Joint Contact Forces Research Articles

Estimation of joint contact pressure in the index finger using a hybrid finite element musculoskeletal approach

The knowledge of local stress distribution in hand joints is crucial to understand injuries and osteoarthritis occurrence. However, determining cartilage contact stresses remains a challenge, requiring numerical models including both accurate anatomical components and realistic tendon force actuation. Contact forces in finger joints have frequently been calculated but little data is available on joint contact pressures. This study aimed to develop and assess a hybrid biomechanical model of the index finger to estimate in-vivo joint contact pressure during a static maximal strength pinch grip task. A finite element model including bones, cartilage, tendons, and ligaments was developed, with tendon force transmission based on a tendon-pulley system. This model was driven by realistic tendon forces estimated from a musculoskeletal model and motion capture data for six subjects. The hybrid model outputs agreed well with the experimental measurement of fingertip forces and literature data on the physiological distribution of tendon forces through the index finger. Mean contact pressures were 6.9 ± 2.7 MPa, 6.2 ± 1.0 MPa and 7.2 ± 1.3 MPa for distal, proximal interphalangeal and metacarpophalangeal joints, respectively. Two subjects had higher mean contact pressure in the distal joint than in the other two joints, suggesting a mechanical cause for the prevalence of osteoarthritis in the index distal joint. The inter-subject variability in joint contact pressure could be explained by different neuromuscular strategies employed for the task. This first application of an effective hybrid model to the index finger is promising for estimating hand joint stresses under daily grip tasks and simulating surgical procedures.

Individual muscle contributions to hip joint-contact forces during walking in unilateral transfemoral amputees with osseointegrated prostheses

Direct skeletal attachment of prostheses in transfemoral amputees circumvents skin-interface complications associated with conventional sockets; however, joint pain and musculoskeletal disease is known to occur postoperatively. This study quantified hip contact forces and the roles of individual muscles in producing hip contact forces during walking in transfemoral amputees with osseointegrated prostheses. Musculoskeletal models were developed for four transfemoral amputees. Gluteus maximus and gluteus medius were the major contributors to the hip contact forces, and the intact limb hip muscles demonstrated greater contributions to hip contact forces than those of the residual limb. The findings may be useful for mitigating walking asymmetry.

Dynamic trajectory adjustment of lower limb exoskeleton in swing phase based on impedance control strategy

The lower limb exoskeleton provides assistance by following the lower limb joints’ desired motion trajectory. However, angle control is not enough to meet the requirements in some special circumstances such as encountering obstacles. In the swing phase of the attached leg with the exoskeleton, there is a different contact force between the sole and the road surface in different road conditions. Therefore, it is particularly important to control the joint angle and contact force simultaneously, that is, it is not only necessary to follow the desired angle but also to minimize the influence of external contact force. In this article, a novel scheme is proposed to adjust the trajectory dynamically in the swing phase. First of all, the physical model is streamlined and the Lagrangian principle is carried out to dynamic analysis and established a model of lower limb exoskeleton in the swing phase. Furthermore, the angle dynamics equation is transformed into a Cartesian coordinate system to calculate the end contact force for the impedance model. Finally, the impedance control strategy together with a disturbance observer is designed which is suitable for nonlinear and strong coupling characteristics. The simulation result shows that the control system can follow the angle accurately in the condition of minimizing external constraints. Hardware experiment shows that lower extremity exoskeleton can adjust motion trajectory actively when encountering obstacles and complete the movement trajectory tracking at the same time.

Knee Medial Compartment Joint Loads In Stationary Cycling With Increased Q-factor

