Design of an ACLI Repression, Reconstruction, and Rehabilitation System

Transcription

1 Design of an ACLI Repression, Reconstruction, and Rehabilitation System AUTHORED BY: Amr Attyah Maribeth Burns Sam Miller Andrew Tesnow SPONSORED BY: Dr. Lance Sherry Department of Systems Engineering and Operations Research George Mason University Fairfax, VA October 21, 2015

2 Contents Introduction:... 4 Context Analysis:... 5 Stakeholder Analysis... 6 Stakeholder Tensions... 9 Win-Win Analysis Gap Analysis Problem Statement Need Statement Proposed Solution/CONOPS Statement of Work Requirements Mission Requirements Functional Requirements Design Requirements Objectives Hierarchy Simulation Requirements Design Alternatives Design Alternatives for Repression Gait analysis app Female supports via clothing Warn Design Alternatives for Reconstruction Decision tool Circular cutting tool New polymer Design Alternatives for Rehabilitation Analysis Goal-Oriented Training Psychologist Method of Analysis Project Management... 27

3 Work Breakdown Structure Project Critical Path/Schedule Risk Mitigation Project Budget Earned Value Analysis CPI/SPI Thanks and Acknowledgements... 29

4 Introduction: Over the past 40 years there has been an increase in participation in NCAA sports. This increase has stemmed from the addition to the Education Amendments of 1972 of Title IX. Title IX is an amendment the offered equal rights for women who wanted to participate in college sports. Since 1972 there has been an over 638% increase in female participation. With this increase there has been an increase in female prone injuries as well, such as Anterior Cruciate Ligament injuries (ACLI). Before delving into how to solve a problem, it is important to get to Graph 1: Participation in NCAA Sports know the system one is working with. The Knee System is composed of 5 main parts, muscles, bones, tendons, meniscus, synovial fluid, and ligaments. The muscles involved are the quadriceps and hamstrings (shown in red). The quadriceps, also known as, the thigh muscle, works with the hamstrings and allows the individual to bend and flex the knee system giving him the ability to walk. The bones (shown in yellow) are the femur (thigh bone), tibia (shin bone), fibula, and patella (knee cap). These give the system structure and allow the individual to stand. Then quadriceps and patellar tendons (shown in blue) hold the patella in place, protecting the knee. The meniscus (purple) and synovial fluid (not shown but is located between the femur and the tibia) give the knee some shock absorption and cushioning, preventing the bones from hitting each other when an individual moves. The ligaments are the ACL (green), PCL, MCL, and LCL (orange). The LCL and MCL prevent the knee from rotating inwards (valgus) or outwards. The PCL and ACL prevent the knee from rolling forwards or backwards. Figure 1: Back View of Leg Muscles Figure 2: Front View of Knee

5 The knee system has many different angles of force being applied to it. This is from the ability of the leg to rotate at the knee, hip, and ankle. All of these movable areas provide the knee system with many different angles and levels of torque. This provides the knee system with many different areas for error to occur. ACL injuries fall into two categories, contact (20%), and noncontact (80%). Since noncontact ACLI are preventable, the project will focus on those types of injuries. The noncontact ACLI can be broken into 5 sub categories: internal/external (24%), internal/external with adduction/abduction (56%), internal/external with flexion/extension (2%), adduction/abduction (13%), and flexion/extension (5%). As can be seen, internal/external with adduction/abduction ACLI is the most common form of ACLI. That is why the project will focus on the contributing variables to that type of injury as well as reducing those variables. Figure 3: Angular Rotation of Leg Figure 4: ACLI must be used. When an ACL tears, it cannot simply grow back. This is because when the ACL tears it breaks in a stringy way, not clean cut. In order to heal this type of tear, the pieces would have to be placed close together to allow the blood to clot between the two pieces. However, the ACL is in a fluid, called synovial fluid. This prevents the ACL pieced from sitting still and does not allow the blood to clot in this liquid. Therefore, a surgical graft Context Analysis: The overarching system has 3 subsystems. The subsystems are repression, reconstruction, and rehabilitation. Currently there are some uses in effect today but they are all faulty. The repression subsystem that is in effect today is not widely practiced or advertised. If one were to want to find out information on how to prevent a tear, there are information and clinics out there. However, these clinics are once every couple of months and not widely attended. The

