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With the internal volar locking plate (VLP) technique emerging as a preferred surgical approach, early post-surgery therapeutic exercises have shown promise in promoting wrist functionality after distal radial fractures (DRFs). The biomechanical microenvironment, particularly the role of biomechanical stimuli, plays a crucial role in guiding stem tissue formation at the fracture site. However, much less is known about how various hand exercises interact with the microenvironment and influence fracture healing outcomes. This study employed the Leap Motion Controller for markerless hand motion capture and utilised an enhanced OpenSim hand model to simulate these motions. An advanced DRF healing model, integrating angiogenesis and the mechano-regulated maturation of callus tissue, was applied to simulate the MSCs differentiation and predict the healing outcomes. The effects of various rehabilitation exercises on DRFs' healing outcomes were systematically analysed. The results showed rehabilitation exercises, such as wrist extension/flexion and ulnar deviation, generally had a higher contact force on the distal radius compared with the slack state. Also, the relationship between contact force and muscle activations was not always linear, reflecting the intricate dynamics of the kinematic system. Exercise could induce changes in the bony bridge and cartilage formation, while angiogenesis remained unaffected. In the initial weeks, gripping exercises proved most beneficial, but as time progressed, extension and flexion exercises became more advantageous. The study highlights the importance of tailoring rehabilitation exercises to the dynamic healing process of DRFs. As the healing trajectory progresses, the therapeutic efficacy of specific exercises evolves, necessitating adaptive and patient-specific rehabilitation programs. [ABSTRACT FROM AUTHOR]

To determine the relationship between knee flexion excursion symmetry and lower extremity kinematics, kinetics, and muscle, joint, and ligament forces in females 1–3 years after ACL reconstruction. Cross-sectional. Laboratory. Twenty-one, college-aged females. Lower extremity kinetics and kinematics, including estimated muscle, tibiofemoral, and ligament forces were assessed using 3D motion analysis and a musculoskeletal modeling approach. Participants demonstrating greater than 10% asymmetry in knee flexion excursion were classified as landing with an "extended knee". Group and between-limb differences were compared. Ten participants were classified as landing with an "extended knee" on the involved limb, while eleven exhibited a symmetric landing pattern. Participants landing with an "extended knee" demonstrated reduced knee extension moment and quadriceps force in the involved limb (p < 0.05). These findings indicate that an "extended knee" landing pattern was associated with reduced knee extension moment and quadriceps muscle force in females 1–3 years after ACL reconstruction. This may represent an altered strategy that clinicians may choose to identify and address during rehabilitation. • Deficits in landing performance can persist up to three years following ACLR. • An "extended knee" landing may be a strategy associated with reduced quadriceps force. • This landing strategy may have implications to second ACL injury and osteoarthritis. [ABSTRACT FROM AUTHOR]

Glenohumeral biomechanics after rotator cuff (RC) tears have not been fully elucidated. This study aimed to investigate the muscle compensatory mechanism in weight-bearing shoulders with RC tears and asses the induced pathomechanics (i.e., glenohumeral translation, joint instability, center of force (CoF), joint reaction force). An experimental, glenohumeral simulator with muscle-mimicking cable system was used to simulate 30° scaption motion. Eight fresh-frozen shoulders were prepared and mounted in the simulator. Specimen-specific scapular anthropometry was used to test six RC tear types, with intact RC serving as the control, and three weight-bearing loads, with the non-weight-bearing condition serving as the control. Glenohumeral translation was calculated using instantaneous helical axis. CoF, muscle forces, and joint reaction forces were measured using force sensors integrated into the simulator. Linear mixed effects models (RC tear type and weight-bearing) with random effects (specimen and sex) were used to assess differences in glenohumeral biomechanics. RC tears did not change the glenohumeral translation (p > 0.05) but shifted the CoF superiorly (p ≤ 0.005). Glenohumeral translation and joint reaction forces increased with increasing weight bearing (p < 0.001). RC and deltoid muscle forces increased with the presence of RC tears (p ≤ 0.046) and increased weight bearing (p ≤ 0.042). The synergistic muscles compensated for the torn RC tendons, and the glenohumeral translation remained comparable to that for the intact RC tendons. However, in RC tears, the more superior CoF was close to where glenoid erosion occurs in RC tear patients with secondary osteoarthritis. These findings underscore the importance of early detection and precise management of RC tears. [ABSTRACT FROM AUTHOR]

Background: In order to reduce the development of hip osteoarthritis related to cam-type femoroacetabular impingement syndrome (FAIS), corrective surgery has evolved to become a safe and effective treatment. Although corrective surgery produces high level of patient satisfaction, it is still unclear how it affects muscle and hip contact forces during level walking.Research Question: The purpose was to compare the muscle force contributions and hip contact forces in patients before and after surgical correction for cam FAIS with healthy control (CTRL) individuals during level walking.Methods: Eleven male patients with symptomatic cam-type morphology, who underwent hip osteochondroplasty, had their level walking recorded pre- and at 2-year postoperatively. The patients were sex-, age-, BMI-matched to 11 CTRL individuals. Sagittal and frontal hip kinematics and kinetics were computed and, subsequently, muscle and hip contact forces were estimated using musculoskeletal modelling and static optimization.Results: Patient-reported outcomes improved postoperatively. The pre- and postoperative FAIS walked slower and with shorter steps than the CTRL. Postoperative biceps femoris (CTRL: 0.35 ± 0.13 N/BW; pre-op: 0.28 ± 0.11 N/BW; post-op: 0.20 ± 0.07 N/BW) and semimembranosus forces (CTRL: 0.77 ± 0.24 N/BW; pre-op: 0.66 ± 0.24 N/BW; post-op: 0.41 ± 0.14 N/BW) were lower at ipsilateral foot-strike. Postoperative rectus femoris force (CTRL: 1.73 ± 0.35 N/BW; pre-op: 1.44 ± 0.24 N/BW; post-op: 1.18 ± 0.23 N/BW) was lower than the other two groups, and the pre- and postoperative FAIS had lower iliacus (CTRL: 1.17 ± 0.18 N/BW; pre-op: 0.93 ± 0.16 N/BW; post-op: 0.94 ± 0.21 N/BW) and psoas (CTRL: 1.55 ± 0.24 N/BW; pre-op: 1.14 ± 0.38 N/BW; post-op: 1.10 ± 0.46 N/BW) muscle forces at contralateral foot-strike compared with the CTRL. Pre- and postoperative FAIS demonstrated lower peak hip contact loading resultant than the CTRL.Significance: The altered gait parameters observed in the preoperative FAIS was not restored after surgery, and was still away from the CTRL. It is possible that the reduced dynamic muscle forces of the biceps femoris, semimembranosus and rectus femoris postoperatively were associated with the protected mechanism that involved the iliopsoas preoperatively. This is an indication that the gait adaptations affected by the FAIS do not restore to normal after surgical correction at the 2-years follow-up. [ABSTRACT FROM AUTHOR]

This study developed a new framework by correlating the clinical measurements in vivo with numerical modeling in silico at different time points for quantifying the magnitudes and directions of oral muscle forces. The human masticatory system has received significant attention in the areas of biomechanics due to its sophisticated co-activation of a group of masticatory muscles which contribute to the fundamental oral functions. However, determination of each muscular force remains fairly challenging in vivo ; the conventional data available may be inapplicable to patients who experience major oral interventions such as maxillofacial reconstruction, in which the resultant unsymmetrical anatomical structure invokes a more complex stomatognathic functioning system. Therefore, this study aimed to (1) establish an inverse identification procedure by incorporating the sequential Kriging optimization (SKO) algorithm, coupled with the patient-specific finite element analysis (FEA) in silico and occlusal force measurements at different time points over a course of rehabilitation in vivo ; and (2) evaluate muscular functionality for a patient with mandibular reconstruction using a fibula free flap (FFF) procedure. The results from this study proved the hypothesis that the proposed method is of certain statistical advantage of utilizing occlusal force measurements, compared to the traditionally adopted optimality criteria approaches that are basically driven by minimizing the energy consumption of muscle systems engaged. Therefore, it is speculated that mastication may not be optimally controlled, in particular for maxillofacially reconstructed patients. For the abnormal muscular system in the patient with orofacial reconstruction, the study shows that in general, the magnitude of muscle forces fluctuates over the 28-month rehabilitation period regardless of the decreasing trend of the maximum muscular capacity. Such finding implies that the reduction of the masticatory muscle activities on the resection side might lead to non-physiological oral biomechanical responses, which can change the muscular activities for stabilizing the reconstructed mandible. [ABSTRACT FROM AUTHOR]

