Introduction. Adolescent Idiopathic Scoliosis (AIS) is a three-dimensional deformity of the spine with unclear etiology. Due to the asymmetry of lateral curves, there are differences in the muscle activation between the convex and concave sides. This study utilized a comprehensive thoracic spine and ribcage musculoskeletal model to improve the biomechanical understanding of the development of AIS deformity and approach an explanation of the condition. Methods. In this study, we implemented a motion capture model using a generic rigid-body thoracic spine and ribcage model, which is kinematically determinate and controlled by spine posture obtained, for instance, from radiographs. This model is publicly accessible via a GitHub repository. We simulated gait and standing models of two AIS (averaging 15 years old, both with left lumbar curve and right thoracic curve averaging 25 degrees) and one control subject. The marker set included extra markers on the sternum and the thoracic and lumbar spine. The study was approved by the regional Research Ethics Committee (Journal number: H17034237). Results. We investigated the difference between the muscle activation on the right and left sides including erector spinae (ES), psoas major (PS), and multifidus (MF). Results of the AIS simulations indicated that, on average throughout the gait cycle, the right ES, left PS and left MF had 46%, 44%, and 23% higher activities compared to the other side, respectively. In standing, the ratios were 28%, 40%, and 19%, respectively. However, for the control subject, the differences were under 7%, except ES throughout the gait, which was 17%. Conclusion. The musculoskeletal model revealed distinct differences in force patterns of the right and left sides of the spine, indicating an instability phenomenon, where larger curves lead to higher muscle activations for stabilization. Acknowledgement. The project is funded by the European Union's Horizon 2020 program through Marie Skłodowska-Curie grant No. [764644]

Head collisions in sport can result in catastrophic cervical spine injuries. Musculo-skeletal (MSK) modelling can help analyse the relationship between players' motion, external loading and internal stresses that lead to injury. However, the literature lacks sport specific MSK models. In automotive research the intervertebral disc behaviour has been represented as viscoelastic elements (“bushing”), whose stiffness and damping parameters are often estimated under quasi-static conditions and may lack validity in dynamic impacts. The aim of this study was to develop a validated cervical spine model for axial impacts for future use in the analysis of head-first rugby collisions.

A drop test rig was used to replicate a sub-catastrophic axial head impact. A load of 80 N from 0.5 m was applied to the cranial aspect of a C2-C6 porcine spinal specimen mounted in the neutral position. The 3D motion of C3-C5 vertebras (4 kHz) and the cranial axial load (1 MHz) were measured via motion capture (Qualysis, Sweden) and a uniaxial load cell (RDP Electronics Ltd, UK). Specimen specific models were created in NMSBuilder and OpenSim after the vertebrae geometries were obtained from the segmentation of micro-CT images of the specimens. The compressive viscoelastic properties of four vertebral joints (C2-C3 through to C5-C6) were optimised via a Genetic Algorithm (MATLAB v2016b, The Mathworks Inc) to minimise tracking errors.

The optimisation converged to a solution of 140–49000 kN/m and 2000–8000 Ns/m for stiffness and damping respectively (RMSE=5.1 mm). Simulated joint displacements ranged between 0.09 – 1.75 mm compared to experimental 0.1 – 0.8 mm.

Optimal bushing parameters were higher than previously reported values measured through quasi-static testing. Higher stiffness and damping values could be explained by the higher-dynamics nature of the event analysed related to a different part of the non-linear intervertebral disc load-displacement curve.

Introduction. This research aims to enhance the control of intricate musculoskeletal spine models, a critical tool for comprehending both healthy and pathological spinal conditions. State-of-the-art musculoskeletal spine models incorporate segments for all vertebra, each possessing 3 degrees-of-freedom (DOF). Manually defining the posture with this amount of DOFs presents a significant challenge. The prevalent method of equally distributing the spine's overall rotation among the vertebrae often proves to be an inadequate assumption, particularly when dealing with the entire spine. Method. We have engineered a comprehensive non-linear spine rhythm and the requisite tools for its implementation in widely utilized musculoskeletal modelling software (1). The rhythm controls lateral bending, axial rotation, and flexion/extension. The mathematical and implementation details of the rhythm are beyond this abstract, but it's noteworthy that the implementation accommodates non-linear rhythms. This means, for example, that one set of rhythm coefficients is used for flexion and another for extension. The rhythm coefficients, which distinguish the movement along the spine, were derived from a review of spine literature. The values for spine and vertebra range-of-motion (ROM) vary significantly in published studies, and no complete dataset was found in any single study. Consequently, the rhythm presented here is a composite, designed to provide the most consistent and average set of rhythm coefficients. Result. The novel spine rhythm simplifies the control of detailed spine models, accommodating varying amounts of input data. It allows for the specification of only the overall motion or the posture at a more detailed level (i.e., lumbar, thoracic, neck). The tools and rhythm coefficients are publicly available on GitHub. Conclusion. The innovative spine rhythm enhances the usability of cutting-edge spine models. For flexion/extension of the spine, it introduces a non-linear rhythm, exhibiting distinct behaviour between flexion and extension - a feature not previously observed in musculoskeletal spine models. 1) The AnyBody Modeling System

