Integrating in vivo and in silico biodynamic studies of cruciate ligament injuries

This paper introduces a new research framework that integrates state-of-the-art in vivo and in silico methods for biodynamic studies of musculoskeletal injuries. The in vivo methods include dynamic radiographic imaging for measuring joint kinematics with unprecedented detail and accuracy. The in silico methods include musculoskeletal dynamic modeling at the joint and tissue levels. We illustrate the framework by a study of isolated PCL injuries, for which clinical treatment remains controversial. The study was able to discern significant increases in joint instability in the injured knees as compared to the intact knees. It also identified two distinctive biodynamic responses indicating two adaptive strategies. New, more holistic insights are gained and their clinical implications are interpreted. Current and future efforts to improve and expand the existing framework are discussed.