Publications
360 results found
Bull AMJ, 2023, Post Mortem Human Tissue for Primary, Secondary and Tertiary Blast Injury, Blast Injury Science and Engineering A Guide for Clinicians and Researchers: Second Edition, Pages: 327-331, ISBN: 9783031103544
Blast injury studies require the ability to replicate the blast injury insult in a controlled manner. This enables the biological, physiological and physical (including anatomical) effects of blast to be understood and mitigation to be evaluated. Post mortem human tissue can be used to simulate the physical response to blast of living human tissues. Animal models are an appropriate surrogate for some physiological, biological and physical effects (Chap. 32 ‘Modelling Blast Brain Injury’ and elsewhere), although these have significant anatomical differences to human tissues. The benefits of using post mortem human tissues include anatomic fidelity and material (or tissue) response. Reservations with the use of such tissues include variability in size, shape and mechanical response, post mortem tissue changes, biohazard and storage, inability to model physiology and lack of availability. Ethical issues should also be considered and addressed. Once the experimental cadaveric model has been deemed appropriate, then it can be applied to many areas of blast injury research, with recent examples in primary, secondary and tertiary blast. This chapter outlines the benefits of using post mortem human subjects, issues with their use, and then presents a number of examples of how they can be used in blast injury research.
Bishop M, Bull AMJ, Clasper J, et al., 2023, Analysis of Explosive Events, Blast Injury Science and Engineering A Guide for Clinicians and Researchers: Second Edition, Pages: 115-131, ISBN: 9783031103544
This chapter considers the forensic investigation of explosions with three sections each outlining methods to assist the Court. In Sect. 10.1, we describe the immediate aftermath and evidence collection indicating how clinical staff caring for victims may help or hinder this process. Thereafter follow two case studies of expert panel review. Section 10.2 reports on the 2005 ‘7/7’ attacks in London. Individuals had been reported alive after the explosions but died before reaching hospital. Had any of these individuals had died from potentially survivable injury? The absence of post-mortem CT imaging made this a complex task, so weapon effects and blast over pressure for each environment were modelled and correlated to probability of survival. In Sect. 10.3, we report on the 1974 Birmingham Pub Bombings on behalf of the Coroner for the Inquests into the bombings. This required examination of reports and images that were over 40 years old. Hospitals had closed and relocated several times during the intervening period. Clinical notes other than autopsy reports could not be located. The reports available including scene photographs were used to assess injury mechanisms and correlate individual’s distance from the seat of the explosions. Contemporary publications in the open literature were matched to individual patients and used to give clinical detail.
Bull AMJ, 2023, Biomechanics in Blast, Blast Injury Science and Engineering A Guide for Clinicians and Researchers: Second Edition, Pages: 21-37, ISBN: 9783031103544
Blast injuries induce a mechanical insult to the human body at all levels. The study of the mechanics of biological systems is called biomechanics. This chapter starts at a foundational level to briefly summarise the fundamental physics of mechanics and then how to apply that to the human body through an understanding of functional anatomy and musculoskeletal dynamics.
Masouros SD, Bull AMJ, 2023, Section Overview, Blast Injury Science and Engineering A Guide for Clinicians and Researchers: Second Edition, ISBN: 9783031103544
This section presents the engineering tools that we currently have at our disposal when investigating blast injury science and engineering and notes the challenges that are yet to be addressed. This short overview describes the various areas that are addressed within the chapters of this section.
Bull AMJ, Clasper J, Mahoney PF, 2023, Blast Injury Science and Engineering A Guide for Clinicians and Researchers, Second Edition, ISBN: 9783031103544
This heavily revised second edition provides a comprehensive multi-disciplinary resource on blast injuries. It features detailed information on the basic science, engineering, and medicine associated with blast injuries. Clear, easy to understand descriptions of the basic science are accompanied by case studies of a variety of clinical problems including heterotopic ossification, hearing damage, and traumatic brain injury, enabling the reader to develop a deep understanding of how to appropriately apply the relevant science into their clinical practice. The use of prosthetics, orthotics and osseointegration in rehabilitation is also covered. Blast Injury Science and Engineering: A Guide for Clinicians and Researchers is a valuable interdisciplinary text primarily focused towards clinical medical professionals and trainees seeking to develop a thorough understanding of injury mechanisms, and the latest treatment techniques. In addition, this resource is of use to individuals in other fields whose work centres around blast injury science such as injury mitigation researchers, military scientists and engineers.
