ARTICLE IN PRESS

Journal of Biomechanics 37 (2004) 383–390

A three-dimensional finite element model of the human anterior

cruciate ligament: a computational analysis with experimental
validation
Yuhua Song, Richard E. Debski, Volker Musahl, Maribeth Thomas, Savio L.-Y. Woo*
Department of Orthopaedic Surgery, Musculoskeletal Research Center, University of Pittsburgh, E1641 Biomedical Science Tower, 210 Lothrop St.,
PO Box 71199, Pittsburgh, PA 15213, USA
Accepted 23 June 2003

Abstract

In this study, the force and stress distribution within the anteromedial (AM) and posterolateral (PL) bundles of the anterior
cruciate ligament (ACL) in response to an anterior tibial load with the knee at full extension was calculated using a validated three-
dimensional finite element model (FEM) of a human ACL. The interaction between the AM and PL bundles, as well as the contact
and friction caused by the ACL wrapping around the bone during knee motion, were included in the model. The AM and PL
bundles of the ACL were simulated as incompressible homogeneous and isotropic hyperelastic materials. The multiple-degrees-of-
freedom (DOF) knee kinematics of a cadaveric knee were first obtained using a robotic/universal force–moment sensor testing
system. These data were used as the boundary conditions for the FEM of the ACL to calculate the forces in the ACL. The calculated
forces were compared to the in situ force in the ACL, determined experimentally, to validate the model. The validated FEM was
then used to calculate the force and stress distribution within the ACL under an anterior tibial load at full extension. The AM and
PL bundles shared the force, and the stress distribution was non-uniform within both bundles with the highest stress localized near
the femoral insertion site. The contact and friction caused by the ACL wrapping around the bone during knee motion played the
role of transferring the force from the ACL to the bone, and had a direct effect on the force and stress distribution of the ACL. This
validated model will enable the analysis of force and stress distribution in the ACL in response to more complex loading conditions
and has the potential to help design improved surgical procedures following ACL injuries.
r 2003 Elsevier Ltd. All rights reserved.

Keywords: ACL; 3-D finite element model; Experimental validation; Stress distribution contact in friction

1. Introduction data can be used to better understand the mechanism of

The human anterior cruciate ligament (ACL) plays an
essential role in maintaining knee stability in multiple
directions and is one of the most frequently injured
ligaments of the knee (Daniel et al., 1994; Griffin et al.,
2000). Based on the anatomy and tensioning patterns of
this ligament during knee flexion and extension, the
ACL can be divided into two bundles, an anteromedial
(AM) bundle and a posterolateral (PL) bundle (Girgis
et al., 1975). Understanding the force and stress
distribution within the AM and PL bundles of the
human ACL during knee motion is important, as the
*Corresponding author. Tel.: +1-412-648-2000; fax: +1-412-648-
2001.
E-mail address: decenzod@msx.upmc.edu (S.L.-Y. Woo).
injury, to improve the design of ACL reconstruction
procedures, to optimize rehabilitation protocols, and to
provide a basis for the close examination of cellular
responses to external forces.
During the last decade, extensive experimental efforts
have been made to quantify the forces and strains in the
ACL in both in vitro and in vivo settings (Woo et al.,
1992, 1997, 1999; Fleming et al., 1993, 2001; Fujie et al.,
1993, 1996; Beynnon et al., 1995; Livesay et al., 1995,
1997; Xerogeanes et al., 1995; Rudy et al., 1996).
Computational models have also been developed to gain
data that would otherwise be difficult to obtain
experimentally. These models include representations
of ligaments as linear or nonlinear springs in diarthro-
dial joints (Wismans et al., 1980; Andriacchi et al., 1983;
Essinger et al., 1989; Blankevoort et al., 1991;

