Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues

Sabri Uzuner

doi:10.29130/dubited.1923916

TR EN

Abstract

Ön çapraz bağ (ACL) yetersizliği diz eklemi mekaniğini değiştirir ve kıkırdak dejenerasyonunu hızlandırabilir. Ancak, interstisyel sıvı basıncı ve kolajen fibril gerilmeleri in vivo olarak ölçülemediği için ACL yetersizliğinin doku içi mekanik sonuçlarını nicel olarak belirlemek deneysel olarak zor olmaya devam etmektedir. Bu çalışmada, insan tibiofemoral ekleminin kişiye özgü, fibril ile güçlendirilmiş poromekanik sonlu eleman modeli, ACL sağlam ve ACL yetersiz durumlarda katı–sıvı etkileşimlerini incelemek için kullanılmıştır. MR görüntülerine dayalı geometri, fizyolojik yükleme altında kıkırdak ve menisküslerin bağlı poromekanik yanıtını yakalamak için anizotropik kolajen fibril ağlarını ve Darcy tipi interstisyel sıvı akışını içermektedir. Tek bacak duruşunu temsil eden ramp sıkıştırma ve posterior çekme (creep) kuvvetleri uygulanarak eklemin zamana bağlı mekanik davranışı değerlendirilmiştir. Sonuçlar, ACL yetersizliğinin lateral tibial kıkırdakta interstisyel sıvı basıncını %19’a kadar ve lateral femoral kondilde %13 artırdığını, buna karşılık kolajen fibril çekme gerilmesinin lateral femoral kıkırdakta %22 ve medial menisküste %5 arttığını göstermiştir. Genel gerilme dağılımları sağlam ve ACL yetersiz dizler arasında benzer olmasına rağmen, yük taşıyan bölgelerde sıvı basınçlanması ve fibril yüklenmesinde lokal artışlar gözlenmiştir. Bu bulgular, ACL yetersizliğinin kıkırdak dokuların iç poromekanik ortamını değiştirdiğini ve tekrarlı fizyolojik yükleme altında dejenerasyona katkıda bulunabileceğini göstermektedir.

Keywords

Poromekanik, fibril ile güçlendirilmiş kıkırdak, katı–sıvı etkileşimi, sonlu eleman modellemesi, ACL yetersizliği

Ethical Statement

ID REB15-1165, University of Calgary, katılımcının MRI verileri için.

Thanks

Calgary Üniversitesi’nde bir çalışma ortamı sağladığı ve sonlu elemanlar analizi gerçekleştirmemize olanak tanıyan Yüksek Performanslı Hesaplama (HPC) platformuna erişim imkanı verdiği için Dr. Leping Li’ye özel teşekkürlerimizi sunarız.

Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues

Abstract

Anterior cruciate ligament (ACL) deficiency alters knee joint mechanics and may accelerate cartilage degeneration. However, the intra-tissue mechanical consequences of ACL deficiency remain difficult to quantify experimentally because interstitial fluid pressure and collagen fibril stresses cannot be measured in vivo. In this study, a subject-specific fibril-reinforced poromechanical finite element model of the human tibiofemoral joint was used to investigate solid–fluid interactions in ACL-intact and ACL-deficient conditions. The MRI-based geometry incorporated anisotropic collagen fibril networks and Darcy-type interstitial fluid flow to capture the coupled poromechanical response of cartilage and menisci under physiological loading. Ramp compression and posterior drawer creep forces representing single-leg stance were applied to evaluate the time-dependent mechanical behavior of the joint. The results showed that ACL deficiency increased interstitial fluid pressure by up to 19% in the lateral tibial cartilage and 13% in the lateral femoral condyle, while collagen fibril tensile stress increased by 22% in the lateral femoral cartilage and by 5% in the medial meniscus. Although the overall stress distributions were similar between intact and ACL-deficient knees, localized increases in fluid pressurization and fibril loading were observed in load-bearing regions. These findings suggest that ACL deficiency modifies the internal poromechanical environment of cartilaginous tissues and may contribute to degeneration under repetitive physiological loading.

Keywords

Poromechanics, Fibril-reinforced cartilage, Solid–fluid coupling, Finite element modeling, ACL deficiency

Supporting Institution

This research received no external funding.

Ethical Statement

ID REB15-1165, University of Calgary, for the MRI data of the participant.

