Digital volume correlation for the characterization of musculoskeletal tissues: Current challenges and future developments

Comparing the predictions of CT-based subject-specific finite element models of human metastatic vertebrae with digital volume correlation measurements

Several conditions can increase the incidence of vertebral fragility fractures, including metastatic bone disease. Computational tools could help clinicians estimate the risk of vertebral fracture in these patients; however, comparison with in vitro data is mandatory before using them in clinical practice. Nine spine segments were tested under compression and imaged with micro-computed tomography (µCT). The displacement field was calculated for each vertebra using a global digital volume correlation (DVC) approach. Subject-specific homogenised finite element models of each vertebra were built from µCT images, applying experimentally matched boundary conditions at the endplates. Numerical and experimental displacements, reaction forces, and locations showing higher strain concentrations were eventually compared. Additionally, given that µCT cannot be performed in clinical settings, the outcomes of a µCT-based model were also compared to those of a model built from clinical CT scans of the same specimen. Good agreement between DVC and µCT-based FE displacements was found, both for healthy (R2 = 0.69 ÷ 0.83, RMSE = 3 ÷ 22%, max error < 45 μm) and metastatic (R2 = 0.64 ÷ 0.93, RMSE = 5 ÷ 18%, max error < 54 μm) vertebrae. Strong correlations were found between µCT-based and clinical CT-based FE model outcomes (R2 = 0.99, RMSE < 1.3%, max difference = 6 μm). Furthermore, the models qualitatively identified the most deformed regions identified with the experiments. In conclusion, the combination of experimental full-field technique and in-silico modelling enabled the development of a promising pipeline to validate bone strength predictors in the elastic range. Further improvements are needed to analyse vertebral post-yield behaviour better.

Understanding the structure and mechanics of the sheep calcaneal enthesis: a relevant animal model to design scaffolds for tissue engineering applications

Tendon or enthesis injuries are a worldwide clinical problem. Along the enthesis, collagen fibrils show a progressive loss of anisotropy and an increase in mineralization reaching the bone. This causes gradients of mechanical properties. The design of scaffolds to regenerate these load-bearing tissues requires validation in vivo in relevant large animal models. The sheep tendon of triceps surae muscle is an optimal animal model for this scope with limited knowledge about its structure and mechanics. We decided to investigate in-depth its structure and full-field mechanics. Collagen fibrils morphology was investigated via scanning electron microscopy revealing a marked change in orientation/dimensions passing from the tendon to the enthesis. Backscatter electron images and nanoindentation at the enthesis/bone marked small gradients of mineralization at the mineralized fibrocartilage reaching 27%wt and indentation modulus around 17-30 GPa. The trabecular bone instead had indentation modulus around 15-22 GPa. Mechanical tensile tests with digital image correlation confirmed the typical non-linear behavior of tendons (failure strain = 8.2 ± 1.0 %; failure force = 1369 ± 187 N) with maximum principal strains reaching mean values of εp1 ∼ 7 %. The typical auxetic behavior of tendon was highlighted by the minimum principal strains (εp2 ∼ 5 %), progressively dampened at the enthesis. Histology revealed that this behavior was caused by a local thickening of the epitenon. Cyclic tests showed a force loss of 21 ± 7 % at the last cycle. These findings will be fundamental for biofabrication and clinicians interested in designing the new generation of scaffolds for enthesis regeneration.

How to Study the Mechanobiology of Intestinal Epithelial Organoids? A Review of Culture Supports, Imaging Techniques, and Analysis Methods

Mechanobiology studies how mechanical forces influence biological processes at different scales, both in homeostasis and in pathology. Organoids, 3D structures derived from stem cells, are particularly relevant tools for modeling tissues and organs in vitro. They currently constitute one of the most suitable models for mechanobiology studies. This review provides an overview of existing or applicable approaches to organoids for mechanical studies. We first present the different types of culture supports, including hydrogels and organ-on-chip. We then discuss advanced imaging techniques, particularly suitable for studying the physical properties of cells, allowing the visualization of mechanical forces and cellular responses. We also describe the approaches and tools available to observe the organoids by microscopy. Finally, we present analytical methods, including computational models and biophysical measurement approaches, which facilitate the quantification of mechanical interactions. This review aims to provide the most comprehensive overview possible of the methods, instrumentations, and tools available to conduct a mechanobiological study on organoids.

