Real-time musculoskeletal (MSK) surrogates could support personalized rehabilitation for children with cerebral palsy (CP), but their credibility depends on subject-wise evaluation, low inference latency, and calibrated uncertainty. We develop a subject-conditioned causal neural surrogate using OpenSim-derived static parameters, temporal joint kinematics, true muscle capacities, and training-only perturbations. On a real pediatric CP gait dataset comprising nine children, we use leave-one-subject-out validation on six development subjects and evaluate a frozen configuration once on three locked test subjects. The surrogate accurately reproduces musculotendon lengths (R-square = 0.92 in development validation and approximately 0.95 on locked subjects; nRMSE < 8%) while requiring only sub-millisecond to few-millisecond neural inference, well below a 100 ms interactive-rehabilitation target. In contrast, direct muscle-force estimation remains unstable at this small, heterogeneous scale: pooled metrics can overstate within-subject, per-muscle accuracy. A Monte Carlo credibility pilot further shows that propagating only +/-5% anthropometry and muscle-capacity variation produces severely overconfident nominal 90% intervals (approximately 4% force coverage and below 1% MT-length coverage). These results establish a leakage-free evaluation and credibility framework for pediatric MSK surrogates, while identifying force modeling and epistemic uncertainty as the central next challenges for clinically credible digital twins.
Joint contact forces govern implant longevity, cartilage health, and rehabilitation outcomes, shaping who develops osteoarthritis, who recovers well from joint replacement, and who benefits from biomechanical interventions. Yet they remain measurable only invasively, in a few dozen patients with instrumented implants. I present a physics-free pipeline to predict instantaneous 3D hip and knee contact forces from an uncalibrated monocular video: no markers, force plates, electromyography, subject-specific imaging, or musculoskeletal model. Parametric body meshes are recovered per frame, encoded as kinematic features, and decoded into forces by a transformer whose pose stream is adaptively modulated at every layer by body shape, joint, side, activity text, and self-supervised video tokens (V-JEPA 2), unifying hip and knee in a single model. Under leave-one-subject-out cross-validation across 26 patients and 25 activity categories from the in vivo OrthoLoad database, the pipeline matches the accuracy of subject-specific musculoskeletal simulations ($0.32 \pm 0.08$ BW RMSE for hip; $0.23 \pm 0.03$ BW for knee) and resolves peak force changes smaller than those reported for gait retraining and osteoarthritis progression. Applied zero-shot to an independent instrumented cohort, it rivals or outperforms prior published methods. Even without curated activity labels, video features alone preserve accuracy and enable end-to-end inference on raw footage. Driven by the predictor, a generative motion prior produces biomechanically plausible variants with reduced peak loading, rediscovering strategies from the predictive simulation literature. This pipeline establishes uncalibrated monocular video as a viable modality for estimating joint loading, opening a path toward retrospective analysis of archived clinical recordings, primary-care screening, and at-home rehabilitation tracking.