Much of our understanding of the role of elbow ligaments to overall joint biomechanics has been developed through in vitro cadaver studies using joint motion simulators. The principle of superposition can be used to indirectly compute the force contributions of ligaments during prescribed motions. Previous studies have analyzed the contribution of different soft tissue structures to the stability of human elbow joints, but have limitations in evaluating the loads sustained by those tissues. This paper introduces a unique, hybrid experimental-computational technique for measuring and simulating the biomechanical contributions of ligaments to elbow joint kinematics and stability. in vitro testing of cadaveric joints is enhanced by the incorporation of fully parametric virtual ligaments, which are used in place of the native joint stabilizers to characterize the contribution of elbow ligaments during simple flexion–extension (FE) motions using the principle of superposition. Our results support previously reported findings that the anterior medial collateral ligament (AMCL) and the radial collateral ligament (RCL) are the primary soft tissue stabilizers for the elbow joint. Tuned virtual ligaments employed in this study were able to restore the kinematics and laxity of elbows to within 2 deg of native joint behavior. The hybrid framework presented in this study demonstrates promising capabilities in measuring the biomechanical contribution of ligamentous structures to joint stability.

References

References
1.
Felstead
,
A.
, and
Ricketts
,
D.
,
2017
, “
Biomechanics of the Shoulder and Elbow
,”
Orthop. Trauma
,
31
(
5
), pp.
300
305
.
2.
Hildebrand
,
K. A.
,
Patterson
,
S. D.
, and
King
,
G. J. W.
,
1999
, “
Acute Elbow Dislocations: Simple and Complex
,”
Orthop. Clin. North Am.
,
30
(
1
), pp.
63
79
.
3.
Chen
,
N. C.
, and
Ring
,
D.
,
2015
, “
Terrible Triad Injuries of the Elbow
,”
J. Hand Surg.
,
40
(
11
), pp.
2297
2303
.
4.
Morrey
,
B.
,
Sanchez-Sotelo
,
J.
, and
Morrey
,
M.
,
2017
,
The Elbow and Its Disorders
,
Elsevier Health Sciences
,
London
.
5.
Morrey
,
B. F.
, and
An
,
K.-N.
,
2005
, “
Stability of the Elbow: Osseous Constraints
,”
J. Shoulder Elbow Surg.
,
14
(
1
), pp.
S174
S178
.
6.
Morrey
,
B. F.
, and
An
,
K.
,
1983
, “
Articular and Ligamentous Contributions to the Stability of the Elbow Joint
,”
Am. J. Sports Med.
,
11
(
5
), pp.
315
319
.
7.
Regan
,
W. D.
,
Korinek
,
S. L.
,
Morrey
,
B. F.
, and
An
,
K. N.
,
1991
, “
Biomechanical Study of Ligaments Around the Elbow Joint
,”
Clin. Orthop. Relat. Res.
, 271, pp.
170
179
.
8.
Callaway
,
G. H.
,
Field
,
L. D.
,
Deng
,
X. H.
,
Torzilli
,
P. A.
,
O'Brien
,
S. J.
,
Altchek
,
D. W.
, and
Warren
,
R. F.
,
1997
, “
Biomechanical Evaluation of the Medial Collateral Ligament of the Elbow
,”
J. Bone Joint Surgery. Am.
,
79
(
8
), pp.
1223
1231
.
9.
Morrey
,
B. F.
,
Tanaka
,
S.
, and
An
,
K. N.
,
1991
, “
Valgus Stability of the Elbow: A Definition of Primary and Secondary Constraints
,”
Clin. Orthop. Relat. Res.
, 265, pp.
187
195
.
10.
Dunning
,
C. E.
,
Gordon
,
K. D.
,
King
,
G. J. W.
, and
Johnson
,
J. A.
,
2003
, “
Development of a Motion-Controlled In Vivo Elbow Testing System
,”
J. Orthop. Res.
,
21
(
3
), pp.
