3D active-passive response of human knee joint in gait is markedly altered when simulated as a planar 2D joint

Musculoskeletal models of the lower extremity make a number of important assumptions when attempting to estimate muscle forces and tibiofemoral compartmental loads in activities such as gait. The knee is commonly idealized as a planar 2D joint in the sagittal plane with no consideration of motions and equilibrium in remaining planes. With muscle forces predicted, the static equilibrium in the frontal plane is then used to estimate compartmental loads neglecting also joint passive resistance and assuming condylar contact centers. We aimed here to comprehensively investigate the effects of such assumptions on predicted results. While simulating gait and using a hybrid lower extremity model that incorporates a detailed validated 3D finite element model of the knee joint, analyses are repeated with out-of-sagittal plane rotations and moment equilibrium equations neglected (2D model) and tibial compartmental forces estimated using equilibrium in the frontal plane while disregarding passive resistance and assuming fixed contact centers (1D model). Large unbalanced out-of-sagittal plane moments reaching peaks of 30 Nm abduction moment and 12 Nm internal moment at 25 % stance period are computed that are overlooked in the 2D model. Consideration of the knee as a planar 2D joint substantially diminishes muscle forces, anterior cruciate ligament force and tibiofemoral contact forces/stresses when compared to the 3D reference model. Total tibiofemoral contact force peaks at 25 % stance at 4.2 BW in the 3D model that drops to 3.0 BW in the 2D model. The location of contact centers on each plateau also noticeably alters (by as much as 5 mm). Tibiofemoral contact forces further change when the location of contact centers on each plateau is fixed. Results highlight the importance of accurate simulation of 3D motions and equilibrium equations as well as passive joint properties and contact centers.