Abstract. OBJECTIVE. Knee varus malalignment increases medial knee compartment loading and is associated with knee osteoarthritis (OA) progression and severity. 1. Altered biomechanical loading and dysregulation of joint tissue biology drive OA progression, but mechanistic links between these factors are lacking. Subchondral bone structural changes are biomechanically driven, involve bone resorption, immune cell influx, angiogenesis, and sensory nerve invasion, and contribute to joint destruction and pain. 2. We have investigated mechanisms underlying this involving RANKL and alkaline phosphatase (ALP), which reflect bone resorption and mineralisation respectively. 3. and the axonal guidance factor Sema3A. Sema3A is osteotropic, expressed by mechanically sensitive osteocytes, and an inhibitor of sensory nerve, blood vessel and immune cell invasion. 4. Sema3A is also differentially expressed in human OA bone. 5. HYPOTHESIS: Medial knee compartment overloading in varus knee malalignment patients causes dysregulation of bone derived Sema3A signalling directly linking joint biomechanics to pathology and pain. METHODS. Synovial fluid obtained from 30 subjects with medial knee OA (KL grade II-IV) undergoing high tibial osteotomy surgery (HTO) was analysed by mesoscale discovery and ELISA analysis for inflammatory, neural and bone turnover markers. 11 of these patients had been previously analysed in a published patient-specific musculoskeletal model. 6. of gait estimating joint contact location, pressure, forces, and medial-lateral condyle load distribution in a published data set included in analyses. Data analysis was performed using Pearson's correlation matrices and principal component analyses. Principal Components (PCs) with eigenvalues greater than 1 were analysed. RESULTS. PC1 (32.94% of variation) and PC2 (25.79% of variation) from PCA analysis and correlation matrices separated patients according to correlated clusters of established inflammatory markers of OA pain and progression (IL6/IL8, r=0.754, p<0.001) and anti-inflammatory mediators (IL4/IL10, r=0.469, p=0.005). Bone turnover marker ALP was positively associated with KL grade (r=0.815, p=0.002) and negatively associated with IL10 (r=−0.402, p=0.018) and first peak knee loading pressures (r=−0.688, p=0.019). RANKL was positively associated with IL4 (r=0.489, p=0.003). Synovial fluid Sema3A concentrations showed separate clustering from all OA progression markers and was inversely correlated with TNF-α (r=−0.423, p=0.022) in HTO patients. Sema3A was significantly inversely correlated with total predicted force in the medial joint compartment (r=−0.621, p=0.041), mean (r=−0.63, p=0.038) and maximum (r=−0.613, p=0.045) calculated medial compartment joint pressures during the first phase and mean (r=−0.618, p=0.043) and maximum (r=−0.641, p=0.034) medial compartment joint pressures during midstance outputs of patient-specific musculoskeletal model. CONCLUSIONS. This study shows joint inflammatory status and mechanical overloading influence subchondral bone-remodelling. Synovial Sema3A concentrations are inversely correlated to patient-specific musculoskeletal model estimations of pathological medial overloading. This study reveals Sema3A as a biological mediator with capacity to induce OA pain and disease progression that is directly regulated by gait mechanical loading. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Abstract. Objectives. Osteoporosis of the pelvis and femur is diagnosed in a high proportion of lower-limb amputees which carries an increased fracture risk and subsequently serious implications on mobility, physical dependency and morbidity. Through the development of biofidelic musculoskeletal and finite element (FE) models, we aim to determine the effect of lower-limb amputation on long-term bone remodelling in the hip and to understand the potential underpinning mechanisms for bone degradation in the younger amputee population. Methods. Our models are patient specific and anatomically accurate. Geometries are derived from MRI-scans of one bilateral, above-knee, amputee and one body-matched control subject. Musculoskeletal modelling enables comparison of muscle and joint reaction-forces throughout gait. This provides the loading scenario implemented in FE. FE modelling demonstrates the effect of loading on the amputated limb via a prosthetic socket by comparing bone mechanical stimulation in amputee and control cases. Results. Musculoskeletal modelling shows that the bilateral amputee has 25% higher peak hip-reaction force than controls but a 54% lower peak knee-reaction force. Compensation for missing muscles and joints cause large-scale changes to the muscle loading patterns of the residual limb. FE analysis shows a 32% reduction in bone stimulation within the proximal femur and an 81% reduction in the distal femoral shaft when compared to the healthy control. A shielding effect from weight-bearing through a prosthetic socket was observed that may offset any increases in joint and muscle loading at the amputated hip. Conclusions. Bone loss in the young amputee population could be driven by unloading osteopenia where altered joint and muscle loads cause altered mechanical stimulus in the femur. Over many cycles of remodelling, a net bone loss occurs. Importantly, this suggests that the issue is preventable, or even reversible, with the implementation of targeted loading regimes or changes to the design of the prosthetic socket. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Occlusal loading and muscle forces during mastication aids in assessment of dental restorations and implants and jaw implant design; however, three-dimensional bite forces cannot be measured with conventional transducers, which obstruct the native occlusion. The aim of this study was to combine accurate jaw kinematics measurements, together with subject-specific computational modelling, to estimate subject-specific occlusal loading and muscle forces during mastication. Motion experiments were performed on one male participant (age: 39yrs, weight: 82kg) with healthy dentition. Two low-profile magnetic sensors were fixed to the participant's teeth and the two dental arches digitised using an intra-oral scanner. The participant performed ten continuous of chewing on a polyurethane rubber sample of known material properties, followed by maximal compression (clenching). This was repeated at the molars, premolars of both the left and right sides, and central incisors. Jaw motion was simultaneously recorded from the sensors, and finite element modelling used to estimate bite force. Specifically, simulations of chewing and biting were performed by driving the model using the measured kinematics, and bite force magnitude and direction quantified. Muscle forces were then evaluated using a rigid-body musculoskeletal model of the patient's jaw. The first molars generated the largest bite forces during chewing (left: 309 N, right: 311 N) and maximum-force biting (left: 496 N, right: 495 N). The incisors generated the smallest bite forces during chewing (75 N) and maximum-force biting (114 N). The anterior temporalis and superficial masseter muscles had the largest contribution to maximum bite force, followed by the posterior temporalis and medial pterygoid muscles. This study presents a new method for estimating dynamic occlusal loading and muscle forces during mastication. These techniques provide new knowledge of jaw biomechanics, including muscle and occlusal loading, which will be useful in surgical planning and jaw implant design

