Statistical Modeling of Lower Limb Kinetics During Deep Squat and Forward Lunge

Personalized statistical modeling of soft tissue structures in the knee

Background and Objective: As in vivo measurements of knee joint contact forces remain challenging, computational musculoskeletal modeling has been popularized as an encouraging solution for non-invasive estimation of joint mechanical loading. Computational musculoskeletal modeling typically relies on laborious manual segmentation as it requires reliable osseous and soft tissue geometry. To improve on feasibility and accuracy of patient-specific geometry predictions, a generic computational approach that can easily be scaled, morphed and fitted to patient-specific knee joint anatomy is presented.

Methods: A personalized prediction algorithm was established to derive soft tissue geometry of the knee, originating solely from skeletal anatomy. Based on a MRI dataset (n = 53), manual identification of soft-tissue anatomy and landmarks served as input for our model by use of geometric morphometrics. Topographic distance maps were generated for cartilage thickness predictions. Meniscal modeling relied on wrapping a triangular geometry with varying height and width from the anterior to the posterior root. Elastic mesh wrapping was applied for ligamentous and patellar tendon path modeling. Leave-one-out validation experiments were conducted for accuracy assessment.

Results: The Root Mean Square Error (RMSE) for the cartilage layers of the medial tibial plateau, the lateral tibial plateau, the femur and the patella equaled respectively 0.32 mm (range 0.14–0.48), 0.35 mm (range 0.16–0.53), 0.39 mm (range 0.15–0.80) and 0.75 mm (range 0.16–1.11). Similarly, the RMSE equaled respectively 1.16 mm (range 0.99–1.59), 0.91 mm (0.75–1.33), 2.93 mm (range 1.85–4.66) and 2.04 mm (1.88–3.29), calculated over the course of the anterior cruciate ligament, posterior cruciate ligament, the medial and the lateral meniscus.

Conclusion: A methodological workflow is presented for patient-specific, morphological knee joint modeling that avoids laborious segmentation. By allowing to accurately predict personalized geometry this method has the potential for generating large (virtual) sample sizes applicable for biomechanical research and improving personalized, computer-assisted medicine.

Statistical shape model-based tibiofibular assessment of syndesmotic ankle lesions using weight-bearing CT

Forced external rotation is hypothesized as the key mechanism of syndesmotic ankle injuries, inducing a three-dimensional deviation from the normal distal tibiofibular joint (DTFJ) alignment. However, current diagnostic imaging modalities are impeded by a two-dimensional assessment, without considering ligamentous stabilizers. Therefore, our aim is threefold: (1) to construct an articulated statistical shape model of the normal DTFJ with the inclusion of ligamentous morphometry, (2) to investigate the effect of weight-bearing on the DTFJ alignment, and (3) to detect differences in predicted syndesmotic ligament length of patients with syndesmotic lesions with respect to normative data. Training data comprised non-weight-bearing CT scans from asymptomatic controls (N = 76), weight-bearing CT scans from patients with syndesmotic ankle injury (N = 13), and their weight-bearing healthy contralateral side (N = 13). Path and length of the syndesmotic ligaments were predicted using a discrete element model, wrapped around bony contours. Statistical shape model evaluation was based on accuracy, generalization, and compactness. The predicted ligament length in patients with syndesmotic lesions was compared with healthy controls. With respect to the first aim, our presented skeletal shape model described the training data with an accuracy of 0.23 ± 0.028 mm. Mean prediction accuracy of ligament insertions was 0.53 ± 0.12 mm. In accordance with the second aim, our results showed an increased tibiofibular diastasis in healthy ankles after weight-bearing. Concerning our third aim, a statistically significant difference in anterior syndesmotic ligament length was found between ankles with syndesmotic lesions and healthy controls (p = 0.017). There was a significant correlation between the presence of syndesmotic injury and the positional alignment between the distal tibia and fibula (r = 0.873, p < 0,001). Clinical Significance: Statistical shape modeling combined with patient-specific ligament wrapping techniques can facilitate the diagnostic workup of syndesmosic ankle lesions under weight-bearing conditions. In doing so, an increased anterior tibiofibular distance was detected, corresponding to an "anterior open-book injury" of the ankle syndesmosis as a result of anterior inferior tibiofibular ligament elongation/rupture.

