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Background: Lateral wedge insoles (LWIs) are non-surgical interventions used in medial knee osteoarthritis (KOA) aiming at restoring correct joint biomechanics. However, the mechanical efficacy of LWIs, based on modulation of the external knee adduction moment, is partially proved and high variability in response to these devices was observed.Research Question: The principal aim of the study was to employ subject-specific musculoskeletal models to investigate the immediate effect of LWIs on the medial compressive force (MCF) in a population with medial KOA and varus alignment.Methods: Fifteen adults (8 healthy controls age 56±3.4, BMI 25.2±2.2, hip-knee-ankle angle -1.3±2.3; and 7 KOA participants age 62±6.6, BMI 31.7±3.9, hip-knee-ankle angle 6.3±2) were recruited. Subject-specific LWIs were designed in CAD based on shape capture of the foot and manufactured via 3D printing. The required degree of heel post was added to the orthotic shell to create insoles with 0°, 5° and 10° of lateral wedge. Gait data were collected for each condition and a musculoskeletal model implemented in the Anybody Modeling System estimated the CFs normalised per bodyweight. The effect of the LWIs with respect to the baseline on the peak and the impulse of the MCF were tested with a Wilcoxon non-parametric test for paired samples.Results: For the KOA group, LWIs did not reduce significantly the impulse and the peak of the MCF. No dose-response trend according to the degree of wedging was observed. A high inter-subject variability was found: the impulse of the MCF varied between -12%, +10%, the peak between -5%, +7%. Moreover, LWIs had no consistent effect on shifting the load from the medial to the lateral compartment.Significance: Subject-specific response to LWIs in a cohort of medial KOA patients was observed. Further studies are necessary to maximise the mechanical effect of LWIs on restoring normal knee joint mechanics. [ABSTRACT FROM AUTHOR]

Abstract Soldiers regularly transport loads weighing >20 kg at slow speeds for long durations. These tasks elicit high energetic costs through increased positive work generated by knee and ankle muscles, which may increase risk of muscular fatigue and decrease combat readiness. This study aimed to determine how modifying where load is borne changes lower-limb joint mechanical work production, and if load magnitude and/or walking speed also affect work production. Twenty Australian soldiers participated, donning a total of 12 body armor variations: six different body armor systems (one standard-issue, two commercially available [cARM1-2], and three prototypes [pARM1-3]), each worn with two different load magnitudes (15 and 30 kg). For each armor variation, participants completed treadmill walking at two speeds (1.51 and 1.83 m/s). Three-dimensional motion capture and force plate data were acquired and used to estimate joint angles and moments from inverse kinematics and dynamics, respectively. Subsequently, hip, knee, and ankle joint work and power were computed and compared between armor types and walking speeds. Positive joint work over the stance phase significantly increased with walking speed and carried load, accompanied by 2.3–2.6% shifts in total positive work production from the ankle to the hip (p < 0.05). Compared to using cARM1 with 15 kg carried load, carrying 30 kg resulted in significantly greater hip contribution to total lower-limb positive work, while knee and ankle work decreased. Substantial increases in hip joint contributions to total lower-limb positive work that occur with increases in walking speed and load magnitude highlight the importance of hip musculature to load carriage walking. [ABSTRACT FROM AUTHOR]

Abstract To investigate lower-limb muscle function during sidestep cutting, prior studies have analysed electromyography (EMG) data together with three dimensional motion analysis. Such an approach does not directly quantify the biomechanical role of individual lower-limb muscles during a sidestep cut. This study recorded three dimensional motion analysis, ground reaction force (GRF) and EMG data for eight healthy males executing an unanticipated sidestep cut. Using a musculoskeletal modelling approach, muscle function was determined by computing the muscle contributions to the GRFs and lower-limb joint moments. We found that bodyweight support (vertical GRF) was primarily provided by the vasti, gluteus maximus, soleus and gastrocnemius. These same muscles, along with the hamstrings, were also primarily responsible for modulating braking and propulsion (anteroposterior GRF). The vasti, gluteus maximus and gluteus medius were the key muscles for accelerating the centre-of-mass towards the desired cutting direction by generating a medially-directed GRF. Our findings have implications for designing retraining programs to improve sidestep cutting technique. [ABSTRACT FROM AUTHOR]

Push-rim wheelchair propulsion is biomechanically inefficient and physiologically stressful to the musculoskeletal structure of human body. This study focuses to obtain a new, optimized propulsion shape for wheelchair users, which is within the ergonomic ranges of joint motion, thus reducing the probability of injuries. To identify the propulsion movement, forward dynamic optimization was performed on a 3D human musculoskeletal model linked to a handle based propulsion mechanism, having shape and muscle excitations as optimization variables. The optimization resulted in a handle path shape with a circularity ratio of 0.95, and produced a net propulsion power of 34.7 watts for an isokinetic propulsion cycle at 50 rpm. Compared to push-rim propulsion, the compact design of the new propulsion mechanism along with the ergonomically optimized propulsion shape may help to reduce the risk of injuries and thus improve the quality of life for wheelchair users. [ABSTRACT FROM AUTHOR]

Highlights • BSP regression tables built using specific populations will be unsuitable for any one study. • 3D scanning is a fast and accurate method for calculating bespoke BSPs. • Data are comparable to cadaveric studies for segment volume, mass, CoM and MoI. Abstract Body segment parameters such as segment mass, centre of mass and moment of inertia, serve as important inputs for musculoskeletal modelling. These parameters are normally derived from regression tables; however, can be poorly representative of the study population with variations of up to 40% recorded between different tables. More recent methods, such as 3D scanning, present a rapid and accurate way to produce subject-specific body segment parameters for use in musculoskeletal models. An infra-red 3D scanner was used to produce full-body scans of 95 males and females. Each was put through an algorithm to calculate bespoke segment mass, centre of mass and inertial properties for each segment of the body, with results comparable to cadaveric data. These methods could be used to increase the specificity of musculoskeletal modelling outputs for individual subjects, improving the accuracy of modelling outputs in biomechanics-related research. [ABSTRACT FROM AUTHOR]

