Welcome to Aalborg University!

Practical remarks
• Daily Schedule:
– Morning session: 9-12
– Lunch: 12-13
– Afternoon session: 13-16
– In this room both days
• Rolls and the/coffee served every morning
• Lunch served in the canteen both days
• Cake and the/coffee served every afternoon
• Social event tonight
• Wireless network is available:
– Eduroam
– AAU-1-Day:
• Thursday password: laugh83mark
• Friday password: nick47spur
 Social event

• Tonight at 19.30

• Pingvin

• Adelgade 12 -
9000 Aalborg
 Overall musculoskeletal
modeling training topics
• Introduction to musculoskeletal modeling
– Basics of musculoskeletal modeling (kinematics and kinetics)
– AnyBody Modeling System
– AnyScript
– The AnyBody Managed Model Repository

• Patient-specific modeling from medical images

– Scaling of musculoskeletal models in general
– Bone morphing to patient-specific geometry
– Strength scaling with muscle volume information
– Detailed joint modeling with Force-dependent kinematics
Motivation

In vivo and non-invasive estimates of

• Muscle loads.
• Joint loads.
• Bone loads.
• Ligament loads.
• Joint movements.
• Etc.

Insight into quantities that are otherwise

impossible or impractical to measure.
 Applications

Orthopaedics Ergonomics

Sports and fitness Industrial design

Vision
 Subject-specific
musculoskeletal model
• 3D mechanical model
• Bones
Change
• Muscles
treatment
Clinical data
• Joints
parameters
MRI • Ligaments
CT
Strength
Knee laxity • Estimates of
Etc. • Forces
Optimisation
• Detailed joint
movements
Prediction of the
Virtuel treatment outcome
Subject-specific
Predictive models
models

Validation
Subject-specific models
Workflow assessing the effect of gait alterations on stresses in the medial
tibial cartilage – Combined musculoskeletal and finite element analysis

K. Halonen, CM Dzialo, M Mannisi, M Venäläinen, M de Zee, Mark; MS Andersen

 Osteoarthritis (OA)

• Slow degeneration of cartilage, bone,

meniscus, ligaments etc

• The most common joint disease with the

knee the most frequent site

• Listed among the top 5 causes of

disability worldwide (WHO, 2016)
Non-surgical biomechanical
interventions
 Literature gap

Knee Adduction Moment (KAM)

may not be a good
surrogate of the internal load1,2

(1) Saxby et al 2016 (2) Richards et al 2018

Musculoskeletal and Finite Element modelling

Musculoskeletal (MS) Finite Element (FE)

 Subject-Specific Multiscale Modelling

Shod Toe-In Toe-Out Width

Subject-Specific Multiscale Modelling: Study Design

(a) End with musculoskeletal model results

(b) Continue onto FEA modelling, using MS

outputs as boundary conditions
Finite element modelling

Subject-specific MS
output is used as
input to move the
FE model of
patient’s knee joint

MS
Input

FE model output:
stresses and
strains in tibial
cartilage
Cartilage deformation

deformation1
Reported
peak
1Liuet al.
2010
Contact pressure vs KAM
Tibiofemoral contact
pressures during the
axial peak forces
Averages in medial contact area
Validation
 Grand Challenge
• A unique opportunity for blind
model validation

• Data:
– Marker trajectories.
– Ground reaction forces.
– CT scans (pre- and post-op).
– EMG.
– Measured knee forces.
– Single plane fluoroscopy.

• 2014 Competition: predict the

medial and lateral knee contact
forces during gait and right turn Fregly et al., (2012)
trials. (Blinded and unblinded)
 Modelling overview
Twente Lower Extremity Model (TLEM) v. 2.0 (Fluit et al, 2013)

1 Pre-op 2 Pre- and post-op 3 Before Bone morphing After 4 Analytical joint
segmentation registration fitting
Nonlinear using
Radial Basis
Functions
 Modelling overview

5 Scaling of
remaining
segments

5 Scaling of remaining 6 Marker tracking 7 Joint modelling and Force-dependent

Kinematics
8 Results
segments
 Unblinded results
2500
2500 Right turn Model
Medial contact force [N]

2500

Lateral contact force [N]

Total contact force [N]

2000 2000 Exp
2000
1500 1500 1500
1000 1000 1000

500 500 500

0 0 0
0 20 40 60 80 100 0 20 40 60 80 100 0 20 40 60 80 100
Gait cycle [%] Gait cyle [%] Gait Cycle [%]

2500 2500
2500
Gait
Lateral contact force [N]
Medial contact force [N]

Total contact force [N]

2000 2000 2000

1500 1500 1500

1000 1000 1000

500 500
500

0 0
0 0 20 40 60 80 100 0 20 40 60 80 100
0 20 40 60 80 100 Gait cycle [%] Gait cycle [%]
Gait cycle [%]

Right turn (unblinded) RMSE [N] R2 Gait (unblinded) RMSE [N] R2

Medial contact force 272 0.85 Medial contact force 210 0.80
Lateral contact force 136 0.71 Lateral contact force 230 0.36
Total contact force 206 0.96 Total contact force 154 0.93
Fluoroscopy
Fluoroscopy
Fluoroscopy