In-situ microscopy and digital image correlation to study the mechanical characteristics of polymer-based materials

In-situ microscopic methods can help researchers to analyse microstructural changes of materials structures under different conditions (e.g., temperature and pressure) at various length scales. Digital Image Correlation (DIC) combines image registration and tracking to enable accurate measurements of changes in materials in 2D and 3D. This review focuses on combining microscopy and DIC to study the properties of materials (including natural/synthetic biomaterials, biological samples and their composites) in academic, public and industry settings, including exciting examples of bioimaging.

Interference fit of cementless tibial implants and the initial mechanical environment: A micro-CT and DVC study

During cementless total knee arthroplasty (TKA), an overlap between the resected tibia and the implant's geometry, termed interference fit, is introduced to facilitate primary stability and direct bone-implant contact. However, little is known about the actual interference achieved and the resulting mechanical response in the surrounding cancellous bone. The aim of this study was (1) to experimentally quantify the actual interference achieved for a commercially available cementless tibial implant and (2) to assess its effect on the post-impaction cancellous bone strain. Seven human cadaveric tibiae were micro-CT scanned intact (23 µm/pixel), once prepared for TKA (46 µm/pixel) and following implantation (46 µm/pixel). The actual interference across the entire bone-implant interface was quantified and, via digital volume correlation, the compressive strains of bone in contact with the implant and at increasing distance, were extracted. An inhomogeneous actual interference was found across the implant pegs and keel (median ± std dev: 0.70 ± 0.27 mm), which was lower than the intended. Limited interference (0.02 ± 0.12 mm) was found directly under the baseplate, with immediate bone-baseplate contact of 54%. The induced compressive strains were related to the actual interference within 3.14 mm from the bone-implant interface (R2 = 0.269-0.450, p < 0.001), with higher compressive strains corresponding to higher interference, but not being related to the bone volume fraction. Clinical Significance: Insight is provided into the interaction between the variability of the resection and the resulting mechanical environment. A complex relationship is apparent, whereby the actual interference accounted for up to 45% of the variation in induced compressive strain magnitude.

Nonlinear Stress-Induced Transformations in Collagen Fibrillar Organization, Disorder and Strain Mechanisms in the Bone-Cartilage Unit

By developing a 3D X-ray modeling and spatially correlative imaging method for fibrous collagenous tissues, this study provides a comprehensive mapping of nanoscale deformation in the collagen fibril network across the intact bone-cartilage unit (BCU), whose healthy functioning is critical for joint function and preventing degeneration. Extracting the 3D fibril structure from 2D small-angle X-ray scattering before and during physiological compression reveals of dominant deformation modes, including crystallinity transitions, lateral fibril compression, and reorientation, which vary in a coupled, nonlinear, and correlated manner across the cartilage-bone interface. A distinct intermolecular arrangement of collagen molecules, and enhanced molecular-level disorder, is found in the cartilage (sliding) surface region. Just below, fibrils accommodate tissue strain by reorientation, which transitions molecular-level kinking or loss of crystallinity in the deep zone. Crystalline fibrils laterally shrink far more (20×) than they contract, possibly by water loss from between tropocollagen molecules. With the calcified plate acting as an anchor for surrounding tissue, a qualitative switch occurs in fibrillar deformation between the articular cartilage and calcified regions. These findings significantly advance this understanding of the complex, nonlinear ultrastructural dynamics at this critical interface, and opens avenues for developing targeted diagnostic and therapeutic strategies for musculoskeletal disorders.

Disc degeneration influences the strain magnitude and stress distribution within the adjacent trabecular bone

Introduction

Up to one in five will suffer from osteoporotic vertebral fracture within their lifetime. Accurate fracture prediction poses challenges using bone mineral density (BMD) measures. Trabecular bone strains may be influenced by the underlying intervertebral disc (IVD). Understanding how disc degeneration alters load distribution to the vertebra may demonstrate that supplementing fracture risk tools with IVD metrics could improve predictions. The aim of this study was to assess the influence of IVD degeneration on the stress and strain magnitude and distribution in the trabecular bone of adjacent vertebrae.

