{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:33:17Z","timestamp":1760149997142,"version":"build-2065373602"},"reference-count":40,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T00:00:00Z","timestamp":1696550400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"KU Leuven Interdisciplinary Network (ID-N) funding program","award":["IDN\/19\/033"],"award-info":[{"award-number":["IDN\/19\/033"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Sensors"],"abstract":"<jats:p>Ultrasound-based ligament strain estimation shows promise in non-invasively assessing knee joint collateral ligament behavior and improving ligament balancing procedures. However, the impact of ultrasound-based strain estimation residual errors on in-silico arthroplasty predictions remains unexplored. We investigated the sensitivity of post-arthroplasty kinematic predictions to ultrasound-based strain estimation errors compared to clinical inaccuracies in implant positioning.Two cadaveric legs were submitted to active squatting, and specimen-specific rigid computer models were formulated. Mechanical properties of the ligament model were optimized to reproduce experimentally obtained tibiofemoral kinematics and loads with minimal error. Resulting remaining errors were comparable to the current state-of-the-art. Ultrasound-derived strain residual errors were then introduced by perturbing lateral collateral ligament (LCL) and medial collateral ligament (MCL) stiffness. Afterwards, the implant position was perturbed to match with the current clinical inaccuracies reported in the literature. Finally, the impact on simulated post-arthroplasty tibiofemoral kinematics was compared for both perturbation scenarios. Ultrasound-based errors minimally affected kinematic outcomes (mean differences &lt; 0.73\u00b0 in rotations, 0.1 mm in translations). Greatest differences occurred in external tibial rotations (\u22120.61\u00b0 to 0.73\u00b0 for MCL, \u22120.28\u00b0 to 0.27\u00b0 for LCL). Comparatively, changes in implant position had larger effects, with mean differences up to 1.95\u00b0 in external tibial rotation and 0.7 mm in mediolateral translation. In conclusion, our study demonstrated that the ultrasound-based assessment of collateral ligament strains has the potential to enhance current computer-based pre-operative knee arthroplasty planning.<\/jats:p>","DOI":"10.3390\/s23198268","type":"journal-article","created":{"date-parts":[[2023,10,6]],"date-time":"2023-10-06T08:29:12Z","timestamp":1696580952000},"page":"8268","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Sensitivity of Model-Based Predictions of Post-TKA Kinematic Behavior to Residual Errors in Ultrasound-Based Knee Collateral Ligament Strain Assessment"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8852-5052","authenticated-orcid":false,"given":"F\u00e9lix","family":"Dandois","sequence":"first","affiliation":[{"name":"Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Or\u00e7un","family":"Taylan","sequence":"additional","affiliation":[{"name":"Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacobus H.","family":"M\u00fcller","sequence":"additional","affiliation":[{"name":"ReSurg SA, Rue Saint-Jean 22, 1260 Nyon, Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lennart","family":"Scheys","sequence":"additional","affiliation":[{"name":"Institute for Orthopaedic Research and Training (IORT), Development and Regeneration Department, KU Leuven, 49 Herestraat, 3000 Leuven, Belgium"},{"name":"Department of Orthopaedics, University Hospitals Leuven, 49 Herestraat, 3000 Leuven, Belgium"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,6]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1664","DOI":"10.1016\/j.joca.2015.05.008","article-title":"Utilization rates of knee-arthroplasty in OECD countries","volume":"23","author":"Pabinger","year":"2015","journal-title":"Osteoarthr. Cartil."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.arth.2013.03.034","article-title":"Comparison of outcomes and survivorship between patients of different age groups following TKA","volume":"28","author":"McCalden","year":"2013","journal-title":"J. Arthroplast."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1016\/j.arth.2013.07.024","article-title":"Why Are Total Knee Arthroplasties Failing Today\u2014Has Anything Changed After 10 Years?","volume":"29","author":"Sharkey","year":"2014","journal-title":"J. Arthroplast."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1007\/s11999-014-3540-y","article-title":"Current modes of failure in TKA: Infection, instability, and stiffness predominate","volume":"472","author":"Le","year":"2014","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1333","DOI":"10.1302\/0301-620X.96B10.34068","article-title":"Increased satisfaction after total knee replacement using sensor-guided technology","volume":"96","author":"Gustke","year":"2014","journal-title":"Bone Jt. J."