Sex-based differences in the tensile properties of the human anterior cruciate ligament

After immense amounts of research, the root cause for the significantly higher rates of anterior cruciate ligament (ACL) failure incidents in females as compared to males still remains unknown and the existing sex-based disparity has not diminished. To date, the possibility that the female ACL is mechanically weaker than the male ACL has not been directly investigated. Although it has been established in the literature that the female ACL is smaller in size, the differences in the structural and material properties of the ACL between sexes have not been studied. The aim of this cadaveric study was to determine if any sex-based differences in the tensile properties of the human ACL exist when considering age as well as ACL and body anthropometric measurements as covariates. Ten male and 10 female unpaired cadaveric knees (mean age 36.75 years) were used for this study. The geometry of the ACL (including length, cross-sectional area, and volume) was analyzed using a 3-D scanning system. The femur-ACL tibia complex was tested to failure along the longitudinal axis of the ligament in a tensile testing machine. The structural properties of the ACL as well as its mechanical properties were determined. Analysis of covariance was performed to assess the effect of sex on tensile properties. The female ACL was found to have a lower mechanical properties (8.3% lower strain at failure; 14.3% lower stress at failure, 9.43% lower strain energy density at failure, and most importantly, 22.49% lower modulus of elasticity) when considering age, ACL, and body anthropometric measurements as covariates.     

High spatial resolution readout of 3-D metabolic organ structure: an automated, low-temperature redox ratio-scanning instrument

Intraorgan compartmentation of metabolic processes plays an important role in the understanding of the physiological function of the integrated organ under normal as well as under pathological conditions. We describe here a technique by which 3-D information on tissue redox state may be obtained by means of automated scanning of surface fluorescence. The instrument allows for serial scanning of frozen tissue. A typical scan of a tissue volume of 3 X 3 X 2 mm at a linear resolution of 50 micron and a spatial resolution of ca. 3 X 10(-7) ml includes 144,000 single-point measurements of pyridine nucleotide and flavoprotein fluorescence within the tissue block. The scanning process is fully computerized and programs have been developed which allow 2- or 3-D reconstruction of the data in terms of "redox ratio models," exemplified here by a 3-D model of a spreading depression wave in the cerebral cortex of a gerbil.     

3-D reconstruction of biological objects using underwater video technique and image processing

This paper describes a 3-D reconstruction method which allows accurate measurements of volume, surface area and other morphometric measurements of three-dimensional biological objects, without removing them from the sea. It represents a novel approach based on multiple views (eight resulted to be sufficient) from underwater video images and a new image processing procedure (MOD3D), whose application has met the basic requirements (i.e. to work on images recorded in turbid waters, with nonuniform lighting, to investigate large areas and in reasonable time, etc.) imposed when operating in the marine environment with simple, easy-to-use and nonprofessional equipment. It is a noninvasive, nondestructive and in the field fast method, thus suitable for sampling also at relevant depth, whose applicability has specifically been set up for a range of growth forms from massive to submassive and irregularly shaped. The accuracy of the method was assessed using models with three levels of 3-D complexity: simple, moderate and complex morphology. A high accuracy of volume measurements made through MOD3D image analysis software was achieved when compared with the laboratory water displacement method, which represents the most accurate method for volume measurement, with an overall mean percent error of about 1.7% (S.D. 2.2%). For all three levels of morphologic complexity, no significant differences (p>0.05) were found. Volume measurements obtained in field based on geometric approximation resulted rough, with significant differences from the MOD3D values (p<0.05). The geometric approximation was lower than MOD3D for simple and moderate morphology, and variable for complex morphology. For all three models, MOD3D values for surface area computation were consistently lower (mean error 13%) than the foil-wrapping values (p<0.05), due to overlap error when foil wrapping. Two applications were made with the bryozoan Pentapora fascialis and the coral Cladocora caespitosa to quantify carbonate standing stock and biomass of these two carbonate framework builders, whose importance has been recently recognised among the temperate sublittoral benthic species. Time required for the 3-D reconstruction method (about 3 h) makes it suitable for routine application particularly for relatively large area investigations, with irregularly shaped objects on rough substrate and several biological objects within the area.     

