Preface

*Knee Surgery—Reconstruction and Replacement* is an intriguing book that addresses the most common injuries noted in a knee surgeon's routine, from biomechanical aspects to special situations of ligament injuries and joint replacement surgeries. It is not a compendium, or a base book, but an update book, complementary to the life of the knee specialist.

#### **João Bosco Sales Nogueira (Editor) and José Alberto Dias Leite (Co-editor)**

**II**

**Chapter 7 99**

**Chapter 8 107**

Management of Flexion Contracture in Total Knee Arthroplasty

Valgus Deformity Correction in Total Knee Replacement: An Overview

*by Kavin Khatri, Deepak Bansal and Karan Rajpal*

*by Melvin J. George*

Programa de Pós Graduação em Cirurgia da Faculdade de Medicina da Universidade Federal do Ceara. (Post Graduation Program of Medicine School of Federal University of Ceara, Brazil)

#### **Leonardo Heráclio do Carmo Araújo (Co-editor)**

Santa Casa de Fortaleza, Brazil

#### **Marcelo José Cortez Bezerra (Co-editor)**

Santa Casa de Fortaleza, Brazil University of Fortaleza, Brazil

**1**

Section 1

Biomechanics

Section 1 Biomechanics

**3**

**Chapter 1**

*Wangdo Kim*

system, knee alignment

**1. Introduction**

**Abstract**

Tibial Femoral Tunnel for

Isokinetic Graft Placement Based

We characterize the concept of a "knee axis" and further the concept of "invari-

ant." It is now generally recognized that one of the features of the tensegrity (*prestressable to the same configuration*) allows the knee tensegrity system to be in producing the knee instantaneous axis (KIA). We found that the line of the ground reaction force (GRF) vector is very close to the KIA. It aligns the knee joint with the GRF such that the reaction forces are torqueless. The reaction to the GRF will then be carried by the whole structures on the knee tensegrity instead. The use of knee tensegrity model introduces the new useful dimensions of sensitivity in foot loading to the knee axis alignment. We demonstrated a method to determine ideal placement of the tibial tunnel with respect to the KIA. Such placement in vivo has the potential to reliably produce an isokinetic graft without risk of impingement.

**Keywords:** knee tensegrity system, knee instantaneous axis, the haptic perceptual

The perceptual psychologist James J. Gibson regarded the senses as aggressively seeking mechanisms rather than mere passive receivers [1]. The active movement involves the concomitant operation of anatomical components, in which foot touches the ground and rotation of the joints are combined, together with voluntary contractions of the muscles. The total flux of stimulation involved in the so-called active movement is enormously complex, but lawful modes of combination occur. Presumably, the modes of combination of these inputs specify the difference

To identify the haptic system's medium, Turvey focused on connective tissue and the conjunction of muscular, connective tissue net, and skeletal as the body's proper characterization [3]. Myers has also posed the medium as a body-wide responsive physiological network—the myofascial meridian [4]. Taking on "geometry" first, cell biologist Donald Ingber placed one final piece of the puzzle: to view the body's architecture in the light of "tensegrity" geometry [5]. "Tensegrity" was coined from the phrase "tension integrity" by the designer R. Buckminster Fuller (working from

The principle of tensegrity describes precisely the relationship between the connective tissues, the muscles, and the skeleton. Weight applied to shank/thigh bones

between touching (active) and being touched (passive) [2].

original structures developed by artist Kenneth Snelson) [6].

on a Tensegrity Model of a Knee

#### **Chapter 1**

## Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee

*Wangdo Kim*

#### **Abstract**

We characterize the concept of a "knee axis" and further the concept of "invariant." It is now generally recognized that one of the features of the tensegrity (*prestressable to the same configuration*) allows the knee tensegrity system to be in producing the knee instantaneous axis (KIA). We found that the line of the ground reaction force (GRF) vector is very close to the KIA. It aligns the knee joint with the GRF such that the reaction forces are torqueless. The reaction to the GRF will then be carried by the whole structures on the knee tensegrity instead. The use of knee tensegrity model introduces the new useful dimensions of sensitivity in foot loading to the knee axis alignment. We demonstrated a method to determine ideal placement of the tibial tunnel with respect to the KIA. Such placement in vivo has the potential to reliably produce an isokinetic graft without risk of impingement.

