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2 pages, 158 KiB

Open AccessEditorial

Special Issue: Musculoskeletal Models in a Clinical Perspective

by Carlo Albino Frigo

Appl. Sci. 2021, 11(14), 6250; https://doi.org/10.3390/app11146250 - 6 Jul 2021

Cited by 1 | Viewed by 1543

Abstract

After the pioneering work of Scott Delp and colleagues dated 1990 (An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures, [...] Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

Research

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11 pages, 15480 KiB

Open AccessArticle

Biomechanical Consequences of Tibial Insert Thickness after Total Knee Arthroplasty: A Musculoskeletal Simulation Study

by Periklis Tzanetis, Marco A. Marra, René Fluit, Bart Koopman and Nico Verdonschot

Appl. Sci. 2021, 11(5), 2423; https://doi.org/10.3390/app11052423 - 9 Mar 2021

Cited by 10 | Viewed by 5698

Abstract

The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations [...] Read more.

The thickness of the tibial polyethylene (PE) insert is a critical parameter to ensure optimal soft-tissue balancing in the intraoperative decision-making procedure of total knee arthroplasty (TKA). However, there is a paucity of information about the kinetic response to PE insert thickness variations in the tibiofemoral (TF) joint, and subsequently, the secondary effects on the patellofemoral (PF) biomechanics. Therefore, the purpose of this study was to investigate the influence of varying PE insert thickness on the ligament and TF compressive forces, as well as on the PF forces and kinematics, after a cruciate-retaining TKA. A previous patient-specific musculoskeletal model of TKA was adapted to simulate a chair-rising motion in which PE insert thickness was varied with 2 mm increments or decrements compared to the reference case (9 mm), from 5 mm up to 13 mm. Greater PE insert thickness resulted in higher ligament forces and concurrently increased the TF compressive force by 21% (13 mm), but slightly unloaded the PF joint with 7% (13 mm) while shifting the patella distally in the trochlear groove, compared to the reference case. Thinner PE inserts showed an opposite trend. Our findings suggest that the optimal PE insert thickness selection is a trade-off between the kinetic outcomes of the TF and PF joints. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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20 pages, 5847 KiB

Open AccessFeature PaperArticle

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

by Carlo Albino Frigo and Lucia Donno

Appl. Sci. 2021, 11(5), 2356; https://doi.org/10.3390/app11052356 - 6 Mar 2021

Cited by 13 | Viewed by 5371

Abstract

A musculoskeletal model was developed to analyze the tensions of the knee joint ligaments during walking and to understand how they change with changes in the muscle forces. The model included the femur, tibia, patella and all components of cruciate and collateral ligaments, [...] Read more.

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

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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11 pages, 1234 KiB

Open AccessArticle

Effects of Hip Abductor Strengthening on Musculoskeletal Loading in Hip Dysplasia Patients after Total Hip Replacement

by Giordano Valente, Fulvia Taddei, Alberto Leardini and Maria Grazia Benedetti

Appl. Sci. 2021, 11(5), 2123; https://doi.org/10.3390/app11052123 - 27 Feb 2021

Cited by 7 | Viewed by 2837

Abstract

Hip dysplasia patients after total hip replacement show worse functional performance compared to primary osteoarthritis patients, and unfortunately there is no research on muscle and joint loads that would help understand rehabilitation effects, motor dysfunctions and failure events. We tested the hypothesis that [...] Read more.

Hip dysplasia patients after total hip replacement show worse functional performance compared to primary osteoarthritis patients, and unfortunately there is no research on muscle and joint loads that would help understand rehabilitation effects, motor dysfunctions and failure events. We tested the hypothesis that a higher functional improvement in hip dysplasia patients who received hip abductor strengthening after hip replacement, would result in different gait function and musculoskeletal loads during walking compared to patients who performed standard rehabilitation only. In vivo gait analysis and musculoskeletal modeling were used to analyze the differences in gait parameters and hip and muscle forces during walking between the two groups of patients. We found that, in a functional scenario of very mild abnormalities, the patients who performed muscle strengthening expressed a more physiological force pattern and a generally greater force in the operated limb, although statistically significant in limited portions of the gait cycle, and likely related to a higher gait speed. We conclude that in a low-demand task, the abductor strengthening program does not have a marked effect on hip loads, and further studies on hip dysplasia patients would help clarify the effect of muscle strengthening on loads. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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12 pages, 8266 KiB