Methods

Ten human cadaveric lumbar bi-segment specimens (20 IVDs, 9 degenerated, 11 non-degenerated) were µCT-imaged under 1000N. Digital volume correlation was used to quantify axial, principal, maximum shear, and von Mises strain in the superior and inferior regions of the vertebra. Volumetric BMD from quantitative-CT was used to calculate Young's modulus, which was then registered with the von Mises strain field to calculate internal von Mises stress.

Results

Two bi-segments fractured during mechanical testing, resulting in N = 8 endplate regions per group. Trabecular bone adjacent to degenerated IVDs presented higher maximum principal and shear strains in the anterior region, relative to non-degenerated (peak ε1: 6,020 ± 1,633 µε versus 3,737 ± 1,548 µε, p < 0.01; peak γmax: 6,202 ± 1948 µε versus 3,938 ± 2086 µε, p < 0.01). Von Mises stress distribution was significantly skewed towards the anterior region in the degenerated group only (28.3% ± 10.4%, p < 0.05). Reduced disc height correlated with increased central-region axial compressive strain, decreased central-region BMD, and increased anterior region von Mises stress (all p < 0.05).

Discussion

Disc degeneration may encourage high strains to be experienced within the anterior region of the adjacent bone, owing to changes in load distribution. This study demonstrates the potential of utilising IVD metrics in fracture risk assessment, to inform clinical decision making and preventative treatment.

3D observations provide striking findings in rubber elasticity

The mechanical response of rubbers has been ubiquitously assumed to be only a function of the imposed strain. Using innovative X-ray measurements capturing the three-dimensional spatial volumetric strain fields, we demonstrate that rubbers and indeed many common engineering polymers undergo significant local volume changes. But remarkably, the overall specimen volume remains constant regardless of the imposed loading. This strange behavior which also leads to apparent negative local bulk moduli is due to the presence of a mobile phase within these materials. Combining X-ray tomographic observations with high-speed radiography to track the motion of the mobile phase, we have revised classical thermodynamic frameworks of rubber elasticity. The work opens broad avenues to understand not only the mechanical behavior of rubbers but a large class of widely used engineering polymers.

Homogenized finite element analysis of distal tibia sections: Achievements and limitations

High-resolution peripheral quantitative computed tomography (HR-pQCT) based micro-finite element (μFE) analysis allows accurate prediction of stiffness and ultimate load of standardised (∼1 cm) distal radius and tibia sections. An alternative homogenized finite element method (hFE) was recently validated to compute the ultimate load of larger (∼2 cm) distal radius sections that include Colles' fracture sites. Since the mechanical integrity of the weight-bearing distal tibia is gaining clinical interest, it has been shown that the same properties can be used to predict the strength of both distal segments of the radius and the tibia. Despite the capacity of hFE to predict structural properties of distal segments of the radius and the tibia, the limitations of such homogenization scheme remain unclear. Therefore, the objective of this study is to build a complete mechanical data set of the compressive behavior of distal segments of the tibia and to compare quantitatively the structural properties with the hFE predictions. As a further aim, it is intended to verify whether hFE is also able to capture the post-yield strain localisation or fracture zones in such a bone section, despite the absence of strain softening in the constitutive model. Twenty-five fresh-frozen distal parts of tibias of human donors were used in this study. Sections were cut corresponding to an in-house triple-stack protocol HR-pQCT scan, lapped, and scanned using micro computed tomography (μCT). The sections were tested in compression until failure, unloaded and scanned again in μCT. Volumetric bone mineral density (vBMD) and bone mineral content (BMC) were correlated to compression test results. hFE analysis was performed in order to compare computational predictions (stiffness, yield load and plastic deformation field pattern) with the compressive experiment. Namely, strain localization was assessed based on digital volume correlation (DVC) results and qualitatively compared to hFE predictions by comparing mid-slices patterns. Bone mineral content (BMC) showed a good correlation with stiffness (R2 = 0.92) and yield (R2 = 0.88). Structural parameters also showed good agreement between the experiment and hFE for both stiffness (R2 = 0.96, slope = 1.05 with 95 % CI [0.97, 1.14]) and yield (R2 = 0.95, slope = 1.04 [0.94, 1.13]). The qualitative comparison between hFE and DVC strain localization patterns allowed the classification of the samples into 3 categories: bad (15 sections), semi (8), and good agreement (2). The good correlations between BMC or hFE and experiment for structural parameters were similar to those obtained previously for the distal part of the radius. The failure zones determined by hFE corresponded to registration only in 8 % of the cases. We attribute these discrepancies to local elastic/plastic buckling effects that are not captured by the continuum-based FE approach exempt from strain softening. A way to improve strain localization hFE prediction would be to use longer distal segments with intact cortical shells, as done for the radius. To conclude, the used hFE scheme captures the elastic and yield response of the tibia sections reliably but not the subsequent failure process.