The effects of single-leg landing technique on ACL loading

Anterior Cruciate Ligament (ACL) injury is one of the most serious and costly injuries of the lower extremity, occurring more frequently in females than males. Injury prevention training programs have reported the ability to reduce non-contact ACL injury occurrence. These programs have also been shown to alter an athletes' lower extremity position at initial contact with the ground and throughout the deceleration phase of landing. The purpose of this study was to determine the influence of single-leg landing technique on ACL loading in recreationally active females. Participants were asked to perform "soft" and "stiff" drop landings. A series of musculoskeletal models were then used to estimate muscle, joint, and ACL forces. Dependent t-tests were conducted to investigate differences between the two landing techniques (p<0.05). Instructing participants to land 'softly' resulted in a significant decrease in peak ACL force (p=0.05), and a significant increase in hip and knee flexion both at initial contact (IC) and the time of peak ACL force (F(PACL)). These findings suggest that altering landing technique using simple verbal instruction may result in lower extremity alignment that decreases the resultant load on the ACL. Along with supporting the findings of reduced ACL force with alterations in sagittal plane landing mechanics in the current literature, the results of this study suggest that simple verbal instruction may reduce the ACL force experienced by athletes when landing.     

How cyclic loading affects the migration of radio-opaque markers attached to tendon grafts using a new method: a study using roentgen stereophotogrammetric analysis (RSA)

An increase in anterior laxity following reconstruction of the anterior cruciate ligament (ACL) can result from lengthening of the graft construct in either the regions of fixation and/or the region of the graft substance between the fixations. RSA could be a useful technique to determine lengthening in these regions if a method can be devised for attaching radio-opaque markers to soft tissue grafts so that marker migration from repeated loading of the graft is limited. Therefore, the objectives of this study were 1) to develop a method for attaching radio-opaque markers to an ACL graft that limits marker migration within the graft, 2) to characterize the error of an RSA system used to study migration, and 3) to determine the maximum amount of migration and the time when it occurs during cyclic loading of ACL grafts. Tendon markers were constructed from a 0.8-mm tantalum ball and a stainless steel suture. Ten double-looped tendon grafts were passed through tibial tunnels drilled in bovine tibias and fixed with a tibial fixation device. Two tendon markers were sewn to one tendon bundle of each graft and the grafts were cyclically loaded for 225,000 cycles from 20 N to 170 N. At specified intervals, simultaneous radiographs were obtained of the tendon markers and a radiographic standard of known length. The bias and imprecision in measuring the length of the radiographic standard were 0.0 and 0.046 mm respectively. Marker migration was computed as the change in distance between the two tendon markers along the axis of the tibial tunnel. Marker migration was greatest after 225,000 cycles with a root mean square (RMS) value of less than 0.2 mm. Because the RMS value indicates the error introduced into measurements of lengthening and because this error is small, the method described for attaching markers to an ACL graft has the potential to be useful for determining lengthening of ACL graft constructs in in vivo studies in humans.     

The development and validation of a charge-coupled device laser reflectance system to measure the complex cross-sectional shape and area of soft tissues

Determination of the stresses in soft tissues such as ligaments and tendons under uniaxial tension require accurate measurement of their cross-sectional area. Of the many methods available, there are concerns regarding contact methods which exert external loads and deform the cross-sectional shape of soft tissues. Hence, the area measurements are affected. On the other hand, non-contact methods have difficulties in dealing with complex shapes, especially with concavities. To address these problems, a new measurement system using a charge-coupled device (CCD) laser displacement sensor has been developed and tested. This system measures the complete surface profile of the object by rotating the laser 360° around the soft tissue. Then, the cross-sectional shape is reconstructed and the cross-sectional area determined via Simpson's rule. The system's accuracy was first verified with objects of various cross-sectional shapes and areas (cylinder: 23.1, 76.5, 510.3 mm²; cuboid: 34.3, 163.8, 316.7 mm², and cylinder with concavities: 121.4 mm²). The CCD laser reflectance system's accuracy was within 2.0% for these objects. To test biological application, the goat Achilles tendon and the anteromedial bundle of the porcine anterior cruciate ligament specimens were measured and compared to values obtained using another accepted technique, the laser micrometer system. The areas obtained using the CCD laser reflectance system were 4.4% and 9.7% lower than those obtained with the laser micrometer system respectively. These differences could be mainly attributed to concavities. Thus, the CCD laser reflectance system is an improved method for measuring the cross-sectional shape and area of soft tissues since it can detect and account for concavities without physically contacting the specimen.     