As Q-Factor (QF: inter-pedal width) is increased, the knee abduction moment also increases. Though the knee abduction moment has been associated with knee medial compartment joint load, it is not a direct measure of joint contact forces. In the absence of in vivo measurement using an instrumented knee implant, musculoskeletal modeling simulations may provide a viable option for estimation of knee joint contact forces. PURPOSE: To estimate the total knee joint compressive force (TCF) and knee medial compartment joint compressive force (MCF) in stationary cycling with increasing QF using musculoskeletal simulation. METHODS: Five recreationally active males cycled on a stationary ergometer at a workrate of 80 Watts and a cadence of 80 rotations per minute at two QF: original QF (150mm), and wide QF (276mm). Wide QF was increased using pedal extenders. Three-dimensional kinematic data (240 Hz, Vicon) and pedal reaction forces using two custom instrumented bike pedals (1200 Hz, Kistler) were collected. A modified gait2392 model with a knee that includes hinge joints for the medial and lateral compartments was used to estimate muscle forces with static optimization and TCF and MCF with joint reaction analysis (3.3 OpenSim, SimTK, Stanford University). Paired samples t-test and Cohen’s d were used to detect differences between conditions. RESULTS: Peak TCF increased from original to wide QF (960.2 ± 258.2 N to 1117.3 ± 202.1 N ; p = 0.299; d = 0.54) and MCF increased from original to wide QF (792.2 ± 98.4 N to 1029.2 ± 315.5 N; p = 0.116; d = 0.89). CONCLUSION: Large standard deviations and small sample size may account for the lack of statistical significance, yet medium and large effect sizes may allude TCF and MCF increases with greater QF (Figure 1). It appears the majority of TCF is born by the medial compartment; TCF and MCF ranged from 1.46 and 1.14 BW for original and 1.75 to 1.42 BW for wide QF, respectively. These loads are much smaller than 2.0-2.5 BW found in walking and 4.0 BW in jogging.

Predicting longitudinal changes in joint contact forces in a juvenile population: scaled generic versus subject-specific musculoskeletal models

Subject-specific musculoskeletal model use in clinical settings is limited due to development-associated time and effort burdens together with potential medical imaging unavailability. As an alternative, this study investigated consistency in estimating longitudinal changes in joint contact forces (JCF) between scaled generic and subject-specific models. For 11 children, joint kinematics and JCF were calculated using subject-specific and scaled generic models. JCF changes estimated by both models were strongly correlated for the hip and knee although JCF estimates varied between models. Findings suggest that within specified limits of accuracy, scaled generic models are sensitive enough to detect JCF changes consistent with subject-specific models.

Impact of alignment and kinematic variation on resistive moment and dislocation propensity for THA with lipped and neutral liners.

Instability and dislocation remain leading indications for revision of total hip arthroplasty (THA). Many studies have addressed the links between implant design and dislocation; however, an understanding of the impact of alignment and kinematic variability on constraint of modern THA constructs to provide joint stability is needed. The objective of this study is to provide objective data to be considered in the treatment algorithm to protect against joint instability. Joint contact and muscle forces were evaluated using musculoskeletal models of THA patients performing activities consistent with posterior and anterior dislocation. Position and joint loads were transferred to a finite element simulation with an experimentally calibrated hip capsule representation, where they were kinematically extrapolated until impingement and eventual dislocation. Cup anteversion and inclination were varied according to clinical measurements, and variation in imposed kinematics was included. The resistive moment provided by the contact force and joint capsule, and overall dislocation rate (dislocations/total simulations) were determined with neutral and lipped acetabular liners. Use of a lipped liner did increase the resistive moment in posterior dislocation, by an average of 5.2 Nm, and the flexion angle at dislocation by 1.4° compared to a neutral liner. There was a reduction in similar magnitude in resistance to anterior dislocation. Increased cup anteversion and inclination, hip abduction and internal rotation all reduced the occurrence of posterior dislocation but increased anterior dislocation. A quantitative understanding of tradeoffs in the dislocation risk inherent to THA construct options is valuable in supporting surgical decision making.

The Uncontrolled Manifold Theory Could Explain Part of the Inter-Trial Variability of Knee Contact Force During Level Walking.

Accurate predictions of joint contact forces through computer simulation of musculoskeletal dynamics can provide insight, in a non-invasive manner, into the joint loads of patients with osteoarthritis and healthy controls. The current approach to assume optimal control, in terms of metabolic energy expenditure, remains a major limitation of the prediction of muscle activation patterns that determine joint contact forces. Stochastically optimal muscle control, in the form of a stochastic component superimposed to the optimal control, could potentially explain the inter-trial variability as observed in measured knee contact forces during level walking. A probabilistic approach was used to predict sets of possible muscle activation patterns within a 5 and 10% limit from the optimal muscle activation pattern. The knee contact forces determined by both the optimal and stochastically optimal muscle activation patterns were compared to the corresponding knee contact force patterns measured by an instrumented implant. The range of muscle control patterns captured the inter-trial variability of knee contact forces for most of the gait cycle, suggesting that the probabilistic approach used here is representative of a stochastically optimal control that accounts for co-contraction, whereas during some time intervals a more explicit representation of the motor control strategy is required. These findings underline the importance of stochastically optimal muscle control in the prediction of knee forces within a multi-body dynamics approach.

