Knee function assessment of anterior cruciate ligament injury with a Kirigami buckling-resistant stretchable sensor

Abstract

Continuous and quantitative monitoring of knee joint function has clinical value in rehabilitation assessment and the timing of return to play for anterior cruciate ligament injury patients. However, the existing approaches, including clinical examination, arthrometry and inertial solutions, can only be used for qualitative, off-line and low-quality evaluations, respectively. Burgeoning Kirigami stretchable sensors could be a disruptive candidate solution, but they usually suffer from structural buckling issues when used for large strain applications, such as knee joint motion capture where the buckling degrades sensor reliability and repeatability. Here, we propose a buckling-resistant stretchable and wearable sensor for knee joint motion capture. It enables continuous and precise motion signal capture of the knee joint and provides high wearing comfort and reliability. Clinical tests were conducted on 30 patients in the field, tracking data provided by the sensor from their initial hospitalization to later surgery. And the full rehabilitation of one subject was recorded and analyzed. The test results show that our sensor can dynamically assess knee function in real time and recommend the best timing for return to play, which paves the way for personalized and telerehabilitation.

Keywords

anterior cruciate ligament / stretchable sensor / wearable

References

[1] ArdernCL, TaylorNF, FellerJA, Webster KE. Fifty-five percent return to competitive sport following anterior cruciate ligament reconstruction surgery: an updated systematic review and meta-analysis including aspects of physical functioning and contextual factors. Br J Sports Med. 2014; 48(21): 1543-1552.

[2] MurrayMM. Optimizing outcomes of ACL surgery: is autograft reconstruction the only reasonable option? J Orthop Res. 2021; 39(9): 1843-1850.

[3] MosesB, Orchard J, OrchardJ. Systematic review: annual incidence of ACL injury and surgery in various populations. Res Sports Med. 2012; 20(3-4): 157-179.

[4] ArdernCL, Webster KE, TaylorNF, FellerJA. Return to sport following anterior cruciate ligament reconstruction surgery: a systematic review and meta-analysis of the state of play. Br J Sports Med. 2011; 45(7): 596-606.

[5] ShahVM, Andrews JR, FleisigGS, McMichaelCS, LemakLJ. Return to play after anterior cruciate ligament reconstruction in National Football League athletes. Am J Sports Med. 2010; 38(11): 2233-2239.

[6] BrophyRH, Schmitz L, WrightRW, et al. Return to play and future ACL injury risk after ACL reconstruction in soccer athletes from the Multicenter Orthopaedic Outcomes Network (MOON) group. Am J Sports Med. 2012; 40(11): 2517-2522.

[7] AhldénM, Samuelsson K, SernertN, ForssbladM, Karlsson J, KartusJ. The Swedish National Anterior Cruciate Ligament Register: a report on baseline variables and outcomes of surgery for almost 18, 000 patients. Am J Sports Med. 2012; 40(10): 2230-2235.

[8] WrightRW, DunnWR, AmendolaA, et al. Risk of tearing the intact anterior cruciate ligament in the contralateral knee and rupturing the anterior cruciate ligament graft during the first 2 years after anterior cruciate ligament reconstruction: a prospective MOON cohort study. Am J Sports Med. 2007; 35(7): 1131-1134.

[9] Barber-WestinSD, NoyesFR. Objective criteria for return to athletics after anterior cruciate ligament reconstruction and subsequent reinjury rates: a systematic review. Phys Sportsmed. 2011; 39(3): 100-110.

[10] Barber-WestinSD, NoyesFR. Factors used to determine return to unrestricted sports activities after anterior cruciate ligament reconstruction. Arthroscopy. 2011; 27(12): 1697-1705.

[11] Engelen-van MelickN, van Cingel REH, TijssenMPW, Nijhuis-vande. Sanden MWG. Assessment of functional performance after anterior cruciate ligament reconstruction: a systematic review of measurement procedures. Knee Surg Sports Traumatol Arthrosc. 2013; 21(4): 869-879.

[12] LeblancMC, Kowalczuk M, AndruszkiewiczN, et al. Diagnostic accuracy of physical examination for anterior knee instability: a systematic review. Knee Surg Sports Traumatol Arthrosc. 2015; 23(10): 2805-2813.

[13] PrattKA, Sigward SM. Detection of knee power deficits following anterior cruciate ligament reconstruction using wearable sensors. J Orthop Sports Phys Ther. 2018; 48(11): 895-902.

[14] SmallSR, Bullock GS, KhalidS, BarkerK, Trivella M, PriceAJ. Current clinical utilisation of wearable motion sensors for the assessment of outcome following knee arthroplasty: a scoping review. BMJ Open. 2019; 9(12): e033832.

