Clinical Biomechanics 15 (2000) 112±122

www.elsevier.com/locate/clinbiomech

A mathematical model of forces in the knee under isometric

quadriceps contractions
Richard A. Huss a,*, Horst Holstein a, John J. OÕConnor b
a
Department of Computer Science, University of Wales Penglais, Aberystwyth, Ceredigion, Wales SY23 3DB, UK
b
Department of Engineering Science and Orthopaedic Engineering Centre, University of Oxford Nueld Orthopaedic Centre, Headington, Oxford
OX3 7LD, UK
Received 14 April 1999; accepted 20 July 1999

Abstract
Objective. To predict the kneeÕs response to isometric quadriceps contractions against a ®xed tibial restraint.
Design. Mathematical modelling of the human knee joint.
Background. Isometric quadriceps contraction is commonly used for leg muscle strengthening following ligament injury or re-
construction. It is desirable to know the ligament forces induced but direct measurement is dicult.
Methods. The model, previously applied to the Lachmann or ÔdrawerÕ tests, combines an extensible ®bre-array representation of
the cruciate ligaments with a compressible Ôthin-layerÕ representation of the cartilage. The model allows the knee con®guration and
force system to be calculated, given ¯exion angle, restraint position and loading.
Results. Inclusion of cartilage deformation increases relative tibio±femoral translation and decreases the ligament forces gen-
erated. For each restraint position, a range of ¯exion angles is found in which no ligament force is required, as opposed to a single
¯exion angle in the case of incompressible cartilage layers.
Conclusions. Knee geometry and ligament elasticity are found to be the most important factors governing the jointÕs response
to isometric quadriceps contractions, but cartilage deformation is found to be more important than in the Lachmann
test.

Relevance
Estimation of knee ligament forces is important when devising exercise regimes following ligament injury or reconstruction. The
®nding of a Ôneutral zoneÕ of zero ligament force may have implications for rehabilitation of the ligament-injured knee. Ó 2000
Elsevier Science Ltd. All rights reserved.

