Knee stiffness and viscosity: New implementation and perspectives in prosthesis development
Keywords:Infrared camera, knee viscosity and stiffness, prosthesis, pendulum test
The pendulum test is a method applied to measure passive resistance of the knee. A new and simple pendulum test with instrumentation based on infrared camera was used to evaluate knee stiffness and viscosity on a female human cadaver. The stiffness and viscosity were calculated based on the kinetic data. During the measurements, the periarticular and intraarticular soft tissue of the knee was gradually removed to determine the stiffness and viscosity as a function of the tissue removal rate. The measurements showed that the removal of tissue around the joint reduces the damping of leg oscillation, and therefore decreases the stiffness and viscosity. The contribution to knee joint damping was 10% for the skin, 20% for ligaments, and 40% for muscles and tendons. Tissue removal has a very large impact on the knee stiffness and viscosity.
Fung YC. Biomechanics: Mechanical properties of living tissues. 2nd ed. New York: Springer-Verlag; 1993. p. 254-62, 525-35. https://doi.org/10.1007/978-1-4757-2257-4.
Anthony CP, Kolthoff NJ. Textbook of anatomy and physiology. 9th ed. St. Louis: Mosby; 1975.
Buckwalter JA, Woo SL, Goldberg VM, Hadley EC, Booth F, Oegema TR, et al. Soft-tissue aging and musculoskeletal function. J Bone Joint Surg Am 1993;75(10):1533-48. https://doi.org/10.2106/00004623-199310000-00015.
Wright V, Johns RJ. Quantitative and qualitative analysis of joint stiffness in normal subjects and in patients with connective tissue diseases. Ann Rheum Dis 1961;20(1):36-46. https://doi.org/10.1136/ard.20.1.36.
Oatis CA. The use of a mechanical model to describe the stiffness and damping characteristics of the knee joint in healthy adults. Phys Ther 1993;73(11):740-9.
Blackburn JT, Riemann BL, Padua DA, Guskiewicz KM. Sex comparison of extensibility, passive, and active stiffness of the knee flexors. Clin Biomech (Bristol, Avon) 2004;19(1):36-43. https://doi.org/10.1016/j.clinbiomech.2003.09.003.
Lin CC, Ju MS, Huang HW. Gender and age effects on elbow joint stiffness in healthy subjects. Arch Phys Med Rehabil 2005;86(1):82-5. https://doi.org/10.1016/j.apmr.2003.12.027.
Ocarino JM, Fonseca ST, Silva PL, Mancini MC, Gonçalves GG. Alterations of stiffness and resting position of the elbow joint following flexors resistance training. Man Ther 2008;13(5):411-8. https://doi.org/10.1016/j.math.2007.03.009.
Dick F. Sports training principles. London: A&C Black; 1997.
Cutolo M, Masi AT. Circadian rhythms and arthritis. Rheum Dis Clin North Am 2005;31(1):115-29, ix-x. https://doi.org/10.1016/j.rdc.2004.09.005.
Cannon SC, Zahalak GI. The mechanical behavior of active human skeletal muscle in small oscillations. J Biomech 1982;15(2):111-21.
Hunter IW, Kearney RE. Dynamics of human ankle stiffness: Variation with mean ankle torque. J Biomech 1982;15(10):747-52.
Tai C, Robinson CJ. Knee elasticity influenced by joint angle and perturbation intensity. IEEE Trans Rehabil Eng 1999;7(1):111-5. https://doi.org/10.1109/86.750561.
Akazawa K, Milner TE, Stein RB. Modulation of reflex EMG and stiffness in response to stretch of human finger muscle. J Neurophysiol 1983;49(1):16-27.
Pousson M, Van Hoecke J, Goubel F. Changes in elastic characteristics of human muscle induced by eccentric exercise. J Biomech 1990;23(4):343-8. https://doi.org/10.1016/0021-9290(90)90062-8.
De Serres SJ, Milner TE. Wrist muscle activation patterns and stiffness associated with stable and unstable mechanical loads. Exp Brain Res 1991;86(2):451-8. https://doi.org/10.1007/BF00228972.
Milner TE, Cloutier C, Leger AB, Franklin DW. Inability to activate muscles maximally during cocontraction and the effect on joint stiffness. Exp Brain Res 1995;107(2):293-305. https://doi.org/10.1007/BF00230049.
Oatis CA, Wolff EF, Lennon SK. Knee joint stiffness in individuals with and without knee osteoarthritis: A preliminary study. J Orthop Sports Phys Ther 2006;36(12):935-41. https://doi.org/10.2519/jospt.2006.2320.
Tiselius P. Joint stiffness determinations in rheumatoid arthritis. Acta Rheum Scad Suppl 1969;14:5249.
Bajd T, Vodovnik L. Pendulum testing of spasticity. J Biomed Eng 1984;6(1):9-16. https://doi.org/10.1016/0141-5425(84)90003-7.
Katz RT, Rovai GP, Brait C, Rymer WZ. Objective quantification of spastic hypertonia: Correlation with clinical findings. Arch Phys Med Rehabil 1992;73(4):339-47. https://doi.org/10.1016/0003-9993(92)90007-J.
