# In vivo evaluation of a 3d musculoskeletal model of the knee joint during passive flexion tests

Nolwenn Fougeron, Ysé Roch, Clément Horteur, Benoît Gaulin, Yohan Payan,

Antoine Perrier

► To cite this version:

Nolwenn Fougeron, Ysé Roch, Clément Horteur, Benoît Gaulin, Yohan Payan, et al.. In vivo evaluation of a 3d musculoskeletal model of the knee joint during passive flexion tests. ESB 2025 - 30th Congress of the European Society of Biomechanics, Jul 2025, Zürich, Switzerland. 2025. hal-05077435

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Submitted on 27 Nov 2025

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Distributed under a Creative Commons Attribution 4.0 International License
# ESB Congress Zurich 2025
## IN VIVO EVALUATION OF A 3D MUSCULOSKELETAL MODEL OF THE KNEE JOINT DURING PASSIVE FLEXION TESTS

Fougeron N.ª, Roch Y.b,c, Dr. Horteur C.b,d, Dr. Gaulin B.b,d, Payan Y.b, Perrier A.b,c,e

### Take Home Message

* Calibrated musculoskeletal model for knee flexion

* In vivo evaluation of the results using MRI data

* Errors on ligaments' elongation < 9 %

* Errors on patella kinematic < 18 mm

* Digital twins offer new opportunities for the personalisation of TKA

## Introduction

Total Knee Arthroplasty (TKA) has a dissatisfaction rate ≈ 25% [1] →
**Limitation of the one-size-fits-all approach**

<figure><img src="image_2.png" /></figure>

Digital twins to personalise the surgical procedure

* Extract key surgical data: **patella's kinematic** and **ligaments' elongations** [2, 3]

* Difficulties in personalising the material properties [4]

**Objective:** Use *in vivo* MRI data to evaluate the knee model of one healthy subject, assuming generic material properties.

## Methodology

<figure><img src="image_3.png" /></figure>

One healthy volunteer

<figure><img src="image_4.png" /></figure>

Low-energy CT-scans

Five non-weight-bearing MRI sessions with ↗ knee angles (0° - 138°)

**Geometry:** Multibody knee model including the femur, tibia, fibula, cartilages, posterior and anterior cruciate ligaments (PCL and ACL), medial and lateral collateral ligaments (MCL and LCL), posterior oblique ligament (POL), anterior lateral ligament (ALL), patellar ligament (PL), lateral and medial patellofemoral ligaments (LPFL and MPFL), lateral and medial patellotibial ligaments (LPTL and MPTL) (see Figure 1). Ligaments were modelled with multiple deformable strands.

**Materials:** Manual calibration of materials' parameters with literature experimental data using 3 MRI + Evaluation of the model using the 2 remaining MRI

**Boundary Conditions:** Fixed tibia and fibula + Flexion (170 N) and compression (70 N) force at the centre of the femoral head.

**Comparison with MRI:** Computation of the Euclidean distance between the patella and femur centroids. Kriging of the collateral ligaments' strands with MRI ligament segmentation (control points) to compute elongation errors (see Figure 2).

<figure><img src="image_5.png" /><figcaption>**Figure 2:** MCL segmentations and associated strands (from 0° to 138°)</figcaption></figure>

## Results

<figure><img src="image_6.png" /></figure>

<figure><img src="image_7.png" /></figure>

<figure><img src="image_8.png" /></figure>

<figure><img src="image_9.png" /><figcaption>**Figure 1:** (left) MRI used for the calibration of the ligaments' materials, (centre) knee multibody model, (right) MRI used for the evaluation</figcaption></figure>

<table><caption>**Table 1:** Elongations and position errors of the MCL, LCL, patella and femur centroids</caption><thead><tr><td>Flexion angles</td><td>25°</td><td>100°</td></tr></thead><tbody><tr><td>LCL</td><td>1.2 %</td><td>8.4 %</td></tr><tr><td>MCL</td><td>5.7 %</td><td>2.5 %</td></tr><tr><td>Patella</td><td>4.4 mm</td><td>16.7 mm</td></tr><tr><td>Femur</td><td>2.9 mm</td><td>17.5 mm</td></tr></tbody></table>

## Discussion and Conclusion

**Limitations of the evaluation method:**

* Comparison strand/3D mesh

* MRI flexions ≠ Clinician flexion tests

**Future improvements:**

* Batch analysis for material calibration

* Cadaveric tests for model validation

Watch our teaser!

<figure><img src="image_10.png" /></figure>

Ligaments' elongations and the patella's kinematics are valuable metrics for many clinical applications that could be estimated using digital twins

a. Univ. Rennes, Inria, CNRS, IRISA-UMR 6074, 35000, Rennes, France
b. Univ. Grenoble Alpes, CNRS, UMR 5525, VetAgro Sup, Grenoble INP, TIMC, 38000 Grenoble, France
c. Twinsight, Grenoble, France
d. Department of Orthopedics and Sport Surgery, Grenoble-Alpes CHU, South Teaching Hospital, Kimberley Avenue, BP 338, 38434 Echirolles Cedex, France
e. Department of Orthopedics and Traumatology, Groupe Hospitalier Diaconesses Croix St-Simon, Paris, France