ABSTRACT
OBJECTIVE: A tendon-transfer is a reconstructive orthopedic surgery where tendons are re-routed from a non-functioning muscle and attached a functioning muscle. Prior work has shown that using a passive implanted device in the ECRL-to-FDP tendon-transfer surgery significantly improves hand grasping function. However, it is still unclear how hand-function improvement, measured by finger joint range of motion and torque, is dependent on the implant's geometry and location within the tendon network. This paper presents a genetic algorithm that determines the device's optimal geometry and location. METHODS: Hand biomechanical simulation platform was developed to model hand function and also model the tendon-transfer surgery with and without the implant. Finger kinematics and joint torque were used to develop three unique objective functions to optimize the implant's parameters. RESULTS: The optimized device resulted in an 11X increase in finger kinematics with only a 0.9% decrease in joint torque when compared with the biomechanical function enabled by the current suture-based surgery. CONCLUSION: Designing implantable devices that modify musculoskeletal function is challenging. Factors like tendon routing and joint kinematics create a complex nonlinear system when considering biomechanical function. A genetic algorithm is an effective tool to tackle these nonlinear landscapes to produce optimized designs. SIGNIFICANCE: The state-of-the-art surgical procedure to repair high median-ulnar nerve palsy leads to poor hand function and severely limits the patient's ability to perform activities of daily life. This work provides a method for defining relevant objective functions for hand biomechanical function and then uses those objective functions with genetic algorithms to optimize the geometry of an orthopedic implant across multiple variables. The achieved biomechanical function is significantly better than hand function enabled by current surgical procedure.
