In cardiac biomechanics, people have been developing a complete model of the patient-specific heart. A finite element bi-ventricular model involves several critical steps. First is the acquisition of patient-specific heart geometry. Second is the definition of material model and its constitutive parameters which is suitable to model the behavior of heart muscle. Third is the integration of fiber orientation of myocardium into the bi-ventricular model. The first objective of this study is to investigate some significant aspects in ventricular biomechanics using a simple model of prolate spheroidal left ventricle (LV). These critical aspects include the geometry of LV, the material model, constitutive parameters and fiber orientations. Results of this simplified model are useful in developing a patient-specific model. For example, parametric study of hyper-elastic material is instructive in determining constitutive parameters of myocardium in a patient-specific model. The second objective of this study is to develop a workflow of building a patient-specific bi-ventricular model. It involves working with experimental data like CT images, DTMRI data and so on. A user defined Fung material model is also reviewed in detail. Two methods of assigning fiber orientation are discussed. Finally, the report points out the future work needed to get a valid patient-specific model which can be useful in research and clinical case. / text

A cerebral aneurysm (CA) is an abnormal distension of the wall of an artery in the brain, which results from arterial wall weakening. CAs are poorly understood, but are believed to be the result of a combination of biological and life-style factors. The low incidence of rupture coupled with risks of interventional treatments provide motivation for identifying and treating only those aneurysms at risk of rupture. Computational models of aneurysm evolution may provide great insight into CA disease mechanisms, and guide clinical decision-making. It is well known that vascular cells sense mechanical forces exerted by bloodflow (i.e. haemodynamic forces), which are translated into a myriad of intra- and inter-cellular responses. In this thesis, hypotheses on the role of the patient-specific haemodynamic environment on the evolution of CAs is examined. Arterial geometries are obtained from images of patient-specific vasculature, and the physiological aneurysm is virtually removed and replaced by a novel, fluid-solid-growth (FSG) model. The model incorporates a constitutive model for the artery, growth and remodelling (G&R) hypotheses for arterial wall constituents, and links between G&R and the haemodynamic environment, which is simulated utilising computational fluid dynamics. It is observed that coupling G&R to the patient-specific haemodynamic environment profoundly impacts the shape and size of the evolving aneurysm geometry; in some cases, the model aneurysm is qualitatively similar to the corresponding physiological aneurysm. This provides tentative support for the hypotheses on haemodynamics-induced G&R investigated here, and motivates the need for improved understanding of arterial adaptation to physiological conditions. This will facilitate the improvement and validation of the model, and may ultimately lead to predictive models with clinical application on a patient-specific basis.

Transcatheter aortic valve implantation (TAVI) is an effective alternative treatment option for patients with severe aortic stenosis, who are at a high risk for conventional surgical aortic valve replacement or considered inoperable. Despite the short- and mid-term survival benefits of TAVI, adverse clinical events, such as paravalvular leak, aortic rupture, and coronary occlusion, have been reported extensively. Many of these adverse events can be explained from the biomechanics perspective. Therefore, an in-depth understanding of biomechanical interaction between the device and native tissue is critical to the success of TAVI. The objective of this thesis was to investigate the biomechanics involved in the TAVI procedure using patient-specific finite element (FE) simulations. Patient-specific FE models of the aortic roots were reconstructed using pre-procedural multi-slice computed tomography images. The models incorporated aged human aortic material properties with material failure criteria obtained from mechanical tests, and realistic stent expansion methods. TAV deployment and tissue-device interaction were simulated; and the simulation results were compared to the clinical observations. Additionally, parametric studies were conducted to examine the influence of the model input on TAVI simulation results and subsequently the potential clinical complications such as paravalvular leak, annular rupture, and coronary artery occlusion. The methodology presented in this thesis could be potentially utilized to develop valuable pre-procedural planning tools to evaluate device performance for TAVI and eventually improve clinical outcomes.

