Front. Mech. Eng.
DOI 10.1007/s11465-014-0306-x
REVIEW ARTICLE
Bhaskar Kumar MADETI, Srinivasa Rao CHALAMALASETTI, S. K. Sundara siva rao BOLLA PRAGADA
Biomechanics of knee joint — A review
© Higher Education Press and Springer-Verlag Berlin Heidelberg 2014
Abstract The present paper is to know how the work is
carried out in the field of biomechanics of knee. Various
model formulations are discussed and further classified
into mathematical model, two-dimensional model and
three-dimensional model. Knee geometry is a crucial part
of human body movement, in which how various views of
knee is shown in different planes and how the forces act on
tibia and femur are studied. It leads to know the forces
acting on the knee joint. Experimental studies of knee
geometry and forces acting on knee shown by various
researchers have been discussed, and comparisons of
results are made. In addition, static and dynamic analysis
of knee has been also discussed respectively to some
extent.
Keywords biomechanics, knee geometry, ligaments,
squat, femorotibial joint, finite element method
1 Introduction
Biomechanics is the science of movement of a human body
in which muscles, bones, tendons and ligaments work
together for the movement of human body. Mind is to
control the movements like a machine. The intrinsic
mechanics of this machine gradually became clear through
the work of the scientists. The knee joint is flexed and
attached to the bone of the thigh. Quadricep muscles are
bounded under the knee. Various forces acting on the knee
and excessive pressure on the ligaments due to over load in
various activities take place, which effects the functioning
of knee due to injuries such as rupture in ligaments [1].
Received May 23, 2014; accepted July 19, 2014
Bhaskar Kumar MADETI ( ) ✉
Department of Mechanical Engineering, Gayatri Vidya Parishad College
of Engineering, Visakhapatnam 530048, India
E-mail: bhaskar_kumar101@yahoo.com, ntcrambo@gmail.com
Srinivasa Rao CHALAMALASETTI, S. K. Sundara siva rao BOLLA
PRAGADA
Department of Mechanical Engineering, AU College of Engineering,
Andhra University, Visakhapatnam 530003, India
Knee ligament injuries are common particularly in sports
and related activities. Rupture of these ligaments may
cause imbalance between knee movement and stability. It
results in abnormal knee kinematics and damage tissues in
and around the joint which lead to severe pain. Healing
process and replacement of ligaments after rupture help to
evaluate the effectiveness of various treatment procedures.
The present paper provides an overview of the current
biological and biomechanical knowledge on normal knee,
as well as injury. Through the utilization of robotics
technology and computational modeling, there is a better
understanding of the kinematics and replacement
mechanics of the knee. The determination of in vivo forces
acting on the human knee and in vivo torques acting across
the femorotibial joint is of great value to clinicians,
researchers and implant designers [2,3]. These inter-
segmental forces and torques calculated from inverse
dynamics are due to the contributions of muscles,
ligaments and contact forces [4]. The technique used to
determine in vivo loading is telemetry which is a direct
experimental approach and mathematical modeling and
predicts in vivo contact loads on the basis of a theoretical
evaluation [5,6].
Mathematical modeling which is an alternative to
theoretical approach relies on mathematical predictions
to determine the in vivo loading of the human knee. The
optimization technique is to solve the indeterminate
muscle force system [7]. In the human knee joint,
components like menisci, cartilages, ligaments and
muscles allow complex mechanical responses to different
types of physiological loads. Ligaments play a key role in
providing stability to the joint during motions. Each
ligament provides stability in more than one degree of
freedom in a knee motion, while the overall joint stability
depends on the contributions of each ligament and their
interactions. Knee joint is essential for activities of human
lower extremity. And any damage of the crucial compo-
nents will affect the movements of knee. Since many
people suffer from the osteoarthritis, it is important to
determine the pressure distribution of the contacts of knee
joints in daily activities. Biomechanical models of the
lower limbs and the knee are used to evaluate knee motion
2 Front. Mech. Eng.
and loading during various sporting tasks. Most of the
authors choose 6-degree-of-freedom models for the
analysis of side-cutting [8–11]. These studies calculate
knee joint angles as well as moments. The translations and
rotations are expressed in the knee joint coordinate system
for femoral and tibial coordinate systems.
