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Trends and Challenges

in Modeling and Simulation:
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October 14,2010 2:00-3:00 p.m. ET
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Modeling and simulation
have been core methods in
modern engineering for
decades. The basic question
of whether the tools and
techniques of today are
sufficient to meet emerging
design challenges has
engaged the global
engineering community in
many segments. This webinar offers insights into the key
challenges facing modern engineering, and some of the
activities that address these challenges.

What makes modern engineering so different

from traditional practice?
How do we manage system complexity?
What are the leading edge initiatives?

The speakers represent two distinct perspectives. Dr. Butts is

an accomplished engineer from the automotive industry and
academic research sector. He will discuss some of the key
developments from this important industry. Dr. Lee is a veteran
of the engineering computing industry and he will offer his
observations on the unique computational trends and the
core technologies that will make a difference for the modern
engineering community in the years to come.

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of healing
A lab studies knees
and machines to help
ligament-graft patients
get back on their feet.

By Daniel Wiznia

e've all heard of athletes tearing their anterior cruciate ligament, which is
one of the ligaments connecting the tibia to the femur. The tear is usually caused by a bad maneuver, such as when an athlete comes to a quick
stop by landing on a leg and rotating the knee. For an active individual, the
injury can be hard to live with . Besides the pain and swelling it causes, the
rupture can make the knee unstable.
As many as 200,000 people a year in the United States undergo surgery to repair a torn ACL, in
Daniel Wiznia. a mechanica l engineer. is a m edical student at Weill Cornell Medical College and assists with re search in
th e Ti ssue Engineering. Regeneration. and Repair Program of th e Hospital for Special Surgery in New York.

which the native ligament is replaced with

a graft, often using part of a tendon from
somewhere else in the patient's body. While
the reconstruction techniques have been well
anterior
established over the past 20 years, not much
has been established regarding the rehabilitative steps a patient should take after surgery.
Experts disagree on when a patient should
begin to walk after surgery or the exercises
that should be included in a physical therapy
regimen. This confusion leads to varied
long-term outcomes.
At the Hospital for Special Surgery in New
fibula
York, we are investigating the biological
mechanisms ofhow tendon heals to bone, in
order to ultimately influence rehabilitative
protocols. Our lab, directed by Scott Rodeo and part
of the hospital's Tissue Engineering, Regeneration, and
Repair Program, has been focusing on how mechanical loads placed on tendons affect the healing process by
initiating biological signals.
Our current model involves studying rodents that
have undergone ACL reconstruction to examine the
effect of mechanical loading on tendon biology. By
observing the results of different therapies on the
rodents, we will develop empirical evidence that will
lead to future protocols for therapy-in short, to have
people heal and return to their normal lives again as

screw to
hold graft
in place
in tibial
tunnel

soon as possible. Our research on rodents will identify

the most promising regimens to try farther up the
food chain.
After an ACL reconstruction has been conducted on
the rodent, we will use a custom-designed computercontrolled system to apply an axial load to the tendonto-bone repair site. We will then examine the healing
process through a variety of mechanical and biological
methodologies.
One therapy that has demonstrated some success in
patients recovering from ACL surgery has been continuous passive motion (CPM). In this therapy, a patient's
leg is placed in a device called a CPM
machine that guides the knee joint
FOUR FORCES USED TO DESCRIBE LOADS APPLIED TO THE KNEE JOINT
slowly through a controlled range of
Compressive and distractive forces
Posterior and anterior forces
motion, a period of flexion to extension (about 90 degrees of motion) that
Compressive
takes about 45 seconds to complete.
force
Distractive
The
therapy is described as passive
fme
because the CPM machine applies
forces to the leg that effect a slow
1
rate of motion, whereas the muscles
remain in a relaxed state and do not
apply significant forces.
Posterior
force
As the knee passes through its range
of motion from flexion to extension,
the new ACL tendon graft experiences
varied tensile loads. While the CPM
Compressive
machine is regularly used in total knee
force
replacement and hip replacement to
increase a patient's range of motion
following surgery, protocols have yet
Posterior
to be refined for post-ACL reconstrucforce
tion therapy. As the role of motion
on healing of the ACL reconstruction
is unknown, we are investigating the

lI t

Ill_

II

L~teriore

October 2010

I mechanical engineering

23

mechanical loads that are felt by the graft as the knee

bends, as well as how these loads affect healing.
Our laboratory decided to build a miniature CPM
machine that we could use with a rodent ACL patient.
There are many designs available, however, and so we
had to identify which one seemed best for the specific
needs of therapy after an ACL graft.
The team working on this project consists of two
orthopedic surgeons, Xiang-Hua Deng and Scott
Rodeo, and me, a medical student and mechanical
engineer. We also had help from mechanical engineer
Carl Imhauser, and two research mechanical engineers, Dan Choi and Mark Stasiak. We decided to use
a four-step process for choosing a design as the basis for
our research. First, we created design criteria for a CPM
machine that would satisfy our research requirements.
Second, we assembled a list of existing CPM designs.
Third, we built m athematical models for each design to
determine which best fulfilled our criteria. Fourth, we
then generated a design of our top candidate in Solidworks, and built a mockup of the device which we are
now currently testing.
To describe loads applied to the knee joint, there are
traditionally four force vectors oriented in relation to
the tibia-compressive/ distractive, anterior/ posterior,
medial/lateral, and internal/external rotation. It is
important to note that approximately 85 percent of the
anterior forces applied to the knee are transmitted to
the ACL graft.
Therefore, our design criteria for the CPM machine
included minimizing the load on the ligament graft by
reducing anterior forces and anterior displacement of

