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<p>Patient-specific simulation frameworks are increasingly used to support orthopaedic trauma decision-making, yet robust coupling of longitudinal loading data to mechano-regulated healing models remains challenging. Here, we present a workflow that links patient-specific finite element mechanics to an established mechano-regulatory reaction-diffusion healing model and updates boundary conditions longitudinally using weekly knee joint forces obtained from musculoskeletal simulation. Rather than proposing a new mechanobiological regulation law, the study addresses three methodological questions: how strongly stimulus choice affects predicted tissue differentiation on identical patient-specific finite element models, whether an Isaksson-based healing model can be stabilised for robust long-term implicit simulation under repeated load updates, and whether computationally efficient linear-elastic mechanics is sufficient for repeated longitudinal simulations under the present loading regime. Mechanical stimulus formulations from the literature were benchmarked on identical patient-specific finite element models to quantify their impact on predicted tissue differentiation. To enable stable long-term implicit simulations, we introduced a numerically robust modification of the available-space saturation terms in the proliferation and matrix production kinetics. In a single distal tibia clinical case, the simulation predicted predominantly bone-permissive stimulus conditions, progressive bone-matrix accumulation initiating from existing bone boundaries, and a pronounced reduction of implant-to-callus stress ratio over the first 40–50&#xa0;days, indicating early critical fixation demand. Synthetic radiographs generated from the final Young’s modulus distribution showed qualitative agreement with the dominant bridging pattern and regions of reduced mineralization observed in follow-up X-rays, whilst suggesting over-persistent callus consistent with the absence of secondary remodelling. Sensitivity analyses showed that small-strain linear elasticity provides near-equivalent stimulus-class distributions at substantially lower computational cost than nonlinear alternatives, supporting its use for high-throughput longitudinal pipelines. These results illustrate feasibility in a single clinical case; cohort-level validation and predictive performance for delayed union/non-union are topics of ongoing and future multi-case studies.</p>

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Patient-Specific Adaptation of a Mechano-Regulatory Bone-Healing Model Using Longitudinal Loading Data

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年7月7日

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  • A. Bäumchen,
  • R. Reinardt,
  • F. Scherf,
  • S. Diebels,
  • E. Liodakis,
  • M. Orth,
  • A. Andres,
  • M. Roland

摘要

Patient-specific simulation frameworks are increasingly used to support orthopaedic trauma decision-making, yet robust coupling of longitudinal loading data to mechano-regulated healing models remains challenging. Here, we present a workflow that links patient-specific finite element mechanics to an established mechano-regulatory reaction-diffusion healing model and updates boundary conditions longitudinally using weekly knee joint forces obtained from musculoskeletal simulation. Rather than proposing a new mechanobiological regulation law, the study addresses three methodological questions: how strongly stimulus choice affects predicted tissue differentiation on identical patient-specific finite element models, whether an Isaksson-based healing model can be stabilised for robust long-term implicit simulation under repeated load updates, and whether computationally efficient linear-elastic mechanics is sufficient for repeated longitudinal simulations under the present loading regime. Mechanical stimulus formulations from the literature were benchmarked on identical patient-specific finite element models to quantify their impact on predicted tissue differentiation. To enable stable long-term implicit simulations, we introduced a numerically robust modification of the available-space saturation terms in the proliferation and matrix production kinetics. In a single distal tibia clinical case, the simulation predicted predominantly bone-permissive stimulus conditions, progressive bone-matrix accumulation initiating from existing bone boundaries, and a pronounced reduction of implant-to-callus stress ratio over the first 40–50 days, indicating early critical fixation demand. Synthetic radiographs generated from the final Young’s modulus distribution showed qualitative agreement with the dominant bridging pattern and regions of reduced mineralization observed in follow-up X-rays, whilst suggesting over-persistent callus consistent with the absence of secondary remodelling. Sensitivity analyses showed that small-strain linear elasticity provides near-equivalent stimulus-class distributions at substantially lower computational cost than nonlinear alternatives, supporting its use for high-throughput longitudinal pipelines. These results illustrate feasibility in a single clinical case; cohort-level validation and predictive performance for delayed union/non-union are topics of ongoing and future multi-case studies.