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Musculoskeletal (MS) models should be able to integrate patient-specific MS architecture and undergo thorough validation prior to their introduction into clinical practice. We present a methodology to develop subject-specific models able to simultaneously predict muscle, ligament, and knee joint contact forces along with secondary knee kinematics. The MS architecture of a generic cadaver-based model was scaled using an advanced morphing technique to the subject-specific morphology of a patient implanted with an instrumented total knee arthroplasty (TKA) available in the fifth "grand challenge competition to predict in vivo knee loads" dataset. We implemented two separate knee models, one employing traditional hinge constraints, which was solved using an inverse dynamics technique, and another one using an 11-degree-of-freedom (DOF) representation of the tibiofemoral (TF) and patellofemoral (PF) joints, which was solved using a combined inverse dynamic and quasi-static analysis, called force-dependent kinematics (FDK). TF joint forces for one gait and one right-turn trial and secondary knee kinematics for one unloaded leg-swing trial were predicted and evaluated using experimental data available in the grand challenge dataset. Total compressive TF contact forces were predicted by both hinge and FDK knee models with a root-mean-square error (RMSE) and a coefficient of determination (R2) smaller than 0.3 body weight (BW) and equal to 0.9 in the gait trial simulation and smaller than 0.4 BW and larger than 0.8 in the right-turn trial simulation, respectively. Total, medial, and lateral TF joint contact force predictions were highly similar, regardless of the type of knee model used. Medial (respectively lateral) TF forces were over- (respectively, under-) predicted with a magnitude error of M < 0.2 (respectively > -0.4) in the gait trial, and under- (respectively, over-) predicted with a magnitude error of M > -0.4 (respectively < 0.3) in the right-turn trial. Secondary knee kinematics from the unloaded leg-swing trial were overall better approximated using the FDK model (average Sprague and Geers' combined error C = 0.06) than when using a hinged knee model (C = 0.34). The proposed modeling approach allows detailed subject-specific scaling and personalization and does not contain any nonphysiological parameters. This modeling framework has potential applications in aiding the clinical decision-making in orthopedics procedures and as a tool for virtual implant design.

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Ground reaction force (GRF) measurement is important in the analysis of human body movements. The main drawback of the existing measurement systems is the restriction to a laboratory environment. This paper proposes an ambulatory system for assessing the dynamics of ankle and foot, which integrates the measurement of the GRF with the measurement of human body movement. The GRF and the center of pressure (CoP) are measured using two six-degrees-of-freedom force sensors mounted beneath the shoe. The movement of foot and lower leg is measured using three miniature inertial sensors, two rigidly attached to the shoe and one on the lower leg. The proposed system is validated using a force plate and an optical position measurement system as a reference. The results show good correspondence between both measurement systems, except for the ankle power estimation. The root mean square (RMS) difference of the magnitude of the GRF over 10 evaluated trials was (0.012 0.001) N/N (mean standard deviation), being (1.1 0.1)% of the maximal GRF magnitude. It should be noted that the forces, moments, and powers are normalized with respect to body weight. The CoP estimation using both methods shows good correspondence, as indicated by the RMS difference of (5.1 0.7) mm, corresponding to (1.7 0.3)% of the length of the shoe. The RMS difference between the magnitudes of the heel position estimates was calculated as (18 6) mm, being (1.4 0.5)% of the maximal magnitude. The ankle moment RMS difference was (0.004 0.001) Nm/N, being (2.3 0.5)% of the maximal magnitude. Finally, the RMS difference of the estimated power at the ankle was (0.02 0.005) W/N, being (14 5)% of the maximal power. This power difference is caused by an inaccurate estimation of the angular velocities using the optical reference measurement system, which is due to considering the foot as a single segment. The ambulatory system considers separate heel and forefoot segments, thus allowing an additional foot moment and power to be estimated. Based on the results of this research, it is concluded that the combination of the instrumented shoe and inertial sensing is a promising tool for the assessment of the dynamics of foot and ankle in an ambulatory setting.

