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Pain is the most significant symptom of knee osteoarthritis (OA), which seriously affects the quality of life of patients. However, the cause of pain, pain relief, and targeted treatment methods are still unclear. Based on the diversified characteristics of knee pain location, this study was aimed to explore the associations between knee pain location and the mechanical properties of soft tissues in patients with knee OA. Fifteen healthy participants and 55 patients with knee OA were recruited and divided into five groups: no pain, anterior superior pain, anterior inferior pain, medial pain, and lateral pain. The Young’s moduli of the muscles, tendons, and ligaments around the knee joint were measured by shear wave elastography (SWE), and the differences between the five groups of soft tissue material properties were compared in this study. The Young’s moduli of the quadriceps tendon (QT), patellar tendon (PT), medial collateral ligament (MCL), and lateral patellar retinaculum (LPR) were strongly associated with pain location and were significantly increased compared with the other four groups, respectively. In addition, the Young’s moduli of the remaining soft tissue were not associated with pain location, and did not change significantly compared with the other four groups. This study provides data reference for the mechanical properties of soft tissue of healthy people and patients with knee OA, and provides a theoretical basis for more targeted pain relief, treatment, and rehabilitation in knee OA.

BACKGROUND The fifth and sixth cervical vertebrae (C5-C6) represent the high-risk segment requiring surgical correction in cervical spondylosis. Anterior cervical discectomy and fusion (ACDF) of C5-C6 includes an intervertebral fusion cage to maintain foraminal height and is combined with anterior plate fixation. The shape of the intervertebral cage can affect the postoperative outcome, including the rates of fusion, subsidence, and neck pain. This study aimed to use finite element (FE) parametric analysis to compare biomechanical properties of changes in intervertebral cage shape for C5-C6 cervical fusion using the anterior cervical plate and cage (ACPC) fixation system. MATERIAL AND METHODS Five shapes were designed for cervical intervertebral cages, square, oval, kidney-shaped, clover-shaped, and 12-leaf-shaped. The performance was evaluated following implantation into the validated normal C5-C6 FE model using simulation with five physiological conditions. The indicators included the maximum von Mises stress of the endplates, the fusion cages, and the cervical vertebrae. The postoperative subsidence-resistance properties were determined, including the interior stress responses of the intervertebral cages and the surrounding tissues. The fusion-promoting properties were evaluated by the interior stress responses of the bone grafts. RESULTS The optimal shape of the cervical intervertebral cage was the 12-leaf-shape for postoperative subsidence resistance. The kidney shape for the cervical intervertebral cage was optimal for postoperative fusion. CONCLUSIONS FE analysis identified the optimal cervical intervertebral cage design for ACPC fixation of C5-C6. This method may be useful for future developments in the design of spinal implants.

The ankle–foot complex in the human body is one of the major determinants in normal human walking. Most of the research study ankle and foot motion by observing people as they move, measuring desired kinematic and kinetic data indoor or outdoor, and numerical simulations in computer. However, very few studies are able to explore the fundamental mechanical principles underlying human musculoskeletal system. In this paper, we developed a three-dimension (3D) passive dynamic walker with flat feet, toes and ankle springs to investigate the impact of the ankle and toe stiffness in the walking motion. The results suggest that the ankle springs have a main impact on the walking motion, where the anterior spring, over any other position, plays a main role in providing sagittal stability. The springs from the sagittal plane control the pitch angle of the robot which impacts on its velocity and step length. The stability got worse along with the step length and velocity increasing especially when the step length overcame 8 cm. The fact that the best configuration of the ankle joint has stiffer stiffness in the sagittal plane than the coronal plane complies in nature with humans where Tibialis Anterior, Soleus and Gastrocnemius muscles are much stronger than other muscles around the ankle. Furthermore, it can be stated that the medial toe plays a more important role than the lateral one, as blocking the medial toe with the stiffest joint (rigid joint) has a negative effect on walking motion. In conclusion, we show that the ankle stiffness of the robot in anterior–posterior position should be higher than that in medial–lateral position and the stiffness in any position should exceed a minimum level to maintain walking stability. Also, adding toes (medial one should be softer than the lateral) in the foot of the robot may benefit biped locomotion especially when taking longer step length.

