Introducing CAMS Knee OpenSim Workshop – State-of-the-art measurement and simulation techniques for investigating functional knee joint mechanics Bill was appointed the position of Professor in Movement Biomechanics within the Department of Health Science and Technology at ETH Zurich in 2012. Born in Portsmouth, England in 1972, he achieved his degree in Mechanical Engineering at the University of Bath, England in 1994, where he also completed his Ph.D. in 1999 using finite element analysis to analyze the bone adaptation that occurs around new designs of hip prostheses. His research aims to provide new approaches for quantifying functional outcome in patients, both pre-operatively and after therapy. Through developing medical engineering concepts for evaluating joint stability and stiffness, his goal is to identify musculoskeletal deficits and movement pathologies at an early time point. Measuring joint contact forces with instrumented implants, CAMS-Knee datasets Dr.-Ing. Philipp Damm is a mechanical engineer with expertise in biomechanics, instrumented implants and in vivo load measurements. He is the head of the group “Instrumented Implants” at Julius Wolff Institute, Charité – Universitätsmedizin Berlin, the scientific leader of OrthoLoad.com project as well as OrthoLoadLab. Aim of his work is to improve the artificial joint replacements and safety tests based on realistic in vivo loads acting on knee, hip as well as on shoulder implants. Especially the friction, occurring in vivo in the joint replacement, and its individual parameter of influence, are in his personal scientific focus. Moreover, his aim is to optimize clinical rehabilitation and physiotherapy and to validate and improve biomechanical methods for calculating forces inside the body. Within the OrthoLoadLab the biomechanical knowledge of his group will be translated into industrial developments and clinical applications. Therefore, the OrthoLoadLab offers a globally unique combination of specific in-depth scientific knowledge of in vivo acting loads and functions combined with the outcome data from the clinical-scientific environment. CAMS-Knee Project, In-vivo knee joint kinematics during dynamic activities Musculoskeletal modeling of the OrthoLoad patients – The challenge to capture the variability in individual load levels Dr. Adam Trepczynski is a computer scientist with specialized expertise in gait analysis, image data processing, and computer modeling. He is currently appointed as a senior postdoctoral researcher at the Julius Wolff Institute, Charité – Universitätsmedizin berlin, where he previously gained extensive experience in evaluating fluoroscopic kinematics, estimating joint forces of the lower limb by means of musculoskeletal modeling, and validating these models based on in vivo measurements of joint loading in the knee and hip. More recently, Dr. Trepczynski has conducted analyses of the interplay between kinematics and loading in the tibio-femoral joint based on the data from the CAMS-Knee project, which are now being extended to the patello-femoral joint in his current project. The measurements of in vivo contact forces at the knee and hip joints show a large inter-individual variability, indicating substantial differences in the subject-specific muscle activation strategies and levels of antagonist muscle co-contraction. Musculoskeletal models based on general optimization criteria cannot predict these differences, while EMG usually only captures surface muscles and is not easy to relate quantitatively to the actual muscle forces. This talk will give an overview of the musculoskeletal modeling results for the worldwide largest cohorts with instrumented knee and hip implants from the Julius Wolff Institute, Charité – Universitätsmedizin berlin. Comparisons of different optimization criteria and estimations of the individual co-contraction will be presented for the two cohorts, along with analyses combining loading and local knee kinematics for the six TKA patients from the CAMS-Knee project. Clinical application of neuro-musculoskeletal modeling in the treatment of cerebral palsy: where are we and where to go? Despite a lot of progress in simulation research worldwide, application to clinical practice is still lacking or only minimally applied in many centers. In this presentations I will present some of the efforts we have made over the years to perform clinically relevant simulation studies and to use simulation outcomes for treatment-decision making. I will show what hurdles we encountered and give some food for thought how to overcome those, and whether or not this is needed – or even desirable – for clinical decision making in the treatment of children with cerebral palsy. Marjolein is Assistant Professor and Head of the Amsterdam UMC (location VUmc) Laboratory for Clinical Movement Analysis. She received her MSc in Human Movement Sciences cum laude in 2004 and her PhD on Modeling of gait in cerebral palsy in 2009, both at the Vrije Universiteit in Amsterdam. In her work she strives towards a better understanding of walking problems in children with neurological movement disorders, in