Department of Mechanical Engineering, Bucknell University, Lewisburg, Pennsylvania, USA.
Musculoskeletal Institute, Geisinger Commonwealth School of Medicine, Scranton, Pennsylvania, USA.
J Orthop Res. 2023 Mar;41(3):570-582. doi: 10.1002/jor.25396. Epub 2022 Jul 11.
Torsional profiles of the lower limbs, such as femoral anteversion, can dictate gait and mobility, joint biomechanics and pain, and functional impairment. It currently remains unclear how the interactions between femoral anteversion, kinematics, and muscle activity patterns contribute to joint biomechanics and thus conditions such as knee pain. This study presents a computational modeling approach to investigating the interactions between femoral anteversion, muscle forces, and knee joint loads. We employed an optimal control approach to produce actuator and muscle-driven simulations of the stance phase of gait for femoral anteversion angles ranging from -8° (retroversion) to 52° (anteversion) with a typically developing baseline of 12° of anteversion and implemented a Monte Carlo analysis for variations in lower limb muscle forces. While total patellofemoral joint load decreased with increasing femoral anteversion, patellofemoral joint load alignment worsened, and knee abduction/adduction magnitude increased with both positive and negative changes in femoral anteversion (p < 0.001). The rectus femoris muscle was found to greatly influence patellofemoral joint loads across all femoral anteversion alignments (R > 0.8, p < 0.001), and the medial gastrocnemius was found to greatly influence knee abduction/adduction moments for the extreme version cases (R > 0.74, p < 0.001). Along with the vastus lateralis, which decreased with increasing femoral anteversion (R = 0.89, p < 0.001), these muscles are prime candidates for future experimental and clinical efforts to address joint pain in individuals with extreme femoral version. These findings, along with future modeling efforts, could help clinicians better design treatment strategies for knee joint pain in populations with extreme femoral anteversion or retroversion.
下肢的扭转形态，如股骨前倾角，会影响步态和活动能力、关节生物力学和疼痛以及功能障碍。目前尚不清楚股骨前倾角、运动学和肌肉活动模式之间的相互作用如何影响关节生物力学，以及如何影响膝关节疼痛等情况。本研究提出了一种计算建模方法，用于研究股骨前倾角、肌肉力和膝关节负荷之间的相互作用。我们采用最优控制方法，针对股骨前倾角在-8°（后倾）到 52°（前倾）范围内的步态支撑相产生了执行器和肌肉驱动模拟，采用典型的 12°前倾基线，并实施了蒙特卡罗分析以研究下肢肌肉力的变化。随着股骨前倾角的增加，总的髌股关节负荷减少，髌股关节负荷对线变差，并且随着股骨前倾角的正向和负向变化，膝关节外展/内收幅度增加（p<0.001）。研究发现，股直肌对所有股骨前倾角对线的髌股关节负荷有很大影响（R>0.8，p<0.001），而对于极端倾斜情况，腓肠肌内侧头对膝关节外展/内收力矩有很大影响（R>0.74，p<0.001）。与随着股骨前倾角增加而减少的股外侧肌一起（R=0.89，p<0.001），这些肌肉是未来针对极端股骨倾斜患者关节疼痛进行实验和临床研究的主要候选肌肉。这些发现以及未来的建模工作可以帮助临床医生更好地为股骨前倾角或后倾角极端的人群设计膝关节疼痛的治疗策略。