The overall distributions of the plantar fascia thickness and Young’s modulus in the ten subjects were systematically investigated in this paper using two-dimensional ultrasound and shear wave elastography (SWE). The statistical analyses showed that ICC1,1 of the plantar fascia thickness and Young’s modulus ranged from 0.950 to 0.991, with the 95% CI in the range of 0.953–0.996. This result indicated that the thickness and Young’s modulus exhibited excellent retest reliability. The conclusion that both the thickness, $d$ , and Young’s modulus, $E$ , of the plantar fascia showed a simple and specific spatial dependence on the characteristics of the gradient distribution can be drawn. As the plantar fascia extends from the calcaneus to the five toes, both the thickness, $d$ , and Young’s modulus, $E$ , of the five bundles of plantar fascia showed a downward trend of a negative exponential function, and the thickness, $d$ , and Young’s modulus, $E$ , were the largest at the tubercle of the calcaneus and closest to the lowest value at the tubercles of the five metatarsal bones. The coefficient of determination (R2) of the fitting curve of thickness, $d$ , and Young’s modulus, $E$ , was higher than 0.959 in all ten subjects. The distribution characteristics of the plantar fascia thickness, $d$ , and Young’s modulus, $E$ , showed good consistency in the healthy subjects in this paper. The conclusions of this paper may provide more accurate references and a basis for material mechanics data for plantar fascia diseases (such as fasciitis) and foot mechanical models (such as finite element models).

This paper aims to further our previous study to investigate the effect of speed on the human metatarsophalangeal (MP) joint kinematics during running on level ground. The 3D motion of the foot segments was captured by a twelve-camera motion analysis system, and the ground reaction forces and moments were recorded by using a six-force plate array. The relative movement between the tarsometatarsi (hindfoot) and phalanges (forefoot) segments were recorded to obtain the 3D orientation and position of the functional axis (FA) of the MP joint. The results show that the FA locates about an average of 19% foot length (FL) anterior to the anatomical axis (AA) across all running speeds, and is also 4.8% FL inferior to the AA during normal and fast run. Similar to walking, the functional axis is more oblique than the anatomical axis with a more anterior–inferior orientation across all the running speeds. This suggests that representing MP joint with the AA may mislead the calculation of joint moment/power and muscle moment arms in both running and walking gait. Compared with previous study, we found that walking and running speeds have statistically significant effects on the position of the FA. The functional axis moves frontward to a more anterior position when the speed increases during walking and running. It transfers upward in the superior direction with increasing speed of walking, but moves more toward the inferior position when the velocity increased further to running. Also, the orientation of FA in sagittal plane became more oblique toward the vertical direction as the speed increased. This may help in moderating the muscular effort, increase the muscle EMA and improve the locomotor performance. These results would contribute to understanding the in vivo biomechanical function of the MP joint and also the foot propulsion during human locomotion.

This paper presents the design, analysis, and development of an anthropomorphic robotic hand coined MCR-hand II. This hand takes the advantages of both the tendon-driven and linkage-driven systems, leading to a compact mechanical structure that aims to imitate the mobility of a human hand. Based on the investigation of the human hand anatomical structure and the related existing robotic hands, mechanical design of the MCR-hand II is presented. Then, using D-H convention, kinematics of this hand is formulated and illustrated with numerical simulations. Furthermore, fingertip force is deduced and analyzed, and mechatronic system integration and control strategy are addressed. Subsequently, a prototype of the proposed robotic hand is developed, integrated with low-level control system, and following which empirical study is carried out, which demonstrates that the proposed hand is capable of implementing the grasp and manipulation of most of the objects used in daily life. In addition, the three widely used tools, i.e., the Kapandji score test, Cutkosky taxonomy, and Kamakura taxonomy, are used to evaluate the performance of the hand, which evidences that the MCR-hand II possesses high dexterity and excellent grasping capability; object manipulation performance is also demonstrated. This paper hence presents the design and development of a type of novel tendon–linkage-integrated anthropomorphic robotic hand, laying broader background for the development of low-cost robotic hands for both industrial and prosthetic use.