order to support treatment selection and improve treatment outcomes. To this end, she has developed and applied novel technologies including the use of patient-specific musculoskeletal modeling and computer simulations to obtain in-depth understanding of muscle function during gait. She spent two summers at Stanford University and received two prestigious seed grants from this group to support her work. In close collaboration with industry, she co-developed and validated an interactive gait lab, which allows for real-time gait analysis, performed on a treadmill placed within a virtual reality environment, and real-time musculoskeletal modeling. Exploiting these new opportunities, she performed several studies on the use of real-time feedback to improve walking performance in children with neurological disorders, and the use of mechanical perturbations to assess the role of spasticity during gait. Musculoskeletal modeling: use for individual clinical decision making? Reinald Brunner is Professor for pediatric orthopedics since 2005 and head of the Neuro-Orthopaedic unit of the University Children’s Hospital Basel since 1992. This unit comprises one of the first motion analysis labs of Europe. His special interest is orthopedic problems in neuromuscular disorders, especially cerebral palsy. He is an internationally recognized specialist in the field. He is further vice dean of the medical faculty responsible for the support of juniors and vice head of the department of bioengineering of the medical faculty. He was awarded by the Royal College of Surgeons Edinburgh 2013 (F.R.C.S. ad hominem), by the Swiss Orthopaedic Society Swiss Orthopaedics 2014 (honorary member), and by the Association for Prosthetics and Orthotics 2016 (the Swiss equivalent of ISPO, honorary member). He leads the EPOS study group for neuromuscular disorders. He further runs programs to support pediatric and neuro-orthopedic treatment in India, Armenia, and Uzbekistan. He serves on Gait & Posture as an associate editor. Gait analysis has become an established tool to assess especially difficult gait disorders. Kinematics gives a precise overview of the movements of segments and joints, one of the clinical questions. Kinetics is more difficult to understand. Interpretation consists of rather speculative conclusions on function and load on muscles and joints. Today’s level of data presentation still lacks this information wanted by the clinician. One step to fill this gap can be offered by musculoskeletal modeling in individual cases. Besides all criticism for inaccuracy, it still presents a well-guessed possibility of muscle function. Important information has been published scientifically. Clinically, even larger errors are acceptable. Although these computed muscle functions remain the result of the original kinematics and kinetics, a view on muscle interplay and activity pattern is possibly different from the simple electrical activity pattern from EMG. Conclusions on causal links from muscle functions to segmental movements, however, still remain hypothetical. Osteoarthritis – where movement modeling meets biology From her PhD (2000) onwards, Ilse Jonkers successfully bridged from a classical human movement science and physical therapy profile towards an integrated biomedical science and biomedical engineering profile, exploiting maximally the use of 3D motion capture and multi-body simulation techniques to advance the understanding on pathological movement. The two-year postdoctoral stay at the bioengineering department at Stanford University (Prof Delp) was a pivotal experience in this process. To date, she is a professor and head of the Human Movement Biomechanics Research Group at KU Leuven. Her group is conducting internationally highly competitive research on the quantification of whole joint loading using multi-body simulation. Its work is known for the development of subject-specific musculoskeletal models containing a high level of anatomical detail, especially in the context of cerebral palsy. More recent research activities relate to the development of multi-scale modelling of bone and cartilage adaptation and advanced medical imaging of cartilage to understand degenerative joint diseases. In this context, Ilse is to elucidate the role of mechanical loading in cartilage homeostasis and disease using multi-axial bioreactor experiments. She is passionate about this new, highly multi-disciplinary research line combining biomedical sciences (human movement science, musculoskeletal modelling, cartilage biology and imaging) and engineering sciences (multi-scale modelling). To design and adapt therapeutic approaches that successfully regenerate native joint cartilage, it is indispensable to understand how articular cartilage is loaded during locomotion. Furthermore, the local cartilage loading needs to be related to the molecular response of the chondrocytes. In my presentation, I will identify biomarkers of early OA during locomotion (using multi-scale modeling), relate the mechanical loading to experimentally measured cartilage deformations (using high-field MRI) and identify the effect of the local