0021-9290/$ - see front matter r 2003 Elsevier Ltd. All rights reserved.
doi:10.1016/S0021-9290(03)00261-6
 ARTICLE IN PRESS
384 Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390
Blankevoort and Huiskes, 1996; Mommersteeg et al.,
1996; Li et al., 1999). These models have helped to predict
joint kinematics and ligament forces. Other researchers
have developed 3-D finite element models (FEM) of the
human ACL by treating it as a continuum such that the
stress distribution in the ACL could be calculated
(Pioletti et al., 1998; Hirokawa and Tsuruno, 2000).
The objective of this study was to determine the force
and stress distribution of the ACL through the use of a
validated 3-D FEM of the ACL. The 3-D FEM was
based on the anatomy and function of the ACL by
considering both the AM and PL bundles, the interac-
tion between them, and the contact and friction that
were caused by the wrapping of the ACL around the
bone during knee motion. The knee kinematics were
obtained experimentally using a robotic/universal force–
moment sensor (UFS) testing system (Fujie et al., 1996;
Rudy et al., 1996) and were used as the boundary
conditions for the FEM. To validate the model, the
force in the ACL was calculated and compared to
the experimental results. With the validated FEM of the
ACL, the stress distribution within the two bundles of
the ACL was calculated.
2. Materials and methods
The experimental knee kinematics and in situ force in
the ACL of a 55-year-old male cadaveric knee were
obtained using the robotic/UFS testing system (Rudy
et al., 1996). This system is composed of a robotic
manipulator and a UFS. It is able to measure
kinematics, forces, and moments in six degrees of
freedom (DOF). Previous studies have demonstrated
that this system has a repeatability of 0.2 mm for
translation, 0.2
for rotation, 0.2 N for forces and
0.01 N m for moments (Rudy et al., 1994). The robotic/
UFS testing system is capable of operating in position-
control mode (i.e. moving the joint to a desired position
in space and measuring the resulting forces) (Fujie et al.,
1993) and force-control mode (i.e. moving the joint to
achieve a pre-determined force–moment target using
force-feedback achieved by the UFS while recording the
resulting knee kinematics) (Fujie et al., 1995; Rudy et al.,
1996).
The experimental protocol for the robotic/UFS
testing in this study was as follows. The cadaveric
human knee specimen was frozen at 80
C until 24 h
before testing, at which time it was thawed at room
temperature (Woo et al., 1986). The specimen was
radiographed for possible bony abnormalities and
clinically examined for any ligament deficiencies. The
joint capsule, skin and muscles were kept intact around
the knee joint while the skin and muscles were dissected
away beyond 10 cm from the joint line. The femur and
tibia were then cut approximately 20 cm away from the
joint line. Each bone was subsequently potted in epoxy
compound and secured with bolts in thick-walled
aluminum cylinders. The femur was fixed to the base
of the robotic manipulator, while the tibia was rigidly
attached to the end-effector of the robot. The specimen
was kept moist with 0.9% saline during dissection and
biomechanical testing.
Initially, the path of passive flexion-extension of the
intact knee from full extension to 90
of knee flexion
was determined by the robotic/UFS testing system while
operating in force-control mode (Sakane et al., 1997).
This system found the positions of the knee throughout
the range of flexion in 1
increments while minimizing
external forces and moments. At each flexion angle, the
positions that satisfied the condition of zero force and
zero moment were recorded and this motion was then
repeated for 10 cycles to minimize viscoelastic effects.
These joint positions, determined at each flexion angle,
served as the reference positions (starting points) for the
application of external loads.
The intact knee was tested at full extension in
response to an incremental anterior tibial load ranging
from 0.0 to 134.0 N while the forces and moments in all
other directions were minimized. The robotic/UFS
testing system applied the anterior tibial load to the
knee in 9 steps (i.e. 0.0, 8.8, 22.2, 44.6, 67.0, 89.2, 100.5,
116.0, and 134.0 N). With the flexion angle fixed, the
reference position and the resulting kinematics of the
knee in the remaining five DOFs were recorded. All soft
tissue (excluding the ACL) and bony contact surfaces
between the femoral condyles and tibial plateaus were
removed. Operating in position-control mode, the
robotic manipulator reproduced the previously recorded
kinematics of the intact knee at full extension, while the
UFS monitored the new sets of forces and moments. At
this point, the in situ force of the ACL was directly
measured, as it was the only remaining structure.
The experimentally obtained multiple DOF knee
kinematics were used as boundary conditions in the 3-
D FEM of the ACL, and the experimental in situ force
of the ACL was compared to the calculated force in the