**Keywords:** knee tensegrity system, knee instantaneous axis, the haptic perceptual system, knee alignment

#### **1. Introduction**

The perceptual psychologist James J. Gibson regarded the senses as aggressively seeking mechanisms rather than mere passive receivers [1]. The active movement involves the concomitant operation of anatomical components, in which foot touches the ground and rotation of the joints are combined, together with voluntary contractions of the muscles. The total flux of stimulation involved in the so-called active movement is enormously complex, but lawful modes of combination occur. Presumably, the modes of combination of these inputs specify the difference between touching (active) and being touched (passive) [2].

To identify the haptic system's medium, Turvey focused on connective tissue and the conjunction of muscular, connective tissue net, and skeletal as the body's proper characterization [3]. Myers has also posed the medium as a body-wide responsive physiological network—the myofascial meridian [4]. Taking on "geometry" first, cell biologist Donald Ingber placed one final piece of the puzzle: to view the body's architecture in the light of "tensegrity" geometry [5]. "Tensegrity" was coined from the phrase "tension integrity" by the designer R. Buckminster Fuller (working from original structures developed by artist Kenneth Snelson) [6].

The principle of tensegrity describes precisely the relationship between the connective tissues, the muscles, and the skeleton. Weight applied to shank/thigh bones would cause it to slide off its knee joint if it were not for the tensional balances that hold it in place and control its pivoting [7]. The invariant feature of tensegrity structures encompasses those that stabilize themselves through a phenomenon known as prestressing. Architects call this type of prestressed structural network, composed of opposing tension and compression elements that self-stabilizes its shape through the establishment of a mechanical force balance, a tensegrity structure. Biotensegrity is a term introduced by Dr. Stephen Levin and denotes the application of tensegrity's principles to biological structures [8].

Tensional forces naturally transmit themselves over the shortest distance between two points, so the elastic members of tensegrity structures are precisely positioned to best withstand applied stress. For this reason, tensegrity structures offer a maximum amount of strength for any given amount of material [4]. The invariant feature of a knee tensegrity system (specified by a given set of *external forces such as the ground reaction force* (*GRF*)) is a stable equilibrium if the structure returns to the originally given configuration after the application of arbitrarily small perturbations with respect to the KIA anywhere within the configuration [5] (**Figure 1**).

Consequently, estimating of the knee axis is one of the key topics for the "2010 ASME Grand Challenge Competition to Predict in Vivo Knee Loads" [11]. Knee functional axis information is referred to the knee instantaneous axis (KIA)

#### **Figure 1.**

*The tensegrity structure of surrounding forces applied to the knee joint: a native system of the knee where six constraints \$΄ are collectively reciprocal to the KIA \$ indicated by* ⊗ *that the virtual coefficient should vanish is necessary, and sufficient conditions [9, 10], or the pair (\$΄ and \$) are in involution. The tensegrity's structure is characterized by the contact normal elements \$΄4 and \$΄5, while all the other elements are, continuous tension elements, showing specific configuration having torqueless connections.*

**5**

*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee*

[12–14]. In that case, the intersegmental force such as ligaments and contact forces are in pure tension/compression and are surrounding the KIA in such a way that

The objective of this study is to show how the knee tensegrity system manages the balance between tension and compression during locomotion by utilizing a

The intra-articular structures of the tensegrity system of the knee include the muscles, the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and articular contact in the medial (P1) and lateral (P2) compartments (**Figure 1**) [15]. We have shown that six constraints are members of the "joint reaction subspace (JRS)" and are spatially oriented in such ways that by imposing an internal tension or "prestress" to reduce the play in the system, this ensures immediate mechanical responsiveness (i.e., that movement of one element is felt by all others) and reduces impact

We have measured the KIA through readily accessible benchmark data [11]. Also, we have measured the GRF on how the progression of the entire body over the limb uses the so-called rockers on foot. The issues of relating the reciprocal connection of the body framework to the movements of cutaneous kinesthesis [9, 10, 15, 16] (zoomed up the pan in **Figure 2**) enunciate that the body's haptic perceptual system registers the covariance of the KIA and GRF. The upward pressure on the surface of support on the ventral side of the foot provides, for every terrestrial animal, a continuous background of stimulation. It is covariant with the continuous input of the appropriate receptors of the articular motion in the knee joint already mentioned. Together they provide what the ordinary person calls the "sense of

