). It was also observed that
hypertrophy of chondrogenically primed MSCs is
regulated by the magnitude of DC. Low (5%) and
intermediate (10%) magnitudes of loading act to
enhance hypertrophy and progression along the
endochondral pathway, as evident by increased
calcium deposition. High magnitudes of dynamic
References
1 R.L. Mauck et al., Osteoarthritis and Cartilage,
14(2):179189, 2006.
2 M.B. Mueller et al., Arthritis and Rheumatism,
58(5),13771388,2008.
This project was funded by the European Research
Council (258463) and Science Foundation Ireland
(12/IA/1554).
578
P 210
NUMERICAL CHARACTERIZATION
OF COLLAGEN HYDROGELS
A. Castro1, D. Lacroix1
1
University of Sheffield, Dept of Mechanical Engineering, Sheffield, United Kingdom
Introduction
Collagen is one of the major components of
extracellular matrix. As so, collagen hydrogels have
been used successfully in diverse tissue engineering
applications, namely on the production of scaffolds
or scaffolds coatings. Having strong non-linear
poro-viscoelastic properties, they are difficult to
characterize fully experimentally or numerically.
This study presents a numerical characterization
of collagen hydrogels, with the aim of being able
to account for the load transfer mechanisms from
the scaffold to the cells, i.e. to understand the
contribution of collagen on the mechanical stimuli
that affects cell behaviour (Lacroix et al., 2006).
a)
b)
Methods
Two
experimental
protocols
for
confined
compression
of
collagen
hydrogels
were
numerically reproduced with V-Biomech (a custom
FE solver previously presented on Alves et al.
(2010) and Castro et al. (2014)). Busby et al. (2013)
performed 5% compression at 0.005s1 using a
cylindrical sample of radius 8mm and height 5mm.
The compression was then hold for 300s. Chandran
and Barocas (2004) performed 10% compression at
0.001s 1 using a rectangular parallelepiped sample
of 3x15x15mm3. The compression was then hold
for 2000s.
Figure 1: C
omparison between experimental results and
numerical calculations: a) Busby et al. (2013);
b) Chandran and Barocas (2004).
The material properties were deducted from the

experimental results of Busby et al., for a hydrogel
with 0.3% of collagen concentration, given that
a similar hydrogel was used on Chandran and
Barocas experiments. The isotropic behaviour
was
modelled
through
the
compressible
Neo-Hookean model, with G=0.0003 MPa and
K=0.0005MPa. The strain-dependent permeability
was modelled through van der Voet model, with
K0=100.00mm 4.N1.s 1 and M=2.00.
Discussion
The minor discrepancy in the stress relaxation
tests between the numerical models and the
referential experiments is most likely related to
fluid flow after the compression stage, which is
happening in theoretical ideal conditions but may
not be so ideal with the experimental apparatus.
Nonetheless, the short-term loading and unloading
responses were well captured by the model. This
shows that collagen hydrogel poro-viscoelastic
properties could be reproduced in a numerical
model so that more complex scaffold architecture
can be studied in the future.
Results
The ramp loading stages, for both experimental
protocols, are successfully reproduced by the
corresponding numerical models (Figure 1),
despite achieving slightly higher stress magnitudes.
The initial stage of the stress relaxation is also fairly
well replicated, but the numerical models achieve
the stress plateau faster and at a slightly lower
magnitude.
References
Alves et al, CMBBE2010, Valencia, Spain, 2010.
Busby et al, J. Biomech., 46, 83740, 2013.
Castro et al, J. Biomech., 47, 297301, 2014.
Chandran and Barocas, J. Biomech. Eng.,
126, 152, 2004.
Lacroix et al, Biomaterials, 27:532634, 2006.
579
P 2 11
MULTI-SCALE SIMULATION OF INTERVERTEBRAL DISC

BIOPHYSICS UNDER BIOREACTOR CONDITIONS BY
COUPLING FINITE ELEMENT AND AGENT-BASED MODELS
J. Reagh1,2, S. Vizel2, C. Ruiz Wills2, T. Di Blasi2, A. Malandrino2,3 , F. Loeser2,
S.C.W. Chan4 , B. Gantenbein-Ritter4 , J. Noailly1,2
1
Universitat Pompeu Fabre, Department of Information and Communication Technologies

DTIC, Barcelona, Spain
2
Institute for Bioengineering of Catalonia IBEC, Biomechanics and Mechanobiology,

Barcelona, Spain
Massachusetts, Institute of Technology, Mechanobiology Laboratory, Cambridge, USA
Institute for Surgical Technology and Biomechanics, University of Bern, Tissue & Organ
Mechanobiology, Bern, Switzerland
Introduction
Advanced Finite element models (FEM) have been
used to investigate the role of mechanical and
nutritional environments in intervertebral disc (IVD)
degeneration. However, as a top-down approach,
FE models possess limited ability to simulate
the associated complex cellular processes.
Alternatively, agent-based models (ABM) employ
a bottom-up approach that is well suited to
simulate such processes. Altogether, FEM and ABM
techniques might allow promising organ-cell multiscale simulations to explore disc degeneration.
Results
FEM calculations led to cell viability as low as 3% in
the center of the disc due to lactate accumulation
and low glucose. This result was nicely reproduced
by the ABM calculations, along with the
corresponding solute profiles. ABM simulation
predicts up to a 1.6 fold increase for the catabolic
enzyme MMP3 over non-loaded (NL) discs. mRNA
for matrix molecules reached approximate minima
of 0.58, 0.51, 0.30 and maxima of 1.58, 1.45, 1.28 fold
change for aggrecan, collagen-I, and collagen-II,
respectively (Fig. 2).
Methods
A specimen-specific poro-hyperelastic FEM of a
bovine caudal intervertebral disc was created and
used to simulate 14 days of cyclic compressiontorsion (CCT) loading under bioreactor conditions
[Chan, 2014]. Calculated tissue deformations were
coupled to solute transport and cellular metabolic
reactions for oxygen, glucose, and lactate via
a
tissue-scale
mechano-transport
algorithm
[Malandrino, 2014].
FEM calculations for solute concentrations and
hydrostatic pressure (HP) were inputted to an
ABM environment. The latter used cells as local
solvers, i.e. agents (Fig. 1), and focused on
cellular processes at the center of the disc.
Agents integrated the FEM biomechanical and
biochemical cues according to rules extracted
from experimental data [Neidlinger-Wilke, 2012
& Hutton, 1999] to predict mRNA expression for
key matrix molecules and catabolic enzymes.
Moreover the ABM was tested against its capacity
to reproduce the time evolution of nutrition-related
solutes and cell viability, as predicted by the FEM.
Discussion
FEM simulations indicate low pH, due to lactate
build-up, is first to induce cell death. This finding
contradicts previous simulations only in compression
[Malandrino, 2014], which found low glucose to be
the initiator. Remarkably, significant increase in
cell death was also observed in bioreactor studies
of CCT versus pure compression [Chan, 2014]. We
anticipate the role of load-induced geometrical
changes, as the latter directly relate to both the
heterogeneous redistribution of tissue porosity, and
diffusion distance changes.
The ABM predicted decreased anabolism and
increased catabolism, caused by reduced
solute transport in the loaded disc. Meanwhile,
the effective up-regulated expression of matrix
molecules during loading cycles revealed that HP
would help maintain matrix production despite
adverse biochemical conditions.
see the next page
580
Ak n o wl e d g e m e n t s
Whitaker International Program
Including the production of cytokines in ABM

simulations is obviously an appropriate next step
[Risbud, 2014]. Preliminary tests including IGF-1 and
IL-1 production by cells qualitatively predicted
findings from the simulated bioreactor experiment,
e.g. ADAMTS over-expression.
References
Chan et al, PLoS One, 8(8), 2013
Hutton et al, Spine, 24(15):150715, 1999
Malandrino et al, J Biomech, 47(6):15205, 2014
Neidlinger-Wilke et al, J Orthop Res, 30(1):11221, 2012
Risbud & Shaprio, Nat. Rev. Rheumatol, 10:4456, 2014
581
P 212
REGIONAL IDENTIFICATION OF MECHANICAL

PROPERTIES IN MURINE THORACIC AORTIC
ANEURYSM AND DISSECTION
S. Avril1, M. Bersi2, C. Bellini2, J. Humphrey2, K. Genovese3
1
2
3
Ecole des Mines, Saint-Etienne, France
Yale University, Biomedical Engineering, New Haven, USA
Universit degli Studi della Basilicata, Dipartimento di Ingegneria e Fisica dellAmbiente,

Potenza, Italy
Introduction
Thoracic aortic aneurysm and dissection (TAAD) is
often characterized by localized changes in aortic
wall composition and structure that result from the
degradation of elastin, loss of smooth muscle cell
function, and remodelling of collagen. Correlations
between wall composition and local mechanical
properties can potentially provide insight into
conditions that render a vessel susceptible to failure.
a good agreement with a traditional identification

approach. Important regional variations of material
properties were identified in the TAAD.
Discussion
Results highlight the necessity to better understand
the mechanobiological processes governing
the balance between ECM production and
degradation in health and disease, as ultimately it
is alterations to this homeostatic balance that can
render vessels susceptible to vascular disorders.
Previous work on TAAD has shown that chronic

infusion of angiotensin-II in atheroprone (ApoE-/-)
mice often results in TAAD [Schriefl, 2012] [Bersi,
2012]. The objective of this work is to establish and
validate a new protocol able to characterize in
vitro the local mechanical properties in these TAAD
murine models.
Methods
The constitutive behaviour of the aorta is modelled
using a microstructurally motivated constrained
mixture model [Bellini, 2014]. Local mechanical
properties are quantified in site-specific aortic
segments by combining, for the first time, a
computer-controlled biaxial testing system (cyclic
pressure loading at different axial stretches
[Gleason, 2004]), a panoramic-Digital-Image-Correlation measurement system [Genovese,
2013], an Optical Coherence Tomographic
scanning system, and a regional inverse analysis.
The regional inverse analysis is based on the virtual
fields method [Avril, 2010] applied at the different
stages of the biaxial loading protocol. Eventually,
the identified regional mechanical properties are
compared to constituent area fractions obtained
using quantitative histological analyses.
Figure 1: S chematic illustrating the identification procedure

on ANG-II TAAD.
Results
Two mice aortas were tested: an untreated
control aorta and an ANG-II induced TAAD. The
control aorta showed a gentle cylindrical shape
whereas the TAAD showed a complex geometry
and extensive intramural thrombosis. The material
properties identified on the control aorta showed
References
Avril et al, J Biomech, 43: 29782985, 2010.
Bersi et al, Int J Adv Eng Sci Appl Math, 4:228240, 2012.
Bellini et al, Ann Biomed Eng, 42:488502, 2014.
Genovese et al, J Mech Behav Biomed Mater,
27:132142, 2013.
Gleason et al, J Biomech Eng, 126:787795, 2004.
Schriefl et al, Thromb Res, 130:139146, 2012.
582
P 213
MECHANICAL BEHAVIOR OF DIFFERENT LOCKING PLATE

FRACTURE FIXATION OPTIONS AT THE DISTAL FEMUR
M. Heyland1, G.N. Duda1, W. Schmoelz3 , K.D. Schaser2, S. Mrdian2
1
2
3
Julius Wolff Institute for Biomechanics and Musculoskeletal Regeneration,

Charit Universittsmedizin, Berlin, Germany
Center for Musculoskeletal Surgery, Charit Universittsmedizin, Berlin, Germany
Medical University Innsbruck, Department of Trauma Surgery and Sports Medicine,

Anichstrasse 35, Innsbruck, Austria
Introduction
Locking plate systems offer numerous configuration
options, but detailed information on the resulting
mechanical behavior is rare. Construct stiffness
influences the mechanical deformation of the
regenerative tissue and thus serves to provide a
direct healing stimulus (Duda, 2003; Epari, 2007). We
hypothesize that fracture fixation configurations
can be rated according to their stiffness.
be achieved in a wellset configuration. Lower

stiffness (concept of relative stability) with callus
growth towards large diameters may compensate
excessive shear movements (Plecko, 2012).
Methods
In vitro cadaver experiments were carried out
on 6 pair of distal human femora in various
configurations: 1) intact bone; 2) reduced distal
femur fracture, set with lag screw and stabilized
with 9-hole LISS plate (distally fully fitted with locking
screws, LS, for all fracture configurations) and 4 LS
in holes 3, 5, 7, 9; 3) same as 2) but LS from hole 3
removed; 4) same as 3) but lag screw removed;
5) same as 2), but set without lag screw; 6) same as
5) but LS from hole 3 removed; 7) 10-mm-distraction
defect model stabilized with 9-hole LISS plate (new
screw holes) and 4 LS in holes 3,5,7,9; 8) same
as 7) but LS from hole 3 removed; 9) same as 7)
but using dynamic locking screws (DLS) instead
of LS proximally; 10) same as 9) but DLS from hole
3 removed. The 10 different configurations were
loaded in 5 cycles each with 500/1000 N axial load
(ball joint proximally, hinged joint distally, 30 mm/min)
and 2/4 Nm torsional moment internally and
externally (x-y-table distally, 4 deg/min, 10 N axial
preload). Primary (slope at 2040% of the curve)
and secondary (6080%) axial stiffness as well as
torsional rigidity (slope internal-external rotation)
were evaluated.
Figure 1: Torsional rigidity of intact bone and different locking

plate fracture fixation configurations (see Methods
section).
Primary stiffness
Results
Resultant mean stiffness of different fixation
constructs range from 12119% of mean axial
(Tab.1) and 1886% of mean torsional intact
bone stiffness (Fig.1). Quotient of mean torsional
rigidity to mean axial stiffness is highest for
intact bone at 5.9Nmm/deg*mm/N. Concerning
fracture configurations, highest quotient showed
configuration 7) with 5.3 Nmm/deg*mm/N and
lowest configuration 4) with 3.5 Nmm/deg*mm/N.
Secondary stiffness
500 N
1000 N
500 N
1000 N
1341 518
1756 361
1945 525
2426 443
1602 265
1836 235
2071 179
1991 596
1264 135
1475 281
1623 408
1465 567
892 361
720 134
806 146
946 164
1207 564
1232 553
1412 611
1181 537
830 339
573 96
640 57
797 70
468 88
433 92
464 89
398 93
399 73
376 87
394 93
371 95
374 24
357 33
381 23
329 50
10
323 23
306 40
311 43
297 58
Table 1: A
xial stiffness [N/mm] at different load levels
(primary: 2040% of load, secondary: 6080% of
load) as mean standard deviation for different
configurations 110 (see Methods section).
Discussion
A wide range of axial and torsional stiffness is
covered by different fixation options, but axial
and torsional stiffness are strongly coupled in
locking plate configurations overly restraining axial
movements compared to torsion. High stiffness
similar to intact bone (absolute stability) can nearly
References
Duda et al, Langenbeck Arch Surg 387:433440, 2003.
Epari et al, J Bone Joint Surg Am 89:15751585, 2007.
Plecko et al, Injury 43:10411051, 2012.
583
P 214
POROELASTIC FINITE ELEMENT MODEL OF OSTEOGENIS

WITHIN A TITANIUM SCAFFOLD COUPLING
BIOLOGY AND MECHANIC
M. Schmitt1, R. Allena1, P. Rouch1
1
Arts et Mtiers ParisTech, LBM / Institut de Biomcanique Humaine Georges Charpak,

Paris, France
Introduction
Bone is a living tissue able to restore itself when it is
injured. However, when a defect exceeds a critical
size a structural support such as a scaffold is required
in order to enhance osteogenesis. Recently, several
experimental [1] and numerical works [2, 3] have
been developed to better understand the complex
process of osteogenesis within scaffolds.
(bone, cartilage and fibrous tissues respectively).

After 1 week, the cells distribution and the mechanical properties of the scaffold are updated
and stored. Then, steps one and two are recomputed to cover a time interval of 12 weeks.
In Figure 1b, the evolution with respect to time of
MSCs and osteoblasts concentrations is represented.
Following a preliminary study [4], we propose

here a more exhaustive three-dimensional (3D)
poroelastic finite element model based on an
animal study. The main goal of the present work
is to evaluate the effects of the mechanics on the
cellular activity (i.e. the mechano-transduction
phenomenon).
METHOD
Our model is based on an experimental study, which
aims to evaluate the osteogenesis within a titanium
scaffold implanted on the non-toothed part of ewes
mandible during 12 weeks. We use a simplified 3D
beam to represent the titanium scaffold (18mm long
and 12 mm width, Figure 1a). The left boundary of
the scaffold is clamped, while the right boundary
is submitted to a cyclic load describing the ewes
mastication.For the sake of computation time, an
algorithm has been developed.
Figure 1: ( a) Titanium scaffold (b) MSCs and osteoblasts

concentration cm and cob respectively at 0, 4, 8
and 12 weeks.
We can observe that the cellular colonization

of the MSCs takes place from the exterior
towards the interior of the scaffold as it has
been experimentally observed. Moreover, since
the differentiation process starts after 14 days of
maturation, we observe that after 4 weeks, there
are few osteoblasts.
First, since the interstitial fluid may have a real

impact on cells activity [5], the scaffold is
considered as a poroelastic material and the
poroelasticity equations are solved during one
mastication cycle.
At the end of the mastication cycle, the average
fluid velocity, which will be involved in the
differentiation pathway of the mesenchymal
stem cells (MSCs), is stored. Second, the reactiondiffusion equations which describe the complex
cellular activity within the scaffold are solved for
1 week. This complex cellular activity occurs in
4 successive steps and involves different type of
cells: i) the migration of the MSCs which couple the
cells concentrations with the principal stress and
directions of the structure and their proliferation
ii) the differentiation of the MSCs into either
osteoblasts, chondrocytes or fibroblasts regulated
by two biophysical stimuli: the shear strain and the
interstitial fluid velocity [2]. iii) the proliferations of
the osteoblasts, chondrocytes and the fibroblasts
and iv) the formation of the extracellular matrix
Currently, micro-computed tomography scanners

of the 12 weeks explanted hemi-mandibles are
being performed in order to validate our mechanobiological approach.
References
[1] Karageorgiou, V. & Kaplan, D. Biomaterials.
26:54745491, 2005.
[2] Prendergast, P. J., Huiskes, R. & Sballe,
K. J Biomech. 30:539548, 1997.
[3] Checa, S. & Prendergast, P. J. J Biomech.
43:961968, 2010.
[4] Schmitt M, Allena R, Schouman T, Frasca S,
Collombet JM, Holy X, Rouch P. Comput. Method.
Biomech. (ahead-of-print), 19, 2015.
[5] Cowin SC, Moss-Salentijn L, Moss ML. J. Biomech.
Eng. 113:191197, 1991.
584
P 2 15
PREDICTIVE MODEL FOR SIMULATING TRABECULAR BONE

REMODELING IN TWO DIMENSIONS
L. Meyer1, C. Collins1, K. Suresh1, H.L. Ploeg1
1
University of Wisconsin, Mechanical Engineering, Madison, USA
Introduction
Currently, about 55% of adults older than 50 years
are affected by or at risk for osteoporosisa
systemic skeletal disease causing deterioration of
bone tissue and associated with a high mortality risk
[ACPM, 2009]. Understanding bone biomechanical
behaviour is imperative to promote bone health
throughout aging, preventing fractures, and
improving treatment options. It is necessary
to consider cellular level biological factors in
addition to mechanical stimuli. Recently, Scheiner
et al. employed one-dimensional (1D) analytical
stress analysis, and systems biology in tandem
to develop mathematical models to predict the
morphological changes in bone resulting from
mechanical and biochemical stimuli [Scheiner,
2013]. The goal of the current study was to develop
an algorithm that could simulate cortical bone
adaptation on a simple two-dimensional (2D)
geometric model, in real time.
sity in the bone decreased by 30% with a 3%

difference between the maximum and minimum
porosity values (Figure 1B). The SED was decreased
by nearly 100%.
Methods
The predictive algorithm was developed in MATLAB
(version R2013a, Simulink) by modifying the
analytical models determined by Scheiner et al.
bone cell interactions to interface with a 2D finite
element (FE) solver. The inputs for biochemical
factors (RANK, RANKL, OPG, PTH, and TGF-) cell
concentrations, initial bone porosity (5%), and
isotropic mechanical properties were assumed
from literature (elastic modulus=10 GPa, Poissons
ratio=0.3) (Scheiner, 2013). These properties were
assigned to a simple 2D geometry under 500N
compressive uniaxial loading (Figure 1A) and
a finite element analysis (FEA) with 4000 linear
quadrahedral elements was performed. The
algorithm uses calculated strain energy density
(SED) and assumed biological factors to minimize
the SED in load bearing tissue by changing the
porosity in relevant areas. The algorithm was
repeated for 5, 10, and 20 time steps to simulate
bone adaptation with time.
Figure 1: A
) Von mises stress distribution at hole with high
stresses in red and lower stresses in green. Applied
load and boundary conditions shown. B) Predicted
porosity distribution across hole after 20 iterations.
Discussion
The presented simulation successfully mimicked
bone remodelling in 2D on a simplified geometry.
The intent of the current research was to expand
Scheiners algorithm from 1D analytical stress
analysis and show remodelling of simulated bone
in response to initial concentrations of biochemical
factors, porosities, and mechanical stimuli. The
algorithm has shown promise in that the results
were consistent with known physiological bone
remodelling patterns. It will be tested on additional
2D structures more representative of bone. Future
versions of the algorithm will be developed to
include additional biochemical factors that
contribute to the response of osteoblasts and
osteoclasts. Finally, the algorithm will be expanded
to three dimensions to model whole bone.
Results
As expected, the simulation found the maximum
Von mises stress located in the stress concentration
caused by the hole (Figure 1A) and bone material
adapted to reduce porosity at that location.
After 20 iterations, the maximum Von mises
stress increased by 11% and the maximum poro
References
American College of Preventive Medicine,
Am J Prev Med, 36(4):36675, 2009.
Scheiner, S., et al., 254:181196, 2013.
585
P 2 16
A MULTISCALE MODELING OF MINERALIZED

TISSUES CONSIDERING THE DYNAMICS
OF CELL MICROMECHANICS
E. Mercuri1
1
Professor, Environmental Engineering, Curitiba, Brazil
Bone tissue is a dynamic system capable

of changing its own density in response to
biomechanical stimuli. The biological system
studied herein consists of three cellular types,
responsive osteoblasts, active osteoblasts and
osteoclasts, and four types of signaling molecules,
PTH, TGF-, RANKL and OPG. This study examines
the biological response to a specific mechanical
stimulus in a cellular model for bone remodeling.
Two-dimensional examples are proposed with
spatial discretization performed through the finite
element method. The temporal evolution of the
biological variables and bone density is obtained
using the Runge-Kutta method. A computational
code named Remold 2D is created in MATLAB.

The strain energy density at the microscale
served as mechanical stimulus to trigger cellular
activity demonstrating the temporal evolution of
density distribution in three diferent models. This
distribution is in agreement with other models in
the literature. The main contribution of this thesis is
the coupling of mechanical and biological models
in a multiscale framework. Another important fact
is that the results can represent the local behavior
of the proposed biological variables. The study is
a first step in the development of more advanced
models to represent the imbalance of bone
homeostasis.
586
P 2 17
FAILURE CHARACTERIZATION OF CORN STALK TISSUE

M. Julias1, D. Cook2
1
2
New York University Abu Dhabi, Abu Dhabi, United Arab Emirates
New York University Abu Dhabi, Engineering, Abu Dhabi, United Arab Emirates
Introduction
Despite advances in breeding techniques, over 800
million people still suffer from hunger or malnutrition
[FAO, 2014]. Yield losses due to crop lodging (failure
of the stalk to remain upright until harvest) range
from 10 to 20% worldwide [Nielsen, 2006]. In an effort
to ease the impeding problem of food security, and
offset losses due to draught disease and climate
change, our group has been investigating the
problem of corn stalk lodging. Forensic and structural
engineering analyses have demonstrated that over
90% of corn stalks fail or break within 3 cm of node
line (see Figure 1, left). In this region, the stalk rind
buckles or creases causing the plant to fall over. The
main objective of this study is to understand how and
why corn stalks fail at this region.
Figures
Figure 1: L eft: Corn stalk bending failure.

Middle: Stalk segment. Right: Cross-section.
Methods
Three point bending tests were performed on dried
and fully matured corn stalks. The failure region of
these stalks was subsequently investigated using
scanning electron microscopy.
Results
Tissue delaminations were frequently observed
just beneath the rind surfaces (Figure 2). In tensile
regions, cracked rind surfaces were observed while
in compressive regions creased surfaces were
often formed. Morphology and appearance of
tissues in the failure differed from the morphology
of tissue in the center of the internode.
Discussion
Tissue delamination appears to be associated with
failure in corn stalks. As the intralayer delamination
grows within the stalk, severity of cracking and/or
creasing of rind surface increases. This ultimately
leads to complete destruction of the stalk.
Preventing the initial delamination or deviating
the delamination from interlayer to intralayer
delamination could inhibit stalk failure.
Figure 2: T issue delaminations (arrows) accompanied by

cracking were observed in the failure region on
the tensile side of the stalk (top) while delaminations and creasing was often observed on the
compressive side of the stalk (bottom).
References
FAO, The State of Food Insecurity in the World, 2014.
Nielsen, B., Agronomy Guide, 2006.
Simitses, G.J., Applied Mechanics Reviews, 39(10):
15171524, 1986.
Morphological and shape differences observed

near the node line (i.e. the failure region) are likely
acting as stress concentrators. Stress concentrators
artificially increase local stresses [Simitses, 1986]
which leave the stalk susceptible to mechanical
failure near the stress concentrators. Minimizing
any of these stress concentrations should improve
stalk strength and reduce the stalk lodging.
587
P 218
ENGINEERING ANALYSIS PROVIDES NEW INSIGHTS

INTO CORN STALK FAILURE
D. Cook1, B. Gardunia2, D. Robertson1, M. Julias1
1
2
Monsanto Company, Discovery Corn Breeding, Huxley, USA
Introduction
For over 100 years, the problem of wind-induced
stalk failure has mystified agricultural researchers
[Garber and Olsen, 1919; Ma et al., 2104].
Surprisingly, biomechanical engineering expertise
has not previously been applied to the problem
of corn stalk failure. In particular, the literature
contains almost no information on corn stalk failure
modalities. The purpose of this study was to perform
the an engineering failure analysis of corn stalk
failure modes and patterns as a first step in applying
biomechanical techniques to this problem.
Furthermore, 89% of creasing failures occur within

3 cm of a junction between adjacent sections of
the stalk. These results indicate strong connections
between corn stalk physiology and failure.
Methods
Corn stalk failure samples were carefully examined
at several locations in North America and Africa
during 2010, 2012, and 2014. To reduce the number
of potential confounding factors, only stalks with
no visible presence of disease or pest damage
were included in this study.
Figure 2: P
roportions of failure types and failure direction
relative to stalk cross-section.
X-ray computed tomography was performed to

obtain high-resolution geometric information of
corn stalks at resolutions ranging from 78 m to
90m per voxel. Customized computer code was
developed to perform automatic analysis of the
geometric features of stalk cross-section
An analysis of corn stalk geometry obtained from

CT data revealed that extreme changes in stalk
geometry occur at nodal junctions (data not
shown due to limit of 2 figures per abstract).
Results
Corn stalks were found to fail in just three modes,
including tensile snapping, longitudinal splitting,
and buckling/creasing (see Figure 1). This is the first
detailed description of corn stalk failure modes in
the scientific literature.
D i s c u s s i o n a n d C o n cl u s i o n
The application of engineering failure analysis
revealed distinct patterns in failure type, direction,
and location. Corn stalk failure locations are
spatially correlated with geometric variation,
suggesting that geometric changes near the node
may act as stress concentrators and may affect
stalk strength and failure patterns.
As agronomists are not familiar with principles of
biomechanics, our research group is currently
working with agricultural scientists to develop
techniques for more accurately assessing stalk
strength [Robertson et al 2014, 2015]. Progress on
the problem of stalk failure will likely be aided by
the introduction of biomechanical principles.
Figure 1: T he three modes of corn stalk failure.
Overall, 91% of all failed samples exhibited buckling

failure. Buckling creases were commonly aligned
with the major diameter of the stalk cross-section,
and the predominant direction of failure was in the
direction of the minor diameter of the corn stalk
(Figure 1).
References
Garber RJ, and Olson PJ, (1919). J.Amer.Soc.
Agron., 11(5):173186.
Ma et al. (2014) Crop Sci.54:28052814.
Robertson et al. (2014), Crop Sci, 54:20382044.
Robertson et al. (2015), Am.J.Botany, 102(1):1 7.
588
P 2 19
CORN STALK STRENGTH IS HIGHLY INFLUENCED

BY PLANT MORPHOLOGY
D. Cook1, M. Julias1, S.Y. Lee1, D. Robertson1
1
Introduction
Corn stalk strength is affected by innumerable
biological processes and adaptation to a
constantly changing environment. As a result, plant
scientists have long sought for simple methods for
determining stalk strength. Several tests have been
proposed [Zuber & Grogan, 1961; Davis & Crane,
1976; Hu et al.,2014], but unfortunately many of
these tests (which were designed by biologists)
exhibit relatively weak to moderate correlations
with stalk strength. The purpose of this study was
to apply engineering tools and techniques to
determine how geometric and tissue parameters
affect stalk strength.
Methods
Corn stalk samples were collected immediately
prior to harvest, scanned at 78m per voxel using
x-ray computed tomography (CT), and then tested
in three-point bending to determine strength.
Geometric
measurements
were
extracted
from CT scan data to obtain detailed threedimensional geometric information. Corn stalk
samples included 5 commercial hybrid varieties
(Monsanto Company). Stalks exhibiting disease
or pest damage were excluded from the study
to reduce the number of confounding factors.
Statistical analyses were performed to determine
relationships between stalk strength and geometric
features.
Figure 1: L inear regression and coefficient of determination

(R2) value between stalk strength and geometric
features.
Geometric data was used to create finite element

models of the corn stalk, and a sensitivity analysis
was performed to determine how stress levels are
affected by variations in geometric and material
parameters.
Figure 2: N
ormalized mean sensitivity values between
maximum stress and variations in geometric and
material parameters
Inset: Finite element model.
Results
Regression analysis was performed on features
that were expected to affect stalk strength.
These included major diameter, minor diameter,
eccentricity, rind thickness, and moment of inertia.
D i s c u s s i o n a n d C o n cl u s i o n
Biology studies have failed to establish reliable
relationships between chemical compositions of
corn stalks and stalk strength. This has surprised most
researchers in this field since chemical composition
should be related to tissue strength. This apparent
dilemma may be explained by the strong
depenence of stalk strength on geometric features
alone. We are currently working with industry
scientists and engineers at Monsanto Company
to apply this new knowledge and develop new
measurement tools for plant breeders.
Most
geometric
features
exhibited
some
relationship with stalk strength, and a selection of
individual and composite geometric features are
plotted against stalk strength in Figure 1.
The moment of inertia (lower right-hand plot of
Figure 1) was calculated by assuming an elliptical
cross-section and three geometric features: major
diameter, minor diameter, and rind thickness.
Although strength ultimately depends upon
numerous factors, the moment of inertia accounts
for 78% of the variation in stalk strength.
References
Davis & Crane (1976), Purdue.Ag.Exp.Paper 5779.
Hu et al.(2013), Theor.Appl.Genet. 126:22572266.
Zuber & Grogan (1961), CropSci, 1(5):378380.
A sensitivity analysis of finite element predictions

of maximum stress levels revealed that geometric
parameters have much higher effects on stress
levels than tissue properties (see Figure 2).
589
P 220
RESPIRATORY AND AEROACOUSTICAL

CONTROLS DURING FLUTE PLAYING
C. Vauthrin1,2, B. Fabre1,2, I. Cossette3
Sorbonne Universites, UPMC Univ Paris 06, UMR 7190, Institut Jean Le Rond dAlembert,
F-75005, Paris, France
CNRS, UMR 7190, Institut Jean Le Rond dAlembert, F-75005, Paris, France, Paris, France
MPBL/CIRMMT, McGill University, Montreal, Quebec, Canada., Schulich School of Music/,

Montral, Canada
Introduction
Among all controls developed by musician, this
study focuses on the interactions between the
respiratory mechanisms and the aero-acoustical
parameters during flute playing. The aim of this
work is to develop our understanding of the
link between the respiratory and aero-acoustic
parameters controlled by the musician.
Representation of the pitch, the Reynolds number,

the adimensional air-jet velocity, the muscular
activity and the total volume for the play of Prlude
laprs-midi dun faune from Debussy.
Figure 1 shows that the musician needs to use
almost his vital capacity and control the expiration
with his inspiratory muscles. Indeed to maintain a
low Reynolds number, the flautist needs to keep his
inspiratory muscles active during the expiration.
In order to perform respiratory and aero-acoustical
measurements, a combined set-up is developed
to acquire muscles activity (of inspiratory and
expiratory muscles) with Electromyography, chestwall volumes (by opto-plethysmography), blowing
pressure in the mouth, trans-diaphragmatic
pressure, lips position (by camera), and sound were
measured during the playing. Different musical
tasks, which present different complexities, are
proposed to three musicians. Musicians are asked
to play standing and sitting, in order to compare
the different breathing strategies developed.
C o n cl u s i o n
First, data analyses indicate a strong correlation
between the musical task, the aero-acoustical
parameters, the respiratory parameters, and
preparatory gesture. They show that a specific
breathing is developed during flute playing, to
differentiate to the tidal breathing. Furthermore,
the aero-acoustical control is independent of the
respiratory-state, but is directly dictated by the
musical task. At last, different respiratory strategies
are perform for the two positions of playing
(standing or sitting).