Ashworth E, Baxter D, Gibb I, et al., 2022, Injuries underbody blast fatalities: identification of five distinct mechanisms of head injury, Journal of Neurotrauma, Vol: 40, Pages: 1-7, ISSN: 0897-7151
Previous research has shown that injuries to the head and neck were prevalent in 73%of all mounted fatalities of underbody blast. The mechanisms that cause such injuries to thecentral nervous system are not yet known. The aim of this study was to identify the head andspinal injuries in fatalities due to underbody blast and then develop hypotheses on the causativemechanisms.All UK military fatalities from underbody blast who suffered a head injury from 2007-2013 in the Iraq and Afghanistan conflicts were identified retrospectively. Post-mortem CTs(PMCTs) were interrogated for injuries to the head, neck and spine. All injuries weredocumented and classified using a radiology classification. Chi-squared and Fisher’s Exacttests were used to show a relationship between variables and form a hypothesis for injurymechanisms.There were 50 fatalities from underbody blast with an associated head injury. Of these,46 had complete CTPMs available for analysis. Chi-squared and Fisher’s exact showed arelationship between lateral ventricle blood and injuries to the abdomen and thorax.Five partially overlapping injury constellations were identified:1. multiple level spinal injury with skull fracture and brainstem injury;2. perimesencephalic haemorrhage3. spinal and brainstem injury;4. parenchymal contusions with injury to C0-C1; and5. an eggshell pattern of fractures from direct impact.These injury constellations can now be used to propose injury mechanisms in order todevelop mitigation strategies or clinical treatments.
Amiri P, Bull AMJ, 2022, Prediction of in vivo hip contact forces during common activities of daily living using a segment-based musculoskeletal model, Frontiers in Bioengineering and Biotechnology, Vol: 10, ISSN: 2296-4185
Background: Quantifying in vivo hip muscle and contact forces during activities of daily living (ADL) provides valuable information for diagnosis and treatment of hip-related disorders. The objective of this study was to utilize Freebody, a segment-based musculoskeletal model, for the prediction of hip contact forces using a novel objective function during seven common ADLs and validate its performance against the publicly available HIP98 dataset.Methods: Marker data, ground reaction forces, and hip contact forces during slow, normal, and fast walking, stair ascent and descent, and standing up and sitting down were extracted for 3 subjects from the HIP98 dataset. A musculoskeletal anatomical dataset was scaled to match the dimensions of each subject, and muscle and hip contact forces were estimated by minimizing a novel objective function, which was the summation of the muscle stresses squared and body weight-normalised hip contact force. The accuracy of predictions were quantified using several metrics, and muscle forces were qualitatively compared to experimental EMGs in the literature.Results: FreeBody predicted the hip contact forces during the ADLs with encouraging accuracy: The root mean squared error of predictions were 44.0 ± 8.5, 47.4 ± 6.5, and 59.8 ± 7.1% BW during slow, normal, and fast walking, 44.2 ± 16.8% and 53.3 ± 12.2% BW for stair ascent and descent, and 31.8 ± 8.2% and 17.1 ± 5.0% BW for standing up and sitting down, respectively. The error in prediction of peak hip contact forces were 14–18%, 24–28%, 17–35% for slow, normal, and fast walking, 7–25% and 15–32% in stair ascent and descent, and around 10% for standing up and sitting down. The coefficient of determination was larger than 0.90 in all activities except in standing up (0.86 ± 0.08).Conclusion: This study has implemented a novel objective function in a segment-based musculoskeletal model, FreeBody, for
