Automated Generation of Three-Dimensional Complex Muscle Geometries for Use in Personalised Musculoskeletal Models

A three-dimensional musculoskeletal model of the pelvis and lower limb of Australopithecus afarensis

OBJECTIVES

Musculoskeletal modeling is a powerful approach for studying the biomechanics and energetics of locomotion. Australopithecus (A.) afarensis is among the best represented fossil hominins and provides critical information about the evolution of musculoskeletal design and locomotion in the hominin lineage. Here, we develop and evaluate a three-dimensional (3-D) musculoskeletal model of the pelvis and lower limb of A. afarensis for predicting muscle-tendon moment arms and moment-generating capacities across lower limb joint positions encompassing a range of locomotor behaviors.

MATERIALS AND METHODS

A 3-D musculoskeletal model of an adult A. afarensis pelvis and lower limb was developed based primarily on the A.L. 288-1 partial skeleton. The model includes geometric representations of bones, joints and 35 muscle-tendon units represented using 43 Hill-type muscle models. Two muscle parameter datasets were created from human and chimpanzee sources. 3-D muscle-tendon moment arms and isometric joint moments were predicted over a wide range of joint positions.

RESULTS

Predicted muscle-tendon moment arms generally agreed with skeletal metrics, and corresponded with human and chimpanzee models. Human and chimpanzee-based muscle parameterizations were similar, with some differences in maximum isometric force-producing capabilities. The model is amenable to size scaling from A.L. 288-1 to the larger KSD-VP-1/1, which subsumes a wide range of size variation in A. afarensis.

DISCUSSION

This model represents an important tool for studying the integrated function of the neuromusculoskeletal systems in A. afarensis. It is similar to current human and chimpanzee models in musculoskeletal detail, and will permit direct, comparative 3-D simulation studies.

Motoneuron-driven computational muscle modelling with motor unit resolution and subject-specific musculoskeletal anatomy

The computational simulation of human voluntary muscle contraction is possible with EMG-driven Hill-type models of whole muscles. Despite impactful applications in numerous fields, the neuromechanical information and the physiological accuracy such models provide remain limited because of multiscale simplifications that limit comprehensive description of muscle internal dynamics during contraction. We addressed this limitation by developing a novel motoneuron-driven neuromuscular model, that describes the force-generating dynamics of a population of individual motor units, each of which was described with a Hill-type actuator and controlled by a dedicated experimentally derived motoneuronal control. In forward simulation of human voluntary muscle contraction, the model transforms a vector of motoneuron spike trains decoded from high-density EMG signals into a vector of motor unit forces that sum into the predicted whole muscle force. The motoneuronal control provides comprehensive and separate descriptions of the dynamics of motor unit recruitment and discharge and decodes the subject's intention. The neuromuscular model is subject-specific, muscle-specific, includes an advanced and physiological description of motor unit activation dynamics, and is validated against an experimental muscle force. Accurate force predictions were obtained when the vector of experimental neural controls was representative of the discharge activity of the complete motor unit pool. This was achieved with large and dense grids of EMG electrodes during medium-force contractions or with computational methods that physiologically estimate the discharge activity of the motor units that were not identified experimentally. This neuromuscular model advances the state-of-the-art of neuromuscular modelling, bringing together the fields of motor control and musculoskeletal modelling, and finding applications in neuromuscular control and human-machine interfacing research.

Designing customized temporomandibular fossa prosthesis based on envelope surface of condyle movement: validation via in silico musculoskeletal simulation

Objective: This study presents an innovative articular fossa prosthesis generated by the envelope surface of condyle movement, and compares its mandible movements, muscle activities, and joint reaction forces with two temporomandibular joint (TMJ) prostheses using multibody musculoskeletal simulation. Methods: A healthy 23-year-old female was recruited for this study. Cone-beam computed tomographic (CBCT) was performed to reconstruct the mandibular bone geometry. A customized TMJ fossa prosthesis was designed based on the subject-specific envelope surface of condyle movement (ESCM). Mandibular kinematics and jaw-closing muscle electromyography (EMG) were simultaneously recorded during maximum jaw opening-closing movements. To validate our prosthesis design, a mandibular musculoskeletal model was established using flexible multibody dynamics and the obtained kinematics and EMG data. The Biomet fossa prosthesis and the ellipsoidal fossa prosthesis designed by imitating the lower limb prostheses were used for comparison. Simulations were performed to analyze the effects of different fossa prostheses on jaw opening-closing motions, mandibular muscle activation, and contact forces. Results: The maximum opening displacement for the envelope-based fossa prosthesis was greater than those for Biomet and ellipsoidal prostheses (36 mm, 35 mm, and 33 mm, respectively). The mandibular musculoskeletal model with ellipsoidal prosthesis led to dislocation near maximal jaw opening. Compared to Biomet, the envelope-based fossa reduced the digastric and lateral pterygoid activation at maximal jaw opening. It also reduced the maximal resistance to condylar sliding on the intact side by 63.2 N. Conclusion: A customized TMJ fossa prosthesis was successfully developed using the ESCM concept. Our study of musculoskeletal multibody modeling has highlighted its advantages and potential. The artificial fossa design successfully achieved a wider condylar range of motion. It also reduced the activation of jaw opening muscles on the affected side and resistance on the intact side. This study showed that an ESCM-based approach may be useful for optimizing TMJ fossa prostheses design.

