Separating the study of kinematic geometry of the human knee from the study of its behaviour under load provides insight into the complex relationship between form and function at the joint. The development of a three-dimensional mathematical model which examines the mobility and stability of the joint in sequence is described in this thesis. A previously proposed model of knee mobility, in which the ligaments and ar- ticular surfaces act as rigid constraints between the bones in a single degree-of- freedom spatial mechanism, was re-examined and its limitations addressed. A new geometric-numerical approach to solving the model kinematics, capable of handling both idealised and more anatomical representations of the articular surfaces, was developed. A database of specimen-specific motion and geometry was established, based on cadaver studies. Articular contact kinematics and ligament length patterns were also quantified. In experiment, all components of passive knee movement were found to be coupled to the flexion angle, providing justification for the underlying concept of the model of knee mobility. Specimen-specific models of mobility were successful in predicting the main fea- tures of passive knee motion through a full range of flexion. Incorporation of second order tibial articular surfaces permitted the prediction of physiological motion com- patible with more realistic contact point movement. Through incorporation of continuous three-dimensional arrays of extensible lig- ament fibres, a preliminary model of knee stability was formulated. Although in need of further refinement, sample predictions of joint behaviour during a/p drawer and axial rotation have demonstrated the potential of the model in highlighting the subtleties of ligament mechanics. It was concluded that the sequential approach is appropriate for the study of joint behaviour in three dimensions and that, based on the success of the analogous two-dimensional theory, it provides an invaluable tool in the study of joint mechanics in activity and in the design and assessment of surgical procedures for treating knee injury and disease.

Passive knee motion is guided by the interaction of the articular surfaces and the restraining role of the soft-tissue structures. It is defined by characteristic kinematics within an envelope of motion. The main goal of this thesis was to simulate this characteristic motion by developing a subject-specific anatomically based finite element model. CT and MR image stacks were used to develop the geometry model and experimental (mechanical) test data was used as model input. Passive knee flexion was simulated and translational and rotational motion described using the Joint Coordinate System (JCS). The model was validated using clinical flexion and AP drawer tests. An ACL reconstruction model was also developed. Highest AP laxity was found at 30?? of flexion when the graft was positioned in the original native ACL insertion point. ACL tunnel positions were simulated according to surgical techniques. For this case, the highest AP laxity was displayed at 0?? of flexion. Four different graft materials were examined, with the quadriceps tendon graft exhibiting highest laxity, followed by the patellar tendon, braided hamstring and finally unbraided hamstring graft. The effect of malpositioning the graft's femoral attachment point from its central location was also investigated. The proximal femoral attachment point most closely mimicked the central attachment point in terms of AP laxity in the native ACL insertion group. In the ACL tunnel group, the posterior femoral attachment point most closely mimicked the intact knee. In this thesis it was found that changing the femoral insertion point of the graft can highly influence the AP laxity behaviour. Also using the surgical technique to create ACL tunnels may not necessarily produce the same kinematic behaviour as the intact knee. Lastly, this thesis has shown the importance of explicitly defining the local reference coordinate system when describing knee kinematics. Changing the coordinate system markedly alters the calculated kinematics. Ideally, a standardisation of local coordinate systems, similar to the JCS, would be proposed within the biomechanics community.

Access to abstract permanently restricted to Ball State community only. / Access to thesis permanently restricted to Ball State community only. / School of Physical Education, Sport, and Exercise Science

Passive knee motion is guided by the interaction of the articular surfaces and the restraining role of the soft-tissue structures. It is defined by characteristic kinematics within an envelope of motion. The main goal of this thesis was to simulate this characteristic motion by developing a subject-specific anatomically based finite element model. CT and MR image stacks were used to develop the geometry model and experimental (mechanical) test data was used as model input. Passive knee flexion was simulated and translational and rotational motion described using the Joint Coordinate System (JCS). The model was validated using clinical flexion and AP drawer tests. An ACL reconstruction model was also developed. Highest AP laxity was found at 30?? of flexion when the graft was positioned in the original native ACL insertion point. ACL tunnel positions were simulated according to surgical techniques. For this case, the highest AP laxity was displayed at 0?? of flexion. Four different graft materials were examined, with the quadriceps tendon graft exhibiting highest laxity, followed by the patellar tendon, braided hamstring and finally unbraided hamstring graft. The effect of malpositioning the graft's femoral attachment point from its central location was also investigated. The proximal femoral attachment point most closely mimicked the central attachment point in terms of AP laxity in the native ACL insertion group. In the ACL tunnel group, the posterior femoral attachment point most closely mimicked the intact knee. In this thesis it was found that changing the femoral insertion point of the graft can highly influence the AP laxity behaviour. Also using the surgical technique to create ACL tunnels may not necessarily produce the same kinematic behaviour as the intact knee. Lastly, this thesis has shown the importance of explicitly defining the local reference coordinate system when describing knee kinematics. Changing the coordinate system markedly alters the calculated kinematics. Ideally, a standardisation of local coordinate systems, similar to the JCS, would be proposed within the biomechanics community.

