格を解剖学的特徴にしたがって表現されており 右脚膝 関節内には 10 本の靭帯と 2 本の関節包が表現されている 図 1(c) シミュレータには SIMM MusculoGraphics 社 を使用する 靭帯束の種類 Stiffness と屈曲角度が 0 の際のひずみを表 1 に示す 靭帯の自然長は屈
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1 Qi An The Analysis of Knee Ligaments Tension by Various Attachment Positions and Gait Patterns Yuki ISHIKAWA (The Univ. of Tokyo), Qi AN (The Univ. of Tokyo), Junki NAKAGAWA (The Univ. of Tokyo), Atsushi YAMASHITA (The Univ. of Tokyo), Hiroyuki OKA (The Univ. of Tokyo), and Hajime ASAMA (The Univ. of Tokyo) Abstract: Knee osteoarthritis (OA) becomes a major public issue, but a strategy to prevent the disease has not established yet due to lack of individual modeling to measure an internal motion of the knee of individual patients. Thus this study shows the effect of ligaments force by various gait patterns and the model with various ligaments position. To make accurate motion, the model include initial displacement and angle which is determined by flexion angle. Ligaments position is given based on anterior-posterior and superior-inferior displacement in sagittal plane. As a result, it can be confirmed that ligaments forces are changed by both ligaments position and gait patterns. These result show an importance of individual modeling for research of knee disease. Keywords: Knee Osteoarthritis, Knee ligament position, Gait pattern, Simulation 1 Quality of Life [1] 2530 [2] [3] Lewek [4] Ling [5] Kuroyanagi [6] Shin (ACL) [8] Shelburne [9] [7] Giron ACL [10] [7] 1(a) 1(b)
2 格を解剖学的特徴にしたがって表現されており 右脚膝 関節内には 10 本の靭帯と 2 本の関節包が表現されている 図 1(c) シミュレータには SIMM MusculoGraphics 社 を使用する 靭帯束の種類 Stiffness と屈曲角度が 0 の際のひずみを表 1 に示す 靭帯の自然長は屈曲角 度が 0 の際のひずみから式 1 にしたがって計算する L0 は靭帯の自然長を表し Le と ε は屈曲角度が 0 の 際の靭帯の長さとひずみを表している 靭帯束の種類は Blankevoort ら [11] の分け方に沿って行い Stiffness と ひずみは Shelburne ら [9] のデータを使用する なお 表 中の PCL は後十字靭帯 MCL は内側側副靭帯 LCL は外側側副靭帯 Mcap と Lcap は内外側の関節包 小 文字の a は前側部 p は後側部 c は中間部をそれぞれ 表している L0 = Le. 1+ε (1) 2.2 膝関節内運動 本研究では 歩容から靭帯への影響を正確に与えるた め 前節のシミュレーションモデルに関節運動を屈曲角 度ごとに指定する DeFrate らは生体の歩行時に X 線 連続写真を用いて膝関節内の運動を計測した [12] この 結果をモデルに反映し 前後方向 内外側方向 上下方 向 内外転 内外反の並進運動と回転運動を屈曲角度に したがって行うように設定する これにより 次章で行 う逆動力学シミュレーションにおいて 光学モーション キャプチャーのマーカデータ群からモデルにフィットす る際に 膝関節の運動を正確に表現することが可能とな る これはマーカデータ群が持っている情報において膝 関節の場合は屈曲伸展の回転運動の情報が支配的であり 他の運動が表現されないという問題点を解決するためで ある 2.3 個体差の生成 Table. 1 Bundle of ligaments, stiffness and strain. a b c d Bundle of ligamentsa Stiffness [N/strain]b Strain(ε) [-]b aacl pacl apcl ppcl amcl cmcl pmcl acmc pcmc LCL Mcapd Lcapd Blankevoort et al. [11] Shelburne et al. [9] 靭帯付着位置の個体差を表現するために 図 2 に示 すように大腿骨に靭帯が付着する位置を矢状面上で前 後上下に変化させる 矢状面とは人体を左右に分ける面 のことである Edwards らは ACL の大腿骨付着位置の 個々人によるばらつきを調べており 標準偏差が 2mm であったため 本研究でも変化を 2mm とする [13] 対 象の靭帯は前十字靭帯前側部 aacl 前十字靭帯後側 部 pacl 後十字靭帯前側部 apcl 後十字靭帯後 側部 ppcl 外側側副靭帯 LCL の 5 本とした 歩容による影響の解析 歩容の生成 前章のモデルを使用し歩行シミュレーションを行う 本研究では靭帯付着位置と歩容の影響を調べるため 逆 動力学シミュレーションを行う 歩行の軌道と床反力を 入力し 靭帯の張力を出力する シミュレーションには 先行研究で用いた左脚離地から始まる歩行一周期の正常 A deeper part of MCL An articular capsule (a) Overall (b) Coordination Fig. 1 Knee model[7]. (c) Ligaments Fig. 2 Ligament position change in sagittal plane.
![[7] Normal 25 Helen hayes 50mm Lat50 100mm Lat100 50mm Med50 100mm Med100](/docs-images/91/105382304/images/3-0.jpg "3(a) 3(b) 3(c) 4 lto lhs rto rhs 25 30 3.")