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"334","DOI":"10.1016\/j.artd.2019.07.003","article-title":"Imageless, robotic-assisted total knee arthroplasty combined with a robotic tensioning system can help predict and achieve accurate postoperative ligament balance","volume":"5","author":"Shalhoub","year":"2019","journal-title":"Arthroplast. Today"},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Matsuda, S., Lustig, S., and van der Merwe, W. (2017). Soft Tissue Balancing in Total Knee Arthroplasty, Springer.","DOI":"10.1007\/978-3-662-54082-4"},{"key":"ref_8","unstructured":"Callaghan, J.J. (2003). The Adult Knee, Lippincott Williams & Wilkins."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/S0268-0033(97)00072-7","article-title":"Finite element analysis of human knee joint in varus-valgus","volume":"12","author":"Bendjaballah","year":"1997","journal-title":"Clin. Biomech."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/j.artd.2020.12.022","article-title":"Improved Compartment Balancing Using Robot-Assisted Total Knee Arthroplasty","volume":"7","author":"Held","year":"2021","journal-title":"Arthroplast. Today"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"3585","DOI":"10.1007\/s00167-020-06283-z","article-title":"MAKO CT-based robotic arm-assisted system is a reliable procedure for total knee arthroplasty: A systematic review","volume":"29","author":"Batailler","year":"2020","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_12","doi-asserted-by":"crossref","unstructured":"Kinney, A.L., Besier, T.F., D\u2019Lima, D.D., and Fregly, B.J. (2013). Update on Grand Challenge Competition to Predict in Vivo Knee Loads. J. Biomech. Eng., 135.","DOI":"10.1115\/1.4023255"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1002\/jor.22023","article-title":"Grand challenge competition to predict in vivo knee loads","volume":"30","author":"Fregly","year":"2012","journal-title":"J. Orthop. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"14","DOI":"10.1123\/jab.2017-0067","article-title":"Non-uniform deformation of the patellar tendon during passive knee flexion","volume":"34","author":"Slane","year":"2017","journal-title":"J. Appl. Biomech."},{"key":"ref_15","unstructured":"Slane, L.C. (2014). Achilles Tendon Elasticity and Deformation Patterns in Young and Middle-Aged Adults Evaluated Using Quantitative Ultrasound Approaches. [Ph.D. Thesis, University of Wisconsin-Madison]."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1016\/j.medengphy.2015.04.004","article-title":"Achilles tendon displacement patterns during passive stretch and eccentric loading are altered in middle-aged adults","volume":"37","author":"Slane","year":"2015","journal-title":"Med. Eng. Phys."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1016\/j.jbiomech.2017.07.020","article-title":"The challenges of measuring in vivo knee collateral ligament strains using ultrasound","volume":"61","author":"Slane","year":"2017","journal-title":"J. Biomech."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"233","DOI":"10.1016\/j.jbiomech.2018.03.035","article-title":"Strain imaging of the lateral collateral ligament using high frequency and conventional ultrasound imaging: An ex-vivo comparison","volume":"73","author":"Gijsbertse","year":"2018","journal-title":"J. Biomech."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Dandois, F., Taylan, O., Bellemans, J., D\u2019hooge, J., Vandenneucker, H., Slane, L., and Scheys, L. (2021). Validated Ultrasound Speckle Tracking Method for Measuring Strains of Knee Collateral Ligaments In-Situ during Varus\/Valgus Loading. Sensors, 21.","DOI":"10.3390\/s21051895"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1097\/CORR.0000000000001169","article-title":"Does Unicondylar Knee Arthroplasty Affect Tibial Bone Strain? A Paired Cadaveric Comparison of Fixed- and Mobile-bearing Designs","volume":"478","author":"Peersman","year":"2020","journal-title":"Clin. Orthop. Relat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1302\/0301-620X.104B1.BJJ-2021-0121.R2","article-title":"Assessment of in vivo bone activity patterns in medial mobile-bearing unicompartmental knee arthroplasty","volume":"104","author":"Beckers","year":"2022","journal-title":"Bone Jt. J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1007\/s00167-016-4414-5","article-title":"Kinematics of a bicruciate-retaining total knee arthroplasty","volume":"25","author":"Heyse","year":"2017","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Shah, D.S., Taylan, O., Verstraete, M., Berger, P., Vandenneucker, H., and Scheys, L. (2021). Can Intraoperative Intra-Articular Loads Predict Postoperative Knee Joint Laxity Following Total Knee Arthroplasty? A Cadaver Study with Smart Tibial Trays. Sensors, 21.","DOI":"10.3390\/s21155078"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1115\/1.3138397","article-title":"A joint coordinate system for the clinical description of three-dimensional motions: Application to the knee","volume":"105","author":"Grood","year":"1983","journal-title":"J. Biomech. Eng."