Mechanical devices are common treating methods for knee osteoarthritis. It has the purpose of reducing the internal joint forces and unloading the damaged structure. The reduction is often achieved by alterations in the frontal plan, shifting the contact force from one compartment to the other, leaving the total compressive force unchanged. The aim of this study was to investigate how internal knee joint forces depend on applied external moments during gait. Musculoskeletal models of the gait of 10 healthy subjects were developed in the AnyBody Modelling System and used to simulate applied joint moments about different axes (load cases), each with the magnitude to compensate the net moment about the respective axis by a specified percentage. For each load case, the total, medial and lateral knee compressive force were computed and compared with a baseline case with no external moments applied. Among the investigated moments, hip flexion-extension, knee flexion-extension and ankle plantarflexion-dorsiflexion moment compensations have the most positive impact on the total knee joint compressive force, and combining the 3, each with a 40% compensation of the muscle moments, reduced the first peak by 23.6%, the second by 30.6% and the impulse by 28.6% with respect to no applied moments. [ABSTRACT FROM AUTHOR]

Highlights • An average joint contact force prediction error of less than 20% was achieved at 25°–60° knee flexion during squats. • The average JCF error behaved almost linearly with knee flexion angle. • At deep flexion, an overestimation of approximately 60% JCF was observed. • Our data indicate that loading estimations from early musculoskeletal gait models at both high and low knee joint flexion angles should be interpreted carefully. • Validation of models was performed against state-of-the-art CAMS-Knee datasets. Abstract Standard musculoskeletal simulation tools now offer widespread access to internal loading conditions for use in improving rehabilitation concepts or training programmes. However, despite broad reliance on their outcome, the accuracy of such loading estimations, specifically in deep knee flexion, remains generally unknown. The aim of this study was to evaluate the error of tibio-femoral joint contact force (JCF) calculations using musculoskeletal simulation compared to in vivo measured JCFs in subjects with instrumented total knee endoprostheses during squat exercises. Using the early but common "Gait2392_simbody" (OpenSim) scaled musculoskeletal models, tibio-femoral JCFs were calculated in 6 subjects for 5 repetitions of squats. Tibio-femoral JCFs of 0.8–3.2 times bodyweight (BW) were measured. While the musculoskeletal simulations underestimated the measured knee JCFs at low flexion angles, an average error of less than 20% was achieved between approximately 25°–60° knee flexion. With an average error that behaved almost linearly with knee flexion angle, an overestimation of approximately 60% was observed at deep flexion (ca. 80°), with an absolute maximum error of ca. 1.9BW. Our data indicate that loading estimations from early musculoskeletal gait models at both high and low knee joint flexion angles should be interpreted carefully. [ABSTRACT FROM AUTHOR]

Abstract Variation in hip joint contact forces directly influences the performance of total hip replacements (THRs). Measurement and calculation of contact forces in THR patients has been limited by small sample sizes, wide variation in patient and surgical factors, and short-term follow-up. This study hypothesised that, at long-term follow-up, unilateral THR patients have similar calculated hip contact forces compared to controls walking at similar (self-selected) speeds and, in contrast, THR patients walking at slower (self-selected) speeds have reduced hip contact forces. It was further hypothesised that there is no difference in calculated hip contact forces between operated and non-operated limbs at long-term follow-up for both faster and slower patients. Gait analysis data for THR patients walking at faster (walking speed: 1.29 ± 0.12 m/s; n = 11) and slower (walking speed: 0.72 ± 0.09 m/s; n = 11) speeds were used. Healthy subjects constituted the control group (walking speed: 1.36 ± 0.12 m/s; n = 10). Hip contact forces were calculated using static optimisation. There was no significant difference (p > 0.31) in hip contact forces between faster and control groups. Conversely, force was reduced at heel strike by 19% (p = 0.002), toe-off by 31% (p < 0.001) and increased at mid-stance by 15% (p = 0.02) for the slower group compared to controls. There were no differences between operated and non-operated limbs for the slower group or the faster group, suggesting good biomechanical recovery at long-term follow-up. Loading, at different walking speeds, presented here can improve the relevance of preclinical testing methods. [ABSTRACT FROM AUTHOR]

Most research considering biarticular muscle function has tended to focus on the sagittal plane. Instead, the purpose of this study was to evaluate the internal/external rotation moment arms of the biarticular muscles of the knee, and then to explore their function. The FreeBody musculoskeletal model of the lower limb was used to calculate the moment arms and moments that each of the muscles of the knee exerted on the proximal tibia of 12 athletic males during vertical jumping. Biceps femoris and tensor fascia latae were external rotators of the tibia, whereas semimembranosus, semitendinosus, sartorius, gracilis, popliteus and the patellar tendon were internal rotators. The magnitudes of the internal/external rotation and flexion moments exerted on the tibia by the biarticular hamstrings were similar, suggesting that the creation of internal/external rotation is a key aspect of their role. One potential reason is to stabilise the tibia during femoral extension (and it is argued that it may be helpful to characterise the creation of active joint stability as the stabilisation of one segment during the rotation of an adjacent segment). A second explanation may be to mechanically couple hip abduction when the hip is flexed with internal rotation of the tibia. [ABSTRACT FROM AUTHOR]

This paper is the second of a three-part series that investigates the architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is widely known to be highly sensitive to its mechanical environment, and therefore has the potential to provide insight into locomotor biomechanics in extinct tetrapod vertebrates such as dinosaurs. Here in Part II, a new biomechanical modelling approach is outlined, one which mechanistically links cancellous bone architectural patterns with three-dimensional musculoskeletal and finite element modelling of the hindlimb. In particular, the architecture of cancellous bone is used to derive a single 'characteristic posture' for a given species--one in which bone continuum-level principal stresses best align with cancellous bone fabric--and thereby clarify hindlimb locomotor biomechanics. The quasi-static approach was validated for an extant theropod, the chicken, and is shown to provide a good estimate of limb posture at around mid-stance. It also provides reasonable predictions of bone loading mechanics, especially for the proximal hindlimb, and also provides a broadly accurate assessment of muscle recruitment insofar as limb stabilization is concerned. In addition to being useful for better understanding locomotor biomechanics in extant species, the approach hence provides a new avenue by which to analyse, test and refine palaeobiomechanical hypotheses, not just for extinct theropods, but potentially many other extinct tetrapod groups as well. [ABSTRACT FROM AUTHOR]