A case-control study of anterior cruciate ligament volume,tibial plateau slopes and intercondylar notch dimensions in ACL-injured knees

The role played by anatomical factors in ACL injury remains elusive. In this study, objective methods were used to characterize ACL volume, tibial slopes and notch geometry from ACL-injured and matched-control subjects. The study tested four hypotheses: (1) the medial tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, (2) the lateral tibial plateau slope is steeper posteriorly in the injured group compared to the non-injured group, (3) the femoral intercondylar notch dimensions are smaller in the injured group compared to the non-injured group and (4) the ACL volume, tibial plateau slopes and intercondylar notch dimensions are all independent of each other. Fifty-four subjects were divided into two groups, those who had suffered a non-contact ACL injury and those who still had two healthy ACLs, matched to the injured subjects by gender, age, height and weight. The lateral tibial plateaus in the uninjured contralateral knees of the injured subjects had a significantly steeper posterior slope (1.8° vs. ?0.3°), a factor that potentially contributed to the ACL injury in the opposite knee. The intercondylar notch dimensions were found to be smaller in the injured subjects, potentially putting the ACL at risk of impingement, and intercondylar notch volume was correlated to ACL volume (r=0.58). Discriminant analysis showed that the notch width at the inlet was the best single predictor of ACL injury.     

Validation study of skull three-dimensional computerized tomography measurements

Recent advances in imaging have led to high-resolution computerized tomography (CT) scanning with exquisitely detailed slice images of the skull and three-dimensional (3-D) surface reconstructions using computer software. It is possible to use CT scans to acquire morphologic information about the skull in a convenient digital form and to derive 3-D measurements from surface reconstruction images. Unfortunately, no effort has been made to date to test the validity of these measurements on laboratory specimens, and no compelling evidence is available from phantom studies to indicate the nature and magnitude of the errors inherent in the measurement technique. We have performed a pilot study to quantify the morphology of the skull based on surface features that can be found in CT scans and 3-D reconstructions. Comparative measurements were obtained from five skulls (two normal and three with dysmorphology) with calipers and a 3-D electromagnetic digitizer. These measurements were statistically compared with those based on original CT scan slices and reformatted 3-D images. It is concluded that 3D-CT measurement techniques are superior to those in which measurements are obtained directly from the original CT slices; 3-D CT methods, however, must be significantly improved before measurements based on these techniques can be used in studies that require a high degree of precision. The results are used to indicate the most fruitful areas of future study.     

Measurement of Cell Wall Volume using Confocal Microscopy and its Application to Studies of Forage Degradation

The distribution of cell wall material between different plantcell types may contribute significantly to the variation indegradability of plant material with a similar overall chemicalcomposition but different anatomy. Assessment of the degradabilityof cell walls in a section suitable for digestion is a three-dimensional(3-D) problem because of the thickness of section required (50–100µm). Optical sectioning of thick sections using confocallaser scanning microscopy (CLSM) provides a method of estimatingthe volume of cell wall material present in tissue sectionsbefore and after digestion, and of visualizing the plant tissueusing 3-D image reconstruction. The use of CLSM enables degradabilitymeasurements to be made on cellsin situand can provide moreimmediate and relevant information than can be obtained by mechanicalfractionation of the tissues. The CLSM method has been usedto visualize thick sections taken from maize and barley internodesbefore and after degradation with cell wall degrading enzymes.Quantitative measurements of cell wall volume and mean cellwall thickness were made on a series of optical sections, andthe potential of the method for quantitation of cell wall degradabilityis assessed. Image analysis; plant anatomy; confocal microscopy; degradation; maize     

The influence of deceleration forces on ACL strain during single-leg landing: a simulation study

Anterior cruciate ligament (ACL) injury commonly occurs during single limb landing or stopping from a run, yet the conditions that influence ACL strain are not well understood. The purpose of this study was to develop, test and apply a 3D specimen-specific dynamic simulation model of the knee designed to evaluate the influence of deceleration forces during running to a stop (single-leg landing) on ACL strain. This work tested the conceptual development of the model by simulating a physical experiment that provided direct measurements of ACL strain during vertical impact loading (peak value 1294N) with the leg near full extension. The properties of the soft tissue structures were estimated by simulating previous experiments described in the literature. A key element of the model was obtaining precise anatomy from segmented MR images of the soft tissue structures and articular geometry for the tibiofemoral and patellofemoral joints of the knee used in the cadaver experiment. The model predictions were correlated (Pearson correlation coefficient 0.889) to the temporal and amplitude characteristic of the experimental strains. The simulation model was then used to test the balance between ACL strain produced by quadriceps contraction and the reductions in ACL strain associated with the posterior braking force. When posterior forces that replicated in vivo conditions were applied, the peak ACL strain was reduced. These results suggest that the typical deceleration force that occurs during running to a single limb landing can substantially reduce the strain in the ACL relative to conditions associated with an isolated single limb landing from a vertical jump.     

Reconstruction and analysis of a deciduous sapling using digital photographs or terrestrial-LiDAR technology

Background and Aims

To meet the increasing need for rapid and non-destructive extraction of canopy traits, two methods were used and compared with regard to their accuracy in estimatating 2-D and 3-D parameters of a hybrid poplar sapling.

