Finite element analysis of the flexor digitorum profundus tendon during a passive rehabilitation protocol
DOI:
https://doi.org/10.17533/udea.redin.20210528Keywords:
finite element method, postoperative rehabilitation, range of movementAbstract
The present study aims to create a patient-specific hand model to simulate the passive rehabilitation on the index finger, quantifying the flexor digitorum profundus (FDP) tendon excursion and the stress experienced during simulated flexion. The computational model used in this analysis was created from an unknown patient dataset available in the Embodi3d online library. The segmentation, three-dimensional reconstruction, and modeling of the structures involved were performed using Materialise Mimics and Rhino3D. The FDP tendon excursion and stress values present in the model were calculated in the ANSYS environment. Based on the finite-element simulation, the FDP tendon presents an excursion of 10.1 mm during passive postoperative flexion. The highest-stress values were observed between the pulleys-FDP tendon contact surfaces. In particular, the pulley A1 exhibited the máximum principal stress of the model with a 58.7 MPa. The pulley A3 showed the same stress distribution pattern that A1 Pulley, but with the lowest values. The FDP Tendon excursión obtained is consistent with the results reported in the literature, which vary from 8 to 11 mm. The stress values found in the model explain the importance of the pulley mechanism keeping the FDP tendon attached to the finger bone during the range of motion experienced. The silico model proposed may potentially be used in the assessment of new medical device proposals in the field of hand reconstructive surgery.
Downloads
References
R. Singh, B. Rymer, P. Theobald, and P. Thomas, “A review of current concepts in flexor tendon repair: physiology, biomechanics, surgical technique and rehabilitation.” Orthopedic reviews, vol. 7, no. 4, Dec. 28, 2015. [Online]. Available: https://doi.org/10.4081/or.2015.6125
G. Riley, “Chronic tendon pathology: molecular basis and therapeutic implications,” Expert Reviews in Molecular Medicine, vol. 7, no. 5, Mar. 30, 2005. [Online]. Available: https://doi.org/10.1017/S1462399405008963
D. generale della programmazione sanitaria, “Rapporto annuale sull’attività di ricovero ospedaliero(dati sdo 2019),” Ministero della Salute, Roma, IT, Tech. Rep., Jan. 2021. [Online]. Available: https://www.salute.gov.it/portale/documentazione/p6_2_2_1.jsp?lingua=italiano&id=3002
A. Momeni, E. Grauel, and J. Chang, “Complications after flexor tendon injuries,” Hand Clinics, vol. 26, no. 2, May. 2010. [Online]. Available: https://doi.org/10.1016/j.hcl.2009.11.004
C. S. Irwin, B. G. Parks, and K. R. Means, “Biomechanical analysis of zone 2 flexor tendon repair with a coupler device versus locking cruciate core suture,” Journal of Hand Surgery, vol. 45, no. 9, Apr. 7, 2020. [Online]. Available: https://doi.org/10.1016/j.jhsa.2020.02.015
M. Wiig and et al., “A lactoferrin-derived peptide (pxl01) for the reduction of adhesion formation in flexor tendon surgery: An experimental study in rabbits,” Journal of Hand Surgery (European Volume), vol. 36, no. 8, Jun. 23, 2011. [Online]. Available: https://doi.org/10.1177%2F1753193411410823
A. N. Nayak and et al., “A mechanical evaluation of zone ii flexor tendon repair using a knotless barbed suture versus a traditional braided suture,” Journal of Hand Surgery, vol. 40, no. 7, Jun. 3, 2015. [Online]. Available: https://doi.org/10.1016/j.jhsa.2015.04.009
C. J. Dy, A. Hernandez, Y. Ma, T. R. Roberts, and A. Daluiski, “Complications after flexor tendon repair: A systematic review and meta-analysis,” Journal of Hand Surgery, vol. 37, no. 3, Feb. 10, 2012. [Online]. Available: https://doi.org/10.1016/j.jhsa.2011.11.006
C. Dennis and et al., “Suture materials - current and emerging trends,” Journal of Biomedical Materials Research, vol. 104, no. 6, Feb. 10, 2016. [Online]. Available: https://doi.org/10.1002/jbm.a.35683
J. A. Greenberg and R. H. Goldman, “Barbed suture: A review of the technology and clinical uses in obstetrics and gynecology,” Reviews in Obstetrics & Gynecology, vol. 6, no. 3, 2013. [Online]. Available: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4002186/
F. Wu, M. Nerlich, and D. Docheva, “Tendon injuries: Basic science and new repair proposals,” EFORT Open Reviews, vol. 2, no. 7, Jul. 17, 2017. [Online]. Available: https://doi.org/10.1302/2058-5241.2.160075