This paper is the last of a three-part series that investigates the architecture of cancellous bone in the main hindlimb bones of theropod dinosaurs, and uses cancellous bone architectural patterns to infer locomotor biomechanics in extinct non-avian species. Cancellous bone is highly sensitive to its prevailing mechanical environment, and may therefore help further understanding of locomotor biomechanics in extinct tetrapod vertebrates such as dinosaurs. Here in Part III, the biomechanical modelling approach derived previously was applied to two species of extinct, non-avian theropods, Daspletosaurus torosus and Troodon formosus. Observed cancellous bone architectural patterns were linked with quasi-static, three-dimensional musculoskeletal and finite element models of the hindlimb of both species, and used to derive characteristic postures that best aligned continuum-level principal stresses with cancellous bone fabric. The posture identified for Daspletosaurus was largely upright, with a subvertical femoral orientation, whilst that identified for Troodon was more crouched, but not to the degree observed in extant birds. In addition to providing new insight on posture and limb articulation, this study also tested previous hypotheses of limb bone loading mechanics and muscular control strategies in non-avian theropods, and how these aspects evolved on the line to birds. The results support the hypothesis that an upright femoral posture is correlated with bending-dominant bone loading and abduction-based muscular support of the hip, whereas a crouched femoral posture is correlated with torsion-dominant bone loading and long-axis rotation-based muscular support. Moreover, the results of this study also support the inference that hindlimb posture, bone loading mechanics and muscular support strategies evolved in a gradual fashion along the line to extant birds. [ABSTRACT FROM AUTHOR]

Modeling of the human hand provides insight for explaining deficits and planning treatment following injury. Creation of a dynamic model, however, is complicated by the actions of multi-articular tendons and their complex interactions with other soft tissues in the hand. This study explores the creation of a musculoskeletal model, including the thumb and index finger, to explore the effects of muscle activation deficits. The OpenSim model utilizes physiological axes of rotation at all joints, passive joint torques, and appropriate moment arms. The model was validated through comparison with kinematic and kinetic experimental data. Simulated fingertip forces resulting from modeled musculotendon loading largely fell within one standard deviation of experimental ranges for most index finger and thumb muscles, although agreement in the sagittal plane was generally better than for the coronal plane. Input of experimentally obtained electromyography data produced the expected simulated finger and thumb motion. Use of the model to predict the effects of activation deficits on pinch force production revealed that the intrinsic muscles, especially first dorsal interosseous (FDI) and adductor pollicis (ADP), had a substantial impact on the resulting fingertip force. Reducing FDI activation, such as might occur following stroke, altered fingertip force direction by up to 83° for production of a dorsal fingertip force; reducing ADP activation reduced force production in the thumb by up to 62%. This validated model can provide a means for evaluating clinical interventions. [ABSTRACT FROM AUTHOR]

This study evaluated the effect of running shoes with differing midsole cushioning on ankle, knee and hip contact forces during running. Joint contact forces were estimated in 40 recreational runners (28 female, 12 male) while running over ground in three shoe conditions. Shoes differed only in midsole cushioning (45, 57 and 70 Asker C). Three-dimensional kinetics and kinematics were collected during running and input to a musculoskeletal model to estimate internal axial forces at the ankle, knee and hip. Multivariate ANOVA suggested that more cushioned shoes, relative to less cushioned shoes, reduced peak joint contact forces (p < 0.01) and load rates (p < 0.01). Ankle joint contact force and load rate were reduced with increased cushioning (p < 0.01) with moderate to large effects observed between pairwise comparisons (p ≤ 0.01-0.05, dz=0.41-1.35). Cushioning effects were also observed for knee joint contact force (p = 0.03) and loading rate (p < 0.01) with load reduction only seen when comparing the soft and hard shoes (p ≤ 0.05, dz=0.41-0.44). Midsole cushioning had less of an effect on hip contact force (p = 0.31) although hip contact force loading rate was influenced by midsole cushioning (p < 0.01) with lower rates observed for soft versus medium and hard shoe comparisons (p ≤ 0.01, dz=0.41-0.62). These results suggest that increasing shoe cushioning properties ∼10-20% may benefit individuals susceptible to high loads at the ankle, and to a lesser extent knee and hip, during running. [ABSTRACT FROM AUTHOR]

The generation of subject-specific musculoskeletal models of the lower limb has become a feasible task thanks to improvements in medical imaging technology and musculoskeletal modelling software. Nevertheless, clinical use of these models in paediatric applications is still limited for what concerns the estimation of muscle and joint contact forces. Aiming to improve the current state of the art, a methodology to generate highly personalized subject-specific musculoskeletal models of the lower limb based on magnetic resonance imaging (MRI) scans was codified as a step-by-step procedure and applied to data from eight juvenile individuals. The generated musculoskeletal models were used to simulate 107 gait trials using stereophotogrammetric and force platform data as input. To ensure completeness of the modelling procedure, muscles’ architecture needs to be estimated. Four methods to estimate muscles’ maximum isometric force and two methods to estimate musculotendon parameters (optimal fiber length and tendon slack length) were assessed and compared, in order to quantify their influence on the models’ output. Reported results represent the first comprehensive subject-specific model-based characterization of juvenile gait biomechanics, including profiles of joint kinematics and kinetics, muscle forces and joint contact forces. Our findings suggest that, when musculotendon parameters were linearly scaled from a reference model and the muscle force-length-velocity relationship was accounted for in the simulations, realistic knee contact forces could be estimated and these forces were not sensitive the method used to compute muscle maximum isometric force. [ABSTRACT FROM AUTHOR]

Background Knowledge of forces acting through the glenohumeral joint during activities of daily living is a prerequisite for improving implant design and aiding rehabilitation planning. Existing data are limited by the number of activities performed and, in some cases, the lack of representation of the glenohumeral loading direction, although high shear force components may cause joint dislocation or implant loosening. This study aims to analyse shoulder compression and shear force components during essential functional activities of daily living. Methods This is a combined modelling and experimental study. Motion data and external forces measured from 25 participants for 26 activities of daily living serve as input into an upper limb musculoskeletal model that quantifies glenohumeral loading. Findings The shoulder contact force exceeds 50% of the body weight in 10/26 activities of daily living with a maximum contact force of 164% of the body weight (SD 69%) for a sit to stand task. The ratio of glenohumeral shear force component to compression force component exceeds 0.5 in 8/26 functional activities, with maximum ratios for reaching across the body (1.09; SD 0.41) and pick and place an everyday object (0.88; SD 0.36). Interpretation This study demonstrates substantial loads through the glenohumeral joint during activities of daily living. The ratios of glenohumeral shear force component to compression force component are considerable when high loads act at long lever arms and at high angles of arm elevation. These glenohumeral ratios represent a key component of loading that should be considered when designing implants, surgical procedures, or rehabilitation protocols. [ABSTRACT FROM AUTHOR]