Computer assisted mosaic arthroplasty (CAMA) is a surgical technique that transplants cylindrical osteochondral grafts to repair damaged cartilage. An earlier in vivo study on sheep showed that short-term clinical outcomes are improved with the use of computer assistance, as compared to the conventional technique. This thesis reports on a study comparing three mosaic arthroplasty techniques -- one conventional and two computer assisted -- on human anatomy. This in vitro study used solid foam femur models modified to incorporate simulated cartilage defects. There were five participating surgeons ranging from a third year resident to a senior orthopedic surgeon. Each of the five participating surgeons performed a total of nine trials. There were three distinct sets of identical solid foam femur models with simulated cartilage defects. Three surgical techniques (conventional, opto-electronic, and patient-specific template) were performed on each. Several measures were made to compare surgical techniques: operative time; surface congruency; defect coverage; graft surface area either too high or too low; air volume below the grafts; and distance and angle of the grafts from the surgical plan. The patient-specific template and opto-electronic techniques resulted in improved surface congruency, defect surface coverage, graft surface within 0.50mm recessed and 0.25mm proud of the original surface, and below-graft air gap volume in comparison to the conventional technique. However, the conventional technique had a shorter operative time. The patient-specific template technique had less variance in surface congruency and shorter operative time than did the opto-electronic technique. / Thesis (Master, Computing) -- Queen's University, 2013-11-28 17:06:06.961

Stroke is one of the leading causes of death in the world, resulting mostly from the sudden rupture of atherosclerotic plaques. From a biomechanical view, plaque rupture can be considered as a mechanical failure caused by extremely high plaque stress. In this PhD project, we are aiming to predict 3D plaque stress based on in-vivo MRI by using fluid structure interaction (FSI) method, and provide information for plaque rupture risk assessment. Fluid structure interaction was implemented with ANSYS 11.0, followed by a parameter study on fibrous cap thickness and lipid core size with realistic carotid plaque geometry. Twenty patients with carotid plaques imaged by in-vivo MRI were provided in the project. A framework of reconstructing 3D plaque geometry from in-vivo multispectral MRI was designed. The followed reproducibility study on plaque geometry reconstruction procedure and its effect on plaque stress analysis filled the gap in the literature on imaging based plaque stress modeling. The results demonstrated that current MRI technology can provide sufficient information for plaque structure characterization; however stress analysis result is highly affected by MRI resolution and quality. The application of FSI stress analysis to 4 patients with different plaque burdens has showed that the whole procedure from plaque geometry reconstruction to FSI stress analysis was applicable. In the study, plaque geometries from three patients with recent transient ischemic attack were reconstructed by repairing ruptured fibrous cap. The well correlated relationship between local stress concentrations and plaque rupture sites indicated that extremely high plaque stress could be a factor responsible for plaque rupture. Based on the 20 reconstructed carotid plaques from two groups (symptomatic and asymptomatic), fully coupled fluid structure interaction was performed. It was found that there is a significant difference between symptomatic and asymptomatic patients in plaque stress levels, indicating plaque stress could be used as one of the factors for plaque vulnerability assessment. A corresponding plaque morphological feature study showed that plaque stress is significantly affected by fibrous cap thickness, lipid core size and fibrous cap surface irregularities (curvedness). A procedure was proposed for predicting plaque stress by using fibrous cap thickness and curvedness, which requires much less computational time, and has the potential for clinical routine application. The effects of residual stress on plaque stress analysis and arterial wall material property characterization by using in-vivo MRI data were also discussed for patient specific modeling. As the further development, histological study of plaque sample has been combined with conventional plaque stress analysis by assigning material properties to each computational element, based on the data from histological analysis. This method could bridge the gap between biochemistry and biomechanical study of atherosclerosis plaques. In conclusion, extreme stress distributions in the plaque region can be predicted by modern numerical methods, and used for plaque rupture risk assessment, which will be helpful in clinical practice. The combination of plaque MR imaging analysis, computational modelling, and clinical study/ validation would advance our understandings of plaque rupture, prediction of future rupture, and establish new procedures for patient diagnose, management, and treatment.