From
the
measurements,
aero-acoustical
describers of flute control are calculated: the
Reynolds number and the adimensional air jet
velocity which indicate the air-jet structure and
characteristics. The representation of the data
recorded are represented.
References
Cossette I. et al, From breath to sound: linking
respiratory mechanisms to aeroacoustics sound
production in flutes. Acustica/ Acta Acustica,
Vol 96 654667 [2010]
De la Cuadra, et al, Analysis of Flute Control Parameters: A Comparison Between a Novice and
an Experienced Flautist. Acustica/ Acta Acustica,
Vol 94 740749 [2008]
590
P 221
COMPUTATIONAL MODELLING OF TRACHEOBRONCHIAL

STENT IN-VIVO LOADING
D. McGrath1, J. Clauser2, A.L. Thiebes3 , C. Cornelissen3 , B. OBrien1,
M. Bruzzi1, S. Jockenhvel3 , P. McHugh1
1
National University of Ireland, Galway, Biomechanics Research Centre BMEC,

Biomedical Engineering, Galway, Ireland
Helmholtz Institute, RWTH Aachen University, Department of Cardiovascular Engineering

Institute of Applied Medical Engineering, Aachen, Germany
3
Helmholtz Institute, RWTH Aachen University, Department of Tissue Engineering & Textile
Implants, Institute of Applied Medical Engineering, Aachen, Germany
Introduction
Tracheobronchial stents are tubular scaffolds
deployed to provide support to damaged or
diseased airways. The stent must keep the affected
lumen patent while limiting tissue damage and
stent migration. The interaction between the
airways and tracheobronchial stents needs to be
understood to be able to improve current stent
designs, but to-date little work has been reported
in the literature on this relationship [Malv, 2011].
This study investigates the interaction of bare and
polyurethane (PU) covered self-expanding stents
with an ovine bronchial model, under different
loading conditions, using a validated stent material
model and in-vivo data of stent deployment.
Methods
A nitinol stent is designed and experimentally
validated; computational models of crimp and
deployment in bare and PU covered configurations
are generated using Abaqus/Explicit. A realistic invivo ovine lung geometry is obtained from CT using
the commercial software Mimics. Material properties
for the airway are obtained experimentally. Invivo stent deployment is simulated in Abaqus and
calibrated against fluoroscopy results pre- and
post-stenting. Physiological lung deformation is
coupled with a pressure analysis to evaluate the
effect of breathing and coughing on both the
bronchus tissue and the stent in question. Results of
the analysis are compared to in-vivo animal results
with respect to inflammation and migration.
Figure 1: ( a) Computational and experimental radial force

results for bare and covered stent configurations.
Inset: crimped PU covered stent (b) Deployed
stent showing stress distribution in bronchus.
Discussion
This study combines validated stent computational
models with in-vivo loading to produce a model
to improve understanding of the stent-bronchus
relationship. Further enhancement of the model
will allow validation against in-vivo animal results
which can lead to improved stent design.
Results
Computational and experimental results simulating
stent crimp and deployment confirm that the
computational models replicate stent behavior
during loading (Figure 1 (a)). This has not been
previously demonstrated for a covered stent
simulation. The in-vivo stent deployment and
pressure loading analyses indicate that the stress
in the tissue directly after stent deployment (Figure
1 (b)) is almost 5 times higher than the maximum
stress observed in the same area during an
unstented cough analysis.
References
Malv et al, J Int Commum Heat Mass,
38:855862, 2011.
591
P 222
BIOMECHANICS OF THE TRACHEAL BIFURCATION

DURING TOTAL LIQUID VENTILATION
P. Bagnoli1, F. Acocella2, M.L. Costantino1, F. De Gaetano1
1
Politecnico di Milano, Chemistry, Materials and Chemical Engineering Giulio Natta,

Milan, Italy
2
Universit degli Studi di Milano, VESPA, Milan, Italy
Introduction
The study of the biomechanical behaviour of the
neonatal airways is crucial to optimise the patient to
machine interaction during any artificial ventilation
treatment. This is particularly important when
neonatal Total Liquid Ventilation (TLV) is concerned,
since during this treatment liquid perfluorocarbons
(PFC) are used instead of gas as a carrier for
oxygen and carbon dioxide into the lungs, thus
inducing a different airway pressure condition
with respect to the gas ventilation [Wolfson, 2005].
Aim of this study is to develop a Finite Element (FE)
model to analyse the biomechanics of the tracheal
bifurcation of preterm neonates during a TLV
treatment performed with a newly designed non
volumetric prototype (Pro-Li-Ve) developed by our
group [Bagnoli Costantino, 2013]. The final goal is to
evaluate if the Pro-Li-Ve flow rate, that is afterloaddependent, can ensure a modulation of the airway
pressure reducing the risk of tracheal collapse.
The model outcomes show the highest maximum

principal stress located on the cartilaginous
rings, when the maximum negative pressure is
applied (Fig.1). The comparison among the model
configurations at different values of airway pressure
and the CT images acquired [Bagnoli, 2013] in vivo
during TLV performed on preterm lambs with the
piston pump shows good matching, thus proving
model reliability.
Methods
A 3D finite element structural model of the tracheal
bifurcation was implemented (ABAQUS/Standard)
to investigate by a computational approach the
deformations of preterm airways in the range of
pressures applied during TLV. The model consists of
7 airway rings, each composed of 3 tissues (cartilage,
smooth muscle, connective tissue) modelled
as hyperelastic materials. The biomechanical
properties of each tissue were experimentally
determined on lamb tracheae and implemented
in the model [Bagnoli, 2013]. A pressure load was
applied on the internal surface of the model,
reproducing the airway pressure tracings acquired
during the respiratory cycle performed using the
Pro-Li-Ve [Bagnoli Costantino, 2013].
Figure 1: F E model of the tracheal bifurcation.
Results
A slight lumen increase was observed during
inspiration due to the applied positive pressure,
(Fig. 1). During expiration a pressure decrease was
recorded at the beginning of expiration, however
not inducing complete collapse, which is followed
by a smooth pressure growth inducing airway
lumen re-opening.
This study was supported by the Italian
Ministry of Education, University and Research
(grant FIRB2008-Futuro in Ricerca RBFR081BZQ).
The implemented model allowed the evaluation of the
tracheal mechanical behaviour when different airway
pressure tracings were applied. Particularly interesting
is the analysis of the deformation pattern during
the expiration phase: a lower tracheal deformation
was obtained with the Pro-Li-Ve with respect to the
results previously obtained with volumetric ventilators
[Costantino, 2014; Bagnoli, 2013].
Moreover, the lumen narrowing recorded with Pro-Li-Ve
occurred at the beginning of the expiration, i.e.
when the lungs are totally filled with perfluorocarbon,
thus reducing the risk of airway collapse.
References
Wolfson, Shaffer. Paediatr Resp Rev, 6: 117127, 2005.
Bagnoli, Costantino. Int J Artif Organs 36(8): 561, 2013.
Bagnoli, et al. J Biomech, 46: 462469, 2013.
Costantino et al. J Biomech, 37: 18371847, 2004.
592
P 224
FIBRONECTIN TETHERS SYNOVIAL FLUID COMPONENTS

IN THE SUPERFICIAL ZONE OF CARTILAGE
ENHANCING WEAR PROTECTION
R. Andresen Eguiluz1, F. Wu2, S. Cook2, C. Brown2, N. Pacifici2,
L. Bonassar3 , D. Gourdon2
1
University of Illinois at Urbana Champaign, Department of Chemical and Biomolecular

Engineering, Urbana, USA
2
Cornell University, Department of Materials Science and Engineering, Ithaca, USA

3
Cornell University, Department of Biomedical Engineering, Ithaca, USA
Introduction
In healthy synovial joints, articular cartilage shows
excellent lubrication and wear resistance over a
persons lifetime. During boundary lubrication, it is the
outermost layer of cartilage that acts as the bearing
surface, which contains lubricin (LUB) 1, fibronectin
(Fn)2, hyaluronan (HA)2, and serum albumin (SA)3,
among others. There have been many interesting
studies on the role of individual components of
synovial fluid (SF)49 and on the synergistic interactions
between two components 1012 to understand the
lubrication mechanisms at the superficial zone. Fn
is a multifunctional glycoprotein which is present in
the superficial zone of articular cartilage2, but not in
transitional or radial zones. This presents the question
of whether Fn acts as a tethering molecule for SF
components, such as LUB, HA or SA. The aim of this
work was to (i) investigate whether Fn affects the

adsorption of LUB, HA, and SA to Fn coated surfaces
and (ii) analyze how Fn modifies the tribological
behavior of those SF components, in particular the
friction coefficient and the protection against wear.
Using a Surface Forces Apparatus we have
measured the normal and shear forces, and
monitored the onset of damage of the confining
Fn-bound surfaces via multiple beam interferometry.
Fn-bound mica surfaces were incubated with
either LUB, HA, or SA. SF was used as control.
Surface functionalization steps were carried out
with surfaces mounted on the SFA, yielding the
same adsorption on both surfaces.
Results
Figure 1: ( A) Representative curves of the normal force normalized by the surfaceradius of curvature R as a functionof the
absolute separation distance Dbetween mica surfaces coated with adsorbed Fn (white squares), with adsorbed
Fnand LUB (cyan circles), with adsorbed Fn and ESF (orange triangles), withadsorbed Fn and HA (black squares),
and with adsorbed Fn and BSA (greendiamonds). (B) Bar charts displaying the average values of the unperturbed
filmthickness D0 and (C)average values for the compressed film thickness (hardwalls) HW of Fn films before (white)
and afterincubation of LUB (cyan), ESF (orange), HA (black), and BSA (green). For (B)and (C) values are reported
as mean+standard deviation, n=4. In all cases, p<0.05 is indicated by single star and p<0.001 by three stars.
see the next page
593
Figure 2: F riction force as a function of normal force between mica surfaces with adsorbed (A) Fn+LUB, (B) Fn+ESF, (C) Fn+HA,
and (D) Fn+BSA all sheared in PBS. The surfaces were sheared at sliding velocities of V=0.3m/s (black circles),
V=3 m/s (red triangles), and V=30m/s (blue squares). Open symbols indicate measurements after the surfaces
became damaged.
References
1 Radin, E. L. et al., Nature 1970, 22, 377378.
2 Balazs, E. A., Struct. Chem. 2009, 20, 233243.
3 Fan, J. et al., Faraday Discuss. 2012, 156, 6985.
4 Swann, D. A. et al., Biochem. J. 1985, 225, 195201.
5 Zappone, B. et al., Biophys. J. 2007, 92, 16931708.
6 Zappone, B. et al., Langmuir 2008, 24, 14951508.
7 Greene, G. W. et al., Proc. Natl. Acad. Sci. U.S.A.
2011, 108, 52555259.
8 Tadmor, R. et al., Macromolecules 2003, 36,
95199526.
9 Lee, D. W. et al., Acta Biomater. 2014, 10,
18171823.
10 Chang, D. P. et al., Soft Matter 2009, 5, 34383445.
11 Das, S. et al., et al., Biomacromolecules 2013,
14, 16691677.
12 Chang, D. P. et al., J. Biomech. 2013, 18.
Discussion
Our findings indicate that LUB binds to Fn and
provides wear protection, similar to what observed
with SF. HA and SA bind to Fn as well, but lack the
wear protection and lubricating properties of LUB.
These results have important implications for our
understanding on boundary lubrication and wear
protection of articular surfaces, and enhance our
knowledge of biotribological interactions that may
be exploited for treatments such as osteoarthritis.
The authors would like to thank funding by NSF
under award 1031068, NIH/NCI under award
1R21CA161532, CONACYT, and the Cornell Center
for Materials Research through Award Number
(NSF DMR-1120296).
594
P 225
THERMO-ELECTRICAL EQUIVALENTS FOR SIMULATING

THE ELECTRO-MECHANICAL BEHAVIOUR
OF BIOLOGICAL TISSUE
I. Cinelli1, P.E. McHugh1, M. Duffy1
1
NUIG, College of Engineering and Informatics, Galway, Ireland
Introduction
Equivalence is one of most popular techniques to
simulate the behaviour of systems governed by the
same type of differential equation. In this case, a
thermo-electrical equivalence is considered as
a method for modelling the inter-dependence
of electrical and mechanical phenomena in
biological tissue. We seek to assess this approach
for multi-scale models (from micro-structure to
tissue scale) of biological media, such as nerve
cells and cardiac tissue, in which the electrical
charge distribution is modelled as a heat
distribution in an equivalent thermal system. This
procedure allows for the reduction in problem
complexity and it facilitates the coupling of
electrical and mechanical phenomena in an
efficient and practical way. Although the findings
of this analysis are mainly addressed towards the
electro-mechanics of tissue within the biomedical
domain, the same approach could be used in
other studies in which a coupled finite element
analysis is required [1].
Figure 1: A
xisymmetric 3-layer nerve cell model and the
calculated action potential for 3 different step-input voltages.
Method
In a first test case, a cell scale model of a nerve
cell is chosen [1] in order to validate the charge
distribution simulated electrically in [2] through
heat transfer analysis. The steady state and
time varying electrical behaviour are analysed
based on the quasi-static theory assumptions for
diffusion of charges in biological media [2]. The
Cable Equation for the electrical transmission
appropriately describes this behaviour. This
equation has the same mathematical structure as
the Heat Equation, hence the overall distribution
of charges across the nerves membrane
is equivalent to heat flux, and the voltage
distribution is equivalent to temperature. Due to its
time dependent behaviour, the flow of charges is
usually observed as an action potential. To address
the problem using the Abaqus CAE software, an
isotropic axisymmetric 3-layer cylindrical model
is generated, representing a section of a nerve
cell (Figure 1). Particular focus needs to be
paid to the representation of the membrane. Its
non-linear properties are described by differential
equations describing the voltage-dependent ionic
currents of sodium, potassium and residual ions
[3]. The Hodgkin-Huxley kinetic model is the most
common and simple active ionic model, based
on Kirchhoffs law [2]. Using this approach the
membrane is represented as an electrical circuit
composed of non-linear resistances in parallel with
a capacitor and a current generator.
C o n cl u s i o n
As shown in Figure 1, the changes in membrane
action potential are due to static and dynamic
equilibrium, achieved by the balance of the ionic
currents, implemented through the Continuity
Equation and applied locally to the membrane
domain. The transfer of ions across the nerve
membrane is simulated using user-defined
subroutines, particularly the USDFLD and DISP in
FORTRAN. Hence, through the use of thermoelectrical equivalents, the propagation of the
action potential can be simulated at the tissue
scale and its trend compares favourably with
published results, generated using an electrical
simulation model of the nerve cell behaviour [2].
References
[1] B.-J. Wang, Abaqus User Conf., 1995.
[2] S. Elia, P. Lamberti,COMSOL Conference 2009,
pp. 17.
[3] A. L. Hodgkin and A. F. Huxley, J. Physiol., vol. 117,
pp. 500544, 1952.
595
P 226
DEFINITION OF A VALIDATED CUSTOM-MADE BREAST

MODEL FOR DYNAMIC NODULE TRACKING
S. Pianigiani1, B.N. Nghiem2, B. Innocenti2
1
2
Introduction
Mammograms are 2D images that show the breasts
in deformed shapes. These images are commonly
adopted to screen the breast in order to detect
eventual pathologies, such as nodules [1]. When
nodules are observed, and breast surgery is
needed, surgeons can experience difficulties in
the identification and the correct removal of them,
i.e. by using needle aspiration. In fact, the boundary
conditions during surgery are completely different
from the one reached during mammography
and could lead to misidentification of the nodule
position that should be avoided.
Results
When comparing the mammograms with the
deformed breast obtained after finite element
simulation, the results provided by the Polynomial
model are the worst and the most time consuming,
while the Neo-Hookean and the Mooney-Rivlin
models show the most accurate reproduction of
the compressed breast, with 95% of area matching.
With the linear method, the breast flattens and
deforms considerably. Fig.1 shows an example of
nodule displacement.
For these reasons, this study aims is to define and

validate a custom-made finite element model of
the breast that could be used to track a nodule
positions under different boundary conditions as
the one during mammography and during surgery
to avoid nodule misidentification.
Methods
A custom-made breast model was defined
according to the shape of a standing patient. The
breast model consists of several parts, such as the
fat, the glandular area and the duct. The model
does not include the nipple and it is considered fully
constrained to the chest. The breast model can be
so used to analyse several configurations: standing
with undeformed breast, standing with deformed
breast during cranio-caudal (CC) mammo
graphy, standing with deformed breast during 45
oblique mammography (MLO) and supine with
undeformed breast simulating surgery conditions.
Different approaches to model the different breast
materials have been used: linear, polynomial,
Neo-Hookean and Mooney-Rivlin models [2, 3]. In
order to identify the best material model among
the selected ones, a validation, based on graphical
comparison between the mammograms and the
deformed models under the same conditions
has been performed. When the best model has
been selected, a sphere simulating a nodule,
with different dimensions, has been inserted in the
different tissues and its displacement has been
tracked during the breast compression.
Generally, the amplitude of the nodule

displacements is dependent by its dimensions,
the material in which was positioned and how this
material was modelled.
Discussion
Although the proposed breast model presents
some limitations, and it is currently at preliminary
stage, it could be foreseen as a valuable tool
that could be used to assist breast surgery. When
using the two non-linear material models that are
better replicating the realistic hyperelastic breast
behaviour, the defined breast model can efficiently
be used to extract nodule tracking information.
References
[1] National Cancer Institute
[2] Krouskop et al., UI, 1998
[3] Fung, 1994
596
P 227
MECHANICAL PROPERTIES OF THE PERIODONTAL

LIGAMENT IN TIME DEPENDANT LOAD AFTER
ORTHODONTIC TREATMENT
C. Dirk1, R. Al-Malat1, J. Scupin1, A. Konermann2, L. Keilig1, S. Reimann1,
I. Hasan1, C. Bourauel1
1
2
Universittsklinikum Bonn, Oral Technology, Bonn, Germany
Universittsklinikum Bonn, Department of Orthodontics, Bonn, Germany
Results
All measured force/deflection diagrams clearly
showed a time-dependant behaviour. High
loading velocities led to higher reaction forces
(18.5 N at 0.1 s at the last measurement) than
low loading velocities (15.9 N at 10 s at the last
measurement). Forces for all loading velocities
increased with increasing time after removing of
the dental braces. The Youngs moduli determined
from FE simulations also increased with increasing
time after removing the fixed appliance and with
increasing loading velocity, while 12 remained
almost stable.
Introduction
In the course of every orthodontic treatment teeth
are moved through the alveolar bone. This affects
the periodontal ligament (PDL) as well. After the
treatment, the PDL has to regenerate to its former
mechanical properties in order to hold the teeth as
tight as before. Finding data about this recovery of
the PDL was the aim of this study.
Methods
22 patients who have had an orthodontic
treatment were examined at the day of removing
the fixed appliance, two days later, one, two and
six weeks later as well as five months later. At every
measurement, the same upper incisor was loaded
using an intraoral loading device [Drolshagen, 2011]
to a displacement of 0.2 mm at different loading
times: 0.1, 0.2, 0.5, 1, 2, 5 and 10 s. The resulting
reaction force was measured. Numerical models
were generated, based on X-rays of the patients
tooth. Time dependant material parameters were
fitted to the individual experimental curves by back
calculation, assuming a bilinear approach with
two Youngs moduli (lower E1 and higher E2) and
an ultimate strain 12, separating the two regimes.
Discussion
This study shows that the PDL is much softer
directly after an orthodontic treatment than that
of non-treated patients, but the general bilinear,
time-dependant behaviour remains the same. The
recovery rate of the PDL is different from patient
to patient, it takes between two to six weeks in
average to stabilise to a normal range.
References
Drolshagen et al, J Biomech, 44: 21362143, 2011
597
P 228
ANALYTICAL MODELLING OF THE STRESS-STRAIN STATE

OF THE PERIODONTAL LIGAMENT IN THE SHAPE
OF THE TWO-SHEETED HYPERBOLOID
K. Yurkevich1, S. Bosiakov2
1
2
Belarusian State University, Bio- and Nanomechanics, Minsk, Belarus
Belarusian State University, Theoretical and Applied Mechanics, Minsk, Belarus
Introduction
Orthodontic treatment of malocclusion and
anomalous tooth position is a complex dental
procedure, and usually implies a sequential
execution of a large number of therapeutic
stages. Different types of tooth movement may
observe depending on the value and duration of
the applied force. Initial teeth movement can be
caused by short-term load.
Discussion
Analytical model of the tooth root and periodontal
ligament in the form of two-sheeted hyperboloid
are proposed. This model allows to find the initial
movement of single-rooted teeth and the stressstrain state of the periodont. Comparative analysis
of the stress tensor components calculation based
on mathematical and finite element model showed
high agreement between the results, except in the
regions near the apex and alveolar ridge.
Initial teeth mobility is described in numerous studies

based on using finite element method [2, 3] or
analytical models [1, 4]. The goal of this study is the
developing the analytical model of the tooth root
initial displacements in the periodontal ligament.
Model of the tooth root in the form of a hyperboloid

allows to study the influence of rounding of the root
on the initial displacement, as well as on the stressstrain state of the periodontal ligament. For the
teeth roots similar to a cone with a small opening
angle, the center of resistance is moved at a
greater distance from the root apex compared to
the roots with a rounded top. To move teeth with
rounded roots it is necessary bigger load than for
teeth with pointed roots.
Methods
The geometrical shape of the tooth root is described
by the equation of two-sheeted hyperboloid. Root
of tooth is rigid body. Periodontal ligament is linearly
elastic material. The outer surface of the periodontal
ligament is rigidly fixed. Motion of the tooth root
is defined via a combination of translational
displacements along the coordinate axes and
rotation angles with respect to the same axis. System
of equilibrium equations of the tooth root is formulated
on the basis of the vanishing of the principal vector
and principal moment of external forces with taking
into account the vanishing of the stresses on the outer
surface of the periodontal ligament.
The results can be used to predict and visualize

the initial tooth movement under the action of
orthodontic forces, evaluation of the stress-strain
state of the periodontal ligament and definitions
of favorable load for orthodontic tooth movement.
References
1 Bosiakov S.M., Yurkevich K.S. Determination of
stiffnesses of the bone tissue at translational
displacements and rotations of the tooth root.
Russian Journal of Biomechanics, 14:3645, 2010.
2 Cattaneo P. M., Dalstra M., Melsen B. The finite
element method: a tool to study orthodontic
tooth movement. Journal of Dental Research,
84:428433, 2005.
3 Jones M. L., Hickman J., Middleton J., Knox J.,
Volp C. A validated finite element method study of
orthodontic tooth movement in the human subject.
Journal of Orthodontics, 28:2938, 2001.
4 Van Schepdael A., Geris L., Van der Sloten J.
Analytical determination of stress patterns in the
periodontal ligament during orthodontic tooth
movement. Medical Engineering and Physics,
35:403410, 2013.
Results
Translational movement of the tooth takes place
under the action of an arbitrary force value when
the line of action of force is located in the plane of
symmetry and passes through the corresponding
roots center of resistance. The ranges of the most
favorable orthodontic loads established based on the
largest compressive stress and optimal stresses values
for orthodontic tooth movement in the periodontal
ligament. Hydrostatic stresses and principal strains
in the periodontal ligament during translation of the
tooth root in the horizontal and vertical planes are
defined. Hydrostatic stress and principal strains are
almost uniformly distributed along the root surface
except in regions near the apex.
598
P 229
TORSIONAL SENSOR DESIGN ON LAYERED TISSUE

J. Melchor1, L. Peralta1, G. Rus1, A. Valera1, E. Snchez1, A. Gmez2, N. Saffari2
1
2
University of Granada, Structural Mechanics, Granada, Spain
Introduction
Reliable quantification of the stiffness modulus of
soft tissue is an open issue with relevance for the
diagnosis of pathologies that manifest as changes
in the consistency of the tissue 1. For this task, we
propose to design a piezoelectric transducer for
non-invasively sensing. The shear stiffness modulus
is then reconstructed from shear ultrasonic
measurements by an inverse problem. It is therefore
necessary to optimize the piezoelectric transducer
model design with respect to two types of
parameters. On one hand, the design parameters,
and, on the other hand, the mechanical model
parameters that characterize the pathology. The
forward problem is implemented by performing
a three-dimensional finite element simulation.
The experimental measurements are simulated
by adding a Gaussian noise on the numerically
predicted signals. In addition, a semi-analytical
estimate of the probability of detection (POD) is
proposed and developed to provide a rational
criterion to optimize the experimental design.
Figure 1: S imulation of torsional transducer
After validation, the POD is used as an optimality

criterion to feed the used genetic algorithms. A set
of sensitivity tests was performed to validate the
robustness of the analytical estimates and verify
the feasibility, sensitivity and specificity of the
designed transducer by the algorithms above.
This work aims to (i) evaluate the optimal

piezoelectric transducer design of the modelbased POD. A second goal is (ii) simulate an
experiment based on the three dimensional model
of wave propagation generated by the proposed
piezoelectric transducer design, and, (iii) carry out
a parametric study to extract practical parameters
for final clinical applications.
Discussion
A strategy based on the inverse problem to
optimize the FEM model has been developed.
First we define a cost function as the difference
between the experimental and theoretical signals
and other statistical tools. Then, we define the POD
(Probability of detection) as the probability that the
signal is greater than the noise through a Taylor series
expansion of the response with respect to noise
and pathology-related mechanical properties,
which is approximated by a finite differences
scheme. After reformulated this concept to the
case that concerns us, the better prediction of
probability of detection for preterm birth. Through
three references in different elastic constants, the
RPOD is defined as robust probability of detection
with a pessimistic criterion. Finally algorithms are
developed to approximate the RPOD from a set of
forward simulations of the sensor-tissue system. The
RPOD is used for optimizing the sensor design.
Methods
A parametric finite element model of the ultrasonic
torsion piezoelectric sensor is programmed in
FEAP, including a new piezoelectric element.
An analytical simplified model is formulated and
validated with the finite element model, which
is aimed at easily predicts trends and design
parameter dependencies2. The formulation of the
POD is derived, and allows to estimate the POD in
the sense of a probabilistic signal to noise ratio, by
just evaluating the model response dependency
on pathology mechanical parameters and to
noise by finite differences.
Results
A transducer model with a disk transmitter and a
ring receiver for accessibility was designed. The
optimization of the design was carried out by
combining a piezoelectric finite element model
and an analytical estimation of the POD. This
allows to estimate the minimum pathology findable
given a proposed sensor design, a layered tissue
geometry and noise level on measurements.
References
1 Matsamura et al., IEEE International Ultrasonics
Symposium, 2009.
2 Melchor et al., Ultrasonics 54(7):19501962, 2014
Spanish Ministerio de Economa for project
DPI2010-17065, Spanish Junta de Andaluca for projects
de Andaluca 20072013.
599
P 230
BIOMECHANICAL PROPERTIES OF RAT CERVIX

