Appendix A: Model description

An anatomically accurate model of the PF and TF joint articular surfaces as well as the
origins and insertions of the muscles and ligaments was derived from digitized magnetic
resonance image (MRI) transverse contours. The subject (male) was placed in the
transmit/receive circularly polarized knee coil of a Siemens Medical Systems Trio 3 Tesla whole
body MRI. The Trio has a state-of-the-art 40mT/m gradient system with a slew rate of 200
T/m/s. A 3D FLASH sequence was used to obtain T1 weighted images with a spatial resolution
of .5mm .5mm 1mm . The imaging plane was oriented along the anatomical transverse plane.
These images are optimal to differentiate between the musculature, tendons, tissue fascia, and
bone (Dhaher and Sun, 2006). The image data set was then imported into an MRI viewing and
analysis package (Source Signal Imaging Inc., San Diego, CA), and re-sampled in the sagittal,
coronal, and axial planes, providing convenient segmentation bases. The muscle-bone junctions
were identified from the MRI images following the procedure outlined in (Dhaher and Kahn,
2002). Polygonal surfaces were used to generate a FE mesh of the knee joint using the
Hypermesh (Altair Engineering, Troy, MI) pre-processor. The knee model included bones,
articular cartilages, menisci, ligaments, and tendons. Bones were modeled as rigid bodies
(Donahue et al., 2002) using 4-node quadrilateral elements that shared linear elastic boundaries
with the articular cartilages. Eight-node hexahedral elements were used to represent the articular
cartilages, ligaments, tendons and menisci. The entire model (Figure 1) includes 76,051 elements
with 74,296 nodes.
The model included bones (femur, tibia, patella, and fibula) and major soft constraints
(articular cartilages, quadriceps tendon (QT), patellar tendon (PT), cruciate ligaments (anterior
(ACL) and posterior (PCL)), collateral ligaments (medial (MCL) and lateral (LCL)),

patellofemoral ligaments (medial (MPL) and lateral (LPL)), retinaculi (medial and lateral), and
menisci. The bones were modeled as rigid bodies while the connective tissues and cartilages
were modeled as transversely isotropic hyperelastic and linear elastic continuum, respectively.
The menisci were modeled as a transversely isotropic, linearly elastic, homogeneous material
and the meniscal horns as an isotropic linear elastic material. Contact between the femoral
articular cartilages and menisci, patellar and femoral articular cartilages, the ACL and the PCL,
the MCL and LCL and the underlying femur and tibia, and the QT and femoral cartilage were
included, resulting in nineteen contact-surface pairs. The contact conditions were surface-tosurface allowing finite sliding between the contact surface pairs, all of which were assumed as
frictionless due to the low friction coefficient typically reported for lubricated synovial joints
(Mow, 1991; Murakami, 1990).
Eight muscles were included in the model: Semitendinosus (ST), Biceps Femoris (BF),
Rectus Femoris (RF), Vastus Intermedius (VI), Vastus Medialis (VM), Vastus Lateralis (VL),
Medial Gastrocnemius (MG), and Lateral Gastrocnemius (LG). Each net muscle force was
distributed across the surface of the muscle-bone junctions. A generic SIMM (Software for
Interactive Musculoskeletal Modeling) musculoskeletal model was used to calculate the initial
(direction at zero flexion angle) nodal muscle force directions based on an equivalent point-topoint representation. The muscle forces followed the rotation of the nodes throughout the
simulations. The attachment of ligaments and articular cartilages on the bones were modeled by
sharing their corresponding nodes on the interface. The nodes of the meniscal horns were
kinematically coupled to the tibia, which ensured that their positions relative to the bone would
remain unchanged. The external periphery of the medial meniscus was connected to the medial

collateral ligament. The femur was fixed in space while the tibia, fibula, and patella were
allowed to move freely, subject to constraints from the ligaments and the articular surfaces.