the knee. We were not concerned if forces were applied

in the posterior direction, as the ACL is primarily
loaded by forces in the anterior direction. In addition,
we required a design that would prevent the knee from
being placed under excessive compressive loads, which
we defined as tw ice the weight of the rodent, and we
required a design that would reduce the amount of
internal and external rotation of the tibia on the femur.
W e also included in our criteria that the design ensure
that the knee follow a natural physiological motion as it
is flexed and extended.
Once we settled on the design criteria, we assembled
a list of four existing CPM designs and one internal
concept that we felt could be suitable for our rodent
model. Designs were included from laboratories that
had developed animal model CPM machines, (two of
the animal designs were built for rabbits, and two were
built for rats) as well as clinical designs. We excluded
animal CPM machines that were not designed specifically for the knee joint.
Then, for each of the five designs , we created mathematical models , which involved deriving a system
of equations developed from force body diagrams,
and solving for the anterior/posterior and compressive/distractive forces at the knee joint as a function
of flexion . Within our models, we assumed that
the knee behaves like a hinge and the joint surfaces
exert negligible friction forces. Because each cycle of
the CPM machine takes approx imately 45 seconds,
we assumed that the leg musculature is passive (the
animals will be placed under anesthesia so there is
minimal muscle activation), and all structures are in

' CLINICAL CPM DESIGN I HINGE MODEL

Results for the design that best met the lab's criteria.

Force vs. flexion angle, rodent model

Fnt =force

0.04

from plate
supporting
femur

0.02
Ul

c
0

-0 .02

-~

-0 .04

~ -0.06

0::

Wt =

weight of
femur

-0.08
-0.1
-0.12

Force in the anteriorI posterior direction is always

zero. Force in the compressive I distractive direction
is never greater than w; and is alwayS distractive.

24 mechanical engineering

I October 2010

20

"

40

60

""'

100

80

Ant/
Post

FLEXION ANGLE

Camp/

Dist

Distractive

The clinical CPM design was rendered in Solidworks (left). The

lab built a device and is now testing it on cadaver rats before
moving on to live subjects. Above is the first generation of the
device, HSS CPM -Version-1.

quasi-static equilibrium. As the systems of the knee

will be moving at very slow velocity, their energies can be assumed to be zero. To solve some of the
equations, we used measurements taken from rodent
anatomy, and we simplified the models to be solved
for only the x-y plane. The results of our models
were represented in graphs of the compressive/ distractive and anterior/ posterior forces vs. angle of
knee flexion.
The models helped the team gain a stronger understanding of the forces applied to the knee by each
design and helped us identify which design best fulfilled
our criteria. The models clarified the extent and direction of forces, some of which were not as intuitive as
one might think, and provided a graphical representation of forces that influenced our understanding of how
forces applied to the leg were translated to the knee
joint. The models were flexible enough to allow for
multiple manipulations and adjustments. Our models
demonstrate that while each device accomplishes a
similar purpose of moving the knee passively through
its range of motion, each device applies a unique set of
forces to the knee joint.
Of the five designs we modeled, the CPM design that
is currently used in the clinic proved to be the most
suitable for our experiments. In the clinical design, the
weight of the femur and tibia are each fully supported
by separate plates. These plates are attached by a hinge,
and provide normal forces which are always aligned
with the anterior/posterior vectors. Therefore, the
normal forces from the plates are always countering the
forces from the weight of the leg in the anterior/ posterior direction, and the anterior/ posterior forces were
found to be zero. In addition, the force in the compressive/distractive direction is never greater than the

weight of the tibia, and is always distractive.

In addition, our models demonstrated that some CPM
designs created forces at the knee that failed to fulfill
our design criteria. For example, one design created
unacceptably high compressive loads. Also, our models
helped elucidate whether springs could counter anterior
forces. It was found that while springs could be helpful,
they also induced compressive forces.
Based on the results of our models, we developed with
SolidWorks a representative prototype of a miniature
CPM similar to the clinical design. We then built the
device in our laboratory.
The machine's motion is powered by a Haydon stepper motor which is controlled by a LabJack data acquisition U3 and a US Digital microstepping motor driver.
With guidance from software engineer Daniel Fichter,
we wrote custom software in Java that allows us to control for displacement, speed, and number of cycles.
Currently, we are in the process of validating the
machine with cadaver rats. Once we complete our
validation, we will begin live animal studies. With our
CPM machine, we hope to gain a better understanding ofhow knee motion and mechanical loading of
the ACL graft will affect healing. We will investigate
the many variables that may influence the mechanical signals on healing, such as the duration of the
CPM therapy, the onset of the therapy after surgery,
the speed of the motion, the number of cycles and the
frequency of cycles.
Currently, knee motion is commonly prescribed to a
patient recuperating from ACL surgery, but we do not
know its effects. ACL graft healing is a slow process, and
with our rodent model, we hope to discover the best
rehabilitative protocols that will hasten recovery and
reduce graft tendon failure rates.
October 2010

mechanical engineering 25