ACL to validate the FEM.
A 3-D FEM was implemented using the MSC/MARC
finite element software (MSC. Software Corporation,
Los Angels, CA) (see Fig. 1(a)). The geometry of both
the femur and tibia of a 65-year old male cadaveric knee
was reconstructed from magnetic resonance images
(MRI) (Sigma, Horizon; GE, Milwaukee, WI). The
insertion sites of each bundle of the ACL were obtained
using the Microscribe digitizing platform (Immersion
Corp., San Jose, CA) (Li et al., 1999). Because the exact
three-dimensional shapes of the AM and PL bundles of
the ACL were not available, solids that joined the
insertion sites were created.
In the 3-D FEM of the ACL, the AM and PL bundles
of the ACL were represented by an incompressible
 ARTICLE IN PRESS
Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390
Fig. 1. 3-D FEM of the ACL for a human left knee: (a) femur and
tibia included in the model (anterior view), (b) without femur and tibia
included in the model (medial view).
hyperelastic material and were assumed to be homo-
geneous and isotropic. Although experimental studies
measuring the mechanical properties of the ACL were
extensive (Woo et al., 1983, 1991; Butler et al., 1986,
1992), the anisotropic mechanical properties of the ACL
were unavailable because the complex structure of the
ACL made the measurement of the mechanical proper-
ties of the ACL difficult. The assumption of homo-
geneity was based on data from Nordin and Frankel
(1980). The time and history based viscoelastic proper-
ties of the ACL were not considered in this study.
The mechanical properties of the ACL were mathe-
matically modeled as a stress-strain curve composed of
two parts: a toe region and a linear region (Butler et al.,
1986, 1992; Woo et al., 1991; Pioletti et al., 1998). In this
study, the strain-energy function (W ) for describing the
incompressible soft tissue behavior was adopted as
(Veronda and Westmann, 1970)
We ¼ a exp½bðI1  3Þ þ C1 ðI2  3Þ;
whereby a; b; C1 are material constants, and I1 ; I2 are
the strain invariants.
385
The material constants (a; b; C1 ) were cited from the
literature, which were determined according to the
experimentally obtained stress–deformation gradient
curve of the human ACL (Pioletti et al., 1998). a is
0.26 MPa, b is 11.35, C1 is 1.49.
Biological soft tissues are subjected to various levels
of residual stress in vivo. Typical residual strains are
approximately 3–5% in the ligament of diarthroidal
joints (Blankevoort et al., 1991; Li et al., 1999). In this
FEM of the ACL, initial in situ strain of the AM and PL
bundles was assumed to be 3%.
As an intra-articular structure, the ACL was wrapped
around the bone during the knee motion. The interac-
tion between the AM and PL bundles, as well as the
effect caused by the wrapping of the ACL around the
bone (femur and tibia), were included in this model
through the proper treatment of the contact and friction
relationship between them. The insertion surfaces of the
ACL on the femur and tibia were attached on the bone,
and treated as a rigid surface. The direct constraint
method for the solution of contact problems and the
Coulomb friction model for the solution of the friction
problem were implemented in MARC software
(MARC, 2000).
With the proper treatment of the boundary condi-
tions, the initial condition, the material model of the
ACL, and the contact and friction within the femur-
ACL-tibia structure, the 3-D FEM of the ACL was used
to calculate the force in the ACL. The model mimicked
the experimental configuration, with the femur fixed and
the tibia free to move in five-DOF (CASE A) (Fig. 1(a)).
The calculated force of the ACL was equal to the
reaction force of the rigid tibial insertion surfaces of the
ACL in response to the knee motion. The corresponding
experimental in situ force in the ACL that was equal to
the reaction force of the tibia was compared to the
calculated force in the ACL to validate the model. The
validated FEM served as a tool to analyze the force and
stress distribution within the ACL. The calculated forces
of the AM and PL bundles were equal to the reaction
forces of the femoral rigid insertion surfaces of the AM
and PL bundles in response to the knee motion. The
forces of the tibial rigid insertion surfaces of the AM
and PL bundles were also calculated and compared to
the forces of the femoral rigid insertion surfaces. The
force differences can help to understand the role of
contact and friction in load transfer, which was caused
by the ACL wrapping around the bone. With the
validated FEM, the equivalent cauchy stress distribution
within the ACL was also calculated.
To further understand the role of the contact and
friction in load transfer and its effect on the stress
distribution of the ACL, the forces of the femoral and
ð1Þ
tibial insertion surfaces of the AM and PL bundles
and the stress distribution of the ACL were calculated
without including the effect of the ACL wrapping
 ARTICLE IN PRESS
386 Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390