The Functional and Anatomical Impacts of Healthy Muscle Ageing

Even "healthy" muscle ageing is often associated with substantial changes in muscle form and function and can lead to increased injury risks and significant negative impacts on quality of life. However, the impacts of healthy muscle ageing on the fibre architecture and microstructure of different muscles and muscle groups throughout the lower limb, and how these are related to their functional capabilities, are not fully understood. Here, a previously established framework of magnetic resonance and diffusion tensor imaging was used to measure the muscle volumes, intramuscular fat, fibre lengths and physiological cross-sectional areas of 12 lower limb muscles in a cohort of healthily aged individuals, which were compared to the same data from a young population. Maximum muscle forces were also measured from an isokinetic dynamometer. The more substantial interpopulation differences in architecture and functional performance were located within the knee extensor muscles, while the aged muscles were also more heterogeneous in muscle fibre type and atrophy. The relationships between architecture and muscle strength were also more significant in the knee extensors compared to other functional groups. These data highlight the importance of the knee extensors as a potential focus for interventions to negate the impacts of muscle ageing.

Non-Linearity in Motor Unit Velocity Twitch Dynamics: Implications for Ultrafast Ultrasound Source Separation

Ultrasound (US) muscle image series can be used for peripheral human-machine interfacing based on global features, or even on the decomposition of US images into the contributions of individual motor units (MUs). With respect to state-of-the-art surface electromyography (sEMG), US provides higher spatial resolution and deeper penetration depth. However, the accuracy of current methods for direct US decomposition, even at low forces, is relatively poor. These methods are based on linear mathematical models of the contributions of MUs to US images. Here, we test the hypothesis of linearity by comparing the average velocity twitch profiles of MUs when varying the number of other concomitantly active units. We observe that the velocity twitch profile has a decreasing peak-to-peak amplitude when tracking the same target motor unit at progressively increasing contraction force levels, thus with an increasing number of concomitantly active units. This observation indicates non-linear factors in the generation model. Furthermore, we directly studied the impact of one MU on a neighboring MU, finding that the effect of one source on the other is not symmetrical and may be related to unit size. We conclude that a linear approximation is partly limiting the decomposition methods to decompose full velocity twitch trains from velocity images, highlighting the need for more advanced models and methods for US decomposition than those currently employed.

Does joint impedance improve dynamic leg simulations with explicit and implicit solvers?

The nervous system predicts and executes complex motion of body segments actuated by the coordinated action of muscles. When a stroke or other traumatic injury disrupts neural processing, the impeded behavior has not only kinematic but also kinetic attributes that require interpretation. Biomechanical models could allow medical specialists to observe these dynamic variables and instantaneously diagnose mobility issues that may otherwise remain unnoticed. However, the real-time and subject-specific dynamic computations necessitate the optimization these simulations. In this study, we explored the effects of intrinsic viscoelasticity, choice of numerical integration method, and decrease in sampling frequency on the accuracy and stability of the simulation. The bipedal model with 17 rotational degrees of freedom (DOF)-describing hip, knee, ankle, and standing foot contact-was instrumented with viscoelastic elements with a resting length in the middle of the DOF range of motion. The accumulation of numerical errors was evaluated in dynamic simulations using swing-phase experimental kinematics. The relationship between viscoelasticity, sampling rates, and the integrator type was evaluated. The optimal selection of these three factors resulted in an accurate reconstruction of joint kinematics (err < 1%) and kinetics (err < 5%) with increased simulation time steps. Notably, joint viscoelasticity reduced the integration errors of explicit methods and had minimal to no additional benefit for implicit methods. Gained insights have the potential to improve diagnostic tools and accurize real-time feedback simulations used in the functional recovery of neuromuscular diseases and intuitive control of modern prosthetic solutions.

Three-dimensional volumetric muscle reconstruction of the Australopithecus afarensis pelvis and limb, with estimations of limb leverage

To understand how an extinct species may have moved, we first need to reconstruct the missing soft tissues of the skeleton, which rarely preserve, with an understanding of segmental volume and muscular composition within the body. The Australopithecus afarensis specimen AL 288-1 is one of the most complete hominin skeletons. Despite 40+ years of research, the frequency and efficiency of bipedal movement in this specimen is still debated. Here, 36 muscles of the pelvis and lower limb were reconstructed using three-dimensional polygonal modelling, guided by imaging scan data and muscle scarring. Reconstructed muscle masses and configurations guided musculoskeletal modelling of the lower limb in comparison with a modern human. Results show that the moment arms of both species were comparable, hinting towards similar limb functionality. Moving forward, the polygonal muscle modelling approach has demonstrated promise for reconstructing the soft tissues of hominins and providing information on muscle configuration and space filling. This method demonstrates that volumetric reconstructions are required to know where space must be occupied by muscles and thus where lines of action might not be feasible due to interference with another muscle. This approach is effective for reconstructing muscle volumes in extinct hominins for which musculature is unknown.