IN THE LAST TRIMESTER OF PREGNANCY
A. Ashofteh Yazdi1, A. Esteki2, M.M. Dehghan3 , F. Tabatabai Ghomsheh4
1
Science and Research Branch Islamic Azad University,

Department of Biomechanics, Tehran, Iran
Shahid Beheshti University of Medical Sciences, Department of Biomedical Engineering,

Tehran, Iran
3
4
University of Tehran, Department of Veterinary Surgery, Tehran, Iran
University of Social Welfare and Rehabilitation Sciences, Department of Ergonomics,

Tehran, Iran
Introduction
Quantitative measurements of mechanical properties of cervix may lead to a more accurate
description of cervical remodeling and prediction of preterm birth 1. The results of this research
provides an insight to the stiffness of the pregnant
cervix and allows us to investigate the mechanical
changes that lead to a premature delivery in the
beginning of the last trimester of pregnancy.
of time and curve fitting tool in Matlab was used to

model the results.
Results and Discussion:
Tensile linear results revealed a Youngs modulus
of 0.014 MPa, as well as an ultimate stress and
strain of 0.3 MPa and 79.9%, respectively. Failure
stress and strain was measured as 0.085 MPa and
190.1%. Cyclic and Relaxation tests indicated a
nonlinear, time-dependent behavior of tissue with
a large range of plastic deformation in the last
trimester of pregnancy.
Exp e r i m e n t a l M e t h o d s :
Cervices were harvested from Wistar rats early in the
last trimester of pregnancy (1517 days). The distal
halves were taken immediately to the laboratory
for mechanical testing. Samples were subjected
to a series of tensile, cyclic and relaxation tests to
measure both linear and nonlinear mechanical
properties of the pregnant tissues. Strain controlled
tensile loadings were implemented to the samples
in the circumferential direction. In the tensile test,
tissue was stretched at the rate of 0.01 mm/sec to
the rupture point. In cyclic test, tissue underwent
10 cycles of loading and unloading at the rate of
1 mm/sec up to 60% strain. The relaxation test was
fulfilled at the rate of 0.01 mm/sec up to 60% strain
and was held for 10 minutes untill the tissue relaxed.
Stress and strain were measured as functions
C o n cl u s i o n
According to previous studies 1,2, Cervix becomes
more compliant as compared to the former two
trimesters and virgin ones. This is related to the
nonlinear viscoelastic behavior of the pregnant tissue
which is due to its compositional and microstructural
changes in the last trimester of pregnancy.
References
1P
oellmann M. J. et al., J. Mech. Behav. Biomed.
Mater., 17:6675, 2013.
2B
arone W. R. et al., J. Mech. Med. Bio.,
12:12500091250026, 2012.
600
P 2 31
ACOUSTIC SHEAR MODULUS OF CERVICAL

INTERVERTEBRAL DISC IS RELATED TO THE FUNCTIONAL
UNITS TORSIONAL STIFFNESS
C. Vergari1, P. Coloma1,2, W. Skalli1
1
Arts et Mtiers ParisTech, LBM/Institut de Biomecanique Humaine Georges Charpak,

Paris, France
Hpital Pierre Wertheimer, Hospices Civils de Lyon, Bron, Service de Neurochirurgie C,

Chirurgie du rachis, Groupement Hospitalier Est, Lyon, France

Preliminary results of first two samples (6 discs)
are presented: average G SWE was 15.2 2.9 kPa.
Average torsional stiffness of the functional
units was 0.13 0.06 Nm/(). A correlation was
observed between GSWE and torsional stiffness
(Pearsons r = 0.85, p = 0.028, Figure 1).
Introduction
Moderate degeneration of intervertebral disc
often goes undetected by magnetic resonance
imaging, increasing risks such as adjacent disc
disease in spine fusion surgery. Measurement of
disc mechanical properties might be more sensitive
to early degeneration. Shearwave elastography
is a technique to non-invasively measure shear
modulus of soft tissues1 which was recently applied
in vivo to cervical intervertebral disc 2. However,
the relation between the acoustic shear
modulus (GSWE) thus measured and the functional
units mechanical properties remains unknown.
The aim of the present work was to determine
the relationship between GSWE and cervical spine
torsional stiffness in vitro.
Six healthy cervical spines (C3-T1) were included.
Posterior arch, common ligaments, ligamentum
flavum, capsular and interspinous ligaments were
preserved for further experimentations; all other
muscles and ligaments were dissected. G SWE
was measured in the medial region of C5-C4 to
C7-C6 discs with a protocol previously described for
oxtail samples 3. Mechanical tests were designed
as follows: C3 and T1 vertebrae are embedded in
resin and tested with three cycles between 2Nm
to 2Nm pure torsional moment (in steps of 0.4Nm).
Kinematics of C5-C4 to C7-C6 functional units is
tracked. The slope of the toe region of the third
cycles moment-rotation curve is then calculated
to determine the units initial torsional stiffnesses.
C o n cl u s i o n
The results will be validated on the remaining
samples, but preliminary data on the first two
specimens are promising in confirming the
relevance of in vivo disc shearwave elastographic
measurements.
References
1 Bercoff J. et al., IEEE T. Ultrason. Ferr. 51:396409, 2004.
2 Vergari C. et al., Europ. radiol. 24:32103216, 2014.
3 Vergari C. et al., P. I. Mech. Eng. H. 228:607615, 2014.
We are grateful to Thomas Joubert and Sylvain Persohn
for their technical help. The study was financed by
the ParisTech BiomecAM chair program.
601
P 232
TENISLE PROPERTIES OF HUMAN NASAL SEPTAL

AND WING CARTILAGE
M. Freutel1, N. Wolf1, S. Wiggenhauser2, S. Schwarz2, N. Rotter2,
A. Ignatius1, L. Drselen1
1
Institute of Orthopaedic Research and Biomechanics, Center of Musculoskeletal Research

Ulm, Ulm, Germany
2
University Hospital Ulm, Department of Otorhinolaryngology, Ulm, Germany
Introduction
Damage or malformation of nasal cartilage
structures, is often caused by trauma, tumour
resections or congenital defects, and leads to
severe psychosocial problems [Rotter, 2007;
Schwarz, 2012]. Since nasal cartilage lacks an
intrinsic regeneration capacity [Rotter, 2007;
Schwarz, 2012], the reconstruction and replacement
of injured cartilage structures is of outstanding
concern. Tissue engineering using implant materials
is regarded as suitable alternative to overcome the
limitations of current clinical options. To improve
and design new implant materials the native
material properties of the cartilage are mandatory
as reference data. Therefore, the aim of this study
was to test the tensile properties of nasal septal
and wing cartilage.
Results
The nasal septal cartilage in vertical direction has
the highest Fmax, E lin and max (Fig.2). The maximum
stress ( max, Fig. 2b) was significantly higher in the
nasal septal cartilage than in the other locations
(p0.008). The linear modulus (E lin, Fig. 2c) was not
statistically different between the three different
test locations.
Methods
For tensile testing dumbbell shaped samples (width:
2 mm), oriented vertical and horizontal to the main
collagen direction were obtained from the nasal
septal cartilage of six human donor noses and one
sample from the right ala of the nose (62.86.6 yrs,
ntotal= 18; Fig.1). After placement in the material
testing machine the specimens were pulled to failure
with 100%l0/min. Thus, the tensile properties (Fmax, max
and Elin) could be determined from the stress-strain
and force elongation curves. Normally distributed
data were examined using one-factor repeated
measures ANOVAs with Bonferronis post-hoc testing
when significant (*p<0.05; GraphPad Prism).
Figure 2: M
aximum force (Fmax; a), maximum stress (max; b)
and linear modulus (Elin; c) of the nasal septal
(vertical and horizontal) and wing cartilage
(mean sd, ntotal=18, *p<0.05).
Discussion
To the authors knowledge, this is the first study
investigating the tensile properties of human
nasal cartilage. The results show the anisotropy
of the material, with a higher strength in vertical
direction. This reveals that mainly loads in vertical
direction are carried by this type of cartilage. The
obtained data serves as reference for various
implant materials to be compared with.
Figure 1: D
umbbell shaped samples obtained from the ala
of the nose (left) and vertical and horizontal samples of the nasal septal cartilage (middle) as well
as a sample with sandpaper (right) to enhance
friction during testing.
References
Rotter et al., J Tissue Eng Regen Med, 1:411416, 2007.
Schwarz et al., J Tissue Eng Regen Med, DOI:
10.1002/term.1650, 2012.
602
P 233
HETEROGENEOUS STRESS DISTRIBUTION RESULTS

IN NON-UNIFORM TUMOR OXYGENATION, CANCER
CELL PROLIFERATION AND DRUG DELIVERY
F. Mpekris1, S. Angeli1, A. Pirentis1, T. Stylianopoulos1
1
University of Cyprus, Cancer Biophysics Laboratory, Nicosia, Cyprus
Introduction
Accumulation
of
mechanical
stresses
within structural components of the tumor
microenvironment compresses intratumoral blood
vessels reducing drastically drug delivery and
oxygen supply, leading to hypoxia and necrosis
[Griffon-Etienne, 1999]. In the present study, we
developed a continuum biphasic computational
model that accounts for both direct and indirect
effects of solid stress on tumor growth, and
highlights the interdependence between oxygen
supply, cancer cell proliferation, accumulation
of solid stress, compression of blood vessels,
reduction in vascular density and drug delivery,
and formation of hypoxia. We studied two distinct
drug delivery cases, namely, chemotherapy alone
and nanocarrier-contained chemotherapy, and
also applied the model to a breast tumor model
derived from MR images.
to the periphery because of intratumoral pressure

gradients oozing drugs out of the tumor (Fig. 1a).
In the normal tissue, the concentration of the drug
(Fig.1a) is lower than in the tumor interior, owing to
the tumor-induced higher vascular density in the
tumor. When the drug is administered following
vessel collapse (Fig. 1b), the concentration of the
internalized drugdecreases drastically.
Methods
To describe kinematics we used the multiplicative
decomposition of the deformation gradient tensor
F = Fe Fg [Rodriguez, 1994], which includes tumor
growth F g, set to be homogeneous and isotropic
[Stylianopoulos, 2013], and the elastic interactions
between host tissue and tumor F e. he total stress
was obtained as the sum of the fluid and solid
phase stresses [Mow, 1980]. The tumor mechanical
behavior was assumed to be incompressible and
neo-Hookean. Oxygen and drug concentrations
were determined using convection, diffusion and
reaction equations.
Figure 1: Internalized drug concentration when the drug

is administered before (a) and after (b) vessel
collapse.Vertical lines show the interface of tumor
and normal tissue.
Discussion
Heterogeneous accumulation of stresses results
in heterogeneous distribution of vascular density,
with higher values at the periphery and lower at
the center of the tumor. The hypo-vascular interior
of the tumor results in inefficient delivery of drugs
affecting treatment efficacy. Our results highlight
the importance of alleviation of solid stresses with
stress-alleviating agents in order to decompress
blood vessels and improve drug delivery.
Results
The magnitude of the compressive solid stress is
higher at the center compared to the periphery
of the tumor resulting in heterogeneous stress
distribution. When solid stress exceeds a critical
value for vessel collapse, tumor vascular density
reduces to values less than the normal tissue baseline
and the tumor interior becomes hypo-vascular and
hypoxic. When drugs are administered prior vessel
collapse, the concentration of the internalized
drug is lower in the center of the tumor compared
References
Griffon-Etienne et al, Cancer Res 59:377682, 1999.
Mow et al, J Biomech Eng, 102:7384, 1980.
Rodriguez et al, J Biomech 27:45567, 1994.
Stylianopoulos et al, Cancer Res 73:383341, 2013.
603
P 234
A PRELIMINARY STUDY ON
CARTILAGE-MENISCUS-CARTILAGE
LINEAR AND PORO-ELASTIC MODELING
L. Ruggiero1, S. Pianigiani2, C. Vitanza3 , T.J. Massart4 , A. Audenino3 , B. Innocenti1
1

2

3
Politecnico di Torino, DIMEAS, Torino, Italy
Universit Libre de Bruxelles, BATir, Bruxelles, Belgium
Introduction
The knee joint biomechanics worsening process,
due to aging or trauma, still hides unknown
aspects due to the complexity of the joint bearing
tissues mechanical interactions. Degenerative
pathologies such as osteoarthritis could affect the
menisci and femoral and/or tibial articular cartilage
contact mechanics that had been thought as
of primary importance preserving adequate
shock absorbing joint capabilities [1]. In order to
analyze the mechanical interactions impacting
on knee soft tissues degeneration, finite element
analyses (FEAs) are currently used to estimate
the biophysical fields sensitive to changes of
tissues material properties [2]. However, modeling
assumptions are controversial and different are the
adopted constitutive material laws. This study aims
to compare a Cartilage-Meniscus-Cartilage (CMC)
simplified finite element (FE) model based on linear
elastic theoretical assumptions v.s. poro-elastic
ones, for both meniscus and articular cartilages.
Results intent to highlight the importance of
material modeling of the CMC structure when
developing a close-to-real FE model of a native
knee.
each single CMC component prior to validation.

Contacts were assumed frictionless for both linear
elastic (CMCLE) and poro-elastic (CMC PE) models.
Finite deformations have been taken into account
considering the Nlgeom feature. Poro-elasticity
was modeled using soil analysis and porous
elements (CAX8RP). CMCPE contact interfaces
were considered impervious while the lateral side
of the tissue was set as pervious. Permeability was
assumed constant. A step pressure of 12 kPa was
considered as prescribed loading condition taking
into account the maximum tibio-femoral force
generated during walking [4]. Contact pressures,
stresses, and displacements were compared and
analyzed.
Results
Contact pressure calculated by the CMCPE model
decreases up to 40% with respect to the CMCLE. On
the contrary, the radial and axial displacements
relative increase for the CMCPE model lies in the
range of 23%. The Von Mises stress distribution and
magnitude is equivalent for both CMC models.
Discussion
A preliminary study evaluating the impact of
material modeling on the loaded CMC structure
was performed. High differences in contact
pressure estimations between the two CMC models
highlight the need of a deeper investigation of the
implication of linear elastic modeling on the CMC
structure contact mechanics.
Methods
The CMC structure mechanical behavior due to
compression was modeled in Abaqus (Dessault
Systmes, Waltham, MA, USA) as superimposed
cylinders, adopting a 2D-axisymmetric assumption
in order to speed-up the computational time.
Material properties for both meniscus and
articular cartilage linear elastic and poro-elastic
material models were taken from literature [2, 3]
and the implemented poro-elastic material
models validated comparing the calculated
stress-relaxation and creep mechanical response
to literature experimental data [3]. A mesh
convergence study has been performed for
References
[1] Pen et al, Clin Biomech, 20(5):498507, 2005.
[2] Innocenti et al, J Arthroplasty, 29(7):14918, 2014.
[3] Boschetti et al, Biorheology, 41(34):15966, 2004.
[4] Latif et al., Procedia Engineering, 68:109115, 2013.
604
P 235
BIOMECHANICAL INVESTIGATION OF PLANTAR SOFT

TISSUE CHANGES IN DIEBETIC PATIENTS
T. Lee1, J.C. Teoh2
1

2
National University of Singapore, Department of Biomedical Engineering, Singapore,

Singapore
Introduction
Diabetic foot is one of the fatal complications of
diabetes mellitus (DM) that is resulted from diabetic
ulceration. Neurological examination is usually
practised by the clinician to assess the foot risk in
DM patients. However, the method is only useful in
diagnosing peripheral neuropathy. The excessively
stiffened tissue that fails to accommodate the
impact force exerted on plantar tissue is the key
cause of foot ulceration. The objective of the
study is to investigate the relationship between the
plantar tissue stiffness and several parameters, e.g.
age, diabetes duration (years of DM), body mass
index (BMI) and HbA1c level. Understanding of the
relationship may help the clinicians in estimating
the risk of their patients in developing foot ulcer.
Similar results are also found in hallux and heel pad.

HbA1c level measures the average level of blood
sugar over a period of weeks or month.
Prolonged exposure to high blood glucose brings
about pathological changes by enhancing reactions
between reducing glucose and cellular protein that
increases the formation of advanced glycation end
products (AGEs) (Ahmed et al., 2007). Accumulation
of these compounds decreases the elasticity of
tissue by the increased intermolecular cross linking
and adversely modified side-chains (Bailey, 2001).
Clinical studies have shown the stiffer plantar tissue
in diabetic patients as compared to their agematched control (Zheng et al., 2000; Gefen et al.,
2001; Sun et al., 2011). There has been a large cohort
of data showing glycated collagen to be consistent
with the HbA1c level (Monnier et al., 1999).
Methods
100 diabetes patients were recruited. Plantar soft
tissue at hallux, 2nd sub metatarsal head (MTH) pad
and heel pad were examined using the indenter
that comprises a motorized stylus. One end of the
stylus indented the tissue and the tissue response was
quantified by the force sensor located at the other end.
Based on the results, BMI also plays a key role in

increasing the plantar soft tissue stiffness as shown
in Fig. 1A to 1C. This may be explained by the strong
relationship between high BMI and DM (Knowler
et al., 1981; Colditz et al., 1990; Chan et al., 1994;
Hanson et al., 1995, Edelstein et al., 1997; Looker et
al., 2001). It is also postulated that the loss in weight
and BMI effectively improve glycemic control
(Heilbronn et al., 1999).

Two out of the four factors (BMI, HbA1c, Age and
years of DM) were plotted against the plantar soft
tissue stiffness. The plantar tissue stiffness is shown
in different colors (blue: low stiffness, red: high
stiffness). As the plantar tissue stiffness increases, the
colour scale will move closer to the red spectrum.
A total of 6 combinations were available. Selected
factors were plotted to evaluate the contribution
of each factor combination to describe the of
plantar soft tissue response.
The results suggested that patients with BMI higher

than 25 kgm2 or HbA1c >9%, as observed from
Fig. 1A to 1F, are likely to have stiffened plantar
tissue that required special attention prevent the
occurrence of foot ulcer.
On the hand, age and years of DM did not affect
the tissue response much (i.e. the color spectrum
obtained is not consistent and hence not conclusive).
Even in young patients with short duration of diabetes,
the tissue stiffness may still be adversely increased as
long as the HbA1c level is high (Fig 1F).
As shown in Fig.1 A to 1F, it can be deduced that HbA1c

level (the blood glucose level) have a more influential
role in altering the tissue stiffness in 2ndsub-MTH.
605
P 236
BIOMECHANICAL RESPONSE OF LOWER

LEG DEEP VEINS TO THE COMBINED ACTION
OF MUSCULAR CONTRACTION AND MEDICAL
COMPRESSION STOCKINGS
P.Y. Rohan1, P. Badel2, B. Lun3 , D. Rastel4 , S. Avril2
1
2
LBM/Institut de Biomcanique Humaine Georges, Paris, France
Ecole Nationale Suprieure des Mines de Saint-Etienne, CIS-EMSE, Saint-Etienne, France

3
SIGVARIS, Applied Research Department, Saint-Just-Saint-Rambert, France

4
Vascular Surgeon, Vascular Surgeon, Grenoble, France
Introduction
In spite of decades of successful use of Medical
Compression Stockings (MCS) for the treatment
of lower leg deep venous insufficiency, the
mechanisms by which they act is still a matter of
debate. Traditionally, the benefit of compression
therapy in deep veins is attributed to a narrowing
of the deep veins and, as a result, to a prevention
of blood pooling in veins. This, however, has never
been conclusively demonstrated. As a matter
of fact, conflicting results have been reported
which call into question this hypothesis and which
highlight the need to address the key question
of whether or not the benefits of action of MCS
are correlated to a decrease in the vein luminal
cross-sectional area. In that respect, the relative
influence of muscular contraction has never, as
far as the authors are concerned, been clarified.
The purpose of this work was therefore to study the
transmission of pressure in the soft tissues of the lower
leg during external compression with and without
muscle activation to improve our understanding
of the main biomechanical parameters affecting
the response of lower leg deep veins to external
compression.
Results
The numerical results obtained with our FE models
confirm those of clinical studies showing that, in
the standing position, it is mainly muscle activation
that is responsible for narrowing deep veins luminal
diameter, not the interface pressure applied by
commercially available MCS which is insufficient to
have a significant impact.
Discussion
From a clinical point of view, this result suggests
that the clinical benefits of MCS are, for a
great part, due to a mechanical action on the
micro-circulation. Indeed, as reported in a
previous study, MCS are effective in reducing
the vein luminal diameter of lower leg superficial
veins (Rohan et al., 2013) but, as shown here, they
have virtually no effect on lower leg deep veins
in the upright position. Interestingly, some studies
also reported that, irrespective of the effects on
the luminal diameter, MCS lead to an increase in
the blood flow in deep veins. These observations
suggest that, by increasing the pressure in the deep
soft tissues of the leg, MCS contribute to emptying
the blood present in the micro-circulation. This
blood is forced into the main deep veins which
carry the blood back to the heart. Lower leg
deep veins therefore carry more blood during
external compression (due to an increased venous
blood flow) but do not see their luminal diameter
decreased, as observed clinically. The fact that
the deep veins are not significantly narrowed by
MCS is actually sound because, otherwise, the
blood return would have been hindered by MCS.
It is envisaged to investigate in the near future the
response of the deep micro-circulation to external
compression.
Methods
We created two Finite-Element (FE) models from
MR images of the calf cross section one for
the study of intramuscular veins (fig 1(a)) and
another one for inter-muscular veins (fig 1(b))
that replicate the major features of the lower leg
geometry. The developed model was used to
simulate the biomechanical response of the leg to
the combined action of elastic compression and
muscle activation.
References
Rohan, C.P.-Y., Badel, P., Lun, B., Rastel, D., Avril, S.,
2013. Biomechanical response of varicose veins to
elastic compression: A numerical study. J. Biomech.
46, 599603. doi:10.1016/j.jbiomech.2012.10.043
Figure 1: F inite-element models of a slice of the lower leg

created from MR images
606
P 237
THE SUTURE PULLOUT CHARACTERISTICS

OF THE PORCINE LINEA ALBA
G. Cooney1, D. Winter2, C.K. Simms1
1
Trinity Centre for Bioengineering, Parsons Building, Trinity College, College Green, Dublin 2,
Ireland, Department of Mechanical and Manufacturing Engineering, Dublin, Ireland
2
4,
University College Dublin, Belfield, Dublin
Ireland, School of Medicine and Medical Science, Dublin, Ireland
Introduction
Incisional hernia is a severe complication postlaparoscopic/laparotomy surgery that is commonly
associated with the linea alba. Presently, the
method by which surgeons suture the linea alba
incision is variable. Although a suture bite width and
bite separation of 10mm is commonly used, there
is no quantitative study to support this suture bite
width/separation combination. This study therefore
focuses on assesssing the optimum parameters of
suture bite width/separation to reduce incisional
hernia ocurrence.
Methods
Suture pullout tests were performed on isolated
porcine linea alba specimens harvested from
fresh/frozen abdominal walls. The tissue was
gripped on one end via a set of custom-made
grips utilising emery paper. One length of suture
was looped through the tissue twice, tying both
ends to a horizontal bar fixed in position with the
middle loop allowed to freely pass around the
curved surface of the bar. The bites of the suture
are set to a specific separation distance from one
another and a set width into the tissue. The sample
was then stretched at a rate of 100 mm/min until
tissue failure. Side studies on the orientation of
suture placement, edge effects, suture type and
freeze cycle effects were also investigated.
Figure 1: A
bove shows the fitted suface of the average of
the plotted data where (A) depicts the recorded
pullout force and (B) depicts the pullout force per
10mm length versus bite depth and separation of
the sutures.
Discussion
Campbell et al. [1] tested the bite width effects of
sutures on human linea alba wound closure. They
observed a plateau in pullout force after 9mm bite
width. However, this may result from edge effects
when the bite width is greater than the distance to
the edge of the tissue causing early failure. Edge
effects were avoided in the present study which
shows no evidence of such a trend. In another
study concerning bite separation it was observed
that there was no increase in pullout force for
separations below 15mm [2]. However, the current
study shows that wound closure is more efficient as
separation decreases below 15 mm, since pullout
force increases with the greater number of sutures
used. The initial conclusion of this work is that it is
better to use bite widths as large as possible with as
many bites as possible. Future work will involve testing
human tissue as well as herniation tests on porcine
abdominal walls using a surrogate abdominal rig to
replicate intra-abdominal pressure.
Results
A surface plot of suture bite width and separation
versus pullout force, see Figuure 1a, shows that
as bite depth increases, pullout force increases
broadly linearly. For large bite widths increasing
separation also results in a linear increase in pullout
force. However, at small bite widths there is little
apparent change. The slope change in pullout
force between different separations increases as
bite width increases. In Figure 1B, comparing each
width and separation against force per 10 mm
length reveals a different profile that more usefully
represents a universal wound length. As before, as
bite width increases, so too does maximum pullout
force per unit length. However, as separation is
increased, pullout force per unit length decreases;
holding true for all bite widths.
References
1 Campbell, J.A. et al., (1989) Surgery, 106 (5),
pp. 888892
2 Descoux, J.G. et al., (1993) Journal of Investigative
Surgery, 6 (2), pp. 201209.
607
P 238
MECHANICAL RESPONSE OF HETEROGENEOUS

MYOCARDIAL TISSUE TO DYNAMIC DEFORMATION.
MATHEMATICAL SIMULATION
L. Smoluk1, A. Smoluk1, Y. Protsenko1
1
Institute of immunology and physiology Ural branch of the RAS, biological motility,
Yekaterinburg, Russia
Introduction
Previously we developed a 3D structural model of the
myocardial morphofunctional unit [1]. This model
reproduces the structural viscoelasticity of isolated
myocardial preparations in the physiological range
of uniaxial deformations without introduction of
the model parameters, depending on the strain
[2]. In this paper we propose the development of
this model to describe the mechanical response
of a two-dimensional inhomogeneous myocardial
tissue layer during the deformation.
behaviour, as well as to minimize changes in the

volume of morphological unit model. Since real
myocardial tissue volume practically unchanges,
proposed modifications solve the problem of
volume change in the initial model [1].
Discussion
Numerical algorithm for calculation the system
consisting of an arbitrary number of structural
was developed on the basis of the myocardial
morphofunctional unit model. The algorithm allows
describing the nonlinear viscoelastic characteristics
of the two-dimensional layer of inhomogeneous
(geometrically and mechanically) myocardial
tissue in steady-state and dynamic conditions.
These results suggest the presence of a certain
optimum in structural and mechanical parameters,
which provides the most efficient mechanical work
of the tissue. Therefore, the developed model
will allow determining the influence of various
spatial and mechanical defects on the resulting
mechanical response of the myocardium, as well
as various external influences on the structure of
the tissue.
Methods
The model is described by the system of nonlinear
differential equations [1]. To describe the response
of myocardial tissue layer a model of transversal
connections of structural blocks is developed.
The connections between blocks are describe
by Hooks springs. Herewith the structure of th
connections is similar to connections in the model
of morphofunctional unit. A structure of single
block in the model was modified. Central part
of the block is presented as elastic continuum.
Generally the model system of equations is not
solved numerically. Therefore the algorithm of
model equation linearization is developed [3].
This work is supported by The program of fundamental research of Presidium of the RAS #43 on strategic
areas of science in 2015 year. Fundamental problems of mathematical modeling
Results
In the proposed model the shear deformation of
each of the structural unit during the deformation
of the entire quasi-2D layer is taken into account.
Therefore, it is possible to reproduce more accurately
the complex nature of the nonlinear mechanical
behaviour of inhomogeneous myocardial tissue
layer during its dynamic deformation. The use of
continuous elastic element in the structural units
can reduce the number of equations describing its
References
1 Smoluk, L. et al, Acta Bioeng Biomech, 2012.
14(4): p. 3744.
2 Smoluk, L. et al, Biophysical J., 2010. 98(3): p. 555a.
3 Smoluk A.T. et al, J. Biomedical Science and Engineering. 2014. V. 7. P. 397404.
608
P 239
FRICTIONAL ANALYSIS OF A NEW SILK FIBROIN

SCAFFOLD FOR PARTIAL MENISCAL REPLACEMENT
D. Warnecke1, N. Scholz1, N. Skaer2, O. Kessler3 , S. Klose1, M. Freutel1,
A. Ignatius1, L. Drselen1
1
Ulm University, Institute of Orthopaedic Research and Biomechanics,

Center of Musculoskeletal Research Ulm ZMFU, Ulm, Germany
2
Orthox Ltd., Orthox Ltd., Abingdon, United Kingdom
Center for Orthopaedics and Sports, Center for Orthopaedics and Sports, Zrich, Switzerland
Introduction
Partial meniscectomy increases the risk of early
osteoarthritis. To overcome this problem a new
silk fibroin scaffold (FibroFix Meniscus; Orthox
Ltd., UK) for partial meniscal replacement was
investigated in a sheep model, showing promising
results [Gruchenberg, 2014]. For adequate long
term results the frictional behaviour is of major
importance because high friction coefficients
increase wear. Therefore, we assessed the frictional
properties of FibroFix samples in comparison to
meniscal tissue.
the friction coefficient (=FR/FN) was determined to

characterise the frictional behaviour of the different
articulating surfaces. Due to the pilot nature of this
study, the results were analysed descriptively.
Results
Using glass as an opposing surface reveals large
differences between the equilibrium friction
coefficients of scaffold and meniscus (Figure 2).
These differences are markedly reduced when
cartilage is chosen as the counter part. The friction
coefficient of FibroFix is in the range of friction
between physiologically articulating surfaces.
Cylindrical FibroFix samples were retrieved from
four flat sheets (n=4, height: 2.30.3 mm), using
a biopsy punch (=5 mm). The bovine cylindrical
meniscus samples (age: 24 month) were extracted
from the medial meniscus at the transition of the
posterior horn and pars intermedia, perpendicular
to the surface. To ensure a consistent sample
thickness of 2 mm, the distal region of the meniscus
sample was removed with a microtome. Flat
cartilage samples were taken from the medial
femoral condyle for use as the opposing surface.
Each sample (FibroFix ; meniscus) was first tested
against the femoral cartilage and after a recovery
time of 24h against glass, which is typically used as
counter surface in many friction studies.
Figure 2: F riction coefficient at equilibrium of meniscus (M)

and the FibroFix scaffold (S) against articular
cartilage (AC) and glass (G)
Discussion
FibroFix samples exhibited satisfactory equilibrium
friction coefficients only slightly above meniscal
friction values when tested against articular cartilage.
However, testing against glass, which is typically used
in many friction studies, leads to a dramatic increase
in friction, which has also been shown for other
meniscal replacement materials [Galley, 2011]. This
phenomenon is most likely attributable to the missing
pressurization of interstitial fluid in both scaffold and
glass surfaces. This emphasises the importance of
choosing appropriate articulating surfaces to obtain
friction coefficients relevant for joints.
References
Galley et al, Clin Orthop Relat Res, 469:
28172823, 2011.
Gruchenberg et al, Knee Surg Sports Traumatol
Arthrosc., 20:100107, 2014.
Figure 1: P
in-on-plate friction testing device; FN: normal
force, FR: friction force, load cell, uS: upper sample,
lS: lower sample
During friction testing in a specially designed pinon-plate testing device (Figure 1) a constant load
FN of 14.6 N was applied to the upper sample and the
lower sample was sliding against it with a velocity of
1 mm/s for 125 minutes until equilibrium. Meanwhile
the friction force FR was recorded and afterwards
This work was supported by the Wellcome Trust
[100917/Z/13/Z]. FibroFix is being developed with
funding from the NIHR Invention for Innovation (i4i)
Programme [II-LS-1010-10009]
609
P 240
MICROSTRUCTURE AND MECHANICAL BEHAVIOR