Open AccessFeature PaperArticle

The Effects of the Rectus Femoris Muscle on Knee and Foot Kinematics during the Swing Phase of Normal Walking

by Carlo Albino Frigo, Christian Wyss and Reinald Brunner

Appl. Sci. 2020, 10(21), 7881; https://doi.org/10.3390/app10217881 - 6 Nov 2020

Cited by 12 | Viewed by 5734

Abstract

The role of rectus femoris (RF) muscle during walking was analyzed through musculoskeletal models to understand the effects of muscle weakness and hyperactivity. Such understanding is fundamental when dealing with pathological gait, but the contribution of RF as a bi-articular muscle is particularly [...] Read more.

The role of rectus femoris (RF) muscle during walking was analyzed through musculoskeletal models to understand the effects of muscle weakness and hyperactivity. Such understanding is fundamental when dealing with pathological gait, but the contribution of RF as a bi-articular muscle is particularly difficult to estimate. Anybody software was used for inverse dynamics computation, and SimWise-4D for forward dynamics simulations. RF force was changed in the range of 0 to 150%, and the resulting kinematics were analyzed. Inverse dynamics showed a short positive RF power in correspondence with the onset of knee extension in the swing phase. Forward dynamics simulations showed an increasing knee flexion and initial toe contact when the RF force was decreased, and increasing knee extension and difficult foot clearance when the RF force was increased. The step became shorter with both increased and reduced RF force. In conclusion, the RF actively contributes to the knee extension in the swing phase. RF also contributes to obtaining a proper step length and to preparing the foot for initial heel contact. So the effect of RF muscle as a bi-articular muscle seems fundamental in controlling the motion of distal segments. RF overactivity should be considered as a possible cause for poor foot clearance in some clinical cases, while RF weakness should be considered in cases with apparent equinus. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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Graphical abstract

16 pages, 4649 KiB

Open AccessArticle

Development of a Musculoskeletal Model of Hyolaryngeal Elements for Understanding Pharyngeal Swallowing Mechanics

by Takuya Hashimoto, Mariko Urabe, Foo Chee-Sheng, Atsuko Murakoshi, Takahiro Kikuchi, Yukihiro Michiwaki and Takuji Koike

Appl. Sci. 2020, 10(18), 6276; https://doi.org/10.3390/app10186276 - 9 Sep 2020

Cited by 8 | Viewed by 3243

Abstract

A detailed understanding of muscle activity in human swallowing would provide insights into the complex neuromuscular coordination underlying swallowing. The purpose of this study was to introduce musculoskeletal analysis to investigate muscle activities involved in swallowing as there are limitations on studying comprehensive [...] Read more.

A detailed understanding of muscle activity in human swallowing would provide insights into the complex neuromuscular coordination underlying swallowing. The purpose of this study was to introduce musculoskeletal analysis to investigate muscle activities involved in swallowing as there are limitations on studying comprehensive muscle activation patterns by conventional methods such as electromyography (EMG) measurement. A musculoskeletal model of swallowing was newly developed based on the skeletal model made from CT data of a healthy volunteer. Individual muscle forces were predicted in pharyngeal swallowing by inverse dynamics’ computations with static optimization, in which the typical trajectories of the hyoid bone and thyroid cartilage analyzed from videofluoroscopic (VF) data of the volunteer were used. The results identified the contribution of individual muscles in pharyngeal swallowing in relation to the movements of the hyoid bone and thyroid cartilage. The predicted sequence of muscle activity showed a qualitative agreement with salient features in previous studies with fine wire EMG measurements. This method, if validated further by imaging and EMG studies, enables studying a broader range of neuromuscular coordination in swallowing. The proposed method offers an avenue to understanding the physiological mechanisms of swallowing and could become useful to evaluate rehabilitation effects on dysphagia. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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14 pages, 1977 KiB