Timiras PS, Navazio FM. The skeleton, joints, and skeletal and cardiac muscles. In: Timiras PS, editor. The physiological basis for aging and geriatrics. 4th ed. New York: Informa Healthcare USA; 2007. p. 329-43. https://doi.org/10.3109/9781420007091.
Riemann BL, Lephart SM. The sensorimotor system, part I: The physiologic basis of functional joint stability. J Athl Train 2002;37(1):71-9.
Helliwell PS. Joint stiffness. In: Wright V, Radin EL, editors. Mechanics of joints: Physiology, pathophysiology and treatment. New York: Marcel Dekker; 1993. p. 203-18.
Wright V. Stiffness: A review of its measurement and physiological importance. Physiotherapy 1973;59(4):107-11.
Blanpied P, Smidt GL. Human plantarflexor stiffness to multiple single-stretch trials. J Biomech 1992;25(1):29-39. https://doi.org/10.1016/0021-9290(92)90243-T.
Wilson GJ, Wood GA, Elliott BC. The relationship between stiffness of the musculature and static flexibility: An alternative explanation for the occurrence of muscular injury. Int J Sports Med 1991;12(4):403-7.
Wartenberg R. Pendulousness of the legs as a diagnostic test. Neurology 1951;1(1):18-24. https://doi.org/10.1212/WNL.1.1.18.
Brown RA, Lawson DA, Leslie GC, MacArthur A, MacLennan WJ, McMurdo ME, et al. Does the Wartenberg pendulum test differentiate quantitatively between spasticity and rigidity? A study in elderly stroke and Parkinsonian patients. J Neurol Neurosurg Psychiatry 1988;51(9):1178-86. https://doi.org/10.1136/jnnp.51.9.1178.
Valle MS, Casabona A, Sgarlata R, Garozzo R, Vinci M, Cioni M. The pendulum test as a tool to evaluate passive knee stiffness and viscosity of patients with rheumatoid arthritis. BMC Musculoskelet Disord 2006;7:89. https://doi.org/10.1186/1471-2474-7-89.
Bohannon RW. Variability and reliability of the pendulum test for spasticity using a Cybex II isokinetic dynamometer. Phys Ther 1987;67(5):659-61.
Syczewska M, Lebiedowska MK, Pandyan AD. Quantifying repeatability of the Wartenberg pendulum test parameters in children with spasticity. J Neurosci Methods 2009;178(2):340-4. https://doi.org/10.1016/j.jneumeth.2008.12.031.
Matthews LS, Ellis D. Viscoelastic properties of cat tendon: Effects of time after death and preservation by freezing. J Biomech 1968;1(2):65-71. https://doi.org/10.1016/0021-9290(68)90008-0.
Clavert P, Kempf JF, Bonnomet F, Boutemy P, Marcelin L, Kahn JL. Effects of freezing/thawing on the biomechanical properties of human tendons. Surg Radiol Anat 2001;23(4):259-62. https://doi.org/10.1007/s00276-001-0259-8.
Bajd T, Bowman B. Testing and modelling of spasticity. J Biomed Eng 1982;4(2):90-6. https://doi.org/10.1016/0141-5425(82)90067-X.
Lin DC, Rymer WZ. A quantitative analysis of pendular motion of the lower leg in spastic human subjects. IEEE Trans Biomed Eng 1991;38(9):906-18. https://doi.org/10.1109/10.83611.
Knecht JF, Wetherbee E. Orthotic options for knee instability and pain. In: Lusardi MM, Nielsen CC, editors. Orthotics and prosthetics in rehabilitation. 2nd ed. St. Louis: Saunders; 2007. p. 333-4.
Edelstein JE, Bruckne J. Orthotics: A comprehensive clinical approach. Thorofare: Slack Inc.; 2002. p. 59-62.
Bowker JH. Transtibial amputation: Surgical management. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies. 3rd ed. Rosemont: Decade; 2004. p. 487-90.
Kapp SL, Fergason JR. Transtibial amputation: Prosthetic management. In: Smith DG, Michael JW, Bowker JH, editors. Atlas of amputations and limb deficiencies. 3rd ed. Rosemont: Decade; 2004. p. 510-1.
Bechtol CO, Ferguson AB, Laing PG. Metals and engineering. In: Bone and joint surgery. Baltimore: Williams & Wilkins; 1959. p. 1370.
Smith GK. Orthopaedic biomaterials. In: Newton DC, Nunamaker DM, editors. Textbook of small animal orthopaedics. Philadelphia, PA: JB Lippincott; 1985. p. 13.
Lu J. Orthopedic bone cement. In: Poitout DG, editor. Biomechanics and biomaterials in orthopaedics. London, UK: Springer; 2004. p. 87-8. https://doi.org/10.1007/978-1-4471-3774-0_8.
Black J. Biological performance of materials: Fundamentals of biocompatibility. 4th ed. USA: Taylor & Francis Group; 2006. p. 406-22.
Berthiaume F, Yarmush ML. Fundamentals of tissue engineering. In: Palsson B, Hubbell JA, Plonsey R, Bronzino JD, editors. Tissue engineering. Boca Raton, FL: CRC Press; 2003. p. 118-20.
Jerman UD, Kreft ME. From tissue engineering to regenerative medicine - A modern approach to the reconstruction of the urinary tract. Zdravniški Vest. 2012;81(10):735-44.