The aim of this research was to determine biomechanical markers which differentiate medial knee osteoarthritis (OA) patients who do and do not show structural progression over a 2-year period. A cohort of 36 subjects was selected from a longitudinal study (Meireles et al 2017) using Kellgren-Lawrence (KL) scores at baseline and 2-year follow-up. The cohort consisted of 10 healthy controls (HC) (KL=0 at both time points), 15 medial knee OA non-progressors (NPKOA) (KL≥1 at baseline and no change over 2 years), and 11 medial knee OA progressors (PKOA) (KL≥1 at baseline and increase of ≥1 over 2 years). 3D integrated motion capture data from three walking trials were processed through a musculoskeletal modelling framework (Smith et al 2016) to estimate knee joint loading parameters (i.e., magnitude of mean contact pressure, and centre of pressure (COP)). Parameters at first and second peak were extracted and compared between groups using Kruskal-Wallis and Mann-Whitney tests. Higher magnitudes were observed in PKOA vs NPKOA, and PKOA vs HC groups at both time points. Additionally, a posterior (1st and 2nd peak), and lateral (2nd peak) shift in medial compartment COP was shown between PKOA and NPKOA, and PKOA and HC subjects. Interestingly, in the studied parameters, no differences were observed between NPKOA and HC groups. Significantly higher magnitude, and a more posterior and lateral COP was observed between PKOA and NPKOA patients. These differences, combined with an absence of difference between NPKOA and HC suggest structural OA progression is driven by a combination of altered loading magnitude and location. These results may serve as guidelines for targeted gait retraining rehabilitation to slow or stop knee OA progression whereby shifting COP anterior and medial and reducing magnitude by ~22% may shift patients from a PKOA to a NPKOA trajectory

Altered mechanical loading is a widely suggested, but poorly understood potential cause of cartilage degeneration in osteoarthritis. In rodents, osteoarthritis is induced following destabilization of the medial meniscus (DMM). This study estimates knee kinematics and contact forces in rats with DMM to gain better insight into the specific mechanisms underlying disease development in this widely-used model. Unilateral knee surgery was performed in adult male Sprague-Dawley rats (n=5 with DMM, n=5 with sham surgery). Radio-opaque beads were implanted on their femur and tibia. 8 weeks following knee surgery, rat gait was recorded using the 3D²YMOX setup (Sanctorum et al. 2019, simultaneous acquisition of biplanar XRay videos and ground reaction forces). 10 trials (1 per rat) were calibrated and processed in XMALab (Knörlein et al. 2016). Hindlimb bony landmarks were labeled on the XRay videos using transfer learning (Deeplabcut, Mathis et al. 2019; Laurence-Chasen et al. 2020). A generic OpenSim musculoskeletal model of the rat hindlimb (Johnson et al. 2008) was adapted to include a 3-degree-of-freedom knee. Inverse kinematics, inverse dynamics, static optimization of muscle forces, and joint reaction analysis were performed. In rats with DMM, knee adduction was lower compared to sham surgery. Ground reaction forces were less variable with DMM, resulting in less variability in joint external moments. The mediolateral ground reaction force was lower, resulting in lower hip adduction moment, thus less force was produced by the rectus femoris. Rats with DMM tended to break rather than propel, resulting in lower hip flexion moment, thus less force was produced by the semimembranosus. These results are consistent with lower knee contact forces in the anteroposterior and axial directions. These preliminary data indicate no overloading of the knee joint in rats with DMM, compared with sham surgery. We are currently expanding our workflow to finite element analysis, to examine mechanical cues in the cartilage of these rats (Fig1G)

