Medial compartment osteoarthritis is a leading cause of years claimed by disability worldwide. Joint replacements improve the quality of life for individuals with end-stage osteoarthritis; however, less invasive interventions to prevent or delay surgery are desirable. Increased contact forces in the medial compartment of the knee joint are thought to accelerate the progression of osteoarthritis.
Knee adduction moment (KAM) and total tibiofemoral force (TF) are potential correlates to medial contact force (MCF) in the knee joint (Kutzner et al., 2013; Nagura et al., 2006). Shull et al. (2012) showed experimentally that shifting the foot progression angle inward during walking (i.e. toe-in gait) could reduce the first peak in KAM during stance. This is accomplished by shifting foot's center of pressure laterally and altering the ground reaction force vector. Lowering the KAM tends to shift knee contact forces laterally, thus potentially alleviating load on the medial compartment. DeMers et al. (2014) showed that muscle recruitment optimization could be leveraged to lower the second peak of TF. His study reveals the sensitivity of contact forces in the knee to internal muscle forces, particularly for muscles crossing the knee joint. Winby et al. (2009) further describes that medial contact force is 42% external forces factors (i..e ground reaction forces) and 58% internal factors (i.e. muscle activation). Decreasing MCF is the focus of interventions to decelerate progression of medial compartment osteoarthritis.
By building a lower-body musculoskeletal model that combines Rajagopal’s full-body musculoskeletal model and Lerner’s contact model of the knee joint, we will confirm whether toe-in gait reduces medial contact force in the knee (Rajagopal et al., 2012; Lerner et al., 2015).
Does decreasing the foot progression angle (toe-in gait) reduce medial contact loads in the knee?
Scale a generic musculoskeletal model to get a subject specific model
Start with a combined model from Apoorva Rajagopal’s full body model and Zach Lerner’s knee contact model
Modify mass in scale tool
Modify tibial joint angles in the model .osim file using patient X-ray image
Adjust marker positions from static trial (one leg is in front of the other)
Run Inverse Kinematics
Input: tracker file (<trialname>.trc)
Outputs: coordinates file (<trialname_IK>.sto)
Run Inverse Dynamics
Inputs: coordinates file; external forces (<GRFs>.mot)
Outputs: results file (<trialname>_results_ID.sto)
Run Static Optimization
Inputs: coordinates file; external forces
Outputs: muscle forces (<trialname>_StaticOptimization_force.sto)
Use Analyze Tool to calculate joint reaction forces
Input: muscle forces
Outputs: results file (<trailname>_ReactionLoads.sto)
This will contain joint reaction forces in the compartments of the knee
Repeat steps 2-4 for all walking trials
Knee Adduction Moment
Conclusion - Toe-in gait reduces first peak in knee adduction moment
Knee Flexion Moment
Conclusion - Toe-in gait reduces range of knee flexion moment
Conclusion - Toe-in gait reduces quadriceps force during early stance, reduces gastrocnemius force during late stance, and has little impact on hamstring force
Conclusion - Toe-in gait leads to shorter steps characterized by lower hip extension during late stance
Conclusion - Toe-in gait yields decreased total knee contact force in late stance
Medial Contact Force
Conclusion: Toe-in gait reduces the first peak of medial contact force in the knee
Study analyzes 6 total steps for 1 subject
Muscle forces are estimated using static optimization
Joint reaction analysis is very sensitive to muscle forces
Lack of arm swing, trunk motion, ligaments, patch contact, etc.
Experiments were performed in a laboratory setting on a treadmill
Find the model, setup files, and our joint reaction results on our simtk webpage:
Perform and an EMG-driven analysis to improve accuracy of muscle forces (vs. over static optimization alone)
Perform a longitudinal study with a wider population to understand if kinematic and muscle recruitment adaptations persist over time
Analyze effectiveness of combining toe-in gait with optimized muscle control to reduce both the first and second peak medial contact force in the knee
We would like the thank the following individuals for assisting with our project
DeMers, Matthew S., et al., 2015. Changes in Tibiofemoral Forces due to Variations in Muscle Activity during Walking. J Orthop Res. 32(6): 769–776.
Lerner, Zachary F. et al., 2016. How Tibiofemoral Alignment and Contact Locations Affect Predictions of Medial and Lateral Tibiofemoral Contact Forces. Journal of Biomechanics, 48(4), 644–650.
Meghan K. Sylvia, et al., 2015. Development of a human knee joint finite element model to investigate cartilage stress during walking in obese and normal weight adults. Summer Biomechanics, Bioengineering and Biotransport Conference, 2015,Snowbird Resort, Utah, USA.
Rajagopal, Apoorva, et al., 2016. Full-Body Musculoskeletal Model for Muscle-Driven Simulation of Human Gait. IEEE Transactions on Biomedical Engineering, VOL. 63, NO. 10
Shull, Pete B., et al., 2012. Toe-in gait reduces the first peak knee adduction moment in patients with medial compartment knee osteoarthritis. Journal of Biomechanics, 46 (2013), 122–128.
Uhlrich, Scott D., et al.. Subject-specific toe-in or toe-out gait modifications reduce the larger knee adduction moment peak more than a non-personalized approach. Journal of Biomechanics, Article In Press.
Winby CR, Lloyd DG, Besier TF, Kirk TB., 2009. Muscle and external load contribution to knee joint contact loads during normal gait. Journal of Biomechanics, 42(14), 2294-300
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