Keywords: Knee; Articular cartilage; Quadriceps; Ligaments

1. Notation ~
Flp ˆ …Flpx ; Flpy † posterior cruciate ligament
force exerted on tibia, acting at
(x, y) coordinate system ®xed in tibia point ~rlp ˆ …rlpx ; rlpy †, of magni-
dr distance of restraining force tude Flp
~
Fp ˆ …Fpx ; Fpy † patellar tendon force exerted on
below tibial plateau
Fq quadriceps force tibia, acting at point
~
Fl ˆ …Flx ; Fly † ligament force exerted on tibia, ~
rlp ˆ …rpx ; rpy †, of magnitude Fp
~
Fc ˆ …Fcx ; Fcy † contact force exerted on tibia,
acting at point ~ rl ˆ …rlx ; rly †, of
magnitude Fl acting at point ~ rc ˆ …rcx ; rcy †, of
~
Fla ˆ …Flax ; Flay † anterior cruciate ligament force magnitude Fc
~
Fr ˆ …Frx ; Fry † restraining force exerted on tibia,
exerted on tibia, acting at point
~
rla ˆ …rlax ; rlay †, of magnitude Fla acting at point ~ rr ˆ …rrx ; rry †, of
magnitude Fr
~
d ˆ …dx ; dy † displacement of femur from ref-
*
Corresponding author. erence position
E-mail address: rah94@aber.ac.uk (R.A. Huss). / knee ¯exion angle
0268-0033/00/$ - see front matter Ó 2000 Elsevier Science Ltd. All rights reserved.
PII: S 0 2 6 8 - 0 0 3 3 ( 9 9 ) 0 0 0 5 9 - 5
 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
2. Introduction
This paper describes the response of the knee to
isometric quadriceps contraction with the aid of a two-
dimensional quasi-static model of the joint, previously
applied to the study of anterior/posterior (A/P) load-
ing [1].
Isometric quadriceps contraction is one of a number
of exercises (along with dynamic quadriceps exercise with
the knee ¯exed, hamstrings exercise, and cycling without
full extension) commonly used in rehabilitation follow-
ing ligament injury or reconstruction. During isometric
quadriceps contraction, the knee is maintained at a
constant ¯exion angle by a restraining force perpendic-
ular to the tibia when the quadriceps are under load. In
rehabilitation, it is desirable to know the ligament forces
induced by the applied muscle forces, with the aim of
minimising the risk of further damage to the ligaments
whilst allowing muscle rehabilitation. Since direct mea-
surement of ligament forces is dicult, a mathematical
model is used to provide estimates of their values. Ex-
perimental measurements of relative tibio±femoral dis-
placements have, however, been made, for example in
vivo by Howell [2] and in vitro by Hirokawa et al. [3].
Many mathematical models of the knee joint have
been devised; early theoretical models of isometric
quadriceps contractions considered the net shear force
at the joint, using experimental data relating to the joint
position and the magnitude of the restraining force. A
recent three-dimensional, quasi-static knee model is de-
scribed by Blankevoort and Huiskes [4] and Mom-
mersteeg et al. [5,6]; three-dimensional measurements of
the tibial and femoral articular surface geometry are
used, with deformable articular cartilage surfaces, and
each ligament is represented by a bundle of individual
®bre bundles. The contact geometry, and ligament in-
sertion sites and force±length relationships are measured
from individual cadaver specimens [5,6], or obtained by
an optimisation procedure [4]. The model uses a large
system of non-linear equations to predict the ¯exing and
extending motion of the knee, ligament forces, and A/P
and varus±valgus laxity, but muscle forces have not yet
been considered.
Shelburne and Pandy [7±9] describe a sagittal-plane
model which incorporates 11 elastic elements repre-
senting the ligaments; the patella is treated as a rectan-
gle. The model has been applied to studying the
relationships between muscle forces, external loads, and
cruciate ligament forces at the knee during isometric
exercises. All articular cartilage layers are rigid, in con-
trast to the present investigation.
OÕConnor et al. [10,11], using a model with cruciate
ligaments represented by inextensible lines determined
by a four-bar kinematic linkage [12], calculated the
varying geometry of the quadriceps, hamstring and
gastrocnemius muscle tendons as the knee ¯exed and
113
extended, and also the ligament and contact forces re-
sulting from given muscle loads. The patellofemoral
joint model assumed that the patellar tendon and
quadriceps force action lines intersect at a point which
moves on a circular path about the centre of the femurÕs
trochlear facet.
Zavatsky and OÕConnor [13] extended this model by
incorporating a representation of the cruciate ligaments
used previously to study the kneeÕs response to A/P
loading (the Lachmann or ÔdrawerÕ tests) [14,15]. In this
model, the cruciate ligaments were represented by con-
tinuous arrays of elastic ®bres joining line-segment at-
tachments on the tibia and femur. The femur and tibia
were thereby able to undergo small relative translations
parallel to the tibial plateau under quadriceps loading.
An anatomical model of the patellofemoral joint was
described by Gill and OÕConnor [16]. This represented
the patella as a rectangular block rolling and sliding on a
circular facet on the femur; at high ¯exion angles, con-
tact transferred from the trochlea to the femoral con-
dyles. The orientation of the patella was determined
using both geometric and force equilibrium constraints.
This patella model has been incorporated into knee
models used to calculate ligament and contact forces
under a variety of external loading situations, using the
approach of Zavatsky and OÕConnor [13]. Many of the