around the bone, i.e. only the ACL and its bony 5
insertion surfaces on the femur and tibia considered in 4

Tibial translation (mm)

the FEM of the ACL (CASE B) (Fig. 1(b)).
3
A sensitivity analysis of the force and stress distribu-
tions within the ACL to the material parameters, a and 2 LATERAL
b; of Eq. (1) was performed. The parameter a was ANTERIOR
1
changed within the range of 0.3070.08 MPa (levels of DISTAL
0.22, 0.27, 0.32, and 0.38), while parameter b remained 0
constant at 11.35. Next, the parameter b was changed -1
within the range of 12.2072.18 (levels of 10.02, 11.47,
-2
12.92, 14.38), while parameter a was held constant at
0 30 60 90 120 150
0.26 MPa. The chosen parameter ranges for a and b (a) Anterior Tibial Load (N)
were obtained from an experimental study performed by
Pioletti et al. in which 5 human knee specimens were 6
tested (males, age range 74.872.1 years) (Pioletti, 1997). 5

Tibial rotation (deg.)

To further understand the sensitivity of the force and
4
stress distribution within the ACL, the geometry of the
3 FLEXION
ACL was altered by individually removing one of the
VALGUS
bundles (either AM or PL bundle present) and compar- 2
INTER AL
ing the results to those of the double bundle case (AM 1
and PL bundles both present). The results may allow the
0
comparison of the force and stress distribution in the
ACL graft after single vs. anatomical reconstruction -1
procedures. 0 30 60 90 120 150
(b) Anterior Tibial Load (N)

Fig. 2. Experimentally obtained kinematics of the knee joint under an

3. Results incremental anterior tibial load at full extension: (a) tibial translation
of the knee, (b) tibial rotation of the knee.
The reference position (starting position) of the
cadaveric knee at full extension during the robotic/
UFS testing was 0.0 mm anterior, 0.1 mm lateral, 140
0.4 mm distal, 5
flexion, 0.4
valgus rotation, and 120
1.4
internal tibial rotation. In response to incremental Calculation
Force of the ACL (N)

100
anterior tibial loads (i.e. 9, 22, 45, 67, 89, 101, 116, Experiment
134 N) at full extension, the experimental multiple DOF 80
knee kinematics were recorded, including tibial transla- 60
tion (Fig. 2(a)) and tibial rotation (Fig. 2(b)). As the
anterior tibial load increased, the anterior tibial 40

translation of the knee showed an obvious increase 20

(Fig. 2(a)).
The corresponding experimental in situ forces in the
ACL under the same incremental loading conditions
were 14, 21, 36, 59, 83, 95, 104, and 129 N, respectively
(Fig. 3). With the experimentally obtained knee kine-
matics input as boundary conditions in the FEM of the
ACL (CASE A), the calculated forces in the ACL were
4, 19, 36, 62, 75, 88, 103, 116 N in response to the 8
incremental anterior tibial loads at full extension. The
calculated force in the ACL varied from the experi-
mental results by 6.375.5 N. The difference between the
calculated force of the ACL and the experimental data
was found to be less than 11% when the applied external
load ranged from 22 to 134 N (Fig. 3).
With the validated knee model (CASE A), the forces
in the AM and PL bundles were calculated under 134 N
anterior tibial load at full extension. The calculated
0
0 20 40 60 80 100 120 140
Anterior Tibial Load (N)
Fig. 3. Comparison of the calculated force in the ACL for CASE A
with the experimental result under an incremental anterior tibial load
at full extension.
force of the AM bundle was 43 N, and that of the PL
bundle was 64 N. The calculated force distribution
within the AM and PL bundles showed that the force
of the PL bundle was 43% higher than that of the AM
bundle in response to an incremental anterior tibial load
(0–134 N) at full extension (Fig. 4).
To understand the role of the contact and friction in
load transfer, the forces of the tibial and femoral
insertion surfaces of the ACL, AM and PL bundles
 ARTICLE IN PRESS
Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390 387