This study aimed to quantify self-reported outcomes and walking gait biomechanics in patients following primary and revision THA. The specific goals of this study were to investigate: (i) if primary and revision THA patients have comparable preoperative outcomes; and (2) if revision THA patients have worse postoperative outcomes than primary THA patients. Forty-three patients undergoing primary THA for osteoarthritis and 23 patients undergoing revision THA were recruited and followed longitudinally for their first 12 postoperative months. Reasons for revision were loosening (73%), dislocation (9%), and infection (18%). Patients completed the Hip dysfunction and Osteoarthritis Outcome Score (HOOS), and underwent gait analysis preoperatively, and at 3 and 12 months postoperatively. A 10 camera motion analysis system (V5 Vantage, Vicon, UK) recorded marker trajectories (100 Hz) during walking at self- selected speeds. A generic lower-body musculoskeletal model (Gait2392) was scaled using principal component analysis [1] and the inverse kinematics tool in Opensim 3.3 was used to compute joint angles for the lower limbs in the sagittal plane. Independent samples t-test were used to compare patient reported outcomes between the primary and revision groups at each timepoint. Statistical parametric mapping was used to compare gait patterns between the two groups at each timepoint. Preoperatively, patients undergoing primary THA reported significantly worse pain (p<0.001), symptoms (p<0.001), function (p<0.001), and quality of life (p=0.004). No differences were observed at 3 and 12 months postoperatively between patients who had received a primary or revision THA. The only observed difference in gait pattern was that patients with a revision THA had reduced hip extension at 3 months, but no differences were observed preoperatively and 12 months. Despite the suggestions in the literature that revision THA is bound to have worse outcomes compared to primary THA, we found no differences in in patient-reported outcomes and gait patterns at 12 months postoperatively. This suggests that it may be possible, in some circumstances, for patients following revision THA to achieve similar outcomes to their peers undergoing primary THA

The tendency towards using inertial sensors for remote monitoring of the patients at home is increasing. One of the most important characteristics of the sensors is sampling rate. Higher sampling rate results in higher resolution of the sampled signal and lower amount of noise. However, higher sampling frequency comes with a cost. The main aim of our study was to determine the validity of measurements performed by low sampling frequency (12.5 Hz) accelerometers (SENS) in patients with knee osteoarthritis compared to standard sensor-based motion capture system (Xsens). We also determined the test-retest reliability of SENS accelerometers. Participants were patients with unilateral knee osteoarthritis. Gait analysis was performed simultaneously by using Xsens and SENS sensors during two repetitions of over-ground walking at a self-selected speed. Gait data from Xsens were used as an input for AnyBody musculoskeletal modeling software to measure the accelerations at the exact location of two defined virtual sensors in the model (VirtualSENS). After preprocessing, the signals from SENS and VirtualSENS were compared in different coordinate axes in time and frequency domains. ICC for SENS data from first and second trials were calculated to assess the repeatability of the measurements. We included 32 patients (18 females) with median age 70.1[48.1 – 85.4]. Mean height and weight of the patients were 173.2 ± 9.6 cm and 84.2 ± 14.7 kg respectively. The correlation between accelerations in time domain measured by SENS and VirtualSENS in different axes was r = 0.94 in y-axis (anteroposterior), r = 0.91 in x-axis (vertical), r = 0.83 in z-axis (mediolateral), and r = 0.89 for the magnitude vector. In frequency domain, the value and the power of fundamental frequencies (F. 0. ) of SENS and VirtualSENS signals demonstrated strong correlation (r = 0.98 and r = 0.99 respectively). The result of test-retest evaluation showed excellent repeatability for acceleration measurement by SENS sensors. ICC was between 0.89 to 0.94 for different coordinate axes. Low sampling frequency accelerometers can provide valid and reliable measurements especially for home monitoring of the patients, in which handling big data and sensors cost and battery lifetime are among important issues

After total hip replacement, force generating capacity of gluteal muscles is an impotant parameter on joint contact forces and primary fixation of total hip replacement. Femoral offset is an option to optimize muscle moment arms, especially main abductor Gluteus Medius and Minimus. To investigate relationship with weak gluteal muscles (Gluteus Medius and Minimus) and increased femoral offset, we build a musculoskeletal model. Creating of three-dimensional femur geometry and scaling of the musculoskeletal model according to the subject were performed with computed tomography data. Obtained gait kinematic and kinetic data were applied and to mimic gluteal muscle weakness, the force generating capacities of Gluteus Medius and Minimus reduced (%20-%80). Analysis were done for both anatomical and +10mm offset. Then, muscle and joint reaction forces obtained from musculoskeletal analysis transfered to CT based finite element model to evaluate changes in maximum principle stresses on femur. According to the results of the musculoskeletal analysis, the weakness of the gluteal muscles caused an increase in the activation of Gluteus Maximus, Rectus Femoris and Tensor Fasciae Latae. Effects of +10 mm femoral offset on total abductor muscle activity increased with reduced muscle strength. As a result of the finite element analysis, no significant difference was observed for maximum principle stresses on femur with varying muscle activites. The results of these analyses are important to understand weakness of gluteal muscles and for planning hip surgery