The varus knee has been defined as a Hip-Knee-Ankle alignment of less than 180 degrees. Varus knee alignment increases the load on the medial knee and also the risk of osteoarthritis. High tibial osteotomy has been designed to modify the malalignment of varus knee. The aim of this study was to investigate the osteotomy effects on knee adduction moment (KAM) and contact forces using a musculoskeletal and subject-specific knee model. A patient with varus knee and no symptoms of any other disease or disability participated in this study. The geometry of the multibody knee model has been modified using MR images. The solutions of its finite element model have been used to determine the parameters of the multibody model. The motion data, ground reaction force and kinetic data have been applied to run the subject-specific musculoskeletal model during the stance phase of gait. After osteotomy, the adduction moment decreased, where the maximum values are comparable to other studies. The pattern of KAM did not witness any significant changes. The total and medial contact forces reduced considerably after surgery, but the lateral contact force did not significantly change. The changes in total and medial contact forces and lack of change in lateral contact force could be explained by modification of the gait pattern after surgery. [ABSTRACT FROM AUTHOR]

Background: Knee adduction moment (KAM) is often used as a surrogate marker of knee contact force (KCF) during walking. Previous studies have reported potential benefits to reduce KAM in patients with knee osteoarthritis (OA) by foot progression angle adjustment. However, KAM is an external moment and it does not consider any muscle contribution to the joint loading, which should pose a greater influence in running than walking.Research Question: This study used a computational model to compare KAM and KCF between runners with and without knee OA during running. In addition, we evaluated the KAM and KCF when runners adjusted to an out-toe running style.Methods: Kinematic, kinetic, and lower limb EMG data were collected from 9 runners with knee OA and 10 healthy counterparts. They were asked to run at their usual speed with standard shoes on an instrumented treadmill.Results: We found no significant difference in the KAM during running between OA and the healthy group (p > 0.376). However, runners with knee OA exhibited a greater total KCF than the healthy counterparts (p < 0.041). We did not observe any reduction in KAM after foot progression angle adjustment (p > 0.346). Surprisingly, an increase in the longitudinal KCF and total KCF were found with adjustment of foot progression angle (p < 0.046).Significance: Unlike the findings reported by the previous walking trials, our findings do not support the notion that foot progression angle adjustment would lead to a lower joint loading during running. [ABSTRACT FROM AUTHOR]

Abnormal kinematics and kinetics have been reported in hip osteoarthritis (OA) patients before and after total hip arthroplasty (THA). These changes can affect the loading of the ipsilateral hip, as well as the contralateral hip and knee joint. As it is not clear how hip and knee loading evolves in THA patients during the first year after surgery, the goal of this study is to define how joint loading changes in patients before and at three evaluation times after THA surgery. Musculoskeletal modelling in combination with gait analysis data was used to calculate hip and knee contact forces in 14 patients before and 3-, 6- and 12-months after unilateral THA, as well as in 18 healthy controls. Results showed that bilateral hip and knee loading were decreased compared to controls, both before and after THA surgery. Loading symmetry was altered compared to controls at 3-months post-surgery for the hip and at all evaluation times, except for 6-months post-surgery, for the knee, with ipsilateral joint loading decreased compared to the contralateral side. To conclude, 12-months after THA joint loading was not normalized, with both hip and knee loading in patients decreased compared to controls. Therefore, no overloading of the ipsi- or contralateral hip and knee joint was found before and up to one year after unilateral THA. [ABSTRACT FROM AUTHOR]

Altered neural control of movement and musculoskeletal deficiencies are common in children with spastic cerebral palsy (SCP), with muscle weakness and contracture commonly experienced. Both neural and musculoskeletal deficiencies are likely to contribute to abnormal gait, such as equinus gait (toe-walking), in children with SCP. However, it is not known whether the musculoskeletal deficiencies prevent normal gait or if neural control could be altered to achieve normal gait. This study examined the effect of simulated muscle weakness and contracture of the major plantarflexor/dorsiflexor muscles on the neuromuscular requirements for achieving normal walking gait in children. Initial muscle-driven simulations of walking with normal musculoskeletal properties by typically developing children were undertaken. Additional simulations with altered musculoskeletal properties were then undertaken; with muscle weakness and contracture simulated by reducing the maximum isometric force and tendon slack length, respectively, of selected muscles. Muscle activations and forces required across all simulations were then compared via waveform analysis. Maintenance of normal gait appeared robust to muscle weakness in isolation, with increased activation of weakened muscles the major compensatory strategy. With muscle contracture, reduced activation of the plantarflexors was required across the mid-portion of stance suggesting a greater contribution from passive forces. Increased activation and force during swing was also required from the tibialis anterior to counteract the increased passive forces from the simulated dorsiflexor muscle contracture. Improvements in plantarflexor and dorsiflexor motor function and muscle strength, concomitant with reductions in plantarflexor muscle stiffness may target the deficits associated with SCP that limit normal gait. [ABSTRACT FROM AUTHOR]

Group-based and individual-based studies in cricket fast bowling have identified common technique characteristics associated with ball release speed. The applicability of these findings to individual bowlers is often questioned, however, due to research approach limitations. This study aims to identify whether the optimal initial body position at front foot contact and subsequent technique to maximise ball release speed exhibit common characteristics for elite male cricket fast bowlers using individual-specific computer optimisations. A planar 16-segment whole-body torque-driven simulation model of the front foot contact phase of fast bowling was customised, evaluated, and the initial body position and subsequent movement pattern optimised, for ten elite male fast bowlers. The optimised techniques significantly increased ball release speed by 4.8 ± 1.3 ms−1 (13.5 ± 4.1%) and ranged between 37.8 and 42.9 ms−1, and in lower peak ground reaction forces and loading rates. Common characteristics were observed within the optimal initial body position with more extended front knees, as well as more flexion of the front and bowling arm shoulders than in current performances. Delays to the onset of trunk flexion, front arm and bowling arm shoulder extension, and wrist flexion were also common in the subsequent movement during the front foot contact phase. Lower front hip extensor and front shoulder flexor torques, as well as greater bowling shoulder extensor torques were also evident. This is useful knowledge for coach development, talent identification, and coaching practice. [ABSTRACT FROM AUTHOR]

The aim of this study was to compare young and adult sprinters on several biomechanical parameters that were previously highlighted as performance-related and to determine the behaviour of several muscle–tendon units (MTU) in the first stance phase following a block start in sprint running. The ground reaction force (GRF) and kinematic data were collected from 16 adult and 21 young well-trained sprinters. No difference between the groups was found in some of the previously highlighted performance-related parameters (ankle joint stiffness, the range of dorsiflexion and plantar flexor moment). Interestingly, the young sprinters showed a greater maximal and mean ratio of horizontal to total GRF, which was mainly attributed to a greater horizontal GRF relative to body mass and resulted in a greater change in horizontal centre of mass (COM) velocity during the stance phase in the young compared with the adult sprinters. Results from the MTU length analyses showed that adult sprinters had more MTU shortening and higher maximal MTU shortening velocities in all plantar flexors and the rectus femoris. Although previously highlighted performance-related parameters could not explain the greater 100 m sprinting times in the adult sprinters, differences were found in the behaviour of the MTU of the plantar flexors and rectus femoris during the first stance phase. The pattern of length changes in these MTUs provides ideal conditions for the use of elastic energy storage and release for power enhancement.