6 clinics focus on having a person do some athletic movements and a coach watching for errors or defects in the action. After the clinic the person may be given an exercise to perform to strengthen an area. For reconstruction, grafts are typically taken from one of three areas. The patellar tendon, quadriceps tendon, or hamstring tendons. These can be broken down into two types of grafts, bone tendon bone (BTB) or bone tendon ligament (BTL). Patellar and quadriceps are BTB and hamstrings are BTL. Each of these types of grafts has a risk associated with them. BTB grafts take 8 weeks to heal and have a 1.3% chance of fracturing the patella. BTL have a 7% chance of the graft being placed in the wrong spot and take 12 weeks to heal. Currently, both grafts are done arthroscopically, through the surgeon making small incisions into the knee and using an arthroscope (camera on a stick) to perform a minimally invasive surgery. Rehabilitation usually consists of a series of movements that are performed to increase flexion, balance, and strength after the surgery. After surgery, only about 44% of athletes will return to their previous level of sports. Figure 5: Autograft Locations We have decided to focus our research on female collegiate soccer athletes because they are one of the main groups of athletes that are affected by ACLI and we have an abundant amount of information on them. Stakeholder Analysis 1.0 Athletic Department 1.1 Female Soccer Collegiate Athletes (FSCA) Their main objectives are to increase average playing time and increase media exposure. An ACL tear may end the college scholarship for FSCAs. It may reduce their opportunity in going to the professional level. It may develop a fear from the sport. It may develop depression and anxiety that affect that may affect their educational performance. FSCAs would benefit from the ACL Repression, Reconstruction, and Rehabilitation (RRR) Program because it would reduce the probability of an ACL tear, and lesson the time needed to get back to sports, and deal with any psychological issues that may develop in the rehabilitation period Valuable They represent a minority of FSCA whose absence will influence winning percentages negatively Replaceable They represent the majority of FSCA, whose absence will not influence winning percentages as much, making them replaceable. 1.2 Athletic Director

7 An athletic director is an administrator who oversees the hiring process for the athletic staff and the purchasing process for the athletic equipment used in the athletic department. The RRR Program will not have any effect on athletic directors. 1.3 Athletic Staff Head Coach They coach s main objective is to increase winning percentages. In order to achieve that, the coach needs to have the whole team available, ready, and their fitness level are up to the desired level. If a valuable athlete is injured, they may need to change the lineups and the way the whole team plays. The RRR program aims to increase winning percentages, which correlates with the goals of the head coach Athletic Trainers The trainers are professional who are assigned to develop sport medical programs that aims to maintain or improve the athlete's fitness level. The RRR program will not have any effect on the trainers because they will be needed to develop neuromuscular, strengthening, and conditioning training programs to reduce the probability of the ACL tear. 2.0 Family of FSCA They include the parents and the siblings of the injured athletes. The family generally cares about the well-being of the injured athlete. An ACL tear may take time, money and effort from the family to support the athlete during recovery period. Since the RRR program aims to reduce the probability of a tear, it correlates with the goals of the family. 3.0 Orthopedic Surgeons An ACL reconstruction surgery is one of the most common procedures done by orthopedic surgeons. The RRR program would reduce the amount of ACL reconstruction surgeries needed, which may decrease the demand for orthopedic surgeons. However, the impact may not be as big because the ACL reconstruction surgery is just one out of many surgeries performed by orthopedic surgeons. 4.0 Physical Therapists Physical therapists are experts who have the knowledge to restore the pre-injury fitness level of the injured athlete. Although the RRR program would decrease the amount of patients who will go through rehabilitation, physical therapists are still needed to develop injury prevention programs. 5.0 Sponsors 5.1 College Institutions Although there is a huge debate in the value of college sports since its expenses are generally higher than its revenues, one of the primary goals of college institutions is to increase media exposures to attract more students to apply. An increase of winning percentages leads to more media exposures. Because the RRR program aims to increase winning percentages, it correlates with the goals of the college institutions. 5.2 Brand Names They are companies that have financial motives to gain out of the athletic competition regulated by the NCAA, by creating contracts with valuable players, and having the