published_or_final_version / Medical Sciences / Master / Master of Medical Sciences

Access to abstract permanently restricted to Ball State community only. / Access to thesis permanently restricted to Ball State community only. / School of Physical Education, Sport, and Exercise Science

The purpose of this study was to examine the relationship between leg dominance and knee mechanics to provide further information about the etiology of ACL injury. Sixteen healthy females between the ages of 18 and 22 who were NCAA Division I varsity soccer players participated in this study. Subjects were instructed to perform a cutting maneuver; where they sprinted full speed and then performed an evasive maneuver (planting on one leg and pushing off to the other leg in a new direction) at a 45° angle with their dominate leg (DL) and non-dominate leg (NDL). Subjects were required to perform five successful cuts on each side given in a random order. Bilateral kinematic and kinetic data were collected during the cutting trials. After the cutting trials, subjects performed bilateral isometric and isokinetic testing using a Cybex Norm dynamometer at a speed of 60°/sec to evaluate knee muscle strength. During the braking phase the NDL showed greater (P=0.003) power absorption, greater (P=0.01) peak internal rotation angle and greater (P=0.005) peak flexion velocity. During the propulsive phase the DL showed greater (P=0.01) power production, greater (P=0.038) peak internal adductor moment and greater (P=0.02) peak extension velocity. In addition, no differences (P>0.05) in knee extensor and flexor isometric and isokinetic torques between the two limbs were shown. The results of this study show that a difference in knee mechanics during cutting does exist between the DL and NDL. The findings of this study will increase the knowledge base of ACL injury in females and aid in the design of more appropriate neuromuscular, plyometric and strength training protocols for injury prevention. / School of Physical Education, Sport, and Exercise Science

Doctor of Philosophy / The aim of the work presented in this thesis was to examine the associations between the kinematics of the knee characterised by the tibiofemoral contact pattern, and degenerative change, in the context of anterior cruciate ligament (ACL) injury. While the natural history of degenerative change following knee injury is well understood, the role of kinematics in these changes is unclear. Kinematics of the knee has been described in a variety of ways, most commonly by describing motion according to the six degrees of freedom of the knee. The advantage of mapping the tibiofemoral contact pattern is that it describes events at the articular surface, important to degenerative change. It was hypothesised that the tibiofemoral contact pattern would be affected by injury to the knee. A model of ACL injury was chosen because the kinematics of the knee have been shown to be affected by ACL injury, and because the majority of chronic ACL-deficient knees develop osteoarthritis, the associations between kinematics and degenerative change could be explored. A technique of tibiofemoral contact pattern mapping was established using MRI, as a quantifiable measure of knee kinematics. The tibiofemoral contact pattern was recorded from 0º to 90º knee flexion while subjects performed a leg-press against a 150N load, using sagittal magnetic resonance imaging (MRI) scans. The technique was tested and found to be reliable, allowing a description of the tibiofemoral contact pattern in 12 healthy subjects. The tibiofemoral contact patterns of knee pathology were then examined in a series of studies of subjects at a variety of stages of chronicity of ligament injury and osteoarthritis. Twenty subjects with recent ACL injury, 23 subjects with chronic ACL deficiency of at least 10 years standing, and 14 subjects with established osteoarthritis of the knee were recruited. The 20 subjects with recent ACL injury were examined again at 12 weeks and 2 years following knee reconstruction. The tibiofemoral contact patterns were examined for each group of subjects and the associations between changes in the contact patterns and evidence of joint damage explored. Evidence of joint damage and severity of osteoarthritis were recorded from xrays, diagnostic MRI, operation reports and bone densitometry at the tibial and femoral condyles of the knee. Each of the three groups with knee pathology exhibited different characteristics in the tibiofemoral contact pattern, and these differences were associated with severity of joint damage and osteoarthritis. The recently ACL-injured knees demonstrated a tibiofemoral contact pattern that was posterior on the tibial plateau, particularly in the lateral compartment. Those with chronic ACL deficiency demonstrated differences in the contact pattern in the medial compartment, associated with severity of damage to the knee joint. Osteoarthritic knees showed reduced femoral roll back and longitudinal rotation that normally occur during knee flexion. Two years following knee reconstruction there was no difference between the contact pattern of the reconstructed and healthy contralateral knees. This technique of tibiofemoral contact pattern mapping is sensitive to the abnormal characteristics of kinematics in ligament injury and osteoarthritis. This is the first time the tibiofemoral contact characteristics of chronic ACL-deficient and osteoarthritis knees have been described and links examined between tibiofemoral contact patterns and degenerative change.