Developing and Validating a Model of Humeral Stem Primary Stability, Intended for In Silico Clinical Trials

In silico clinical trials (ISCT) can contribute to demonstrating a device's performance via credible computational models applied on virtual cohorts. Our purpose was to establish the credibility of a model for assessing the risk of humeral stem loosening in total shoulder arthroplasty, based on a twofold validation scheme involving both benchtop and clinical validation activities, for ISCT applications. A finite element model computing bone-implant micromotion (benchtop model) was quantitatively compared to a bone foam micromotion test (benchtop comparator) to ensure that the physics of the system was captured correctly. The model was expanded to a population-based approach (clinical model) and qualitatively evaluated based on its ability to replicate findings from a published clinical study (clinical comparator), namely that grit-blasted stems are at a significantly higher risk of loosening than porous-coated stems, to ensure that clinical performance of the stem can be predicted appropriately. Model form sensitivities pertaining to surgical variation and implant design were evaluated. The model replicated benchtop micromotion measurements (52.1 ± 4.3 µm), without a significant impact of the press-fit ("Press-fit": 54.0 ± 8.5 µm, "No press-fit": 56.0 ± 12.0 µm). Applied to a virtual population, the grit-blasted stems (227 ± 78µm) experienced significantly larger micromotions than porous-coated stems (162 ± 69µm), in accordance with the findings of the clinical comparator. This work provides a concrete example for evaluating the credibility of an ISCT study. By validating the modeling approach against both benchtop and clinical data, model credibility is established for an ISCT application aiming to enrich clinical data in a regulatory submission.

Biomechanics of the Human Osteochondral Unit: A Systematic Review

The damping system ensured by the osteochondral (OC) unit is essential to deploy the forces generated within load-bearing joints during locomotion, allowing furthermore low-friction sliding motion between bone segments. The OC unit is a multi-layer structure including articular cartilage, as well as subchondral and trabecular bone. The interplay between the OC tissues is essential in maintaining the joint functionality; altered loading patterns can trigger biological processes that could lead to degenerative joint diseases like osteoarthritis. Currently, no effective treatments are available to avoid degeneration beyond tissues' recovery capabilities. A thorough comprehension on the mechanical behaviour of the OC unit is essential to (i) soundly elucidate its overall response to intra-articular loads for developing diagnostic tools capable of detecting non-physiological strain levels, (ii) properly evaluate the efficacy of innovative treatments in restoring physiological strain levels, and (iii) optimize regenerative medicine approaches as potential and less-invasive alternatives to arthroplasty when irreversible damage has occurred. Therefore, the leading aim of this review was to provide an overview of the state-of-the-art-up to 2022-about the mechanical behaviour of the OC unit. A systematic search is performed, according to PRISMA standards, by focusing on studies that experimentally assess the human lower-limb joints' OC tissues. A multi-criteria decision-making method is proposed to quantitatively evaluate eligible studies, in order to highlight only the insights retrieved through sound and robust approaches. This review revealed that studies on human lower limbs are focusing on the knee and articular cartilage, while hip and trabecular bone studies are declining, and the ankle and subchondral bone are poorly investigated. Compression and indentation are the most common experimental techniques studying the mechanical behaviour of the OC tissues, with indentation also being able to provide information at the micro- and nanoscales. While a certain comparability among studies was highlighted, none of the identified testing protocols are currently recognised as standard for any of the OC tissues. The fibril-network-reinforced poro-viscoelastic constitutive model has become common for describing the response of the articular cartilage, while the models describing the mechanical behaviour of mineralised tissues are usually simpler (i.e., linear elastic, elasto-plastic). Most advanced studies have tested and modelled multiple tissues of the same OC unit but have done so individually rather than through integrated approaches. Therefore, efforts should be made in simultaneously evaluating the comprehensive response of the OC unit to intra-articular loads and the interplay between the OC tissues. In this regard, a multidisciplinary approach combining complementary techniques, e.g., full-field imaging, mechanical testing, and computational approaches, should be implemented and validated. Furthermore, the next challenge entails transferring this assessment to a non-invasive approach, allowing its application in vivo, in order to increase its diagnostic and prognostic potential.

