Experimental Methods

Three fresh-frozen cadaveric forearm specimens

were used in the study. None of the specimens
had any indication of prior forearm injury or
pathology. Each specimen was dissected on the
volar aspect of the wrist, and the wrist capsule
164 B. R. Thoomukuntla et al.
and associated ligaments were released along the
volar border of the radiocarpal joint (to allow
insertion of a pressure sensor). Each specimen
was also dissected in the mid-forearm to isolate
the flexor digitorum profundus (FDP), flexor
digitorum superficialis (FDS), and flexor pollicis
longus (FPL) tendons. All other soft tissue in the
mid-forearm was removed, and the bones were
mounted to the plastic loading fixture in neutral
rotation. A suture loop of 1-0 braided polyester
was secured to each tendon to allow load application.
A 1.25 (31.8mm) schedule 40 pipe was
placed between the fingers and the thumb, and
tape was used to maintain the digit position when
loading was not applied (Fig. 1).
Pressurex film was cut into 30mm 25mm
pieces, which were wrapped in plastic to prevent
joint fluid from obstructing the ink. Tekscan 4201
sensors were trimmed to 32mm by 23mm and
werewrappedin plastic to prevent joint fluid from
contaminating the sensors. For each experiment,
either a piece of Pressurex film or the Tekscan sensor
was placed into the radiocarpal joints. Using
a plastic pulley system and calibrated water jugs
for weights, static forces of 50 N, 30 N, and 30N
were applied the FDP, FDS, and FPL tendons,
respectively, to simulate grasp of the pipe. Because
wrist extensor tendons were not loaded, the palm
was taped to the loading fixture to prevent wrist
flexion. The load was held for about 30 seconds.
Tekscan data were recorded as soon as the applied
load was stable. The loads were released, and the
film or sensor was removed from the joint. For
each specimen, the process was repeated four or
five times for each sensor system.
Local pressure data were derived from the output
of each trial using the prior calibration curve
for the corresponding sensing system. Contact
areas were manually selected from the pressure
distributions evident from the sensing system.
The resulting data allowed for determination
of the peak contact pressure, contact area, and
contact force in the radioscaphoid joint and radiolunate
joint of each specimen with the applied
loading.
Magnetic Resonance Imaging
Two sets of MRI were performed for each specimen
without load and in the functionally
loaded state, using the same experimental setup
as above. Each specimen and loading fixture was
mounted inside a 14-cm receiving coil and placed
with the wrist at the isocenter of a 9.4T MRI scanner
(Unity INOVA; Varian Inc., Palo Alto, CA,
USA). The coil was manually tuned for each specimen.
Because each specimen size and mass was
different, coil tuning and MRI parameters were
slightly different for each specimen. The frontal
plane field of view (FOV) was generally 60mm
60mm with a 512 512 pixel array, resulting in a
resolution of 0.117mm,and the slice thicknesswas
always 1mm. Because of the large size of specimen
3, the FOV had to be set at 100mm 100mm
to prevent edge and wrap artifacts in the images,
resulting in a resolution of 0.195mm. Each image
set was obtained with a gradient echo sequence.
Four excitations or averages (NEX = 4) were
taken to improve the image signal-to-noise ratio
(SNR). The relaxation time (TR = 800 ms) and the
flip angle (45) were consistent for all specimens.
Excitation time (approximately TE = 5 ms) varied
somewhat, as the minimum excitation time
was used. Because loading shifted the specimen
slightly, the excitation time was generally different
for unloaded image sets and loaded image sets
of the same specimen.
Analysis of 3D Surface Contact Models
The image set obtained without loading was
used to construct geometric surface models of
the bones, including the cartilage surfaces. The
radius, scaphoid, and lunate bones (with cartilage)
were manually segmented in each image.
Preliminary Validation of MRI-based Modeling 165
The resulting contours were assembled, and
Nuages software was used to generate triangularfaceted
geometric surface models of the bones.13
To analyze the contact mechanics in the functionally
loaded state, the carpal bone models
(developed from the unloaded state, where the
cartilage is undeformed) must be moved to the
correct positions and orientations in the loaded
state. These kinematic transformations from the
unloaded state to the functionally loaded state
were determined using 3D voxel image registration
of the isolated bones (individual bones
without cartilage on a black background). The
radius was used as a fixed reference, so the isolated
radius from the loaded state was registered
to the isolated radius from the unloaded
state using Analyze 5.0 software. The resulting
transformation was used to transform the isolated
scaphoid image and isolated lunate image
from the loaded state into the unloaded coordinate
system. Then, the isolated carpal bones from
the unloaded state were registered to the respective
transformed carpal bones from the loaded
state, providing the final carpal kinematic transformations.
Applying the final kinematic transformations to
the scaphoid and lunate bone models places them
in the functionally loaded state. To analyze the
contact mechanics, we applied these kinematics
for the loaded state in a displacement prescribed
model in the Joint_Model program developed at
Columbia University.19 This program was used
to determine the interpenetration (overclosure) of
the bone models, which provides a direct measure
of shared cartilage deformation by the depth of
interpenetration. Because the same effective compressure
modulus (4 MPa) and cartilage thickness
(1mm) were assumed for all bones in this model,
the local cartilage deformation for each bone was
half of the value of the interpenetration.19 The
region of interpenetration directly defines the contact
area. By using a defined linear contact rule,
local contact pressures, the contact pressure distributions,
and contact force were determined for
each joint. For this study, the contact rule specifies
that contact pressure is proportional to the
interpenetration of the model surfaces,
P = E = E
d
2 t
(1)
where P is the local contact pressure, E is the
modulus of the cartilage, t is the thickness of the
cartilage on each bone, and d is the local interpenetration.
The theoretical cartilage strain, , is
the interpenetration divided by the total cartilage
thickness (2t). The contact pressure is evaluated
throughout the contact area. Integration of
the local contact pressures over the contact area
yields the total contact force for the articulating
pair. Both radioscaphoid and radiolunate contact
were evaluated using the Joint_Model program
and parameters as described to determine contact
area, peak contact pressure, and contact force.
These contact mechanics data from the models
were then compared to the corresponding data
from the experimental sensor systems.
For additional validation data, contact area was
also calculated directly from apparent contact on
each MR image. The curve of contact between
each articulating pair was carefully segmented,
and the length of the curve was calculated. The
length of each curve was multiplied by image slice
thickness to obtain contact area for each image,
and areas from all relevant images were summed
to obtain contact area. This direct measure of contact
area was compared to the model data and the
other experimental measures.
RESULTS
The MRI-based model kinematics indicated reasonable
bone motions from the unloaded to the
loaded state (Table 1). Frontal plane motions
(proximal-distal and radioulnar) were all less than
1mm. The largest motions were dorsal, and these
reached a maximum of 1.7mm for the lunate in
specimen 1. The rotations were generally quite
small, with the majority under 0.1. The largest
rotation was for the lunate in specimen 1, but
was still under 0.5. The positions and orientations
of the carpal bones for all models appeared
to be within normal anatomical limits (Fig. 2). All
of these kinematics are well within what would
be considered reasonable. The dorsal translation
is consistent with the consistently dorsal contact
from the experimental measures and seen in all of
the models.
Qualitatively, there was good correspondence
between the results of MRI-based contact modeling
and the experimental measures. The relative
size, shape, and location of radioscaphoid
and radiolunate contact areas were consistent
(Fig. 3). The location of contact on the radius
for both the scaphoid and lunate was consistently
near the dorsal rim of the radius.