A unique combination of invariants, such as the KIA and GRF, a *compound* invariant, is just another invariant. It is a unit, and the components do not have to be combined or associated. Only if percepts were combinations of sensations would they have to be associated. Otherwise, we can postulate that when the KIA and GRF are completely covariant when they *always* go together, they constitute a single "stimulus." If the knee tensegrity system is capable of extracting invariants from changing haptic stimuli, there is no reason why it should not extract invariants that seem to us highly complex. Therefore, the reaction torque caused by the foot-ground at the knee will be taken on partially by muscles surrounding the

Perception is not based on the structure of force as it falls upon the plantar side of the foot, the erroneous theory of the passive, sense-datum theory, but on continuous modifications brought about by foot movement which cooperates with body posture to reveal its invariants—a surface of support. The pattern of a compound invariant may indicate the neural loops of an active perceptual system that includes the adjustments of the perceptual organs, our locomotor apparatus. We may suppose that the brain governs the orienting of the organs of perception so that the whole locomotor system of afferent/efferent loops resonates to the patterns of compound invariants [17]. Locomotion is controlled not by the brain, but

*DOI: http://dx.doi.org/10.5772/intechopen.82237*

**2. Materials and methods**

fatigue at the joint.

support."

joint.

**3. Results and discussion**

those forces result in no (virtual) works [9, 10].

unique combination of the KIA and GRF stimuli.

*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee DOI: http://dx.doi.org/10.5772/intechopen.82237*

[12–14]. In that case, the intersegmental force such as ligaments and contact forces are in pure tension/compression and are surrounding the KIA in such a way that those forces result in no (virtual) works [9, 10].

The objective of this study is to show how the knee tensegrity system manages the balance between tension and compression during locomotion by utilizing a unique combination of the KIA and GRF stimuli.

#### **2. Materials and methods**

*Knee Surgery - Reconstruction and Replacement*

would cause it to slide off its knee joint if it were not for the tensional balances that hold it in place and control its pivoting [7]. The invariant feature of tensegrity structures encompasses those that stabilize themselves through a phenomenon known as prestressing. Architects call this type of prestressed structural network, composed of opposing tension and compression elements that self-stabilizes its shape through the establishment of a mechanical force balance, a tensegrity structure. Biotensegrity is a term introduced by Dr. Stephen Levin and denotes the

Tensional forces naturally transmit themselves over the shortest distance between two points, so the elastic members of tensegrity structures are precisely positioned to best withstand applied stress. For this reason, tensegrity structures offer a maximum amount of strength for any given amount of material [4]. The invariant feature of a knee tensegrity system (specified by a given set of *external forces such as the ground reaction force* (*GRF*)) is a stable equilibrium if the structure returns to the originally given configuration after the application of arbitrarily small perturbations with

application of tensegrity's principles to biological structures [8].

respect to the KIA anywhere within the configuration [5] (**Figure 1**).

Consequently, estimating of the knee axis is one of the key topics for the "2010 ASME Grand Challenge Competition to Predict in Vivo Knee Loads" [11]. Knee functional axis information is referred to the knee instantaneous axis (KIA)

*The tensegrity structure of surrounding forces applied to the knee joint: a native system of the knee where six constraints \$΄ are collectively reciprocal to the KIA \$ indicated by* ⊗ *that the virtual coefficient should vanish is necessary, and sufficient conditions [9, 10], or the pair (\$΄ and \$) are in involution. The tensegrity's structure is characterized by the contact normal elements \$΄4 and \$΄5, while all the other elements are, continuous tension* 

*elements, showing specific configuration having torqueless connections.*

**4**

**Figure 1.**

The intra-articular structures of the tensegrity system of the knee include the muscles, the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and articular contact in the medial (P1) and lateral (P2) compartments (**Figure 1**) [15]. We have shown that six constraints are members of the "joint reaction subspace (JRS)" and are spatially oriented in such ways that by imposing an internal tension or "prestress" to reduce the play in the system, this ensures immediate mechanical responsiveness (i.e., that movement of one element is felt by all others) and reduces impact fatigue at the joint.