Modern three-dimensional digital methods for studying locomotor biomechanics in tetrapods

Here, we review the modern interface of three-dimensional (3D) empirical (e.g. motion capture) and theoretical (e.g. modelling and simulation) approaches to the study of terrestrial locomotion using appendages in tetrapod vertebrates. These tools span a spectrum from more empirical approaches such as XROMM, to potentially more intermediate approaches such as finite element analysis, to more theoretical approaches such as dynamic musculoskeletal simulations or conceptual models. These methods have much in common beyond the importance of 3D digital technologies, and are powerfully synergistic when integrated, opening a wide range of hypotheses that can be tested. We discuss the pitfalls and challenges of these 3D methods, leading to consideration of the problems and potential in their current and future usage. The tools (hardware and software) and approaches (e.g. methods for using hardware and software) in the 3D analysis of tetrapod locomotion have matured to the point where now we can use this integration to answer questions we could never have tackled 20 years ago, and apply insights gleaned from them to other fields.

A myoelectric digital twin for fast and realistic modelling in deep learning

Muscle electrophysiology has emerged as a powerful tool to drive human machine interfaces, with many new recent applications outside the traditional clinical domains, such as robotics and virtual reality. However, more sophisticated, functional, and robust decoding algorithms are required to meet the fine control requirements of these applications. Deep learning has shown high potential in meeting these demands, but requires a large amount of high-quality annotated data, which is expensive and time-consuming to acquire. Data augmentation using simulations, a strategy applied in other deep learning applications, has never been attempted in electromyography due to the absence of computationally efficient models. We introduce a concept of Myoelectric Digital Twin - highly realistic and fast computational model tailored for the training of deep learning algorithms. It enables simulation of arbitrary large and perfectly annotated datasets of realistic electromyography signals, allowing new approaches to muscular signal decoding, accelerating the development of human-machine interfaces.

Does joint impedance improve dynamic leg simulations with explicit and implicit solvers?

The nervous system predicts and executes complex motion of body segments actuated by the coordinated action of muscles. When a stroke or other traumatic injury disrupts neural processing, the impeded behavior has not only kinematic but also kinetic attributes that require interpretation. Biomechanical models could allow medical specialists to observe these dynamic variables and instantaneously diagnose mobility issues that may otherwise remain unnoticed. However, the real-time and subject-specific dynamic computations necessitate the optimization these simulations. In this study, we explored the effects of intrinsic viscoelasticity, choice of numerical integration method, and decrease in sampling frequency on the accuracy and stability of the simulation. The bipedal model with 17 rotational degrees of freedom (DOF)-describing hip, knee, ankle, and standing foot contact-was instrumented with viscoelastic elements with a resting length in the middle of the DOF range of motion. The accumulation of numerical errors was evaluated in dynamic simulations using swing-phase experimental kinematics. The relationship between viscoelasticity, sampling rates, and the integrator type was evaluated. The optimal selection of these three factors resulted in an accurate reconstruction of joint kinematics (err < 1%) and kinetics (err < 5%) with increased simulation time steps. Notably, joint viscoelasticity reduced the integration errors of explicit methods and had minimal to no additional benefit for implicit methods . Gained insights have the potential to improve diagnostic tools and accurize real-time feedback simulations used in the functional recovery of neuromuscular diseases and intuitive control of modern prosthetic solutions.

On the estimation of hip joint loads through musculoskeletal modeling

Noninvasive estimation of joint loads is still an open challenge in biomechanics. Although musculoskeletal modeling represents a solid resource, multiple improvements are still necessary to obtain accurate predictions of joint loads and to translate such potential into practical utility. The present study, focused on the hip joint, is aimed at reviewing the state-of-the-art literature on the estimation of hip joint reaction forces through musculoskeletal modeling. Our literature inspection, based on well-defined selection criteria, returned seventeen works, which were compared in terms of methods and results. Deviations between predicted and in vivo measured hip joint loads, taken from the OrthoLoad database, were assessed through quantitative deviation indices. Despite the numerous modeling and computational improvements made over the last two decades, predicted hip joint loads still deviate from their experimental counterparts and typically overestimate them. Several critical aspects have emerged that affect muscle force estimation, hence joint loads. Among them, the physical fidelity of the musculoskeletal model, with its parameters and geometry, plays a crucial role. Also, predicted joint loads are markedly affected by the selected muscle recruitment strategy, which reflects the underlying motor control policy. Practical guidelines for researchers interested in noninvasive estimation of hip joint loads are also provided.

