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However, much less is known about how atrophic muscle conditions interact with the microenvironment and influence fracture healing outcomes. To this end, this study developed an atrophy-adjusted tibial fracture musculoskeletal model to simulate physiological loadings on the fractured tibia associated with partial weight-bearing (PWB) walking rehabilitation, incorporating various degrees of muscle atrophy and clinically observed muscle deformation at fracture callus. An anatomically muscle-informed tibial fracture healing model, integrating muscle load distributions onto the insertion surface of the bone geometry, was then used to predict dynamic mesenchymal stem cell\u00a0differentiations and deviatoric strains during gait. The effects of PWB% and rehabilitation walking speed on healing outcomes in patients with various levels of muscle atrophy were systematically evaluated. The results show that the muscle loadings and knee contact forces substantially decline with the increased level of muscle atrophy. Directly using musculoskeletal simulations without accounting for patient-specific muscle atrophy could overstate temporal fluctuations of healing trajectories, leading to overestimation in the risk of fracture non-union and unsuccessful angiogenesis. Besides, the tolerance of PWB% level and rehabilitation walking speed varies according to different levels of muscle atrophy. Our results can recommend PWB walking protocols to enhance endochondral ossification, while controlling the risk of vessel rupture. The study highlights the impact of muscle atrophy on the early healing process, aiming to assist physiotherapists and orthopedic surgeons in prescribing personalized rehabilitation protocols based on patient-specific muscle conditions.<\/jats:p>","DOI":"10.1007\/s10237-026-02101-6","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:44:19Z","timestamp":1783431859000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Effect of muscle atrophy on fracture healing: insights from a tibial musculoskeletal-finite element model"],"prefix":"10.1007","volume":"25","author":[{"given":"Qianjun","family":"Ding","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lunjian","family":"Li","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lihai","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,7]]},"reference":[{"key":"2101_CR1","volume-title":"Partial weight bearing in hip fracture rehabilitation","author":"SA Abdalbary","year":"2018","unstructured":"Abdalbary SA (2018) Partial weight bearing in hip fracture rehabilitation, vol 4. 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