#### **3. Results and discussion**

We have measured the KIA through readily accessible benchmark data [11]. Also, we have measured the GRF on how the progression of the entire body over the limb uses the so-called rockers on foot. The issues of relating the reciprocal connection of the body framework to the movements of cutaneous kinesthesis [9, 10, 15, 16] (zoomed up the pan in **Figure 2**) enunciate that the body's haptic perceptual system registers the covariance of the KIA and GRF. The upward pressure on the surface of support on the ventral side of the foot provides, for every terrestrial animal, a continuous background of stimulation. It is covariant with the continuous input of the appropriate receptors of the articular motion in the knee joint already mentioned. Together they provide what the ordinary person calls the "sense of support."

A unique combination of invariants, such as the KIA and GRF, a *compound* invariant, is just another invariant. It is a unit, and the components do not have to be combined or associated. Only if percepts were combinations of sensations would they have to be associated. Otherwise, we can postulate that when the KIA and GRF are completely covariant when they *always* go together, they constitute a single "stimulus." If the knee tensegrity system is capable of extracting invariants from changing haptic stimuli, there is no reason why it should not extract invariants that seem to us highly complex. Therefore, the reaction torque caused by the foot-ground at the knee will be taken on partially by muscles surrounding the joint.

Perception is not based on the structure of force as it falls upon the plantar side of the foot, the erroneous theory of the passive, sense-datum theory, but on continuous modifications brought about by foot movement which cooperates with body posture to reveal its invariants—a surface of support. The pattern of a compound invariant may indicate the neural loops of an active perceptual system that includes the adjustments of the perceptual organs, our locomotor apparatus. We may suppose that the brain governs the orienting of the organs of perception so that the whole locomotor system of afferent/efferent loops resonates to the patterns of compound invariants [17]. Locomotion is controlled not by the brain, but

#### **Figure 2.**

*A unique combination of the KIA and GRF invariant. When deformed by the shank to the ground via GRF, the strain is distributed over the whole structure, not localized in the area being deformed, i.e., the joint itself. A reaction torque is zero on the knee joint if the GRF line of action intersects the joint axis, or the configuration can exert a large force on the ground without overloading the knee joint. A considerable ground reaction force can be exerted on a foot when the vector nearly coincides with a reciprocal screw of joints. It is indicative of the "sense of support" being manifested based on the close correspondence of the vector of the ground reaction force at COP, and the IAK with fluctuations at the spatial scale of a millimeter (GRF-KIA coupling).*

by information. We showed that the GRF might reciprocally be used to control locomotion.

We should choose surgical procedures that not only reconstruct the anatomy but also restore the articular kinesthesis, that is, the pickup of own movement [18–21]. In such an application, avoiding roof impingement during reconstruction of a torn ACL might find benefit in choosing a tunnel placement that can come near to a tensegrity model of a knee.

We found that the line of the ground reaction force (GRF) vector is very close to the KIA. It aligns the knee joint with the GRF such that the reaction forces are torqueless. The reaction to the GRF will then be carried by the whole structures on the knee tensegrity instead.

**7**

**Author details**

Wangdo Kim

provided the original work is properly cited.

\*Address all correspondence to: mwdkim@gmail.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium,

Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia - UTEC, Lima, Peru

*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee*

*DOI: http://dx.doi.org/10.5772/intechopen.82237*

#### **Conflicts of interest**

The author declares no conflicts of interest.

#### **Abbreviations**


*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee DOI: http://dx.doi.org/10.5772/intechopen.82237*

#### **Author details**

Wangdo Kim Ingeniería Mecánica, Universidad de Ingenieria y Tecnologia - UTEC, Lima, Peru

\*Address all correspondence to: mwdkim@gmail.com

© 2019 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/ by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

*Knee Surgery - Reconstruction and Replacement*

by information. We showed that the GRF might reciprocally be used to control

*at COP, and the IAK with fluctuations at the spatial scale of a millimeter (GRF-KIA coupling).*

*A unique combination of the KIA and GRF invariant. When deformed by the shank to the ground via GRF, the strain is distributed over the whole structure, not localized in the area being deformed, i.e., the joint itself. A reaction torque is zero on the knee joint if the GRF line of action intersects the joint axis, or the configuration can exert a large force on the ground without overloading the knee joint. A considerable ground reaction force can be exerted on a foot when the vector nearly coincides with a reciprocal screw of joints. It is indicative of the "sense of support" being manifested based on the close correspondence of the vector of the ground reaction force* 