A biophysically guided constitutive law of the musculotendon-complex: modelling and numerical implementation in Abaqus

BACKGROUND AND OBJECTIVE

Many biomedical, clinical, and industrial applications may benefit from musculoskeletal simulations. Three-dimensional macroscopic muscle models (3D models) can more accurately represent muscle architecture than their 1D (line-segment) counterparts. Nevertheless, 3D models remain underutilised in academic, clinical, and commercial environments. Among the reasons for this is a lack of modelling and simulation standardisation, verification, and validation. Here, we strive towards a solution by providing an open-access, characterised, constitutive relation (CR) for 3D musculotendon models.

METHODS

The musculotendon complex is modelled following the state-of-the-art active stress approach and is treated as hyperelastic, transversely isotropic, and nearly incompressible. Furthermore, force-length and -velocity relationships are incorporated, and muscle activation is derived from motor-unit information. The CR was implemented within the commercial finite-element software package Abaqus as a user-subroutine. A masticatory system model with left and right masseters was used to demonstrate active and passive movement.

RESULTS

The CR was characterised by various experimental data sets and was able to capture a wide variety of passive and active behaviours. Furthermore, the masticatory simulations revealed that joint movement was sensitive to the muscle's in-fibre passive response.

CONCLUSIONS

This user-material provides a "plug and play" template for 3D neuro-musculoskeletal finite element modelling. We hope that this reduces modelling effort, fosters exchange, and contributes to the standardisation of such models.

A toolbox for the retrodeformation and muscle reconstruction of fossil specimens in Blender

Accurate muscle reconstructions can offer new information on the anatomy of fossil organisms and are also important for biomechanical analysis (multibody dynamics and finite-element analysis (FEA)). For the sake of simplicity, muscles are often modelled as point-to-point strands or frustra (cut-off cones) in biomechanical models. However, there are cases in which it is useful to model the muscle morphology in three dimensions, to better examine the effects of muscle shape and size. This is especially important for fossil analyses, where muscle force is estimated from the reconstructed muscle morphology (rather than based on data collected in vivo). The two main aims of this paper are as follows. First, we created a new interactive tool in the free open access software Blender to enable interactive three-dimensional modelling of muscles. This approach can be applied to both palaeontological and human biomechanics research to generate muscle force magnitudes and lines of action for FEA. Second, we provide a guide on how to use existing Blender tools to reconstruct distorted or incomplete specimens. This guide is aimed at palaeontologists but can also be used by anatomists working with damaged specimens or to test functional implication of hypothetical morphologies.

A toolbox for the retrodeformation and muscle reconstruction of fossil specimens in Blender

Accurate muscle reconstructions can offer new information on the anatomy of fossil organisms and are also important for biomechanical analysis (multibody dynamics and finite-element analysis (FEA)). For the sake of simplicity, muscles are often modelled as point-to-point strands or frustra (cut-off cones) in biomechanical models. However, there are cases in which it is useful to model the muscle morphology in three dimensions, to better examine the effects of muscle shape and size. This is especially important for fossil analyses, where muscle force is estimated from the reconstructed muscle morphology (rather than based on data collected in vivo). The two main aims of this paper are as follows. First, we created a new interactive tool in the free open access software Blender to enable interactive three-dimensional modelling of muscles. This approach can be applied to both palaeontological and human biomechanics research to generate muscle force magnitudes and lines of action for FEA. Second, we provide a guide on how to use existing Blender tools to reconstruct distorted or incomplete specimens. This guide is aimed at palaeontologists but can also be used by anatomists working with damaged specimens or to test functional implication of hypothetical morphologies.

A toolbox for the retrodeformation and muscle reconstruction of fossil specimens in Blender

Accurate muscle reconstructions can offer new information on the anatomy of fossil organisms and are also important for biomechanical analysis (multibody dynamics and finite-element analysis (FEA)). For the sake of simplicity, muscles are often modelled as point-to-point strands or frustra (cut-off cones) in biomechanical models. However, there are cases in which it is useful to model the muscle morphology in three dimensions, to better examine the effects of muscle shape and size. This is especially important for fossil analyses, where muscle force is estimated from the reconstructed muscle morphology (rather than based on data collected in vivo). The two main aims of this paper are as follows. First, we created a new interactive tool in the free open access software Blender to enable interactive three-dimensional modelling of muscles. This approach can be applied to both palaeontological and human biomechanics research to generate muscle force magnitudes and lines of action for FEA. Second, we provide a guide on how to use existing Blender tools to reconstruct distorted or incomplete specimens. This guide is aimed at palaeontologists but can also be used by anatomists working with damaged specimens or to test functional implication of hypothetical morphologies.