Abstract Concurrent multiscale simulation strategies are required in computational biomechanics to study the interdependence between body scales. However, detailed finite element models rarely include muscle recruitment due to the computational burden of both the finite element method and the optimization strategies widely used to estimate muscle forces. The aim of this study was twofold: first, to develop a computationally efficient muscle force prediction strategy based on proportional-integral-derivative (PID) controllers to track gait and chair rise experimental joint motion with a finite element musculoskeletal model of the lower limb, including a deformable knee representation with 12 degrees of freedom; and, second, to demonstrate that the inclusion of joint-level deformability affects muscle force estimation by using two different knee models and comparing muscle forces between the two solutions. The PID control strategy tracked experimental hip, knee, and ankle flexion/extension with root mean square errors below 1°, and estimated muscle, contact and ligament forces in good agreement with previous results and electromyography signals. Differences up to 11% and 20% in the vasti and biceps femoris forces, respectively, were observed between the two knee models, which might be attributed to a combination of differing joint contact geometry, ligament behavior, joint kinematics, and muscle moment arms. The tracking strategy developed in this study addressed the inevitable tradeoff between computational cost and model detail in musculoskeletal simulations and can be used with finite element musculoskeletal models to efficiently estimate the interdependence between muscle forces and tissue deformation. [ABSTRACT FROM AUTHOR]

Recent developments in musculoskeletal (MS) modeling have been geared towards model customization. Personalization of the spine profile could affect estimates of spinal loading and stability, particularly in the upright standing posture where large inter-subject variations in the lumbar lordosis have been reported. This study investigates the biomechanical consequences of changes in the spinal profile. In 31 participants (healthy and with back pain), (1) the spine external profile was measured, (2) submaximal contractions were recorded in a dynamometer to calibrate the EMG-driven MS model and finally (3) static lifting in the upright standing challenging spine stability while altering load position and magnitude were considered. EMG signals of 12 trunk muscles and angular kinematics of 17 segments were recorded. For each participant, the MS model was constructed using either a generic or a personalized spinal profile and 17 biomechanical outcomes were computed, including individual muscle forces, ratios of muscle group forces, spinal loading and stability parameters. According to the ANOVA results and corresponding effect sizes, personalizing the spine profile induced medium and large effects on about half MS model outcomes related to the trunk muscle forces and negligible to small effects on spinal loading and stability as more aggregate outcomes. These effects are explained by personalized spine profiles that were a little more in extension as well as more pronounced spine curvatures (lordosis and kyphosis). These findings suggest that spine profile personalization should be considered in MS spine modeling as it may impact muscle force prediction and spinal loading. [ABSTRACT FROM AUTHOR]

Abstract Previous in-vivo studies suggest that the ratio of total lumbar rotation over pelvic rotation (lumbo-pelvic rhythm) during trunk sagittal movement is essential to evaluate spinal loads and discriminate between low back pain and asymptomatic population. Similarly, there is also evidence that the lumbo-pelvic rhythm is key for evaluation of realistic muscle and joint reaction forces and moments predicted by various computational musculoskeletal models. This study investigated the effects of three lumbo-pelvic rhythms defined based on in-vivo measurements on the spinal response during moderate forward flexion (60°) using a combined approach of musculoskeletal modeling of the upper body and finite element model of the lumbosacral spine. The muscle forces and joint loads predicted by the musculoskeletal model, together with the gravitational forces, were applied to the finite element model to compute the disc force and moment, intradiscal pressure, annular fibers strain, and load-sharing. The results revealed that a rhythm with high pelvic rotation and low lumbar flexion involves more global muscles and increases the role of the disc in resisting spinal loads, while its counterpart, with low pelvic rotation, recruits more local muscles and engages the ligaments to lower the disc loads. On the other hand, a normal rhythm that has balanced pelvic and lumbar rotations yields almost equal disc and ligament load-sharing and results in more balanced synergy between global and local muscles. The lumbo-pelvic rhythm has less effect on the intradiscal pressure and annular fibers strain. This work demonstrated that the spinal response during forward flexion is highly dependent on the lumbo-pelvic rhythm. It is therefore, essential to adapt this parameter instead of using the default values in musculoskeletal models for accurate prediction of muscle forces and joint reaction forces and moments. The findings provided by this work are expected to improve knowledge of spinal response during forward flexion, and are clinically relevant towards low back pain treatment and disc injury prevention. [ABSTRACT FROM AUTHOR]

Abstract Background Rotator cuff tears in older individuals may result in decreased muscle forces and changes to force distribution across the glenohumeral joint. Reduced muscle forces may impact functional task performance, altering glenohumeral joint contact forces, potentially contributing to instability or joint damage risk. Our objective was to evaluate the influence of rotator cuff muscle force distribution on glenohumeral joint contact force during functional pull and axilla wash tasks using individualized computational models. Methods Fourteen older individuals (age 63.4 yrs. (SD 1.8)) were studied; 7 with rotator cuff tear, 7 matched controls. Muscle volume measurements were used to scale a nominal upper limb model's muscle forces to develop individualized models and perform dynamic simulations of movement tracking participant-derived kinematics. Peak resultant glenohumeral joint contact force, and direction and magnitude of force components were compared between groups using ANCOVA. Findings Results show individualized muscle force distributions for rotator cuff tear participants had reduced peak resultant joint contact force for pull and axilla wash (P ≤ 0.0456), with smaller compressive components of peak resultant force for pull (P = 0.0248). Peak forces for pull were within the glenoid. For axilla wash, peak joint contact was directed near/outside the glenoid rim for three participants; predictions required individualized muscle forces since nominal muscle forces did not affect joint force location. Interpretation Older adults with rotator cuff tear had smaller peak resultant and compressive forces, possibly indicating increased instability or secondary joint damage risk. Outcomes suggest predicted joint contact force following rotator cuff tear is sensitive to including individualized muscle forces. Highlights • Rotator cuff tears result in reduced compression and peak joint contact force. • Rotator cuff muscle distribution affects glenohumeral joint contact force. • Joint contact forces after rotator cuff tear may increase secondary injury risk. • Individualized computational models enable more relevant joint force predictions. [ABSTRACT FROM AUTHOR]

Abstract There is a clear relationship between lumbar spine loading and back musculoskeletal disorders in manual materials handling. The incidence of back disorders is greater in women than men, and for similar work demands females are functioning closer to their physiological limit. It is crucial to study loading on the spine musculoskeletal system with actual handlers, including females, to better understand the risk of back disorders. Extrapolation from biomechanical studies conducted on unexperienced subjects (mainly males) might not be applicable to actual female workers. For male workers, expertise changes the lumbar spine flexion, passive spine resistance, and active/passive muscle forces. However, experienced females select similar postures to those of novices when spine loading is critical. This study proposes that the techniques adopted by male experts, male novices, and females (with considerable experience but not categorized as experts) impact their lumbar spine musculoskeletal systems differently. Spinal loads, muscle forces, and passive resistance (muscle and ligamentous spine) were predicted by a multi-joint EMG-assisted optimization musculoskeletal model of the lumbar spine. Expert males flexed their lumbar spine less (avg. 21.9° vs 30.3–31.7°) and showed decreased passive internal moments (muscle avg. 8.9% vs 15.9–16.0%; spine avg. 4.7% vs 7.1–7.8%) and increased active internal moments (avg. 72.9% vs 62.0–63.9%), thus producing a different impact on their lumbar spine musculoskeletal systems. Experienced females sustained the highest relative spine loads (compression avg. 7.3 N/BW vs 6.2–6.4 N/BW; shear avg. 2.3 N/BW vs 1.7–1.8 N/BW) in addition to passive muscle and ligamentous spine resistance similar to novices. Combined with smaller body size, less strength, and the sequential lifting technique used by females, this could potentially mean greater risk of back injury. Workers should be trained early to limit excessive and repetitive stretching of their lumbar spine passive tissues. [ABSTRACT FROM AUTHOR]

Abstract A reliable evaluation of muscle forces in the human body is highly desirable for several applications in both clinical and research contexts. Several models of muscle force distribution based on non-invasive measurements have been proposed since 1836 (Weber and Weber, 1836), amongst which Crowninshield's model (Crowninshield and Brand, 1981), which maximizes a cost-function representing the muscle fiber endurance, is the most popular. It is worth noting that Crowninshield's model is the most widely adopted notwithstanding its major limitations of physiological coherence. Forster et al. (2004) pointed out that "these (conventional) criteria however do not predict co-contraction adequately". Besides, electromyographic (EMG)-driven models have been proposed to assess individual muscle forces, which have not been broadly adopted due to their complexity and the need for a calibration before each test. In this context, a cost function based on kinematic and electromyographic data could provide the advantage of being physiologically more coherent with muscle activations compared to conventional cost-functions based on kinematics solely, and easier to use than the EMG-driven models. The objective of this study is to propose the first cost-function based on kinematics and electromyographic data to quantify muscle forces. When applying this new cost-function on a database of upper limb motions data of 17 subjects, healthy or with cerebral palsy, the muscle force prediction of the proposed model was 17.74% more coherent with the EMG pattern than the prediction of Crowninshield's model. And on average, these results were more consistent whether the subjects were healthy or with cerebral palsy. In conclusion, we propose this cost-function for the quantification of muscle forces. [ABSTRACT FROM AUTHOR]