Principal polynomial shape analysis: A non-linear tool for statistical shape modeling

BACKGROUND AND OBJECTIVES

The most widespread statistical modeling technique is based on Principal Component Analysis (PCA). Although this approach has several appealing features, it remains hampered by its linearity. Principal Polynomial Analysis (PPA) can capture non-linearity in a sequential algorithm, while maintaining the interesting properties of PCA. PPA is, however, computationally expensive in handling shape surface data. To this end, we propose Principal Polynomial Shape Analysis (PPSA) as an adjusted approach for non-linear shape analyzes. The aim of this study was to assess PPSA's features, its model boundaries and its general applicability.

METHODS

PCA and PPSA-based shape models were investigated on one verification and three model evaluation experiments. In the verification experiment, the estimated mean of the PCA and PPSA model on a data set of synthetic lower limbs of different lengths in different poses were compared to the real mean. Further, the PCA-based and PPSA shape models were tested for three challenging cases namely for shape model creation of gait marker data, for regression analysis on aging faces and for modeling pose variation in full body scans. For the latter, additionally a Fundamental Coordinate Model (FCM) and a PPSA model on Fundamental Coordinate(FC) space was created. The performances were evaluated based on model-based accuracy, generalization, compactness and specificity.

RESULTS

In the verification experiment, the scaling error reduced from 75% to below 1% when employing PPSA instead of PCA for a training set with 180° angular variation. For the model evaluation experiments, the PPSA models described the data as accurate and generalized as the PCA-based shape models. The PPSA models were slightly more compact and specific (up to 30%) than the PCA-based models. In regression, PCA and PPSA-based parameterizations explained a similar amount of variation. Lastly, for the full body scans, applying PPSA to parameterizations improved the compactness and accuracy.

CONCLUSIONS

PPSA describes the non-linear relationships between principal variations in a parameterized space. Compared to standard PCA-based shape models, capturing the non-linearity reduced the nonsense information in the shape components and improved the description of the data mean.

Statistical kinematic modelling: concepts and model validity

Data reduction techniques are applied to reduce the volume of data while maintaining its integrity. For cyclic motion data, a reliable overview comparing these methods is lacking. Therefore, this study aims to evaluate the features of the different data reduction techniques by applying them to large public data sets. The periodicity of cyclic motion can be exploited by either analysing a single cycle or studying a series of cycles. Analysing single cycles requires a pre-processing step to isolate the amplitude variability. Three different alignment techniques were evaluated, namely Linear length normalisation (LLN), piecewise LLN (PLLN) and continuous registration (CR). CR showed to remove the most phase variation. For the data reduction, three techniques were assessed (i.e., principal component analysis (PCA), principal polynomial analysis (PPA) and multivariate functional PCA (MFPCA)) based on the in- and out-of-sample error, the compactness and the computation time. The differences were found to be minimal. From our results, PPA appeared to be most useful for data compression. Further, we recommend PCA and MFPCA for classification and feature extraction purposes. We suggest the use of PCA when computation time is key and we advise the use of MFPCA when the inclusion of different data sources is desired. In contrast, the analysis of a series of cycles requires a pre-processing step to decompose the series. Further, a regression model was used to compensate for the difference in fundamental frequency. PCA on FC and MFPCA with splines were applied on the frequency compensated curves. Both methods performed as good.

A review of musculoskeletal modelling of human locomotion

Locomotion through the environment is important because movement provides access to key resources, including food, shelter and mates. Central to many locomotion-focused questions is the need to understand internal forces, particularly muscle forces and joint reactions. Musculoskeletal modelling, which typically harnesses the power of inverse dynamics, unites experimental data that are collected on living subjects with virtual models of their morphology. The inputs required for producing good musculoskeletal models include body geometry, muscle parameters, motion variables and ground reaction forces. This methodological approach is critically informed by both biological anthropology, with its focus on variation in human form and function, and mechanical engineering, with a focus on the application of Newtonian mechanics to current problems. Here, we demonstrate the application of a musculoskeletal modelling approach to human walking using the data of a single male subject. Furthermore, we discuss the decisions required to build the model, including how to customize the musculoskeletal model, and suggest cautions that both biological anthropologists and engineers who are interested in this topic should consider.