Methods

The first method consisted of the analysis of high definition photographs in Tree Analyser (TA) software (PIAF-INRA/Kasetsart University). TA allowed the extraction of individual traits using a space carving approach. The second method utilized 3-D point clouds acquired from terrestrial light detection and ranging (T-LiDAR) scans. T-LiDAR scans were performed on trees without leaves to reconstruct the lignified structure of the sapling. From this skeleton, foliage was added using simple modelling rules extrapolated from field measurements. Validation of the estimated dimension and the accuracy of reconstruction was then achieved by comparison with an empirical data set.

Key Results

TA was found to be slightly less precise than T-LiDAR for estimating tree height, canopy height and mean canopy diameter, but for 2-D traits both methods were, however, fully satisfactory. TA tended to over-estimate total leaf area (error up to 50 %), but better estimates were obtained by reducing the size of the voxels used for calculations. In contrast, T-LiDAR estimated total leaf area with an error of <6 %. Finally, both methods led to an over-estimation of canopy volume. With respect to this trait, T-LiDAR (14·5 % deviation) greatly surpassed the accuracy of TA (up to 50 % deviation), even if the voxels used were reduced in size.

Conclusions

Taking into account their magnitude of data acquisition and analysis and their accuracy in trait estimations, both methods showed contrasting potential future uses. Specifically, T-LiDAR is a particularly promising tool for investigating the development of large perennial plants, by itself or in association with plant modelling.     

Comparison of gross body fat‐water magnetic resonance imaging at 3 Tesla to dual‐energy X‐ray absorptiometry in obese women

Objective:

Improved understanding of how depot‐specific adipose tissue mass predisposes to obesity‐related comorbidities could yield new insights into the pathogenesis and treatment of obesity as well as metabolic benefits of weight loss. We hypothesized that three‐dimensional (3D) contiguous “fat‐water” MR imaging (FWMRI) covering the majority of a whole‐body field of view (FOV) acquired at 3 Tesla (3T) and coupled with automated segmentation and quantification of amount, type, and distribution of adipose and lean soft tissue would show great promise in body composition methodology.

Design and Methods:

Precision of adipose and lean soft tissue measurements in body and trunk regions were assessed for 3T FWMRI and compared to dual‐energy X‐ray absorptiometry (DXA). Anthropometric, FWMRI, and DXA measurements were obtained in 12 women with BMI 30‐39.9 kg/m².

Results:

Test–retest results found coefficients of variation (CV) for FWMRI that were all under 3%: gross body adipose tissue (GBAT) 0.80%, total trunk adipose tissue (TTAT) 2.08%, visceral adipose tissue (VAT) 2.62%, subcutaneous adipose tissue (SAT) 2.11%, gross body lean soft tissue (GBLST) 0.60%, and total trunk lean soft tissue (TTLST) 2.43%. Concordance correlation coefficients between FWMRI and DXA were 0.978, 0.802, 0.629, and 0.400 for GBAT, TTAT, GBLST, and TTLST, respectively.

Conclusions:

While Bland–Altman plots demonstrated agreement between FWMRI and DXA for GBAT and TTAT, a negative bias existed for GBLST and TTLST measurements. Differences may be explained by the FWMRI FOV length and potential for DXA to overestimate lean soft tissue. While more development is necessary, the described 3T FWMRI method combined with fully‐automated segmentation is fast (<30‐min total scan and post‐processing time), noninvasive, repeatable, and cost‐effective.     

The Intra‐ and Inter‐instrument Reliability of DXA Based on Ex Vivo Soft Tissue Measurements

Objective: Comparison of ex‐vivo soft tissue measurements using the GE/Lunar pencil (DPX‐L; GE/Lunar Co., Madison, WI) and fan beam (Prodigy dual‐energy X‐ray absorptiometers (DXA) GE/Lunar Co.). Research Methods and Procedures: Intra‐instrument reliability was assessed by repeatedly scanning soft tissue phantoms for lean tissue (water) and fat tissue (methanol) using one DPX‐L and two identical Prodigy DXAs at fast, medium, and slow scan modes. For each machine, 10 scans of each phantom were performed at each scan speed. The number of scans per instrument totaled 60. Data were analyzed using ANOVA to ascertain whether scan speed affected the intra‐instrument reliability and to test whether soft tissue measurements differed among instruments. Percentage fat (phantom density) was the outcome variable. Results: Intra‐instrument reliability, expressed as coefficient of variation, ranged between 0.7% and 5.2% for the DPX‐L and 0.4% and 4.5% for the Prodigy, with the lowest coefficients of variation observed when scanning the fat tissue phantom. Scan speed also affected the intra‐instrument reliability (p < 0.01). Furthermore, differences in the measurement of percentage body fat for both the lean and fat tissue phantoms were observed among all three absorptiometers (all p < 0.01). After adjusting for scan speed, differences persisted for all three instruments. Discussion: Intra‐ and inter‐instrument reliability of DXA machines, even those from the same manufacturer, remains unpredictable. Thus, when measuring body composition using DXA, it is important to consider that even in the absence of measurement bias, the use of different DXA machines, particularly when using a variety of speed settings, will increase the residual error around the true value.     

