An in vitro simulation study of impulsive force transmission along the lower skeletal extremity

Several investigators have revealed that a relationship exists between articular cartilage deterioration and the mechanical stress that results from transient impulsive forces created in the lower extremity during gait. This study is an investigation of the transmission of impulse waves through the lower extremity and the effect of knee pathology and prosthetic knee replacement on their transmission.

An in vitro experiment is performed using human cadaver specimens that are instrumented with accelerometers. The distal end of the tibia is impacted with a vibration shaker to simulate heel strike. The results indicate that the normal knee joint is able to attenuate 59% of the transient peak force applied to it by the tibia. This attenuation capacity is reduced by knee pathology and decreases further with implantation of a knee prosthesis. The results indicate that abnormalities at the knee may increase the risk of degenerative changes at the ankle, hip and in the spine due to increased transient impulsive forces.     

The role of transmembrane proteins on force transmission in skeletal muscle

Lateral transmission of force from myofibers laterally to the surrounding extracellular matrix (ECM) via the transmembrane proteins between them is impaired in old muscles. Changes in geometrical and mechanical properties of ECM of skeletal muscle do not fully explain the impaired lateral transmission with aging. The objective of this study was to determine the role of transmembrane proteins on force transmission in skeletal muscle. In this study, a 2D finite element model of single muscle fiber composed of myofiber, ECM, and the transmembrane proteins between them was developed to determine how changes in spatial density and mechanical properties of transmembrane proteins affect the force transmission in skeletal muscle. We found that force transmission and stress distribution are not affected by mechanical stiffness of the transmembrane proteins due to its non-linear stress–strain relationship. Results also showed that the muscle fiber with insufficient transmembrane proteins near the end of muscle fiber transmitted less force than that with more proteins does. Higher stress was observed in myofiber, ECM, and proteins in the muscle fiber with fewer proteins.     

Bicycle spoke injuries in the lower extremity

This study reports the authors' 5-year experience with treating lower extremity injuries in bicycle passengers caused by the spokes. This patient group was selected from 716 lower extremity injuries that received treatment at our outpatient plastic surgery clinic. A total of 26 patients were treated during the study. Patients ranged from 2 to 19 years old, with a mean age of 5.6 years. The authors treated more female passengers (62 percent) than male passengers. The right foot (52 percent) was involved more often than was the left. Most patients were injured in the afternoon, from 2 to 7 PM (62 percent), and between May and October (77 percent). The rear wheel (89 percent) injured the majority of patients. The Achilles tendon was the most common site of injury (63 percent). The typical types of wounds observed included the following: type I, laceration with partial avulsion of skin and subcutaneous tissue (41 percent) and laceration forming a distally based flap (33 percent); type II, abrasions with ecchymoses and friction burn from the shearing effect of the spokes creating a partial- to full-thickness skin defect (26 percent). Of the type I injuries, full-thickness skin lacerations (33 percent) were closed primarily. Partial-thickness skin lacerations, abrasions, ecchymoses, and skin defects (67 percent) were treated conservatively with wound irrigation and dressing. The wound healing time for type I injuries was 29 days; for type II injuries, it was 27 days. These healing times were prolonged compared with healing by first intention. No significant difference was found in healing time when comparing both types of injury. Four patients required hospitalization. No patient required skin grafting. No fractures were noted because these patients were selected from the outpatient plastic surgery clinic and did not include patients from the emergency room. Since the first report of bicycle spoke injuries a half-century ago, prevention has not improved.     

Troponin in embryonic chick skeletal muscle cells in vitro. An immunoelectron microscope study

The fine structurel distribution of troponin on thin filaments in developing myofibrils was investigated by the use of immunoelectron microscopy. Embryonic chick skeletal muscle cells grown in vitro were treated with antibodies against each of the troponin components (troponin T, I, and C) from adult chicken muscles. Each antibody was distributed along the thin filaments with a period of 38 nm. It is concluded that these newly synthesized regulatory proteins are assembled at their characteristic position from the initial phases of myofibrillogenesis.     