Multiscale mechanical characterisation of the craniofacial system under external forces

Premature fusion of craniofacial joints, i.e. sutures, is a major clinical condition. This condition affects children and often requires numerous invasive surgeries to correct. Minimally invasive external loading of the skull has shown some success in achieving therapeutic effects in a mouse model of this condition, promising a new non-invasive treatment approach. However, our fundamental understanding of the level of deformation that such loading has induced across the sutures, leading to the effects observed is severely limited, yet crucial for its scalability. We carried out a series of multiscale characterisations of the loading effects on normal and craniosynostotic mice, in a series of in vivo and ex vivo studies. This involved developing a custom loading setup as well as software for its control and a novel in situ CT strain estimation approach following the principles of digital volume correlation. Our findings highlight that this treatment may disrupt bone formation across the sutures through plastic deformation of the treated suture. The level of permanent deformations observed across the coronal suture after loading corresponded well with the apparent strain that was estimated. This work provides invaluable insight into the level of mechanical forces that may prevent early fusion of cranial joints during the minimally invasive treatment cycle and will help the clinical translation of the treatment approach to humans.

Full-field strain distribution in hierarchical electrospun nanofibrous poly-L(lactic) acid/collagen scaffolds for tendon and ligament regeneration: A multiscale study

Regeneration of injured tendons and ligaments (T/L) is a worldwide need. In this study electrospun hierarchical scaffolds made of a poly-L (lactic) acid/collagen blend were developed reproducing all the multiscale levels of aggregation of these tissues. Scanning electron microscopy, microCT and tensile mechanical tests were carried out, including a multiscale digital volume correlation analysis to measure the full-field strain distribution of electrospun structures. The principal strains (εp1 and εp3) described the pattern of strains caused by the nanofibers rearrangement, while the deviatoric strains (εD) revealed the related internal sliding of nanofibers and bundles. The results of this study confirmed the biomimicry of such electrospun hierarchical scaffolds, paving the way to further tissue engineering and clinical applications.

A Comprehensive Mechanical Characterization of Subject-Specific 3D Printed Scaffolds Mimicking Trabecular Bone Architecture Biomechanics

This study presents a polymeric scaffold designed and manufactured to mimic the structure and mechanical compressive characteristics of trabecular bone. The morphological parameters and mechanical behavior of the scaffold were studied and compared with trabecular bone from bovine iliac crest. Its mechanical properties, such as modulus of elasticity and yield strength, were studied under a three-step monotonic compressive test. Results showed that the elastic modulus of the scaffold was 329 MPa, and the one for trabecular bone reached 336 MPa. A stepwise dynamic compressive test was used to assess the behavior of samples under various loading regimes. With microcomputed tomography (µCT), a three-dimensional reconstruction of the samples was obtained, and their porosity was estimated as 80% for the polymeric scaffold and 88% for trabecular bone. The full-field strain distribution of the samples was measured using in situ µCT mechanics and digital volume correlation (DVC). This provided information on the local microdeformation mechanism of the scaffolds when compared to that of the tissue. The comprehensive results illustrate the potential of the fabricated scaffolds as biomechanical templates for in vitro studies. Furthermore, there is potential for extending this structure and fabrication methodology to incorporate suitable biocompatible materials for both in vitro and in vivo clinical applications.