The abductor pollicis longus (APL) is one of the primary radial deviators of the wrist, owing to its insertion at the base of the first metacarpal and its large moment arm about the radioulnar deviation axis. Although it plays a vital role in surgical reconstructions of the wrist and hand, it is often neglected while simulating wrist motions in vitro . The aim of this study was to observe the effects of the absence of APL on the distribution of muscle forces during wrist motions. A validated physiological wrist simulator was used to replicate cyclic planar and complex wrist motions in cadaveric specimens by applying tensile loads to six wrist muscles – flexor carpi radialis (FCR), flexor carpi ulnaris, extensor carpi radialis longus (ECRL), extensor carpi radialis brevis, extensor carpi ulnaris (ECU) and APL. Resultant muscle forces for active wrist motions with and without actuating the APL were compared. The absence of APL resulted in higher forces in FCR and ECRL – the synergists of APL – and lower forces in ECU – the antagonist of APL. The altered distribution of wrist muscle forces observed in the absence of active APL control could significantly alter the efficacy of in vitro experiments conducted on wrist simulators, in particular when investigating those surgical reconstructions or rehabilitation of the wrist heavily reliant on the APL, such as treatments for basal thumb osteoarthritis. [ABSTRACT FROM AUTHOR]

Surface EMG is a non-invasive measurement of an individual muscle activity and it can be used as the indirect form of a simulated muscle forces validation. The quantitative curves comparison has some potential, which has not been fully exploited yet [13] . The purpose of current study was to quantitatively compare muscle forces predicted using musculoskeletal models to measured surface electromyography signals. A metrics based on correlation and an electromechanical delay correction for a quantitative trend validation has been proposed. Kinematics of a normal gait was collected for three healthy subjects together with ground reaction forces and EMG signals of eight different muscles of both legs. Dynamic simulations have been performed for two models of differing complexity from OpenSim library (Gait2392 and Gait2354) [2,5,6] , static optimization method and computed muscle control algorithm [20] have been used. It has been shown, that the level of force-EMG trend compliance, obtained for applied models and simulation techniques, is related rather to the selected muscle than to applied optimization criteria or technique. The contribution of analyzed muscles during gait has been predicted better by complex model than by simplified model. Moreover relationship between the body proportion of subject and the degree of correlation has been observed. Proposed metrics and obtained results can be the basis for further identification of cost functions, which could most closely describe motor control strategy. [ABSTRACT FROM AUTHOR]

To reduce lifting and associated low back injuries, manual material handling operations often involve pulling-pushing of carts at different weights, orientations, and heights. The loads on spine and risk of injury however need to be investigated. The aim of this study was to evaluate muscle forces, spinal loads and trunk stability in pull–push tasks in sagittal-symmetric, static upright standing posture. Three hand-held load magnitudes (80, 120 and 160 N) at four elevations (0, 20, 40 and 60 cm to the L5-S1) and 24 force directions covering all pull/push orientations were considered. For this purpose, a musculoskeletal finite element model with kinematics measured earlier were used. Results demonstrated that peak spinal forces occur under inclined pull (lift) at upper elevations but inclined push at the lowermost one. Minimal spinal loads, on the other hand, occurred at and around vertical pull directions. Overall, spinal forces closely followed variations in the net external moment of pull–push forces at the L5-S1. Local lumbar muscles were most active in pulls while global extensor muscles in lifts. The trunk stability margin decreased with load elevation except at and around horizontal push; it peaked under pulls and reached minimum at vertical lifts. It also increased with antagonist activity in muscles and intra-abdominal pressure. Results provide insight into the marked effects of variation in the load orientation and elevation on muscle forces, spinal loads and trunk stability and hence offer help in rehabilitation, performance enhancement training and design of safer workplaces. [ABSTRACT FROM AUTHOR]

Computational methods to estimate muscle forces during walking are becoming more common in biomechanical research but not yet in clinical gait analysis. This systematic review aims to identify the current state-of-the-art, examine the differences between approaches, and consider applicability of the current approaches in clinical gait analysis. A systematic database search identified studies including estimated muscle force profiles of the lower limb during healthy walking. These were rated for quality and the muscle force profiles digitised for comparison. From 13.449 identified studies, 22 were finally included which used four modelling approaches: static optimisation, enhanced static optimisation, forward dynamics and EMG-driven. These used a range of different musculoskeletal models, muscle-tendon characteristics and cost functions. There is visually broad agreement between and within approaches about when muscles are active throughout the gait cycle. There remain, considerable differences (CV 7%-151%, range of timing of peak forces in gait cycle 1%-31%) in patterns and magnitudes of force between and within modelling approaches. The main source of this variability is not clear. Different musculoskeletal models, experimental protocols, and modelling approaches will clearly have an effect as will the variability of joint kinetics between healthy individuals. Limited validation of modelling approaches, particularly at the level of individual participants, makes it difficult to conclude if any of the approaches give consistently better estimates than others. While muscle force modelling has clear potential to enhance clinical gait analyses future research is needed to improve validation, accuracy and feasibility of implementation in clinical practice. [ABSTRACT FROM AUTHOR]

The choice of the cost-function for predicting muscle forces during a movement remains a challenge, especially in patients with neuromuscular disorders. Forward dynamics-based optimisations mainly track joint kinematics or torques, combined with a least-excitation criterion. Tracking marker trajectories and/or electromyography (EMG) has rarely been proposed. Our objective was to determine the best tracking objective-function to accurately predict the upper-limb muscle forces. A musculoskeletal model was created and EMG was simulated to obtain a reference movement – a shoulder abduction. A Gaussian noise (mean = 0; standard deviation = 15%) was added to the simulated EMG. Another noise – corresponding to the actual soft tissue artefacts (STA) of experimental shoulder abduction movements – was added to the trajectories of the markers placed on the model. Muscle forces were estimated from these noisy data, using forward dynamics assisted by six non-linear least-squared objective-functions. These functions involved the tracking of marker trajectories, joint angles or torques, with and without EMG-tracking. All six approaches used the same musculoskeletal model and were solved using a direct multiple shooting algorithm. Finally, the predicted joint angles, muscle forces and activations were compared to the reference values, using root-mean-square errors (RMSe) and biases. The force RMSe of the approach tracking both marker trajectories and EMG (18.45 ± 12.60 N) was almost five times lower than the one of the approach tracking only joint angles (82.37 ± 66.26 N) or torques (85.10 ± 116.40 N). Therefore, using EMG as a complementary tracking-data in forward dynamics seems to be promising for the estimation of muscle forces. [ABSTRACT FROM AUTHOR]

Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces. [ABSTRACT FROM AUTHOR]

The study aims to investigate the effects of different loads and speed during running on inter- and intra-individual muscle force amplitudes, variabilities and coordination patterns. Nine healthy participants ran on an instrumentalized treadmill with an empty weight vest at two velocities (2.6 m/s and 3.3 m/s) or while carrying three different loads (4.5, 9.1, 13.6 kg) at 2.6 m/s while kinematics and kinetics were synchronously recorded. The major lower limb muscle forces were estimated using a musculoskeletal model. Muscle force amplitudes and variability, as well as coordination patterns were compared at the group and at the individual level using respectively statistical parametric mapping and covariance matrices combined with multidimensional scaling. Increasing the speed or the load during running increased most of the muscle force amplitudes (p < 0.01). During the propulsion phase, increasing the load increased muscle force variabilities around the ankle joint (modification of standard deviation up to 5% of body weight (BW), p < 0.05) while increasing the speed decreased variability for almost all the muscle forces (up to 10% of BW, p < 0.05). Each runner has a specific muscle force coordination pattern signature regardless of the different experimental conditions (p < 0.05). Yet, this individual pattern was slightly adapted in response to a change of speed or load (p < 0.05). Our results suggest that adding load increases the amplitude and variability of muscle force, but an increase in running speed decreases the variability. These findings may help improve the design of military or trail running training programs and injury rehabilitation by progressively increasing the mechanical load on anatomical structures. [ABSTRACT FROM AUTHOR]