A biomechanical field testing approach in snow sports: Case studies toward a detailed analysis of joint loading

In this study, kinematic and kinetic measurements were combined to assess the effects of removing the stiff shaft from a ski boot. It was hypothesized that joint flexion at the ankle, knee and hip increase and reduce joint loading specifically at the knee. A previously developed force sensor was combined with a high-speed camera system for data collection of 6 degrees of freedom ground reaction forces and three-dimensional marker data in the field on a wave slope. The collected data were used as input to a musculoskeletal model for the estimation of joint kinematics and joint moments and contact forces in the ankle and knee. The force sensor, which was previously used for skiing, had experienced wear and tear and was thus prone to breakage. As a result, joint loading could only be analyzed for two skiers. These two skiers did not use the added range of ankle flexion to its full extent, but showed substantial reductions in joint moments and joint contact forces (e.g. knee compression force from 85 to 57 N/kg). Only one of the five experienced skiers tested was able to adopt the anticipated movement pattern by substantially increased maximum ankle joint flexion angle (from 10° to 37°) and knee joint flexion angle (from 93° to 105°) and the respective ranges of motion when skiing through a wave course. The study provides information on possible individual adaptations to ski boot modifications. The mechanical construction of the force sensor will need to be modified to withstand the high forces expected during freestyle skiing. The study also supports the future use of this measurement setup for comprehensive studies in snow sports, provided that a sufficient training period is given.

Technique for Medial Closing-Wedge Proximal Tibia Osteotomy in the Valgus Knee

Valgus malalignment can be corrected with a medial closing-wedge proximal tibia osteotomy in patients with symptomatic lateral compartment disease. Advantages of this technique include the inherent stability of the closing wedge with direct bone contact and reliable healing that enables early weight bearing and shorter recovery time. In addition, a tibial-based osteotomy alters joint contact forces in both flexion and extension versus femoral-based osteotomies. The purpose of this article is to present a reproducible technique for medial closing-wedge proximal tibia osteotomy and review the indications, preoperative planning, rationale, and clinical outcomes.

Higher knee contact forces might underlie increased osteoarthritis rates in high functioning amputees: A pilot study.

High functioning military transtibial amputees (TTAs) with well-fitted state of the art prosthetics have gait that is indistinguishable from healthy individuals, yet they are more likely to develop knee osteoarthritis (OA) of their intact limbs. This contrasts with the information at the knees of the amputated limbs that have been shown to be at a significantly reduced risk of pain and OA. The hypothesis of this study is that biomechanics can explain the difference in knee OA risk. Eleven military unilateral TTAs and eleven matched healthy controls underwent gait analysis. Muscle forces and joint contact forces at the knee were quantified using musculoskeletal modeling, validated using electromyography measurements. Peak knee contact forces for the intact limbs on both the medial and lateral compartments were significantly greater than the healthy controls (P ≤ .006). Additionally, the intact limbs had greater peak semimembranosus (P = .001) and gastrocnemius (P ≤ .001) muscle forces compared to the controls. This study has for the first time provided robust evidence of increased force on the non-affected knees of high functioning TTAs that supports the mechanically based hypothesis to explain the documented higher risk of knee OA in this patient group. The results suggest several protentional strategies to mitigate knee OA of the intact limbs, which may include the improvements of the prosthetic foot control, socket design, and strengthening of the amputated muscles.

