The aim of this study was twofold: first, to determine which muscles and ligaments resist the adduction moment at the knee during normal walking; and second, to describe and explain the contributions of muscles, ligaments, and the ground reaction force to medial and lateral compartment loading. Muscle forces, ground reaction forces, and joint motions obtained from a dynamic optimization solution for normal walking were used as input to a three-dimensional model of the lower limb. A static equilibrium problem was solved at each instant of the gait cycle to determine tibiofemoral joint loading at the knee. Medial compartment loading was determined mainly by the orientation of the ground reaction force. Because this force vector passed medial to the knee, it applied an adduction moment about the joint during stance. In contrast, all of the force transmitted by the lateral compartment was due to muscle and ligament action. The muscles that contributed most to support and forward propulsion during normal walking (quadriceps and gastrocnemius) also contributed most to knee stability in the frontal plane. The knee ligaments, particularly those of the posterior lateral corner, provided stability to the knee at certain periods of the stance phase, when activity of the important stabilizing muscles was low. ß

The pattern of ACL force in drop-landing cannot be explained by the anterior pull of the quadriceps force alone.

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Knee-ligament loading during the stance phase of gait is explained by the pattern of anterior shear force applied to the leg. The distribution of force at the tibiofemoral joint is determined by the variation in the external adductor moment applied at the knee. The forces acting at the tibiofemoral and patellofemoral joints are similar during normal and ACL-deficient gait. Hamstrings facilitation is more effective than quadriceps avoidance in reducing ATT during ACL-deficient gait.

Treatment of medial compartment knee osteoarthritis with high tibial osteotomy can produce an unintended change in the slope of the tibial plateau in the sagittal plane. The effect of changing posterior tibial slope (PTS) on cruciate ligament forces has not been quantified for knee loading in activities of daily living. The purpose of this study was to determine how changes in PTS affect tibial shear force, anterior tibial translation (ATT), and knee-ligament loading during daily physical activity. We hypothesized that tibial shear force, ATT, and ACL force all increase as PTS increases. A previously validated computer model was used to calculate ATT, tibial shear force, and cruciateligament forces for the normal knee during three common load-bearing tasks: standing, squatting, and walking. The model calculations were repeated with PTS altered in 18 increments up to a maximum change in tibial slope of 108. Tibial shear force and ATT increased as PTS was increased. For standing and walking, ACL force increased as tibial slope was increased; for squatting, PCL force decreased as tibial slope was increased. The effect of changing PTS on ACL force was greatest for walking. The true effect of changing tibial slope on knee-joint biomechanics may only be evident under physiologic loading conditions which include muscle forces. ß

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