Uncertainty in Muscle–Tendon Parameters can Greatly Influence the Accuracy of Knee Contact Force Estimates of Musculoskeletal Models

Understanding the sources of error is critical before models of the musculoskeletal system can be usefully translated. Using in vivo measured tibiofemoral forces, the impact of uncertainty in muscle–tendon parameters on the accuracy of knee contact force estimates of a generic musculoskeletal model was investigated following a probabilistic approach. Population variability was introduced to the routine musculoskeletal modeling framework by perturbing input parameters of the lower limb muscles around their baseline values. Using ground reaction force and skin marker trajectory data collected from six subjects performing body-weight squat, the knee contact force was calculated for the perturbed models. The combined impact of input uncertainties resulted in a considerable variation in the knee contact force estimates (up to 2.1 BW change in the predicted force), especially at larger knee flexion angles, hence explaining up to 70% of the simulation error. Although individual muscle groups exhibited different contributions to the overall error, variation in the maximum isometric force and pathway of the muscles showed the highest impacts on the model outcomes. Importantly, this study highlights parameters that should be personalized in order to achieve the best possible predictions when using generic musculoskeletal models for activities involving deep knee flexion.

Three-dimensional polygonal muscle modelling and line of action estimation in living and extinct taxa

Biomechanical models and simulations of musculoskeletal function rely on accurate muscle parameters, such as muscle masses and lines of action, to estimate force production potential and moment arms. These parameters are often obtained through destructive techniques (i.e., dissection) in living taxa, frequently hindering the measurement of other relevant parameters from a single individual, thus making it necessary to combine multiple specimens and/or sources. Estimating these parameters in extinct taxa is even more challenging as soft tissues are rarely preserved in fossil taxa and the skeletal remains contain relatively little information about the size or exact path of a muscle. Here we describe a new protocol that facilitates the estimation of missing muscle parameters (i.e., muscle volume and path) for extant and extinct taxa. We created three-dimensional volumetric reconstructions for the hindlimb muscles of the extant Nile crocodile and extinct stem-archosaur Euparkeria, and the shoulder muscles of an extant gorilla to demonstrate the broad applicability of this methodology across living and extinct animal clades. Additionally, our method can be combined with surface geometry data digitally captured during dissection, thus facilitating downstream analyses. We evaluated the estimated muscle masses against physical measurements to test their accuracy in estimating missing parameters. Our estimated muscle masses generally compare favourably with segmented iodine-stained muscles and almost all fall within or close to the range of observed muscle masses, thus indicating that our estimates are reliable and the resulting lines of action calculated sufficiently accurately. This method has potential for diverse applications in evolutionary morphology and biomechanics.

A review of musculoskeletal modelling of human locomotion

Locomotion through the environment is important because movement provides access to key resources, including food, shelter and mates. Central to many locomotion-focused questions is the need to understand internal forces, particularly muscle forces and joint reactions. Musculoskeletal modelling, which typically harnesses the power of inverse dynamics, unites experimental data that are collected on living subjects with virtual models of their morphology. The inputs required for producing good musculoskeletal models include body geometry, muscle parameters, motion variables and ground reaction forces. This methodological approach is critically informed by both biological anthropology, with its focus on variation in human form and function, and mechanical engineering, with a focus on the application of Newtonian mechanics to current problems. Here, we demonstrate the application of a musculoskeletal modelling approach to human walking using the data of a single male subject. Furthermore, we discuss the decisions required to build the model, including how to customize the musculoskeletal model, and suggest cautions that both biological anthropologists and engineers who are interested in this topic should consider.

Using Musculoskeletal Models to Estimate in vivo Total Knee Replacement Kinematics and Loads: Effect of Differences Between Models

Total knee replacement (TKR) is one of the most performed orthopedic surgeries to treat knee joint diseases in the elderly population. Although the survivorship of knee implants may extend beyond two decades, the poor outcome rate remains considerable. A recent computational approach used to better understand failure modes and improve TKR outcomes is based on the combination of musculoskeletal (MSK) and finite element models. This combined multiscale modeling approach is a promising strategy in the field of computational biomechanics; however, some critical aspects need to be investigated. In particular, the identification and quantification of the uncertainties related to the boundary conditions used as inputs to the finite element model due to a different definition of the MSK model are crucial. Therefore, the aim of this study is to investigate this problem, which is relevant for the model credibility assessment process. Three different generic MSK models available in the OpenSim platform were used to simulate gait, based on the experimental data from the fifth edition of the "Grand Challenge Competitions to Predict in vivo Knee Loads." The outputs of the MSK analyses were compared in terms of relative kinematics of the knee implant components and joint reaction (JR) forces and moments acting on the tibial insert. Additionally, the estimated knee JRs were compared with those measured by the instrumented knee implant so that the "global goodness of fit" was quantified for each model. Our results indicated that the different kinematic definitions of the knee joint and the muscle model implemented in the different MSK models influenced both the motion and the load history of the artificial joint. This study demonstrates the importance of examining the influence of the model assumptions on the output results and represents the first step for future studies that will investigate how the uncertainties in the MSK models propagate on disease-specific finite element model results.