S. Thomopoulos, W. C. Parks, D. B. Rifkin, and K. A. Derwin, “Mechanisms of tendon injury and repair,” Journal of Orthopaedic Research, vol. 33, no. 6, Jan. 29, 2015. [Online]. Available: https://doi.org/10.1002/jor.22806
L. M. Galatz, L. Gerstenfeld, E. Heber, and S. A. Rodeo, “Tendon regeneration and scar formation: The concept of scarless healing,” Journal of Orthopaedic Research, vol. 33, no. 6, Feb. 11, 2015. [Online]. Available: https://doi.org/10.1002/jor.22853
B. Zafonte, D. Rendulic, and R. M. Szabo, “Flexor pulley system: Anatomy, injury, and management,” Journal of Hand Surgery, vol. 39, no. 12, Dec. 1, 2014. [Online]. Available: https://doi.org/10.1016/j.jhsa.2014.06.005
A. Sapienza, H. K. Yoon, R. Karia, and S. K. Lee, “Flexor tendon excursion and load during passive and active simulated motion: A cadaver study,” Journal of Hand Surgery (European Volume), vol. 38, no. 9, 2013. [Online]. Available: https://doi.org/10.1177%2F1753193412469128
K. F. Lutsky, E. L. Giang, and J. L. Matzon, “Flexor tendon injury, repair and rehabilitation,” Orthopedic Clinics of North America, vol. 46, no. 1, Jan. 2015. [Online]. Available: https://doi.org/10.1016/j.ocl.2014.09.004
H. M. Starr, M. Snoddy, K. E. Hammond, and J. G. Seiler, “Flexor tendon repair rehabilitation protocols: A systematic review,” Journal of Hand Surgery, vol. 38, no. 9, Sep. 1, 2013. [Online]. Available: https://doi.org/10.1016/j.jhsa.2013.06.025
A. Chesney, A. Chauhan, A. Kattan, F. Farrokhyar, and A. Thoma, “Systematic review of flexor tendon rehabilitation protocols in zone ii of the hand,” Journal of the American Society of Plastic Surgeons, vol. 127, no. 4, Apr. 2011. [Online]. Available: https://journals.lww.com/plasreconsurg/Abstract/2011/04000/Systematic_Review_of_Flexor_Tendon_Rehabilitation.23.aspx
E. George, P. Liacouras, F. J. Rybicki, and D. Mitsouras, “Measuring and establishing the accuracy and reproducibility of 3d printed medical models,” RadioGraphics, vol. 37, no. 5, Aug. 11, 2017. [Online]. Available: https://doi.org/10.1148/rg.2017160165
A. F. Hernández and et al., “Application of 3d modeling methodology using ct scans for numerical analysis,” Revista facultad de ingeniería Universidad de Antioquia, no. 72, Sep. 2014. [Online]. Available: https://revistas.udea.edu.co/index.php/ingenieria/article/view/15747
V. Chulvi, D. Cebrian, . Sancho, and R. Vidal, “Automated design of customized implants,” Revista facultad de ingeniería Universidad de Antioquia, no. 68, Sep. 2013. [Online]. Available: http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-62302013000300010
(2019, Oct. 8,) Hand bst 3 1.0.0. Embodi 3D. [Online]. Available: https://www.embodi3d.com/files/file/28972-hand-bst-3/
N. Wake and et al., “Creating patient-specific anatomical models for 3d printing and ar/vr: a supplement for the 2018 radiological society of north america(rsna)hands-on course,” 3D Printing in Medicine, vol. 5, no. 17, Dec. 30, 2019. [Online]. Available: https://threedmedprint.biomedcentral.com/articles/10.1186/s41205-019-0054-y
G. Mitsionis and et al., “Feasibility of partial a2 and a4 pulley excision: Residual pulley strength,” Journal of Hand Surgery (European Volume), vol. 25, no. 1, Feb. 1, 2000. [Online]. Available: https://journals.sagepub.com/doi/10.1054/jhsb.1999.0332
T. Krauthammer, “Accuracy of the finite element method near a curved boundary,” Computers & Structures, vol. 10, no. 6, Dec. 1979. [Online]. Available: https://doi.org/10.1016/0045-7949(79)90061-0
J. Y. Rho, L. Kuhn, and P. Zioupos, “Mechanical properties and the hierarchical structure of bone,” Medical Engineering & Physics, vol. 20, no. 2, Mar. 1998. [Online]. Available: https://doi.org/10.1016/S1350-4533(98)00007-1
H. R. Screen, D. A. Lee, D. L. Bader, and J. C. Shelton, “An investigation into the effects of the hierarchical structure of tendon fascicles on micromechanical properties,” Proceedings of the Institution of Mechanical Engineers, Part H: Journal of Engineering in Medicine, vol. 218, no. 2, Feb. 1, 2004. [Online]. Available: https://doi.org/10.1243%2F095441104322984004
R. W. Ogden. (1997) Non-linear elastic deformations. Dover Publications, Inc. [Online]. Available: https://n9.cl/6xz7y
F. Elza, L. Joana, and B. Luisa, “Human femur assessment using isotropic and orthotropic materials dependent of bone density,” Polytechnic Institute of Bragança, Bragança, PT, 2009. [Online]. Available: https://bibliotecadigital.ipb.pt/handle/10198/1664