During human walking, mechanical energy transfers between segments via joints. Joint mechanics of the human body are coordinated with each other to adapt to speed change. The aim of this study is to analyze the functional behaviors of major joints during walking, and how joints and segments alter walking speed during different periods (collision, rebound, preload, and push-off) of stance phase. In this study, gait experiment was performed with three different self-selected speeds. Mechanical works of joints and segments were determined with collected data. Joint function indices were calculated based on net joint work. The results show that the primary functional behaviors of joints would not change with altering walking speed, but the function indices might be changed slightly (e.g., strut functions decrease with increasing walking speed). Waist acts as strut during stance phase and contributes to keep stability during collision when walking faster. Knee of stance leg does not contribute to altering walking speed. Hip and ankle absorb more mechanical energy to buffer the strike during collision with increasing walking speed. What is more, hip and ankle generate more energy during push-off with greater motion to push distal segments forward with increasing walking speed. Ankle also produces more mechanical energy during push-off to compensate the increased heel-strike collision of contralateral leg during faster walking. Thus, human may utilize the cooperation of hip and ankle during collision and push-off to alter walking speed. These findings indicate that speed change in walking leads to fundamental changes to joint mechanics.

AIMS The purpose of this study was to detect and compare the surface temperature of plantar vessels in mild diabetic peripheral neuropathy (DPN) patients and healthy controls, to explore a simple, convenient and reliable method for early diagnosis of DPN, and to explore the influence of sex and age on vascular surface temperature. MATERIALS AND METHODS In this study, 60 mild DPN patients (30 males and 30 females) and 60 healthy volunteers were randomly recruited according to their age and sex. Intra-class correlation coefficient was used to evaluate the repeatability of skin temperature measurement in the vascular area. A general linear model was used to analyse the difference of skin temperature between mild DPN patients and healthy controls. RESULTS The infrared detection results of skin temperature corresponding to blood vessels showed excellent test-retest reliability. There was no significant difference in skin temperature between sex and age. But there were significant differences in skin temperature between mild DPN patients and healthy controls, except for the posterior tibial artery. CONCLUSIONS For mild DNP patients, in case of no obvious abnormality in the infrared detection of lower extremity arterial surface temperature, the small vessels have shown early abnormal body surface temperature, that is, the surface temperature of related vessels increased. The research conclusions of this article not only enable us to better understand the correlation between body surface temperature and hemodynamic parameters, but also provide an in vivo, non-invasive, and convenient way of thinking and methods for early diagnosis of DPN.

BACKGROUND The fifth and sixth cervical vertebra (C5-C6) is the most easily injured segment encountered in clinical practice. The anterior cervical plate and cage (ACPC) fixation system is always used to reconstruct the intervertebral height and maintain the segmental stability. The postoperative effect, such as subsidence, neck pain, and non-fusion, is greatly affected by the cervical cage structure design. This study determined reasonable structure size parameters that present optimized biomechanical properties related to the postoperative subsidence often accompanied with ACPC. MATERIAL AND METHODS Twenty bionic cages with different structural sizes (distance between the center of the cage and groove, groove depth, and groove width) were designed and analyzed based on the regression optimization design and analysis method combined with FE analysis. Because a previous study showed that greater stresses on the endplate are associated with higher risk of subsidence, the optimization object was selected as the stresses on endplate to lower it. RESULTS The postoperative stresses on the endplate of all cages with bionic structure design were proved to be lower than with the original one. The optimal structure size was the distance between the center of the cage and groove=0 mm, groove depth=3 mm, and groove width=4 mm. Regression analysis found the cage with optimized bionic structural parameters resulted in a 22.58% reduction of endplate stress response compared with the original one. CONCLUSIONS The bionic cage with optimized structural sizes can reduce the subsidence risk, suggesting that the optimization method has great potential applications in the biomechanical engineering field.