Brachytherapy is an important method of breast cancer treatment; however, improvements in both treatment planning and delivery are needed. The procedure involves insertion of catheters in the tumor site, which, in current practice, is prone to clinically significant error. In order to improve on contemporary catheter placement accuracy, integration of pre-operative imaging, supplemented by computerized surgical planning and mathematical optimization were used to develop and test an intra-operative immobilization and catheter guidance system. A custom-template specific to each patient with optimally-placed guide-holes for catheter insertion was designed and fabricated for use on phantom studies. Template creation is based on a virtual reality reconstruction of the patient's anatomy from computed tomography imaging. The template fits on the patient's breast, immobilizing the soft tissue, to provide pre-planned catheter insertion holes for guidance to the tumor site. Agar-based phantom and target models were used for quantitative validation of the template using computed tomography imaging for template planning and validation. Planned catheter tracks were compared to post-insertion image data and distance measurements from target location were used to create an error measure. Using the latest template design spanning multiple experiments resulted in a mean of 2.6 mm, 95%, CI =3.1-2.2, which is within the clinically acceptable range of 3 mm, as validated with our clinical collaborators. Validation of the brachytherapy template on phantom tissue produced clinically acceptable results. Use of a patient-specific template for breast brachytherapy is feasible and may improve the procedure accuracy and outcome. This work has been a proof-of-concept, providing evidence to support moving forward with the next phase of patient-specific breast template trials for use in brachytherapy. / Thesis (Master, Computing) -- Queen's University, 2011-10-03 15:17:07.933

Knee joint kinematics is the result of a complex roto-translation movementcharacteristic of the tibio-femoral (TF) and patello-femoral (PF) articulations.This movement depends on the shape of the femur, the tibial plateau andthe patella. Moreover, it depends also on the morphological and mechanicalproperties of the soft tissues of the knee joint. In fact, the knee is characterizedby an extrinsic stability due to the active constraints (muscles and tendons)and passive soft tissues (menisci, retinaculum and ligaments) that surround it.As a result, knee kinematics and kinetics are different in each human being, andsometimes, even in the same person, with the right knee behaving differentlycompared to the left one.The ideal total knee arthroplasty TKA, used to correct pathologies that couldaffect the knee joint, should enable the restoration of the patient’s functionalknee kinematics and kinetics, so that the patient does not normally notice theTKA implant.Nowadays, TKA surgery is a well-established procedure and surgeons maychoose from among the broad range of TKA solutions available on the marketto meet the patient’s request. Prostheses may differ because of shape, materials,and mechanical constraints of their components. Consequently, the restorationof the knee joint biomechanics is limited by the degrees of freedom guaranteedby the adopted design solution.Despite the success of TKAs, pain and limited motor skills are reportedto still affect the clinical outcomes and not all patients are shown to be happyafter a TKA.Current complaints regarding post-TKA surgery might be related to the absenceof a proven tool that enables predicting patient-specific outcomes based ondifferent TKA solutions and providing guidelines to surgeons. In fact, surgicalpre-planning is usually based on a patient’s evaluation that the clinician canmake also based on medical images, and clinical experience. Data reported inthe literature can help in guiding the surgeon to a final decision regarding thebest subject-specific solution.Numerical methods, able to simulate knee biomechanics for various configurations,can be fundamental for the development of the appropriate reliableand effective tools to support clinically-tailored responses to a question.In particular, they can be used for subject-specific analyses on the intact kneeand for supporting the surgical pre-planning phase by comparing the effect ofdifferent solutions.When developing a subject-specific knee model, different kinds of datainputsare needed, such as the knee shapes and alignment information, softtissuesbehavior and boundary conditions describing the investigated motortasks. Often, most of this requested data are unlikely to be available (e.g.subject-specific soft-tissues material properties). Consequently, it is a commonoperating procedure to integrate literature data with subject-specific informationin order to develop knee models for collecting personalized outputsthat could be used to address research and clinical questions.However, up to now, the resulting effect of different generalized sources, asa mix of subject-specific and literature data, still needs to be evaluated for itsimpact on personalized outputs concerning knee behaviour.Furthermore, clinical