Inverse dynamic musculoskeletal human body models are commonly used to predict the spinal loads and trunk muscle forces. These models include rigid body segments, mechanical joints, active and passive structural components such as muscles, tendons and ligaments. Several studies used simple definition of lumbar spinal discs idealized as spherical joints with infinite translational stiffness. The aim of the current sensitivity study was to investigate the influence of disc translational stiffness (shear and compressive stiffness) on the joint kinematics and forces in intervertebral discs (L1−L5), trunk muscles and ligaments for an intermediately flexed position (55°). Based on in vitro data, a range of disc shear stiffness (100−200 N/mm) and compressive stiffness (1900−2700 N/mm) was considered in the model using the technique of force dependent kinematics (FDK). Range of variation in spinal loads, trunk muscle forces and ligaments forces were calculated (with & without load in hands) and compared with the results of reference model (RM) having infinite translational stiffness. The discs’ centers of rotation (CoR) were computed for L3−L4 and L4−L5 motion segments. Between RM and FDK models, maximum differences in compressive forces were 7% (L1−L2 & L2−L3), 8% (L3−L4) and 6% (L4−L5) whereas in shear forces 35% (L1−L2), 47% (L2−L3), 45% (L3−L4) and more than 100% in L4−L5. Maximum differences in the sum of global and local muscle forces were approximately 10%, whereas in ligament forces were 27% (supraspinous), 40% (interspinous), 56% (intertransverse), 58% (lig. flavum) and 100% (lig. posterior). The CoRs were predicted posteriorly, below (L3−L4) and in the disc (L4−L5). FDK model predicted lower spinal loads, ligament forces and varied distribution of global and local muscle forces. Consideration of translational stiffnesses influenced the model results and showed increased differences with lower stiffness values. [ABSTRACT FROM AUTHOR]

Although the orientations of the hand and forearm vary for different wrist rehabilitation protocols, their effect on muscle forces has not been quantified. Physiologic simulators enable a biomechanical evaluation of the joint by recreating functional motions in cadaveric specimens. Control strategies used to actuate joints in physiologic simulators usually employ position or force feedback alone to achieve optimum load distribution across the muscles. After successful tests on a phantom limb, unique combinations of position and force feedback – hybrid control and cascade control – were used to simulate multiple cyclic wrist motions of flexion-extension, radioulnar deviation, dart thrower’s motion, and circumduction using six muscles in ten cadaveric specimens. Low kinematic errors and coefficients of variation of muscle forces were observed for planar and complex wrist motions using both novel control strategies. The effect of gravity was most pronounced when the hand was in the horizontal orientation, resulting in higher extensor forces ( p < 0.017) and higher out-of-plane kinematic errors ( p < 0.007), as compared to the vertically upward or downward orientations. Muscle forces were also affected by the direction of rotation during circumduction. The peak force of flexor carpi radialis was higher in clockwise circumduction ( p = 0.017), while that of flexor carpi ulnaris was higher in anticlockwise circumduction ( p = 0.013). Thus, the physiologic wrist simulator accurately replicated cyclic planar and complex motions in cadaveric specimens. Moreover, the dependence of muscle forces on the hand orientation and the direction of circumduction could be vital in the specification of such parameters during wrist rehabilitation. [ABSTRACT FROM AUTHOR]

An essential input to the musculoskeletal (MS) trunk models that estimate muscle and spine forces is kinematics of the thorax, pelvis, and lumbar vertebrae. While thorax and pelvis kinematics are usually measured via skin motion capture devices (with inherent errors on the proper identification of the underlying bony landmarks and the relative skin-sensor-bone movements), those of the intervening lumbar vertebrae are commonly approximated at fixed proportions based on the thorax-pelvis kinematics. This study proposes an image-based kinematics measurement approach to drive subject-specific (musculature, geometry, mass, and center of masses) MS models. Kinematics of the thorax, pelvis, and individual lumbar vertebrae as well as disc inclinations, gravity loading, and musculature were all measured via different imaging techniques. The model estimated muscle and lumbar forces in various upright and flexed postures in which kinematics were obtained using upright fluoroscopy via 2D/3D image registration. Predictions of this novel image-kinematics-driven model (Img-KD) were compared with those of the traditional kinematics-driven (T-KD) model in which individual lumbar vertebral rotations were assumed based on thorax-pelvis orientations. Results indicated that while differences between Img-KD and T-KD models remained small for the force in the global muscles (attached to the thoracic cage) (<15%), L4-S1 compression (<15%), and shear (<20%) forces in average for all the simulated tasks, they were relatively larger for the force in the local muscles (attached to the lumbar vertebrae). Assuming that the skin-based measurements of thorax and pelvis kinematics are accurate enough, the T-KD model predictions of spinal forces remain reliable. [ABSTRACT FROM AUTHOR]

• A patient specific FE model of the hemipelvis was developed. • The influences of the muscle force contribution and loading cycle discretization on the predicted micromotion and interfacial bone strains were investigated. • The acetabular cup micromotion and interfacial bone strains can be predicted just using the joint contact force. • The gait cycle needs to be adequately discretised to capture the micromotion at the bone-implant interface. The aim of this study was to investigate the influence of the muscle force contribution and loading cycle discretization on the predicted micromotion and interfacial bone strains in the implanted acetabulum. To this end, a patient specific finite element model of the hemipelvis was developed, based on the CT-scan and gait analysis results, collected as part of the authors' previous work. Outcomes of this study suggests that the acetabular cup micromotion and interfacial bone strains can be predicted just using the joint contact force. This helps to reduce the complexity of the finite element models by ignoring the contribution of muscle forces and the associated challenges of mapping these forces to the pelvis. However, the gait cycle needs to be adequately discretised to capture the micromotion at the bone-implant interface. The Dalstra load case, which includes muscle forces, has been widely adopted in the literature for studying the mechanical environment in the intact and implanted acetabulum. To simplify the modelling approach, some researchers ignore the contribution of muscle forces. The Dalstra load case is also divided into eight separate load steps (five in the stance phase and three in the swing phase), however, it is unclear whether this adequately captures the micromotions, for a cementless acetabular cup, during a simulated activity. The aim of this study was to investigate the influence of the muscle force contribution and loading cycle discretization on the predicted micromotion and interfacial bone strains. In this work, a patient specific finite element model of the hemipelvis was developed, based on the CT-scan and gait analysis results, collected as part of the authors' previous work. Finite element simulations were performed using the joint contact and muscle forces derived from two sources. The first approach was used the load case proposed by Dalstra et al. The second approach used joint contact and muscle forces predicted by a musculoskeletal model. Additionally, the musculoskeletal load case was discretised into 50 equal load steps and the results compared with the equivalent Dalstra load steps. The results showed that the contribution of the muscle forces resulted in minor differences in both the magnitude and distribution of the predicted acetabular micromotion (up to 4.01% in the mean acetabular micromotion) and interfacial bone strains (up to 10.34% in the mean interfacial bone strains). The degree of gait cycle discretisation had a significant influence on the acetabular micromotion with a difference of 20.89% in the mean acetabular micromotion. Outcomes of this study suggests that the acetabular cup micromotion and interfacial bone strains can be predicted just using the joint contact force. This helps to reduce the complexity of the finite element models by ignoring the contribution of muscle forces and the associated challenges of mapping these forces to the pelvis. However, the gait cycle needs to be adequately discretised to capture the micromotion at the bone-implant interface. [ABSTRACT FROM AUTHOR]

The presence of muscle redundancy and co-activation of agonist–antagonist pairs in vivo makes the optimization of the load distribution between muscles in physiologic joint simulators vital. This optimization is usually achieved by employing different control strategies based on position and/or force feedback. A muscle activated physiologic wrist simulator was developed to test and iteratively refine such control strategies on a functional replica of a human arm. Motions of the wrist were recreated by applying tensile loads using electromechanical actuators. Load cells were used to monitor the force applied by each muscle and an optical motion capture system was used to track joint angles of the wrist in real-time. Four control strategies were evaluated based on their kinematic error, repeatability and ability to vary co-contraction. With kinematic errors of less than 1.5°, the ability to vary co-contraction, and without the need for predefined antagonistic forces or muscle force ratios, novel control strategies – hybrid control and cascade control – were preferred over standard control strategies – position control and force control. Muscle forces obtained from hybrid and cascade control corresponded well with in vivo EMG data and muscle force data from other wrist simulators in the literature. The decoupling of the wrist axes combined with the robustness of the control strategies resulted in complex motions, like dart thrower׳s motion and circumduction, being accurate and repeatable. Thus, two novel strategies with repeatable kinematics and physiologically relevant muscle forces are introduced for the control of joint simulators. [ABSTRACT FROM AUTHOR]