predictions of this model were found to be in good
agreement with experiment [17].
Huss et al. [1,18] extended the model of A/P laxity
described by Zavatsky and OÕConnor [14,15] by addi-
tionally allowing the joint surfaces to deform under
load. The contact forces were calculated using a Ôthin-
layerÕ constitutive equation for articular cartilage, and a
simpli®ed geometrical representation of the contact
area. The addition of cartilage deformation was found
to have a signi®cant e€ect on the force/displacement
relationship, but was less important than ligamentous
deformation.
In this paper, the ligament model of Zavatsky and
OÕConnor [14,15], the patella model of Gill and
OÕConnor [16], and the contact force calculation of Huss
et al. [1,18] are combined to produce a model of the
response of the knee to isometric quadriceps contrac-
tions in which both ligaments and cartilage layers are
able to deform. The contribution of cartilage deforma-
tion is determined by comparing the results to those of a
model in which the surfaces are rigid. Consequences for
rehabilitation are discussed.
3. Methods
3.1. Loading regime and geometry
The system of forces acting on the tibia is shown in
Fig. 1. A restraining force ~
Fr resists extension of the leg
114 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
Fig. 1. Forces applied to the tibia in response to a quadriceps force Fq .
Dotted lines represent the unloaded state.
when the subject applies a quadriceps force ~ Fq . The re-
straining force is applied at a chosen distance dr below
the tibial plateau. The quadriceps force is transmitted to
the tibia by the patellar tendon, which exerts a force ~ Fp .
A tibio±femoral contact force ~ Fc is generated, and there
may also be forces ~ Fla and ~
Flp in the anterior and pos-
terior cruciate ligaments. The collateral ligaments are
omitted from the current analysis.
The coordinate system is ®xed in the tibia with its
origin at O, at the front of the tibial insertion of the
anterior cruciate ligament (ACL). The x-axis is directed
posteriorly parallel to the tibial plateau and the y-axis is
directed proximally.
As in the model of A/P laxity [1,18], the joint con-
®guration is described by a ¯exion angle / giving the
position of the joint in the absence of any external
forces, and a displacement ~ d ˆ …dx ; dy † of the femur
relative to the tibia from this neutral position.
3.2. Ligament model
The cruciate ligaments are represented by continuous
arrays of elastic ®bres joining line-segment attachments
on the tibia and femur. The natural lengths of the ®bres
are de®ned by specifying a ¯exion angle for each liga-
ment or part of a ligament, at which all ®bres are just
taut with ~d ˆ~0.
Under load, the strain can be found for each ®bre,
given its natural length and the joint con®guration (/
and ~d). A non-linear stress±strain relationship is used to
determine the stress, which is integrated over those parts
of the ligaments where the ®bres are taut to give the
ligament force. The line of action is found by consid-
ering moments about an arbitrarily-chosen point. Full
details of the ligament calculations are given by Zavat-
sky and OÕConnor [14,15].
3.3. Contact model
The contact force is calculated as described in Huss
et al. [1,18] using a thin-layer approximation. The fem-
oral condyles are treated as rigid spheres indenting
uniform planar elastic layers (representing the articular
cartilage) bonded to a rigid substrate. The calculations
take into account the varying pro®le of the femoral
condyles with ¯exion angle, described by OÕConnor et
al. [19].
3.4. Patella model
The model incorporates the patella mechanism of Gill
and OÕConnor [16]. The patellar tendon is represented as
an inextensible string connecting the tibial tubercule and
the inferior pole of the patella, with the quadriceps
tendon lying parallel to the femur (unless it wraps
around the femur). Additional geometric and force-
balance considerations allow the orientation of the pa-
tellar tendon to be found, given / (and, in the present
model, ~ d) together with the force ratios for the patellar
tendon, quadriceps tendon and patellofemoral contact.
The present analysis is restricted to trochlear contact.
3.5. Equilibrium equations
Static equilibrium requires the total force acting on
the tibia and the total ¯exing moment to be zero. In a
2D model, static equilibrium requires
Fcx ‡ Fpx ‡ Frx ‡ Flax ‡ Flpx ˆ 0; …1†
Fcy ‡ Fpy ‡ Fry ‡ Flay ‡ Flpy ˆ 0; …2†
rcx Fcy ÿ rcy Fcx ‡ rpx Fpy ÿ rpy Fpx ‡ rrx Fry ÿ rry Frx
‡ rlax Flay ÿ rlay Flax ‡ rlpx Flpy ÿ rlpy Flpx ˆ 0: …3†
For a choice of model parameters including dr and
input variables /, Fr , all measurable externally, we seek
the values of Fq , dx , dy , Frx , Fry , rrx , rry , Flax , Flay , rlax , rlay ,
Flpx , Flpy , rlpx , rlpy , Fcx , Fcy , rcx , rcy , Fpx , Fpy , rpx , and rpy
and have three equilibrium equations, Eqs. (1)±(3) on
these 23 unknowns. We use the solution of the contact
problem to give Fcx , Fcy , rcx , and rcy as functions of /, dx
and dy , giving four additional equations. The method of
Zavatsky and OÕConnor gives Flax , Flay , rlax , rlay , Flpx ,
Flpy , rlpx , and rlpy as functions of /, dx and dy (eight
additional equations). The patella model of Gill and
OÕConnor gives Fpx , Fpy , rpx , and rpy as functions of Fq ,
/, dx and dy (four equations). Given dr and Fr , it is
 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122 115