The triceps surae primarily acts as plantarflexor of the ankle joint. However, the group also causes inversion and eversion at the subtalar joint. Despite this, the Achilles tendon moment arm is generally measured without considering the potential influence of inversion/eversion of the foot during plantarflexion. This study investigated the effect of foot inversion and eversion on the plantarflexion Achilles tendon moment arm. Achilles tendon moment arms were determined using the centre-of-rotation method in magnetic resonance images of the left ankle of 11 participants. The foot was positioned at 15° dorsiflexion, 0° or 15° plantarflexion using a Styrofoam wedge. In each of these positions, the foot was either 10° inverted, neutral or 10° everted using an additional Styrofoam wedge. Achilles tendon moment arm in neutral foot position was 47.93 ± 4.54 mm and did not differ significantly when the foot was positioned in 10° inversion and 10° eversion. Hence, inversion/eversion position of the foot may not considerably affect the length of the Achilles tendon moment arm. This information could be useful in musculoskeletal models of the human lower leg and foot and when estimating Achilles tendon forces during plantarflexion with the foot positioned in inversion or eversion.

This study presents the development of a number of finite element (FE) models of the pelvis using different continuum and structural modelling approaches. Four FE models were developed using different modelling approaches: continuum isotropic, continuum orthotropic, hybrid isotropic and hybrid orthotropic. The models were subjected to an iterative adaptation process based on the Mechanostat principle. Each model was adapted to a number of common daily living activities (walking, stair ascent, stair descent, sit-to-stand and stand-to-sit) by applying onto it joint and muscle loads derived using a musculoskeletal modelling framework. The resulting models, along with a structural model previously developed by the authors, were compared visually in terms of bone architecture, and their response to a single load case was compared to a continuum FE model derived from computed tomography (CT) imaging data. The main findings of this study were that the continuum orthotropic model was the closest to the CT derived model in terms of load response albeit having less total bone volume, suggesting that the role of material directionality in influencing the maximum orthotropic Young’s modulus should be included in continuum bone adaptation models. In addition, the hybrid models, where trabecular and cortical bone were distinguished, had similar outcomes, suggesting that the approach to modelling trabecular bone is less influential when the cortex is modelled separately.

Diabetic foot is one of the most debilitating complications of diabetes and may lead to plantar ulcers. In the last decade, gait analysis, musculoskeletal modelling (MSM) and finite element modelling (FEM) have shown their ability to contribute to diabetic foot prevention and suggested that the origin of the plantar ulcers is in deeper tissue layers rather than on the plantar surface. Hence the aim of the current work is to develop a methodology that improves FEM-derived foot internal stresses prediction, for diabetic foot prevention applications. A 3D foot FEM was combined with MSM derived force to predict the sites of excessive internal stresses on the foot. In vivo gait analysis data, and an MRI scan of a foot from a healthy subject were acquired and used to develop a six degrees of freedom (6 DOF) foot MSM and a 3D subject-specific foot FEM. Ankle kinematics were applied as boundary conditions to the FEM together with: 1. only Ground Reaction Forces (GRFs); 2. OpenSim derived extrinsic muscles forces estimated with a standard OpenSim MSM; 3. extrinsic muscle forces derived through the (6 DOF) foot MSM; 4. intrinsic and extrinsic muscles forces derived through the 6 DOF foot MSM. For model validation purposes, simulated peak pressures were extracted and compared with those measured experimentally. The importance of foot muscles in controlling plantar pressure distribution and internal stresses is confirmed by the improved accuracy in the estimation of the peak pressures obtained with the inclusion of intrinsic and extrinsic muscle forces. [ABSTRACT FROM AUTHOR]

This study aims at defining gait pathomechanics in patients with hip osteoarthritis (OA) and their effect on hip joint loading by combining analyses of hip kinematics, kinetics and contact forces during gait. Twenty patients with hip OA and 17 healthy volunteers matched for age and BMI performed three-dimensional gait analysis. Hip OA level was evaluated based on plane radiographs using the Tönnis classification. Hip joint kinematics, kinetics as well as hip contact forces were calculated. Waveforms were time normalized and compared between groups using statistical parametric mapping analysis. Patients walked with reduced hip adduction angle and reduced hip abduction and external rotation moments. The work generated by the hip abductors during the stance phase of gait was largely decreased. These changes resulted in a decrease and a more vertical and anterior orientation of the hip contact forces compared to healthy controls. This study documents alterations in hip kinematics and kinetics resulting in decreased hip loading in patients with hip OA. The results suggested that patients altered their gait to increase medio-lateral stability, thereby decreasing demand on the hip abductors. These findings support discharge of abductor muscles that may bear clinical relevance of tailored rehabilitation targeting hip abductor muscles strengthening and gait retraining. [ABSTRACT FROM AUTHOR]

Previous studies suggested that a pronounced weakness of the extensor muscles relative to the flexor muscles could increase the risk of occurrence of lateral epicondylalgia. This study investigates this hypothesis by estimating the ratio of extensor to flexor muscle capacities among healthy non-players (n = 10), healthy tennis players (n = 20), symptomatic players (n = 6), and players who have recovered from lateral epicondylalgia (n = 6). Maximum net joint moments in flexion or extension were measured during seven tasks involving the voluntary contraction of wrist and fingers. Using these data, the muscle capacities of the main muscle groups of the hand (wrist flexors, wrist extensors, finger flexors, finger extensors, and intrinsic muscles) were estimated using a musculoskeletal model. These capacities were then used to compute the extensor/flexor capacity ratios about the wrist and the finger joints. Compared to healthy non-players, healthy players presented higher extensor muscle capacities and greater capacity ratios showing that playing tennis generates specific adaptations of muscle capacities. Interestingly, symptomatic players, similar to those of non-players, showed more imbalanced ratios than healthy players. These results confirm that the ratio of extensor/flexor muscle capacities seems to be associated with lateral epicondylalgia and can be further used to understand its incidence and consequences. [ABSTRACT FROM AUTHOR]