This paper introduces a new approach for computing lower extremity muscle forces by incorporating equations that consider “bone structure” and “prevention of bending by load reduction” into existing optimization algorithms. Lower extremity muscle and joint forces, during normal gait, were calculated and compared using two different optimization approaches. We added constraint equations that prevent femoral bending loads to an existing approach that considers “minimal total muscular force”. Gait parameters such as kinematics, ground reaction forces, and surface electromyographic activation patterns were examined using standardized gait analysis. A subject-specific anatomic model of the lower extremities, obtained from magnetic resonance images of a healthy male, was used for the simulations. Finite element analysis was used to calculate femoral loads. The conventional method of calculating muscle forces leads to higher rates of femoral bending and structural stress than the new approach. Adding equations with structural subject-specific parameters in our new approach resulted in reduced femoral stress patterns. These findings show that our new approach improves the accuracy of femoral stress and strain simulations. Structural overloads caused by bending can be avoided during inverse calculation of muscle forces. [ABSTRACT FROM AUTHOR]

Unstable sitting on a wobble chair with different balance difficulty levels can be used as an effective tool in exercises as well as evaluation and therapeutic stages of rehabilitation. No data on muscle activity levels and spinal loads are however available to assess its safety compared to other regular daily activities. The goal of this study was to estimate muscle forces and spinal loads in a seated unstable wobble chair task. In vivo 3D kinematics of the trunk and seat collected in an earlier study were used here to drive computational trunk musculoskeletal models of 6 normal and 6 low-back pain subject groups sitting on a wobble chair for a duration of 10 s. Results revealed no significant differences between kinematics, muscle forces, spinal loads and force plate reaction forces when comparing these two groups. The estimated muscle forces and spinal loads were moderate though larger than those in a stationary sitting posture. Local spinal forces at the L5-S1 disc varied with time and reached their peaks (1473 N and 1720 N in compression, 691 N and 687 N in posterior–anterior shear and 153 N and 208 N in right–left shear, respectively for healthy and CLBP groups) being much greater relative to those in the stationary sitting posture (means of 12 subjects: 768 N, 284 N and 0 N, respectively). The wobble chair with characteristics considered in this study is found hence safe enough as a therapeutic exercise for both healthy and low-back pain subjects. [ABSTRACT FROM AUTHOR]

Background Persons with lower limb amputation walk with increased and asymmetric trunk motion; a characteristic that is likely to impose distinct demands on trunk muscles to maintain equilibrium and stability of the spine. However, trunk muscle responses to such changes in net mechanical demands, and the resultant effects on spinal loads, have yet to be determined in this population. Methods Building on a prior study, trunk and pelvic kinematics collected during level-ground walking from 40 males (20 with unilateral transfemoral amputation and 20 matched controls) were used as inputs to a kinematics-driven, nonlinear finite element model of the lower back to estimate forces in 10 global (attached to thorax) and 46 local (attached to lumbar vertebrae) trunk muscles, as well as compression, lateral, and antero-posterior shear forces at all spinal levels. Findings Trunk muscle force and spinal load maxima corresponded with heel strike and toe off events, and among persons with amputation, were respectively 10–40% and 17–95% larger during intact vs. prosthetic stance, as well as 6–80% and 26–60% larger during intact stance relative to controls. Interpretation During gait, larger spinal loads with transfemoral amputation appear to be the result of a complex pattern of trunk muscle recruitment, particularly involving co-activation of antagonistic muscles during intact limb stance; a period when these individuals are confident and likely to use the trunk to assist with forward progression. Given the repetitive nature of walking, repeated exposure to such elevated loading likely increases the risk for low back pain in this population. [ABSTRACT FROM AUTHOR]

Background Despite improvements in rotator cuff surgery techniques, re-tear rate remains above 20% and increases with tear severity. Mechanical stresses to failure of repaired tendons have been reported. While optimal immobilization postures were proposed to minimize this stress, post-operative rehabilitation protocols have never been assessed with respect to these values. Purpose was to use musculoskeletal simulation to predict when the stress in repaired tendons exceeds safety limits during passive movements. Hence, guidelines could be provided towards safer post-operative exercises. Methods Sixteen healthy participants volunteered in passive three-dimensional shoulder range-of-motion and passive rehabilitation exercises assessment. Stress in all rotator cuff tendons was predicted during each movement by means of a musculoskeletal model using simulations with different type and size of tears. Safety stress thresholds were defined based on repaired tendon loads to failure reported in the literature and used to discriminate safe from unsafe ranges-of-motion. Findings Increased tear size and multiple tendons tear decreased safe range-of-motion. Mostly, glenohumeral elevations below 38°, above 65°, or performed with the arm held in internal rotation cause excessive stresses in most types and sizes of injury during abduction, scaption or flexion. Larger safe amplitudes of elevation are found in scapular plane for supraspinatus alone, supraspinatus plus infraspinatus, and supraspinatus plus subscapularis tears. Interpretation This study reinforces that passive early rehabilitation exercises could contribute to re-tear due to excessive stresses. Recommendations arising from this study, for instance to keep the arm externally rotated during elevation in case of supraspinatus or supraspinatus plus infraspinatus tear, could help prevent re-tear. [ABSTRACT FROM AUTHOR]

This work documents the progress towards the implementation of an embedded solution for muscular forces assessment during cycling activity. The core of the study is the adaptation to a real-time paradigm an inverse biomechanical model. The model is well suited for real-time applications since all the optimization problems are solved through a direct neural estimator. The real-time version of the model was implemented on an embedded microcontroller platform to profile code performance and precision degradation, using different numerical techniques to balance speed and accuracy in a low computational resources environment. [ABSTRACT FROM AUTHOR]

Background There has been a renewed interest in lateralizing the center of rotation (CoR) in implants used in reverse shoulder arthroplasty. The aim of this study was to determine the sensitivity of lateralization of the CoR on the glenohumeral joint contact forces, muscle moment arms, torque across the bone–implant interface, and the stability of the implant. Methods A 3-dimensional virtual model was used to investigate how lateralization affects deltoid muscle moment arm and glenohumeral joint contact forces. This model was virtually implanted with 5 progressively lateralized reverse shoulder prostheses. The joint contact loads and deltoid moment arms were calculated for each lateralization over the course of 3 simulated standard humerothoracic motions. Results Lateralization of the CoR leads to an increase in the overall joint contact forces across the glenosphere. Most of this increased loading occurred through compression, although increases in anterior/posterior and superior/inferior shear were also observed. Moment arms of the deltoid consistently decreased with lateralization. Bending moments at the implant interface increased with lateralization. Progressive lateralization resulted in improved stability ratios. Conclusions Lateralization results in increased joint loading. Most of that loading occurs through compression, although there were also increases in shear forces. Anterior/posterior shear is currently not accounted for in implant fixation studies, leaving its effect on implant fixation unknown. Future studies should incorporate shear forces into their models to more accurately assess fixation methods. [ABSTRACT FROM AUTHOR]

The aim of this study was to analyse the kinematics and kinetics of the lower extremities in the sagittal plane, when running under unstable surface conditions. It was hypothesized that 1) a greater effect of the unstable surface would occur in the gastrocnemius, soleus, and tibialis anterior muscles, contributing to plantar- and dorsi-flexion, compared to muscles involved in hip and knee movements, and 2) the step-to-step absolute variability would be larger in the unstable condition. Eleven male-subjects completed running trials on stable and unstable surfaces in a laboratory setup. Inverse kinematic and dynamic analyses were conducted to calculate kinematics and moments at the lower extremity joints. Additionally, muscle force and activation related variables were calculated for six lower limb muscles using musculoskeletal modelling. Furthermore, the individual SD was calculated for all the variables as a measurement of absolute step-to-step variability. The unstable surface led to a decrease in joint ROM of the knee and ankle by 8.3% and 11.4%, and a decrease of 13.3% on average in force development of the ankle plantar-flexor, which also was reflected by decreasing muscle peak forces of Soleus and Gastrocnemius of 10.3% and 10.8%. Furthermore, an increase of force of Biceps Femoris and activation of Vastus Lateralis were found during the unstable condition. The step-to-step variability increased up to 158% when changing to the unstable condition. In conclusion, the findings revealed for the first time, lower ankle muscle forces mostly reflecting biomechanical adjustments to the surface conditions as well as larger absolute variability when running on the unstable surface. [ABSTRACT FROM AUTHOR]

