Development and validation of a fiber-based ACL model for surgical simulations

  • S. Martelli
  • A. Joukhadar
  • S. Zaffagnini
  • M. Marcacci
Basic Tools and Applications in Knee Surgery
Part of the Lecture Notes in Computer Science book series (LNCS, volume 1205)


ACL has a fundamental role in knee biomechanics and ACL insufficiency is probably the most common knee pathology. Nevertheless complete knowledge of ACL biomechanics is not achieved and predictions on ACL behaviour or optimal treatment are hard and still controversial, although of primary importance for a safe and good individual reconstruction. In this paper we describe the construction and validation of a new ACL model, computable by its anatomical description and aiming at reliable predictions in a virtual surgical environment.

In our model, ACL is made of 9 curvilinear connected fibers, corresponding to the individual surface fibers, which are described as a succession of 20 punctual physical particles linked by linear viscoelastic relations, and they can twist, bend and stretch under applied forces.

The model has been validated on 4 fresh pig knees and has given very consistent results to describe the ligament's anatomy, function and mechanics. Simulations of passive kinematics give interesting results on fibers elongations, forces and ligament deformations, confirming the expected correlation between fibers' strain and stress.

The advantage and the feature of this method with respect to previous models is the possibility to take into account more accurately ACL anatomy, mechanical properties and the ligament behaviour during the whole range of motion. All input are geometrical data, that can be acquired in fixed position. The output is the simulation of ACL that describes the forces exerted and respects sizes and shapes of the ligament. The model accuracy and the simple input it requires let us envisage a useful application on human ACL to develop surgical planning and simulation.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. [1]
    MZ Benbjaballah, A Shirazi-Adl: Biomechanics of the human knee joint in compression: reconstruction, mesh generation, and finite element analysis The knee, vol.2, n.2, 1995, pp.69–79.CrossRefGoogle Scholar
  2. [2]
    L. Blankevoort, R. Huiskes: Ligament-Bone interaction in a 3-Dimensional model of the knee, J Biomech. Eng., Vol.113, August 1991, pp.263–269.PubMedGoogle Scholar
  3. [3]
    L. Blankevoort, R Huiskes, A de Lange: Recruitment of the knee joint ligaments, Trans of ASME, vol. 113, Feb. 1991.Google Scholar
  4. [4]
    FK Fuss: Anatomy of the Cruciate Ligaments and their function in extension and flexion of the human knee joint, Am. J Anat., n.184, 1989, pp 165–176.CrossRefGoogle Scholar
  5. [5]
    L. Good, J. Gillquist: The value of intraoperative isometry measurements in ACL reconstruction: an in vivo correlation between substitute tension and length change, J Arthroscopy, n. 9(5), 1993, pp.525–532.Google Scholar
  6. [6]
    A Joukhadar: RobotPhy: Dynamic modeling system for robotics applications, INRIA report n.2543, May 1995Google Scholar
  7. [7]
    DA Loch, Z Luo, J Lewis, N Stewart: A theoretical model of the knee and ACL: theory and experimental verification, J Biomechs, vol.25, n.1, 1992, pp.81–90.CrossRefGoogle Scholar
  8. [8]
    TJ Mommersteeg, JK Koolos et al.: The fibre bundle anatomy of human cruciate ligaments, J. Anat., n.187, 1995, pp.461–471.Google Scholar
  9. [9]
    Smith BA, Livesay GA, Woo SLY, Biology and biomechanics of the anterior cruciate ligament, Clin Sports Med, vol. 12, n. 4, Oct. 1993, pp. 637–670.PubMedGoogle Scholar
  10. [10]
    J Wismans, F Velpaus, F Janssen, J Huson, P Struben: A three-dimensional mathematical model of the knee joint, J Biomech, vol. 13, 1980, pp. 677–685.CrossRefPubMedGoogle Scholar
  11. [11]
    SL Woo, GA Johnson, BA Smith: Mathematical modeling of ligaments and tendons, Trans. of ASME, vol.115, Nov.1993, pp. 468–473.Google Scholar
  12. [12]
    AB Zavatsky, JJ O'Connor: A model of human ligaments in the sagittal plane. Part I: response to passive flexion, Proc. Instn Mec Engrs, vol.206, 1992, pp.125–134.Google Scholar
  13. [13]
    V Dessenne, S Lavallé, R Julliard, R Orti, S Martelli, P Cinquin: Computer-Assisted Antrior Cruciate Ligament Reconstruction: First Clinical Tesxts. J Image Guided Surgery, 1:59–64 (1995).CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 1997

Authors and Affiliations

  • S. Martelli
    • 1
  • A. Joukhadar
    • 2
  • S. Zaffagnini
    • 1
  • M. Marcacci
    • 1
  1. 1.Lab. BiomeccanicaIst. Ortopedici RizzoliBolognaItaly
  2. 2.INRIA, Equipe SHARPGrenobleFrance

Personalised recommendations