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

Hip osteoarthritis may be caused by increased or abnormal intra-articular forces, which are known to be related to structural articular cartilage damage. Femoral torsional deformities have previously been correlated with hip pain and labral damage, and they may contribute to the onset of hip osteoarthritis by exacerbating the effects of existing pathoanatomies, such as cam and pincer morphologies. A comprehensive understanding of the influence of femoral morphotypes on hip joint loading requires subject-specific morphometric and biomechanical data on the movement characteristics of individuals exhibiting varying degrees of femoral torsion. The aim of this study was to evaluate hip kinematics and kinetics as well as muscle and joint loads during gait in a group of adult subjects presenting a heterogeneous range of femoral torsion by means of personalized musculoskeletal models. Thirty-seven healthy volunteers underwent a 3D gait analysis at a self-selected walking speed. Femoral torsion was evaluated with low-dosage biplanar radiography. The collected motion capture data were used as input for an inverse dynamics analysis. Personalized musculoskeletal models were created by including femoral geometries that matched each subject’s radiographically measured femoral torsion. Correlations between femoral torsion and hip kinematics and kinetics, hip contact forces (HCFs), and muscle forces were analyzed. Within the investigated cohort, higher femoral antetorsion led to significantly higher anteromedial HCFs during gait (medial during loaded stance phase and anterior during swing phase). Most of the loads during gait are transmitted through the anterior/superolateral quadrant of the acetabulum. Correlations with hip kinematics and muscle forces were also observed. Femoral antetorsion, through altered kinematic strategies and different muscle activations and forces, may therefore lead to altered joint mechanics and pose a risk for articular damage. The method proposed in this study, which accounts for both morphological and kinematic characteristics, might help in identifying in a clinical setting patients who, as a consequence of altered femoral torsional alignment, present more severe functional impairments and altered joint mechanics and are therefore at a higher risk for cartilage damage and early onset of hip osteoarthritis.

Generic scaled versus subject-specific models for the calculation of musculoskeletal loading in cerebral palsy gait: Effect of personalized musculoskeletal geometry outweighs the effect of personalized neural control

BACKGROUND

Musculoskeletal modelling is used to assess musculoskeletal loading during gait. Linear scaling methods are used to personalize generic models to each participant's anthropometry. This approach introduces simplifications, especially when used in paediatric and/or pathological populations. This study aimed to compare results from musculoskeletal simulations using various models ranging from linear scaled to highly subject-specific models, i.e., including the participant's musculoskeletal geometry and electromyography data.

METHODS

Magnetic resonance images (MRI) and gait data of one typically developing child and three children with cerebral palsy were analysed. Musculoskeletal simulations were performed to calculate joint kinematics, joint kinetics, muscle forces and joint contact forces using four modelling frameworks: 1) Generic-scaled model with static optimization, 2) Generic-scaled model with an electromyography-informed approach, 3) MRI-based model with static optimization, and 4) MRI-based model with an electromyography-informed approach.

FINDINGS

Root-mean-square-differences in joint kinematics and kinetics between generic-scaled and MRI-based models were below 5° and 0.15 Nm/kg, respectively. Root-mean-square-differences over all muscles was below 0.2 body weight for every participant. Root-mean-square-differences in joint contact forces between the different modelling frameworks were up to 2.2 body weight. Comparing the simulation results from the typically developing child with the results from the children with cerebral palsy showed similar root-mean-square-differences for all modelling frameworks.

INTERPRETATION

In our participants, the impact of MRI-based models on joint contact forces was higher than the impact of including electromyography. Clinical reasoning based on overall root-mean-square-differences in musculoskeletal simulation results between healthy and pathological participants are unlikely to be affected by the modelling choice.

ESB Clinical Biomechanics Award 2020: Pelvis and hip movement strategies discriminate typical and pathological femoral growth - Insights gained from a multi-scale mechanobiological modelling framework

BACKGROUND

Many children with cerebral palsy (CP) develop skeletal deformities during childhood. So far, it is unknown why some children with CP develop bony deformities whereas others do not. The aims of this study were to (i) investigate what loading characteristics lead to typical and pathological femoral growth, and (ii) evaluate why some children with CP develop femoral deformities whereas other do not.

METHODS

A multi-scale mechanobiological modelling workflow was used to simulate femoral growth based on three-dimensional motion capture data of six typically developing children and 16 children with CP. Based on the growth results, the participants with CP were divided into two groups: typical growth group and pathological growth group. Gait kinematics and femoral loading were compared between simulations resulting in typical growth and those resulting in pathologic growth.

FINDINGS

Hip joint contact forces were less posteriorly-oriented in the pathological growth simulations compared to the typical ones. Compared to the typically developing participants, the CP group with pathological femoral growth presented increased knee flexion and no hip extension. The CP group with simulated typical growth presented similar sagittal plane joint kinematics but differed in the frontal plane pelvic and hip movement strategy, which normalized the hip joint contact force and therefore contributed to typical femoral growth trends.