405
411
.
11.
Ferreira
,
L. M.
,
King
,
G. J. W.
, and
Johnson
,
J. A.
,
2017
, “
In-Vitro Quantification of Medial Collateral Ligament Tension in the Elbow
,”
J. Appl. Biomech.
,
33
(
4
), pp.
277
281
.
12.
Lewis
,
J. L.
,
Lew
,
W. D.
, and
Schmidt
,
J.
,
1982
, “
A Note on the Application and Evaluation of the Buckle Transducer for the Knee Ligament Force Measurement
,”
ASME J. Biomech. Eng.
,
104
(
2
), pp.
125
128
.
13.
Woo
,
S. L.-Y.
,
Fox
,
R. J.
,
Sakane
,
M.
,
Livesay
,
G. A.
,
Rudy
,
T. W.
, and
Fu
,
F. H.
,
1998
, “
Biomechanics of the ACL: Measurements of In Situ Force in the ACL and Knee Kinematics
,”
Knee
,
5
(
4
), pp.
267
288
.
14.
Woo
,
S. L.-Y.
,
Abramowitch
,
S. D.
,
Kilger
,
R.
, and
Liang
,
R.
,
2006
, “
Biomechanics of Knee Ligaments: Injury, Healing, and Repair
,”
J. Biomech.
,
39
(
1
), pp.
1
20
.
15.
Yoo
,
Y. S.
,
Tsai
,
A. G.
,
Ranawat
,
A. S.
,
Bansal
,
M.
,
Fu
,
F. H.
,
Rodosky
,
M. W.
, and
Smolinski
,
P.
,
2010
, “
A Biomechanical Analysis of the Native Coracoclavicular Ligaments and Their Influence on a New Reconstruction Using a Coracoid Tunnel and Free Tendon Graft
,”
Arthroscopy: J. Arthroscopic Relat. Surg.
,
26
(
9
), pp.
1153
1161
.
16.
Fisk
,
J. P.
, and
Wayne
,
J. S.
,
2009
, “
Development and Validation of a Computational Musculoskeletal Model of the Elbow and Forearm
,”
Ann. Biomed. Eng.
,
37
(
4
), pp.
803
812
.
17.
Chande
,
R. D.
,
Hargraves
,
R. H.
,
Ortiz-Robinson
,
N.
, and
Wayne
,
J. S.
,
2017
, “
Predictive Behavior of a Computational Foot/Ankle Model Through Artificial Neural Networks
,”
Comput. Math. Methods Med.
, 2017, p. 3602928.
18.
Naghibi Beidokhti
,
H.
,
Janssen
,
D.
,
van de Groes
,
S.
,
Hazrati
,
J.
,
Van den Boogaard
,
T.
, and
Verdonschot
,
N.
,
2017
, “
The Influence of Ligament Modelling Strategies on the Predictive Capability of Finite Element Models of the Human Knee Joint
,”
J. Biomech.
,
65
, pp.
1
11
.
19.
Ewing
,
J. A.
,
Kaufman
,
M. K.
,
Hutter
,
E. E.
,
Granger
,
J. F.
,
Beal
,
M. D.
,
Piazza
,
S. J.
, and
Siston
,
R. A.
,
2016
, “
Estimating Patient-Specific Soft-Tissue Properties in a TKA Knee
,”
J. Orthop. Res.
,
34
(
3
), pp.
435
443
.
20.
Shiba
,
R.
,
Sorbie
,
C.
,
Siu
,
D. W.
,
Bryant
,
J. T.
,
Cooke
,
T. D. V.
, and
Wevers
,
H. W.
,
1988
, “
Geometry of the Humeroulnar Joint
,”
J. Orthop. Res.
,
6
(
6
), pp.
897
906
.
21.
Grood
,
E. S.
, and
Suntay
,
W. J.
,
1983
, “
A Joint Coordinate System for the Clinical Description of Three-Dimensional Motions: Application to the Knee
,”
ASME J. Biomech. Eng.
