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Marker\u2010based scaling provides a noninvasive, efficient, and cost\u2010effective strategy for personalizing generic MSK models, yet its reliability and accuracy remain insufficiently validated. This study proposes a hybrid scaling approach (FlexiScale), which combines segment\u2010wise linear scaling with global nonlinear morphing based on radial basis function (RBF) interpolation. This method enables simultaneous adjustment of relative segment orientations and overall skeletal geometry. To comprehensively evaluate its performance, two simpler baseline models were also constructed, including a uniform linear scaling model and a segmental linear scaling model. A reliability analysis was conducted by comparing knee joint contact forces predicted by the three scaling models with in\u00a0vivo measurements obtained from an instrumented knee prosthesis under identical gait conditions. Furthermore, an accuracy validation was performed by comparing joint contact forces and muscle forces predicted by each scaling model against those derived from medical image\u2013based subject\u2010specific models across three daily activities (level walking, stair ascent, and stair descent) in both male and female subjects. Compared to conventional linear methods, FlexiScale consistently produced the most accurate and reliable geometric and biomechanical predictions across tasks and subjects. These findings demonstrate that the proposed hybrid approach can generate geometrically and biomechanically more accurate and robust MSK models than conventional linear scaling methods, even without medical imaging, thereby supporting subject\u2010specific assessments and large\u2010scale applications in clinical and research settings.<\/jats:p>","DOI":"10.1002\/cnm.70142","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T15:11:11Z","timestamp":1770131471000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["<scp>F<\/scp>\n                    lexi\n                    <scp>S<\/scp>\n                    cale: A Hybrid Marker\u2010Based Scaling Method for Geometrically and Biomechanically Accurate Lower Limb Musculoskeletal Models"],"prefix":"10.1002","volume":"42","author":[{"given":"Jinghao","family":"Xu","sequence":"first","affiliation":[{"name":"Tribology Research Institute 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