Interpretable Machine Learning on Simulation-Derived Biomechanical Features for Hamstrings-Quadriceps Imbalance...

Hamstrings-quadriceps (H-Q) imbalance represents a biomechanical marker of knee instability and injury risk in running. This in silico (simulation-based) study introduces a digital machine learning framework designed to estimate H-Q imbalance using biomechanical features derived entirely from synthetic running trials and conceptually mappable to inertial-sensor domains. Key biomechanical predictors included the dynamic hamstrings-to-quadriceps ratio (H:Qdyn), the knee moment limb symmetry index (LSI), and the early-stance co-contraction index (CCI), all standard indicators of muscular balance and coordination in sports medicine. A reduced musculoskeletal framework emulating flexor-extensor balance, limb symmetry, and co-contraction patterns generated 573 synthetic running trials for 160 virtual subjects across three speeds. These interpretable features trained a calibrated gradient-boosting classifier evaluated via ROC-AUC, PR-AUC, balanced accuracy, F1, and Brier score. Across all conditions, the model achieved ROC-AUC 0.933 (95% CI 0.908-0.958), balanced accuracy 0.943 (95% CI 0.924-0.962), PR-AUC 0.918 (95% CI 0.892-0.943), F1 0.940 (95% CI 0.919-0.958), and Brier 0.056 (95% CI 0.041-0.072), outperforming the logistic baseline. Dynamic H:Q ratio and knee moment symmetry were the dominant predictors, while co-contraction provided complementary biomechanical nuance. These results demonstrate that simulation-derived frameworks can reproduce IMU-relevant biomechanical variability, enabling interpretable machine learning for transparent assessment of muscular balance in sports medicine.