INTERPRETATION

Our simulation results identified specific gait features, which may contribute to pathological femoral growth. Furthermore, the hip joint contact force orientation in the sagittal plane seems to be the dominant factor for determining femoral growth simulations.

On the 3D Nature of the Magpie (Aves: Pica pica) Functional Hindlimb Anatomy During the Take-Off Jump

Take-off is a critical phase of flight, and many birds jump to take to the air. Although the actuation of the hindlimb in terrestrial birds is not limited to the sagittal plane, and considerable non-sagittal plane motion has been observed during take-off jumps, how the spatial arrangement of hindlimb muscles in flying birds facilitates such jumps has received little attention. This study aims to ascertain the 3D hip muscle function in the magpie (Pica pica), a bird known to jump to take-off. A musculoskeletal model of the magpie hindlimb was developed using μCT scans (isotropic resolution of 18.2 μm) to derive bone surfaces, while the 3D muscle path definition was further informed by the literature. Function was robustly characterized by determining the 3D moment-generating capacity of 14 hip muscles over the functional joint range of motion during a take-off leap considering variations across the attachment areas and uncertainty in dynamic muscle geometry. Ratios of peak flexion-extension (FE) to internal-external rotation (IER) and abduction-adduction (ABD) moment-generating capacity were indicators of muscle function. Analyses of 972 variations of the 3D muscle paths showed that 11 of 14 muscles can act as either flexor or extensor, while all 14 muscles demonstrated the capacity to act as internal or external rotators of the hip with the mean ratios of peak FE to IER and ABD moment-generating capacity were 0.89 and 0.31, respectively. Moment-generating capacity in IER approaching levels in the FE moment-generating capacity determined here underline that the avian hip muscle function is not limited to the sagittal plane. Together with previous findings on the 3D nature of hindlimb kinematics, our results suggest that musculoskeletal models to develop a more detailed understanding of how birds orchestrate the use of muscles during a take-off jump cannot be restricted to the sagittal plane.

Musculoskeletal modelling of the Nile crocodile (Crocodylus niloticus) hindlimb: Effects of limb posture on leverage during terrestrial locomotion

We developed a three-dimensional, computational biomechanical model of a juvenile Nile crocodile (Crocodylus niloticus) pelvis and hindlimb, composed of 47 pelvic limb muscles, to investigate muscle function. We tested whether crocodiles, which are known to use a variety of limb postures during movement, use limb orientations (joint angles) that optimise the moment arms (leverages) or moment-generating capacities of their muscles during different limb postures ranging from a high walk to a sprawling motion. We also describe the three-dimensional (3D) kinematics of the crocodylian hindlimb during terrestrial locomotion across an instrumented walkway and a treadmill captured via X-ray Reconstruction of Moving Morphology (biplanar fluoroscopy; 'XROMM'). We reconstructed the 3D positions and orientations of each of the hindlimb bones and used dissection data for muscle lines of action to reconstruct a focal, subject-specific 3D musculoskeletal model. Motion data for different styles of walking (a high, crouched, bended and two types of sprawling motion) were fed into the 3D model to identify whether any joints adopted near-optimal poses for leverage across each of the behaviours. We found that (1) the hip adductors and knee extensors had their largest leverages during sprawling postures and (2) more erect postures typically involved greater peak moment arms about the hip (flexion-extension), knee (flexion) and metatarsophalangeal (flexion) joints. The results did not fully support the hypothesis that optimal poses are present during different locomotory behaviours because the peak capacities were not always reached around mid-stance phase. Furthermore, we obtained few clear trends for isometric moment-generating capacities. Therefore, perhaps peak muscular leverage in Nile crocodiles is instead reached either in early/late stance or possibly during swing phase or other locomotory behaviours that were not studied here, such as non-terrestrial movement. Alternatively, our findings could reflect a trade-off between having to execute different postures, meaning that hindlimb muscle leverage is not optimised for any singular posture or behaviour. Our model, however, provides a comprehensive set of 3D estimates of muscle actions in extant crocodiles which can form a basis for investigating muscle function in extinct archosaurs.

Automatic generation of personalised skeletal models of the lower limb from three-dimensional bone geometries

The generation of personalised and patient-specific musculoskeletal models is currently a cumbersome and time-consuming task that normally requires several processing hours and trained operators. We believe that this aspect discourages the use of computational models even when appropriate data are available and personalised biomechanical analysis would be beneficial. In this paper we present a computational tool that enables the fully automatic generation of skeletal models of the lower limb from three-dimensional bone geometries, normally obtained by segmentation of medical images. This tool was evaluated against four manually created lower limb models finding remarkable agreement in the computed joint parameters, well within human operator repeatability. The coordinate systems origins were identified with maximum differences between 0.5 mm (hip joint) and 5.9 mm (subtalar joint), while the joint axes presented discrepancies between 1° (knee joint) to 11° (subtalar joint). To prove the robustness of the methodology, the models were built from four datasets including both genders, anatomies ranging from juvenile to elderly and bone geometries reconstructed from high-quality computed tomography as well as lower-quality magnetic resonance imaging scans. The entire workflow, implemented in MATLAB scripting language, executed in seconds and required no operator intervention, creating lower extremity models ready to use for kinematic and kinetic analysis or as baselines for more advanced musculoskeletal modelling approaches, of which we provide some practical examples. We auspicate that this technical advancement, together with upcoming progress in medical image segmentation techniques, will promote the use of personalised models in larger-scale studies than those hitherto undertaken.

