A Systematic Review of the Associations Between Inverse Dynamics and Musculoskeletal Modeling to Investigate Joint Loading in a Clinical Environment

Abstract

The assessment of knee or hip joint loading by external joint moments is mainly used to draw conclusions on clinical decision making. However, the correlation between internal and external loads has not been systematically analyzed. This systematic review aims, therefore, to clarify the relationship between external and internal joint loading measures during gait. A systematic database search was performed to identify appropriate studies for inclusion. In total, 4,554 articles were identified, while 17 articles were finally included in data extraction. External joint loading parameters were calculated using the inverse dynamics approach and internal joint loading parameters by musculoskeletal modeling or instrumented prosthesis. It was found that the medial and total knee joint contact forces as well as hip joint contact forces in the first half of stance can be well predicted using external joint moments in the frontal plane, which is further improved by including the sagittal joint moment. Worse correlations were found for the peak in the second half of stance as well as for internal lateral knee joint contact forces. The estimation of external joint moments is useful for a general statement about the peak in the first half of stance or for the maximal loading. Nevertheless, when investigating diseases as valgus malalignment, the estimation of lateral knee joint contact forces is necessary for clinical decision making because external joint moments could not predict the lateral knee joint loading sufficient enough. Dependent on the clinical question, either estimating the external joint moments by inverse dynamics or internal joint contact forces by musculoskeletal modeling should be used.

Keywords: gait analysis; hip joint; inverse dynamics; joint contact forces; joint moments; knee joint; musculoskeletal modeling.

Figure 1

Simplified schematic comparison of inverse dynamics (ID) and musculoskeletal (MSK) modeling for calculating the internal joint contact forces. ID only takes external forces as the ground reaction force (GRF) and a lever arm from the joint center to the GRF vector into consideration when calculating the joint moment as surrogate measure for joint loading. In contrast, with MSK modeling not only the external forces but also internal (muscle) forces are considered for calculating the internal joint contact forces as the representation of the joint loading.

Figure 2

Flow diagram of study selection and results. mKOA, medial knee osteoarthritis; ACLR, anterior cruciate ligament reconstruction; APM, arthroscopic partial meniscectomy.

Figure 3

Coefficient of determinations between the first and second peaks of the joint moments and medial knee joint contact force (mKCF). The * indicates significant correlations. The exact p-values can be found in the Supplementary Table 4. Colored bars represent the findings for the first peak and the white bars with colored text for the second peak of the same study. KAM, knee adduction moment; KFM, knee flexion moment; KEM, knee extension moment; F_sup, superior force; TKR, Patients after total knee replacement; mKOA, Patients with medial knee osteoarthritis; APM, Patients after arthroscopic partial meniscectomy; ACLR, Patients after anterior cruciate ligament reconstruction; inv., involved leg; uninv., uninvolved leg.

Figure 4

Coefficient of determinations between the maximal values of the joint moments and medial knee joint contact force (mKCF). The * indicates significant correlations. The exact p-values can be found in the Supplementary Table 5. KAM, knee adduction moment; KFM, knee flexion moment; KEM, knee extension moment; ACLR, Patients after anterior cruciate ligament reconstruction; inv., involved leg; uninv., uninvolved leg.

Figure 5

Coefficient of determinations between the first and second peaks of the joint moments and total knee joint contact force (tKCF). The * indicates significant correlations. The exact p-values can be found in the Supplementary Table 6. Colored bars represent the findings for the first peak and the white bars with colored text for the second peak of the same study. KAM, knee adduction moment; KFM, knee flexion moment; F_sup, superior force; TKR, Patients after total knee replacement; mKOA, Patients with medial knee osteoarthritis.