Background and objective: Physiological cross-sectional area (PCSA) of a muscle plays a significant role in determining the force contribution of muscle fascicles to skeletal movement. This parameter is typically calculated from the lengths of muscle fibres selectively sampled from the superficial layer of the muscle. However, recent studies have found that the length of fibres in the superficial layer often differs significantly ( p  < 0.5) from the length of fibres in the deep layer. As a result, PCSA estimation is inaccurate. In this paper, we propose a method to automatically reconstruct fibres in the whole volume of a muscle from those selectively sampled on the superficial layer. Methods: The method performs a centripetal Catmull–Rom interpolation of the input fibres within the volume of a muscle represented by its 3D surface model, automatically distributing the fibres among multiple heads of the muscle and shortening the deep fibres to support large attachment areas with extremely acute angles. Results: Our C++ implementation runs in a couple of seconds on commodity hardware providing realistic results for both artificial and real data sets we tested. Conclusions: The fibres produced by the method can be used directly to determine the personalised mechanical muscle functioning. Our implementation is publicly available for the researchers at https://mi.kiv.zcu.cz/ . [ABSTRACT FROM AUTHOR]

Diabetes neuropathy and vasculopathy are the two major complications of diabetes mellitus, leading to diabetic foot disease, of which the worst consequences are plantar ulcers and amputations. Motor impairments like joint stiffness and loss of balance are distinctive effects of diabetes and they have been extensively explored. However, while altered muscle function has been also assessed through experimentally measured surface electromyography, little is known about muscle forces. The objective of this study was to estimate muscle forces in subjects with diabetes and to use these data to identify differences with respect to a population of healthy subjects matched for age and BMI. This was obtained by generating musculoskeletal models of 10 diabetic and 10 control subjects in OpenSim starting from experimentally recorded data. Dynamic simulations of motion were run and hence muscle forces calculated. Student T test (p<0.05) was used to compare joints kinematics, kinetics and muscle forces between the two populations. Significant changes were observed between lower limb muscle forces and activation of diabetic and healthy subjects, as well as between joints kinematics and kinetics. In particular muscles related to foot movements proved to be stronger in the healthy population. The typical ankle rigidity of the diabetic population was confirmed by a lower range of motion registered at the ankle plantar/flexion angle associated with weaker dorsal-plantar flexor muscles. The information provided by this methodology can help planning specific training programs aiming at augmenting muscle strength and joints mobility, and they can also improve the evaluation of the potential benefits. [ABSTRACT FROM AUTHOR]

Musculoskeletal models are widely used to estimate joint kinematics, intersegmental loads, and muscle and joint contact forces during movement. These estimates can be heavily affected by the soft tissue artefact (STA) when input positional data are obtained using stereophotogrammetry, but this aspect has not yet been fully characterised for muscle and joint forces. This study aims to assess the sensitivity to the STA of three open-source musculoskeletal models, implemented in OpenSim. A baseline dataset of marker trajectories was created for each model from experimental data of one healthy volunteer. Five hundred STA realizations were then statistically generated using a marker-dependent model of the pelvis and lower limb artefact and added to the baseline data. The STA׳s impact on the musculoskeletal model estimates was finally quantified using a Monte Carlo analysis. The modelled STA distributions were in line with the literature. Observed output variations were comparable across the three models, and sensitivity to the STA was evident for most investigated quantities. Shape, magnitude and timing of the joint angle and moment time histories were not significantly affected throughout the entire gait cycle, whereas magnitude variations were observed for muscle and joint forces. Ranges of contact force variations differed between joints, with hip variations up to 1.8 times body weight observed. Variations of more than 30% were observed for some of the muscle forces. In conclusion, musculoskeletal simulations using stereophotogrammetry may be safely run when only interested in overall output patterns. Caution should be paid when more accurate estimated values are needed. [ABSTRACT FROM AUTHOR]

The recent development of a soft tissue artifact (STA) suppression method allows us to re-evaluate the tibiofemoral kinematics currently linked to non-contact knee injuries. The purpose of this study was therefore to evaluate knee joint kinematics and kinetics in six degrees of freedom (DoF) during the loading phases of a jump lunge and side cut using this in silico method. Thirty-five healthy adults completed these movements and their surface marker trajectories were then scaled and processed with OpenSim’s inverse kinematics (IK) and inverse dynamics tools. Knee flexion angle-dependent kinematic constraints defined based on previous bone pin (BP) marker trajectories were then applied to the OpenSim model during IK and these constrained results were then processed with the standard inverse dynamics tool. Significant differences for all hip, knee, and ankle DoF were observed after STA suppression for both the jump lunge and side cut. Using clinically relevant effect size estimates, we conclude that STA contamination had led to misclassifications in hip transverse plane angles, knee frontal and transverse plane angles, medial/lateral and distractive/compressive knee translations, and knee frontal plane moments between the NoBP and the BP IK solutions. Our results have substantial clinical implications since past research has used joint kinematics and kinetics contaminated by STA to identify risk factors for musculoskeletal injuries. [ABSTRACT FROM AUTHOR]

Kinematic models of lower limb joints have several potential applications in musculoskeletal modelling of the locomotion apparatus, including the reproduction of the natural joint motion. These models have recently revealed their value also for in vivo motion analysis experiments, where the soft-tissue artefact is a critical known problem. This arises at the interface between the skin markers and the underlying bone, and can be reduced by defining multibody kinematic models of the lower limb and by running optimization processes aimed at obtaining estimates of position and orientation of relevant bones. With respect to standard methods based on the separate optimization of each single body segment, this technique makes it also possible to respect joint kinematic constraints. Whereas the hip joint is traditionally assumed as a 3 degrees of freedom ball and socket articulation, many previous studies have proposed a number of different kinematic models for the knee and ankle joints. Some of these are rigid, while others have compliant elements. Some models have clear anatomical correspondences and include real joint constraints; other models are more kinematically oriented, these being mainly aimed at reproducing joint kinematics. This paper provides a critical review of the kinematic models reported in literature for the major lower limb joints and used for the reduction of soft-tissue artefact. Advantages and disadvantages of these models are discussed, considering their anatomical significance, accuracy of predictions, computational costs, feasibility of personalization, and other features. Their use in the optimization process is also addressed, both in normal and pathological subjects. [ABSTRACT FROM AUTHOR]