8 players promoting their brand on the field. The RRR program aims to increase average playing time for valuable players, which correlates with the goals of brand names. 6.0 Tool Manufactures 6.1 Repression Product Manufactures They develop products that aim to monitor and collect and analyze data about the moving subject, such as gait analysis. Repression products also include types of repression gear that help reduce the strain on ACL, such as prophylactic knee braces. The RRR will be beneficial for repression product manufacturers because it will make use of such products. 6.2 Reconstruction Product Manufactures These manufacturers develop medical products that are used during ACL reconstruction operations. Because of the multi functionalities that these products have, they are not only used for ACL surgeries. Therefore, the demand for reconstruction products will not be affected by the RRR program. 6.3 Rehabilitation Product Manufacturers They develop products that aim to monitor and collect data about the moving subject before they analyze the data, such as gait analysis. Rehabilitation products also include types of rehabilitation gear that helps support the knee and add stability, such as the functional knee braces. Although the use of it in the rehabilitation program will be less, the use of these products may increase in the repression Health Insurances These Insurances will pay for the ACL reconstruction surgery. Their main objective is to make profit. The RRR Program will be beneficial to them if it cut on the number of ACL injuries per year because it will reduces their average spending on ACL surgeries.

9 Figure 6: Stakeholder Tensions: Existing Tensions Stakeholder Tensions Most of the stakeholders have economical goals, except for the family who care about the wellbeing of the athlete. There are tensions between the family, who don't want the injured athlete to go back to sport because of the high risk of the ACL re-tear, and the injured athlete who want to go back to sport. There are also tensions between the athletic department who needs to be funded, and the college who needs a team with high winning percentages to increase their media exposure. In the athletic department there are tensions between the athletic director who needs high performance evaluation and the athletic staff who need to maintain their jobs. In addition, more knee surgeries correlate with the economic goals of orthopedic surgeons and physical therapists, but it does not correlate with the economic goals of the insurances that will pay for the surgery.

10 Figure 7: Stakeholder Tensions: New System Tensions The RRR program will influence 3 main areas. First, reduction in surgery operations, this is influenced by the repression program. Decreasing the probability of a tear correlates with the economic goals of health insurances positively, while it correlates with the economic goals of the orthopedic surgeons and the physical therapists negatively. Second influence is the increase in winning percentages. Because winning percentages is influenced heavily by valuable players, decreasing their risk of ACL tear would correlates with the professional goals of the team, the coach, the athletic department. High winning percentages also lead to high media exposures for the athletes, college institutions. The third influence is the changes in market demands. Decreasing the probability of ACL tears, would decrease the demand for orthopedic surgeons and physical therapists since less surgeries are needed. However, because physical therapists work also in repression and sometimes get hired to train the athletes, the demand for physical therapists may not get affected. The RRR program will make use of repression gears, rehabilitation gear, and it will not change market demands for reconstruction products because of its multi-functionality.

11 Win-Win Analysis Stakeholder Tensions Description Win-Win Family-Athlete Tension - Family: cares about well-being of the athlete, so they do not want them to go back to sport for the high probability of injury. - Family: Develop a repression program that decreases probability of a tear or a re-tear (for injured athletes), will leave families pleased for the precautions taken by the athletes. Athlete-Coach Tension - Athlete: cares about an increase in playing time to increase media exposure, so they want to go back to sport as soon as possible. -Athlete: cares about increase in playing time, don t want the coach to sit them in bench. - Athlete: Develop a repression program that decreases probability of a tear or a re-tear (for injured athletes), will increase average playing time for athletes. -Athlete: repression program increases time for self-development which increases opportunity in becoming starters. Athletic Director-Athletic Staff Tension -Coach: want to increase winning percentages, so they want the athletes to be able to have high performance in the field. Athletic Director: cares about the overall staff performance and finding budgets to fund the athletic department. -Coach: repression program would increase playing time for valuable players, which lead to an increase in winning percentage. -Athletic Director: will not be influenced by the system. College-Athletic Department Tension -Athletic Staff: cares about maintaining their job, so trainers need to minimize athletes injuries, whereas coaches need to maximize winning percentages -College: cares about generating revenue from the athletic department or media exposure to attract more students, so they need the athletic department to have a high winning percentage. -Athletic staff: a repression program will help trainers minimize risk of injuries, where as it would increases winning percentages for coaches by protecting valuable players from ACL tears. -College: developing a repression program will help athletic department to increases winning percentages. Athlete-Orthopedic Surgeon Tension -Athletic Department: want to be funded to be able to give high winning percentages. -Athletes: want to keep playing and not worry about injuries. -Athletic Department: The RRR program will not influence funding. -Athletes: develop a repression program will reduce risk of ACL injury -Orthopedic Surgeon: their economic goals are based on the demand for knee -Orthopedic Surgeon: while reducing the risk of ACLI may influence their economic