Thanks

Special thanks to Dr. Leping Li for providing a work environment at the University of Calgary and access to the High-Performance Computing (HPC) platform to perform finite element analysis.

References

Agostinone, P., Di Paolo, S., Grassi, A., Pinelli, E., Bontempi, M., Bragonzoni, L., & Zaffagnini, S. (2020). ACL deficiency influences medio-lateral tibial alignment and knee varus–valgus during in vivo activities. Knee Surgery, Sports Traumatology, Arthroscopy, 29(2), 389–397. https://doi.org/10.1007/S00167-020-05979-6
Ali, A. A., Harris, M. D., Shalhoub, S., Maletsky, L. P., Rullkoetter, P. J., & Shelburne, K. B. (2017). Combined measurement and modeling of specimen-specific knee mechanics for healthy and ACL-deficient conditions. Journal of Biomechanics, 57, 117–124. https://doi.org/10.1016/j.jbiomech.2017.04.008
Andriacchi, T. P., Briant, P. L., Bevill, S. L., & Koo, S. (2006). Rotational changes at the knee after ACL injury cause cartilage thinning. Clinical Orthopaedics and Related Research, 442, 39–44. https://doi.org/10.1097/01.blo.0000197079.26600.09
Ardatov, O., Aleksiuk, V., Maknickas, A., Stonkus, R., Uzieliene, I., Vaiciuleviciute, R., Pachaleva, J., Kvederas, G., & Bernotiene, E. (2023). Modeling the impact of meniscal tears on von mises stress of knee cartilage tissue. Bioengineering, 10(3), Article 314. https://doi.org/10.3390/bioengineering10030314
Asaeda, M., Deie, M., Fujita, N., Kono, Y., Terai, C., Kuwahara, W., Watanabe, H., Kimura, H., Adachi, N., Sunagawa, T., & Ochi, M. (2017). Gender differences in the restoration of knee joint biomechanics during gait after anterior cruciate ligament reconstruction. The Knee, 24(2), 280–288. https://doi.org/10.1016/j.knee.2017.01.001
Below, S., Arnoczky, S. P., Dodds, J., Kooima, C., & Walter, N. (2002). The split-line pattern of the distal femur: A consideration in the orientation of autologous cartilage grafts. Arthroscopy, 18(6), 613–617. https://doi.org/10.1053/jars.2002.29877
Dean, R. S., & LaPrade, R. F. (2020). ACL and posterolateral corner injuries. Current Reviews in Musculoskeletal Medicine, 13(1), 123–132. https://doi.org/10.1007/S12178-019-09581-3
Deng, R., Uzuner, S., & Li, L. P. (2024). Impact of knee geometry on joint contact mechanics after meniscectomy. Scientific Reports, 14(1), Article 28595. https://doi.org/10.1038/s41598-024-79662-y
DePhillipo, N. N., Moatshe, G., Brady, A., Chahla, J., Aman, Z. S., Dornan, G. J., Nakama, G. Y., Engebretsen, L., & LaPrade, R. F. (2018). Effect of meniscocapsular and meniscotibial lesions in ACL-deficient and ACL-reconstructed knees: A biomechanical study. The American Journal of Sports Medicine, 46(10), 2422–2431. https://doi.org/10.1177/0363546518774315
Girgis, F. G., Marshall, J. L., & Al Monajem, A. R. S. (1975). The cruciate ligaments of the knee joint. Anatomical, functional and experimental analysis. Clinical Orthopaedics and Related Research, 106, 216–231. https://doi.org/10.1097/00003086-197501000-00033

