Comparative validation of two patient-specific modelling pipelines for predicting knee joint forces during level walking

Over the past few years, the use of computer models and simulations tailored to the patient's physiology to assist clinical decision-making has increased enormously. While several pipelines to develop personalized models exist, their adoption on a large scale is still limited due to the required niche computational skillset and the lengthy operations required. Novel toolboxes, such as STAPLE, promise to streamline and expedite the development of image-based skeletal lower limb models. STAPLE-generated models can be rapidly generated, with minimal user input, and present similar joint kinematics and kinetics compared to models developed employing the established INSIGNEO pipeline. Yet, it is unclear how much the observed discrepancies scale up and affect joint contact force predictions. In this study, we compared image-based musculoskeletal models developed (i) with the INSIGNEO pipeline and (ii) with a semi-automated pipeline that combines STAPLE and nmsBuilder, and assessed their accuracy against experimental implant data. Our results showed that both pipelines predicted similar total knee joint contact forces between one another in terms of profiles and average values, characterized by a moderately high level of agreement with the experimental data. Nonetheless, the Student t-test revealed statistically significant differences between both pipelines. Of note, the STAPLE-based pipeline required considerably less time than the INSIGNEO pipeline to generate a musculoskeletal model (i.e., 60 vs 160 min). This is likely to open up opportunities for the use of personalized musculoskeletal models in clinical practice, where time is of the essence.