Joint contact force and movement deceleration among badminton forward lunges: a musculoskeletal modelling study

ABSTRACT Joint contact force is the actual force applied on the articular surface that could predict performance and injuries, but rarely reported for badminton sport. The study sought to calculate lower limb joint contact force and decelerative kinematics for badminton forward lunges. Fifteen badminton players performed backhand and forehand forward lunges in random order. The kinematic and kinetic data were input to scale a musculoskeletal model and solve inverse dynamics in the simulations. Outcome variables were compared between lunge conditions using repeated measures MANOVA. Forehand lunge produced higher compressional ankle contact force (p = 0.040, partial η2 = 0.14), faster touchdown hip abduction (p = 0.031, partial η2 = 0.16), and larger horizontal deceleration of the mass centre (p = 0.016, partial η2 = 0.19) and torso (p = 0.031, partial η2 = 0.16) compared to backhand lunge. Despite the statistical significance, we found that the increments of joint loading in forehand lunge were small (<5%) with limited effect size and could be attributed to the larger movement deceleration during braking. These force changes could possess performance merits. However, its linkage to injury risk is unclear and warrants further investigation.

Effect of gap outside contact area on lubrication of metal-on-Metal total hip replacement

Ball-in-socket metal on metal (MOM) contacts were analysed using the Abaqus Finite Element package to simulate dry contact between the acetabular cup and the femoral head. Different cup thicknesses of 4, 6, 8, and 10 mm were considered using a polyurethane foam block support system. Elastohydrodynamic lubrication (EHL) analyses were developed for the contacts using three different approaches to specify the contact. These were (i) A simple model based on the radii of relative curvature, (ii) An equivalent contact model developed so that its dry contact area and maximum pressure replicated the values obtained from the FE analysis, and (iii) A modified version of (ii) that also ensured equivalence of the gap shape outside the contact area. Published in vivo information for the hip joint contact forces over the walking cycle was used to specify the operating conditions for the EHL analysis. The analysis method was found to be effective for all points of the walking cycle for cases where the cup thickness exceeded 5 mm and modelling approach (ii) was identified as satisfactory. For a cup thickness of 4 mm, membrane action began to emerge in the FE analyses so that such contacts behaved in a different way.

Effect of exercise on knee joint contact forces in people following medial partial meniscectomy: A secondary analysis of a randomised controlled trial

BackgroundArthroscopic partial meniscectomy may cause knee osteoarthritis, which may be related to altered joint loading. Previous research has failed to demonstrate that exercise can reduce medial compartment knee loads following meniscectomy but has not considered muscular loading in their estimates. Research questionWhat is the effect of exercise compared to no intervention on peak medial tibiofemoral joint contact force during walking using an electromyogram-driven neuromusculoskeletal model, following medial arthroscopic partial meniscectomy? MethodsThis is a secondary analysis of a randomized controlled trial (RCT). 41 participants aged between 30–50 years with medial arthroscopic partial meniscectomy within the past 3–12 months, were randomly allocated to either a 12-week, home-based, physiotherapist-guided exercise program or to no exercise (control group). Three-dimensional lower-body motion, ground reaction forces, and surface electromyograms from eight lower-limb muscles were acquired during self-selected normal- and fast-paced walking at baseline and follow-up. An electromyogram-driven neuromusculoskeletal model estimated medial compartment contact forces (body weight). Linear regression models evaluated between-group differences (mean difference (95% CI)). ResultsThere were no significant between-group differences in the change (follow-up minus baseline) in first peak medial contact force during self-selected normal- or fast-paced walking (0.07 (−0.08 to 0.23), P = 0.34 and 0.01 (−0.19 to 0.22), P = 0.89 respectively). No significant between-group difference was found for change in second peak medial contact force during normal- or fast-paced walking (0.09 (−0.09 to 0.28), P = 0.31 and 0.02 (−0.17 to 0.22), P = 0.81 respectively). At the individual level, variability was observed for changes in first (range −26.2% to +31.7%) and second (range −46.5% to +59.9%) peak tibiofemoral contact force. SignificanceThis is the first study to apply electromyogram-driven neuromusculoskeletal modelling to an exercise intervention in a RCT. While our results suggest that a 12-week exercise program does not alter peak medial knee loads after meniscectomy, within-participant variability suggests individual-specific muscle activation patterns that warrant further investigation.

Hip muscle and joint contact forces before, 6 and 12 months after minimally invasive periacetabular osteotomy.