Automated creation and tuning of personalised muscle paths for OpenSim musculoskeletal models of the knee joint

Computational modelling is an invaluable tool for investigating features of human locomotion and motor control which cannot be measured except through invasive techniques. Recent research has focussed on creating personalised musculoskeletal models using population-based morphing or directly from medical imaging. Although progress has been made, robust definition of two critical model parameters remains challenging: (1) complete tibiofemoral (TF) and patellofemoral (PF) joint motions, and (2) muscle tendon unit (MTU) pathways and kinematics (i.e. lengths and moment arms). The aim of this study was to develop an automated framework, using population-based morphing approaches to create personalised musculoskeletal models, consisting of personalised bone geometries, TF and PF joint mechanisms, and MTU pathways and kinematics. Informed from medical imaging, personalised rigid body TF and PF joint mechanisms were created. Using atlas- and optimisation-based methods, personalised MTU pathways and kinematics were created with the aim of preventing MTU penetration into bones and achieving smooth MTU kinematics that follow patterns from existing literature. This framework was integrated into the Musculoskeletal Atlas Project Client software package to create and optimise models for 6 participants with incrementally increasing levels of personalisation with the aim of improving MTU kinematics and pathways. Three comparisons were made: (1) non-optimised (Model 1) and optimised models (Model 3) with generic joint mechanisms; (2) non-optimised (Model 2) and optimised models (Model 4) with personalised joint mechanisms; and (3) both optimised models (Model 3 and 4). Following optimisation, improvements were consistently shown in pattern similarity to cadaveric data in comparison (1) and (2). For comparison (3), a number of comparisons showed no significant difference between the two compared models. Importantly, optimisation did not produce statistically significantly worse results in any case.

In Silico-Enhanced Treatment and Rehabilitation Planning for Patients with Musculoskeletal Disorders: Can Musculoskeletal Modelling and Dynamic Simulations Really Impact Current Clinical Practice?

Over the past decades, the use of computational physics-based models representative of the musculoskeletal (MSK) system has become increasingly popular in many fields of clinically driven research, locomotor rehabilitation in particular. These models have been applied to various functional impairments given their ability to estimate parameters which cannot be readily measured in vivo but are of interest to clinicians. The use of MSK modelling and simulations allows analysis of relevant MSK biomarkers such as muscle and joint contact loading at a number of different stages in the clinical treatment pathway in order to benefit patient functional outcome. Applications of these methods include optimisation of rehabilitation programs, patient stratification, disease characterisation, surgical pre-planning, and assistive device and exoskeleton design and optimisation. This review provides an overview of current approaches, the components of standard MSK models, applications, limitations, and assumptions of these modelling and simulation methods, and finally proposes a future direction.

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

Musculoskeletal modelling is an important platform on which to study the biomechanics of morphological structures in vertebrates and is widely used in clinical, zoological and palaeontological fields. The popularity of this approach stems from the potential to non-invasively quantify biologically important but difficult-to-measure functional parameters. However, while it is known that model predictions are highly sensitive to input values, it is standard practice to build models by combining musculoskeletal data from different sources resulting in 'generic' models for a given species. At present, there are little quantitative data on how merging disparate anatomical data in models impacts the accuracy of these functional predictions. This issue is addressed herein by quantifying the accuracy of both subject-specific human limb models containing individualised muscle force-generating properties and models built using generic properties from both elderly and young individuals, relative to experimental muscle torques obtained from an isokinetic dynamometer. The results show that subject-specific models predict isokinetic muscle torques to a greater degree of accuracy than generic models at the ankle (root-mean-squared error - 7.9% vs. 49.3% in elderly anatomy-based models), knee (13.2% vs. 57.3%) and hip (21.9% vs. 32.8%). These results have important implications for the choice of musculoskeletal properties in future modelling studies, and the relatively high level of accuracy achieved in the subject-specific models suggests that such models can potentially address questions about inter-subject variations of muscle functions. However, despite relatively high levels of overall accuracy, models built using averaged generic muscle architecture data from young, healthy individuals may lack the resolution and accuracy required to study such differences between individuals, at least in certain circumstances. The results do not wholly discourage the continued use of averaged generic data in musculoskeletal modelling studies but do emphasise the need for to maximise the accuracy of input values if studying intra-species form-function relationships in the musculoskeletal system.