Validity of a New Abdominal Bioelectrical Impedance Device to Measure Abdominal and Visceral Fat: Comparison With MRI

Abdominal fat, and in particular, visceral adipose tissue (VAT), is the critical fat depot associated with metabolic aberrations. At present, VAT can only be accurately measured by computed tomography or magnetic resonance imaging (MRI). This study was designed to compare a new abdominal bioelectrical impedance (BIA) device against total abdominal adipose tissue (TAAT) and VAT area measurements made from an abdominal MRI scan, and to assess its reliability and accuracy. One‐hundred twenty participants were recruited, stratified by gender and BMI. Participants had triplicate measures of abdominal fat and waist circumference (WC) with the AB‐140 (Tanita, Tokyo, Japan) and WC measurements using a manual tape measure. A single abdominal MRI scan was performed as the reference method. Triplicate measures with the AB‐140 showed excellent precision for “visceral fat level,” trunk fat %, and WC. AB‐140 “visceral fat level” showed significantly stronger correlations with MRI TAAT area than with MRI VAT area (r = 0.94 vs. 0.65 in men and 0.92 vs. 0.64 in women). AB‐140 WC showed good correlation with manual WC measurements (r = 0.95 in men and 0.90 in women). AB‐140 and manual WCs showed comparable correlations with MRI TAAT area (r = 0.92 and 0.96 in men and 0.88 and 0.88 in women). AB‐140 is a simple, quick, and precise technique to measure abdominal fat and WC in healthy adults. It provides a useful proxy for TAAT measured by MRI, comparable to the correlation obtained with manual WC measurements. Neither the AB‐140 abdominal fat measures nor WC measurement appear to provide a useful proxy measure of VAT.     

Breast volume assessment based on 3D surface geometry: verification of the method using MR imaging

Differences in breast volume and contour are subjectively estimated by surgeons. 3D surface imaging using 3D scanners provides objective breast volume quantification, but precision and accuracy of the method requires verification. Breast volumes of five test individuals were assessed using a 3D surface scanner. Magnetic resonance imaging (MRI) reference volumes were obtained to verify and compare the 3D scan measurements. The anatomical thorax wall curvature was segmented using MRI data and compared to the interpolated curvature of the posterior breast volume delimitation of 3D scan data. MRI showed higher measurement precision, mean deviation (expressed as percentage of volume) of 1.10+/-0.34% compared to 1.63+/-0.53% for the 3D scanner. Mean MRI [right (left) breasts: 638 (629)+/-143 (138) cc] and 3D scan [right (left) breasts: 493 (497)+/-112 (116) cc] breast volumes significantly correlated [right (left) breasts: r=0.982 (0.977), p=0.003 (0.004)]. The posterior thorax wall of the 3D scan model showed high agreement with the MRI thorax wall curvature [mean positive (negative) deviation: 0.33 (-0.17)+/-0.37 cm]. High correspondence and correlation of 3D scan data with MRI-based verifications support 3D surface imaging as sufficiently precise and accurate for breast volume measurements.     

Hip extension, knee flexion paradox: a new mechanism for non-contact ACL injury

Considering that an athlete performs at-risk sports activities countless times throughout the course of his or her career prior to the instance of anterior cruciate ligament (ACL) injury, one may conclude that non-contact ACL injury is a rare event. Nevertheless, the overall number of non-contact ACL injuries, both in the US and worldwide, remains alarming due to the growing number of recreational and professional athletes participating in high-risk activities. To date, numerous non-contact ACL injury mechanisms have been proposed, but none provides a detailed picture of sequence of events leading to injury and the exact cause of this injury remains elusive. In this perspective article, we propose a new conception of non-contact ACL injury mechanism that comprehensively integrates risk factors inside and outside the knee joint. The proposed mechanism is robust in the sense that it is biomechanically justifiable and addresses a number of confounding issues related to ACL injury.