Klemt C, Toderita D, Reilly P, et al., 2022, Biceps Tenodesis cannot be used as primary treatment option in baseball pitchers with intact rotator cuff muscles, CLINICAL BIOMECHANICS, Vol: 100, ISSN: 0268-0033
Saeidi M, Barnes S, Berthaume M, et al., 2022, Low-cost locally manufacturable unilateral imperial external fixator for low- and middle-income countries, Frontiers in Medical Technology, Vol: 4, Pages: 1-8, ISSN: 2673-3129
Treating open fractures in long bones can be challenging and if not performed properly can lead to poor outcomes such as mal/non-union, deformity, and amputation. One of the most common methods of treating these fracture types is temporary external fixation followed by definitive fixation. The shortage of high-quality affordable external fixators is a long-recognised need, particularly in Low- and Middle-Income Countries (LMICs). This research aimed to develop a low-cost device that can be manufactured locally to international standards. This can provide surge capacity for conflict zones or in response to unpredictable incidents and situations. The fixator presented here and developed by us, the Imperial external fixator, was tested on femur and tibia specimens under 100 cycles of 100 N compression-tension and the results were compared with those of the Stryker Hoffmann 3 frame. The Imperial device was stiffer than the Stryker Hoffmann 3 with a lower median interfragmentary motion (of 0.94 vs. 1.48 mm). The low-cost, easy to use, relatively lightweight, and easy to manufacture (since minimum skillset and basic workshop equipment and materials are needed) device can address a critical shortage and need in LMICs particularly in conflict-affected regions with unpredictable demand and supply. The device is currently being piloted in three countries for road traffic accidents, gunshot wounds and other conflict trauma—including blast cohorts.
Goodwin JE, Bull AMJ, 2022, Novel Assessment of Isometric Hip Extensor Function: Reliability, Joint Angle Sensitivity, and Concurrent Validity, JOURNAL OF STRENGTH AND CONDITIONING RESEARCH, Vol: 36, Pages: 2762-2770, ISSN: 1064-8011
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van der Kruk E, Strutton P, Koizia LJ, et al., 2022, Why do older adults stand-up differently to young adults?: investigation of compensatory movement strategies in sit-to-walk, npj Aging, Vol: 8, ISSN: 2731-6068
Functional motor redundancy enables humans to move with distinct muscle activation patterns while achieving a similar outcome. Since humans select similar strategies, there seems to be an optimal control. However, older adults move differently to young adults. The question is whether this is this due to an altered reinforcement scheme, altered sensory inputs, or due to alterations in the neuromusculoskeletal systems, so that it is no longer optimal or possible to execute the same movement strategies. The aim of this study was to analyse natural compensation strategies in the vital daily-life-task, sit-to-walk, in relation to neuromuscular capacity and movement objectives in younger (27.2 ± 4.6 years, N = 27, 14♀) and elderly (75.9 ± 6.3 years, N = 23, 12♀) adults. Aspects of the neuromuscular system that are prone to age-related decline and feasible to quantify were assessed (i.e. strength, nerve conductivity, fear of falling). Kinematics and muscle activity were recorded and joint kinetics were estimated using biomechanical models. Elderly men consistently used their arms when standing up. This strategy was not associated with a lack of or a reduction in strength, but with a reduction, but no lack of, ankle joint range of motion, and with increased fear of falling. The results show that humans preferentially maintain a minimum threshold of neuromuscular reserve to cope with uncertainties which results in compensation prior to coming up against physical limitations. Smaller base of support while standing up, a compensatory strategy with possibly greater risk of falls, was associated with muscular weakness, and longer nerve conduction latencies.