Appendix B1: Stress and elasticity tensors

The material model was implemented in Abaqus 6.9 using a user-defined subroutine
(UMAT) for which the implementation of the Cauchy stress, spatial elasticity, and stress rate
tensors are required. Here, we present a brief summary of the necessary equations. Detailed
derivations of the general formulas presented herein are given in (Prot and Skallerud, 2009).
From the strain energy function given in Equation (1) the second Piola-Kirchhoff stress
tensor is given by S = 2

where

W
and the Cauchy stress is obtained as
C

1
1
2
FSF T = dev +
( J 1) 1, = 2W1 B + 2W4 a a
J
J
D1

a = F a 0 , B = F F T , and Wi

denotes

2
W
(W1 = c1 , W2 = c 2 exp c3 ( I 4 1) ( I 4 1)). The
I i

associated spatial description of the elasticity tensor can be decoupled as follows,

c = c ISO + cVOL ,
2
2
2
Jc ISO = 4W44 dev(a a ) dev(a a ) (1 + 1) + tr 1 1 + tr II
3
9
3
4
1
4
( J 1) II +
(J )1 1
cVOL =
2
D1
D1

where W44 =

1
2W
, dev () = ( II 1 1) : () , and II denotes the fourth order identity tensor
3
I 4 I 4

expressed using indicial notation by II ijkl =

1
( ik jl + il jk ) .
2

For the tangent stiffness matrix, Abaqus uses the Jaumann stress rate for continuum
elements and C J / J is required for UMAT,
1
C J ijkl = J (cijkl + ( ik jl + il jk + jk il + jl ik ))
2

where C J is the Jaumann tangent moduli and cijkl is the ijkl element of the spatial elasticity tensor
described previously.

Appendix B2: Initial strain

In the current study, the initial stretches were included in the FE model of the ligaments
by defining three different configurations (Weiss et al., 1995): the stress-free state, the reference
state, and the current state. Using a multiplicative decomposition, the total deformation gradient
is then defined as Fc = Fr F0 , where F0 is the deformation gradient from the stress-free state to the
reference state (the initial stretch in the ligament) and Fr is the deformation gradient from the
reference state to the current state (determined from the static equilibrium of the joint at the zero
flexion angle). If an initial stretch field is assumed to be uni-axial stretch,

F0 = 0

0
1

where is the stretch in the local fiber-direction. Then the total stress corresponding to the
current state can be computed from the following equation

2
W T
Fc
Fc
J c C

where Jc = det (Fc) and C is the right Cauchy-Green deformation tensor ( C = FcT Fc ). The initial
stretches used in the analysis were derived from data reported in the literature and are given in
Tables B1 through B3 for the MCL, ACL, and LCL, respectively. Due to the lack of
experimental data, the initial stretches in the PCL, MPL, and LPL were set to zero at full
extension (Pena et al., 2006). In our simulations, the initial strain data from the experiments are
enforced in discrete regions in search of a static equilibrium in the finite element code (regions
described in Tables B1, B2, and B3). Figure B1 shows an exemplar initial stretch configuration
after the equilibrium step of the analysis.

Figure B1

The initial stretch (SVD1 in the legend) in the fibers after the equilibrium step.
For clarity, only the ligaments with initial stretch imposed are displayed.

Table B1

Initial stretch for MCL in full extension as reported by (Gardiner et al., 2001).
In this table as well as Tables B2 and B3, the numerical value 1.0 indicates a
strain-free initial state.

Location
Anterior
Middle
Posterior

Table B2

Middle
1.026
1.039
1.048

Superior
1.024
1.052
1.058

Initial stretch for ACL in full extension as reported by (Pena et al., 2006).

Location
Anterior
Posterior

Table B3

Inferior
1.015
1.02
1.027

Inferior
1.014
1.027

Middle
1.020
1.024

Superior
1.004
1.004

Initial stretch for LCL in full extension as reported by (Pena et al., 2006).
Location
Anterior
Middle
Posterior

Initial Stretch
1.0
1.0
1.08

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