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Using musculoskeletal modelling to estimate knee joint loading pre and post high tibial osteotomy

Bowd, Jake, Van Rossom, Sam, Williams, David, Elson, David, Wilson, Chris, Whatling, Gemma, Holt, Cathy, Jonkers, Ilse (2022) Using musculoskeletal modelling to estimate knee joint loading pre and post high tibial osteotomy. Clinical Biomechanics, 101 . Article Number 105855. ISSN 0268-0033. (doi:10.1016/j.clinbiomech.2022.105855) (KAR id:99484)



Both medial knee osteoarthritis and associated varus alignment have been proposed to alter knee joint loading and consequently overloading the medial compartment. Individuals with knee osteoarthritis and varus deformity are candidates for coronal plane corrective surgery, high tibial osteotomy. This study evaluated knee loading and contact location for a control group, a pre-surgery cohort and the same cohort 12 months post-surgery using a musculoskeletal modelling approach.


Joint kinematics during gait were measured in 30 knee osteoarthritis patients, before and after high tibial osteotomy, and 28 healthy adults. Using a musculoskeletal model that incorporated patient-specific mechanical tibial femoral angle, the resulting muscle, ligament, and contact forces were calculated and the medial - lateral condyle load distribution was analysed.


Surgery changed medial compartment contact force throughout stance relative to pre-surgery. This reduction in medial compartment contact force pre- vs post-HTO is observed despite a significant increase in post-surgery walking speed compared to pre-HTO, where increased speed is typically associated with increased joint loading.


This study has estimated the effects of high tibial osteotomy on knee loading using a generic model that incorporates a detailed knee model to better understand tibiofemoral contact loading. The findings support the aim of surgery to unload the medial knee compartment and lateralise joint contact forces.

Item Type: Article
DOI/Identification number: 10.1016/j.clinbiomech.2022.105855
Additional information: For the purpose of open access, the author has applied a CC BY public copyright licence to any Author Accepted Manuscript version arising from this submission.
Uncontrolled keywords: Contact forces, Malalignment, Varus, High tibial osteotomy, Osteoarthritis
Divisions: Divisions > Division of Natural Sciences > Sport and Exercise Sciences
Funders: Versus Arthritis (
Engineering and Physical Sciences Research Council (
Depositing User: Jake Bowd
Date Deposited: 11 Jan 2023 14:44 UTC
Last Modified: 03 May 2024 03:16 UTC
Resource URI: (The current URI for this page, for reference purposes)

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