Weinberg PDD, Schroter RCC, Parker KHH, et al., 2022, In Memoriam: Colin Caro 1925-2022, JOURNAL OF BIOMECHANICAL ENGINEERING-TRANSACTIONS OF THE ASME, Vol: 144, ISSN: 0148-0731
Dyball D, Bennett AN, Schofield S, et al., 2022, Post-traumatic growth amongst UK armed forces personnel who were deployed to Afghanistan and the role of combat injury, mental health and pain: the ADVANCE cohort study, PSYCHOLOGICAL MEDICINE, ISSN: 0033-2917
Dyball D, Bennett A, Schofield S, et al., 2022, Mental health outcomes of male UK military personnel deployed to Afghanistan and the role of combat-injury: The ADVANCE cohort study, The Lancet Psychiatry, Vol: 9, Pages: 547-554, ISSN: 2215-0366
Background: The long-term psychosocial outcomes of UK Armed Forces personnel who sustained serious combat-injuries during deployment to Afghanistan are largely unknown. This study hypothesised that the rates of probable Post Traumatic Stress Disorder (PTSD), depression, anxiety and mental health multimorbidity will be greater among a representative sample of ex-/serving military personnel with combat injuries compared to a matched sample of uninjured ex-/serving military personnel.Methods: 579 combat-injured and a comparison group of 565 uninjured male UK Armed Forces ex-/serving personnel, frequency-matched by age, rank, regiment, deployment, and role on deployment were included in this analysis. Participants had a median age of 33 (IQR 30, 37) at time of assessment. 90·3% identified as white and 9·7% were from all other ethnic groups. Participants completed a comprehensive health assessment including both physical health assessment and self-reported mental health measures.Results: The rates of PTSD (16·9% vs 10·5%; Adjusted Odds Ratio (AOR) 1·67 (95% Confidence Interval (CI) 1·16, 2·41), depression (23·6% vs 16·8%; AOR 1·46 (95%CI 1·08, 2·03), anxiety (20·8% vs 13·5%; AOR 1·56 (95%CI 1·13, 2·24) and mental health multimorbidity (15·3% vs 9·8%; AOR 1·62 (95%CI 1·12, 2·49) were greater in the injured versus uninjured group respectively. Minimal differences in odds of reporting any poor mental health outcome were noted between the amputation injury subgroup and the uninjured group, whereas up to double the odds were noted for the non-amputation injury subgroup.Interpretation: Serious physical combat-injuries are associated with poor mental health outcomes. However, type of injury influences this relationship. Regardless of injury, this cohort represents a group who present with greater rates of PTSD compared to the
Sargent W, Bull AMJ, Gibb I, 2022, Focused Assessment with Sonography in Trauma (FAST) performance in paediatric conflict injury, CLINICAL RADIOLOGY, Vol: 77, Pages: 529-534, ISSN: 0009-9260
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Boos C, Schofield S, Cullinan P, et al., 2022, Association between combat-related traumatic injury and cardiovascular risk, Heart, Vol: 108, Pages: 367-374, ISSN: 1355-6037
Objective The association between combat-related traumatic injury (CRTI) and cardiovascular risk is uncertain. This study aimed to investigate the association between CRTI and both metabolic syndrome (MetS) and arterial stiffness.Methods This was a prospective observational cohort study consisting of 579 male adult UK combat veterans (UK-Afghanistan War 2003–2014) with CRTI who were frequency-matched to 565 uninjured men by age, service, rank, regiment, deployment period and role-in-theatre. Measures included quantification of injury severity (New Injury Severity Score (NISS)), visceral fat area (dual-energy X-ray absorptiometry), arterial stiffness (heart rate-adjusted central augmentation index (cAIx) and pulse wave velocity (PWV)), fasting venous blood glucose, lipids and high-sensitivity C reactive protein (hs-CRP).Results Overall the participants were 34.1±5.4 years, with a mean (±SD) time from injury/deployment of 8.3±2.1 years. The prevalence of MetS (18.0% vs 11.8%; adjusted risk ratio 1.46, 95% CI 1.10 to 1.94, p<0.0001) and the mean cAIx (17.61%±8.79% vs 15.23%±8.19%, p<0.0001) were higher among the CRTI versus the uninjured group, respectively. Abdominal waist circumference, visceral fat area, triglycerides, estimated insulin resistance and hs-CRP levels were greater and physical activity and high-density lipoprotein-cholesterol lower with CRTI. There were no significant between-group differences in blood glucose, blood pressure or PWV. CRTI, injury severity (↑NISS), age, socioeconomic status (SEC) and physical activity were independently associated with both MetS and cAIx.Conclusions CRTI is associated with an increased prevalence of MetS and arterial stiffness, which are also influenced by age, injury severity, physical activity and SEC. The longitudinal impact of CRTI on clinical cardiovascular events needs further examination.