[15] De FazioR, Mastronardi VM, De VittorioM, ViscontiP. Wearable sensors and smart devices to monitor rehabilitation parameters and sports performance: an overview. Sensors. 2023; 23(4): 1856.

[16] KimDH, LuN, MaR, et al. Epidermal electronics. Science. 2011; 333(6044): 838-843.

[17] SchwartzG, TeeBCK, MeiJ, et al. Flexible polymer transistors with high pressure sensitivity for application in electronic skin and health monitoring. Nat Commun. 2013; 4: 1859.

[18] TeeBCK, WangC, AllenR, Bao Z. An electrically and mechanically self-healing composite with pressure-and flexion-sensitive properties for electronic skin applications. Nat Nanotechnol. 2012; 7(12): 825-832.

[19] SonD, KangJ, VardoulisO, et al. An integrated self-healable electronic skin system fabricated via dynamic reconstruction of a nanostructured conducting network. Nat Nanotechnol. 2018; 13(11): 1057-1065.

[20] LiuY, GaoY, KimBJ, et al. Stretchable hybrid platform-enabled interactive perception of strain sensing and visualization. SmartMat. 2024; 5(4): e1247.

[21] ChoiYS, JeongH, YinRT, et al. A transient, closed-loop networ. of wireless, body-integrated device. for autonomous electrotherapy. Science. 2022; 376(6596): 1006-1012.

[22] XinM, YuT, JiangY, et al. Multi-vital on-skin optoelectronic biosensor for assessing regional tissue hemodynamics. SmartMat. 2023; 4(3): e1157.

[23] DingQ, WangH, ZhouZ, et al. Stretchable, self-healable, and breathable biomimetic iontronics with superior humidity-sensing performance for wireless respiration monitoring. SmartMat. 2023; 4(2): e1147.

[24] WangY, WangY. Recent progress in MXene layers materials for supercapacitors: high-performance electrodes. SmartMat. 2023; 4(1): e1130.

[25] YokotaT, InoueY, TerakawaY, et al. Ultraflexible, large-area, physiological temperature sensors for multipoint measurements. Proc Natl Acad Sci USA. 2015; 112(47): 14533-14538.

[26] GaoW, Emaminejad S, NyeinHYY, et al. Fully integrated wearable sensor arrays for multiplexed in situ perspiration analysis. Nature. 2016; 529(7587): 509-514.

[27] GanL, ZengZ, LuH, et al. A large-scalable spraying-spinning process for multifunctional electronic yarns. SmartMat. 2023; 4(2): e1151.

[28] SempionattoJR, LinM, YinL, et al. An epidermal patch for the simultaneous monitoring of haemodynamic and metabolic biomarkers. Nat Biomed Eng. 2021; 5(7): 737-748.

[29] WangC, QiB, LinM, et al. Continuous monitoring of deep-tissue haemodynamics with stretchable ultrasonic phased arrays. Nat Biomed Eng. 2021; 5(7): 749-758.

[30] SongE, XieZ, BaiW, et al. Miniaturized electromechanical devices for the characterization of the biomechanics of deep tissue. Nat Biomed Eng. 2021; 5(7): 759-771.

[31] YiuC, LiuY, ZhangC, et al. Soft, stretchable, wireless intelligent three-lead electrocardiograph monitors with feedback functions for warning of potential heart attack. SmartMat. 2022; 3(4): 668-684.

[32] TaoJ, Khosravi H, DeshpandeV, LiS. Engineering by cuts: how Kirigami principle enables unique mechanical properties and functionalities. Adv Sci. 2022; 10(1): e2204733.

[33] BrooksAK, Chakravarty S, AliM, YadavalliVK. Kirigami-inspired biodesign for applications in healthcare. Adv Mater. 2022; 34(18): e2109550.

[34] IsobeM, Okumura K. Initial rigid response and softening transition of highly stretchable kirigami sheet materials. Sci Rep. 2016; 6: 24758.

[35] HaT, TranJ, LiuS, et al. A chest-laminated ultrathin and stretchable e-tattoo for the measurement of electrocardiogram, seismocardiogram, and cardiac time intervals. Adv Sci. 2019; 6(14): 1900290.

[36] ThomeéR, NeeterC, GustavssonA, et al. Variability in leg muscle power and hop performance after anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc. 2012; 20(6): 1143-1151.

RIGHTS & PERMISSIONS

2024 The Authors. SmartMat published by Tianjin University and John Wiley & Sons Australia, Ltd.