The present study introduced a new method to simultaneously optimize the path, magnitude and orientation of medial and lateral femorotibial contact forces using bone geometry constraints. The new method will be numerically compared to the known contact point method while estimating the muscle and contact forces for the stance phase of a single gait trial. A single generic lower extremity model was modified to allow knee flexion with an instantaneous rotation center. The contact point method simulated medial and lateral contact forces with no limited magnitude and with predefined one-dimensional paths and orientations. The new contact zone method simulated contact forces with a limited magnitude and with two-dimensional paths and orientations constrained by the geometry of the bones. A high and low limit was used to study the effect of limiting the contact force magnitude on the predicted forces. The paths of the contact forces for the contact zone method showed a difference up to 25.5 mm with respect to the contact point model. The contact zone method also allowed for more shear contact forces and for some modulation of the external frontal moment. Further limiting the contact force magnitude induced noticeable differences of muscle forces. The contact zone method allows the path, magnitude and orientation of the femorotibial contact forces to be sensitive to knee bone geometries and to the amount of allowable joint contact force. Such a method is promising in characterizing the contact forces with modified gait, bone geometries and knee strength associated with pathological conditions such as osteoarthritic and ACL-deficiency. [ABSTRACT FROM AUTHOR]

While no consensus allows explaining how and when human-like traits arose in fossil hominin hands, the recent discoveries of the Lomekwian stone tools (3.3 Ma) support the view that early hominins were able to use forceful grips in order to manipulate large-sized blocks for pounding activities. Then, assessing gripping abilities of contemporaneous hominin, i.e. Australopithecus afarensis , is necessary, particularly with regards to its unusual 5th ray morphology that has been deemed crucial to ensure forceful grips. Here, we present a musculoskeletal simulation based on the A. afarensis hand morphology that includes an original 5th carpometacarpal joint. Our first results suggest a limited influence of muscle parameters (e.g., PCSA) and support the value of simulations for studying extinct taxa even in absence of soft-tissue data. Given the inability for the pulp of the 5th ray to face the surface of a large-sized object, the A. afarensis hand would have had limited possibility to exert sufficient force to make the Lomekwian stone tools. [ABSTRACT FROM AUTHOR]

Background: To ensure an efficient and targeted adaptation with low injury risk during strength exercises, knowledge of the participant specific internal loading conditions is essential. The goal of this study was to calculate the lower limb muscles forces during the strength exercises deadlifts, goodmornings and splits squats by means of musculoskeletal simulation. Methods: 11 participants were assessed performing 10 different variations of split squats by varying the step length as well as the maximal frontal tibia angle, and 13 participants were measured performing deadlift and goodmorning exercises. Using individualised musculoskeletal models, forces of the Quadriceps (four parts), Hamstrings (four parts) and m. gluteus maximus (three parts) were computed. Results: Deadlifts resulted highest loading for the Quadriceps, especially for the vasti (18-34 N/kg), but not for the rectus femoris (8-10 N/kg), which exhibited its greatest loading during split squats (13-27 N/kg) in the rear limb. Hamstrings were loaded isometrically during goodmornings but dynamically during deadlifts. For the m. gluteus maximus, the highest loading was observed during split squats in the front limb (up to 25 N/kg), while deadlifts produced increasingly, large loading over large ranges of motion in hip and knee. Conclusions: Acting muscle forces vary between exercises, execution form and joint angle. For all examined muscles, deadlifts produced considerable loading over large ranges of motion, while split squats seem to be highly dependent upon exercise variation. This study provides key information to design strength-training programs with respect to loading conditions and ranges of motion of lower extremity muscles. [ABSTRACT FROM AUTHOR]

Companies need continuous improvement studies in manufacturing processes to improve the product quality and decrease the costs. The most important factor that affects quality and cost of the product is employee. The investigation, analysis and evaluation of working conditions that affect employees play an important role for improvements to be made in the production processes. Long-term and repeated working postures during the manufacturing activities may cause various severity of strain on employee's body and musculoskeletal disorders (MSDs) in time. MSDs have a negative effect on employee performance and work productivity. Working postures can be analysed using observational methods such as RULA, REBA, NIOSH and OWAS. In addition to these, analysis can also be done using software that allows evaluation considering joint reaction forces by examining the human body according to biomechanical principles. In this study, postural disorders observed in assembly process of wheel hay rake in a company that produces agricultural tools were evaluated using Computer Aided Ergonomics (CAE) software AnyBody Modelling System (AMS) which provides an analysis of the human body according to biomechanical principles. As a result of the evaluation, a new assembly unit design was proposed to remove the postural disorders during the work. [ABSTRACT FROM AUTHOR]

The goal of this study was to gain insight into how ankle exoskeletons affect the behavior of the plantarflexor muscles during walking. Using data from previous experiments, we performed electromyographydriven simulations of musculoskeletal dynamics to explore how changes in exoskeleton assistance affected plantarflexor muscle-tendon mechanics, particularly for the soleus. We used a model of muscle energy consumption to estimate individual muscle metabolic rate. As average exoskeleton torque was increased, while no net exoskeleton work was provided, a reduction in tendon recoil led to an increase in positive mechanical work performed by the soleus muscle fibers. As net exoskeleton work was increased, both soleus muscle fiber force and positive mechanical work decreased. Trends in the sum of the metabolic rates of the simulated muscles correlated well with trends in experimentally observed whole-body metabolic rate (R2=0.9), providing confidence in our model estimates. Our simulation results suggest that different exoskeleton behaviors can alter the functioning of the muscles and tendons acting at the assisted joint. Furthermore, our results support the idea that the series tendon helps reduce positive work done by the muscle fibers by storing and returning energy elastically. We expect the results from this study to promote the use of electromyography-driven simulations to gain insight into the operation of muscle-tendon units and to guide the design and control of assistive devices. [ABSTRACT FROM AUTHOR]