2 Model formulation of the knee
The femur and tibia were modeled as two rigid bodies. The
deformation of cartilages was assumed to be relatively
small compared with joint motions without affecting
relative motions and forces in the tibia-femoral joint.
Furthermore, friction forces were neglected because of the
extremely low coefficient of friction of the articular
surfaces [12]. The model resistant to motion was
essentially from the ligamentous structures and the contact
forces [13]. The resistance to motion by the ligamentous
structures and the contact forces was to stimulate these
forces as non-linear spring elements. The functional ranges
were determined by varying length during motion.
Meniscectomy on joint motions is minimal do to the
absence of joint axial compressive loads, compared with
that of cutting ligaments [14,15]. Loading conditions were
limited to ligaments of the knee joints and was not
subjected to external axial compressive loads [16].
2.1 Mathematical model
The lower extremity was modeled which composed of four
rigid body segments including pelvis, thigh, leg and foot
(Fig. 1) [17]. An axis system was developed in each body
segment and moved with it. These coordinate systems
were used to define joint orientation. The coordinates of
bony landmarks were used to construct a right-handed
orthogonal anatomically based reference frame for each
coordinate system [6]. The positive x-axis was oriented in
the superior direction. The positive y-axis was oriented in
the anterior direction [18]. The positive z-axis extended
from the origin towards the left of the body. The rigid body
segments were assumed to be interconnected by a ball-and-
socket joint in which 3 rotations and no translation were
obtained. The joint translation did occur in normal and
pathological joints, whose magnitude was usually small
and difficult to measure [19]. Consequently, the lines of
action of the joint reaction which passed through the joint
centers and the joint moments obtained were the net
reaction moments needed to sustain motion and generated
the measured moment. Since the friction coefficient
between articulating surfaces is very small, i.e., 0.00–
0.005 [20–22], the articulating surfaces between body
segments were assumed to be free of friction.
The coordinate system of sensor, the femoral coordinate
system and the tibial coordinate system were developed, as
well as their relationships to the knee joint coordinate
Fig. 1 Mechanical model of human lower limbs
system. A universal force-moment sensor was capable of
measuring the 3 forces and 3 moments with respect to an
embedded orthogonal sensor coordinate system treated as a
single [6 1] matrix [23]. Mathematical modeling is an
alternative theoretical methodology which relies on
mathematical predictions to determine the in vivo loading
of the human knee. Mathematical modeling is approached
by using optimization techniques to solve an indeterminate
muscle force system [7,24–30], and utilize a reduction
method to minimize the number of unknown muscle forces
so that the number of motion equations is equal to the
number of unknown quantities which keeps the system
solvable [31–38]. The alternative to direct measurement of
joint forces using telemetry was to theoretically predict the
interactive contact forces and the torques acting across
each joint by developing a mathematical model. This was a
very difficult task since the human leg modeled by Brand et
al. was comprised of 47 muscles and each joint was
represented by 3 interactive forces and 3 interactive
torques [39].
The interactive forces and torques are represented by
muscles, ligaments and contact forces. And these contact
forces are in fact contact surfaces with distributed pressure
across them. Using mathematical modeling techniques, 3
interactive forces and 3 torques acting on the joint are
replaced by resultants after idealizing. The human knee
joint is comprised of 3 rigid bodies: femur, tibia and
patella. Therefore, this joint can be defined by 6 interactive
forces and 6 active torques [31]. Fluoroscopic analysis has
determined that the patella remains in contact with the
femur, but rotates and translates with respect to the tibia
[40]. Modeling the human knee joint is quite difficult since
it involves 3 rigid bodies which experience motion patterns
unlike those of any other joint in the body. Leg is
comprised of more muscles and interactive forces which is
represented by resultant forces and torques. The system is
indeterminate because only some equations of motion can
be derived. Additional equations could be derived as
constitutive relationships, which have not yet been
attempted successfully.