IN PASSIVE SKELETAL MUSCLE
M. Mohammadkhah1, P. Murphy2, C. Simms1
1
Trinity College Dublin, Mechanical and Manufacturing Engineering, Dublin, Ireland
Trinity College Dublin, Zoology Building, School of Natural Sciences, Dublin, Ireland
Introduction
The mechanical properties of passive skeletal
muscle are important in a range of different
applications such as impact biomechanics and
rehabilitation engineering. Due to the anisotropic
and hierarchical quality of muscle, evaluating its
response under mechanical loading is difficult.
Apart from the complexity normally associated
with soft tissues, it has recently been observed
that the stress response to stretching in both the
fibre and cross fibre directions is two orders of
magnitude stiffer for tension than compression, but
conventional fibre-reinforced composite theory
fails to capture this [Takaza, 2014].
Figure 1: P
assive quasi-static compressive behavior in
porcine and chicken muscle
The main objective of this research is to study the

microstructural response of skeletal muscle to
externally applied deformation, testing the novel
hypothesis that the passive mechanical behavior
of skeletal muscle tissue is dominated by soft but
incompressible muscle fibres surrounded by stiff
but initially slack collagen fibres. This hypothesis is
examined using different muscles from a variety
of species to better understand the origin of the
tension/compression asymmetry.
Cross sections of fibres showed a clear preferred

orientation in the compression deformation applied
in the fibre and cross fiber directions tending to align
perpendicular to the applied deformation (see
Figure 2D & E). However, in the other cases, no clear
oriented tendency was observed.
Methods
To extend our existing data on porcine tissue
uniaxial, quasi-static compression and tensile tests
have been conducted on fresh chicken pectoralis
muscle at various fibre orientations.
Separately, for microstructural analysis, undeformed
and deformed samples of chicken pectoralis
muscle were fixed in PFA and 8 mm sections of
wax embedded tissue were cut and stained using
picrosirius red for light microscope analysis. Image
analysis was performed using ImageJ.
Results
The nonlinear and anisotropic behavior of skeletal
muscle was observed in chicken as it was previously
seen in porcine tissue [Van Loocke, 2006], see
Figure 1. The results also illustrated that the crossfiber direction is stiffer than the 45 direction, and
the fiber direction is the least stiff direction within
the muscle. However, chicken muscle is stiffer than
porcine muscle.
Figure 2: M
uscle fibres cross section orientation; muscle
was either undeformed (A, control) or deformed
by 30% tension, either in the fibre (B) or cross fibre
(C) direction, or 30% compression in the fibre (D) or
cross fibre (E) direction
Discussion
The observed stiffness difference between the fresh
porcine and chicken tissues refers to anisotropic
differences between chicken and pig and it is
expected to be attributable to micro structural
differences between species. The focus of current
work is visualizing collagen organization across
species and under different deformation conditions.
The average muscle fibre cross-sectional area

(CSA) decreased with tensile stretch applied in
the fibre direction, but increased with compressive
stretch applied in the fibre direction. For tensile
as well as compressive deformation in the crossfibre direction, the CSA decreased compared to
the control. A statistically significant difference
between the undeformed control and the
deformed CSAs was observed in all cases.
References
Takaza, M. et al, J the Mechanical Behaviour of
Biomedical Materials, 40: 115126, 2014.
Van Loocke, M. et al, J Biomech, 39: 29993009, 2006.
610
P 2 41
MATHEMATICAL CORRELATION OF NATIVE

& DECELLULARISED TISSUE HISTOARCHITECTURE
TO MECHANICAL INTEGRITY
A. Kouvaka1, L. Morticelli2, S. Jockenhoevel3 , S. Cebotari2, G. Gerosa4 , A. Haverich2,
A. Hilfiker2, S. Korossis2, M. Harder1, M. Granados2
1
2
3
4
Corlife oHG, Corlife oHG, Hannover, Germany
Hannover Medical School, Department of Cardiothoracic, Transplantation

and Vascular Surgery, Hannover, Germany
RWTH Aachen, Tissue Engineering & Textile Implants, Aachen, Germany
University of Padova Medical School, Cardiac Thoracic and Vascular Surgery,

Padova, Germany
Introduction
The current European Union regulatory guidelines
for quality control of tissue engineering products
are not only time and resource consuming but
also subjective. The aim of this project is the
development of a semi-automatic tool that
will act as a faster, cost effective and objective
method to assess the mechanical integrity of
tissue engineering constructs. This work was based
on the hypothesis that it is possible to predict the
mechanical behaviour of a tissue construct using
quantitative biochemical measurements of its
extracellular matrix (ECM) constituents.
In the above equations, the possible values for

the Pericardium, Mitral and Pulmonary variables
were set to either 0 or 1, depending on the type of
tissue of which the specific mechanical property
was considered. A value of either 0 or 1 was also
given to the Orientation parameter, depending
on whether the along fibre (0 to the direction of
loading; 1) or the across fibre (90 to the direction
of loading; 1) tissue direction was considered.
Methods
Multiple regression analysis was conducted using
biochemical data as predictors and mechanical
data as the dependent variables. The predictor
variables used were the hydroxyproline (HXP) and
glycosaminoglycan (GAG) content of fresh and
decellularised porcine pericardium, mitral and
pulmonary valve leaflets [Luo, 2014; Morticelli, 2013]
and the collagen orientation of the tissue samples
subjected to uniaxial tensile loading to failure. The
dependent variables included the mechanical
properties of the aforementioned tissues obtained
under uniaxial tensile loading to failure.
Discussion
The regression analysis of previously obtained
experimental data indicated a correlation
between tissue structure (collagen orientation) and
mechanical properties. Although the present study
indicated that there was no significant correlation
between the mechanical properties studied and
the HXP/GAG contents at the 95% confidence level,
the collagen orientation and tissue type were able
to explain the variance in the data. Although this
study produced encouraging preliminary results,
further correlation models incorporating more
statistically-consistent experimental data need to
be conducted. In addition, future work will also
focus on characterising tissue histoarchitecture
using non-destructive methods, such as 2-photon
laser microscopy.
Results
The regression analysis results for the collagen
phase slope (E coll) showed that the statistically
significant predictors at the 95% confidence level
were the collagen orientation and the type of
tissue, whereas the HXP and GAG content and the
tissue treatment (native or decellularised) were not
significant. The overall significance for the predictor
variables was F = 0.0007 and the model explained
76% of the data variance (Equation 1). For the
ultimate tensile strength (suts), the significance
of the variables was F = 0.0009 and the model
explained 75% of the data variance (Equation 2).
In the case of the failure strain (suts) the significance
of the variables was F = 0.001 and the variance
explained was 73% (Equation 3).
References
Luo et al, Tissue Eng Part A, 20(2122):296374, 2014
Morticelli et al, J Heart Valve Dis, 22(3):34053, 2013
611
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MODELING OF PERFUSION IN LIVER LOBES USING

HOMOGENIZATION APPROACH
J. Turjanicov1, E. Rohan1
1
University of West Bohemia, Faculty of Applied Sciences, Plzen, Czech Republic
Introduction
As any biological tissue, liver parenchym has a
hierarchical structure with two separated vascular
systems, one belonging to the hepatic artery and
the other to the hepatic portal vein. At lower
scales, on the lobulus level, these systems form two
trees of vessels which lie within the portal track.
From there, the blood flows through the sinusoids
to the central vein (model for sinusoidal perfusion
was presented in [Ricken, 2010]).
where K3 is permeability in dual porosity Y 3 and p k is

Y-periodic on Y.
Results
The homogenization procedure was implemented
in the software SfePy. The parameters used
for
geometrical
representation
of
lobular
microstructure were taken from [Siggers, 2014].
Resulting pressure in the dual porosity p1 is depicted
on Figure 1.
The aim of our recent work is to model perfusion

in the venous branching structures at lower scales
based on a porous medium approach.
Methods
The liver tissue is seen as a double porous medium
consisting from matrix perforated by microcanals
(sinusoids) and two mutually disconnected canal
networks representing portal track and central
vein.
We assume that the medium has a periodic
structure generated by the periodic cell Ywith the
decomposition Y=Y1 U Y 2 U Y 3 into 3 non-overlapping
parts. Subdomains Y1, Y2 represent the channels 1
and 2, respectively, whereas Y 3 represents the dual
porosity (a sinusoidal network).
Figure 1: C
haracteristic response p1
Discussion
The computed pressures in dual porosity are
necessary to express the effective Barenblatt
coefficients, which can be used as an
approximate description of blood perfusion in the
liver parenchym. Further use is expected in the
multicompartment model of the liver perfusion.
The behaviour of the porous medium is described by

the Biot model. Using the unfolding homogenization
method (which has been applied in [Rohan, 2010]),
we can derive the local problems on periodic
cell Y with solutions in the form of the so-called
characteristic responses. Than, the expression of
the effective permeability coefficients Cij1, Cij2,
depending on the geometry and permeability of
the primary porosity in Y1 and Y2 can be computed.
The effective Barenblatt coefficients (see [Rohan,
2010]) related to the flow between the channels
1 and 2 describe the net fluid exchange through
rigid fixed interface of respective channel and dual
porosity matrix. They are also proportional to the
perfusion velocity and pressure in the dual porosity.
The later one is the the characteristic response
pk, k=1,2 (Y-periodic function), which is the solution
of the problem (see Rohan, 2013]):
Authors are grateful for the support by projects NT
13326 and SGS-2013-026
References
Ricken, T. et al, Biomech Model Mechanobiol,
9: 435450, 2010.
Rohan, E. et al, Int J Multiscale Com Eng,
8.1:81102, 2010.
Rohan, E. et al, IFAC Proceedings Volumes,
7.1:10291034, 2013.
Siggers, J.H. et al, Biomech Model Mechanobiol,
13.2: 363378, 2014.
612
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NUMERICAL MODELING OF BIOHEAT

TRANSFER PROBLEMS
B. Mochnacki1, E. Majchrzak2, M. Ciesielski3 , M. Dziewonski4 ,
M. Jasinski5, G. Kaluza4 , M. Paruch4 , L. Turchan4
1
Silesian University of Technology, Institute of Computational Mechanics

and Engineering, Gkiwice, Poland
3
Higher School of Labour Safety Management, Mathematics

and Computer Science, Katowice, Poland
Czestochowa University of Technology, Institute of theoretical

and Applied Informatics, Czestochowa, Poland
Silesian University of Technology, Institute of Computational Mechanics

and Engineering, Gliwice, Poland
5
Silesian University of Technology, Institute of Computational

Mechanics and Enginnering, Gliwice, Poland
Introduction
The problems connected with the bioheat transfer
can be divided into several groups. So, one can
consider the models of blood-perfused tissue (tissue
models) basing, as a rule, on the well known Pennes
equation [Pennes, 1948; Majchrzak, 2011] and
concerning the homogeneous or heterogeneous
parts of human body. The main assumption of the
Pennes equation is that the tissue is supplied by the
big number of uniformly distributed capillary blood
vessels. When there is a need to take into account the
large and thermally significant blood vessels (arteries
and veins) then the vessel models [Majchrzak, 1999]
should be considered. The next group of bioheat
transfer models is called the whole-body human
thermal ones. The human body is divided into the
segments (head, neck etc.). They are considered
seperately but the mutual connections are taken
into account (e.g. [Salloum, 2007]).
Results
The authors are going to present the mathematical
models and the results of numerical simulations
concerning the following bioheat transfer
problems:
Heating of skin tissue subjected to a strong external
heat source. The algorithm is supplemeted by the
procedures determining the Arrhenius integral and
the degree of skin tissue burn.
Numerical modeling of cryosurgery treatment
using both the external and internal cryoprobes
(estimation of the temporary shape of frozen
region).
Identification of the local depth of burn wound
on the basis of skin surface temperature (use of
thermal imaging).
Identification of the size and tumor position on
the basis of skin surface temperature (the inverse
problem).
In this paper the tissue models will be discussed

both in the case of steady and transient bioheat
transfer problems.
Heating of skin tissue insulated by layers of

protective clothing.
Methods
From the mathematical point of view the tissue
models are created by the single of the system
of partial differential equations supplemented by
the geometrical, physical, boundary and initial
conditions (transient problems). The physical
conditions concern the values of thermophysical
parameters of different types of tissue. They can
be also temperature dependent functions. The
boundary conditions determine the heat exchange
between the tissue domain and environment
(for instance the function describing the external
heat flux which affects the skin tissue). The intial
conditions determine the internal temperature
field in the tissue domain at the initial moment of
time t=0 (transient problems).
Sensitivity analysis of temperature field changes

due to perturbations of tissue parameters.
Discussion
The examples presented show the numerous
applications ofcomputer methods in the scope
of bioheat transfer problems. The numerical
simulations constitute the effective and quite exact
method of bioheat transfer analysis and taking into
account the possibilities of modern IT equipment
they will be increasingly used in medical practice.
References
E
. Majchrzak et al. Comput Mater Sci,
268270: 257262, 2011.
E
. Majchrzak, B.Mochnacki, CAMES,
6(3): 439447, 1999.
H.H. Pennes, J Appl Physiol, 1(2): 93122, 1948.
M.Salloum et al, Int J Therm Sci, 46: 371384, 2007.
The practical problems from the scope of bioheat

transfer are too complex that it is impossible to obtain
the analytical solution and only the numerical methods
can be applied. The authors of this paper have
considerable experience in the use of such methods
as BEM, FDM, CVM (boundary element method, finite
difference method, control volume method).
613
P 244
RESIDUAL STRAIN AND STRESS

IN PIG INTERVERTEBRAL DISCS
S. Le Floch1, D. Ambard1, A. Baldit2, P. Kouyoumdjian3 , P. Caadas1, F. Cherblanc1
1
LMGC, UMR 5508 University of Montpellier, BIOTIC, Montpellier, France

2
LaBPS National Engineering School of Metz, France, Metz, France
Hospital Carmeau, Charles Coulomb Lab UMR 5221 University of Montpellier,

Nmes, France
Introduction
The intervertebral disc growth, which is at the heart
of the development of the juvenile idiopathic
scoliosis, constitutes an example of biological
growth influenced by mechanical loads. In order
to better understand the early development of this
pathology, we propose to study the residual strains
and stresses generated through the biological
growth process of the disc.
2012], our first preliminary results seem to indicate a

smaller opening angle. Such an opening behaviour
correspond to a residual extension of the external
layer of the annulus fibrosis (stretch of 1,05) and
a residual compression of the internal layer of the
annulus fibrosis (stretch of 0,85), see fig. 1.B).
Methods
Two lumbar discs (L4L5 and L5S1, graded I)
were harvested from cadavers of domestic pigs
obtained from a local slaughter house. The lumbar
spine was excised and stored in a 12 C freezer.
IVD were separated from the vertebral bodies by
blunt dissection. Annulus fibrosus was separated
from the nucleus using a surgical knife. Then,
the stresses due to growth of the annulus fibrosis
were released by cutting the sample at the left
posterior part. After cutting, samples were stored
for 1 hour in physiological conditions, i.e., in a
0.15 M NaCl solution at T=37C. The opening angles
were measured by a similar method proposed
by [Michalek, 2012], see fig. 1.A). In addition to
measured opening angle, we characterized the
mechanical properties of the IDV tissue at 6 and
3 different locations (i.e. samples) for the L4L5 and
L5S1 discs respectively, using uni-axial traction tests
in the circumferential direction. The procedure,
similar to [Baldit, 2014], was to estimate the
5mechanical parameters of the hyperelastic strain
energy potential:
Figure 1: A
). Opening angle measured on L4L5 disc harvested
from a domestic pig. B). Reconstructed residual
Cauchy stress and strain.
Discussion
Our preliminary results (n=2 discs) show that pig
intervertebral discs present residual strains and
stresses, as other biological tissues grown under
physiological mechanical loads. Further experiments
and numerical reconstruction of residual strains
and stresses, with sample-specific mechanical
properties, will allow us to better understand disc
growth and generation of residual stresses.
(1)
The mechanical properties of the different samples
together with the opened stress-free geometries
allowed us to evaluate numerically the residual
strain and stress fields using a numerical closing
procedure (FEM) similar to [Ohayon, 2007].
We thank Labex Numev (convention ANR-10-LABX-20)
for their financial support.
Results
For the L4L5 and L5S1 pig discs, we measured
opening angles alpha0 of respectively 22 and 49,
corresponding to angles PHI0 of 169 and 155,5.
The estimated mechanical parameters for L4L5
and L5S1 discs are respectively: G = 47,943,3/
/46,726,6 kPa, K = 506528/817965 kPa,
K1 = 1,362,04/3,51,89 kPa, K2 = 16101560/
/853397, kdisp=0,0280,0336/0,03920,0158.
Compared to a study on bovine discs [Michalek,
References
Michalek et al, J. Biomech. 45(7):12271231, 2012
Baldit et al, Biomech. Model Mechanobiol.
13:643652, 2014.
Ohayon et al, Physiol Heart Circ Physiol 293:
19871996, 2007.
614
P 245
BIOMECHANICAL EFFECT OF A UNILATERAL

STABILIZATION OF THE SUBAXIAL CERVICAL SPINE
C. Schilling1, G. Schmeiser2, T.M. Grupp1, R. Kothe2
1
2
Aesculap AG, Research and Development, Tuttlingen, Germany
Schn Clinic Eilbek, Clinic for Spinal Surgery, Hamburg Eilbeck, Germany
Introduction
Multisegmental
spondylogenic
cervical
myelopathy (mSCM) is the most frequent
progressive disease in the cervical spine in the
elderly population without conservative treatment
options. The goal of surgical intervention is to
establish an effective decompression, followed
by a dorsal instrumentation. The current standard
procedures are laminoplasty (motion preserving)
or laminectomy with screw-rod-stabilization (fusion)
having both disadvantages e.g. high invasivity,
C5-pareses (fusion) or secondary kyphosis
(laminoplasty). To reduce invasivity an unilateral
approach for laminoplasty was developed which
could be used in combination with a unilateral
fixation. The goal of the study was to evaluate the
stabilization behavior of this new treatment option
in comparison to the current standard procedures.

In FE (Fig. 1) and LB the ROM and NZ of LM and
LK stayed at the level of NAT (p > 0.05), whereas
the instrumentations LMU, LMB, LKB lead to a
significant reduction (p < 0.01) without significant
difference of LMU to LMB and LKB (p > 0.05). In AR
the stabilization of all instrumentations were less
pronounced but with the same tendency seen in
FE and LB.
Ten human cervical specimens C2-T7 were tested
in the conditions: Native (NAT), laminoplasty (LM),
laminoplasty with unilateral stabilization (LMU),
laminoplasty with bilateral stabilization (LMB),
laminektomy with bilateral stabilization (LKB) and
laminektomy (LK). The intrumented level was from
C3-C6.
Figure 1: F E ROM results
For each segment condition in vitro flexibility tests

were performed. The applied load was 2.5Nm. The
3D-kinematics of the entire cervical spine segment
in the three main loading directions flexionextension (FE), lateral bending (LB) and axial
rotation (AR) was measured. Statistical analysis on
the parameters range of motion (ROM) and neutral
zone (NZ) to determine differences of the specific
conditions was assessed using an ANOVA followed
by a post-hoc test (Scheffe), with a significance
level of p = 0.05 (Statistica 10.0).
C o n cl u s i o n
For the two standard instrumentations (LM and
LKB) the degree of stabilization was as expected
(no stabilization for LM, maximal stabilization for
LKB). Interestingly the LMU exhibited almost the
same degree of stabilization as the LKB. Therefore
the LMU could be seen as an interesting minimal
invasive treatment option for mSCM.
615
P 246
PEDICLE SUBTRACTION OSTEOTOMY (PSO):

A FINITE ELEMENT ANALYSIS OF LUMBAR
INSTABILITY AND POSSIBLE TREATMENTS
C. Ottardi1, L. Prosdocimo1, M. Sasso1, A. Luca2, F. Galbusera2, V. Tomaso1
1
Politecnico di Milano, Chemistry, Material and Chemical Engineering, Milano, Italy

2
IRCCS Istituto Ortopedico Galeazzi, Milano, Italy
Introduction
Pedicle Subtraction Osteotomy (PSO) is a surgical
technique performed in case of severe sagittal
spinal imbalance. It consists in a resection of the
posterior bony elements, ligaments and a wedge
of vertebral body [Bergin et al. 2010]. The aim
of this work was to quantify, with a numerical
comparative analysis, the biomechanical changes
due to PSO on different lumbar levels and to
investigate possible surgical solutions.
Methods
The study was performed using a validated finite
element model (FEM) of the intact lumbar spine
(L1-S1) complete of all the osteo-ligamentous
structures (Figure 1a). First, a Pedicle Subtraction
Osteotomy (PSO) was simulated on L3, increasing
the lumbar lordosis of approximately 30 (Figure 1b).
The same surgical technique was then performed
on L4 (Figure 1c). A friction was defined along the
fracture path. Both the intact and destabilized
models were loaded with a follower load of 500 N
and pure moments of 7.5 Nm in flexion-extension,
lateral bending and axial rotation. In a second
step all the models were instrumented with spinal
fixator, two levels above and below the osteotomy
site and the same loading conditions were applied.
Different combinations of materials (TiAl4V and
CrCo) and devices (single vs. double rod and
different rod diameters) were studied.
Figure 1: Intact model (a), osteotomy in L3 (b) and

osteotomy in L4 (c)
Results
The results were evaluated in terms of Range of
Motion (RoM), stresses on the instrumentation in
particular at the interface between screw and
rods and internal loads along the rods. The RoM
of both destabilized models definitely increases,
compared to the intact one. Using two parallel rods
causes a significant stress reduction on the devices.
Also a change of the material imply different stress
distribution, due to the higher stiffness of the Cr-Co
alloys.
Discussion
PSO is considered an effective treatment when is
necessary to restore a sagittal alignment, in case
of rigid spinal deformities.Different type of lumbar
instability produced following PSO were studied. The
results indicates that the configuration with Cr-Co
double parallel rods, produces the higher stress
reduction on the implants near the treated level,
suggesting a less risk of failure of the device in the
medium-long term.
References
Bergin et al. Orthopedics, 33(8):58694, 2010
616
P 247
ALTERATIONS IN CROSS-SECTIONAL AREAS OF TRUNK

EXTENSOR MUSCLES DUE TO INTRAOPERATIVE INJURIES
DURING POSTERIOR LUMBAR SURGERY
N. Arjmand1, M.S. Ghiasi2, A. Shirazi-Adl3
1
Sharif University of Technology, Iran, Tehran, Mechanical Engineering, Tehran, Iran

2
3
Ecole Polytechnique de Montreal, Montreal, Canada, Mechanical Engineering,

Montreal, Canada
Introduction
Iatrogenic intraoperative injuries to paraspinal
muscles occur during posterior lumbar surgery
(PLS) and cause postoperatively a reduction in
their cross-sectional area (CSA) and contractile
density 1. Quantification of the extent of such
reduction in CSAs of individual back muscles
while accounting for fatty infiltrated portions is
crucial for the evaluation of postoperative muscle
recruitments and spinal loads/stability.
Results
In healthy controls, ~22% of CSA of the bulk of
ES+MF was found noncontractile at the lower
levels. This proportion along with the total CSA
underwent negligible variations over time (<2%)
demonstrating no confounding effect. Following
PLS, significant reductions were observed only in
the geometrical CSA of MF by ~14 and 11% as
well as in its contractile CSA by ~26 and 14% at
the L5-S1 and L4-L5 levels, respectively (p<0.05).
Methods
Pre- and post-operative (~6 months) CSAs
of
multifidus
(MF),
erector
spinae
(ES)
(longissimus+iliocostalis), quadratus lumborum (QL)
and iliopsoas (IP) were measured in six patients
undergoing PLS using a 3-Tesla-MRI scanner at
the T12 through S1 levels (slice thickness of 3 mm).
Single level (L4-L5 or L5-S1) decompression via
vertebral lamina fenestration was accomplished.
To examine the presence of any confounding
effects on recorded changes within ~6 months
period, measurements were also carried out
on ten healthy matching controls. Images were
imported into Mimics (version 17.0). Muscles were
traced over their outer fascial boundaries using a
mouse-guided tool and the encompassed areas
(i.e., geometrical CSAs) were calculated. The CSAs
of contractile (pure muscle) and intramuscular
noncontractile (fat and connective tissues)
components were quantified by analyzing signal
intensity of pixels.
Discussion
The geometrical CSA of only the more medially
located MF muscle was significantly reduced.
Evaluation of the postoperative area of all
posterior paraspinal muscles based solely on their
geometrical CSA could underestimate the total
muscle atrophy. Significant drop in post-operative
CSAs of MF may have profound effects on patterns
of muscle activities and spinal loads/stability
that indicates the case for minimally invasive
approaches.
References
1 Gejo R. et al., Spine 24: 10238, 1999.
Supported by grants from the Sharif University of
Technology (Tehran), INSF (Tehran) and IRSST
(Montral).
617
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DOES WRONG POSITION OF THE PELVIC BONES

HAVE AN IMPACT ON THE SHAPE OF SCOLIOSIS?
MECHANICAL TESTING
M. Dluski1
1
CNT ART, Rzeszw, Poland
Introduction
The study of the mechanics of the human spine
is challenging for the biomedical engineer. In
particular, when the spine is in a pathological
condition which is scoliosis. The aim of the present
study is an attempt to determine whether the
wrong position of the pelvic bones has an impact
on the shape of scoliosis. Asymmetric pelvis have
already been analyzed by various researchers [AlEisa, 2007; Dluski, 2015; Gum, 2007].
in the FEM model) initiates the appearance of a

second arch called in scoliosis as compensatory.
Further studies will be more precise and will
use sophisticated models to explore presented
correlations.
Methods
Simulations were carried out using two simple
models of the spine.In the first case, a computer
program was used for calculating the buckling
where the spine is mapped as a 2D rod model (in
the frontal plane). The rod was placed on a resilient
ground and a small torque was applied, which
resulted in simulation of sloping position of the
pelvis. The model was loaded with a vertical force
which mapped the body weight. Temporary use of
horizontal tension member simulates correction of
the center of gravity.In the second case a simple
3D model was used having a retained physiologic
curvature in the sagittal plane, which was analyzed
with use of finite element method (FEM). Model
mounted on a suitable bearing. Accordingly
burdening of the basis get the effect of the skewed
pelvis. The use of appropriate boundary conditions
allowed to simulate correction of the center of
gravity.
Figure 1: 2
D rod buckling model of the spine
Results
In both models, the initial bending followed in
accordance with an abnormal pelvic position was
shown in the models as a slight rotation of the base.
The use of corrective tension member in the 2D
model (Figure 1) and the corresponding boundary
conditions in the 3D model (Figure 2) shows the
appearance of a second arch of scoliosis. The
3D model can be seen as an additional deformation
of rotation along the long axis of the spine model.
Discussion
The shape of scoliosis may be dependent on the
arrangement of the pelvis [Debska, 2013]. The
analyzes carried out on simple models of the spine
showed that arise of the lateral curvature was due
to a forced base tilt, mapping from sloping position
of the pelvis. In the initial phase, there is a one
arched bend toward the base tilt. Then the reaction
initiated aimed at straighten curves (through the
use of tension member in rod model and adding
of appropriate boundary conditions and forces
Figure 2: 3
D FEM model of the spine
References
Al-Eisa et al, Spine, 31(5):135143, 2007
Debska at al, J Orthop Trauma Surg Rel Res,
2 (32): 2737, 2013
Dluski, Scoliosis, 10(Suppl 1):P14, 2015
Gum et al, Eur Spine J, 16:15791586, 2007
618
P 249
LUMBOPELVIC RHYTHM DURING FORWARD