Background The major complication in nonconforming total shoulder replacement (TSR) is glenoid loosening and is attributed to posteriorly directed humeral head translations. Whether the posterior translations observed clinically are induced by radial mismatch is unclear. The objective of our study was to explain the posterior glenohumeral translations observed clinically after TSR by determining the glenohumeral translation and contact force as a function of radial mismatch. We hypothesized that the posterior direction of glenohumeral translation during scaption would be related to the radial mismatch and that the joint contact force would increase as the radial mismatch increased. Methods A 6-degrees-of-freedom computational model of the glenohumeral joint was developed. We determined the muscle forces, joint contact force, and glenohumeral translation for radial mismatches from 1 mm to 20 mm with the shoulder positioned from 20° to 60° of scaption. Results As the radial mismatch increased, the contact location of the humeral head moved posteriorly and inferiorly. The middle deltoid force decreased by 3%, while the supraspinatus and infraspinatus muscle forces increased by 9% and 11%, respectively. The joint contact force remained relatively constant. Conclusions Increased posterior glenohumeral translations were observed with increased radial mismatch. Clinical observations of posterior translation may be attributed to the balancing forces of the middle deltoid, infraspinatus, and supraspinatus muscles. High radial mismatches may lead to eccentric posterior loading on the glenoid component, which could lead to implant loosening and failure. [ABSTRACT FROM AUTHOR]

An anatomically detailed eighteen-rotational-degrees-of-freedom model of the human spine using optimization constrained to equilibrium and stability requirements is developed and used to simulate several symmetric tasks in upright and flexed standing postures. Predictions of this stability and kinematics-driven (S + KD) model for trunk muscle forces and spine compressive/shear loads are compared to those of our existing kinematics-driven (KD) model where both translational and rotational degrees-of-freedom are included but redundancy is resolved using equilibrium conditions alone. Unlike the KD model, the S + KD model predicted abdominal co-contractions that, in agreement with electromyography data, increased as lifting height increased at a constant horizontal moment arm. The S + KD model, however, could not fully explain the CNS strategy in activating antagonistic muscles for most of the remaining tasks. Despite quite distinct activities in individual muscles, both models predicted L4-L5 intradiscal pressure that matched the in vivo data, the L4-S1 compression loads, and the sum of all trunk muscle forces. For modeling applications in ergonomics, where the compressive spine loads are of interest, the two models yielded <15% difference. In the field of rehabilitation, where detailed muscle forces are required, the S + KD model explained more properly the CNS strategy in activating the antagonistic muscles for some tasks. [ABSTRACT FROM AUTHOR]

A wide range of loading conditions involving external forces with varying magnitudes, orientations and locations are encountered in daily activities. Here we computed the effect on trunk biomechanics of changes in force location (two levels) and orientation (5 values) in 4 subjects in upright standing while maintaining identical external moment of 15 Nm, 30 N m or 45 Nm at the L5-S1. Driven by measured kinematics and gravity/external loads, the finite element models yielded substantially different trunk neuromuscular response with moderate alterations (up to 24% under 45 Nm moment) in spinal loads as the load orientation varied. Under identical moments, compression and shear forces at the L5-S1 as well as forces in extensor thoracic muscles progressively decreased as orientation of external forces varied from downward gravity (90°) all the way to upward (-25°) orientation. In contrast, forces in local lumbar muscles followed reverse trends. Under larger horizontal forces at a lower elevation, lumbar muscles were much more active whereas extensor thoracic muscle forces were greater under smaller forces at a higher elevation. Despite such differences in activity pattern, the spinal forces remained nearly identical (< 6% under 45 Nm moment). The published recorded surface EMG data of extensor muscles trend-wise agreed with computed local muscle forces as horizontal load elevation varied but were overall different from results in both local and global muscles when load orientation altered. Predictions demonstrate the marked effect of external force orientation and elevation on the trunk neuromuscular response and spinal forces and questions attempts to estimate spinal loads based only on consideration of moments at a spinal level. [ABSTRACT FROM AUTHOR]

This study examined the effect of body segment parameter (BSP) perturbations on joint moments calculated using an inverse dynamics procedure and muscle forces calculated using computed muscle control (CMC) during gait. BSP (i.e. segment mass, center of mass location (com) and inertia tensor) of the left thigh, shank and foot of a scaled musculoskeletal model were perturbed. These perturbations started from their nominal value and were adjusted to + 40% in steps of 10%, for both individual as well as combined perturbations in BSP. For all perturbations, an inverse dynamics procedure calculated the ankle, knee and hip moments based on an identical inverse kinematics solution. Furthermore, the effect of applying a residual reduction algorithm (RRA) was investigated. Muscle excitations and resulting muscle forces were calculated using CMC. The results show only a limited effect of an individual parameter perturbation on the calculated moments, where the largest effect is found when perturbing the shank com (MScom,shank, the ratio of absolute difference in torque and relative parameter perturba-tion, is maximally - 7.81 N m for hip flexion moment). The additional influence of perturbing two parameters simultaneously is small (MSmass+com,thigh is maximally 15.2 N m for hip flexion moment). RRA made small changes to the model to increase the dynamic consistency of the simulation (after RRA MScom,shank is maximally 5.01 N m). CMC results show large differences in muscle forces when BSP are perturbed. These result from the underlying forward integration of the dynamic equations. [ABSTRACT FROM AUTHOR]

This study investigated changes in patellofemoral (PF) kinematics for different loading configurations of the quadriceps muscle: single line of action (SL), physiological-based multiple lines of action (ML), weak vastus medialis (WVM), and weak vastus lateralis (WVL). Fourteen cadaveric knees were flexed from 15° to 120° knee flexion using a loading rig with the ability to load different heads of the quadriceps and hamstring muscles in their anatomical orientation. PF rotation in the sagittal plane) and medial lateral translation were significantly different (p < 0.05) for SL and ML, with maximum differences of 2.8° and 0.9 mm at 15° and 45° knee flexion, respectively. Compared to the ML, the WVM induced an average lateral shift of 1.5 mm and an abduction rotation of 0.8°, whereas a 0.9 mm medial shift and 0.6° adduction rotation was seen when simulating a WVL. The difference in the sagittal plane resultant force orientation of 26° between SL and ML was the major contributor to the change in PF rotation in the sagittal plane, while the difference in the frontal plane resultant force orientation of both the WVM and WVL from the ML (17° medial and 8° lateral, respectively) were the primary reasons for the change in PF frontal plane rotation and medial lateral translation. The two PF kinematic were significantly different from the ML for WVM and WVL (p < 0.05). The results suggest that quadriceps muscle loading configuration can have a large influence on PF kinematics during full extension but less in deeper flexion. Therefore, using quadriceps single line loading for simulating activities with low flexion angles might not be sufficient to accurately replicate the physiological condition. [ABSTRACT FROM AUTHOR]

Two artificial neural networks (ANNs) are constructed, trained, and tested to map inputs of a complex trunk finite element (FE) model to its outputs for spinal loads and muscle forces. Five input variables (thorax flexion angle, load magnitude, its anterior and lateral positions, load handling technique, i.e., one- or two-handed static lifting) and four model outputs (L4-L5 and L5-S1 disc compression and anterior-posterior shear forces) for spinal loads and 76 model outputs (forces in individual trunk muscles) are considered. Moreover, full quadratic regression equations mapping input-outputs of the model developed here for muscle forces and previously for spine loads are used to compare the relative accuracy of these two mapping tools (ANN and regression equations). Results indicate that the ANNs are more accurate in mapping input-output relationships of the FE model (RMSE = 20.7 N for spinal loads and RMSE = 4.7 N for muscle forces) as compared to regression equations (RMSE = 120.4 N for spinal loads and RMSE=43.2 N for muscle forces). Quadratic regression equations map up to second order variations of outputs with inputs while ANNs capture higher order variations too. Despite satisfactory achievement in estimating overall muscle forces by the ANN, some inadequacies are noted including assigning force to antagonistic muscles with no activity in the optimization algorithm of the FE model or predicting slightly different forces in bilateral pair muscles in symmetric lifting activities. Using these user-friendly tools spine loads and trunk muscle forces during symmetric and asymmetric static lifts can be easily estimated. [ABSTRACT FROM AUTHOR]

Abstract: Repairing large segmental defects in long bones caused by fracture, tumour or infection is still a challenging problem in orthopaedic surgery. Artificial materials, i.e. titanium and its alloys performed well in clinical applications, are plenary available, and can be manufactured in a wide range of scaffold designs. Although the mechanical properties are determined, studies about the biomechanical behaviour under physiological loading conditions are rare. The goal of our numerical study was to determine the suitability of open-porous titanium scaffolds to act as bone scaffolds. Hence, the mechanical stability of fourteen different scaffold designs was characterized under both axial compression and biomechanical loading within a large segmental distal femoral defect of 30mm. This defect was stabilized with an osteosynthesis plate and physiological hip reaction forces as well as additional muscle forces were implemented to the femoral bone. Material properties of titanium scaffolds were evaluated from experimental testing. Scaffold porosity was varied between 64 and 80%. Furthermore, the amount of material was reduced up to 50%. Uniaxial compression testing revealed a structural modulus for the scaffolds between 3.5GPa and 19.1GPa depending on porosity and material consumption. The biomechanical testing showed defect gap alterations between 0.03mm and 0.22mm for the applied scaffolds and 0.09mm for the intact bone. Our results revealed that minimizing the amount of material of the inner core has a smaller influence than increasing the porosity when the scaffolds are loaded under biomechanical loading. Furthermore, an advanced scaffold design was found acting similar as the intact bone. [Copyright &y& Elsevier]