Gracia, G., Cavaignac, M., Marot, V., Mouarbes, D., Laumonerie, P., & Cavaignac, E. (2022). Epidemiology of combined injuries of the secondary stabilizers in ACL-deficient knees: Medial meniscal ramp lesion, lateral meniscus root tear, and ALL tear: A prospective case series of 602 patients with ACL tears from the SANTI study group. American Journal of Sports Medicine, 50(7), 1843–1849. https://doi.org/10.1177/03635465221092767
Gu, K. B., & Li, L. P. (2011). A human knee joint model considering fluid pressure and fiber orientation in cartilages and menisci. Medical Engineering & Physics, 33(4), Article 497. https://doi.org/10.1016/j.medengphy.2010.12.001
Guess, T. M., & Razu, S. (2017). Loading of the medial meniscus in the ACL deficient knee: A multibody computational study. Medical Engineering & Physics, 41(1), Article 26. https://doi.org/10.1016/j.medengphy.2016.12.006
Hamsayeh Abbasi Niasar, E., & Li, L. P. (2023). Characterizing site-specific mechanical properties of knee cartilage with indentation-relaxation maps and machine learning. Journal of the Mechanical Behavior of Biomedical Materials, 142, Article 105826. https://doi.org/10.1016/j.jmbbm.2023.105826
Hamsayeh Abbasi Niasar, E., & Li, L. P. (2025). Implication of region-dependent material properties of articular cartilage in the contact mechanics of porcine knee joint. BMC Musculoskeletal Disorders, 26(1), Article 149. https://doi.org/10.1186/s12891-025-08290-y
Hofmann, G., Jubin, P., Gerligand, P., Gallois-Bernos, A., Franklin, S., Smulders, N., Gerhardt, L. C., & Valster, S. (2016). In-vitro method for determining corneal tissue friction and damage due to contact lens sliding. Biotribology, 5, 23–30. https://doi.org/10.1016/j.biotri.2016.01.001
Korpershoek, J. V., de Windt, T. S., Vonk, L. A., Krych, A. J., & Saris, D. B. F. (2020). Does anterior cruciate ligament reconstruction protect the meniscus and its repair? A systematic review. Orthopaedic Journal of Sports Medicine, 8(7), Article 2325967120933895. https://doi.org/10.1177/2325967120933895
Kwon, H. M., Kang, K.-T., Kim, J. H., & Park, K. K. (2020). Medial unicompartmental knee arthroplasty to patients with a ligamentous deficiency can cause biomechanically poor outcomes. Knee Surgery, Sports Traumatology, Arthroscopy, 28(9), 2846–2853. https://doi.org/10.1007/s00167-019-05636-7
Li, L. P., Cheung, J. T. M., & Herzog, W. (2009). Three-dimensional fibril-reinforced finite element model of articular cartilage. Medical & Biological Engineering & Computing, 47(6), 607–615. https://doi.org/10.1007/s11517-009-0469-5
Lohmander, L. S., Östenberg, A., Englund, M., & Roos, H. (2004). High prevalence of knee osteoarthritis, pain, and functional limitations in female soccer players twelve years after anterior cruciate ligament injury. Arthritis and Rheumatology, 50(10), 3145–3152. https://doi.org/10.1002/ART.20589
Marcacci, M., Andriolo, L., Kon, E., Shabshin, N., & Filardo, G. (2016). Aetiology and pathogenesis of bone marrow lesions and osteonecrosis of the knee. EFORT Open Reviews, 1(5), 219–224. https://doi.org/10.1302/2058-5241.1.000044
McDonald, L. S., Boorman-Padgett, J., Kent, R., Stone, K., Wickiewicz, T. L., Pearle, A. D., & Imhauser, C. W. (2016). ACL deficiency increases forces on the medial femoral condyle and the lateral meniscus with applied rotatory loads. Journal of Bone and Joint Surgery, 98(20), 1713–1721. https://doi.org/10.2106/JBJS.15.00878
Motta, F., Barone, E., Sica, A., & Selmi, C. (2022). Inflammaging and osteoarthritis. Clinical Reviews in Allergy & Immunology, 64(2), 222–238. https://doi.org/10.1007/S12016-022-08941-1
Musahl, V., Citak, M., O’Loughlin, P. F., Choi, D., Bedi, A., & Pearle, A. D. (2010). The effect of medial versus lateral meniscectomy on the stability of the anterior cruciate ligament-deficient knee. American Journal of Sports Medicine, 38(8), 1591–1597. https://doi.org/10.1177/0363546510364402
Nessler, T., Denney, L., & Sampley, J. (2017). ACL injury prevention: What does research tell us? Current Reviews in Musculoskeletal Medicine, 10(3), 281–288. https://doi.org/10.1007/S12178-017-9416-5
Patil, S. S., Shekhar, A., & Tapasvi, S. R. (2017). Meniscal preservation is important for the knee joint. Indian Journal of Orthopaedics, 51(5), 576–587. https://doi.org/10.4103/ortho.ijortho_247_17
Samuelsen, B. T., Aman, Z. S., Kennedy, M. I., Dornan, G. J., Storaci, H. W., Brady, A. W., Turnbull, T. L., & LaPrade, R. F. (2020). Posterior medial meniscus root tears potentiate the effect of increased tibial slope on anterior cruciate ligament graft forces. American Journal of Sports Medicine, 48(2), 334–340. https://doi.org/10.1177/0363546519889628
Seon, J. K., Gadikota, H. R., Kozanek, M., Oh, L. S., Gill, T. J., & Li, G. (2009). The effect of anterior cruciate ligament reconstruction on kinematics of the knee with combined anterior cruciate ligament injury and subtotal medial meniscectomy: An in vitro robotic investigation. Arthroscopy – The Journal of Arthroscopic and Related Surgery, 25(2), 123–130. https://doi.org/10.1016/j.arthro.2008.09.020