12 Athlete-Physical Therapist Tension operations. -Athletes: want to keep playing and not worry about injuries. goals negatively, they will still be needed for other common surgeries. -Athletes: develop a repression program will reduce risk of ACL injury. Athletic Department- Tool Manufacturers Tension -Physical Therapist: many achieve economic goals based on people's injury -Athletic Department: want to be funded to be able to buy useful equipment for athletes to give high winning percentages. -Physical Therapist: while a repression program may reduce the number of clients for physical therapists in rehabilitation, it may increase their demand in repression. -Athletic Department: The RRR program will not influence funding. -Tool Manufacturers: develop products the help with repression, reconstruction, and rehabilitation, so they need their products to be in demand Table 1: Win-Win Analysis -Tool Manufacturers: The RRR program will make use of the repression products. The rehabilitation products at the very least it will not be affected because its products are also used in repression, while the reconstruction products will not be influenced because of its multifunctionality, Gap Analysis Problem Statement Figure 8: Gap Analysis R1: Repression. R2: Reconstruction. R3: Rehabilitation. System Problem Statement 10% of female collegiate athletes injure their ACL and 44% of them return to their athletic career. 1. Repression Problem Statement Females have a 10% of tearing their ACL. Males have a 6.25% of tearing their ACL. 2. Reconstruction Problem Statement

13 Bone tendon bone grafts take 8 weeks to heal, have a 1.3% chance of fracturing the patella, and an 18% chance of developing arthritis within 5 years. Bone tendon ligament grafts take 12 weeks to heal themselves, do not affect the patella, and have a 4% chance of developing arthritis within 5 years. Both types of grafts have a 78% chance of developing arthritis in 14 years. 65% of the patients have a lack of knowledge of those surgery risks. 3. Rehabilitation Problem Statement After rehab, 56% of collegiate athletes will not return to sports. Need Statement System Need Statement There needs to be a system that decreases the likelihood of ACLI by xx%. 1. Repression Need Statement There is a need for a system that detects the probability of an individual s likelihood of an ACLI because each person has different inputs that affect their likelihood of a tear with different weights with a 95% CI. 2. Reconstruction Need Statement There is a need for a system that decreases the total number of patients having to get an act surgery. 3. Rehabilitation Need Statement There is a need for a system that reduces the number of people who have to participate in rehab by xx%. Proposed Solution/CONOPS: The proposed solution is an ACLI Handling System that encompasses the repression, reconstruction, and rehabilitation sub-systems. The repression sub-system would provide athletes with a personalized program to lower the probability of suffering an ACLI. The reconstruction sub-system would inform the athlete about the risks and benefits of different reconstructive ACL surgeries. The rehabilitation sub-system would provide personalized support for the athlete to have a higher probability of returning to sports. Combinations of the three sub-systems will be modeled in a simulation to determine the combination with the highest performance with respect to cost efficiency. Statement of Work: 1. Background Anterior Cruciate Ligament (ACL) tears have been rising. ACL s are an important component of the knee system and when torn can cause long term problems if not handled correctly. ACL

14 injuries (ACLI s) are unfortunately a common occurrence in sports, and can cause an athlete to miss 6 to 12 months of play time. Female athletes are 3 times more likely to tear an ACL and therefore be grounded from sports. Differences in anatomy such as Q-Angle, the angle that the femur takes from hip bone to knee system, and Quadriceps dominance, a tendency to activate the quadriceps muscle system much more than the hamstring system, both have a positive impact on the rate of ACL tears. Since female athletes have been shown to have more ACLI s than males, and the differences in anatomy have both been shown to contribute to stress on the knee system, there seems to be a correlation between Q-angle, Quad dominance and the rate of ACL tears. 2. System Information 2.1 Existing System No official inter-related system exists that marries the processes of repression, reconstruction and repression. Repression is handled by sport leaders, coaches and trainers. The surgeons that reconstruct ACL s do not have any input or output from repression technicians. Rehabilitation is run by professionals but do not incorporate psychology into their routines. 2.2 Future System The future system would be an interconnected system between repression technicians, surgeons and physical therapists. The repression tech would have a defined system to follow and would take an athlete's physical attributes in mind to develop counterbalancing muscles and good form to counteract quad dominance. Surgeons would be able to tailor a specific type of surgery more effectively to an athlete's needs. Physical therapists would have a psychologically based rehab program that would be better tailored for the specific athlete. 3. Scope of Work The project team shall further research the system and topic to further understand the problem, and talk with the sponsor to understand and acquire system requirements. The project team will formulate a concept of operations based on the research. Design and functional requirements will be derived from the research and through meetings with the sponsor. The system team will create alternatives for each subsystem, and model each subsystem using Java. The project team will use the created models as a way to test and acquire data for analysis. The alternatives will be evaluated using utility/cost analysis and sensitivity analysis. Then, the project team shall provide recommendations for the each subsystem. Throughout the course of the project, the project team shall create Project Management Documentation and submit a hardcopy of all documentation. 4. Specific Requirements or Tasks