Accurate estimation of muscle forces during daily activities such as walking is critical for a reliable evaluation of loads on the knee joint. To evaluate knee joint muscle forces, the importance of the inclusion of the hip joint alongside the knee and ankle joints when treating the equilibrium equations remains yet unknown. An iterative kinematics-driven finite element model of the knee joint that accounts for the synergy between passive structures and active musculature is employed. The knee joint muscle forces and biomechanical response are predicted and compared with our earlier results that did not account for moment equilibrium equations at the hip joint. This study indicates that inclusion of the hip joint in the optimization along the knee and ankle joints only slightly ( < 10%) influences total forces in quadriceps, lateral hamstrings and medial hamstrings. As a consequence, even smaller differences are found in predicted ligament forces, contact forces/areas, and cartilage stresses/strains during the stance phase of gait. The distribution of total forces between the uni- and bi-articular muscle components in quadriceps and in lateral hamstrings; however, substantially alter at different stance phases. [ABSTRACT FROM AUTHOR]

Abstract: Using a validated finite element model of the intact knee joint we aim to compute muscle forces and joint response in the stance phase of gait. The model is driven by reported in vivo kinematics–kinetics data and ground reaction forces in asymptomatic subjects. Cartilage layers and menisci are simulated as depth-dependent tissues with collagen fibril networks. A simplified model with less refined mesh and isotropic depth-independent cartilage is also considered to investigate the effect of model accuracy on results. Muscle forces and joint detailed response are computed following an iterative procedure yielding results that satisfy kinematics/kinetics constraints while accounting at deformed configurations for muscle forces and passive properties. Predictions confirm that muscle forces and joint response alter substantially during the stance phase and that a simplified joint model may accurately be used to estimate muscle forces but not necessarily contact forces/areas, tissue stresses/strains, and ligament forces. Predictions are in general agreement with results of earlier studies. Performing the analyses at 6 periods from beginning to the end (0%, 5%, 25%, 50%, 75% and 100%), hamstrings forces peaked at 5%, quadriceps forces at 25% whereas gastrocnemius forces at 75%. ACL Force reached its maximum of 343N at 25% and decreased thereafter. Contact forces reached maximum at 5%, 25% and 75% periods with the medial compartment carrying a major portion of load and experiencing larger relative movements and cartilage strains. Much smaller contact stresses were computed at the patellofemoral joint. This novel iterative kinematics-driven model is promising for the joint analysis in altered conditions. [Copyright &y& Elsevier]

Abstract: Background: Biological massive skeletal reconstructions in tumours adopt a long rehabilitation protocol aimed at minimising the fracture risk. To improve rehabilitation and surgical procedures it is important to fully understand the biomechanics of the reconstructed limb. The aim of the present study was to develop a subject-specific musculoskeletal model of a patient with a massive biological skeletal reconstruction, to investigate the loads acting on the femur during gait, once the rehabilitation protocol was completed. Methods: A personalised musculoskeletal model of the patient''s lower limbs was built from a CT exam and registered with the kinematics recorded in a gait analysis session. Predicted activations for major muscles were compared to EMG signals to assess the model''s predictive accuracy. Findings: Gait kinematics showed only minor discrepancies between the two legs and was compatible with normality data. External moments showed slightly higher differences and were almost always lower on the operated leg exhibiting a lower variability. In the beginning of the stance phase, the joint moments were, conversely, higher on the operated side and showed a higher variability. This pattern was reflected and amplified on the femoral forces where the differences became important: on the hip, a maximum difference of 1.6BW was predicted. The variability of the forces seemed, generally, lower on the operated leg than on the contralateral one. Interpretation: Small asymmetries in kinematic patterns might be associated, in massive skeletal reconstruction, to significant difference in the skeletal loads (up to 1.6BW for the hip joint reaction) during gait. [Copyright &y& Elsevier]

Abstract: An important question in assessing the stability of a total hip arthroplasty is the effect of daily physical activities of patients. The aim of this study is to examine these effects when standing up from three different seat heights. A musculoskeletal body model has been modified to simulate the three different seat heights. The calculated muscle forces have been transferred to a finite element model of a pelvis. The pelvis model was created from a hemipelvis CT dataset. As an implant component, a metal socket with a polyethylene insert was used. A primary implantation situation was modelled. For the analysed patient activities the highest hip contact forces and the highest micromotions occur at the beginning of the motion. The results of this study show that standing up from a certain seat height can have a significant influence on the micromotions in the implant–bone interface. [Copyright &y& Elsevier]

Abstract: While there are a growing number of increasingly complex methodologies available to model geometry and material properties of bones, these models still cannot accurately describe physical behaviour of the skeletal system unless the boundary conditions, especially muscular loading, are correct. Available in vivo measurements of muscle forces are mostly highly invasive and offer no practical way to validate the outcome of any computational model that predicts muscle forces. However, muscle forces can be verified indirectly using the fundamental property of living tissue to functional adaptation and finite element (FE) analysis. Even though the mechanisms of the functional adaptation are not fully understood, its result is clearly seen in the shape and inner structure of bones. The FE method provides a precise tool for analysis of the stress/strain distribution in the bone under given loading conditions. The present work sets principles for the determination of the muscle forces on the basis of the widely accepted view that biological systems are optimized light-weight structures with minimised amount of unloaded/underloaded material and hence evenly distributed loading throughout the structure. Bending loading of bones is avoided/compensated in bones under physiological loading. Thus, bending minimisation provides the basis for the determination of the musculoskeletal system loading. As a result of our approach, the muscle forces for a human femur during normal gait and sitting down (peak hip joint force) are obtained such that the bone is loaded predominantly in compression and the stress distribution in proximal and diaphyseal femur corresponds to the material distribution in bone. [Copyright &y& Elsevier]

Abstract: In the prediction of bone remodelling processes after total hip replacement (THR), modelling of the subject-specific geometry is now state-of-the-art. In this study, we demonstrate that inclusion of subject-specific loading conditions drastically influences the calculated stress distribution, and hence influences the correlation between calculated stress distributions and changes in bone mineral density (BMD) after THR. For two patients who received cementless THR, personalized finite element (FE) models of the proximal femur were generated representing the pre- and post-operative geometry. FE analyses were performed by imposing subject-specific three-dimensional hip joint contact forces as well as muscle forces calculated based on gait analysis data. Average values of the von Mises stress were calculated for relevant zones of the proximal femur. Subsequently, the load cases were interchanged and the effect on the stress distribution was evaluated. Finally, the subject-specific stress distribution was correlated to the changes in BMD at 3 and 6 months after THR. We found subject-specific differences in the stress distribution induced by specific loading conditions, as interchanging of the loading also interchanged the patterns of the stress distribution. The correlation between the calculated stress distribution and the changes in BMD were affected by the two-dimensional nature of the BMD measurement. Our results confirm the hypothesis that inclusion of subject-specific hip contact forces and muscle forces drastically influences the stress distribution in the proximal femur. In addition to patient-specific geometry, inclusion of patient-specific loading is, therefore, essential to obtain accurate input for the analysis of stress distribution after THR. [Copyright &y& Elsevier]

Abstract: Temporomandibular joint and masticatory muscle forces generated during bilateral biting on an experimental device simulating a symmetrically balanced maximum intercuspation, are unknown. The basic motor control strategies during such tasks, executed either strictly controlled or developed rather habitually, are also quite unclear. The main goal of this study was to compare muscle and joint forces at various magnitudes of force under two experimental conditions: (1) generation of a bite force vector perpendicular to the maxillary occlusal plane, (2) development of a directionally unrestricted (quasi-habitual) bite force, both with identical magnitude. Additionally, the experimental results were evaluated on the basis of optimisation strategies displaying physiologically reasonable neuromuscular objectives for coordinated muscle contraction. In 10 normal subjects, the electric activities of all jaw muscles were recorded bilaterally. Intraoral force transfer and force measurement were achieved by a measuring device with one anterior and two posterior force transmission points. Prior to the experiments, the force transmission was balanced at a directionally unrestricted resultant bite force of 100N. Under visual feedback-control, the subjects generated resultant forces of 50, 100, 150, 200, 300, and 400N, respectively. Joint and muscle forces were calculated based on the electromyograms of all jaw muscles, lines of action, geometrical data of the skull, and physiological cross-sectional areas acquired from all subjects. To identify possible motor control strategies, various physiologically reasonable objective functions were applied. The results revealed significant differences in force patterns generated under the two experimental conditions. Directionally unrestricted biting created higher forces in nearly all muscles and in the jaw joints. Muscle forces normalised with the magnitude of the inherent resultant force, and the findings from the optimisation calculations indicate variable central control mechanisms under the two experimental conditions, both minimizing energy consumption. [Copyright &y& Elsevier]