questions are often focused on specific requests thatpartially use features of more complex knee models that could require too muchtime to be efficiently incorporated into daily clinical evaluations.For these reasons, the principal aims of this research have been to assess,first, the impact of differently derived generalized sources on the developmentof an intact subject-specific knee model or after a TKA; second,to provide guidelines to identify efficient clinically-tailored data sourcesused in and for knee modeling.To accomplish these tasks, a numerical knee model of an intact knee wasdeveloped based on both subject-specific and literature data sources. Theinfluence of different approaches to deal with a subject’s information, such asthe reconstruction of the knee geometries from different imaging sources, hasiiibeen evaluated. Moreover, a sensitivity analysis was performed to understandthe potential changes on kinetics and kinematics outcomes due to differentlyderived literature inputs, such as models and the properties that characterizethe joint materials and ligaments description. The outputs collected after finiteelement analyses were analyzed and compared with already published experimentaloutcomes for the same analyzed specimen and replicated boundaryconditions.Additionally, the effects on knee joint contact forces and kinematics afterTKA surgery and due to the mis-alignment of implant components or misidentificationsof ligament insertions were evaluated in another sensitivityanalysis performed with a rigid body analysis for four different TKA designsimplanted in a subject-specific knee model. As for the intact knee model, theanalyzed configurations were compared against already published experimentaloutputs or literature data replicating similar boundary conditions.Moreover, several dedicated knee models were developed to address specificclinical questions, such as the lack of biomechanical explanations for certainbehaviours of TKA designs.Once compared to already published experimental or literature data, the resultsof the developed models agree.The main results from the numerical simulations performed show that, changingthe values of some of the parameters used as inputs, the knee model kinematicsis less influenced than the contact forces and stresses outputs.In particular, in developing an intact knee model, the main effecting parameteris the material properties selection for the knee cartilage layers. Among theconfigurations analyzed using subject-specific knee models with TKAs, theposition of the tibial component and the height of the patellar buttonare the most effecting inputs.Exploring the different chapters of this research thesis, several specific resultsare shown regarding each main step followed in developing a knee numericalmodel. For example, new approaches based on MRIs have been suggested andtested proving that they are suitable for collecting subject-specific informationregarding geometrical shapes and landmark definitions. Moreover, a newgraphical method was proposed resulting more effective and immediate thanconventional representations in reporting huge amount of data. In particular,the method is the favourite to show complex biomechanical analyses especiallyfor the clinical audience that replied to a survey. Furthermore, the differentmodels tailored to address specific clinical questions collected useful biomechanicalresults, to provide clinical advice or industrial guidelines, and can beconsidered as examples of what should be included in a knee model for similarscenarios.The results of this thesis offer several contributions. Generally, these findingscould provide useful guidelines for knee-model developers to achievea more balanced approach to subject-specific intact knee models based upongeneral sources in order to improve the understanding of personalized kneebiomechanics.To address a general comment to the title of this thesis, there is no singleanswer. In fact, the selection of data sources is case-dependent using, forexample, the subject’s or literature available data to describe material’s behavioror the boundary conditions of a specific motor task. Moreover, differentclinical questions can be addressed with different numerical approaches, e.g.finite element analysis is necessary especially in the case that stress outputs arerequested, but can be too time-consuming for addressing complex sensitivityanalyses.Once the knee model developer has identified the necessary data sources andthe approaches to be implemented, the question-tailored knee models can thusbe used for several applications such as predicting subject-specific abnormalknee kinematics and kinetics for different TKA designs, polyethylene wear,patellofemoral dislocation and bone remodeling, choosing the best fitting TKAdesign for a specific patient, and developing a procedure to optimize TKAimplant designs. / Doctorat en Sciences de l'ingénieur et technologie / info:eu-repo/semantics/nonPublished

No description available.