Introduction: It is well known that foot massage is a very prevalent stress relief method in China. Literatures have reported various massage-inducted peripheral nerve injuries. However, massage-inducted lateral plantar nerve (LPN) injury is very rare. Here, we represent an unusual case of massage-inducted LPN damage, and we also report the diagnostic method of this patient using musculoskeletal ultrasonography combined with electromyography (EMG). Patient concerns: A 21-year-old woman presented symptoms of redness, swelling, pain and numbness in the medial right ankle joint for 2 days. Diagnosis: The results of musculoskeletal ultrasonography and EMG provide great help for doctors to make accurate diagnosis. The patient was eventually diagnosed with LPN injury. Interventions: No further foot massage was allowed. Vitamin B12 was taken orally for 2 months. Conservative therapy, including electrical stimulation therapy and infrared therapy, was conducted. Besides, active rehabilitation training was also performed. Outcomes: The discomfort symptoms were relieved significantly after 2 months conservative treatment. Clinical symptoms and EMG examination illustrated satisfactory result during follow up time. Conclusion: The report showed that the masseur should be very careful when doing foot massage to prevent nerve damage. Besides, musculoskeletal ultrasonography combined with EMG can provide important evidence for accurate and effective diagnosis of LPN injury.

This paper aims to develop and validate a subject-specific framework for modelling the human hand. This was achieved by combining medical image-based finite element modelling, individualized muscle force and kinematic measurements. Firstly, a subject-specific human hand finite element (FE) model was developed. The geometries of the phalanges, carpal bones, wrist bones, ligaments, tendons, subcutaneous tissue and skin were all included. The material properties were derived from in-vivo and in-vitro experiment results available in the literature. The boundary and loading conditions were defined based on the kinematic data and muscle forces of a specific subject captured from the in-vivo grasping tests. The predicted contact pressure and contact area were in good agreement with the in-vivo test results of the same subject, with the relative errors for the contact pressures all being below 20%. Finally, sensitivity analysis was performed to investigate the effects of important modelling parameters on the predictions. The results showed that contact pressure and area were sensitive to the material properties and muscle forces. This FE human hand model can be used to make a detailed and quantitative evaluation into biomechanical and neurophysiological aspects of human hand contact during daily perception and manipulation. The findings can be applied to the design of the bionic hands or neuro-prosthetics in the future. Electronic supplementary material The online version of this article (10.1007/s10439-019-02439-2) contains supplementary material, which is available to authorized users.

Vertebral fractures associated with the loss of structural integrity of neoplastic vertebrae are common, and determined to the deterioration of the bone quality in the lesion area. The prediction of the fracture risk in metastatically involved spines can guide in deciding if preventive solutions, such as medical prophylaxis, bracing, or surgery are indicated for the patient. In this study, finite element models of 22 thoracolumbar vertebrae were built based on CT scans of three spines, covering a wide spectrum of possible clinical scenarios in terms of age, bone quality and degenerative features, taking into account the local material properties of bone tissue. Simulations were performed in order to investigate the effect of the size and location of the tumoral lesion, the bone quality and the vertebral level in determining the structural stability of the neoplastic vertebrae. Tumors with random size and positions were added to the models, for a total of 660 simulations in which a compressive load was simulated. Results highlighted the fundamental role of the tumor size, whereas the other parameters had a lower, but non-negligible impact on the axial collapse of the vertebra, the vertebral bulge in the transverse plane and the canal narrowing under the application of the load. All the considered parameters are radiologically measurable, and can therefore be translated in a straightforward way to the clinical practice to support decisions about preventive treatment of metastatic fractures.

