Biomechanical modeling of joint kinetics in the study of knee osteoarthritis

在动态活动中，人体肌肉骨骼系统的完整性可能会受到过度和/或异常负荷的损害。膝关节骨性关节炎（OA）是膝关节的进行性退行性变，与步态中的机械因素特别相关，是世界范围内致残的主要原因之一。现代步态分析是测量膝关节OA的机械和神经肌肉因素的一种成熟方法，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，报告的关节力是概念性的量，并不一定存在于任何单一关节结构中。为了了解膝关节OA和其他肌肉骨骼系统疾病的破坏途径，确定准确的关节接触力是很重要的。这可以通过将步态和肌电图数据与更复杂的建模和优化技术相结合来实现，这些技术包括行为肌肉模型和更具体的关节解剖。此外，特定对象的肌肉骨骼建模和仿真可以结合关节几何、排列、肌肉激活模式和下肢动力学的变化，以确定个体独特的生物力学反应。这将使生物力学信息以一种比通常报道的广义模式更具体、更与临床相关的方式呈现。对模型的保守和手术干预效果的模拟也将提供一种有效和道德的方式，为个体量身定制治疗策略。

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.