 Bhaskar Kumar MADETI et al. Biomechanics of knee joint
2.2 Two-dimensional model
For two-dimensional model a free-body diagram was
developed from pelvis to foot, modeling the lower
extremity as a kinematic chain working from the foot/
ground interaction through to the pelvis/trunk interaction.
Seven rigid bodies were modeled and denoted with a letter
defining each body [41]. The masses of patellar ligaments
and quadriceps muscles were neglected. A transformation
was initially derived from the foot to the Newtonian
reference frame. Next transformations were then defined
between adjacent rigid bodies. Toe and tibia were defined
with respect to the foot. The patellar ligament motion and
the femur were defined with respect to the tibia. The patella
was modeled as remaining in contact with the femur, but
oriented with respect to the patellar ligament. The trunk
and femur were defined with respect to the pelvis. A loop
was formed by the tibia, femur, quadriceps, patella and
patellar ligament.
2.3 Three-dimensional Model
The three-dimensional computer model includes a material
description for the patellar kinematics, the linear momen-
tum balance, elastic constitutive laws for the different
joints and a unique contact formulation allowing slips.
Inertial and gravitational effects were neglected in three-
dimensional models reflecting its quasi-static nature. A
comprehensive 3-D computer model based on finite
element was developed for analyzing articular biomecha-
nics on patellofemoral biomechanics. The developed
model computes the joint kinematics with the association
of tendinous and ligamentous forces, articular contact
pressures and stresses occurring in the joint during its
movement. The components constituting the joints like
bones, cartilages and tendons were modeled by using non-
linear elastic materials. A unilateral contact which allows
for large slip between patella and femur was implemented
by using Lagrangian formulation [42]. An accurate three-
dimensional model of the canine knee was created to
determine the forces in the knee ligaments and the knee
joint reaction forces during the stance phase of a slow
walk. A quasi-static model considered both the tibiofe-
moral and patellofemoral articulations [43]. A model
which is capable of reconstructing the 3D positions of the
tibiofemoral joint at a number of known positions could
provide credible movement patterns for the remainder of
the flexion-extension cycle for use in musculoskeletal
models. The goal was therefore to assess whether a new
three-dimensional model of knee kinematics based on a
modified four-bar linkage which could consider the
cruciate ligament lengthening characteristics as well as
tibiofemoral internal/external rotation, was capable of
simulating the kinematics of the tibiofemoral joint during
loaded and unloaded in vivo knee flexion. Furthermore, by
extracting the parameter sets to reconstruct the known
3
kinematics of all individuals, such a generic model has the
ability of reconstructing the specific tibiofemoral kine-
matics [44].
2.4 Finite element analysis model
Recently, some authors have presented a three-dimensional
finite element (FE) model of the healthy human knee joint
including bones, ligaments and patellar tendon, menisci
and articular cartilages. Bones were considered to be rigid.
Articular cartilages and menisci were linearly elastic,
isotropic and homogeneous. Here the ligaments were
hyperelastic and transversely isotropic. Initial strains on
the patellar tendon and ligaments were considered. The
model was validated using experimental and numerical
results obtained when compared to previous results. The
main goal was to analyze the combined role of menisci and
ligaments in load transmission and the stability of the
human knee [45]. Finite element model of each implanted
cadaver specimen was created for dynamic analysis.
Specimen-specific tibial, femoral and patellar bones were
manually extracted from magnatic resonance (MR) scan
images via segmentation. Size-matched computer-aided
design component surfaces were aligned to the extracted
bones using digitized points. For all analyses, bones and
femoral components were meshed with triangular shell
elements, while polyethylene patellar and tibial compo-
nents were represented by 8-noded solid hexahedral
elements [46]. To reduce the cost of computation without
sacrificing kinematic prediction, bones and implant
components were considered to be rigid for all analyses
with component contact defined by a previously verified
pressure-over closure relationship [47]. A coefficient
friction of 0.04 was applied to the articular surface
interfaces [47,48]. An anatomically based model for
characterizing a human knee joint was formulated so that
its internal joint forces or torques during flexion could be
accurately analyzed. In bio-joint model, several assump-
tions commonly made on a knee joint in exoskeleton
design were relaxed [49].