Previous studies on knee biomechanics have mainly focused on the joint structure itself, largely neglecting the material properties of the muscles and connective tissues around the knee joint. Therefore, this study was purposed to conduct a systematic in vivo examination of the material properties of muscles, tendons, and ligaments, and investigated the respective influences of gender and age on the material properties. The participants were 50 healthy males and females within the following four age groups: 21-30 years, 31-40 years, 41-50 years, and above 51 years. The Young's moduli of the muscles, tendons, and ligaments around the knee joint were measured by shear wave elastography (SWE). Analysis of the Young's modulus results showed that excellent repeatability could be achieved by using SWE. For muscles, the intraclass correlation coefficient (ICC) and 95% confidence interval (CI) ranged between 0.952 and 0.987, and 0.923 and 0.992, respectively. The ICC ranged from 0.920 to 0.941, and the 95% CI was between 0.872 and 0.969 for tendons and ligaments. Additionally, the Young's moduli of the muscles, tendons, and ligaments of males were greater than those of females. With the exception for medial patellar retinaculum (MPR), the Young's moduli of other observed tissues decreased with age for both males and females, indicating that age has a significant impact on the Young's moduli of muscles, tendons, and ligaments. Hence, SWE is a reliable and repeatable technique that can be used to assess the Young's moduli of the muscles, tendons, and ligaments around the knee joint. Furthermore, gender and age affects the material properties. The results of this study provide an in vivo database of the material properties of muscles and connective tissues, and thus may prove useful for the prevention and treatment of knee joint injuries and diseases.

Important aspects of spider locomotion rely on a hydraulic mechanism. So far, this has not been theoretically analysed. In this work, the flow mechanism of a main hydraulic joint in a spider leg was studied. The purpose is to gain insight into a biohydraulic mechanism using an engineering approach to improve our understanding of the hemolymph flow path in the spider’s legs and to contribute to the theoretical analysis of the spider’s hydraulic transmission mechanism, thereby providing an inspiration for advanced biomimetic hydraulic systems. During the study, Micro-CT results were used to reconstruct the detailed flow channel. The high-pressure areas (inlet, joint, and closed leg end) and low pressures in between are also identified. Then, the internal flow field was investigated using computational fluid dynamics. At the same time, the method of dynamic mesh regeneration, elastic smoothing, is used to simulate muscle contraction and joint extension. The different functions of the channels are substantiated by the velocity profiles. Finally, a bionic hydraulic system was designed according to the trajectory of haemolymph in the flow channel.

The objective of this study was to investigate the feasibility of using shear wave elastography (SWE) to indirectly measure passive muscle force and to examine the effects of muscle mass and scan angle. We measured the Young's moduli of 24 specimens from six muscles of four swine at different passive muscle loads under different scan angles (0°, 30°, 60° and 90°) using SWE. Highly linear relationships between Young's modulus E and passive muscle force F were found for all 24 muscle specimens at 0o scan angle with coefficients of determination R2 ranging from 0.984 to 0.999. The results indicate that the muscle mass has no significant effect on the muscle E–F relationship, whereas E–F linearity decreases disproportionately with increased scan angle. These findings suggest that SWE, when carefully applied, can provide a highly reliable tool to measure muscle Young's modulus, and could be used to assess the muscle force quantitatively.

Macroscopic mechanical properties of digitigrade paw pads, such as non-linear elastic and variable stiffness, have been investigated in previous studies. However, little is known about the micro-scale structural characteristics of digitigrade paw pads or the relationship between these characteristics and the exceptional cushioning of the pads. The digitigrade paw pad consists of a multi-layered structure, which is mainly comprised of a stratified epithelium layer, a dermis layer and a subcutaneous layer. The stratified epithelium layer and dermal papillae constitute the epidermis layer. Finite element analyses were carried out and showed that the epidermis layer effectively attenuated the ground impact across impact velocities of 0.05–0.4 m/s, and that the von Mises stresses were uniformly distributed in this layer. The dermis layer encompassing the subcutaneous layer can be viewed as a hydrostatic system, which can store, release and dissipate impact energy. All three layers in the paw pad work as a whole to meet the biomechanical requirements of animal locomotion. These findings provide insights into the biomechanical functioning of digitigrade paw pads and could be used to facilitate bio-inspired, ground-contacting component development for robots and machines, as well as contribute to footwear design.