La réhabilitation des fonctions physiologiques dentaires à l’aide de restaurations céramiques collées est l’un des enjeux majeurs de la dentisterie conservatrice. S’il est maintenant bien établi que la jonction céramique/composite revêt une importance capitale pour la durabilité de l’assemblage, les observations par le biais d’un scanner X-µCT nous ont permis de mettre en évidence plusieurs types de défauts (décollement, bulles d’air) dont l’analyse mécanique révèle leur influence néfaste pour la tenue de la restauration. Les travaux réalisés portent également sur l’influence des paramètres de conception de la prothèse sur la résistance mécanique de l’assemblage prothétique dentaire. Ces études préliminaires ont été réalisées sur une modélisation EF 2D simplifiée permettant de s’affranchir de la variabilité morphologique des géométries réelles. Les résultats montrent notamment l’influence significative du dimensionnement de l’intrados prothétique, laissé libre de paramétrage dans le cadre des procédés CFAO employés en dentisterie. Une étude mécanique 3D étendant la modélisation jusqu’au ligament parodontal a ensuite été réalisée afin d’approcher le problème de manière plus réaliste. Les résultats obtenus mettent notamment en évidence des zones fortement sollicitées au niveau de la ligne cervicale de la prothèse, en coïncidence avec un mode de rupture clinique fréquent. Cette modélisation 3D a également fait l’objet d’une étude complémentaire permettant de justifier l’emploi des données géométriques présentes au sein des procédés CFAO modernes dans le cadre d’une optimisation mécanique de forme. Une méthode de rétroconception basées sur l’interpolation de surfaces B-Splines et utilisant les données scannées lors de l’opération médicale est finalement proposée afin d’intégrer un calcul mécanique « patient specific » dans la chaîne numérique des procédés CFAO. / The rehabilitation of dental function following the fitting of prostheses obtained by cemented ceramic restorations is one of the major challenges of restorative dentistry. It is now well established that the ceramic/composite interface has an important significance for the longevity of the restoration and its observation using X-ray µ-CT enabled us to characterize some types of defects within the cement layer (air voids and debonding). The mechanical analysis of the restored tooth considering those defects exhibits their negative influence on the strength of the assembly. The influence of design parameters has also been studied considering a simplified 2D axisymmetric FE model in order to avoid the morphological diversity of real geometries. Results show that the design of the inner shape of the crown (editable within the CAD/CAM process) is mechanically relevant. A 3D finite element study extending to the periodontal ligament has then been realized in order to approach this problem in a more realistic perspective. Results show high stresses near from the cervical margin of the crown, coinciding with a common clinical failure mode. This 3D model was also used in a additional study allowing us to conclude that the geometrical data used in modern CAD/CAM processes are sufficient to develop a mechanical optimization of the restoration design. A reverse engineering method based on the interpolation of B-Spline surfaces on scanned data acquired during clinic procedures is therefore introduced in order to integrate a patient specific mechanical optimization within the digital chain of CAD/CAM processes.

Thesis (PhD (Mechanical and Mechatronic Engineering))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: A methodology to facilitate analysis of dynamic subject-specific patellofemoral function is presented. An enhanced understanding of patellofemoral biomechanics will enable orthopaedic surgeons to identify the mechanisms responsible for imbalances in the joint stabilisers, while also providing objective information on which to base treatment methods. Dynamic patellofemoral function of three volunteers was simulated with a musculoskeletal computational model. The individuals underwent scans from which three-dimensional models of their patellofemoral joints were constructed. Skeletal muscles and soft tissue stabilisers were added to the skeletal models, after which subject-specific motion was simulated. After trochlear engagement, the patellae of the volunteers followed a lateral path, whereas patella tilt was subject-specific. Comparison of the predicted tilt and mediolateral position values at 30 degrees knee flexion to in-vivo MRI values showed a mean accuracy of 62.1 % and 96.9 % respectively. The patellofemoral contact load . quadriceps tendon load ratio varied between 0.7 and 1.3, whereas the mediolateral load component . resultant load ratio ranged between 0 and 0.4. Both parameters. values were similar to previous findings. The medial patellofemoral ligament tension decreased with knee flexion, while the patellar tendon-quadriceps tendon ratio followed a similar trend to that of previous findings (varied between 0.4 and 1.2). After induction of a tubercle osteotomy in the coronal plane, Volunteer One.s patella engaged the trochlear groove at an earlier knee flexion angle, while the patella of Volunteer Two only underwent a small medial displacement. Finite element analyses were employed to investigate the influence of the osteotomy on the patellofemoral pressure distribution. The mean pressure