AND BACKWARD SAGITTAL TRUNK ROTATIONS
USING INERTIAL SENSORS
N. Arjmand1, A. Tafazzol1, A. Shirazi-Adl2
1
2
cole Polytechnique, Montral, Canada, Mechanical Engineering, Montreal, Canada
Introduction
Evaluation of the ratio of total lumbar rotation
over pelvic rotation (lumbopelvic rhythm)
during trunk sagittal movements is valuable in
patient discrimination for diagnostic purposes
and in biomechanical modelling for spinal load
predictions. The pattern of this rhythm during
forward bending in asymptomatic populations,
however, remains contentious as some have
measured a sequential rhythm while others
suggest a simultaneous one 1. The present study
aims to measure lumbopelvic rhythm in healthy
individuals using inertial tracking devices that are
robust (no cameras or transmitters required), low-cost, light, portable, and, hence, suitable tools
for measurement of human movements in the
workplaces and clinical centers.
Results
The mean peak voluntary flexion rotations of the
thorax, pelvis, and lumbar were 121 (SD 9.9), 53.0
(SD 5.2), and 60.2 (SD 8.6), respectively. The mean
lumbopelvic ratio (calculated as the total lumbar
rotation to the total pelvis rotation) for 10 intervals
of trunk flexion (i.e., 010%, 1020%, , and
90100% of full trunk flexion) continuously decreased
with forward flexion (2.57, 2.52, 2.35, 2.24, 2.11, 1.97,
1.82, 1.6, 1.35, and 1.14). Conversely, the mean
lumbopelvic ratio for 10 intervals of trunk extension
(i.e., 010%, 1020%,, and 90100% of total
trunk backward extension) increased as subjects
returned to their initial upright posture from the
fully flexed posture (1.07, 1.31, 1.57, 1.79, 1.98, 2.14,
2.31, 2.51, 2.71, and 2.90). A rather simultaneous
rhythm between the lumbar and pelvis movements
was found during both forward and backward
trunk movements.
METHOD
8 young healthy males with no recent back
complications volunteered for the study after
signing an informed consent form. Their mean age,
body mass and height were 25.3 years (SD 1.3),
80.1kg (SD 6.3), and 180.7 cm (SD 5.8), respectively.
The sensors were securely attached to the spinous
processes at the T5, L1, and S1 levels using doublesided tapes and elastic Velcro straps to prevent
movement of the sensors with respect to the
underlying skin. With no constraint on the pelvis,
participants bent slowly forward (to their maximum
voluntary rotation) from a neutral upright position
and subsequently lifted backward to their initial
posture in three trials with their feet shoulder width
apart and their knees extended.
Discussion
While the lumbar spine contributed more to
the trunk rotation during early and final stages
of forward flexion and backward extension,
respectively, the pelvis contributed more during
final and early stages of forward flexion and
backward extension, respectively. Pure sequential
movements of the lumbar and pelvis as suggested
by some were not observed in this study during
voluntary sagittal trunk rotation. Practitioners in the
field of ergonomics and rehabilitation may use such
portable and easy-to-use devices to accurately
measure lumbopelvic ratios in the workplaces and
clinical centers.
References
1 Tafazzol et al., Clinical Biomechanics 29: 713, 2014.
Supported by grants from the Sharif University of
Technology (Tehran) and IRSST (Montral).
619
P 250
INFLUENCE OF INJECTED CROSSLINKER

ON POROELASTIC MATERIAL PROPERTIES
OF DEGENERATED DISC
K. Khalaf1, M. Nikkhoo2, Y.W. Kuo3 , Y.C. Hsu3 , M. Haghpanahi4 ,
M. Parnianpour5, J.L. Wang3
1
Khalifa University of Science, Technology and Research, Biomedical Engineering,

Abu Dhabi, United Arab Emirates
Science and Research Branch, Islamic Azad University, Department of Biomedical

3
National Taiwan University, Institute of Biomedical Engineering, Taipei,

Iran University of Science and Technology, School of Mechanical Engineering, Tehran, Iran
5
University of Wisconsin, Department of Industrial and Manufacturing, Milwaukee, USA
Results
Injection of Genipin increased the permeability for
both degenerated disc groups and increased the
elastic modulus for moderate degenerated discs.
No significant effect was observed on the Poissons
ratio of the discs (Figure 1).
Introduction
New
treatment
approaches
to
damaged
intervertebral discs are of great interest. Reagents,
such as the peptide crosslinker Genipin, have recently
shown significant promise towards the recovery
of disc function [Chuang et al., 2010]. However,
the effectiveness and influence of Genipin on the
material disc properties have not yet been well
established. The purpose of this study is to investigate
and quantify the changes in the poroelastic disc
material properties upon artificial degeneration and
short-term in situ regeneration treatments.
Methods
Experimental protocol.
A total of 40 porcine thoracic discs from juvenile
pigs were dissected. Upon the removal of the facet
joint and muscle tissue, the discs were incubated for
7 days in a whole disc culture system. Specimens were
equally assigned to 5 groups: intact (I), moderate
degeneration
(M),
moderate
degeneration
treated with Genipin (MX), severe degeneration
(S), and severe degeneration treated with Genipin
(SX). Moderate degeneration was simulated by
injecting 0.5 ml trypsin solution (0.25%) into the disc
on the first day. Severe degeneration was created
by applying 4hr fatigue loading (F rms= 420N, 2.5 Hz)
1-day after trypsin injection. Genepin treatment
(1 ml, 0.33%) was applied 1day after trypsin
injection/fatigue loading. After a 7-day-incubation
period, a 1hr unconfined creep test was conducted
under a constant 0.8 MPa compressive loading
using a custom-made material testing apparatus.
FE modeling.
A validated backward FE analysis algorithm and
quadratic response surface (QRS) regression
[Nikkhoo et al, 2013] were used to identify the
optimal sets of elastic modulus, permeability
and Poissons ratio for intact, degenerated and
regenerated discs by correlating their responses
during creep loading experiments to those
obtained from poroelastic FE simulations.
Figure 1: D
isc material properties (*: p<0.05)
Data Analysis.
One-way ANOVA was conducted to compare the
poroelastic material properties among each group.
see the next page
620
Discussion
This study confirms that Genipin can potentially
recover the damaged disc structure/function,
by restoring its hydraulic permeability (fluid flow
capability) and elastic modulus (disc strength).
The lack of recovery of the elastic modulus of
severely degenerated discs may be due to either
an insufficient dosage of Genipin or the cracks and
tears in the anulus fibrosus [Hsu et al., 2013]. The
insignificant change in Poissons ratio indicates that
Genipin does not influence the bulging capacity
of the disc. These results shed light on the etiology
of disc degeneration and provide quantitative

evidence regarding its potential benefit as a
therapeutic modality. Future studies are needed
for further investigating severely damaged discs.
References
C
huang et al., J Biomed Mater Res A, 92:
297302, 2010.
Hsu et al., Spine, 38:E14461453, 2013.
Nikkhoo et al., Proc Inst Mech Eng H, 227:
672682, 2013.
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P 251
VERTEBRAL ENDPLATE CONCAVITY PREDICTS

FAILURE LOAD UNDER HIGH IMPACT LOADING
IN A RABBIT SPINAL EXPLANT MODEL
S. Dudli1, W. Enns-Bray2, A. Rmmeler2, S.J. Ferguson2, B. Helgason2
1
University of California San Francisco, Department of Orthopaedic Surgery,

San Francisco, USA
2
ETH, Institute for Biomechanics, Zrich, Switzerland
Introduction
Assessment of vertebral fracture risk (VFA) is based
on bone quality and morphometric measures such
as lateral DXA or QCT in combination with gender,
age, and spine fracture status [Hulme 2007, Krege
2013]. However, bone strength is also affected by
bone geometry. Therefore, including a measure
for the shape of the vertebral endplate, which is
the weakest element under axial spine loading,
may increase sensitivity and specificity for VFA. We
hypothesize that the central endplate concavity
affects fracture risk under high-impact loading.
Methods
Rabbit spinal segments (disc/endplates + 1/3
vertebrae) were harvested from T10/T11-L5/6
(n = 16) and scanned with a microCT100
(20 um resolution, SCANCO Medical, Brttisellen,
Switzerland) (Figure 1). Specimens were glued in
parallel aluminium caps, which guarantee axial
loading. Burst fractures were induced using a
dropped weight (1 J). Force was measured with an
impact load cell (Kistler 9321A, 250 kHz) fixed under
the specimens (Figure 2).
Figure 2: f orce-time curve of impact.
Categorical variables were the anatomical level

and the individual rabbit. Dependent variables
were failure load (F), maximal endplate stress
(sigma), energy at failure (E), and Boolean
parameters for endplate fracture (CaFr, CrFr).
All variables were tested for normal distribution
and heteroscedasticity. Pearson correlations for all
variables were calculated. Models for dependent
variables were built by stepwise inclusion of
significant independent variables and confirmed
with a bidirectional model optimization algorithm.
Results
15 of 16 specimens showed endplate fractures and
were included in the analysis. The area under the
entire curve, which was almost constant (CV = 3.8%),
was considered proportional to the impact energy
and the area to failure proportional to failure
energy (CV = 48%). Selected significant correlations
are listed in table 1. The calculated models were:
(1)
(2)
(3)
(4)
Figure 1: m
id-sagittal microCT image of rabbit spinal
segment.
From microCT images the following variables were

calculated: minimal endplate-endplate distance
(d), cross-sectional area of caudal and cranial
endplate (CaA, CrA), endplate thickness in the
central core (CaTh, CrTh), width, depth, maximal
slope, and total volume of the concavity (CaV, CrV).
F ~ a1*d + a2*CaV (a1, a2 > 0)

sigma ~ b1*CaA (b1 < 0)
E ~ c1*CaTh (c1 < 0)
CaFr ~ d1*CaTh (d1 > 0)
see the next page
622
level
F
-0.54
sigma
E
CaTh
0.54
CaV
0.79
-0.62
-0.53
0.61
CaFr
is more pronounced than in humans, hence it must

be investigated how these findings translate to
human VFA. However, our results are in agreement
with FE models showing lower central core stress
with increasing concavity [Langrana, 2006]. Energy
at failure and fracture probability of the caudal
endplate are best predicted by caudal endplate
thickness. Interestingly, thicker endplates fractured
more often and at lower energy. In conclusion,
these findings suggest that not only bone quality
measures but also geometric measures (endplate
concavity and thickness) should be considered in
VFA.
CaA
0.73
-0.67
-0.63
0.63
0.50
CaTh
0.65
-0.62
CaA
-0.62
0.83
-0.62
0.59
Table 1: Selected significant correlations.
Discussion
Larger volumes of caudal endplate concavities
associate with higher failure load of spinal segments
and remain significant even when accounting for
caudal cross-sectional endplate area and thickness,
the two independent variables correlating with the
anatomical level. Endplate concavity in the rabbit
References
H
ulme et al, Bone, 41:94657, 2007.
K
rege et al, Bonekey Rep, 2:404, eCollection, 2013.
L angrana et al, Spine J, 6:26778, 2006.
623
P 252
A NEW METHOD TO EVALUATE IMPINGEMENT

IN CERVICAL AND LUMBAR SPINAL
DISC ARTHROPLASTY IN VITRO
T. Grupp1, J.J. Yue2, R. Garcia3 , C. Kaddick4 , R.A. Schierjott5, B. Fritz6 , C. Schilling6 ,
J. Schwiesau6
1
Aesculap AG Ludwig Maximilians University Clinic for Orthopaedic Surgery, Campus
Grosshadern, Munich, Germany, Research & Development, 78532 Tuttlingen, Germany
2
Yale University School of Medicine, New Haven CT, USA, Dept. of Orthopaedics and
Rehabilitation, New Haven, USA
3
4
Orthopedic Care Center, Aventura FL, USA, Orthopaedics, Aventura, USA
EndoLab Mechanical Engineering GmbH, Thansau, Germany, Biomechanics,

Thansau, Germany
Hochschule Furtwangen University, Campus Tuttlingen, Germany, Industrial Engineering,

Tuttlingen, Germany
6
Aesculap AG, Research & Development, Tuttlingen, Germany
Introduction
In spinal disc arthroplasty implant-related compli
cations are subsidence, migration, displacement,
wear, subluxation of the polyethylene core and
impingement between the superior and inferior
metal endplates or between a metal endplate
and the polyethylene inlay. Impingement as
a complication in cervical and lumbar disc
arthroplasty has been previously described in
individual case reports [13], radiographic cohort
evaluations [4] and retrieval studies [5, 6]. This
study aims to develop a test method to evaluate
impingement in spinal disc arthroplasty in terms
of wear, metal ion concentration and particle
release.
with a pore size of 0.015 m and analysed using SEM

micrographs. The total volume of the bulk element
debris was analysed by inductively coupled plasma
mass spectrometry and calculated in relation to
the element concentration in the lubricant.
Results
The volumetric wear rates are in good correlation
to the ion concentration The particle size of the
cobalt-chromium wear particles released by
impingement revealed that most of the detected
cobalt-chromium particles were in a size range
between 0.2 and 4 m.
Discussion
The
newly
introduced
impingement
wear
simulation proved to be suitable to predict in vivo
impingement behaviour [3] and particle release of
TDA devices in a pre-clinical test.
Methods
Impingement simulation was performed on a
6-station spinal wear simulator with a customized
setup on cervical and lumbar spinal disc devices
by creating an impingement contact stress by
a displacement of the range of motion of +2 in
the impingement direction and applying a torque
of 3 Nm (cervical) and 8 Nm (lumbar) in flexion,
extension, lateral bending and combined flexionbending. The wear particles were separated
from the lubricant using an enzymatic digestion
protocol, filtered through a polycarbonate filter
References
1 van Ooij et al.; Spine 2007;32:2239
2 Kurtz et al.; Spine 2008;33:4819
3 Austen et al.; Eur Spine 2012;21:S51320
4 Kfer et al.; Spine 2008;33:24449
5 Lebl et al.; Spine 2012;37:E120917
6 Rundell et al.; J ASTM Int. 2011;8:114.
624
P 253
ANALYSIS OF BIOMECHANICAL EFFICACY

OF TWO STEP TRACTION THERAPY
Y.H. Kim1, W.M. Park1, K. Kim2, S. Lee3 , S. Lee3
1
Kyung Hee University, Department of Mechanical Engineering,

Yongin-si, Korea, Republic of Korea
2
Kyung Hee University, Department of Applied Mathematics,

Yongin-si, Korea, Republic of Korea
Korea Institute of Science and Technology Information, Scientific Data Research Center,
Daejeon-si, Korea, Republic of Korea
Introduction
Conservative treatments are preferentially used
to treat low back pain prior to surgical methods
and traction therapy is one of the most common
conservative treatments. However, biomechanical
efficacy of traction therapy is not well known.
While a clinical study has reported the occurrence
of large disc protrusion during motorized traction
therapy [Deen, 2003], the reason was not well
explained in spite of previously performed
experimental and computational studies. In this
study, we hypothesized that two step traction
therapy consisting of a global axial traction and
a local decompression could reduce risk of disc
damage during traction therapy. Biomechanical
efficacy of two step traction therapy was analysed
by using finite element (FE) analysis.
L1-2, L4-5 and L5-S1 decreased continuously. The

fibers of annulus fibrosus in the posterior region,
and intertransverse and posterior longitudinal
ligaments experienced stress primarily during
global axial traction, these stresses decreased
during local decompression. However, stresses
on the ligaments and fibers of annulus fibrosus in
anterior region increased, when the L4 spinal bone
was excessively translated.
Methods
In this study, a validated three dimensional FE
model of the healthy lumbar spine was used.
One-third of body weight of the volunteer was
applied on the center of the L1 vertebra toward
the superior direction for the first global axial
traction. Then L4 vertebra was pushed along
anterior direction as much as 7 mm for the second
local decompression. All translational movement
of the sacrum was constrained, and translation of
the L1 vertebra in the axial direction was allowed.
Only flexion-extension rotation of the L1 vertebra
was allowed for FE analysis. We investigated the
changes in the lordosis angle, intradiscal pressure,
and stress on the fibers of the annulus fibrosus and
ligaments during two-step traction therapy by
using finite element analysis.
Figure 1: L ordosis angles (variation from initial value)

between the superior planes of the upper and
lower vertebrae during the two-step traction;
the solid lines in step 1 and 2 show the initial
locations of spinal bones.
Discussion
We found that local decompression was very
useful for reducing tensile stress on the fibers of
the annulus fibrosus and ligaments generated by
the axial traction force for reduction of intradiscal
pressure. However, excessive local decompression
could result in an increase in intradiscal pressure at
the L2-L3 and L3-L4 MSUs, stress on the fibers of the
annulus fibrosus in the anterior and lateral regions.
Thus, proper lordosis angle restoration using
additional local decompression helps decrease
in the risk of soft-tissue damage and increases the
beneficial effects of reduced intradiscal pressure
in traction therapy.
Results
The lordosis angle between the superior planes
of the L1 vertebra and the superior plane of the
sacrum was 44.6 at baseline, 35.2 with global
axial traction, and 46.4 with local decompression
(Figure 1). The initial intradiscal pressure at each
motion segment unit (MSU) was assumed to be
zero. The pressure at all MSUs decreased with a
global traction. While the pressures at L2-3 and L3-4
segments initially decreased and then increased
during a local decompression, the pressures at
References
Deen et al, Mayo Clin Proc, 78:15541556, 2003.
625
P 254
A NOVEL KINEMATIC MODEL FOR A FUNCTIONAL

SPINAL UNIT AND A LUMBAR SPINE
A. Ciszkiewicz1, G. Milewski1
1
Division of Experimental Mechanics and Biomechanics, Institute of Applied Mechanics,

Faculty of Mechanical Engineering, Cracow University of Technology, Cracow, Poland
Results
Position and displacement analysis of the
presented FSU model using a constraint equations
method leads to a system of 3 nonlinear equations.
This system is numerically solved for several sets
of three angular variables. In the same way, the
lumbar spine model consisting of 4 separate FSU
mechanisms connected in a serial way could be
solved, too. Each pair of vertebrae has to be solved
separately using following equations systems
Introduction
Over the years modelling of the functional spinal
unit (FSU) or the spine was a subject of many
research projects. Several multibody models of
the FSU were presented such as a simple model
where all passive elements of the FSU are replaced
with one spherical joint [Nightingale, 2000].
Models where passive structures are represented
by flexible elements are very popular [Gudavalli,
1999]. It is also very common to use stiffness matrix
to describe the intervertebral joint [Christophy,
2013]. The aim of this work is to propose the novel
kinematic model for the FSU and the lumbar spine.
Method
The model of the FSU (Fig. 1) consists of three
fixed-length links connected to two platforms
(corresponding to the vertebrae) by spherical
joints. Two links represent facet joints while the
third one represents anterior longitudal ligament.
The proposed FSU model is a spatial, parallel
mechanism with 3 degrees of freedom. There are
three angular, input variables that correspond to
flexion, lateral bending and axial rotation. Flexible
elements representing other ligaments and the disc
can also be complemented to facilitate static and
dynamic analysis. The lumbar spine model contains
4 separate FSU models connected in a serial way.
Discussion
Analysis of the kinematic structure of the FSU
with methods commonly used in robotics can
eventually lead to better guiding mechanisms.
The proposed mechanism of the FSU can be used
as a reference in the study of spine guidance it
is relatively simple and easy to solve. It can also
reproduce the displacements of the actual FSU as
well as the whole lumbar spine segment in three
degrees of freedom (flexion, lateral bending and
axial rotation).
References
Christophy M., et al, Multibody Syst Dyn,
30:413432, 2013.
Gudavalli M. R., Triano J., J Manipulative Physiol
Ther, 22(3):201208, 1999.
Nightingale R. W., et al, J Biomech,
33:191197, 2000.
Figure 1: T he parallel model of the FSU.
It is notable that facet joints and passive elements

of the spine (ligaments) define and limit the
intervertebral displacements in the FSU. Surface
analysis of the facet joints leads to a conclusion
that their contact can be described with
sphere-sphere contact pair. If linear displacement
of the spheres is not considered, this contact pair
can be substituted with a link of length equal
to the distance between spheres. The link is
connected to the vertebrae with spherical joints.
For the purpose of kinematic analysis a complex
system of ligaments can be substituted with one
ligament that experiences low strains and has a
great influence on possible displacements of the
vertebrae. Anterior longitudal ligament is chosen
as a substitute ligament.
626
P 255
DO DEGENERATED HUMAN LUMBAR SPINE SEGMENTS

EXHIBIT BIPHASIC VISCOELASTIC PROPERTIES?
J. Costi1, I. Lawless1, D. Sommerfeld2, D. Amin1, R. Stanley1, B. Ding3
1
Flinders University, Computer Science, Engineering & Mathematics, Adelaide, Australia
Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany

3
Introduction
The intervertebral disc (IVD) exhibits nonlinear,
anisotropic, viscoelastic multiphasic, behaviour
that differs depending on the applied direction
of six degree of freedom (6DOF) motion. These
properties may result from interactions between
the solid phase and fluid flow (poroelasticity), as
well as from solid phase intrinsic viscoelasticity itself.
Poroelastic behaviour has been demonstrated
for articular cartilage [Mow, 1980] and normal
IVDs [Costi, 2008], however the time-dependent
behaviour of degenerated IVDs and the relative
6DOF contributions of the solid and fluid phases
has not been studied. We hypothesised that the
poroelastic behaviour of degenerated discs would
play a minor role compared to its solid-phase
intrinsic viscoelastic behaviour.
each for stiffness and phase angle. Significant

differences were accepted when p<0.05 (2-tailed),
and a Bonferroni adjustment was used for all
statistical post hoc pairwise multiple comparisons.
Results
For the stiffness data, the poroelastic group
exhibited larger %changes relative to 0.001 Hz up to
0.1 Hz compared to the viscoelastic DOFs (p<0.05,
Figure 1). However, at 1 Hz the viscoelastic group
exhibited greater %changes for both stiffness and
phase angle.
Methods
Fifteen degenerated (Thompson grades 35)
human lumbar isolated IVDs were tested in each
of 6DOFs at four dynamic loading frequencies
(0.001 Hz, 0.01 Hz, 0.1 Hz and 1 Hz) while exposed
to physiologic preload (0.5MPa), hydration
(protease-inhibited, phosphate-buffered saline
bath) and temperature (37 C) conditions in a
hexapod robot [Ding, 2014]. The primary testing
axis was driven in position control while the offaxis coupling was minimized in load control.
Non-destructive cycle amplitudes were 1.1 MPa
compression, 0.6 mm shear, 3 lateral bending,
5 flexion, 2 extension and 2 axial rotation.
Average stiffness over the entire final load-unload
cycle and phase angle over all loading cycles was
calculated for all specimens in each DOF and at
each loading frequency. To address the hypothesis
that poroelastic DOFs exhibit significantly lower
frequency-dependent effects compared with
intrinsic viscoelastic DOFs, the DOFs were divided
into two groups. The poroelastic group represented
those DOFs expected to favour fluid flow effects
during loading (compression, lateral bending,
flexion, and extension), and the viscoelastic group
represented those remaining DOFs that were
expected to exhibit primarily intrinsic (solid phase)
viscoelastic behaviour (shears and axial rotation).
For comparisons between different DOFs, stiffnesses
and phase angles for each DOF were normalised
and expressed as percentage change relative
to 0.001 Hz for the other frequencies. Separate
repeated measures ANOVAs were performed
between the poroelastic and viscoelastic groups
Figure 1: M
ean (95% CIs) stiffnesses and phase angles
plotted as a percentage of those at 0.001 Hz
as a function of frequency.
Discussion
Generally, stiffness increased and phase angle
decreased with increasing loading frequency.
These effects become stronger at 1 Hz, compared
to slower frequencies. Strong biphasic differences
occur at 1 Hz, dominated by the intrinsic viscoelastic
response of the solid phase for both stiffness and
phase angle.
Degenerated discs exhibited a markedly different
biphasic response compared to normal discs at
1 Hz (Costi, 2008). In normal discs, the poroelastic
response dominates. However, in degenerated
discs, the intrinsic viscoelastic response dominates.
References
Costi et al, J Biomech, 33:17311738, 2008.
Ding et al, J Dyn Syst-T ASME, 136(6):112, 2014.
Mow et al, J Biomech Eng, 102:7384, 1980.
627
P 256
MULTISCALE BIOMECHANICS OF HUMAN LUMBAR

INTERVERTEBRAL DISCS: NANO-MICRO-ORGAN SCALE
J. Costi1
1
Introduction
Low back problems are prevalent in society.
Motion-preservation strategies (e.g., nucleus
replacement, total disc replacement and posterior
stabilization devices) are currently in use or in
development (Costi, 2011), however, their longterm performance is unknown (Freeman, 2006).
While these medical devices restore some function
to the spinal motion segment, the risk of adjacentlevel degeneration does not appear to have been
reduced (van den Eerenbeemt, 2010).
Results
The challenge is to replicate the complex

biomechanical function of the motion segment
to improve the quality of motion and minimize
adjacent level problems, while ensuring device
longevity for the younger, more active patient.
Biological, tissue engineering strategies for
regeneration and repair of intervertebral disc (disc)
tissue are being developed and these offer exciting
opportunities (and challenges) for the longer
term (Nerurkar, 2010). A thorough understanding
of the biomechanical function of disc tissue is
required in order to ensure the proper design and
longevity of these medical devices. There is a
limited fundamental, basic science understanding
of normal and degenerated disc tissue function
across the macro-, micro- and nano-scales.
Figure 1: N
anoscale topographical image of collagen
type I fibrils.
Our long-term program of research is focused on

developing a fundamental understanding of how the
disc functions across these scales, in order to develop
improved models and experimental techniques to
facilitate rigorous study of normal and diseased tissue
to provide baseline data for computational, tissue
engineering and therapeutic developments.
Figure 2: Internal disc tissue maximum shear strains after 20,000

cycles of combined bending motion, measured
experimentally using stereoradiography techniques.
An overview of these and other current research

projects within this program will be discussed, such
as those listed below:
Discussion
The results of the nano- and micro-scale studies
have revealed new insights into possible
mechanisms underlying the role of collagen I in
normal and degenerated tissue.
1. R
egional nano- and micro-tensile properties of
collagen type I in the outer anulus fibrosus of
normal and degenerated cadaver disc tissue
(Figure 1).
2. M
easurement of internal disc strains using
stereoradiography techniques to improve
understanding of how discs become injured
during certain lifting activities (Figure 2).
The findings from the internal disc strain studies

suggest that significant disorganisation of the
tissue occurs after repetitive lifting motions that
may lead to long-term risk of disc herniation, and
endplate damage.
Methods
This research is being achieved with state of the art
testing systems such as a custom-designed six degree
of freedom hexapod robot, which represents one
of the most advanced materials testing systems in
the world (Ding, 2014). At the microscale, we are
using a commercial biaxial tensile testing system to
determine the properties of normal and degenerated
collagen I fibres. At the nanoscale we are conducting
nanoindentation on collagen I fibrils.
References
Costi et al, Expert Rev Med Devices. 8:35776, 2011.
Ding et al, J Dyn Syst-T ASME, 136:112, 2014.
Freeman et al, Eur Spine J, 15(Suppl 3):S439447, 2006.
Nerurkar et al, Nature Materials 8:986992, 2009.
Nerurkar et al, J Biomech, 43:10171030, 2010.
van den Eerenbeemt et al, Eur Spine J, 19:
12621280, 2010.
628
P 257
VALIDATION OF LOWER RISKS OF THE LOOSENING OF

THE SCREWS IN SPINAL FUSION WITH THE FLEXIBLE ROD
D. Tawara1, T. Tsujikami1, H. Murakami2
1
Ryukoku University, Department of Mechanical and Systems Engineering, Otsu, Japan

2
Kanazawa University, Department of Orthopaedic Surgery, Kanazawa, Japan
Introduction
Loosening and dissociation of the pedicle screws
in spinal fusion with posterior instrumentation for
osteoporotic vertebral fractures often occurs,
possibly because of the increase of failure due
to the occurrence of high stress and reduction
of fixity around a screw [Mayer HM, 2002]. An
improved rod with a damper structure has thus
been proposed to allow more flexible fixation.
In our previous study, our finite element analysis
showed fewer failure possibilities in bone around
the screw by using the flexible rod, suggesting the
low risks of loosening [Tawara D, 2014]. Therefore,
experimental validation of lower risks of loosening in
the flexible rod is necessary. In this study, we made
4 kinds of simplified specimens of spinal fusion with
the rigid/flexible rods and performed pull out tests
for the screw after cyclic loading of the specimens.
Feasibility of the flexible rod was discussed based
on the comparison of the push out loads.
Results
Comparison of the maximum pull out loading
values between the models is shown in Fig. 2.
The control group is a case which is performed
without the test application of the cyclic loading.
The maximum loads of all the models were small
compared with the control group. The maximum
loads of the models I and III in which a rigid rod was
used decreased significantly.
Methods
Four kinds of simplified specimens of the spinal
fusion with the rigid/flexible rods using imitation
bone i.e. SawBones were made as shown in Fig.1.
Model I and II are specimens which just connect
2 imitation bones of 40 mm 40 mm 50 mm by
rigid/flexible rods. Model III and IV are specimens
in which another imitation bone is inserted into
the model I and II assuming that an intervertebral
disk exists and supports/transfers reaction forces
in internal case. Cyclic compressive/tensile
loadings of 10 7 times were applied to all models
on the fatigue tester supposing to internal loading
conditions. Then, we performed pull out tests for
each screw and compared the maximum pull out
loading values [JIS, No.T0311, 2009].
Figure 2: P
ull out loading values of the models.
Discussion
The smaller maximum load values of the models
compared with the control group means that
damage was given appropriately around the
boundary between the imitation bone and the
screw. The significant differences of the load
values between model I/III and II/IV indicates the
flexible rod has lower risks of loosening compared
with the rigid rod. In addition, stiffness of the real
intervertebral disks is smaller than that of the model
III/IV, but might be between the models I/II and
III/IV. Because the differences of the loads in both
model I/II and III/IV were significant, effectiveness
of the flexible rod was again accepted.
References
JIS, No.T0311, 2009.
Mayer HM et al, Eur Spine J, 11: S85S91, 2002.
Tawara D et al, JBSE, 13-00163, 2014.
Figure 1: F our kinds of simplified specimens.
629
P 258
INTERVERTEBRAL DISC AND FACET JOINT

CONTRIBUTIONS TO THE SIX AXIS MECHANICAL
PROPERTIES OF THE HUMAN LUMBAR
FUNCTIONAL SPINAL UNIT
I. Lawless1, D. Sommerfeld2, D. Amin1, R. Stanley1, B. Ding3 , J. Costi1
1
Institute of Biomechanics, TUHH Hamburg University of Technology, Hamburg, Germany