mechanical cues to constituent expression (using bioreactor experiments). Through careful documentation of the mechanobiological response, we will be able to design future rehabilitation approaches and preventive exercise programs that optimize cartilage health. Symbiosis between Orthopedix Surgical Simulations and in vivo Measurements Darryl Thelen is the Weideman Professor of Mechanical Engineering at the University of Wisconsin-Madison. He is also the Associate Dean for Research in the College of Engineering. Prof. Thelen’s neuromuscular biomechanics lab develops computational models, novel sensor technologies and dynamic imaging protocols to investigate the structure, mechanics and behavior of musculoskeletal tissues within the human body. Current projects are aimed at improving orthopedic treatments of gait disorders in children, enhancing the precision of total knee joint replacement and investigating biomechanical factors that contribute to osteoarthritis. His research has been supported by the NIH, NSF and a number of private companies and foundations. Dr. Thelen received his bachelor’s degree in mechanical engineering from Michigan State University in 1987 and his MSE and PhD degrees in mechanical engineering from the University of Michigan in 1988 and 1992, respectively. He has been on the faculty of the University of Wisconsin-Madison since 2002. Computational models provide a powerful platform to simulate orthopedic procedures, and thereby predict the effect of surgical factors on function. However, the complexity of the musculoskeletal system makes it challenging to validate models in a manner needed to instill confidence among clinicians. In this talk, we will discuss the coupled use of high-throughput computing and imaging to address this challenge. High-throughput computing platforms are used to perform probabilistic surgical simulations that account for the complex interplay between anatomical, physiological and surgical factors. These model predictions are then compared to sparse in vivo measurements of musculoskeletal mechanics and outcomes on patients. We will show examples of using a coupled modeling-measurement approach for probing the outcomes of ACL reconstruction and pediatric orthopedic procedures. Objective comparisons between models and in vivo measures is shown to provide for an enhanced causal understanding of the effects of surgical decisions and an improved appreciation for the inherent variability present in clinical outcomes. Investigation of the interaction between bone and muscles as well as the biomechanical influences and its impacts in both the intact and injured musculoskeletal system Georg Duda is Professor of Biomechanics and Musculoskeletal Regeneration at the Charité – Humboldt University of Berlin and Free University of Berlin and an Associated Faculty Member at the Wyss Institute for Biologically Inspired Engineering at Harvard University. He received his Master’s degree in precision engineering from the Technical University of Berlin, Germany, in 1991 and his Ph.D. degree in Mechanical Engineering from the Technical University of Hamburg-Harburg in 1996. He has been recipient of over a dozen awards for inventions, start-up engagements and PhD student mentoring. Georg is the founding director of the Julius Wolff Institute at the Charité, Humboldt University and Free University of Berlin. The Julius Wolff Institute brings together researchers from engineering, mathematics, biology, biochemistry and clinical scientists in order to develop new therapeutic strategies for regeneration of injured or degenerated joint, bones and muscles. Conceptually, Georg’s research aims at understanding endogenous cascades of tissue formation, cytokine signaling and cellular self-organization especially in bone. This understanding is transferred to enable regeneration in clinically challenging healing scenarios of tissues normally capable of regeneration (bone) and those with intrinsic impaired regenerative capacity. Mechanical straining and adaptation due to mechanical cues plays a central role in all these tissues. The aim of Georg’s work is to understand the mechano-biological cues of regeneration and adaptation and how they can be employed to enable healing even in tissues with impaired regenerative capacity such as muscle, cartilage or tendon. All approaches are motivated by clinical challenges, employ basic research principles and aim at being translated into daily clinical routine. Examples of translation include innovative concepts for joint replacement procedures, angle stable fixation of implants or cell therapies for muscle regeneration. Given his broad interest, core to all his activities is the close collaboration with clinical partners, specifically the scientific education of clinical scientists as core members of his team of research. From Knee Impedance Estimation to the CYBATHLON: Towards Wearable Robots for Application in Daily Life Roger Gassert is Professor of Rehabilitation Engineering at ETH Zurich. He received an M.Sc. degree in microengineering and a PhD degree in neuroscience robotics from the Ecole Polytechnique Fédérale de Lausanne (EPFL), Switzerland, in 2002 and 2006, respectively. Following postdoctoral positions at Imperial College London, UK, Simon Fraser University, Canada, and ATR International, Japan, he was appointed Assistant Professor of Rehabilitation Engineering at ETH Zurich in 2008. His research is concerned with the development and application of robotics, wearable sensor technologies and non-invasive neuroimaging to assess, explore and restore human sensorimotor function after neurological injury. Wearable robots, e.g. in the form of powered lower limb prostheses and exoskeletons, promise to restore gait in persons with amputation or spinal cord injury. While the technology has evolved significantly over the past decade and an increasing number of products have entered the market, the majority of lower limb prostheses are still passive, and the application of exoskeletons is mostly limited to lab and clinical environments. Powered devices are challenged in their ability to reproduce human gait and cope with daily “obstacles” such as uneven ground and stairs. This talk will present our efforts to overcome some of these limitations, through research and events such as the CYBATHLON, a championship for pilots with disabilities using state of the art assistive technology to compete in tasks inspired by activities of daily living. Software Demo 1: Simulating the CAMS-Knee Datasets in OpenSim Software Demo 2: Simulating passive knee joint mechanics with articular contact in OpenSim Software Demo 4: Simulating knee mechanics during movement with COMAK in OpenSim Software Demo 3: OpenSim Moco Software Demo 6: MAP Client Software Demo 5: Artisynth Software Demo 5: Artisynth Software Demo 6: Mimics Innovation Suite Coupling Computational Models and Novel Sensors to Personalize Total Knee Arthroplasty Combining simulations and experiments to design a muscle coordination retraining strategy that reduces knee contact force Investigating meniscus forces using a combined multibody-FEM model Combining statistical shape modelling and musculoskeletal simulation to investigate the relationship between joint shape and function Live Data Collection Live Data Collection Live Data Collection Live Data CollectionKeynotes
William (Bill) R. Taylor, Laboratory for Movement Biomechanics, ETH Zurich
Philipp Damm, Instrumented Implants, Julius Wolff Institute, Charité – Universitätsmedizin Berlin & Orthoload
Pascal Schütz, Laboratory for Movement Biomechanics, ETH Zurich
Adam Trepczynski, Musculoskeletal & Functional Analysis, Julius Wolff Institute, Charité – Universitätsmedizin Berlin
Marjolein van der Krogt, Clinical Motion Analysis Laboratory, Amsterdam UMC
Reinald Brunner, Department of Neuro-Orthopaedics, University Children’s Hospital Basel
Ilse Jonkers, Human Movement Biomechanics Research Group, KU Leuven
Darryl Thelen, UW Neuromuscular Biomechanics Lab, University of Wisconsin-Madison
Georg Duda, Julius Wolff institute & Berlin-Brandenburg Center for Regenerative Therapies, Charité – Universitätsmedizin Berlin
Roger Gassert, Rehabilitation Engineering Laboratory, ETH Zurich
Software Demonstrators
Colin Smith, Laboratory for Movement Biomechanics, ETH Zurich
Nick Bianco, Neuromuscular Biomechanics Lab, Stanford University
Bryce Killen, Human Movement Biomechanics Research Group, KU Leuven
John Lloyd, Electrical and Computer Engineering, University of British Columbia
Benedikt Sagl, University Clinic of Dentistry, Medical University of Vienna
Mariska Wesseling, Materialise
Invited Talks
Josh Roth, Biomechanical Advances in Medicine Lab, University of Wisconsin-Madison
Scott Uhlrich, Neuromuscular Biomechanics Lab, Stanford University
Benedikt Sagl, University Clinic of Dentistry, Medical University of Vienna
Allison Clouthier, Spine and Movement Biomechanics Laboratory, University of Ottawa
OpenSim Experts
Live Demo
Pascal Schütz, Laboratory for Movement Biomechanics, ETH Zurich
Jörn Dymke, Instrumented Implants, Julius Wolff Institute, Charité – Universitätsmedizin Berlin
Barbara Postolka, Laboratory for Movement Biomechanics, ETH Zurich
Michael Plüss, Laboratory for Movement Biomechanics, ETH Zurich
Organising committee
Pascal Schütz is leading the Clinical Movement Analysis group within the
Laboratory for Movement Biomechanics with a strong interest in understanding
the in-vivo function of the tibio-femoral joint during dynamic activities. In the
context of his PhD, he analysed the role of activity and implant design on the
tibio-femoral kinematics in subjects with a total knee replacement. Thereby he
used the unique moving fluoroscope, integrated and synchronised in a lab setting
with motion capture and force plates. These datasets provide the base for
modelling joint contact forces and soft tissue loading within the lab.
He was leading the measurements of the CAMS-Knee project at the Laboratory
for Movement Biomechanics and played a key role in post-processing and
preparation of the fluoroscopic, motion capture, force plate and EMG data.
In ongoing projects, his research group focuses on understanding the joint
kinematics in healthy knees as well as in unsatisfactory outcomes after total knee
replacement.
