TY - JOUR
T1 - Gait alteration strategies for knee osteoarthritis
T2 - a comparison of joint loading via generic and patient-specific musculoskeletal model scaling techniques
AU - Dzialo, Christine Mary
AU - Mannisi, Marco
AU - Halonen, Kimmo
AU - de Zee, Mark
AU - Woodburn, Jim
AU - Andersen, Michael Skipper
PY - 2019/7/21
Y1 - 2019/7/21
N2 - Gait modifications and laterally wedged insoles are non-invasive approaches used to treat medial compartment knee osteoarthritis. However, the outcome of these alterations is still a controversial topic. This study investigates how gait alteration techniques may have a unique effect on individual patients; and furthermore, the way we scale our musculoskeletal models to estimate the medial joint contact force may influence knee loading conditions. Five patients with clinical evidence of medial knee osteoarthritis were asked to walk at a normal walking speed over force plates and simultaneously 3D motion was captured during seven conditions (0°-, 5°-, 10°-insoles, shod, toe-in, toe-out, and wide stance). We developed patient-specific musculoskeletal models, using segmentations from magnetic resonance imaging to morph a generic model to patient-specific bone geometries and applied this morphing to estimate muscle insertion sites. Additionally, models were created of these patients using a simple linear scaling method. When examining the patients’ medial compartment contact force (peak and impulse) during stance phase, a ‘one-size-fits-all’ gait alteration aimed to reduce medial knee loading did not exist. Moreover, the different scaling methods lead to differences in medial contact forces; highlighting the importance of further investigation of musculoskeletal modeling methods prior to use in the clinical setting.
AB - Gait modifications and laterally wedged insoles are non-invasive approaches used to treat medial compartment knee osteoarthritis. However, the outcome of these alterations is still a controversial topic. This study investigates how gait alteration techniques may have a unique effect on individual patients; and furthermore, the way we scale our musculoskeletal models to estimate the medial joint contact force may influence knee loading conditions. Five patients with clinical evidence of medial knee osteoarthritis were asked to walk at a normal walking speed over force plates and simultaneously 3D motion was captured during seven conditions (0°-, 5°-, 10°-insoles, shod, toe-in, toe-out, and wide stance). We developed patient-specific musculoskeletal models, using segmentations from magnetic resonance imaging to morph a generic model to patient-specific bone geometries and applied this morphing to estimate muscle insertion sites. Additionally, models were created of these patients using a simple linear scaling method. When examining the patients’ medial compartment contact force (peak and impulse) during stance phase, a ‘one-size-fits-all’ gait alteration aimed to reduce medial knee loading did not exist. Moreover, the different scaling methods lead to differences in medial contact forces; highlighting the importance of further investigation of musculoskeletal modeling methods prior to use in the clinical setting.
KW - Gait modifications
KW - knee contact force
KW - lateral insoles
KW - magnetic resonance imaging
KW - medial compartment knee osteoarthritis
KW - morphing
KW - musculoskeletal model
KW - scaling
UR - http://www.scopus.com/inward/record.url?scp=85075531608&partnerID=8YFLogxK
U2 - 10.1080/23335432.2019.1629839
DO - 10.1080/23335432.2019.1629839
M3 - Journal article
VL - 6
SP - 54
EP - 65
JO - International Biomechanics
JF - International Biomechanics
SN - 2333-5432
IS - 1
ER -