The Effects of External Loads and Muscle Forces on the Knee Joint Ligaments during Walking: A Musculoskeletal Model Study

Abstract

A musculoskeletal model was developed to analyze the tensions of the knee joint ligaments during walking and to understand how they change with changes in the muscle forces. The model included the femur, tibia, patella and all components of cruciate and collateral ligaments, quadriceps, hamstrings and gastrocnemius muscles. Inputs to the model were the muscle forces, estimated by a static optimization approach, the external loads (ground reaction forces and moments) and the knee flexion/extension movement corresponding to natural walking. The remaining rotational and translational movements were obtained as a result of the dynamic equilibrium of forces. The validation of the model was done by comparing our results with literature data. Several simulations were carried out by sequentially removing the forces of the different muscle groups. Deactivation of the quadriceps produced a decrease of tension in the anterior cruciate ligament (ACL) and an increase in the posterior cruciate ligament (PCL). By removing the hamstrings, the tension of ACL increased at the late swing phase, while the PCL force dropped to zero. Specific effects were observed also at the medial and lateral collateral ligaments. The removal of gastrocnemius muscles produced an increase of tension only on PCL and lateral collateral ligaments. These results demonstrate how musculoskeletal models can contribute to knowledge about complex biomechanical systems as the knee joint.

Immediate Effect of Restricted Knee Extension on Ground Reaction Force and Trunk Acceleration during Walking

“…Knee osteoarthropathy (OA) is a major disease that causes knee joint contracture, joint stiffness, and decrease in knee extensor muscle strength [ 14 , 15 ]. Ground reaction force (GRF) during walking and muscle forces affect the external load on the knee [ 16 ], increasing mechanical stress on the knee in patients with knee OA. In addition to knee OA flexion contracture, knee adduction moment at the gait stance phase is increased by varus malalignment, resulting in lateral thrust.…”

The effect of modelling parameters in the development and validation of knee joint models on ligament mechanics: A systematic review

“…According to the quality assessment results presented in Table 2 , several articles had limited modelling technique descriptions [ 15 , 16 , 19 , 20 , 27 , 33 ] and validation methods [ 16 , 18 , 25 , 27 , 35 , 37 , 38 ]. In 12 of the selected studies [ 14 – 17 , 20 , 24 – 27 , 31 , 37 , 38 ], the sensitivity of the model outputs on ligament model parameters has not been assessed. In one study [ 26 ], findings were not fully supported by the literature.…”

“…A range of musculoskeletal modelling software packages has been used across the selected studies ( Fig 2A and Table 3 ). 14 studies [ 15 – 17 , 20 – 25 , 27 , 29 , 32 , 34 , 35 ] used OpenSim [ 39 ], four studies [ 18 , 36 – 38 ] used SIMM [ 40 ], two studies [ 26 , 28 ] used AnyBody Modelling System (AnyBody Technology, Aalborg, Denmark), one study [ 30 ] used ADAMS [ 41 ], one study [ 14 ] used SimWise-4D platform (Design Simulation Technologies, DST, Canton, MI, USA), one study [ 19 ] used KneeSIM (LifeModeler Inc., San Clemente, CA), one study [ 33 ] used Musculoskeletal Joint Modeler [ 42 ], and one study [ 31 ] used Working Model 3D (Working Model 3D, MSC, Software Corp., Santa Ana, CA, USA).…”

“…Out of the 25 studies included, 20 studies were designed to simulate the intact knee joint [ 14 – 17 , 19 – 22 , 24 – 27 , 29 – 34 , 37 , 38 ], two studies modelled both intact and ACL-deficient knee [ 35 , 36 ], one study modelled the intact and PCL-deficient knees [ 28 ], one study modelled the ACL-reconstructed knee [ 18 ], and one study modelled the lateral extra-articular reconstructed knee [ 23 ] ( Fig 2B and Table 3 ). Nine studies modelled one leg [ 19 , 21 , 23 , 24 , 29 – 31 , 33 , 36 ], eight studies developed the whole-body models [ 15 , 16 , 20 , 22 , 26 – 28 , 34 ] and eight studies modelled the lower-body [ 14 , 17 , 18 , 25 , 32 , 35 , 37 , 38 ] ( Fig 2C and Table 3 ).…”

“…These models included geometry from 127 participants/patients’ knees and three cadaveric knees. Intact knee geometries were extracted fully or partially from segmented medical imaging (CT or MRI) of cadaveric specimens [ 25 , 26 , 30 ], participants [ 14 , 21 , 23 , 24 , 29 , 31 , 36 ], patients [ 18 , 22 ], saw bone [ 33 ] or by scaling the generic reference models based on anthropometric data of study participants [ 15 – 17 , 20 , 21 , 27 , 28 , 32 , 34 , 35 , 37 ] ( Fig 2D and Table 3 ). In the rest of the studies, the geometry was taken from available data in the literature [ 19 , 38 ].…”