Atomic force and total internal reflection fluorescence microscopy for the study of force transmission in endothelial cells

This paper describes the combined use of atomic force microscopy (AFM) and total internal reflection fluorescence microscopy (TIRFM) to examine the transmission of force from the apical cell membrane to the basal cell membrane. A Bioscope AFM was mounted on an inverted microscope, the stage of which was configured for TIRFM imaging of fluorescently labeled human umbilical vein endothelial cells (HUVECs). Variable-angle TIRFM experiments were conducted to calibrate the coupling angle with the depth of penetration of the evanescent wave. A measure of cellular mechanical properties was obtained by collecting a set of force curves over the entire apical cell surface. A linear regression fit of the force-indentation curves to an elastic model yields an elastic modulus of 7.22 +/- 0. 46 kPa over the nucleus, 2.97 +/- 0.79 kPa over the cell body in proximity to the nucleus, and 1.27 +/- 0.36 kPa on the cell body near the edge. Stress transmission was investigated by imaging the response of the basal surface to localized force application over the apical surface. The focal contacts changed in position and contact area when forces of 0.3-0.5 nN were applied. There was a significant increase in focal contact area when the force was removed (p < 0.01) from the nucleus as compared to the contact area before force application. There was no significant change in focal contact coverage area before and after force application over the edge. The results suggest that cells transfer localized stress from the apical to the basal surface globally, resulting in rearrangement of contacts on the basal surface.     

Role of microsurgery in lower extremity reconstruction

Developments in reconstructive microsurgery have heralded a new phase of limb-saving procedures. Although pedicled local fasciocutaneous or muscle flaps continue their useful role, microsurgical free tissue transfer is usually required for larger defects and also for areas without locoregional options. As this treatment modality has become more established, innovation and technical refinements have resulted in an evolution of flap surgery, including perforator and free-style free flaps, that has been applied to lower limb surgery. Effective outcome measures, bioelectronic prostheses, and composite tissue allotransplantation are the three major trends leading into a new era of lower limb reconstruction. This article outlines the role of microsurgical free tissue transfer for lower limb salvage and reconstruction.     

The three-dimensional determination of internal loads in the lower extremity

A three-dimensional model of the lower limb containing 47 muscles was developed to study the differences between a two- and three-dimensional approach for determining internal loads, the role of the dynamic joint representation, and the behavior of different load-bearing criteria in walking and running. The problem of redundancy of the musculo-skeletal system was resolved by applying inverse dynamics and static optimization methods. Different hypothetical load-bearing capabilities of hinge, spherical and intermediate joint types for the knee and the ankle joints were tested. It was found that even almost planar movements such as walking and running are associated with significant three-dimensional intersegment moments, especially in the frontal plane. Thus, a two-dimensional approach may underestimate internal loads up to 60%. It is shown that pure hinge joints are inappropriate for modeling the dynamical joint function of the knee and ankle joints. A more flexible joint representation in combination with a squared muscle stress minimization criterion predicted a lot of synergistic as well as antagonistic muscle activation which was also found in the EMG patterns. The results indicate the importance of muscular joint stabilization in natural human movements. Compared to in vivo measurements it is speculated that the predicted force magnitudes are considerably overestimated due to error propagation and still insufficient anatomical models. Thus, increased efforts to improve further the reliability of internal load calculations should be made in the future.     

Management of compound injuries of the lower extremity.

The reconstructive surgeon experienced in the use of rotated or free muscle and myocutaneous flaps, skilled in microvascular surgery, and interested in lower extremity trauma, may favorably alter the course of management of these historically difficult problems. It can be of great advantage to the patient if this surgeon is involved in the primary evaluation, so that all initial therapy can be performed with the future reconstructive goals in mind.     

Lipid peroxidation of skeletal muscle: an in vitro study

The process of lipid peroxidation of skeletal muscle has been examined in vitro by monitoring the autoxidation of skeletal-muscle homogenates. Skeletal-muscle tissue has been shown to have considerable capacity for autoxidation and the process has been found to be initiated by a free-radical-mediated mechanism, critically dependent on the presence of free iron in the homogenate. The initiating radicals have not been firmly identified, but the results suggest that neither superoxide or hydroxyl radicals are involved. An in vitro technique for assessment of the antioxidant capacity of muscle tissue has also been developed which is capable of demonstrating differences between muscle tissues with differing vitamin E contents.     

Atomic force microscopy study of the rabbit skeletal muscle ryanodine receptors in different functional states

Atomic force microscope was applied to investigate the effect of extrinsic phospholipid on the structure of rabbit skeletal muscle ryanodine receptor/calcium release channel (RyR1). In addition, in the presence of extrinsic phospholipid, the height and elasticity of the RyR1s in different functional states were also measured. The results indicate: (i) most of the RyR1s showed a normal structure only in the presence of extrinsic phospholipid; (ii) treatment of the RyR1s with AMP and Ca²⁺ together could increase their Young’s Modulus but not change their apparent height; (iii) no detectable change in either height or Young’s Modulus of the RyR1s appeared, if the RyR1s were treated with other activators or inhibitors.     

