Development and Evaluation of a Subject-Specific Lower Limb Model With an Eleven-Degrees-of-Freedom Natural Knee Model Using Magnetic Resonance and Biplanar X-Ray Imaging During a Quasi-Static Lunge

Abstract

Musculoskeletal (MS) models can be used to study the muscle, ligament, and joint mechanics of natural knees. However, models that both capture subject-specific geometry and contain a detailed joint model do not currently exist. This study aims to first develop magnetic resonance image (MRI)-based subject-specific models with a detailed natural knee joint capable of simultaneously estimating in vivo ligament, muscle, tibiofemoral (TF), and patellofemoral (PF) joint contact forces and secondary joint kinematics. Then, to evaluate the models, the predicted secondary joint kinematics were compared to in vivo joint kinematics extracted from biplanar X-ray images (acquired using slot scanning technology) during a quasi-static lunge. To construct the models, bone, ligament, and cartilage structures were segmented from MRI scans of four subjects. The models were then used to simulate lunges based on motion capture and force place data. Accurate estimates of TF secondary joint kinematics and PF translations were found: translations were predicted with a mean difference (MD) and standard error (SE) of 2.13 ± 0.22 mm between all trials and measures, while rotations had a MD ± SE of 8.57 ± 0.63 deg. Ligament and contact forces were also reported. The presented modeling workflow and the resulting knee joint model have potential to aid in the understanding of subject-specific biomechanics and simulating the effects of surgical treatment and/or external devices on functional knee mechanics on an individual level.

Subject-Specific Modeling of Femoral Torsion Influences the Prediction of Hip Loading During Gait in Asymptomatic Adults

“…MRI (Dejtiar et al, 2020;Modenese and Kohout, 2020), it is also a rather time-consuming approach (Andersen, 2021), and it could introduce additional uncertainties and errors in the identification of muscle insertion and origins (Carbone et al, 2012;Valente et al, 2014).…”

“…Higher RMSD values were found for subjects with high femoral antetorsion or high femoral retrotorsion, indicating that the more a subject’s morphology differs from the generic model, the more important it is to account for these differences. While a fully subject-specific modeling approach would require the inclusion of bone geometries and muscle lines of actions from CT scans or MRI ( Dejtiar et al, 2020 ; Modenese and Kohout, 2020 ), it is also a rather time-consuming approach ( Andersen, 2021 ), and it could introduce additional uncertainties and errors in the identification of muscle insertion and origins ( Carbone et al, 2012 ; Valente et al, 2014 ).…”

“…Torsional deformities of the femur and tibia ( Bruce and Stevens, 2004 ; Alexander et al, 2020 ) have also been associated with knee and patellar complications ( Eckhoff et al, 1997 ; Powers, 2003 ; Stevens et al, 2014 ; Bretin et al, 2011 ). However, a better understanding of the femorotibial and femoropatellar joint mechanics, specifically of their response to torsional forces, would require a more complex multi-DOF modeling approach of the knee complex, accounting for specific morphological variations of the tibia and femur, specifically of their articulating surfaces, as well as passive soft-tissue structures which constrain knee rotations ( Marra et al, 2014 ; Lenhart et al, 2015 ; Dejtiar et al, 2020 ).…”

Torsional deformities and overuse injuries: what does the literature tell us

“…However, similar studies investigating the effect of sustained musculoskeletal loads on the onset of overuse injuries are still lacking and appear to be needed. Computational methods such as musculoskeletal modelling and finite element analysis that combine patient-specific anatomy, kinematics, and kinetics can estimate the mechanical stimulus experienced in the regions of interest, such as cartilage stresses and contact pressures (71,72,73,74); ligament forces, strains and elongation patterns (75,76); strains and stresses on the bone (77,78,79); as well as on specific sub-regions of the bone, such as the proximal femur growth plate (80,81,82). The computational nature of these methods enables a thorough evaluation of the musculoskeletal loads occurring during various activities of daily living, demanding occupational tasks, sport activities, and strengthening programs across large samples of the population (83,84,85,86,87).…”

Subject‐specific muscle properties from diffusion tensor imaging significantly improve the accuracy of musculoskeletal models

“…However, such subject‐specific models are currently much more expensive and time‐consuming to produce relative to generic‐based or ‘averaged’ models and as such have rarely been used to this extent in any species. However, research into the validity of subject‐specific models of the human musculoskeletal system is becoming more widespread, as it is thought that such models may be more accurate for certain tasks than the often used generic or scaled generic models (Lenaerts et al ., 2008; Scheys et al ., 2008; Scheys et al ., 2009; Scheys et al ., 2011; Valente et al ., 2014; Navacchia et al ., 2016; Prinold et al ., 2016; Dejtiar et al ., 2020; Gu and Pandy, 2020; Modenese and Kohout, 2020; Nardini et al ., 2020). For example, models with subject‐specific musculoskeletal geometry have been shown to be more effective for predicting muscle moment arms and joint contact forces, with respective differences of 36% (Scheys et al ., 2008) and 0.61 xBW (Lenaerts et al ., 2008) relative to generic models.…”