Sharifi, M., Shirazi-Adl, A., & Marouane, H. (2018). Computation of the role of kinetics, kinematics, posterior tibial slope and muscle cocontraction on the stability of ACL-deficient knee joint at heel strike – Towards identification of copers from non-copers. Journal of Biomechanics, 77, 171–182. https://doi.org/10.1016/j.jbiomech.2018.07.003
Shirazi, R., & Shirazi-Adl, A. (2009). Analysis of partial meniscectomy and ACL reconstruction in knee joint biomechanics under a combined loading. Clinical Biomechanics, 24(9), 755–761. https://doi.org/10.1016/j.clinbiomech.2009.07.005
Sutter, E. G., Liu, B., Utturkar, G. M., Widmyer, M. R., Spritzer, C. E., Cutcliffe, H. C., Englander, Z. A., Goode, A. P., Garrett, W. E., & DeFrate, L. E. (2019). Effects of anterior cruciate ligament deficiency on tibiofemoral cartilage thickness and strains in response to hopping. American Journal of Sports Medicine, 47(1), 96–103. https://doi.org/10.1177/0363546518802225
Tissakht, M., & Ahmed, A. M. (1995). Tensile stress-strain characteristics of the human meniscal material. Journal of Biomechanics, 28(4), 411–422. https://doi.org/10.1016/0021-9290(94)00081-E
Uzuner, S. (2024a). Exploring the multifaceted dynamics of cartilage: A comparative modeling study. Düzce University Journal of Science and Technology, 12(2), 669–679. https://doi.org/10.29130/dubited.1347207
Uzuner, S. (2024b). Numerical analysis of a poroelastic cartilage model: Investigating the influence of changing material properties in osteoarthritis. Proceedings of the Institution of Mechanical Engineers, Part E: Journal of Process Mechanical Engineering, 238(4), 1894–1902. https://doi.org/10.1177/09544089241248147
Uzuner, S., Kuntze, G., Li, L. P., Ronsky, J. L., & Kucuk, S. (2022). Creep behavior of human knee joint determined with high-speed biplanar video-radiography and finite element simulation. Journal of the Mechanical Behavior of Biomedical Materials, 125, Article 104905. https://doi.org/10.1016/j.jmbbm.2021.104905
Uzuner, S., Li, L., Kucuk, S., & Memisoglu, K. (2020). Changes in knee joint mechanics after medial meniscectomy determined with a poromechanical model. Journal of Biomechanical Engineering, 142(10), Article 101006. https://doi.org/10.1115/1.4047343
Uzuner, S., & Li, L. P. (2024). Alteration in ACL loading after total and partial medial meniscectomy. BMC Musculoskeletal Disorders, 25(1), Article 94. https://doi.org/10.1186/s12891-024-07201-x
Uzuner, S., Rodriguez, M. L., Li, L. P., & Kucuk, S. (2019). Dual fluoroscopic evaluation of human tibiofemoral joint kinematics during a prolonged standing: A pilot study. Engineering Science and Technology, an International Journal, 22(3), 794–800. https://doi.org/10.1016/j.jestch.2018.12.014
Vairis, A., Stefanoudakis, G., Petousis, M., Vidakis, N., Tsainis, A.-M., & Kandyla, B. (2016). Evaluation of an intact, an ACL-deficient, and a reconstructed human knee joint finite element model. Computer Methods in Biomechanics and Biomedical Engineering, 19(3), 263–270. https://doi.org/10.1080/10255842.2015.1015526
Von Porat, A., Roos, E. M., & Roos, H. (2004). High prevalence of osteoarthritis 14 years after an anterior cruciate ligament tear in male soccer players: A study of radiographic and patient relevant outcomes. Annals of the Rheumatic Diseases, 63(3), 269–273. https://doi.org/10.1136/ARD.2003.008136
Wang, H., Kang, H., Yao, J., Cheng, C. K., & Woo, S. L.-Y. (2019). Evaluation of a magnesium ring device for mechanical augmentation of a ruptured ACL: Finite element analysis. Clinical Biomechanics, 68, 122–127. https://doi.org/10.1016/j.clinbiomech.2019.06.002
Weng, P.-W., Chen, C.-H., Luo, C.-A., Sun, J.-S., Tsuang, Y.-H., Cheng, C.-K., & Lin, S.-C. (2017). The effects of tibia profile, distraction angle, and knee load on wedge instability and hinge fracture: A finite element study. Medical Engineering & Physics, 42, Article 48. https://doi.org/10.1016/j.medengphy.2017.01.007
Woo, S. L.-Y., Akeson, W. H., & Jemmott, G. F. (1976). Measurements of nonhomogeneous, directional mechanical properties of articular cartilage in tension. Journal of Biomechanics, 9(12), 785–791. https://doi.org/10.1016/0021-9290(76)90186-X
Yao, Q., Wu, X., Tao, C., Gong, W., Chen, M., Qu, M., Zhong, Y., He, T., Chen, S., & Xiao, G. (2023). Osteoarthritis: Pathogenic signaling pathways and therapeutic targets. Signal Transduction and Targeted Therapy, 8(1), Article 56. https://doi.org/10.1038/s41392-023-01330-w
Zaffagnini, S., Signorelli, C., Bonanzinga, T., Grassi, A., Galán, H., Akkawi, I., Bragonzoni, L., Cataldi, F., & Marcacci, M. (2016). Does meniscus removal affect ACL-deficient knee laxity? An in vivo study. Knee Surgery, Sports Traumatology, Arthroscopy, 24(11), 3599–3604. https://doi.org/10.1007/s00167-016-4222-y