70 8
7 contact force between
60 bone and ACL
Calculated Force (N)

Calculated force (N)

6 Interaction force between
AM bundle AM and PL bundles
50 5
PL bundle 4
40 3
30 2
1
20 0
10 -1
0 20 40 60 80 100 120 140
0 Anterior Tibial Load (N)
0 20 40 60 80 100 120 140
Fig. 5. The interaction force between the AM and PL bundles and the
Anterior Tibial Load (N) contact force caused by the ACL wrapping around the bone for CASE
A under an incremental anterior tibial load at full extension.
Fig. 4. Comparison of force distribution within the AM and PL
bundles for CASE A under an incremental anterior tibial load at full
extension.

were calculated under 134 N anterior tibial load at full

extension. For CASE A, the calculated force of the tibial
insertion surface of the ACL was 116 N, that of the AM
bundle was 51 N, and that of the PL bundle was 64 N;
the calculated force of the femoral insertion surface of
the ACL was 107 N, that of the AM bundle was 43 N,
and that of the PL bundle was 64 N. For CASE B, the
calculated force of the tibial insertion surface of the
ACL was 114 N, that of the AM bundle was 50 N, and
that of the PL bundle was 64 N under 134 N anterior
tibial load at full extension. With these boundary
conditions, the calculated forces of the femoral insertion
surfaces for the ACL, AM and PL bundles were the
same as those of the tibial insertion surfaces.
The force difference between the calculated forces of
the tibial and femoral insertion surfaces for CASE A
was the force transferred from the ACL to bone by
contact and friction caused by the ACL wrapping
around the bone. The force difference between the force
of the ACL and the sum of AM and PL bundles was the
interaction force between the AM and PL bundles.
According to the calculated results of CASE A and
CASE B, the interaction forces between the AM and PL
bundles were 0–0.3 N. The contact and friction forces
between the ACL and bone were 0.5–7.8 N under the
incremental anterior tibial loads at full extension for
CASE A (Fig. 5).
With the validated FEM of the ACL (CASE A), the
stress distribution in the AM and PL bundles of the
ACL was found to be non-uniform (Fig. 6(a)). The
maximum equivalent Cauchy stresses of both bundles
were localized on the lateral portion of the bundles near
the femoral insertion site where the stresses in the PL
bundle ranged from 6.8 to 24.0 MPa, and, in the AM
Fig. 6. Equivalent Cauchy stress distribution within the AM and PL
bundle, the stresses ranged from 5.9 to 16.5 MPa. The
bundles under a 134 N anterior tibial load with the knee at full
stresses in the mid-substance of the PL bundle ranged extension (medial view). (a) CASE A: contact and friction included
from 6.1 to 6.9 MPa, while those near the tibial insertion when the ACL wraps around the bone (b) CASE B: contact and
site ranged from 1.6 to 6.2 MPa. The corresponding friction caused by the ACL wrapping around the bone not included.
 ARTICLE IN PRESS
388 Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390
stresses for the AM bundle ranged from 4.7 to 6.2 MPa,
and 2.6 to 5.3 MPa, in the mid-substance and near the
tibial insertion site, respectively (Fig. 6(a)). Including the
contact and friction caused by the ACL wrapping
around the bone in the FEM of the ACL also influenced
the stress distribution of the ACL, especially for the AM
bundle as it had more contact with the bone under
anterior tibial load at full extension. Compared to the
stress distribution of CASE B (Fig. 6(b)), the stress in
the AM bundle was more localized on the lateral aspect.
The stresses near the femoral insertion site were
increased, and the maximum stress in the ACL increased
from 18.3 to 24.0 MPa for CASE A.
To understand the sensitivity of the force and stress
distributions within the ACL to the material parameters,
a and b were altered individually. When the parameter a
was changed within the range of 0.3070.08 MPa with b
constant at 11.35, compared to the calculation results
with a ¼ 0:26 MPa and b ¼ 11:35; the maximum differ-
ence in the force of the ACL was –2.470.47 N with an
applied anterior tibial load of 116 N. Likewise, the
minimum difference in force was 0.2070.56 N with an
applied anterior tibial load of 45 N. In terms of the stress
distribution, the average difference of the maximum
equivalent stress was found to be 0.4670.88 MPa. For
the cases in which parameter b was altered within the