15 4.1. Program and Project Management Support The project team shall provide project management support during the period of performance for the ACL Handling project. The project management support should be focused on the areas of creating/maintaining documentation for the budget, EVM, Gantt Chart, Pert Chart, Statement of Work, and WBS. The changes made to the project shall be visible in the project management documents Requirements Analysis, Documentation, and Recommendations The project team will be expected to conduct a stakeholder analysis. The stakeholder analysis should be documented and reflect the tensions between stakeholders. The project team shall develop requirements through requirements analysis, as well as meeting with the project sponsor. Recommendations shall be evaluated using utility/cost analysis along with a sensitivity analysis, and the calculations/data used shall be documented and presented in hardcopy Work Breakdown Structure (WBS) The project team shall create a WBS that breaks down the project into high level tasks broken down into secondary level tasks. The higher level task breakdown should be developed so that the correlation between the higher level tasks and the secondary tasks are easily visible and logical.

16 Figure 9: WBS 5. Performance Schedule The contractor shall create a performance schedule in the form of a Gantt Chart that will reflect the deliverables and work stated in the WBS on a timeline. The Gantt Chart should include a critical path along with a breakdown of high level tasks into lower level tasks. The Gantt Chart shall be created in Microsoft Project. The Performance Schedule will be due at the start of the project, along with the weekly achievement summaries. 6. Earned Value Management Reporting The project team s performance throughout the project will be evaluated by Earned Value Management. The team will provide the data used in calculating the EVM along with the budget and schedule. 7. Deliverables The documents and presentations the deliverables consist of will be submitted in the form of Microsoft Word for text, Microsoft Projection for presentations, and Microsoft Project for

17 scheduling. Other software may be used as long as it is approved. The deliverables shall be submitted in the form of two hard copies. 7.1 Weekly Status Report The project team shall submit a weekly status report consisting of timesheets and weekly accomplishment summaries. The timesheets shall be created/maintained in Microsoft Excel, and will consist of individual team member time sheets as well as a total project team timesheet. The weekly accomplishment summaries will include accomplishments, issues, and plans for the following week. 7.2 Deliverables Table Deliverable Project Management Plan Timesheet Weekly Accomplishment Summary Earned Value Management Scheduled Deadlines 5 days after project kick off Every Monday Every Monday Weekly Project Briefing 1 9/28/2015 Project Briefing 2 10/5/2015 Project Briefing 3 10/26/2015 Project Briefing 4 11/9/2015 Project Plan 10/21/2015 Final Deliverable 12/9/ Degree Team Evaluations 10/21/2015 & 12/9/2016 Faculty Presentation 11/20/2015 Project Briefing 1 (Spring) Project Briefing 2 (Spring) Project Briefing 3 (Spring) TBD TBD TBD