possible to calculate Frx , Fry , rrx , rry (four equations). In
total, 23 equations are therefore available.
3.6. Solution technique
In fact, Fq rather than Fr was treated as chosen input
for the purpose of presenting results. The chosen inputs
were /, Fq , and dr ; quantities to be solved for were dx , dy ,
and Fr .
An initial approximate solution was obtained as fol-
lows:
1. With the ligaments assumed to be inextensible and
the articular cartilage incompressible, the lines of ac-
tion of the patellar tendon, contact and restraining
forces and the magnitude of the patellar tendon force

Fig. 2. Horizontal component of displacement dx versus quadriceps force Fq for ¯exion angles of 0°, 20°, 40°, 60°, 80° and 100°. dr ˆ 200 mm:
(a) Compressible cartilage. (b) Incompressible cartilage.
116 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122

were calculated at the speci®ed ¯exion angle / with
~
d ˆ~ 0.
2. The intersection of the patellar tendon and con-
tact force lines of action was found and was used as
described by Zavatsky and OÕConnor [13] to
ascertain whether an ACL or a PCL force was re-
quired for equilibrium, in the absence of deformable
tissues.
3. Eqs. (1)±(3) were solved for Fr , Fl and Fc .
4. Using the compressible cartilage model, the value of
dy required to produce the value of Fc calculated in
step 3 was found by solving the equation
Fc …dy † ˆ Fc …step 3†: …4†
5. Using the extensible ligament model, the value of dx
required to produce the value of Fl calculated in step
3 was found by solving the equation
Fl fdx ; dy …step 4†; /g ˆ Fl …step 3†: …5†

Fig. 3. Ligament force Fl versus quadriceps force Fq for ¯exion angles of 0°, 20°, 40°, 60°, 80° and 100°. dr ˆ 200 mm: (a) Compressible cartilage. (b)
Incompressible cartilage.
 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122 117

With the value of Fr thereby calculated, and the lines of 4. Results

action of the other forces rede®ned by the values of dx
and dy , the equilibrium equations were resolved. This
process was repeated iteratively to satisfy a convergence
criterion.
For comparison, the calculations were repeated with
the articular cartilage incompressible. Fc was then in-
dependent of dy , which was ®xed at 0 mm. Given /, Fq
and dr , the variables to be solved for were dx , Fc and Fr .
The solution technique otherwise was analogous to that
already described.
Fig. 2(a) and (b) compare the compressible and in-
compressible models, respectively, and show that the
absolute value of horizontal displacement increases with
increasing quadriceps force, tending towards an as-
ymptotic value as described by Zavatsky and OÕConnor
[13]. Inclusion of compressible cartilage layers increases
the displacement by between 36% at 40° ¯exion and
105% at 0° ¯exion. Anterior displacement occurs
at lower ¯exion angles and posterior displacement