L. L. Vignoli and P. P. Kenedi, “Bone anisotropy - analytical and finite element analysis,” Latin American Journal of Solids and Structures, vol. 13, no. 1, Jan. 2016. [Online]. Available: https://doi.org/10.1590/1679-78251814
C. Santiuste, M. Rodríguez, E. Giner, and H. Miguélez, “The influence of anisotropy in numerical modeling of orthogonal cutting of cortical bone,” Composite Structures, vol. 116, 2014. [Online]. Available: https://doi.org/10.1016/j.compstruct.2014.05.031
T. A. Carniel and E. A. Fancello, “A transversely isotropic coupled hyperelastic model for the mechanical behavior of tendons,” Journal of Biomechanics, vol. 54, Mar. 21, 2017. [Online]. Available: https://doi.org/10.1016/j.jbiomech.2017.01.042
D. Moratal. (2012) Finite element analysis - from biomedical applications to industrial developments. InTech. [Online]. Available: https://n9.cl/0axol
E. F. Morgan, G. U. Unnikrisnan, and A. I. Hussein, “Bone mechanical properties in healthy and diseased states,” Annual Review of Biomedical Engineering, vol. 20, Jun. 2018. [Online]. Available: https://doi.org/10.1146/annurev-bioeng-062117-121139
S. D. Rawson, L. Margetts, J. Wong, and S. H. Cartmell, “Sutured tendon repair; a multi-scale finite element model,” Biomech Model Mechanobio, vol. 14, May. 20, 2014. [Online]. Available: https://doi.org/10.1007/s10237-014-0593-5
W. F. Mao, Y. F. Wu, Y. L. Zhou, and J. B. Tang, “A study of the anatomy and repair strengths of porcine flexor and extensor tendons: are they appropriate experimental models?” Journal of Hand Surgery (European Volume), vol. 36, no. 8, Jul. 18, 2011. [Online]. Available: https://doi.org/10.1177%2F1753193411414117
R. G. Rodríguez and et al., “Biomechanical analysis of damaged intervertebral disc using reflective photoelasticity,” Revista Facultad de Ingeniería Universidad de Antioquia, no. 78, Mar. 2016. [Online]. Available: http://www.scielo.org.co/scielo.php?pid=S0120-62302016000100010&script=sci_arttext&tlng=en
J. F. Weber, A. M. Agur, A. Y. Fattah, K. D. Gordon, and M. L. Oliver, “Tensile mechanical properties of human forearm tendons,” Journal of Hand Surgery (European Volume), vol. 40, no. 7, May. 4, 2015. [Online]. Available: https://doi.org/10.1177%2F1753193415584715
K. Kursa, L. Lattanza, E. Diao, and D. Rempel, “In vivo flexor tendon forces increase with finger and wrist flexion during active finger flexion and extension,” Journal of Orthopaedic Research, vol. 24, no. 4, Apr. 2006. [Online]. Available: https://doi.org/10.1002/jor.20110
Y. Liu and et al., “Objective evaluation of hand rom and motion quality based on motion capture and brunnstrom scale,” IEEE/ASME (AIM) International Conference on Advanced Intelligent Mechatronics, Hong Kong, CN, 2019. [Online]. Available: https://ieeexplore.ieee.org/document/8868793
U. C. Ugbolue, W. H. Hsu, R. J. Goitz, and Z. M. Li, “Tendon and nerve displacement at the wrist during finger movements,” Clinical Biomechanics, vol. 20, no. 1, Jan. 1 2005. [Online]. Available: https://doi.org/10.1016/j.clinbiomech.2004.08.006
Z. M. Li, S. Dun, D. A. Harkness, and T. L. Brininger, “Motion enslaving among multiple fingers of the human hand,” Human Kinetics Journals, vol. 8, no. 1, 2004. [Online]. Available: https://doi.org/10.1123/mcj.8.1.1
J. A. Parellada, A. R. Balkissoon, C. W. Hayes, and W. F. Conway, “Bowstring injury of the flexor tendon pulley system: Mr imaging,” AJR American Journal of Roentgenology, vol. 167, no. 2, 1996. [Online]. Available: https://www.ajronline.org/doi/10.2214/ajr.167.2.8686601
Published
How to Cite
Issue
Section
License
Copyright (c) 2021 Revista Facultad de Ingeniería Universidad de Antioquia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Revista Facultad de Ingeniería, Universidad de Antioquia is licensed under the Creative Commons Attribution BY-NC-SA 4.0 license. https://creativecommons.org/licenses/by-nc-sa/4.0/deed.en
You are free to:
Share — copy and redistribute the material in any medium or format
Adapt — remix, transform, and build upon the material
Under the following terms:
Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.
NonCommercial — You may not use the material for commercial purposes.
ShareAlike — If you remix, transform, or build upon the material, you must distribute your contributions under the same license as the original.
The material published in the journal can be distributed, copied and exhibited by third parties if the respective credits are given to the journal. No commercial benefit can be obtained and derivative works must be under the same license terms as the original work.
Twitter