Inverse dynamic estimates of muscle recruitment and joint contact forces are more realistic when minimizing muscle activity rather than metabolic energy or contact forces.

BACKGROUND Assessment of contact forces is essential for a better understanding of mechanical factors affecting progression of osteoarthritis. Since contact forces cannot be measured non-invasively, computer simulations are often used to assess joint loading. Contact forces are to a large extent determined by muscle forces. These muscle forces are computed using optimization techniques that solve the muscle redundancy problem by assuming that muscles are coordinated in a way that optimizes performance (e.g., minimizes muscle activity or metabolic energy). However, it is unclear which of the many proposed performance criteria best describes muscle coordination. RESEARCH QUESTION Which performance criterion best describes muscle recruitment patterns and knee contact forces recorded using electromyography (EMG) and load cell instrumented prostheses?. METHODS We solved the muscle redundancy problem based on six different groups of performance criteria: muscle activations, volume-scaled activations, forces, stresses, metabolic energy, and joint contact forces. Computed muscle excitations and knee contact forces during over-ground walking were validated against recorded EMG signals and measured contact forces for four subjects with instrumented knee prostheses in the "Grand Challenge Competition to Predict in Vivo Knee Loads" dataset. RESULTS Performance criteria based on either stress or muscle activation (either unscaled or scaled by muscle volume), both to a power of 3 or 4, resulted in the best agreement between measured and simulated values. These performance criteria outperformed all other criteria in terms of agreement between simulated muscle excitations and EMG, whereas good agreement between measured and predicted contact forces was also observed for minimization of contact forces and metabolic energy. SIGNIFICANCE Given the large differences in accuracy obtained with different performance criteria (e.g., root mean square errors of contact forces differed up to 0.45 body weight), the results of our study are important to improve the validity of in silico assessment of joint loading.