The role of bone metastases on the mechanical competence of human vertebrae

Spine is the most common site for bone metastases. The evaluation of the mechanical competence and failure location in metastatic vertebrae is a biomechanical and clinical challenge. Little is known about the failure behaviour of vertebrae with metastatic lesions. The aim of this study was to use combined micro-Computed Tomography (microCT) and time-lapsed mechanical testing to reveal the failure location in metastatic vertebrae. Fifteen spine segments, each including a metastatic and a radiologically healthy vertebra, were tested in compression up to failure within a microCT. Volumetric strains were measured using Digital Volume Correlation. The images of undeformed and deformed specimens were overlapped to identify the failure location. Vertebrae with lytic metastases experienced the largest average compressive strains (median ± standard deviation: -8506 ± 4748microstrain), followed by the vertebrae with mixed metastases (-7035 ± 15605microstrain), the radiologically healthy vertebrae (-5743 ± 5697microstrain), and the vertebrae with blastic metastases (-3150 ± 4641microstrain). Strain peaks were localised within and nearby the lytic lesions or around the blastic tissue. Failure between the endplate and the metastasis was identified in vertebrae with lytic metastases, whereas failure localised around the metastasis in vertebrae with blastic lesions. This study showed for the first time the role of metastases on the vertebral internal deformations. While lytic lesions lead to failure of the metastatic vertebra, vertebrae with blastic metastases are more likely to induce failure in the adjacent vertebrae. Nevertheless, every metastatic lesion affects the vertebral deformation differently, making it essential to assess how the lesion affects the bone microstructure. These results suggest that the properties of the lesion (type, size, location within the vertebral body) should be considered when developing clinical tools to predict the risk of fracture in patients with metastatic lesions.

Bone metastases do not affect the measurement uncertainties of a global digital volume correlation algorithm

Introduction: Measurement uncertainties of Digital Volume Correlation (DVC) are influenced by several factors, like input images quality, correlation algorithm, bone type, etc. However, it is still unknown if highly heterogeneous trabecular microstructures, typical of lytic and blastic metastases, affect the precision of DVC measurements.

Methods: Fifteen metastatic and nine healthy vertebral bodies were scanned twice in zero-strain conditions with a micro-computed tomography (isotropic voxel size = 39 μm). The bone microstructural parameters (Bone Volume Fraction, Structure Thickness, Structure Separation, Structure Number) were calculated. Displacements and strains were evaluated through a global DVC approach (BoneDVC). The relationship between the standard deviation of the error (SDER) and the microstructural parameters was investigated in the entire vertebrae. To evaluate to what extent the measurement uncertainty is influenced by the microstructure, similar relationships were assessed within sub-regions of interest.

Results: Higher variability in the SDER was found for metastatic vertebrae compared to the healthy ones (range 91-1030 με versus 222–599 με). A weak correlation was found between the SDER and the Structure Separation in metastatic vertebrae and in the sub-regions of interest, highlighting that the heterogenous trabecular microstructure only weakly affects the measurement uncertainties of BoneDVC. No correlation was found for the other microstructural parameters. The spatial distribution of the strain measurement uncertainties seemed to be associated with regions with reduced greyscale gradient variation in the microCT images.

Discussion: Measurement uncertainties cannot be taken for granted but need to be assessed in each single application of the DVC to consider the minimum unavoidable measurement uncertainty when interpreting the results.

Biomechanical evaluation of different strain judging criteria on the prediction precision of cortical bone fracture simulation under compression

Introduction: The principal strain or equivalent strain is mainly used in current numerical studies to determine the mechanical state of the element in the cortical bone finite element model and then perform fracture simulation. However, it is unclear which strain is more suitable for judging the element mechanical state under different loading conditions due to the lack of a general strain judging criterion for simulating the cortical bone fracture. Methods: This study aims to explore a suitable strain judging criterion to perform compressive fracture simulation on the rat femoral cortical bone based on continuum damage mechanics. The mechanical state of the element in the cortical bone finite element model was primarily assessed using the principal strain and equivalent strain separately to carry out fracture simulation. The prediction accuracy was then evaluated by comparing the simulated findings with different strain judging criteria to the corresponding experimental data. Results: The results showed that the fracture parameters predicted using the principal strain were closer to the experimental values than those predicted using the equivalent strain. Discussion: Therefore, the fracture simulation under compression was more accurate when the principal strain was applied to control the damage and failure state in the element. This finding has the potential to improve prediction accuracy in the cortical bone fracture simulation.