The objective of this study was to develop and validate\ud a subject-specific framework for modelling the human\ud foot. This was achieved by integrating medical image-based\ud finite element modelling, individualised multi-body musculoskeletal\ud modelling and 3D gait measurements. A 3D\ud ankle–foot finite element model comprising all major foot\ud structures was constructed based on MRI of one individual.\ud A multi-body musculoskeletal model and 3D gait measurements\ud for the same subject were used to define loading and\ud boundary conditions. Sensitivity analyses were used to investigate\ud the effects of key modelling parameters on model\ud predictions. Prediction errors of average and peak plantar\ud pressures were below 10% in all ten plantar regions at five\ud key gait events with only one exception (lateral heel, in early\ud stance, error of 14.44%). The sensitivity analyses results suggest\ud that predictions of peak plantar pressures are moderately\ud sensitive to material properties, ground reaction forces and\ud muscle forces, and significantly sensitive to foot orientation.\ud The maximum region-specific percentage change ratios\ud (peak stress percentage change over parameter percentage\ud change) were 1.935–2.258 for ground reaction forces, 1.528–\ud 2.727 for plantar flexor muscles and 4.84–11.37 for foot\ud orientations. This strongly suggests that loading and boundary conditions need to be very carefully defined based on\ud personalised measurement data.

In the panorama of available musculoskeletal modeling software, AnyBody software is a commercial tool that provides a full body musculoskeletal model which is increasingly exploited by numerous researchers worldwide. In this regard, model validation becomes essential to guarantee the suitability of the model in representing the simulated system. When focusing on lumbar spine, the previous works aimed at validating the AnyBody model in computing the intervertebral loads held several limitations, and a comprehensive validation is to be considered as lacking. The present study was aimed at extensively validating the suitability of the AnyBody model in computing lumbar spine loads at L4L5 level. The intersegmental loads were calculated during twelve specific exercise tasks designed to accurately replicate the conditions during which Wilke et al. (2001) measured in vivo the L4L5 intradiscal pressure. Motion capture data of one volunteer subject were acquired during the execution of the tasks and then imported into AnyBody to set model kinematics. Two different approaches in computing intradiscal pressure from the intersegmental load were evaluated. Lumbopelvic rhythm was compared with reference in vivo measurements to assess the accuracy of the lumbopelvic kinematics. Positive agreement was confirmed between the calculated pressures and the in vivo measurements, thus demonstrating the suitability of the AnyBody model. Specific caution needs to be taken only when considering postures characterized by large lateral displacements. Minor discrepancy was found assessing lumbopelvic rhythm. The present findings promote the AnyBody model as an appropriate tool to non-invasively evaluate the lumbar loads at L4L5 in physiological activities.

Background.Soft tissue artifact (STA) is increasingly becoming a focus of research as the skin marker method is widely employed in motion capture technique. At present, medical imaging methods provide reliable ways to investigate the cervical STA. Among these approaches, magnetic resonance imaging (MRI) is a highly preferred tool because of its low radiation.Methods.In the study, the 3D spatial location of vertebral landmarks and corresponding skin markers of the spinous processes of the second (C2), fifth (C5), and sixth (C6) cervical levels during flexion and lateral bending were investigated. A series of static postures were scanned using MRI. Skin deformation was obtained by the Mimics software.Results.Results shows that during flexion, the maximum skin deformation occurs at C6, in the superior–inferior (Z) direction. Upon lateral bending, the maximum skin displacement occurs at C2 level, in the left–right (Y) direction. The result presents variability of soft tissue in the terms of direction and magnitude, which is consistent with the prevailing opinion.Discussion.The results testified variability of cervical STA. Future studies involving large ranges of subject classification, such as age, sex, height, gravity, and etc. should be performed to completely verify the existing hypothesis on human cervical skin deformation.