Open AccessArticle

Assessment of Motion and Muscle Activation Impacts on Low Back Pain during Pregnancy Using an Inertial Measurement Unit

by Saori Morino, Mamoru Yamashita, Fumiko Umezaki, Hiroko Hatanaka and Masaki Takahashi

Appl. Sci. 2020, 10(11), 3690; https://doi.org/10.3390/app10113690 - 26 May 2020

Cited by 1 | Viewed by 3173

Abstract

Specific physiological changes during pregnancy exert excessive strain on muscles such as the erector spinae (ES) and contribute to low back pain (LBP). The link between LBP and sit-to-stand (STS) motion has previously been investigated through motion analysis using an inertial measurement unit [...] Read more.

Specific physiological changes during pregnancy exert excessive strain on muscles such as the erector spinae (ES) and contribute to low back pain (LBP). The link between LBP and sit-to-stand (STS) motion has previously been investigated through motion analysis using an inertial measurement unit (IMU); however, the factors leading to LBP have not been revealed. Moreover, clinicians require an effective assessment method for reducing the physical burden on pregnant women. Therefore, the investigation of the relationships between motion, muscle load calculated from musculoskeletal model for pregnancy, and the severity of LBP during STS in pregnant women was conducted. Furthermore, this study proposes a method for assessing motion and muscle load during STS using an IMU. The relationship among (i) motion evaluation indices and ES muscle torque, and (ii) the ES torque and the intensity of LBP during STS was investigated. As the results, significant positive correlations were observed between (i) the angular velocity of the torso in the sagittal plane and ES torque, and (ii) two types of evaluation indices of ES torque and intensity of LBP. The proposed method by an IMU attached to the torso could effectively assess ES load related to LBP during STS in pregnant women. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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Review

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22 pages, 11306 KiB

Open AccessReview

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

by Bryce A Killen, Antoine Falisse, Friedl De Groote and Ilse Jonkers

Appl. Sci. 2020, 10(20), 7255; https://doi.org/10.3390/app10207255 - 16 Oct 2020

Cited by 28 | Viewed by 5355

Abstract

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 [...] Read more.

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. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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Other

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28 pages, 793 KiB

Open AccessPerspective

A Conceptual Blueprint for Making Neuromusculoskeletal Models Clinically Useful

by Benjamin J. Fregly

Appl. Sci. 2021, 11(5), 2037; https://doi.org/10.3390/app11052037 - 25 Feb 2021

Cited by 27 | Viewed by 5548

Abstract

The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on [...] Read more.

The ultimate goal of most neuromusculoskeletal modeling research is to improve the treatment of movement impairments. However, even though neuromusculoskeletal models have become more realistic anatomically, physiologically, and neurologically over the past 25 years, they have yet to make a positive impact on the design of clinical treatments for movement impairments. Such impairments are caused by common conditions such as stroke, osteoarthritis, Parkinson’s disease, spinal cord injury, cerebral palsy, limb amputation, and even cancer. The lack of clinical impact is somewhat surprising given that comparable computational technology has transformed the design of airplanes, automobiles, and other commercial products over the same time period. This paper provides the author’s personal perspective for how neuromusculoskeletal models can become clinically useful. First, the paper motivates the potential value of neuromusculoskeletal models for clinical treatment design. Next, it highlights five challenges to achieving clinical utility and provides suggestions for how to overcome them. After that, it describes clinical, technical, collaboration, and practical needs that must be addressed for neuromusculoskeletal models to fulfill their clinical potential, along with recommendations for meeting them. Finally, it discusses how more complex modeling and experimental methods could enhance neuromusculoskeletal model fidelity, personalization, and utilization. The author hopes that these ideas will provide a conceptual blueprint that will help the neuromusculoskeletal modeling research community work toward clinical utility. Full article

(This article belongs to the Special Issue Musculoskeletal Models in a Clinical Perspective)

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