The effects of external loads and muscle forces on the knee joint ligaments during walking: A musculoskeletal model study

A musculoskeletal model was developed to analyze the tensions of the knee joint ligaments during walking and to understand how they change with changes in the muscle forces. The model included the femur, tibia, patella and all components of cruciate and collateral ligaments, quadriceps, hamstrings and gastrocnemius muscles. Inputs to the model were the muscle forces, estimated by a static optimization approach, the external loads (ground reaction forces and moments) and the knee flexion/extension movement corresponding to natural walking. The remaining rotational and translational movements were obtained as a result of the dynamic equilibrium of forces. The validation of the model was done by comparing our results with literature data. Several simulations were carried out by sequentially removing the forces of the different muscle groups. Deactivation of the quadriceps produced a decrease of tension in the anterior cruciate ligament (ACL) and an increase in the posterior cruciate ligament (PCL). By removing the hamstrings, the tension of ACL increased at the late swing phase, while the PCL force dropped to zero. Specific effects were observed also at the medial and lateral collateral ligaments. The removal of gastrocnemius muscles produced an increase of tension only on PCL and lateral collateral ligaments. These results demonstrate how musculoskeletal models can contribute to knowledge about complex biomechanical systems as the knee joint.