Combined Effects of External Moments and Muscle Activations on ACL Loading during Numerical Simulations of a Female Model in OpenSim

Abstract

Background: Anterior cruciate ligament (ACL) injuries have been studied using a variety of methods and tools. However, each is hindered by specific limitations with respect to its application. Aim: To assess the combined effects of external moments and muscle activations on ACL loading using serial, forward dynamics (FD) simulations of single leg, hyperextension landings in OpenSim. Methods: The FD tool of OpenSim was iteratively run using different combinations of knee-spanning muscle activation levels, internal rotation and valgus knee moment magnitudes. A regression was conducted on the data in order to predict ACL loading under different conditions. Results: A purely abduction moment leads to greater mean ACL loading than a purely internal rotation moment or any combination of the two. Additionally, the generalized boosted regression model using both external moments and certain knee muscles identified the internal rotation moment as the most important variable in predicting the ACL load (R2 = 0.9; p < 0.0001). Conclusion: This study demonstrated a novel and practical application of an OpenSim musculoskeletal model that supports the ACL injury mechanism of landing with low knee flexion angles, high muscle forces of the Quadriceps muscles and an external knee valgus moment, though further investigation is needed.

Keywords

• knee joint
• biomechanics
• motion analysis
• computer simulations
• in silico
• injury mechanism