Hazell GA, Pearce AP, Hepper AE, et al., 2022, Injury scoring systems for blast injuries: a narrative review, British Journal of Anaesthesia, Vol: 128, Pages: e127-e134, ISSN: 0007-0912
Injury scoring systems can be used for triaging, predicting morbidity and mortality, and prognosis in mass casualty incidents. Recent conflicts and civilian incidents have highlighted the unique nature of blast injuries, exposing deficiencies in current scoring systems. Here, we classify and describe deficiencies with current systems used for blast injury. Although current scoring systems highlight survival trends for populations, there are several major limitations. The reliable prediction of mortality on an individual basis is inaccurate. Other limitations include the saturation effect (where scoring systems are unable to discriminate between high injury score individuals), the effect of the overall injury burden, lack of precision in discriminating between mechanisms of injury, and a lack of data underpinning scoring system coefficients. Other factors influence outcomes, including the level of healthcare and the delay between injury and presentation. We recommend that a new score incorporates the severity of injuries with the mechanism of blast injury. This may include refined or additional codes, severity scores, or both, being added to the Abbreviated Injury Scale for high-frequency, blast-specific injuries; weighting for body regions associated with a higher risk for death; and blast-specific trauma coefficients. Finally, the saturation effect (maximum value) should be removed, which would enable the classification of more severe constellations of injury. An early accurate assessment of blast injury may improve management of mass casualty incidents.
Urbanczyk CA, Bonfiglio A, McGregor AH, et al., 2021, Comparing optical and electromagnetic tracking systems to facilitate compatibility in sports kinematics data., International Biomechanics, Vol: 8, Pages: 75-84, ISSN: 2333-5432
Electromagnetic (EM) tracking has been used to quantify biomechanical parameters of the lower limb and lumbar spine during ergometer rowing to improve performance and reduce injury. Optical motion capture (OMC) is potentially better suited to measure comprehensive whole-body dynamics in rowing. This study compared accuracy and precision of EM and OMC displacements by simultaneously recording kinematics during rowing trials at low, middle, and high rates on an instrumented ergometer (n=12). Trajectories calculated from OMC and EM sensors attached to the pelvis, lumbar spine, and right leg were highly correlated, but EM tracking lagged behind ergometer and OMC tracking by approximately 6%, yielding large RMS errors. When this phase-lag was corrected by least squares minimization, agreement between systems improved. Both systems demonstrated an ability to adequately track large dynamic compound movements in the sagittal plane but struggled at times to precisely track small displacements and narrow angular ranges in medial/lateral and superior/inferior directions. An OMC based tracking methodology can obtain equivalence with a previously validated EM system, for spine and lower limb metrics. Improvements in speed and consistency of data acquisition with OMC are beneficial for dynamic motion studies. Compatibility ensures continuity by maintaining the ability to compare to prior work.
