3D finite element models reveal regional fatty infiltration modulates tibialis anterior force generating capacity in FSHD.

Facioscapulohumeral muscular dystrophy (FSHD) is a progressive neuromuscular disorder characterized by muscle damage, fibro-fatty infiltration, and ultimately weakness. The tibialis anterior (TA), very often involved relatively early in FSHD, is a primary dorsiflexor and important for ambulation. Recent work using magnetic resonance imaging to quantify fat infiltration in the TA volume observed a steep decline in force generation after fat reached ~20% in volume. Additional imaging studies have identified regional fat infiltration patterns that may contribute to the non-linear relationship between fat volume and muscle strength due to the distribution of fat within the muscle structure. The goals of this study were to 1) develop a pipeline for creating subject-specific models of the TA that include fat infiltration patterns measured from MRI and predict force generation, 2) compare models created using this pipeline with clinical measures of muscle strength, and 3) use the models to investigate the impact of regional fat distribution on muscle force generation. Twelve subject-specific models were created, and the model-predicted forces strongly correlate to clinical measures of strength in the same subjects (manual muscle testing (MMT): r = 0.75, and quantitative muscle testing (QMT): r = 0.54). The models showed fat amount accounts for 48% and muscle volume accounts for 74% of the variation in force. To investigate the impact of fat distribution, we developed eight pseudo maps to systematically vary fat location and amount in all subject-specific geometries. The models revealed that fat location modulates force generation, with the middle region involvement having the greatest impact in reducing force. This work highlights the need to characterize and understand the impact of intra-muscular fat distributions in neuromuscular diseases.