An interactive graphics-based model of the lower extremity to study orthopaedic surgical procedures.

We have developed a model of the human lower extremity to study how surgical changes in musculoskeletal geometry and musculotendon parameters affect muscle force and its moment about the joints. The lines of action of 43 musculotendon actuators were defined based on their anatomical relationships to three-dimensional bone surface representations. A model for each actuator was formulated to compute its isometric force-length relation. The kinematics of the lower extremity were defined by modeling the hip, knee, ankle, subtalar, and metatarsophalangeal joints. Thus, the force and joint moment that each musculotendon actuator develops can be computed for any body position. The joint moments calculated with the model compare well with experimentally measured isometric joint moments. We developed a graphical interface to the model that allows the user to visualize the musculoskeletal geometry and to manipulate the model parameters to study the biomechanical consequences of orthopaedic surgical procedures. For example, tendon transfer and lengthening procedures can be simulated by adjusting the model parameters according to various surgical techniques. Results of the simulated surgeries can be analyzed quickly in terms of postsurgery muscle forces and other biomechanical variables. Just as interactive graphics have enhanced engineering design and analysis, we have found that graphics-based musculoskeletal models are effective tools for designing and analyzing surgical procedures.