Fig. 4. Ligament force Fl versus quadriceps force Fq and ¯exion angle /. dr ˆ 200 mm. The thick solid line in (a) indicates the boundary of the region
within which Fl ˆ 0; thick dotted lines indicate the line in (b) along which Fl ˆ 0: (a) Compressible cartilage. (b) Incompressible cartilage.
118 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
at higher ¯exion angles, as described by Mandtl et al.
[20]
Figs. 3 and 4 show that cartilage deformation sub-
stantially reduces the ligament forces induced by quad-
riceps loading, the reduction being more than 50% in
some cases. For both models, the ACL is loaded at
lower ¯exion angles and the PCL at higher ¯exion
Fig. 5. Horizontal component of displacement dy versus ¯exion angle
for six values of quadriceps load. dr ˆ 430 mm: (a) Experimental results
of Hirokawa et al. [13], redrawn from Table 1 of their paper. (b) Re-
sults of incompressible cartilage model. (c) Results of compressible
cartilage model.
angles, consistent with the directions of tibial displace-
ments in Fig. 2. With compressible cartilage layers, the
ligament forces also tend more rapidly towards asymp-
totic values.
Fig. 4(a) also shows that cartilage deformation in-
troduces a region of zero ligament force at around
/ ˆ 62.5° with the restraining load positioned 200 mm
below the tibial plateau, whereas in Fig. 4(b) the liga-
ment force is zero only at a single ¯exion angle of 62.5°,
as described by Zavatsky and OÕConnor [13].
It can be seen from Figs. 2±4 that the results broadly
con®rm those of Zavatsky and OÕConnor [13], despite
the slightly di€erent patella models used. The region of
zero ligament force moves to higher ¯exion angles as the
restraint position is moved distally (increasing dr ).
Larger ligament forces are required for equilibrium at
high ¯exion angles with the restraint near the knee, and
at low ¯exion angles with the restraint located more
distally.
Fig. 5 shows qualitative agreement between the the-
ory and HirokawaÕs experiment [3]. The variation of the
horizontal displacement with ¯exion angle and quadri-
ceps force is similar in form, but the calculation under-
estimates the measurement.
Fig. 6 shows better agreement between the theory and
HowellÕs experiment [2] but the calculation if anything
overestimates the measurement.
5. Discussion
Inclusion of cartilage deformation in the present
model is found to increase the dynamic laxity of the
joint signi®cantly, more so than for passive laxity. The
Fig. 6. Horizontal component of displacement dx versus ¯exion angle,
showing a histogram of the experimental results of Howell [14] under
maximal quadriceps loading, and the model results under 2500 N
quadriceps forces with compressible and incompressible articular car-
tilage.
 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
additional freedom causes a region of zero ligament
force in which the patellar tendon, contact and re-
straining forces intersect. The model results are in broad
agreement with the experiments of Hirokawa et al. [3]
and Howell [2], and suggest how isometric quadriceps
exercises following cruciate ligament injury may be
planned to minimise danger to the ligaments; the region
of zero ligament force may broaden slightly the range of
possible exercises. The greater e€ect on dynamic laxity,
compared to passive laxity [1], suggests that reproducing
normal passive laxity in a replacement with more rigid
surfaces is not a guarantee of normal behaviour under
load.
5.1. Antero-posterior laxity
Cartilage deformation has been found to make a
more signi®cant contribution to the dynamic antero-
posterior laxity of the joint (compare Fig. 2(a) and (b))
than was found in the study of the passive Lachmann
test [1].
In the latter the contact force has to balance only the
vertical component of the ligament force, whereas in the
Isometric Quadriceps test it also has to balance the
relatively larger component of the patellar tendon force.
5.2. Region of zero ligament force
Deformation of articular cartilage allows the liga-
ments to slacken, leading to a general reduction of lig-
ament forces, and possibly a region of zero ligament
force. In this region, the tightening e€ect of the external
forces is exactly balanced by the slackening e€ect of
cartilage deformation.
The thick continuous line in Fig. 4(a) indicates the
boundary of the region of no ligament force. The region
contains the dotted line de®ning the ÔcriticalÕ ¯exion
angle (62.5°) of zero ligament force according to the
incompressible cartilage model [13]. In that model, a
ligament force is not required when the restraining force,
patellar tendon force and contact force pass through a
single point. The additional freedom imparted by car-
tilage deformation enables concurrency of the forces
over a range of ¯exion.
5.3. E€ect of varying restraint position
Zavatsky and OÕConnor [13] found that the position
of zero ligament force moved to higher ¯exion angles as
the restraining force moved more distally. The same
e€ect is found when the cartilage layers are allowed to
deform, except that a range of angles is now found for
zero ligament force.
Below dr ˆ 134 mm, the region of no ligament force
vanishes; again, this agrees with the results of Zavatsky
119
