Modeling Musculoskeletal Dynamics during Gait: Evaluating the Best Personalization Strategy through Model Anatomical Consistency

Michele Conconi,Nicola Sancisi,Claudia Mazzà,Erica Montefiori

doi:10.3390/app11188348

Michele Conconi, Nicola Sancisi + Show 2 more

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https://doi.org/10.3390/app11188348

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Abstract

No consensus exists on how to model human articulations within MSK models for the analysis of gait dynamics. We propose a method to evaluate joint models and we apply it to three models with different levels of personalization. The method evaluates the joint model’s adherence to the MSK hypothesis of negligible joint work by quantifying ligament and cartilage deformations resulting from joint motion; to be anatomically consistent, these deformations should be minimum. The contrary would require considerable external work to move the joint, violating a strong working hypothesis and raising concerns about the credibility of the MSK outputs. Gait analysis and medical resonance imaging (MRI) from ten participants were combined to build lower limb subject-specific MSK models. MRI-reconstructed anatomy enabled three levels of personalization using different ankle joint models, in which motion corresponded to different ligament elongation and cartilage co-penetration. To estimate the impact of anatomical inconsistency in MSK outputs, joint internal forces resulting from tissue deformations were computed for each joint model and MSK simulations were performed ignoring or considering their contribution. The three models differed considerably for maximum ligament elongation and cartilage co-penetration (between 5.94 and 50.69% and between −0.53 and −5.36 mm, respectively). However, the model dynamic output from the gait simulations were similar. When accounting for the internal forces associated with tissue deformation, outputs changed considerably, the higher the personalization level the smaller the changes. Anatomical consistency provides a solid method to compare different joint models. Results suggest that consistency grows with personalization, which should be tailored according to the research question. A high level of anatomical consistency is recommended when individual specificity and the behavior of articular structures is under investigation.

Highlights

The aim of this paper is to show how anatomical consistency can be used to discriminate among different joint models
The effects of joint personalization were more evident when looking at single individuals: Maximum-Congruence Floating Axis Joint (MCJ) showed good anatomical consistency for each of the modeled dataset; Morphologically Fitted Hinge Joint (MFJ) exceeded the experimental threshold of
While our analysis focused on the effect of anatomical inconsistency on the ankle joint, a comprehensive approach should look at the whole kinematic chain (KC) including joints with more complex kinematics, such as the knee or the articulations within the foot

Summary

Introduction

Musculoskeletal (MSK) models allow the evaluation of quantities otherwise not directly measurable in vivo, such as muscle and joint internal forces, during gait and other daily tasks. They bring the advantages of predictions into the process of designing and personalizing interventions and medical devices. MSK models are not yet employed on a wide scale in healthcare [3,4] and a well-established framework to accurately predict neuromusculoskeletal dynamics of healthy and pathologic individuals is still lacking [5] This is associated to the lack of gold standards, which makes it difficult to quantify the advantages or disadvantages of available approaches [2]

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