3
Introduction
The functional spinal unit (FSU) is a three joint
multiplex comprised of an intervertebral disc (IVD)
and two sagittally symmetrical diarthrodial synovial
facets. The strength and flexibility of the healthy
spine results from the cumulative contribution of
these joints to load bearing and flexibility at each
spinal level. The pathological spine can experience
deficits in mechanical behaviour or pain as a
result of injury or degeneration to one or more of
the three joints of the FSU. Accordingly, current
interventions tend to treat and replace the FSU
component-wise. However, there remains limited
literature on the complex six degree of freedom
(6DOF) mechanical properties of the joints, whose
nominal function the interventions must reproduce
in order to restore quality of life [Costi, 2011].
Results
Left and right lateral shear, lateral bending and
axial rotation demonstrated symmetry and were
pooled for analysis.
Significant differences were found between the
intact FSU and IVD for both stiffness and phase
angle in lateral shear, axial rotation, and extension
(p<0.021). Significant stiffness differences were
found in anterior (Figure 1) and posterior shear
(p<0.005 except phase angle p>0.086).
There were no significant differences in stiffness and
phase angle for compression (p>0.099), flexion
(p>0.093) and lateral bending (p>0.057, except
for phase angle p=0.008), generally indicating
minimal facet interaction in those directions over
the explored range.
The aim of this study was to determine the

component-wise contribution of the IVD and facet
joints to the 6DOF mechanical properties of the
FSU.
Methods
Fifteen osseoligamentous human lumbar FSUs were
tested in each of 12 directions at 0.1 Hz along 6DOF
while exposed to physiologic preload (0.5 MPa),
hydration (protease-inhibited, phosphate-buffered
saline bath) and temperature (37C) conditions in
a hexapod robot [Ding, 2014]. The testing suite was
then repeated after a complete facetectomy,
leaving only the IVD. The primary testing axis was
driven in position control while the off-axis coupling
was minimized in load control. Five non-destructive
cycles were applied having amplitudes of 1.1 MPa
compression, 0.6 mm shear, 3 lateral bending,
5 flexion, 2 extension and 2 axial rotation.
Average stiffness over the entire final load-unload
cycle and phase angle over all loading cycles
was calculated for all specimens in each DOF.
Bonferroni-adjusted paired t-tests were used to
detect significant differences (p<0.05) between
the intact FSU and IVD tests in each direction.
Independent samples t-test for equality of means
was used to assess directional symmetry.
Figure 1: C
ontribution of the IVD and facet joints to FSU
behaviour in anterior shear.
Discussion
The contribution of the facet joints was highly
direction dependent, accounting for the majority
of FSU non-linear behaviour and more energy
absorption (phase angle) than intuition would
suggest (Figure 1). If highly efficacious implants
are to be designed, we first need to understand
the mechanical properties of the joints they
are intended to replace. This work explores the
contribution of the components of the lumbar FSU
to its overall behaviour in asymmetric 6DOF.
References
Costi et al, Expert Rev Med Devices. 8:35776, 2011.
Ding et al, J Dyn Syst-T ASME, 136:112, 2014.
630
P 259
DIGITAL VOLUME CORRELATION (DVC) TO INVESTIGATE

THE STRAIN DISTRIBUTION AND FAILURE IN THE
PROPHYLACTIC AUGMENTED VERTEBRAE
V. Danesi1, G. Tozzi2, M. Palanca1, S. Renzo3 , L. Cristofolini1
1
2
University of Bologna, Department of Industrial Engineering, Bologna, Italy

3
Tecres SpA, Tecres SpA, Verona, Italy
Introduction
The aim of this study was the application of Digital
Volume Correlation (DVC) in conjunction with
high-resolution micro-CT imaging, to investigate
the strain distribution of prophylactic-augmented
vertebrae. We focused on local and global failure
mechanism during compression. The effect of
different types of augmentation materials was
assessed.
The force and work to ultimate failure in prophylactic-augmented vertebrae was consistently larger than
in the controls (Fig.1). However, in some cases the
first-failure force and work were lower than for the
control. The internal strain distribution was investigated to elucidate the failure mechanism. Failure
started at the trabecular-cement interface, and later propagated throughout trabecular bone within
the vertebral body (Fig.2). Conversely the cement
region was unaffected even at the final stage.
Methods
Twelve single thoracic porcine vertebrae (T1, T2
and T3) were divided in three groups:
A
ugmentation with Cal-CEMEX Spine (Tecres,
Italy) was performed on 4 intact vertebrae.
A
ugmentation with Mendec Spine (Tecres, Italy)
was performed on 4 intact vertebrae.
T he remaining 4 specimens
untreated control group.
served
as
an
Destructive tests were performed with a step-wise

axial compression (0%, 5%, 10%, 15% and 20%),
with 50 N of preload. MicroCT images were acquired
at each step (typically 35 micron resolution). DVC
analysis (LaVision, UK) was performed on the
microCT-reconstructed volumes to obtain the
full-field displacement and strain distribution, in
order to identify the onset and progression of
bone-biomaterial failure in the natural and
prophylactic augmented vertebral body. The
microCT and DVC parameters were optimized to
reduce errors affecting the computed strains.
Figure 2: Internal 3D view of augmented specimen in the preload (0% strain) and final (20% strain) compression
stages. Damage progressively developed from the
bone-cement interface and then spread across the
trabecular bone. Both types of cements showed a
similar trend.
Discussion
This study allowed a better understanding of
the failure process in vertebrae prophylactic-augmented with different biomaterials. While in all
specimens prophylactic augmentation reduced
the risk of reaching ultimate failure, in some cases
it increased the risk of partial failure. The variability
of the mechanical performance of the treatment
seems to confirm a recent study [Cristofolini, 2015],
in which the effect of augmentation seemed to
depend on the quality of augmentation itself. Our
finding suggests that the most critical region is the
bone-cement interface where the onset of fracture
is recognizable, consistently with [Tozzi et al., 2012,
2014]. The same failure mechanism was observed for
the two different cement types under investigation.
Results
The authors would like to thank the European Society
of Biomechanics (ESB mobility award 2014) and the
Royal Society (RG130831).
Figure 1: T ypical force-displacement curves during

destructive testing for augmented and control
vertebrae. Each compression step was followed
by a relaxation period (~15min) and microCT
imaging (~100min).
References
Cristofolini et al, J Eng in Med, under review.
Palanca et al ESB 2015 Prague
Tozzi et al, J Biomech 45: 35663.
Tozzi et al, J Biomech 47: 346674.
631
P 260
EFFECT OF GEOMETRY CHANGE ON BIOMECHANICAL

PARAMETERS OF FINITE ELEMENT MODEL OF THE
CERVICAL SPINE
I. Zafarparandeh1, R. Hassan1, D. Erbulut1, A.F. Ozer2
1
KOC University, Mechanical Engineering, Istanbul, Turkey

2
Koc University, Neurosurgery, Istanbul, Turkey
Introduction
Various finite element (FE) models of the cervical
spine have been proposed in the literature1. Most of
the FE models assume that symmetry occurs about
mid-saggital plane while some other considers the
accurate asymmetric geometry of the cervical
spine. The proposed models are used to predict
the motion response and internal biomechanics
under different loading types. The aim of this paper
is to investigate the influence of change in the
geometry of the cervical spine on the predicted
biomechanical parameters by the FE model.
the less sensitivity to the change in the geometry

compared to other models. The ROM for the flexion
loading, the predicted segmental rotation of the
ASYM model were elevated compared with the
predicted of the SYM model and were closer to the
mean values in the previously published work. When
the extension loading was compared to flexion
loading, the moment-rotation curves produced
by the ASYM and SYM models were more similar.
In axial rotation, the rotation by the ASYM model
was closer to in vitro study from the literature. In
lateral bending, the ASYM model predicted values
more similar to the experimental results. In general,
the assumption of symmetry about the mid-sagittal
plane did not generate major errors in the motion
analysis of the cervical spine.

The exact geometry of the asymmetric model
(C2-C7) was obtained from the CT data. A midsagittal plane was used to cut the surface of the
asymmetric model based on the average of the
width the vertebrae, Figure 1. The obtained surface
was mirrored about the mid-sagittal plane and the
surface of the symmetric model was constructed.
Hexahedral mesh was generated on the surface
of vertebrae and discs. Five types of ligaments
with the same number of truss elements were used
in both models: anterior longitudinal ligament,
posterior longitudinal ligament, capsular ligament,
interspinous ligament, ligamentum flavum. Threedimensional gap elements (GAPUNI) were used
to simulate facet (apophyseal) joints. The load
was applied on top of C2 and bottom surface of
C7 was fixed in all directions for both models. The
predicted responses of both models were validated
under flexion, extension, lateral bending, and axial
rotation. The biomechanical parameters including
range of motion (ROM), intradiscal pressure (IDP),
facet load (FL), and ligament stress (LS) were
compared. Both the asymmetric and symmetric
models were compared under five different
conditions: intact (Int), without nucleus (WoNuc),
without ligaments (WoLig), without rebar (WoReb),
and without facet (WoFac). The predicted ROM
was compared to the published results in the
literature2,3,4.
In Figure 2, IDP is compared for C4-C4 segment. The
results are presented in all directions. The maximum
change in the IDP due to symmetry assumption was
58% for the NoFac condition under axial rotation,
and the minimum was 4% for the Int condition under
lateral bending. The predicted IDP results were
more sensitive under axial rotation compared to
other motion directions. The WoReb model showed
References
1 Panjabi M.M., Spine, 12:26842699, 1998.
2 Goel V.K. et al, J Orthopaed Res, 6:611619, 1988.
3 Nightingale et al, J Biomech, 40:535542, 2007.
4 Wheeldon J.A. et al, J Biomech, 39:375380, 2006.
632
P 2 61
THE EFFECT OF THE POSTERIOR ELEMENTS

ON VERTEBRAL STRENGTH PREDICTION
J. Choisne1, C. Travert1, J.M. Valiadis1, P. Rouch1, W. Skalli1
1

Paris, France
Results
Whole vertebra failure strength was 3388 N 1874
and vertebral body failure strength was 3325 N 1834
(Figure 1). Correlation between the two models
were R=1 (p < 0.0001). Mean failure strength
difference was 64 N 46 [min = 23; max = 193] with
a RMSE of 0.2% (7 N). Mean differences in stiffness
was 139N/mm 72 [min = 44; max = 333] with a
RMSE of 0.1% (16 N/mm).
Introduction
Patient-specific finite element models (FEM)
derived from quantitative computed tomography
(QCT) scans are used to predict failure strength of
vertebral bodies [Crawford, 2003; Buckley, 2007;
Imai, 2006]. These models applied axial compressive
forces to the vertebral body after resection of
the posterior arch. To the best of our knowledge,
these studies never quantified the effect of the
posterior elements resection on vertebral strength
prediction. Therefore, the purpose of this study was
to investigate the effect of the presence of the
posterior arch during anterior compression on the
prediction of the vertebral failure strength.
Discussion
Resection of the posterior arch in our FE model did
not affect the vertebral strength prediction but was
lower of 1.9% in average. These results comfort the
studies which did not include the posterior elements
in their models and will help the present model to
perform faster with less computation time.
Methods
28 lumbar vertebrae (L1-L5) from 8 donors (8F aged:
87 yo 8) were dissected from all soft tissue (with
care to preserve the vertebral body endplates)
and scanned on a QCT machine (Scanner ICT
256, Philips Healthcare, Cleveland, OH, 120 Kv,
1489 mA/s and a slice thickness of 0.33 mm).
A calibration phantom (QRM-ESP, QRM GmbH,
Germany) was used to map gray scale values to
bone mineral density. Hexahedral meshes were
generated with a custom-built algorithm including
8304 elements for the vertebral body and 8736
for the posterior elements. Material properties
for each element were assigned using density-modulus relationship [Kopperdahl, 2002]. PMMA
on the vertebral endplates was modelled for
parallelism (E = 2.5 GPa, ? = 0.3). Lower PMMA layer
was completely constrained and the upper PMMA
layer was used to apply an anterior compressive
force located at the anterior third of the vertebra
using rigid elements for load distribution. Vertebral
failure load was defined when 1mm3 of elements
reached
1.5%
deformation
[Sapin,
2012].
Simulations were performed with and without the
posterior arch elements.
References
Crawford et al, Bone, 33: 744750, 2003.
Buckley et al, Bone, 40: 767774, 2007.
Imai et al, Spine, 31: 17891794, 2006
Kopperdahl et al., J. of Ortho. Res., 20:801805,2002
Sapin et al, Spine, 37:E156E162, 2012
Figure 1: V
ertebral failure load for each vertebra with and
without the posterior arch.
633
P 262
INTERNAL LUMBAR SPINE MOTION DURING LIFTING

A. Pavlova1, K. Cooper2, J. Meakin3 , R. Barr1, R. Aspden1
1

2
Robert Gordon University, School of Health Sciences, Aberdeen, United Kingdom

3
University of Exeter, Biophysics Research Group, Aberdeen, United Kingdom
Introduction
Lumbar curvature is important for the stability of the
spine under load [Aspden 1989] and it was shown
that each individual has an intrinsic shape specific
to them [Meakin 2009]. Recently, it was found that
healthy adults with a curvy (lordotic) lumbar spine
prefer to lift weights from the floor by stooping
and those with straight (flat) spines prefer to squat
[Pavlova 2014]. The aim of this study was to track
internal lumbar spine curvature during lifting in the
same cohort and compare lumbosacral motion
between individuals with different spine shapes.
Methods
Magnetic resonance imaging (MRI) was used to
take mid-sagittal images of the lumbar spine in
30 healthy adults (age: 1865 years) while they
stood upright and bending forward to 30, 45 and
60. MRI visible markers (paintballs) were attached
to the skin at L1, L3, L5 and S1 spinous processes. At
a separate session participants lifted a weighted
box (615kg) from the floor without instruction. The
position of markers on the skin at L1, L3 and L5 was
tracked using Vicon motion capture and sacral
angle (to horizontal) was measured. Matching
markers on the back during MRI and lifting sessions
allowed us to calculate vertebral centroid positions
(L1, L3, L5, S1) during lifting (Figure 1). Active shape
modelling, which involves principal components
analysis, was then used to identify variations in
lumbar spine shape from MRI [Meakin 2009]. The
mode of variation describing overall curvature
was used to group participants into curvy and
straight spine sub-groups (total N=8) by their
deviation (> 1SD) from the mean shape.
Figure 1: M
easured and calculated vertebral centroids and
their external markers.
Results
At the point of picking up the box from the floor
individuals with curvy spines had more lumbar
lordosis than those with straight spines (Figure 2),
despite stooping to pick up the load. From upright
standing intersegmental motion occurred earlier
at the upper lumbar levels (L1-L3) compared
with lower lumbar (L3-L5). During lifting straight
spines had greater rigid-body motion of the entire
lumbar spine compared with curvy spines who
demonstrated more varied intersegmental motion
with greater sacral flexion.
Figure 2: L umbar curvature at the point of pick up

for 8 participants with curvy or straight spines.
(L1, L3, L5 are centred on S1)
Discussion
Individuals with very lordotic spines retained some
degree of internal lordosis despite stooping when
lifting. The lumbar spine appears more mobile at
the upper levels, L1-L3, and greater flexibility was
apparent in those with the most lumbar lordosis.
References
Aspden, Spine, 14:266274, 1989
Meakin et al, J Anat, 215:206211, 2009.
Pavlova et al, Bone Joint J, SUPP 4:1717, 2014.
634
P 263
EXPLORING THE RELATIONSHIP BETWEEN DECREASED

NUCLEUS PULPOSUS TISSUE TONICITY AND ITS
INFLAMMATORY RESPONSE
I.T.M. Arkesteijn1, K. Wrtz-Kozak2, K. Ito1,3
1
Eindhoven University of Technology, Orthopaedic Biomechanics, Eindhoven, Netherlands

2
3
ETH Zrich, Institut fr Biomechanik, Zrich, Switzerland
University Medical Center Utrecht, Department of Orthopaedics, Utrecht, Netherlands
Introduction
Inflammation in the nucleus pulposus (NP) of
degenerating intervertebral discs is believed to
be involved in discogenic back pain. Furthermore,
studies have shown that minor defects in the outer
annulus fibrosus (AF) can induce an inflammatory
response in the NP [Korecki, 2008; Sobajima,
2005]. As defects in the AF would allow the NP
to swell, resulting in decreased tissue tonicity, we
hypothesize that this phenomenon initiates the
inflammatory cascade. More specifically, we
hypothesize that there is a negative relationship
between NP tissue tonicity and its inflammatory
response. In this study, different tonicities were
created in isolated NP tissue and its inflammatory
response was determined.
Figure 1: T he % change in wet weight compared to that

at tissue harvest for different PEG concentration
treatments. *p<0.05 vs. 30% PEG group.
Methods
To create different tonicities, bovine caudal NPs (n
= 8) were harvested and dialyzed against different
concentrations of polyethylene glycol (PEG, %w/v
in PBS) for 100 minutes: a) 0%, b) 10%, c) 20%, or d)
30%. Subsequently, the NPs were put in a previously
designed artificial annulus system [van Dijk, 2013]
to limit any further swelling and cultured for 7 or
21 days in hypoxia (5% O 2) at pH 7.2. The weight of
the NP samples was determined prior to and after
culture. In addition the [H2O], [sGAG] tissue, [sGAG]
and [DNA] were analyzed. The tissues tonicity
medium
was calculated from the [sGAG]tissue and [H 2O]. On
day 0, 3, 7 and 21, the secretion of TNF-, IL-1,
IL-6 and IL-8 was determined in an ELISA, as well
as the gene expression of anabolic factors ACAN,
COL2, TIMP-1; catabolic factors MMP-3/-13,
ADAMTS-4/-5, COX-2; and neurovascular growth
factors VEGF, NGF.
Figure 2: T he tissue tonicity post-culture. *p<0.05 vs. 30% PEG

and native group.
Inflammatory cytokine assay results, and gene

expression of anabolic, catabolic and neurovascular
growth factors are still pending.
Discussion
So far, different NP tissue tonicities were created
using the artificial annulus system [van Dijk, 2013].
Although, the standard deviations in terms of water
were large within groups, the tissue tonicities were
well controlled. If a negative relationship between
the inflammatory response and the tissues tonicity
is demonstrated, this will provide new insights in the
pathology of degenerative disc disease and have
implications for treatments thereof.
Results
By altering the PEG concentration during the
initial sample shrinkage step prior to enclosing
the sample in the artificial annulus, we were able
to create four distinct tissue swelling conditions.
These conditions ranged from no change w.r.t in
situ wet weight (30% PEG) to almost a doubling of
the water content (0% PEG, Figure 1). As expected
the [DNA] and [sGAG]tissue remained unchanged
during culture. Thus, four levels of tissue tonicity
were achieved (Figure 2).
References
Korecki CL et al, Spine, 33:23541, 2008.
Sobajima S et al, Spine J, 5:1423, 2005.
van Dijk BGM et al, Spine J, 13:45463, 2013.
635
P 264
ROLE OF MUSCLE DAMAGE ON LOADING

AT THE LEVEL ADJACENT TO A LUMBAR SPINE
FUSION A BIOMECHANICAL ANALYSIS
M. Malakoutian1, J. Street2, H.J. Wilke3 , I. Stavness4 , M. Dvorak2, S. Fels5, T. Oxland1
1
University of British Columbia, Department of Mechanical Engineering, Vancouver, Canada

2
University of British Columbia, Department of Orthopaedics, Vancouver, Canada

3
University of Ulm, Institute of Orthopaedic Research and Biomechanics Center

of Musculoskeletal Research, Ulm, Germany
University of Saskatchewan, Department of Computer Science, Saskatoon, Canada
University of British Columbia, Department of Electrical and Computer Engineering,

Vancouver, Canada
Introduction
Adjacent segment changes to a spinal fusion have
been studied using in vitro techniques, but these
produce predictable results [Volkheimer, 2015].
Therefore, alternative approaches are needed
that better represent the complexity of the lumbar
spine, particularly in situations where the paraspinal
muscles are dysfunctional. Musculoskeletal models
of the lumbar spine hold promise in this regard
[Bresnahan, 2010], but have not been used to
address the effect of muscle damage on adjacent
segment loading. The objective of this study was to
investigate the effect of muscle damage on postoperative spinal loading at the adjacent levels to
a spinal fusion during upright postures by using a
recently developed musculoskeletal model of the
lumbar spine.
Methods
A musculoskeletal model of the spine was created
in ArtiSynth, a biomechanical modelling software
toolkit. The model included the entire spine and
rib cage, with the lumbar vertebrae being mobile,
and 210 muscle fascicles. For validation, the in vivo
experiments conducted in [Daggfeldt, 2003] and
[Wilke, 2001] were simulated by the model, which
led to the results that were in good agreement with
the in vivo measured values. Then, to address the
objective of this study, loading at the L1-L2 and
L5-S1 were estimated during upright standing,
before and after simulated paraspinal muscle
damage along the lumbar spine, both with a spinal
fusion at L2-L5 and with no spinal fusion (see Figure 1).
Figure 1: S imulation of muscle damage to the longissimus

thoracis pars thoracis. For fascicles with multiple
attachments points, the points that were located
at injury levels were removed and the remaining
points were reconnected together to again form
that fascicle.
Discussion
A musculoskeletal model of the lumbar spine
predicted increased compressive forces after
muscle damage at the adjacent levels to a spinal
fusion. The largest increases were at the rostral
adjacent segment compared to the caudal level,
and the changes occurred with or without a spinal
fusion. This suggests that the paraspinal muscles
of the lumbar spine play an important role in the
etiology of adjacent segment changes beside a
spinal fusion.
Results
The axial compressive forces at the adjacent levels
increased after simulated muscle damage, with
the largest changes being at the rostral level (78%
increase in presence of spinal fusion; 73% increase
without spinal fusion) compared to the caudal
level (41% in presence of fusion and 32% without
fusion). Shear forces increased in a similar manner
at both the rostral and caudal levels.
References
Volkheimer et al, European Spine J, under review.
Bresnahan et al, Spine, 35.16:761767, 2010.
Wilke et al, Clin. Biomech, 16:111126, 2001.
Daggfeldt et al, J Biomech, 36.6:815825, 2003.
636
P 265
SIMULATING THE INTERACTIONS BETWEEN MUSCLE

FUNCTION AND DISC MULTIPHYSICS THROUGH
A PREDICTIVE LUMBAR SPINE FE MODEL
T. Toumanidou1, T.T. Dao2, M.C. Ho Ba Tho2, J. Noailly1,3
1
Institute for Bioengineering of Catalonia, Biomechanics and Mechanobiology BMMB,

Barcelona, Spain
University of Technology of Compigne, UMR CNRS 7338 Biomechanics and BioEngineering,

Compigne, France
3
Universitat Pompeu Fabra, Department of Information and Communication Technologies

DTIC, Barcelona, Spain
Introduction
Understanding the pathophysiology of low
back disorders remains challenging due to the
complex interactions between mechanical loads
and biological processes, largely depending on
intervertebral disc (IVD) condition and external
loads. Since such loads are transferred through
spine muscles, this research focuses on the coupling
between muscle action and IVD condition. Finite
element (FE) modelling including patient-based
model personalization was used.
standing position (distributed body weight, 60 sec).

We explored the relation between muscle forces
and disc condition considering degenerative and
healthy IVD properties.
Previous rest increased the IDP at all levels but
L5/S1, by up to 28% in standing position (Fig 2A).
Overnight swelling added to the muscle capacity
to counterbalance the forward bending induced
by the anterior body weight. The importance of this
interaction was further reflected when we simulated
complete muscle inactivity: due to damage
and osmotic pressure loss at the upper levels, the
overnight disc strengthening was not sufficient
to balance the gravity loads and therefore, the
IDP was further increased at these levels (Fig. 2A).
The overnight pressurization of the nearly healthy
(grade 2) L5/S1 disc kept the segment mechanically
stable, ensuring a 50% load relieve at the L5/
S1 level in standing, even with muscle inactivity.
A comparative study between healthy and
degenerated disc effects after night rest revealed
that the mechanical stabilization of the system with
healthy IVD properties required up to 75% lower
muscle activation than degenerated properties did
(Fig. 2B) in standing with previous rest.
Methods
An 84-fascicle network for the basic local and
global muscles that act on the lumbar spine
was coupled to a patient-specific L1-S1 osteoligamentous FE model of a 64kg patient (Fig. 1A).
For the muscles, a five-parameter constitutive
model
represented
a
quasi-incompressible
hyperelastic matrix reinforced by active and
passive fibres [Toumanidou et al, 2013].
Muscle properties were calibrated per fascicle and

per level against static optimization results based
on patient dynamic MRI and matching multi(rigid)body model (Fig. 1B). For the discs, a fibrereinforced porohyperelastic material was used for
the annulus fibrosus and an osmo-porohyperelastic
formulation for the nucleus pulposus. Pfirrmann
grade-specific parameters were used for the
degenerated discs, and considered fibrosis,
osmotic pressure loss, and accumulated damage
[Malandrino et al, in press]. We simulated a night
rest (free disc swelling, 8 hours), followed by a
see the next page
637
Remarkably, our IDP results at the upper levels after

night rest (grade 3, 0.060.07 MPa) were similar to
the in vivo measurements from [Sato et al,1999] for
lying patients. In standing, the IDP results for healthy
IVD properties lied in the range of measurements
of [Andersson et al,1974] at L3/L4 (0.260.42 MPa)
and [Sato et al,1999] at L4/L5 (0.220.75 MPa).
interaction between muscle activity and IVD

mechanical competence, highlighting possible
serious consequences of muscle weakness along
disc degeneration.
References
T oumanidou et al,Proc CMMBE:160161,2013;
M
alandrino et al,Frontiers in Bioeng Biotech (in
press); Sato et al,Spine,24(23):24682474,1999;
Andersson et al,Scand J Rehab Med 6:104114,1974
C o n cl u s i o n
A personalized musculoskeletal lumbar spine
model was successfully created, taking into
account patient disc condition. Results allowed
the first educated considerations about the
My SPINE-269909 (EC-FP7)
638
P 266
IDENTIFICATION OF THE CERVICAL

SPINEs MENISCOIDS BY MRI
T. Pglov1, K. Jelen1, P. Tursa2
1
Faculty of Physical Education and Sport, Anatomy and Biomechanics,

Prague 6, Czech Republic
Hospital Na Homolce, Department of Radiology, Prague 5, Czech Republic
Introduction
Meniscoids (fibrous or synovial folds), are formed in
synovial joints in an early fetal period already. They
are part of all the cervical spines intervertebral
joints of all ages [Kos, Wolf 1975]. Histologically
meniscoids can be divided into three different
groups synovial (membranous) meniscoids, fat
pads and fibrous meniscoids [Kos, Wolf, 1975;
Mercer, Bogduk 1993]. MRI is a diagnostic method,
which is able to show in detail predominantly the
meniscoids wedge filling the space between the
incongruent facets and meniscoids hyperthrophied
by degenerative processes [Yu, Sether, Haughton
1987]. Viewing meniscoids using MRI is important
for assessing their possible role in the formation of
pathological functional disorders.
also in another similar sections of MRI (Fig.1). The

best viewable are meniscoids in the segment C1 /
, where they wedge-filled the space of convexly
2
formed articulated surfaces of the atlas/axis.
Discussion
Meniscoids are part of all cervical spines facet
joints. They differ histologically, in size and by their
placement. MRI is a diagnostic method, capable
to display meniscoids [Friedrich et al. 2007]. They
are being detailed investigated primarily in the C 1 / 2
articulation, where we can afterwards evaluate
their shape changes. The next step is mapping the
segment in the presence of functional changes in
comparison with the situation under physiological
conditions. The results of our work will serve for the
objectification of influence of manual medicine
used in everyday practice to correct functional
changes in the sense of joint blockage.
Methods
On cadaveric material was found how the
meniscoids are stored and their shape characteristic.
Two torsos of the cervical spine were dissected.
In the first case meniscoids were evaluated by
direct view at the facet joint, in the second case
in a sagittal section through the facet column of
the cervical spine. To find the appropriate MRI
sequences two other anatomical torsos were used.
In vivo three probands were examined. On the
resulting sections were evaluated the presence,
location and shape of meniscoidal folds.
References
Friedrich, Klaus M. et al. High-Field Magnetic
Resonance Imaging of Meniscoids in the Zygapophyseal Joints of the Human Cervical Spine.
Spine [online]. 2007, vol. 32, issue 2, s. 244248.
Kos, J.,Wolf, J. Die Menisci der Zwischenwirbelgelenke und ihre mgliche Rolle bei Wirbelblockierung. Man Med. 1972;10:105114.
Mercer, S. A N. Bogduk. Intra-articular inclusions of
the cervical synovial joints. Rheumatology [online].
1993, vol. 32, issue 8, s. 705710.
Yu, S W, L Sether A V M Haughton. Facet joint
menisci of the cervical spine: correlative MR
imaging and cryomicrotomy study. Radiology
[online]. 1987, vol. 164, issue 1, s. 7982.
Results
The anatomical study served to identify
meniscoids, to study their shape and location in
the intervertebral space. Sagittal section through
anatomical material illustrates well the position of
meniscoids, which is afterwards being evaluated
639
P 2 67
CAN BALLET DANCERS MAINTAIN MAXIMUM TURNOUT

