A Patient-Specific Foot Model for the Estimate of Ankle Joint Forces in Patients with Juvenile Idiopathic Arthritis

Juvenile idiopathic arthritis (JIA) is the leading cause of childhood disability from a musculoskeletal disorder. It generally affects large joints such as the knee and the ankle, often causing structural damage. Different factors contribute to the damage onset, including altered joint loading and other mechanical factors, associated with pain and inflammation. The prediction of patients' joint loading can hence be a valuable tool in understanding the disease mechanisms involved in structural damage progression. A number of lower-limb musculoskeletal models have been proposed to analyse the hip and knee joints, but juvenile models of the foot are still lacking. This paper presents a modelling pipeline that allows the creation of juvenile patient-specific models starting from lower limb kinematics and foot and ankle MRI data. This pipeline has been applied to data from three children with JIA and the importance of patient-specific parameters and modelling assumptions has been tested in a sensitivity analysis focused on the variation of the joint reaction forces. This analysis highlighted the criticality of patient-specific definition of the ankle joint axes and location of the Achilles tendon insertions. Patient-specific detection of the Tibialis Anterior, Tibialis Posterior, and Peroneus Longus origins and insertions were also shown to be important

Subject-specific upper extremity modelling

Insight into the mechanical interaction between muscles and bones can be of great help to understand normal function of the human body and to improve diagnoses and treatments of musculoskeletal disorders. This research presented in this thesis aims to improve the predictions of a musculoskeletal model of the shoulder and elbow (the Delft Shoulder and Elbow Model or DSEM) by extracting anatomical information from MRI scans and other imaging modalities. Several techniques are presented to personalise anatomical parameters and the effect on muscle and joint force predictions are calculated. Due to difficulties related to validation of modelling results and the limited ability to measure all relevant model parameters in vivo, it is concluded that subject-specific models are not likely to lead to a vast new range of applications in the near future.BioMechanical EngineeringMechanical, Maritime and Materials Engineerin

Predicting muscle forces in the shoulder by constraining the inverse optimisation with EMG and a forward muscle model

The Dutch Shoulder and Elbow Model (DSEM) is a musculoskeletal model of the shoulder that can be used to predict internal shoulder loading (muscle forces, joint reaction forces, etc.). The DSEM uses an inverse optimisation method to predict muscle forces from net joint moments. In this study two new modes are presented that constrain the inverse optimisation with muscle force boundaries based on muscle dynamics (inverse forward dynamical mode) and boundaries based on EMG-recordings (EMG-assisted mode). The new modes were validated with measurements of two standardised movements (abduction and ante exion) from two subjects. A proof of concept has been given that both new modes work. It was concluded that DSEM predictions can be dominated by morphological differences between the subject and the cadaver on which the DSEM is based. Until better scaling routines are developed the IFDO mode is not very useful. When EMG-constraints are added, muscle and GH-joint reaction forces are predicted to be higher. Adding EMG for one muscle can predict cocontraction in other muscles. By adding EMG-based constraints, the DSEM can account for individual strategies in control strategy for the data that was analysed and is therefore an interesting topic for future research.BioMechanical EngineeringMechanical, Maritime and Materials Engineerin

Effect of Transducer Orientation on Errors in Ultrasound Image-Based Measurements of Human Medial Gastrocnemius Muscle Fascicle Length and Pennation

Ultrasound imaging is often used to measure muscle fascicle lengths and pennation angles in human muscles in vivo. Theoretically the most accurate measurements are made when the transducer is oriented so that the image plane aligns with muscle fascicles and, for measurements of pennation, when the image plane also intersects the aponeuroses perpendicularly. However this orientation is difficult to achieve and usually there is some degree of misalignment. Here, we used simulated ultrasound images based on three-dimensional models of the human medial gastrocnemius, derived from magnetic resonance and diffusion tensor images, to describe the relationship between transducer orientation and measurement errors. With the transducer oriented perpendicular to the surface of the leg, the error in measurement of fascicle lengths was about 0.4 mm per degree of misalignment of the ultrasound image with the muscle fascicles. If the transducer is then tipped by 20° , the error increases to 1.1 mm per degree of misalignment. For a given degree of misalignment of muscle fascicles with the image plane, the smallest absolute error in fascicle length measurements occurs when the transducer is held perpendicular to the surface of the leg. Misalignment of the transducer with the fascicles may cause fascicle length measurements to be underestimated or overestimated. Contrary to widely held beliefs, it is shown that pennation angles are always overestimated if the image is not perpendicular to the aponeurosis, even when the image is perfectly aligned with the fascicles. An analytical explanation is provided for this finding

Clinical applications of musculoskeletal modelling for the shoulder and upper limb

Musculoskeletal models have been developed to estimate internal loading on the human skeleton, which cannot directly be measured in vivo, from external measurements like kinematics and external forces. Such models of the shoulder and upper extremity have been used for a variety of purposes, ranging from understanding basic shoulder biomechanics to assisting in preoperative planning. In this review, we provide an overview of the most commonly used large-scale shoulder and upper extremity models and categorise the applications of these models according to the type of questions their users aimed to answer. We found that the most explored feature of a model is the possibility to predict the effect of a structural adaptation on functional outcome, for instance, to simulate a tendon transfer preoperatively. Recent studies have focused on minimising the mismatch in morphology between the model, often derived from cadaver studies, and the subject that is analysed. However, only a subset of the parameters that describe the model's geometry and, perhaps most importantly, the musculotendon properties can be obtained in vivo. Because most parameters are somehow interrelated, the others should be scaled to prevent inconsistencies in the model's structure, but it is not known exactly how. Although considerable effort is put into adding complexity to models, for example, by making them subject-specific, we have found little evidence of their superiority over current models. The current trend in development towards individualised, more complex models needs to be justified by demonstrating their ability to answer questions that cannot already be answered by existing models. © 2013 International Federation for Medical and Biological Engineering