Boos CJ, Schofield S, Cullinan P, et al., 2021, The Relationship Between Combat-related Traumatic Injury and Cardiometabolic Risk, Annual Scientific Sessions of the American-Heart-Association / Resuscitation Science Symposium, Publisher: LIPPINCOTT WILLIAMS & WILKINS, ISSN: 0009-7322
Toderita D, Henson D, Klemt C, et al., 2021, An anatomical atlas-based scaling study for quantifying muscle and hip joint contact forces in above and through-knee amputees using validated musculoskeletal modelling, IEEE Transactions on Biomedical Engineering, Vol: 68, Pages: 3447-3456, ISSN: 0018-9294
Objective: Customisation of musculoskeletal modelling using magnetic resonance imaging (MRI) significantly improves the model accuracy, but the process is time consuming and computationally intensive. This study hypothesizes that linear scaling to a lower limb amputee model with anthropometric similarity can accurately predict muscle and joint reaction forces. Methods: An MRI-based anatomical atlas, comprising 18 trans-femoral and through-knee traumatic lower limb amputee models, is developed. Gait data, using a 10-camera motion capture system with two force plates, and surface electromyography (EMG) data were collected. Muscle and hip joint contact forces were quantified using musculoskeletal modelling. The predicted muscle activations from the subject-specific models were validated using EMG recordings. Anthropometry based multiple linear regression models, which minimize errors in force predictions, are presented. Results: All predictions showed excellent (error interval c=00.15), very good (c=0.150.30) or good (c=0.300.45) similarity to the recorded EMG data, demonstrating that the models accurately computed muscle activations. The primary predictors of discrepancies in force predictions were differences in pelvis width (p<0.001), body mass index (BMI, p<0.001) and stump length to pelvis width ratio (p<0.001) between the respective individual and underlying dataset. Conclusion: Linear scaling to a model with the most similar pelvis width, BMI and stump length to pelvis width ratio results in modelling outcomes with minimal errors. Significance: This study provides robust tools to perform accurate analyses of musculoskeletal mechanics for high-functioning lower limb military amputees, thus facilitating the further understanding and improvement of the amputee's function.
Bin Abd Razak H, Chew D, Kazezian Z, et al., 2021, Autologous protein solution - a promising solution for osteoarthritis?, EFORT Open Reviews, Vol: 6, Pages: 716-726, ISSN: 2396-7544
Henson DP, Edgar C, Ding Z, et al., 2021, Understanding lower limb muscle volume adaptations to amputation., Journal of Biomechanics, Vol: 125, Pages: 1-8, ISSN: 0021-9290
Amputation of a major limb, and the subsequent return to movement with a prosthesis, requires the development of compensatory strategies to account for the loss. Such strategies, over time, lead to regional muscle atrophy and hypertrophy through chronic under or overuse of muscles compared to uninjured individuals. The aim of this study was to quantify the lower limb muscle parameters of persons with transtibial and transfemoral amputations using high resolution MRI to ascertain muscle volume and to determine regression equations for predicting muscle volume using femur- and tibia-length, pelvic-width, height, and mass. Twelve persons with limb loss participated in this study and their data were compared to six matched control subjects. Subjects with unilateral transtibial amputation showed whole-limb muscle volume loss in the residual-limb, whereas minor volume changes in the intact limb were found, providing evidence for a compensation strategy that is dominated by the intact-limb. Subjects with bilateral-transfemoral amputations showed significant muscle volume increases in the short adductor muscles with an insertion not affected by the amputation, the hip flexors, and the gluteus medius, and significant volume decreases in the longer adductor muscles, rectus femoris, and hamstrings. This study presents a benchmark measure of muscle volume discrepancies in persons with limb-loss, and can be used to understand the compensation strategies of persons with limb-loss and the impact on muscle volume, thus enabling the development of optimised intervention protocols, conditioning therapies, surgical techniques, and prosthetic devices that promote and enhance functional capability within the population of persons with limb loss.
Yeh C, Calder J, Antflick J, et al., 2021, Maximum dorsiflexion increases Achilles tendon force during exercise for midportion Achilles tendinopathy, Scandinavian Journal of Medicine and Science in Sports, Vol: 31, Pages: 1674-1682, ISSN: 0905-7188
Rehabilitation is an important treatment for non-insertional Achilles tendinopathy. To date, eccentric loading exercises (ECC) have been the predominant choice; however, mechanical evidence underlying their use remains unclear. Other protocols, such as heavy slow resistance loading (HSR), have shown comparable outcomes, but with less training time. This study aims to identify the effect of external loading and other variables that influence Achilles tendon (AT) force in ECC and HSR. Ground reaction force and kinematic data during ECC and HSR were collected from 18 healthy participants for four loading conditions. The moment arms of the AT were estimated from MRIs of each participant. AT force then was calculated using the ankle torque obtained from inverse dynamics. In the eccentric phase, the AT force was not larger than in the concentric phase in both ECC and HSR. Under the same external load, the force through the AT was larger in ECC with the knee bent than in HSR with the knee straight due to increased dorsiflexion angle of the ankle. Multivariate regression analysis showed that external load and maximum dorsiflexion angle were significant predictors of peak AT force in both standing and seated positions. Therefore, to increase the effectiveness of loading the AT, exercises should apply adequate external load and reach maximum dorsiflexion during the movement. Peak dorsiflexion angle affected the AT force in a standing position at twice the rate of a seated position, suggesting standing could prove more effective for the same external loading and peak dorsiflexion angle.