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"150","DOI":"10.2106\/JBJS.I.00498","article-title":"An Experimental Model for Kinematic Analysis of the Knee","volume":"91","author":"Victor","year":"2009","journal-title":"J. Bone Jt. Surg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1080\/10255842.2020.1761960","article-title":"Prediction of patellofemoral joint kinematics and contact through co-simulation of rigid body dynamics and nonlinear finite element analysis","volume":"23","author":"Razu","year":"2020","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_27","first-page":"549","article-title":"Computational modelling of mobile bearing TKA anterior\u2013posterior dislocation","volume":"19","author":"Zakaria","year":"2015","journal-title":"Comput. Methods Biomech. Biomed. Eng."},{"key":"ref_28","unstructured":"Victor, J. (2009). A Comparative Study on the Biomechanics of the Native Human Knee Joint and Total Knee Arthroplasty. [Ph.D. Thesis, Katholieke Universiteit Leuven]."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"56","DOI":"10.1016\/j.medengphy.2016.12.001","article-title":"Evaluation of predicted knee function for component malrotation in total knee arthroplasty","volume":"40","author":"Vanheule","year":"2017","journal-title":"Med. Eng. Phys."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1115\/1.2894883","article-title":"Ligament-bone interaction in a three-dimensional model of the knee","volume":"113","author":"Blankevoort","year":"1991","journal-title":"J. Biomech. Eng."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"955","DOI":"10.1016\/0021-9290(95)00149-2","article-title":"Validation of a three-dimensional model of the knee","volume":"29","author":"Blankevoort","year":"1996","journal-title":"J. Biomech."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"102680","DOI":"10.1016\/j.jelekin.2022.102680","article-title":"Relative contribution of altered neuromuscular factors to muscle activation-force relationships following chronic stroke: A simulation study","volume":"66","author":"Son","year":"2022","journal-title":"J. Electromyogr. Kinesiol."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Guess, T.M., Stylianou, A.P., and Kia, M. (2014). Concurrent Prediction of Muscle and Tibiofemoral Contact Forces During Treadmill Gait. J. Biomech. Eng., 136.","DOI":"10.1115\/1.4026359"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"2809","DOI":"10.1007\/s00167-015-3661-1","article-title":"Patient-specific positioning guides for total knee arthroplasty: No significant difference between final component alignment and pre-operative digital plan except for tibial rotation","volume":"25","author":"Boonen","year":"2015","journal-title":"Knee Surg. Sports Traumatol. Arthrosc."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1177\/875647939000600106","article-title":"Interpretation of the Correlation Coefficient: A Basic Review","volume":"6","author":"Taylor","year":"2016","journal-title":"J. Diagn. Med. Sonogr."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"474","DOI":"10.1016\/j.jbiomech.2011.11.052","article-title":"Dynamic finite element knee simulation for evaluation of knee replacement mechanics","volume":"45","author":"Baldwin","year":"2012","journal-title":"J. Biomech."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1177\/0363546503262694","article-title":"Force Measurements on the Fibular Collateral Ligament, Popliteofibular Ligament, and Popliteus Tendon to Applied Loads","volume":"32","author":"LaPrade","year":"2004","journal-title":"Am. J. Sports Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jor.2016.12.005","article-title":"Bi-cruciate substituting total knee arthroplasty improved medio-lateral instability in mid-flexion range","volume":"14","author":"Kaneko","year":"2017","journal-title":"J. Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Marra, M.A., Vanheule, V., Fluit, R., Koopman, B.H.F.J.M., Rasmussen, J., Verdonschot, N., and Andersen, M.S. (2015). A Subject-Specific Musculoskeletal Modeling Framework to Predict In Vivo Mechanics of Total Knee Arthroplasty. J. Biomech. Eng., 137.","DOI":"10.1115\/1.4029258"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1085","DOI":"10.1055\/s-0040-1701453","article-title":"Higher Component Malposition Rates with Patient-Specific Cruciate Retaining TKA than Contemporary Posterior Stablisized TKA","volume":"34","author":"Kumar","year":"2021","journal-title":"J. Knee. Surg."}],"container-title":["Sensors"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/19\/8268\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:01:53Z","timestamp":1760130113000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1424-8220\/23\/19\/8268"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,6]]},"references-count":40,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["s23198268"],"URL":"https:\/\/doi.org\/10.3390\/s23198268","relation":{},"ISSN":["1424-8220"],"issn-type":[{"type":"electronic","value":"1424-8220"}],"subject":[],"published":{"date-parts":[[2023,10,6]]}}}