Summary. The quantification of T1Rho relaxation times is not related with internal loading. Improvements in modeling and imaging techniques might lead to better understanding of the pathomechanics of the knee. Introduction. The onset and progression of knee osteoarthritis has been associated with an increased external knee adduction moment (EKAM). However, this external measure has no direct relationship with internal loading of the knee. For a better understanding of the pathomechanics of the knee musculoskeletal models could be used to relate external and internal knee loading. Consequently, high internal loading might cause cartilage degeneration in patients with OA. T1RhoMRI can detect changes in proteoglycan content and is therefore a non-invasive measure of cartilage degeneration in knee OA. The purpose of this study was to relate internal loading of the knee simulated by musculoskeletal models with cartilage health using T1rhoMRI. Patients & Methods. Preliminary results showed data of seven women (50–65yrs), four healthy and three OA. Subjects underwent 3D gait analysis (VICON Nexus) at comfortable walking speed, EKAM was calculated. Simulations of multi-body musculoskeletal models were driven based on the motion capture data, in order to calculate internal medial-lateral knee forces (MLforce). Besides a T1RhoMRI scan of the knee (Phillips 3T) provided cartilage health of the midsection of the medial condyle according to Pedersen et al, 2011 [4]. Differences between healthy and OA were tested with a one sided T-test, correlations between EKAM and MLforce were calculated. Results. Anthropometrics and walking speed showed no significantly different between OA patients and healthy controls. OA patients had significant larger EKAM and MLforce (p<0.05). T1Rho values were not significantly different between the groups. EKAM was positively correlated with MLforce (R. 2. =0.91, p<0.05) in healthy subjects, no association was found in knee OA patients (R. 2. < 0.01). Discussion / Conclusion. The current study demonstrates that external loading of the knee does not predict internal loading in knee OA patients. We did not find a significant effect of knee OA on cartilage quality assessed by T1Rho MRI. However a non-significant increase was visible at the posterior region of the femoral condyle in OA patients. This elevated T1Rho relaxation is in line with expectations and could be related to an increased cartilage degeneration

Abstract. Objectives. Neonatal motor development transitions from initially spontaneous to later increasingly complex voluntary movements. A delay in transitioning may indicate cerebral palsy (CP). The general movement optimality score (GMOS) evaluates infant movement variety and is used to diagnose CP, but depends on specialized physiotherapists, is time-consuming, and is subject to inter-observer differences. We hypothesised that an objective means of quantifying movements in young infants using motion tracking data may provide a more consistent early diagnosis of CP and reduce the burden on healthcare systems. This study assessed lower limb kinematic and muscle force variances during neonatal infant kicking movements, and determined that movement variances were associated with GMOS scores, and therefore CP. Methods. Electromagnetic motion tracking data (Polhemus) was collected from neonatal infants performing kicking movements (min 50° knee extension-flexion, <2 seconds) in the supine position over 7 minutes. Tracking data from lower limb anatomical landmarks (midfoot inferior, lateral malleolus, lateral knee epicondyle, ASIS, sacrum) were applied to subject-scaled musculoskeletal models (Gait2354_simbody, OpenSim). Inverse kinematics and static optimisation were applied to estimate lower limb kinematics (knee flexion, hip flexion, hip adduction) and muscle forces (quadriceps femoris, biceps femoris) for isolated kicks. Functional principal component analysis (fPCA) was carried out to reduce kicking kinematic and muscle force waveforms to PC scores capturing ‘modes’ of variance. GMOS scores (lower scores = reduced variety of movement) were collected in parallel with motion capture by a trained operator and specialised physiotherapist. Pearson's correlations were performed to assess if the standard deviation (SD) of kinematic and muscle force waveform PC scores, representing the intra-subject variance of movement or muscle activation, were associated with the GMOS scores. Results. The study compared GMOS scores, kinematics, and muscle force variances from a total of 26 infants with a mean corrected gestational age of 39.7 (±3.34) weeks and GMOS scores between 21 and 40. There was a significant association between the SD of the PC scores for knee flexion and the GMOS scores (PC1: R = 0.59, p = 0.002; PC2: R = 0.49, p = 0.011; PC3: R = 0.56, p = 0.003). The three PCs captured variances of the overall flexion magnitude (66% variance explained), early-to-late kick knee extension (20%), and continual to biphasic kicking (6%). For hip flexion, only the SD of PC1 correlated with GMOS scores (PC1: R = 0.52, p = 0.0068), which captured the variance of the overall flexion magnitude (81%). For the biceps femoris, the SD of PC1 and PC3 associated with GMOS scores (PC1: R = 0.50, p = 0.002; PC3: R = 0.45, p = 0.03), which captured the variance of the overall bicep force magnitude (79%) and early-to-late kick bicep activation (8%). Conclusions. Infants with reduced motor development as scored in the GMOS displayed reduced variances of knee and hip flexion and biceps femoris activation across kicking cycles. These findings suggest that combining objectively measured movement variances with existing classification methods could facilitate the development of more consistent and accurate diagnostic tools for early detection of CP. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Introduction and Objective. The human body is designed to walk in an efficient way. As energy can be stored in elastic structures, it is no surprise that the strongest elastic structure of the human body, the iliofemoral ligament (IFL), is located in the lower limb. Numerous popular surgical hip interventions, however, affect the structural integrity of the hip capsule and there is a growing evidence that surgical repair of the capsule improves the surgical outcome. Though, the exact contribution of the iliofemoral ligament in energy efficient hip function remains unelucidated. Therefore, the objective of this study was to evaluate the influence of the IFL on energy efficient ambulation. Materials and Methods. In order to assess the potential passive contribution of the IFL to energy efficient ambulation, we simulated walking using the large public dataset (n=50) from Schreiber in a the AnyBody musculoskeletal modeling environment with and without the inclusion of the IFL. The work required from the psoas, iliacus, sartorius, quadriceps and gluteal muscles was evaluated in both situations. Considering the large uncertainty on ligament properties a parameter study was included. Results. A significant reduction in the active component of all hip flexors was observed when the IFL is intact. The required muscle work was found to be reduced by as much as 48% (CI: 29–62%), 61% (CI: 35–84%) and 38% (CI: 2–69%) for the psoas, iliacus, and sartorius muscle respectively. The IFL inclusion has no major effect on the required work from the quadriceps and the gluteal muscle group. The energy storage in the IFL is largest at maximal hip extension and the contribution to forward motion is the largest at the start of the swing phase. Conclusions. The iliofemoral ligament seems to be a crucial structure in energy efficient walking. The findings support need for meticulous reconstruction of the capsule ligament in case of surgical damage