Previous studies on different periacetabular osteotomy approaches for correction of hip dysplasia disagree on the time course of normalisation of muscle function postoperatively, some stating that especially hip flexor function is not fully normalised after 12 months. The purpose of this study was to evaluate hip function during walking before, and 6 and 12 months after minimally invasive periacetabular osteotomy. Using conventional 3D inverse dynamics followed by static optimisation, we calculated hip net joint moment and angular impulse, as well as individual muscle forces and hip joint contact force, during walking for 32 patients with hip dysplasia and 32 matched controls. None of the extensor and abductor measures were significantly different between controls and patients tested preoperatively, nor between any of the 3 time points patients were tested. For all of the flexor measures, patients' preoperative values were lower than controls', but had increased to values above the controls 6 months postoperatively. Hip muscle function during walking seemed normalised after 6 months after minimally invasive periacetabular osteotomy, while joint contact force did not fully normalise until 12 months postoperatively, perhaps because the hip joint structures need a longer time to heal than the muscles and a potential pain alleviating strategy was still in effect. Movement pattern in patients with hip dysplasia https://clinicaltrials.gov/ct2/show/NCT01344421, NCT01344421.

Single-event multilevel surgery, but not botulinum toxin injections normalize joint loading in cerebral palsy patients

BackgroundMany patients with cerebral palsy present a pathologic gait pattern, which presumably induces aberrant musculoskeletal loading that interferes with natural bone growth, causing bone deformations on the long term. Botulinum toxin interventions and single-event multilevel surgeries are used to restore the gait pattern, assuming that a normal gait pattern restores musculoskeletal loading and thus prevents further bone deformation. However, it is unknown if these interventions are able to restore musculoskeletal loading. Hence, we investigated the impact of botulinum toxin injections and single-event multilevel surgery on musculoskeletal loading. MethodsGait data collected in 93 children with bilateral cerebral palsy, which included pre- and post multi-level botulinum toxin (49 children) and single-event multilevel surgery (44 children) assessments, and 15 typically developing children were retrospectively processed using a musculoskeletal modelling workflow to calculate joint angles, moments, muscle and joint contact force magnitudes and orientations. Differences from the typically developing waveform were expressed by a root-mean square difference were compared using paired t-tests for each intervention separately (alpha <0.05). FindingsBotulinum toxin induced significant changes in the joint angles, but did not improve the muscle and joint contact forces. Single-event multilevel surgery induced significant kinematic and kinetic changes, which were associated with improved muscle and joint contact forces. InterpretationThe present results indicate that botulinum toxin injections were not able to restore normal gait kinematics nor musculoskeletal loading, whereas single-event multilevel surgery did successfully restore both. Therefore, single-event multilevel surgery might be protective against the re-occurrence of bone deformation on the longer term.

Individuals with mild-to-moderate hip osteoarthritis walk with lower hip joint contact forces despite higher levels of muscle co-contraction compared to healthy individuals

To compare hip joint contact forces (HJCF), hip muscle forces, and hip muscle co-contraction levels between individuals with mild-to-moderate hip osteoarthritis (OA) and healthy controls during walking. Eighteen participants with mild-to-moderate hip OA and 23 healthy controls walked at a self-selected speed while motion capture and electromyographic data were synchronously collected. HJCF were computed using a calibrated electromyography-informed neuromusculoskeletal model. Hip joint contact forces, muscle forces, and co-contraction indices for flexor/extensor and adductor/abductor muscle groups were compared between groups using independent sample t-tests (P<0.05). There was no between-group difference in self-selected walking speed. On average, participants with hip OA walked with 11% lower first peak (mean difference 235 [95% confidence interval (CI) 57-413] N) and 22% lower second peak (mean difference 574 [95%CI 304-844] N) HJCF compared to controls. Hip muscle forces were also significantly lower in the hip OA compared to control group at first (mean difference 224 [95%CI 66-382] N) and second (mean difference 782 [95%CI 399-1164] N) peak HJCF. Participants with hip OA exhibited higher levels of hip muscle co-contraction in both flexor/extensor and adductor/abductor muscle groups. Consistent with existing literature, hip joint angles (extension, adduction) and external moments (flexion, extension, adduction) were lower in hip OA compared to controls. Lower HJCF were detected in mild-to-moderate hip OA, primarily due to lower hip muscle force production, and despite higher levels of hip muscle co-contraction. Findings suggest that lower loading of the hip joint during walking is a feature of mild-to-moderate hip OA, which could have implications for the pathogenesis of hip OA and/or disease progression.

