Biomechanical modeling of joint kinetics in the study of knee osteoarthritis

在动态活动期间，过量和/或异常负荷可能会损害人体肌肉骨骼系统的完整性。膝关节骨关节炎(OA)是膝关节的进行性退行性变，尤其与步态中的机械因素有关，是全世界导致残疾的主要原因之一。现代步态分析是测量膝骨性关节炎力学和神经肌肉因素的成熟方法，但常用的步态数据逆动力学建模只计算关节处的净合力和力矩，而不考虑跨越关节的肌肉的力贡献。因此，报告的联结力是概念量，不一定在任何单个联接结构中实际存在。为了了解膝骨性关节炎和其他肌肉骨骼系统疾病的破坏途径，准确地确定关节接触力是很重要的。这可以通过将步态和肌电数据与更复杂的建模和优化技术相结合来实现，这些技术结合了行为肌肉模型和更具体的关节解剖。此外，特定于对象的肌肉骨骼建模和模拟可以结合关节几何、对齐、肌肉激活模式和下肢动力学的变化，以确定个人独特的生物力学反应。这将允许生物力学信息以比通常报道的广义模式更具体、更临床相关的方式呈现。对保守和手术干预对模型的影响的模拟也将提供一种针对个人量身定制治疗策略的有效和合乎伦理的方式。

The integrity of the human musculoskeletal system can be compromised with excessive and/or abnormal loading during dynamic activities. Knee osteoarthritis (OA), the progressive degeneration of the knee joint, has been particularly associated with mechanical factors during gait and is one of the main causes of disability across the world. Modern gait analysis is an established method of measuring the mechanical and neuromuscular factors of knee OA, but commonly used inverse dynamics modeling with gait data calculates only net resultant forces and moments at a joint, not accounting for force contributions from muscles spanning the joint. Reported joint forces are therefore conceptual quantities that are not necessarily physically present in any single joint structure. To understand the destructive pathways of knee OA and other diseases of the musculoskeletal system, it is important to determine accurate joint contact forces. This can be achieved by combining gait and electromyography data with more sophisticated modeling and optimization techniques that incorporate behavioral muscle models and more specific joint anatomy. Further, subject-specific musculoskeletal modeling and simulation can combine variations in joint geometry, alignment, muscle activation patterns, and lower limb dynamics to determine the unique biomechanical response of an individual. This will allow biomechanical information to be presented in a more specific, clinically-relevant manner than commonly reported generalized patterns. Simulations of the effects of both conservative and surgical interventions on the models will also provide an efficient and ethical manner of tailoring treatment strategies to an individual.