Personalized MR-based musculoskeletal models compared to rescaled generic models in the presence of increased femoral anteversion: Effect on hip moment arm lengths

Advanced biomechanical analysis of muscle function during gait relies on the use of a musculoskeletal model. In clinical practice, personalization of the model is usually limited to rescaling a generic model to approximate the patient's anthropometry, even in the presence of bony deformities, as in the case of cerebral palsy (CP). However, the current state of the art in biomechanics allows highly detailed subject-specific models to be built based on magnetic resonance (MR) images. We hypothesized that moment arm length (MAL) calculations from MR-based models would be more accurate than those from rescaled generic musculoskeletal models. Our study compared hip muscle MAL estimated by (1) a personalized model based on full-leg MR scans and (2) a rescaled generic model of both lower limbs in six children presenting with increased femoral anteversion. Personalized MR-based models were created using a custom-built workflow. Rescaled generic models were created based on three-dimensional positions of anatomical markers measured during a standing trial. For all 12 lower limb models, the hip flexion, adduction and rotation MAL of 13 major muscles were analyzed over a physiological range of hip motion using Software for interactive musculoskeletal modelling (SIMM) (Motion Analysis Corporation, USA). Our results showed that rescaled generic models, which do not take into account the subject's femoral geometry, overestimate MAL for hip flexion, extension, adduction, abduction and external rotation, but underestimate MAL for hip internal rotation. The differences in MAL introduced by taking the aberrant femoral geometry into account in the MR-based model were consistent with major gait characteristics presented in CP patients.