3 Knee geometry
The geometrical data of the model developed here were
obtained by magnetic resonance imaging (MRI) for soft
tissues and computerized tomography (CT) for bones, with
images taken from a normal adult volunteer. The CT and
MRI blocks consisted of parallel digital images were
separated at intervals of 1.5 mm in the sagittal, coronal and
axial planes with the knee at 0° flexion. The contours of the
femur, tibia, articular cartilage, menisci and ligaments
(patellar tendon, anterior cruciate, posterior cruciate,
medial collateral and lateral collateral) were manually
identified in each image with the help of surgeons from the
Traumatology Department of the University of Zaragoza.
4 Front. Mech. Eng.
As shown in Fig. 2, the proximal coordinate system is
fixed to the distal femur and is represented by capital
letters, I, J, K. The distal coordinate system is fixed to tibia
and is represented by lower case letters, i, j, k. The K-axis is
used to define the flexion-extension motion. The i-axis
describes the internal-external rotation.
Fig. 2 Knee geometry based on Eulerian angles
Patella allows the femur and tibia to extend up to 0°–
180°. Anterior neutral-position shift which is attributed to
the inherent tilt of the tibial plateau may cause an anterior
translation of the tibia during tibiofemoral joint loading
[50].
Fig. 3 (a) Sagittal view; (b) frontal view
The sagittal and frontal-plane moments were calculated
from force-plate and cine photographic data [51] as shown
in Fig. 3.
Forces are shown in Fig. 4 [52] which is a free body
diagram of the leg in frontal plane as a dancer lands from a
vertical jump. The arrows represent the forces [52]. The
force diagram of right leg and foot is the free body diagram
in which we could know some values by using moment
equations [53] as shown in Fig. 5.
The floating axis is orthogonal to both axes and is used
to measure the abduction-adduction motion. These 3 axes
are mutually orthogonal when the knee joint is in its neutral
position. Figure 6 shows the translations and rotations as
expressed in the knee joint coordinate system for femoral,
tibial and sensor coordinate system [54].
Figure 7 shows a simplified knee-joint force model
including muscle, ligament, and bearing forces transmitted
by the knee. Where, Q represents quadriceps; H represents
hamstrings (resultant); G represents gastrocnemius (medial
and lateral); M represents medial collateral ligament; L
represents lateral collateral ligament; Ac represents ante-
rior cruciate ligament; Pc represents posterior cruciate
ligament; J represents total joint force (resultant).
In Fig. 8, knee joint force (J) is distributed between the
medial and lateral plateaus as Jm and Jl. Adduction of the
tibia shifts the center of pressure medially, causing tension
in the lateral ligament. Abduction causes a shift in the
center of pressure toward the lateral side. Tension in the
medial ligament is necessary for equilibrium [51].
From this geometry, forces are clearly shown in various
views, and unknown forces are known by moment
equations. Knee geometry plays an important role in the
present paper.
 Bhaskar Kumar MADETI et al. Biomechanics of knee joint
Fig. 4 Free body diagram of a dancer leg [52]
Fig. 5 Free body diagram of tibia
4 Experimental study
Experiments had been performed on knee joints. And so
many variations of force with time and leg position were
shown for normal test subjects walking on level surfaces.
The test procedure involved the measurement of external
force actions transmitted to the leg and their correlation
with photographic records and was processed to obtain the
resultant force and moment acting at the joint, taking
account of the effect of gravity and accelerations [55].
5
Fig. 6 Tibiofemoral joint coordinate system
Fig. 7 Simplified knee-joint force model
Strain gauge transducers were used for the measurement of
force in order to calculate moments, by which knee center
of rotation was estimated [56]. The moment actions were
transmitted by the development of tension in muscular or
ligamentous connections crossing the joint and the
corresponding reaction at the joint. Quantification of the
errors associated with measurements was obtained using
an isokinetic dynamometer for knee evaluation at 60(° )/s
and 180(° )/s. Five normal subjects were tested. A triaxial
6 Front. Mech. Eng.

Fig. 8 (a) Adduction moment; (b) abduction moment

electrogoniometer was used to measure the kinematics. A

custom-designed load cell was used to measure the 3
orthogonal components of the reaction force applied by the
isokinetic dynamometer to the leg [17].