18 Final Deliverable (Spring) SIEDS Conference Extended Abstract TBD TBD Table 2: Deliverables 8. Period of Performance The period of performance will be 8 months after the project assignment. The total billable hours for the project will be 168 hours. 9. Place of Performance The place of performance will be up to the discretion of the project lead. The team will be required to attend meetings twice a week at 4400 University Dr. Fairfax, VA The software necessary for the project will be provided at the Nguyen Engineering Building. The travel costs to this location will not be reimbursed. 10. Furnished Equipment The borrowed software and hardware used throughout the project shall remain the property of George Mason University, and will be used to work on the deliverables. The software can consist of computer programs along with the access to journal databases. The borrowed equipment shall be returned at the end of the project. 11. Reimbursable Costs The only reimbursable costs will be the travel and hotel costs for trips to competitions. The competitions will take place at the University of Virginia and West Point, in April 2016 and May 2016 respectively. 12. Project Tools Development The assigned project team shall develop and apply methods and tools aid in fulfilling requirements. The costs associated with acquiring, developing, and applying these tools will count as billable hours, and will be need to be noted in the weekly status report. Travel to outside sources to acquire data and the acquisition of not already provided software/hardware will not be reimbursed. 13. Special Instructions The project team will be required to prepare a thirty minute presentation along with the submission of each deliverable; the presentation will be given on the date of completion for each deliverable based on the Gantt Chart. A review of the deliverable as well as the presentation will take place during the presentation as well as after. This review will ensure the quality of each deliverable through critiques and necessary changes. The review will take place

19 at the Nguyen Engineering Building. All project team members will be required to attend and contribute to these presentations. 14. Quality Assurance and Performance Requirements Quality and performance will be measured during the performance period. Performance will be tracked in a project team developed Project Performance Tracking and Reporting spreadsheet. Quality throughout the project will be ensured through review meetings for each deliverable. Suggested changes or critiques shall be made before the completion of the next deliverable. If the deliverable is not completed on time or is deemed low quality the content of that deliverable will have to completed within a two day window and a penalty will be given. 15. Protection of Information The project team shall be held responsible for protecting private/personal information throughout the course of the project. Any information/data acquired or used in the project that contains private or personal information shall be shown without any explicit personal information, and instead in the form of data and metrics. 16. Method of Award The project will be awarded to a project team deemed with the highest interest and qualifications for the project. Requirements: Mission Requirements: The above figure shows the five direct mission requirements. Figure 10: Mission Requirements 1. The system shall reduce the probability of ACLI in female collegiate athletes by 50%. 2. The system shall decrease number of surgeries by 25%. 3. The system shall increase the number of athletes that return to sports by 25%. 4. The system shall cost no more than $36, The system shall have up to a 5 year life cycle as applied to each individual athlete.

20 Functional Requirements: The ten main functions that the ACLI Repression, Reconstruction, and Rehabilitation system will include are: 1. The system shall decrease ACL strain caused by q-angle by 25% 2. The system shall decrease ACL strain caused by quad-dominance by 25% 3. The system shall decrease the number of ACLI by 50% 4. The system shall decrease the probability of leaving sports due to pain by 25%. 5. The system shall decrease the probability of leaving sports due to fear by 50%. 6. The system shall decrease the probability of leaving sports from social reasons by 25%. 7. The system shall lower the cost of handling ACLI by 25%. 8. The systems component costs shall not be more than $27,000 for surgery and $8,000 for rehabilitation. 9. The system shall cover an athlete through their entire NCAA career. 10. The system shall be maintained throughout an athlete's NCAA career The ACLI Repression, Reconstruction, and Rehabilitation system, will detect the impact that specific variables will impact the system, specifically Q-Angle and Quad-Dominance. From there it will decrease the number of ACLI by decreasing strain caused by these two variables. If an athlete were to still tear their ACL, after they complete reconstruction and rehabilitation, the system decrease the probability of an athlete leaving a sport due to pain, fear, and/or social reasons. This can be done by taking into account an individual s personal learning styles, fears, and motivation. The new system will also be fiscally reasonable and in place over the athlete s entire career and up dated as seen fit... Design Requirements: DR1.1.1 The system shall decrease bad rotational force (torque) by 25%. DR1.1.2 The system shall decrease bad coordinate plane forces on Knee systems by 25%. DR1.1.3 The system shall decrease bad coordinate forces on hip systems by 25%. DR1.1.4 The system shall decrease bad coordinate forces on ankle systems by 25%. DR1.1.5 The system shall decrease ACLI by training by 25%.