and OÕConnor, although the critical value of dr is
slightly higher than their value due to the di€erent pa-
tella models used. Once the restraining force is proximal
to the intersection of the patellar tendon and contact
force lines of action at full extension, it ceases to be
possible to ®nd a ¯exion angle at which Fl ˆ 0 N with the
quadriceps loaded.
The range of / with zero Fl is signi®cantly wider at
dr ˆ 200 mm than it is for higher values of dr . The
condition for zero ligament force is illustrated in Fig. 7
for a quadriceps force of 1000 N. For comparison, the
line of no ligament force is also shown for the incom-
pressible cartilage model.
5.4. Correlation with experimental results
Fig. 5 illustrates the A/P tibial displacements induced
by a variety of quadriceps loads; the experimental re-
sults of Hirokawa et al. [3] are shown along with those
of the incompressible and compressible cartilage models.
Hirokawa et al. used a radiographic technique to mea-
sure the relative tibio±femoral displacement of cadaveric
specimens, with the femur ®xed and the tibia held at a
constant ¯exion angle via a ®ve degree-of-freedom uni-
versal joint. Quadriceps forces were simulated using a
variety of weights attached to the quadriceps tendon.
Tibial rotation was also measured.
The value of dr used in the model calculations was
430 mm. The general features are similar to the experi-
mental results: displacement increases non-linearly with
load; anterior tibial displacement is observed from ex-
tension to a transitional angle around 80±90°, with a
peak at approximately 30°, and posterior displacements
at higher angles.
Fig. 7. Graph of restraint position versus ¯exion angle, for a quadri-
ceps force of 1000 N. The solid line shows where no ligament force is
required for equilibrium with incompressible cartilage (after Zavatsky
and OÕConnor [5], Fig. 4(a)), and the dotted lines show the corre-
sponding boundaries of no ligament force with compressible cartilage.
120 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
The experimentally-measured magnitude of the tibial
displacement is however considerably larger than that
calculated in either model, reaching a maximum of 8 mm
as opposed to 2 mm in the incompressible cartilage
model, or 2.5 mm when the cartilage layers are allowed
to deform.
Hirowaka et al. [3] note that rotation of the tibia may
introduce an error into their results, and provide esti-
mates of the resulting errors. These reduce the maximum
to around 6.3 mm. This is still considerably more than
that predicted by the compressible cartilage model. To
approach the experimental values of the tibial dis-
placement, very considerable and unphysical changes to
the elasticity of the model articular cartilage and liga-
ment ®bres are required. The discrepancy may be due to
the greater laxity shown by cadaver than by normal
knees, or to rotation of the tibia, which is ignored in this
2D model. Omission from the model of the constraint
o€ered by the collateral ligaments is likely to result in
predicted displacements being higher than in real life,
and so cannot be the cause of this discrepancy.
Howell [2] used an arthrometer to measure the ante-
rior tibial translation during maximum isometric quad-
riceps contraction in vivo in 22 normal patients at
/ ˆ 15°, 30°, 45°, 60°, and 75°. The restraining force ~ Fr
was applied 290 mm below the joint line. Fig. 6 shows
the resulting tibial displacements. The model calcula-
tions using a quadriceps force of 2500 N now underes-
timate the measurements. (No actual force values were
measured by Howell.)
5.5. Clinical relevance
As the main features of the results are broadly similar
to those reported by Zavatsky and OÕConnor [13],
similar clinical lessons may be drawn.
The analysis suggests that, with deformable cartilage,
ligament forces do not increase steadily with increasing
quadriceps force but reach relatively small asymptotic
values (Fig. 3(a)). This could explain why relatively
weak and slender ligaments can survive even in the
presence of large muscle forces.
The model predictions allow rehabilitation regimes
following cruciate ligament injury or repair to be plan-
ned in such a way as to minimise ligament forces. The
discovery of a region of zero ligament force in the
compressible cartilage model, as opposed to a single
¯exion angle, may permit a wider range of ¯exion angles
to be used in such treatments, or make slight inaccura-
cies in setting up exercises less critical. Very substantial
quadriceps forces may be borne within this region
without risking damage to the ligaments. When the
cartilage is made incompressible (e.g. following total
knee replacement), this e€ect is removed.
The previous study of the Lachmann test [1] sug-
gested that cartilage deformation made relatively little
contribution to the passive laxity of the knee. When the
surfaces are replaced by the more rigid components of a
prosthesis, the passive laxity could appear to be quite
normal. However the signi®cant contribution of carti-
lage deformation to dynamic laxity, in the presence of
muscle forces, implies that a replaced knee may exhibit
signi®cantly less dynamic laxity than the normal.
5.6. Limitations of the present approach
