{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,12]],"date-time":"2026-07-12T06:17:45Z","timestamp":1783837065349,"version":"3.55.0"},"reference-count":89,"publisher":"Public Library of Science (PLoS)","issue":"1","license":[{"start":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T00:00:00Z","timestamp":1643241600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001230","name":"Macquarie University","doi-asserted-by":"publisher","award":["MQRES"],"award-info":[{"award-number":["MQRES"]}],"id":[{"id":"10.13039\/501100001230","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>The ligaments in the knee are prone to injury especially during dynamic activities. The resulting instability can have a profound impact on a patient\u2019s daily activities and functional capacity. Musculoskeletal knee modelling provides a non-invasive tool for investigating ligament force-strain behaviour in various dynamic scenarios, as well as potentially complementing existing pre-planning tools to optimise surgical reconstructions. However, despite the development and validation of many musculoskeletal knee models, the effect of modelling parameters on ligament mechanics has not yet been systematically reviewed.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>This systematic review aimed to investigate the results of the most recent studies using musculoskeletal modelling techniques to create models of the native knee joint, focusing on ligament mechanics and modelling parameters in various simulated movements.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Data sources<\/jats:title>\n<jats:p>PubMed, ScienceDirect, Google Scholar, and IEEE Xplore.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Eligibility criteria for selecting studies<\/jats:title>\n<jats:p>Databases were searched for articles containing any numerical ligament strain or force data on the intact, ACL-deficient, PCL-deficient, or lateral extra-articular reconstructed (LER) knee joints. The studies had to derive these results from musculoskeletal modelling methods. The dates of the publications were between 1 January 1995 and 30 November 2021.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Method<\/jats:title>\n<jats:p>A customised data extraction form was created to extract each selected study\u2019s critical musculoskeletal model development parameters. Specific parameters of the musculoskeletal knee model development used in each eligible study were independently extracted, including the (1) musculoskeletal model definition (i.e., software used for modelling, knee type, source of geometry, the inclusion of cartilage and menisci, and articulating joints and joint boundary conditions (i.e., number of degrees of freedom (DoF), subjects, type of activity, collected data and type of simulation)), (2) specifically ligaments modelling techniques (i.e., ligament bundles, attachment points, pathway, wrapping surfaces and ligament material properties such as stiffness and reference length), (3) sensitivity analysis, (4) validation approaches, (5) predicted ligament mechanics (i.e., force, length or strain) and (6) clinical applications if available. The eligible papers were then discussed quantitatively and qualitatively with respect to the above parameters.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec006\">\n<jats:title>Results and discussion<\/jats:title>\n<jats:p>From the 1004 articles retrieved by the initial electronic search, only 25 met all inclusion criteria. The results obtained by aggregating data reported in the eligible studies indicate that considerable variability in the predicted ligament mechanics is caused by differences in geometry, boundary conditions and ligament modelling parameters.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec007\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>This systematic review revealed that there is currently a lack of consensus on knee ligament mechanics. Despite this lack of consensus, some papers highlight the potential of developing translational tools using musculoskeletal modelling. Greater consistency in model design, incorporation of sensitivity assessment of the model outcomes and more rigorous validation methods should lead to better agreement in predictions for ligament mechanics between studies. The resulting confidence in the musculoskeletal model outputs may lead to the development of clinical tools that could be used for patient-specific treatments.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0262684","type":"journal-article","created":{"date-parts":[[2022,1,27]],"date-time":"2022-01-27T18:47:58Z","timestamp":1643309278000},"page":"e0262684","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":20,"title":["The effect of modelling parameters in the development and validation of knee joint models on ligament mechanics: A systematic review"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1845-0205","authenticated-orcid":true,"given":"Sara Sadat","family":"Farshidfar","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Cadman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danny","family":"Deng","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Appleyard","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan\u00e8","family":"Dabirrahmani","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,1,27]]},"reference":[{"issue":"2","key":"pone.0262684.ref001","doi-asserted-by":"crossref","first-page":"114","DOI":"10.1007\/s12178-016-9329-8","article-title":"Basic biomechanic principles of knee instability.","volume":"9","author":"JP Zlotnicki","year":"2016","journal-title":"Current Reviews in Musculoskeletal Medicine"},{"issue":"4","key":"pone.0262684.ref002","doi-asserted-by":"crossref","first-page":"266","DOI":"10.1136\/ewjm.174.4.266","article-title":"Knee instability: isolated and complex.","volume":"174","author":"TK Kakarlapudi","year":"2001","journal-title":"West J Med"},{"key":"pone.0262684.ref003","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.medengphy.2019.08.002","article-title":"Finite element models of the tibiofemoral joint: A review of validation approaches and modelling challenges.","volume":"74","author":"RJ Cooper","year":"2019","journal-title":"Medical Engineering & Physics"},{"issue":"8","key":"pone.0262684.ref004","doi-asserted-by":"crossref","first-page":"170670","DOI":"10.1098\/rsos.170670","article-title":"The effects of geometric uncertainties on computational modelling of knee biomechanics.","volume":"4","author":"Q Meng","year":"2017","journal-title":"R Soc Open Sci"},{"key":"pone.0262684.ref005","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1016\/j.medengphy.2019.02.009","article-title":"The effect of articular geometry features identified using statistical shape modelling on knee biomechanics","volume":"66","author":"AL Clouthier","year":"2019","journal-title":"Medical engineering & physics"},{"issue":"4","key":"pone.0262684.ref006","doi-asserted-by":"crossref","first-page":"143","DOI":"10.1080\/10255842.2019.1709118","article-title":"Analytical and computational sliding wear prediction in a novel knee implant: a case study","volume":"23","author":"MS Hussin","year":"2020","journal-title":"Computer Methods in Biomechanics and Biomedical Engineering"},{"key":"pone.0262684.ref007","doi-asserted-by":"crossref","first-page":"239","DOI":"10.1016\/j.clinbiomech.2006.10.003","article-title":"Morphological muscle and joint parameters for musculoskeletal modeling of the lower extremity.","volume":"22","author":"M Horsman","year":"2007","journal-title":"Clinical biomechanics (Bristol, Avon)"},{"key":"pone.0262684.ref008","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1080\/01495739808936707","article-title":"A Three-Dimensional Musculoskeletal Model of the Human Knee Joint. 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