21 DR1.1.6 The system shall decrease ACLI by warning by 25%. DR1.2.1 The system shall decrease bad coordinate plane forces on knee systems by 25% DR1.2.2 The system shall decrease bad coordinate forces on hip systems by 25% DR1.2.3 The System shall decrease bad coordinate forces on ankle systems by 25% DR1.2.4 The system shall decrease ACLI by training by 25% DR1.2.5 The system shall decrease ACLI by warning by 25% DR1.2.1 The system shall decrease bad coordinate plane forces on knee systems by 25%. DR3.1.1 The system shall inform the injured person of the pain associated with each graft. DR3.1.2 The system shall inform the injured person of the risk associated with each graft. DR3.1.3 The system shall inform the injured person of the ways to interact with each person in their social circle. DR4.1.1 The repression system shall cost less than the surgery and rehabilitation combined. DR4.2.1 The repression system shall cost no more than $15,000 for a college to implement. DR4.2.2 The reconstruction system shall cost no more than $27,000. DR4.2.3 The rehabilitation system shall cost no more than $8,000.

22 DR5.1.1 The system shall start when an athlete starts a college sport. DR5.1.2 The system shall end when the athlete chooses to leave the sport. DR5.1.3 The system shall end when the athlete becomes ineligible to compete in the sport. DR5.2.1 The system shall receive updates within 30 days of a new scientific study suggesting change. Objectives Hierarchy: Table 3: Design Requirements Figure 11: Objectives Hierarchy The objectives hierarchy shown in above is composed of five categories. The first category regards the optimization of an athlete's playing time. This is the where the variables that increase one s probability of an ACLI are minimized. The second category minimizes the actual number of surgeries performed on the total population of the athletes. The third category maximizes the number of athletes who return to sports after they go through rehabilitation. The fourth category focuses on minimizing the costs of each system. This forces the system to be fiscally reasonable. The last category works with the lifecycle and upkeep of the system. Simulation Requirements: The simulation for the ACLI Repression, Reconstruction, and Rehabilitation System has 5 main requirements: 1. The simulation shall have athletes for inputs. 2. The simulation shall have outputs. 3. The simulation shall model 1 year. 4. The simulation shall model probability within the system. 5. The simulation will be created using CPN Tools

23 The first requirement states that the system shall have only athletes for inputs. No other types of persons will be taken into account. The second requirement lists the outputs for the system. These outputs are athletes that do not tear their ACL, athletes that do tear their ACL and then have a failure during surgery, athletes that do tear their ACL, go through surgery, and then do not want to participate in sports any more, and athletes that do tear their ACL, go through surgery, and then return to sports. The total number of outputs will equal the total number of inputs. This means that there will be no unaccounted for athletes. The third requirement shows the time span that the model will cover. The fourth simulation requirement models the probability within the system. This includes the probability of tearing an ACL, the probability of choosing a graft with a risk associated to it, the probability of an athlete wanting to return to sports post-surgery, and the probability of failures during rehab. These probabilities will be collected from existing data for the As-Is simulation. The probability for the To-Be simulation will be derived from research. Design Alternatives: Design Alternatives for Repression: The female focused exercise repression program alternative would provide athletes with exercises aimed at reducing the impact of q-angle and quad-dominance on the ACL. The exercises would focus on decreasing the horizontal force on the knee system, decreasing quaddominance by strengthening the hamstrings and gluteus muscles, and increasing flexion during dynamic movements. Dynamic movements would include cutting and landing during jumps. The exercises would be measured in terms of repetitions and duration of each exercise. Gait analysis app The gait analysis app alternative would take inputs from an athlete. Possible inputs could sex, weight, height, age, and trauma. Then use a video recording device to record the athlete performing a dynamic movement. The recording would be used to collect metrics related to the knee system. Possible metrics could include step length, stride length, cadence, speed, foot angle, and hip angle. The gait analysis app would then use these metrics to provide the athlete with personalized physical suggestions to lower the probability of an ACL tear. Female supports via clothing The female supports alternative would provide the athlete with supports in the form of clothing. The supports would counterbalance the horizontal forces caused by q-angle and quaddominance.