Abstract: Background: Activities involving axial trunk rotations/moments are common and are considered as risk factors for low back disorders. Previous biomechanical models have failed to accurately estimate the trunk maximal axial torque exertion. Moreover, the trunk stability under maximal torque exertions has not been investigated. Methods: A nonlinear thoracolumbar finite element model along with the Kinematics-driven approach is used to study biomechanics of maximal axial torque generation during upright standing posture. Detailed anatomy of trunk muscles with six distinct fascicles for each abdominal oblique muscle on each side is considered. While simulating an in vivo study of maximal axial torque exertion, effects of antagonistic coactivities, coupled moments and maximum muscle stress on results are investigated. Findings: Predictions for trunk axial torque strength and relative muscle activities compared well with reported measurements. Trunk strength in axial torque was only slightly influenced by variations in coupled moments. Presence of abdominal antagonistic coactivities and alterations in maximum strength of muscles had, however, greater effect on maximal torque exertion. Abdominal oblique muscles play crucial role in generating moments in all three planes while back muscles are mainly effective in balancing moments in sagittal/coronal planes. Trunk stability is not of a concern in maximum axial torque exertions nor is it improved by antagonistic abdominal coactivities. Interpretation: In contrast to previous biomechanical model studies, the Kinematics-driven approach accurately predicts the trunk response in maximal isometric axial torque exertions by taking into account detailed anatomy of abdominal oblique muscles while satisfying equilibrium requirements in all planes/directions. In maximal torque exertions, the spine is at much higher risk of tissue injury due to large segmental loads than of instability. [Copyright &y& Elsevier]

Abstract: Background: Salter innominate osteotomy of the pelvis is widely used to improve the coverage of the femoral head in developmental dysplasia of the hip, but the biomechanical and geometric changes after this osteotomy are not well understood. Methods: A CT dataset of an 8-year-old child with severe dysplasia of both hips was used to create a polyamide model of the left hemipelvis and proximal femur. The hemipelvis was mounted to a holding device and the proximal femur attached to a sensor guided industrial robot. The robot was programmed to apply joint forces and torques based on single-leg stance. Two major muscles were represented by wires connected to hydraulic cylinders; muscle forces were adjusted to balance the joint moments. Resulting joint forces were measured using a pressure measuring sensor before and after Salter osteotomy of the hip. Geometric changes were recorded using a three-dimensional ultrasound measurement system. Findings: The preoperative hip joint resultant force was 583N (270% body weight), while after the operation a mean force of 266N (120% body weight) was measured. Postoperative muscle forces were roughly half the preoperative values. The hip joint was translated medially and caudally. Postoperatively, the length of gluteus medius and maximus muscles increased. Interpretation: The preoperative value of the resultant hip joint force is comparable to values reported in the literature. The results suggest that Salter innominate osteotomy leads to a reduction of hip joint and muscle forces in addition to increasing joint contact area. [Copyright &y& Elsevier]

Abstract: Background: The muscle forces tend to change when any musculoskeletal system is damaged. It is necessary to predict and explain the patterns of muscle forces in the stump of a left trans-tibial amputee during walking, and to study the effects of the prosthetic alignment. Methods: Musculoskeletal modeling and computer simulation were combined to calculate muscle forces in the trans-tibial lower limb during walking. The prosthesis was aligned to be in optimal position for the subject and then changed into +6° and −6° in the sagittal plane relatively. Kinematic data of the stump wearing a prosthesis and ground reaction forces were simultaneously recorded by a gait analysis system and a force platform, respectively. The data were input into a model of the lower trans-tibial extremity with three-dimensional geometry and the corresponding seven muscle forces were predicted by a static optimization. Findings: Muscles performed much more actively in stance than in swing phase. Most muscles appeared very active around both heel-strike and toe-off. Muscle forces predicted were similar to that in temporal distribution at all three alignment conditions but the major muscles such as gluteus maximus, hamstrings, vasti and rectus femoris generated remarkable greater forces in −6° and +6° alignments than the normal condition. Interpretation: The above results showed the muscle forces increasing at the mal-alignment. Because the incorrect alignment could break the relative position of the socket and foot, and that would generate the extra joint moments. As a result, muscle forces increased, and the long-duration fatigue occurs more easily. The finding suggests that the proper prosthetic alignment is very important for the stump muscles normal activities. [Copyright &y& Elsevier]

Abstract: This in vitro study evaluated the effects of four different muscle-loading ratios on active glenohumeral joint abduction. Eight cadaveric shoulders were tested using a shoulder simulator designed to reproduce unconstrained abduction of the humerus via computer-controlled pneumatic actuation. Forces were applied to cables that were sutured to tendons or fixed to bone, to simulate loading of the supraspinatus, subscapularis, infraspinatus/teres minor, and anterior, middle, and posterior deltoid muscles. Four sets of muscle-loading ratios were employed, based on: (1) equal loads, (2) average physiological cross-sectional areas (pCSAs), (3) constant values of the product of electromyographic (EMG) data and pCSAs, and (4) variable ratios of the EMG and pCSA data which changed as a function of abduction angle. The investigator generated passive motions with no muscle loads simulated. Repeatability was quantified by five successive trials of the passive and simulated active motions. There was improved repeatability in the simulated active motions versus passive motions, significant for abduction angles less than 40° (p=0.02). No difference was found in the repeatability of the four different muscle-loading ratios for simulated active motions (p⩾0.067 for all angles). The improved repeatability of active over passive motion suggests simulated active motion should be employed for in vitro simulations of shoulder motion. [Copyright &y& Elsevier]

Abstract: Muscle forces stabilize the spine and have a great influence on spinal loads. But little is known about their magnitude. In a former in vitro experiment, a good agreement with intradiscal pressure and fixator loads measured in vivo could be achieved for standing and extension of the lumbar spine. However, for flexion the agreement between in vitro and in vivo measurements was insufficient. In order to improve the determination of trunk muscle forces, a three-dimensional nonlinear finite element model of the lumbar spine with an internal fixation device was created and the same loads were applied as in a previous in vitro experiment. An extensive adaptation process of the model was performed for flexion and extension angles up to 20° and −15°, respectively. With this validated computer model intra-abdominal pressure, preload in the fixators, and a combination of hip- and lumbar flexion angle were varied until a good agreement between analytical and in vivo results was reached for both, intradiscal pressure and bending moments in the fixators. Finally, the fixators were removed and the muscle forces for the intact lumbar spine calculated. A good agreement with the in vivo results could only be achieved at a combination of hip- and lumbar flexion. For the intact spine, forces of 170, 100 and 600N are predicted in the m. erector spinae for standing, 5° extension and 30° flexion, respectively. The force in the m. rectus abdominus for these body positions is less than 25N. For more than 10° extension the m. erector spinae is unloaded. The finite element method together with in vivo data allows the estimation of trunk muscle forces for different upper body positions in the sagittal plane. In our patients, flexion of the upper body was most likely a combination of hip- and lumbar spine bending. [Copyright &y& Elsevier]

Abstract: Inverse dynamic optimization is a popular method for predicting muscle and joint reaction forces within human musculoskeletal joints. However, the traditional formulation of the optimization method does not include the joint reaction moment in the moment equilibrium equation, potentially violating the equilibrium conditions of the joint. Consequently, the predicted muscle and joint reaction forces are coordinate system-dependent. This paper presents an improved optimization method for the prediction of muscle forces and joint reaction forces. In this method, the location of the rotation center of the joint is used as an optimization variable, and the moment equilibrium equation is formulated with respect to the joint rotation center to represent an accurate moment constraint condition. The predicted muscle and joint reaction forces are independent of the joint coordinate system. The new optimization method was used to predict muscle forces of an elbow joint. The results demonstrated that the joint rotation center location varied with applied loading conditions. The predicted muscle and joint reaction forces were different from those predicted by using the traditional optimization method. The results further demonstrated that the improved optimization method converged to a minimum for the objective function that is smaller than that reached by using the traditional optimization method. Therefore, the joint rotation center location should be involved as a variable in an inverse dynamic optimization method for predicting muscle and joint reaction forces within human musculoskeletal joints. [Copyright &y& Elsevier]