A Musculoskeletal Model Customized for Sagittal and Frontal Knee Kinematics With Improved Knee Joint Stability.

Current lower limb musculoskeletal (MSK) models focus on sagittal plane kinematics. However, abnormal gait is typically associated with sagittal plane motions crossing into other planes, limiting the use of current MSK models. The purpose of this study was twofold, first, to extend the capability of a full-body MSK model from the literature to include frontal knee plane kinematics during healthy gait, and second, to propose and implement a realistic muscle discretization technique. Two MSK model constructs were derived-the first construct (Knee2_SM) allowed two degrees-of-freedom (sagittal and coronal) at the knee and the second construct (Knee2_MM) implemented multiline elements for all the lower limb muscles in conjunction with two knee degrees-of-freedom. Motion analysis data of normal gait cycle from 10 healthy adults were used to compare joint kinematics, muscle moment arms, muscle forces, and muscle activations, between new constructs and the original model. Knee varus-valgus trajectories were estimated with the mean peak values ranging from 9.49 deg valgus to 1.57 deg varus. Knee2_MM predicted a significant difference (p < 0.05) in moment arms and forces in those muscles responsible for medial-lateral stability of the knee. The simulated muscle activations generated by the Knee2_MM model matched more closely to the experimental electromyography (EMG) when qualitatively compared. This study enhances the capability of the sagittal plane full-body MSK model to incorporate knee varus-valgus motion while keeping the joint stability intact and improving muscle prediction.