We should choose surgical procedures that not only reconstruct the anatomy but also restore the articular kinesthesis, that is, the pickup of own movement [18–21]. In such an application, avoiding roof impingement during reconstruction of a torn ACL might find benefit in choosing a tunnel placement that can come near to a

We found that the line of the ground reaction force (GRF) vector is very close to the KIA. It aligns the knee joint with the GRF such that the reaction forces are torqueless. The reaction to the GRF will then be carried by the whole structures on

**6**

locomotion.

**Figure 2.**

tensegrity model of a knee.

the knee tensegrity instead.

COP center of pressure GRF ground reaction force KIA knee instantaneous axis

The author declares no conflicts of interest.

**Conflicts of interest**

**Abbreviations**

### **References**

[1] Gibson JJ. Observations on active touch. Psychological Review. 1962;**69**:477-491

[2] Gibson JJ. The Senses Considered as Perceptual Systems. Boston: Houghton; 1966

[3] Turvey MT, Fonseca ST. The medium of haptic perception: A tensegrity hypothesis. Journal of Motor Behavior. 2014;**46**(3):143-187

[4] Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Elsevier; 2014

[5] Ingber DE. The architecture of life. Scientific American. 1998;**278**(1):48-57

[6] Skelton RE, de Oliveira MC. Tensegrity Systems. Dordrecht/New York: Springer; 2009

[7] Swanson RL 2nd. Biotensegrity: A unifying theory of biological architecture with applications to osteopathic practice, education, and research—A review and analysis. The Journal of the American Osteopathic Association. 2013;**113**(1):34-52

[8] Hutson MA, Ellis RM. Textbook of Musculoskeletal Medicine. Oxford/New York: Oxford University Press; 2006

[9] Kim W, Veloso AP, Araújo D, Vleck V, João F. An informational framework to predict reaction of constraints using a reciprocally connected knee model. Computer Methods in Biomechanics and Biomedical Engineering. 2015;**18**(1):78-89

[10] Kim W, Veloso AP, Vleck VE, Andrade C, Kohles SS. The stationary configuration of the knee. Journal of the American Podiatric Medical Association. 2013;**103**(2):126-135

[11] Fregly BJ, Besier TF, Lloyd DG, Delp SL, Banks SA, Pandy MG, et al. Grand challenge competition to predict in vivo

knee loads. Journal of Orthopaedic Research. 2012;**30**(4):503-513

[12] Kim W, Choi Y, Lee HG. The duality of knee functional axes and foot contact. Journal of Functional Morphology and Kinesiology. 2016;**1**(4):387

[13] Kim W, Choi Y, Lee H. Observations on the knee functional axis during active movements. SM Musculoskeletal Disorders. 2016;**1**(1):5

[14] Kim W, Kim YH, Veloso AP, Kohles SS. Tracking knee joint functional axes through Tikhonov filtering and Plűcker coordinates. Journal of Novel Physiotherapies. 1 Mar 2013; Suppl **4**(1):11732

[15] Kim W, Veloso A, Tan J, Andrade C. A reciprocal connection at knee joint. In: ASME 2010 Summer Bioengineering Conference; Naples, FL; 2010

[16] Kim W, Kohles SS. A reciprocal connection factor for assessing kneejoint function. Computer Methods in Biomechanics and Biomedical Engineering. 2011;**15**(9):911-917

[17] Gibson JJ. The visual perception of objective motion and subjective movement. Psychological Review. 1954;**61**(5):304-314

[18] Adrian CP, Haussler KK, Kawcak C, Reiser RF, Riegger-Krugh C, Palmer RH, et al. The role of muscle activation in cruciate disease. Veterinary Surgery. 2013;**42**(7):765-773

[19] Jerosch J, Prymka M. Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage. Archives of Orthopaedic and Trauma Surgery. 1996;**115**(3-4):162-166

**9**

*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee*

*DOI: http://dx.doi.org/10.5772/intechopen.82237*

[21] Jerosch J, Prymka M. Proprioception

and joint stability. Knee Surgery, Sports Traumatology, Arthroscopy.