Introduction. Modification in joint loading, and specifically shear stress, is found to be an important mechanical factor in the development of osteoarthritis (OA). Cartilage shear stresses can be investigated using finite element (FE) modelling, where typically in vivo joint loading as measured by an instrumented hip prosthesis is used as boundary condition. However, subject-specific gait characteristics substantially affect joint loading. The goal of this study is to investigate the effect of subject-specific joint loading as calculated using a subject-specific musculoskeletal model and integrated motion capture data on acetabular shear stress. Methods. Three healthy control subjects walked at self-selected speed while measuring marker trajectories (Vicon, Oxford Metrics, UK) and force data (two AMTI force platforms; Watertown, MA). A subject-specific MRI-based musculoskeletal model consisting of 14 segments, 19 degrees of freedom and 88 musculotendon actuators, and including wrapping surfaces around the hip joint, was used. All analyses were performed in OpenSim 3.1. The model was scaled to the dimensions of each subject using the marker positions of a static pose. A kalman smoother procedure was used to calculate joint angles. Muscle forces were calculated using static optimization, minimizing the sum of squared muscle activations, and hip contact forces (HCF) were calculated and normalized to body weight (BW). To calculate shear stress, HCFs and joint angles calculated during the stance phase of gait were imposed to a hip finite element model (hip_n10rb) using FFEbio 2.5. In the model, femoral and acetabular cartilage were represented using the Mooney-Rivlin formulation (c1=6.817, bulk modulus=1358.86) and the pelvis and femur bones as rigid bodies. Peak HCF as well as maximal acetabular shear stress, magnitude and location, and the HCF at the time of maximal shear stress were compared between subjects. Results. Maximal shear stress was lower for S3 compared to S1 and S2 (9.14, 9.48 and 7.14 MPa for S1, S2 and S3 respectively). Nevertheless, HCF at the time instance of peak stress as well as peak HCF were highest for S3 (S1: 2.40/4.54 BW, S2: 2.97/4.78 BW and S3: 3.13/6.46 BW respectively). Maximal shear stress also occurred earlier in the stance phase for S3 compared to S1 and S2 (31, 26 and 11% of the stance phase for S1, S2 and S3 respectively). In addition, the location of the peak maximal shear stress was found to be more superior for S3. Discussion. Subject-specific loading patterns clearly influence the calculated maximal shear stress in the acetabular cartilage, affecting both the magnitude and the location of the stress. In addition, higher shear stresses are not coinciding with higher HCFs. This finding highlights the need of subject-specific rather than generic loading patterns when assessing cartilage shear stresses and associated risk in OA development in individual patients