range of 12.2072.18 with a constant at 0.26 MPa, the
maximum difference in the force of the ACL was
7.7715.7 N with an applied anterior tibial load of 22 N.
The minimum difference was found to be 4.39715.5 N
with an applied anterior tibial load of 116 N. Finally, the
average difference of the maximum equivalent stress was
found to be 1.1173.31 MPa.
A sensitivity analysis was also performed to compare
the force and stress distribution results of a single
bundle ACL (AM or PL bundle present) with those of a
double bundle ACL (AM and PL bundles present). For
the case in which only the AM bundle was present, the
force in the ACL was found to be 50.8 N and the
maximum equivalent stress was 16.5 MPa in response to
knee kinematics under a 134 N anterior tibial load. For
the case in which only the PL bundle was present, the
corresponding force was found to be 63.4 N and the
maximum equivalent stress was 20.8 MPa in response to
knee kinematics under a 134 N anterior tibial load. For
the case in which both AM and PL bundles existed, the
corresponding force in the ACL was found to be 116 N
with a maximum equivalent stress of 24 MPa in response
to knee kinematics under a 134 N anterior tibial load.
4. Discussion
A 3-D FEM of a human ACL was constructed based
on the geometry of a 65-year-old male cadaveric knee.
Using the kinematics data determined experimentally
from a 55-year-old male cadaveric knee as the boundary
conditions of the FEM, the force in the ACL was
calculated when the knee was subjected to an anterior
tibial load with the knee at full extension. The calculated
forces of the ACL for the anterior tibial load from 0 to
134 N were compared to those in situ forces in the ACL
obtained experimentally. The calculation results
matched the experimental results well; therefore the
FEM was validated. Thus, the force and stress distribu-
tion within the AM and PL bundles of the ACL were
calculated with the validated FEM. The anatomy and
function of the ACL, including both the AM and PL
bundles, and the interaction between them, as well as the
contact and friction caused by the ACL wrapping
around the bone, were considered in this study. Thus,
the FEM of the ACL and the data obtained have added
important new information to those reported previously
in literature (Pioletti et al., 1998; Hirokawa and
Tsuruno, 2000). These new information include the
load transferred by the ACL wrapping around the bone,
the interaction force between the AM and PL bundles,
and the unevenly distributed force and stress within the
AM and PL bundles.
The calculated force distribution within the ACL
clearly indicates that the AM and PL bundles share the
load sustained by the ACL, and that at full extension,
the PL bundle endures more force than the AM bundle
under anterior tibial load. The interaction force between
the AM and PL bundles was calculated to be negligible.
These findings correspond to published experimental
results from our research center (Sakane et al., 1997).
On the other hand, contact and friction were caused
when the ACL wrapped around the bone, which
predominantly occurred between the AM bundle and
bone. The contact and friction caused by the ACL
wrapping around the bone played the role of transfer-
ring the force from the ACL to the bone, so the
calculated force in the femoral insertion surface of the
ACL was decreased. This also has an effect on the stress
distribution in the ACL. Compared to the case not
including the contact and friction caused by the ACL
wrapping around the bone, the stress in the AM bundle
was more localized on the lateral aspect and the stresses
near the femoral insertion site increased. The contact
and friction caused by the ACL wrapping around the
bone will play an important role at higher flexion angles,
as there will be more contact between ACL and bone,
especially during other loading conditions, such as the
pivot shift test.
The calculated results for CASE A showed that the
stress range in the PL bundle was higher than that of the
AM bundle. Within the ACL, the highest stress was
localized near the femoral insertion site, and the stress in
the mid-substance was higher than that near the tibial
insertion site. Clinical reports indicate that most ACL
tears occur near the femoral insertion site and in the
 ARTICLE IN PRESS
Y. Song et al. / Journal of Biomechanics 37 (2004) 383–390