[20] Jerosch J, Prymka M. Knee joint proprioception in patients with posttraumatic recurrent patella dislocation. Knee Surgery, Sports Traumatology, Arthroscopy.

1996;**4**(1):14-18

1996;**4**(3):171-179

*Tibial Femoral Tunnel for Isokinetic Graft Placement Based on a Tensegrity Model of a Knee DOI: http://dx.doi.org/10.5772/intechopen.82237*

[20] Jerosch J, Prymka M. Knee joint proprioception in patients with posttraumatic recurrent patella dislocation. Knee Surgery, Sports Traumatology, Arthroscopy. 1996;**4**(1):14-18

[21] Jerosch J, Prymka M. Proprioception and joint stability. Knee Surgery, Sports Traumatology, Arthroscopy. 1996;**4**(3):171-179

**8**

*Knee Surgery - Reconstruction and Replacement*

[2] Gibson JJ. The Senses Considered as Perceptual Systems. Boston: Houghton; knee loads. Journal of Orthopaedic Research. 2012;**30**(4):503-513

[12] Kim W, Choi Y, Lee HG. The duality of knee functional axes and foot contact. Journal of Functional Morphology and Kinesiology.

[13] Kim W, Choi Y, Lee H. Observations on the knee functional axis during active movements. SM Musculoskeletal

[14] Kim W, Kim YH, Veloso AP, Kohles SS. Tracking knee joint functional axes through Tikhonov filtering and Plűcker coordinates. Journal of Novel Physiotherapies. 1 Mar 2013; Suppl

[15] Kim W, Veloso A, Tan J, Andrade C. A reciprocal connection at knee joint. In: ASME 2010 Summer Bioengineering

[16] Kim W, Kohles SS. A reciprocal connection factor for assessing kneejoint function. Computer Methods in Biomechanics and Biomedical Engineering. 2011;**15**(9):911-917

[17] Gibson JJ. The visual perception of objective motion and subjective movement. Psychological Review.

[18] Adrian CP, Haussler KK, Kawcak C, Reiser RF, Riegger-Krugh C, Palmer RH, et al. The role of muscle activation in cruciate disease. Veterinary Surgery.

[19] Jerosch J, Prymka M. Knee joint proprioception in normal volunteers and patients with anterior cruciate ligament tears, taking special account of the effect of a knee bandage. Archives of Orthopaedic and Trauma Surgery.

1954;**61**(5):304-314

2013;**42**(7):765-773

1996;**115**(3-4):162-166

Conference; Naples, FL; 2010

2016;**1**(4):387

**4**(1):11732

Disorders. 2016;**1**(1):5

[3] Turvey MT, Fonseca ST. The medium of haptic perception: A tensegrity hypothesis. Journal of Motor Behavior.

[4] Myers TW. Anatomy Trains: Myofascial Meridians for Manual and Movement Therapists. Edinburgh: Elsevier; 2014

[5] Ingber DE. The architecture of life. Scientific American. 1998;**278**(1):48-57

[6] Skelton RE, de Oliveira MC. Tensegrity Systems. Dordrecht/New

[7] Swanson RL 2nd. Biotensegrity: A unifying theory of biological architecture with applications to osteopathic practice, education, and research—A review and analysis. The Journal of the American Osteopathic Association. 2013;**113**(1):34-52

[8] Hutson MA, Ellis RM. Textbook of Musculoskeletal Medicine. Oxford/New York: Oxford University Press; 2006

[9] Kim W, Veloso AP, Araújo D, Vleck V, João F. An informational framework to predict reaction of constraints using a reciprocally connected knee model. Computer Methods in Biomechanics and Biomedical Engineering. 2015;**18**(1):78-89

[10] Kim W, Veloso AP, Vleck VE, Andrade C, Kohles SS. The stationary configuration of the knee. Journal of the American Podiatric Medical Association. 2013;**103**(2):126-135

[11] Fregly BJ, Besier TF, Lloyd DG, Delp SL, Banks SA, Pandy MG, et al. Grand challenge competition to predict in vivo

[1] Gibson JJ. Observations on active touch. Psychological Review.

1962;**69**:477-491

**References**

2014;**46**(3):143-187

York: Springer; 2009

1966

**11**

Section 2

Ligament Injuries