Berthaume MA, Bull AMJ, 2021, Cyamella (a popliteal sesamoid bone) prevalence: a systematic review, meta-analysis, and proposed classification system, Clinical Anatomy, Vol: 34, Pages: 810-820, ISSN: 0897-3806
INTRODUCTION: The cyamella is a rare, generally asymptomatic, knee sesamoid bone located in the proximal tendon of the popliteal muscle. Only two studies have investigated cyamella presence/absence in humans, putting ossified prevalence rates at 0.57-1.8%. We aim to 1) determine cyamella prevalence in a Korean population, 2) examine coincident development of the cyamella and fabella, and 3) perform a systematic review and meta-analysis on the cyamella in humans. MATERIALS AND METHODS: Medical computed tomography scans of 106 individuals were reviewed. A systematic review and meta-analysis were performed following PRISMA guidelines. RESULTS: Cyamellae were found in 3/212 knees (1.4%), and presence/absence was uncorrelated to height, age, and sex. The cyamella was not found coincidentally with the fabella, although the statistical power was low. Our systematic review/meta-analysis revealed cyamellae were generally asymptomatic and ossification could occur at 14 years. Cyamellae were equally likely to be found in both sexes, knees, one or both knees, and there appeared to be no global variation in prevalence rates. Cyamellae were found in three distinct locations. CONCLUSIONS: There is little support for the role of intrinsic genetic and/or environmental factors in cyamella development in humans. However, the apparent phylogenetic signal in Primates suggests genetics plays a role in cyamella development. We propose a cyamella classification system based on cyamella location (Class I, popliteal sulcus; Class II, tibial condyle; Class III, fibular head) and hypothesize locations may correspond to distinct developmental pathways, and cyamella function may vary with location. This article is protected by copyright. All rights reserved.
van Der Kruk E, Silverman AK, Reilly P, et al., 2021, Compensation due to age-related decline in sit-to-stand and sit-to-walk, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290
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van der Kruk E, Silverman AK, Koizia L, et al., 2021, Age-related compensation: Neuromusculoskeletal capacity, reserve & movement objectives, JOURNAL OF BIOMECHANICS, Vol: 122, ISSN: 0021-9290
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Rebelo EA, Grigoriadis G, Carpanen D, et al., 2021, An experimentally validated finite element model of the lower limb to investigate the efficacy of blast mitigation systems, Frontiers in Bioengineering and Biotechnology, Vol: 9, ISSN: 2296-4185
Improvised explosive devices (IEDs) used in the battlefield cause damage to vehicles and their occupants. The injury burden to the casualties is significant. The biofidelity and practicality of current methods for assessing current protection to reduce the injury severity is limited. In this study, a finite-element (FE) model of the leg was developed and validated in relevant blast-loading conditions, and then used to quantify the level of protection offered by a combat boot. An FE model of the leg of a 35 years old male cadaver was developed. The cadaveric leg was tested physically in a seated posture using a traumatic injury simulator and the results used to calibrate the FE model. The calibrated model predicted hindfoot forces that were in good correlation (using the CORrelation and Analysis or CORA tool) with data from force sensors; the average correlation and analysis rating (according to ISO18571) was 0.842. The boundary conditions of the FE model were then changed to replicate pendulum tests conducted in previous studies which impacted the leg at velocities between 4 and 6.7 m/s. The FE model results of foot compression and peak force at the proximal tibia were within the experimental corridors reported in the studies. A combat boot was then incorporated into the validated computational model. Simulations were run across a range of blast-related loading conditions. The predicted proximal tibia forces and associated risk of injury indicated that the combat boot reduced the injury severity for low severity loading cases with higher times to peak velocity. The reduction in injury risk varied between 6 and 37% for calcaneal minor injuries, and 1 and 54% for calcaneal major injuries. No injury-risk reduction was found for high severity loading cases. The validated FE model of the leg developed here was able to quantify the protection offered by a combat boot to vehicle occupants across a range of blast-related loading conditions. It can now be used as a design an