3 [7] Normal 25 Helen hayes 50mm Lat50 100mm Lat100 50mm Med50 100mm Med100 3(a) 3(b) 3(c) 4 lto lhs rto rhs Normal Med50 50mm Med mm Lat50 50mm Lat mm 5 6 aacl pacl Van de Pol ACL ACL [14] 7 8 apcl ppcl PCL 9 LCL LCL 3.3 (a) Med50 (b) Normal (c) Lat50 Fig. 3 Various gait patterns[7]. Fig. 4 Varus-Valgus knee angle in one gait cycle. ACL LCL PCL ACL LCL Lat100 PCL N A P S I 10 aacl aacl aacl 11 pacl pacl pacl
4 ACL 12 apcl apcl 13 ppcl ppcl PCL 14 LCL LCL Fig. 5 aacl forces in various gait patterns. Fig. 6 pacl forces in various gait patterns. 4 ACL PCL LCL Fig. 7 apcl forces in various gait patterns.
5 Fig. 8 ppcl forces in various gait patterns. Fig. 11 pacl forces with different ligament positions. Fig. 9 LCL forces in various gait patterns. Fig. 12 apcl forces with different ligament positions. Fig. 10 aacl forces with different ligament positions. Fig. 13 ppcl forces with different ligament positions.
6 Fig. 14 LCL forces with different ligament positions. (B) [1] March, L. M. and Bachmeier, C. J. M.: Economics of Osteoarthritis a Global Perspective, Baillieres Clinical Rheumatology, Vol. 11, No. 4, pp. 817/834 (1997). [2] Yoshimura, N., Muraki, S., Oka, H., Mabuchi, A., En-yo, Y., Yoshida, M., Saika, A., Suzuki, T., Yoshida, H., Kawaguchi, H., Nakamura, K. and Akune T.: Prevalence of Knee Osteoarthritis, Lumbar Spondylosis and Osteoporosis in Japanese Men and Women: The Research on Osteoarthritis/Osteoporosis against Disability (ROAD), Journal of Bone and Mineral Metabolism, Vol. 27, No. 5, pp. 620/628 (2009). [3] Vol. 20 No. 3 pp. 235/240 (2005) [4] Lewek, M.D., Scholz, J., Rudolph, K.S. and Snyder-Mackler, L.: Stride-to-stride Variability of Knee Motion in Patients with Knee Osteoarthritis, Gait & Posture, Vol. 23, No. 4, pp. 505/511, (2006) [5] Ling, S.M., Conwit, R.A., Talbot, L., Shermack, M., Wood, J.E., Dredge, E.M., Weeks, M.J., Abernethy, D.R. and Metter, E.J.: Electromyographic Patterns Suggest Changes in Motor Unit Physiology Associated with Early Osteoarthritis of the Knee, Osteoarthritis and Cartilage, Vol. 15, No. 10, pp. 1134/1140, (2007). [6] Kuroyanagi, Y., Nagura, T., Kiriyama, Y., Matsumoto, H., Otani, T., Toyama, Y. and Suda, Y.: A Quantitative Assessment of Varus Thrust in Patients with Medial Knee Osteoarthritis, The Knee, Vol. 19, No. 2, pp. 130/134, (2012). [7] Ishikawa, Y., An, Q., Tamura, Y., Yamashita, A., Oka, H. and Asama, H.: Effect of Mediolateral Knee Displacement on Ligaments and Muscles around Knee Joint: Quantitative Analysis with Three-dimensional Musculoskeletal Ligament Knee Model, Proceedings of the 12th International Conference on Intelligent Autonomous Systems (IAS-12), pp. 447/456 (2012). [8] Shin, C.S., Chaudhari, A.M. and Andriacchi, T.P.: The Influence of Deceleration Forces on ACL Strain during Single-leg Landing: a Simulation Study, Journal of Biomechanics, Vol. 40, No. 5, pp. 1145/1152, (2007). [9] Shelburne, K.B., Kim, H.J., Sterett, W.I. and Pandy, M.G.: Effect of Posterior Tibial Slope on Knee Biomechanics during Functional Activity, Journal of Orthopaedic Research, Vol. 29, No. 2, pp. 223/231, (2011). [10] Giron, F., Cuomo, P., Aglietti, P., Bull, A.M.J. and Amis, A.A.: Femoral Attachment of the Anterior Cruciate Ligament, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 14, No. 3, pp. 250/256, (2006). [11] Blankevoort, L., Huiskes, R. and De Lange, A.: Recruitment of Knee Joint Ligaments, Journal of Biomechanical Engineering, Vol.113, No. 1, pp. 94/103, (1991). [12] DeFrate, L.E., Papannagari, R., Gill, T.J., Moses, J.M., Pathare, N.P. and Li, G.: The 6 Degrees of Freedom Kinematics of the Knee After Anterior Cruciate Ligament Deficiency An In Vivo Imaging Analysis, The American Journal of Sports Medicine, Vol. 34, No. 8, pp. 1240/1246, (2006). [13] Edwards, A., Bull, A.M.J. and Amis, A.A.: The Attachments of the Anteromedial and Posterolateral Fibre Bundles of the Anterior Cruciate Ligament, Knee Surgery, Sports Traumatology, Arthroscopy, Vol. 16, No. 1, pp. 29/36, (2008). [14] Van de Pol, G.J., Arnold, M.P., Verdonschot, N. and van Kampen, A.: Varus Alignment Leads to Increased Forces in the Anterior Cruciate Ligament, The American Journal of Sports Medicine, Vol. 37, No. 3, pp. 481/487, (2009).
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