AND JOINT ROTATIONS THROUGH A SERIES OF ELEV
AND SAUT MOVEMENTS?
D. Cantergi1, A. Picon2, C. Rodes2, J. Loss1, I. Sacco2
1
2
Federal University of Rio Grande do Sul, School of Physical Education, Porto Alegre, Brazil
University of So Paulo, Physical Therapy, Speech, Occupational Therapy, So Paulo, Brazil
Introduction
Turnout is the main ballet element [Hamilton,
2006]. When performing, dancers are expected
to keep 180 of turnout, which should come from
70, 5 and 25 of lateral rotation on hip, knee and
ankle/feet, respectively, in each side [Champion,
2008]. Yet, most dancers use compensations for
enhancing turnout [Coplan, 2002]. Turnout should
be maximum during all performance, but can
dancers keep it the same in a series? This study
assessed the kinematic features of turnout on series
of elev and saut.
Ankle
Hip()
Turnout()
Elev 1
40.0 9
51.2 25
51.3 25
145.4 16
Elev2
38. 6 10
50.2 26
52.6 25
143.4 14
Elev3
38.2 10
50.2 26
51.8 25
142.0 15
Elev4
39.7 10
49.8 26
51.5 25
141.2 14
Saut 1
39.6 12
45.0 9
66.0 14
139.5 17
Saut2
39.2 12
44.4 9
66.1 13
142.0 19
Saut3
40.5 13
45.5 8
66.0 13
141.7 21
Saut4
40.0 13
44.2 9
66.8 14
140.0 19
Saut5
39.2 15
44.0 9
65.4 12
141.0 21
Saut6
39.9 15
43.2 9
66.1 13
139.9 22
Turnout
Elev
0.01
0.05
0.02
0.15
Saut
0.84
0.002
0.61
0.05
Discussion
Mean maximum turnout assessed ranged between
139 and 145. Although small differences were
found, these were not higher than two degrees.
This indicates the ballerinas were able to keep the
same maximum turnout in all joints during a series.
Maximum degrees of lateral rotation in each joint,
however, were quite different than what literature
suggests, particularly on the knee joint. While
the knee was supposed to be responsible for not
more than 10 of turnout, it did over 40 of the
lateral rotation. A common compensation used
by dancers is the screwing of the knees, that
uses the contact force between feet and floor
in order to enhance lateral rotation of the knee.
This study did not differentiate contact and aerial
phases of the saut, so we may only speculate
that maximum knee lateral rotation may have
occurred in contact phase. Further studies should
analyse the entire time series. Also should verify if
ballet dancers with different level of experience or
from different methodological backgrounds will be
able to maintain the same maximum turnout in a
series and if the same compensations will be used.
Results
Mean maximum turnout from each elev and
saut are presented in table 1.
Knee()
Hip
Table 2: V
alue of p for each comparison. Differences are
highlighted in bold font.
Methods
15 elite ballerinas (52.53.6 kg, 1.610.05 m, 22.13.5
years of age, 15.05.1 years of experience) did
2 series of 4 elev and 8 saut. Kinematic data was
obtained using OptiTrack cameras and processed
(low-pass 4 th order Butterworth, 6 Hz cutoff
frequency) on Amass and Visual 3D. Turnout was
considered the sum of left and right lateral rotation
between feet and in each joint. Maximum turnout
was compared in all elevs and second to sixth
sauts. Data was tested with repeated measures
ANOVA and Bonferroni Post-hoc when necessary
(<0.05).
Ankle()
Knee
C o n cl u s i o n
The ballerinas presented the same maximum
turnout in all repetitions of elev and saut series.
While the hip should be responsible for over a
fourth of the turnout, in this study the hip did about
a third of the turnout in elev and less than a half
in saut, while the knee joint, which should perform
less than 10% of the turnout, was responsible for
almost a third of it in both movements.
References
Champion and Chatfield, J Dance Med Sci
12(4):121135, 2008.
Hamilton, Br j sport med 40(4):299303, 2006.
Coplan, J Orthop Sports Phys Ther 32(11):
579584, 2002.
Table 1: Mean maximum turnout in each joint for all eleve

and saut movements.
Statistics results are presented in table 2. Post-hoc

indicated difference in eleve between 1st and 2 nd
(p=0.028) and 1 st and 3 rd (p=0.013) in ankle, and 1 st
and 2 nd (p=0.012) in hip, and saut between 3 rd
and 6 th (p=0.001) on knee.
640
P 268
IN-BIOREACTOR PROBABILISTIC MODEL-BASED

MONITORING OF TISSUE PROPERTIES
G. Rus1, L. Peralta1, J. Melchor1, J. Baena2, N. Bochud1, J. Marchal3 ,
G. Jimnez4 , J. Soto1
1

2
Breca Health Care, Breca Health Care, Granada, Spain
Federal University of Rio de Janeiro, Mechanical Engineering, Rio de Janeiro, Brazil

4
University of Granada, Instituto de Biopatologa y Medicina Regenerativa IBIMER,

Granada, Spain
Introduction
Quantitative control of tissue processes in
bioreactors is an open problem in tissue
engineering, aimed at creating artificial tissues and
organs. To standardize and optimize the process, it
is necessary to control most of the parameters that
may vary its effectiveness. We propose to monitor
the mechanical changes that underwent during
the process using transmission ultrasound and the
inverse problem.
The rational principles of continuum mechanics
are proposed together with a formal probabilistic
formulation
to
address
the
problem
of
characterizing mechanical properties of tissue
samples based on noninvasive and non-ionizing
ultrasonic measurements. In this work, multiple
models of ultrasound-tissue interaction are
proposed, implemented and contrasted against
experimental observations. The probabilistic inverse
problem solution is used to define the probability
function of the model parameters and the model
class plausibility 1,2.
Figure 1: S chematic experimental and electronic setup.
Results
The evolution of the relevant reconstructed
mechanical parameters during the reaction process
is shown in Fig. 2 for two of the aforementioned
model classes
Methods
The proposed methodology consists of four
elements: An novel (1) experimental setup based
on ultrasound-tissue interactions is monitored in
real time using the bioreactor designed in Fig.
1, a (2) set of alternative models that simulate
the ultrasound-tissue interaction is numerically
solved by the transfer matrix formalism, and a (3)
stochastic model-class selection formulation is used
to rank which of the models are more plausible,
and (4) to reconstruct the evolution of the relevant
mechanical parameters during the culture
reaction time. Three alternative models are tested
to idealize the removal of energy by dissipation
or radiation: viscous, hysteretic, proportional to
integer time derivatives of the particle movement,
and based on their fractional time derivatives.
Figure 2: E
volution of model parameters. Viscoelastic (left)
and Hystertic damping model (right).
Discussion
Ultrasound monitoring is feasible for quantifying
real-time evolution of mechanical parameters
of tissue with high sensitivity. Several mechanical
parameters can be reconstructed simultaneously
from a single measurement. Furthermore, different
constitutive models can be fed for model
hypothesis testing.
References
1 Bochud et al., IEEE T ULTRASON FERR, 59:
14431456, 2012.
2 Beck et al., J. Engineering Mechanics, 2:
192203, 2004.
Spanish Ministerio de Economa for project DPI201017065, Spanish Junta de Andaluca for projects
de Andaluca 2007-2013.
641
P 2 69
THE EFFECT OF HYDRATATION TO POISSONS

RATION OF PVA SCAFFOLDS
J. Anderov1, F. Lopot1, M. Buzgo2, M. Kralovic2, K. Jelen1
1
Charles University in Prague, Faculty of Physical Education and Sport, Anatomy

and Biomechanics, Praha, Czech Republic
Charles University in Prague, 2nd Faculty of medicine, Biophysics, Praha, Czech Republic
Introduction
A number of production parameters affect the
properties of nanofibrous scaffolds (i.e. polymer
type, the type of collector, voltage etc.) [Haghe,
2007]. The electrospinning is also influenced
by environmental conditions (i.e. temperature,
humidity), as well as post-production processes
(cross-linking). To produce scaffolds that satisfy all
requirements of their use, it is necessary to identify
all parameters and their mutual interactions to the
partial and final qualities of scaffolds.
The Poissons ratio value of hydrated samples is

smaller, from 0.18 to 0.41. Axial deformation rate is
the greatest for the solution ratio of 1:1 (21.38%),
a minimum change over dry state measurements
is also detected at this point. For other solution
ratios samples, a decline is recorded in the axial
deformation of 19.25% 6.05%. The values of
Poissons ratio of hydrated samples is 0.110.41.
When comparing the values of axial deformation by
the time of cross-linking, a decline of 17%4.54%
is observed again because of hydration. Poissons
ratio for dry samples is ranging from 0.38 to 0.53
and 0.22 to 0.31 for hydrated samples. In both
cases, the highest values are detected for samples
cross-linked for 48 hours. The axial deformation
rate changed minimally in samples cross-linked for
24 hours.
Methods
The research subjects were polyvinyl-alcohol
scaffolds produced by electro-spinning. The
solution molecular weights were 40 kDa and 220
kDa. The measured scaffolds were produced with
the following solution ratios: 1: 3, 1: 2, 1: 1, 2: 1, 3: 1,
and a cross-linked by Glyoxal for 24, 48 and 72 hours.
Discussion
The nanofibrous scaffolds are highly porous
materials. We presume therefore, that a tensile test
causes gradual routing and zooming of nanofibres
in scaffolds, and filling of the pores occurs. Poissons
ratio oscillates around 0.5 for the dry samples, the
fibres possibly filled the space completely and
the limit of incompressibility has been reached.
The sile test changes the structure of the samples,
not just their volume. Filling the space between
fibres is likely to occur much faster in the hydrated
samples. Poisson ratio has not reached the limit
of incompressibility (maximum achieved value
of 0.41). We assume this phenomenon occurs
because of the binding of water molecules onto
the nanofibres, and it therefore prevents the
fibres from completely filling the space, thus the
incompressibility limit is not reached. It is certainly
appropriate to further verify this assertion for example
by using Scanning Electron Microscopy (SEM).
A tensile test was utilised, where controlled

variable was displacement and velocity 1,5mms 1.
A transversal deformation had been detected
by HD camera recording, which was used for
the calculation of Poissons ratio. Samples were
adjusted to the size of 70x15 mm and measured
in dry and hydrated states (Ringers solution).
Loading protocol can be divided into 3 parts.
The sample was stretched 5 mm in the first part,
deformation was held for 30 seconds in the second
part, and then the sample was stretched until
complete rupture.
Results
All measured samples respond to a pull of 6% 0.52%
of the axial strain, with Poissons ratio ranging
from 0.35 to 0.58. Samples in ratio 1:1 show the
greatest degree of axial deformation; the increase
is 20.33%.
References
Haghe, A. et al, Aplications and Materials Sci,
204/6: 18301834, 2007.
642
P 270
SENSITIVITY ANALYSIS OF A FE MODEL FOR SHOULDER

IMPLANT WEAR PREDICTION
F. Di Puccio1, L. Mattei1, M. Borghini1
1
Universit di Pisa, Dip. Ingegneria Civile e Industriale, Pisa, Italy
Introduction
Recently, clinical practice of total shoulder arthroplasty
(TSA) has been increasing to treat shoulder pain and
disability. Unfortunately, this procedure reports a high
failure rate, up to 60% [Gonzalez, 2011], mainly due
to implant loosening caused by wear of the plastic
component. This issue, largely faced for hip and knee
implants, still requires to be properly tackled for TSAs.
In the literature, only a few wear models for TSAs can
be found, e.g. [Hopkins, 2007; Quental, 2015], which
are quite complex and computationally expensive.
In fact, they include advanced modelling aspects,
as realistic joint geometry and heterogeneous bone
properties, but simplify wear laws and boundary
conditions.
Figure 1: T SA models: AwP (a,b); AnP (c); boundary
conditions (d).
As wear prediction is computationally very

expensive, the structural finite element (FE)
model should be as simple as possible. The aim
of this study is to develop a simple and reliable FE
model for wear prediction of anatomical shoulder
replacement (SR), on the basis of an extensive
sensitivity analysis considering: i) implant structure,
ii) bone material properties, iii) contact location.
Results
Preliminary results, depicted in Fig.2, highlighted
that: i) the effect of pegs on the contact pressure
is neglegible (differences in the maximum contact
pressure pmax <5%); ii) the effect of Eb on pmax for
all models is very low (variation of 210%); iii) the
contact location affects the contact pressure profile
for aspherical inserts (AwP and AnP), particularly
close to the edge, whilst influences only slightly the
value of pmax in SnP case. The difference of pmax
between AnP and SnP resulted lower than 10%.
Methods
Three FE models of anatomical SRs were developed
consisting in a rigid spherical head in contact with
a glenoid component in UHMWPE cemented in
a bone substrate (Fig.1). The models differ for
the shape of the plastic component assumed as:
1) aspherical and with pegs (AwP); 2) aspherical
with no pegs (AnP); 3) spherical with no pegs (SnP). A
thin layer of cement was also modelled. A sensitivity
analysis of the contact pressure distribution was
carried out for all models by applying a vertical
load to the head. Two load levels (406 N and 750N)
were simulated in combination with: 1) 5 values
of the bone elastic modulus (Eb=0.53 GPa);
2) 8 contact regions simulated by displacing the
head towards the insert edge. The outcomes of the
FE contact analysis were then used to predict SRs
wear under 3D loads (up to 1kN) and kinematics.
Figure 2: A
n example of contact pressure (a) and wear
map (b) for the SnP model.
Discussion
This study provided some simplifying assumptions
for developing a wear predictive model for SR.
In fact, many model features, included when the
bone-implant behaviour is investigated, marginally
affect the contact pressure and can be neglected,
as the non homogeneous property of the bone. As
an example wear maps for the plastic insert are
reported in Fig.2.b.
References
Gonzalez J.F. et al, J Shoulder Elbow Surg 20:
666682, 2011.
Hopkins A.R. et al, J Biomech Eng, 129:
223230, 2007.
Quental C. et al, Med Biol Eng Comput 53:
111122, 2015.
643
P 271
SPATIALLY RESOLVED DETERMINATION OF ENAMEL

THICKNESS BASED ON ULTRASOUND IMAGING
C. Blase1, M. Blume2, A. Habib1, R. Sader2, J. Bereiter-Hahn1
1
Institute for Cell Biology and Neuroscience, Goethe University, Frankfurt, Germany,
Biosciences, Frankfurt, Germany
Goethe University, Frankfurt, Germany, Dept. of Oral, Cranio-Maxillofacial and Plastic Facial
Surgery, Frankfurt, Germany
Introduction
Ultrasound (US) is a widely used modality for medical
imaging, since it is non-invasive and relatively
cheap. The ability of US imaging to detect internal
structures, like tissue interfaces or lesion sites makes
it a promising candidate for dental imaging. So far
the inherent technical difficulties of US imaging in
tissues / organs with very heterogeneous (acoustic)
properties and limited access have prevented its
widespread use. In this study we use sound velocity
data measured on sections of extracted teeth
to do 3D reconstructions of the enamel layer of
human frontal teeth.
Methods
The spatial distribution of sound velocity was
measured in 15 sections of extracted human
teeth by use of a scanning acoustic microscope
(SAM). Freshly extracted teeth were fixed in 4%
formaldehyde solution and embedded in PMMA.
Sections of ca. 1 mm thickness were cut along the
coronal-apical axis. Radio frequency (RF) data of
teeth were collected in a scan region o 20 x 20 mm
by a SAM at 30 MHz with a lateral step size of 10 m
and a sampling rate of 500 MSa/s. Sound velocity
was determined for every scan position from local
section thickness and time of flight of the US signal.
Figure 1: D
istribution of sound velocity [m/s] in a section of a
human tooth.
Six human frontal teeth (3133 and 4143) were

extracted during surgery and fixed in formaldehyde
solution. The frontal tooth face was oriented
perpendicular to the US pulse, to achieve normal
incidence. RF data from whole teeth were collected
by SAM. The time of flight corresponding to enamel
and dentin surface were isolated for each scan
position. Surface curvature was determined to
adjust for refraction of the US waves. Enamel and
dentin surfaces were reconstructed using average
sound velocities.
Figure 2: R
econstruction of enamel (top layer) and dentin
surface (bottom layer) from US imaging at 30 MHz.
Discussion
Enamel and dentin surfaces can be determined
non-invasively from US measurements with a high
spatial resolution. Accuracy of these measurements
is limited by the surface curvature of the tooth and
differences in sound velocity between the specific
sound velocity for the individual tooth and the
averaged sound velocity used for reconstruction.
In the cases where surface inclination is > 15
from normal incidence, refraction severely limits
the penetration depth of the US signal.
Results
Sound velocities were estimated for enamel
(594696 m/s) and dentin (407379 m/s) layers.
Values for sound velocity differed by ca. 5% within
one teeth and up to 20% between teeth.
Enamel layer thickness was determined for all
investigated teeth. Thickness varied between 0.1
mm close to the cementoenamel junction and up
to 0.85 mm towards the coronal tip. In comparison to
optical measurements of enamel thickness from tooth
sections, layer thickness was overestimated by 25%.
Non-invasive US based measurements of enamel

thickness can be performed with high spatial
resolution and ca. 95% accuracy in frontal teeth
with flat surfaces. This information can be used for
planning of dental intervention.
644
P 272
BIOMECHANICAL CONSIDERATIONS IN THE

DEVELOPMENT OF A NOVEL
POLYCARBONATE-URETHANE
MENISCAL IMPLANT
J.Elsner1,M.Shemesh2, V.Condello3 , E.Hershman4 , E.Linder-Ganz2
1
2
3
ActiveImplants, ResearchandDevelopment, Memphis, USA
ActiveImplants, ResearchandDevelopment, Netanya, Israel
OspedaleSacroCuoreDonCalabria, OrthopaedicSurgery, Negrar, Italy

4
LenoxHillHospital, OrthopaedicSurgery, NewYorkCity, USA
INTRODU C TION
Torn menisci are traditionally repaired, meniscectomized, or replaced with allografts or biodegradable-scaffolds. The efficacy of such treatments may
decline with age. Nowadays, conservative care and
multiple meniscectomies are the mainstream treatment for middle-aged patients with post-meniscectomy pain. At a later age, more invasive treatments
as joint-replacements are used. Therefore, there is a
need to accommodate middle-aged-patients with a
solution that can delay more aggressive treatments
(Fig. 1). A meniscus implant with a reliable biomechanical performance that does not rely on regeneration has thus far not been offered in clinical practice.
RESU L TS
Contact pressure distributions were in good agreement
with those measured under the intact natural
meniscus prior to meniscectomy (Fig. 2). Specifically,
peak and average pressures developed under the
implant were found to be similar to those of the
natural meniscus. The contact area measured under
the implant (658135mm2) was also restored when
compared to the natural meniscus (642 96 mm2).
Outputs of the FE model confirmed that internal strains/
/stresses within the device components remained
within the materials allowed limits. The evaluation
of an implant in a sheep model showed no signs of
wear or degradation of the materials. Histology
METHODS
A
composite,
self-centering
discoid-shaped
polycarbonate-urethane meniscus implant, reinforced
circumferentially with UHMWPE fibers is proposed. The
implants shape was based on extensive MRI study
that included the geometrical analysis of more than
100 knee scans[1]. The proposed composite structure
aims to mimic the function of collagen fibers of the
natural meniscus, which are arranged mainly in a
circumferential pattern, within a hydrated matrix
[2]. Biomechanical evaluation of the implant was
focused on several in-vitro measurements of contact
pressure under the implant in cadaver knees and
computational finite element (FE) analyses.
of the cartilage and surrounding tissues showed no

significant difference between the control and the
3 and 6 month groups.
DIS C USSION
A new implant concept is proposed for treating
middle-aged patients with medial pain associated
with dysfunctional meniscus. Our results show that the
implant can reduce cartilage pressures to acceptable
levels, while preserving existing soft and hard tissues, and
thus it has the potential to postpone more aggressive
treatments to a later age. Short-term clinical results
demonstrate encouraging prospects for this concept
in terms of pain relief and quality of life measures.
Currently, the device is under clinical investigation in
a multi-center study in Europe, and the US
Pressure distribution under the meniscus was measured by using pressure sensitive films and quantified
with respect to the natural meniscus. The effects of
changes in the geometry and material properties of
the composite structure were investigated. Finite element analyses were used to evaluate internal stresses and strains, and to support the selection of optimal implant configuration. The last pre-clinical step
was a large-animal study in which both implant and
surrounding tissue (specifically cartilage) were evaluat
ed, quantitatively, in a sheep model over six months [3].
RE F EREN C ES
[1] Elsner et al. J Biomech Eng. 2010
[2] Elsner et al. J Biomech Eng. 2010
[3] Zur et al. Knee Surg Sports Traumatol Arthrosc. 2011
645
Authors Index
A
Amin, D. . . . . . . . . . . . . . P 255, P 258
Abdalrahman, T. . . . . . O 117
Amis, A. A. . . . . . . . . . . . O 320, P 085
Baca, A. . . . . . . . . . . . . . O 068
Abdelgaied, A. . . . . . . O 087, O 188
Amling, M. . . . . . . . . . . . O 008, P 003
Badel, P. . . . . . . . . . . . . . O 169, P 236
Abdelhack, M. . . . . . . . P 133
An, S. . . . . . . . . . . . . . . . . O 020
Bader, R. . . . . . . . . . . . . . O 089
Abdel-Sayed, P. . . . . . O 133
Anan, M. . . . . . . . . . . . . . P 130
Baena, J. . . . . . . . . . . . . P 268
Abdollahi, M. . . . . . . . . O 034
Anderov, J. . . . . . . . . . P 269
Bagnoli, P. . . . . . . . . . . . P 222
Ackermann, M. . . . . . . P 083
Anderst, W. . . . . . . . . . . O 259
Bah, M. . . . . . . . . . . . . . . O 005
Acocella, F. . . . . . . . . . . P 222
Andreev, P. . . . . . . . . . . P 054
Bailey, C. . . . . . . . . . . . . P 109, P 195,
Acosta, V. . . . . . . . . . . . O 154
Andres, F.J. . . . . . . . . . . P 009
Adachi, K. . . . . . . . . . . . P 063
Adachi, T. . . . . . . . . . . . . O 048, P 020
Adamopoulos, C. . . . . P 204
Adams, G. . . . . . . . . . . . O 042, P 034
Andresen Eguiluz, R. . . P 224

Andrews, D. . . . . . . . . . . P 105
Andriotis, O. . . . . . . . . . PT 04, O 080,
P 002, P 030
P 058
Bala, Y. . . . . . . . . . . . . . . P 033
Balabani, S. . . . . . . . . . . O 022, O 218
Baldit, A. . . . . . . . . . . . . . P 244
Baleani, M. . . . . . . . . . . O 287, P 038
Angeli, S. . . . . . . . . . . . . P 233
Bances, L. . . . . . . . . . . . . O 296
Angelini, L. . . . . . . . . . . . O 046
Bancone, C. . . . . . . . . . O 024
P 208
Anitha, D. . . . . . . . . . . . . P 043
Bandeiras, C. . . . . . . . . O 248
Adouni, M. . . . . . . . . . . . O 241
Annaheim, S. . . . . . . . . O 106
Afonso, H. . . . . . . . . . . . P 146
Antonova, N. . . . . . . . . . P 137, P 160,
Adeeb, S. . . . . . . . . . . . . O 035, O 203,

O 223, P 061,
Agres, A. . . . . . . . . . . . . O 011, O 243

Agu, O. . . . . . . . . . . . . . . O 022
Agudo Martnez, A. . . . P 134
Ahluwalia, A. . . . . . . . . O 094, O 213
Ahmed Shokri, A. . . . . P 050
Aigner, P. . . . . . . . . . . . . P 159
Aiyangar, A. . . . . . . . . . O 259
Ajaxon, I. . . . . . . . . . . . . O 287
Alario Bernab, R. . . . . O 072, P 059
Albertini, J.N. . . . . . . . . O 169
Albiol, L. . . . . . . . . . . . . . P 205
Al-Daghreer, S. . . . . . . . P 208
Alexandra, M. . . . . . . . . P 143
Alimohammadi, M. . . . O 022
Allegretti, D. . . . . . . . . . P 072
Allena, R. . . . . . . . . . . . . P 214
Banzo, J.C. . . . . . . . . . . O 084

Barani Lonbani, Z. . . . . P 187
P 138
Bar-On, B. . . . . . . . . . . . . O 291
Applegate, L.A. . . . . . . O 247
Baron, C. . . . . . . . . . . . . O 174
Appoo, J.J. . . . . . . . . . . O 056
Barr, R. . . . . . . . . . . . . . . . O 219, P 262
Arampatzis, A. . . . . . . . O 226, O 243,
Barreto, S. . . . . . . . . . . . . P 207
O 315
Barrett, D. . . . . . . . . . . . . P 044, P 045
Ariza-Gracia, M.A. . . . O 051, P 134
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Arkesteijn, I.T.M. . . . . . P 263
Bauer, C.M. . . . . . . . . . . P 175
Armagan, G. . . . . . . . . . O 205
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Baumbach, S. . . . . . . . . O 270, O 307
Arts, C. . . . . . . . . . . . . . . O 252
Baumgartner, D. . . . . . O 206
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P 262
Bekaert, L. . . . . . . . . . . . O 220
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P 026, P 058,
P 109, P 195
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Amabile, C. . . . . . . . . . . P 114
P 212, P 236
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O 086, O 227,
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Bursa, J. . . . . . . . . . . . . . O 058, O 095,
P 052
Bernard, S. . . . . . . . . . . . O 175
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O 152
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P 227
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P 097, P 134
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P 109
Bobrowitsch, E. . . . . . . . P 104, P 107

Bochud, N. . . . . . . . . . . . O 136, P 268
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Boeth, H. . . . . . . . . . . . . . O 011, O 244,
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O 197
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Buenzli, P. . . . . . . . . . . . . O 195
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O 047, O 069,
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O 182, P 166
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Carriero, A. . . . . . . . . . . O 266
Carroll, S. . . . . . . . . . . . . O 184
Carvalho, C. . . . . . . . . . O 262
Carvalho, S. . . . . . . . . . . P 168
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Casagrande, G. . . . . . . O 216
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Castagnoli, C. . . . . . . . P 141
Bonassar, L. . . . . . . . . . . P 224
Burg, J. . . . . . . . . . . . . . . O 081
Castilho, M. . . . . . . . . . . O 249
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Castro, A. . . . . . . . . . . . . P 210
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Cattaneo, I. . . . . . . . . . . O 097
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P 040
Cavinato, A. . . . . . . . . . O 264
Cibera, V. . . . . . . . . . . . . P 126
Coutts, L.V. . . . . . . . . . . PT 04
Cebotari, S. . . . . . . . . . . O 212, P 154,
Cichon, R. . . . . . . . . . . . O 157
Crevoisier, X. . . . . . . . . P 119
Ciesielski, M. . . . . . . . . . P 243
Cripton, P. . . . . . . . . . . . PT 12, O 204,
P 241
Coutts, L. . . . . . . . . . . . . . O 040, P 030,
P 199
Cederlund, A. . . . . . . . . O 186
Cilla, M. . . . . . . . . . . . . . O 004, P 203
Cegoino, J. . . . . . . . . . O 296
Cinelli, I. . . . . . . . . . . . . . P 225
Celik, C. . . . . . . . . . . . . . O 205
Ciszkiewicz, A. . . . . . . . P 254
Celzard, A. . . . . . . . . . . . O 253
Claeyssens, F. . . . . . . . . O 251
Cepri, J. . . . . . . . . . . . . P 009
Claiborne, T.E. . . . . . . . P 155
Ceylan, H. . . . . . . . . . . . P 051
Clauser, J. . . . . . . . . . . . P 221
Chabrand, P. . . . . . . . . O 258
Cleather, D. . . . . . . . . . . O 047
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Clement, J. . . . . . . . . . . O 195
Chakouch, M. . . . . . . . P 090
Cloutier, G. . . . . . . . . . . P 185
Chakravarty, P. . . . . . . O 264
Cloutier, L. . . . . . . . . . . . O 235
Chakroun, F. . . . . . . . . . O 202
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DAgostino, P. . . . . . . . . O 082
Chalupa, B. . . . . . . . . . . O 134, P 008,
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DAiuto, M. . . . . . . . . . . . P 192
Colen, S. . . . . . . . . . . . . . O 255
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P 088, P 135
Chamorro, C.J.G. . . . . O 126

Chan, S.C.W. . . . . . . . . P 211
Chang, Y. . . . . . . . . . . . . P 004, P 170
Chapman, R. . . . . . . . . . O 128
Chappell, M. . . . . . . . . . O 242
Charleux, F. . . . . . . . . . . P 090
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Chatzistefani, N. . . . . . . O 242
Chaure, J. . . . . . . . . . . . O 168
Chaushev, N. . . . . . . . . P 160
Completo, A. . . . . . . . . O 248
Condello, V. . . . . . . . . . P 272
Cndor, M. . . . . . . . . . . PT 02
Consolo, F. . . . . . . . . . . . O 304, P 156
Cook, D. . . . . . . . . . . . . . P 219, P 218,
P 217, O 292
Chaves, V. . . . . . . . . . . . O 163
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Cook, S. . . . . . . . . . . . . . P 224
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Checa, S. . . . . . . . . . . . . O 004, O 232,
Cooper, C. . . . . . . . . . . . PT 04, O 040,
P 205
P 030, P 040
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Correa, J.C.F. . . . . . . . . O 032, O 067
O 310
Cheng, Y.S. . . . . . . . . . . O 160

Cheong, V.S. . . . . . . . . P 166
Cherblanc, F. . . . . . . . . P 244
Chevalier, Y. . . . . . . . . . O 274, O 275
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Chiementin, X. . . . . . . . O 110, O 225
P 222
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P 261
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P 258
Christen, P. . . . . . . . . . . . O 267
Cottet, J. . . . . . . . . . . . . . O 312
iii
Cristofolini, L. . . . . . . . . . O 193, O 194,

P 259
Croce, D. . . . . . . . . . . . . P 192
Culik, J. . . . . . . . . . . . . . . PT 14
Cunha Reis, C. . . . . . . . P 143
Curcio dos Reis, A. . . . O 067
Curtolo, M. . . . . . . . . . . . P 005
D
O 193, O 194,
P 021, P 202
Damion, R.A. . . . . . . . . O 020

Damm, P. . . . . . . . . . . . . O 001, O 012,
O 227, P 052
Dammer, R. . . . . . . . . . . O 089
Danesi, V. . . . . . . . . . . . . O 193, P 259
Dao, T.T. . . . . . . . . . . . . . P 265
Darendeliler, A.M. . . . . P 101
David, W. . . . . . . . . . . . . O 074
Davis, N. . . . . . . . . . . . . . O 171
De Beule, M. . . . . . . . . . O 144, O 180,
P 162, P 164
De Gaetano, F. . . . . . . . P 070, P 222

de Gelidi, S. . . . . . . . . . . O 026
De Gregorio, M.A. . . . O 168
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De Raeve, E. . . . . . . . . . P 078
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Debusschere, N. . . . . . O 144, P 162
Deehan, D. . . . . . . . . . . P 062
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Delassus, P. . . . . . . . . . . O 150
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Della Corte, A. . . . . . . . O 024
P 030, P 040,
Dempwolf, H. . . . . . . . . O 089
Denis, K. . . . . . . . . . . . . . O 038, O 039,
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P 044, P 045
Dunne, N. . . . . . . . . . . . . O 037, O 319

Duran Escalante, A. . . P 046, O 053
Dennerlein, F. . . . . . . . . O 108
Durazo, E. . . . . . . . . . . . . O 209
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Drselen, L. . . . . . . . . . . P 232, P 239
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Dvorak, M. . . . . . . . . . . . P 264
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Dyshko, B. . . . . . . . . . . . O 161
O 255
Dziewonski, M. . . . . . . . P 243
Despotova, D. . . . . . . . . P 180
Di Martino, E.S. . . . . . . . O 056

