Recurring Meeting of the Advisory Board

Date(s): November 20-21, 2014

Due to scheduling conflicts, the group meeting with the Advisory Board members were scheduled on an individual basis with each member. Please refer to Meeting Minutes for more details.

Contents

  1. Progress Report
  2. Meeting Minutes

Progress Report

Project Specific Aims

Project Infrastructure

Project Contact

Advisory Board

Progress Period

Development Team during Progress Period

See https://simtk.org/project/xml/team.xml?group_id=485 for full details on the project team.

Goals of Progress Period

Please also refer to previous meeting minutes of the Advisory Board at RecurringMeetings/2014-05-19. It should be noted that the timeline of activities has deviated from the original proposal, i.e., see the Roadmap and the proposed timeline of the proposal in GrantInformation/proposal.pdf.

Activities of Progress Period

Details of activities can be found in past meeting minutes of various teams at RecurringMeetings.

Plans for Next Progress Period (November 20, 2014 - May 2014)

It should be noted that the timeline of activities has deviated from the original proposal, i.e., see the Roadmap and the proposed timeline of the proposal in GrantInformation/proposal.pdf.

Meeting Minutes

Date, Time, Means:

Attendees:

  1. Ahmet Erdemir (Cleveland Clinic)
  2. Jack Andrish (Cleveland Clinic)
  3. Paul Saluan (Cleveland Clinic)
  4. Yasin Dhaher (Northwestern University)
  5. Trent Guess (University of Missouri)
  6. Rami Korhonen (University of Eastern Finland)

Agenda:

  1. Progress update, see progress report at:
  2. Recap of previous meeting minutes, see meeting minutes at:
  3. Action items for following meeting.
  4. Other.

Immediate Action Items:

See notes for details.

Notes:

  1. Due to scheduling conflicts, a series of meetings were conducted to inform the Advisory Board about Open Knee(s) activities and get feedback.
  2. Progress update.
    • Ahmet provided a summary of progress emphasizing the need for change of experimentation schedule and the resulting delay of modeling activities. The Advisory Board members found the justification appropriate and they seemed to be impressed with the group's tackling of logistically challenging experimentation.
    • Ahmet went over current properties of the tested knees. He informed the Advisory Board about the difficulty to acquire healthy knee specimens from elderly donors particularly based solely on X-rays. Jack Andrish acknowledged the potential difficulty of pre-screening of specimens before purchase. He advised to score all the knees to come up with compartmental and overall grading for osteoarthritis level of each knee. He noted that this can be accomplished by using the readily collected MRI. Carl Winalski will be able to provide more insight in this regard. This approach may result in an update in the specifications for specimen characteristics.
    • Ahmet emphasized the need for surgeons' assistance during specimen dissection, particularly to curate secondary tissues. Jack Andrish is usually available in Wednesdays. Paul Saluan is not necessarily available but he may be able to get residents and/or fellows to help the Open Knee(s) team.
    • Primary and secondary tissues for prospective testing were discussed along with tissue testing protocols that have been implemented. Advisory Board members considers the development of a physical tissue bank from primary and secondary tissue structures of the knees a good idea.
      • Trent Guess asked about the possibility to test the transverse ligament, which connects anterior segments of the menisci. He noted the lack of information in literature on the material properties of this tissue. Open Knee(s) testing team will try to curate transverse ligament samples from upcoming knee specimens to keep in freezer as part of secondary tissue bank.
      • Rami Korhonen provided his experience with meniscus testing. In particular, his group found meniscus to be very soft under compression. Their indentation tests also revealed the lateral meniscus to be homogeneous whereas the medial to be stiffer on the anterior side. Rami also advised grading of the meniscus during dissection. Their team has noticed that there may not be a correlation between MRI based scoring of meniscal health and its biomechanical properties, i.e., any damage may not be visible in the MRI.
      • Rami Korhonen also noted the role of subchondral bone on cartilage mechanics. They have been collecting CT images and data to characterize subchondral bone properties. The testing team stores bone samples from Open Knee(s) specimens, which can later be used to obtain mechanical properties of subchondral bone.
    • Ahmet described the possibility to establish a traditional summer internship program for Open Knee(s) for convenience. Trent Guess and some of his colleagues may be interested in sending students to such a program.
    • Jack Andrish wondered if the open development approach of Open Knee(s) may inhibit scholarly publishing and prospective funding renewals. Ahmet does not see this as an issue as model development procedures, novel types of data, and use cases may result in new knowledge that can lead into publications. In addition, Ahmet noted that NIH has started to acknowledge products other than publications as part of progress. Open Knee(s) results in specifications for various procedures, data, and models, which are all part of the outcome of the activity.
    • Trent Guess and Ahmet discussed an Open Knee(s) publication in a special issue of the Journal of Knee Surgery. Trent is a co-editor. A use case exploring clinical utility of Open Knee(s) is a possibility.
    • Yasin Dhaher asked for the possibility to incorporate cloud computing for other simulation software, e.g., Abaqus. Ahmet noted the limitations associated with licensing of such software. Yasin recommended to reach out to software companies to provide such capabilities.
  3. Recap of previous meeting minutes.
    • The discussions mainly focused on progress and change of experimentation and modeling schedule (see item above).
  4. Action items for following meeting.
    • See Immediate Action Items above.
  5. Other.
    • Ahmet described potential development of use cases to promote Open Knee(s) for explorations of healthy and diseased knee biomechanics. Laxity simulations, pivot shift, patellofemoral joint loading, all are possible scenarios for evaluating Open Knee(s). Paul Saluan and Jack Andrish have an interest in such simulation scenarios as part of their clinical program.
    • Ahmet encouraged Advisory Board members to promote Open Knee(s), therefore increase its visibility. This will help bring the community together and allow additional funding to prioritize development of additional knee models with different specifications. Paul Saluan is willing to spread the word in that regard.
    • Jack Andrish notices the potential utility of Open Knee(s) by its incorporation to clinical training and practice where physicians can manipulate the joint virtually and evaluate its biomechanical response. Ahmet noted that this is indeed an ultimate goal for Open Knee(s) clinical translation. Nonetheless, Ahmet also acknowledged that this will take significant time and effort as models should be at a level of robustness and credibility sufficient for clinical decision making.
    • Yasin Dhaher is interested in the classification of the knees based on their shape. This way, exploration of differences in morphologies, particularly that of the cartilage, may be possible, including morphing of existing cartilage anatomies to patient-specific characteristics. Ahmet and Yasin briefly talked about the opportunity to spin-off a synergistic study, possibly relying on Osteoarthritis Initiative data and funding programs.
    • Rami Korhonen recently submitted a project on knee and cartilage mechanics to a funding program in Finland. The program emphasized open access. If funded, Open Knee(s) experience may be beneficial.

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