,
105
(
2
), pp.
136
144
.
22.
Woo
,
S. L.
,
Johnson
,
G. A.
, and
Smith
,
B. A.
,
1993
, “
Mathematical Modeling of Ligaments and Tendons
,”
ASME J. Biomech. Eng.
,
115
(
4B
), pp.
468
473
.
23.
Blankevoort
,
L.
,
Kuiper
,
J. H.
,
Huiskes
,
R.
, and
Grootenboer
,
H. J.
,
1991
, “
Articular Contact in a Three-Dimensional Model of the Knee
,”
J. Biomech.
,
24
(
11
), pp.
1019
1031
.
24.
Dos Remedios
,
C.
,
Chantelot
,
C.
,
Migaud
,
H.
,
Le Nen
,
D.
,
Fontaine
,
C.
, and
Landjerit
,
B.
,
2003
, “
Effect of Anterior and Posterior Capsule Release on Elbow Joint Stability: An Experimental Study
,”
Revue De Chirurgie Orthopedique Et Reparatrice De L'appareil Moteur
,
89
(
8
), pp.
693
698
.
25.
Nielsen
,
K. K.
, and
Olsen
,
B. S.
,
1999
, “
No Stabilizing Effect of the Elbow Joint Capsule. A Kinematic Study
,”
Acta Orthop. Scand.
,
70
(
1
), pp.
6
8
.
26.
de Haan
,
J.
,
Schep
,
N. W. L.
,
Eygendaal
,
D.
,
Kleinrensink
,
G.-J.
,
Tuinebreijer
,
W. E.
, and
den Hartog
,
D.
,
2011
, “
Stability of the Elbow Joint: Relevant Anatomy and Clinical Implications of In Vivo Biomechanical Studies
,”
Open Orthop. J.
,
5
, pp.
168
176
.
27.
Dunning
,
C. E.
,
Zarzour
,
Z. D.
,
Patterson
,
S. D.
,
Johnson
,
J. A.
, and
King
,
G. J.
,
2001
, “
Muscle Forces and Pronation Stabilize the Lateral Ligament Deficient Elbow
,”
Clin. Orthop. Relat. Res.
, 388, pp.
118
124
.
28.
Golan
,
E. J.
,
Shukla
,
D. R.
,
Nasser
,
P.
, and
Hausman
,
M.
,
2016
, “
Isolated Ligamentous Injury Can Cause Posteromedial Elbow Instability: A Cadaveric Study
,”
J. Shoulder Elbow Surg.
,
25
(
12
), pp.
2019
2024
.
29.
Armstrong
,
A. D.
,
Dunning
,
C. E.
,
Faber
,
K. J.
,
Duck
,
T. R.
,
Johnson
,
J. A.
, and
King
,
G. J. W.
,
2000
, “
Rehabilitation of the Medial Collateral Ligament-Deficient Elbow: An In Vivo Biomechanical Study
,”
J. Hand Surg.
,
25
(
6
), pp.
1051
1057
.
30.
Morrey
,
B. F.
, and
An
,
K. N.
,
1985
, “
Functional Anatomy of the Ligaments of the Elbow
,”
Clin. Orthop. Relat. Res.
, 201, pp.
84
90
.
31.
Rahman
,
M.
,
Cil
,
A.
,
Bogener
,
J. W.
, and
Stylianou
,
A. P.
,
2016
, “
Lateral Collateral Ligament Deficiency of the Elbow Joint: A Modeling Approach
,”
J. Orthop. Res.
,
34
(
9
), pp.
1645
1655
.
32.
Sharifi Kia, D., and Willing, R., 2018, “Development of a Hybrid Computational/Experimental Framework for Evaluation of Damage Mechanisms of a Linked Semiconstrained Total Elbow System,”
J. Shoulder Elbow Surg
., 27(4), pp. 614–623.
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