Di Puccio, F. . . . . . . . . . O 046, P 074,
P 270
Dias, J. . . . . . . . . . . . . . . . O 239, P 168

Daz-Zuccarini, V. . . . . O 022
Dickinson, A. . . . . . . . . . O 115, O 166,
O 166
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Favre, J. . . . . . . . . . . . . . O 264, P 119
E
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Fazaeli, S. . . . . . . . . . . . . O 019
Fehervary, H. . . . . . . . . . O 057, O 146
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Ferguson, S.J. . . . . . . . . O 106, O 137,
O 221, O 273,
Edginton, R. . . . . . . . . . . O 018
P 028, P 251,
Egges, A. . . . . . . . . . . . . O 125
O 137, O 221,
Ehrig, R. . . . . . . . . . . . . . . O 244
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O 223, P 061,
Dluski, M. . . . . . . . . . . . . P 248
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Di Blasi, T. . . . . . . . . . . . . P 211
P 121, P 208
O 273, P 028,
P 251
Fernanda, C. . . . . . . . . . O 032
Fernandes, P. . . . . . . . . O 249
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Fernndez Collazo, G. O 144
Elsner, J. . . . . . . . . . . . . . P 272
Fernndez-Parra, R. . . O 168
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Ferreira de Almeida, D. O 180
Engelhardt, C. . . . . . . . . O 208, P 089
Ferreira, A.S. . . . . . . . . . O 309
Enns-Bray, W. . . . . . . . . P 028, P 036,
Ferreira, C. . . . . . . . . . . . P 169
P 251
Ferroni, M. . . . . . . . . . . . O 213
Enrico, S. . . . . . . . . . . . . . P 042
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Erdil, M. . . . . . . . . . . . . . . P 051
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Filipovic, N. . . . . . . . . . . P 136
Escribano, J. . . . . . . . . . PT 02
Filova, E. . . . . . . . . . . . . . O 139
O 315, P 205,
Esfandiar Jahromi, B. . O 310
Finet, G. . . . . . . . . . . . . . P 185
P 213
Esteki, A. . . . . . . . . . . . . . P 230
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Dudli, S. . . . . . . . . . . . . . . P 251
Ettinger, M. . . . . . . . . . . . O 114
P 156
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Evans, N. . . . . . . . . . . . . . O 242
Firsov, N. . . . . . . . . . . . . . P 138
Duman, O.M. . . . . . . . . O 205
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Dousteyssier, B. . . . . . . P 115
Duarte, M. . . . . . . . . . . . O 308
Dubini, G. . . . . . . . . . . . . O 211, P 072
Duda, G.N. . . . . . . . . . . O 004, O 011,
O 012, O 232,
O 243, O 244,
iv
Fischer, M. . . . . . . . . . . . O 284
Ganse, B. . . . . . . . . . . . . P 112
Glasmacher, B. . . . . . . O 212
Fisher, J. . . . . . . . . . . . . . O 020, O 087,
Gantenbein-Ritter, B. . P 211
Goff, E. . . . . . . . . . . . . . . O 267
O 188, O 189,
Gao, X. . . . . . . . . . . . . . . PT 08
Goggin, P. . . . . . . . . . . . O 196
Garcia Aznar, J.M. . . . PT 02
Gokgol, C. . . . . . . . . . . . O 145
Garcia Gonzalez, A.L. O 053, P 046
Goldmann, T. . . . . . . . . P 056
Garcia, R. . . . . . . . . . . . . P 252
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Gomez, H. . . . . . . . . . . . O 014
P 111, P 140
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Fleischer, B. . . . . . . . . . . O 114
Fletcher, L. . . . . . . . . . . . O 177
Flis, V. . . . . . . . . . . . . . . . P 158
Flohr, M. . . . . . . . . . . . . . O 003, P 062
Flores Espejo, J.L. . . . . O 053, P 046
Florescu, V. . . . . . . . . . . O 088
Florido, J. . . . . . . . . . . . . O 265
Folgado, J. . . . . . . . . . . . O 180, O 207,
O 249
Follet, H. . . . . . . . . . . . . . O 009, O 173,

O 174, P 033
Font-Llagunes, J.M. . . O 124, P 118

Francisco, P. . . . . . . . . . P 168
Franck, J. . . . . . . . . . . . . O 023
Franzoni, M. . . . . . . . . . . O 097
Freire, A.R. . . . . . . . . . . . O 279, O 280,
P 019, P 073
Freutel, M. . . . . . . . . . . . P 232, P 239

Fritz, B. . . . . . . . . . . . . . . . O 086, P 252
Fritzen, C.P. . . . . . . . . . . O 059
Fritzsche, M. . . . . . . . . . P 191
Fruhauf, A.M.A. . . . . . . O 032
Frydrysek, K. . . . . . . . . . O 272, O 306
P 025
Gmez, L.F. . . . . . . . . . . O 265
Gardunia, B. . . . . . . . . . P 218
Gondwe, C. . . . . . . . . . . P 108
Garijo, N. . . . . . . . . . . . . O 301
Gonzalez, I. . . . . . . . . . . PT 02
Garon, M. . . . . . . . . . . . . O 295
Gonzlez-Lluch, C. . . . P 086
Garzn Alvarado, D.A. O 268
Goossens, Q. . . . . . . . . O 038, O 039,
Gasser, T.C. . . . . . . . . . . O 153
O 255
Gauthier, R. . . . . . . . . . . O 173
Gorecki, D. . . . . . . . . . . O 231
Gehlen, T. . . . . . . . . . . . . O 243
Gorodkov, A. . . . . . . . . P 151
Geindreau, C. . . . . . . . . O 169
Gourdon, D. . . . . . . . . . P 224
Genovese, K. . . . . . . . . P 212
Grabowski, P. . . . . . . . . P 021
Gentil, F. . . . . . . . . . . . . . P 014
Graf, E. . . . . . . . . . . . . . . P 175
Gentile, G. . . . . . . . . . . . O 098
Granados, M. . . . . . . . . O 212, P 154,
Georg, S. . . . . . . . . . . . . P 103
George, N. . . . . . . . . . . . P 105
Georgiadis, M. . . . . . . . O 317
Georgopoulou, U. . . . . P 204
Geraldes, D.M. . . . . . . . P 085
Gerassimov, N. . . . . . . . O 131
Geris, L. . . . . . . . . . . . . . . O 029
Gerosa, G. . . . . . . . . . . . P 241
Fukuda, T.Y. . . . . . . . . . O 067
Gerych, D. . . . . . . . . . . . O 109
Fukutani, A. . . . . . . . . . . P 098
Geurts, J. . . . . . . . . . . . . O 252
Fulvia, T. . . . . . . . . . . . . . P 042
Gfhler, M. . . . . . . . . . . . P 161
Funk, S. . . . . . . . . . . . . . . O 013
Ghattamaneni, N.R. . . O 299
Frst, A. . . . . . . . . . . . . . . O 298
Ghazanfari, S. . . . . . . . . O 019
Fuss, F. . . . . . . . . . . . . . . . P 092
Gheduzzi, S. . . . . . . . . . O 112
Ghiasi, M.S. . . . . . . . . . . P 247
P 241
Granegger, M. . . . . . . . P 159
Grasa, J. . . . . . . . . . . . . . P 097
Grassi, A. . . . . . . . . . . . . P 127
Grassi, L. . . . . . . . . . . . . . O 010, P 029
Gravier, M. . . . . . . . . . . . O 165
Grecco, L.C. . . . . . . . . . O 032
Green, E. . . . . . . . . . . . . O 018
Greenwood, C. . . . . . . O 042
Grimal, Q. . . . . . . . . . . . O 175
Grimmer, K. . . . . . . . . . . P 011, P 012
Grogan, J.A. . . . . . . . . . O 172
Grossi, T. . . . . . . . . . . . . . O 211
Gruca, G. . . . . . . . . . . . . O 094
Grupp, T.M. . . . . . . . . . . O 071, O 073,
O 086, P 245,
Ghista, D. . . . . . . . . . . . . P 163
Gabrielli, F. . . . . . . . . . . O 100
Gianluca, I. . . . . . . . . . . P 042
Galajdova, A. . . . . . . . . P 167
Giannopoulou, E. . . . . O 015
Galbusera, F. . . . . . . . . P 246
Gill, H.S. . . . . . . . . . . . . . P 069
Galfe, M. . . . . . . . . . . . . O 188
Gillard, F. . . . . . . . . . . . . P 189
Gallant, J. . . . . . . . . . . . P 173
Ginebra, M.P. . . . . . . . . O 287
Guille, M. . . . . . . . . . . . . O 231
Gallo, J. . . . . . . . . . . . . . P 125
Giorgi, M. . . . . . . . . . . . . O 266
Guimares, J. . . . . . . . . O 308
Gallo, L.M. . . . . . . . . . . . O 085, O 202,
Giovanni, P. . . . . . . . . . . P 157
Guizar-Sicairos, M. . . . O 317
P 178
Girldez-Snchez, M.A. . P 018
Gulan, U. . . . . . . . . . . . . O 217
Ganghoffer, J.F. . . . . . . P 206
Giusti, S. . . . . . . . . . . . . . O 213
Gussew, A. . . . . . . . . . . . P 048
P 252
Gu, W. . . . . . . . . . . . . . . . PT 08
Gudena, R. . . . . . . . . . . O 035
Gueorguiev, B. . . . . . . . O 041, O 298,
P 110
Guzik-Kopyto, A. . . . . . P 095
Heinemann, F. . . . . . . . O 198
Howieson, A. . . . . . . . . . P 198
Gzik, M. . . . . . . . . . . . . . . O 305, P 017,
Heinlein, B. . . . . . . . . . . . O 278, P 175
Hsu, Y.C. . . . . . . . . . . . . P 250
Heinrich, G. . . . . . . . . . . O 254
Hua, X. . . . . . . . . . . . . . . P 111
Heinzelmann, H. . . . . . O 312
Huang, S. . . . . . . . . . . . . P 149
Helgason, B. . . . . . . . . . P 028, P 251
Hugentobler, I. . . . . . . . P 178
Heller, M. . . . . . . . . . . . . P 044, P 045
Hulsen, D. . . . . . . . . . . . . O 252
Habib, A. . . . . . . . . . . . . P 271
Hellmich, C. . . . . . . . . . O 117, O 302
Humphrey, J. . . . . . . . . P 212
Haffner-Luntzer, M. . . . O 008, O 233,
Henao Murillo, L. . . . . . O 021
Hung, W.C. . . . . . . . . . . P 184
Herasi, M. . . . . . . . . . . . . P 131
Hurschler, C. . . . . . . . . . O 114, P 116
Haghpanahi, M. . . . . . . O 256, P 250
Herbert, A. . . . . . . . . . . . P 140
Hutchinson, C. . . . . . . . O 242
Hahner, J. . . . . . . . . . . . . O 254
Heris, H.K. . . . . . . . . . . . O 299
Hutchinson, J. . . . . . . . . P 034
Haiter-Neto, F. . . . . . . . O 279
Herrera, A. . . . . . . . . . . . P 146
Hutchinson, J.R. . . . . . . O 297
Hamitouche, C. . . . . . . P 115
Hershman, E. . . . . . . . . . P 272
Hynck, L. . . . . . . . . . . . . P 124
Han, H.C. . . . . . . . . . . . . O 151
Herzog, W. . . . . . . . . . . . O 187
Han, S.W. . . . . . . . . . . . . O 048
Hetsroni, I. . . . . . . . . . . . O 013
Han, W.S. . . . . . . . . . . . . P 115
Heuijerjans, A. . . . . . . . O 185
Hangartner, P. . . . . . . . O 317
Hewera, S. . . . . . . . . . . . O 157
Hansen, U. . . . . . . . . . . . O 276, P 085
Heyland, M. . . . . . . . . . . P 213
Hao, Z. . . . . . . . . . . . . . . . O 245
Hidenori, T. . . . . . . . . . . . O 075
Harato, K. . . . . . . . . . . . . P 186
Hilfiker, A. . . . . . . . . . . . . O 212, P 241
Hardaker, C. . . . . . . . . . O 087
Hill, J. . . . . . . . . . . . . . . . . O 319
Harder, M. . . . . . . . . . . . O 212, P 241
Hill, R. . . . . . . . . . . . . . . . . O 288
Harislamova, L. . . . . . . P 023
Hinteregger, M. . . . . . . P 161
Hartato, K. . . . . . . . . . . . P 057
Hinber, C. . . . . . . . . . . O 254
P 066, P 171,
P 194
P 003
Hartlova, J. . . . . . . . . . . O 269
Harvey, N.C. . . . . . . . . . PT 04, O 040,
P 030, P 040
Hasan, I. . . . . . . . . . . . . . O 198, O 200,

P 227
Hasanov, R. . . . . . . . . . . P 054
Hashemi, J. . . . . . . . . . . O 241
Hassan, C. . . . . . . . . . . . P 060
Hassan, R. . . . . . . . . . . . P 260
Hassani, K. . . . . . . . . . . . P 147
Haubold, L. . . . . . . . . . . O 011
Hausherr, T. . . . . . . . . . . O 247
Huler, K.L. . . . . . . . . . O 003
Havelkov, L. . . . . . . . . P 124
Haverich, A. . . . . . . . . . O 212, P 154,
Hirjakov, Z. . . . . . . . . . P 181
Hirtler, L. . . . . . . . . . . . . . O 030
Ho Ba Tho, M.C. . . . . . . P 265
I
Iablonskii, P. . . . . . . . . . O 212
Iacono, F. . . . . . . . . . . . . P 047
Iannaccone, F. . . . . . . . O 144, P 162
Iglic, A. . . . . . . . . . . . . . . PT 05
Ignasiak, D. . . . . . . . . . . O 221
Ignatius, A. . . . . . . . . . . O 008, O 233,
P 003, P 232,
P 239
Ihlemann, J. . . . . . . . . . O 285
Imai, K. . . . . . . . . . . . . . . P 020
Imran, A. . . . . . . . . . . . . P 120
Ingham, E. . . . . . . . . . . . O 188, O 189,
P 140
Ho, M.L. . . . . . . . . . . . . . P 184
Ingram, D. . . . . . . . . . . . O 208, P 089
Hoechel, S. . . . . . . . . . . P 103
Innocenti, B. . . . . . . . . . PT 01, O 072,
Hofemeier, P. . . . . . . . . O 316
Hofmann, S. . . . . . . . . . . O 176
Holderied, M. . . . . . . . . O 073
Holinka, J. . . . . . . . . . . . O 030
Holland, J. . . . . . . . . . . . P 062
Holzner, M. . . . . . . . . . . . O 217
Homaee, A. . . . . . . . . . . O 282
Homaei, E. . . . . . . . . . . . O 282
Homminga, J. . . . . . . . . O 167
O 240, O 261,
P 059, P 192,
P 226, P 234
Inoue, Y. . . . . . . . . . . . . . P 020
Insperger, T. . . . . . . . . . . O 123
Ionova, V. . . . . . . . . . . . P 138
Irvine, A. . . . . . . . . . . . . . P 209
Isaka, T. . . . . . . . . . . . . . P 098
Isaksson, H. . . . . . . . . . . O 010, P 029
Ischer, R. . . . . . . . . . . . . . O 312
P 241
Horak, Z. . . . . . . . . . . . . . P 056
Haythornthwaite, T. . . . O 087
Horbens, M. . . . . . . . . . . O 289
Heck, T. . . . . . . . . . . . . . . O 016
Horny, L. . . . . . . . . . . . . . P 150
Hedayati, R. . . . . . . . . . O 286, P 144
Horst, G. . . . . . . . . . . . . . P 191
Heesterbeek, P. . . . . . . P 122
Hose, R. . . . . . . . . . . . . . . P 153
Iwamoto, Y. . . . . . . . . . . P 130
Heilmann, A. . . . . . . . . . O 008
Hoviattalab, M. . . . . . . P 131, O 034
Izquierdo-Alvarez, A. . O 016
vi
Ismail, S.H. . . . . . . . . . . . O 069

Ito, K. . . . . . . . . . . . . . . . . O 021, O 176,
O 185, O 252,
O 303, P 263
Jung, J.H. . . . . . . . . . . . . P 007
Kengo, H. . . . . . . . . . . . . O 075
Jakob, F. . . . . . . . . . . . . . O 008, O 233
Jung, T. . . . . . . . . . . . . . . O 244
Kent, N. . . . . . . . . . . . . . . O 288
Jms, T. . . . . . . . . . . . . O 181
Jurkojc, J. . . . . . . . . . . . . P 066, P 087,
Kerkhof, F. . . . . . . . . . . . P 102
P 095, P 171
Kessler, O. . . . . . . . . . . . P 239
Jurvelin, J.S. . . . . . . . . . O 010, P 029
Kettenberger, U. . . . . . O 271
Janeczek, C. . . . . . . . . . P 161
Jansova, M. . . . . . . . . . . O 269
Janssen, D. . . . . . . . . . . O 074, P 032,
Khalaf, K. . . . . . . . . . . . . O 034, P 250

K
Khatib, O. . . . . . . . . . . . . O 178
Janssens, L. . . . . . . . . . . O 057
Kabacinski, J. . . . . . . . . P 010
Kiely, D. . . . . . . . . . . . . . . P 153
Janura, M. . . . . . . . . . . . P 125, P 181
Kadarman, A.H. . . . . . . P 050
Kiknadze, G. . . . . . . . . . P 151
Jaremko, J.L. . . . . . . . . O 223
Kaddick, C. . . . . . . . . . . P 252
Jarque-Bou, N.J. . . . . . P 100
Kaftandjian, V. . . . . . . . P 033
Jasinski, M. . . . . . . . . . . P 243
Kahelin, C. . . . . . . . . . . . P 105
Jauch, S.Y. . . . . . . . . . . P 069
Kahrizi, S. . . . . . . . . . . . . P 131
Jeffers, J.R.T. . . . . . . . . . O 127, O 128,
Kaliviotis, E. . . . . . . . . . . P 137
P 122
O 320
Jelen, K. . . . . . . . . . . . . . O 109, O 134,

P 135, P 266,
P 269
Jenkins, T. . . . . . . . . . . . . PT 04, O 040,

P 030, P 040
Kalofonos, H. . . . . . . . . . O 015
Kalozoumis, P. . . . . . . . P 154
Kaluza, G. . . . . . . . . . . . P 243
Kamal, Z. . . . . . . . . . . . . P 121
Kamm, R. . . . . . . . . . . . . O 318
Jennings, L. . . . . . . . . . . O 087, O 189
Kang, M.J. . . . . . . . . . . . P 149
Ji, B. . . . . . . . . . . . . . . . . . P 044, P 045
Kang, S. . . . . . . . . . . . . . P 129
Ji, H.S. . . . . . . . . . . . . . . . P 149
Kanis, L.A. . . . . . . . . . . . P 142
Jimnez Aguilar, E. . . . O 310
Kapinski, N. . . . . . . . . . . P 113
Jimenez Cruz, D. . . . . . O 103, P 109
Kara, D. . . . . . . . . . . . . . . P 051
Jimnez, G. . . . . . . . . . . P 268
Karabegovic, A. . . . . . P 161
Jin, X. . . . . . . . . . . . . . . . . O 282
Karatsis, E. . . . . . . . . . . . O 294
Jin, Z. . . . . . . . . . . . . . . . . O 020
Karimpour, M. . . . . . . . . O 022
Jochymczyk-Wozniak, K. . P 066
Karjalainen, J. . . . . . . . . P 029
Jockenhvel, S. . . . . . . P 221, P 241
Karl, M. . . . . . . . . . . . . . . P 049
Jolles-Haeberli, B. . . . . O 264
Karniadakis, G.M. . . . . O 218
Jomha, N. . . . . . . . . . . . P 061
Karpukhina, N. . . . . . . . O 288
Jones, A.C. . . . . . . . . . . O 020, P 111,
Karunaratne, A. . . . . . . O 007
P 117, O 138
Kat, C.J. . . . . . . . . . . . . . O 164
Kim, D.S. . . . . . . . . . . . . . P 007

Kim, J.K. . . . . . . . . . . . . . P 004, P 170
Kim, K. . . . . . . . . . . . . . . . P 253
Kim, K.M. . . . . . . . . . . . . O 113
Kim, M. . . . . . . . . . . . . . . P 208
Kim, S.B. . . . . . . . . . . . . . P 004, P 129,
P 170
Kim, Y.H. . . . . . . . . . . . . . P 253

King, L. . . . . . . . . . . . . . . P 044, P 045
Kiriazov, P. . . . . . . . . . . . P 180
Kirillova, E. . . . . . . . . . . . P 023
Kirilova-Doneva, M. . . O 131
Kito, N. . . . . . . . . . . . . . . P 130
Klein. J. . . . . . . . . . . . . . . KT 01
Klose, S. . . . . . . . . . . . . . P 239
Kneissel, M. . . . . . . . . . . O 232, P 205
Ko, C.Y. . . . . . . . . . . . . . P 004, P 129,
P 170
Kobayashi, H. . . . . . . . . P 057
Kochergin, A. . . . . . . . . O 161
Koivumki, J. . . . . . . . . O 181
Kolmeder, S. . . . . . . . . . O 285
Komeili, A. . . . . . . . . . . . O 035, P 121
Konermann, A. . . . . . . . P 227
Knig, N. . . . . . . . . . . . . . P 172
Jones, C. . . . . . . . . . . . . O 036
Katarzyna, J.W. . . . . . . P 087
Jones, G. . . . . . . . . . . . . P 140
Kathrein, S. . . . . . . . . . . . P 084
Jones, M. . . . . . . . . . . . . P 198
Katsamenis, O.L. . . . . . PT 04, P 030
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P 102
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Juana, M. . . . . . . . . . . . . P 031
O 182
Keilig, L. . . . . . . . . . . . . . O 198, O 200,

P 227
Julias, M. . . . . . . . . . . . . P 218, P 219,

P 217
Jung, H. . . . . . . . . . . . . . . O 033
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Kendall, J. . . . . . . . . . . . P 092
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P 054
Kornfeind, P. . . . . . . . . . O 068
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P 241
Kostova, V. . . . . . . . . . . P 137, P 138,

P 160
Kothe, R. . . . . . . . . . . . . . P 245
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O 121
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Lobbezoo, F. . . . . . . . . . P 093
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ix
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Oxland, T. . . . . . . . . . . . . PT 12, O 204,

P 197, P 199,
Noda, M. . . . . . . . . . . . . P 063
P 264
Nohava, J. . . . . . . . . . . . O 055
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P 170
Nolte, D. . . . . . . . . . . . . . O 043
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Novak, K. . . . . . . . . . . . . P 188
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Muraru, L. . . . . . . . . . . . . P 078
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P. del Palomar, A. . . . . O 084
Murawa, M. . . . . . . . . . . P 010
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Pacifici, N. . . . . . . . . . . . P 224
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Page, A. . . . . . . . . . . . . . O 052
Pea, E. . . . . . . . . . . . . . . O 060, O 148,

O 168, P 203
Pagiatakis, C. . . . . . . . . P 139
Pietschmann, M. . . . . . O 275
Pglov, T. . . . . . . . . . . . . P 266
Pea, J.A. . . . . . . . . . . . O 060
Pilato, M. . . . . . . . . . . . . O 098, O 149
O 307
Peake, J. . . . . . . . . . . . . P 187
Pillet, H. . . . . . . . . . . . . . . P 114
Pakdel, A. . . . . . . . . . . . P 190
Pearson, W. . . . . . . . . . . O 166
Pinto, O.T. . . . . . . . . . . . . O 142
Palacio-Torralba, J. . . O 310
Peeraer, L. . . . . . . . . . . . P 078
Pioletti, D. . . . . . . . . . . . . PT 10, O 002,
Palanca, M. . . . . . . . . . . O 193, O 194,
Peers, K. . . . . . . . . . . . . . O 262
O 120, O 133,
P 259
Peiret, A. . . . . . . . . . . . . . P 118
O 208, O 247,
Palmanovitch, E. . . . . . O 013
Peirlinck, M. . . . . . . . . . . P 164
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Pelletier, H. . . . . . . . . . . . O 284
Pandorf, T. . . . . . . . . . . . P 062
Pennati, G. . . . . . . . . . . . P 072
Pandy, M. . . . . . . . . . . . . KT 03
Peralta, L. . . . . . . . . . . . . O 136, O 265,
Pahr, D. . . . . . . . . . . . . . . O 118, O 270,
Pani, M. . . . . . . . . . . . . . . P 042
Pankaj, P. . . . . . . . . . . . . O 076, O 078,
O 079, O 119,
O 121, O 179,
O 236, P 035
Panyasantisuk, J. . . . . . O 118
Paoloni, M. . . . . . . . . . . . O 222
Papageorgis, P. . . . . . . O 311
P 229, P 268
Perez Anson, M.A. . . . P 024, P 025

Prez, M.A. . . . . . . . . . . O 301
Prez-del Palomar, A. O 296
Prez-Gonzlez, A. . . . P 009, P 086,
P 100
Perilli, E. . . . . . . . . . . . . . . O 077, O 165,

P 027
O 271, P 089
Piperi, C. . . . . . . . . . . . . . P 204
Piqueras, C. . . . . . . . . . . O 122
Pirentis, A. . . . . . . . . . . . O 311, P 233
Piroddi, S. . . . . . . . . . . . . P 123
Piszczatowski, S. . . . . . O 065, O 234,
P 071
Pithioux, M. . . . . . . . . . . O 174, P 033

Pitto, L. . . . . . . . . . . . . . . . P 123
Pivonka, P. . . . . . . . . . . . O 195, O 302,
P 094, P 096
Pleva, L. . . . . . . . . . . . . . O 272, O 306
Papavassiliou, A.G. . . P 204
Perrin, D. . . . . . . . . . . . . . O 169
Ploeg, H.L. . . . . . . . . . . . P 039, P 215
Papavassiliou, K.A. . . . P 204
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Pappalardo, O. . . . . . . O 147, P 157
Pesce, M. . . . . . . . . . . . . O 318
Polat, G. . . . . . . . . . . . . . P 051
Parente, M. . . . . . . . . . . P 014
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Polydorou, C. . . . . . . . . O 311
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Park, W.M. . . . . . . . . . . . P 253
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Parkes, M. . . . . . . . . . . . O 127, O 128
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Pfaff, A. . . . . . . . . . . . . . . O 073
Parnianpour, M. . . . . . . O 034, P 250
Pflanz, D. . . . . . . . . . . . . . O 232, P 205
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Piero Llorens, D. . . . . . O 051
O 261, P 059,
P 192
Pashazanoosi, A.A. . . P 121
Pialat, J.B. . . . . . . . . . . . O 009

Pianigiani, S. . . . . . . . . . PT 01, O 072,
O 240, O 261,
Pashkouleva, D. . . . . . . O 131
P 059, P 192,
Passini, F. . . . . . . . . . . . . O 137
P 226, P 234
O 152, O 153,
P 188
Porada, V. . . . . . . . . . . . P 167
Portnoy, S. . . . . . . . . . . . O 066
Prado, F.B. . . . . . . . . . . . O 279, O 280,
P 019, P 073
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Pudlo, P. . . . . . . . . . . . . . O 100
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Punzi, N. . . . . . . . . . . . . . P 074
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Puppini, G. . . . . . . . . . . . O 147
O 255
Piekarczyk, P. . . . . . . . . O 234
Puwanun, S. . . . . . . . . . . O 246
Pauk, J. . . . . . . . . . . . . . . O 101
Piergiovanni, M. . . . . . . O 216
Pavesi, A. . . . . . . . . . . . . O 318
Pierron, F. . . . . . . . . . . . . P 189
Pavlova, A. . . . . . . . . . . O 219, P 262
Piestrak, P. . . . . . . . . . . . O 228
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Paxton, H. . . . . . . . . . . . . O 297
Pietraszewski, B. . . . . . . O 063, O 162,
Quenneville, E. . . . . . . . O 295
Payan, C. . . . . . . . . . . . . O 174
O 228, P 179
xi
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Quixad, A.P. . . . . . . . . O 159
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Rus, G. . . . . . . . . . . . . . . . O 265, P 229,
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P 268, O 136
Raab, D. . . . . . . . . . . . . . O 157
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Rabelo, N.D.D.A. . . . . O 067
Robertson, D. . . . . . . . . O 292, P 218,

P 219
Rabin, Y. . . . . . . . . . . . . . P 091
Russo, A. . . . . . . . . . . . . . O 130
Rusu, L. . . . . . . . . . . . . . . P 174
Rutherford, M. . . . . . . . . O 319
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Rodes, C. . . . . . . . . . . . . P 267
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Ralph, M. . . . . . . . . . . . . O 176
Rodrigues, J. . . . . . . . . . O 249
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Ramos, A. . . . . . . . . . . . . O 248
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Rankin, K. . . . . . . . . . . . . O 115
Rasova, K. . . . . . . . . . . . P 008, P 088,
P 088
P 134
P 170
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Saade, A. . . . . . . . . . . . . O 100
O 308, P 080,
Saarakkala, S. . . . . . . . O 181
P 142
Sacco, I. . . . . . . . . . . . . . P 267
Rasponi, M. . . . . . . . . . . O 318, P 156,

P 156
Rastel, D. . . . . . . . . . . . . P 236
Raum, K. . . . . . . . . . . . . . O 175
Rogers, K.D. . . . . . . . . . O 042

Rohan, E. . . . . . . . . . . . . P 242
Sachenkov, O. . . . . . . . P 023, P 053,

P 054
Rohan, P.Y. . . . . . . . . . . P 236
Sader, R. . . . . . . . . . . . . . P 271
Rokita, A. . . . . . . . . . . . . O 162
Saey, T. . . . . . . . . . . . . . . P 078
O 304, P 155,
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Saffari, N. . . . . . . . . . . . . P 229
P 156, P 157
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Rehman, I.U. . . . . . . . . . O 246

Rehman, S. . . . . . . . . . . P 117
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O 255
Rossi, A.C. . . . . . . . . . . . O 280, P 019,
O 119, O 121,
P 035
Salmoria, G.V. . . . . . . . P 142
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P 073
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P 214, P 261
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xii
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P 252
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P 164
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P 114, P 231,
P 261
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P 247, P 249
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P 127, P 132,
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Souckova, M. . . . . . . . . P 081
P 200
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Speranza, S. . . . . . . . . . O 304
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P 091

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