In situ calibration of miniature sensors implanted into the anterior cruciate ligament part II: force probe measurements

Abstract

The arthroscopically implantable force probe transducer, which measures the effects of local ligament fiber tension, was inserted into the anteromedial band of the anterior cruciate ligament after measurements with the differential variable reluctance transducer were completed in Part I of this study. The overall goals in Part II remained the same, with additional experiments included to determine the sensitivity of output voltage from the transducer to medial-lateral placement of the device within the anteromedial band and to depth of placement within a given insertion hole. Calibration curves of output voltage from the arthroscopically implantable force probe transducer versus resultant force in the ligament were generated during a separate series of knee-loading experiments identical to those performed in Part I. The output voltage for a given probe placement was highly sensitive to the depth of implantation into the anteromedial band. When the probe was completely buried within the ligament, voltage outputs were often sporadic or absent even though surface fibers had clearly developed tension. When the probe was only partially inserted into the hole, such that the end of the probe was slightly proud to the surface, voltage output was significantly higher as the device measured tension in the superficial fibers. Voltage outputs for proud placement were always significantly higher than corresponding voltages for deep placements for all test conditions. With proud placements, voltage outputs were not sensitive to small deviations in medial-lateral position within the anteromedial band. Mean coefficients of variation for output voltage (four repeated placements of the probe into the same central hole) ranged from 0.156 to 0.359 (deep and proud insertions). Output voltage from the probe generally followed the pattern of resultant force in the ligament during passive knee extension. For anterior tibial loading, the contribution of deep fibers to resultant force did not depend on the knee flexion angle at which the test was conducted; the contribution of superficial fibers was greatest beyond 45 degrees of flexion and least at full extension. The contributions of the anteromedial band to resultant force in the ligament were not significantly different between the three modes of loading (anterior tibial force, internal tibia torque, and varus moment) at either 0 or 10 degrees of flexion; this was true for both superficial and deep fibers. We found it necessary to secure the probe within the insertion site using a suture (for both deep and proud placements) to obtain repeatable readings. Puncturing the anteromedial band clearly produced tissue damage; the insertion hole often produced a permanent plane of cleavage in the anteromedial band. However, this tissue damage did not alter the overall ability of the ligament to generate resultant force.