As shown in Fig. 9, forces and moments in 6-degree-of-
freedom of the unconstrained human knee joint vs. time
relationships under anterior and posterior translation were
tested. The force and moment were controlled by a robotic
system for the joint testing [23].

Fig. 9 Robotic system to control forces and moments at the
human knee joint
An adjustable fixture recorded the motion of the femur
in the X (anterior-posterior), Y (medial-lateral) plane and
rotation of the tibia about its axis during tibiofemoral joint
loading as shown in Fig. 10. In this experiment, by taking
several specimen (tibia and femur) for 60° and 120° knee
flexion the maximum peak load was 6.8 kN for 60° and
5.1 kN for 120°, respectively, and average peak load was
4.9 kN for 60° and 4.4 kN for 120°, respectively [51].
Fig. 10 Tibia and femur joint loading arrangement
A series of vertical jumps were performed by the dancers
in ballet rotating the legs such that heels were together
while toes and knees point outward in the frontal plane
landing on a force plate obtained from vernier Software
and Technology which was interfaced to a computer with
some software. Simultaneously, the dancers were video-
taped in the frontal and sagittal planes. The sagittal plane
was the plane of symmetry that divided the body into right
and left side. One jump per dancer was chosen for analysis
 Bhaskar Kumar MADETI et al. Biomechanics of knee joint
based on the jump’s smoothness, symmetry and quality
[52].
Various approaches such as reduction, optimization,
telemetry for comparison of knee interaction forces for
different activities like walking, stair descent, stair ascent,
etc., for these entire activities knee interactive forces have
been calculated. In walking it is about 2 to 4 times the body
weight, in stair ascent it is about 2.8 to 4.4 times the body
weight, in stair descent it is about 2.8 to 4.9 times the body
weight. These forces are developed on knee in various
activities and given with respect to the body weights [41].
Moments developed on the knee are also obtained by
different activities. The values are obtained in past
decades, with the help of which research may be extended.
Masses as percentage of total body mass of body
segments for female college-age gymnasts were calculated
with respect to percentage of total body mass of body
segments for human body head, left/right (L/R) upper arm,
L/R lower arm, trunk, L/R thigh, L/R lower leg and L/R
foot. Location of mass center of each segment of all body
parts has determined.
Reconstructed bone surfaces and cruciate ligaments
from MRI at 0°, 30° and 90° knee flexion are shown in
Fig. 11. The movement of the femur relative to the tibia
was analyzed by registering the surface models of the tibia
at 30° and 90° knee flexion onto the tibia at 0° flexion.
Sagittal view of the tibia and the posterior cruciate
ligament as reconstructed from the MRI data. A shift
from a lax concave shape at 0° and almost straight at 30°
and 90° can be seen, posing the question as to whether a
linear four-bar linkage model is capable of modelling the
kinematics of the knee [44]. The four-bar linkage model
(solid bars) for describing the movement of the femur
relative to the tibia is shown in Fig. 11(b). Here, the
reconstructed surface of the tibia is overlaid on the in vivo
Fig. 11 (a) MRI at knee flexion; (b) four-bar linkage model
7
MRI at 0°, 30° and 90° flexion angle, respectively [44].
In vivo kinematics of the tibiofemoral joint was derived
from open MRI for 12 healthy subjects for knee flexion
under both passive and active neuromuscular patterns. An
average tibial internal rotation of 1.8°0.9° was observed
for the unloaded knee at 30° and 7.1°4.6° at 90° knee
flexion, while an average tibial internal rotation of 4.0°
2.5° occurred at 30° and 5.6°3.6° at 90° for the loaded
knee [44].