24 Warn The warn alternative would inform the athlete when their knees are in a position that would significantly increase the likelihood of incurring an ACLI due to high amounts of horizontal force. The warn alternative could be in the form of a knee brace with attached sensors. Upon reaching above a certain threshold of horizontal force or inward angle, the knee brace would alarm the athlete through an audio signal. Design Alternatives for Reconstruction: Decision tool The decision alternative would provide the athlete with information on different types of ACL reconstructive surgeries. The information would primarily be focused on the risks, costs, and recovery time associated with each type of surgery. This would aid the athlete in selecting a surgery that would best fit their personalized criteria. Circular cutting tool The circular cutting tool alternative would provide the athlete with an improved BTB surgery. The circular cutting tool would hopefully lessen the probability of suffering patella failure, due to a BTB surgery. It would accomplish this by harvesting the graft from the patella tendon without leaving ninety degree angles in the tendon, and instead leave a circular cut in the patella. New polymer The new polymer alternative would give the athlete an additional graft option to consider when getting reconstructive surgery. A new polymer for synthetic grafts would allow this lessen the cost of reconstructive surgery, and shorten the recovery time from surgery for the athlete without the risk of the synthetic graft deteriorating. Design Alternatives for Rehabilitation: Analysis The analysis alternative would work similarly to the analysis alternative for repression. Additionally the rehabilitation analysis would have an additional input from the athlete on the type of reconstructive surgery they choose. Based on the type of reconstructive surgery, the analysis would take the input and provide the athlete with constraints. Goal-Oriented Training The goal-oriented training alternative would use the athlete s competitive nature to fuel their rehabilitation. It would give the athlete s weekly goals for rehabilitation exercises to be completed at a specific intensity. The weekly goals would increase in intensity until the athlete could return to sport specific training.

25 Psychologist The psychologist alternative would incorporate a psychological analysis into the as-is rehabilitation sub-system. The psychological analysis would provide the psychical trainers working with the recovering athletes a better understanding of the athlete. The increased understanding could be used to better motivate or encourage the athlete to complete the rehabilitation program. Method of Analysis: Graph 2: Method of Analysis - Repression The graph above is a percentage of ACL tear vs cost per individual. The graph was used to compare the repression sub-system alternatives and combinations of alternatives based on their effectiveness of lowering the probability of suffering an ACL tear as well as cost. Currently, the best alternative based on the criteria seems to be Training, Warn, and Pants.

26 Graph 3: Method of Analysis - Reconstruction The graph above is a percentage of medical technicality vs cost per individual graft for the reconstruction sub-system. The points on the graph represent the reconstruction sub-system alternatives. Based on this graph the best alternative seems to be the decision tool alternative, since it has the highest performance while having the second lowest cost. Graph 4: Method of Analysis - Rehabilitation The graph above was used to compare the rehabilitation alternatives, based on their percentage of athletes not returning to sport and cost. The analysis, goal-oriented training, and psychologist seem to be the current preferred alternative. This alternative provides the lowest percentage of athletes not returning to sport without costing significantly higher than the other alternatives.

27 Project Management Work Breakdown Structure Figure 12: WBS Project Critical Path/Schedule Risk Mitigation Figure 13: Critical Path Since the later ends of our project are mostly on the critical path, we will have to focus on meeting our project timeline with more diligence. This will include working on individual tasks

28 with more than one systems engineer. Our design of experiment has our testing procedure and metrics we want for our analysis. This means that the testing phase won t be intense. This will make up for some of the critical path risk. Our documentation phase which includes our presentations and poster for the fall semester will be less intense because we will mostly be using our PowerPoint slides that we have been developing all semester. Project Budget: The proposed project budget is $159, Earned Value Analysis: Graph 5: Budget Graph 6: Earned Value

29 Looking at our Earned Value Analysis up to week 7, we see that we are underproduction and way under actual cost. This may be because of midterm testing and scheduling conflicts. This may also be because we keep finding new design alternatives that require more research and therefore stop those tasks from being completely finished. What I mean is, that Design Alternative research and design alternatives requirements have been perpetually in the 80% complete range when they should have been complete. This is a phenomenon that is consistent with our iterative design process. We will model our Gantt chart to reflect this in a further report. CPI/SPI: Graph 7: CPI/SPI Reviewing our CPI/SPI ratio, we see that we are performing efficiently cost wise but are behind schedule. Therefore we need to assign more work to our 4 system engineers to get back on schedule. This lack in Earned Value should not be a cause of alarm because we are not working the planned value hours. This could be because of midterm tests and other classes. This phenomenon can be expected to balance itself out when workload decreases after midterms. Thanks and Acknowledgements We would like to give a special thanks to the people that have helped us through this semester: Dr. Sherry, Dr. Adelman, Dr. Costa, Dr. Zaidi, Dr. Ganesan, Dr. Anderson, GMU Smart Lab, Crystal Lee, Proactive Physical Therapy and Wellness, and Filipe Fernandes.