The biomechanical effect of clavicular shortening on shoulder muscle function, a simulation study

Background Malunion of the clavicle with shortening after mid shaft fractures can give rise to long-term residual complaints. The cause of these complaints is as yet unclear. Methods In this study we analysed data of an earlier experimental cadaveric study on changes of shoulder biomechanics with progressive shortening of the clavicle. The data was used in a musculoskeletal computer model to examine the effect of clavicle shortening on muscle function, expressed as maximal muscle moments for abduction and internal rotation. Findings Clavicle shortening results in changes of maximal muscle moments around the shoulder girdle. The mean values at 3.6 cm of shortening of maximal muscle moment changes are 16% decreased around the sterno-clavicular joint decreased for both ab- and adduction, 37% increased around the acromion-clavicular joint for adduction and 32% decrease for internal rotation around the gleno-humeral joint in resting position. Interpretation Shortening of the clavicle affects muscle function in the shoulder in a computer model. This may explain for the residual complaints after short malunion with shortening. Level of evidence Basic Science Study. Biomechanics. Cadaveric data and computer model</p

Ultrasound imaging of the human medial gastrocnemius muscle: How to orient the transducer so that muscle fascicles lie in the image plane

The length and pennation of muscle fascicles are frequently measured using ultrasonography. Conventional ultrasonography imaging methods only provide two-dimensional images of muscles, but muscles have complex three-dimensional arrangements. The most accurate measurements will be obtained when the ultrasound transducer is oriented so that endpoints of a fascicle lie on the ultrasound image plane and the image plane is oriented perpendicular to the aponeurosis, but little is known about how to find this optimal transducer orientation in the frequently-studied medial gastrocnemius muscle. In the current study, we determined the optimal transducer orientation at 9 sites in the medial gastrocnemius muscle of 8 human subjects by calculating the angle of misalignment between three-dimensional muscle fascicles, reconstructed from diffusion tensor images, and the plane of a virtual ultrasound image. The misalignment angle was calculated for a range of tilts and rotations of the ultrasound transducer relative to a reference orientation that was perpendicular to the skin and parallel to the tibia. With the transducer in the reference orientation, the misalignment was substantial (mean across sites and subjects of 6.5°, range 1.4 to 20.2°). However for all sites and subjects a near-optimal alignment (on average 2.6°, range 0.5° to 6.0°) could be achieved by maintaining 0° tilt and applying a small rotation (typically less than 10°). On the basis of these data we recommend that ultrasonographic measurements of medial gastrocnemius muscle fascicle architecture be obtained, at least for relaxed muscles under static conditions, with the transducer oriented perpendicular to the skin and nearly parallel to the tibia

Modelling clavicular and scapular kinematics: from measurement to simulation

Musculoskeletal models are intended to be used to assist in prevention and treatments of musculoskeletal disorders. To capture important aspects of shoulder dysfunction, realistic simulation of clavicular and scapular movements is crucial. The range of motion of these bones is dependent on thoracic, clavicular and scapular anatomy and therefore different for each individual. Typically, patient or subject measurements will therefore not fit on a model that uses a cadaveric morphology. Up till now, this problem was solved by adjusting measured bone rotations such that they fit on the model, but this leads to adjustments of on average 3.98° and, in some cases, even more than 8°. Two novel methods are presented that decrease this discrepancy between experimental data and simulations. For one method, the model is scaled to fit the subject, leading to a 34 % better fit compared to the existing method. In the other method, the set of possible joint rotations is increased by allowing some variation on motion constraints, resulting in a 42 % better fit. This change in kinematics also affected the kinetics: muscle forces of some important scapular stabilizing muscles, as predicted by the Delft Shoulder and Elbow Model, were altered by maximally 17 %. The effect on the glenohumeral joint contact force was however marginal (1.3 %). The methods presented in this paper might lead to more realistic shoulder simulations and can therefore be considered a step towards (clinical) application, especially for applications that involve scapular imbalance. © 2013 International Federation for Medical and Biological Engineering

How does passive lengthening change the architecture of the human medial gastrocnemius muscle?

Copyright © 2017 the American Physiological Society. There are few comprehensive investigations of the changes in muscle architecture that accompany muscle contraction or change in muscle length in vivo. For this study, we measured changes in the three-dimensional architecture of the human medial gastrocnemius at the whole muscle level, the fascicle level and the fiber level using anatomical MRI and diffusion tensor imaging (DTI). Data were obtained from eight subjects under relaxed conditions at three muscle lengths. At the whole muscle level, a 5.1% increase in muscle belly length resulted in a reduction in both muscle width (mean change - 2.5%) and depth (-4.8%). At the fascicle level, muscle architecture measurements obtained at 3,000 locations per muscle showed that for every millimeter increase in muscle-tendon length above the slack length, average fascicle length increased by 0.46 mm, pennation angle decreased by 0.27° (0.17° in the superficial part and 0.37° in the deep part), and fascicle curvature decreased by 0.18 m -1 . There was no evidence of systematic variation in architecture along the muscle's long axis at any muscle length. At the fiber level, analysis of the diffusion signal showed that passive lengthening of the muscle increased diffusion along fibers and decreased diffusion across fibers. Using these measurements across scales, we show that the complex shape changes that muscle fibers, whole muscles, and aponeuroses of the medial gastrocnemius undergo in vivo cannot be captured by simple geometrical models. This justifies the need for more complex models that link microstructural changes in muscle fibers to macroscopic changes in architecture