The dynamometer with the high time-resolution servo
system has been recently developed to assess the isotonic
force-velocity relationships [59]. This servo system can
measure force under the steady state and provides a new
dimension to understand force-velocity characteristics of
human multi-joint movements. The force-velocity relation-
ships were linear in both bilateral and unilateral knee-hip
extension movements and in both young and elderly
women so that maximum isometric force, Fmax, and
unloaded velocity, Vmax, could be estimated by extrapolat-
ing the linear regressions on to the force respectively. The
force-power relationship was then determined by quadratic
fit. The maximum power output, Pmax, appeared at 50% of
maximum force [60]. The quadriceps muscles of human
body are quite important in daily activities of knee joints.
The determination of quadriceps forces poses significant
challenges since it cannot be measured in vivo. A novel
approach was presented to obtain the forces in squat
through the combination of motion photography, force
transducers measuring, multi-rigid-body theory and finite
element analysis [53].
The squat angle was defined as 0° in standing upright
and increased with squatting process. Experimental
equipment included two 50 kg and two 100 kg calibrated
sensors, a computer, a digital camera, a tripod, wood
plates, wires, and so on. Dynamic signal acquisition and
8 Front. Mech. Eng.
analysis system DHDAS 5923 was adopted to record and
analyze the real-time signals from all sensors. At the same
time, the motions of subjects were photographed with
digital cameras.
Force transducers measured the feet reaction forces. The
positions of gravity center in squat were determined to
achieve the quadriceps torques as shown in Fig. 12. Based
on the multi-rigid-body dynamics and above obtained data,
the quadriceps forces were estimated in squat. After the
quadriceps forces were achieved and they were exerted on
the FE model of knee joint, the contact pressure on the
femur, tibia, and patella cartilages increased with the squat
angle. The contact pressure of lateral meniscus was steady,
relative to the significant variation of peak pressure on
medial meniscus and the peak value of contact pressure on
all components appeared at 90°.
Fig. 12 The photographed picture of squat
From the above study it is clearly observed that accurate
values may not be obtained. Earlier they used force plates
and motion photography to get the forces. In general,
errors take place in force plate due to that dislocation of
foot in motion photography pictures may be delayed a bit.
Recently, squat equipment is used to measure forces. The
forces can also be determined with the help of magnetic
resonance scans.
5 Static analysis
Foot is placed on the force platform facing the frontal cine
camera. The resultant ground-to-foot force and its point of
application were determined from force-plate measure-
ments. Rapid fluctuations of load were observed due to
small movements of the particular person to maintain
balance on the plate. Although the balancing movements
produced some side-to-side and fore-and-aft ground-to-
foot shear forces during the initial part of the balancing
maneuver, these moments were very small in magnitude
and disappeared once balance equilibrium was achieved.
The only recordable external load was the vertical ground-
to-foot force which equaled body weight in each subject.
The force-platform results were synchronized with a
recording of the individual's stance position in the coronal
plane, and determined using the frontal camera. At the
completion of each static assessment, the coordinates of
the knee could be calculated in order to determine the
spatial alignment of the limb in the coronal plane.
The analysis method calculates the force actions of the
knee joint using static methods. Considering a free body of
the tibia and foot and noting that all muscle forces are
assumed to be zero, from the equilibrium conditions of
force balance in the vertical direction and moment balance
about the joint center, the possible existing joint-loading
situations are similar to the situations in the dynamic
analysis.
For static analysis, it is assumed that no active muscle
forces are contributing to the calculation of joint forces.
This introduces major error into static analysis methods,
particularly in subjects with knee-flexion deformity when
significant force actions are required in the major muscle
groups spanning the knee to maintain equilibrium. The
muscle forces can be only determined from sagittal-plane
assessment. Since static forms of analysis are planar, only
force actions occurring in the coronal plane can be
assessed. Therefore, it is not possible to calculate the
effect of muscle contraction in the sagittal plane. However,
it is apparent that muscle action contributes significantly to
total joint force, and joint load calculated by static are most
noticeable.
6 Dynamic analysis
In dynamic analysis, the femur axis was fixed, while the
tibia was moving. The system of axes (x′, y′, z′) attached to
the tibia was its centroidal principal system of axes as
shown in Fig. 6. The tibiofemoral joint coordinate system
was used to define the rotation and translation vectors that
described the three-dimensional tibiofemoral motions [54].