Recent developments in musculoskeletal modelling have enabled numerous studies to explore how individual muscles contribute to progression, support and mechanical loading during gait. However, the literature still lacks data on the contributions of musculo-tendon forces to several structures, making it difficult to determine the primary contributors. The aim of the present study was thus to provide a comprehensive investigation of individual muscle contributions to ground reaction (i.e. 3D ground reaction force and moment), and to joint contact, ligament and bone (i.e. compression-traction of bony segments) forces during normal gait. We used a 3D lower limb musculoskeletal model coupled with a static optimisation method using a pseudo-inverse, which indeed yielded data on individual muscle contributions currently missing from the literature. We report the individual muscle contributions to (i) 3D ground reaction force and moment, (ii) hip, tibiofemoral, patellofemoral and ankle joint contact forces, (iii) tibiofemoral and ankle ligament forces, and (iv) femur, patella and tibia bone forces. In line with the recent literature, the primary contributors are the vastii, gluteus medius, soleus, rectus femoris, gemellus, quadratus femoris, gluteus maximus, and adductors. While the current observations are made on a generic model, the present method offers a comprehension tool that can shed light on the underlying mechanisms governing the musculoskeletal system. [ABSTRACT FROM AUTHOR]

Individuals with hand amputation suffer substantial loss of independence. Performance of sophisticated prostheses is limited by the ability to control them. To achieve natural and simultaneous control of all wrist and hand motions, we propose to use real-time biomechanical simulation to map between residual EMG and motions of the intact hand. Here we describe a musculoskeletal model of the hand using only extrinsic muscles to determine whether real-time performance is possible. Simulation is 1.3 times faster than real time, but the model is locally unstable. Methods are discussed to increase stability and make this approach suitable for prosthesis control. [ABSTRACT FROM PUBLISHER]

Sparse geometric information from limited field-of-view medical images is often used to reconstruct the femur in biomechanical models of the hip and knee. However, the full femur geometry is needed to establish boundary conditions such as muscle attachment sites and joint axes which define the orientation of joint loads. Statistical shape models have been used to estimate the geometry of the full femur from varying amounts of sparse geometric information. However, the effect that different amounts of sparse data have on reconstruction accuracy has not been systematically assessed. In this study, we compared shape model and linear scaling reconstruction of the full femur surface from varying proportions of proximal and distal partial femur geometry in combination with morphometric and landmark data. We quantified reconstruction error in terms of surface-to-surface error as well as deviations in the reconstructed femur’s anatomical coordinate system which is important for biomechanical models. Using a partial proximal femur surface, mean shape model-based reconstruction surface error was 1.8 mm with 0.15° or less anatomic axis error, compared to 19.1 mm and 2.7–5.6° for linear scaling. Similar results were found when using a partial distal surface. However, varying amounts of proximal or distal partial surface data had a negligible effect on reconstruction accuracy. Our results show that given an appropriate set of sparse geometric data, a shape model can reconstruct full femur geometry with far greater accuracy than simple scaling. [ABSTRACT FROM PUBLISHER]

Primary causes of surgical revision after total hip arthroplasty are polyethylene wear and implant loosening. These factors are particularly related to joint friction and thus patients' physical activity. Assessing implant wear over time according to patients' morphology and physical activity level is key to improve follow-up and patients' quality of life. An approach initially proposed for tibiofemoral prosthetic wear estimation was adapted to compute two wear factors (force-velocity, directional wear intensity) using a musculoskeletal model. It was applied on 17 participants with total hip arthroplasty to compute joint angular velocity, contact force, sliding velocity, and wear factors during common daily living activities. Differences were observed between gait, sitting down, and standing up tasks. An incremental increase of both global wear factors (time-integral) was observed during gait from slow to fast speeds (p ≤ 0.01). Interestingly, these two wear factors did not result in same trend for sitting down and standing up tasks. Compared to gait, one cycle of sitting down or standing up tends to induce higher friction-related wear but lower cross-shear-related wear. Depending on the wear factor, significant differences can be found between sitting down and gait at slow speed (p ≤ 0.05), and between sitting down (p ≤ 0.05) or standing up (p ≤ 0.05) and gait at fast speed. Furthermore, depending on the activity, wear can be fostered by joint contact force and/or sliding velocity. This study demonstrated the potential of wear estimation to highlight activities inducing a higher risk of implant wear after total hip arthroplasty from motion capture data. • The faster the participants walk, the higher the wear factor are. • One cycle of sitting down or standing up lead to higher friction-related wear than gait. • The wear factors can be fostered by joint contact force and/or sliding velocity. [ABSTRACT FROM AUTHOR]

Introduction: Mechanical loading is known to determine the course of bone fracture healing. We hypothesise that lower limb long bone loading differs with knee flexion angle during walking and frontal knee alignment, which affects fracture healing success. Materials and methods: Using our musculoskeletal in silico modelling constrained against in vivo data from patients with instrumented knee implants allowed us to assess internal loads in femur and tibia. These internal forces were associated with the clinical outcome of fracture healing in a relevant cohort of 178 extra-articular femur and tibia fractures in patients using a retrospective approach. Results: Mean peak forces differed with femoral compression (1,330-1,936 N at mid-shaft) amounting to about half of tibial compression (2,299-5,224 N). Mean peak bending moments in the frontal plane were greater in the femur (71-130 Nm) than in the tibia (from 26 to 43 Nm), each increasing proximally. Bending in the sagittal plane showed smaller mean peak bending moments in the femur (-38 to 43 Nm) reaching substantially higher values in the tibia (-63 to -175 Nm) with a peak proximally. Peak torsional moments had opposite directions for the femur (-13 to -40 Nm) versus tibia (15-48 Nm) with an increase towards the proximal end in both. Femoral fractures showed significantly lower scores in the modified Radiological Union Scale for Tibia (mRUST) at last follow-up ( p < 0.001) compared to tibial fractures. Specifically, compression ( r = 0.304), sagittal bending ( r = 0.259), and frontal bending ( r = -0.318) showed strong associations ( p < 0.001) to mRUST at last follow-up. This was not the case for age, body weight, or localisation alone. Discussion: This study showed that moments in femur and tibia tend to decrease towards their distal ends. Tibial load components were influenced by knee flexion angle, especially at push-off, while static frontal alignment played a smaller role. Our results indicate that femur and tibia are loaded differently and thus require adapted fracture fixation considering load components rather than just overall load level., Competing Interests: MH reports grants from Stryker, during the conduct of the study. PD reports grants from the OrthoLoadClub, during the conduct of the study. GD reports grants from Pluristem, DePuy Synthes, Implantec, Implantcast, S&N, Stryker, Zimmer, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Heyland, Deppe, Reisener, Damm, Taylor, Reinke, Duda and Trepczynski.)