mid-substance (Sherman et al., 1991). The stress
distribution within the ACL corresponds to those
clinical reports and offers additional information for
understanding the mechanism of ACL injury.
The results of the sensitivity analysis show that the
force and stress distributions within the ACL are not
sensitive to the change of the material parameter a; but
are sensitive to the change of the material parameter b:
However, when comparing a single bundle ACL
reconstruction to the anatomical (double bundle) case,
it can be seen that, in response to the same knee
kinematics under a 134 N anterior tibial load, the forces
for the two single bundle reconstruction cases (AM
bundle and PL bundle individually) are quite different
from the case in which both bundles were included
(double bundle). These differences are also noted in the
maximum equivalent stresses. This indicates that, when
comparing single bundle versus anatomical reconstruc-
tions, variations in the force and stress distributions in
the ACL graft will be evident.
A limitation of the current model is the representation
of the ACL as an isotropic and homogenous material.
As a soft tissue, the ACL cannot resist compressive
loads. Therefore, an assumption of isotropy is invalid
for the ACL model when analyzing knee motion at
higher flexion angles. In this study, an anterior tibial
load at full extension was applied, eliminating any
compressive and bending behavior due to the geometric
configuration of the ACL. Thus, modeling the ACL as
an isotropic material is a valid assumption in this study
and will not influence the results. Additionally, the
homogenous assumption based on data from Nordin
and Frankel (1980) will not influence the stress
distribution of the ACL, but instead will have a certain
effect on the stress magnitude within the ACL because
the mechanical properties of the ACL near the femoral
insertion vary from those in the mid-substance of the
ACL.
Because of this, the next step is to incorporate a more
realistic representation of the mechanical properties of
the ACL in the FEM in order to improve the accuracy
of force and stress calculations under more complex
loading conditions and at higher flexion angles. The fact
that the knee used to reconstruct the geometry model
was not the same knee used to obtain the experimental
data may also cause error in the calculated results.
Nevertheless, for anterior tibial loads at full extension,
the calculated results of the ACL corresponded well with
the experimental data. A geometry model for a subject-
specific knee will need to be included in the future
studies.
Although only one subject was used in this study, the
purpose of this work was to determine the feasibility of
developing a FEM of the human ACL. This goal was
accomplished as a validated FEM of the human ACL
was created and the force and stress distribution within
389
the AM and PL bundles of the ACL under an anterior
tibial load at full extension was determined. The findings
from the validated FEM of the ACL of one subject can
not only be a valuable tool to help determine this force
and stress distribution within the AM and PL bundles of
the ACL, but will also offer valuable information to
further the understanding of the mechanism of ACL
injury, as well as providing the basis for the study of
cellular response.
With the methodology developed in this study,
statistical studies with multiple knees will be performed
in the future to further validate the computational
model of the ACL and to determine the force and stress
distribution in the ACL with statistical significance.
Furthermore, the method to develop a validated FEM
of the ACL described in this work provides a basis for
further development of a subject-specific FEM of the
ACL. This future model will include new information
obtained from this study, including the load transferred
by the ACL wrapping around the bone and the
interaction force between the AM and PL bundles.
Eventually, the calculated results from the subject-
specific FEM of the ACL can provide more relevant
information to improve both the design of an appro-
priate surgical procedure following ACL injury and the
rehabilitation protocol for an individual patient.
Acknowledgements
Financial support of the NIH grant xAR39683 is
gratefully acknowledged.
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