Doctor of Philosophy / The aim of the work presented in this thesis was to examine the associations between the kinematics of the knee characterised by the tibiofemoral contact pattern, and degenerative change, in the context of anterior cruciate ligament (ACL) injury. While the natural history of degenerative change following knee injury is well understood, the role of kinematics in these changes is unclear. Kinematics of the knee has been described in a variety of ways, most commonly by describing motion according to the six degrees of freedom of the knee. The advantage of mapping the tibiofemoral contact pattern is that it describes events at the articular surface, important to degenerative change. It was hypothesised that the tibiofemoral contact pattern would be affected by injury to the knee. A model of ACL injury was chosen because the kinematics of the knee have been shown to be affected by ACL injury, and because the majority of chronic ACL-deficient knees develop osteoarthritis, the associations between kinematics and degenerative change could be explored. A technique of tibiofemoral contact pattern mapping was established using MRI, as a quantifiable measure of knee kinematics. The tibiofemoral contact pattern was recorded from 0º to 90º knee flexion while subjects performed a leg-press against a 150N load, using sagittal magnetic resonance imaging (MRI) scans. The technique was tested and found to be reliable, allowing a description of the tibiofemoral contact pattern in 12 healthy subjects. The tibiofemoral contact patterns of knee pathology were then examined in a series of studies of subjects at a variety of stages of chronicity of ligament injury and osteoarthritis. Twenty subjects with recent ACL injury, 23 subjects with chronic ACL deficiency of at least 10 years standing, and 14 subjects with established osteoarthritis of the knee were recruited. The 20 subjects with recent ACL injury were examined again at 12 weeks and 2 years following knee reconstruction. The tibiofemoral contact patterns were examined for each group of subjects and the associations between changes in the contact patterns and evidence of joint damage explored. Evidence of joint damage and severity of osteoarthritis were recorded from xrays, diagnostic MRI, operation reports and bone densitometry at the tibial and femoral condyles of the knee. Each of the three groups with knee pathology exhibited different characteristics in the tibiofemoral contact pattern, and these differences were associated with severity of joint damage and osteoarthritis. The recently ACL-injured knees demonstrated a tibiofemoral contact pattern that was posterior on the tibial plateau, particularly in the lateral compartment. Those with chronic ACL deficiency demonstrated differences in the contact pattern in the medial compartment, associated with severity of damage to the knee joint. Osteoarthritic knees showed reduced femoral roll back and longitudinal rotation that normally occur during knee flexion. Two years following knee reconstruction there was no difference between the contact pattern of the reconstructed and healthy contralateral knees. This technique of tibiofemoral contact pattern mapping is sensitive to the abnormal characteristics of kinematics in ligament injury and osteoarthritis. This is the first time the tibiofemoral contact characteristics of chronic ACL-deficient and osteoarthritis knees have been described and links examined between tibiofemoral contact patterns and degenerative change.

Ground reaction force (GRF) data collected and synchronized with film data to determine peak GRF and calculate moments about ankle and knee during rope skipping. Two, five minute conditions were analyzed for 10 subjects. Condition 1 was set rate and style. Condition 2 was subjects' own rate and style. Means and standard deviations were reported for peak GRF, ankle and knee moments. One way ANOVAs reported no significant difference between conditions for variables measured. Efficiency and nature of well phased impacts during rope skipping may be determined by combination of GRF, similarities in magnitude and direction of joint moments, and sequencing of segmental movements. Technique and even distribution of force across articulations appear more important than magnitudes of force produced by given styles.