In previous applications of the finite element method in modeling mechanical behavior of skeletal muscle, the passive and active properties of muscle tissue were lumped in one finite element. Although this approach yields increased understanding of effects of force transmission, it does not support an assessment of the interaction between the intracellular structures and extracellular matrix. In the present study, skeletal muscle is considered in two domains: (1) the intracellular domain and (2) extracellular matrix domain. The two domains are represented by two separate meshes that are linked elastically to account for the trans-sarcolemmal attachments of the muscle fibers' cytoskeleton and extracellular matrix. With this approach a finite element skeletal muscle model is developed, which allows force transmission between these domains with the possibility of investigating their interaction as well as the role of the trans-sarcolemmal systems. The model is applied to show the significance of myofascial force transmission by investigating possible mechanical consequences due to any missing link within the trans-sarcolemmal connections such as found in muscular dystrophies. This is realized by making the links between the two meshes highly compliant at selected intramuscular locations. The results indicate the role of extracellular matrix for a muscle in sustaining its physiological condition. It is shown that if there is an inadequate linking to the extracellular matrix, the myofibers become deformed beyond physiological limits due to the lacking of mechanical support and impairment of a pathway of force transmission by the extracellular matrix. This leads to calculation of a drop of muscle force and if the impairment is located more towards the center of the muscle model, its effects are more pronounced. These results indicate the significance of non-myotendinous force transmission pathways.

When analyzing complex biomechanical problems such as predicting the effects of orthopedic surgery, subject-specific musculoskeletal models are essential to achieve reliable predictions. The aim of this paper is to present the Twente Lower Extremity Model 2.0, a new comprehensive dataset of the musculoskeletal geometry of the lower extremity, which is based on medical imaging data and dissection performed on the right lower extremity of a fresh male cadaver. Bone, muscle and subcutaneous fat (including skin) volumes were segmented from computed tomography and magnetic resonance images scans. Inertial parameters were estimated from the image-based segmented volumes. A complete cadaver dissection was performed, in which bony landmarks, attachments sites and lines-of-action of 55 muscle actuators and 12 ligaments, bony wrapping surfaces, and joint geometry were measured. The obtained musculoskeletal geometry dataset was finally implemented in the AnyBody Modeling System (AnyBody Technology A/S, Aalborg, Denmark), resulting in a model consisting of 12 segments, 11 joints and 21 degrees of freedom, and including 166 muscle-tendon elements for each leg. The new TLEM 2.0 dataset was purposely built to be easily combined with novel image-based scaling techniques, such as bone surface morphing, muscle volume registration and muscle-tendon path identification, in order to obtain subject-specific musculoskeletal models in a quick and accurate way. The complete dataset, including CT and MRI scans and segmented volume and surfaces, is made available at http://www.utwente.nl/ctw/bw/research/projects/TLEMsafe for the biomechanical community, in order to accelerate the development and adoption of subject-specific models on large scale. TLEM 2.0 is freely shared for non-commercial use only, under acceptance of the TLEMsafe Research License Agreement.

Walking is a constrained movement which may best be observed during the double stance phase when both feet contact the floor. When analyzing a measured movement with an inverse dynamics model, a violation of these constraints will always occur due to measuring errors and deviations of the segments model from reality, leading to inconsistent results. Consistency is obtained by implementing the constraints into the model. This makes it possible to combine the inverse dynamics model with optimization techniques in order to predict walking patterns or to reconstruct non-measured rotations when only a part of the three-dimensional joint rotations is measured. In this paper the outlines of the extended inverse dynamics method are presented, the constraints which define walking are defined and the optimization procedure is described. The model is applied to analyze a normal walking pattern of which only the hip, knee and ankle flexions/extensions are measured. This input movement is reconstructed to a kinematically and dynamically consistent three-dimensional movement, and the joint forces (including the ground reaction forces) and joint moments of force, needed to bring about this movement are estimated.

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