Perspectives: a vital biomechanical model of synovial joint design.

Making a durable joint requires adapting the one present at birth to its subsequent mechanical usage and then maintaining it. The total loads on a joint's momentarily loaded area plus the size of that area determine the unit loads on its articular cartilage and subchondral bone. Given those facts, this model suggests the following. For adaptation: As is true for bone, a threshold range of unit loads that could turn cartilage modeling ON would lie below this tissue's microdamage threshold. When a joint's unit loads rose to that modeling threshold, chondral modeling would begin enlarging the momentarily loaded area to reduce and keep the unit loads on it below the microdamage thresholds of the bone and cartilage supporting that area. For maintenance: Maintenance activities would control the stiffness of cartilage and bone, which would also affect a joint's momentarily loaded area. These activities would usually repair whatever microdamage normally arises in those tissues, and could modify their microdamage thresholds too. In children, modeling and maintenance in bone and cartilage would function effectively. In adults chondral modeling becomes ineffective, but maintenance activities in bone and cartilage would remain effective, and likewise for modeling in the subchondral bone. This model assigns special importance in joint design to the stiffness of bone, cartilage, and ligament (as distinguished from their strength), to the typical largest unit loads applied to them by a subject's usual weekly physical activities, and to their microdamage.