THE EFFECT OF MEDIAL HAMSTRING WEAKNESS ON KNEE CONTACT FORCES DURING RUNNING

When used to reconstruct the anterior cruciate ligament (ACL), the medial hamstrings graft has been shown to produce lower rates of osteoarthritis (OA) than the patellar tendon graft. The goal of this study was to determine how reducing medial hamstring strength during surgery affects joint contact forces during loading, and hence the joint’s proclivity towards OA. A previously developed model of the entire body was used to perform a muscle-actuated forward dynamics simulation of running for two cases: normal muscle strength and medial hamstrings (i.e. semitendinosus and gracilis) weakened by 30%. The muscle forces from these simulations were then used to actuate a discrete element model in a forward dynamics simulation. Weakening the medial hamstrings caused an overall decrease in total hamstrings force by <1%, total quadriceps force by 2%, and cartilage contact force by 4%. This decreased force may be protective against long-term OA and hence may help explain the lower rates of OA in patients who receive medial hamstring grafts.

Comparative analysis of the biomechanics of the adjacent segments after minimally invasive cervical surgeries versus anterior cervical discectomy and fusion: A finite element study

PurposePercutaneous full-endoscopic anterior cervical discectomy (PEACD) and posterior cervical foraminotomy (PCF) as alternatives to anterior cervical discectomy and fusion (ACDF) are extensively used in the treatment of patients with cervical spondylotic radiculopathy. The possibility of avoiding the risk of accelerated degeneration of the adjacent segments caused by fusion is claimed to be the theoretical advantage of these approaches; however, there is a paucity of supportive evidence from biomechanical data. Therefore, this study investigated and compared the effects of PCF, PEACD, and ACDF on the adjacent segments and operative segments of the cervical spine from a biomechanical standpoint. MethodA normal and intact three-dimensional finite element digital model of C4–C7 was constructed and validated, and the finite element models of PEACD, PCF, and ACDF were obtained by modifying the C4–C7 model. All models were exposed to identical conditions of load during flexion, extension, axial rotation, and lateral bending. We calculated the range of motion (ROM), intervertebral disc pressure (IDP), and facet joint contact force (FJCF) of the operative segment and the adjacent segment in different motion conditions. ResultThe conventional ACDF had a remarkable influence on the ROM and IDP of the operative segment and the adjacent segments. In the PEACD model, the change of ROM was not noticeable; the IDP of the operative segment was significantly smaller, whereas the change of IDP of the adjacent segment was insignificant. In the PCF model, the ROM and IDP of all segments remained unaffected.During extension, the facet joint contact force changed significantly after ACDF, and it changed slightly after PECAD and PCF. ConclusionBy comparatively analyzing the biomechanical changes of the cervical spine after PCF, PEACD, and ACDF using the finite element method, we suggested that PCF and PEACD were more suitable for surgical intervention of cervical spondylotic radiculopathy than ACDF from a biomechanical point of view and PCF may outperform PEACD.

Patellofemoral joint contact forces at different activities - effects of modeling assumptions

Purpose: Osteoarthritis (OA) at the knee most commonly begins at the patellofemoral (PF) joint. A dominant theory of OA aetiology is that mechanical overloading disrupts the physiological remodeling processes (homeostasis) of the cartilage, to eventually result in its breakdown, causing severe pain and disability. Besides reduced PF contact area it is increased load(i.e. the PF joint contact force = PFJCF) that increases cartilage stress. Neither stress, nor the PFJCF can be measured directly, but can be estimated from the force in the patellar tendon, as a resultant of the force in the quadriceps.

Knee joint contact forces during gait for patients undergoing high tibial osteotomy

Purpose: Varus knee deformity can significantly increase medial knee joint loading that has been demonstrated to accelerate knee degeneration in presence of osteoarthritis (OA). High tibial osteotomy (HTO) surgery is performed in early stages of knee OA with the aim to unload the medial compartment of the tibiofemoral joint and slow down knee degeneration. Therefore, it is clinically important to measure joint loading to better understand whether the clinical aim of the surgery is achieved. External knee adduction moments (EKAM) are routinely used to infer medial tibiofemoral joint load.