title: Coupling lateral bending and shearing mechanisms to define knee injury criteria for pedestrian safety.
abstract: OBJECTIVE
  In car-pedestrian accidents, lateral bending and shearing kinematics have been identified as principal injury mechanisms causing permanent disabilities and impairments to the knee joint. Regarding the combined lateral bending and shearing contributions of knee joint kinematics, developing a coupled knee injury criterion is necessary for improving vehicle countermeasures to mitigate pedestrian knee injuries.
  
  
  METHODS
  The advantages of both experimental tests and finite element (FE) simulations were combined to determine the reliable injury tolerances of the knee joint. First, 7 isolated lower limb tests from postmortem human subjects (PMHS) were reported, with dynamic loading at a velocity of 20 km/h. With the intention of replicating relevant injury mechanisms of vehicle-pedestrian impacts, the experimental tests were categorized into 3 groups by the impact locations on the tibia: the distal end to prioritize pure bending, the middle diaphysis to have combined bending and shearing effects, and the proximal end to acquire pure shearing. Then, the corresponding FE model was employed to provide an additional way to determine exact injury occurrences and develop a robust knee injury criterion by the variation in both the lateral bending and shearing contributions through a sensitivity analysis of impact locations.
  
  
  RESULTS
  Considering the experimental test results and the subsequent sensitivity analysis of FE simulations, both the tolerances and patterns of knee joint injuries were determined to be influenced by impact locations due to various combined contributions of lateral bending and shearing. Both medial collateral ligament and cruciate ligament failures were noted as the onsets of knee injuries, namely, initial injuries. Finally, a new injury criterion categorized by initial injury patterns of knee joint was proposed by coupling lateral bending and shearing levels.
  
  
  CONCLUSIONS
  The developed injury criterion correlated the combined joint kinematics to initial knee injuries based on subsegment tests and FE simulations conducted with a biofidelic lower limb model. This provides a valuable way of predicting the risk of knee injury associated with vehicle-pedestrian crashes and thereby represents a further step to promote the design of vehicle countermeasures for pedestrian safety.
authors.affiliation: Laboratoire de Biomécanique Appliquée IFSTTAR-Aix-Marseille Université, 13916 Marseille, France. fuhao.mo@ifsttar.fr
authors.forename: Fuhao
authors.initials: F
authors.lastname: Mo
authors.forename: Catherine
authors.initials: C
authors.lastname: Masson
authors.forename: Dominique
authors.initials: D
authors.lastname: Cesari
authors.forename: Pierre Jean
authors.initials: PJ
authors.lastname: Arnoux
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D001696:Biomechanical Phenomena; D020342:Finite Element Analysis; D006801:Humans; D007718:Knee Injuries / Q000503:physiopathology*; D007719:Knee Joint / Q000502:physiology*; D008297:Male; D008953:Models, Anatomic; D012449:Safety; D015599:Trauma Severity Indices; D016138:Walking / Q000293:injuries*