This joint coordinate system consisted of a medial-lateral
axis (x-axis) which was fixed on the femur, an axis (z′-axis)
which was fixed on the tibial mechanical axis and a floating
axis perpendicular to these two fixed axes. The angular
velocity and angular acceleration vectors of the tibia with
respect to the femur were thus obtained by differentiating
this rotation vector with respect to time. The distances
between the tibial and femoral attachment points of the
different ligaments were calculated in order to find how
their lengths changed during motion. Analysis included
 Bhaskar Kumar MADETI et al. Biomechanics of knee joint
expressing the coordinates of each attachment point with
respect to one bony coordinate system: the tibia and the
femur. It was accomplished by establishing the transfor-
mation between the two coordinate systems. The equations
governing the three-dimensional motion of the tibia were
the second-order differential Newton and Euler equations
of motion. Newton’s equations were written in a scalar
form with respect to the femoral fixed system of axes.
Ground reaction forces were determined by walking large
dogs at a slow speed of 0.9 m/s across a force plate [61].
The reference for describing the kinematics during
flexion was defined at the tibial position of 0° knee. Rigid
transformation matrices were computed for the femur
between each pair of poses (0°–30° and 30°–90°). The
surface models of the femur at 30° and 90° flexion were
respectively transformed into the reference system for
registration of the ligament insertion sites. In vivo internal/
external rotation was calculated with reference to the same
axis of the femur. Here, the axes were projected onto the
tibial plateau represented by the x-y plane of the tibia
coordinate system. And the angle of their intersection was
computed to define the internal/external rotation. The
external force system acting on the tibia consisted of 3
ground-to-foot forces (Fx, Fy, and Fz) and 3 moments or
torques (Mx, My, and Mz) acting about the center of rotation
of the knee as shown in Fig. 3. Fx was the fore-and-aft
shear force acting at the foot in the line of progression; Fy
was the vertical component; Fz was the side-to-side
ground-to-foot force. The effect of Mz was to flex or
extend the tibia about the axis of the Z grid. Similarly, Mx
tended to abduct or adduct the tibia relative to the thigh,
and My was acted to rotate or twist it about its long axis in
the coronal plane. Knee moment Mx was calculated [51].
From the data, true coordinates of the centers of rotation
for the ankle, knee and hip were calculated.
By using force-plate, 3 forces and 3 moments were
known and further leaded to calculate the center of
pressure of the foot and the magnitude and direction of the
resultant ground-to-foot force. The force-plate and cine-
photographic data were processed to calculate the external
force system acting on the knee for each interval
throughout the stance phase of the gait cycle. The weight,
height and skeletal dimensions of each subject were
compared with cadaver measurements and radiographs of
the knee to determine the scaling factors which were
necessary to calculate the points of attachment and the
lines direction of muscles and ligaments at the knee.
7 Conclusions
The following conclusions are made from the above
discussions:
1) In mathematical modeling, forces are predicted. The
number of equations should be equal to the number of
9
unknowns to solve the problem. There is accuracy and also
complexity.
2) Two-dimensional models are not preferred due to
inaccuracy, while three-dimensional models are preferred,
because in two-dimensional models some data are
neglected but not in three-dimensional models.
3) Recently, three-dimensional finite element analysis
models are generated to reduce complexity. Stress and
strains are clearly observed in the knee joint. Accurate
models are made with the help of magnetic resonance scan.
4) With the help of motion photography and force
transducer, forces on the knee joint can be obtained.
Further torques on knee joint can also be calculated.
5) In knee geometry, forces acting on a point may be
represented with a single force, but sometimes varying
loads are obtained due to adduction and abduction
moments of knee. Therefore, complexity may increase
while considering varying loads.
6) With a mechanical force representation by using a
free-body diagram for equilibrium conditions for the joints
of knee and hip, one can exactly predict the direction in
which the forces act.
7) Forces andmoments should be resolved at the joints of
human body, and all forces are obtained by solving the
equations.
8) The three-dimensional finite element analysis models
have to be generated to reduce complexity in the analysis.
Accurate three-dimensional models are made with the help
of magnetic resonance scanner.
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