in Volunteer One.s patellofemoral joint was alleviated (17 % smaller) at all angles of flexion with the exception of 60 degrees (12 % greater). Pressure in Volunteer Two.s joint was alleviated at 30 and 45 degrees knee flexion (6 % smaller), while it was elevated (9.1 % greater) at other angles of flexion. Two commercial patellofemoral prostheses were tested on the three Volunteers. joints in the virtual environment. Prosthesis Two delivered patella shift and tilt patterns similar to the baseline values. Patellar tendon tension was slightly greater after resurfacing, with the tensions elevated most with Prosthesis Two. Medial patellofemoral ligament tension was reduced most with Prosthesis Two, while lateral retinaculum tension was increased slightly. Prosthesis Two was the best candidate to reproduce patella kinematics, while the patellofemoral kinetics was largely independent from the type of prosthesis used. The prostheses performed worse for Volunteer Three, supporting the need for the development of patient-specific prostheses. Three validated subject-specific musculoskeletal models facilitated the analysis of the individuals. patellofemoral biomechanics. The technique can potentially be employed by orthopaedic surgeons to visualise the change that an osteotomy or patellofemoral arthroplasty might induce on an individual.s patellofemoral joint. This technique might aid in the development of a tool to assist biomedical engineers in the development of new patellofemoral prostheses. Most importantly, the outcome of surgical intervention may be predicted beforehand, and a treatment procedure may be tailored to optimally fit the patellofemoral biomechanics of that individual. / AFRIKAANSE OPSOMMING: 'n Ondersoekmetode van die dinamiese gedrag van pasiënt-spesifieke patellofemorale gewrigte word beskryf. Indien die patellofemorale biomeganika beter verstaan word, kan ortopediese chirurge die meganismes wat verantwoordelik is vir oneffektiewe stabiliseerders identifiseer en behandeling op objektiewe bevindinge baseer. Die dinamiese patellofemorale funksie van drie vrywilligers is gesimuleer m.b.v. `n spier-skelet rekenaarmodel. Drie-dimensionele modelle van die individue se patellofemorale gewrig is gekonstrueer m.b.v. skanderings. Die skeletspiere en sagte ondersteuningsweefsel is tot die model toegevoeg, voordat vrywilliger-spesifieke beweging gesimuleer is. Die knieskywe van die vrywilligers het `n laterale pad gevolg nadat dit die groef binnegetree het, met die tiltwaardes uniek vir elke vrywilliger. Vergelyking van die beraamde knieskyf mediolaterale tilt en posisies by 30 grade fleksie met in-vivo magnetiese resonansieskandering waardes het `n akkuraatheid van 62.1 % en 96.9 % respektiewelik getoon. Die patellofemorale kontaklas-kwadriseps seningspanning verhouding het gewissel tussen 0.7 en 1.3; asook die mediale komponent – resultante komponent patellofemorale kontaklas wat gewissel het tussen 0 en 0.4. Beide parameters se waardes was soortgelyk aan voorheen-gepubliseerde data. Die mediale patellofemorale ligamentspanning het afgeneem met fleksie. Die patella sening-kwadriseps seningspanning verhouding was soortgelyk aan vorige gepubliseerde waardes en het gewissel tussen 0.4 en 1.2. Nadat 'n tuberkel-osteotomie in die koronale vlak aangebring is, het Vrywilliger Een se patella die femorale groef vroeër binnegetree. Vrywilliger Twee se patella het slegs `n mediale verskuiwing ondergaan. Eindige element analises is ingespan om die effek van die osteotomie op die spanningsverspreiding in die patellofemorale gewrig te ondersoek. Die gemiddelde spanning in Vrywilliger Een se gewrig was minder by alle hoeke van fleksie (17 % minder), met uitsondering van die spanning by 60 grade (12 % meer). Die spanning in Vrywilliger Twee se gewrig was minder by 30 en 45 grade (6 % minder), maar hoër by ander hoeke (9.1 % meer). Twee kommersiële patellofemorale prosteses is getoets op die drie Vrywilligers d.m.v. die model. Prostese Twee het die knieskyf-kinematika die beste nageboots. Die patella-seningspanning was effens groter na die vervanging. Prostese Twee het gesorg vir die grootste toename. Die mediale patellofemorale ligamentspanning was die kleinste toe Prostese Twee gebruik is, maar dit het gesorg vir effense hoër laterale retinakulumlaste. Die analises het getoon dat Prostese Twee die beste kandidaat is om die korrekte kinematika te herbewerkstellig. Die kinetika daarteenoor was onafhanklik van die tipe prostese wat gebruik is. Geeneen van die twee prosteses was geskik vir Vrywilliger Drie nie, wat as motivering vir die ontwikkeling van pasiënt-spesifieke prosteses dien. Drie bekragtigde vrywilliger-spesifieke spier-skelet modelle het die analise van patellofemorale biomeganika bewerkstellig. Die tegniek het die potensiaal om ortopediste in staat te stel om die effek van `n osteotomie of patellofemorale vervanging te visualiseer. Die tegniek kan verder gebruik word deur biomediese ingenieurs in die vervaardiging van nuwe patellofemorale prosteses. Meer belangrik is die feit dat die resultaat van chirurgiese ingryping voorspel kan word en optimale behandelingsprosedures beplan kan word vir die patellofemorale biomeganika van `n individu.