Abstract. OBJECTIVES. Bone health deterioration is a major public health issue. General guidelines for the limitation of bone loss prescribe a healthy lifestyle and a minimum level of physical activity. However, there is no specific recommendation regarding targeted activities that can effectively maintain lumbar spine bone health. To provide a better understanding of such influencing activities, a new predictive modelling framework was developed to study bone remodelling under various loading conditions. METHODS. The approach is based on a full-body subject-specific musculoskeletal model [1] combined with structural finite element models of the lumbar vertebrae. Using activities recorded with the subject, musculoskeletal simulations provide physiological loading conditions to the finite element models which simulate bone remodelling using a strain-driven optimisation algorithm [2]. With a combination of daily living activities representative of a healthy lifestyle including locomotion activities (walking, stair ascent and descent, sitting down and standing up) and spine-focused activities involving twisting and reaching, this modelling framework generates a healthy bone architecture in the lumbar vertebrae. The influence of spine-focused tasks was studied by adapting healthy vertebrae to an altered loading scenario where only locomotion activities were performed. RESULTS. The spine-focused activities were responsible for 57% of the overall bone mechanical stimulus of the five lumbar vertebrae. Cortical bone maintenance was more influenced by these activities in the superior vertebrae than in the inferior ones, with a stimulus degradation of 74% in L1 against 24% in L5 when adapted to the altered loading scenario. Trabecular bone stimulus degradation varied between 53% and 68%. CONCLUSION. The study suggests that locomotion activities are insufficient to maintain lumbar spine bone health. When appropriate, larger spine movements should be recommended as part of the minimum daily physical activities. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Abstract. Objectives. Catastrophic neck injuries in rugby tackling are rare (2 per 100,000 players per year) with 38% of these injuries occurring in the tackle. The aim of this study was to determine the primary mechanism of cervical spine injury during rugby tackling and to highlight the effect of tackling technique on intervertebral joint loads. Methods. In vivo and in vitro experimental data were integrated to generate realistic computer simulations representative of misdirected tackles. MRI images were used to inform the creation of a musculoskeletal model. In vivo kinematics and neck muscle excitations were collected during lab-based staged tackling of the player. Impact forces were collected in vitro using an instrumented anthropometric test device during experimental simulations of rugby collisions. Experimental kinematics and muscle excitations were prescribed to the model and impact forces applied to seven skull locations (three cranial and four lateral). To examine the effects of technique on intervertebral joint loads the model's neck angle was altered in steps of 5° about each rotational axis resulting in a total of 1,623 experimentally informed simulations of misdirected tackles. Results. Neck flexion angles and cranial impact locations had the largest effects on maximal compression, anterior shear and flexion moment loads. During posterior cranial impacts compression forces and flexion moments increased from 1500 to 3200 N and 30 to 60 Nm respectively between neck angles of 30° extension and 30° flexion. This was more evident at the C5-C6 and C6-C7 joints. Anterior shear loads remained stable throughout neck angle ranges however during anterior impacts they were directed posteriorly when the neck was flexed. Conclusions. The combination of estimated joint loads in the lower cervical spine support buckling as the primary injury mechanism of anterior bilateral facet dislocations observed in misdirected rugby tackles and highlights the importance of adopting a correct tackling technique. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Abstract. Objectives. The need for gender specific knee arthroplasty is debated. This research aimed to establish whether gender differences in patellar tendon moment arm (PTMA), a composite measure that characterises function of both the patellofemoral and tibiofemoral joints, are a consequence of knee size or other variation. Methods. PTMA about the instantaneous helical axis was calculated from positional data acquired using optical tracking. First, data post-processing was optimised, comparing four smoothing techniques (raw, Butterworth filtered, generalised cross-validation cubic spline interpolated and combined filtered/interpolated) using a fabricated knee. Then PTMA was measured during open-chain extension for N=24 (11 female) fresh-frozen cadaveric knees, with physiologically based loading and extension rates (420°/s) applied. Gender differences in PTMA were assessed before and after accounting for knee size with epicondylar width. Results. Combined smoothing enabled sub-mm accuracy (root-mean-squared (RMS) error 0.16mm, max error 0.47mm), whereas large errors were measured for raw (RMS 3.61mm, max 23.71mm), filtered-only (RMS 1.19mm, max 7.38mm) and interpolated-only (RMS 0.68mm, max 1.80mm) techniques. Before scaling, average PTMA throughout knee flexion was 46mm and mean, maximum, and minimum absolute values of PTMA were larger in males (mean differences >8mm, p<0.001), as were the PTMAs at terminal extension and flexion, and the change in PTMA from peak to terminal extension (differences >4mm, p<0.05). After scaling, the PTMA in deep flexion and the change in PTMA from peak to terminal extension were still larger in male knees (differences >2mm, p<0.05). The flexion angle of peak PTMA, unaffected by scaling, was closer to terminal extension for female knee (female 15°, male 29°, p<0.05). Conclusion. Gender differences in PTMA were identified both before and after accounting for knee size, with implications for gender-specific arthroplasty and musculoskeletal models. The developed measurement framework could also be applied in vivo for accurate measurement of the PTMA. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Abstract. Objective. Explore whether high tibial osteotomy (HTO) changes knee contact forces and to explore the relationship between the external knee adduction moment (EKAM) pre and 12 months post HTO. Methods. Three-dimensional gait analysis was performed on 17 patients pre and 12-months post HTO using a modified Cleveland marker-set. Tibiofemoral contact forces were calculated in SIMM. The scaled musculoskeletal model integrated an extended knee model allowing for 6 degrees of freedom in the tibiofemoral and patellofemoral joint. Joint angles were calculated using inverse kinematics then muscle and contact forces and secondary knee kinematics were estimated using the COMAC algorithm. Paired samples t-test were performed using SPSS version 25 (SPSS Inc., USA). Testing for normality was undertaken with Shapiro-Wilk. Pearson correlations established the relationships between EKAM1 to medial KCF1, and EKAM2 to medial KCF2, pre and post HTO. Results. Total knee contact force peak 1 significantly reduced from 2.6 x body weight pre-HTO to 2.3 x body weight 12-months post-HTO. Medial contact force peak 1 significantly reduced from 1.7 x body weight pre-HTO to 1.5 x body weight 12-months post-HTO. Second peak lateral knee contact force significantly increased from 0.9 body weight pre-HTO to 1.1 x body weight 12-months post-HTO. Furthermore, this study found very strong correlations between EKAM1 and medial KCF1 pre-HTO (r=0.85) as well as post-HTO (r=0.91). There was a significantly moderate relationship between EKAM2 and medial KCF2 pre-HTO (r=0.625). Conclusion. HTO significantly reduced overall and medial KCF during the first half of stance whilst increasing second half of stance peak lateral knee contact force. This study demonstrated a strong relationship between EKAM peaks and respective medial KCF peaks, supporting the usefulness of EKAM as a surrogate measure of medial compartment tibiofemoral contact forces. This demonstrates HTO successfully offloads the tibiofemoral joint overall, as well as offloading the medial compartment