Ding Z, Jarvis H, Bennett A, et al., 2021, Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees: a pilot study, Journal of Orthopaedic Research, Vol: 39, Pages: 850-860, ISSN: 0736-0266
High functioning military transtibial amputees (TTAs) with well‐fitted state of the art prosthetics have gait that is indistinguishable from healthy individuals, yet they are more likely to develop knee osteoarthritis (OA) of their intact limbs. This contrasts with the information at the knees of the amputated limbs that have been shown to be at a significantly reduced risk of pain and OA. The hypothesis of this study is that biomechanics can explain the difference in knee OA risk. Eleven military unilateral TTAs and eleven matched healthy controls underwent gait analysis. Muscle forces and joint contact forces at the knee were quantified using musculoskeletal modeling, validated using electromyography measurements. Peak knee contact forces for the intact limbs on both the medial and lateral compartments were significantly greater than the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peak semimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces compared to the controls. This study has for the first time provided robust evidence of increased force on the non‐affected knees of high functioning TTAs that supports the mechanically based hypothesis to explain the documented higher risk of knee OA in this patient group. The results suggest several protentional strategies to mitigate knee OA of the intact limbs, which may include the improvements of the prosthetic foot control, socket design, and strengthening of the amputated muscles.
Kazezian Z, Yu X, Ramette M, et al., 2021, Development of a rodent high energy blast injury model for investigating conditions associated with traumatic amputations, Bone and Joint Research, Vol: 10, Pages: 1-8, ISSN: 2046-3758
In recent conflicts, most injuries to the extremities are due to blast resulting in a large number of lower limb amputations. These lead to heterotopic ossification (HO), phantom limb pain (PLP), and functional deficit. The mechanism of blast loading produces a combined facture and amputation. Therefore, to study these conditions, in vivo models that replicate this combined effect are required. The aim of this study is to develop a preclinical model of blast-induced lower limb amputation.
Smith SHL, Coppack RJ, van den Bogert AJ, et al., 2021, Review of musculoskeletal modelling in a clinical setting: Current use in rehabilitation design, surgical decision making and healthcare interventions, Clinical Biomechanics, Vol: 83, Pages: 1-9, ISSN: 0268-0033
BackgroundMusculoskeletal modelling is a common means by which to non-invasively analyse movement. Such models have largely been used to observe function in both healthy and patient populations. However, utility in a clinical environment is largely unknown. The aim of this review was to explore existing uses of musculoskeletal models as a clinical intervention, or decision-making, tool.MethodsA literature search was performed using PubMed and Scopus to find articles published since 2010 and relating to musculoskeletal modelling and joint and muscle forces.Findings4662 abstracts were found, of which 39 relevant articles were reviewed. Journal articles were categorised into 5 distinct groups: non-surgical treatment, orthoses assessment, surgical decision making, surgical intervention assessment and rehabilitation regime assessment. All reviewed articles were authored by collaborations between clinicians and engineers/modellers. Current uses included insight into the development of osteoarthritis, identifying candidates for hamstring lengthening surgery, and the assessment of exercise programmes to reduce joint damage.InterpretationThere is little evidence showing the use of musculoskeletal modelling as a tool for patient care, despite the ability to assess long-term joint loading and muscle overuse during functional activities, as well as clinical decision making to avoid unfavourable treatment outcomes. Continued collaboration between model developers should aim to create clinically-friendly models which can be used with minimal input and experience by healthcare professionals to determine surgical necessity and suitability for rehabilitation regimes, and in the assessment of orthotic devices.
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