Statistical-Shape Prediction of Lower Limb Kinematics During Cycling, Squatting, Lunging, and Stepping-Are Bone Geometry Predictors Helpful?

Purpose: Statistical shape methods have proven to be useful tools in providing statistical predications of several clinical and biomechanical features as to analyze and describe the possible link with them. In the present study, we aimed to explore and quantify the relationship between biometric features derived from imaging data and model-derived kinematics. Methods: Fifty-seven healthy males were gathered under strict exclusion criteria to ensure a sample representative of normal physiological conditions. MRI-based bone geometry was established and subject-specific musculoskeletal simulations in the Anybody Modeling System enabled us to derive personalized kinematics. Kinematic and shape findings were parameterized using principal component analysis. Partial least squares regression and canonical correlation analysis were then performed with the goal of predicting motion and exploring the possible association, respectively, with the given bone geometry. The relationship of hip flexion, abduction, and rotation, knee flexion, and ankle flexion with a subset of biometric features (age, length, and weight) was also investigated. Results: In the statistical kinematic models, mean accuracy errors ranged from 1.60° (race cycling) up to 3.10° (lunge). When imposing averaged kinematic waveforms, the reconstruction errors varied between 4.59° (step up) and 6.61° (lunge). A weak, yet clinical irrelevant, correlation between the modes describing bone geometry and kinematics was observed. Partial least square regression led to a minimal error reduction up to 0.42° compared to imposing gender-specific reference curves. The relationship between motion and the subject characteristics was even less pronounced with an error reduction up to 0.21°. Conclusion: The contribution of bone shape to model-derived joint kinematics appears to be relatively small and lack in clinical relevance.

A Semi-active Exoskeleton Based on EMGs Reduces Muscle Fatigue When Squatting

In dynamic manufacturing and warehousing environments, the work scene made it impossible for workers to sit, so workers suffer from muscle fatigue of the lower limb caused by standing or squatting for a long period of time. In this paper, a semi-active exoskeleton used to reduce the muscle fatigue of the lower limb was designed and evaluated. (i) Background: The advantages and disadvantages of assistive exoskeletons developed for industrial purposes were introduced. (ii) Simulation: The process of squatting was simulated in the AnyBody.7.1 software, the result showed that muscle activity of the gluteus maximus, rectus femoris, vastus medialis, vastus lateralis, vastus intermedius, and erector spinae increased with increasing of knee flexion angle. (iii) Design: The exoskeleton was designed with three working modes: rigid-support mode, elastic-support mode and follow mode. Rigid-support mode was suitable for scenes where the squatting posture is stable, while elastic-support mode was beneficial for working environments where the height of squatting varied frequently.The working environments were identified intelligently based on the EMGs of the gluteus maximus, and quadriceps, and the motor was controlled to switch the working mode between rigid-support mode and elastic-support mode. In follow mode, the exoskeleton moves freely with users without interfering with activities such as walking, ascending and descending stairs. (iv) Experiments: Three sets of experiments were conducted to evaluate the effect of exoskeleton. Experiment one was conducted to measure the surface electromyography signal (EMGs) in both condition of with and without exoskeleton, the root mean square of EMGs amplitude of soleus, vastus lateralis, vastus medialis, gastrocnemius, vastus intermedius, rectus femoris, gluteus maximus, and erector spinae were reduced by 98.5, 97.89, 80.09, 77.27, 96.73, 94.17, 70.71, and 36.32%, respectively, with the assistance of the exoskeleton. The purpose of experiment two was aimed to measure the plantar pressure with and without exoskeleton. With exoskeleton, the percentage of weight through subject's feet was reduced by 63.94, 64.52, and 65.61% respectively at 60°, 90°, and 120° of knee flexion angle, compared to the condition of without exoskeleton. Experiment three was purposed to measure the metabolic cost at a speed of 4 and 5 km/h with and without exoskeleton. Experiment results showed that the average additional metabolic cost introduced by exoskeleton was 2.525 and 2.85%. It indicated that the exoskeleton would not interfere with the movement of the wearer Seriously in follow mode. (v) Conclusion: The exoskeleton not only effectively reduced muscle fatigue, but also avoided interfering with the free movement of the wearer.