The expression of the skeletal muscle force-length relationship in vivo: A simulation study

The force-length relationship is one of the most important mechanical characteristics of skeletal muscle in humans and animals. For a physiologically realistic joint range of motion and therefore range of muscle fibre lengths only part of the force-length curve may be used in vivo, i.e. only a section of the force-length curve is expressed. A generalised model of a mono-articular muscle-tendon complex was used to examine the effect of various muscle architecture parameters on the expressed section of the force-length relationship for a 90° joint range of motion. The parameters investigated were: the ratio of tendon resting length to muscle fibre optimum length (L_TR:L_F·OPT) (varied from 0.5 to 11.5), the ratio of muscle fibre optimum length to average moment arm (L_F·OPT:r) (varied from 0.5 to 5), the normalised tendon strain at maximum isometric force (c) (varied from 0 to 0.08), the muscle fibre pennation angle (θ) (varied from 0° to 45°) and the joint angle at which the optimum muscle fibre length occurred (φ). The range of values chosen for each parameter was based on values reported in the literature for five human mono-articular muscles with different functional roles. The ratios L_TR:L_F·OPT and L_F·OPT:r were important in determining the amount of variability in the expressed section of the force-length relationship. The modelled muscle operated over only one limb at intermediate values of these two ratios (L_TR:L_F·OPT=5; L_F·OPT:r=3), whether this was the ascending or descending limb was determined by the precise values of the other parameters. It was concluded that inter-individual variability in the expressed section of the force-length relationship is possible, particularly for muscles with intermediate values of L_TR:L_F·OPT and L_F·OPT:r such as the brachialis and vastus lateralis. Understanding the potential for inter-individual variability in the expressed section is important when using muscle models to simulate movement.     

Myofascial force transmission also occurs between antagonistic muscles located within opposite compartments of the rat lower hind limb

Force transmission via pathways other than myotendinous ones, is referred to as myofascial force transmission. The present study shows that myofascial force transmission occurs not only between adjacent synergistic muscles or antagonistic muscles in adjacent compartments, but also between most distant antagonistic muscles within a segment. Tibialis anterior (TA), extensor hallucis longus (EHL), extensor digitorum longus (EDL), peroneal muscles (PER) and triceps surae muscles of 7 male anaesthetised Wistar rats were attached to force transducers, while connective tissues at the muscle bellies were left fully intact. The TA + EHL-complex was made to exerted force at different lengths, but the other muscles were held at a constant muscle–tendon complex length. With increasing TA + EHL-complex length, active force of maximally activated EDL, PER and triceps surae decreased by maximally 5%, 32% and 16%, respectively. These decreases are for the largest part explained by myofascial force transmission. Particularly the force decrease in triceps surae muscles is remarkable, because these muscles are located furthest away from the TA + EHL-complex. It is concluded that substantial extramuscular myofascial force transmission occurs between antagonistic muscles even if the length of the path between them is considerable.     

An examination of possible quadriceps force at the time of anterior cruciate ligament injury during landing: A simulation study

Anterior cruciate ligament (ACL) rupture is a common and traumatic injury. Although, identifying the mechanism of ACL injury has received considerable research attention, there are still many unanswered questions. One proposed mechanism asserts that the ACL is injured due to an aggressive quadriceps muscle contraction. However, recently it has been questioned if the magnitude of quadriceps force needed to tear the ACL is physiologically realistic under the conditions where injury occurs during landing (e.g. near full knee extension and within 50ms after impact). To answer this question, a simple simulation model was developed to examine the upper bounds of quadriceps force that can be developed under these conditions. The model included force-length, and force-velocity properties as well as activation dynamics. Model parameters were chosen to provide a high estimate for possible quadriceps force in a young healthy man. The effects of varying quadriceps pre-activation levels were also examined. When using realistic pre-activation levels, the simulated quadriceps force was less than half of what has been shown to cause ACL injury. Even when using maximum pre-activation, the quadriceps force still did not reach close to the level shown to cause injury. Therefore, we conclude that quadriceps force alone seems to be an unlikely mechanism for ACL injury.