Details

Primary Language

English

Subjects

Biomechanic

Journal Section

Research Article

Authors

Sabri Uzuner ^*
0000-0002-9099-1324
Türkiye

Publication Date

October 23, 2026

Submission Date

April 6, 2026

Acceptance Date

August 5, 2026

Published in Issue

Year 2026 Volume: 14 Number: 4

DOI

https://doi.org/10.29130/dubited.1923916

IZ

https://izlik.org/JA23BG53US

APA

Uzuner, S. (2026). Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues. Duzce University Journal of Science and Technology, 14(4), 1114-1124. https://doi.org/10.29130/dubited.1923916

AMA

1.Uzuner S. Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues. DUBİTED. 2026;14(4):1114-1124. doi:10.29130/dubited.1923916

Chicago

Uzuner, Sabri. 2026. “Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues”. Duzce University Journal of Science and Technology 14 (4): 1114-24. https://doi.org/10.29130/dubited.1923916.

EndNote

Uzuner S (October 1, 2026) Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues. Duzce University Journal of Science and Technology 14 4 1114–1124.

IEEE

[1]S. Uzuner, “Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues”, DUBİTED, vol. 14, no. 4, pp. 1114–1124, Oct. 2026, doi: 10.29130/dubited.1923916.

ISNAD

Uzuner, Sabri. “Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues”. Duzce University Journal of Science and Technology 14/4 (October 1, 2026): 1114-1124. https://doi.org/10.29130/dubited.1923916.

JAMA

1.Uzuner S. Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues. DUBİTED. 2026;14:1114–1124.

MLA

Uzuner, Sabri. “Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues”. Duzce University Journal of Science and Technology, vol. 14, no. 4, Oct. 2026, pp. 1114-2, doi:10.29130/dubited.1923916.

Vancouver

1.Sabri Uzuner. Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues. DUBİTED. 2026 Oct. 1;14(4):1114-2. doi:10.29130/dubited.1923916

Abstract

Keywords

Ethical Statement

Thanks

Altered Fluid Pressurization and Fibril Loading in ACL-Deficient Knee Tissues

Abstract

Keywords

Supporting Institution

Ethical Statement

Thanks

References

Details

Primary Language

Subjects

Journal Section

Authors

Publication Date

Submission Date

Acceptance Date

Published in Issue

DOI

IZ

Cite