The present approach has a number of limitations.
Only isometric quadriceps contractions are considered,
whereas in reality it is common for more than one
muscle group to act simultaneously, and loading is likely
to be dynamic. Development of the present model to
cover more complex loading regimes is possible.
Various important structures within the knee are
omitted from the model, particularly the collateral
ligaments and the menisci. Omission of the collateral
ligaments simpli®es the analysis; they are also found to
be relatively sensitive to the choice of attachment areas
and to contribute relatively little to the total ligament
forces under A/P loading [15]. They do however have a
large impact on tibial rotation (which occurs during
isometric quadriceps exercise) and abduction/adduction
[21]. Under isometric quadriceps loading, Harfe et al.
[21] found that the medical collateral ligament (MCL)
slackened in the range 15° < / < 45° and tightened in
the range 90° < / < 120°, whereas the lateral collateral
ligament (LCL) slackened at all ¯exion angles. This
suggests that including the MCL in the model would
provide an additional restraint at higher ¯exion angles,
resulting in less tibial translation than is currently
predicted, while the inclusion of the LCL would have
little e€ect.
The present calculations underestimate HirokawaÕs
measurements of tibial displacement [3], suggesting that
constraints o€ered by the menisci to antero-posterior
movement are small. However, because the menisci
spread the compressive force over larger areas of carti-
lage and therefore reduce the contact pressures, their
omission is likely to lead to an overestimate of the extent
of cartilage deformation.
A purely 2D model naturally has limitations. A 2D
ligament model cannot fully represent the physical
cruciate ligaments, and the patterns of ®bre recruit-
ment and extension following relative tibio±femoral
displacement. The four-bar linkage omits important
aspects of the kneeÕs kinematics, particularly the Ôscrew-
homeÕ mechanism (the external rotation of the tibia
during the ®nal stage of extension). The transverse
forces within the joint are also ignored; these will be
more important in the present model than when purely
A/P forces were being discussed, as the quadriceps has a
marked inclination in the frontal plane. A 3D kinematic
 R.A. Huss et al. / Clinical Biomechanics 15 (2000) 112±122
mechanism [22,23], and 3D modelling of the cruciate
ligaments [24], helps to address these diculties.
The present contact force calculation could also be
improved. The true 3D shape of the tibial and femoral
surfaces is not taken fully into account, though the ef-
fective local spherical radius of curvature of the femoral
condyles is used to modify the force calculation [1].
Articular cartilage is actually non-linear, viscoelastic
and non-isotropic; it has been modelled in detail as a
biphasic system comprising a solid matrix and a liquid
phase by Mow et al. [25]. Over time scales of a few
seconds, however, its response to load is nearly instan-
taneous and it is therefore appropriate to model it as an
elastic solid in the current circumstances.
6. Conclusions
Isometric quadriceps contractions were studied using
a 2D quasistatic model of the knee incorporating de-
formable ligaments and articular cartilage. The model
calculations presented have outcomes that are broadly
comparable to those of equivalent models with incom-
pressible cartilage and inextensible ligament ®bres.
Compressible cartilage therefore is of secondary im-
portance in knee modelling.
Whereas an inextensible ligament model can give
only the ratios of forces, the extensible ligament mod-
els, both with and without cartilage deformation, show
displacements and ligament forces which vary non-lin-
early with the applied quadriceps force and tend to
asymptotic values. Incorporation of compressible car-
tilage layers reduces the values of the ligament forces
and increases the relative A/P translation between the
tibia and femur.
In the absence of compressible cartilage layers, con-
sideration of the lines of action of the patellar tendon,
contact, restraining and cruciate ligament forces shows
whether an ACL or a PCL force is required for equi-
librium at a given ¯exion angle; it is found that for each
¯exion angle there is a single restraint position at which
no ligament forces are required for equilibrium. When
the cartilage is made compressible, the increased ¯exi-
bility a€orded to the joint results in a range rather than
a single value of restraint position leading to zero liga-
ment force.
Comparing the results to those of Zavatsky and
OÕConnor [13], it is clear that knee geometry alone is
sucient for most purposes for predicting whether lig-
ament forces will be required in a given loading regime,
and that adding ligament elasticity gives a reasonable
approximation to the relative tibio±femoral displace-
ments, and hence ligament forces. Cartilage deformation
is a less important, but still signi®cant, modi®er of this
behaviour.
121
Acknowledgements
RAH was supported during the course of this work
by a University of Wales, Aberystwyth Postgraduate
Studentship.
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