Introduction and Objective. Clinically, it is considered that spastic muscles of patients with cerebral palsy (CP) are shortened, and produce higher force in shorter muscle lengths. Yet, direct quantification of spastic muscles’ forces is rare. Remarkably, previous intraoperative tests in which muscle forces are measured directly as a function of joint angle showed for spastic gracilis (GRA) that its passive forces are low, and only a small percentage of its maximum active force is measured in flexed knee positions. However, the relationship of force characteristics of spastic GRA with its muscle-tendon unit length (l. MTU. ) is unknown. Combining intraoperative experiments with participants’ musculoskeletal models developed based on their gait analyses, we aimed to test if spastic GRA muscle (1) operates at short l. MTU. compared to that of typically developing (TD) children, and exerts higher (2) passive and (3) active forces at shorter lengths, within gait-relevant l. MTU. range. Materials and Methods. Ten limbs of seven children with CP (GMFCS-II) were tested. Pre-surgery, gait analyses were conducted. Intraoperatively, isometric spastic GRA distal forces were measured in ten hip-knee joint angle combinations, in two conditions: (i) passive state and (ii) maximal activation of the GRA exclusively. In OpenSim, gait_2392 model was used for each limb to calculate l. MTU. 's per each hip and knee angle combination and the gait-relevant l. MTU. range, and to analyze gait relevant spastic muscle force - l. MTU. data. l. MTU. values were normalized for the participants’ thigh lengths. Two-way ANOVA was used to compare the patients’ l. MTU. to those of the seven age-matched TD children to test the first hypothesis. In order to test the second and the third hypotheses, Spearman's rank correlation coefficient (ρ) was calculated to seek a correlation between the muscle's operational length (represented by mean l. MTU. within gait cycle) and muscular force characteristics (the percent force at shortest l. MTU. of peak force, either in passive or in active conditions) within gait-relevant l. MTU. range. Results. ANOVA showed that l. MTU. 's of spastic GRA are shorter (on average by 15.4%) compared to those of TD. At the shortest gait-relevant l. MTU. , the GRA passive force was 84.6 (13.7)% of the peak passive force; and the active force was 55.8 (33.9)% of the peak active force. Passive state forces show an increase at longer lengths, whereas active state force characteristics vary in a patient-specific way. Spearman's rank correlation indicated weak correlations between muscle's operational length and muscular force characteristics (ρ= −0.30 P= 0.40, and ρ= −0.27 P= 0.45, for passive and active states, respectively). Therefore, only the first hypothesis was confirmed. Conclusions. Novel muscle force - l. MTU. data for spastic GRA were obtained using intraoperative data and modelling combined. The modelling showed in concert with the clinical considerations that spastic GRA may be a shortened muscle. However, because the model does not distinguish the muscle-belly and tendon lengths, it cannot isolate shorter muscle belly length and how this compares to the data of TD children remains unknown. Moreover, the absence of a strong correlation between shorter operational muscle length and higher force production either in passive or in active conditions highlights the influence of other factors (e.g., muscle structural proteins, and muscle mechanical characteristics including intermuscular interactions etc.) on the pathology rather than ascribing it solely to the length of a spastic muscle itself